A social identity perspective on interoperability in the emergency services: emergency responders’ experiences of multi-agency working during the COVID-19 response in the UK

Recent research has shown that multi-agency emergency response is beset by a range of challenges, calling for a greater understanding of the way in which these teams work together to improve future multi-agency working. Social psychological research shows that a shared identity within a group can improve the way in which that group works together and can facilitate effective outcomes. In the present study, 52 semi-structured interviews were conducted with 17 strategic and/or tactical responders during the COVID-19 pandemic to understand the possible role of shared identity in the multi-agency response to COVID-19 and whether this was linked to factors that facilitated or challenged interoperability. Findings show evidence of a shared identity at a horizontal intergroup level among responders locally. However, there was limited evidence for a shared identity at the vertical intergroup level between local and national responders. Three key factors linked to shared identity appeared to contribute to effective multi-agency working. First, pre-existing relationships with other responders facilitated the ease with which responders were able to work together initially. Second, a sense of ‘common fate’ helped bring responders together, and finally, group leaders were able to strategically reinforce a sense of shared identity within the group

The contribution of geogenic particulate matter to lung disease in indigenous children

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. Indigenous children have much higher rates of ear and lung disease than non-Indigenous children, which may be related to exposure to high levels of geogenic (earth-derived) particulate matter (PM). The aim of this study was to assess the relationship between dust levels and health in Indigenous children in Western Australia (W.A.). Data were from a population-based sample of 1077 Indigenous children living in 66 remote communities of W.A. (>2,000,000 km2), with information on health outcomes derived from carer reports and hospitalisation records. Associations between dust levels and health outcomes were assessed by multivariate logistic regression in a multi-level framework. We assessed the effect of exposure to community sampled PM on epithelial cell (NuLi-1) responses to non-typeable Haemophilus influenzae (NTHi) in vitro. High dust levels were associated with increased odds of hospitalisation for upper (OR 1.77 95% CI [1.02–3.06]) and lower (OR 1.99 95% CI [1.08–3.68]) respiratory tract infections and ear disease (OR 3.06 95% CI [1.20–7.80]). Exposure to PM enhanced NTHi adhesion and invasion of epithelial cells and impaired IL-8 production. Exposure to geogenic PM may be contributing to the poor respiratory health of disadvantaged communities in arid environments where geogenic PM levels are high

Systems Thinking and Complexity Science Methods and the Policy Process in Non-Communicable Disease Prevention: A Systematic Scoping Review

Background: Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy. Methods: Systematic scoping review: We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by 13 October 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS. Results: 4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decision-making; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use. Conclusion: This review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policymaking, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.</jats:p

Mainstreaming domestic and gender-based violence into sociology and the criminology of violence

Sociological and criminological views of domestic and gender-based violencegenerally either dismiss it as not worthy of consideration, or focus on specificgroups of offenders and victims (male youth gangs, partner violence victims). Inthis paper, we take a holistic approach to violence, extending the definition fromthat commonly in use to encompass domestic violence and sexual violence. Weoperationalize that definition by using data from the latest sweep of the CrimeSurvey for England and Wales. By so doing, we identify that violence is currentlyunder-measured and ubiquitous; that it is gendered, and that other forms of violence (family violence, acquaintance violence against women) are equally ofconcern. We argue that violence studies are an important form of activity forsociologists

Public behaviour in response to perceived hostile threats: An evidence base and guide for practitioners and policymakers

