Music, musicians, and social advocacy: Environmental conservation, knowledge-sharing, and cultivating a culture of wisdom in northern Tanzania

Popular music and musicians in Tanzania play an important role in identifying and confronting a variety of locally relevant concerns. Prior research in the region has focused especially on the relationship between hip hop and social problems such as poverty and drug-use among urban youth. While individual artists and groups of people brought together by their shared interest in music have both been included in this research, their engagement with local and global environmental issues and community-based education have not been exhaustively addressed. This thesis seeks to fill this gap by exploring the relationships of music-makers and their communities with environmental concerns and various forms of knowledge production and maintenance. Drawing on formal interviews, informal conversations, and my participation in the collaborative production of an album and music video, this thesis presents several case studies which demonstrate unique and innovative approaches to confronting environmental and educational issues. Environmental advocacy and activism are carried out by musicians in Tanzania both through their musical production itself and extra-musical efforts. Chaca na Nduguzee’s “Maji Uhai” (Water is life), explicitly addresses the crisis of clean water in Tanzania. Another artist, P-Culture, uses nostalgic language and visual depictions to simultaneously construct local indigenous identities and pan-African ones, united by their relationship to the land in her video for “Dream Land.” There are also a number of communities centered around musical production involved in local waste-cleanup efforts and creating sustainable forms of ecotourism. Many of these artists and their communities are also involved in the maintenance and production of diverse knowledges and the eventual naturalization of collective wisdom based in humane decision-making. The ways in which the communities and individuals I present in my case studies do the work of producing, sharing, and encouraging particular ways of thinking and forms of knowledge are varied and plural, in both their specific educational goals and their modes of transmission and creation. A hip hop collective known as Okoa Mtaa (Saving the neighborhood), and the multi-faceted organization entitled the United African Alliance Community Center (UAACC) both organize public educational programming on a variety of topics. Between these two organizations alone, educational approaches include film production and screening, free classes for children and adults in a variety of subjects, as well as workshops aimed at professional development for hip hop artists and producers. My collaboration with musician Chaca na Nduguzee, other Arusha-based artists, and musicians within a Hadzabe community also demonstrate innovative modes of maintaining and cultivating knowledge and wisdom both within Tanzania and beyond its national and cultural borders. The unrelenting desire of the communities and individuals behind these efforts to empower others through intellectual growth, in conjunction with the multiplicity of strategies they already use, may not be the singular solution to the societal problems they seek to resolve, but they are already making a difference in the lives and musical production of many people in northern Tanzania. I conclude by addressing the significance of the advocacy and actions carried out by the musically-minded people I represent through my analysis. Their musical expression and extra-musical work directed towards the development of alternative ways of thinking about and being in the world for both those within their music-centered communities and those with whom they directly and indirectly interact offers not only methods for others to adapt and repurpose in confronting their comparable environmental and educational concerns, but is already making an impact. In this thesis, I argue that music-centered communities and the individual artists which populate them confront local environmental challenges; foster the growth of a culture of wisdom; and nurture the maintenance, continued production, and transmission of various bodies of knowledge, including IK and TEK, through both music-making itself and extra-musical actions

Relative effectiveness and safety of pharmacotherapeutic agents for patent ductus arteriosus (PDA) in preterm infants: A protocol for a multicentre comparative effectiveness study (CANRxPDA)

Introduction Patent ductus arteriosus (PDA) is the most common cardiovascular problem that develops in preterm infants and evidence regarding the best treatment approach is lacking. Currently available medical options to treat a PDA include indomethacin, ibuprofen or acetaminophen. Wide variation exists in PDA treatment practices across Canada. In view of this large practice variation across Canadian neonatal intensive care units (NICUs), we plan to conduct a comparative effectiveness study of the different pharmacotherapeutic agents used to treat the PDA in preterm infants. Methods and analysis A multicentre prospective observational comparative-effectiveness research study of extremely preterm infants born 29 weeks gestational age with an echocardiography confirmed PDA will be conducted. All participating sites will self-select and adhere to one of the following primary pharmacotherapy protocols for all preterm babies who are deemed to require treatment. Standard dose ibuprofen (10 mg/kg followed by two doses of 5 mg/kg at 24 hours intervals) irrespective of postnatal age (oral/intravenous). Adjustable dose ibuprofen (oral/intravenous) (10 mg/kg followed by two doses of 5 mg/kg at 24 hours intervals if treated within the first 7 days after birth. Higher doses of ibuprofen up to 20 mg/kg followed by two doses of 10 mg/kg at 24 hours intervals if treated after the postnatal age cut-off for lower dose as per the local centre policy). Acetaminophen (oral/intravenous) (15 mg/kg every 6 hours) for 3-7 days. Intravenous indomethacin (0.1-0.3 mg/kg intravenous every 12-24 hours for a total of three doses). Outcomes The primary outcome is failure of primary pharmacotherapy (defined as need for further medical and/or surgical/interventional treatment following an initial course of pharmacotherapy). The secondary outcomes include components of the primary outcome as well as clinical outcomes related to response to treatment or adverse effects of treatment. Sites and sample size The study will be conducted in 22 NICUs across Canada with an anticipated enrollment of 1350 extremely preterm infants over 3 years. Analysis To examine the relative effectiveness of the four treatment strategies, the primary outcome will be compared pairwise between the treatment groups using χ 2 test. Secondary outcomes will be compared pairwise between the treatment groups using χ 2 test, Student\u27s t-test or Wilcoxon rank sum test as appropriate. To further examine differences in the primary and secondary outcomes between the four groups, multiple logistic or linear regression models will be applied for each outcome on the treatment groups, adjusted for potential confounders using generalised estimating equations to account for within-unit-clustering. As a sensitivity analysis, the difference in the primary and secondary outcomes between the treatment groups will also be examined using propensity score method with inverse probability weighting approach. Ethics and dissemination The study has been approved by the IWK Research Ethics Board (#1025627) as well as the respective institutional review boards of the participating centres. © 2021 Author(s). Published by BMJ

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Evaluation of Health-Related Values and Preferences of Adults Who Were Preterm Infants and Parents of Preterm Infants Concerning Use of Prophylactic Cyclooxygenase Inhibitor Drugs

Importance: there is wide variability in the use of prophylactic cyclooxygenase inhibitor (COX-I) drugs to prevent morbidity and mortality in preterm infants. Parents of preterm infants are rarely involved in this decision-making process. Objective: to explore the health-related values and preferences of adults who were preterm infants and families of preterm infants concerning the prophylactic use of indomethacin, ibuprofen, and acetaminophen initiated within the first 24 hours after birth.Design, setting, and participants: this cross-sectional study used direct choice experiments conducted in 2 phases of virtual video-conferenced interviews between March 3, 2021, and February 10, 2022: (1) a pilot feasibility study and (2) a formal study of values and preferences, using a predefined convenience sample. Participants included adults born very preterm (gestational age &lt;32 weeks) or parents of very preterm infants currently in the neonatal intensive care unit (NICU) or having graduated from the NICU in the last 5 years.Main outcomes and measures: relative importance of clinical outcomes, willingness to use each of the COX-Is when presented as the only option, preference for using prophylactic hydrocortisone vs indomethacin, willingness to use any of the COX-Is when all 3 options are available, and relative importance of having family values and preferences included in decision-making.Results: of 44 participants enrolled, 40 were included in the formal study (31 parents and 9 adults born preterm). The median gestational age of the participant or the participant's child at birth was 26.0 (IQR, 25.0-28.8) weeks. Death (median score, 100 [IQR, 100-100]) and severe intraventricular hemorrhage (IVH) (median score, 90.0 [IQR, 80.0-100]) were rated as the 2 most critical outcomes. Based on direct choice experiments, most participants were willing to consider prophylactic indomethacin (36 [90.0%]) or ibuprofen (34 [85.0%]), but not acetaminophen (4 [10.0%]) when offered as the only option. Among participants who initially chose indomethacin (n = 36), if prophylactic hydrocortisone was offered as a potential therapy with the caveat that both cannot be used simultaneously, only 12 of 36 (33.3%) preferred to remain with indomethacin. Variability in preference was noted when all 3 COX-I options were available, indomethacin (19 [47.5%]) being the most preferred option followed by ibuprofen (16 [40.0%]), while the remainder opted for no prophylaxis (5 [12.5%]). Conclusions and Relevance: The findings of this cross-sectional study of former preterm infants and parents of preterm infants suggest that there was minimal variability in how participants valued the main outcomes, with death and severe IVH being rated as the 2 most important undesirable outcomes. While indomethacin was the most preferred form of prophylaxis, variability was noted in the choice of COX-I interventions when participants were presented with the benefits and harms of each drug.</p

