Medical maximization: The effect of personality on triage decision-making.

Mass Casualty Incidents (MCIs) rapidly overwhelm the ability of local medical resources to deliver comprehensive and definitive medical care and they have been occurring more frequently in recent decades and affect countries of all socioeconomic backgrounds (Hart et al., 2018). As such, it is important to understand how individuals make such decisions in these events and what factors can hinder or help the process. In this study we focused on the critical role of maximization within MCI triage. Triaging an MCI requires juggling the demand and supply of resources, time, and focus, likely leading to various decisions involving compromise/sacrifice. In a vignette study, hosted on Amazon Mturk (n = 235, Mean age = 38.05, 51.49% self-identified as male), which involved triaging over 100 patients we found that trait differences maximization impacted the willingness to use a "black tag". Furthermore, maximization also impacted how much information an individual needed about the patient before being willing to use a black tag. Overall, this research demonstrates the importance of understanding factors that create individual differences in how people make decisions during MCI events, especially those decisions that involve the use of potentially lifesaving treatments.

Estimating the economic burden attributable to online only child sexual abuse offenders: implications for police strategy.

Evidence is beginning to emerge of the serious negative effects online only child sexual abuse (OOCSA) can have on victims. Establishing the scale and nature of the problem could assist police in prioritizing suspects. In study 1, scoping review identified eleven studies that examined OOCSA's impact on victims. Five themes emerged from narrative review; definitional issues, a new normal, OOCSA grooming processes, comparisons with offline CSA, mechanisms between OOCSA and harm. In study 2, OOCSA national prevalence was estimated by applying 2.9% rate of OOCSA observed from original police data to a lower bound ("sexual communication with a child" crimes recorded by the police), middle (scaling up to estimate undetected offenses) and upper bound estimate of the national offender pool (self-reported sexual solicitation offenders). Recent UK Home Office figures were adapted to establish economic costs. Lifetime costs estimates attributable to OOCSA are £7.4 million (police reports), £59.6 million (including undetected offenders) and £1.4 billion (national prevalence estimates). Over 75% of this is non-financial costs borne by victims in terms of emotional harm and lost output. Government bears around 20% of the cost burden, mostly non-financial costs for police forces. Findings are discussed in relation to evidence-led recommendations for prioritization and wider police actions that can be taken to avoid the considerable economic and social burden associated with OOCSA offenses.

United Kingdom Early Detection Initiative (UK-EDI): protocol for establishing a national multicentre cohort of individuals with new-onset diabetes for early detection of pancreatic cancer.

INTRODUCTION: Pancreatic cancer is a leading cause of cancer deaths worldwide. Screening for this disease has potential to improve survival. It is not feasible, with current screening modalities, to screen the asymptomatic adult population. However, screening of individuals in high-risk groups is recommended. Our study aims to provide resources and data that will inform strategies to screen individuals with new-onset diabetes (NOD) for pancreatic cancer. METHODS AND ANALYSIS: The United Kingdom Early Detection Initiative (UK-EDI) for pancreatic cancer is a national, prospective, observational cohort study that aims to recruit 2500 individuals with NOD (<6 months postdiagnosis) aged 50 years and over, with follow-up every 6 months, over a 3-year period. For study eligibility, diagnosis of diabetes is considered to be clinical measurement of haemoglobin A1c ≥48 mmol/mol. Detailed clinical information and biospecimens will be collected at baseline and follow-up to support the development of molecular, epidemiological and demographic biomarkers for earlier detection of pancreatic cancer in the high-risk NOD group. Socioeconomic impacts and cost-effectiveness of earlier detection of pancreatic cancer in individuals with NOD will be evaluated. The UK-EDI NOD cohort will provide a bioresource for future early detection research to be conducted. ETHICS AND DISSEMINATION: The UK-EDI study has been reviewed and approved by the London-West London and GTAC Research Ethics Committee (Ref 20/LO/0058). Study results will be disseminated through presentations at national and international symposia and publication in peer-reviewed, Open Access journals.

Avoidant authority: The effect of organizational power on decision-making in high-uncertainty situations.

