Probation practice and attention-deficit hyperactivity disorder.

RATIONALE: Twenty-one Community Rehabilitation Companies were set up following the division of the National Probation Services during 'Transforming Rehabilitation' in England and Wales, under a 2013 Ministry of Justice initiative. Reunification commenced in 2018. A study completed prior to these changes suggested that probation officers had had little training in recognising attention-deficit hyperactivity disorder (ADHD) and may have been underestimating its prevalence among their clientele. Given the substantial changes in probation staffing and organisation since 2018, a new study seems warranted. AIMS: The aim of the study was to understand experiences of people under a community sentence who reported having ADHD and of probation staff working with them. METHODS: Using a qualitative research design, one-to-one semi-structured interviews were conducted with client facing probation staff recruited from one Community Rehabilitation Company. Service users undertaking a community sentence who had been diagnosed with or self-identified as having ADHD were then identified and recruited by these staff; those who consented were also interviewed. Transcripts were analysed using a thematic analytic approach. RESULTS: Thirteen probation staff and six male offenders under community sentences, agreed to participate and completed interviews. The overarching themes emerging from the two groups were similar, both reflecting on descriptions of ADHD; treatment of ADHD; experiences of having or working with ADHD in the wider community and in the criminal justice system specifically and visions of future support needs tied to the order. In addition, probation officers specifically raised the matter of payment by results. Both service users and probation staff identified gaps in knowledge, experience and services, but areas of good practice were also identified. CONCLUSION: The findings highlight the continuing under-acknowledgement of tailored clinical support for people serving a community sentence who have ADHD together with a lack of support and training about ADHD for probation staff. Return to the national organisation of probation services and recognition of need for a range of relevant skills offers a great opportunity for re-evaluating supervision and management of offenders under community sentences who have ADHD. These findings provide the basis for a template for developing knowledge and support provision for probation staff to recognise ADHD, or its likelihood, and their capacity to follow through with appropriately informed personalised supervision plans and access to specialist service advice and support.

Interpersonal violence in a deprived Scottish urban area with aggregations of physical health risks and psychiatric morbidity: an ecological study.

BACKGROUND: Glasgow, Scotland, has previously shown exceptional levels of violence among young men, shows aggregations of health conditions, with shortened life expectancy. Health conditions can be both causes and consequences of violence, of shared community-level socio-economic risk factors, and can result from large-scale social forces beyond the control of populations with high levels of violence. The aim of the study was to provide an in depth understanding of the Public Health problem of violence among young adult men in Glasgow East. METHOD: Ecological investigation of violence and its associations with health conditions in areas of contrasting socioeconomic deprivation. National survey of 1916 British men aged 18-34 years, augmented by a sub-sample of 765 men in Glasgow East (GE). Participants completed questionnaires covering current physical and sexual health, psychiatric symptoms, substance misuse, lifestyle, and crime and violence. RESULTS: The 5-year prevalence of violence was similar in both surveys but fights involving weapons (AOR 3.32, 95% CI 2.29-4.79), gang fights (AOR 2.30, 95% CI 1.77-2.98), and instrumental violence supporting criminal lifestyles were more common in GE, where 1 in 9 men had been in prison. Violent men in both samples reported poorer physical and sexual health and all types of psychiatric morbidity except depression, with multiple high-risk behaviours for both future poor health and violence. Associations between drug and alcohol dependence and violence in GE could not be entirely explained by deprivation. CONCLUSION: Violence in deprived urban areas is one among many high-risk behaviours and lifestyle factors leading to, as well as resulting from, aggregations of both psychiatric and physical health conditions. Poverty partly explained raised levels of violence in GE. Other factors such as drug and alcohol misuse and macho attitudes to violence, highly prevalent among men in this socially excluded community, also contributed. Multi-component preventive interventions may be needed in deprived areas and require future investigations into how multiple co-existing risk factors produce multimorbidity, including psychiatric disorders, substance misuse, poor physical health and violence.

Gang membership and sexual violence: associations with childhood maltreatment and psychiatric morbidity.

