Search results for: secondary primary cancers

Authors: A. Kherraf, M. Bouziane, L. Azzouzi, R. Habbal

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Introduction: Hypocalcaemia is a rare cause of heart failure. We report the clinical case of a young patient with reversible dilated cardiomyopathy secondary to hypocalcaemia in the context of hyperparathyroidism. Clinical case: We report the clinical case of a 23-year-old patient with a history of thyroidectomy for papillary thyroid carcinoma 3 years previously, who presented to the emergency room with a progressive onset dyspnea and edema of the lower limbs. Clinical examination showed hypotension at 90/70 mmHg, tachycardia at 102 bpm, and edema of the lower limbs. The ECG showed a regular sinus rhythm with a prolonged corrected QT interval to 520ms. The chest x-ray showed cardiomegaly. Echocardiography revealed dilated cardiomyopathy with biventricular dysfunction and a left ventricular ejection fraction of 45%, as well as moderate mitral insufficiency by restriction of the posterior mitral leaflet, moderate tricuspid insufficiency, and a dilated inferior vena cava with a pulmonary arterial pressure estimated at 46 mmHg. Blood tests revealed severe hypocalcemia at 38 mg / l with normal albumin and thyroxine levels, as well as hyperphosphatemia and increased TSH. The patient received calcium intake and vitamin D supplementation and was treated with beta blockers, ACE inhibitors, and diuretics with good progress and progressive normalization of cardiac function. Discussion: The cardiovascular manifestations of hypocalcaemia usually appear with deeply low serum calcium levels. This can lead to hypotension, arrhythmias, ventricular fibrillation, prolonged QT interval, or even heart failure. Heart failure is a rare and serious complication of hypocalcemia but most often characterized by complete normalization of myocardial function after treatment. The etiology of the hypocalcaemia, in this case, was probably related to accidental parathyroid removal during thyroidectomy. This is why careful monitoring of calcium levels is recommended after surgery. Conclusion: Hypocalcemic heart failure is rare but reversible heart disease. Systematic monitoring of serum calcium should be performed in all patients after thyroid surgery to avoid any complications related to hypoparathyroidism.

Keywords: hypocalcemia, heart failure, thyroid surgery, hypoparathyroidism

Procedia PDF Downloads 125

Authors: Ramanen Sugunesegran, Michael L. Williams

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Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term term data for RMVr. Electronic searches of five databases were performed to identify all relevant studies reporting minimum 5-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and freedom from moderate or worse mitral regurgitation (MR) at 5-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-years were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at 8-years post RMVr was 95.0%. Freedom from moderate or worse MR at 7-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and freedom from moderate or worse MR recurrence.

Keywords: mitral valve disease, mitral valve repair, robotic cardiac surgery, robotic mitral valve repair

Procedia PDF Downloads 68

Authors: Mahesh Kumar Jat, Manisha Choudhary

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Rapid population and economic growth resulted in changes in large-scale land use land cover (LULC) changes. Changes in the biophysical properties of the Earth's surface and its impact on climate are of primary concern nowadays. Different approaches, ranging from location-based relationships or modelling earth surface - atmospheric interaction through modelling techniques like surface energy balance (SEB) have been used in the recent past to examine the relationship between changes in Earth surface land cover and climatic characteristics like temperature and precipitation. A remote sensing-based model i.e., Surface Energy Balance Algorithm for Land (SEBAL), has been used to estimate the surface heat fluxes over Mahi Bajaj Sagar catchment (India) from 2001 to 2020. Landsat ETM and OLI satellite data are used to model the SEB of the area. Changes in observed precipitation and temperature, obtained from India Meteorological Department (IMD) have been correlated with changes in surface heat fluxes to understand the relative contributions of LULC change in changing these climatic variables. Results indicate a noticeable impact of LULC changes on climatic variables, which are aligned with respective changes in SEB components. Results suggest that precipitation increases at a rate of 20 mm/year. The maximum and minimum temperature decreases and increases at 0.007 ℃ /year and 0.02 ℃ /year, respectively. The average temperature increases at 0.009 ℃ /year. Changes in latent heat flux and sensible heat flux positively correlate with precipitation and temperature, respectively. Variation in surface heat fluxes influences the climate parameters and is an adequate reason for climate change. So, SEB modelling is helpful to understand the LULC change and its impact on climate.

Keywords: remote sensing, GIS, object based, classification

Procedia PDF Downloads 104

Authors: Mercy Marimirofa, Farai Machinga, Alfred Zvoushe, Tsitsidzaishe Musvosvi

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The Government of Zimbabwe embarked on integrating family planning with Sexually Transmitted Infection (STI) and Human Immunodeficiency Virus (HIV) services in May 2020 with support from the World Health Organization (WHO). There was high HIV prevalence, incidence rates and STI infections among women attending FP clinics. Spilhaus is a specialized center of excellence clinic which offers a range of sexual reproductive health services. HIV services were limited to testing only, and clients were referred to other facilities for further management. Integration of services requires that all the services be available at one point so that clients will access them during their visit to the facility. Objectives: The study was conducted to assess the impact the one-stop-shop model has made in accessing integrated Family Planning services and sexual reproductive health services compared to the supermarket approach. It also assessed the relationship family planning services have with other sexual reproductive health services. Methods: A secondary data analysis was conducted at Spilhaus clinic in Harare using family planning registers and HIV services registers comparing years 2019 and 2021. A 2 sample t-test was used to determine the difference in clients accessing the services under the two models. A Spearman’s rank correlation was used to determine if accessing family planning services has a relationship with other sexual reproductive health services. Results: In 2019, 7,548 clients visited the Spilhaus clinic compared to 8,265 during the period January to December 2021. The median age for all clients accessing services was 32 years. An increase of 69% in the number of services accessed was recorded from 2019 to 2021. More services were accessed in 2021. There was no difference in the number of clients accessing family planning services cervical cancer, and HIV services. A difference was found in the number of clients who were offered STI screening services. There was also a relationship between accessing family planning services and STI screening services (ρ = 0.729, p-value=0.006). Conclusion: Programming towards SRH services was a great achievement, the use of an integrated approach proved to be cost-effective as it minimised the required resources for separate programs. Clients accessed important health needs at once. The integration of these services provided an opportunity to offer comprehensive information which addressed an individual’s sexual reproductive health needs.

Keywords: intergration, one stop shop, family planning, reproductive health

Procedia PDF Downloads 45

Authors: Saniye Çeşmecioğlu

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The importance of project sustainability and success has become increasingly significant due to the proliferation of external environmental factors that have decreased project resistance in contemporary times. The primary approach to forestall the failure of projects is to ensure their long-term viability through the strategic selection of projects as creating judicious project selection framework within the organization. Decision-makers require precise decision contexts (models) that conform to the company's business objectives and sustainability expectations during the project selection process. The establishment of a rational model for project selection enables organizations to create a distinctive and objective framework for the selection process. Additionally, for the optimal implementation of this decision-making model, it is crucial to establish a Project Management Office (PMO) team and Project Steering Committee within the organizational structure to oversee the framework. These teams enable updating project selection criteria and weights in response to changing conditions, ensuring alignment with the company's business goals, and facilitating the selection of potentially viable projects. This paper presents a multi-criteria decision model for selecting project sustainability and project success criteria that ensures timely project completion and retention. The model was developed using MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique) and was based on broadcaster companies’ expectations. The ultimate results of this study provide a model that endorses the process of selecting the appropriate project objectively by utilizing project selection and sustainability criteria along with their respective weights for organizations. Additionally, the study offers suggestions that may ascertain helpful in future endeavors.

Keywords: project portfolio management, project selection, multi-criteria decision making, project sustainability and success criteria, MACBETH

Procedia PDF Downloads 45

Authors: Amare Setegn Enyew, Bikila Teklu Wodajo

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The primary aim of flexible pavement design is to ensure the development of economical and safe road infrastructure. However, failures can still occur due to improper or erroneous structural design. In Ethiopia, the design of flexible pavements relies on doing calculations manually and selecting pavement structure from catalogue. The catalogue offers, in eight different charts, alternative structures for combinations of traffic and subgrade classes, as outlined in the Ethiopian Roads Authority (ERA) Pavement Design Manual 2001. Furthermore, design modification is allowed in accordance with the structural number principles outlined in the AASHTO 1993 Guide for Design of Pavement Structures. Nevertheless, the manual calculation and design process involves the use of nomographs, charts, tables, and formulas, which increases the likelihood of human errors and inaccuracies, and this may lead to unsafe or uneconomical road construction. To address the challenge, a software called AASHERA has been developed for AASHTO 1993 and ERA design methods, using MATLAB language. The software accurately determines the required thicknesses of flexible pavement surface, base, and subbase layers for the two methods. It also digitizes design inputs and references like nomographs, charts, default values, and tables. Moreover, the software allows easier comparison of the two design methods in terms of results and cost of construction. AASHERA's accuracy has been confirmed through comparisons with designs from handbooks and manuals. The software can aid in reducing human errors, inaccuracies, and time consumption as compared to the conventional manual design methods employed in Ethiopia. AASHERA, with its validated accuracy, proves to be an indispensable tool for flexible pavement structure designers.

Keywords: flexible pavement design, AASHTO 1993, ERA, MATLAB, AASHERA

Procedia PDF Downloads 46

Authors: M. K. Witek-Hajduk, T. M. Napiórkowski

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A number of studies discussed the topic of benefits of retailers-manufacturers cooperation and coopetition. However, there are only few publications focused on the benefits of cooperation and coopetition between retailers and their suppliers of durable consumer goods; especially in the context of business model of cooperating partners. This paper aims to provide a clustering approach to segment retailers selling consumer durables according to the benefits they obtain from their cooperation with key manufacturers and differentiate the said retailers’ in term of the business models of cooperating partners. For the purpose of the study, a survey (with a CATI method) collected data on 603 consumer durables retailers present on the Polish market. Retailers are clustered both, with hierarchical and non-hierarchical methods. Five distinctive groups of consumer durables’ retailers are (based on the studied benefits) identified using the two-stage clustering approach. The clusters are then characterized with a set of exogenous variables, key of which are business models employed by the retailer and its partnering key manufacturer. The paper finds that the a combination of a medium sized retailer classified as an Integrator with a chiefly domestic capital and a manufacturer categorized as a Market Player will yield the highest benefits. On the other side of the spectrum is medium sized Distributor retailer with solely domestic capital – in this case, the business model of the cooperating manufactrer appears to be irreleveant. This paper is the one of the first empirical study using cluster analysis on primary data that defines the types of cooperation between consumer durables’ retailers and manufacturers – their key suppliers. The analysis integrates a perspective of both retailers’ and manufacturers’ business models and matches them with individual and joint benefits.

Keywords: benefits of cooperation, business model, cluster analysis, retailer-manufacturer cooperation

Procedia PDF Downloads 239

Authors: JinWoog Lee, SeongHyeok Lee, ChanYong Choi, Yujin Lim, Hojin Cho

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Primary function of the trackbed in a conventional railway track system is to decrease the stresses in the subgrade to be in an acceptable level. A properly designed trackbed layer performs this task adequately. Many design procedures have used assumed and/or are based on critical stiffness values of the layers obtained mostly in the field to calculate an appropriate thickness of the sublayers of the trackbed foundation. However, those stiffness values do not consider strain levels clearly and precisely in the layers. This study proposes a method of computation of stiffness that can handle with strain level in the layers of the trackbed foundation in order to provide properly selected design values of the stiffness of the layers. The shear modulus values are dependent on shear strain level so that the strain levels generated in the subgrade in the trackbed under wheel loading and below plate of Repeated Plate Bearing Test (RPBT) are investigated by finite element analysis program ABAQUS and PLAXIS programs. The strain levels generated in the subgrade from RPBT are compared to those values from RC (Resonant Column) test after some consideration of strain levels and stress consideration. For comparison of shear modulus G obtained from RC test and stiffness moduli Ev2 obtained from RPBT in the field, many numbers of mid-size RC tests in laboratory and RPBT in field were performed extensively. It was found in this study that there is a big difference in stiffness modulus when the converted Ev2 values were compared to those values of RC test. It is verified in this study that it is necessary to use precise and increased loading steps to construct nonlinear curves from RPBT in order to get correct Ev2 values in proper strain levels.

Keywords: modulus, plate load test, resonant column test, trackbed foundation

Procedia PDF Downloads 478

Authors: Hammam Aljabri, Hong G. Im

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Hydrogen is a promising future fuel to support the transition of the energy sector toward carbon neutrality. The direct utilization of H2 in Internal Combustion Engines (ICEs) is possible, and this technology faces mainly two challenges; high NOx emissions and severe knocking at mid to high loads. In this study, we numerically investigated the potential of H2 combustion in a truck-size engine operated in SI mode. To mitigate the knocking nature of H2 combustion, we have focused on studying the effects of three primary parameters; the compression ratio (CR), the air-fuel ratio, and the spark time. The baseline case was set using a CR of 16.5 and an equivalence ratio of 0.35. In simulations, the auto-ignition tendency was evaluated based on the maximum pressure rise rate and the local pressure fluctuations at the monitoring points set along the wall of the combustion chamber. To mitigate the auto-ignition tendency while enabling a wider range of engine operation, the effect of lowering the compression ratio was assessed. The results indicate that by lowering the compression ratio from 16.5:1 to 12.5:1, an indicated thermal efficiency of 47.5% can be achieved. Aiming to restrain the auto-ignition while maintaining good efficiency, a reduction in the equivalence ratio was examined under different compression ratios. The result indicates that higher compression ratios will require lower equivalence ratios, and due to practical limitations, a lower equivalence ratio of 0.25 was set as the limit. Using a compression ratio of 13.5 combined with an equivalence ratio of 0.3 resulted in an indicated thermal efficiency of 48.6%, that is, at a fixed spark time. It is found that under such lean conditions, the incomplete combustion losses and exhaust losses were high. Thus, advancing the spark time was assessed as a possible solution. The results demonstrated the advantages of advancing the spark time, where an indicated thermal efficiency exceeding 50% was achieved using a compression ratio of 14.5:1 and an equivalence ratio of 0.25.

Keywords: hydrogen, combustion, engine knock, SI engine

Procedia PDF Downloads 114

Authors: Kai-Shiang Chang, Shiao-Shing Chen, Saikat Sinha Ray, Hung-Te Hsu

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In recent years, membrane bioreactors (MBR) have been widely utilized as it can effectively replace conventional activated sludge process (CAS). Membrane bioreactor (MBR) is found to be more effective technology compared to other conventional activated sludge process and advanced membrane separation technique. Additionally, as far as the MBR is concerned, it is having excellent control of sludge retention time (SRT) and hydraulic retention time (HRT) and conducive to the retention of high concentration of sludge biomass. The membrane bioreactor (MBR) can effectively reduce footprint in terms of area and omit the secondary processing procedures in the conventional activated sludge process (CAS). Currently, as per the membrane technology, the ceramic membrane is found to have highly strong anti-acid-base properties, and it is more suitable than polymeric membrane while using for backwash and chemical cleaning. This study is based upon the treatment of Cutting Fluid wastewater, as the Cutting Fluid is widely used in the cutting equipment. However, the Cutting Fluid wastewater is very difficult to treat. In this study, the ceramic membrane was used and combine with of MBR system to treat the Cutting Fluid wastewater. In this present study, different kind of chemical coagulants have been utilized for pretreatment purpose in order to get the supernatant and simultaneously this wastewater (supernatant) was treated by MBR process. Nevertheless, ceramic membrane has three advantages such as high mechanical strength, drug resistance and reuse. During the experiment, the backwash technique was used for every interval of 10 minutes in order to avoid fouling of the membrane. In this study, during pretreatment the Chemical Oxygen Demand (COD) removal efficiency was found to be 71-86% and oil removal efficiency was analyzed to be 83-92%. This pretreatment study suggests that it is quiet effective methodology to reduce COD and oil concentration. Finally, In the MBR system when the HRT is more than 7.5 hour, the COD removal efficiency was found to be 87-93% and could achieve 100% oil removal efficiency. Coagulation test series were seen in Refs coagulants for the treatment of wastewater containing cutting oil with better oil and COD removal efficiency. The results also showed that the oil removal efficiency in the MBR system could reduce the oil content to less than 1 mg / L when the oil quality was 126 mg / L. Therefore, in this paper, the performance of membrane bioreactor by utilizing ceramic membrane has been demonstrated for treatment of Cutting Fluid wastewater.

Keywords: membrane bioreactor, cutting fluid, oil, chemical oxygen demand

Procedia PDF Downloads 292

Authors: Manuela S. Tolentino, John G. Nepomuceno

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The purpose of this investigation was to assess the implementation of inclusive education (IE) in 6 elementary and 5 secondary public schools in the City Schools Division of Dasmarinas. Participants in this study were 11 school heads, 73 teachers, 22 parents and 22 students (regular and with special needs) who were selected using purposive sampling. A 30-item questionnaire was used to gather data on the extent of the implementation of IE in the division while focus group discussion (FGD) was used to gather insights on what facilitate and hinder the implementation of the IE program. This study assessed the following variables: school culture and environment, inclusive education policy implementation, and curriculum design and practices. Data were analyzed using frequency count, mean and ranking. Results revealed that participants have similar assessment on the extent of the implementation of IE. School heads rated school culture and environment as highest in terms of implementation while teachers and pupils chose curriculum design and practices. On the other hand, parents felt that inclusive education policies are implemented best. School culture and environment are given high ratings. Participants perceived that the IE program in the division is making everyone feel welcome regardless of age, sex, social status, physical, mental and emotional state; students with or without disability are equally valued, and students help each. However, some aspects of the IE program implementation are given low ratings namely: partnership between staff, parents and caregivers, school’s effort to minimize discriminatory practice, and stakeholders sharing the philosophy of inclusion. As regards education policy implementation, indicators with the highest ranks were school’s effort to admit students from the locality especially students with special needs, and the implementation of the child protection policy and anti-bullying policy. The results of the FGD revealed that both school heads and teachers possessed the welcoming gesture to accommodate students with special needs. This can be linked to the increasing enrolment of SNE in the division. However, limitations of the teachers’ knowledge on handling learners, facilities and collaboration among stakeholders hinder the implementation of IE program. Based on the findings, inclusion program framework was developed for program enhancement. This will be the basis for the improvement of the program’s efficiency, the relationship between stakeholders, and formulation of solutions.

Keywords: inclusion, inclusive education, framework, special education

Procedia PDF Downloads 154

Authors: Auezhan Amanov, Inho Cho, Young-Sik Pyun

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Control element drive mechanism (CEDM) nozzle is manufactured as welded on the reactor vessel and currently uses Alloy 690 material. The top of the reactor is equipped with about 100 CEDM nozzles with an internal diameter of about 70 mm. Relatively large Inlet/Outlet nozzles are equipped with two outlet nozzles and four inlet nozzles on the reactor wall. The inner diameter of the nozzle is vulnerable to stress corrosion cracking (SCC), and in order to solve this problem, an ultrasonic nanocrystal surface modification (UNSM) treatment is performed on the inner diameter of the nozzle and the weld surface. The ultimate goal is to improve the service life of parts by applying compressive residual stress and suppressing primary water stress corrosion cracking (PWSCC). The main purpose is to design and fabricate a UNSM treatment device for the internal diameter processing of CEDM nozzles and inlet/outlet nozzles. In order to develop the system, the basic technology such as the development of UNSM tooling is developed and the mechanical properties and fatigue performance of before and after UNSM treatment of reactor nozzle material made of Ni-based alloys using the specimen are compared and evaluated. The inner diameter of the nozzle was treated by a newly developed UNSM treatment under the optimized treatment parameters. It was found that the mechanical properties and fatigue performance of nozzle were improved in comparison with the untreated nozzle, which may be attributed to the increase in hardness, induced compressive residual stress.

Keywords: control element drive mechanism nozzle, fatigue, Ni-based alloy, ultrasonic nanocrystal surface modification, UNSM

Procedia PDF Downloads 94

Authors: Martial Amou

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This study was carried out to assess the situation of households’ livelihood under a changing climate pattern in the Zio district of Togo, West Africa. The study examined three important aspects: (i) assessment of households’ livelihood situation under a changing climate pattern, (ii) farmers’ perception and understanding of local climate change, (iii) determinants of adaptation strategies undertaken in cropping pattern to climate change. To this end, secondary sources of data, and survey data collected from 235 farmers in four villages in the study area were used. Adapted conceptual framework from Sustainable Livelihood Framework of DFID, two steps Binary Logistic Regression Model and descriptive statistics were used in this study as methodological approaches. Based on Sustainable Livelihood Approach (SLA), various factors revolving around the livelihoods of the rural community were grouped into social, natural, physical, human, and financial capital. Thus, the study came up that households’ livelihood situation represented by the overall livelihood index in the study area (34%) is below the standard average households’ livelihood security index (50%). The natural capital was found as the poorest asset (13%) and this will severely affect the sustainability of livelihood in the long run. The result from descriptive statistics and the first step regression (selection model) indicated that most of the farmers in the study area have clear understanding of climate change even though they do not have any idea about greenhouse gases as the main cause behind the issue. From the second step regression (output model) result, education, farming experience, access to credit, access to extension services, cropland size, membership of a social group, distance to the nearest input market, were found to be the significant determinants of adaptation measures undertaken in cropping pattern by farmers in the study area. Based on the result of this study, recommendations are made to farmers, policy makers, institutions, and development service providers in order to better target interventions which build, promote or facilitate the adoption of adaptation measures with potential to build resilience to climate change and then improve rural livelihood.

Keywords: climate change, rural livelihood, cropping pattern, adaptation, Zio District

Procedia PDF Downloads 306

Authors: Mihretu Erjabo

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Halaba special district is characterized by drought, soil erosion, high population pressure, poor livestock production, lack of feed for livestock, very deep water table, very low productivity of crops and food insufficiency. In order to address these problems, the woreda agricultural development office along with other management practices such as soil physical conservation measures agroforestry was introduced decades ago as a means to alleviate the problem. However, the level of agroforestry adoption remains low. Objective of this study was to identify the factors that influence adoption of agroforestry technologies by farmers in the district. Random sampling was employed to select two kebele administrations and respondents. Data collection was conducted by rural household questionnaire survey, participatory rural appraisal, questionnaires for local and woreda extension staff, secondary data resources and field observation. A sample of 12 key informants, 6 extension staffs, and 182 households, were used in the data collection. Chi square test used to determine significant relationships between adoption of agroforestry and 15 selected variables. Out of which eleven were found to be significant to affect farmers’ adoptiveness. These were frequency of visits of farmers (13.39%), participation in training (11.49%), farmers’ attitude towards agroforestry practices (10.61%), frequency of visits of extensionists (10.38%), participation in extension meeting (10.34%), participation in field day (10.28%), land holding size (9.29%), level of literacy (8.78%), awareness about the importance of agroforestry technology packages (7.06%), time taken from their residence to nearest extension (5.04%) and gender of respondents (3.34%). This study also identified various factors that result in low adoption rates of agroforestry including fear of competition, seedling, rainfall and labour shortage, free grazing, financial problem, expecting trees as soil degrader and long span of trees and lack of need ranking. To improve farmers’ adoption, the factors identified should be well addressed by launching a series and recurrent outreach extension program appropriate and suitable to farmers need.

Keywords: farmers attitude, farmers participation, soil degradation, technology packages

Procedia PDF Downloads 141

Authors: Prem Bahadur Giri, Trilochana Pokhrel

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The nationalization of forest during early 1960s had become a counterproductive for the conservation of forest in Nepal. Realizing this fact, the Government of Nepal initiated a paradigm shift from government-controlled forestry system to people’s direct participation for managing forestry, conceptualizing community forest approach in the early 1980s. The community forestry approach is expected to promote sustainable forest management, restoring degraded forests for enhancing the forest condition on one hand, and on the other, improvement of livelihoods, particularly of low-income people and forest dependent communities, as well as promoting community ownership to forest. As a result, establishment of community forests started and had taken faster momentum in Nepal. Of the total land in Nepal, forest occupies 6.5 million hectares which is around 45 percent of the forest area. Of the total forest area 1.8 million hectarehas been handed-over to community management. A total of 19,361 ‘community forest users groups’ are already created to manage the community forest.Tostreamlinethe governance of community forest, the enactment of ‘Forest Act 1993’ provides a clear legal basis for managing community forest in Nepal. This article is based on an in-depth study taking a case of Tarpakha Community Forest (TCF) located in Siranchok Rural Municipality of Gorkha District in Nepal. It mainly discusses on to extent the TCF able to achieve twin objectives of this community forest for catalyzing socio-economic improvement of the targeted community and conservation of forest. The primary information was generated through in-depth interviews along with group discussion with members, management committee, and other relevant stakeholders. The findings reveal that there is significant improvement of regeneration of forest and also changes in the socio-economic status of local community. However, coordination with local municipality and forest governing entities is still weak.

Keywords: community forest, nepal, socio-economic benefit, sustainable forest management

Procedia PDF Downloads 58

Authors: Aamir Hasan, Subhash Mishra

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The purpose of the study was to determine the key drivers which influence the shopping behavior of the customers in the retail store. In today‟s competitive world with increasing number of retail stores, the retailers need to be more customer oriented. Retail has changed and expanded in all lines of business, be it apparel,jewelry, footwear, groceries etc. The modern consumer is posing a challenging task for the Indian retailer. More aware, more confident and much more demanding, therefore the retailers are looking for ways to deliver better consumer value and to increase consumer purchase intention. Retailers tend to differentiate themselves by making their service easier to consumers. The study aims to study the key drivers that can influence shopping behavior in retail store. A survey (store intercept) method was employed to elicit primary information from 300 shoppers in different retail stores of Lucknow. The findings reveal the factors that play a greater role in influencing the shopping behavior of customers in retail store. As such, a survey of retail store customers‟ attitude towards reduced price, sales promotion, quality of the products, proximity to the home, customer service, store atmospherics were analyzed to identify the key drivers influencing shopping behavior in retail store. A questionnaire based on a five-item Likert scale, as well as random sampling, was employed for data collection. Data analysis was accomplished using SPSS software. The paper has found shopping experience, store image and value for money as three important variable out of which shopping experience emerged as a dominant factor which influences the consumer's shopping behavior in the retail store. Since the research has established empirical evidences in determining the key drivers which influences the shopping behavior of the customers in the retail store, it serves as a foundation for a deeper probe into the shopping behavior of the customers in the retail store research domain in the Indian context.

Keywords: retail, shopping, customers, questionnaire

Procedia PDF Downloads 402

Authors: Geetika Vajpayee, Sugandha Asthana, Pratibha Kumari, Shanthy Sundaram

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Pseudomonas species possess a variety of promising properties of antifungal and growth promoting activities in the wheat plant. In the present study, Pseudomonas fluorescens MTCC-9768 is tested against plant pathogenic fungus Tilletia indica, causing Karnal bunt, a quarantine disease of wheat (Triticum aestivum) affecting kernels of wheat. It is one of the 1/A1 harmful diseases of wheat worldwide under EU legislation. This disease develops in the growth phase by the spreading of microscopically small spores of the fungus (teliospores) being dispersed by the wind. The present chemical fungicidal treatments were reported to reduce teliospores germination, but its effect is questionable since T. indica can survive up to four years in the soil. The fungal growth inhibition tests were performed using Dual Culture Technique, and the results showed inhibition by 82.5%. The interaction of antagonist bacteria-fungus causes changes in the morphology of hyphae, which was observed using Lactophenol cotton blue staining and Scanning Electron Microscopy (SEM). The rounded and swollen ends, called ‘theca’ were observed in interacted fungus as compared to control fungus (without bacterial interaction). This bacterium was tested for its antagonistic activity like protease, cellulose, HCN production, Chitinase, etc. The growth promoting activities showed increase production of IAA in bacteria. The bacterial secondary metabolites were extracted in different solvents for testing its growth inhibiting properties. The characterization and purification of the antifungal compound were done by Thin Layer Chromatography, and Rf value was calculated (Rf value = 0.54) and compared to the standard antifungal compound, 2, 4 DAPG (Rf value = 0.54). Further, the in vivo experiments showed a significant decrease in the severity of disease in the wheat plant due to direct injection method and seed treatment. Our results indicate that the extracted and purified compound from the antagonist bacteria, P. fluorescens MTCC-9768 may be used as a potential biocontrol agent against T. indica. This also concludes that the PGPR properties of the bacteria may be utilized by incorporating it into bio-fertilizers.

Keywords: antagonism, Karnal bunt, PGPR, Pseudomonas fluorescens

Procedia PDF Downloads 379

Authors: Diab Z., Hamad A., Dixit A., Al-Rikabi M., Keshaverzi F.

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Introduction: According to the NICE guidelines, 2020Prasugrel is the recommended first line treatment in adults with acute coronary syndromes (ACS) in patients with ST-segment-elevation myocardial infarction (STEMI), defined as ST elevation or new left bundle branch block on ECG , that cardiologists intend to treat with primary percutaneous coronary intervention (PCI). The current literature suggests that this is largely due to safety and efficacy, and cost effectiveness. We wanted to do an audit to examine the adherence of the MRI hospital with guidelines in using prasugrel as first-line therapy in patients with STEMI and undergoing PPCI. AIM: To examine the adherence of the MRI hospital with guidelines in using prasugrel as first-line therapy in patients with STEMI and undergoing PPCI Methods: We looked at the patients presented to MRI during1^st of January 2022 to 28th February 2022. We included all the people who were above 18 and were brought to the hospital through the PPCI pathway and diagnosed as ACS and underwent PPCI. We excluded Patients who were brought to the hospital through the PPCI pathway and underwent coronary angiography and their diagnosis was found other than STEMI or if the outcome was death before discharge or they were above age >75 (as per guideline increase bleeding risk of prasugrel in a person aged 75 or older). Results: The total number of patients was 100. There were a total of seventy patients who had STEMI and fit the criteria for inclusion. Out of these, only 72.9% (51) were given Prasugrel as a first line. Seventeen (17) 24.3% STEMI patients were candidates for prasugrel as first-line therapy but were instead offered (clopidogrel/ticagrelor). Two 2 (2.9%) STEMI patients were not given prasugrel as first-line therapy because of C/I (CVA) or the use of anticoagulant Nine 9 (9%) of them died before discharge. Eleven 11 (11%) were above the age of 75. Ten 10 (10%) of patients had a diagnosis other than STEMI. Conclusions and recommendations: Our audit has shown the need to increase awareness amongst staff re: the first line use of Prasugrel as per NICE guidelines. We aim to arrange awareness sessions for staff and increase visibility of the guidelines for the staff to encourage them to adhere to the guideline. Further research is needed to find the optimum treatment in patients above 75.

Keywords: pasurgrel, PCI, NICE, STEMI

Procedia PDF Downloads 60

Authors: E. Von Cheong, Carol Sinnott, Darren Dahly, Patricia M. Kearney

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Introduction and Aim: Adverse childhood experiences (ACEs) are all too common and have been linked to poorer health and wellbeing across the life course. While the prevention of ACEs is a worthy goal, it is important that we also try to lessen the impact of ACEs for those who do experience them. This study aims to investigate associations between adverse childhood experiences (ACEs) and later-life depressive symptoms; and to explore whether perceived social support (PSS) moderates these. Method: We analysed baseline data from the Mitchelstown (Ireland) 2010-11 cohort involving 2047 men and women aged 50–69 years. Self-reported assessments included ACEs (Centre for Disease Control ACE questionnaire), PSS (Oslo Social Support Scale), and depressive symptoms (CES-D). The primary exposure was self-report of at least one ACE. We also investigated the effects of ACE exposure by the subtypes abuse, neglect, and household dysfunction. Associations between each of these exposures and depressive symptoms were estimated using logistic regression, adjusted for socio-demographic factors that were selected using the Directed Acyclic Graph (DAG) approach. We also tested whether the estimated associations varied across levels of PSS (poor, moderate, and good). Results: 23.7% of participants reported at least one ACE (95% CI: 21.9% to 25.6%). ACE exposures (overall or subtype) were associated with a higher odds of depressive symptoms, but only among individuals with poor PSS. For example, exposure to any ACE (vs. none) was associated with 3 times the odds of depressive symptoms (Adjusted OR 2.97; 95% CI 1.63 to 5.40) among individuals reporting poor PSS, while among those reporting moderate PSS, the adjusted OR was 1.18 (95% CI 0.72 to 1.94). Discussion: ACEs are common among older adults in Ireland and are associated with higher odds of later-life depressive symptoms among those also reporting poor PSS. Interventions that enhance perception of social support following ACE exposure may help reduce the burden of depression in older populations.

