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Objective: Bipolar patients in the United States (US) compared to those from the Netherlands and Germany (here abbrev. as “Europe”) have more Axis I comorbidities and more poor prognosis factors such as early onset and psychosocial adversity in childhood. We wished to examine whether these differences also extended to Axis II personality disorders (PDs).Methods: 793 outpatients with bipolar disorder diagnosed by SCID gave informed consent for participating in a prospective longitudinal follow up study with clinician ratings at each visit. They completed detailed patient questionnaires and a 99 item personality disorder inventory (PDQ-4). US versus European differences in PDs were examined in univariate analyses and then logistic regressions, controlling for severity of depression, age, gender, and other poor prognosis factors.Results: In the univariate analysis, 7 PDs were more prevalent in the US than in Europe, including antisocial, avoidant, borderline, depressive, histrionic, obsessive compulsive, and schizoid PDs. In the multivariate analysis, the last 4 of these PDs remained independently greater in the US than Europe.Conclusions: Although limited by use of self report and other potentially confounding factors, multiple PDs were more prevalent in the US than in Europe, but these preliminary findings need to be confirmed using other methodologies. Other poor prognosis factors are prevalent in the US, including early age of onset, more childhood adversity, anxiety and substance abuse comorbidity, and more episodes and rapid cycling. The interactions among these variables in relationship to the more adverse course of illness in the US than in Europe require further study.

Citizenship is emerging as one of the world’s leading models to shift mental health care from artificial psychiatric settings into more natural community settings by incorporating human rights. This paper describes a four-session roundtable series entitled Citizenship, Social Justice, and Collective Empowerment: Living Outside Mental Illness. These roundtables were part of the New England Mental Health Technology Transfer Center Network (MHTTC). They were built on the conviction that people who have lived experiences of mental health challenges and engaged in making community connections should be at the center of teaching about those experiences. Presenters shared their experiences about how they navigated stigma and discrimination on their way to community inclusion, belonging, and empowerment. The common theme across the series was the citizenship framework. The citizenship framework has inspired people to become involved in an individual and collective dynamic experience that connects them with the 5R’s of rights, responsibilities, roles, resources, relationships, and a sense of belonging in society. The outcomes from the discussion on the webinars demonstrated that peer support could be a promising intervention to increase the sense of belonging in the community. Supplementary Information The online version contains supplementary material available at 10.1007/s11126-021-09968-x.

Musical Intervention (MI) is a public space that supports individuals who seek opportunities for creativity and connection with the broader community. This study sought to evaluate and understand N...

The convergence of large datasets, increased computational power, and enhanced algorithm design has led to the increased success of machine learning (ML) and artificial intelligence (AI) across a wide variety of healthcare professions but which, so far, have eluded formal discussion in physiotherapy. This is a concern as we begin to see accelerating performance improvements in AI research in general, and specifically, an increase in competence within narrow domains of practice in clinical AI. In this paper we argue that the introduction of AI-based systems within the health sector is likely to have a significant influence on physiotherapy practice, leading to the automation of tasks that we might consider to be core to the discipline. We present examples of some of these AI-based systems in clinical practice, specifically video analysis, natural language processing (NLP), robotics, personalized healthcare, expert systems, and prediction algorithms. We address some of the key ethical implications of these emerging technologies, discuss the implications for physiotherapists, and explore how the resultant changes may challenge some long-held assumptions about the status of the profession in society.

Much media and academic representations of police work focuses on action, and moments of excitement, drama, and danger. In this article, we consider, instead, those long periods of relative inactivity that characterize routine operational policing, which we refer to as times of “nothing” (consciously using quote marks since we argue that these quiet periods are actually opportunities in which valuable work is done). We identify three types of “nothing”: nothing that is inevitable and necessary; nothing as a creative space; and nothing as the absence of demand. We argue that we need to understand these and their part in policing practice. Moreover, recognizing the importance of “nothing” in police work serves as a corrective to politicized representations of policing and can help derail aggressive, hypermasculinized policing tropes.

Objective: Enzalutamide is effective in treating metastatic castrate-resistant prostate cancer (mCRPC) but can have side effects that require treatment breaks (TB). We conducted a retrospective analysis of outcomes of patients who had extended TB due to toxicity compared to continuous dosing. Methods: Patients prescribed enzalutamide for mCRPC from September 2011 to February 2018 were included. TB was defined as an interruption of four weeks or more. Overall survival (OS) from enzalutamide start, time to prostate-specific antigen failure (TTF) and total enzalutamide treatment time (TTT) were analysed for TB and continuous responders (>50% PSA drop), and a significance level of 0.05 was assigned. Results: A total of 110 patients were continuous responders, and 29 had TB. The median number of interruptions was one (range 1–7), and time on treatment was 70% in the TB group. The TB group had significantly improved OS (100 vs. 60 months; hazard ratio=1.8, 95% confidence interval 1.17–2.77, p=0.02), prolonged TTF (median 11 vs. 6 months; p=0.008) and TTT (median 15 vs. 8 months; p=0.0001). Conclusion: Extended TB do not seem to impact OS or treatment duration adversely in patients who are responding and experiencing toxicity, and may be a useful option in managing toxicity. Prospective trials could explore this further. Level of evidence: Level 2c.

Despite efforts to increase the implementation of active teaching and learning in higher education, teaching approaches based on information transfer are still dominant. The slow adoption has been attributed to reluctance on the part of teachers. Active digital pedagogies, such as the flipped classroom, transfer the responsibility for learning to the students, thus challenging the traditional role of the teacher. The purpose of this study was to investigate how flipped classroom supervision is aligned with conceptions of teaching among teachers working in undergraduate physiotherapy education. Data were collected through a focus-group interview with three teachers who had recently participated in flipped classroom supervision and were analysed using qualitative thematic analysis. Supervision in the flipped classroom was viewed mostly positively by the physiotherapy teachers interviewed. The less defined teaching role and the increased social interaction constituted the most radical departure from their previous experiences in traditional teaching environments. The teachers found that the teaching and learning environment enhanced the quality of students’ work. There was no indication that the student-centred pedagogies conflicted with the teachers’ conceptions of teaching and learning. The findings do not support the idea that the existing teaching culture represents a barrier to technology-supported education.

Background People experiencing homelessness have unique health needs and barriers to medical and behavioral health care (mental health, substance use disorder, and overall well-being) compared to housed people. It remains unclear why many people experiencing homelessness do not access care when community-based homeless health care resources are available at low or no cost. This qualitative study examined perspectives of people experiencing homelessness and staff members at community-based homeless health and service organizations in San Francisco’s Mission District on unmet medical and behavioral health needs and barriers to accessing care. Methods We conducted 34 interviews between September and November 2020: 23 with people experiencing homelessness and 11 with staff at community-based homeless health and service organizations in the Mission District. Qualitative interviews were transcribed, coded, and analyzed using the Framework Method on NVivo Qualitative Data Analysis Software. Results Both staff and homeless participants reported unmet and common health needs of mental illness, physical injury and disability, food and nutrition insecurity, and substance use disorder. Barriers to care included negative prior health care experiences, competing priorities, and provider turnover. Recommendations for improving services included building more trust with people experiencing homelessness by training clinic staff to treat patients with respect and patience and expanding clinical outreach and health education programs. Conclusions People experiencing homelessness face many different health needs and barriers to care, some of which community-based organizations have the ability to address. These findings can help inform future strategies for homeless health care programs to identify and target the specific unmet health needs and barriers to care of people experiencing homelessness in their communities.

Police services in England and Wales have developed varied approaches to the use of conditional cautions, and this study examines the effectiveness of one set of reforms: a Revised Conditional Caution Framework. With an overall aim of diverting offenders from the Criminal Justice System and addressing offenders’ criminogenic needs, various programmes of meaningful activity were mandated for offenders. The Revised Conditional Caution Framework refers offenders to a relevant ‘pathway’, to address their offending behaviour(s). If an offender fails to complete the activity within the relevant pathway, without good reason, they revert back through the court system. The aim of the Revised Conditional Caution Framework was to apply meaningful conditions to the conditional caution (e.g. alcohol educational intervention), to focus upon addressing the root cause of the offending behaviour. In this study, the authors evaluated the effectiveness of the Revised Conditional Caution Framework in reducing reoffending. The research was conducted between January 2018 and May 2019 and adopted a mixed methodology of qualitative and quantitative research; notably, focus groups with police officers, semi-structured interviews with offenders and pathway providers and an analysis of police data on offender compliance levels. We found that the Revised Conditional Caution Framework is perceived by many professionals and offenders to provide a platform for tackling the root cause of recidivism and thereby reducing reoffending. It is argued that the premise of Revised Conditional Caution Framework is one that conceives of offending in individualistic terms that pay insufficient attention to the social and economic context in which offending is situated. The article also raises questions about the impact of the Revised Conditional Caution Framework on police professionalism and argues that it might be understood as a restriction on the exercise of discretion since it further restricts officers’ scope to respond to offenders and criminal behaviour.

Background: An internal thoracic artery graft to the left anterior descending artery is standard in coronary bypass surgery, but controversy exists on the best second conduit. The RAPCO trials (Radial Artery Patency and Clinical Outcomes) were designed to compare the long-term patency of the radial artery (RA) with that of the right internal thoracic artery (RITA) and the saphenous vein (SV). Methods: In RAPCO-RITA (the RITA versus RA arm of the RAPCO trial), 394 patients Results: In the RA versus RITA comparison, the estimated 10-year patency was 89% for RA versus 80% for free RITA (hazard ratio for graft failure, 0.45 [95% CI, 0.23–0.88]). Ten-year patient survival estimate was 90.9% in the RA arm versus 83.7% in the RITA arm (hazard ratio for mortality, 0.53 [95% CI, 0.30–0.95]). In the RA versus SV comparison, the estimated 10-year patency was 85% for the RA versus 71% for the SV (hazard ratio for graft failure, 0.40 [95% CI, 0.15–1.00]), and 10-year patient survival estimate was 72.6% for the RA group versus 65.2% for the SV group (hazard ratio for mortality, 0.76 [95% CI, 0.47–1.22]). Conclusions: The 10-year patency rate of the RA is significantly higher than that of the free RITA and better than that of the SV. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00475488.

Background The immune system undergoes a myriad of changes with age. While it is known that antibody-secreting plasma and long-lived memory B cells change with age, it remains unclear how the binding profile of the circulating antibody repertoire is impacted. Results To understand humoral immunity changes with respect to age, we characterized serum antibody binding to high density peptide microarrays in a diverse cohort of 1675 donors. We discovered thousands of peptides that bind antibodies in age-dependent fashion, many of which contain di-serine motifs. Peptide binding profiles were aggregated into an “immune age” by a machine learning regression model that was highly correlated with chronological age. Applying this regression model to previously-unobserved donors, we found that a donor’s predicted immune age is longitudinally consistent over years, suggesting it could be a robust long-term biomarker of humoral immune ageing. Finally, we assayed serum from donors with autoimmune disease and found a significant association between “accelerated immune ageing” and autoimmune disease activity. Conclusions The circulating antibody repertoire has increased binding to thousands of di-serine peptide containing peptides in older donors, which can be represented as an immune age. Increased immune age is associated with autoimmune disease, acute inflammatory disease severity, and may be a broadly relevant biomarker of immune function in health, disease, and therapeutic intervention.

