Following the herds?: a new distribution of hunting kites in Southwest Asia

Remote-sensing analysis of open-source satellite imagery has identified a major, new distribution of undocumented hunting kite structures in northern Arabia. This new data has important implications on the environmental viability of hunting and on possible settlement patterns during the early and middle Holocene. Running across the eastern side of the Nafud Desert in Saudi Arabia, this research has identified star-shaped kites in a distribution that continues on to southern Iraq. From a broader perspective, this new distribution appears to represent a continuation of the well-known arc of kites recorded running principally through southern Syria and eastern Jordan. As well as representing an important archaeological identification in its own right, this new distribution also has important implications in terms of the paleoenvironment of the region, faunal dispersals and human cultural connections.Introduction Background Methodology Results Discussion - Distribution - Dating - Monumentality and connectivity Conclusio

Establishing a baseline for the study of maritime cultural heritage in the Gaza Strip

As a result of its geographic location, cultural diversity and historical trajectory, the Gaza strip is a key zone of scholarly enquiry and has a central role in the historical, social, political, economic, legislative and environmental discourses for the wider region. Existing historical knowledge of Gaza is dominated by combative narrative trends that emphasise the events of the 20th and 21st centuries and invoke archaeology extensively. In this context, cycles of material preservation and damage—often accompanying other forms of violence—have attracted the attention of academics and international media. Among the corollaries of this situation, is the destruction and marginalisation of vulnerable cultural heritage, particularly maritime cultural heritage, which is subjected to additional environmental, climatic, and anthropogenic pressures. As a means of countering the challenges on current field research in the region and to further assess the damage and threats faced by archaeological fabric, this paper combines data from coastal and archaeological research conducted in the Gaza Strip to create a benchmark for the study of its maritime archaeology. Additional information on the alteration of coastal landscape is deduced through the analysis of aerial photographs and satellite imagery. This study falls within the scope of the Maritime Endangered Archaeology in the Middle East and Africa Project (MarEA). MarEA aims to comprehensively document and assess vulnerable maritime archaeology (underwater, nearshore, coastal) and produce baseline information that can enhance existing infrastructure on archaeological monitoring and management.</p

Power, conflict and ritual on the fen-edge: the anarchy-period castle at Burwell, Cambridgeshire, and its pre-conquest landscape

Burwell, Cambridgeshire is best known as possessing a castle constructed by King Stephen during the mid-twelfth century civil war commonly referred to as ‘the Anarchy’. Documentary sources confirm that the king built a series of fortifications around the East Anglian fen-edge during A.D. 1144 in an attempt to restrict the activities of the rebellious baron Geoffrey de Mandeville, Earl of Essex, who was using the Isle of Ely as a base to raid the surrounding countryside. Written texts also reveal how de Mandeville was mortally wounded during a skirmish or siege which subsequently took place at Burwell. A combination of topographic and geophysical survey, supplemented by documentary analysis, suggests that the castle was constructed in a landscape with a complex earlier history. It is suggested that during the Romano-British period a temple complex was developed on the site, with a spring rising on the edge of the fens providing the likely focus for ritual activity. Burwell later developed into an important early medieval place and the castle itself may have been inserted into a thegnly enclosure — an act which probably sought to appropriate a recognised pre-existing centre of power. The current research provides the most comprehensive assessment of the site to date, and supports existing interpretations which consider the twelfth-century castle to be incomplete. Analysis also gives additional insight into the functional and symbolic significance of the castle at Burwell, and sheds important light on the character of power and conflict in the fenland during the mid-twelfth century

‘Stick that knife in me’: Shane Meadows’ children

This article brings Shane Meadows’ Dead Man's Shoes (2004) into dialogue with the history of the depiction of the child on film. Exploring Meadows’ work for its complex investment in the figure of the child on screen, it traces the limits of the liberal ideology of the child in his cinema and the structures of feeling mobilised by its uses – at once aesthetic and sociological – of technologies of vision

