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Marine ingredients are still regarded as a vital constituent of aquaculture and other livestock feeds. Despite numerous publications that have discussed the sustainability issues, there are few sources that provide detailed information that allow for quantification of marine ingredient environmental impact. A Life Cycle Inventory was compiled from many available literature sources that will allow for Life Cycle Assessments (LCAs) of marine ingredients using standard methodologies. While this inventory is the most complete to date, there are still important data gaps that the industry should endeavour to fill. Demonstration of the inventory using an economically allocated LCA showed that marine ingredients are very variable in their impact between and even within species, mostly depending on the fuel intensity of the fishery from which they are sourced. Marine ingredients were typically lower in environmental footprint compared to terrestrial ingredients, although LCAs do not take into account the stock status of fisheries, which must be considered separately. • We provide a comprehensive data set of marine ingredients LCIs to produce mass or economically allocated LCAs. • We include the broadest range of species and geographies to date for any marine ingredient LCI. • We include the first demonstration of eFIFO methodology linked to LCA. • Marine ingredients have variable impacts between different species and locations. • Marine ingredients typically have lower LCA impacts than terrestrial ingredients. [ABSTRACT FROM AUTHOR]

Glucose transporter type1 (GLUT-1) deficiency may be rare, but it is a preventable cause of severe learning difficulties; and therefore there is an urgency in making an early diagnosis. Suspicions must be roused when intractable seizures occur in infancy. These may be associated with acquired microcephaly and developmental delay. The finding of low glucose sugar levels in the cerebrospinal fluid, but not in the blood will identify the condition. The gene encoding the GLUT-1 protein is located on the short arm of chromosome 1, and inheritance is by a dominant trait. Patients with this syndrome can have heterozygous mutations, with one allele being a normal wild type and one being mutant. An efficient transport of glucose across the blood–brain barrier is essential as it is such an important fuel for the brain, and this is provided by glucose transporter type1 in the endothelial cells of the brain capillaries. Another minor contribution to the symptomatology of GLUT-1 may be impaired transport of an oxidised form of vitamin C. Treatment with anti-epileptic drugs may be needed, and the ketogenic diet may reduce symptoms, as ketosis can provide an alternative source of fuel for the brain. It has also been suggested that antioxidant thioctic acid may be of benefit. Substances such as caffeine and phenobarbitone should be avoided as they inhibit glucose transport. [Copyright &y& Elsevier]

Examines the relation of low birth weight to psychological stress in pregnancy in Great Britain. Use of life events inventory and a state anxiety index in the study; Association of low birth weight and prematurity with objective major life events; Importance of cigarette smoking as mediator of stress on the fetus. INSET: THE LIVER, AND ITS INFIRMITIES.

Examines the relationship between psychosocial stress on the onset of premature labor in England. Verification of the stressful events affecting the occurrence of preterm labour; Relevance of Life Events Inventory devised by Cochrane and Robertson in the identification; Need to consider antenatal care for the incidence of premature labour.

The author comments on a study which examined the biopsychosocial aspects of chronic daily headache (CDH) in children. He claims that CDH in children may help promote an understanding of the mechanisms underlying the symptoms of children presenting in hospitals. He argues against the study researchers' use of the term somatization, and instead recommend illness behavior. However, he supports them in viewing CDH in a biopsychosocial manner.

In this article, the author reflects on the neurodevelopment pediatrics practices in the town of Sheffield, England. Topics discussed include annual conference of hosted by the periodical, work of several neurodevelopment pediatricians including John Lorber, Victor Dubowitz, and Peter Baxter, and retirement of Martin Bax from the post of editor of the periodical.

Objective: To determine the underlying etiologies in a contemporary cohort of infants with infantile spasms and to examine response to treatment. Methods: Identification of the underlying etiology and response to treatment in 377 infants enrolled in a clinical trial of the treatment of infantile spasms between 2007 and 2014 using a systematic review of history, examination, and investigations. They were classified using the pediatric adaptation of International Classification of Diseases, Tenth Revision (ICD‐10). Results: A total of 219 of 377 (58%) had a proven etiology, of whom 128 (58%) responded, 58 of 108 (54%) were allocated hormonal treatment, and 70 of 111 (63%) had combination therapy. Fourteen of 17 (82%, 95% confidence interval [CI] 59% to 94%) infants with stroke and infarct responded (compared to 114 of 202 for the rest of the proven etiology group (56%, 95% CI 48% to 62%, chi‐square 4.3, P = .037): the better response remains when treatment allocation and lead time are taken into account (odds ratio 5.1, 95% CI 1.1 to 23.6, P = .037). Twenty of 37 (54%, 95% CI 38% to 70%) infants with Down syndrome had cessation of spasms compared to 108 of 182 (59%, 95% CI 52% to 66%, chi‐square 0.35, P = .55) for the rest of the proven etiology group. The lack of a significant difference remains after taking treatment modality and lead‐time into account (odds ratio 0.8, 95% CI 0.4 to 1.7, P = .62). In Down syndrome infants, treatment modality did not appear to affect response: 11 of 20 (55%) allocated hormonal therapy responded, compared to 9 of 17 (53%) allocated combination therapy. Significance: This classification allows easy comparison with other classifications and with our earlier reports. Stroke and infarct have a better outcome than other etiologies, whereas Down syndrome might not respond to the addition of vigabatrin to hormonal treatment. [ABSTRACT FROM AUTHOR]

Sustainable intensification (SI) is defined and interpreted in terms of a framework to support production of farmed aquatic animals in Asia and their trade with Europe. A novel holistic perspective to value chain analysis, informed by a range of sustainability tools, is used to explain the dynamic in the trade that is having significant impacts on livelihoods in both regions. The origins of SI in agriculture are first described and their congruence with aquaculture clarified. Asian aquaculture systems, based on their emergent properties, are then located within a SI framework considering possible boundaries (enterprise, zone or whole value chain). The implications of conventional intensification, and alternatives are explored with reference to specific examples and impacts on the local and global environment, human and aquatic animal health and welfare. The challenges to sustainability of such value chains and implications for their governance, food culture and consumer habits are considered. Local consumption of seafood in Asia is found to be a major driver of growth and alternative markets for exports regionally and in Low and Medium income countries (LMIC) are likely to impact on employment and power in the value chain between Europe and Asia. The benefits of viewing farmed seafood as part of broader food landscapes are identified in the analysis, as is a shift in the focus from volume to value in terms of goal setting. More holistic perspectives of sustainability also emerge as necessary to describe and interpret global value chains rather than limited reductionist, production- orientated views. A diversity of trends in the development of farmed seafood is identified in contrast to any simplistic move to intensification, likely informed by economic, environmental and social factors in producer and consumer countries. Statement of relevance Global imbalances in production and consumption of farmed seafood are stimulating trade between Asia and Europe. The dynamic of global value chains around this emergent trade and their alignment with broader sustainability criteria, as applied to sustainable intensification of food production, are highly relevant to global food security. [ABSTRACT FROM AUTHOR]

