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Description du sujet. En Afrique de l'Ouest, en particulier au Burkina Faso, l’intensification des parcs arborés est de plus en plus préconisée dans les interventions d’accompagnement des populations rurales confrontées à la diminution progressive des arbres dans leurs systèmes de production agricole et pastorale. Cependant, la mise en œuvre de ces interventions se heurte à un contexte social dominé par une diversité d’acteurs aux intérêts souvent antagonistes. Objectifs. Cette étude vise à identifier les acteurs pertinents à inclure dans un processus de réflexion pour co-construire des scénarii d’intensification des parcs arborés. Méthode. Pour ce faire, une démarche purement qualitative a été mobilisée en combinant une revue de littérature, des ateliers de cartographie des acteurs et des entretiens semi-directifs dans les communes de Koumbia, Guéguéré et Dano. Résultats. Les résultats montrent que dans les communes de Koumbia et Dano, la gestion et l’usage des arbres sont réalisés par une diversité d’acteurs ayant des intérêts convergents pour l’intensification des parcs arborés et interreliés par des échanges commerciaux, d’informations et de connaissances et des relations de pouvoir. Conclusions. Cette étude a permis de définir collectivement les contours d’une plateforme d’innovation incluant tous les acteurs dans chaque village, avec une gouvernance centrale au niveau de la commune en vue de co-construire des scénarii d’intensification des parcs arborés. Characterization of agroforestry actors for co-designing innovation platforms along the Koumbia Guéguéré Dano transect in Burkina Faso Description of the subject. In West Africa, particularly in Burkina Faso, the intensification of agroforestry parks is being increasingly advocated as a means of supporting rural populations faced with the steady reduction of trees in their agricultural and pastoral production systems. However, the implementation of these interventions is situated within a social context characterized by a diversity of actors with often divergent interests. Objectives. This study aimed at identifying relevant stakeholders to be included in a reflection process to co-construct agroforestry park intensification scenarios. Method. To that end, a purely qualitative approach was used, combining literature review, stakeholder mapping workshops and semi-directive interviews in the municipalities of Koumbia, Guéguéré et Dano. Results. The results show that in the communes of Koumbia and Dano, the management and use of trees is carried out by a diversity of actors with similar (converging) interests in the intensification of agroforestry parks and interconnected by commercial, information, and knowledge exchanges and power relations. Conclusions. This study made it possible to collectively define the contours of an innovation platform including all actors in each village with a centralized management at the commune level, allowing the co-construction of tree-park intensification.

The loosely applied concepts of transformations and transitions often result in unarticulated different visions and expectations among stakeholders regarding the orientation and ambition of a particular initiative related to system transitions/transformations. In this paper, a strategic scoping canvas and an associated facilitation process are presented as a way of enhancing shared understanding among stakeholders. Illustrations are provided of initial application in three cases related to food system transitions in Peru, Ethiopia, and Bangladesh, exploring the connectivity with approaches commonly used in the context of system transformations, including the Multi-Level Perspective on sustainability transitions, the Leverage Points approach, Capability Approach, and the theory of Large System Change. We conclude that the canvas and associated facilitation approach has proved useful in different contexts, offering opportunities for complementing existing methodologies, and potentially enhancing their efficacy in facilitated multi-stakeholder processes.

The aim of this project was to explore the theme of social innovation for nutrition-sensitive and sustainable agriculture, resulting in examples of improved production and consumption of nutritious food. Social innovation refers to the generation and implementation of new ideas about how people organize interpersonal activities, or social interactions, to meet one or more common goals and in the process change basic routines, resources, and decision-making processes. In the country context of Myanmar, this research aimed to capture a variety of social innovation cases related to processes of agricultural transformation. Through the method of a collaborative case study write-shop, Myanmar-specific social innovations were identified, illustrating various forms of social innovation across the cases with citizen engagement processes. The write-shop method, in combination with the embedded expertise of development practitioners, proved to be a promising approach to identify niche innovations, distil insights, reframe actions, and promote critical thinking among different actors.

Food systems undergo rapid changes in response to economic and market forces, and environmental and dietary changes. This study aimed to disentangle adaptation strategies in farm households balancing interests in the commercial aspects of farming and the consumption of nutritious foods. The area of interest was Central Myanmar, Pakokku region. A literature-based framework was used to identify entry points for adaptation strategies at the farm household level. A purposive sampling strategy was used to select smallholders (<5 acres), engaged in market-oriented agriculture (≥10 years). In 14 households, in-depth interviews were conducted, using a life course perspective depicting the household history in relation to agricultural developments and household food and nutrition security. The narratives of smallholders confirmed that household food and nutrition security was grounded in mixed livelihood strategies, including migration. Diet quality depended largely on income. Supportive strategies were a frugal lifestyle, responsible use of resources, participation in community activities, and different forms of social innovation. The study shows how the understanding of local diets provides insights in entry points for nutrition-sensitive agriculture, and suggests a need for alternative adaptation strategies, replacing those promoting specialization and intensification, for more holistic solutions that reinforce the flexibility and resilience of farmers.

Description du sujet. En Afrique de l'Ouest, en particulier au Burkina Faso, l'intensification des parcs arborés est de plus en plus préconisée dans les interventions d'accompagnement des populations rurales confrontées à la diminution progressive des arbres dans leurs systèmes de production agricole et pastorale. Cependant, la mise en œuvre de ces interventions se heurte à un contexte social dominé par une diversité d'acteurs aux intérêts souvent antagonistes. Objectifs. Cette étude vise à identifier les acteurs pertinents à inclure dans un processus de réflexion pour co-construire des scénarii d'intensification des parcs arborés. Méthode. Pour ce faire, une démarche purement qualitative a été mobilisée en combinant une revue de littérature, des ateliers de cartographie des acteurs et des entretiens semi-directifs dans les communes de Koumbia, Guéguéré et Dano. Résultats. Les résultats montrent que dans les communes de Koumbia et Dano, la gestion et l'usage des arbres sont réalisés par une diversité d'acteurs ayant des intérêts convergents pour l'intensification des parcs arborés et interreliés par des échanges commerciaux, d'informations et de connaissances et des relations de pouvoir. Conclusions. Cette étude a permis de définir collectivement les contours d'une plateforme d'innovation incluant tous les acteurs dans chaque village, avec une gouvernance centrale au niveau de la commune en vue de co-construire des scénarii d'intensification des parcs arborés.

Description of the subject. We present a literature overview of innovation platform practices in Africa, combined with case studies of sub-national platforms established in Senegal and Burkina Faso. Objectives. The main objective was to understand how the facilitation process of innovation platforms can become more effective. Two specific objectives were to study RAMSES II innovation platform cases in Senegal and Burkina Faso where we observed and reflect on the facilitation of agroforestry innovation platforms. A final objective was to position the case results in a literature overview of IP experiences in Africa. Method. Information on innovation platforms was collected by combining an analysis of RAMSES II agroforestry innovation platform cases and an innovation platform literature review. Results. The study illustrates how the organizational position of the facilitating research agents contributed to shaping platform agendas, functions, and outcomes. This process hinges on the deployment of legitimacy claims, which appeal to technical expertise and scientific narratives, in this case on agroforestry. Institutional embeddedness is shown to be a critical aspect of agency in innovation platform multi-actor processes, contributing to framing local understandings of agroforestry and to channel collective efforts. Conclusions. The institutional identity of facilitating research agents and their relationship to members of a platform requires a more open and process oriented role. Coordination and facilitation roles can also be taken up by other members of the platform. This enhances the platform’s ability to ground their agendas into local needs and priorities. It also enhances sustainability, as active membership during the project period prepares platform members to continue after project closure. Premières expériences pour ancrer les Plateformes d'Innovation agroforestière dans leur contexte institutionnel local Description du sujet. Nous présentons un aperçu de la littérature sur les pratiques des plateformes d'innovation en Afrique, combiné à des études de cas de plateformes locales établies au Sénégal et au Burkina Faso. Objectifs. L'objectif principal était de comprendre comment le processus de facilitation des plateformes d’innovation peut devenir plus efficace. Deux objectifs spécifiques étaient d'étudier les cas des plateformes d’innovation RAMSES II au Sénégal et au Burkina Faso où nous avons observé et réfléchi à la facilitation des plateformes d’innovation agroforestières. Un objectif final est de positionner les résultats de l'étude de cas dans une vue d'ensemble de la littérature sur les expériences avec les plateformes d’innovation en Afrique. Méthode. Les informations sur les plateformes d’innovation ont été recueillies en combinant une analyse des cas des plateformes d’innovation agroforesterie RAMSES II et une revue de la littérature sur les plateformes d’innovation. Résultats. L'étude illustre comment la position organisationnelle des agents de recherche facilitateurs a contribué à structurer les programmes, les fonctions et les résultats de la plateforme. Ce processus repose sur le déploiement de revendications de légitimité, qui font appel à l'expertise technique et aux perspectives scientifiques, en l'occurrence sur l'agroforesterie. L'intégration institutionnelle s'avère être un aspect essentiel pour autonomiser les différents acteurs, contribuant à obtenir des compréhensions communes sur l'agroforesterie et à canaliser les efforts collectifs. Conclusions. L'identité institutionnelle des agents facilitateurs de recherche et leur relation avec les membres d'une plateforme nécessitent un rôle plus ouvert et axé sur les processus. Les rôles de coordination et de facilitation peuvent également être assumés par d'autres membres de la plateforme. Cela améliore la capacité de la plateforme à ancrer ses agendas dans les besoins et les priorités locales. Cela améliore également la durabilité, car une adhésion active pendant la durée du projet prépare les membres de la plateforme à continuer après la clôture du projet.

In the field of work, there is a shift towards more value-based approaches to study the sustainable employability of the present-day worker. The capability approach offers a value based and innovative conceptualisation and framework of sustainable employability characterized by contextuality, normativity and diversity. The capabilities of Dutch employees have been established and validated, yet it is not known which conversion factors on a personal, work and organizational level enable employees to achieve value in work in different Dutch occupational sectors. Our qualitative approach included seven focus groups in different occupational sectors including elderly care, higher education, insurance work, facility management and the oil-, car- and chemical industry. Each focus group included 5-11 participants and took approximately one and a half hour. A qualitative content analysis was used to analyse the data, by combining deductive and inductive coding respectively. Deductive coding involved assigning themes to the conversion of resources into capabilities at the organizational, work and personal level. On the organizational conversion level, important themes were cultural aspects, power relations, shortage of personnel and policies for self-management. On the work conversion level, social contacts, communication and workload, tasks and schedules were identified. Social contacts were described as a work value in itself, but also conditional for achieving other work values. On the personal conversion level, experienced work stress, motivation and the ability to achieve values informally within the company. From our findings it follows that focus groups are sensitive to identify conversion factors on all three levels of conversion. In addition, companies and their employees might effectively increase work capabilities by being sensitive to all three conversion levels simultaneously. Further research is necessary to study the effect of a capability-based intervention at the work floor.

Hepatic steatosis is associated with poor cardiometabolic health, with de novo lipogenesis (DNL) contributing to hepatic steatosis and subsequent insulin resistance. Hepatic saturated fatty acids (SFA) may be a marker of DNL and are suggested to be most detrimental in contributing to insulin resistance. Here, we show in a cross-sectional study design (ClinicalTrials.gov ID: NCT03211299) that we are able to distinguish the fractions of hepatic SFA, mono- and polyunsaturated fatty acids in healthy and metabolically compromised volunteers using proton magnetic resonance spectroscopy ( 1 H-MRS). DNL is positively associated with SFA fraction and is elevated in patients with non-alcoholic fatty liver and type 2 diabetes. Intriguingly, SFA fraction shows a strong, negative correlation with hepatic insulin sensitivity. Our results show that the hepatic lipid composition, as determined by our 1 H-MRS methodology, is a measure of DNL and suggest that specifically the SFA fraction may hamper hepatic insulin sensitivity. Hepatic steatosis is associated with poor cardiometabolic health, with de novo lipogenesis (DNL) contributing to hepatic steatosis and subsequent insulin resistance. Here, the authors use 1 H-MRS methodology to show hepatic SFA fraction is a measure of DNL and specifically may hamper hepatic insulin sensitivity.

Background The role of haloperidol as treatment for ICU delirium and related symptoms remains controversial despite two recent large controlled trials evaluating its efficacy and safety. We sought to determine whether haloperidol when compared to placebo in critically ill adults with delirium reduces days with delirium and coma and improves delirium-related sequelae. Methods This multi-center double-blind, placebo-controlled randomized trial at eight mixed medical-surgical Dutch ICUs included critically ill adults with delirium (Intensive Care Delirium Screening Checklist ≥ 4 or a positive Confusion Assessment Method for the ICU) admitted between February 2018 and January 2020. Patients were randomized to intravenous haloperidol 2.5 mg or placebo every 8 h, titrated up to 5 mg every 8 h if delirium persisted until ICU discharge or up to 14 days. The primary outcome was ICU delirium- and coma-free days (DCFDs) within 14 days after randomization. Predefined secondary outcomes included the protocolized use of sedatives for agitation and related behaviors, patient-initiated extubation and invasive device removal, adverse drug associated events, mechanical ventilation, ICU length of stay, 28-day mortality, and long-term outcomes up to 1-year after randomization. Results The trial was terminated prematurely for primary endpoint futility on DSMB advice after enrolment of 132 (65 haloperidol; 67 placebo) patients [mean age 64 (15) years, APACHE IV score 73.1 (33.9), male 68%]. Haloperidol did not increase DCFDs (adjusted RR 0.98 [95% CI 0.73–1.31], p  = 0.87). Patients treated with haloperidol (vs. placebo) were less likely to receive benzodiazepines (adjusted OR 0.41 [95% CI 0.18–0.89], p  = 0.02). Effect measures of other secondary outcomes related to agitation (use of open label haloperidol [OR 0.43 (95% CI 0.12–1.56)] and other antipsychotics [OR 0.63 (95% CI 0.29–1.32)], self-extubation or invasive device removal [OR 0.70 (95% CI 0.22–2.18)]) appeared consistently more favorable with haloperidol, but the confidence interval also included harm. Adverse drug events were not different. Long-term secondary outcomes (e.g., ICU recall and quality of life) warrant further study. Conclusions Haloperidol does not reduce delirium in critically ill delirious adults. However, it may reduce rescue medication requirements and agitation-related events in delirious ICU patients warranting further evaluation. Trial registration : ClinicalTrials.gov (#NCT03628391), October 9, 2017.

Trials involving Asian patients with acute stroke have suggested that endovascular treatment alone is not inferior to the usual practice of thrombolysis before endovascular treatment. This trial involving European patients did not show noninferiority or superiority of endovascular treatment alone.