Tribology of Polymer Film with Hard Interlayers on Si Surface - Role of Surface Energy on Adhesion and Static Friction

Ph.DDOCTOR OF PHILOSOPH

Early Success With Retention in Care Among People Living With HIV at Decentralized ART Satellite Sites in Yangon, Myanmar, 2015–2016

Introduction: Myanmar is one of the countries in the Asia-Pacific region hit hardest by the HIV epidemic that is concentrated among urban areas and key populations. In 2014, the National AIDS Programme (NAP) launched a new model of decentralized service delivery with the establishment ART satellite sites with care delivered by HIV peer workers.Methods: ART satellite sites are implemented by non-government organizations to service high burden HIV areas and populations that suffer stigma or find access to public sector services difficult. They provide continuity of HIV care from outreach testing, counseling, linkage to care, and retention in care. Anti-retroviral (ART) initiation occurs at health facilities by specialist physicians. We conducted a retrospective cohort study of people living with HIV (PLHIV) who were initiated on ART from 2015 to 2016 at five ART satellite sites in Yangon, Myanmar to assess outcomes and time from enrolment to ART initiation.Results: Of 1,339 PLHIV on ART treatment in 2015–16, 1,157 (89%) were retained, and 5% were lost from care and 5% reported dead, at the end of March 2018. Attrition rates (death and lost-to-follow-up) were found to be significantly associated with a CD4 count ≤ 50 cells/mm3 and having baseline weight ≤ 50 kg. Median time taken from enrolment to ART initiation was 1.9 months (interquartile range: 1.4–2.5).Conclusion: We report high rates of retention in care of PLHIV in a new model of ART satellite sties in Yangon, Myanmar after 3 years of follow-up. The delays identified in time taken from enrolment to ART initiation need to be explored further and addressed. This initial study supports continuation of plans to scale-up ART satellite sites in Myanmar. To optimize outcomes for patients and the program and accelerate progress to reduce HIV transmission and end the HIV epidemic, operational research needs to be embedded within the response

High prevalence of vaccine-preventable anal human papillomavirus infections is associated with HIV infection among gay, bisexual, and men who have sex with men in Nairobi, Kenya

Background: Human papillomavirus (HPV) infection is associated with anal cancers and is more prevalent in gay, bisexual, and men who have sex with men (gbMSM), partly due to their vulnerability to HIV infection. Baseline HPV genotype distributions and risk factors can inform the design of next-generation HPV vaccines to prevent anal cancer. Methods: A cross-sectional study was conducted among gbMSM receiving care at a HIV/STI clinic in Nairobi, Kenya. Anal swabs were genotyped using a Luminex microsphere array. Multiple logistic regression methods were used to identify risk factors for four HPV outcomes (any HPV, any HR-HPV, and 4- and 9-valent vaccine-preventable HPVs). Results: Among 115 gbMSM, 51 (44.3%) were HIV-infected. Overall HPV prevalence was 51.3%; 84.3% among gbMSM living with HIV and 24.6% among gbMSM without HIV (p \u3c 0.001). One-third (32.2%) had HR-HPV and the most prevalent vaccine-preventable HR-HPV genotypes were 16, 35, 45, and 58. HPV-18 was uncommon (n = 2). The 9-valent Gardasil vaccine would have prevented 61.0% of HPV types observed in this population. In multivariate analyses, HIV status was the only significant risk factor for any HPV (adjusted odds ratio [aOR]:23.0, 95% confidence interval [95% CI]: 7.3–86.0, p \u3c 0.001) and for HR-HPV (aOR: 8.9, 95% CI: 2.8–36.0, p \u3c 0.001). Similar findings were obtained for vaccine-preventable HPVs. Being married to a woman significantly increased the odds of having HR-HPV infections (aOR: 8.1, 95% CI: 1.6–52.0, p = 0.016). Conclusions: GbMSM living with HIV in Kenya are at higher risk of anal HPV infections including genotypes that are preventable with available vaccines. Our findings support the need for a targeted HPV vaccination campaign in this population

High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015.

