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Congenital diaphragmatic hernia (CDH) is a rare heterogenous disorder with varying degrees of severity. Infant survival rates in high-income countries are approaching 80% in isolated CDH; however, over 50% will have long-term morbidities. Advanced antenatal imaging, including ultrasound and magnetic resonance imaging, has made it possible to prognosticate severity of CDH and to stratify risk when counseling expectant parents. Risk stratification can also better prepare healthcare teams to enable optimal neonatal management, and provide options for fetal intervention or, where legally permitted, pregnancy termination. Factors that may affect the immediate and long-term prognosis for CDH include prenatal diagnosis, gestational age at detection and delivery, side of the defect, presence of additional structural or genetic abnormalities, defect size, estimation of fetal lung volume, the extent of visceral herniation, and the delivery center’s experience in caring for neonates with CDH. Optimizing the outcome for families and infants begins with an early prenatal diagnosis followed by referral to a diverse and inclusive multidisciplinary center with CDH expertise. Prediction of disease severity is supported by accurate fetal imaging and comprehensive genetic testing, and allows the care team to provide realistic outcome expectations during the counseling of expectant parents of all racial and ethnic backgrounds.

Abstract BackgroundIn the United States, patients with monochorionic diamniotic twins who undergo in utero fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS) may travel great distances for care. After delivery, many parents cannot return to study sites for formal pediatric evaluation due to geographic location and cost. ObjectiveThe aim of this study was to collect long-term pediatric outcomes in patients who underwent FLP for TTTS. MethodsWe assessed the feasibility of using a web-based survey designed in REDCap (Research Electronic Data Capture; Vanderbilt University) to collect parent-reported outcomes in children treated for TTTS at a single center during 2011‐2019. Patients with ≥1 neonatal survivor were invited via email to complete 5 possible questionnaires: the child status questionnaire (CSQ); fetal center questionnaire (FCQ); ResultsA total of 389 patients in 26 different states and 2 international locations had an email address on file and received an invitation in 2019 to complete the survey (median pediatric age 48.9, IQR 1.0‐93.6 months). Among surveyed mothers in 2019, the overall response rate was 37.3% (145/389), and the questionnaire completion rate was 98% (145/148), 87.8% (130/148), 71.1% (81/100), 86.4% (19/22), and 74.3% (110/148) for the CSQ, FCQ, ASQ ConclusionsThis is the first study to use both REDCap and computer automation to aid in the dissemination, collection, and reporting of surveys to collect long-term pediatric outcomes in the field of fetal medicine.

Objective Whitin 6 weeks prior to an in-person musculoskeletal specialty care visit, ​​1) Is the number of self-reported in-person contacts associated with psychological and social factors? and 2) Is the number of remote and total contacts associated with psychological and social factors? Methods We enrolled 148 adult patients in a cross-sectional study of people visiting a musculoskeletal specialist for a new or return visit. Patients completed a survey of social health, indicated the number of self-reported remote and in-person care episodes, and completed measures of unhelpful thoughts regarding symptoms, general distress, and demographics. Results Accounting for potential confounding in multivariable analysis, more self-reported in-person care episodes were independently associated with more unhelpful thoughts about symptoms (higher score on NPTQ; RC 0.05; 95% CI: 0.02 to 0.09; P

IntroductionWe have demonstrated that transposons derived from ctDNA can be transferred between cancer cells. The present research aimed to investigate the cellular uptake and intracellular trafficking of Multiple Myeloma-zip code (MM-ZC), a cell-specific zip code, in myeloma cell lines. We demonstrated that MM-ZC uptake by myeloma cells was concentration-, time- and cell-type-dependent.MethodsFlow cytometry and confocal microscopy methods were used to identify the level of internalization of the zip codes in MM cells. To screen for the mechanism of internalization, we used multiple inhibitors of endocytosis. These experiments were followed by biotin pulldown and confocal microscopy for validation. Single interference RNA (siRNA) targeting some of the proteins involved in endocytosis was used to validate the role of this pathway in ZC cell internalization.ResultsEndocytosis inhibitors identified that Monensin and Chlorpromazine hydrochloride significantly reduced MM-ZC internalization. These findings suggested that Clathrin-mediated endocytosis and endosomal maturation play a crucial role in the cellular uptake of MM-ZC. Biotin pulldown and confocal microscopic studies revealed the involvement of proteins such as Clathrin, Rab5a, Syntaxin-6, and RCAS1 in facilitating the internalization of MM-ZC. Knockdown of Rab5a and Clathrin proteins reduced cellular uptake of MM-ZC and conclusively demonstrated the involvement of Clathrin-Rab5a pathways in MM-ZC endocytosis. Furthermore, both Rab5a and Clathrin reciprocally affected their association with MM-ZC when we depleted their proteins by siRNAs. Additionally, the loss of Rab5a decreased the Syntaxin-6 association with MMZC but not vice versa. Conversely, MM-ZC treatment enhanced the association between Clathrin and Rab5a.ConclusionOverall, the current study provides valuable insights into the cellular uptake and intracellular trafficking of MM-ZC in myeloma cells. Identifying these mechanisms and molecular players involved in MM-ZC uptake contributes to a better understanding of the delivery and potential applications of cell-specific Zip-Codes in gene delivery and drug targeting in cancer research.