BACKGROUND: Gang members engage in many high-risk sexual activities that may be associated with psychiatric morbidity. Victim-focused research finds high prevalence of sexual violence towards women affiliated with gangs. AIMS: To investigate associations between childhood maltreatment and psychiatric morbidity on coercive and high-risk sexual behaviour among gang members. METHOD: Cross-sectional survey of 4665 men 18-34 years in Great Britain using random location sampling. The survey oversampled men from areas with high levels of violence and gang membership. Participants completed questionnaires covering violent and sexual behaviours, experiences of childhood disadvantage and trauma, and psychiatric diagnoses using standardised instruments. RESULTS: Antisocial men and gang members had high levels of sexual violence and multiple risk behaviours for sexually transmitted infections, childhood maltreatment and mental disorders, including addictions. Physical, sexual and emotional trauma were strongly associated with adult sexual behaviour and more prevalent among gang members. Other violent behaviour, psychiatric morbidity and addictions accounted for high-risk and compulsive sexual behaviours among gang members but not antisocial men. Gang members showed precursors before age 15 years of adult preference for coercive rather than consenting sexual behaviour. CONCLUSIONS: Gang members show inordinately high levels of childhood trauma and disadvantage, sexual and non-sexual violence, and psychiatric disorders, which are interrelated. The public health problem of sexual victimisation of affiliated women is explained by these findings. Healthcare professionals may have difficulties promoting desistance from adverse health-related behaviours among gang members whose multiple high-risk and violent sexual behaviours are associated with psychiatric morbidity, particularly addictions.

Team-based suicide prevention: lessons learned from early adopters of collaborative care.

Suicide prevention in clinical settings requires coordination among multiple clinicians with expertise in different disciplines. We aimed to understand the benefits and challenges of a team approach to suicide prevention in primary care, with a particular focus on Veterans. The Veterans Health Administration has both a vested interest in preventing suicide and it has rapidly and systematically adopted team-based approaches for primary care interventions, including suicide prevention. We conducted eight focus groups and eight in-depth interviews with primary care providers (PCPs), behavioral health providers and nurses located in six regions within one Veterans Administration Catchment Area in the northeast of the US. Transcripts were analyzed using simultaneous deductive and inductive content analysis. Findings revealed that different clinicians were thought to have particular expertise and roles. Nurses were recognized as being well positioned to identify subtle changes in patient behavior that could put patients at risk for suicide; behavioral health providers were recognized for their skill in suicide risk assessment; and PCPs were felt to be an integral conduit between needed services and treatment. Our findings suggest that clinician role-differentiation may be an important by-product of team-based suicide prevention efforts in VHA settings. We contextualize our findings within both a processual and relational interprofessional framework and discuss implications for the implementation of team-based suicide prevention.

"I Despise Myself for Thinking about Them." A Thematic Analysis of the Mental Health Implications and Employed Coping Mechanisms of Self-Reported Non-Offending Minor Attracted Persons.

'Non-offending pedophiles' or 'minor attracted persons' are individuals who suppress an attraction to children. Previous analyses of this population's mental illness employed overt self-report methods, limited by social desirability. Additionally, studies assessing the coping mechanisms employed to remain offense-free are underpowered; understanding of these would facilitate the rehabilitation of prior offenders. A thematic analysis of coping mechanisms and mental illness was conducted on 5,210 posts on the 'Virtuous Pedophiles' forum. Four themes emerged for coping mechanisms: Managing risk and attraction to children, Managing mood, Managing preferences prosocially and Friends, family and relationships, with 13 subthemes. Five themes emerged for mental ill-health, including: Addiction, Anxiety, Depression, Self-hatred/Self-harm/Suicide and Other. Self-hatred/Self-harm/Suicide accounted for almost a third of discussed mental ill-health. These results highlight the severity of mental ill-health amongst this population and the coping mechanisms employed to remain offense-free.

Support for the predictive validity of the multifactor offender readiness model (MORM): forensic patients' readiness and engagement with therapeutic groups.

BACKGROUND: Treatment non-engagement in forensic health settings has ethical and economic implications. The multifactor offender readiness model (MORM) provides a framework for assessing treatment readiness across person, programme and contexts. AIMS: To answer the following question: Are the internal factors of the MORM associated with likelihood of engagement in groups by patients in forensic mental health services? METHOD: In a retrospective design, associations were investigated between internal factors of the MORM, measured as part of assessment for group participation, and the outcomes of treatment refusal, treatment dropout and treatment completion. RESULTS: One hundred and eighteen male patients in a high security hospital consecutively referred for group treatment agreed to participate. Internal factors of the MORM associated with treatment refusals included: psychopathic cognition, negative self-evaluation/affect and effective goal-seeking strategies. Those associated with dropouts included emotional dysregulation, low competencies to engage and low levels of general distress. MORM factors associated with completion included: low motivation, ineffective goal-seeking strategies, absence of psychopathic cognition, high levels of general distress and competency to engage. CONCLUSIONS: Internal factors of the MORM could be useful contributors to decisions about treatment readiness for hospitalised male offender-patients. Up to one in three programmes offered were refused, so clinical use of the MORM to aid referral decisions could optimise the most constructive use of resources for every individual. Copyright © 2016 John Wiley & Sons, Ltd.

