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Background: Whilst the uniqueness of loneliness and social isolation is now recognised for members of the Armed Forces Community, there is currently a lack of evidence examining these experiences within the Military Widow/er population. Therefore, this scoping review aimed to search and synthesise the current evidence base exploring experiences of loneliness and social isolation in this community. Method: Six databases were searched; ASSIA; CINAHL; ProQuest Dissertation & Theses Global; PsycArticles; Medline; Web of Science. Any article type was included if they focused on UK or international Military Widows and loneliness and social isolation. In the absence of loneliness and social isolation, related aspects were included, for example, social support. Results: A thematic synthesis was completed on the nine eligible papers, where key findings were coded and generated into four themes; Experiences of Loneliness and Social Isolation, The Uniqueness of the Military, Access to Social Support, and The Importance of Peer Support. Conclusions: Evidence supports the need for military-specific support services with peers who recognise the individuals' unique experiences of loneliness and social isolation. None of the available evidence focused specifically on social isolation, however this was often prevalent in the results. All of the studies were carried out in the USA and Israel, with none including the views of widowers. Further evidence is required, particularly relating to a UK-context. [ABSTRACT FROM AUTHOR]

Metalwork was a major technological innovation that displaced stone-tool technologies and transformed human society and the environment. However, our understanding of these processes remains partial. In this paper, we approach the stone-to-metal transition from a novel angle–the presence of flint knapping at metal production sites. Drawing on excavations at the Late Bronze and Iron Age copper smelting sites in Timna Valley, Israel, we demonstrate that systematic production of expedient stone tools was integral to these sites' industrial operations, placing it at the heart of the very same metal circulation networks that were presumably responsible for its displacement. The observations from Timna, coupled with evidence for the use of chipped stone technology in other early Iron Age metallurgical contexts, support the hypothesis that it was probably both the high accessibility of iron and its qualities that put an end to the stone tool industry. Copper and bronze could not easily fulfill the function of the ad hoc stone tools and were not used to replace stone tools even if they were available and accessible. [ABSTRACT FROM AUTHOR]

Scholars have identified a range of variables that predict public health compliance during COVID-19, including: psychological, institutional and situational variables as well as demographic characteristics, such as gender, location and age. In this paper, we argue that religious affiliation is also a clear predictor for compliance with public health guidelines. Based on a sample representative survey (N = 800) of Haredi Jews in Israel, we found that Haredi Jews mostly followed COVID-19 health regulations. Among the respondents who were non-compliant, however, we found large divergences which mostly reflected religious affiliation. While members of Lithuanian and Sephardi communities reported following guidelines, Hasidim, a more charismatic sub-group, were 12% and 14% more likely to flout public health guidelines than their Lithuanian and Sephardi counterparts, respectively. Despite this inner diversity, all Haredim were portrayed in Israeli media as one homogeneous group that was blamed for flouting public health guidelines and spreading COVID-19. Based on these findings, we argue for the importance of public health messaging that attends to diverse aspects of religious dogma, practice and observance by creating partnerships and sustainable relationships between different actors and stakeholders. In addition, we found that compliance was also shaped by knowledge about COVID-19 and public concern. Taking these findings together, health communication that acknowledges religious diversity while providing critical knowledge about the pandemic is key to developing and implementing community-focused interventions and public health programs. Practically, these insights help to improve pandemic governance as well as contributing theoretically to the study of public health relations and religion by highlighting how discourses around health vary and how differently positioned actors shape representations of responsiveness and health compliance. [ABSTRACT FROM AUTHOR]

Past research has stressed the role of age and generation in climate change discourse, worries, and willingness to act. Therefore, the present paper aimed to examine the role of chronological age (as an arbitrary factor, which represents ageism) in lay people's climate change-related attitudes, feelings, and behavioral intentions. Two experiments in different countries, Australia and Israel, were conducted for this purpose. The first study examined the impact of the age of the speaker, who provides information about the climate crisis and the second examined the impact of the age of the group being blamed for the situation. Outcome variables included perceived responsibility and motivation for the current climate situation in study 1 and perceived climate change-related attitudes, feelings, and behavioral intentions in study 2. In study 1 (n = 250, Australia), the age of the speaker, a climate activist, varied randomly to test the hypothesis that a younger activist would be more influential and increase motivation and responsibility to act compared to an older activist. In study 2 (n = 179, Israel), the age (young vs. old) of the group identified as being responsible for the climate crisis varied randomly, to test the hypothesis that people would be more willing to identify older people as being responsible for the current climate situation, and this would impact climate change-related attitudes, feelings, and behavioral intentions. Both studies resulted in null effects. Additionally, there was no interaction between the age of the respondent and the age of the source of the message or the age group being blamed by the message. The present study has failed to show that strategies that emphasize intergenerational conflict and ageism impact people's attitudes, feelings, and behavioral intentions towards the current climate situation. This possibly can serve as an instigator for strategies that emphasize intergenerational solidarity, rather than conflict, as a guiding principle in future campaigns that advocate climate change adaptation and mitigation measures. [ABSTRACT FROM AUTHOR]

Eight olivine beads found at the Middle Chalcolithic site of Tel Tsaf (ca. 5,200–4,700 cal. BC), Jordan Valley, Israel, underscore a new facet of interregional exchange for this period. The current paper presents the olivine beads assemblage, its morphometric and technological characteristics, and chemical composition. The results of the chemical analysis suggest that all eight beads derive from the same source. By means of comparison with the chemical characteristics of known olivine sources, we argue for a northeastern African–western Arabian provenience and cautiously suggest Ethiopia as a probable origin. Finally, we discuss the significance of the assemblage, its possible origin, and the mechanisms that may have brought the beads to the site. [ABSTRACT FROM AUTHOR]

The Lower Paleolithic Late Acheulian in the Levant marks a fascinating chapter in human cultural and biological evolution. Nevertheless, many aspects of the Late Acheulian are still undeciphered, hindered by the complex nature of each site on the one hand, a scarcity of wide, multidisciplinary studies on the other, and by difficulties in obtaining absolute chronology for this timeframe. Therefore, subjects such as human subsistence strategies and modes of adaptation, regional diversity, and the possible existence and nature of interactions between hominin groups are largely understudied. The discovery and study of Jaljulia, a large-scale Late Acheulian site at the central Coastal Plain, Israel, add valuable insights to the research of this chapter in human history. Considered to represent recurrent occupations at a favored, water and flint-rich setting, the site has provided extensive lithic assemblages obtained from several localities. Absolute chronology places the human activity on-site at roughly 500–300 ky (and possibly even later), which is suggested to be divided into several main occupation phases. Geomorphological and sedimentological analyses show a change in environmental conditions, from aeolian sand deposition and overlying Hamra soil during the Middle Pleistocene to high energy fluvial regime which transported large gravels in a north-south paleo-channel. Wetland environments, correlating to the human activity on site, developed later due to higher sea levels and a coastline shifts to the eastward, which caused a blockage of the Yarkon stream corridor to the sea by marine sand. In this paper we present results of the study of the site, including geomorphological formation and post-depositional processes, absolute chronology, lithic and faunal analyses. The site's extensive lithic assemblages are currently under study and future investigations are expected to shed more light on the technological nature of Late Acheulian Jaljulia. [ABSTRACT FROM AUTHOR]

Nineteen broken and complete bone fish hooks and six grooved stones recovered from the Epipaleolithic site of Jordan River Dureijat in the Hula Valley of Israel represent the largest collection of fishing technology from the Epipaleolithic and Paleolithic periods. Although Jordan River Dureijat was occupied throughout the Epipaleolithic (~20–10 kya the fish hooks appear only at the later stage of this period (15,000–12,000 cal BP). This paper presents a multidimensional study of the hooks, grooved stones, site context, and the fish assemblage from macro and micro perspectives following technological, use wear, residue and zooarchaeological approaches. The study of the fish hooks reveals significant variability in hook size, shape and feature type and provides the first evidence that several landmark innovations in fishing technology were already in use at this early date. These include inner and outer barbs, a variety of line attachment techniques including knobs, grooves and adhesives and some of the earliest evidence for artificial lures. Wear on the grooved stones is consistent with their use as sinkers while plant fibers recovered from the grooves of one hook shank and one stone suggest the use of fishing line. This together with associations between the grooved stones and hooks in the same archaeological layers, suggests the emergence of a sophisticated line and hook technology. The complexity of this technology is highlighted by the multiple steps required to manufacture each component and combine them into an integrated system. The appearance of such technology in the Levantine Epipaleolithic record reflects a deep knowledge of fish behavior and ecology. This coincides with significant larger-scale patterns in subsistence evolution, namely broad spectrum foraging, which is an important first signal of the beginning of the transition to agriculture in this region. [ABSTRACT FROM AUTHOR]

Dedicated inpatient care for eating disorders has profound impact on patients' embodied practices and lived realities. Analyses of inpatients' accounts have shown that participants endorse complex and conflicting attitudes toward their experiences in eating disorders wards, yet the apparent ambivalence that characterizes inpatient experiences has not been subject to critical examination. This paper examines the narrated experiences of 13 participants (12 women and one man; age 18–38 years at first interview) with past or present anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified, who had been hospitalized in an inpatient eating disorders ward for adults in central Israel. The interviews, which took place in 2005–2006, and again in 2011, were part of a larger longitudinal study exploring the subjective experiences of eating disorders and recovery among Israeli adults. Employing qualitative analysis, this study finds that the participants' accounts were concerned with dynamics of difference and belonging, as they played out in various aspects of inpatient care, including diagnosis, treatment, relationships with fellow patients and staff, and everyday life in hospital. Notably, participants simultaneously defined themselves as connected to, but also distinct from, the eating disordered others who formed their reference group at the ward. Through negotiating a protectively ambivalent positioning, participants recognized their eating disordered identities and connected with others on the ward, while also asserting their non-disordered individuality and distancing themselves from the potential dangers posed by ‘excessive’ belonging. The paper suggests that this ambivalent positioning can usefully be understood through the anthropological concept of liminality: being both a part of and apart from one's community. [ABSTRACT FROM AUTHOR]

Chopping tools/choppers provide one of the earliest and most persistent examples of stone tools produced and used by early humans. These artifacts appeared for the first time ~2.5 million years ago in Africa and are characteristic of the Oldowan and Acheulean cultural complexes throughout the Old World. Chopping tools were manufactured and used by early humans for more than two million years regardless of differences in geography, climate, resource availability, or major transformations in human cultural and biological evolution. Despite their widespread distribution through time and space in Africa and Eurasia, little attention has been paid to the function of these items, while scholars still debate whether they are tools or cores. In this paper, we wish to draw attention to these prominent and ubiquitous early lithic artifacts through the investigation of 53 chopping tools retrieved from a specific context at Late Acheulean Revadim (Israel). We combined typo-technological and functional studies with a residue analysis aimed at shedding light on their functional role within the tool-kits of the inhabitants of the site. Here we show that most of the chopping tools were used to chop hard and medium materials, such as bone, most probably for marrow extraction. A few of the tools were also used for cutting and scraping activities, while some also served as cores for further flake detachment. The chopping tools exhibit extraordinarily well-preserved bone residues suggesting they were used mainly for bone-breaking and marrow acquisition. We discuss the data and explore the tool versus core debate also in light of a sample of 50 flake cores made on pebbles/cobbles retrieved from the same archeological layer. The results add further pieces to the puzzle of activities carried out at Revadim and add to our knowledge of the production and use of these enigmatic tools and their role in human evolutionary history. [ABSTRACT FROM AUTHOR]

The miniaturization of stone tools, as reflected through the systematic production of bladelets and bladelet tools (microliths), characterized many industries of the Late Pleistocene, with the Levantine Epipalaeolithic serving as a well-studied example. It is commonly held that microliths were used as modular inserts in composite projectiles, while their incorporation in other tools for different tasks is generally overlooked, the latter aspect being the main focus of this paper. We present here a more inclusive approach through a case study of the Geometric Kebaran (Middle Epipalaeolithic, ca. 18,500–15,000 cal BP) site of Neve David, Mount Carmel, Israel. Recent excavations at the site exposed a variety of features, and one well-preserved shallow pit provided a large lithic assemblage with ca. 90 microliths. We studied this assemblage using both the low- and high- magnification use-wear protocols, accompanied by a range of experiments. Our results show that a) the fragmentation rate is very high in this assemblage (ca. 90%), b) most of the microliths have identifiable use-wear, c) the microliths were commonly used as inserts in composite projectiles, d) many microliths were used for functions not related to weaponry and hunting, such as wood-working, weed harvesting and meat processing. These findings strongly support the suggestion that the small insets, regardless of their specific type (trapeze, rectangle, backed/retouched bladelet), were used in a wide variety of composite tools. We argue that such a versatile approach and flexibility in the use of microliths reflect a technological advantage where a minimal set of microlithic types, produced in large numbers, could provide the required elements for weapons, as well as for a variety of cutting, processing and harvesting tools needed for mundane tasks at a large Middle Epipalaeolithic camp. [ABSTRACT FROM AUTHOR]

The history of mudbrick production and construction in the southern Levant may be dated as far back to the Pre-Pottery Neolithic A. However, at many of the sites where mudbrick remains were noted, their preservation was poor, so investigation of their production and the related construction techniques in antiquity was precluded. The 7,200 year old (cal BP) site of Tel Tsaf, located in the Jordan Valley, is distinguished by outstanding preservation of mudbrick architecture, which enables us to delve into various issues related to mudbrick technology, construction and preservation. The present paper discusses some of the mudbrick features at Tel Tsaf and their characteristics and offers a comprehensive analytical study of the mudbricks from multiple contexts and phases. These demonstrate consistency in three of the four measured variables: magnetic susceptibility, organic content and calcium carbonate equivalent. The results of our study suggest that while we can identify morphometric variability between bricks and walls, by and large, a uniform composition characterized the tested assemblages without any temporal or spatial variability. This indicates that a single locally-sourced raw material was used and that recycling of old decayed mudbricks was likely practiced. The consistency of mudbrick-production during all phases of the occupation at Tel Tsaf and the absence of multiple recipes implies that a shared production and technological know-how was maintained for at least 500 years at the site. [ABSTRACT FROM AUTHOR]

A longstanding debate concerns the function of carinated elements in both, the Levantine, and European Aurignacian. The present study aims to contribute to this topic with the evaluation of the carinated assemblage from layer D in Hayonim Cave, Western Galilee, Israel, one of the type sites of the Levantine Aurignacian. An operational chain reconstruction with an attribute analysis is paired with a typological approach to the preparation and maintenance products based on artefacts defined as West European Aurignacian. The results of this study are investigated with multivariate statistics offering a methodological contribution. The data is subjected to a transformation into a distance matrix using the Gower distance and tested with the adonis-algorithm for significance. The results clearly indicate that the carinated items in Hayonim Cave did fully or partially function as cores. They are accompanied by diagnostic preparation- and- maintenance products known from the literature e.g. Thèmes bladelets. The statistical analysis indicates only a minor correlation with stratigraphy yet supports the techno-typological criteria applied for defining artefact categories (cores, debitage, tools), as well as the proposed differentiation of carinated 'core' types. The non-carinated cores in Hayonim Cave are characterised by a high variability in typology and reduction concepts. A curious similarity to the Levallois-concept is observed on some of the flake cores. It is therefore suggested that the frequent recycling of Middle Palaeolithic artefacts in the Levantine Aurignacian might have given the Aurignacian flint-knappers the opportunity to study the Levallois concept and apply an approximation of it in their own core reduction strategies. The notion that Palaeolithic flint-knappers actively observed former technological systems through the discarded artefacts directly opens up a new trajectory for the understanding of lithic reduction concept permanence. The conceptual diversification and variability in Hayonim Cave D indicate a highly dynamic period in the Levantine Upper Palaeolithic which increased the adaptive potential and promoted a rapid cultural change. [ABSTRACT FROM AUTHOR]

The origin of the tin used for the production of bronze in the Eurasian Bronze Age is still one of the mysteries in prehistoric archaeology. In the past, numerous studies were carried out on archaeological bronze and tin objects with the aim of determining the sources of tin, but all failed to find suitable fingerprints. In this paper we investigate a set of 27 tin ingots from well-known sites in the eastern Mediterranean Sea (Mochlos, Uluburun, Hishuley Carmel, Kfar Samir south, Haifa) that had been the subject of previous archaeological and archaeometallurgical research. By using a combined approach of tin and lead isotopes together with trace elements it is possible to narrow down the potential sources of tin for the first time. The strongly radiogenic composition of lead in the tin ingots from Israel allows the calculation of a geological model age of the parental tin ores of 291 ± 17 Ma. This theoretical formation age excludes Anatolian, central Asian and Egyptian tin deposits as tin sources since they formed either much earlier or later. On the other hand, European tin deposits of the Variscan orogeny agree well with this time span so that an origin from European deposits is suggested. With the help of the tin isotope composition and the trace elements of the objects it is further possible to exclude many tin resources from the European continent and, considering the current state of knowledge and the available data, to conclude that Cornish tin mines are the most likely suppliers for the 13th–12th centuries tin ingots from Israel. Even though a different provenance seems to be suggested for the tin from Mochlos and Uluburun by the actual data, these findings are of great importance for the archaeological interpretation of the trade routes and the circulation of tin during the Late Bronze Age. They demonstrate that the trade networks between the eastern Mediterranean and some place in the east that are assumed for the first half of the 2nd millennium BCE (as indicated by textual evidence from Kültepe/Kaneš and Mari) did not exist in the same way towards the last quarter of the millennium. [ABSTRACT FROM AUTHOR]

Most papers on the physical condition of birds during spring migration focused on food availability preceding migratory take-off. Only a few studies examined the effect of climate conditions at the wintering grounds upon autumn arrival on bird physical condition later on. Here, we hypothesized that environmental conditions upon arrival at the wintering grounds, and not necessarily upon departure, have a crucial carry-over effect on bird spring migration. Using 29,000 observations of the lesser whitethroat, Sylvia curruca, and the eastern Bonelli’s warbler, Phylloscopus orientalis, we found temperatures upon arrival at the African wintering grounds to be the only climatic variable correlated with birds’ body state upon spring stopover in Israel, six months later. Two different mechanisms could explain these results. One possibility is that high temperatures create favorable conditions for insect activity, which allows rapid recovery from autumn migration and hence successful winter survival and maintenance. Another possible scenario is that harsh conditions, due to the heat and dry environment, cause high mortality, permitting survival of larger individuals which, then, enjoy reduced inter- and intra-specific competition. Whatever the mechanism is, our findings suggest that conditions upon autumn arrival, and not necessarily at the end of winter as traditionally thought, may have a major impact on migrating birds. [ABSTRACT FROM AUTHOR]

