Major Harm Research Articles

Duty of Candour legislation in post-colonoscopy colorectal cancer: a prospective cohort study.

This study investigated the application of Duty of Candour (DoC) legislation in the context of post-colonoscopy colorectal cancers (PCCRCs). DoC mandates transparent disclosure of notifiable safety incidents to patients in the English National Health Service, including incidences leading to severe or moderate harm. This study aimed to analyze the application of DoC in PCCRCs, improve understanding of the legislation, and identify challenges in DoC implementation. A national audit of PCCRCs was conducted between September 2021 and May 2022. PCCRCs were identified using linked administrative datasets, and root-cause analyses were performed using structured templates. "Avoidability" and harm were categorized into specific levels, and guidance was provided on improving consistency in judgments. 16% of 1724 PCCRCs resulted in major harm or death, of which 27% (75) were probably or definitely avoidable. Hospitals deemed DoC discharge necessary in only 53% of these cases. When including moderate harm, 11% of all PCCRCs would trigger DoC discharge, yet this was deemed necessary in only 45% of such cases. There is inconsistent application of DoC in PCCRC cases. Challenges include determining "avoidability" and harm, particularly when diagnosis is delayed. Clearer guidance and definitions of harm are needed to improve adherence to regulations.

Voluntary Neonatal Medication Incident Reporting-A Single Centre Retrospective Analysis.

Background: Medication errors in neonatal intensive care units (NICUs) are prevalent, with dosage and prescription errors being the most common. Aims: To identify the common medication errors reported over twelve years using a voluntary, nonanonymous incident reporting system (RiskMan clinical incident reporting information system) at an Australian tertiary NICU. Methods: This was a single-centre cohort study conducted at a tertiary NICU. All medication-related incidents (errors) reported prospectively through the RiskMan online voluntary reporting database from January 2010 to December 2021 were included. The medication incidents were grouped into administration, prescription, pharmacy-related, and others, which included the remaining uncommon incidents. Results: Over the study period, 583 medication errors were reported, including administration-related (41.3%), prescription-related (24.5%), pharmacy-related (10.1%), and other errors (24%). Most incidents were reported by nursing and midwifery staff (77%) and pharmacists (17.5%). Most outcomes were minor or insignificant (98%), with only a few resulting in major or significant harm. There was one extreme incident that may have contributed to the death of a neonate and nine moderate incidents. Conclusions: Our results demonstrate that medication errors are common and highlight the need to support improvement initiatives and implement existing evidence-based interventions in routine practice to minimise medication errors in the NICU.

Implementation of a Standardized Tool for Root Cause Analysis Selection.

This study sought to determine if a standardized root cause analysis (RCA2) selection algorithm, developed by the Veterans Affairs, would select high-risk events for RCA. Physician-entered incident reports for all surgical service admissions and perioperative visits were queried over 12 months in the DATIX Clinical Incident Management System. Independent reviewers assigned potential harm and event frequency scores using an institutional scoring system and then calculated and rounded average scores. These were classified using RCA2 terminology (catastrophic, major, moderate, minor for harm; frequent, occasional, uncommon, remote for frequency). The scores were then evaluated with the standardized Safety Assessment Code Matrix (SAC) algorithm from the National Patient Safety Foundation's RCA2 guidelines to determine Potential Harm Scores. The SAC combines severity and probability to determine the necessity of conducting an RCA. Catastrophic and major high-frequency events (matrix score = 3) were classified as "RCA recommended." The study then compared cases selected for RCAs using the updated RCA2 algorithm against cases selected using a current, institutional-specific RCA selection process. One hundred four cases were reviewed, comprising 20 catastrophic, 48 major harm, 26 moderate harm, and 10 minor harm events. After removing 9 high-variance cases, our institution's current selection process selected 18 cases for RCAs, including 6/20 catastrophic, 8/39 major harm, and 4/36 moderate/minor harm events. Only 17.3% of cases had an RCA completed, while the standardized RCA2 algorithm recommended investigation for 56.7% of patient safety events, based on SAC Matrix scoring. Current RCA selection processes rendered 4 RCAs on low potential harm or low-frequency events, while 45 potential high-frequency, high potential harm events did not complete RCAs. Standardizing the selection of patient safety incidents for RCA using the RCA2 algorithm improves case identification based on the event frequency and potential harm score. Thus, this algorithm has the potential to advance patient safety.

Reproductive life and differentiated thyroid carcinoma in women: reciprocal influences on their respective outcome.

