Case Files Research Articles

Caring Under Pressure: Investigating Parental Attitudes in Mother–Child Chronic Illness Dynamics

Background: The presence of chronic illnesses in both a mother and a child poses a significant challenge for mothers in managing these conditions, yet how maternal attitudes adapt to dual illness remains poorly understood. This study aims to explore parenting styles in families dealing with mother–child chronic illnesses. Methods: Mothers of children aged 2–6 were recruited from three pediatric clinics and categorized based on the health status of both the mother and the child. Data collection included case files and the Parental Attitude Scale (PAS), which assessed democratic, authoritarian, overprotective, and permissive attitudes. The interaction between mother–child health status and higher levels of parental subscales was analyzed using the chi-square test. Multiple logistic regression analysis was then performed to evaluate this interaction, controlling for confounding baseline characteristics. Results: In total, 878 mother–child pairs were included. Mothers exhibited varying attitudes based on education, employment, and the child’s age. Chronic illness in both mother and child and only the child having an illness were significantly associated with higher overprotective scores (p < 0.001). The percentage of mothers with high permissive scores was higher when only the mother had an illness and when both were healthy, compared to the case of both mother and child having an illness (p = 0.018). After adjusting for confounding factors, having a sick child showed a 1.6-fold increase in the likelihood of a high overprotective score, and both the mother and child having an illness showed a 2.94-fold increase. Similarly, after adjusting for the same confounding factors, the likelihood of a high permissive score was 2.56 times lower when both were ill compared to when both were healthy. Conclusions: This study reveals that when a child is affected by a chronic illness—whether or not the mother is also ill—mothers tend to exhibit higher levels of overprotection and lower levels of permissiveness, while their levels of authoritarianism and democratic attitudes in parenting remain relatively stable.

Supporting the educational success of children in foster care: the educational advocacy program

ABSTRACT Children in foster care face a heightened risk of poor educational outcomes, yet published research on programs designed to improve outcomes remains scant. Findings from an evaluation of the Educational Advocacy Program (EAP) that works with foster and adoptive caregivers and educators to address unmet educational needs are presented to help fill this gap. Youth, services data, and contact information for caregivers and educators were drawn from EAP files for cases closed during 2018–2019 (n = 234). Surveys of identified educators and caregivers as well as district foster care liaisons were conducted. Youth information was linked to state administrative data on foster care placements. Descriptive and bivariate analyses of program outcomes, program satisfaction, and placement stability were completed. Caregivers and educators perceived benefits for themselves and youth served. EAP staff ratings of post-service youth function were congruent with caregiver ratings of youth school outcomes. Statistically significant decreases in youth placement moves were found during and after services compared to before EAP onset. While not a causal design, results indicate that EAP holds promise for supporting caregiver and educator collaboration and improving youth school and placement outcomes. Implications for future research and practice are discussed.

Understanding services provided to children in DFV shelters: Exposing the ‘invisible’ work

Abstract This study examines practice responses for children who reside in the context of domestic and family violence (DFV) shelters in Australia. DFV is a recognized form of child abuse and identified as such in child protection legislations, policies, and practice guidelines. The prevalence of children who experience DFV is unknown and underestimated. DFV shelters that provide crisis accommodation and case management services were traditionally established to respond to the needs of women and are therefore adult centred. Increasingly, practitioners employed in DFV shelters are also responding to the needs of children and young people; however, they are not resourced to do so. This qualitative study conducted in South Australia explores practice responses provided for children and young people while they are residing in a DFV shelter with their mothers. Data were extracted and analysed from the DFV shelter case files of seventeen women and their children using a co-designed data collection instrument. The findings provide insight into children’s experiences due to DFV. Practitioners in DFV shelters were found to be providing an array of services to children exposing this ‘invisible’ work. Understanding the complex needs and service provided to children have practice implications for the DFV sector.

Anthropometric Indices of Obstructive Sleep Apnea Patients in Mauritius.

Background Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder, affecting a significant number of individuals globally.It is associated with poor quality of life and an increased risk of all-cause mortality. It is estimated that most of the patients suffering from OSA are obese. Anthropometric indices can help guide doctors towardthe diagnosis. Objectives This study aimed to establish specific anthropometric thresholds associated with OSA risk, allowing clinicians to identify individuals more likely to have OSA and who may need further evaluation, such as polysomnography. This targeted screening approach would enable better resource allocation to those at higher risk, potentially enhancing the efficiency of OSA diagnosis and management. Methods We conducted a descriptive study using data from the sole private sleep clinic in Mauritius. We analyzed case files of consecutive patients diagnosed with OSA over a 3.5-year period from January 2015 to June 2018. Results The study population comprised 170 patients (79.4% males) diagnosed with OSA by a polygraphy test.The mean age of OSA diagnosis in men and women was 51.7 ± 14.0 years and 53.8 ± 12.5 years, respectively.The mean neck circumference (NC) for males and females was 41.9 ± 3.9 cm and 38.2 ± 3.9 cm, while the mean waist circumference (WC) was 105.6 ± 12.2 cm for men and 103.4 ± 14.5 cm for women. The body mass index (BMI) was 29.1± 5.0 kg/m2 and 31.4± 6.8 kg/m2 for males and females, respectively. The apnea-hypopnea index (AHI) averaged to 42.1 ± 19.7 events/hour for men and 33.3 ± 16.4 events/hour for women.In male patients, we found a positive significant correlation (p<0.001) between AHI and the following parameters: BMI (r=0.443), WC(r=0.337), WC-to-height ratio (WHr) (r=0.378), NC(r =0.274), and neck-to-height ratio (NHr) (r =0.321).In women, we observed a positive significant correlation between apnea severity and the following: BMI (r=0.396, p=0.029), WC (r=0.462, p=0.005), and WHr (r=0.494, p=0.003).No significant relationships were observed between AHI and the following parameters in women: NC (r=0.317, p=0.064) and NHr (r=0.311, p=0.069). A total of 83.5% of patients had a Mallampati score of 3-4. Conclusion This study represents a pioneering effort on the island. While further research is necessary to establish exact anthropometric cutoff values, the findings offer crucial insights for physicians to identify high-risk individuals. With just a scale, measuring tape, and calculator, healthcare professionals can detect important health markers that extend beyond diagnosing OSA. These simple measurements not only help in predicting OSA but also provide a broader view of an individual's overall health, identifying risks that go beyond sleep issues. This research sets an important foundation for future OSA studies within the Mauritian population.

Mixed venous to arterial pCO2-gap is poorly correlated to cardiac index in 1526 pulmonary artery catheter monitored critically ill patients

