Meningkatkan Hasil Belajar Siswa Pada Mata Pelajaran IPS Dengan Menggunakan Metode Diskusi Di Kelas IV SDN 12 Biau

Penelitian ini di latarbelakangi rendahnya hasil belajar siswa. Penelitian ini bertujuan untuk meningkatkan hasil belajar siswa pada mata pelajaran IPS dengan menggunakan metode diskusi dikelas IV SDN 12 Biau Kabupaten Buol. Jenis penelitian ini adalah penelitian tindakan kelas (PTK) yang dilaksanakan di SDN 12 Biau dengan menggunakan metode diskusi. Penelitian ini menggunakan desain penelitian Kemmis da Mc. Taggart yang terdiri atas dua siklus, setiap siklus terdiri empat tahap yaitu perencanaan, pelaksanaan tindakan, observasi, dan refleksi. Sebelum melakukan penelitian, peneliti terlebih dahulu memberikan tes awal dengan hasil yang diperoleh yaitu ketuntasan belajar klasikal 13% dan daya serap klasikal 51,53%. Hasil observasi aktivitas guru dan siswa yang di peroleh pada tindakan siklus I yaitu siswa 59,09% dan guru 60,41%. Kemudian pada siklus II hasil observasi aktivitas guru dan siswa mengalami peningkatan, pada hasil observasi aktivitas guru mencapai 85,41% dan siswa mencapai 88,64%. Adapun hasil penelitian yang diperoleh pada tindakan siklus I yaitu ketuntasan belajar klasikal 50% dan daya serap klasikal 71,28%. Pada tindakan siklus II diperoleh ketuntasan belajar klasikal 89,74% dan daya serap klasikal 86,67%,. Hal ini berarti pembelajaran pada siklus II telah memenuhi indikator keberhasilan dengan ketuntasan belajar klasikal minimal 80% dan nilai rata-rata hasil belajar siswa individu minimal 65%. Dengan demikian, maka dapat disimpulkan bahawa pembelajaran dengan menggunakan metode diskusi dapat meningkatkan hasil belajar siswa pada pelajaran IPS di kelas IV SDN 12 Biau

A Follow-up Experience of 6 months after Treatment of Children with Severe Acute Malnutrition in Dhaka, Bangladesh

Aim: As there is lack of information about what happens to children after recovery from severe acute malnutrition (SAM), we report their relapse, morbidity, mortality and referral during follow-up period. Methods: From February 2001 to November 2003, 180 children completing acute and nutrition rehabilitation (NR) phases of protocolized management were advised for 6-months follow-up. The mean (SD) age was 12 (5) months, 55% were infants, 53% were male and 68% were breast-fed. Results: The follow-up compliance rate dropped from 91% at first to 49% at tenth visit. The common morbidities following discharge included fever (26%), cough (24%) and diarrhoea (20%). Successful follow-up done in 124 children [68.9% (95% CI 61.8-75.2%)], partial follow-up in 45 [25% (95% CI 19.2-31.8%)], relapse in 32 [17.8% (95% CI 12.9-24%)] and 5 [2.8% (95% CI 1.2-6.3%)] died. Conclusion: Our findings highlight need for follow-up as part of overall management of SAM and recommend an effective community follow-u

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Hubungan Gaya Hidup terhadap Risiko Hipertensi pada Lansia di Wilayah Kerja Puskesmas Layang Kota Makassar

Hipertensi atau tekanan darah tinggi adalah tekanan darah melebihi batas normal 120/80 mmHg. Pada usia lanjut tekanan darah akan cenderung tinggi sehingga lebih besar berisiko terkena hipertensi salahsatunya disebabkan gaya hidup tidak sehat misalnya; aktifitas fisik, pola tidur, dan merokok. Penelitian ini bertujuan untuk mengetahui pengaruh gaya hidup terhadap risiko hipertensi pada lansia di Puskesmas Layang. Metode penelitian ini menggunakan survey analitik&nbsp; dengan pendekatan cross sectional. Sampel diambil dengan teknik sampling sebanyak 43 sampel yang memenuhi kriteria ekslusi. Metode analisis data menggunakan uji univeriat untuk mendeskripsikan karakteristik reposden dan uji bivariat menggunakan uji chi square. Hasil penelitian menunjukkan gaya hidup buruk berdasarkan Aktifitas Fisik sebesar 39,5%, Merokok 68,9%, Pola Tidur 76,0% , Stress 55,6% pada penderita hipertensi di Puskesmas Layang dan tidak terdapat pengaruh gaya hidup berdasarkan Aktifitas Fisik p= 0,356 &gt; 0,05, Merokok, Pola Tidur p= 0,476 &gt; 0,05, Stres p= 0,166 &gt; 0,05 terhadap risiko hipertensi pada lansia di wilayah kerja Puskesmas Layang. Disarankan kepada masyarakat untuk mengubah gaya hidup ke arah yang lebih sehat, terutama mengurangi atau bahkan berhenti merokok, melakukan aktifitas fisik, mengatur pola makan, dan lebih mengontrol keadaan stres secara baik serta pihak puskesmas perlu menindak lanjuti agar dapat mencegah dan meminimalisir kejadian hipertensi dengan mengendalikan faktor risiko

Assessment of bacteria and water quality parameters in cage cultured Pangasius hypophthalmus in Temerloh, Pahang River, Malaysia

Pangasius hypophthalmus or famously known by local Malaysians as Patin Hitam is one of the most important sources of food in Malaysia. It is widely cultured in the Peninsular Malaysia especially in Pahang as Patin and is a popularly consumed freshwater fish. Global economic interest in the fish has increased its demand in the USA and Europe. However, high mortality due to bacterial and viral infections is the main problem that needs to be solved. Therefore, bacteria in P. hypophthalmus in Pahang is being focused with the factors connected to the prevalence of bacteria and virus in P. hypophthalmus. This research was conducted for two cycles (February-September 2016 and January-August 2017) in different farms in Temerloh, Pahang. Bacteria and virus samples were taken from three organs of Patin Hitam which are kidney, liver and spleen. Physical parameters for water quality were measured using a multiparameter probe sensor (YSI, USA) and chemical parameters were analysed with DR900 colorimeter (Hach, USA). Bacteria samples were identified using biochemical test kits, API 20NE and 20E, followed by confirmation of the bacteria using Polymerase Chain Reaction (PCR). Virus samples were identified using conventional PCR. There are several bacteria isolated throughout the culture period. The highest prevalence of Aeromonas hydrophila in Temerloh in the first cycle was in May 2016 (40%), however, was equally evident in four out of the seven months of the second cycle, which was in April, May, June and July 2017 (20%). There was a relationship between the prevalence of A. hydrophila and iron, nitrite and pH in the first cycle in Temerloh. However, there was no relationship in the second cycle. Significantly, these results could contribute to better treatment of fish disease and development of standard operating procedure of future fish culture for early disease prevention

Hubungan antara Pola Pemberian ASI terhadap Perkembangan Motorik Kasar pada Bayi Usia 6-11 Bulan di Puskesmas Rappokalling Kota Makassar

ASI adalah makanan dan minuman yang dibutuhkan oleh bayi hingga ia berusia 6 bulan. ASI memiliki beberapa manfaat yaitu meningkatkan daya tahan tubuh, pertumbuhan dan perkembangan motorik kasar pada bayi, meningkatkan kecerdasan, daya pengelihatan, serta mengurangi risiko terkena penyakit. Penelitian ini bertujuan untuk mengetahui hubungan antara pola pemberian ASI terhadap perkembangan motorik kasar pada bayi usia 6-11 bulan di Puskesmas Rappokalling Kota Makassar Tahun 2019. Jenis penelitian ini menggunakan desain survey analitik dengan pendekatan cross sectional. Populasi dalam penelitian ini adalah seluruh bayi yang berusia 6-11 bulan sebanyak 193 bayi di Puskesmas Rappokalling. Teknik pengambilan sampel yaitu accidental sampling dan diperoleh sebanyak 128 bayi di Puskesmas Rappokalling. Metode analisis data menggunakan uji bivariat dengan uji chi square. Hasil penelitian ini didapatkan ibu yang memberikan ASI eksklusif sebanyak 81 orang (63,3%). Dan ibu yang memberikan ASI non eksklusif sebanyak 47 orang (36,7%). Dari 128 anak didapatkan perkembangan motorik kasar pada anak usia 6-11 bulan yang normal sebanyak 112 anak (87,5%), dan yang abnormal sebanyak 16 anak (12,5%). Kesimpulan dari penelitian ini adalah ada hubungan yang signifikan antara pola pemberian ASI terhadap perkembangan motorik kasar pada bayi usia 6-11 bulan di Puskesmas Rappokalling Kota Makassar