Use and Appreciation of Mycenaean Pottery in the Levant, Cyprus and Italy

Pottery made in the aegean during the Late Bronze Age has been found widely distributed in many parts of the Mediterranean. At some four hundred sites outside Greece, Mycenaean dinner and storage vessels, as well as some figurines have been discovered. As such, this class of archaeological artifacts constitutes one of the main sources by which to study Mycenaean trade and interregional contact. However, the role of pottery in international exchange during this period is not properly understood. That role depended on the patterns of consumption in the societies importing Mycenaean pottery. In this book, such patterns of consumption are investigated for the three areas with the largest amounts of Mycenaean pots: the Levant, Cyprus and Italy. For each of these areas, three sites have been selected for a detailed analysis of the cultural contexts of Mycenaean pots on a local level. Variations and similarities between these sites form the basis for a discussion of the cultural significance of this class of material in the region as a whole. The variations in the cultural significance of Mycenaean pottery in these areas show that the meaning of archaeological artifacts depends on the contexts in which they were used, discarded and rediscovered

Inhibition of insulin- and insulin-like growth factor-I-stimulated growth of human breast cancer cells by 1,25-dihydroxyvitamin D3 and the vitamin D3 analogue EB1089

1, 25 Dihydroxyvitamin D3 (1,25-(OH)2D3) and a number of synthetic vitamin D3 analogues with low calcaemic activity, have been shown to inhibit breast cancer cell growth in vitro as well as in vivo. The purpose of the present study was to investigate a possible interaction of 1, 25-(OH)2D3 and the vitamin D3 analogue EB1089 with the insulin-IGF-I regulatory system. The oestrogen receptor-positive MCF-7 human breast cancer cells used in this study are able to grow autonomously and their growth is stimulated by insulin. In order to avoid interference of IGF-binding proteins (IGF-BPs), we used an analogue of IGF-I, long R3 IGF-I, which stimulated MCF-7 cell growth similar to insulin. The growth stimulation by insulin and by long R3 IGF-I was completely inhibited by 1,25-(OH)2D3 and EB1089. Autonomous growth was also inhibited by 1,25-(OH)2D3 and EB1089. The analogue EB1089 was active at 50 times lower concentrations than 1,25-(OH)2D3. It was shown that growth inhibition was not achieved through downregulation of insulin and IGF-I binding after 48 h. Paradoxically, after prolonged treatment (8 days), an upregulation of insulin and IGF-I binding was observed. Two possible intracellular mediators of the insulin-IGF mitogenic signal are C-FOS and mitogen-activated protein (MAP) kinase. Insulin-induced C-FOS mRNA was inhibited by 1,25-(OH)2D3, suggesting that it could be involved in the growth inhibition by 1,25-(OH)2D3. MAP kinase activation appeared not to be involved in growth stimulation by both insulin and IGF-I. Together, the present study demonstrates that vitamin D3 compounds can block the mitogenic activity of insulin and IGF-I, which may contribute to their tumour suppressive activity observed in vivo. Copyrigh

The preparation and properties of lanthanum-promoted nickel-alumina catalysts:Structure of the precipitates

Precursors of La-promoted Ni-alumina catalysts have been prepared by precipitation from their nitrate solutions at pH 7 using solutions of NH4HCO3, Na2CO3 or K2CO3. The preparation was carried out either by coprecipitation from a mixed salt solution or by sequential precipitation of Al3+, La3+ and Ni2+ in succession. In the absence of promoter, the precipitate with Ni/Al ratio of 2.5 is of the pyroaurite structure and has the composition Ni5Al2(OH)14CO3.4H2O. Two types of lanthanum-containing precipitate were made in which either extra La was added (Ni/Al kept constant at 2.5) or the proportion Ni/(Al+La) was kept constant at 2.5. The majority of these precipitates were single compounds which also had the pyroaurite structure. At high La contents, the series in which La is added gives separation of the compounds La2O(CO3)2 and LaONO3 in addition to the layer structure; with the series in which the La is substituted for Al, all the samples appeared to have the pyroaurite structure, even one in which no Al was present. The sequential precipitation route yields smaller crystallites than does coprecipitation. Materials precipitated with NH4HCO3 in all cases contained NH4NO3 while those precipitated with Na2CO3 gave inclusion of NaNO3. In both cases, the presence of the nitrates causes a decrease of crystallinity of the layer compound. Potassium is not included in the precipitate in any of the samples examined. A model is presented for the structure of the lanthanum-containing precipitates

