The largest field of pyramids in Egypt – consisting of 31 pyramids built over a millennium, including the famous Great Pyramid at Giza – lies along a narrow strip of land in the desert several kilometres west of the Nile River.

The Nile was at the heart of ancient Egyptian civilisation, and the location of so many pyramids some distance away from the river has until now not been fully explained.

In a new study published in Communications Earth & Environment, we addressed this puzzle. When the pyramids were built they sat next to a now-vanished branch of the Nile, which likely provided transport for workers and their materials.

A changing river

Like other rivers, the Nile adjusts and changes over time in response to climate change, floods and droughts. People and places also move with the river. In the past, civilisations fell and rose on its ebb and flow.

The Nile has not always looked or functioned the way it does now. By reading the landscape in Egypt, traces of the former river and its branches can be found hidden just beneath the land surface.

Now obscured by areas of cultivation and urban settlements, buried by centuries of mud from the modern river, the old channels and their stories have largely been lost to time. Once a mosaic of waterways and wetlands, the Nile is ready to share its secrets again.

Many scholars have discussed and sought answers to the mysteries of the Nile. Previous research has documented evidence for the existence of parts of ancient waterways or wetlands, particularly near the Giza pyramids.

Upstream near Luxor, Nile migration patterns have been investigated, and downstream abandoned channels have been discovered in the Nile Delta. Yet until now we did not have a comprehensive map and understanding of the waterways that fed the extensive pyramid chain from Lisht to Giza in the past.

The Ahramat Branch

Using satellite imagery, high-resolution digital elevation data and historical maps, we identified and traced the long path of a previously unknown channel of the Nile. What we have called the Ahramat Branch once flowed along the Western Desert margin of the Nile floodplain, close to the ancient pyramids.

Many of the pyramids, built during the Old Kingdom (roughly 2700–2200 BCE) and the Middle Kingdom (2050–1650 BCE), have causeways that lead to the branch. Many of these paths terminate in temples that may have acted as river docks in the past.

This suggests the Ahramat Branch was active during multiple phases of pyramid construction and was probably used as a transportation waterway for workmen and building materials to the sites.

Some pyramids have longer or differently angled causeways than others, indicating the builders adapted their construction approaches to the changing riverscape and local conditions at the desert margin.

Other pyramids were connected to inlets associated with tributaries of the Ahramat Branch on the edge of the Western Desert. In all, analysis of the ground elevation of 31 pyramids and their proximity to the floodplain helped explain the position and relative water level of the Ahramat Branch during the time between the Old Kingdom and the Second Intermediate Period (roughly 2649–1540 BCE).

Digging deep

Once we had mapped the Ahramat Branch, we surveyed the landscape and its shape, and took deep core samples of soil and sediment to study the structure and sedimentology of the former river. We also worked with archaeologists, scientists and members of local communities to gather more context for our work.

The path of the defunct waterway lies between 2.5 and 10.25 kilometres west of the modern Nile river.

Our research suggests the branch ran for about 64 kilometres, was between two and eight metres deep, and between 200 and 700 metres wide. This is similar to the width of the river today.

At one of the sites we examined, near the town of Jirzah, the Ahramat Branch has a symmetrical channel shape. It has also been filled in with muddy and sandy sediment different to other surrounding deposits and the underlying bedrock. This indicates that the old channel has been slowly buried by fine sediment deposited by floods, as the main flow diverted towards the path of the modern river.

What happened to the Ahramat Branch?

Over time, the Ahramat Branch moved eastward and eventually water stopped flowing along it. We don’t know exactly why. Perhaps the Ahramat Branch and its daughter, the modern river, were active together for a time.

The river may have gradually moved to the lower-lying floodplain, towards the current location of the Nile. It is also possible that tectonic activity tilted the whole floodplain to the northeast.

A third possibility is that an increase in windblown sand may have filled up the river’s channel. Increases in sand deposition are most likely related to periods of desertification in the Sahara desert in North Africa.

The movement and diminishing of the Ahramat Branch might also be explained by an overall reduction in water flow due to reduced rainfall and greater aridity in the region, particularly during the end of the Old Kingdom.

This research shows that a multidisciplinary approach to river science is needed to gain a better understanding of dynamic river landscapes. If we want to understand and protect the rivers we have today – and the environmentally and culturally significant sites to which they are inextricably tied – we need a greater appreciation of the interconnected factors that affect rivers and how they can be managed.

Timothy J. Ralph, Associate Professor, Macquarie University; Eman Ghoneim, Professor and Director of Space and Drone Remote Sensing Lab, University of North Carolina Wilmington, and Suzanne Onstine, Associate Professor, Department of History, University of Memphis

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Many Australians with disability feel on the edge of a precipice right now. Recommendations from the disability royal commission and the NDIS review were released late last year. Now a draft NDIS reform bill has been tabled. In this series, experts examine what new proposals could mean for people with disability.

