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Higher education in evolutionary anthropology involves providing students with in‐depth knowledge of biological and cultural heritage sites and collections that are frequently inaccessible. Indeed, most sites, fossils, and archaeological remains can be visited or manipulated only rarely and solely by specialists with extensive experience. Owing to the development of 3D and medical imaging techniques, this fragile heritage is now more widely accessible, and in a dynamic way. However, exclusive adoption of virtual teaching and learning has a negative impact on student engagement and, naturally, on exchanges with instructors, and thus cannot be used without some reservations. In the ITAP (Immersion dans les Terrains de l’Anthropologie biologique et de la Préhistoire) project of the higher education STEP (Soutien à la Transformation et à l’Expérimentation Pédagogiques) transformation program at the University of Bordeaux, we combine student‐active teaching with Master's students fully immersed in ongoing fieldwork, laboratory study, and dissemination of research results in order to develop more individually shaped learning curricula and to foster both professional and new interdisciplinary skills. Here, we present examples of experiments conducted in the ITAP project using both authentic and virtual collections of archaeological, experimental, and reference materials that help to break down the barriers between research activities and higher education, as well as providing a more general appraisal of the appropriate use of virtual tools in higher education by combining them with real‐life situations. The article describes examples of novel teaching methods that we have developed in our Master's program in evolutionary anthropology, where we combine student‐active teaching with Master's students fully immersed in ongoing fieldwork, laboratory study, and dissemination of research results.

La fracturation osseuse est une pratique couramment observée sur les gisements paléolithiques, celle-ci intervenant dans diverses chaînes opératoires de transformation et d'utilisation des ressources animales, notamment alimentaires. La moelle osseuse, contenue dans la cavité médullaire des os longs, est une ressource alimentaire non négligeable pour de nombreux groupes humains, en particulier dans les zones périglaciaires, tels les Nunamiuts d'Alaska ou les Koriaks de Sibérie. Différents procédés sont mis en œuvre pour sa leur récupération; variabilité s'explique en partie par l'existence de traditions techniques et de modes de consommation de la moelle, propres aux différents groupes. Ces traditions entraînent souvent une standardisation des procédés de fracturation à l'intérieur de chaque groupe. De tels schémas récurrents sont-ils perceptibles dans le registre paléolithique? Si oui, est-il possible de mettre en évidence une transmission des gestes relatifs à la récupération de la moelle? Afin d'apporter des éléments de réponse à ces questions nous proposons dans le cadre de cet article, une étude détaillée des traces de percussion observées sur les os longs d'antilope saïga (Saiga tatarica), provenant de l'ensemble supérieur Magdalénien moyen de Saint-Germain-la-Rivière (Gironde). Les schémas observés ont ensuite été comparés à ceux décrits dans la littérature afin d'apprécier leurs spécificités et de discuter des paramètres ayant pu influer sur cette répartition des traces. Les vestiges fauniques de Saint-Germain-la-Rivière sont intensément fracturés et présentent de nombreuses traces de percussion d'origine anthropique attribuables à cette activité de fracturation de l'os. Des récurrences dans la localisation des traces de percussion ont pu être mises en évidence. Celles-ci varient selon les éléments squelettiques considérés et sont plus ou moins marquées. L'existence de telles récurrences tend à prouver que la disposition des points d'impact dépend d'un choix délibéré. Ces choix ne semblent pas être dictés exclusivement par l'existence de contraintes mécaniques (e. g. la structure osseuse) ou ergonomiques spécifiques aux éléments squelettiques. Par ailleurs, l'existence d'une variabilité inter- et intra-spécifique, observable d'après les données de la littérature laisse à penser qu'il s'agit de choix dictés en partie par un facteur culturel. L'analyse des traces de percussion a également permis de mettre en évidence, dans certains cas, la présence de plusieurs points d'impact sur une surface réduite. L'une des hypothèses que l'on peut émettre ici serait qu'il y ait eu plusieurs tentatives pour fracturer l'os. Ces pièces posent alors la question de l'acharnement et de la maîtrise du geste et pourraient évoquer des os fracturés par des novices. Bones collected on Palaeolithic archaeological sites are rarely found whole. While a range of natural factors and mechanisms can be the cause of this bone fragmentation (e.g. carnivores, weathering, and sediment compaction), human activity is often a major agent, as bone fracturing takes place in many operational sequences involving the transformation and exploitation of animal resources, particularly in terms of the use of bone marrow and the bone itself as a raw material. The bone marrow contained in the medullary cavity of