February 2015

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FEBRUARY 2015 FACES E-NEWSLETTER

  1. CEC SPOTLIGHT: MARIA TAVERAS
  2. RECIPE OF THE MONTH
  3. FACES APARTMENTS 2014 STATISTICS
  4. FACES FELLOWSHIP ANNOUNCEMENT
  5. CENTER FOR SUDEP RESEARCH ESTABLISHED
  6. UPDATE IN CBD RESEARCH
  7. REFRACTORY EPILEPSY
  8. SUDDEN UNEXPECTED DEATH DATA ENHANCEMENT AND AWARENESS ACT
  9. TIDES FOUNDATION
  10. NOTEWORTHY NEWS
  11. AES CONFERENCE RECAP
  12. FACESFORWARD CAMPAIGN
  13. FUNDRAISING CORNER: FUDGERAISER

1) CEC SPOTLIGHT: MARIA TAVERAS

Maria TaverasMaria Taveras is an Administrative Assistant at the NYU Comprehensive Epilepsy Center. She first joined the group in September 2008, and assists neurologists Ruben Kuzniecky , MD, Blanca Vazquez, MD, and Sanjeev Kothare, MD. She coordinates doctors’ patient schedules, assists international patients with their treatment, requests prescription refills, and provides general assistance for patients.

Maria comes to work determined to assist patients of the Epilepsy Center in any possible way!

 

2) RECIPE OF THE MONTH

By: Courtney Glick, MS, RD, CDN

CLICK HERE TO VISIT THE NUTRITION SECTION OF OUR WEBSITE!

Taking Breakfast to the Next Level!

We are one month into 2015 and, chances are, if you made a new year’s resolution to lose weight or change your diet, you have already run out of ideas and/or steam. Breakfast is the most important meal of the day because it gets your metabolism going. Multiple studies have shown that people who eat breakfast weigh less than those who skip. With our fast paced lives, getting a good breakfast in everyday can be difficult! Here are two quick, easy ways to take a plain old breakfast staple (oatmeal) to the next level. These oatmeal recipes are both quick and healthy breakfast ideas for you and your family. Both recipes incorporate chia or flax seed, which are the richest source of omega 3s in any non-marine whole food. In addition, both flax and chia seeds contribute tons of fiber (4- 6g per 1 tablespoon), which helps you stay full. February is Heart Awareness Month and these two breakfasts are as heart healthy as it gets. Between the fiber, whole grains, and omega 3s – these are sure to “warm” your heart and bellies this month.

OVERNIGHT NO-COOK OATMEAL

Nutrition (makes 1 serving): 220 calories, 4g fat, 31g carbs, 7g fiber, 14g protein
This oatmeal recipe requires no cooking. It can be done ahead of time so you can “grab and go”. It is also packed with fiber and omega 3s!

Ingredients:

  • 1/4 cup uncooked old fashioned rolled oats
  • 1/3 cup almond milk or coconut milk
  • 1/4 cup low-fat Greek yogurt
  • 1-1/2 teaspoon dried chia seeds
  • 1/4 teaspoon vanilla extract
  • 1/4 to 1/3 cup raspberries (cut each berry in half), or enough to fill jar
  • ½ tablespoon. honey (optional)
  • Cinnamon to taste

Directions:

In a half pint (1 cup) mason jar, add oats, almond milk, yogurt, chia seeds, vanilla, and raspberries. Put lid on jar and shake until well combined. Refrigerate overnight or as long as 2-3 days.
-------------------------------------------------------OR------------------------------------------------------------------------
If you don’t have time to make the above recipe, this next recipe can be assembled in less than 5 minutes. All the dry ingredients can be kept at your work desk for a quick breakfast if you don’t have time before you leave the house.

HEALTHIER INSTANT OATMEAL

Nutrition (makes 1 serving): 220 calories, 7g fat, 30g carbohydrate, 13g fiber, 7g protein

Ingredients:

1 packet Quaker low sugar maple/brown sugar oatmeal (has 40 less calories, 10g fewer carbs and 50% less sugar compared to the original)
1 tablespoon chia or flax seeds
2/3 cup water (or milk if desired)
½ cup berries

Directions:

Mix chia seeds, oatmeal and berries together in a bowl and add hot milk or water. Let it sit for 60 seconds, then enjoy.

