Flake morphology as a record of manual pressure during stone tool production

Relative to the hominin fossil record there is an abundance of lithic artefacts within Pleistocene sequences. Therefore, stone tools offer an important source of information regarding hominin behaviour and evolution. Here we report on the potential of Oldowan and Acheulean flake artefacts to provide a record of the biomechanical demands placed on the hominin hand during Lower Palaeolithic stone tool production sequences. Specifically, we examine whether the morphometric attributes of stone flakes, removed via hard hammer percussion, preserve correlates of the pressures experienced across the dominant hand of knappers. Results show that although significant and positive relationships exist between flake metrics and manual pressure, these relationships vary significantly between subjects. Indeed, we identify two biomechanically distinct strategies employed by knappers; those that alter their hammerstone grip pressure in relation to flake size and mass and those who consistently exert relatively high manual pressures. All individuals experience relatively high gripping pressure when detaching particularly large flakes. Amongst other results, our data indicate that the distinctive large flake technology associated with the Acheulean techno-complex may be demonstrative of an ability to withstand, and by extension, to exert higher manual pressures. However inferences from smaller flake artefacts, especially, must be treated with caution due to the variable biomechanical strategies employed

Integration of oncology and palliative care: a Lancet Oncology Commission

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

A Hitherto Unnoticed Middle English Manuscript of the Seven Sages

In the very exhaustive and thorough account of the Middle English versions of the Seven Sages by Dr. Killis Campbell, which appeared in these Publications, XIV, pp. 37 f., I see that the Bodleian MS. has escaped notice. As I believe that no one has hitherto called attention to this version, it may be worth while to give a brief account of it here. I came across it some years ago whilst working through a number of the Rawlinson MSS. in the Bodleian Library. The MS. in question bears the press mark MS. Rawl. Poet. 175 (New Catalogue 14667) and is a parchment MS. of the middle of the 14th century, The Seven Sages occupying fol. 109-131b. This Rawlinson version is in the Northern dialect and agrees very closely indeed with MS. C (Cotton Galba E. IX); in fact in the portions which I have examined, these two MSS. agree almost word for word, as the following specimen and collations show. To give some idea of the MS. I here append (1) 11. 1-128 in full, (2) the readings from the Rawlinson MS. which differ from MS. C in the Avis story, and (3) the readings from the Rawl. MS. which differ from MS. C in the last portion of the whole (ll. 3913-4002). Contractions are denoted by italics.</jats:p

The Franks casket /

"Reprinted from the Furnivall celebration volume".Mode of access: Internet