Background: Public behaviour and the new hostile threats • Civil contingencies planning and preparedness for hostile threats requires accurate and up to date knowledge about how the public might behave in relation to such incidents. Inaccurate understandings of public behaviour can lead to dangerous and counterproductive practices and policies. • There is consistent evidence across both hostile threats and other kinds of emergencies and disasters that significant numbers of those affected give each other support, cooperate, and otherwise interact socially within the incident itself. • In emergency incidents, competition among those affected occurs in only limited situations, and loss of behavioural control is rare. • Spontaneous cooperation among the public in emergency incidents, based on either social capital or emergent social identity, is a crucial part of civil contingencies planning. • There has been relatively little research on public behaviour in response to the new hostile threats of the past ten years, however. • The programme of work summarized in this briefing document came about in response to a wave of false alarm flight incidents in the 2010s, linked to the new hostile threats (i.e., marauding terrorist attacks). • By using a combination of archive data for incidents in Great Britain 2010-2019, interviews, video data analysis, and controlled experiments using virtual reality technology, we were able to examine experiences, measure behaviour, and test hypotheses about underlying psychological mechanisms in both false alarms and public interventions against a hostile threat. Re-visiting the relationship between false alarms and crowd disasters • The Bethnal Green tube disaster of 1943, in which 173 people died, has historically been used to suggest that (mis)perceived hostile threats can lead to uncontrolled ‘stampedes’. • Re-analysis of witness statements suggests that public fears of Germany bombs were realistic rather than unreasonable, and that flight behaviour was socially structured rather than uncontrolled. • Evidence for a causal link between the flight of the crowd and the fatal crowd collapse is weak at best. • Altogether, the analysis suggests the importance of examining people’s beliefs about context to understand when they might interpret ambiguous signals as a hostile threat, and that. Tthe concepts of norms and relationships offer better ways to explain such incidents than ‘mass panic’. Why false alarms occur • The wider context of terrorist threat provides a framing for the public’s perception of signals as evidence of hostile threats. In particular, the magnitude of recent psychologically relevant terrorist attacks predicts likelihood of false alarm flight incidents. • False alarms in Great Britain are more likely to occur in those towns and cities that have seen genuine terrorist incidents. • False alarms in Great Britain are more likely to occur in the types of location where terrorist attacks happen, such as shopping areass, transport hubs, and other crowded places. • The urgent or flight behaviour of other people (including the emergency services) influences public perceptions that there is a hostile threat, particularly in situations of greater ambiguity, and particularly when these other people are ingroup. • High profile tweets suggesting a hostile threat, including from the police, have been associated with the size and scale of false alarm responses. • In most cases, it is a combination of factors – context, others’ behaviour, communications – that leads people to flee. A false alarm tends not to be sudden or impulsive, and often follows an initial phase of discounting threat – as with many genuine emergencies. 2.4 How the public behave in false alarm flight incidents • Even in those false alarm incidents where there is urgent flight, there are also other behaviours than running, including ignoring the ‘threat’, and walking away. • Injuries occur but recorded injuries are relatively uncommon. • Hiding is a common behaviour. In our evidence, this was facilitated by orders from police and offers from people staff in shops and other premises. • Supportive behaviours are common, including informational and emotional support. • Members of the public often cooperate with the emergency services and comply with their orders but also question instructions when the rationale is unclear. • Pushing, trampling and other competitive behaviour can occur,s but only in restricted situations and briefly. • At the Oxford Street Black Friday 2017 false alarm, rather than an overall sense of unity across the crowd, camaraderie existed only in pockets. This was likely due to the lack of a sense of common fate or reference point across the incident; the fragmented experience would have hindered the development of a shared social identity across the crowd. • Large and high profile false alarm incidents may be associated with significant levels of distress and even humiliation among those members of the public affected, both at the time and in the aftermath, as the rest of society reflects and comments on the incident. Public behaviour in response to visible marauding attackers • Spontaneous, coordinated public responses to marauding bladed attacks have been observed on a number of occasions. • Close examination of marauding bladed attacks suggests that members of the public engage in a wide variety of behaviours, not just flight. • Members of the public responding to marauding bladed attacks adopt a variety of complementary roles. These, that may include defending, communicating, first aid, recruiting others, marshalling, negotiating, risk assessment, and evidence gathering. Recommendations for practitioners and policymakers • Embed the psychology of public behaviour in emergencies in your training and guidance. • Continue to inform the public and promote public awareness where there is an increased threat. • Build long-term relations with the public to achieve trust and influence in emergency preparedness. • Use a unifying language and supportive forms of communication to enhance unity both within the crowd and between the crowd and the authorities. • Authorities and responders should take a reflexive approach to their responses to possible hostile threats, by reflecting upon how their actions might be perceived by the public and impact (positively and negatively) upon public behaviour. • To give emotional support, prioritize informative and actionable risk and crisis communication over emotional reassurances. • Provide first aid kits in transport infrastructures to enable some members of the public more effectively to act as zero responders

Cosmopolitan Sentiment: Politics, Charity, and Global Poverty

Duties to address global poverty face a motivation gap. We have good reasons for acting yet we do not, at least consistently. A ‘sentimental education’, featuring literature and journalism detailing the lives of distant others has been suggested as a promising means by which to close this gap (Nussbaum in Upheavals of Thought: The Intelligence of Emotions, CUP, Cambridge, 2001; Rorty in Truth and Progress: Philosophical Papers, vol. 3, CUP, Cambridge, 1998). Although sympathetic to this project, I argue that it is too heavily wed to a charitable model of our duties to address global poverty—understood as requiring we sacrifice a certain portion of our income. However, political action, aimed at altering institutions at both a global and a local level is likely to be necessary in order to provide effective long-term solutions to poverty globally. To rectify this, the article develops an alternative dialogical account of sentimental education, suitable for motivating support for political action to address global poverty

Gene dysregulation in acute HIV-1 infection – early transcriptomic analysis reveals the crucial biological functions affected

IntroductionTranscriptomic analyses from early human immunodeficiency virus (HIV) infection have the potential to reveal how HIV causes widespread and lasting damage to biological functions, especially in the immune system. Previous studies have been limited by difficulties in obtaining early specimens.MethodsA hospital symptom-based screening approach was applied in a rural Mozambican setting to enrol patients with suspected acute HIV infection (Fiebig stage I-IV). Blood samples were collected from all those recruited, so that acute cases and contemporaneously recruited, uninfected controls were included. PBMC were isolated and sequenced using RNA-seq. Sample cellular composition was estimated from gene expression data. Differential gene expression analysis was completed, and correlations were determined between viral load and differential gene expression. Biological implications were examined using Cytoscape, gene set enrichment analysis, and enrichment mapping.ResultsTwenty-nine HIV infected subjects one month from presentation and 46 uninfected controls were included in this study. Subjects with acute HIV infection demonstrated profound gene dysregulation, with 6131 (almost 13% of the genome mapped in this study) significantly differentially expressed. Viral load was correlated with 1.6% of dysregulated genes, in particular, highly upregulated genes involved in key cell cycle functions, were correlated with viremia. The most profoundly upregulated biological functions related to cell cycle regulation, in particular, CDCA7 may drive aberrant cell division, promoted by overexpressed E2F family proteins. Also upregulated were DNA repair and replication, microtubule and spindle organization, and immune activation and response. The interferome of acute HIV was characterized by broad activation of interferon-stimulated genes with antiviral functions, most notably IFI27 and OTOF. BCL2 downregulation alongside upregulation of several apoptotic trigger genes and downstream effectors may contribute to cycle arrest and apoptosis. Transmembrane protein 155 (TMEM155) was consistently highly overexpressed during acute infection, with roles hitherto unknown.DiscussionOur study contributes to a better understanding of the mechanisms of early HIV-induced immune damage. These findings have the potential to lead to new earlier interventions that improve outcomes

Serum IGF-1 Affects Skeletal Acquisition in a Temporal and Compartment-Specific Manner

Insulin-like growth factor-1 (IGF-1) plays a critical role in the development of the growing skeleton by establishing both longitudinal and transverse bone accrual. IGF-1 has also been implicated in the maintenance of bone mass during late adulthood and aging, as decreases in serum IGF-1 levels appear to correlate with decreases in bone mineral density (BMD). Although informative, mouse models to date have been unable to separate the temporal effects of IGF-1 depletion on skeletal development. To address this problem, we performed a skeletal characterization of the inducible LID mouse (iLID), in which serum IGF-1 levels are depleted at selected ages. We found that depletion of serum IGF-1 in male iLID mice prior to adulthood (4 weeks) decreased trabecular bone architecture and significantly reduced transverse cortical bone properties (Ct.Ar, Ct.Th) by 16 weeks (adulthood). Likewise, depletion of serum IGF-1 in iLID males at 8 weeks of age, resulted in significantly reduced transverse cortical bone properties (Ct.Ar, Ct.Th) by 32 weeks (late adulthood), but had no effect on trabecular bone architecture. In contrast, depletion of serum IGF-1 after peak bone acquisition (at 16 weeks) resulted in enhancement of trabecular bone architecture, but no significant changes in cortical bone properties by 32 weeks as compared to controls. These results indicate that while serum IGF-1 is essential for bone accrual during the postnatal growth phase, depletion of IGF-1 after peak bone acquisition (16 weeks) is compartment-specific and does not have a detrimental effect on cortical bone mass in the older adult mouse

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder