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Recent research reveals that the arid western interior of South Africa has experienced substantially more humid conditions on several occasions during the last 70 000 years. These findings, likely regional in scope, speak to changes to the resource base available to prehistoric hunter-gatherers. Together with recent archaeological findings from this region, there has emerged a growing recognition that previously archaeologically overlooked areas of South Africa's arid interior need to be included in models of human history. This presents new challenges for archaeologists and palaeoclimatologists, particularly given the prevalence of surficial, rather than stratified, archaeological evidence throughout much of this region.

The greatest concentration of pans in southern Africa occurs in the western Free State province, South Africa. A feature of many Free State pans is their fringing lunettes, located on the southern and south-eastern margins. Lunette dunes associated with pans in the neighbouring and presently drier Kalahari region show depositional ages, determined by optically stimulated luminescence (OSL) dating, primarily in the Holocene. However, to date, the precise timing of Free State lunette accumulation has not been investigated. The morphology, sedimentology and age of lunettes at five pan sites in the western Free State panfield are reported here. The lunettes form distinct topographic features, with heights up to 5 m above the pan floor, and all have been dissected by gully erosion. Sediment in the sand size class dominates in the lunettes, often overlying clay-rich basal or pan floor sediments. The intra- and intersite data consistency of 46 OSL ages is interpreted as reflecting regional causal factors responsible for lunette accretion, with phases of lunette building at 12—10 ka, 5.5—3 ka, 2—1 ka and 0.3—0.07 ka ago. These are in good agreement with the findings from pan-fringing lunettes in the southwest Kalahari and consistent with established records of palaeocirculation and wind direction over central southern Africa during the late Pleistocene. Lunettes in the western Free State are currently not in a major accretion phase. They are subject to degradation by localized fluvial erosion, with sediment being recycled into the pans.

Recent research reveals that the arid western interior of South Africa has experienced substantially more humid conditions on several occasions during the last 70 000 years. These findings, likely regional in scope, speak to changes to the resource base available to prehistoric hunter-gatherers. Together with recent archaeological findings from this region, there has emerged a growing recognition that previously archaeologically overlooked areas of South Africa's arid interior need to be included in models of human history. This presents new challenges for archaeologists and palaeoclimatologists, particularly given the prevalence of surficial, rather than stratified, archaeological evidence throughout much of this region.

The recent surge in piracy attacks off the coast of Somalia has triggered an international response which is unprecedented in terms of the number of actors involved.The International Response to Somali Piracy presents a comprehensive treatment of the international response to Somali piracy, exploring current initiatives to counter the piracy.

Patients who had received a drug-eluting stent and then dual antiplatelet therapy for 12 months were randomly assigned to 18 more months of therapy or aspirin alone. Continued therapy resulted in lower rates of stent thrombosis and major adverse cardiovascular events but more bleeding. Millions of patients worldwide undergo coronary stenting each year for the treatment of ischemic heart disease. 1 , 2 Although drug-eluting stents reduce the rate of restenosis as compared with bare-metal stents, there is concern that drug-eluting stents may be associated with a risk of stent thrombosis beyond 1 year after treatment. 3 Stent thrombosis is rare, yet it is frequently associated with myocardial infarction and may be fatal. 3 Furthermore, ischemic events, such as myocardial infarction, stroke, or death from cardiovascular causes, that are unrelated to the treated coronary lesion may also occur beyond 1 year. 4 , 5 The use of dual antiplatelet therapy . . .

Findings from the randomised phase 3 NeoALTTO trial in women with HER2-positive early breast cancer showed that the combination of lapatinib and trastuzumab significantly improved rates of pathological complete response compared with either drug alone. Here, we report data for the prespecified secondary endpoints of event-free and overall survival, and assess the association between these outcomes and pathological complete response. We enrolled women with HER2-positive early breast cancer and randomly assigned them to receive oral lapatinib (1500 mg), intravenous trastuzumab (4 mg/kg loading dose followed by 2 mg/kg), or lapatinib (1000 mg) plus trastuzumab (same dose as for single agent) in combination for 6 weeks, followed by an additional 12 weeks of the assigned anti-HER2 therapy in combination with weekly paclitaxel (80 mg/m2). Definitive surgery was done 4 weeks after the last dose of paclitaxel. After surgery, women received three cycles of FEC (fluorouracil 500 mg/m2 plus epirubicin 100 mg/m2 plus cyclophosphamide 500 mg/m2) given intravenously every 3 weeks, followed by 34 weeks of the same assigned neoadjuvant anti-HER2 therapy. The primary endpoint was pathological complete response. Secondary endpoints included event-free and overall survival (intention-to-treat analysis), and the association between pathological complete response and event-free or overall survival (analysed by landmark analysis at 30 weeks after randomisation). Follow-up is ongoing, and the trial is registered with ClinicalTrials.gov, number NCT00553358. 455 patients were enrolled: 154 (34%) were assigned to the lapatinib group, 149 (33%) to the trastuzumab group, and 152 (33%) to the lapatinib plus trastuzumab group. At an event follow-up of 3·77 years (IQR 3·50–4·22), 3-year event-free survival was 78% (95% CI 70–84) in the lapatinib group, 76% (68–82) in the trastuzumab group, and 84% (77–89) in the combination group. Event-free survival did not differ between the lapatinib and trastuzumab groups (HR 1·06, 95% CI 0·66–1·69, p=0·81), nor between the combination and trastuzumab groups (0·78, 0·47–1·28, p=0·33). Median survival follow-up was 3·84 years (IQR 3·60–4·24), and 3-year overall survival was 93% (95% CI 87–96) for lapatinib, 90% (84–94) for trastuzumab, and 95% (90–98) for combination therapy. Overall survival did not significantly differ between the lapatinib and trastuzumab groups (HR 0·86, 95% CI 0·45–1·63, p=0·65), nor between the combination and trastuzumab groups (0·62, 0·30–1·25, p=0·19). Landmark analyses showed that 3-year event-free survival was significantly improved for women who achieved pathological complete response compared with those who did not (HR 0·38, 95% CI 0·22–0·63, p=0·0003), as was 3-year overall survival (0·35, 0·15–0·70, p=0·005). Adverse events occurred in 149 (99%) patients receiving lapatinib, 142 (96%) patients receiving trastuzumab, and 147 (99%) patients receiving combination therapy. The most common adverse events were diarrhoea, rash or erythema, hepatic adverse events, and neutropenia (not related to FEC administration), and were consistent with known safety profiles of lapatinib and trastuzumab. Three primary and eight secondary cardiac events occurred, with no significant difference in incidence between treatment groups for primary or any cardiac events. Although event-free survival or overall survival did not differ between treatment groups, findings from our study confirm that patients who achieve pathological complete response after neoadjuvant anti-HER2 therapy have longer event-free and overall survival than do patients without pathological complete response. GlaxoSmithKline.

RNA viruses exhibit substantial structural, ecological and genomic diversity. However, genome size in RNA viruses is likely limited by a high mutation rate, resulting in the evolution of various mechanisms to increase complexity while minimising genome expansion. Here we conduct a large-scale analysis of the genome sequences of 99 animal rhabdoviruses, including 45 genomes which we determined de novo, to identify patterns of genome expansion and the evolution of genome complexity. All but seven of the rhabdoviruses clustered into 17 well-supported monophyletic groups, of which eight corresponded to established genera, seven were assigned as new genera, and two were taxonomically ambiguous. We show that the acquisition and loss of new genes appears to have been a central theme of rhabdovirus evolution, and has been associated with the appearance of alternative, overlapping and consecutive ORFs within the major structural protein genes, and the insertion and loss of additional ORFs in each gene junction in a clade-specific manner. Changes in the lengths of gene junctions accounted for as much as 48.5% of the variation in genome size from the smallest to the largest genome, and the frequency with which new ORFs were observed increased in the 3' to 5' direction along the genome. We also identify several new families of accessory genes encoded in these regions, and show that non-canonical expression strategies involving TURBS-like termination-reinitiation, ribosomal frame-shifts and leaky ribosomal scanning appear to be common. We conclude that rhabdoviruses have an unusual capacity for genomic plasticity that may be linked to their discontinuous transcription strategy from the negative-sense single-stranded RNA genome, and propose a model that accounts for the regular occurrence of genome expansion and contraction throughout the evolution of the Rhabdoviridae.