The international variability of surgery for rectal prolapse.

Objective: There is a lack of consensus regarding the optimal approach for patients with full-thickness rectal prolapse. The aim of this international survey was to assess the patterns in treatment of rectal prolapse. Design: A 23-question survey was distributed to the Pelvic Floor Consortium of the American Society of Colorectal Surgeons, the Colorectal Surgical Society of Australia and New Zealand, and the Pelvic Floor Society. Questions pertained to surgeon and practice demographics, preoperative evaluation, procedural preferences, and educational needs. Setting: Electronic survey distributed to colorectal surgeons of diverse practice settings. Participants: 249 colorectal surgeons responded to the survey, 65% of which were male. There was wide variability in age, years in practice, and practice setting. Main outcome measures: Responses to questions regarding preoperative workup preferences and clinical scenarios. Results: In preoperative evaluation, 19% would perform anorectal physiology testing and 70% would evaluate for concomitant pelvic organ prolapse. In a healthy patient, 90% would perform a minimally invasive abdominal approach, including ventral rectopexy (56%), suture rectopexy (31%), mesh rectopexy (6%) and resection rectopexy (5%). In terms of ventral rectopexy, surgeons in the Americas preferred a synthetic mesh (61.9% vs 38.1%, p=0.59) whereas surgeons from Australasia preferred biologic grafts (75% vs 25%, p<0.01). In an older patient with comorbidities 81% would perform a perineal approach. Procedure preference (Delormes vs Altmeier) varied according to location (Australasia, 85.9% vs 14.1%; Europe, 75.3% vs 24.7%; Americas, 14.1% vs 85.9%). Most participants were interested in education regarding surgical approaches, however there is wide variability in preferred methods. Conclusion: There is significant variability in the preoperative evaluation and surgery performed for rectal prolapse. Given the lack of consensus, it is not surprising that most surgeons desire further education on the topic.

Homo medicus: The transition to meat eating increased pathogen pressure and the use of pharmacological plants in Homo.

The human lineage transitioned to a more carnivorous niche 2.6 mya and evolved a large body size and slower life history, which likely increased zoonotic pathogen pressure. Evidence for this increase includes increased zoonotic infections in modern hunter-gatherers and bushmeat hunters, exceptionally low stomach pH compared to other primates, and divergence in immune-related genes. These all point to change, and probably intensification, in the infectious disease environment of Homo compared to earlier hominins and other apes. At the same time, the brain, an organ in which immune responses are constrained, began to triple in size. We propose that the combination of increased zoonotic pathogen pressure and the challenges of defending a large brain and body from pathogens in a long-lived mammal, selected for intensification of the plant-based self-medication strategies already in place in apes and other primates. In support, there is evidence of medicinal plant use by hominins in the middle Paleolithic, and all cultures today have sophisticated, plant-based medical systems, add spices to food, and regularly consume psychoactive plant substances that are harmful to helminths and other pathogens. We propose that the computational challenges of discovering effective plant-based treatments, the consequent ability to consume more energy-rich animal foods, and the reduced reliance on energetically-costly immune responses helped select for increased cognitive abilities and unique exchange relationships in Homo. In the story of human evolution, which has long emphasized hunting skills, medical skills had an equal role to play.

All Models Are Wrong, and Some Are Religious: Supernatural Explanations as Abstract and Useful Falsehoods about Complex Realities.

Many cognitive and evolutionary theories of religion argue that supernatural explanations are byproducts of our cognitive adaptations. An influential argument states that our supernatural explanations result from a tendency to generate anthropomorphic explanations, and that this tendency is a byproduct of an error management strategy because agents tend to be associated with especially high fitness costs. We propose instead that anthropomorphic and other supernatural explanations result as features of a broader toolkit of well-designed cognitive adaptations, which are designed for explaining the abstract and causal structure of complex, unobservable, and uncertain phenomena that have substantial impacts on fitness. Specifically, we argue that (1) mental representations about the abstract vs. the supernatural are largely overlapping, if not identical, and (2) when the data-generating processes for scarce and ambiguous observations are complex and opaque, a naive observer can improve a bias-variance trade-off by starting with a simple, underspecified explanation that Western observers readily interpret as "supernatural." We then argue that (3) in many cases, knowledge specialists across cultures offer pragmatic services that involve apparently supernatural explanations, and their clients are frequently willing to pay them in a market for useful and effective services. We propose that at least some ethnographic descriptions of religion might actually reflect ordinary and adaptive responses to novel problems such as illnesses and natural disasters, where knowledge specialists possess and apply the best available explanations about phenomena that would otherwise be completely mysterious and unpredictable.

Middle-earth wasn't built in a day: How do we explain the costs of creating a world?

Dubourg and Baumard explain why fictional worlds are attractive to consumers. A complete account of fictional worlds, however, should also explain why some people create them. Creation is a costly and time-consuming process that does not resemble exploration but does resemble the culturally universal phenomenon of knowledge specialization.

The Biological Roots of Music and Dance : Extending the Credible Signaling Hypothesis to Predator Deterrence.

After they diverged from panins, hominins evolved an increasingly committed terrestrial lifestyle in open habitats that exposed them to increased predation pressure from Africa's formidable predator guild. In the Pleistocene, Homo transitioned to a more carnivorous lifestyle that would have further increased predation pressure. An effective defense against predators would have required a high degree of cooperation by the smaller and slower hominins. It is in the interest of predator and potential prey to avoid encounters that will be costly for both. A wide variety of species, including carnivores and apes and other primates, have therefore evolved visual and auditory signals that deter predators by credibly signaling detection and/or the ability to effectively defend themselves. In some cooperative species, these predator deterrent signals involve highly synchronized visual and auditory displays among group members. Hagen and Bryant (Human Nature, 14(1), 21-51, 2003) proposed that synchronized visual and auditory displays credibly signal coalition quality. Here, this hypothesis is extended to include credible signals to predators that they have been detected and would be met with a highly coordinated defensive response, thereby deterring an attack. Within-group signaling functions are also proposed. The evolved cognitive abilities underlying these behaviors were foundations for the evolution of fully human music and dance.

Strength is negatively associated with depression and accounts for some of the sex difference: A replication and extension.

Background: Depression occurs about twice as often in women as in men, a disparity that remains poorly understood. In a previous publication, Hagen and Rosenström predicted and found that grip strength, a highly sexually dimorphic index of physical formidability, mediated much of the effect of sex on depression. Striking results like this are more likely to be published than null results, potentially biasing the scientific record. It is therefore critical to replicate and extend them. Methodology: Using new data from the 2013-14 cycle of the National Health and Nutrition Examination Survey, a nationally representative sample of US households (n = 3650), we replicated models of the effect of sex and grip strength on depression reported in Hagen and Rosenström, along with additional potential confounds and a new detailed symptom-level exploration. Results: Overall, the effects from the original paper were reproduced although with smaller effect sizes. Grip strength mediated 38% of the effect of sex on depression, compared to 63% in Hagen and Rosenström. These results were extended with findings that grip strength had a stronger association with some depression symptoms, like suicidality, low interest and low mood than with other symptoms, like appetite changes. Conclusions: Grip strength is negatively associated with depression, especially its cognitive-affective symptoms, controlling for numerous possible confounds. Although many factors influence depression, few of these reliably occur cross-culturally in a sex-stratified manner and so are unlikely to explain the well-established, cross-cultural sex difference in depression. The sex difference in upper body strength occurs in all populations and is therefore a candidate evolutionary explanation for some of the sex difference in depression. Lay summary: Why are women at twice the risk of developing depression as men? Depression typically occurs during social conflicts, such as physical or sexual abuse. Physically strong individuals can often single-handedly resolve conflicts in their favor, whereas physically weaker individuals often need help from others. We argue that depression is a credible cry for help. Because men generally have greater strength than women, we argue that men may be more likely to resolve conflicts using physical formidability and women to signal others for help. We find that higher grip strength is associated with lower depression, particularly symptoms like feeling down or thoughts of suicide and that strength accounts for part of the sex difference in rates of depression.

Competitive gossip: the impact of domain, resource value, resource scarcity and coalitions.

