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Let G be a nontrivial, undirected, simple graph. Let S be a subset of V (G). S is a restrained cost effective set of G if for each vertex v in S, degS(v) \(\leq\) degV (G)rS(v) and the subgraph induced by the vertex set, V (G) r S has no isolated vertex. The maximum cardinality of a restrained cost effective set is the restrained cost effective number, CEr(G). In this paper, the restrained cost effective sets of paths, cycles, complete graphs, complete product of graphs and graphs resulting from line graph of graphs with maximum degree of 2 were characterized. As a direct consequence, the bounds or exact values for the restrained cost effective number were determined as well.

This study aimed to determine the relationship between weather conditions as to wet and dry as recorded in the Department of Science and Technology (DOST) – Philippine Atmospheric, Geophysical and Astronomical Services Administration (PAGASA) Weather Forecast Station and the crimes committed in Pagadian City in calendar years 2014-2018. Weather conditions as to wet and dry were correlated to crimes against person and property that was committed in Pagadain City. It employed a quantitative descriptive correlational method of research using the data of crime occurrences recorded in the Philippine National Police Pagadian City Station and the rainfall data from Department of Science and Technology (DOST) – Philippine Atmospheric, Geophysical and Astronomical Services Administration (PAGASA) Weather Forecast Station in the city statistically treated using frequency count, mean, paired sample t-test, and chi-square test. Findings of the study revealed that physical injuries were profiled the highest in crimes against persons, followed by murder, homicide, and rape. At the same time, theft cases were dominantly registered for crimes against properties, followed by robbery, carnapping, and cattle rustling. The average distribution of murder, homicide, and physical injuries during the wet season outnumbered the cases during the dry season, except for rape cases that were higher during the dry season. Likewise, robbery, theft, carnapping, and cattle rustling were higher during the wet season than the dry season. The average distribution differences of crimes committed between the wet and the dry seasons tested at a 0.05 level of significance were not significant. The relationship between crimes against persons and the weather conditions was not significant. The relationship between crimes against properties and the weather conditions was also not significant. Moreover, crimes against persons and properties in the city do not depend on weather conditions. Murder, homicide, physical injuries, rape, robbery, theft, carnapping, cattle rustling, and the like could happen in the city regardless of whether it is wet or dry weather conditions, and there is a need to implement the crime prevention programs designed by the researcher.

BACKGROUND Mobility challenges, transportation, and finances may serve as barriers to diabetic retinopathy (DR) screening in the growing elderly population in Ontario. Screening of patients in their own nursing homes using teleophthalmology may improve accessibility to DR screening. OBJECTIVE To report the feasibility, results, and patient satisfaction of a pilot expansion of the Toronto Tele-Retinal Screening Program in an elderly long-term care home. METHODS A pilot project was initiated with a cohort of elderly patients with Type II diabetes mellitus (DM) in long-term care who were referred to the Toronto Tele-Retinal Screening Program for DR screening between April 1, 2022 and July 1, 2022. RESULTS A total of 28 patients were screened for DR. Half (14/28) of patients suffered from a fall within the last year and 35% (10/28) were fully dependent for mobility. Overall, 14.3% (4/28) of patients could not be successfully imaged. Of the patients imaged, 8.3% (2/24) were advised to arrange an urgent follow-up. Pathologies identified included uncontrolled glaucoma (4.1%, 1/24), non-proliferative DR (NPDR) (8.3%, 2/24), wet age-related macular degeneration (AMD) (8.3%, 2/24), and dry AMD (37.5%, 9/24). A total of 20.8% (5/24) patients could not undergo tabletop imaging due to mobility issues. Screening of 60% (3/5) of these patients were successful with the handheld camera. Overall, 90% (17/19) of patients rated their subjective screening experience as either “brilliant” or “really good.” CONCLUSIONS This pilot project demonstrated that the implementation of the Toronto Tele-Retinal Screening Program into elderly long-term care homes may mitigate common barriers to eye screening with a good subjective patient experience.

As empirical studies have progressed, various metrics and study areas have been incorporated into safety perception and worry about victimization. In this study, the Knowledge, Attitude, and Behavior Model was applied in evaluating the cognitive and emotional domains of 401 residents of Zamboanga del Sur, Phillipines focusing on their knowledge of crime prevention, safety perception, and fears of victimization. Using the model, the knowledge of crime prevention, safety perception, and fear of victimization was considered an exploratory variable based on the common-sense assumption that feelings and emotions govern how people perceive certain things. The result shows that implemented crime prevention strategies in the province were observable, and community awareness is considerable. Regarding safety and security, the respondents rated the province as safe for everyone and moderately safe when personal belongings are left unattended. The threats to physical safety and security against persons and property are less likely to occur. Finally, the data show a statistically significant weak positive correlation between crime prevention and the perception of safety and security. The associations of safety and security and general satisfaction with personal safety among the representative samples show a significant positive weak correlation. Knowledge of crime prevention strategy and general satisfaction with personal safety shows a weak, statistically significant positive correlation. Thus, awareness of crime prevention significantly influences the safety perception, level of worry, and satisfaction with personal safety.

