Geoarchaeological observations on the Roman town of Ammaia

This article presents, for the first time, multidisciplinary geoarchaeological work by a joint Belgo-Italian team from the universities of Ghent and Cassino in and around the Roman urban site of Ammaia in the northern Alentejo region of Portugal. This project is a geoarchaeological case study to investigate the conditioning effects of landscape and landscape evolution on a Roman urban site (and vice versa) in the Iberian peninsula. The site and landscape presentation is followed by a brief discussion of the aims and approaches of the chosen geoarchaeological strategy. With this study we approach the cultural landscape around Ammaia by means of techniques which combine methods both of the geosciences and of archaeological survey. The specific problems of assessing and reconstructing a Roman landscape, much altered by physical movements of the soil and by a two-millennia long period of human interference, will therefore be tackled in a multidisciplinary way. This means first of all making use of all relevant cartographic material, available aerial photographs and relevant satellite images. All important pre-existing archaeological information is inventoried and mapped and new fieldwork organised. This fieldwork, combining traditional archaeological survey techniques and geomorphologic observations, is being used to build a database of landscape features and sites with archaeological relevance for the period concerned. As many field data and cartographic elements as possible are being assembled in a Geographic Information System, specifically developed for this project. This GIS has already enhanced much new cartographic material of crucial importance in reconstructing the landmarks of the site and territory of Ammaia in the first centuries of our era and has helped to evaluate and interpret the evolution of the landscape shortly before, during, and since Roman times. A large part of this contribution is dedicated to reporting on some major observations and results obtained during three field campaigns, in the summers of 2001, 2002 and 2004. These results relate primarily to three fields of archaeological concern with specific relevance to the landscape background: the tracing of the circuit wall of the Roman city, the intra-urban cartography and the supply of water to the urban area during Roman imperial times. The authors believe these investigations to be examples of good practice in the field of geoarchaeology of the classical Mediterranean landscape

Factors affecting linkage to care and engagement in care for newly diagnosed HIV-positive adolescents within fifteen adolescent medicine clinics in the United States

Early linkage to care and engagement in care are critical for initiation of medical interventions. However, over 50 % of newly diagnosed persons do not receive HIV-related care within 6 months of diagnosis. We evaluated a linkage to care and engagement in care initiative for HIV-positive adolescents in 15 U.S.-based clinics. Structural and client-level factors (e.g. demographic and behavioral characteristics, clinic staff and location) were evaluated as predictors of successful linkage and engagement. Within 32 months, 1,172/1,679 (69.8 %) of adolescents were linked to care of which 1,043/1,172 (89 %) were engaged in care. Only 62.1 % (1,043/1,679) of adolescents were linked and engaged in care. Linkage to care failure was attributed to adolescent, provider, and clinic-specific factors. Many adolescents provided incomplete data during the linkage process or failed to attend appointments, both associated with failure to linkage to care. Additional improvements in HIV care will require creative approaches to coordinated data sharing, as well as continued outreach services to support newly diagnosed adolescents

Searching for keV Sterile Neutrino Dark Matter with X-ray Microcalorimeter Sounding Rockets

High-resolution X-ray spectrometers onboard suborbital sounding rockets can search for dark matter candidates that produce X-ray lines, such as decaying keV-scale sterile neutrinos. Even with exposure times and effective areas far smaller than XMM-Newton and Chandra observations, high-resolution, wide field-of-view observations with sounding rockets have competitive sensitivity to decaying sterile neutrinos. We analyze a subset of the 2011 observation by the X-ray Quantum Calorimeter instrument centered on Galactic coordinates l = 165, b = -5 with an effective exposure of 106 seconds, obtaining a limit on the sterile neutrino mixing angle of sin^2(2 theta) < 7.2e-10 at 95% CL for a 7 keV neutrino. Better sensitivity at the level of sin^2(2 theta) ~ 2.1e-11 at 95\% CL for a 7 keV neutrino is achievable with future 300-second observations of the galactic center by the Micro-X instrument, providing a definitive test of the sterile neutrino interpretation of the reported 3.56 keV excess from galaxy clusters.Comment: 13 pages, 13 figures, submitted to Ap

Close contact casting vs surgery for initial treatment of unstable ankle fractures in older adults

