"Measuring the Environmental Context of Child Growth in Burkina Faso"

Child growth failure, as indicated by low height-for-age z-scores (HAZ), is an important metric of health, social inequality, and food insecurity. Understanding the environmental pathways to this outcome can provide insight into how to prevent it. While other studies have examined the environmental determinants of HAZ, there is no agreed upon best-practices approach to measure the environmental context of this outcome. From this literature, we derive a large set of potential environmental predictors and specifications including temperature and precipitation levels, anomalies, and counts as well as vegetation anomalies and trends, which we include using linear, nonlinear, and interactive specifications. We compare these measures and specifications using four rounds of DHS survey data from Burkina Faso and a large set of fixed effects regression models, focusing on exposures from the time of conception through the second year of life and relying on joint hypothesis tests and goodness-of-fit measures to determine which approach best explains HAZ. Our analysis reveals that nonlinear and interactive transformations of climate anomalies, as opposed to climate levels or vegetation indices, provide the best explanation of child growth failure. These results underline the complex and nonlinear pathways through which climate change affects child health and should motivate climate-health researchers to more broadly adopt measures and specifications that capture these pathways.

Walking the Line: Conducting Transect Walks in Burkina Faso

In this article we present results from transect walks and participatory mapping done in Burkina Faso. Since the Sahelian drought of the 1970s, researchers have continued to depict the Sahelian region of West Africa as an environment experiencing severe degradation; a narrative that persists over time. Recently, however, analyses of satellite imagery have identified remarkable patterns of greening across the Sahel. The causes of this greening are hotly debated. Through this project we aim to inform these debates with on-the-ground perceptions of local farmers and pastoralists. The transect walk method is a community-based process that collects information on the land-use/land-cover (LULC) features across villages. Transects help triangulate data by combining high-resolution satellite imagery, firsthand observations, and local experiences of ecological processes. We describe the methodology behind transects and discuss how they contextualize an otherwise removed process of environmental analysis. We also describe the challenges that arise throughout the fieldwork process.

Participatory Mapping with Herders in a Climate Adaptation Research Project

Declining grazing lands threaten the livelihoods of Fulɓe herders in Burkina Faso and other parts of Africa. I used GIS to spatially represent ethnographic narratives about land use and land cover changes. In a place where maps were unavailable or treated as closely held community secrets, I used participatory mapping to offer participants the opportunity to control the process and resulting maps. Our project sought to understand environmental challenges from a fine-grained emic perspective using high-resolution satellite imagery and focus groups. I reflect on challenges of conducting fieldwork in one's home country, which made it easier to build relationships and interact with officials. At the same time, however, I faced the intersecting challenges of "being an outsider and a woman" as I interacted with Fulɓe men and that of being "too educated" in interacting with women.

The REBOA window: a cadaveric study delineating the optimum site for austere cannulation of the femoral artery for resuscitative endovascular balloon occlusion of the aorta

INTRODUCTION

Haemorrhage is the major cause of early mortality following traumatic injury. Patients suffering from non-compressible torso haemorrhage are more likely to suffer early death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) can be effective in initial resuscitation; however, establishing swift arterial access is challenging, particularly in a severe shock. This is made more difficult by anatomical variability of the femoral vessels.

METHODS

The femoral vessels were characterised in 81 cadaveric lower limbs, measuring specifically the distance from the inferior border of the inguinal ligament to the distal part of the origin of the profunda femoris artery (PFA), and from the distal part of the origin of the PFA to where the femoral vein lies posterior to and is completely overlapped by the femoral artery.

RESULTS

The femoral vein lay deep to the femoral artery at a mean distance of 105 mm from the inferior border of the inguinal ligament. The PFA arose from the femoral artery at a mean distance of 51.1 mm from the inguinal ligament. From the results, it is predicted that the PFA originates from the common femoral artery approximately 24 mm from the inguinal ligament, and the femoral vein is completely overlapped by the femoral artery by 67.7 mm distal from the inguinal ligament, in 95% of subjects.

CONCLUSIONS

Based on the results, proposed is an 'optimal access window' of up to 24 mm inferior to the inguinal ligament for common femoral arterial catheterisation for pre-hospital REBOA, or more simply within one finger breadth.

