**2. The following case serves to illustrate the result of AMI usual treatment at present**

52-year-old male, with grade II obesity, dyslipidemia, hypertension, and smoking history and with no previous cardiovascular events, arrives at the hospital 60 minutes after the onset of symptoms. The first electrocardiogram (ECG) shows rS in V1, V2, and V3 and ST-segment elevation from V1 to V6 (**Figure 1**).

At admission the arterial blood pressure was 145/80 mm of hg, the heart rate was 78 beats per minute, and the Killip Kimball grade was A. The patient received aspirin (250 mg), clopidogrel (600 mg), unfractionated heparin in intravenous bolus (5000 UI), and rosuvastatin (40 mg). At 80 minutes after admission, 140 minutes from the onset of symptoms, coronary angiography is performed showing single-vessel disease with thrombotic occlusion of the middle third of the anterior descending artery (ADA) and TIMI 0 flow. Primary angioplasty is performed to the middle third of the ADA with thromboaspiration and stent implantation achieving an adequate result with TIMI 3 flow, symptom relief, and absence of complications.

**245**

**Figure 3.** *ECG at 48 hours.*

*Primary Angioplasty: From the Artery to the Myocardium*

The post-procedure ECG shows QS in V1, V2, and V3 and ST level and negative T

IECA and B blockers are started. It evolves without recurrence of symptoms; however, at 48 hours, the ECG shows QS from V1 to V5 and low R in V6 (**Figure 3**). Note that despite early assistance, it no longer has positive vectors in V1, V2, and V3, and after the usual successful treatment and aligned with the guidelines based on current evidence, it continues to lose precordial vectors after primary angioplasty. The echocardiogram shows antero-apical dyskinesia and impaired ventricular function, with an ejection fraction of 35% measured by the Simpson method. There are several mechanisms by which the myocardium is lost in the

*DOI: http://dx.doi.org/10.5772/intechopen.91832*

from V1 to V6 (**Figure 2**).

*ECG postprimary angioplasty.*

**Figure 2.**

different phases of AMI.

**Figure 1.** *ECG at admission.*

*Primary Angioplasty: From the Artery to the Myocardium DOI: http://dx.doi.org/10.5772/intechopen.91832*

*Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions*

contributed to improving early and late artery permeability [15, 16]. The enormous effort focused on the treatment of the coronary artery has led to the fact that the success of primary angioplasty is now greater than 95% [7]. The angiographic success rate ceased to be a problem. However, the post-AMI incidence of death and heart failure remains around 20% during the first year [17], and as mentioned earlier this correlates directly with the amount of myocardium damaged and the

**2. The following case serves to illustrate the result of AMI usual**

rS in V1, V2, and V3 and ST-segment elevation from V1 to V6 (**Figure 1**).

52-year-old male, with grade II obesity, dyslipidemia, hypertension, and smoking history and with no previous cardiovascular events, arrives at the hospital 60 minutes after the onset of symptoms. The first electrocardiogram (ECG) shows

At admission the arterial blood pressure was 145/80 mm of hg, the heart rate was 78 beats per minute, and the Killip Kimball grade was A. The patient received aspirin (250 mg), clopidogrel (600 mg), unfractionated heparin in intravenous bolus (5000 UI), and rosuvastatin (40 mg). At 80 minutes after admission, 140 minutes from the onset of symptoms, coronary angiography is performed showing single-vessel disease with thrombotic occlusion of the middle third of the anterior descending artery (ADA) and TIMI 0 flow. Primary angioplasty is performed to the middle third of the ADA with thromboaspiration and stent implantation achieving an adequate result with TIMI 3 flow, symptom relief, and absence of complications.

deterioration of ventricular function.

**treatment at present**

**244**

**Figure 1.** *ECG at admission.* The post-procedure ECG shows QS in V1, V2, and V3 and ST level and negative T from V1 to V6 (**Figure 2**).

IECA and B blockers are started. It evolves without recurrence of symptoms; however, at 48 hours, the ECG shows QS from V1 to V5 and low R in V6 (**Figure 3**).

