Implementasi Model Pembelajaran Kooperatif Tipe Jigsaw II Untuk Meningkatkan Hasil Belajar Siswa Kelas VIII B SMPN 2 Sirenja Pada Materi Teorema Pythagoras

Tujuan penelitian ini adalah untuk memperoleh deskripsi tentang implementasi model pembelajar­an kooperatif tipe Jigsaw II untuk meningkatkan hasil belajar siswa kelas VIII B SMP Negeri 2 Sirenja pada materi Teorema Pythagoras. Jenis penelitian ini adalah penelitian tindakan kelas yang mengacu pada desain Kemmis dan Mc. Taggart yakni perencanaan, pelaksanaan tindakan, observasi dan refleksi. Penelitian ini dilakukan dalam dua siklus. Subjek penelitian ini adalah siswa kelas VIII B SMP Negeri 2Sirenja yang berjumlah 30 orang siswa. Teknik pengumpulan data diperoleh dari data hasil observasi guru dan siswa. Penelitian ini dilakukan dalam dua siklus dan masing-masing siklus dilaksanakan dalam dua kali pertemuan. Hasil penelitian menunjukkan bahwa pembelajaran dengan menggunakan model pembelajaran kooperatif tipe Jigsaw II dapat meningkatkan hasil belajar siswa yang ditunjukkan dengan peningkatan jumlah siswa yang tuntas pada siklus I sebanyak 21 orang siswa (70%) dan jumlah siswa yang tidak tuntas sebanyak 9 orang (30%). Pada siklus II, jumlah siswa yang dinyatakan tuntas mengalami peningkatan yaitu sebanyak 27 orang siswa dengan persentase sebesar 90% dan 3 orang siswa dinyatakan belum tuntas dengan persentase sebesar 10%

Psychosocial Characteristics and Pain Burden of Patients With Suspected Sphincter of Oddi Dysfunction in the EPISOD Multicenter Trial

Patients with several painful functional gastrointestinal disorders (FGIDs) are reported to have a high prevalence of psychosocial disturbance. These aspects have not been studied extensively in patients with suspected Sphincter of Oddi dysfunction (SOD)

Effect of Endoscopic Sphincterotomy for Suspected Sphincter of Oddi Dysfunction on Pain-Related Disability Following Cholecystectomy: The EPISOD Randomized Clinical Trial

Abdominal pain after cholecystectomy is common and may be attributed to sphincter of Oddi dysfunction. Management often involves endoscopic retrograde cholangiopancreatography (ERCP) with manometry and sphincterotomy

Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction?

Biliopancreatic-type postcholecystectomy pain, without significant abnormalities on imaging and laboratory test results, has been categorized as “suspected” sphincter of Oddi dysfunction (SOD) type III. Clinical predictors of “manometric” SOD are important to avoid unnecessary ERCP, but are unknown

Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass

Background and Aims The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases yet standard ERCP is not possible due to surgically altered gastroduodenal anatomy. Laparoscopic-ERCP (LA-ERCP) has been proposed as an option but supporting data are derived from single center small case-series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP. Methods This is retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all of the following were achieved: reaching the papilla, cannulating the desired duct and providing endoscopic therapy as clinically indicated. Results A total of 579 patients (median age 51, 84% women) were included. Indication for LA-ERCP was biliary in 89%, pancreatic in 8%, and both in 3%. Procedure success was achieved in 98%. Median total procedure time was 152 minutes (IQR 109-210) with median ERCP time 40 minutes (IQR 28-56). Median hospital stay was 2 days (IQR 1-3). Adverse events were 18% (laparoscopy-related 10%, ERCP-related 7%, both 1%) with the clear majority (92%) classified as mild/moderate whereas 8% were severe and 1 death occurred. Conclusion Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher due to the added laparoscopy-related events

Percutaneous transhepatic vs. endoscopic retrograde biliary drainage for suspected malignant hilar obstruction: study protocol for a randomized controlled trial

Abstract Background The optimal approach to the drainage of malignant obstruction at the liver hilum remains uncertain. We aim to compare percutaneous transhepatic biliary drainage (PTBD) to endoscopic retrograde cholangiography (ERC) as the first intervention in patients with cholestasis due to suspected malignant hilar obstruction (MHO). Methods The INTERCPT trial is a multi-center, comparative effectiveness, randomized, superiority trial of PTBD vs. ERC for decompression of suspected MHO. One hundred and eighty-four eligible patients across medical centers in the United States, who provide informed consent, will be randomly assigned in 1:1 fashion via a web-based electronic randomization system to either ERC or PTBD as the initial drainage and, if indicated, diagnostic procedure. All subsequent clinical interventions, including crossover to the alternative procedure, will be dictated by treating physicians per usual clinical care. Enrolled subjects will be assessed for successful biliary drainage (primary outcome measure), adequate tissue diagnosis, adverse events, the need for additional procedures, hospitalizations, and oncological outcomes over a 6-month follow-up period. Subjects, treating clinicians and outcome assessors will not be blinded. Discussion The INTERCPT trial is designed to determine whether PTBD or ERC is the better initial approach when managing a patient with suspected MHO, a common clinical dilemma that has never been investigated in a randomized trial. Trial registration ClinicalTrials.gov, Identifier: NCT03172832 . Registered on 1 June 2017.https://deepblue.lib.umich.edu/bitstream/2027.42/142379/1/13063_2018_Article_2473.pd

Functional Anatomy in a Hasanlu (Iran) Dentition: Scallops at the Dentin-Enamel Junction

Dental records offer some of the most valuable information for tracing evolution and for verifying identity postmortem (Hillson 1996). The dentinenamel junction (DEJ) is the intersection of two hard structures, dentin and enamel (Brauer, Marshall, and Marshall 2010). The type I, type III and von Korff collagen fibers acting at the junction give stability to the tooth (Lin, Douglas, and Erlandsen 1993; Bishop, Malhotra, and Yoshida 1991; Ohsaki and Nagata 1994). It is thought that a larger scallop area allows for more of the type I fibers to attach to enamel, which would confer stability to the DEJ (Lin, Douglas, and Erlandsen 1993). In this paper, vertical cross sections of the maxillary teeth of a Hasanlu individual's scallops were analyzed by measuring the scallop areas from the cross sections. Canines were found to have a larger log(area) distribution than incisors, molars and premolars. The comparisons of the individual teeth indicated that the log(area) scallop sizes were in most instances the same across the entire dentition. However, the left canines were found to have log(area) values different from right premolar 3, left molar 2, right incisor 2 and right premolar 4. This suggests that it is important to consider individual teeth when making comparisons across the dentition, as right canines did not show significant differences in cases in which left canines did. When the locations of the various scallops within an individual tooth were compared, there were not any patterns indicative of a relationship. This could mean that scallop development within a tooth is unique to an individual, as 11 suggested by Gustafon (1961). Future studies should take into account the various locations in the individual tooth, as scallop areas can vary by location. Comparing the scallop locations of the antimeric pairs showed that there were significant differences in log(area) not only between the labial locations of the canines but also between the mesial and mesial occlusal locations in the second molars. These differences in scallop sizes could be due to the differential development of scallops in these regions. It was also possible that the similarities in most of the antimeric pair locations were a result of the similar architecture of the antimeres at the DEJ. Furthermore, even though there were quadratic, linear and quartic relationships observed, none of these relationships appeared in antimeric pairs. Since only one cross section was taken, the relationship may not have been observed in one of the antimeres. In sections of the teeth where there were lines of best fit for the data, it is likely that the bending of the DEJ dictated the production of scallops. A 3D section of enamel, similar to the one used by Brauer et al., should be used to compare the incremental spacing of the scallops along the length of the DEJ (2010)