Sudden unexpected death in epilepsy: is death by seizures a cardiac disease?

RESULTS: Sudden unexpected death in epilepsy (SUDEP) gains more and more acknowledgment across the various interdisciplinary fields. Accordingly, we performed in a prospective setting a case-control study of all SUDEP cases in a well-defined part of Denmark (Northern Jutland), between January 1998 and September 2000. We attempted to look into the cardiopathologic mechanism behind this phenomenon by assessing the degree of myocardial fibrosis in SUDEP patients versus controls. The histologic evaluation was possible in 65% of the cases (15/23) whose death was attributed to SUDEP and in 71% (15/21) of controls. Forty percent of the SUDEP cases (6/15) presented several foci of fibrotic changes in the deep and subendocardial myocardium in contrast to 1 control (6.6%, P = 0.03). None of the subjects from the SUDEP group showed fibrotic changes in their conduction system as compared with 1 control (6.6%). The quantitative evaluation of fibrosis demonstrated a trend toward more fibrosis in the deep and subendocardial myocardium of the SUDEP cases. Forty percent of cases in the SUDEP group were men (6/15), characteristically young at time of death (mean age 38 years) and with a late epilepsy onset (mean age 21 years). Antemortem, 73% of the SUDEP patients (11/15) had experienced infrequent seizures (self-reported). We conclude that the SUDEP cases displayed significant fibrosis of the myocardium when this was assessed by qualitative means. This fibrosis may be the consequence of myocardial ischemia as a direct result of repetitive epileptic seizures, which, associated with the ictal sympathetic storm, may lead to lethal arrhythmias.     

Split-ticket Voting in Times of Sub-national Government Reorganisation: Evidence from Denmark

Local government amalgamations may have unintended consequences on electoral behaviour. Using the most recent local elections in Denmark as its case, this article demonstrates that inter-level split-ticket voting between three levels (national, regional and local) decreased slightly from 2001 to 2005 – that is, simultaneously with the implementation of a major reform, where many municipalities and all the counties were amalgamated. These amalgamations affect the level of split voting through a process where the local party system operates as an intervening variable: the larger municipalities have a more nationalised local party system, which leads to fewer voters being vote splitters by necessity. The analyses combine general electoral statistics with large voter surveys and benefit from the quasi-experimental setting offered by the fact that not all municipalities were amalgamated.     

The Impact of Assembly Size on Representativeness

Choosing the number of seats in a legislature is a balancing act between efficiency and representativeness. This article focuses on representativeness and hypothesises that the larger the assembly, the higher the vote–seat proportionality, the higher the number of parties represented, and the higher the representation of otherwise under-represented groups. An approach using simulations of elections is introduced and applied in testing the hypotheses in the case of Danish local elections. Two thousand six hundred and forty-six elections are simulated, and a positive, but non-linear, relationship is demonstrated between number of seats and proportionality, number of parties, and percentage of women councillors.     

Perceptions of Public and Private Performance: Evidence from a Survey Experiment

Media, politicians, and reform proponents frequently assert that public sector organizations are inefficient and burdened by administrative procedures. But are negative stereotypes of the public sector reflected in people's perceptions of public service provision? Given the methodological challenges of isolating the perception of publicness from other factors related to public organizations, little is known about whether public organizations have a negative image. The authors use a survey experimental design to isolate the effect of publicness on perceptions of the performance of hospitals. The results suggest that public sector organizations have a negative image on productivity‐related aspects of performance but not on normative aspects of performance. As this article is a randomized experiment, it provides strong evidence regarding the causal nature of the relationship between publicness and perceptions of performance. Implications for researchers aiming to understand these mechanisms and for public managers concerned about the image of their organization are discussed.     

Vital Democracy: A Theory of Democracy in Action

Scottish citizens benefit from 19 per cent more public spending per head than English citizens. The ‘Barnett formula’ is slowly reducing the gap, but very little is known about the countries' relative needs and hence about how far the present gap is defensible: the aim of this paper is to throw some light on the countries' relative needs. We begin with the complex formulae that the Westminster government uses to assess the spending needs of English local authorities, and we use these English formulae to assess the needs of Scottish local authorities for three major blocks of local services. These formulae suggest that Scotland needs 6.4 per cent more per head than England for environmental, protective and cultural services, 8.1 per cent more for highway maintenance, and between 24.3 per cent and 35.3 per cent more for fire services. We also combine these results with those of two other papers concerned with local education and social services to show that these English formulae put Scotland's per capita needs for local government services as a whole at about 6 per cent above England's. However, we then compare the relative needs of Scottish local authorities as assessed by the English formulae with their relative needs as assessed by the Scottish needs formulae that are currently used by Holyrood, and we find major differences. This suggests either that at least one country uses seriously flawed formulae to assess needs, or that the two countries have different conceptions of need.     

Local Party System Nationalisation: Does Municipal Size Matter?

Local party systems are not necessarily copies of their country's national party system. Some national parties do not field candidates in all municipalities, while in other municipalities there are non-partisan lists/local parties. In this article it is hypothesised that the larger the municipality (in number of inhabitants), the more the local party system will resemble the national party system (and vice versa). The hypothesis is tested using data from the 2001 local elections in Denmark. For this purpose, an index of local party system nationalisation is developed. The index is formulated in general terms so as to make it applicable in other settings and in comparisons between countries and over time.     

Municipal Amalgamations and the Democratic Functioning of Local Councils: The Case of The Danish 2007 Structural Reform

This article discusses the effects of the structural reform in Denmark in 2007 – where a large number of municipalities were amalgamated – on local councillors' influence on decisions taken in the local political realm. The analysis uses data from two large surveys, a pre-reform survey (2003) and a post-reform survey (2009). The analysis shows that the amalgamations have led to an increase in the perceived influence of leading councillors vis-à-vis other councillors and a decrease in the perceived influence of the council vis-à-vis its top administrative officers. Furthermore, it is found that there is an increase in the number of councillors who find that local political decisions are determined by laws and rules from central government, but at the same time it is shown that this increase cannot be ascribed to the amalgamations.     

Vulnerability without capabilities? Small state strategy and the international counter-piracy agenda

Today, small European states regularly need to go out of area and out of tried and tested institutional settings to defend their security interests. How do small European states meet this challenge most effectively? This analysis suggests that small states can influence multilateral decisions on international security by combining norm entrepreneurship with lobbying and taking on the role as an “honest broker”. However, economic capacity, an effective state administration, and interests compatible with the agendas of the great powers are key to success. Based on a comprehensive empirical material including 19 elite interviews as well as official documents and other written material, we process trace how one small European state, Denmark, influenced the development of international counter-piracy cooperation and the development of an international counter-piracy strategy for the Gulf of Aden and off the Horn of Africa and discuss which lessons the Danish case may hold for other small states.     

Local Political Leadership: The Art of Circulating Political Capital

In this article, local political leadership is modelled as circulation of political capital. Based on intensive case studies of the political leadership performance of four mayors in Denmark, this article asks why the concept of political capital, introduced to local government studies in 1961 by Banfield, has in many ways sunk into oblivion. This article resuscitates the concept of political capital, using it to generate a general theory of local political leadership. In this framework, the crucial component of effective leadership is the mayor's ability, within a given institutional framework, to circulate (earn and spend) political capital. Effective leadership occurs when the leader continuously invests his or her political capital in ways which yield the greatest return. Clarence N. Stone's distinction between ‘power over’ and ‘power to’ is central to the model. Mayors performing what James H. Svara has labelled ‘facilitative leadership’ can in some cases accumulate substantial amounts of political capital.