THE NUMBERED HEAD TOGETHER LEARNING MODEL ON THE CRITICAL THINKING ABILITY OF IV CLASS SD STUDENTS

The low critical thinking abilities of students are caused by the application of non-innovative learning models. Learning is still teacher-centered so that students cannot develop critical thinking skills to the maximum. The aim of this research is to determine differences in critical thinking abilities of students who are treated using the Numbered Heads Together learning model. This research is quantitative research with the type of experimental research. The research was conducted in class IV of SD N 10 Gondosari. Data analysis was carried out using the t-test (Paired T Test). Based on the results of the T Test (Paired T Test) calculations, the Sig value is obtained. (2-tailed) is 0.000 which means Sig. (2-tailed) < 0.05. From these calculations, the T test results were less than the significance level. It can be concluded that there is a difference in the average test results before and after the Numbered Head Together (NHT) learning model is implemented. There are significant differences in critical thinking abilities between students taught using the Numbered Heads Together learning model

Basiliximab induction therapy in kidney transplantation: Benefits for long term allograft function after 10 years?

The interleukin-2 receptor antagonist basiliximab has proven in large clinical trials to be safe and effective to reduce acute rejections in the first year after renal transplantation. Since acute rejections are a risk factor for chronic graft loss, their effective reduction might have a positive effect on long term allograft survival. So far data is spares to prove this hypothesis and 10-year follow up on basiliximab induction therapy is not available. In our center, 41 patients were enrolled in the multicenter trial CHIB201 in 1995/96 comparing basiliximab vs no induction therapy after renal transplantation. We retrospectively analyzed the outcome of these patients after 10 years. The main reason for patient death with functioning graft were infectious complications (basiliximab: 3/20, placebo 1/19), 21% of all patients developed cancer without an obvious correlation to specific immunosuppression. Death censored 10-year graft survival was equivalent in both groups: 65% in the basiliximab and 68% in the placebo group with a mean s-creatinine-clearance of 60 and 44 ml/min. In this small study patient and graft survival was equivalent 10 years after transplantation comparing basiliximab induction therapy and placebo

MANAJEMEN KESISWAAN DALAM MENINGKATKAN BAKAT DAN MINAT PADA SMP NU AL-MA’RUF KUDUS TAHUN PELAJARAN 2019-2020

Manajemen kesiswaan bagi lembaga pendidikan dapat menentukan peningkatan mutu pendidikan, prestasi akademik dan non akademik siswa. Lemahnya manajemen kesiswaan dapat berimbas pada kurang optimalnya kegiatan pembinaan bakat dan minat siswa. Oleh karena itu, diperlukan adanya manajemen kesiswaan yang berdaya guna baik dari sisi manajemen sistem (perencanaan, pelaksanaan, evaluasi, dan tindak lanjut), serta komponen sistem (guru/pembimbing, siswa, sarana dan prasarana, waktu, dan biaya) untuk mengelola bakat dan minat siswa. Penelitian ini bertujuan untuk: (1) mendeskripsikan dan menganalisis proses manajemen kesiswaan dalam meningkatkan bakat dan minat siswa (2) mendeskripsikan faktor pendukung dan penghambat; (3) mengdeskripsikan upaya pemecahan masalah dalam manajemen kesiswaan dalam meningkatkan bakat dan minat siswa di SMP NU Al- Ma’ruf Kudus. Penelitian ini menggunakan pendekatan kualitatif dengan jenis kualitatif deskriptif. Lokasi penelitian di SMP NU Al-Ma’ruf Kudus. Subjek penelitian adalah kepala sekolah, wakil kepala bidang kesiswaan, guru/pembimbing, pengawas, komite sekolah, dan siswa. Data penelitian diperoleh dari primer dan sekunder. Sumber data dari informan, dokumen atau arsip, sumber pustaka, dan hasil penelitian yang relevan. Teknik pengumpulan data menggunakan observasi dan wawancara mendalam tentang manajemen kesiswaan dalam meningkatkan bakat dan minat siswa. Uji keabsahan data menggunakan trianggulasi dan perpancangan keikutsertaan. Data yang terkumpul kemudian dianalisis menggunakan metode induksi dan metode deduksi dengan model interaktif Milles dan Huberman yang dimulai dari reduksi data, penyajian data, penarikan simpulan/verifikasi. Hasil analisis data dan temuan penelitian disimpulkan (1) Proses pelaksanaan manajemen kesiswaan untuk meningkatkan bakat dan minat siswa di SMP NU Al-Ma’ruf Kudus meliputi perencanaan, pengorganisasian, pelaksanaan, monitoring, evaluasi, pelaporan dan tindak lanjut; (2) Faktor pendukung dan penghambat dalam pelaksanaan manajemen kesiswaan untuk bakat dan minat siswa di berasal dari internal dan eksternal. Faktor internal meliputi: sumber daya manusia, metode, materi, waktu, sarana dan prasarana serta pembiayaan. Faktor eksternal berasal dari luar lembaga yaitu: dukungan dari wali murid, donatur, dan Dinas Pendidikan Kabupaten Kudus; (3) Upaya pemecahan masalah hambatan dilaksanakan secara internal dan eksternal. Upaya internal meliputi: peningkatan kompetensi dan kualifikasi pembimbing, penjaringan peserta melalui tes, membentuk tim, panduan teknis, sarana dan prasarana, waktu, pembiayaan. Upaya eksternal meliputi: meminta dukungan orang tua/wali, membina kerjasama pihak-pihak dan instansi terkait seperti Dinas Pendidikan dan Kebudayaan dan Kantor Kementerian Agama dan sponshorship. Saran yang disampaikan kepada pengawas, kepala sekolah, wakil kepala bidang kesiswaan, guru, komite dan siswa mengimplementasikan manajemen kesiswaan dengan optimal, efektif dan efisien sehingga bakat dan minat siswa dapat meningkat

Evaluating the efficacy, safety and evolution of renal function with early initiation of everolimus-facilitated tacrolimus reduction in de novo liver transplant recipients: Study protocol for a randomized controlled trial

Background: Introduction of calcineurin inhibitors had led to improved survival rates in liver transplant recipients. However, long-term use of calcineurin inhibitors is associated with a higher risk of chronic renal failure, neurotoxicity, de novo malignancies, recurrence of hepatitis C viral (HCV) infection and hepatocellular carcinoma. Several studies have shown that everolimus has the potential to provide protection against viral replication, malignancy, and progression of fibrosis, as well as preventing nephrotoxicity by facilitating calcineurin inhibitor reduction without compromising efficacy. The Hephaistos study evaluates the beneficial effects of early initiation of everolimus in de novo liver transplant recipients. Methods/Design: Hephaistos is an ongoing 12-month, multi-center, open-label, controlled study aiming to enroll 330 de novo liver transplant recipients from 15 centers across Germany. Patients are randomized in a 1:1 ratio (7–21 days post-transplantation) to receive everolimus (trough levels 3–8 ng/mL) with reduced tacrolimus (trough levels <5 ng/mL), or standard tacrolimus (trough levels 6–10 ng/mL) after entering a run-in period (3–5 days post-transplantation). In the run-in period, patients are treated with induction therapy, mycophenolate mofetil, tacrolimus, and corticosteroids according to local practice. Randomization is stratified by HCV status and model of end-stage liver disease scores at transplantation. The primary objective of the study is to exhibit superior renal function (estimated glomerular filtration rate assessed by the Modification of Diet in Renal Disease (MDRD)-4 formula) with everolimus plus reduced tacrolimus compared to standard tacrolimus at Month 12. Other objectives are: to assess the incidence of treated biopsy-proven acute rejection, graft loss, or death; the incidences of components of the composite efficacy endpoint; renal function via estimated glomerular filtration rate using various formulae (MDRD-4, Nankivell, Cockcroft-Gault, chronic kidney disease epidemiology collaboration and Hoek formulae); the incidence of proteinuria; the incidence of adverse events and serious adverse events; the incidence and severity of cytomegalovirus and HCV infections and HCV-related fibrosis. Discussion: This study aims to demonstrate superior renal function, comparable efficacy, and safety in de novo liver transplant recipients receiving everolimus with reduced tacrolimus compared with standard tacrolimus. This study also evaluates the antiviral benefit by early initiation of everolimus. Trial registration: NCT0155121

study protocol for a randomised controlled trial

Background Immunosuppression with calcineurin inhibitors remains the mainstay of treatment after kidney transplantation; however, long-term use of these drugs may be associated with nephrotoxicity. In this regard, the current approach is to optimise available immunosuppressive regimens to reduce the calcineurin inhibitor dose while protecting renal function without affecting the efficacy. The ATHENA study is designed to evaluate renal function in two regimens: an everolimus and reduced calcineurin inhibitor-based regimen versus a standard treatment protocol with mycophenolic acid and tacrolimus in de novo kidney transplant recipients. Method/Design ATHENA is a 12-month, multicentre, open-label, prospective, randomised, parallel-group study in de novo kidney transplant recipients (aged 18 years or older) receiving renal allografts from deceased or living donors. Eligible patients are randomised (1:1:1) prior to transplantation to one of the following three treatment arms: everolimus (starting dose 1.5 mg/day; C0 3–8 ng/mL) with cyclosporine or everolimus (starting dose 3 mg/day; C0 3–8 ng/mL) with tacrolimus or mycophenolic acid (enteric-coated mycophenolate sodium at 1.44 g/day or mycophenolate mofetil at 2 g/day) with tacrolimus; in combination with corticosteroids. All patients receive induction therapy with basiliximab. The primary objective is to demonstrate non-inferiority of renal function (eGFR by the Nankivell formula) in one of the everolimus arms compared with the standard group at month 12 post transplantation. The key secondary objective is to assess the incidence of treatment failure, defined as biopsy-proven acute rejection, graft loss, or death, among the treatment groups. Other objectives include assessment of the individual components of treatment failure, incidence and severity of viral infections, incidence and duration of delayed graft function, incidence of indication biopsies, slow graft function and wound healing complications, and overall safety and tolerability. Exploratory objectives include evaluation of left ventricular hypertrophy assessed by the left ventricular mass index, evolution of human leukocyte antigen and non-human leukocyte antigen antibodies, and a cytomegalovirus substudy. Discussion As one of the largest European multicentre kidney transplant studies, ATHENA will determine whether a de novo everolimus-based regimen can preserve renal function versus the standard of care. This study further assesses a number of clinical issues which impact long-term outcomes post transplantation; hence, its results will have a major clinical impact

Design and rationale of the ATHENA study – A 12-month, multicentre, prospective study evaluating the outcomes of a de novo everolimus-based regimen in combination with reduced cyclosporine or tacrolimus versus a standard regimen in kidney transplant patients: study protocol for a randomised controlled trial

Background: Immunosuppression with calcineurin inhibitors remains the mainstay of treatment after kidney transplantation; however, long-term use of these drugs may be associated with nephrotoxicity. In this regard, the current approach is to optimise available immunosuppressive regimens to reduce the calcineurin inhibitor dose while protecting renal function without affecting the efficacy. The ATHENA study is designed to evaluate renal function in two regimens: an everolimus and reduced calcineurin inhibitor-based regimen versus a standard treatment protocol with mycophenolic acid and tacrolimus in de novo kidney transplant recipients. Method/Design: ATHENA is a 12-month, multicentre, open-label, prospective, randomised, parallel-group study in de novo kidney transplant recipients (aged 18 years or older) receiving renal allografts from deceased or living donors. Eligible patients are randomised (1:1:1) prior to transplantation to one of the following three treatment arms: everolimus (starting dose 1.5 mg/day; C0 3–8 ng/mL) with cyclosporine or everolimus (starting dose 3 mg/day; C0 3–8 ng/mL) with tacrolimus or mycophenolic acid (enteric-coated mycophenolate sodium at 1.44 g/day or mycophenolate mofetil at 2 g/day) with tacrolimus; in combination with corticosteroids. All patients receive induction therapy with basiliximab. The primary objective is to demonstrate non-inferiority of renal function (eGFR by the Nankivell formula) in one of the everolimus arms compared with the standard group at month 12 post transplantation. The key secondary objective is to assess the incidence of treatment failure, defined as biopsy-proven acute rejection, graft loss, or death, among the treatment groups. Other objectives include assessment of the individual components of treatment failure, incidence and severity of viral infections, incidence and duration of delayed graft function, incidence of indication biopsies, slow graft function and wound healing complications, and overall safety and tolerability. Exploratory objectives include evaluation of left ventricular hypertrophy assessed by the left ventricular mass index, evolution of human leukocyte antigen and non-human leukocyte antigen antibodies, and a cytomegalovirus substudy. Discussion: As one of the largest European multicentre kidney transplant studies, ATHENA will determine whether a de novo everolimus-based regimen can preserve renal function versus the standard of care. This study further assesses a number of clinical issues which impact long-term outcomes post transplantation; hence, its results will have a major clinical impact. Trial registration: Clinicaltrials.gov: NCT01843348 , date of registration – 18 April 2013; EUDRACT number: 2011-005238-21, date of registration – 20 March 201

Localization of apoptosis proteins and lymphocyte subsets in chronic rejection of human liver allograft

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