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East African ecosystems have been shaped by long-term socio-ecological–environmental interactions. Although much previous work on human–environment interrelationships have emphasised the negative impacts of human interventions, a growing body of work shows that there have also often been strong beneficial connections between people and ecosystems, especially in savanna environments. However, limited information and understanding of past interactions between humans and ecosystems of periods longer than a century hampers effective management of contemporary environments. Here, we present a late Holocene study of pollen, fern spore, fungal spore, and charcoal analyses from radiocarbon-dated sediment sequences and assess this record against archaeological and historical data to describe socio-ecological changes on the Laikipia Plateau in Rift Valley Province, Kenya. The results suggest a landscape characterised by closed forests between 2268 years before present (cal year BP) and 1615 cal year BP when there was a significant change to a more open woodland/grassland mosaic that continues to prevail across the study area. Increased amounts of charcoal in the sediment are observed for this same period, becoming particularly common from around 900 cal year BP associated with fungal spores commonly linked to the presence of herbivores. It is likely these trends reflect changes in land use management as pastoral populations improved and extended pasture, using fire to eradicate disease-prone habitats. Implications for contemporary land use management are discussed in the light of these findings.

The expansion of the caravan trade in eastern Africa during the nineteenth century is considered to have had significant ecological, economic and social consequences. While available historical doc...

"This paper presents the process of designing creative workshops that inform the construction of preschools in indigenous communities. The authors aim to answer the following: What is the most effective way to design and execute a workshop that enables community members of other cultures to create a preschool in their local neighborhood? How can this preschool foster and retain creativity among children through its architecture while remaining culturally celebratory and relevant? The authors use the Design Thinking process to develop a workshop for community leaders to conceptualize, ideate, and prototype these buildings. By combining discussion-based research on creativity in early education with the development process of the workshop (and its implementation in the Mayangna community in rural Nicaragua), the authors conclude that, to build a culture- and creativity-promoting workshop model that might be used around in preschool design around the world, the process must be highly adaptive, and indigenous voices must lead the project through longstanding relationships with continued input and redirection."

Research on the social dimensions of climate change is increasingly focused on people's experiences, values and relations to the environment as a means to understand how people interpret and adapt to changes. However, a particular challenge has been making seemingly temporally and geographically distant climate change more immediate and local so as to prompt behavioural change. Environmental humanists, anthropologists and historians have tried to address the challenge through analysis of the experiences, philosophies and memories of weather. Archaeology, commonly preoccupied by hard science approaches to climate change, has largely been absent from this conversation. Nevertheless, with its insights into material outcomes of human experiences and relations, it can become integral to the discussion of ‘weathering’ climate change and historicizing weather. Here, drawing on the subtleties of responses by Ilchamus communities in Kenya and using a mix of historical and archaeological sources, we highlight their experiences of weather since the end of the Little Ice Age and explore the potential of building archaeologies of weather.

Summary: Background: Sepsis bundles, promulgated by Surviving Sepsis Campaign have not been widely adopted because of variability in sepsis identification strategies, implementation challenges, concerns about excess antimicrobial use, and limited evidence of benefit. Methods: A 1-hour septic shock and a 3-hour sepsis bundle were implemented using a Breakthrough Series Collaborative in 14 public hospitals in Queensland, Australia. A before (baseline) and after (post-intervention) study evaluated its impact on outcomes and antimicrobial prescription in patients with confirmed bacteremia and sepsis. Findings: Between 01 July 2017 to 31 March 2020, of 6976 adults presenting to the Emergency Departments and had a blood culture taken, 1802 patients (732 baseline, 1070 post-intervention) met inclusion criteria. Time to antibiotics in 1-hour 73.7% vs 85.1% (OR 1.9 [95%CI 1.1-3.6]) and the 3-hour bundle compliance (48.2% to 63.3%, OR 1.7, [95%CI 1.4 to 2.1]) improved post-intervention, accompanied by a significant reduction in Intensive Care Unit (ICU) admission rates (26.5% vs 17.5% (OR 0.5, [95%CI 0.4 to 0.7]). There were no significant differences in-hospital and 30-day post discharge mortality between the two phases. In a post-hoc analysis of the post-intervention phase, sepsis pathway compliance was associated with lower in-hospital mortality (9.7% vs 14.9%, OR 0.6, 95%CI 0.4 to 0.8). The proportions of appropriate antimicrobial prescription at baseline and post-intervention respectively were 55.4% vs 64.1%, (OR 1.4 [95%CI 0.9 to 2.1]). Interpretation: Implementing 1-hour and 3-hour sepsis bundles for patients presenting with bacteremia resulted in improved bundle compliance and a reduced need for ICU admission without adversely influencing antimicrobial prescription. Funding: Queensland Health.

