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A critical issue in education since 2020 has been the impact of the COVID-19 pandemic in the teaching and learning process. The pandemic has affected all areas of education and foreign language teaching has not been the exception. The study presents key aspects of teacher experience and training in relation to their use of ICT, which has become ubiquitous for teaching and learning during the last two years. For this study, a mixed methodology approach was used with a semistructured questionnaire that was administered through social networks as well as WhatsApp and emails. A total of 184 responses were recorded from English teachers from all educational levels, public and private schools as well as language institutions. The results showcase that the main aspects affecting the development of classes are teachers' experience using ICT tools, training received, and technology appropriation. Moreover, the availability of a variety of tools for synchronous and asynchronous instruction, communication, and evaluation allowed teachers to rapidly transition into Emergency Remote Teaching. These results inform education stakeholders of the difficulties and opportunities brought by the COVID-19 pandemic.

The advent of COVID-19 generated unprecedented disruptions in the education sector throughout the world. This study presents a comparison of teacher characteristics, perceptions about the development of online educational activities and the difficulties experienced at the beginning of online teaching implementation and at the end of 2020 in Paraguay. A mixed methodology was used with focus group interviews and semi-structured questionnaires administered through electronic means. Teachers from all educational levels in Paraguay, from public and private institutions, were considered. At the beginning of the pandemic, 1030 teachers participated. In the follow-up study, 299 teachers participated, mainly from the capital city and the Central Department. The study revealed significant proportions of teachers who were forced to acquire new equipment and increased technological services. The main means of communication used, at all levels, were WhatsApp and educational platforms. At the end of 2020, there were a higher proportion of teachers trained in the use of technological tools for teaching. The main problem faced by teachers in remote activities is associated with internet connection. Although challenging, teachers also considered the opportunities granted by the situation. These teaching experiences serve to establish and design mechanisms to make education in times of pandemic bearable.

Summary: Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022–July 2023). The first phase involved a survey to MASCC-MSG members (January 2022–May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023–May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received.

The analysis of Argentina's science and technology system has been carried out based on different historical periods and policies. It is for this reason that its beginning is usually associated with the 50s. By 1956, the Commission for Scientific Research was in place. Little research has been done on this institution. It is responsible for promoting Science and Technology in the province, where most universities are located. This paper seeks to analyze the creation of the aforementioned Commission as a policy designed to promote and develop science and technology in Buenos Aires. To this end, the qualitative methodology and, in particular, the analysis of documents will be used. The main source is Provincial Decree No. 21.996/56, which established the Commission. One of the most important results of this research is the identification of characteristics in both the mission and the institutional objectives of the creation of the Commission that are associated with this period. Therefore, although this organization represents the institutionalization of a policy, its history expresses a great disarticulation from the productive sector and its tendency towards the academy.

A partir de un análisis cuantitativo de la Encuesta Nacional de Adolescencia y Juventud 2018, de la República Oriental del Uruguay, se analizan la intensidad y el calendario que presentan tres eventos de transición a la vida adulta (primer trabajo estable, primera autonomía residencial y tenencia del/la primer/a hijo/a) de acuerdo con los factores sexo y nivel educativo alcanzado en jóvenes de 24 a 30 años de todo el territorio nacional. Se concluye que la transición a la vida adulta puede retardarse en aquellos/as jóvenes de mayor nivel educativo y presentarse en forma prematura en aquellos/as con menor nivel educativo

The production process of recycled paper generates a significant amount of wastewater. In many cases, the companies do not have a fully adequate effluent treatment system, due to the high cost of conventional physical or chemical treatment systems, which leads to contaminated wastewater. Due to this problem, this research aims to evaluate a bioremediation system based on a flotation system with Typha domingensis plants, for the recovery of wastewater generated in the paper recycling process. The effluent treatment system was installed in the vegetation house of the Multidisciplinary Center for Technological Research (CEMIT), San Lorenzo, Paraguay. It consisted of Typhas plants arranged in plastic containers, which were classified in relation to the effluent concentration (100 %; 50 %; 30 %), in three replicates. For the evaluation of efficiency, physicochemical determinations of pH, temperature, turbidity, conductivity, BOD5, COD, total phosphorus and total nitrogen were carried out at 7-day intervals over a 4-week period. The results obtained indicate significant differences in the percentage of removal of the different pollutant concentrations, where the COD and BOD5 parameters showed removal values of 99 % and 92 %. In the case of Total Nitrogen and Total Phosphorus the values were around 92 % and 75 %, respectively, demonstrating the efficiency of the plant in the treatment of the effluent. This kind of wastewater treatment system has the potential to decrease the load of effluent pollutants produced in paper recycling. Therefore, this study concluded that the system composed of T. domingensis is an option as a potential phytoremediation system for the treatment of wastewater from paper recycling.

Introducción: La vacunación en poblaciones expuestas a mayor riesgo de enfermedad grave y muerte consecuentes a la infección por SARS-CoV-2, ha generado un gran impacto en la salud pública mundial. Indudablemente, el beneficio ha sido evidenciado mayormente en personas con comorbilidades crónicas, donde la artritis reumatoide (AR) juega un rol importante. Objetivo: Analizar la vacunación contra Sars-CoV-2 en pacientes paraguayos con AR, durante la pandemia COVID19. Métodos: Se realizó un estudio multicéntrico, en el que se analizó transversalmente a una cohorte de pacientes con AR, durante el periodo de octubre a diciembre del año 2022. Para el estudio se registraron variables clínico-epidemiológicas y relacionadas con la vacunación (i.e. acceso a la vacunación, tipo, número de dosis). Se realizó un análisis descriptivo de las variables con el software R-4.3.2. Resultados: Se incluyeron 568 pacientes, 84,1% eran mujeres, con un promedio de edad de 55,5±13,9 años. El 88,7% (504) pacientes, recibieron al menos una dosis de vacuna contra SARS-CoV-2. 85% (483) recibieron dos dosis, mientras que el 60,9% (344) pacientes recibieron el primer refuerzo, y 21,2% el segundo refuerzo. Conclusiones: En esta serie de pacientes paraguayos con AR el porcentaje de vacunación contra SARS-CoV-2 fue más elevado que el registrado en la población general del país. Esto podría estar relacionado con la prioridad de esta población para acceder a las vacunas y a la insistencia de sus médicos en completar el esquema de vacunación.

Bismine sodium salt (BSNa), a Schiff base with two sodium carboxylates, has shown promising electrochemical performance as an anode material. However, its synthesis involves toxic reagents and generates impurities, requiring significant solvent use for purification. This study introduces a novel synthetic method using sodium hydroxide as the sole reagent, which acts as both a base and Na source in the ion exchange step. With this procedure, we reduce the amounts of chemicals, diminish toxicity, improve the purity of the target compound, and use less solvent while maintaining comparable electrochemical performance. Additionally, the procedure is carried out under anhydrous conditions that avoid the undesirable hydrolysis of the imine linkages. In a previous report, the processing of the composite electrode was not established. In this article, we address this issue; the electrochemical performance, specifically the rate capability, is enhanced by processing the electrodes in laminate form rather than powder. As alternative to N-methyl-2-pyrrolidone (NMP), a common but disadvantageous solvent in laminate processing, other solvents were explored by testing acetone (DMK), methylisopropylketone (MIPK), and a DMK-NMP mixture. The remarkable electrochemical performance (specific capacity of 260–280 mAh/g, and capacity retentions higher than 84% at 1C (260 mA/g) remained consistent across these solvents. Furthermore, we investigated replacing copper with aluminum as the current collector to reduce costs and increase the energy density of the battery. While aluminum performed comparably to copper at low specific currents C/10 (26 mA/g), it showed a significant shift in the redox process potentials at higher specific currents.

Introducción: Evaluar la prevalencia y el impacto del uso de líneas medias canalizadas por el Equipo de Infusión y Accesos Vasculares mediante punción eco-guiada comparada con la estrategia endovenosa convencional (punción de catéter venoso periférico por enfermeras de hospitalización) en una unidad de nefrología y trasplante renal. Material y Método: Estudio observacional retrospectivo. Se compararon 3 periodos: pre-implantación, implantación y consolidación del Equipo de Infusión y Accesos Vasculares. Se incluyeron todos los pacientes ingresados en las unidades de hospitalización de Nefrología y Trasplante Renal que requirieron de la colocación de catéteres vasculares periféricos y línea media. Se analizó la prevalencia de acceso venoso, el tiempo de permanencia y los motivos de retirada (complicaciones). Resultados: La incidencia de los catéteres vasculares periféricos fue decreciente mientras que el de las líneas medias se incrementó progresivamente en los tres períodos. Así mismo, no se observaron diferencias en el tiempo medio de permanencia de los catéteres vasculares periféricos mientras que la permanencia de días de la línea media se incrementó. Se confirma en todos los periodos una tasa de complicaciones más elevada y variable en los catéteres vasculares periféricos; mientras que en la línea media la tasa de complicaciones fue menor y más estable. Conclusiones: La implementación de un programa de terapia intravenosa en pacientes nefrológicos ha permitido minimizar el número de dispositivos venosos por paciente, con la consecuente reducción de punciones durante el ingreso, así como la disminución de las complicaciones asociadas a la canalización venosa (menor morbilidad).

The sciences are a complex and especially demanding area of study for undergraduate students, particularly in the earlier years, which are a critical period of adaptation to a new educational stage. The use of new teaching models is encouraged to improve their learning, such as flipped classroom (FC), which pursues more meaningful and effective learning that encourages an active role for students. The aim of this study is to perform a systematic review to evaluate the effectiveness of the FC model in learning in the field of experimental and health sciences in higher education during the 2014-2021 period, specifically in students' performance, determining the influence of students' motivation and self-regulation during the process. The phases and quality standards for systematic reviews were complied with in the search for and compilation of the articles analysed. Science students generally view FC as satisfactory. The results show increased motivation and self-regulation and, by extension, a general positive impact on academic performance as benefits. Furthermore, motivation and self-regulation are regarded as key requirements for good performance in an FC environment in the sciences. However, to achieve good results, FC must be applied in such a way that students are able to reflect on their own learning process.

El estudio busca conocer los patrones culturales de violencia contra adolescentes en el departamento de Alto Paraná, Paraguay, durante los años 2020-2021. La investigación cualitativa, transversal y de alcance exploratoria-descriptiva. Se realizaron 32 entrevistas (21 individuales y 11 grupales) a informantes claves, conformada por líderes y lideresas adultos, referentes institucionales y adolescentes (varones y mujeres) de forma intencional en el 2021. Se indagó los patrones culturales aplicando las dimensiones de pautas de crianza y violencia contra las mujeres. Las respuestas en general difieren según actores y según la posición que ocupan en la comunidad. Los principales hallazgos se resumen en la presencia de relaciones adultocéntricas en los espacios de convivencia comunitaria; la aceptación del castigo físico como forma de disciplinamiento familiar y de resolución de conflictos naturalizadas en el proceso de crianza; mientras que entre adolescentes y adultas mujeres la violencia física no es aceptada.

Several technological approaches have been used to develop vaccines against COVID-19, including those based on inactivated viruses, viral vectors, and mRNA. This study aimed to monitor the maintenance of anti-SARS-CoV-2 antibodies in individuals from Brazil according to the primary vaccination regimen, as follows: BNT162b2 (group 1; 22) and ChAdOx1 (group 2; 18). Everyone received BNT162b2 in the first booster while in the second booster CoronaVac, Ad26.COV2.S, or BNT162b2. Blood samples were collected from 2021 to 2023 to analyze specific RBD (ELISA) and neutralizing antibodies (PRNT50). We observed a progressive increase in anti-RBD and neutralizing antibodies in each subsequent dose, remaining at high titers until the end of follow-up. Group 1 had higher anti-RBD antibody titers than group 2 after beginning the primary regimen, with significant differences after the 2nd and 3rd doses. Group 2 showed a more expressive increase after the first booster with BNT162B2 (heterologous booster). Group 2 also presented high levels of neutralizing antibodies against the Gamma and Delta variants until five months after the second booster. In conclusion, the circulating levels of anti-RBD and neutralizing antibodies against the two variants of SARS-CoV-2 were durable even five months after the 4th dose, suggesting that periodic booster vaccinations (homologous or heterologous) induced long-lasting immunity.

