Biochemical assessment of patients following ketogenic diets for epilepsy : current practice in the UK and Ireland

Biochemical assessment is recommended for patients prior to initiating and following a ketogenic diet (KD). There is no published literature regarding current practice in the UK and Ireland. We aimed to explore practice in comparison with international guidelines, determine approximate costs of biochemical testing in KD patients across the UK and Ireland, and promote greater consistency in KD services nationally. A survey was designed to determine the biochemical tests requested for patients at baseline, 3, 6, 12, 18, and 24 months + on KD. The survey was circulated to 39 centers across the UK and Ireland. Sixteen centers completed the survey. Full blood count, electrolytes, calcium, liver function tests (LFTs), lipid profile, and vitamin D were requested at all centers at baseline, in keeping with international guidelines. Bicarbonate, total protein, and urinalysis were less consistently requested. Magnesium and zinc were requested by all centers, despite not being specifically recommended for pre-diet evaluation in guidelines. Urea and electrolyte profiles and some LFTs were consistently requested at follow-up, in accordance with guidelines. Other LFTs and renal tests, full blood count, lipid profile, acylcarnitine profile, selenium, vitamin D, and urinalysis were less consistently requested at follow-up. The mean costs of the lowest and highest number of tests requested at baseline in our participating centers were £167.54 and £501.93; the mean costs of the lowest and highest number of tests requested at 3-month follow-up were £19.17 and £450.06. Biochemical monitoring of KD patients varies widely across the UK and Ireland and does not fully correspond to international best practice guidelines. With an ongoing drive for cost-effectiveness within health care, further work is needed to streamline practice while ensuring patient safety. [Abstract copyright: © 2019 The Authors. Epilepsia Open published by Wiley Periodicals Inc. on behalf of International League Against Epilepsy.

Transverse Sizes of CIV Absorption Systems Measured from Multiple QSO Sightlines

We present tomography of the circum-galactic metal distribution at redshift 1.7 to 4.5 derived from echellete spectroscopy of binary quasars. We find CIV systems at similar redshifts in paired sightlines more often than expected for sightline-independent redshifts. As the separation of the sightlines increases from 36 kpc to 907 kpc, the amplitude of this clustering decreases. At the largest separations, the CIV systems cluster similar to Lyman-break galaxies (Adelberger et al. 2005a). The CIV systems are significantly less correlated than these galaxies, however, at separations less than R_1 ~ 0.42 +/- 0.15 h-1 comoving Mpc. Measured in real space, i.e., transverse to the sightlines, this length scale is significantly smaller than the break scale estimated from the line-of-sight correlation function in redshift space (Scannapieco et al. 2006a). Using a simple model, we interpret the new real-space measurement as an indication of the typical physical size of enriched regions. We adopt this size for enriched regions and fit the redshift-space distortion in the line-of-sight correlation function. The fitted velocity kick is consistent with the peculiar velocity of galaxies as determined by the underlying mass distribution and places an upper limit on the outflow (or inflow) speed of metals. The implied time scale for dispersing metals is larger than the typical stellar ages of Lyman-break galaxies (Shapley et al. 2001), and we argue that enrichment by galaxies at z > 4.3 played a greater role in dispersing metals. To further constrain the growth of enriched regions, we discuss empirical constraints on the evolution of the CIV correlation function with cosmic time. This study demonstrates the potential of tomography for measuring the metal enrichment history of the circum-galactic medium.Comment: 22 pages, 15 figures, 1 tabl

Virtual placements to develop employability skills for civil and environmental engineering students

This project work addresses the crucial need to encourage undergraduate civil and environmental engineering students to gain employment skills and training right from the start of their studies so that their overall employability increases; their confidence level in networking with industry and within the workplace increases; and so that they are successfully able to obtain employment after finishing their studies. This initiative is a stepping-stone employability exercise which focuses specifically on first year students to help them engage with industry right from the start of their course. It is proposed that they would gain some realistic work experience both individually and as part of group within a virtual work environment using an action learning approach. The virtual environment used was based on SecondLife, a popular virtual reality programme. A pilot scheme was set up and run at Brunel University during the summer of 2014 using eight self-selecting first year students. The scheme’s outputs were extensively monitored and evaluated to assess its impact on the development of employability skills. This approach may prove a cost effective way of letting students gain an insight into the workplace whilst improving these skills. It may also prove a way for employers to select from a large range of students the best to actually undertake their real work-based internships

Ketogenic diets as an adjuvant therapy for glioblastoma (KEATING): a randomized, mixed methods, feasibility study

This is a post-peer-review, pre-copyedit version of an article published in Journal of Neuro-Oncology. The final authenticated version is available online at: http://dx.doi.org/10.1007/s11060-020-03417-8Purpose We conducted a feasibility study to investigate the use of ketogenic diets (KDs) as an adjuvant therapy for patients with glioblastoma (GBM), investigating (i) trial feasibility; (ii) potential impacts of the trial on patients’ quality of life and health; (iii) patients’ perspectives of their decision-making when invited to participate in the trial and (iv) recommending improvements to optimize future phase III trials. Methods A single-center, prospective, randomized, pilot study (KEATING), with an embedded qualitative design. Twelve newly diagnosed patients with GBM were randomized 1:1 to modifed ketogenic diet (MKD) or medium chain triglyceride ketogenic diet (MCTKD). Primary outcome was retention at three months. Semi-structured interviews were conducted with a purposive sample of patients and caregivers (n=15). Descriptive statistics were used for quantitative outcomes and qualitative data were analyzed thematically aided by NVivo. Results KEATING achieved recruitment targets, but the recruitment rate was low (28.6%). Retention was poor; only four of 12 patients completed the three-month diet (MCTKD n=3; MKD n=1). Participants’ decisions were intuitive and emotional; caregivers supported diet implementation and infuenced the patients’ decision to participate. Those who declined made a deliberative and considered decision factoring diet burden and quality of life. A three-month diet was undesirable to patients who declined and withdrew. Conclusion Recruitment to a KD trial for patients with GBM is possible. A six-week intervention period is proposed for a phase III trial. The role of caregiver should not be underestimated. Future trials should optimize and adequately support the decision-making of patients

