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Objectives A thorough understanding of user needs and behavioural intent-to-use underpins the development of a responsive health information system. This study aimed to examine health workers’ intent-to-use an electronic health record (EHR) system in an urban, rural and remote setting in the Philippines.Methods Following the Unified Theory of Acceptance and Use of Technology framework, user acceptance and the factors influencing intent-to-use the EHR were examined through a self-administered questionnaire. A total of 128 EHR users, comprising physicians, nurses, midwives, barangay health workers and administrative staff, were surveyed. Median scores for each domain were compared across the sites using the Kruskal-Wallis test. Ridge regression analysis was used to identify factors associated with behavioural intent-to-use.Results Over 94% of users across all sites reported their intent-to-use the EHR in the near future. Of the seven predictor variables examined, only self-efficacy was found to be significantly associated with behavioural intent-to-use. Intent-to-use the EHR increased by 31% (p=0.007) for each unit increase in self-efficacy score among participants.Discussion Acceptance was high across the three sites, with self-efficacy being a predictor of intent-to-use the technology. This suggests that users are more likely to adopt an EHR if they believe they have the capacity to successfully navigate the technology and perform their designated tasks with it.Conclusion Co-producing interventions with primary care providers is crucial in sustaining EHR systems. Rather than developing a technology based on the surveillance needs of policymakers, an EHR developed from the grassroots was shown to be well-received by end-users.

Objectives This study measured changes in patient satisfaction levels before and after the introduction of primary care system strengthening interventions in urban, rural, and remote sites in the Philippines.Methods A previously validated 16-item questionnaire was distributed to 200 patients per site before implementation of interventions and to a different set of 200 patients 1 year after implementation. We compared the percentage change in highly satisfied patients per site before and after implementing interventions using a two-proportion Z-test.Results The urban site had a significant increase in patient satisfaction in 13 survey items, which corresponded to the domains of healthcare availability, service efficiency, technical competency and health communication. The rural site had a significant increase in six survey items, which corresponded to the domains of service efficiency, environment, location, health communication and handling. The remote site had a decrease in patient satisfaction in 10 survey items, with a significant increase in only 4 items under the domains of healthcare availability and handling.Conclusion Our findings support the ‘inverse equity hypothesis’, where well-resourced urban communities quickly adopt complex health interventions while rural and remote settings experience delays in effectively meeting patient needs and system demands. Extended intervention periods and targeted strategies may be necessary to impact patient satisfaction in underserved areas considerably.

Introduction Strengthening primary care helps address health inequities that continue to persist in the Philippines. The Philippine Primary Care Studies pilot-tested interventions to improve the primary care system. One intervention was the provision of a free subscription to an electronic decision support application called UpToDate (UTD) for primary care providers (PCPs), including doctors, nurses, midwives and community health workers (CHWs). This study aimed to (1) assess the feasibility of using UTD as information source for PCPs in urban, rural and remote settings, (2) determine the acceptability of UTD as an information source for PCPs and (3) examine the impact of UTD access on PCP clinical decision-making.Methods Four focus group discussions (FGDs) and two key informant interviews (KII) were conducted to gather insights from 30 PCPs. Thematic analysis through coding in NVivo V.12 was done using the technology acceptance model (TAM) as a guiding framework.Results All PCPs had positive feedback regarding UTD use because of its comprehensiveness, accessibility, mobility and general design. The participants relayed UTD’s benefit for point-of-contact use, capacity-building and continuing professional development. PCPs across the three sites, including CHWs with no formal medical education, were able to provide evidence-based medical advice to patients through UTD. However, external factors in these settings impeded the full integration of UTD in the PCPs’ workflow, including poor internet access, unstable sources of electricity, lack of compatible mobile devices and the need for translation to the local language.Conclusion UTD was a feasible and acceptable clinical decision support tool for the PCPs. Factors affecting the feasibility of using UTD include technological and environmental factors (ie, internet access and the lack of translation to the local language), as well as the organisational structure of the primary care facility which determines the roles of the PCPs. Despite the difference in roles and responsibilities of the PCPs, UTD positively impacted decision-making and patient education for all PCPs through its use as a point-of-contact tool and a tool for capacity-building.

Caralluma dalzielii N. E. Brown belonging to family Asclepiadaceae, is a popular cactus-shaped plant native to East Africa. The aerial parts are used traditionally for treating various diseases including infertility. The present study evaluated the effects of the aqueous extract of the aerial parts of Caralluma dalzielii (AECD) on reproductive performance of female Wistar rats. Adult female virgin rats were allotted into four major groups namely pre-conception, post-conception, implantation site and ovariectomized rats' groups. Each group was subdivided into 4 groups and treated orally with 125, 250, 500 mg/kg of AECD or distilled water (vehicle). In the pre-conception and post-conception groups, litter sizes, pups' weights, deformities, gestation length and reproductive indices were determined. Number of implantation sites and weights of embryos were assessed in the implantation site group while in the ovariectomised rats' group, uterine weights were determined. AECD produced no difference in litter size and reproductive indices in pre-conception group while in post-conception group the litter size at 500 mg/kg was significantly (p < 0.05) reduced compared to the control. Post-implantation loss index was high, and the other reproductive indices were reduced at 500 mg/kg. Whereas at the dose of 125 mg/kg, post-implantation loss index was reduced, and litter size was increased when compared to the control group. At 500 mg/kg, AECD caused a significant (p < 0.05) decrease in the number of implantation sites and weight of embryos while at 125 mg/kg the implantation sites increased. A significant (p < 0.05) increase in the uterine weight in the ovariectomised rats' group was observed at all dose levels. Our study provides scientific evidence that supports the traditional use of AECD in the treatment of infertility. At a lower dose, AECD acts by increasing the number of implantation sites and litter size of animals but at a higher dose, it may be embryotoxic. AECD increases uterine wet weight in ovariectomised rats suggesting that the plant may be oestrogen-like.

Palawan, where health care facilities are still limited, is one of the most malaria endemic provinces in the Philippines. Since 1999, microscopists (community health workers) have been trained in malaria diagnosis and feasibility of early diagnosis and treatments have been enhanced throughout the province. To accelerate the universal access of malaria patients to diagnostic testing in Palawan, positive health seeking behavior should be encouraged when malaria infection is suspected.In this cross-sectional study, structured interviews were carried out with residents (N = 218) of 20 remote malaria-endemic villages throughout Palawan with a history of suspected malaria from January to February in 2012. Structural equation modeling (SEM) was conducted to determine factors associated with appropriate treatment, which included: (1) socio-demographic characteristics; (2) proximity to a health facility; (3) health seeking behavior; (4) knowledge on malaria; (5) participation in community awareness-raising activities.Three factors independently associated with appropriate treatment were identified by SEM (CMIN = 10.5, df = 11, CFI = 1.000, RMSEA = .000): "living near microscopist" (p < 0.001), "not living near private pharmacy" (p < 0.01), and "having severe symptoms" (p < 0.01). "Severe symptoms" were positively correlated with more "knowledge on malaria symptoms" (p < 0.001). This knowledge was significantly increased by attending "community awareness-raising activities by microscopists" (p < 0.001).In the resource-limited settings, microscopists played a significant role in providing appropriate treatment to all participants with severe malaria symptoms. However, it was considered that knowledge on malaria symptoms made participants more aware of their symptoms, and further progressed self-triage. Strengthening this recognition sensitivity and making residents aware of nearby microscopists may be the keys to accelerating universal access to effective malaria treatment in Palawan.

Objective: To describe the vocal acoustic measures of nonsmoking Filipino young adults without voice complaints at a private tertiary hospital in Quezon City; to determine if our baseline values are distributed normally and comparable to data in similar studies done abroad; and to recommend normative voice parameters which may be used as baseline data in our institution and for comparison in future studies. Methods: Design: Cross-sectional study Setting: Private tertiary hospital Participants: A total of 70 subjects were recruited at random. Results: Values extracted for f0, Jitter %, Jitter dB, Shimmer %, Shimmer dB and NHR showed normal distribution of results. The average vocal acoustic values found in the present study for male voices producing the vowel /a/ were fo = 130.6 ± 13.65Hz, jitter = 0.0.46 % ± 0.184, jitter dB: 37.62dB ± 16.664, shimmer %= 0.23%, shimmer dB=0.23 ± 0.67 and NHR = 0.13 ± 0.010. The average values found for female voices, producing the vowel /a/ were fo = 218.38 ± 26.192Hz, jitter = 0.87% ± 0.61, jitter dB: 34.82 ± 22.5, shimmer %= 2.72 ± 1.07 shimmer dB=0.23db ± 0.67 and NHR = 0.12dB ± 0.016. Values retrieved from this study show similar trends with other papers abroad. Conclusions: Voice acoustic systems are composed of different recording criteria, recording instrumentations and algorithms which primarily cause the differences in the results obtained in various studies, thus precluding a single normalization. Following international recommendations for individual normalization per institution, we have obtained our own values. Our data was comparable to the results of other international studies. However further investigation is recommended in areas where possibilities of interdialectic variation may produce an effect on the outcome of the study. Keywords: vocal acoustic measures, computerized speech lab, normative voice parameters

The virtual audiometer (VA) is a software application that simulates a pure tone audiometer by delivering tones of different frequencies and intensities by air conduction. Objective: To determine correlation between hearing thresholds measured by virtual and pure tone audiometry and degree of agreement in their hearing loss classification. Methods: Analytic, cross-sectional study set in a Philippine tertiary institution. Subjects were recruited from the outpatient department in September 2005 and comprised of cooperative, clinically normal and abnormal hearing individuals. Thirty-two subjects made 64 total ears tested (n=64), giving 0.90 correlation at 0.05 level of significance (a) (p = 0.05) and 99% power. Each subject underwent pure tone and virtual audiometry, the average thresholds calculated, and degree of hearing loss categorized according to classification by the World Health Organization (WHO). Results were not revealed until both examinations were completed. Data were stratified by frequency and compared by Pearson’s correlation, while Kappa statistics determined degree of agreement between WHO grades of hearing impairment. Results: Average age was 40.2 years, with 20-80 year range and 18.5 years standard deviation. Nine subjects were male while 23 were female (M:F ratio = 0.39). Of 64 ears, 34 were clinically normal and 30 abnormal. Pearson’s correlation demonstrated significant positive correlation between virtual and pure tone thresholds with 99% confidence at 0.05 level of significance. Kappa statistics also showed significant degrees of agreement in WHO grades by both instruments, meaning VA will probably categorize hearing loss in the same manner as pure tone audiometry. Conclusion: A strong positive correlation exists between hearing thresholds measured by virtual and pure tone audiometry with a significant degree of agreement in hearing loss classification. This supports the possibility of using the virtual audiometer as a clinic-based, air-conduction audiometer for screening and monitoring. When used in conjunction with other examinations, valuable information on over-all integrity of the audiologic system may be ascertained. Key words: audiometer, audiometry, air-conduction, hearing test, hearing screening, hearing monitoring

© 2019 American Physical Society. Molecular dynamics simulations and methods of importance sampling are used to study the heat transport of low-dimensional carbon lattices. For both carbon nanotubes and graphene sheets, heat transport is found to be anomalous, violating Fourier’s law of conduction with a system size dependent thermal conductivity and concomitant nonlinear temperature profiles. For carbon nanotubes, the thermal conductivity is found to increase as the square root of the length of the nanotube, while for graphene sheets the thermal conductivity is found to increase as the logarithm of the length of the sheet over the system sizes considered. The particular length dependence and nonlinear temperature profiles place carbon lattices into a universality class with nonlinear lattice models, and suggest that heat transport through carbon nanostructures is better described by a Levy walk rather than simple diffusion.

We present numerical results for the equation of state of an infinite chain of hydrogen atoms. A variety of modern many-body methods are employed, with exhaustive cross-checks and validation. Approaches for reaching the continuous space limit and the thermodynamic limit are investigated, proposed, and tested. The detailed comparisons provide a benchmark for assessing the current state of the art in many-body computation, and for the development of new methods. The ground-state energy per atom in the linear chain is accurately determined versus bond length, with a confidence bound given on all uncertainties.

An approach for estimating the attenuation constant of propagation in a sandstorm at a wavelength of 1550 nm with various prevailing visibility is described in this study. An adequate dust particle size, distribution statistics, and generalized Mie scattering theory were used in the estimation. The visibility is calculated using the computed attenuation at a wavelength of 550 nm. The findings are compared to the measured data found in the literature. To regale, a detailed sensitivity analysis for various sandstorm structures is presented. This analysis is used to signalize a dusty channel in order to simulate a single input-output 1550 nm free space optical link. By computing the bit error rate of the system, the performance of the optical link in flurry dust with attenuation smaller than 10 dB/km is investigated. [ABSTRACT FROM AUTHOR]