Friday, April 30, 2021

Association of Body Mass Index, Blood Sugar and Glycated Hemoglobin Levels with Types of Macular Edema in Patients with Type-2 Diabetes Mellitus - Juniper Publishers

JOJ Ophthalmology - Juniper Publishers  


Abstract

Introduction: Diabetes mellitus (DM) is a metabolic disease defined by elevated blood glucose. DM is a global epidemic and the prevalence is anticipated to continue to increase.

Material & Methods: After ethical approval and taking consent 130 patients with macular edema of type 2 Diabetes Mellitus (>18 years) attending were included. In this hospital-based cross-sectional study, the patients had preliminary demographic and medical evaluation along with history taking, anthropometric, complete ophthalmological and hemo-dynamic assessment were also done.

Observation & Results: There was a statistically significant trend of increasing proportion of cystoid and serous macular edema from early and simple macular edema with increasing HbA1c levels (p<0.001).

Conclusion: Keeping in view a wide spectrum of severity grades of OCT based diabetic macular edema and only a few cases in some categories (serous macular edema), the findings of present study should be considered as a preliminary attempt. Further studies on a larger population are recommended

Keywords: Retinopathy; Macular Edema; Optical coherence tomography

Introduction

Diabetes mellitus (DM) is a metabolic disease defined by elevated blood glucose. DM is a global epidemic and the prevalence is anticipated to continue to increase. DM is can be further classified as type 1 (T1DM), which causes pancreatic beta cell failure due to which insufficient insulin is type 2 (T2DM) is characterized by insulin resistance [1]. Type II diabetes is most dominant form of diabetes contributing for almost 90% of total burden of diabetes [2]. Diabetic retinopathy is a cause of visual loss on a global scale. The pathology is closely associated with vascular, glial, and neuronal components of the diabetic retina. Treatments for the vision-threatening complications of diabetic macular edema and proliferative diabetic retinopathy have greatly improved. As per recent studies, diabetes markedly impacts the retinal neurovascular unit and its interdependent vascular, neuronal, glial, and immune cells [3]. Laboratory and clinical evidence show that, microvascular changes, inflammation and retinal neurodegeneration may contribute to diabetic retinal damage in the early stages of diabetic retinopathy [4].

Clinically, diabetic changes in the retina can be divided into two stages: non-proliferative diabetic retinopathy and proliferative diabetic retinopathy. Early stage of DR is represented by NPDR, wherein the pathology is increased vascular permeability and capillary occlusion. During this stage, the fundus findings include microaneurysms, hemorrhages and hard exudates while the patients may be asymptomatic4. Proliferative diabetic retinopathy is an advanced type of DR, the patients may experience severe vision impairment. This stage is characterized by neovascularization [4]. However, in addition to hyperglycemia, other factors like hypertension, dyslipidemia, and particularly the genetic load, have an immense influence on the severity and clinical course of diabetic retinopathy (DR) [5]. Using OCT, DME can be classified into four main types presented as the OCT Classification of Diabetic Macular Edema given by Koleva-Georgieva: [6]

Type 1: Early diabetic macular edema

Type 2: Simple diabetic macular edema

Type 3: Cystoid diabetic macular edema:

3a, mild.

3b, intermediate.

3c, severe

Type 4: Serous macular detachment

Materials and Methods

The study is a hospital-based cross-sectional study. 130 diabetic patients who were attending the Outpatient Department of Ophthalmology and Outpatient Department of Medicine of our tertiary center, referred to Outpatient Department of Ophthalmology of our tertiary center were evaluated. The retinal/ macular changes were evaluated and were included in the study. Patients with macular edema of type 2 Diabetes Mellitus (>18 years) attending Ophthalmology and Medicine OPD of our tertiary health center were included. The exclusion criteria comprised of patients who had gestational DM, undergone any intra-ocular laser treatment or intra-ocular injection in the past 3 months, patients suffering from non-diabetic maculopathy (age-related macular degeneration / macular dystrophy), patients who have undergone any intraocular surgery in the past 3 months, patients with history of intake of drugs like corticosteroids, nephrotoxic in the past 3 months or any non-diabetic renal disease and patients with significant media haziness preventing adequate visualization of the fundus. Informed and written consent was obtained from the all the patients. All the patients were given the freedom to withdraw from the study, if they wished so.

The patients included underwent a series of examinations; their best corrected visual acuity was measured using Snellen’s chart for both the eyes, which was followed by torch light examination, distant direct ophthalmoscopy, slit lamp examination, fundus evaluation by direct ophthalmoscope and fundus photography by Zeiss. Goldman’s Applanation Tonometer was used to measure the intraocular pressure (IOP). Macular edema and its severity were assessed and evaluated by using Optical Coherence Tomography (OCT) following the criteria described by Koleva-Georgieva. The patients under evaluation were subjected to preliminary demographic and medical evaluation and history taking, anthropometric and hemo-dynamic assessment were also assessed. Analysis of the data assessed was done using the Statistical Package for Social Sciences, version 21.0 or above (Tables 1-8).

Observations & Results

Among males, cystoids macular edema was most common (37.3%) followed by simple (32%), early (20%) and serous macular edema (10.7%) whereas among females early and cystoid macular edema (32.7%) were most common followed by simple (25.5%) and serous macular edema (9.1%). However, on evaluating the data statistically, no significant association between types of macular edema and gender was observed (p=0.430).

A dominance of early and simple macular edema types in age group 41-50 years and 51-60 years and a dominance of cystoid and serous macular edema in age group 61-70 years was seen. It was seen that proportion of those with early macular edema showed a declining trend with increasing age whereas other macular edema types showed an increasing trend with increasing age. Serous edema was present in only 61-70 years old patients. Statistically, the relationship between age and type of edema was significant (p=0.003).

In the normal weight group (BMI 18.5-24.9 kg/m2), maximum (40%) had simple macular edema followed by cystoid (31.1%), early (15.6%) and serous (13.3%) macular edema. In overweight group (BMI 25.0-29.9 kg/m2) too, maximum had cystoid macular edema (37.8%) followed by early (29.3%), simple (29.3%) and serous macular edema. In obese (>30 kg/m2) group, out of 3 patients, 2 (66.7%) had early macular edema while 1 (33.3%) had cystoid macular edema. On evaluating the data statistically, we did not find a significant association between BMI and types of macular edema (p=0.180).

Among those with HbA1c <7%, majority had early macular edema (54.2%) followed by simple (33.3%) and cystoid (12.5%) macular edema. Among those with HbA1c 7.1-8.5%, maximum had simple macular edema (40%) followed by cystoid (30.9%), early (21.8%) and serous (7.3%) macular edema. On the other hand, among those with HbA1c >8.5%, majority had cystoids macular edema (51%) followed by serous (17.6%), early and simple macular edema (15.7% each) respectively. Thus, there was a statistically significant trend of increasing proportion of cystoid and serous macular edema from early and simple macular edema with increasing HbA1c levels (p<0.001). Among those with fasting blood sugar >125 mg/dl, maximum (38.8%) had cystoids macular edema followed by early (27.1%), simple (24.7%) and serous (9.4%) macular edema respectively whereas among those with fasting blood sugar 100-124 mg/dl, maximum had simple macular edema (37.8%) followed by cystoid (28.9%), early (22.2%) and serous macular edema (11.1%) respectively. On evaluating the data statistically, there was no significant association between fasting blood sugar levels and types of diabetic macular edema.

Among those with post-prandial blood sugar levels >200 mg/dl, maximum (38.2%) had cystoid macular edema followed by early and simple macular edema (25.8%) and serous (10.1%) macular edema respectively whereas among those with blood sugar levels <200 mg/dl, maximum (36.6%) had simple macular edema followed by cystoid (29.3%), early (24.4%) and serous macular edema (9.8%) respectively. On evaluating the data statistically, the association between post-prandial blood sugar levels and types of macular edema was not found to be significant (p=0.622)./

Discussion

Glycemic control is an important risk factor associated with diabetic macular edema. Chronic hyperglycemia could damage the vascular endothelial cells and affects the integrity of bloodretinal barrier (BRB), which in turn results in fluid extravasation that is manifested as macular edema. In more specific terms, “hyperglycemia leads to an accumulation of free radicals and advanced glycemic end-products (AGE’s) and gluco-toxins, which form cross-links on proteins, lipids, and nucleic acids to alter the structure and function of these components within the BRB” [7]. HbA1c is a known marker of glycemic control over long term. Several studies show that odds of macular edema are 1.08 to 1.73 times higher for every 1% increase in HbA1c [8-12]. Romero- Aroca et al.12 in their study reported found the odds of macular edema to be 4.01 times higher among those with HbA1c >7% as compared to those having HbA1c <7%.

Jew OM et al, [13] evaluated the risk factors for clinically significant macular edema amongst patients in type 2 diabetes in a case control study involving 150 patients with bilateral non-proliferative diabetic retinopathy (NPDR) and CSME in either eye were compared to 150 patients with bilateral NPDR and no CSME in both eyes. The study reported CSME group to have a significantly higher HbA1c and FBG (P<0.05). The authors did not find any significant difference for BMI while, multiple logistic regression analysis showed that HbA1c had significantly high odds of developing CSME. Kamoi K et al, [14] performed a study to identify the most significant risk factors for in clinically significant macular edema type 2 diabetes mellitus and retinopathy, using optical coherence tomography in 7 subjects with clinically significant macular edema (group 1) and 124 without any clinically significant macular edema (group 2) diabetic retinopathy patients. Body mass index was found to be a significantly (p <0.001) negative predictor.

The study by Varma et al, [15] suggested a greater burden of DME among non-Hispanic blacks, individuals with high levels of HbA1c, and those with longer duration of diabetes. The study by Leveziel N et al, [16] found that 355 (12.6%) persons with type-2 diabetes also had diabetic macular edema, and diabetic macular edema had independent and significant association with age, duration of diabetes, HbA1c, systolic blood pressure, and stage of diabetic retinopathy. Prakash & Kothari [17] conducted a study among 170 type 2 diabetes mellitus patients and found out that the mean HbA1c levels were significantly higher in clinically significant macular edema group (10.09±1.74) as compared to non- clinically significant macular edema group (8.90±2.18).

Martín-Merino E et al, [18] examined the risk factors associated with the development of diabetic macular edema among patients diagnosed with type 2 diabetes in a case-control study of 2405 subjects divided in two groups of 211 diabetic macular edema patients and 2194 controls. They reported that diabetic macular edema increased with high HbA1c≥7%.

Singh et al, [19] found that cystoid macular edema and serous retinal detachment were associated with increased fasting and post prandial blood sugar levels respectively. The findings of present study, we assessed the prevalence of different types of diabetic macular edema based on OCT evaluation and to find out various risk factors associated with them. Keeping in view a wide spectrum of severity grades of OCT based diabetic macular edema and only a few cases in some categories (serous macular edema), the findings of present study should be considered as a preliminary attempt. Further studies on a larger population are recommended.

Conclusion

The results of this study depict that a substantial fraction of diabetic patients with macular edema have major association with old age, increased blood sugar fasting and post prandial blood sugar levels, glycated hemoglobulin and body mass index. Glycemic control and adoption of a healthy lifestyle are found to be of paramount importance in diabetic patients in order to avoid macular edema. Regular ophthalmic evaluation and routine follow-up should be made essential for assessment of diabetic patients especially who have had diabetes since a prolonged period.

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Tuesday, April 27, 2021

Public Space as Interior and Interior as Public Space - Juniper Publishers

Civil Engineering Research - Juniper Publishers


    

Principles and Contexts in the Formation of Public Spaces and Interiors

The saying that there is only one architecture holds true. The breadth of architectural tasks ranges from chair design to urban plans, but in reality only the scale changes, the principles and creative tools remain the same. The compositional principles are used again and it is up to the architects to use them for the solved task and how to evaluate their effect for optimal design. We can document this in the context of urban space and building interiors. I would liken the public space perceived by the architect’s point of view to the interior of the building by analogy. The public space is the interior of the built environment. The mutual analogy between the parts of the city and the interior of the buildings that make it up is supported by similar means of expression in their creation. The same rules apply to the design of the interior and public space as for any architecture. The scope and size of the solution are different, but the principles for the solution remain the same.

Designing and shaping the interior and public space is a complex matter, at the end of which is a functional architecture for a people. Operational and aesthetic aspects must go hand in hand. Public space, like a room or communication in a house, leads somewhere, has a function and something takes place in it. Just as individual rooms have a purpose, so do the exteriors of our cities. Somewhere it is necessary to speed up to just pass, somewhere there is space for stopping, gathering, resting, etc. As in the interiors of buildings, the architect must support these required functions with means of expression, create the necessary atmosphere, easy orientation, facilitate maintenance, promote safety, etc.

The street space, like the corridor, is linear and has the task of facilitating the flow of people in both directions, signaling entrances to buildings, resp. rooms set up along it. Streets and corridors function as veins and arteries in the body of buildings and cities. They create a bloodstream that supplies life to the city and its houses Figure 1.

By widening the street, we get a boulevard, which can be compared to a passage. The boulevard is a street of greater importance and greater width. Similarly, the passage is the superior line space in the interior. Streets and boulevards then converge on the square, just as corridors and passages lead to halls, which are centers for gatherings, and therefore the most important places.

Smaller spaces are rooms or small squares in the city, piazzettas. The one-sided oriented longitudinal spaces of the colonnade can then be boldly compared to galleries. And finally, the atriums or patios are courtyards, ie spaces surrounded on all sides. An example of a public space that evokes an association with the interior is Křižovnické náměstí in Prague. The space, founded in the Middle Ages, is one of the most beautiful small squares in Prague with its picturesqueness. From the north, the square is bounded by the Church of St. Francis and the Monastery of the Crusaders, from the east by St. Salvator, from the south by a number of burgher houses and from the west by the Bridge Tower.

The charm of the whole space lies mainly in contrast to its closed nature with an open view of Prague Castle. As we walk through the square from east to west, we experience the feeling of a man in a beautifully furnished room facing the window, from which a fascinating view of the exterior opens up. If we observe Prague Castle from Křižovnické náměstí, we experience a telescopic effect, when the castle appears closer to us than it actually is. Prague Castle as a large giant and a small space intimately tuned against it, tied with the umbilical cord of Charles Bridge. Square as a room with a view and a room with a view as a square. The design of public spaces is in many ways very close to the spatial solution of the interiors. Spatial principles work across all architectural disciplines Figure 2.


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Friday, April 23, 2021

The Needs and Applications of Delivery Systems to Fortify Food with Active Ingredients - Juniper Publishers

 Nutrition and Food Science - Juniper Publishers


Abstract

Fortifying food products with bioactive agents is a major initiative within the food industry for human health. However, many agents are water insoluble with low bioavailability; some are unstable and easily degrade during storage. Thus, it is necessary to overcome these obstacles before adding them to the final food products. Entrapping bioactive agents into suitable delivery systems such as liposomes, emulsions, etc., has been proven to be a useful method. This review simply describes the reasons for bioactive agents needed to be entrapped in delivery systems, the common formulations used, and their applications. This would provide a general understanding of how active ingredients generally enrich food.

Keywords: Active ingredients; Delivery systems; Emulsion; Liposome

Introduction

Consumers are increasingly demanding a healthy diet rich in active ingredients such as flavors, vitamins, minerals, antioxidants, lipids and so on [1-3]. However, on the one hand, the compositions of active ingredients in natural food are usually limited; on the other hand, some agents may be high in raw food, but their bioavailability is very low [4-6]. For example, β-carotene has received increasing attention during the past 30 years due to its beneficial health effects such as antioxidant and anticancer activities as well as its ability to reduce the risk of heart disease and certain chronic disease [7]. However, humans cannot synthesize β-carotene in their bodies, and they must obtain it from the foods they consume. Many vegetables and fruits (peppers, tomatoes, carrots, mangoes, and kale) are rich in β-carotene, but literatures show that only a minor part (<10%) of the carotenoids in these raw foods is absorbed [8,9]. In addition, many active ingredients including β-carotene also have many other disadvantages such as low water-solubility, physical or chemical instability, undesirable flavor, and so on [10-12]. All of them make active ingredients difficult to directly incorporate into final food products. Therefore, development of strategies to incorporate active ingredients is necessary if such foods are to keep successful and initiative in the marketplace.

Luckily, these challenges can be overcome by entrapping active ingredients into suitable delivery systems. During the past decades, delivery systems (such as liposomes, emulsions, lipid particles, microcapsules, beads, etc.) have been effectively designed and utilized in food industry to encapsulate, protect, and deliver functional components before introduced into final food products [13-16].

Among of them, emulsions especially for oil-in-water emulsion have attracted the interest of many research groups in food and pharmaceutical fields due to their favorable properties such as good biocompatibility, easy design and preparation [3,17]. To obtain uniform emulsion, the oil phase dissolved with bioactive agents is mixed with emulsifier water solution, blended and then passed through a homogenizer. In this system, emulsifiers play an important role in the formation of emulsion and its stability thereafter. To be an effective emulsifier, ingredients should exhibit perfect emulsifying activity [18]. That means it should quickly adsorb to the surfaces of small oil droplet form an interfacial coating and appreciably decrease the interfacial tension during homogenization [3]. Synthetic emulsifiers such as Tween 20, tween 80 are the traditional emulsifiers for many products. With the increasing demand for food and beverage with natural ingredients in recent years, many food manufacturers are trying to replace synthetic emulsifiers with natural and sustainable alternatives. To date, researchers have found a lot of natural emulsifiers (such as protein, polysaccharides, phospholipids, and bio surfactants), which are able to form and stabilize oil droplets [18-21]. Chung et al., [18] found that emulsion prepared by using quillaja saponin as a natural emulsifier could produce whitish milk similar to a commercial liquid creamer. Lin et al., [22] have prepared β-carotene loaded emulsion by using modified starch. He et al., [4] have fabricated curcumin emulsions containing Konjac glucomannan stabilized with whey protein isolate and achieved a controlled and sustainable release of bioactive compounds from emulsions. Lv et al., [20] have compared the effectiveness of a number of natural emulsifiers (whey protein, gum arabic and quillaja saponin) on the production and stability of vitamin E fortified emulsions and found that whey protein isolate and quillaja saponin were more effective at forming emulsions containing fine droplets than gum arabic, while quillaja saponin based and gum arabic based emulsions exhibited better resistance to pH change. Due to the above-mentioned advantages, emulsions are already widely utilized in the food industry, e.g., in dressings, sauces, soups, beverages, dips, creams, and desserts [6,19,22].

Liposome, as one of the most common used formulations, also has great potential to embed bioactive agents. A liposome is a self-assembling and cell-resembling delivery system with concentric bilayer structure. The size of liposome is typically about 10 to 1000nm with the structure varying from a balloonlike unilamellar to an onion-like multiple structures [3,12]. There are different hydrophilic and hydrophobic regions in liposomes separated by surfactant substances (such as phospholipids) [3]. Therefore, both hydrophilic and lipophilic molecules and even amphiphilic molecules can all be entrapped in the special bilayer. Since liposomes were first described in the 1960s by Alec Bangham, they have been beneficial in medical, cosmetic, and agricultural fields, and have become integral to food research. More recently, liposomes have been widely used to encapsulate proteins/peptides/enzymes, polyphenols/flavones, essential oils/fatty acids, vitamins, energetic substrates, and minerals [3,23-25]. Active agents in the form of liposomes could then be effectively added into different food products: dairy products (milk, cheese, and yogurt), drinks (juices and milk drinks), meat (pork, beef, and rabbit), and other products (chocolate, tofu, etc.) [12,27-32].

Delivery systems containing bioactive agents could be directly added into food material with simple blending or homogenization and bring a number of benefits to food industry: supplying good protection for bioactive agents against environment stress, masking off-flavor (bitterness, astringency), improving storage and handling characteristics, extending shelf life, besides increasing bioavailability. However, the food system microenvironment (pH, intrinsic component, and ionic strength etc.) and emulsifier properties used are critical factors needed to take into account if appropriate final food is wanted [3,6]. For example, whey proteinbased emulsion could effectively inhibit oxidation of fish oil in milk, but is less stable in yoghurt and dressing [18].

Conclusion

A number of challenges associated with active ingredient need to be addressed when incorporated into food. Suitable delivery systems such as emulsions, liposomes, etc. could be designed to encapsulate active agents followed by simple blending or homogenization. However, whether appropriate final food could be obtained is dependent on food and emulsifier properties.

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Tuesday, April 20, 2021

The Impact of Maternal HPA Activity on Postnatal Outcomes, A Narrative Review - Juniper Publishers

Pediatrics & Neonatology - Juniper Publishers

Introduction

Excessive foetal exposure to maternal Hypothalamic-Pituitary-Adrenal (HPA) activity, and in particular glucocorticoids such as cortisol, can result in poor developmental outcomes for offspring [1]. The relation between HPA activity and development has been evidenced by research examining both animal and human samples [2]. In response, clinically based interventions that seek to reduce exposure to, or the impact of, foetal overexposure to HPA activity, have gained importance [3,4]. The purpose of this review is to describe the relationship between prenatal overexposure to maternal HPA activity and adverse postnatal effects in human offspring. First, we will discuss the function of the HPA axis during pregnancy and the theory underpinning its role in offspring outcomes will be described. Following this, research examining the relationship between maternal HPA activity and offspring birth and development will be outlined. We will conclude with a discussion of the implications for future research.

HPA Axis and pregnancy

Central to stress regulation in the human body is the HPA axis [5]. In response to stress eliciting stimuli, the HPA axis is activated to provide an increase in glucocorticoid concentrations [6]. Corticotrophin-releasing hormone (CRH), secreted by the paraventricular nucleus of the hypothalamus, stimulates release of adrenocorticotrophic hormone (ACTH) by the anterior pituitary gland which, in turn, stimulates peripheral secretion of cortisol by the adrenal cortex. HPA activity has been demonstrated to follow a daily diurnal pattern in which elevated levels of cortisol present in the morning decrease over the course of the day [7]. During the second and third trimesters of pregnancy, peripheral concentrations of CRH increase substantially as a result of placental activity, initiating an up to three-fold increase in peripheral cortisol [2]. Evidence suggests that by the end of gestation, this increase in peripheral cortisol results in a downregulation of CRH and a subsequent attenuation of HPA responsiveness to distress [8].

The path by which maternal glucocorticoid concentrations reach the foetus is the placenta [2]. This is supported by studies finding significant correlations between maternal cortisol levels and amniotic cortisol concentrations [5,9]. The placenta is lined with the enzyme HSD11B2 which works to protect the fetus from excessive glucocorticoid levels. Factors such as maternal psychological distress (such as anxiety), however, can weaken this enzyme and allow the fetus to be exposed to higher glucocorticoid concentrations [2].

Exposure during pregnancy to appropriate levels of glucocorticoids is important for foetal maturation [10]. For example, exposure to cortisol during the third trimester is crucial for the development of offspring’s cardiovascular, pulmonary, and renal systems, as well as overall foetal growth [11]. However, when a fetus’ is exposed to excessive amounts of glucocorticoid levels for a prolonged period, the development, birth, and susceptibility of the infant to physical illness may be influenced [12]. This is believed to occur through the process of foetal programming, a concept born out of the Barker hypothesis [13]. The Barker hypothesis stipulates that adult vulnerability to diseases (e.g., diabetes, and stroke) originate in the fetus and are programmed by the intrauterine environment [14]. Epidemiological research has increasingly supported this proposition, and both animal and human studies have backed the role of glucocorticoid overexposure in the early programming of later life disease [15,16]. From this research base, recent attention has been directed to the possible role of glucocorticoid overexposure in newborn birth and the cognitive, emotional, and behavioural development of offspring.

Maternal HPA activity and offspring birth

Research has considered the relationship between glucocorticoid exposure and offspring characteristics at birth, including birth-weight and size at gestation [17-19]. Overall, studies examining both central and peripheral glucocorticoid concentrations appear to support the relationship, although findings seem to vary across study methods [2,20]. For example, Bolten et al. [21] examined maternal salivary cortisol levels at waking and at three time points after waking, during early (13–18 weeks) and late (35-37 weeks) gestation. Eighty-one mother-child dyads were observed, and results indicated that maternal cortisol levels at both gestational points were negatively associated with offspring birth-weight and size [21]. Additional analyses indicated that maternal cortisol levels explained 19.8% of the variance in infant birth weight and 9% of the variance in body length; these results were independent of pregnancy complications, gestational age, parity, pre-pregnancy maternal body-mass-index (BMI), smoking, and infant’s sex [21].

By contrast, Goedhart et al. [22] examined 2810 mothers and assessed cortisol levels in maternal plasma at one time point after 20 weeks’ gestation. Their results showed no association between maternal cortisol levels and offspring birth-weight or size after controlling for the same factors as Bolten et al. [21], plus maternal age. Similar findings have been demonstrated between other studies observing salivary cortisol and plasma cortisol [18]. It may be that the medium through which cortisol is sampled may have impacted the results of these studies.

However, there are also other variables which may have impacted these results. These include the different study sample sizes and the number of times cortisol was assessed over pregnancy and within each period of sampling. Unlike Goedhart et al. [22], Bolten et al. [21] accounted for the diurnal pattern of cortisol release throughout the day and throughout pregnancy. Indeed, after further analysis, Goedhart et al. [22] also found that the time at which cortisol was sampled moderated their results; maternal cortisol was independently related to lower birth-weight and smaller size at gestation only for mothers who provided a blood sample before 9 am. This suggests that the timing of cortisol sampling is an essential factor when examining its impact on foetal growth.

The variability across studies in this area has made it difficult to distinguish between the effects of maternal cortisol and the consequences of variable study designs [20]. Cherak et al. [20] recently attempted to mitigate this limitation by conducting a highly specific systematic review and meta-analysis with strict inclusion criteria [20]. Nine studies were analysed, comprising of 1606 mother-child dyads, and findings indicated that maternal salivary cortisol was negatively correlated to offspring birthweight across all trimesters [20]. It was also observed that these factors were most strongly correlated during the third trimester and that studies examining this period of pregnancy demonstrated the lowest degree of heterogeneity. Cherak et al. [20] subsequently concluded that their findings highlight the third trimester of pregnancy as a possible critical period for foetal development and growth [23].

Similar patterns of study results and variability have also been demonstrated when examining offspring gestational age at birth [7,24]. For example, Giurgescu [25] conducted a systematic review in which 15 studies investigating the impact of cortisol overexposure and preterm birth (delivery before 37 weeks) were examined. Most findings indicated that higher levels of cortisol posed a higher risk of preterm birth [25]. However, the gestational age at which cortisol samples were collected appeared to influence study results. Specifically, studies examining maternal cortisol between 7- 24 and 27- 37 weeks’ gestation were related to preterm birth. However, no such association was found when cortisol was assessed between 24- 27 weeks.

In a more recent study, Entringer et al. [7] observed 25 healthy pregnant women over four days and used an ecological momentary assessment (EMA) measure of salivary cortisol. EMA refers to the repeated sampling of participant’s experience in real time and in their natural environment [26]. It aims to minimise recall bias and maximise ecological validity [26]. Findings from this study indicated that higher cortisol levels at awakening were related to a shorter pregnancy duration of up to one week. They also found that a one-time plasma or salivary sample of cortisol in a laboratory setting was not associated with offspring gestational age at birth. One limitation of this study was its small sample size, though the advantages of using an EMA approach were argued to outweigh this limitation as it provided 112 assessments per subject [7]. Overall, studies considering birth-related factors highlight the importance of appropriate sampling of cortisol activity during pregnancy. In the studies which better utilised this knowledge, findings suggested that glucocorticoid overexposure can lead to preterm birth, lower birth-weight, and smaller size at gestation.

In addition to newborn birth and size, research has also considered glucocorticoid effects on offspring cognition, emotionality, and temperament [27-30]. Overall, studies investigating these areas of literature are few and vulnerable to an even greater range of biological and environmental confounds than previously discussed. For example, research places an even greater emphasis on the notion of so-called critical periods during pregnancy in which the fetus is more susceptible to glucocorticoid impacts [1]. Additionally, studies in this area look at infant or childhood developmental outcomes which means that results are vulnerable to the influence of factors such as genetics and the postnatal environment [31]. Of importance are factors that influence the parent-child relationship, and consequently child development, such as maternal mental health [32].

During foetal life, the brain undergoes rapid development, and this makes the fetus more vulnerable to dysregulation of the maternal HPA activity [1]. Excessive exposure to cortisol and CRH, for example, have been found to reduce brain plasticity and neurotransmitter activity, and to obstruct the formation of neural connections [33]. Such impacts can have subsequent effects on foetal programming and may influence offspring cognition and neurodevelopment [33].

Maternal HPA activity and offspring development

In research considering the cognitive development of infants in relation to HPA activity, some studies have assessed cognitive development using the Bayley Scales of Infant Development [10,34]. For example, Huizink et al. [34] assessed the mental development of 170 offspring at 3 and 8 months post-birth. Maternal salivary cortisol was assessed during early (15–17 weeks), mid (27–28 weeks) and late (37–38 weeks) gestation, and samples were taken seven times during each period. Results showed that early morning values of cortisol in late pregnancy were negatively related to results on the BSID at 3 months, but not at 8 months. Davis & Sandman [10] performed a similar study on 125 full-term infants. Maternal salivary cortisol was measured five times during pregnancy (at 15, 19, 25, 30, and 36 weeks) and offspring development was measured when infants were 3, 6, and 12 months of age. Findings indicated that, at 12 months, exposure to elevated cortisol during early gestation was associated with lower scores on the BSID, while elevated cortisol in late gestation was associated with higher scores. One strength of these studies was their large sample size, longitudinal designs, and the fact that they controlled for postnatal confounding factors, such as maternal psychopathology. However, while Huizink et al. [34] accounted for the diurnal nature of cortisol, Davis & Sandman [10] did not. Both studies also examined low-risk samples of mothers, limiting the ability to make generalisations from their results to clinical populations. Despite these limitations, however, both studies support the role of glucocorticoid exposure in shaping offspring cognitive development, particularly during late gestation [10].

At least two studies using older child samples have also considered cortisol overexposure and childhood intellectual functioning [28]. For example, LeWinn et al. [31] compared IQ scores at 7 years of age between 74 sibling pairs. Siblings were born at different times and exposed to different amounts of prenatal cortisol during late gestation (31- 36 weeks). IQ was assessed using the Wechsler Intelligence Scale for Children (WISC; edition not specified) and maternal cortisol was collected from plasma. Within sibling pairs, maternal cortisol was negatively associated with verbal IQ, independent of prenatal and postnatal confounding factors. Similar findings were also observed in a more recent study by Aizer et al. [28]. However, neither of these studies controlled for post-natal maternal mental health. This is significant because studies such as Bergman et al. [35] suggest that the mother-child relationshi m p ay mediate the association between in utero cortisol exposure and offspring cognitive development. Such results, however, suggest that cortisol can have an impact on offspring cognition without postnatal intervention.

At least two studies using older child samples have also considered cortisol overexposure and childhood intellectual functioning [28]. For example, LeWinn et al. [31] compared IQ scores at 7 years of age between 74 sibling pairs. Siblings were born at different times and exposed to different amounts of prenatal cortisol during late gestation (31- 36 weeks). IQ was assessed using the Wechsler Intelligence Scale for Children (WISC; edition not specified) and maternal cortisol was collected from plasma. Within sibling pairs, maternal cortisol was negatively associated with verbal IQ, independent of prenatal and postnatal confounding factors. Similar findings were also observed in a more recent study by Aizer et al. [28]. However, neither of these studies controlled for post-natal maternal mental health. This is significant because studies such as Bergman et al. [35] suggest that the mother-child relationshi m p ay mediate the association between in utero cortisol exposure and offspring cognitive development. Such results, however, suggest that cortisol can have an impact on offspring cognition without postnatal intervention.

However, while cortisol overexposure appears to impact offspring temperament, this relationship may be more complicated than initially thought [2]. For Example, Braithwaite et al. [39] examined 216 5-week-old infants exposed to high concentrations of cortisol at 32 weeks’ gestation and found sex differences in offspring temperament. Specifically, females tended to show greater reactivity and anxiety towards challenging tasks while males showed less reactivity and greater aggression. Such sex-dependent findings have also been supported in other recent studies [40-42]. Additionally, research has suggested that the impact of glucocorticoid exposure in utero may be mediated by factors such as low birth weight [5] and foetal brain development [43].

Indeed, studies examining prenatal glucocorticoid exposure, brain development, and offspring emotionality support the claim by Gutteling et al. [43,45,38]. For example, Davis et al. [38] studied the impact of synthetic glucocorticoid exposure on brain development and affective problems in 54 full-term children aged 6- 10-years-old. Results indicated that children who were exposed to synthetic glucocorticoid treatment between 24-34 weeks’ gestation had significantly thinner cortices in areas associated with stress and emotion regulation. Interestingly, thinner cortices, but not glucocorticoid treatment, was associated with affective problems. In other child studies, however, thinner cortices have been associated with depressive symptomatology [45]. Consequently, these findings suggest that glucocorticoid treatment may make children more vulnerable to affective problems through the impact it has on their brain development. This is supported by Buss et al. [44] longitudinal study in which higher cortisol levels during early gestation (15 weeks) were associated with greater affective problems in girls, and this appeared to be mediated by amygdala volume. Together, these studies support the notion that there are areas of the foetal brain that are vulnerable to maternal HPA activity and have subsequent impacts on offspring emotionality [1]. Buss et al. [44] study also support the notion of sex- specific effects.

Other studies considering offspring brain maturation have investigated offspring HPA development [43,44]. Recently, for example, Davis et al. [47] examined prenatal maternal cortisol levels and infant behavioural responses to stress. Plasma cortisol was assessed in 116 mothers at 15, 19, 25, 31 and 36 + weeks’ gestation and infant stress reactivity was assessed at 24 hours’ post-birth in a heel-prick scenario. Statistical analyses showed that infants who were exposed to higher levels of maternal cortisol in mid-late gestation were more reactive to the stressful procedure. Elevated maternal cortisol levels during early pregnancy was also a predictor of a slower behavioural recovery rate. All findings were independent of delivery type, prenatal medical history, socioeconomic status or child race, sex or birth order.F indings from studies considering exogenous administrations of glucocorticoids also support these findings [48]. At least one of these studies has also suggested that increased cortisol reactivity in offspring can continue into childhood, though again, results may be more pronounced for girls than boys [19].

Overall, studies suggest that prenatal overexposure to maternal glucocorticoid concentrations can influence foetal brain development and subsequent offspring emotionality and stress reactivity. Most of the studies in this area are longitudinal, account for the possible critical period of later gestation, use various means of measuring cortisol, and consider additional mediating factors such as offspring sex. This is a great strength in this literature. The primary limitation, however, is the low-risk sample frequently used in research. Again, such samples limit the ability for research to generalise their results to clinical populations of pregnant women.

In summary, foetal overexposure to maternal HPA activity can have implications for offspring birth and subsequent development. Specifically, excessive exposure during late gestation can lead to preterm birth, low birth-weight, and smaller size at gestation. Similar trends in exposure can also lead to unfavourable offspring cognitive functioning, temperament, and emotionality. Recent research further proposes that these relationships are largely mediated by foetal brain development and dependent on offspring sex. An alternative medium through which offspring development may be impacted is low birth weight. Both preterm birth and low birth weight have been associated with increased risk of later behavioural and psychological concerns [48]. However, newborns born prematurely or at a lower birth weight also demonstrate underdeveloped brains [49]. Consequently, the mediating role of low birth weight may again be better attributed to foetal brain development.

Implications for future research

The present review leads to several implications for future research. First, more research is required to further clarify the impact of foetal overexposure to glucocorticoids. Some of this research needs to take an exploratory approach to identify additional factors that have potential to confound study findings. For example, studies could further examine the role of foetal brain development in mediating prenatal cortisol exposure and postnatal cognitive, emotional, and behavioural difficulties [43]. Other research should continue to build upon current findings using improved study methods which account for the natural patterns of HPA activity. They should use approaches that have greater ecological validity than measuring one-off samples of cortisol, such as EMA [7]. To prevent confounding results research should also account for prenatal and postnatal factors such as genetics, offspring sex and maternal mental health. Longitudinal research methods will also add to current findings by allowing researchers to consider the impact of critical periods in foetal development.

Second, research should use larger samples of mother-child dyads and direct their attention towards populations that may exhibit clinically elevated prenatal cortisol concentrations [10]. Currently, research has focused more on healthy, low-risk samples of mothers. However, this has limited the potential for studies to generalise their findings to clinical populations. There is some evidence suggesting that prenatal maternal depression and anxiety may increase prenatal maternal cortisol levels [2]. Consequently, research may benefit from using samples of pregnant women with clinical presentation of psychopathology [10]. At the same time, other research suggests that there is no correlation between maternal anxiety and depression and cortisol levels during pregnancy [2]. Further research is therefore required to bring greater clarity to this area of literature.

Finally, research needs to investigate ways of limiting the impact of foetal overexposure to maternal glucocorticoid concentrations. Given the results across studies this implication appears imperative, and there are at least two ways of addressing this. For example, psychological interventions could aim to reduce prenatal maternal distress. Some researchers have begun considering such interventions out of the understanding that prenatal psychopathology can lead to increases in maternal cortisol levels [4]. As previously mentioned, while some studies support this correlation, others do not [2]. Consequently, it may be more appropriate for interventions to address the HSD11B2 enzyme and aim to prevent it from weakening. Another method of intervening may be to focus on the parent-child relationship post-birth [32]. As previously mentioned, this relationship can mediate the adverse effects of foetal overexposure to cortisol [35]. Currently, research investigating interventions during the postnatal period show promising results and suggest that increasing parental warmth and responsiveness are useful in mitigating the adverse effects of foetal glucocorticoid overexposure [32].

To conclude, excessive foetal exposure to maternal HPA activity can result in unfavourable birth and development outcomes in offspring. Further research is required to clarify this relationship in human samples, however findings to date indicate that interventions aimed at minimising the effects of this relationship are crucial.

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Friday, April 16, 2021

Review on Students Interest and Self-Motivation to Learning Mathematics education in Ethiopian - Juniper Publishers

Biostatistics and Biometrics - Juniper Publishers

Abstract

A review of Articles the effect of student attention and self-forced rewards mathematics special education. The review implications of the strategies designed to promote intrinsic motivation is presented mathematic educational. Each and every one subject are indispensable for learner and educator, but mathematics teaching serves a all-purpose reason of school to build up human beings psychologically, in good physical shape and in the flesh It makes populace imaginative and accountable. One part of the assemblage presents line of attack for all students, and the other part contains strategies for students. Aggravated students understanding school success because they display behaviors such as choose challenging activities and spending more time on task. Nowadays mathematic Educational can create a fundamental revolution in education. This consists of a variety of tools that help to provide learning materials and support the learning process to achieve learning goals in mathematic Educational. Review believed that from immemorial time, transfer knowledge; the rapid penetration of information technology among people has changed their lifestyle mathematic educational. The rapid evolutions from the application of technology including productive and information technologies in human life have brought about dramatic changes in industrial, economic, political, and civil structures of societies and these changes have been a significant impact on the life and work of people around the world and seriously dealt with the traditional methods of teaching, learning and educational. The use of rewards undermines intrinsic motivation and results in the slower acquisition of skills and more errors in the learning process.

Keywords: Mathematic educational; Fundamental revolution

Introduction

Based on occurrence with mathematics at discipline, student‟ build up wide-ranging attitude about its environment and value and about their own ability and meditation in doing it [1]. Attitudes and behaviors are repeatedly considered by means of self-report which facilitate financially viable survey manner to be in employment on a bulky weighing machine which hold that instructional method that are extremely successful with greenhorn learners. Additional more students’ attitudes and behaviors have been established to be subjective by school and classroom factor. Attitude seen as cognitive and effective orientation or disposition towards an object, idea, person, and situation [2].The absence of academic motivation and lack of interest is also likely to be mathematicsstudents’ neglect of their studies. Research over the last two decades has indicated that adolescents’ academic motivation declines over time. Recent learning show that as children get older, their interests and attitudes toward school in general and toward specific subject areas such as mathematics, art, and science tend to deteriorate [3].Informally, interest is defined in Collins Dictionary as “something that happiness you and attracts your attention so that you want to learn or hear supplementary about it or continue doing it.” Self-motivation can also be definedas the “motivation arising from an individual’s internal desires for the satisfaction and fulfillment of definite needs.

In recent times, the ministry has premeditated and implement teaching subdivision expansion program to make stronger human possessions development by preparation knowledgeable and ground-breaking people with special attention to engineering, technology and natural sciences, through introduce high quality discipline and mathematics curricula at primary and less important schools and the approve rule of the 70:30 university intake ratios in goodwill of science & technology [4]. Consequently, my understanding showed that most students in secondary schools think that mathematics is difficult, and they lacked interest and personal enthusiasm for mathematics. The review think upon these; can it be that the mathematics instructors around these individuals are not good in mathematics or that these mathematics instructors will not know how well to guide their students in patience, so that the total impression made by these mathematics instructors is deadening.The reviewer believes his experience are the baseline for further studies to carry out a more focused and comprehensive research and will use a very unique approach by introducing variables that have not been examined by earlier researchers; he investigates how math anxiety, its usefulness, the condense of the student, and student inspiration affect their interest in mathematics quantitative approach. The review will let somebody be on familiar terms with the educational institutions on these variables in the formation of students’ interest.

Objective of the Review

The purpose of this review interest and self-motivation make tote learning of mathematics education.

Review litterateurs

Motivation in Mathematics Education: High student realization comes from students who are motivated from inside. For that reason, instead of giving rewards, teachers need to consistently teach students to become fundamentally motivated. Student motivation affects every aspect of school life, from attendance, to educational performance, to extra-curricular activities. Promoting the maximum student motivation possible is extremely important for every teacher especially in today's instructive climate, where schools are continuously under pressure to improve test scores, responsibility[5]. And accountability. Students with learning disabilities face even greater challenge each day as they walk into classrooms. Because these students can struggle with the easiest of tasks presented by teachers, students with learning can seem like the most unmotivated of all, going to extremes not to show their weaknesses. As a result of these pressures, teachers bombard students with the promise of rewards; stickers for good behavior, treats for completing assignments, lunches for turning in homework. Of all the rewards given, grades are the most common reward [6]. There is a need to train teachers in how to teach students so that they become intrinsically motivated, instead of just propelled along by the vision of the next external reward. The key factors are to create an autonomous classroom environment, and to teach students to perceive themselves as decision makers. Teachers also need to feel that they are in control of the material to be taught, how to teach it, and how to teach the students to be in control of the content. These strategies do not often appear in reading methods texts or math books, although they are key issues in improving the achievement of all students. 

Students have been rewarded for good behavior for many years, even before the development of Skinner's theory of operant conditioning. In the 1800's New York City established a token economy as a means of rewarding correct schoolwork and punishing school offenses [7]. In fact, though, it was the theory of operant conditioning that leads to the widespread use of rewards in the classroom. Basically stated, operant conditioning means that if a reinforcer is delivered after a certain behavior, then the behavior will be strengthened. A reinforcer is no matter which given that will increase the chance of the behavior happening again. In school, reinforcers usually are things like stickers, praise, treats, and grades. While operant conditioning was gaining in popularity, motivation theorists were changing their ideas. Researchers were rejecting the idea that man is motivated by drives and instincts alone, and accepting the idea that man is motivated by sources both inside the body and outside in the world [8]. In the 1970'sEdward Deci [9,10] defined the poles apart kinds of motivation as intrinsic motivation and extrinsic motivation, intrinsic motivation is the act of completing an activity for the pleasure of doing the activity itself. In research conducted during the last 50 years, it has been established that intrinsic and extrinsic motivations have different effects on education. The presence of intrinsic motivation produces many behaviors that result in school success like sustained interest in tasks, hazard taking, and the conquering of new challenges [11-13].Children with learning disabilities have even been shown to execute at levels higher than what was expected by psychological tests [14]. External rewards, however, tend to have negative effects in school.Different forms of extrinsic motivation tends to take attention away from the most important aspect of school, a child's learning. Rewards can undermine intrinsic interest in an activity, and even deter a person from returning to an activity later[8-10, 15]. In addition, rewards have been shown to have detrimental effects on the process of learningfound that rewards resulted in more[16].

Mathematics Teaching for Intrinsic Motivation

A familiar subject matter in the research regarding intrinsic motivation is the expansion of an autonomous classroom climate. When children experience in control of their surroundings, they are not only on the inside motivated to work, but also familiarity positive feelings of self-worth [17]. It is also important to note that even though a teacher may feel that the environment is autonomous, the child may perceive it in a different way. A child's perception of the environment should be taken into consideration when developing an education plan (Adelman, 1989). Creating an environment where kids see themselves as having control is one where they have some choices. Giving children choices in their learning can be a very authoritative tool in developing intrinsic motivation[12].Alfie Kohn [18] has not compulsory many ways to give children choice in the classroom. With respect to academic learning, children can make choices in what they learn simply by choosing what trade book to read. Students make a decision how to gain knowledge of by decide on what types of groups to work in, or where they will work in the classroom. 

Students can make choice in how well they learn by helping to establish the criteria by which their material will be graded. Finally, students need to engage in discussions about why they become skilled at certain things in school. Kohn also points to the significance of including children in deliberations about social and behavioral issues in the classroom, such as rules and procedures.In addition to Kohn, other researchers have stated the importance of involving students in the decision manufacture process going on in the classroom[12].Saw that giving small children a choice of materials for an art project produced better art projects. Also, giving students learning options, helping them to sample the options, and then decide on a particular option deeply involve students in their own learning process [11]. Not only have student made decisions about their knowledge, but they have also experienced monitoring and evaluation skills.

