Post-mortem toxicology: A pilot study to evaluate the use of a Bayesian network to assess the likelihood of fatality

The challenge of interpreting post-mortem drug concentrations is well documented and relies on appropriate sample collection, knowledge of case circumstances as well as reference to published tables of data, whilst taking into account the known issues of post-mortem drug redistribution and tolerance. Existing published data has evolved from simple data tables to those now including sample origin and single to poly drug use, but additional information tends to be specific to those reported in individual case studies. We have developed a Bayesian network framework to assign a likelihood of fatality based on the contribution of drug concentrations whilst taking into account the pathological findings. This expert system has been tested against casework within the coronial jurisdiction of Sunderland, UK. We demonstrate in this pilot study that the Bayesian network can be used to proffer a degree of confidence in how deaths may be reported in cases when drugs are implicated. It has also highlighted the potential for deaths to be reported according to the pathological states at post-mortem when drugs have a significant contribution that may have an impact on mortality statistics. The Bayesian network could be used as complementary approach to assist in the interpretation of post-mortem drug concentrations

“She Persisted in her Revolt”: Between Slavery and Freedom in Saint-Domingue

This article argues that women of colour were particularly well placed to take advantage of the porous boundary between slavery and freedom, flexible categories that operated on a continuum. Through a fine-grained analysis of the legal case of Marie Victoire Morisseau, one of the few appeals from Saint-Domingue that reached the Conseil du roi in Versailles, this article inserts women of colour into debates over who had the authority to arbitrate the boundary between slavery and freedom. It concludes that slavery and freedom were gendered categories that were less absolute for women of colour than for men. They were more manipulable, more permeable and possible to traverse, and less about legal absolutes and documents that provided “proof” and more about social experience and lived reality.Le présent article soutient que les femmes de couleur étaient particulièrement bien placées pour tirer parti de la frontière poreuse entre l’esclavage et la liberté, des catégories souples qui s’inscrivaient dans un continuum. En passant au peigne fin l’affaire Marie Victoire Morisseau – l’un des rares appels de Saint-Domingue à être parvenus au Conseil du roi à Versailles –, cet article fait intervenir le facteur des femmes de couleur dans le débat sur l’autorité apte à définir la frontière entre esclavage et liberté. Il conclut qu’il s’agissait de catégories genrées, moins absolu pour les femmes de couleur que pour les hommes. Ces catégories étaient sujettes à interprétation, perméables et franchissables, l’expérience sociale et la réalité vécue comptant davantage que le légalisme et les « preuves » à l’appui

Conceptualizing and advancing a growing quality of care concern: nursing home resident choice in daily life

Nursing home resident choice in daily life is recognized as vital to resident quality of life and quality of care. Advocacy and policy activities to promote resident choice abound, yet little research exists to guide nursing home staff in how to enable resident choice on a moment to moment basis. Our three studies developed conceptual and practical tools to elucidate the factors, challenges, and behaviors involved in enabling resident choice. We first crafted a conceptual model, the “REAlizing Resident CHoice (REACH)” model, as described in the first paper. The REACH model identifies the factors influencing staff efforts to enable resident choice and the broader contextual dimensions within which the resident-staff member relationship exists. The REACH model was developed through a literature review of 1,969 abstracts and expert opinion. The second study assessed 1) tensions nursing home staff members encounter when trying to enable resident choice and 2) resolutions employed in the face of these tensions. We conducted semi-structured, qualitative interviews with 26 staff participants in two Veterans Health Administration (VHA) Community Living Centers (i.e., nursing homes). Participants highlighted intra-personal, inter-personal, and organizational tensions that affected their resident choice enabling efforts. Resolutions to these tensions focused on preventive practices, education, reinforcement, deliberation, collaboration, and leadership. A formative assessment tool, the “Supporting Choice Observational Tool (SCOT),” was developed in the third study. The SCOT provides nursing home staff with detailed, non-graded feedback on how to offer and enable resident choice in-the-moment. We created the SCOT using the following methodologies, in order: ethnographic observation, tool piloting, expert panel consultation, and a representational algorithm. SCOT results can inform discussion amongst co-workers and supervisors on how to advance their resident choice enabling efforts. These three studies address an important research gap. They provide scientifically grounded concepts and tools to assist nursing home staff, researchers, and policy makers in advocating for and instituting resident choice. The REACH model can be used to frame future research, and future studies can be undertaken to validate the SCOT. Findings from the second study could improve quality improvement initiatives targeting tensions and resolutions in enabling resident choice.2018-02-17T00:00:00

