The document discusses a study on the effects of equine assisted activities (EAA) on children with autism. It describes how 50 children between ages 7-12 with autism participated in 12 weekly 1-hour EAA sessions including riding, grooming, and games. Activities targeted social/communication skills and sensory processing. Parents and teachers completed pre/post tests and follow ups to evaluate impacts on social function and attention. The study aimed to see if EAA improved these areas and if effects were sustained after the intervention ended.
Shada ParkerEnc 11023282019Rationale for Selection of th.docxklinda1
Shada Parker
Enc 1102
3/28/2019
Rationale for Selection of the Multimodal Texts
Effective presentation of the resume will require the presenter to facilitate listening, speaking, reading and viewing of the ideas contained in the presentation. While these activities can be achieved independently and in isolation, multimodal texts have the potential to combine all the activities in a single medium. This makes multimodal texts the most desirable tool to compose and present print, sound and visual information.
Multimodal texts have been selected as the media choice for presenting the items suggested in the proposal. Multimodal texts utilize more than one creative component such as written and spoken language, visuals both still and moving, audio, gestural and spatial illustrations of ideas, opinions and information in general.
Multimodal texts make use of linguistic tools such as vocabulary, structure, grammar etc. of both spoken and written English. Visual components in multimodal texts depict color and viewpoints of moving and stationary images that specifically attract the attention of the audience. Audio aspects such as volume, pitch and rhythm of the sound effects make the audience maintain longer spans of attentiveness which is paramount when dealing with a mixed type of audience in terms of age and gender composition. Gestural aspects are the other major component that will be utilized in the presentation. It is important to use body movements and facial expressions to emphasize on important ideas and information. Spatial component will be primarily in form of the presentation layout and organization of the objects in the visual and textual components to ensure that the audience can follow the presentation and can retain the flow of ideas and information.
Using multimodal texts will be a refashioning of the ideas contained in the proposal to make the elaboration easy and simplified while at the same time pleasing to the audience who will remain glued to the presentation. Multimodal texts have the potential to influence the achievement of the goals and objectives highlighted in the proposal by creating a clearer picture of the information contained in the proposal to the audience who are particularly significant in the development of the proposal from a wish to a reality.
Basically, as a creative writer I will take advantage of technology based media and multimodal composition to present my qualifications and experience to the interviewers. Despite the fact that majority of my audience are not yet familiar with this emerging tools, I am particularly positive that they will be in a position to enjoy the presentation and consider me for the position. This is in line with the fact that tacit method of presentation limits on creativity while multimodal texts facilitate the full realization and utilization of creativity in presentation. This makes multimodal text the preferred method of presenting the resume as a way of seeking employment..
Shada ParkerEnc 11023282019Rationale for Selection of th.docxklinda1
Shada Parker
Enc 1102
3/28/2019
Rationale for Selection of the Multimodal Texts
Effective presentation of the resume will require the presenter to facilitate listening, speaking, reading and viewing of the ideas contained in the presentation. While these activities can be achieved independently and in isolation, multimodal texts have the potential to combine all the activities in a single medium. This makes multimodal texts the most desirable tool to compose and present print, sound and visual information.
Multimodal texts have been selected as the media choice for presenting the items suggested in the proposal. Multimodal texts utilize more than one creative component such as written and spoken language, visuals both still and moving, audio, gestural and spatial illustrations of ideas, opinions and information in general.
Multimodal texts make use of linguistic tools such as vocabulary, structure, grammar etc. of both spoken and written English. Visual components in multimodal texts depict color and viewpoints of moving and stationary images that specifically attract the attention of the audience. Audio aspects such as volume, pitch and rhythm of the sound effects make the audience maintain longer spans of attentiveness which is paramount when dealing with a mixed type of audience in terms of age and gender composition. Gestural aspects are the other major component that will be utilized in the presentation. It is important to use body movements and facial expressions to emphasize on important ideas and information. Spatial component will be primarily in form of the presentation layout and organization of the objects in the visual and textual components to ensure that the audience can follow the presentation and can retain the flow of ideas and information.
Using multimodal texts will be a refashioning of the ideas contained in the proposal to make the elaboration easy and simplified while at the same time pleasing to the audience who will remain glued to the presentation. Multimodal texts have the potential to influence the achievement of the goals and objectives highlighted in the proposal by creating a clearer picture of the information contained in the proposal to the audience who are particularly significant in the development of the proposal from a wish to a reality.
Basically, as a creative writer I will take advantage of technology based media and multimodal composition to present my qualifications and experience to the interviewers. Despite the fact that majority of my audience are not yet familiar with this emerging tools, I am particularly positive that they will be in a position to enjoy the presentation and consider me for the position. This is in line with the fact that tacit method of presentation limits on creativity while multimodal texts facilitate the full realization and utilization of creativity in presentation. This makes multimodal text the preferred method of presenting the resume as a way of seeking employment..
This capstone project describes the use of hippotherapy with children who have autism spectrum disorders (ASD). It details the rationale, frames of references and a review of the literature. Also provided are descriptions of the investigation of hippotherapy outcome measures being used by current occupational therapists. Five hippotherapy sites were visited and at least one full day of sessions was observed at each. Occupational therapists were also interviewed about current practices. Findings support the use of non-standardized testing for measuring outcomes of children with ASD. Also noted are the various methods for delivering hippotherapy services.
Analysis Of Hippotherapy Outcome Measureslacygardner
This paper describes the use of hippotherapy with children who have autism spectrum disorders (ASD). It details the rationale, frames of references and a review of the literature. Furthermore, descriptions of a capstone project are provided on the investigation of hippotherapy outcome measures being used by current occupational therapists. Five hippotherapy sites were visited and at least one full day of sessions was observed at each. Occupational therapists were also interviewed about current practices. Findings support the use of non-standardized testing for measuring outcomes of children with ASD. Also noted are the various methods for delivering hippotherapy services.
1
4
Discrete Trial Training (DTT) effect on children with ASD
Introduction
Autism Spectrum Disorder (ASD) is a condition that affects the development of an individual affecting their behaviour and the ability to communicate (Autism Spectrum Disorder, 2021). In most cases, this disorder exhibits its symptoms within the initial two years of an individual, despite its diagnosis being plausible for individuals of all ages. Persons diagnosed with this disorder often have repetitive behaviours and restricted interests, find it difficult to partake in social interactions and communication with others, and show other symptoms that may impede the individual's ability to perform well in school, work and several other aspects of life ("Autism Spectrum Disorder, 2021). The individuals diagnosed with the disorder will, in some cases, be reliant on their families and individuals close to them for help and support. Despite the disorder's potency as a life-long condition, some services and treatments are provided, helping an individual diagnosed with the condition improve the quality of their life. It is also important to note that the disorder has several different variations; hence, the spectrum of different characteristics, unique to every diagnosed individual.
According to studies conducted, one in fifty-four children is diagnosed with the disorder in the United States, occurring in children of all racial backgrounds and socioeconomic groups ("Data and Statistics on Autism Spectrum Disorder | CDC," 2021). According to the same report, the disease is four times more likely to occur in boys than in girls. Between 2009 to 2017, the number of children aged between 3-17 years diagnosed with development disorders, inclusive of ASD, increased from 16.2% to 17.8%. (Ünlü et al., 2018). In the use of discrete trial training (DTT), children are taught a plethora of skills, which include academic, language, and social skills, necessary to facilitate their development. In the treatment of ASD, options are limited. However, early diagnosis, coupled with behaviour interventions, is considered to have the best outcomes in managing the disorder's symptoms (Masi et al., 2017).
The prevalence of ASD in children has been noted to rise significantly in the population (Masi et al., 2017; "Data and Statistics on Autism Spectrum Disorder | CDC," 2021), affecting a larger portion of the population. This number of affected individuals is projected to rise even higher in the coming years, a problem in society that needs to be addressed. In the treatment of the disorder, drug interventions, while widely used, have failed to prove their efficiency in improving or managing symptoms in most cases (Masi et al., 2017). The treatment options for the disorder are also very limited. The use of drug interventions, early diagnosis, and early behavioural interventions is very expensive and inaccessible to many individuals affected by the condition. Identifying the disorder i ...
Learning by Body was a project aimed to exchange methodologies and experiences in the field of sport and physical activities in Adult Education. The partrnership have seen different kind of organizations, of five different countries: Italy, Portugal, Turkey, France, Romania.
The project has been an important opportunity, for the participants and the organizations, to increase knowledges and skills. Important achievement have been:
• increased knowledge concerning the important of sport and physical activity in adult education;
• increased knowledge about best practices, organizational models and teaching methods related to non formal educational physical activities among the partnership.
• opportunities to know each other and to create an informal network among the partner organization.
