Search results for: group intervention

Authors: Manik Sharma

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Understanding the anatomy and normal anatomical variations of the lower limb arterial system is undeniably important not only to understand the pathology involving the vessels of the lower limb but also as a part of endovascular intervention and surgical planning in cases that demand them as a part of treatment. There have been very few cases of duplication of SFA cited in the literature, close to six worldwide and this being the seventh case in the world and first to be reported in the Indian population. We incidentally came across this normal variant during US lower limb (US-LL) duplex scan in a patient with claudicating pain in bilateral lower limbs hence suspected of having peripheral vascular disease. It was confirmed on CT-Peripheral Angiography (CT-PA), which was done successively.

Keywords: peripheral vascular disease, claudicating pain, normal anatomical variants, endovascular intervention, duplication, CT-peripheral angiography, duplex scan, Iohexol

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Authors: Zohreh Rostami, Arezoo Khosravi, Mohammad Nikpoor Aghdam, Mahmood Salesi

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Background: Cardiovascular mortality in chronic kidney disease (CKD) and end stage renal disease (ESRD) patients have a strong relationship with baseline or progressive left ventricular hypertrophy (LVH) meanwhile in hemodialysis patients 10% decrement in left ventricular mass was associated with 28% reduction in cardiovascular mortality risk. In consonance with these arguments, we designed a study to measure morphological and functional echocardiographic variations early after transplantation. Method: The patients with normal renal function underwent two advanced echocardiographic studies to examine the structural and functional changes in left ventricular mass before and 3-month after transplantation. Results: From a total of 23 participants 21(91.3%) presented with left ventricular hypertrophy, 60.9% in eccentric and 30.4% in concentric group. Diastolic dysfunction improved in concentric group after transplantation. Both in pre and post transplantation global longitudinal strain (GLS)- average in eccentric group was more than concentric (-17.45 ± 2.75 vs -14.3 ± 3.38 p=0.03) and (-18.08 ± 2.6 vs -16.1 ± 2.7 p= 0.04) respectively. Conclusion: Improvement and recovery of left ventricular function in concentric group was better and sooner than eccentric after kidney transplantation. Although fractional shortening and diastolic function and GLS-4C in pre-transplantation in concentric group was worse than eccentric, but therapeutic response to kidney transplantation in concentric was more and earlier than eccentric group.

Keywords: chronic kidney disease, end stage renal disease, left ventricular hypertrophy, global longitudinal strain

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Authors: Rahul Jain, Jagdish Chander, Anish Gupta

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Introduction: Laparoscopic common bile duct exploration (LCBDE) allows cholecystectomy and the removal of common bile duct (CBD) stones to be performed during the same sitting, thereby decreasing hospital stay. CBD exploration through choledochotomy can be closed primarily with an absorbable suture material, but can lead to biliary leakage postoperatively. In this study we tried to find a solution to further lower the incidence of bile leakage by using fibrin glue to reinforce the sutures put on choledochotomy suture line. It has haemostatic and sealing action, through strengthening the last step of the physiological coagulation and biostimulation, which favours the formation of new tissue matrix. Methodology: This study was conducted at a tertiary care teaching hospital in New Delhi, India, from 2011 to 2013. 20 patients with CBD stones documented on MRCP with CBD diameter of 9 mm or more were included in this study. Patients were randomized into two groups namely Group A in which choledochotomy was closed with polyglactin 4-0 suture and suture line reinforced with fibrin glue, and Group ‘B’ in which choledochotomy was closed with polyglactin 4-0 suture alone. Both the groups were evaluated and compared on clinical parameters such as operative time, drain content, drain output, no. of days drain was required, blood loss & transfusion requirements, length of postoperative hospital stay and conversion to open surgery. Results: The operative time for Group A ranged from 60 to 210 min (mean 131.50 min) and Group B 65 to 300 min (mean 140 minutes). The blood loss in group A ranged from 10 to 120 ml (mean 51.50 ml), in group B it ranged from 10 to 200 ml (mean 53.50 ml). In Group A, there was no case of bile leak but there was bile leak in 2 cases in Group B, minimum 0 and maximum 900 ml with a mean of 97 ml and p value of 0.147 with no statistically significant difference in bile leak in test and control groups. The minimum and maximum serous drainage in Group A was nil & 80 ml (mean 11 ml) and in Group B was nil & 270 ml (mean 72.50 ml). The p value came as 0.028 which is statistically significant. Thus serous leakage in Group A was significantly less than in Group B. The drains in Group A were removed from 2 to 4 days (mean: 3 days) while in Group B from 2 to 9 days (mean: 3.9 days). The patients in Group A stayed in hospital post operatively from 3 to 8 days (mean: 5.30) while in Group B it ranged from 3 to 10 days with a mean of 5 days. Conclusion: Fibrin glue application on CBD decreases bile leakage but in statistically insignificant manner. Fibrin glue application on CBD can significantly decrease post operative serous drainage after LCBDE. Fibrin glue application on CBD is safe and easy technique without any significant adverse effects and can help less experienced surgeons performing LCBDE.

Keywords: bile leak, fibrin glue, LCBDE, serous leak

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Authors: Breanna Wright, Peter Bragge

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Diagnostic error rates in healthcare are approximately 10% of cases. Diagnostic errors can cause patient harm due to inappropriate, inadequate or delayed treatment, and such errors contribute heavily to medical liability claims globally. Therefore, addressing diagnostic error is a high priority. In most cases, diagnostic errors are the result of faulty information synthesis rather than lack of knowledge. Specifically, the majority of diagnostic errors involve cognitive factors, and in particular, cognitive biases. Emergency Departments are an environment with heightened risk of diagnostic error due to time and resource pressures, a frequently chaotic environment, and patients arriving undifferentiated and with minimal context. This project aimed to develop a behavioural, evidence-informed intervention to reduce diagnostic error in Emergency Departments through co-design with emergency physicians, insurers, researchers, hospital managers, citizens and consumer representatives. The Forum Process was utilised to address this aim. This involves convening a small (4 – 6 member) expert panel to guide a focused literature and practice review; convening of a 10 – 12 person citizens panel to gather perspectives of laypeople, including those affected by misdiagnoses; and a 18 – 22 person structured stakeholder dialogue bringing together representatives of the aforementioned stakeholder groups. The process not only provides in-depth analysis of the problem and associated behaviours, but brings together expertise and insight to facilitate identification of a behaviour change intervention. Informed by the literature and practice review, the Citizens Panel focused on eliciting the values and concerns of those affected or potentially affected by diagnostic error. Citizens were comfortable with diagnostic uncertainty if doctors were honest with them. They also emphasised the importance of open communication between doctors and patients and their families. Citizens expect more consistent standards across the state and better access for both patients and their doctors to patient health information to avoid time-consuming re-taking of long patient histories and medication regimes when re-presenting at Emergency Departments and to reduce the risk of unintentional omissions. The structured Stakeholder Dialogue focused on identifying a feasible behavioural intervention to review diagnoses in Emergency Departments. This needed to consider the role of cognitive bias in medical decision-making; contextual factors (in Victoria, there is a legislated 4-hour maximum time between ED triage and discharge / hospital admission); resource availability; and the need to ensure the intervention could work in large metropolitan as well as small rural and regional ED settings across Victoria. The identified behavioural intervention will be piloted in approximately ten hospital EDs across Victoria, Australia. This presentation will detail the findings of all review and consultation activities, describe the behavioural intervention developed and present results of the pilot trial.