Keywords: adverse childhood experiences, depression, later-life, perceived social support

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Authors: Amanda J. Burridge, Keith J. Edwards, Paul A. Wilkinson, Tom Batstone, Erik H. Murchie, Lorna McAusland, Ana Elizabete Carmo-Silva, Ivan Jauregui, Tracy Lawson, Silvere R. M. Vialet-Chabrand

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The rate of genetic progress in wheat production must be improved to meet global food security targets. However, past selection for domestication traits has reduced the genetic variation in modern wheat cultivars, a fact that could severely limit the future rate of genetic gain. The genetic variation in agronomically important traits for the wild relatives and progenitors of wheat is far greater than that of the current domesticated cultivars, but transferring these traits into modern cultivars is not straightforward. Between the elite cultivars of wheat, photosynthetic capacity is a key trait for which there is limited variation. Early screening of wheat wild relative and progenitors has shown differences in photosynthetic capacity and efficiency not only between wild relative species but marked differences between the accessions of each species. By identifying wild relative accessions with improved photosynthetic traits and characterising the genetic variation responsible, it is possible to incorporate these traits into advanced breeding programmes by wide crossing and introgression programmes. To identify the potential variety of photosynthetic capacity and efficiency available in the secondary and tertiary genepool, a wide scale survey was carried out for over 600 accessions from 80 species including those from the genus Aegilops, Triticum, Thinopyrum, Elymus, and Secale. Genotype data were generated for each accession using a ‘Wheat Wild Relative’ Single Nucleotide Polymorphism (SNP) genotyping array composed of 35,000 SNP markers polymorphic between wild relatives and elite hexaploid wheat. This genotype data was combined with phenotypic measurements such as gas exchange (CO₂, H₂O), chlorophyll fluorescence, growth, morphology, and RuBisCO activity to identify potential breeding material with enhanced photosynthetic capacity and efficiency. The data and associated analysis tools presented here will prove useful to anyone interested in increasing the genetic diversity in hexaploid wheat or the application of complex genotyping data to plant breeding.

Keywords: wheat, wild relatives, pre-breeding, genomics, photosynthesis

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Authors: Bushra Zafar, Usman Qamar

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Large data sample size and dimensions render the effectiveness of conventional data mining methodologies. A data mining technique are important tools for collection of knowledgeable information from variety of databases and provides supervised learning in the form of classification to design models to describe vital data classes while structure of the classifier is based on class attribute. Classification efficiency and accuracy are often influenced to great extent by noisy and undesirable features in real application data sets. The inherent natures of data set greatly masks its quality analysis and leave us with quite few practical approaches to use. To our knowledge first time, we present a new approach for investigation of structure and quality of datasets by providing a targeted analysis of localization of noisy and irrelevant features of data sets. Machine learning is based primarily on feature selection as pre-processing step which offers us to select few features from number of features as a subset by reducing the space according to certain evaluation criterion. The primary objective of this study is to trim down the scope of the given data sample by searching a small set of important features which may results into good classification performance. For this purpose, a heuristic for wrapper-based feature selection using genetic algorithm and for discriminative feature selection an external classifier are used. Selection of feature based on its number of occurrence in the chosen chromosomes. Sample dataset has been used to demonstrate proposed idea effectively. A proposed method has improved average accuracy of different datasets is about 95%. Experimental results illustrate that proposed algorithm increases the accuracy of prediction of different diseases.

Keywords: data mining, generic algorithm, KNN algorithms, wrapper based feature selection

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Authors: Ravid Yinon

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Introduction: Pelvic trauma causes high mortality, particularly among the elderly population. Pelvic injury ranges from low-energy incidents such as falls to high-energy trauma like motor vehicle accidents. The mortality rate among high-energy trauma patients is higher, as can be expected. The elderly population is more vulnerable to pelvic trauma even at low energy mechanisms due to the fragility and diminished physiological reserve of these patients. The aim of this study is to examine whether there is a higher long-term mortality in pelvic injuries in the elderly from the low-energy mechanism than those injured in high energy. Methods: A retrospective cohort study was conducted in a level 1 trauma center with injured patients aged 65 years and over with pelvic trauma. The patients were divided into two groups of low and high-energy mechanisms of injury. Multivariate analysis was conducted to characterize the differences between the groups. Results: There were 585 consecutive injured patients over the age of 65 with a documented pelvic injury who were treated at the primary trauma center between 2008-2020. The injured in the high energy group were younger (mean HE- 75.18, LE-80.73), with fewer comorbidities (mean 0.78 comorbidities at HE and 1.28 at LE), more men (52.6% at HE and 27.4% at LE), were consumed more treatments facilities such as angioembolization, ICU admission, emergency surgeries and blood products transfusion and higher mortality rate at admission (HE- 19/133, 14.28%, LE- 10/452, 2.21%) compared to the low energy group. However, in a long-term follow-up of one year after the injury, mortality in the low-energy group was significantly higher (HE- 14/114, 12.28%, LE- 155/442, 35.06%). Discussion: Although it can be expected that in the mechanism of high energy, the mortality rate in the long term would be higher, it was found that mortality at the low energy patient was higher. Apparently, low-energy pelvic injury in geriatric patients is a measure of frailty in these patients, causes injury to more frail and morbid patients, and is a predictor of mortality in this population in the long term. Conclusion: The long-term follow-up of injured elderly with pelvic trauma should be more intense, and the healthcare provider should put more emphasis on the rehabilitation of these special patient populations in an attempt to prevent long-term mortality.

Keywords: pelvic trauma, elderly trauma, high energy trauma, low energy trauma

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Authors: Ahmed Ismail, Mustafa Baysal

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Although the energy source in the world is mainly based on fossil fuels today, there is a need for alternative energy generation systems, which are more economic and environmentally friendly, due to continuously increasing demand of electric energy and lacking power resources and networks. Distributed Energy Resources (DERs) such as fuel cells, wind and solar power have recently become widespread as alternative generation. In order to solve several problems that might be encountered when integrating DERs to power system, the microgrid concept has been proposed. A microgrid can operate both grid connected and island mode to benefit both utility and customers. For most distributed energy resources (DER) which are connected in parallel in LV-grid like micro-turbines, wind plants, fuel cells and PV cells electrical power is generated as a direct current (DC) and converted to an alternative currents (AC) by inverters. So the inverters are assumed to be primary components in a microgrid. There are many control techniques of parallel inverters to manage active and reactive sharing of the loads. Some of them are based on droop method. In literature, the studies are usually focused on improving the transient performance of inverters. In this study, the performance of two different controllers based on droop control method is compared for the inverters operated in parallel without any communication feedback. For this aim, a microgrid in which inverters are controlled by conventional droop controller and modified droop controller is designed. Modified controller is obtained by adding PID into conventional droop control. Active and reactive power sharing performance, voltage and frequency responses of those control methods are measured in several operational cases. Study cases have been simulated by MATLAB-SIMULINK.

Keywords: active and reactive power sharing, distributed generation, droop control, microgrid

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Authors: Kadry M. Sadek, Tarek K. Abouzed, Mousa A. Ayoub

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The presence of endocrine-disrupting compounds, such as bisphenol A (BPA), in the environment can cause serious health problems. However, there are controversial opinions. This study investigated the reproductive, metabolic, oxidative and immunologic-disrupting effects of bisphenol A in male rabbits. Rabbits were divided into five groups. The first four rabbit groups were administered oral BPA (1, 10, 50, or 100 mg/kg/day) for ten weeks. The fifth group was administered corn oil as the vehicle. BPA significantly decreased serum testosterone, estradiol and the free androgen index (FAI) and significantly increased sex hormone binding globulin (SHBG) compared with the placebo group. The higher doses of BPA showed a significant decrease in follicular stimulating hormone (FSH) and luteinizing hormone (LH). A significant increase in blood glucose levels was identified in the BPA groups. The non-significant difference in insulin levels is a novel finding. The cumulative testicular toxicity of BPA was clearly demonstrated by the dose-dependent decrease in absolute testes weight, primary measures of semen quality and a significant increase in testicular malonaldehyde (MDA). Moreover, BPA significantly decreased total antioxidant capacity (TAC) and significantly increased immunoglobulin G (IgG) at the highest concentration. Our results suggest that BPA, especially at higher doses, is associated with many adverse effects on metabolism, oxidative stress, immunity, sperm quality and markers of androgenic action. These results may reflect the estrogenic effects of BPA, which we hypothesize could be related, in part, to an inhibitory effect on testicular steroidogenesis. The induction of oxidative stress by BPA may play an additional role in testicular toxicity. These results suggest that BPA poses a threat to endocrine and reproductive functions.

Keywords: bisphenol A, oxidative stress, rabbits, semen quality, steroidogenesis

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Authors: Farideh Halakou, Emel Sen, Attila Gursoy, Ozlem Keskin

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Protein–Protein Interactions (PPIs) mediate major biological processes in living cells. The study of PPIs as networks and analyze the network properties contribute to the identification of genes and proteins associated with diseases. In this study, we have created the sub-networks of brain and lung metastasis from primary tumor in breast cancer. To do so, we used seed genes known to cause metastasis, and produced their interactions through a network-topology based prioritization method named GUILDify. In order to have the experimental support for the sub-networks, we further curated them using STRING database. We proceeded by modeling structures for the interactions lacking complex forms in Protein Data Bank (PDB). The functional enrichment analysis shows that KEGG pathways associated with the immune system and infectious diseases, particularly the chemokine signaling pathway, are important for lung metastasis. On the other hand, pathways related to genetic information processing are more involved in brain metastasis. The structural analyses of the sub-networks vividly demonstrated their difference in terms of using specific interfaces in lung and brain metastasis. Furthermore, the topological analysis identified genes such as RPL5, MMP2, CCR5 and DPP4, which are already known to be associated with lung or brain metastasis. Additionally, we found 6 and 9 putative genes that are specific for lung and brain metastasis, respectively. Our analysis suggests that variations in genes and pathways contributing to these different breast metastasis types may arise due to change in tissue microenvironment. To show the benefits of using structural PPI networks instead of traditional node and edge presentation, we inspect two case studies showing the mutual exclusiveness of interactions and effects of mutations on protein conformation which lead to different signaling.

Keywords: breast cancer, metastasis, PPI networks, protein conformational changes

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Authors: Shakhawath Hossain, Tazkia Tahsin

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Introduction/Background: Intellectual disability is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. Vocational education is a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. Instrumental Activities of Daily Living activities to support daily life within the home and community. Like as community mobility, financial management, meal preparation, and clean-up, shopping. Material and Method: Electronic searches of Medline, PubMed, Google scholar, OT Seeker literature using the key terms of intellectual disability, vocational rehabilitation, instrumental activities of daily living and Occupational Therapy, as well as a thorough manual search for relevant literature. Results: There were 13 articles, all qualitative and quantitative, which are included in this review. All studies were mixed methods in design. To take the Occupational Therapy services, there is a significant improvement in their children's various areas like as sensory issues, cognitive abilities, perceptual skills, visual, motor planning, and group therapy. After taking the vocational and instrumental activities of daily living training children with intellectual disabilities to participate in their daily activities and work as an employee different company or organizations. Conclusion: The persons with intellectual disability are an integral part of our society who deserves social support and opportunities like other human beings. From the result section of the project papers, it is found that the significant benefits of Occupational Therapy services in the aspects of vocational and instrumental activities of daily living.

Keywords: occupational therapy, daily living activities, intellectual disabilities, instrumental ADL

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Authors: Engy S. El-Kayal, Mohamed M. S. Arafa

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There are various causes of ankle pain including traumatic and non-traumatic causes. Various imaging techniques are available for assessment of AP. MRI is considered to be the imaging modality of choice for ankle joint evaluation with an advantage of its high spatial resolution, multiplanar capability, hence its ability to visualize small complex anatomical structures around the ankle. However, the high costs and the relatively limited availability of MRI systems, as well as the relatively long duration of the examination all are considered disadvantages of MRI examination. Therefore there is a need for a more rapid and less expensive examination modality with good diagnostic accuracy to fulfill this gap. HRU has become increasingly important in the assessment of ankle disorders, with advantages of being fast, reliable, of low cost and readily available. US can visualize detailed anatomical structures and assess tendinous and ligamentous integrity. The aim of this study was to compare the diagnostic accuracy of HRU with MRI in the assessment of patients with AP. We included forty patients complaining of AP. All patients were subjected to real-time HRU and MRI of the affected ankle. Results of both techniques were compared to surgical and arthroscopic findings. All patients were examined according to a defined protocol that includes imaging the tendon tears or tendinitis, muscle tears, masses, or fluid collection, ligament sprain or tears, inflammation or fluid effusion within the joint or bursa, bone and cartilage lesions, erosions and osteophytes. Analysis of the results showed that the mean age of patients was 38 years. The study comprised of 24 women (60%) and 16 men (40%). The accuracy of HRU in detecting causes of AP was 85%, while the accuracy of MRI in the detection of causes of AP was 87.5%. In conclusions: HRU and MRI are two complementary tools of investigation with the former will be used as a primary tool of investigation and the latter will be used to confirm the diagnosis and the extent of the lesion especially when surgical interference is planned.

