Efektivitas Modul Pembelajaran Berbasis Proyek Menggunakan Kreasi Pengetahuan untuk Meningkatkan Prestasi Belajar Siswa pada Mata Pelajaran Animasi 3d

Penelitian yang berjudul “efektivitas modul pembelajaran berbasis proyek menggunakan kreasi pengetahuan untuk meningkatkan prestasi belajar siswa pada mata pelajaran Animasi 3D” ini dilatarbelakangi oleh masih sangat terbatasnya pembahasan secara sistematis terkait kreasi pengetahuan dalam pendidikan yang diguna fungsikan untuk usaha peningkatan prestasi belajar siswa. Penelitian ini bertujuan untuk meningkatkan prestasi belajar siswa dalam materi layout 3D melalui penggunaan modul pembelajaran berbasis proyek menggunakan kreasi pengetahuan. Penelitian ini dilaksanakan di SMK Negeri 3 Tangerang Selatan dengan sampel penelitian siswa kelas 2 Kota Tangerang Selatan. Penelitian ini menggunakan pendekatan kuantitatif dengan metode eksperimen kuasi. Adapun desain penelitian yang digunakan adalah Nonequivalent Control Group Desain. Untuk mencapai tujuan penelitian digunakan instrumen penelitian berupa tes pemahaman materi.. Hasil penelitian menunjukkan bahwa modul pembelajaran berbasis proyek menggunakan kreasi pengetahuan untuk meningkatkan prestasi belajar siswa  pada mata pelajaran layout 3D  efektif dalam meningkatkan prestasi belajar siswa. Hal ini terlihat dari hasil uji beda rata-rata (uji-t/wilcoxon) prestasi belajar siswa di kelas eksperimen mengalami peningkatan lebih tinggi dari kelas kontrol. Berdasarkan hasil penelitian ini, modul pembelajaran berbasis proyek menggunakan kreasi pengetahuan untuk meningkatkan prestasi belajar siswa  pada mata pelajaran Animasi 3D dengan materi Layout 3D dapat menjadi alternatif modul yang dapat diterapkan dalam upaya meningkatkan kualitas pendidikan terutama prestasi belajar siswa dalam materi layout 3D. Oleh karena itu, modul ini dapat direkomendasikan untuk diterapkan dalam pembelajaran Animasi 3D di sekolah SMK. Selanjutnya, strategi ini juga dapat direkomendasikan untuk diterapkan pada semua mata pelajaran di SMK

Urticaria and infections

Urticaria is a group of diseases that share a distinct skin reaction pattern. Triggering of urticaria by infections has been discussed for many years but the exact role and pathogenesis of mast cell activation by infectious processes is unclear. In spontaneous acute urticaria there is no doubt for a causal relationship to infections and all chronic urticaria must have started as acute. Whereas in physical or distinct urticaria subtypes the evidence for infections is sparse, remission of annoying spontaneous chronic urticaria has been reported after successful treatment of persistent infections. Current summarizing available studies that evaluated the course of the chronic urticaria after proven Helicobacter eradication demonstrate a statistically significant benefit compared to untreated patients or Helicobacter-negative controls without urticaria (p < 0.001). Since infections can be easily treated some diagnostic procedures should be included in the routine work-up, especially the search for Helicobacter pylori. This review will update the reader regarding the role of infections in different urticaria subtypes

Epidemiology, comorbidities, and healthcare utilization of patients with chronic urticaria in Germany

Background: Comprehensive data on the epidemiology and comorbidities of chronic urticaria (CU) in Germany are either limited, or not contemporary. Objectives: To investigate the epidemiology of CU, overall comorbidities and healthcare resource utilized by patients with CU in Germany, using an anonymized statutory health insurance (SHI) database. Methods: Anonymized SHI claims research database of the Institute for Applied Health Research, Berlin [InGef] (01 January 2015-30 September 2018) was used to analyse insured individuals with a confirmed diagnosis of CU (ICD-10-GM codes). Twelve-month diagnosed prevalence and incidence, comorbidities (vs. atopic dermatitis and psoriasis), and healthcare utilization by patients with CU were investigated. Results: Of 4 693 772 individuals of all ages listed in the database, 3 538 540 were observable during 2017. Overall, 17 524 patients (˜0.5%) were diagnosed with CU; chronic spontaneous urticaria (CSU: 71.2%), chronic inducible urticaria (CIndU: 19.7%), CSU+CIndU (9.1%). Females, vs. males, had higher diagnosed prevalence (0.62% vs. 0.37%) and diagnosed incidence (0.18% vs. 0.11%) of CU among all patients. Patients most frequently visited general practitioners (41.3% of total visits). Hypertensive diseases (43.5%), lipoprotein metabolism disorders (32.1%) and affective disorders (26.0%) were the most frequently reported comorbidities of special interest. Rates of most comorbidities of special interests were similar to atopic dermatitis and psoriasis patients, and all higher vs. overall population. More than half (54.1%) of all CU patients were not prescribed any treatment. Second-generation H1 -antihistamines were the most commonly prescribed medication for adult (17.9%) and paediatric (27.9%) patients. Patients with CIndU (paediatric, 15.5%; adult, 7.8%) were more often hospitalized versus patients with CSU (paediatric, 9.9%; adult, 4.6%). Conclusions: In Germany, prevalence of CU along with multiple comorbidities may pose increased burden on the healthcare system. Awareness of adhering to treatment guidelines, and aiming for complete control of urticaria, needs to be driven and may improve outcomes

Epidemiology, comorbidities, and healthcare utilization of patients with chronic urticaria in Germany

Abstract Background Comprehensive data on the epidemiology and comorbidities of chronic urticaria (CU) in Germany are either limited, or not contemporary. Objectives To investigate the epidemiology of CU, overall comorbidities and healthcare resource utilized by patients with CU in Germany, using an anonymized statutory health insurance (SHI) database. Methods Anonymized SHI claims research database of the Institute for Applied Health Research, Berlin [InGef] (01 January 2015–30 September 2018) was used to analyse insured individuals with a confirmed diagnosis of CU (ICD‐10‐GM codes). Twelve‐month diagnosed prevalence and incidence, comorbidities (vs. atopic dermatitis and psoriasis), and healthcare utilization by patients with CU were investigated. Results Of 4 693 772 individuals of all ages listed in the database, 3 538 540 were observable during 2017. Overall, 17 524 patients (˜0.5%) were diagnosed with CU; chronic spontaneous urticaria (CSU: 71.2%), chronic inducible urticaria (CIndU: 19.7%), CSU+CIndU (9.1%). Females, vs. males, had higher diagnosed prevalence (0.62% vs. 0.37%) and diagnosed incidence (0.18% vs. 0.11%) of CU among all patients. Patients most frequently visited general practitioners (41.3% of total visits). Hypertensive diseases (43.5%), lipoprotein metabolism disorders (32.1%) and affective disorders (26.0%) were the most frequently reported comorbidities of special interest. Rates of most comorbidities of special interests were similar to atopic dermatitis and psoriasis patients, and all higher vs. overall population. More than half (54.1%) of all CU patients were not prescribed any treatment. Second‐generation H 1 ‐antihistamines were the most commonly prescribed medication for adult (17.9%) and paediatric (27.9%) patients. Patients with CIndU (paediatric, 15.5%; adult, 7.8%) were more often hospitalized versus patients with CSU (paediatric, 9.9%; adult, 4.6%). Conclusions In Germany, prevalence of CU along with multiple comorbidities may pose increased burden on the healthcare system. Awareness of adhering to treatment guidelines, and aiming for complete control of urticaria, needs to be driven and may improve outcomes

Novel modified endoscopic mucosal resection of large GI lesions (> 20 mm) using an external additional working channel (AWC) may improve R0 resection rate: initial clinical experience

Background En-bloc resection of large, flat dysplastic mucosal lesions of the luminal GI tract can be challenging. In order to improve the efficacy of resection for lesions ≥2 cm and to optimize R0 resection rates of lesions suspected of harboring high-grade dysplasia or early adenocarcinoma, a novel grasp and snare EMR technique utilizing a novel over the scope additional accessory channel, termed EMR Plus (EMR+), was developed. The aim of this pilot study is to describe the early safety and efficacy data from the first in human clinical cases. Methods A novel external over-the-scope additional working channel (AWC) (Ovesco, Tuebingen, Germany) was utilized for the EMR+ procedure, allowing a second endoscopic device to be used through the AWC while using otherwise standard endoscopic equipment. The EMR+ technique allows tissue retraction and a degree of triangulation during endoscopic resection. We performed EMR+ procedure in 6 patients between 02/2018–12/2018 for lesions in the upper and lower GI tract. Results The EMR+ technique utilizing the AWC was performed successfully in 6 resection procedures of the upper and/or lower GI tract in 6 patients in 2 endoscopy centers. All resections were performed successfully with the EMR+ technique, all achieving an R0 resection. No severe adverse events occurred in any of the procedures. Conclusions The EMR+ technique, utilizing an additional working channel, had an acceptable safety and efficacy profile in this preliminary study demonstrating it’s first use in humans. This technique may allow an additional option to providers to remove complex, large mucosal-based lesions in the GI tract using standard endoscopic equipment and a novel AWC device

Assessment of esophagogastric junction morphology by dynamic real-time MRI: comparison of imaging features to high-resolution manometry

Purpose To assess the esophagogastric junction (EGJ) on real-time MRI and compare imaging parameters to EGJ morphol- ogy on high-resolution manometry (HRM). Methods A total of 105 of 117 eligible patients who underwent real-time MRI and high-resolution manometry for GERD- like symptoms between 2015 and 2018 at a single center were retrospectively evaluated (male n = 57; female n = 48; mean age 52.5 ± 15.4 years). Real-time MRI was performed at a median investigation time of 15 min (1 frame/40 ms). On HRM, EGJ morphology was assessed according to the Chicago classification of esophageal motility disorders. Real-time MRI was performed at 3 T using highly undersampled radial fast low-angle shot acquisitions with NLINV image reconstruction. A 10 mL pineapple juice bolus served as oral contrast agent at supine position. Real-time MRI films of the EGJ were acquired during swallowing events and during Valsalva maneuver. Anatomic and functional MRI parameters were compared to EGJ morphology on HRM. Results On HRM, n = 42 patients presented with EGJ type I (40.0%), n= 33 with EGJ type II (31.4%), and n= 30 with EGJ type III (28.6%). On real-time MRI, hiatal hernia was more common in patients with EGJ type III (66.7%) than in patients with EGJ type I (26.2%) and EGJ type II (30.3%; p < 0.001). Sliding hiatal hernia was more frequent in patients with EGJ type II (33.3%) than in patients with EGJ type III (16.7%) and EGJ type I (7.1%; p = 0.017). The mean esophagus–fundus angle of patients was 85 ± 31° at rest and increased to 101 ± 36° during Valsalva maneuver. Conclusion Real-time MRI is a non-invasive imaging method for assessment of the esophagogastric junction. Real-time MRI can visualize dynamic changes of the EGJ during swallowing events

Real-time MRI for dynamic assessment of gastroesophageal reflux disease: comparison to pH-metry and impedance

Purpose To evaluate the diagnostic potential of real-time MRI for dynamic assessment of gastroesophageal reflux in patients with GERD (gastroesophageal reflux disease)-like symptoms compared to pH-metry and impedance. Methods Patients who underwent real-time MRI and pH-metry between 2015–2018 were included in this retrospective study. Real-time MRI at 3 T was achieved by undersampled radial FLASH acquisitions with iterative image reconstruction by NLINV. Real-time MRI visualized transit of pineapple juice through the gastroesophageal junction and during Valsalva maneuver. MRI results were compared to 24 h pH-metry to assess acidic reflux (following Lyon Consensus guidelines) and to impedance to assess non-acidic reflux. A standard 2 × 2 table was chosen to calculate diagnostic performance. Results 91/93 eligible patients fulfilled inclusion criteria (male n = 49; female n = 42; median age 55 y). All MRI studies were successfully completed without adverse events at a mean examination time of 15 min. On real-time MRI, reflux was evident in 60 patients (66 %). pH-metry revealed reflux in 41 patients (45 %), and impedance in 54 patients (59 %). Compared to pH-metry and impedance, real-time MRI sensitivity was 0.78 (95 % CI: 0.66-0.87), specificity 0.67 (95 % CI: 0.45-0.84) and PPV 0.87 (95 % CI: 0.75-0.94). Conclusion Real-time MRI is an imaging method for assessment of gastroesophageal reflux in patients with GERD-like symptoms. Considering its high positive predictive value, real-time MRI can accurately identify patients in which further invasive testing with pH-metry and impedance might be considered

Assessment of esophageal motility disorders by real-time MRI

Purpose To investigate imaging findings of esophageal motility disorders on dynamic real-time. Material and methods 102 patients with GERD-like symptoms were included in this retrospective study between 2015−2018. Dynamic real-time MRI visualized the transit of a 10 mL pineapple juice bolus through the esophagus and EGJ with a temporal resolution of 40 ms. Dynamic and anatomic parameters were measured by consensus reading. Imaging findings were compared to HRM utilizing the Chicago classification of esophageal motility disorders, v3.0. Results All 102 patients completed real-time MRI in a median examination time of 15 min. On HRM, 14 patients presented with disorders with EGJ outlet obstruction (EGJOO) (13.7 %), 7 patients with major disorders of peristalsis (6.9 %), and 32 patients with minor disorders of peristalsis (31.4 %). HRM was normal in 49 patients (48.0 %). Incomplete bolus clearance was significantly more frequent in patients with esophageal motility disorders on HRM than in patients with normal HRM (p = 0.0002). In patients with motility disorders with EGJOO and major disorders of peristalsis, the esophageal diameter tended to be wider (23.6 ± 8.0 vs. 21.2 ± 3.5 mm, p = 0.089) and the sphincter length longer (19.7 ± 7.3 vs. 16.7 ± 3.0 mm, p = 0.091) compared to patients with normal HRM. 3/7 patients with achalasia type II were correctly identified by real-time MRI and one further achalasia type II patient was diagnosed with a motility disorder on MRI films. The other 3/7 patients presented no specific imaging features. Conclusion Real-time MRI is an auxiliary diagnostic tool for the assessment of swallowing events. Imaging parameters may assist in the detection of esophageal motility disorders

Uncertainty in the Representation of Orography in Weather and Climate Models and Implications for Parameterized Drag

The representation of orographic drag remains a major source of uncertainty for numerical weather prediction (NWP) and climate models. Its accuracy depends on contributions from both the model grid‐scale orography (GSO) and the subgrid‐scale orography (SSO). Different models use different source orography datasets and different methodologies to derive these orography fields. This study presents the first comparison of orography fields across several operational global NWP models. It also investigates the sensitivity of an orographic drag parameterisation to the inter‐model spread in SSO fields and the resulting implications for representing the northern hemisphere winter circulation in a NWP model. The inter‐model spread in both the GSO and the SSO fields is found to be considerable. This is due to differences in the underlying source dataset employed and in the manner in which this dataset is processed (in particular how it is smoothed and interpolated) to generate the model fields. The sensitivity of parameterised orographic drag to the inter‐model variability in SSO fields is shown to be considerable and dominated by the influence of two SSO fields: the standard deviation and the mean gradient of the SSO. NWP model sensitivity experiments demonstrate that the inter‐model spread in these fields is of first‐order importance to the inter‐model spread in parameterised surface stress, and to current known systematic model biases. The revealed importance of the SSO fields supports careful reconsideration of how these fields are generated, guiding future development of orographic drag parameterisations and re‐evaluation of the resolved impacts of orography on the flow