Overlooking Feigning Behavior May Result in Potential Harmful Treatment Interventions: Two Case Reports of Undetected Malingering

Clinicians tend to overestimate their ability to recognize feigning behavior in psychiatric patients, especially if it concerns patients who have been admitted for observation. Feigning can be either externally motivated (e.g., for financial compensation, known as malingering) or internally motivated (e.g., to assume the “sick role,” known as factitious disorder). Persistent presentation of severe symptoms is usually associated with the factitious disorder. We present two patients with strong external incentives who consistently and convincingly feigned severe psychiatric symptoms during a protracted period of inpatient observation in a specialized center; both were engaged in a procedure for medical asylum. The first case presented with the clinical picture of a psychotic depression with severe motor symptoms, and the second case showed symptoms of a chronic post-traumatic stress disorder with secondary psychotic symptoms. Both cases were thoroughly investigated but feigning was overlooked, and unnecessary and harmful treatment interventions were given. To prevent iatrogenic damage, we recommend a critical attitude that takes malingering as an option into account in settings where patients are often involved in high stake legal procedures. A clinical sign that might indicate feigning is therapy-resistant symptoms. To rule out feigning a comprehensive, multimethod approach is required, but an active stance toward collateral information is essential. Specialized psychological tests may be useful for preliminary screening, but for their use in culturally diverse populations as in refugee mental health more research is needed.     

Examination of Hacking and Blunt Force Skeletal Trauma

Hacking trauma is prevalent in forensic cases involving genocide and dismemberment, but research into the identification of this type of trauma is lacking. The present study examines characteristics of hacking and blunt force skeletal trauma in order to determine if there is a point at which blunt force trauma becomes distinguishable from hacking trauma. Ten implements with a range of blade angles (i.e., the striking surface of the implement) were used in conjunction with a controlled-force hacking device to impact 100 limb bones of white-tailed deer (Odocoileus virginianus). Observations of the trauma included the occurrence and degree of fragmentation, the entrance widths of the impacts, and composite scores of six hacking characteristics, especially the distinctive V-shaped kerf. ANOVA tests and regression analyses were used to assess the relationships between these characteristics and the blade angles. A significant relationship (p-value = 0.011) was found between the composite hacking scores and the blade angles, indicating that blunt force and hacking trauma can be distinguished. The entrance widths of the impacts exhibited a significant relationship with the blade angles (p-value = 0.037). There was also a significant relationship between the visibility of a V-shaped kerf in the bones (p-value = 0.003), with visibility decreasing around the 60° blade angle. These data should assist in establishing guidelines to differentiate hacking and blunt force skeletal trauma in cases where the implement is on a spectrum between sharp and blunt.     

What Draws Politicians’ Attention? An Experimental Study of Issue Framing and its Effect on Individual Political Elites

What politicians devote attention to, is an important question as political attention is a precondition of policy change. We use an experimental design to study politicians’ attention to incoming information and deploy it among large samples of elected politicians in three countries: Belgium, Canada, and Israel. Our sample includes party leaders, ministers and regular members of parliament. These elites were confronted with short bits of summary information framed in various ways and were then asked how likely it was that they would read the full information. We test for three frames: conflict, political conflict, and responsibility. We find that framing moderates the effect of messages on politicians’ attention to information. Politicians react more strongly (i.e., they devote more attention) to political conflict frames than to non-political conflict frames and they react stronger to political responsibility attributions than to non-political responsibility attributions. Conflict frames attract more attention than consensus frames only from members of opposition parties. Political conflict frames attract more attention from government party politicians. These effects occur largely across issues and across the three countries.     