long bones is an important food resource for many human groups, particularly in periglacial areas, such as among the Nunamiut of Alaska or the Siberian Koriak. These groups each use different processes to remove the bone marrow. This variability is partly explained by the technical traditions and modes of consumption specific to each group, which often lead to a standardization of fracturing techniques within the group. Can recurring patterns of this kind be observed in the Palaeolithic context? And if so, is it possible to demonstrate the transmission of such processes in terms of the removal of the bone marrow? To help answer such questions, we present in this article a detailed study of the percussion marks observed on saiga antelope (Saiga tatarica) long bones from the upper complex at Saint-Germain-la-Rivière (Gironde), attributed to the Middle Magdalenian. This includes an inventory of the number of impact marks on each fragment, their nature, their arrangement in relation to each other, and their location on the anatomical element. The degree of percussion has been calculated for the different parts of the anatomical elements in order to establish whether there were any preferred impact zones. The patterns observed were then compared with those described in publications in order to establish their specific characteristics and to assess the parameters that may have affected such distributions of marks. Saint-Germain-la-Rivière has already been the subject of a detailed taphonomic study (Costamagno, 1999) demonstrating the significant role of Magdalenian hunter-gatherers in the accumulation and modification of bone remains and the limited impact of carnivores. This homogeneity in the constitution of the assemblage reduces the risk of confusion between human and natural agents in the attribution of the marks observed. The corpus studied was composed of 640 bone remains, all of which were fragments of the main long bones containing bone marrow (humeri, radioulnae, femurs, tibias, and metapodials). The faunal remains at Saint-Germain-la-Rivière were intensely fractured and present numerous human percussion marks that can be attributed to this activity of fracturing the bone. Almost 19% of the corpus presented such marks. No correlation was observed between the distribution of the percussion marks and the conservation/identification of the different skeletal parts. Recurrences in the location of the impact points were nonetheless identified. These recurrences varied in relation to the skeletal elements considered and differed in degree. In the case of the radii, for example, the vast majority of impact marks were found on the proximal parts, in contrast with the humeri and tibias for which the distribution of percussion marks, although more variable, appeared to indicate a selection predominantly in favour of the distal parts. The preferred percussion surface also varied according to the element, mainly the anterior surface in the case of the radii but the lateral or medial surfaces in the case of the humeri. The existence of such recurrences indicates that the arrangement of the impact points results from deliberate choice. This choice of location to perform the fracturing of the bone does not appear to be dictated solely by mechanical constraints (e.g. bone structure) or ergonomic constraints specific to each skeletal element. If that were the case, the patterns observed for a specific species would be relatively similar from one level to another and one site to another. However this is not the case, as at Saint-Germain-la-Rivière, for a single taxon, the saiga antelope, the pattern observed in the upper complex (Middle Magdalenian) differs from that observed in the lower complex (Lower Magdalenian). The most striking case is that of the radii, as between the two complexes the arrangement of the impact points is diametrically opposed. This variability is not specific to this species as at other sites attributed to different techno-complexes, differences in the choice of the location of the percussion marks have also been observed, particularly for reindeer and ibex. This is also the case for sites attributed to the same period. Thus, while we cannot completely exclude the possibility of a preferential choice in relation to the bone structure itself, the existence of such inter and intra-species variability suggests choices dictated in part by cultural factors. Furthermore, the analysis of percussion marks has allowed us to highlight in some cases the presence of several impact points on the same bone fragment. Thus, some of the bone fragments have multiple percussion marks (up to eight identified), sometimes located over a small area and in the form of chopmarks. This type of mark is generally attributed to the disarticulation stage of the limbs during the butchery process. Given their location on the bone element, this does not however appear to be the case here. Moreover, they do not appear to be of a technical nature and cannot be attributed to retouchers. One of the hypotheses that we can put forward here is that several attempts were made at fracturing the bone. This then raises the question of the tenacity and mastery of the technique and could imply that these bones were fractured by novices.