Background: We investigated our institution’s mCRPC enzalutamide or abiraterone patients examining PSA responses and impact of sequencing of these drugs. Methods: All enzalutamide / abiraterone mCRPC patients (2011-2018) were included. Rates of PSA >50% response (PSA50) were compared. Time to treatment failure (TTF) and overall survival (OS) was analysed as per lines of previous therapy and timing of chemotherapy. Results: 363 patients included (Enza n=236, Abi n=127), with 15.6 months median follow-up. PSA50 was greater in enzalutamide group (58% vs 31% p

We present a case of prostate-specific antigen (PSA) bounce in a 76 year old man who underwent salvage radiotherapy to the prostate bed following biochemical relapse 6 years post-radical prostatectomy for a T2N0 Gleason grade 3 + 3 prostate adenocarcinoma; 10 months following completion of salvage radiotherapy for biochemical PSA recurrence of 0.2 μg/L. Following undetectable results (

Our understanding of habitable early Earth environments is limited by the preservation potential of Archean rock deposits. Sedimentary intervals within the relatively homogeneous volcanic sequences of the Barberton Greenstone Belt (BGB), South Africa and Swaziland, and the eastern Pilbara Craton (PC) in Western Australia provide the best windows into interpreting variability in early Earth environments due to their low strain and low metamorphic grade. These deposits host Earth's oldest, most convincing, evidence of life (~3.3-3.5 Ga), and contribute to a better understanding of both the setting and the origin of life (OoL) and the search for life on other planets, such as Mars.The 3481 ± 2 Ma Dresser Formation, PC contains one of these preservation windows. Previous outcrop studies indicate changes in dominant volcanism composition (mafic to felsic), transitions from subaqueous to subaerial sedimentary facies, and large regional tectonic events that promoted circulation of hydrothermal fluids and secondary alteration. Here we present detailed lithologic and mineralogic details of this early Earth surface deposit, obtained from a recent drilling campaign.Three fresh drillcores obtained through the lower chert member of the Dresser Formation (~15 m thickness) were drilled at ~75 m below the weathered surface via HQ diamond drilling. Core sites were selected to provide a 3D perspective of geologic variability. Results show a high degree of complex lithology consisting of repeating bedded black carbonaceous cherts (TOC of up to 0.16 wt %), jaspilitic cherts, bedded carbonates, volcanogenic sandstones, beds of sulfidized stromatolites, edgewise conglomerates, laminated siliceous deposits that are texturally similar to hot spring sinter and directly overlie putative feeder veins, and thin spherulitic beds with petrographic similarities (spherical shapes, quenched features, radial crystal splays, and off-centered vesicles) to younger impact spherule beds. In addition, veins of carbonate, chert, barite and sulfides were identified throughout much of the lower chert member. Lithologic variability occurs on scales of millimetres-decimetres vertically, and from metres to decametres laterally, while mapping of regional scale (kms) stratigraphic sections indicate repetition of specific lithologic successions identified in the cores.The marked heterogeneity and variability both across stratigraphy and along strike contrasts sharply with marine settings, which are relatively homogeneous and consistent over 10’s-100’s of kilometres laterally, and across tens of metres vertically. Younger geologic systems that show similar depositional associations and sharp lateral facies changes include geothermal environments. The presence of sulfidized stromatolites, bedded black cherts, and hot spring deposit indicate that there were a diverse range of habitats (both marine and terrestrial) that hosted life. If spherulitic beds are impactor in origin, they would represent the oldest evidence of a bolide impact in the geologic record. The Dresser Formation provides insights into complex, dynamic, early Earth environments that host apparently already diverse microbial communities adapted to a range of habitats.

Hydrothermal sealing is one of the mechanisms thought to aid pressure build-up within a volcano. Whakaari (White Island), New Zealand’s most active volcano, has a long history of phreatic and phreatomagmatic eruptions, and is ideally suited for an investigation into seal development from conduit-filling lithologies, where little prior experimental evidence exists. Here we provide an insight into Whakaari’s conduit by studying variably altered rocks ejected as ballistics. We find that hydrothermal alteration, particularly acid sulphate alteration, affects conduit-filling lithologies, lavas and tuffs, differently. In inherently low porosity lithologies like lavas, alteration increases fluid pathways by net dissolution of primary minerals and reduces rock stiffness. Counterintuitively, in tuffs that are inherently porous and permeable, alteration decreases fluid pathways by net precipitation of secondary minerals and increases rock stiffness. Such alteration-related pore filling of tuffs together with pore compaction under subsurface pressures can develop zones of low porosity and permeability within the volcano's conduit. When fluid injection rates are high, these zones could aid pressure build-up and predispose the volcano to eruptions. We discuss these results with observed seismicity at Whakaari and provide implications for ground deformation.