Left Atrial Reservoir Function and Outcomes in Secondary Mitral Regurgitation

BackgroundLeft atrial (LA) size is a marker of disease severity and is related to worse outcomes in secondary mitral regurgitation (MR). The prognostic value of LA function assessed by LA reservoir strain (LARS), however, remains unknown. The aim of this study was to investigate the prognostic implications of LARS in patients with significant secondary MR.MethodsLARS was evaluated using speckle-tracking echocardiography in patients with more than mild (grade ≥ 2) secondary MR. The population was divided into two groups according to the median LARS value (9.8%). The primary end point was all-cause mortality.ResultsA total of 666 patients (mean age, 66 ± 11 years; 68% men) were included. On multivariable analysis, more severe MR was independently associated with more impaired LARS (LARS P = .001). During a median follow-up period of 5 years (interquartile range, 2-10), 383 patients (58%) died. Patients with LARS P P ConclusionsLARS is independently associated with all-cause mortality in patients with significant secondary MR and has incremental prognostic value over LA volume and left ventricular global longitudinal strain. LARS may improve risk stratification of patients with secondary MR.</p

Prognostic value of left atrial reservoir function in patients with severe primary mitral regurgitation undergoing mitral valve repair

Aims: Mitral regurgitation (MR) has a significant haemodynamic impact on the left atrium. Assessment of left atrial reservoir strain (LARS) may have important prognostic implications, incremental to left atrial (LA) volume, and conventional parameters of left ventricular (LV) structure and function. This study investigated whether preoperative assessment of LARS by speckle tracking echocardiography is associated with long-term outcomes in patients undergoing mitral valve repair for severe primary MR. Methods and results: Echocardiography was performed prior to mitral valve surgery in 566 patients (age 64 +/- 12years, 66% men) with severe primary MR. The study population was subdivided based on a LARS value of 22%, using a spline curve analysis. The primary endpoint was all-cause mortality. During a median follow-up of 7 (4-12) years, 129 (22.8%) patients died. Patients with LARS 22% (2%, 3% and 5%, respectively, P Conclusion: Preoperative LARS is independently associated with all-cause mortality in patients undergoing mitral valve repair for primary MR and provides incremental prognostic value over LA volume. LARS might be helpful to guide timing of mitral valve surgery in patients with severe primary MR.</p

Updated analysis of the non-CO2 climate impacts of aviation and potential policy measures pursuant to EU Emissions Trading System Directive Article 30(4)

