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The scarcity of Romano-British human remains from north-west England has hindered understanding of burial practice in this region. Here, we report on the excavation of human and non-human animal remains1 and material culture from Dog Hole Cave, Haverbrack. Foetal and neonatal infants had been interred alongside a horse burial and puppies, lambs, calves and piglets in the very latest Iron Age to early Romano-British period, while the mid- to late Roman period is characterised by burials of older individuals with copper-alloy jewellery and beads. This material culture is more characteristic of urban sites, while isotope analysis indicates that the later individuals were largely from the local area. We discuss these results in terms of burial ritual in Cumbria and rural acculturation. Supplementary material is available online (https://doi.org/10.1017/S0068113X20000136), and contains further information about the site and excavations, small finds, zooarchaeology, human osteology, site taphonomy, the palaeoenvironment, isotope methods and analysis, and finds listed in Benson and Bland 1963.
Isotope ratios of tooth enamel from ten Early Neolithic individuals buried in a long cairn at Whitwell in central England were measured to determine where they sourced their childhood diet. Five individuals have low Sr concentrations (11–66 ppm) and high 87Sr/86Sr ratios (0.7164–0.7212). Three individuals have relatively low 87Sr/86Sr ratios (0.712–0.711) and Sr concentrations ranging between 54 and 109 ppm. Two individuals have strontium isotope values that bridge the gap between the isotope compositions of these two groups. The high 87Sr/86Sr values are rare in human enamel and exclude sources within the biosphere of central England. Oxygen isotope values are comparable to those found within human archaeological populations buried in temperate regions of Europe. The strontium isotope results should be interpreted in the context of other evidence for migration from northern France to Britain during the Early Neolithic.
The Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort study of the Canadian Consortium on Neurodegeneration in Aging (CCNA) is a national initiative to catalyze research on dementia, set up to support the research agendas of CCNA teams. This cross-country longitudinal cohort of 2310 deeply phenotyped subjects with various forms of dementia and mild memory loss or concerns, along with cognitively intact elderly subjects, will test hypotheses generated by these teams.
The COMPASS-ND protocol, initial grant proposal for funding, fifth semi-annual CCNA Progress Report submitted to the Canadian Institutes of Health Research December 2017, and other documents supplemented by modifications made and lessons learned after implementation were used by the authors to create the description of the study provided here.
The CCNA COMPASS-ND cohort includes participants from across Canada with various cognitive conditions associated with or at risk of neurodegenerative diseases. They will undergo a wide range of experimental, clinical, imaging, and genetic investigation to specifically address the causes, diagnosis, treatment, and prevention of these conditions in the aging population. Data derived from clinical and cognitive assessments, biospecimens, brain imaging, genetics, and brain donations will be used to test hypotheses generated by CCNA research teams and other Canadian researchers. The study is the most comprehensive and ambitious Canadian study of dementia. Initial data posting occurred in 2018, with the full cohort to be accrued by 2020.
Availability of data from the COMPASS-ND study will provide a major stimulus for dementia research in Canada in the coming years.
The nature of landscape use and residence patterns during the British earlier Neolithic has often been debated. Here we use strontium and oxygen isotope analysis of tooth enamel, from individuals buried at the Hambledon Hill causewayed enclosure monument complex in Dorset, England to evaluate patterns of landscape use during the earlier Neolithic. Previous analysis suggests that a significant proportion of the artefacts found at the site may originate from lithology of Eocene and Upper to Middle Jurassic age that the enclosures overlook to the immediate west and south. The excavators therefore argued that the sector of landscape visible from Hambledon Hill provides an approximate index for the catchment occupied by the communities that it served. Most of the burial population exhibit isotope ratios that could be consistent with this argument. Connections between Hambledon Hill and regions much further afield are also hypothesised, based on the presence of artefacts within the assemblage that could have been sourced from lithology in Somerset, Devon, and Cornwall in south-west England. However, few of the sampled individuals have strontium isotope ratios consistent with having obtained the majority of their diet from such areas during childhood. The individuals who exhibit the highest strontium isotope ratios are all adult males, whom the excavators suggest to have died during one or more episodes of conflict, following the burning and destruction of surrounding defensive outworks built during the 36th century bc. At least one of these individuals, who was found with an arrowhead amongst his ribs, did not obtain his childhood diet locally and has 87Sr/86Sr values that could be comparable to those bioavailable in the south-west peninsula.
Emergency admissions to hospital are a major financial burden on health services. In one area of the United Kingdom (UK), we evaluated a predictive risk stratification tool (PRISM) designed to support primary care practitioners to identify and manage patients at high risk of admission. We assessed the costs of implementing PRISM and its impact on health services costs. At the same time as the study, but independent of it, an incentive payment (‘QOF’) was introduced to encourage primary care practitioners to identify high risk patients and manage their care.
We conducted a randomized stepped wedge trial in thirty-two practices, with cluster-defined control and intervention phases, and participant-level anonymized linked outcomes. We analysed routine linked data on patient outcomes for 18 months (February 2013 – September 2014). We assigned standard unit costs in pound sterling to the resources utilized by each patient. Cost differences between the two study phases were used in conjunction with differences in the primary outcome (emergency admissions) to undertake a cost-effectiveness analysis.
We included outcomes for 230,099 registered patients. We estimated a PRISM implementation cost of GBP0.12 per patient per year.
Costs of emergency department attendances, outpatient visits, emergency and elective admissions to hospital, and general practice activity were higher per patient per year in the intervention phase than control phase (adjusted δ = GBP76, 95 percent Confidence Interval, CI GBP46, GBP106), an effect that was consistent and generally increased with risk level.
Despite low reported use of PRISM, it was associated with increased healthcare expenditure. This effect was unexpected and in the opposite direction to that intended. We cannot disentangle the effects of introducing the PRISM tool from those of imposing the QOF targets; however, since across the UK predictive risk stratification tools for emergency admissions have been introduced alongside incentives to focus on patients at risk, we believe that our findings are generalizable.
A predictive risk stratification tool (PRISM) to estimate a patient's risk of an emergency hospital admission in the following year was trialled in general practice in an area of the United Kingdom. PRISM's introduction coincided with a new incentive payment (‘QOF’) in the regional contract for family doctors to identify and manage the care of people at high risk of emergency hospital admission.
Alongside the trial, we carried out a complementary qualitative study of processes of change associated with PRISM's implementation. We aimed to describe how PRISM was understood, communicated, adopted, and used by practitioners, managers, local commissioners and policy makers. We gathered data through focus groups, interviews and questionnaires at three time points (baseline, mid-trial and end-trial). We analyzed data thematically, informed by Normalisation Process Theory (1).
All groups showed high awareness of PRISM, but raised concerns about whether it could identify patients not yet known, and about whether there were sufficient community-based services to respond to care needs identified. All practices reported using PRISM to fulfil their QOF targets, but after the QOF reporting period ended, only two practices continued to use it. Family doctors said PRISM changed their awareness of patients and focused them on targeting the highest-risk patients, though they were uncertain about the potential for positive impact on this group.
Though external factors supported its uptake in the short term, with a focus on the highest risk patients, PRISM did not become a sustained part of normal practice for primary care practitioners.
The appearance of the distinctive ‘Beaker package’ marks an important horizon in British prehistory, but was it associated with immigrants to Britain or with indigenous converts? Analysis of the skeletal remains of 264 individuals from the British Chalcolithic–Early Bronze Age is revealing new information about the diet, migration and mobility of those buried with Beaker pottery and related material. Results indicate a considerable degree of mobility between childhood and death, but mostly within Britain rather than from Europe. Both migration and emulation appear to have had an important role in the adoption and spread of the Beaker package.
We use high-resolution Keck, VLT, or Hubble Space Telescope spectra of background quasars to examine the kinematic properties of the multiphase, metal-enriched circumgalactic medium in the outskirts of galaxies at 0.08 < zgal < 1.0, focusing on the low-ionization Mgii and high-ionization Ovi doublets. The absorption kinematics of low-ionization gas in the circumgalactic medium depend strongly on the star formation activity and the location about the host galaxy, where the largest velocity dispersions are associated with blue, face-on galaxies probed along the minor axis. Conversely, high-ionization gas kinematics are independent of galaxy star formation activity and orientation.