The polygraph, an instrument designed to identify deception, first entered the American courtroom more than 90 years ago. In Frye v. United States (1923), the D.C. Circuit Court excluded expert testimony about the findings from a polygraph. The court noted that the “systolic blood pressure deception test, ” the polygraph, had “not yet gained such standing and scientific recognition among physiological and psychological authorities as would justify the courts in admitting expert testimony.…”
Since then, the polygraph and its modern incarnations have continued to incite legal controversy and debate. The public, press and fact finders are no less fascinated with the polygraph now than they were in the beginning of the twentieth century (Keeler, 1930; Myers, Latter, & Abdolahhi-Arena, 2006). Overwhelmingly, courts have banned results of polygraph testing in criminal proceedings (United States v. Scheffer, 1998). The reasoning for this has largely centered on lack of general acceptance in the scientific community and concerns about prejudicial impact of the findings on the jury (Myers et al., 2006). Nevertheless, the polygraph continues to be widely used by law enforcement, in employment screenings, and for specific types of forensic assessments, such as sexual offender evaluations (Grubin, 2010). Accordingly, litigators, corporate counsel, and trial consultants need to have a current understanding of the scientific underpinnings of the polygraph, the improvements to the instrument throughout the decades, and the ongoing controversies regarding the interpretation of results.
High-profile schemes to defraud the elderly of their lifetime savings have headlined top newspapers and tabloids alike. As crime rates -- and vulnerable populations -- increase, the scientific and legal communities must pool our ever-increasing knowledge and resources to protect elderly family members.
Are Measures of Cognitive Effort and Motivation Useful in Differentiating Feigned from Genuine Psychiatric Symptoms?
This study examined the accuracy of two measures of cognitive effort and motivation, the Test of Memory Malingering (TOMM; Tombaugh, 1996) and the Validity Indicator Profile Verbal subtest (VIP-V; Frederick, 2003) using a simulation study design with psychiatric patients (n = 88) and community participants instructed to feign mental illness (n = 29). Little research has evaluated either the TOMM or the VIP in psychiatric patients, a group that may be at an increased risk of misclassification, despite the common use of these measures by forensic evaluators to assess for malingering. Specificity for the TOMM (94.2%) and the VIP-V (71.6%) were somewhat lower than the original validation samples, but Sensitivity rates were mixed: lower for the TOMM (62.1%) but higher for the VIP-V (73.1%). Additionally, VIP-V indicators were examined using Receiver Operating Curve (ROC) and stepwise discriminant analyses. The implications of these results for forensic assessment are discussed.
In United States v. Beatty, 642 F.3d 514 (6th Cir. 2011), the United States Court of Appeals for the Sixth Circuit upheld a decision by the U.S. District Court for the Eastern District of Tennessee to recognize antisocial personality disorder (ASPD) as a mental disease for the purposes of conditional release under the civil commitment statute according to Title 18 United States Code Service (18 U.S.C.S.) § 4243 (hospitalization of a person found not guilty by reason of insanity; 1984).
Gender Differences in Professional Development Among AP-LS Members: Results of the Professional Development of Women Survey
The current survey was designed to examine gender differences in professional development among American Psychology - Law Society (AP-LS) members. The survey was based on the University of California, Irvine NSF ADVANCE survey, and examines issues related to work climate, workload, productivity, job satisfaction, work/life balance, and leadership among AP-LS members.
A partial preview of this chapter is available in Google Books.
This study describes the potential problems and possible solutions to the integration of multiple malingering measures. Multivariate prediction models, using both discriminant function analyses and regression tree approaches, are compared. Study measures, including an abbreviated version of the SIRS (SIRS-A), the MMPI-2, the TOMM and the VIP Verbal subtest, were administered to 29 community members instructed to malinger and 87 psychiatric patients instructed to respond honestly. Predictive accuracy varied substantially across measures and the correlations between tests ranged from .19 to .79. Further, 48% of the psychiatric sample were misclassified as malingering by at least one test and 46% of the malingering sample were classified as honest by at least one test; “unanimous” findings occurred in only half of the cases. Multivariate models identified the SIRS-A as the strongest predictor of malingering, but the MMPI-2, TOMM, and VIP provided significant contributions to these models. The implications of these findings for the problem of multiple, contradictory indicators in general, and the specific problems associated with clinical assessments of malingering in particular, are discussed.