High failure rates of the Spectron EF stem at a minimum of 10 year's follow-up.

We prospectively followed 112 hips, undergoing THA with a Spectron EF stem. At mean follow-up of 11.2years, 21 patients had died. We obtained radiological follow-up in 99% and clinical follow-up in 100% of the surviving 91 hips. Fifty-four percent demonstrated osteolysis in at least one Gruen zone. Twenty-two hips required revision for all causes, with a further five stems radiologically loose. With endpoint being stem revision for aseptic loosening or radiological failure, survivorship at 11years was 0.783. We believe the addition of a rougher surface finish has contributed to the high levels of osteolysis and stem failure seen with the Spectron EF.

Predicting involvement in prison gang activity: street gang membership, social and psychological factors.

The aim of this study was to examine whether street gang membership, psychological factors, and social factors such as preprison experiences could predict young offenders' involvement in prison gang activity. Data were collected via individual interviews with 188 young offenders held in a Young Offenders Institution in the United Kingdom. Results showed that psychological factors such as the value individuals attached to social status, a social dominance orientation, and antiauthority attitudes were important in predicting young offenders' involvement in prison gang activity. Further important predictors included preimprisonment events such as levels of threat, levels of individual delinquency, and levels of involvement in group crime. Longer current sentences also predicted involvement in prison gang activity. However, street gang membership was not an important predictor of involvement in prison gang activity. These findings have implications for identifying prisoners involved in prison gang activity and for considering the role of psychological factors and group processes in gang research.

Community males show multiple-perpetrator rape proclivity: development and preliminary validation of an interest scale.

The literature on Multiple Perpetrator Rape (MPR) is scant; however, a significant proportion of sexual offending involves multiple perpetrators. In addition to the need for research with apprehended offenders of MPR, there is also a need to conduct research with members of the general public. Recent advances in the forensic literature have led to the development of self-report proclivity scales. These scales have enabled researchers to conduct evaluative studies sampling from members of the general public who may be perpetrators of sexual offenses and have remained undetected, or at highest risk of engaging in sexual offending. The current study describes the development and preliminary validation of the Multiple-Perpetrator Rape Interest Scale (M-PRIS), a vignette-based measure assessing community males' sexual arousal to MPR, behavioral propensity toward MPR and enjoyment of MPR. The findings show that the M-PRIS is a reliable measure of community males' sexual interest in MPR with high internal reliability and temporal stability. In a sample of university males we found that a large proportion (66%) did not emphatically reject an interest in MPR. We also found that rape-supportive cognitive distortions, antisocial attitudes, and high-risk sexual fantasies were predictors of sexual interest in MPR. We discuss these findings and the implications for further research employing proclivity measures referencing theory development and clinical practice.

An evaluation of mandatory polygraph testing for sexual offenders in the United kingdom.

This research examined whether a government-initiated pilot project of mandatory polygraph testing would increase the disclosures made by community-supervised sexual offenders in the United Kingdom. The Offender Managers of 332 pilot polygraph sexual offenders and 303 sexual offenders who were receiving usual community supervision were telephoned quarterly, over a 21-month period, to collect information about numbers of clinically relevant disclosures, the seriousness of disclosures made, and actions taken as a result of disclosures. Perceptions of polygraph usefulness were also collected. Offender Managers in the pilot polygraph group-compared to comparison Offender Managers-reported (a) a higher proportion of offenders making at least one disclosure (i.e., 76.5% vs. 51.2% respectively), and (b) that their offenders made more total disclosures overall (Ms = 2.60 vs. 1.25 respectively). The majority of disclosures made by sexual offenders in the polygraph group were associated with the polygraph session itself. Polygraph Offender Managers reported being more likely to take an action that involved increasing supervision, informing a third party, informing Multi-Agency Public Protection Arrangements (MAPPA), changing supervision focus, or issuing a warning to the offender. However, the relative seriousness of disclosures did not appear to differ across groups. In terms of polygraph test results, one third of offenders (most notably those who were higher in risk) failed their first test with "Deception Indicated." This outcome-received on a first test-was most likely to elicit clinically relevant disclosures. Offender Managers described the polygraph as aiding supervision strategies. This research and its associated caveats are discussed.

Fear and Masculinity as Motivational Narratives for Knife-Related Crime: A Systematic Review of the Literature.

Males are routinely identified as both the victims and perpetrators of knife-related crime. Explanations have typically fallen into two categories: fear of further victimization (i.e., need for protection) and masculine gender norms (e.g., a display of "toughness"). However, these two works of literature have not yet been brought together to provide us with a fruitful theoretical understanding of why some young men engage in knife-related crime. The purpose of this systematic review is to consolidate and synthesize the available research on fear and masculinity as explanations for knife-related crime. In all, 23 studies were identified as meeting the inclusion criteria. The findings of the studies reviewed highlight the importance of considering the cognitive analysis of risk and perceptions of risk in young males' decisions to engage in knife-related crime. These perceptions of risk are shaped by previous victimization through a contagion effect and contribute to the development of an aggressive masculinity that justifies the behavior. However, it is not very well understood the role of fear contagion, and victimization in the shaping of masculine ideals within groups of young men involved in knife-related crimes. Additional research is needed to explore these findings and shed light on the complex interplay between these factors to inform viable treatment options for young men engaged in knife-related crime.

Dermatology and pathology arrangements: navigating the compliance risks.

Purchased service arrangements, establishing in-house professional pathology services, conducting technical component histology within a dermatology practice, and electronic medical records technology donations are ways that dermatology practices are responding to the current health care delivery and payment changes. This article will provide a general framework for navigating the compliance risks and structure considerations associated with these relationships between dermatologists and pathologists.

Developing textile sustainability education in the curriculum: pedagogical approaches to material innovation in fashion.

The textile industry needs to adopt environmentally sustainable approaches to address ecologically damaging practices. Whilst driven by initiatives such as Textiles 2030, it is current students who will carry this agenda forward. This project investigated pedagogical approaches to develop sustainable textiles for the fashion design curriculum. Pilot studies, using bacterial cellulose (BC) as a material for millinery, revealed members of the public were prepared to experiment with this novel material, and BC was compatible with traditional hat-making techniques. A further study challenged secondary school students, based on an experiential learning model, to grow their own BC biofilm, exploring this as a sustainable apparel fabric. Initial attitudes of reluctance developed into acceptance once engaged in the practical activity. This study illustrates that with appropriate communication and education strategies, the principles of sustainability in fashion, and the acceptability of novel materials, can be engendered in different audiences.

Hands on Biofilm! Utilizing a public audience in a citizen science project to assess yield variability when culturing kombucha pellicle.

The pellicle biofilm generated during the Kombucha tea fermentation process has, when dried, textile-like properties that may have real-life applications. However, pellicle yield can vary depending on inoculation and incubation conditions, which affects research investigations on the properties of the pellicle. To generate data on variability to help define optimum pellicle growth conditions, as part of a public engagement event about biofilm, a citizen science activity was hosted whereby visitors to a science festival were invited to select incubation conditions and inoculate different media with liquid or solid (pellicle). More than 220 samples were inoculated (in excess of 1200 visitors, mainly in family groups). The most popular incubation conditions were coconut water or tea medium, 30°C/room temperature and liquid inoculum. The most productive/reproducible in terms of yield and variability were tea medium, 30°C, and liquid inoculum, which reflect some of the conditions most used in the domestic setting for kombucha culture. The event provided both useful research data and generated public interest in a research area of which many will have been unaware. Interest in the results of the activity, available several weeks after the activity, was sustained using email contact and FlickR for the dissemination of images and data.

Hands On Biofilm! A multidisciplinary public engagement event using kombucha tea pellicle as an accessible example of biofilm.

Public engagement with science has become increasingly important for the scientific community. There are many documented public engagement events that focus on aspects of microbiology, but relatively few utilise biofilms as a topic, despite their importance. Kombucha tea pellicles are easy to grow biofilms, facilitating their use within the public domain as examples of these complex communities. The aim of this work was to deliver a public engagement event that introduced visitors to general concepts about biofilm, and applications around sustainability, using kombucha. The event encouraged visitors to: build a biofilm using model clay; inoculate kombucha tea cultures using different incubation conditions, as part of a citizen science experiment to assess impact on pellicle biofilm yield; create garments and drapes on mini-mannequins using dried kombucha pellicle fabric, and demonstrate the range and importance of fermented foods (including kombucha tea), and 'good bacteria'. Quantitative and qualitative indicators of engagement were built into the activities. More than 1200 visitors, mainly in family groups, visited the event over a 4-h period. Knowledge of biofilms was low at the beginning of the event. Participation in all activities was high. Indicators of quantitative engagement were impressive, but it was difficult to obtain qualitative evidence other than observations from the delivery team (nineteen members) because of the intensity of the event and volume of visitors. The event was clearly successful in terms of fulfilment of aims, audience engagement and enthusiasm: the embedded evaluations helped to evidence the impact and reach of the event, enabling confidence in dissemination of good practice in the enhancement of public understanding of the importance of biofilm in general, and kombucha in particular.

Rumination and the displacement of aggression in United Kingdom gang-affiliated youth.