To analyze the reciprocal influences between female reproductive life and DTC management. Data on pregnancy outcome in DTC patients indicate that after conceiving, these women may need an increased L-T4 dose to maintain suppressed serum TSH levels. Nevertheless, this does not determine major harm in terms of pregnancy outcome. Analogously, the most recent findings obtained with the propensity score matching approach have confirmed that pregnancy does not significantly affect DTC clinical course and eventually tumor prognosis. A recent metanalysis and a large case-control study excluded a significant effect of radioactive iodine treatment (RAIT) on several reproductive variables in DTC patients, providing reassuring evidence that the current recommendations on RAIT for women of childbearing age are sufficiently well tolerated and do not affect fertility nor pregnancy rate. Overall, the most recent studies have provided sufficiently reassuring evidence that the occurrence of pregnancy and DTC management are of no reciprocal harm for adverse outcome in affected women of childbearing age. Thus, female DTC patients should be managed according to the individual response to treatment before pregnancy. When DTC diagnosis is made after conception, delaying surgery does not represent a harm in most patients.

Psychological outcomes of dementia risk estimation in MCI patients: Results from the PreDADQoL project.

Understanding the impact of biomarker-based dementia risk estimation in people with mild cognitive impairment (MCI) and their care partners is critical for patient care. MCI patients and study partners were counseled on Alzheimer's disease (AD) biomarker and dementia risk was disclosed. Data on mood, quality of life (QoL), and satisfaction with life (SwL) were obtained 1 week and 3 months after disclosure. Seventy-five dyads were enrolled, and two-thirds of the patients opted for biomarker testing. None of the participants experienced clinically relevant depression or anxiety after disclosure. All dyads reported moderate to high QoL and SwL throughout the study. Patients reported more subthreshold depressive symptoms 1 week and lower QoL and SwL 3 months after disclosure. In patients, depression (odds ratio [OR]: 0.76) and anxiety (OR: 0.81) were significant predictors for the decision against biomarker testing. No major psychological harm is to be expected in MCI patients and care partners after dementia risk disclosure. This study is registered in the German clinical trials register (Deutsches Register Klinischer Studien, DRKS): http://www.drks.de/DRKS00011155, DRKS registration number: DRKS00011155, date of registration: 18.08.2017. Patients with mild cognitive impairment (MCI) and study partners were counseled on Alzheimer's disease (AD) biomarker-based dementia risk estimation. About two-thirds of patients opted for biomarker testing and received their dementia risk based on their AD biomarker status. Patients who decided in favor or against CSF biomarker testing differed in psychological features. We did not observe major psychological harm after the dementia risk disclosure. Coping strategies were associated with better subsequent mood and well-being in all participants.

Longitudinal study of the manifestations and mechanisms of technology-related prescribing errors in pediatrics.

To examine changes in technology-related errors (TREs), their manifestations and underlying mechanisms at 3 time points after the implementation of computerized provider order entry (CPOE) in an electronic health record; and evaluate the clinical decision support (CDS) available to mitigate the TREs at 5-years post-CPOE. Prescribing errors (n = 1315) of moderate, major, or serious potential harm identified through review of 35322 orders at 3 time points (immediately, 1-year, and 4-years post-CPOE) were assessed to identify TREs at a tertiary pediatric hospital. TREs were coded using the Technology-Related Error Mechanism classification. TRE rates, percentage of prescribing errors that were TREs, and mechanism rates were compared over time. Each TRE was tested in the CPOE 5-years post-implementation to assess the availability of CDS to mitigate the error. TREs accounted for 32.5% (n = 428) of prescribing errors; an adjusted rate of 1.49 TREs/100 orders (95% confidence interval [CI]: 1.06, 1.92). At 1-year post-CPOE, the rate of TREs was 40% lower than immediately post (incident rate ratio [IRR]: 0.60; 95% CI: 0.41, 0.89). However, at 4-years post, the TRE rate was not significantly different to baseline (IRR: 0.80; 95% CI: 0.59, 1.08). "New workflows required by the CPOE" was the most frequent TRE mechanism at all time points. CDS was available to mitigate 32.7% of TREs. In a pediatric setting, TREs persisted 4-years post-CPOE with no difference in the rate compared to immediately post-CPOE. Greater attention is required to address TREs to enhance the safety benefits of systems.

