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New radiocarbon (14C) dates suggest a simultaneous appearance of two technologically and geographically distinct axe production practices in Neolithic Britain; igneous open-air quarries in Great Langdale, Cumbria, and from flint mines in southern England at ~4000–3700 cal BC. In light of the recent evidence that farming was introduced at this time by large-scale immigration from northwest Europe, and that expansion within Britain was extremely rapid, we argue that this synchronicity supports this speed of colonization and reflects a knowledge of complex extraction processes and associated exchange networks already possessed by the immigrant groups; long-range connections developed as colonization rapidly expanded. Although we can model the start of these new extraction activities, it remains difficult to estimate how long significant production activity lasted at these key sites given the nature of the record from which samples could be obtained.
The reliability of health technology assessment (HTA) is built on accessing evidence systematically to inform conclusions and recommendations; however, the availability of primary evidence is a source of bias which can undermine an HTA. This omission is often because attempts to generate primary evidence have not been completely successful. Where partial evidence exists, ignoring it constitutes avoidable bias. Taking the Hip Op trial as an example (a study of developmental dysplasia of the hip (DDH)) we consider how despite lack of quantitative outcomes data, rich information was obtained that should inform HTA in this area.
The Hip Op trial was an open label trial comparing early against late surgery in the management of DDH. In parallel, a qualitative study attempted to explore the experience of parents of children with DDH.
The trial protocol called for recruitment of 636 children, but due to changes in clinician equipoise and service configuration only 29 could be recruited. The trial was stopped early. While baseline data for the 29 children was available, no estimate of effect was attempted due to a lack of outcome data; however, the qualitative data was rich, representing the biggest qualitative sample worldwide on this topic. It reflected the patient experience, and shows a clear preference towards early intervention, despite the absence of quantitative evidence.
The qualitative work here gives a clear indication that parents have a strong preference. This is data which would not be captured in traditional HTA reports, which tend to focus on quantitative data and meta-analysis. This is, however, information that is important to patients, and should inform clinicians and payers. We discuss how HTA do-ers should make efforts to find this data from ‘failed’ primary research and incorporate it into their reports, and how HTA do-ers could be alert to this situation.
The best method for quantifying the marine reservoir effect (MRE) using the global IntCal Marine13 calibration curve remains unresolved. Archaeologists frequently quantify uncertainty on MRE values as errors computed from single pairs of marine-terrestrial radiocarbon ages, which we argue significantly overstates their accuracy and precision. Here, we review the assumptions, methods, and applications of estimating MRE via an estimate of the additional regional offset between the marine and terrestrial calibration curves (ΔR) for the Prince Rupert Harbour (PRH) region of British Columbia, Canada. We acknowledge the influence on ΔR of MRE variation as (1) a dynamic oceanographic process, (2) its variable expression in biochemical and geochemical pathways, and (3) compounding errors in sample selection, measurement, and calculation. We examine a large set of marine-terrestrial pairs (n = 63) from PRH to compare a common archaeological practice of estimating uncertainty from means that generate an uncertainty value of ±49 years with a revised, more appropriate estimate of error of ± 230 years. However, we argue that the use of multiple-pair samples estimates the PRH ΔR as 273 ± 38 years for the last 5,000 years. Calculations of error that do not consider these issues may generate inaccurate age estimates with unjustifiable precision.
Objective: The purpose of this study was to investigate primary care pediatrician (PCP) perceptions of prevalence of, time spent in, and satisfaction with behavioral health services across clinics with and without on-site behavioral health providers (BHPs). Methods: A cross-sectional survey design was used to examine satisfaction across sites. Data were collected on PCP perceptions of behavioral health services among 60 pediatricians within two academic medical systems. Results: PCPs perceived behavioral health issues are prevalent and a time-consuming aspect of medical appointments and preferred to have on-site BHPs over off-site referral sources. Compared to sites without an on-site BHP, sites with on-site BHPs were more satisfied with behavioral health service availability and resources, felt they spent more time addressing medical concerns, and spent less time providing anticipatory guidance. Discussion: Study limitations included questions surrounding the validity of survey items to accurately assess PCP perceptions, lack of rigorous experimental design, and reliance on self-report data.