The project has been implemented through various activities:
• Transnational meetings: the six project meetings have been important occasions to experiment different methodologies and to share local experiences;
• Local Activities: to experiment the different approaches in the local contexts, and to disseminate the project results.
Specific participative methodologies has been used, according to the activity (i.e. cooperative learning and expressive methods) in order to facilitate the exchange among the participants and to allow a direct and personal experience of the approaches and methods proposed .
Among the results achieved, we’d like to mention:
• Increased knowledge about physical activity and sport in Adult Education:
• Creation of new courses in sport and physical activity, for learners and teachers.
• Collection of short stories of experiences with sport and physical activities.
• A manual of the project.
• Organization of public events “Learning by Body Day” organized in all partner Countries.
• Creation of a website including information related to the project.
• Creation of a facebook page.
.
Therapeutic_Horseback_Riding_Outcomes_of (1).pdfSGB Media Group
Therapeutic Horseback Riding Outcomes of Parent-Identified Goals for Children with Autism Spectrum Disorder: An ABA′ Multiple Case Design Examining Dosing and Generalization to the Home and Community"
Presentation that we made at 22nd USSSA national conference, Las Vegas oct 15 2010. We explain a little bit of our swim for babies, todlers and children program.
(Stotler,2020) Using Audio and Videograph a form of BiofeedbackJacob Stotler
Special treatment approach topic in counseling. Using video and audio as a means for intervention with clients and children. Using Audio and Videograph as a biofeedback device in the clinical setting/as a treatment intervention.
This capstone project describes the use of hippotherapy with children who have autism spectrum disorders (ASD). It details the rationale, frames of references and a review of the literature. Also provided are descriptions of the investigation of hippotherapy outcome measures being used by current occupational therapists. Five hippotherapy sites were visited and at least one full day of sessions was observed at each. Occupational therapists were also interviewed about current practices. Findings support the use of non-standardized testing for measuring outcomes of children with ASD. Also noted are the various methods for delivering hippotherapy services.
Analysis Of Hippotherapy Outcome Measureslacygardner
This paper describes the use of hippotherapy with children who have autism spectrum disorders (ASD). It details the rationale, frames of references and a review of the literature. Furthermore, descriptions of a capstone project are provided on the investigation of hippotherapy outcome measures being used by current occupational therapists. Five hippotherapy sites were visited and at least one full day of sessions was observed at each. Occupational therapists were also interviewed about current practices. Findings support the use of non-standardized testing for measuring outcomes of children with ASD. Also noted are the various methods for delivering hippotherapy services.
1
4
Discrete Trial Training (DTT) effect on children with ASD
Introduction
Autism Spectrum Disorder (ASD) is a condition that affects the development of an individual affecting their behaviour and the ability to communicate (Autism Spectrum Disorder, 2021). In most cases, this disorder exhibits its symptoms within the initial two years of an individual, despite its diagnosis being plausible for individuals of all ages. Persons diagnosed with this disorder often have repetitive behaviours and restricted interests, find it difficult to partake in social interactions and communication with others, and show other symptoms that may impede the individual's ability to perform well in school, work and several other aspects of life ("Autism Spectrum Disorder, 2021). The individuals diagnosed with the disorder will, in some cases, be reliant on their families and individuals close to them for help and support. Despite the disorder's potency as a life-long condition, some services and treatments are provided, helping an individual diagnosed with the condition improve the quality of their life. It is also important to note that the disorder has several different variations; hence, the spectrum of different characteristics, unique to every diagnosed individual.
According to studies conducted, one in fifty-four children is diagnosed with the disorder in the United States, occurring in children of all racial backgrounds and socioeconomic groups ("Data and Statistics on Autism Spectrum Disorder | CDC," 2021). According to the same report, the disease is four times more likely to occur in boys than in girls. Between 2009 to 2017, the number of children aged between 3-17 years diagnosed with development disorders, inclusive of ASD, increased from 16.2% to 17.8%. (Ünlü et al., 2018). In the use of discrete trial training (DTT), children are taught a plethora of skills, which include academic, language, and social skills, necessary to facilitate their development. In the treatment of ASD, options are limited. However, early diagnosis, coupled with behaviour interventions, is considered to have the best outcomes in managing the disorder's symptoms (Masi et al., 2017).
The prevalence of ASD in children has been noted to rise significantly in the population (Masi et al., 2017; "Data and Statistics on Autism Spectrum Disorder | CDC," 2021), affecting a larger portion of the population. This number of affected individuals is projected to rise even higher in the coming years, a problem in society that needs to be addressed. In the treatment of the disorder, drug interventions, while widely used, have failed to prove their efficiency in improving or managing symptoms in most cases (Masi et al., 2017). The treatment options for the disorder are also very limited. The use of drug interventions, early diagnosis, and early behavioural interventions is very expensive and inaccessible to many individuals affected by the condition. Identifying the disorder i ...
Learning by Body was a project aimed to exchange methodologies and experiences in the field of sport and physical activities in Adult Education. The partrnership have seen different kind of organizations, of five different countries: Italy, Portugal, Turkey, France, Romania.
The project has been an important opportunity, for the participants and the organizations, to increase knowledges and skills. Important achievement have been:
• increased knowledge concerning the important of sport and physical activity in adult education;
• increased knowledge about best practices, organizational models and teaching methods related to non formal educational physical activities among the partnership.
• opportunities to know each other and to create an informal network among the partner organization.
The project has been implemented through various activities:
• Transnational meetings: the six project meetings have been important occasions to experiment different methodologies and to share local experiences;
• Local Activities: to experiment the different approaches in the local contexts, and to disseminate the project results.
Specific participative methodologies has been used, according to the activity (i.e. cooperative learning and expressive methods) in order to facilitate the exchange among the participants and to allow a direct and personal experience of the approaches and methods proposed .
Among the results achieved, we’d like to mention:
• Increased knowledge about physical activity and sport in Adult Education:
• Creation of new courses in sport and physical activity, for learners and teachers.
• Collection of short stories of experiences with sport and physical activities.
• A manual of the project.
• Organization of public events “Learning by Body Day” organized in all partner Countries.
• Creation of a website including information related to the project.
• Creation of a facebook page.
.
Therapeutic_Horseback_Riding_Outcomes_of (1).pdfSGB Media Group
Therapeutic Horseback Riding Outcomes of Parent-Identified Goals for Children with Autism Spectrum Disorder: An ABA′ Multiple Case Design Examining Dosing and Generalization to the Home and Community"
Presentation that we made at 22nd USSSA national conference, Las Vegas oct 15 2010. We explain a little bit of our swim for babies, todlers and children program.
(Stotler,2020) Using Audio and Videograph a form of BiofeedbackJacob Stotler
Special treatment approach topic in counseling. Using video and audio as a means for intervention with clients and children. Using Audio and Videograph as a biofeedback device in the clinical setting/as a treatment intervention.
Similar to The_Effects_of_Equine_Assisted_Activitie.pdf (20)
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
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.
Key Topics:
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:
Rapid adaptation within the first second, with further slow adaptation.
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
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).
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
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.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
1. 1
The Effects of Equine Assisted Activities on the Social Functioning of Children with
Autism
Margaret M. Bass, Ph.D.
Maria Llabre, Ph.D.
Autism is a spectrum disorder with a range of complex neurodevelopment symptoms
that is four times more prevalent in males than females (American Psychiatric Association,
2007). This disorder knows no racial, ethnic, social boundaries, family income, lifestyle, or
educational levels and can affect any family, and any child. The indicators of ASD are often
present before age 3, and are often accompanied with deficits in the following areas:
cognitive performance, learning, attention, communication, socialization, behavioral
development and sensory processing. According to the Autism Society of America, autism is
the fastest growing developmental disability, which is estimated to have between a ten to
seventeen percent growth rate each year (Autism Society, 2010). According to a recent report
by the CDC, the prevalence of Autism has risen to 1 in 110 births. This means that as many as
1.5 million Americans today are believed to have an autism spectrum disorder (Department of
Health and Human Services, Centers for Disease Control and Prevention, 2009).
Equine Assisted Activities, consist of a broad variety of equestrian programs that can
include therapeutic riding, driving, vaulting and un-mounted sessions that provide the
individual with a disability the opportunity to achieve their individualized goals (NARHA,
2010). The EAA lessons are developed and implemented by a certified NARHA instructor
to meet the student's goals, which is directly dependent on their purpose for participation (i.e.:
recreation, therapeutic, &/or sports competition). These EAA programs are not considered
therapy, but are viewed as therapeutic if a participant is able to show improvement within one
or more of the following areas: physical, social, emotional or educational (NARHA, 2010).
These EAA activities can take place on the ground and during mounted sessions, thus giving
the individual a safe and meaningful equestrian experience. For an individual with Autism,
2. 2
the EAA session can provide a multi-sensory experience, because these activities involve the
senses of vision, hearing, smell & tactile (Sams, M. J., Fortney, E. V. & Willenbring, S.,
2006). The multi-sensory equestrian environment and the relationship created between the
horse and the participant can provide more than just riding skills.
The principle of this study was to further investigate the effects of EAA activities on
children with Autism. Using a larger sample size and additional controls, we duplicated our
2006 pilot study to further investigate the effects on the research subjects. The objective of
this study was to identify if equine assisted activities improved the social function and
attention of children diagnosed with autism spectrum disorder, as well as to evaluate if the
effects sustained two months after the intervention was completed.
Methods
Participants
Prior to the recruitment of the project participants, the study and forms were examined
and approved through the Western Institutional Review Board (WIRB). Once approved,
GHETC worked collaboratively with local agencies (Parent to Parent of Miami, APD,
University of Miami CARD center) to announce and recruit prospective participants. During
the recruitment efforts, parents were screened over the phone to answer questions and to
insure they met eligibility criteria. From these efforts, fifty children who met the study
eligibility criteria and completed the required forms within the specified time frame were
recruited into the study.
The research eligibility criterion consisted of the following: child had to be between 7
and 12 years of age; diagnosis of autism spectrum disorder as specified in DSM-IV-TR
(American Psychiatric Association, 2007) from the referring agency and/or the child’s
physician; child's physician had to complete the medical application, parents had to complete
the WIRB forms and the GHETC forms, complete the consent to pre-testing, twelve weeks of
3. 3
equine assisted activities and two post testing sessions for themselves, as well as the child's
teacher; no significant equine therapy (child has not received hippotherapy services by a
licensed therapist over the past year). If the subject had received equestrian therapy within
their lifetime, participation did not exceed six months and the child had never participated in
EAA activities.
Following the enrollment efforts, the pre-assessment forms were distributed &
completed by the parents prior to the randomization of the experimental & control groups.
Once the forms were collected from the parents the project participants were randomized into
the two conditions using a randomization schedule provided by Maria Llabre, Ph.D.,
statistical consultant.
Intervention
During the intervention phase, the participants were provided twelve consecutive
EAA activities on Saturdays, each session lasting one hour and fifteen minutes. The
instruction provided the project participants training within the following program facets:
mounting/dismounting, warm-up exercises, riding skills, mounted games & horsemanship
activities.
Mounting/Dismounting
This facet of the intervention averaged two and a half minutes for each of these steps,
which took place at the beginning and end of the mounted session. During this component,
the GHETC certified instructors assisted the subjects in learning to appropriately and safely
mount and dismount their program horse or pony. These processes were verbalized and
visually shown to the subjects using step by step instruction and a corresponding picture
book, which was developed by GHETC. The mounting/dismounting segment of the program
lasted a total of five minutes and was aimed at stimulating verbal communication,
proprioception and vestibular processing.
4. 4
Exercises
After successfully mounting the horse, the subjects performed ten minutes of warm-up
exercises to stretch their bodies in preparation of the riding class. During each session, the
participants executed a series of exercises: arm circles, trunk twists, maintaining two-point,
yoga stretches, opposite and same side toe touches, as well as posting at the walk. As the
weeks progressed, so did the difficulty of the movements. For example, during the beginning
weeks on the intervention, we asked the participants to perform arm circle exercises and
posting at the walk as separate exercises. As the subjects balance and coordination improved,
we incorporated posting at the walk while performing arm circles, as well as holding two
point with one hand out, until they could maintain their stability without the use of their
hands.
Through the direction of the riding instructors, the trained side walkers provided the
riders verbal, modeling and/or physical prompts as needed to assist them in acquisition of
these exercises. These procedures targeted the participants’ vestibular processing while also
engaging the subjects in physically demanding exercises to assist them in the development of
their riding abilities.
Riding Skills
The subjects participated in twenty-five minutes of riding skills, which were
specifically designed to encourage attention, sensory seeking, as well as gross and fine motor
domains. Participants were instructed how to perform various English riding skills: direct
rein, open guided rein, changing direction, maintaining two-point position, and use of proper
riding aids (leg, seat, hand & voice or using sign language), upward and downward transitions
(halt/walk/trot, trot/walk/halt), schooling patterns (figure eight, serpentine & tracking across
5. 5
the diagonal and center), reading and following ring signage (Whoa, Go & Slow) to perform
various riding skills, sitting trot, posting trot & identification of the correct diagonal. To
increase both expressive and receptive language we incorporated activities that employed
both the students' riding skills and language. For example, the project participants worked
toward performing an open guided rein to maneuver their horses through lettered cones while
making up a word for each letter and then using the word to develop a sentence.
Mounted Games
The individualized and group segment of the equine assisted activities session lasted
twenty minutes and focused on individualized and group games while on the horse. The
games were carried out by the instructor and focused on social and communication skills. The
following games were incorporated as a part of the sessions: relay races, red light/green light,
red rover, egg & spoon, ride a buck (holding a dollar bill under upper thigh while performing
riding skills), musical letters, simon sayes, & word relays, word flash cards (individual &
group).
Horsemanship
During fifteen minutes of each equine assisted activities session
the subjects learned about the equine, as well as how to groom and care for their horse/pony.
As a part of this instructional segment, we developed a picture book to assist the participants
in the identification of the grooming tools, as well to assist them in the identification of the
riding equipment (saddle pad, close contact saddle, girth, halter, bridle & reins) & their
apparel (helmet & half -chaps). During this facet of the intervention, the participants were
instructed how to recognize and properly utilize the various grooming tools, (e.g., curry
comb, hoof pick, body brush, mane/tail comb). Participants were educated about basic horse
anatomy and the corresponding human parts. As a part of this instruction, the subjects were
asked to verbally express or point to the analogous part.
6. 6
The EAA activities utilized were selected to target the participants’ vestibular
processing while also allowing the children to engage in physically challenging exercises to
increase attention, and to assist in the development of their gross and fine motor domains.
We provided each individual the level of support and prompts they needed: physical,
modeling, verbal, & worked toward independence. Throughout each of the one hour and
fifteen minute EAA sessions, participants were verbally and physically reinforced (i.e., high
five, hugs) upon completion of the exercises. Instructors and volunteers alike made efforts to
maintain eye contact with all participants during the sessions.
Outcome Testing
Following the twelve week period, parents and teachers of the participants in both the
intervention and control conditions completed the post-test measures. The post data was
collected and the 2nd
post packet was mailed to the parents & teachers for the final completion
& collection of the research data. In August, following the 2nd
post-testing, the control
participants began receiving their equine assisted activity sessions.
The surveys were collected and were reviewed for accuracy & completeness.
Following this procedure, the data was entered into the University of Miami database at the
Behavioral Medicine Research Center where the questionnaires were scored, and the data
was analyzed.
Measures
The Social Responsiveness Scale (SRS) and Sensory Profile (SP) were completed by
teachers and parents to assess social functioning at three times: pre-and-post intervention and
a two month follow-up.
Social Responsiveness Scale
The Social Responsiveness Scale (SRS) (Constantino, 2002) is a 65-item
questionnaire that measures the severity of autism spectrum disorder symptoms. Raw scores
7. 7
may be computed for five treatment subscales: social awareness, social cognition, social
communication, social motivation, and autistic mannerisms. According the SRS manual,
social awareness is operationally defined as the “ability to pick up on social cues;” social
motivation is defined as “the extent to which a respondent is generally motivated to engage in
social-interpersonal behavior;” and social cognition is defined as “expressive social
communication” (Constantino, 2002, p. 17). The measurement is administered to parents or
teachers, who rate participants’ on a 4-point Likert scale ranging from 0 (never true) to 3
(almost always true). Examples of questions include: “Seems much more fidgety in social
situations than when alone” (social motivation subscale); “Doesn’t recognize when others are
trying to take advantage of him or her” (social cognition subscale); and “Doesn’t seem to
mind being out of step with or not on the same wavelength as others” (social awareness
subscale) (Constantino, 2002, p. 17).
The SRS has high overall internal consistency (α = .97), and retest temporal stability
in males and females (r = .85 and r = .77, respectively). Internal consistency for each
treatment scale was also tested and yielded high Cronbach alpha scores, with social
communication being the highest (α = .92) (Constantino, 2002).
Sensory Profile
The Sensory Profile (SP) (W. Dunn, 1999) is a 125-item questionnaire that is
administered to parents or teachers (School Companion, W. Dunn, 2006). The measurement
uses a 5-point Likert scale ranging from 1 (always) to 5 (never). The questions address
overall social functioning and the degree to which children exhibit problems in (a) sensory
processing, (b) modulation, and (c) behavioral and emotional responses. The SP for parents
is composed of nine subscales: sensory seeking, emotionally reactive, low endurance/tone,
oral sensory sensitivity, inattention/distractibility, poor registration, sensory sensitivity,
sedentary, and fine motor/perception. The School Companion is scored in four quadrants:
8. 8
registration, seeking, sensitivity, and avoiding. There are also four new factor scores: need
for external supports, awareness/inattention, tolerance for sensory input, and availability for
learning.
Data Analysis and Results
Pretest
Means and standard deviations were computed for all subscales from the SRS and SP
administered to the parents and the teachers at each of the three time points (pretest, posttest,
and follow-up). This information is included in Tables 1 through 5. We first compared the
groups on their means at pretest using independent group t-tests. We then compared them at
posttest and at follow-up. All t-tests were conducted at the .05 level of significance.
A comparison between the treatment and control groups on the SP subscales
administered to parents revealed no significant difference (p> .05) between the means on any
of the subscales. Similar results were obtained when comparing the means between the two
groups at pretest for the teachers’ subscales based on the four factors and the four quadrants.
With respect to the SRS, a comparison between the treatment and control group
subscale means at pretest indicated no significant difference (p> .05) on the parent or teacher
data. We concluded that the randomization rendered the two groups comparable with respect
to the outcome measures at pretest.
Posttest
For the parent data, t-tests comparing the means between the treatment and control
groups at posttest indicated significant group differences on the following SP scales: Sensory
seeking, emotionally reactive, inattention/distractibility, and sensory sensitivity. All p’s < .05.
Group differences were not statistically significant at posttest on the following SP scales from
the parents: low endurance/tone, oral sensory sensitivity, poor registration, sedentary, and fine
motor/perceptual (p > .05).
9. 9
For the SP teacher data at posttest, all four quadrant scores: registration, seeking,
sensitivity, and avoiding; as well as all four factor scores: need for external supports,
awareness and attention, tolerance for sensory input, and availability for learning yielded
significant mean differences between treatment and control groups (p < .05).
In terms of the SRS parent data, significant group differences at posttest were
observed in all but one subscale. There was no significant group difference in the awareness
subscale (p > .05). However, the differences in cognition, communication, motivation, and
mannerisms were significant (p < .05). For the teacher SRS data, significant group
differences in the means were observed on all the subscales.
Follow-up
At the two month follow-up, parents detected significant differences in the
inattention/distractibility, sensory sensitivity, and fine motor/perceptual subscales of the SP.
However, the teachers no longer detected significant differences in either the four quadrant or
four factor subscales of the SP. Similarly, there was no significant group difference on any of
the subscales of the SRS at follow-up for either parents or teachers. In conclusion, we
observed treatment effects from both teacher and parent data at posttest. These effects had
subsided for most of the subscales except for three scales of the SP completed by parents.
Discussion
The results of this study indicate that EAA activities may be an valuable therapeutic
option for children with autism spectrum disorders. More specifically, compared to wait list
control participants, autistic children in the experimental group improved in critical areas
such as sensory seeking, emotional reactive, inattention/distractibility and sensory sensitivity.
The experimental subjects also demonstrated improved cognition, communication as well as
motivation following the intervention. Both parents and teachers observed treatment effects at
the first posttest. Although there was a significant difference following the initial posttest for
10. 10
the experimental group, these effects had subsided for most of the subscales except for three
scales of the SP completed by parents.
The observed increase in social functioning may be attributed to an array of reasons.
Perhaps the exposure to the horse was, in some way, highly stimulating. The fact that
participants had not been exposed to therapeutic horseback riding argues that this experience
may have been a unique multisensory event that was directly associated either with the
physical presence or natural movement of the horse. Possibly it is the relationship that was
built between the subject and their horse, which empowered them to learn and enhance their
functioning levels. It is also possible that the intervention affected participants’ motivation
levels during and after the intervention. The act of riding the horse may have been perceived
as a rewarding stimulus that accounted for elevated levels of motivation and social
engagement.