At $14.4 billion over four years, the federal budget’s biggest savings come from efforts to rein in the cost of the National Disability Insurance Scheme (NDIS). The government also plans to invest $213.8 million to fight fraud and co-design NDIS reforms with people with disability. Previous estimates show up to 20% of NDIS expenditure may be fraudulent.

Alongside his “back on track” reform bill in March, NDIS Minister Bill Shorten, announced a taskforce to tackle overcharging that can mean participants pay more than people outside the scheme for the same product or service.

Chaired by the Australian Consumer and Competition Commission (ACCC), the taskforce will collaborate with the NDIS Quality and Safeguards Commission and the National Disability Insurance Agency (NDIA) to combat this so-called “NDIS tax”. But how does this taskforce work and will it be effective?

Overcharging NDIS participants

Currently, the NDIA (which administers the NDIS) provides individual funding to NDIS participants to purchase a range of reasonable and necessary goods and services from providers. The NDIA also has guidelines that set the maximum prices registered providers can charge NDIS participants for each item. For example, the capped price for cleaning services is around $54 per hour ($76 per hour in remote areas and $81 in very remote areas.)

However, there have been reports of providers charging the maximum price set by the NDIA as soon as a client is identified as an NDIS participant. Some providers employ a “twin pricing” strategy, charging an NDIS participant more than they would charge a non-participant. For example, a provider might charge an NDIS participant $130 for a waterproof mattress protector but charge everyone else $90 for the same item.

Previously, these activities were not necessarily fraudulent. However, the NDIS Code of Conduct was amended in December last year, making it illegal for the NDIS providers to charge a higher price for goods for a participant “without a reasonable justification”.

What can NDIS participants do?

NDIS participants are one of the key contributors to the operation of the new taskforce. They can report suspicious overcharging activities.

For example, if they are purchasing a shower chair, they could do a quick online search and obtain several quotes. If they believe they have been overcharged, they should double-check their service agreement to verify they have received the agreed-upon chair, then contact their service provider for an explanation. Ultimately, if they cannot resolve the issue, they can report the case to the taskforce.

Participants can also contact the ACCC if they receive a faulty product or one that does not match their agreement. And they can report providers who intimidate them into signing a contract or pressure them to purchase services they do not need.

What happens next?

Once the taskforce is tipped off, they can initiate an investigation, although the NDIS participant may not be notified of the process or the outcomes.

The taskforce will investigate suspected illegal overcharging of NDIS participants, misleading conduct, unfair contract terms, and anti-competitive agreements set by service providers.

Providers who are found in breach of the NDIS Code of Conduct may face unscheduled site visits, receive compliance notices, be permanently banned, incur financial penalties, and even face criminal sanctions where fraud is suspected.

Will the taskforce be effective?

Co-designed NDIS taskforces that operate mainly based on participant reports can certainly work. The Fraud Fusion Taskforce, established in 2022 to disrupt NDIS fraud and criminal activity, led to more than 2,000 tip-offs in February 2024 alone. Some of these investigations have led to prosecutions.

The ACCC taskforce could be particularly effective in combating price differentiation for tangible goods purchased by NDIS participants, such as wheelchairs, pillows and assistive technology for vision or hearing. But it is important to note some participants may lack the time, skills or capacity required to compare prices and report them to the taskforce.

Controlling price differentiation for services such as those provided by occupational therapists, in-home support and physiotherapists is more complicated.

Service providers may charge the maximum price for a variety of reasons. For one thing, becoming a registered NDIS provider is costly because of administrative expenses and costs related to quality and risk control. There are also expenses associated with registration, compliance and regular audits. And the price of services might depend on the provider’s level of experience and location. The flexibility of service providers and their reputation can also be factors.

Participants with more than one disability might require complex services, and providers could charge a higher price to serve participants with greater needs.

A pricing model that needs redesign

As part of its findings, the NDIS Review said the scheme’s pricing model did not encourage quality and efficiency, with price caps acting more like “price anchors” than “price ceilings”. The 2024–25 budget pledges $5.3 million to investigate pricing reforms to “strengthen transparency, predictability, and alignment”.

These are important because the current model can encourage service providers to focus on profitability rather than on improving service quality. And the fee-for-service approach can encourage over servicing that discourages capacity building, particularly for people with complex disabilities.

While the ACCC taskforce may well prove effective in controlling unfair overcharging of goods, a review of the pricing model for services is also needed to minimise exploitation of the system.

