Search results for: emergency remote learning
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 8942

Search results for: emergency remote learning

1622 Tiaki Moemoeā: The Dream Keeper’s Role Within the Learning Journey of Cook Island Nursing Students

Authors: Yvonne Kainuku, Wendy Trimmer

Abstract:

A critical element in closing the gaps in health disparities is the presence of a culturally appropriate health workforce. This study presents one of the findings from a qualitative study that explored the lived experiences of Cook Islands peoples during their three-year nursing training within a Bachelor of Nursing Pacific (BNP) programme in Aotearoa NZ. The study utilized both qualitative and context-specific methods; these included the Tivaevae Research Model and Qualitative Inquiry. The aim of the research was to collect stories from registered nurses about their experiences of culturally responsive pedagogy and their connection to content relating to Pacific world views and Pacific ways of knowing while they were students. Further to this, the researcher sought to recognize factors that supported the participant's successful completion of becoming a registered nurse. This study will introduce the theme of Tiaki moemoeā (dream keeper), identifying essential elements that engage learners along their journey. The various features that define the theme Tiaki moemoeā (dream keeper) have the potential to contribute to transformational change in nursing education training in Aotearoa, New Zealand.

Keywords: education, nursing, pacific, pedagogy

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1621 Perusing the Influence of a Visual Editor in Enabling PostgreSQL Query Learn-Ability

Authors: Manuela Nayantara Jeyaraj

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PostgreSQL is an Object-Relational Database Management System (ORDBMS) with an architecture that ensures optimal quality data management. But due to the shading growth of similar ORDBMS, PostgreSQL has not been renowned among the database user community. Despite having its features and in-built functionalities shadowed, PostgreSQL renders a vast range of utilities for data manipulation and hence calling for it to be upheld more among users. But introducing PostgreSQL in order to stimulate its advantageous features among users, mandates endorsing learn-ability as an add-on as the target groups considered consist of both amateur as well as professional PostgreSQL users. The scope of this paper deliberates providing easy contemplation of query formulations and flows through a visual editor designed according to user interface principles that standby to support every aspect of making PostgreSQL learn-able by self-operation and creation of queries within the visual editor. This paper tends to scrutinize the importance of choosing PostgreSQL as the working database environment, the visual perspectives that influence human behaviour and ultimately learning, the modes in which learn-ability can be provided via visualization and the advantages reaped by the implementation of the proposed system features.

Keywords: database, learn-ability, PostgreSQL, query, visual-editor

Procedia PDF Downloads 168
1620 Advancements in Arthroscopic Surgery Techniques for Anterior Cruciate Ligament (ACL) Reconstruction

Authors: Islam Sherif, Ahmed Ashour, Ahmed Hassan, Hatem Osman

Abstract:

Anterior Cruciate Ligament (ACL) injuries are common among athletes and individuals participating in sports with sudden stops, pivots, and changes in direction. Arthroscopic surgery is the gold standard for ACL reconstruction, aiming to restore knee stability and function. Recent years have witnessed significant advancements in arthroscopic surgery techniques, graft materials, and technological innovations, revolutionizing the field of ACL reconstruction. This presentation delves into the latest advancements in arthroscopic surgery techniques for ACL reconstruction and their potential impact on patient outcomes. Traditionally, autografts from the patellar tendon, hamstring tendon, or quadriceps tendon have been commonly used for ACL reconstruction. However, recent studies have explored the use of allografts, synthetic scaffolds, and tissue-engineered grafts as viable alternatives. This abstract evaluates the benefits and potential drawbacks of each graft type, considering factors such as graft incorporation, strength, and risk of graft failure. Moreover, the application of augmented reality (AR) and virtual reality (VR) technologies in surgical planning and intraoperative navigation has gained traction. AR and VR platforms provide surgeons with detailed 3D anatomical reconstructions of the knee joint, enhancing preoperative visualization and aiding in graft tunnel placement during surgery. We discuss the integration of AR and VR in arthroscopic ACL reconstruction procedures, evaluating their accuracy, cost-effectiveness, and overall impact on surgical outcomes. Beyond graft selection and surgical navigation, patient-specific planning has gained attention in recent research. Advanced imaging techniques, such as MRI-based personalized planning, enable surgeons to tailor ACL reconstruction procedures to each patient's unique anatomy. By accounting for individual variations in the femoral and tibial insertion sites, this personalized approach aims to optimize graft placement and potentially improve postoperative knee kinematics and stability. Furthermore, rehabilitation and postoperative care play a crucial role in the success of ACL reconstruction. This abstract explores novel rehabilitation protocols, emphasizing early mobilization, neuromuscular training, and accelerated recovery strategies. Integrating technology, such as wearable sensors and mobile applications, into postoperative care can facilitate remote monitoring and timely intervention, contributing to enhanced rehabilitation outcomes. In conclusion, this presentation provides an overview of the cutting-edge advancements in arthroscopic surgery techniques for ACL reconstruction. By embracing innovative graft materials, augmented reality, patient-specific planning, and technology-driven rehabilitation, orthopedic surgeons and sports medicine specialists can achieve superior outcomes in ACL injury management. These developments hold great promise for improving the functional outcomes and long-term success rates of ACL reconstruction, benefitting athletes and patients alike.

Keywords: arthroscopic surgery, ACL, autograft, allograft, graft materials, ACL reconstruction, synthetic scaffolds, tissue-engineered graft, virtual reality, augmented reality, surgical planning, intra-operative navigation

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1619 Exploring Syntactic and Semantic Features for Text-Based Authorship Attribution

Authors: Haiyan Wu, Ying Liu, Shaoyun Shi

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Authorship attribution is to extract features to identify authors of anonymous documents. Many previous works on authorship attribution focus on statistical style features (e.g., sentence/word length), content features (e.g., frequent words, n-grams). Modeling these features by regression or some transparent machine learning methods gives a portrait of the authors' writing style. But these methods do not capture the syntactic (e.g., dependency relationship) or semantic (e.g., topics) information. In recent years, some researchers model syntactic trees or latent semantic information by neural networks. However, few works take them together. Besides, predictions by neural networks are difficult to explain, which is vital in authorship attribution tasks. In this paper, we not only utilize the statistical style and content features but also take advantage of both syntactic and semantic features. Different from an end-to-end neural model, feature selection and prediction are two steps in our method. An attentive n-gram network is utilized to select useful features, and logistic regression is applied to give prediction and understandable representation of writing style. Experiments show that our extracted features can improve the state-of-the-art methods on three benchmark datasets.

Keywords: authorship attribution, attention mechanism, syntactic feature, feature extraction

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1618 The Perception of ‘School’ as a Positive Support Factor

Authors: Yeliz Yazıcı, Alev Erenler

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School is an institution designed to provide learning, teaching places and environments under guidance of selected teachers. School is not just a place or institution but it is a place where complex and living structures are alive and always changing. It is also an undeniable fact that schools have shaped the ideas, future, society as well as the students and their lives. While this is the situation, schools having academic excellence is considered as successful ones. Academic excellence is a composition of excellence in teachers, management and physical environment, also. This is the general perception of the authorities and parents when the excellence is the point but the school is a developing and supporting organism. In this concept, the main aim of this study is to compare student and teacher perceptions of school as a ‘positive support factor’. The study is designed as a quantitative and qualitative design and a questionnaire is applied to both teachers and students via online and face to face meetings. It is aimed to define the perceptions of the participants related to the school as a positive support factor. It means the role of school in establishing self-efficacy, shaping and acquiring the behavior etc. Gathered data is analyzed via SPSS program and the detailed discussion is carried in the frame of the related literature.

Keywords: positive support factor, education, school, student teacher perception

Procedia PDF Downloads 169
1617 Food Processing Technology and Packaging: A Case Study of Indian Cashew-Nut Industry

Authors: Parashram Jakappa Patil

Abstract:

India is the global leader in world cashew business and cashew-nut industry is one of the important food processing industries in world. However India is the largest producer, processor, exporter and importer eschew in the world. India is providing cashew to the rest of the world. India is meeting world demand of cashew. India has a tremendous potential of cashew production and export to other countries. Every year India earns more than 2000 cores rupees through cashew trade. Cashew industry is one of the important small scale industries in the country which is playing significant role in rural development. It is generating more than 400000 jobs at remote area and 95% cashew worker are women, it is giving income to poor cashew farmers, majority cashew processing units are small and cottage, it is helping to stop migration from young farmers for employment opportunities, it is motivation rural entrepreneurship development and it is also helping to environment protection etc. Hence India cashew business is very important agribusiness in India which has potential make inclusive development. World Bank and IMF recognized cashew-nut industry is one the important tool for poverty eradication at global level. It shows important of cashew business and its strong existence in India. In spite of such huge potential cashew processing industry is facing different problems such as lack of infrastructure ability, lack of supply of raw cashew, lack of availability of finance, collection of raw cashew, unavailability of warehouse, marketing of cashew kernels, lack of technical knowledge and especially processing technology and packaging of finished products. This industry has great prospects such as scope for more cashew cultivation and cashew production, employment generation, formation of cashew processing units, alcohols production from cashew apple, shield oil production, rural development, poverty elimination, development of social and economic backward class and environment protection etc. This industry has domestic as well as foreign market; India has tremendous potential in this regard. The cashew is a poor men’s crop but rich men’s food. The cashew is a source of income and livelihood for poor farmers. Cashew-nut industry may play very important role in the development of hilly region. The objectives of this paper are to identify problems of cashew processing and use of processing technology, problems of cashew kernel packaging, evolving of cashew processing technology over the year and its impact on final product and impact of good processing by adopting appropriate technology packaging on international trade of cashew-nut. The most important problem of cashew processing industry is that is processing and packaging. Bad processing reduce the quality of cashew kernel at large extent especially broken of cashew kernel which has very less price in market compare to whole cashew kernel and not eligible for export. On the other hand if there is no good packaging of cashew kernel will get moisture which destroy test of it. International trade of cashew-nut is depend of two things one is cashew processing and other is packaging. This study has strong relevance because cashew-nut industry is the labour oriented, where processing technology is not playing important role because 95% processing work is manual. Hence processing work was depending on physical performance of worker which makes presence of large workforce inevitable. There are many cashew processing units closed because they are not getting sufficient work force. However due to advancement in technology slowly this picture is changing and processing work get improve. Therefore it is interesting to explore all the aspects in context of cashew processing and packaging of cashew business.

Keywords: cashew, processing technology, packaging, international trade, change

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1616 Contentious Issues Concerning the Methodology of Using the Lexical Approach in Teaching ESP

Authors: Elena Krutskikh, Elena Khvatova

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In tertiary settings expanding students’ vocabulary and teaching discursive competence is seen as one of the chief goals of a professional development course. However, such a focus often is detrimental to students’ cognitive competences, such as analysis, synthesis, and creative processing of information, and deprives students of motivation for self-improvement and self-development of language skills. The presentation is going to argue that in an ESP course special attention should be paid to reading/listening which can promote understanding and using the language as a tool for solving significant real world problems, including professional ones. It is claimed that in the learning process it is necessary to maintain a balance between the content and the linguistic aspect of the educational process as language acquisition is inextricably linked with mental activity and the need to express oneself is a primary stimulus for using a language. A study conducted among undergraduates indicates that they place a premium on quality materials that motivate them and stimulate their further linguistic and professional development. Thus, more demands are placed on study materials that should contain new information for students and serve not only as a source of new vocabulary but also prepare them for real tasks related to professional activities.

Keywords: critical reading, english for professional development, english for specific purposes, high order thinking skills, lexical approach, vocabulary acquisition

Procedia PDF Downloads 159
1615 Environmental Restoration Science in New York Harbor - Community Based Restoration Science Hubs, or “STEM Hubs”

Authors: Lauren B. Birney

Abstract:

The project utilizes the Billion Oyster Project (BOP-CCERS) place-based “restoration through education” model to promote computational thinking in NYC high school teachers and their students. Key learning standards such as Next Generation Science Standards and the NYC CS4All Equity and Excellence initiative are used to develop a computer science curriculum that connects students to their Harbor through hands-on activities based on BOP field science and educational programming. Project curriculum development is grounded in BOP-CCERS restoration science activities and data collection, which are enacted by students and educators at two Restoration Science STEM Hubs or conveyed through virtual materials. New York City Public School teachers with relevant experience are recruited as consultants to provide curriculum assessment and design feedback. The completed curriculum units are then conveyed to NYC high school teachers through professional learning events held at the Pace University campus and led by BOP educators. In addition, Pace University educators execute the Summer STEM Institute, an intensive two-week computational thinking camp centered on applying data analysis tools and methods to BOP-CCERS data. Both qualitative and quantitative analyses were performed throughout the five-year study. STEM+C – Community Based Restoration STEM Hubs. STEM Hubs are active scientific restoration sites capable of hosting school and community groups of all grade levels and professional scientists and researchers conducting long-term restoration ecology research. The STEM Hubs program has grown to include 14 STEM Hubs across all five boroughs of New York City and focuses on bringing in-field monitoring experience as well as coastal classroom experience to students. Restoration Science STEM Hubs activities resulted in: the recruitment of 11 public schools, 6 community groups, 12 teachers, and over 120 students receiving exposure to BOP activities. Field science protocols were designed exclusively around the use of the Oyster Restoration Station (ORS), a small-scale in situ experimental platforms which are suspended from a dock or pier. The ORS is intended to be used and “owned” by an individual school, teacher, class, or group of students, whereas the STEM Hub is explicitly designed as a collaborative space for large-scale community-driven restoration work and in-situ experiments. The ORS is also an essential tool in gathering Harbor data from disparate locations and instilling ownership of the research process amongst students. As such, it will continue to be used in that way. New and previously participating students will continue to deploy and monitor their own ORS, uploading data to the digital platform and conducting analysis of their own harbor-wide datasets. Programming the STEM Hub will necessitate establishing working relationships between schools and local research institutions. NYHF will provide introductions and the facilitation of initial workshops in school classrooms. However, once a particular STEM Hub has been established as a space for collaboration, each partner group, school, university, or CBO will schedule its own events at the site using the digital platform’s scheduling and registration tool. Monitoring of research collaborations will be accomplished through the platform’s research publication tool and has thus far provided valuable information on the projects’ trajectory, strategic plan, and pathway.

