The case against compulsory casefinding in controlling AIDS--testing, screening and reporting

The spread of acquired immune deficiency syndrome (AIDS) demands a comprehensive and effective public health response. Because no treatment or vaccine is currently available, traditional infection control measures are being considered. Proposals include compulsory testing and screening of selected high risk populations. The fairness and accuracy of compulsory screening programs depend upon the reliability of medical technology and the balancing of public health and individual confidentiality interests. This Article proposes criteria for evaluating compulsory testing and screening programs. It concludes that voluntary identification, education, and counselling of infected persons is the most effective means of encouraging the behavioral changes that are necessary to halt the spread of AIDS.     

A Narrative Approach to the Practice of Mediation

Thinking in narrative terms is proving useful in a number of disciplines. Such thinking has already contributed to a growing body of work in the family therapy field. Here, we seek to demonstrate the usefulness and applicability of the ideas developed by Michael White and David Epston (among others) to the practice of mediation. Distinctions are drawn from the problem-solving approach with regard to both basic theoretical assumptions and method. A transcribed mediation scenario is used to illustrate and comment on the techniques of narrative mediation in action.     

The tools to understand: community as co-researcher on culture-specific protective factors for Alaska Natives

A collaborative research process engaging Alaska Native communities in the study of protective factors in Alaska Native sobriety and the design of a preventative intervention using its findings is described. Study 1 was discovery oriented qualitative research whose objectives were identification of protective factors and development of a heuristic model. Study 2 involved quantitative survey methods to develop and test ameasure of protective factors identified by the qualitative study. Empirical data from these studies is presented, and the role of Alaska Native co-researchers who did not possess specialist research training is described in the design and implementation of the study, interpretation of findings, and design of the intervention model and tools. Benefits that emerged from co-researcher involvement in this process, to the community and to the co-researchers themselves, are described.     

A fatal wound from an unusual military projectile: potential dangers of live military ordnance to the autopsy pathologist

During ground maintenance on an F-14 aircraft, a worker was removing the Mark 124 cartridge activated devices (CADS) from the aircraft when a second worker entered the cockpit of the aircraft and energized the electrical system, causing the four CADS to detonate. One of the four CADS became an airborne projectile. It struck the first worker in front of the right arm, passed through his chest, and became embedded in his thoracic spine. An immediate concern at autopsy was whether or not the device retained any explosive potential. Recommendations for autopsy procedures in cases involving military ordnance are discussed.     

The effects of latent print processing on questioned documents produced by office machine systems utilizing inkjet technology and toner

Counterfeiting of currency and identity documents, death threats, illegitimate business transactions, and terrorist-related activities are some examples of the types of crimes that often involve documents produced from printers and copiers. Although standard protocol typically requires a questioned document (QD) examination prior to latent print (LP) processing, occasionally, items of evidence may be submitted for a QD examination following the application of a series chemicals utilized in the development of latent fingerprints. In such cases, the forensic examiner must take into account any previous treatments prior to initiating an examination on documents produced with a printer or copier. This study was devised to examine the effects of a latent print development technique [ninhydrin, physical developer, and a bleach enhancer] on the physical and chemical examination of documents produced from copiers and printers.     

Patterns of Practice in Mental Health Courts: A National Survey

Mental health courts (MHCs) represent an important new development at the interface of the criminal justice and mental health systems. MHCs are criminal courts for persons with mental illness that were in part created to divert this population from jail/prison into community treatment. MHCs are proliferating rapidly despite limited knowledge regarding their characteristics or their efficacy. We surveyed the entire population of adult MHCs in the United States, n = 90. In the past 8 years, MHCs have been created in 34 states, with an aggregate current caseload of 7,560 clients in MHCs nationally. Most courts (92%) reported using jail as a sanction for noncompliance, if only rarely. Further, jail sanction use was significantly predicted by increased judicial supervision and number of felons in the court. Implications for MHCs and social monitoring are discussed.     

An empirical study of tissue banking in Australia: navigating regulatory and ethical challenges

Collections of tumour samples can be an invaluable resource for medical research. There are, however, numerous ethical and legal challenges associated with tumour banking. While there has been extensive discussion of these issues in the legal and ethical literature, there are few available empirical data in relation to the activities of tumour banks in Australia, their practices around ethically charged issues, and their success in implementing complex regulatory guidelines. The aim of this study was to gain more information about the activities of tumour banks in New South Wales, Australia, with a particular focus on their management of, and attitudes towards, ethical and regulatory issues. A survey of 27 tumour collection and research facilities was conducted using a 55-item questionnaire. There is significant heterogeneity of research methodologies as well as of methods for gaining consent and ensuring donor privacy, and there is general concern among the research community about ethical and regulatory issues related to tumour banking. Heterogeneity of practice and uncertainty about ethical and regulatory requirements is problematic in its potential to hinder research and its potential to generate the space for unethical practice, whether intentional or unintentional. There is a pressing need to address these issues so that tumour banks can be used in the most ethical and efficient way possible.     

Medical Ethics at Guantanamo Bay and Abu Ghraib: The Problem of Dual Loyalty

Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation or signs of torture. Military medical personnel are placed in a position of a "dual loyalty" conflict. They have to balance the medical needs of their patients, who happen to be detainees, with their military duty to their employer. The United States military medical system failed to protect detainee's human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism.     

Psychosocial treatment in the 21st century

Over the past 50 years, psychosocial treatment has played an increasingly prominent role in helping persons with mental illness live in communities rather than in institutions. This paper briefly reviews evidence for and discusses three forms of treatment-assertive community treatment, supported employment, and cognitive behavior treatment-which have been studied extensively and are widely accepted as effective interventions. Forces are discussed that have shaped these and other psychosocial treatment over the past five decades. Despite the accumulated evidence, many questions remain about the cost-effectiveness and applicability of these treatments in specific populations and service environments. The development of these and other treatments has been, and continues to be, shaped by concerns about rising health care costs, a heightened emphasis on evidence-based treatment and by consumers taking a more active role in determining the services, and outcomes that are most helpful to them.