Burden of illness for super-refractory status epilepticus patients

Objective: To provide an estimate of the annual number of super-refractory status epilepticus (SRSE) cases in the US and to evaluate utilization of hospital resources by these patients.

Methods: The Premier Hospital Database was utilized to estimate the number of SRSE cases based on hospital discharges during 2012. Discharges were classified as SRSE cases based on an algorithm using seizure-related International Classification of Diseases-9 (ICD-9) codes, Intensive Care Unit (ICU) length of stay (LOS), and treatment protocols (e.g. benzodiazepines, anti-epileptic drugs (AEDs), and ventilator use). Secondary analyses were conducted using more restrictive algorithms for SRSE.

Results: A total of 6,325 hospital discharges were classified as SRSE cases from a total of 5,300,000 hospital discharges. Applying a weighting based on hospital characteristics and 2012?US demographics, this projected to an estimated 41,156 cases of SRSE in the US during 2012, an estimated incidence rate of ～13/100,000 annually for SRSE in the US. Secondary analyses using stricter SRSE algorithms resulted in estimated incidence rates of ～11/100,000 and 8/100,000 annually. The mean LOS for SRSE hospitalizations was 16.5 days (median =11; interquartile range [IQR]?=?6–20), and the mean ICU LOS was 9.3 days (median =6; IQR =3–12). The mean cost of an SRSE hospitalization was $51,247 (median = $33,294; 95% CI = $49,634–$52,861).

Limitations: The analysis uses ICD-9 diagnostic codes and claims information, and there are inherent limitations in any methodology based on treatment protocol, which created challenges in distinguishing with complete accuracy between SRSE, RSE, and SE on the basis of care patterns in the database.

Conclusion: SRSE is associated with high mortality and morbidity, which place a high burden on healthcare resources. Projections based upon the findings of this study suggest an estimated 25,821–41,959 cases of SRSE may occur in the US each year, but more in-depth studies are required.     

Tullock on the organization of scientific inquiry

In (Tullock, The organization of inquiry, Duke University Press, Durham, NC, 1966), Gordon Tullock sets out to establish how knowledge is developed and dispersed in science, to such a high degree of reliability, despite the lack of formal organizational structure. He contrasts this against the unreliability of the “non-sciences”. In this essay, I review his perspective and consider the validity of his proposed reforms.     

Expressive voting and two-dimensional political competition: an application to law and order policy by New Labour in the UK

There has been much debate regarding the electoral strategy adopted by New Labour in the lead-up to and then during their time in government. This paper addresses the issue from the perspective of left/right and liberal/authoritarian considerations by examining data on individual attitudes from the British Social Attitudes survey between 1986 and 2009. The analysis indicates that New Labour’s move towards the right on economic and public policy was the main driver towards attracting new centrist voters and could thus be labelled ‘broadly’ populist. The move towards a tougher stance on law and order was more ‘narrowly’ populist in that it was used more to minimise the reduction in support from Labour’s traditional base on the left than to attract new votes. The evidence presented provides support for an expressive theory of voting in that law and order policy was arguably used to counter alienation amongst traditional, left-wing Labour supporters.     

Fixed versus flexible election terms: explaining innovation in the timing of Canada’s election cycle

This paper argues that there is an efficiency gain underlying the recent adoption of legislation calling for a fixed 4-year governing term by the federal and most provincial governments in Canada. The efficiency gain arises from foreclosing an externality produced by the Canadian constitutional provision that sets a maximum length for a legislative term (5 years) while allowing the governing party (through the Governor General) to dissolve the House early. Because the opportunistic use of surprise can improve the governing party’s probability of winning, strategic choice can lead to elections being held at times that most disadvantage the incumbent’s rivals. Evidence from Canada is introduced suggesting that federal elections became less predictable through successive reductions in the campaign time given to competitors, thus raising the cost of this externality. The same reasoning suggests that the party most likely to propose this legislative innovation will be the party in opposition rather than in power and/or the new leader of an established party facing loss in the upcoming election. By fulfilling the fixed term even when it could benefit by calling the election early, the party establishes a precedent that raises the political cost to others of cancelling the fixed term legislation.     

A proposal for a more objective measure of de facto constitutional constraints

In this paper we propose two new indicators of de facto constitutional constraints. The indicators are based on the presence or the absence of easily observable political events. This makes the proposed measures relatively objective and easy to verify relative to the most widely used indicators of de jure and de facto constitutions. This paper describes the indicators and demonstrates their usefulness for research on economic development.     

Testing the Influence of Substitute Sites in Nature Valuation by Using Spatial Discounting Factors

This paper investigates the effect of nearby nature substitute sites on preferences for nature restoration. Contrary to prior studies, we use a respondent-centric approach to control for substitute sites. We assess each respondent-specific spatial context by computing densities of nature substitute sites within various ranges from each respondent’s home. This approach considers the use and non-use values of nature together. Data from three similar discrete choice experiments carried out in Flanders (Belgium) are compared. Different spatial discounting factors are tested to explore how the substitution effect behaves with regard to distance. Latent class analyses are performed to account for preference heterogeneity among respondents. We observe divergent behaviours across groups of respondents. The “distance-to-substitutes” affects how respondents gauge substitute sites. We find a significant influence of the squared average buffer distance but this effect varies in sign across case studies and classes of respondents. Our results demonstrate that individual-specific GIS data can significantly improve the representation of the spatial context and the transferability of value functions. However, the roles played by preference heterogeneity and nature perception on respondents’ capacity to value nature still deserves further attention in future research.     

Heterogeneous Impact of Soil Contamination on Farmland Prices in the Belgian Campine Region: Evidence from Unconditional Quantile Regressions

We estimate a hedonic-pricing model using geo-coded farmland-transaction data from the Campine region, situated in the north-east of Belgium. Unlike previous hedonic studies, we use the method of unconditional quantile regression (Firpo et al., in Econometrica 77(3):953–973, 2009). An important advantage of this new method over the traditional conditional quantile regression (Koenker and Bassett, in Econometrica 46(1):33–50, 1978) is that it allows for the estimation of potentially heterogeneous effects of cadmium pollution along the entire (unconditional) distribution of farmland prices. Using a threshold specification of the hedonic-pricing model, we find evidence of a U-shaped valuation pattern, where cadmium pollution of the soil has a negative and significant impact on prices only in the middle range of the distribution, insofar as cadmium concentrations are above the regulatory standard of 2 parts per million for agricultural land. Results obtained from a probit model to classify land plots into different price segments further suggest that the heterogeneous impact of soil pollution on price can be directly related to the variety of amenities that farmland provides.     

Controlling Episodic Air Pollution with a Seasonal Gas Tax: The Case of Cache Valley,Utah

Using daily data spanning 10 years, we establish a statistical relationship between episodic particulate-matter \((\hbox {PM}_{2.5})\) concentrations and vehicle trips in Cache Valley, Utah, and estimate an average gas-price elasticity for the region. We also estimate the benefits and costs associated with a seasonal gas tax set to reduce vehicle trips during the winter-inversion season and thereby lower health costs through concomitant decreases in the \(\hbox {PM}_{2.5}\) concentrations. We find a strong positive relationship between vehicle trips reduced and associated reductions in \(\hbox {PM}_{2.5}\) concentrations. Further, we estimate a mean gas price elasticity of approximately \(-\)0.3 in what we call a “high price variability environment.” Incorporating these results, cost-benefit analysis suggests that the social net benefit for Cache Valley associated with the imposition of a seasonal gas tax during the winter-inversion season is highly dependent upon the type of benefit estimation method used.