Grafting refers to a surgical procedure to move tissue from one site to another on the body, or from another creature, without bringing its own blood supply with it. Instead, a new blood supply grows in. A similar technique where tissue is transferred with the blood supply intact is called a flap. In some instances a graft can be an artificially manufactured device. Examples of this are a tube to carry blood flow across a defect or from an artery to a vein for use in hemodialysis. Autografts and isografts are not considered as foreign and, therefore, do not elicit rejection. Allografts and xenografts may be rejected. Autograft: graft taken from one part of the body of an individual and transplanted onto another site in the same individual, e.g. skin graft. Isograft: graft taken from one individual and placed on another individual of the same genetic constitution, e.g. grafts between identical twins. Allograft: graft taken from one individual placed on genetically non-identical member of the same species.
Xenograft: graft taken from one individual placed on an individual belonging to another species, e.g. animal to man. The term grafting is most applied to skin grafting, however many tissues can be grafted: skin, nerves, neurons, blood vessels and cornea are tissues grafted today. Specific types include: Skin grafting is used to treat skin loss due to a wound, infection, or surgery. In the case of damaged skin, it is removed, new skin is grafted in its place. Skin grafting can reduce the course of treatment and hospitalization needed, can improve function and appearance. There are two types of skin grafts:Split-thickness skin grafts Full-thickness skin grafts Bone grafting is used in dental implants, as well as other instances; the bone may be autologous harvested from the iliac crest of the pelvis, or banked bone. Vascular grafting is the use of prosthetic blood vessels in surgical procedures. Ligament grafting repair, as with anterior cruciate ligament reconstruction or ulnar collateral ligament reconstruction.
Large amount of skin loss due to infections Burns Skin cancer surgery Hematoma development when the graft is placed over an active bleed Infection Seroma development Shear force disrupting growth of new blood supply Inappropriate bed for new blood supply to grow from, such as cartilage, tendons, or bone
NHS Blood and Transplant
NHS Blood and Transplant is an executive non-departmental public body of England's Department of Health and Social Care. It was established on 1 October 2005 to take over the responsibilities of two separate NHS agencies: UK Transplant, founded by Dr. Geoffrey Tovey in 1972, the National Blood Service, its remit is to provide a reliable, efficient supply of blood and associated services to the NHS. Since NHSBT was established, the organisation has maintained or improved the quality of the services delivered to patients, stabilised the rising cost of blood, centralised a number of corporate services. NHSBT has the responsibility for optimising the supply of blood and tissues and raising the quality and efficiency of blood and transplant services. NHSBT's roles are stated to include: encouraging people to donate organs and tissues optimising the safety and supply of blood and tissues helping to raise the quality and clinical outcomes of NHS blood and transplant services providing expert advice to other NHS organisations, the Department of Health and devolved administrations providing appropriate advice and support to health services in other countries commissioning and conducting research and development engaging in implementing relevant EU statutory frameworks and guidance being involved in broader international developmentsIn 2009/10 NHSBT strategic objectives were focused on the efficient provision of a safe and sustainable supply of blood and its components, the identification and referral of more organ donors and the establishment of NHSBT as an effective and responsive organisation, focused on the needs of donors and patients.
The year saw a record high in organ donation and transplantation together with an increase in the number of people signing up to donate blood. The National Blood Service, now renamed Blood Donation, is the organisation for England which collects blood and other tissues, tests and supplies all the hospitals in England. Other official blood services in the United Kingdom include the Northern Ireland Blood Transfusion Service, Scottish National Blood Transfusion Service and the Welsh Blood Service; the NBS was formed in 1946 as the Blood Transfusion Service and is still referred to as this. The name change came about in 1991 to reflect the move away from a regionally based service to a nationally organised one; the service operates out of fifteen centres, collects around 2.1 million donations per year and supplies 8,000 units of blood every day. Service directors proposed a reconfiguration and centralisation strategy in 2006, based on the closure of most local processing and testing labs, subsequent operation out of just three large'supercentres' to serve the same geographical area.