Keywords: environmental science, citizen science, STEM, technology

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1614 Conceptual Design of a Residential House Based on IDEA 4E - Discussion of the Process of Interdisciplinary Pre-Project Research and Optimal Design Solutions Created as Part of Project-Based Learning

Authors: Dorota Winnicka-Jasłowska, Małgorzata Jastrzębska, Jan Kaczmarczyk, Beata Łaźniewska-Piekarczyk, Piotr Skóra, Beata Kobiałko, Agata Kołodziej, Błażej Mól, Ewelina Lasyk, Karolina Brzęczek, Michał Król

Abstract:

Creating economical, comfortable, and healthy buildings which respect the environment is a necessity resulting from legal regulations, but it is also a response to the expectations of a modern investor. Developing the concept of a residential house based on the 4E and the 2+2+(1) IDEAs is a complex process that requires specialist knowledge of many trades and requires adaptation of comprehensive solutions. IDEA 4E assumes the use of energy-saving, ecological, ergonomics, and economic solutions. In addition, IDEA 2+2+(1) assuming appropriate surface and functional-spatial solutions for a family at different stages of a building's life, i.e. 2, 4, or 5 members, enforces certain flexibility of the designed building, which may change with the number and age of its users. The building should therefore be easy to rearrange or expand. The task defined in this way was carried out by an interdisciplinary team of students of the Silesian University of Technology as part of PBL. The team consisted of 6 undergraduate and graduate students representing the following faculties: 3 students of architecture, 2 civil engineering students, and 1 student of environmental engineering. The work of the team was supported by 3 academic teachers representing the above-mentioned faculties and additional experts. The project was completed in one semester. The article presents the successive stages of the project. At first pre-design studies were carried out. They allowed to define the guidelines for the project. For this purpose, the "Model house" questionnaire was developed. The questions concerned determining the utility needs of a potential family that would live in a model house - specifying the types of rooms, their size, and equipment. A total of 114 people participated in the study. The answers to the questions in the survey helped to build the functional programme of the designed house. Other research consisted in the search for optimal technological and construction solutions and the most appropriate building materials based mainly on recycling. Appropriate HVAC systems responsible for the building's microclimate were also selected, i.e. low, temperature heating, mechanical ventilation, and the use of energy from renewable sources was planned so as to obtain a nearly zero-energy building. Additionally, rainwater retention and its local use were planned. The result of the project was a design of a model residential building that meets the presented assumptions. A 3D VR spatial model of the designed building and its surroundings was also made. The final result was the organization of an exhibition for students and the academic community. Participation in the interdisciplinary project allowed the project team members to better understand the consequences of the adopted solutions for achieving the assumed effect and the need to work out a compromise. The implementation of the project made all its participants aware of the importance of cooperation as well as systematic and clear communication. The need to define milestones and their consistent enforcement is an important element guaranteeing the achievement of the intended end result. The implementation of PBL enables students to the acquire competences important in their future professional work.

Keywords: architecture and urban planning, civil engineering, environmental engineering, project-based learning, sustainable building

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1613 Enhancing Knowledge Graph Convolutional Networks with Structural Adaptive Receptive Fields for Improved Node Representation and Information Aggregation

Authors: Zheng Zhihao

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Recently, the Knowledge Graph Framework Network (KGCN) has developed powerful capabilities in knowledge representation and reasoning tasks. However, traditional KGCN often uses a fixed weight mechanism when aggregating information, failing to make full use of rich structural information, resulting in a certain expression ability of node representation and easily causing over-smoothing problems. In order to solve these challenges, the paper proposes an distinct graph neural network model called KGCN-STAR (Knowledge Graph Convolutional Network with Structural Adaptive Receptive Fields). This model dynamically adjusts the perception of each node by introducing a structural adaptive receptive field. Wild range and a subgraph aggregator is designed to capture local structural information more effectively. Experimental results show that KGCN-STAR shows significant performance improvement on multiple knowledge graph data sets, especially showing considerable capabilities in the task of representation learning of complex structures.

Keywords: knowledge graph(KG), graph neural networks (GNN), structural adaptive receptive fields, information aggregation

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1612 Innovative Schools as Birthplaces for Promoting Educational Innovations: A Case Study of Two Hungarian Schools

Authors: Khin Khin Thant Sin

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This study is a case study which investigates successful and ongoing bottom-up innovations for school improvement initiatives in Hungary. Two innovative schools are selected in this study due to their outstanding achievement during the past ten years in Hungary. In one school, data from the personal experiences of a school principal who initiated the bottom-up innovation are included. For the second school, three interviews were carried out with two schoolteachers and one secondary school student. In addition, desk research, including the principal’s published articles, the schoolteachers’ master thesis, the school websites, and other published articles, are analysed to explore the schools’ innovative processes. This study investigates how bottom-up innovation led to major achievements in student learning, teacher professional development, networking and collaboration with other schools, and the establishment of successful partnerships with universities. The highlight of this study is how innovative schools can be the major sources promoting educational innovations as well as improving teacher education, especially in initial teacher education and continuous professional development.

Keywords: school innovation, teacher education, hungary, educational innovation, school improvement

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1611 Porul: Option Generation and Selection and Scoring Algorithms for a Tamil Flash Card Game

Authors: Anitha Narasimhan, Aarthy Anandan, Madhan Karky, C. N. Subalalitha

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Games can be the excellent tools for teaching a language. There are few e-learning games in Indian languages like word scrabble, cross word, quiz games etc., which were developed mainly for educational purposes. This paper proposes a Tamil word game called, “Porul”, which focuses on education as well as on players’ thinking and decision-making skills. Porul is a multiple choice based quiz game, in which the players attempt to answer questions correctly from the given multiple options that are generated using a unique algorithm called the Option Selection algorithm which explores the semantics of the question in various dimensions namely, synonym, rhyme and Universal Networking Language semantic category. This kind of semantic exploration of the question not only increases the complexity of the game but also makes it more interesting. The paper also proposes a Scoring Algorithm which allots a score based on the popularity score of the question word. The proposed game has been tested using 20,000 Tamil words.

