Off-Label Use of Phosphodiesterase Type 5 Inhibitor Erectile Dysfunction Medication to Enhance Sex Among Gay and Bisexual Men in Australia: Results from the FLUX Study

Introduction: Gay and bisexual men (GBM) use erectile dysfunction medications (EDM) such as Viagra™, Cialis™ and Levitra™ often with little evidence of medical indication that might necessitate their use. Aim: We investigate the prevalence and contexts of, and motivations for, EDM use, and its relationship to sexual risk behavior. Method: Between September 2014 and July 2015, Australian GBM were invited to enroll online through social networking and gay community sites to complete a comprehensive survey looking at licit and illicit drug use and their associated behaviors. A total of 2250 GBM completed the questionnaire. Main outcome measures: Any EDM use, and at least weekly use in the previous six months. Results: Two thirds (67.7%) reported no history of EDM use in their lifetime. Approximately one in ten participants (11.1%) had last used EDM more than six months ago. In the previous six months, 11.5% reported using EDM less than monthly, 5.3% at least monthly, and 4.5% weekly or more often. Among men who had used EDM in the previous six months, the most common reasons cited for its use were: to maintain an erection for longer (73.3%), to make it easier to get hard (67.3%), and difficulty in attaining or maintain an erection (53.5%). Conclusion: While some GBM use EDM specifically for erectile dysfunction, many also use EDM to enhance their sexual experiences. Often, this occurs in the context of intensive sex partying, which may include risky sexual behavior. The use of EDM in the context of intensive sex partying (which include the combined use of EDM and illicit drugs), with the associated potential for increased risk of HIV transmission, indicates a need to consider the use of EDM among GBM in HIV prevention

Risk, Reliability and Resilience: Phytolith Evidence for Alternative 'Neolithization' Pathways at Kharaneh IV in the Azraq Basin, Jordan.

'Neolithization' pathway refers to the development of adaptations that characterized subsequent Neolithic life, sedentary occupations, and agriculture. In the Levant, the origins of these human behaviors are widely argued to have emerged during the Early Epipaleolithic (ca. 23 ka cal BP). Consequently, there has been a pre-occupation with identifying and modeling the dietary shift to cereal and grains during this period, which is considered to have been a key development that facilitated increasing sedentism and, eventually, agriculture. Yet, direct evidence of plant use in the form of macrobotanical remains is extremely limited at Epipaleolithic sites and the expected 'Neolithization' pathway has not been robustly demonstrated. However, new direct microbotanical phytolith evidence from the large aggregation site of Kharaneh IV, in the Azraq Basin, suggests that increasingly settled occupation was not the result of wild grass and cereal use, but rather the result of a typical hunter-gatherer balance, based on the use of mostly reliable resources supplemented by some risky resources. Moreover, and illustrating this balance, the direct botanical evidence emphases the importance of the wetlands as an under-recognized reliable plant resource. Significantly, the use of these reliable wetland plant resources at Kharaneh IV represents an unexpected 'Neolithization' pathway

The environmental setting of Epipalaeolithic aggregation site Kharaneh IV

The archaeological site of Kharaneh IV in Jordan's Azraq Basin, and its relatively near neighbour Jilat 6 show evidence of sustained occupation of substantial size through the Early to Middle Epipalaeolithic (c. 24,000 - 15,000 cal BP). Here we review the geomorphological evidence for the environmental setting in which Kharaneh IV was established. The on-site stratigraphy is clearly differentiated from surrounding sediments, marked visually as well as by higher magnetic susceptibility values. Dating and analysis of off-site sediments show that a significant wetland existed at the site prior to and during early site occupation (~ 23,000 - 19,000 BP). This may explain why such a substantial site existed at this location. This wetland dating to the Last Glacial Maximum also provides important information on the palaeoenvironments and potential palaeoclimatic scenarios for today's eastern Jordanian desert, from where such evidence is scarce

Occupying wide open spaces? Late Pleistocene hunter–gatherer activities in the Eastern Levant

With a specific focus on eastern Jordan, the Epipalaeolithic Foragers in Azraq Project explores changing hunter-gatherer strategies, behaviours and adaptations to this vast area throughout the Late Pleistocene. In particular, we examine how lifeways here (may have) differed from surrounding areas and what circumstances drew human and animal populations to the region. Integrating multiple material cultural and environmental datasets, we explore some of the strategies of these eastern Jordanian groups that resulted in changes in settlement, subsistence and interaction and, in some areas, the occupation of substantial aggregation sites. Five years of excavation at the aggregation site of Kharaneh IV suggest some very intriguing technological and social on-site activities, as well as adaptations to a dynamic landscape unlike that of today. Here we discuss particular aspects of the Kharaneh IV material record within the context of ongoing palaeoenvironmental reconstructions and place these findings in the wider spatial and temporal narratives of the Azraq Basin