What are we talking about at the annual meetings of ABCT? An analysis of presentations from 1997-2006
The purpose of this article is to bring a descriptive quantitative evaluation of the content of the conferences for the most recent 10-year period, from 1997 through 2006. In this article we focus on areas covered at the conference dealing with psychopathology research and treatment. The annual convention is a forum where the early conceptualizations of psychopathology, and interventions, have been presented and refined. The diversity of problems is impressive: psychotic disorders; health and somatic concerns; depression and related affective disorders; addictions; eating disorders; disorders associated with advanced age; and anxiety disorders, to name just a few. This analysis was intended to be descriptive, and therefore to stimulate additional discussion among members of ABCT. It is our hope that the presentation of this material highlights the current and changing areas of focus at the conference, and therefore in the field of cognitive and behavior therapy (CBT). It is also our hope that it will stimulate discussion about whether we should continue these trends, direct our attention to areas that are not as well represented at the annual conference, or develop a broad range of "tracks" that effectively covers all the various areas of CBT. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A preview of this chapter is available in Google Books.
Validation of an abbreviated version of the structured interview of reported symptoms in outpatient psychiatric and community settings
This study examined the effectiveness of an abbreviated version of the Structured Interview of Reported Symptoms (SIRS-A) in identifying malingered mental illness. The SIRS-A is comprised of 69 items drawn from the SIRS (R. Rogers et al. 1992, SIRS: Structured Interview of Reported Symptoms: Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc.), substantially reducing the administration time. A simulation design was used with three samples; 87 psychiatric outpatients who responded honestly were compared to 29 community-dwelling adults and 24 psychiatric patients instructed to malinger psychopathology. The SIRS-A generated sensitivity comparable to or exceeding that of the SIRS normative data, but specificity was poorer; many genuinely impaired patients were misclassified as malingering. Although these findings suggest the SIRS-A may be an effective means to assess malingering in psychiatric populations, further research assessing the reasons for the elevated false positive rates is necessary.
Therapeutic misconception (TM)-when clinical research participants fail to adequately grasp the difference between participating in a clinical trial and receiving ordinary clinical care-has long been recognized as a significant problem in consent to clinical trials. We suggest that TM does not primarily reflect inadequate disclosure or participants' incompetence. Instead, TM arises from divergent primary cognitive frames. The researchers' frame places the clinical trial in the context of scientific designs for assessing intervention efficacy. In contrast, most participants have a cognitive frame that is personal and focused primarily on their medical problems. To illustrate this, we draw on interview material from both clinical researchers and participants in clinical trials. We suggest that reducing TM requires encouraging subjects to adjust their frame, not just add information to their existing frame. What is necessary is a scientific reframing of participation in a clinical trial.
Sensing of Endogenous Nucleic Acids by the Innate Immune System during Viral Infection: A Dissertation
Innate sensing of nucleic acids lies at the heart of antiviral host defense. However, aberrant activation of innate sensors by host nucleic acids can also lead to the development of autoimmune diseases. Such host nucleic acids can also be released from stressed, damaged or dying cells into the tissue microenvironment. It however remains unclear how the extracellular nucleic acids impacts the quality of the host immune responses against viral infections. Using a mouse model of influenza A virus (IAV) infection, we uncovered an important immune-regulatory pathway that tempers the intensity of the host-response to infection. We found that host-derived DNA from necrotic cells accumulates in the lung microenvironment during IAV infection, and is sensed by the DNA receptor Absent in Melanoma 2 (AIM2). AIM2-deficiency resulted in severe immune pathology highlighted by enhanced recruitments of immune cells, and excessive systemic inflammation after IAV challenge, which led to increased morbidity and lethality in IAV-infected mice. Interestingly, these effects of AIM2 were largely independent of its ability to mediate IL-1β maturation through inflammasome complexes. Finally, ablation of accumulated DNA in the lung by transgenic expression of DNaseI in vivo had similar effects. Collectively, our results identify a novel mechanism of cross talk between PRR pathways, where sensing of hostderived nucleic acids limits immune mediated damage to virus infected tissues.
