2% (25/347) of participants seroconverted during the study period, resulting in an incidence rate of 15.56/100 person-years. In subgroup analysis, the HIV incidence rate was higher among migrants than nonmigrants (incidence rate ratio, 1.26; 95% confidence interval [CI], 0.47-3.87). In the time-dependent Cox regression model, bisexual MSM had a higher risk of contracting HIV than gay men (adjusted hazard ratio, 2.19; 95% CI, 1.02-4.72). Conclusions Our findings suggest a high HIV incidence rate among Chinese MSM. Further expansion of pre-exposure prophylaxis and other effective HIV prevention interventions are urgently needed.Background Understanding local epidemiology and etiologies of community-acquired pneumonia in hospitalized patients is crucial for determining the appropriateness of treatment guidelines. We aim to determine the etiologies, severity, and outcomes in adults hospitalized for community-acquired pneumonia and to study the impact of empirical antibiotic therapy on patient outcomes. Methods We performed a prospective observational cohort study involving adults hospitalized for community-acquired pneumonia in Hong Kong. Sputum, nasopharyngeal aspirate, blood, and urine were collected for bacterial culture, molecular tests for detection of viruses and atypical pathogens, and antigen tests. Multivariable logistic regression model and Cox proportional hazard models were performed to determine independent factors associated with prolonged hospitalization and mortality. Results From February 2017 to July 2018, 258 patients were enrolled.  https://www.selleckchem.com/  The median age was 73 (interquartile range, 61-80) years, 66% were male, 57% had underlying chronic illnesses, 13% had CURB-65 score ≥3, and 10% had higher 1-year mortality. Pathogens were identified in 45% of patients; 20% had viral, 15% had bacterial, and 9% had polymicrobial pneumonia. Streptococcus pneumoniae (12%), influenza virus (12%), and Mycoplasma pneumoniae (1.2%) were the most common bacterial, viral, and atypical pathogens, respectively. Nonadherence to local empirical antibiotic treatment guidelines (primarily recommending beta-lactam and doxycycline) was observed in 25% and was independently associated with prolonged hospitalization (≥7 days) and higher mortality, after adjustment for age, underlying chronic illness, and disease severity. Conclusions Adherence to treatment guidelines was associated with shorter hospitalization and improved survival. We provided evidence for the use of doxycycline for coverage of atypical pathogens in nonsevere pneumonia.Background Reconstructing maxillofacial defects is quite challenging for most surgeons due to the region's complex anatomy and cosmetic and functional effects on patients. The use of pre-made alloplastic implants and autogenous grafts is often associated with resorption, infection, and displacement. Recent technological advances have led to the use of custom computer-designed patient-specific implants (PSIs) in reconstructive surgery. This study describes our experience with PSI, details the complications we faced, how to overcome them, and finally, evaluates patient satisfaction. Case presentation Six patients underwent reconstruction of various maxillofacial defects arising due to different etiologies using PSI. A combined total of 10 implants was used. PEEK was used to fabricate 8, while titanium was used to fabricate 2. No complications were seen in any patient both immediately post-op and in subsequent follow-ups. All patients reported a high level of satisfaction with the final result both functionally and cosmetically. Conclusion The use of computer-designed PSI enables a more accurate reconstruction of maxillofacial defects, eliminating the usual complications seen in preformed implants and resulting in higher patient satisfaction. Its main drawback is its high cost.Despite recent advances in our understanding of the unique mechanical behavior of natural structural materials such as nacre and human bone, traditional manufacturing strategies limit our ability to mimic such nature-inspired structures using existing structural materials and manufacturing processes. To this end, we introduce a customizable single-step approach for additively fabricating geometrically-free metallic-based structural composites showing directionally-tailored, location-specific properties. To exemplify this capability, we present a layered metal-ceramic composite not previously reported exhibiting significant directional and site-specific dependence of properties along with crack arrest ability difficult to achieve using traditional manufacturing approaches. Our results indicate that nature-inspired microstructural designs towards directional properties can be realized in structural components using a novel additive manufacturing approach.Purpose of review Pediatricians and other primary care providers are often the first and sole healthcare clinicians of patients who present with tics. However, limited primary care pediatric training in neuropsychiatric concerns, as well as perceived lack of comfort and preparation, make it challenging for these clinicians to confidently identify and manage tic disorders. Recent findings Current empirical findings of tic disorder management relevant to pediatric physicians, including assessment, psychoeducation, behavioral interventions, psychotropic medications, and alternative treatments are reviewed. Summary This article discusses neuropsychiatric and medical complexities of tic disorder assessment, with particular emphasis on differential and comorbid diagnoses. Tiered referral recommendations, based on symptom severity, impairment, and consideration of comorbid conditions, are provided. Future directions for tic management, including dissemination of evidence-based treatments of tic disorders and multidisciplinary teams within pediatric primary care settings, are included.Persistent vocalizations (PVs) are a common behavioral symptom of dementia. There are currently no known studies examining physiological measurement in nursing home (NH) residents with dementia exhibiting PVs. Measures of heart rate (HR) could provide objective evidence of a person's response to a disruption in their internal or external environment. This was a two-case observational study involving NH residents with advanced dementia. HRs were collected via a sensor belt. We found a 39-45 bpm increase in HRs in both participants when comparing a day without PVs to a day exhibiting PVs. This is the first study to demonstrate a change in HR associated with PVs and potential evidence of stress in the person in response to either an internal or external stimuli.