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The selection of appropriate learning media is proven to have a positive impact on students' knowledge and abilities in the learning process. They were referring to material in learning carried out by sports students as one of the preparations for teachers who must understand refereeing regulations so that the entire learning process can really utilize learning media. This study aims to determine the effect of the application of learning media on remembering the knowledge and ability of volleyball referees. The research method used in this study is quasi-experiment with a pretest and posttest quasi-experimental control group research design. This study involved 30 volleyball referee students who were obtained using cluster random sampling. This research instrument is an instrument that uses a questionnaire on the level of knowledge and ability of volleyball referees, divided into 10 indicators. This questionnaire obtained a reliability of 0.826. The analysis of this data used prerequisite tests (normality test using the Kolmogorov Smirnov test, homogeneity test using the Levin statistical test), and a t-test conducted with the help of SPSS 25 to test the effect on each subject. The results showed that the average score of the experimental volleyball referee group was 216.93 ± 7.75, while the average score of the control volleyball referee knowledge and ability level group was 189.47 ± 7.18, the experimental group was better than the control group.

The survey in North Sumatra was conducted by researchers in the areas of Medan, Tanah Karo, Tebing Tinggi, Asahan, Serdang Bedagai, Deli Serdang, Labuhan Batu, Tanjung Balai, Humbahas, and Binjai, many coaches and athletes still do not have adequate guidance in Indonesian. Most of the information is still in foreign languages, making it difficult to understand Sambo's techniques and rules. This study aims to develop a digital application-based sambo sports book. Method, in this research, uses the research and development (R&D) method. The research subjects consisted of 10 athletes, coaches, and sambo sports enthusiasts for the main field trial and 20 athletes, coaches, and sambo sports enthusiasts for the operational field trial. Data were collected through observation, interviews, and questionnaires, with instruments in the form of feasibility assessment sheets from sambo sports experts, linguists, media experts, and user subjects. Data analysis was carried out using a percentage quantitative descriptive technique. The results showed that this digital application-based sambo sports book was very good and feasible. This book has great potential to improve the understanding of sambo techniques and rules among athletes, coaches, and sambo enthusiasts by providing easy-to-understand guidelines in Indonesian and emphasizing the importance of technology-based approaches in Sambo.

Lifelong Learning or can also be expressed as Continuous Learning, in Islamic teachings is a big concept which is widely represented in the verses of the Qur’an and Hadith texts, as well as narrated by scholars and thinkers in their various opinions. Among contemporary scholars and thinkers who describe the concept of Lifelong Learning or Continuous Learning is Prof. Dr. ‘Abd Al-Karîm Bakkâr, M.A. in his various works, especially his work entitled Haula Al-Tarbiyah wa Al-Ta’lîm which is the primary data source in this research article. The research used in tis article is a type of qualitative research with descriptive-analytical literature study. Data collection uses documentation techniques and literature study, while analysis uses inductive-interpretative content analysis techniques. The result of the discussion show that ‘Abd Al-Karîm Bakkâr has a comprehensive concept of Lifelong Learning or Continuous Learning so that it is relevant to be implemented by lecturers and students in higher education in facing the digital era like today, through three strategies, namely (1) high motivation in learning-teaching, (2) enthusiastic about literacy, especially digital literacy, and (3) stepping into pedagogical-heutagogical-cybergogy learning.

Daily pedestrian travels involve navigating various locations, putting them at risk because they are vulnerable worldwide to road users. Road traffic accidents claim the lives of many pedestrians every year. Any roadway and traffic management design must consider the speed at which pedestrians cross or walk. To improve current operating policies and to provide logical safety assessments, it is essential to comprehend the characteristics of pedestrian speed. While crossing several vehicular lanes, pedestrians must look for vehicle gaps in each route according to the direction of traffic. However, existing studies often overlook the diversity in pedestrian behaviors. This paper seeks to summarize the pedestrian crossing speeds, delays, and gap acceptance behavior in Asian nations based on several investigations. Several notable pieces of information were also formulated through tabulation. By averaging the pedestrian speed of some Asian countries, it was found that pedestrians move at 1.23 m/s, and Indonesian pedestrians move slower than other countries’ pedestrians. Gap acceptance behavior depends on age, gender, group/individual, education status, day/night, vehicle type, traffic flow, waiting location etc. Such factors are also the influencing factors for pedestrian speed too. The study’s conclusions will help mitigate traffic safety issues by creating an effective intersection control system. Practitioners and policymakers can use the study results to develop effective management strategies to lessen collisions between pedestrians and vehicles in uncontrolled locations in urban areas.

This study investigates the perspective of non-formal education leaders in Jambi province, Indonesia on the implementation of Merdeka curriculum policies in non-formal education providing equal education service managed by the community. Six leaders were selected using purposive sampling and data was collected through open-ended telephone interviews and one-on-one meetings. The findings revealed that the leaders had interesting experiences implementing the new curriculum, with a focus on providing non-formal education units. However, there were challenges in translating the curriculum structures into the operational curriculum of educational units, especially for students who are not of school age. The leaders suggested socialization, assistance, and training actively pour the curriculum into the operational curriculum. They also recommended support from the government in the form of material and non-material support. Further research is needed to evaluate the effectiveness of the policies and strategies used by non-formal education units in the implementation of the new curriculum, including those managed by the government and community, and to compare the implementation in non-formal and formal education units.

The Klagison River is one of the rivers located in the North Sorong District to the Sorong Manoi District. The flow of the Klagison River is used by the sand mining industry to dispose of liquid waste products from mining sites. Mining activities are in the middle of the Klagison River so that it can affect the quality of river water and experience a decrease in carrying capacity due to the high level of turbidity in river water caused by sedimentation. The purpose of this research is to provide knowledge about the content of metal elements in sediments by identifying the constituent elements of the Klagison River sediments, Sorong City, West Papua. Determination of the sampling point using the purposive sampling method and the sediment collection tool using the Ekman grab. The method of analyzing the constituent elements of the sediment uses the XRF (X-Ray Fluorescence) method. Based on the research results, there are various types of metal elements contained in the sediments of the Klagison River, namely the elements Al, Si, P, S, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, Rb, Sr, Zr and Re where the dominant concentration of metal elements from 5 observation stations is Fe>Si>K>Cl>Al>Ca. At the 5 observation stations, the element Fe>Si>K>Cl>Al>Ca was the highest compared to the other 4 observation stations. This is because station 5 is the mouth of the Klagison River so that it becomes a place for liquid waste deposits to coalesce.

Berdasarkan hasil studi pendahuluan 79% guru sekolah dasar di Kabupaten Batubara masih menggunakan bahan ajar cetak dalam materi Pendidikan jasmani. Tujuan penelitian ini adalah untuk mengetahui efektifitas bahan ajar berbasis aplikasi dalam meningkatkan keterampilan passing bawah bola voli siswa Sekolah Dasar Negeri (SDN) UPT Perkebunan Tanah Itamulu. Bahan ajar ini merupakan hasil riset pengembangan yang dilakukan melalui uji validitas, uji pemakaian (skala kecil dan skala besar). Penelitian ini dilakukan mulai bulan Juli 2022 sampai Oktober 2022 di Sekolah UPT SDN 01 Perkebunan Tanah Itam Ulu Kec. Datuk Lima Puluh Kabupaten Batubara, Sumatera Utara. Penelitian ini menggunakan pendekatan kualitatif model Borg and Ghall. Subjek penelitian ini adalah siswa SDN 01 Perkebunan Tanah Itam Ulu sebanyak 50 orang. Instrumen yang digunakan untuk pengumpulan data dalam penelitian ini adalah angket. Dan teknik analisis data menggunakan rumus persentase. Hasil penelitian dilihat dari hasil penilaian ahli materi (90,4%) dan ahli media (90,1%). Hasil uji pemakaian skala kecil 84% (baik) dan skala besar 88,3% (baik). Berdasarkan data hasil penelitian ini maka bahan ajar passing bawah bola voli berbasis aplikasi layak digunakan siswa dalam pembelajaran passing bawah bola voli di SDN UPT Perkebunan Tanah Itam Ulu Kecamatan Datuk Lima Puluh Kabupaten Batubara. Dengan demikian bagi guru yang ingin mengajarkan passing bawah bola voli dapat menjadikan bahan ajar aplikasi ini sebagai salah satu pilihan bahan ajar pada siswa dalam materi passing bawah bola voli. karena bahan ajar ini dapat digunakan secara mandiri oleh siswa melalui handpone android.

This research is a research activity testing the effectiveness of table tennis digital teaching materials, which previously this product has gone through a development process (expert judgment, small-scale field tests and large-scale field tests). This study aims to obtain teaching material products that are effectively used by students in learning table tennis. The method used in this research is the experimental method. The subjects involved in this study were 30 experimental groups and 30 control groups. The subjects of this study were students who were taking table tennis courses at the Physical Health and Recreation Education Study Program, Medan State University. The data analysis technique used in this study is the feasibility percentage technique. Based on the results of data analysis, it can be described that the results of the research can be seen from the results of the pretest, the two groups have almost the same percentage of learning outcomes. where the experimental group's pretest results were 41.92% while the control group was 42.50% with a difference of 0.88%. Based on this percentage, it can be categorized that student learning outcomes in the cognitive aspect have not been completed. Furthermore, the results of the post-test of the two groups experienced an increase from the results of the pre-test, where the experimental group achieved a completeness percentage of 92.2% while the control group was 82.1%, this percentage can be categorized as complete classically, but in the post-test results the percentage of the experimental group was higher than with the percentage of the control group. Based on this research data, it can be concluded that the digital materials developed in this study are suitable for use by educators as teaching materials in table tennis lectures.

The integration of cutting-edge technologies such as the Internet of Things (IoT), robotics, and machine learning (ML) has the potential to significantly enhance the productivity and profitability of traditional fish farming. Farmers using traditional fish farming methods incur enormous economic costs owing to labor-intensive schedule monitoring and care, illnesses, and sudden fish deaths. Another ongoing issue is automated fish species recommendation based on water quality. On the one hand, the effective monitoring of abrupt changes in water quality may minimize the daily operating costs and boost fish productivity, while an accurate automatic fish recommender may aid the farmer in selecting profitable fish species for farming. In this paper, we present AquaBot, an IoT-based system that can automatically collect, monitor, and evaluate the water quality and recommend appropriate fish to farm depending on the values of various water quality indicators. A mobile robot has been designed to collect parameter values such as the pH, temperature, and turbidity from all around the pond. To facilitate monitoring, we have developed web and mobile interfaces. For the analysis and recommendation of suitable fish based on water quality, we have trained and tested several ML algorithms, such as the proposed custom ensemble model, random forest (RF), support vector machine (SVM), decision tree (DT), K-nearest neighbor (KNN), logistic regression (LR), bagging, boosting, and stacking, on a real-time pond water dataset. The dataset has been preprocessed with feature scaling and dataset balancing. We have evaluated the algorithms based on several performance metrics. In our experiment, our proposed ensemble model has delivered the best result, with 94% accuracy, 94% precision, 94% recall, a 94% F1-score, 93% MCC, and the best AUC score for multi-class classification. Finally, we have deployed the best-performing model in a web interface to provide cultivators with recommendations for suitable fish farming. Our proposed system is projected to not only boost production and save money but also reduce the time and intensity of the producer’s manual labor.

This study aims to measure the knowledge of high school students about PON XXI which will be held in North Sumatra - Aceh in 2024. This research uses a qualitative descriptive method with survey techniques. The sample for this research was 192 people from several schools with 3 districts/cities namely area of ​​Medan city, Deli Serdang Regency, and Serdang Bedagai Regency. Data collection techniques using observation and questionnaires. Based on research results from the questionnaire, information was obtained that 47 students (23.9%) had never heard of PON 93 people (47.2%) students did not understand about PON 37 people (17.3%) students did not know at all how many years PON was held. 16 people (8.1%) students did not know where the host of PON XXI would be held; and 118 people (59.9%) students responded to know the attributes of PON XX in Papua. From the results of the data obtained, it is known that there are still many high school/equivalent students who do not know about the grand PON event which will be held in 2024 in North Sumatra and Aceh. It can be seen from the average percentage obtained by 31.3% of students who do not have knowledge about PON and the events that will be held in 2024.It can be concluded that it is necessary to carry out socialization about PON XXI which will be held in North Sumatra - Aceh in 2024.