This study presents the complete genome sequence of a novel nege-like virus identified in whiteflies (Bemisia tabaci MEAM1), provisionally designated as whitefly negevirus 1 (WfNgV1). The virus possesses a single-stranded RNA genome comprising 11,848 nucleotides, organized into four open reading frames (ORFs). These ORFs encode the putative RNA-dependent-RNA-polymerase (RdRp, ORF 1), a glycoprotein (ORF 2), a structural protein with homology to those in the SP24 family, (ORF 3), and a protein of unknown function (ORF 4). Phylogenetic analysis focusing on RdRp and SP24 amino acid sequences revealed a close relationship between WfNgV1 and Bemisia tabaci negevirus 1, a negevirus sequence recently discovered in whiteflies from Israel. Both viruses form a clade sharing a most recent common ancestor with the proposed nelorpivirus and centivirus taxa. The putative glycoprotein from ORF 2 and SP24 (ORF 3) of WfNgV1 exhibit the characteristic topologies previously reported for negevirus counterparts. This marks the first reported negevirus-like sequence from whiteflies in the Americas. [ABSTRACT FROM AUTHOR]

Human salmonellosis cases are often caused by Salmonella serovars Enteritidis and Typhimurium and associated with the consumption of eggs and egg products. Many countries therefore implemented general surveillance programmes on pullet and layer farms. The identification of risk factors for Salmonella infection may be used to improve the performance of these surveillance programmes. The aims of this study were therefore to determine 1) whether local farm density is a risk factor for the infection of pullet and layer farms by Salmonella Enteritidis and Typhimurium and 2) whether the sampling effort of surveillance programmes can be reduced by accounting for this risk factor, while still providing sufficient control of these serovars. We assessed the importance of local farm density as a risk factor by fitting transmission kernels to Israeli surveillance data during the period from June 2017 to April 2019. The analysis shows that the risk of infection by serovars Enteritidis and Typhimurium significantly increased if infected farms were present within a radius of approximately 4 km and 0.3 km, respectively. We subsequently optimized a surveillance programme that subdivided layer farms into low and high risk groups based on the local farm density with and allowed the sampling frequency to vary between these groups. In this design, the pullet farms were always sampled one week prior to pullet distribution. Our analysis shows that the risk-based surveillance programme is able to keep the between-farm R0 of serovars Enteritidis and Typhimurium below 1 for all pullet and layer farms, while reducing the sampling effort by 32% compared to the currently implemented surveillance programme in Israel. The results of our study therefore indicate that local farm density is an important risk factor for infection of pullet and layer farms by Salmonella Enteritidis and Typhimurium and can be used to improve the performance of surveillance programmes. [ABSTRACT FROM AUTHOR]

The novel coronavirus, COVID-19, first identified in Wuhan, China, in December 2019, rapidly spread across the globe and resulted in significant public concern. In response, numerous countries have implemented guidelines aimed at promoting social distancing, limiting movement and gatherings, instituting lockdowns and curfews, and closing institutions. As a result, the media, including news releases, has become a primary source of information for many individuals (Laor & Lissitsa, 2022). The present study seeks to investigate differences between major television programs featured on public and commercial channels in Israel, utilizing the lens of framing theory. Specifically, twelve monologues broadcast simultaneously on both channels were analyzed to compare differences in content, topics, format, and accompanying visuals. The study's results indicate that both commercial and public channels exhibited similar behavior in shaping public opinion during the crisis period. Specifically, both channels displayed criticism of the government's conduct and utilized negative framing techniques while neglecting to provide space for popular voices. Nevertheless, certain distinctions between the commercial and public broadcasting spheres still persist, particularly in the realm of visual presentation, as some long-standing elements that typify each channel have endured over time. [ABSTRACT FROM AUTHOR]

This paper explores several data mining and time series analysis methods for predicting the magnitude of the largest seismic event in the next year based on the previously recorded seismic events in the same region. The methods are evaluated on a catalog of 9,042 earthquake events, which took place between 01/01/1983 and 31/12/2010 in the area of Israel and its neighboring countries. The data was obtained from the Geophysical Institute of Israel. Each earthquake record in the catalog is associated with one of 33 seismic regions. The data was cleaned by removing foreshocks and aftershocks. In our study, we have focused on ten most active regions, which account for more than 80% of the total number of earthquakes in the area. The goal is to predict whether the maximum earthquake magnitude in the following year will exceed the median of maximum yearly magnitudes in the same region. Since the analyzed catalog includes only 28 years of complete data, the last five annual records of each region (referring to the years 2006–2010) are kept for testing while using the previous annual records for training. The predictive features are based on the Gutenberg-Richter Ratio as well as on some new seismic indicators based on the moving averages of the number of earthquakes in each area. The new predictive features prove to be much more useful than the indicators traditionally used in the earthquake prediction literature. The most accurate result (AUC = 0.698) is reached by the Multi-Objective Info-Fuzzy Network (M-IFN) algorithm, which takes into account the association between two target variables: the number of earthquakes and the maximum earthquake magnitude during the same year. [ABSTRACT FROM AUTHOR]

One of the central questions of the transition from mobile hunter-gatherers to sedentary farming communities concerns the establishment of new social structures and group identities. Along with other important factors, such as territory, ideology or economy, biological relationships might have played a decisive role in defining social groups. We therefore systematically analyzed teeth and jaw remains from nine sites in the Near East dating from the Natufian to the Late PPNB as primary proxy data for the reconstruction of familial relationships. This paper presents the results of morphological analyses on the teeth of the individuals from Kfar HaHoresh, one of the investigated Pre-Pottery Neolithic B sites. Kfar HaHoresh is located in the Nazareth hills of Galilee (32°42'20'' N 35°16'28'' E), Israel. Different statistical methods were applied to our data of epigenetic traits with the aim of determining biological relationships within the community, whereby the data of the eight other sites were used as cross-references. Our comparison of the traits of all individuals from Kfar HaHoresh indicates a rather heterogeneous community, but clearly shows one cluster belonging to a quite homogenous group, suggesting close biological relations between females and sub-adults. Interestingly, none of the male individuals belongs to this cluster, although their number outweighs that of the female individuals. This might suggest matrilocal residence patterns. However, due to the incomplete preservation of the teeth along with several other uncertainties, our conclusion must be seen as preliminary. A cross-examination of the results on skeletons excavated after our investigation should also be taken into consideration. [ABSTRACT FROM AUTHOR]

The archaeological record indicates that elephants must have played a significant role in early human diet and culture during Palaeolithic times in the Old World. However, the nature of interactions between early humans and elephants is still under discussion. Elephant remains are found in Palaeolithic sites, both open-air and cave sites, in Europe, Asia, the Levant, and Africa. In some cases elephant and mammoth remains indicate evidence for butchering and marrow extraction performed by humans. Revadim Quarry (Israel) is a Late Acheulian site where elephant remains were found in association with characteristic Lower Palaeolithic flint tools. In this paper we present results regarding the use of Palaeolithic tools in processing animal carcasses and rare identification of fat residue preserved on Lower Palaeolithic tools. Our results shed new light on the use of Palaeolithic stone tools and provide, for the first time, direct evidence (residue) of animal exploitation through the use of an Acheulian biface and a scraper. The association of an elephant rib bearing cut marks with these tools may reinforce the view suggesting the use of Palaeolithic stone tools in the consumption of large game. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the laser power stability of the SubCyclo probe for micropulse transscleral cyclophotocoagulation after repeated use. Materials and methods: This experimental study involved 6 new probes. Each probe was connected to the SubCyclo mode (2,000 mW power, 31.3% duty cycle, and 100 seconds duration) of the Vitra 810 laser delivery system (Quantel Medical, France). Laser power measurements were taken using a calibrated laser power meter (Nova, Ophir Optronics Solutions, Israel) every 10 seconds from 10 to 90 seconds during each of the 40 cycles. Intra-rater reliability was assessed using intraclass correlation (ICC). A linear mixed model for repeated measures and pairwise comparisons with Bonferroni adjustment were used for the analysis. Results: The mean (SD) power outputs of all probes for the first cycle and all cycles were 421.9 (19.7) mW and 436.7 (16.1) mW, respectively. During the first cycle, the mean (SD) laser power gradually decreased from 444.3 (13.4) mW at 10 seconds to 407.3 (17.0) mW at 90 seconds (Fig 3). For all cycles, the power was 446.0 (13.6) mW at 10 seconds and gradually declined to 426.8 (21.0) mW at 90 seconds. Pairwise comparisons revealed significant differences in mean laser power outputs after 16 cycles of repeated use compared to the first cycle. The ICC estimate (95% CI) for intra-rater reliability was 0.96 (0.89, 0.99). Conclusions: The SubCyclo probe maintains stable laser power outputs throughout repeated use for up to 16 cycles, with a significant increase observed after 16 cycles. [ABSTRACT FROM AUTHOR]

