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BACKGROUND: Gastric cancer is associated with significant undernutrition responsible for an increase in morbidity and mortality after gastrectomy. AIM: To evaluate the impact of enteral nutrition by jejunostomy feeding in patients undergoing gastrectomy for cancer. METHODS: Between 2003 and 2017, all patients undergoing gastrectomy for cancer treatment were included retrospectively. A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared. RESULTS: Of the 172 patients included, 60 received jejunostomy. Preoperatively, the two groups were comparable with respect to the nutritional parameters studied (body mass index, albumin, etc.). In the postoperative period, the J + group lost less weight and albumin: 5.74 ± 8.4 vs 9.86 ± 7.5 kg (P = 0.07) and 7.2 ± 5.6 vs 14.7 ± 12.7 g/L (P = 0.16), respectively. Overall morbidity was 25% in the J + group and 36.6% in the J - group (P = 0.12). The J + group had fewer respiratory, infectious, and grade 3 complications: 0% vs 5.4% (P = 0.09), 1.2% vs 9.3% (P = 0.03), and 0% vs 4.7% (P = 0.05), respectively. The 30-day mortality was 6.7% in the J + group and 6.3% in the J - group (P = 0.91). CONCLUSION: Jejunostomy feeding after gastrectomy improves nutritional characteristics and decreases postoperative morbidity. A prospective study could confirm our results.
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The study assessed the impacts of aquatic plant silages on feeding efficiency and dairy cattle health as an alternative to conventional corn silage under high altitude conditions. Mid-lactation Holstein cows were assigned to treatment groups according to a randomized complete block design of parity, previous 105-d milk yield, and body weight. Cows (nâ¯=â¯8 per group) were fed with aquatic plant silage inoculated with Bacillus subtilis (BS), Yeast (YS), or conventional corn silage without inoculants (control) in addition to [standard grain feed] for 75 consecutive days. BS and YS had higher protein contents than control silage (111.20⯱â¯7.68, 112.10⯱â¯6.83 vs 76.94⯱â¯3.48â¯g/kg DM), while feeding efficiency was comparable between treatments (1.07, 0.99, and 0.90, respectively). In addition, the addition of aquatic plant silage in ruminant diets enhanced immunity and antioxidant capacity when compared with control group. Metagenomic analysis showed similar composition in rumen microbiota between YS and control groups, with higher enrichment for energy and nitrogen utilization pathways in YS-treated cows. This study highlights the use of aquatic plant silage as an alternative feed for dairy cattle with higher protein than corn silage. Our results suggest YS or BS could potentially boost immune and antioxidant functions, improving adaptation to high-altitudes and reducing demand for high input corn production on the Qinghai-Tibetan Plateau.
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BACKGROUND: Poor oral intake (POI) among medical-surgical inpatients can cause malnutrition and delay recovery due to medical consequences and the need for more invasive nutritional support. Many psychiatric conditions can cause POI; however, the role that psychiatric conditions play in POI has received limited attention to date. OBJECTIVE: This review aggregates available information on POI due to psychiatric conditions and provides a framework for the clinical approach to these conditions in hospitalized adult patients. METHODS: We searched PubMed and EMBASE for reviews of POI due to psychiatric causes, but no relevant publications were identified. Diagnostic criteria for relevant conditions in the DSM-5-TR and Rome IV were reviewed, as were C-L psychiatry textbooks and relevant society websites. This review was further supplemented by a case conference at the authors' institution. RESULTS: We have divided results into five sections for clinical utility: (1) the need to rule out medical and psychotropic causes of POI; (2) unpleasant somatic experiences causing POI; (3) mood, psychotic, catatonic, and neurocognitive disorders that can present with POI; (4) eating and feeding disorders; and (5) personal and interpersonal explanations of POI. Within each section, we review how to identify and manage each condition, specifically considering effects of treatment on oral intake. CONCLUSIONS: The clinical management of POI varies based on cause. For instance, psychostimulants can cause POI due to inappetence; however, they can treat POI due to abulia by improving motivation. The fact that such a broad range of psychiatric conditions can cause POI calls for a systematic clinical approach that considers the categories of potential causes. We also identified a need for prospective studies focused on the management of POI due to psychiatric conditions, as the literature on this topic is limited to case reports, case series, and retrospective cohort studies.
