An archaeological analysis of later prehistoric settlement and society in Perthshire and Stirlingshire

This thesis presents the first ever synthesis of the Late Bronze Age and Iron Age in Perthshire and Stirlingshire. It draws on evidence from excavations, field survey and aerial survey, the latter two largely undertaken by the Royal Commission on the Ancient and Historical Monuments of Scotland. It is clear from this study that the key to appreciating the structure of the data within this region is a sound understanding of the history of research. Several key players are identified in the history of antiquarian research in the area, with Christian Maclagan and David Christian emerging as pioneers in field recording. However, aerial and ground survey, particularly since the mid-1970s has been crucial in altering the perceived nature of the archaeological resource, with the density of known upland settlement increasing dramatically, and numerous plough-truncated sites being identified in lowland cropmarks. The geology, geomorphology and soils of the study area is characterised, and factors that might have affected how later prehistoric people interacted with and perceived their environment are identified. These include sea level change in the Forth Valley in the Iron Age, climatic deterioration in the Early Iron Age and major forest clearance and increased cultivation in the Late Iron Age. A mosaic of vegetation types can be envisaged for the later prehistoric landscape, which seems to have opened out in the last few hundred years of the first millennium ВС, perhaps to cope with an increased population. Analysis of existing excavated data on plant macrofossils provided further detail here, suggesting that such crops were grown and processed in both the upland and lowland zones. While the absence of significant quantities of cereal pollen need not conclusively imply a pastoral dimension to the later prehistoric economy, a reassessment of zoo-archaeological evidence made it quite clear that domestic cattle and sheep/goat were in use, in addition to domestic horses and wild animals. Following this, a critical review of the chronological framework is provided, followed by reclassification of the various site types known. It proves possible to assign broad date ranges to the different types of site identified. This new classification is used as the basis for an assessment of dating and function of these sites. The case studies of Stirling, south-east Perthshire and north-east Perthshire enable an assessment of site morphology and settlement patterns on a more local level, armed with a regionally-specific chronological and functional framework. These various lines of enquiry are then drawn together to provide a narrative describing the nature of later prehistoric settlement and society. The study area is then put into context, through comparison with the evidence from adjacent areas of Eastern Scotland. The previous models, which emphasised the differences between settlement, society and economy in areas north and south of the Forth, as a long-term structural feature of Scottish archaeology have been shown to be erroneous. It is not until the Late Iron Age that marked differences in the settlement of Stirlingshire and Perthshire can be observed. A conscious decision was made in this study to move away from the status-dominated assumptions of previous accounts. When we look at the Iron Age of Stirlingshire in a chronologically dynamic way, we see rather than the no-man's land described by previous authors, or the highly stratified society envisaged by those who assume that the lowland brochs are high-status, a wealthy area with a high enough population to necessitate large-scale woodland clearance by the final years of the first millennium ВС. In Perthshire too, both highland and lowland, there is little evidence of a social hierarchy at any time. The contextual, temporally dynamic approach to later prehistoric remains taken here has enabled us to gain a much more firmly-based view of settlement and society in Perthshire and Stirlingshire

Déclaration sur l’approche par l’archéologie sociale du changement climatique

Manifiesto sobre Arqueología Social del Cambio Climático aprobado en la Cumbre SACC celebrada en Kiel. Aprobado y firmado el 6 de septiembre de 2021.[ES] El SACC es un grupo independiente, constituido en Kiel, de investigadores e investigadoras que trabajan sobre cambio climático. El objetivo de SACC es reunir científicos y científicas internacionales y representantes de importantes organizaciones internacionales de las áreas de arqueología, paleoecología y gestión del patrimonio para con el fin de discutir y evaluar la contribución de la investigación arqueológica y paleo-ecológica para comprender la interrelación entre el cambio social, el cultural, el ecológico y el climático. Pretendemos resaltar cómo la arqueología, a través del estudio de la conducta adaptativa en el pasado, es capaz de reforzar tanto la resiliencia socio-ecológica de nuestras sociedades, como su capacidad adaptativa ante el actual cambio climático. Además, pretendemos contribuir a la comprensión del impacto del cambio climático en los yacimientos y sitios arqueológicos y patrimoniales, así como en los paisajes culturales, los museos, las colecciones y archivos patrimoniales. SACC celebrará cumbres cada dos años y emitirá una declaración o manifiesto al término de cada una de ellas. S ACC está organizada por un comité interino presidido por las personas convocantes del SACC 1.[EN] SACC is an independent group of researchers working on climate change in the past constituted in Kiel. The aim of SACC is to bring together international scientists and representatives of important international organisations in the fields of archaeology, paleoecology and heritage management to discuss and evaluate the contribution of archaeological and paleo-ecological research to understand the link between social, cultural, ecological and climatic change; and to highlight how archaeology, through the study of past adaptive behaviour, is able to enhance socio-ecological resilience of societies as well as their adaptive capacity to current climate change; furthermore, to contribute to the understanding of the impact of climate change on archaeological and heritage sites as well as on cultural landscapes, museums, collections, and archives. SACC will hold its summit every second year with a declaration at the end of each summit. SACC is organized by a steering committee chaired by the SACC 1 organisers.[FR] Le SACC est un groupe indépendant de chercheurs travaillant sur le changement climatique dans le passé, qui s’est formé à Kiel. L’objectif du S ACC est de réunir des scientifiques internationaux et des représentants d’organisations internationales importantes dans les domaines de l’archéologie, de la paléoécologie et de la gestion du patrimoine. Il a pour objectif de discuter et d’évaluer la contribution de la recherche archéologique et paléo-écologique à la compréhension du lien entre les changements sociaux, culturels, écologiques et climatiques et de souligner comment l’archéologie, par l’étude du comportement adaptatif du passé, est capable d’améliorer la résilience socioécologique des sociétés ainsi que leur capacité d’adaptation au changement climatique actuel. En outre, il contribue à la compréhension de l’impact du changement climatique sur les sites archéologiques et patrimoniaux ainsi que sur les paysages culturels, les musées, les collections et les archives. Le SACC tiendra son conseil tous les deux ans avec une déclaration à la fin de chaque conseil. Il est organisé par un comité de pilotage présidé par les organisateurs de SACC 1.Peer reviewe

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown