*2.1. Climatic Conditions*

The climate of Podkarpacie is transitional between oceanic and continental climates. It has 3 climatic zones: lowland, submontane and mountain. Average annual temperatures range from 8.3 to 9.5 ◦C. Annual rainfall ranges from 600 to 1000 mm [19].


**6. The role of the speech language therapist (SLT)**

**30 day mortality rate (%)**

142 Seminars in Dysphagia

**Sample size (N)**

22% 201 CVA (n=97)

20% 128 CVA (n=34)

22% 112 CVA (n=33)

36% 61 CVA (n=50)

28% 361 CVA (n=120)

15.8% 359 Head and neck cancer (n=97)

10% 77 Neurologic disorders (n=71)

CVA (n=73) Malignancy (n=61) Head injury (n=59) Cerebral palsy (n=38) Congenital anomaly (n=19) Motor neuron disease (n=7)

Dementia (n=5)

Other (n=23)

Other (n=9)

Malignant oesophageal obstruction (n=33) Dementia (n=16) Other neurologic disorders (n=13) Parkinsons (n=12)

Other malignancies (n=5)

Head and neck cancer (n=6)

Non neurologic cerebral hypoxia (n=30) Cranial tumour (n=23) Head and neck cancer (n=19) Motor neuron disease (n=13)

19% 83 CVA (n=83) Norway Ha & Hauge, 2003

Head and neck cancer (n=27) Chronic neurological disorders (n=22) Other (n=30)

18.5% 187 Malignancy (n=187) USA Keung et al., 2012

Head and neck trauma (n=3)

Dementia (n=21) Malignancy (n=9)

Dementia (n=103) Oropharyngeal malignancy

(n=65) Other (n=73)

**Table 1.** International mortality rates 30 days post PEG placement

**Medical condition Country Researchers**

Bosnia Herzegovina Vanis, Saray, Gornjakovic &

Sweden Malmgren et al., 2011

Turkey Ermis et al., 2012

Turkey Gundogan et al., 2014

Britain Longcroft-Wheaton et al., 2009

Israel Abuksis et al., 2004

USA Sanders et al., 2000

Mesihovic, 2012

Evidence exists to support the involvement of an SLT in the assessment and treatment of patients with dysphagia. Langmore et al. (2011) [108] suggested that it is important for an SLT to assess a patient with head and neck cancer and to determine the most optimal approach for each patient to be able to recover swallowing or to compensate for losses due to surgical or chemo-radiation intervention. The role of the SLT in the management of patients with dysphagia who may require enteral nutrition, is not to recommend the route of enteral nutrition, but rather to make a recommendation of whether or not the patient can eat orally and is safe to do so. All discussions and decisions relating to enteral nutrition, whether short or long term, should take place within an inter-professional team including the patient and caregivers.

Considering the multitude of risk factors that exist for poor outcomes post PEG insertion, it follows that a patient should be individually assessed for the presence of any risk factors before being recommended for the procedure [85-87]. A comprehensive assessment by the team needs to consider factors such as: 1) the potential benefits to the individual should they receive a PEG, 2) biochemical parameters, like blood albumin level, 3) multiple comorbidi‐ ties, 4) prognosis, 5) and the presence ofrisk factors that may place a patient atrisk of mortality post procedure, such as being over the age of 60 years and a low BMI [10, 19, 23, 25, 45, 56, 69, 87-89, 90].

Strong emphasis is placed upon a team approach when assessing patients who may be recommended for long term enteral nutrition [85-87]. A rigorous assessment, by a team, for each patient being considered for a PEG ought to be in place. The team needs to ensure that all risk factors which could affect outcome are considered and that an informed decision respects patient autonomy [60, 85-87]. A patient who is considered a high risk for mortality should not be considered a candidate for the procedure as it would be a futile intervention. Better patient selection would improve the outcome of patients who are recommended for and fitted with a PEG [91].


*5.1. Traditional Benchmark Functions*

The proposed HGTO-BWO was investigated via the solving of various traditional benchmark functions [71]; F1 to F13 have constant dimensions of 30, while the functions F14 to F23 have different dimensions. These functions are divided into the functions from F1 to F7, which are unimodal; F8 to F13, which are multi-modal; and F14 to F23, which are composites (See Supplementary Materials). Table 2 shows the statistical results of all the traditional benchmark functions; it includes the worst, average, best, standard deviation (std), and *p*-value. The values given in bold indicate the best solutions obtained by the proposed HGTO-BWO approach.

**Table 2.** Statistical analysis of traditional benchmark functions solved via the HGTO-BWO approach and other techniques.

**Table 2.** *Cont.*

**Table 2.** *Cont.*

**Table 2.** *Cont.*

**Table 2.** *Cont.*


**Jinde Zheng**

Jinde Zheng received the B.S. degree in mathematics from Anhui Normal University, Wuhu, China, in 2009, and the Ph.D. degree in mechanical engineering from Hunan University, Changsha, China, in 2014. From 2014 to 2016, he was a Lecturer with the Department of Mechanical Engineering, Anhui University of Technology, where he has been an Associate Professor, since 2016; he was promoted to Professor in 2021. He has authored more than 110 articles. His research interests include machinery health monitoring and fault diagnosis, statistical signal processing, and complexity theory.


*2.7. Carotenoid Content Evaluation*

Carotenoid content, specifically β-carotene and lycopene, was determined by the spectrophotometric method by selecting different wavelengths: 470 nm (β-carotene) and 503 nm (lycopene). The amount of carotenoids was calculated according to the following equation [27]:

$$\text{Carotenoids} \left( \frac{m\text{g}}{\text{g}} \right) = \frac{A \times M\_{\text{w}} \times D\_f}{M\_{\text{a}} \times L} \tag{1}$$

where *A* is the absorbance of the extracts at the corresponding wavelength; *Mw* is molecular weight, *Df* is the sample dilution rate, *Ma* is molar absorptivity (2500 L mol−1 cm−1 and 3450 L mol−1 cm−1, respectively), and *L* is the cell diameter of the spectrophotometer (1 cm).


**14. Conclusion**

portant article emphasizes particular skills that are often amiss for individuals with disa‐ bilities, Abilities, especially the ability to make eye contact, develop appropriate greetings, recognize personal space, and interpret nonverbal communication, that apply to individu‐

Based on previous studies, and addressing the gap in identified interventions specific to the sexual development of individuals with ASD, a current intervention program called Growing Up Aware is in the process of being developed at Columbia University [14]. The first research component attempted to better understand how parents teach their children with ASD about sexuality. Results of the study showed that the majority of pa‐ rents indicated a strong interest in learning how to better communicate with their chil‐ dren about sexual and reproductive health [14]. This is met currently by insufficient availability of materials for parents. Many clinical providers appear under-equipped, with normative knowledge and skills themselves about how to address questions of pa‐ rents regarding their child's changing sexual development based on parental perception. Clinicians need to become better equipped to help families with unusual or inappropri‐

Medication side effects that were not troubling to a child with ASD may cause signifi‐ cant distress in an adult with ASD by decreasing sexual desire or interfering with sexual potency [56]. Self-injury may result if appropriate instruction about masturbation is not provided. Medications such as fluoxetine or sertraline (selective serotonin reuptake inhib‐ itors) are frequently prescribed for persons with ASD to help with anxiety or repetitive behaviors. This group of medications can cause a decrease in sexual desire or make it much more difficult to attain an orgasm. Since masturbation is one of the most frequent sexual behaviors within the ASD population, unintentional self-injury may result from prolonged attempts to reach orgasm. Appropriate instruction in masturbatory behaviors may be necessary in order to prevent self-injury [46].

**12. Medication concerns**

of behavioral interventions.

**13. Public intervention**

In summary, our literature review and ample experiences of the families in our clinical practice show that, while every person has the innate basis for developing sexuality in a multitude of expressions and experiences, individuals with disabilities (and especially in‐ dividuals with an Autism Spectrum Disorder) most often require additional education and help to become able to express their sexuality in a socially appropriate way. While most neurotypically developing peers form intimate relationships beginning in adoles‐ cence and into adulthood, along a variety of experiences from dating to partnering in committed relationships, many individuals with an Autism Spectrum Disorder remain living with their family of origin into their adulthood and have significant difficulty nav‐ igating the social expectations surrounding relationships. Their difficulty may pertain to recognizing their own needs and wants, as well as to recognizing their partner's wishes coupled with more inexperience than their peers in this arena. Individuals with ASD and their parents and caregivers frequently identify this difficulty when directly asked about it. Sexuality education in a supportive format that includes the individual's family and their particular values and background will be most effective. Interventions need to be individualized with a long-range goal that matches the cognitive, social, and emotional developmental level of the person with ASD. As the prevalence of persons with ASD in‐ creases in our society, we are more than ever called to support their ability to mature in‐ to adults capable of functioning in all areas of life, including sexuality and intimacy.

### **Author details**

Maria R. Urbano, Kathrin Hartmann, Stephen I. Deutsch, Gina M. Bondi Polychronopoulos and Vanessa Dorbin

\*Address all correspondence to<EMAIL_ADDRESS>
Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Nor‐ folk, Virginia, USA

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**Chapter 20**

**Clinical Implications of a Link Between Fetal Alcohol**

**Spectrum Disorders (FASD) and Autism or Asperger's**

**Disorder – A Neurodevelopmental Frame for Helping**

The teratogenic effect of alcohol was first observed by paediatrician Paul Lemoine in Nantes, France in 1968, when he linked facial dysmorphic and growth features with maternal use of alcohol (wine) in pregnancy. His initial series was 127 infants. Subsequently the syndrome Fetal Alcohol Syndrome was defined in 2 classic papers in 1973 by David smith and Ken Jones in Seattle. Their initial case series were 8 patients. The recognition that prenatal alcohol exposure did not just cause dysmorphic facial features and growth delay was made by Sterling Clarren in Seattle in 1978 with the introduction of the term Fetal Alcohol Effect ( FAE) to describe children with alcohol exposure but no facial features. This descriptive clinical term was changed to Alcohol Related Neurodevelopmental Disorder (ARND) by the Institute of

**2. A conceptual understanding of the spectrum of effects of prenatal alcohol**

In the same vein as Autistic Spectrum Disorders, Fetal Alcohol Spectrum Disorders (FASD,) initially described by Streissguth & O'Malley in 2000 is an umbrella term to describe the continuum of complex neuropsychiatric, cognitive, behavioral, social, language, communica‐ tion and other multi-sensory deficits. There are, however, two conditions within this spectrum which describe the range of conditions caused by prenatal alcohol exposure. They are Fetal

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© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

**Understanding and Management**

Additional information is available at the end of the chapter

Kieran D. O'Malley and Susan D. Rich

http://dx.doi.org/10.5772/54924

**1. Introduction**

Medicine in 1996.

**exposure**