Twenty Thousand-Year-Old Huts at a Hunter-Gatherer Settlement in Eastern Jordan

Ten thousand years before Neolithic farmers settled in permanent villages, hunter-gatherer groups of the Epipalaeolithic period (c. 22–11,600 cal BP) inhabited much of southwest Asia. The latest Epipalaeolithic phase (Natufian) is well-known for the appearance of stone-built houses, complex site organization, a sedentary lifestyle and social complexity—precursors for a Neolithic way of life. In contrast, pre-Natufian sites are much less well known and generally considered as campsites for small groups of seasonally-mobile hunter-gatherers. Work at the Early and Middle Epipalaeolithic aggregation site of Kharaneh IV in eastern Jordan highlights that some of these earlier sites were large aggregation base camps not unlike those of the Natufian and contributes to ongoing debates on their duration of occupation. Here we discuss the excavation of two 20,000-year-old hut structures at Kharaneh IV that pre-date the renowned stone houses of the Natufian. Exceptionally dense and extensive occupational deposits exhibit repeated habitation over prolonged periods, and contain structural remains associated with exotic and potentially symbolic caches of objects (shell, red ochre, and burnt horn cores) that indicate substantial settlement of the site pre-dating the Natufian and outside of the Natufian homeland as currently understood

A Unique Human-Fox Burial from a Pre-Natufian Cemetery in the Levant (Jordan)

New human burials from northern Jordan provide important insights into the appearance of cemeteries and the nature of human-animal relationships within mortuary contexts during the Epipalaeolithic period (c. 23,000–11,600 cal BP) in the Levant, reinforcing a socio-ideological relationship that goes beyond predator-prey. Previous work suggests that archaeological features indicative of social complexity occur suddenly during the latest Epipalaeolithic phase, the Natufian (c. 14,500–11,600 cal BP). These features include sedentism, cemeteries, architecture, food production, including animal domestication, and burials with elaborate mortuary treatments. Our findings from the pre-Natufian (Middle Epipalaeolithic) cemetery of ‘Uyun al-Hammam demonstrate that joint human-animal mortuary practices appear earlier in the Epipalaeolithic. We describe the earliest human-fox burial in the Near East, where the remains of dogs have been found associated with human burials at a number of Natufian sites. This is the first time that a fox has been documented in association with human interments pre-dating the Natufian and with a particular suite of grave goods. Analysis of the human and animal bones and their associated artefacts provides critical data on the nature and timing of these newly-developing relationships between people and animals prior to the appearance of domesticated dogs in the Natufian

Morphine for treatment of cough in idiopathic pulmonary fibrosis (PACIFY COUGH):a prospective, multicentre, randomised, double-blind, placebo-controlled, two-way crossover trial

Background: Idiopathic pulmonary fibrosis is a progressive fibrotic lung disease, with most patients reporting cough. Currently, there are no proven treatments. We examined the use of low dose controlled-release morphine compared with placebo as an antitussive therapy in individuals with idiopathic pulmonary fibrosis. Methods: The PACIFY COUGH study is a phase 2, multicentre, randomised, double-blind, placebo-controlled, two-way crossover trial done in three specialist centres in the UK. Eligible patients aged 40–90 years had a diagnosis of idiopathic pulmonary fibrosis within 5 years, self-reported cough (lasting &gt;8 weeks), and a cough visual analogue scale (VAS) score of 30 mm or higher. Patients were randomly assigned (1:1) to placebo twice daily or controlled-release morphine 5 mg orally twice daily for 14 days followed by crossover after a 7-day washout period. Patients were randomised sequentially to a sequence group defining the order in which morphine and placebo were to be given, according to a computer-generated schedule. Patients, investigators, study nurses, and pharmacy personnel were masked to treatment allocation. The primary endpoint was percentage change in objective awake cough frequency (coughs per h) from baseline as assessed by objective digital cough monitoring at day 14 of treatment in the intention-to-treat population, which included all randomised participants. Safety data were summarised for all patients who took at least one study drug and did not withdraw consent. This study was registered at ClinicalTrials.gov, NCT04429516, and has been completed. Findings: Between Dec 17, 2020, and March 21, 2023, 47 participants were assessed for eligibility and 44 were enrolled and randomly allocated to treatment. Mean age was 71 (SD 7·4) years, and 31 (70%) of 44 participants were male and 13 (30%) were female. Lung function was moderately impaired; mean forced vital capacity (FVC) was 2·7 L (SD 0·76), mean predicted FVC was 82% (17·3), and mean predicted diffusion capacity of carbon monoxide was 48% (10·9). Of the 44 patients who were randomised, 43 completed morphine treatment and 41 completed placebo treatment. In the intention-to-treat analysis, morphine reduced objective awake cough frequency by 39·4% (95% CI –54·4 to –19·4; p=0·0005) compared with placebo. Mean daytime cough frequency reduced from 21·6 (SE 1·2) coughs per h at baseline to 12·8 (1·2) coughs per h with morphine, whereas cough rates did not change with placebo (21·5 [SE 1·2] coughs per h to 20·6 [1·2] coughs per h). Overall treatment adherence was 98% in the morphine group and 98% in the placebo group. Adverse events were observed in 17 (40%) of 43 participants in the morphine group and six (14%) of 42 patients in the placebo group. The main side-effects of morphine were nausea (six [14%] of 43 participants) and constipation (nine [21%] of 43). One serious adverse event (death) occurred in the placebo group. Interpretation: In patients with cough related to idiopathic pulmonary fibrosis, low dose controlled-release morphine significantly reduced objective cough counts over 14 days compared with placebo. Morphine shows promise as an effective treatment to palliate cough in patients with idiopathic pulmonary fibrosis, and longer term studies should be the focus of future research. Funding: The Jon Moulton Charity Trust.</p