Grade Research Articles

Higher abatacept exposure after transplant decreases acute GVHD risk without increasing adverse events

AbstractIn the ABA2 study, the T-cell costimulation blockade agent, abatacept, was safe and effective in preventing acute graft-versus-host disease (aGVHD) after unrelated-donor hematopoietic cell transplant (HCT), leading to US Food and Drug Administration approval. Here, we performed a determination of abatacept pharmacokinetics (PK), which enabled an examination of how abatacept exposure-response relationships affected clinical outcomes. We performed a population PK analysis of IV abatacept using nonlinear mixed-effect modeling and assessed the association between abatacept exposure and key transplant outcomes. We tested the association between the trough after dose 1 (Ctrough_1) and grade (GR) 2 or 4 aGVHD (GR2-4 aGVHD) through day +100. An optimal Ctrough_1 threshold was identified via recursive partitioning and classification tree analysis. This demonstrated that abatacept PK was characterized by a 2-compartment model with first-order elimination. The ABA2 dosing regimen was based on previous work targeting a steady-state abatacept trough of 10 μg/mL. However, a higher Ctrough_1 (≥39 μg/mL, attained in ∼60% of patients on ABA2) was associated with a favorable GR2-4 aGVHD risk (hazard ratio, 0.35; 95% confidence interval, 0.19-0.65; P < .001), with a Ctrough_1 <39 μg/mL associated with GR2-4 aGVHD risk indistinguishable from placebo (P = .37). Importantly, no significant association was found between Ctrough_1 and key safety indicators, including relapse, and cytomegalovirus or Epstein-Barr virus viremia. These data demonstrate that a higher abatacept Ctrough_1 (≥39 μg/mL) was associated with a favorable GR2-4 aGVHD risk, without any observed exposure-toxicity relationships. This trial was registered at www.clinicaltrials.gov as #NCT01743131.

Educating Children through Increasing Interest in Reading Books

The aims of this study is to describe that the development of the era which is increasing in this digital era requires parents to pay more attention to the development of their children's personality, especially in the field of education, both formal education and non-formal education from the family, in terms of increasing children's literacy or interest in reading. to books both school lessons and books about knowledge. Introducing children to books even when they are toddlers by reading them is one way for children to love and enjoy reading books. The reality these days is that many children grow and develop b ut don't like reading books. In increasing interest in reading, the active role of parents and the school is required because interest in reading does not grow by itself among children, but must continue to be nurtured and encouraged from the surrounding environment. Some areas have reading rooms to increase people's interest in reading. The purpose of writing this journal is to find out the importance of education through increasing interest in reading in children since they were toddlers so that children love books more and enjoy reading, so that their knowledge increases. The type of research used and carried out in this journal is a descriptive qualitative method. Data collection was carried out through a study of increasing interest in reading in gra de 4 students of the MI school by establishing a reading corner and making it a habit to read books and then summarizing them every 15 minutes every day. Data collection in this journal is taken from various sources both books and scientific data in the form of manuscripts as evidenced by the inclusion of a bibliography. The result of the literature study is that there is a strong correlation between the level of interest in reading from the role of school and parents in children.

Efficacy and safety of capmatinib plus pembrolizumab in treatment (tx)-naïve patients with advanced non–small cell lung cancer (NSCLC) with high tumor PD-L1 expression: Results of a randomized, open-label, multicenter, phase 2 study.

