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With the increase of cosmetic injectable hyaluronic acid (HA), there have been more cases with serious complications, including skin necrosis, blindness, and cerebral embolism. Patients who have recovered from HA filler-induced total vision loss are extremely rare. We report a case of a 27-year-old female who developed severe ocular pain on the right side and total vision loss following a 1.0 ml HA filler injection in the nasal dorsum. She arrived at our hospital 4 hours later. Her visual acuity was no light perception (NLP), and she exhibited eyelid ptosis, ophthalmoplegia, and frontal and nasal ecchymosis. She was promptly treated with subcutaneous and retrobulbar hyaluronidase injections, as well as intra-arterial 1500 IU hyaluronidase injections into the right ophthalmic artery with DSA assistance. Her vision improved from NLP to counting fingers at 1.0 meters. Unfortunately, 13 hours later, she felt an intense headache, and her vision again decreased to NLP. We immediately performed an injection of 1500 IU hyaluronidase combined with 8 mg alteplase for intra-arterial thrombolysis (IAT) into the right ophthalmic artery. Her vision improved immediately afterward. After 3 months, her visual acuity had significantly recovered from NLP (admission vision status) to 20/50 (Snellen chart with glasses). Similarly, skin, conjunctival, eye movement, and ptosis symptoms completely recovered. This case demonstrates that reversal of complete blindness due to embolism of the ophthalmic and central retinal arteries could be accomplished through multidisciplinary therapies, especially IAT using fibrinolytic agents combined with hyaluronidase followed by an anticoagulant regimen. Level of evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

The polarization hysteresis loops and the dynamics of domain switching in ferroelectric Pb(Zr0.52Ti0.48)O3 (PZT), antiferroelectric PbZrO3 (PZ) and relaxor-ferroelectric Pb0.9La0.1(Zr0.52Ti0.48)O3 (PLZT) thin films deposited on Pt/Ti/SiO2/Si substrates were investigated under various bipolar electric fields during repetitive switching cycles. Fatigue behavior was observed in PZT thin films and was accelerated at higher bipolar electric fields. Degradation of energy storage performance observed in PZ thin films corresponds to the appearance of a ferroelectric state just under a high bipolar electric field, which could be related to the nonuniform strain buildup in some regions within bulk PZ. Meanwhile, PLZT thin films demonstrated fatigue-free in both polarization and energy storage performance and independent bipolar electric fields, which are probably related to the highly dynamic polar nanodomains. More importantly, PLZT thin films also exhibited excellent recoverable energy-storage density and energy efficiency, extracted from the polarization hysteresis loops, making them promising dielectric capacitors for energy-storage applications.

Background Treatment of HIV with antiretroviral therapy (ART) can improve the health of people living with HIV (PLHIV), stop onward transmission of HIV and effectively prevent the spread of the virus. In 2016, we conducted a systematic review to assess the feasibility of treatment monitoring for PLHIV on ART in low and middle-income countries (LMICs), in line with the 90-90-90 treatment target. By 2020, global estimates suggest the 90-90-90 target remains unattainable in many LMICs. This study aims to review the progress and identify needs for public health interventions to improve viral load monitoring and viral suppression for PLHIV in LMICs. Methods A literature search was conducted using an update of the initial search strategy developed for the 2016 review with key search terms relevant to HIV treatment and care, decentralization and viral load monitoring. Electronic databases (Medline and PubMed) were searched to identify relevant literature published in English between Dec 2015 and August 2021. The primary outcome was initial viral load (VL) monitoring (the proportion of PLHIV on ART and eligible for VL monitoring who received a VL test). Secondary outcomes included follow-up VL monitoring (the proportion of PLHIV who received a follow-up VL after an initial elevated VL test), confirmation of treatment failure (the proportion of PLHIV who had two consecutive elevated VL results) and switching treatment regimen rates (the proportion of PLHIV who switched treatment regimen after confirmation of treatment failure). Results The search strategy identified 1984 non-duplicate records, of which 34 studies were included in the review. More than 85% (29/34) of included studies were conducted in 11 sub-Saharan African countries (SSA) using routinely collected program data; two studies were conducted among key populations (KPs) attending research clinics. Sixty per cent (20/34) of these studies were designed to evaluate VL monitoring and/or VL cascade among PLHIV on ART, and most were published in 2019–2021. Marked variations in initial VL monitoring coverage were reported across study settings/countries (range: 12–93% median: 74% IQR: 46-82%) and study populations (adults (range: 25–96%, median: 67% IQR: 50-84%), children, adolescents/young people (range: 2–94%, median: 72% IQR: 47-85%), and pregnant women (range: 32–82%, median: 57% IQR: 43-71%)). Community-based models reported higher VL monitoring (median: 85%, IQR: 82%-88%) compared to decentralised care at primary health facility (median: 64%, IRQ: 48%-82%). Suboptimal uptake of follow-up VL monitoring and low regimen switching rates were observed. Conclusions There was a marked increase in the number of studies of VL monitoring for PLHIV on ART in LMICs over the past five years. Substantial gaps in VL coverage across study settings and study populations were evident, with limited data availability outside of SSA and in KPs. Further research is needed to fill the data gaps. Development and implementation of innovative, community-based interventions are required to improve VL monitoring and address the “failure cascade” in PLHIV on ART who fail to achieve viral suppression.

The dielectric properties, tunability and figure-of-merit (FOM) of relaxor Pb0.9La0.1(Zr0.52Ti0.48)O3 (PLZT) films have been investigated. Dielectric measurements indicated that the dielectric constant (at zero-bias field), tunability and FOM are enhanced as the film thickness increases, which are mainly attributed to the presence of an interfacial layer near the film-electrode interface. Experimental results illustrated that a slight reduction is observed in both dielectric constant and tunability (−2%) in a wide-frequency range (10 kHz–1 MHz), meanwhile, the FOM value decreases significantly (−17%) with increasing frequency, arising from the higher dielectric loss value. The 1000-nm PLZT film shows the largest tunability of 94.6% at a maximum electric-field of 1450 kV/cm, while the highest FOM factor is 37.6 at 1000 kV/cm, due to the combination of medium tunability (88.7%) and low dielectric loss (0.0236). All these excellent results indicated that the relaxor PLZT films are promising candidates for specific applications in microwave devices.

Background Treatment of HIV with antiretroviral therapy (ART) can save lives and stop the spread of the virus. In 2014, UNAIDS launched the 90–90–90 treatment target. By 2020, it remains unattainable in many low and middle-income countries (LMICs). This review aimed to identify research gaps and needs for interventions to improve viral load monitoring and viral suppression for people living with HIV (PLHIV) in LMICs. Methods Medline and PubMed were searched to identify relevant literature, published in English between Dec 2015 and May 2020, using key search terms of a review published in 2016. The primary outcome was initial viral load (VL) monitoring (the proportion of PLHIV on ART and eligible for VL monitoring who receive a VL test). Secondary outcomes include follow-up VL monitoring (the proportion of PLHIV who receive a follow-up VL after an initial elevated VL test), confirmation of treatment failure (the proportion of PLHIV who had two consecutive elevated VL test results) and switching treatment regimen rates (the proportion of PLHIV switching treatment regimen after confirmation of treatment failure). Results The search identified 1829 non-duplicate records, of which 23 were included in the review. More than 80% (19/23) of included studies were conducted in 11 sub-Saharan African countries (SSA) and most were published in 2019–2020. Marked variations in initial VL monitoring coverage were reported across study settings (11–93%) and study populations (adults (25–93%), children and adolescents (2–94%), and pregnant women (32–67%)). Suboptimal uptake of follow-up VL monitoring and low regimen switching rates after confirmed treatment failure were observed. Conclusions Substantial gaps in VL coverage across study settings and study populations remained evident with limited data availability outside of SSA. Further research is needed to fill the data gaps. Interventions to address the ‘failure cascade’ in PLHIV on ART who fail to achieve viral suppression are required.

