Threat assessment: defining an approach for evaluating risk of targeted violence.

Although the field of risk assessment has made tremendous advances in the past 20 years, assessments of targeted violence continue to pose a significant challenge to law enforcement, mental health, and other professionals. These specific and critical assessments require an innovative approach. The threat assessment model, developed and refined by the U.S. Secret Service, provides a useful framework for thinking about assessments of potential for targeted violence. In this paper, we attempt to define this approach as it has been developed by the Secret Service, and apply it within the existing professional/scientific literature on risk assessment. We begin with a brief review of existing models and approaches in risk assessment, and identification of some gaps in our existing knowledge as it relates to assessments of targeted violence. We then proceed with an outline of the threat assessment approach, including a review of principles and guiding operational questions, and discussion of its use in assessment of targeted violence.

Assassination in the United States: an operational study of recent assassins, attackers, and near-lethal approachers.

This study is the first operational exploration of the thinking and behavior of all 83 persons known to have attacked, or approached to attack, a prominent public official or public figure in the United States since 1949. In addition to data about each attack or near-attack and each subject's demographic and background characteristics, information was gathered about each subject's ideas and actions in the days and weeks before their attacks or near-lethal approaches. Questions were examined about each subject's movement from the idea of attack to actual attack, motives, selection of targets, planning, communication of threat and intent, symptoms of mental illness, and significant life experiences. In every case, the attack or near-attack was the end result of an understandable, and often discernible, process of thinking and action. Implications for protectors, investigators, and researchers are discussed.

GFS Mark II inflatable penile prosthesis: four-year clinical study.

OBJECTIVE: The objective of the study was to evaluate the mechanical performance and the patient/partner satisfaction of the GFS Mark II inflatable penile prosthesis (IPP). METHOD: A total of 138 patients had GFS Mark II IPP implants between October 1988 and December 1991 with a follow-up of twelve to fifty months (mean 31.7 months) were studied. Each patient was evaluated for prosthesis performance and each patient/partner satisfaction was evaluated by a questionnaire and personal interview. RESULTS: There was only one prosthetic mechanical problem which involved the tubing. There were seven problems requiring explanation; two of which were postoperative infections. Thirteen patients required an addition of normal saline through the resipump as an office procedure. Ninety-three percent of the patients and 98 percent of the partners reported satisfaction with the use of the prosthesis. Men who had a previously inserted penile prosthesis replaced with the GFS Mark II IPP preferred the GFS over the malleable and the self-contained prosthesis, but there was no conclusive preference between the different IPPs. CONCLUSIONS: This study concludes that the GFS Mark II connectorless IPP has shown few mechanical problems over a four-year period and has a good patient/partner satisfaction. This prosthesis has the additional feature of the resipump to adjust the fluid volume as an office procedure when required.

The G.F.S. Mark II inflatable penile prosthesis.

The G.F.S. Mark II inflatable penile prosthesis was implanted in 80 men who were followed for up to 27 months. In this study there have been no mechanical problems. Of the patients 6 required repositioning of the reservoir pump and 4 required postoperative addition of fluid to the reservoir pump. This study indicates that the revised connectorless G.F.S. Mark II inflatable penile prosthesis has eliminated the previous problems with connectors and tubings. The G.F.S. Mark II inflatable penile prosthesis reservoir pump provides a means of postoperative fluid adjustment within the system performed as an office procedure.

The designated forensic professional program: a state government-university partnership to improve forensic mental health services.

As the law/mental health field has expanded and matured in the last 20 years, the sophistication required by mental health professionals in order to respond appropriately to legal questions has grown significantly. Courts and legislatures define a growing number of legal competencies. Judges and attorneys are more familiar with mental health law than they were 10 or 20 years ago.

[Value of bronchography in childhood with special reference to nuclear medicine preliminary examinations]. / Stellenwert der Bronchographie im Kindesalter unter besonderer Berücksichtigung nuklearmedizinischer Vorfelduntersuchungen.

