Abstract
Supporting families and friends of homicide victims (‘survivors’) requires understanding how homicide impacts on survivors. Although recent work has examined how the loss of a loved one and events following a homicide—such as media coverage, the criminal justice processes and the perpetrator’s sentence—affects survivors, there has been little consideration of how final ‘case conclusions’ (other than the perpetrator’s sentence)—such as homicide–suicide, cold-case homicide or perpetrator declared permanently unfit for trial or acquitted of murder or manslaughter—impacts on survivors. This article examines existing literature about how different final case conclusions, other than the perpetrator’s sentence, impact on survivors. A novel conceptual framework—the ‘Homicide Case Pathway’—is presented to organize these efforts. There are shared and diverse effects of final case conclusions on survivors, centred on five key themes—emotions and feelings, denial of justice, lack of closure, belief in the system and hope. There is a clear need to conduct further research into the effect of final case conclusions on survivors, in order to better understand survivors’ experiences, and subsequently identify and implement suitably tailored victim support strategies for survivors.
Although homicide—the killing of one person by another—is a comparatively rare form of interpersonal violence, it is nevertheless estimated to account for approximately half a million deaths annually worldwide, or approximately 6.2 deaths per 100,000 population. 6 While all forms of interpersonal violence represent cause for public policy concern, homicide merits particular attention, given its extreme and irreversible nature.
To date, homicide research has tended to focus intensively on homicide victims and/or perpetrators; however, there is a growing body of research on the impact of homicide on ‘survivors’ (also known as proxy victims)—primarily the family and friends of victims. From this research, it is clearly evident (and unsurprising) that sudden traumatic bereavement due to homicide has devastating, long-lasting and far-reaching effects on survivors. 7 A recent systematic review 8 not only highlights these effects but also shows that events following a victim’s death—such as media coverage, criminal justice processes and the perpetrator’s sentence—can adversely impact on survivors. That systematic review, however, did not examine how final case conclusions (other than the perpetrator’s sentence)—such as cold-case homicide, homicide–suicide and perpetrator either declared permanently unfit for trial or acquitted of murder or manslaughter—impact on survivors.
Using a novel conceptual framework to structure its efforts, this article reviews existing literature and considers how different final case conclusions (other than the perpetrator’s sentence) impact on survivors. Examining this question will enable us to gain a more comprehensive understanding of the impact of homicide on survivors, in order to identify and implement suitably tailored victim support strategies.
The Effect of Homicide on Survivors
Research on the impact of homicide on survivors can be classified into two broad categories. The first category of research examines how the loss of a loved one affects survivors’ thoughts, feelings and behaviours, and how they cope with this loss. Research consistently shows that families bereaved by homicide experience psychological effects (such as anxiety, depression and post-traumatic stress disorder [PTSD]) and emotional effects (such as rage, guilt and blame) following the death of a loved one. 9 In fact, it has been estimated that more than one in five immediate family members of homicide victims develops homicide-related PTSD. 10 In addition, familial survivors also experience physical problems (such as sleeping problems and loss of appetite), employment problems (such as an inability to work), social problems (such as avoidance behaviour and deterioration of relationships) and financial problems (such as difficulties paying for funeral, mortgage and court proceedings). 11 It has also been observed that other non-familial survivors, such as close friends of homicide victims, can experience similar impacts. 12
Given the diversity of these experiences, it is not surprising that survivors adopt different strategies to cope with the loss of a loved one. While some survivors access support from others (such as family, friends or formal support agencies) or through religion, other survivors engage in personal problem-solving (such as trying to forgive the perpetrator) or advocacy initiatives. 13 A minority of survivors also engage in potentially maladaptive coping strategies, such as using drugs or alcohol or creating distance between themselves and the memory of the homicide. 14 The extent to which survivors adopt these strategies may affect how well survivors cope with the loss of a loved one.
The second category of research examines how an event following a homicide —such as media coverage, the criminal justice processes and the perpetrator’s sentence (‘case conclusion’)—impacts on survivors. A recent systematic review by Connolly and Gordon 15 extensively investigated these questions and showed that survivors are often subject to media coverage about the crime, either the graphic portrayal of the homicide or negative commentary about the victim’s role in his/her death, and this has an adverse effect on their ability to grieve. The review also reveals that survivors often experience inadequate communication by the police about the status of their loved one’s case, insensitive treatment by criminal justice personnel (e.g., a lack of compassion), delays in the processing of their loved one’s case and unfairness in the court proceedings (e.g., a perceived focus on the perpetrator’s, rather than the victim’s, rights and the use of plea bargaining to reduce the perpetrator’s charge).