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Objective To investigate the status and influencing factors of pressuring feeding style among caregivers in remote rural areas of Sichuan province. Methods Multistage sampling was conducted to select infants of 6-11 months old who had received complementary food and their caregivers in remote rural areas of Sichuan province.A questionnaire was used to collect sociodemographic characteristics of infants and their caregivers,pressuring feeding behaviors,feeding environment,and caregivers' negative emotions.Quantile regression was employed to analyze the factors influencing pressuring feeding among caregivers of infants. Results A total of 1358 pairs of infants and their caregivers were included,with the pressuring feeding behavior score of 11 (8,14).Parity was the protective factor for caregivers' pressuring feeding (ß25=-1.17,P<0.001;ß50=-1.40,P=0.002;ß75=-2.18,P<0.001).Whether infants played with toys while eating (ß25=1.00,P<0.001;ß50=1.20,P=0.003;ß75=1.42,P<0.001) and whether infants watched TV/mobile phones (ß25=0.50,P=0.048;ß50=1.07,P=0.004) were the risk factors.At the 75th percentile,caregivers' negative emotions were the risk factor for pressuring feeding (ß75=0.94,P=0.015).Caregivers' education background (ß25=0.83,P=0.034;ß50=0.87,P=0.021) and family income (ß75=1.09,P=0.012) were also significantly associated with pressuring feeding scores at different quartile points. Conclusion Pressuring feeding behaviors of caregivers in remote rural areas of Sichuan province need to be improved.Based on the characteristics of infants and their families,guidance should be carried out to improve the feeding environment and the mental health of caregivers,thereby promoting reasonable feeding behaviors among caregivers of infants in rural areas.
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Cuidadores , Conducta Alimentaria , Población Rural , Humanos , Lactante , Cuidadores/psicología , Femenino , China , Masculino , Encuestas y Cuestionarios , AdultoRESUMEN
Sotorasib is approved to be taken as 960 mg orally once daily (8 × 120-mg tablets) for the treatment of KRAS G12C-mutated nonsmall cell lung cancer. Dispersion of tablets in water could be an alternative method for patients who require a liquid formulation due to dysphagia and enteral administration. A clinical study was conducted to assess the pharmacokinetics of 960 mg of sotorasib administered as tablets and as tablets dispersed in water in healthy volunteers. Each subject received 960 mg of sotorasib by mouth, as tablets and as tablets dispersed in water on Days 1 and 4. Sotorasib median time to maximum observed plasma concentration was similar when administered as tablets and as tablets predispersed in water. The geometric least squares mean ratios (water dispersion/tablets) for area under the concentration-time curve from time 0 extrapolated to infinity and maximum observed plasma concentration were 1.049 and 1.080, respectively. Sotorasib 960 mg was well tolerated. Administration of 960 mg of sotorasib as tablets predispersed in water achieved similar systemic exposures to that of sotorasib administered as oral tablets. In vitro evaluations were performed to assess the feasibility of administering sotorasib through an enteral feeding tube. Approximately 98% of sotorasib was recovered, with no new impurities, from enteral feeding tubes. Collectively, these results support that sotorasib can be administered by mouth and via enteral feeding tubes as tablets predispersed in water.
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To genuinely assess the effect of secondary metal promotion on improving the SAPO-34 catalytic performance in MTO reaction, a broad spectrum of metals from different groups of the periodic table (alkali and alkaline earth metals, transition metals, rare earth metals, and basic metals) were investigated. Metals were added through a direct incorporation route with Me/Al2O3 molar ratio of 0.05. Some metals seamlessly incorporated into the SAPO-34 framework and replaced the Si and Al atoms, while others partially merged or even failed to be combined with SAPO and emerged as amorphous phases. Although, in some cases, the surface area of the metal-promoted samples increased due to enhanced nucleation rate and smaller particle formation, the majority of the promoted samples suffered from a severe loss in crystallinity that resulted in inferior catalytic performance. It was also illustrated that hydrogen co-feeding with methanol (H2/MeOH molar ratio of 1.5) at ambient pressure could extend the catalyst lifetime by 27% due to hydrogenation and cracking of the coke species and improve the light olefins selectivity.
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The mirid bug (Riptortus pedestris), a major soybean pest, migrates into soybean fields during the pod filling stage and causes staygreen syndrome, which leads to substantial yield losses. The mechanism by which R. pedestris elicits soybean (Glycine max) defenses and counter-defenses remains largely unexplored. In this study, we characterized a protein family from R. pedestris, designated Riptortus pedestris HAMP 1 (RPH1) and its putative paralogs (RPH1L1, 2, 3, 4, and 5), whose members exhibit dual roles in triggering and inhibiting plant immunity. RPH1 and RPH1L1 function as herbivore-associated molecular patterns (HAMPs), activating pattern-triggered immunity (PTI) in tobacco (Nicotiana benthamiana) and G. max. Furthermore, RPH1 stimulates jasmonic acid and ethylene biosynthesis in G. max, thereby enhancing its resistance to R. pedestris feeding. Additionally, RPH1 homologs are universally conserved across various herbivorous species, with many homologs also acting as HAMPs that trigger plant immunity. Interestingly, the remaining RPH1 putative paralogs (RPH1L2-5) serve as effectors that counteract RPH1-induced PTI, likely by disrupting the extracellular perception of RPH1. This research uncovers a HAMP whose homologs are conserved in both chewing and piercing-sucking insects. Moreover, it unveils an extracellular evasion mechanism utilized by herbivores to circumvent plant immunity using functionally differentiated paralogs.
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Establishing healthy feeding habits during infancy is crucial for optimal growth. However, certain parental feeding and cultural practices might hinder the development of children's healthy eating behaviours. This research explored responsive feeding practices among migrant mothers in Australia. Semi-structured telephone interviews were conducted in their native language with 20 Arabic and 20 Mongolian-speaking migrant mothers with children under 2 years old or currently pregnant. Thematic analysis was conducted using the framework method. Both cultural groups followed a variety of feeding practices, including on demand responsive feeding or structured schedules. Arabic-speaking mothers tended to demonstrate responsive feeding practices more frequently than Mongolian-speaking mothers, except for those using formula feeding, who consistently followed a fixed feeding routine. When introducing solid foods, mothers from both groups often overlooked their babies' hunger and satiety cues, frequently pressuring their children to finish their entire plate. One cited reason for this was the challenge parents faced in identifying such cues. Arabic-speaking mothers often supplemented with formula top-ups after introducing solid foods, due to the belief that breast milk or solid foods alone might not sufficiently nourish their infants. Additionally, some Arabic-speaking mothers used food-based rewards to encourage eating. Mongolian mothers expressed a cultural preference for chubby babies, a potential reason why they may have been inclined to pressure-feed their children. Moreover, both groups reported using digital devices to distract their children during meals. This study highlights the necessity of tailoring future resources and services related to responsive feeding practices to accommodate diverse literacy levels and cultural backgrounds.
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BACKGROUND: Congenital heart disease (CHD) is the most common birth defect, occurring in roughly 40,000 US births annually. Malnutrition and feeding intolerance (FI) in CHD ranges from 30-42% and is associated with longer hospitalization and increased mortality. Cardiopulmonary bypass (CPB) required for surgical repair of CHD induces a systemic inflammatory response worsening intestinal dysbiosis and inducing intestinal epithelial barrier dysfunction (EBD), possibly contributing to post-operative FI. OBJECTIVE: To determine the relationship of post-operative FI with intestinal Microbiome, short-chain fatty acids (SCFA), and EBD in pediatric CHD after cardiac surgery. METHODS: Prospective study of patients aged 0-15 years undergoing cardiac surgery with CPB. Samples were collected pre-operatively and post-operatively to evaluate the gut microbiome, plasma EBD markers, short-chain fatty acids (SCFA), and plasma cytokines. Clinical data was collected to calculate a FI score and evaluate patient status post-operatively. RESULTS: We enrolled 26 CPB patients and identified FI (n=13). Patients with FI had unique microbial shifts with reduced SCFA-producing organisms, Rothia, Clostridium innocuum, and Intestinimonas. Patients who developed FI had associated elevations in plasma EBD markers, claudin-2 (p<0.05), claudin-3 (p<0.01), and fatty acid binding protein (p<0.01). Patients with FI had reduced plasma and stool SCFAs. Mediation analysis showed the microbiome functional shift was associated with reductions in stool butyric and propionic acid in patients with FI. CONCLUSION: We provide novel evidence that intestinal dysbiosis, markers of EBD, and SCFA depletion are associated with FI. This data will help towards identifying mechanism and therapeutics to improve clinical outcomes following pediatric cardiac surgery.
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BACKGROUND: High-risk neonates continuing to need enteral nutrition, but otherwise medically ready for discharge home from the NICU, are often offered ongoing hospitalization for nasogastric tube (NGT) feeding, versus discharge after placement of gastrostomy tube. Our group developed an interdisciplinary algorithm to support a third option-discharge home with enteral nutrition via NGT. Our objective was to develop a cross-institutional and interdisciplinary pathway to optimize outcomes for neonates discharged with NGTs. METHODS: A program to support home NGT feeding use was created, "Passport Home Program," based upon feedback from parents, nurses, speech-language pathologists, otolaryngologists, and neonatal intensivists, amongst others, spanning four hospitals across our health system. RESULTS: Standardized educational materials for caregivers of neonates requiring ongoing NGT feeding on discharge were created and consist of an in-hospital curriculum with specific competency thresholds, including demonstrating NGT replacement and confirmation with pH test strips. A discharge kit, including a QR code for a video reviewing safe techniques for home NGT placement, is distributed, along with support staff contact information. Members of an emergency department were trained in neonatal NGT replacement in case of issues after business hours. Each patient is followed in a dedicated outpatient multi-disciplinary clinic. DISCUSSION: This is an interdisciplinary and multi-institutional effort to standardize a pathway for neonates discharged home from the NICU with NGTs. This has the potential to lead to earlier discharge, better outcomes for patients and families, as well as lower costs. This best practice algorithm serves as an example pathway applicable across fields of medicine.
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OBJECTIVE: To assess the relationship between breastfeeding and the risk of developing nephrotic syndrome using a population-based nationwide birth cohort in Korea. STUDY DESIGN: This nationwide cohort study utilized data from the Korean National Health Information Database and the Korean National Health Screening Program for Infants and Children. The study included all children born between January 1, 2010, and December 31, 2018, who underwent their first health screening, which included a specific questionnaire on breastfeeding between 4 and 6 months of age. Associations between nephrotic syndrome and exclusive breastfeeding were estimated using adjusted hazard ratios (aHR) derived from Cox proportional hazards models, adjusted for sociodemographic variables, with follow-up until the occurrence of nephrotic syndrome, eight years post-index date, death, or December 31, 2022, whichever was first. RESULTS: The study population comprised 1,787,774 children (median follow-up: 7.96 years; IQR: 6.31-8.00 years), including 612,556 exclusively breastfed and 1,175,218 formula-fed children. Exclusive breastfeeding was associated with a decreased risk of developing nephrotic syndrome (aHR: 0.80; 95% CI: 0.69 - 0.93). Subgroup analysis stratified by sex mirrored the overall findings, although statistical significance was not observed in girls (boys: aHR, 0.75; 95% CI, 0.62-0.92; girls: aHR, 0.87; 95% CI, 0.70 - 1.09). Sensitivity analysis confirmed these results. CONCLUSION: Exclusive breastfeeding was associated with a 20% reduced risk of developing nephrotic syndrome up to 8 years of age.
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OBJECTIVE: Despite substantial research indicating difficulties with emotion regulation across eating disorder presentations, emotion regulation has yet to be studied in adults with avoidant/restrictive food intake disorder (ARFID). We hypothesized that (1) those with ARFID would report greater overall emotion regulation difficulties than nonclinical participants, and (2) those with ARFID would not differ from those with other eating disorders on the level of emotion regulation difficulty. METHODS: One hundred and thirty-seven adults (age 18-30) from an outpatient clinic with ARFID (n = 27), with other primarily restrictive eating disorders (e.g., anorexia nervosa; n = 34), and with binge/purge eating disorders (e.g., bulimia nervosa; n = 51), as well as nonclinical participants (n = 25) recruited via Amazon Mechanical Turk (MTurk) completed the Difficulties in Emotion Regulation Scale (DERS). We compared DERS scores across groups. RESULTS: In line with expectations, patients with ARFID scored significantly higher than nonclinical participants on the DERS Total (p = 0.01) with a large effect size (d = 0.87). Also as hypothesized, those with ARFID did not differ from those with other primarily restrictive (p = 0.99) or binge/purge disorders (p = 0.29) on DERS Total. DISCUSSION: Adults with ARFID appear to exhibit emotion regulation difficulties which are greater than nonclinical participants, and commensurate with other eating disorders. These findings highlight the possibility of emotion regulation difficulties as a maintenance mechanism for ARFID.
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Optimal nutrition during infancy is critical given its influence on lifelong health and wellbeing. Two novel methods of infant complementary feeding, commercial baby food pouch use and baby-led weaning (BLW), are becoming increasingly popular worldwide. Household food insecurity may influence complementary feeding practices adopted by families, but no studies have investigated the use of BLW and baby food pouches in families experiencing food insecurity. The First Foods New Zealand study was a multicentre, observational study in infants 7.0-9.9 months of age. Households (n = 604) were classified into one of three categories of food insecurity (severely food insecure, moderately food insecure, and food secure). The use of complementary feeding practices was assessed via a self-administered questionnaire, both at the current age (mean 8.4 months) and retrospectively at 6 months. Mothers experiencing severe food insecurity had 5.70 times the odds of currently using commercial baby food pouches frequently (≥5 times/week) compared to food secure mothers (95% CI [1.54, 21.01]), reporting that pouches were 'easy to use' (89%) and made it 'easy to get fruits and vegetables in' (64%). In contrast, no evidence of a difference in the prevalence of current BLW was observed among mothers experiencing moderate food insecurity (adjusted OR; 1.28, 95% CI [0.73, 2.24]) or severe food insecurity (adjusted OR; 1.03, 95% CI [0.44, 2.43]) compared to food secure mothers. The high prevalence of frequent commercial baby food pouch use in food insecure households underscores the need for research to determine whether frequent pouch use impacts infant health.
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Summary: Background. Current recommendations for infant weaning suggest introducing common food allergens by the age of 12 months. While homemade meals are advisable, there is a notable demand for commercially available complementary foods (CACF). Furthermore, emerging evidence suggests a potential link between the consumption of ultra-processed products and the incidence of allergic diseases. This study aimed to examine the presence of the fourteen main food allergens in CACF ingredients through label analysis and evaluate their extent of processing. Methods. Between January and February 2024, labels of all CACF found in infant feeding sections of 10 Portuguese grocery retailers were analyzed. CACF were categorized based on the NOVA food classification system's processing levels. Milk formulas, products for children over 15 months, and those for children with food allergies or intolerances were excluded Results. Of the 492 products analysed, 132 contained wheat and 112 contained milk. 16 products included fish and 6 contained egg. Soy was listed as an ingredient in 11 products, mainly as soy lecithin. Only 2 product contained nuts, and 1 product contained peanuts. None of the products contained the remaining six allergens. The majority of milk- and wheat-containing products were classified as ultra-processed and contained added sugars and/or sweeteners. Conclusions. Despite the current guidelines, commercial baby foods often lack major allergens, namely nuts and peanuts, eggs, and shellfish. Our results underscore the need for healthy, age-appropriate, minimally processed products that incorporate rather than exclude major food allergens.
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AIM: Present a study protocol investigating the biobehavioral efficacy of side-lying vs. supine positions on physiologic and behavioural responses of preterm infants during their transition from tube to full oral feeding, and identify associated infant characteristics. DESIGN: Within-subject cross-over design. METHODS: Sixty preterm infants born at ≤35 weeks gestational age (GA) from a level 3 NICU are observed during their transition to full oral feeding. Each undergoes two feedings within 24 h: One in the supine position and one in the side-lying position. Continuous physiologic and video data are collected 30 min before and after feeding. Physiologic measures include heart rate, respiratory rate, oxygen saturation, and autonomic nervous system regulation (heart rate variability and splanchnic-cerebral oxygen ratio). Behavioural responses are assessed via microanalysis of the sucking and breathing waveforms and videotaped feedings (Suck-breathe coordination and Early Feeding Skills assessment tool). Data are analysed using linear mixed-effects models. IRB was obtained in September 2021, with funding awarded by the National Institute of Nursing Research in July 2021. CONCLUSION: This study will enhance our understanding of the effects of the side-lying position on preterm infant feeding, providing guidance for its clinical use as a feeding strategy. IMPLICATIONS: Provides vital knowledge to guide evidence-based practices in enhancing oral feeding in preterm infants and inform future pivotal efficacy trials. IMPACT: If effective, this intervention could significantly enhance the management of feeding challenges in preterm infants across neonatal care settings. REPORTING METHOD: Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013. PATIENT OR PUBLIC CONTRIBUTION: While direct parent involvement was not documented in our protocol, informal feedback on data collection procedures from parents was incorporated. Additionally, extensive engagement with healthcare professionals during study design addressed patient safety, logistical challenges, and ethical standards in NICU settings. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04942106; registered on 28 June 2021. Available at: https://clinicaltrials.gov/ct2/show/NCT04942106.