Mona Nikidehaghani, Senior Lecturer in Accounting, University of Wollongong

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What’s been described as the largest underpayment class action in Australian legal history has just been settled. Who was allegedly underpaid? Thousands of junior doctors who, subject to court approval, are set to share back-pay of almost a quarter of a billion dollars.

Amireh Fakhouri, who brought the claim on behalf of junior doctors in New South Wales, alleged that when they worked in the state’s public health system from December 2014 to December 2020, NSW Health had failed to pay the overtime and weekend meal break entitlements she and her colleagues were owed.

More than 20,000 claimants are now set to be eligible for a share in the nearly A$230 million settlement.

But repayment was never the main goal of the class action. Fakhouri, who is now training as a GP in Victoria, said she hoped instead it would change the work culture in medicine.

A rite of passage?

Our health-care system has routinely relied on the labour of junior doctors. These include interns (those who have completed their university medical training and are in their first year of being practising doctors), residents (who have completed their internship and hold a general registration) and registrars (specialists in training).

Junior doctors often provide much of the staffing for night and weekend shifts and complete burdensome administrative tasks for consultants (senior doctors).

Overworking junior doctors has been normalised for decades. We see this depicted in books (such as The House of God and This is Going to Hurt: Secret Diaries of a Junior Doctor) and TV shows (such as House and Scrubs).

This is a safety issue. Doctor fatigue has considerable effects on patient safety through potential medical errors, poor quality patient care, longer patient recovery, reduced physician empathy and impacts on the doctor-patient relationship.

A 2020 study found that when doctors reported even moderate tiredness their chance of making a medical error rose by 53%.

Put simply, stretched, demoralised and tired doctors will do harm. Eventually, that will affect you.

It’s not just long hours

The expectation of working long hours is only part of the culture of medicine.

Our research and global evidence shows “teaching by humiliation” and other forms of verbal mistreatment have also been normalised.

A 2018 study of NSW interns and residents found more than 50% experienced bullying. Some 16-19% (mostly female) experienced sexual harassment.

Some of the junior doctors who are victims of mistreatment later become the perpetrators, perpetuating this harmful culture.

Junior doctors are suffering

The impact of long hours on junior doctors and of the abuse they are subjected to is vividly evident through research, including ours. Junior doctors have significantly high levels of depression, anxiety and thoughts of suicide.

As we’ve been saying for almost a decade, there is a desperate need for better work-life balance for junior doctors and deep culture change in our health-care system.

But there is often little sympathy for junior doctors. In 2022, one hospital threatened to remove comfortable lounges to prevent juniors napping on quiet night shifts. Just last week, we heard of a similar case involving junior doctors at another hospital, who were told “sleeping is not part of your job description”.

A culture of silence

This class action was needed because on a day-to-day basis, junior doctors mostly do not complain.

They internalise distress as failure (not being tough enough) and fear that a diagnosis of depression or anxiety will result in patients and colleagues avoiding them.

They don’t report mistreatment or reject overwork as, often, their senior doctors control their career progression.

This is important, because contrary to perceptions of doctors as wealthy elites, our research shows junior doctors often find it hard to progress, get a job in their city of choice, or find full-time roles. The pressure on junior doctors to “make it” in an increasingly competitive environment grows stronger. Such professional problems reinforce the culture of not complaining for fear of blow-back.

Most of those who do take action, report ineffective or personally harmful outcomes when reporting to senior colleagues. This fulfils a vicious cycle of silence as junior doctors become ill but do not seek help.

We wanted to lift the silence

We used theatre to lift the culture of silence about health-care worker distress due to workplace pressure.

We conducted interviews with junior and senior doctors about their experiences and used their verbatim stories to craft the script of the play Grace Under Pressure.

The aim is for this “verbatim theatre” to facilitate conversations and actions that promote positive culture change.

What needs to be done?

It often takes brave public legal action such as this lawsuit to catalyse culture change – to nudge hospitals to prevent junior doctors from working back-to-back shifts, to protect time off for a personal life, ensure meal breaks, and provide means to hold powerful senior doctors to account.

Culture change is hard, slow and requires multi-pronged strategies. We need a safe way for junior doctors to report their concerns, and training so they know their options for responding to mistreatment. We need senior doctors and hospital managers to be trained in how to encourage and respond constructively to complaints.

Our research shows that when this happens, culture change is possible.

Correction: we have updated the article to reflect the correct value of the settlement.

Claire Hooker, Senior Lecturer and Coordinator, Health and Medical Humanities, University of Sydney; Alex Broom, Professor of Sociology & Director, Sydney Centre for Healthy Societies, University of Sydney; Karen Scott, Associate Professor, Sydney Medical School, University of Sydney, and Louise Nash, Associate Professor and Psychiatrist, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.