3) FACES APARTMENTS 2014 STATISTICS

The FACES Apartments program is provided “cost-free” to families who travel from far away to receive epilepsy treatment at NYU Langone Medical Center. Year round, two standard rooms are available for occupancy at the Affinia Shelburne Hotel located on 37th Street and Lexington Avenue. This hotel is conveniently located within walking distance to NYULMC. Requests for accommodations are awarded on a first-come, first-serve basis. Priority is based on financial necessity and medical severity. Furthermore, only 1 room per family is granted. In case there is no availability, families will be referred to the NYU Hospitality Hotline at 212-263-2092, where families may be able to secure hotel accommodations at a discounted rate.

In 2014, FACES was able to serve:

  • 73 families total
  • Families came from 24 states and 2 different countries
  • Length of stay ranged from 1 day to 8 weeks
  • A total of 567 room nights were provided

If you would like to inquire about a FACES Apartment, please email facesapartments@nyumc.org. Your message will be returned within 48 hours.

4) FACES FELLOWSHIP ANNOUNCEMENT

FACES is pleased to announce Daniel English, PhD, as the inaugural winner of the FACES postdoctoral Fellowship. The mission of FACES is to improve the quality of life for all those affected by epilepsy and seizures. The program funds research to improve epilepsy care, advances new therapies, and fosters a supportive community for children, families and caregivers who live with the challenges of epilepsy. With this new initiative, FACES seeks to stimulate basic and translatable neuroscience work that has potential to have an impact on patient lives. The grant will provide $50,000 in direct costs to support the work.

Dr. English is a postdoctoral fellow in the laboratory of György Buzsáki, a pioneer and leader in the fields of neuronal oscillations, epilepsy and in vivo electrophysiological techniques. Since joining Dr. Buzsáki’s laboratory in 2012, he has completed a project investigating hippocampal sharp wave ripple oscillations in freely behaving mice using simultaneous LFP and intracellular membrane potential recording. He used these techniques to perform experiments aimed at furthering our understanding of how ripple oscillations are generated and how individual pyramidal neurons are recruited to individual ripple events. This project resulted in a first author publication in the Journal of Neuroscience, which demonstrates the critical roles of, and interaction between, excitation and inhibition in generating ripple oscillations and in the selective recruitment of individual pyramidal neurons to specific ripple events. With the FACES Postdoctoral Fellowship, Dr. English aims to utilize his expertise in intracellular recording in awake and behaving rodent models of epilepsy with the goal of understanding how pathological oscillations contribute to the disease.

5) Center for SUDEP Research established

By: Rachel Jurd, PhD

The Center for SUDEP Research is a new initiative that has been established to study Sudden Unexpected Death in Epilepsy (SUDEP). This virtual center includes over 40 clinicians and scientists from 14 institutes across the U.S. and U.K. This five-year research project is being supported with a $27.3 million grant from the National Institutes of Health (NIH) and brings together many of the leaders in the field of SUDEP research.

SUDEP is the sudden and premature death of a person with epilepsy without apparent or known cause of death. It is the most common cause of premature mortality for people with epilepsy. Individuals with refractory epilepsy have a 35% lifetime chance of succumbing to SUDEP. There are currently no targeted treatments or devices available to prevent it. The cause of SUDEP is unknown, but research efforts have centered on structural and/or functional defects in brain areas that control cardiovascular and respiratory functions. Such abnormalities can cause breathing and heart rate disruptions following a seizure, which in a subset of cases, are catastrophic and lead to sudden death.

The Center is composed of a multidisciplinary group of investigators with expertise in molecular biology, genetics, neuropathology, electrophysiology, brain imaging, epilepsy, cardiology, and bioinformatics. The team will be involved in nine projects that combine basic research and clinical findings with the common goal of quickly taking SUDEP lab results into the clinic.

Drs. Orrin Devinsky and Daniel Friedman are involved in two of the Center’s projects. The first project will investigate autonomic and neuroimaging biomarkers of SUDEP. Changes in brain structures in people with epilepsy will be examined and linked to abnormal breathing patterns and cardiac arrhythmias that occur during seizures. These studies will provide insights into mechanisms that lead to a fatal scenario and suggest pre-mortem indications and risk factors that identify those most at risk of SUDEP.

The second project will investigate neuropathologic changes associated with SUDEP. Researchers will collect postmortem brain tissue from individuals who have died from SUDEP as well as tissue from patients who are at high risk for SUDEP that have undergone epilepsy surgery. A variety of immunohistochemistry and microscopy studies will be performed to examine the role of brainstem dysfunction and the role of two key neurotransmitters, adenosine and serotonin, in SUDEP.

“Over the past 5 years there has been a tremendous increase in SUDEP research”, says Daniel Friedman, MD. “The Center for SUDEP Research has gathered together the leaders in the field and we hope to capitalize on their momentum, innovation, and diverse array of skills to figure out why SUDEP occurs and how we can prevent it.”

For further information about the Center for SUDEP Research: http://csr.case.edu/index.php/Main_Page

To learn more about SUDEP: http://www.epilepsy.com/node/2000093

6) UPDATE IN CBD RESEARCH

By: Diana Ruvolo, RN

Over the past 12 months, an ongoing expanded access study from Dr. Orrin Devinsky has evaluated the effectiveness of cannabidiol (CBD) on patients with difficult to control epilepsy. CBD is the most abundant and non-psychoactive cannabinoid found in cannabis. Animal studies and anecdotal reports from people using medical marijuana suggest CBD plays a role in reducing seizures for people with epilepsy.

In this study, children and young adults with severe, childhood onset epilepsy were enrolled in a prospective observation study. Participants were given Epidiolex, an oil based medication provided by G.W. Pharmaceuticals that contains 98% CBD extract.

After 3 months of treatment, data from a total of 58 patients from epilepsy centers in New York, Boston, and San Francisco has showed encouraging results. After the initial 3 months, 40% of patients reported a 50% seizure reduction and 10% of patients had achieved seizure freedom.

Although initial results have been promising, further research and placebo studies are needed to objectively verify the efficiency of the medication. G.W. Pharmaceuticals has ongoing and future studies throughout the country to evaluate the effectiveness of Epidiolex. These studies will focus on patients with Dravet Syndrome and Lennox-Gastaut Syndrome. They are designed as double blind placebo studies, in which neither the doctor nor patient knows if the medication or a placebo is being used. These studies will provide much needed scientific information about CBD and are an important step in making this medication more widely available.

7) REFRACTORY EPILEPSY

By: Sloka Iyengar, PhD

Anti-epileptic drugs (AEDs) are effective in two-thirds of people with epilepsy; the remaining one-third of the patient population where AEDs are not effective have ‘drug-resistant’, ‘uncontrolled’, ‘intractable’ or ‘refractory’ epilepsy.

An individual with epilepsy is defined to have refractory epilepsy when he/she has failed to become (and remain) seizure-free with two AEDs. The AEDs should be chosen appropriately keeping in mind the person’s seizure type and must be tolerated well by the person. Refractory epilepsy is associated with a diminished quality of life, because of the effects of uncontrolled seizures on physical and psychological health, as well as additional societal and financial burden.

The causes of refractoriness are many – incorrect diagnosis; incorrect treatment; failure of treatment despite correct diagnosis and treatment; or failure due to lifestyle-related factors and triggers. Incorrect diagnosis occurs more often than one would expect. For example, conditions like hypoglycemia, psychogenic non-epileptic seizures (PNES), panic attacks, and movement disorders (tics and tremors) have the potential to be diagnosed as epilepsy. It is easy to see that AEDs will not work in these conditions. Incorrect treatment may occur due to the wrong drug; the correct drug in the wrong dose; toxicity; or external factors like sleep deprivation or excessive stress. Non-compliance is another cause of refractoriness. Polytherapy (administration of more than one drug at a time), may lead to refractoriness because of excessive toxicity issues with noncompliance or drug-drug interactions.

Studying the neurobiology of seizures can also give us some clues into refractoriness. Two main theories exist – the multidrug transporter hypothesis and the target hypothesis. Transporters such as P-glycoprotein (P-gp) are present in the blood brain barrier and lead to efflux of AEDs. An increase in levels of P-gp can lead to decreased efficacy of drug. The target hypothesis proposes that AEDs stop working because AED targets are altered in structure, form or location. If that happens, one can see how AEDs stop acting even if the patient is taking them as instructed.

In patients with epilepsy that exhibit refractoriness, epilepsy surgery can be a viable option. However, surgery may not be possible if the seizure focus is not localized. In these cases, alternative approaches like dietary modalities or vagus nerve stimulation (VNS) may have to be done.

Sloka S. Iyengar, PhD is an epilepsy researcher and has been investigating mechanisms that can cause groups of neurons to generate and sustain spontaneous seizures. For her graduate work, Sloka worked with Dr. David Mott where she used electrophysiology to study epileptic circuits. In New York, Sloka conducted her postdoctoral research at the Nathan Kline Institute where she examined the role of a part of the brain called the hippocampus in seizures. Presently, she has switched focus from basic epilepsy research to clinical research with Dr. Jeffrey Politsky at the Northeast Regional Epilepsy Group. In addition to research, Sloka also has a strong interest in epilepsy advocacy and education


8) SUDDEN UNEXPECTED DEATH DATA ENHANCEMENT AND AWARENESS ACT

Laura Crandall, MA who is a Sudden Unexplained Death in Childhood researcher at the NYU Langone Comprehensive Epilepsy Center, was instrumental in having legislation introduced - Sudden Unexpected Death Data Enhancement and Awareness Act. It was passed by both Senate and House and was signed into law on December 18, 2014. Laura was invited to join President Obama when he signed.

Please click here to visit the legislation on congress.gov

Please click here to visit the SUDC website

Laura Crandall, MA (in the white shirt) with
President Obama signing, and other SUDC collaborators.

9) TIDES FOUNDATION

Antigua and Barbuda seal

FACES has received a gift from the Tides Foundation through the Frank Walter Fund for medical aide to send doctors and nurses from the NYU Langone Comprehensive Epilepsy Center to the island of Antigua. They will train medical staff and provide care to pediatric patients with epilepsy. FACES Executive Director, Pamela Mohr and Dr. Derek Chong, met with Ambassador Walter Aubrey Webson at the Antiguan Consulate before the holidays to discuss the details of this new program which is scheduled for Fall 2015. .

 

 

 

Top left: Barbara Paca, representing Tides
Foundation, Jackley Peters, Attache to
Ambassaor Webson, Pamela Mohr, and
Derek Chong, MD.

This gift will provide funding to send two epileptologists, one epilepsy nurse or nurse practitioner, and one EEG technologist to the island to run a 4-day epilepsy clinic to evaluate and care for all children on the island with epilepsy.

 

The primary goals will be:

  1. To study the distribution of ages and epilepsy types on the island
  2. Review available medications versus what would be needed to improve patient care options
  3. Help plan infrastructure for improved delivery of epilepsy care to island children.

Stay tuned for an update next Fall 2015!

10) NOTEWORTHY NEWS

Top 10 National Press Articles

  1. SLEEP POSITION LINKED TO DEATH RISK FOR THOSE WITH EPILEPSY
  2. RECOGNIZING AND ADDRESSING ANTIEPILEPTIC DRUG SIDE EFFECTS
  3. LOCAL FAMILIES HAVING TROUBLE GETTING MEDICAL MARIJUANA APPROVAL FROM DOCTORS
  4. RECOGNIZING AND ADDRESSING ANTIEPILEPTIC DRUG SIDE EFFECTS
  5. BREVARD FAMILY UNITED AFTER EPILEPSY SURGERY
  6. CANNABIDIOL TREATMENT: DOCTORS VERSUS PATIENTS
  7. FDA TRIES TO REGULATE BULK CAFFEINE SALES; REPORTS OF SEIZURES, DEATH
  8. ALCYONE LIFESCIENCES APPOINTS MICHAEL ROGAWSKI, INTERNATIONAL EXPERT IN TREATMENT OF SEIZURES AND EPILEPSY TO ITS CLINICAL AND SCIENTIFIC ADVISORY BOARD
  9. HOPE FUND: A LIFETIME OF SEIZURES CAN'T DIM MAN'S ZEST FOR LIFE
  10. COWETA’S ZENSEN PUTS FACE ON NEED FOR LEGALIZATION

11) AES CONFERENCE RECAP

By: Nako Ishii

On December 5-9, 2014, more than 5,000 of the world’s leading epilepsy professionals gathered together at the Washington State Convention Center in Seattle for the 68th Annual American Epilepsy Society (AES) Meeting.