Additionally, more recent research shows that survivors experience inadequate communication by prosecutors (e.g., not being informed about postponed court proceedings), a lack of involvement in decision-making regarding the charge and sentence of the perpetrator, feelings of frustration and disappointment by the limitations placed on their participation in the process of providing victim impact statements in the sentencing hearing, and a feeling that the victim (and survivor) did not have a voice in the prosecution of the perpetrator. 16 While this research on survivors’ involvement in criminal justice processes has largely illuminated survivors’ negative experiences, some research on survivors providing victim impact statements in the sentencing hearing of the perpetrator shows some (albeit limited) positive experiences—some survivors report feeling happy that they participated in the sentencing hearing. 17
Finally, Connolly and Gordon’s 18 systematic review also shows how perpetrator sentences impact on survivors—they generally feel dissatisfied with the perceived leniency of the sentences that are handed down to perpetrators. This observation continues to find support in ongoing research. 19 In fact, survivors appear to believe that perpetrators’ sentences are not representative of the harm experienced by the family, and thus such sentences devalue their loved one’s life. 20
This investigation into the impact of perpetrators’ sentences on survivors is an important one, as it captures survivors’ experiences of the finalization of a homicide case. However, such an investigation is limited because it only captures these experiences for survivors in homicide cases where the perpetrators have been processed through the judicial system ‘and’ convicted of the crime. As such, it does not consider survivors’ experiences of the finalization of a case in homicide cases that are not processed through the judicial system (such as cold-case homicide or homicide–suicide), or homicide cases that are processed through the judicial system, but do not result in a conviction (such as perpetrator either declared permanently unfit for trial or acquitted of murder or manslaughter). In order to more comprehensively understand the impact of homicide on survivors, it is necessary to investigate how final case conclusions (other than the perpetrator’s sentence) impact on survivors. To do so, we need to first develop an overarching conceptual framework that links different case conclusions to each stage of the criminal justice process that a homicide case can progress through.
The Homicide Case Pathway
As illustrated by the Homicide Case Pathway (see Figure 1), there are clear stages that a homicide case must progress through, after the homicide (Stage 1), in order to resolve the case and punish the perpetrator: the police investigation (Stage 2), court proceeding (Stage 3) and sentencing hearing (Stage 4). The second and third stages form part of the process of ‘resolving’ the case—identifying and charging the perpetrator in the police investigation and, through prosecution in a court proceeding, confirming the perpetrator and determining whether or not the perpetrator should be convicted for the homicide. The final stage—determining the type of sentence (e.g., death or prison) and the duration of a prison sentence in a sentencing hearing—forms part of the process of ‘punishing’ the convicted perpetrator.

As can be seen in Figure 1, homicide cases can conclude (referred to henceforth as the ‘case conclusion’) after different stages in the Homicide Case Pathway. Case conclusions may be intermediary—that is, the homicide case will proceed further in the process of either resolving the case or punishing the perpetrator—or final—that is, the homicide case will not proceed further. Although some homicide cases will reach the final case conclusion in the process of punishing the perpetrator, this is not true of all homicide cases. Some homicide cases reach their final conclusion before proceeding to the process of punishing the perpetrator—that is, after the police investigation (e.g., homicide–suicide or cold-case homicide)—or after the court proceeding (e.g., perpetrator identified by police is acquitted of murder or manslaughter, or declared permanently unfit for trial). For example, at Stage 2 (the police investigation), the identification of a perpetrator may lead to the perpetrator being processed in a court proceeding (in which case, Stage 2 produces an intermediary case conclusion, in the form of a solved homicide) or it may result in no further actions, such as when a perpetrator committed suicide after the homicide (in which case, Stage 2 produces a final case conclusion of homicide–suicide). Regardless of whether or not the case proceeds to the process of ‘punishing’ the perpetrator, all homicide cases will have a final case conclusion in the process of ‘resolving’ the case.