Individuals in positions of power are often required to make high-stakes decisions. The approach-inhibition theory of social power holds that elevated power activates approach-related tendencies, leading to decisiveness and action orientation. However, naturalistic decision-making research has often reported that increased power often has the opposite effect and causes more avoidant decision-making. To investigate the potential activation of avoidance-related tendencies in response to elevated power, this study employed an immersive scenario-based battery of least-worst decisions (the Least-Worst Uncertain Choice Inventory for Emergency Responses; LUCIFER) with members of the United States Armed Forces. In line with previous naturalistic decision-making research on the effect of power, this research found that in conditions of higher power, individuals found decisions more difficult and were more likely to make an avoidant choice. Furthermore, this effect was more pronounced in domain-specific decisions for which the individual had experience. These findings expand our understanding of when, and in what contexts, power leads to approach vs. avoidant tendencies, as well as demonstrate the benefits of bridging methodological divides that exist between "in the lab" and "in the field" when studying high-uncertainty decision-making.

An Economic Evaluation of the Impact of Using Rapport-Based Interviewing Approaches With Child Sexual Abuse Suspects.

Two studies examined whether rapport-based interviewing with child sexual abuse (CSA) suspects provides greater interview yield that could result in overall cost-savings to the investigation. First, multi-level modelling was applied to 35 naturalistic CSA suspect interviews to establish whether rapport-based interviewing techniques increase "yield" - defined as information of investigative value. The Observing Rapport Based Interviewing Technique (ORBIT coding manual was used to code interviews; it includes an assessment of both interpersonal adaptive and maladaptive rapport-based interviewer engagement as well as motivational interviewing (MI) strategies. The impact of these two strands (interpersonal and MI) on extracting information of investigative value (including strengthening a case for court and safeguarding) were examined. Adaptive interpersonal strategies increased case strengthening and safeguarding yield, with motivational interviewing having the largest impact on safeguarding yield. Both strategies increase the likelihood of gaining additional types of economic yield. Maladaptive interviewer strategies reduced case strengthening and different types of economic yield. In study two, literature-based economic estimates were applied to establish the potential cost benefits from following national ORBIT rapport training. Further training in adaptive and motivational interviewing could contribute cost savings between £19 and £78 million (annual unit costs) increasing to £238-£972 million (lifetime costs) for online CSA across England and Wales; and £157-£639 million (annual unit costs) increasing to £2-£8 billion (lifetime costs) for all CSA. Failure to commit training resource to this, or an alternative strategy, could mean the cost burden attributable to maladaptive interviewing (between £1 and £6 million for online CSA and £12 and £48 million for all CSA) is not successfully averted.

The Effect of a 3-Minute Mindfulness Intervention, and the Mediating Role of Maximization, on Critical Incident Decision-Making.

OBJECTIVE: In this study, we extend the impact of mindfulness to the concept of least-worst decision-making. Least-worst decisions involve high-uncertainty and require the individual to choose between a number of potentially negative courses of action. Research is increasingly exploring least-worst decisions, and real-world events (such as the COVID-19 pandemic) show the need for individuals to overcome uncertainty and commit to a least-worst course of action. From sports to business, researchers are increasingly showing that "being mindful" has a range of positive performance-related benefits. We hypothesized that mindfulness would improve least-worst decision-making because it would increase self-reflection and value identification. However, we also hypothesized that trait maximization (the tendency to attempt to choose the "best" course of action) would negatively interact with mindfulness. METHODS: Three hundred and ninety-eight participants were recruited using Amazon MTurk and exposed to a brief mindfulness intervention or a control intervention (listening to an audiobook). After this intervention, participants completed the Least-Worst Uncertain Choice Inventory for Emergency Responders (LUCIFER). RESULTS: As hypothesized, mindfulness increased decision-making speed and approach-tendencies. Conversely, for high-maximizers, increased mindfulness caused a slowing of the decision-making process and led to more avoidant choices. CONCLUSIONS: This study shows the potential positive and negative consequences of mindfulness for least-worst decision-making, emphasizing the critical importance of individual differences when considering both the effect of mindfulness and interventions aimed at improving decision-making.

Prioritizing Indecent Image Offenders: A Systematic Review and Economic Approach to Understand the Benefits of Evidence-Based Policing Strategies.