Decorating the living space, objects, body and clothes with colour is a widespread human practice. While the habitual use of red mineral pigments (such as iron-oxide, e.g., ochre) by anatomically modern humans started in Africa about 140,000 years ago, the earliest documentation of the use of organic plant or animal-based red pigments is known from only 6,000 years ago. Here, we report the oldest reliable evidence of organic red pigment use 15,000 years ago by the first sedentary hunter-gatherers in the Levant. SEM-EDS and Raman Spectroscopy analyses of 10 red-stained shell beads enabled us to detect and describe the use of a colourant made of Rubiaceae plants roots (Rubia spp., Asperula spp., Gallium spp.) to colour personal adornments from the Early Natufian of Kebara cave, Mount Carmel, Israel. This adds a previously unknown behavioural aspect of Natufian societies, namely a well-established tradition of non-dietary plant processing at the beginning of the sedentary lifestyle. Through a combined multidisciplinary approach, our study broadens the perspectives on the ornamental practices and the chaînes opératoires of pigmenting materials during a crucial period in human history. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic began impacting Europe in early 2020, posing significant challenges for individuals requiring care. This group is particularly susceptible to severe COVID-19 infections and depends on regular health care services. In this article, we examine the situation of European care recipients aged 50 years and older 18 months after the pandemic outbreak and compare it to the initial phase of the pandemic. In the descriptive section, we illustrate the development of (unmet) care needs and access to health care throughout the pandemic. Additionally, we explore regional variations in health care receipt across Europe. In the analytical section, we shed light on the mid- and long-term health consequences of COVID-19-related restrictions on accessing health care services by making comparisons between care recipients and individuals without care needs. We conducted an analysis using data from the representative Corona Surveys of the Survey of Health, Ageing and Retirement in Europe (SHARE). Our study examines changes in approximately 3,400 care-dependent older Europeans (aged 50+) interviewed in 2020 and 2021, comparing them with more than 45,000 respondents not receiving care. The dataset provides a cross-national perspective on care recipients across 27 European countries and Israel. Our findings reveal that in 2021, compared to the previous year, difficulties in obtaining personal care from someone outside the household were significantly reduced in Western and Southern European countries. Access to health care services improved over the course of the pandemic, particularly with respect to medical treatments and appointments that had been canceled by health care institutions. However, even 18 months after the COVID-19 outbreak, a considerable number of treatments had been postponed either by respondents themselves or by health care institutions. These delayed medical treatments had adverse effects on the physical and mental health of both care receivers and individuals who did not rely on care. [ABSTRACT FROM AUTHOR]

Burnt materials are very common in the archaeological record. Their identification and the reconstruction of their firing history are crucial for reliable archaeological interpretations. Commonly used methods are limited in their ability to identify and estimate heating temperatures below ~500⁰C and cannot reconstruct the orientation in which these materials were burnt. Stepwise thermal demagnetization is widely used in archaeomagnetism, but its use for identifying burnt materials and reconstructing paleotemperatures requires further experimental verification. Here we present an experimental test that has indicated that this method is useful for identifying the firing of mud bricks to 190⁰C or higher. Application of the method to oriented samples also enables reconstruction of the position in which they cooled down. Our algorithm for interpreting thermal demagnetization results was tested on 49 miniature sun-dried "mud bricks", 46 of which were heated to a range of temperatures between 100⁰C to 700⁰C under a controlled magnetic field and three "bricks" which were not heated and used as a control group. The results enabled distinguishing between unheated material and material heated to at least 190⁰C and accurately recovering the minimum heating temperature of the latter. Fourier-Transform Infrared Spectroscopy (FTIR) on the same materials demonstrated how the two methods complement each other. We implemented the thermal demagnetization method on burnt materials from an Iron Age structure at Tell es-Safi/Gath (central Israel), which led to a revision of the previously published understanding of this archaeological context. We demonstrated that the conflagration occurred within the structure, and not only in its vicinity as previously suggested. We also showed that a previously published hypothesis that bricks were fired in a kiln prior to construction is very unlikely. Finally, we conclude that the destruction of the structure occurred in a single event and not in stages over several decades. [ABSTRACT FROM AUTHOR]

Reports from many settings suggest that pediatric overweight and obesity increased in 2020 and 2021, presumably due to lifestyle changes associated with the COVID-19 pandemic. Many of these previous reports have relied on convenience samples or subsets of the population. Here, we present results of a longitudinal study of the entire population of Israel, a nation of approximately 9 million people, with the proportion with underweight, normal weight, overweight, and obesity at age 7 and at age 14–15, across the years 2017–2021. Our results show that the prevalence of overweight and obesity, which had been steady or improving through 2019, increased relatively quickly in 2020 and 2021. For example, among 7-year-olds, the percentage of children with obesity in 2019 was 6.8% (99% CI: 6.69–7.05), and by 2021, it had increased to 7.7% (99% CI: 7.53–7.93). There were important disparities in overweight and obesity based on SES; for example, the rate ratio for obesity comparing the poorest with the wealthiest 14–15-year-olds in 2019 was 1.63 (99% CI: 1.55–1.72). However, these disparities did not change meaningfully in 2020 and 2021, implying that while obesity did become more prevalent, this increase in prevalence was not differential across socioeconomic status. Like many other nations, Israel too experienced considerable increases in pediatric overweight and obesity in 2020–2021, erasing the improvements of the previous years among younger children. [ABSTRACT FROM AUTHOR]

Over the past decade, the popularity of installing advanced driver-assistance systems (ADAS) in cars has increased markedly. However, the effectiveness of ADAS is subject to debate, primarily because these systems intervene in drivers' perceptions and actions and could lead to adaptive behavior. Using complete national data for the installation of three leading safety systems and speeding tickets issued over the course of an entire year, allowed us to pinpoint the impact of these safety systems at a national level. Employing zero-inflated negative binomial regression models, we found that the installation of the three safety systems was associated with higher number of speeding tickets. These findings are in line with the literature that indicates adaptive behavior in the context of risk. However, when we accounted for the proneness to commit other traffic violations, the effect of the safety systems on the prevalence of speeding tickets was evident only for those prone to violations. Further research should be conducted to identify which drivers will be more likely to be affected and under what circumstances and safety system types. [ABSTRACT FROM AUTHOR]

Here we present the paleopathological profiles of two young adult males, identified as brothers through ancient DNA analysis, who were buried together beneath the floor of an elite early Late Bronze Age I (ca. 1550–1450 BC) domestic structure at the urban center of Megiddo (modern Israel). Both individuals displayed uncommon morphological variants related to developmental conditions, and each exhibited extensive bone remodeling consistent with chronic infectious disease. Additionally, one brother had a healed fracture of the nose, as well as a large square piece of bone cut from the frontal bone (cranial trephination). We consider the potential etiologies for the appearance of the skeletal anomalies and lesions. Based on the bioarchaeological context, we propose that a shared epigenetic landscape predisposed the brothers to acquiring an infectious disease and their elite status privileged them enough to endure it. We then contextualize these potential illnesses and disorders with the trephination procedure. The infrequency of trephination in the region indicates that only selected individuals could access such a procedure, and the severity of the pathological lesions suggests the procedure was possibly intended as curative to deteriorating health. Ultimately, both brothers were buried with the same rites as others in their community, thus demonstrating their continued integration in society even after death. [ABSTRACT FROM AUTHOR]

Background and objective: Over the past decade, researchers have been seeking to understand the consequences of adult attention-deficit/hyperactivity disorder (ADHD) for different types of everyday behaviors. In this study, we investigated the associations between ADHD and political participation and attitudes, as ADHD may impede their active participation in the polity. Methods: This observational study used data from an online panel studying the adult Jewish population in Israel, collected prior the national elections of April 2019 (N = 1369). ADHD symptoms were assessed using the 6-item Adult ADHD Self-Report (ASRS-6). Political participation (traditional and digital), news consumption habits, and attitudinal measures were assessed using structured questionnaires. Multivariate linear regression analyses were conducted to analyze the association between ADHD symptoms (ASRS score <17) and reported political participation and attitudes. Results: 200 respondents (14.6%) screened positive for ADHD based on the ASRS-6. Our findings show that individuals with ADHD are more likely to participate in politics than individuals without ADHD symptoms (B = 0.303, SE = 0.10, p =.003). However, participants with ADHD are more likely to be passive consumers of news, waiting for current political news to reach them instead of actively searching for it (B = 0.172, SE = 0.60, p =.004). They are also more prone to support the idea of silencing other opinions (B = 0.226, SE = 0.10, p =.029). The findings hold when controlling for age, sex, level of education, income, political orientation, religiosity, and stimulant therapy for ADHD symptoms. Conclusions: Overall, we find evidence that individuals with ADHD display a unique pattern of political activity, including greater participation and less tolerance of others' views, but not necessarily showing greater active interest in politics. Our findings add to a growing body of literature that examines the impact of ADHD on different types of everyday behaviors. [ABSTRACT FROM AUTHOR]

