Summary: Purpose:We studied overall and cause-specific mortality rates in a large cohort of patients with epilepsy compared with mortality rates of the general population in the same geographic area.Methods: The cohort consisted of all patients (N = 9,061) aged >15 years admitted with a diagnosis of epilepsy for inpatient care in Stockholm during the years 1980-1989. All patients were followed in the National Cause-of-Death Register, from which the causes of death were obtained, until December 31, 1992. Thus, 53,520 person-years were observed. Mortality rates were compared with those of the general population of Stockholm.Results: We observed 4,001 deaths in the cohort, compared with an expected number of 1,109 deaths in the general population. This yielded a standardized mortality ratio (SMR) of 3.6[95% confidence interval (CI) 3.5-3.71. Although highest in the younger patients, the SMR was significantly increased in all age groups. The excess mortality rate in the cohort was due to a wide range of causes of death, including malignant neoplasms [SMR 2.6 (2.4-2. Conclusions: Our results demonstrate that this large subgroup of patients with a diagnosis of epilepsy, once hospitalized and discharged, is a population at risk, with an excess mortality rate due to several different causes. Key Words: Epilepsy-Mortality-Standardized mortality ratio-Epidemiology-Cause of death.Patients with epilepsy have consistently been found to have a higher death rate than the general population (1-5). Although overall mortality rate has been analyzed in several studies, few researchers have investigated causespecific mortality rates in patients with epilepsy.In previous studies based on patients in institutions (6,7) and referral centers (3,s) researchers have analyzed a highly selected population with severe epilepsy. Studies (9,lO) based on cause-of-death registers have comprised large cohorts of patients. However, the validity of the diagnosis and the patients selection are uncertain in these studies because epilepsy is seldom entered as a diagnosis on death certificates. On the other hand, population-based studies, which provide valid information representative of the epilepsy population in general, have, on the whole, comprised a comparatively small number of patient-years and deaths (1,2,4). Therefore,

The effects of a mobile telephone task on young and elderly drivers choice reaction time, headway, lateral position, and workload were studied when the subjects were driving in a car-following situation, in the VTI driving simulator. It was found that a mobile telephone task had a negative effect upon the drivers choice reaction time, and that the effect was more pronounced for the elderly drivers. Furthermore, the subjects did not compensate for their increased reaction time by increasing their headway during the phone task. The subjects mental workload, as measured by the NASA-TLX, increased as a function of the mobile telephone task. No effect on the subjects lateral position could be detected. Taken together, these results indicate that the accident risk can increase when a driver is using the mobile telephone in a car following situation. The reasons for the increased risk, and possible ways to eliminate it, are also discussed.

The effects of a mobile telephone task on drivers' reaction time, lane position, speed level, and workload were studied in two driving conditions (an easy or rather straight versus a hard or very curvy route). It was predicted that the mobile telephone task would have a negative effect on drivers' reaction time, lane position, and workload and lead to a reduction of speed. It was also predicted that the effects would be stronger for the hard driving task. The study was conducted in the VTI driving simulator. A total of 40 subjects, experienced drivers aged 23 to 61, were randomly assigned to four experimental conditions (telephone and easy or hard driving task versus control and easy or hard driving task). Contrary to the predictions, the strongest effects were found when the subjects were exposed to the easy driving task. In the condition where drivers had to perform the easy driving task, findings showed that a mobile telephone task had a negative effect on reaction time and led to a reduction of the speed level. In the condition where drivers had to perform the hard driving task, findings showed that a mobile telephone task had an effect only on the drivers' lateral position. Finally, the mobile telephone task led to an increased workload for both the easy and the hard driving task. The results are discussed in terms of which subtask, car driving or telephone task, the subjects gave the highest priority. Some implications for information systems in future cars are discussed.

Summary:Purpose: Suicide is considered to be one of the most important causes of death contributing to the increased mortality of persons with epilepsy. We investigated the association between the risk of suicide in persons with epilepsy and clinical factors that might increase or have been suggested to increase the risk of suicide.Methods: A case-control study was nested within a cohort of 6,880 patients registered in the Stockholm County In-Patient Register with a diagnosis of epilepsy. The study population was followed up through the National Cause of Death Register. Twenty-six cases of suicide, 23 cases of suspected but not proven suicide, and 171 controls, living epilepsy patients, were selected from the cohort. Clinical data were collected through medical record review.Results: There was a ninefold increase in risk of suicide with mental illness and a 10-fold increase in relative risk (RR) with the use of antipsychotic drugs. The estimated RR of suicide was 16.0 [95% confidence interval (CI), 4.4-58.3] for onset of epilepsy at younger than 18 years, compared with onset after 29 years. The risk of suicide seemed to increase with high seizure frequency and antiepileptic drug (AED) polytherapy, although the estimates were imprecise and the associations not statistically significant. Insufficient data on seizure frequency and changes in AED dosage due to incomplete case records were associated with high RRs. We found no association between risk of suicide and any particular AED, with type of epilepsy, or localization or lateralization of epileptogenic focus on EEG [RR ‫ס‬ 0.3 (95% CI, 0.1-1.7)].Conclusions: The profile of the epilepsy patient who commits suicide that emerges from our study is a patient with early onset (particularly onset during adolescence) but not necessarily severe epilepsy, psychiatric illness, and perhaps inadequate neurologic follow-up. Previous reports of an association with temporal lobe epilepsy could not be confirmed.