Abstract Background The participation of health professionals in designing interventions is considered vital to effective implementation, yet in areas such as clinical coordination is rarely promoted and evaluated. This study, part of Equity-LA II, aims to analyse the design process of interventions to improve clinical coordination, taking a participatory-action-research (PAR) approach, in healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. This participatory process was planned in four phases, led by a local steering committee (LSC): (1) dissemination of problem analysis results and creation of professionals’ platform, (2) selection of problems and intervention (3) intervention design and planning (4) adjustments after evaluation of first implementation stage. Methods A descriptive qualitative study based on documentary analysis, using a topic guide, was conducted in each intervention network. Documents produced regarding the intervention design process were selected. Thematic content analysis was conducted, generating mixed categories taken from the topic guide and identified from data. Main categories were LSC characteristics, type of design process (phases, participants’ roles, methods) and associated difficulties, coordination problems and interventions selected. Results LSCs of similar composition (managers, professionals and researchers) were established, with increasing membership in Chile and high turnover in Argentina, Colombia and Mexico. Following results dissemination and selection of problems and interventions (more participatory in Chile and Colombia: 200–479 participants), the interventions were designed and planned, resulting in three different types of processes: (1) short initial design with adjustments after first implementation stage, in Colombia, Brazil and Mexico; (2) longer, more participatory process, with multiple cycles of action/reflection and pilot tests, in Chile; (3) open-ended design for ongoing adaptation, in Argentina and Uruguay. Professionals’ time and the political cycle were the main barriers to participation. The clinical coordination problem selected was limited communication between primary and secondary care doctors. To address it, through discussions guided by context and feasibility criteria, interventions based on mutual feedback were selected. Conclusions As expected in a flexible PAR process, its rollout differed across countries in participation and PAR cycles. Results show that PAR can help to design interventions adapted to context and offers lessons that can be applied in other contexts.

Introducción: Paraguay asumió el reto de lograr cobertura universal mediante redes basadas en Atención Primaria de la Salud con Unidades de Salud de la Familia (USF) en el primer nivel de atención. Un desafío es la atención integral ante enfermedades no transmisibles, principal causa de mortalidad en el país. Objetivo: analizar la capacidad de las USF para la atención de personas con hipertensión arterial y diabetes en el sistema nacional de salud. El diseño fue no experimental, cuantitativo, transversal, descriptivo con componente analítico. Metodología: Incluyó a 761 USF de 12 regiones sanitarias agrupados en 4 ejes territoriales. Se adaptó el método de evaluación SARA de la OMS con 75 variables, aplicando un cuestionario a profesionales de salud entre noviembre y diciembre de 2022. Se calculó índices de disponibilidad y preparación así como un índice que los integra. La medida continua de estos índices se categorizó en 3 grupos: suficiente >0,75 a 1; intermedio 0,5 a 0,75 y bajo

Paraguay se propuso alcanzar cobertura y acceso universal mediante redes basadas en Atención Primaria de la Salud con Unidades de Salud Familiar (USF). Un desafío es abordar las enfermedades no transmisibles, causantes de mortalidad prematura en el país. El objetivo del estudio fue evaluar la capacidad de las USF para la atención de personas con hipertensión arterial y diabetes. El diseño fue observacional, descriptivo, transversal con componente analítico. Incluyó a 172 USF de las 4 Regiones Sanitarias que conforman el Eje Sur. Se adaptó el método de evaluación SARA de la OMS con 75 indicadores trazadores, aplicando un cuestionario dirigido a profesionales de salud entre noviembre y diciembre de 2022. Se calculó índices de síntesis de disponibilidad y preparación que se midieron de 0 a 1. La mediana del índice de disponibilidad fue 0,71, el de preparación 0,76 y el índice SARA USF-DM/HTA 0,74. La disponibilidad de medicamentos fue la principal brecha seguida de equipamiento básico para neuro exploración, equipos de comunicación e internet. En la preparación resultaron con menor desempeño actividades de supervisión y evaluación, así como la gestión de casos en la red de servicios. Solo el 44,2 % de las USF tuvo un desempeño de disponibilidad y preparación suficiente. Las USF rurales tuvieron menor desempeño que las urbanas. Hubo diferencia significativa entre las regiones sanitarias p