جائحة كورونا في سياق النزوح القسري: وجهات نظر من الشرق الأوسط وشرق أفريقيا

Across the Middle East and East Africa, COVID-19 is compounding vulnerabilities already experienced by populations forcibly displaced by war (refugees, asylum-seekers, internally-displaced and stateless persons). In addition to the devastating health threat the pandemic poses, lockdown measures imposed by governments to reduce transmission are having outsized effects on forcibly displaced populations, further entrenching poverty, xenophobia and creating new humanitarian protection issues. This summary paper puts forward considerations of the ways in which humanitarian actors, civil society organisations and government departments with specific responsibilities towards displaced people can contribute to lessening vulnerabilities in this pandemic. For further considerations and details on local COVID-19 responses by forcibly displaced populations across the Middle East & East Africa, see our full Background Paper: COVID-19 and forced displacement in the Middle East & East Africa.Au Moyen-Orient et en Afrique de l’Est, la COVID-19 aggrave les vulnérabilités déjà éprouvées par les populations déplacées de force par la guerre (réfugiés, demandeurs d’asile, personnes déplacées et apatrides). Outre la menace sanitaire dévastatrice que représente la pandémie, les mesures de confinement imposées par les gouvernements pour réduire la transmission ont des conséquences démesurées sur les populations déplacées de force, contribuant à renforcer la pauvreté, la xénophobie et générant de nouveaux problèmes en matière de protection humanitaire. Les intervenants humanitaires, les organisations de la société civile et les ministères ayant des responsabilités spécifiques envers les personnes déplacées ont plusieurs rôles importants à jouer afin de réduire les vulnérabilités dans cette pandémie, que nous examinons ci-dessous.Katika Mashariki ya Kati na Afrika Mashariki, COVID-19 imeongeza mazingira hatarishi ambayo tayari wanayapitia watu waliolazimika kukimbia makazi yao kutokana na vita (wakimbizi, watafuta hifadhi, watu waliokimbia makazi yao nchini mwao na wasio na uraia). Pamoja na hatari kubwa ya kiafya kutokana na janga la gonjwa hili, hatua za vizuizi vya kutoka nje zilizowekwa na serikali kupunguza kuenea ugonjwa zimekuwa na madhara ya kupitiliza kwa watu waliolazimika kukimbia makazi yao, kuongeza umaskini, chuki dhidi ya wageni na kusababisha masuala mapya ya ulinzi wa kibinadamu. Jarida hili la muhtasari linatoa maoni juu ya njia ambazo watoa misaada ya kibinadamu, asasi au mashirika ya kiraia na idara za serikali zilizo na majukumu maalumi kwa watu waliokimbia makazi yao zinaweza kuchangia kupunguza mazingira hatarishi katika janga la gonjwa hili, ambayo tunayazungumzia hapo chini. Kwa maoni na maelezo ya kina zaidi kuhusu miitikio mahalia ya COVID-19 kwa watu waliolazimika kukimbia makazi yao Mashariki ya Kati na Afrika Mashariki, angalia Andiko letu kamili: COVID-19 katika muktadha wa kulazimika kukimbia makazi: Uzoefu kutoka Mashariki ya Kati na Afrika Mashariki.Please note: there is an accompanying infographic summarising the key points from the briefing.DFIDWellcome Trus

COVID-19 in the Context of Forced Displacement: Perspectives from the Middle East and East Africa

This background paper presents considerations on how the COVID-19 pandemic is accentuating existing vulnerabilities of populations forcibly displaced by war (refugees, asylum-seekers, internally-displaced and stateless persons), in settings across East Africa and the Middle East. In addition to the devastating health threat the pandemic poses, lockdown measures imposed by governments to reduce transmission are having outsized effects on forcibly displaced populations, further entrenching poverty, xenophobia and creating new humanitarian protection issues. With the exceptional physical distancing requirements of this pandemic adding impetus to a global drive towards the localisation of humanitarian responses, we also describe some of the local responses to COVID-19 mounted by forcibly displaced communities and humanitarian actors early in the epidemic. We end by offering suggestions for how greater inclusion could help address vulnerabilities of displaced people to COVID-19. This background paper is based on a rapid review of existing published and grey literature and personal communication with humanitarian actors, social scientists and representatives of local organisations working in diverse settings of displacement in the Middle East and East Africa. It was developed for the Social Science in Humanitarian Action Platform (SSHAP) by the RECAP project at the London School of Hygiene & Tropical Medicine (led by Diane Duclos and Jennifer Palmer). Summary considerations on the ways humanitarian actors, civil society organisations and government departments with specific responsibilities towards displaced people can lessen vulnerabilities in this pandemic are available in a summary paper: Operational considerations: COVID-19 and forced displacement in the Middle East & East Africa

Dilemmas of transgression: ethical responses in a more-than-human world

To transgress is ‘to do something that is not allowed’; in a human-constructed world, animals, especially those seen as ‘incompanionate’, are often deemed to be doing something not allowed. We explore the ethical dilemmas of ‘transgression’ in the context of critical reflection on an instructive example of dingo–human relations on Fraser Island, Australia, which has incited ongoing debate from diverse publics about the killing of ‘problem’ dingoes. We outline the historical and ethical complexity of such relations and suggest that human–nonhuman encounters,direct or indirect, have the potential to produce new, less anthropocentric topologies in which transgression is reconstructed, and humans and animals can share space more equitably. The kind of knowledge and ethical re-positioning beginning to emerge in dingo–human relations suggests transgression itself as a metaphor for its further re-imagining: a disruption of spatial, emotional and ethical boundaries to shape more responsive, respectful and less anthropocentric topologies

Organic, Symbiotic Digital Collection Development

One of the critical success factors most evident in this project is cooperation and collaboration on a community-wide scale. while grants and internal resource allocations provided the necessary start-up funds, partnership working enabled the project leaders to lever additional funds from other sources. Success has bred success, with other partners wanting to participate as a result of initial achievement. Care needs to be taken however, when there is multiple bidding for funds as a partner institution, and clarity of role is required in applications

Taking and sharing photographs of restaurant food via social media and the blurring of online-offline consumer leisure experiences

