Is the Ketogenic Diet Effective for Treatment in Controlling Seizures in Children with Epilepsy?

Objective: The objective of this selective EBM review is to determine whether or not the ketogenic diet is an effective treatment in controlling seizures in children with epilepsy. Study Design: Review of three randomized control trials (RCTs) published in the year 2016. Data Sources: Three RCTs were selected using Medline, PubMed, and Academic Search Premier. Studies were selected that reviewed the ketogenic diet (KD) in controlling seizures in children with epilepsy. All articles were chosen according to date of publication, relevance of topic, effect on quality of life, and patient-oriented evidence that matters (POEM). Outcomes Measured: Seizure diaries and various scoring tests including the Hague Restrictions in Childhood Epilepsy Scale (HARCES) were utilized to assess control of seizures with number of occurrences. Results: All three RCTs found that there were significant improvements in seizure control and frequency when using the KD as treatment in management of epilepsy in children. Study Ijiff et al. found seizures to be less severe after four months of using the KD as compared to care as usual (p=.038) based on the HARCES (Ijiff DM, Postulart D, Lambrechts, DAJE, et al. Epilepsy Behav. 2016; 60:153-157. doi: 10.1016/j.yebeh.2016.04.033). Lambrechts et al. analyzed seizure diaries revealing a significant improvement of seizure frequency among patients on the KD in comparison to the care as usual group (p=0.024) (Lambrechts, DAJE, Kinderen RJA, Vles JSH, Louw AJA, Aldenkamp AP, Majoie HJM. Acta Neurol Scand. 2017;135(2):231-239. doi: 10.1111/ane.12592). The third article, Kim et al. compared the use of KD and modified Atkin’s diet (MAD), concluding that while the KD was effective in controlling seizures, there was no significant difference between the two diets (p=0.314) (Kim DW, Kang HC, Park JC, Kim HD. Pediatrics. 2004;114(6):1627‐1630. doi: 10.1542/peds.2004-1001). Conclusions: All three studies concluded that the ketogenic diet was effective in controlling seizures in children with epilepsy. Two found statistically significant improvement in seizure control with use of the KD when compared to care as usual, but one study found no statistical significance when comparing the KD and MAD. While the KD has been found to improve seizure control and frequency, more research is indicated to investigate other possible therapeutic diets and their outcomes

The history of disaster incidents and impact in Nepal 1900-2005: ecological, geographical, and development perspectives

The people of Nepal today are exposed to perennial local disaster events and profound vulnerability to disaster. The combined efforts of government, donors, UN agencies, NGOs, and Nepalese communities are needed to avert the impacts of disaster events. Much more can be done immediately to reduce the impacts by reviewing the scope and distribution of past disaster events. This article provides an overview of Nepal’s disaster vulnerability through an analysis of the record of disaster events that occurred from 1900 to 2005. The data were generated from historical archives and divided into incidents at the district, subnational, and national levels. Statistical and Geographical Information System (GIS) analyses were carried out to generate district level disaster vulnerability maps. It is concluded that small-scale, local disasters have a greater cumulative impact in terms of casualties than large-scale, national disasters

Efficacy of D-cycloserine augmented brief intensive cognitive-behavioural therapy for paediatric obsessive-compulsive disorder: A randomised clinical trial

Objective: To examine the efficacy of weight-adjusted D-cycloserine (DCS) (35 or 70 mg) relative to placebo augmentation of intensive exposure therapy for youth with obsessive-compulsive disorder (OCD) in a double-blind, randomised controlled trial, and examine whether antidepressant medication or patient age moderated outcomes. Methods: Youth (n = 100, 7–17 years) with OCD were randomised in a 1:1 ratio to either DCS + exposure (n = 49) or placebo + exposure (n = 51). Assessments occurred posttreatment, 1 month later, and at 3 and 6 months. Pills were ingested immediately before sessions. Results: Significant improvements on all outcomes were observed at posttreatment, and to 6-month follow-up. Treatment arms did not differ across time, with no significant time-by-medication interactions on symptom severity (T1 to T2 estimate: 9.3, 95% confidence interval [CI]: −11.2 to −7.4, and estimate −10.7, 95% CI: −12.6 to −8.7), diagnostic severity (T1 to T2 estimate: −2.0, 95% CI: −2.4 to −1.5 and estimate −2.5, 95% CI: −3.0 to −2.0) or global functioning (T1 to T2 estimate: 13.8, 95% CI: 10.6 to 17.0, and estimate 16.6, 95% CI: 13.2 to 19.9). Neither antidepressants at baseline nor age moderated primary outcomes. There were significantly fewer responders/remitters at 1- and 6-month follow-up among youth in the DCS condition stabilised on SSRIs, relative to youth not taking SSRIs. Conclusions: DCS augmented intensive exposure therapy did not result in overall additional benefits relative to placebo. Intensive exposure proved effective in reducing symptoms for the overall sample