Summary: Background: We previously demonstrated the safety and immunogenicity of an MF59-adjuvanted COVID-19 vaccine based on the SARS-CoV-2 spike glycoprotein stabilised in a pre-fusion conformation by a molecular clamp using HIV-1 glycoprotein 41 sequences. Here, we describe 12-month results in adults aged 18–55 years and ≥56 years. Methods: Phase 1, double-blind, placebo-controlled trial conducted in Australia (July 2020–December 2021; ClinicalTrials.gov NCT04495933; active, not recruiting). Healthy adults (Part 1: 18–55 years; Part 2: ≥56 years) received two doses of placebo, 5 μg, 15 μg, or 45 μg vaccine, or one 45 μg dose of vaccine followed by placebo (Part 1 only), 28 days apart (n = 216; 24 per group). Safety, humoral immunogenicity (including against virus variants), and cellular immunogenicity were assessed to day 394 (12 months after second dose). Effects of subsequent COVID-19 vaccination on humoral responses were examined. Findings: All two-dose vaccine regimens were well tolerated and elicited strong antigen-specific and neutralising humoral responses, and CD4+ T-cell responses, by day 43 in younger and older adults, although cellular responses were lower in older adults. Humoral responses waned by day 209 but were boosted in those receiving authorised vaccines. Neutralising activity against Delta and Omicron variants was present but lower than against the Wuhan strain. Cross-reactivity in HIV diagnostic tests declined over time but remained detectable in most participants. Interpretation: The SARS-CoV-2 molecular clamp vaccine is well tolerated and evokes robust immune responses in adults of all ages. Although the HIV glycoprotein 41-based molecular clamp is not being progressed, the clamp concept represents a viable platform for vaccine development. Funding: This study was funded by the Coalition for Epidemic Preparedness Innovations, the National Health and Medical Research Council of Australia, and the Queensland Government.

Introduction: Creativity is a capacity that is related to divergent thinking and is fundamental in the changing society of the 21st century for training competent students who can function in society. There are several psychometric tests for measuring creativity, among which the Creative Intelligence Test (CREA) stands out, which is widely used in various age groups. Method: A systematic review of the use of the CREA Test in education was carried out, examining in-depth 37 articles, which particularly focus on analysing the relationship between creativity and the three variables of academic performance, age and sex. How to enhance students' creativity was also analysed. Results: Multiple discrepancies were found between creativity and performance. This is also the case with the relationship between age and creativity, as it was not possible to derive a conclusive result from the works contributed. Furthermore, analyses by sex showed that in most of the studies there were no significant differences in creative abilities between women and men. Discussion and Conclusion: Positive teaching environments influence the development of creativity, as occurs with the increase in creativity measured after the various interventions applied in different settings and age groups. It is concluded that creativity is enhanced in educational environments where active student-centred methodologies that promote flexibility and fluency as well as originality are applied.

Experimental autoimmune orchitis (EAO) is a well-established rodent model of organ-specific autoimmunity associated with infertility in which the testis immunohistopathology has been extensively studied. In contrast, analysis of testis biopsies from infertile patients associated with inflammation has been more limited. In this work, testicular biopsies from patients with idiopathic non-obstructive azoospermia diagnosed with hypospermatogenesis (HypoSp) [mild: n = 9, and severe: n = 11], with obstructive azoospermia and complete Sp (spermatogenesis) (control group, C, n = 9), and from Sertoli cell-only syndrome (SCOS, n = 9) were analyzed for the presence of immune cells, spermatogonia and Sertoli cell (SCs) alterations, and reproductive hormones levels. These parameters were compared with those obtained in rats with EAO. The presence of increased CD45+ cells in the seminiferous tubules (STs) wall and lumen in severe HypoSp is associated with increased numbers of apoptotic meiotic germ cells and decreased populations of undifferentiated and differentiated spermatogonia. The SCs showed an immature profile with the highest expression of AMH in patients with SCOS and severe HypoSp. In SCOS patients, the amount of SCs/ST and Ki67+ SCs/ST increased and correlated with high serum FSH levels and CD45+ cells. In the severe phase of EAO, immune cell infiltration and apoptosis of meiotic germ cells increased and the number of undifferentiated and differentiated spermatogonia was lowest, as previously reported. Here, we found that orchitis leads to reduced sperm number, viability, and motility. SCs were mature (AMH-) but increased in number, with Ki67+ observed in severely damaged STs and associated with the highest levels of FSH and inflammatory cells. Our findings demonstrate that in a scenario where a chronic inflammatory process is underway, FSH levels, immune cell infiltration, and immature phenotypes of SCs are associated with severe changes in spermatogenesis, leading to azoospermia. Furthermore, AMH and Ki67 expression in SCs is a distinctive marker of severe alterations of STs in human orchitis.

ABSTRACT Powassan virus (POWV) is an emerging tick-borne Flavivirus that causes lethal encephalitis and long-term neurologic damage. Currently, there are no POWV therapeutics, licensed vaccines, or reverse genetics systems for producing infectious POWVs from recombinant DNA. Using a circular polymerase extension reaction (CPER), we generated recombinant LI9 (recLI9) POWVs with attenuating NS1 protein mutations and a recLI9-split-eGFP reporter virus. NS1 proteins are highly conserved glycoproteins that regulate replication, spread, and neurovirulence. POWV NS1 contains three putative N-linked glycosylation sites that we modified individually in infectious recLI9 mutants (N85Q, N208Q, and N224Q). NS1 glycosylation site mutations reduced replication kinetics and were attenuated, with 1–2 log decreases in titer. Severely attenuated recLI9-N224Q exhibited a 2- to 3-day delay in focal cell-to-cell spread and reduced NS1 secretion but was lethal when intracranially inoculated into suckling mice. However, footpad inoculation of recLI9-N224Q resulted in the survival of 80% of mice and demonstrated that NS1-N224Q mutations reduce POWV neuroinvasion in vivo. To monitor NS1 trafficking, we CPER fused a split GFP11-tag to the NS1 C-terminus and generated an infectious reporter virus, recLI9-NS1-GFP11. Cells infected with recLI9-NS1-GFP11 revealed NS1 trafficking in live cells and the novel formation of large NS1-lined intracellular vesicles. An infectious recLI9-NS1-GFP11 reporter virus permits real-time analysis of NS1 functions in POWV replication, assembly, and secretion and provides a platform for evaluating antiviral compounds. Collectively, our robust POWV reverse genetics system permits analysis of viral spread and neurovirulence determinants in vitro and in vivo and enables the rational genetic design of live attenuated POWV vaccines. IMPORTANCE Our findings newly establish a mechanism for genetically modifying Powassan viruses (POWVs), systematically defining pathogenic determinants and rationally designing live attenuated POWV vaccines. This initial study demonstrates that mutating POWV NS1 glycosylation sites attenuates POWV spread and neurovirulence in vitro and in vivo. Our findings validate a robust circular polymerase extension reaction approach as a mechanism for developing, and evaluating, attenuated genetically modified POWVs. We further designed an infectious GFP-tagged reporter POWV that permits us to monitor secretory trafficking of POWV in live cells, which can be applied to screen potential POWV replication inhibitors. This robust system for modifying POWVs provides the ability to define attenuating POWV mutations and create genetically attenuated recPOWV vaccines.

Summary:. The encephalocele is a malformation that is manifested by the protrusion of brain tissue through a defect in the skull. The meningoencephalocele contains the meninges and brain tissue. Frontoethmoidal or nasal meningoencephalocele is rare; the frequency is approximately one in 40,000 live births. Three subtypes are currently known: nasoethmoid, nasofrontal, and nasoorbital. The authors report the clinical case of a 2-month-old girl with a very rare giant nasofrontal meningoencephalocele, which affected vision and breathing. The patient underwent surgery at an early age to avoid significant functional sequelae and promote the normal development and growth of the girl.

Paraguay definió como prioridad lograr acceso y cobertura universal basado en Atención Primaria de Salud, incorporando a las Unidades de Salud de la Familia (USF) en las comunidades. El objetivo del estudio fue proporcionar métricas para gestionar mejoras en la red asistencial nacional analizando el grado de preparación del primer nivel de atención para proveer servicios de salud integrales. El diseño fue no experimental, cuantitativo, transversal, descriptivo con componente analítico. Incluyó a 216 establecimientos de las Regiones Sanitarias de Concepción, Amambay, Caaguazú, Canindeyú e Itapúa que representaban el 88% del total de USF de estas regiones. Se adaptó el método de evaluación SARA de la OMS con 82 indicadores trazadores, aplicando un cuestionario en línea dirigido a profesionales de salud en julio de 2022. El índice de preparación se midió de 0 a 1 y resultó que el 66,2% de las USF eran rurales y 33,8% urbanas. La mediana de preparación general fue 0,655 mientras que la mediana de la capacidad de diagnóstico fue 0,500, de disponibilidad de medicamentos esenciales 0,625, de infraestructura 0,650, de capacidad para prevenir infecciones 0,667 y de disponibilidad de equipamiento básico 0,833. Sólo el 13,89% tuvo una preparación suficiente, 75,0% intermedia y 11,11% baja. Hubo menor desempeño en las áreas rurales y el 31,02% carecía de personal completo según la norma. Se concluyó que las USF presentaron limitaciones para proveer servicios de salud integrales a las comunidades y que se requiere mejorar el desempeño con base en evaluaciones y ajustes periódicos.