Early predictors of refractory status epilepticus: an international two-center study.

BACKGROUND AND PURPOSE: Status epilepticus (SE) refractory to first- and second-line antiepileptic drugs carries high mortality. Little is known on early prediction of refractory SE (RSE)­an essential tool for planning appropriate therapy. Our aim was to identify and validate independent early RSE predictors in adults. METHODS: Clinical and laboratory data on consecutive intensive care unit patients with SE from two academic care centers (a derivation data set from a Swiss center and a validation data set from a US center) were assessed. Multivariable analysis was performed with the derivation set to identify RSE predictors at SE onset. Their external validity was evaluated with an independent validation set. Measures of calibration and discrimination were assessed. RESULTS: In all, 302 patients were analyzed (138 with and 164 without RSE), 171 in the derivation data set and 131 in the validation data set. Acute SE etiology, coma/stupor and serum albumin <35 g/l at SE onset were independent predictors for RSE in the derivation data set [odds ratio (OR) 2.02, 95% confidence interval (CI) 1.01-4.07; OR 4.83, 95% CI 2.42-9.68; OR 2.45, 95% CI 1.16-5.16]. The prediction model showed good measures of calibration (Hosmer-Lemesow goodness-of-fit test P = 0.99) and discrimination (area under the receiver operating characteristic curve 0.8) on the derivation data set­results that were similar in the validation data set (Hosmer-Lemeshow P = 0.24; area under the receiver operating characteristic curve 0.73). CONCLUSIONS: This study confirms the independent prognostic value of readily available parameters for early RSE prediction. Prospective studies are needed to identify additional robust predictors, which could be added to the proposed model for further optimization towards a reliable prediction scoring system.

Single-photon technique for the detection of periodic extraterrestrial laser pulses.

To draw humankind's attention to its existence, an extraterrestrial civilization could well direct periodic laser pulses toward Earth. We developed a technique capable of detecting a quasi-periodic light signal with an average of less than one photon per pulse within a measurement time of a few tens of milliseconds in the presence of the radiation emitted by an exoplanet's host star. Each of the electronic events produced by one or more single-photon avalanche detectors is tagged with precise time-of-arrival information and stored. From this we compute a histogram displaying the frequency of event-time differences in classes with bin widths on the order of a nanosecond. The existence of periodic laser pulses manifests itself in histogram peaks regularly spaced at multiples of the-a priori unknown-pulse repetition frequency. With laser sources simulating both the pulse source and the background radiation, we tested a detection system in the laboratory at a wavelength of 850 nm. We present histograms obtained from various recorded data sequences with the number of photons per pulse, the background photons per pulse period, and the recording time as main parameters. We then simulated a periodic signal hypothetically generated on a planet orbiting a G2V-type star (distance to Earth 500 light-years) and show that the technique is capable of detecting the signal even if the received pulses carry as little as one photon on average on top of the star's background light.

[Complications of first ray osteotomies: a consecutive series of 475 feet with first metatarsal Scarf osteotomy and first phalanx osteotomy]. / Complications des ostéotomies du premier rayon: à propos d'une série continue de 475 pieds traités par ostéotomies du premier métatarsien (Scarf) et de la première phalange.

PURPOSE OF THE STUDY: Available studies on Scarf osteotomies of the first metatarsal (M1) and first phalange (P1) shortening and varus displacement have reported good results, but have have not focused on complications. We reviewed a consecutive series of 475 feet operated on over a five year period. Our goal was to determine the incidence of complications and to compare our data with reports in the literature. We wanted to know if association with Weil osteotomy on the lateral metatarsals affects the rate of complications. MATERIAL AND METHODS: We used the following inclusion criteria: hallux valgus>35 degrees, adult subject, with or without impact on the lateral ray, no prior foot surgery, no systemic disease, no other co-morbid condition. We distinguished two groups: group 1 with isolated first ray disease, and group 2 with hallux valgus and lateral metatarsalgia requiring surgery. RESULTS: We determined the incidence of each complication. Metatarso-phalangeal joint (MTP1) stiffness was the most frequent complication: incidence declined with postoperative time: 41.7% at day 35, 5.7% at day 120. The joint was very stiff with defective pulp weight-bearing in 1.3% of the feet at 12 months. Late wound healing was observed in 5.7% of feet and secondary osteotomy displacement in 1%. Incidence of other complications, including operative site infection, was less than 1%. General complications were: reflex dystrophy (1.3%) and deep vein thrombosis (0.6%). Excepting a longer period of postoperative stiffness, we were unable to identify any change in the rate of postoperative complications in feet with an associated Weil osteotomy of the first ray. DISCUSSION: Our findings confirm that Scarf M1 osteotomies with varus shortening of P1 generates fewer complications than the techniques used earlier. Certain complications have disappeared: nonunion after M1 and P1 osteotomy, great toe claw, symptomatic iatrogenic hallux valgus. Complications with a very low incidence in all series are: operative site infection, osteonecrosis of the M1 head, fracture of M1 at weight bearing. Notching of the two osteotomy pieces with elevation of the metatarsal head and transfer metatarsalgia has been reported by authors using short diaphyseal osteotomies. A stiff MTP1 remains the most frequent complication. Overtly stiff joints (30% loss of range of motion) were observed in 4.6% of our patients at 12 months; 1.3% had major stiffness (20 degrees extension, 0 degrees plantar flexion). This stiffness has been reported by others using the same technique but the risk factors have not been identified. CONCLUSION: This prospective work enabled us to establish the rate of secondary complications of first ray surgery for M1 Scarf osteo-tomy and P1 osteotomy. Complications are rare, a further argument favoring use of these osteotomies. This statistical study enables us discuss the risk of complications at the preoperative interview, keeping in mind the specific elements inherent in each particular situation.

Kinship-based politics and the optimal size of kin groups.

Kin form important political groups, which change in size and relative inequality with demographic shifts. Increases in the rate of population growth increase the size of kin groups but decrease their inequality and vice versa. The optimal size of kin groups may be evaluated from the marginal political product (MPP) of their members. Culture and institutions affect levels and shapes of MPP. Different optimal group sizes, from different perspectives, can be suggested for any MPP schedule. The relative dominance of competing groups is determined by their MPP schedules. Groups driven to extremes of sustainability may react in Malthusian fashion, including fission and fusion, or in Boserupian fashion, altering social technology to accommodate changes in size. The spectrum of alternatives for actors and groups, shaped by existing institutions and natural and cultural selection, is very broad. Nevertheless, selection may result in survival of particular kinds of political structures.

Chayanov revisited: a model for the economics of complex kin units.

Chayanov's model of the peasant economy is based on autarkic nuclear family households. Expansion to the more complex households and kin groups common in peasant societies shows that the sharp changes Chayanov observed in the consumer/producer ratio over the domestic cycle are smoothed by the intergenerational structure of complex households and extended kin groups. This amelioration may be retarded by competition between constituent units. Understanding the dynamics of the developmental cycle and micropolitics of domestic groups is a useful correction to Chayanov's widely used formulation, especially in developing countries where complex kin structures are common.

Demographic dynamics and kinship in anthropological populations.

Changes in fertility and mortality affect the size of surviving sibling sets and thus numbers of surviving kin. Because the genealogical generations specifying kinship relations are not temporal cohorts and most plausible demographic changes in anthropological populations are period shocks, the effect of such shocks on kin counts are complex. Shocks increasing fertility or decreasing mortality produce larger numbers of kin per ego and decrease the inequality of the distribution of kin and vice versa. Effects are more diffuse at more distant collateral ranges. Effects are stronger the more intense the shock and the longer its duration. Kinship distributions return to their initial state after the shock and as the original age structure of the population is ergodically reattained. Alternating shocks produce more complex patterns. Implications of these outcomes are that opportunities for political networking and consolidation by means of kinship are altered by demographic instabilities, as are the dynamics of kin selection. This analysis is limited for simplicity to unilineal agnatic reckoning of kin.

Kinship structures and survival: maternal mortality on the Croatian-Bosnian border 1750-1898.

This is an analysis of maternal survival of up to 13,202 mothers following 56,546 births in south central Slavonia (Croatia) in the period 1714-1898, using automated family reconstitution of 23,307 marriages, 112,181 baptisms, and 94,077 burials from seven contiguous Catholic parishes. Physiological factors have the effects commonly expected. Maternal risk is increased by general economic and social conditions that are plausibly related to withdrawal of men's labour from family farming as a result of military mobilizations and growing levels of wage labour. Risk is decreased by membership in large patriarchal kin groups, but is increased by both the presence of classic rivals (husband's brothers' wives) and being married to a husband junior among his brothers. The analysis demonstrates the sensitivity of maternal survival to macrolevel changes in such factors as the collapse of feudalism, military involvement, economic stagnation, and monetization, as well as to microeconomic and micropolitical factors at the household and local kin-group level.

A consortium-based research education program for residents.

With growing pressures to consolidate and reorganize health care delivery systems, graduate medical education (GME) consortia can draw faculty from affiliated members to assemble educational programs. The authors report on consortium-based research education seminars of a quality that many residency programs would be unable to develop and support on their own. Drawing a diverse faculty from consortium members and area universities, the OHEP Center for Medical Education's annual Research Workshop Series focuses on the design of research projects; data analysis and hypothesis testing; and written and oral presentation of scientific research. Each spring, OHEP sponsors a research forum in which the best research projects from consortium members are presented by the resident-researchers, who compete for recognition and prize money. Further, of the 128 presentations made thus far at the annual OHEP Research Forum, 25% were subsequently published. The consortium's research education program has been well received by residents, is cost-effective, and is an integral component of the research curricula of many area residency programs. Including research training in GME provides residents an opportunity to become more competitive for fellowship, faculty, and leadership positions.

Structural and behavioural changes in the short term preventive check in the northwest Balkans in the 18th and 19th centuries.

Fertility responded negatively to grain insufficiency (proxied by grain price increases), and mortality responded positively in Croatia-Slavonia-Srem in the 18th and 19th centuries, as in most of Europe. Shifts in the intensity and timing of these responses occurred over time as social and economic structures changed. Shifts in the elasticity of fertility with respect to grain supply inversely mimic and lag changes in the elasticity of mortality. Both appear to be induced by increasing land shortage, the collapse of feudalism, and differences in the patterns of adjustment to post-feudal conditions among former civil and military serfs. Generally, responses are stronger for civil and former civil serfs, who may have been in less favorable economic circumstances than the military. Fertility responses in the year of a price shock come to dominate those in the year following, suggesting a shift from contraception to abortion as economic and social conditions apparently worsened and strategies of control intensified. Analysis of monthly responses supports the conjecture based on the annual responses. The shift to the preventive check and strength of the preventive check in the same year as the price shock is unusual in Europe and beyond. Analysis is based on 25 parishes and employs lagged annual and monthly time series analysis with corrections for autocorrelation, in combination with ethnographic and historical data.

Urban versus rural: fertility decline in the cities and rural districts of Prussia, 1875 to 1910.

PIP: This study examined the level and pace of fertility decline in 54 large cities in Prussia during 1875-1910. Data were obtained from census records for 1875, 1880, 1885, 1890, 1895, 1900, 1905, and 1910. Analysis was based on pooled cross sectional time series methods and theories that structural socioeconomic change was a key factor in the decline of fertility in Prussian cities. During 1875-1910, city population grew from 3.8 to 9.6 million. The general marital fertility rate (GMFR) in the 54 cities declined from 281 to 164 during 1875-1910. Catholicism, female labor force participation (FLFP), manufacturing, mining, banking, and communication were statistically positively related to urban fertility level. Pace of decline was related significantly to language, education, FLFP, income, communications, insurance, population size, infant mortality, and married sex ratio. Population size was related to pace but not level. Education and banking had a stronger impact in rural areas. In the city equation, the variables plus dummies accounted for 90% of the variance. A very important variable explaining change in fertility level in Prussia was Catholicism. The most important variables for explaining fertility change in Prussia were infant mortality rate and insurance. Infant mortality, communications, insurance, and income increased in importance over time. FLFP declined over time, but contributed the most to predicted change in GMFR throughout the period, especially in nontraditional occupations. The analysis explained both rapid and slow urban fertility declines and closely approximated predicted fertility. Prussia differs from present developing country contexts in that the population was largely agrarian but literate.^ieng

Evaluating the Slavonian census of 1698. Part I: structure and meaning.

"Microsimulation, other demographic tools, and evidence of history and ethnography are used to evaluate an important 17th century household census [in Slavonia, which is modern Croatia]. Linguistic, ethnographic, and internal evidence allow adjustment of anomalies in census categories. Microsimulation based on historically and ethnographically plausible rates and household formation scenarios produces simulated households in accord with those of the adjusted census. Results permit estimation of the true population of the region, of the kinship and age composition of households under frontier conditions, and the probable future composition of households as the frontier stabilized and land shortage began to exert pressure for greater density and household complexity. Part I concentrates on historical, ethnographic, and linguistic evidence." (SUMMARY IN FRE)

Demographic constraints on population growth of early humans : Emphasis on the probable role of females in overcoming such constraints.

The human population grew at very low average rates for most of its existence. Mortality was reasonably severe and expectation of life at birth was low. The level of fertility necessary to achieve even inifinitesimal population growth under such mortality implies birth intervals sufficiently short to conflict with the ability to care for and carry children in a mobile foraging economy. Techniques for the control of mortality, especially of children before puberty and of women in childbirth, and of child care exchange, probably developed by females, may have been essential in permitting population growth under conditions of mobile foraging.

Fertility decline in Prussia: estimating influences on supply, demand, and degree of control.

Change in marital fertility in 407 Prussian Kreise from 1875 to 1910 is modeled to depend on the gap between the number of desired surviving births, N*, divided by child survival, s, and the number that would be born under natural marital fertility, M, given the age at marriage. Some fraction of this gap is averted, depending on the propensity to avert unwanted births, D. Although none of these components is observed directly, we can estimate each indirectly under strong assumptions. Decline in N*/s accounts for twice as much of the decline in fertility as does an increase in D. Natural fertility rose during the period. Unwanted births increased slightly, despite a tripling of births averted. The most important causes of decline in N* were increases in female labor supply, real income, and health workers. A rising level of education is the most important cause of increasing propensity to avert births. Demand-side changes were important causes of the transition, but changes in readiness to contracept also were important, as was the interaction of the two.

Age estimation from the number of teeth erupted in young children: an aid to demographic surveys.

The reporting of children's ages by parents is surprisingly inaccurate in many innumerate societies, but accurate knowledge of age is important for estimating recent changes in demographic rates. The timing of the eruption of children's teeth is largely independent of environmental influences and can provide a relatively accurate and unbiased estimate of a child's age. We have collected published data from 42 studies of children's dentition and have transformed them into estimates of age for children with particular numbers of teeth. We present estimates for different populations, but the lack of significant differences between these estimates justifies the use of a standard set.

[Short-term demographic fluctuations in the Croatian military border, 1830-1847: a contribution to historical demography]. / Kurzfristige demographische Schwankungen in der kroatischen Militargrenze 1830-47: ein Beitrag zur historischen Demographie

"Crude birth, death and marriage rates are examined for [Austria's] Croatian military defence zone and 'cordon sanitaire' against Turkey for the period 1830-1847.... The data suggest that between about one and four fifths of the variance in long term swings and in annual fluctuations from the moving averages of birth, death, and nuptiality rates can be explained by a combination of linear trend over time, an epidemic year, and primarily three economic indicators: grain lagged by one year, grain in the report year (perhaps as a proxy for other plant production), and livestock in the report year." (summary in ENG)

A kin-based measure of r and an evaluation of its effectiveness.

A relation is shown between r and the ratio (S) of those living who are youngest in their sibsets to those who are oldest. This extends Goldman's work on the relation between r and the ratio (Z) of younger to older ever born sisters. Solved for r, these relations provide kin-based measures of r. Tested against microsimulated population data, the S-based measure, though working from fewer observations per population, performs as well or better than any Z-based measure. Since the data needed to compute S make considerably fewer demands on respondents' knowledge, the S-based measure appears preferable in actual application.