Student decision making not only helps in the liberation of content information but can also be an important part of a behavioral organization program.In addition to the classroom climate, children require to receive instruction cover areas relevant to intrinsic motivation. As a result of receiving personal causation training, both teachers and students in grades 5,6, and 7 felt like they had some control in their atmosphere, and students saw increases in academic achievement [19]. After receiving training, teachers intended classroom movements in self-concept, achievement motivation, realistic goal setting, and the origin-pawn concept. Specific goals for the students were to be able to determine goals for self, classify strengths and weaknesses, determine the deed to take toward goals, and to tell if the action is leading toward a goal.Stipek (1993) [20] recommend the use of learning centers in the classroom to provide somewhere to stay for the need for classroom conference, individualization of work, and the chance for students to have choices. Even though learning centers have conventionally been used with younger children, they can be used effectively with students of all ages. Another way to structure the classroom to promote intrinsic motivation is through the use of interactive journals [20].At what time plunder are given, children don't perceive themselves in control of learning, they approach and complete tasks differently than when rewards are not prearranged, and their work is judge as less creative[12,7,17]. Repeated failures in school cause them to build barriers to protect themselves, and therefore they become uninvolved in school [21]. Rewards, then, should be replaced with teaching that is focused on the built-in incentive of the student. A widespread goal should be to have the student’s attention be at the center of their knowledge, not a reward. Students who are taught to perceive themselves as causal agent in the classroom fit into place in more risk-taking behavior and amplify their accomplishment [19]. Also, students who make a distinction themselves as more in control of learning have better self-esteem [17].

Characteristics of teacher in Intrinsic Motivation in Mathematics Education

Teachers typically describe high-quality learner as hardworking, interested, and motivated [13]. Motivation is a word heard over and over again as crucial to a child's learning and is often heard as being a major problem in schools today. Two types of motivation, intrinsic and extrinsic incentive, have been documented by [9,10]. Decide scribes an intrinsically aggravated person as one who engages in a hullabaloo for the activity itself; the reward being the activity. A child who cleans his room for the purpose of displaying his baseball card collection is said to be fundamentally motivated. Extrinsic incentive occurs when a person completes an activity because it leads to the acceptance of an outside reward. A child who is promised a journey to the movies after cleaning his room is said to be extrinsically motivated. While the majority of rewards given in school can be thought of as extrinsic motivators, children learn the most when guided by intrinsic enthusiasm. 

Children who are intrinsically motivated display number of behaviors that allow them to perform accordingly with their academic abilities [13]. For example, children who are intrinsically motivated become deeply involved in the task at hand and experience a feeling of enjoyment [12]. And seek out challenges with the intention of conquering them (Adelman and Taylor, 1990).According to DeCharms [19].An intrinsically annoyed person feels that he can try to produce a change in the environment and feels confident that the alter will occur. Children seen demonstrating this individuality in the classroom would be characterize as motivated, good students. Children with knowledge disabilities also benefit from intrinsic inspiration. These children tend to work longer and harder on tasks than extrinsically motivated children with learning disabilities (Haywood, 1968), and have been open to the elements to establish critical interior systems of self-reward and mastery goals (Harter 1978). Children exhibiting high levels of intrinsic motivation can achieve at levels that are higher than predicted by psychological testing [14].

The Effect of Rewards on Learning in Mathematics Education

The field of study on motivation was also going away through an assortment of changes beginning in the 1950's. Motivation researchers and dissonance theorists began to reject Freud's contemplation that man is motivated only by drives and instincts [8]. Sallow went on to explain that motivation is man's effort to change his environment, and then feel satisfied when the desired alter occurs. This opinion, along with recognition of intrinsic and extrinsic encouragement lead to the completion of many investigate studies on the effects of enthusiasm on concert[21]. As a result, the idea began to materialize that extrinsic motivators may have a downbeat end item for consumption on a person's internal motivation. Since many of the rewards given in school are extrinsic motivators, school become the setting for a large body of research. During the last 50 years researchers have methodically investigated the effects of rewards on all aspects of school[8].Establish that the imbursement of money to college students to lie about enjoying a dull learning task did little to change the student's opinion of the task. In the same way[9,10].Discovered that money as a reward has detrimental effects on motivation.Intrinsically motivated college students become less motivated when paid money as a reward. On the other hand, when fundamentally aggravated students were given praise as a reward, their motivation was enhanced. In addition, in 1972 Deci found that at what time a human being perceives a reward to be more that what is warranted for a given situation, the person puts forth supplementary effort in an activity. 

The type and enormity of a reward have an effect on motivation and arrangement.The timing o f a reward also affects inspiration. In a study done at a nursery school[15]. Assigned 51 children with a high interest in drawing to one of three experimental conditions. One group of students agreed to absolute a drawing activity for a reward of a certificate and star, one group completed the drawing activity and then received a surprise reward, and the third group completed the activity but acknowledged no reward. The authors then studied the amount of time subjects spent with the drawing supplies during free choice time. Lepper et al. found that the subject who received no award or an unanticipated reward spent significantly more time drawing than subjects in the expected award condition.Rewards contracted for proceeding to an activity begins appearing to chip away at interest in that activity later on, since students in the unforeseen reward condition motionless spent substantial time drawing during free time. In adding together to the type, quantity, and time of a reward, researchers also studied the effect of plunder on the procedure of knowledge.

The importance of Science and Mathematics Subjects

All subject are necessary for learner and educator, but mathematics instruction serve a universal principle of school to enlarge person being emotionally, vigorous, and physically. It make people creative and accountable [22]. Mathematics education enables learner to congregate society difficulty for adequately qualified and flexible or pliable occupation force. For some scientists’ethnos mathematics meant to bring, classified in sequence of math (knowledge and the mathematical practice of cultural assemblage of people) to school. From time this issue has been confused with cultural or indigenous mathematics [23]. In South Africa the idea of ethnomathematics bring ethnic and impartial tension. Students’ background in the classroom causes inequalities. Whites claimed that they have more ability to learn math than black because, new technology is the result of their innovation. They accept that mathematic is a new and foreign verbal communication to every single one student before they go to school. Students on or after the beginning are one and the same to learn this completely innovative knowledge which is called ethno mathematics.Currently, the world is becoming more and more technical and the study of science and mathematics is becoming highly valued. Sustainable success in global economy demands workers with advanced thinking, way of thinking and problem-solving skills [24]. The percentage of women graduate with organic sciences degree has grown from 25% in 1960 to 62% in 2005, whereas only 21% of physical science degrees were awarded to women in 2005. Overall, women comprise 24.8% of computer and mathematical professional, down from 27% in 2006.

Global Discourses on and Experiences of STEM

Experiences from developed countries and emerging economies underscore that increasing the number of high schools, college, and postgraduate students majoring in STME subjects is critical for sustainable economic development. It is not uncommon to see most STME graduates go into STME jobs and occupations that are among the highest paid and fastest growing. Moreover, at the global level, individuals with STME degrees who enter STME careers experience lower unemployment rates compared to workers who enter other fields, which means that STME workers enjoy greater job security. In other cases, students who study STME can enter a variety of fields and earn a salary premium, even when they pursue non-STME occupations. In turn, STME education boosts countries’ competitive edge and innovative capacity, both of which sustain economic growth (Japan International Cooperation Agency [23,24].