Contrasting approaches, principles, and previous learning experiences widely confront chemistry instruction. Therefore a comprehensive and precise understanding of the nature and mechanism of chemistry instruction is essential in attaining mastery of science subjects like chemistry. This study explored the determinants that affect students’ chemistry in tertiary education. This study utilized an explanatory sequential mixed-method research design wherein quantitative data is collected and analyzed. Qualitative data was collected and analyzed based on quantitative results. The respondents (n=253) were the students who took their chemistry subjects from 2016-2017, 2017-2018, 2018-2019, and 2019-2020. The study revealed that the type of school significantly affects students’ chemistry learning. Based on students’ responses, it was revealed that classroom dynamics, a supportive learning environment, the prospect for attractive compensation, poor study habits, non-aligned of academic track, and teachers are the determinants affecting students’ academic performance in chemistry.

This study proposed an investigation regarding waste management participation in the Municipal of Orani, Bataan, Philippines.

Background: HIV-associated nephropathy (HIVAN) is a renal parenchymal disease that occurs exclusively in patients living with HIV (PLHIV). It is a serious kidney condition that may possibly lead to end-stage renal disease (ESRD), particularly in the HIV-1 seropositive patients. Summary: The African-American population has increased susceptibility to this comorbidity due to a strong association found in the APOL1 gene, specifically two missense mutations in the G1 allele and a frameshift deletion in the G2 allele, although a “second hit” event is postulated to have a role in the development of HIVAN. HIVAN presents with proteinuria, particularly in the nephrotic range, as with other kidney diseases. The diagnosis requires biopsy and typically presents with collapsing subtype FSGS and microcyst formation in the tubulointerstitial region. Gaps still exist in the definitive treatment of HIVAN – concurrent use of antiretroviral therapy and adjunctive management with like Renal-Angiotensin-Aldosterone System (RAAS) inhibitors, steroids, or renal replacement therapy (RRT) showed benefits. Key Message: This study reviews the current understanding of HIVAN including its epidemiology, mechanism of disease, related genetic factors, clinical profile, and pathophysiologic effects of management options for patients.

There has been a significant push in recent years to deploy fundamental knowledge and methods of photochemistry toward biological ends. Photoreactive groups have enabled chemists to activate biological function using the concept of photocaging. By granting spatiotemporal control over protein activation, these photocaging methods are fundamental in understanding biological processes. Peptides and proteins are an important group of photocaging targets that present conceptual and technical challenges, requiring precise chemoselectivity in complex polyfunctional environments. This review focuses on recent advances in photocaging techniques and methodologies, as well as their use in living systems. Photocaging methods include genetic and chemical approaches that require a deep understanding of structure-function relationships based on subtle changes in primary structure. Successful implementation of these ideas can shed light on important spatiotemporal aspects of living systems.

Background Intravascular ultrasound (IVUS) provides endoluminal views and cross-sectional images of carotid arteries but lacks overview of vascular territory provided by angiography. Co-registration of IVUS with angiographic images may provide the potential to navigate both imaging modalities in a synchronous manner. The objective of this study is to evaluate the feasibility and accuracy of co-registering both imaging modalities in the carotid vasculature of the neck. Methods Fourteen patients with 15 cervical carotid artery lesions underwent angiography and subsequent treatment. In each case, an IVUS catheter was advanced to the target lesion and a reference angiography sequence was acquired. This was followed by an electrocardiography-triggered fluoroscopy sequence that was initiated upon IVUS catheter pullback. IVUS data collected during pullback were registered with fluoroscopy and evaluated for error and clinical usability. Results A total of 32 landmarks were identified that demonstrated reasonable agreement during IVUS–angiography co-registration. There was a mean registration error distance of 3.36 mm (SD 2.82 mm) between targets. The longitudinal extent and severity of the disease through the target segment could be easily evaluated after co-registration. Conclusion Semiautomatic tracking and co-registration of angiography and IVUS is a new technology and has the potential to increase the use of IVUS in carotid disease and to proivde the opportunity to optimize procedural outcomes.

Objectives This study aims to provide assessment tool on public elementary schools in Iligan City regarding corresponding level of knowledge of the educational workforce on Dengue Fever and Insecticide Treated Screen (ITS) program, perceptions and prevalent anti-dengue practices for which to support Anti-Dengue Advocacy Program. Methods The study utilized a descriptive research design. It involves general knowledge as to the causes and mode of transmission of dengue fever. It also determined the level of knowledge of ITS as a program on the following parameters distribution, coordinating programs, composition, level of protection, durability, effectivity, and usage as well as their perception regarding the usefulness, amount of information dissemination, level, prevalent practices benefits and possible barriers on the utilization of Insecticide Treated Screen (ITS) program. Results This study yields respondents have higher understanding on the concept of dengue, low understanding on Insecticide Treated Screen as a program and average understanding of ITS as a product. Probable barriers have been identified that limits the use of the product, which include ITS being prone to damage by the students. Conclusion This study implicates respondents are fairly knowledgeable of ITS as a product, it does not coincide with their knowledge of ITS as a program. Information dissemination is limited particularly on the subject of ITS being a program.

