By: Nicholas Eckman, Keith E. Williams, Katherine Riegel, Candace Paul
OBJECTIVE. A structured intervention was used to teach chewing to two children with special needs. Neither child had a history of chewing or eating high-textured food.
METHOD. The intervention combined oral–motor and behavior components to teach chewing. A multiple baseline design was used to evaluate treatment effectiveness.
RESULTS. Both children improved their chewing skills while increasing the texture of foods eaten and the variety of foods eaten.
CONCLUSION. This structured intervention could be used to teach chewing to a range of children who did not acquire this skill during normal development.
Weaning is the process of gradually introducing an infant human or another mammal to what will be its adult diet while withdrawing the supply of its mother's milk. The process takes place only in mammals, as only mammals produce milk.
Approaches To Nutritional Health Awareness And First Aid In Students With Spe...John Berberich
Video: https://youtu.be/xwVOthcoA-U
Approaches to Nutritional Health Awareness and First Aid in Students with Special Needs - Amy Wang, John Berberich, Moizz Akhtar, Aviv Crish, Rahil Desai, Trivianne Franklin, Forest Gries, Navedeep Kaur, Ryan Pavelka, Catherine Shanahan, Kate Whelihan, Joy Lewis DO
AT Still University
Early childhood caries (ECC) as the presences of one or more decayed (noncavitated or cavitated), missing (as a result of caries), or filled tooth surface in any primary tooth in a child 71 months of age or younger.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Weaning is the process of gradually introducing an infant human or another mammal to what will be its adult diet while withdrawing the supply of its mother's milk. The process takes place only in mammals, as only mammals produce milk.
Approaches To Nutritional Health Awareness And First Aid In Students With Spe...John Berberich
Video: https://youtu.be/xwVOthcoA-U
Approaches to Nutritional Health Awareness and First Aid in Students with Special Needs - Amy Wang, John Berberich, Moizz Akhtar, Aviv Crish, Rahil Desai, Trivianne Franklin, Forest Gries, Navedeep Kaur, Ryan Pavelka, Catherine Shanahan, Kate Whelihan, Joy Lewis DO
AT Still University
Early childhood caries (ECC) as the presences of one or more decayed (noncavitated or cavitated), missing (as a result of caries), or filled tooth surface in any primary tooth in a child 71 months of age or younger.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
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Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
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2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
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Describe the primary categories of smells and the concept of odor blindness.
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Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
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Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
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Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Journal Reporting - Teaching Chewing: A Structured Approach
1. Teaching Chewing:
A Structured
Approach
Laisa Marie Gregorio, UST OT Intern, 2013
2. Background
Chewing is one of many problems commonly
seen in children with congenital delays, e.g.
Down syndrome, autism spectrum disorder, cri
du chat and cerebral palsy.
Problems in chewing = neuromotor deficits and
or lack of experience
3. Background
Institutional deprivation = lack of exposure to or practice
in chewing high textured food
Lack of literature
(Butterfield & Parson, 1973) Modeling, shaping and positive
reinforcement = teaching a kid with DS to bite graham crackers
(Gisel et. al., 1994) oral-motor intervention for kids with CP;
includes 3 components (tongue lateralization, lip control and
vigor of chewing); cookie progresses in hardness; 5-7 min before
school lunch meal for 10-20 weeks
4. Background
Oral-motor functioning and behavioral
approaches
Stimulus fading
Positive/social reinforcement
Peer modeling
Token reinforcement
= Goal of the study
5. Method
Participant and Setting
9 y/o Sam with Down syndrome
Eats only limited number of pureed foods
Leaves meal before finishing
Refuses to self-feed
Goal: to establish chewing, increase variety and
texture of solid foods eaten, establish open-cup
drinking, eliminate inappropriate mealtime behaviors
124 meal sessions, 19 days, day-treatment program
6. Method
Participant and Setting
5 y/o Frank who has had kidney transplant, stroke,
microcephaly, and neuromotor dysfunction
Gastrostomy tube dependent
Only eats smooth foods
Drinks thin liquids without difficulty
7. Method
Participant and Setting
Left side weakness, difficulty coordinating tongue
movement
Goal: to establish chewing, increase texture of solid
foods eaten, eliminate inappropriate mealtime
behaviors, eliminate gastrostomy feedings
149 meal sessions, 20 days, day-treatment feeding
program
8. Method
Sessions were conducted by a PhD- or master’s-
level feeding therapist
Some by graduate interns under supervision of a
feeding therapist
Neither child required adaptive seating
Final 2 weeks: different environments by different
persons to promote generalization
9. Dependent Measures
Data by therapist in charge
Interobserver reliability: another therapist or a graduate
intern
Primary behaviors:
Chew: at least 3x within 5 s
Mouth clean: within 30 s of acceptance
Used as determinants of the outcomes of the intervention
10. Dependent Measures
Secondary Behaviors:
Accept: within 5 s of presentation
Expel: before next bite
Negative vocalizations
Gag: neck extension, tongue protrusion, changes in skin
color
Tongue lateralization
Bite
11. Dependent Measures
Dietary intake by pediatric nutritionist
Interobserver agreement:
Sam: reliability of 30% of chewing sessions – chew
and mouth clean
82% agreement (7 – 100%)
reliability of 39% of texture-fading sessions and
mouth clean
87% agreement (23 – 100%)
12. Dependent Measures
Interobserver agreement:
Frank: reliability of 24% of chewing sessions – chew
and mouth clean
88% agreement (13 – 100%)
reliability of 30% of texture-fading sessions and
mouth clean
92% agreement (75 – 100%)
13. Procedures - Baseline
Conducted to assess children’s ability to eat
high-textured foods and to chew
Baseline chewing sessions
10 min
Child was presented with dry, crisp foods, and asked
to take bites
All inappropriate meal behaviors are ignored
Attempt to leave -> redirected
14. Procedures - Baseline
Baseline texture-fading sessions
Presented with regular-textured table foods
and milk from an open cup
Same as chewing sessions
15. Procedures - Baseline
Treatment package
Instruct the child to bite and chew
Improve tongue lateralization
Improve lip closure
Increase texture of foods eaten
Implemented in 2 types of meal sessions
16. Procedures – Chewing Sessions
Primary focus: biting and chewing
10 min
Bite a small piece of crisp, dissolvable food on molars
Bites = reinforcement
Preferred drink after each bite
Chews = additional praise
Expels = placed back
17. Procedures – Chewing Sessions
Primary focus: biting and chewing
Swallows w/o biting = another piece placed on molars
Refuses = held to mouth w/o comment until accepted
Gagging ignored
Alternate placing of food to L or R
Ended when timer rang
18. Procedures – Decision Rules
Used to change the schedule of reinforcement
Size of the food pieces presented also increased
Sam: termination criterion was changed from
10 min to specific number of bites (9)
19. Procedures – Texture-fading
Sessions
Primary focus: increase tolerance of higher-textured
foods, improve lip closure, improve tongue
lateralization
20 min
Bite textured food
Bites = praise, given verbal prompts
Chewing or attempting to chew = praised + tangible
reinforcement for 10 s
Expels = ignored, placed back
Refuses = held to mouth w/o comment until accepted
20. Procedures – Texture-fading
Sessions
Primary focus: increase tolerance of higher-textured
foods, improve lip closure, improve tongue
lateralization
Gagging ignored
Alternate placing of food to L or R
Tongue lateralization = praise + tangible reinforcement for
10 s
Consumes preferred liquid = praise + tangible
reinforcement for 10 s
Ended when timer rang
21. Procedures – Decision Rules
Used to determine when texture would
be increased to the next step in the
fading sequence
Mouth clean ≥ 80% of bites, 3/4 meals
Expels ≤ 20% of bites, 3/4 meals
Gags ≤ 20% of bites, 3/4 meals
22. Procedures – Food textures
Food textures
Pureed – smooth food w/o lumps
Ground – processed food (lumps w/ size no
larger than 0.25 in)
Mashed – with a fork (lumps’ size within
0.25 - 0.5 in)
Table – regular-texture table food
23. Procedures – Food textures
Table – regular-texture table food
If fading procedure required less than spoonful, table
food was cut into smaller pieces (approx. 0.5 in)
At the end of treatment, both boys were biting
pieces off some foods
Starting texture – ground
Texture-fading manipulated 2 variables: texture and
spoon volume
24.
25. Procedures – Meals
At the end of treatment for both children
Presented with a range of table foods
Praises were given for accepting and
chewing bites of food
Conducted at a variety of settings with
children’s caregivers to promote
generalization
26. Parent Training
Done before discharge from intensive
treatment
Therapists as models, then return
demonstration by caregivers for feedback
Simplified version of data collection system
Training videos and written home treatment
plan
27. Experimental Design
Multiple baseline design was used to evaluate
effectiveness of treatment
3 baseline chewing sessions and 3 baseline
texture-fading sessions for Sam
5 baseline chewing sessions and 5 baseline
texture-fading sessions for Frank
28. Results
Effective in increasing both variety and texture
of food eaten by both boys
Successful in eliminating the need for Frank’s
gastrostomy tube feedings
29. Results
Sam
13 – more
than 80 foods
Frank
3 low
textured-
foods – 50
foods
32. Discussion
Intervention was able to achieve its goals
Both boys were able to eat family meals and to eat in a variety of
settings outside home
Not clear which component was responsible for the results
Not all of the skills targeted might be necessary for some kids
Component analysis
33. Discussion
Treatment differs from others with the same
goals but through the use of chewy tubes or
other nonnutritive objects
Thus, study agrees with Gisel: use of food
stimuli in treatment would elicit natural eating
reaction
Also prevents possible problems in generalization
34. Recommendation
Study was conducted in an intensive basis under
tightly controlled environment of a day-
treatment program -> other settings with other
samples of children