A case history of a rural workshop using the Stanford Design Thinking Model in a -remote part of the Rio San Juan Nicaragua. The program is run under UNICAM UNAN-Managua believed to be the largest program of its kind. It is a chance to see how both facilitators and participants can learn in very simple settings. It is a chance to understand what kinds of things are impacting the lives of rural people in their quest for the basics of existence such as food and water. Most of all it is a living action of the dream of bringing top level education to the rural people of Nicargua. All the action takes place in a simple rancho at the edge of the Rio San Juan where participants come by canoe, and by foot.

Purpose The complex and occasionally chaotic nature of health care has been previously described in the literature, as has the broadening recognition that different management approaches are required for different types of problems rather than a “one size fits all” approach. The CYNEFIN framework from Snowden outlines a consistent cognitive approach that offers the leader and leadership team an ability to urgently apply the correct actions to a given situation. This paper proposes a variant CYNEFIN approach for healthcare. Design/methodology/approach Consistent and accurate decision-making within health care is the hallmark of an effective and pragmatic leader and leadership team. An awareness of how one’s cognitive biases and heuristics may adversely impact on this cognitive process is paramount, as is an understanding of the calibration between fast and slow thinking. Findings The authors propose a variant CYNEFIN approach for health care of “act-probe-sense-respond” to resolve complex and time-critical emergency scenarios, using the differing contexts of a cardiac arrest and an evolving crisis management problem as examples. The variant serves as a pragmatic sense-making framework for the health-care leader and leadership team that can be adopted for many time-critical crisis situations. Originality/value The variant serves as a pragmatic sense-making framework for the health-care leader that can be adopted for many crisis situations.

BackgroundDuring the initial 26-week SPARK (Safety Paediatric efficAcy phaRmacokinetic with Kuvan®) study, addition of sapropterin dihydrochloride (Kuvan®; a synthetic formulation of the natural cofactor for phenylalanine hydroxylase, tetrahydrobiopterin; BH4), to a phenylalanine (Phe)-restricted diet, led to a significant improvement in Phe tolerance versus a Phe-restricted diet alone in patients aged 0–4 years with BH4-responsive phenylketonuria (PKU) or mild hyperphenylalaninaemia (HPA). Based on these results, the approved indication for sapropterin in Europe was expanded to include patients ResultsAll 51 patients who completed the 26-week SPARK study period entered the extension period. Patients who were previously treated with a Phe-restricted diet only (‘sapropterin extension’ group; n = 26), were initiated on sapropterin at 10 mg/kg/day, which could be increased up to 20 mg/kg/day. Patients previously treated with sapropterin plus Phe-restricted diet, remained on this regimen in the extension period (‘sapropterin continuous’ group; n = 25). Dietary Phe tolerance increased significantly at the end of the study versus baseline (week 0), by 38.7 mg/kg/day in the ‘sapropterin continuous’ group (95% CI 28.9, 48.6;p p = 0.1929). Patients in both groups had normal neuromotor development and growth parameters.ConclusionsLong-term treatment with sapropterin plus a Phe-restricted diet in patients who initiated sapropterin at 4-responsive PKU or mild HPA maintained improvements in dietary Phe tolerance over 3.5 years. These results continue to support the favourable risk/benefit profile for sapropterin in paediatric patients (4-responsive PKU. Frequent monitoring of blood Phe levels and careful titration of dietary Phe intake to ensure adequate levels of protein intake is necessary to optimise the benefits of sapropterin treatment.Trial registrationClinicalTrials.gov, NCT01376908. Registered 17 June 2011,https://clinicaltrials.gov/ct2/show/NCT01376908.

The Rising from the Depths (RftD) network aims to identify the ways in which Marine Cultural Heritage (MCH) can contribute to the sustainable development of coastal communities in Kenya, Tanzania, Mozambique and Madagascar. Although the coastal and marine heritage of eastern Africa is a valuable cultural and environmental resource, it remains largely unstudied and undervalued and is subject to significant threat from natural and anthropogenic processes of change. This paper outlines the aims of the RftD network and describes the co-creation of a challenge-led research and sustainability programme for the study of MCH in eastern Africa. Through funding 29 challenge-led research projects across these four Global South countries, the network is demonstrating how MCH can directly benefit East African communities and local economies through building identity and place-making, stimulating resource-centred alternative sources of income and livelihoods, and enhancing the value and impact of overseas aid in the marine sector. Overall, Rising from the Depths aims to illustrate that an integrated consideration of cultural heritage, rather than being a barrier to development, should be positioned as a central facet of the transformative development process if that development is to be ethical, inclusive and sustainable.

ObjectiveIn 2014, an escalation plan and morning handover meetings were implemented in an intensive care unit (ICU) to reduce access block for post-operative care. In this study, the improvement intervention is revisited 5 years on with the objective to see if the changes are sustained and to understand factors contributing to sustainability.DesignA mixed-method approach was used, with quantitative analysis of ICU administrative data and qualitative analysis of interviews with hospital management and ICU staff.SettingICU with mixed surgical and non-surgical cases in a regional hospital in Australia.ParticipantsInterview participants: ICU nurses (four), ICU doctors (four) and hospital management (four).Main outcome measuresMonthly number of elective surgeries were cancelled due to unavailability of ICU beds. Staff perceptions of the interventions and factors contributed to sustainability.ResultsAfter a decline in elective surgeries being cancelled in the first year after the intervention, there was an increase in cancellations in the following years (χ2=16.38, p=0.003). Lack of knowledge about the intervention and competitive interests in the management of patient flow were believed to be obstacles for sustained effects of the original intervention. So were communication deficiencies that were reported within the ICU and between ICU and other departments. There are discrepancies between how nurses and doctors use the escalation plan and regard the availability of ICU beds.ConclusionImprovement interventions in healthcare that appear initially to be successful are not necessarily sustained over time, as was the case in this study. In healthcare, there is no such thing as a ‘fix and forget’ solution for interventions. Management commitment to support communication within and between microsystems, and to support healthcare staff understanding of the underlying reasons for intervention, are important implications for change and change management across healthcare systems.

This retrospective matched-cohort analysis compared health-economic burdens of adults (≥18 years; n = 377) with phenylketonuria (PKU) and age/gender-matched non-PKU controls (n = 3770) in Germany. Healthcare costs and resource-utilization were analyzed for the year 2015. Differences between groups were tested using 95% CI of mean differences (MD). PKU patients had significantly higher mean costs in total (MD €3307, 95% CI €1736–€4879), for pharmaceuticals (MD €1912, 95% CI €1195–€2629) [including dietary amino-acid supplements (MD €1268, 95% CI €864–€1672)], and outpatient costs (MD €395, 95% CI €115–€675). Inpatient costs (MD €904, 95% CI -€293 to €2100) and costs for aids and remedies (MD €97, 95% CI -€10 to €203) were also higher in PKU patients. PKU patients had more outpatient visits and stayed longer in hospital. Adult PKU patients incur higher total healthcare costs than non-PKU controls, especially regarding pharmaceuticals and outpatient costs, and more frequent resource-utilization, resulting in higher health-economic burden for the statutory healthcare system.

In the 12,000 years preceding the Industrial Revolution, human activities led to significant changes in land cover, plant and animal distributions, surface hydrology, and biochemical cycles. Earth system models suggest that this anthropogenic land cover change influenced regional and global climate. However, the representation of past land use in earth system models is currently oversimplified. As a result, there are large uncertainties in the current understanding of the past and current state of the earth system. In order to improve representation of the variety and scale of impacts that past land use had on the earth system, a global effort is underway to aggregate and synthesize archaeological and historical evidence of land use systems. Here we present a simple, hierarchical classification of land use systems designed to be used with archaeological and historical data at a global scale and a schema of codes that identify land use practices common to a range of systems, both implemented in a geospatial database. The classification scheme and database resulted from an extensive process of consultation with researchers worldwide. Our scheme is designed to deliver consistent, empirically robust data for the improvement of land use models, while simultaneously allowing for a comparative, detailed mapping of land use relevant to the needs of historical scholars. To illustrate the benefits of the classification scheme and methods for mapping historical land use, we apply it to Mesopotamia and Arabia at 6 kya (c. 4000 BCE). The scheme will be used to describe land use by the Past Global Changes (PAGES) LandCover6k working group, an international project comprised of archaeologists, historians, geographers, paleoecologists, and modelers. Beyond this, the scheme has a wide utility for creating a common language between research and policy communities, linking archaeologists with climate modelers, biodiversity conservation workers and initiatives. Fil: Morrison, Kathleen D.. University of Pennsylvania; Estados Unidos Fil: Hammer, Emily. University of Pennsylvania; Estados Unidos Fil: Boles, Oliver. University of Pennsylvania; Estados Unidos Fil: Madella, Marco. University of the Witwatersrand; Sudáfrica. Universitat Pompeu Fabra; España Fil: Whitehouse, Nicola. University of Glasgow; Reino Unido Fil: Gaillard, Marie-Jose. Linnaeus University; Suecia Fil: Bates, Jennifer. University of Pennsylvania; Estados Unidos Fil: Linden, Marc Vander. Bournemouth University; Sudáfrica Fil: Merlo, Stefania. University of the Witwatersrand; Sudáfrica Fil: Yao, Alice. University of Chicago; Estados Unidos Fil: Popova, Laura. Arizona State University; Estados Unidos Fil: Hill, Austin Chad. University of Pennsylvania; Estados Unidos Fil: Antolin, Ferran. Universiat Basel; Suiza Fil: Bauer, Andrew. University of Stanford; Estados Unidos Fil: Biagetti, Stefano. University of the Witwatersrand; Sudáfrica. Universitat Pompeu Fabra; España Fil: Bishop, Rosie R.. University of Stavanger; Noruega Fil: Buckland, Phillip. Universidad de Umea; Suecia Fil: Cruz, Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; Argentina Fil: Dreslerová, Dagmar. Institute Of Archaeology Of The Academy Of Sciences Of The Czech Republic; Hungría Fil: Dusseldorp, Gerrit. Leiden University; Países Bajos Fil: Ellis, Erle C.. University of Maryland; Estados Unidos. University Of Johannesburg; Sudáfrica Fil: Filipovich, Ruben Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Bio y Geociencias del NOA. Universidad Nacional de Salta. Facultad de Ciencias Naturales. Museo de Ciencias Naturales. Instituto de Bio y Geociencias del NOA; Argentina Fil: Foster, Thomas. University of Tulsa; Estados Unidos Fil: Hannaford, Matthew J.. Lincoln University.; Nueva Zelanda Fil: Harrison, Sandy P.. University of Reading; Reino Unido Fil: Hazarika, Manjil. Cotton University; India Fil: Herold, Hajnalka. University of Exeter; Reino Unido Fil: Hilpert, Johanna. Universitat zu Köln; Alemania Fil: Kaplan, Jed O.. The University Of Hong Kong; Hong Kong Fil: Kay, Andrea. Max Planck Institute For The Science Of Human History; Alemania Fil: Goldewijk, Kees Klein. Utrecht University; Países Bajos Fil: Kolár, Jan. Masaryk University; República Checa Fil: Kyazike, Elizabeth. Kyambogo University; Uganda Fil: Laabs, Julian. University of Bern; Suiza Fil: Lancelotti, Carla. Universitat Pompeu Fabra; España Fil: Lane, Paul. University of the Witwatersrand; Sudáfrica. University of Cambridge; Estados Unidos Fil: Lawrence, Dan. University of Durham; Reino Unido Fil: Lewis, Krista. University of Arkansas; Estados Unidos Fil: Lombardo, Umberto. University of Bern; Suiza Fil: Lucarini, Giulio. Consiglio Nazionale delle Ricerche; Italia. University of Naples; Italia Fil: Arroyo Kalin, Manuel. Colegio Universitario de Londres; Reino Unido Fil: Marchant, Rob. University of York; Reino Unido Fil: Mayle, Francis. University of Reading; Reino Unido Fil: McClatchie, Meriel. University College; Irlanda Fil: McLeester, Madeleine. Dartmouth College; Estados Unidos Fil: Mooney, Scott. Unsw Sydney; Australia Fil: Moskal-Del Hoyo, Magdalena. Wladyslaw Szafer Institute Of Botany Of The Polish Academy Of Sciences; Polonia Fil: Navarrete, Vanessa. Universitat Autònoma de Barcelona; España Fil: Ndiema, Emmanuel. National Museums Of Kenya; Kenia Fil: Neves, Eduardo Góes. Universidade de Sao Paulo; Brasil Fil: Nowak, Marek. Jagiellonian University; Polonia Fil: Out, Welmoed A.. Moesgaard Museum; Dinamarca Fil: Petrie, Cameron. Universitat Pompeu Fabra; España. University of Cambridge; Estados Unidos Fil: Phelps, Leanne N.. Royal Botanic Gardens; Reino Unido. University of Edinburgh; Reino Unido Fil: Szakonyi, Zsolt. Eötvös University; Hungría Fil: Rostain, Stéphen. Centre National de la Recherche Scientifique; Francia Fil: Russell, Thembi. University of the Witwatersrand; Sudáfrica Fil: Sluyter, Andrew. Louisiana State University; Estados Unidos Fil: Styring, Amy K.. University of Oxford; Reino Unido Fil: Tamanaha, Eduardo. The Mamirauá Sustainable Development Institute; Brasil Fil: Thomas, Evert. The Alliance of Bioversity International and CIAT; Perú Fil: Veerasamy, Selvakumar. Tamil University; India Fil: Welton, Lynn. University of the Witwatersrand; Sudáfrica Fil: Zanon, Marco. Institute of Pre- and Protohistoric Archaeology; Alemania

