Provisional Survey of Aitutaki, Cook islands Sites and Monuments May-June 2017

The archaeological survey work detailed in this report was undertaken by Colin Richards and Jane Downes (University of the Highlands and Islands, UK), Kate Welham (Bournemouth University, UK), Francisco Torres Hochstetter (MAPSE, Rapa Nui (Easter Island), Chile) and Lawrence Shaw (New Forest National Park Authority, UK), working with Ngaakitai Pureariki (Punarei Aitutaki), with the permission of the Aitutaki Council, and Cook Islands Research Permit (Ref. 15-16a), working between 23rd May and 2nd June 2017. The archaeological work comprised site survey and location using GPS, geophysical survey, and surface collection of artefacts. A database of the sites has been produced as a Cultural Heritage Record, and lodged with the Aitutaki Islands Council. All artefacts have been left on the island with the Aitutaki Islands Council

Care for the Future: Heritage Education in the Context of Rapa Nui (Easter Island) and Other Small Island Communities.

Education is accepted to be the principal means by which archaeological heritage can be both enjoyed and preserved. Links between research and education through outreach are an important part of archaeological projects on Rapa Nui, for example providing new information for site interpretation. Knowledge exchange between researchers and heritage managers can be another important outcome, or impact, of research. The preliminary findings from doctoral interview-based research with residents pertaining to archaeology, heritage management and heritage education programs that have taken place on Rapa Nui the island will be discussed here. We examine the role archaeological heritage is playing in Rapa Nui in education contexts, and make some observations as to the impact and legacy of this important work. One aspect of the education program is in developing links between researchers, heritage managers, museums and school pupils between Rapa Nui, and the islands of Orkney, Scotland. The benefits and potential of links between small island communities in heritage education and management are considered in this paper

Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

Background: Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial. Methods: NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries that assessed the efficacy and safety of rivaroxaban versus aspirin for secondary stroke prevention in patients with ESUS. For this prespecified subgroup analysis, cohorts with and without PFO were defined on the basis of transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE). The primary efficacy outcome was time to recurrent ischaemic stroke between treatment groups. The primary safety outcome was major bleeding, according to the criteria of the International Society of Thrombosis and Haemostasis. The primary analyses were based on the intention-to-treat population. Additionally, we did a systematic review and random-effects meta-analysis of studies in which patients with cryptogenic stroke and PFO were randomly assigned to receive anticoagulant or antiplatelet therapy. Findings: Between Dec 23, 2014, and Sept 20, 2017, 7213 participants were enrolled and assigned to receive rivaroxaban (n=3609) or aspirin (n=3604). Patients were followed up for a mean of 11 months because of early trial termination. PFO was reported as present in 534 (7·4%) patients on the basis of either TTE or TOE. Patients with PFO assigned to receive aspirin had a recurrent ischaemic stroke rate of 4·8 events per 100 person-years compared with 2·6 events per 100 person-years in those treated with rivaroxaban. Among patients with known PFO, there was insufficient evidence to support a difference in risk of recurrent ischaemic stroke between rivaroxaban and aspirin (hazard ratio [HR] 0·54; 95% CI 0·22–1·36), and the risk was similar for those without known PFO (1·06; 0·84–1·33; pinteraction=0·18). The risks of major bleeding with rivaroxaban versus aspirin were similar in patients with PFO detected (HR 2·05; 95% CI 0·51–8·18) and in those without PFO detected (HR 2·82; 95% CI 1·69–4·70; pinteraction=0·68). The random-effects meta-analysis combined data from NAVIGATE ESUS with data from two previous trials (PICSS and CLOSE) and yielded a summary odds ratio of 0·48 (95% CI 0·24–0·96; p=0·04) for ischaemic stroke in favour of anticoagulation, without evidence of heterogeneity. Interpretation: Among patients with ESUS who have PFO, anticoagulation might reduce the risk of recurrent stroke by about half, although substantial imprecision remains. Dedicated trials of anticoagulation versus antiplatelet therapy or PFO closure, or both, are warranted. Funding: Bayer and Janssen