Equity and cost-effectiveness of multilateral adaptation finance: are they friends or foes?

This paper analyzes potential criteria to allocate international funding for adaptation to climate change, as a response to one of the main governance challenges of international adaptation funding—the prioritization of project proposals given scarce funding. Based on the review of the equity and cost-effectiveness literature and relevant policy documents, we identify three potential indicators for equity (vulnerability level, poverty, equal funding per capita), and three indicators for cost-effectiveness (economic savings in absolute and relative terms, human lives saved). Applying these simple indicators to information provided in all 39 project documents considered by the Adaptation Fund Board (AFB) in 2011, we find that projects approved or endorsed by the AFB rank high according to one cost-effectiveness indicator (absolute economic savings), while they rather rank low according to all equity and further cost-effectiveness indicators. Furthermore, we analyze whether equity and cost-effectiveness are two contradicting goals, or whether ways can be found to reconcile both goals in multilateral adaptation finance. We conclude from both the theory and the 39 analyzed project documents that a pure economic definition of cost-effectiveness tends to be in contradiction with equity but that trade-offs between equity and cost-effectiveness can be limited if relative economic savings or human live savings are used as indicator for cost-effectiveness.     

Neuropsychological,Psychological, and Vocational Assessment of High Achievers in a Medicolegal Context

High achievers are a unique subset of persons referred for neuropsychological and psychological assessments in medicolegal contexts, including personal injury, disability, and workers’ compensation cases. Literature in this area is limited and poorly integrated, and neither a conceptual model nor best evidence-informed practices for the assessment of high achievers in the medicolegal context have yet emerged. Construct and methodological issues also hamper the ability of assessors to accurately and fairly assess this specialist group, which is particularly troubling in high-stakes forensic assessments. This paper reviews the current methodological issues involved in the assessment of high achievers and proposes an integrated, multimethod assessment model based on a particular vocational group, namely that of business leaders and entrepreneurs, that draws from available empirical research in different fields of psychological inquiry.     

Neurocognitive Disorders in DSM-V: Forensic Perspective

Although determination of diagnosis of cognitive impairments constitutes one of the core objectives of forensic neuropsychological assessment, the diagnostic criteria for cognitive disorders provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association 2000) have been of low internal and external validity and limited utility. This paper reviews the evolution of diagnosis of cognitive disorders from current DSM-IV-TR to the proposed DSM-V (American Psychiatric Association 2010). The conceptual framework is tracked, along with the body of literature associated with the DSM-V proposal on Minor and Major Neurocognitive Disorders. The quality of evidence for internal and external validity is reviewed, as well as the fairness and utility of newly proposed diagnoses from both clinical and forensic perspectives. Significant conceptual, evidentiary, psychometric, assessment, and practical questions are raised related to the new classification, and recommendations are offered for improvement to the proposal of the DSM-V Work Group on Neurocognitive Disorders.     

Beyond Traumatic Brain Injury: Advancing Forensic Neuropsychological Assessment

As research on the cognitive impact of medical conditions and mental health disorders advances, it is imperative for forensic neuropsychologists to stay abreast of rapidly accumulating new empirical evidence from neuroscience and neuropsychology to disentangle multiple determinants of cognitive impairment. Although medicolegal neuropsychological assessments traditionally focused on traumatic brain injury (TBI) sequelae, it is equally important to consider the potential impact of any other acquired, or secondarily induced brain impairments, regardless of their source. Such injuries or conditions are at times assumed to cause a lesser cognitive impact than TBIs; however, their effects depend entirely on the factor in question. Injuries and illnesses implicated in civil litigation—and eventually affecting competency—can indeed involve TBI, but also anoxic/hypoxic injuries, pain, depression, posttraumatic stress disorder (PTSD), sensory deficits (e.g., tinnitus), and fatigue, and all, in turn, can affect an individual’s cognitive function and quality of life. Impairments caused by these conditions can be disabling and resistant to treatment, particularly, when the treatment is based on incorrect diagnostic, prognostic, and causality assumptions.     

Anoxia-Hypoxia in Forensic Neuropsychological Assessment: Cognitive Impact of Pulmonary Injuries,Respiratory Distress,Cerebral Blood Hypoperfusion,and Major Surgeries

Pulmonary injuries, respiratory distress, blood loss-related cerebral blood perfusion, and major surgeries are common features of medical histories in forensic neuropsychological assessments. Unless the explicit reason for referral is determination of the cognitive impact of one of these adverse medical conditions, their contribution to neuropsychological causality determination can be overlooked, minimized, or misattributed to other causes. Given the underlying common denominator among these conditions, that is, sub-optimal oxygen delivery to the brain, transient or long-term debilitating injuries causing neuropsychological change of various degrees can result. A thorough understanding of the impact of these medical events is paramount in forensic neuropsychological assessment for diagnosis, causality, and functional impact determination, prognosis, rehabilitation, and recommendations. In this paper, we critically review the available empirical evidence regarding anoxia and hypoxia arising from pulmonary injuries and respiratory distress, cerebral blood hypoperfusion, and major surgeries, together with evidence of their impact on cognitive functioning. Medical and psychological electronic search engines [PubMed, PsycINFO, and Google Scholar (up to January 2018)] have been screened for neuroscience-related and neuropsychological literature pertaining to pulmonary injuries and respiratory distress, cerebral blood perfusion, and major surgeries, and subsequently optimized for the issue under review.     

DSM-5 Neurocognitive Disorders: Validity, Reliability, Fairness, and Utility in Forensic Applications

A previously published paper (Schultz Psychological Injury and Law 3: 271–288, 2010) on forensic considerations regarding neurocognitive disorders within the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5; American Psychiatric Association, 2013) reviewed evidence for internal and external validity, as well as the fairness and utility of the proposed classification. Given recent publication of the DSM-5, in May 2013, the current paper provides an update on this review. It focuses on changes in the final version of the neurocognitive disorders section of the DSM-5 as compared with the earlier proposal in 2010 and raises a range of new conceptual, methodological, and clinical practice issues related to this classification. An examination of forensic neuropsychologists’ diagnostic choices and their associated pitfalls follows. Discussion extends to the unresolved issue of disorder threshold, associated risks of overdiagnosis of mild neurocognitive disorder and underdiagnosis of major neurocognitive disorder, and the absence of a moderately severe disorder classification. Methodological concerns in diagnostic determinations, especially with DSM-5 Criteria A and B, issues associated with subtypes and specifiers, as well as functional assessments of activities of daily living, now embedded in the diagnosis, follow. Subtype omissions and methodological inconsistencies are highlighted.The vulnerability of neuropsychologists and psychiatrists during courtroom testimony on neurocognitive disorders-particularly with conceptual, methodological, and practical issues-will be addressed through clinical and forensic practice recommendations.     

Early Intervention with Compensated Lower Back-Injured Workers at Risk for Work Disability: Fixed versus Flexible Approach

Low back pain (LBP), a leading cause of disability, has been linked with profound economic, personal, and social costs (Hills 2006; World Health Organization 2003). This significant effect propels research in identifying modifiable risk factors that protract LBP; these factors can be targeted in early intervention (EI) (Pransky, Journal of Occupational & Environmental Medicine, 49(3):249–251, 2007; Schultz et al., Journal of Occupational Rehabilitation, 17:327–352, 2007, Journal of Occupational Rehabilitation, 18(2), 140–151, 2008; White et al. 2013). This randomized controlled study evaluated the effectiveness of two approaches, fixed versus flexible, in delivering proactive, interdisciplinary EI with 63 workers within a workers' compensation interdisciplinary case management setting (i.e., WorkSafeBC, Canada). Off-work 4 to 10 weeks post-back injury, the workers were also at risk of protracted work disability (N?=?24 at high risk; N?=?39 at moderate risk). Fixed, protocol-driven, interdisciplinary, multimodal, clinical, occupational, and case management-based EI was compared with a flexible, individual need-driven EI with the same modalities as the fixed approach. Results showed a significant narrowing of the outcome gap between the two interventions. High-risk injured workers tended to benefit more from a fixed, protocol-driven approach, as shown in the pilot study (Schultz et al. Journal of Occupational Rehabilitation, 18(2), 140–151, 2008). The results indicated that moderate-risk workers benefitted from a more flexible, need-based, individual, and low-intensity approach as compared with a fixed approach. The flexible approach for moderate-risk workers was also less costly and consumed fewer rehabilitation and health care resources. Recommendations for future research and practice included larger sample sizes, controllability of research interventions, risk for disability-EI matching, and conditions under which a flexible delivery of multimodal EI is more efficacious than a fixed approach, and vice versa.     

Between Euroscepticism and Eurosupport: The Attitudes of Urban and Rural Populations in Poland 2000–2008

Three main factors explain public support for EU membership: utilitarian expectations, the role of values and ideas, and class partisanship. In the Polish case, public opinion polls and issues more specific to Poland, such as the role of the Catholic Church, populist political parties and profound Euroscepticism among farmers, suggest that although these theoretical explanations overlap, each of them has a different explanatory value. The economic approach remains the best predictor of support for EU membership, and whereas values and identity are closely linked to and dependent upon economic expectations, the impact of national politics appears largely decoupled from Polish Euroscepticism.     

Making Civilian Casualties Count: Approaches to Documenting the Human Cost of War

Our understanding of civilian casualties is not based solely on what is reported but also who reports these human rights abuses. Competing interests at the data collection stage have impeded the development of a more thorough understanding of civilian victimization during conflict. We find that current definitions of “casualty” neglect nonphysical forms of victimization and that group-based definitions of “civilian” can obscure the role of different individuals in conflict. We contend that the dominant definition of “civilian casualty” should be expanded to include the full array of harm inflicted on individuals, including psychological harm and what we refer to as multiple casualties of conflict. Expanding our definition of civilian casualties to include different degrees and kinds of wartime victimization would improve both documentation and analysis. We propose several areas for improvement in terms of the documentation of civilian casualties as well as potential solutions to the problems we identify.     

Determining Disability: New Advances in Conceptualization and Research

This special issue of Psychological Injury and Law on disability presents state-of-the-art conceptualization and empirical research that will help psychologists and attorneys in the area of disability determination. This paper constitutes an introduction to and contextualization of the articles in the issue. It focuses on key advances in the field of disability research that are anticipated to move forward the practice of psychological injury and law. These new advances include the following: (1) a theoretical shift toward an integrative and dynamic biopsychosocial framework of health and disability, (2) development of complex multidimensional constructs of motivation, including primary, secondary, and tertiary gains and losses involved in disability claims, (3) increased emphasis on the perception of fairness and justice in disability claims from both psychological and legal perspectives, (4) increased understanding of the functional impact of psychological impairment, (5) inclusion of age-related factors in predicting disability, and (6) the interdisciplinary growth of this field.