Helping with inquiries: theory and practice in forensic science

This thesis investigates the reasoning practices of forensic scientists, with specific focus on the application of the Bayesian form of probabilistic reasoning to forensic science matters. Facilitated in part by the insights of evidence scholarship, Bayes Theorem has been advocated as an essential resource for the interpretation and evaluation of forensic evidence, and has been used to support the production of specific technologies designed to aid forensic scientists in these processes. In the course of this research I have explored the ways in which Bayesian reasoning can be regarded as a socially constructed collection of practices, despite proposals that it is simply a logical way to reason about evidence. My data are drawn from two case studies. In the first, I demonstrate how the Bayesian algorithms used for the interpretation of complex DNA profiles are themselves elaborately constructed devices necessary for the anchoring of scientific practice to forensic contexts. In the second case study, an investigation of a more generalised framework of forensic investigation known as the Case Assessment and Interpretation (CAI) model, I show how the enactment of Bayesian reasoning is dependent on a series of embodied, experiential and intersubjective knowledge-forming activities. Whilst these practices may seem to be largely independent of theoretical representations of Bayesian reasoning, they are nonetheless necessary to bring the latter into being. This is at least partially due to the ambiguities and liminalities encountered in the process of applying Bayesianism to forensic investigation, and also may result from the heavy informational demands placed on the reasoner. I argue that these practices, or 'forms of Bayes', are necessary in order to negotiate areas of ontological uncertainty. The results of this thesis therefore challenge prevailing conceptions of Bayes Theorem as a universal, immutable signifier, able to be put to work unproblematically in any substantive domain, Instead, I have been able to highlight the diverse range of practices required for 'Bayesian' reasoners to negotiate the sociomaterial contingencies exposed in the process of its application

Health trajectories in regeneration areas in England:the impact of the New Deal for Communities intervention

BACKGROUND: A large body of evidence documents the adverse relationship between concentrated deprivation and health. Among the evaluations of regeneration initiatives to tackle these spatial inequalities, few have traced the trajectories of individuals over time and fewer still have employed counterfactual comparison. We investigate the impact of one such initiative in England, the New Deal for Communities (NDC), which ran from 1999 to 2011, on socioeconomic inequalities in health trajectories. METHODS: Latent Growth Curve modelling of within-person changes in self-rated health, mental health and life satisfaction between 2002 and 2008 of an analytical cohort of residents of 39 disadvantaged areas of England in which the NDC was implemented, compared with residents of comparator, non-intervention areas, focusing on: (1) whether differences over time in outcomes can be detected between NDC and comparator areas and (2) whether interventions may have altered socioeconomic differences in outcomes. RESULTS: No evidence was found for an overall improvement in the three outcomes, or for significant differences in changes in health between respondents in NDC versus comparator areas. However, we found a weakly significant gap in life satisfaction and mental health between high and low socioeconomic status individuals in comparator areas which widened over time to a greater extent than in NDC areas. Change over time in the three outcomes was non-linear: individual improvements among NDC residents were largest before 2006. CONCLUSIONS: There is limited evidence that the NDC moderated the impact of socioeconomic factors on mental health and life satisfaction trajectories. Furthermore, any NDC impact was strongest in the first 6 years of the programmes

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

The evolution, devolution and distribution of UK Biometric Imaginaries

This article critically examines UK biometric policymaking by charting the bodies identified by the 2018 Home Office Biometric Strategy as playing key roles in the oversight of biometric data used in law enforcement and other related functions. The article argues that oversight actors are embedded in biometric imaginaries promoted by the UK Home Office and the devolved Scottish administration. By mapping oversight of UK biometrics policy together with developments in Scotland, the article challenges sociotechnical imaginaries studies which assume the power of national governments to project dominant, cohesive and instrumental visions. The article peels away that image to reveal UK biometric policy as located within a patchwork in which embedded commissioners, regulators and advisors challenge biometric imaginaries through interpretive flexibility and standpoint. By identifying technical, operational, legislative and ethical issues, these actors challenge the UK government imaginary and act as channels of critique between it and wider stakeholder communities. The article further challenges assumptions concerning the cohesion of national imaginaries by highlighting a diverging approach to biometric governance in Scotland. The article uses these observations to sketch a means to further characterise the notion of the biometric imaginary and to address biometric policymaking more widely

Emerging forensic genetic technologies: Contested anticipations of legitimation, caution and social situatedness

This chapter sees the partially realised nature of these technologies as an opportunity rather than a problem. It utilises this opportunity to explore interpretations of emerging forensic DNA technologies to illuminate how they render orderings of various domains fluid and malleable. Such domains include the natural and social sciences, ethics, law, commerce and society at large. The chapter draws on the conceptual framing of interpretive flexibility as developed via social construction of technology studies, which have highlighted the different perceptions of technology on the part of different stakeholders embedded in sociotechnical networks. Differing standpoints and interpretations of technology may lead to contested plans and imaginaries. Framing technolegal anticipation (namely, anticipations of law-science-technology-society relations) in terms of embedded interpretive flexibility enables the chapter to illuminate differing normative interpretations of technology and sociotechnical engagement. Here, discursive responses to three notable examples of emerging forensic DNA methods are explored: rapid DNA analysis, forensic DNA phenotyping (FDP) and forensic genealogical testing. These three examples are presented in order to examine how their perceived status embodies differing assumptions concerning how science and wider society should engage, which, in turn, order relations between domains in different ways