Pengaruh model pembelajaran problem based learning terhadap hasil belajar siswa kelas X pada materi struktur atom di SMA katolik santa rosa de lima tondano

Problem Based Learning model is a problem-based learning model that exposes students to practical problems to be solved that focus on the final results. The purpose of this study is to find out whether the Problem Based Learning learning model on atomic structure material is better than conventional learning models. The population in this study were all class X students of Santa Rosa de Lima Tondano Catholic High School. The sample of this study was class XA and class XB Catholic School Santa Rosa de Lima Tondano with the number of students 30 people, for the experimental class 15 people and the control class 15 people, in the even semester the academic year 2018/2019.Hypothesis testing uses the t-test to see differences in student learning outcomes between the experimental class and the control class. Based on the results of the study obtained the value of t_count (4.21)> t_table (1.701) at the real level α = 0.05. So that H_0 is rejected and H_1 is accepted. where the average value obtained in the experimental class 82.66 and the average value for the control class 71.33. So the conclusion is that there is a positive effect of the implementation of the Problem Based Learning learning model on atomic structure material on student learning outcomes at Santa Rosa de Lima Tondano Catholic High School.Model pembelajaran Problem Based Learningadalah model pembelajaran berbasis masalah yang menghadapkan siswa pada permasalahan praktis untuk dipecahkan yang menitik beratkan kepadahasil akhir. Tujuan penelitian ini adalah untuk mengetahui apakah model pembelajaran Problem Based Learning pada materi struktur atom lebih baik dari model pembelajaran konvensional. Populasi dalam penelitian ini adalah seluruh siswa kelas X SMA Katolik Santa Rosa de Lima Tondano. Sampel penelitian ini adalah kelas XA dan kelas XB SMA Katolik Santa Rosa de Lima Tondano dengan jumlah siswa 30 orang, untuk kelas eksperimen 15 orang dan kelas kontrol 15 orang, pada semester genap tahun ajaran 2018/2019.Pengujian hipotesis menggunakan  uji-t untuk melihat perbedaan hasil belajar siswa antara kelas eksperimen dan kelas kontrol. Berdasarkan hasil penelitian diperoleh nilai  (4,21) >  (1,701) pada taraf nyata α = 0,05. Sehingga  ditolak dan  diterima. dimana diperoleh nilai rata-rata pada kelas eksperimen 82,66 dan nilai rata-rata untuk kelas kontrol 71,33. Maka kesimpulannya terdapat pengaruh yang positif dari pelaksanaan model pembelajaran Problem Based Learningpada materi struktur atom terhadap hasil belajar siswa di SMA Katolik Santa Rosa de Lima Tondano

Cerebrospinal fluid immunoglobulin light chain ratios predict disease progression in multiple sclerosis

Objective To determine whether the ratio of cerebrospinal fluid (CSF) immunoglobulin kappa to lambda light chains at time of multiple sclerosis (MS) diagnosis predicts disease progression and whether this was intrinsic to CSF plasmablasts. Methods CSF and peripheral blood were obtained from patients undergoing elective diagnostic lumbar puncture and included clinically isolated syndrome (CIS) (n=43), relapsing remitting MS (RRMS; n=50), primary progressive MS (PPMS; n=20) and other neurological disease controls, both inflammatory (ONID; n=23) and non-inflammatory (OND; n=114). CSF samples were assayed for free and immunoglobulin-associated light chains and on B cells and plasmablasts. Clinical follow-up data were collected during a 5-year follow-up period where available. Results There was an increased median CSF κ:λ free light chain (FLC) in all MS groups (CIS: 18.2, 95% CI 6.8 to 30.3; RRMS: 4.4, 95% CI 2.7 to 11.4; PPMS: 12.0, 95% CI 3.6 to 37.1) but not controls (OND: 1.61, 95% CI 1.4 to 1.9; ONID: 1.7, 95% CI 1.3 to 2.2; p10) CSF κ:λ FLC (0.0, 95% CI 0 to 2.5 vs 2.5, 95% CI 0 to 4, high vs low; p=0.049). CSF κ:λ FLC correlated with CSF IgG1 κ:λ (r=0.776; p<0.0001) and was intrinsic to CSF plasmablasts (r=0.65; p=0.026). Conclusions These data demonstrate that CSF immunoglobulin κ:λ ratios, determined at the time of diagnostic lumbar puncture, predict MS disease progression and may therefore be useful prognostic markers for early therapeutic stratification

Diets of the Barents Sea cod (Gadus morhua) from the 1930s to 2018

A new dataset on the diet of Atlantic cod in the Barents Sea from the 1930s to the present day has been compiled to produce one of the largest fish diet datasets available globally. Atlantic cod is one of the most ecologically and commercially important fish species in the North Atlantic. The stock in the Barents Sea is by far the largest, as a result of both successful management and favourable environmental conditions since the early 2000s. As a top predator, cod plays a key role in the Barents Sea ecosystem. The species has a broad diet consisting mainly of crustaceans and teleost fish, and both the amount and type of prey vary in space and time. The data – from Russia, Norway and the United Kingdom – represent quantitative stomach content records from more than 400 000 fish and qualitative data from 2.5 million fish. Many of the data are from joint collaborative surveys between Norway and Russia. The sampling was conducted throughout each year, allowing for seasonal, annual and decadal comparisons to be made. Visual analysis shows cod diets have changed considerably from the start of the dataset in the 1930s to the present day. There was a large proportion of herring in the diets in the 1930s, whereas in more recent decades capelin, invertebrates and other fish dominate. There are also significant interannual asynchronous fluctuations in prey, particularly capelin and euphausiids. Combining these datasets can help us understand how the environment and ecosystems are responding to climatic changes, and what influences the diet and prey switching of cod. Trends in temperature and variability indices can be tested against the occurrence of different prey items, and the effects of fishing pressure on cod and prey stocks on diet composition could be investigated. The dataset will also enable us to improve parametrization of food web models and to forecast how Barents Sea fisheries may respond in the future to management and to climate change. The Russian data are available through joint projects with the Polar Branch of the Russian Federal Research Institute of Fisheries and Oceanography (VNIRO).publishedVersio

Unilateral Carotid Body Resection in Resistant Hypertension:A Safety and Feasibility Trial

SummaryAnimal and human data indicate pathological afferent signaling emanating from the carotid body that drives sympathetically mediated elevations in blood pressure in conditions of hypertension. This first-in-man, proof-of-principle study tested the safety and feasibility of unilateral carotid body resection in 15 patients with drug-resistant hypertension. The procedure proved to be safe and feasible. Overall, no change in blood pressure was found. However, 8 patients showed significant reductions in ambulatory blood pressure coinciding with decreases in sympathetic activity. The carotid body may be a novel target for treating an identifiable subpopulation of humans with hypertension

ATM Regulates Differentiation of Myofibroblastic Cancer-Associated Fibroblasts and Can Be Targeted to Overcome Immunotherapy Resistance

Myofibroblastic cancer-associated fibroblast (myoCAF)-rich tumors generally contain few T cells and respond poorly to immune-checkpoint blockade. Although myoCAFs are associated with poor outcome in most solid tumors, the molecular mechanisms regulating myoCAF accumulation remain unclear, limiting the potential for therapeutic intervention. Here, we identify ataxia-telangiectasia mutated (ATM) as a central regulator of the myoCAF phenotype. Differentiating myofibroblasts in vitro and myoCAFs cultured ex vivo display activated ATM signaling, and targeting ATM genetically or pharmacologically could suppress and reverse differentiation. ATM activation was regulated by the reactive oxygen species-producing enzyme NOX4, both through DNA damage and increased oxidative stress. Targeting fibroblast ATM in vivo suppressed myoCAF-rich tumor growth, promoted intratumoral CD8 T-cell infiltration, and potentiated the response to anti-PD-1 blockade and antitumor vaccination. This work identifies a novel pathway regulating myoCAF differentiation and provides a rationale for using ATM inhibitors to overcome CAF-mediated immunotherapy resistance.SignificanceATM signaling supports the differentiation of myoCAFs to suppress T-cell infiltration and antitumor immunity, supporting the potential clinical use of ATM inhibitors in combination with checkpoint inhibition in myoCAF-rich, immune-cold tumors

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme