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The Importance of Video Fluoroscopy Swallowing Study for Nasogastric Tube Removal in Rehabilitation Patients (재활치료환자의 비위관(nasogastric tube)제거에 따른 비디오 투시연하검사(VFSS)의 중요성 평가)

  • Jung, Myoyoung;Choi, Namgil;Han, Jaebok;Song, Jongnam;Kim, Weonjin
    • Journal of the Korean Society of Radiology
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    • v.9 no.1
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    • pp.1-7
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    • 2015
  • Acute phase patients who are unconscious and are suffering from cerebral infarction, cranial nerve disorders, or cerebral apoplexy are susceptible to aspiration pneumonia due to dysphagia. In these cases, a nasogastric tube is inserted to supply nutrients. Although bedside screening tests are administered during recovery after rehabilitation, clinical examinations may not be able to ascertain asymptomatic aspiration. Therefore, a video fluoroscopy swallowing study (VFSS) was performed in 10 patients with dysphagia after rehabilitation therapy; these patients had nasogastric tubes inserted, and a rehabilitation specialist assessed the degree of swallowing based on the patients' diet and posture. If aspiration or swallowing difficulties were observed, dysphagia rehabilitation therapy was administered. The patients were reassessed approximately 30-50 days after administration of therapy, based on the patients' condition. If aspiration is not observed, the nasogastric tube was removed. A functional dysphagia scale was used to analyze the VFSS images, and the scores were statistically calculated. The mean score of patients with nasogastric tubes was $49.79{\pm}9.431$, thereby indicating aspiration risk, whereas the group without nasogastric tubes showed a mean score of $11.20{\pm}1.932$, which indicated low risk of aspiration. These results demonstrated that a significantly low score was associated with nasogastric tube removal. Mann-Whitney's test was performed to assess the significance of both the groups, and the results were statistically significant with a P value <0.001. In conclusion, VFSS can effectively assess the movements and structural abnormalities in the oral cavity, pharynx, and esophagus. It can also be used to determine the aspiration status and ascertain the appropriate diet or swallowing posture for the patient. Therefore, VFSS can potentially be used as a reliable standard test to assess swallowing in order to determine nasogastric tube removal.

Effect of a Combined Treatment with Uniconazole, Silver Thiosulfate on Reduction of Ozone Injury in Tomato Plant (Uniconazole 과 Silver Thiosulfate 의 복합처리가 토마토의 오존피해경감에 미치는 효과)

  • Ku, Ja-Hyeong;Won, Dong-Chan;Kim, Tae-Il;Krizek, Donld T.;Mirecki, Roman M.
    • Korean Journal of Environmental Agriculture
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    • v.11 no.1
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    • pp.50-58
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    • 1992
  • Studies were conducted to determine the combined effect of uniconazole [(E) -1-(4-chlorophenyl)-4, 4-demethyl 2-(1,2,4 triazol-1-yl)-1-penten-3-ol] and silver thiosulfate $[Ag {(S_2O_3)}^3\;_2-]$ (STS) on reduction of ozone injury in tomato plants(Lycopersicon esculentum Mill. 'Pink Glory'). Plants were given a 50ml soil drench of uniconazole at concentrations of 0, 0.001, 0.01 and 0.1 mg/pot at the stage of emerging 4th leaf. Two days prior to ozone fumigation, STS solution contained 0.05% Tween-20 was also sprayed at concentrations of 0, 0.3 and 0.6 mM. Uniconazole at 0.01 mg/pot and STS at 0.6 mM were effective in providing protection against ozone exposure(20h at 0.2ppm) without severe retardation of plant height and chemical phytotoxicity, respectively. Combined treatment with uniconazole, STS significantly reduced ozone injury at the lower concentration than a single treatment with uniconazole or STS. Uniconazole treatment reduced plant height, stem elongation and transpiration rate on a whole plant level and increased chlorophyll concentration. STS did not give any effect on plant growth and chlorophyll content but increased transpiration rate in non-ozone-fumigated plants. Ethylene production in the leaves of ozone-fumigated plants was decreased by uniconazole and STS pretreatment, but there was no protective effect on epinasty of leaves in uniconazole-treated plants. STS increased ethylene production in non-ozone-fumigated plants, but it significantly reduced the degree of epinasty and defoliation of cotyledons when plants were exposed to ozone. Uniconazole slightly increased superoxide dismutase and peroxidase activities. But STS showed little or no effects on such free radical scavengers. Day of flowering after seeding was shortened and percentages of fruit set were increased by uniconazole treatment. STS was highly effective on protecting reduction of fruit set resulting from ozone fumigation. These results suggest that combined use of uniconazole and STS should provide miximum protection against ozone injury without growth retardation resulting in yield loss.

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Harvest Date and Cultivar Effects on Forage Yield and Quality of Fall Sown Oat (수확시기와 품종이 추파연맥의 사초수량 및 사료가치에 미치는 영향)

  • Lee, G.S.;Kim, D.A.
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.19 no.4
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    • pp.339-346
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    • 1999
  • This experiment was carried out to determine harvest date and cultivar effects on the agronomic characteristics, forage yield, and quality of fall sown oat (Avena sativa L.) at the forage experimental field, College of Agriculture and Life Sciences, Seoul National University, Suweon from August to November 1993. The experiment was arranged in a split plot design with three replications. The main plots were consisted of the harvesting dates, suchas early (11 October), mid(21 October), and late(1 November), the subplots were consisted of different maturities of oat cultivars, such as 'West', 'Cayuse' and 'Magnum'. The first heading date of an early maturing culivar, West, was observed on 10 October, and the heading increased up to 30% at the late harvesting date. The average dry matter (DM) content of oat cultivars increased significantly from 12.8 to 15.9% as the growing stage progressed(p<0.01). The average dry matter percentage of West, Cayuse, and Magnum was 15.4, 13.4, and 13.5%, respectively. The crude protein (CP) content of oat cultivars decreased significantly from 20.1 to 13.3% as the harvesting date was delayed(p<0.01), and the CP contents of midseason and late maturing cultivars, Cayuse and Magnum, respectively, were significantly higher than that of an early maturing cultivar West (p<0.01). The mid harvesting date showed the highest acid detergent fiber(ADF) and neutral detergent fiber (NDF) contents than the other harvesting dates, and an early maturing cultivar West had higher ADF and NDF contents than the midseason and late maturing cultivars, Cayuse and Magnum, respectively. The in vitro dry matter digestibility(IVDMD) of oat cultivar West decreased as the harvesting date was delayed, but that of Cayuse and Magnum decreased only by the mid harvesting date. Cayuse and Magnum showed 3~4% higher digestibility than West. The correlation coefficient between IVDMD and ADF content was -0.86. The average dry matter yield of oat cultivars increased from 2,901 to 5,901kg/ha as the harvesting date was delayed(p<0.01), but no significant difference was found among oat cultivars. The corrdelation coefficient between DM yield and gorwing degree days(GDD) was +0.86. The results of this study indicate that a delay in harvesting date would be recommendable for the increase of dry matter yield when fall-sown oat is grown. Especially, the DM yield of the midseason and late maturing cultivars, Cayuse and Magnum, respectively, can be increased without much change of forage quality although the harvesting date are delayed.

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Changes in Subjective/Objective Symptoms and the Light Transmissibility of Lens Associated with Overusage of Daily Disposable Circle Contact Lenses in Normal Eyes (일회용 써클소프트렌즈의 초과 착용에 의한 정상안의 자·타각적 증상 및 렌즈 광투과율의 변화)

  • Park, Mijung;Kwon, Hae Lim;Choi, Sae Ah;Kim, So Ra
    • Journal of Korean Ophthalmic Optics Society
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    • v.18 no.4
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    • pp.429-439
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    • 2013
  • Purpose: This study was assessed to investigate the change of subjective and/or objective symptoms and the light transmissibility of lens caused by over-usage of daily disposable circle contact lenses (circle lens). Methods: Three daily disposable circle lenses made of etafilcon A, hilafilcon B, and nelfilcon A were applied on 20 normal eyes free from any eye diseases by when subjects complained any kind of discomfort. On the first and the last days of lens wearing, subjective discomfort, blinking rate, non-invasive break-up time, lens centration on corneal surface and visible light transmissibility of lens were recorded at every case and compared. Results: The circle lens wearers complained discomfort when they wore the circle lens more than 15 hours, in excess of 8 hours being the recommended wearing time and the most circle lens wearers quit the lens wearing when they wore more than 30 hours. On the last day of lens wearing, the representative subjective discomforts were stiffness, dryness and tiredness. When the subjects wore circle lens more than the recommended time, a tendency of increased blinking rate and decreased NIBUT was observed when it compared with the values right after lens wearing. On the last day of lens wearing, the lens centration was shown to be decentrated from the pupil center compared with the centration right after the wearing. These changes in lens centration and blinking rate were consistently shown in all cases of lens wearing however, the difference in the degree of subjective and/or objective change was present depending on lens materials and subjects. The visible light transmissibility of circle lens has largely been changed. Conclusions: From these results, it was thought that the decreased NIBUT induced dryness and stiffness and decreased visible light transmissibility caused more blinking when daily disposable circle lens was exceedingly used, which provoked lens decentration and subjective discomfort. However, the difference of subjective and/or objective change was largely varied in accordance with the lens material types and individuality and thus it may occur some unexpected problems by the individual base. Therefore, the education about the necessity to comply with the recommended wearing time and the problem will be essential.

Lower respiratory tract infection of positive antigen test for respiratory syncytial virus on children under 2 years of age (2세 이하의 소아에서 respiratory syncytial virus의 항원검사에 양성인 하기도 감염)

  • Jeong, Jea Heon;Moon, Kyoung Hee;Lee, Chang Woo;Choi, Du Young;Oh, Yeun Geun;Yoon, Hyang Suk;Cho, Ji Hyun;Kim, Jong Duck
    • Clinical and Experimental Pediatrics
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    • v.49 no.4
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    • pp.394-400
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    • 2006
  • Purpose : This study was design and performed for evaluations of resent clinical pattern of bronchiolitis caused by RSV infection with children under 2 year of age for 5 years, who were admitted to pediatric ward. Methods : The inclusion criteria of the patients were children under 24 month-of-age, clinical manifestations of lower respiratory tract infection, and RSV antigen that was detected by a direct immunofluorescence test from the nasal secretions. The additional laboratory and simple chest X-ray findings were reviewed from the medical records of children who were admitted Wonkwang university hospital from Jan. 1999 to Dec. 2003. Results : In the 5 year study duration, 127 patients were enrolled and outbreak of RSV bronchiolitis took place in 2001. The 80 cases(63 percent) of RSV infection were concentrated in later autumn and winter. Number of the cases show coughing were 120(94.5 percent), but rale was audible in 78 cases(61.4 percent). Dyspnea, wheezing, and intercostal retraction were noticed in 27(21.3 percent), 21(16.5 percent), and 4(3 percent) cases respectively. The most common chest X-ray finding was hyperinflation of the lung that was noticed in 110 cases(86.6 percent). Care with mechanical ventilator for more than 2 days required in 5 cases. Conclusion : Lower respiratory tract infection by RSV was common in late autumn and winter season but year-round infection was noticed. The severity of RSV respiratory tract infectiontakes in some degree a grave course. So we suggest that population-based surveillance of acute respiratory infection due to RSV is necessary for assessment of prevalence and epidemiology of this disease.

Structural Behavior of Mixed $LiMn_2O_4-LiNi_{1/3}Co_{1/3}Mn_{1/3}O_2$ Cathode in Li-ion Cells during Electrochemical Cycling

  • Yun, Won-Seop;Lee, Sang-U
    • Proceedings of the Materials Research Society of Korea Conference
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    • 2011.05a
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    • pp.5-5
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    • 2011
  • The research and development of hybrid electric vehicle (HEV), plug-in hybrid electric vehicle (PHEV) and electric vehicle (EV) are intensified due to the energy crisis and environmental concerns. In order to meet the challenging requirements of powering HEV, PHEV and EV, the current lithium battery technology needs to be significantly improved in terms of the cost, safety, power and energy density, as well as the calendar and cycle life. One new technology being developed is the utilization of composite cathode by mixing two different types of insertion compounds [e.g., spinel $LiMn_2O_4$ and layered $LiMO_2$ (M=Ni, Co, and Mn)]. Recently, some studies on mixing two different types of cathode materials to make a composite cathode have been reported, which were aimed at reducing cost and improving self-discharge. Numata et al. reported that when stored in a sealed can together with electrolyte at $80^{\circ}C$ for 10 days, the concentrations of both HF and $Mn^{2+}$ were lower in the can containing $LiMn_2O_4$ blended with $LiNi_{0.8}Co_{0.2}O_2$ than that containing $LiMn_2O_4$ only. That reports clearly showed that this blending technique can prevent the decline in capacity caused by cycling or storage at elevated temperatures. However, not much work has been reported on the charge-discharge characteristics and related structural phase transitions for these composite cathodes. In this presentation, we will report our in situ x-ray diffraction studies on this mixed composite cathode material during charge-discharge cycling. The mixed cathodes were incorporated into in situ XRD cells with a Li foil anode, a Celgard separator, and a 1M $LiPF_6$ electrolyte in a 1 : 1 EC : DMC solvent (LP 30 from EM Industries, Inc.). For in situ XRD cell, Mylar windows were used as has been described in detail elsewhere. All of these in situ XRD spectra were collected on beam line X18A at National Synchrotron Light Source (NSLS) at Brookhaven National Laboratory using two different detectors. One is a conventional scintillation detector with data collection at 0.02 degree in two theta angle for each step. The other is a wide angle position sensitive detector (PSD). The wavelengths used were 1.1950 ${\AA}$ for the scintillation detector and 0.9999 A for the PSD. The newly installed PSD at beam line X18A of NSLS can collect XRD patterns as short as a few minutes covering $90^{\circ}$ of two theta angles simultaneously with good signal to noise ratio. It significantly reduced the data collection time for each scan, giving us a great advantage in studying the phase transition in real time. The two theta angles of all the XRD spectra presented in this paper have been recalculated and converted to corresponding angles for ${\lambda}=1.54\;{\AA}$, which is the wavelength of conventional x-ray tube source with Cu-$k{\alpha}$ radiation, for easy comparison with data in other literatures. The structural changes of the composite cathode made by mixing spinel $LiMn_2O_4$ and layered $Li-Ni_{1/3}Co_{1/3}Mn_{1/3}O_2$ in 1 : 1 wt% in both Li-half and Li-ion cells during charge/discharge are studied by in situ XRD. During the first charge up to ~5.2 V vs. $Li/Li^+$, the in situ XRD spectra for the composite cathode in the Li-half cell track the structural changes of each component. At the early stage of charge, the lithium extraction takes place in the $LiNi_{1/3}Co_{1/3}Mn_{1/3}O_2$ component only. When the cell voltage reaches at ~4.0 V vs. $Li/Li^+$, lithium extraction from the spinel $LiMn_2O_4$ component starts and becomes the major contributor for the cell capacity due to the higher rate capability of $LiMn_2O_4$. When the voltage passed 4.3 V, the major structural changes are from the $LiNi_{1/3}Co_{1/3}Mn_{1/3}O_2$ component, while the $LiMn_2O_4$ component is almost unchanged. In the Li-ion cell using a MCMB anode and a composite cathode cycled between 2.5 V and 4.2 V, the structural changes are dominated by the spinel $LiMn_2O_4$ component, with much less changes in the layered $LiNi_{1/3}Co_{1/3}Mn_{1/3}O_2$ component, comparing with the Li-half cell results. These results give us valuable information about the structural changes relating to the contributions of each individual component to the cell capacity at certain charge/discharge state, which are helpful in designing and optimizing the composite cathode using spinel- and layered-type materials for Li-ion battery research. More detailed discussion will be presented at the meeting.

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The effects of the mulberry and silkworm intake on androgen receptor mRNA and myogenic regulatory factors expression of rats muscle for resistance exercise (오디와 누에 섭취가 rats의 저항성 운동에 따른 androgen receptor mRNA와 myogenic regulatory factors의 발현에 미치는 영향)

  • Yang, Sung Jun;Kim, Chang Yong;Lee, Jo Byoung;Kang, Sung Sun;Lee, Jong Jin
    • Journal of Sericultural and Entomological Science
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    • v.51 no.2
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    • pp.99-106
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    • 2013
  • The purpose of this study is to investigate the effects of supplementation of mulberry powder, mulberry extract and silkworm powder during the 8 weeks of resistance exercise on Androgen receptor(AR) mRNA and Myogenic regulatory factors(MRFs) expression of rats muscle. Fifty males, Sprague-Dawley rat, were randomly divided into 5 groups: CON(control group, n = 10), REG(resistance exercise group, n = 10), MP REG(mulberry powder intake and resistance exercise group, n = 10), ME REG(mulberry extract intake and resistance exercise group, n = 10) and SP REG(silkworm powder intake and resistance exercise group, n = 10). After climbing the ladder without weights during the 1 week of adaptation period, the rats in the resistance exercise group were trained to climb a 0.98-m vertical(80 degree incline) ladder with weights in their tail during 7 weeks(10 times each day, 2 days per week). After exercise, the skeletal muscle was extracted from the flexor hallucis longus. After separating the total ribonucleic acid (RNA) of each group, quantitative polymerase chain reaction was used to analyze RNA quantitatively. AR mRNA and MRFs expression revealed that all of the treated groups had significantly difference. AR mRNA expression increased in ME REG $6.24{\pm}1.85$ and SP REG $9.68{\pm}0.28$ fold compared to CON. Myod mRNA expression increased in MP REG $6.04{\pm}0.47$, ME REG $4.31{\pm}1.58$ and SP REG $8.11{\pm}0.57$ fold compared to CON. And myogenin mRNA expression increased in MP REG $4.11{\pm}0.42$, ME REG $4.12{\pm}0.45$ and SP REG $6.50{\pm}0.61$ fold compared to CON. In conclusion, during the resistance exercise, providing mulberry and silkworm gives positive effect on AR mRNA and MRFs expression increase.

Assessment of Antioxidant Activity and Residue Level of Phenolic Antioxidants in Autoxidation of Linoleic Acid (리놀레인산 자동산화에 미치는 페놀계 산화방지제의 활성 및 잔존량 평가)

  • Choi, Seung-Hyun;Kim, Jae-Min;Choi, Sun-Il;Jung, Tae-Dong;Oh, Ji-Won;Cho, Bong-Yeon;Lee, Jin-Ha;Lee, Ok-Hwan
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.45 no.7
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    • pp.1065-1070
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    • 2016
  • This study assessed the antioxidant activity and residue level of phenolic antioxidants in autoxidation of linoleic acid. The antioxidant activity of phenolic antioxidants was measured based on peroxide value of linoleic acid at $50^{\circ}C$ for 8 days. We further evaluated the residue level of phenolic antioxidants in the autoxidation period by HPLC-UV. The residue level of antioxidants changed with time starting on day 0 (100%) and was determined by 100-remaining of antioxidants (%). Our results showed that peroxide values ranged from 0.33 to 10.18 meq/kg in propyl gallate, from 0.67 to 11.01 meq/kg in dodecyl gallate, from 0.01 to 10.34 meq/kg in octyl gallate, from 0.01 to 4.17 meq/kg in butylated hydroxytoluene (BHT), from 1.00 to 5.85 meq/kg in butylated hydroxyanisole (BHA), from 0.33 to 4.18 meq/kg in 2,4,5-trihydroxybutyrophenone, and from 1.00 to 11.01 meq/kg in tert-butylhydroquinone (TBHQ). Among the residue levels of antioxidants, on day 8, BHT showed the highest level while TBHQ showed the lowest. BHT showed the highest correlation coefficient, whereas BHA showed the lowest. This study proves that the residual level of phenolic antioxidants has a good correlation with the degree of autoxidation in linoleic acid.

A Study on the Nursing Performance of the Home Care Nurses in Seoul (서울지역 가정간호사의 업무수행능력 실태조사)

  • Suh, Moon-Ja;Park, Ho-Ran;Kang, Hyun-Sook;Kim, So-Sun;Shin, Kyung-Lim;Kim, Keun-Soon;Kim, Hae-Sook
    • Journal of Korean Academic Society of Home Health Care Nursing
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    • v.6
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    • pp.46-58
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    • 1999
  • The purpose of this research was to find out the state of the nursing performance of the home care nurses in Seoul in order to provide the data for the practical work guide. The data were collected from fifty home care nurses working in 22 institutions located in Seoul. The research tool used for this research was modified and tested by Song Jong-Rye(1999) which was originally modified the standard tool of American Nurses Association (1998) and was partly supplement and adjusted for this research. The reliability of this tool was Cronbach's $\alpha$=.0982. The collected data were statistically processed using SAS for t-test, ANOVA. $Scheff\'{e}$ test. Among the surveyees, 50% have been working as a home care nurse more than three years and 74.0% of them were married. And 52% have B.S degree with certification of home care nurse from the certification program for Home Care Nurses affiliated at nursing schools. Half of the home care nursing organizations were based on the general hospitals, and most(78%) of the responsible senior personnels of those organizations were nurses. The following results are drawn from this research. 1) The level of nursing performance by the task sectors General performance level of home care nurses was relatively high in grade of 3.06 from total 4.00. Among the task sectors. the ethical field scored the highest points, and the next were nursing intervention, professional training, and data gathering, and the research sector scored the lowest point. 2) The level of nursing performance by general features of home care nurses Statistically relevant correlation between performance according to the duration of working experience as a nurse(p=0.8951) and performance according to the duration of working as home care nurse(p=0.2263) did not emerge. Also, performance by marriage status(p=0.2218), education(p=0.5733), and taking the certification program for home card nurse(p =0.1560) has no statistically meaningful correlation. 3) The level of nursing performance by the type of home care nursing organizations There exists a significant difference(p=0.002) between performances by the types of organizations. Most of the responsible senior personnels of the home care nursing organization were nurses. The level of nursing performance of the home care nursing organization under nurse management was relatively higher than that of home care nursing organizations led by medical doctors or non-medical professional, but this was not proved as statistically meaningful(p =0.3617). 4) The level of nursing performance by task sectors according to the characteristic of home care nursing service organization There exists a significant difference between nursing performances by task sectors according to the characteristics of home care nursing organization(p=0.002). In case of model research center of one College of Nursing, the nursing performance in the sectors of organization, theory, and data gathering were lower than that of in hospital based home care nursing service. And in case of local home care centers, performances in sectors of organization, theory, data gathering, nursing intervention. professional training, and research sectors were significantly low. Based on the obtained results, overall performance of home care nurses can be appraised as relatively good. Especially, performances in sectors of the nursing intervention, nursing plan. and data gathering including the in direct nursing were recorded high scores. From this, it can be concluded that high quality of nursing is relatively practicing for home patients at these days. Since the high quality of nursing for patients was directly related to the level of nursing performances of home care nurses, it is required to improve practical performance level of them by making constant evaluation and running continual education program and supplementing curriculum for the sectors with low scores.

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Relationships between Learning Modes and Knowledge Structures of Primary School Children: Reflected on the Concept Maps of the 'Structure and Function of Plant' Unit ('식물의 구조와 기능'에 대한 초등학교 아동들의 지식구조와 학습성향과의 관계)

  • Kim, Jong-Jung;song, Nam-Hi
    • Journal of The Korean Association For Science Education
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    • v.22 no.4
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    • pp.796-805
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    • 2002
  • This study examined the knowledge structure constructed by children before formal instruction, and successive changes in the structural complexity of knowledge during and after the learning of 'Structure and Function of Plant' unit. It also investigated how those changes were affected by children's learning modes. The researchers made the 5th graders draw the first draft of their concept map to see the pre-existing knowledge structure concerned with the unit and four more concept maps after completing every fourth lesson. And to see how long their knowledge structures were preserved, the researchers made children draw additional concept maps in 3 days, 3 months, and 7 months after completing the unit. Children drew their current concept maps on the basis of the previous one while learning the unit and without the previous one after completing the unit. Each concept map drawn by children showed the degree of their current understanding on the structures and functions of plants. The results revealed that only two levels of hierarchy and five relationships among the components of the first concept map(relationship, hierarchy, cross link and example) were proven to be valid in terms of conceptual relevance. Growth in the structural complexity of knowledge took place progressively throughout the unit and the effects of learning mode on the growth were favorably reflected in concept map scores of meaningful learners over time(relationship, cross link, example: p<.01, hierarchy: p<.05). Although there were some differences on the concept map scores between two types of learners, they commonly showed that knowledge restructuring had occurred apparently in the early periods from the 1st to the 6th lesson and had not occurred at all in the last period of the unit. The frequency of tuning was higher in rote learners than in meaningful learners throughout the unit, but the frequency of accretion was reverse. Concept map scores of rote learners constructed in the course of learning of the unit decreased little by little gradually in all the categories after completing the unit. However, the average total map score of meaningful learners increased a little more in 7 months than in 3 months after completing the unit. Therefore it can be inferred that meaningful learners construct more stable and well-differentiated knowledge structures than the rote learners.