Bolivian health and social care professionals' experiences of decision-making in oncology and palliative care

In the UK, end-of-life care strategies recommend patients and families are involved in decision making around treatment and care. In Bolivia, such strategies do not exist, and access to oncology services depends on finance, geography, education and culture. Compared to more developed countries, the delivery of oncology services in Latin America may result in a higher percentage of patients presenting with advanced incurable disease. The objective of this study was to explore decision-making experiences of health and social care professionals who cared for oncology and palliative care patients attending the Instituto Oncológico Nacional, Cochabamba (Bolivia). Patients were predominantly from the Quechua tradition, which has its own ethnic diversity, linguistic distinctions and economic systems. Qualitative data were collected during focus groups. Data analysis was conducted using Interpretative Phenomenological Analysis. Three interrelated themes emerged: (i) making sense of structures of experience and relationality; (ii) frustration with the system; and (iii) the challenges of promoting shared decision making. The study uncovered participants' lived experiences, emotions and perceptions of providing care for Quechua patients. There was evidence of structural inequalities, the marginalisation of Quechua patients and areas of concern that social workers might well be equipped to respond to, such as accessing finances for treatment/care, education and alleviating psychological or spiritual suffering.

How useful are databases in environmental and criminal forensics?

Advances in computational and information technologies have facilitated the acquisition of geospatial information for regional and national soil and geology databases. These have been completed for a range of purposes from geological and soil baseline mapping to economic prospecting and land resource assessment, but have become increasingly used for forensic purposes. On the question of provenance of a questioned sample, the geologist or soil scientist will draw invariably on prior expert knowledge and available digital map and database sources in a ‘pseudo Bayesian’ approach. The context of this paper is the debate on whether existing (digital) geology and soil databases are indeed useful and suitable for forensic inferences. Published and new case studies are used to explore issues of completeness, consistency, compatibility and applicability in relation to the use of digital geology and soil databases in environmental and criminal forensics. One key theme that emerges is that, despite an acknowledgement that databases can be neither exhaustive nor precise enough to portray spatial variability at the scene of crime scale, coupled with expert knowledge, they play an invaluable role in providing background or
reference material in a criminal investigation. Moreover databases can offer an independent control set of samples.

A specific pathway can be identified between genetic characteristics and behaviour profiles in Prader-Willi syndrome via cognitive, environmental and physiological mechanisms

Behavioural phenotypes associated with genetic syndromes have been extensively investigated in order to generate rich descriptions of phenomenology, determine the degree of specificity of behaviours for a particular syndrome, and examine potential interactions between genetic predispositions for behaviour and environmental influences. However, relationships between different aspects of behavioural phenotypes have been less frequently researched and although recent interest in potential cognitive phenotypes or endophenotypes has increased, these are frequently studied independently of the behavioural phenotypes.

Taking Prader-Willi syndrome (PWS) as an example, we discuss evidence suggesting specific relationships between apparently distinct aspects of the PWS behavioural phenotype and relate these to specific endophenotypic characteristics.

The framework we describe progresses through biological, cognitive, physiological and behavioural levels to develop a pathway from genetic characteristics to behaviour with scope for interaction with the environment at any stage.

We propose this multilevel approach as useful in setting out hypotheses in order to structure research that can more rapidly advance theory.