Background: Post-migration follow-up of migrants identified to be at-risk of developing tuberculosis during the initial screening is effective, but programmes vary across countries. We aimed to review main strategies applied to design follow-up programmes and analyse the effect of key programme characteristics on reported coverage (i.e., proportion of migrants screened among those eligible for screening) or yields (i.e., proportion of active tuberculosis among those identified as eligible for follow-up screening). Methods and findings: We performed a systematic review and meta-analysis of studies reporting yields of follow-up screening programmes. Studies were included if they reported the rate of tuberculosis disease detected in international migrants through active case finding strategies and applied a post-migration follow-up (defined as one or more additional rounds of screening after finalising the initial round). For this, we retrieved all studies identified by Chan and colleagues for their systematic review (in their search until January 12, 2017) and included those reporting from active follow-up programmes. We then updated the search (from January 12, 2017 to September 30, 2022) using Medline and Embase via Ovid. Data were extracted on reported coverage, yields, and key programme characteristics, including eligible population, mode of screening, time intervals for screening, programme providers, and legal frameworks. Differences in follow-up programmes were tabulated and synthesised narratively. Meta-analyses in random effect models and exploratory analysis of subgroups showed high heterogeneity (I2 statistic > 95.0%). We hence refrained from pooling, and estimated yields and coverage with corresponding 95% confidence intervals (CIs), stratified by country, legal character (mandatory versus voluntary screening), and follow-up scheme (one-off versus repetitive screening) using forest plots for comparison and synthesis. Of 1,170 articles, 24 reports on screening programmes from 7 countries were included, with considerable variation in eligible populations, time intervals of screening, and diagnostic protocols. Coverage varied, but was higher than 60% in 15 studies, and tended to be lower in voluntary compared to compulsory programmes, and higher in studies from the United States of America, Israel, and Australia. Yield varied within and between countries and ranged between 53.05 (31.94 to 82.84) in a Dutch study and 5,927.05 (4,248.29 to 8,013.71) in a study from the United States. Of 15 estimates with narrow 95% CIs for yields, 12 were below 1,500 cases per 100,000 eligible migrants. Estimates of yields in one-off follow-up programmes tended to be higher and were surrounded by less uncertainty, compared to those in repetitive follow-up programmes. Yields in voluntary and mandatory programmes were comparable in magnitude and uncertainty. The study is limited by the heterogeneity in the design of the identified screening programmes as effectiveness, coverage and yields also depend on factors often underreported or not known, such as baseline incidence in the respective population, reactivation rate, educative and administrative processes, and consequences of not complying with obligatory measures. Conclusion: Programme characteristics of post-migration follow-up screening for prevention and control of tuberculosis as well as coverage and yield vary considerably. Voluntary programmes appear to have similar yields compared with mandatory programmes and repetitive screening apparently did not lead to higher yields compared with one-off screening. Screening strategies should consider marginal costs for each additional round of screening. In a systematic review, Dr Kayvan Bozorgmehr and colleagues explore mandatory, voluntary, repetitive or one-off post-migration follow-up for tuberculosis prevention and control. Author summary: Why was this study done?: Follow-up screening of migrants after an initial pre- or post- entry screening for tuberculosis has been shown to be effective to identify migrants suffering from tuberculosis that had either been missed in the initial screening or reactivated afterwards. However, little is known about the design and characteristics of the existing follow-up screening programmes and how these might affect outcome parameters, such as coverage (the proportion of migrants screened among those eligible for screening) and yields (proportion of active tuberculosis among those identified as eligible for follow-up screening). What did the researchers do and find?: We performed a systematic review and identified 23 studies reporting data from follow-up screening programmes for tuberculosis in migrants. Despite high heterogeneity with respect to important programme characteristics, coverage was higher than 60% in the majority of studies and tended to be lower in voluntary compared to compulsory programmes. Yields were below 1,500 cases per 100,000 eligible migrants in the majority of studies with large sample sizes and tended to be higher in one-off compared to repetitive follow-up programmes, while being comparable between voluntary and mandatory programmes. What do these findings mean?: Consensus is needed on what the best mode, timing, and criteria for follow-up screening among migrants are. Yield appears to be meaningfully high to justify follow-up programmes from a public health perspective. Mandatory or repetitive follow-up programmes do not appear to be superior to voluntary or one-off follow-up programmes with respect to yields. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, which enforced social distancing and isolation, teachers were required to handle multiple challenges related to their work, including dealing with remote teaching, in addition to personal, medical and financial challenges. The goal of the current research was to examine factors that contributed to professional burnout and commitment to work among teachers during the first and second waves of the COVID-19 pandemic. Methods: A total of 344 elementary school teachers in Israel completed online self-report questionnaires, including assessments of stressors, anxiety, resilience, self-efficacy beliefs, and coping strategies. Structured Equation Modeling [SEM] was used to examine the contribution of these factors to professional burnout and commitment. Results: The gaps between needed and received support had a direct effect on teachers' burnout and commitment, and an indirect effect through anxiety and self-efficacy beliefs. Stress relating to remote teaching and support-gaps regarding remote teaching were the most significant of all the stressors and sources of support. Conclusions: Collectively, these findings highlight the significance of remote teaching as the main cause of stress and professional burnout and suggest that proper preparation of teachers—before and during times of crisis, may have a significant impact on their mental and professional well-being. [ABSTRACT FROM AUTHOR]

Objectives: Chest X-ray (CXR) is routinely required for assessing Central Venous Catheter (CVC) tip position after insertion, but there is limited data as to the movement of the tip location during hospitalization. We aimed to assess the migration of Central Venous Catheter (CVC) position, as a significant movement of catheter tip location may challenge some of the daily practice after insertion. Design and settings: Retrospective, single-center study, conducted in the Intensive Care and Cardiovascular Intensive Care Units in Tel Aviv Sourasky Medical Center 'Ichilov', Israel, between January and June 2019. Patients: We identified 101 patients with a CVC in the Right Internal Jugular (RIJ) with at least two CXRs during hospitalization. Measurements and results: For each patient, we measured the CVC tip position below the carina level in the first and all consecutive CXRs. The average initial tip position was 1.52 (±1.9) cm (mean±SD) below the carina. The maximal migration distance from the initial insertion position was 1.9 (±1) cm (mean±SD). During follow-up of 2 to 5 days, 92% of all subject's CVCs remained within the range of the Superior Vena Cava to the top of the right atrium, regardless of the initial positioning. Conclusions: CVC tip position can migrate significantly during a patient's early hospitalization period regardless of primary location, although for most patients it will remain within a wide range of the top of the right atrium and the middle of the Superior Vena Cava (SVC), if accepted as well-positioned. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic has led to the isolation of the population in Israel, including the elderly. The present study aimed to compare the consumption of medical services among adults over the age of 65 in Israel at the time of the first COVID-19 lockdown relative to the corresponding period the year before. Methods: We conducted a retrospective longitudinal observational quantitative research based on the Natali Healthcare Solutions Israel database of subscribers. Company subscribers over the age of 65 (N = 103,955) were included in the sample (64.5% women) in two time periods, before the COVID-19 outbreak-P1, in 2019, and during the first COVID-19 lockdown- P2 in 2020. Logistic regression was applied to examine service consumption for study variables. Results: The average number of referrals to services was lower during the COVID-19 lockdown period (M = 0.3658, SD = 0.781) compared to the corresponding period in the previous year (M = 0.5402, SD = 0.935). The average number of ambulance orders, doctor home visits and service refusals were higher when compared to the same period in the previous year. During both time periods, women (P1- M = 0.5631, SD = 0.951; P2- M = 0.3846, SD = 0.800) required significantly more (p <.000) services than men (P1- M = 0.5114, SD = 0.910; P2- M = 0.3417, SD = 0.753). Older, widowed people, living in non-Jewish/mixed localities, or in average or below average socioeconomic status localities required relatively more services to those with opposite socio-demographic traits (p <.000). Summary and conclusions: In a large sample of elderly in Israel, findings indicate a decrease in referrals to medical care during the first COVID-19 lockdown period, yet an increase in ambulance orders, doctor visits and service refusals. Socio-demographic characteristics showed a similar effect in both time periods. The period of the first COVID-19 lockdown was characterized by a higher incidence of medical service refusals as compared to the equivalent period in the previous year. [ABSTRACT FROM AUTHOR]

Background: Patient-Reported Outcome Measures (PROMs) aim to evaluate the quality of care based on the perspectives of patients rather than clinical indicators. Qualitative research is needed to identify these perspectives in people with type 2 diabetes. Objective: To identify, for the first time in Israel, aspects valuable for people with type 2 diabetes that can be relevant for PROMs in diabetes care. Methods: A qualitative study included three focus groups totalling 19 people with type 2 diabetes. Inclusion criteria were: (1)type 2 diabetes, (2)diabetes duration of at least six months, and (3)adults aged 45–80 years. Purposive sampling enabled recruitment of heterogeneous participants. Also, two experts' panels with healthcare providers involved in diabetes care (n = 23) were conducted to provide triangulation of information (more testimony about what is valuable for people with type 2 diabetes). Discussions were recorded, transcribed and thematically analysed. Results: Four domains were deemed valuable for people with type 2 diabetes: (1)challenges of living with diabetes, including reduced physical function, healthy lifestyle struggles, sexual dysfunction, and financial burden, (2)mental health issues, including depression, distress, anxiety, frustration, and loneliness, (3)self-management ability, including management of lifestyle modifications and treatment, knowledge about the disease and treatment, and (4)patient-clinician relationships, including the devotion of clinicians, trust in clinicians and treatment, shared decision-making, and multidisciplinary care under one roof. Experts favour using PROMs in diabetes routine care and even acknowledged their necessity to improve the treatment process. However, only some of the domains raised by people with type 2 diabetes were identified by the experts. Conclusions: There are content gaps between perspectives of people with type 2 diabetes and their healthcare providers. PROMs are essential in addressing issues largely not addressed in routine diabetes care. We recommend that researchers and healthcare providers, who intend to utilize PROMs for diabetes care, consider the aforementioned domains. [ABSTRACT FROM AUTHOR]

Background: Although a wide range of intervention programs and methods have been implemented to increase health professionals' (HPs) adherence with infection prevention and control (IPC) guidelines and decrease the incidence of healthcare associated infections (HAIs), a significant discrepancy remains between the guidelines and their implementation in practice. Objectives: This study proposes an applied tool based on the integrated theoretical framework of the positive deviance (PD) approach for developing more effective interventions to mitigate this discrepancy. Methods: A qualitative study guided by the PD approach based on data from two sources: (1) in-depth archival analysis of systematic review articles, and (2) integration and synthesis of findings based on an extensive empirical study we conducted, involving 250 HPs (nurses, physicians, support staff and cleaning staff) from three governmental hospitals in Israel, over 35 months (January 2017 to November 2020). Results: The barriers faced by HPs were classified into four main categories: (1) individual-motivational, (2) social-cultural, (3) organizational, and (4) work environment and resource-centered. For each barrier, we constructed a set of questions based on the PD approach. For each question, we adapted and applied methodological tools (e.g., in-depth interviews, focus groups, social network maps, video clips and simulations) to help solve the problem. Conclusion: Translating a theory-based approach into an applied tool that offers step-by-step actions can help researchers and practitioners adopt and implement the approach within intervention programs to mitigate barriers. [ABSTRACT FROM AUTHOR]

