Approaches to resource mapping have been presented in previous sections of this Manual. Here we may add that, in developing resiliencebased approaches to counselling, mapping sources of resilience at different systemic levels will be important in determining points of intervention. A variety of maps have been developed (see Landau and Weaver (2006) later in this chapter) that will be helpful to programme planners as a kind of checklist of the potential points of intervention. This non-stigmatizing site may be an important place to offer information on understanding stress reactions and tools to cope with stress, anger management and routes to other forms of counselling, if needed. The sports group itself may have the capacity to function as a kind of peer support group with the aid of a psychosocial counsellor. In trying to determine what types of counselling may need to be added to what already exists, it will be important to understand the different effects or impacts of migration and displacement at different levels. One needs to be able to consider interventions that not only strengthen family and community supports, but address the impact that stress, grief, transition and loss can have on family and community interactions. Multilevel approaches to determining which counselling methods to use do consider the impacts of expressed community needs at multiple systemic levels. Family stress needs to be addressed at the family level, often with community support. Based on this vision of recovery, one can then explore with the community the different options for counselling as a part of the process of developing a strategic plan for a set of counselling interventions that are the most important for this early phase of intervention. What is the process for establishing the priorities and how are these priorities negotiated among community members and with providers That process may include a discussion of different types of counselling approaches that are traditionally utilized or preferred by the community, what may be limitations of these approaches, and what additional approaches are needed to complement existing services in order to address the unique challenges of the current emergency situation. Promote social cohesion and be effective in promoting cross-community communication and preventing communal fragmentation. Acknowledge the diversity of needs and determine which counselling interventions will most likely lead to practical success and thus increase the efficacy of the community. The development of the priority must respect or take into consideration the power dynamics in the community. The issue of sharing and distributing resources in a fair and equitable way brings in a more ethical dimension for how priorities are established. It is important for practitioners to be both culturally and structurally competent in facilitating this process of negotiation. The choice of particular counselling approaches should be determined by the goals and priorities articulated by the community. Then the community may explore with provider organizations which counselling options may be available, feasible to implement and most viable. The community would benefit from knowing about counselling programmes that most closely fit their goals, so that trainers in these particular approaches may be sought. This determination is accomplished by interviewing community members, stakeholders and provider organizations. Some of the options for community-based counselling approaches at different levels are presented below. It will be important to wait before offering counselling that targets specific mental health difficulties that only become apparent months after an initial crisis. A group of trained counsellors, constantly retrained and supervised, should be allowed to adopt flexible approaches in intervening with groups and individuals, while adhering to precise ethical principles and overarching models of work. Others have been developed in a variety of other settings, but have the potential to be implemented in emergency humanitarian contexts. These are more structured and validated, and are therefore potentially easier to scale, in the case of a lack of resources or foundation capacity. It was originally developed in non-emergency contexts, in settings such as workplaces or schools.
Voluntary vaccination programs fail to achieve such rates, thus necessitating the recommendation for mandatory programs. Of note, her egg allergy alone does not preclude her from receiving inactivated influenza vaccine because her reaction is mild. For severe (anaphylactic) reactions to eggs, consultation with an allergist prior to vaccination with inactivated vaccine is recommended. While antivirals, including oseltamivir, are recommended for chemoprophylaxis in outbreak settings for certain high-risk groups, they are not recommended as a substitute for vaccination. Furthermore, amantadine is no longer recommended for influenza infections for 2 reasons: high levels of resistance against the adamantanes in influenza A viruses and lack of activity against influenza B viruses. There was no recent travel, well water use, exposure to reptiles or ill contacts, or recent viral illness. On physical examination, the girl appears well nourished and well hydrated, and is growing appropriately. Chronic nonspecific diarrhea affects approximately 15% of children, with onset between 6 and 36 months of age. It is defined by intermittent or regular passage of 2 to 6 watery bowel movements daily, typically during the daytime. Chronic nonspecific diarrhea is a functional process without inflammation, maldigestion, or malabsorption. Treatment involves control of symptoms through increased fiber and limiting sucrose and fructose in the diet. The evaluation of a child with chronic diarrhea should be determined by the clinical situation, and may include testing stool for fecal fat, reducing substances, pH, cultures, ova and parasites, and occult blood. The child in the vignette has no other associated symptoms, or any evidence of failure to thrive, that would