Understanding the development and use of musical instruments in prehistory is often hampered by poor preservation of perishable materials and the relative rarity of durable examples. Here, the authors present a pair of third-millennium BC copper cymbals, excavated at Dahwa, Oman. Although they are the only well-contextualised examples from Arabia, the Dahwa cymbals are paralleled by contemporaneous examples from the Indus Valley and images in Mesopotamian iconography. Not only do the cymbals add to the body of evidence interpreted in terms of Indus migrants in Early Bronze Age Oman, they also suggest shared musical and potentially ritual practices around the Arabian Gulf at that time.

Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women’s well-being and ensure healthcare system preparedness during future public health crises.

KCl-, KBr-, and KI-kaolinite intercalation complexes were synthesized by gradually heating potassium-halide discs of the dimethylsulfoxide (DMSO)-kaolinite intermediate at temperatures to 330°C. Two types of complexes were identified by infrared spectroscopy: almost non-hydrous, obtained during thermal treatment of the DMSO complex; and hydrated, produced by regrinding the disc in air. The former showed basal spacings with integral series of 00l reflections indicating ordered stacking of parallel 1:1 layers. Grinding resulted in delamination and formation of a disordered “card-house” type structure. The frequencies of the kaolinite OH bands show that the strength of the hydrogen bond between the intercalated halide and the inner-surface hydroxyl group decreases as Cl > Br > I. The positions of the H2O bands imply that halide-H2O interaction decreases in the same order. Consequently, the strength of the hydrogen bond between H2O and the oxygen atom plane increases in the opposite sequence.

In the non-hydrous KCl-kaolinite complex the inner hydroxyl band of kaolinite at 3620 cm-1 is replaced by a new feature at 3562 cm-1, indicating that these OH groups are perturbed. It is suggested that Cl ions penetrate through the ditrigonal hole and form hydrogen bonds with the inner OH groups. In contrast, Br and I ions are too large to pass into the ditrigonal holes and do not form hydrogen bonds with the inner hydroxyls.

Impulsive aggressive (IA, or impulsive aggression) behavior describes an aggregate set of maladaptive, aggressive behaviors occurring across multiple neuropsychiatric disorders. IA is reactive, eruptive, sudden, and unplanned; it provides information about the severity, but not the nature, of its associated primary disorder. IA in children and adolescents is of serious clinical concern for patients, families, and physicians, given the detrimental impact pediatric IA can have on development. Currently, the ability to properly identify, monitor, and treat IA behavior across clinical populations is hindered by two major roadblocks: (1) the lack of an assessment tool designed for and sensitive to the set of behaviors comprising IA, and (2) the absence of a treatment indicated for IA symptomatology. In this review, we discuss the clinical gaps in the approach to monitoring and treating IA behavior, and highlight emerging solutions that may improve clinical outcomes in patients with IA.

Introduction: Quality improvement and patient safety (QIPS) are increasingly recognized as integral to the provision and advancement of emergency medicine (EM) care. In 2015, QIPS were added to the Canadian Medical Education Directives for Specialists (CanMEDS) framework. However, the level of QIPS education and support that Canadian EM residents receive is unknown. In order to better plan national QIPS efforts aimed at enabling EM residents to improve their local care settings, we sought to assess the current state of QIPS education and support in Canadian EM residency programs. Methods: This was a descriptive, cross-sectional electronic survey that was disseminated to all current Canadian EM residents from both Royal College (RC) and Family Medicine - EM training streams. Residents were recruited either directly or through their program's administrative assistant. The survey consisted of multiple-choice, Likert and free-text entry questions. Themes included a) familiarity with QIPS; b) local opportunities for QIPS projects and mentorship; and c) desire for further QIPS education and involvement. The survey was open for a five-week period, with formal reminders after the first and third weeks. Descriptive statistics are reported. Results: 189 (35%) of 535 current EM residents completed the survey, representing all 17 medical schools. 77% of respondents were from the RC stream. 54.7% of respondents reported being “somewhat” or “very” familiar with QIPS. 47.2% of respondents reported “not knowing” or “not having readily available” QIPS projects to participate in their local environment, and 51.5% had equivalent responses with respect to QIPS mentorship opportunities. Only 17.5% of respondents reported that QIPS methodologies were already formally taught in their residency program, and 66.9% indicated a desire for increased QIPS teaching. The majority of respondents were “slightly” (35.9%), “moderately” (23.2%) or “very” (11.3%) interested in becoming involved with QIPS training and initiatives. Conclusion: Responding Canadian EM residents are interested in obtaining greater QIPS education as well as project and mentorship opportunities, but many perceive that they do not have adequate access to these at the current time. As the importance of QIPS increases in the EM community, supporting residents with more robust educational infrastructures may be necessary. Future efforts may include the standardizing of QIPS postgraduate curricula and improving access to QIPS opportunities across the country.

