NOMAS® International Online Continuing Education
Online CEU instruction for Occupational Therapy, Speech Pathology and Nursing professionals
Welcome! These online courses focus on evaluation, treatment and therapeutic intervention in the NICU for neonates and subsequently for older infants and children who present with feeding disorders.

Individuals who provide services to these patients may come from a variety of educational and professional backgrounds but all have one goal in common: to resolve oral, pharyngeal, and esophageal phase swallowing and feeding disorders in the neonatal and pediatric populations. These courses are designed to help you meet that goal.

SERIES ONE - (Course of 11 talks)

"Neonatal and Pediatric Feeding Disorders: Evaluation and Treatment in the NICU and After Discharge."
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Course Description:

The 11 talks in this online course focus on feeding difficulties in term and preterm infants, evaluation and treatment of sensory and motor-based feeding problems after discharge from NICU or special care nursery, videofluoroscopic studies of infants and children showing examples, procedure and diagnosis, and weaning from tube to oral feeding using a sensory-based protocol.

The full course is made up of all 11 talks. Each talk runs about 1 hour. Talks may also be purchased and viewed individually with some exceptions. Please see CEU statements, below, for CEU details.
+ View SERIES ONE Courses Learning Outcomes, and Order Talks
    Series One Learning Outcomes:
  •  
  • Describe the changing anatomy and physiology of the infant oral mechanism and its impact on feeding.
  • Analyze disorganized and dysfunctional sucking patterns in the poor feeder as described by the NOMAS®.
  • Identify specific feeding problems in the NICU so as to implement Diagnostic-Based Intervention.
  • Differentiate sensory from motor-based feeding disorders.
  • Explain the relationship between gastroesophageal reflux and esophageal motility as it relates to the intake of solid food.
  • Discuss the Palmer Protocol for Sensory-Based Weaning from tube to oral feeding.
Presenter: Marjorie Meyer Palmer M.A., CCC-SLP

GRAPHIC Non-financial disclosure: founder and director of NOMAS® International; current member, the American Academy of Cerebral Palsy and the NIDCAP Federation International.

Financial disclosure: Ms. Palmer is financially compensated for teaching live courses on feeding and online continuing education courses on feeding. She conducts certification courses for the NOMAS® and administers the non-exclusive copyright license renewal program for NOMAS® Certified Professionals. She is sole distributor of the "Fantastic Feeding Dropper."
NOTE: Talk 2 may be taken alone but Talk 3 must be taken with Talk 2. Talk 9 may be taken alone but Talk 10 must be taken with Talk 9.

All 11 Series One Talks

GRAPHIC SPECIAL - Order all 11 talks in Series One for $375!

Introductory, intermediate and advanced material
($850 if taken individually)

1. Anatomy and Physiology of the Oral Mechanism: Reflexive to Volitional. $40. Introductory. Runs: 44:16

Course Objectives
1. List the Six Primitive Oral Reflexes.
2. Explain Changes in Oral Anatomy: Birth to Six Months.
3. Describe Volitional Bolus Transfer During the Management of Solid Food.
Describes anatomical/physiologic changes that occur during the first six months of life and beyond. Discussed: primitive oral reflexes, the first transition in feeding, and the development of the volitional bolus transfer. Participants will view changing oral-motor patterns from reflexive to volitional.

2. Evaluation of Neonatal Sucking Based upon the NOMAS®. $95. Advanced. Runs: 45:19

Course Objectives
1. List the Two Types of Normal Suck Patterns.
2. List Three Characteristics of Jaw & Tongue Movement in the Disorganized Suck.
3. Describe at least Four Characteristics of Dysfunctional Suck.
Introduces sucking patterns of the neonate based on the NOMAS®. Describes observable characteristics of jaw and tongue function during dysfunctional suck; coordination of suck / swallow / breathe; disorganized suck; and evaluation process.

3. Diagnostic Based Treatment for the Infant with Feeding Disorders (must be taken with #2). $190. Advanced (includes courses #2 and #3). Runs: 49:33

Course Objectives
1. Suggest Ways to Improve Neonatal Feeding in the NICU.
2. Difference between External Pacing and Regulation For the Disorganized Feeder.
3. Use of Therapeutic Techniques for the Dysfunctional Feeder.
Prescriptive treatment based on diagnosis of suck pattern. Discusses therapeutic techniques to improve feeding with infants who present with dysfunctional suck and intervention strategies for those infants with disorganized suck. Describes when use of particular techniques is contra-indicated.

4. Sensory and Motor Aspects of Neonatal Sucking. $55. Intermediate. Runs: 52:44

Course Objectives
1. Recognize the differences between motor and sensory disorders of neonatal sucking.
2. Identify four characteristics of a motor based feeding disorder.
3. Describe three types of sensory feeding problems.
View aspects of sensory/motor function during non-nutritive/nutritive suck. Discusses deviant oral-motor patterns; clinical signs of an “altered sensory system” including perseveration, habituation, poor adaptability; visceral hyperalgesia.

5. Dysphagia versus Prematurity. $75. Advanced. Runs: 43:26

Course Objectives
1. Describe the feeding difficulty for a premature infant with a disorganized suck.
2. Recognize the clinical signs of dysphagia.
3. Know when to appropriately refer for an MBS study.
View clinical and videofluoroscopic presentations of premature infants from 31 weeks PCA and compare their performance to infants with dysphagia secondary to such medical conditions as TEF, esophageal stricture, neurological issues, GER and dysmotility.

6. Neonatal and Pediatric Swallow Studies: Procedure, Interpretation, and Diagnosis. $95. Advanced. Runs: 41:34

Course Objectives
1. Properly Select Position, Utensil, And Consistencies For The MBS.
2. Describe The Oral, Pharyngeal, And Esophageal Phases Of Swallow.
3. Accurately Diagnose The Problem.
View a variety of modified barium swallow (MBS) studies with neonatal/pediatric patients; analyze oral, pharyngeal, esophageal phases of swallow; examples of dysphagia in all phases will be viewed.

7. Differential Diagnosis of Motor vs. Sensory-Based Feeding Disorders. $40. Introductory. Runs: 42:46

Course Objectives
1. Describe jaw and tongue movements of the child with hypertonicity.
2. Explain persistent oral-motor patterns in a child with hypotonicity.
3. Identify clinical signs of sensory-based oral feeding disorder.
Discusses deviant oral-motor patterns secondary to both oro-facial hypotonia and hypertonia; sensory-based oral feeding aversion; underlying etiologies; and differential diagnosis.

8. Treatment and Transitions for Sensory-Based Feeding Disorders. $65. Intermediate. Runs: 64:41

Course Objectives
1. Explain the use of "incremental progression" as a treatment strategy.
2. Outline the "wheat germ" program.
3. Identify clinical signs of sensory-based oral feeding disorder.
Introduction to “Incremental Progression” as a therapeutic intervention strategy for management of sensory-based oral feeding problems. Uses case studies to outline subtle changes in placement, volume, texture, utensils. Discusses the CHEW program for development of mastication; “Wheat Germ Program” for transition from pureed foods to solids.

9. Gastroesophageal Reflux and Esophageal Dysmotility: ID and Management, Part I. $95. Advanced. Runs: 57:51

Course Objectives
1. Describe the correlation between gastroesophageal reflux and esophageal dysmotility.
2. Conduct a competent clinical (bedside) feeding evaluation.
3. Accurately diagnose esophageal phase dysphagia when it is the underlying etiology of an oral feeding disorder.
Outlines types of GER; provides examples of relationship between GER/esophageal dsymotility; discusses clinical signs of esophageal dysmotility; view MBS studies.

10. Gastroesophageal Reflux and Esophageal Dysmotility: ID and Management, Part II (must be taken with #9). $185 (includes #9 and #10). Advanced. Runs: 36:02

Course Objectives
1. Describe the three types of gastroesophageal reflux.
2. Explain esophageal dysmotility and its impact on the transition onto solids.
3. Plan effective intervention strategies for progression onto solids.
Discusses therapeutic management for esophageal phase dysphagia using “Incremental Progression” to implement subtle changes in consistency, volume, bolus size while insuring adequate caloric intake/weight gain; provides review of underlying etiologies, preferred texture consistencies.

11. Weaning from Gastrostomy Tube onto Oral Feeding. $95. Advanced. Runs: 45:30

Course Objectives
1. Describe the process of transitioning from continuous drip feeding onto bolus.
2. Determine when it is appropriate to implement a 60-hour wean.
3. Be able to select the appropriate candidate for weaning.
Discusses the Palmer Protocol for Sensory-Based Weaning in detail; outlines five phases of progression; case studies presented.
This course is offered for .85 CEUs (Varied Level, Professional Area)
PIX

ASHA:
This course is offered for .85 ASHA CEUs (8.5 Contact Hours) (Varied Level, Professional Area)² for successful completion of the full course of 11 talks. ASHA does not offer credit for individual talks in this Series.

For successful completion a quiz must be passed for all 11 talks. To receive ASHA CEUs, the participant must download, fill out, and mail or FAX the CEU Participant Form (see below) OR just provide their ASHA Membership Number.
AOTA - Target Audience, Occupational Therapists:
This course is offered for .85 CEUs (8.5 Contact Hours) for successful completion (quizzes passed) of the full course. .15 CEUs (1.5 Contact Hours) is granted for successful completion (quizzes passed) of any two talks. AOTA does not endorse specific course content, products, or clinical procedures. Provider #6555.
California Board of Registered Nursing:
This course is offered for .85 CEUs (8.5 Contact Hours) for successful completion of the full course. .15 CEUs (1.5 Contact Hours) is granted for successful completion of any two talks. Provider #CEP 13879.

SERIES TWO - (Course of 12 talks)

"NOMAS® International Symposia Talks"
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Course Description:

The 12 talks in this online course focus on the etiology, diagnosis, and treatment of feeding difficulties in the term and preterm infant. Evaluation and treatment strategies for the “difficult to feed” infant both in the NICU or special care nursery are discussed as well as those feeding issues that persist after discharge.

The full course is made up of all 12 talks. Each talk runs about 1 hour. The talks may be viewed for CEU course credit either individually or as a group.
+ View SERIES TWO Courses Learning Outcomes, and Order Talks
GRAPHIC SPECIAL - Order all 12 talks in Series Two for $375!

Introductory, intermediate and advanced material
(Save $45)!

1. Diseases and medical conditions of the infant that interfere with successful feeding. $35. Intermediate instructional level. Runs: 53:00. CEU: .05

Botas Course Objectives
1. Identify infants at high risk for feeding difficulties.
2. Identify strategies for supporting successful feedings.
3. Identify infants appropriate for referral to a feeding specialist.
Learning Outcome:
Identify infants at risk for feeding difficulties and explain strategies for supporting successful feeding.
Carlos Botas M.D., Director, Neonatal Services Kaiser Permanente Medical Center; Associate Clinical Professor of Pediatrics, UC San Francisco School of Medicine. Dr. Botas has no financial or nonfinancial relationships to disclose.

2. Non-nutritive suck (NNS): measurement, context, and use in predicting feeding skills. $35. Advanced instructional level. Runs: 59:30. CEU: .1

Bingham Course Objectives
1. Understand rationale for measurement, and tools and validation for measuring non-nutritive suck in the NICU.
2. Understand qualitative and quantitative aspects of NNS ontogeny in premature newborns.
3. How NNS evaluation relates to feeding performance in light of immediate/contextual factors that influence NNS behavior.
Learning Outcome:
Describe the qualitative and quantitative aspects of NNS ontogeny in premature infants and how these relate to feeding performance.
Peter Bingham M.D. , Associate Professor of Neurology and Pediatrics, University of VT, Burlington, VT. Dr. Bingham has no financial or nonfinancial relationships to disclose.

3. Maturation of the gastrointestinal tract: when is baby ready to feed? $35. Advanced instructional level. Runs: 44:00. CEU: .05

Berseth Course Objectives
1. Describe the normal maturation of gastrointestinal motility in the premature.
2. Describe the normal maturation of digestion and absorption in the premature.
3. Describe disorders that impact upon the normal developmental process and interfere with feeding.
Learning Outcome:
Describe the normal maturation of gastrointestinal motility in the premature infant and identify disorders that impact the normal developmental process.
Carol Lynn Berseth, M.D. , Director, Medical Affairs North America, Mead Johnson Nutrition. Dr. Berseth is a salaried employee of Mead Johnson Nutrition and has no nonfinancial relationships to disclose.

4. Development of self-regulation in the NICU newborn. $35. Intermediate instructional level. Runs: 37:00. CEU: .05

VandenBerg Course Objectives
1. Describe self regulation and identify regulatory behaviors of full term newborns or less mature or premature newborns.
2. Describe factors which impact infant self regulation.
3. Identify and describe developmental recommendations to facilitate self regulation.
Learning Outcome:
Explain self-regulation in the newborn and describe factors that impact the development of regulatory behaviors.
Kathleen A. VandenBerg, PhD. , Master NIDCAP Trainer; Director, Neurodevelopmental Center Division of Neonatology, Department of Pediatrics, University of California San Francisco School of Medicine. Dr. VandenBerg has no financial or nonfinancial relationships to disclose.

5. Maturation of the premature infant: sleeping, breathing, and feeding. $35. Intermediate instructional level. Runs: 39:00. CEU: .05

Dusick Course Objectives
1. Identify the components of state, breathing, and oral control needed for feeding.
2. Correctly identify immature breathing and apnea that will interfere with feeding.
3. Identify risk factors for aspiration and how to diagnose aspiration.
Learning Outcome:
Describe the components of state, breathing, and feeding in the premature infant and identify risk factors for aspiration.
Anna Dusick, M.D. , formerly, Medical Director, Waisman Center; Visiting Professor of Pediatrics, University of Wisconsin School of Medicine and Public Health. Dr. Dusick has no financial or nonfinancial relationships to disclose.

6. Cue-based, co-regulated approach to feeding. $35. Intermediate instructional level. Runs: 38:00. CEU: .05

Thoyre Course Objectives
1. Describe the significance of focused feeding assessment.
2. Identify short-term effectiveness of using a co-regulated feeding approach with enhanced auditory assessment.
3. Describe the skill of infant oral feeding using a dynamic systems theory framework.
Learning Outcome:
Describe the skill of infant oral feeding using a focused feeding assessment.
Suzanne Thoyre, PhD. , Director, Doctoral and Post-Doctoral Programs; Associate Professor, University of North Carolina, Chapel Hill. Dr. Thoyre has no financial or nonfinancial relationships to disclose.

7. Kangaroo Care: Science underlying practice and issues of implementation. $35. Intermediate instructional level. Runs: 60:00. CEU: .1

Helm Course Objectives
1. Describe the literature that establishes importance of experience on the fetal brain.
2. Describe the benefits of kangaroo care for both infants and mothers.
3. Discuss the issues associated with early and often kangaroo care in high-tech nurseries.
Learning Outcome:
Explain the benefits of kangaroo care for both infants and mothers.
James M. Helm, PhD. , Infant Development Specialist, Clinical Assoc. Professor of Pediatrics, Adjunct Assistant Professor Special Education, University of North Carolina School of Medicine. Dr. Helm has no financial or nonfinancial relationships to disclose.

8. Effects of cranial shape and pharyngeal arch function in the preterm and high-risk infant. $35. Advanced instructional level. Runs: 87:00. CEU: .1

Chappel Course Objectives
1. Appreciate the impact of developmental care-giving on the synactive development of first order neurons and cranial nerves in response to head shape.
2. Discuss the neurodevelopmental differences between oral-tracheo and naso-tracheal intubation.
3. Plan appropriate care-giving strategies to impact synactive development of the head and neck areas.
Learning Outcome:
Describe the differences between oro-tracheo and naso-tracheal intubation and their impact on early feeding in the context of the synactive development of the head and neck.
John Chappel, M.A., RPT. , NIDCAP Certified Pediatric Physical Therapist, Morristown Memorial Hospital, Morristown, New Jersey. Mr. Chappel has no financial or nonfinancial relationships to disclose.

9. Olfaction: the unexplored sense and its relationship to early feeding. $35. Advanced instructional level. Runs: 68:20. CEU: .1

Bingham Course Objectives
1. Review basic neuroanatomy and developmental neurobiology of olfaction.
2. Discuss the ways in which odors affect newborn behavior.
3. Discuss how knowledge of these effects might contribute to supporting early growth and development of sick newborns.
Learning Outcome:
Explain the ways in which odors may affect newborn feeding performance.
Peter Bingham M.D. , Associate Professor of Neurology and Pediatrics, University of VT, Burlington, VT. Dr. Bingham has no financial or nonfinancial relationships to disclose.

10. Feeding in the typical newborn: breast feeding and bottle feeding, Part I $35. Intermediate instructional level. Runs: 66:00. CEU: .1

Dusick Course Objectives
1. Describe a typical feeding and the reasons it is efficient.
2. Describe how feeding matures for increased intake in the infant.
3. Identify problems that can occur with the flow rate of the feeding.
Learning Outcome:
Explain the maturation of feeding skills in the normal newborn.
Anna Dusick, M.D. , formerly, Medical Director, Waisman Center; Visiting Professor of Pediatrics, University of Wisconsin School of Medicine and Public Health. Dr. Dusick had no financial or nonfinancial relationships to disclose.

11. Feeding in the atypical newborn: breast feeding and bottle feeding, Part II $35. Intermediate instructional level. Runs: 63:00. CEU: .1

Dusick Course Objectives
1. Identify feeding problems that can be unsafe for the infant’s health.
2. Identify support to assist oral feeding in the infant with atypical development.
3. Explain using tube feedings in the least intrusive and most developmentally helpful manner to support growth in the infant with atypical development.
Learning Outcome:
Identify feeding problems in the atypical infant and describe the use of supportive interventions that may be used to assist the infant.
Anna Dusick, M.D. , formerly, Medical Director, Waisman Center; Visiting Professor of Pediatrics, University of Wisconsin School of Medicine and Public Health. Dr. Dusick had no financial or nonfinancial relationships to disclose.

12. Visceral hyperlgesia and esophageal dysmotility for solids in older infants secondary to gastroesophageal reflux. $35. Advanced instructional level. Runs: 42:00. CEU: .05

Palmer Course Objectives
1. Define characteristics and recognize visceral hyperalgesia in the older infant.
2. Explain correlation between gastroesophageal reflux and visceral hyperalgesia.
3. Understand why the feeding problems of these patients are often mis-diagnosed as “behavioral.”
Learning Outcome:
Describe the characteristics of visceral hyperalgesia and explain why infants with this condition are often mis-diagnosed as having behaviorally based feeding problems.
Marjorie Meyer Palmer, M.A., CCC-SLP, Neonatal/Pediatric Feeding Specialist. Ms. Palmer's disclosures can be found in the Series One Talks.
AOTA - Target Audience, Occupational Therapists:
This course is approved for .9 CEUs (1 contact hour is granted for successful completion (quizzes passed) of any two talks less than one (1) hour in length. Total course of all 12 talks is 9 contact hours (quizzes passed). AOTA Provider #6555. AOTA does not endorse specific course content, products, or clinical procedures. Provider #6555.
California Board of Registered Nursing:
This course is approved for .9 CEUs (1 contact hour is granted for successful completion of any two talks less than one (1) hour in length. Total course of all 12 talks is 9 contact hours. Provider #CEP 13879.
REFUNDS: Refunds may be requested for any reason but only if the course for which a refund is sought has not been accessed. A course is considered "accessed" when an initial login has been performed.

ACCESS PERIODS: Customers are reminded that courses must be accessed (initial login performed) within seven consecutive days of purchase. Once accessed, courses must be completed within another period of seven consecutive days following the initial access.

DISCONTINUATION: Courses offered on this website do not expire. If visibly for sale on this site, courses are viable for their access periods.

SERIES 3 - (Course of 2 talks)

"Clinics in Pediatric Feeding"
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Course Description:

This series addresses those challenging issues that frequently arise during feeding therapy with pediatric patients. Such issues include but are not limited to difficulty with the transition from liquids to pureed foods, an inability to transition onto age appropriate solids, lack of the development of mastication, and sensory-based feeding aversion. Each clinic addresses a primary issue and presents one or more case studies with evaluation results and treatment strategies for the remediation of the primary feeding problem. Other issues may be discussed that are beyond the scope of the main subject but are important considerations when providing feeding therapy. These may include issues such as inadequate tongue base retraction, pharyngeal pooling, gastroesophageal reflux, esophageal dysmotility, and/or a hypersensitive gag resulting in a sensory-based oral feeding aversion.
+ View SERIES THREE Courses Learning Outcomes, and Order Talks
    Series Three Learning Outcomes:
  •  
  • List a minimum of three etiologies that underlie a sensory-based oral feeding aversion.
  • Identify two characteristics of feeding difficulty that occur during the esophageal phase of swallow.
  • Describe three variables that can be modified as part of a feeding program to help a child make the transition from liquids to pureed foods.
  • List two oral-motor issues and two oral-sensory issues that interfere with the successful transition from pureed food to solids.
  • Explain the Feeding Transition Readiness assessment tool.
  • Define three different categories of foods that may be used in a feeding program.
Presenter: Marjorie Meyer Palmer M.A., CCC-SLP

