Deliberate self-harm patients who discharge themselves from the general hospital without adequate psychosocial assessment

Deliberate self-harm patients who leave the acute hospital environment before the completion of psychiatric assessment have an increased risk of subsequent self-harm. We considered the available data on 50 premature self-discharges identified prospectively in a general hospital with a well-developed integrated-care pathway for self-harm patients, and compared them to a control group. The self-discharge group was found to be more likely to have attempted self-poisoning without alcohol intoxication or other forms or combinations of self-harm, and an absence of identifiable previous self-harm or prior contact with local specialist psychiatric services. The two groups showed no difference in age, sex, or area of residence based on community mental health team sectors. It is proposed that these findings indicate hypotheses for further studies of why people leave the hospital without adequate assessment, and how service design could be improved in order to help them.     

Guilty plea hearings and judicial supervision: Some differences between federal and state judges regarding Rule 11 and a defendant’s right to due process

Samples of 120 district court judges from six randomly selected circuit court jurisdictions were compared with 62 circuit and criminal court judges in Tennessee concerning their compliance with Rule 11 of the Federal Rules of Criminal Procedure (U.S.C.A., 1986) governing guilty plea hearings. Among other things, Rule 11 provides that judges will inquire of defendants in open court about the voluntariness of their guilty pleas, whether they understand that they are waiving several important constitutional rights, whether there is a factual basis for the guilty plea, whether they realize they have a right to an attorney, and whether they understand the nature and consequences of the charges against them. It was found that federal judges are substantially in compliance with these provisions of Rule 11, although full compliance was not observed for all issue areas. By comparison, Tennessee trial judges adhered to these provisions (duplicated in the Tennessee Rules of Criminal Procedure verbatim) much less frequently. Various reasons for these discrepancies are discussed, as are some implications for defendant’s access to due process and certain constitutional guarantees.     

Retrospective and prospective voting in a one-party-dominant democracy: Taiwan's 1996 presidential election

Public Choice - Several theories of voting behavior suggest that voters evaluate candidates in an election based on the candidates; past performance and future promise. There is a dispute in the...     

Self-extraction of teeth involving gamma-hydroxybutyric acid

A case involving self-extraction of teeth linked to the abuse of gamma-hydroxybutyric acid (GHB) is reported. A 28-year-old woman and her 29-year-old boyfriend were discovered by paramedics following an extensive period of GHB use. The paramedics were alerted by a neighbor who had heard screaming from the house. On presentation to the accident and emergency department, it was noted that the female had 18 fresh extraction sockets visible intra-orally. At the scene, a mirror, a pair of pliers, and a bowl containing human teeth were found. Charges of assault were taken to the courts against the boyfriend who was subsequently acquitted. Odontological evidence centered on whether or not it was possible to self-extract the teeth using the pliers found. This case is the first to describe possible oral self-mutilation under the influence of GHB and odontologists should always consider self-injury as an explanation for intra- and perio-oral injuries of unknown origin.     

Mortality in cerebral palsy (CP): the importance of the cause of CP on the manner of death

Cerebral palsy (CP) is a nonprogressive motor deficit present or sustained in the perinatal period. We reviewed the files of the Office of Chief Medical Examiner of the City of New York for the 1997-2001 interval seeking those with any mention of cerebral palsy. There were 26 such cases, including 18 natural deaths, three accidents, two homicides, two therapeutic complications, and one death classified as undetermined. Proper reporting and careful investigation of these deaths is required for accurate certification of cause and manner of death, as well as for adequate tracking of these deaths for public health purposes.