EARNED SECURE ATTACHMENT OF AVOIDANT PERSONALITY DISORDER CLIENT IN MATT HAIG'S THE MIDNIGHT LIBRARY

Penelitian ini bertujuan untuk menyelidiki kelekatan aman yang dikembangkan oleh Nora Seed yang memiliki Gangguan Kepribadian Menghindar dalam novel The Midnight Libary karya Matt Haig. Dengan menggunakan konsep AvPD milik Milton, teori psikoanalisis milik Sigmund Freud, teori tahapan perkembangan psikososial milik Erikson, dan teori keterikatan milik Pearson, penelitian ini menggunakan metode deskriptif analitis untuk menganalisis penyebab dan gejala AvPD Nora, kontestasi pikiran Nora, perkembangan psikososial Nora, dan pengembangan kelekatan aman Nora. Hasil penelitian ini menunjukkan bahwa selama perkembangan kelekatan aman Nora. Hasil penelitian ini menunjukkan bahwa selama perkembangan psikososial Nora dari masa kanak-kanak hingga remaja, ketidakhadiran orang tua sebagai panutan mempengaruhi Nora untuk mengembangkan kepribadian yang tidak sehat. Kepribadian yang tidak sehat ini pada akhirnya mempengaruhi Nora untuk mengembangkan AvPD di masa dewasanya yang menyebabkan id Nora sebagian besar dipengaruhi oleh thanatos dan mempengaruhinya untuk melakukan upaya bunuh diri. Namun demikian, superego Nora berhasil mempengaruhi ego dengan memberikan pertimbangan tentang tanggung jawab Nora terhadap perannya sebagai kakak dan guru piano. Ego mengambil pertimbangan ini dan memutuskan untuk tidak memenuhi dorongan id, oleh karena itu, upaya bunuh diri Nora mengalami kegagalan. Kontestasi pikiran ini terrefleksikan selama jiwa Nora bereksplorasi dalam kehidupan alternatif yang terletak antara hidup dan mati. Selanjutnya, hasil penelitian ini juga menunjukkan bahwa Nora membangun kelekatan aman dari hubungannya dengan Bu Elm yang mengisi kekosongan peran orang tua bagi Nora dan membantu Nora memperbaiki kepribadiannya dan meredakan gejala AvPDnya. Pada akhirnya, Nora mampu meredakan diri dari gejala AvPD, memperbaiki kepribadiannya menjadi lebih percaya diri, lebih menghargai diri, berani, dan mudah bergaul, dan mulai menghargai hidupnya dengan aktif membantu orang-orang di sekitarnya. Kata kunci: gangguan kepribadian menghindar, keterikatan aman yang diperoleh, psikoanalisis, The Midnight Library. Matt Haig. ************* This study aims to investigate Nora Seed’s earned secure attachment of her Avoidant Personality Disorder in Matt Haig’s The Midnight Library. Deploying Millon’s concept of AvPD, Sigmund Freud’s theory of psychoanalysis, Erikson’s stages of psychosocial development, and Pearson’s theory of attachment, this study applies the descriptive-analytical method to analyze the causes and symptoms of Nora’s AvPD, Nora’s mind contestation, Nora’s psychosocial development, and Nora’s earned secure attachment development. The results of this study show that during the psychosocial development from Nora’s childhood to her teenage years, her parents’ absence as role models affected Nora to develop an unhealthy personality. This unhealthy personality eventually influences Nora to develop AvPD in her adulthood which causes Nora’s id to be affected mainly by Thanatos and leads her to commit a suicidal attempt. Nevertheless, Nora’s superego succeeded in influencing the ego by considering Nora’s responsibility toward her role as a sister and piano teacher. The ego takes this Consideration and decides not to fulfil the id’s urge. Therefore, Nora fails her suicidal attempt. This mind contestation was portrayed during Nora’s soul exploration in the alternate lives between life and death. Further, the results also show that Nora develops earned secure attachment from her relationship with Mrs. Elm, who substitutes Nora’s parents and assists Nora to resolve her unhealthy personality and remits her AvPD. In the end, Nora can remit her AvPD symptoms, resolves her unhealthy personality with confidence, braveness, and starts to appreciate her life by actively being helpful to people around her. Keywords: avoidant personality disorder, earned secure attachment, psychoanalysis, The Midnight Library. Matt Haig

PENGARUH MOTIVASI INVESTASI, PENGETAHUAN INVESTASI DAN TEKNOLOGI INFORMASI TERHADAP MINAT BERINVESTASI DI PASAR MODAL (STUDI PADA MAHASISWA FIA DAN FEB UNISMA YANG SUDAH MENEMPUH MATA KULIAH MENGENAI INVESTASI)

The results showed that in the partial test there was a significant positive effect between investment motivation variables on investment interest, this was indicated by a tcount of 5.619> 1.6632 ttable with a Significant value of 0,000 (0,000 1.6632 ttable with a Significant value of 0.041 (0,000 1.6632 ttable with a Significant value of 0.001 ( 0,000 2.71 F table with a Significance of F of 0,000 (0,000 <0.05) so it can be concluded that simultaneous Motivation, Knowledge, and Information Technology influences Investment Interest

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Boosting the L2 Learners’ Reading Comprehension Capability by Employing Nearpod Media

Objective: This study aimed to enhance L2 learners' reading comprehension by integrating Nearpod media into the teaching strategy at Universitas Almuslim. The main goal was to evaluate the effectiveness of this technology-based learning in boosting L2 reading comprehension. Method: A pre-experimental research design was employed in this study, in which the L2 learners at Universitas Almuslim were grouped without a control group for comparison. Pre-tests and post-tests were conducted using the Nearpod platform to assess the L2 learners' reading comprehension skills. The data acquired from the pre-test and post-test were quantitatively analyzed with SPSS Statistics Output to determine whether or not there was a significant difference when using the Nearpod media in class. Results: The outcomes revealed a significant difference in the L2 reading comprehension when exposed to Nearpod. It showed that the post-test reading comprehension mean score was higher than the pre-test mean score. Thus, the null hypothesis (Ho) was rejected, whereas the alternative hypothesis (Ha) was accepted. Novelty: By integrating technology into the classroom, this study contributes to the growing body of knowledge on effective strategies for language learning. The findings emphasize the potential of Nearpod media to engage and empower L2 learners, providing a novel and prospective option for boosting language teaching, particularly in reading comprehension

Training manual on approach to unwell children under 5 years

In line with the SDG, Ministry of Health Malaysia aims to end all preventable deaths among newborn and children under 5 years and developed the ‘Training Manual on Approach to Unwell Children under 5 years’ (ATUCU5) based on the WHO IMCI strategy. ATUCU5 is meant for training of our health care providers on three main components, which includes early detection of danger signs, improvements in the case management skills and proper immediate treatment

Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex: A Post Hoc Analysis of the CREDENCE Randomized Clinical Trial

Rationale &amp; Objective: It is unclear whether the effect of canagliflozin on adverse kidney and cardiovascular events in those with diabetic kid-ney disease varies by age and sex. We assessed the effects of canagliflozin among age group categories and between sexes in the Canagli-flozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study.Study Design: Secondary analysis of a random-ized controlled trial. Setting &amp; Participants: Participants in the CREDENCE trial. Intervention: Participants were randomly assigned to receive canagliflozin 100 mg/d or placebo.Outcomes: Primary composite outcome of kid-ney failure, doubling of serum creatinine con-centration, or death due to kidney or cardiovascular disease. Prespecified secondary and safety outcomes were also analyzed. Out-comes were evaluated by age at baseline (&lt;60, 60-69, and &gt;_70 years) and sex in the intention-to-treat population using Cox regression models.Results: The mean age of the cohort was 63.0 &amp; PLUSMN; 9.2 years, and 34% were female. Older age and female sex were independently associ-ated with a lower risk of the composite of adverse kidney outcomes. There was no evidence that the effect of canagliflozin on the primary outcome (acomposite of kidney failure, a doubling of serum creatinine concentration, or death from kidney or cardiovascular causes) differed between age groups (HRs, 0.67 [95% CI, 0.52-0.87], 0.63 [0.4 8-0.82], and 0.89 [0.61-1.29] for ages &lt;60, 60-69, and &gt;_70 years, respectively; P = 0.3 for interaction) or sexes (HRs, 0.71 [95% CI, 0.5 4-0.95] and 0.69 [0.56-0.8 4] in women and men, respectively; P = 0.8 for interaction). No differences in safety outcomes by age group or sex were observed.Limitations: This was a post hoc analysis with multiple comparisons.Conclusions: Canagliflozin consistently reduced the relative risk of kidney events in people with diabetic kidney disease in both sexes and across age subgroups. As a result of greater background risk, the absolute reduction in adverse kidney outcomes was greater in younger participants.Funding: This post hoc analysis of the CREDENCE trial was not funded. The CREDENCE study was sponsored by Janssen Research and Development and was conducted collaboratively by the sponsor, an academic-led steering committee, and an academic research organization, George Clinical.Trial Registration: The original CREDENCE trial was registered at ClinicalTrials.gov with study number NCT02065791

Effect of SGLT2 Inhibitors on Stroke and Atrial Fibrillation in Diabetic Kidney Disease: Results From the CREDENCE Trial and Meta-Analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus.METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis.RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (&lt;45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]).CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02065791