Keywords: Porul game, Tamil word game, option selection, flash card, scoring, algorithm

Procedia PDF Downloads 397
1610 Qualitative Evaluation of the Morris Collection Conservation Project at the Sainsbury Centre of Visual Arts in the Context of Agile, Lean and Hybrid Project Management Approaches

Authors: Maria Ledinskaya

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This paper examines the Morris Collection Conservation Project at the Sainsbury Centre for Visual Arts in the context of Agile, Lean, and Hybrid project management. It is part case study and part literature review. To date, relatively little has been written about non-traditional project management approaches in heritage conservation. This paper seeks to introduce Agile, Lean, and Hybrid project management concepts from business, software development, and manufacturing fields to museum conservation, by referencing their practical application on a recent museum-based conservation project. The Morris Collection Conservation Project was carried out in 2019-2021 in Norwich, UK, and concerned the remedial conservation of around 150 Abstract Constructivist artworks bequeathed to the Sainsbury Centre for Visual Arts by private collectors Michael and Joyce Morris. The first part introduces the chronological timeline and key elements of the project. It describes a medium-size conservation project of moderate complexity, which was planned and delivered in an environment with multiple known unknowns – unresearched collection, unknown condition and materials, unconfirmed budget. The project was also impacted by the unknown unknowns of the COVID-19 pandemic, such as indeterminate lockdowns, and the need to accommodate social distancing and remote communications. The author, a staff conservator at the Sainsbury Centre who acted as project manager on the Morris Collection Conservation Project, presents an incremental, iterative, and value-based approach to managing a conservation project in an uncertain environment. Subsequent sections examine the project from the point of view of Traditional, Agile, Lean, and Hybrid project management. The author argues that most academic writing on project management in conservation has focussed on a Traditional plan-driven approach – also known as Waterfall project management – which has significant drawbacks in today’s museum environment, due to its over-reliance on prediction-based planning and its low tolerance to change. In the last 20 years, alternative Agile, Lean and Hybrid approaches to project management have been widely adopted in software development, manufacturing, and other industries, although their recognition in the museum sector has been slow. Using examples from the Morris Collection Conservation Project, the author introduces key principles and tools of Agile, Lean, and Hybrid project management and presents a series of arguments on the effectiveness of these alternative methodologies in museum conservation, as well as the ethical and practical challenges to their implementation. These project management approaches are discussed in the context of consequentialist, relativist, and utilitarian developments in contemporary conservation ethics, particularly with respect to change management, bespoke ethics, shared decision-making, and value-based cost-benefit conservation strategy. The author concludes that the Morris Collection Conservation Project had multiple Agile and Lean features which were instrumental to the successful delivery of the project. These key features are identified as distributed decision making, a co-located cross-disciplinary team, servant leadership, focus on value-added work, flexible planning done in shorter sprint cycles, light documentation, and emphasis on reducing procedural, financial, and logistical waste. Overall, the author’s findings point largely in favour of a Hybrid model which combines traditional and alternative project processes and tools to suit the specific needs of the project.

Keywords: project management, conservation, waterfall, agile, lean, hybrid

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1609 Navigating Rapids And Collecting Medical Insights: A Data Collection Of Athletes Presenting To The Medical Team At The International Canoe Federation Canoe Slalom World Championships 2023

Authors: Grace Scaplehorn, Muhammad Adeel Akhtar, Jane Gibson

Abstract:

Background: Canoe Slalom entails the skilful navigation of a carbon composite canoe or kayak through a series of 18-25 hanging gates, strategically positioned along the course, either upstream or downstream, amidst currents of whitewater rapids in natural and man-made river settings. Athletes compete individually in timed trials, competing for the fastest course time, typically around 80 to 120 seconds. In the new discipline of Kayak Cross, descents of the course are initiated by groups of four athletes freefalling simultaneously from a starting platform situated 3m above the river. Kayak Cross athletes, in contrast to Canoe Slalom, can make physical contact with suspended gates without incurring time penalties and are required to perform a kayak roll half way down the course. The Canoe Slalom World Championships were held at Lee Valley Whitewater Centre, London, from 19th to 24th September 2023. The event comprised 299 international athletes competing for 10 World Championship titles in Canoe/Kayak Slalom events (Olympic Debut Munich 1972), and the new Kayak Cross discipline (Olympic Debut Paris 2024). The inaugural appearance of Kayak Cross at the World Championships occurred in 2017, in Pau, France. There is limited literature surrounding Kayak Cross and the incidence of athlete injuries compared to traditional Canoe Slalom, hence it was felt important to undertake this review to address the perception that the event is dangerous. Aim: The study aimed to quantify and collate data collected from athletes presenting to the event medical centre. Methods: Athletes’ details were collected at initial assessments from the start of the practice period (16th–18th September) and throughout the event. Demographics such as age, sex and nationality were recorded along with presenting complaints, treatment, medication administered and outcome. Specifically, injuries were then sub-classified into body regions. The data does not include athletes who sought medical attention from their own governing body’s medical team. Results: During the 8-day period, there were 11 individual presentations to the medical centre, 3.7% of the athlete population (n=299). The mean age was 23.9 years (n=7), 6 were male (n=10). The most common presentation was minor injury (n=9), with 6 being musculoskeletal and 3 comprising skin damage, followed by insect sting/allergy (n=1) and pain relief requests (n=1). Five presentations were event-related, all being musculoskeletal injuries; 2 shoulder/arm, 1 head/neck, 1 hand/wrist and 1 other (data was not recorded). Of these injuries, the only intervention was 2 cases of 400mg Ibuprofen, which was given to both shoulder/arm injuries. Four of the 11 presentations were pre-existing injuries, which had been exacerbated due to increased intensity of practice. Two patients were advised to return for review, with 100% compliance. There were no unplanned re-presentations, and no emergency transfers to secondary care. Both the Kayak Cross and Canoe Slalom competitions resulted in 1 new event-related athlete presentation each. Conclusion: The event resulted in a negligible incidence of presentations at the medical centre, for both Kayak Cross and Canoe Slalom. This data holds significance in informing risk assessments and medical protocols necessary for the organisation of canoe slalom events.

Keywords: canoe slalom, kayak cross, athlete injuries, event injuries

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1608 Raising Test of English for International Communication (TOEIC) Scores through Purpose-Driven Vocabulary Acquisition

Authors: Edward Sarich, Jack Ryan

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In contrast to learning new vocabulary incidentally in one’s first language, foreign language vocabulary is often acquired purposefully, because a lack of natural exposure requires it to be studied in an artificial environment. It follows then that foreign language vocabulary may be more efficiently acquired if it is purpose-driven, or linked to a clear and desirable outcome. The research described in this paper relates to the early stages of what is seen as a long-term effort to measure the effectiveness of a methodology for purpose-driven foreign language vocabulary instruction, specifically by analyzing whether directed studying from high-frequency vocabulary lists leads to an improvement in Test of English for International Communication (TOEIC) scores. The research was carried out in two sections of a first-year university English composition class at a small university in Japan. The results seem to indicate that purposeful study from relevant high-frequency vocabulary lists can contribute to raising TOEIC scores and that the test preparation methodology used in this study was thought by students to be beneficial in helping them to prepare to take this high-stakes test.

Keywords: corpus vocabulary, language asssessment, second language vocabulary acquisition, TOEIC test preparation

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1607 Human Relationships in the Virtual Classrooms as Predictors of Students Academic Resilience and Performance

Authors: Eddiebal P. Layco

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The purpose of this study is to describe students' virtual classroom relationships in terms of their relationship to their peers and teachers; academic resilience; and performance. Further, the researcher wants to examine if these virtual classroom relations predict students' resilience and performance in their academics. The data were collected from 720 junior and senior high school or grade 7 to 12 students in selected state universities and colleges (SUCs) in Region III offering online or virtual classes during S.Y. 2020-2021. Results revealed that virtual classroom relationships such as teacher-student and peer relationships predict academic resilience and performance. This implies that students' academic relations with their teachers and peers have something to do with their ability to bounce back and beat the odds amidst challenges they faced in the online or virtual learning environment. These virtual relationships significantly influence also their academic performance. Adequate teacher support and positive peer relations may lead to enhanced academic resilience, which may also promote a meaningful and fulfilled life academically. Result suggests that teachers should develop their students' academic resiliency and maintain good relationships in the classroom since these results in academic success.

Keywords: virtual classroom relationships, teacher-pupil relationship, peer-relationship, academic resilience, academic performance

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1606 Identifying the Goals of a Multicultural Curriculum for the Primary Education Course

Authors: Fatemeh Havas Beigi

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The purpose of this study is to identify the objectives of a multicultural curriculum for the primary education period from the perspective of ethnic teachers and education experts and cultural professionals. The research paradigm is interpretive, the research approach is qualitative, the research strategy is content analysis, the sampling method is purposeful and it is a snowball, and the sample of informants in the research for Iranian ethnic teachers and experts until the theoretical saturation was estimated to be 67 people. The data collection tools used were based on semi-structured interviews and individual interviews and focal interviews were used to collect information. The data format was also in audio format and the first period coding and the second coding were used to analyze the data. Based on data analysis 11 Objective: Paying attention to ethnic equality, expanding educational opportunities and justice, peaceful coexistence, anti-ethnic and racial discrimination education, paying attention to human value and dignity, accepting religious diversity, getting to know ethnicities and cultures, promoting teaching-learning, fostering self-confidence, building national unity, and developing cultural commonalities for a multicultural curriculum were identified.

Keywords: objective, multicultural curriculum, connect, elementary education period

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1605 In Vitro Intestine Tissue Model to Study the Impact of Plastic Particles

Authors: Ashleigh Williams

Abstract:

Micro- and nanoplastics’ (MNLPs) omnipresence and ecological accumulation is evident when surveying recent environmental impact studies. For example, in 2014 it was estimated that at least 52.3 trillion plastic microparticles are floating at sea, and scientists have even found plastics present remote Arctic ice and snow (5,6). Plastics have even found their way into precipitation, with more than 1000 tons of microplastic rain precipitating onto the Western United States in 2020. Even more recent studies evaluating the chemical safety of reusable plastic bottles found that hundreds of chemicals leached into the control liquid in the bottle (ddH2O, ph = 7) during a 24-hour time period. A consequence of the increased abundance in plastic waste in the air, land, and water every year is the bioaccumulation of MNLPs in ecosystems and trophic niches of the animal food chain, which could potentially cause increased direct and indirect exposure of humans to MNLPs via inhalation, ingestion, and dermal contact. Though the detrimental, toxic effects of MNLPs have been established in marine biota, much less is known about the potentially hazardous health effects of chronic MNLP ingestion in humans. Recent data indicate that long-term exposure to MNLPs could cause possible inflammatory and dysbiotic effects. However, toxicity seems to be largely dose-, as well as size-dependent. In addition, the transcytotic uptake of MNLPs through the intestinal epithelia in humans remain relatively unknown. To this point, the goal of the current study was to investigate the mechanisms of micro- and nanoplastic uptake and transcytosis of Polystyrene (PE) in human stem-cell derived, physiologically relevant in vitro intestinal model systems, and to compare the relative effect of particle size (30 nm, 100 nm, 500 nm and 1 µm), and concentration (0 µg/mL, 250 µg/mL, 500 µg/mL, 1000 µg/mL) on polystyrene MNLP uptake, transcytosis and intestinal epithelial model integrity. Observational and quantitative data obtained from confocal microscopy, immunostaining, transepithelial electrical resistance (TEER) measurements, cryosectioning, and ELISA cytokine assays of the proinflammatory cytokines Interleukin-6 and Interleukin-8 were used to evaluate the localization and transcytosis of polystyrene MNPs and its impact on epithelial integrity in human-derived intestinal in vitro model systems. The effect of Microfold (M) cell induction on polystyrene micro- and nanoparticle (MNP) uptake, transcytosis, and potential inflammation was also assessed and compared to samples grown under standard conditions. Microfold (M) cells, link the human intestinal system to the immune system and are the primary cells in the epithelium responsible for sampling and transporting foreign matter of interest from the lumen of the gut to underlying immune cells. Given the uptake capabilities of Microfold cells to interact both specifically and nonspecific to abiotic and biotic materials, it was expected that M- cell induced in vitro samples would have increased binding, localization, and potentially transcytosis of Polystyrene MNLPs across the epithelial barrier. Experimental results of this study would not only help in the evaluation of the plastic toxicity, but would allow for more detailed modeling of gut inflammation and the intestinal immune system.

Keywords: nanoplastics, enteroids, intestinal barrier, tissue engineering, microfold (M) cells

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1604 Philosophical Foundations of Education at the Kazakh Languages by Aiding Communicative Methods

Authors: Duisenova Marzhan

Abstract:

This paper considers the looking from a philosophical point of view the interactive technology and tiered developing Kazakh language teaching primary school pupils through the method of linguistic communication, content and teaching methods formed in the education system. The values determined by the formation of new practical ways that could lead to a novel qualitative level and solving the problem. In the formation of the communicative competence of elementary school students would be to pay attention to other competencies. It helps to understand the motives and needs socialization of students, the development of their cognitive abilities and participate in language relations arising from different situations. Communicative competence is the potential of its own in pupils creative language activity. In this article, the Kazakh language teaching in primary school communicative method is presented. The purpose of learning communicative method, personal development, effective psychological development of the child, himself-education, expansion and growth of language skills and vocabulary, socialization of children, the adoption of the laws of life in the social environment, analyzed the development of vocabulary richness of the language that forms the erudition to ensure continued improvement of education of the child.

Keywords: communicative, culture, training, process, method, primary, competence

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1603 An Analysis of Uncoupled Designs in Chicken Egg

Authors: Pratap Sriram Sundar, Chandan Chowdhury, Sagar Kamarthi

Abstract:

Nature has perfected her designs over 3.5 billion years of evolution. Research fields such as biomimicry, biomimetics, bionics, bio-inspired computing, and nature-inspired designs have explored nature-made artifacts and systems to understand nature’s mechanisms and intelligence. Learning from nature, the researchers have generated sustainable designs and innovation in a variety of fields such as energy, architecture, agriculture, transportation, communication, and medicine. Axiomatic design offers a method to judge if a design is good. This paper analyzes design aspects of one of the nature’s amazing object: chicken egg. The functional requirements (FRs) of components of the object are tabulated and mapped on to nature-chosen design parameters (DPs). The ‘independence axiom’ of the axiomatic design methodology is applied to analyze couplings and to evaluate if eggs’ design is good (i.e., uncoupled design) or bad (i.e., coupled design). The analysis revealed that eggs design is a good design, i.e., uncoupled design. This approach can be applied to any nature’s artifacts to judge whether their design is a good or a bad. This methodology is valuable for biomimicry studies. This approach can also be a very useful teaching design consideration of biology and bio-inspired innovation.

Keywords: uncoupled design, axiomatic design, nature design, design evaluation

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1602 Constructing a Bayesian Network for Solar Energy in Egypt Using Life Cycle Analysis and Machine Learning Algorithms

Authors: Rawaa H. El-Bidweihy, Hisham M. Abdelsalam, Ihab A. El-Khodary

Abstract:

In an era where machines run and shape our world, the need for a stable, non-ending source of energy emerges. In this study, the focus was on the solar energy in Egypt as a renewable source, the most important factors that could affect the solar energy’s market share throughout its life cycle production were analyzed and filtered, the relationships between them were derived before structuring a Bayesian network. Also, forecasted models were built for multiple factors to predict the states in Egypt by 2035, based on historical data and patterns, to be used as the nodes’ states in the network. 37 factors were found to might have an impact on the use of solar energy and then were deducted to 12 factors that were chosen to be the most effective to the solar energy’s life cycle in Egypt, based on surveying experts and data analysis, some of the factors were found to be recurring in multiple stages. The presented Bayesian network could be used later for scenario and decision analysis of using solar energy in Egypt, as a stable renewable source for generating any type of energy needed.

Keywords: ARIMA, auto correlation, Bayesian network, forecasting models, life cycle, partial correlation, renewable energy, SARIMA, solar energy

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1601 Provotyping Futures Through Design

Authors: Elisabetta Cianfanelli, Maria Claudia Coppola, Margherita Tufarelli

Abstract:

Design practices throughout history return a critical understanding of society since they always conveyed values and meanings aimed at (re)framing reality by acting in everyday life: here, design gains cultural and normative character, since its artifacts, services, and environments hold the power to intercept, influence and inspire thoughts, behaviors, and relationships. In this sense, design can be persuasive, engaging in the production of worlds and, as such, acting in the space between poietics and politics so that chasing preferable futures and their aesthetic strategies becomes a matter full of political responsibility. This resonates with contemporary landscapes of radical interdependencies challenging designers to focus on complex socio-technical systems and to better support values such as equality and justice for both humans and nonhumans. In fact, it is in times of crisis and structural uncertainty that designers turn into visionaries at the service of society, envisioning scenarios and dwelling in the territories of imagination to conceive new fictions and frictions to be added to the thickness of the real. Here, design’s main tasks are to develop options, to increase the variety of choices, to cultivate its role as scout, jester, agent provocateur for the public, so that design for transformation emerges, making an explicit commitment to society, furthering structural change in a proactive and synergic manner. However, the exploration of possible futures is both a trap and a trampoline because, although it embodies a radical research tool, it raises various challenges when the design process goes further in the translation of such vision into an artefact - whether tangible or intangible -, through which it should deliver that bit of future into everyday experience. Today designers are making up new tools and practices to tackle current wicked challenges, combining their approaches with other disciplinary domains: futuring through design, thus, rises from research strands like speculative design, design fiction, and critical design, where the blending of design approaches and futures thinking brings an action-oriented and product-based approach to strategic insights. The contribution positions at the intersection of those approaches, aiming at discussing design’s tools of inquiry through which it is possible to grasp the agency of imagined futures into present time. Since futures are not remote, they actively participate in creating path-dependent decisions, crystallized into designed artifacts par excellence, prototypes, and their conceptual other, provotypes: with both being unfinished and multifaceted, the first ones are effective in reiterating solutions to problems already framed, while the second ones prove to be useful when the goal is to explore and break boundaries, bringing closer preferable futures. By focusing on some provotypes throughout history which challenged markets and, above all, social and cultural structures, the contribution’s final aim is understanding the knowledge produced by provotypes, understood as design spaces where designs’s humanistic side might help developing a deeper sensibility about uncertainty and, most of all, the unfinished feature of societal artifacts, whose experimentation would leave marks and traces to build up f(r)ictions as vital sparks of plurality and collective life.

Keywords: speculative design, provotypes, design knowledge, political theory

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1600 Knowledge Transfer in Industrial Clusters

Authors: Ana Paula Lisboa Sohn, Filipa Dionísio Vieria, Nelson Casarotto, Idaulo José Cunha

Abstract:

This paper aims at identifying and analyzing the knowledge transmission channels in textile and clothing clusters located in Brazil and in Europe. Primary data was obtained through interviews with key individuals. The collection of primary data was carried out based on a questionnaire with ten categories of indicators of knowledge transmission. Secondary data was also collected through a literature review and through international organizations sites. Similarities related to the use of the main transmission channels of knowledge are observed in all cases. The main similarities are: influence of suppliers of machinery, equipment and raw materials; imitation of products and best practices; training promoted by technical institutions and businesses; and cluster companies being open to acquire new knowledge. The main differences lie in the relationship between companies, where in Europe the intensity of this relationship is bigger when compared to Brazil. The differences also occur in importance and frequency of the relationship with the government, with the cultural environment, and with the activities of research and development. It is also found factors that reduce the importance of geographical proximity in transmission of knowledge, and in generating trust and the establishment of collaborative behavior.