Note that despite early assistance, it no longer has positive vectors in V1, V2, and V3, and after the usual successful treatment and aligned with the guidelines based on current evidence, it continues to lose precordial vectors after primary angioplasty. The echocardiogram shows antero-apical dyskinesia and impaired ventricular function, with an ejection fraction of 35% measured by the Simpson method. There are several mechanisms by which the myocardium is lost in the different phases of AMI.

**Figure 3.** *ECG at 48 hours.*


*2.6. Whole Plant Regeneration from Somatic Embryos*

To accelerate complete plant development from somatic embryos, the effects of Kn and IAA on further conversion of somatic embryos were studied. The somatic embryos were sub-cultured on the MS medium augmented with different concentrations of Kn (0.05–1.0 mg L−1) and IAA (0.1–1.0 mg L−1), either individually or in combination. After 8 weeks of culture, the average number of shoots and roots developed by somatic embryos were evaluated. All cultures were incubated at 10 ± 2 ◦C in a 16/8-h light/dark cycle with 60% RH. Each treatment consisted of 10 somatic embryos in 30 mL borosilicate culture vials and 150 mL conical flasks, and the experiment was repeated 3 times.


*2.1. Feedstock Characterization*

The three feedstocks used were characterized in accordance with accepted environmental practices. All measurements were conducted in triplicate and the average and standard deviation of each data is reported. The total solids content of each sludge was measured by drying in an oven at 105 ◦C for at least 8 h until constant weight was reached.

The pH of the raw and carbonized samples was measured using a Profi-Line pH 3310 (WTW, Milan, Italy) portable pH-meter by placing 1 g of solids in 20 g of deionized water, shaking for at least 90 min, allowing the mixture to settle for 15 min, and then reading the pH. The total Chemical Oxygen Demand (COD) was measured using a closed reflux titration method [43] using potassium dichromate digestion solution, sulfuric acid reagent, ferroin indicator solution, and a standard ferrous ammonium sulphate titrant according to standard procedures. The same method was used for soluble COD following filtration of the sample through a 0.45 μm filter [43]. Organic nitrogen in the trinegative state was measured via the semi-micro Kjeldahl method. Ammonium nitrogen was measured [43] by first buffering the sample at pH 9.5 with a borate buffer (to decrease hydrolysis), then distilling in a solution of boric acid, and determining the concentration via acid titration with H2SO4. To measure the total phosphorous, samples were first digested in H2SO4, forming molybdophosphoric acid, which was then reduced by stannous chloride to molybdenum blue. The concentration was measured photometrically at 690 nm and compared against a calibration curve [43].

Ultimate analysis to determine elemental composition of C, H, N, S, and O (by difference) was conducted on a LECO 628 analyzer (LECO, Moenchengladbach, Germany) equipped with Sulphur module for CHN (ASTM D-5373 standard method) and S (ASTM D-1552 standard method) determination. Proximate analyses were done on a LECO Thermogravimetric Analyzer TGA 701 (LECO Corporation, St. Joseph, MI, USA). Samples were heated at 20 ◦C min−1 to 105 ◦C in air and held until constant weight (< ±0.05%) to provide a dry baseline. They were subsequently heated at 16 ◦C min−1 from 105 ◦C to 900 ◦C in nitrogen with a hold time of 7 min, where the mass loss was attributed to Volatile Matter (VM). Finally, samples were held at 800 ◦C in air to oxidize the Fixed Carbon (FC) until the mass change stay within ±0.5% by weight. Mass remaining after this was considered to be ash (inorganic matter) content. The Higher Heating Value, HHV, was measured using an IKA 200C isoperibolic calorimeter (IKA-Werke GmbH, Staufen, Germany) according to the CEN/TS 14918 standard.

Inductively coupled plasma-optical emission spectroscopy (Arcos Ametek, Spectro, Germany) was used to determine the inorganic concentration of the sludge samples. Briefly, samples were oven-dried at 105 ◦C until constant weight and then acid-digested in concentrated nitric acid (650 mL−1; Carlo Erba, Milano, Italy) using a single reaction chamber microwave digestion system (UltraWAVE, Milestone Inc., Sheldon CT USA) and Teflon-lined vials to prevent interference. Elements were quantified using certified multi-element standards (CPI International).

#### *2.2. Hydrothermal Carbonization and Product Analysis*

Hydrothermal carbonization typically occurs between 180 and 250 ◦C under autogenous pressure (up to 50 bar) but below the critical point [18]. The present work utilized a 50 mL stainless steel batch HTC reactor rated to withstand 300 ◦C and 140 bar, with temperature and pressure monitoring and temperature control, as previously described [44,45]. The thickened and digested sludges were used as-received. The reactor was loaded with 35.0 mL ± 0.1 mL biomass, which maintained a biomass (dry biomass)-to-water ratio of about 0.03:1. The dewatered sludge had a solid content of 25 wt% and needed to be diluted to ensure that the biomass was fully submerged. The reactor was filled with 20.00 g ± 0.01 g of dewatered sludge and 15.00 g ± 0.01 g of deionized water to cover the sludge, resulting in a biomass-to-water ratio of 0.17:1. Prior to each run, the reactor was sealed and purged with nitrogen gas; then it was heated up to the desired reaction temperature (190 ◦C, 220 ◦C and 250 ◦C) and held at the set point for the desired reaction time (30 min and 60 min). At least three experimental runs for each of the temperature/time combinations were performed for each of the three sludge samples.

After the reaction time, the reactor was cooled by placing a cold (−25 ◦C) stainless steel disk under its bottom and by blowing compressed air into its outer walls. The reactor was cooled to ambient temperature in less than 15 min, at which point the produced gas was measured by flowing it into a graduate cylinder filled with water [45]. As reported in the literature, where the CO2 content is always greater than 90 vol.%, the produced gas was assumed to be comprised entirely of CO2 [45,46]. The gas yield was estimated according to the ideal gas law under the assumption of standard temperature and pressure as:

$$Y\_{\text{gus}} = \frac{\text{Mass}\_{\text{CO}\_2}}{\text{Mass}\_{\text{Sludgse, dry}}} \tag{1}$$

The liquid and solid HTC products were filtered through a pre-dried and weighed piece of cellulose filter paper. The filter paper was then put in the oven overnight at 105 ◦C and weighed to calculate the solids produced. The solid yield of the hydrochar, *Yhydrochar*, was calculated as:

$$Y\_{hydrochur} = \frac{Mass\_{hydrochur, dry}}{Mass\_{Sholgc, dry}} \tag{2}$$

The liquid yield was computed as the complement to 1 of the gas and solid yields.

The solid hydrochar was characterized according to the same methods described in Section 2.1. for Higher Heating Value (HHV), proximate, and ultimate analyses. The hydrochar's relative solid reactivity was measured using a Mettler-Toledo Thermogravimetric Analyzer–Differential Scanning Calorimeter (TGA-DSC-1, Mettler-Toledo LLC, Columbus, Ohio, USA) in an oxidative atmosphere. The TGA-DSC was calibrated with NIST-traceable gold, indium, and aluminum and the mass was measured to ±0.1 μg and temperature to ±0.1 ◦C. Approximately 10 mg of sample was loaded into a 70 μL alumina crucible. Samples were heated at 20 ◦C min−1 up to 110 ◦C in air flowing at 50 mL min−1 and held for 30 min to drive off any residual moisture. They were subsequently heated at 20 ◦C min−1 up to 950 ◦C and held for 30 min to oxidize all material. The mass fraction of sample converted (*X*) at any time, *t*, was calculated as:

$$X = \frac{m\_i - m\_t}{m\_i - m\_f} \tag{3}$$

where *mi* is the initial mass, *mt* is the mass at any time, *t*, and *mf* is the final mass after the hold at 950 ◦C. Derivative thermogravimetric (DTG) curves were plotted as *dX*/*dt* (s−1) versus temperature. Differential scanning calorimeter (DSC) data was normalized as heat flow per sample mass at any given instant (*mt*). DTG curves are compared to those from an in-house sample of Illinois No. 6 coal, a high volatile bituminous coal from the Illinois #6 (Herrin) seam from the Argonne Premium Coal Bank [47]. The coal sample is well characterized in the literature and is often used as a standard on which to compare solid fuel oxidation [47–49].

Dewaterability—and the improvement due to HTC was determined by measuring the Capillary Suction Time (CST) required for water to be separated from sludge across a filter paper (Whatman 17 CHR, VWR International, Milan, Italy) using a Triton Electronics Ltd. capillary suction timer type 304B according to standard methods [43]. CST provides a quantitative assessment of how readily sludge releases water.

The liquid phase remaining after hydrothermal carbonization was characterized by measuring pH, COD, organic nitrogen, ammonia nitrogen, and phosphorous as described above. Measurements of Readily Biodegradable COD (RBCOD) were performed following the procedure described in literature [50]. To measure NH4 + nitrogen and soluble COD, samples were screened through a 0.45 μm filter [43].

#### **3. Results**

To assess the optimal point to withdraw sludge from the wastewater treatment process for hydrothermal carbonization in terms of resulting hydrochar properties, three samples were pulled from various points along the process: Thickened, Digested, and Dewatered (Figure 1). The feedstocks characteristics are presented in Tables 1 and 2. These three samples were subjected to hydrothermal carbonization at three temperatures (190 ◦C, 220 ◦C, 250 ◦C) and two residence times (30 min, 60 min) each, producing a total of 18 hydrochar samples for analysis.

Looking at the data of the different raw sludges, it is clear that they differ substantially. Thickened sludge contains about 46 wt% elemental carbon and 15 wt% ash. In digested sludge, the carbon decreases to about 26 wt%, and the ash content increases to 45 wt%, due to stabilization during anaerobic digestion. Dewatered sludge contains 36 wt% carbon and about 28 wt% ash. Thus, even if dewatering is a mechanical process, it greatly modifies the sludge characteristics. The supernatant from sludge dewatering has high concentrations of inorganic compounds such as N-NH4 +, P compounds, CaCO3, Mg, K, Na, and other minerals that contribute to the ash content [51]. The dewatering unit washes away these inorganics strongly decreasing the ash content of the dewatered sludge: this reflects on an increase in elemental C, H, N, and O, and also in FC and VM. VM variation is extremely significant, passing from a value of 50 wt% in the digested sludge to about 66 wt% in the dewatered sludge. These differences are also due to the fact that the digested sludge, immediately upstream of the dewatering operation, is chemically conditioned with organic polyelectrolyte (1–10 g/kg dry solids [52]) that is quickly adsorbed on the sludge particles.

ofrawthickenedsludge,rawdigestedsludge,andrawdewateredsludgeandproductsofhydrothermalcarbonizationofthickened,

#### *Energies* **2020** , *13*, 2890

**Table 2.** *Cont*.


**6. Acknowledgments**

During this research study, we received competitive funds from the Ministry of Education, Science and Innovation (MICINN) (EDU2010-19250 / EDUC) for 2010-2013, and Excellence Research Group funds from the Junta de Castilla y León (GR259), with FEDER funds from the European Union for 2009-2010-2011 (BOCyL 27 on April 2009). Both were awarded to the Director/Main Researcher (J. N. García). We are very grateful to Victoria Rosa Sturley for her help with the English version.

*Correspondence* should be addressed to Departamento de Psicología, Sociología y Filosofía. Área Psicología Evolutiva y de la Educación. Campus de Vegazana s/n, 24071 – León, Spain. Phone: +34-987291041 (university); +34-987222118 (home); +34-652817871 (cell); Fax: +34-987291035 (university). E-mail<EMAIL_ADDRESS>
#### **7. References**

100 Learning Disabilities

forums, contact numbers, FAQs, etc. Some of them, usually the associations aimed at or related to psychology or educational psychology professionals, which generally have an evaluation function, offer diagnosis. Other services they offer are stimulation and leisure activities, treatment and guidelines, counseling and information for families. Most of them also offer information, courses and seminars for professionals who work with these pupils. Among the materials offered we would like to point out information on the disorders, how the family can face them, recommended treatment for the school and on the current legislation around the matter. They also often present screening protocols, guidelines for assessment, psychometric tests or intervention programs, treatment strategies and

To sum up, the development of Spanish LD associations is underway but still insufficient. However, there is another type of association, which is private and generally works at the national level, which has been founded and run by professionals from different areas whose aim is therapeutic and to offer guidance. They are focused both on treatment and family and

This chapter has addressed intervention with pupils with specific LD from a contextual point of view, based on the inclusion of the family as a focal point of development. We started by analyzing the studies which focused on the family and found it to be ideal for specific interventions. We then went on to describe empirical experiences in which parents were responsible for the application of specific intervention measures with children with LD. These were both remedial-preventive as well of collaboration with school tasks

The results of the studies reviewed support the need for a comprehensive assessment and intervention for students with LD (Gortmaker, et al., 2007; Polloway, et al., 2001). Intervention with the students themselves and treating their problems is necessary, but it is also necessary to take their family into consideration. Parents of students with LD need help to educate their children and to deal with their problems, but their own needs also require attention (Dyson, 2010; Karende, Mehta, & Kulkarni; 2007; Rolfsen & Martínez, 2008). Due to this, we finished by looking at the need to work directly with parents. We offered suggestions on activities, procedures for them to help their children effectively, such as parents' programs, support groups and associations. We have presented this with a focus on general guidelines which can help professionals actively work with and through the family. The empirical practices revised have shown parents to be effective for working with LD students. Therefore, intervention with and through families in the case of learning disabilities is well-established as necessary. We, thus, intend to continue this line of work

During this research study, we received competitive funds from the Ministry of Education, Science and Innovation (MICINN) (EDU2010-19250 / EDUC) for 2010-2013, and Excellence Research Group funds from the Junta de Castilla y León (GR259), with FEDER funds from

and research to improve the situation of children with LD and their families.

techniques, and practical proposals.

teacher guidance.

**5. Conclusions**

including homework.

**6. Acknowledgments**

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**7**

*University of León*

*Spain*

**Preventing Children's Writing Difficulties**

Patricia Robledo-Ramón and Jesús-Nicasio García-Sánchez

**Through Specific Intervention in the Home**

In recent times there has been a wealth of studies, both from the empirical (Bodovski & Youn, 2010, Burnett & Farkas, 2008; Mensha & Kiernan, 2010; Powell, Son, file, & John, 2010; Robledo & Garcia, 2009; Xia, 2010; Yun & Kusum, 2008) and from the legal point of view, confirming the need to consider the family, and especially parents, in educational processes, both due to their natural impact on student learning and for their potential to successfully stimulate students (Cayo, 2008; Hegarty, 2008; Hood, Conlon, & Andrews, 2009; Rogers, Wiener, Marton, & Tannock, 2009). Moreover, in the European context, given the constant changes the education systems are facing and the increasing educational requirements (Novoa, 2010), the context that supports the important role of parents in the academic

Nowadays, skills development it an established priority (Muñoz, 2008). Skills development is defined as the sets of knowledge, skills and attitudes required to transfer and apply knowledge from different areas and subjects to reality in order to understand it and solve real problems with expertise and efficiency across different types of contexts (Junta de Castilla y León [Government of the Region of Castile and Leon], 2009). So from this perspective, it is believed that the involvement of people and everyday environments in students' lives could be an excellent supplement to formal educational institutions in their efforts to empower children to develop lifelong learning applicable to real life. When we take into account the fact that the natural context where students spend more time other than school is the family it becomes apparent how ideal it is to involve parents in the improvement of basic skills, including the most important area in compulsory education –

Communicative competence refers to the use of language as a means of oral and written communication, learning, building one's thinking and personal and behavioral regulation. It is therefore highly relevant in the field of education and is very applicable to the social field, which means it can be approached through different contexts (Frijters, Barron, & Brunello, 2000; Hood, et al., 2009; Reyes, Alexandra, & Azuara, 2007; Strasser & Lissi, 2009). Thus, the goal of educators is to train competent communicators to operate naturally in different everyday communicative contexts that involve both the use of oral language and reading and writing (Pérez & Zayas, 2007). However, despite the triple configuration of this competence, empirical experience confirms that its stimulation in schools tends to offer a

**1. Introduction**

progress of their children is especially relevant.

linguistic communication competence (Fernández, 2007).


*Supporting open minds since 2005*

Micro-grids - Applications, Operation, Control and Protection http://dx.doi.org/10.5772/intechopen.77550 Edited by Mahmoud Ghofrani

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Gaspard D\'Hoop, Olivier Deblecker, Leila Ghomri, Mounir Khiat, Sid Ahmed Khiat, Mohamed Mankour, Edward Donahue, Ali Hadi Abdulwahid, Andreea El-Leathey, Ramamoorty M, S.V.N.L. Lalitha

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