Personalized Feeding Infusion Rate of Nutrition to Improve Glycemic Variability Control in Critical Care Patients

Control-based algorithms in the intensive care unit (ICU) patients have been developed to deliver a sufficient amount of insulin, but optimizing the rate of feeding of nutrition in ICU patients to improve glycemic variability control has not been done yet. Continuous feeding is commonly used for nutrition in critically ill patients who cannot be fed orally to maintain a normal blood sugar concentration, but optimizing its rate, for these individuals, is needed to avoid the adverse outcomes caused by medications such as insulin. This paper develops a control-based algorithm combines a predictive control algorithm with a revised nonlinear compartmental model used in the ICU to design personalized feeding function rates to improve patient glycemic variability. Our control algorithm is robust and acts very quickly to avoid medical intervention effects.

Build Independent Self-feeding Function: A Pilot Study on a Child with Autism and Feeding Disorder

The high occurrence of feeding disorders among children with autism spectrum disorder has caught the attention of professionals from different disciplines. When taking an insight into their feeding problems, mixed physical, behavioral and psychological difficulties were encountered, such as oral skill deficits (e.g., chew, swallow, and coordination), fine motor skill deficits, food selectivity (e.g., texture aversion), food neophobia, and so on. However, the traditional non-oral tube feeding method for maintaining their nutrition consumption is criticized as too intrusive and inadequate for training self-feeding skills. Therefore, to target both establishing independent self-feeding function and food consumption variety (nutrition) while using less intrusive intervention method, the present study tested the effectiveness of a multicomponent behavioral intervention protocol on a child with autism and feeding disorder, setting across physical, behavioral and psychological background. A task analysis on self-feeding function resulted in a backward-chain training procedure on swallowing, chewing, and fine motor skills, separately and then combined. The training procedure consisted of 3 key components: 1) swallowing training, 2) chewing training starting with using a chew facilitator tube, 3) fine motor training targeting on self-feeding; and 4) fine motor-chewing-swallowing coordination training with multiple types of food. The results showed the present multicomponent behavioral intervention protocol successfully established the participant’s self-feeding skills: ameliorated his oral and fine motor skills, cultivated his independent self-feeding function, and increased his food consumption volume and variety.

Build Independent Self-feeding Function: A Pilot Study on a Child with Autism and Feeding Disorders

The high occurrence of feeding disorders among children with autism spectrum disorder has caught the attention of professionals from different disciplines. When taking an insight into their feeding problems, mixed physical, behavioral and psychological difficulties were encountered, such as oral skill deficits (e.g., chew, swallow, and coordination), fine motor skill deficits, food selectivity (e.g., texture aversion), food neophobia, and so on. However, the traditional non-oral tube feeding method for maintaining their nutrition consumption is criticized as too intrusive and inadequate for training self-feeding skills. Therefore, to target both establishing independent self-feeding function and food consumption variety (nutrition) while using a less intrusive intervention method, the present study tested the effectiveness of a multicomponent behavioral intervention protocol on a child with autism and feeding disorder, setting across physical, behavioral and psychological background. A task analysis on self-feeding function resulted in a backward-chain training procedure on swallowing, chewing, and fine motor skills, separately and then combined. The training procedure consisted of 3 key components: 1) swallowing training, 2) chewing training starting with using a chew facilitator tube, 3) fine motor training targeting on self-feeding; and 4) fine motor-chewing-swallowing coordination training with multiple types of food. The results showed the present multi-component behavioral intervention protocol successfully established the participant’s self-feeding skills: ameliorated his oral and fine motor skills, cultivated his independent self-feeding function, and increased his food consumption volume and variety.

Differentiated appendages in Isoxys illuminate origin of arthropodization

The Cambrian fossil record has produced remarkable insights into the origin of euarthropods, particularly the evolution of their versatile body plan of segments bearing specialized, jointed appendages for different functions including feeding and locomotion [01, 02]. Early euarthropod evolution involved a major transition from lobopodian-like taxa [03, 04, 05] to organisms featuring a fully sclerotized trunk (arthrodization) and limbs (arthropodization) [02, 06, 07, 08]. However, the precise origin of arthropodization remains controversial because some of the earliest branching euarthropods possess a broad dorsal carapace that obscures critical details of the trunk and appendage organization [09, 10, 11, 12, 13, 14, 15]. Here, we demonstrate the presence of fully arthropodized ventral appendages in the upper stem-group euarthropod Isoxys curvirostratus from the early Cambrian Chengjiang biota in South China. Micro-computed tomography reveals the detailed three-dimensional structure of the biramous appendages in I. curvirostratus for the first time. In addition to the raptorial frontal appendages I. curvirostratus also possesses two batches of morphologically distinct biramous limbs, with the first batch consisting of four pairs of short cephalic appendages bearing prominent endites with a feeding function, followed by a second batch of elongate trunk appendages for locomotion. Each biramous limb bears an endopod with more than 12 well-defined podomeres, and an exopod consisting of a slender shaft carrying approximately a dozen paddle-shaped lamellae. Our findings clarify the enigmatic appendicular organization of Isoxys, one of the most ubiquitous euarthropods in Cambrian Burgess Shale-type deposits worldwide [01, 10, 11, 12, 14, 15, 16, 17, 18]. Critically, our new material shows that the trunk of I. curvirostratus was not arthrodized. The phylogenetic position of isoxyiids as possibly the earliest branching members of Deuteropoda [01, 02, 07, 15, 19], suggests that arthropodized biramous appendages evolved before the pattern of full trunk arthrodization that characterizes most extant and extinct members of this successful animal phylum.

A sophisticated case of division of labour in the trimorphic stamens of the Cassia fistula (Leguminosae) flower

Buzz-pollinated pollen flowers have pollen as the primary resource for pollinators and must deal with a conflict between the exploitation of pollen grains by bees and pollination success. It has been hypothesized that heterostemony allows division of labour between stamens as a solution to the pollen dilemma. To test the division of labour hypothesis, we chose Cassia fistula, which has a trimorphic androecium and analysed androecium development, pollen grain release mechanisms and visitor behaviour. We explored the reflectance of floral organs and carried out an exclusion experiment to test the attractiveness of each stamen morph to the bee species. Finally, we explored the structural, ultrastructural and functional variation between the pollen grains, including pollen viability across stamen morphs. The differences among the three stamen morphs, which is developed from two whorls of the stamen, are the first evidence of the division of labour in our study system. Large Bombus and Xylocopa bees actively and exclusively exploited the pollen grains from the central poricidal anthers generating pollen deposition on their bodies. The reflectance pattern of floral organs indicated a targeting of these large bees to the central anthers, corroborated by the anther manipulative experiment where only the exclusion of the anthers positioned in the flower centre, especially the intermediate stamens, reduced bee visits. Both results revealed a division of labour, in which the intermediate stamen morph was responsible for both floral attractiveness and pollen resources. Only the largest stamen morph produced germinable pollen grains, highlighting their role as pollinating stamens. The smallest stamen morph has a less clear function, likely representing an economy in pollen production for feeding function. Our findings suggest that the evolution of the trimorphic androecium is associated with division of labour in large pollen flowers and can represent a strong strategy for circumventing the pollen dilemma, optimizing the feeding function by reducing pollen grain investment from central anthers.

Selecting the Proportional-Integral (PI) Regulator Parameters from the Condition of Maximum Permissible Deviation in Leap Impacts on the System

The amplitude-frequency characteristic, which determines the parameters of the PI controller for linear objects, is either a monotonically feeding function, or has one resonant peak, and practically does not have a drop at a frequency less than the resonant one. The parameters of the PI controller selected in this way ensure, that the maximum deviation of the controlled value does not exceed the set value when stepping on the input of the object.

Effectiveness of Frenotomy in Ankyloglossia Treatment Between 0-1 Years Old

Objective: The aim of this study is to present the frenotomy technique in cases of ankyloglossia (tongue-tie), which is diagnosed and treated in the first year of life. Patients were operated by a single surgeon. Method: Cases of ankyloglossia operated at Biruni University Faculty of Medicine Hospital Pediatric Surgery Clinic Between 2016-2020 were evaluated retrospectively in terms of clinical complaints, age, type of ankyloglossia, surgical technique, indications and results of surgery. Results: Frenotomy was performed in 56 patients including 47 boys (84%) and 9 girls (16%), between the ages of 0-1. Average age of the patients was 93 days (1-360). Patients were divided into two groups as Group 1 (n: 40: 0-90 days old) and Group 2 (n: 16: 90-360 days old). Patients were admitted with complaints of having difficulty in sucking the mother’s breast, not being able to take their tongue out, feeding with a bottle, pain at the nipple and not being able to grasp the breast. No additional intervention was required for bleeding in Group 1, and in 12 (75%) patients in Group 2 bleeding control was achieved using bipolar cautery. During follow-up, significant improvement was obtained in all patients who had difficulty in sucking and gripping the nipple. Improvement was observed in 15 of 25 patients with nipple pain. Conclusion: Frenotomy is an easily applied surgical procedure with minimal complications. Additional application may be required for bleeding control in infants older than 3 months. It should be considered that the probability of recurrence may depend on the type, intervention used and thickness of the frenulum, and phrenotomy may not be sufficient. The improvement in breast feeding function of Frenotomy may provide a significant improvement in the complaints of nipple pain, and may contribute to the emotional attachment between the mother and her baby. Randomized controlled trials are required to determine the effects of phrenotomy.

Oral Feeding Outcome after Analgesic and Sedative Exposure in VLBW Preterm Infant

Objective The objective of this study was to assess the association of analgesics and sedatives on oral feeding function and need for feeding tube at discharge in the very low birth weight (VLBW) (<1,500 g) preterm infant. Study Design A retrospective review of surviving inborn infants < 1,500 g and < 32 weeks' gestation (n = 209), discharged between January 1, 2012, and December 31, 2014, from the neonatal intensive care unit identified exposure to analgesic and sedative medications, demographics, medical course, and nasogastric or gastrostomy tube (GT) feeding at discharge. Predictive modeling with logistic regression to identify independent factors associated with discharge on tube feedings. Results Out of 209, 45 (21.5%) infants received an analgesic/sedative with 23 out of 45 (51.1%) discharged with tube feedings. Infants discharged with tube feedings were born smaller, of younger gestation, with greater SNAPPE-II scores, periventricular leukomalacia, chronic lung disease, postnatal glucocorticoids, lansoprazole, and longer time intubated. After adjusting for covariates, exposure to analgesic/sedatives (fentanyl, midazolam, or morphine) was independently predictive of discharge on tube feedings. Conclusion Analgesic and sedative exposure in VLBW infants is highly associated with poor oral feeding and need for tube feedings at discharge.

Craniodental functional evolution in sauropodomorph dinosaurs

Sauropodomorpha included the largest known terrestrial vertebrates and was the first dinosaur clade to achieve a global distribution. This success is associated with their early adoption of herbivory, and sauropod gigantism has been hypothesized to be a specialization for bulk feeding and obligate high-fiber herbivory. Here, we apply a combination of biomechanical character analysis and comparative phylogenetic methods with the aim of quantifying the evolutionary mechanics of the sauropodomorph feeding apparatus. We test for the role of convergence to common feeding function and divergence toward functional optima across sauropodomorph evolution, quantify the rate of evolution for functional characters, and test for coincident evolutionary rate shifts in craniodental functional characters and body mass. Results identify a functional shift toward increased cranial robustness, increased bite force, and the onset of static occlusion at the base of the Sauropoda, consistent with a shift toward bulk feeding. Trends toward similarity in functional characters are observed in Diplodocoidea and Titanosauriformes. However, diplodocids and titanosaurs retain significant craniodental functional differences, and evidence for convergent adoption of a common “adaptive zone” between them is weak. Modeling of craniodental character and body-mass evolution demonstrates that these functional shifts were not correlated with evolutionary rate shifts. Instead, a significant correlation between body mass and characters related to bite force and cranial robustness suggests a correlated-progression evolutionary mode, with positive-feedback loops between body mass and dietary specializations fueling sauropod gigantism.