A shift in HIV reporting practices: a biopolitical analysis.

The Center for Disease Control and Prevention (CDC), mainstream medical journals and many state legislatures are calling for a drastic shift in what has become standard HIV reporting practice throughout the United States (Burke, 1997; Richardson, 1997a; Rotello, 1997). We are now experiencing a challenge to the long held practice of confidential and anonymous HIV reporting (Grumman, 1997; Richardson, 1998). The federal government, the American Medical Association and several major AIDS organizations have supported state level proposals that require public health officials to adopt name reporting, i.e., monitoring HIV by name not by number (Richardson, 1997b; Richardson, 1997c; Kong, 1997). With number identification, the practice commonly used, there is no link made between number and the patient's name thus assuring anonymity. This article details this shift in public health policy and the biopolitical factors surrounding HIV testing and reporting. This shift is one in which the "duty to warn" takes precedence over the long held professional value of confidentiality.

Confidentiality of social work records in the computer age.

Computers have brought social, cultural, and economic benefits. They also are challenging social workers to preserve a basic tenet of the profession--confidentiality. Electronic record systems and rapid changes in communication over the Internet are outpacing the profession's ability to ensure privacy. This article discusses ideas of information protection and makes recommendations to minimize violations of privacy.

The credibility of nonprofit boards: a view from the 1990s and beyond.

The wrongdoings of nonprofit organizations have become grist for the media mill. The authors explore five of the more recently publicized cases of nonprofits gone wrong: the United Way of America, National Association for the Advancement of Colored People, Foundation for New Era Philanthropy, Jewish Community Center of Greater Washington, and Upsala College, and their significance in regard to the role and functioning of the board. Discussion focuses on the implications of these cases in regard to nonprofits' credibility and strategic options for enhancing accountability. Unless governing boards address some of their deficiencies, tighter government regulations, increased donor skepticism, and greater demands and expectations upon them will result.

Impact of group homes on the values of adjacent residential properties.

The economic impact of locating small group homes in various single-family residential neighborhoods was assessed. Sales within 229 m of 19 homes, which occurred 24 months prior and subsequent to licensing, were examined using a computer assisted mass appraisal model and an adaptive estimation procedure. The findings confirm earlier studies that refute the notion that such homes adversely impact real estate values of adjacent properties. An extensive review of relevant literature and litigation was provided.

Life vs. death: the value of ethical uncertainty.

Technological advances, demographic changes, and scarce resources are forcing health care professionals to make life-or-death decisions with increasing frequency. The author analyzes the dangers of professional control in situations involving treatment-or-nontreatment choices, proposes a way of protecting the powerless in these situations, and explores the importance of procedures to guard against easy certainty.

The board of directors and agency accountability.

The demand for greater accountability in the social service arena has forced those responsible for funding and operating programs to look for more efficient ways to evaluate them. The board of directors of the nonprofit organization, as legally constituted, is the most appropriate body to exercise the accountability function.

Fetal movements and ultrasound: effect of maternal intravenous glucose administration.

Fetal movements were directly visualized with a real-time ultrasound unit, and they were recorded after the random intravenous administration of either glucose or saline solution to the mother. A significant increase in fetal activity was seen 1 hour after the administration of glucose.

Endometrial estrogen and progesterone receptors in a uterus didelphys.

A 23-year-old woman with a uterus didelphys and a totally occluded left tube had a hysterectomy one year after having a child. Endometrial estrogen and progesterone receptors, both cytoplasmic and nuclear, were determined in five longitudinal sections of each horn. The amount and distribution of these receptors were normal, but the receptor content of the right horn was higher than that of the left.