The National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme commissions research to inform health services in the United Kingdom. The program prioritises research ideas from literature, guidelines, patients, and clinicians, to decide which research should be funded. We get clinical input on these ideas through (i) committees of clinicians and patients and (ii) seeking written advice from multiple clinicians — a refereeing process. Chairs of our committees suggested that the material we sent to clinicians was too extensive and the method of response too burdensome. We set out to determine whether reducing the information provided or burden of response would improve the engagement of clinicians with our processes, and hence improve the quality of advice provided, and the research available to health services.
We undertook a factorial randomized controlled trial (University of Southampton Faculty of Medicine Ethics Committee #8192, Trial registration: ACTRN12614000167662). Each participant was randomized to receive one of two types of material to comment on, and one of two means to respond. In the first allocation participants were randomised in a 1:1 ratio between receiving a ‘vignette’ (a briefing paper of up to ten pages discussing possible research = usual practice), or a ‘commissioning brief’ (a single page summarising the proposed research). In the second allocation, the method of response was randomized, between a structured form and free text email.
We randomized 460 clinical experts, and 356 (77.4 percent) responded. The responses were graded for quality on a scale of 0 to 4 (higher scores better). Non-response was scored as 0. Analysis using ANOVA gave results of a structured response scoring .34 points (Standard Deviation, SD .36) over a freeform response (p = .02); and the commissioning brief as .04 points over a vignette (p = .81).
This was the first randomized trial to take place inside the secretariat of the HTA program. The difference in quality score between the brief and the vignette allocations was neither statistically nor practically important. The difference between the structured and freeform response was statistically significant, and sufficiently large to be important in practice. While the choice of material to share with clinicians seems unimportant we have shown that it is worth sending a structured response form to experts.
It is vitally important that research questions posed are important and that funded research meets a research need or a gap in evidence; these needs may be observed at a local, national or international level. Identifying such research priorities for a national research funder can be challenging, particularly for complex health problems such as health inequalities, where there is a need to consult a large number of experts with a range of expertise. Many methods are used in the identification of such research priorities, however, these can be resource intensive, costly, and logistically challenging particularly where large numbers of people are required and geographical distances are great.
This study investigated the use of Delphi type survey methods in identifying important research priorities related to health inequalities. Public health professionals with an interest in health inequalities were asked to identify research priorities, these research priorities were subsequently compared to those identified using different methods.
Fifty-two public health professionals agreed to take part, the response rates were high, (69 percent, 50 percent and 40 percent) across three survey rounds; which indicated that participants were receptive to the methodology and motivated to respond. The themes identified as encompassing the most important research priorities were: mental health, environmental issues and health behaviours. Within these themes, topic areas which emerged most strongly included: community interventions for prevention of mental health problems, and the food and alcohol environment.
Delphi type survey methods are effective as a means of obtaining opinions from a wide number of relevant experts identifying potential priority topic areas where there is a need for research evidence. Opinions may be sought at local and national levels in order to inform national research priorities.
In this paper, we report progress on “Neighborhoods: our people, our places” an international study about how people living with dementia interact with their neighborhoods. The ideas of social health and citizenship are drawn upon to contextualize the data and make a case for recognizing and understanding the strengths and agency of people with dementia. In particular, we address the lived experience of the environment as a route to better understanding the capabilities, capacities, and competencies of people living with dementia. In doing this, our aim is to demonstrate the contribution of social engagement and environmental support to social health.
The study aims to “map” local spaces and networks across three field sites (Manchester, Central Scotland and Linkoping, Sweden). It employs a mix of qualitative and participatory approaches that include mobile and visual methods intended to create knowledge that will inform the design and piloting of a neighborhood-based intervention.
Our research shows that the neighborhood plays an active role in the lives of people with dementia, setting limits, and constraints but also offering significant opportunities, encompassing forms of help and support as yet rarely discussed in the field of dementia studies. The paper presents new and distinctive insights into the relationship between neighborhoods and everyday life for people with dementia that have important implications for the debate on social health and policy concerning dementia friendly communities.
We end by reflecting on the messages for policy and practice that are beginning to emerge from this on-going study.
In the United Kingdom (UK), an ageing population met with the reduction of social care funding has led to reduced support for older people marked with an increased demand on family care-givers. Assistive telecare (AT) devices are viewed as an innovative and effective way to support older people. However, there is limited research which has explored adoption of AT from the perspectives of family care-givers. In-depth, semi-structured interviews were conducted with 14 family care-givers of patients who used the Assistive Telehealth and Telecare service in Cambridgeshire, UK. Family care-givers were either the spouse (N = 8) or child of the patient (N = 6). The patients' age ranged from 75 to 98, and either received a telecare standalone device or connected service. Framework analysis was used to analyse the transcripts. This study revealed that family care-givers play a crucial role in supporting the patient's decision to adopt and engage with AT devices. Knowledge and awareness, perceived responsibility, usefulness and usability, alongside functionality of the equipment, were influential factors in the decision-making process. AT devices were viewed positively, considered easy to use, useful and functional, with reassurance of the patient's safety being a core reason for adoption. Efforts to increase adoption and engagement should adapt recruitment strategies and service pathways to support both the patient and their care-giver.
To evaluate the relationship between Emergency Physician (EP) productivity and patient satisfaction with Emergency Department (ED) care.
This retrospective observational study linked administrative and patient experience databases to measure correlations between the patient experience and EP productivity. The study was performed across three Calgary EDs (from June 2010 to July 2013). Patients>16 years old with completed Health Quality Council of Alberta (HQCA) ED Patient Experience Surveys were included. EP productivity was measured at the individual physician level and defined as the average number of patients seen per hour. The association between physician productivity and patient experience scores from six composite domains of the HQCA ED Patient Experience Survey were examined using Pearson correlation coefficients, linear regression modelling, and a path analysis.
We correlated 3,794 patient experience surveys with productivity data for 130 EPs. Very weak non-significant negative correlations existed between productivity and survey composites: “Staff Care and Communication” (r=-0.057, p=0.521), “Discharge Communication” (r=-0.144, p=0.102), and “Respect” (r=-0.027, p=0.760). Very weak, non-significant positive correlations existed between productivity and the composite domains: “Medication Communication” (r=0.003, p=0.974) and “Pain management” (r=0.020, p=0.824). A univariate general linear model yielded no statistically significant correlations between EP productivity and patient experience, and the path analysis failed to show a relationship between the variables.
We found no correlation between EP productivity and the patient experience.
Prince Rupert Harbour (PRH), on the north Pacific Coast of British Columbia, contains at least 157 shell middens, of which 66 are known villages, in an area of approximately 180 km2. These sites span the last 9500 yr and in some cases are immense, exceeding 20,000 m2 surface area and several meters in depth. Recent archaeological research in PRH has become increasingly reliant on radiocarbon dates from marine shell for developing chronologies. However, this is problematic as the local marine reservoir effect (MRE) remains poorly understood in the region. To account for the MRE and to better date the Harbour’s sites, we propose a ΔR of 273±38 for the PRH area, based on our work at the site of Kitandach (GbTo-34), a massive shell midden-village centrally located within the Harbour. We followed the multiple paired sample approach for samples from specific contexts and ensured contemporaneity within the groups of marine and terrestrial materials by statistically assessing for outliers using the χ2 test. Taking together, the results for this and previous studies, it appears the MRE was fairly constant over the past 5000 yr.
Between the Alaska Range to the south and the Brooks Range to the north, the Yukon River and its tributaries form an extensive network of waterways leading through the lowlands of interior Alaska deep into the North American continent (Fig 1). Despite the extremely cold winters of this arctic and subarctic landscape, much of the region remained unglaciated during the last 50,000 years. The central Alaskan lowlands are at the west end of the “ice-free corridor,” thought by most prehistorians to be the pathway to the Americas for Asian hunter-gatherers crossing the continental Beringian “landbridge.” Until recently, relatively little was known of the early human prehistory of Alaska's interior. Growing interest in the timing, nature and paleoecological context of the initial peopling of the Americas has prompted excavation at a number of early sites in central Alaska and the adjacent Yukon (see Powers & Hamilton 1978; West 1981; Fagan 1987: 119-134; Hamilton 1989; Powers & Hoffecker 1989).
