Threats to public figures and association with approach, as a proxy for violence: The importance of grievance.

The adoption of the term grievance-fuelled violence reflects the fact that similarities exist between those committing violent acts in the context of grievance in different settings, so potentially allowing the application of insights gained in the study of one group to be applied to others. Given the low base rate of violence against public figures, studies in the field of violence against those in the public eye have tended to use, as a proxy for violence, attempts by the individuals concerned to achieve unwarranted and unwanted proximity to the subject of their attention, given that approach is a necessary prerequisite for most forms of attack. In such studies, one factor that has frequently been considered is whether the making of threats is associated with a subsequent approach. The results have been varied, with no correlation found in some, a negative correlation in others, and a positive correlation in at least one. Such studies have been retrospective, using case files prepared for other purposes, and samples of cases have been selected according to their victims' sector of employment - for instance, politicians, celebrities, judiciary, and the corporate world. This study of a sample of 126 threat assessment cases, using a prospective methodology, looks at the associations between the making of threats and subsequent approach from a different angle - that of a standardised and validated classification of underlying motivation. It finds that particular types and forms of threat are significantly associated with subsequent approach in cases that are fuelled by grievance, but not in those with the motivation of seeking a relationship. Furthermore, when a sample with a mixture of motivational categories was examined in the manner of previous studies, such associations with threat were not apparent. These results refine the existing understanding of the significance of threats in public-facing cases. Future research projects in this area might usefully incorporate the consideration of underlying motivation, in particular grievance.

The Phenomenology of Group Stalking ('Gang-Stalking'): A Content Analysis of Subjective Experiences.

Epidemiological data suggest that as many as 0.66% of adult women and 0.17% of adult men in the western world may suffer the subjective experience of being group-stalked ('gang stalked') at some point in their lives. Yet the gang stalking experience has been subject to little scientific study. This paper reports an attempt to elicit the core phenomena involved in gang-stalking by allowing them to emerge de novo through the qualitative analysis of accounts of individuals who describe being gang-stalked. Fifty descriptions of gang-stalking that satisfied study inclusion criteria were identified from the internet and subjected to content analysis. Twenty-four core phenomena were elicited, together with 11 principal sequelae of the experience of being gang-stalked. These were then divided into groups, producing a framework for the phenomena of the gang-stalking experience. The results were compared with frequencies of the same categories of experience then extracted from the original data of the only previous study on gang-stalking phenomena. Whilst the methodology of the current study was more rigorous, the core phenomena were similar in each. The current study confirmed the seriousness of the sequelae of the gang-stalking experience. These support the need for further exploration of the phenomenon, for which this study forms a basis.

Fixated Threat Assessment Centers: preventing harm and facilitating care in public figure threat cases and those thought to be at risk of lone-actor grievance-fueled violence.

The rediscovery of the importance of mental illness in the risk assessment and management of those who threaten, approach, and harm public figures has led to a new way of dealing with those that threaten public figures. This approach emphasises the role of "fixation" which may be defined as an intense preoccupation pursued to an abnormally intense degree. It integrates a threat assessment paradigm with the literature on stalking. The need for such an approach was highlighted in research on the prevalence of harassment of public figures. Psychiatry has a key role in this approach which sees mental health clinicians and Police work together in Fixated Threat Assessment Centres (FTACs). An FTAC functions by assessing the level of concern and sharing information to facilitate interventions that are often mental health based. The purpose is not the hopeless task of identifying those who will go on to perpetrate serious violence, rather to intervene in the group they emerge from, to prevent harm. As well as decreasing risk to the persons fixated upon, this approach improves care to the mentally disordered people who harass and threaten them and, in doing so, decreases the likelihood of their criminalization while enhancing their quality of life. As expertise in the area has grown, policing and security agencies in several countries have expanded the FTAC model to cover individuals thought at risk of lone-actor grievance-fueled violence, a term that captures both different forms of mass killing and lone actor terrorism.

Factors associated with attendance, engagement and wellbeing change in an arts on prescription intervention.

BACKGROUND: Arts on prescription interventions have grown in number in recent years with a corresponding evidence base in support. Despite the growth and presence of these interventions, there have been no evaluations to date as to what factors predict patient success within these referral schemes. METHODS: Using the largest cohort of patient data to date in the field (N = 1297), we set out to understand those factors that are associated with attendance, programme engagement and wellbeing change of patients. Factors associated with these outcomes were assessed using three binary logistic regression models. RESULTS: Baseline wellbeing was associated with each outcome, with higher baseline wellbeing being associated with attendance and engagement, and lower baseline wellbeing associated with positive wellbeing change. Additionally, deprivation was associated with attendance, with those from the median deprivation quintile being more likely to attend. CONCLUSIONS: The role of baseline wellbeing in each outcome of these analyses is the most critical associative factor. Whilst those that are lower in wellbeing have more to gain from these interventions, they are also less likely to attend or engage, meaning they may need additional support in commencing these types of social prescribing interventions.

Influences of Playing Position and Quality of Opposition on Standardized Relative Distance Covered in Domestic Women's Field Hockey: Implications for Coaches.

Vinson, D, Gerrett, N, and James, DVB. Influences of playing position and quality of opposition on standardized relative distance covered in domestic women's field hockey: Implications for coaches. J Strength Cond Res 32(6): 1770-1777, 2018-The purpose of this study was to compare the standardized relative distance covered by the various playing positions (defenders, midfielders, and forwards) against different quality of opponents in domestic women's field hockey. Data were collected from 13 individuals competing for 1 team in the English Premier League across an 18-game season. Data were collected using portable global positioning system technology. Distance data were grouped into 6 speed zones relative to individual players' maximum sprint speeds and then standardized by dividing by the number of on-pitch minutes. Dependent variables included distance covered in the 6 speed zones, as well as the number of sprints and repeated sprint efforts (RSEs) completed in the highest speed zone. Participants covered a significantly greater total distance when competing against opponents from top 3 teams compared with middle 3 teams (111.78 ± 2.65 m·min vs. 107.35 ± 2.62 m·min, respectively). This was also true for distance covered in zone 4 (running) (29.47 ± 1.69 m·min vs. 27.62 ± 1.45 m·min, respectively) and zone 5 (fast running) (23.42 ± 1.76 m·min vs. 21.52 ± 1.79 m·min, respectively). Defenders (99.77 ± 4.36 m·min) covered significantly less total meters per minute than midfielders (117.20 ± 4.36 m·min) and completed significantly fewer RSEs per on-pitch minute (0.21 ± 0.03 and 0.33 ± 0.03, respectively). Midfielders covered significantly less distance in zone 2 (walking) than forwards (19.38 ± 1.64 m·min and 30.33 ± 2.12 m·min, respectively). Conversely, midfielders were shown to cover significantly more distance in zone 3 (jogging) than forwards (32.84 ± 1.10 m·min and 24.61 ± 1.42 m·min, respectively). A standardized and relative assessment may be useful for coaches' and performance analysts' understanding of players' performance in different positions or against different quality opponents.

'Artlift' arts-on-referral intervention in UK primary care: updated findings from an ongoing observational study.

Background: Arts for health interventions are an accepted option for medical management of mental wellbeing in health care. Updated findings are presented from a prospective longitudinal follow-up (observational) design study of an arts on referral programme in UK general practice, over a 7-year period (2009-2016). Methods: Primary care process and mental wellbeing outcomes were investigated, including progress through the intervention, changes in mental wellbeing, and factors associated with those outcomes. A total of n =1297 patients were referred to an eight or 10-week intervention over a period from 2009 to 2016. Patient sociodemographic information was recorded at baseline, and patient progress (e.g. attendance) assessed throughout the intervention. Results: Of all referrals, 51.7% completed their course of prescribed art (the intervention). Of those that attended, 74.7% engaged with the intervention as rated by the artists leading the courses. A significant increase in wellbeing was observed from pre- to post-intervention (t = -19.29, df =523, P < 0.001, two-tailed) for those that completed and/or engaged. A sub sample (N =103) of these referrals self-reported multi-morbidities. These multiple health care service users were majority completers (79.6%), and were rated as having engaged (81.0%). This group also had a significant increase in well-being, although this was smaller than for the group as a whole (t = -7.38, df =68, P < 0.001). Conclusion: Findings confirm that art interventions can be effective in the promotion of well-being for those that complete, including those referred with multi-morbidity, with significant changes in wellbeing evident across the intervention periods.

The Influence of Exercise Intensity on Postexercise Baroreflex Sensitivity.

