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PURPOSE: This study aimed to describe health care use by type of health providers and care settings visited by children with spina bifida (SB) and to compare this use between children with and without a shunt. METHODS: Health care use data were extracted from a larger study on the health and functioning of children with SB aged 3–6 years. The present study focused on the medical information subsection of a parent-reported survey related to SB care, general care, specialty care (e.g., neurosurgery), emergency care, and complications related to SB and shunts. RESULTS: Parents of 101 children with SB participated. Most of the children were male with myelomeningocele and had a shunt. They visited a health care provider for SB care an average of 7.4 times and a specialist an average of 11.9 times in the previous 12 months. Most visited a multidisciplinary clinic for SB-related care and a private physician’s office for general care. Children with a shunt had more SB-related medical visits, more visits to a specialist, and a greater number of different types of specialists than those without it. Frequency of emergency room visits did not differ between the two groups. Health providers informed parents about headaches, vomiting, and fever as signs of complications, and some parents did report shunt-related complications. CONCLUSION: SB is a complex medical condition requiring that children receive medical care from various medical specialists, especially for children with a shunt. Findings on health care use suggest high levels of monitoring and care coordination that parents navigate to care for their child.

Purpose of ReviewSince 2007, voluntary medical male circumcision (VMMC) programs have been associated with substantially reduced HIV incidence across 15 prioritized countries in Eastern and Southern Africa. Drawing on the programmatic experience of global VMMC leaders, this report reviews progress made in the first 15 years of the program, describes programmatic and research gaps, and presents considerations to maximize the impact of VMMC.Recent FindingsOverall, key programmatic and research gaps include a lack of robust male circumcision coverage estimates due to limitations to the data and a lack of standardized approaches across programs; challenges enhancing VMMC uptake include difficulties reaching populations at higher risk for HIV infection and men 30 years and older; limitations to program and procedural quality and safety including variations in approaches used by programs; and lastly, sustainability with limited evidence-based practices. Considerations to address these gaps include the need for global guidance on estimating coverage, conducting additional research on specific sub-populations to improve VMMC uptake, implementation of responsive and comprehensive approaches to adverse event surveillance, and diversifying financing streams to progress towards sustainability.SummaryThis report’s findings may help establish a global VMMC research and programmatic agenda to inform policy, research, and capacity-building activities at the national and global levels.

Arecaceae (Palmae) is an ecologically and economically important family characteristic of the vegetation in tropical and subtropical regions, with at least 125 species occurring in the Philippines, most of them endemics. We monitored changes in stem density, mortality and recruitment of palm populations for twelve years within a 16-ha Forest Dynamic Plot located in northern Luzon, the Philippines. We recorded a total of 4,060 stems, dominated by Pinanga insignis (46%) and P. maculata (34%), followed by Caryota cumingii (19%), and a few stems (Orania decipiens and Areca whitfordii. Half (51%) of the initially recorded stems in the 2004 census died after the 2016 census, while an additional 1,086 (36%) stems were recorded in the same period. Overall palm population declined with the decreasing populations of P. insignis and P. maculata due to higher mortality than recruitment during the 2004–2010 and 2010–2016 census intervals while C. cumingii population increased in the same period. Regarding topographic position, the stem density of P. maculata is higher in valleys > midslopes > ridges across censuses, higher in valleys and midslopes than ridges for C. cumingii across censuses, and higher in midslopes than valleys for P. insignis during the 2016 census only. Mortality and recruitment were weakly observed along topographic positions between species and across censuses. Our result presents how palm population may change within twelve years with population trends differing between species, indicating the importance of palms in understanding the population dynamics of plant communities in a fast-changing environment.

BACKGROUND: South Texas has higher TB disease incidence than much of the United States. We evaluated a multi-site South Texas interferon-gamma release assay (IGRA)-based testing and latent TB infection (LTBI) treatment program targeting high-risk populations.METHODS: Number of IGRA tests, test results, LTBI confirmation, and treatment outcomes were collected over 2.5 years. Sixteen semi-structured patient interviews and 10 site-based focus groups were conducted with providers, nurses, and administrators. Grounded theory identified themes associated with successful outcomes.RESULTS: Of 9,050 IGRA tests, 687 (8%) were positive; 340 (49%) confirmed as LTBI; 191 initiated LTBI treatment; and 130 (68% of initiators) completed treatment. Patient barriers to treatment completion included lack of knowledge, misconceptions, and treatment toxicities. Clinic staff concurred that toxicity was a barrier to treatment and requiring new processes with limited resources were implementation barriers.CONCLUSIONS: Over 9,000 patients were screened with a high prevalence of IGRA positivity, but confirming LTBI, initiating, and completing treatment were challenging. Qualitative evaluation supports low literacy patient education on LTBI and toxicities and expanded support for process implementation and provider training. These findings highlight challenges at all levels of the LTBI care cascade and provide patient, staff, and provider perspectives on implementation of these programs.

Kanban is a productivity system used to help manage workflow at different stages of knowledge work in the office. This paper aims to explore Kanban’s impact on the productivity among selected STEM Senior High School Students of De La Salle University Integrated School. It also examines the effects of sex and grade level on the usage of Kanban and productivity. An online survey questionnaire will be administered to a purposive sample of 70 SHS students. Data from the online survey will be subjected to data analysis using the Microsoft Excel spreadsheet program. Results show that females updated their Kanban more frequently as compared to males. The majority stated that Kanban helps them visualize their ongoing tasks. Consequently, it was seen that although female students had a higher frequency, male students had a higher perception of productivity. From this, it can be implied that higher frequency does not necessarily mean higher perceptions of productivity. In terms of frequency and GWA, from the data, there was no seen relationship between the two variables as the frequency did not affect the GWA. With that, it is recommended to examine the difference in productivity between the face-to-face and online classes to see whether the pandemic has influenced the productivity of students.

The maintenance of redox and metabolic homeostasis is integral to embryonic development. Nuclear factor erythroid 2-related factor 2 (NRF2) is a stress-induced transcription factor that plays a central role in the regulation of redox balance and cellular metabolism. Under homeostatic conditions, NRF2 is repressed by Kelch-like ECH-associated protein 1 (KEAP1). Here, we demonstrate that Keap1 deficiency induces Nrf2 activation and postdevelopmental lethality. Loss of viability is preceded by severe liver abnormalities characterized by an accumulation of lysosomes. Mechanistically, we demonstrate that loss of Keap1 promotes aberrant activation of transcription factor EB (TFEB)/transcription factor binding to IGHM Enhancer 3 (TFE3)-dependent lysosomal biogenesis. Importantly, we find that NRF2-dependent regulation of lysosomal biogenesis is cell autonomous and evolutionarily conserved. These studies identify a role for the KEAP1–NRF2 pathway in the regulation of lysosomal biogenesis and suggest that maintenance of lysosomal homeostasis is required during embryonic development.

Immune-mediated anti-tumoral responses, elicited by oncolytic viruses and augmented with checkpoint inhibition, may be an effective treatment approach for glioblastoma. Here in this multicenter phase 1/2 study we evaluated the combination of intratumoral delivery of oncolytic virus DNX-2401 followed by intravenous anti-PD-1 antibody pembrolizumab in recurrent glioblastoma, first in a dose-escalation and then in a dose-expansion phase, in 49 patients. The primary endpoints were overall safety and objective response rate. The primary safety endpoint was met, whereas the primary efficacy endpoint was not met. There were no dose-limiting toxicities, and full dose combined treatment was well tolerated. The objective response rate was 10.4% (90% confidence interval (CI) 4.2–20.7%), which was not statistically greater than the prespecified control rate of 5%. The secondary endpoint of overall survival at 12 months was 52.7% (95% CI 40.1–69.2%), which was statistically greater than the prespecified control rate of 20%. Median overall survival was 12.5 months (10.7–13.5 months). Objective responses led to longer survival (hazard ratio 0.20, 95% CI 0.05–0.87). A total of 56.2% (95% CI 41.1–70.5%) of patients had a clinical benefit defined as stable disease or better. Three patients completed treatment with durable responses and remain alive at 45, 48 and 60 months. Exploratory mutational, gene-expression and immunophenotypic analyses revealed that the balance between immune cell infiltration and expression of checkpoint inhibitors may potentially inform on response to treatment and mechanisms of resistance. Overall, the combination of intratumoral DNX-2401 followed by pembrolizumab was safe with notable survival benefit in select patients (ClinicalTrials.gov registration: NCT02798406).

Alcoholic beverages have long been one of the most popular commodities. They have been mass-produced worldwide because of their popularity and demand. On a survey by Statista in 2021, alcohol consumption is projected to increase in the Philippines. Thus, the popularity of numerous alcoholic beverages piqued the curiosity of consumers and researchers alike. This study used conjoint analysis that aims to have a better understanding of consumer preferences for alcohol consumption among youths. Additionally, the study considered the following attributes: (1) type of alcoholic beverage, (2) oral sensation, (3) flavor, (4) origin, (5) color, and (6) price. Results revealed that the product’s price is the most crucial attribute influencing consumer preferences by 26.311%, followed by the type of alcoholic beverage with an importance score of 26.237%. The least considered attribute is the product’s color, having an importance score of 7.790%. These were supported by two statistical tests, the Pearson’s Correlation Test and Kendall’s Tau Test, which both obtained a value higher than 0.8. Managerial implications were presented in the study to help provide strategies and development for alcoholic beverage distribution in the Philippines based on the findings of this study, which relate to young consumers.

This report presented the longitudinal optical coherence tomography angiography (OCTA) findings in a patient with malignant hypertension choroidopathy. An 87-year-old woman presented with acute unilateral central vision loss in the setting of hypertensive emergency. Spectral domain optical coherence tomography showed massive serous macular detachment. OCTA revealed extensive flow loss in the neuroretina and choriocapillaris. With blood pressure (BP) normalization and without any ocular intervention, visual acuity recovered on subsequent visits. Flow loss in the neuroretinal capillaries persisted, but significant improvement in the perfusion of the choriocapillaris was observed. This case demonstrates extensive choriocapillaris flow loss in the acute phase of malignant hypertension, and a temporal relationship between BP normalization, improvement of choriocapillaris perfusion, and decrease of subretinal fluid, providing additional insight into the pathophysiology of this life- and sight-threatening systemic condition.

Neural circuitry is typically modulated via invasive brain implants and tethered optical fibres in restrained animals. Here we show that wide-field illumination in the second near-infrared spectral window (NIR-II) enables implant-and-tether-free deep-brain stimulation in freely behaving mice with stereotactically injected macromolecular photothermal transducers activating neurons ectopically expressing the temperature-sensitive transient receptor potential cation channel subfamily V member 1 (TRPV1). The macromolecular transducers, ~40 nm in size and consisting of a semiconducting polymer core and an amphiphilic polymer shell, have a photothermal conversion efficiency of 71% at 1,064 nm, the wavelength at which light attenuation by brain tissue is minimized (within the 400-1,800 nm spectral window). TRPV1-expressing neurons in the hippocampus, motor cortex and ventral tegmental area of mice can be activated with minimal thermal damage on wide-field NIR-II illumination from a light source placed at distances higher than 50 cm above the animal's head and at an incident power density of 10 mW mm-2. Deep-brain stimulation via wide-field NIR-II illumination may open up opportunities for social behavioural studies in small animals. Ministry of Education (MOE) Nanyang Technological University G.H. acknowledges startup support from the Wu Tsai Neurosciences Institute of Stanford University, a National Institutes of Health (NIH) Pathway to Independence Award (National Institute on Aging 5R00AG056636-04), a National Science Foundation (NSF) CAREER Award (2045120), the Rita Allen Foundation Scholars Program, a gift from the Spinal Muscular Atrophy (SMA) Foundation, and seed grants from the Wu Tsai Neurosciences Institute and the Bio-X Initiative of Stanford University. X.W. acknowledges support from the Stanford Graduate Fellowship. K.S.O. acknowledges the NeuroTech training programme supported by the National Science Foundation under Grant No. 1828993. K.P. thanks Nanyang Technological University (startup grant: M4081627) and Singapore Ministry of Education Academic Research Fund Tier 2 (MOE2016-T2-1-098) for financial support.

Nuclear power plant (NPP) is currently considered as one of the most reliable power sources. However, 182 of them are considered decommissioned and inactive including the one in Bataan, Philippines. The aim of this study was to investigate the acceptance of the reopening of Bataan Nuclear Power Plant (BNPP) by integrating the Theory of Planned Behavior and Protection Motivation Theory. A total of 815 Filipinos answered an online questionnaire which consisted of 37 questions. The Structural Equation Modeling (SEM) indicated that knowledge towards nuclear power plants was the key factor in determining people's acceptance towards NPP reopening. In addition, knowing the benefits would lead to positive perceived behavioral control (PBC) and attitude towards intention. Results showed that PBC and attitude are mediators towards the acceptance of people regarding the reopening of BNPP. If an individual's knowledge gravitates towards the perceived risk, then this can lead to the negative acceptance of the NPP reopening. On the other hand, if an individual's knowledge gravitates towards the perceived benefits, then this will lead to positive acceptance. This study is the first study that explored the acceptance of the reopening BNPP. Finally, the study's model construct would also be very beneficial for researchers, government, and even private sectors worldwide.

To determine the relationship between macular microvascular abnormalities on optical coherence tomography angiography and silent cerebral infarctions (SCIs) on cerebral magnetic resonance imaging in sickle cell disease.Patients (age18 years old) from our previous pediatric sickle cell disease study cohort who had prior optical coherence tomography angiography and brain magnetic resonance imaging were identified. Brain magnetic resonance imaging images were compared with macular optical coherence tomography angiography scans to identify macular vascular density differences between patients with SCI and without SCI.Sixty-eight eyes from 34 patients who underwent optical coherence tomography angiography were evaluated, of whom 28 eyes from 14 patients met the inclusion criteria for this study. Eight patients (57%) with SCI and 6 patients (43%) without SCI were identified. The mean age (17 years in SCI and 16.3 years in non-SCI) was comparable between groups. There was no statistically significant difference in systemic complications. Deep capillary plexus vessel density was lower in the temporal quadrant in patients with SCI (49.3% vs. 53.7%, P = 0.014).Patients with SCI were found to have lower vessel density in the deep capillary plexus compared with those without SCI. This finding suggests that deep capillary plexus vessel density may have utility as an imaging biomarker to predict the presence of SCI.

The pandemic has caused all of the programs that are offered in primary schools to be interrupted. Evaluating the student’s learning at this level is essential because education development throughout the epidemic is critical, as there was no other educational alternative available during the pandemic. This study examines the use of deep learning neural network (DLNN) to evaluate the parameters influencing primary school students’ online learning experiences during the COVID-19 pandemic. The researchers considered this issue since primary students’ online learning experiences needed more attention. To carefully analyze the relationships between the parameters of primary students’ learning experience, an online questionnaire was utilized, subject to parents’ participation. A total of 385 Filipino elementary school students were selected and surveyed using a purposive sampling method. Participants in this research ranged in age from seven to thirteen and were supervised by their parents or legal guardians. The result of the study showed that open communication, social presence, design and organization, and facilitation had the most impact on predicting students’ experiences with online education, having a high accuracy from DLNN of 96.12%. This demonstrates the significance of open communication, draws attention to the importance of helping students feel welcomed and appreciated, and demonstrates the influence that instructors have on the overall positive learning experiences of their students. Finally, the findings of this study gave a strong framework and clear conclusions that both schools and the government’s education department could use to improve the way primary education is taught online across the country. Finally, the results and findings of this study could be applied and extended to other related education studies worldwide.

The cGAS–STING axis plays an important role in protecting higher organisms against invading pathogens or cancer by promoting the production of cytokines and interferons.

Endogenous endophthalmitis caused by Aspergillus species tends to be very aggressive, often leading to devastating visual outcomes. Historically, intravitreal amphotericin injections have played a central role in management, but with variable visual outcomes and a risk of toxicity. Limited reports suggest that use of intravitreal voriconazole is a safe and efficacious alternative, though these cases were treated with only few intravitreal injections. Here, we report a case of bilateral endogenous Aspergillus endophthalmitis treated with 8 intravitreal voriconazole injections in the right eye and 11 in the left eye with good best-corrected final visual outcome (20/50 right eye and 20/40 left eye).

The electromechanical properties of monolayer 1-T NiTe

Jollibee is one of the most widely known fast food in Filipino-based restaurants in the world. However, the COVID-19 pandemic has impacted restaurants across the world. The decrease in profit and dividend, and even closure of branches were evident. This study aimed to determine the relationships between Jollibee’s price, food quality, culture/social influence, and service quality through the SERVQUAL dimensions on customer satisfaction during the COVID-19 pandemic using the structural equation modeling (SEM) approach. A total of 303 respondents were recruited using a purposive sampling approach to answer an online survey through social media platforms. This study found that among the factors mentioned, responsiveness, reliability, and assurance dimensions yielded to be statistically insignificant to the service quality. Due to the normal attributes the staff and restaurant have, the different factors were deemed insignificant. At the same time, the service quality was observed to have the largest significant direct relationship with customer satisfaction, followed by the cultural influence, food quality, COVID-19 protocols, and pricing. It was also seen that cleanliness and appearance, empathetic staff, food quality, price, and proper implementation of COVID-19 protocol prevention would lead to high levels of satisfaction among customers in Jollibee fast-food restaurant. Moreover, cultural/social influence has played a big role seeing that the indicators represent the feeling of belongingness since childhood. This study is the first study that analyzed the factors affecting the customer satisfaction of Jollibee. Finally, this study could be used as a basis for fast-food companies and service-related industries to increase its performance by enhancing customer satisfaction worldwide.

Voluntary medical male circumcision (VMMC) provides partial protection against female-to-male transmission of HIV. The Maximizing the Impact of Voluntary Medical Male Circumcision in Zambia (MAXZAM) project was a phased implementation of a demand generation strategy for VMMC through economic compensation. Previously published findings showed increased uptake of VMMC when compensation was provided. This paper is a follow-up evaluation of the MAXZAM project exploring additional factors associated with uptake of VMMC. Factors found associated include the outreach setting in which men were approached, number of information sources seen, heard, or read about VMMC, their self-reported HIV risk behaviors, their self-reported intention to go through the procedure, and their behavioral-psychographic profile. The findings highlight the importance of considering general (e.g., intensifying mass communications and targeting specific settings) and person-centered demand generation approaches (e.g., considering the client's psychographic profile and HIV risk level) to maximize effect on VMMC uptake.

Beginning in March 2020, to reduce COVID-19 transmission, the US President's Emergency Plan for AIDS Relief supporting voluntary medical male circumcision (VMMC) services was delayed in 15 sub-Saharan African countries. We reviewed performance indicators to compare the number of VMMCs performed in 2020 with those performed in previous years. In all countries, the annual number of VMMCs performed decreased 32.5% (from 3,898,960 in 2019 to 2,631,951 in 2020). That reduction is largely attributed to national and local COVID-19 mitigation measures instituted by ministries of health. Overall, 66.7% of the VMMC global annual target was met in 2020, compared with 102.0% in 2019. Countries were not uniformly affected; South Africa achieved only 30.7% of its annual target in 2020, but Rwanda achieved 123.0%. Continued disruption to the VMMC program may lead to reduced circumcision coverage and potentially increased HIV-susceptible populations. Strategies for modifying VMMC services provide lessons for adapting healthcare systems during a global pandemic.