Targeting the Most Harmful Offenders for an English Police Agency: Continuity and Change of Membership in the “Felonious Few”

Funder: University of CambridgeAbstract Research Question How concentrated is the total harm of offences with detected offenders (identified suspects) among the complete list of all detected offenders in a given year in an English police agency, and how consistent is the list of highest-harm “felonious few” offenders from one year to the next? Data Characteristics of 327,566 crimes and 39,545 unique offenders as recorded by Northamptonshire Police in 7 years from 2010 to 2016 provide the basis for this analysis. Methods Crime and offender records were matched to harm weightings derived from the Cambridge Crime Harm Index (Sherman et al. 2016a; Sherman et al., Policing, 10(3), 171–183, 2016b). Descriptive statistics summarize a concentration of harm identifying the felonious few, changes over time in membership of the “few”, offender typologies and tests for escalation of severity, frequency and intermittency across repeated offences. Findings Crime harm is much more concentrated among offenders than crime volume: 80% of crime harm that is identified to an offender is linked to a felonious few of just 7% of all detected offenders. While chronic repeat offenders are the majority contributors to harm totals of this group, those with the most general range of offence types contribute the most harm. Individual members of the felonious few rarely maintain that position year on year; over 95% of each year’s list is composed of individuals not present in previous years. Within individual crime histories, we observe a pattern of de-escalation in crime harm per offence over time. “One-time” offenders, those with just one crime record, typically made up a third of the felonious few in both number and harm contribution. Conclusions These findings demonstrate the potential to target a small number of repeat offenders for harm reduction strategies using a metric of total crime severity, not just volume, despite a substantial portion of crime harm caused by one-time offenders that may be largely unpredictable. </jats:sec

Aligning Policing and Public Health Promotion: Insights from the World of Foot Patrol

Foot patrol work is rarely described in relation to public health, even though police routinely encounter health risk behaviors and environments. Through a qualitative study of foot patrol policing in violent ‘hotspots’ of Philadelphia, we explore some prospects and challenges associated with bridging security and public health considerations in law enforcement. Noting existing efforts to help advance police officer knowledge of, and attitudes toward health vulnerabilities, we incorporate perspectives from environmental criminology to help advance this bridging agenda. Extending the notion of capable guardianship to understand foot patrol work, we suggest that the way forward for theory, policy, and practice is not solely to rely on changing officer culture and behavior, but rather to advance a wider agenda for enhancing collective guardianship, and especially ‘place management’ for harm reduction in the city

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

The effectiveness of police intelligence management: a New Zealand case study

Intelligence-driven policing strategies are coming to the fore in many countries around the world. This is evidenced by the espousal of the term in the mission statements of police services in Australia and New Zealand, the recent adoption of the National Criminal Intelligence Sharing Plan by the US government, and most notably by the legal commitment to the National Intelligence Model in the UK through the Police Reform Act of 2002. This paper considers intelligence-driven crime reduction as a three-stage process, requiring that: law enforcement interpret the criminal environment, influence decision-makers, and finally that decision-makers impact on the criminal environment. This 3i model (interpret, influence, impact) is used as the framework for an evaluation of the intelligence process in three New Zealand police districts. The results of interviews with 50 decision-makers and intelligence staff suggest that there are difficulties identifying a clear decision-making structure and that there is perceived to be a lack of understanding of intelligence-led policing at the leadership levels of the organization. Furthermore, issues with training, and data quality and availability hamper the ability of intelligence analysts to contribute to the crime reduction effort. This lack of clarity in intelligence use and application may have a negativ