Keywords: industrial clusters, interorganizational learning, knowledge transmission channels, textile and clothing industry

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1599 Impacts of School-Wide Positive Behavioral Interventions and Supports on Student Academics, Behavior and Mental Health

Authors: Catherine Bradshaw

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Educators often report difficulty managing behavior problems and other mental health concerns that students display at school. These concerns also interfere with the learning process and can create distraction for teachers and other students. As such, schools play an important role in both preventing and intervening with students who experience these types of challenges. A number of models have been proposed to serve as a framework for delivering prevention and early intervention services in schools. One such model is called Positive Behavioral Interventions and Supports (PBIS), which has been scaled-up to over 26,000 schools in the U.S. and many other countries worldwide. PBIS aims to improve a range of student outcomes through early detection of and intervention related to behavioral and mental health symptoms. PBIS blends and applies social learning, behavioral, and organizational theories to prevent disruptive behavior and enhance the school’s organizational health. PBIS focuses on creating and sustaining tier 1 (universal), tier 2 (selective), and tier 3 (individual) systems of support. Most schools using PBIS have focused on the core elements of the tier 1 supports, which includes the following critical features. The formation of a PBIS team within the school to lead implementation. Identification and training of a behavioral support ‘coach’, who serves as a on-site technical assistance provider. Many of the individuals identified to serve as a PBIS coach are also trained as a school psychologist or guidance counselor; coaches typically have prior PBIS experience and are trained to conduct functional behavioral assessments. The PBIS team also identifies a set of three to five positive behavioral expectations that are implemented for all students and by all staff school-wide (e.g., ‘be respectful, responsible, and ready to learn’); these expectations are posted in all settings across the school, including in the classroom, cafeteria, playground etc. All school staff define and teach the school-wide behavioral expectations to all students and review them regularly. Finally, PBIS schools develop or adopt a school-wide system to reward or reinforce students who demonstrate those 3-5 positive behavioral expectations. Staff and administrators create an agreed upon system for responding to behavioral violations that include definitions about what constitutes a classroom-managed vs. an office-managed discipline problem. Finally, a formal system is developed to collect, analyze, and use disciplinary data (e.g., office discipline referrals) to inform decision-making. This presentation provides a brief overview of PBIS and reports findings from a series of four U.S. based longitudinal randomized controlled trials (RCTs) documenting the impacts of PBIS on school climate, discipline problems, bullying, and academic achievement. The four RCTs include 80 elementary, 40 middle, and 58 high schools and results indicate a broad range of impacts on multiple student and school-wide outcomes. The session will highlight lessons learned regarding PBIS implementation and scale-up. We also review the ways in which PBIS can help educators and school leaders engage in data-based decision-making and share data with other decision-makers and stakeholders (e.g., students, parents, community members), with the overarching goal of increasing use of evidence-based programs in schools.

Keywords: positive behavioral interventions and supports, mental health, randomized trials, school-based prevention

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1598 Attention-Based ResNet for Breast Cancer Classification

Authors: Abebe Mulugojam Negash, Yongbin Yu, Ekong Favour, Bekalu Nigus Dawit, Molla Woretaw Teshome, Aynalem Birtukan Yirga

Abstract:

Breast cancer remains a significant health concern, necessitating advancements in diagnostic methodologies. Addressing this, our paper confronts the notable challenges in breast cancer classification, particularly the imbalance in datasets and the constraints in the accuracy and interpretability of prevailing deep learning approaches. We proposed an attention-based residual neural network (ResNet), which effectively combines the robust features of ResNet with an advanced attention mechanism. Enhanced through strategic data augmentation and positive weight adjustments, this approach specifically targets the issue of data imbalance. The proposed model is tested on the BreakHis dataset and achieved accuracies of 99.00%, 99.04%, 98.67%, and 98.08% in different magnifications (40X, 100X, 200X, and 400X), respectively. We evaluated the performance by using different evaluation metrics such as precision, recall, and F1-Score and made comparisons with other state-of-the-art methods. Our experiments demonstrate that the proposed model outperforms existing approaches, achieving higher accuracy in breast cancer classification.

Keywords: residual neural network, attention mechanism, positive weight, data augmentation

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1597 Higher Education Teachers' Perceptions of Core Competencies and Innovation: The Case of Mohamed V University Abu Dhabi

Authors: Khalid Soussi

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Implementing innovative teaching and learning methods is of pivotal importance for student motivation and teaching quality. At the center of such quality are teaching competencies. The present paper investigates three teachers’ core competencies related to their innovative teaching performance: educational/pedagogical competency, teaching competency, and social competency. The paper also attempts to describe the influence of social factors on innovation in higher education. Many recent studies highlight the technological competency as an independent one, but it is believed in this study that the latter makes part of the pedagogical competency. A Likert scale questionnaire was used to measure teachers’ judgements of core competencies role in innovative teaching performance. The study also attempted to demarcate the social variables that may affect innovative teaching in higher education. The findings indicate that teachers’ educational competency and teaching competency were generally confirmed to be either important or very important for innovation in teaching performance. Regarding social competency, the study also shows that satisfaction from job, daily working hours, amount of workload, flexibility in the functioning and the quality of students are the main factors that have a large effect on teachers’ innovative teaching performance.

Keywords: higher education, innovative teaching, teaching competencies, teaching performance

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1596 Formative Assessment in an Introductory Python Programming Course

Authors: María José Núñez-Ruiz, Luis Álvarez-González, Cristian Olivares-Rodriguez, Benjamin Lazo-Letelier

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This paper begins with some concept of formative assessment and the relationship with learning objective: contents objectives, processes objectives, and metacognitive objectives. Two methodologies are describes Evidence-Based teaching and Question Drive Instruction. To do formative assessments in larges classes a Classroom Response System (CRS) is needed. But most of CRS use only Multiple Choice Questions (MCQ), True/False question, or text entry; however, this is insufficient to formative assessment. To do that a new CRS, call FAMA was developed. FAMA support six types of questions: Choice, Order, Inline choice, Text entry, Associated, and Slider. An experiment participated in 149 students from four engineering careers. For results, Kendall's Range Correlation Analysis and descriptive analysis was done. In conclusion, there is a strong relation between contents question, process questions (ask in formative assessment without a score) and metacognitive questions, asked in summative assessment. As future work, the lecturer can do personalized teaching, because knows the behavior of all students in each formative assessment

Keywords: Python language, formative assessment, classroom response systems, evidence-Based teaching, question drive instruction

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1595 Implementation of the Science Curriculum of the Colleges of Education: Successes and Challenges

Authors: Cecilia Boakye, Joseph Ghartey Ampiah

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In this study, we present a case study in which we explored how the 2007 science curriculum of the colleges of education in Ghana was implemented at W College of Education. Purposive sampling was used to select 13 participants, comprising 2 tutors and 6 teacher trainees from W College of Education and, 5 newly qualified Junior High School (JHS) science teachers who were products of W College. Interviews, observations and content analysis were used to collect data. Using the deductive and inductive analytic approaches, the findings showed that although upgraded laboratories have provided for teaching authentic science at W College of Education, they are rather used to accommodate large classes at the expense of practical activities. The teaching and learning methods used by the tutors do not mirror effectively the objectives of the 2007 science curriculum of the colleges of education. There are challenges such as: (a) lack/inadequate equipment and materials, (b) time constraint, and (c) an examination- oriented curriculum that influence the implementation of the curriculum. Some of the suggestions that were made are that: (a) equipment and materials should be supplied to the colleges to facilitate the proper implementation of the curriculum, and (b) class sizes should be reduced to provide enough room for practical activities.

Keywords: class size, teaching, curriculum implementation, examination-oriented curriculum, teaching and time-constraint

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1594 Environmental Planning for Sustainable Utilization of Lake Chamo Biodiversity Resources: Geospatially Supported Approach, Ethiopia

Authors: Alemayehu Hailemicael Mezgebe, A. J. Solomon Raju

Abstract:

Context: Lake Chamo is a significant lake in the Ethiopian Rift Valley, known for its diversity of wildlife and vegetation. However, the lake is facing various threats due to human activities and global effects. The poor management of resources could lead to food insecurity, ecological degradation, and loss of biodiversity. Research Aim: The aim of this study is to analyze the environmental implications of lake level changes using GIS and remote sensing. The research also aims to examine the floristic composition of the lakeside vegetation and propose spatially oriented environmental planning for the sustainable utilization of the biodiversity resources. Methodology: The study utilizes multi-temporal satellite images and aerial photographs to analyze the changes in the lake area over the past 45 years. Geospatial analysis techniques are employed to assess land use and land cover changes and change detection matrix. The composition and role of the lakeside vegetation in the ecological and hydrological functions are also examined. Findings: The analysis reveals that the lake has shrunk by 14.42% over the years, with significant modifications to its upstream segment. The study identifies various threats to the lake-wetland ecosystem, including changes in water chemistry, overfishing, and poor waste management. The study also highlights the impact of human activities on the lake's limnology, with an increase in conductivity, salinity, and alkalinity. Floristic composition analysis of the lake-wetland ecosystem showed definite pattern of the vegetation distribution. The vegetation composition can be generally categorized into three belts namely, the herbaceous belt, the legume belt and the bush-shrub-small trees belt. The vegetation belts collectively act as different-sized sieve screen system and calm down the pace of incoming foreign matter. This stratified vegetation provides vital information to decide the management interventions for the sustainability of lake-wetland ecosystem.Theoretical Importance: The study contributes to the understanding of the environmental changes and threats faced by Lake Chamo. It provides insights into the impact of human activities on the lake-wetland ecosystem and emphasizes the need for sustainable resource management. Data Collection and Analysis Procedures: The study utilizes aerial photographs, satellite imagery, and field observations to collect data. Geospatial analysis techniques are employed to process and analyze the data, including land use/land cover changes and change detection matrices. Floristic composition analysis is conducted to assess the vegetation patterns Question Addressed: The study addresses the question of how lake level changes and human activities impact the environmental health and biodiversity of Lake Chamo. It also explores the potential opportunities and threats related to water utilization and waste management. Conclusion: The study recommends the implementation of spatially oriented environmental planning to ensure the sustainable utilization and maintenance of Lake Chamo's biodiversity resources. It emphasizes the need for proper waste management, improved irrigation facilities, and a buffer zone with specific vegetation patterns to restore and protect the lake outskirt.

Keywords: buffer zone, geo-spatial, lake chamo, lake level changes, sustainable utilization

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1593 A Case of Severe Iatrogenic Cushing’s Syndrome Followed by Adrenal Crisis, Multifocal Pneumonia, Sepsis, Pulmonary Embolism and Prolonged Adrenal Insufficiency

Authors: Jelena Maletkovic

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Background: Endogenous Cushing’s syndrome is a rare disease, but iatrogenic or drug related Cushing syndrome from glucocorticoid products is commonly seen in clinical practice. With high dose and long term use of glucocorticoids, patients can develop isolated hypothalamic-pituitary-adrenal (HPA) suppression, or HPA axis suppression can be accompanied by overt iatrogenic Cushing’s syndrome. This is a rare case where severe Cushing’s syndrome developed from an unknown medication and was followed by severe and prolonged adrenal insufficiency and multiple potentially fatal complications. Case: This is a 37-year-old woman who is presented to Emergency Room (ER) with shortness of breath and chest pain. Four months prior to this presentation the patient was a generally healthy woman who was looking for improvement in her appearance and visited local Rejuvenation Clinic. After initial consultation with a nurse, she was contacted by a physician over the phone and was advised to start taking multiple injectable medications that will arrive by mail. Medications without any labels on bottles were delivered and the patient started daily intramuscular injections. Over the next two months, she noticed rounding of her face and swelling around her eyes. She gained 20 pounds, mostly abdominal fat and became extremely fatigued. Her muscles on legs were visibly decreasing in size and she felt significant muscle weakness. Unexplained bruising occurred. She started growing hair on face and developed secondary amenorrhea. New severe back pain started. She developed depression and headaches. Finally, over a few days, a number of red-purple stretch marks that were sensitive and painful appeared over her abdomen, upper part of arms and legs. She then became suspicious that these dramatic symptoms are caused by injectable medication and she discontinued injections. Over the next few days she presented to ER with low blood pressure and oxygen saturation of 75%. Studies revealed extensive pneumonia as well as multiple pulmonary emboli. Her white blood count was elevated with 32 000 and she also had acute kidney failure on admission. She was treated for sepsis and was also given stress dose steroids. Steroids were tapered over 48 hours and discontinued. After being discharged to home, on her first visit to endocrinology clinic she had undetectable ACTH of < 2pg/mL and undetectable 8am cortisol of < 0.2mcg/dL. She did not respond to an intramuscular injection of cosyntropin 250mcg and her repeated cortisol after 60 minutes was only 1mcg/dL. The patient was diagnosed with adrenal insufficiency and was started on hydrocortisone 20mg+10mg. It took close to 2 years of slow tapering for recovery of this patient’s HPA axis and resolve all the sequelae from Cushing’s syndrome. Conclusion: Misuse and abuse of glucocorticoids have been present almost since these medications were discovered. This is a rare case where not only severe Cushing’s syndrome in full clinical picture developed but also the patient suffered multiple potentially fatal complications and prolonged adrenal insufficiency. Visits to herbal, rejuvenation, esthetic, and similar clinics are becoming more and more popular and physicians need to be aware of possible non-benign nature of medications that their patients may be using.

Keywords: iatrogenic, Cushing's syndrome, adrenal crisis, steroid abuse

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