Kimberley points of Western Australia: Pressure flaking, projections and prestige

Kimberley points are pressure flaked bifaces with marginal projections, produced within the last millennium, in north Western Australia. These points were hafted for hunting and fighting in recent times, although there is some suggestion that smaller points tended to be hafted for use in favour of larger points, which were reserved for trade and exchange. Kimberley Points are imbued with strong social signalling and prestige qualities, known from Historic times. This paper examines whether these qualities are reflected archaeologically in their marginal projections produced with pressure flaking; and their morphology and production. Multiple sources of Kimberley Point archaeology, ethnography, and production are critically reviewed. As prestige items, the marginal projections are found to very likely relate to their social value, rather than functional drive, which this study investigates using morphological approaches. Samples from both ethnographic collections and archaeological surface assemblages are analysed. The study finds that biface elongation, length and perimeter length each greatly influenced the number of and size of marginal projections, regardless of raw material. This aspect of production probably reflects the value and social prestige for large serrated points, likely produced by the knapper before an audience in virtuoso displays of pressure flaking. It is conceivable that these complex social practices emerged around 1,000 years ago. This study provides a rare glimpse into the social values of stone tool produces, and links archaeological data to social values in the past

Technological organisation and points in the southern Kimberley

The anthropogenic manipulation of stone is ubiquitous in every part of the world, throughout human prehistory. The durability of stone technologies creates an enduring material link between the tool maker and the archaeologist, particularly in Australia, where stone tools are a dominant component of the extant archaeological record, and as such, provide fundamental access to our understanding of the technology and lifeways of Australia’s Indigenous ancestors. This research, which is part of the ARC Linkage project: Lifeways of the First Australians, analyses stone artefacts from excavated and surface assemblages in the southern Kimberley region. This thesis by compilation focuses on the technological development of points, which are a distinctive, Holocene component of the Australian lithic suite, in order to test a series of hypotheses, which are presented in a collection of published manuscripts, and unpublished manuscripts currently being reviewed. Lithic artefacts are produced by reduction. When a stone is worked into a tool, it reduces in size, with some fragments resulting in usable pieces, others in debitage. The process of reduction forms the basic premise for this thesis, where reduction is quantified by a morphological methodology outlined in Chapters 1 and 2, and applied to a number of assemblages in order to reconstruct the life history of stone tools from the Kimberley region (Chapters 3 – 7). Chapter 3 presents a robust chronology for point technology in the Kimberley region, where direct percussion points first appear in the archaeological record between 6,000 and 5,000 years ago, and Kimberley Points appear within the last 1,000 years. Chapter 4 provides detailed examination of a large, excavated point assemblage from the Mt Behn rock shelter. This analysis demonstrates that points were produced within a reduction continuum, where changes in reduction intensity and artefact morphology were sensitive to environmental change during the mid to late Holocene. Chapter 5 presents analyses of multiple surface assemblages across the Kimberley, where backing technology is shown to be a regular component of point technologies. The presence of the Kimberley Backed Point challenges the existing model of spatial distributions of backing in Australia. Chapter 6 presents a remarkable point from Carpenters Gap 1, which was recovered with sizable portions of adhering hafting resin, an organic resin which was directly dated. This artefact provides the most compelling evidence for hafting technology used in the mid to late Holocene, and reveals that people were hafting small, lightly reduced points with both mastic and binding. Chapter 7 employs a novel approach to model the level of pedagogy, or teaching and learning, present in two different point reduction sequences. This manuscript demonstrates that pedagogy can be gleaned from stone artefact assemblages, and shows that Kimberley Points represent a shift towards a greater emphasis on a formal pedagogy within the last millennium of Kimberley prehistory. Finally, this thesis culminates in Chapter 8, which presents a summary of the conclusions and discussions offered throughout the manuscripts, and recommends areas of research for further investigation

Metal-Age maritime culture at Jareng Bori rockshelter, Pantar Island, eastern Indonesia