The Present Study
Using the homicide case pathway as a conceptual framework, which takes into account the sequential progress of a homicide case and distinguishes between the processes of resolving the case and punishing the perpetrator, this article organizes and examines current empirical knowledge about how different final case conclusions in the process of resolving a homicide case impact on survivors. Confining our review to the process of resolving the case allows us to examine the final case conclusions for all homicide cases, in a way that extends on the knowledge gained from Connolly and Gordon’s 21 systematic review.
Given each final case conclusion in the process of resolving a homicide case differs in whether or not a perpetrator is identified and charged in the police investigation, and whether or not the perpetrator is confirmed and/or convicted through prosecution in a court proceeding, it is reasonable to expect that different final case conclusions in the process of resolving the case may affect survivors in diverse ways. Where possible, we will present data about the impacts of those case conclusions.
Method
Article Identification
Articles were identified by searching empirical journal articles published in English. No publication date restrictions were imposed. Studies were included on the basis of three characteristics. First, the participants in the study were homicide survivors (such as family and/or close friends of the deceased). Second, the study specified the final case conclusion, in relation to the Homicide Case Pathway (e.g., homicide–suicide, cold-case homicide or perpetrator declared permanently unfit for trial, acquitted of murder or manslaughter, convicted for manslaughter, or convicted for murder). Finally, the study specified how the final case conclusion affected the survivors.
Information Sources and Search
Studies were identified through a search of two electronic databases: Web of Science and PsycInfo. The search was completed on 16 March 2018. Search terms relating to the death of a victim (homicid*/murder/manslaughter/femicide/violent death) were combined with search terms relating to both the final case conclusion (court/verdict/guilty/acquit*/‘not criminally responsible’/unsolved/sentence*/outcome/suspect*/accuse*/charge*/‘mental illness’/‘mentally ill’/‘mental disorder’/‘mentally disordered’/ ‘psychiatric disorder’) and the homicide survivor (family/friend/relative/survivor/‘proxy victim’/partner/girlfriend/boyfriend/kin/spouse/child) (* denotes a placeholder for an unknown or wildcard term. For instance, a search for ‘homicid*’ would return search results for the terms ‘homicide,’ ‘homicides,’ and ‘homicidal’). Searches in Web of Science were conducted according to topic. Searches in PsychInfo were conducted according to keywords, title and abstract. No specific search restrictions around publication status were used in these searches.
Study Selection
References were obtained from the database searches and duplicate references were removed. The abstracts of references were screened for potential eligibility. Two authors then independently assessed the full text of the articles identified as potentially eligible to confirm each study’s eligibility. Both the authors agreed on the eligibility of each study.
Data Collection Process and Data Items
The following data was extracted from each eligible study: (a) participant characteristics (number of survivors and number of independent victims; survivors’ location, sex, race, relationship to victim, and average number and range of years since the homicide; (b) design (qualitative or quantitative, and cross-sectional or longitudinal); (c) method (interview or survey); (d) final case conclusion (e.g., homicide–suicide, cold-case homicide or perpetrator declared permanently unfit for trial, acquitted of murder or manslaughter, convicted for manslaughter, or convicted for murder); and (e) effects of final case conclusion on survivors. There were no a priori categories identified for the effects that survivors may experience. One author extracted the data and a second author checked the extracted data. The second author agreed with the data extracted by the first author. Both authors assessed the risk of bias within each eligible study, in relation to the data analysis procedures used; specifically, whether or not multiple coders were used to analyse the results.
Results
Study Selection
The database searches identified 2,088 references: 1,248 from Web of Science and 840 from PsycInfo. There were 1,848 references after duplicate references were removed. The abstracts for each of these references were screened for potential eligibility. Of these, 205 references (classified as books, book chapters or theses) were excluded for not being published empirical journal articles. A further 1,630 references were excluded for not relating to either the death of a victim, the final case conclusion or the homicide survivor. The remaining 13 articles were deemed potentially eligible. Two reviewers independently assessed the full text of these 13 articles and excluded 7 articles for not specifying the final case conclusion and 3 articles for not specifying how the final case conclusion affected survivors. Three articles, based on two independent studies using a qualitative methodology, were identified.