suggest a diagnosis of celiac disease. Infectious colitis is typically associated with profuse, voluminous diarrhea with or without blood, and children with infectious colitis are often quite ill. Inflammatory bowel disease typically presents with an ill-appearing patient who, in addition to diarrhea, may suffer from fevers, rash, joint pain, weight loss, and often presents with abnormal laboratory values such as anemia and elevated inflammatory markers. The rash is pruritic, but the patient is well in other respects and takes no medications. His physical examination is remarkable only for a rash on the chest and back with sparing of the extremities, face, and groin (Q274A, Q274B). Individual lesions are oval thin plaques oriented with long axes parallel to Langer lines of skin stress (C274A). The plaques have scale that is located at the trailing edge of lesions, unlike at the leading edge, as is the case in tinea corporis. Several other disorders cause eruptions that are limited to or prominently involve the trunk. Among these are confluent and reticulated papillomatosis (often treated with minocycline) (C274B), secondary syphilis (treated with intramuscular penicillin) (C274C), tinea versicolor (treated with topical selenium sulfide) (C274D), and tinea corporis (if multiple lesions are present, oral treatment is needed with griseofulvin). C274A: the lesions of pityriasis rosea are aligned with long axes oriented parallel to lines of skin stress. Pityriasis rosea usually occurs in the spring and fall, and most often affects adolescents and young adults. In as many as 80% of patients, the initial lesion is a round or oval erythematous scaling patch with central clearing (herald patch) (C274E). The herald patch may be confused with tinea corporis, although border elevation is common in the latter. Within 2 weeks, a generalized eruption appears that is composed of erythematous papules and plaques (C274A). Since lesions are arranged along lines of skin stress, they may mimic the boughs of a fir tree ("Christmas-tree" appearance) (C274F). In individuals of color, the eruption may differ: it may have an "inverse" distribution (with lesions concentrated on the extremities and relative sparing of the trunk) or lesions may be papules with fewer plaques (C274G). If pruritus is significant, a topical corticosteroid may be applied or a sedating antihistamine may be taken at bedtime. An emollient containing phenol or menthol may be applied as needed as a counter irritant to mask the perception of pruritus. Both erythromycin and acyclovir have been proposed as possible treatments, although current evidence does not support their use.
Diseases
Occupational therapy assistants administer and continuously modify individualized invehicle and community mobility assessments within the naturalistic context of the community in response to the occupational performance and safety behaviors of the client. They also implement an individualized intervention plan, within the parameters established in collaboration with the occupational therapist that reflects the contexts of the client and meets his or her occupational performance and safety needs. National board certification is generally required as a condition of state licensure and employment. The dance therapist, sometimes called a movement therapist, focuses on rhythmic body movements as a medium of physical and psychological change. A recreation therapist uses recreational activities for intervention in some physical, social or emotional behavior to bring about a desired change in that behavior and promote the growth and development of the patient. An individual trained and educated in a systematic process of assisting persons with physical, mental, developmental, cognitive, and emotional disabilities to achieve their personal, career, and independent living goals assessment and appraisal, diagnosis and treatment planning, career (vocational) counseling, individual and group counseling interventions for adjustments to the medical and psychosocial impact of disability, case management, program evaluation and research, job analysis and placement Sources: Commission on Rehabilitation Counselor Certification and Rhea, Ott, and Shafritz, the counseling, and consultation on rehabilitation resources and technology. Assistive Technology Practitioner Assistive Technology Supplier Definition to come. Instruction is usually provided one-on-one and can include skills such as how to use a long cane, the operation of low vision devices and electronic travel aids when appropriate, how to orient oneself to new environments, navigate public transportation systems, how to cross streets safely, and traveling by using hearing, remaining vision, and other senses. Adult clients can also benefit from an O&M specialist evaluating their current use of travel-related skills, discussing their future goals, and helping them select a program of instruction that will allow them to reach Source: San Francisco State University Orientation and Mobility Program web site their greatest travel potential. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support Source: the Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American engagement in everyday life activities that affect health, well-being, and quality of life. Occupational therapists can evaluate both the skills of the client and the environmental features that occupational therapy assistant. Based services in the certification area to clients (individuals, groups, or populations) in the last 3 on this assessment, they recommend modification and intervention strategies that improve the fit between the person and his or calendar years. Occupational therapists provide screening and in-depth clinical assessment which may include instrumental dysphagia assessments including videofluroscopy. Occupational therapists can help hours of experience delivering occupational therapy services in the certification area to clients older adults by developing strategies to help or maintain safety and well-being, to assist with life transitions, and to compensate (individuals, groups, or populations) in the last 5 calendar years. Service delivery may be paid or for challenges they experience in activities of daily living, instrumental activities of daily living, leisure participation, social voluntary. Occupational therapists enable children and adults with visual impairment to engage in their chosen daily living activities safely <li>Minimum of 2,000 hours of experience as an occupational therapist or occupational therapy and as independently as possible. This is accomplished by 1) teaching the person to use their remaining vision as efficiently as assistant. Service delivery may be paid or Occupational therapists provide treatment for people recovering from a mental or physical illness to regain their independence and stability and to engage in normal daily occupations (work, home, family life, school, leisure). They also may fabricate custom orthotics to improve function, evaluate years of practice as an occupational therapist. Service delivery may be paid or Occupational therapists use their unique expertise to help children with social-emotional, physical, cognitive, communication, and voluntary. Occupational therapy practitioners offer a continuum of services related to community mobility, delivering occupational therapy services in the certification area to clients (individuals, groups, or from evaluation of driving performance, through counseling and support for lifestyle changes, to maintaining independence and populations) in the last 3 calendar years. Recreational Therapist Assistants work in a variety of settings providing treatments using recreational activities, including games, sports, and crafts. A provider trained and educated in the applied science of medically prescribed therapeutic exercise, education and adapted physical activities designed to improve the quality of line and health of adults and children by developing physical fitness, increasing mobility and independence, and improving psychosocial behavior. Kinesiotherapists, as compared with physical therapists, put more emphasis on geriatric care, reconditioning and fitness, and psychiatric care. Respiratory emergencies are commonplace in the treatment of critical care patients. Diagnosis and treatment is very important for this group since chronic lung disease is the major cause of morbidity and mortality among them. Furthermore, as this segment of the population increases, life expectancy is being extended. This level of care includes diagnostics testing, therapeutics, monitoring, rehabilitation of patients with disorders of the cardiopulmonary system, as well as, education of the patient and family in regard to those disorders. Included in the area of pulmonary diagnostics are the following; collection and analysis of physiological specimens, interpretation of physiological data, administration of tests of the cardiopulmonary system, and the conduct of both neurophysiological and sleep disorders studies. In the course of conducting these tests, the Pulmonary Function Technologist is able to setup, calibrate, maintain, and ensure the quality assurance of the pulmonary function testing equipment.
Dietary Methods Some suitable dietary methods [3] are explained below, and their requirements and efficacy are listed in table 1. Diet Records/Diaries the child/parent is asked to keep a record of all the foods and drinks consumed by the child over a period of time [3], typically between 3 and 7 days. Recordings tend to become less accurate if too many consecutive days are requested as fatigue tends to set in. Food can be weighed if suitable scales are provided or recorded in household measures. Some instruction from staff regarding the best way to achieve the recording is desirable but not always possible, in which case written instructions are important. Now that digital photography is accessible to most people via mobile telephones, a helpful adjunct to recording foods is to photograph them at the mealtime. The written description is still important, as foods are not always completely recognisable in photographs, but this will certainly help the subject to record exactly what was eaten. When the diet records (and photographs) are received, they should be assessed by staff and the subject contacted to talk through the record and to clarify any parts that are not explicit. This can be done either face-to-face or by telephone, but if the child and parent are to be interviewed together, a face-to-face session might be more effective. It has been found that children can only recall foods eaten up to a few hours previously; they sometimes recall phantom foods which were not eaten, and the more complex the meal, the more likely they are to be inaccurate in their recall [2]. On the other hand, parents can only aid their child to recall meals at which they were present, and this is unlikely to be the case with all meals eaten by the child. In order to characterise a diet, more than one recall for each child is necessary. Therefore, the child and parent need to go through this procedure several times (3 times is probably the minimum), each a few days apart; this is time-consuming for both the subjects and the staff. For example, when studying infants, formula milk, breast milk and infant food must be covered, and when studying children living in different countries, foods specific to each country must be covered. If they are doing this at home, then it would be best done in consultation with the child (and others with knowledge) about meals eaten away from the parent. The simplest answer is to allocate standard portion sizes, but these must be adjusted to the age of the child. Nutrient Analysis Food Frequency Questionnaires the child /parent is presented with a list of foods and drinks and asked to indicate the frequency with which they are usually consumed by the child from a predetermined list of frequencies [6]. Such a list can be administered as a self-completion questionnaire or in an interview by trained staff (particularly if literacy is a problem). The food/ drinks listed must be the ones