The profound effect of COVID-19 pandemic has not eluded Vietnam, a lower-middle-income country that borders China, the country where the outbreak originated. Currently facing a second wave, Vietnam experienced several months of insignificant community-transmission, when the epidemic was effectively under control. This paper provides an account of the policies developed by the national COVID-19 response team during the first wave, from January to July 2020. Three key components were identified, including (i) the timely and decisive responses from the national and local authorities in the early phase of the pandemic, (ii) a society-wide approach, supported by an effective risk communication strategy which managed to gain the public trust, and (iii) an effective preventive medicine and infectious disease control system, residing in early case identification, strict isolation, effective contact tracing and compulsory quarantine of close contacts. While several other important components of the health system, such as financing and human resources remain largely under-explored, the results of this study show that a mixture of measures may lead to an effective epidemic management.

Functional oxides on silicon have been the subject of in-depth research for more than 20 years. Much of this research has been focused on the quality of the integration of materials due to their intrinsic thermodynamic incompatibility, which has hindered the flourishing of the field of research. Nevertheless, growth of epitaxial transition metal oxides on silicon with a sharp interface has been achieved by elaborated kinetically controlled sequential deposition while the crystalline quality of different functional oxides has been considerably improved. In this Research Update, we focus on three applications in which epitaxial ferroelectric oxides on silicon are at the forefront, and in each of these applications, other aspects of the integration of materials play an important role. These are the fields of piezoelectric microelectromechanical system devices, electro-optical components, and catalysis. The overview is supported by a brief analysis of the synthesis processes that enable epitaxial growth of oxides on silicon. This Research Update concludes with a theoretical description of the interfaces and the possibility of manipulating their electronic structure to achieve the desired coupling between (ferroelectric) oxides and semiconductors, which opens up a remarkable perspective for many advanced applications. © 2021 Author(s).

Polarization fatigue, i.e., the loss of polarization of ferroelectric capacitors upon field cycling, has been widely discussed as an interface related effect. However, mechanism(s) behind the development of fatigue have not been fully identified. Here, we study the fatigue mechanisms in Pt/PbZr0.52Ti0.48O3/SrRuO3 (Pt/PZT/SRO) capacitors in which all layers are fabricated by pulsed laser deposition without breaking the vacuum. With scanning transmission electron microscopy, we observed that in the fatigued capacitor, the Pt/PZT interface becomes structurally degraded, forming a 5 nm–10 nm thick non-ferroelectric layer of crystalline ZrO2 and diffused Pt grains. We then found that the fatigued capacitors can regain the full initial polarization switching if the externally applied field is increased to at least 10 times the switching field of the pristine capacitor. These findings suggest that polarization fatigue is driven by a two-step mechanism. First, the transient depolarization field that repeatedly appears during the domain switching under field cycling causes decomposition of the metal/ferroelectric interface, resulting in a non-ferroelectric degraded layer. Second, this interfacial non-ferroelectric layer screens the external applied field causing an increase in the coercive field beyond the usually applied maximum field and consequently suppresses the polarization switching in the cycled capacitor. Our work clearly confirms the key role of the electrode/ferroelectric interface in the endurance of ferroelectric-based devices.

Automation is the key for small and medium enterprises (SMEs) to gain profit and win market. Investment required for automation projects are normally high and would cost extra whenever upgrade is needed. Sometimes, present automation system cannot adapt to the change and must be replaced. These matters cause SMEs to consider whether to invest on automation or not. This paper proposes a concept for an automation system which can be integrated into larger systems with reasonable prices. A case study in footwear industry is analyzed and prototype of automated conveying system is fabricated to demonstrate the opportunity of this concept. The result of implementation proven that SMEs can save up to 50% of the cost if applying the proposed concepts.

The paper is to develop a stimulated model of an automatic production line in shoe manufacturing industry by integrating Internet of things (IoT) technology and industrial robots. Firstly, a conceptual design and prototype development of the simulated model is proposed for experimental study. Secondly, a control software in combination with human-machine interface (HMI) for the prototype is developed by using the programmable logic controller(PLC) and a Ardruno micro-controller. Finally, a model integrated system for automatic database management is provided by using the IoT technology.

The LEDs lighting device with phosphor ingredient (pcLEDs) is among the most common lighting methods in recent years and evaluated by chromatic uniformity and lighting capacity. Therefore, we introduce the phosphor particles that can improve the scattering efficiency (SEPs) to apply in pcLEDs at 8500 K correlated color temperature (CCT) with the expectation to produce better pcLEDs by enhancing both quantity and quality of emitted light. Combining various materials such as CaF 2 and SiO 2 with yellow Y 3 Al 5 O 12 :Ce 3+ phosphor composition in the pcLEDs simulation created by the LightTools program is the mechanism of this research. The simulated pcLEDs are tested and the results will be verified with Mie-scattering theory. The observation of the simulation leads to the conclusion about the scattering coefficients of SEPs at 455 nm and 595 nm wavelengths. The calculation showed that CaF 2 is better for color homogeneity yet suffer from luminous flux deficiency as the concentration gets higher. On the other hand, SiO 2 is the scattering enhancement material that can maintain high luminous flux regardless of its concentration.

Color uniformity is one of the essentials for the on-going development of WLED. To achieve a high color uniformity index, increasing the scattering events within the phosphor layers was reported to be the most efficient method and in this article, ZnO is the chosen material to apply in this method. After analyzing the scattering properties through the scattering cross-section 𝐶𝑠𝑐𝑎(𝐷,𝜆), scattering coefficient 𝜇𝑠𝑐𝑎(𝜆) and scattering phase function 𝜌(𝜃,𝜆), the which outcomes comfirm that ZnO can enhance the scattered light in the phosphor layers. Moreover, the findings from the study of ZnO concentration from 2% to 26% suggest that color uniformity also depends on the fluctuation of ZnO concentration, therefore, to control color uniformity the focus should be implied on both size and concentration of ZnO. The experimental results from this research show that the luminous flux of WLED is at the peak if the concentration of ZnO is at 6%, and when the concentration of ZnO is at 18% and has 100 nm particles size, the ΔCCT reaches the lowest level. The final choice should be based on the desired characteristic of WLEDs, however, if the WLED need to excel in both luminous flux and ΔCCT then 6% ZnO concentration with particles size from 100 nm-300 nm is the optimal choice.