Study Characteristics
Table 1 provides a summary of the included articles, including information about the study participants, design, methods and results. The results for two articles by Wellman 22 were based solely on the authors’ interpretation of their results—there was no supporting evidence (e.g., quotes) accompanying the authors’ interpretation of their results. This is in contrast to Thiel, 23 where the authors’ interpretation of their results were provided in conjunction with supporting evidence (e.g., quotes). All included studies only used one coder to analyse the results.
* Results were based on the sample of homicide survivors.
^ These two articles (based on the same study) reported the survivor’s relationship to the victims, but only for the selected quotes provided. Based on the quotes outlined in both articles, the authors of this review were able to identify the survivor’s relationship to the victims for only 21 (out of 24) survivors. All the survivors were immediate family members of the victim (spouses, children, siblings, parents, grandparents or grandchildren).
# The study did not report the average number of years (range of years) since homicide. The authors of this review calculated this information based on the year the homicide occurred (reported in the study), and an assumption that the interviews were conducted in 2012 (the year research funding was obtained, according to the article.
Synthesis of Results
The results of each included study are discussed below, in the context of the broader themes identified. When considering the results of the studies, it is important to note that the articles of Wellman 27 were based on the same study and, therefore, the same sample of homicide survivors. In addition, each study only investigated one final case conclusion—either cold-case homicide, or acquittal of murder or manslaughter—and did not compare the effects of different final case conclusions on survivors.
The very limited research conducted to date gives rise to five broad themes about the effect of final case conclusions—cold-case homicide and acquitted of murder or manslaughter—on homicide survivors; emotions and feelings, denial of justice, lack of closure, belief in the system and hope.
Theme 1—Emotions and Feelings: Regardless of whether the perpetrator was acquitted of murder or manslaughter, or the homicide case was declared a cold-case homicide, survivors reported experiencing the emotion of anger. This was experienced when learning of the failure to apprehend a suspect, 28 or that the perpetrator was acquitted of murder or manslaughter. 29 Feelings of shock and pain, however, were uniquely experienced by survivors who learned the perpetrator was acquitted of murder or manslaughter. Specifically, survivors in Thiel 30 expressed that learning the perpetrator was acquitted of murder or manslaughter reintroduced the sense of shock they initially experienced after learning about the death of their loved one—they found it impossible to comprehend. They also reported that such knowledge led them to continually feel pain.
Theme 2—Denial of Justice: A sense of being denied justice was reported only by survivors who had been through a court proceeding and learned that the perpetrator was acquitted of murder or manslaughter. This can be seen in survivors’ reports that the court did not confirm what they believed was ‘black and white’. 31 In contrast, survivors who had not been through the court proceeding—those in cold-case homicides—did not report a sense of being denied justice.
Theme 3—Lack of Closure: A lack of closure was a common experience for survivors who learned that the perpetrator was acquitted of murder or manslaughter, and those whose loved one’s cases were declared a cold-case homicide. In particular, survivors in cold-case homicides described feeling haunted on a daily basis 32 and expressed feeling being in a limbo-like state of existence 33 from not knowing the identity of the perpetrator. Similarly, survivors who learned the perpetrator was acquitted of murder or manslaughter reported that they could not put the case to rest—they searched for information and answers, in an attempt to restore order in their lives. 34 They also reported not being able to begin grieving in normative ways and that their continued feelings of pain compounded their feelings of not being able to move on.
Theme 4—Belief in the System: Survivors, regardless of whether the perpetrator was acquitted of murder or manslaughter, or the case was declared a cold-case homicide, appeared to hold a belief that the criminal justice system would lead to justice. In the case of cold-case homicides, survivors reported feeling confident that their loved one’s case would be solved. 35 However, when survivors went through a court proceeding and the perpetrators were acquitted of murder or manslaughter, survivors seemed to feel that this previously held belief about justice being achieved was betrayed. For instance, they described observing the court case as an eye-opening experience, where things that they thought of as ‘black and white’ could be turned around simply by the way they were presented. 36 Some survivors also reported that they thought an acquittal would mean that the police investigation would be reopened, but soon they realized that the case was finished and nothing else was going to happen because the police believed the person acquitted was guilty. 37
Theme 5—Hope: Only survivors in cold-case homicides reported that they maintained hope, in relation to finding the answers in their loved one’s case and bringing the perpetrators to justice. 38 Survivors who had been through the court proceeding and learned that the perpetrator was acquitted of murder or manslaughter did not mention that they maintained such hope.