The concept of gang aggression oftentimes elicits images of brutal intergang violence. In reality, gang-related aggression can vary widely, can have various motivations and causal factors, and includes interpersonal as well as intergroup aggression. This study examined the tendency of UK youth to engage in displaced aggression (aggression aimed at undeserving targets) and examined the relationship among gang affiliation, ruminative thought, and aggression levels. Students in three London schools were asked to complete a questionnaire that assessed levels of gang affiliation, rumination about aversive events, and a tendency to engage in displaced aggression. Our analyses found a three-way interaction between gang affiliation, rumination, and gender, such that males who were high in affiliation and rumination had the greatest tendency to displace aggression toward innocent others. Additionally, it was shown that rumination could account for a significant part of the correlation between gang affiliation and displaced aggression. Furthermore, regression analyses showed that even after controlling for trait aggression, anger, hostility, and irritability, rumination remained a significant predictor of displaced aggression. The implications for understanding gang-related aggression and for conducting future research in this area were discussed.

Gang Members, Gang Affiliates, and Violent Men: Perpetration of Social Harms, Violence-Related Beliefs, Victim Types, and Locations.

Adult gang involvement attracts little empirical attention, so little is known about how they compare to nongang violent men in social harms beyond gang contexts. This study, based on unpublished data of 1,539 adult males, aged 19 to 34, from the Coid et al. national survey, compared gang members' (embedded in a gang; n = 108), affiliates' (less embedded in a gang; n = 119), and violent men's (no gang association; n = 1,312) perpetration of social harms by assessing their violence-related dispositions and beliefs, victim types, and locations of violence. Results showed that compared with violent men, gang members and affiliates were equally more likely to: cause social harms to a wider range of victims, including family and friends; seek violence; be excited by violence; and carry weapons. Gang members and affiliates were equally more likely than violent men to be violent at home, in friends' homes, and at work; they also thought about hurting people, but felt regret for some of their violence. A decreasing gradient was identified in gang members' (highest), affiliates' (next highest) and violent men's (lowest) beliefs in violent retaliation when disrespected, the use of violence instrumentally and when angry, and worry about being violently victimized. Implications of findings are that interventions need to address anger issues across all levels of adult gang membership. Importantly, adult gang members' regrets regarding violence and anxiety about being violently victimized could be key factors that interventions could use to help them relinquish their gang involvement.

Reproducibility of Bacterial Cellulose Nanofibers Over Sub-Cultured Generations for the Development of Novel Textiles.

The textile industry is in crisis and under pressure to minimize the environmental impact on its practices. Bacterial cellulose (BC), a naturally occurring form of cellulose, displays properties superior to those of its cotton plant counterpart, such as enhanced purity, crystallinity, tensile strength, and water retention and is thus suitable for an array of textile applications. It is synthesized from a variety of microorganisms but is produced in most abundance by Komagataeibacter xylinus. K. xylinus is available as a type strain culture and exists in the microbial consortium commonly known as Kombucha. Whilst existing literature studies have described the effectiveness of both K. xylinus isolates and Kombucha in the production of BC, this study investigated the change in microbial communities across several generations of sub-culturing and the impact of these communities on BC yield. Using Kombucha and the single isolate strain K. xylinus as inocula in Hestrin and Schramm liquid growth media, BC pellicles were propagated. The resulting pellicles and residual liquid media were used to further inoculate fresh liquid media, and this process was repeated over three generations. For each generation, the thickness of the pellicles and their appearance under SEM were recorded. 16S rRNA sequencing was conducted on both pellicles and liquid media samples to assess changes in communities. The results indicated that the genus Komagataeibacter was the most abundant species in all samples. Cultures seeded with Kombucha yielded thicker cellulose pellicles than those seeded with K. xylinus, but all the pellicles had similar nanofibrillar structures, with a mix of liquid and pellicle inocula producing the best yield of BC after three generations of sub-culturing. Therefore, Kombucha starter cultures produce BC pellicles which are more reproducible across generations than those created from pure isolates of K. xylinus and could provide a reproducible sustainable model for generating textile materials.

Legal issues for pathologists.

For better or for worse, the practice of pathology has evolved rapidly in the last decade, particularly the last several years. The dominance of certain national and regional pathology providers and the in-sourcing of pathology services as a revenue stream by nonpathology specialists have transformed pathology services into a commodity in many market, rather than a professional medical service. Despite significant health care reform and a myriad of compliance laws and regulations, it is unlikely that pathology practice will return to "the good old days." As a result, it is important for pathologists to become familiar with the trends in their specialty and have familiarity with the legal issues presented by these trends.