Feed Disturbances Research Articles

Gross Motor Function Classification System: impact and utility.

In summary, the GMFCS has had, and continues to have, a major effect on the health care of children with CP. The number of citations of the GMFCS has been increasing every year, and the classification system has had good uptake internationally and across the spectrum of health professionals for use in research design and clinical practice by providing a system for clearly communicating about children's gross motor function. The utility of diagnostic labels such as diplegia has been questioned. However, although by definition CP is a disorder of posture and movement, the movement disability is often only one of the neurodevelopmental problems for many children with CP. When a complete description of a child's clinical presentation is required we recommend that the GMFCS be used together with the Surveillance of Cerebral Palsy in Europe classification indicating the type and topography of movement impairment. When appropriate the clinical profile will similarly be enhanced with details of other impairments and disabilities such as epilepsy or sensory, learning, feeding, or emotional disturbance. The observations in this annotation are constrained by the amount of information in the public domain. Although these sources adequately represent the effect of the GMFCS on research design, they are less likely to inform us of how the GMFCS is being used in administration, clinical practice, or education. It is not yet clear whether information is being used for these purposes or in assisting with case load management, as intended by the developers. By its localized nature, such information might remain difficult to gauge. We would therefore be interested to hear from others who are using the system for these or any other purposes.

Circadian Rhythms in Infants

After completing this article, readers should be able to: 1. Describe how circadian rhythms are generated. 2. Describe how lighting influences the circadian system. 3. Delineate the period during which the origin of circadian rhythms develops. 4. Describe the relationship between maternal circadian rhythms and the development of circadian rhythms in infants. 5. Characterize the potential sequelae of impaired fetal and early neonatal circadian rhythms related to sleep patterns. 6. Describe beneficial lighting patterns for preterm infants in the neonatal intensive care nursery. Circadian rhythms are endogenously generated rhythms that have a period length of about 24 hours. Evidence gathered over the past decade indicates that the circadian timing system develops prenatally, with the suprachiasmatic nuclei (SCN) in the anterior hypothalamus, the site of a circadian clock, present by mid-gestation in primates. Recent evidence also shows that the circadian system of primate infants is responsive to light at very early stages (as early as 25 to 28 weeks’ gestation in humans) and that low-intensity lighting can regulate the developing clock. After birth, circadian system outputs mature progressively, with rhythms in sleep-wake cycles, body temperature, and hormone production generally developing between 1 and 3 months of age. The importance of light in regulation of circadian rhythm in infants is highlighted by the early establishment of rest-activity patterns that are in phase with the 24-hour light-dark cycle in preterm infants exposed to low-intensity cycled lighting. With the continued elucidation of circadian system development and influences on human physiology and illness, it is anticipated that consideration of circadian biology will become an increasingly important component of neonatal care. ### The Circadian Timing System Notable examples of circadian rhythms include the sleep-wake cycle and daily rhythms in body temperature and hormone production. Circadian rhythms are also involved in the pathogenesis of illnesses, such as reactive airway disease (eg, asthma) and myocardial infarction. The system responsible …

Head and neck cancer treatment in the elderly--evaluation and management of complications

With the population over age 70 growing, treatment for head and neck cancer in the elderly has increased. We retrospectively evaluated their management and outcome. Subjects numbered 121--83 men and 38 women from 70 to 94 years old--initially treated at our hospital. We classified them into 2 groups by age--the aged at 70-79 years (55 men and 26 women) and the very old at 80 years and older (28 men and 12 women). We also evaluated a younger control group aged 50-59 years (37 men and 19 women). Primary tumor sites were the oral cavity (28.1%), larynx (28.1%), paranasal sinus (15.8%), and hypopharynx (9.9%). Preoperative geriatric disease was seen in 54% of controls, 74% of the aged, and 93% of the very old. Cardiovascular and respiratory diseases were most common. Surgical treatment and irradiation were essential for cancer treatment. Postoperative complications, including pneumonia, delirium, renal and cardiovascular hypofunction occurred in 56.5% of controls, 48.2% of the aged, and 47.8% of the very old. The frequency of postoperative complications correlated significantly with the American Society of Anesthesiologist classification of physical status (ASA) and preoperative performance status (PS). The complications of irradiation including pneumonia, dehydration, and feeding disturbance occurred in 53% of the very old. Cures were achieved in 83.9% of controls, 81.5% of the aged, and 65.0% of the very old. Cause specific 5-year survival in those cured was 85.2% of controls, 84.5% of the aged, and 80.0% of the very old. Median survival in those not cured was 4 months in controls, 9.6 months in the aged, and 5 months in the very old. We concluded that curative treatment is important in the elderly, and the success of curative treatment and the prevention of complications depend on careful assessment of systemic disease, PS, ASA, and mental activity.

Fiberoptic Nasotracheal Intubation in Pediatric Patients with Difficult Mouth Opening: A case report

We present two pediatric patients, one with Pierre Robin syndrome and one with temporomandibular joint ankylosis with limited mouth opening. They had historical and physical evidence of airway obstruction, difficult feeding, and sleep disturbance. They were scheduled for oromaxillofacial surgery. In each case, two different-sized fiberoptic bronchoscopes were used for nasotracheal intubation. After loss of consciousness following an IV injection of ketamine or inhalation of sevoflurane while maintaining spontaneous respiration, 10% lidocaine was sprayed into one nostril. Following insertion of a 60 cm Olympus LF-2 fiberoptic bronchoscope (OD: 3.8 mm) through the same nostril without tube placement, the vocal cords were visualized and topical anesthesia of the larynx was achieved by spraying 2% lidocaine through the biopsy channel. Thirty seconds later, the bronchoscope was passed into the trachea and 2% lidocaine was sprayed intratracheally. Then, the bronchoscope was withdrawn. An endotracheal tube was advanced through the same nostril and positioned in the nasopharynx and the ultrathin fiberoptic bronchoscope (OD: 2.2 mm) was threaded through the tube. There was neither a cough nor laryngeal spasm during advancement of the tube into the trachea. Extubation was performed without compromise in the operating room. The patients were discharged uneventfully.

The comparison of disturbance rejection properties of one-point control schemes for etbe reactive distillation

The performance of an ETBE reactive distillation column was evaluated by using dynamic simulations under open-loop operation and one-point control schemes for controlling the ETBE purity. In multiloop process control, the choice of the control scheme can have a profound effect on the disturbance rejection properties so that some standard control schemes, namely, LV, DV, LB and (L/D)V, were investigated. It is shown that open-loop operation is not acceptable because no correction can be made so that the process objectives could not be satisfied. The disturbance rejection properties could be increased with a one-point control scheme. The LV scheme has the 'best' disturbance rejection properties among the control schemes studied for feed disturbances.

Catecholamines and serotonin are differently regulated by tetrahydrobiopterin. A study from 6-pyruvoyltetrahydropterin synthase knockout mice.

(6R)-L-erythro-5,6,7,8-Tetrahydrobiopterin (BH4) is an essential cofactor for tyrosine hydroxylase (TH), tryptophan hydroxylase, phenylalanine hydroxylase, and nitric-oxide synthase. These enzymes synthesize neurotransmitters, e.g. catecholamines, serotonin, and nitric oxide (NO). We established mice unable to synthesize BH4 by disruption of the 6-pyruvoyltetrahydropterin synthase gene, the encoded protein of which catalyzes the second step of BH4 biosynthesis. Homozygous mice were born at the almost expected Mendelian ratio, but died within 48 h after birth. In the brain of homozygous mutant neonates, levels of biopterin, catecholamines, and serotonin were extremely low. The number of TH molecules was highly dependent on the intracellular concentration of BH4 at nerve terminals. Alteration of the TH protein level by modulation of the BH4 content is a novel regulatory mechanism. Our data showing that catecholaminergic, serotonergic, and NO systems were differently affected by BH4 starvation suggest the possible involvement of BH4 synthesis in the etiology of monoamine-based neurological and neuropsychiatric disorders.

Incorporation of dynamic behaviour in an automated process synthesis system

Incorporating non-economic criteria into an automated process synthesis procedure enables an engineer to prune, more easily and more effectively, the large design space early in the design process. Although existing synthesis procedures are based on the use of steady state modelling, issues such as operability and flexibility are best handled through the use of dynamic models. This paper describes a discrete programming approach, implemented in the Jacaranda synthesis tool, incorporating dynamic modelling for the generation of process designs, which meet specified criteria for operability or flexibility. Particular attention is given to implementation issues, including especially how to incorporate dynamic modelling efficiently in an automated environment. An example of the design of separation sequences with good start-up and feed disturbance behaviour is presented.

Experimental investigation of conventional control strategies for a heterogeneous azeotropic distillation column

Abstract In this work, a laboratory scale sieve plate distillation column was constructed to investigate the conventional control strategies of an isopropyl alcohol (IPA), cyclohexane (CyH) and water (H2O) heterogeneous azeotropic distillation column. Steady state process analysis showed that the optimal operation point should be located at a critical reflux, a transition point at which the distillation path switches from a route that passes through IPA+H2O azeotrope to one that passes through IPA+CyH azeotrope. At this critical reflux, a high purity IPA product can be obtained with minimum energy consumption and maximum product recovery. However, the steady state is extremely sensitive to feed disturbances. A good control strategy must be able to maintain a steady column temperature profile that shows a plateau near 70°C to ensure passage around IPA+CyH azeotrope. In this study, an inverse double loop control strategy is recommended. Through experimental testing, the proposed control strategy was demonstrated to keep the product IPA purity at the desired high-purity level under all feed disturbance changes while other conventional control strategies fail.

Model-based quality monitoring of batch and semi-batch processes

Abstract In this paper, a model-based inferential quality monitoring approach for a class of batch systems is investigated. Given the appropriate model form, the batch quality monitoring problem can be reduced to the problem of state estimation for batch and semi-batch processes. Because feed upsets are often a major source of disturbance in this type of system, it is shown that estimating the initial conditions can lead to improved state estimates throughout the batch as well as improved monitoring and control of end-use quality in many cases. The approach taken in this paper is to reduce the effects of the initial uncertainty resulting from feed disturbances by using algorithms designed to perform on-line smoothing of the initial conditions. First, an Extended Kalman Filter-based fixed-point smoothing algorithm is presented and compared to a popular approach to estimating the initial conditions. Subsequently, a nonlinear optimization-based approach is introduced and analyzed. A sub-optimal on-line approximation to the optimization problem is developed and shown to be directly related to the Extended Kalman Filter-based results. Finally, some practical implementation aspects are discussed, along with simulation results from an industrially relevant example application.

Experimental investigation of optimal conventional control strategy for a heterogeneous azeotropic distillation column

In this work, a laboratory scale sieve plate distillation column was constructed to investigate the optimum conventional control strategy of an isopropyl alcohol(IPA), cyclohexane(CyH) and water(H 20) heterogeneous azeotropic distillation column. Steady state process analysis showed that the optimal operation point should be located at a critical reflux, a transition point at which the distillation path switches from a route that passes through IPA+H 20 azeotrope to one that passes through IPA+CyH azeotrope. At this critical reflux, a high purity IPA product can be obtained with minimum energy consumption and maximum product recovery. However, the steady state is extremely sensitive to feed disturbances. A good control strategy must be able to maintain a steady column temperature profile that shows a plateau near 70°C to ensure passage around IPA+CyH azeotrope. In this study, a inverse double loop control strategy were recommended. Through experimental testing, the proposed control strategy was demonstrated to keep the product IPA purity at the desired high-purity level under all feed disturbance changes.

Dynamics and Control of a Heterogeneous Azeotropic Distillation Column: Conventional Control Approach

In this work, bifurcation analysis and dynamic simulation were used to investigate the optimum conventional control strategy of an isopropyl alcohol (IPA), cyclohexane (CyH), and water (H2O) heterogeneous azeotropic column. Steady-state process analysis shows that the optimal operation point should be located at a critical reflux, a transition point at which the distillation path switches from a route that passes through the IPA + H2O azeotrope to one that passes through the IPA + CyH azeotrope. A good control strategy must be able to maintain a steady column temperature profile that shows a plateau near 70 °C to ensure passage around the IPA + CyH azeotrope. An inverse double-loop control strategy is proposed based on principal component analysis. This scheme is capable of maintaining the desired column temperature profile given all kinds of feed disturbances, thus keeping the product IPA purity at the desired level.

Hypothalamic neuronal histamine: Implications of its homeostatic control of energy metabolism

In a series of studies on histaminergic functions in the hypothalamus, probes to manipulate activities of histaminergic neuron systems were applied to assess its physiologic and pathophysiologic implications using non-obese normal and Zucker obese rats, an animal model of genetic obesity. Food intake is suppressed by either activation of H 1-receptor or inhibition of the H 3-receptor in the ventromedial hypothalamus (VMH) or the paraventricular nucleus, each of which is involved in satiety regulation. Histamine neurons in the mesencephalic trigeminal sensory nucleus modulate masticatory functions, particularly eating speed through the mesencephalic trigeminal motor nucleus, and activation of the histamine neurons in the VMH suppress intake volume of feeding at meals. Energy deficiency in the brain, i.e., intraneuronal glucoprivation, activates neuronal histamine in the hypothalamus. Such low energy intake in turn accelerates glycogenolysis in the astrocytes to prevent the brain from energy deficit. Thus, both mastication and low energy intake act as afferent signals for activation of histaminergic nerve systems in the hypothalamus and result in enhancement of satiation. There is a rationale for efficacy of a very-low-calorie conventional Japanese diet as a therapeutic tool for weight reduction. Feeding circadian rhythm is modulated by manipulation of hypothalamic histamine neurons. Hypothalamic histamine neurons are activated by an increase in ambient temperature. Hypothalamic neuronal histamine controls adaptive behavior including a decrease in food intake and ambulation, and an increase in water intake to maintain body temperature to be normally constant. In addition, interleukin-1β, an endogenous pyrogen, enhanced turnover of neuronal histamine through prostaglandin E 2 in the brain. Taken together, the histamine neuron system in the hypothalamus is essential for maintenance of thermoregulation through the direct and indirect control of adaptive behavior. Behavioral and metabolic abnormalities of obese Zucker rats including hyperphagia, disruption of feeding circadian rhythm, hyperlipidemia, hyperinsulinemia, and disturbance of thermoregulation are essentially derived from a defect in hypothalamic neuronal histamine. Abnormalities produced by depletion of neuronal histamine from the hypothalamus in normal rats mimick those of obese Zuckers. Grafting the lean Zucker fetal hypothalamus into the obese Zucker pups attenuates those abnormalities. These findings indicate that histamine nerve systems in the brain play a crucial role in maintaining homeostatic energy balance.

へん桃摘出術が奏効した幼児呼吸困難例

A pediatric case of dyspnea treated with tonsillectomy is described, and our indications and timing of tonsillectomy in infants and children are discussed. 24-month-old boy with inborn stridor was referred to our department with a 3-day history of cyanosis on crying associated with symptoms of a common cold. He weighed 7.8kg and was 75cm tall. Findings included labored breathing, and both sternal depression and paradoxical movement of the thorax were evident. The child had grade III hypertrophic tonsils according to the grading system of Mackenzie. Because of severe nasal obstruction and rhinorrhea, he was reached with antibiotics and an airway was inserted, followed by tonsillectomy under general anesthesia. Since his symptoms of dyspnea including stridor disappeared, he was discharged from the hospital 7 days after the surgery. His food intake and daily activity increased postoperatively. Subsequent growth has been uneventful and he has reached 89cm in height and 14 kg in weight over the past 12 months since surgery.Although tonsillectomy in children has been controversial because of the importance of the immune response in the tonsils, we suggest that this surgical treatment is useful in patients with any of the following indications: marked dyspnea, feeding disturbance and suppression of weight gain.

Fussy Babies: To Treat or Not to Treat?

In this prospective study, the developmental outcomes of 39 infants with high irritability and sensory processing problems, also described as regulatory disordered, were examined at 7–30 months and at 3 years using clinical interdisciplinary assessment. Infants with regulatory disorders were defined as being behaviourally difficult with disturbances in sleep, feeding, state control, self-calming, mood regulation and sensory processing. The performance of samples of infants with regulatory disorders, 13 untreated and 26 treated, and 11 normal children were compared at 3 years. All subjects in the clinical sample were offered 12 weeks of Intervention after the initial assessment to address regulatory problems. Of the 39 subjects, 26 chose treatment, thus resulting in a self-selected treated sample. Post hoc analysis revealed that, at 7–30 months, untreated subjects had more sleep problems and were more irritable whereas treated subjects had more feeding problems and their mothers reported feeling depressed. At 3 years, the children with regulatory disorders differed from their normal counterparts in sensory integration, mood regulation, attention, motor control, sleep and behavioural control. Untreated subjects showed more emotional and behavioural problems than treated subjects. Treated subjects had more motor and sensory integrative problems than untreated subjects but, despite the fact that they had more constitutional problems, they did not show the emotional and behavioural problems that were found in the untreated group. The clinical importance of these findings for occupational therapists is discussed.

Bulimia nervosa in Rochester, Minnesota from 1980 to 1990.

Numerous studies have estimated the frequency of bulimia nervosa among high school girls and college women, but population-based trends in incidence in a community have not been reported. In this study we determined the incidence of bulimia nervosa by identifying persons residing in the community of Rochester, Minnesota, who had the disorder initially diagnosed during the 11-year period from 1980 to 1990. Using our comprehensive population-based data resource (the Rochester Epidemiology Project), we identified cases by screening 777 medical records with diagnoses of bulimia; feeding disturbance; rumination syndrome; adverse effects of cathartics, emetics, or diuretics; polyphagia; sialosis; or vomiting. We identified 103 Rochester residents (100 female and 3 male) who fulfilled DSM-III-R diagnostic criteria for bulimia nervosa during the 11-year study period. Mean +/- S.D. age for females at the time of diagnosis was 23.0 +/- 6.1 years (range, 14.4 to 40.2 years). Yearly incidence in females rose sharply from 7.4 per 100000 population in 1980 to 49.7 in 1983, and then remained relatively constant around 30 per 100000 population. The annual age-adjusted incidence rates were 26.5 per 100000 population for females and 0.8 per 100000 population for males. The overall age- and sex-adjusted annual incidence was 13.5 per 100000 population. Bulimia nervosa is a common disorder in adolescent girls and young women from 15 to 24 years of age. Histories of alcohol or drug abuse, depression, or anorexia nervosa were higher than expected in the general population.

Eating habits and attitudes among mothers of children with feeding disorders.

Feeding disturbances in young children are common.1 Furthermore, eating disorders are a substantial source of psychiatric morbidity among women of childbearing age.2 There has been no published research examining whether feeding disturbances of clinical severity in children are related to abnormal eating habits and attitudes among their mothers—though there is evidence that parents with eating disorders can adversely influence their young children's development, including feeding.3 If there were such a relation it would have important implications for the management of such children. Over 12 months the mothers of all children with ICD-10 (International Classification of Diseases, 10th revision)4 diagnoses of a feeding disorder who were referred to local child psychiatric clinics covering one geographical area were identified (n=32). ICD-10 criteria require that a feeding disorder in infancy or …

Toward a unified theory of serotonin dysregulation in eating and related disorders.

Patients with eating disorders (EDs) exhibit several clinical features and biologic findings indicative of serotonin (5-hydroxytryptamine, 5-HT) dysregulation. These include feeding disturbances, depression and suicide, impulsivity and violence, anxiety and harm avoidance, obsessive-compulsive features, seasonal variation of symptoms, as well as disturbances in neuroendocrine and vascular tissues, as well as other neurochemical systems linked to 5-HT, such as temperature. This review attempts to integrate available results from controlled studies in humans, with particular focus on cerebrospinal fluid (CSF), platelet and plasma studies, as well as pharmacologic challenge strategies using a variety of serotonergic agents. Taken together, these findings support the concept of altered post-synaptic, hypothalamic 5-HT receptor sensitivity in bulimia nervosa (BN), regardless of the presence of anorexia nervosa (AN) or major depression (MD), although these conditions may be associated with other disturbances in 5-HT function, perhaps pre-synaptic ones. The observation that different response measures of 5-HT function in the same subjects may be simultaneously increased, decreased and no different in patients compared to controls is consistent with a 5-HT dysregulation hypothesis. It may be that a variety of psychobiological stressors, such as dieting, binge-eating, purging, drug abuse, photoperiodic changes, as well as psychosocial-interpersonal stressors, perturb and interact with an already vulnerable 5-HT system.

Four-year follow-up of a sample of regulatory disordered infants

In this prospective descriptive study, the developmental outcomes of 9 untreated infants with moderate to severe regulatory disorders were examined at 8 to 11 months and again at 4 years of age and compared with 13 normal infants. Regulatory disordered infants were defined as being behaviorally difficult, exhibiting disturbances in sleep, feeding, state control, self-calming, and mood regulation and evidencing poor sensory processing. Eight of the nine regulatory disordered children had developmental, sensorimotor, and/or emotional and behavioral deficits at 4 years. Group differences were found in atten tion and activity level, emotional maturity, motor coordination, and tactile sensitivity at 4 years. For normal infants, ratings of difficultness on the Bates Infant Characteristics Questionnaire and higher baseline cardiac vagal tone were related to better developmental outcomes and behavioral organization respectively at 4 years. In contrast, ratings of difficultness and higher baseline cardiac vagal tone in regulatory disordered infants were associated with poorer developmental outcomes and behavioral difficulties at 4 years. At the time the study was conducted, the clinical significance of regulatory problems was not known, therefore treatment was not considered. The results of this study suggest that untreated regulatory disordered infants may not outgrow behavioral difficulties over time.

Feeding disturbances and EEG activity changes after amygdaloid kainate lesions in the rat

Kainic acid (KA), in various concentrations, was applied iontophoretically into the central nucleus of the amygdala. Microlesions with this cell specific neurotoxin caused body weight loss, hypo- or aphagia and hypo- or adipsia in a dose-dependent manner. EEG-examinations proved that even low doses of KA produced seizure activity; however, these epileptiform symptoms disappeared within the first 48 h after the operations. Thus, the lasting feeding disturbances produced by iontophoretic KA applications to the central nucleus of the amygdala (i.e., even these fine microlesions) were not related causally to the pathological EEG activity changes. Our findings, along with previous data, indicated that the body weight loss and feeding deficits were due to the KA-induced impairment of complex regulatory mechanisms.

Adaptive on-line optimal control of bioreactors: application to anaerobic degradation

The control of bioreactors is particularly important due to ever-changing reactor and feed conditions. In adaptive optimal control reactor, conditions are adjusted to obtain the best performance, as determined by a performance index (PI), which is often a function of more than one output variable. An empirical, linear input-output model is used whose parameters are updated at each sampling time using on-line measurements. In this example, for anaerobic wastewater treatment, two relations are used of the form, y 1( t) = b 1, 1 u( t−1 - d 1) + c 1; y 2( t) = b 2, 1 u( t − 1 − d 2) + c 2. These are linear models relating feed flow rate, u, to methane production rate, y 1, and organic acids concentration y 2. The performance index (PI) was taken as a compromise between high methane rate and low organic acids as PI = methane production rate - Constant X (Total organic acids conc.). This was expressed in terms of the model parameters and maximized by the method of steepest ascent. In this way the feed rate could be continually adjusted for changing conditions, as caused by feed disturbances or biological adaptation. This dynamic optimization method has considerable advantage for slow systems, in that a steady state is not needed. One and two stage, anaerobic biofilm fluidized sandbed reactors were used to continuously degrade whey to biogas and residual organic acids. A PC computer was used to handle the on-line GC data and to serve as controller for the feed flow rate. Preliminary work involved testing conventional feedback control, for which pH setpoint control performed best. A complex simulation model based on mechanistic, dynamic mass balance-kinetic relations was established to describe the experimental response of the reactors. The simulation model was used to design the controller and to determine useful values for the control parameters; it proved extremely useful as it made lengthy experiments unnecessary. The PI function was shown by simulations to have a suitably sharp optimum. Automatic control experiments for one and two stage reactors were made in which responses were obtained for step changes in the performance index constant and for square wave increases in the feed concentration. The optimizer performed well, changing the feed rate to maintain the loading approximately constant with changed feed concentration. For a single stage system a new optimum was found after 5 h for a change in the PI constant and after 2 h for a step change in the feed concentration.