Le site magdalénien de Saint-Germain-la-Rivière (Gironde, France) a régulièrement été sollicité dans le cadre de plusieurs débats concernant le Paléolithique supérieur récent d'Europe de l'Ouest. L'essentiel de ces travaux s'appuient sur l'analyse, d'une part, du matériel mis au jour par R. Blanchard – notamment la célèbre sépulture – et, d'autre part, de celui provenant des fouilles plus méthodiques conduites par G. Trécolle dans le talus. À la suite de l'étude de l'ensemble des collections menée par M. Lenoir qui a permis d'attribuer les différentes occupations du gisement (talus et terrasses) aux phases inférieure et moyenne du Magdalénien, plusieurs travaux individuels ont été réalisés sur différents registres (lithique, parure, ossements). Une réévaluation collective dans un cadre stratigraphique critiqué et chronologique renouvelé s'avérait néanmoins nécessaire. Afin de préciser le processus de mise en place du Magdalénien dans sa période « classique » (phases moyenne et supérieure), des membres du projet « Magdatis » ont analysé plusieurs gisements attribués au Magdalénien moyen ancien de Gironde. La séquence des fouilles Trécolle s'est naturellement placée au cœur de nos recherches. Dans un premier temps, un retour sur les archives de terrain laissées par ce fouilleur minutieux a été nécessaire. Cette révision archéostratigraphique a conduit à répartir une large part des vestiges en deux ensembles tout en pondérant certaines interfaces problématiques. Partant de cette nouvelle proposition de découpage de la séquence, une réévaluation du matériel archéologique a été entreprise. La comparaison des industries lithiques et osseuses apporte de nouvelles données concernant la nature des comportements techniques et économiques de ces premiers moments du Magdalénien en Europe de l'Ouest. Du côté des matières premières lithiques ou osseuses, on note une certaine continuité des deux ensembles. La gestion différentielle de l'outillage domestique et de l'équipement de chasse en silex s'avère également un levier dialectique efficace pour appréhender la transformation de ces sociétés de chasseurs-cueilleurs. L'industrie osseuse montre, entre les deux ensembles, des éléments de continuité (extraction de baguettes par double rainurage) et des différences (dans l'ensemble supérieur : outillage moins diversifié, objets décorés plus fréquents). La systématisation d'une production laminaire normée dans la seconde phase s'accompagwne d'une augmentation des gabarits des pointes osseuses. La confection de morphotypes différents d'armatures lithiques (microlamelles à dos vs lamelles scalènes) et l'évolution des types de base des pointes osseuses mais aussi la présence ou non de rainures illustrent une recomposition de l'armement. La révision de la faune a également permis de préciser chacun des ensembles et, grâce à l'étude taphonomique, les tableaux de chasse respectifs. Des différences dans les stratégies de chasse des saïgas (groupes de femelles ou hardes mixtes) et leur traitement (intensité de la recherche de moelle, techniques de fracturation) sont notées. La mise en évidence d'une exploitation de gibiers de petite taille (avifaune et mésofaune) dès les premières occupations magdaléniennes vient compléter l'image de ces chasseurs d'antilopes et de rennes. Le croisement des différentes données offre l'opportunité de préciser les processus et les rythmes des changements techniques et économiques qui marquent cette période. De nouvelles datations 14C directes sur espèces ou objets particuliers permettent en outre d'éclairer sous un nouveau jour deux étapes de mise en place du Magdalénien. La séquence des fouilles Trécolle peut ainsi être replacée dans l'ensemble du site de Saint-Germain-la-Rivière et comparée à d'autres gisements contemporains d'Europe de l'Ouest. The Magdalenian site of Saint-Germain-la-Rivière (Gironde, France) has often figured in debates and discussions about the Late Upper Palaeolithic of Western Europe. Most of the discussions are based on the material excavated by R. Blanchard—in particular the now well-known burial—as well as the more rigorous excavations by G. Trécolle in the slope deposits. After the detailed study of all this material by M. Lenoir, which allowed the material from the slope and terrace deposits to be attributed to the Lower and Middle Magdalenian, many other studies were carried out by various researchers on specific aspects of the collections (lithics, personal ornaments, fauna). It became clear, however, that the stratigraphic framework and chronology of the site needed to be reexamined. In order to understand the rise of the classic Magdalenian in Gironde, members of the Magdatis project reexamined many early Middle Magdalenian sites and collections of that area. The thorough