STEM in Ethiopia

The Ethiopian education system consists of two cycles of primary education; two years of general secondary education; followed by either a university preparatory program or technical vocational education and training (TVET). Mathematics is offered separately all the way from kindergarten through secondary school, and science is given as environmental science (integrated form) in the first cycle of primary (Grades 1 to 4). It is further offered as integrated science in Grades 5 and 6 and separately as biology, chemistry, and physics thereafter. Ethiopia offers early specialization, offering courses in biology, chemistry, and physics starting from Grade 7. Thereafter, students’ study STM and related subjects, including physical, mathematical, and engineering science; life science and health; teaching, business and economics; and other related fields [23,24].In addition, recently the Ethiopian government placed special emphasis on science, technology, engineering, and mathematics education. One example of this is the setting of the target of a 70:30 enrolment mix, where 70% of students enrolled should be in science and technology and 30% in social sciences. In addition, the government has established the Centre for Strengthening Mathematics and Science Education in Ethiopia (CSMASEE) under the federal MoE, which is responsible for science and mathematics education across the sector. Ethiopia’s membership in SMASE-Africa, a regional association where African countries exchange skills, experiences and issues in teacher education in mathematics and science, which it joined in 2007, later evolved into more collaboration between Ethiopia and the Japanese government, which led to the launch of the CSMASEE(Japan International Cooperation Agency [23,24].

Gender-Sensitive approaches

Gender Differences in Achievements of Mathematics

Near the beginning findings show that girls be inclined to have more unenthusiastic attitudes towards mathematics than boys do, and those attitudes tend to become more unconstructive as pupils moves from basic to secondary school [25]. The wide-ranging attitude of the class towards mathematics associated to the pre-eminence of tuition and social, psychosomatic weather of the class and to increase encouraging attitudes needs individual effort and mathematics nervousness can concentrate from end to last part systematic destination. However, recent confirmation suggested that collaborative approaches could promote positive attitude among students. Furthermore, attitude actions require considerable cleansing[25].Distinguish two elemental approaches to illustrate attitude towards math: First a simple definition explain it as the degree of effect associated with mathematics that is Attitude is the emotional disposition towards mathematics. The after that was three constituent definition distinguishes emotional reply, think and behaviors as constituent of come within reach of [25].Report that mathematics self-assurance, attitude towards mathematics, emotional Stacey found that students with heartening attitude towards mathematics steps forward to more authoritative behavioral and residential theoretical understanding.For short term trends at fourth grade, 41 countries had similar data from 2011 that can be compared to 2015.

In mathematics, about half of these countries (21) had higher standard achievement in 2015 than 2011, and another 15 remained at 2011 levels. Only five countries had lower achievement in 2015 [26]. Thorough importance on capacity development that is gender sensitive. In some cases this involves capacity development activities that appreciate the different needs and capacities of men and women, while in other cases the emphasis is on providing specific opportunities for women, in recognition of the enormous participation and agency of women in global access to key resources and services.Of the 36 countries participating in the science part of the TIMSS 2007 at grade 4, significant gender differences favoring boys were found in 8 countries; gender differences favoring girls were found in 6. It is of special importance to note that the advantage of boys in math, even at an early stage grade 4, is highly correlated with advantage in science. Of the 8 countries, where significant gender differences favoring boys were found among grade 4 science students, 7 were also in the 12-country list with significant gender differences in mathematics. Of the 6 countries where girls scored higher than boys in science in grade 4, 4 – Armenia, Qatar, Tunisia and Kuwait – also had gender differences favoring girls among 4th graders in mathematics (ibid).

In grade 8 significant gender differences favoring boys were found in 8 countries [27]. Five of the 16 countries with 20-year trends raised mathematics achievement across their entire eighth grade distribution, with increased percentages of students at all four international benchmarks. Among the 16 countries, the number of improving countries increased at each higher benchmark 5 at Low, 6 at Intermediate, 8 at High, and 10 at highly developed [26]. A sexual characteristics toolkit developed with partners has been taken up widely to build this knowledge, and apply it directly in capacity development activities, working closely with key partners. Gender compassion will be built into the design of capacity development actions. For example, the content and arrangement of farming recommendation provided through advisory services will be adjusted to accommodate preferences of women and of women within can be gender transformative by improving control of resources and participation in decision-making. Current evidence will be synthesized, and new knowledge and evidence will be generated to inform investment, design, and implementation of these services [26].Based on research from 1914 through 2011 that spanned more than 30 countries, the study found the differences in grades between girls and boys were largest for language courses and smallest for math and science. The female advantage in school performance in math and science did not become apparent until junior or middle school, according to the study, published in the APA journal Psychological Bulletin. The degree of gender disparity in grades increased from elementary to middle school but decreased between high school and college [28]. Similar to the findingsour consequences put it to somebody that for in cooperation boys and girls, math grades fall over the course of junior high and high school [29]. The previous studies that focused on students’ science administration from using 1998-1999 ECLS-K data, Kohlhaas and her colleagues found that gender difference started as near the beginning as in the third grade with male students having higher science average mean scores than the female students. In fifth grade, male students still had better performance in science than females [30].

Gender Differences in Achievements of Science

In attendance are lots of factors that affect girl’s math accomplishment in poles apart society. These factors can be parents’ environment, and parental hold up, enlightening issue, learners’ socioeconomic circumstance, and learners’ self-possession that may have an effect on their expectation’s achievement in math. Mathematics has been easier whispered than done area under conversation for countless students to productively learn. Female students’ completion in math is a far and wide recognized as a national awkwardness [31-37]. The comprehensive, information show sexual characteristics differentiation in math accomplishment. Grade 4 science important gender difference favoring girls were establish in the TIMSS 2007 in 10 countries 5 of which were Muslim: Algeria, Kazakhstan, Kuwait, Qatar and Tunisia while Grade 8 science, significant sexual characteristics differences favoringgirls were set up only in 4 country – all Muslim: Bahrain, Kuwait, Qatar and Turkey[38-46]. In eighth grade science, Singapore had the best presentation at the TIMSS intercontinental benchmark, with 42 percent of students reaching the Advanced Benchmark, followed by Chinese Taipei (27%) and Japan (24%). In these countries, 86 percent or more reached the Intermediate Benchmark [26].

Do Gender differences Increase with Age?

In science, more than one-third of the countries (17 of 41) had advanced achievement in 2015, 16 remain at 2011 levels, and 8 had lower achievement in 2015. There were comparable levels of short term improvement at eighth grade, with more than half the countries (18 out of 34) showing improvement in mathematics compare to 2011 and only 3 declining, and 15 out of 34 countries presentation enhancement in science and only 4 declining [26]. In 2007, gender difference favoring boys were found in 12 countries among 4 grade students in mathematics, but only in 8 countries in the midst of 8 grade[26]. A to some degree different picture was found in the science part of the TIMSS 2007: in 8 countries sexual characteristics differences favorboys were found in the middle of 4 grade students; in grade 8 the number increased to [25]. It is of special importance to note, that most countries where sexual category difference favoring boys exist in grade 4 did not formulate obvious to be able to close them in grade 8. what's more, in most cases these gender differences became superior in grade[27].

Conclusion

Motivation is almost certainly the most significant thing that educator can be objective to get better learning. Plentiful irritated punitive conjectures have been postulated to explain motivation. At the same time as each of these theories has several genuineness, no on its own theory seems to sufficiently explain all human motivation. The in sequence is that human beings in all-purpose and students in scrupulous are multifaceted creature with multifaceted requirements and desires. About student, very diminutive if any sophistication can occur unless students are motivated on a consistent basis. The explanation feature impacting student stimuli are: student, teacher, content, method/process, and environment.From the examination the subsequent findings were obtained. More than a few reviews had done on relationship connecting students‟ attitude and students‟ show in mathematics and these studies show there was constructive relationship between the two. For this reason, students‟ attitude towards mathematics is a chief issue that might heaviness the presentation of the student.The inclination psychotherapy in mathematics and science based on the literature and discussion made it is over and through with that mathematics and science achievement score sex dissimilarity (for males and females) was not get hold of for mathematics and discipline achievement scores. The effect of sex in these variables appears to non about mathematics and science achievement scores among students at primary schools.About differences in mathematics and science achievement score among students, due to location of the schools, the findings obtained disclosed that student’s score were postponed significantly. The difference between town and rustic schools was also important.

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