Pembelajaran Piano Untuk Anak Autisme Di Sekolah Musik Moritza

Penelitian ini bertujuan untuk mengetahui proses pembelajaran piano untuk anak autisme di Sekolah Musik Moritza. Subjek dalam penelitian ini adalah murid dan guru piano di Sekolah Musik Moritza. Sedangkan objek penelitiannya adalah pembelajaran piano di Sekolah Musik Moritza. Pendekatan yang digunakan dalam penelitian ini adalah pendekatan kualitatif dengan jenis penelitian deskriptif. Teknik pengumpulan yaitu, teknik observasi, wawancara, dan dokumentasi. Selanjutnya, teknik pengolahan dan analisis data dengan mereduksi, display, serta verifikasi data. Hasil penelitian menunjukkan bahwa proses pembelajaran piano untuk anak Autisme di Sekolah Musik Moritza terdiri dari kegiatan menyapa murid, me-riview pelajaran yang dilakukan selama 3 menit, memberikan materi, guru melakukan evaluasi kepada murid, dan mengajarkan bernyanyi kepada murid di waktu 5 menit terakhir. Materi yang digunakan merupakan buku I (easy part piano 01) dan buku II (easy part piano 02). Selain itu, ada pula lagu pop dan lagu anak-anak. Metode yang diajarkan berupa reading,hearing, memory singing, dan finger drill. Reading yaitu tahap melatih murid untuk membaca notasi balok. Hearing yaitu tahap dimana murid mendengar dan peka terhadap dinamika maupun aksen dalam musik. Memory singing yaitu murid menyanyikan lagu yang sudah pernah bahkan sering dinyanyikan sebelumnya (notation singing) guna melatih daya ingat murid. Pada metode finger drill melatih keterampilan dan penjarian murid dalam bermain piano, yang diawali dengan memainkan tangga nada C mayor. Terdapat pula metode Q yang memiliki komponen diantaranya; murid harus paham tujuan belajar mereka dan apa yang sedang dan akan mereka lakukan, guru menjelaskan materi secara visual dan matematikal, guru mengajarkan satu materi dalam satu waktu, guru mengajarkan yang mudah terlebih dahulu, guru melakukan review pelajaran sebelumnya, guru melakukan kritik permainan yang bersifat positif, dan guru harus mampu membesarkan kepercayaan diri murid

Long-term weight loss maintenance and management following a VLCD: a 3-year outcome.

Background: Effective weight loss treatment is important as obesity has severe health and socioeconomic repercussions. Emerging evidence suggests that rapid initial weight loss results in better long-term weight loss maintenance. This remains controversial and contradicts current recommendations for slower weight loss. Aim: To determine the effect of a very low calorie diet (VLCD) with group-based behaviour therapy on weight loss and long-term weight management by means of a retrospective database analysis. Methods: Data for this retrospective analysis included participants who embarked on the LighterLife Total VLCD programme between 2007 and 2010, and whose weights at baseline and at least 12 months were available (n = 5965). Results: Data were available for 5965 individuals at 1 year, 2044 at 2 years and 580 at 3 years. At baseline, the majority of individuals were Caucasian (n = 5155), female (n = 5419), ≥ 40 years old (n = 4272), 49% were within the body mass index (BMI) range of 30-35 kg/m2 while 51% had a BMI > 35 kg/m2. The average initial weight of the whole cohort was 99.1 kg (SD 16.6). Initial weight and BMI at entry onto programme, as well as numbers of weeks of weight loss were all significantly associated with weight loss achieved on the first weight loss attempt. Weight lost during the initial weight loss phase was the only factor, which was significantly associated with percentage weight loss maintenance for years 1, 2, and 3. Conclusion: The findings of this retrospective analysis suggest that provided a longer term weight loss management programme is adhered to, large amounts of initial weight loss can result in important longer term weight loss maintenance in motivated individuals

Escalation of care in children at high risk of clinical deterioration in a tertiary care children’s hospital using the Bedside Pediatric Early Warning System

Background: Escalation and de-escalation are a routine part of high-quality care that should be matched with clinical needs. The aim of this study was to describe escalation of care in relation to the occurrence and timing of Pediatric Intensive Care Unit (PICU) admission in a cohort of pediatric inpatients with acute worsening of their clinical condition. Methods: A monocentric, observational cohort study was performed from January to December 2018. Eligible patients were children: 1) admitted to one of the inpatient wards other than ICU; 2) under the age of 18 years at the time of admission; 3) with two or more Bedside-Paediatric-Early-Warning-System (BedsidePEWS) scores ≥ 7 recorded at a distance of at least one hour and for a period of 4 h during admission. The main outcome -the 24-h disposition – was defined as admission to PICU within 24-h of enrolment or staying in the inpatient ward. Escalation of care was measured using an eight-point scale—the Escalation Index (EI), developed by the authors. The EI was calculated every 6 h, starting from the moment the patient was considered eligible. Analyses used multivariate quantile and logistic regression models. Results: The 228 episodes included 574 EI calculated scores. The 24-h disposition was the ward in 129 (57%) and the PICU in 99 (43%) episodes. Patients who were admitted to PICU within 24-h had higher top EI scores [median (IQR) 6 (5–7) vs 4 (3–5), p < 0.001]; higher initial BedsidePEWS scores [median (IQR) 10(8–13) vs. 9 (8–11), p = 0.02], were less likely to have a chronic disease [n = 62 (63%) vs. n = 127 (98%), p < 0.0001], and were rated by physicians as being at a higher risk of having a cardiac arrest (p = 0.01) than patients remaining on the ward. The EI increased over 24 h before urgent admission to PICU or cardiac arrest by 0.53 every 6-h interval (CI 0.37–0.70, p < 0.001), while it decreased by 0.25 every 6-h interval (CI -0.36–0.15, p < 0.001) in patients who stayed on the wards. Conclusion: Escalation of care was related to temporal changes in severity of illness, patient background and environmental factors. The EI index can improve responses to evolving critical illness

Down-titration of biologics for the treatment of rheumatoid arthritis: A systematic literature review

Biologic therapies have improved the management of rheumatoid arthritis (RA) and the treat-to-target approach has resulted in many patients achieving remission. In the current treatment landscape, clinicians have begun considering dose reduction/tapering for their patients. Rheumatology guidelines in Asia, Europe, and the United States include down-titration of biologics but admit that the level of evidence is moderate. We conducted a systematic literature review to assess the published studies that evaluate down-titration of biologics in RA. The published literature was searched for studies that down-titrated the following biologics: abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab. Eligible studies included randomized controlled trials (RCTs), non-RCTs, observational, and pharmacoeconomic studies. The outcomes of interest were (1) efficacy and health-related quality of life, (2) disease flares, and (3) impact on cost. Eleven full-text publications were identified; only three were RCTs. Study results suggest that dosing down may be an option in many patients who have achieved remission or low disease activity. However, some patients are likely to experience a disease flare. Across the studies, the definition of disease flare and the down-titration criteria were inconsistent, making it difficult to conclude which patients may be appropriate and when to attempt down-titration. Studies have evaluated the practice of dosing down biologic therapy in patients with RA; however, a relatively small number of RCTs have been published. Although down-titration may be an option for some patients in LDA or remission, additional RCTs are needed to provide guidance on this practice

Stabilization of angiotensin-(1-7) by key substitution with a cyclic non-natural amino acid

Angiotensin-(1-7) [Ang-(1-7)], a heptapeptide hormone of the renin-angiotensin-aldosterone system (RAAS), is a promising candidate as a treatment for cancer that reflects its antiproliferative and anti-angiogenic properties. However, the peptide’s therapeutic potential is limited by the short half-life and low bioavailability resulting from rapid enzymatic metabolism by peptidases including angiotensin-converting enzyme (ACE) and dipeptidyl peptidase 3 (DPP 3). We report the facile assembly of three novel Ang-(1-7) analogues by solid-phase peptide synthesis which incorporates the cyclic non-natural δ-amino acid ACCA. The analogues containing the ACCA substitution at the site of ACE cleavage exhibit complete resistance to human ACE, while substitution at the DDP3 cleavage site provided stability against DPP 3 hydrolysis. Furthermore, the analogues retain the anti-proliferative properties of Ang-(1-7) against the 4T1 and HT-1080 cancer cell lines. These results suggest that ACCA-substituted Ang-(1-7) analogues which show resistance against proteolytic degradation by peptidases known to hydrolyze the native heptapeptide may be novel therapeutics in the treatment of cancer