that this population are likely to consume; this is specific to the age, country, ethnicity and background of the Nutrient analysis of the food records and 24-hour recalls collected requires trained staff and a suitable dietary analysis programme which can accommodate all the foods eaten and provide upto-date nutrient contents for all the nutrients of interest [7]. Obtaining this type of analysis package needs careful thought, since foods change over time and off-the-shelf versions of these packages do not always cover culturally specific foods, new foods on the market or some specific nutrients. It is best to involve an expert dietician/nutritionist in this process as the interpretation of the records requires an intimate knowledge of foods. This can be due to misunderstanding, memory lapse, deliberate changes to the diet to make recording easier, deliberate misreporting and so on. There are several methods available to assess the level of misreporting of energy intake which can be tailored to the age, sex and size of the individual and take their usual physical activity level into account [9, 10]. Often the analysis is performed with and without the energy reporting status considered, sometimes with different results obtained. To interpret dietary data, it is also helpful to compare food group intakes, bearing in mind that the statistical methods used need to be able to cope with the fact that some food groups are not eaten at all by some children. An understanding of differences in foods eaten can help in the communication of results to the general public. Conclusion Interpretation the average nutrient content of the diet can be used in group analysis but is not accurate at the individual level [2]. Periodicity: Articles are published continuously in 1 issue per year Form of journal: electronic online journal Journal language: English Journal website: Oksana Belous State Research Institute of Xisco, Russia Ana Carla Marques Pinheiro, Ds. Regional Office of the Public Health Authority of the Slovak Republic in Nitra, Slovakia Ing. Slovak University of Agriculture in Nitra, Slovakia Chairman Editorial Board: prof.
As methanol is metabolized to formic acid, the serum osmol gap will fall, while an elevated anion gap metabolic acidosis eventually develops. Serum methanol and formate levels may help to guide the management of patients following methanol ingestion, although these measurements are not rapidly available in many centers. Serum methanol concentrations of 20 mg/dL or higher are associated with toxicity if untreated, so clinical intervention is indicated at this threshold. Methanol (along with other toxic alcohols) are poorly adsorbed by activated charcoal. Therefore, activated charcoal would not be useful in the management of the boy in the vignette. Directing the boy to follow up within 1 week would not be appropriate, given that he is at risk for developing significant toxicity from conversion of methanol to its toxic metabolite over the next several hours. This patient is in need of prompt evaluation to determine his need for further management. Since methanol is metabolized slowly, clinical effects may not become apparent until 8 to 24 hours after ingestion. This delay in the accumulation of formic acid provides an opportunity for clinical intervention to prevent the development of significant toxicity from methanol ingestion. Fomepizole, a competitive antagonist of alcohol dehydrogenase, minimizes the conversion of methanol to its toxic metabolite and is the antidote of choice for patients at significant risk for methanol poisoning. Although expensive, fomepizole has few adverse effects and has replaced ethanol as the treatment of choice for methanol toxicity in recent years. Hemodialysis may be indicated for children with extremely high serum methanol concentrations. Zanamivir is a neuraminidase inhibitor that is administered by inhalation of a powder. This mechanism has been linked to bronchospasm in patients with asthma, as well as in individuals without airway disease. While reactive airway disease is not a contraindication to the use of zanamivir, it is not recommended in this population. Patients with asthma, along with individuals with other underlying pulmonary conditions, are considered to be at high risk of developing severe influenza. In the 2014 to 2015 season, 26% of children hospitalized for influenza in the United States had asthma or underlying reactive airways disease. Other high-risk groups include children with diabetes mellitus, hemodynamically significant cardiac disease, immunosuppression, and neurologic disorders. Amantadine and rimantadine are adamantanes, antiviral agents that are thought to prevent release of viral nucleic acid into the host cell by blocking the M2 protein. The adamantanes are no longer recommended for the treatment of influenza infections, as there are high levels of resistance against the adamantanes in influenza A viruses and they have no activity against influenza B viruses. Adverse effects most commonly ascribed to the adamantanes include central nervous system and gastrointestinal symptomatology. There are 3 licensed neuraminidase inhibitors: oseltamivir, zanamivir, and peramivir. Peramivir was licensed in December of 2014 and has not been studied fully in children. Oseltamivir and zanamivir are the only antivirals currently recommended for prophylaxis and treatment of influenza infections in children. Currently, most influenza viruses are susceptible to the neuraminidase inhibitors. If there is concern for osteltamivir or peramivir resistance, use of intravenous zanamivir (which is investigational) is recommended. Adverse events ascribed to the neuraminidase inhibitors in general include gastrointestinal symptoms. Due to toxicity concerns, including hemolytic anemia, teratogenicity, and the availability of influenza-specific therapies, ribavirin is not recommended for treatment of influenza infections. She reports periumbilical pain that occurs 5 to 6 times weekly and is described as a twisting feeling that ranges from 4 to 7 on a scale of 10.
Gigartina mamillosa and other Gigartina species (Carrageenan). Rogaine 5.
Source: http://www.rxlist.com/script/main/art.asp?articlekey=96696
Streptococcus pyogenes can cause tonsillitis, and first-degree heart block is a minor Jones criteria for diagnosing rheumatic fever. However, the onset of rheumatic fever is usually a few weeks after the tonsillitis, and other symptoms of rheumatic fever should be present. The most likely pathogen causing concomitant tonsillitis and electrocardiogram changes, especially in an unvaccinated child with an ill foreign contact, is C diphtheriae. His most recent episode started yesterday, along with symptoms of an upper respiratory tract infection. His physical examination findings are only significant for nasal congestion and a mildly inflamed oropharynx. An underlying etiology is more frequently identified in patients with gross hematuria than in those presenting with asymptomatic microscopic hematuria. On review of the history, physical examination, and urinalysis results for the boy in the vignette, the most likely diagnosis is immunoglobulin A (IgA) nephritis. The presence of blood clots, with or without dysuria, is consistent with urinary tract bleeding. Bright red hematuria is usually indicative of lower urinary tract bleeding, whereas glomerular hematuria (as in nephritis) is described as cola-colored, tea-colored, or brown. Signs and symptoms of myoglobinuria include myalgia, muscle weakness, and dark urine secondary to muscle breakdown. In children, this most often occurs with viral myositis, trauma associated with extensive muscle injury, excessive exertion, drug overdose, seizures, and metabolic disorders (hypokalemia increases the risk for muscle breakdown). With IgA nephropathy, the interval between the antecedent illness and nephritis is shorter. Acute poststreptococcal glomerulonephritis: the most common acute glomerulonephritis. The mother is a 34-year-old gravida 2, para 0 woman with type A1 gestational diabetes (hemoglobin A1C of 6. The baby was delivered by cesarean delivery with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. At 3 hours of life, she was brought to the nursery, where her test strip glucose was 30 mg/dL (1. You recommend repeating the test strip in 30 minutes and sending a plasma glucose test to the laboratory. All neonates experience a physiologic drop in serum glucose levels in the first hour of life. Most neonates have sufficient glycogen stores, gluconeogenesis capacity, and appropriate glucose utilization such that glucose levels return to normal from the physiologic nadir within 4 hours. In comparison, neonatal hypoglycemia is characterized by persistently low glucose levels with or without clinical manifestations. A neonate who is symptomatic with jitteriness, irritability, or hypothermia should be treated with intravenous dextrose. Asymptomatic neonates should be treated if their plasma glucose levels are less than 40 mg/dL (2. Instead, point-ofcare testing using glucose oxidase test strips is generally the test of choice. However, at low glucose values, glucose oxidase test strips may vary by 10 to 20 mg/dL (0. Therefore, a plasma glucose test must be sent to confirm the diagnosis of neonatal hypoglycemia. Poor perfusion in the delivery room would cause a falsely low glucose oxidase test strip. In general, test strips are rapid and accurate in the normal range of glucose values. The maternal history of gestational diabetes does not alter the reliability of the test strips.