Method of administration of PROMIS scales did not significantly impact score level, reliability, or validity
OBJECTIVES: To test the impact of the method of administration (MOA) on score level, reliability, and validity of scales developed in the Patient Reported Outcomes Measurement Information System (PROMIS).
STUDY DESIGN AND SETTING: Two nonoverlapping parallel forms each containing eight items from each of three PROMIS item banks (Physical Function, Fatigue, and Depression) were completed by 923 adults with chronic obstructive pulmonary disease, depression, or rheumatoid arthritis. In a randomized crossover design, subjects answered one form by interactive voice response (IVR) technology, paper questionnaire (PQ), personal digital assistant (PDA), or personal computer (PC) and a second form by PC, in the same administration. Method equivalence was evaluated through analyses of difference scores, intraclass correlations (ICCs), and convergent/discriminant validity.
RESULTS: In difference score analyses, no significant mode differences were found and all confidence intervals were within the prespecified minimal important difference of 0.2 standard deviation. Parallel-forms reliabilities were very high (ICC = 0.85-0.93). Only one across-mode ICC was significantly lower than the same-mode ICC. Tests of validity showed no differential effect by MOA. Participants preferred screen interface over PQ and IVR.
CONCLUSION: We found no statistically or clinically significant differences in score levels or psychometric properties of IVR, PQ, or PDA administration compared with PC.
Can Streamlined Multicriteria Decision Analysis Be Used to Implement Shared Decision Making for Colorectal Cancer Screening
BACKGROUND: Current US colorectal cancer screening guidelines that call for shared decision making regarding the choice among several recommended screening options are difficult to implement. Multicriteria decision analysis (MCDA) is an established method well suited for supporting shared decision making. Our study goal was to determine whether a streamlined form of MCDA using rank-order-based judgments can accurately assess patients' colorectal cancer screening priorities.
METHODS: We converted priorities for 4 decision criteria and 3 subcriteria regarding colorectal cancer screening obtained from 484 average-risk patients using the analytic hierarchy process (AHP) in a prior study into rank-order-based priorities using rank order centroids. We compared the 2 sets of priorities using Spearman rank correlation and nonparametric Bland-Altman limits of agreement analysis. We assessed the differential impact of using the rank-order-based versus the AHP-based priorities on the results of a full MCDA comparing 3 currently recommended colorectal cancer screening strategies. Generalizability of the results was assessed using Monte Carlo simulation.
RESULTS: Correlations between the 2 sets of priorities for the 7 criteria ranged from 0.55 to 0.92. The proportions of differences between rank-order-based and AHP-based priorities that were more than +/-0.15 ranged from 1% to 16%. Differences in the full MCDA results were minimal, and the relative rankings of the 3 screening options were identical more than 88% of the time. The Monte Carlo simulation results were similar.
CONCLUSIONS: Rank-order-based MCDA could be a simple, practical way to guide individual decisions and assess population decision priorities regarding colorectal cancer screening strategies. Additional research is warranted to further explore the use of these methods for promoting shared decision making.
Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population
OBJECTIVE: Acute lower extremity ischemia (ALI) is a common vascular surgery emergency associated with high rates of morbidity and mortality. The purpose of this study was to assess contemporary trends in the incidence of ALI, the methods of treatment, and the associated mortality and amputation rates in the U.S. Medicare population.