This paper explores consumer motivations for the taking and sharing of photographs of restaurant food online. In particular, it examines consumer-generated images of food across social media sites as part of a wider trend towards the sharing of experiences (and photographs) online. Sharing behaviour has been linked to levels of online community participation, engagement and commitment (Nov and Ye, 2008) and the expression of creative ability in terms of photograph composition and skill (Cook et al, 2009; Xu and Bailey, 2010). Offline, motivations for taking and sharing photographs with others have received academic research interest in a number of contexts (for example: mobile phone users-Chua et al, 2009; tourist photographs-Belk and Joyce, 2011; photographing natural disasters-Owen, 2013). Of particular interest to this study has been research into the social use of image-sharing as a means of creating and maintaining social relationships and self-presentation (Van House et al, 2005; Marcus, 2015; Sheldon and Bryant, 2016) in line with the idea of socially-constructed realities. The paper is based on the results of an online, semi-structured questionnaire survey completed by 67 international respondents of mixed genders and age groups (in line with standard research ethics procedures). Responses were analysed via descriptive statistics and a thematic review. The anonymised results provide initial insights into the extent to which photographs of restaurant food posted on social media were perceived to: reflect people's lifestyles; act as tools to maintain social relationships and facilitate the sharing of personal experiences; and contribute to the presentation of 'self' (Goffman, 1978). Overall, the findings draw attention to ways in which the taking and sharing of photographs of restaurant food online represent or distort offline leisure experiences. A number of questions are raised by the findings, not least whether participation in social media itself as a leisure activity supersedes, or at least impacts on, the 'lived experience' (Denzin, 1985) of other offline leisure activities (such as 'eating out'). In the words of one of the respondents in this study, 'the longer you spend time taking photos, the more likely the food will be cold'. Bibliography • Belk, R., & Hsiu-yen Yeh, J. (2011). Tourist photographs: signs of self. International Journal of Culture, Tourism and Hospitality Research, 5(4), 345-353. • Chua, A. Y., Lee, C. S., Goh, D. H. L., & Ang, R. P. (2009, November). Motivations for media sharing among mobile phone users. In Digital Information Management, 2009. ICDIM 2009. Fourth International Conference on (pp. 1-6). IEEE. • Cook, E., Teasley, S. D., & Ackerman, M. S. (2009, May). Contribution, commercialization & audience: understanding participation in an online creative community. In Proceedings of the ACM 2009 international conference on Supporting group work (pp. 41-50). ACM. • Denzin, N. K. (1985). Emotion as Lived Experience. Symbolic Interaction, 8(2), 223-240. • Goffman, E. (1978). The presentation of self in everyday life (p. 56). Harmondsworth. • Marcus, S.R. (2015) Picturing ourselves into being: assessing identity, sociality and visuality on Instagram. Presented at the International Communication Association conference, San Juan, Puerto Rico. • Nov, O., & Ye, C. (2008). Community photo sharing: Motivational and structural antecedents. ICIS 2008 Proceedings, 91. • Owen, D. M. (2013). Citizen Photojournalism: Motivations for Photographing a Natural Disaster and Sharing the Photos on the Web (Doctoral dissertation, University of Akron). • Sheldon, P., & Bryant, K. (2016). Instagram: Motives for its use and relationship to narcissism and contextual age. Computers in Human Behavior, 58, 89-97. • Van House, N., Davis, M., Ames, M., Finn, M., & Viswanathan, V. (2005, April). The uses of personal networked digital imaging: an empirical study of cameraphone photos and sharing. In CHI'05 extended abstracts on Human factors in computing systems (pp. 1853-1856). ACM. • Xu, A., & Bailey, B. (2012, February). What do you think?: a case study of benefit, expectation, and interaction in a large online critique community. In Proceedings of the ACM 2012 conference on Computer Supported Cooperative Work (pp. 295-304). ACM

An innovative and integrated model for global outbreak response and research - a case study of the UK Public Health Rapid Support Team (UK-PHRST)

Background Despite considerable institutional experimentation at national and international levels in response to calls for global health security reform, there is little research on organisational models that address outbreak preparedness and response. Created in the aftermath of the 2013–16 West African Ebola epidemic, the United Kingdom’s Public Health Rapid Support Team (UK-PHRST) was designed to address critical gaps in outbreak response illuminated during the epidemic, while leveraging existing UK institutional strengths. The partnership between the government agency, Public Health England, and an academic consortium, led by the London School of Hygiene and Tropical Medicine, seeks to integrate outbreak response, operational research and capacity building. We explored the design, establishment and early experiences of the UK-PHRST as one of the first bodies of its kind globally, paying particular attention to governance decisions which enabled them to address their complex mission. Methods We conducted a qualitative case study using 19 in-depth interviews with individuals knowledgeable about the team’s design and implementation, review of organisational documents, and observations of meetings to analyse the UK-PHRST’s creation, establishment and initial 2 years of operations. Results According to key informants, adopting a triple mandate (response, research and capacity building) established the team as novel in the global epidemic response architecture. Key governance decisions recognised as vital to the model included: structuring the team as a government-academic collaboration which leveraged long-term and complementary UK investments in public health and the higher education sector; adopting a more complex, dual reporting and funding structure to maintain an ethos of institutional balance between lead organisations; supporting a multidisciplinary team of experts to respond early in outbreaks for optimal impact; prioritising and funding epidemic research to influence response policy and practice; and ensuring the team’s activities reinforced the existing global health architecture. Conclusion The UK-PHRST aims to enhance global outbreak response using an innovative and integrated model that capitalises on institutional strengths of the partnership. Insights suggest that despite adding complexity, integrating operational research through the government-academic collaboration contributed significant advantages. This promising model could be adopted and adapted by countries seeking to build similar outbreak response and research capacities