Fine-scale adaptive divergence and population genetic structure of Aedes aegypti in Metropolitan Manila, Philippines.

BACKGROUND: The adaptive divergence of Aedes aegypti populations to heterogeneous environments can be a driving force behind the recent expansion of their habitat distribution and outbreaks of dengue disease in urbanized areas. In this study, we investigated the population genomics of Ae. aegypti at a regional scale in Metropolitan Manila, Philippines. METHODS: We used the Pool-Seq double digestion restriction-site association DNA sequencing (ddRAD-Seq) approach to generate a high number of single nucleotide polymorphisms (SNPs), with the aim to determine local adaptation and compare the population structure with 11 microsatellite markers. A total of 217 Ae. aegypti individuals from seven female and seven male populations collected from Metropolitan Manila were used in the assays. RESULTS: We detected 65,473 SNPs across the populations, of which 76 were non-neutral SNPs. Of these non-neutral SNPs, the multivariate regression test associated 50 with eight landscape variables (e.g. open space, forest, etc.) and 29 with five climate variables (e.g. air temperature, humidity, etc.) (P-value range 0.005-0.045) in female and male populations separately. Male and female populations exhibited contrasting spatial divergence, with males exhibiting greater divergence than females, most likely reflecting the different dispersal abilities of male and female mosquitoes. In the comparative analysis of the same Ae. aegypti individuals, the pairwise FST values of 11 microsatellite markers were lower than those of the neutral SNPs, indicating that the neutral SNPs generated via pool ddRAD-Seq were more sensitive in terms of detecting genetic differences between populations at fine-spatial scales. CONCLUSIONS: Overall, our study demonstrates the utility of pool ddRAD-Seq for examining genetic differences in Ae. aegypti populations in areas at fine-spatial scales that could inform vector control programs such as Wolbachia-infected mosquito mass-release programs. This in turn would provide information on mosquito population dispersal patterns and the potential barriers to mosquito movement within and around the release area. In addition, the potential of environmental adaptability observed in Ae. aegypti could help population control efforts.

Prevalence and risk indicators of early childhood caries among toddlers in Caloocan City, Philippines: a cross-sectional study.

BACKGROUND: Limited published data exist on early childhood caries (ECC) among children 2 years old and below. The study aimed to determine ECC prevalence and its association with socio-demographic indicators, feeding practices and oral health behaviours among children aged 2 years and below in the Philippines. METHODS: A cross-sectional study observed young children aged 4-24 months in primary health centers. Each child's caregiver was interviewed and dental examinations were done on every child by one calibrated dentist using the ICDAS. Poisson regression using robust variance estimator analysis identified significant variables associated with ECC. RESULTS: Seven hundred three healthy children were observed at a mean age of 13.3 ± 2.4 months. ECC prevalence was 29.2% (95% confidence interval: 26.0-32.7) among toddlers who showed a mean number of 6.7 ± 3.1 erupted teeth. Multiple regression revealed that child's age (prevalence ratio, PR = 1.07), caregiver's educational level (PR = 1.43), continued breastfeeding (PR = 1.36), frequent eating (PR = 1.24), visible plaque observed by the caregiver (PR = 1.34) and in the oral examination (PR = 2.90) were significant to ECC prevalence. CONCLUSIONS: ECC is alarmingly prevalent in toddlers, marked by early onset and untreated decay. Prioritizing preventive measures in the first two years of life is crucial for understanding dietary impacts and promoting oral hygiene.

Reconciling devolution with health financing and public financial management: challenges and policy options for the health sector.