Importance Ankle fractures cause substantial morbidity in older persons. Surgical fixation is the contemporary intervention but is associated with infection and other healing complications. Objective To determine whether initial fracture treatment with close contact casting, a molded below-knee cast with minimal padding, offers outcome equivalent to that with immediate surgery, with fewer complications and less health resource use. Design, Setting, and Participants This was a pragmatic, equivalence, randomized clinical trial with blinded outcome assessors. A pilot study commenced in May 2004, followed by multicenter recruitment from July 2010 to November 2013; follow-up was completed May 2014. Recruitment was from 24 UK major trauma centers and general hospitals. Participants were 620 adults older than 60 years with acute, overtly unstable ankle fracture. Exclusions were serious limb or concomitant disease or substantial cognitive impairment. Interventions Participants were randomly assigned to surgery (n = 309) or casting (n = 311). Casts were applied in the operating room under general or spinal anesthesia by a trained surgeon. Main Outcomes and Measures The primary 6-month, per-protocol outcome was the Olerud-Molander Ankle Score at 6 months (OMAS; range, 0-100; higher scores indicate better outcomes and fewer symptoms), equivalence prespecified as ±6 points. Secondary outcomes were quality of life, pain, ankle motion, mobility, complications, health resource use, and patient satisfaction. Results Among 620 adults (mean age, 71 years; 460 [74%] women) who were randomized, 593 (96%) completed the study. Nearly all participants (579/620; 93%) received allocated treatment; 52 of 275 (19%) who initially received casting later converted to surgery, which was allowable in the casting treatment pathway to manage early loss of fracture reduction. At 6 months, casting resulted in ankle function equivalent to that with surgery (OMAS score, 66.0 [95% CI, 63.6-68.5] for surgery vs 64.5 [95% CI, 61.8-67.2] for casting; mean difference, –0.6 [95% CI, –3.9 to 2.6]; P for equivalence = .001). Infection and wound breakdown were more common with surgery (29/298 [10%] vs 4/275 [1%]; odds ratio [OR], 7.3 [95% CI, 2.6-20.2]), as were additional operating room procedures (18/298 [6%] for surgery and 3/275 [1%] for casting; OR, 5.8 [95% CI, 1.8-18.7]). Radiologic malunion was more common in the casting group (38/249 [15%] vs 8/274 [3%] for surgery; OR, 6.0 [95% CI, 2.8-12.9]). Casting required less operating room time compared with surgery (mean difference [minutes/participant], –54 [95% CI, –58 to –50]). There were no significant differences in other secondary outcomes: quality of life, pain, ankle motion, mobility, and patient satisfaction. Conclusions and Relevance Among older adults with unstable ankle fracture, the use of close contact casting compared with surgery resulted in similar functional outcomes at 6 months. Close contact casting may be an appropriate treatment for such patients

A comprehensive assessment of benign genetic variability for neurodegenerative disorders

Over the last few years, as more and more sequencing studies have been performed, it has become apparent that the identification of pathogenic mutations is, more often than not, a complex issue. Here, with a focus on neurodegenerative diseases, we have performed a survey of coding genetic variability that is unlikely to be pathogenic. We have performed whole-exome sequencing in 478 samples derived from several brain banks in the United Kingdom and the United States of America. Samples were included when subjects were, at death, over 60 years of age, had no signs of neurological disease and were subjected to a neuropathological examination, which revealed no evidence of neurodegeneration. This information will be valuable to studies of genetic variability as a causal factor for neurodegenerative syndromes. We envisage it will be particularly relevant for diagnostic laboratories as a filter step to the results being produced by either genome-wide or gene-panel sequencing. We have made this data publicly available at www.alzforum.org/exomes/hex

Treated Incidence of Psychotic Disorders in the Multinational EU-GEI Study

Importance: Psychotic disorders contribute significantly to the global disease burden, yet the latest international incidence study of psychotic disorders was conducted in the 1980s. Objectives: To estimate the incidence of psychotic disorders using comparable methods across 17 catchment areas in 6 countries and to examine the variance between catchment areas by putative environmental risk factors. Design, Setting, and Participants: An international multisite incidence study (the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions) was conducted from May 1, 2010, to April 1, 2015, among 2774 individuals from England (2 catchment areas), France (3 catchment areas), Italy (3 catchment areas), the Netherlands (2 catchment areas), Spain (6 catchment areas), and Brazil (1 catchment area) with a first episode of nonorganic psychotic disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes F20-F33) confirmed by the Operational Criteria Checklist. Denominator populations were estimated using official national statistics. Exposures: Age, sex, and racial/ethnic minority status were treated as a priori confounders. Latitude, population density, percentage unemployment, owner-occupied housing, and single-person households were treated as catchment area-level exposures. Main Outcomes and Measures: Incidence of nonorganic psychotic disorders (ICD-10 codes F20-F33), nonaffective psychoses (ICD-10 codes F20-F29), and affective psychoses (ICD-10 codes F30-F33) confirmed by the Operational Criteria Checklist. Results: A total of 2774 patients (1196 women and 1578 men; median age, 30.5 years [interquartile range, 23.0-41.0 years]) with incident cases of psychotic disorders were identified during 12.9 million person-years at risk (crude incidence, 21.4 per 100 000 person-years; 95% CI, 19.4-23.4 per 100 000 person-years). A total of 2183 patients (78.7%) had nonaffective psychotic disorders. After direct standardization for age, sex, and racial/ethnic minority status, an 8-fold variation was seen in the incidence of all psychotic disorders, from 6.0 (95% CI, 3.5-8.6) per 100 000 person-years in Santiago, Spain, to 46.1 (95% CI, 37.3-55.0) per 100 000 person-years in Paris, France. Rates were elevated in racial/ethnic minority groups (incidence rate ratio, 1.6; 95% CI, 1.5-1.7), were highest for men 18 to 24 years of age, and were lower in catchment areas with more owner-occupied homes (incidence rate ratio, 0.8; 95% CI, 0.7-0.8). Similar patterns were observed for nonaffective psychoses; a lower incidence of affective psychoses was associated with higher area-level unemployment (incidence rate ratio, 0.3; 95% CI, 0.2-0.5). Conclusions and Relevance: This study confirmed marked heterogeneity in risk for psychotic disorders by person and place, including higher rates in younger men, racial/ethnic minorities, and areas characterized by a lower percentage of owner-occupied houses.The European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) Project is funded by grant agreement HEALTH-F2-2010-241909 (Project EU-GEI) from the European Community’s Seventh Framework Programme. The Brazilian study was funded by grant 2012/0417-0 from the São Paulo Research Foundation. Dr Kirkbride is funded by the Wellcome Trust and grant 101272/Z/13/Z from the Royal Society. Ms Jongsma and Dr Jones are funded by the National Institute of Health Research Collaboration of Leadership in Applied Health Research and Care East of England

Prediction of outcome in newly diagnosed myeloma: a meta-analysis of the molecular profiles of 1,905 trial patients

Robust establishment of survival in multiple myeloma (MM) and its relationship to recurrent genetic aberrations is required as outcomes are variable despite apparent similar staging. We assayed copy number alterations (CNA) and translocations in 1036 patients from the NCRI Myeloma XI trial and linked these to overall survival (OS) and progression-free survival. Through a meta-anlysis of these data with data from MRC Myeloma IX trial, totalling 1905 newly diagnosed MM patients (NDMM), we confirm the association of t(4;14), t(14;16), t(14;20), del(17p) and gain(1q21) with poor prognosis with hazard ratios (HRs) for OS of 1.60 (P=4.77 × 10−7), 1.74 (P=0.0005), 1.90 (P=0.0089), 2.10 (P=8.86 × 10−14) and 1.68 (P=2.18 × 10−14), respectively. Patients with ‘double-hit’ defined by co-occurrence of at least two adverse lesions have an especially poor prognosis with HRs for OS of 2.67 (P=8.13 × 10−27) for all patients and 3.19 (P=1.23 × 10−18) for intensively treated patients. Using comprehensive CNA and translocation profiling in Myeloma XI we also demonstrate a strong association between t(4;14) and BIRC2/BIRC3 deletion (P=8.7 × 10−15), including homozygous deletion. Finally, we define distinct sub-groups of hyperdiploid MM, with either gain(1q21) and CCND2 overexpression (P<0.0001) or gain(11q25) and CCND1 overexpression (P<0.0001). Profiling multiple genetic lesions can identify MM patients likely to relapse early allowing stratification of treatment

Evaluation of a permanent SHM system performance in detecting damage scenarios considering runnability thresholds

In this work the authors present an investigation of the capability of a permanent monitoring system to detect the presence of damages that would lead to an exceedance of the structural thresholds imposed by design specifications. The target structure is a double-span steel truss railway bridge, located in Italy and currently instrumented with an in-situ monitoring system. Thanks to a FE model of the longest span, a set of damage scenarios can be simulated, identifying damage entities that lead to the exceedance of thresholds imposed in terms of runability assessment, considering deck and/or track geometry. In particular, the paper discusses the capability of tiltmeters to detect such damage scenarios

A three-year project on Structural Health Monitoring of railway bridges: main results and lessons learnt

Bridges and viaducts worldwide are threatened by ageing, increasing loads and climate-related extreme events. The situation calls for immediate actions to prevent catastrophic failures and extend the life of our infrastructural heritage. In this regard, thanks to significant efforts from academics, Structural Health Monitoring is paving its way towards application in the real world. Unlike the simple monitoring activity, which is not new in the field, SHM is more identifiable as a paradigm, encompassing several steps and involving many stakeholders. Also, the focus is not on a project level but on the network as a whole. Such a new perspective offers the opportunity - and obliges at the same time - to look for synergies among different bridges, with the aim of designing standardized guidelines to foster SHM scalability. Embracing this vision, in 2020, the Mechanical Engineering Department of Politecnico di Milano gave birth to a project oriented to testing the application of Structural Health Monitoring on the Italian railway infrastructure. The project had a twofold objective: on the one hand, the realisation of an automated software to extract and deliver information from the monitoring systems installed on three pilot bridges; on the other hand, the draft of guidelines that could report the lessons learnt and generalise as much as possible the design and exploitation of SHM on railway bridges. Given the interest in the feasibility of an extensive adoption of such practice, the pilot bridges were selected to be representative of the whole network. This paper wraps up the three-year project, intending to share the experience gained in the field and the take-home messages for future applications of SHM, with a focus on the key aspects for a broad spectrum adoption of this paradigm