Spin-orbit-coupling (SOC) plays a critical role in spin-to-charge conversion (SCC) mechanism. The SCC process is usually investigated by injecting a spin current from ferromagnet (FM) into a large SOC normal metal (SOC-NM) and then measuring the voltage generated by inverse spin Hall effect (ISHE). Recently, a new mechanism of SCC at inversion symmetry breaking interfaces between topological insulators (TIs) and magnetically ordered materials has been introduced, which is driven by the inverse Rashba-Edelstein effect (IREE). Motivated by this result, we have investigated the IREE effect of a simple binary three-dimensional TI Bi85Sb15 (BiSb). The model system used here is a trilayer of FeGaB/Ag/BiSb with different Ag thickness made insitu with a combination of dc magnetron sputtering and pulsed laser ablation. The SCC efficiency has been evaluated by measuring ferromagnetic resonance (FMR) driven ISHE voltage and extraction of the Gilbert damping (α) and interfacial spin mixing conductance (g↑↓) from the FMR line shape analysis. It is interesting to note that the charge current (Ic) increases with Ag thickness. This observation indicated that the IREE process at the Ag/BiSb interface dominates over ISHE in the bulk of BiSb film. The conversion efficiency of IREE is determined by calculating the IREE length (λIREE), which increases with the thickness of the Ag layer. These findings offer a method to generate and detect the IREE in a room temperature deposited heterostructure using simple coplanar waveguide setup.

Abstract The high fat diet alters intestinal microbiota due to increased intestinal permeability and susceptibility to microbial antigens leads to metabolic endotoxemia. But probiotic juices reported for various health benefits. In this background we hypothesized that pectinase treated probiotic banana juice has diverse effects on HFD induced obesity and non-alcoholic steatohepatitis. 20 weeks fed HFD successfully induced obesity and its associated complications in experimental rats. The supplementation of probiotic banana juice for 5 months at a dose of 5 mL/kg bw/day resulted significant decrease (p

Purpose: To optimize the gypsum mold temperatures for pressed PEEK, and to estimate the impact, tensile strength and flexural properties of pressed and milled PEEK. Where appropriate, these properties were compared with those of PMMA. Materials and Methods: Since the mold temperature could affect the properties of the injected parts, the temperature of 20 gypsum specimens was monitored using the multi-thermocouple system (n = 5). A total of 210 specimens were prepared for mechanical tests according to the ISO standard for denture base polymer (n = 10). The Izod impact, tensile strength, and flexural behavior were assessed. PEEK-OptimaNI1 (PEEK-pressed) was tested after processing via the pressing method at4 different mold temperatures. Machining PEEK-Juvora (PEEK-milled) specimens were prepared using the CAD-CAM production method. Data were analyzed via one-way ANOVA performed at a confidence level of 95% and a significant P-value of (P ≤ 0.05). Results: In comparison to the furnace temperature more heat was required to preheat the gypsum mold up to 100, 150, 175 and 200 °C for pressing purposes. The highest impact strength was 5.7 kJ/m2 for PEEK-pressed at 100 °C mold temperature and 4 kJ/m2 for PEEK-milled. The latter had a higher tensile strength of 118 MPa. The best result for PEEK-pressed was 97 MPa at 200 °C mold temperature. Under a 4-point bending test, Young’s modulus of PEEK-milled was 5591 MPa, while the highest for PEEK-pressed was 4936 MPa at 200 °C mold temperature. Conclusions: Compared to PMMA, given the superior mechanical properties of PEEK, it may become the material of choice for future use. Dentures constructed from PEEK polymer could well be routinely constructed in the near future. Keywords: Polyetheretherketone, Denture base material, Impact strength, 4-point bend, Tensile strength, Mold temperature, Injection molding, CAD-CAM