work of Trécolle at Saint-Germain-la-Rivière was pivotal to this reassessment. Initially, this involved the analysis of his fieldnotes which led to an archaeostratigraphic reattribution of most artefacts into two principal units, with a potentially problematic interface between these. Once these new archaeostratigraphic divisions had been determined, analysis of the artefacts could proceed. The comparison of the lithic and bone/antler industries with those of other sites has afforded us new insights into the nature of the types of technical and economic behaviour of this initial Magdalenian in Western Europe. In terms of lithic and osseous raw material, we have found a good degree of continuity between the two units. The differing treatment of domestic versus hunting flint tools is also an important aspect to consider in the discussion of the changes that took place in hunter-gatherer societies at this time. The bone/antler industry shows some continuity between units (for example the use of the groove and splinter technique), but also some differences (in the upper unit: less diversity in tools; a higher frequency of decorated objects). The systematization of standardized blade production in the upper unit is accompanied by an increase in size of antler points. The production of different lithic projectile morphotypes (backed microbladelets versus scalene bladelets), in parallel with a change in base types within antler points, in addition to the presence or absence of grooves, demonstrate that changes occurred in the toolkits used. A reassessment of the faunal remains also helped to clarify the practices having occurred in each of the two principal stratigraphic units; combined with a taphonomic analysis, the specific subsistence practices in each could be identified. Different hunting strategies were noticed regarding saiga antelope (hunting within female groups versus mixed herds) as well as differing carcass treatment (degree of intensity of marrow extraction, carcass processing techniques). Our analysis also revealed that small-game hunting (birds and small mammals) had already been practised in the earliest Magdalenian phases at the site, thus providing a more complete picture of these reindeer and saiga antelope hunters. Taking into account all of these data and practices allows us to be more specific about the type and pace of technical and subsistence changes having occurred during this period. New 14C dates taken directly from bones of identified species or characteristic organic artefacts also aid us in shedding new light on the two main phases of the Magdalenian. The Trécolle excavation and its collections can thus be placed within the overall Saint-Germain-la-Rivière site sequence and compared with other contemporaneous sites in Western Europe which have also benefited from a renewed stratigraphic, archaeological and chronological assessment and framework.

Whilst calcineurin inhibitors (CNI) are the cornerstone of immunosuppressive maintenance therapy in kidney transplantation, several studies have investigated the safety of CNI withdrawal in order to avoid their numerous side effects. In this context, we performed several years ago a clinical randomized trial evaluating CNI weaning in stable kidney transplant recipients without anti-HLA immunization. The trial was interrupted prematurely due to a high number of de novo DSA (dnDSA) and biopsy proven acute rejection (BPAR) in patients who underwent tacrolimus weaning, resulting in treatment for rejection and resumption of tacrolimus. We report here the long-term outcomes of patients included in this clinical trial. Ten years after randomization, all patients are alive with a functional allograft. They all receive tacrolimus therapy except one with recurrent cutaneous neoplasia issues. Long-term eGFR was comparable between patients of the two randomized groups (46.4 ml/min vs 42.8 ml/min). All dnDSA that occurred during the study period became non-detectable and all rejections episodes were reversed. The retrospective assessment of HLA DQ single molecule epitope mismatching determined that a majority of patients who developed dnDSA after tacrolimus withdrawal would have been considered at high immunological risk. Minimization of immunosuppression remains a challenging objective, mainly because of the issues to properly select very low immunological risk patients. Valuable improvements have been made the last decade regarding evaluation of the allograft rejection notably through the determination of numerous at-risk biomarkers. However, even if the impact of such tools still need to be clarify in clinical routine, they may permit an improvement in patients’ selection for immunosuppression minimization without increasing the risk of allograft rejection.

