Welfare and child support program knowledge gaps reduce program effectiveness

There is little research on knowledge of the policy rules that could affect individuals, either in general or in evaluations of new programs. The lack of research is surprising, given that knowledge gaps could limit the effectiveness of reforms or lead to incorrect inferences regarding the effects of a policy change. In this article, we use survey data to examine the level and sources of welfare participants' policy knowledge in the context of a substantial change in child support and welfare policy in Wisconsin. We find very low levels of knowledge of child support policy rules. Multivariate analyses suggest that people tend to learn policy rules by experience; we find less consistent support for knowledge being primarily imparted through interactions with caseworkers. A difference‐in‐difference analysis suggests that if participants had been more knowledgeable, program impacts would have been larger. Implications of this research for policy implementation and policy evaluations are discussed. © 2007 by the Association for Public Policy Analysis and Management     

Fatal embolism of the anterior spinal artery after local cervical analgetic infiltration

A 66-year-old man received a local infiltration of cortisone and xylocain in the left paravertebral region between the fifth and sixth cervical vertebrae. Respiratory failure occurred 2.5 h later with subsequent successful resuscitation. During the following 2 months of assisted ventilation up to the patients death, tetraplegia with concurrent full consciousness throughout was observed. Magnetic resonance imaging confirmed an ischaemic lesion of the upper anterior cervical myelon. The forensic autopsy revealed pneumonia as cause of death. Neuropathology confirmed anterior infarction at the C2/C3 level of the cervical myelon, with obstruction of the anterior spinal artery by an epithelialised fibrocartilaginous embolus. The autoptic findings suggest that this embolus stems from the site of previous analgetic infiltration, with accidental laceration of an intervertebral disc and subsequent transportation of discous material via injection canula into an artery.