A landscape archaeological study of the Mesolithic Neolithic in the milfield basin, Northumberland

The primary objective of this thesis is the construction of a landscape-scale synthesis of past human behaviour during the Mesolithic-Neolithic in the Milfield Basin, Northumberland. Previous archaeological studies in this area have been dominated by site-based research with little account taken of the wider landscape setting, settlement patterns and land-use strategies. To acquire the appropriate 'landscape' (off-site) data this study has included a fieldwork component consisting of a 7km sampling transect which extended across the interfluve from watershed to watershed and sampled all the different environmental zones of the basin. This area, of nearly 6 million square metres, was systematically fieldwalked, geomorphologically mapped and test-pitted. A total of 146 test pits were opened to sample the subsurface lithic content and sediment stratigraphy of each of the different geomorphological slope types. The subsequent data was analysed in a G.I.S. environment and interpreted in combination with published palynological data, existing site-based archaeological data including the author's recent excavations at the Coupland complex. The method of acquiring, analysing and interpreting the fieldwalking data is an innovative contribution to landscape archaeology techniques and includes a model of lithic scatter slope displacement and archaeological inference for ploughed slope environments. The study culminates in a diachronic synthesis of Mesolithic-Neolithic behaviour together with associated thematic discussion. Consequently, this thesis contributes towards two areas of research: landscape archaeological syntheses and methodological/taphonomic studies. The principal findings of this study include new models of prehistoric settlement and land-use for this area, a re-evaluation of the Mesolithic-Neolithic transition, a reconsideration of the late Neolithic 'ritual complex' and the identification of processes affecting surface lithic scatters and their implications for subsequent interpretation

Archaeology and Environment in Northumberland

Eventful, influential and absorbing, the early history of Northumberland is a fascinating story that has rarely been brought together under one cover. In this authoritative historical account, the authors bring to bear a huge quantity of old and new data and craft it into an in-depth synthesis. The authors deliver this history in chronological order from a perspective that places human activity and environment at its core. The narrative extends from the Palaeolithic through to, and including, the Anglo-Saxon period. This enormous sweep of history is supported by a robust radiocarbon chronology, with all available dates for the region brought together and calibrated against the most recent calibration curves for the first time. The geographic focus of the volume is North Northumberland but the narrative frequently extends to cover the whole county and occasionally further afield into neighbouring areas so as to deal with key topics at an appropriate geographic scale and to take account of important information from nearby areas. This second volume in the Till-Tweed monograph series follows on from the first volume, Managing Archaeological Landscapes in Northumberland , which provided a considerable quantity of new field data, in addition to presenting a landscape management methodology based around the "landform element" approach

Lateglacial and Early Holocene palaeoenvironmental change and human activity at Killerby Quarry, North Yorkshire, UK

The hunter-gatherers that entered the British peninsula after ice-retreat were exploiting a dynamic, rapidly changing environment. Records of vegetation change and human occupation during the Lateglacial to Early Holocene in northern Britain are more commonly found at upland and cave sites. However, recent research highlights many areas of the Swale–Ure Washlands that preserve extensive environmental sequences in low-lying ice-wastage basins, channels and depressions. The Lateglacial–Early Holocene environment of Killerby Quarry, North Yorkshire, is investigated here using a multi-proxy approach of sedimentary ancient DNA (sedaDNA), pollen, sedimentological (geochemistry and portable optically stimulated luminescence), and rare and well-preserved archaeology (Lavvu structures and lithics). Results show that the wetland basins and kettleholes were small lakes or ponds in the Lateglacial surrounded by sedge-fen and birch woodland. A gradual (centennial scale) succession to reed-swamp and then marsh is seen by the Early Holocene. This environment formed the resource-scape for hunter-gatherer transitory settlement in both the Lateglacial (Late Upper Palaeolithic) and Holocene (Early Mesolithic), attracted by the rich communities of pond-related flora and fauna as well as easy strategic landscape access by way of the River Swale, an arterial route through the landscape connecting the North Sea Basin with the Pennine uplands via the palaeolakes around Killerby

Ending the Cinderella Status of Terraces and Lynchets in Europe : The Geomorphology of Agricultural Terraces and Implications for Ecosystem Services and Climate Adaptation

Terraces and lynchets are ubiquitous worldwide and can provide increasingly important Ecosystem Services (ESs), which may be able to mitigate aspects of climate change. They are also a major cause of non-linearity between climate and erosion rates in agricultural systems as noted from alluvial and colluvial studies. New research in the ‘critical zone’ has shown that we must now treat soil production as an ecologically sensitive variable with implications for soil carbon sequestration. In this review and synthesis paper we present a modified classification of agricultural terraces, review the theoretical background of both terraces and lynchets, and show how new techniques are transforming the study of these widespread and often ancient anthropogenic landforms. The problems of dating terraces and the time-consuming nature of costly surveys has held back the geomorphological and geoarchaeological study of terraces until now. The suite of techniques now available, and reviewed here,includes Digital Elevation Models (DEMs) - Structure from Motion (SfM) photogrammetry, Airborne and Terrestrial Laser Scanning (ALS-TLS); optically stimulated luminescence (OSL and pOSL), portable x-ray fluorescence (pXRF), Fourier-transform infra-red analysis (FTIR), phytoliths from plants, and potentially environmental DNA. Three process-related geomorphological questions arise from using this suite of methods; a) can they provide both a chronology of formation and use history, b) can we identify the sources of all the soil components? c) can terrace soil formation and ecosystem services be modelled at the slope to catchment scale? The answers to these questions can also inform the management of the large areas of abandoned and under-used terraces that are resulting from both the economics of farming and rural population changes. Where possible, examples are drawn from a recently started ERC project (TerrACE; ERC-2018-2023; https://www.terrace.no/) that is working at over 15 sites in Europe ranging from Norway to Greece

Early to Middle Bronze Age agricultural terraces in north-east England : morphology, dating and cultural implications

Terracing is found widely in the Mediterranean and in other hilly and mountainous regions of the world. Yet while archaeological attention to these ‘mundane' landscape features has grown, they remain understudied, particularly in Northern Europe. Here, the authors present a multidisciplinary study of terraces in the Breamish Valley, Northumberland. The results date their construction to the Early to Middle Bronze Age, when they were built by cutting back the hillside, stone clearance and wall construction. Environmental evidence points to their use for cereal cultivation. The authors suggest that the construction and use of these terraces formed part of an Early to Middle Bronze Age agricultural intensification, which may have been both demographically and culturally driven

The Beaker phenomenon and the genomic transformation of northwest Europe

From around 2750 to 2500 bc, Bell Beaker pottery became widespread across western and central Europe, before it disappeared between 2200 and 1800 bc. The forces that propelled its expansion are a matter of long-standing debate, and there is support for both cultural diffusion and migration having a role in this process. Here we present genome-wide data from 400 Neolithic, Copper Age and Bronze Age Europeans, including 226 individuals associated with Beaker-complex artefacts. We detected limited genetic affinity between Beaker-complex-associated individuals from Iberia and central Europe, and thus exclude migration as an important mechanism of spread between these two regions. However, migration had a key role in the further dissemination of the Beaker complex. We document this phenomenon most clearly in Britain, where the spread of the Beaker complex introduced high levels of steppe-related ancestry and was associated with the replacement of approximately 90% of Britain’s gene pool within a few hundred years, continuing the east-to-west expansion that had brought steppe-related ancestry into central and northern Europe over the previous centuries

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research