In islet transplantation (ITx), primary graft function (PGF) or beta cell function measured early after last infusion is closely associated with long term clinical outcomes. We investigated the association between PGF and 5 year insulin independence rate in ITx and pancreas transplantation (PTx) recipients. This retrospective multicenter study included type 1 diabetes patients who underwent ITx in Lille and PTx in Nantes from 2000 to 2022. PGF was assessed using the validated Beta2-score and compared to normoglycemic control subjects. Subsequently, the 5 year insulin independence rates, as predicted by a validated PGF-based model, were compared to the actual rates observed in ITx and PTx patients. The study enrolled 39 ITx (23 ITA, 16 IAK), 209 PTx recipients (23 PTA, 14 PAK, 172 SPK), and 56 normoglycemic controls. Mean[SD] PGF was lower after ITx (ITA 22.3[5.2], IAK 24.8[6.4], than after PTx (PTA 38.9[15.3], PAK 36.8[9.0], SPK 38.7[10.5]), and lower than mean beta-cell function measured in normoglycemic control: 36.6[4.3]. The insulin independence rates observed at 5 years after PTA and PAK aligned with PGF predictions, and was higher after SPK. Our results indicate a similar relation between PGF and 5 year insulin independence in ITx and solitary PTx, shedding new light on long-term transplantation outcomes.

Purpose To describe the Nestlé Nutritional Profiling System (NNPS) developed to guide the reformulation of Nestlé products, and the results of its application in the USA and France. Design The NNPS is a category-specific system that calculates nutrient targets per serving as consumed, based on age-adjusted dietary guidelines. Products are aggregated into 32 food categories. The NNPS ensures that excessive amounts of nutrients to limit cannot be compensated for by adding nutrients to encourage. A study was conducted to measure changes in nutrient profiles of the most widely purchased Nestlé products from eight food categories ( n  = 99) in the USA and France. A comparison was made between the 2009–2010 and 2014–2015 products. Results The application of the NNPS between 2009–2010 and 2014–2015 was associated with an overall downwards trend for all nutrients to limit. Sodium and total sugars contents were reduced by up to 22 and 31 %, respectively. Saturated Fatty Acids and total fat reductions were less homogeneous across categories, with children products having larger reductions. Energy per serving was reduced by <10 % in most categories, while serving sizes remained unchanged. Conclusions The NNPS sets feasible and yet challenging targets for public health-oriented reformulation of a varied product portfolio; its application was associated with improved nutrient density in eight major food categories in the USA and France. Confirmatory analyses are needed in other countries and food categories; the impact of such a large-scale reformulation on dietary intake and health remains to be investigated.

The choice between Basiliximab (BSX) or Anti-Thymocyte Globulin (ATG) as induction therapy in non-immunized kidney transplant recipients remains uncertain. Whilst ATG may allow steroid withdrawal and a decrease in tacrolimus, it also increases infectious complications. We investigated outcomes in non-immunized patients receiving a very low dosage of ATG versus BSX as induction. Study outcomes were patient/graft survival, cumulative probabilities of biopsy proven acute rejection (BPAR), infectious episode including CMV and post-transplant diabetes (PTD). Cox, logistic or linear statistical models were used depending on the studied outcome and models were weighted on propensity scores. 100 patients received ATG (mean total dose of 2.0 mg/kg) and 83 received BSX. Maintenance therapy was comparable. Patient and graft survival did not differ between groups, nor did infectious complications. There was a trend for a higher occurrence of a first BPAR in the BSX group (HR at 1.92; 95%CI: [0.77; 4.78]; p = 0.15) with a significantly higher BPAR episodes (17% vs 7.3%, p = 0.01). PTD occurrence was significantly higher in the BSX group (HR at 2.44; 95%CI: [1.09; 5.46]; p = 0.03). Induction with a very low dose of ATG in non-immunized recipients was safe and associated with a lower rate of BPAR and PTD without increasing infectious complications.

In islet transplantation (ITx), primary graft function (PGF) or beta cell function measured early after last infusion is closely associated with long term clinical outcomes. We investigated the association between PGF and 5 year insulin independence rate in ITx and pancreas transplantation (PTx) recipients. This retrospective multicenter study included type 1 diabetes patients who underwent ITx in Lille and PTx in Nantes from 2000 to 2022. PGF was assessed using the validated Beta2-score and compared to normoglycemic control subjects. Subsequently, the 5 year insulin independence rates, as predicted by a validated PGF-based model, were compared to the actual rates observed in ITx and PTx patients. The study enrolled 39 ITx (23 ITA, 16 IAK), 209 PTx recipients (23 PTA, 14 PAK, 172 SPK), and 56 normoglycemic controls. Mean[SD] PGF was lower after ITx (ITA 22.3[5.2], IAK 24.8[6.4], than after PTx (PTA 38.9[15.3], PAK 36.8[9.0], SPK 38.7[10.5]), and lower than mean beta-cell function measured in normoglycemic control: 36.6[4.3]. The insulin independence rates observed at 5 years after PTA and PAK aligned with PGF predictions, and was higher after SPK. Our results indicate a similar relation between PGF and 5 year insulin independence in ITx and solitary PTx, shedding new light on long-term transplantation outcomes.

About 10-20% of pancreas allografts are still lost in the early postoperative period despite the identification of numerous detrimental risk factors that correlate with graft thrombosis. We conducted a multicenter study including 899 pancreas transplant recipients between 2000 and 2018. Early pancreas failure due to complete thrombosis, long-term pancreas, kidney and patient survivals were analyzed and adjusted to donor, recipient and perioperative variables using a multivariate cause-specific Cox model stratified to transplant centers. Pancreas from donors with history of hypertension (6.7%), as well as with high body mass index (BMI), were independently associated with an increased risk of pancreas failure within the first 30 post-operative days (respectively, HR= 2.57, 95% CI from 1.35 to 4.89 and HR= 1.11, 95% CI from 1.04 to 1.19). Interaction term between hypertension and BMI was negative. Donor hypertension also impacted long-term pancreas survival (HR= 1.88, 95% CI from 1.13 to 3.12). However, when pancreas survival was calculated after the postoperative day 30, donor hypertension was no longer a significant risk factor (HR= 1.22, 95% CI from 0.47 to 3.15). A lower pancreas survival was observed in patients receiving a pancreas from a hypertensive donor without RAAS (Renin Angiotensin Aldosterone System) blockers compared to others (50% vs 14%, p < 0.001). Pancreas survival was similar among non-hypertensive donors and hypertensive ones under RAAS blockers. Donor hypertension was a significant and independent risk factor of pancreas failure. The well-known pathogenic role of renin-angiotensin-aldosterone system seems to be involved in the genesis of this immediate graft failure.

This study explores the impact of using kidneys from very-aged donors to address the organ shortage, focusing on risk factors for graft loss and delayed graft function (DGF), independent of recipient factors. Data were sourced from the French multicentric prospective DIVAT cohort and retrospectively analyzed. The study included adult recipients transplanted between 2007 and 2018 receiving kidneys from brain-deceased donors over 70. The primary endpoint was death-censored graft survival, and secondary endpoint DGF. Among 1036 patients with a median follow-up of 3.96 years (2.01–6.31), donor hypertension (HR 1.46 95% CI (1.09–1.95), cold ischemia time (HR 1.03 per hour 95% CI (1.01–1.06) and HLA mismatches (after adjustment on DGF, HR 1.98 (1.45–2.71)) were significant risk factors for graft loss. Considering DGF, donor serum creatinine (HR 1.01 95% CI (1.01–1.01) per μmol/L), warm and cold ischemia times (HR 1.01 95% CI (1.0–1.01) per minute and HR 1.05 95% CI (1.02–1.08) per hour) and the use of SCOT preservation solution (HR 3.90 95% CI (1.26–11.84)) were deleterious, while hypothermic perfusion machine was protective (HR 0.65 95% CI (0.43–0.99)). The findings emphasize the paucity of modifiable variables associated with long-term outcomes in very-aged donors and the need for peri-transplant preservation strategies.