Radiocarbon ages were measured on replicate samples of burnt grain and 5 mollusk species collected from a single sealed layer at an archaeological site (Hornish Point) on the west coast of South Uist, Scotland. The aim was to examine the impact of using different mollusk species on ΔR determinations that are calculated using the paired terrestrial/marine sample approach. The mollusk species examined inhabit a range of environments and utilize a variety of food sources within the intertidal zone. Several authors have suggested that these factors may be responsible for observed variations in the 14C activity of mollusk shells that were contemporaneous in a single location. This study found no significant variation in the 14C ages of the mollusk species, and consequently, no significant variation in calculated values of ΔR. The implication is that in an area where there are no carboniferous rocks or significant local inputs of freshwater to the surface ocean, any of a range of marine mollusk species can be used in combination with short-lived terrestrial material from the same secure archaeological context to accurately determine a ΔR value for a particular geographic location and period in time.
We assessed the evidence for variations in the marine radiocarbon reservoir effect (MRE) at coastal, archaeological Iron Age sites in north and west Scotland by comparing AMS measurements of paired marine and terrestrial materials (4 pairs per context). ΔR values were calculated from measurements on material from 3 sites using 6 sets of samples, all of which were deposited around 2000 BP. The weighted mean of the ΔR determinations was −79 ± 17 14C yr, which indicates a consistent, reduced offset between atmospheric and surface ocean 14C specific activity for these sites during this period, relative to the present day (ΔR = ∼0 14C yr). We discuss the significance of this revised ΔR correction by using the example of wheelhouse chronologies at Hornish Point and their development in relation to brochs. In addition, we assess the importance of using the concepts of MRE correction and ΔR variations when constructing chronologies using 14C measurements made on materials that contain marine-derived carbon.
This paper examines 2 potential sources of the radiocarbon offset between human and terrestrial mammal (horse) bones recovered from Norse (∼AD 870–1000) pagan graves in Mývatnssveit, north Iceland. These are the marine and freshwater 14C reservoir effects that may be incorporated into human bones from dietary sources. The size of the marine 14C reservoir effect (MRE) during the Norse period was investigated by measurement of multiple paired samples (terrestrial mammal and marine mollusk shell) at 2 archaeological sites in Mývatnssveit and 1 site on the north Icelandic coast. These produced 3 new δR values for the north coast of Iceland, indicating a δR of 106 ± 10 14C yr at AD 868–985, and of 144 ± 28 14C yr at AD 1280–1400. These values are statistically comparable and give an overall weighted mean δR of 111 ± 10 14C yr.
The freshwater reservoir effect was similarly quantified using freshwater fish bones from a site in Mývatnssveit. These show an offset of between 1285 and 1830 14C yr, where the fish are depleted in 14C relative to the terrestrial mammals. This is attributed to the input of geothermally derived CO2 into the groundwater and subsequently into Lake Mývatn. We conclude the following: i) some of the Norse inhabitants of Mývatnssveit incorporated non-terrestrial resources into their diet that may be identified from the stable isotope composition of their bone collagen; ii) the MRE off the north Icelandic coast during the Norse period fits a spatial gradient of wider North Atlantic MRE values with increasing values to the northwest; and iii) it is important to consider the effect that geothermal activity could have on the 14C activity of samples influenced by groundwater at Icelandic archaeological sites.
An instrumented indentation method is developed for generating maps of time-dependent viscoelastic and time-independent plastic properties of polymeric materials. The method is based on a pyramidal indentation model consisting of two quadratic viscoelastic Kelvin-like elements and a quadratic plastic element in series. Closed-form solutions for indentation displacement under constant load and constant loading-rate are developed and used to determine and validate material properties. Model parameters are determined by point measurements on common monolithic polymers. Mapping is demonstrated on an epoxy-ceramic interface and on two composite materials consisting of epoxy matrices containing multiwall carbon nanotubes. A fast viscoelastic deformation process in the epoxy was unaffected by the inclusion of the nanotubes, whereas a slow viscoelastic process was significantly impeded, as was the plastic deformation. Mapping revealed considerable spatial heterogeneity in the slow viscoelastic and plastic responses in the composites, particularly in the material with a greater fraction of nanotubes.
We give a progress report on a programme of observations to obtain flux densities at 8.4 GHz for a large sample of radio sources selected from the Parkes 2700 MHz Survey. So far, about 1000 flux measurements have been made with a typical accuracy of 10%.