There has been increasing interest and research attention towards citizenship-based practices and care within health and social care settings. A framework for implementing citizenship-based interventions has helped support the participation in society of persons who have experienced major life disruptions. Yet, having ways to measure the impact of citizenship 'in action' within specific socio-cultural contexts has proved challenging. We report on the development of the Strathclyde Citizenship Measure (SCM) which seeks to establish a psychometrically sound measure of citizenship that is relevant to the Scottish context. We outline the three phases of developing the SCM: (1) item generation, (2) item reduction and piloting, and (3) measure validation. Having generated items for the SCM using concept mapping techniques, we piloted it with 407 participants who completed an online survey of a 60-item version of the SCM. The aims were to assess the validity of the items and reduce the number of items using principal components analysis for the final measure. This resulted in a 39 item SCM. We then sought to establish the psychometric properties of this shorter version of the SCM through testing its reliability, convergent, concurrent and discriminant validity. The 39 item SCM was administered online to 280 Scottish residents along with additional measures including the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), the Depression, Anxiety and Stress Scale (DASS21), the Sense of Belonging Instrument (SOBI-A); the Big Five Personality Inventory (Shortened Version; BFI-10) and the Personal Social Capital Scale (PSCS-16). The factor structure and dimensionality of the SCM was examined using exploratory factor analysis and it was found to be reliable and valid. This paper explores the potential for the application of the SCM across health and social care settings and identifies future work to develop citizenship tools to facilitate dialogues about citizenship across health and social care practice settings.

IntroductionMultiple stakeholders have recently called for greater research on the barriers to citizenship and community belonging faced by people with mental health challenges. Citizenship has been defined as a person’s access to the rights, roles, responsibilities, resources and relationships that help people feel a sense of belonging. Factors that may impact citizenship include financial precarity; intersecting forms of marginalization and oppression (e.g., racism); and the mental health care people receive. Research has yet to examine experiences of citizenship among youth with mental health challenges. To address this gap, this study will examine how youth experience citizenship; predictors of citizenship; how citizenship shapes recovery; and the degree to which youth are receiving citizenship-oriented care.MethodsThe research objectives will be evaluated using a multiphase mixed methods research design. Quantitative data will be collected cross-sectionally using validated self-report questionnaires. Qualitative data will be collected using a hermeneutic phenomenological method using semi-structured interviews and focus groups.AnalysesMultiple stepwise regression analyses will be used to determine predictors of citizenship and if of citizenship predict recovery. Pearson correlations will be computed to determine the relationship between participants’ perceived desire for, and receipt of citizenship-oriented care. Phenomenological analysis will be used to analyze qualitative data. Findings will then be mixed using a weaving method in the final paper discussion section.ConclusionFindings from this study may support the development of citizenship-oriented healthcare in Canada.