Background Single-cell sequencing technology has opened an unprecedented ability to interrogate cancer. It reveals significant insights into the intratumoral heterogeneity, metastasis, therapeutic resistance, which facilitates target discovery and validation in cancer treatment. With rapid advancements in throughput and strategies, a particular immuno-oncology study can produce multi-omics profiles for several thousands of individual cells. This overflow of single-cell data poses formidable challenges, including standardizing data formats across studies, performing reanalysis for individual datasets and meta-analysis. Methods N/A Results We present BioTuring Browser, an interactive platform for accessing and reanalyzing published single-cell omics data. The platform is currently hosting a curated database of more than 10 million cells from 247 projects, covering more than 120 immune cell types and subtypes, and 15 different cancer types. All data are processed and annotated with standardized labels of cell types, diseases, therapeutic responses, etc. to be instantly accessed and explored in a uniform visualization and analytics interface. Based on this massive curated database, BioTuring Browser supports searching similar expression profiles, querying a target across datasets and automatic cell type annotation. The platform supports single-cell RNA-seq, CITE-seq and TCR-seq data. BioTuring Browser is now available for download at www.bioturing.com. Conclusions N/A

IntroductionHepatitis C virus (HCV) is a global public health threat, and novel models of care are required to treat those currently or previously at highest risk of infection, particularly persons who inject drugs (PWID; ever injected), as conventional healthcare models do not have the reach to deliver cure of HCV to disadvantaged, disproportionately affected communities. In Western Europe and Australasia, it is estimated that HCV affects between 0.4% and 1.0% of the regions’ populations, accordingly, it affects between 0.4% and 0.7% of the populations of countries in this study (Scotland, Wales and Australia). Reaching mEthadone users Attending Community pHarmacies with HCV (REACH HCV) will evaluate community pharmacy-based diagnostic outreach and HCV treatment against conventional HCV testing and treatment pathways for clients receiving opioid substitution therapy (OST) in community pharmacies.Methods and analysisREACH HCV is an international multicentre cluster randomised controlled trial with sites in Scotland, Wales and Australia. The sites are community pharmacies which are randomised equally to one of two pathways: the pharmacy intervention pathway or the education-only (control) pathway. Participants are recruited from OST clients in these pharmacies.In the pharmacy intervention pathway, participants receive a rapid point-of-care HCV PCR test in their pharmacy by a study outreach nurse. If positive, direct-acting antivirals (DAAs) are delivered to participants via their pharmacist in line with their OST schedule.In the education-only pathway, pharmacists counsel OST clients on HCV and refer them to the nearest nurse-led clinic or general practitioner offering HCV testing according to standard care protocols. If positive, DAAs are delivered as in the intervention pathway.The primary endpoint for both pathways is sustained viral response at 12 weeks post-treatment . Secondary outcomes are: cost-efficacy by pathway; participants tested by pathway; adherence to therapy by pathway and impact of blood test results on treatment decisions.A statistical analysis plan will be finalised prior to data lock. Analysis will be by intention to treat (ITT) to show superiority. Modified ITT analysis will also be undertaken to explore the steps in the pathways.Ethics and disseminationThe trial received ethical favourable opinion from the East of Scotland Research Ethics Committee 2 (19/ES/0025) for UK sites and approval from the Alfred Hospital Ethics Committee (148/19) for Australian sites and complies with principles of Good Clinical Practice. Final results will be presented in peer-reviewed journals and at relevant conferences.Trial registration numberClinicalTrials.gov Registry NCT03935906.Protocol versionV.4.0—19 March 2020.

Medical staff caring for COVID-19 patients face mental stress, physical exhaustion, separation from families, stigma, and the pain of losing patients and colleagues. Many of them have acquired SARS-CoV-2 and some have died. In Africa, where the pandemic is escalating, there are major gaps in response capacity, especially in human resources and protective equipment. We examine these challenges and propose interventions to protect healthcare workers on the continent, drawing on articles identified on Medline (Pubmed) in a search on 24 March 2020. Global jostling means that supplies of personal protective equipment are limited in Africa. Even low-cost interventions such as facemasks for patients with a cough and water supplies for handwashing may be challenging, as is ‘physical distancing’ in overcrowded primary health care clinics. Without adequate protection, COVID-19 mortality may be high among healthcare workers and their family in Africa given limited critical care beds and difficulties in transporting ill healthcare workers from rural to urban care centres. Much can be done to protect healthcare workers, however. The continent has learnt invaluable lessons from Ebola and HIV control. HIV counselors and community healthcare workers are key resources, and could promote social distancing and related interventions, dispel myths, support healthcare workers, perform symptom screening and trace contacts. Staff motivation and retention may be enhanced through carefully managed risk ‘allowances’ or compensation. International support with personnel and protective equipment, especially from China, could turn the pandemic’s trajectory in Africa around. Telemedicine holds promise as it rationalises human resources and reduces patient contact and thus infection risks. Importantly, healthcare workers, using their authoritative voice, can promote effective COVID-19 policies and prioritization of their safety. Prioritizing healthcare workers for SARS-CoV-2 testing, hospital beds and targeted research, as well as ensuring that public figures and the population acknowledge the commitment of healthcare workers may help to maintain morale. Clearly there are multiple ways that international support and national commitment could help safeguard healthcare workers in Africa, essential for limiting the pandemic’s potentially devastating heath, socio-economic and security impacts on the continent.

Men who have sex with men (MSM) are disproportionally affected by the HIV epidemic. Self-efficacy is an important individual psychosocial factor associated with access to and use of health and HIV-related services. We estimated HIV testing prevalence and examined the relationship between HIV testing self-efficacy and self-reported HIV testing behavior among young MSM (YMSM) in Myanmar. We enrolled 585 MSM aged 18–24 years from six urban areas using respondent-driven sampling (RDS) technique. RDS analyses were performed to provide estimates for the key outcome of interest. More than a third (34.5%) had never been tested for HIV, whereas 27.5% and 38.0% had their most recent HIV test more than three months and within the past three months from the time of interview, respectively. Young MSM who reported high self-efficacy (adjusted relative risk ratio [ARR]=7.35, 95%CI = 2.29–23.5) and moderate self-efficacy (ARR = 8.61, 95%CI = 3.09–24.0) were more likely to report having tested for HIV in the past three months compared to their counterparts who reported low self-efficacy. Findings highlight a positive association between self-efficacy and HIV testing uptake, indicating a potential causal relationship. Further research is needed to examine the direction of this association and inform future public health interventions targeting YMSM in Myanmar.

Background Panax vietnamensis Ha et Grushv. or Vietnamese ginseng (VG) is a recently discovered ginseng species. Studies on its chemical constituents have shown that VG is remarkably rich in ginseng saponins, particularly ocotillol saponins. However, the psychopharmacological effects of VG have not been characterized. Thus, in the present study we screened the psychopharmacological activities of VG in mice. Methods VG extract (VGE) was orally administered to mice at various dosages to evaluate its psychomotor (open-field and rota-rod tests), sedative–hypnotic (pentobarbital-induced sleeping test), antistress (cold swimming test), anxiolytic (elevated plus-maze test), and cognitive (Y-maze and passive-avoidance tests) effects. Results VGE treatment increased the spontaneous locomotor activity, enhanced the endurance to stress, reduced the anxiety-like behavior, and ameliorated the scopolamine-induced memory impairments in mice. In addition, VGE treatment did not alter the motor balance and coordination of mice and did not potentiate pentobarbital-induced sleep, indicating that VGE has no sedative-hypnotic effects. The effects of VGE were comparable to those of the Korean Red Ginseng extract. Conclusion VG, like other ginseng products, has significant and potentially useful psychopharmacological effects. This includes, but is not limited to, psychomotor stimulation, anxiolytic, antistress, and memory enhancing effects.

ObjectiveProlonged continuous video-electroencephalography (cEEG) is recommended for neonates at risk of seizures. The cost and expertise required to provide a real-time response to detected seizures often limits its utility. We hypothesised that the first hour of cEEG could predict subsequent seizures.Design and settingRetrospective multicentre diagnostic accuracy study.Patients266 term neonates at risk of seizure or with suspected seizures.InterventionThe first hour of cEEG was graded by expert and novice interpreters as normal, mildly, moderately or severely abnormal; seizures were identified.Main outcome measuresAssociation between abnormalities in the first hour of cEEG and the presence of seizures during total cEEG monitoring.Results50/98 (51%) of neonates who developed seizures had their first seizure in the first hour of cEEG monitoring. The ‘time-to-event’ risk of seizure from 0 to 96 hours was 0.38 (95% CI 0.32 to 0.44) while the risk in the first hour was 0.19 (95% CI 0.15 to 0.24). cEEG background was normal in 48% of neonates, mildly abnormal in 30%, moderately abnormal in 13% and severely abnormal in 9%. Inter-rater agreement for determination of background was very good (weighted kappa=0.81, 95% CI 0.72 to 0.91). When neonates with seizures during the first hour were excluded, an abnormal background resulted in 2.4 times increased risk of seizures during the subsequent monitoring period (95% CI 1.3 to 4.4, pConclusionsThe first hour of cEEG in at-risk neonates is useful in identifying and predicting whether seizures occur during cEEG monitoring up to 96 hours. This finding enables identification of high-risk neonates who require closer observation.

ObjectiveCD4+ T lymphocyte count remains the most common biomarker of immune status and disease progression in human immunodeficiency virus (HIV)-positive individuals. VISITECT®CD4 is an instrument-free, low-cost point-of-care CD4 test with a cut-off of 350 CD4 cells/μL. This study aimed to evaluate VISITECT®CD4 test's diagnostic accuracy.MethodsTwo hundred HIV-positive patients attending a tertiary HIV centre in South India were recruited. Patients provided venous blood for reference and VISITECT®CD4 tests. An additional finger-prick blood sample was obtained for VISITECT®CD4. VISITECT®CD4's diagnostic performance in identifying individuals with CD4 counts ≤350 cells/μL was assessed by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) taking flow cytometry as the reference.ResultsThe overall agreement between VISITECT®CD4 and flow cytometry was 89.5% using venous blood and 81.5% using finger-prick blood. VISITECT®CD4 showed better performance using venous blood [sensitivity: 96.6% (95% confidence interval: 92.1%–98.9%), specificity: 70.9% (57.1%–82.4%), PPV: 89.7% (83.9%–94.0%) and NPV: 88.6% (75.4%–96.2%)] than using finger-prick blood [sensitivity: 84.8% (77.9%–90.2%), specificity: 72.7% (59.0%–83.9%), PPV: 89.1% (82.7%–93.8%) and NPV: 64.5% (51.3%–76.3%)].ConclusionVISITECT®CD4 performed well using venous blood, demonstrating its potential utility in decentralization of CD4 testing services in resource-constrained settings.

Background Exposure to high ambient temperatures during pregnancy may increase the risk of adverse pregnancy outcomes due to physiological and anatomical changes in pregnancy compromising the ability to thermoregulate. Methods A systematic review and meta-analysis of studies that assessed associations between ambient heat, and preterm birth, birth weight and stillbirths. Articles were identified through a search of Medline (PubMed) and Web of Science. Titles and abstracts were screened, eligible studies extracted and risk of bias assessed using the Joanna Briggs Institute appraisal tools. Results 14,880 records were screened and a total of 70 studies included. In 40 of 47 studies, preterm births were more frequent at higher than lower temperatures. In random effects meta-analysis, the odds of a preterm birth rose 1.05-fold per 1 °C increase in temperature (95%CI=1.03, 1.07), and 1.16 fold during heat waves (95%CI=1.10, 1.23). Reduced birth weight associated with higher temperature was found in in 18 of 28 studies, with considerable heterogeneity. Studies on stillbirths (n = 8) all showed temperature-stillbirth associations, with stillbirths increasing 1.05-fold per 1 °C rise in temperature (95%CI=1.01, 1.08). Associations between temperature and outcomes were largest among women in lower socioeconomic groups and at age extremes. The multiple temperature metrics and lag analyses limited comparison between studies and settings. Conclusions As frequency of heat exposures is increasing, prevention for pregnant women during heat waves should become a standard aspect of heat adaptation. Key messages Increase in extreme temperature events may have major implications for child health unless much more is done to provide heat adaptation services for pregnant women. Links between socio-economic status and study outcomes suggest higher vulnerability for already disadvantaged groups.

Epitaxial (PbMg1/3Nb2/3O3)2/3-(PbTiO3)1/3 (PMN-PT) films with different out-of-plane orientations were prepared using a CeO2/yttria stabilized ZrO2 bilayer buffer and symmetric SrRuO3 electrodes on silicon substrates by pulsed laser deposition. The orientation of the SrRuO3 bottom electrode, either (110) or (001), was controlled by the deposition conditions and the subsequent PMN-PT layer followed the orientation of the bottom electrode. The ferroelectric, dielectric and piezoelectric properties of the (SrRuO3/PMN-PT/SrRuO3) ferroelectric capacitors exhibit orientation dependence. The properties of the films are explained in terms of a model based on polarization rotation. At low applied fields domain switching dominates the polarization change. The model indicates that polarization rotation is easier in the (110) film, which is ascribed to a smaller effect of the clamping on the shearing of the pseudo-cubic unit cell compared to the (001) case.

Background Syphilis has been and still is one of the greatest global health concerns. Syphilis can seriously damage the nervous system of infected individuals including infants born to infected mother. Treatment of syphilis is simple and effective with penicillin but diagnosis is challenging, particularly in resource-constrained settings, due to the need for a laboratory-based confirmatory test. Current point of care (POC) tests for syphilis are available but cannot distinguish active infections from past treated infections with a misclassification rate of up to 50% (low specificity). We developed a prototype rapid POC test (IgA Confirm) that can differentiate active syphilis from past treated infections at the point of care. Methods We conducted a prospective diagnostic accuracy study to assess the specificity (and sensitivity) of the IgA Confirm test in identifying active syphilis infections classified by Treponema pallidum Antibobody (TPAb) and rapid plasma regain (RPR) laboratory serology. Between June-December 2018, 500 pregnant women attending Rahima Moosa Mother and Child hospital, South Africa were recruited and provided venous blood samples for syphilis testing including the IgA Confirm (index) and laboratory serology (reference) tests. Results The IgA Confirm demonstrate a sensitivity of 100% (5/5) for identifying samples with active syphilis infections (TPAb positive and RPR positive); 100% (9/9) specificity for identifying samples with past or treated infections (TPAb positive, RPR negative) and, 99.4% (484/487) specificity for samples with no evidence of syphilis (TPAb and RPR negative). Conclusion This study showed that the IgA Confirm test has the ability to identify active syphilis infection and meet the WHO Target Product Profile for syphilis confirmatory testing. Future study is needed to further evaluate diagnostic performance of the test in high prevalence setting. Disclosure No significant relationships.