BACKGROUND: The number of people living with HIV on antiretroviral treatment (ART) in Myanmar has been increasing rapidly in recent years. This study aimed to estimate rates of virological failure on first-line ART and switching to second-line ART due to treatment failure at the Integrated HIV Care program (IHC). METHODS: Routinely collected data of all adolescent and adult patients living with HIV who were initiated on first-line ART at IHC between 2005 and 2015 were retrospectively analyzed. The cumulative hazard of virological failure on first-line ART and switching to second-line ART were estimated. Crude and adjusted hazard ratios were calculated using the Cox regression model to identify risk factors associated with the two outcomes. RESULTS: Of 23,248 adults and adolescents, 7,888 (34%) were tested for HIV viral load. The incidence rate of virological failure among those tested was 3.2 per 100 person-years follow-up and the rate of switching to second-line ART among all patients was 1.4 per 100 person-years follow-up. Factors associated with virological failure included: being adolescent; being lost to follow-up at least once; having WHO stage 3 and 4 at ART initiation; and having taken first-line ART elsewhere before coming to IHC. Of the 1032 patients who met virological failure criteria, 762 (74%) switched to second-line ART. CONCLUSIONS: We found high rates of virological failure among one third of patients in the cohort who were tested for viral load. Of those failing virologically on first-line ART, about one quarter were not switched to second-line ART. Routine viral load monitoring, especially for those identified as having a higher risk of treatment failure, should be considered in this setting to detect all patients failing on first-line ART. Strategies also need to be put in place to prevent treatment failure and to treat more of those patients who are actually failing

Long-term outcomes of second-line antiretroviral treatment in an adult and adolescent cohort in Myanmar.

BACKGROUND: Myanmar has a high burden of Human Immunodeficiency Virus (HIV) and second-line antiretroviral treatment (ART) has been available since 2008 in the public health sector. However, there have been no published data about the outcomes of such patients until now. OBJECTIVE: To assess the treatment and programmatic outcomes and factors associated with unfavorable outcomes (treatment failure, death and loss to follow-up from care) among people living with HIV (aged ≥ 10 years) receiving protease inhibitor-based second-line ART under the Integrated HIV Care Program in Myanmar between October 2008 and June 2015. DESIGN: Retrospective cohort study using routinely collected program data. RESULTS: Of 824 adults and adolescents on second-line ART, 52 patients received viral load testing and 19 patients were diagnosed with virological failure. However, their treatment was not modified. At the end of a total follow-up duration of 7 years, 88 (11%) patients died, 35 (4%) were lost to follow-up, 21 (2%) were transferred out to other health facilities and 680 (83%) were still under care. The incidence rate of unfavorable outcomes was 7.9 patients per 100 person years follow-up. Patients with a history of injecting drug use, with a history of lost to follow-up, with a higher baseline viral load and who had received didanosine and abacavir had a higher risk of unfavorable outcomes. Patients with higher baseline C4 counts, those having taken first-line ART at a private clinic, receiving ART at decentralized sites and taking zidovudine and lamivudine had a lower risk of unfavorable outcomes. CONCLUSIONS: Long-term outcomes of patients on second-line ART were relatively good in this cohort. Virological failure was relatively low, possibly because of lack of viral load testing. No patient who failed on second-line ART was switched to third-line treatment. The National HIV/AIDS Program should consider making routine viral load monitoring and third-line ART drugs available after a careful cost-benefit analysis

Multi agent monitoring system

Agent technology has evolved from research interest stage into practical implementation stage. At first, there were lots of research work on agent modeling but the deployment of agent systems is still lacking. Multi Agent Development Environment (MADE) is designed to bridge the gap between initial system design and agent implementation. Agents also need to interact with each other in the multi agent environment systems to solve common problem in order to achieve individual or shared goals. FIPA has standardized Agent Communication Language (ACL) for agent communications. Though agent deployment system and agent communication protocol has established this far, there is still a lack of widespread use on multi agent monitoring system. In agent deployment environment, the mental states, transitions, goal achieved, task performed for each agent are needed to monitor. This can be achieved through multi agent monitoring system. But practical software to monitor the agent mental state is rare. This can be due to practical tools or software not easily available currently to monitor the agents or agent monitoring system needs to collaborate with the agent development environment and there are not many development environment exists. Likewise, the exact definition on what multi agent monitoring system should perform in order to achieve the monitoring purpose is not exactly defined. The purpose of this report is to address the key issues and challenges in developing such a multi agent monitoring system.Bachelor of Engineerin

Electrocatalytic synthesis of ammonia under ambient conditions with Ru@Co₃O₄ nanowires as electrocatalyst

Ammonia production is essential for agriculture and chemical industry but the current industrial Haber-Bosch process is energy-intensive and emits much greenhouse gases. Electrochemical methods, like nitrogen reduction reaction (NRR), have potential as an alternative, but are limited by low yield and efficiency. Nitrate ions offer a promising alternative due to their better reaction kinetics and lower dissociation energy for ammonia synthesis, with economic and environmental benefits as they are a common water pollutant. This project aims to investigate Ru@Co3O4 nanowires as an electrocatalyst for sustainable ammonia synthesis and also to optimise the concentrations of Ru addition. The results indicate that 4mM Ru@Co3O4 nanowires have comparable performance for nitrate reduction to other reported electrocatalysts, achieving approximately 88% Faradaic Efficiency at -0.4V vs RHE and ammonia yield of around 3930 micrograms/hcm2 at - 0.6V vs RHE. Therefore, the results of this study provide a promising foundation for the development of high-performance electrocatalysts to mitigate the issues associated with current ammonia production methods.Bachelor of Engineering (Materials Engineering

The Effect of Silica Abrasive Particle Sizes in Polyester Based Composite on the Tribological Properties of Ti64

© 2017 Trans Tech Publications, Switzerland. Investigation of the tribological characteristics of Ti6Al4V (Ti64) was performed by using a pin-on-disc tribometer. Polymer composites composed of a polyester resin matrix and silica abrasives with two different particle sizes were used as the counterface pin material. The macro and micro surface features on the wear track in relation to different abrasive particle sizes were analyzed by using optical microscope and scanning electron microscope. The wear depth was monitored by utilizing surface profiler and the change in hardness of Ti64 was measured by using Vickers hardness tester before and after the test. The effect of sliding speeds on the coefficient of friction was also studied. During sliding against Ti64 substrate, the results showed lower coefficient of friction, smoother surface features, and lower wear rate for the case of the polymer composite pin with smaller silica particles size when compared to that of polymer composite pin with larger silica particles size. The higher sliding speed generated more wear debris, much deeper wear depth, and wider wear track on Ti64 substrate.status: publishe

Alarming prevalence and clustering of modifiable noncommunicable disease risk factors among adults in Bhutan: a nationwide cross-sectional community survey

Abstract Background Bhutan is currently facing a double burden of non-communicable (NCDs) and communicable diseases, with rising trends of NCDs. The 2014 STEPS survey identified high prevalence of several NCD risk factors; however, associations with socio-demographic characteristics as well as clustering of risk factors were not assessed. This study aimed to determine the distribution and clustering of modifiable NCD risk factors among adults in Bhutan and their demographic and social determinants. Methods This was secondary analysis of data from NCD Risk Factors WHO STEPS Survey 2014 in Bhutan. A weighted analysis was conducted to calculate the prevalence of NCD risk factors, and associations were explored using weighted log-binomial regression models. Results This study included 2822 Bhutanese aged 18–69 years; 52% were 18–39 years, 62% were female, and 69% were rural resident. Prevalence of high salt intake, unhealthy diet and tobacco use were 99, 67 and 25% respectively. Raised blood pressure was the commonest (36%) modifiable biological risk factor followed by overweight (33%). The median NCD risk factors per person was 3 (Inter Quartile Range: 2–4); 52.5%% had > = 3 risk factors. A statistically significant difference was found between male vs. female in alcohol consumption(aPR 0.71, 95% CI: 0.53–0.97), low physical activity(aPR 2.06, 95% CI: 1.54–2.75), impaired fasting glycaemia(aPR 1.24, 95% CI: 1.01–1.52), and being overweight(aPR 1.46, 95% CI: 1.31–1.63). Low physical activity was more common among those with secondary and above education level vs. those without any formal education(aPR 1.71, 95% CI: 1.24–2.35), and among those residing in urban areas vs. those in rural(aPR 3.43, 95% CI: 2.27–5.18). Older participants and urban residents were more likely to have > = 3 NCD risk factors compared to younger(aPR 1.46, 95% CI: 1.35–1.58) and rural residents(aPR 1.21, 95% CI: 1.10–1.32). Conclusion Lifestyle modifications at the population level are urgently required in Bhutan as several NCD risk factors such as high salt intake, unhealthy diet, overweight, and high blood pressure were alarmingly high and frequently clustered. Moreover there is a need to consider policy and socio-political and economic factors that have undermined global and national progress to address the rise of NCDs and their risk factors in Bhutan as elsewhere