PIP: A 23-year-old white woman was admitted with a complaint of increasing dysmenorrhea since the birth of her child 1 year before. She was diagnosed as having a uterus didelphys and a totally occluded left tube, and hysterectomy was performed. 5 longitudinal sections of each uterine horn was examined for both progesterone and estrogen endometrial nuclear and cytoplasmic hormone receptors. Cytoplasmic receptor values were in the expected normal range, and in general descended from the fundus to the cervix as in normal uteri. Nuclear receptor values were also in the expected range for secretory nuclei and their distrubtion was as seen in normal uteri. Both receptors (estrogen + progesterone; cytoplasmic + nuclear) however, were higher in the right horn vs. the left horn; this difference is ascribed to the woman's earlier pregnancy.

Assessment of fetal lung maturity: a comparison of the lecithin/sphingomyelin ratio and the tests of optical density at 400 and 650 nm.

Seventy-eight amniotic fluid samples were obtained by transabdominal amniocentesis and were analyzed for their L/S ratio and optical density at 400 and 650 nm. The L/S ratio was considered to be mature if the values were greater than 2.0. The optical density of the fluids decreased with prolonged refrigeration. With freshly centrifuged samples, the OD650 reading of greater than 0.15 gave the best correlation with the mature L/S ratio. There were 3.8% false positive results and 14.1% false negative results. The study confirms that the OD650 test on fresh amniotic fluid is a rapid and inexpensive way to determine fetal maturity. All samples with values of less than 0.15 must, however, also be tested for their L/S ratio since some of the infants with these values may also be mature.

The role of ultrasonography in the management of endometritis/salpingitis/peritonitis.

Ultrasonography has been used as an adjunct in managing pelvic infections when culdocentesis is contraindicated. Twenty-three of 42 women presenting with endometritis/salpingitis/peritonitis (ESP) had ultrasonographic masses. The erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and the highest temperature in the first 24 hours failed to distinguish those with sonographic masses from 19 patients without pelvic masses. The clinical parameter that tended to distinguish patients with masses versus no masses occurred in individuals who had an IUD at the time of admission. If a patient had an ESR greater than 65 mm/hr and an IUD, sonography demonstrated a mass in 71.4% of the cases. The clinical response to multidrug therapy (bactericidal-bacteriostatic, bactericidal-bactericidal, and triple-drug therapy) were comparable in the patient populations with or without a sonographic mass. Sonography is of little use in the acute phase of ESP. It is best reserved for those patients who do not respond to adequate antibiotic therapy and for the serial evaluation of a large tubo-ovarian complex when conservative management is indicated.

Intrauterine transfusion with continuous ultransonic assistance.

This paper describes a technic of intrauterine transfusion using continuous real time ultransonic assistance and discusses complications of intrauterine transfusion. The advantage of ultrasound-assisted intrauterine transfusion in reducing fetal injury and radiation exposure is emphasized.

Comparison of fetal maturity evaluation with ultrasonic biparietal diameter and amniotic fluid lecithin-sphingomyelin ratio.

Fetal head biparietal (BP) measurements by ultrasonic techniques and amniotic fluid lecithin-sphingomyelin (L/S) ratios were simultaneously determined (within 2 days) on 84 occasions in 72 women. Using the criteria for maturity of an L/S ratio of 2.0 or more or a BP measurement of 9.0 cm or more, there was agreement between these test results in 66.7% of the cases. The BP incorrectly predicted the L/S ratio 33.3% of the time, with a false positive rate of 27.3% and a false negative rate of 6.0%. If an L/S ratio of 1.5 were used as the critical determinant, the BP false positive rate remained high (9.5%). A high false negative error (21.4%) occurred if a BP value of 9.3 cm was used. These results suggest that ultrasonic BP measurements should not be used as the only criteria of fetal maturity in the management of high-risk pregnancies.

Fetal movements and placental lactogen levels for fetal-placental evaluation. A preliminary report.

Fetal movements were measured by 37 pregnant women during a 10-minute period while they were lying on their left side at various times during the day with the highest rates in the evening. Preliminary assessments of fetal movement and serum hPL levels in pregnant women suggest that the two tests might complement each other in providing more information about the status of the placenta and fetus.