Neuropathology of deaths due to acute alcohol toxicity in Australia, 2011–2022

BackgroundA major alcohol-related harm is structural pathology affecting the brain. The study aimed to: 1. Determine the frequency and nature of neuropathology amongst cases of death due to acute alcohol toxicity; 2. Compare diagnoses of brain atrophy with pathology in other organs; 3. Determine the demographic, clinical and organ pathology correlates of brain atrophy. Methods:Retrospective study of 500 cases of death attributed to acute alcohol toxicity in Australia, 2011–2022. Data on clinical characteristics, toxicology, neuropathology and other organ pathology were retrieved from police reports, autopsies, toxicology and coronial findings. ResultsMean age was 49.5 years, 69.4 % were male, with alcohol use problems documented in 70.2 %. Brain atrophy was diagnosed in 60 cases (12.0 %), most commonly in the cerebellum (32 cases, 6.4 %). Atrophy at other sites was present in 37 (7.4 %). The presence of brain atrophy was lower than other major pathologies: cardiomegaly (32.6 %, p<.001), nephro/arteriosclerosis (30.2 %, p<.001), and chronic obstructive pulmonary disease (21.8 %, p<.001) but not hepatic cirrhosis (11.9 % p=1.0). Those diagnosed with atrophy were older (53.4v 49.0 years, p<.001), more likely to have documented alcohol problems (85.0v 68.2 %, Odds ratio: OR 2.53) and seizure history (10.0v 3.0 %, OR 2.92), to have cardiomegaly (43.3v 31.0 %, OR 1.90, COPD (48.3v 18.2 %, 3.57) and nephro/arteriosclerosis (50.0 v 27.4 %, OR 2.27). Conclusions:Despite the majority of cases having a history of alcohol problems, the level of neuropathology amongst cases of death due to acute alcohol toxicity was comparatively low.

Elicitation of security threats and vulnerabilities in Insurance chatbots using STRIDE

Although chatbots are used a lot for customer relationship management (CRM), there needs to be more data security and privacy control strategies in chatbots, which has become a security concern for financial services institutions. Chatbots gain access to large amounts of vital company information and clients’ personal information, which makes them a target of security attacks. The loss of data stored in chatbots can cause major harm to companies and customers. In this study, STRIDE (viz. Spoofing, Tampering, Repudiation, Information disclosure, Denial of service, Elevation of privilege) modelling was applied to identify the data security vulnerabilities and threats that pertain to chatbots used in the insurance industry. To do this, we conducted a case study of a South African insurance organisation. The adopted methodology involved data collection from stakeholders in the insurance organisation to identify chatbot use cases and understand chatbot operations. After that, we conducted a STRIDE-based analysis of the chatbot use cases to elicit security threats and vulnerabilities in the insurance chatbots in the organisation. The results reveal that security vulnerabilities associated with Spoofing, Denial of Service, and Elevation of privilege are more relevant to insurance chatbots. The most security threats stem from Tampering, Elevation of privilege, and Spoofing. The study extends the discussion on chatbot security. It fosters an understanding of security threats and vulnerabilities that pertain to insurance chatbots, which is beneficial for security researchers and practitioners working on the security of chatbots and the insurance industry.

Modelling of Gas Leakage Detector with Safety System

Abstract: Leaking of gas is the major problem with industrial sector, domestic areas and vehicles run by LPG gas. Many accidents occur in day-to-day life like explosion because of gas leakage. If gas leakage is not detected earlier then major harm is caused. Due to leakage of LPG gas, it produces hazardous and toxic impact for living things.[1] LPG and natural gas is highly combustible and can burn even at some distance from the source of outflow. The main aim of this project is to present the detection of leakage, alert the danger to people and on the exhaust fan to throw out the gas to prevent from explosion. The gas will be detected by using MQ5 gas sensor. It will immediately turn on the buzzer and exhaust fan and also off the all of the lights, fans of the house for safety, when the sensor detect any gas leakage. This system is controlled by Arduino platform

USPSTF Recommendations and Overdiagnosis.

Overdiagnosis is the concept that some cancers detected at screening would never have become clinically apparent during a woman's lifetime in the absence of screening. This could occur if a woman dies of a cause other than breast cancer in the interval between mammographic detection and clinical detection (obligate overdiagnosis) or if a mammographically detected breast cancer fails to progress to clinical presentation. Overdiagnosis cannot be measured directly. Indirect methods of estimating overdiagnosis include use of data from randomized controlled trials (RCTs) designed to evaluate breast cancer mortality, population-based screening studies, or modeling. In each case, estimates of overdiagnosis must consider lead time, breast cancer incidence trends in the absence of screening, and accurate and predictable rates of tumor progression. Failure to do so has led to widely varying estimates of overdiagnosis. The U.S. Preventive Services Task Force (USPSTF) considers overdiagnosis a major harm of mammography screening. Their 2024 report estimated overdiagnosis using summary evaluations of 3 RCTs that did not provide screening to their control groups at the end of the screening period, along with Cancer Intervention and Surveillance Network modeling. However, there are major flaws in their evidence sources and modeling estimates, limiting the USPSTF assessment. The most plausible estimates remain those based on observational studies that suggest overdiagnosis in breast cancer screening is 10% or less and can be attributed primarily to obligate overdiagnosis and nonprogressive ductal carcinoma in situ.

Measuring financial divide in the rural environment. The potential role of the digital transformation of finance

Financial inclusion, which means the promotion of an affordable, timely and adequate access to a wide range of regulated financial products and services, as well as its use by all the segments of the society, is a high potential tool that may contribute to the development of the rural environment, while its absence could in turn cause a major harm. The availability of a sufficient level of financial literacy, which can be defined as the ability to understand financial concepts and risks, as well as the motivation and trust to use it when making financial decisions, is frequently deemed to be a need to reach financial inclusion by the academic literature. Financial literacy is, in turn, influenced by different variables, such as the degree of rural or urban predominance, the level of education and the available income in the household. This paper analyses the impact of such factors on financial literacy. The degree of financial literacy tends to be lower in rural environments, with limited incomes and poorer educational backgrounds, which creates a vicious circle that potentially worsens the situation of what has been called the empty Spain. Considering the importance of financial literacy to reach financial inclusion, we remark the potential of digital transformation as a valuable tool to break this negative trend in the less populated Spanish regions, and so, a cornerstone for the regenerative development of the Spanish rural areas.

Assessing current handover practices in surgery: A survey of non-consultant hospital doctors in Ireland

BackgroundHandovers of care are potentially hazardous moments in the patient journey and can lead to harm if conducted poorly. Through a national survey of surgical doctors in Ireland, this paper assesses contemporary surgical handover practices and evaluates barriers and facilitators of effective handover. MethodsAfter ethical approval and pre-testing with a representative sample, a cross-sectional, online survey was distributed to non-consultant hospital doctors (NCHDs) working in the Republic of Ireland. A mixed-methods approach was used, combining data using triangulation design. Main findingsA total of 201 responses were received (18.5%). Most participants were senior house officers or senior registrars (49.7% and 37.3%). Most people (85.1%) reported that information received during handover was missing or incorrect at least some of the time. One-third of respondents reported that a near-miss had occurred as a result of handover within the past three months, and handover-related errors resulted in minor (16.9%), moderate (4.9%), or major (1.5%) harm. Only 11.4% had received any formal training. Reported barriers to handover included negative attitudes, a lack of institutional support, and competing clinical activities. Facilitators included process standardisation, improved access to resources, and staff engagement. ConclusionsSurgical NCHDs working in Irish hospitals reported poor compliance with international best practice for handover and identified potential harms. Process standardisation, appropriate staff training, and the provision of necessary handover-related resources is required at a national level to address this significant patient safety concern.

Effective factors for improving quality of life and sexual issues in the spouses of addicted men: a case-control study

ABSTRACT Background: Addiction is a serious personal and social problem that has caused major harm in recent years. It not only affects the life of the addicted individuals, but also exposes those around him and his relatives to damage. Methods: The aim of this study was to investigate effective factors for improving quality of life and sexual issues in the spouses of addicted men. This research is a descriptive, post-event, or causal-comparative study. The statistical population included spouses of addicted men who were referred to addiction therapy centers in northern Iran and spouses of non-addicted men, from which 120 individuals were selected for sampling. Results: The results showed that the fear of sex in women is greater than in men. According to the findings of this study, there is a significant difference between sexual issues and quality of life, and the components of sexual issues and quality of life, in the spouses of addicted men and non-addicted men. Conclusions: We suggest that, since sexual issues are one of the problems of addicts and their spouses, as well as the problems of society as a whole, this issue should be considered in addiction therapy clinics.

Uncovering the Risks of Anticancer Therapy Through Incident Report Analysis Using a Newly Developed Medical Oncology Incident Taxonomy.

