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The aim of this study was to develop appropriate autonomous learning materials of structure and written expression of TOEFL preparation for autonomous learners for the Centre for Language and Development of Yogyakarta State University based on the learning needs and target needs of the autonomous learners. The research was an educational research and development (R&D) adapting ADDIE model (Branch, 2009). Two instruments (questionnaire and test) for needs analysis and two instruments for validation were used. The data from the needs analysis and the material validation were analyzed quantitatively through descriptive statistics. The research findings revealed that the autonomous learning materials were appropriate in terms of input, learning activities, layout, design and organization. The learners’ role is to learn the materials individually and teacher's role is to be a guide and cooperator. All of the learning activities include reading of explanations of forms and functions, doing practices for forms and functions, multiple choice, and doing reflection. Every unit has the following organizing unit title, instructions for learners, grammatical form and functions, activities of forms, functions, and TOEFL tests items, online activities for further learning, learning essentials, reflection, self-test (TOEFL) and answer keys.

Background The Union in collaboration with national TB programme (NTP) started the community-based MDR-TB care (CBMDR-TBC) project in 33 townships of upper Myanmar to improve treatment initiation and treatment adherence. Patients with MDR-TB diagnosed/registered under NTP received support through the project staff, in addition to the routine domiciliary care provided by NTP staff. Each township had a project nurse exclusively for MDR-TB and 30 USD per month (max. for 4 months) were provided to the patient as a pre-treatment support. Objectives To assess whether CBMDR-TBC project's support improved treatment initiation. Methods In this cohort study (involving record review) of all diagnosed MDR-TB between January 2015 and June 2016 in project townships, CBMDR-TBC status was categorized as "receiving support" if date of project initiation in patient's township was before the date of diagnosis and "not receiving support", if otherwise. Cox proportional hazards regression (censored on 31 Dec 2016) was done to identify predictors of treatment initiation. Results Of 456 patients, 57% initiated treatment: 64% and 56% among patients "receiving support (n = 208)" and "not receiving support (n = 228)" respectively (CBMDR-TBC status was not known in 20 (4%) patients due to missing diagnosis dates). Among those initiated on treatment (n = 261), median (IQR) time to initiate treatment was 38 (20, 76) days: 31 (18, 50) among patients "receiving support" and 50 (26,101) among patients "not receiving support". After adjusting other potential confounders (age, sex, region, HIV, past history of TB treatment), patients "receiving support" had 80% higher chance of initiating treatment [aHR (0.95 CI): 1.8 (1.3, 2.3)] when compared to patients "not receiving support". In addition, age 15-54 years, previous history of TB and being HIV negative were independent predictors of treatment initiation. Conclusion Receiving support under CBMDR-TBC project improved treatment initiation: it not only improved the proportion initiated but also reduced time to treatment initiation. We also recommend improved tracking of all diagnosed patients as early as possible.