A Systematic Review: Relationship Between Medication Adherence and Hypertension

Chronic diseases are defined as conditions that are present for over one year and limit activities of daily living or require ongoing medical attention. Heart disease is the number one leading chronic disease in the United States, making up one third of all deaths. In turn it costs the health system $216 billion per year (Center for Disease Control and Prevention, 2023). Uncontrolled blood pressure is a key risk factor for heart disease and stroke. 1 in 2 adults will need to take prescription medication to control blood pressure and lower the risk of having a cardiovascular event. This systematic review is aimed to explore the relationship between medication adherence and blood pressure. Studies between 2012-2020 will be utilized. This systematic review did find an association between medication adherence and decreased blood pressure. Many factors played a role in medication adherence such as: health literacy, socioeconomic status, frequency of disease monitoring, co-payments and medication taking reminders. Definition of terms in Appendix A

A stylistic approach to the God of Small Things written by Arundhati Roy

This thesis presents a creative-analytical hybrid production in relation to the stylistic distinctiveness in The God of Small Things, the debut novel of Arundhati Roy. Roy’s text drew the world’s gaze after winning the Booker Prize in 1997. Many studies have been written on diverse aspects of the book, and much has been said regarding the writer’s style. However, those studies rarely focus on the minutiae of Roy’s writing and this thesis provides a greater degree of detailed analysis. The objective is to achieve a deeper understanding of the relationship between style and literary aesthetics in The God of Small Things by studying the stylistic patterns behind Roy’s resonating poetic prose. The stylistic study is carried out adopting two approaches: the corpus-based approach (Part A) and the empirical-creative approach (Part B). The first section provides a stylistic analysis concentrating on the most significant stylistic features of the novel. The study is based on the list of style markers rendered by Leech and Short, Style in Fiction (1981) and elaborated according to the following key aspects that were extracted from the repertoire using my intuitive observation of the novel. These chosen style markers taken together represent key aspects of Roy’s style: (1) Lexis—Roy’s very frequent and particular utilization of adjectives; (2) Grammar—the high concentration of minor sentences and the listing of noun phrases in the text; (3) Figures of Speech— repetition and neologism. The second section presents a self-written pastiche which aims at imitating Roy’s style in literary prose and adapting its approach to a Chinese context. The creative process serves as an experiment on taking pastiche writing as an “experiential” approach to stylistics. In addition, since the resemblance of the pastiche to Roy’s style should not be the only value of the piece, some key themes in the original text are also reproduced. The analysis in Part A illustrates patterns of Roy’s stylistic choices. On the use of adjectives, Roy tends to arrange adjectival elements in sequence, construct a fixed “like” sentence structure, and adopt combining word forms and affective adjectives. On minor sentences, Roy chooses to separate adverbial phrases, sentence fragments starting with “like”, “as though”, and clauses beginning with “that”, “which”, “and”, “but”, “or”. As for repetitions, there is repeated use of set phrases, sentence patterns and recurrent appearance of certain lines and images. Lastly, on neologisms, Roy’s patterns of creating new words include hyphenation, direct merging, and prefix/suffix building. The pastiche is entitled Hong Kong Locust Stand I. By juxtaposing with the original, it is found that many stylistic features in The God of Small Things, are present in the pastiche, though with variation. While stylistic elements cannot totally be independent from the theme, the atmosphere, character and plot of the pastiche also demonstrate qualities representing those in Roy’s novel. The pastiche presents an innovative and respectful way to come to terms with Roy’s style through selective imitation and creative adaptation. In conclusion, it is hoped that this study opens the way for further hybrid studies of style that incorporate both analytical and creative approaches

術前治療による乳癌局所微小環境への治療検討:化学療法と内分泌療法による血管新生と腫瘍内浸潤リンパ球サブタイプに対しての影響

要約のみTohoku University笹野公伸論

Exploring Problem-Based Learning for Middle School Design and Engineering Education in Digital Fabrication Laboratories

This is a research study of design and engineering classes that use a problem-based learning (PBL) approach in digital fabrication makerspaces in two middle schools. In these studies, teachers employ a PBL approach and provide an ill-structured problem scenario to facilitate design and engineering lessons in the FabLab (fabrication laboratory). Students in each school tackled different challenges that they defined for themselves in groups. This study provides examples of student-student interactions separated into key themes—defining specifications with teammates, personal exploration, and communication about discoveries. This study also provides examples of teacher-student interactions, and themes include demonstrations with tangible objects, discussing prototype failure, and managing behavioral issues. The purpose of this study is to provide insights about PBL in a nontraditional, technology-rich FabLab environment

Bridging Constructionism & Metacognition: Productive Artifact Documentation for Elementary School Maker Education

My dissertation is a qualitative design-based research study that explores Singaporean elementary school students’ documentation and reflection practices in a maker learning environment. In this work, I build upon literature from Constructionism, Metacognition, and formative assessment methods. I investigate the following research questions regarding student-driven documentation of maker processes: 1. How might artifact documentation and organization, as a mode of formative assessment, provide new insights to students and teachers in complex making/construction processes? 2. How could artifact documentation embedded in a collaborative tool contribute to students' identification and reflection of new knowledge gained during their making process? Over the course of two and a half years, I developed prototypes of the CoCreator App, informed by constructionist pedagogy and metacognitive practices. Then, I implemented the CoCreator App prototypes in two schools and an afterschool makerspace in Singapore, where students and teachers used it as their technology-facilitated process for documentation. Through analysis of students’ and teachers’ interviews, observations and field notes of classroom sessions, I reveal opportunities for thoughtful design of documentation tools that advance and challenge the theoretical underpinnings of Constructionism and Metacognition, and cater to elementary school students’ learning and reflection. My design recommendations include: multimodal choices of documentation, integration with students’ routines and workflows, organization of artifacts to achieve a balance between multimodality and integration with routines. Finally, I end with a note about the essential role that teachers play in engaging with students’ artifacts and nurturing a culture of documentation in the classroom, to inch closer to helping students develop intrinsic motivation towards student-driven formative assessment

Clinical and microbiological characteristics of cryptococcosis in Singapore: predominance of Cryptococcus neoformans compared with Cryptococcus gattii

SummaryObjectivesTo describe the clinical features, treatments, outcomes, and subtype prevalence of cryptococcosis in Singapore.MethodsAll patients with laboratory confirmed cryptococcal infections admitted from 1999 to 2007 to a teaching hospital in Singapore were reviewed retrospectively. Identification and molecular types of Cryptococcus neoformans variants and Cryptococcus gattii were determined by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP). Serotypes were inferred with a multiplex PCR method.ResultsOf 62 patients with cryptococcosis, C. neoformans var. grubii was the predominant subtype (in 95%), affecting mainly immunocompromised hosts (91%) with HIV infection (80%). Patients with HIV were younger (median age 36.5 vs. 49.5 years, p=0.006) and less likely to present with an altered mental status (14% vs. 50%, p=0.013). In contrast, delayed treatment (median 7 days vs. 2 days, p=0.03), pulmonary involvement (58% vs. 14%, p=0.03), and initial treatment with fluconazole (25% vs. 2%, p=0.02) were more common in HIV-negative patients. C. gattii was uncommon, affecting only three patients, all of whom were immunocompetent and had disseminated disease with pulmonary and neurological involvement. All C. gattii were RFLP type VG II, serotype B and all C. neoformans var. grubii were RFLP type VN I, serotype A, except for one that was RFLP type VN II.ConclusionC. neoformans var. grubii, subtype VN I, was the predominant subtype in Singapore, infecting younger, mainly immunocompromised hosts with HIV. C. gattii was uncommon, causing pulmonary manifestations in older, immunocompetent patients and were RFLP type VG II

Analysis of behavioral intention to use cloud-based tools in a MOOC: a technology acceptance model approach

MOOC students' adoption of cloud-based tools has the potential to enrich the learning process and enhance the management of knowledge. The aims of this study are to evaluate the behavioral intention to use cloud-based tools in MOOC context, and to explore the factors that influence this intention, based on extended technology of acceptance model (TAM). This paper reports the findings of a case study conducted on the edX platform. Survey data collected from 133 end-users were analyzed by using structured equation modeling (SEM) to validate the causal relationship among the various constructs of the research model proposed. The findings suggested that the perceived ease of use and the perceived usefulness influence the attitude toward the cloud-based tools used in a MOOC.This study has been co-funded by the Erasmus+ Programme of the European Union, project MOOC-Maker (561533-EPP-1-2015-1-ES-EPPKA2- CBHE-JP

Noninvasive predictors of clinically significant portal hypertension in NASH cirrhosis: Validation of ANTICIPATE models and development of a lab-based model

Noninvasive predictors; Portal hypertension; CirrhosisPredictores no invasivos; Hipertensión portal; CirrosisPredictors no invasius; Hipertensió portal; CirrosiClinically significant portal hypertension (CSPH), defined as hepatic venous pressure gradient (HVPG) ≥ 10 mm Hg, identifies patients with compensated cirrhosis at a high risk of decompensation. However, HVPG is an invasive and nuanced method. The ANTICIPATE models, which include liver stiffness measurements by transient elastography (TE) and platelet count ± body mass index, are robust noninvasive surrogates of CSPH but required external validation in patients with nonalcoholic steatohepatitis (NASH) cirrhosis. Additionally, TE is not widely available worldwide. The aims of the study were: (1) to externally validate the ANTICIPATE models using baseline data from patients with compensated NASH cirrhosis screened/enrolled in a multicenter international randomized controlled trial; and (2) to develop and externally validate a model using only laboratory values. Regarding aim 1, both ANTICIPATE models showed good calibration and discrimination (area under the curve [AUC] > 0.8) in our cohort (n = 222). Regarding aim 2, a new lab-based model using the Fibrosis-4 index (FIB-4 [age, aspartate aminotransferase, alanine aminotransferase, platelet count]) plus serum albumin was developed. The discrimination in the training cohort (n = 309) was good (AUC of 0.78 [95% confidence interval [CI]:0.72–0.83]). It was then externally validated in a separate cohort of 245 patients with compensated NASH cirrhosis (AUC of 0.8 [95% CI: 0.75–0.86]). Given the difference in the prevalence of CSPH between training (74%) and validation (39%) cohorts, the model required an update of the baseline risk to achieve a good calibration. The updated model was named FIB4+. In conclusion, both ANTICIPATE models performed well in predicting the presence of CSPH in NASH cirrhosis. A model using FIB-4 plus albumin (FIB4+) can be used to predict CSPH where TE is not available.Supported by the Yale Liver Center, National Institutes of Health (P30 DK34989)