Incident reporting systems were developed to identify possible and actual harm in healthcare facilities. They have the potential to capture important safety trends and to enable improvements that can mitigate the risk of future patient harm and suffering. We recently developed and validated a taxonomy specific for medical oncology designed to enhance the identification, tracking, and trending of incidents that may lead to patient harm. The current project was designed to test the ability of such a taxonomy to be applied across different organizations delivering medical oncology care and to identify specific risks that could result in future harm. We analyzed 309 randomly selected medical oncology-related incident reports from 3 different cancer centers that had been posted between January 2019 and December 2020. Each report was assigned up to 2 incident categories. We used a 2-step process to reconcile reviewer discrepancies. In a secondary analysis, each of the incidents was reviewed and recoded to identify events which may result in major or catastrophic harm. Three hundred four incidents met criteria for inclusion. Three hundred incidents (98.7%) were successfully coded. Sixty-seven percent of incidents were encompassed by the following 4 of 21 categories: prescriber ordering (22%), nursing care (15%), pharmacy (14%), and relational/communication issues (15%). Of 297 evaluable incidents, 47% did not reach the patient, 44.7% reached the patient without harm, 7.7% caused minor injury, and 0.7% caused severe injury or death. Submission rates by physicians varied between the 3 sites accounting for 1.7%, 10.7%, and 16.1% of reports. Secondary analysis identified 9 distinct scenarios that may result in major or catastrophic patient harm. A medical oncology-specific incident reporting taxonomy has the potential to increase our understanding of inherent risks and may lead to process improvements that improve patient safety.

Development of Image Based Model for Basic Standing Yoga Poses that Control Type-2 Diabetes

Yoga is one of the ancient practices originated in India that helps in balancing mind and body of human. For the past few decades it has got wide spread throughout the world. Many are practicing it in the presence of yoga tutor or following some online modes. But improper practice may cause major harm to muscles and ligaments of the human body. There are different asanas proposed in the Patanjali Yoga Sutra that can cure different diseases. This paper, proposes a mathematical model for a set of yoga asanas that can help cure Type -2 Diabetes. A noninvasive analysis has been implemented using Kinect Sensor and LabVIEW software to analyze the performance of the practitioner. The joints are subjected to the flexibility of the practitioner without any overstress.

Pharmacists' role in supporting the return of over 10,000 preemptive pharmacogenomics results: The Mayo Clinic experience.

To develop a pharmacist-driven, exploratory pharmacogenomics implementation model with the goal of creating a process for pharmacists to interpret pharmacogenomics results from RIGHT 10K Study samples and provide electronic consults to providers. A train-the-trainer model program was initiated whereby pharmacogenomics pharmacists developed a documentation template and a quick reference guide as a standard guide to train other pharmacists. Pharmacists completed electronic consults (e-consults) reviewing pharmacogenomics results, with reference to drug-gene interactions, for patients with "semi-urgent" and "clinically actionable" results, defined as those indicating a potential for gene-drug interactions to cause major harm and those indicating a potential for an adverse drug reaction or reduced efficacy, respectively. Outcomes measured included the number of consults over time, number and role of pharmacists involved, average time to complete e-consults over time, and gene-drug pairs for semi-urgent consults per month. A total of 395 pharmacists were trained. The total number of e-consults completed was 2,843: 61 semi-urgent and 2,782 clinically actionable consults. The average time spent per consult was 24 minutes, and the average number of e-consults per pharmacist was 7. CYP2C19-clopidogrel was the most common gene-drug pair targeted in semi-urgent consults. Pharmacy leaders planning to implement similar pharmacogenomics programs can utilize this data to estimate hiring needs for future pharmacogenomics implementation, while also considering the potential additional cost of developing resources.

Patch-Transformer Network: A Wearable-Sensor-Based Fall Detection Method.

Falls can easily cause major harm to the health of the elderly, and timely detection can avoid further injuries. To detect the occurrence of falls in time, we propose a new method called Patch-Transformer Network (PTN) wearable-sensor-based fall detection algorithm. The neural network includes a convolution layer, a Transformer encoding layer, and a linear classification layer. The convolution layer is used to extract local features and project them into feature matrices. After adding positional coding information, the global features of falls are learned through the multi-head self-attention mechanism in the Transformer encoding layer. Global average pooling (GAP) is used to strengthen the correlation between features and categories. The final classification results are provided by the linear layer. The accuracy of the model obtained on the public available datasets SisFall and UnMib SHAR is 99.86% and 99.14%, respectively. The network model has fewer parameters and lower complexity, with detection times of 0.004 s and 0.001 s on the two datasets. Therefore, our proposed method can timely and accurately detect the occurrence of falls, which is important for protecting the lives of the elderly.