Those with better reputations often obtain more resources than those with poorer reputations. Consequently, gossip might be an evolved strategy to compete for valuable and scarce material and social resources. Influenced by models of non-human primate competition, we test the hypotheses that gossip: (i) targets aspects of reputation relevant to the domain in which the competition is occurring, (ii) increases when contested resources are more valuable, and (iii) increases when resources are scarcer. We then test hypotheses derived from informational warfare theory, which proposes that coalitions strategically collect, analyse and disseminate gossip. Specifically, we test whether: (iv) coalitions deter negative gossip, and (v) whether they increase expectations of reputational harm to competitors. Using experimental methods in a Mechanical Turk sample (n = 600), and survey and ego network analysis methods in a sample of California sorority women (n = 74), we found that gossip content is specific to the context of the competition; that more valuable and scarcer resources cause gossip, particularly negative gossip, to intensify; and that allies deter negative gossip and increase expectations of reputational harm to an adversary. These results support social competition theories of gossip. This article is part of the theme issue 'The language of cooperation: reputation and honest signalling'.

Toward a productive evolutionary understanding of music.

We discuss approaches to the study of the evolution of music (sect. R1); challenges to each of the two theories of the origins of music presented in the companion target articles (sect. R2); future directions for testing them (sect. R3); and priorities for better understanding the nature of music (sect. R4).

The impact of information about tobacco-related reproductive vs. general health risks on South Indian women's tobacco use decisions.

Smokeless tobacco use among Indian women is increasing despite prevention efforts. Evolutionary theories suggest that reproductive-aged women should be more concerned about immediate threats to reproduction than threats to survival occurring late in life. This study therefore compared an anti-tobacco intervention that emphasized near-term reproductive harms to one involving general harms occurring later in life. Scheduled Tribal women (N = 92) from Karnataka, India participated in this study. At baseline, women reported tobacco use and knowledge of harms, provided a saliva sample to assess use, and randomly viewed either a general harms presentation (GHP) or reproductive harms presentation (RHP). At followup, women reported their use, knowledge of harms and intentions to quit, and provided another saliva sample. At baseline, participants were aware of general harms but not reproductive harms. Both interventions increased knowledge of harms. Women in the RHP condition did not list more harms than women in the GHP condition, however, and the RHP was not more effective in reducing tobacco use than the GHP. In the RHP condition fetal health was particularly salient. In the GHP condition, oral health was highly salient, aligning with the local disease ecology and research on tobacco use and attractiveness.

Ethnoscientific expertise and knowledge specialisation in 55 traditional cultures.

People everywhere acquire high levels of conceptual knowledge about their social and natural worlds, which we refer to as ethnoscientific expertise. Evolutionary explanations for expertise are still widely debated. We analysed ethnographic text records (N = 547) describing ethnoscientific expertise among 55 cultures in the Human Relations Area Files to investigate the mutually compatible roles of collaboration, proprietary knowledge, cultural transmission, honest signalling, and mate provisioning. We found relatively high levels of evidence for collaboration, proprietary knowledge, and cultural transmission, and lower levels of evidence for honest signalling and mate provisioning. In our exploratory analyses, we found that whether expertise involved proprietary vs. transmitted knowledge depended on the domain of expertise. Specifically, medicinal knowledge was positively associated with secretive and specialised knowledge for resolving uncommon and serious problems, i.e. proprietary knowledge. Motor skill-related expertise, such as subsistence and technological skills, was positively associated with broadly competent and generous teachers, i.e. cultural transmission. We also found that collaborative expertise was central to both of these models, and was generally important across different knowledge and skill domains.

Acculturation and market integration are associated with greater trust among Tanzanian Maasai pastoralists.

Acting on socially learned information involves risk, especially when the consequences imply certain costs with uncertain benefits. Current evolutionary theories argue that decision-makers evaluate and respond to this information based on context cues, such as prestige (the prestige bias model) and/or incentives (the risk and incentives model). We tested the roles of each in explaining trust using a preregistered vignette-based study involving advice about livestock among Maasai pastoralists. In exploratory analyses, we also investigated how the relevance of each might be influenced by recent cultural and economic changes, such as market integration and shifting cultural values. Our confirmatory analysis failed to support the prestige bias model, and partially supported the risk and incentives model. Exploratory analyses suggested that regional acculturation varied strongly between northern vs. southern areas, divided by a small mountain. Consistent with the idea that trust varies with socially transmitted values and regional differences in market integration, people living near densely populated towns in the southern region were more likely to trust socially learned information about livestock. Higher trust among market-integrated participants might reflect a coordination solution in a region where traditional pastoralism is beset with novel conflicts of interest.

Organ Preservation in the Treatment of Stage II and III Rectal Cancer.

CASE SUMMARY: A 65-year-old man underwent colonoscopy to evaluate rectal bleeding and was found to have a low rectal mass. Biopsy revealed moderately differentiated microsatellite stable adenocarcinoma. The tumor was palpable at the fingertip in the anterior rectum with the inferior border 5 cm from the anal verge by rigid proctoscopy. CEA was 0.8 ng/mL. CT imaging of the chest, abdomen, and pelvis showed no evidence of distant metastases. MRI confirmed a 5-cm mass with one 8-mm mesorectal lymph node metastasis and no extramural venous invasion. The tumor penetrated the mesorectal fat to a depth of 4 mm, and the circumferential margin was estimated to be 1 mm from the tumor (). He was presented at the multidisciplinary tumor board conference and interviewed and examined at the multidisciplinary clinic. He was dismayed at the prospect of his surgical options, a low anterior resection versus abdominoperineal resection, and wished to keep the options for organ preservation available. Standard long-course chemoradiation was initiated, with resolution of his bleeding after 2 weeks. He then completed 6 cycles of folinic acid, fluorouracil, and oxaliplatin (FOLFOX) chemotherapy (consolidation total neoadjuvant therapy (TNT)). The tumor was no longer palpable on office examination. A complete clinical response (cCR) was confirmed by flexible sigmoidoscopy () and MRI (). He was entered into the nonoperative management program with intense surveillance scheduling and has no evidence of recurrent disease almost 2 years after completion of TNT.

Origins of music in credible signaling.

Music comprises a diverse category of cognitive phenomena that likely represent both the effects of psychological adaptations that are specific to music (e.g., rhythmic entrainment) and the effects of adaptations for non-musical functions (e.g., auditory scene analysis). How did music evolve? Here, we show that prevailing views on the evolution of music - that music is a byproduct of other evolved faculties, evolved for social bonding, or evolved to signal mate quality - are incomplete or wrong. We argue instead that music evolved as a credible signal in at least two contexts: coalitional interactions and infant care. Specifically, we propose that (1) the production and reception of coordinated, entrained rhythmic displays is a co-evolved system for credibly signaling coalition strength, size, and coordination ability; and (2) the production and reception of infant-directed song is a co-evolved system for credibly signaling parental attention to secondarily altricial infants. These proposals, supported by interdisciplinary evidence, suggest that basic features of music, such as melody and rhythm, result from adaptations in the proper domain of human music. The adaptations provide a foundation for the cultural evolution of music in its actual domain, yielding the diversity of musical forms and musical behaviors found worldwide.

Perianal basal cell carcinoma: a common cancer in an uncommon location.

This is a case of a perianal basal cell carcinoma, a common skin cancer in an unusual location. Our patient is a 67-year-old male with a perianal lesion. He first noticed this painless lesion 5 years prior to presentation and was having fecal incontinence and weight loss. He had a fully encompassing ulcerated lesion involving the entirety of the anal margin. We performed a biopsy that returned on pathology as a basal cell carcinoma. Due to the size of the lesion and his current nutritional status, it was determined to be unresectable. We were able to provide him with a diverting colostomy to address his incontinence and this allowed the patient to recover enough to undergo treatment with radiation (total of 5400 cGy). To our knowledge, this is the largest perianal basal cell carcinoma reported in the literature and an example of combining palliative surgery and radiation as a treatment option.

Mental health is biological health: Why tackling "diseases of the mind" is an imperative for biological anthropology in the 21st century.

The germ theory of disease and the attendant public health initiatives, including sanitation, vaccination, and antibiotic treatment, led to dramatic increases in global life expectancy. As the prevalence of infectious disease declines, mental disorders are emerging as major contributors to the global burden of disease. Scientists understand little about the etiology of mental disorders, however, and many of the most popular psychopharmacological treatments, such as antidepressants and antipsychotics, have only moderate-to-weak efficacy in treating symptoms and fail to target biological systems that correspond to discrete psychiatric syndromes. Consequently, despite dramatic increases in the treatment of some mental disorders, there has been no decrease in the prevalence of most mental disorders since accurate record keeping began. Many researchers and theorists are therefore endeavoring to rethink psychiatry from the ground-up. Anthropology, especially biological anthropology, can offer critical theoretical and empirical insights to combat mental illness globally. Biological anthropologists are unique in that we take a panhuman approach to human health and behavior and are trained to address each of Tinbergen's four levels of analysis as well as culture. The field is thus exceptionally well-situated to help resolve the mysteries of mental illness by integrating biological, evolutionary, and sociocultural perspectives.

Household composition and the infant fecal microbiome: The INSPIRE study.

OBJECTIVES: Establishment and development of the infant gastrointestinal microbiome (GIM) varies cross-culturally and is thought to be influenced by factors such as gestational age, birth mode, diet, and antibiotic exposure. However, there is little data as to how the composition of infants' households may play a role, particularly from a cross-cultural perspective. Here, we examined relationships between infant fecal microbiome (IFM) diversity/composition and infants' household size, number of siblings, and number of other household members. MATERIALS AND METHODS: We analyzed 377 fecal samples from healthy, breastfeeding infants across 11 sites in eight different countries (Ethiopia, The Gambia, Ghana, Kenya, Peru, Spain, Sweden, and the United States). Fecal microbial community structure was determined by amplifying, sequencing, and classifying (to the genus level) the V1-V3 region of the bacterial 16S rRNA gene. Surveys administered to infants' mothers identified household members and composition. RESULTS: Our results indicated that household composition (represented by the number of cohabitating siblings and other household members) did not have a measurable impact on the bacterial diversity, evenness, or richness of the IFM. However, we observed that variation in household composition categories did correspond to differential relative abundances of specific taxa, namely: Lactobacillus, Clostridium, Enterobacter, and Klebsiella. DISCUSSION: This study, to our knowledge, is the largest cross-cultural study to date examining the association between household composition and the IFM. Our results indicate that the social environment of infants (represented here by the proxy of household composition) may influence the bacterial composition of the infant GIM, although the mechanism is unknown. A higher number and diversity of cohabitants and potential caregivers may facilitate social transmission of beneficial bacteria to the infant gastrointestinal tract, by way of shared environment or through direct physical and social contact between the maternal-infant dyad and other household members. These findings contribute to the discussion concerning ways by which infants are influenced by their social environments and add further dimensionality to the ongoing exploration of social transmission of gut microbiota and the "old friends" hypothesis.

Evolutionary Models of Leadership : Tests and Synthesis.

This study tested four theoretical models of leadership with data from the ethnographic record. The first was a game-theoretical model of leadership in collective actions, in which followers prefer and reward a leader who monitors and sanctions free-riders as group size increases. The second was the dominance model, in which dominant leaders threaten followers with physical or social harm. The third, the prestige model, suggests leaders with valued skills and expertise are chosen by followers who strive to emulate them. The fourth proposes that in small-scale, kin-based societies, men with high neural capital are best able to achieve and maintain positions of social influence (e.g., as headmen) and thereby often become polygynous and have more offspring than other men, which positively selects for greater neural capital. Using multiple search strategies we identified more than 1000 texts relevant to leadership in the Probability Sample of 60 cultures from the Human Relations Area Files (HRAF). We operationalized the model with variables and then coded all retrieved text records on the presence or absence of evidence for each of these 24 variables. We found mixed support for the collective action model, broad support for components of the prestige leadership style and the importance of neural capital and polygyny among leaders, but more limited support for the dominance leadership style. We found little evidence, however, of emulation of, or prestige-biased learning toward, leaders. We found that improving collective actions, having expertise, providing counsel, and being respected, having high neural capital, and being polygynous are common properties of leaders, which warrants a synthesis of the collective action, prestige, and neural capital and reproductive skew models. We sketch one such synthesis involving high-quality decision-making and other computational services.