Abstract Background The CO2 gap is the difference between mixed venous and arterial CO2, and can be estimated by the difference in partial pressure in CO2 (Pv-aCO2 or ∆PCO2). ∆PCO2 is affected by cardiac output (CO), CO2 production and solubility. The central venous-to-arterial CO2 gap has been proposed as a less invasive surrogate for P(v-a)CO2 and has been investigated as a measure of adequacy of resuscitation, and to guide sepsis management. Nevertheless, the CO2-gap as determinant of CO has never been thoroughly investigated in large cohort of critically ill ICU-patients. This study aims to investigate the relationship between ∆PCO2 and cardiac index (CI) in a retrospective cohort of critically ill patients in a large quaternary cardiothoracic intensive care unit. Methods Over 62 months, pulmonary artery catheter monitored critically ill patients were identified and their case files reviewed in retrospect. Extracorporeal membrane oxygenation (ECMO) patients were excluded. P(v-a)CO2 measurements were defined as mixed venous and arterial pCO2 measurements drawn simultaneously or within maximum 30 minutes together with PA-measurements. Correlation coefficients were calculated between P(v-a)CO2 and CI, serum lactate, mixed venous saturations (SvO2), cardiac power index (CPI), inotropic score (IS), central venous pressure (CVP) and minute expiratory volume (MV)(Table 1). We used receiver operator characteristic (ROC) curves to assess the diagnostic performance of P(v-a)CO2 as a surrogate for CI lower than 2,2L/min/m2. Multivariate linear regression analysis was performed with P(v-a)CO2 as an dependent variable. Results 4414 P(v-a)CO2 measurements were identified from 1526 patients. Median P(v-a)CO2 was 0,86 kPa (0,66-1,1) or 6.45 mmHg (4.95-8.25), and mean CI was 2.7l/min/m2 (2.2-3.2). Correlation coefficients of P(v-a)CO2 with the other variables remained poor (&amp;gt; 0,35). The area under the ROC curve for P(v-a)CO2 as a predictor of CI&amp;lt;2.2l/min/m2 was 0.65, p&amp;lt;0.0001 (Fig. 1B). A value of P(v-a)CO2 &amp;gt; 6.9 mmHg was found to have the highest sensitivity and specificity, with a poor performance of 61.21% sensitivity and 62.73% specificity. Conclusion This large retrospective study in 1526 critically ill cardiac ICU-patients did not demonstrate a strong relationship between P(v-a)CO2 and CI, nor with any other hemodynamic variable found in the ICU patient cohort studied (Table 1). This raises scepticism regarding the efficacy of P(v-a)CO2 as a physiological goal in guiding resuscitation and management of this precarious patient group. Therefore, we argue that the PA-catheter remains the cornerstone in assessing critically ill (cardiothoracic) ICU patients.

“Unduly Harsh?”: An Empirical Examination of Best Interests Assessments in the Context of Parental Deportation

Abstract Thousands of people are deported from the UK every year, having served a sentence for a serious criminal offence, it being determined that it is no longer in the public interest for them to remain in the UK. For those who are parents, they can appeal against deportation on grounds that it would breach their right to family life and have an unduly harsh impact on their children. Detailed guidance has emerged, setting out the factors that should be taken into account in determining this question in a manner that is compliant with children’s rights. Drawing on an in-depth analysis of a sample of deportation case files, this paper provides a unique empirical insight into the extent to which this guidance is applied in practice, with a particular reference to children’s rights principles and processes.

“Throw Dat Hat!”: Educational Experiences, Attainment, and Aspirations of Adolescent Female Trafficking Survivors in a Residential Facility

This study addresses the gap in research on the educational experiences of adolescent human trafficking survivors, with a focus on their past, present, and future educational experiences and goals. Its objective is to inform the best practices for educational programming within female adolescent residential care centers in the United States. Drawing on a subset of data from a broader mixed-methods case study conducted at the Allasso House residential facility, this research involved 11 current residents. The data sources included case files detailing their past educational experiences, assessments of their current educational achievements, and interviews exploring their future aspirations. The findings reveal key themes related to the residents past risk factors, current educational successes and barriers, and tensions in setting future goals. Most of the residents expressed a desire to attain high school equivalency, identifying financial stability as a primary motivation. They also aspired to form healthy families, while placing significant value on material success. Unlike studies that define success primarily through survival, sobriety, and the avoidance of re-trafficking, this research highlights the broader aspirations of these adolescents, emphasizing the critical role of education in general wellbeing, risk mitigation, and future success. This study underscores the importance of prioritizing educational attainment and long-term aspirations in future research and in the design of residential programs for adolescent survivors of trafficking.

Mi történik az igazságszolgáltatásban? Hatóságok és bántalmazottak a kapcsolati erőszak színterén

Aim: Although it was possible to sanction acts falling within the conceptual scope of domestic violence earlier as well, from 1 July 2013, the Hungarian Criminal Code contains an independent criminal offense covering a wide range of abusive behaviours committed against family members. This article presents the essence of the regulation, the statistical data of the past few years, as well as the difficulties and best practices that we can encounter when analysing the application of the law. It’s the summary of the judicial practice of the criminal offense of domestic violence. Methodology: The research methodology behind the study consisted of criminal-statistical and legislative analysis, focus groups, in-depth interviews and case file reviews. Findings: A number of to-dos are being formulated for the future, including: conducting a follow-up analysis, establishing uniform legal practice, popularizing the relevant instruction of the chief of police, increasing the responsibility of the child protection alert system, organizing targeted trainings, strengthening professional collaborations and providing information for victims, inspiring the imposition of more severe punishments, and a change in communication directions. This study presents the most typical difficulties from the side of the authorities and the victims. Value: The analysis of the criminal offense from many aspects helps to draw conclusions and find the directions to follow.

Category traversing: early Korean immigrants eluding the U.S. state

ABSTRACT This paper explores category traversing, the process through which migrants navigate state-imposed immigration categories. In the early twentieth century, Asian migrants were categorically excluded from entering the U.S. under the Asiatic Barred Zone, while exemptions were granted to merchants, diplomats and students. Drawing on immigrant case files from the U.S. National Archives, we highlight how Korean migrants navigate student status to circumvent race-based exclusion. At ports of entry, they curated a performance to present as a student in the eyes of immigration officials, with a proper display of scholarly knowledge and financial ability. Even after entry, failure to maintain student status invited scrutiny from officials. Responding to these demands, migrants agentially traversed the categories of student and worker to remain in a country that sought to exclude them. This paper contributes to this special issue by documenting (a) how migrants perform in accordance with state-imposed categories to navigate immigration regimes and (b) how they challenge those categories by traversing them as they see fit.

Digital group archives in residential childcare: an investigation into memory responsibility

This article discusses phase two of the ARCH project (Archiving Residential Children’s Homes), and in particular, the development of a co-designed ‘digital archive’ that stores everyday, shared events and experiences for care experienced young people who live in residential children’s homes. We present research with young people living in residential care, care workers and care experienced adults about the types of everyday information or records they would like to be able to store, share and access in the future. There was a desire for the digital archive to have a different feel and purpose to content recorded in individual case files, with easy access to the archive deemed important. There were mixed views about the representation of events and experiences and whether these should contain mainly ‘light-hearted’ events and experiences. Our research gives an insight into memory-keeping practices within a residential children’s home and invites questions about whose responsibility it is for gathering, filtering and treasuring childhood experiences.

AI in the Courtroom: Enhancing Legal Decision-Making through Predictive Modelling

Legal outcome prediction or legal judgement prediction is the process of making predictions of the possible outcome of a legal proceeding based on its case file. This work focuses on the importance of allowing less privileged or marginalised groups to have better access to law services. This work discusses the implementation of 13 different deep learning models and the results obtained for each of them. The range of models employed encompasses a spectrum from basic perceptron models to more complex convolutional network models and encoder-based models. The models like multi-layer perceptron (MLP), convolutional neural network (CNN) model, BERT, LegalBERT, DistilBERT, RoBERTa and the different combinations of these encoder-based models are implemented. The input to these models is the case files and their corresponding judgement status. Four different classes of petitions and appeals, submitted to the court, were considered to train all the models. The efficiency of these models was tested in terms of various performance metrics like training accuracy, testing accuracy, training loss, validation loss and [Formula: see text]1 score.

The use of investigation management documents in rape and serious sexual offence cases

