A review of the literature on human behaviour in dwelling fires

Most fire-related injuries and fatalities in the UK, and other parts of the world, continue to occur during fires in the home – incidents where it is acknowledged that human factors play a contributing role. Yet the field of fire safety lacks an up-to-date review of the literature on human behaviour during fires in domestic spaces. Given there is now a growing body of work looking at human behaviour in dwelling fires, a review of the literature in this area is timely. Drawing from published studies, this paper sets out what is currently known about human behaviour in dwelling fires and highlights the differences that appear to exist between these spaces and what is known and accepted about human behaviour in public, commercial and industrial spaces. This paper then goes on to consider the nature of “fire risk”, arguing that much of the work in this area continues to conflate, or fails to recognise the existence of, different types of risk profiles, instead considering fire risk as a single type of risk, based mainly on factors related to fatalities. However, research findings point towards fire risk as at least three separate forms: the risk of a fire occurring, the risk of fire injury and the risk of fire fatality. By drawing together the literature on human behaviour in dwelling fires this paper argues that those who survive dwelling fires cannot be considered as “near miss fatalities”, but instead must be treated as a separate and distinct group

Recollection of flame height and smoke volume in domestic fires

When a domestic fire occurs, how well do people perceive and recall the fire hazards they encounter? Although much research has been conducted on threat or risk perception and memory for threatening stimuli, to the authors' knowledge no studies have systematically tested how well people perceive and recall the threat stimulus in a fire context. This is an important topic given that domestic fires are usually the main source of fire-related injuries and deaths, and human behaviour is believed to play a significant role in such outcomes. Moreover, eyewitness testimonies play a significant role in subsequent fire, insurance and coroner investigations. The current study – part of wider research on human behaviour in domestic fires, called LIFEBID – sought to address the gap in knowledge by conducting an online experiment testing participants' (a) memories for the size of the flames and smoke witnessed in a mock kitchen fire, and (b) reported willingness to engage with the fire hazards. Participants' behaviours and attitudes in relation to other risky activities and control over events were also measured. The results revealed that accurate recollections of flame height and smoke volume can be obtained from members of the public, in certain cases. Accuracy was negatively impacted when the flames and smoke witnessed were larger in size. The size of the fire hazards also had an impact on participants' willingness to engage with the hazards, moderating the number who stated that they could have successfully extinguished the flames or would have entered the room with the smoke. Although there were signs that many participants recognised the risks posed by the larger hazards, a not inconsiderable number were still willing to engage with them. Being someone who takes greater risks in a health/safety domain and believing in one's ability to control what happens to oneself did not explain this finding. There is a clear need for a deeper investigation into people’s perceptions of fire hazards in a domestic fire context and their associated behaviours and fire outcomes

Island vulnerability and resilience to wildfires: A case study of Corsica

The number of wildfires occurring globally is exacerbated by urbanisation and changes in weather patterns. In response, researchers have conducted studies of wildfires and human behaviour in regions such as Australia and the USA. Regions in Europe have received less attention, despite facing the same issues. Even more overlooked are one particular type of territory: islands. With their climates, islands across the Mediterranean remain attractive second home and tourist destinations, resulting in urban development. Yet due to certain features (e.g. cultural, socio-political, geographical), the ways in which their people deal with wildfires may differ somewhat from that in some mainland territories. This paper explores human behaviour in wildfire emergencies in the context of island vulnerability and resilience in Europe, with the Mediterranean island of Corsica as a case study. Qualitative analysis of semi-structured interviews (n = 8) with Corsican professionals involved in wildfire management and quantitative analysis of around 100 surveys from civilians was conducted. This analysis revealed that Corsica’s population approach to wildfire safety is shaped by available information as well as a strong risk culture, which stands in contrast with new/temporary residents moving into the island each summer season. The results drawn from the analysed sample suggest potential social vulnerability in wildfires when a decision to evacuate the population is taken by emergency managers as the most effective emergency response. Population behaviour were not influenced by property attachment, perceived risk, hazard knowledge, community closeness and locus of control, suggesting that island WUI resident characteristics may not be generalised from human behaviour in wildfires studies carried out in the USA or Australia

Perception and recollection of fire hazards in dwelling fires

Current understanding of dwelling fire injury outcomes is impacted by data limitations, confounds, and failures to adequately examine occupant behaviour. For instance, research rarely considers: occupant perception of fire hazard properties (e.g. size of flames/smoke when first encountered); resultant engagement (enter smoky room, tackle flames); whether hazard size percepts are accurate when recollected for investigators; and what the best recollection method is. Two experiments (N = 141, 132) presented short videos of kitchen fires where hazard size was either Small, Mid or Large. Immediately after seeing this (Experiment 1), or after a delay (Experiment 2), participants’ performance at recollecting hazard size and their willingness to (hypothetically) engage with the hazards was tested. Recollection performance was compared across three methods. Interestingly, free recall resulted in poor performance but performance improved by 2-3 times when using two types of layperson-friendly descriptors (text, pictures) that allowed hazard size to be referenced to other scene elements. Pictures had a slight advantage over text descriptors. Larger hazards were recollected less accurately than small ones, albeit still somewhat meaningfully; the exception was mid-sized smoke and attentional narrowing effects are discussed. Importantly, while increased hazard size reduced willingness, a concerning percentage of participants nevertheless considered engaging with the largest hazards; such risky behaviours may explain injury outcomes. Prior fire experience and gender affected recollection and willingness, often interacting with hazard size. Delayed recollection and individual differences did not. These findings suggest occupant behaviour, characteristics and hazard size data need capturing to help assess fire injury risks