9118 Background: Capmatinib is a selective MET inhibitor approved for patients (pts) with metastatic NSCLC harboring MET exon 14 skipping mutation. Pembrolizumab (pembro) is a programmed death protein-1 (PD-1) inhibitor approved as monotherapy for pts with advanced NSCLC expressing PD-ligand 1 (PD-L1). Preclinical studies have shown that capmatinib enhances T cell mediated antitumor response in mice treated with PD-1 inhibitors. Combining capmatinib with pembro may be beneficial in pts with advanced NSCLC expressing high tumor PD-L1. Methods: Herein we evaluated the efficacy and safety of capmatinib plus pembro (combo) versus pembro alone in tx-naïve pts with advanced MET-unselected NSCLC expressing PD-L1 with tumor proportion score (TPS) ≥50%, and no ALK or EGFR tumor aberrations. Pts received pembro 200 mg IV q3w in the pembro alone arm or with capmatinib 400 mg orally BID in the combo arm. The primary endpoint was investigator-assessed progression-free survival (PFS) using RECIST v1.1. Secondary endpoints included overall response rate (ORR), disease control rate (DCR), pharmacokinetics and safety. Results: As of the data cut off (DCO) of 28 Feb 2021, 76 pts were randomized 2:1 to the combo arm (n = 51) or pembro alone arm (n = 25). Baseline demographics and disease status were mostly comparable across study arms. At this interim analysis, PFS data were not mature. Median PFS (95% CI) was 6.3 (3.2, not evaluable [NE]) months in the combo arm and 4.3 (2.3, NE) months in the pembro alone arm. The ORR (95% CI) was 15.7% (7.0%, 28.6%) and 28.0% (12.1%, 49.4%) in the combo and pembro alone arms, respectively. The DCR (95% CI) was comparable across study arms; combo: 56.9% (42.2%, 70.7%) and pembro alone: 56.0% (34.9%, 75.6%). In the combo arm, capmatinib exposure (Cmax: 3580 ng/mL [n = 7] and AUCtau: 19700 hr*ng/mL [n = 2]) was consistent with data from previous studies. Tx-related grade (GR) ≥3 adverse events (AEs) were more common in the combo (37.3%) vs pembro alone arm (16%). Tx-related AEs occurring in ≥10% of pts are shown in the Table. Tx discontinuation and dose adjustment/interruptions were more common in the combo (27.5% and 52.9%) vs pembro alone arm (16% and 16%). Capmatinib was stopped prematurely in the combo arm, and at DCO, 32 (62.7%) pts in the combo arm and 18 (72%) pts in the pembro alone arm were receiving pembro monotherapy. Conclusions: Combination tx with capmatinib and pembro was not well tolerated and did not improve antitumor activity in tx-naïve pts with advanced NSCLC with PD-L1 TPS ≥50%. Clinical trial information: NCT04139317. [Table: see text]

P13: CAN PATIENT-REPORTED OCULAR SYMPTOMS GUIDE DOSE MODIFICATIONS IN PATIENTS WITH RELAPSED/REFRACTORY MULTIPLE MYELOMA RECEIVING BELANTAMAB MAFODOTIN?

Introduction: Belantamab mafodotin (belamaf) is a B-cell maturation antigen (BCMA)-targeting antibody-drug conjugate approved as a monotherapy for triple-class refractory adult patients with relapsed/refractory multiple myeloma (RRMM). This hypothesis generating post hoc analysis of DREAMM-2 trial (NCT03525678) data examined relationships between corneal exam findings, best-corrected visual acuity (BCVA) changes and direct patient-reported ocular symptoms per the Ocular Surface Disease Index (OSDI) questionnaire. This approach may provide insight into relationships between corneal exam findings, BCVA, ocular symptoms, impact on quality of life to determine if BCVA decline and symptoms can guide dosing. Surrogate marker identification for results from corneal exam findings would help providers determine if dosing adjustments are necessary. Methods: Snellen chart BCVA assessment and corneal eye exams were performed on all patients receiving belamaf (2.5 mg/kg, q3w) by ECPs at baseline (BL) and before each dose. Corneal exam findings (keratopathy) and BCVA were assessed per protocol-defined criteria. Grade (GR) assessment, relative to BL, was based on the worst finding in the worse eye. Patient-reported ocular symptoms and vision-related functioning, as per the OSDI, were used to evaluate the impact of treatment-related ocular toxicity. The OSDI patient-reported outcome questionnaire assesses eye symptoms/effects on vision-related function and was performed in all patients before each belamaf dose. Items 1–5 address the frequency of eye-related symptoms and items 6–9 address functional limitation frequency. OSDI was considered positive, clinically meaningful and potentially treatment associated when at least one question 1–5 (sensitivity to light, gritty/painful eyes, blurred or poor vision) was reported as experienced “all of the time” and at least one question 6–9 (driving at night, reading, working with PC or watching TV) was reported as experienced “most of the time.” Results: GR 3–4 (severe) keratopathy was observed 5% of the time in patients not reporting frequent ocular symptoms measured by the OSDI questionnaire (no items 1–9 ≥ “most of the time”). In patients who reported no items 1–5 “all of the time” AND no items 6–9 ≥ “most of the time” (OSDI negative), GR 3–4 keratopathy was observed 6.5% of the time (Table). In patients who reported “no deterioration from BL” for any OSDI eye-related symptoms or functional limitations, GR 3–4 keratopathy was observed ~3%–7% of the time and GR 0–2 (mild) keratopathy ~23%–34% of the time. Similar results were observed in patients with BL BCVA ≤20/30 who reported “no deterioration from BL” for any eye-related adverse events (AEs) or functional limitations (GR 3–4 keratopathy: ~2%–6% of the time; GR 0–2 keratopathy: ~19%–28% of the time); patients with worse BL visual acuity (BCVA >20/30) who reported “no deterioration” for items 1–9 had lower incidence of GR 3–4 (~0%–1%) and GR 0–2 keratopathy (~3%–8%). Conclusions: These results suggest that hematologists/oncologists may be able to use ocular symptoms and the OSDI tool as potential surrogate markers for eye exam results to help determine whether dosing changes are needed. Validation with other belamaf dose regimens is ongoing. Funding Source: GSK(205678) Encore statement: Previously presented as Poster 2746 at the American Society of Hematology Annual Meeting, 11–14 December 2021; submitted with permission and on behalf of the original authors.

Can Patient-Reported Ocular Symptoms Guide Dose Modifications in Patients with Relapsed/Refractory Multiple Myeloma Receiving Belantamab Mafodotin?

Can Patient-Reported Ocular Symptoms Guide Dose Modifications in Patients with Relapsed/Refractory Multiple Myeloma Receiving Belantamab Mafodotin?

Influence of crumb rubber incorporating different warm mix asphalt additives on the mechanical performance of the WMA mixture

The compacting and mixing processes involving hot mix asphalt during asphalt production can lead to air pollution as a result of a high volatile organic compound. An alternative solution that can reduce greenhouse gas emissions is by using warm-mix asphalt (WMA). A proper application of additives to the WMA can improve the asphalt mixture's strength, durability, and workability. In this study, a 60/70 grade asphalt binder was added with 5% of crumb rubber (CR) and three different WMA additives at the recommended dosages, namely Sasobit, Cecabase, and Rediset. The wet method was used to blend the additives with virgin asphalt binders. The mixing and compacting temperatures were set at 135°C and 125°C, respectively, to mix the asphalt mixture. Mechanical performance tests were performed to evaluate the impact of WAM additives with CR on asphalt mixture. Based on the results, all the modified asphalt mixtures showed a better mechanical performance than the virgin asphalt mixture in terms of indirect tensile strength, moisture resistance, permanent deformation, and stiffness. Among all the WMA additives, Sasobit with CR showed the most significant impact on the asphalt mixture's performance.

P-219: Relationship between corneal exam findings, best-corrected visual acuity, and ocular symptoms in patients with relapsed or refractory multiple myeloma receiving belantamab mafodotin