METHODS: This was an observational study using Medicare claims data between 1998 and 2009. Outcomes examined included trends in the incidence of ALI; trends in interventions for ALI; and trends in amputation, mortality, and amputation-free survival rates.
RESULTS: Between 1998 and 2009, the incidence of hospitalization for ALI decreased from 45.7 per 100,000 to 26.0 per 100,000 (P for trend < .001). The percentage of patients undergoing surgical intervention decreased from 57.1% to 51.6% (P for trend < .001), whereas the percentage of patients undergoing endovascular interventions increased from 15.0% to 33.1% (P for trend < .001). In-hospital mortality rates decreased from 12.0% to 9.0% (P for trend < .001), whereas 1-year mortality rates remained stable at 41.0% and 42.5% (P for trend not significant). In-hospital amputation rates remained stable at 8.1% and 6.4% (P for trend not significant), whereas 1-year amputation rates decreased from 14.8% to 11.0% (P for trend < .001). In-hospital amputation-free survival after hospitalization for ALI increased from 81.2% to 85.4% (P for trend < .001); however, 1-year amputation-free survival remained unchanged.
CONCLUSIONS: Between 1998 and 2009, the incidence of ALI among the U.S. Medicare population declined significantly, and the percentage of patients treated with endovascular techniques markedly increased. During this time, 1-year amputation rates declined. Furthermore, although in-hospital mortality rates declined after presentation with ALI, 1-year mortality rates remained unchanged.
Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Health-related quality of life (HRQoL) assessments are increasingly used to evaluate treatment effects and to shape the delivery of value based care. Valid generic and disease specific tools are available for quantifying HRQoL in patients with non-toxic goitre. However, few studies have applied these validated instruments to assess HRQoL in patients with benign non-toxic goitre. Limited evidence suggests that patients with non-toxic goitre have HRQoL impairments in multiple HRQoL domains. While the HRQoL-impact of non-toxic goitre may be small relative to other severely disabling medical conditions, treatment is almost exclusively elected for HRQoL indications. Thus better quantification of HRQoL, particularly at better (or more favorable) levels where many patients score, is essential. Web and mobile technologies have eased the ability to deliver surveys to patients. Routine consideration of HRQoL provides the opportunity to monitor the impact of treatment on the outcomes most meaningful for patients and the opportunity to help shape the delivery of value based health care.
Persistent medication affordability problems among disabled Medicare beneficiaries after Part D, 2006-2011
BACKGROUND: Disabled Americans who qualify for Medicare coverage typically have multiple chronic conditions, are highly dependent on effective drug therapy, and have limited financial resources, putting them at risk for cost-related medication nonadherence (CRN). Since 2006, the Part D benefit has helped Medicare beneficiaries afford medications.
OBJECTIVE: To investigate recent national trends in medication affordability among this vulnerable population, stratified by morbidity burden.
DESIGN AND SUBJECTS: We estimated annual rates of medication affordability among nonelderly disabled participants in a nationally representative survey (2006-2011, n=14,091 person-years) using multivariate logistic regression analyses.
MEASURE: Survey-reported CRN and spending less on other basic needs to afford medicines.
RESULTS: In the 6 years following Part D implementation, the proportion of disabled Medicare beneficiaries reporting CRN ranged from 31.6% to 35.6%, while the reported prevalence of spending less on other basic needs to afford medicines ranged from 17.7% to 21.8%. Across study years, those with multiple chronic conditions had consistently worse affordability problems. In 2011, the prevalence of CRN was 37.3% among disabled beneficiaries with > /= 3 morbidities as compared with 28.1% among those with fewer morbidities; for spending less on basic needs, the prevalence was 25.4% versus 15.7%, respectively. There were no statistically detectable changes in either measure when comparing 2011 with 2007.
CONCLUSIONS: Disabled Medicare beneficiaries continue to struggle to afford prescription medications. There is an urgent need for focused policy attention on this vulnerable population, which has inadequate financial access to drug treatments, despite having drug coverage under Medicare Part D.