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For over 120 years, the shell middens of western Scotland and the series of open-air sites on Oronsay have been the focus of debate in European Mesolithic studies. This paper challenges the significance of Oronsay in light of results from the geophysical survey and test-excavation of a new limpet and periwinkle shell midden dated to the late 5th or start of the 4th millennium cal bc at Port Lobh, Colonsay that offers fresh evidence to re-evaluate critically the role of Oronsay and coastal resources in island settlement models ahead of the Mesolithic–Neolithic transition. Test excavations recovered a marine molluscan assemblage dominated by limpet and periwinkle shells together with crab, sea urchin, a fishbone assemblage composed mainly of Gadidae, some identifiable bird and mammal bone, carbonised macroplant remains, and pumice as well as a bipolar lithic assemblage and coarse stone implements. Novel seasonality studies of saithe otolith thin-sections suggest wintertime tidal fishing practices. At least two activity events may be discerned, dating from the late 5th millennium cal bc. The midden could represent a small number of rapidly deposited assemblages or maybe the result of stocastic events within a more extended timeframe. We argue that alternative research questions are needed to advance long-standing debates about seasonal inter-island mobility versus island sedentism that look beyond Oronsay to better understand later Mesolithic occupation patterns and the formation and date of Oronsay middens. We propose alternative methodological strategies to aid identification of contemporaneous sites using geophysical techniques and lithic technological signatures.
Clostridioides difficile infection (CDI) remains a significant public health concern, resulting in excess morbidity, mortality, and costs. Additional insight into the burden of CDI in adults aged <65 years is needed.
A 6-year retrospective cohort study was conducted using data extracted from United States Veterans Health Administration electronic medical records.
Patients aged 18–64 years on January 1, 2011, were followed until incident CDI, death, loss-to-follow-up, or December 31, 2016. CDI was identified by a diagnosis code accompanied by metronidazole, vancomycin, or fidaxomicin therapy, or positive laboratory test. The clinical setting of CDI onset was defined according to 2017 SHEA-IDSA guidelines.
Of 1,073,900 patients, 10,534 had a CDI during follow-up. The overall incidence rate was 177 CDIs per 100,000 person years, rising steadily from 164 per 100,000 person years in 2011 to 189 per 100,000 person years in 2016. Those with a CDI were slightly older (55 vs 51 years) and sicker, with a higher baseline Charlson comorbidity index score (1.4 vs 0.5) than those without an infection. Nearly half (48%) of all incident CDIs were community associated, and this proportion rose from 41% in 2011 to 56% in 2016.
The findings from this large retrospective study indicate that CDI incidence, driven primarily by increasing community-associated infection, is rising among young and middle-aged adult Veterans with high service-related disability. The increasing burden of community associated CDI in this vulnerable population warrants attention. Future studies quantifying the economic and societal burden of CDI will inform decisions surrounding prevention strategies.
Extra-care housing (ECH) has been hailed as a potential solution to some of the problems associated with traditional forms of social care, since it allows older people to live independently, while also having access to care and support if required. However, little longitudinal research has focused on the experiences of residents living in ECH, particularly in recent years. This paper reports on a longitudinal study of four ECH schemes in the United Kingdom. Older residents living in ECH were interviewed four times over a two-year period to examine how changes in their care needs were encountered and negotiated by care workers, managers and residents themselves. This paper focuses on how residents managed their own changing care needs within the context of ECH. Drawing upon theories of the third and fourth age, the paper makes two arguments. First, that transitions across the boundary between the third and fourth age are not always straightforward or irreversible and, moreover, can sometimes be resisted, planned-for and managed by older people. Second, that operational practices within ECH schemes can function to facilitate or impede residents’ attempts to manage this boundary.