The interplay between devolution, health financing and public financial management processes in health-or the lack of coherence between them-can have profound implications for a country's progress towards universal health coverage. This paper explores this relationship in seven Asian and African countries (Burkina Faso, Kenya, Mozambique, Nigeria, Uganda, Indonesia and the Philippines), highlighting challenges and suggesting policy solutions. First, subnational governments rely heavily on transfers from central governments, and most are not required to allocate a minimum share of their budget to health. Central governments channelling more funds to subnational governments through conditional grants is a promising way to increase public financing for health. Second, devolution makes it difficult to pool funding across populations by fragmenting them geographically. Greater fiscal equalisation through improved revenue sharing arrangements and, where applicable, using budgetary funds to subsidise the poor in government-financed health insurance schemes could bridge the gap. Third, weak budget planning across levels could be improved by aligning budget structures, building subnational budgeting capacity and strengthening coordination across levels. Fourth, delays in central transfers and complicated procedures for approvals and disbursements stymie expenditure management at subnational levels. Simplifying processes and enhancing visibility over funding flows, including through digitalised information systems, promise to improve expenditure management and oversight in health. Fifth, subnational governments purchase services primarily through line-item budgets. Shifting to practices that link financial allocations with population health needs and facility performance, combined with reforms to grant commensurate autonomy to facilities, has the potential to enable more strategic purchasing.

Multidecadal mangrove forest change in Macajalar Bay, Northern Mindanao, Philippines (1950-2020) using remote sensing and geographic information systems.

The mangrove forest in Macajalar Bay is regarded as an important coastal ecosystem since it provides numerous ecosystem services. Despite their importance, the clearing of mangroves has been rampant and has reached critical rates. Addressing this problem and further advancing its conservation require accurate mangrove mapping. However, current spatial information related to mangroves is sparse and insufficient to understand the historical change dynamics. In this study, the synergy of 1950 vegetation maps and Landsat images was explored to provide multidecadal monitoring of mangrove forest change dynamics in Macajalar Bay, Philippines. Vegetation maps containing the 1950 mangrove extent and Landsat images were used as input data to monitor the rates of loss over 70 years. In 2020, the mangrove forest cover was estimated to be 201.73 ha, equivalent to only 61.99% of the 325.43 ha that was estimated in 1950. Between 1950 and 2020, net mangrove loss in Macajalar Bay totaled 324.29 ha. The highest clearing rates occurred between 1950 and 1990 when it recorded a total of 258.51 ha, averaging 6.46 ha/year. The original mangrove forest that existed in 1950 only represents 8.56% of the 2020 extent, suggesting that much of the old-growth mangrove had been cleared before 2000 and the existing mangrove forest is mainly composed of secondary mangrove forest stands. Across Macajalar Bay, intensified clearing that happened between 1950 and 1990 has been driven by large-scale aquaculture developments. Mangrove gains on the other hand were evident and have increased the total extent by 79.84 ha since 2000 as a result of several afforestation programs. However, approximately half of these gains that were observed since 2010 exhibited low canopy cover. As of writing, approximately 85% of the 2020 mangrove forest stands fall outside the 1950 original mangrove extent. Examining the viability of the original mangrove forest for mangrove reforestation together with promoting site-species matching, and biophysical assessment are necessary undertakings to advance current mangrove conservation initiatives in Macajalar Bay.

Radiation Oncology Training in the Philippines: Bridging Gaps for Improved Cancer Care in Low- and Middle-Income Countries.

PURPOSE: Radiation oncology in the Philippines, a large lower- and middle-income country in Southeast Asia, is facing a critical shortage in manpower, with only 113 radiation oncologists (ROs) over 55 radiotherapy (RT) centers serving 100 million population. Paramount to workforce expansion is ensuring that training programs can produce adequately trained specialists. In this study, we describe the current state of radiation oncology training programs in the Philippines. METHODS: This is a cross-sectional observational analysis of the nine radiation oncology residency training programs in the Philippines. Data were collected from a survey of the program directors, the Philippine Radiation Oncology Society database, and a PubMed literature search. RESULTS: Eight of the nine programs are in the National Capital Region. Since program standardization in 2005, there have been 82 four-year residency graduates, with up to 18 new graduates annually. Faculty-to-trainee ratio ranges from 0.5 to 2.67. In terms of technology, all programs have intensity-modulated RT and high-dose-rate brachytherapy, but only six are equipped with computed tomography-based image guidance and stereotactic capabilities. Clinical education schemes vary per institution regarding curriculum implementation, resident activities, and methods of evaluation. Required resident case logs are not met for lung, GI, genitourinary, bone and soft tissue, and hematologic malignancies. In total, there are only 22 resident-led publications from 10 unique individuals in two training programs. CONCLUSION: Program expansions are warranted to meet the projected demand for ROs in the Philippines, but training programs must first improve key aspects of staffing, technology, clinical education, and research. Addressing training challenges related to resource limitations necessitates local and international collaborations with higher-capacity centers to bridge gaps for continued quality improvement with the aim of ultimately delivering better overall cancer care.

Pakikisama: Filipino Patient Perspectives on Health Care Access and Utilization.

PURPOSE: Filipinos have unique social determinants of health, cultural values, and beliefs that contribute to a higher prevalence of cardiovascular comorbidities such as hypertension, diabetes, and dyslipidemia. We aimed to identify Filipino values, practices, and belief systems that influenced health care access and utilization. METHODS: We conducted 1-on-1 semistructured interviews with self-identified Filipino patients. Our qualitative study utilized a constant-comparative approach for data collection, thematic coding, and interpretive analysis. RESULTS: We interviewed 20 Filipinos in a remote rural community to assess structural and social challenges experienced when interacting with the health care system. Our results suggest that Filipinos regard culture and language as pillars of health access. Filipinos trust clinicians who exhibited positive tone and body language as well as relatable and understandable communication. These traits are features of Pakikisama, a Filipino trait/value of "comfortableness and getting along with others." Relatability and intercultural values familiarity increased Filipino trust in a health care clinician. Filipinos may lack understanding about how to navigate the US Health care system, which can dissuade access to care. CONCLUSIONS: For the Filipino community, culture and language are fundamental components of health access. Health care systems have the opportunity to both improve intercultural clinical training and increase representation among clinicians and support staff to improve care delivery and navigation of health services. Participants reported not routinely relying on health care navigators.

Shared Decision Making in Oncology and Its Implementation in Cervical Cancer Management in the Philippines: A Narrative Review.

PURPOSE: Shared decision making (SDM) is an approach where clinicians and patients make decisions together using the best available evidence. Although much studied, recognized to be ethically imperative, and recommended in international health policies, it remains poorly implemented. In the Philippines, there are limited studies on patient decision making preferences and SDM. Practical guidance on the implementation of SDM or use of patient decision aids (PtDAs) is often not detailed in existing national clinical practice guidelines in oncology. METHODS: We performed a systematic search of Philippine literature on SDM in oncology and an iterative review of international literature on the philosophy and methods of SDM, the utility and effectiveness of PtDAs, and the facilitators and barriers to implementation or usage. We contextualized our review to the cervical cancer management and health service delivery in the Philippines. RESULTS: Local literature is limited to five scientific publications and two registered studies. International literature encompasses patient decisional preferences, the role of PtDAs and the standards for their development and evaluation, their effectiveness, and barriers and facilitators to their use in cancer-related decision making. We discussed the implications on the management of cervical cancer in the Philippines, challenges in health service delivery and standards, and SDM research. CONCLUSION: Local SDM research is limited. Our preliminary experience in a multicenter clinical trial in Manila on PtDA use in the framework of SDM in cervical cancer suggest good patient and clinician acceptability. Challenges to implementation such as unfavorable financial situations, urgency of clinical decisions, low patient or caregiver educational attainment, and poor integration of multidisciplinary and SDM in organizational workflows will be important when implementing SDM in different settings.

Teaching Literacy to Filipino Deaf Students in Multilingual Classrooms Amid a Pandemic.

This article describes the current landscape of teaching literacy to Filipino Deaf students in a multilingual, multi-cultural classroom amid the pandemic. The article highlights the uniqueness of Filipino Deaf students as multilingual learners in a multi-cultural classroom and the lack of literature and research on Deaf multilingualism both locally and globally. Moreover, the article focuses on the role of Deaf teachers in teaching Filipino Deaf students, especially in their literacy development. The steps being done to ensure that the curriculum is inclusive of Deaf learners who use Filipino Sign Language (FSL), teacher preparation and materials development, and the challenges in the shift to distance learning amid the COVID-19 pandemic are also discussed. Future directions and recommendations include review of curriculum and adaptation, enhancement of teacher preparation, promotion of collaborative teaching and research efforts, and the production of more appropriate and accessible instructional materials for Deaf students.

Visualizing a Framework in Teaching Literacy to Filipino Deaf Students in Multimodal Learning Spaces.

In this article, we visualize a framework of the intersectionality of literacy, spatial justice, and multimodality in teaching literacy to Filipino Deaf students. We propose a metaphor-based framework and discuss how it can be used in teaching literacy to Filipino Deaf students through classroom examples as well as suggestions and recommendations for teachers. We do this mainly through redefining the term literacy, allowing students access to different modalities, and restructuring learning spaces. We also explore the relationship between spatial justice and the concept of Deaf Space and how this applies in the "new normal" of online learning due to the pandemic. We also address the issue of how classroom and education structure may inadvertently produce spatial injustice, especially for Deaf students. Implications and additional questions in teaching Filipino Deaf students are also discussed.

Deaf on the Prairie: Combining Traditional and Contemporary Learning Theories.

This single case study concerns an 11-year-old girl, Agata, who recently moved to a rural community in the United States from the Philippines. Agata is profoundly deaf, has had no access to amplification, and has had very limited access to language and formal school. The journey through the next year, including the COVID-19 pandemic, saw Agata's language and literacy skills blossom at an unexpected rate. The study examines the how and why of Agata's progress by using multiple sources of both quantitative and qualitative data. A conceptual framework of both direct instruction theory (Engelmann & Carnine, 1982) and resilience theory (Garmezy, 1993) was used to systematically analyze the factors that contributed to Agata's growth and offer a more thorough understanding of the complex challenges and potential successes in supporting students from Asian communities who are d/Deaf or hard of hearing (d/DHH).

Economic implications of novel regimens for tuberculosis treatment in three high-burden countries: a modelling analysis.

BACKGROUND: With numerous trials investigating novel drug combinations to treat tuberculosis, we aimed to evaluate the extent to which future improvements in tuberculosis treatment regimens could offset potential increases in drug costs. METHODS: In this modelling analysis, we used an ingredients-based approach to estimate prices at which novel regimens for rifampin-susceptible and rifampin-resistant tuberculosis treatment would be cost-neutral or cost-effective compared with standards of care in India, the Philippines, and South Africa. We modelled regimens meeting targets set in the WHO's 2023 Target Regimen Profiles (TRPs). Our decision-analytical model tracked cohorts of adults initiating rifampin-susceptible or rifampin-resistant tuberculosis treatment, simulating their health outcomes and costs accumulated during and following treatment under standard-of-care and novel regimen scenarios. Price thresholds included short-term cost-neutrality (considering only savings accrued during treatment), medium-term cost-neutrality (additionally considering savings from averted retreatments and secondary cases), and cost-effectiveness (incorporating willingness-to-pay for improved health outcomes). FINDINGS: Total medium-term costs per person treated using standard-of-care regimens were estimated at US$450 (95% uncertainty interval 310-630) in India, $560 (350-860) in the Philippines, and $730 (530-1090) in South Africa for rifampin-susceptible tuberculosis (current drug costs $46) and $2100 (1590-2810) in India, $2610 (2090-3280) in the Philippines, and $3790 (3090-4630) in South Africa for rifampin-resistant tuberculosis (current drug costs $432). A rifampin-susceptible tuberculosis regimen meeting the optimal targets defined in the TRPs could be cost-neutral in the short term at drug costs of $140 (90-210) per full course in India, $230 (130-380) in the Philippines, and $280 (180-460) in South Africa. For rifampin-resistant tuberculosis, short-term cost-neutral thresholds were higher with $930 (720-1230) in India, $1180 (980-1430) in the Philippines, and $1480 (1230-1780) in South Africa. Medium-term cost-neutral prices were approximately $50-100 higher than short-term cost-neutral prices for rifampin-susceptible tuberculosis and $250-550 higher for rifampin-resistant tuberculosis. Health system cost-neutral prices that excluded patient-borne costs were 45-70% lower (rifampin-susceptible regimens) and 15-50% lower (rifampin-resistant regimens) than the cost-neutral prices that included patient costs. Cost-effective prices were substantially higher. Shorter duration was the most important driver of medium-term savings with novel regimens, followed by ease of adherence. INTERPRETATION: Improved tuberculosis regimens, particularly shorter regimens or those that facilitate better adherence, could reduce overall costs, potentially offsetting higher prices. FUNDING: WHO.

Copywriters' preference evaluation on online copywriting course attributes during the COVID-19 pandemic.

Copywriting online course has become a famous online training over the past years and the reliance on online courses increased even during the COVID-19 pandemic. In recent years, online courses have become a popular training platform, especially for copywriting courses. The demand for online courses increased during the COVID-19 pandemic, prompting the need to optimize the learning experience of an online course's target audience. This study aimed to determine the combination of online course attributes most preferred by Filipino copywriters such as course style, payment method, course delivery, module duration, and course type. 292 Filipino copywriters from a leading Philippine-based copywriting group voluntarily participated in this study and answered an online questionnaire quantitative survey which was distributed using the purposive sampling method. Conjoint Analysis with an orthogonal design revealed that copywriters consider the course style attribute as the most important (46.007%), followed by payment method (18.236%), and course delivery (15.435%). Module duration (10.489%) and while the course type (9.833%) were was the least considered attribute of an online course. The result shows that Filipino copywriters prefer an intermediate-level video course on a Facebook group that lasts 1 to 3 hours per module and is paid per course for a total utility score of 0.281, while the least preferred combination was a beginner-level audiobook course that lasts less than 30 minutes per module, delivered via email, and paid per module, for a total utility score of -0.281. This study is the first study that analyzed the copywriters' preference for online copywriting course attributes during the COVID-19 pandemic. The findings of this study are beneficial to online course creators who are targeting copywriters. Finally, the result of this study can be expanded further to other online courses worldwide.

Spatiotemporal models of dengue epidemiology in the Philippines: Integrating remote sensing and interpretable machine learning.

Previous dengue epidemiological analyses have been limited in spatiotemporal extent or covariate dimensions, the latter neglecting the multifactorial nature of dengue. These constraints, caused by rigid and traditional statistical tools which collapse amidst 'Big Data', prompt interpretable machine-learning (iML) approaches. Predicting dengue incidence and mortality in the Philippines, a data-limited yet high-burden country, the mlr3 universe of R packages was used to build and optimize ML models based on remotely sensed provincial and dekadal 3 NDVI and 9 rainfall features from 2016 to 2020. Between two tasks, models differ across four random forest-based learners and two clustering strategies. Among 16 candidates, rfsrc-year-case and ranger-year-death significantly perform best for predicting dengue incidence and mortality, respectively. Therefore, temporal clustering yields the best models, reflective of dengue seasonality. The two best models were subjected to tripartite global exploratory model analyses, which encompass model-agnostic post-hoc methods such as Permutation Feature Importance (PFI) and Accumulated Local Effects (ALE). PFI reveals that the models differ in their important explanatory aspect, rainfall for rfsrc-year-case and NDVI for ranger-year-death, among which long-term average (lta) features are most relevant. Trend-wise, ALE reveals that average incidence predictions are positively associated with 'Rain.lta', reflective of dengue cases peaking during the wet season. In contrast, those for mortality are negatively associated with 'NDVI.lta', reflective of urban spaces driving dengue-related deaths. By technologically addressing the challenges of the human-animal-ecosystem interface, this study adheres to the One Digital Health paradigm operationalized under Sustainable Development Goals (SDGs). Leveraging data digitization and predictive modeling for epidemiological research paves SDG 3, which prioritizes holistic health and well-being.

Older Chinese and Filipino American Immigrants with Type 2 Diabetes and their Adult Child: A Qualitative Dyadic Exploration of Family Support.

Type 2 Diabetes (T2D) among older Asian American immigrants (AA) is a growing concern. Asian Americans represent 9% of diagnosed diabetes. Very little is known on how older Asian American immigrants with T2D navigate diabetes management, in particular the role of family support. This qualitative study examines Chinese and Filipino Americans, the two largest Asian subgroups in the US (4.2 million, and 3.6 million, respectively), and family support dynamics among adult children and their parents diagnosed with T2D. Ten dyads (n = 20) made up of adult children and aging parents participated in in-depth and dyadic interviews. Results indicate that family support occurs in a trajectory of stages. The following thematic patterns emerged in these dyads around support: independence, transitions, partnership, and stepping in. The findings point to various supportive stages that Asian American adult children and aging parents with T2D experience and the importance of developing supportive interventions for both adult children and aging parents at these various stages.

Nonlinear Fourier classification of 663 rogue waves measured in the Philippine Sea.

Rogue waves are sudden and extreme occurrences, with heights that exceed twice the significant wave height of their neighboring waves. The formation of rogue waves has been attributed to several possible mechanisms such as linear superposition of random waves, dispersive focusing, and modulational instability. Recently, nonlinear Fourier transforms (NFTs), which generalize the usual Fourier transform, have been leveraged to analyze oceanic rogue waves. Next to the usual linear Fourier modes, NFTs can additionally uncover nonlinear Fourier modes in time series that are usually hidden. However, so far only individual oceanic rogue waves have been analyzed using NFTs in the literature. Moreover, the completely different types of nonlinear Fourier modes have been observed in these studies. Exploiting twelve years of field measurement data from an ocean buoy, we apply the nonlinear Fourier transform (NFT) for the nonlinear Schrödinger equation (NLSE) (referred to NLSE-NFT) to a large dataset of measured rogue waves. While the NLSE-NFT has been used to analyze rogue waves before, this is the first time that it is systematically applied to a large real-world dataset of deep-water rogue waves. We categorize the measured rogue waves into four types based on the characteristics of the largest nonlinear mode: stable, small breather, large breather and (envelope) soliton. We find that all types can occur at a single site, and investigate which conditions are dominated by a single type at the measurement site. The one and two-dimensional Benjamin-Feir indices (BFIs) are employed to examine the four types of nonlinear spectra. Furthermore, we verify on a part of the data set that for the localized types, the largest nonlinear Fourier mode can be attributed directly to the rogue wave, and investigate the relation between the height of the rogue waves and that of the dominant nonlinear Fourier mode. While the dominant nonlinear Fourier mode in general only contributes a small fraction of the rogue wave, we find that soliton modes can contribute up to half of the rogue wave. Since the NLSE does not account for directional spreading, the classification is repeated for the first quartile with the lowest directional spreading for each type. Similar results are obtained.

Impact of primary care system interventions on healthcare worker satisfaction and intention to stay in the Philippines: a follow-up study.

BACKGROUND: The Philippines has a shortage and uneven distribution of healthcare workers (HCWs). Job satisfaction is an important element to HCW retention and attracting new HCWs into the health system. OBJECTIVE: This study measured HCWs' intent to stay and HCWs' satisfaction after implementation of multiple interventions intended to strengthen the primary care system, and determine factors significantly associated with HCWs' intent to stay. METHODOLOGY: This is a serial cross-sectional study in urban, rural and remote primary care sites in the Philippines. All physicians, nurses, midwives, dentists, community health workers and support staff were invited to participate. Baseline HCWs' intent to stay and satisfaction were obtained using a self-administered questionnaire prior to implementation of interventions. The same survey was again conducted in the years 2021 and 2022, corresponding to 5 and 6 years after initial implementation for the urban site, and 2 and 3 years for the rural and remote sites. We used multiple logistic regression to determine factors associated with intent to stay. RESULTS: There were 430 survey respondents (89.4% response rate) for year 2021, and 417 survey respondents (97.4% response rate) for year 2022. The urban and rural sites had significant increase in several HCW satisfaction domains, while the remote site had significant decrease in several HCW satisfaction domains. There was no significant difference in the intent to stay in the three sites. Factors that decreased intent to stay included length of employment, job involvement and employment as a nurse, while factors that increased intent to stay included job satisfaction, enjoyment and working in the urban site. CONCLUSION: HCW satisfaction improved in the urban site and rural site, while HCW satisfaction declined in the remote site. Intention to stay of primary care HCWs did not significantly change.

The impact of a mixed reality technology-driven health enhancing physical activity program among community-dwelling older adults: a study protocol.

Background: Physical inactivity and a sedentary lifestyle among community-dwelling older adults poses a greater risk for progressive physical and cognitive decline. Mixed reality technology-driven health enhancing physical activities such as the use of virtual coaches provide an emerging and promising solution to support healthy lifestyle, but the impact has not been clearly understood. Methods and analysis: An observational explanatory sequential mixed-method research design was conceptualized to examine the potential impact of a user-preferred mixed reality technology-driven health enhancing physical activity program directed toward purposively selected community-dwelling older adults in two senior centers in the Philippines. Quantitative components of the study will be done through a discreet choice experiment and a quasi-experimental study. A total of 128, or 64 older adults in each center, will be recruited via posters at community senior centers who will undergo additional screening or health records review by a certified gerontologist to ensure safety and proper fit. Treatments (live coaching with video-based exercise and mixed reality technology-driven exercise) will be assigned to each of the two senior center sites for the quasi-experiment. The participants from the experimental group shall be involved in the discreet choice experiment, modeling, and usability evaluations. Finally, a qualitative sample of participants (n = 6) as key informants shall be obtained from the experimental group using purposive selection. Discussion: This study protocol will examine the health impact of a promising mixed reality program in health promotion among older adults. The study utilizes a human-centered mixed method research design in technology development and evaluation in the context of developing nations.Clinical trial registration: ClinicalTrials.gov, identifier NCT06136468.

Evaluation of cytokine profiles related to Mycobacterium tuberculosis latent antigens using a whole-blood assay in the Philippines.

Introduction: There is no useful method to discriminate between latent tuberculosis infection (LTBI) and active pulmonary tuberculosis (PTB). This study aimed to investigate the potential of cytokine profiles to discriminate between LTBI and active PTB using whole-blood stimulation with Mycobacterium tuberculosis (MTB) antigens, including latency-associated antigens. Materials and methods: Patients with active PTB, household contacts of active PTB patients and community exposure subjects were recruited in Manila, the Philippines. Peripheral blood was collected from the participants and used for whole-blood stimulation (WBS) with either the early secretory antigenic target and the 10-kDa culture filtrate protein (ESAT-6/CFP-10), Rv3879c or latency-associated MTB antigens, including mycobacterial DNA-binding protein 1 (MDP-1), α-crystallin (Acr) and heparin-binding hemagglutinin (HBHA). Multiple cytokine concentrations were analyzed using the Bio-Plex™ multiplex cytokine assay. Results: A total of 78 participants consisting of 15 active PTB patients, 48 household contacts and 15 community exposure subjects were eligible. The MDP-1-specific IFN-γ level in the active PTB group was significantly lower than that in the household contact group (p < 0.001) and the community exposure group (p < 0.001). The Acr-specific TNF-α and IL-10 levels in the active PTB group were significantly higher than those in the household contact (TNF-α; p = 0.001, IL-10; p = 0.001) and community exposure (TNF-α; p < 0.001, IL-10; p = 0.01) groups. However, there was no significant difference in the ESAT-6/CFP-10-specific IFN-γ levels among the groups. Conclusion: The patterns of cytokine profiles induced by latency-associated MTB antigens using WBS have the potential to discriminate between LTBI and active PTB. In particular, combinations of IFN-γ and MDP-1, TNF-α and Acr, and IL-10 and Acr are promising. This study provides the first demonstration of the utility of MDP-1-specific cytokine responses in WBS.