Keywords: behavioural intervention, cognitive bias, decision-making, diagnostic error

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Authors: Sahar Oudeh, Abbas Javaheri Vayeghan, Mahmood Ahmadi-Hamedani

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This study aimed to investigate the effect of diabetic duration on platelet and platelet indices in streptozotocin-induced diabetic male and female rats. Thirty-two healthy adult Wistar rats (16 females and 16 males) were randomly divided into 4 groups of eight, including 1) control group (4 females and 4 males who did not undergo any treatment until the end of 28 days), 2) 7-day diabetic group (4 females and 4 males who were diabetic for 7 days and were euthanized after 7 days), 3) 14-day diabetic group (4 females and 4 males who were diabetic for 14 days and were euthanized after 14 days), and 28-day diabetic group (4 females and 4 males who were diabetic for 28 days and were euthanized after 28 days). Diabetes was induced by intraperitoneal injection of streptozotocin (65 mg/kg). After induction of diabetes in the groups, blood samples were taken from their hearts after anesthesia, and platelet counts (PLT) and platelet indices were measured by an automatic blood cell counter (Nihon Kohden, Celltac Alpha VET MEK-6550, Japan). Statistical differences among groups were analyzed using one-way analysis of variance (ANOVA) followed by Tukey’s multiple tests. The results of this study showed that PLT and mean platelet volume (MPV) significantly increased in 7 and 14-day diabetic groups compared to the control group, whereas plateletcrit (PCT) and platelet distribution rate (PDW) significantly increased in 14 and 28-day diabetic groups, respectively. Significant differences were observed between female and male rats in PCT and PLT in the 14-day diabetic group and PDW in the 28-day diabetic group. According to the results of this study, measurement and analysis of platelet indices can be used as a method for the early diagnosis of diabetes and its complications.

Keywords: diabetic duration, streptozotocin, female and male rats, platelet indices

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Authors: Yu-Hsiang Yu

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The immunomodulatory effect of propolis has been widely investigated in the past decade. However, the beneficial effects in broilers are still poorly understood. The aim of this study was to evaluate the effect of propolis added in drinking water on immunomodulatory and antibody production in broiler. Total of 48 chicks were randomly allocated into four groups with 12 broilers per group. All birds were intranasal inoculated with Newcastle Disease vaccine at 4 and 14 days old of age. Four groups, including control without any treatment, groups of A, B and F [3 days of anterior (A), 3 days of posterior (P) and 6 days of full (F)] were supplied the propolis at 300 ppm in drinking water when vaccination was performed, respectively. Our results showed that no significant difference was found in growth performance, antibody production and immune organ index among groups. However, propolis treatments in broilers significantly reduced IL-4 expression in spleen at 14 days-old of age and bursa at 28 days-old of age compared with control group. The expression of IFN-gamma in spleen (A, P and F group) and bursal (F group) were elevated compared with control group at 28 days-old of age. In conclusion, our results indicated that propolis-treated birds could bear the capability for immunomodulatory effects by change Th1 subset cytokine expression in vaccination.

Keywords: propolis, broiler, immunomodulatory, vaccination

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Authors: Fuyuan Ma, Ying Wang, Xin Wang

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Social networks have become breeding grounds for the rapid spread of rumors and malicious information, posing threats to societal stability and causing significant public harm. Existing research focuses on simulating the spread of information and its impact on users through propagation dynamics and applies methods such as greedy approximation strategies to approximate the optimal control solution at the global scale. However, the greedy strategy at the global scale may fall into locally optimal solutions, and the approximate simulation of information spread may accumulate more errors. Therefore, we propose a multi-scale control model for network group behavior, introducing individual and group scales on top of the greedy strategy’s global scale. At the individual scale, we calculate the propagation influence of nodes based on their structural attributes to alleviate the issue of local optimality. At the group scale, we conduct precise propagation simulations to avoid introducing cumulative errors from approximate calculations without increasing computational costs. Experimental results on three real-world datasets demonstrate the effectiveness of our proposed multi-scale model in controlling network group behavior.

Keywords: influence blocking maximization, competitive linear threshold model, social networks, network group behavior

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Authors: Victoria Bila, Iryna Ventskivska, Oleksandra Zahorodnia

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The goal of the study: To study the distribution of patients of the Kiyv Perinatal Center according to the Robson system and compare it with world data. Materials and methods: a comparison of the distribution of patients of Kiyv Perinatal center according to the Robson system for 2 periods - the first quarter of 2019 and 2020. For each group, 3 indicators were analyzed - the share of this group in the overall structure of patients of the Perinatal Center for the reporting period, the frequency of abdominal delivery in this group, as well as the contribution of this group to the total number of abdominal delivery. Obtained data were compared with those of the WHO in the guidelines for the implementation of the Robson system in 2017. Results and its discussion: The distribution of patients of the Perinatal Center into groups in the Robson classification is not much different from that recommended by the author. So, among all women, patients of group 1 dominate; this indicator does not change in dynamics. A slight increase in the share of group 2 (6.7% in 2019 and 9.3% - 2020) was due to an increase in the number of labor induction. At the same time, the number of patients of groups 1 and 2 in the Perinatal Center is greater than in the world population, which is determined by the hospitalization of primiparous women with reproductive losses in the past. The Perinatal Center is distinguished from the world population and the proportion of women of group 5 - it was 5.4%, in the world - 7.6%. The frequency of caesarean section in the Perinatal Center is within limits typical for most countries (20.5-20.8%). Moreover, the dominant groups in the structure of caesarean sections are group 5 (21-23.3%) and group 2 (21.9-22.9%), which are the reserve for reducing the number of abdominal delivery. In group 2, certain results have already been achieved in this matter - the frequency of cesarean section in 2019 here amounted to 67.8%, in the first quarter of 2020 - 51.6%. This happened due to a change in the leading method of induction of labor. Thus, the Robson system is a convenient and affordable tool for assessing the structure of caesarean sections. The analysis showed that, in general, the structure of caesarean sections in the Perinatal Center is close to world data, and the identified deviations have explanations related to the specialization of the Center.

Keywords: cesarian section, Robson system, Kyiv Perinatal Center, labor induction

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Authors: Regina Connolly, Justin Connolly

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Despite the benefits which they confer, Information & Communication Technologies (ICT) also have the potential to be used negatively. This paper focuses on one of those negative social effects - adolescent cyberbullying. Although early research in this field has pointed to the fact that the successful intervention and resolution of bullying incidents is to a large degree dependent on such incidents being reported to an adult caregiver, the literature consistently shows that adolescents who have been bullied tend not to inform others of their experiences. However, the reasons underlying such reluctance to seek adult intervention remain undetermined. Similarly, the degree to which gender, age or other variables apply in the case of adolescents’ resistance to report cyberbullying experiences has yet to be established. Understanding the factors that influence this resistance to communicate on the part of adolescents will assist caregivers, teachers and those involved in the formulation of school anti-bullying policies in their attempts to counter the cyberbullying phenomenon.

Keywords: information and Communication technologies, technology-enabled bullying, cyberbullying

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Authors: Hsiu-Tsu Cho

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Collective efficacy refers to a group’s sense of its capacity to complete a task successfully or to reach objectives. Little effort has been expended on investigating the relationship between the emotion expression of a leader and collective efficacy. In this study, we examined the impact of the different emotions and emotion expression of a group leader on collective efficacy and explored whether the emotion–expressive effects differed under conditions of negative and positive emotions. A total of 240 undergraduate and graduate students recruited using Facebook and posters at a university participated in this research. The participants were separated randomly into 80 groups of four persons consisting of three participants and a confederate. They were randomly assigned to one of five conditions in a 2 (pride vs. guilt) × 2 (emotion expression of group leader vs. no emotion expression of group leader) factorial design and a control condition. Each four-person group was instructed to get the reward in a group competition of solving the five-disk Tower of Hanoi puzzle and making decisions on an investment case. We surveyed the participants by employing the emotional measure revised from previous researchers and collective efficacy questionnaire on a 5-point scale. To induce an emotion of pride (or guilt), the experimenter announced whether the group performance was good enough to have a chance of getting the reward (ranking the top or bottom 20% among all groups) after group task. The leader (confederate) could either express or not express a feeling of pride (or guilt) following the instruction according to the assigned condition. To check manipulation of emotion, we added a control condition under which the experimenter revealed no results regarding group performance in maintaining a neutral emotion. One-way ANOVAs and post hoc pairwise comparisons among the three emotion conditions (pride, guilt, and control condition) involved assigning pride and guilt scores (pride: F(1,75) = 32.41, p < .001; guilt: F(1,75) = 6.75, p < .05). The results indicated that manipulations of emotion were successful. A two-way between-measures ANOVA was conducted to examine the predictions of the main effects of emotion types and emotion expression as well as the interaction effect of these two variables on collective efficacy. The experimental findings suggest that pride did not affect collective efficacy (F(1,60) = 1.90, ns.) more than guilt did and that the group leader did not motivate collective efficacy regardless of whether he or she expressed emotion (F(1,60) = .89, ns.). However, the interaction effect of emotion types and emotion expression was statistically significant (F(1,60) = 4.27, p < .05, ω2 = .066); the effects accounted for 6.6% of the variance. Additional results revealed that, under the pride condition, the leader enhanced group efficacy when expressing emotion, whereas, under the guilt condition, an expression of emotion could reduce collective efficacy. Overall, these findings challenge the assumption that the effect of expression emotion are the same on all emotions and suggest that a leader should be cautious when expressing negative emotions toward a group to avoid reducing group effectiveness.

Keywords: collective efficacy, group leader, emotion expression, pride, guilty

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Authors: Anguo Chen, Huajie Chen, Caimei Yang, Qihua Hong, Jun Feng

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The experiment was conducted with 360 one-day-old Avian commercial broilers to study the effects of dietary cinnamon extract (CE), garlic extract (GE) and yucca extract (YE) on growth performance and serum biochemical parameters in broilers. The chickens were randomly divided equally into 4 treatment groups, each group with 3 replications, and received the same basal corn-bean diets included a starter from 1 d to 21 d and then a grower until 42 d, added with recommended dose 250 mg/kg CE, 25 mg/kg GE and 10 mg/kg YE to relevant group, respectively. The birds were kept in a stainless steel net coop each replication with 24 h light and were fed and drunk ad libitum. At 21 d and 42 d of age, 6 chicks were respectively picked out from every group and were bled to collect serum samples and intestinal samples for laboratory analysis. The results showed that the average daily gain (ADG) of CE, GE and YE group were increased by 7.20% (P<0.05), 3.43% (P>0.05) and 4.89% (P>0.05), feed gain ratio (F/G) was improved by 9.71% (P<0.05), 3.40% (P>0.05) and 3.40% (P>0.05) compared with the control, respectively. At 21 d of age, the content of serum urea nitrogen (SUN) and serum uric acid (SUA) and the activity of serum xanthine oxidase (SXO) in CE group were reduced by 35.17% (P<0.01), 13.73% (P<0.01) and 16.33% (P<0.05) compared with the control, respectively. At 42 d of age, SUN and SUA level and SXO activity were lowered by 24.35% (P<0.01), 15.49% (P<0.05) and 23.09% (P<0.01), respectively. The SXO activity in CE group was decreased by 14.86% (P<0.01) and 15.34%(P<0.01) compare with GE and YE group, respectively. Also, adding CE, GE and YE into broiler diets resulted in lower UN and UA level of intestinal contents. It is clear that CE was more significantly decreased the SXO activity and SUA levels than GE and YE, especially at the latter period, thereby it may play a more important role in improving the growth performance of broilers.

Keywords: cinnamon extract, broiler, growth performance, serum uric acid, serum xanthine oxidase

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Authors: Orkide Donma, Mustafa M. Donma

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Basal metabolic rate (BMR) is widely used and an accepted measure of energy expenditure. Its principal determinant is body mass. However, this parameter is also correlated with a variety of other factors. The objective of this study is to measure BMR and compare it with the values obtained from predictive equations in adults classified according to their body mass index (BMI) values. 276 adults were included into the scope of this study. Their age, height and weight values were recorded. Five groups were designed based on their BMI values. First group (n = 85) was composed of individuals with BMI values varying between 18.5 and 24.9 kg/m². Those with BMI values varying from 25.0 to 29.9 kg/m² constituted Group 2 (n = 90). Individuals with 30.0-34.9 kg/m², 35.0-39.9 kg/m², > 40.0 kg/m² were included in Group 3 (n = 53), 4 (n = 28) and 5 (n = 20), respectively. The most commonly used equations to be compared with the measured BMR values were selected. For this purpose, the values were calculated by the use of four equations to predict BMR values, by name, introduced by Food and Agriculture Organization (FAO)/World Health Organization (WHO)/United Nations University (UNU), Harris and Benedict, Owen and Mifflin. Descriptive statistics, ANOVA, post-Hoc Tukey and Pearson’s correlation tests were performed by a statistical program designed for Windows (SPSS, version 16.0). p values smaller than 0.05 were accepted as statistically significant. Mean ± SD of groups 1, 2, 3, 4 and 5 for measured BMR in kcal were 1440.3 ± 210.0, 1618.8 ± 268.6, 1741.1 ± 345.2, 1853.1 ± 351.2 and 2028.0 ± 412.1, respectively. Upon evaluation of the comparison of means among groups, differences were highly significant between Group 1 and each of the remaining four groups. The values were increasing from Group 2 to Group 5. However, differences between Group 2 and Group 3, Group 3 and Group 4, Group 4 and Group 5 were not statistically significant. These insignificances were lost in predictive equations proposed by Harris and Benedict, FAO/WHO/UNU and Owen. For Mifflin, the insignificance was limited only to Group 4 and Group 5. Upon evaluation of the correlations of measured BMR and the estimated values computed from prediction equations, the lowest correlations between measured BMR and estimated BMR values were observed among the individuals within normal BMI range. The highest correlations were detected in individuals with BMI values varying between 30.0 and 34.9 kg/m². Correlations between measured BMR values and BMR values calculated by FAO/WHO/UNU as well as Owen were the same and the highest. In all groups, the highest correlations were observed between BMR values calculated from Mifflin and Harris and Benedict equations using age as an additional parameter. In conclusion, the unique resemblance of the FAO/WHO/UNU and Owen equations were pointed out. However, mean values obtained from FAO/WHO/UNU were much closer to the measured BMR values. Besides, the highest correlations were found between BMR calculated from FAO/WHO/UNU and measured BMR. These findings suggested that FAO/WHO/UNU was the most reliable equation, which may be used in conditions when the measured BMR values are not available.

Keywords: adult, basal metabolic rate, fao/who/unu, obesity, prediction equations

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Authors: Sintija Miļuna, Ričards Melderis, Loreta Briuka, Dagnija Rostoka, Ingus Skadiņš, Juta Kroiča

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Objectives Smokeless tobacco products in Latvia become more available and favorable to young adults, especially students and athletes like hockey and floorball players. The aim of the research was to detect visual mucosal changes in the oral cavity in smokeless tobacco users and to evaluate pro - inflammatory and anti - inflammatory cytokine (IL-6, IL-1, IL-8, TNF Alpha) levels in saliva from smokeless tobacco users. Methods A smokeless tobacco group (n=10) and a control group (non-tobacco users) (n=10) were intraorally examined for oral lesions and 5 ml of saliva were collected. Saliva was analysed for Il-6, IL-1, Il-8, TNF Alpha using ELISA Sigma-Aldrich. For statistical analysis IBM Statistics 27 was used (Mann - Whitney U test, Spearman’s Rank Correlation coefficient). This research was approved by the Ethics Committee of Rīga Stradiņš University No.22/28.01.2016. This research has been developed with financing from the European Social Fund and Latvian state budget within the project no. 8.2.2.0/20/I/004 “Support for involving doctoral students in scientific research and studies” at Rīga Stradiņš University. Results IL-1, IL-6, IL-8, TNF Alpha levels were higher in the smokeless tobacco group (IL-1 83.34 pg/ml vs. 74.26 pg/ml; IL-6 195.10 pg/ml vs. 6.16 pg/ml; IL-8 736.34 pg/ml vs. 285.26 pg/ml; TNF Alpha 489.27 pg/ml vs. 200.9 pg/ml), but statistically there is no difference between control group and smokeless tobacco group (IL1 p=0.190, IL6 p=0.052, IL8 p=0.165, TNF alpha p=0.089). There was statistical correlation between IL1 and IL6 (p=0.023), IL6 and TNF alpha (p=0.028), IL8 and IL6 (p=0.005). Conclusions White localized lesions were detected in places where smokeless tobacco users placed sachets. There is a statistical correlation between IL6 and IL1 levels, IL6 and TNF alpha levels, IL8 and IL6 levels in saliva. There are no differences in the inflammatory cytokine levels between control group and smokeless tobacco group.

Keywords: smokeless tobacco, Snus, inflammatory biomarkers, oral lesions, oral pathology

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Authors: Luna Shamieh

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Various players are part of the game in an asymmetric war, all making efforts to provide human security to their own adherents. Although a fragile state is not able to provide sufficient and comprehensive services, it still provides special services and security to the elite; the insurgents as well provide services and security to their associates. The humanitarian organisations, on the other hand, provide some fundamental elements of human security, but only in the regions, they are able to access when possible (if possible). The counterinsurgents (security forces of the state and intervention forces) operate within a narrow band defined by the vision of the responsibility to protect and the perspective of the resolution of the conflict through combat; hence, the possibility to provide human security is shaken at this end. This article examines how each player provides human security from the perspective of freedom from want in order to secure basic and strategic needs, freedom from fear through providing protection against all kinds of violence, and the freedom to live in dignity. It identifies a vicious cycle caused by the intervention of the different players causing a centrifugal force that may lead to disintegration of the nation under war.

Keywords: asymmetric war, counterinsurgency, fragile state, human security, insurgency

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Authors: Calvin Rong, Regina Agassian, Mindy Engle-Friedman

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Climate changes, including rising sea levels and increases in global temperature, can have major effects on resource availability, leading to increased competition for resources and rising food prices. The abstract nature and often delayed consequences of many ecological problems cause people focus on immediate, specific, and personal events and circumstances that compel immediate and emotional involvement. This finding may be explained by the challenges humans have in imagining themselves in the future, a shortcoming that interferes with decision-making involving far-off rewards, and leads people to indicate a lower concern toward the future than to present circumstances. The present study sought to assess whether priming people to think of themselves in the future might strengthen the connection to their future selves and stimulate environmentally-protective behavior. We hypothesize that priming participants to think about themselves in the future would increase concern for the future environment. 45 control participants were primed to think about themselves in the present, and 42 participants were primed to think about themselves in the futures. After priming, the participants rated their concern over access to clean water, food, and energy on a scale of 1 to 10. They also rated their predicted care levels for the environment at age points 40, 50, 60, 70, 80, and 90 on a scale of 1(not at all) to 10 (very much). Predicted care levels at age 90 for the experimental group was significantly higher than for the control group. Overall the experimental group rated their concern for resources higher than the control. In comparison to the control group (M=7.60, SD=2.104) participants in the experimental group had greater concern for clean water (M=8.56, SD=1.534). In comparison to the control group (M=7.49, SD=2.041) participants in the experimental group were more concerned about food resources (M=8.41, SD=1.830). In comparison to the control group (M=7.22, SD=1.999) participants in the experimental group were more concerned about energy resources (M=8.07, SD=1.967). This study assessed whether a priming strategy could be used to encourage pro-environmental practices that protect limited resources. Future-self priming helped participants see past short term issues and focus on concern for the future environment.

Keywords: climate change, future, priming, global warming

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Authors: Seyed Abolhassan Naeini, Hamed Yekehdehghan

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Shallow foundations cannot be used when the bedding soil is soft. A suitable method for constructing foundations on soft soil is to employ pile groups to transfer the load to the bottom layers. The present research used results from tests carried out in northern Iran (Langarud) and the FLAC3D software to model a pile group for investigating the effects of various parameters on pile cap settlement under static and seismic conditions. According to the results, changes in the strength parameters of the soil, groundwater level, and the length of and distance between the piles affect settlement differently.

Keywords: FLACD 3D software, pile group, settlement, soil

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Authors: Majed Zobairy, Payam Mohammadpanahi

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Introduction: Skill movement education is one of extremely important duty for sport coaches and sport teachers. Researchers have done lots of studies in this filed to gain the best methodology in movement learning. One of the essential aspects in skill movement education is observational learning. Observational learning, or learning by watching demonstrations, has been characterized as one of the most important methods by which people learn variety of skill and behaviours.The purpose of this study was determined the effect of observational practice on the volleyball service learning with emphasis on the Role of Self–Efficacy. Methods: The Sample consisted of100 male students was assigned accessible sampling technique and homogeneous manner with emphasis on the Role of Self–Efficacy level to 4 groups. The first group performed physical training, the second group performed observational practice task, the third practiced physically and observationally and the fourth group served as the control group. The experimental groups practiced in a one day acquisition and performed the retention task, after 72 hours. Kolmogorov-Smirnov test and independent t-test were used for Statistical analyses. Results and Discussion: Results shows that observation practice task group can significantly improve volleyball services skills acquisition (T=7.73). Also mixed group (physically and observationally) is significantly better than control group regarding to volleyball services skills acquisition (T=7.04). Conclusion: Results have shown observation practice task group and mixed group are significantly better than control group in acquisition test. The present results are in line with previous studies, suggesting that observation learning can improve performance. On the other hand, results shows that self-efficacy level significantly effect on acquisition movement skill. In other words, high self-efficacy is important factor in skill learning level in volleyball service.

Keywords: observational practice, volleyball service, self–efficacy, sport science

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Authors: Ebenezer Joseph, Veena Easvaradoss, S. Sundar Manoharan, David Chandran, Sumathi Chandrasekaran, T. R. Uma

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Perceptual reasoning is the ability that incorporates fluid reasoning, spatial processing, and visual motor integration. Several theories of cognitive functioning emphasize the importance of fluid reasoning. The ability to manipulate abstractions and rules and to generalize is required for reasoning tasks. This study, funded by the Cognitive Science Research Initiative, Department of Science and Technology, Government of India, analyzed the effect of 1-year chess training on the perceptual reasoning of children. A pretest–posttest with control group design was used, with 43 (28 boys, 15 girls) children in the experimental group and 42 (26 boys, 16 girls) children in the control group. The sample was selected from children studying in two private schools from South India (grades 3 to 9), which included both the genders. The experimental group underwent weekly 1-hour chess training for 1 year. Perceptual reasoning was measured by three subtests of WISC-IV INDIA. Pre-equivalence of means was established. Further statistical analyses revealed that the experimental group had shown statistically significant improvement in perceptual reasoning compared to the control group. The present study clearly establishes a correlation between chess learning and perceptual reasoning. If perceptual reasoning can be enhanced in children, it could possibly result in the improvement of executive functions as well as the scholastic performance of the child.

Keywords: chess, cognition, intelligence, perceptual reasoning

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Authors: Sadeq Al Yaari, Muhammad Alkhunayn, Ayah Al Yaari, Ayman Al Yaari, Montaha Al Yaari, Adham Al Yaari, Sajedah Al Yaari, Fatehi Eissa

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Developmental co-ordination disorder (DCD) (also known as dyspraxia) causes a child to speak less well than expected in social conversations. We propose that the smart speaking technology could help improve sound production mechanism at both phonetic and phonological levels, which leads to better articulation of an utterance. The participants are twelve privately beginner pupils aged between 6-12 years old and diagnosed with DCD (apraxia) divided into two groups: Experimental group (n=6) and control group (called apraxic control group) (n=6). A total of fifty typically developing and achieving (TD) pupils participated as control group 2 in both groups and were preassigned into two groups (27 pupils with the treatment group and 23 with the apraxic control group). Weekly quizzes were given to all participants each week for four continuous months and results were analyzed by psychoneurolinguists and a statistician. Although being taught by the same speech-language therapist (SLT), treatment group along with TD groups were taught a full-time speaking course with sociolinguistic themes covering both phonetic and phonological properties. The course lasted for a whole semester whereby smart speaking aids have become dominant while apraxic control group and its TD group were not. Compared with apraxic control group and its TD subgroup, results show obvious changes in speaking behavioral mechanism of the DCD experimental group and its TD subgroup. Improvement could be taken from the scores where the zero marks disappeared in the fourth week (end of the first month of treatment). Good marks (5 +/10) were seen starting from the eighth week and culminating with full marks in the week number 15 of treatment where some participants scored full mark. This study concludes to support the primacy of the smart educational technology for speaking purposes and also shows that such aids can expand the range of academic performance differential categories. Further research is required to evaluate the current demonizing of smart educational aids and weighting more reasonably the relationship specificity that speaking aids can offer to other language skills, as well as their limitations.

Keywords: smart educational technology, speaking aids, pupils with SCD, apraxia

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Authors: Mustafa Gulsen, Mitat Koz

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The aim of this study is to investigate the effect of lumbar stabilisation and proprioceptive neuromuscular facilitation (PNF) training on muscle strength and muscle endurance. The participants were 64 between the ages of 15-69 (53.04 ± 14.59), who were graded protrusion and bulging lumbar herniation according to 'Macnab Classification'. The participants were divided into four groups as each group had 16 participants: lumbar stabilitation training, PNF training, physical therapy and control groups. Sociodemographic features were recorded. Then their muscle strength tests (by isokinetic dynamometer (Cybex 770 Norm Lumex Inc, Ronkonkoma, NY, USA) were recorded. Before and after applications; visual analogue scale (VAS), Oswestry Disability İndex were applied by a physical therapist. The participants in lumbar stabilisation group performed 45 minutes, 5 days in a week for 4 weeks strength training with a physical therapist observation. The participants in PNF group performed 5 days in a week for 4 weeks with pelvic patterns of PNF by a physiotherapist. The participants in physical therapy group underwent Hotpack, Tens and Ultrasound therapy 5 days in a week for 4 weeks. The participants in control group didn’t take any training programme. After 4 weeks, the evaluations were repeated. There were significant increases in muscle strength and muscle endurance in lumbar stabilization training group. Also in pain intensity at rest and during activity in this group and in Oswestry disability index of patients, there were significant improvements (p < 0.05). In PNF training group likewise, there were significant improvements in muscle strength, muscle endurance, pain intensity at rest and with activity and in Oswestry disability index (p < 0.05). But improvements in the Lumbar Stabilization group was better than PNF Group. We found significant differences only in pain intensity at rest and with activity and in Oswestry disability index (p < 0.05). in the patients in Physical Therapy group. We think that appropriate physiotherapy and rehabilitation program which will be prepared for patients, to protect the waist circumference of patients with low muscle strength and low muscle endurance will increase muscle strength and muscle endurance. And it is expected that will reduce pain and will provide advances toward correcting functional disability of the patients.

Keywords: disc herniation, endurance, lumbar stabilitation exercises, PNF, strength

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Authors: Hsin-Hsin Chang, Jann-Tay Wang, Wang-Huei Sheng

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Background: Hospital-associated infections (HAIs) have significant medical and social resource consumption. In view of medical technology change rapidly and the prolonged average life expectancy, the patients' chances of receiving invasive medical devices have also increased. As well as the potential disease of the patients, the aging, and immune dysfunction makes the disease more serious, raising the risk of HAIs. In our adult intensive care units, catheter-associated urinary tract infections (CAUTIs) have an average of 4.6% in 2014, which is much higher than that of the National Healthcare Safety Network (NHSN). Therefore, we started the intervention of CAUTI bundle care. Methods: This 3-year intervention was conducted in adults’ intensive care units (ICUs) during January 2015 to December 2017. The implementation of CAUTI bundle care in order to reduce invasive catheter-associated infections were built on evidence-based infection control measures. Prospective surveillance was performed on all patients admitted to hospital. The four major directions are 'Leader Engagement', 'Educate Personnel', 'Executive Multidisciplinary Teamwork', 'Innovation and Improvement of Tools'. Results: During the intervention period, there were 167,024 patient-days with a total of 508 episodes of CAUTIs in the entire adult ICUs identified. The incidence of CAUTIs in adult ICU was significantly decreased in the intervention period (from 2015 to 2017), from 4.6 to 3.6 per 1000 catheter days (p=0.05). Conclusion: The necessity for the implementation of CAUTI bundle care in the health care system plays an important role in the quality and policy of infection control. Multidisciplinary teamwork, education, a comprehensive checklist and from time to time audit feedback to improve healthcare workers’ compliance are the keys to success.

Keywords: bundle care, hospital-associated infections, leader engagement, multidisciplinary team work

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Authors: Prashanta Dhoj Adhikari

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We report the introduction of the active surface functionalization group on chemical vapor deposition (CVD) grown graphene film by wet deposition method. The activity of surface functionalized group was tested with surface modified carbon nanotubes (CNTs) and found that both materials were amalgamated by chemical bonding. The introduction of functional group on the graphene film surface and its vigorous role to bind CNTs with the present technique could provide an efficient, novel route to device fabrication.

Keywords: chemical vapor deposition, graphene film, surface functionalization

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Authors: Sheila Shamuganathan, Mageswary Karpudewan

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This study investigated the effectiveness of green chemistry integrated with Science Writing Heuristic (SWH) in enhancing matriculation students’ responsible environmental behaviour. For this purpose 207 matriculation students were randomly assigned into experimental (N=118) and control (N=89) group. For the experimental group the chemistry concepts were taught using the instructional approach of green chemistry integrated with Science Writing Heuristic (SWH) while for the control group the same content was taught using green chemistry. The data was analysed using ANCOVA and findings obtained from the quantitative analysis reveals that there is significant changes in responsible environmental behaviour (F 1,204) = 32.13 (ηp² = 0.14) which favours the experimental group. The responses of the qualitative data obtained from an interview with the experimental group also further strengthen and indicated a significant improvement in responsible environmental behaviour. The outcome of the study suggests that using green chemistry integrated with Science Writing Heuristic (SWH) could be an alternative approach to improve students’ responsible environmental behaviour towards the environment.