PURPOSE: The purpose of this study was to investigate the influence of exercise intensity on postexercise supine and tilt baroreflex sensitivity (BRS). METHOD: Nine healthy, active men performed 2 conditions of interval cycling of 40% maximal work rate (WRmax) and 75% WRmax of matched work done and a control condition of no exercise in a counterbalanced order. BRS outcome measures were determined at preexercise and postexercise up to +24 hr in supine and tilt positions. R-R interval and blood pressure data were collected over consecutive 10-min periods and were analyzed by Fast Fourier transformation analysis. RESULTS: A fully repeated analysis of variance revealed a significant interaction (p < .05) between time and condition in supine for BRSαLF, F(3, 134) = 5.19, p < .05, ES = .39, and BRSTFTG, F(3, 134) = 5.65, p < .05, ES = .41, and in tilt for BRSUpUp, F(3, 134) = 3.54, p < .05, ES = .31, BRSDownDown, F(3, 134) = 5.94, p < .05, ES = .43, BRSαLF, F(4, 134) = 6.23, p < .05, ES = .44, and BRSTFTG, F(4, 134) = 9.22, p < .05, ES = .54. There were significant differences (p < .05) between condition comparisons at +15 min and between control and 75% WRmax and between the 40% WRmax and 75% WRmax conditions at +60 min. At +15 min, BRS was lower in the 75% WRmax condition compared with the 40% WRmax condition and the control condition, and it was lower in the 40% WRmax condition than in the control condition. CONCLUSION: The findings demonstrate an intensity-dependent relationship in the BRS response following exercise.

Effects of long-term training cessation in young top-level road cyclists.

In cycling, it is common practice to have a break in the off season longer than 4 weeks while adopting an almost sedentary lifestyle, and such a break is considered to be long-term detraining. No previous studies have assessed the effect of training cessation with highly trained young cyclists. The purpose of the present investigation was to examine effects of 5 weeks of training cessation in 10 young (20.1 ± 1.4 years) male road cyclists for body composition, haematological and physiological parameters. After training cessation, body mass of cyclists increased (P = 0.014; ES = 0.9). [Formula: see text] (L · min-1 = -8.8 ± 5.0%, mL · kg-1·min-1 = -10.8 ± 4.2%,), Wmax (W = -6.5 ± 3.1%, W · kg-1 = -8.5 ± 3.3%,), WLT1 (W = -12.9 ± 7.0%, W · kg-1 = -14.8 ± 7.4%,), WLT2 (W = -11.5 ± 7.0%, W · kg-1 = -13.4 ± 7.6%,) and haematological (red blood cells count, -6.6 ± 4.8%; haemoglobin, -5.4 ± 4.3% and haematocrit, -2.9 ± 3.0%) values decreased (P ≤ 0.028; ES ≥ 0.9). Five weeks of training cessation resulted in large decreases in physiological and haematological values in young top-level road cyclists suggesting the need for a shorter training stoppage. This long-term detraining is more pronounced when expressed relative to body mass emphasising the influence of such body mass on power output. A maintenance programme based on reduced training strategies should be implemented to avoid large declines in physiological values in young cyclists who aspire to become professionals.

Outcome and Efficacy of Interventions by a Public Figure Threat Assessment and Management Unit: A Mirrored Study of Concerning Behaviors and Police Contacts Before and After Intervention.

Specialized units for the assessment and management of concerning behaviors towards public figures have been set up in various jurisdictions. Their efficacy has been demonstrated descriptively and in terms of reduction in concern rates. This study of 100 consecutive cases from the Fixated Threat Assessment Centre (FTAC) in the UK uses a novel measure of outcome in the form of reduction in behaviors of concern and in police call-outs/stops, using data culled from police and health service records. It adopts a mirrored design, comparing individuals over 12-month and 2-year periods before and after FTAC intervention. It demonstrates significant reductions in both numbers of individuals involved in, and number of actual incidents of, concerning communication and problematic approach, as well as police call-outs/stops. Most results are consistent across subgroups with regard to gender, previous convictions, concern level, compulsory hospitalization and grievance-driven behavior. Such threat assessment units reduce risky behavior and save police time and, possibly, costs. Copyright © 2016 John Wiley & Sons, Ltd.

'Art Lift' intervention to improve mental well-being: an observational study from U.K. general practice.

