Upaya Meningkatkan Hasil Belajar Siswa Dalam Penguasaan Materi Pelajaran Narrative Text Pada Pelajaran Bahasa Inggris Melalui Penerapan Model Pembelajaran Kooperatif Tipe Jigsaw Di Kelas Viii-d SMP Negeri 3 Medan

 Penelitian ini dilatarbelakangi permasalahan yang muncul di SMP Negeri 3 Medan yaitu setelah guru melaksanakan pembelajaran Bahasa Inggris pada materi Narrative text guru mengetahui bahwa hasil belajar masih rendah. Hal ini tercermin dari perolehan tes hasil belajar yaitu bahwa tidak ada siswa yang mencapai ketuntasan individual. Ini juga menunjukkan bahwa belum tercapai standar ketuntasan klasikal karena prosentase ketuntasan adalah sebesar 0%. Dalam proses pembelajaran keaktifan siswalah yang seharusnya ditingkatkan karena proses belajar bukanlah menyampaikan materi tapi bagaimana siswa dapat memperoleh informasi dengan cara-cara mereka sendiri maupun bimbingan guru. Selain itu dalam pembelajaran, ketertarikan siswa atau respon siswa juga sangat mempengaruhi perolehan hasil belajar. Dengan menyadari berbagai Kenyataan diatas maka sebagai seorang guru professional merasa perlu untuk memperbaiki pembelajaran yaitu dengan mengadakan penelitian. Penelitian ini merupakan penelitian tindakan kelas dengan meningkatkan pembelajaran Bahasa Inggris untuk meningkatkan hasil belajar siswa Kelas VIII-D SMP Negeri 3 Medan. Penelitian ini merupakan penelitian tindakan kelas yang dilakukan sebanyak dua siklus. Berdasarkan analisis data dalam penelitian ini bahwa penerapan metode Jigsawdapat meningkatkan kemampuan individual siswa dan ketuntasan klasikal siswa. Penerapan Model Pembelajaran Jigsaw juga dapat membuat siswa lebih aktif. Siswa merespon positif terhadap pembelajaran dengan menerapkan Model Pembelajaran Jigsaw. Model Pembelajaran Jigsawdapat meningkatkan Hasil Belajar Narrative text  siswa Kelas VIII-DSMP Negeri 3 Medan, yaitu nilai rata-rata kelas pada saat pre test 47,537,44; siklus 1: 70,26; siklus 2: 81,79. Model pembelajaran kooperatif tipe Jigsaw dapat menciptakan suasana pembelajaran yang efektif, dan siswa aktif bekerja sama, hal ini ditunjukkan pada nilai sikap siswa pada siklus 1: 45,95; meningkat pada siklus 2: 80,62

UPAYA MENINGKATKAN HASIL BELAJAR SISWA DALAM PENGUASAAN MATERI PELAJARAN NARRATIVE TEXT PADA PELAJARAN BAHASA INGGRIS MELALUI PENERAPAN MODEL PEMBELAJARAN KOOPERATIF TIPE JIGSAW DI KELAS VIII-D SMP NEGERI 3 MEDAN

 Penelitian ini dilatarbelakangi permasalahan yang muncul di SMP Negeri 3 Medan yaitu setelah guru melaksanakan pembelajaran Bahasa Inggris pada materi Narrative text guru mengetahui bahwa hasil belajar masih rendah. Hal ini tercermin dari perolehan tes hasil belajar yaitu bahwa tidak ada siswa yang mencapai ketuntasan individual. Ini juga menunjukkan bahwa belum tercapai standar ketuntasan klasikal karena prosentase ketuntasan adalah sebesar 0%. Dalam proses pembelajaran keaktifan siswalah yang seharusnya ditingkatkan karena proses belajar bukanlah menyampaikan materi tapi bagaimana siswa dapat memperoleh informasi dengan cara-cara mereka sendiri maupun bimbingan guru. Selain itu dalam pembelajaran, ketertarikan siswa atau respon siswa juga sangat mempengaruhi perolehan hasil belajar. Dengan menyadari berbagai kenyataan diatas maka sebagai seorang guru professional merasa perlu untuk memperbaiki pembelajaran yaitu dengan mengadakan penelitian. Penelitian ini merupakan penelitian tindakan kelas dengan meningkatkan pembelajaran Bahasa Inggris untuk meningkatkan hasil belajar siswa Kelas VIII-D SMP Negeri 3 Medan. Penelitian ini merupakan penelitian tindakan kelas yang dilakukan sebanyak dua siklus. Berdasarkan analisis data dalam penelitian ini bahwa penerapan metode Jigsawdapat meningkatkan kemampuan individual siswa dan ketuntasan klasikal siswa. Penerapan Model Pembelajaran Jigsaw juga dapat membuat siswa lebih aktif. Siswa merespon positif terhadap pembelajaran dengan menerapkan Model Pembelajaran Jigsaw. Model Pembelajaran Jigsawdapat meningkatkan Hasil Belajar Narrative text  siswa Kelas VIII-DSMP Negeri 3 Medan, yaitu nilai rata-rata kelas pada saat pre test 47,537,44; siklus 1: 70,26; siklus 2: 81,79. Model pembelajaran kooperatif tipe Jigsaw dapat menciptakan suasana pembelajaran yang efektif, dan siswa aktif bekerja sama, hal ini ditunjukkan pada nilai sikap siswa pada siklus 1: 45,95; meningkat pada siklus 2: 80,62

