The Environmental Context and Function of Burnt-Mounds : New Studies of Irish Fulachtaí Fiadh

The authors acknowledge funding from The Leverhulme Trust (F/00144/AI) and assistance from a large number of individuals including; Margaret Gowen (access to sites and assistance throughout),A. Ames, H, Essex (pollen processing), S. Rouillard & R. Smith (illustrations), C. McDermott, S. Bergerbrandt, all the staff of Margaret Gowen & Co. Ltd, TVAS Ireland and CRDS. Excavation works and some post-excavation analysis was paid for my Bord Gáis and the National Roads Authority (now Transport Infrastructure Ireland). Thanks also to David Smith for access to the Maureen Girling collection and assistance with identifications.Peer reviewedPostprintPostprin

Evidence for increased expression of the Amundsen Sea Low over the South Atlantic during the late Holocene

The Amundsen Sea Low (ASL) plays a major role in the climate and environment of Antarctica and the Southern Ocean, including surface air temperature and sea ice concentration changes. Unfortunately, a relative dearth of observational data across the Amundsen and Bellingshausen seas prior to the satellite era (post-1979) limits our understanding of the past behaviour and impact of the ASL. The limited proxy evidence for changes in the ASL are primarily restricted to the Antarctic where ice core evidence suggests a deepening of the atmospheric pressure system during the late Holocene. However, no data have previously been reported from the northern side of the ASL. Here we report a high-resolution, multi-proxy study of a 5000-year-long peat record from the Falkland Islands, a location sensitive to contemporary ASL dynamics which modulates northerly and westerly airflow across the southwestern South Atlantic sector of the Southern Ocean. In combination with climate reanalysis, we find a marked period of wetter, colder conditions most likely the result of enhanced southerly airflow between 5000 and 2500 years ago, suggesting limited ASL influence over the region. After 2500 years ago, drier and warmer conditions were established, implying more westerly airflow and the increased projection of the ASL onto the South Atlantic. The possible role of the equatorial Pacific via atmospheric teleconnections in driving this change is discussed. Our results are in agreement with Antarctic ice core records and fjord sediments from the southern South American coast, and suggest that the Falkland Islands provide a valuable location for reconstructing high southern latitude atmospheric circulation changes on multi-decadal to millennial timescales

The environmental context and function of Burnt-Mounds: new studies of Irish Fulachtaí Fiadh

Burnt mounds, or fulachtaí fiadh as they are known in Ireland, are probably the most common prehistoric site type in Ireland and Britain. Typically Middle–Late Bronze Age in age (although both earlier and later examples are known), they are artefact-poor and rarely associated with settlements. The function of these sites has been much debated with the most commonly cited uses being for cooking, as steam baths or saunas, for brewing, tanning, or textile processing. A number of major infrastructural development schemes in Ireland in the years 2002–2007 revealed remarkable numbers of these mounds often associated with wood-lined troughs, many of which were extremely well-preserved. This afforded an opportunity to investigate them as landscape features using environmental techniques – specifically plant macrofossils and charcoal, pollen, beetles, and multi-element analyses. This paper summarises the results from eight sites from Ireland and compares them with burnt mound sites in Great Britain. The fulachtaí fiadh which are generally in clusters, are all groundwater-fed by springs, along floodplains and at the bases of slopes. The sites are associated with the clearance of wet woodland for fuel; most had evidence of nearby agriculture and all revealed low levels of grazing. Multi-element analysis at two sites revealed elevated heavy metal concentrations suggesting that off-site soil, ash or urine had been used in the trough. Overall the evidence suggests that the most likely function for these sites is textile production involving both cleaning and/or dyeing of wool and/or natural plant fibres and as a functionally related activity to hide cleaning and tanning. Whilst further research is clearly needed to confirm if fulachtaí fiadh are part of the ‘textile revolution’ we should also recognise their important role in the rapid deforestation of the wetter parts of primary woodland and the expansion of agriculture into marginal areas during the Irish and British Bronze Ages

Nonlinear landscape and cultural response to sea-level rise

Dataset S1 (separate file). Relative sea-level database for Scilly comprising directly dated radiocarbon and optically stimulated luminescence samples with corresponding metainformation (lithostratigraphy, elevation, depositional environment and indicative meaning interpretations, paleotidal range change and sea-level calculations) following the ‘HOLSEA’ (‘Geographic Variability of Holocene Relative Sea Level’) protocol (Khan et al., 2019*). Dataset S2 (separate file). Table containing pollen results as relative abundance (genus level), modelled ages and age uncertainty for pollen samples, landcover index results (community cluster numbers and nMDS ordination axes 1 and 2), foraminifera results as species counts and transfer function results as paleomarsh elevations with uncertainty (1σ). Foraminifera samples with low test concentrations have indicative ranges (from mean high water neap tides to highest astronomical tides) in place of paleomarsh elevation estimations. Foraminifera abbreviations: H.wil – Haplophragmoides wilbertii ; J.mac – Jadammina macrescens ; M.fus – Miliammina fusca ; P.ipo – Polysaccammina ipohalina ; T.inf – Trochammina infalta ; T.och – Trochammina ochracea ; A.bat - Ammonia batavus ; A.mam – Asterigerinata mamilla ; B.var – Bolivina variablis; E.cri – Elphidium crispum ; E.wil – Elphidium Williamsoni ; F.spp. – Fissurina spp. ; Elphidium spp. ; H.ger – Haynesina germanica ; L.lob – Lobatula lobatula ; O.spp. – Oolha spp. ; Q.sem – Quinqueloculina seminula; R.spp. – Rosalina spp.. Dataset S3 (separate file). Database containing three worksheets for developing archaeological indices for Scilly. ‘SWBritain’ – Radiocarbon dates from Devon and Cornwall used to develop a summed probability distribution curve as an estimate of population demographic variation in Southwest Britain. ‘NWFrance’ - Radiocarbon dates from Brittany and Normandy used to develop a summed probability distribution curve as an estimate of population demography in Northwest France. ‘Scilly’ – Archaeological monuments from Scilly used to develop a probabilistic index of population variability.The article associated with these datasets is located in ORE at: http://hdl.handle.net/10871/123489Rising sea levels have been associated with human migration and behavioral shifts throughout prehistory, often with an emphasis on landscape submergence and consequent societal collapse. However, the assumption that future sea-level rise will drive similar adaptive responses is overly simplistic. Whilst the change from land to sea represents a dramatic and permanent shift for pre-existing human populations, the process of change is driven by a complex set of physical and cultural processes with long transitional phases of landscape and socio-economic change. Here we use reconstructions of prehistoric sea-level rise, paleogeographies, terrestrial landscape change and human population dynamics to show how the gradual inundation of an island archipelago resulted in decidedly non-linear landscape and cultural responses to rising sea-levels. Interpretation of past and future responses to sea-level change requires a better understanding of local physical and societal contexts to assess plausible human response patterns in the future.Historic EnglandWelsh GovernmentHigher Education Funding Council for Wale

Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

BackgroundAnterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability.MethodsWe did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367.FindingsBetween Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications.InterpretationSurgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat