Tropical islands of the Anthropocene: Deep histories of anthropogenic terrestrial-marine entanglement in the Pacific and Caribbean.

Islands are useful model systems for examining human-environmental interactions. While many anthropogenic effects visible in the archaeological and paleoecological records are terrestrial in nature (e.g., clearance of tropical forests for agriculture and settlement; introduction of nonnative flora and fauna), native peoples also relied heavily on marine environments for their subsistence and livelihood. Here we use two island case studies-Palau (Micronesia) and the Lesser Antilles (Caribbean)-and approach their long-term settlement history through a "ridge-to-reef" perspective to assess the role that human activity played in land- and seascape change over deep time. In particular, we examine the entanglement of terrestrial and marine ecosystems resulting from anthropogenic effects and cultural responses to socio-environmental feedback. We suggest that on the humanized tropical islands of the Anthropocene, mangroves, near shore and littoral areas, and coral reefs were major sites of terrestrial-marine interface chronicling and modulating anthropogenic effects.

No evidence for widespread island extinctions after Pleistocene hominin arrival.

The arrival of modern humans into previously unoccupied island ecosystems is closely linked to widespread extinction, and a key reason cited for Pleistocene megafauna extinction is anthropogenic overhunting. A common assumption based on late Holocene records is that humans always negatively impact insular biotas, which requires an extrapolation of recent human behavior and technology into the archaeological past. Hominins have been on islands since at least the early Pleistocene and Homo sapiens for at least 50 thousand y (ka). Over such lengthy intervals it is scarcely surprising that significant evolutionary, behavioral, and cultural changes occurred. However, the deep-time link between human arrival and island extinctions has never been explored globally. Here, we examine archaeological and paleontological records of all Pleistocene islands with a documented hominin presence to examine whether humans have always been destructive agents. We show that extinctions at a global level cannot be associated with Pleistocene hominin arrival based on current data and are difficult to disentangle from records of environmental change. It is not until the Holocene that large-scale changes in technology, dispersal, demography, and human behavior visibly affect island ecosystems. The extinction acceleration we are currently experiencing is thus not inherent but rather part of a more recent cultural complex.

Co-ideation and co-design in co-creation research: Reflections from the 'Co-Creating Safe Spaces' project.

INTRODUCTION: Numerous frameworks for defining and supporting co-created research exist. The practicalities of designing and conducting co-created research are clearly important, yet the utility of these frameworks and their operationalisation within local contexts and involving a diversity of stakeholders and interests are currently not well-researched. METHODS: Using an instrumental case study approach, we examined the utility of a published systematic framework designed to improve clarity about co-creation as a concept and approach. The framework is explored based on the first two processes that correspond to our own work to date: co-ideation and co-design. RESULTS: Our study showed that diverse stakeholders bring challenges regarding research priorities, methods, language and the distribution of power within co-creation processes. Co-creation activities were incremental, adaptable, responsive and made best use of established relationships, structures and collective leadership to meet the competing demands of funders and human research ethics committees, while ensuring the meaningful participation of multiple stakeholders. CONCLUSION: The findings highlight the iterative, fluid and deeply relational nature of co-created research. Rather than seeking to categorise these processes, we argue that the social relations of research production that provide the structures within which all co-created knowledge is generated are more important drivers of effective knowledge mobilisation and implementation. Thus, close attention to these social relations is needed in co-created research. PATIENT OR PUBLIC CONTRIBUTION: People with lived experience of emotional distress and/or suicidal crisis, including academic researchers, service and peer workers, carers and advocates were involved in the co-ideation and co-design of this research. All authors identify as people with lived experience, from both academic and nonresearch backgrounds.

Colonial Legacies Influence Biodiversity Lessons: How Past Trade Routes and Power Dynamics Shape Present-Day Scientific Research and Professional Opportunities for Caribbean Scientists.