Arts for health interventions are emerging as an alternative option to medical management of mental health problems and well-being. This study investigated process and outcomes of an art intervention on patients referred by primary care professionals, including associations between patient characteristics (e.g., sex), progress through the intervention (e.g., attendance), and changes in mental well-being. Referral criteria included people with anxiety, depression, or stress; low self-esteem, confidence, or overall well-being; and chronic illness or pain. The study took place in U.K.-based general practitioner practices, with a total of 202 patients referred to a 10-week intervention. Patient sociodemographic information was recorded at baseline, and patient progress assessed throughout the intervention. Significant improvement in well-being was revealed for the 7-item (t = -6.049, d.f. = 83, P < 0.001, two-tailed) and 14-item (t = -6.961, d.f. = 83, P < 0.001, two-tailed) scales. Of referred patients, 77.7% attended and 49.5% completed. Most patients were female, and from a range of socioeconomic groups, and those who completed were significantly older (t = -2.258, d.f. = 145, P = 0.025, two-tailed). Findings reveal that this art intervention was effective in the promotion of well-being and in targeting women, older people, and people from lower socioeconomic groups.

Heart rate variability: effect of exercise intensity on postexercise response.

The purpose of the present study was to investigate the influence of two exercise intensities (moderate and severe) on heart rate variability (HRV) response in 16 runners 1 hr prior to (-1 hr) and at +1 hr, +24 hr, +48 hr, and +72 hr following each exercise session. Time domain indexes and a high frequency component showed a significant decrease (p < .001) between -1 hr and +1 hr for severe intensity. The low frequency component in normalized units significantly increased (p < .01) for severe intensity at +1 hr. Only severe exercise elicited a change in HRV outcomes postexercise, resulting in a reduction in the parasympathetic influence on the heart at +1 hr; however values returned to baseline levels by +24 hr.

Exploring the perceptions of success in an exercise referral scheme: a mixed method investigation.

BACKGROUND: Exercise referral schemes feature as one of the prevalent primary care physical activity interventions in the United Kingdom, without extensive understanding of how those involved in providing and participating view success. The present research explores and reveals the constituents of "success," through comparison, contradiction, and integration of qualitative and quantitative research findings. METHOD: A population-based cohort design formed the basis for a mixed method approach to the research. The quantitative component used a three-stage binary logistic regression to identify patient sociodemographic characteristics and referral reasons associated with three outcomes (n=1,315). The qualitative component (n=28) comprised four focus groups with patients (n=17), individual interviews with exercise providers (n=4), and referring health professionals (n=7). The research components were compared at discussion stage to offer insights into the concept of "success." RESULTS: The integrated findings highlighted the multidimensional nature of the concept of success, containing a wide range of concepts such as empowerment, inclusion, and confidence. The traditional notions of success such as, attendance, weight loss, and blood pressure reduction featured amid a more holistic view which incorporated psychological and social aspects as both influences and outcomes. CONCLUSION: These findings can enable future development of more representative evaluations of the benefits of exercise referral. This mixed methods research approach can facilitate the development of sophisticated, tailored, evidence-based interventions in the future.

Management and treatment of stalkers: problems, options, and solutions.

Legal sanctions alone are often ineffective in preventing stalking because, in the absence of treatment, the fundamental problems driving the stalker remain unresolved. Criminal justice interventions can be problematic because of difficulties in framing anti-stalking legislation and inconsistencies in their application. Civil remedies in the form of restraining orders may be ineffective or counterproductive. Treatment of stalkers involves pharmacotherapy when mental illness is present, but the mainstays of treatment for non-psychotic stalkers are programmes of psychological intervention. These depend on accurate assessment of the risks inherent in stalking and on the identification of psychological deficits, needs, and responsivity factors specific to the individual. Treatment can then be tailored to suit the stalker, thereby enhancing therapeutic efficacy. Developing a framework for identifying the risk factors and shaping the delivery of treatment is crucial. Two service innovations developed specifically to work with stalkers are presented as options to overcome current management deficiencies.

Stalkers and harassers of British royalty: an exploration of proxy behaviours for violence.

Study of risk factors for violence to prominent people is difficult because of low base rates. This study of harassers of the royal family examined factors suggested in the literature as proxies for violence--breaching security barriers, achieving proximity, approach with a weapon, and approach with homicidal ideation. A stratified sample of different types of approach behaviour was randomly extracted from 2,332 Royalty Protection Police files, which had been divided into behavioural types. The final sample size was 275. Significant differences in illness symptomatology and motivation were found for each proxy group. Querulants were significantly over-represented in three of the four groups. There was generally little overlap between the proxy groups. There is no evidence of the proxy items examined being part of a "pathway to violence". Different motivations may be associated with different patterns of risk. Risk assessment must incorporate knowledge of the interactions between motivation, mental state, and behaviour.

Factors associated with escalation and problematic approaches toward public figures.

Detailed comparison of factors associated with abnormal approach to the prominent and with escalation from communication to approach has not hitherto been undertaken. This partially reflects the failure of individual studies to adopt compatible terminologies. This study involves a careful dissection of six public figure studies, three involving U.S. politicians, two Hollywood celebrities, and one the British Royal Family. Common findings were unearthed across six headings. Approachers were significantly more likely to exhibit serious mental illness, engage in multiple means of communication, involve multiple contacts/targets, and to incorporate into their communication requests for help. They were significantly less likely to use threatening or antagonistic language in their communications, except in those cases involving security breaches. These results emphasize the importance of integrating mental health findings and preventive measures into risk management. Approach should not be regarded as a single behavioral category and has multiple motivations. Future studies should adopt standard terminology, preferably taken from the general stalking research.

Abnormal attentions toward the British Royal Family: factors associated with approach and escalation.

Abnormal approach and escalation from communication to physical intrusion are central concerns in managing risk to prominent people. This study was a retrospective analysis of police files of those who have shown abnormal attentions toward the British Royal Family. Approach (n = 222), compared with communication only (n = 53), was significantly associated with specific factors, most notably serious mental illness and grandiosity. In a sample of those who engaged in abnormal communication (n = 132), those who approached (n = 79) were significantly more likely to evidence mental illness and grandiosity, to use multiple communications, to employ multiple means of communication, and to be driven by motivations that concerned a personal entitlement to the prominent individual. Logistic regression produced a model comprising grandiosity, multiple communications, and multiple means of communication, for which receiver operating characteristic (ROC) analysis gave an area under the curve (AUC) of 0.82. The implications of these findings are discussed in relation to those for other target groups.

Diversion of mentally disordered people from the criminal justice system in England and Wales: An overview.

The form that diversion mechanisms take in a given jurisdiction will be influenced both by mental health law and sentencing policies, and by the structure of criminal justice and health care systems. In England and Wales, treatment in hospital in lieu of any other sentence is available as a disposal option following a finding of guilt. In addition, there is a National Health Service, free at the point of delivery, the existence of which creates the potential for a co-ordinated nationwide response to mental disorder within the criminal justice system. In recent years, the National Health Service has taken over the delivery of health care in prisons, including psychiatric services, with the principle being one of equivalence between the quality of health provision provided in the community and that provided in prisons. However, problems within the system dictate that an important place remains for add-on diversion initiatives at courts and police stations, which aim to circumvent some of the delays in dealing with mentally disordered people or to prevent them entering the criminal justice system in the first place. It has been demonstrated that such mechanisms can be highly effective, and a government-sponsored review in 1992 recommended their general adoption. A lack of central co-ordination determined that progress was very slow. A new government-commissioned report in 2009 set out detailed recommendations for reform throughout the system. It laid emphasis on a co-ordinated response at all levels and between all agencies, and placed importance on linking initiatives with community services and with preventative measures, including attention to the effects of social exclusion. Some grounds for optimism exist, although there are particular problems in implementing change at a time of financial austerity.

Protecting the prominent? A research journey with Paul Mullen.

Recent research from the United Kingdom has called into question entrenched assumptions from the USA about public figure threat assessment, in particular the low importance given to mental illness and to the making of threats. This article reviews some of the evidence, concluding that the high prevalence of psychotic illness in threateners and harassers of public figures and the frequency of warning behaviours determines that these factors should be accorded a central role in the assessment and management of such cases. It is noted that data in US studies do not differ greatly from those in UK studies, but rather their interpretation. The practical benefits of attending to the factors in question are illustrated by reference to the activities of the United Kingdom's Fixated Threat Assessment Centre. The overlap is noted between the fields of public figure threat assessment and stalking, which have hitherto developed separately. The issue of public figure threat assessment is used to illustrate some of the attitudes and personal qualities which have typified the career and achievements of Paul Mullen in forensic psychiatry research.