Perceptions of autonomous vehicles: Relationships with road users, risk, gender and age

Fully automated self-driving cars, with expected benefits including improved road safety, are closer to becoming a reality. Thus, attention has turned to gauging public perceptions of these autonomous vehicles. To date, surveys have focused on the public as potential passengers of autonomous cars, overlooking other road users who would interact with them. Comparisons with perceptions of other existing vehicles are also lacking. This study surveyed almost 1000 participants on their perceptions, particularly with regards to safety and acceptance of autonomous vehicles. Overall, results revealed that autonomous cars were perceived as a “somewhat low risk“ form of transport and, while concerns existed, there was little opposition to the prospect of their use on public roads. However, compared to human-operated cars, autonomous cars were perceived differently depending on the road user perspective: more risky when a passenger yet less risky when a pedestrian. Autonomous cars were also perceived as more risky than existing autonomous trains. Gender, age and risk-taking had varied relationships with the perceived risk of different vehicle types and general attitudes towards autonomous cars. For instance, males and younger adults displayed greater acceptance. Whilst their adoption of this autonomous technology would seem societally beneficial – due to these groups’ greater propensity for taking road user risks, behaviours linked with poorer road safety – other results suggested it might be premature to draw conclusions on risk-taking and user acceptance. Future studies should therefore continue to investigate people’s perceptions from multiple perspectives, taking into account various road user viewpoints and individual characteristics

The degree of acute descending control of spinal nociception in an area of primary hyperalgesia is dependent on the peripheral domain of afferent input

Descending controls of spinal nociceptive processing play a critical role in the development of inflammatory hyperalgesia. Acute peripheral nociceptor sensitization drives spinal sensitization and activates spino–supraspinal–spinal loops leading to descending inhibitory and facilitatory controls of spinal neuronal activity that further modify the extent and degree of the pain state. The afferent inputs from hairy and glabrous skin are distinct with respect to both the profile of primary afferent classes and the degree of their peripheral sensitization. It is not known whether these differences in afferent input differentially engage descending control systems to different extents or in different ways. Injection of complete Freund's adjuvant resulted in inflammation and swelling of hairy hind foot skin in rats, a transient thermal hyperalgesia lasting 72 h). In hairy skin, transient hyperalgesia was associated with sensitization of withdrawal reflexes to thermal activation of either A- or C-nociceptors. The transience of the hyperalgesia was attributable to a rapidly engaged descending inhibitory noradrenergic mechanism, which affected withdrawal responses to both A- and C-nociceptor activation and this could be reversed by intrathecal administration of yohimbine (α-2-adrenoceptor antagonist). In glabrous skin, yohimbine had no effect on an equivalent thermal inflammatory hyperalgesia. We conclude that acute inflammation and peripheral nociceptor sensitization in hind foot hairy skin, but not glabrous skin, rapidly activates a descending inhibitory noradrenergic system. This may result from differences in the engagement of descending control systems following sensitization of different primary afferent classes that innervate glabrous and hairy skin

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Proceedings of the 13th annual conference of INEBRIA

CITATION: Watson, R., et al. 2016. Proceedings of the 13th annual conference of INEBRIA. Addiction Science & Clinical Practice, 11:13, doi:10.1186/s13722-016-0062-9.The original publication is available at https://ascpjournal.biomedcentral.comENGLISH SUMMARY : Meeting abstracts.https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-016-0062-9Publisher's versio

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The UK BESECU firefighter study: A study of UK firefighters' emotional, cognitive and behavioural reactions to emergencies

A survey of UK firefighters revealed them to be seemingly psychologically prepared for what their job would expose them to but not immune to experiencing emotional arousal or perceived risk during emergency events. A number of aspects, such as the event posing serious consequences to their lives/well-being, were singled out as particularly distressing and linked with greater emotional arousal, while other aspects, ones focused on other people/circumstances, reduced perceived risk. Traffic accidents appeared to be a special case, inducing lower arousal and risk than another commonly attended emergency, domestic fires. More years of service had a positive effect on the risk perceived during a stressful event but heightened the emotional arousal in that moment. Received support was one of the most significant predictors of posttraumatic stress and growth, as well as being significantly linked to peri-event thoughts/feelings, although other variables not tested here, e.g. individual differences, might be better at explaining posttraumatic states than event-related variables. The sample reported that safety work with a risk group, migrants, was underway and appeared to be beneficial in reducing instances of "inappropriate behaviour" during emergencies but communication difficulties were an issue and training on this matter would appear desirable. Significant differences in responses across the UK were detected and consequences for international comparisons are discussed