Staff opposed this strategy. In July 2015 it was decided to shut the blood supply chain manufacturing facilities in Sheffield and Newcastle in 2017 and transfer their work to Manchester. Blood donation vehicles are allowed the use of blue lights and sirens for the use of emergency blood transports. In some cases this will require the use of a police escort for the transporting vehicle in order to safely and navigate major road junctions. Escort is provided by several motorbike units; the service depends on voluntary donations from the public. Blood was collected from various donor clinics located over the country. In 1994, the first mobile session was held in Elstree, hosted by The Joely Bear Appeal. In the South West from 1946 and since the formation of the NHS the service was a mobile collection service visiting all parts of the rural community. Local Organisers called up the Donors from their own lists this only changed in the 1990s; this link with the Local Organisers was inherited from the Wartime Red Cross and St.
Johns blood collection teams. These mobile teams continue to collect, but two centres- Bristol and Plymouth have static bases in local venues. Blood donation sessions are set up throughout the country and take place in many diverse venues, from village halls and mobile collection units. Donors are required to be fit and healthy, weigh 50 kilograms and aged between 17 and 60. However, regular donors are permitted to donate past the age of 60 as long. Donors are encouraged to give blood up to three times a year. Since February 2012, male donors have been allowed to donate up to four times a year. In 2013-14 1,986 people complained. 1,949 said they did not have their blood taken when they had made an appointment. Besides the main blood donations, known as "whole blood", platelets are collected; as platelets can only be stored for a few days and frequent donors are in great demand and, why platelet donors are asked to attend at least 8 – 10 times per year. As one of the two arms of NHSBT, Organ Donation and Transplantation ensures that organs donated for transplant are matched and allocated to patients in a fair and unbiased way.
Matching in the case of kidneys, is so important that donation and allocation needs to be organised nationally. The larger the pool of organs, the better the likelihood there is of a good match. Unlike some other NHS organisations, ODT do not have a direct relationship with patients and do not provide "hands on" care. However, in providing support to transplantation services across England, everything ODT does affects the quality of service delivered to individual patients. In the 1968
National Assembly (France)
The National Assembly is the lower house of the bicameral Parliament of France under the Fifth Republic, the upper house being the Senate. The National Assembly's members are known as députés. There are 577 députés, each elected by a single-member constituency through a two-round voting system. Thus, 289 seats are required for a majority; the assembly is presided over by a president from the largest party represented, assisted by vice-presidents from across the represented political spectrum. The term of the National Assembly is five years; this measure is becoming rarer since the 2000 referendum reduced the presidential term from seven to five years: a President has a majority elected in the Assembly two months after the presidential election, it would be useless for him/her to dissolve it for those reasons. Following a tradition started by the first National Assembly during the French Revolution, the "left-wing" parties sit to the left as seen from the president's seat, the "right-wing" parties sit to the right, the seating arrangement thus directly indicates the political spectrum as represented in the Assembly.
The official seat of the National Assembly is the Palais Bourbon on the banks of the river Seine. It is guarded by Republican Guards; the Constitution of the French Fifth Republic increased the power of the executive at the expense of Parliament, compared to previous constitutions. The President of the Republic can decide to dissolve the National Assembly and call for new legislative elections; this is meant as a way to resolve stalemates where the Assembly cannot decide on a clear political direction. This possibility is exercised; the last dissolution was by Jacques Chirac in 1997, following from the lack of popularity of prime minister Alain Juppé. The National Assembly can overthrow the executive government by a motion of no confidence. For this reason, the prime minister and his cabinet are from the dominant party or coalition in the assembly. In the case of a president and assembly from opposing parties, this leads to the situation known as cohabitation. While motions de censure are periodically proposed by the opposition following government actions that it deems inappropriate, they are purely rhetorical.
Since the beginning of the Fifth Republic, there has only been one single successful motion de censure, in 1962 in hostility to the referendum on the method of election of the President, President Charles de Gaulle dissolved the Assembly within a few days. The government used to set the priorities of the agenda for the assembly's sessions, except for a single day each month. In practice, given the number of priority items, it meant that the schedule of the assembly was entirely set by the executive. This, was amended on 23 July 2008. Under the amended constitution, the government sets the priorities for two weeks in a month. Another week is designated for the assembly's "control" prerogatives, and the fourth one is set by the assembly. One day per month is set by a "minority" or "opposition" group. Members of the assembly can ask oral questions to ministers; the Wednesday afternoon 3 p.m. session of "questions to the Government" is broadcast live on television. Like Prime Minister's Questions in Britain, it is a show for the viewers, with members of the majority asking flattering questions, while the opposition tries to embarrass the government.
The history of national representation for two centuries is linked to history of the democratic principle and the uneven road that it had to go before finding in the French institutions the consecration, its own today. Although the French have periodically elected representatives since 1789, the mode of appointment and the powers of these representatives have varied according to the times, the periods of erasure of the parliamentary institution coinciding with a decline in public liberties. In this respect, the names are not innocent; the name of National Assembly, chosen in the fervor of 1789, just reappears - if we except the short parenthesis of 1848 - in 1946. In the meantime, more or less reductive appellations "Instituted by the Constitution of the year III in August 1795," Chamber of deputies of the departments "," House of Representatives "," Legislative body "," Chambers of deputies ", etc.) which show, to varying degrees, the reluctance or the declared hostility of some governments or governments to the principle
National Marrow Donor Program
The National Marrow Donor Program is a nonprofit organization founded in 1986 and based in Minneapolis, Minnesota that operates the Be The Match Registry of volunteer hematopoietic cell donors and umbilical cord blood units in the United States. The Be The Match Registry is the world's largest hematopoietic cell registry, listing nearly 16 million individuals and nearly 238,000 cord blood units. Hematopoietic cells from NMDP donors or cord blood units are used to transplant patients with a variety of blood, bone marrow or immune system disorders; as of September 2016, the NMDP had facilitated more than 80,000 transplants worldwide. The NMDP coordinates the collection of hematopoietic cells that are used to perform what used to be called bone marrow transplants, but are now more properly called hematopoietic cell transplants. Patients needing a hematopoietic cell transplant but who lack a suitably matched donor in their family can search the Be The Match registry for a matched unrelated donor or cord blood unit.
Hematopoietic cells are used to transplant patients with life-threatening disorders such as leukemia, aplastic anemia, as well as certain immune system and metabolic disorders. Hematopoietic cells can come from umbilical cord blood, or the circulating blood. Hematopoietic cells are a type of adult stem cell that can multiply and differentiate into the three types of blood cells: red blood cells, white blood cells, platelets. Bone marrow and PBSCs come from living adult donors. Bone marrow is extracted from the donor's pelvic bones while the donor is under general or local anesthesia. PBSCs are collected from the donor's blood after five or six days of taking a drug that causes hematopoietic cells in the bone marrow to move into the circulating blood. In both cases, recovery is swift and donors have restored marrow and blood cell counts in under two weeks. Cord blood cells are obtained from the umbilical cord and placenta of a newborn baby after the cord is clamped and cut as in a normal delivery.
The cord blood is stored frozen in a bank until needed for a transplant. The baby is not harmed in any way by this collection, as the cord blood is collected from tissues that in the past had been discarded as medical waste; the Be The Match registry is one of many registries of unrelated donors and cord blood units in the world. Most large, developed nations have such registries. Large registries of unrelated donors are needed because only about 30% of patients with diseases treatable with hematopoietic cell transplantation can find a HLA matched donor among their family members; the remaining 70% require an unrelated hematopoietic cell donor as a transplant source. Because the odds that two random individuals are HLA matched exceeds one in 20,000, a registry's success depends on a large number of volunteer donors; the NMDP coordinates hematopoietic cell transplants by managing a worldwide network of affiliated organizations. These organizations have established relationships with the NMDP and work together to arrange the collection and transfer of donated bone marrow or PBSCs, or the transfer of collected cord blood.
When an adult volunteer donor registers with the NMDP, their HLA and contact information is sent to the NMDP, which stores it in their computers. The NMDP has nearly 238,000 cord blood units, listed by HLA type, in its Be The Match registry; these cord blood units are stored at 19 NMDP-affiliated cord blood banks around the world. Physicians look for donor material on behalf of a patient by submitting the patient's HLA tissue type to the NMDP, which searches its computerized database for matching donor or cord blood units. If the NMDP finds a match with an adult donor, they notify the donor. After educating the potential donor about the donation process, the NMDP asks them to donate. If the potential donor wishes to proceed, they receive a medical exam, which includes testing the blood for infectious diseases. If the potential donor meets all requirements, the NMDP collects their bone marrow or peripheral blood stem cells and sends them by courier to the patient. If the NMDP finds a match to a cord blood unit, they notify the cord blood bank that stores that unit and arrange to send it to the patient.
