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The occurrence of nonlocal objects, raw materials, and ideas in the southwestern United States (U.S. SW) has long been recognized as evidence of interaction between prehispanic peoples of this region and those of greater Mesoamerica. Although many archaeologists have analyzed the directionality and potential means by which these objects and concepts moved across the landscape, few have assessed the degree to which Mesoamerican practices and traditional assemblages remained intact as the artifacts and ideas moved farther from their places of origin. The current study analyzes the distribution and deposition of blue-green stone mosaics, a craft technology that was well established in Mesoamerica by the Late Preclassic period (300 BC–AD 250) and spread to the U.S. SW by the start of the Hohokam Pioneer period (AD 475). We assess the spatial distribution, contextual deposition, and morphology of mosaics at sites within Hohokam Canal System 2, located in the Phoenix Basin of Arizona. We use these data to infer mosaics’ social value and function within Hohokam social structure. Analyses suggest that, although the technology of mosaic making may have originated in Mesoamerica, the contexts and ways in which mosaics were used in the Hohokam regional system were decidedly Hohokam.
Archaeological evidence and the text of the Strategikon show that it was only in the late sixth century AD that the Roman-Byzantine military adopted the stirrup. It is now widely argued that the Avars, who settled in the Carpathian basin in the sixth century, played a key role in introducing iron stirrups to the Roman-Byzantine world. However, the evidence to support this assertion is limited. Although hundreds of stirrups have been found in Avar graves in the Carpathian basin, very few stirrups of sixth- or seventh-century date are known from the Roman-Byzantine empire - no more than seven - and only two of these are of definitively Avar type. The text of the Strategikon, sometimes argued to support this Avar source, can be interpreted differently, as indeed can the archaeological evidence. While the debate about the Roman-Byzantine adoption of the stirrup has focused mostly on finds from the Balkans, two early stirrups are known from Asia Minor, from Pergamon and Sardis. This paper presents a third, previously unpublished stirrup, from a seventh-century deposit at Aphrodisias in Caria; this is the first stirrup found in Asia Minor from a datable context. Here we present this find and its context, and use it to reconsider the model of solely Avar stirrup transmission that has dominated scholarship to date. So varied are the early stirrups that multiple sources of influence, Avar and other, and even a degree of experimentation, seem more likely to underpin the Roman-Byzantine adoption of this technology.
This chapter concerns Roman sculptors and considers whether sculptors in the Roman empire fit the modern criteria for the term ‘professional’, as has been developed in the sociology of modern professions. While the lack of a regulatory system governing stone carving practitioners in the Roman world might make it hard to fit them into most modern definitions of professionals, it is argued that Roman sculptors saw their work as skilled and used their specialist knowledge to obtain social and economic rewards.
A large-scale measles outbreak (11 495 reported cases, 60% aged ≥15 years) occurred in Georgia during 2013–2015. A nationwide, multistage, stratified cluster serosurvey for hepatitis B and C among persons aged ≥18 years conducted in Georgia in late 2015 provided an opportunity to assess measles and rubella (MR) susceptibility after the outbreak. Residual specimens from 3125 participants aged 18–50 years were tested for Immunoglobulin G antibodies against MR using ELISA. Nationwide, 6.3% (95% CI 4.9%–7.6%) of the surveyed population were seronegative for measles and 8.6% (95% CI 7.1%–10.1%) were seronegative for rubella. Measles susceptibility was highest among 18–24 year-olds (10.1%) and declined with age to 1.2% among 45–50 year-olds (P < 0.01). Susceptibility to rubella was highest among 25–29 year-olds (15.3%), followed by 18–24 year-olds (11.6%) and 30–34 year-olds (10.2%), and declined to <5% among persons aged ≥35 years (P < 0.001). The susceptibility profiles in the present serosurvey were consistent with the epidemiology of recent MR cases and the history of the immunization programme. Measles susceptibility levels >10% among 18–24 year-olds in Georgia revealed continued risk for outbreaks among young adults. High susceptibility to rubella among 18–34 year-olds indicates a continuing risk for congenital rubella cases.
Refractory depression is a major contributor to the economic burden of depression. Radically open dialectical behaviour therapy (RO DBT) is an unevaluated new treatment targeting overcontrolled personality, common in refractory depression, but it is not yet known whether the additional expense of RO DBT is good value for money.
To estimate the cost-effectiveness of RO DBT plus treatment as usual (TAU) compared with TAU alone in people with refractory depression (trial registration: ISRCTN85784627).
We undertook a cost-effectiveness analysis alongside a randomised trial evaluating RO DBT plus TAU versus TAU alone for refractory depression in three UK secondary care centres. Our economic evaluation, 12 months after randomisation, adopted the perspective of the UK National Health Service (NHS) and personal social services. It evaluated cost-effectiveness by comparing the net cost of RO DBT with the net gain in quality-adjusted life-years (QALYs), estimated using the EQ-5D-3L measure of health-related quality of life.
The additional cost of RO DBT plus TAU compared with TAU alone was £7048 and was associated with a difference of 0.032 QALYs, yielding an incremental cost-effectiveness ratio (ICER) of £220 250 per QALY. This ICER was well above the National Institute for Health and Care Excellence (NICE) upper threshold of £30 000 per QALY. A cost-effectiveness acceptability curve indicated that RO DBT had a zero probability of being cost-effective compared with TAU at the NICE £30 000 threshold.
In its current resource-intensive form, RO DBT is not a cost-effective use of resources in the UK NHS.
Declaration of interest
R.H. is co-owner and director of Radically Open Ltd, the RO DBT training and dissemination company. D.K. reports grants outside the submitted work from the National Institute for Health Research (NIHR). T.L. receives royalties from New Harbinger Publishing for sales of RO DBT treatment manuals, speaking fees from Radically Open Ltd, and a grant outside the submitted work from the Medical Research Council. He was co-director of Radically Open Ltd between November 2014 and May 2015 and is married to Erica Smith-Lynch, the principal shareholder and one of two directors of Radically Open Ltd. H.O'M. reports personal fees outside the submitted work from the Charlie Waller Institute and Improving Access to Psychological Therapy. S.R. provides RO DBT supervision through her company S C Rushbrook Ltd. I.R. reports grants outside the submitted work from NIHR and Health & Care Research Wales. M. Stanton reports personal fees outside the submitted work from British Isles DBT Training, Stanton Psychological Services Ltd and Taylor & Francis. M. Swales reports personal fees outside the submitted work from British Isles DBT Training, Guilford Press, Oxford University Press and Taylor & Francis. B.W. was co-director of Radically Open Ltd between November 2014 and February 2015.
Individuals with depression often do not respond to medication or psychotherapy. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting overcontrolled personality, common in refractory depression.
To compare RO DBT plus treatment as usual (TAU) for refractory depression with TAU alone (trial registration: ISRCTN 85784627).
RO DBT comprised 29 therapy sessions and 27 skills classes over 6 months. Our completed randomised trial evaluated RO DBT for refractory depression over 18 months in three British secondary care centres. Of 250 adult participants, we randomised 162 (65%) to RO DBT. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), assessed masked and analysed by treatment allocated.
After 7 months, immediately following therapy, RO DBT had significantly reduced depressive symptoms by 5.40 points on the HRSD relative to TAU (95% CI 0.94–9.85). After 12 months (primary end-point), the difference of 2.15 points on the HRSD in favour of RO DBT was not significant (95% CI –2.28 to 6.59); nor was that of 1.69 points on the HRSD at 18 months (95% CI –2.84 to 6.22). Throughout RO DBT participants reported significantly better psychological flexibility and emotional coping than controls. However, they reported eight possible serious adverse reactions compared with none in the control group.
The RO DBT group reported significantly lower HRSD scores than the control group after 7 months, but not thereafter. The imbalance in serious adverse reactions was probably because of the controls' limited opportunities to report these.
