Cardiac Ventricular Laceration Due to Child Abuse: Abusive Ventricular Laceration

Traumatic cardiac ventricular ruptures in children are rare. Only a single case of left ventricular rupture due to child abuse has been reported. We report a child who sustained a fatal left ventricular apical rupture. It appeared to have resulted from hydrostatic forces resulting from abusive blunt thoracic injury. That he was being abused was previously missed when he was presented to the emergency department with facial pyoderma. It was not noted that he also had lip and oral mucosal injury, sites not affected by staph toxins. As a result, his underlying, abusive and secondarily infected, facial flow type scald burn was not appreciated. Within a week thereafter his fatal injury occurred, accompanied by extensive and obvious associated abusive injuries. Postmortem high‐detail whole body computed tomography scanning aided the autopsy. Although rare, ventricular rupture from abusive blunt thoracic injury can occur.     

Embedding employability skills for the legal professionals of the future

This article provides a case study on embedding employability skills into law courses at one higher education institution. The aim of the project was to further embed employability skills within curriculum delivery as part of a holistic student skills development strategy. The authors used the four-stage process, suggested by the Higher Education Academy’s Framework on Embedding Employability in Higher Education to design the project: defining employability, reviewing and mapping current employability skills, prioritising actions and measuring impact. The authors draw out three ways in which the project has wider potential relevance. From an educational theory perspective, the project represents a way to embed employability skills in a Framework for Higher Education Qualifications level appropriate way, through reference to Biggs’ taxonomy of learning. For higher education institutions, the project is particularly topical in light of the rapidly changing regulatory landscape that is becoming increasingly skills focused in nature. It is suggested that embedding employability in law courses now will assist future institutional engagement with the potentially new route to qualifying as a solicitor through the Solicitors Qualifying Examination. Individual law teachers also reported benefits to embedding employability skills in tutorial sessions from a classroom management perspective.     

Assessing the relevance of self-reported ADHD symptoms and cognitive functioning for psychopathy using the PCL-R and the TriPM

Psychopathy and ADHD are highly comorbid disorders, possibly linked to the underlying trait of impulsivity. It is therefore likely that ADHD symptoms are also of importance when studying cognitive functioning linked to psychopathy. Few studies of psychopathy and cognitive functioning have taken ADHD symptoms into account. In this cross-sectional study, male offenders (n = 201 of whom 105 were neuropsychologically tested) were recruited from all high security correctional facilities in Sweden. The aim of the study was to investigate if self-reported ADHD symptoms and cognitive functioning could predict specific subcomponents of psychopathy in offenders. Results showed that self-rated ADHD symptoms (ASRS) and psychopathy were highly correlated. Furthermore, the associations of ASRS and PCL-R Facet 3, as well as TriPM Disinhibition, were remarkably high. As expected, ASRS was not related to either Facet 1 or 2 of the PCL-R, or to TriPM Boldness. Cognitive functioning did not contribute in predicting psychopathy beyond the effect of ASRS. The high overlap in reported symptoms highlights the importance of thorough clinical assessments to be able to distinguish psychopathic personality traits from ADHD and lessen the risk of misdiagnosis. Further, it points to the need of finding discriminative measures possibly linked to etiological underpinnings.     

Policy entrepreneurship in the development of public sector strategy: the case of London health reform

The development of health policy is recognized as complex; however, there has been little development of the role of agency in this process. Kingdon developed the concept of policy entrepreneur (PE) within his ‘windows’ model. He argued inter-related ‘policy streams' must coincide for important issues to become addressed. The conjoining of these streams may be aided by a policy entrepreneur. We contribute by clarifying the role of the policy entrepreneur and highlighting the translational processes of key actors in creating and aligning policy windows. We analyse the work in London of Professor Sir Ara Darzi as a policy entrepreneur. An important aspect of Darzi's approach was to align a number of important institutional networks to conjoin related problems. Our findings highlight how a policy entrepreneur not only opens policy windows but also yokes together a network to make policy agendas happen. Our contribution reveals the role of clinical leadership in health reform.     

The public health implications of United Kingdom offender healthcare policy: a holistic approach to achieve individual and societal gains

In 2009, two seminal documents were published by the United Kingdom (UK) government concerning healthcare services for offenders. The Bradley review into diversion for people with mental health problems and learning disabilities emphasised a need to improve offender health, not least because of the high economic costs to society as a whole resulting from unresolved mental illness, physical ill-health and substance abuse problems commonly experienced by offenders. The Bradley review made wide-reaching recommendations for change, requiring strong partnership between health and justice agencies at both central government and local levels. A framework for the delivery of Bradley's recommendations has been set out in Improving health, supporting justice, the Department of Health's offender health strategy which sets out the direction of travel for the next 10 years.This paper discusses the reality of working toward improving health services for this marginalised group in the context of the influence of the current straitened financial climate on the allocation of resources to publically funded healthcare in the UK; it examines the historically based, and widely held, belief in the principle of “less eligibility” within our society, whereby there is much public and media resistance to allocating resources to improving care for offenders when other, more “deserving”, groups are perceived to be in continuing need.     

The mental health and substance misuse needs of male ex-armed forces personnel in prison

Ex-armed forces personnel constitute the largest known occupational group in prison but there is little evidence regarding their mental health, or substance misuse, needs. A total of 105 participants were interviewed and measures assessing symptoms of common mental health (CMH) problems and substance misuse were completed along with a review of their health care records. Forty (38%) participants screened for current CMH problems (CCMH) and high levels of dual symptomology and alcohol misuse were assessed. Thirty-nine (37%) had a mental health diagnosis recorded, most commonly for post-traumatic stress disorder (PTSD), depression and personality disorder. Those who screened for a CCMH problem were more likely to have pre-service vulnerability to negative health outcomes and those with dual symptomology were more likely to have experienced deployment during their service. Findings suggest the mental health needs of this group are similar to the general prison population. Potentially higher prevalences of PTSD and alcohol misuse may direct service provision.     

Birds of a Feather Fight Together: Status-Enhancing Violence,Social Distance and the Emergence of Homogenous Gangs

Objectives

This study proposes a theoretical framework for understanding two empirical findings from gang research: (1) gangs are generally racially homogenous, even in heterogeneous environments, and (2) gang violence tends to be intra-racial. We draw from the extensive literature on street gangs as well as from research on group formation and status-enhancing behavior to develop a theoretical model of gang formation.

Methods

Using game theory, we model the simultaneous decisions of individuals to commit status-enhancing acts of violence and to seek protection by joining a gang. We then conduct computer simulations to examine the resulting patterns of violence and gang composition.

Results

We demonstrate that as long as some social distance exists between racial groups in a community, gang violence will be intra-racial and gangs will be homogenous. We find that our results are robust to a number of simple variations of the model and allow us to generate several hypotheses about the nature of gang formation and patterns of violence.

Conclusions

When violence is motivated by socially constructed rewards, socially closer targets are likely to yield greater rewards. In such a system, individuals must reduce their likelihood of victimization by entering a social contract of non-violence (i.e. gang membership) with individuals who might view them as status-enhancing targets (i.e. socially close individuals). The result is that gangs are made up of socially close individuals interested in attacking other socially close individuals. Therefore, gangs tend to be racially homogenous and violence is overwhelmingly intra-racial.

     

The effective design,implementation and enforcement of socio-economic equality duties: lessons from the pupil premium

Abstract

The UK has extremely high levels of socio-economic inequality, which are predicted to rise over the next five years. Traditionally, equality law was seen as inappropriate to address socio-economic inequality but in the last decade, a growing number of equality duties have been introduced to address this persistent form of inequality. There is, however, little research on the principles that underpin these duties. This article seeks to address this gap through the use of data from interviews conducted with primary school personnel implementing the pupil premium. The article explores understandings of socio-economic inequality by individuals in schools; policy conflicts; the wider context of action to address socio-economic inequality; different decision-making processes; and accountability mechanisms. On the basis of the findings of this study, broad principles are outlined to inform the design, implementation and enforcement of socio-economic equality duties in the future.