Purpose In the context of rising reports of rape, set against falling convictions, it has been argued that rape has been de facto decriminalised in England and Wales. This paper aims to explore how police and prosecutors investigating rape and serious sexual offences (RASSO) use and perceive investigation management documents (IMDs), and how high-quality IMDs may lead to better justice outcomes. IMDs must be started by police at the beginning of an investigation and should document: what an officer is/is not doing and why; what the reasonable lines of enquiry are and their outcomes; and what has translated to evidence and supports charge, disclosure or unused material. The document is shared with the crown prosecution service at the point a charging decision is sought. Design/methodology/approach Semi-structured interviews were conducted with 32 police officers and five crown prosecutors across five areas in Year 2 of Operation Soteria Bluestone, a project that aimed to improve how police investigate rape. These interviews were analysed using the qualitative method of thematic analysis. Findings Three main themes were identified relating to timeliness, understanding, and quality of IMDs. It was found that IMDs are not always started at the beginning of RASSO investigations or even at all. Officers also lacked understanding around the purpose of IMDs, often seeing them as duplications of other case files. Finally, prosecutors and police concurred that the quality of IMDs are generally poor and lacking in critical reflection. Originality/value To the best of the author’s knowledge, this is the first academic paper to consider the use of IMDs by police and prosecutors in RASSO investigations. As such, it is both a unique contribution to the field and also provides a platform for future research. Understanding how police officers can produce the highest quality IMDs, in a timely fashion, is of paramount importance given the wider societal context of increasing reports of rape alongside low charge rates. Implications for training are considered.

Complicit masculinity of judges

The paper focuses on how unjust provocation reduction, regulated in Article 29 of the Turkish Penal Code, is applied in cases of violence against women, LGBTI, and transgender individuals in Turkey, also known as "masculinity sentence reduction" by feminist lawyers. In particular, I will look into case files in which the "masculinity defence" made by almost all perpetrators in femicide cases is accepted by the court as a justification for reducing the sentence of the perpetrator. I will examine how masculinity is portrayed in judicial decisions, specifically looking at provocation defences to demonstrate how jurisdiction plays a part in perpetuating masculine domination within society. Using theories of masculinity and masculine domination, I will try to reveal the contribution of judges to the "masculine legal culture" as a form of "complicit masculinity".

Pattern of kidney diseases admission and outcome in Bauchi, Northeast Nigeria: a 2 year review

Background Kidney diseases are a heterogeneous group of disorders which if left untreated could lead to chronic kidney disease (CKD) which inadvertently progress to end-stage kidney disease. Renal replacement therapy for end-stage kidney disease is unaffordable, not widely available and require huge financial resources. Knowledge of the prevailing type of kidney disease will help to develop measures of prevention of the disease. This study aims to evaluate the burden and pattern of kidney disease and to determine its outcome over a 2 year period. Patients and methods This is a retrospective study of kidney diseases admission and outcome at Abubakar Tafawa Balewa university teaching hospital over a 2 year period. All case files of patients admitted were retrieved and those with diagnosis of kidney disease were evaluated. Results One thousand and nineteen patients were admitted during the period, 98 of which had kidney disease diagnosis, with 10.4% disease burden. The mean age of the patients was 48.71 ± 12.2 years. CKD accounted for 51% of the total admission, followed by urinary tract infection, acute Kidney injury, Nephrotic syndrome, and Nephritic syndrome each accounting for 19.3, 15.4, 9.2, and 5.1%, respectively. Overall six (10.5%) patients died on admission. Conclusion The burden of kidney disease is high in our study and is mainly due to high prevalence of CKD that affects younger age group.

Prevalence of Haemoprotozoan Parasites of Dogs in Umuahia metropolis, Abia state: A Retrospective Study

This retrospective study investigated the prevalence of haemoprotozoan parasites of dogs in Umuahia, Southern Nigeria. The study population included sick dogs presented to the Abia State Veterinary Clinic, Umuahia from 2015 to 2022. A total of 560 case files of dogs were reviewed and data were presented using descriptive statistics and analysed using Chi square to determine association of various factors with prevalence of haemoprotozoan parasite. The overall prevalence of haemoprotozoan parasite in surveyed dogs was 118 (21.10%). The young dogs had a higher prevalence of 79 (22.40%) compared to the adult 39 (18.80%). The female dogs had a higher prevalence of 77 (25.50%) than male 41 (15.90%). The local breed had a higher prevalence of 28.80% than the exotic breeds 18.50%. There was a significant association (P &lt; 0.05) between haemoparasitism and sex, as well as breed of dogs surveyed. Babesia spp was the most common haemoprotozoan parasite, representing 63 (53.49%) while Anaplasma was the least abundant 3 (2.54%). Haemoprotozoan parasite spp was found to be more prevalent in young dogs than adult dogs. It was concluded that haemoparasites are prevalent among sick dogs presented at the Abia State veterinary clinic, Umuahia, and there is need to raise awareness on the prevention and control of haemoprotozoan parasite infections in dogs.