PurposeKatipuneros RPG: Bisperas ng Himagsikan (Katipuneros RPG: The Eve of the Revolution) is an immersive and gamified theater that engages its “audiences” in the initiation rites of a secret revolutionary movement in the Philippines in 1896. This descriptive qualitative research evaluates such experiential approach to learning history by investigating the experiences and insights of a group of students from the University of the Philippines Los Baños (UPLB), who participated in Katipuneros RPG.Design/methodology/approachTextual data obtained from the participants' reflection papers and focus group discussion transcripts were analyzed using open and axial coding.FindingsThree key themes summarized the participants' learning experiences as they went through the play, as follows: (1) Katipuneros RPG as an immersive, interactive and intrinsically motivating medium for learning history; (2) the knowledge, values and skills that served as facilitating factors for their learning and (3) the insights the participants gained about history and life in general.Practical implicationsThe research argues that in Katipuneros RPG, learners take on a more active role in studying history as the “teacher” vanishes in lieu of a learning system the allows students to think critically, reflect and collaborate. The approach integrates elements of development theater, immersive play and gamified learning, as well as the principles of constructivist, play-based and multi-sensorial learning.Social implicationsAs an innovative learning tool, it is a viable medium to teach history in the current socio-political context of the Philippines.Originality/valueThe study hopes to contribute to literature on pedagogical approaches for teaching and learning history through immersive environments.

A variety of surgical techniques for masculinizing chest wall reconstruction has been described. One well-described approach is the double incision subcutaneous mastectomy with free nipple grafts. There is little documentation available that clearly describes the healing process of free nipple grafts for patients and their caregivers. The nipple-areolar complex is harvested as a full-thickness skin graft. It is resized and repositioned to conform to a more masculine aesthetic. A bolster of nonadherent dressing is tied over the graft and left in position for 7 days as adherence, imbibition, and inosculation occur. The superficial layer of epidermis of the graft initially exfoliates as it is replaced by upwardly migrating cells of follicular epithelium. This is observed as a sloughing which can be disturbing to the patient although it is an expected progression of the healing process. Viable pink dermis will be seen underneath. Pigmentation of the nipple graft can take 3-9 months. Free nipple grafts are useful in cosmetic and reconstructive surgery of the breast. Additional documentation of the healing process provided here can help reassure the patient and their primary care providers.

Light is a uniquely powerful tool for spatiotemporal control of molecular structure, necessitating the development of new photocaging approaches. This communication describes the design, synthesis, and reactivity of two new photoreactive boronic acid reagents for backbone N-H modification and subsequent photocleavage.

Recurrence and drug resistance are major challenges in the treatment of acute myeloid leukemia (AML) that spur efforts to identify new clinical targets and active agents. STAT3 has emerged as a potential target in resistant AML, but inhibiting STAT3 function has proven challenging. This paper describes synthetic studies and biological assays for a naphthalene sulfonamide inhibitor class of molecules that inhibit G-CSF-induced STAT3 phosphorylation in cellulo and induce apoptosis in AML cells. We describe two different approaches to inhibitor design: First, variation of substituents on the naphthalene sulfonamide core allows improvements in anti-STAT activity and creates a more thorough understanding of anti-STAT SAR. Second, a novel approach involving hybrid sulfonamide–rhodium(II) conjugates tests our ability to use cooperative organic–inorganic binding for drug development, and to use SAR studies to inform metal conjugate design. Both approaches have produced compounds with improved binding potency. In vivo and in cellulo experiments further demonstrate that these approaches can also lead to improved activity in living cells, and that compound 3aa slows disease progression in a xenograft model of AML.

Several studies link maternal cardiovascular disease (CVD) to maternal and fetal morbidity and mortality. This study describes the profile of maternal, obstetric, and neonatal outcomes among pregnant women with CVD in a tertiary hospital in the Philippines. It identifies the clinical and sociodemographic variables associated with these outcomes. A single-center, retrospective analysis of pregnant women admitted for delivery at the Philippine General Hospital from 2015 to 2019 was performed. Of these patients, pregnant women with CVD were identified as the cohort for this study. Data on clinical and sociodemographic factors, maternal major adverse cardiovascular events, neonatal adverse clinical events, and obstetric complications were collected. Logistic regression analysis was performed to determine the odds ratio for the risk factors for small-for-gestational-age (SGA) babies and preterm birth. Among 30,053 delivery admissions in the Philippine General Hospital from 2015 to 2019, 293 (0.98%) pregnant women had CVD. Of the CVDs present in this cohort, congenital heart diseases (n = 119, 40.6%) were the most common, followed by rheumatic heart disease (n = 109, 37.2%). Maternal adverse events were rarely observed. Four women experienced symptomatic arrhythmias, two presented with worsening heart failure, three experienced thromboembolic events, and one had cerebrovascular infarction. There was no reported maternal death, cardiac arrest, shock, or acute renal failure. The majority (69.3%) of the women included in the study were delivered by spontaneous vaginal delivery and assisted vaginal delivery by vacuum or forceps; however, a significant portion of these women had undergone cesarean section. Almost all the study cohort delivered live births, with most neonates being delivered at 37–38 weeks gestational age (83.6%) and only 16.0% born preterm. However, a significant portion, a third of the neonates, were classified as having low birth weight. Around 17.4% of neonates born from gravidocardiac mothers were admitted neonatal intensive care unit. Conditions associated with preterm birth were low educational attainment, previous history of early neonatal death, maternal low ejection fraction, and abnormal maternal left ventricular geometry. The conditions associated with SGA babies were high gravidity and parity, a history of abortion/stillbirth, a history of previous cesarean section delivery, low ejection fraction, a history of multiple gestations, and higher BMI. In this cohort study, adverse maternal outcomes were rarely observed. CVD in pregnancy is associated with an increased risk of preterm birth and SGA babies. We identified certain maternal conditions and sociodemographic factors associated with these outcomes. Despite having CVD, our study cohort had no mortality from the pregnancy.