Keywords: ankle pain (AP), high-resolution ultrasound (HRU), magnetic resonance imaging (MRI) ultrasonography (US)

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Authors: Jackson Andreas Theo Pola, Leksono Mucharam, Hari Oetomo, Budi Susanto, Wisnu Nugraha

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About half of the world oil reserves are located in carbonate reservoirs, where 65% of the total carbonate reservoirs are oil wet and 12% intermediate wet [1]. Oil recovery in oil wet or mixed wet carbonate reservoirs can be increased by dissolving surfactant to injected water to change the rock wettability from oil wet to more water wet. The Wakamuk Field operated by PetroChina International (Bermuda) Ltd. and PT. Pertamina EP in Papua, produces from main reservoir of Miocene Kais Limestone. First production commenced on August, 2004 and the peak field production of 1456 BOPD occurred in August, 2010. It was found that is a complex reservoir system and until 2014 cumulative oil production was 2.07 MMBO, less than 9% of OOIP. This performance is indicative of presence of secondary porosity, other than matrix porosity which is of low average porosity 13% and permeability less than 7 mD. Implementing chemical EOR in this case is the best way to increase oil production. However, the selected chemical must be able to lower the interfacial tension (IFT), reduce oil viscosity, and alter the wettability; thus a special chemical treatment named SeMAR has been proposed. Numerous laboratory tests such as phase behavior test, core compatibility test, mixture viscosity, contact angle measurement, IFT, imbibitions test and core flooding were conducted on Wakamuk field samples. Based on the spontaneous imbibitions results for Wakamuk field core, formulation of SeMAR with compositional S12A gave oil recovery 43.94% at 1wt% concentration and maximum percentage of oil recovery 87.3% at 3wt% concentration respectively. In addition, the results for first scenario of core flooding test gave oil recovery 60.32% at 1 wt% concentration S12A and the second scenario gave 96.78% of oil recovery at concentration 3 wt% respectively. The soaking time of chemicals has a significant effect on the recovery and higher chemical concentrations affect larger areas for wettability and therefore, higher oil recovery. The chemical that gives best overall results from laboratory tests study will also be a consideration for Huff and Puff injections trial (pilot project) for increasing oil recovery from Wakamuk Field

Keywords: Wakamuk field, chemical treatment, oil recovery, viscosity

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Authors: Chen-Ya Juan

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In recent years, the increasing number of children with special needs has brought a lot of attention by many scholars and experts in education, which enforced the preschool teachers face the harsh challenge in the classroom. To protect the right of equal education for all children, enhance the quality of children learning, and take care of the needs of children with special needs, the special education paraprofessional becomes one of the future employment trends for students of the department of the early childhood care and education. Problem-based learning is a problem-oriented instruction, which is different from traditional instruction. The instructor first designed an ambiguous problem direction, following the basic knowledge of early intervention, students had to find clues to solve the problem defined by themselves. In the class, the total instruction included 20 hours, two hours per week. The primary purpose of this paper is to investigate the relationship of student academic scores, self-awareness, learning motivation, learning attitudes, and early intervention knowledge. A total of 105 college students participated in this study and 97 questionnaires were effective. The effective response rate was 90%. The student participants included 95 females and two males. The average age of the participants was 19 years old. The questionnaires included 125 questions divided into four major dimensions: (1) Self-awareness, (2) learning motivation, (3) learning attitudes, and (4) early intervention knowledge. The results indicated (1) the scores of self-awareness were 58%; the scores of the learning motivations was 64.9%; the scores of the learning attitudes was 55.3%. (2) After the instruction, the early intervention knowledge has been increased to 64.2% from 38.4%. (3) Student’s academic performance has positive relationship with self-awareness (p < 0.05; R = 0.506), learning motivation (p < 0.05; R = 0.487), learning attitudes (p < 0.05; R = 0.527). The results implied that although students had gained early intervention knowledge by using PBL instruction, students had medium scores on self-awareness and learning attitudes, medium high in learning motivations.

Keywords: college students, children with special needs, problem-based learning, learning motivation

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Authors: S. H. Jang

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Posterior reversible encephalopathy syndrome (PRES) is characterized by acute neurologic symptoms (visual loss, headache, altered mentality and seizures) and by typical imaging findings (bilateral subcortical and cortical edema with predominatly posterior distribution). Nephrotic syndrome is a syndrome comprising signs of proteinuria, hypoalbuminemia, and edema. It is well known that hypertension predispose patient with nephrotic syndrome to PRES. A 45-year old male was referred for suddenly developed vertigo, disequilibrium. He had previous history of nephrotic syndrome. His medical history included diabetes controlled with medication. He was hospitalized because of generalized edema a few days ago. His vital signs were stable. On neurologic examination, his mental state was alert. Horizontal nystagmus to right side on return to primary position was observed. He showed good grade motor weakness and ataxia in right upper and lower limbs without other sensory abnormality. Brain MRI showed increased signal intensity in FLAIR image, decreased signal intensity in T1 image and focal enhanced lesion in T1 contrast image at whole midbrain, pons and cerebellar peduncle symmetrically, which was compatible with vasogenic edema. Laboratory findings showed severe proteinuria and hypoalbuminemia. He was given intravenous dexamethasone and diuretics to reduce vasogenic edema and raise the intra-vascular osmotic pressure. Nystagmus, motor weakness and limb ataxia improved gradually over 2 weeks; He recovered without any neurologic symptom and sign. Follow-up MRI showed decreased vasogenic edema fairly. We report a case of brain stem PRES in normotensive, nephrotic syndrome patient.

Keywords: posterior reversible encephalopathy syndrome, MRI, nephrotic syndrome, vasogenic brain edema

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