Chaucer’s London, with a population of around 50,000, had experienced considerable immigration from the Home Counties, Midlands and elsewhere in England in the fourteenth century. In addition to accommodating such incomers, Londoners would also regularly come across Scots, Welsh, Irish, Flemings, Florentines, and Hanseatics. This was, then, a city of multiple identities and shifting linguistic variety. Variation and change therefore characterised London texts and the development of London English during the late medieval period. Chaucer was particularly sensitive to such variation – to geographical distinctions and to emerging social differences articulated linguistically: this shows in his appreciation of the position of French in England as well as of the various ‘Englishes’ that he would have encountered. Chaucer’s verse reveals a writer exceptionally aware of the languages around him, whether he is contrasting the Knight with the Miller, or re-performing Northern speech in his Reeve’s Tale. All in all, the rich range of socio-linguistic usages available in the language of London gave Chaucer numerous opportunities for the literary invention that typifies his achievement.
Thomas Hoccleve referred to Chaucer as the ‘firste fyndere of our faire langage’. The word fyndere is carefully chosen, as a modified translation of the first ‘canon’ of classical and medieval rhetoric, the ancestor of present-day English invention. Any assessment of Chaucer’s ‘poetic art’ requires us not just to identify the linguistic choices available to him, it also requires us to ask how those choices relate to his broader poetics. Chaucer’s use of ‘pronouns of power’, for example, do not only characterise particular choices from the linguistic resources of London Middle English, they are also a matter of style, a notion for which classical and medieval literary theoreticians had their own terminology, distinguishing high, middle and low styles, widely recognised as having distinct functions relating to social status and roles. It is conceivably as a metrist, however, that Chaucer’s skill as a ‘finder’ is perhaps most subtly demonstrated, as examples from his works show.
Thomas Frederick Simmons (1815–84) combined his ecclesiastical duties and liturgical interests with editing the fourteenth-century Middle English Lay folks’ mass book (1879) for the Early English Text Society, with the aim of showing the continuity of the English Church from the medieval period through the Reformation. In the light of modern scholarship, this article recontextualises both medieval text and Simmons's own editorial practice, and shows how Simmons, as a second-generation Tractarian churchman, sought in this text – and others associated with it – evidence for the Church of England's Catholic underpinning in an imagined medieval English Church.
Syndromic surveillance is a form of surveillance that generates information for public health action by collecting, analysing and interpreting routine health-related data on symptoms and clinical signs reported by patients and clinicians rather than being based on microbiologically or clinically confirmed cases. In England, a suite of national real-time syndromic surveillance systems (SSS) have been developed over the last 20 years, utilising data from a variety of health care settings (a telehealth triage system, general practice and emergency departments). The real-time systems in England have been used for early detection (e.g. seasonal influenza), for situational awareness (e.g. describing the size and demographics of the impact of a heatwave) and for reassurance of lack of impact on population health of mass gatherings (e.g. the London 2012 Olympic and Paralympic Games).We highlight the lessons learnt from running SSS, for nearly two decades, and propose questions and issues still to be addressed. We feel that syndromic surveillance is an example of the use of ‘big data’, but contend that the focus for sustainable and useful systems should be on the added value of such systems and the importance of people working together to maximise the value for the public health of syndromic surveillance services.
Nikita Khrushchev's proposal to give parents of non-Russian children the choice of whether to send their children to a school with education in their own tongue, or to a Russian school, was first advanced at the end of 1958. It immediately provoked a furious response from leaders of the non-Russian republics of the multi-national Soviet Union, and was an issue contributing to political purges in Azerbaijan and Latvia in 1959. In this article, Jeremy Smith uses documents from archives in four Soviet republics to analyze the responses from the republics. Smith shows that republic leaders were mostly agreed on an alternative solution to the question of language of instruction, and pursued different strategies both to oppose the introduction of the reform and to obstruct its implementation once it was passed. The episode also underlines the uncertainty involved in center-periphery relations in the USSR.