Socio-Economic Burden of Myocardial Infarction Among Cancer Patients

Cancer patients face a higher risk of future myocardial infarction (MI), even after completion of anticancer therapies. MI is a critical source of physical and financial stress in non-cancer patients, but its impacts associated with cancer patients also saddled with the worry (stress) of potential reoccurrence is unknown. Therefore, we aimed to quantify MI's stress and financial burden after surviving cancer and compare to those never diagnosed with cancer. Utilizing cross-sectional national survey data from 2013-2018 derived from publicly available U.S. datasets, the National Health Interview Survey (NHIS), and economic data from the National Inpatient Sample (NIS), we compared the socio-economic outcomes among those with MI by cancer-status. We adjusted for social, demographic, and clinical factors. Overall, 19,504 (10.2%) of the 189,836 NHIS survey responders reported having cancer for more than 1 year. There was an increased prevalence of MI among cancer survivors compared to non-cancer patients (8.8% vs. 3.2%, P0.05). There was no difference in annual residual family income by cancer status; however, 3 lowest deciles of residual income representing 21.1% cancer-survivor with MI had a residual income of <$9,000. Myocardial infarction continues to represent an immense source of financial and perceived stress. In conclusion, although cancer patients face a higher risk of subsequent MI, this does not appear to advance their reported stress significantly

Cardiovascular adverse events associated with BRAF versus BRAF/MEK inhibitor: Cross-sectional and longitudinal analysis using two large national registries

BACKGROUND: Cardiovascular adverse events (CVAEs) associated with BRAF inhibitors alone versus combination BRAF/MEK inhibitors are not fully understood. METHODS: This study included all adult patients who received BRAF inhibitors (vemurafenib, dabrafenib, encorafenib) or combinations BRAF/MEK inhibitors (vemurafenib/cobimetinib; dabrafenib/trametinib; encorafenib/binimetinib). We utilized the cross-sectional FDA\u27s Adverse Events Reporting System (FAERS) and longitudinal Truven Health Analytics/IBM MarketScan database from 2011 to 2018. Various CVAEs, including arterial hypertension, heart failure (HF), and venous thromboembolism (VTE), were studied using adjusted regression techniques. RESULTS: In FAERS, 7752 AEs were reported (40% BRAF and 60% BRAF/MEK). Median age was 60 (IQR 49-69) years with 45% females and 97% with melanoma. Among these, 567 (7.4%) were cardiovascular adverse events (mortality rate 19%). Compared with monotherapy, combination therapy was associated with increased risk for HF (reporting odds ratio [ROR] = 1.62 (CI = 1.14-2.30); p = 0.007), arterial hypertension (ROR = 1.75 (CI = 1.12-2.89); p = 0.02) and VTE (ROR = 1.80 (CI = 1.12-2.89); p = 0.02). Marketscan had 657 patients with median age of 53 years (IQR 46-60), 39.3% female, and 88.7% with melanoma. There were 26.2% CVAEs (CI: 14.8%-36%) within 6 months of medication start in those receiving combination therapy versus 16.7% CVAEs (CI: 13.1%-20.2%) among those receiving monotherapy. Combination therapy was associated with CVAEs compared to monotherapy (adjusted HR: 1.56 (CI: 1.01-2.42); p = 0.045). CONCLUSIONS AND RELEVANCE: In two independent real-world cohorts, combination BRAF/MEK inhibitors were associated with increased CVAEs compared to monotherapy, especially HF, and hypertension

Metabolomic signatures of carfilzomib‐related cardiotoxicity in patients with multiple myeloma

