Patient and prisoner experiences : major mental illness and masculinity in the context of violent offending behaviour

Traditional understandings of violence by the mentally disordered largely look to mental illness to explain such behaviour. More recently, research has begun to examine the role of alternative factors in driving violent offending in this context. Masculinity is one such factor to which little consideration has thus far been given, in spite of a wealth of literature which associates the construction and maintenance of a masculine identity with violence in the non-mentally disordered context. This thesis proceeds from these current understandings, and examines the nature of the relationship between mental illness, masculinity and violent behaviour. In order to examine this issue, interviews were conducted with a group of 10 male patients diagnosed with major mental illness and with violent offending histories, in a medium secure forensic psychiatric hospital in Scotland. A group of 10 male prisoners serving life sentences in a Scottish adult male prison following convictions for homicide offences were also interviewed, and acted as a comparator group. Following an analysis of these interviews, findings emerged in relation to three key areas of patients’ and prisoners’ accounts: past experiences of violent offending, present experiences of institutional settings, and future hopes for recovery and desistance. In particular, significant similarities and divergences in the experiences of the two groups were apparent, and this thesis advances two key arguments in light of this. Considering first the similarities in patients’ and prisoners’ experiences, it is posited here that for both the mentally ill and non-mentally ill male population the task of constructing and maintaining a masculine identity is a particularly pervasive force in their life histories. It will be demonstrated that for patients and prisoners in this study, masculinity plays a significant role in past violent offending, as well as having important implications for adaptation to present institutional settings, and the creation of a recovered and desisting identity for the future. Second, in looking to the divergences in patients’ and prisoners’ accounts, it is asserted that where major mental illness is present it serves to intercede in these three areas of men’s lives. Extracts from interviews with male patients will illustrate the interceding role of mental illness in violent scenarios from their pasts. In addition, it will be demonstrated that patients’ and prisoners’ respective present situations in institutional settings vary, as diagnosis of mental illness leads patients to be placed in a secure hospital rather than the prison, and the differing nature of these environments results in divergences in adaptation to these settings. Finally, in relation to the future, while prisoners focussed on their hopes for desistance from offending, the diagnosis of mental illness led patients to place recovery from such disorders as the primary process at this point

Building Communities and Enhancing Belonging: A Route Map for Assessment Design

A sense of belonging to a community in HE has been linked to positive outcomes for students such as increased engagement, identity development and retention (Masika & Jones, 2015; Soria & Stubblefield, 2015) and has emerged as a buffer to declining mental health following the COVID-19 pandemic (Gopalan et al., 2021).A key challenge for students undertaking assessment and engaging in feedback is that it tends to be an individual experience and often fraught with stress. Through dialogue with staff and students, our research project established that assessment and feedback practices mediate belonging and communities in unseen ways. Meaningful interactions between staff and students can have a lasting impact on their work and make them feel that they matter (Gravett & Ajjawi, 2022), for example, group assignments support the formation of communities that outlast assessment deadlines.The following route map draws on our project findings to provide key questions and ideas for how to support a sense of belonging at each stage in the assessment design journey

The Impact of COVID-19 on the Justice Voluntary Sector

Executive summaryThis report presents findings from two research projects exploring the impact of the COVID-19 pandemic on third sector justice organisations and workers in Scotland. This work has been funded by the Criminal Justice Voluntary Sector Forum in partnership with Community Justice Scotland, and the Scottish Funding Council COVID-19 Response Scheme. Qualitative individual semi-structured interviews and a group interview explored the impacts of the pandemic on third sector justice organisations, the added value of the sector during the pandemic, efficiencies and good practice that should continue, and key challenges facing the sector. Key findings• The sector has adapted to the pandemic with agility and flexibility, continuing to support their service users despite increasing demand and increasing complexity of service users’ vulnerabilities. They have additionally filled gaps due to statutory organisations in particular failing to adapt or being unable to keep up with demand.• Face-to-face working is essential for building and maintaining relationships that underpin effective service provision, as well as reducing isolation, and it is imperative that this be retained.• Despite difficulties of working remotely, there have been notable positives and good practice that organisations are keen to share and retain. • Organisations are still reactive rather than being able to develop preventative approaches facilitating early intervention. This was the case prior to the pandemic but has been exacerbated by the events of the last two years. • The justice voluntary sector faces a staffing crisis resulting from the loss of experienced and dedicated staff, as well as far fewer applicants to vacant posts. • As is well documented, the precarious funding and short-term funding cycles pose significant challenges to sustainability of the sector in terms of service provision and staffing.• Though the pandemic has for some facilitated the development of valuable partnerships, third sector organisations are still largely excluded from discussions and decisions impacting them. Their value needs to be more clearly recognised outside of the sector. Local authorities need to genuinely partner with the justice voluntary sector to ensure that the needs of their local populations are met

Student Belonging Good Practice Guide

This Good Practice Guide offers a toolkit and a conversation starter for anyone working in higher education (HE) who is thinking about embarking on a student belonging project. As well as sharing hints and tips, it draws upon student belonging insights via case studies, an extended literature review and student voice. We aim to provide those of you working within student partnerships or with a professional interest in student engagement easy access to key definitions and debates in the field of student belonging. As this guide provides a shorthand to the contexts of student belonging, we anticipate readers may wish to use the ideas presented here during your curriculum planning or project setting phase, to ensure student voice, orientation and partnership working are at the core of your academic lifecycles and institutional activity preparations. We hope this guide will help you to facilitate communication, influence policy and encourage focus and investment in student engagement in your institution. We believe in being inclusive so much of what you read below will describe student belonging and engagement through this lens. Through our case studies this guide will touch on key themes aligned to student belonging and engagement: student voice, student-staff collaborative working, transitions and orientation, the student journey/lifecycle. These cases are a work in progress – we don’t have all the answers (yet) but we do hope it will be useful to those of you who are looking to explore methods to gain further insights into student mattering, engagement and identity. We will discuss initial findings and the next steps that the partner institutions have adopted but in the main these case studies will set the scene for others wishing to follow suit. Throughout the case studies we offer tools for colleagues in higher education institutions (HEI) to use – these include pre-arrival survey questions, and activities to harness self-perceived student identity and attachment to the university. However, these are not prescriptive; we recognise that each institution will need – and should, in the name of good practice – use these as conversation starters or prompts for approaches that are specific and tailored to your institution and its unique student body.This guide is the output of a RAISE Network-funded project, in partnership with Teesside University, Edinburgh Napier University and Nottingham Trent University. Researching Advancing and Inspiring Student Engagement (RAISE) is a worldwide network of staff and students in HE who work or have an interest in the research and promotion of student engagemen

Reduced lymphatic reserve in heart failure with preserved ejection fraction

Background: Microvascular dysfunction plays an important role in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). However, no mechanistic link between systemic microvasculature and congestion, a central feature of the syndrome, has yet been investigated. Objectives: This study aimed to investigate capillary–interstitium fluid exchange in HFpEF, including lymphatic drainage and the potential osmotic forces exerted by any hypertonic tissue Na+ excess. Methods: Patients with HFpEF and healthy control subjects of similar age and sex distributions (n = 16 per group) underwent: 1) a skin biopsy for vascular immunohistochemistry, gene expression, and chemical (water, Na+, and K+) analyses; and 2) venous occlusion plethysmography to assess peripheral microvascular filtration coefficient (measuring capillary fluid extravasation) and isovolumetric pressure (above which lymphatic drainage cannot compensate for fluid extravasation). Results: Skin biopsies in patients with HFpEF showed rarefaction of small blood and lymphatic vessels (p = 0.003 and p = 0.012, respectively); residual skin lymphatics showed a larger diameter (p = 0.007) and lower expression of lymphatic differentiation and function markers (LYVE-1 [lymphatic vessel endothelial hyaluronan receptor 1]: p < 0.05; PROX-1 [prospero homeobox protein 1]: p < 0.001) compared with control subjects. In patients with HFpEF, microvascular filtration coefficient was lower (calf: 3.30 [interquartile range (IQR): 2.33 to 3.88] l × 100 ml of tissue–1 × min–1 × mm Hg–1 vs. 4.66 [IQR: 3.70 to 6.15] μl × 100 ml of tissue–1 × min–1 × mm Hg–1; p < 0.01; forearm: 5.16 [IQR: 3.86 to 5.43] l × 100 ml of tissue–1 × min–1 × mm Hg–1 vs. 5.66 [IQR: 4.69 to 8.38] μl × 100 ml of tissue–1 × min–1 × mm Hg–1; p > 0.05), in keeping with blood vascular rarefaction and the lack of any observed hypertonic skin Na+ excess, but the lymphatic drainage was impaired (isovolumetric pressure in patients with HFpEF vs. control subjects: calf 16 ± 4 mm Hg vs. 22 ± 4 mm Hg; p < 0.005; forearm 17 ± 4 mm Hg vs. 25 ± 5 mm Hg; p < 0.001). Conclusions: Peripheral lymphatic vessels in patients with HFpEF exhibit structural and molecular alterations and cannot effectively compensate for fluid extravasation and interstitial accumulation by commensurate drainage. Reduced lymphatic reserve may represent a novel therapeutic target

Negative stereotypes of the Scottish diet:A qualitative analysis of deep-fried Mars bar references in best selling newspapers in Scotland, 2011-14

AbstractThe Scottish diet is associated in the UK media and popular discourse with unhealthy deep-fried foods. In addition to the stereotype's negative effects on perceptions of Scottish food, culture and people, there is evidence that the stereotype of the Scottish diet has negative effects on food behaviour and public health in Scotland, having been shown to encourage consumption of deep-fried foods and discourage positive dietary change. The most notorious deep-fried food associated with Scotland is the deep-fried Mars bar (DFMB), arguably invented in Stonehaven (near Aberdeen), and first reported in the Scottish and UK press in 1995. This article reports findings from an analysis of newspaper references to the DFMB in the two highest selling newspapers in Scotland, the Scottish Sun and the Daily Record, between 2011 and 2014. A keyword search (“deep fried Mars bar”) using the online media database Lexis Library generated 97 unique records, and the resulting dataset was analysed thematically and discursively. Analysis showed that both newspapers clearly associated the DFMB with Scotland. Further, both newspapers portrayed the DFMB and the broader “deep-fried” Scottish diet stereotype ambivalently (mixed positive and negative associations). However, the Daily Record actively criticised the DFMB stereotype much more often than did the Scottish Sun. These findings suggest that the Scottish population encounters different messages in the press about food and nutrition from people elsewhere in the UK, and that these messages vary depending on choice of media in Scotland. Given the known negative effects of the stereotype, differences in Scottish media discourse should be considered a potential factor in persistent health inequalities affecting Scotland. Educational efforts, and opening discussion with journalists and amongst the Scottish public, may be helpful

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

Functional and quality of life outcomes of localised prostate cancer treatments (prostate testing for cancer and treatment [ProtecT] study)

Objective To investigate the functional and quality of life (QoL) outcomes of treatments for localised prostate cancer and inform treatment decision-making. Patients and Methods Men aged 50–69 years diagnosed with localised prostate cancer by prostate-specific antigen testing and biopsies at nine UK centres in the Prostate Testing for Cancer and Treatment (ProtecT) trial were randomised to, or chose one of, three treatments. Of 2565 participants, 1135 men received active monitoring (AM), 750 a radical prostatectomy (RP), 603 external-beam radiotherapy (EBRT) with concurrent androgen-deprivation therapy (ADT) and 77 low-dose-rate brachytherapy (BT, not a randomised treatment). Patient-reported outcome measures (PROMs) completed annually for 6 years were analysed by initial treatment and censored for subsequent treatments. Mixed effects models were adjusted for baseline characteristics using propensity scores. Results Treatment-received analyses revealed different impacts of treatments over 6 years. Men remaining on AM experienced gradual declines in sexual and urinary function with age (e.g., increases in erectile dysfunction from 35% of men at baseline to 53% at 6 years and nocturia similarly from 20% to 38%). Radical treatment impacts were immediate and continued over 6 years. After RP, 95% of men reported erectile dysfunction persisting for 85% at 6 years, and after EBRT this was reported by 69% and 74%, respectively (P < 0.001 compared with AM). After RP, 36% of men reported urinary leakage requiring at least 1 pad/day, persisting for 20% at 6 years, compared with no change in men receiving EBRT or AM (P < 0.001). Worse bowel function and bother (e.g., bloody stools 6% at 6 years and faecal incontinence 10%) was experienced by men after EBRT than after RP or AM (P < 0.001) with lesser effects after BT. No treatment affected mental or physical QoL. Conclusion Treatment decision-making for localised prostate cancer can be informed by these 6-year functional and QoL outcomes