This essay seeks to establish the parameters of our uncertainty concerning one of the most difficult periods of Roman history, the period between the traditional end of the Roman monarchy and the passing of the Licinio-Sextian legislation. In addition to some methodological observations, the essay attempts to offer a model for understanding Roman choices and decisions in a period of change and transformation.
Mild behavioral impairment (MBI) describes later life acquired, sustained neuropsychiatric symptoms (NPS) in cognitively normal individuals or those with mild cognitive impairment (MCI), as an at-risk state for incident cognitive decline and dementia. We developed an operational definition of MBI and tested whether the presence of MBI was related to caregiver burden in patients with subjective cognitive decline (SCD) or MCI assessed at a memory clinic.
MBI was assessed in 282 consecutive memory clinic patients with SCD (n = 119) or MCI (n = 163) in accordance with the International Society to Advance Alzheimer's Research and Treatment – Alzheimer's Association (ISTAART–AA) research diagnostic criteria. We operationalized a definition of MBI using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Caregiver burden was assessed using the Zarit caregiver burden scale. Generalized linear regression was used to model the effect of MBI domains on caregiver burden.
While MBI was more prevalent in MCI (85.3%) than in SCD (76.5%), this difference was not statistically significant (p = 0.06). Prevalence estimates across MBI domains were affective dysregulation (77.8%); impulse control (64.4%); decreased motivation (51.7%); social inappropriateness (27.8%); and abnormal perception or thought content (8.7%). Affective dysregulation (p = 0.03) and decreased motivation (p=0.01) were more prevalent in MCI than SCD patients. Caregiver burden was 3.35 times higher when MBI was present after controlling for age, education, sex, and MCI (p < 0.0001).
MBI was common in memory clinic patients without dementia and was associated with greater caregiver burden. These data show that MBI is a common and clinically relevant syndrome.
This paper is a synopsis of Falkland Islands Dependencies Survey Scientific Report No. 29. Glaciological and climatic investigations carried out in South Georgia during the International Geophysical Year are described. The budgets of the Hodges and Hamberg Glaciers for 1957–58 are given and discussed in relation to climatic factors. Temperature measurements indicate that the Hodges Glacier, and probably all ice in South Georgia below an altitude of 1,000 m., is geophysically temperate. The fluctuations of South Georgian glaciers during relatively recent times are briefly discussed.
The marine faunas of tropical America underwent substantial evolutionary turnover in the past 3 to 4 million years in response to changing environmental conditions associated with the rise of the Isthmus of Panama, but the ecological signature of changes within major clades is still poorly understood. Here we analyze the paleoecology of faunal turnover within the family Pectinidae (scallops) over the past 12 Myr. The fossil record for the southwest Caribbean (SWC) is remarkably complete over this interval. Diversity increased from a low of 12 species ca. 10–9 Ma to a maximum of 38 species between 4 and 3 Ma and then declined to 22 species today. In contrast, there are large gaps in the record from the tropical eastern Pacific (TEP) and diversity remained low throughout the past 10 Myr. Both origination and extinction rates in the SWC peaked between 4 and 3 Ma, and remained high until 2–1 Ma, resulting in a 95% species level turnover between 3.5 and 2 Ma. The TEP record was too incomplete for meaningful estimates of origination and extinction rates. All living species within the SWC originated within the last 4 Myr, as evidenced by a sudden jump in Lyellian percentages per faunule from nearly zero up to 100% during this same interval. However, faunules with Lyellian percentages near zero occurred until 1.8 Ma, so that geographic distributions were extraordinarily heterogeneous until final extinction occurred. There were also striking differences in comparative diversity and abundance among major ecological groups of scallops. Free-swimming scallops constituted the most diverse guild throughout most of the last 10 Myr in the SWC, and were always moderately to very abundant. Leptopecten and Argopecten were also highly diverse throughout the late Miocene and early Pliocene, but declined to very few species thereafter. In contrast, byssally attaching scallops gradually increased in both diversity and abundance since their first appearance in our samples from 8–9 Ma and are the most diverse group today. Evolutionary turnover of scallops in the SWC was correlated with strong ecological reorganization of benthic communities that occurred in response to declining productivity and increased development of corals reefs.
The tomb of Mary Queen of Scots is widely recognized as one of the most important visual symbols of dynastic power that can still be viewed in Britain today. Although art historians had originally regarded the strongly Catholic depiction of Mary in captivity, the so-called Sheffield portrait, as the model for the effigy, for more than a century the consensus is that it was based on one of Nicholas Hilliard’s miniature portraits. In this essay a study of the images as well as related documents in the exchequer and Hardwick Hall accounts reestablishes that the Sheffield type was indeed the specific model for the tomb. This does more than simply settle a long-standing question. It also opens the way for an exploration of the content of this most popular portrait of Mary, which was fraught with significance not only for King James VI, Mary’s son, but also the crypto-Catholic nobleman Henry Howard, first earl of Northampton, who was in charge of the tomb’s completion.
Large-scale trends in planktonic foraminiferal diversity have so far been based on utilization of synoptic biostratigraphic range charts. Although this approach ensures the taxonomic consistency and quality of the data being used, it takes no formal account of any sampling biases that might exist in the fossil record. We demonstrate that the occurrence data of planktonic foraminifera, as recorded in the primary literature, are strongly biased by sampling. We do this by demonstrating that raw diversity curves derived from the land-based and deep-sea records are strikingly different, but that they each correlate with the intensity of sampling in their respective environments, and thus are ultimately controlled by the structure of the geological record in each setting. Because sampling of the Mesozoic record is best in our land record whereas sampling of the Cenozoic is best in our deep-sea record, we combine the two to generate the best-supported estimates of species and genus diversity over time from these data. We correct for sampling bias using shareholder quorum subsampling and a modeling approach. The data are then transformed to generate a range-through plot of species richness that is compared with two earlier estimates of the diversity history where comparable species-in-bin data can be recovered. No robust statistical correlation is found among the three estimates. Although differences in amplitude are to be expected, differences in the actual shape of the curve are surprising. We conclude that these differences stem from the nature of the data themselves, namely the taxonomic scheme adopted and the taxonomic coverage used.
IN the ten songs of his opening section of the Psalmes, Sonets, & songs of 1588, with which we begin, Byrd offered the strongest evidence that the overall message of this sequence was at least in part a personal one – or that he wished to make that impression. As Rivkah Zim explains, “sixteenth-century commentators encouraged individuals to recognize representations of their own experiences and emotions in psalms, and to use them as models for personal prayer and meditation.” Byrd may have originally set these psalms to music for other people and other purposes – although at least one appears to have been originally designed for inclusion in the set – but in publishing them, he placed what might have been perceived as his personal prayers before his Queen and her public.
Thematically, through his text selection and settings, Byrd portrayed in this section the moral virtue of holiness, a depiction of the truly righteous as defined by divine law and obeisance. Byrd's decision to open his story this way was probably stimulated by a 1571 tract “An Homilee agaynst disobedience,” in which John Jewell, the Queen's royally appointed homilist, proclaimed: “whereby it is evident, that obedience is the principall vertue of all vertues, and in deede the verye roote of all vertues, and the cause of all felicitie.” Significant, in this light, are Byrd's references to the Decalogue (in the total number of ten psalms selected and in the special use of BE 12: 6, with its references to a holy place or “sacred tent”) and to other aspects of Old Testament law as depicted in Psalm 119 (BE 12: 3 and 4). Byrd also provided here a clarifying portrayal of the “blessed” people who would follow the Lord's commandments in the proper spirit (BE 12: 8), and the “wicked” ones who would not (BE 12: 7). All of the above evokes the Mosaic Covenant, which, suggestively, outlines a pact whereby God agrees to protect his law-abiding followers from their enemies. As much as this representation of a holy subject would seem grounded in Old Testament theology, it was not without contemporary relevance.