Abstract To expand the genomic information of Hypericaceae, particularly on Cratoxylum, we characterized seven novel complete plastid genomes (plastomes) of five Cratoxylum and two of its allied taxa, including C. arborescens, C. formosum subsp. formosum, C. formosum subsp. pruniflorum, C. maingayi, C. sumatranum, Hypericum hookerianum, and Triadenum breviflorum. For Cratoxylum, the plastomes ranged from 156,962 to 157,792 bp in length. Genomic structure and gene contents were observed in the five plastomes, and were comprised of 128–129 genes, which includes 83–84 protein-coding (CDS), 37 tRNA, and eight rRNA genes. The plastomes of H. hookerianum and T. breviflorum were 138,260 bp and 167,693 bp, respectively. A total of 110 and 127 genes included 72 and 82 CDS, 34 and 37 tRNA, as well as four and eight rRNA genes. The reconstruction of the phylogenetic trees using maximum likelihood (ML) and Bayesian inference (BI) trees based on the concatenated CDS and internal transcribed spacer (ITS) sequences that were analyzed separately have revealed the same topology structure at genus level; Cratoxylum is monophyletic. However, C. formosum subsp. pruniflorum was not clustered together with its origin, raising doubt that it should be treated as a distinct species, C. pruniflorum based on molecular evidence that was supported by morphological descriptions.

Pemeliharaan perbaikan mesin maupun pipa selalu dilakukan oleh tim maintenance yang ditugaskan dari kantor PDAM Tirta Daroy. Sistem penugasan perbaikan mesin dan pipa dilakukan oleh pimpinan bagian pemeliharaan kepada setiap anggota teknisi. Saat ini sistem penugasan dilakukan dengan menelpon teknisi-teknisi tersebut untuk melakukan perbaikan disuatu tempat. Setiap teknisi tersebut nantinya akan berkumpul pada tempat terjadinya kerusakan dan melakukan perbaikan kerusakan pipa atau mesin tersebut. Berdasarkan sistem yang telah berjalan saat ini, semua sistem penugasan tidak tertulis dengan jelas, hanya dilakukan dengan metode informasi langsung via telepon kepada setiap teknisi. Dari sistem yang telah berjalan maka terdapat kendala yaitu sistem penugasan tidak terdata dengan baik. Maka oleh sebab itu diperlukan sebuah sistem informasi pemeliharaan pipa dan mesin yang dapat memberikan informasi penugasan berbasis teks via SMS Gateway yang dapat direkam oleh database sistem informasi tersebut, sehingga dapat menghasilkan laporan penugasan dan data teknis dari kegiatan penugasan perbaikan dengan baik. Tujuan penelitian ini adalah membangun sistem informasi penugasan maintenance mesin dan pipa berbasis layanan global sistem communication pada PDAM Tirta Daroy Banda Aceh. Metodologi pengembangan sistem menggunakan metode SDLC (Software Development Life Cycle) dengan menggunakan pemrograman PHP dan MySQL. Hasil penelitian adalah sistem yang dirancang telah berhasil meningkatkan kinerja petugas dalam menghasilkan laporan maintenance dan laporan detil per maintenance. Disamping itu juga sistem informasi telah berhasil mengirimkan pesan kepada teknisi melalui SMS dengan baik.

This study aims to determine the carcass components of super free-range chicken on fermented corn cobs with different levels. This research was carried out in the laboratory of the Poultry Livestock Unit, Faculty of Animal Husbandry, University of Halu Oleo Kendari. This study used 64 super free-range chickens using a Completely Randomized Design (CRD) with 4 treatments, namely P0 (feed without fermented corn cobs) P1 (feed containing 2% fermented corn cobs) P2 (feed containing 4% fermented corn cobs) P3 (feed containing 4% fermented corn cobs) feed containing 6% fermented corn cobs) and 4 replications. The variables observed were slaughter weight, carcass percentage, carcass components, and abdominal fat. The data obtained were tabulated and analysed using analysis of variance. The use of fermented corn cobs in feed with a level of 2-6% does not significant effect (P>0.05) on slaughter weight, percentage of carcass, but significant effect (P

The study purpose. The online learning system, media, and resources used by lecturers to achieve volleyball learning goals are known to be not optimal. This study aimed to develop an e-learning video media that can be used by students as a learning resource to learn the material for upper serve, jump serve, and floating serve in volleyball games. Materials and methods. The research subjects were students who were divided into treatment groups and control groups where each group consisted of 40 people. The research method used was an experimental method with a before-after research design (one-group pretest and posttest design). A rubric test is an instrument used to measure the effectiveness of video media in improving student service skills. Results. The results of the research and data analysis found that the service skills (upper serve, jump serve, and floating serve) in the treatment group with the help of e-learning video media were better than in the control group who did not receive e-learning. Conclusions. The treatment group has better service skills than the control group. During the Covid-19 pandemic, it is recommended for lecturers to use e-learning video media in teaching volleyball service material.

Background: The relationship between malocclusion and respiration has been debated for decades. Aim: The aim of this study is to assess dental occlusion in relation to mouth breathing and different types of pharyngeal lymphoid tissue obstruction in children. Settings and Design: This was a cross-sectional study of 200 children aged between 6 and 12 years who were clinically examined and divided into two groups: mouth breathers and nasal breathers. Materials and Methods: The children were subjected to otorhinolaryngologic examination to identify the type of pharyngeal obstruction. Dental interarch relationship and pharyngeal tissue obstruction were diagnosed and appropriate cross tabulations were done. Statistical Analysis Used: The data collected were statistically analyzed using the SPSS version 15.0 software. Results: Statistically significant association was found between type of breathing and pharyngeal lymphoid tissue obstruction (P = 0.001), dental occlusion and type of breathing (P = 0.001), and pharyngeal lymphoid tissue obstruction and dental occlusion (P = 0.001). Higher prevalence of crossbite, deep bite, and Class II malocclusion was seen in children with adenotonsillar hypertrophy as well as mouth breathing habit. Conclusion: Obstructive tonsils and adenoids are risk factors for the development of malocclusion. Early detection and correction of airway obstruction can help in proper growth of the dentofacial region.

Accurate demarcation of anatomical landmarks in 3D medical imaging is a safety-critical and challenging task. State-of-the-art approaches formulate landmark localization either as a classification or as a regression problem. In this study, feature classification is performed as a verification step in a cascaded Hough regression networks (HRNs) for hippocampus localization in the structured magnetic resonance images of the brain. Global and local features of the landmarks are learned with coarse prediction and fine-tuning convolutional neural networks for coarse-to-fine localization. Siamese network was trained to learn a deep metric for verifying the roughly estimated locations. Feature verification with the Siamese network drops the outlier predictions and increase the robustness in prediction. Three-view patches(TVPs) with a size of $64\times 64\times 3$ are fed for rough estimation while the TVP sizes for Siamese-based verification and Hough regression network (HRN)-based fine-grained estimations are $32\times 32\times 3$ and $16\times 16\times 3$ , respectively. The experiment was performed on the Gwangju Alzheimer’s and Related Dementia’s (GARD) cohort data set. The proposed approach demonstrated better performance with the errors of 1.70±0.50 millimeters(mm) and 1.66±0.49 mm for localizing the left and right hippocampi in the GARD data set. In Alzheimer’s Disease Neuroimaging Initiative (ADNI) data set, the observed errors were 1.79 ± 0.83 mm and 1.55 ± 0.61 mm for localizing left and right hippocampus, respectively. Our results are comparable to those obtained by the state-of-the-art methods.

Penelitian ini mempunyai tujuan buat mengetahui dampak metode mengajar resiprokal menggunakan kemampuan gerak pada menaikkan keterampilan servis bola voli di siswa taraf SMP. Penelitiaan memakai sampel 20 peserta didik dipengaruhi dengan teknik purposive random sampling. Selanjutnya, penelitian menggunakan metode eksperimen serta teknik pengumpulan data menggunakan uji tes keterampilan servis dan keterampilan gerak (Barrow Motor Ability Tes). kemudian teknik analisis data yang dipergunakan menggunakan uji anava. hasil asal pengujian hipotesis dapat disimpulkan bahwa belajar servis bola voli dengan memakai metode resiprokal lebih baik pada siswa yang mempunyai kemampuan gerak tinggi dibandingkan menggunakan siswa berkemampuan motilitas rendah.

The COVID-19 epidemic caused global roads and highway networks to be disrupted to historic proportions. While the world is focused on combating COVID-19 pandemic, people are still dying and being injured as a result of traffic collisions on the highways owing to movement restrictions. Although the impact of shutdown mechanisms on traffic safety is still being studied, initial studies reveal a decrease in traffic flow and a rise in risky driving behaviors. On the other hand, it is important to investigate how the epidemic has influenced travel behavioral characteristics in order to design mobility regulations for the post-COVID-19 future. Considering numerous investigations, the present study attempts to provide an overview of the influence of the COVID-19 pandemic on road traffic crashes, deaths, and injuries, as well as road travel behavior. The magnitude of COVID-19 was found to result in fewer crashes and injuries, as well as a reduction in road safety performance, but substantially greater serious accidents. According to a study of many papers, Travel objective, method of transportation, mileage traveled, and numbers of trips for principal travel were considerably different before and during the epidemic. The result of this study have significant legislative ramifications and also can help to guide how further lockdowns are managed in terms of traffic safety and travel behavior.

This study aims to analyze the concept of education for the regeneration of da’i through halaqah tarbiyah in the Wahdah Islamiyah Islamic organization. This research is a qualitative research with a descriptive approach, where the research seeks to analyze the concept and implementation of the education for regeneration of dai through halaqah tarbiyah which is carried out by the Wahdah Islamiyah organization. Findings and conclusions from the research, First, the education of da’i regeneration through halaqah tarbiyah in Wahdah is carried out in a structured manner with a directed and gradual curriculum (marhalah) which aims to create an ideal Muslim personality (tawkin syakshiyah al-muslimah al-mutamayyizah) which has the characters of a believer, mushlih, mujahid, muta'awin, and mutqin; Third, the concept of a da’i cadre education curriculum through halaqah tarbiyah in Wahdah Islamiyah originates from the Al-Qur'an and As-Sunnah with an emphasis on three aspects of education; tsaqafiyah, ruhiyah, and jasadiyah. Fourth, the concept of the education evaluation of the da’i Wahdah Islamiyah regeneration includes evaluation of the objectives, input, process, and output as well as educators. AbstrakPenelitian ini bertujuan menganalisis konsep pendidikan kaderisasi da’i melalui halaqah tarbiyah di ormas Islam Wahdah Islamiyah. Penelitian ini termasuk jenis penelitian kualitatif dengan pendekatan deskriptif, di mana penelitian berupaya menganalisis konsep dan pelaksanaan pendidikan kaderisasi da’i melalui halaqah tarbiyah yang dilaksanakan di ormas Wahdah Islamiyah. Temuan dan simpulan dari penelitian, Pertama, Pendidikan kaderisasi da’i melalui halaqah tarbiyah di Wahdah dilakukan secara terstruktur dengan kurikulum yang terarah dan bertahap (ber-marhalah). Kedua, tujuannya melahirkan pribadi muslim ideal (tawkin syakshiyah al-muslim al-mutamayyizah) yang memiliki karakter Mukmin, Mushlih, Mujahid, Muta’awin, dan Mutqin; Ketiga, Konsep kurikulum pendidikan kaderisasi da’i melalui halaqah tarbiyah di Wahdah Islamiyah bersumber dari Al-Qur’an dan As-Sunnah dengan penekanan pada tiga aspek pendidikan; tsaqafiyah, ruhiyah, dan jasadiyah. Keempat, konsep evaluasi pendidikan kaderisasi da’i Wahdah Islamiyah mencakup evaluasi terhadap tujuan, input, proses, dan output serta tenaga pendidik.

Politeness of expression and character education are both crucial aspects, in the current era of disruption, especially concerning sociopragmatic political purposes. The realization of politeness acts of language in the context of communication and global communication has now penetrated without limits on social distance, time, and goals. The problem is the act of language in electronic media, especially Instagram, giving space to the user to be more open in expressing his goals and objectives, including to the president in relation to specific goals and politics. This study aims to identify the forms of positive politeness acts of followers' comments on President Jokowi's official Instagram account and describe the intent of politico pragmatic power of positive politeness of followers of Jokowi's Instagram accounts. The data source of this study was the speech of followers on the official Instagram account of Indonesian President Jokowi #MenujuIndonesiaMaju managed by the President's Digital Communication Team for the period October-November 2018. The study data were in the form of comments from Jokowi's Instagram account followers who had positive politico pragmatic politeness. The data collection technique was carried out using documentation, note-taking techniques, and continued with heuristic listening techniques. Data analysis was performed with an intralingual equivalent technique which was strengthened by an extra lingual equivalent and sharpened with Levinson's politeness analysis technique based on the principle of harmony in Javanese culture. The results of the study showed that the form of positive politeness acts that were most used by followers was by giving attention to the speech partners. Political propaganda power of dominant followers’ comments was in the form of the power to ask and support rather than the power of praise, the power of influence, the power of motivation, and the power of suggestion. It shows that Instagram account followers have an optimistic attitude towards Jokowi's leadership. Jokowi's managerial, and leadership performance has a positive face among followers. This power of praise, motivation, and advice is an essential component in the formation of children's character education in the current era of disruption of education.

The occurrence of the supernumerary tooth in the nasal cavity is uncommon. If not diagnosed and treated early, it may lead to various complications. Nasal endoscopy not only helps in proper diagnosis but also is an effective approach towards the extraction of the nasal tooth. It increases precision and reduces morbidity associated with the surgery.

Agarwood is a valuable aromatic resinous wood that is biosynthesised when a fungal attack injures the healthy wood tissue of the Aquilaria tree. The magnitude of infection related to sap flow (SF) is one of the most critical functional traits to evaluate the tree’s response to various adverse conditions. Therefore, the objective of this study was to investigate the reliability of sonic tomography (SoT) and sap flow meter (SFM) in studying the influence of inoculation fungi Pichia kudriavzevii Boidin, Pignal and Besson, and Paecilomyces niveus Stolk and Samson, on deteriorated wood (Dt) and SF rate in Aquilaria malaccensis Lam. A. malaccensis trees with small, medium, and large diameters were inoculated with each fungus separately at the bottom, middle, and top positions of the tree and the area of sapwood was measured after 6, 12, and 24 months to stimulate the agarwood formation. Furthermore, the SF rate was assessed using SFM in the position of the selected trees. There was a significant difference (p ≤ 0.05) in Dt% and SF rate between inoculated and uninoculated trees. The Dt percentage in trees inoculated with P. kudriavzevii, P. niveus, and control trees was 25.6%, 25.7%, and 15.0%, respectively. The SF rate was lower in P. kudriavzevii, with 207.7 cm3/h, than in the control trees, with 312.9 cm3/h in the small-diameter class. In summary, the results of this study emphasise the importance of inoculation duration (24 months) and the effects of water conductivity, especially tree diameter class (small), on the biosynthetic response of resinous substance.

Angle tilt is an important factor that affects the amount of solar radiation received on the surface of solar panels. Fixed-mounted solar panels cannot receive the maximum amount of solar radiation. How to get the maximum solar radiation by positioning the surface of the solar panel at a certain slope to be directly facing the sun. This study aims at determining the optimum slope angle of solar panels in the city of Meulaboh (4,152 LU, 96,131 BT). The method of calculating the total value of solar radiation on a sloping surface simulated with Pvsyst Software is used to determine the annual optimum tilt angle. NASA SSE solar radiation data from 1983 – 2005 were used to support simulations in this study. The results showed that the tilt angle that can produce the maximum output energy in the city of Meulaboh (4,152 LU, 96,131 BT, Johan Pahlawan) is at an angle of 5° with the orientation directly facing south.

There is ongoing research for the automatic diagnosis of Alzheimer's disease (AD) based on traditional machine learning techniques, and deep learning-based approaches are becoming a popular choice for AD diagnosis. The state-of-the-art techniques that consider multimodal diagnosis have been shown to have accuracy better than a manual diagnosis. However, collecting data from different modalities is time-consuming and expensive, and some modalities may have radioactive side effects. Our study is confined to structural magnetic resonance imaging (sMRI). The objectives of our attempt are as follows: 1) to increase the accuracy level that is comparable to the state-of-the-art methods; 2) to overcome the overfitting problem, and; 3) to analyze proven landmarks of the brain that provide discernible features for AD diagnosis. Here, we focused specifically on both the left and right hippocampus areas. To achieve the objectives, at first, we incorporate ensembles of simple convolutional neural networks (CNNs) as feature extractors and softmax cross-entropy as the classifier. Then, considering the scarcity of data, we deployed a patch-based approach. We have performed our experiment on the Gwangju Alzheimer's and Related Dementia (GARD) cohort dataset prepared by the National Research Center for Dementia (GARD), Gwangju, South Korea. We manually localized the left and right hippocampus and fed three view patches (TVPs) to the CNN after the preprocessing steps. We achieve 90.05% accuracy. We have compared our model with the state-of-the-art methods on the same dataset they have used and found our result comparable.

Objective: The aim of the study is to look at the effects of climate on the way and place of childcare and their impact on children's health. Method: The method used is field exploration by observing how parents take care of their children, and measuring the temperature and humidity of the caregiver, besides looking for secondary data at the local health center regarding the level of health of infants (health center visits for treatment and types of diseases that are mainly affected by climate). Result: Soil as a reservoir for germs occurs because the residential environment is not clean due to a poor drainage system which results in dirty water not being channeled properly, being absorbed into the soil and stagnant. In addition, high wind speeds also have an impact on household displacement from endemic places into settlements. It takes non-physical and physical efforts to prevent children from contracting the disease. Non-physical efforts through good behavior, and physically by making playtime comfortable and safe for children. Conclusion: Children who play in nature using soil media are at risk of causing disease. Soil as a reservoir for germs occurs because the residential environment is not clean due to a poor drainage system, resulting in dirty water not being channeled properly, absorbed into the soil and stagnant.

Patches from three orthogonal views of selected cerebral regions can be utilized to learn convolutional neural network (CNN) models for staging the Alzheimer disease (AD) spectrum including preclinical AD, mild cognitive impairment due to AD, and dementia due to AD and normal controls. Hippocampi, amygdalae and insulae were selected from the volumetric analysis of structured magnetic resonance images (MRIs). Three-view patches (TVPs) from these regions were fed to the CNN for training. MRIs were classified with the SoftMax-normalized scores of individual model predictions on TVPs. The significance of each region of interest (ROI) for staging the AD spectrum was evaluated and reported. The results of the ensemble classifier are compared with state-of-the-art methods using the same evaluation metrics. Patch-based ROI ensembles provide comparable diagnostic performance for AD staging. In this work, TVP-based ROI analysis using a CNN provides informative landmarks in cerebral MRIs and may have significance in clinical studies and computer-aided diagnosis system design.

Particulate matter (PM) is one of the primary pollutants found in the indoor environment. It can cause deterioration of the indoor air quality (IAQ) and is often linked with adverse health effects especially towards susceptible subgroup of the population like children. School children are exposed to PM inside the classroom, as this indoor PM may originate from both indoor and outdoor sources. Furthermore, ambient surrounding could be one of the major factors that contribute to its high concentration, specifically for school environment like government-subsidized schools in Malaysia whereby the schools are using natural ventilation systems to control the thermal comfort inside the classrooms. Hence the infiltration of outdoor PM into the indoor is probably high and significant. The high concentration of PM may affect the children’s health and learning performances. Due to this reason, it is important to study the effects of PM towards children. Thus, this study aims to assess the concentrations of PM and selected IAQ parameters in the school indoor environment with distinct background characteristics including residential, industrial, and rural areas. PM and IAQ parameters (temperature, relative humidity (RH), carbon monoxide (CO) and carbon dioxide (CO2)) were assessed for 8-hours duration via DustMate Environmental Dust Detector (Turnkey Instruments, USA) and VelociCalc® Multi-Function Ventilation Meter 9565 (TSI®, USA) respectively, during occupied and non-occupied time in the classrooms. Second, considering the children’s prolonged and repetitive exposure towards PM in school indoor environment and their body sensitivity, this study also screened for the prevalence of non-specific respiratory disease (NSRD) and persistent cough and phlegm (PCP) among children via structured questionnaire developed by American Thoracic Society’s Division of Lung Diseases (ATS-DLD-78-C). Higher concentrations of PM and prevalence of respiratory symptoms in the school from the industrial area were expected, due to the high concentration of PM originated from nearby industrial activities and anthropogenic sources. Hopefully, better understanding and insights on the issue were obtained through this study.

Ceratocystis wilt disease surveys were conducted in three selected Malaysian Acacia mangium plantations. These completed surveys revealed the occurrence of the wilt disease, with the incidence of infection ranging from 7.5% to 13.6%. Signs of wood-boring insects, bark peeling due to squirrel activity, and pruning wounds were often associated with this disease. The fungus most frequently isolated from the diseased trees was the Ceratocystis fungus. The analysis on the morphological characteristics has identified the fungus as Ceratocystis fimbriata complex. Phylogenetic analysis based on the sequences of the ITS, and concatenated sequences of EF1α-βT regions grouped the isolates within the C. fimbriata sensu stricto, in comparison to other C. fimbriata isolates. Pathogenicity tests were conducted on six to nine-month-old healthy A. mangium seedlings by inoculating these seedlings with eight out of the 16 isolates. The results demonstrated that all the isolates were pathogenic, with mortality beginning as early as two weeks after inoculation. However, an ANOVA test indicated a significant difference between the pathogenicity levels among the fungal isolates. The results also showed that pathogen aggressiveness was not correlated with geographical origin. A host range test was also conducted by using C. fimbriata SSB3 and FRIM1162 isolates against several forest plantation species. The findings suggested that only A. mangium was susceptible to C. fimbriata. The other species remained healthy with no symptoms of infection even after seven weeks of treatment, as compared to the A. mangium species, where between 38 to 60% of the inoculated plants had died. This study provides new information on the status of Ceratocystis wilt disease, especially on the occurrence and effects on A. mangium plantation, by giving insights on how to control and manage this ferocious plant pathogen in the future.

Ideally the increase in electrical energy needs is proportional to the supply, but these conditions often cannot be met by the energy provider. This condition can affect the quality of electrical energy supply to customers, such as system outages to power outages. Short-term solutions and concrete steps in an effort to overcome these problems is saving electricity usage. In accordance with presidential regulation no. 5 of 2006 concerning energy conversion and the decision of the Minister of National Education No. 13 of 2012 about Savings on the Use of Electric Energy in government and private institutions, it is necessary to make efficient use of electricity in the University Of Serambi Mekkah Faculty of Engineering. There is no data on energy consumption in the building. It is necessary to conduct an energy audit of the building to determine the level of energy use in the building. The initial IKE value is a guideline for decision making whether or not a detailed audit is needed for the building. The audit results are Energy Saving Opportunities (PHE) that can be obtained by applying the optimal Energy Consumption Intensity (IKE). The results obtained energy savings reached 45.65% from the initial data.

This sociopragmatics study aims to investigate the various types of directive speech acts and the markers of local wisdom in the communication of elementary students in Kolaka. The research design employed is qualitative descriptive, chosen for its ability to describe the types of directive speech acts and the manifestation of local wisdom within the context of elementary school students. The participants in this study consisted of elementary school students from Kolaka Regency. Data were collected through nonparticipant observation, and the analysis followed qualitative data procedures based on the interactive model developed by Miles and Huberman, which involved data reduction, data presentation, and drawing conclusions. The findings revealed four types of directive speech acts commonly used by elementary school students: demanding, commanding, begging, and challenging. These directive speech acts were found to be influenced by the cultural context, specifically manifested through the use of clitics. The clitics -ko, -mi, - ka, -hae, and -na were identified as significant markers of the local wisdom in the communication of elementary students, observed in utterances such as lihatko, ayomi, pindahko, biarmi, siniko, and jemputna. These clitics not only serve as markers of cultural identity but also indicate different levels of politeness in communication. Further implications for language teaching practices are also discussed.

Metarhizium anisopliae (Metchnikoff) Sorokin, a pathogenic fungus to insects, infects the subterranean termite, Coptotermes curvignathus Holmgren, a devastating pest of plantation trees in the tropics. Electron microscopy and proteomics were used to investigate the infection and developmental process of M. anisopliae in C. curvignathus. Fungal infection was initiated by germ tube penetration through the host’s cuticle as observed at 6 h post-inoculation (PI), after which it elongated into the host’s integumental tissue. The colonization process continued as seen from dissemination of blastospores in the hemocoel at 96 h PI. At this time point, the emergent mycelia had mummified the host and forty-eight hours later, new conidia were dispersed on the termites’ body surface. Meanwhile, hyphal bodies were observed in abundance in the intercellular space in the host’s body. The proteomes of the pathogen and host were isolated separately using inoculated termite samples withdrawn at each PI-time point and analyzed in two-dimensional electrophoresis (2-DE) gels. Proteins expressed in termites showed evidence of being related to cell regulation and the immune response, while those expressed in M. anisopliae, to transportation and fungal virulence. This study provides new information on the interaction between termites and its entomopathogen, with potential utilization for developing future biopesticide to control the termite population.

ABSTRAK Â Penelitian dilaksanakan di Laboratorium Penyakit Tumbuhan dan rumah kasa Jurusan Hama dan Penyakit Tumbuhan Fakultas Pertanian Universitas Brawijaya, Malang sejak Nopember 2013-Februari 2014. Persentase perkecambahan spora A.solani pada ekstrak daun tomat lebih tinggi dibandingkan dengan ekstrak batang tomat dan air destilasi pada semua waktu pengamatan. Demikian pula persentase perkecambahan spora A. solani pada ekstrak batang tomat lebih tinggi dibandingkan dengan air destilasi. Varietas tomat yang berbeda mempengaruhi intensitas dan laju infeksi penyakit bercak coklat. Intensitas penyakit dan laju infeksi tercepat terdapat pada Varietas Gondol dibandingkan dengan varietas lainnya. Â Kata Kunci: A. solani, perkecambahan spora, intensitas penyakit, varietas tomat.

Background: There are limited data on the failure of second-line antiretroviral therapy (ART) and the use of third-line ART in people living with HIV in resource-limited settings. Since 2011, the Médecins Sans Frontières (MSF) HIV/tuberculosis programme in Mumbai, India, has been providing third-line ART to patients in care. Objective: To describe the experiences and programmatic challenges during management of suspected second-line ART failure and third-line ART therapy for patients living with HIV, including the use of HIV viral load (VL) testing. Design: This was a retrospective, observational cohort study of patients with suspected second-line ART treatment failure, who were followed for at least 12 months between January 2011 and March 2014. Results: A total of 47 patients with suspected second-line failure met the inclusion criteria during the study period. Twenty-nine of them (62%) responded to enhanced adherence support, had a subsequent undetectable VL after a median duration of 3 months and remained on second-line ART. The other 18 patients had to be initiated on a third-line ART regimen, which consisted of darunavir–ritonavir, raltegravir, and one or more appropriate nucleoside or nucleotide reverse transcriptase inhibitors, based on the results of HIV genotype testing. Of the 13 patients for whom follow-up VL results were available, 11 achieved virological suppression after a median duration of 3 months on third-line ART (interquartile range: 2.5–3.0). No serious treatment-related adverse events were recorded. Conclusions: With intensive counselling and adherence support in those suspected of failing second-line ART, unnecessary switching to more expensive third-line ART can be averted in the majority of cases. However, there is an increasing need for access to third-line ART medications such as darunavir and raltegravir, for which national ART programmes should be prepared. The cost of such medications and inadequate access to VL monitoring and HIV genotype testing are currently major barriers to optimal management of patients failing second-line ART.

The population addition in Indonesia has become so significant that it becomes one of factor for number of vehicles increasing that will ultimately add to the number of violations in road traffic. It is also caused by a lack of understanding and awareness ofroad users that obey the rules so as to improve safety in road traffic. This research aims to create and design multimedia content that will serve as an information medium traffic safety for road users based 2D animation. In this multimedia content will be presented how things happen on the highway, especially at the traffic light and causal arise if the road users do not comply with regulations in road traffic. The results of this research is multimedia products 2D animation about traffic safety. The results of this study can be used to convey information to road users and also become material for early childhood education. The results of this study can also be used as a model to enrich the scientific learning and teaching materials in Multimedia Systems course for students in the Department of Information Engineering University of Serambi Mekkah

The purpose of this research is to produce a new product in the form of censorship media and video assistant referee (VAR) in assisting referee leadership in a championship to achieve fair play. This research uses the Research and Development (R&D) method from Sugiyono using ten steps. The place of research was carried out at the All-Indonesian Volleyball Association, Deli Serdang Regency. The population and sample in this study were 36 Deli Serdang Regency volleyball players with a small sample of 6 people, a large sample of 16, and a comparison sample of 14. For the referee sample, six nationally licensed and nine regional licensed referees. The results of this study include Net and VAR sensors used to develop a player error detection tool when smashing and blocking. The results are obtained from the data from expert validation, including: (1) Material experts 92.3% with the "Very Eligible" category. (2) Media Experts 92.5% with the "Very Eligible" category. In large-scale trials on referees and athletes, the resulting percentages were 90.8% and 92.7%, respectively, while in the comparison trial, the percentage produced was 92.5%.

This study aims to analyze the thermal comfort level of students in secondary schools in the tropical city of Makassar. The analysis is carried out based on data surveyed from eight selected high schools. The study involved 1594 students in 48 classrooms. The recorded data includes personal data and measured environmental parameters. At the same time, students were asked to fill out questionnaires related to their thermal comfort levels. The surveyed classrooms showed high air temperatures. The air temperatures ranged from 28.2 °C in the morning to 33.6 °C in the midday. The radiant temperatures were similar to the air temperature, which indicated that the airflow speed was low. The only parameter that could meet the Indonesian national standard was relative humidity. However, many students still feel comfortable (−1 to +1) based on TSV (thermal sensation vote) and TCV (thermal comfort vote). Even though about 80% of respondents accepted this hot temperature, most of them preferred to have a decrease in the air temperature. Regarding the PMV (predicted mean vote), only about 23% respondents were predicted to feel slightly warm (+1). The regression analyses show that the neutral temperatures were 29.0 °C and 28.5 °C for TSV and TCV, respectively.

BackgroundLittle is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India.MethodsA retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation.ResultsThe median age was 16 (IQR 14-18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8-250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens.ConclusionsEarly mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial support for co-infected adolescents. Operational research among co-infected adolescents will be especially important in designing effective interventions for this vulnerable group.

BACKGROUND: Adverse events (AEs) among HIV-infected patients with multidrug-resistant tuberculosis (MDR-TB) receiving anti-TB and antiretroviral treatments (ART) are under-researched and underreported. Hypothyroidism is a common AE associated with ethionamide, p-aminosalicylic acid (PAS), and stavudine. The aim of this study was to determine the frequency of and risk factors associated with hypothyroidism in HIV/MDR-TB co-infected patients. METHODS: This was a prospective, observational cohort study, using routine laboratory data in a Médecins Sans Frontières (MSF) clinic in collaboration with Sewri TB Hospital, Mumbai, India. Hypothyroidism was defined as a thyroid stimulating hormone (TSH) result >10 mIU/L at least once during treatment. Patients having a baseline result and one additional result after 3 months were eligible for enrolment. RESULTS: Between October 2006 and March 2013, 116 patients were enrolled, 69 of whom were included. The median (IQR) age was 38 years (34-43) and 61% were male. By March 2013, 37/69 (54%) had hypothyroidism after at least 90 days of treatment. Age, gender, CD4 counts and stavudine-based ART were not associated with the occurrence of hypothyroidism in multivariate models. The co-administration of PAS and ethionamide was found to double the risk of hypothyroidism (RR: 1.93, 95% CI: 1.06-3.54). DISCUSSION: High rate of hypothyroidism was recorded in a Mumbai cohort of MDR-TB/HIV co-infected patients on treatment. This is a treatable and reversible AE, however, it may go undiagnosed in the absence of regular monitoring. Care providers should not wait for clinical symptoms, as this risks compromising treatment adherence. Simple, affordable and reliable point-of-care tools for measuring TSH are needed, especially in high MDR-TB burden countries. Our findings suggest the need for TSH screening at baseline, three months, six months, and every six months thereafter for HIV-infected patients on MDR-TB treatment regimens containing PAS and/or ethionamide, until newer, safer and more efficacious MDR-TB regimens become available.

As a response to the need to provide an acceptable thermal comfort and air quality in indoor environments, various ventilation performance indicators were developed over the years. These metrics are mainly geared towards air distribution, heat and pollutant removals. Evidence exists of influencing factors on these indicators as centered on ventilation design and operations. Unlike other indoor environments, health care environment requires better performance of ventilation system to prevent an incidence of nosocomial and other hospital acquired illnesses. This study investigates, using in-situ experiments, the ventilation efficiency in a dentistry surgical room. Thermal and hygric parameters were monitored on the air terminal devices and occupied zone over a period of one week covering both occupied and unoccupied hours. The resulting time-series parameters were used to evaluate the room’s ventilation effectiveness. Also, the obtained parameters were benchmarked against ASHRAE 170 (2013) and MS1525 (2014) requirements for ventilation in health care environment and building energy efficiency respectively. The results show that the mean daily operative conditions failed to satisfy the provisions of both standards. Regarding effectiveness, the findings reveal that the surgical room ventilation is ineffective with ventilation efficiency values ranging between 0 and 0.5 indicating air distribution short-circuiting. These results suggest further investigations, through numerical simulation, on the effect of this short-circuiting on thermal comfort, infection risk assessments and possible design improvements, an endeavour that forms our next line of research inquiries.

Road Infrastructures contribute towards many severe accidents and it needs supervision as to improve road safety levels. The numbers of fatalities have increased annually and road authority should seriously consider conducting programs or activities to periodically monitor, restore of improve road infrastructure. Implementation of road safety audits may reduce fatalities among road users and maintain road safety at acceptable standards. This paper is aimed to discuss the aspects of road infrastructure in Malaysia. The research signifies the impact of road hazards during the observations and the impact of road infrastructure types on road accidents. The F050 (Jalan Kluang-Batu Pahat) road case study showed that infrastructure risk is closely related with number of accident. As the infrastructure risk increase, the number of road accidents also increase. It was also found that different road zones along Jalan Kluang-Batu Pahat showed different level of intersection volume due to number of road intersection. Thus, it is hoped that by implementing continuous assessment on road infrastructures, it might be able to reduce road accidents and fatalities among drives and the community.

Ventilation systems play a significant role in maintaining the indoor thermal and hygric balance. Nevertheless, the systems had been implicated to result in many problems. In the tropical climate, especially for energy efficiency purposes, building spaces are operated with differential ventilation. Such spaces operate on 24-hrs basis, some on 8-hrs while others are either naturally ventilated or served with mechanical supply-exhaust fan systems with non-conditioned outdoor air. This practice had been found to result in condensation problems. This study involves a quantitative appraisal of the effect of operative conditions and hygrothermal quality of building envelopes on condensation risk. The in-situ experiment is combined with an analytical approach to assessing the hygrothermal quality of building envelopes in a tropical climate building under differential ventilation between adjacent spaces. The case-studied building is with a known history of condensation and associated damages including mould growth. The microclimate measurement and hygrothermal performance of the wall and floor against condensation and mould growth risks had been previously reported elsewhere. As a step further, the present study evaluates the effects of various envelope insulation types and configurations together with the HVAC cooling set-points on envelope hygrothermal performance. The results revealed that overcooling the air-conditioned side increases condensation risk on the non-air-conditioned side of the envelopes. The envelopes failed criteria for surface condensation at existing operative conditions irrespective of envelope hygrothermal quality improvements. However, the envelope performed well at improved cooling operative conditions even at existing envelope hygrothermal quality. It is, therefore, important to ascertain the envelope hygrothermal quality as well the cooling operative conditions while embarking on energy efficiency operations in mechanical ventilation systems under differential ventilation.

BackgroundSignificant adverse events (AE) have been reported in patients receiving medications for multidrug- and extensively-drug-resistant tuberculosis (MDR-TB & XDR-TB). However, there is little prospective data on AE in MDR- or XDR-TB/HIV co-infected patients on antituberculosis and antiretroviral therapy (ART) in programmatic settings.MethodsMédecins Sans Frontières (MSF) is supporting a community-based treatment program for drug-resistant tuberculosis in HIV-infected patients in a slum setting in Mumbai, India since 2007. Patients are being treated for both diseases and the management of AE is done on an outpatient basis whenever possible. Prospective data were analysed to determine the occurrence and nature of AE.ResultsBetween May 2007 and September 2011, 67 HIV/MDR-TB co-infected patients were being treated with anti-TB treatment and ART; 43.3% were female, median age was 35.5 years (Interquartile Range: 30.5-42) and the median duration of anti-TB treatment was 10 months (range 0.5-30). Overall, AE were common in this cohort: 71%, 63% and 40% of patients experienced one or more mild, moderate or severe AE, respectively. However, they were rarely life-threatening or debilitating. AE occurring most frequently included gastrointestinal symptoms (45% of patients), peripheral neuropathy (38%), hypothyroidism (32%), psychiatric symptoms (29%) and hypokalaemia (23%). Eleven patients were hospitalized for AE and one or more suspect drugs had to be permanently discontinued in 27 (40%). No AE led to indefinite suspension of an entire MDR-TB or ART regimen.ConclusionsAE occurred frequently in this Mumbai HIV/MDR-TB cohort but not more frequently than in non-HIV patients on similar anti-TB treatment. Most AE can be successfully managed on an outpatient basis through a community-based treatment program, even in a resource-limited setting. Concerns about severe AE in the management of co-infected patients are justified, however, they should not cause delays in the urgently needed rapid scale-up of antiretroviral therapy and second-line anti-TB treatment.