BackgroundThe grading of radiological severity in clinical trials in tuberculosis (TB) remains unstandardised. The aim of this study was to generate and validate a numerical score for grading chest x-ray (CXR) severity and predicting response to treatment in adults with smear-positive pulmonary TB. Methods At a TB clinic in Papua, Indonesia, serial CXRs were performed at diagnosis, 2 and 6 months in 115 adults with smear-positive pulmonary TB. Radiographic findings predictive of 2-month sputum microscopy status were used to generate a score. The validity of the score was then assessed in a second data set of 139 comparable adults with TB, recruited 4 years later at the same site. Relationships between the CXR score and other measures of TB severity were examined. Results The estimated proportion of lung affected and presence of cavitation, but not cavity size or other radiological findings, significantly predicted outcome and were combined to derive a score given by percentage of lung affected plus 40 if cavitation was present. As well as predicting 2-month outcome, scores were significantly associated with sputum smear grade at diagnosis (p<0.001), body mass index, lung function, haemoglobin, exercise tolerance and quality of life (p<0.02 for each). In the validation data set, baseline CXR score predicted 2-month smear status significantly more accurately than did the proportion of lung affected alone. In both data sets, CXR scores decreased over time (p<0.001). Conclusion This simple, validated method for grading CXR severity in adults with smear-positive pulmonary TB correlates with baseline clinical and microbiological severity and response to treatment, and is suitable for use in clinical trials.

BackgroundVitamin D (vitD) and L-arginine have important antimycobacterial effects in humans. Adjunctive therapy with these agents has the potential to improve outcomes in active tuberculosis (TB).MethodsIn a 4-arm randomised, double-blind, placebo-controlled factorial trial in adults with smear-positive pulmonary tuberculosis (PTB) in Timika, Indonesia, we tested the effect of oral adjunctive vitD 50,000 IU 4-weekly or matching placebo, and L-arginine 6.0 g daily or matching placebo, for 8 weeks, on proportions of participants with negative 4-week sputum culture, and on an 8-week clinical score (weight, FEV1, cough, sputum, haemoptysis). All participants with available endpoints were included in analyses according to the study arm to which they were originally assigned. Adults with new smear-positive PTB were eligible. The trial was registered at ClinicalTrials.gov NCT00677339.Results200 participants were enrolled, less than the intended sample size: 50 received L-arginine + active vitD, 49 received L-arginine + placebo vit D, 51 received placebo L-arginine + active vitD and 50 received placebo L-arginine + placebo vitD. According to the factorial model, 99 people received arginine, 101 placebo arginine, 101 vitamin D, 99 placebo vitamin D. Results for the primary endpoints were available in 155 (4-week culture) and 167 (clinical score) participants. Sputum culture conversion was achieved by week 4 in 48/76 (63%) participants in the active L-arginine versus 48/79 (61%) in placebo L-arginine arms (risk difference −3%, 95% CI −19 to 13%), and in 44/75 (59%) in the active vitD versus 52/80 (65%) in the placebo vitD arms (risk difference 7%, 95% CI −9 to 22%). The mean clinical outcome score also did not differ between study arms. There were no effects of the interventions on adverse event rates including hypercalcaemia, or other secondary outcomes.ConclusionNeither vitD nor L-arginine supplementation, at the doses administered and with the power attained, affected TB outcomes.Registry ClinicalTrials.gov. Registry number: NCT00677339

Recent days, more and more people are becoming interested in "free-energy". "Free-energy" means the energy sources used freely without to pay. The sources of "free-energy" are sunlight, rainfall, wind energy, wave power, and tidal power. There are other sources of power such as gravity, electrical charge in the atmosphere and ionosphere, and a mass. FESS (Flywheel Energy Storage System) is an attempt to store kinetic energy generated from the rotation flywheel in which the electrical power output from the generator as an input to the motor. Mass flywheel greatly affects the amount of power generated by a generator which will serve as a flywheel device or distributors of energy while at the induction generator to eventually convert mechanical energy into electrical energy and vice versa. In this system design becomes very important for the flywheel can store the kinetic energy. This research aims to design and build mechanisms as a means of comparison FESS flywheel effect of the geometry of the kinetic energy generated. The research method is done by making three different geometric design flywheels, and then analyzed with the help of FESS. From the experimental results, flywheel 1 with a ringtype web-concave generate kinetic energy of 312.30 J and specific energy of 31.23 J / kg, at the flywheel 2 which is type-straight arm kinetic energy gained by 316.73 J and energy specific of 31.67 J / kg and flywheel 3 with a ring-type web-straight kinetic energy obtained by 284.997 J and specific energy of 28.49 J / kg. From the research data we can conclude that each design geometry flywheel has a different contribution to the performance of energy storage.

Mahasiswa memiliki berbagai tuntutan akademik yang harus diselesaikan terutama dalam pengerjaan tugas akhir skripsi yang seringkali menjadi hambatan dan adanya kesulitan ketika harus membagi waktu diantara mengerjakan tugas akhir dengan kegiatan akademik lainnya. Tuntutan akademik yang harus dihadapi dan tidak siapnya individu untuk menghadapinya juga dapat mengakibatkan gangguan psikologis yaitu stres. Prevalensi kejadian stres cukup tinggi dimana hampir lebih dari 350 juta penduduk dunia mengalami stres dan merupakan penyakit dengan peringkat keempat di dunia. Tujuan penelitian ini adalah untuk mengetahui hubungan spiritualitas dengan stres pada mahasiswa keperawatan yang mengerjakan tugas akhir skripsi di STIKes Surya Global Yogyakarta. Merupakan penelitian kuantitatif dengan desain cross-sectional, teknik pengambilan sampel menggunakan teknik proporsi sampling dan besar sampel penelitian ini sebanyak 59 responden. Instrumen penelitian mempergunakan kuesioner untuk mengukur spiritualitas dan stres mahasiswa, sedangkan uji statistik menggunakan uji Kendal’s Tau. Hasil penelitian menunjukkan bahwa spiritualitas mahasiswa keperawatan yang mengerjakan skripsi sebagian besar dalam kategori baik yaitu sebanyak 40 responden (67.8%), sedangkan tingkat stres mahasiswa sebagian besar dalam kategori sedang, yaitu sebanyak 39 responden (66.1%), hasil uji statistik menunjukkan bahwa nilai koefisien korelasi sebesar 0.380 dan dengan nilai p-value sebesar 0.003. Kesimpulannya adalah terdapat hubungan yang bermakna antara spiritualitas dengan stres pada mahasiswa keperawatan yang mengerjakan skripsi di STIKes Surya Global Yogyakarta.