Investigation pathways for tuberculosis among HIV-positive adults in South Africa

Background and aims: The World Health Organization (WHO) recommendation for regular tuberculosis (TB) screening of people living with HIV (PLHIV) using a symptom screen (WHO tool), with Xpert MTB/RIF (Xpert) as the initial diagnostic test has major resource implications. This thesis examined alternative investigation pathways, including Determine TB-LAM (LF-LAM) for TB screening, a clinical score to triage symptomatic individuals for Xpert, and repeating Xpert if the initial test was negative. Design and setting: Prospective cohort of PLHIV, attending four HIV clinics in South Africa. Methods: A systematic sample of adults attending for routine HIV care were enrolled in the XPHACTOR study, which tested a novel algorithm for prioritising investigation with Xpert. At enrolment sputum was collected from all and sent for immediate Xpert if any of: current cough, fever ≥3 weeks, body mass index (BMI) <18.5kg/m2, CD4 <100 cells/mm3 (or <200 if pre-ART) or weight loss ≥10%; otherwise, sputum was stored. Urine was stored if CD4 <200 cells/mm3. At attendance for immediate Xpert result, further investigations were facilitated per national guidelines. For those at highest risk of TB, who had negative initial Xpert result, a repeat sputum sample was stored. Participants were reviewed monthly to 3 months, when sputum and blood were taken for mycobacterial culture. At study completion stored sputa were tested with Xpert, and urine with LF-LAM. We defined TB as “confirmed” if Xpert, line probe assay or culture for M. tuberculosis within six months of enrolment were positive, and “clinical” if TB treatment was started without microbiological confirmation. Results: 3722 participants enrolled into XPHACTOR, and 167/3678 (4.5%) fulfilled case definitions for TB (124 confirmed, 43 clinical); 32.6% reported WHO tool symptoms. Amongst 424 participants with LF-LAM results, 56/424 (13%) had TB (40 confirmed, 16 clinical). Using grade 1 cut-off on pre-2014 reference card, LF-LAM sensitivity for confirmed TB (all clinical TB excluded) in CD4<100 vs. CD4 ≥100 was 16.7% (95% CI 4.7%, 37.4%) vs. 6.3% (95% CI 0.2%, 30.2%). 1048 participants who were WHO tool positive at enrolment provided data for development of a clinical prediction model for TB. The final model comprised ART status; BMI; CD4; number of WHO symptoms. When converted to a clinical score, a cut-off score of ≥3 identified those with TB with sensitivity and specificity of 91.8% and 34.3% respectively. If investigation was prioritised for individuals with score of ≥3, 68% (717/1048) symptomatic individuals would be tested, among whom the prevalence of TB would be 14.1% (101/717); 32% (331/1048) of tests would be avoided, but 3% (9/331) with TB would be missed amongst those not tested. Amongst 227 participants with an initial negative Xpert result, 28 (12%) had TB diagnosed during study follow-up (16 confirmed, 12 clinical); stored sputum tested positive on Xpert in 5/227 (2%). Conclusion: Sensitivity of LF-LAM as a screening test is too low for use. Our clinical score, which requires external validation, may help prioritise TB investigation among symptomatic individuals. Amongst PLHIV with a negative Xpert result, further investigation using appropriate diagnostic modalities is more likely to lead to TB treatment than immediately repeating sputum for Xpert. More efficient TB case finding strategies are needed for PLHIV established in care, to minimise unnecessary investigation of large numbers who do not have TB

Analisis Efektivitas Mesin Pengelasan Menggunakan Metode Overall Equipment Effectiveness (OEE) pada VAI 4 Plant PT Bakrie Pipe Industries

Penelitian tugas akhir ini dilakukan pada PT Bakrie Pipe Industries yang merupakan Perusahaan manufaktur penghasil pipa baja dan telah menerapkan pemeliharaan preventif. Terkait dengan penerapan pemeliharaan tersebut, ternyata ditemui adanya frekuensi kerusakan (breakdown) yang cukup tinggi pada mesin high frequency welding di antara mesin-mesin produksi lainnya. Pada penelitian ini digunakan metode Overall Equipment Effectiveness (OEE) untuk mengevaluasi efektivitas mesin tersebut dengan menghitung availability ratio, performance ratio, dan quality ratio-nya. Dari hasil perhitungan didapat Nilai OEE mesin high frequency welding 67%, yaitu masih dibawah standar world class OEE sebesar 85%. Faktor yang mempengaruhi rendahnya nilai OEE tersebut adalah akibat rendahnya nilai performance ratio sebesar 79% serta reduced speed losses yaitu 18%. Selanjutnya untuk mengetahui akar penyebab permasalahan tersebut dilakukan analisis critical downtime dengan menggunakan diagram pareto serta diagram sebab dan akibat. Berdasarkan hasil semua analisis di atas ditemukan welding trip, impeder problem, dan base nose problem sebagai critical downtime. Disimpulkan penyebab ketiga masalah di atas, faktor utamanya adalah belum diadakannya pelatihan terkait penanganan mesin. Pada penelitian ini juga disarankan penerapan autonomous maintenance disamping pelatihan terjadwal terhadap operator yang terkait. ­ Kata kunci: Pemeliharaan, OEE, Enam kerugian utama, Diagram Pareto, Diagram Sebab dan Akibat. This final year project was conducted at PT Bakrie Pipe Industries, a manufacturer of welded steel pipe, where in its operation the company already implementing the preventive maintenance. Associated with the maintenance application, it was found that the frequency of breakdown in such welding operation using High Frequency Welding (HFW) is significantly high compared to the other production machines during operation. In this research the Overall Equipment Effectiveness (OEE) is used to evaluate the effectiveness of the observed machine by means of using availability ratio, performance ratio, and its quality ratio. The result show that OEE value of the observed machine is around 67%, which is far below 85% of the world class OEE standard. Factors that affecting low OEE value is found due to lower performance ratio around 79% as well as reduced speed losses around 18%. Furthermore to determine the root cause of these problems, analysis of critical downtime using pareto chart and cause and effect diagram was also performed. Based on the above analysis, it is found that welding trip, impeder problem, and base nose problem are causes of critical downtime. It is concluded that the third cause of the above problems related to the handling machine, where the training of managing this problems has never been conducted. In this project, it is also recommended that the implementation of autonomous maintenance in addition to the scheduled training is necessary to the operators.Keywords: Maintenance, OEE, Six Big Losses, Pareto Chart, Cause and Effect Diagram DAFTAR PUSTAKA[1]R. K. Mobley, L. R. Higgins and D. J. Wikoff, Maintenance Engineering Handbook Seventh Edition, United States of America: McGraw-Hill, 2008.[2]H. Siringoringo and S. , "Analisis Pemeliharaan Produktif Total Pada PT Wahana Eka Paramitra GKD Group," Jurnal Teknologi &amp; Rekayasa, vol. 9, 2004.[3]S. A. Kumar and N. Suresh, Production and Operations Management, New Delhi: New Age International (P) Limited, 2008.[4]B. Dhillon, Engineering Maintenance: A Modern Approach, United States of America: CRC PRESS, 2002.[5]A. Daryus, Diktat Kuliah Manajemen Pemeliharaan Mesin, Jakarta: Universitas Darma Persada, 2007.[6]Vorne Industries Inc., "TPM - Total Productive Maintenance," 2013. [Online]. Available: http://www.leanproduction.com/tpm.html. [Accessed 7 Februari 2015].[7]A. B. Badiru, Handbook of Industrial and Systems Engineering, United States of America: Taylor &amp; Farncis Group, 2006.[8]R. Smith and R. K. Mobley, Rules of Thumb for Maintenance Reliability Engineers, 2007.[9]S. Parihar, S. Jain and L. Bajpai, "Calculation of OEE for an Assembly Process," International Journal of Research in Mechanical Engineering &amp; Technology, 2012.[10]Vorne Industries, "Fast Track OEE," Itasca, 2002-2008.[11]Lean Six Sigma Training, "Toyota Production System," Lean Six Sigma Training, 6 Mei 2013. [Online]. Available: www.leansixsigmatraining

Pembentukan Pos Upaya Kesehatan Kerja pada Industri Kecil Pembuat Alat Rumah Tangga di Kelurahan Bugangan Kota Semarang