Introduction: There is currently significant interest in all-ceramic dental restorations. A potential non-metallic material for such restorations is an apatite-mullite glass-ceramic that could be processed to shape using different processing techniques. The aim of this study was to assess and evaluate the ability of an apatite-mullite glass-ceramic material to be processed using three routes: lost-wax casting, hot pressing and CAD-CAM milling. Methods: A batch of glass for an apatite-mullite glass-ceramic material was produced based on the formula (4.5SiO2-3Al2O3-1.5P2O5-3CaO-0.5 CaF 2). The batch was converted into glass by heating at 1050˚C/1450˚C for two hours. The final melt was quenched to obtain a glass frit. The glass was thermally treated based on the DTA data. The sequence of crystallization and their micro structural evaluation were analysed using X-ray diffraction (XRD) and scanning electron microscopy (SEM). An anatomically correct mould of an upper right first molar was selected to trial the three different manufacturing techniques. Empress II and VITA block mark II materials were used as control materials. Results: The apatite-mullite material being evaluated can be cast and milled to shape, but the ceramic form of the material is not capable of being hot pressed. Conclusion: The materials tested show great possibility as restorative materials and could be heat treated inside and outside the investment casting material to produce a crystalline microstructure of apatite and apatite-mullite. It is possible to produce acceptable restorations using the milling technique. Hot pressing the material is not recommended due to its high liquidus temperature.

This research was carried out to design tutorials on the care of undeveloped social skills of university students, through which they express their needs, feelings, preferences, opinions and rights, respecting others and as a consequence self-reinforcement is observed and the probability of obtaining external reinforcement is maximized. The study was approached from the interpretive paradigm, qualitative approach, the projective - holistic method as a systematic process. Diagnostic information was collected from students and tutors, through interviews and focus groups, focused on behavioral, personal and situational skills. From all of this, categories and subcategories were identified that allowed choosing strategies to meet the needs. As a result, it was demonstrated that social skills, an important aspect for insertion and work performance, have not been developed despite the existence of the accompaniment of tutors. Also, the strategies used in the tutorial actions are not adequate; therefore, they must be modified. Also, it was concluded that university institutions must carry out planning processes for tutorials after diagnosis.

Measurements of magnetization [M(H, T)] and anomalous Hall resistance [Rxy(H, T)] are performed over a broad range of magnetic field (H) and temperatures (T) on sputter deposited 10 nm thick films of (FeCo)1−xGdx. The Gd content (x) in the films was changed by varying the Gd source power from 20 W to 50 W, in steps of 5 W. The saturation magnetization (Ms) of these films at 300 K shows a distinct minimum for the source power of 40 W. Measurements of M(H) for the 40 W sample at several temperatures establish full compensation of the antiferromagnetically coupled magnetic sublattices of Gd and FeCo at Tcomp = 270 K ± 10 K. The approach to compensation is characterized by the emergence of perpendicular magnetic anisotropy (PMA) and a diverging coercive field. The Rxy (H) of this sample, as well as of those prepared at 30 W and 50 W, scales with M(H) at T > Tcomp and T < Tcomp. However, this scaling fails in the vicinity of Tcomp where the Rxy undergoes a sign reversal. Our analysis of these data in the framework of the existing models for Rxy(H, T) in ferrimagnets suggests that the role of spin disorder and its topological contribution to Rxy may be necessary to account for the observed behavior. A precise identification of Tcomp is also important to stabilize technologically useful non-trivial spin textures and PMA in these systems.

Abstract Background Previous work indicated that an ultrashort pulse (USP) 425 nm laser is capable of inactivating murine norovirus (MNV: Virol. J. 11:20), perhaps via an impulsive stimulated Raman scattering (ISRS) mechanism, and does not substantially damage human plasma proteins (PLOS One 9:11). Here, further investigation of virus inactivation by laser light is performed. Methods In this study, we evaluate whether inactivation of MNV is specific to the USP wavelength of 425 nm, or if it occurs at other visible wavelengths, using a tunable mode-locked Ti-Sapphire laser that has been frequency doubled to generate femtosecond pulses at wavelengths of 400, 408, 425, 450, 465, and 510 nm. Continuous Wave (CW) lasers are also applied. Singlet oxygen enhancers are used to evaluate the sensitivity of MNV to singlet oxygen and oxygen quenchers are used to evaluate effects on virus inactivation as compared to untreated controls. Results > 3 log10 inactivation of MNV pfu occurs after irradiation with an average power of 150 mW at wavelengths of 408, 425 or 450 nm femtosecond-pulsed light for 3 h. Thus results suggest that the mechanism by which a laser inactivates the virus is not wavelength-specific. Furthermore, we also show that irradiation using a continuous wave (CW) laser of similar power at 408 nm also yields substantial MNV inactivation indicating that inactivation does not require a USP. Use of photosensitizers, riboflavin, rose bengal and methylene blue that generate singlet oxygen substantially improves the efficiency of the inactivation. The results indicate a photochemical mechanism of the laser-induced inactivation where the action of relatively low power blue laser light generates singlet oxygen. Conclusion Results suggest formation of short-lived reactive oxygen species such as singlet oxygen by visible laser light as the cause of virus inactivation rather than via an ISRS mechanism which induces resonant vibrations.

The aim of the present study was to evaluate the tolerance potential of Horse gram rhizobia to aluminium (Al) toxicity, the enhancement in pod formation, symbiotic efficiency and biosorption potential in the rhizobia inoculated Horse gram (Macrotyloma uniflorum (Lam.) Verdc.) plants. Initially, 32 isolates of Horse gram rhizobia were screened for their tolerance of Al in growth media. Among the 32 strains, HGR 4, 6, 13 and 25 that were more tolerant were inoculated individually to Horse gram plants and the plants were then screened for the ability of pod formation, symbiotic efficiency and biosorption potential. Among them, maximum pod formation was observed in Horse gram upon inoculation with HGR-6 and grown at 400 µg g-1 of Al. Maximum nodulation was observed in Horse gram upon inoculation with HGR-6 and HGR-13 grown at 200 µg g-1 Al. Leghaemoglobin content was maximum on inoculation with HGR-13 at 400 µg g-1 of Al. The strain HGR-13 has shown biosorption potential in soil and as well as in root nodules even at 300 µg g-1 of Al though it was maximum at 100 µg g-1. This study demonstrated that the Horse gram plants inoculated with Rhizobium strains HGR - 4, 6, 13 and 25, besides having nitrogen fixing ability also have the ability to grow in Al contaminated soils. Hence, Horse gram plants associated with these strains of rhizobia could be used in phytoremediation of metal (Al) contaminated soils.

Purpose: This study aims to stimulate scholarly attention and practical application pertaining to individuals recognized as "Docs." Through conducting a comprehensive analysis and acquiring a profound understanding of its many connotations, the objective is to shift attitudes and approaches concerning those who are seen to possess knowledge and value within society. Design/methodology/approach: For this study, culturally relevant pedagogies were used as theoretical frameworks in addition to Sankofa and concept explication being used as methodologies. Findings: The authors identified three themes: (1) honorary cultural practice-community nomination of "professahs" and "docs," (2) (Black) robinhoods -- cultural signifiers of distinction and relatability and (3) docs as catalysts -- elevating community via consciousness, trust and mentorship as significant understandings of this distinction. Originality/value: The study emphasizes the importance of "Docs" in both academic and social contexts. The role of "Docs" serves to alleviate potential conflicts of being a Black intellectual. This study further reveals the ways in which Docs align with, promote or possibly undermine established frameworks of thought. Finally, this study provides institutions with opportunities to consider strategies for the utilization, recognition and integration of individuals who are frequently overlooked or undervalued.

BackgroundCongenital diaphragmatic hernia (CDH) is a fetal defect comprising an incomplete diaphragm and the herniation of abdominal organs into the chest cavity that interfere with fetal pulmonary development. Though the most promising treatment for CDH is via interventional fetoscopic tracheal occlusion (TO) surgery in-utero, it has produced mixed results due to the static nature of the inserted occlusion. We hypothesize that a suitable noninvasively-actuatable, cyclic-release tracheal occlusion device can be developed to enable dynamic tracheal occlusion (dTO) implementation.ObjectiveTo conduct an in-vitro proof-of-concept investigation of the construction of thermo-responsive polymer valves designed for targeted activation within a physiologically realizable temperature range as a first step towards potential development of a noninvasively-actuatable implantable device to facilitate dynamic tracheal occlusion (dTO) therapy.MethodsSix thermo-responsive polymer valves, with a critical solution temperature slightly higher than normal physiological body temperature of 37°C, were fabricated using a copolymer of n-isopropylacrylamide (NIPAM) and dimethylacrylamide (DMAA). Three of the valves underwent ethylene oxide (EtO) sterilization while the other three served as controls for EtO-processing compatibility testing. Thermal response actuation of the valves and their steady-state flow performances were evaluated using water and caprine amniotic fluid.ResultsAll six valves consisting of 0.3-mole fraction of DMAA were tested for thermal actuation of caprine amniotic fluid flow at temperatures ranging from 30-44°C. They all exhibited initiation of valve actuation opening at ~40°C with full completion at ~44°C. The overall average coefficient of variation (CV) for the day-to-day flow performance of the valves tested was less than 12%. Based on a Student t-test, there was no significant difference in the operational characteristics for the EtO processed versus the non-EtO processed valves tested.ConclusionsWe successfully fabricated and demonstrated physiological realizable temperature range operation of thermo-responsive polymer valves in-vitro and their suitability for standard EtO sterilization processing, a prerequisite for future in-vivo surgical implantation testing.

Abstract Introduction Fetal exsanguination is a rare complication of cordocentesis. Successful correction of fetal thrombocytopenia is essential for the reduction of risks. Case Report A 25-year-old, gravida 3, P2-0-0-0-2, was referred at 27 weeks of gestation for evaluation of newly diagnosed nonimmune hydrops secondary to parvovirus infection. Despite the use of ancillary platelet transfusions to correct the severe fetal thrombocytopenia, prolonged bleeding from the cord puncture site still occurred, necessitating five intrauterine transfusions to ultimately correct the fetal anemia. Conclusions The use of a smaller-diameter procedure needle, correction of the fetal thrombocytopenia early in the procedure, and external cord compression with the ultrasound transducer were ultimately successful measures in allowing for minimal loss of transfused red cells from the intravascular compartment.

In the United Kingdom and other European Union countries guidelines for driving following a first unprovoked seizure require the risk of another seizure in the next year to be less than 20%. Using data from one clinical trial, we previously developed a prognostic model to inform driving guidelines. The objective of this work is to externally validate our published model and demonstrate its generalisability.A cohort of 620 people with a first unprovoked seizure was used to develop the original model which included variables for aetiology, first degree relative with epilepsy, seizures only while asleep, electroencephalogram, computed tomography or magnetic resonance scan result, and treatment policy. The validation cohorts consisted of 274 (United Kingdom), 305 (Italy), and 847 (Australia) people. The model was evaluated using discrimination and calibration methods. A covariate, missing from the Italian dataset, was handled via five imputation methods. Following external validation, the model was fitted to a pooled population comprising all validation datasets and the development dataset. The model was stratified by dataset.The model generalised relatively well. All methods of imputation performed fairly similarly. At six months, the risk of a seizure recurrence following a first ever seizure, based on the pooled datasets, is 15% (95% CI: (12% to 18%)) for patients who are treated immediately and 18% (95% CI: (15 to 21%)) otherwise. Individuals can be reliably stratified into risk groups according to the clinical factors included in the model.Our prognostic model, used to inform driving regulations, has been validated and consequently has been proven as a valuable tool for predicting risk of seizure recurrence following a first seizure in people with various combinations of risk factors. Additionally, there is evidence to support one worldwide overall prognostic model for risk of second seizure following a first.

Recently suggested magnifying Maxwell fisheye lenses, which are made of two half-lenses of different radii, have been fabricated and characterized. The lens action is based on control of polarization-dependent effective refractive index in a lithographically formed tapered waveguide. We have studied wavelength and polarization dependent performance of the lenses, and their potential applications in waveguide mode sorting.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of death, particularly in developing countries. Little is known about the effects of economic development on COPD mortality, although economic development may potentially have positive and negative influences over the life course on COPD. We took advantage of a unique population whose rapid and recent economic development is marked by changes at clearly delineated and identifiable time points, and where few women smoke, to examine the effect of macro-level events on COPD mortality. METHODS: We used Poisson regression to decompose sex-specific COPD mortality rates in Hong Kong from 1981 to 2005 into the effects of age, period and cohort. RESULTS: COPD mortality declined strongly over generations for people born from the early to mid 20th century, which was particularly evident for the first generation to grow up in a more economically developed environment for both sexes. Population wide COPD mortality decreased when air quality improved and increased with increasing air pollution. COPD mortality increased with age, particularly after menopause among women. CONCLUSIONS: Economic development may reduce vulnerability to COPD by reducing long-lasting insults to the respiratory system, such as infections, poor nutrition and indoor air pollution. However, some of these gains may be offset if economic development results in increasing air pollution or increasing smoking.

BACKGROUND: Little is known about the effect of physical exercise on influenza-associated mortality. METHODS AND FINDINGS: We collected information about exercise habits and other lifestyles, and socioeconomic and demographic status, the underlying cause of death of 24,656 adults (21% aged 30-64, 79% aged 65 or above) who died in 1998 in Hong Kong, and the weekly proportion of specimens positive for influenza A (H3N1 and H1N1) and B isolations during the same period. We assessed the excess risks (ER) of influenza-associated mortality due to all-natural causes, cardiovascular diseases, or respiratory disease among different levels of exercise: never/seldom (less than once per month), low/moderate (once per month to three times per week), and frequent (four times or more per week) by Poisson regression. We also assessed the differences in ER between exercise groups by case-only logistic regression. For all the mortality outcomes under study in relation to each 10% increase in weekly proportion of specimens positive for influenza A+B, never/seldom exercise (as reference) was associated with 5.8% to 8.5% excess risks (ER) of mortality (P

BackgroundThe impact of influenza on morbidity and hospitalization in the tropics and subtropics is poorly quantified. Uniquely, the Hong Kong Special Administrative Region has computerized hospital discharge diagnoses on 95% of total bed days, allowing disease burden for a well-defined population to be accurately assessed.Methods and findingsInfluenza-associated morbidity and hospitalization was assessed by Poisson regression models for weekly counts of hospitalizations in Hong Kong during 1996 to 2000, using proportions of positive influenza types A (H1N1 and H3N2) and B isolations in specimens sent for laboratory diagnosis as measures of influenza virus circulation. We adjusted for annual trend, seasonality, temperature, and relative humidity, as well as respiratory syncytial virus circulation. We found that influenza was significantly associated with hospitalization for acute respiratory disease (International Classification of Diseases version 9 codes [ICD9] 460-466 and 480-487) and its subcategory pneumonia and influenza (ICD9 480-487) for all age groups. The annual rates of excess hospitalization per 100,000 population for acute respiratory diseases for the age groups 0-14, 15-39, 40-64, 65-74, and 75+ were 163.3 (95% confidence interval [CI], 135-190), 6.0 (95% CI, 2.7-8.9), 14.9 (95% CI, 10.7-18.8), 83.8 (95% CI, 61.2-104.2), and 266 (95% CI, 198.7-330.2), respectively. Influenza was also associated with hospitalization for cerebrovascular disease (ICD9 430-438) for those aged over 75 y (55.4; 95% CI, 23.1-87.8); ischemic heart disease (ICD9 410-414) for the age group 40-64 y (5.3; 95% CI, 0.5-9.5) and over 75 y (56.4; 95% CI, 21.1-93.4); and diabetes mellitus (ICD9 250) for all age groups older than 40 y.ConclusionsInfluenza has a major impact on hospitalization due to cardio-respiratory diseases as well as on cerebrovascular disease, ischemic heart disease, and diabetes mellitus in the tropics and subtropics. Better utilization of influenza vaccine during annual epidemics in the tropics will enhance global vaccine production capacity and allow for better preparedness to meet the surge in demand that is inevitable in confronting a pandemic.

This research was carried out to design tutorials on the care of undeveloped social skills of university students, through which they express their needs, feelings, preferences, opinions and rights, respecting others and as a consequence self-reinforcement is observed and the probability of obtaining external reinforcement is maximized. The study was approached from the interpretive paradigm, qualitative approach, the projective-holistic method as a systematic process. Diagnostic information was collected from students and tutors, through interviews and focus groups, focused on behavioral, personal and situational skills. From all of this, categories and subcategories were identified that allowed choosing strategies to meet the needs. As a result, it was demonstrated that social skills, an important aspect for insertion and work performance, have not been developed despite the existence of the accompaniment of tutors. Also, the strategies used in the tutorial actions are not adequate; therefore, they must be modified. Also, it was concluded that university institutions must carry out planning processes for tutorials after diagnosis.