Cyber Operational Risk: Cyber risk is routinely cited as one of the most important sources of operational risks facing organisations today, in various publications and surveys. Further, in recent years, cyber risk has entered the public conscience through highly publicised events involving affected UK organisations such as TalkTalk, Morrisons and the NHS. Regulators and legislators are increasing their focus on this topic, with General Data Protection Regulation (“GDPR”) a notable example of this. Risk actuaries and other risk management professionals at insurance companies therefore need to have a robust assessment of the potential losses stemming from cyber risk that their organisations may face. They should be able to do this as part of an overall risk management framework and be able to demonstrate this to stakeholders such as regulators and shareholders. Given that cyber risks are still very much new territory for insurers and there is no commonly accepted practice, this paper describes a proposed framework in which to perform such an assessment. As part of this, we leverage two existing frameworks – the Chief Risk Officer (“CRO”) Forum cyber incident taxonomy, and the National Institute of Standards and Technology (“NIST”) framework – to describe the taxonomy of a cyber incident, and the relevant cyber security and risk mitigation items for the incident in question, respectively.Summary of Results: Three detailed scenarios have been investigated by the working party:

• ∙ Employee leaks data at a general (non-life) insurer: Internal attack through social engineering, causing large compensation costs and regulatory fines, driving a 1 in 200 loss of £210.5m (c. 2% of annual revenue).

• ∙ Cyber extortion at a life insurer: External attack through social engineering, causing large business interruption and reputational damage, driving a 1 in 200 loss of £179.5m (c. 6% of annual revenue).

• ∙ Motor insurer telematics device hack: External attack through software vulnerabilities, causing large remediation / device replacement costs, driving a 1 in 200 loss of £70.0m (c. 18% of annual revenue).

• ∙ While the presented scenarios are deemed material at this point in time, the threat landscape moves fast and could render specific narratives and calibrations obsolete within a short-time frame.

• ∙ There is a lack of historical data to base certain scenarios on and therefore a high level of subjectivity is used to calibrate them.

• ∙ No attempt has been made to make an allowance for seasonality of renewals (a cyber event coinciding with peak renewal season could exacerbate cost impacts)

• ∙ No consideration has been given to the impact of the event on the share price of the company.

• ∙ Correlation with other risk types has not been explicitly considered.

Continental paleoclimate proxies with near-global coverage are rare. Land snail δ18O is one of the few proxies abundant in Quaternary sediments ranging from the tropics to the high Arctic tundra. However, its application in paleoclimatology remains difficult, attributable in part to limitations in published calibration studies. Here we present shell δ18O of modern small (<10 mm) snails across North America, from Florida (30°N) to Manitoba (58°N), to examine the main climatic controls on shell δ18O at a coarse scale. This transect is augmented by published δ18O values, which expand our coverage from Jamaica (18°N) to Alaska (64°N). Results indicate that shell δ18O primarily tracks the average annual precipitation δ18O. Shell δ18O increases 0.5–0.7‰ for every 1‰ increase in precipitation δ18O, and 0.3–0.7‰ for every 1°C increase in temperature. These relationships hold true when all taxa are included regardless of body size (ranging from ~1.6 to ~58 mm), ecology (herbivores, omnivores, and carnivores), or behavior (variable seasonal active periods and mobility habits). Future isotopic investigations should include calibration studies in tropical and high-latitude settings, arid environments, and along altitudinal gradients to test if the near linear relationship between shell and meteoric precipitation δ18O observed on a continental scale remains significant.

Surface texturing of transparent conductive oxides is crucial to improve the fraction of incident light trapped in the absorber layer of thin film silicon based solar cells to improve the device performance. In this work, we fabricate and compare periodic, overlapping, and random surface textures and patterns on aluminium doped zinc oxide (AZO) using direct laser processing. The effects of the used laser wavelength, laser operating frequency, and pulse periodicity on the structural, morphological, and optical response of the AZO films were investigated. By optimizing the laser parameters and the associated process conditions, a drastic increase up to 60% in the transmittance haze over the entire solar was achieved.