As a treatment for relapsed or refractory multiple myeloma (MM), carfilzomib has been associated with a significant risk of cardiovascular adverse events (CVAE). The goals of our study were to evaluate the metabolomic profile of MM patients to identify those at high risk prior to carfilzomib treatment and to explore the mechanisms of carfilzomib-CVAE to inform potential strategies to protect patients from this cardiotoxicity. Global metabolomic profiling was performed on the baseline and post-baseline plasma samples of 60 MM patients treated with carfilzomib-based therapy, including 31 who experienced CVAE, in a prospective cohort study. Baseline metabolites and post-baseline/baseline metabolite ratios that differ between the CVAE and no-CVAE patients were identified using unadjusted and adjusted methods. A baseline metabolomic risk score was created to stratify patients. We observed a lower abundance of tauroursodeoxycholic acid (T-UDCA) in CVAE patients at baseline (odds ratio [OR] = 0.47, 95% confidence interval [CI] = 0.21-0.94, p = 0.044) compared with the no-CVAE patients. A metabolite risk score was able to stratify patients into three risk groups. The area under the receiver-operating curve of the model with clinical predictors and metabolite risk score was 0.93. Glycochenodeoxycholic acid (OR = 0.56, 95% CI = 0.31-0.87, p = 0.023) was significantly lower in post-baseline/baseline ratios of CVAE patients compared with no-CVAE patients. Following metabolomic analysis, we created a baseline metabolite risk score that can stratify MM patients into different risk groups. The result also provided intriguing clues about the mechanism of carfilzomib-CVAE and potential cardioprotective strategies

Mental health burden for NHS healthcare staff during the COVID-19 pandemic: first results of a longitudinal survey

Background The current investigation aimed to assess the mental health burden on healthcare workers during the early stages of the COVID-19 pandemic. Methods A link to an online survey was sent to an estimate of 18,100 employees of Sheffield Teaching Hospitals NHS Foundation Trust (STH) who had access to email. The survey was completed between 2nd and June 12, 2020.1390 healthcare workers (medical, nursing, administrative and other professions) participated in the first survey. Data from a general population sample (n = 2025) was used for comparison. Severity of somatic symptoms was measured by the PHQ-15. Severity and probable diagnosis of depression, anxiety, and PTSD were measured by the PHQ-9, GAD-7, and ITQ. Linear and logistic regressions were performed to determine if population group predicted the severity of mental health outcomes, and probable diagnosis of depression, anxiety, and PTSD. Additionally, ANCOVAs were performed to compare mental health outcomes between occupational roles in HCWs. Analysis was performed using SPSS. Findings Healthcare workers are more likely to experience greater severity of somatic symptoms, as well as severity and probable diagnosis of depression and anxiety, compared to the general population, but not increased traumatic stress symptoms. Scientific and technical, nursing and admin staff were more likely to experience worse mental health outcomes, compared to medical staff. Interpretation The COVID-19 pandemic has led to increased mental health burden in some, but not all healthcare workers during the first acute phase of the pandemic. The findings from the current investigation provide valuable insights into which healthcare workers are particularly vulnerable to developing adverse mental health outcomes during and after a pandemic

Electrocardiographic features of immune checkpoint inhibitor associated myocarditis

Background Myocarditis is a highly morbid complication of immune checkpoint inhibitor (ICI) use that remains inadequately characterized. The QRS duration and the QTc interval are standardized electrocardiographic measures that are prolonged in other cardiac conditions; however, there are no data on their utility in ICI myocarditis. Methods From an international registry, ECG parameters were compared between 140 myocarditis cases and 179 controls across multiple time points (pre-ICI, on ICI prior to myocarditis, and at the time of myocarditis). The association between ECG values and major adverse cardiac events (MACE) was also tested. Results Both the QRS duration and QTc interval were similar between cases and controls prior to myocarditis. When compared with controls on an ICI (93±19 ms) or to baseline prior to myocarditis (97±19 ms), the QRS duration prolonged with myocarditis (110±22 ms, p<0.001 and p=0.009, respectively). In contrast, the QTc interval at the time of myocarditis (435±39 ms) was not increased compared with pre-myocarditis baseline (422±27 ms, p=0.42). A prolonged QRS duration conferred an increased risk of subsequent MACE (HR 3.28, 95% CI 1.98 to 5.62, p<0.001). After adjustment, each 10 ms increase in the QRS duration conferred a 1.3-fold increase in the odds of MACE (95% CI 1.07 to 1.61, p=0.011). Conversely, there was no association between the QTc interval and MACE among men (HR 1.33, 95% CI 0.70 to 2.53, p=0.38) or women (HR 1.48, 95% CI 0.61 to 3.58, p=0.39). Conclusions The QRS duration is increased in ICI myocarditis and is associated with increased MACE risk. Use of this widely available ECG parameter may aid in ICI myocarditis diagnosis and risk-stratification