Assessment of natural enemies of honeybee (Apis mellifera jemenitica) in the Asir region, Southwestern, Saudi Arabia

The occurrence and status of natural enemies of honey bee Apis mellifera (Hymenoptera: Apidae) in the southwestern region of Saudi Arabia was conducted during 2019 and 2020. The existence of natural enemies, particularly pests and predators, is one of the most significant problem for beekeepers in the Asir region. A total of 78 apiaries were selected from two different geographical locations (Sarat and Tihama) in the Asir region. Honey bee colonies were attacked by 17 pests and predators species in the Tihama region, compared to 15 in Sarwat mountain region of southwestern Saudi Arabia. In order of significance, wasp (Philanthus triangulum), bee-eating bird (Merops apiaster), Varroa-mite (Varroa destructor), wax moth (Achroia grisella), and spider (Misumena sp.) are the most prevalent pests that inflict major harm to apiaries in southwestern Saudi Arabia. There were also some other pests and predators that had insignificant effect on bees. Generally, the recorded natural enemy’s incidences usually occurred in the months of September-October and December to February.

Risk prediction of Alzheimer’s dementia in mild cognitive impairment – Impact of AD biomarker disclosure on quality of life, mental health and risk knowledge: The PreDADQoL study

AbstractBackgroundExpanded technologies in early AD detection have led to an increasing number of individuals with mild cognitive impairment (MCI) asking for biomarker‐based risk prediction of Alzheimer’s dementia. However, standardized approaches for counseling and disclosure of individuals with MCI are lacking in clinical practice. First studies on cognitively healthy individuals and MCI patients have reported no major impact on psychological wellbeing after AD biomarker disclosure, but data on quality of life, health behavior changes and risk knowledge of individuals with MCI before and after AD biomarker disclosure is sparse.MethodThe transnational (Germany and Spain) project PreDADQoL recruited a total of 76 MCI patients and caregivers. Dyads received a standardized counseling on predictive biomarker‐based diagnosis of AD. MCI patients consenting to cerebrospinal fluid (CSF)‐biomarker testing received a standardized disclosure of their biomarker status and consecutive dementia risk. Following a mixed‐methods approach the empirical part of the project conducted follow‐up visits over 3 months to assess the effects of predictive AD diagnosis on various outcomes.ResultCounseling on biomarker‐based AD detection and disclosure of dementia risk has no major impact on mental health and quality of life on MCI patients and their caregivers on short term follow‐up. Although the counseling included recommendations on lifestyle modification, individuals with MCI and caregivers reported a significantly less beneficial lifestyle 3 months after risk disclosure as compared to baseline. Despite adequate numeracy skills, the dementia risk perception in individuals with MCI did not correlate with the communicated risk, whereas caregivers’ risk perception correlated significantly with the communicated risk.ConclusionOur findings confirm that predictive AD diagnosis causes no major harm with regard to mental health and quality of life. However, despite the psychoeducational approach during the counseling and disclosure sessions with facilitating supplies, such as visual aids and take‐home material, the anticipated fostering effects on health behavior and risk knowledge remain modest. Our study contributes to the extended understanding of individuals with MCI and their caregivers when facing early AD detection. The PreDADQoL study will synergize empirical data with ethical and legal considerations for a guidance of good clinical practice in the field of predictive AD diagnosis.

Crime severity, relational distance, and bystander reporting

ObjectivesThis study examined the effects of crime severity and relational distance on bystanders' willingness to report crime and provide a statement to police. MethodsA sample of 1438 adults in the U.S. completed a factorial vignette survey. Participants read three crime scenarios and indicated their willingness to report and provide a statement to police. Crime severity (major harm or minor harm), bystander relationship to the perpetrator (family member, friend, or stranger), and bystander relationship to the victim (family member, friend, or stranger) were manipulated across scenarios. Multilevel models were estimated. ResultsCrime severity increased the willingness to report, whereas a close relationship with the perpetrator decreased it. However, a close relationship with the victim attenuated the effect of relational distance to the perpetrator on the willingness to report. Crime severity and relational distance did not influence the willingness to provide a statement, with one exception. ConclusionsCrime severity and relational distance influence bystanders' willingness to report, but do not appear to influence the willingness to provide a statement. The willingness to report and provide a statement are related, but may be distinct dimensions of the willingness to cooperate.