Cord blood units are shipped frozen, in specially designed coolers, are thawed after arrival at the patient's hospital. The transplant physician evaluating the patient considers a number of clinical factors to decide whether to use an adult donor's marrow or PBSC, or cord blood for a particular patient; the NMDP cooperates with Bone Marrow Donors Worldwide, an organization that coordinates communications among the world's registries. BMDW is based in The Netherlands. Throughout the world, there are an estimated 30 million volunteer hematopoietic cell donors. Most national registries, including the NMDP's Be The Match registry, have access to these worldwide volunteer donors, either through the BMDW or through individually arranged agreements. Although based in the United States, the NMDP has worldwide connections. More than 50 percent of the transplants arranged by the NMDP involve either a foreign patient or a foreign donor; the NMDP contracts with seven donor centers outside of the United States.
These are located in The Netherlands, Sweden and Germany. In addition, the NMDP is affiliated with many transplant centers outside of the United States. Although the NMDP operates the sole federally funded and Congressionally authorized stem cell registry in the United States, another domestic registry
The Republicans (France)
The Republicans is a centre-right, conservative political party in France. The party was formed on 30 May 2015 by renaming the Union for a Popular Movement party, founded in 2002 under the leadership of former President of France Jacques Chirac; the party used to be one of the two major political parties in the French Fifth Republic along with the centre-left Socialist Party, following the 2017 legislative election, it remains the second largest party in the National Assembly. LR is a member of the European People's Party, the Centrist Democrat International, the International Democrat Union. After the election in November 2014 of Nicolas Sarkozy, the President of France from 2007 to 2012, as president of the Union for a Popular Movement, Sarkozy put forward a request to the party's general committee to change its name to "The Republicans" and alter the statutes of the party. With the name chosen, vice-president of the UMP Nathalie Kosciusko-Morizet presented Sarkozy and the party's political bureau the proposed new statutes.
The proposed statutes provided for, among other provisions, the election of the presidents of the departmental federations by direct democracy, the end of the political currents and consulting members on election nominations. Critics of Sarkozy claimed it was "illegal" for him to name the party "Republicans" because every French person is a republican if they support the values and ideals of the French Republic that emanated from the French Revolution, as such the term is above party politics; the new name was adopted by the party bureau on 5 May 2015 and approved by the party membership on 28 May by an online "yes" vote of 83.3% on a 45.7% turnout after a court ruling in favour of Sarkozy. The new party statutes were adopted by 96.3% of voters and the composition of the new political bureau by 94.8%. The change to the name "The Republicans" was confirmed at the party's founding congress on 30 May 2015 at the Paris Event Centre in Paris, attended by 10,000 activists. Angela Merkel, chairwoman of the centre-right CDU, sent a congratulatory message to the congress.
The Republicans thus became the legal successor of the UMP and the leading centre-right party in France. The organisation has been declared in the préfecture de Saône-et-Loire on 9 April 2015. According to the statement of this declaration, its aim is to "promote ideas of the right and centre, open to every people who wish to be member and debate in the spirit of a political party with republican ideas in France or outside France"; this party foundation was published in the Journal officiel de la République française on 25 April 2015. On 3 July 2016, Nicolas Sarkozy announced that he would resign as leader that year in order to compete to be the right-wing candidate in the 2017 presidential election. After winning the party's presidential primary, François Fillon suffered a historic defeat in the first round of the presidential election, with the candidate of the right failing to continue to the second round for the first time in the history of the Fifth Republic amid "Penelopegate". In the second round of the legislative elections in June, The Republicans and its allies suffered further losses, losing nearly a hundred deputies, which represented its worst performance.
After Emmanuel Macron was elected as president, he appointed three right-wing politicians in his government – Édouard Philippe as Prime Minister, Bruno Le Maire as French Ministry for the Economy and Finance, Gérald Darmanin as Minister of Public Action and Accounts. As a consequence, a parliamentary group including LR dissidents supportive of the government line, "The Constructives", was formed in the National Assembly, separate from the existing group. On 11 July, the political bureau of The Republicans agreed to hold a leadership election for president of the party on 10 and 17 December. Politics of France List of political parties in France The Republicans group The Republicans group Official web site of Les Républicains
A vascular bypass is a surgical procedure performed to redirect blood flow from one area to another by reconnecting blood vessels. This is done to bypass around a diseased artery, from an area of normal blood flow to another normal area, it is performed due to inadequate blood flow caused by atherosclerosis, as a part of organ transplantation, or for vascular access in hemodialysis. In general, someone's own vein is the preferred graft material for a vascular bypass, but other types of grafts such as polytetrafluoroethylene, polyethylene terephthalate, or a different person's vein are commonly used. Arteries can serve as vascular grafts. A surgeon sews the graft to the source and target vessels by hand using surgical suture, creating a surgical anastomosis. Common bypass sites include the heart to treat coronary artery disease, the legs, to treat peripheral vascular disease. Cardiac bypass is performed when the arteries that bring blood to the heart muscle become clogged by plaque; such a condition may cause chest pain from a heart attack.
In the legs, bypass grafting is used to treat peripheral vascular disease, acute limb ischemia and trauma. While there are many anatomical arrangements for vascular bypass grafts in the lower extremities depending on the location of the disease, the principle is the same: to restore blood flow to an area without normal flow. For example, a femoral-popliteal bypass might be used. A fem-pop bypass may refer to the above- or below-knee popliteal artery. Other anatomic descriptions of lower extremity bypasses include: "fem-fem" - femoral to femoral bypass, e.g. from right to left. Used when there is no inflow to one femoral artery but there is aortic flow. "aorto-bifem" - aortic to both femoral arteries. Used when there is disease at the aortic bifurcation, known as Leriche syndrome, or in both iliac arteries. "ax-bifem" - axillary artery to both femoral artery bypass. Either axillary artery can be used as the origin of the bypass. Used when patient cannot tolerate a more invasive and higher risk aorto-bifem, or when removing an infected aortic graft such as an EVAR device.
"fem-tib" - femoral to one of the three tibial arteries. Used for disease of the femoral and tibial arteries, this procedure is used most in people with diabetes, which tends to create disease in the tibial arteries rather than the more proximal arteries. A "DP" bypass - any vascular bypass where the target is the dorsalis pedis artery on the dorsum of the foot, it is used in similar situations to those described for the fem-tib bypass. A vascular bypass is created to serve as an access point to the circulatory system for hemodialysis; such a bypass is referred to as an arteriovenous fistula if it directly connects a vein to an artery without using synthetic material. In the skull, when blood flow is blocked or a damaged cerebral artery prevents adequate blood flow to the brain, a cerebral artery bypass may be performed to improve or restore flow to an oxygen-deprived area of the brain; when several arteries are blocked and several bypasses are needed, the procedure is called multiple bypass.
The number of bypasses needed does not always increase the risk of surgery, which depend more on the patient's overall health. Prior to constructing a bypass, most surgeons will obtain or perform an imaging study to determine the severity and location of the diseased blood vessels. For cardiac and lower extremity disease, this is in the form of an angiogram. For hemodialysis access, this can be done with ultrasound. A CT angiogram will take the place of a formal angiogram; the lack of an adequate venous conduit is a relative contraindication to bypass surgery, depending on the area of disease, alternatives may be used. Medical conditions such as ischemic heart disease or chronic obstructive pulmonary disease that increase the risk of surgery are relative contraindications. For coronary and peripheral vascular disease, lack of "runoff" to the distal area is a contraindication because a vascular bypass around one diseased artery to another diseased area does not solve the vascular problem. If a patient is deemed to be too high-risk to undergo a bypass, he or she may be a candidate for angioplasty or stenting of the relevant vessel.
Dogma in vascular bypass technique says to obtain distal control. This means that in a vessel with flow through it, a surgeon must be have exposure of the furthest and nearest extents of the blood vessel in which the bypass is being created, so that when the vessel is opened, blood loss is minimized. After the necessary exposure, clamps are used on both the proximal and distal end of the segment. Exceptions exist where there is no blood flow through the target vessel at the area of proposed entry, as is the case with an intervening occlusion. If the organ perfused by an artery is sensitive to temporary occlusion of blood flow, such as in the brain, various other measures are taken. In neurosurgery, excimer laser assisted non-occlusive anastomosis is a technique use to create a bypass without interrupting the blood supply in the recipient blood vessels; this reduces a rupture of an aneurysm. The ELANA technique is a subtle modification of other methods to establish a connection between blood vessels to create a bypass in or to the brain.