The eruption of A.D. 79 has long dominated archaeological discourse on Vesuvius. Other eruptions, both earlier and later, have received less attention but are no less valuable from an archaeological point of view.1 Those eruptions deposited distinctive volcanic materials often easily identifiable in the stratigraphic record, thereby providing dated termini ante quos, which can in turn offer a snapshot of life around the volcano in different periods. The eruption of A.D. 79 provides just such an horizon for 1st-c. A.D. Campania; the earlier ‘Avellino pumices eruption’ does the same for the Bronze Age.2 By tracking the volcanic deposits that can be tied to such events, the situation on the ground prior to the eruptions can be examined, as can the ways in which communities and landscapes reacted to, and recovered from, them.
Since 2010, a team from the Tunisian Institut National du Patrimoine and the University of Oxford1 has been investigating Utica’s monumental centre, located at the tip of the promontory on which the city is built (fig. 1). The range and scale of architectural elements littering this area were remarked upon by most antiquarian investigators of the site. Nathan Davis, working at the site in 1858, noted that, despite the fact that it “had been ransacked for building materials”, this part of the city was covered with “marble and granite shafts, capitals, and cornices, of every order, size, and dimension”.2 Alfred Daux even observed that local residents referred to the largest building of the zone as the “Dar Es Sultan” (Palace of the Sultan), such was its magnificence.3 Aerial photographs commissioned by A. Lézine in the 1950s (fig. 2) show the area at the head of the promontory almost completely robbed out during and immediately after the Second World War, giving it a rather desolate aspect.
It has been ten years since the publication of Lorenzo Lazzarini's monumental volume on the quarrying, use and properties of the coloured marbles of Greece: Poikiloi Lithoi, Versiculores Maculae: I Marmi Colorati della Grecia Antica (Lazzarini 2007). The first study since Angelina Dworakowska's Quarries in Ancient Greece (Dworakowska 1975) to attempt a large-scale examination of quarrying across Greece, Lazzarini's approach is fundamentally an archaeometric one. Analysis of the evidence for quarrying in different regions is set alongside minero-petrographic and geochemical analyses of the materials extracted. Lazzarini focuses on 12 lithotypes: marmor lacedaemonium from Laconia, variously referred to as serpentino and porfido verde antico; three stone types from the Mani peninsula: rosso antico tenario, nero antico tenario and cipollino tenario; from Chios, the famous marmor chium or portasanta, breccia di Aleppo and nero antico chiota; the breccia di settebasi and semesanto of Skyros; the intensively exploited marmor carystium or cipollino verde, as well as the marmor chalcidicum or fior di pesco from Euboea; and from central and northern Greece, marmor thessalicum or verde antico and the breccia policroma della Vittoria. For each of these lithotypes, Lazzarini considers the evidence for their use and distribution, illustrated with a distribution map in each case, and provides a thorough overview of what is known about their quarries. Archaeological and geological approaches are here combined, and this is a hallmark of much recent work on the question of quarrying and stone use through Greek history.
Severe traumatic brain injury (TBI) in older age is associated with high rates of mortality. However, little is known about outcome following mild TBI (mTBI) in older age. We report on a prospective cohort study investigating 3 month outcome in older age patients admitted to hospital-based trauma services. First, 50 mTBI older age patients and 58 orthopedic controls were compared to 123 community control participants to evaluate predisposition and general trauma effects on cognition. Specific brain injury effects were subsequently evaluated by comparing the orthopedic control and mTBI groups. Both trauma groups had significantly lower performances than the community group on prospective memory (d=0.82 to 1.18), attention set-shifting (d=−0.61 to −0.69), and physical quality of life measures (d=0.67 to 0.84). However, there was only a small to moderate but non-significant difference in the orthopedic control and mTBI group performances on the most demanding task of prospective memory (d=0.37). These findings indicate that, at 3 months following mTBI, older adults are at risk of poor cognitive performance but this is substantially accounted for by predisposition to injury or general multi-system trauma. (JINS, 2014, 20, 1–9)