During delivery the indication for prophylaxis has been controversial and, given the lack of convincing evidence that infective endocarditis is related to either vaginal or caesarean delivery, antibiotic prophylaxis is not recommended during vaginal or caesarean delivery. Heart failure due to acute valve regurgitation is the most common complication, requiring urgent surgery when medical treatment cannot stabilize the patient. If infective endocarditis is diagnosed, antibiotics should be given guided by culture and antibiotic sensitivity results and local treatment protocols. Antibiotics that can be given during all trimesters of pregnancy are penicillin, ampicillin, amoxicillin, erythromycin, mezlocillin, and cephalosporins. There is a definite risk to the fetus in all trimesters of pregnancy with group D drugs (aminoglycosides, quinolones, and tetracyclines) and they should therefore only be used for vital indications. Adolescents should be given advice on contraception, and pregnancy issues should be discussed as soon as they become sexually active. A risk assessment should be performed prior to pregnancy and drugs reviewed so that those which are contraindicated in pregnancy can be stopped or changed to alternatives where possible (see Section 11. The follow-up plan should be discussed with the patient and, if possible, her partner. Women with significant heart disease should be managed jointly by an obstetrician and a cardiologist with experience in treating pregnant patients with heart disease from an early stage. High risk patients should be managed by an expert multidisciplinary team in a specialist centre. All women with heart disease should be assessed at least once before pregnancy and during pregnancy, and hospital delivery should be advised. Disease-specific risk can be assessed, and is described in these guidelines in the respective Moderate/severe systemic atrioventricular valve regurgitation (possibly related to ventricular dysfunction). Moderate/severe sub-pulmonary atrioventricular valve regurgitation (possibly related to ventricular dysfunction). In general, the risk of complications increases with increasing disease complexity. Therefore, risk estimation can be further refined by taking into account predictors that have been identified in studies that included larger populations with various diseases. If pregnancy is decided upon, intensive specialist cardiac and obstetric monitoring needed throughout pregnancy, childbirth, and the puerperium. Extremely high risk of maternal mortality or severe morbidity; pregnancy contraindicated. The risk may be lower with the minimally invasive hysteroscopic techniques such as the Essure device. Hysteroscopic sterilization is performed by inserting a metal micro-insert or polymer matrix into the interstitial portion of each fallopian tube. Three months after placement, correct device placement and bilateral tubal occlusion are confirmed with pelvic imaging. Advantages of hysteroscopic sterilization include the ability to perform the procedure in an outpatient setting and without an incision. Given the lack of published data about contraception in heart disease, advice should be provided by physicians or gynaecologists with appropriate training. Monthly injectables that contain medroxyprogesterone acetate are inappropriate for patients with heart failure because of the tendency for fluid retention. Low dose oral contraceptives containing 20 mg of ethinyl estradiol are safe in women with a low thrombogenic potential, but not in women with complex valvular disease. Fontan, Eisenmenger) intrauterine implants are indicated only when progesterone-only pills or dermal implants have proved unacceptable and, if used, they should only be implanted in a hospital environment.