_In vivo_ photoacoustic molecular imaging with simultaneous multiple selective targeting using antibody-conjugated gold nanorods

The use of gold nanorods for photoacoustic molecular imaging in vivo with simultaneous multiple selective targeting is reported. The extravasation of multiple molecular probes is demonstrated, and used to probe molecular information of cancer cells. This technique allows molecular profiles representing tumor characteristics to be obtained and a heterogeneous population of cancer cells in a lesion to be determined. The results also show that the image contrast can be enhanced by using a mixture of different molecular probes. In this study, HER2, EGFR, and CXCR4 were chosen as the primary target molecules for examining two types of cancer cells, OECM1 and Cal27. OECM1 cells overexpressed HER2 but exhibited a low expression of EGFR, while Cal27 cells showed the opposite expression profile. Single and double targeting resulted in signal enhancements of up to 3 dB and up to 5 dB, respectively, and hence has potential in improving cancer diagnoses

Molecular Epidemiologic Analysis of Methicillin-Resistant Staphylococcus aureus Isolates from Bacteremia and Nasal Colonization at 10 Intensive Care Units: Multicenter Prospective Study in Korea

We investigated molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) isolated at 10 intensive care units (ICUs) in Korea. MRSA isolates from bacteremia and nasal colonization were collected prospectively from October 2008 through May 2009 at 10 University-affiliated hospital ICUs. A total of 83 and 175 MRSA strains were isolated from bacteremia and nasal colonization, respectively. Acquired group accounted for 69.9% (n = 58) of bacteremia and 73.1% (n = 128) of nasal colonization. Pulsed-field gel electrophoresis (PFGE) type B (SCCmec type II/ST5) was dominant in the acquired group followed by PFGE type D (SCCmec type IVA/ST72; a community genotype). Seven of 58 (12.1%) acquired bacteremia and 15 of 128 (11.8%) acquired nasal colonizations had SCCmec type IVA/ST72 genotype, which indicated that the community genotype had already emerged as a cause of ICU acquired MRSA infection or colonization. Antibiotic resistance rates to ciprofloxacin, tetracycline, clindamycin and trimethoprim/ sulfamethoxazole were 84.4%, 67.1%, 78.1%, and 12.0%, respectively. Susceptibility to ciprofloxacin best predicted a community genotype (sensitivity 96.5%; specificity 96.9%; odds ratio 861; 95% confidence interval 169-4,390, P < 0.001) and the positive predictive value was 90.2%. Among 23 nasal re-colonized strains, 7 MRSA strains (30.4%) were different from the originally colonized strains on the basis of PFGE types

An audit and feedback intervention for reducing antibiotic prescribing in general dental practice:the RAPiD Cluster Randomised Controlled Trial

Acknowledgments: We thank the TRiaDS Research Methodology Group, including Irene Black, Debbie Bonetti, Heather Cassie, Martin Eccles, Sandra Eldridge, Jill J. Francis, Jeremy M. Grimshaw, Lorna Macpherson, Lorna McKee, Susan Michie, Nigel Pitts, Derek Richards, Douglas Stirling, Colin Tilley, Carole Torgerson, Shaun Treweek, Luke Vale, and Alan Walker for their guidance and contribution to the design and development of the study. We also thank Maria Prior for overseeing the running of the study, drafting of the published protocol, and her contribution to the design and analysis of the process evaluation. Thanks are also extended to Jill Farnham, Jenny Eades, Sarah Blackburn, and Lorna Barnsley for providing invaluable administrative support for this study. The views expressed in this article are those of the authors and may not reflect those of the funder. Funding: This study was conducted as part of the TRiaDS programme of implementation research which is funded by NHS Education for Scotland (NES). The Health Services Research Unit which is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates supported the study. The funder had no influence over the design, conduct, analysis and write up of the study. Data Availability: Researchers can request to access the data from the Information Services Division of NHS National Services Scotland http://www.isdscotland.org/. Some restrictions may apply for the protection of privacy and appropriate usage of the data.Peer reviewedPublisher PD

Reduced Health-Related Quality of Life in Elders with Frailty: A Cross-Sectional Study of Community-Dwelling Elders in Taiwan

PURPOSE: Exploring the domains and degrees of health-related quality of life (HRQOL) that are affected by the frailty of elders will help clinicians understand the impact of frailty. This association has not been investigated in community-dwelling elders. Therefore, we examined the domains and degree of HRQOL of elders with frailty in the community in Taiwan. METHODS: A total of 933 subjects aged 65 years and over were recruited in 2009 from a metropolitan city in Taiwan. Using an adoption of the Fried criteria, frailty was defined by five components: shrinking, weakness, poor endurance and energy, slowness, and low physical activity level. HRQOL was assessed by the short form 36 (SF-36). The multiple linear regression model was used to test the independent effects of frailty on HRQOL. RESULTS: After multivariate adjustment, elders without frailty reported significantly better health than did the pre-frail and frail elders on all scales, and the pre-frail elders reported better health than did the frail elders for all scales except the scales of role limitation due to physical and emotional problems and the Mental Component Summary (MCS). The significantly negative differences between frail and robust elders ranged from 3.58 points for the MCS to 22.92 points for the physical functioning scale. The magnitude of the effects of frail components was largest for poor endurance and energy, and next was for slowness. The percentages of the variations of these 10 scales explained by all factors in the models ranged from 11.1% (scale of role limitation due to emotional problems) to 49.1% (scale of bodily pain). CONCLUSIONS: Our study demonstrates that the disabilities in physical health inherent in frailty are linked to a reduction in HRQOL. Such an association between clinical measures and a generic measure of the HRQOL may offer clinicians new information to understand frailty and to conceptualize it within the broader context of disability

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Causes of Perinatal Death at a Tertiary Care Hospital in Northern Tanzania 2000-2010: A Registry Based Study.

Perinatal mortality reflects maternal health as well as antenatal, intrapartum and newborn care, and is an important health indicator. This study aimed at classifying causes of perinatal death in order to identify categories of potentially preventable deaths. We studied a total of 1958 stillbirths and early neonatal deaths above 500 g between July 2000 and October 2010 registered in the Medical Birth Registry and neonatal registry at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. The deaths were classified according to the Neonatal and Intrauterine deaths Classification according to Etiology (NICE). Overall perinatal mortality was 57.7/1000 (1958 out of 33 929), of which 1219 (35.9/1000) were stillbirths and 739 (21.8/1000) were early neonatal deaths. Major causes of perinatal mortality were unexplained asphyxia (n=425, 12.5/1000), obstetric complications (n=303, 8.9/1000), maternal disease (n=287, 8.5/1000), unexplained antepartum stillbirths after 37 weeks of gestation (n= 219, 6.5/1000), and unexplained antepartum stillbirths before 37 weeks of gestation (n=184, 5.4/1000). Obstructed/prolonged labour was the leading condition (251/303, 82.8%) among the obstetric complications. Preeclampsia/eclampsia was the leading cause (253/287, 88.2%) among the maternal conditions. When we excluded women who were referred for delivery at KCMC due to medical reasons (19.1% of all births and 36.0% of all deaths), perinatal mortality was reduced to 45.6/1000. This reduction was mainly due to fewer deaths from obstetric complications (from 8.9 to 2.1/1000) and maternal conditions (from 8.5 to 5.5/1000). The distribution of causes of death in this population suggests a great potential for prevention. Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care, monitoring of labour for fetal distress, and proper newborn resuscitation may reduce some of the categories of deaths

Global burden of disease due to smokeless tobacco consumption in adults : analysis of data from 113 countries

BACKGROUND: Smokeless tobacco is consumed in most countries in the world. In view of its widespread use and increasing awareness of the associated risks, there is a need for a detailed assessment of its impact on health. We present the first global estimates of the burden of disease due to consumption of smokeless tobacco by adults. METHODS: The burden attributable to smokeless tobacco use in adults was estimated as a proportion of the disability-adjusted life-years (DALYs) lost and deaths reported in the 2010 Global Burden of Disease study. We used the comparative risk assessment method, which evaluates changes in population health that result from modifying a population's exposure to a risk factor. Population exposure was extrapolated from country-specific prevalence of smokeless tobacco consumption, and changes in population health were estimated using disease-specific risk estimates (relative risks/odds ratios) associated with it. Country-specific prevalence estimates were obtained through systematically searching for all relevant studies. Disease-specific risks were estimated by conducting systematic reviews and meta-analyses based on epidemiological studies. RESULTS: We found adult smokeless tobacco consumption figures for 115 countries and estimated burden of disease figures for 113 of these countries. Our estimates indicate that in 2010, smokeless tobacco use led to 1.7 million DALYs lost and 62,283 deaths due to cancers of mouth, pharynx and oesophagus and, based on data from the benchmark 52 country INTERHEART study, 4.7 million DALYs lost and 204,309 deaths from ischaemic heart disease. Over 85 % of this burden was in South-East Asia. CONCLUSIONS: Smokeless tobacco results in considerable, potentially preventable, global morbidity and mortality from cancer; estimates in relation to ischaemic heart disease need to be interpreted with more caution, but nonetheless suggest that the likely burden of disease is also substantial. The World Health Organization needs to consider incorporating regulation of smokeless tobacco into its Framework Convention for Tobacco Control