AbstractScientists recognize the Caribbean archipelago as a biodiversity hotspot and employ it for their research as a natural laboratory. Yet they do not always appreciate that these ecosystems are in fact palimpsests shaped by multiple human cultures over millennia. Although post-European anthropogenic impacts are well documented, human influx into the region began about 5,000 years prior. Thus, inferences of ecological and evolutionary processes within the Caribbean may in fact represent artifacts of an unrecognized human legacy linked to issues influenced by centuries of colonial rule. The threats posed by stochastic natural and anthropogenically influenced disasters demand that we have an understanding of the natural history of endemic species if we are to halt extinctions and maintain access to traditional livelihoods. However, systematic issues have significantly biased our biological knowledge of the Caribbean. We discuss two case studies of the Caribbean's fragmented natural history collections and the effects of differing governance by the region's multiple nation states. We identify knowledge gaps and highlight a dire need for integrated and accessible inventorying of the Caribbean's collections. Research emphasizing local and international collaboration can lead to positive steps forward and will ultimately help us more accurately study Caribbean biodiversity and the ecological and evolutionary processes that generated it.

Men, suicide, and family and interpersonal violence: A mixed methods exploratory study.

Research has shown a link between gender, violence, and suicide. This relationship is complex, and few empirical studies have explored suicide and family and interpersonal violence perpetrated by men. Drawing on a coronial dataset of suicide cases and a mixed methods design, this study integrated a quantitative analysis of 155 suicide cases with a qualitative analysis of medico-legal reports from 32 cases. Findings showed different types and patterns of family and intimate partner violence for men who died by suicide. Men used violence in response to conflict, but also to dominate women. Cumulative, interwoven effects of violence, mental illness, alcohol and other drug use, socioeconomic, and psychosocial circumstances were observed in our study population. However, the use of violence and suicidal behaviour was also a deliberate and calculated response by which some men sought to maintain influence or control over women. Health and criminal justice interventions served as short-term responses to violence, mental illness, and suicidal behaviour, but were of limited assistance.

Using seafaring simulations and shortest-hop trajectories to model the prehistoric colonization of Remote Oceania.

The prehistoric colonization of islands in Remote Oceania that began ∼3400 B.P. represents what was arguably the most expansive and ambitious maritime dispersal of humans across any of the world's seas or oceans. Though archaeological evidence has provided a relatively clear picture of when many of the major island groups were colonized, there is still considerable debate as to where these settlers originated from and their strategies/trajectories used to reach habitable land that other datasets (genetic, linguistic) are also still trying to resolve. To address these issues, we have harnessed the power of high-resolution climatic and oceanographic datasets in multiple seafaring simulation platforms to examine major pulses of colonization in the region. Our analysis, which takes into consideration currents, land distribution, wind periodicity, the influence of El Niño Southern Oscillation (ENSO) events, and "shortest-hop" trajectories, demonstrate that (i) seasonal and semiannual climatic changes were highly influential in structuring ancient Pacific voyaging; (ii) western Micronesia was likely settled from somewhere around the Maluku (Molucca) Islands; (iii) Samoa was the most probable staging area for the colonization of East Polynesia; and (iv) although there are major differences in success rates depending on time of year and the occurrence of ENSO events, settlement of Hawai'i and New Zealand is possible from the Marquesas or Society Islands, the same being the case for settlement of Easter Island from Mangareva or the Marquesas.

'Shadowing' as a management strategy for chemotherapy outpatient primary support persons.

Despite growing numbers of patients with cancer receiving chemotherapy in outpatient settings and the corresponding increase in care demands on family and close friends, little is known about the experiences of those informal carers supporting people with cancer during their chemotherapy trajectories. Using an interpretivist theoretical framework, this study explored the experiences of primary support persons of chemotherapy outpatients through in-depth interviews with 17 participants nominated as their primary support persons by people receiving chemotherapy at a large tertiary hospital in Australia. The study demonstrates that primary support persons of chemotherapy outpatients face distinct challenges, being at the frontline of treatment and managing side effects with minimal support at home. This role involves sensitive provision of complex medical and social care in circumstances that profoundly challenge the everyday worlds of both patient and carer. From the moment of diagnosis, informal carers in this context face the 'double whammy' of needing to 'manage' the cancer diagnosis experience as well as the chemotherapy trajectory experience. This study points to the significant level of responsibility that primary support persons take on, and the extent to which patients and clinicians rely on their support and management skills. It also points, however, to the lack of recognition they receive for assuming this role, and their sense of frustration in the face of this invisibility. The conceptualisation of the informal carer role as a 'shadowing' role explicitly represents the protective, vigilant, but almost invisible, support role described by the participants in this study.

Bereaved families and the coronial response to traumatic workplace fatalities: Organizational perspectives.

Work remains a significant source of illness, injury, and death in developed countries. In Australia, for example, over 2,000 people die from work-related causes each year, with heavy social, economic, and personal costs (Safe Work Australia, 2013a ). Most die as a result of work-related disease. However, many die from trauma. In 2012, 223 workers were fatally injured in Australia and in the United States the figure was 4,383 (Bureau of Labor Statistics, 2014 ; Safe Work Australia, 2013b ). Apart from the immediate tragedy of each worker's death, these deaths affect the victim's immediate family, wider family, friends, and co-workers. It has been estimated that, on average, every death has an impact on at least 20 other people (Dyregrov, Nordanger, & Dyregrov, 2003 ), especially when the deceased had several families, which is an increasingly common phenomenon (OECD, 2014 ). Little is known, however, about how regulatory responses following a traumatic workplace fatality meet the needs of surviving families. With a focus on the coronial investigation, this article provides information about the regulatory responses to a traumatic workplace fatality and examines how various organizations involved in the coronial process following the death viewed its ability to accommodate the needs and wishes of surviving families.

Religious Perspectives on Human Suffering: Implications for Medicine and Bioethics.

The prevention and relief of suffering has long been a core medical concern. But while this is a laudable goal, some question whether medicine can, or should, aim for a world without pain, sadness, anxiety, despair or uncertainty. To explore these issues, we invited experts from six of the world's major faith traditions to address the following question. Is there value in suffering? And is something lost in the prevention and/or relief of suffering? While each of the perspectives provided maintains that suffering should be alleviated and that medicine's proper role is to prevent and relieve suffering by ethical means, it is also apparent that questions regarding the meaning and value of suffering are beyond the realm of medicine. These perspectives suggest that medicine and bioethics have much to gain from respectful consideration of religious discourse surrounding suffering.

Religious perspectives on the use of psychopharmaceuticals as an enhancement technology.

The use of psychopharmaceuticals as an enhancement technology has been the focus of attention in the bioethics literature. However, there has been little examination of the challenges that this practice creates for religious traditions that place importance on questions of being, authenticity, and identity. We asked expert commentators from six major world religions to consider the issues raised by psychopharmaceuticals as an enhancement technology. These commentaries reveal that in assessing the appropriate place of medical therapies, religious traditions, like secular perspectives, rely upon ideas about health and disease and about normal human behavior. But unlike secular perspectives, faith traditions explicitly concern themselves with ways in which medicine should or should not be used to live a "good life".

Estimated energetic demands of thermoregulation during ancient canoe passages from Tahiti to Hawaii and New Zealand, a simulation analysis.

Prehistoric colonization of East Polynesia represents the last and most extensive of human migrations into regions previously uninhabited. Although much of East Polynesia is tropical, the southern third, dominated by New Zealand-by far the largest Polynesian landmass-ranges from a warm- to cool-temperate climate with some islands extending into the Subantarctic. The substantial latitudinal variation implies questions about biocultural adaptations of tropical people to conditions in which most of their familiar resources were absent and their agriculture marginal. Perhaps the most basic question, but one which has never been explored, is the extent to which sailing out of the tropics on long-distance colonizing voyages imposed physiological stress on canoe crews and passengers. In this paper we use trajectories of simulated voyages from Tahiti to New Zealand and Tahiti to Hawaii to obtain along-trip environmental parameters which are then used to model the energy expenditure of these long overseas journeys. Results show that travelers to New Zealand are exposed to much harsher environmental conditions, leading to significantly greater in-trip thermoregulatory demands. For both destinations, travelers with larger body sizes exhibit lower modeled heat loss and hence obtain an energetic advantage, with greater gains for females. Such physiological features, notably of Samoans who probably formed the founding population in East Polynesia, may help explain successful voyaging to temperate latitudes.

Reported Rates of Intraocular Inflammation with Intravitreal Aflibercept Administered via Pre-Filled Syringe or from Vials in Clinical Practice Between 2012 and 2022.

Purpose: To determine the reported rates of intraocular inflammation (IOI) in patients treated with intravitreal aflibercept (IVT-AFL) 2 mg in routine clinical practice (ie, outside interventional studies), across all indications and within all countries (excluding the United States), with access to either the vial presentation or pre-filled syringe (PFS). Patients and methods: A search was conducted using the Bayer EYLEA® Global Safety Pharmacovigilance Database for reported cases of IOI and IVT-AFL use between October 2012 and March 31, 2022. Results: With more than 10 years of post-marketing experience with the IVT-AFL vial presentation (>25 million sold units), and over 2 years of experience with the PFS of IVT-AFL (>6.7 million sold units) the rate of any IOI, including endophthalmitis, outside the United States was 0.3 events per 10,000 units for the PFS and 1.2 events per 10,000 units for the vial presentation. The event rates specifically for endophthalmitis were 0.1 per 10,000 units for the IVT-AFL PFS and 0.6 per 10,000 units for the IVT-AFL vial presentation. Conclusion: In patients with retinal diseases treated in routine clinical practice with IVT-AFL either from a vial or the PFS, medically important adverse events of IOI, and in particular, endophthalmitis, are infrequently reported events. Numerically, reported rates of IOI and endophthalmitis are low for the vial presentation and even lower for the PFS.

A probable case of leprosy from colonial period St. Vincent and the Grenadines, Southeastern Caribbean.

OBJECTIVE: To document and differentially diagnose facial pathology found in an isolated skull from St. Vincent and the Grenadines, southeastern Caribbean. To directly date this individual using radiocarbon dating. MATERIALS: Isolated skull recovered from Petite Mustique Island. METHODS: Describe facial pathology occurring in this individual and compare with known diseases or disease processes that impact the craniofacial complex. RESULTS: Features of the rhinomaxillary syndrome are present, indicating a diagnosis of leprosy. Dating places the time of death to the late 18th or early 19th centuries. CONCLUSIONS: Analysis of the rhinomaxillary syndrome produces a diagnosis of early-stage leprosy in an individual that correlates with the apparent attempt to locate a leprosarium on Petite Mustique Island in the first decade of the 19th century. SIGNIFICANCE: Location and time corroborate historical records of at least one attempt to locate a leprosarium on Petite Mustique Island. Only directly dated individual with leprosy in the western hemisphere and possibly the earliest yet recorded. LIMITATIONS: This is an isolated find that is archaeologically unprovenienced. SUGGESTIONS FOR FURTHER RESEARCH: Professional archaeological survey of Petite Mustique.

Co-creating safe spaces: Study protocol for translational research on innovative alternatives to the emergency department for people experiencing emotional distress and/or suicidal crisis.

INTRODUCTION: Safe spaces are an alternative to emergency departments, which are often unable to provide optimum care for people experiencing emotional distress and/or suicidal crisis. At present, there are several different safe space models being trialled in Australia. However, research examining the effectiveness of safe space models, especially in community settings, is rare. In this paper, we present a protocol for a study in which we will investigate the implementation, effectiveness, and sustainability of safe space models as genuine alternatives for people who might usually present to the emergency department or choose not to access help due to past negative experiences. MATERIAL AND METHODS: We will use a mixed methods, co-designed study design, conducted according to the principles of community-based participatory research to obtain deep insights into the benefits of different safe space models, potential challenges, and facilitators of effective practice. We developed the study plan and evaluation framework using the RE-AIM framework, and this will be used to assess key outcomes related to reach, effectiveness, adoption, implementation, and maintenance. Data collection will comprise quantitative measures on access, use, satisfaction, (cost) effectiveness, distress, and suicidal ideation; and qualitative assessments of service implementation, experience, feasibility, acceptability, community awareness, and the fidelity of the models to service co-design. Data will be collected and analysed concurrently throughout the trial period of the initiatives. DISCUSSION: This study will enable an extensive investigation of safe spaces that will inform local delivery and provide a broader understanding of the key features of safe spaces as acceptable and effective alternatives to hospital-based care for people experiencing emotional distress and/or suicidal crisis. This study will also contribute to a growing body of research on the role and benefits of peer support and provide critical new knowledge on the successes and challenges of service co-design to inform future practice.

A sociological autopsy lens on older adult suicide in rural Australia: Addressing health, psychosocial factors and care practices at the intersection of policies and institutions.

This paper examines the interrelationship between suicide, health, socioeconomic, and psychosocial factors in contributing to suicide in older adults in rural Australia. Drawing on a coronial dataset of suicide cases and a mixed methods sociological autopsy approach, our study integrated a quantitative analysis of 792 suicide cases with a qualitative analysis of medico-legal reports from 30 cases. The sociological autopsy provided novel insights into the entanglement of policy and service provision at the state-level with individual end-of-life decisions. Particular attention is drawn to age and gendered dimensions of suicide, especially in relation to health and social issues. The study showed a continuity between suicide and the patterning of an individual's life course, including experiences and consequences of inequality and marginality; a desire to meet culturally-normative ideals of autonomy; and a fragmented, under-funded, and intimidating social care system that offered limited options.

Suicide in rural Australia: A retrospective study of mental health problems, health-seeking and service utilisation.

BACKGROUND: Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia. METHODS: A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010-2015 from the National Coronial Information System. RESULTS: There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010-2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated. CONCLUSIONS: Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.

PNIPAAm-grafted-collagen as an injectable, in situ gelling, bioactive cell delivery scaffold.

We synthesized two thermoresponsive, bioactive cell scaffolds by decorating the backbone of type I bovine collagen with linear chains of poly(N-isopropylacrylamide) (PNIPAAm), with the ultimate aim of providing facile delivery via injection and support of retinal pigment epithelial (RPE) cells into the back of the eye for the treatment of retinal degenerative diseases. Both scaffolds displayed rapid, subphysiological phase transition temperatures and were capable of noninvasively delivering a liquid suspension of cells that gels in situ forming a cell-loaded scaffold, theoretically isolating treatment to the injection site. RPE cells demonstrated excellent viability when cultured with the scaffolds, and expulsion of cells arising from temperature-induced PNIPAAm chain collapse was overcome by incorporating a room-temperature incubation period prior to scaffold phase transition. These results indicate the potential of using PNIPAAm-grafted-collagen as a vehicle for the delivery of therapeutic cells to the subretinal space.

Responding to change: thermo- and photo-responsive polymers as unique biomaterials.

Responsive polymer systems that react to thermal and light stimuli have been a focus in the biomaterials literature because they have the potential to be less invasive than currently available materials and may perform well in the in vivo environment. Natural and synthetic polymer systems created to exhibit a temperature-sensitive phase transition lead to in situ forming hydrogels that can be degradable or non-degradable. These systems typically yield physical gels whose properties can be manipulated to accommodate specific applications while requiring no additional solvents or cross-linkers. Photo-responsive isomerization, dimerization, degradation, and triggered processes that are reversible and irreversible may be used to create unique gel, micelle, liposome, and surface-modified polymer systems. Unique wavelengths induce photo-chemical reactions of polymer-bound chromophores to alter the bulk properties of polymer systems. The properties of both thermo- and photo-responsive polymer systems may be taken advantage of to control drug delivery, protein binding, and tissue scaffold architectures. Systems that respond to both thermo- and photo-stimuli will also be discussed because their multi-responsive properties hold the potential to create unique biomaterials.

Temporomandibular joint osteoarthritis at Chelechol ra Orrak, Palau.

OBJECTIVE: To explore the frequency and severity of temporomandibular joint osteoarthritis (TMJ-OA) and its causative factors in a skeletal assemblage from the prehistoric site of Chelechol ra Orrak, Palau, western Micronesia. MATERIALS: 50 temporomandibular joint surfaces (mandibular condyles and articular eminences), representing a minimum of 22 adult individuals, 17 of which retain teeth. METHODS: Joint surfaces were macroscopically evaluated for characteristics associated with TMJ-OA and joint morphology. Dental remains were scored for tooth wear and staining. RESULTS: Nine individuals (40.1 %) displayed lesions typical of TMJ-OA. The strongest associations were between tooth wear and TMJ-OA. CONCLUSIONS: Indirect effects of parafunctional dental activity appear to be a factor in TMJ-OA frequency at Chelechol ra Orrak. While betel nut chewing may be one of those activities, it does not appear to be solely driving the presence of TMJ-OA. SIGNIFICANCE: This study highlights the association between a specific parafunctional use of the temporomandibular joint and the potential pathological consequences. It also reinforces the need to carefully evaluate the archaeological context of skeletal remains in order to evaluate specific etiological factors in the presence of TMJ-OA in present and past populations. LIMITATIONS: Sample sizes are limited in this study. This will increase as excavations continue. SUGGESTIONS FOR FURTHER RESEARCH: Because dental occlusion appears to be associated with TMJ-OA, focus on dental conditions affecting occlusal patterns, such as third molar agenesis, antemortem tooth loss, and malocclusion, and their relationship to TMJ-OA frequency, are recommended.