Objective: To determine which characteristics of older patients who use a hospital ED are associated with repeat visits during the 90 days following the index visit. Methods: The study was conducted in the ED of a 400-bed university-affiliated acute care community hospital in Montreal. Patients aged 2 7 5 years who visited the ED between 08:OO and and 16:OO on a convenience sample of days over an 8-week period (July and August 1994) were assessed using a questionnaire, physical and cognitive status instruments, and a functional problem checklist. The hospital's administrative database was used to identify repeat visits during the 90 days following the ED visit. The representativeness of the sample was assessed by analyses of ED visits made by 4,466 persons aged 2 6 5 years during a 12-month period (September 1993 to August 1994) using the hospital's administrative database. Results: 256 patients aged 2 7 5 years visited the ED during the study period and 167 were assessed. Of these, 54 (32%) were admitted to the hospital. Among the 113 patients released from the ED, 27 (24%) made repeat visits during the next 90 days. In univariate analyses, repeat visits were significantly associated with the number of functional problems, cognitive impairment, and previous ED visits. In multiple logistic regression, male gender, living alone, and number of functional problems were independent predictors of repeat visits. In the administrative data analyses, nighttime arrival to the ED for the index visit was significantly associated with repeat visits. Conclusions: Self-reported risk factors can help to identify a group of elders likely to make repeated ED visits; the development of a screening instrument incorporating questions on these problems and implementation of appropriate interventions might improve these patients' quality of life and reduce the demand for further ED care in this age group.

The excavation of two adjacent round barrows at Trelystan, Long Mountain, Powys, in igjQ, has revealed a complex sequence of Late Neolithic and Early Bronze Age funerary structures and traces of Late Neolithic settlement. The earliest structure was a large pit grave, dated to about 2400 be, which was superseded at about 2200 be by a settlement represented by stake-walled buildings associated with Grooved Ware. Following this some activity took place, possibly domestic, which is represented by sherds probably derived from several southern Beakers, which by analogy with sites elsewhere are to be dated to a period after about 1850 be. The subsequent Bronze Age cemetery, dated to between about 1800 and 1500 be (but possibly continuing later), presents a sequence of burial types and structures which can broadly be seen to illustrate a change from the concept of barrow cemetery to that of cemetery barrow. The earliest burials, which consist of cremations in pits and occasionally accompanied by a Food Vessel, were covered by separate small mounds of stone or turf, or a combination of the two. These were eventually overlain by and amalgamated beneath two larger turf barrows associated with Food Vessel Urns, which employed stake circles in their construction and which acted as repositories for additional cremation burials. The cemetery was sited along a pre-existing boundary fence, set up after the Late Neolithic phase, which was renewed at various times throughout the life of the cemetery in response to changes in its layout. A small undated cemetery of inhumation graves, possibly of the Early Christian period, was founded on the eastern side of the barrows at a later date.

Obsidian is often seen as a proxy for exchange and networking even though the relationship between these elements can be somewhat indirect. Nevertheless, recent studies which involve the provenance analysis of a large number of artefacts from a single site have opened up a number of avenues which are simply not visible when only a small number of artefacts can be provenanced. In this paper, after evaluating the efficacy of our pXRF protocol for the provenancing of large numbers of obsidian artefacts, we go on to use the data set we generated from Kenan Tepe, in SE Turkey, to discuss the wide range of sources present including the hitherto poorly understood Group 3d. Our integrated study of the techno-morphological and contextual aspects of the artefacts alongside the provenance analysis also allows us to track the use of obsidian through time and to profile the use of individual sources. HighlightsAttribution of 882 obsidian artefacts from late prehistoric/early historic Kenan Tepe, south east Turkey to their geological sources. Analysis of change through time in the use of obsidian sources at a single site. Importance of contextual analysis of obsidian use.The first large scale occurrence of the unlocated Group 3d obsidian.

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Contact across long distances is evident in the Neolithic of the Near East, whether driven by social networks, exchange links, or movement of individuals or populations. Movement of material, such as obsidian, can elucidate these processes but is often studied within a bounded world that places Mesopotamia at the center. This paper focuses on links that cut across the traditionally imposed boundaries between Northern Mesopotamia and the Caucasus. While Armenia is one of the world's most obsidian-rich landscapes, reports of Armenian obsidians in Northern Mesopotamia are scarce. The confirmation (or lack thereof) of these rare reports has important consequences regarding the movement of people, material, and information out of the Caucasus. As discussed here, all but one report either cannot be corroborated or are demonstrably erroneous. For one archaeological site, data processing methods led to overlaps in the signals for different obsidian sources. For another site, one element used in source identification suffered from unsystematic error. For other sites, data and key details went unpublished at the time. To corroborate past work that had identified Armenian obsidian at Domuztepe, 66 artifacts were newly sourced by electron microprobe analysis and confirmed by portable X-ray fluorescence. This sample was biased toward artifacts potentially from Armenia. Our analyses revealed that 15 artifacts match Pokr Arteni, one of the most used