International audience; Simple Summary There have been huge improvements in both vaccination and the management of COVID-19 in patients with cancer. In addition, different variants may be associated with different presentations. Therefore, we examined whether indicators of the severity of COVID-19 in patients with cancer who present to hospital varied during different waves of the pandemic and we showed that these indicators remained predictive. We validated that the COVID-19 Risk in Oncology Evaluation Tool (CORONET), which predicts the severity of COVID-19 in cancer patients presenting to hospital, performed well in all waves. In addition, we examined patient outcomes and the factors that influence them and found that there was increased vaccination uptake and steroid use for patients requiring oxygen in later waves, which may be associated with improvements in outcome. Patients with cancer have been shown to have increased risk of COVID-19 severity. We previously built and validated the COVID-19 Risk in Oncology Evaluation Tool (CORONET) to predict the likely severity of COVID-19 in patients with active cancer who present to hospital. We assessed the differences in presentation and outcomes of patients with cancer and COVID-19, depending on the wave of the pandemic. We examined differences in features at presentation and outcomes in patients worldwide, depending on the waves of the pandemic: wave 1 D614G (n = 1430), wave 2 Alpha (n = 475), and wave 4 Omicron variant (n = 63, UK and Spain only). The performance of CORONET was evaluated on 258, 48, and 54 patients for each wave, respectively. We found that mortality rates were reduced in subsequent waves. The majority of patients were vaccinated in wave 4, and 94% were treated with steroids if they required oxygen. The stages of cancer and the median ages of patients significantly differed, but features associated with worse COVID-19 outcomes remained predictive and did not differ between waves. The CORONET tool performed well in all waves, with scores in an area under the curve (AUC) of >0.72. We concluded that patients with cancer who present to hospital with COVID-19 have similar features of severity, which remain discriminatory despite differences in variants and vaccination status. Survival improved following the first wave of the pandemic, which may be associated with vaccination and the increased steroid use in those patients requiring oxygen. The CORONET model demonstrated good performance, independent of the SARS-CoV-2 variants.

This paper provides a perspective on the recent concept of recovery-oriented systems of care with respect to its origins in the past and its status in the present, prior to considering directions in which such systems might move in the future. Although influential in practice, this concept has yet to be evaluated empirically and has not been the object of a review. Recovery-oriented systems of care emerged from the efforts of persons with mental health and/or substance use disorders who advocated for services to go beyond the reduction of symptoms and substance use to promote a life in the community. Subsequent efforts were made to delineate the nature and principles of such services and those required of a system of such care. Coincident with the U.S. Substance Abuse and Mental Health Services Administration dropping reference to behavioral health in its revised definition of recovery, confusions and limitations began to emerge. Recovery appeared to refer more to a process of self-actualization for which an individual is responsible than to a process of healing from the effects of a behavioral health condition and associated stigma. In response, some systems are aiming to address social determinants of behavioral health conditions that transcend the scope of the individual and to develop a citizenship-oriented approach to promote community inclusion.

This study employed a citizenship measure to explore mental health providers' views of citizenship to support the societal participation of people with mental illnesses, with citizenship defined as a person's (or people's) strong connection to the 5Rs of rights, responsibilities, roles, resources and relationships and a sense of belonging that is validated by others. Providers identified key structural barriers to full citizenship for clients. Their comments reflect openness to citizenship as a framework for understanding their clients and the need for greater access to normative community life, but also skepticism regarding providers' and public mental health centers' abilities to incorporate citizenship approaches in current care models. Findings suggest there are challenges to implementing "citizenship-oriented care" in public mental health settings, but efforts to address these challenges can support the goal of "a life in the community."

The technology at the heart of the most innovative progress in health care artificial intelligence (AI) is in a subdomain called machine learning (ML), which describes the use of software algorithms to identify patterns in very large datasets. ML has driven much of the progress of health care AI over the past 5 years, demonstrating impressive results in clinical decision support, patient monitoring and coaching, surgical assistance, patient care, and systems management. Clinicians in the near future will find themselves working with information networks on a scale well beyond the capacity of human beings to grasp, thereby necessitating the use of intelligent machines to analyze and interpret the complex interactions between data, patients, and clinical decision makers. However, as this technology becomes more powerful, it also becomes less transparent, and algorithmic decisions are therefore progressively more opaque. This is problematic because computers will increasingly be asked for answers to clinical questions that have no single right answer and that are open-ended, subjective, and value laden. As ML continues to make important contributions in a variety of clinical domains, clinicians will need to have a deeper understanding of the design, implementation, and evaluation of ML to ensure that current health care is not overly influenced by the agenda of technology entrepreneurs and venture capitalists. The aim of this article is to provide a nontechnical introduction to the concept of ML in the context of health care, the challenges that arise, and the resulting implications for clinicians.

