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Objective: To evaluate the sociodemographic characteristics and disease‐related factors associated with diagnostic delay in Canadian patients with axial spondyloarthritis (axSpA). Methods: Data from 542 Canadian patients who participated in the International Map of Axial Spondyloarthritis online survey were analysed. Diagnostic delay was calculated as the difference between age at diagnosis and age at onset of the first symptoms reported by participants. Univariate and multivariate analyses were used to evaluate possible factors associated with diagnostic delay. Results: The mean age (± SD) of the surveyed participants was 44.3 ± 13.9 years and 63.1% were female. The average diagnostic delay was 9.0 ± 10.5 years (median, 5.0 years; interquartile range, 1.0–13.8). In the multivariate regression analysis, the three variables most strongly associated with longer diagnostic delay were use of nonsteroidal anti‐inflammatory drugs (NSAIDs) (B = 2.991; 95% CI = 1.075–4.909), medium or high functional limitation (B = 1.541; 95%CI = 0.186–2.896), and number of HCPs seen before diagnosis (B = 1.524, 95%CI = 1.072–1.977). Conclusion: Diagnostic delay continues to be a barrier to optimal care for Canadian axSpA patients. Significant diagnostic delay, associated with a high number of HCP visits prior to diagnosis, high use of NSAIDs, and marked functional limitation in daily life, illustrate the convoluted axSpA patient journey. [ABSTRACT FROM AUTHOR]

This paper focuses on the historical and archaeological evidence for ‘valuables’ passing through Suakin, as part of the Red Sea-Indian Ocean trade. The main locations on Suakin Island Town investigated 2002-2013 are briefly described. Interviews show that at Suakin, in the later 19th century/early 20th century, imported valuables included fabrics from Europe, perfume oils, cloths and wooden chests from India; porcelain from China and Turkey; rugs from Persia/Iran and glass from Italy. Interviews and early modern European accounts indicate the range of products from the hinterland, such as cotton, gold, ivory, ostrich feathers, slaves, horses, gum arabic, ebony, musk, tobacco, rubber and coffee. Local fishermen supplied fish, shells, pearls and mother-of-pearl. The archaeological evidence indicates pottery and porcelain from the Arabian Peninsula, south-west Asia, south Asia, China and south-east Asia, while identifications of wood samples indicates teak from south and south-east Asia. A combination of archaeological, historical and ethnographic evidence is needed to build up a picture of the trade in valuables. [ABSTRACT FROM AUTHOR]

London. Thames & Hudson. 2000. £24.95 (hb) The Complete Temples of Ancient Egypt is a companion book to three other 'complete' titles published by Thames & Hudson on Pyramids, Tutankhamen [...]

The conservation of built heritage is recognized as a vehicle for sustaining local identity and a powerful instrument for urban regeneration. The problem of how to engage local culture in this process, however, has received comparatively little attention, despite the recognition of ‘stakeholders’ and the importance of their involvement. This research examines how collaboration between stakeholders might be established to conserve and thus help regenerate the historic and largely abandoned port town of Suakin. Semi-structured interviews were conducted with representatives of Suakin’s stakeholder groups and supported through archival analysis and observational studies. The intention was to explore the stakeholders’ views of the ‘conservation drivers’, ‘conservation practice’, and ‘conservation challenges and enablers’ affecting Suakin. The stakeholders’ response provides a preliminary status to the various perspectives concerning the conservation of Suakin’s built heritage. The findings identify a number of major issues impacting Suakin’s conservation and reveal a potential for implementing a comprehensive and inclusive conservation approach. The research establishes the case for further research to determine best methods to enable stakeholders to collaboratively address the issues impacting Suakin’s conservation. This approach to stakeholder involvement represents a new step towards the conservation of Suakin and a new contribution towards the conservation process. [ABSTRACT FROM AUTHOR]

The aim of this work was to explore the impact of local cultural dynamics on the conservation of the built heritage of Suakin, an abandoned historic port on the Red Sea coast of Sudan, through a collaborative stakeholder approach. Key representatives of local stakeholder groups attended a two-day workshop and took part in a series of collaborative activities. These encompassed the production of a rank-ordered list of the key local cultural dynamics impacting on the port's conservation, agreement to a number of actions to address obstacles to conservation, identification of local cultural values collectively determined by stakeholder and confirmation of the value of an integrated conservation approach. The workshop enabled a shared understanding and responsibility between stakeholders and established a commitment to further action to address the key local cultural dynamics impacting on the conservation. This collaborative stakeholder participation represented a new step in the port's conservation and invited the development of more formal protocols to enable the equal representation and participation of stakeholders in future conservation activities and initiatives. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about an architectural study of Baalbeck, a city created around the remains of a Roman temple complex, that was published in a previous issue.

Objectives: This study aims to establish expert consensus recommendations for clinical information on imaging requests in suspected/known axial spondyloarthritis (axSpA), focusing on enhancing diagnostic clarity and patient care through guidelines., Materials and Methods: A specialised task force was formed, comprising 7 radiologists, 11 rheumatologists from the Assessment of Spondyloarthritis International Society (ASAS) and a patient representative. Using the Delphi method, two rounds of surveys were conducted among ASAS members. These surveys aimed to identify critical elements for imaging referrals and to refine these elements for practical application. The task force deliberated on the survey outcomes and proposed a set of recommendations, which were then presented to the ASAS community for a decisive vote., Results: The collaborative effort resulted in a set of six detailed recommendations for clinicians involved in requesting imaging for patients with suspected or known axSpA. These recommendations cover crucial areas, including clinical features indicative of axSpA, clinical features, mechanical factors, past imaging data, potential contraindications for specific imaging modalities or contrast media and detailed reasons for the examination, including differential diagnoses. Garnering support from 73% of voting ASAS members, these recommendations represent a consensus on optimising imaging request protocols in axSpA., Conclusion: The ASAS recommendations offer comprehensive guidance for rheumatologists in requesting imaging for axSpA, aiming to standardise requesting practices. By improving the precision and relevance of imaging requests, these guidelines should enhance the clinical impact of radiology reports, facilitate accurate diagnosis and consequently improve the management of patients with axSpA., Competing Interests: Competing interests: TD: speakers bureau: Canon MS, Lilly, MSD, Novartis, Pfizer and UCB; consultant: Lilly; grant/research support: Canon MS. CG: speakers bureau: Boehringer Ingelheim. VN-C: has received speakers fees from AbbVie, Eli Lilly, Fresenius Kabi, Janssen, MSD, Novartis, Pfizer, UCB Pharma; consultant of AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma; grant/research support from AbbVie and Novartis. IE: speakers bureau: AbbVie, Novartis. HH: speakers bureau: AbbVie, MSD, Janssen, Roche, Sobi and Pfizer, consultant of Roche, Boehringer Ingelheim, Janssen, MSD, AbbVie, Novartis and Sobi. PMM: honoraria from AbbVie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, and is supported by the National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre (BRC). WM: speaking: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, UCB consultant: AbbVie, BMS, Celgene, Eli Lilly, Galapagos, Novartis, Pfizer, UCB grants: AbbVie, Eli Lilly, Novartis, Pfizer, UCB. HM-O: research grants from Janssen, Novartis, Pfizer and UCB, honoraria/speaker fees from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda and UCB. MØ: speaker fees: AbbVie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MEDAC, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi and UCB. XB: consultant: AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Gilead, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB; grant/research support: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Merck, Novartis and UCB. MRu: speaker fees from and/or advisor for AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, Novartis, UCB. KGH: speaker fees from Novartis, MSD and Pfizer. Consulting for AbbVie and Calyx. Co-founder of BerlinFlame. SJP: speaking fees from MSD, Pfizer, AbbVie, UCB, Novartis; consulting fees and/or honoraria from AbbVie, UCB, Novartis and research support from AbbVie, MSD and Novartis. MRe: ISS grant; ASAS consultant. RGWL: consultant: Calyx, CARE Arthritis, Image Analysis Group. UW: speaker fees: Novartis, Eli Lilly. AGJ: none for this article. MdH: speaker fees from UBC. FAS: speaker fees: Novartis, Pfizer, AbbVie, Janssen., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ on behalf of EULAR.)