13TASK3: Potential policy action to reduce non-CO2climate impactsFollowing a review of scientific literature, and expert workshop discussions, a range of potential mitigation measures were identified to reduce the non-CO2climate impacts of aviation7. Basedon various criteria in line with EU climate policy goals, the below six options were shortlisted to be considered in greater detail in terms of design, administration, incentives, caveats and constraints, and further research needs. These six options wereconsidered representative of similar considerations and details exhibited by an original longer list of options. Type of MeasureMain non-CO2effect(s) addressed by the measureFinancial1.NOXchargeNOX2.Inclusion of aircraft NOXemissions in EU ETSNOXFuel3.Reduction in maximum limit of aromatics within fuel specificationsSoot particulates and contrail-cirrus4.Mandatory use of Sustainable Aviation Fuels (SAF)Soot particulates and contrail-cirrusATM5.Avoidance of ice-supersaturated areasContrail-cirrus6.A climate chargeAll (NOX, water vapour, soot, sulphates, contrails) 1.NOXchargeThis measure is defined as a monetary charge on the total NOXemissions over an entire flight, approximated by certified Landing Take-Off (LTO) NOXemissions data, the distance flown and a factor accounting for the relation between LTO and cruise emissions.A legal analysis from 2009 suggested that neither ICAO’s Chicago Convention nor ICAO’s recommended policies on taxes and charges should prevent the implementation of such a measure. This option would incentivise engine manufacturers to reduce LTO NOXemissions during their engine design process, and airlines to minimise NOXemissions in operation, while taking into account associated trade-offs.Further research would be needed in these key areas:oUnder certain future scenarios of declining emissions of tropospheric ozone precursors from surface sources, combined with increasing aviation emissions, aviation NOXmay lead to a net negative climate forcing (i.e. cooling). As such, there is a need to monitor the scientific understanding of this issue as it further evolves over time.7These options would be in addition to those already in place, such as the aircraft engine NOXand nvPM emissions standard and airport NOXcharging schemes. 14oExisting analytical methods, such as the Boeing fuel flow method (BFF2) and the DLR fuel flow method, have been used in the past to estimate cruise NOXemissions based on LTO NOXdata. However, the robustness of these methods when applied to recent technological developments, such as lean burn staged combustion, is still being assessed and the methods may need to be updated. Research to develop and agree on an accurate, internationally recognised methodology for estimating cruise NOXemissions will be important for the implementation of this measure.oIn order to compare the climate change impact of NOXemissions to CO2emissions, an appropriate CO2equivalent emissions metric and time horizon would need to be agreed politically. In doing so, it is important to ensure that the trade-off between NOXand CO2emissions in engine design does not result in unintended consequences and a resulting net warming effect. oThe level of the charge should reflect the climate damage costs of aircraft NOxemissions. Using the aforementioned metric, these costs could be related to the damage costs of CO2, which are an on-going point of discussion.The necessary legislation and implementation of this option would need to be considered within the context of the regulatory framework of the Single European Sky Performance and Charging Scheme8, as well as other financial policy options (including those already in place).If the outstanding research issues linked to this measure are addressed, and there is the political will to take the option forward, then the measure could potentially be implemented in the mid-term (5 to 8 years)9.2.Inclusion of aircraft NOXemissions in EU ETSThe EU Emissions Trading System (ETS) is a ‘cap and trade’ scheme in which emission allowances for CO2emissions are traded among incumbent operators in a number of different sectors, including aviation. The system allows opt-ins for emissions of N2O and PFCs for stationary installations.This measure would see the extension of the scope of the EU ETS by incorporating aviation NOXemissions. As the EU ETS legislation uses the CO2equivalent emissions metric ‘GWP100’ to convert other greenhouse gases to CO2equivalents, it is assumed that including aircraft NOXinto EU ETS would also require using GWP100.This option would incentivise engine manufacturers to reduce NOXemissions during their engine design process, and airlines to minimise NOXemissions in operation, while taking into account associated trade-offs.Further research would be needed on the sameissues as the ‘NOXcharge’ measure.In contrast to other measures outlined in this report, this measure could be implemented by adjusting existing ETS legislation and building on existing administrative processes and 8COMMISSION IMPLEMENTING REGULATION (EU) 2019/317 of 11 February 2019 laying down a performance and charging scheme in the single European sky and repealing Implementing Regulations (EU) No 390/2013 and (EU) No 391/2013.9Rough estimates of timescales to implement policy options have been provided, but are dependent on addressing the identified research needs and the political will to take the options forward. For the purpose of this study, short-term is defined as 2-5 years, mid-term as 5-8 years and long-term as 8+ years. 