Purpose People with lived experience of mental health problems (MHPs) are often marginalised and have difficulty achieving community inclusion. Citizenship, a relatively novel concept in mental health, provides a means of understanding what is necessary for marginalised individuals and groups to gain a sense of belonging within their communities. By exploring the “what, why, how and who” of citizenship, the purpose of this paper is to provide a rationale for the inclusion of citizenship as part of a person-centred and holistic mental health strategy. Design/methodology/approach A community-based participatory research (CBPR) approach, with peer researchers, was adopted to develop a model of citizenship within a Scottish context. The aim of the model is to link the concept of citizenship with specific strategies that systems, agencies and individuals can use within mental health policy and practice to promote greater inclusion and participation. Concept mapping was used as part of a mixed-methods participatory methodology and data were then analysed using multivariate statistical methods of multidimensional scaling and hierarchical cluster analysis. Findings It is argued that using a CBPR approach, utilising concept mapping, encourages the development of a model of citizenship that is entirely grounded in the perspectives and lived experiences of people with MHPs. The need for adequate resources, preparatory work, training, research management and reflexive practice are key to the success of a CBPR approach with peer researchers. Originality/value Working with peer researchers and key stakeholder groups is central to a CBPR approach and the implementation of a model of citizenship within mental health policy and practice. Developing a model of citizenship derived specifically from the experiences of people with lived experience is likely to promote their inclusion. It provides a means of challenging the structural deficits and inequalities that cause distress and prevent people with lived experience of MHPs of recovering their citizenship.

This paper explores how New Zealand Police used story-telling as a crucial driver of co-creation in order to affect a major culture change. Using evidence from over 240 semi-structured interviews, our research challenges current thinking about police cultures and shows how allowing members of an agency to develop and share reflective narratives can promote attachment to new cultural values, through sensemaking. In so doing it extends current literature on co-creation and co-production, and the impact of story-telling on power relationships in organizational culture. It suggests that the crafting and sharing of stories enables value-attribution in a co-creative environment.

Purpose The purpose of this paper is to evaluate a long-term programme within a police service that sought to transform the policing of adult sexual assault cases through reforming case management and investigation practices, as well as cultural perspectives among staff. Design/methodology/approach The study is based on a case-study approach of change and reform within a single police service. Fieldwork consisted of more than 240 semi-structured interviews and focus groups with police officers, civilian staff, victim advocates, crown prosecutors, defence lawyers, doctors and staff from victim specialist support agencies. Extensive documentary analysis supplemented the primary findings. Findings Changes to investigations of sexual assault were perceived to be wide-ranging and deeply embedded, and were regarded positively by police officers, staff and external agencies. These are identified in terms of improvements to initial reporting of offences, the development of more rigorous case management and investigations, and enhanced relations with external support agencies. Research limitations/implications The study is necessarily limited to one case study and the analysis would be usefully developed through further application to other police services. Social implications The findings have considerable implications for police leaders and managers and wider society. Victim support and recovery agencies benefit from the reforms outlined, and there are considerable consequences for wider criminal justice that continues to disadvantage victims. Originality/value The paper has considerable originality since it offers a “deep” and “thick” understanding of reform within a particular context. The programme of reform was highly unusual since it was designed and delivered over a ten-year period and addressed many aspects of police organisation.

Background: Citizenship has been promoted within mental health for several decades however, its application in the field of mental health policy and practice is relatively novel. The voices of people who experience mental health problems (MHPs) are often absent in ongoing discourses about citizenship. Aims: To explore how adults with experience of MHPs and other life disruptions identify potential barriers to citizenship.Method: A community based participatory research approach was adopted with peer researchers. Six focus groups (N = 40) using semi-structured interviews were conducted, consisting of participants who had experience of MHPS and other life disruption(s) within the last 5 years. The focus groups were audio recorded, transcribed verbatim and analysed in NVIVO using a thematic approach. Results: Three major themes associated with participants lived experiences of barriers to citizenship were identified: ‘stigmatisation (internal & external) creates further divide’; ‘being socially excluded leads to isolation’; and ‘a sense of difference (as perceived by the self and others)’. Conclusions: Those who have experienced major life disruption(s) face multi-level barriers to citizenship. An awareness of such barriers has important implications for mental health research, policy and practice. Citizenship-oriented implementation strategies that aim to address multi-level barriers merit further investigation.