The differences involve. In conventional techniques, the recipient artery is temporarily interrupted and ope
France the French Republic, is a country whose territory consists of metropolitan France in Western Europe and several overseas regions and territories. The metropolitan area of France extends from the Mediterranean Sea to the English Channel and the North Sea, from the Rhine to the Atlantic Ocean, it is bordered by Belgium and Germany to the northeast and Italy to the east, Andorra and Spain to the south. The overseas territories include French Guiana in South America and several islands in the Atlantic and Indian oceans; the country's 18 integral regions span a combined area of 643,801 square kilometres and a total population of 67.3 million. France, a sovereign state, is a unitary semi-presidential republic with its capital in Paris, the country's largest city and main cultural and commercial centre. Other major urban areas include Lyon, Toulouse, Bordeaux and Nice. During the Iron Age, what is now metropolitan France was inhabited by a Celtic people. Rome annexed the area in 51 BC, holding it until the arrival of Germanic Franks in 476, who formed the Kingdom of Francia.
The Treaty of Verdun of 843 partitioned Francia into Middle Francia and West Francia. West Francia which became the Kingdom of France in 987 emerged as a major European power in the Late Middle Ages following its victory in the Hundred Years' War. During the Renaissance, French culture flourished and a global colonial empire was established, which by the 20th century would become the second largest in the world; the 16th century was dominated by religious civil wars between Protestants. France became Europe's dominant cultural and military power in the 17th century under Louis XIV. In the late 18th century, the French Revolution overthrew the absolute monarchy, established one of modern history's earliest republics, saw the drafting of the Declaration of the Rights of Man and of the Citizen, which expresses the nation's ideals to this day. In the 19th century, Napoleon established the First French Empire, his subsequent Napoleonic Wars shaped the course of continental Europe. Following the collapse of the Empire, France endured a tumultuous succession of governments culminating with the establishment of the French Third Republic in 1870.
France was a major participant in World War I, from which it emerged victorious, was one of the Allies in World War II, but came under occupation by the Axis powers in 1940. Following liberation in 1944, a Fourth Republic was established and dissolved in the course of the Algerian War; the Fifth Republic, led by Charles de Gaulle, remains today. Algeria and nearly all the other colonies became independent in the 1960s and retained close economic and military connections with France. France has long been a global centre of art and philosophy, it hosts the world's fourth-largest number of UNESCO World Heritage Sites and is the leading tourist destination, receiving around 83 million foreign visitors annually. France is a developed country with the world's sixth-largest economy by nominal GDP, tenth-largest by purchasing power parity. In terms of aggregate household wealth, it ranks fourth in the world. France performs well in international rankings of education, health care, life expectancy, human development.
France is considered a great power in global affairs, being one of the five permanent members of the United Nations Security Council with the power to veto and an official nuclear-weapon state. It is a leading member state of the European Union and the Eurozone, a member of the Group of 7, North Atlantic Treaty Organization, Organisation for Economic Co-operation and Development, the World Trade Organization, La Francophonie. Applied to the whole Frankish Empire, the name "France" comes from the Latin "Francia", or "country of the Franks". Modern France is still named today "Francia" in Italian and Spanish, "Frankreich" in German and "Frankrijk" in Dutch, all of which have more or less the same historical meaning. There are various theories as to the origin of the name Frank. Following the precedents of Edward Gibbon and Jacob Grimm, the name of the Franks has been linked with the word frank in English, it has been suggested that the meaning of "free" was adopted because, after the conquest of Gaul, only Franks were free of taxation.
Another theory is that it is derived from the Proto-Germanic word frankon, which translates as javelin or lance as the throwing axe of the Franks was known as a francisca. However, it has been determined that these weapons were named because of their use by the Franks, not the other way around; the oldest traces of human life in what is now France date from 1.8 million years ago. Over the ensuing millennia, Humans were confronted by a harsh and variable climate, marked by several glacial eras. Early hominids led a nomadic hunter-gatherer life. France has a large number of decorated caves from the upper Palaeolithic era, including one of the most famous and best preserved, Lascaux. At the end of the last glacial period, the climate became milder. After strong demographic and agricultural development between the 4th and 3rd millennia, metallurgy appeared at the end of the 3rd millennium working gold and bronze, iron. France has numerous megalithic sites from the Neolithic period, including the exceptiona