Empathy in paediatric intensive care nurses part 1 : behavioural and psychological correlates

Aim: To determine if differences exist between paediatric intensive care nurses andallied health professionals in empathy, secondary trauma, burnout, pain exposureand pain ratings of self and others. Early and late career differences were alsoexamined. Background: Nurses are routinely exposed to patient pain expression. This workcontext may make them vulnerable to adverse outcomes such as desensitization topatient pain or a compromise in personal well-being. Design : Cross-sectional study. Methods : Data were collected from a convenience sample of paediatric intensivecare nurses (n=27) and allied health professionals (n=24), from September 2014–June 2015, at a Canadian health centre. Both groups completed one demographicand three behavioural scales. Participants underwent fMRI while rating the pain ofinfant and adult patients in a series of video clips. Data were analyzed using para-metric and non-parametric methods. fMRI results are reported in a second paper. Results : Nurses were significantly more likely to be exposed to pain at work thanallied health professionals and scored significantly higher on dimensions of empathy,secondary trauma and burnout. Nurses scored their own pain and the pain of infantand adult patients, higher than allied health participants. Less experienced nurseshad higher secondary trauma and burnout scores than more experienced nurses. Conclusions : Paediatric intensive care work demands, such as patient pain expo-sure, may be associated with nurse’s higher report of empathy and pain in self andothers, but also with higher levels of secondary trauma and burnout, when com-pared with allied health professionals

Empathy in paediatric intensive care nurses part 2 : neural correlates

Aims : To determine if there are brain activity differences between paediatric intensive care nurses and allied health professionals during pain intensity rating tasks and test whether these differences are related to the population observed (infant or adult) and professional experience. Background : The underestimation of patients’ pain by healthcare professionals has generally been associated with patterns of change in neural response to vicarious pain, notably reduced activation in regions associated with affective sharing and increased activation in regions associated with regulation, compared with controls. Paediatric nurses, however, have recently been found to provide higher estimates of infants’ pain in comparison to allied health controls, suggesting that changes in neural response of this population might be different than other health professionals. Design : Cross‐sectional study. Methods : Functional MRI data were acquired from September 2014–June 2015 and used to compare changes in brain activity in 27 female paediatric care nurses and 24 allied health professionals while rating the pain of infants and adults in a series of video clips. Results : Paediatric nurses rated infant and adult pain higher than allied health professionals, but the two groups’ neural response only differed during observation of infant pain; paediatric nurses mainly showed significantly less activation in the medial prefrontal cortex (linked to cognitive empathy) and in the left anterior insula and inferior frontal cortex (linked to affective sharing). Conclusions : Patterns of neural activity to vicarious pain may vary across healthcare professions and patient populations and the amount of professional experience might explain part of these differences

Relative effectiveness and safety of pharmacotherapeutic agents for patent ductus arteriosus (PDA) in preterm infants: a protocol for a multicentre comparative effectiveness study (CANRxPDA)

Introduction Patent ductus arteriosus (PDA) is the most common cardiovascular problem that develops in preterm infants and evidence regarding the best treatment approach is lacking. Currently available medical options to treat a PDA include indomethacin, ibuprofen or acetaminophen. Wide variation exists in PDA treatment practices across Canada. In view of this large practice variation across Canadian neonatal intensive care units (NICUs), we plan to conduct a comparative effectiveness study of the different pharmacotherapeutic agents used to treat the PDA in preterm infants.Methods and analysis A multicentre prospective observational comparative-effectiveness research study of extremely preterm infants born &lt;29 weeks gestational age with an echocardiography confirmed PDA will be conducted. All participating sites will self-select and adhere to one of the following primary pharmacotherapy protocols for all preterm babies who are deemed to require treatment.Standard dose ibuprofen (10 mg/kg followed by two doses of 5 mg/kg at 24 hours intervals) irrespective of postnatal age (oral/intravenous).Adjustable dose ibuprofen (oral/intravenous) (10 mg/kg followed by two doses of 5 mg/kg at 24 hours intervals if treated within the first 7 days after birth. Higher doses of ibuprofen up to 20 mg/kg followed by two doses of 10 mg/kg at 24 hours intervals if treated after the postnatal age cut-off for lower dose as per the local centre policy).Acetaminophen (oral/intravenous) (15 mg/kg every 6 hours) for 3–7 days.Intravenous indomethacin (0.1–0.3 mg/kg intravenous every 12–24 hours for a total of three doses).Outcomes The primary outcome is failure of primary pharmacotherapy (defined as need for further medical and/or surgical/interventional treatment following an initial course of pharmacotherapy). The secondary outcomes include components of the primary outcome as well as clinical outcomes related to response to treatment or adverse effects of treatment.Sites and sample size The study will be conducted in 22 NICUs across Canada with an anticipated enrollment of 1350 extremely preterm infants over 3 years.Analysis To examine the relative effectiveness of the four treatment strategies, the primary outcome will be compared pairwise between the treatment groups using χ2 test. Secondary outcomes will be compared pairwise between the treatment groups using χ2 test, Student’s t-test or Wilcoxon rank sum test as appropriate. To further examine differences in the primary and secondary outcomes between the four groups, multiple logistic or linear regression models will be applied for each outcome on the treatment groups, adjusted for potential confounders using generalised estimating equations to account for within-unit-clustering. As a sensitivity analysis, the difference in the primary and secondary outcomes between the treatment groups will also be examined using propensity score method with inverse probability weighting approach.Ethics and dissemination The study has been approved by the IWK Research Ethics Board (#1025627) as well as the respective institutional review boards of the participating centres.Trial registration number NCT04347720

Lessons Learned from Stock Collapse and Recovery of North Sea Herring: a Review

The collapse and recovery of North Sea herring in the latter half of the 20th century had both ecological and economic consequences. We review the effect of the collapse and investigate whether the increased understanding about the biology, ecology, and stock dynamics gained in the past three decades can aid management to prevent further collapses and improve projections of recovery. Recruitment adds the most uncertainty to estimates of future yield and the potential to reach biomass reference points within a specified time-frame. Stock¿recruitment relationships must be viewed as being fluid and dependent on ecosystem change. Likewise, predation mortality changes over time. Management aimed at maximum sustainable yield (MSY) fishing mortality targets implies interannual variation in TACs, and variability in supply is therefore unavoidable. Harvest control rules, when adhered to, aid management greatly. We advocate that well-founded science can substantially contribute to management through improved confidence and increased transparency. At present, we cannot predict the effects of collapse or recovery of a single stock on the ecosystem as a whole. Moreover, as managers try to reconcile commitments to single-species MSY targets with the ecosystem-based approach, they must consider the appropriate management objectives for the North Sea ecosystem as a whole.JRC.G.4-Maritime affair