No abstract

Summary:Purpose: Because frequent seizures constitute a major risk factor for sudden unexpected death in epilepsy (SUDEP), the treatment with antiepileptic drugs (AEDs) may play a role for the occurrence of SUDEP. We used data from routine therapeutic drug monitoring (TDM) to study the association between various aspects of AED treatment and the risk of SUDEP.Methods: A nested case-control study was based on a cohort consisting of 6,880 patients registered in the Stockholm County In Ward Care Register with a diagnosis of epilepsy. Fifty-seven SUDEP cases, and 171 controls, living epilepsy patients, were selected from the cohort. Clinical data including data on TDM were collected through medical record review.Results: The relative risk (RR) of SUDEP was 3.7 (95% CI, 1.0-13.1) for outpatients who had no TDM compared with those who had one to three TDMs during the 2 years of observation. RR was 9.5 (1.4-66.0) if carbamazepine (CBZ) plasma levels at the last TDM were above and not within the common target range (20-40 M). High CBZ levels were associated with a higher risk in patients receiving polytherapy and in those with frequent dose changes. Although the subgroup of patients with high CBZ levels was small (six cases of 33 with CBZ therapy), and the result should be interpreted with caution, no similar associations were demonstrated for phenytoin plasma levels and risk of SUDEP. No association was found between SUDEP risk and within-patient variation in AED levels over time.Conclusions: Polytherapy, frequent dose changes, and high CBZ levels as identified risk factors for SUDEP all point to the risks associated with an unstable severe epilepsy. It is unclear whether high CBZ levels per se represent a risk factor or just reflect other unidentified aspects of a severe epilepsy. Our results, however, prompt further detailed analyses of the possible role of AEDs in SUDEP in larger cohorts and suggest that reasonable monitoring of the drug therapy may be useful to reduce risks.

a b s t r a c tWe have investigated and modeled the injection of biomass into blast furnaces (BF), in place of pulverized coal (PC) from fossil sources. This is the easiest way to reduce CO 2 emissions, beyond efficiencyimprovements. The considered biomass is either pelletized, torrefied or pyrolyzed. It gives us three cases where we have calculated the maximum replacement ratio for each. It was found that charcoal from pyrolysis can fully replace PC, while torrefied material and pelletized wood can replace 22.8% and 20.0% respectively, by weight.Our energy and mass balance model (MASMOD), with metallurgical sub-models for each zone, further indicates that (1) more Blast Furnace Gas (BFG) will be generated resulting in reduced fuel consumption in an integrated plant, (2) lower need of limestone can be expected, (3) lower amount of generated slag as well, and (4) reduced fuel consumption for heating the hot blast is anticipated. Overall, substantial energy savings are possible, which is one of the main findings in this paper.Due to the high usage of PC in Sweden, large amounts of biomass is required if full substitution by charcoal is pursued (6.19 TWh/y). But according to our study, it is likely available in the long term for the blast furnace designated M3 (located in Luleå).Finally, over a year with almost fully used production capacity (2008 used as reference), a 28.1% reduction in on-site emissions is possible by using charcoal. Torrefied material and wood pellets can reduce the emissions by 6.4% and 5.7% respectively. The complete replacement of PC in BF M3 can reduce 17.3% of the total emissions from the Swedish steel industry.

The main objective has been to describe different cases of the methanol production from steel-work off gases (Coke oven gas and Basic oxygen furnace gas) and biomass based synthesis gas. The SSAB steel mill in the town of Luleå, Sweden has been used as a basis to analyze four different methanol production cases. The studied biomass gasification technology is based on a fluidized bed gasifier unit, where the production capacity is determined from case to case coupled to the heat production required to satisfy the local district heating demand. Critical factors are the integration of the gases with availability to the synthesis unit, to balance the steam system of the biorefinery and to meet the district heat demand of Luleå. For each case, the annual production potential of methanol, the overall production efficiencies and the effects on the total steel plant have been estimated.