Keywords: science writing heuristic, green chemistry, pro environmental behaviour, laboratory

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Authors: Muhammad Mustafa Jafar, Syed Ashar Mahfooz, Muhammad Ejaz Saleem, Muhammad Asif Raza, Asghar Abbas, Rao Zahid Abbas, Muhammad Kasib Khan, Hafiz Muhammad Ishaq

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The Babesia gradually attained resistance against the synthetic medicines. To overcome the drug resistance, herbal therapy has gained more attention as compared to allopathic therapy. Peganumharmala (harmal) is a plant which has shown effective results against various protozoal diseases. Therefore, the present study was planned to monitor the efficacy of Peganumharmala (aqueous extract) against Babesiosis in cattle. For this purpose, a total of forty (n=40) infected animals were randomly divided into four equal groups (A, B, C, and D). Group A was treated with aqueous extract of Peganum harmala at 7.5 mg/kg, group B at 10 mg/kg and group C at 12.5 mg/kg of body weight. Group D served as a control group (normal). It was observed that there was a stabilization in hematological parameters (white and red blood cells, hemoglobin and Packed cell volume) in infected animals treated with Peganum harmala at different doses. Results of this study hence indicated that Peganum harmala extract at 12.5mg/kg BW is more effective against Babesiosis than lower doses.

Keywords: Babesiosis, cattle, control, Peganum harmala

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Authors: Judith Hanke

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Due to the increase of students with reading difficulties, digital reading support with diagnostics was developed to foster the individual student's reading comprehension. The digital reading support focused on the reading comprehension of elementary school students. The digital reading packages consist of literary texts with aligned reading exercises. The number of students with German as a second language is growing in Germany. Students with multilingualism, language 1, and language 2 learn German together in school. The research's focus is on determining whether and to what extent multilingualism, language 1, and language 2 affect reading comprehension. For the methodology, an ABA design was selected for the intervention study to examine the reading support. The study was expedited from April 2023 until July 2023 and collected quantitative data of individuals, groups, and classes. It comprised a survey group (N = 58) and a control group (N = 53). The quantitative data was collected from 3 classes of 3 teachers and 47 students for all three test times. To show differences between the groups, a standardized reading comprehension test was used for the three test times, pretest, posttest, and follow-up. The standardized test consists of three subtests regarding word comprehension, sentence comprehension, and text comprehension. The main findings include that students who spoke German as their first language had the best test scores. Interestingly, students with a different language had better testing scores than students with German as the first language and (an) other language/s. Also, the students with another language outperformed the native language speakers in one of the subtests of the post-testing. The variables of spoken language at home and German as a second language were also examined and correlated with the test results. One significant correlation was found between spoken language at home and the text comprehension test of the pretesting. Additionally, the variable German as a second language had multiple significant correlations in the pretest, posttest and follow-up. The study's significance is to understand the influence of several languages, language 1, and language 2, on reading comprehension.

Keywords: multilingualism, language 1, language 2, reading comprehension, second language

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Authors: Farah Ali, Tehreem Fayyaz, Musadiq Idris

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The present work was undertaken to investigate effects of various extracts of W. somniferafor anti-diabetic activity in alloxan induced diabetic rabbits. Rabbits were acclimatized for a week to standard laboratory temperature. Animals were fed according to a strict schedule (8 am, 3 pm and 10 pm) with green fodder (Medicago sativa) and tap water ad libitum. Animals were divided into nine groups of six rabbits each in a random manner. Body weights and physical activities of all rabbits were recorded before start of experiments. The animals of group 1 and 2 were given lactose (250 mg/kg,p.o) and Withaniasomniferaroot powder (100 mg/kg, p.o) respectively daily from day 1-20. Animals of group 3 were given alloxan (100 mg/kg,i.v) as a single dose on day 1. Powdered root of Withaniasomnifera in the doses of 100, 150, 200 mg/kg and its aqueous and ethanol extracts (equivalent to 200 mg/kg of crude drug) were given to the treated animals (groups 4-8), respectively by oral route for three weeks (day 1-20o.d), along with alloxan (100 mg/kg, i.v) as a single dose on day 1. Group 9 was treated with metformin (200 mg/kg, p.o) daily from day 1-20, along with a single dose of alloxan (100 mg/ kg, i.v) on day 1. Fasting serum glucose concentration in groups 3-9 was increased significantly (p<0.05) on day 3, with a maximum increase (215.3 mg/dl) in animals of toxic control (TC) group (3) on day 21 of the experiment as compared to normal control (NC) group (1). Effects of different doses (100, 150, 200 mg/kg, p.o) of W. somnifera root powder (WS) decreased the fasting serum glucose concentration as compared to toxic control group, with a maximum decrease (88.3 mg/dl) in group 2 (treated control) on day 21 of the experiment. Metformin (200 mg/kg, p.o) (reference control), aqueous extract (AWS) and ethanol extract (EWS) of W. somnifera (equivalent to 100 mg/kg W.somnifera root, p.o) antagonized the effects of alloxan as compared to toxic control group. These results indicate that the W. somnifera possess significant anti –diabetic activity.

Keywords: diabetes, serum, glucose, blood, sugar, rabbits

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Authors: Sara Ataei, Molouk Hadjibabaie, Amirhossein Moslehi, Maryam Taghizadeh-Ghehi, Asieh Ashouri, Elham Amini, Kheirollah Gholami, Alireza Hayatshahi, Mohammad Vaezi, Ardeshir Ghavamzadeh

Abstract:

Acute kidney injury (AKI) is one of the complications of hematopoietic stem cell transplantation and is associated with increased mortality. N-acetylcysteine (NAC) is a thiol compound with antioxidant and vasodilatory properties that has been investigated for the prevention of AKI in several clinical settings. In the present study, we evaluated the effects of intravenous NAC on the prevention of AKI in allogeneic hematopoietic stem cell transplantation patients. A double-blind randomized placebo-controlled trial was conducted, and 80 patients were recruited to receive 100 mg/kg/day NAC or placebo as intermittent intravenous infusion from day -6 to day +15. AKI was determined on the basis of the Risk-Injury-Failure-Loss-Endstage renal disease and AKI Network criteria as the primary outcome. We assessed urine neutrophil gelatinase-associated lipocalin (uNGAL) on days -6, -3, +3, +9, and +15 as the secondary outcome. Moreover, transplant-related outcomes and NAC adverse reactions were evaluated during the study period. Statistical analysis was performed using appropriate parametric and non-parametric methods including Kaplan–Meier for AKI and generalized estimating equation for uNGAL. At the end of the trial, data from 72 patients were analyzed (NAC: 33 patients and placebo: 39 patients). Participants of each group were not different considering baseline characteristics. AKI was observed in 18% of NAC recipients and 15% of placebo group patients, and the occurrence pattern was not significantly different (p = 0.73). Moreover, no significant difference was observed between groups for uNGAL measures (p = 0.10). Transplant-related outcomes were similar for both groups, and all patients had successful engraftment. Three patients did not tolerate NAC because of abdominal pain, shortness of breath and rash with pruritus and were dropped from the intervention group before transplantation. However, the frequency of adverse reactions was not significantly different between groups. In conclusion, our findings could not show any clinical benefits from high-dose NAC particularly for AKI prevention in allogeneic hematopoietic stem cell transplantation patients.

Keywords: acute kidney injury, N-acetylcysteine, hematopoietic stem cell transplantation, urine neutrophil gelatinase-associated lipocalin, randomized controlled trial

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Authors: Komal Khan, Hafsa Zaneb, Saima Masood, Muhammad Younus, Sanan Raza

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Cigarette smoke induces many physiological and pathological changes in respiratory tract like goblet cell hyperplasia and regional distention of airspaces. It is also associated with elevation of inflammatory profiles in different airway compartments. As probiotics are generally known to promote mucosal tolerance, it was postulated that prophylactic use of probiotics can be helpful in reduction of respiratory damage induced by cigarette smoke exposure. Twenty-four adult mice were randomly divided into three groups (cigarette-smoke (CS) group, cigarette-smoke+ Lactobacillus (CS+ P) group, control (Cn) group), each having 8 mice. They were exposed to cigarette smoke for 28 days (6 cigarettes/ day for 6 days/week). Wright-Giemsa staining of bronchoalveolar lavage fluid (BALF) was performed in three mice per group. Tissue samples of trachea and lungs of 7 mice from each group were processed by paraffin embedding technique for haematoxylin & eosin (H & E) and alcian blue- periodic acid-Schiff (AB-PAS) staining. Then trachea (goblet cell number, ratio and loss of cilia) and lungs (airspace distention) were studied. The results showed that the number of goblet cells was increased in CS group as a result of defensive mechanism of the respiratory system against irritating substances. This study also revealed that the cells of CS group having acidic glycoprotein were found to be higher in quantity as compared to those containing neutral glycoprotein. However, CS + P group showed a decrease in goblet cell index due to enhanced immunity by prophylactically used probiotics. Moreover, H & E stained tracheas showed significant loss of cilia in CS group due to propelling of mucous but little loss in CS + P group because of having good protective tracheal epithelium. In lungs, protection of airspaces was also much more evident in CS+ P group as compared to CS group having distended airspaces, especially at 150um distance from terminal bronchiole. In addition, a comprehensive analysis of inflammatory cells population of BALF showed neutrophilia and eosinophilia was significantly reduced in CS+ P group. This study proved that probiotics are found to be useful for reduction of changes in micro-architecture of the respiratory system. Thus, dietary supplementation of probiotic as prophylactic measure can be useful in achieving immunomodulatory effects.

Keywords: cigarette smoke, probiotics, goblet cells, airspace enlargement, BALF

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Authors: Heena Akbar, Winnie Niumata, Danielle Gallegos

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Type 2 diabetes is a significant public health problem for Māori and Pasifika communities in Queensland, who are experiencing a higher burden of morbidity and mortality from the condition. Despite this higher burden, there are few initiatives that are culturally tailored to improve prevention and management. Modification of personal behaviors through women’s wellness programs aimed at early intervention has been shown to reduce the risk of developing complications in established type 2 diabetes and may reduce hospitalization rates from preventable complications related to this disease. The 24-week Pasifika Women’s Diabetes Wellness Program (PWDWP) was culturally co-designed and co-developed with Māori and Pasifika women with type 2 diabetes through a community-academia partnership in Queensland. Underpinned by Social Cognitive Theory and the Indigenous Pacific Health frameworks to include family culture & spirituality and integrating a collectivist and whānau (family) centered approach to self-care, the program takes into consideration the cultural shame associated with acknowledging the disease and tailors the interventions using talanoa (storytelling or conversation in a relational context) as the key strategy to come to a shared meaning for behavior change. The pilot trial is a 12-week intervention followed by a 12-week follow-up period conducted with 50 women with type 2 diabetes, 25 women who will receive the intervention and 25 women who will receive usual care. The pilot program provides in-person and virtual access to culturally supported prevention and self-management of Māori and Pasifika women with type 2 diabetes with the aim to improve healthy lifestyles and reduce late hospital presentations from diabetes-related complications for better diabetes-related outcomes. This study will test and evaluate the effectiveness of the PWDWP pilot trial in partnership with Māori & Pasifika community organizations and key stakeholders for improved glycated hemoglobin (HbA1c) levels associated with poor management of type 2 diabetes.

Keywords: culturally co-designed intervention, Indigenous methodology, Māori and Pasifika communities, type 2 diabetes self-management

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Authors: Fariba Dortaj, Reza Asadinejad, Akram Dortaj, Atena Baziyar

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The aim of this study was to determine the effect of distance education (based on MOOC) on the components of academic engagement of Kerman PNU. The research was quasi-experimental method that cluster sampling with an appropriate volume was used in this study (one class in experimental group and one class in controlling group). Sampling method is single-stage cluster sampling. The statistical society is students of Kerman Payam Noor University, which) were selected 40 of them as sample (20 students in the control group and 20 students in experimental group). To test the hypothesis, it was used the analysis of univariate and Co-covariance to offset the initial difference (difference of control) in the experimental group and the control group. The instrument used in this study is academic engagement questionnaire of Zerang (2012) that contains component of cognitive, behavioral and motivational engagement. The results showed that there is no significant difference between mean scores of academic components of academic engagement in experimental group and the control group on the post-test, after elimination of the pre-test. The adjusted mean scores of components of academic engagement in the experimental group were higher than the adjusted average of scores after the test in the control group. The use of technology-based education in distance education has been effective in increasing cognitive engagement, motivational engagement and behavioral engagement among students. Experimental variable with the effect size 0.26, predicted 26% of cognitive engagement component variance. Experimental variable with the effect size 0.47, predicted 47% of the motivational engagement component variance. Experimental variable with the effect size 0.40, predicted 40% of behavioral engagement component variance. So teaching with technology (MOOC) has a positive impact on increasing academic engagement and academic performance of students in educational technology. The results suggest that technology (MOOC) is used to enrich the teaching of other lessons of PNU.

Keywords: educational technology, distance education, components of academic engagement, mooc technology

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