Agrobiodiversity, Rural Transformations and Household Experiences of Globalised Change: A Case Study from Southern Bolivia

This paper examines reconfigurations of household economies and agrobiodiversity through the experiences and responses of rural households to local manifestations of globalisation and environmental change in the Central Valley of Tarija, Bolivia, from the 1950s to the present. Research participant narratives from seven study communities document a widely experienced regional shift from rain-fed agriculture and pastured livestock production for household consumption to market-oriented production of regionally-specialised commodities. Particularly important to this reconfiguration are changing land access and use regimes, household responses to changing opportunities, discourses and social requirements related with ‘modernising lifestyles’, market integration and dependence, changing environmental and ecological conditions, and greater availability of consumer goods and technologies. We analyse how these processes have combined to reconfigure the range of livelihood possibilities available to rural households, or their ‘landscapes of possibility’, in ways that favour transition to specialised commodity production. Patterns of change in household agrobiodiversity use, however, are entwined with threads of persistence, underscoring the contingent nature of rural transitions and the role of local agency and creativity in responding to and sometimes shaping how globalisation unfolds. Examining rural transition through the experiences of households in particular contexts over time offers insights for development policy and practice to support producers’ ability to respond to globalisation and environmental change in ways they see as desirable and beneficial to their livelihoods and wellbeing

Forest-linked livelihoods in a globalized world.

Forests have re-taken centre stage in global conversations about sustainability, climate and biodiversity. Here, we use a horizon scanning approach to identify five large-scale trends that are likely to have substantial medium- and long-term effects on forests and forest livelihoods: forest megadisturbances; changing rural demographics; the rise of the middle-class in low- and middle-income countries; increased availability, access and use of digital technologies; and large-scale infrastructure development. These trends represent human and environmental processes that are exceptionally large in geographical extent and magnitude, and difficult to reverse. They are creating new agricultural and urban frontiers, changing existing rural landscapes and practices, opening spaces for novel conservation priorities and facilitating an unprecedented development of monitoring and evaluation platforms that can be used by local communities, civil society organizations, governments and international donors. Understanding these larger-scale dynamics is key to support not only the critical role of forests in meeting livelihood aspirations locally, but also a range of other sustainability challenges more globally. We argue that a better understanding of these trends and the identification of levers for change requires that the research community not only continue to build on case studies that have dominated research efforts so far, but place a greater emphasis on causality and causal mechanisms, and generate a deeper understanding of how local, national and international geographical scales interact.This work was funded by the UK’s Department for International Development (grant number 203516-102) and governed by the University of Michigan’s Institutional Review Board (HUM00092191). JAO acknowledges the 520 support of a European Union FP7 Marie Curie international outgoing fellowship (FORCONEPAL). LVR was funded by the European Research Council (ERC) under the European Union’s Horizon 2020 Research and Innovation Programme (Grant agreement No. 853222 FORESTDIET). AJB acknowledges the support of an Australian Research Council Australia Laureate Fellowship (grant number 525 FL160100072). LBF acknowledges support from the European Union Marie Curie global fellowship (CONRICONF). PM was supported by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (Grant agreement No 677140 MIDLAND)

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Learning as You Journey: Anishinaabe Perception of Social-ecological Environments and Adaptive Learning

This paper explores the linkages between social-ecological resilience and adaptive learning. We refer to adaptive learning as a method to capture the two-way relationship between people and their social-ecological environment. In this paper, we focus on traditional ecological knowledge. Research was undertaken with the Anishinaabe people of Iskatewizaagegan No. 39 Independent First Nation, in northwestern Ontario, Canada. The research was carried out over two field seasons, with verification workshops following each field season. The methodology was based on site visits and transects determined by the elders as appropriate to answer a specific question, find specific plants, or locate plant communities. During site visits and transect walks, research themes such as plant nomenclature, plant use, habitat descriptions, biogeophysical landscape vocabulary, and place names were discussed. Working with elders allowed us to record a rich set of vocabulary to describe the spatial characteristics of the biogeophysical landscape. However, elders also directed our attention to places they knew through personal experiences and journeys and remembered from stories and collective history. We documented elders' perceptions of the temporal dynamics of the landscape through discussion of disturbance events and cycles. Again, elders drew our attention to the ways in which time was marked by cultural references to seasons and moons. The social memory of landscape dynamics was documented as a combination of biogeophysical structures and processes, along with the stories by which Iskatewizaagegan people wrote their histories upon the land. Adaptive learning for social-ecological resilience, as suggested by this research, requires maintaining the web of relationships of people and places. Such relationships allow social memory to frame creativity, while allowing knowledge to evolve in the face of change. Social memory does not actually evolve directly out of ecosystem dynamics. Rather, social memory both frames creativity within, and emerges from, a dynamic social-ecological environment

Community-based enterprises and the commons: The case of San Juan Nuevo Parangaricutiro, Mexico

Commons scholarship has tended to focus on the administration and use of commons by individuals and households and less so on collective enterprises that extract, transform and market what they harvest from the commons. In this paper, we consider Nuevo San Juan, a Mexican case that is well known in the community forestry and commons literature. In San Juan, indigenous community members who hold the rights for the commons are also the members of the enterprise that transforms and markets goods from the commons. We argue that such a strategy is one way to confront internal and external pressures on a commons. We draw upon the transcripts of 40 interviews undertaken during 2006 which are analyzed using a framework developed from the social, community-based and indigenous enterprise literature. Our goal was to utilize this framework to analyze the San Juan Forest Enterprise and understand its emergence and formation as a long-standing community-based enterprise that intersects with a commons, and thereby identify factors that increase chances of success for community enterprises. We found that by starting from the community-based and indigenous enterprise literature and using that literature to engage with thinking on commons, it was possible to consider the enterprise from the perspective of a regulatory framework rather than from the poles of dependency and modernization theories in which much commons work has been based. Enterprise and commons intersect when both are guided by core cultural values and the enterprise can become a new site for the creation of social and cultural cohesion. We also found that there were a number of necessary conditions for commons-based community-enterprises to retain internal and external legitimacy, namely: (1) leadership representative of the broad social mission rooted in the customary institutions, values and norms of the community; (2) accountability of enterprise leaders to the memberships they represent; and (3) a close adherence to the political goals of the community as a whole

Agency and Resilience: Teachings of Pikangikum First Nation Elders, Northwestern Ontario

Although scholars of social-ecological resilience propose unity between humans and the natural world, much of this work remains based on Cartesian division of mind and body that denies it. We present an example of a unified system of resilience thinking shared with us by Anishinaabe (Ojibway) elders of Pikangikum First Nation, northwestern Ontario. The elders' views of boreal forest disturbance and renewal are distinct from western scientific approaches in their recognition of agency, the ability to individually express free will in nonhuman beings including animals, plants, rocks, and forest fire within their landscape. Pikangikum elders perceive that, if relationships based on respect, reciprocity, and noninterference are maintained with other agents, renewal will continue. The proposition of living landscapes composed of diverse nonhuman agents poses challenges to collaboration with western worldviews, which view nature largely as mechanistic and without moral standing. We suggest that a greater attention to nonwestern ontologies can contribute to productive cross-cultural partnerships directed toward fostering resilience

Biocultural Design: Harvesting Manomin with Wabaseemoong Independent Nations

This essay describes how biocultural design (BD) was utilized to develop a manomin (wild rice, Zizania palustris) harvest camp and the prospect of this approach to implement the principles reflected in recent calls for an Ethnobiology V. In this case, BD brought together knowledge, practices, and innovation within an intentional process of co-design to respond to the specific community aspirations of restoring relationships with manomin. The paper provides an overview of the benefits and challenges of using the practice of BD to re-establish wild rice harvesting. The information presented here is part of a larger initiative to restore manomin habitats, harvest practices, and consumption being undertaken by Wabaseemoong Independent Nations, Northwestern Ontario, Canada.</em