GRAPHIC Non-financial disclosure: founder and director of NOMAS® International; current member, the American Academy of Cerebral Palsy and the NIDCAP Federation International.

Financial disclosure: Ms. Palmer is financially compensated for teaching live courses on feeding and online continuing education courses on feeding. She conducts certification courses for the NOMAS® and administers the non-exclusive copyright license renewal program for NOMAS® Certified Professionals. She is sole distributor of the "Fantastic Feeding Dropper."

1. Transition from Liquids to Pureed Food and Beyond. Cost: $105. Runs: 1 hour. Offered for 0.1 CEUs.

Course Objectives
1. List a minimum of three etiologies that underlie a sensory-based oral feeding aversion.
2. Identify two characteristics of feeding difficulty that occur during the esophageal phase of swallow.
3. Describe three variables that can be modified as part of a feeding program to help a child make the transition from liquids to pureed foods.
This course focuses on the evaluation and treatment of children who have not yet been able to transition from liquids to pureed foods. A therapeutic program is outlined and a checklist is provided for data collection. Five pages of downloadable handouts are included.

2. Transition from Pureed Food to Solids. Cost: $135. Runs: 2 hours. Offered for 0.2 CEUs.

Course Objectives
1. List two oral-motor issues and two oral-sensory issues that interfere with the successful transition from pureed food to solids.
2. Explain the Feeding Transition Readiness assessment tool.
3. Define three different categories of foods that may be used in a feeding program.
This course discusses the child who has not yet made the transition from pureed food to solids and outlines both sensory and motor issues. Treatment strategies are outlined and a Feeding Transition Readiness tool is explained and included in the five pages of handouts.
ASHA Approved Provider

ASHA:
​Course #1: "Transition from Liquids to Pureed Food and Beyond" is offered for 0.1 ASHA CEUs (Intermediate Level; Professional Area).
Course #2: "Transition from Pureed Food to Solids" is offered for 0.2 ASHA CEUs (Intermediate Level; Professional Area).

For successful completion, a quiz must be passed. To receive ASHA CEUs, the participant must download, fill out, and mail or FAX the CEU Participant Form (see below) OR just provide their ASHA Membership Number.

ASHA CEU Credits

Form download and submission information
+ Download / Submit ASHA CEU Application Form MUST be submitted to receive ASHA CEU credits.

ASHA CEU Application Form


The ASHA CEU Participant form is in PDF format. Adobe Reader is required to view and print the form. If you do not have Reader on your computer, it is available as a quick download, free of charge, from Adobe software.

INSTRUCTIONS:
Download the ASHA CEU FORM.
Print, fill-out and fax completed form to: 831-623-9007 OR mail form to:

Therapeutic Media
1528 Merrill Road
San Juan Bautusta, CA 95045-9602.

Therapeutic Media will forward completed forms to ASHA along with course results. ASHA CEU credit will not be given unless the CEU form is completed and submitted.

Fantastic Feeding Dropper

Order the "Fantastic Feeding Dropper" From Therapeutic Media
Aid for problematic feeders. Dropper goes into mouth, baby opens mouth, baby starts to suck with cupped tongue.
Dropper
  •  
  • Delivers small boluses of 1-ml or less
  • Does not require an open mouth to deliver oral nutrition
  • Useful for thin liquid, thickened liquid, pureed foods
  • Soft, pliable, easy to bite and chew
  •  
Droppers are individually wrapped and sterile. Can be re-used easily. Droppers are $2.00 each, sold in batches of five. Minimum order is 5; maximum order is 25. Prices include $5.00 for shipping/handling.

5-Pack ($15)10-pack ($25)15-pack ($35)20-pack ($45)25-pack ($55)