Objective: To investigate how cancer patients' and family members' perspective and health locus of control are presented in clinical encounter decision-making. Methods: Semi-structured in-depth interviews were carried out with 16 cancer patients and 6 family members living in Israel (n = 22). Interviews were transcribed verbatim, and data were analyzed using thematic analysis. Results: Following the health locus of control model, the findings were divided into an external and internal locus of control themes, and we added a theme regarding shared decision-making. Internal locus of control sub-themes included asking for a second opinion, negotiating with the doctor, asking questions, looking for information, and fighting for their rights. External locus of control sub-themes included powerful others, oncologists, and fate. The dominant approach of most of the interviewees was an external locus of control. Women demonstrated more external locus of control than men. On the direct question of who should decide on treatment—the doctor, the patient, or both jointly—the answers ranged from only the doctor (n = 8) to together (n = 7) to only the patient (n = 8). Conclusions: This study provides insights into different aspects of locus of control in the clinical encounter involving cancer patients. The findings reflect the need to devote comprehensive attention to cancer patients' perceptions and experiences in the clinical encounter. A patient-centered care approach and a personalized framework for decision-making in cancer care are essential to achieving better treatment outcomes. Further research can engage in the development and validation of an up-to-date health locus of control questionnaire for cancer patients based on the findings of this study. [ABSTRACT FROM AUTHOR]

Household water food and energy (WFE) expenditures, reflect respective survival needs for which their resources and social welfare are inter-related. We developed a policy driven quantitative decision-making strategy (DMS) to address the domain geospatial entities' (nodes or administrative districts) of the WFE nexus, assumed to be information linked across the domain nodal-network. As investment in one of the inter-dependent nexus components may cause unexpected shock to the others, we refer to the WFE normalized expenditures product (Volume) as representing the nexus holistic measure. Volume rate conforms to Boltzman entropy suggesting directed information from high to low Volume nodes. Our hypothesis of causality-driven directional information is exemplified by a sharp price increase in wheat and rice, for U.S. and Thailand respectively, that manifests its impact on the temporal trend of Israel's administrative districts of the WFE expenditures. Welfare mass (WM) represents the node's Volume combined with its income and population density. Formulation is suggested for the nodal-network WM temporal balance where each node is scaled by a human-factor (HF) for subjective attitude and a superimposed nodal source/sink term manifesting policy decision. Our management tool is based on two sequential governance processes: one starting with historical data mapping the mean temporal nodal Volumes to single out extremes, and the second is followed by WM balance simulation predicting nodal-network outcome of policy driven targeting. In view of the proof of concept by model simulations in in our previous research, here HF extends the model and attention is devoted to emphasize how the current developed decision-making approach categorically differs from existing nexus related methods. The first governance process is exemplified demonstrating illustrations for Israel's districts. Findings show higher expenditures for water and lower for energy, and maps pointing to extremes in districts' mean temporal Volume. Illustrations of domain surfaces for that period enable assessment of relative inclination trends of the normalized Water, Food and Energy directions continuum assembled from time stations, and evolution trends for each of the WFE components. [ABSTRACT FROM AUTHOR]

The submerged site of Ohalo II was occupied during the Last Glacial Maximum (LGM), between 23,500–22,500 cal BP, bridging the Upper Paleolithic/Epipaleolithic transition in the southern Levant. The site is known for the excellent preservation of its brush huts and botanical remains. This study examines the behavior of its past inhabitants through analysis of the entire faunal assemblage found on the three successive floors of Brush Hut 1. Furthermore, it provides an opportunity to test differing models of prey choice and assess whether the observed resource diversification is the result of resource depression (explained by Optimal Foraging Theory) or resource abundance (explained by Niche Construction Theory). We focused on a quantitative, qualitative and spatial investigation of the more than 20,000 faunal remains, combining traditional zooarchaeological methods with microwear analysis of teeth and Fourier Transform Infrared Spectroscopy (FTIR) of burnt bones. Identification of faunal remains to the most detailed level possible, combined with analysis of skeletal element frequencies allowed reconstruction of a profile of the desired prey, highlighting the importance of small, expedient prey compared to larger game (ungulates). FTIR was used to identify degrees of burning and to develop a key to identifying burnt bones from water-logged environments. Availability of multiple food sources within a rich habitat may have driven exploitation of those varied local resources, rather than targeting energetically-rich large prey. The choice of a littoral habitat that could be intensively exploited is an example of niche selection. Comparison with contemporaneous and later sites contributes to the ongoing discussion about Early Epipaleolithic prey choice, and the impact, if any, of the LGM in the Jordan Valley. Ohalo II is an example of diverse prey choice motivated by abundance rather than stress, at a 23,000-year-old fisher-hunter-gatherers camp. [ABSTRACT FROM AUTHOR]

Indigenous and other marginalized racial/ethnic minorities have poorer health status than majority populations, including higher rates of type 2 diabetes. These disparities have typically been addressed using a 'deficit-based' discourse that isolates disease management from the broader social, economic, political context and does not incorporate patient perspectives. We aimed to explore factors affecting glycemic control among Indigenous Arabs with diabetes in Israel using a strengths-based approach that centered participants' knowledge of their context, needs, resources and strengths. We conducted an exploratory sequential mixed methods study, which included 10 focus groups (5 men's, 5 women's) and 296 quantitative in-person surveys. Participants with diagnosed diabetes were randomly drawn from the patient list of the largest healthcare service organization (survey response rate: 93%). Prominent and interconnected themes emerged from focus group discussions, including: diet, physical activity, and social, economic, mental/psychological and political stress. The discussions raised the need for adapting diabetes management approaches to incorporate participants' communal, physical and psychological well-being, and socioeconomic/political realities. The connections between these factors and diabetes management were also reflected in multivariable analyses of the survey data. Women (OR: 2.03; 95% CI: 1.09–4.63), people with disabilities (OR: 2.43; 95% CI: 1.28–4.64), and unemployed people (OR: 2.64; 95% CI: 1.28–5.44) had higher odds of economic barriers to diabetes management. Furthermore, female sex (OR: 2.26; 95% CI: 1.25–4.09), unemployment (OR: 4.07; 95% CI: 1.64–10.10), and suboptimal glycemic control (OR: 1.20, 95% CI: 1.03–1.41 per 1-unit increase in HbA1c) were associated with moderate-to-severe depressive symptoms. A pro-active, team-based healthcare approach incorporating Indigenous/minority participants' knowledge, experience, and strengths has the potential to improve individuals' diabetes management. Healthcare services should be structured in ways that enable providers to listen to their patients, address their key concerns, and foster their strengths. [ABSTRACT FROM AUTHOR]

Transposable elements (TEs) represent a major portion of most eukaryotic genomes, yet little is known about their mutation rates or how their activity is shaped by other evolutionary forces. Here, we compare short- and long-term patterns of genome-wide mutation accumulation (MA) of TEs among 9 genotypes from three populations of Daphnia magna from across a latitudinal gradient. While the overall proportion of the genome comprised of TEs is highly similar among genotypes from Finland, Germany, and Israel, populations are distinguishable based on patterns of insertion site polymorphism. Our direct rate estimates indicate TE movement is highly variable (net rates ranging from -11.98 to 12.79 x 10−5 per copy per generation among genotypes), differing both among populations and TE families. Although gains outnumber losses when selection is minimized, both types of events appear to be highly deleterious based on their low frequency in control lines where propagation is not limited to random, single-progeny descent. With rate estimates 4 orders of magnitude higher than base substitutions, TEs clearly represent a highly mutagenic force in the genome. Quantifying patterns of intra- and interspecific variation in TE mobility with and without selection provides insight into a powerful mechanism generating genetic variation in the genome. Author summary: Transposable elements (TEs) are a significant portion of most eukaryotic genomes, yet our understanding of their rates of mobility and their patterns of accumulation remain very limited. Here, we estimate genome-wide rates of gain and loss of TEs in Daphnia magna, a well-studied model organism in ecology, and compare these rates of mutation to the long-term accumulation of TEs in the genome. Rates vary remarkably among genotypes and populations, and between different types of TEs within the same lineage. Despite this variation, over long time periods, TE content in the genome is extremely similar across genotypes within the species. We compare our results to the few estimates available from other taxa, and argue that TEs are an important source of mutagenesis in the genome worthy of further investigation. [ABSTRACT FROM AUTHOR]

Background: Despite several intervention programs, the Bedouin population living in the Southern District of Israel has the highest mortality rate among children and adolescents from unintentional injuries. Our research questions asked: (1) How does increasing the involvement and participation of Bedouin community members influence the issue of unintentional injuries among children? (2) How does reframing of the technical issue of safety into security influence community involvement and cooperation? Objectives: 1) To identify effective and efficacious positive deviance practices through community-based participatory research with adults, children, and professionals in the Bedouin community. 2) To create wider and deeper connections and cohesion between and among diverse Bedouin communities by seeding and sparking opportunities for social networking and cross-learning. Methods: The study used a qualitative multi-method approach to generate a hybrid intervention model for reducing unintentional childhood injuries among the Bedouins. To frame the issue of unintentional injuries from the lived perspective of the Bedouins, we employed the Positive Deviance (PD) and Community Based Participatory Research (CBPR) approach. Drawing upon theatrical traditions, entertainment-education (EE), was employed as a way to narratively engage and persuade the Bedouins. Results: Our research resulted in: (1) the emergence of several PD ideas and practices for preventing and avoiding children's injuries; (2) the actual creation of a safe and secure playroom for children at a neighborhood mosque; and (3) the creation of cascading and cross-learning social networks between and among members of the Bedouin community spread across various locations. Conclusion: This study helped in reframing the technical issue of accidents and safety into the notion of sacredness and security, enhanced the association between emotions and cognition by means of experiential and EE methods, and stimulated creative thinking and the emergence of new culturally and contextually relevant ideas and practices through the PD process. It demonstrated the synergistic power of using a hybrid model that combined the rigor and vigor of different health communication approaches to address a significant disparity in the burden of child accidents faced by the Bedouins. Our study generated solutions that emerged from, and directly benefitted, Bedouin children—those, who face overwhelming risk of injury and death from preventable accidents. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injury (TBI) is an important global public health burden, where those injured by high-energy transfer (e.g., road traffic collisions) are assumed to have more severe injury and are prioritised by emergency medical service trauma triage tools. However recent studies suggest an increasing TBI disease burden in older people injured through low-energy falls. We aimed to assess the prevalence of low-energy falls among patients presenting to hospital with TBI, and to compare their characteristics, care pathways, and outcomes to TBI caused by high-energy trauma.Methods and Findings: We conducted a comparative cohort study utilising the CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) Registry, which recorded patient demographics, injury, care pathway, and acute care outcome data in 56 acute trauma receiving hospitals across 18 countries (17 countries in Europe and Israel). Patients presenting with TBI and indications for computed tomography (CT) brain scan between 2014 to 2018 were purposively sampled. The main study outcomes were (i) the prevalence of low-energy falls causing TBI within the overall cohort and (ii) comparisons of TBI patients injured by low-energy falls to TBI patients injured by high-energy transfer-in terms of demographic and injury characteristics, care pathways, and hospital mortality. In total, 22,782 eligible patients were enrolled, and study outcomes were analysed for 21,681 TBI patients with known injury mechanism; 40% (95% CI 39% to 41%) (8,622/21,681) of patients with TBI were injured by low-energy falls. Compared to 13,059 patients injured by high-energy transfer (HE cohort), the those injured through low-energy falls (LE cohort) were older (LE cohort, median 74 [IQR 56 to 84] years, versus HE cohort, median 42 [IQR 25 to 60] years; p < 0.001), more often female (LE cohort, 50% [95% CI 48% to 51%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001), more frequently taking pre-injury anticoagulants or/and platelet aggregation inhibitors (LE cohort, 44% [95% CI 42% to 45%], versus HE cohort, 13% [95% CI 11% to 14%]; p < 0.001), and less often presenting with moderately or severely impaired conscious level (LE cohort, 7.8% [95% CI 5.6% to 9.8%], versus HE cohort, 10% [95% CI 8.7% to 12%]; p < 0.001), but had similar in-hospital mortality (LE cohort, 6.3% [95% CI 4.2% to 8.3%], versus HE cohort, 7.0% [95% CI 5.3% to 8.6%]; p = 0.83). The CT brain scan traumatic abnormality rate was 3% lower in the LE cohort (LE cohort, 29% [95% CI 27% to 31%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001); individuals in the LE cohort were 50% less likely to receive critical care (LE cohort, 12% [95% CI 9.5% to 13%], versus HE cohort, 24% [95% CI 23% to 26%]; p < 0.001) or emergency interventions (LE cohort, 7.5% [95% CI 5.4% to 9.5%], versus HE cohort, 13% [95% CI 12% to 15%]; p < 0.001) than patients injured by high-energy transfer. The purposive sampling strategy and censorship of patient outcomes beyond hospital discharge are the main study limitations.Conclusions: We observed that patients sustaining TBI from low-energy falls are an important component of the TBI disease burden and a distinct demographic cohort; further, our findings suggest that energy transfer may not predict intracranial injury or acute care mortality in patients with TBI presenting to hospital. This suggests that factors beyond energy transfer level may be more relevant to prehospital and emergency department TBI triage in older people. A specific focus to improve prevention and care for patients sustaining TBI from low-energy falls is required. [ABSTRACT FROM AUTHOR]

Background: Contact mixing plays a key role in the spread of COVID-19. Thus, mobility restrictions of varying degrees up to and including nationwide lockdowns have been implemented in over 200 countries. To appropriately target the timing, location, and severity of measures intended to encourage social distancing at a country level, it is essential to predict when and where outbreaks will occur, and how widespread they will be. Methods: We analyze aggregated, anonymized health data and cell phone mobility data from Israel. We develop predictive models for daily new cases and the test positivity rate over the next 7 days for different geographic regions in Israel. We evaluate model goodness of fit using root mean squared error (RMSE). We use these predictions in a five-tier categorization scheme to predict the severity of COVID-19 in each region over the next week. We measure magnitude accuracy (MA), the extent to which the correct severity tier is predicted. Results: Models using mobility data outperformed models that did not use mobility data, reducing RMSE by 17.3% when predicting new cases and by 10.2% when predicting the test positivity rate. The best set of predictors for new cases consisted of 1-day lag of past 7-day average new cases, along with a measure of internal movement within a region. The best set of predictors for the test positivity rate consisted of 3-days lag of past 7-day average test positivity rate, along with the same measure of internal movement. Using these predictors, RMSE was 4.812 cases per 100,000 people when predicting new cases and 0.79% when predicting the test positivity rate. MA in predicting new cases was 0.775, and accuracy of prediction to within one tier was 1.0. MA in predicting the test positivity rate was 0.820, and accuracy to within one tier was 0.998. Conclusions: Using anonymized, macro-level data human mobility data along with health data aids predictions of when and where COVID-19 outbreaks are likely to occur. Our method provides a useful tool for government decision makers, particularly in the post-vaccination era, when focused interventions are needed to contain COVID-19 outbreaks while mitigating the collateral damage from more global restrictions. [ABSTRACT FROM AUTHOR]

This article presents new archaeological observations and multidisciplinary research from Dor, Israel to establish a more reliable relative sea level for the Carmel Coast and Southern Levant between the Middle Bronze Age and the Roman period (ca. 3500–1800 y BP). Our record indicates a period of low relative sea level, around -2.5 m below present, from the Middle Bronze Age to the Hellenistic period (ca. 3500–2200 y BP). This was followed by a rapid rise to present levels, starting in the Hellenistic period and concluding during the Roman period (ca. 2200–1800 y BP). These Roman levels agree with other relative sea-level indications from Israel and other tectonically stable areas in the Mediterranean. Several relative sea-level reconstruction models carried out in the current study provide different predictions due to their parameters and do not model the changes observed from field data which points to a non-isostatic origin for the changes. Long-term low stable Iron Age relative sea level can be seen in Dor, where Iron Age harbor structures remain around the same elevation between ca. 3100–2700 y BP. A similar pattern occurs at Atlit, the Iron Age harbor to the north used continuously from ca. 2900 y BP to the beginning of the Hellenistic period (ca. 2200 y BP). An examination of historical and archaeological sources reveals decline and occasional disappearance of Hellenistic sites along the coast of Israel at ca. 2200 y BP (2nd century BCE), as in the case of Yavneh Yam, Ashdod Yam, Straton's Tower, and tel Taninim. In Akko-Ptolemais, the large harbor installations built in the Hellenistic period were never replaced by a substantial Roman harbor. The conclusions of this research are thus relevant for the sea-level research community and for the historical analyses of the Israeli and South Levantine coastline. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has unleashed multiple public health, socio-economic, and institutional crises. Measures taken to slow the spread of the virus have fostered significant strain between authorities and citizens, leading to waves of social unrest and anti-government demonstrations. We study the temporal nature of pandemic-related disorder events as tallied by the "COVID-19 Disorder Tracker" initiative by focusing on the three countries with the largest number of incidents, India, Israel, and Mexico. By fitting Poisson and Hawkes processes to the stream of data, we find that disorder events are inter-dependent and self-excite in all three countries. Geographic clustering confirms these features at the subnational level, indicating that nationwide disorders emerge as the convergence of meso-scale patterns of self-excitation. Considerable diversity is observed among countries when computing correlations of events between subnational clusters; these are discussed in the context of specific political, societal and geographic characteristics. Israel, the most territorially compact and where large scale protests were coordinated in response to government lockdowns, displays the largest reactivity and the shortest period of influence following an event, as well as the strongest nationwide synchrony. In Mexico, where complete lockdown orders were never mandated, reactivity and nationwide synchrony are lowest. Our work highlights the need for authorities to promote local information campaigns to ensure that livelihoods and virus containment policies are not perceived as mutually exclusive. [ABSTRACT FROM AUTHOR]

Tsunami events in antiquity had a profound influence on coastal societies. Six thousand years of historical records and geological data show that tsunamis are a common phenomenon affecting the eastern Mediterranean coastline. However, the possible impact of older tsunamis on prehistoric societies has not been investigated. Here we report, based on optically stimulated luminescence chronology, the earliest documented Holocene tsunami event, between 9.91 to 9.29 ka (kilo-annum), from the eastern Mediterranean at Dor, Israel. Tsunami debris from the early Neolithic is composed of marine sand embedded within fresh-brackish wetland deposits. Global and local sea-level curves for the period, 9.91–9.29 ka, as well as surface elevation reconstructions, show that the tsunami had a run-up of at least ~16 m and traveled between 3.5 to 1.5 km inland from the palaeo-coastline. Submerged slump scars on the continental slope, 16 km west of Dor, point to the nearby "Dor-complex" as a likely cause. The near absence of Pre-Pottery Neolithic A-B archaeological sites (11.70–9.80 cal. ka) suggest these sites were removed by the tsunami, whereas younger, late Pre-Pottery Neolithic B-C (9.25–8.35 cal. ka) and later Pottery-Neolithic sites (8.25–7.80 cal. ka) indicate resettlement following the event. The large run-up of this event highlights the disruptive impact of tsunamis on past societies along the Levantine coast. [ABSTRACT FROM AUTHOR]