Through symposia, lectures, scientific exhibitions, poster and platform presentations, the AES meeting identifies new trends and cutting-edge research that continues to move the field of epilepsy forward year after year. This meeting brings together professionals from around the world who are involved in both research and the clinical care for people with epilepsy from private practice, academia and government and provides a space for discussion and further collaboration.

Research Coordinator, Rachel Hennessy
presenting her HEP study poster

This year, several of our CEC’s staff and physicians were invited to present on their expertise. Dr. Blanca Vazquez was involved in the Spanish Symposium titled “Complementary and Alternative Approaches to Epilepsy Treatments” and spoke on non-conventional medical treatments, specifically mind-body therapies.

Our understanding of Sudden Unexpected Death in Epilepsy (SUDEP) is moving forward thanks to a broad range of research including animal models, the search for clinical biomarkers, and collaborative work with coroners, medical examiners and device developers. One such initiative is NASR (the North American SUDEP Registry) headed by Dr. Orrin Devinsky, who updated the community of its progression during a SUDEP Panel and also organized a Symposium titled, “The Epidemiology, Pathophysiology & Prevention of SUDEP”. This symposium reviewed the basic and clinical science of SUDEP and addressed several topics including, the epidemiology, clinical risk factors, potential role of preventive strategies, gaps in how physicians educate patients and families, current biomarkers of SUDEP and the evidence for the role of devices in seizure detection and their potential role in preventing SUDEP.

Check out this awesome cartoon
of Dr. Jacqueline French!

Dr. Jacqueline French also presented on SUDEP as part of the FDA Town Hall Update. Studies have suggested that patients randomized into placebo-controlled clinical trials of antiepileptic drugs had a higher likelihood of having SUDEP if they were randomized to the placebo arm compared to those who received the drug. Dr. French and Dr. Billy Dunn co-chaired a panel to examine these findings and led an interactive audience discussion, specifically requested by the FDA, to provide community input to the regulatory process.

As expected, Cannabidiol (CBD), the most abundant non-psychoactive cannabinoid in the cannabis plant, was a hot topic this year and there were several sessions devoted to its potential as a treatment for epilepsy. Animal studies demonstrate anticonvulsant efficacy in multiple species and anecdotal reports suggest efficacy in children with treatment-resistant epilepsies (TRE), especially Dravet syndrome. Dr. Devinsky, in collaboration with several colleagues including Dr. Dan Friedman, presented the preliminary results in children with TRE in an expanded access treatment program that is currently enrolling at NYU.

Next year’s AES Meeting is set for December 4-8, 2015 and will be held in Philadelphia, PA at the Pennsylvania Convention Center.

Enjoy some photos of the Human Epilepsy Project (HEP) research team at the AES Conference

From left to right: Catherine Freyer,
Kevin McKenna, Sabrina Cristaro,
BSN, Vickie Mays, and Rachel Hennessy

Heath Pardoe, PhD,
and Ruben Kuzniecky, MD

Sabrina Cristofaro, BSN presenting
her poster at the convention center

 

Primary Investigators Drs. Daniel Lowenstein,
Ruben Kuzniecky, and Jacqueline French

The entire HEP
research team

 

12) FACESFORWARD CAMPAIGN

Epilepsy is one of the world’s most common neurological diseases, but it remains one of the least funded and recognized. By June 1, 2015, FACES would like to raise $100,000 to help foster epilepsy and seizure awareness, but we need your support!

You can help move FACESforward by joining the 2015 campaign – moving us one step closer to finding a cure.

We encourage you to:

DONATE in honor of a friend, a doctor, or yourself.
   
CREATE your own FACESforward 2015 Fundraising Page.
Tell your story and encourage friends & loved ones to give toward your personal goal!
   
PROMOTE FACESforward 2015 by telling others about it, and encouraging them to participate! E- mail everyone you know!
SHARE the link on your Facebook, LinkedIn and Twitter profiles, and in your e-mail signature.

 

Thank you for helping the FACESforward 2015 Campaign

A STORY OF HOPE:

“Katie…Katie...can you hear me? We need you to try to clench your fist, move your thumb, move your index finger, move your middle finger, move your ring finger, and move your pinky.” I could hear him saying.