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Improved understanding of mosquito-plant feeding interactions can reveal insights into the ecological dynamics of pathogen transmission. In wild malaria vectors Anopheles gambiae s.l. and An. funestus group surveyed in selected dryland ecosystems of Kenya, we found a low level of plant feeding (2.8%) using biochemical cold anthrone test but uncovered 14-fold (41%) higher rate via DNA barcoding targeting the chloroplast rbcL gene. Plasmodium falciparum positivity was associated with either reduced or increased total sugar levels and varied by mosquito species. Gut analysis revealed the mosquitoes to frequently feed on acacia plants (~ 89%) (mainly Vachellia tortilis) in the family Fabaceae. Chemical analysis revealed 1-octen-3-ol (29.9%) as the dominant mosquito attractant, and the sugars glucose, sucrose, fructose, talose and inositol enriched in the vegetative parts, of acacia plants. Nutritional analysis of An. longipalpis C with high plant feeding rates detected fewer sugars (glucose, talose, fructose) compared to acacia plants. These results demonstrate (i) the sensitivity of DNA barcoding to detect plant feeding in malaria vectors, (ii) Plasmodium infection status affects energetic reserves of wild anopheline vectors and (iii) nutrient content and olfactory cues likely represent potent correlates of acacia preferred as a host plant by diverse malaria vectors. The results have relevance in the development of odor-bait control strategies including attractive targeted sugar-baits.
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Anopheles , Código de Barras del ADN Taxonómico , Ecosistema , Mosquitos Vectores , Plasmodium falciparum , Animales , Mosquitos Vectores/parasitología , Mosquitos Vectores/genética , Anopheles/parasitología , Anopheles/genética , Anopheles/metabolismo , Kenia , Plasmodium falciparum/genética , Plasmodium falciparum/metabolismo , Malaria/transmisión , Malaria/parasitología , Acacia/metabolismo , Acacia/parasitología , Acacia/genética , Conducta Alimentaria/fisiología , Ribulosa-Bifosfato Carboxilasa/metabolismo , Ribulosa-Bifosfato Carboxilasa/genéticaRESUMEN
Rotifers are small, ubiquitous invertebrate animals found throughout the world and have emerged as a promising model system for studying molecular mechanisms in the fields of experimental ecology, aquatic toxicology, and geroscience. However, the lack of efficient gene expression manipulation techniques has hindered the study of rotifers. In this study, we used the L4440 plasmid with two reverse-oriented T7 promoters, along with RNase-deficient E. coli HT115, to efficiently produce dsRNA and thereby present an efficient feeding-based RNAi method in Brachionus plicatilis. We targeted Bp-Ku70 & Ku80, key proteins in the DNA double-strand breaks repair pathway, and then subjected rotifers to UV radiation. We found that the mRNA expression, fecundity, as well as survival rate diminished significantly as a result of RNAi. Overall, our results demonstrate that the feeding-based RNAi method is a simple and efficient tool for gene knockdown in B. plicatilis, advancing their use as a model organism for biological research.
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INTRODUCTION: To date, there are no caregiver-reported screening measures of oral behaviors related to feeding. The goal of this study was to develop such a measure. METHOD: Caregivers of 803 children referred to a feeding clinic and 188 comparison children reported their children's frequency of nine oral behaviors. These data were used to develop an Oral Behavior Screener (OBS). Both the psychometrics of the OBS and the relations between the OBS and child demographics were examined. RESULTS: As expected, the clinical sample demonstrated more deficits in oral behaviors than the comparison sample. We also found special needs status and age were linked to the OBS summary score. DISCUSSION: The OBS is a brief screener that can be used by clinicians to examine the need for further assessment, possible targets for intervention, oral behaviors often associated with feeding problems.
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Direct evidence of trophic interactions between extinct species is rarely available in the fossil record. Here, we describe fish-mammal associations from the middle Eocene of Messel (Germany), consisting of three specimens of holosteans (one Atractosteus messelensis (Lepisosteidae) and two Cyclurus kehreri (Amiidae)) each preserved with a bat specimen (Palaeochiropteryx tupaiodon) lying in close contact with its jaws. This suggests that these fishes probably died after failed swallowing attempts, with the bat wing membrane entangled in their jaws resulting in a fatal handicap. Based on data from modern gars and bowfins, A. messelensis and C. kehreri may have opportunistically attacked drowning and dying individuals or scavenged on floating/sinking carcasses. This hypothesis is also supported by the unusually high number of bat specimens preserved in the deposits of the Eocene Lake Messel, suggesting that this group of small mammals may have represented a substantial food source for generalist feeders. This is the earliest case of chiropterophagy and the first known evidence of bat consumption by lepisosteid and amiid fishes, emphasizing the high trophic variability and adaptability of these groups throughout their evolutionary histories. The newly described associations provide important information for reconstructing the Eocene Lake Messel palaeoecosystem and its trophic web.