Background: Infantile spasms constitutes a severe infantile epilepsy syndrome that is difficult to treat and has a high morbidity. Hormonal therapies or vigabatrin are the most commonly used treatments. We aimed to assess whether combining the treatments would be more effective than hormonal therapy alone.Methods: In this multicentre, open-label randomised trial, 102 hospitals (Australia [three], Germany [11], New Zealand [two], Switzerland [three], and the UK [83]) enrolled infants who had a clinical diagnosis of infantile spasms and a hypsarrhythmic (or similar) EEG no more than 7 days before enrolment. Participants were randomly assigned (1:1) by a secure website to receive hormonal therapy with vigabatrin or hormonal therapy alone. If parents consented, there was an additional randomisation (1:1) of type of hormonal therapy used (prednisolone or tetracosactide depot). Block randomisation was stratified for hormonal treatment and risk of developmental impairment. Parents and clinicians were not masked to therapy, but investigators assessing electro-clinical outcome were masked to treatment allocation. Minimum doses were prednisolone 10 mg four times a day or intramuscular tetracosactide depot 0·5 mg (40 IU) on alternate days with or without vigabatrin 100 mg/kg per day. The primary outcome was cessation of spasms, which was defined as no witnessed spasms on and between day 14 and day 42 from trial entry, as recorded by parents and carers in a seizure diary. Analysis was by intention to treat. The trial is registered with The International Standard Randomised Controlled Trial Number (ISRCTN), number 54363174, and the European Union Drug Regulating Authorities Clinical Trials (EUDRACT), number 2006-000788-27.Findings: Between March 7, 2007, and May 22, 2014, 766 infants were screened and, of those, 377 were randomly assigned to hormonal therapy with vigabatrin (186) or hormonal therapy alone (191). All 377 infants were assessed for the primary outcome. Between days 14 and 42 inclusive no spasms were witnessed in 133 (72%) of 186 patients on hormonal therapy with vigabatrin compared with 108 (57%) of 191 patients on hormonal therapy alone (difference 15·0%, 95% CI 5·1-24·9, p=0·002). Serious adverse reactions necessitating hospitalisation occurred in 33 infants (16 on hormonal therapy alone and 17 on hormonal therapy with vigabatrin). The most common serious adverse reaction was infection occurring in five infants on hormonal therapy alone and four on hormonal therapy with vigabatrin. There were no deaths attributable to treatment.Interpretation: Hormonal therapy with vigabatrin is significantly more effective at stopping infantile spasms than hormonal therapy alone. The 4 week period of spasm cessation required to achieve a primary clinical response to treatment suggests that the effect seen might be sustained, but this needs to be confirmed at the 18 month follow-up.Funding: The Castang Foundation, Bath Unit for Research in Paediatrics, National Institute of Health Research, the Royal United Hospitals Bath NHS Foundation Trust, the BRONNER-BENDUNG Stifung/Gernsbach, and University Children's Hospital Zurich. [ABSTRACT FROM AUTHOR]

The article provides information on febrile seizures. Topics discussed include the classifications of febrile seizures as proposed by the International League Against Epilepsy (ILAE) in 2010, the connection between febrile seizures and epilepsy, and when and how to use the rescue medication benzodiazepines in case of an emergency at home. Also mentioned are the results of a study on the role of antipyretics and antiepileptic drugs in preventing recurrence.

Aim We aimed to investigate the relationship between movement disorders, changes on brain magnetic resonance imaging ( MRI), and vigabatrin therapy in children with infantile spasms. Method Retrospective review and brain MRI analysis of children enrolled in the International Collaborative Infantile Spasms Study ( ICISS) who developed a movement disorder on vigabatrin therapy. Comparisons were made with controls within ICISS who had no movement disorder. Results Ten of 124 infants had a movement disorder and in eight it had developed on vigabatrin therapy. Two had a movement disorder that resolved on dose-reduction of vigabatrin, one had improvement on withdrawing vigabatrin, two had resolution without any dose change, and in three it persisted despite vigabatrin withdrawal. The typical brain MRI changes associated with vigabatrin therapy were noted in two infants. Ten control infants were identified. Typical MRI changes noted with vigabatrin were noted in three controls. Interpretation It is possible that in two out of eight cases, vigabatrin was associated with the development of a movement disorder. In six out of eight cases a causal relationship was less plausible. The majority of infants treated with vigabatrin did not develop a movement disorder. MRI changes associated with vigabatrin do not appear to be specifically related to the movement disorder. [ABSTRACT FROM AUTHOR]

Summary [ABSTRACT FROM AUTHOR]

To examine the underlying etiology of infantile spasms from the United Kingdom Infantile Spasms Study (UKISS), using the pediatric adaptation of ICD 10. Infants were enrolled in a randomized controlled trial or a parallel epidemiologic study. Etiological information included history, examination, and investigations. The infants were classified as proven etiology, if a neurologic disease was identified; as no identified etiology, if no neurologic disease was identified; and as not fully investigated, if a major piece of information was missing. Proven etiology was subclassified using the pediatric adaptation of ICD 10. The results were then examined to identify further methods of classification. Of 207 infants, 127 (61%) had proven etiology, 68 (33%) had no identified etiology, and 12 (6%) were not fully investigated. Etiologies were prenatal in 63, perinatal in 38, postnatal in 8, and 18 other. The most common etiologies were: hypoxic-ischemic encephalopathy (HIE) 21 (10%), chromosomal 16 (8%), malformations 16 (8%), stroke 16 (8%), tuberous sclerosis complex (TSC) 15 (7%), and periventricular leukomalacia or hemorrhage 11 (5%). The remaining 32 etiologies were all individually uncommon. Response to treatment is given for individual etiologies. Our method of classification allows the reporting of results by individual diseases, disease groups, or categories and is structured and clear. It avoids the use of poorly defined terms such as symptomatic and cryptogenic. It can adapt to new neurologic diseases, such as gene defects, and can be used for comparison of different groups of infants, thereby aiding meta-analysis. [ABSTRACT FROM AUTHOR]

Summary: Background: Infantile spasms is a severe infantile seizure disorder that is difficult to treat and has a high morbidity. Absence of spasms on days 13 and 14 after randomisation is more common in infants allocated hormone treatments than in those allocated vigabatrin. We sought to assess whether early control of spasms is associated with improved developmental or epilepsy outcomes. Methods: Infants enrolled in the United Kingdom Infantile Spasms Study (UKISS) were randomly assigned hormone treatment (n=55) or vigabatrin (n=52) and were followed up until clinical assessment at 12–14 months of age. We assessed neurodevelopment with the Vineland adaptive behaviour scales (VABS) at 14 months of age on an intention to treat basis. Findings: Of 107 infants enrolled, five died and 101 survivors reached both follow-up assessments. Absence of spasms at final clinical assessment (hormone 41/55 [75%] vs vigabatrin 39/51 [76%]) was similar in each treatment group (difference 1·9%, 95% CI −18·3% to 14·4%; χ2=0·05; p=0·82). Mean VABS score did not differ significantly (hormone 78·6 [SD 16·8] vs vigabatrin 77·5 [SD 12·7]; difference 1·0, 95% CI −4·9 to 7·0; t99 =0·35, p=0·73). In infants with no identified underlying aetiology, the mean VABS score was higher in those allocated hormone treatment than in those allocated vigabatrin (88·2 [17·3] vs 78·9 [14·3]; difference 9·3, 95% CI 1·2 to 17·3; t95 =2·28, p=0·025). Interpretation: Hormone treatment controls spasms better than does vigabatrin initially, but not at 12–14 months of age. Better initial control of spasms by hormone treatment in those with no identified underlying aetiology may lead to improved developmental outcome. [Copyright &y& Elsevier]

Efficiency assessments of marine ingredient use in aquaculture are required to fully understand their contribution to global seafood supply and their impacts on all UN Sustainable Development Goals. Fish In: Fish Out (FIFO) ratios have become the principal metric used to ensure aquaculture does not negatively impact wild fish stocks. However, several approaches have been advocated to calculate the FIFO ratio and there have been criticisms that the different approaches employed lead to over- or under- estimates of the dependence of aquaculture on marine ingredients. Critically, FIFO does not align with Life Cycle Assessment as a measure of other environmental impacts. In this paper we present an alternative method to calculate the FIFO ratio based on the principle of economic allocation (economic Fish In: Fish Out – eFIFO) as commonly used in Life Cycle Assessments. Economic allocation acts as a proxy for the nutritional value of ingredients and places higher importance on the more limiting co-products generated and their relative demand. Substitution of marine ingredients by alternate feed ingredients has significantly reduced the amount of fishmeal and fish oil in aquafeed formulations for most farmed fish species, resulting in a continually decreasing FIFO ratio. Results show that most aquaculture species groups assessed in this study are net producers of fish, while salmon and trout aquaculture are net neutral, producing as much fish biomass as is consumed. Overall, global fed-aquaculture currently produces three to four times as much fish as it consumes. Tracking historical prices of fish oil against fishmeal, the relative higher price of fish oil leads to relatively higher allocation of fish to fish oil compared to fishmeal. This leads to relatively higher eFIFO for species with high fish oil requirements. • Economic allocation is applied to the co-production of fishmeal and fish oil to assess the fish in: fish out (FIFO) ratio. • Economic allocation avoids double counting of fish resources. • Economic allocation gives a higher impact to the limiting feed ingredient, reflecting socio-economic drivers of fisheries. • The economic FIFO (eFIFO) ratio is compared to previously published FIFO ratios for the main aquaculture species groups. [ABSTRACT FROM AUTHOR]