Human immunodeficiency virus infection in cases presenting to the Philadelphia Medical Examiner's Office.

Serum samples were available from 492 of 1,058 cadavers seen at the Philadelphia Medical Examiner's Office between August 4 and December 15, 1989. These sera were tested for the presence of antibodies to human immunodeficiency virus (HIV) by enzyme-linked immunosorbent assay (ELISA) and Western blot. The overall prevalence of HIV in the autopsy population was 2.24%. The following populations showed increased prevalence as compared to the total sampled population: blacks (3.60%, p less than 0.01), males (2.51%, n.s.), and homicide victims (3.74%, n.s.). Seroprevalence data from this study are compared with those from earlier studies of other related populations, with regard to overall prevalence and risk factor analysis.     

Empire and the business of health insurance.

I examine the development of privately provided insurance since World War II, giving special attention to Empire Blue Cross, and argue that the competition between employers and unions for the loyalty of workers after the passage of the Taft-Hartley Act helped diffuse private health insurance benefits already favored by federal policies. For-profit insurers did not challenge the privileged status of Blue Cross plans because they recognized the political benefits that the plans offered and because they did not wish to offend the plans' sponsors. A relatively easy and profitable business, health insurance has been greatly disturbed by the system inflation accompanying the introduction of Medicare and Medicaid programs. Now self-insurance and various managed-care schemes are major threats. The future may bring consolidation and the strengthening of pools, just the opposite of today's system fragmentation.     

Involuntary outpatient treatment as “desintitutionalized coercion”: The net-widening concerns

In American jurisprudence, two justifications have traditionally been put forth to support the government's social control of persons with mental illness: police power and parens patriae. As public mental hospitals became less available as loci in which to exercise these functions, governments sought alternative means to achieve the same ends. One prominent but quite controversial means is involuntary outpatient treatment (IOT). While the concerns about IOT have been myriad, one often alluded to but never documented is that of “net-widening.” That is, once IOT became available, it would be applied to an ever greater number of individuals, progressively expanding the margins of the designated population to whom it is applied, despite the formal standard for its application remaining constant. We tested the net-widening belief in a naturalistic experiment in Massachusetts. We found that net-widening did not occur, despite an environment strongly conducive to that expansion. At this time, whatever the arguments against IOT might be, net-widening should not be one of them.     

Does involuntary outpatient commitment lead to more intensive treatment?

Studies of involuntary outpatient commitment (OPC) among persons with severe mental illness have concluded that OPC is only effective in improving treatment outcomes when it is sustained for 6 months or longer and is combined with frequent outpatient services. This article explores factors that influence the delivery of outpatient services to subjects in a randomized trial of OPC and finds 2 general patterns. Outpatient visits were more frequent among all subjects with apparent clinical need, regardless of study assignment, and among subjects whose OPC was sustained beyond an initial court order. These results suggest that, in practice, sustained OPC represents a consensual agreement between clinicians and the court to more intensively address the complex needs of persons with severe and persistent mental illness.     

Comparative proportionality review: A nationwide examination of reversed death sentences

A required part of the appellate review of death sentences in many capital punishment jurisdictions is comparative proportionality review. This procedure requires the court to compare the death sentence under review with sentences in similar cases to determine whether it is excessive. This article examines those death sentences from across the country that have been reversed on comparative proportionality grounds. Relatively few death sentences have been reversed on these grounds, and the number of reversals is decreasing. The reviews that reverse sentences infrequently compare only to other death sentences, commonly use a method that requires more than a mere common aggravating factor for selecting comparison cases, and rarely use the frequency method of comparative proportionality review.     

Industrial practices of research conversion and technology transfer

The conversion of R&D into commercial new products has long been considered a basic tenet of industrial innovation and competitiveness. This paper describes the key variables that affect the successful commercialization of new technologies in industrial companies. Drawing on the authors' own research and consulting experience with hundreds of US and foreign companies, the paper examines the more effective practices, identifies key barriers and problem areas, and provides some conclusions and implications for practicing managers.