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Penelitian ini bertujuan untuk mengetahui: 1) Hubungan keterampilan komunikasi dengan motivasi belajar siswa di SMP se-Kecamatan Telaga. 2) Hubungan pemberian reward dengan motivasi belajar siswa di SMP se-Kecamatan Telaga. 3) Hubungan antara keterampilan komunikasi dan pemberian reward dengan motivasi belajar siswa di SMP se-Kecamatan Telaga. Metode yang digunakan dalam penelitian ini yaitu kuantitatif dengan teknik korelasional. Teknik pengumpulan data menggunakan kuesioner. Hasil penelitian ini menunjukkan bahwa: 1) Keterampilan komunikasi dengan motivasi belajar siswa memiliki hubungan yang positif dengan koefisien korelasi 82%. 2) Pemberian reward dengan motivasi belajar siswa memiliki hubungan yang positif dengan koefisien korelasi 76%. 3) Keterampilan komunikasi dan pemberian reward dengan motivasi belajar siswa memiliki hubungan yang positif dengan koefisien korelasi 70%. Untuk itu disarankan: 1) Guru, diharapkan untuk lebih meningkatkan keterampilan komunikasi, agar lebih percaya diri saat mengajar. 2) siswa, diharapkan dapat meningkatkan motivasi belajar siswa, agar bisa mendapatkan prestasi. 3) Bagi peneliti selanjutnya, diharapkan dapat melakukan penelitian lanjutan yang berkaitan dengan keterampilan komunikasi, pemberian reward, dan motivasi belajar siswa dengan menambah faktor-faktor lain guna mendapatkan berbagai informasi dalam upaya meningkatkan motivasi belajar siswa.

PDGFRA has been shown to be commonly altered in high-grade gliomas (HGGs), including histone 3 lysine 27-mutated diffuse midline gliomas (H3K27M DMG), a disease with almost no long-term survivors. Here, we performed comprehensive genomic and transcriptomic analysis of 260 high-grade glioma cases, which revealed PDGFRA genomic alterations (mutations and/or amplifications) in 13% of patients. H3K27M DMGs had significantly higher PDGFRA expression compared to H3 wild-type tumors, and PDGFRA gene amplification resulted in even higher expression levels in H3K27M DMGs as well as H3 wild-type HGGs. We tested a panel of patient- derived pHGG/H3K27M DMG models against a range of PDGFRA inhibitors, including avapritinib, a potent small molecule inhibitor with relatively selective activity against both wild-type and mutant PDGFRA. Avapritinib showed supra-micromolar blood-brain barrier penetration in our pre-clinical models and demonstrated significant survival impact in an aggressive patient-derived H3K27M DMG mouse xenograft model. Finally, building on this preclinical activity, we report here the first clinical experience using avapritinib in eight pediatric and young adult patients with high-grade glioma (H3K27M DMG and/or PDGFRA altered). Avapritinib has thus far been well tolerated with no significant acute toxicities. Most importantly, our preliminary data reveal radiographic response evaluated by RAPNO criteria in 50% of patients, a striking outcome rarely seen in this patient population. In summary, we report that avapritinib is a selective, CNS-penetrant small molecule inhibitor of PDGFRA that shows potent activity in preclinical models and produces promising clinical responses with good tolerability in patients with high-grade glioma. This suggests a promising role for avapritinib therapy in this population with previously dismal outcomes. Citation Format: Lisa Mayr, Maria Trissal, Kallen Schwark, Jenna Labelle, Andrew Groves, Julia Furtner-Srajer, Jeffrey Supko, Liesa Weiler-Wichtl, Olivia Hack, Jacob Rozowsky, Joana G. Marques, Eshini Pandatharatna, Ulrike Leiss, Verena Rosenmayr, Frank Dubois, Noah F. Greenwald, Sibylle Madlener, Armin S. Guntner, Hana Pálová, Natalia Stepien, Daniela Lötsch-Gojo, Christian Dorfer, Karin Dieckmann, Andreas Peyrl, Amedeo A. Azizi, Alicia Baumgartner, Ondřej Slabý, Petra Pokorná, Pratiti Bandopadhayay, Rameen Beroukhim, Keith Ligon, Christof Kramm, Annika Bronsema, Simon Bailey, Ana Guerreiro Stücklin, Sabine Mueller, David T. Jones, Natalie Jäger, Jaroslav Štěrba, Leonhard Müllauer, Christine Haberler, Chandan Kumar-Sinha, Arul Chinnaiyan, Rajen Mody, Mary Skrypek, Nina Martinez, Daniel C. Bowers, Carl Koschmann, Johannes Gojo, Mariella Filbin. Clinical response to the PDGFRα inhibitor avapritinib in high-grade glioma patients. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5719.

SARS-CoV-2-related mortality and hospitalizations differ substantially between New York City neighborhoods. Mitigation efforts require knowing the extent to which these disparities reflect differences in prevalence and understanding the associated drivers. Here, we report the prevalence of SARS-CoV-2 in New York City boroughs inferred using tests administered to 1,746 pregnant women hospitalized for delivery between March 22nd and May 3rd, 2020. We also assess the relationship between prevalence and commuting-style movements into and out of each borough. Prevalence ranged from 11.3% (95% credible interval [8.9%, 13.9%]) in Manhattan to 26.0% (15.3%, 38.9%) in South Queens, with an estimated city-wide prevalence of 15.6% (13.9%, 17.4%). Prevalence was lowest in boroughs with the greatest reductions in morning movements out of and evening movements into the borough (Pearson R = −0.88 [−0.52, −0.99]). Widespread testing is needed to further specify disparities in prevalence and assess the risk of future outbreaks., New York City is one of the areas most affected by the SARS-CoV-2 pandemic in the United States, and there has been large variation in rates of hospitalisation and death by city borough. Here, the authors show that boroughs with the largest reduction in daily commutes also had the lowest SARS-CoV-2 prevalence.

Targeting oncogenic fusion-genes in pediatric high-grade gliomas (pHGG) with entrectinib has emerged as a highly promising therapeutic approach. Despite ongoing clinical studies, to date, no reports on the treatment of cerebrospinal fluid (CSF) disseminated fusion-positive pHGG exist. Moreover, clinically important information of combination with other treatment modalities such as intrathecal therapy, radiotherapy and other targeted agents is missing. We report on our clinical experience of entrectinib therapy in two CSF disseminated ROS1/NTRK-fusion-positive pHGG cases. Combination of entrectinib with radiotherapy or intrathecal chemotherapy appears to be safe and has the potential to act synergistically with entrectinib treatment. In addition, we demonstrate CSF penetrance of entrectinib for the first time in patient samples suggesting target engagement even upon CSF dissemination. Moreover, in vitro analyses of two novel cell models derived from one case with NTRK-fusion revealed that combination therapy with either a MEK (trametinib) or a CDK4/6 (abemaciclib) inhibitor synergistically enhances entrectinib anticancer effects. In summary, our comprehensive study, including clinical experience, CSF penetrance and in vitro data on entrectinib therapy of NTRK/ROS1-fusion-positive pHGG, provides essential clinical and preclinical insights into the multimodal treatment of these highly aggressive tumors. Our data suggest that combined inhibition of NTRK/ROS1 and other therapeutic vulnerabilities enhances the antitumor effect, which should be followed-up in further preclinical and clinical studies.

The global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand.

OBJECTIVE: To describe differences in outcomes between pregnant women with and without coronavirus dsease 2019 (COVID-19). DESIGN: Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription-polymerase chain reaction. All infants of mothers with COVID-19 underwent SARS-CoV-2 testing. SETTING: Three New York City hospitals. POPULATION: Pregnant women >20 weeks of gestation admitted for delivery. METHODS: Data were stratified by SARS-CoV-2 result and symptomatic status, and were summarised using parametric and nonparametric tests. MAIN OUTCOME MEASURES: Prevalence and outcomes of maternal COVID-19, obstetric outcomes, neonatal SARS-CoV-2, placental pathology. RESULTS: Of 675 women admitted for delivery, 10.4% were positive for SARS-CoV-2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities among women with symptomatic COVID-10 versus asymptomatic COVID-19 versus no COVID-19. Caesarean delivery rates were 46.7% in symptomatic COVID-19, 45.5% in asymptomatic COVID-19 and 30.9% in women without COVID-19 (P = 0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID-19 versus 4.5% of women without COVID-19 (P

This article presents the results of a questionnaire-based survey on self-assessment of the effects of metal detecting among British Armed Forces veterans with PTSD (Post Traumatic Stress Disorder) and/or other diagnosed or undiagnosed psychological challenges. Although the qualitative analysis presented here only is a first step towards understanding its beneficial effects, the authors conclude that archaeological metal detecting can be regarded as having the potential to positively influence well-being and happiness for people suffering from mental health challenges. The findings suggest that practitioners perceive metal detecting as having a significantly positive and lasting effect on their health and well-being. A significant number of respondents perceive metal detecting as having mitigated specific symptoms of their psychological disorders (PTSD, depression, anxiety). The key factors for the beneficial effect of metal detecting appear to be of both mental, sensory, physical and social nature. First and foremost, however, its beneficial effect seems to be deeply rooted in the fact that the participants interact with archaeological heritage.

Privat metaldetektorbrug og jagten på oldtidsfund er en populær fritidsbeskæftigelse for et stigende antal danskere. Resultaterne af en online spørgeundersøgelse kaster lys på en hidtil overset dimension af detektorhobbyen, nemlig dens brug som aktiv selvterapi. Undersøgelsens målgruppe var aktive detektorbrugere med psykiske problemer som depression, stress, angst og posttraumatisk stresslidelse (PTSD). Vores resultater viser, at metaldetektorhobbyen for denne gruppe har en varig og positiv indflydelse på deres velvære og psykiske sundhed. For enkeltes vedkommende viser resultaterne sågar, at hobbyen har lindret eller gjort det nemmere at håndtere deres psykologiske problemer. Vores undersøgelse kaster dermed også lys over arkæologiens potentiale som socialt aktiv og som kilde til mental sundhed, personligt velvære og lykkefølelse. Denne alternative brug af arkæologien åbner for en lang række perspektiver og muligheder for dansk museumsarkæologi i det hele taget.

The purpose of this study is to assess the rate of spontaneous preterm birth (SPTB) versus indicated preterm birth (IPTB) in triplet pregnancies and determine factors associated with these outcomes.This is a review of triplet pregnancies delivering at our institution from 2003 to 2015. Patients delivering prior to 24 weeks gestational age (GA) were excluded. SPTB included cases of preterm labor or preterm premature rupture of membranes37 weeks. IPTB was defined as deliveries37 weeks for maternal or fetal complications.Of 80 triplet pregnancies, 18 (22.5%) were not complicated by SPTB or IPTB and reached their scheduled delivery date. In the remaining 62 pregnancies, IPTB occurred in 31 patients and SPTB in 31 patients. Parity was the only significant factor associated with reaching a scheduled delivery, with 56.3% of parous women reaching a scheduled delivery versus 14.1% of nulliparous women (p = 0.001). There were no significant differences in maternal age, parity, chorionicity, or use of ART between the SPTB and ITPB groups.While the majority of our triplet patients delivered preterm, IPTB occurred as frequently as SPTB in our population. Parous women were significantly less likely to experience SPTB or to require preterm delivery for maternal or fetal indications.

Objective: The objective of our study was to evaluate the prevalence and clinical factors associated with hyponatremia in patients with preeclampsia. Study design: This is a descriptive study of all patients who delivered at our institution from 2013 to 2014. Patients with preeclampsia were identified from electronic medical records. Preeclampsia with and without severe features was defined using the criteria outlined in the American Congress of Obstetricians and Gynecologists Hypertension in Pregnancy guidelines. As sodium levels have been shown to be approximately 5 mEq/L lower in pregnancy, hyponatremia was defined as a sodium level Results: We identified 332 pregnancies complicated by preeclampsia, including 277 singletons and 55 twins. Hyponatremia was noted in 32 (9.7%) patients. Preeclampsia with severe features was present in the majority of patients with hyponatremia, and hyponatremia was more common in those with preeclampsia with severe features compared to those without (P Conclusion: Hyponatremia is not uncommon in preeclampsia, and is even more common in those with preeclampsia with severe features and twin gestations. As women with preeclampsia are at risk for hyponatremia, serum sodium should be monitored, especially in women with preeclampsia with severe features or twin gestations.

Background Our objective was to determine the predictive value of the prenatal diagnosis of isolated clubfoot in twin gestations compared to singleton gestations. Methods A prospectively entered ultrasound database was reviewed for all pregnancies scanned at our institution from 2002 to 2014. Cases of suspected clubfoot were identified. Neonates with associated anomalies or aneuploidy, and patients who delivered at other institutions were excluded. Neonatal charts were reviewed for the confirmation of clubfoot. The chi-squared (χ2) test, Fisher’s exact test and the Mann-Whitney U test were used in the analysis, with p Results Of those women who had prenatal ultrasound and subsequently delivered at our hospital, 84 pregnancies had isolated clubfoot suspected in the antenatal period. Of these pregnancies, 20 were twin gestations and 64 were singleton gestations. Overall, 51/84 (60.7%) pregnancies had clubfoot confirmed during the neonatal period. Of the twin pregnancies, only 35% (7/20) had a confirmed diagnosis of clubfoot at birth compared to 68.8% (44/64) of the singleton pregnancies (P = 0.008). Gestational age at diagnosis, breech presentation, neonatal gender, unilateral vs. bilateral clubfoot and suspicion of clubfoot in the presenting twin (Twin A) vs. the non-presenting twin (Twin B) did not correlate with an accurate diagnosis of clubfoot in twins. Conclusion False-positive prenatal diagnosis of isolated clubfoot is more common in twin gestations compared to singletons. This may be due to transient malpositioning or a result of diminished space. Obstetric providers should consider the possibility of a false-positive diagnosis and use caution when counseling patients about a prenatal suspicion for clubfoot, especially in twin gestations.

Severe combined immunodeficiency syndrome (SCID) is a life-threatening condition leading to early infant death as a result of severe infection, due to impaired cellular and humoral immune systems. Various forms of SCID are classified based on the presence or absence of T cells, B cells and natural killer cells. Patients usually present with recurrent infections and failure to thrive. Definitive treatment is hematopoietic stem cell transplantation. To achieve the best outcome, it should be performed prior to the development of severe infection. In This study, we described 10 patients (6 male and 4 female) with SCID who were admitted to Mofid Children Hospital, Tehran, Iran, from 2006 to 2013. We reviewed patients' clinical manifestation, laboratory data, family history and outcome. The mean age at the time of diagnosis was 131.8 days. One patient had non-consanguineous parents. Seven patients received BCG vaccine before the diagnosis of SCID, three of them showed disseminated BCG infection. One patient presented with invasive pulmonary aspergillosis. Flow cytometric analysis showed T⁻B⁺NK⁻ in three patients, T⁻B⁻NK⁺ in five patients, T⁻B⁻NK⁻ in one patient, and T⁻B⁺NK⁺ in one patient. This study highlights the importance of early diagnosis and patient referral before the occurrence of serious infection.

OBJECTIVE Our objective was to describe utilization and impact of sonographic growth assessment in pregnancies with low pregnancy-associated plasma protein-A (PAPP-A). METHODS Singleton pregnancies with PAPP-A ≤5th percentile and no other risk factors for fetal growth restriction from January 2011-June 2013 were included. Antepartum and delivery data were obtained by reviewing medical records. Outcomes of pregnancies referred for sonographic growth assessment were compared with those not referred for ultrasound. Fisher's exact test, chi-square analysis, and Mann-Whitney U were used for statistical comparison. RESULTS Two hundred ninety-five patients were included. Of 285 pregnancies reaching the third trimester, 77.5% were referred for ultrasound, with the initial scan at a median gestational age of 28 weeks [26-29]. Referral for growth scans was associated with earlier gestational age at delivery and higher rates of delivery for fetal indications. Those who did not undergo growth scans were more likely to deliver a small for gestational age infant at term, 20.7% versus 35.0% (p = 0.04). There was one third-trimester fetal demise, occurring in a patient who had been undergoing growth scans. CONCLUSION Growth scans in those with low PAPP-A were associated with delivery at earlier gestational age, with higher rates of delivery for fetal indications and lower rates of small for gestational age newborns at term. No significant differences in neonatal outcomes were observed.

Teaching and resource materials on the Middle East are identified in three areas: textbooks, audiovisual materials (filmstrips, audiotapes, maps, and films), and background reading for teachers on Middle Eastern history, religion, daily life, literature, and politics. For each resource, a brief annotation and ordering information are given. (Author/DB)

To determine whether routine cervical length (CL) and fetal fibronectin (fFN) screening is associated with improved clinical outcomes in asymptomatic patients with twin pregnancies.We compared outcomes between two large cohorts of twin pregnancies who delivered in New York City from 2003 to 2012. One cohort (n = 532) was managed by a single group practice, delivered at one large academic medical center, and underwent routine serial CL and fFN screening. The second cohort (n = 456) delivered at a second large academic center and only underwent CL and fFN testing as clinically indicated. Outcomes measured include cerclage placement, preterm birth (PTB), spontaneous PTB (sPTB), and antenatal corticosteroid (ACS) exposure.Rates of cerclage placement, PTB, and SPTB were similar between the two groups. However, routine CL and fFN screening was associated with improved rates of ACS exposure in patients who delivered34 weeks (91.3% versus 74.7%, p = 0.005) and 34-36 6/7 weeks (41.3% versus 13.9%, p 0.001) without increased ACS exposure in women who delivered at term. In patients who delivered34 weeks, routine CL and fFN screening was significantly associated with improved rates of ACS exposure within 1-14 days of delivery and within 1-7 days of delivery.In twin pregnancies, routine CL and fFN screening does not reduce the risk of PTB or SPTB. However, the routine use of these tests is associated with significantly improved ACS exposure and timing for women who deliver preterm without increasing ACS exposure to women who deliver at term.