Background and Purpose— The incidence of cerebral venous thrombosis (CVT) varies between studies, but it is estimated to be between 2 and 5 per million per year. A recent study in the Netherlands with comprehensive ascertainment suggested a much higher incidence. It is uncertain whether these differing estimates reflect the quality of ascertainment or true variation. The purpose of this study was to determine the incidence of CVT in Adelaide, using a novel clinical and radiological methodology. Methods— We retrospectively identified CVT International Classification of Diseases-coded cases from all Adelaide public hospitals from 2005 to 2011. We also searched all neuroimaging studies (259 101) from these hospitals for text variations containing venous thromb. All potential cases were reviewed, and cases of incident CVT ascertained. Associations and outcomes were determined. Results— Of 169 possible cases, 105 cases of CVT were confirmed (59 cases by both coding and neuroimaging, 40 from neuroimaging alone, and 6 from coding alone). In our population of 953 390 adults, this represented an incidence of 15.7 million per year (95% confidence interval, 12.9–19.0), the highest incidence reported. Of these cases, a possible procoagulant predisposition was identified in 48%. Fifty-five of 105 cases occurred in females. Relative risk of CVT in females of reproductive age was insignificantly higher than in males (1.18 [95% confidence interval, 0.94–1.48]). Conclusions— Cerebral venous sinus thrombosis in our study was more common than previously reported, perhaps because of more complete ascertainment. Future CVT incidence studies should include comprehensive capture and review of neuroimaging.

In 2008, Aboriginal elder Mr Ward died of heat stroke while being transported in the back of a prison van operated by private security company GSL (now G4S). This article will address the role accountability mechanisms can play in improving correctional and custodial services and whether existing oversight frameworks can provide a proper supervision and quality control of private security operators. It will focus on the key reports issued by Western Australia's Inspector of Custodial Services, the independent office to oversee the prisoner transfer system. Another central source of information will be an examination of the report and recommendations handed down by the Western Australian Coroner Alastair Hope in June 2009. The Hope Report details the numerous failings of the system which led to the Ward tragedy. Both GSL and the Western Australian state government had breached a duty of care to Mr Ward. Further, it remains highly problematical having a range of oversight bodies if elected government is able to simply ignore the subsequent advice. Parliament must therefore remain a central part of the system of political accountability.