Citizenship is gaining currency in health and social care internationally as a way of making sense of the lived experiences of people with major life disruptions who face exclusion, marginalisation and discrimination, but the concept is often contested, poorly defined and understood. This paper charts the development of an empirical model of citizenship within Scotland, UK. A mixed-method, community-based participatory research approach using 10 focus groups (n = 77), concept-mapping exercises (n = 45) and statement clarity and relevant ratings (n = 242) was used to develop a model of citizenship that is grounded in the lived experience of participants, which is absent from current conceptualisations of citizenship. Multidimensional scaling and hierarchical cluster analysis revealed five core domains emerging from our work: 'building relationships', 'autonomy and acceptance', 'access to services and supports', 'shared values and social roles' and 'civic rights and responsibilities' representing the personal meanings of citizenship for participants. We argue that the value of this model is that it is draws upon the personal understandings and experiences of participants who emphasised the 'banal ordinariness' of its core elements. We suggest that the model makes an original contribution by clearly illustrating the practical applicability of citizenship as a concept; thus, enhancing existing theories of citizenship. Our model highlights the interplay between the relational and structural aspects of citizenship and acknowledges the barriers that marginalised groups face in claiming their citizenship rights. It offers a call to action for policy makers and practitioners to set goals that contribute to the social inclusion of those who have experienced major life disruptions.

The chapter will outline recent cases and controversies (such as the use of facial recognition at Notting Hill Carnival and the rise of predictive policing) that illustrate emerging debates about wider matters of privacy and data protection in terms of Big Data, and the concern about disproportionality and ethics. It is argued that these are important matters in their own right, but also because each is related to legitimacy, and so public support, trust and confidence in policing. The chapter explores these debates in three parts: Governing AI: challenges of regulating software that is opaque and remains the IP of private software corporations; probably hard for non-specialists to understand; self-learning AI is (by definition) hard to regulate once it is initiated; Privacy: what level of personal information is included? It might be that ‘personal identifiers’ are not included but nonetheless, other characteristics or behaviour are included that actually reveal private information (e.g. that personal health issues can be identified) Disproportionality: the negative spiral that means those already subject to greater police attention become ever more closely targeted. Not only does this raise problems of equity (and legal problems perhaps) it is also inefficient in terms of tackling crime since it misdirects attention away from swathes of offenders who will never become subject to police attention. None of these debates arise solely from the growth of big data policing, they have antecedents. However, it is argued that while there are no simple ‘solutions’ to the problems identified it is important to recognise the nature of these challenges such that they do not get lost in the rush to embrace new technologies and practices of policing.

Data from multiple sources point to the desire for revenge in response to grievances or perceived injustices as a root cause of violence, including firearm violence. Neuroscience and behavioral studies are beginning to reveal that the desire for revenge in response to grievances activates the same neural reward-processing circuitry as that of substance addiction, suggesting that grievances trigger powerful cravings for revenge in anticipation of experiencing pleasure. Based on this evidence, the authors argue that a behavioral addiction framework may be appropriate for understanding and addressing violent behavior. Such an approach could yield significant benefits by leveraging scientific and public health-oriented drug abuse prevention and treatment strategies that target drug cravings to spur development of scientific and public-health-oriented “gun abuse” prevention and treatment strategies targeting the revenge cravings that lead to violence. An example of one such “motive control” strategy is discussed. Approaching revenge-seeking, violence, and gun abuse from the perspective of compulsion and addiction would have the added benefit of avoiding the stigmatization as violent of individuals with mental illness while also acknowledging the systemic, social, and cultural factors contributing to grievances that lead to violent acts.