Monitoring deliberate self-harm presentations to general hospitals

Monitoring of deliberate self-harm (DSH) presentations to hospitals (and in other settings) is receiving increased attention in many countries. This is due to greater recognition of the size of the problem and awareness of its relevance to suicide prevention policy initiatives, because of the strong association between DSH and suicide. A system for monitoring all DSH presentations has been in place in the general hospital in Oxford for 30 years. Based on our experience, in this paper we describe procedures for monitoring, including case definition and identification, linkage of persons and episodes in order to investigate repetition of DSH and other outcomes (including deaths), and data protection and ethical issues. We also provide details of how to carry out monitoring, including different models of data collection, and what data to collect. Finally we consider the potential uses of the data for both clinical and research purposes, including evaluation of national suicide prevention initiatives.     

Devolution in the United Kingdom: Statehood and Citizenship in Transition

The United Kingdom evolved as a "state of unions," in whichgovernment arrangements were territorially varied in line withthe particular circumstances of the sequence of acts of unionbetween the core state territory of England and Wales, Scotland,and Ireland. The recent devolution reforms have built on thatterritorial nonuniformity, embedding a number of idiosyncrasiesinto the devolved UK state: a lopsidedness that leaves the biggestand wealthiest part of the United Kingdom—England—governedcentrally wihle the non-English nations have devolved government,devolved government arrangements for those nations that aremarkedly asymmetrical, and an underdeveloped system of intergovernmentalrelations connecting United Kingdom—level and devolvedpolitical arenas. Together these issues pose important questionsof whether the devolution reforms amount to a coherent overallpackage, whether the reforms are stable, and whether they erodea common UK citizenship.     

Identification of human skeletal remains by comparison of bony details of the cranium using computerized tomographic (CT) scans

A case is described where a cranium from an unknown individual is identified by comparison of antemortem and postmortem computerized tomographic (CT) images of the bony structure of the skull. While on at least one occasion CT scans of individual cranial landmarks have been used to identify unknown remains, this study is remarkable because positive identification of a deceased individual was accomplished by performing a CT scan on an unidentified cranium and comparing multiple landmarks and images with corresponding features in an antemortem CT scan of a missing man. Bony details of the frontal and sphenoid sinuses, ethmoid and mastoid air cells, sagittal cranial suture, and the torcula (the internal occipital protuberance) were exactly the same on both CT scans, confirming them as the same person.