Identifying Factors in Medication Non-Adherence in Teens Diagnosed with Juvenile Arthritis: A Pilot Study

Purpose: The purpose of this study was to identify factors that correlate with medication non-adherence in teens diagnosed with juvenile arthritis. Background: The impact of medication non-adherence often begins in childhood where children depend and learn from their care-givers how to manage their health. Children with chronic disorders are among those at risk for a higher medication non-adherence. Juvenile arthritis (JA) is a chronic childhood disorder where often medication non-adherence is an issue. Methodology: This was a mixed-method qualitative and quantitative pilot study. Teens between the ages of 11 – 17 years, with juvenile arthritis were asked to volunteer in this study. Their medication adherence score were measured utilizing a Modified Medication Adherence Scale (MMAS). The second survey was to assess the patient’s knowledge of their medication and was called the open-ended questionnaire. Fisher’s exact test was used to determine if there was a statistical relationship between age, gender and ethnicity with their Modified Medication Adherence Score (MMAS). Knowledge comprehension of their medication’s action was then compared to medication adherence scores. Results: Results varied as some patients scored lowered on their MMAS, but were knowledgeable about the action of their medication. The highest factor for all age groups, genders and ethnicity were forgetfulness. There were inherent limitations in this study as results were varied, subjective and skewed. Conclusions: Based on this study, teens between the ages of 16-17 years of age scored higher in medication adherence. Gender and ethnicity were not shown to have a statistical relationship in their medication adherence scores. Forgetfulness was the common factor identified in medication non-adherence, while medication knowledge was not a factor in medication adherence scores

Active Learning for Deep Neural Networks on Edge Devices

When dealing with deep neural network (DNN) applications on edge devices, continuously updating the model is important. Although updating a model with real incoming data is ideal, using all of them is not always feasible due to limits, such as labeling and communication costs. Thus, it is necessary to filter and select the data to use for training (i.e., active learning) on the device. In this paper, we formalize a practical active learning problem for DNNs on edge devices and propose a general task-agnostic framework to tackle this problem, which reduces it to a stream submodular maximization. This framework is light enough to be run with low computational resources, yet provides solutions whose quality is theoretically guaranteed thanks to the submodular property. Through this framework, we can configure data selection criteria flexibly, including using methods proposed in previous active learning studies. We evaluate our approach on both classification and object detection tasks in a practical setting to simulate a real-life scenario. The results of our study show that the proposed framework outperforms all other methods in both tasks, while running at a practical speed on real devices

Teaching Cultural Competence: A Comparison of Outcomes Between In-Class and Study Abroad Programs

This study examined whether students develop cultural competence in classrooms and study abroad programs by comparing three groups of students: students in a Cross-Cultural Human Development Class (CCHD), Study Abroad programs (SA), and the control group. Participants were 106 undergraduate students from a predominantly White institution in the United States. CCHD students took a semester-long course in culture and human development, and SA students attended a short-term study abroad program. Students took pre- and post-surveys to examine their cultural competence skills. The results demonstrated that the cultural competence skills of the SA students were significantly improved after the program. CCHD students also demonstrated similarly increased cultural competence after completing the semester long course emphasizing cultural diversity, while the control group did not show an increase in cultural competence. Implications for teaching courses in cross-cultural psychology are discussed

Stent Implantation for Effective Treatment of Refractory Chylothorax due to Superior Vena Cava Obstruction as a Complication of Congenital Cardiac Surgery

Chylothorax is a serious complication of congenital cardiac surgery and is significantly associated with increased morbidity and mortality. Central venous obstruction, which is often related to the insertion of central venous catheters for postoperative management, is known to be an important risk factor for treatment failure and mortality associated with this condition. We present the case of a 6-month-old girl with refractory chylothorax after surgical repair of tetralogy of Fallot. The chylous drainage continued for more than 2 months despite maximal conservative therapy (water restriction, total parenteral nutrition, and infusion of somatostatin and steroid) and surgical ligation of the thoracic duct. Subsequently, we observed stenosis of the superior vena cava (SVC) caused by large thrombi possibly associated with the prolonged use of central venous catheter placed in the internal jugular vein. Because transcatheter balloon dilation failed to relieve the stenosis, we performed stent implantation for the SVC and innominate vein. After the procedure, chylous drainage dramatically reduced, and the patient was discharged from the hospital. In conclusion, central venous obstruction due to thrombosis should be routinely examined when chylothorax is diagnosed and is resistant to conservative therapy after congenital heart surgery. Stent implantation can effectively relieve the venous obstruction and thus be a life-saving treatment option for this difficult condition

Effect of biopsy on survival of melanoma patients

Background Cutaneous malignant melanoma has a poor prognosis. The detrimental effect of incisional biopsies on the outcome of malignant melanoma has been debated. The aim of this study was to determine the effect of the presence and type of biopsy on the prognosis of malignant melanoma. Methods The medical records of 109 malignant melanoma patients treated at Tokushima University Hospital from 1983 to 2007 were reviewed. After excluding 28 cases with stage 0 disease or incomplete data, 81 cases were analyzed in detail with respect to patient sex, age, tumor site, clinical stage at diagnosis, presence of ulceration or lymph node metastasis, and prognosis. The five-year survival and five-year disease-free survival rates of patients who underwent incisional or excisional biopsies were compared with those who did not undergo a biopsy. Results The male-to-female ratio was 1:1.19. The mean age was 61.3 years (range, 19–93 years). The most common site was a lower extremity, and the most common clinical stage was stage II. No significant differences in clinicopathological features, five-year survival rates, and five-year disease-free survival rates were observed among the three groups. Conclusions The presence and type of biopsy neither affected the metastatic rate nor the prognosis of malignant melanoma. The use of incisional biopsies is not encouraged because tumor thickness cannot be measured accurately. However, they may be helpful for confirming the diagnosis if an excisional biopsy cannot be performed

Polymorphism of Matrix Metalloproteinase-3 Promoter Gene as a Risk Factor for Coronary Artery Lesions in Kawasaki Disease

Kawasaki disease (KD) is a major cause of acquired coronary artery diseases in childhood. The serum levels of matrix metalloproteinase (MMP)-3 and MMP-9 in KD have been reported to be significantly higher than other diseases. Several studies have demonstrated that MMP-3 5A/6A polymorphism and MMP-9 C-1562T polymorphism modify each transcriptional activity in allele specific manner. We hypothesized that these polymorphisms may play a role as a risk factor for development of coronary artery lesions (CAL) in KD. Eighty-three patients, diagnosed with KD in Cheju National University Hospital from January 2000 to February 2004, were divided into two groups according to the presence of CAL. Genotyping of MMP-3 and MMP-9 gene polymorphisms were determined by restriction fragment length polymorphism. With regard to MMP-3 gene polymorphism, the KD with CAL group had a higher frequency of 6A/6A genotype than control group (p=0.0127) and the KD without CAL group (p=0.0036). However, no significant differences in the allele and genotype distributions of the MMP-9 polymorphism were observed. These findings suggest that MMP-3 6A/6A genotype may be an independent risk factor for CAL formation in KD

Population-specific association of Clock gene polymorphism with annual cycle timing in stonechats

Timing is essential for survival and reproduction of organisms across the tree of life. The core circadian clock gene Clk has been implicated in annual timing and shows highly conserved sequence homology across vertebrates except for one variable region of poly Glutamine repeats. Clk genotype varies in some species with latitude, seasonal timing and migration. However, findings are inconsistent, difficult to disentangle from environmental responses, and biased towards high latitudes. Here we combine field data with a common-garden set up to study associations of Clk with latitude, migration and annual-cycle timing within the stonechat species complex with trans-equatorial distribution range. Including 950 individuals from nine populations with diverse migratory strategies. Gene diversity was lowest in resident African and Canary Island populations and increased with latitude, independently of migration distance. Repeat length and annual-cycle timing was linked in a population-specific way. Specifically, equatorial African stonechats showed delayed timing with longer repeat length for all annual-cycle stages. Our data suggest that at low latitudes with constant photoperiod, Clk genotype might orchestrate a range of consistent, individual chronotypes. In contrast, the influence of Clk on annual-cycle timing at higher latitudes might be mediated by its interactions with genes involved in (circadian) photoperiodic pathways