The role of reflexive (algorithmic) testing in laboratory medicine: adapting to the new era.

Centralized Laboratory Services, Inc. (CLS) is a large, freestanding laboratory that is an affiliate of the Health Insurance Plan of New York, a managed care organization with more than 1 million members in New York and New Jersey. The laboratory work for this membership is consolidated at CLS, which thus serves an ambulatory patient population. The Medical Director at CLS is charged with optimizing laboratory utilization by clinicians who are part of the system.

Violence against women during the Liberian civil conflict.

CONTEXT: Civilians were often the casualties of fighting during the recent Liberian civil conflict. Liberian health care workers played a crucial role in documenting violence against women by soldiers and fighters during the war. OBJECTIVE: To document women's experiences of violence, including rape and sexual coercion, from a soldier or fighter during 5 years of the Liberian civil war from 1989 through 1994. DESIGN: Interview and survey. SETTING: High schools, markets, displaced persons camps, and urban communities in Monrovia, Liberia, in 1994. PARTICIPANTS: A random sample of 205 women and girls between the ages of 15 and 70 years (88% participation rate). RESULTS: One hundred (49%) of 205 participants reported experiencing at least 1 act of physical or sexual violence by a soldier or fighter. Survey participants reported being beaten, tied up, or detained in a room under armed guard (17%); strip-searched 1 or more times (32%); and raped, subjected to attempted rape, or sexually coerced (15%). Women who were accused of belonging to a particular ethnic group or fighting faction or who were forced to cook for a soldier or fighter were at increased risk for physical and sexual violence. Of the 106 women and girls accused of belonging to an ethnic group or faction, 65 (61%) reported that they were beaten, locked up, strip-searched, or subjected to attempted rape, compared with 27 (27%) of the 99 women who were not accused (P< or =.02, .07, .001, and .06, respectively). Women and girls who were forced to cook for a soldier or fighter were more likely to report experiencing rape, attempted rape, or sexual coercion than those who were not forced to cook (55% vs 10%; P< or =.001, .06, and .001, respectively). Young women (those younger than 25 years) were more likely than women 25 years or older to report experiencing attempted rape and sexual coercion (18% vs 4%, P=.02 and .04, respectively). CONCLUSIONS: This collaborative research allowed Liberian women to document wartime violence against women in their own communities and to develop a unique program to address violence against women in Liberia.

Selection factors in the choice of immunoassay technology: implementing technology in the new era.

Centralized Laboratory Services, Inc. is a large, freestanding laboratory that underwent a major equipment reconfiguration for the performance of endocrine/tumor marker/anemia assays (N = 15) in August 1995. Before the transition these assays were done on six instruments, none of which were computer interfaced. All assays were subsequently consolidated on four ACS-180+ instruments (Chiron Diagnostics, Norwood, MA), which were interfaced to our laboratory information system (Cerner Corp, Kansas City, MO). Our experience suggests that significant increases in productivity and reductions in cost are possible through instrument upgrades. Both laboratory-specific and analytical system-specific factors were found to be important in the optimal selection of immunoassay technology. As laboratorians necessarily adjust to changing economic and organizational circumstances and are compelled to "do more with less," technology assessment will become an increasingly important function for senior laboratory management.

Rape as a crime of war. A medical perspective.

Although widespread, rape of women has been an underreported aspect of military conflict until recently. The current war in the former Yugoslavia has focused attention on the use of rape as a deliberate strategy to undermine community bonds and weaken resistance to aggression. In addition to providing treatment for individual survivors, the medical community has an important role to play in investigating and documenting incidents of rape. Such documentation can help to establish the magnitude of rape in war and hold perpetrators accountable. Since rape in war affects not only the individual but also the family and community to which the survivor belongs, the restoration of social and community bonds is central to the process of healing and must be addressed within the specific cultural setting.

A new reversed passive hemagglutination test for detection of HBsAg.

A new reversed passive hemagglutination test for HBsAg, termed Raphadex B, has been developed using immunochemically purified chimpanzee anti-HBs bound to stabilized human erythrocytes. The test has been found to have equivalent sensitivity to the Ausria 125I radioimmunoassay, and detected a similar number of HBsAg-containing specimens in screening of volunteer blood donors. This method offers an economical approach to third generation methodology for hepatitis B screening of blood donors.