An Intersectional Approach to Equity, Inequity, and Archaeology

The year 2020 was an awakening for some. For others, it reiterated the persistent social injustice in the United States. Compelled by these events, 30 diverse individuals came together from January to May 2021 for a semester-long seminar exploring inequity in archaeological practice. The seminar's discussions spotlighted the inequity and social injustices that are deeply embedded within the discipline. However, inequity in archaeology is often ignored or treated narrowly as discrete, if loosely bound, problems. A broad approach to inequity in archaeology revealed injustice to be intersectional, with compounding effects. Through the overarching themes of individual, community, theory, and practice, we (a subset of the seminar's participants) explore inequity and its role in various facets of archaeology, including North-South relations, publication, resource distribution, class differences, accessibility, inclusive theories, service to nonarchaeological communities, fieldwork, mentorship, and more. We focus on creating a roadmap for understanding the intersectionality of issues of inequity and suggesting avenues for continued education and direct engagement. We argue that community-building - by providing mutual support and building alliances - provides a pathway for realizing greater equity in our discipline.Fil: Rivera Prince, Jordi A.. University of Florida; Estados UnidosFil: Blackwood, Emily M.. University of Maine; Estados UnidosFil: Brough, Jason A.. University of Maine; Estados UnidosFil: Landázuri, Heather A.. University of Maine; Estados UnidosFil: Leclerc, Elizabeth L.. University of Maine; Estados UnidosFil: Barnes, Monica. American Museum of Natural History; Estados UnidosFil: Brasil, Kareen Kristina. Columbia University; Estados UnidosFil: Gutierrez, Maria Amelia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil. Investigaciones Arqueológicas y Paleontológicas del Cuaternario Pampeano. Universidad Nacional del Centro de la Provincia de Buenos Aires. Investigaciones Arqueológicas y Paleontológicas del Cuaternario Pampeano; ArgentinaFil: Herr, Sarah. Desert Archaeology, Inc.; MéxicoFil: Maasch, Kirk A.. University of Maine; Estados UnidosFil: Sandweiss, Daniel H.. University of Maine; Estados Unido

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Creación de un seminario basado en la equidad de contenido y formato: Un estudio de caso y un llamado a la acción

Creación de un seminario basado en la equidad de contenido y formato: Un estudio de caso y un llamado a la acción Creating a Seminar Based on Content and Format Equity: A Case Study and Call to Actio