Background Belantamab mafodotin (belamaf; GSK2857916) is a B-cell maturation antigen (BCMA)-targeting antibody–drug conjugate approved in the United States and European Union as a monotherapy for heavily pretreated adult patients with relapsed or refractory multiple myeloma (RRMM). Ocular events (OEs) during the pivotal DREAMM-2 trial (NCT03525678) included corneal exam findings (superficial punctate keratopathy and/or microcyst-like epithelial changes), decline in best-corrected visual acuity (BCVA), and ocular symptoms. Dose reductions or delays based on corneal exam findings and BCVA were used to manage OEs. Here we performed a post hoc investigation of relationships between corneal exam findings, BCVA changes, and patient-reported ocular symptoms to explore if BCVA decline and symptoms could guide dosing, rather than corneal exams. Methods Eye evaluations (including a corneal exam and BCVA assessment of Snellen visual acuity) were performed on all patients receiving single-agent belamaf (2.5 mg/kg) by ophthalmologists at baseline and prior to each belamaf dose. Changes in the corneal epithelium (keratopathy) and BCVA were both assessed as per protocol-defined criteria and assessment of grade (GR) was based on the worse eye. BCVA grading was relative to baseline. Patient-reported ocular symptoms were reported as per the Common Terminology Criteria for Adverse Events. Results In 12.5% of eye evaluations, GR 3–4 keratopathy was associated with minimal or no (GR ≤1) BCVA changes. When patient-reported ocular symptoms were also considered, GR 3–4 keratopathy with GR ≤1 BCVA changes and no ocular symptoms was observed in only 7.5% of evaluations. Mild or no (GR ≤2) keratopathy was associated with GR ≤1 BCVA changes in 59.5% of evaluations, or in 38.8% of evaluations with no ocular symptoms reported. Overall, GR 3–4 keratopathy was found in 24.9% of evaluations; by contrast, patients had GR 2–4 BCVA changes or ocular symptoms in 53.6% of evaluations. Conclusions These findings suggest that BCVA changes and ocular symptoms should be further investigated to determine if they can be used as potential surrogate markers (eg, frequency of eye examinations based on symptoms) for the management of belamaf dosing to potentially reduce the burden on patients and healthcare professionals. Funding Source GSK (205678; NCT03525678). Drug linker technology licensed from Seagen Inc.; mAb produced using POTELLIGENT Technology licensed from BioWa. Encore Statement ©2021 American Society of Clinical Oncology, Inc. Reused with permission. This abstract was accepted and previously presented at the 2021 ASCO Annual Meeting. All rights reserved. Belantamab mafodotin (belamaf; GSK2857916) is a B-cell maturation antigen (BCMA)-targeting antibody–drug conjugate approved in the United States and European Union as a monotherapy for heavily pretreated adult patients with relapsed or refractory multiple myeloma (RRMM). Ocular events (OEs) during the pivotal DREAMM-2 trial (NCT03525678) included corneal exam findings (superficial punctate keratopathy and/or microcyst-like epithelial changes), decline in best-corrected visual acuity (BCVA), and ocular symptoms. Dose reductions or delays based on corneal exam findings and BCVA were used to manage OEs. Here we performed a post hoc investigation of relationships between corneal exam findings, BCVA changes, and patient-reported ocular symptoms to explore if BCVA decline and symptoms could guide dosing, rather than corneal exams. Eye evaluations (including a corneal exam and BCVA assessment of Snellen visual acuity) were performed on all patients receiving single-agent belamaf (2.5 mg/kg) by ophthalmologists at baseline and prior to each belamaf dose. Changes in the corneal epithelium (keratopathy) and BCVA were both assessed as per protocol-defined criteria and assessment of grade (GR) was based on the worse eye. BCVA grading was relative to baseline. Patient-reported ocular symptoms were reported as per the Common Terminology Criteria for Adverse Events. In 12.5% of eye evaluations, GR 3–4 keratopathy was associated with minimal or no (GR ≤1) BCVA changes. When patient-reported ocular symptoms were also considered, GR 3–4 keratopathy with GR ≤1 BCVA changes and no ocular symptoms was observed in only 7.5% of evaluations. Mild or no (GR ≤2) keratopathy was associated with GR ≤1 BCVA changes in 59.5% of evaluations, or in 38.8% of evaluations with no ocular symptoms reported. Overall, GR 3–4 keratopathy was found in 24.9% of evaluations; by contrast, patients had GR 2–4 BCVA changes or ocular symptoms in 53.6% of evaluations. These findings suggest that BCVA changes and ocular symptoms should be further investigated to determine if they can be used as potential surrogate markers (eg, frequency of eye examinations based on symptoms) for the management of belamaf dosing to potentially reduce the burden on patients and healthcare professionals.

Identifying prognostic factors associated with overall survival in second-line paclitaxel plus ramucirumab treated human epidermal growth factor receptor 2-negative advanced/recurrent gastric cancer.

This study aimed to identify the overall survival prolongation index in patients who received paclitaxel plus ramucirumab as second line chemotherapy for human epidermal growth factor receptor (HER) 2-negative advanced/ recurrent gastric cancer (AGC). We included 77 patients who underwent second line chemotherapy (paclitaxel plus ramucirumab) for AGC at our institution between January 2015 and September 2020. To determine factors associated with survival, univariate and multivariate analyses were performed, and hazard ratios and their 95% confidence intervals (95% CI) were calculated. In the multivariate analysis, grade ≥1 neutropenia (yes) and the number of anti-cancer drugs used (≥5) were independently and significantly associated with survival. Compared to the patients without grade ≥1 neutropenia, patients with grade ≥1 neutropenia had a survival hazard ratio of 0.455 (95% CI: 0.214-0.966; p = 0.040). The median second line treatment durations in patients with grade ≥1 neutropenia (n = 54) and in those without grade ≥1 neutropenia (n = 23) were 133 days (95% CI, 98-190 days) and 70 days (95% CI, 41-128 days), respectively (log-rank test, p = 0.026). This study demonstrated that AGC patients with initial neutropenia may benefit from paclitaxel plus ramucirumab therapy.

Assessment of alternative approaches of primary cervical cancer screening among women in low-income environments

Alternative techniques for detecting cancer of the cervix uteri alongside its early precancerous lesions still remain necessary for low income environments since morbidity and mortality due to cervical cancer continues to be on the rise. We recruited one thousand and seventy-seven women aged 15-55 years from selected study hospitals in Eastern Uganda and examined them using Papanicolaou (Pap) smear, direct visual inspection with 5% acetic acid solution (VIA), and human papillomavirus (HPV) DNA testing. Study participants detected with high-grade lesions (HSIL) or cancer cells on Pap smear test, positive VIA test (acetowhite lesions, cervical ulcer or growth), and positive high-risk HPV DNA (relative light units (RLU) were immediately scheduled for colposcopy and cervical biopsy. Of the forty percent of the women confirmed with pap smear positive, 43 of the 63 women had invasive carcinoma (68.3%), while 89 out of 137 women with confirmed biopsy were diagnosed with high grade CIN (CIN2,3) (65%). DVI identified 46 of 63 carcinomas (73%) as well as 47 of 74 high grades CIN (CIN 2, 3) (64%). There was a variation in HPV DNA results due to the cutoff value considered in defining the final result. HPV DNA of high-risk HPV types was detected 39 (61.9%) out the 63 women diagnosed invasive cervical cancer, while 66 (73.3%) or 46 (51%) was detected in the biopsy of women diagnosed with high grade CIN (CIN 2,3). Similarity in identification of high-grade cervical abnormalities was registered by the testing methods. Both VIA and HPV genetic testing methods diagnosed similar numbers of high grade CIN 2,3 and invasive cancer cases as Pap smears. Nevertheless, individual test methods categorized study participants with no cervical disease as being positive. Key words: Visual inspection with acetic acid (VIA), cervical intraepithelial neoplasia (CIN), human papillomavirus (HPV).

A Study on Improvement of Maintenance Strategy based on Analysis of Bridge Safety Grade

A Study on Improvement of Maintenance Strategy based on Analysis of Bridge Safety Grade

The Effectiveness of Chemistry Module Integrated with Islamic Values in Atomic Structure Materials on Online Learning of Integrated Islamic Senior High School

The research aims at a) developing a chemistry module integrated with Islamic values on atomic structure material, b) analyzing the feasibility and the effectiveness of the module in online learning. The type of this module is a digital module (PDF) published as the learning media in the pandemic era. The subjects of the research are grade X students in SMA IT Nur Hidayah and SMA IT Ibnu Abbas located in Soloraya. The samples consist of the control class and the experiment class selected by purposive sampling. The instrument of reliability was tested using Cronbach Alpha formula and the content of the module was validated using Aiken formula. The data analysis used was descriptive qualitative. The findings of the research show that the development of the chemistry module integrated with Islamic values was analyzed using Borg and Gall (1983) developing stages that consist of 9 stages. The chemistry module integrated with Islamic values is feasible and it is categorized as “very good” and effective to be used to develop the students' cognitive. Thus, the chemistry module integrated with Islamic values could be implemented to enhance the SMA Islam Terpadu students’ cognitive competencies in online learning.

Hyperdynamic Valve: A Rare Case of Ehlers-Danlos Syndrome

Ehlers-Danlos syndrome is a group of rare genetic disorders of collagen characterized by skin hyperextensibility, joint hypermobility and tissue fragility. The authors describe a rare case of a 52-year-old woman that presented to the clinic with chronic joint pain and talipes equinovarum since childhood. Large eyes, sunken cheeks, thin nose and lobeless ears were noticed on clinical examination. Beighton joint hypermotility criteria were met with a positive Walker and Steinberg sign, elbow extension superior to 10° and knee extension in genu recurvatum more than 10°. An aortic diastolic grade III/VI heart murmur was heard. The complementary study was unremarkable. Moderate aortic insufficiency was found on transthoracic echocardiogram. Genetic testing confirmed positivity for COL1A2, a gene that encodes pro-alpha2 chain type of collagen, which causes cardiac-valvular Ehlers-Danlos syndrome. Authors intend to warn to collagen-related syndromes, since severe complications are associated with a reduced life expectancy for individuals with this condition. J Med Cases. 2021;12(7):284-287 doi: https://doi.org/10.14740/jmc3692

AN EXAMINATION OF SELF-EFFICACY IN DIGITAL READING AMONG STUDENT TEACHERS OF PRIMARY EDUCATION

The research aims to examine self-efficacy in digital reading among student teachers of primary education focusing on certain variables. The model of the research is descriptive survey model. The data is collected during the 2020-2021 academic year via Google Form. The data is analysed through SPSS 22.0 programme. The analysis showed that the concerned student teachers’ self-efficacy in digital reading is in ‘good’ standards. There is no significant difference in the self-efficacy in digital reading of the students teacher according to gender. However, depending on the grade level variable, the findings show that student teachers' self-efficacy in digital reading has changed significantly. In accordance with this difference, first grade students’ mean of analysis scores in digital reading is lower than those in other grade levels. Finally, the analysis showed that there is no effect of daily internet use in the mean of scores of student teachers’ self-efficacy in digital reading. As a result of the research, it is suggested that more research should be done on self-efficacy in digital reading for academic literature and focus on different education years and different undergraduate programmes. Article visualizations:

Notch inhibitors induce diarrhea, hypercrinia and secretory cell metaplasia in the human colon.

In humans, inhibition of Notch oncogenic signaling leads to tumor regression. Preclinical studies indicate that Notch signaling contributes to the maintenance of intestinal homeostasis. Here, we sought to describe the intestinal effects of a first-in-human Notch inhibitor in an indication of refractory cancer. Between 2014 and 2017, adult patients treated for refractory cancer with the novel Notch inhibitor LY3039478 and who had grade ≥ 2 diarrhea were referred to the gastroenterology department of a tertiary hospital in the Paris region of France. Eleven patients (median (range) age: 72 (29-83)) were included in the study. All patients had advanced cancer: adenoid cystic carcinoma (n=3, 27 %), sarcoma (n=3, 27 %), and other types (n=5, 46 %). In all cases, digestive tract endoscopy revealed abundant mucus in the intestinal lumen, and digestive tract biopsies showed an abnormally low proportion of enterocytes and marked elevation of the proportion of pseudostratified goblet cells. Microscopic inflammation was seen in colon biopsies from 2 of the 11 patients (18 %). The clinical, endoscopic and histological abnormalities were dependent on the dose of Notch inhibitor. All patients resolved their digestive signs or symptoms after discontinuing the dose and the median (range) time interval between discontinuation of the Notch inhibitor and resolution of all the gastrointestinal signs and symptoms was 7 days (4-24). Likewise, the median time interval between discontinuation and resolution of the histological abnormalities was 7 days (1-10). Blocking Notch signaling induces secretory cell metaplasia of the intestinal epithelium, which in turn leads to transient diarrhea. Our results confirm the role of Notch signaling in intestinal homeostasis in humans.

Analysis of Students’ Problems in Determining Adjective Clause of Report Text at Grade XI of SMAN 2 Kerinci Academic Years 2015/2016

One of them carries out important rule that is using adjective clauses especially who, which, when, and where. Based on the finding above, it can be seen that students who has understood what adjevtive clause is and how to find out in the report text. This research was aimed to find out students’ problems in determining adjective clause of report text at grade XI of SMAN 2 Kerinci Academic Years 2015/2016. And to find out the causes of students’ problems in determining adjective clause of report text at grade XI of SMAN 2 Kerinci Academic Years 2015/2016. The method of this research was descriptive reserach. The sample of this research was class XI IA1 of SMAN 2 Kerinci. There were 28 students. The data were collected by using grammar test for quantitative data and using interview for qualitative data. The result of this research showed that the students at XI IA1 of SMAN 2 Kerinci were very good in determining adjective clause of report text. It indicated the mean of students’ score. It was 71.5 The researcher found that most of the students were able to determine adjective clauses of report text and few of them didn’t understand how to use them. It can be concluded that the students problems in determining adjective clauses of report text were no gotten by all students. It was concluded that the students’ problems in determining adjective clauses of report text was good. It is caused the students did not understand what their teacher had taught about tenses especially adjective clauses, they felt bored to study grammar.

Alignment between Curriculum, Textbook and Board of Intermediate and Secondary Education Question Papers of English at Secondary Level

This study deals with the alignment between National Curriculum, Textbooks, and Question papers of Board of Intermediate and Secondary Education (BISE) in the subject of English at secondary level. The purpose of the study was to check the alignment of National Curriculum for English Language, 2006 with the Textbooks of English for Grade IX-X, and to evaluate the Board of Intermediate and Secondary Education (BISE) question papers with reference to cognitive domain of Bloom’s taxonomy and with the corresponding textbooks. This study was done through document analysis. The documents analyzed for the study were the National Curriculum for English Language, Textbooks of English for Grade IX-X, and question papers of BISE of year 2014 and 2015. The instruments used for this study were the 1) Curriculum Textbook Alignment Framework and 2) Curriculum Textbook Alignment Rubric. The question papers of Board of Intermediate and Secondary Education were analyzed through the checklist developed by researcher. It was validated through expert opinion. Findings of the study depict that the SLOs stated in the textbooks of English were not completely matched with the SLOs narrated in National Curriculum Furthermore, the textbooks are not very helpful in achieving those SLOs with the help of the assessment exercises given in the textbook because most of the questions given in the textbook are not related to SLOs of National Curriculum. Findings further report that the all the question papers of Board of Intermediate and Secondary Education (BISE) for year 2014 and 2015 focused on knowledge and understanding level of Bloom’s taxonomy of cognitive domain and very less focus were given on application, analysis, synthesis and evaluation abilities. It was recommended that the same SLOs of National Curriculum of English Language for Grade IX-X should be included in the textbooks otherwise the alignment will suffer and the SLOs of higher order thinking skills should also be included in the textbooks. There should be a balance between the higher level and lower level cognitive skills Paper setters should be well aware of the Bloom’s taxonomy of cognitive domain and question papers should include items of all cognitive levels in accordance with assessment scheme of Board of Intermediate and Secondary Education, and specifications mentioned in the National Curriculum of English.

Outcomes of simultaneous anterior cruciate ligament and medial collateral ligament reconstruction

Multiligamentous knee injuries (MLKI) are rare orthopedic injuries with involvement of two or more ligaments in the knee. There are variety of combinations of MLKI and one such relatively common and important injury pattern is anterior cruciate ligament (ACL) plus medial collateral ligament (MCL) injury. Though MCL grade 1 and 2 does not warrant surgical management, grade 3 defintely needs reconstruction or repair according to past studies so as to avoid valgus instability. A retrospective study was conducted evaluating the outcomes of combined ACL and MCL injuries in 22 patients at our centre. Road traffic accidents (RTA) accounted for 45.5% of the total cases as the most common mechanism of injury. Out of 22 patients operated with simultaneous ACL and MCL reconstruction, 14 (63.6%) had good results based on Lyscholm scoring system, 5 (22.8%) had excellent results, and 3(13.6%) had fair result and none of our patients had poor results. Simultaneous single stage management of ACL and MCL injury has advantages like early rehabilitation, reduced number of hospital stay as well as absence of necessity for getting admitted and operated for each ligament separately which also brings down the cost to the patient. Keywords: Reconstruction, ACL, MCL, Lyscholm.

Does functional outcome mandate fusion in spondylolisthesis management? A retrospective analysis of 76 cases with one year follow-up

Introduction: Lumbar spondylolisthesis is a common condition in the middle-aged population that causes significant morbidity. In the management of spondylolisthesis, spinal fusion with instrumentation has been the standard of care. This study aimed to analyze whether fusion is a necessary component for achieving an optimal functional outcome in the management of spondylolisthesis. Materials and Methods: This is a retrospective study involving 76 patients who underwent a transforaminal lumbar interbody fusion with a minimum follow-up of one year. Parameters assessed were preoperative pain score with VAS, functional ability with ODI, radiological outcome with reduction of slip grade, slip angle, and lumbar lordosis improvement. MacNab’s criteria for functional outcome and Lee’s criteria for fusion were utilized. Statistical analysis was performed with students’ paired t-test and Pearsons’ correlation analysis. Results: Improvement in VAS and ODI was noted as 8.2 to 2.1 and 72 to 14 respectively. Slip angle improved from 240 to 6o and 78% of the patients showed radiological fusion and 89% showed good clinical outcomes at 1-year follow-up. Correlation analysis showed no significant correlation between the pain scores and radiological fusion parameters analyzed (r=0.142, p=0.361). However, a significant correlation was noted between the fusion group and functional outcome parameters like the ODI score (r=0.34, p Conclusion: TLIF ensures successful fusion in spondylolisthesis patients. Spina fusion is a necessary prerequisite for a successful functional outcome in spondylolisthesis patients undergoing TLIF. Slip angle reduction is not mandatory in all patients of lumbar spondylolisthesis. Keywords: Fusion, Spondylolisthesis, TLIF, PLIF, Interbody Fusion, Spine.

THE RELATIONSHIP BETWEEN SELF-ESTEEM AND FUTURE ORIENTATION IN EDUCATION CLASS XI STUDENTS AT SMA NEGERI 11 PALEMBANG, INDONESIA

This study aims to determine the relationship between self-esteem and future orientation in education in XI grade students at SMA Negeri 11 Palembang. The dependent variable in this study is the future orientation of education, while self-esteem is the independent variable. This study uses a scale of future orientation in education and a scale of self-esteem. This research uses quantitative methods. The sample used in this study were 142 class XI students at SMA Negeri 11 Palembang. The results of this study indicate a very significant relationship between self-esteem and future orientation in education of class XI students at SMA Negeri 11 Palembang with a value of r = 0.572, R Square = 0.328, p = 0.000. As the result of significance level (p) = 0.000 which the p-value Article visualizations:

Optimization of CT slice thickness in 3D-CRT and IMRT planning of low grade glioma

Optimization of CT slice thickness in 3D-CRT and IMRT planning of low grade glioma