Much of the research on slavery in Africa still relies heavily on documentary and oral sources and uses archaeology more as a means to materialize the practices of slave trading and ownership than as an independent source of evidence. This is perhaps understandable given that their marginal status generally meant enslaved persons left far fewer material traces of their presence than other labour categories. Moreover, even where material evidence has been interpreted as indicative of either slave trading or slave ownership, alternative explanations can usually also be forwarded. In the absence of supporting documentary evidence, verification of the presence of slaves, therefore, may be hard to achieve. Nonetheless, as recent studies now demonstrate, new information about the lives of enslaved individuals, the wider impacts of slave raiding and the organization of slave trading can be gleaned from analysis of material and bioarchaeological evidence at multiple spatial scales, and when several different material and landscape indicators occur together convincing arguments for the presence of slavery can be made. The aim of this chapter is to review these emerging approaches to highlight their possible relevance for the study of slavery systems in other contexts.

‘Heritage’ means different things to different people, and has diverse connotations. Literally meaning ‘that which can be inherited,’ the term is used to refer to all forms of cultural and natural property across the disciplines and often also as a synonym for local tradition and knowledge. Regardless of how heritage is defined, it tends to be seen as a social good, something that needs to be protected, and a resource that can be employed to promote tourism, cultural renaissance, and community resilience. However, at a time of increasing pressure to boost economic growth, protecting Africa’s multi-faceted heritage can be seen as a potential barrier to rapid development, leading to damage and destruction. This chapter explores the implications of different assessments of the ‘worth’ of Africa’s tangible and intangible heritage and some of the practical and conceptual challenges arise as a result using examples from across sub-Saharan Africa as case studies.