One-off recreational sessions can be entertaining, but can hardly reach the intended psychosocial objectives. Yet timing and continuity, due to volatility of the security situation, are often a challenge in these contexts. Activities should always be tailored to the needs and preferences of the target population, knowing that creativity expresses in different form in different cultures, but is present in all cultures. While the restoration of individual and family rituals has an important role to play in terms of self-care and psychosocial well-being, this chapter concerns collective and communitybased rituals and celebrations only. Tales, legends, staged ritual dramas, songs, proverbs and scriptures all contain elements of reflection on the human condition that can also shed light on the current problems. In the aftermath of an emergency, rituals and celebrations can perform several functions. This is an example of collective ritual of transition used to respond to war-related adversity (here and here). Yet they should design and implement programmes that allow for support to rituals and celebrations in various forms, which will be described below. Both religious and non-religious rituals and celebrations can be daily (for example, Muslim daily prayers or flag-raising), weekly (for example, Sunday masses or elderly gatherings), yearly (for example, Eid, Christmas, Labour Day, Independence Day), occasional (for example, weddings, funerals), periodic (for example, initiations, coming-of-age processes). It is important, at the very beginning of a psychosocial support programme, to create a calendar of the rituals and celebrations that can be calendarized, to understand the scope of the necessary financial and manpower commitments. Hospitality: Coffee ceremonies, meals, "good manners", greetings and farewells, relations with guests. Rituals of devotion: Fasting, abstaining from X, seclusion, paying alms, worship, special food. Recognition that a person has changed, therefore social position/relationships change. It is important that all religious and ethnic/cultural groups present in a camp or a community be represented, always using a conflict-sensitive approach (see chapter on Integration of mental health and psychosocial support in conflict transformation and mediation). If such locations are not available in a close range, the project might consider the establishment of temporary dedicated spaces (rub halls, tents, caravans, shadings) or renting/rehabilitating available structures for the purpose. It is important to recreate a symbolic enclosure to these spaces, even with simple objects such as fences, pathways, boards, images, plants and decorations. If deemed appropriate, partnerships should be established with them to jointly carry out these activities. Eid Mubarak, Dari-Recreational and Counselling Centre for Families, Baalbeck, Lebanon. Not only should safety and security be provided, but participants should be made aware that these measures are in place. Staff Local authorities, camp managers, section members who do not feel comfortable, or leaders, teachers, journalists, artists and perceive their presence as potentially obstructive media activists should be involved from the to the smooth implementation of the activity, inception of the activity. If supervisors as a good managerial practice and deemed necessary, ad hoc committees can be lessons learned exercise. Special attention should be paid to testing some of the assumptions on the positive effects of the specific activity on the well-being of participants through discussions with religious leaders, cultural activists and selected members of communities. Preparation of the main celebrations and rituals can be linked to sporting events or activities, such as tournaments and contests. The ritual and the celebration can be linked to the other creative activities supported or connected to the programme.
The degree of the curve is nearly always calculated using a technique known as the Cobb method. On an X-ray of the spine, the examiner draws two lines: One line extends out and up from the edge of the top vertebrae of thecurve. The Cobb method is limited because it cannot fully determine the three-dimensional aspect of the spine. Anewtechniqueusingcalculationsbasedongeometricprinciplesoftheapexofthecurveaswellasthetopandbottomof the curve may prove to be accurate in determining all the dimensions of the curve. Determining the End of Growth Even if the curve is accurately calculated, it still remains difficult to predict whether the scoliosis will progress. One way of predicting whether or not the curvature will progress is knowing when the child will stop growing. If the child will stop growing within a year, then progression should be very slight. In addition, other methods have been developed to help predict the end of the growth stage. Alowgrade indicates that the skeleton still has considerable growth; a high grade means that the child has nearly stopped growing and a smallcurveisunlikelytoprogressmuchfurther. To Screen or Not to Screen for Scoliosis Screening programs for scoliosis, which began in the 1940s, are now mandatory in middle or high schools in many states. TheAmericanAcademyofOrthopaedicSurgeonsrecommendsthatgirlsbescreenedtwice,atages10and12,andthatboys be screened once at 13 or 14. One study, however, argues that over 40% of high school sophomores with newly diagnosed scoliosishadshownnosignsofthedisorderinearlierscreeningtests. Preventive Services Task Force issued a recommendation against routine screening to detect adolescent scoliosis. Schoolsoftenreferchildrenwithminorcurveswhoarenotatanyriskforaprogressiveorseriousconditionto physicians, and such over-referrals add considerably to the costs of the health system. Experts against screening argue, then, that such programs result in early treatments that either will not prevent curve progression and surgery, or are unnecessary in the first place since curvatures often do not progress at all. Withoutscreening,thechancesareslimthatchildrenwithscoliosiswillbediagnosedatanearlystageiftheycan only rely on examinations by a family physician or pediatrician. Such physicians often do not even look at backs and, if they do, they tend to use only the forward bend test, which is not accurate. Such guidelines would detect about 95% of all genuinely serious cases while referring only 3% of all children tested, thereby cutting costs without jeopardizing children. Treatment for scoliosis has undergone major changes over the past decade and a number of options are available. Whetherscoliosis is treated immediately or simply monitored is not an easy decision, however. Experts estimate that curves less than 19 degrees will progress 10% in girls between ages 13 and 15 years and 4% in children older than 15 years. Thoracic curves, those in the upper spine, are more likely to progress than thoracolumbar curves or lumbar curves, those of the middle to lower spine. Children in poor health may suffer more from stressful scoliosis treatments than other children. On the other hand, children who have existing conditions that threaten the lung and heart problems may warrant immediate, aggressive treatment. Surgery is suggested for patients with curvatures over 50 degrees, in untreated patients or when braces have failed. In adults, scoliosis rarely progresses beyond 40 degrees, but surgery may be required if the patient is in a great deal of pain or if it is causing neurologic problems.