Persistence of the embryonic “fifth aortic arch” in postnatal life is a rare, enigmatic – and at times controversial – condition, with variable anatomical forms and physiological consequences. First described in humans over 40 years ago by Van Praagh, the condition was labelled the “great pretender” by Gerlis 25 years later, because of its apparent propensity to mimic anatomically similar structures. Despite many subsequent case reports citing the condition, the true developmental origin of these structures remains unresolved, and has been the subject of debate among embryologists for more than a century. A persistent fifth aortic arch has been defined as an extrapericardial structure, arising from the ascending aorta opposite or proximal to the brachiocephalic artery, and terminating in the dorsal aorta or pulmonary arteries via a persistently patent arterial duct. This description may therefore encompass various anatomical forms, such as a unilateral double-lumen aortic arch, an unrestrictive aortopulmonary shunt, or a critical vascular channel for either the systemic or pulmonary circulation. The physiological properties of these vessels, such as their response to prostaglandins, may also be unpredictable. In this article, we demonstrate a number of cases that fulfil the contemporary definition of “persistent fifth aortic arch” while acknowledging the embryological controversies associated with this term. We also outline the key diagnostic features, particularly with respect to the use of new cross-sectional imaging techniques.

The consumption of n-3 PUFAs is low, particularly the long chain (>18 carbon atoms) fatty acids that are most commonly found in fish oils. These dietary fatty acids have been shown to have a great effect on the health and immune status of different species including humans, rats and poultry. The current paper reviews studies on the effect of dietary polyunsaturated fatty acids on B- and T-cell subpopulations in peripheral blood, spleen, and thymus of poultry.

This paper presents the results of an investigation of the flow around rectangular and chamfered cavities at high subsonic and low supersonic speeds. Pressures measured on the faces of the cavities are integrated to find the pressure drag of the cavities. The types of cavity tested range from simple sawcuts to cavities so long that the two ends can be regarded as independent and the results for these are compared with the sum of the drags of isolated forward and rear facing steps.

Although the Reynolds numbers of the tests are similar to those in flight conditions the maximum depth of the cavities tested is only 6 mm so that the pressure resolution on the vertical faces of the cavities is limited. In spite of this it is estimated that the maximum error in the drag of any particular cavity is less than the skin friction drag on a smooth surface equal in area to half the plan area of the cavity.

Iatrogenic Horner’s syndrome is a rare complication that can occur after trauma, cervical central line insertion, chest tube insertion, and rarely following adult thoracic and neck surgery, especially in high risk patients with hypertension and diabetes. The majority of cases reported in the literature describe non-iatrogenic Horner’s syndrome in adults as an unusual presentation for cervical tumours or apical lung carcinoma. In children, there are some reports describing acquired Horner’s syndrome following trauma or invasive intervention near the cervical–thoracic area. Less has been written about the incidence of Horner’s syndrome following paediatric cardiac surgery.

The rTSSA-II (recombinant Trypomastigote Small Surface II) antigen was evaluated by ELISA to detect anti-Trypanosoma cruzi antibodies in sera from naturally infected dogs and humans. For this evaluation ELISA-rTSSA-II was standardized and groups were classified according to the results obtained through xenodiagnosis, ELISA and PCR. Sensitivity (Se), Specificity (Sp), Kappa index (KI) and area under curve (AUC) were determined. The Se was determined by using 14 sera from dogs infected with T. cruzi VI (TcVI) whereas Sp was determined by using 95 non-chagasic sera by xenodiagnosis, ELISA-Homogenate and PCR. The performance of ELISA-rTSSA-II in dog sera was high (AUC=0·93 and KI=0·91). The Se was 92·85% (1 false negative) and Sp was 100%. Two sera from dogs infected with TcI and 1 with TcIII were negative. For patients infected with T. cruzi, reactivity was 87·8% (36/41), there was only 1 indeterminate, and Sp was 100%. Fifty-four sera from non-chagasic and 68 sera from patients with cutaneous leishmaniasis did not react with rTSS-II. ELISA-rTSSA-II showed a high performance when studying sera from naturally infected dogs and it also presented 100% Sp. This assay could be an important tool to carry out sero-epidemiological surveys on the prevalence of T. cruzi circulating lineages in the region.