Public space lighting (PSL) contributes to pedestrians' feeling of safety (FoS) in urban areas after natural dark. However, little is known how different PSL attributes, such as illuminance, light temperature, uniformity and glare, affect people's FoS in different contextual settings. The present study aims to bridge this knowledge gap by developing a model linking different PSL attributes with FoS, while controlling for individual, locational, environmental and temporal factors. To develop such model, the study employs a novel interactive user-oriented method, based on a specially-designed mobile phone application–CityLightsTM. Using this app, a representative sample of observers reported their impressions of PSL attributes and FoS in three cities in Israel, following a set of predetermined routes and points. As the study shows, higher levels of illumination and uniformity positively affect FoS, while lights perceived as warm tend to generate higher FoS than lights perceived as cold. These findings may guide future illumination polices aimed at promoting energy efficiency while ensuring urban sustainability. [ABSTRACT FROM AUTHOR]

Background: Identifying stage II patients with colorectal cancer (CRC) at higher risk of progression is a clinical priority in order to optimize the advantages of adjuvant chemotherapy while avoiding unnecessary toxicity. Recently, the intensity and the quality of the host immune response in the tumor microenvironment have been reported to have an important role in tumorigenesis and an inverse association with tumor progression. This association is well established in microsatellite instable CRC. In this work, we aim to assess the usefulness of measures of T-cell infiltration as prognostic biomarkers in 640 stage II, CRC tumors, 582 of them confirmed microsatellite stable.Methods and Findings: We measured both the quantity and clonality index of T cells by means of T-cell receptor (TCR) immunosequencing in a discovery dataset (95 patients with colon cancer diagnosed at stage II and microsatellite stable, median age 67, 30% women) and replicated the results in 3 additional series of stage II patients from 2 countries. Series 1 and 2 were recruited in Barcelona, Spain and included 112 fresh frozen (FF, median age 69, 44% women) and 163 formalin-fixed paraffin-embedded (FFPE, median age 67, 39% women) samples, respectively. Series 3 included 270 FFPE samples from patients recruited in Haifa, Northern Israel, as part of a large case-control study of CRC (median age 73, 46% women). Median follow-up time was 81.1 months. Cox regression models were fitted to evaluate the prognostic value of T-cell abundance and Simpson clonality of TCR variants adjusting by sex, age, tumor location, and stage (IIA and IIB). In the discovery dataset, higher TCR abundance was associated with better prognosis (hazard ratio [HR] for ≥Q1 = 0.25, 95% CI 0.10-0.63, P = 0.003). A functional analysis of gene expression on these tumors revealed enrichment in pathways related to immune response. Higher values of clonality index (lower diversity) were not associated with worse disease-free survival, though the HR for ≥Q3 was 2.32 (95% CI 0.90-5.97, P = 0.08). These results were replicated in an independent FF dataset (TCR abundance: HR = 0.30, 95% CI 0.12-0.72, P = 0.007; clonality: HR = 3.32, 95% CI 1.38-7.94, P = 0.007). Also, the association with prognosis was tested in 2 independent FFPE datasets. The same association was observed with TCR abundance (HR = 0.41, 95% CI 0.18-0.93, P = 0.03 and HR = 0.56, 95% CI 0.31-1, P = 0.042, respectively, for each FFPE dataset). However, the clonality index was associated with prognosis only in the FFPE dataset from Israel (HR = 2.45, 95% CI 1.39-4.32, P = 0.002). Finally, a combined analysis combining all microsatellite stable (MSS) samples demonstrated a clear prognosis value both for TCR abundance (HR = 0.39, 95% CI 0.26-0.57, P = 1.3e-06) and the clonality index (HR = 2.13, 95% CI 1.44-3.15, P = 0.0002). These associations were also observed when variables were considered continuous in the models (HR per log2 of TCR abundance = 0.85, 95% CI 0.78-0.93, P = 0.0002; HR per log2 or clonality index = 1.16, 95% CI 1.03-1.31, P = 0.016).Limitations: This is a retrospective study, and samples had been preserved with different methods. Validation series lack complete information about microsatellite instability (MSI) status and pathology assessment. The Molecular Epidemiology of Colorectal Cancer (MECC) study had information about overall survival instead of progression-free survival.Conclusion: Results from this study demonstrate that tumor lymphocytes, assessed by TCR repertoire quantification based on a sequencing method, are an independent prognostic factor in microsatellite stable stage II CRC. [ABSTRACT FROM AUTHOR]

For years there has been much speculation surrounding the abandonment of the Middle Bronze Age IIB palace of Tel Kabri, ca. 1700 BCE. There are no weapons, hoards of money and jewelry, or visible evidence for fire, which rules out hostile attack or conquest. There are also no indications of drought or environmental degradation that might have forced the inhabitants to vacate the site, nor mass graveyards to indicate a pandemic. The current study uses micro-geoarchaeological methods to show that the demise of the palace was rapid, with walls and ceilings collapsing at once prior to abandonment. Macroscopic data (stratigraphic and structural) from five excavation seasons were reexamined, showing that at least nine Potential Earthquake Archaeological Effects (PEAEs) are found and associated with the last occupation phase of the site's palace. All lines of evidence point to the possibility that an earthquake damaged the palace, possibly to a point where it was no longer economically viable to repair. This conclusion is compounded by the discovery of a 1–3 m wide trench that cuts through the palace for 30 m, which may be the result of ground shaking or liquefaction caused by an earthquake. This study shows the importance of combining macro- and micro-archaeological methods for the identification of ancient earthquakes, together with the need to evaluate alternative scenarios of climatic, environmental, and economic collapse, as well as human-induced destruction before a seismic event scenario can be proposed. [ABSTRACT FROM AUTHOR]

Renewed excavations at the Neolithic site of Beisamoun (Upper Jordan Valley, Israel) has resulted in the discovery of the earliest occurrence of an intentional cremation in the Near East directly dated to 7031–6700 cal BC (Pre-Pottery Neolithic C, also known as Final PPNB, which spans ca. 7100–6400 cal BC). The funerary treatment involved in situ cremation within a pyre-pit of a young adult individual who previously survived from a flint projectile injury. In this study we have used a multidisciplinary approach that integrates archaeothanatology, spatial analysis, bioanthropology, zooarchaeology, soil micromorphological analysis, and phytolith identification in order to reconstruct the different stages and techniques involved in this ritual: cremation pit construction, selection of fuel, possible initial position of the corpse, potential associated items and funerary containers, fire management, post-cremation gesture and structure abandonment. The origins and development of cremation practices in the region are explored as well as their significance in terms of Northern-Southern Levantine connections during the transition between the 8th and 7th millennia BC. The bones are distributed throughout the bottom of the pit, partly superimposed one on the other to a thickness of 40 cm. However, the density of remains was not very marked except at the centre of the pit (Fig 6). If there was an apparent anatomical disorder at first glance, by looking at the details some interesting patterning could be observed. Cranial and mandibular fragments were found only in the southern half of the structure. Next to the south wall on the upper level, we found the base of the skull (mandible reversed and occipital fragments); the rest of the cranial vault and face (frontal, maxillars, parietals and temporals) were found slightly lower down at the centre of the pit. Conversely, the cervical vertebrae were dispersed out from the centre to the northern half of the pit. The thoracic column and some of the ribs were concentrated in the centre, roughly following a west-east direction. The lumbar vertebrae were found in the middle and against the south-western wall of the structure with several vertebral fragments in close proximity to the sacrum, coccyx and the left coxal. The right coxal is found diametrically opposite to this coherent group, lying almost complete not far from the north-eastern wall of the pit. Altogether, despite an absence of articulated joints and dispersion of certain elements, the bones of the axial skeleton show some anatomical coherence. [ABSTRACT FROM AUTHOR]

Background: The best management of hypertension in frail oldest-old (≥80 years of age) remains unclear and we still lack guidelines that provide specific recommendations. Our study aims to investigate guideline use in general practitioners (GPs) and to examine if guideline use relates to different decisions when managing hypertension in frail oldest-old. Design/Setting: Cross-sectional study among currently active GPs from 29 countries using a case-vignettes survey. Methods: GPs participated in a survey with case-vignettes of frail oldest-olds varying in systolic blood pressure (SBP) levels and cardiovascular disease (CVD). GPs from 26 European countries and from Brazil, Israel and New Zealand were invited. We compared the percentage of GPs reporting using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GPs' sex, years of experience, prevalence of oldest-old and location of their practice), we used a mixed-effects regression model accounting for clustering within countries. Results: Overall, 2,543 GPs from 29 countries were included. 59.4% of them reported to use guidelines. Higher guideline use was found in female (p = 0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in self-reported guideline use, ranging from 25% to 90% of the GPs, but there was no difference in hypertension treatment decisions in frail oldest-old patients between GPs that did not use and GPs that used guidelines, irrespective of the guidelines they used. Conclusion: Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users concerning hypertension treatment decisions. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients. [ABSTRACT FROM AUTHOR]