In 2013, there were an estimated 50,000 individuals involved in downloading and sharing indecent images of children (IIOC) in the United Kingdom (UK). This poses challenges for limited police resources. We argue that police officers can make most effective use of limited resources by prioritizing those offenders who pose the greatest risk of contact offending, by nature of demonstrable pedophilia, hebephilia or dual offending status and thus, those at highest risk must be dealt with first. What is currently lacking is a clear idea of the potential scale of the problem in socio-economic terms and why, therefore, it is so important that evidence-based approaches to offender detection and investigation continue to be a top priority for funders and policy makers. A systematic literature review was undertaken to address two related questions. First, what is the scale of the problem in the UK, in terms of the number of pedophilic and hebephilic individuals who pose a risk of contact offending against a child? Second, what is the potential socio-economic burden generated by the national IIOC suspect pool if left unattended to by targeted police action? Applying population estimates of pedophilia and hebephilia to the male population (16-89 years), we estimate there are between 2,365-5,991 males with paedophila and 12,218-30,952 males with hebephilia who are likely contact offenders. Applying average prevalence and incidence based costing methods to a conservative estimate of one victim per offender, the combined socio-economic burden from these persons could amount to £236-£597 million (incident costs) increasing to £2.9-£7.3 billion (lifetime costs; £3.3-£8.3 billion including QALY measures). Applying the same costs to CEOP (2013) estimate of 50,000 IIOC offenders we estimate that between 6,000 and 27,500 dual offenders could have already committed past contact offenses, contributing an economic burden of between £97-£445 million (incident costs) increasing to £1.2-£5.4 billion (lifetime costs; £1.4-£6.2 billion including QALY measures). Future contact offenses could contribute a further burden of £16-£18.6 million (incident costs) increasing to £198-£227 million (lifetime costs; £226-£260 million including QALY measures). Drawing upon these findings, we argue for the benefits of a research-informed prioritization approach to target IIOC offenders.

Police Perfection: Examining the Effect of Trait Maximization on Police Decision-Making.

Police officers around the world must often select between equally unappealing, uncertain courses of action in an attempt to achieve the best outcome. Despite the immense importance of such decisions, there remains a lack of understanding in the study of individual differences in police decision-making. Here, using a sample of senior police officers recruited from decision-making training events across the United Kingdom (n = 96), we used the Least-worst Uncertain Choice Inventory For Emergency Responses (LUCIFER) to measure the effect of maximization on both domain-specific (police) and domain-general (military) decisions. In line with a wealth of research on traditional "consumer" decisions, we found that police officers who were "maximizers" found decisions more difficult. Gender and previous military experience also influenced the process of decision-making. Specifically, police officers with military experience took more time to assess the situation but were faster to choose a course of action and commit to it. Female police officers also were slower to assess the situation. As recent events show, the outcomes of police decisions have significant consequences for the public, the officers involved, the police force as a whole, and the wider population, yet psychological research has yet to fully explore the role of individual differences in how such decisions are made. While this study does not seek to identify factors associated with "good" or "better" decision-makers, it provides strong support for the need to factor in perspectives of the individual when creating theory, or applied tools, in support of police decision-making.

Choice and consequence: A naturalistic analysis of least-worst decision-making in critical incidents.

Individuals responsible for decision-making during critical incidents must wrestle with uncertainty, complexity, time pressure, and accountability. Critical incidents are defined as rare events where demand outstrips resources and where there are high stakes, uncertainty, and dynamic and ever-shifting elements that frustrate clear predictions. This paper argues that critical-incident decision-making is highly complex because many critical incidents have no such analogue, and thus there is no prior experience to draw upon. Further, while prescriptive models argue for a selection of a "best" outcome, rarely in critical incidents is there a "best" outcome and, instead, more likely a "least-worst" one. Most options are high risk, most will carry negative consequences, and many will be immutable and irreversible once committed to. This paper analyzes data collected from critical decision method interviews with members of the United States Armed Forces to explore the psychological processes of making (or not making) least-worst decisions in high-consequence situations. Specifically, and based on thematic analysis of interviews with those who have made least-worst decisions while serving as part of the Armed Forces, we identify a host of exogenous (external to the incident such as resources, political agendas) and endogenous factors (features of the incident itself-size, scale, duration) that affect the decision-making process. These factors have, to date, not been factored into theoretical models of how high-stakes decisions are made under conditions of uncertainty.

The right to silence and the permission to talk: Motivational interviewing and high-value detainees.

Motivational interviewing (MI) is an evidence-based intervention that has proved effective across diverse clinical contexts with clients ambivalent about and resistant to behavioral change. This article argues that the principles of MI can be successfully applied to law enforcement (LE) interviews with high-value detainees (HVDs; i.e., terrorist suspects). Although the forms of ambivalence and resistance may differ from those in clinical contexts, HVDs must make the decision whether to talk or not when they are interviewed. We argue there is likely ambivalence regarding this. We theorized that 4 MI-consistent (MI) skills may be useful for LE interviewers: reflective listening, summaries, rolling with resistance, and developing discrepancies. Using the Observing Rapport Based Interpersonal Techniques coding manual (Alison, Alison, Elntib, & Noone, 2012), we analyzed 804 tapes of LE interviews with 75 terrorism suspects in the United Kingdom. Multilevel structural equation modeling revealed that MI skills encouraged detainee engagement and subsequent information gain. It also revealed that any approach antithetical to MI had a profoundly negative impact on detainee engagement and subsequent information gain-potentially through creating reactance (a form of resistance based on motivations to regain a freedom when it is threatened). Overall, this research provides unique evidence for the use of specific skills and approaches that can increase or decrease HVD engagement and information provided. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Information sharing in interteam responses to disaster.

Research demonstrates that information sharing is facilitated by familiarity, and having a common understanding of problems, use of lexicon, and semantic meaning. These factors can be difficult to develop within extreme environments such as disasters as members of the multi-agency system that responds often have limited experience of working together. Public inquiries repeatedly highlight the impact of information sharing difficulties on public safety, but limited academic research has focused on identifying concrete behaviours that facilitate interteam information sharing within such environments. This paper presents a case study of a national disaster response exercise involving 1,000 emergency responders. Data consist of structured observations, recordings of interteam meetings, and interviews with emergency responders. Results of mixed-method analysis indicate that interteam information sharing is delayed by limited situation awareness and poor articulation. Conversely, adopting behaviours that promote common frames for understanding interteam capabilities and information requirements improves information sharing and potentially reduces cognitive effort required to process information. Findings contribute to interteam communication theory by highlighting that in complex, time-constrained environments, having a shared understanding of responsibilities and information requirement is important for minimizing redundant deliberation and improving relevance and speed. PRACTITIONER POINTS: Facilitating the exchange and interpretation of relevant information is important for improving situation assessment, decision-making, and the implementation of appropriate actions for addressing risks.Interteam information sharing can be particularly challenging when teams are comprised of members from across different organizations with different language and cultures that must form ad hoc to rapidly respond to problems in extreme environments.Adopting communication strategies that develop common frames-of-reference can facilitate information sharing and interteam responses to disasters.

Revenge versus rapport: Interrogation, terrorism, and torture.

This review begins with the historical context of harsh interrogation methods that have been used repeatedly since the Second World War. This is despite the legal, ethical and moral sanctions against them and the lack of evidence for their efficacy. Revenge-motivated interrogations (Carlsmith & Sood, 2009) regularly occur in high conflict, high uncertainty situations and where there is dehumanization of the enemy. These methods are diametrically opposed to the humanization process required for adopting rapport-based methods-for which there is an increasing corpus of studies evidencing their efficacy. We review this emerging field of study and show how rapport-based methods rely on building alliances and involve a specific set of interpersonal skills on the part of the interrogator. We conclude with 2 key propositions: (a) for psychologists to firmly maintain the Hippocratic Oath of "first do no harm," irrespective of perceived threat and uncertainty, and (b) for wider recognition of the empirical evidence that rapport-based approaches work and revenge tactics do not. Proposition (a) is directly in line with fundamental ethical principles of practice for anyone in a caring profession. Proposition (b) is based on the requirement for psychology to protect and promote human welfare and to base conclusions on objective evidence. (PsycINFO Database Record

A taxonomy of endogenous and exogenous uncertainty in high-risk, high-impact contexts.

By reference to a live hostage negotiation exercise, this study presents a taxonomy of uncertainty that can be usefully applied to assist in the categorization and application of findings from decision-making research conducted in naturalistic (specifically critical incident) settings. Uncertainty was measured via observational methods (during the exercise and by reference to video footage), decision logs, and postincident simulated recall interviews with trainee police officers. Transcripts were coded and analyzed thematically. Uncertainty was dichotomized as deriving from either endogenous sources (about the problem situation itself) or exogenous sources (about the operating system that is dealing with the incident). Overall, exogenous uncertainty (75%) was more prevalent than endogenous uncertainty (25%), specifically during discussions on plan formulation and execution. It was also qualitatively associated with poor role understanding and trust. Endogenous uncertainty was more prevalent during discussions on situation assessment and plan formulation. The taxonomy provides a useful way for organizational researchers to categorize uncertainty during the naturalistic observations of workplace interactions and decision making. It reduces the complexity associated with observational research to allow organizational psychologists to better tailor their recommendations for reducing uncertainty. Dealing with endogenous uncertainties would entail targeting decision making specific to the problem incident (e.g., introduce training or policy to reduce redundant fixation on rote-repetitive superordinate goals and focus on more short-term actionable goals during situation assessments). Dealing with exogenous uncertainties would entail improving decision making relating to management and team processes across critical incidents (e.g., training to clarify distributed roles in critical incident teams to aid plan formulation and execution). Organizational researchers interested in uncertainty management in the workplace should utilize this taxonomy as a guide to (a) categorize uncertainty and (b) generate applicable recommendations from their findings.

Paraphilias: definition, diagnosis and treatment.

There is a great deal of controversy concerning paraphilia, and defining what is normal versus deviant or disordered, given that this is to some degree dependent on cultural views of acceptability. In this article, we outline these issues and describe recent progress in diagnosing and treating paraphilias.

The effects of subjective time pressure and individual differences on hypotheses generation and action prioritization in police investigations.

When individuals perceive time pressure, they decrease the generation of diagnostic hypotheses and prioritize information. This article examines whether individual differences in (a) internal time urgency, (b) experience, and (c) fluid mental ability can moderate these effects. Police officers worked through a computer-based rape investigative scenario, in which 35 were subjected to a time pressure manipulation, with their hypotheses generation and prioritization skills compared with a control (n = 41). Group 1 was told they would "get less time to complete the scenario compared with other officers," although both groups had equal amounts of time. Regression analyses found that time pressure reduced hypothesis generation and that individual differences in time urgency moderated this effect; individuals who tend to perceive time to pass more slowly than it is continued to generate hypotheses despite the presence of time pressure. Time pressure also influenced the likelihood of action prioritization at the start of the investigation. Time pressure was found to increase action prioritization, but only for officers with low time urgency or high fluid ability. Experience had no effect on time pressure during the investigative scenario. Implications of these findings are discussed.

Child pornography and likelihood of contact abuse: a comparison between contact child sexual offenders and noncontact offenders.

This study examined a sample of 120 adult males convicted of offences involving indecent images of children (IIOC); 60 had a previous contact child sexual offence (dual offenders) and 60 had no evidence of an offence against a child. Analyses explored socio-demographic characteristics, previous convictions, and access to children. Of the 120 offenders, a subsample of 60 offenders (30 dual offenders and 30 non-contact) were further examined in terms of the quantity of IIOC, types of IIOC, and offending behavior. The study found the two offender groups could be discriminated by previous convictions, access to children, the number, proportion, and type of IIOC viewed. The IIOC preferences displayed within their possession differentiated dual offenders from non-contact IIOC offenders. Within group comparisons of the dual offenders differentiated sadistic rapists from sexual penetrative and sexual touching offenders. The paper suggests there may be a homology between IIOC possession, victim selection, and offending behavior. Implications for law enforcement are discussed in terms of likelihood of contact offending and assisting in investigative prioritization.

When do we believe experts? The power of the unorthodox view.

This paper examines the extent to which orthodoxy (degree of typicality) and congruence (degree of similarity with own opinion) mediate the influence of expert advice on decision makers' judgments. Overall, 227 members of the public and 60 police officers completed an online questionnaire involving an investigation into a child sex offence. Participants were asked to first (i) formulate their own "profile" of a likely offender then (ii) estimate the guilt of two presented suspect descriptions (orthodox vs. unorthodox), and, following the presentation of an "expert's" profile that matched either the orthodox or the unorthodox suspect, (iii) re-evaluate their guilt judgments of the two suspects based on this new advice. Finally, (iv) the perceived similarity (congruence) between the participants' own and the expert profile was assessed. Results revealed two key findings. First, expert profiles that matched a suspect's description elevated perceptions of guilt in that suspect, whilst also, simultaneously, very significantly decreasing the perception of guilt of the alternative suspect. This suggests a powerful rejection and downward revision of the other suspect. Second, perceived similarity of the profile (to one's own profile) was only a significant factor in increasing guilt judgments when assigning guilt to the unorthodox (as opposed to orthodox) suspect. Comparisons of lay judgments with those of police officers revealed few significant differences in effects. The finding that advice is most influential when unorthodox and incongruent suggests that decision makers are more likely to reevaluate judgments when expert advice contributes novel information that contradicts their beliefs. The practical implications of these findings are discussed for profilers, police, and decision research in general.

The impact of outcome knowledge, role, and quality of information on the perceived legitimacy of lethal force decisions in counter-terrorism operations.

According to the phenomenon of hindsight bias, once people know the outcome of an event, they tend to have biased estimates of the probability that the event would have occurred. In this study, we investigated whether hindsight bias affected judgements about the legitimacy of lethal force decisions in police shooting incidents for counter-terrorism operations. We also assessed to what extent this hindsight bias was mediated by factors such as role and information quality. Four hundred and eighty participants completed a short questionnaire that manipulated role (as senior police officer, Independent Police Complaints Commissioner, or family member, plus a "no role" control group), information quality (detailed/good or vague/ambiguous), and outcome knowledge (knowledge of outcome/hindsight versus no knowledge of outcome/foresight) in a 4 x 2 x 2 design. Results indicated that outcome knowledge affected the perception of threat and decision quality but not the blameworthiness of the senior police officer. Quality of information had a significant effect on all three dependent variables and role had a significant impact on judgements as to whether the decision to shoot was correct and also the perceived threat, though not on perceived blameworthiness. These findings indicate that people who have to judge the liability of lethal force decisions are not able to ignore outcome information, and are strongly influenced by the quality of information and by the role in which they are receiving the information.

What works in offender profiling? A comparison of typological, thematic, and multivariate models.

Utilizing a sample of 85 stranger rapists, three models (Hazelwood's (1987) Power and Anger FBI model, the Behavioral Thematic evaluation of Canter, Bennell, Alison, and Reddy (2003), and the Massachusetts Treatment Center: Rape classification system revision 3 (MTC:R3, Knight & Prentky, 1990)) were contrasted with a multivariate regression approach to assess their ability to predict an offender's previous convictions from crime scene information. In respect of the three aforementioned models, logistic regression and AUC analysis indicated that the Power and Anger FBI model was the most effective, followed by the MTC:R3, and then the Behavioral Thematic evaluation. However, predictive analyses based on a multivariate approach using a mixture of crime scene behaviors, as opposed to the grouping of behaviors into themes or types as in the three models, far exceeded the predictive ability of the three models under AUC analysis. The results suggest that emphasis should be placed on further exploration of the predictive validity of each of the individual behaviors that comprise existing thematic, typological, and multivariate classification systems, especially those that are subject to inter-situational variation.

When is profiling possible? Offense planning and aggression as moderators in predicting offender age from victim age in stranger rape.

Debate continues with regard to the possibility of inferring an offender's characteristic features from crime scene details (the process of so-called "offender profiling"). We argue that psychology generally has benefited from appreciating context in predicting behavior. In the same way, profiling would benefit from an appreciation of context in predicting characteristics. This "reverse" process is contingent on various "if...then" relationships. As one example, this paper demonstrates how profiling offender age from victim age is contingent on (i) the level of planning and (ii) the level of aggression displayed during the offense. Eighty-five stranger rape case records formed the data set. Moderated regression analysis revealed that victim age is a significant predictor of offender age only in cases where the offender has (i) shown evidence of planning the attack and/or (ii) acts in a gratuitously aggressive manner. The theoretical bases for these findings may lie in the extent to which offenders disparately plan and target victims and how extreme aggressiveness in stranger rapes may relate to a near-peer proxy for an offender's anger. The implications of the results for the processes and methods involved in offender profiling suggest that certain crime scene factors can have differential moderating effects on predictive outcomes.