A realist approach to understanding alliancing within Local Government public health and social care service provision.

BACKGROUND: Within the current context of continued austerity and post-pandemic recovery, it remains important that Local Government services address the increasing needs of residents as cost-effectively as possible. Alliancing, whereby services work collaboratively focusing on the 'whole-system', has gained popularity as a tool with the potential to support collaborative whole systems approaches. This synthesis aims to identify how alliancing can be successfully operationalised in the commissioning of public health, wider National Health Service (NHS) and social care-related services. METHODS: A realist literature synthesis was undertaken in order to identify underlying generative mechanisms associated with alliancing, the contextual conditions surrounding the implementation and operationalisation of the alliancing approach mechanisms, and the outcomes produced as a result. An iterative approach was taken, using a recent systematic review of the effectiveness of Alliancing, online database searches, and grey literature searches. RESULTS: Three mechanistic components were identified within the data as being core to the successful implementation of alliances in public health and social care-related services within Local Government: (i) Achieving a system-level approach; (ii) placing local populations at the heart of the system; and (iii) creating a cultural shift. Programme theories were postulated within these components. CONCLUSIONS: The alliancing approach offers an opportunity to achieve system-level change with the potential to benefit local populations. The realist synthesis approach taken within this study has provided insights into the necessary contextual and mechanistic factors of the Alliancing approach, above and beyond effectiveness outcomes typically collected through more conventional evaluation methodologies.

Psychopathy and arousal: a new interpretation of the psychophysiological literature.

The psychophysiological literature on psychopathy is reviewed in the context of low-arousal theory. Difficulties in the theory are discussed both in general terms and specifically in relation to psychopathy. Contrary to the low-arousal theory, the data indicate that psychopaths exhibit a wider degree of variability in arousal levels and reactivity than normal indiciduals. A more accurate model of the disorder might be one in which psychopaths display a faster rate and a greater magnitude of change in physiological and behavioral activity than normals. It is suggested that psychopathy might be usefully viewed as a biochemical disturbance manifested in abnormal oscillations in neurotransmitter functioning, autonomic activity, and behavior. The literature is reexamined in light of this hypothesis, and a number of avenues for further research are discussed.