The future for beef

Beef is a fast-growing, multi -billion dollar industry today in the United States. And the outlook for tomorrow is most favorable. Beef consumption has increased by 26 pounds per capita during the past 15 years, hitting an all-time high of 90 pounds per capita in 1962. During the same period quality has improved, and now. beef commands even wider consumer acceptance than in the mid-1940\u27s. New technology has lowered production and marketing costs. But even a strong, healthy industry must be sensitive to change--and take advantage of new opportunities for growth and improvement. The beef industry is no exception.https://lib.dr.iastate.edu/card_reports/1016/thumbnail.jp

Comparative Coastal Risk Index (CCRI): A multidisciplinary risk index for Latin America and the Caribbean

As the world's population grows to a projected 11.2 billion by 2100, the number of people living in low-lying areas exposed to coastal hazards is projected to increase. Critical infrastructure and valuable assets continue to be placed in vulnerable areas, and in recent years, millions of people have been displaced by natural hazards. Impacts from coastal hazards depend on the number of people, value of assets, and presence of critical resources in harm's way. Risks related to natural hazards are determined by a complex interaction between physical hazards, the vulnerability of a society or social-ecological system and its exposure to such hazards. Moreover, these risks are amplified by challenging socioeconomic dynamics, including poorly planned urban development, income inequality, and poverty. This study employs a combination of machine learning clustering techniques (Self Organizing Maps and K-Means) and a spatial index, to assess coastal risks in Latin America and the Caribbean (LAC) on a comparative scale. The proposed method meets multiple objectives, including the identification of hotspots and key drivers of coastal risk, and the ability to process large-volume multidimensional and multivariate datasets, effectively reducing sixteen variables related to coastal hazards, geographic exposure, and socioeconomic vulnerability, into a single index. Our results demonstrate that in LAC, more than 500,000 people live in areas where coastal hazards, exposure (of people, assets and ecosystems) and poverty converge, creating the ideal conditions for a perfect storm. Hotspot locations of coastal risk, identified by the proposed Comparative Coastal Risk Index (CCRI), contain more than 300,00 people and include: El Oro, Ecuador; Sinaloa, Mexico; Usulutan, El Salvador; and Chiapas, Mexico. Our results provide important insights into potential adaptation alternatives that could reduce the impacts of future hazards. Effective adaptation options must not only focus on developing coastal defenses, but also on improving practices and policies related to urban development, agricultural land use, and conservation, as well as ameliorating socioeconomic conditions

Face Inversion Reduces the Persistence of Global Form and Its Neural Correlates

Face inversion produces a detrimental effect on face recognition. The extent to which the inversion of faces and other kinds of objects influences the perceptual binding of visual information into global forms is not known. We used a behavioral method and functional MRI (fMRI) to measure the effect of face inversion on visual persistence, a type of perceptual memory that reflects sustained awareness of global form. We found that upright faces persisted longer than inverted versions of the same images; we observed a similar effect of inversion on the persistence of animal stimuli. This effect of inversion on persistence was evident in sustained fMRI activity throughout the ventral visual hierarchy, including the lateral occipital area (LO), two face-selective visual areas—the fusiform face area (FFA) and the occipital face area (OFA)—and several early visual areas. V1 showed the same initial fMRI activation to upright and inverted forms but this activation lasted longer for upright stimuli. The inversion effect on persistence-related fMRI activity in V1 and other retinotopic visual areas demonstrates that higher-tier visual areas influence early visual processing via feedback. This feedback effect on figure-ground processing is sensitive to the orientation of the figure

IPCC reasons for concern regarding climate change risks

The reasons for concern framework communicates scientific understanding about risks in relation to varying levels of climate change. The framework, now a cornerstone of the IPCC assessments, aggregates global risks into five categories as a function of global mean temperature change. We review the framework's conceptual basis and the risk judgments made in the most recent IPCC report, confirming those judgments in most cases in the light of more recent literature and identifying their limitations. We point to extensions of the framework that offer complementary climate change metrics to global mean temperature change and better account for possible changes in social and ecological system vulnerability. Further research should systematically evaluate risks under alternative scenarios of future climatic and societal conditions