One month to 16 years old 288 children suffering from recurrent and chronic bronchitis, asthma, cystic fibrosis, malformations and various other lung diseases have been undergone 133Xe-Gas/99mTc-HAM lung scintigraphy. By means of results and taking in consideration scintigraphic findings the strategy of bronchographic indication is laid open being of higher load for the children based on anaesthesia and x-ray. Thus the number of bronchographs could be reduced from 47 (1984) via 33 (1985) to 22 (1986) by means of lung-scintigraphic imaging.

The Health Security Partnership. A federal-state universal insurance and cost-containment program.

The Health Security Partnership attempts to assure (1) that all Americans have insurance coverage for a set of comprehensive health care benefits, (2) that cost-containment issues are addressed in a manner that does not impinge negatively on the quality of care, and (3) that provider freedom to deliver appropriate clinical care is strengthened. It assigns important responsibilities to the federal government (eg, specification of benefits, review of proposed state health care budgets), while permitting states to select, develop, and administer specific program design features they deem appropriate (eg, states could build on and expand the existing health system infrastructure, including private insurance, and/or extend the role of tax-supported programs). It is estimated that in its first year the program would add about 5% to America's health expenditures, but within a few years, cost-containment efforts and administrative efficiencies would reduce overall expenditures below what they otherwise would be.

Mentor GFS inflatable prosthesis.

A new inflatable penile prosthesis is described. The operative approaches, infrapubic and scrotal, are discussed and compared. The results of 56 successive implants are presented. The simplicity of the device which combines the usual intra-abdominal reservoir and the scrotal pump into a scrotal "resipump" is discussed. The device has shown a good performance and is a valuable addition to the varieties of penile implants.

Intracavernous medication for treatment of premature ejaculation.

Sixteen men complained of premature ejaculation during a five-month period between May, 1987, and October, 1987. Eight patients entered this study using intracavernous vasoactive drugs as treatment for their problem. The patients, ages twenty-four through fifty-eight (average 42 years), were all physically healthy and taking no medications. Five patients had normal findings on nocturnal tumescence monitor, while 3 patients did not use the monitor. A mixture of phentolamine mesylate, 1.0 mg/mL, and papaverine hydrochloride, 30 mg/mL, was used. The dosage required was from 0.10 mL to 0.40 mL. All 8 patients responded successfully to this treatment. Three patients stated they were cured and stopped the treatment. The other 5 patients continued using the medication after fourteen months. The drug-induced erection lasted between two and four hours despite ejaculation. There have been no side effects through April, 1988. All patients report satisfaction with the results of this treatment. The study showed that intracavernous medication therapy can be successful in the treatment of premature ejaculation.

Classification of sexual dysfunction for management of intracavernous medication-induced erections.

A total of 75 patients was placed into 1 of 3 classes of sexual dysfunction based on nocturnal penile tumescence tracings rather than on etiology of the sexual dysfunction. The patients then were given an intracavernous injection with incremental dosages of 0.2 to 1.0 ml. of a combination of papaverine hydrochloride and phentolamine mesylate vasoactive intracavernous therapy. The results of the study were categorized as class 1--mild sexual dysfunction (100% successful with low dosages of medication), class 2--moderate sexual dysfunction (95% successful but larger dosages of medication were required) and class 3--severe sexual dysfunction (a 50:50 chance of a successful treatment and even higher dosages of medication were required). A portable home nocturnal tumescence monitor classification of severity of sexual dysfunction provided a guideline for the intracavernous pharmacological injection initial dosage and the probability of success or failure in patients who desire this form of therapy for male sexual dysfunction.

For profits: a look at the bottom line.

This paper examines the expansion of for-profit health care organizations, focusing on hospitals. It argues that much of the support of for-profits derives from American market ideology and the assumption that the search for profits leads to efficiency in production. In the health field, there is no evidence, however, that such gains in efficiency exist or that, if they do, they are shared with patients in the form of lower costs of care or with employees in the form of higher wages. The paper presents a number of reasons for concluding that for-profits would not serve the needs of patients, care deliverers, local communities, or the health care system. Potential efficiency gains, even if realized, would be far outweighed by the damage that for-profits would cause.