It was the middle of my fourth brain surgery when the anesthesiologist woke me so I could participate in my own brain surgery. At 12 years old, I was the youngest person to ever have an awake craniotomy at NYU Langone Medical Center. When I woke up, I heard a voice. He was telling me to move my hand and arm. It felt like three minutes but it was 45 minutes. It was Dr. Howard Weiner’s voice. He is one of the best pediatric neurosurgeons in the world.

This was a life changing experience for me and my family. Through the rough and hard, we fought together. For two months, I laid in the pediatric ICU. There were many nurses and doctors who would comfort me. I always told them, “I’m going to be like you someday because I want to help people”. Two months of my summer were spent sitting in the hospital staring out the window. You might think “poor girl, I feel bad for her”, but don’t. It was hard and long, but it was for a good reason.

My name is Katie and I have epilepsy. I am not afraid to say I have epilepsy and I have had five brain surgeries. Some people may not like to tell others things like this, but I like to embrace it. I’m not afraid of being made fun of anymore. I want people to understand and I want to tell them that it’s okay to be yourself. Creating awareness about this condition is what I want to do. I have met so many people who live with similar disorders through FACES.

I sat in the hospital staring out the window and just thought, “I’m so happy, but I’m so upset”. I made friends with the doctors and nurses at the hospital. While I knew my friends were at the pool with each other having fun without me, I was in the hospital coloring. I’m happy I took a chance that changed me so much and made me think so differently than I use to. In sixth grade, when I was told I could have a brain surgery that might help my epilepsy, I was surprised. My parents kept saying, it’s up to you”. I told them, “You never know until you try and if I don’t try, I will never know”. And so I tried. Even though the turnout wasn't exactly what we had hoped for and a few things went wrong, I’m happy I did it. It brought me to a whole new level of thinking.

I had five brain surgeries. I was supposed to have three, but I had five. My experience is something no one else has experienced and I like that. It’s part of what makes me “me”. The first surgery: they took pictures of my brain; second surgery: they put grids all over my brain to evaluate and see what parts needed to be operated on; third surgery: they took the grids off and started the removal of damaged tissue. Then, there was a problem. They couldn’t do the surgery because the piece they would have to remove is that part that controls my left arm and hand. Fourth surgery: they woke me up and made me do testing with my hand.

After my surgeries, my hand was partly paralyzed. I had to do some therapy. And you may be asking “what about the fifth?” Here’s the twist. I got an infection that occurs only every 2-3 years. The fifth surgery: the infection was cleared out with the help of a famous plastic surgeon. I then had to take heavy duty antibiotics for eight weeks. That’s the story of my surgeries. This event has had a life changing impact on me that has changed my way of thinking.

The journey isn’t over for me. I am getting better all the time. I take less medication now. School is more fun and I don’t get as tired as I used to. I want to continue to be a representative for FACES, so other people and families will feel the support and compassion that has been given to me.

13) FUNDRAISING CORNER: FUDGERAISER

By: Juliet Berninger

We held our fourth FUDGERAISER for FACES this past November. The FUDGERAISER was headed up by my sons Nick and Luke Berninger in honor of their younger brother, Eric. He has epilepsy and is a patient if Dr. Devinsky. This year we received tons of help from Kristian Thame , Julia Levine, Jake Lorah and the D'Amato family in making, packaging, and selling fudge for $10 a piece. We had a few different flavors to offer with chocolate peanut butter cup being the most popular. A special thank you goes to St. Joseph Regional high school in Montvale, NJ, for allowing us to set up a fudge stand at one of their biggest football games of the season! We were thrilled to raise $2,340 with matching funds of $2,000. A total of $4,340 was donated to FACES.

Enjoy some photos!

FACES Needs Your Help

With the help of our fantastic FACES community, the 2014 FACES Gala Auction included 375 exclusive packages and helped the Gala raise over $4.8 million to support our mission and programs. FACES is now accepting donations for the 2015 Gala, being held at Pier Sixty at Chelsea Piers on Monday, March 2, 2015. Help us make this year’s auction bigger and better! Our auction is one of the largest in New York, and includes items such as designer bags, sporting events, high-end electronics, vacation packages, fine jewelry and much more.

 

 

 

 

 

 

If you are interested in donating items to the 2015 Gala Auction, please contact Alyssa Giorgio at alyssa.giorgio@nyumc.org

PLEASE CLICK HERE TO VISIT THE PEACE OF MIND LECTURE PAGE

Click here to apply today! Deadline to apply is April 13, 2015