Schottky-based band lineups for refractory semiconductors

An overview is presented of band alignments for small-lattice parameter, refractory semiconductors. The band alignments are estimated empirically through the use of available Schottky barrier height data, and are compared to theoretically predicted values. Results for tetrahedrally bonded semiconductors with lattice constant values in the range from C through ZnSe are presented. Based on the estimated band alignments and the recently demonstrated p-type dopability of GaN, we propose three novel heterojunction schemes which seek to address inherent difficulties in doping or electrical contact to wide-gap semiconductors such as ZnO, ZnSe, and ZnS

Mass-dependent evolution of the relation between supermassive black hole mass and host spheroid mass since z ~ 1

We investigate the evolution of supermassive black hole mass (M_BH) and the host spheroid mass (M_sph) in order to track the history of the M_BH-M_sph relationship. The typical mass increase of M_BH is calculated by a continuity equation and accretion history, which is estimated from the active galactic nucleus (AGN) luminosity function. The increase in M_sph is also calculated by using a continuity equation and a star formation model, which uses observational data for the formation rate and stellar mass function. We find that the black hole to spheroid mass ratio is expected to be substantially unchanged since z~1.2 for high mass objects (M_BH>10^8.5M_SUN and M_sph>10^11.3M_SUN). In the same redshift range, the spheroid mass is found to increase more rapidly than the black hole mass if M_sph>10^11M_SUN. The proposed mass-dependent model is consistent with the current available observational data in the M_BH-M_sph diagram.Comment: 15 pages, 8 figures, accepted to MNRA

Learning to become an online editor: the editathon as a learning environment

This study explores Wikipedia as a site for learning. It traces how people learn to become Wikipedia editors through engagement in an editathon, a training event for people who want to become a volunteer editor. The study is original in its emphasis on the various types of knowledge editors acquire as they develop expertise. Determining the knowledge needed to contribute to Wikipedia is significant in terms of understanding Wikipedia as a site for learning. Data was gathered from nine participants who took part in an “editathon” event. The study used a rigorous methodology, combining quantitative social network analysis, documenting the online activity of participants as they created and edited Wikipedia pages, with qualitative interviews about participants’ lived experiences during the editathon. Conceptual and procedural knowledge are representative of the foundational knowledge needed to contribute to Wikipedia actively as an editor. However, these knowledge types on their own are not sufficient. Editors also develop socio-cultural and relational forms of knowledge to enable them to operate and problem-solve effectively. The relationship between the physical and the digital is important, since socio-cultural and relational knowledge are developed through active experimentation as the editathon engage with physical objects to create the online wiki pages

Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact.

BACKGROUND: Interventions to promote healthy eating make a potentially powerful contribution to the primary prevention of non communicable diseases. It is not known whether healthy eating interventions are equally effective among all sections of the population, nor whether they narrow or widen the health gap between rich and poor. We undertook a systematic review of interventions to promote healthy eating to identify whether impacts differ by socioeconomic position (SEP). METHODS: We searched five bibliographic databases using a pre-piloted search strategy. Retrieved articles were screened independently by two reviewers. Healthier diets were defined as the reduced intake of salt, sugar, trans-fats, saturated fat, total fat, or total calories, or increased consumption of fruit, vegetables and wholegrain. Studies were only included if quantitative results were presented by a measure of SEP. Extracted data were categorised with a modified version of the "4Ps" marketing mix, expanded to 6 "Ps": "Price, Place, Product, Prescriptive, Promotion, and Person". RESULTS: Our search identified 31,887 articles. Following screening, 36 studies were included: 18 "Price" interventions, 6 "Place" interventions, 1 "Product" intervention, zero "Prescriptive" interventions, 4 "Promotion" interventions, and 18 "Person" interventions. "Price" interventions were most effective in groups with lower SEP, and may therefore appear likely to reduce inequalities. All interventions that combined taxes and subsidies consistently decreased inequalities. Conversely, interventions categorised as "Person" had a greater impact with increasing SEP, and may therefore appear likely to reduce inequalities. All four dietary counselling interventions appear likely to widen inequalities. We did not find any "Prescriptive" interventions and only one "Product" intervention that presented differential results and had no impact by SEP. More "Place" interventions were identified and none of these interventions were judged as likely to widen inequalities. CONCLUSIONS: Interventions categorised by a "6 Ps" framework show differential effects on healthy eating outcomes by SEP. "Upstream" interventions categorised as "Price" appeared to decrease inequalities, and "downstream" "Person" interventions, especially dietary counselling seemed to increase inequalities. However the vast majority of studies identified did not explore differential effects by SEP. Interventions aimed at improving population health should be routinely evaluated for differential socioeconomic impact