This agree with the statement that guar gum improved the volume and texture of bread made from frozen dough (Ribotta et al. It was partially confirmed that hydrocolloids are used in food products to modify texture and improve moisture retention (Linden and Lorient, 1999). Sensory analysis of rolls made from semi-finished frozen products after baking and 3 days after baking Insignificant differences were found among samples of rolls (P >0. Sensory assessors evaluated all samples as identical in Table 2 Results (expressed as median) of the sensory analyses of the tested rolls (samples A-D) after baking and 3 days after baking. Samples Characteristics A taste pliancy texture porosity stickiness gumminess crispness quality 2 a After baking B 2 a 3 day after baking D 2 a C 2 a A 2 a B 2 a C 2 a D 2a 3a 2a 3a 4a 4a 2a 2a 3a 3a 2a 3a 3a 2a 3a 2a 3a 2a 3a 3a 3a 2a 2a 4a 2a 3a 3a 3a 2a 3a 4a 2a 4a 3a 3a 2a 2a 3a 3a 4a 4a 2a 2a 2a 2a 3a 4a 4a 3a 2a 2a 3a 2a 4a 5a 2a 2a Hedonic scales used: Taste: 1-very good to 5 very bad. Our results disagree with those of Selomulyo and Zhou (2007) who found that effects of frozen storage on bread include lowering of loaf volume and deterioration in the texture of the final product. However, the quality of final bakery products is not good, especially flaking and crackling crust is very often after freezing for several 5 Changes of roll firmness A, F (g) after baking 4. Therefore it is very important to eliminate these problems associated with freezing and frozen storage, thus, the guar gum have been used in individual amount to improve the baking quality and extend the shelf life of bakery products made from semi-finished frozen products. Results of chemical analysis showed no significant differences in moisture of rolls after baking and 3 days after baking. Measurement of texture properties, firmness A and firmness F, showed that samples of rolls with additions of guar gum had lower firmnesses (A, F) in comparison to control samples of rolls after baking. Sensory analysis showed that sensory assessors evaluated samples of rolls as the same in all monitored characteristics. But visual assessment of rolls showed that rolls with lower additions of guar gum (5 and 10 g. Solution of problem as a flaking and crackling crust or irregular porosity of crumb may be the guar gum. Moreover, lower additions of guar gum did not increase the final price of the bakery product so much. Physical properties of fresh and frozen stored, microwave-reheated breads, containing hydrocolloids. Effects of emulsifiers and hydrocolloids on whole wheat bread quality: a response surface methodology study. Optimizing of rye bread recipes containing mono-diglyceride, guar gum, and carboxymethylcellulose using a maturograph and an ovenrise recorder. Effect of freezing and frozen storage on the gelatinization and retrogradation of amylopectin in dough baked in a differential scanning calorimeter. Effect of emulsifier and guar gum on micro structural, rheological and baking performance of frozen bread dough. Combined effects of inulin, pectin and guar gum on the quality and stability of partially baked frozen bread. Optimization of hydrocolloid addition to improve wheat bread dough functionality: a response surface methodology study. A contribution to the study of staling of white bread: effect of water and hydrocolloid. Stability of frozen starch pastes: effect of freezing, storage and xanthan gum addition. Sensory Analysis - General Guidance for the Selection, Training and Monitoring of Assessors - Part 1: Selected Assessors. Cereals and cereal products - Determination of moisture content - Routine reference method. Stefan Balla, Constantine the Philosopher University, Faculty of Central European Studies, Institut for Teacher Training, Drazovska 4, 94901 Nitra, Slovakia, Email: sballa@ukf. We examined the detection limit (the sensitivity with which we can detect the presence of the allergen in a sample) and the reliability for performing an analysis.
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