Activism, arenas and accounts in conflicts over tobacco control

Purpose - The purpose of this paper is to provide theoretical and empirical insights into the effective use of external accounts by social activists in conflict arenas in order to bring about change. Design/methodology/approach - This paper presents a longitudinal case study of Action on Smoking and Health UK (ASH) and their use of external accounts and other activist practices during the period 1999-2010. The authors explore these practices from the perspective of one organisation engaged in conflict arenas concerning the (un)acceptability of tobacco production, consumption and governance. The authors conduct the exploration based upon a dynamic conflict arena framework that attends to the range of external accounting and activist practices, tactical intentions and states of conflict used by ASH to confront the tobacco industry and bring about change in tobacco governance. Findings - The study identifies the use of a diverse range of external accounts and other activist practices. This assemblage of practices was used to confront, counter-act and to co-operate with actors engaged in tobacco-related conflicts. The evidence suggests that the deployment of different types of external accounts by ASH was aligned to the context of the particular conflict arena involved, and was influenced by the strategy and engagement tactics of the activists and other actors, as well as power dynamics and acceptability of the tobacco governance in the conflict arena. Whilst ASH used different external accounts in specific episodes of activism, these individual accounts also contributed to an emerging holistic account of the unacceptable consequences of tobacco production, consumption and governance. Originality/value - This study provides new theoretical and empirical insights into how external accounts can contribute to the problematisation of governance and development of social and environmental change agendas. The dynamic conflict arena framework developed in this paper creates new visibilities and possibilities for developing external accounting practices and for researching this fast-developing area of social and environmental accounting.PostprintPeer reviewe

Accounts of nature and the nature of accounts : critical reflections on environmental accounting and propositions for ecologically informed accounting

Purpose The purpose of this paper is to review and synthesise academic research in environmental accounting and demonstrate its shortcomings. It provokes scholars to rethink their conceptions of “accounts” and “nature”, and alongside others in this AAAJ special issue, provides the basis for an agenda for theoretical and empirical research that begins to “ecologise” accounting. Design/methodology/approach Utilising a wide range of thought from accounting, geography, sociology, political ecology, nature writing and social activism, the paper provides an analysis and critique of key themes associated with 40 years research in environmental accounting. It then considers how that broad base of work in social science, particularly pragmatic sociology (e.g. Latour, Boltanksi and Thévenot), could contribute to reimagining an ecologically informed accounting. Findings Environmental accounting research overwhelmingly focuses on economic entities and their inputs and outputs. Conceptually, an “information throughput” model dominates. There is little or no environment in environmental accounting, and certainly no ecology. The papers in this AAAJ special issue contribute to these themes, and alongside social science literature, indicate significant opportunities for research to begin to overcome them. Research limitations/implications This paper outlines and encourages the advancement of ecological accounts and accountabilities drawing on conceptual resources across social sciences, arts and humanities. It identifies areas for research to develop its interdisciplinary potential to contribute to ecological sustainability and social justice. Originality/value How to “ecologise” accounting and conceptualise human and non-human entities has received little attention in accounting research. This paper and AAAJ special issue provides empirical, practical and theoretical material to advance further work.PostprintPeer reviewe

Exploring and mapping the knowledge and practice terrain

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Accounting and accountability in the Anthropocene

This research received funding from the Walton Family Foundation (2017-693, 2018-1371), the David and Lucile Packard Foundation (2017-66205, 2019-68336), and the Gordon and Betty Moore Foundation (5668.01).Purpose: This paper aims to interrogate the nature and relevance of debates around the existence of, and ramifications arising from, the Anthropocene for accounting scholarship. Design/methodology/approach: The paper’s aim is achieved through an in-depth analysis of the Anthropocene, paying attention to cross disciplinary contributions, interpretations and contestations. Some points of connection between the Anthropocene and accounting scholarship are then proposed and illuminated through a case study drawn from the seafood sector. Findings: This paper develops findings in two areas. First, there are suggestions about how accounting scholarship might be further developed by the provocation that thinking about the Anthropocene provides. Second, we suggest new accounting research findings, through engagement with the case study, and propose that the concept of stewardship may re-emerge in discussions about accountability in the Anthropocene. Research limitations/implications: The paper argues that accounting scholarship focused on social, environmental and sustainability concerns may be further developed by engagement with Anthropocene debates. Practical implications: While accounting practice might have to change to deal with Anthropocene induces effects, this paper focuses on implications for accounting scholarship. Social implications: Human wellbeing is likely to be impacted should environmental impacts accelerate. In addition, an Anthropocene framing alters the understanding of nature-human interactions and how this affects accounting thought. Originality/value: This is the first paper in accounting to seek to establish connections between accounting, accountability and the Anthropocene.Publisher PDFPeer reviewe

Quantifying neutralising antibody responses against SARS-CoV-2 in dried blood spots (DBS) and paired sera

The ongoing SARS-CoV-2 pandemic was initially managed by non-pharmaceutical interventions such as diagnostic testing, isolation of positive cases, physical distancing and lockdowns. The advent of vaccines has provided crucial protection against SARS-CoV-2. Neutralising antibody (nAb) responses are a key correlate of protection, and therefore measuring nAb responses is essential for monitoring vaccine efficacy. Fingerstick dried blood spots (DBS) are ideal for use in large-scale sero-surveillance because they are inexpensive, offer the option of self-collection and can be transported and stored at ambient temperatures. Such advantages also make DBS appealing to use in resource-limited settings and in potential future pandemics. In this study, nAb responses in sera, venous blood and fingerstick blood stored on filter paper were measured. Samples were collected from SARS-CoV-2 acutely infected individuals, SARS-CoV-2 convalescent individuals and SARS-CoV-2 vaccinated individuals. Good agreement was observed between the nAb responses measured in eluted DBS and paired sera. Stability of nAb responses was also observed in sera stored on filter paper at room temperature for 28 days. Overall, this study provides support for the use of filter paper as a viable sample collection method to study nAb responses.</p

Procalcitonin Is Not a Reliable Biomarker of Bacterial Coinfection in People With Coronavirus Disease 2019 Undergoing Microbiological Investigation at the Time of Hospital Admission

Abstract Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11–1.70] ng/mL vs 0.24 [0.10–0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51–.60]).</jats:p

Implementation of corticosteroids in treating COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK:prospective observational cohort study

BACKGROUND: Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. METHODS: We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. FINDINGS: Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70–0·89], p=0·0001, for 70–79 years; 0·52 [0·46–0·58], p80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75–80% in January, 2021. INTERPRETATION: Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. FUNDING: UK National Institute for Health Research and UK Medical Research Council

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice