Surveillance of human immunodeficiency virus (HIV) antibodies in medicolegal autopsies in Finland--monitoring early changes in HIV-seropositivity among risk groups and average population.

In order to cooperate with voluntary screening programs aimed at the surveillance of the HIV epidemic in Finland, we have studied medicolegal autopsies for HIV antibodies since 1986 using an enzyme immunoassay on postmortem sera. The investigation covered 47.4% and 39.2%, respectively, of all deaths under the age of 65 years in the metropolitan areas of Helsinki and Turku--two cities on the densely populated southern coast of Finland from which most HIV infections have thus far been detected. Nine HIV-positive cases (0.12%) were detected among the 7305 medicolegal autopsies tested in 1986 to 1990. This figure is higher than the prevalence of 0.01 to 0.03% in voluntary screening programs for the general population would suggest. Seven of our cases had previously tested positive, and two were previously unknown cases, indicating that people at high risk are clustered in the medicolegal autopsy series. Of the six cases in an early stage of infection, three committed suicide suggesting the importance of HIV-screening in suicide cases in tracing symptomless HIV carriers. Five of the cases were detected in 1990, a year when the number of new HIV infections had more than doubled compared to the previous two years. This suggests that testing of medicolegal autopsies as surrogate tests for the population gives useful information even in low-prevalence areas like Finland. Such testing has none of the ethical problems of many other back-up surveys, and may be particularly sensitive to early changes in epidemiology.     

Leadership Harvard Style

The John F. Kennedy School of Government at Harvard is teaching a new approach to leadership. This article outlines some of the elements of this approach and contrasts them with standard models on leadership in the literature.     

Are disturbed and normal adolescents equally competent to make decisions about mental health treatments?

This study uses a structured vignette procedure to assess competency to make treatment decisions in two groups of adolescents, one at risk for institutional placement and the other a matched community sample. Scores on Factual Understanding (the ability to recall facts), Inferential Understanding (the ability to make inferences about those facts), and Reasoning (the ability to weigh risks and benefits of various treatment options and to make choices based on that reasoning) were compared. Results showed that while at-risk adolescents and their community, counterparts did not differ in their factual and inferential understanding abilities, the at-risk adolescents did significantly less well than the community adolescents in reasoning. This difference could not be fully explained by differences in verbal IQ. Girls, no matter what their risk status, scored higher than boys on the Reasoning scale. Implications for legal policies concerning adolescents are discussed.     

The Whole-Brain Concept of Death Remains Optimum Public Policy

"Brain death," the determination of human death by showing the irreversible loss of all clinical functions of the brain, has become a worldwide practice. A biophilosophical account of brain death requires four sequential tasks: (1) agreeing on the paradigm of death, a set of preconditions that frame the discussion; (2) determining the definition of death by making explicit the consensual concept of death; (3) determining the criterion of death that proves the definition has been fulfilled by being both necessary and sufficient for death; and (4) determining the tests of death for physicians to employ at the patient's bedside to demonstrate that the criterion of death has been fulfilled. The best definition of death is "the cessation of functioning of the organism as a whole." The whole-brain criterion is the only criterion that is both necessary and sufficient for death. Brain death tests are used only in the unusual case in which a patient's ventilation is being supported. Brain death critics have identified weaknesses in its formulation. But despite its shortcomings, the whole-brain death formulation comprises a concept and public policy that make intuitive and practical sense and that has been well accepted by many societies.     

The distribution of ethanol in postmortem blood specimens.

Ethanol was determined by gas chromatography in a variety of tissues and body fluids secured at autopsy in 61 cases. The specimens tested included right and left heart blood, femoral blood, pericardial fluid, cerebrospinal fluid, vitreous humor, urine, stomach contents, and brain. Statistical analysis of the cases revealed no significant differences among the various blood sites tested. However, the variations in blood ethanol concentrations among the various sampling sites within each case were as follows: 40 cases showed differences of less than 25%; 16 cases revealed variability between 25% and 50%, 4 cases had differences exceeding 50%. In one case, satisfactory blood analyses could not be accomplished. The larger variances occurred especially in those instances in which stomach alcohol concentration was 0.50% or greater. In one case, the variability amongst the different blood sites exceeded 400% (femoral blood--0.043%, right atrium--0.070%, root of aorta--0.156%); the brain was 0.050%, and the stomach contents was 1.2%. For all 61 cases, variances in blood alcohol content among the different sampling sites in a single cadaver ranged from 1.8 to 428%.     

The European community software directive: The United Kingdom implementation

Conclusion The Regulations appear to have reinforced the protection available to software producers under United Kingdom law. The provisions of the Software Directive and the Regulations are complex and not without significant inconsistencies which are likely to prove to be a source of litigation. The drafters of the Regulations chose, unlike many of its European partners, not to adopt the wording of the Software Directive but to write their own interpretation, adding an element of uncertainty to the law in this area, which is perhaps inevitable bearing in mind the linguistic problems of translating and interpreting any directive coupled with the ambiguity and omission of definitions of several key terms. More important, however, than any academic argument will be the practical impact of the new law and its effectiveness in achieving its aim.     

Lon L. Fuller,Gustav Radbruch,and the “positivist” theses

For helpful suggestions and criticism I am grateful to Delf Buchwald (Göttingen), Malte Dießelhorst (Göttingen), Ralf Dreier (Göttingen), Bonnie Litschewski Paulson (Göttingen and St. Louis), Martin Schulte (Münster), Alexander Somek (Vienna), and Kenneth I. Winston (Boston). In correspondence, Walter Ott (Zurich) and Carola Vulpius (Dresden) responded in a most helpful way to my queries.