Posterior reversible encephalopathy syndrome (PRES) is a reversible leukoencephalopathy characterised by subcortical vasogenic oedema and neurological signs. We present the case of a 64-year-old ...woman who presented to hospital with symptomatic primary hyperparathyroidism. Her parathyroid hormone (PTH) level on admission was elevated at 1,330ng/l (normal range15-68ng/l) and her serum calcium measured 4.83mmol/l (normal range 2.25-2.54mmol/l). Technectium-99m sestamibi scan demonstrated a focus of radiotracer uptake consistent with a right upper parathyroid adenoma or carcinoma. After commencing appropriate medical treatment, the patient developed intractable seizures necessitating endotracheal intubation. Magnetic resonance imaging of her brain revealed bilateral symmetrical T2 hyperintensities in the posterior circulation consistent with PRES. Following stabilisation and further medical treatment for hypercalcaemia, the patient underwent a parathyroidectomy. Preoperative rapid PTH assay measured 1,021ng/l. Following excision, PTH levels fell to just 10ng/l. She was extubated in the intensive care unit on postoperative day 1 and made an uneventful recovery. At her 6-week follow-up appointment, all neurological symptoms had resolved. PRES is a rare neurological entity more often seen in the setting of hypertension, immunosuppression and renal failure. The development of new neurological manifestations in the setting of known risk factors should raise suspicion for the underlying diagnosis.
Problem-based learning (PBL) has over the years become a learning strategy established for teaching students in medicine. In order to use PBL as a teaching tool, faculty must be familiar with PBL and ...comfortable with the role transition from 'teacher' to 'facilitator'. This transition is critical for the success of PBL. This article describes the faculty development process undertaken in Pakistan at the onset of introduction of PBL in the curriculum.
At the Foundation University Medical College (FUMC), we initiated a faculty development program in PBL. The program consisted of two-day, hands-on facilitator training workshops conducted five times over the year and led by in-house faculty. A total of 180 faculty members completed these workshops. The workshops consisted of interactive sessions on the philosophy of PBL, small group dynamics, the role of the facilitator, an introduction to case design, wrap-up PBL sessions and assessment in PBL. Participants were provided with pre-workshop reading material in the form of 'PBL Handbooks', which contained details of the PBL process and specific responsibilities of the facilitator. Participants were also given a chance to experience the role of the facilitator by facilitating the faculty-learner group through a PBL session and receiving feedback. A retrospective pre-post survey was conducted to gauge changes in participants' perceptions of PBL.
The faculty reported a significant increase in their regard for PBL as an instructional paradigm (p=<0.001). They also generally became more interested in empowering students with self-directed learning using PBL as a teaching tool and showed a greater desire to be facilitators (p=<0.001).
This evaluation reveals that facilitator training workshops can help not just to improve the facilitation skills of participants but also to stimulate interest amongst faculty to use PBL in the curriculum. Such workshops can be run in Pakistan at minimal cost: the only cost we incurred was for photocopying the reading material. How much difficulty the faculty will actually have serving as facilitator in the PBL process will only become evident when they lead PBL groups over the coming year.
This article presents the results of an experimental and theoretical study of I-section fiber-reinforced plastic (FRP) beams subjected to a gradually increasing midspan load. The load is applied ...about the beam major axis from the compression flange side through a point below the shear center. The boundary conditions are flexurally and torsionally pinned. A 4 2 1/4 in. 3 pultruded I-section is adopted for the study and beam span lengths of 108, 96, 84, and 72 in. are used. The flexural-torsional response of the FRP beams is studied experimentally up to the maximum loadcarrying capacity. The experimental peak loads are compared with those arrived at theoretically using an equilibrium approach and are found to be in good agreement. To obtain a design expression for estimating the beam buckling load, an elastic buckling moment expression from the load and resistance factor design (LRFD) specification of the American Institute of Steel Construction is first modified. Next, a LRFD approach for the beam is outlined and its use demonstrated through analysis and design examples.
This study is an experimental and theoretical investigation into whether region or religion has a stronger impact on cultural values and was also conducted to determine whether a ‘Muslim World’ ...exists. Sunni Muslims raised in Virginia, United States (sample size n1 = 72); in Khyber Pakhtunkhwa, Pakistan (n2 = 83); and Christians raised in Virginia, United States (n3 = 89) were compared using multiple pairwise three-level one-way multivariate analyses of covariance (MANCOVAs) on the Cultural Value Dimensions with a Religiosity covariate. Follow-up analyses of covariance (ANCOVAs) were conducted to determine specific differences based on statistically significant MANCOVAs. Pakistani-raised Sunni Muslims were significantly higher on the Masculinity and Uncertainty Avoidance Indices and significantly lower on the Indulgence Index than both Virginia-raised Christians and Virginia-raised Sunni-Muslims. No statistically significant differences were found to exist between Christians and Sunni Muslims raised in the same region (Virginia, U.S.). Findings suggest no ‘Muslim World’ exists based on Hofstede and Minkov’s (2013) quantitatively established cultural values. Results indicate that although religious identification does influence identity, the geographic region in which one is raised has a much stronger impact on cultural values and individual identity than religious affiliation or religiosity. Implications for homeland security, military, defense, information, influence, intelligence, and diplomatic policy and practice are discussed.
This article presents a procedure for estimating the cracking moment of a fiber reinforced plastic (FRP) angle section subjected to unsymmetrical or biaxial bending. The procedure is demonstrated by ...means of numerical examples for both equal and unequal-leg angle sections subjected to bending about non-principal axes of the cross section.
Original chromosome counts for 16 species of tropical African Gladiolus, 5 southern African, and 3 Eurasian species, 17 of these not before examined, confirm that x = 15 is probably the ancestral ...basic number for the genus. Until now, x = 15 has been the only recorded base number in Gladiolus, but several tropical African species have been found to depart from this pattern, the only known examples of dysploidy in the genus. In subgenus Gladiolus, G. atropurpureus has x = 12 (2n = 24 + 0-5B, 36); G. serapiflorus, G. gregarius, and G. pseudospicatus have x = 11 (2n = 22); G. unguiculatus has x = 13 (2n = 26 + 0-2B, also possibly 2n = 24); and G. actinomorphanthus has 2n = 28. Because on morphological grounds most of these species do not seem to be immediately related, we suggest that dysploid reduction in tropical African Gladiolus may have occurred in four separate lineages. Results confirm polyploidy in G. dalenii, 2n = 60 and 90, and the three Eurasian species examined. The first count for the Malawian G. bellus, 2n = 60, indicates polyploidy in only one more tropical African species of Gladiolus. Counts of 2n = 39 in two populations of G. decoratus suggest triploidy based on x = 13, making this one more possible example of dysploidy for the genus. Although the chromosomes of Gladiolus are relatively small, some karyotypic details provide additional data relating to species relationships. Measurements of total chromosome length show that irrespective of base number, most of the diploid species have a comparable amount of chromosome material. Two species, G. melleri (2n = 30) and G. decoratus (2n = 39), however, have significantly higher amounts of chromosome material, ca. 33-40% above expected levels, a condition possibly related to their characteristic rapid growth and flowering early in the growing season.
Pultruded fiber reinforced plastic (PFRP) structural sections are rapidly gaining impetus in civil engineering applications. Thin-walled open beams with channel, I-shaped, and other types of sections ...are of practical importance to designers. In this paper, a load and resistance factor design (LRFD) approach for lateraltorsional buckling is presented based on an experimental and theoretical study of the behavior of PFRP channel section beams under the influence of gradually increasing static loads. Some experimental results for combined bending and torsion are also presented. Single span members with unrestrained end warping are considered with concentrated vertical loads passing through (a) the shear center, (b) the geometric centroid, and (c) a location which is neither at the shear center nor at the centroid. A pair of concentrated loads are applied symmetrically about the beam midspan, through a system of loading plates and tie rods in order to allow an unrestrained deformation of the beam. The loads are increased gradually and the resulting midspan vertical, lateral, and torsional deflections are recorded. The loads are generated with hydraulic jacks and recorded by means of calibrated load cells. Strains are also recorded at key locations using electrical resistance gages. Relationships between the applied load and the resulting deflections and strains are plotted and compared for the three load cases. The magnitude and significance of the warping stresses in comparison to the flexural stresses are identified. For the case of shear center loading, the deflections are monitored for various clear spans of the beam. This information is then utilized to generate the relationship between the lateral torsional instability load
versus the minor axis slenderness ratio. An approximate theoretical formula is also developed to predict the lateral-torsional buckling load as possible prelude to the evolution of a formal construction specification formula for use by design engineers. The predicted buckling loads found using the formula are in excellent agreement with the experimental results. A comparison of the results from the formula applied to the case of compression flange loading is also made to those using the current AISC-LRFD specification. Lastly, the use of a proposed LRFD approach is demonstrated by means of analysis and design examples. The effect of the applied load height on the buckling load capacity is explained using the buckling formula.