15precedents (e.g. monitoring, reporting, verification and accreditation -MRVA; baseline; cap and auctioned allowances). The same EU ETS geographical scope for aviation could be applied to NOXas that for CO2emissions.The uncertainty about the climate impact of NOX, and the potential unintended consequences, introduces a political risk for the integrity of the EU ETS which needs to be taken into account when considering it as an opt-in non-CO2gas in the EU ETS. In this sense, the measure differs from the ‘NOx charge’.If the outstanding research issues linked to this measure are addressed, and there is the political will to take the option forward, then the measure could potentially be implemented in the mid-term (5 to 8 years).3.Reduction in maximum limit of aromatics within fuel specifications This measure would entail reducing the maximum volume concentration of aromatics within fuel uplifted at European airports.Lower aromatics in fuels provide a cleaner burn and reduced non-volatile Particulate Matter (nvPM) emissions, which are directly linked to contrail cirrus formation and radiative properties. In addition, the reduction in aromatics improves the energy density of the fuel, which reduces the mass of fuel needed for a specific flight and results in a small reduction in overallfuel burn / CO2emissions (approx. 1%).The aromatics concentration could be reduced through blending certain sustainable aviation fuels (SAF) with conventional Jet A-1 fuel, through hydro-treatment of Jet A-1 fuel or through changes in production processes by refineries.Jet A-1 fuel is the most commonly used aviation fuel in the world. Its fuel specifications are managed through the four main standardisation committees, including US ASTM (D1655) and UK DEF STAN (91-091). Engagement with these committees to discuss the climate benefits of low aromatic fuels will be crucial. This measure would require fuel producers to adapt their production processes to meet the new standard, which may result in higher CO2emissions in refineries. Further research would be needed in these key areas:oThe scientific understanding of the contribution of nvPM to the formation of contrail cirrus is evolving, but confidence level in the magnitude of the net positive climate forcing effect (i.e. warming) is low. As such, there is a need to monitor the scientific understanding of this issue as it further develops over time.oA cost-effectiveness assessment is needed to assess options for reducing the aromatics limit. While the maximum volume concentration of aromatics is 25 volumepercent, the actual content in Jet A-1 fuel currently used within the aviation sector is not well known. Studies have revealed that it can vary extensively. As such, the specifications of fuels being used in Europe will need to be monitored in order to beable to assess the impact of a reduced maximum limit of aromatics. oSpecial consideration will need to be given to the effect on military aircraft, which can be relatively old compared to commercial aircraft, and theuse of lower aromatics fuels may have airworthiness consequences for parts of the engine (e.g. rubber seals) where the fuel supply is shared. For this reason, ASTM and DEF STAN are currently considering an 8% minimum aromatics limit for fossil based fuels, though this is currently just guidance. 16oA system to monitor the aromatics content of fuels used in the aviation sector would need to be set up to ensure that the policy delivers the anticipated benefits.Existing fuel specification committees use a consensus-driven, technical approach. While a legally imposed EU standard would ensure a specific outcome, it would disrupt the current global approach to managing fuel quality standards.An alternative option to this measure could be an incentive for the sale of fuel with low aromatics.If the outstanding research issues linked to this measure are addressed, and there is the political will to take the option forward, then the measure could potentially be implemented in the mid-(5 to 8 years) to long-term (+8 years).4.Mandatory use of Sustainable Aviation Fuels (SAF)This measure would entail the mandatory use of SAF, for instance through an EU blending mandate specifying that a certain percentage of the total Jet A-1 fuel sold in Europe over a set time period would have to be SAF.Within the European regulatory framework, SAF would be defined as per the criteria in the new Renewable Energy Directive (RED II) 2018/2001/EU.SAF typically have lower aromatic concentrations and thus the same benefits as summarised in the ‘Reduction in maximum limit of aromatics within fuel specifications’ measure, as long as the aromatics content in the fossil part of the blend does not increase and offset the benefits. In addition, SAF also have lower lifecycle CO2emissions compared to conventional fossil based fuels and lower sulphur content resulting in lower SO4emissions.This measure would incentivise the use of SAF in the single market by providing certainty to SAF producers and an impetus to up-scale their production and benefit from economies of scale. It may also increase airline operational costs, depending on the size of the mandate and subsequent supply-side response from the SAF market.Further research would be needed in these key areas:oBlending mandates have already been introduced or announced inindividual European states. A cost-benefit assessment would be needed to inform a decision on the level of an EU blending mandate. This assessment would need to consider realistic yet ambitious levels, the impact on stakeholders and potential implementation processes (e.g. a dynamic blending mandate that increases over time in order to provide certainty to the market for long-term investments).oAs per option (3), a system to monitor the characteristics of SAF being used in operation within Europe would be needed to ensure compliance with the mandate and provide valuable oversight on the environmental benefits from this measure.A ‘control point’ will need to be identified (e.g. blending location), where the total SAF going to the aviation sector in Europe can be identified and hence compliance with the blending mandate can be monitored. This could build on existing legislation (e.g. RED II, FQD).The mandating of SAF results could be considered as a holistic approach with simultaneous reductions in CO2, nvPM and sulphur emissions, although it does not address NOxemissions. 