Heart failure (HF) is a chronic, debilitating condition associated with significant morbidity, mortality, and socioeconomic burden. Patients with end-stage HF (ESHF) who are not a candidate for advanced therapies will continue to progress despite standard medical therapy. Thus, the focus of care shifts from prolonging life to controlling symptoms and improving quality of life through palliative care ( PC). Because the condition and prognosis of HF patients evolve and can rapidly deteriorate, it is imperative to begin the discussion on end-of-life (EOL) issues early during HF management. These include the completion of an advance directive, do-not-resuscitate orders, and policies on device therapy and discontinuation as part of advance care planning (ACP). ESHF patients who do not have indications for advanced therapies or those who wish not to have a left ventricular assist device (LVAD) or heart transplant (HT) often experience high symptom burden despite adequate medical management. The proper identification and assessment of symptoms such as pain, dyspnea, nausea, depression, and anxiety are essential to the management of ESHF and may be underdiagnosed and undertreated. Psychological support and spiritual care are also crucial to improving the quality of life during EOL. Caregivers of ESHF patients must also be provided supportive care to prevent compassion fatigue and improve resilience in patient care. In this narrative review, we compare the international guidelines and provide an overview of end-of-life and palliative care for patients with ESHF.

Introduction Cranio-cervical artery dissection (CeAD) is a common cause of cerebrovascular events in young subjects with no clear treatment strategy established. We evaluated the incidence of major adverse cardiovascular events (MACE) in CeAD patients treated with and without stent placement. Methods COMParative effectiveness of treatment options in cervical Artery diSSection (COMPASS) is a single high-volume center observational, retrospective longitudinal registry that enrolled consecutive CeAD patients over a 2-year period. Patients were ≥ 18 years of age with confirmed extra- or intracranial CeAD on imaging. Enrolled participants were followed for 1 year evaluating MACE as the primary endpoint. Results One-hundred ten patients were enrolled (age 53 ± 15.9, 56% Caucasian, and 50% male, BMI 28.9 ± 9.2). Grade I, II, III, and IV blunt vascular injury was noted in 16%, 33%, 19%, and 32%, respectively. Predisposing factors were noted in the majority (78%), including sneezing, carrying heavy load, chiropractic manipulation. Stent was placed in 10 (10%) subjects (extracranial carotid n = 9; intracranial carotid n = 1; extracranial vertebral n = 1) at the physician's discretion along with medical management. Reasons for stent placement were early development of high-grade stenosis or expanding pseudoaneurysm. Stented patients experienced no procedural or in-hospital complications and no MACE between discharge and 1 year follow up. CeAD patients treated with medical management only had 14% MACE at 1 year. Conclusion In this single high-volume center cohort of CeAD patients, stenting was found to be beneficial, particularly with development of high-grade stenosis or expanding pseudoaneurysm. These results warrant confirmation by a randomized clinical trial.

Objectives. This study is a retrospective cohort that aims to describe the profile of orthopedic geriatric patients aged 60 years old and above with acute hip fractures occurring within one month of admission in the Philippine General Hospital managed by a multidisciplinary team approach. Methods. Data collection from the database was done to gather information regarding the patient profile, time to surgery, causes for delay in consultation, length of hospital stay, and follow-up rate, since this model was implemented. Results. Overall, we saw a decrease in the time from admission to surgery and a decrease in the length of hospital stay, when compared to previous data. Follow-up rates and compliance to maintenance medication are at 96% and 72% respectively. Conclusion. The implementation of a multidisciplinary approach and fracture liaison service presents us with favorable results in addressing hip fractures and osteoporosis.

Pose® Method gait retraining has been claimed to modify running form and prevent injury. This study examined the running biomechanics before and after Pose® Method gait retraining. Fourteen runners underwent a 4-week Pose® Method gait retraining program delivered by a certified coach. Paired t-tests were employed to compare vertical average (VALR) and instantaneous loading rates (VILR), lower limb kinematics, footstrike angle and trunk flexion in the sagittal plane before and after the training. Kinetically, there were no significant differences in the VALR (p= 0.693) and VILR (p= 0.782) before and after the training. Kinematically, participants exhibited greater peak hip flexion (p= 0.008) and knee flexion (p= 0.003) during swing. Footstrikeangle also reduced significantly (p= 0.008), indicating a footstrike pattern switch from rearfoot strike to midfoot strike. There was no significant difference in the trunk flexion in the sagittal plane after training (p= 0.658). After a course of Pose® Method gait retraining, runners demonstrated a footstrike pattern switch and some kinematics changes at the hip and knee joint during swing. However, injury-related biomechanical markers (e.g., VALR and VILR) and the trunk kinematics remained similar after training. Runners may consider other gait retraining programs for impact loading reduction.

This study compared five commercially available probiotics vis-à-vis antibiotic growth promotant (AGP) supplementation and absence of feed additive based on efficiency, intestinal morphometry, and energy digestibility in improving broiler chicken production. A total of 630 straight run (Cobb) day-old broiler chicks were distributed to seven treatments following a completely randomized design, with ten replicates per treatment and nine birds per replicate per cage. Dietary treatments consisted of basal diet in combination with the following: without probiotics and AGP supplementation (treatment 1); 75 ppm each of chlorotetracycline (CTC) and Zn bacitracin (treatment 2); probiotic A, Bacillus subtilis (treatment 3); probiotic B, Bacillus subtilis (treatment 4); probiotic C, Enterococcus faecium (treatment 5); and probiotic D, Bacillus subtilis (treatment 6); probiotic E, Enterococcus faecium, Bifidobacterium spp., Pediococcus spp., and Lactobacillus spp. (treatment 7). At day 42, energy digestibility was determined by fasting three randomly selected birds from each treatment for 12 h and then subjecting them to their corresponding dietary treatments. Excreta were collected and pooled after 24 h of feeding. Pooled excreta were weighed, oven-dried, and subjected to energy analyses after 3-day collection. Apparent total tract metabolizable energy was then computed. At day 47, three birds were randomly selected per treatment for intestinal morphometry (villi height and crypt depth) of the duodenum, jejunum, and ileum. Dietary supplementation using probiotics showed no significant effect on overall body weight, weight gain, feed consumption, feed efficiency, dressing percentage, mortality, harvest recovery, carcass quality parameters (e.g., meat to bone ratio and abdominal fat content), intestinal morphometry, and energy digestibility. Birds under treatment 7 (basal feed + probiotic E) generated the highest income over feed and chick cost.

A stable gaze is necessary to optimize visual conditions during running. Head accelerations generally remain stable when looking in front; however, it is unclear if this response is similar when the head is turned sideways, and whether other adaptive strategies are present to maintain this stability. The purpose of this study, therefore, was to examine whether runners maintained stable head accelerations while gazing at fixed targets in front and to their sides. The authors collected biomechanical data from 13 runners as they directed their gaze to visual targets located in front, 45°, and 90° to the sides at a random sequence. Vertical head and tibial accelerations were the primary outcome measures, while vertical loading rate, footstrike angle, contact time, stride length, and stride rate were the secondary measures. A reduction in vertical head accelerations was found in the rightmost direction (P = .04), while an increase in vertical tibial accelerations was found on the same direction (P = .02). No other significant differences were observed for the other variables. The results of this study suggest that the tibia accommodated the increased shock to maintain head stability.

Introduction The link between cannabis use and erectile dysfunction remains unclear. Moreover, the effect of cannabis in tandem with current Western dietary habits is an area in male sexual health that has yet to be explored. This study seeks to investigate the impact of diet and cannabis on penile health in an animal model. Aim To determine the effects of diet and oral cannabis extract on fibrosis and oxidative stress within the corpora cavernosa of mice. Methods This is a pilot animal study in which groups of 2-month old C57BL/6J male mice were fed a normal chow diet (NCD) or high-fat diet (HFD) daily and treated with or without either MJ or THC extract for 2 months. After euthanization, mouse penises were isolated and processed for immunohistochemical studies to determine: (i) smooth muscle cell to collagen content, (ii) myofibroblast proliferation, and (iii) anti-oxidative activity. Main Outcome Measures Quantitative assessment of immunohistochemical markers of fibrosis and oxidative stress within the corpora cavernosa of mice fed a high-fat diet in combination with either oral marijuana (MJ) or Δ-9-tetrahydrocannabinol extract (THC). Results The combination of HFD with MJ resulted in: (i) a decrease in the smooth/collagen ratio in the corpora cavernosa, (ii) an increase in alpha-smooth muscle actin expression in the tunica albuginea compatible with myofibroblast proliferation, and (iii) a decrease in heme oxygenase 1 expression indicating an increase in oxidative stress. Significant histological changes were not observed in the HFD + THC group. Conclusions HFD combined with oral MJ extract led to structural alterations in erectile tissue that are associated with accelerated corporal fibrosis. However, the addition of THC to the diet did not exacerbate histological changes within the corpora. Further studies are warranted to elucidate the discrepant effects between MJ and THC in order to optimize the therapeutic potential of cannabis and minimize its adverse effects on penile health.

OBJECTIVE: A group of established aesthetic physicians sought to develop treatment guidelines for assessing Asian face morphologies that reflect accurate and current beauty standards across Asia. DESIGN: Physicians completed surveys, debated, and voted on their clinical strategies and developed an alternative simplified visual tool of assessment (SVAT) that discerns between country variations in genetic and ideal morphotypes. SETTING: Electronic and paper surveys were followed by consensus debates and voting. PARTICIPANTS: Established aesthetic physicians practicing regularly on Asian patients. MEAUSUREMENTS: A clinically applicable SVAT was developed, which considered facial index, mid-face projection, upper and lower face shape, submalar contour, nose length and dorsal height, eye shape and brow shape, proportion of lips-to-lower face and ratio of upper-to-lower lip, and chin shape. RESULTS: For facial shape change, physicians always assessed the horizontal thirds, facial symmetry, and lip-chin complex profile, and also analyzed overall face shapes and Ogee curves. Criteria for creating oval-shaped faces was also defined and included treating indications, such as loss of angularity and bilateral masseter muscle hypertrophy, narrow jawlines, and longer and wider foreheads. Critical differences and similarities in country-specific aesthetic preferences, treatment requests, and considerations or strategies were uncovered, including the inadequacy of assessing overall peripheral facial shapes. CONCLUSION: This consensus establishes the assessment and treatment criteria for achieving ideal shapes for Asian patients. Specific descriptors are affected by variations; therefore, we present the visual criteria for Asian facial morphotypes. We hope that physicians new to treating Asian patients can use this clinical information to improve their practice.

Most Frequency Modulation broadcast stations are stacking antennas in order to extend the radiation of energy and propagation of signal. This paper presents a design of an optimized shunt-fed FM broadcast antenna also with a circular polarity for weather infiltration and no constraint of the orientation of transmitter and receiver. The method primarily includes the optimization of the relative spacing of dipoles to exhibit a circular azimuth pattern, axial ratio requirement for circularly polarized antenna and the gain in far field. The circular pattern shaping method uses a uniform linear array of two elements and the principle of array multiplication. Two control factors are being utilized to shape the radiation pattern as follows: the relative distance spacing, separating the two elements and their excitation phase difference. In the optimization process, a more accurate and consistent solutions like Global Response Surface Method was used. GRSM yields the most optimal objective value and it follows to determine the optimum values of the parameters in the current design. Results show that the pattern produced by the proposed method can resemble a circular form and exhibited an increased in antenna gain as compared to the commonly used shunt-fed slanted V dipole antenna. The results of the optimized design of a FM antenna and its characteristics are validated using an antenna simulation software.

SummaryWe introduce a novel structural variant calling pipeline (BioGraph) that leverages a read compression and indexing format to discover alleles, assess their supporting coverage, and assign useful quality scores. To evaluate BioGraph’s performance, we run five sequencing replicates of the individual HG002 through the BioGraph variant calling pipeline, as well as two other short-read sv-calling pipelines. BioGraph detects the GIAB benchmark SVs at a peak sensitivity of ≈59% compared to ≈42% sensitivity from the other pipelines. The overall precision of BioGraph is lower than other pipelines (≈81% and ≈90%, respectively), however, adjusting for quality score, BioGraph calls were sensitive to a greater number of SV calls given the same false discovery rate compared to the other pipelines. Cumulatively ≈77% of GIAB benchmark SVs are discovered by BioGraph in at least one replicate. After merging discovered calls and running BioGraph Coverage to create a squared-off project-level VCF, we find ≈90% percent of discovered true positive alleles have at least 5x coverage in all replicates, thus increasing per-replicate recall of alleles having at least 1x coverage to ≈76.9%.

Introduction: Cranio-Cervical Artery Dissection (CeAD) is a relatively common cause of cerebrovascular event in young subjects for which no clear treatment strategy is established. We evaluated the incidence of major adverse cardiovascular events (MACE) in CeAD patients treated with and without stent placement. Methods: COMParative effectiveness of treatment options in cervical Artery diSSection (COMPASS) is a single high-volume center prospective longitudinal registry that enrolled consecutive CeAD patients over a 2-year period. Patients were ≥18 years of age with confirmed extra- or intracranial CeAD on imaging. Enrolled participants were followed for 1-year evaluating MACE as the primary end-point. Results: One-hundred eleven patients were enrolled (age 53 ± 15.9, 56% Caucasian, 50% male, BMI 28.9 ± 9.2). Grade 1, 2, 3, and 4 blunt vascular injury noted in 16%, 33%, 19%, and 32%, respectively. Forty-percent of dissections were due to known trauma. A predisposing factor was noted in the majority (78%), including violent sneezing, carrying heavy load, sports/recreation activity, chiropractic manipulation, and abrupt/prolonged head rotation. Stent was placed in 11 (10%) subjects (extracranial carotid n=8; intracranial carotid n=2; extracranial vertebral n=2) at the physician’s discretion. Similar to the CADISS trial, there was no significant difference between antiplatelet/anticoagulant groups in terms of MACE. Stented patients experienced fewer MACE than non-stented patients (log rank p=0.1), as depicted in the Kaplan-Meier curve (Figure 1). The CeAD patients with stents did not experience any MACE events in the 1-year follow-up. Conclusion: In this single high-volume center cohort of CeAD patients, we report a promising strategy of MACE prevention using stent placement. This data will help sample size estimation for a future randomized trial.

Side-chain modifications that respond to external stimuli provide a convenient approach to control macromolecular structure and function. Responsive modification of backbone amide structure represents a direct and powerful alternative to impact folding and function. Here, we describe a new photocaging method using histidine-directed backbone modification to selectively modify peptides and proteins at the amide N-H bond. A new vinylogous photocleavage method allows photorelease of the backbone modification and, with it, restoration of function.

