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.     

Discovery and identification of new D13S317 primer binding site mutations

During the course of conventional testing of CODIS standards at the Alabama Department of Forensic Sciences, a sample with a heterozygous null genotype at D13S317 was discovered using the PowerPlex 1.1 kit (Promega, Madison, WI). The loss of both alleles was confirmed when the sample was amplified using PowerPlex 1.2 primers and resulted in a 9, 10 genotype at this locus. To determine the cause of the silent alleles, the ADFS designed D13S317 primers which encompassed the PowerPlex 1.1 D13S317 primer binding sites and sequenced the region. Both alleles showed the presence of two substitutions (T-->A and G-->T) at positions 1 and 5 (5'-->3') of the reverse primer (positions 196 and 200 of the sequence in GenBank accession number ). Since the mutations were identical on both alleles, they may be assumed to be of ancestral origin.     

The use of expensive health technologies in the era of managed care: the remarkable case of neonatal intensive care

The use of neonatal intensive care (NIC) continued to rise rapidly in the 1990s despite the concerns of observers about its cost effectiveness and its successes being mostly in facilities with high volume and capabilities. The objective of this study is to test the effects of insurance type, competition among hospitals, and market pressure from managed care plans on the supply and cost of NIC. The analysis uses logistic and linear models with techniques to avoid bias from (a) market area definitions based on actual patient flows and (b) self-selection of hospitals by patients with unmeasured risk of needing NIC. The data source contains all births in short-term hospitals in New Jersey during 1990 and 1994. Both the number of days and charges for NIC are reported. Key findings are that the decision of a hospital to offer NIC was associated with teaching status, the proportion of infants in the market area with documented high risk, and the market concentration of major competitors. The market share of managed care plans and the concentration of enrollment were not associated with either NIC being offered or with the standardized charges. Whether a particular patient was given to a NIC depended on patient risk factors and whether a NIC unit was present, but not on payer group. The results are consistent with the hypothesis that young insured parents (with the advice of their obstetricians) prefer hospitals with NIC and also are relatively profitable enrollees for health plans. In conclusion: using the results here and in other research, public and private policy makers may consider several ways to strengthen the incentives for health plans to contract for cost-effective birth-related services. The results also raise questions for a number of regulatory and payment policies and call for better public data on costs and outcomes for NIC.     

Cerebral ischemia or post traumatic thrombosis of the A. carotis occuring to a car driver (author's transl)]

A short while after leaving a public-house a 71 year old man as the driver of his car was involved in a head-on collision with another car. On admission to a hospital he was unconscious with a distinct debility for the left side of his body and showed a changing anisocoria. Angiography of the right carotid artery revealed an occlusion. It was suspected that this was the terminal state of a generalized arteriosclerotic occlusion which was considered being the reason for the accident. The autopsy-findings showed, however, a posttraumatic thrombosis (whiplash-trauma of the cervical vertebral column) of the right arteria carotis and of the right arteria vertebralis with thromboembolia in a small pontine artery with an infarct-like ischemic softening. The differentiation from an apoplexia is of importance for the differential diagnosis.     

Mainstreaming: A case for optimism and cynicism

This paper seeks to evaluate the concept of mainstreaming against a range of feminist critiques of laws and legal systems and to examine the case for the pursuit of feminist politics through mainstreaming strategies. It begins, in section two, by identifying theme sin existing mainstreaming literature, and then in section three considers the potential of mainstreaming to tackle the causes o fine quality. In particular it questions whether mainstreaming can address the patriarchal nature of laws and legal systems and the essentialising tendencies of law, and whether mainstreaming can effectively tackle market-driven inequality. A final section considers the conditions under which feminists might consider engagement with mainstreaming and the limits of such strategies. This revised version was published online in July 2006 with corrections to the Cover Date.     

Effects of marital conflict and family structure on the self-concepts of pre- and early adolescents

This study explored the effects of marital conflict and family structure on the self-concepts of youth aged 8–12. Subjects were 16 mother-youth pairs from intact parent families (IP) and 17 mother-youth pairs from separated parent families (SP). Results revealed youth in families with low marital hostility and high marital affection had significantly more positive self-concepts. Analyses suggested differences between IP and SP groups may best be explained by differences in marital hostility. The authors discuss the effects of marital discord on parenting within an ecosystems perspective.This study received partial support from the Indiana University School of Nursing Alumni Association and Sigma Theta Tau, Alpha Chapter.Research interests: children's social networks, marital structure, and parenting.Research interests: chronic illness in children.     

Entrepreneurship and University Technology Transfer

This paper argues that it is important to devote greater attention to the study of entrepreneurship in technology transfer in the light of greater government attention, the growth in the phenomenon, the need to identify how wealth can be created from spin-outs, changes in the cultures of universities and differences with technological entrepreneurship in general. The paper summarizes the contributions made by the papers presented in the special issue in terms of their levels of analysis. At the spin-out level, issues are raised concerning identification of typologies of spin-out firms, the evolution of spin-outs and external resources. At the university level, issues concerning policies, internal resources and processes are discussed. An agenda for further research is elaborated which relates to the need to examine further levels of analysis: the academic entrepreneurs themselves and how they recognize opportunities and shape their ideas to meet the market; the nature of internal university environments, processes and resources; and the nature of the scientific discipline which may have implications for the process of creation and development of spin-out ventures.