17If the outstanding research issues linked to this measure are resolved, and there is the political will to take the option forward, then the measure could potentially be implemented in the short-(2 to 5 years) to mid-term (5 to 8 years).5.Avoidance of ice-supersaturated areasThis measure involves optimizing flight trajectories to avoid climate-sensitive regions, such as ice-supersaturated areas, in order to reduce the climate impact of aviation. This can be considered a potential first step towards full optimisation of flight profiles for climate impacts.Contrails are largely formed in ice-supersaturated and low-temperature areas, and thus avoiding these regions reduces contrail cirrus occurrence that have a net positive radiative forcing effect (i.e. warming).Prior to a flight plan being filed, Air Navigation Service Providers (ANSPs) and airline operators would need to have all the relevant information (e.g. temperature, humidity) in order to identify the ice-supersaturated areas. The route network would also have to be designed to allow such deviations based on this pre-flight tactical planning. Further research would be needed in these key areas:oA pilot project involving ANSPs,ICAO, meteorological institutes and airlines operating over the Atlantic would be needed to assess the feasibility and benefits of this measure. This should include the effect of such a measure on existing Single European Sky operational initiatives such as Free Route Airspace. Implementation over mainland European airspace would be a challenge as this region already faces capacity constraints during daily peak periods.oFlight detours (horizontal and vertical) to avoid ice-supersaturated areas are likely to have an impact on airlines in terms of costs, and will also lead to trade-offs with regard to fuel burn and emissions (e.g. CO2and NOX). An appropriate CO2equivalent emissions metric that permits a comparison between the climate change impact of contrail-cirrus and other aviation emissions will be required to determine the maximum detour that still ensures an overall reduction in climate impact from a flight. oMost of the contrail cirrus forcing that results in significant warming is believed to be due to a few large-scale events. It would therefore be advisable to ‘target’ flights that impact these events, rather than all flights. Identification of these few large-scale events should be a topic of further research as meteorological forecast models presently have only limited capability to predict persistent contrails correctly in time and space.Demonstration and communication on the environmental benefits would be needed, as well as potentially additional incentives, to ensure buy-in from stakeholders. If the outstanding research issues are addressed, including positive results from a pilot-phase project in the short-term, and there is the political will totake the option forward, then the measure could potentially be implemented in a more complete form in the mid-term (5-8 years). 186.A climate chargeThe concept of this policy measure is to levy a charge on the full climate impact of each individual flight. This makes it both the measure with the broadest coverage and the one that is likely to be the most complicated to implement. The introduction of a charge requires a good estimate of the climate costs at a flight level. Currently, there is no scientific consensus on the methodology to calculate these costs.It could be argued that a levy that aims to internalise the external costs would be considered a charge and not a tax. In this case, the charge would be related to recover the external costs of the climate impact of aviationFurther research would be needed on the same issues as the ‘Avoidance of ice-supersaturated areas’ measure, but with a larger geographical scope and including the level of the charge to be set for the climate damage costs of CO2, which is an on-going point of discussion.The necessary legislation and implementation of this option will need to be considered within the context of the regulatory framework of the Single European Sky Performance and Charging Scheme10. Significant more research is needed to develop and define this measure. If there is the political will to take this forward, then the measure could potentially be implemented in the long-term (+8 years).10COMMISSION IMPLEMENTING REGULATION (EU) 2019/317 of 11 February 2019 laying down a performance and charging scheme in the single European sky and repealing Implementing Regulations (EU) No 390/2013 and (EU) No 391/2013. 19CONCLUDING REMARKSThe latest scientific understanding on the climate change effects of non-CO2emissions from aviation activities has advanced over the last 10 years. While uncertainties remain with regard to these impacts, and how to assess them in terms of CO2equivalent emissions metrics, there are a rangeof policy options with associated pros and cons that the European Commission could evaluate. Specific research issues, which are identified this report, would need to be addressed in order to take these options forward