We previously reported on the lack of utility of the 1 mg overnight dexamethasone (DEX) test in mild and/or periodic Cushing’s syndrome, as most patients with the condition suppressed to 1 mg DEX. It is possible that a lower dose of DEX as part of an overnight DEX test might be able to distinguish between mild and/or periodic Cushing’s syndrome and those without the condition. The objective of the current study is to determine the sensitivity and specificity of a 0.25 mg overnight DEX suppression test, the standard 1 mg overnight DEX suppression test, and the two-day low-dose (Liddle test) DEX suppression test with and without correction for DEX levels in patients evaluated for mild and/or periodic Cushing’s syndrome. Thirty patients determined to have Cushing’s syndrome by biochemical testing and 14 patients determined not to have the condition had the 0.25 mg and standard 1 mg overnight DEX suppression test and the two-day low-dose DEX suppression tests. Our results show that morning serum cortisol and cortisol/DEX ratios following an overnight dexamethasone suppression test were similar in patients with Cushing’s syndrome and those not having Cushing’s syndrome. However, a morning cortisol value above 7.6 μg/dl following a dose of DEX of 0.25 mg was found in 12 patients with Cushing’s syndrome and none in those not having Cushing’s syndrome, suggesting that a high cortisol value after this low dose of dexamethasone can indicate that further testing for Cushing’s syndrome is warranted. Our data suggest that the traditional 1 mg overnight or the 2 mg/2 day DEX suppression testing should no longer be used as a screening test in patients who could have mild and/or periodic Cushing’s syndrome, while the 0.25 mg dose of DEX may pick up some patients with mild Cushing’s syndrome.

Objective: To investigate the distribution and aerosolized particle counts generated during mastoidectomy, we utilized low-cost and locally available material and developed a plastic tent creating a barrier between the health care workers (HCW) and patient. Methods: The barrier tent is a clear plastic bag attached to the microscope lens. The tent is draped and tucked underneath the patient’s head and upper torso with surgeon’s arms also passed underneath and secured with clamps. We demonstrated the area of greater contamination by spread of droplet particles and bone dust after drilling using fluorescent dye. Particle counts inside and outside the barrier was determined and then comparison with and without the tent after drilling of cadaveric temporal bone were also done. Results: The area with highest concentration of contamination (“hot zone”) was noted opposite the surgeon’s hand drill which is dependent on the operator’s handedness. Other hot zones noted were opposite the operator and on the operator’s side. Particle determination of aerosol size 0.3 and 2.5µm inside the barrier tent were at peak levels after bone drilling procedure. Then a significant drop of particle counts was noted at 2 minutes after drilling was stopped with flattening observed at 8 minutes. Conclusion: Our experimental results suggest that the improvised barrier tent can be effective in mitigating aerosols generated during mastoid surgery and may serve as an added protection for the operating room team.

Background Relapse free survival of pediatric AML remains only 60%. Current standard myelosuppressive therapy has been maximized, so novel therapies with minimal toxicities are needed to improve outcomes. Previously, we found atovaquone (AQ), an FDA-approved drug that treats pneumocystis jiroveci pneumonia (PJP), reduces AML burden - by suppressing oxidative phosphorylation (OXPHOS) - in xenograft mice. Clinically achievable concentrations of AQ for anti-PJP are 40-80µM, but the anti-leukemia effects are observed as low as 10µM (Stevens et al, Bld Adv, 2019). This makes AQ an ideal drug to incorporate into AML treatment. AQ is a daily administered oral medication, and plasma levels depend on patient compliance, absorption, and entero-hepatic recirculation, which can be compromised due to the patient population and adverse events (AE) of chemotherapy. Here we investigated the feasibility of incorporating AQ into standard pediatric AML treatment. Methods Patients with de novo AML were enrolled at two children's hospitals in the USA. Daily administration of AQ at established PJP prophylaxis dosing was combined with standard chemotherapy for AML, based on the Medical Research Council (MRC) backbone of cytarabine 100mg/m2 q12h x 10 days, and daunorubicin 50mg/m2/dose on days 1, 3, and 5. As it was unclear if our AQ dosing would provide adequate PJP prophylaxis, it was left to provider discretion to give additional PJP protection. AQ compliance, AEs (per NCI CTCAE v5), parent/caregiver ease of administration score (scale: 1-5, 1=very difficult, 5=very easy to administer) and peripheral blood/bone marrow pharmacokinetics (PK) were collected during Induction 1. Real time AQ plasma concentration results were not provided. To address feasibility of achieving adequate levels, all gastrointestinal (GI) AEs ≥ grade 2 were collected, in addition to grade 4 or greater AEs. Patients who took at least 85% of planned doses and missed less than 2 consecutive doses of AQ were eligible for analyses. Correlative biology studies assessed AQ induced apoptosis at 30uM, effects on OXPHOS and relevant signaling activities. Patient derived xenografts (PDX) were established and treated with AQ. This trial is registered with ClinicalTrials.gov (NCT03568994). Results A total of 26 pediatric AML patients enrolled (ages 8 months - 19.7 years, mean 10.7 years); 24 patients were evaluable for this study. Two patients had Grade ≥ 3 GI toxicities that prohibited enteral administration so they were excluded from AQ PK and ease of administration analyses. We found that 14/24 (58%) patients achieved plasma levels above the target anti-leukemia concentration (10µM) by day 11. At the end of induction, 19/24 (75%) patients achieved plasma levels above 10µM, but only 7/24 (29%) patients achieved adequate levels for PJP prophylaxis (40µM). Only 1 patient achieved levels above 40µM throughout the trial [FIG A]. Mean ease of administration score was 3.8. For the youngest patients (x ≤ 2.6years), the average score was 3.4 which was not significantly different from older patients (ANOVA, p > 0.05) [FIG B]. Ease of administration scores showed no association with plasma levels (Pearson's correlation, p > 0.05). Finally, correlative biology studies in patient samples demonstrated robust AQ-induced apoptosis, OXPHOS suppression, and prolonged survival in a PDX model receiving AQ [FIG C]. Conclusion Our data demonstrate the feasibility of combining AQ with traditional chemotherapy for pediatric AML. Patients of all ages were able to tolerate AQ and no AEs were attributable to AQ administration. The target anti-leukemic concentration of AQ in the plasma (> 10uM) was frequently achieved, but concentrations of > 40uM at standard dosing were rare. Low plasma levels of AQ did not correlate with the presence of GI related AEs or weight loss, so plasma levels should be monitored to ensure sufficient PJP prophylaxis. Our correlative biology results support suppression of OXPHOS as the primary mechanism of action by which AQ exerts its anti-leukemia effect, and AQ may be an active anti-leukemia agent for pediatric AML patients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

The present study was conducted to evaluate the in vivo efficacy of pumpkin seeds as an alternative natural anthelmintic for chickens. Ninety Philippine Jolo native chickens of mixed sexes, aged 4?5 months and weighing 1?2 kg, were randomly distributed into three treatment groups with 30 chickens per group. Control group A was fed basic mash feed, group B received feed mixed with ground pumpkin seeds (2 g/bird per day), and group C received mebendazole-medicated feed (30 mg/kg body weight). Fifteen randomly selected chickens from each group were euthanized and necropsied before treatment, and the remaining fifteen in each group were euthanized and necropsied at 3 days after the end of the treatment. Gastrointestinal worm and fecal egg counts were determined. Three genera of helminths were identified from necropsy: Ascaridia spp., Heterakis spp., and Raillietina spp. Results indicate that compared to mebendazole, pumpkin seed was moderately effective in reducing worm counts of Ascaridia spp. and Raillietina spp., marginally active in reducing worm counts of Heterakis spp., and moderately effective in reducing egg output of the worms. The results suggest that pumpkin seed has the potential to be used as an alternative anthelmintic for chickens.

S-Arylation of cysteine residues is an increasingly powerful tool for site-specific modification of proteins, providing novel structure and electronic perturbation. The present work demonstrates an operationally-simple cysteine arylation reaction 2-nitro-substituted arylboronic acids, promoted by a simple nickel(ii) salt. The process exhibits strikingly fast reaction rates under physiological conditions in purely aqueous media with excellent selectivity toward cysteine residues. Cysteine arylation of natural proteins and peptides allows attachment of useful reactive handles for stapling, imaging, or further conjugation.

Article-at-a-Glance Background Health care workers (HCWs) can acquire and transmit influenza to their patients and coworkers, even while asymptomatic. The U.S. Healthy People 2010 initiative set a national goal of 60% coverage for HCW influenza vaccination by 2010. Yet vaccination rates remain low. In the 2008–2009 influenza season, Flushing Hospital Medical Center (FHMC; New York) adopted a "push/pull" point-of-dispensing (POD) vaccination model that was derived from emergency preparedness planning for mass vaccination and/or prophylaxis to respond to an infectious disease outbreak, whether occurring naturally or due to bioterrorism. Launch of the HCW Vaccination Program In mid-September 2008, a two-week HCW vaccination program was launched using a sequential POD approach. In Push POD, teams assigned to specific patient units educated all HCWs about influenza vaccination and offered on-site vaccination; vaccinated HCWs received a 2009 identification (ID) validation sticker. In Pull POD, HCWs could enter the hospital only through one entrance; all other employee entrances were "locked down." A 2009 ID validation sticker was required for entry and to punch in for duty. Employees without the new validation sticker were directed to a nearby vaccination team. After the Push/Pull POD was completed, the employee vaccination drive at FHMC was continued for the remainder of the influenza season by the Employee Health Service. Results Using this model, in two days 72% of the employees were reached, with 54% of those reached accepting vaccination. Conclusions This model provides a novel approach for institutions to improve their HCW influenza vaccination rates within a limited period through exercising emergency preparedness plans for infectious disease outbreaks.

A selection of individuals from the biotech ecosystem give their views on the challenges facing the sector over the coming years.

OBJECTIVE: The study explored whether baseline individual differences in executive function (EF) affect the relation between elevations in internal states and subsequent likelihood of lapsing from a dietary prescription. METHOD: Participants were 189 adults with overweight/obesity in a behavioral weight loss treatment who completed a neuropsychological EF task at intake and a two-week EMA protocol measuring internal states and dietary lapses at start of treatment. RESULTS: Generalized estimating equations found relations between momentary elevations in tiredness (b=.06, p=.01) and deprivation (b=.06, p=.047) and subsequent likelihood of lapsing were more robust for participants with lower EF, whereas the relation between momentary elevations in boredom and subsequent likelihood of lapsing (b=.04, p=.03) was more robust for participants with higher EF. DISCUSSION: Results provide support for EF impacting the relation between elevations in internal states and likelihood of dietary lapse, informing the development of personalized behavioral weight loss treatments.