Trauma History in a Medium-Secure Adult Male Forensic Mental Health Setting

Forensic services have shifted their focus to the importance of forensic practice becoming more trauma informed. Trauma exposure is pervasive in forensic mental health populations and has been found to negatively impact the course of severe mental illness (SMI) and increase risk of violence. This study aimed to explore the trauma histories of adult male inpatients in a medium-secure psychiatric hospital, and examine childhood and adulthood trauma as predictors of diagnoses, self-harm, suicidality, hospital re-admissions, substance use, and nature of offense. The case files of 85 male patients in a medium secure unit in the UK were reviewed. Eighty-seven percent of patients had a schizophrenia diagnosis and 86% had extensive trauma histories, the most common trauma type being physical violence in childhood (44.7%). One patient had a PTSD diagnosis. Logistic regressions demonstrated that cumulative childhood and adulthood trauma significantly increased the odds of self-harm. Cumulative childhood trauma exposure was found to decrease the likelihood of having a schizophrenia diagnosis. There is a serious under-recognition of the extent and consequences of trauma exposure; trauma histories are likely greater than the findings of this study and existing literature suggests. Implications for clinical practice, trauma-informed care (TiC), and future research are proposed.

Pregnancy Outcome Among Grand Multiparous Women at Delta State University, Oghara, Nigeria

Abstract Background: Grand multiparity presents a significant challenge to the obstetrician, especially in developing countries, including Nigeria. Objective: To determine the incidence and complications associated with grand multiparity at the Delta State University Teaching Hospital (DELSUTH), Oghara, Delta State, Nigeria. Materials and Methods: A retrospective descriptive study of grand multiparous women in DELSUTH between July 1, 2014, and June 30, 2023. Data retrieved from the hospital records and case files were analyzed. Results: The results revealed that during the period under review, the incidence of grand multiparity was 7.8% (146 grand multiparous women in 1874 deliveries). The majority (79.1%, n = 106) were para 5 and 6 (mean age: 37 ± 4.2 years). They were mostly farmers (49.3%) and housewives (17.9%) with a primary level of education (41.8%). Fifty-one percent (51.5%) were booked. Anemia (30.6%) and hypertensive disorders (12.7%) were the most common complications in the antenatal period, whereas hypertensive disorders (14.2%) were the most common complications seen during labor. The majority (61.9%) of the women had vaginal delivery. There was one case of maternal mortality (0.7%). The majority of the babies were of normal birth weight (57.3%, n = 82). One hundred and thirty-one of the babies (91.6%) were live births, whereas 8.4% (n = 12) suffered perinatal death. Conclusion: This study concludes that grand multiparity contributes to maternal and perinatal morbidity and mortality in Oghara, Nigeria.

Retinal thickness and macular microvascular changes seen on optical coherence tomography angiography (OCTA) in patients with sickle cell retinopathy in a tertiary care eye hospital

PurposeTo report retinal thickness values and macular vascular flow characteristics identified by optical coherence tomography angiography (OCT-A) in patients with various sickle cell genotypes in a population from sub-Saharan Africa. DesignRetrospective, observational study. MethodsThis is a single-institution case series of adult patients with various sickle cell genotypes who presented to the Eye Foundation Hospital Lagos between January 2022 and December 2023. Case files of patients were reviewed, and macular OCT and OCT-A images analyzed quantitatively for macular thickness, areas of flow loss, size of foveal avascular area, parafoveal flow, as well as vascular density in both the superficial and deep vascular plexi. The findings were compared by sickle cell genotype and comparisons made with age matched normal patients. ResultsA total of 38 eyes of 19 patients’ records were reviewed, and 35 eyes met the inclusion criteria; 16 eyes of 9 age and gender matched controls were included. The mean central foveal thickness (CFT) was 242.4 μm ± 33.3 μm among patients’ eyes, while a mean CFT of 236.1 μm ± 10.1 μm was measured among controls (p = 0.312). A smaller mean FAZ area of 0.270 mm2 ± 0.116 mm2 was seen among the control eyes compared to a mean of 0.314 mm2 ± 0.206 mm2 among patients’ eyes (p = 0.439). The mean flow area was larger among control eyes with 0.849 mm2 ± 0.647 mm2 compared to a mean flow of 0.822 mm2 ± 0.471 mm2 among patients’ eyes (0.868). The mean superficial foveal vessel density was greater among control eyes (19.30 ± 4.58) compared to patient eyes (18.77 ± 7.78) (p = 0.765). The mean deep foveal vessel density was greater among controls (35.30 ± 8.36) than among patients (34.06 ± 9.30) (p = 0.650). The difference between eyes of SC (53.37 ± 5.13) patients and SS (47.94 ± 8.44) patients in the deep temporal perifoveal VD was statistically significant (p = 0.035). ConclusionThe retina in eyes with sickle retinopathy and that of controls tends to be thickest in the nasal quadrant, then the superior, then inferior, and then thinnest in the temporal quadrant. Macular vessel density in both the superficial and deep capillary plexi was thicker among controls compared to eyes with sickle cell retinopathy. Among patients’ eyes, the deep capillary vessel density in the temporal perifoveal quadrant was greater among SC patients compared to SS (p = 0.035).

A 10-year retrospective analysis of sudden unexpected death in the young investigated at Salt River Mortuary, Cape Town.

Sudden unexpected death in the young (SUDY) is defined as the rapid, unsuspected demise of an apparently healthy individual between the ages of one and 40 years. There is a gap in research pertaining to this population in a South African context. This retrospective study aimed to explore the burden, scope of post-mortem investigation, and risk factors of SUDY admissions to Salt River Mortuary (SRM) in Cape Town between 1 January 2010 and 31 December 2019. Medico-legal case files pertaining to SUDY cases from SRM were reviewed. SRM received a total of 34 601 admissions in the 10-year period; of which 1 997 (5.77%) were SUDY cases. Nearly two-thirds (62.59%) of the SUDY admissions were male. The leading cause of death was pneumonia (17.11%), and the most prevalent organ system implicated in cause of death was the pulmonary system (45.19%). At least 32.46% of SUDY cases were infectious-related, with varying degrees of confidence. A large proportion of cases had no history of acute or chronic illness (45.43%), and no family history of illness (56.66%). In total, 52 potential candidates were identified for a molecular autopsy, of which 47 have stored biological samples for future investigations. This study advocates for the routine performance of post-mortem ancillary microbiological and toxicological testing in cases of SUD, considering the large burden of infectious disease and substance abuse in South Africa. The retention of biological samples in undetermined or non-specific natural cases is also urged, to allow for cause of death determination on a molecular level.

A refugee history perspective

This article draws upon ongoing research in refugee history and specifically a close examination of confidential individual case files in the archives of the UNHCR to explore aspects of the cultural representation of refugees in different sites of population displacement in the modern world. Reflections by Roland Barthes and Abdulrazak Gurnah FBA provide the starting point to consider visual culture and cultural representation in efforts to assist refugees, such as the UN campaign for World Refugee Year in 1959–1960. No less significant have been the efforts by refugees themselves to make themselves heard in relation to the international refugee regime. The article ends with a plea for scholars and refugees to engage in the co-production of knowledge about population displacement and its consequences. (This article is published in the thematic collection `The arts and humanities: rethinking value for today—views from Fellows of the British Academy’, edited by Isobel Armstrong.)