We are very grateful to HHRF for allowing us the opportunity to implement this much
needed research. The results of this study will provide the industry valuable evidence for the
effectiveness of Equine Assisted Activities in assisting children diagnosed with Autism. This
study is the second of its kind to evaluate and quantify the impact of EAA on the social
functioning of children diagnosed with ASD. Our results indicate that EAA services are a
beneficial intervention for this population. Additional studies are needed to further assess its
therapeutic effects, as well as to identify why the EAA activities provide individuals with
ASD such positive results. We are very excited about sharing these results with the
professional community and will notify you as soon as our paper has been accepted by a
juried publication.
12. 12
Table 2. Means and standard deviation for sensory profile (Teacher Data on School Factors)
Timepoints / Variables
Group
Experimental Control
Mean Std Mean Std
Pretest
School Factor 1 66.52 15.61 68.33 18.31
School Factor 2 45.94 8.98 44.03 8.12
School Factor 3 55.77 12.80 56.08 11.72
School Factor 4 39.11 11.36 39.07 10.67
Posttest
School Factor 1 78.84 14.51 68.02 16.61
School Factor 2 48.95 7.47 43.23 7.15
School Factor 3 67.08 8.95 57.01 13.14
School Factor 4 45.31 7.84 36.67 10.29
Follow-up
School Factor 1 75.20 15.16 69.73 16.53
School Factor 2 47.20 7.83 43.39 8.06
School Factor 3 62.80 10.55 57.91 14.74
School Factor 4 43.30 8.33 37.88 10.68
13. 13
Table 3. Means and standard deviation for sensory profile (Teacher Data on School Quadrants)
Timepoints / Variables
Group
Experimental Control
Mean Std Mean Std
Pretest
Registration 55.20 12.92 55.62 14.24
Seeking 39.93 10.67 39.69 10.70
Sensitivity 52.67 9.75 52.89 8.56
Avoiding 59.51 15.29 59.38 14.27
Posttest
Registration 64.84 11.65 54.48 14.26
Seeking 44.92 9.11 39.83 8.55
Sensitivity 60.53 7.55 52.35 8.20
Avoiding 69.86 10.83 58.24 13.40
Follow-up
Registration 61.96 11.54 56.04 14.02
Seeking 43.24 9.83 40.16 8.64
Sensitivity 57.48 9.17 53.23 9.91
Avoiding 65.81 11.39 59.53 14.96
14. 14
Table 4. Means and standard deviation for social responsiveness scale (Parent Data)
Timepoints / Variables
Group
Experimental Group
Mean Std Mean Std
Pretest
Social Awareness 10.56 4.08 10.76 4.67
Social Cognition 16.83 5.78 16.97 7.64
Social Communication
32.07 11.12 30.31
14.3
9
Social Motivation 15.56 6.21 14.01 7.26
Autistic Mannerisms 17.48 7.72 16.33 8.21
Posttest
Social Awareness 9.24 3.03 10.50 4.40
Social Cognition 13.16 5.52 18.32 6.48
Social Communication
22.44 8.99 30.68
13.9
2
Social Motivation 9.64 4.85 13.78 7.15
Autistic Mannerisms 11.72 5.02 17.72 7.47
Follow-up
Social Awareness 9.61 3.19 9.94 4.16
Social Cognition 15.72 6.03 18.34 7.27
Social Communication
26.56 10.10 29.83
13.3
7
Social Motivation 11.68 5.98 13.54 8.06
Autistic Mannerisms 14.48 5.87 17.74 7.86
15. 15
Table 5. Means and standard deviation for social responsiveness scale (Teacher Data)
Timepoints / Variables
Group
Experimental Group
Mean Std Mean Std
Pretest
Social Awareness 11.72 2.73 11.63 4.73
Social Cognition 19.00 5.11 18.15 6.60
Social Communication 33.64 9.57 31.76 12.67
Social Motivation 16.12 6.17 15.94 7.86
Autistic Mannerisms 18.96 6.91 16.41 8.07
Posttest
Social Awareness 9.76 2.83 12.39 4.31
Social Cognition 15.44 5.45 19.49 6.07
Social Communication 24.08 10.23 34.66 12.26
Social Motivation 11.16 5.07 16.03 6.88
Autistic Mannerisms 13.56 5.75 18.36 6.70
Follow-up
Social Awareness 10.12 2.82 11.71 3.97
Social Cognition 16.20 4.80 18.60 6.82
Social Communication 27.40 8.48 33.08 13.20
Social Motivation 12.44 4.88 15.65 6.87
Autistic Mannerisms 15.08 7.06 17.50 6.99
16. 16
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