Paying for Happiness: Experimental Results from a Large Cash Transfer Program in Malawi

This study analyzes the short‐term impact of an exogenous, positive income shock on caregivers’ subjective well‐being (SWB) in Malawi using panel data from 3,365 households targeted to receive Malawi's Social Cash Transfer Program that provides unconditional cash to ultra‐poor, labor‐constrained households. The study consists of a cluster‐randomized, longitudinal design. After the baseline survey, half of these village clusters were randomly selected to receive the transfer and a follow‐up was conducted 17 months later. We find that the short‐term impact of household income increases from the cash transfer leads to substantial SWB gains among caregivers. After a year's worth of transfers, caregivers in beneficiary households have higher life satisfaction and are more likely to believe in a better future. We examine whether program impacts on consumption, food security, resilience, and hopefulness could explain the increase in SWB but do not find that any of these mechanisms individually mediate our results.     

Management strategies in response to an institutional crisis: The case of earthquakes in the Netherlands

When a policy sector is confronted with a relatively strong and steep decline in legitimacy, we speak of an institutional crisis. We know little about the causes or consequences of these crises. This article explores how institutional crises are managed. It focuses on the effects of management strategies observed in a case study of an institutional crisis in the Netherlands. While we found that policy elites displayed a tendency to maintain the status quo of a policy sector, we also found that the effectiveness of their response strategies was negated by the counter‐response it evoked among freshly energized interest, advocacy and citizen groups. We conclude that the resolution of an institutional crisis is inherently contested. Based on our case study, we develop a theoretical model and formulate propositions that may help to improve our understanding of institutional crisis management.     

Government Communication Effectiveness and Satisfaction with Police Performance: A Large‐Scale Survey Study

For the last two decades, performance management theories and practices have focused on outcome‐oriented management but have paid little attention to the role of public communication. Using multiple large data sets from Kansas City, Missouri, for 2009–14, this research suggests that the perceived effectiveness of public communication has a more substantial impact on public satisfaction with police protection and crime prevention than neighborhood crime rates and broken windows factors and that perceived effectiveness moderates the negative impact of crime rates. After controlling for residents’ demographic characteristics, the authors find that the perceived effectiveness of communication is associated with public satisfaction with the content and quality of the city website and the government television channel. The implications for public safety management and police–citizen relations as well as directions for future research on public communication strategies and public performance management are presented.     

Ideologically Sophisticated Donors: Which Candidates Do Individual Contributors Finance?

Individuals are the single largest source of campaign contributions, yet we know little about their motivations. For instance, the existing literature questions whether individual contributors sophisticatedly differentiate among candidates according to policy positions, particularly among same‐party candidates. We analyze this issue by combining data from a new survey of over 2,800 in‐ and out‐of‐state donors associated with the 2012 Senate elections, FEC data on contributors’ professions, and legislative records. Three major findings emerge. First, policy agreement between a donor's positions and a senator's roll calls significantly influences the likelihood of giving, even for same‐party contributors. Second, there is a significant effect of committee membership corresponding to a donor's occupation; this holds even for donors who claim that other motivations dominate, but it does not appear to be motivated by an expectation of access. Third, conditional upon a donation occurring, its size is determined by factors outside a legislator's control.     

Child Health in Elementary School Following California's Paid Family Leave Program

We evaluate changes in elementary school children health outcomes following the introduction of California's Paid Family Leave (PFL) program, which provided parents with paid time off following the birth of a child. Our health outcomes—overweight, ADHD, and hearing‐related problems—are characterized by diagnosis rates that only pick up during early elementary school. Moreover, our health outcomes have been found to be negatively linked with many potential implications of extended maternity leave—increased breastfeeding, prompt medical checkups at infancy, reduced prenatal stress, and reduced non‐parental care during infancy. Using the Early Childhood Longitudinal Studies (ECLS) within a difference‐in‐differences framework, our results suggest improvements in health outcomes among California elementary school children following PFL's introduction. Furthermore, the improvements are driven by children from less advantaged backgrounds, which is consistent with the notion that California's PFL had the greatest effect on leave‐taking duration after childbirth mostly for less advantaged mothers who previously could not afford to take unpaid leave.