Left Atrial Remodeling after Mitral Valve Repair for Primary Mitral Regurgitation: Evolution over Time and Prognostic Significance

Left atrial (LA) dilatation is associated with worse outcomes in primary mitral regurgitation (MR). However, the effects of mitral valve repair on LA size and its prognostic implications are not well known. In the current study, LA volume index (LAVi) and LA reservoir strain (LASr) were evaluated immediately before and after surgery, and during long-term follow-up in 226 patients undergoing mitral valve repair for primary MR (age 62 +/- 13 years, 66% male). Mean LAVi was reduced significantly after surgery and at long-term follow-up (from 56 +/- 28 to 38 +/- 21 to 32 +/- 17 mL/m(2); p = 42 mL/m(2) at long-term follow-up showed significant higher mortality rates compared to patients with LAVI < 42 mL/m(2) (p < 0.001), even after adjusting for clinical covariates. In conclusion, significant LA reverse remodeling was observed both immediately and at long-term follow-up after mitral valve repair. LA dilatation at long term follow-up after surgery was still associated with all-cause mortality

Factors influencing the admission decision for Medical Psychiatry Units: A concept mapping approach

Objective Medical Psychiatry Units (MPUs), also known as Complexity Intervention Units (CIUs), provide care for complex patients suffering from both psychiatric and physical disorders. Because there is no consensus on the indications for admission to an MPU, daily practice and effectiveness research are hampered. This study therefore used a concept mapping approach to investigate which organizational and medical factors determine the decision to admit a patient to an MPU. Methods The first step of the concept mapping approach was to create a list of factors determining MPU admission from literature. Secondly, clinical experts sorted and ranked these factors. The sorted and ranked data were then analyzed, and a draft conceptual framework was created. A final conceptual MPU admission framework was then drawn during an expert consensus meeting and recommendations for implementation were suggested. Results Thirteen clinical experts defined 90 factors from literature, which were sorted and ranked by 40 experts from 21 Dutch hospitals. This concept mapping approach resulted in a five-cluster solution for an MPU admission framework based on: 1. Staff competencies and organizational pre-requisites; 2. Patient context; 3. Patient characteristics; 4. Medical needs and capabilities; and 5. Psychiatric symptoms and behavioral problems. Furthermore, three inclusion and two exclusion criteria were formulated to help the clinicians decide whether or not to admit patients to an MPU. These criteria can be implemented in daily practice. Conclusion Implementing the five criteria derived from this conceptual framework will help make the admission decision for complex patients with psychiatric and physical disorders to an MPU more correct, consistent, and transparent