Salah satu lokasi pusat pembuatan peralatan rumah tangga dari logam di Kota Semarang berada di Kelurahan Bugangan. Pekerja di lokasi tersebut rentan terpapar oleh faktor risiko bahaya yang ada di lingkungan kerja sehingga berisiko terjadi kecelakaan kerja maupun penyakit akibat kerja. Di lokasi tersebut memerlukan adanya Pos Upaya Kesehatan Kerja (Pos UKK). Tujuan kegiatan ini adalah membentuk Pos UKK untuk kelompok pekerja pembuat peralatan rumah tangga sehingga para pekerja di lokasi tersebut dapat bekerja dengan aman, sehat, dan produktif.. Hasil yang didapatkan dari kegiatan ini adalah terbentuknya Pos UKK Produksi Barang Logam yang berlokasi di salah satu rumah pekerja. Untuk keberlanjutan Pos UKK tersebut, petugas PUSKESMAS yang hadir bersedia membina secara berkelanjutan Pos UKK yang telah terbentuk, dan petugas dari Dinas Kesehatan Kota Semarang bersedia membina dan mengawasi petugas puskesmas. Kesimpulan dari laporan kegiatan ini adalah pembentukan Pos UKK berhasil dilaksanakan dengan melibatkan para pengusaha, pekerja industri alat rumah tangga di Bugangan, Puskesmas Bugangan, dan Dinas Kesehatan Kota Semarang

The utility of repeat Xpert MTB/RIF testing to diagnose tuberculosis in HIV-positive adults with initial negative result

Background: Amongst HIV-positive adults in South Africa with initial negative Xpert results, we compared the yield from repeating Xpert MTB/RIF (“Xpert”) on sputum to guideline-recommended investigation for tuberculosis (TB). Methods:  A systematic sample of adults attending for HIV care were enrolled in a cohort exploring TB investigation pathways. This substudy was restricted to those at highest risk of TB (CD4&lt;200 cells/mm3 or unknown) who had a negative initial Xpert result. At attendance for the Xpert result, a repeat sputum sample was stored, and further investigations facilitated per national guidelines. Participants were reviewed monthly, with reinvestigation if indicated, for at least three months, when sputum and blood were cultured for mycobacteria, and the stored sputum tested using Xpert. We defined TB as “confirmed” if Xpert, line probe assay or Mycobacterium tuberculosis culture within six months of enrolment were positive, and “clinical” if TB treatment was started without microbiological confirmation. Results: Amongst 227 participants with an initial negative Xpert result (63% female, median age 37 years, median CD4 count 100 cells/mm3), 28 (12%) participants had TB diagnosed during study follow-up (16 confirmed, 12 clinical); stored sputum tested positive on Xpert in 5/227 (2%). Amongst 27 participants who started TB treatment, the basis was bacteriological confirmation 11/27 (41%); compatible imaging 11/27 (41%); compatible symptoms 2/27 (7%); and unknown 3/27 (11%).  Conclusions:  Amongst HIV-positive individuals at high risk of active TB with a negative Xpert result, further investigation using appropriate diagnostic modalities is more likely to lead to TB treatment than immediately repeating sputum for Xpert. TB diagnostic tests with improved sensitivity are needed.</ns4:p

High-dose vitamin D(3) during intensive-phase antimicrobial treatment of pulmonary tuberculosis: a double-blind randomised controlled trial.

BACKGROUND: Vitamin D was used to treat tuberculosis in the pre-antibiotic era, and its metabolites induce antimycobacterial immunity in vitro. Clinical trials investigating the effect of adjunctive vitamin D on sputum culture conversion are absent. METHODS: We undertook a multicentre randomised controlled trial of adjunctive vitamin D in adults with sputum smear-positive pulmonary tuberculosis in London, UK. 146 patients were allocated to receive 2·5 mg vitamin D(3) or placebo at baseline and 14, 28, and 42 days after starting standard tuberculosis treatment. The primary endpoint was time from initiation of antimicrobial treatment to sputum culture conversion. Patients were genotyped for TaqI and FokI polymorphisms of the vitamin D receptor, and interaction analyses were done to assess the influence of the vitamin D receptor genotype on response to vitamin D(3). This trial is registered with ClinicalTrials.gov number NCT00419068. FINDINGS: 126 patients were included in the primary efficacy analysis (62 assigned to intervention, 64 assigned to placebo). Median time to sputum culture conversion was 36·0 days in the intervention group and 43·5 days in the placebo group (adjusted hazard ratio 1·39, 95% CI 0·90-2·16; p=0.14). TaqI genotype modified the effect of vitamin D supplementation on time to sputum culture conversion (p(interaction)=0·03), with enhanced response seen only in patients with the tt genotype (8·09, 95% CI 1·36-48·01; p=0·02). FokI genotype did not modify the effect of vitamin D supplementation (p(interaction)=0·85). Mean serum 25-hydroxyvitamin D concentration at 56 days was 101·4 nmol/L in the intervention group and 22·8 nmol/L in the placebo group (95% CI for difference 68·6-88·2; p<0·0001). INTERPRETATION: Administration of four doses of 2·5 mg vitamin D(3) increased serum 25-hydroxyvitamin D concentrations in patients receiving intensive-phase treatment for pulmonary tuberculosis. Vitamin D did not significantly affect time to sputum culture conversion in the whole study population, but it did significantly hasten sputum culture conversion in participants with the tt genotype of the TaqI vitamin D receptor polymorphism. FUNDING: British Lung Foundation

Kecenderungan topik penelitian di bidang ilmu perpustakaan dan informasi dengan pendekatan kaidah zipf

Introduction. This research aims to obtain the mapping of research in the field of Library and Information in Berkala Ilmu Perpustakaan dan Informasi(BIP) published by Universitas Gadjah Mada.  The Research Method.This was abibliometric analysis using Zipf (frequency spread of word) with research samples of 20 jurnal articles published by BIP in 2017.Data Collection Method. Every article was examined by the highest word frequencyresulting keywords and subjects for each article. Further analysis was conducted to classify subject grouping based on Hawkins theory.Results and Discussions. The results indicated that research topics in Berkala Ilmu Perpustakaan dan Informasi UGM in 2017 were classified into two categories: (1) There were, 16 articlesrelated to the topic “Librarians”, (2) There were 4 articles related to the topic“Information Science”. The result is the tendency of research topics in the field of the IPI entered into a group of librarianship.Conclusion. The research topics in the field of Library and Information Science is more likely to enter the librarianship group. Future advice is that researchers are expected to develop research by raising other topics

Ethnic Variation in Inflammatory Profile in Tuberculosis

PMCID: PMC3701709This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

What causes symptoms suggestive of tuberculosis in HIV-positive people with negative initial investigations?

OBJECTIVE: To identify the causes of symptoms suggestive of tuberculosis (TB) among people living with the human immunodeficiency virus (PLHIV) in South Africa. METHODS: A consecutive sample of HIV clinic attendees with symptoms suggestive of TB (1 of cough, weight loss, fever or night sweats) at enrolment and at 3 months, and negative initial TB investigations, were systematically evaluated with standard protocols and diagnoses assigned using standard criteria. TB was 'confirmed' if Mycobacterium tuberculosis was identified within 6 months of enrolment, and 'clinical' if treatment started without microbiological confirmation. RESULTS: Among 103 participants, 50/103 were pre-antiretroviral therapy (ART) and 53/103 were on ART; respectively 68% vs. 79% were female; the median age was 35 vs. 45 years; the median CD4 count was 311 vs. 508 cells/mm³. Seventy-two (70%) had 5% measured weight loss and 50 (49%) had cough. The most common final diagnoses were weight loss due to severe food insecurity (n = 20, 19%), TB (n = 14, 14%: confirmed n = 7; clinical n = 7), other respiratory tract infection (n = 14, 14%) and post-TB lung disease (n = 9, 9%). The basis for TB diagnosis was imaging (n = 7), bacteriological confirmation from sputum (n = 4), histology, lumbar puncture and other (n = 1 each). CONCLUSION: PLHIV with persistent TB symptoms require further evaluation for TB using all available modalities, and for food insecurity in those with weight loss

The Theoretical Description for Chlorantraniliprole Electrochemical Determination, Assisted by Squaraine Dye – Nano-CuS Composite

The theoretical description for the chlorantraniliprole electrochemical determination, assisted by the hybrid composite of squaraine dye with CuS nanoparticles has been described. The correspondent reaction mechanism has been proposed, and the correspondent mathematical model has been developed and analyzed by means of linear stability theory and bifurcation analysis. It has been shown that the chlorantraniprole electrochemical anodical determination on high potential may be efficiently provided by cupper sulfide nanoparticles, stabilized by the squaraine dye. On the other hand, the oscillatory and monotonic instability is also possible, being caused by DEL influences of the electrochemical stage. DOI:&nbsp;http://dx.doi.org/10.17807/orbital.v13i3.151