Background Men who have sex with men (MSM) are disproportionally affected by the HIV epidemic. HIV testing coverage among MSM, particularly in low-resource settings, remains low. Self-efficacy is an important individual psychosocial factor associated with access to health care and health outcomes but the association between self-efficacy and HIV testing uptake among key populations is poorly understood. Methods A cross sectional study was conducted with 585 MSM aged 18–24 years recruited by 33 seed respondents from six urban areas in Myanmar via respondent-driven sampling (RDS). RDS analyses were performed to provide population estimates of HIV testing coverage. Sensitivity analysis was performed to assess potential bias due to inclusion of seed and HIV positive respondents on final population estimates. Multinomial logistic regression was use to examine the relationship between self-efficacy and HIV testing uptake. Results More than a third (34.5%) had never been tested for HIV (never tester), 27.5% and 38.0% had their most recent HIV test more than three months (non-recent tester) and within the past three months (recent tester), from the time of interview, respectively. Sensitivity analysis showed similar point estimates excluding seed or HIV positiverespondents (Table1). Results of multinomial logistic regression analyses show that YMSM who reported high self-efficacy (adjusted Relative Risk Ratio [ARR]= 7.35, 95% CI: 2.29–23.5) and moderate self-efficacy (ARR= 8.61, 95% CI: 3.09–24.0) are more likely to report having tested for HIV in the past three months compared to their counterparts who reported low self-efficacy after adjusting for potential confounders. Conclusion HIV testing coverage among YMSM is suboptimal and there is a positive association between self-efficacy and HIV testing uptake among YMSM. Further research is needed to examine the direction of this association to inform future public health interventions targeting YMSM in Myanmar. Disclosure No significant relationships.

BiVO4 is a promising light harvester for the construction of photoanode for solar-driven water splitting, but it suffers from low charge mobility and slow oxygen evolution reaction kinetics. Herein, we report on a novel strategy using AgOx (e.g. Ag2O and AgO) nanoparticles as hole collectors to boost the BiVO4 photoanode to its best photocatalytic performance. AgOx helps to boost the charge transfer efficiency at the BiVO4/electrolyte interface up to 93%, being much higher than 40% achieved for a bare BiVO4 photoanode. AgOx also contributes to improving the photostability of BiVO4 by offering an efficient quenching of the photogenerated holes, which are harmful to the BiVO4, e.g. causing an oxidative dissolution of V. In a pH 7 phosphate buffer electrolyte and under 1 sun illumination, the best BiVO4/AgOx photoanode generates a photocatalytic current density of 4.65 mA/cm2 at 1.23 V vs. reversible hydrogen electrode. It represents a 2.3-fold improvement of activity in comparison to a bare BiVO4 without AgOx decoration. The current BiVO4/AgOx can be placed among the top-tier photoanodes for solar water splitting made of BiVO4 light harvester.

Relaxor ferroelectric Pb0.9La0.1(Zr0.52Ti0.48)O3 (PLZT) thin films have been epitaxially grown via pulsed laser deposition on SrRuO3/SrTiO3 single crystal with different orientations. The high recoverable energy-storage density and energy-storage efficiency in the epitaxial PLZT thin films are mainly caused by the coexistence of relaxor and antiferroelectric-like behaviors. The recoverable energy-storage density of 12.03, 12.51 and 12.74 J/cm3 and energy-storage efficiency of 86.50, 88.14 and 88.44%, respectively, for the PLZT(001), PLZT(011) and PLZT(111) thin films measured at 1000 kV/cm. The high energy density and high efficiency indicate that the relaxor epitaxial PLZT(111) thin film is a promising candidate for high pulsed power capacitors.

OBJECTIVE Seizure onset in the insular cortex as a cause of refractory epilepsy is underrepresented in the pediatric population, possibly due to difficulties localizing seizure onset in deep anatomical structures and limited surgical access to the insula, a complex anatomical structure with a rich overlying vascular network. Insular seizure semiology may mimic frontal, temporal, or parietal lobe semiology, resulting in false localization, incomplete resection, and poor outcome. METHODS The authors retrospectively reviewed the records of all pediatric patients who underwent insular cortical resections for intractable epilepsy at Miami Children's Hospital from 2009 to 2015. Presurgical evaluation included video electroencephalography monitoring and anatomical/functional neuroimaging. All patients underwent excisional procedures utilizing intraoperative electrocorticography or extraoperative subdural/depth electrode recording. RESULTS Thirteen children (age range 6 months–16 years) with intractable focal epilepsy underwent insular-opercular resection. Seven children described symptoms that were suggestive of insular seizure origin. Discharges on scalp EEG revealed wide fields. Four patients were MRI negative (i.e., there were no insular or brain abnormalities on MRI), 4 demonstrated insular signal abnormalities, and 5 had extrainsular abnormalities. Ten patients had insular involvement on PET/SPECT. All patients underwent invasive investigation with insular sampling; in 2 patients resection was based on intraoperative electrocorticography, whereas 11 underwent surgery after invasive EEG monitoring with extraoperative monitoring. Four patients required an extended insular resection after a failed initial surgery. Postoperatively, 2 patients had transient hemiplegia. No patients had new permanent neurological deficits. At the most recent follow-up (mean 43.8 months), 9 (69%) children were seizure free and 1 had greater than 90% seizure reduction. CONCLUSIONS Primary insular seizure origin should be considered in children with treatment-resistant focal seizures that are believed to arise within the perisylvian region based on semiology, widespread electrical field on scalp EEG, or insular abnormality on anatomical/functional neuroimaging. There is a reasonable chance of seizure freedom in this group of patients, and the surgical risks are low.

In this paper, the problem of designing a Position Mooring (PM) system for a barge ship is addressed. A mathematical model of a system comprising a barge ship and mooring system is derived. Hydrodynamic coefficients of the low speed model for PM ship are identified by suitable experiments. A PID control scheme is implemented to achieve PM for the vessel by changing the tension of the mooring ropes. The proposed strategy is finally tested on station keeping, and desired positions of a 1/50 scale model ship are obtained.

Lately, tugboats are widely used to maneuver vessels by pushing or towing them where tugboats use rope. In order to correctly control the motion of tugboat and towed vessel, the dynamics of the towline would be well identified. In real application environment, the towing rope length changes and the towing load is not constant due to the various sizes of towed vessel. And there are many ropes made by many types of materials. It means that it is not easy to obtain rope dynamics, such that it is too difficult to satisfy the given control purpose by designing control system. Thus real time identification or adaptive control system design method may be a solution. However it is necessary to secure sufficient information about rope dynamics to obtain desirable control performance. In this paper, the authors try to have several rope dynamic models by changing the rope length to consider real application conditions. Among them, a representative model is selected and the others are considered as uncertain models which are considered in control system design. The authors design a robust control to cope with strong uncertain and nonlinear property included in the real plant. The designed control system based on robust control framework is evaluated by simulation.

We report on the correlated investigation between crystal structures, field-induced phase transition, and energy storage properties of both polycrystalline and epitaxial antiferroelectric PbZrO3 (PZO) films grown by pulsed laser deposition on Si and SrTiO3 substrates. The structural characterization revealed the polycrystalline structure of the PZO films on Pt/Si and the epitaxial relationship between the films and the SrTiO3/Si and SrTiO3 substrates. Different to normal ferroelectric fi lms, the polycrystalline PZO films show similar polarization loops but with a higher maximum polarization, resulting in a larger energy storage density under the same conditions. Due to the larger electric breakdown strength (2800 kV/cm), however, the epitaxial PZO films grown on SrTiO3/Si have a higher recoverable energy storage density (24.9 J/cm3) than those on Pt/Si (23.4 J/cm3 at 2500 kV/cm) and on SrTiO3 (22.0 J/cm3 at 2550 kV/cm). Additionally, the introduction of SrRuO3 oxide-electrode improves the endurance performance of energy storage properties of the films on STO/Si by suppressing the formation of the dead layer between the film and the electrode. In this way, applications based on PZO films would be more easily integrated on Si and open the way to develop high-power commercial energy storage systems.

Relaxor ferroelectric thin films show excellent energy-storage performance for pulse-power applications. In this study, La-doped Ba1-xLax(Zr0.25Ti0.75)O3 (BLZT, x = 0–8%) thin films were grown on LaNiO3 buffered Ca2Nb3O10-nanosheet/Si substrates. BLZT thin films indicate prominently increasing relaxor behavior with increasing La-doping concentration, which is conducive to obtaining a very slim polarization hysteresis loop with a low remanent polarization and a high breakdown strength. As a result, BLZT thin films with 5 mol.% La-doping simultaneously exhibit a great 72.2 J/cm3 recoverable energy-storage density and a large 78.6% energy-storage efficiency under a high 3.8 MV/cm breakdown strength. These results present a promising environmentally friendly candidate for the next generation of advanced energy-storage capacitor applications.

IntroductionDespite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua New Guinea remains suboptimal. An unacceptable number of babies are infected with HIV and mothers not retained in treatment. This study aimed to describe the characteristics of this programme and to investigate the factors associated with programme performance outcomes.MethodsWe conducted a retrospective analysis of clinical records of HIV-positive pregnant women at two hospitals providing prevention of mother to child transmission services. All women enrolled in the prevention of mother to child transmission programme during the study period (June 2012–June 2015) were eligible for inclusion. Using logistic regression, we examined the factors associated with maternal loss to follow-up (LTFU) before birth and before infant registration in a paediatric ARV programme.Results763 of women had records eligible for inclusion. Demographic and clinical differences existed between women at the two sites. Almost half (45.1%) of the women knew their HIV-positive status prior to the current pregnancy. Multivariate analysis showed that women more likely to be LTFU by the time of birth were younger (adjusted OR (AOR)=2.92, 95% CI 1.16 to 7.63), were newly diagnosed with HIV in the current/most recent pregnancy (AOR=3.50, 95% CI 1.62 to 7.59) and were in an HIV serodiscordant relationship (AOR=2.94, 95% CI 1.11 to 7.84). Factors associated with maternal LTFU before infant registration included being primipara at the time of enrolment (AOR=3.13, 95% CI 1.44 to 6.80) and being newly diagnosed in that current/most recent pregnancy (AOR=2.49, 95% CI 1.31 to 4.73). 6.6% (50 of 763) of exposed infants had a positive HIV DNA test.ConclusionsOur study highlighted predictors of LTFU among women. Understanding these correlates at different stages of the programme offers important insights for targets and timing of greater support for retention in care.

Background Current point-of-care tests (POCT) for syphilis, based on the detection of Treponema pallidum (TP) total antibodies, have limited capacity in distinguishing between active and past/treated syphilis. We report the development and early evaluation of a new prototype POCT based on the detection of TP-IgA antibodies, a novel biomarker for active syphilis. Methods The TP-IgA POCT (index test) was developed in response to the World Health Organisation (WHO) target product profile (TPP) for a POCT for confirmatory syphilis testing. Two sub-studies were conducted consecutively using 458 pre-characterised stored plasma samples in China (sub-study one, addressing the criteria for the WHO TPP), and 503 venous blood samples collected from pregnant/postpartum women in South Africa (sub-study two, addressing potential clinical utility). Performance of the index test was assessed against standard laboratory-based serology using a combination of treponemal (TPHA) and non-treponemal (rapid plasma reagin [RPR]) tests. Findings In sub-study one, the index test demonstrated 96·1% (95%CI=91·7%-98·5%) sensitivity and 84·7% (95%CI=80·15–88·6%) specificity for identification of active syphilis (TPHA positive, RPR positive). It correctly identified 71% (107/150) samples of past-treated syphilis (TPHA positive, RPR negative). In sub-study two, the index test achieved 100% (95%CI=59%-100%) sensitivity for active syphilis and correctly identified all nine women with past syphilis. Interpretation The TP-IgA POCT has met the WHO TPP for a POCT for diagnosis of active syphilis and demonstrated its potential utility in a clinical setting. Future studies are warranted to evaluate field performance of the final manufactured test. Funding Saving Lives at Birth: Grand Challenge for Development, Thrasher Research Fund, and the Victorian Government Operational Infrastructure Scheme.

Background Checkpoint blockade immunotherapy has improved metastatic cancer patient survival, but response rates remain low. There is an unmet need to identify mechanisms and tools to circumvent resistance. In human patients, responses to checkpoint blockade therapy correlate with tumor mutation load, and intrinsic resistance associates with pre-treatment signatures of epithelial mesenchymal transition (EMT), immunosuppression, macrophage chemotaxis and TGFβ signaling. Methods To facilitate studies on mechanisms of squamous cell carcinoma (SCC) evasion of checkpoint blockade immunotherapy, we sought to develop a novel panel of murine syngeneic SCC lines reflecting the heterogeneity of human cancer and its responses to immunotherapy. We characterized six Kras-driven cutaneous SCC lines with a range of mutation loads. Following implantation into syngeneic FVB mice, we examined multiple tumor responses to α-PD-1, α-TGFβ or combinatorial therapy, including tumor growth rate and regression, tumor immune cell composition, acquired tumor immunity, and the role of cytotoxic T cells and Tregs in immunotherapy responses. Results We show that α-PD-1 therapy is ineffective in establishing complete regression (CR) of tumors in all six SCC lines, but causes partial tumor growth inhibition of two lines with the highest mutations loads, CCK168 and CCK169. α-TGFβ monotherapy results in 20% CR and 10% CR of established CCK168 and CCK169 tumors respectively, together with acquisition of long-term anti-tumor immunity. α-PD-1 synergizes with α-TGFβ, increasing CR rates to 60% (CCK168) and 20% (CCK169). α-PD-1 therapy enhances CD4 + Treg/CD4 + Th ratios and increases tumor cell pSmad3 expression in CCK168 SCCs, whereas α-TGFβ antibody administration attenuates these effects. We show that α-TGFβ acts in part through suppressing immunosuppressive Tregs induced by α-PD-1, that limit the anti-tumor activity of α-PD-1 monotherapy. Additionally, in vitro and in vivo, α-TGFβ acts directly on the tumor cell to attenuate EMT, to activate a program of gene expression that stimulates immuno-surveillance, including up regulation of genes encoding the tumor cell antigen presentation machinery. Conclusions We show that α-PD-1 not only initiates a tumor rejection program, but can induce a competing TGFβ-driven immuno-suppressive program. We identify new opportunities for α-PD-1/α-TGFβ combinatorial treatment of SCCs especially those with a high mutation load, high CD4+ T cell content and pSmad3 signaling. Our data form the basis for clinical trial of α-TGFβ/α-PD-1 combination therapy (NCT02947165). Electronic supplementary material The online version of this article (10.1186/s40425-018-0493-9) contains supplementary material, which is available to authorized users.

Measuring CD4 counts remains an important component of HIV care. The Visitect CD4 is the first instrument-free low-cost point-of-care CD4 test with results interpreted visually after 40 min, providing a result of ≥350 CD4 cells/mm3., Measuring CD4 counts remains an important component of HIV care. The Visitect CD4 is the first instrument-free low-cost point-of-care CD4 test with results interpreted visually after 40 min, providing a result of ≥350 CD4 cells/mm3. The field performance and diagnostic accuracy of the test was assessed among HIV-infected pregnant women in South Africa. A nurse performed testing at the point-of-care using both venous and finger-prick blood, and a counselor and laboratory staff tested venous blood in the clinic laboratory (four Visitect CD4 tests/participant). Performance was compared to the mean CD4 count from duplicate flow cytometry tests on venous blood (FACSCalibur Trucount). In 2017, 156 patients were enrolled, providing a total of 624 Visitect CD4 tests (468 venous and 156 finger-prick samples). Of 624 tests, 28 (4.5%) were inconclusive. Generalized linear mixed modeling showed better performance of the test on venous blood (sensitivity = 81.7%; 95% confidence interval [CI] = 72.3 to 91.1]; specificity = 82.6%, 95% CI = 77.1 to 88.1) than on finger-prick specimens (sensitivity = 60.7%; 95% CI = 45.0 to 76.3; specificity = 89.5%, 95% CI = 83.2 to 95.8; P = 0.001). No difference in performance was detected by cadre of health worker (P = 0.113) or between point-of-care versus laboratory-based testing (P = 0.108). Adequate performance of Visitect CD4 with different operators and at the point of care, with no need of electricity or instrument, shows the potential utility of this device, especially for facilitating decentralization of CD4 testing services in rural areas.

Weather conditions, especially temperature and precipitation, play a critical role in shaping patterns of diarrhoeal diseases. They determine the frequency of outbreaks, and the spatial and seasonal distribution of cases. Not surprisingly, it is anticipated that the burden of diarrhoeal diseases will escalate with climate change, in tandem with gradual increments in mean temperatures, but also during episodic heatwaves. The degree and nature of this escalation will, however, vary with the mix of pathogens in an area, the quality of sanitation services, food hygiene regulations and their enforcement, and the age structure of the population, among other factors. Understanding these patterns can inform the design of measures to prevent and control heat-related diarrhoea. In this editorial, we sum evidence on the heat sensitivity of enteric infections in South Africa (SA) and other parts of sub-Saharan Africa (19 studies), drawing on articles located in a systematic review (methods detailed in Manyuchi et al. [1]), and consider the implications of these findings for control of diarrhoea in SA in the context of climate change.

Unprotected sex, common among people who inject drugs, puts them and their partners at risk of sexually transmitted infections including human immunodeficiency virus (HIV). This analysis assesses the changes in sexual risk behavior with regular female partners (RFPs), among married men who inject drugs, before and after implementation of a HIV prevention intervention, and identifies correlates of unprotected sex. People who inject drugs (PWID) were assessed at three points: baseline, preintervention follow-up visit (FV)1, and postintervention FV2. Descriptive analysis was used for reporting changes in sexual behavior over time. Generalized estimating equation assessed the population-averaged change in self-reported unprotected sex with an RFP, attributable to intervention uptake. Multivariable logistic regression determined correlates of self-reported unprotected sex with an RFP at FV2. Findings suggest that the proportion of men reporting any unprotected sex remained high (baseline = 46.0%, FV1 = 43.5%, FV2 = 37.0%). A reduction was observed in unprotected sex after the intervention phase, but this could not be attributed to uptake of the intervention. Higher odds of self-reported unprotected sex with an RFP in the past three months at FV2 were associated with self-reported unprotected sex at baseline, living with family, and being HIV-negative. Married male PWID should receive counseling for safe sex with RFPs, especially those who are HIV-negative and live with their families.

Thin film capacitors of the lead-free (K0.5Na0.5)NbO3 (KNN) with (100) orientation were grown on Pt/Ti/SiO2/SOI (silicon-on-insulator) substrates by pulsed laser deposition. The films are pure phases and do not show other crystal orientations. The remnant polarization Pr, saturation polarization Psat, longitudinal d33,f and transverse (d31,f and e31,f) piezoelectric coefficients of the KNN films were determined (Pr=12.6 µC/cm2, Psat=25.0 µC/cm2, d33,f=58 pm/V, d31,f=−42 pm/V and e31,f=−5.6 C/m2). These values are well comparable with the highest values reported for lead-free films of different compositions and therefore these KNN films form a potential alternative to PZT films in lead-free MEMS applications.

Due to its physical properties gallium-nitride (GaN) is gaining a lot of attention as an emerging semiconductor material in the field of high-power and high-frequency electronics applications. Therefore, the improvement in the performance and/or perhaps even extension in functionality of GaN based devices would be highly desirable. The integration of ferroelectric materials such as lead-zirconate-titanate (PbZrxTi1-xO3) with GaN has a strong potential to offer such an improvement. However, the large lattice mismatch between PZT and GaN makes the epitaxial growth of Pb(Zr1-xTix)O-3 on GaN a formidable challenge. This work discusses a novel strain relaxation mechanism observed when MgO is used as a buffer layer, with thicknesses down to a single unit cell, inducing epitaxial growth of high crystallinity Pb(Zr0.52Ti0.48)O-3 (PZT) thin films. The epitaxial PZT films exhibit good ferroelectric properties, showing great promise for future GaN device applications.

Piezoelectric lead-zirconate-Titanate (PZT) thin films were deposited on 4-inch (111)Pt/Ti/SiO2/Si(001) wafers using large-Area pulsed laser deposition (PLD). This study was focused on the homogeneity in film thickness, microstructure, ferroelectric and piezoelectric properties of PZT thin films. The results indicated that the highly textured (001)-oriented PZT thin films with wafer-scale thickness homogeneity (990 nm ± 0.8%) were obtained. The films were fabricated into piezoelectric cantilevers through a MEMS microfabrication process. The measured longitudinal piezoelectric coefficient (d 33f = 210 pm/V ± 1.6%) and piezoelectric transverse coefficient (e 31f = -18.8 C/m2 ± 2.8%) were high and homogeneity across wafers. The high piezoelectric properties on Si wafers will extend industrial application of PZT thin films and further development of piezoMEMS.

Density-based spatial clustering of applications with noise (DBSCAN) is the most commonly used density-based clustering algorithm, where it can discover multiple clusters with arbitrary shapes. DBSCAN works properly when the input data type is homogeneous, but the DBSCAN's approach may not be sufficient when the input dataset has textual heterogeneity (e.g., when we intend to find clusters from geo-tagged posts on social media relevant to a certain point-of-interest (POI)), thus leading to poor performance. In this paper, we present DBSTexC, a new density-based clustering algorithm using spatio--textual information on Twitter. We first define POI-relevant and POI-irrelevant tweets as the records that contain and do not contain a POI name or its coherent variations, respectively. By taking into account the fractions of POI-relevant and POI-irrelevant tweets, our DBSTexC algorithm shows a much higher clustering quality than the DBSCAN case in terms of the F1 score and its variants. DBSTexC can be thought of as a generalized version of DBSCAN due to the findings that it performs identically as DBSCAN when the inputs are homogeneous and far outperforms DBSCAN when the heterogeneous input data type is given.

Introduction In Myanmar, men who have sex with men (MSM) experience high risk of HIV infection. However, access to HIV testing and prevention services remains a challenge among this marginalized population. The objective of this study was to estimate population prevalence and correlates of prior HIV testing among young MSM (YMSM) and informs the development of HIV testing and intervention programmes that respond to the specific needs of this population. Methods Five hundred and eighty-five YMSM aged 18 to 24 years were recruited using respondent-driven sampling (RDS) in a cross-sectional survey conducted in six townships of Myanmar. RDS-adjusted population estimates were calculated to estimate prevalence of HIV testing; RDS-weighted logistic regression was used to examine correlates of HIV testing in the past 6 months and in a lifetime. Results There were 12 participants who reported receiving a HIV-positive test; of those, five were tested in the past 6 months. The RDS-weighted prevalence estimates of lifetime (any prior) HIV testing was 60.6% (95% CI: 53.3% to 66.4%) and of recent (≤ 6 months) HIV testing was 50.1% (95% CI: 44.1% to 55.5%). In multivariable analysis, sexual identity was associated with lifetime but not recent HIV testing. Lifetime and recent HIV testing were associated with having three or more male sexual partners in the past 12 months (adjusted ORs (aORs) = 2.28, 95% CIs: 1.21 to 4.32 and 2.69, 95% CI: 1.59 to 4.56), having good HIV-related knowledge (aORs = 1.96, 95% CIs: 1.11 to 3.44 and 1.77, 95% CI: 1.08 to 2.89), reporting high HIV testing self-efficacy (aORs = 13.5, 95% CIs: 6.0 to 30.1 and 9.81, 95% CI: 4.27 to 22.6) and having access to and use of non-HIV health-related services in the past 12 months (aORs = 13.2, 95% CIs: 6.85 to 25.6 and 7.15, 95% CI: 4.08 to 12.5) respectively. Conclusions HIV testing coverage among YMSM aged 18 to 24 years old in Myanmar is still suboptimal. Integrated HIV testing and prevention services in existing health service provision systems with tailored HIV information and education programmes targeting YMSM to improve HIV-related knowledge and self-efficacy may help to promote regular HIV testing behaviour and contribute to sustainable control of the HIV epidemic among this marginalized population in Myanmar.

The energy-storage performance and piezoelectric properties were determined for epitaxial antiferroelectric (AFE) PbZrO3 (PZ), ferroelectric (FE) PbZr0.52Ti0.48O3 (PZT), and relaxor ferroelectric (RFE) Pb0.9La0.1Zr0.52Ti0.48O3 (PLZT) thin films that were deposited on to SrTiO3 buffered Si substrates. The films were investigated by directly measuring the polarization hysteresis loops and piezoelectric strain curves. The square polarization loop with a high remanent polarization and a large piezoelectric coefficient obtained in PZT thin films allow them to be useful for various applications in ferroelectric field effect transistors and/or in MEMS actuators. Meanwhile, there is a jump of about 0.9% in the strain curve of PZ thin films around the field-induced AFE-FE phase transition, which is useful in digital displacement transducers due to a good ON/OFF strain state. The large recoverable energy-storage density, excellent energy-storage efficiency, and low strain hysteresis due to a slim hysteresis loop combine to make PLZT thin films as a potential candidate for a broad range of applications from energy storage to nano-positioning precision systems.

Everyday about 90% of cargos are delivered by ships, and thousands of vessels enter and depart the international container harbors such as Shanghai, Singapore, Hong Kong, Busan, Rotterdam, etc. Maneuvering at harbor is known as the most sophisticated and difficult procedure, because the effectiveness of actuators during low speed berthing is reduced. In this paper, a new berthing method is discussed. Tugboats are combined with damper systems to ensure safe berthing. A mathematical model describing the interaction between unactuated ship, tugboats and damper systems is presented. An optimal controller is designed to maneuver the ship without oscillation and overshoot. MCL (Marine Cybernetics Lab) model ship is used to evaluate the efficiency of the proposed approach through MatLab simulation.

Earlier theoretical reports predicted that the usage of a piezoelectric stressor layer around the FinFET, i.e., the PiezoFET, offers a great potential for steep subthreshold slope devices. For the first time, we analyzed the practical realization of such PiezoFETs comprising a piezoelectric stressor layer, lead–zirconate–titanate (PZT), and aluminum–nitride (AlN) deposited on n-type silicon FinFETs. A high-piezoelectric response in the range of 100 pm/V has been obtained for the PZT PiezoFET evidencing the converse piezoelectric effect in the device. The piezoelectric response for the AlN device was much less (13 pm/V) as expected. Underlying device properties, such as subthreshold swing (SS) and low-field electron mobility have been significantly affected by the presence of the PZT stressor. A 20%–50% change in the mobility and a change in the SS (about 5 mV/decade) have been observed. The change can be attributed to the strain induced reduction of the interface trap density at the ${\rm Si}/{\rm SiO}_{2}$ interface. This strain is partly formed by the bias over the piezoelectric layer, which indicates the converse piezoelectric effect related tunable strain in both the silicon channel and gate oxide.

The effect of two poling processes on the ferroelectric and piezoelectric properties of sol–gel and pulsedlaser-deposited Pb(Zr0.45Ti0.55)O3 (PZT) thin films has been investigated as a function of the poling field, poling temperature and poling time. In the case of dc-electric field poling at an elevated temperature (200 °C), the remnant polarization and effective piezoelectric coefficient are found to increase with and saturate at high dc-poling field (400 kV/cm) and long poling time (30 minutes). The room-temperature poling process using ac electric field poling, shows the same trend with poling field but much shorter poling times (100 seconds), with only a slightly lower saturation value of polarization. It is suggested that in room-temperature poling screening charges are merely rearranged, whereas in high temperature poling these charges are largely removed. A much larger improvement in the properties of sol–gel PZT thin films is found, as compared to those deposited using pulsed laser deposition (PLD), indicating that a poling process is required for sol–gel films.

As life expectancy increases, it is imperative that health care providers recognize the importance of safe medication use within an aging geriatric population. Dealing with a cohort that has different biological and medical demands requires pharmacists to pay particular attention to details when treating this subset of individuals. In particular, this manuscript will focus on Alzheimer's disease (AD) and considerations when dealing with new treatment options. The Food and Drug Administration's recent approval of the increased dosage strength, donepezil 23 mg, previously only available in 5 mg and 10 mg strengths, has raised efficacy and safety concerns. Reservations stem from unproven superiority along with an increased incidence of adverse events. The purpose of the manuscript is to provide a brief insight into these concerns and provide readers the knowledge necessary to make a clinically sound decision when treating patients with moderate-to-severe AD.

Very good crystallinity and highly c-axis-oriented aluminum nitride (AlN) thin films are sputtered on titanium (Ti) to fabricate thin piezoelectric cantilevers. Raman spectroscopy measurements and X-ray diffraction (XRD) indicate the high quality of these AlN films. A fabrication process, fully CMOS compatible, is developed to realize slender piezoelectric microcantilevers. Actuation enhancement for the AlN piezoelectric cantilevers is achieved by coating the slender beams with a thin PECVD silicon nitride (SiN) layer. Very good linearity and high displacement, up to 19.5 nm for 200 μm long cantilevers and 4.25 nm for 100 μm long cantilevers for 1 V actuation at quasi-static mode, are obtained with a 500 nm SiN top layer. These displacement values are three times larger than our previously reported values for cantilevers without SiN layer coating. This makes these cantilevers, without the need of employing nonstandard metals such as platinum (Pt), very promising for micro/nanoactuators.

The transverse piezoelectric coefficient e31,f and mass-sensitivity were measured on piezoelectric cantilevers based on epitaxial PZT thin-films with film-thicknesses ranging from 100 to 2000 nm. The highest values of e31,f and mass-sensitivity were observed at a film thickness of 500–750 nm, while the observed remnant polarization Pr and longitudinal piezoelectric coefficient d33,f values become saturated with a film thickness of 750–1000 nm. To obtain high performance by making use of its optimal film thickness, PZT thin films with various Zr/Ti ratios from 20/80 to 80/20 were studied. The experimental results indicated that the ferroelectric property reached a highest remnant polarization Pr at a Zr/Ti ratio of 20/80, while the longitudinal piezoelectric coefficient d33,f increased with increasing Zr content and reaches a maximum at a Zr/Ti ratio of 52/48. The findings suggest that the optimal composition for mass-sensitivity and transverse piezoelectric coefficient e31,f was shifted to the tetragonal part of the phase diagram with the Zr/Ti ratios of 45/55 and 40/60, respectively.