While survivors in cold-case homicides also reported that a lack of resolution in their loved one’s case acted as a potential protection from additional pain, there was insufficient information provided to understand the cause of the additional pain; for instance, the pain associated with observing a court case. As such, we could not categorize this effect into a broader theme.
Discussion
Homicide cases can have a wide range of final case conclusions, which may differentially impact on homicide survivors. Using a novel conceptual framework —the Homicide Case Pathway—to highlight all possible final case conclusions in a homicide and organize existing literature into case conclusion categories, this article examined what is currently empirically known about how different final case conclusions in the process of resolving a case impact on survivors. This review clearly demonstrates that when a logical conceptual framework is applied, there is virtually no empirical evidence about how such conclusions affect those who have lost a loved one to homicide. Nevertheless, the scant amount of information that is available provides preliminary insights into five key themes, illustrating both shared and diverse effects of different final case conclusions on homicide survivors.
Notably, it appears that particular feelings and emotions, beliefs about both receiving justice for victims and the justice system as a whole, and perceptions of hope vary across different final case conclusions. Anger and a lack of a closure was experienced by survivors in both cold-case homicides and cases where the perpetrator was acquitted of murder or manslaughter. However, only survivors in cases where the perpetrator was acquitted of murder or manslaughter experienced feelings of shock and pain, a sense of being denied justice, and that their beliefs in justice being achieved were betrayed. Conversely, only survivors in cold-case homicides felt confident that their loved one’s case would be solved and held hope that the perpetrator would be brought to justice. It is reasonable to propose that these differences may be due to the different mechanisms associated with each final case conclusion—for example, whether or not a perpetrator is identified and charged in the police investigation and whether or not the perpetrator is confirmed and/or convicted through prosecution in a court proceeding. In line with previous research, 39 these results also suggest that survivors may experience ‘re-victimization’ as a homicide case progresses through the criminal justice system—with feelings of anger and shock being experienced both after learning about the death of their loved one and after their loved one’s case has progressed, at least in part, through the criminal justice system.
It is important to recognize, however, that the above themes are unlikely to capture the diversity in homicide survivors’ experiences of final case conclusions. The studies identified only investigated the experiences of family members of homicide victims and not the experiences of victims’ close friends. It is possible, for instance, that close friends of homicide victims may have different experiences to family members. 40 This may occur if family members and close friends have different levels of involvement in the criminal justice processes that follow the homicide. In addition, existing studies only examined two out of a multitude of possible final case conclusions; namely cold-case homicides and perpetrator acquitted of murder or manslaughter. Although, it is worth noting that the study on acquittal 41 did not distinguish between different reasons for acquittal (e.g., there was insufficient evidence to prove the suspect was the perpetrator, or the perpetrator acted either in self-defence or when his/her mental capacity was completely impaired), which may affect homicide survivors in different ways. Similarly, other final case conclusions—such as cold-case homicide, homicide–suicide or perpetrator declared permanently unfit for trial, convicted for murder, or convicted for manslaughter (distinguishing between perpetrators found to have not intended to kill, used excessive force in self-defence or acted when his/her mental capacity was partially impaired)—may also be associated with their own distinct set of impacts on survivors.
Some important methodological characteristics of the included studies should also be acknowledged. For example, although meeting our inclusion criteria and providing valuable insights, Wellman’s 42 work did not specifically ask a research question about the effect of a cold-case homicide classification on homicide survivors. Instead, that research asked more generally about the effect of homicide on survivors, with information about the final case conclusion emerging only incidentally, as a small portion of the overall results. Further, the included papers used qualitative methods with only one coder to analyse the results. While the use of qualitative methods is an understandable choice, given the small samples under consideration, the use of only one coder to analyse the results risks introducing subjectivity into data interpretation. 43
An additional challenge for the present review was the need, at times, to rely on other researchers’ interpretation of their qualitative findings. This occurred when interpretations were provided without supporting quotes to illustrate those interpretations 44 ; contrast this with Thiel 45 who provides a quote suggesting ‘betrayal of belief in system’, which supports a theme of denial of justice. Similarly, the results obtained to date are from very small samples and may not be representative of homicide survivors more broadly. This issue is compounded by the use of sampling techniques such as ‘snowballing’, and interviewing multiple family members of the same homicide victim who are likely to have similar experiences.
On a positive note, the observation that the studies included in this review have all been published relatively recently (2014–2016) hints that while this specific line of enquiry has gone largely unexplored for many years, it may slowly be emerging as an area of growing research activity. There are a range of other directions that future research may fruitfully explore, using the Homicide Case Pathway as a conceptual framework. First, it would be beneficial to more thoroughly investigate how final case conclusions in the process of resolving a case impact survivors. This would include further examination of the final case conclusions of cold-case homicide and perpetrators acquitted of murder or manslaughter, and new research into the final case conclusions of homicide–suicide and perpetrator declared permanently unfit for trial, convicted for murder or convicted for manslaughter. Given each of these final case conclusions differ in whether or not a perpetrator is identified and charged in the police investigation, and whether or not the perpetrator is confirmed and/or convicted through prosecution in a court proceeding, it is likely that many additional themes about survivors’ experiences, not yet identified, would emerge from these studies.
Second, research could examine how different reasons for a specific case conclusion impact survivors. For the case conclusion, convicted of manslaughter, this could involve investigating how the use of plea bargaining or defences that reduce murder to manslaughter (e.g., a finding that the perpetrator used excessive force in self-defence or acted when his/her mental capacity was partially impaired) impact on homicide survivors compared to a finding that the perpetrator did not intend to kill the victim (thus, reducing murder to manslaughter). For the case conclusion, acquitted of murder or manslaughter, researchers could examine how a finding that the perpetrator acted in self-defence or when his/her mental capacity was completely impaired impacts on homicide survivors compared to a finding that there was insufficient evidence to prove the suspect was in fact the perpetrator. Comparing the different reasons for each final case conclusion has the potential to inform the themes identified in this review, such as survivors’ beliefs in the criminal justice system and the denial of justice.
Third, future research could investigate survivors’ experiences of the final case conclusions in the process of ‘resolving’ the case versus the final case conclusions in the process of ‘punishing’ the perpetrator (for those homicide cases that proceed to the final stage in the Homicide Case Pathway; see Figure 1). For example, a survivor may report being satisfied with the resolution of a case—such as a conviction for murder—but dissatisfied with the perpetrator’s punishment—such as a sentence of prison for a duration shorter than his/her natural life. This research would provide some insight into survivors’ satisfaction with the sentencing of perpetrators. As such, it would be informative for justice policy, given community expectations about sentencing are an important consideration when forming sentencing guidelines.
Finally, each of the above research questions could be further examined to investigate what factors interact with how different final case conclusions impact on survivors. For example, when a perpetrator is identified, it would be valuable to examine whether the impact of final case conclusions on survivors varies depending on factors related to the perpetrator, such as whether the perpetrator is known to the survivor or not, or what the perpetrator’s reason or motivation for the homicide was (for example, ‘revenge’ versus ‘in the course of another crime’). Similarly, it would also be worthwhile to examine whether factors about the survivors themselves affect how final case conclusions impact survivors, such as the gender of the survivor, the survivor’s relationship to the victim (e.g., parent, sibling, child or friend) or the coping strategies used by the survivor.
Conducting this additional research into the effects of final case conclusions on homicide survivors is of utmost importance as it has the potential to highlight even more diversity in homicide survivors’ experiences. Along with the results of this review, such findings would suggest the need for, and importance of, victim support agencies taking into account the final case conclusion that homicide survivors experience, when identifying and implementing suitably tailored support for homicide survivors. In addition, such research may also help to explore the questions arising from van Wijk and colleagues’ 46 study in regard to whether going through the judicial process may pose specific risks to homicide survivors relative to survivors who do not go through that process.
In summary, by developing a novel conceptual framework—the Homicide Case Pathway—and applying that framework to organize current empirical knowledge about the impacts of final case conclusions on homicide survivors, this article has been able to demonstrate substantial limits in existing knowledge, while nevertheless providing suggestive evidence of differential impacts of final case conclusions on homicide survivors. Using the Homicide Case Pathway to guide the conceptualization and structure of future research is likely to lead to more nuanced understandings of homicide survivors’ experiences and needs. This may then reveal new information about how systemic practices at each stage of the homicide pathway may affect survivors’ experiences.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The authors received no financial support for the research, authorship and/or publication of this article.