The archaeological record of Wallacea remains exceptionally fragmentary. This is especially the case for late Holocene human occupation of the region when lifestyle and culture in marginal island environments is relatively unknown. Here we report on the archaeology of Jareng Bori rockshelter, a Metal-Age site spanning c. 1800 cal. BP up to the late historic period and situated on the eastern coast of Pantar Island in the Lesser Sunda Islands of eastern Indonesia. We use osteoarchaeological (human and vertebrate remains), invertebrate zooarchaeological (crustacean and molluscan remains), technological (lithics, shell, and pottery) and chemical sourcing (obsidian and metal) datasets to discuss networking, migration, and human subsistence strategies during this recent period of history. While some communities were no doubt living in open village settlements where they were producing pottery, the data indicate that aspects of maritime life-ways continued much as in earlier Pleistocene settlements, with people using rockshelters like Jareng Bori to pursue a range of subsistence activities focused on the shoreline. Shellfishing of rocky and reef intertidal species and fishing for mostly small herbivorous and omnivorous fishes was practised, while domestic animals only appear in the late historic period. Wider regional cultural interactions and networking are epitomized by obsidian exchange, dental modification practices, and pottery decorations, while lithic analyses indicates continuity of stone tool technology up until recent times

Determinants of penetrance and variable expressivity in monogenic metabolic conditions across 77,184 exomes

Penetrance of variants in monogenic disease and clinical utility of common polygenic variation has not been well explored on a large-scale. Here, the authors use exome sequencing data from 77,184 individuals to generate penetrance estimates and assess the utility of polygenic variation in risk prediction of monogenic variants

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

SARS-CoV-2 Omicron is an immune escape variant with an altered cell entry pathway

Vaccines based on the spike protein of SARS-CoV-2 are a cornerstone of the public health response to COVID-19. The emergence of hypermutated, increasingly transmissible variants of concern (VOCs) threaten this strategy. Omicron (B.1.1.529), the fifth VOC to be described, harbours multiple amino acid mutations in spike, half of which lie within the receptor-binding domain. Here we demonstrate substantial evasion of neutralization by Omicron BA.1 and BA.2 variants in vitro using sera from individuals vaccinated with ChAdOx1, BNT162b2 and mRNA-1273. These data were mirrored by a substantial reduction in real-world vaccine effectiveness that was partially restored by booster vaccination. The Omicron variants BA.1 and BA.2 did not induce cell syncytia in vitro and favoured a TMPRSS2-independent endosomal entry pathway, these phenotypes mapping to distinct regions of the spike protein. Impaired cell fusion was determined by the receptor-binding domain, while endosomal entry mapped to the S2 domain. Such marked changes in antigenicity and replicative biology may underlie the rapid global spread and altered pathogenicity of the Omicron variant

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Investigation of hospital discharge cases and SARS-CoV-2 introduction into Lothian care homes

Background The first epidemic wave of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over one-third of care homes reported an outbreak, while there was limited testing of hospital patients discharged to care homes. Aim To investigate patients discharged from hospitals as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. Methods A clinical review was performed for all patients discharges from hospitals to care homes from 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease 2019 (COVID-19) test history, clinical assessment at discharge, whole-genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis using Cluster Investigation and Virus Epidemiological Tool software. Patient timelines were obtained using electronic hospital records. Findings In total, 787 patients discharged from hospitals to care homes were identified. Of these, 776 (99%) were ruled out for subsequent introduction of SARS-CoV-2 into care homes. However, for 10 episodes, the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data were available. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission, leading to 10 positive cases in their care home. Conclusion The majority of patients discharged from hospitals were ruled out for introduction of SARS-CoV-2 into care homes, highlighting the importance of screening all new admissions when faced with a novel emerging virus and no available vaccine

Specialised lithic technology of terminal Pleistocene maritime peoples of Wallacea

Excavation in Tron Bon Lei shelter on the Indonesian Island of Alor has uncovered a rich Pleistocene lithic assemblage, which includes obsidian artefacts representing a specialised industry previously undetected in any early stone tool assemblage of Island South East Asia (ISEA). Portable X-ray florescence of the obsidian assemblage has revealed three discrete sources, and that at least one of the sources is likely off-island. This indicates that inter-island exchange networks were active from the terminal Pleistocene onwards. Obsidian from all sources was reduced exclusively using bipolar anvil-resting techniques, resulting in the production of exceptionally small bipolar cores and flakes. The assemblage reveals extraordinary effort to reduce the obsidian, with cores being typically smaller than ten millimetres, and many around six millimetres at discard. Using reduction sequence analyses and technological observations, we document this specialised industry and discuss the role these artefacts may have played in the lifeways of the people of Alor Island