'Where's the map?': Integrating ethnography with maps to understand the complementarity between pastoral mobility and border formation

The resettlement of herders in pastoral zones is often criticized for hindering pastoral mobility, which is essential to survival. We integrate narratives of conflict and environmental change with maps to demonstrate the complementarity between pastoral mobility - porous borders- and border demarcation - rigid borders. We use evidence from the Sondré-Est Pastoral Zone in southern Burkina Faso, where herders were voluntarily resettled near agricultural villages following the droughts of the 1970s. Over time, however, farmers encroached on the borders of the pastoral zone and surrounding grazing areas declined. This increased land-use disputes. Tensions were exacerbated by the fact that these communities kept maps as community secrets. We re-created the administrative boundaries of the pastoral zone to map land-use/land-cover changes and conflict hot spots. The maps show that conflicts happened along porous borders where agricultural fields encroached. Herders called for a clear demarcation of the border of the pastoral zone to preserve exclusive access to resources within it. Simultaneously, they also wanted to maintain shared access to other resources outside the pastoral zone. The herders' desire for both border clarity and some form of flexibility underlines the complementary between both processes, especially in times of resource scarcity and land-use conflict. The mystery around the maps helps sustain ambiguity that is key for pursuing both goals.

Participatory Mapping with High-resolution Satellite Imagery: A Mixed method Assessment of Land Degradation and Rehabilitation in Northern Burkina Faso

Sahelian West Africa is a region that suffers from high population densities, frequent severe droughts, and enormous pressure on natural resources. Because of these challenges, it is the place where the term "desertification" was originally coined. Recently, however, experts have identified large zones of "greening" where the amount of vegetation exceeds what one would expect based on rainfall alone. This pattern is well documented, but its mechanisms remain poorly understood. This research employs participatory mapping linked with high-resolution satellite imagery to better understand the human role behind regional vegetation trends. Through a case study of three communities in northern Burkina Faso, this paper presents a pilot methodology for explicitly mapping perceived areas of both land degradation and rehabilitation. Combining participatory mapping exercises with standard image classification techniques allows areas of land degradation and rehabilitation to be precisely located and their extents measured for individual communities and their surrounding terroirs. Results of the spatial analysis show that the relative proportion of greening and browning varies among communities. In the case of Sakou, nearly 60 percent of its terroir is degraded. While in another, Kouka, this is 48 percent. This method also elicits perspectives of Burkinabè agro-pastoralists on the local land-use practices driving these twin environmental processes. Altogether, this case study demonstrates the analytical power of integrating ethnography and high-resolution satellite imagery to provide a bottom-up perspective on social-ecological dynamics.

Appendicitis due to incarceration within a laparoscopic umbilical port-site hernia secondary to a degree of intestinal malrotation

A 37-year-old woman presented with an incarcerated hernia at a previous umbilical laparoscopic port site. This was found to contain an ischaemic appendix, which was managed successfully with open appendicectomy and a mesh repair. Previous imaging from a year prior to these events demonstrated a degree of intestinal malrotation with the caecal pole lying just under the umbilicus. Finding the appendix within an incisional port site is very rare, for this to occur at the umbilicus is unique.

An anatomical study of additional radial wrist extensors including a unique extensor carpi radialis accessorius

BACKGROUND

In this study, 82 forearms from 41 cadavers were dissected to establish the incidence of variant additional radial wrist extensors. Three variants have been described in the literature: extensor carpi radialis intermedius (ECRI), extensor carpi radialis accessorius (ECRA) and extensor carpi radialis tertius (ECRT).

MATERIALS AND METHODS

Of the 41 cadavers studied, 5/41 (12%) had an additional radial wrist extensor. Of these 5 individuals, 2 had bilateral additional muscles and 3 were unilateral. Of the 82 forearms, 7/82 (9%) had additional radial wrist extensors.

RESULTS

We found 4 examples of ECRI and 3 examples of ECRA. We did not find any examples of ECRT. One specimen of ECRA had an atypical, previously undescribed, course.

CONCLUSIONS

These accessory muscles are of clinical relevance, as they may be a contributing factor in tennis elbow and nerve entrapment, or cause diagnostic confusion, especially in ultrasound scans. However, they may also be used for tendon transfer. Of the 7 muscles found in the current study, 3 would have been suitable for such procedures.

Ground-truthing Sahelian Greening: Ethnographic and Spatial Evidence from Burkina Faso

Historically, the Sahel of West Africa has been considered synonymous with desertification. In recent decades, however, satellite images reveal patterns of enhanced vegetation termed the "greening of the Sahel." This greening is well-documented but its mechanisms remain poorly understood. The Sahel is also a region emerging from a thirty-year period of reduced rainfall in which several severe droughts occurred. As a response to droughts and land degradation, farmers have rehabilitated thousands of hectares of degraded soils by constructing low barriers of rock through widespread soil and water conservation (SWC) development projects. Remote sensing analyses suggest that these extensive soil conservation projects may explain greening in northern Burkina Faso. This study combines ethnographic fieldwork with the analysis of Geographic Information System (GIS) and remote sensing (RS) data to test whether SWC investments contribute to greening. Ethnographic data reveals a tension between the perceptions of rural producers who feel that their SWC efforts contribute to greening and those of state officials who contend that SWC has only local impacts and that the regional landscape continues to degrade. Our analysis of GIS and RS data suggest that both perspectives are valid but contingent on particular spatial and temporal scale used for analysis.

Unraveling the Sikasso Paradox: Agricultural Change and Malnutrition in Sikasso, Mali

When cash cropping leads to agricultural and livelihood changes in the Global South, concern about food security is common among policy makers. This is indeed the case in the Sikasso region of Mali, where many have suggested that the ubiquitous cash crop cotton is a cause of the unexpectedly high rates of malnutrition in the region. Using household and forest surveys, we found little evidence that cotton cultivation is associated with malnutrition or decreased food security at a household level, but we did find evidence of a coassociation between cotton cultivation, loss of natural capital, and malnutrition at the village level.

Indirect Reciprocity, Resource Sharing, and Environmental Risk: Evidence from Field Experiments in Siberia

Integrating information from existing research, qualitative ethnographic interviews, and participant observation, we designed a field experiment that introduces idiosyncratic environmental risk and a voluntary sharing decision into a standard public goods game. Conducted with subsistence resource users in rural villages on the Kamchatka Peninsula in Northeast Siberia, we find evidence consistent with a model of indirect reciprocity and local social norms of helping the needy. When participants are allowed to develop reputations in the experiments, as is the case in most small-scale societies, we find that sharing is increasingly directed toward individuals experiencing hardship, good reputations increase aid, and the pooling of resources through voluntary sharing becomes more effective. We also find high levels of voluntary sharing without a strong commitment device; however, this form of cooperation does not increase contributions to the public good. Our results are consistent with previous experiments and theoretical models, suggesting strategic risks tied to rewards, punishments, and reputations are important. However, unlike studies that focus solely on strategic risks, we find the effects of rewards, punishments, and reputations are altered by the presence of environmental factors. Unexpected changes in resource abundance increase interdependence and may alter the costs and benefits of cooperation, relative to defection. We suggest environmental factors that increase interdependence are critically important to consider when developing and testing theories of cooperation

Famines are a Thing of the Past: Food Security Trends in Northern Burkina Faso

Sub-Saharan Africa is often portrayed as a region of chronic hunger, conflict, and poverty. The country of Burkina Faso is a bright spot on the continent where government agencies, NGOs, and development organizations have progressively improved food security to the point where citizens often state, "famines of the past could never happen again." This study evaluates such claims by looking at food security trends over the last 18 years using ethnographic participatory fieldwork and grain price data. Community members have invested in numerous soil and water conservation (SWC) measures that buffer their crops from droughts and agro-climatic variability. There is also a national famine early warning system in place and improved infrastructure that helps the government and NGOs efficiently provide food assistance in times of need. Thus, fewer households are affected when droughts occur due to these adaptations and food insecurity is not as severe or widespread as in the past. Local grain prices are, however, rising and becoming more closely linked to world food markets. Just as most households are becoming more food secure, those who are dependent on grain purchases are becoming more food insecure.

Sexual harassment among nursing professionals: evidence and prescriptions for administrators

The results of this study indicate that the experience of sexual harassment among nursing professionals may be more widespread than previously reported. With only one percent of respondents reporting ¿quid pro quo¿ harassment, the vast majority of harassment fell into the ¿hostile environment¿ category where the victim's perceptions are all important. Health care administrators should be cautioned that harassment and discrimination are evolving and expanding areas of the law, necessitating current knowledge of the standards for actionable conduct. To lower the risk of liability from claims of both victims and the accused, harassment and discrimination policies should be aggressive, proactive, fair, and thorough.