A scoring system for early prognostic assessment after neonatal seizures

OBJECTIVE: The aim of this study was to devise a scoring system that could aid in predicting neurologic outcome at the onset of neonatal seizures. METHODS: A total of 106 newborns who had neonatal seizures and were consecutively admitted to the NICU of the University of Parma from January 1999 through December 2004 were prospectively followed-up, and neurologic outcome was assessed at 24 months’ postconceptional age. We conducted a retrospective analysis on this cohort to identify variables that were significantly related to adverse outcome and to develop a scoring system that could provide early prognostic indications. RESULTS: A total of 70 (66%) of 106 infants had an adverse neurologic outcome. Six variables were identified as the most important independent risk factors for adverse outcome and were used to construct a scoring system: birth weight, Apgar score at 1 minute, neurologic examination at seizure onset, cerebral ultrasound, efficacy of anticonvulsant therapy, and presence of neonatal status epilepticus. Each variable was scored from 0 to 3 to represent the range from “normal” to “severely abnormal.” A total composite score was computed by addition of the raw scores of the 6 variables. This score ranged from 0 to 12. A cutoff score of =4 provided the greatest sensitivity and specificity. CONCLUSIONS: This scoring system may offer an easy, rapid, and reliable prognostic indicator of neurologic outcome after the onset of neonatal seizures. A final assessment of the validity of this score in routine clinical practice will require independent validation in other centers.

Glycaemic memory

Glycaemic memory describes the deferred effects of prior glycaemic status on diabetic complications later in life, independent of more recent glycaemic control. Prospective evidence for glycaemic memory derives from extended studies after trials that compared intensive versus standard glycaemic control. These studies in type 1 diabetes (e.g. DCCT) and type 2 diabetes (e.g. UKPDS) have shown that a period of poor glycaemic control earlier in the course of the disease is associated with an increased burden of complications much later in the course of the disease, even when glycaemic control is latterly improved. The Veterans Affairs Diabetes Trial suggested that more than 12-15 years of poor control in older type 2 patients minimised the benefits of subsequently improved glycaemic control. The delayed adverse effects of hyperglycaemia emphasise the importance of effective early glycaemic control. © SAGE Publications 2008 Los Angeles.

Language independent on-off voice over IP source model with lognormal transitions

The recent explosive growth of voice over IP (VoIP) solutions calls for accurate modelling of VoIP traffic. This study presents measurements of ON and OFF periods of VoIP activity from a significantly large database of VoIP call recordings consisting of native speakers speaking in some of the world's most widely spoken languages. The impact of the languages and the varying dynamics of caller interaction on the ON and OFF period statistics are assessed. It is observed that speaker interactions dominate over language dependence which makes monologue-based data unreliable for traffic modelling. The authors derive a semi-Markov model which accurately reproduces the statistics of composite dialogue measurements. © The Institution of Engineering and Technology 2013.