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La enseñanza de las matemáticas en el aula multigrado está a cargo de un docente que es responsable de atender más de dos grados, simultáneamente. Estas escuelas multigrado se presentan debido a la necesidad de atender a los niños y niñas que, por lo general, viven en sectores rurales pequeños y aislados, con pocos recursos económicos y sin acceso a tecnologías; de ahí la importancia de ser muy creativos y recursivos en estos centros pedagógicos y lograr una formación digna e integrada para los estudiantes. Esta investigación tiene como objetivo realizar una caracterización del proceso de enseñanza y aprendizaje de las matemáticas en el aula multigrado, mediante un enfoque de tipo cualitativo bajo la metodología del análisis documental. Para el estudio se han revisado documentos científicos desarrollados en los últimos 15 años, identificando aspectos asociados a la temática. Igualmente, se realizó un análisis a 18 entrevistas de educadores expertos en el aula multigrado y/o en la educación matemática, lo cual generó un aporte al proceso de enseñanza y aprendizaje de las matemáticas. Los resultados encontrados evidencian la falta de capacitación y orientación a los docentes multigrado, como el potencial que tienen estas aulas para el desarrollo del pensamiento matemático.

Objectives. Defining eligibility for preexposure prophylaxis (PrEP) is key to measuring the degree of PrEP implementation. While the clinical exclusion criteria are identical across different guidelines, definitions of substantial HIV risk are not. In this study, we aimed to estimate the proportion of men who have sex with men (MSM) being tested at a community-based voluntary human immunodeficiency virus (HIV) counseling and testing center in Lisbon that would be eligible for PrEP according to guidelines from the World Health Organization (WHO), the US Public Health Service and Centers for Disease Control and Prevention (US-CDC), the European AIDS Clinical Society (EACS), and the Portuguese National Health Service (PNHS). Methods. We used baseline data from 3392 HIV-negative MSM with valid information on eligibility for PrEP enrolled in the Portuguese Lisbon Cohort of MSM—an observational study designed as an open prospective, noninterval cohort—between March 2014 and March 2018. Results. At baseline, the proportion of MSM eligible for PrEP was 67.7% according to the US-CDC, 60.6% according to the PNHS guidelines, 58.9% according to the WHO, and 46.5% according to the EACS guidelines. The most frequently met criteria were those related to condomless anal intercourse. Conclusions. In conclusion, in the same population, the proportion of men eligible for PrEP differed by guideline, ranging from 46.5% to 67.7%, though if they all seem to include the same well-known predictors of HIV seroconversion. Policy implications. These results show that both the allocation of resources and the approaches to individual risk prediction are highly dependent on the chosen guideline. Moving the focus from assessing risk to assessing whether PrEP is a suitable option for a given individual in a given moment of his life might help to overcome guidelines limitations and create more equitable access. This study was partially funded by FEDER funds through the Operational Programme for Competitiveness and Internationalization and by national funds of Fundação para a Ciência e Tecnologia (FCT), under the scope of the Research Unit of Epidemiology – Institute of Public Health of the University of Porto (EPIUnit) (POCI-01-0145-FEDER-006862; ref. UID/DTP/04750/2013); Paula Meireles was the recipient of PhD grant SFRH/BD/112867/2015 co-funded by the FCT and the Programa Operacional Capital Humano/Fundo Social Europeu (POCH/FSE) Program.

Lecanicillium lecanii is an entomopathogenic fungus used commercially as a biocontrol alternative in agriculture and horticulture. Inside the infection process enzymes and proteins such as chitinases, proteases, lipases and hydrophobins are produced. In the classification of chitinases are β-N-acetylglucosaminidases; which are enzymes capable of hydrolyzing at the non-reducing ends of N-acetylD-glucosamine (GlcNAc) residues of chitin oligosaccharides, releasing GlcNAc monomers. In addition to hydrolyzing Hex has been found to be capable of carrying out transglycosylation (TGA), transferring an oligosaccharide to a suitable acceptor to form a new glycosidic bond; Thus, obtaining oligosaccharides with a specific degree of polymerization and acetylation. Therefore, the objective of the present work was to purify the Hex and hydrophobins of Lecanicillium lecanii in submerged culture. In the first experimental stage, the Hex was purified obtaining a pure enzyme of 50 kDa. Its TGA activity on donor substrates was evaluated, producing transglycosylated oligosaccharides with a degree of polymerization between 2 and 6 with various degrees of acetylation. In the second experimental stage, the Hex peptides were identified and sequenced, which presented identity with a Rhizopus oligosporus chitinase. Additionally, different substrates were evaluated from those used in the first stage, to carry out TGA, where Hex was able to transglycosylate without requiring an acceptor substrate, producing oligosaccharides with a degree of polymerization of 3 to 6. In the third experimental stage, by circular dichroism spectroscopy, it was observed that there are no changes in the secondary structure of Hex, when carrying out the hydrolysis reaction or TGA evaluating different temperatures and pH values, which was attributed to local changes. in the amino acids of the active site. Finally, in the fourth stage, it was possible to purify a hydrophobin class I of 12 kDa from the biomass obtained from the submerged culture, this protein allowed modifying hydrophobic and hydrophilic surfaces. Lecanicillium lecanii es un hongo entomopatógeno utilizado comercialmente como una alternativa de biocontrol en agricultura y horticultura. Dentro del proceso de infección se producen enzimas y proteínas tales como quitinasas, proteasas, lipasas e hidrofobinas. En la clasificación de las quitinasas se encuentran las β-N-acetilglucosaminidasas; que son enzimas capaces de hidrolizar en los extremos no reductores de los residuos de N-acetil-Dglucosamina (GlcNAc) de los oligosacáridos de quitina, liberando monómeros de GlcNAc. Se ha visto que las Hex además de hidrolizar son capaces de llevar a cabo transglicosilación (TGA), transfiriendo un oligosacárido a un aceptor adecuado para formar un nuevo enlace glucosídico; obteniendo así oligosacáridos con grado específico de polimerización y acetilación. Por lo anterior, el objetivo del presente trabajo fue purificar las Hex e hidrofobinas de Lecanicillium lecanii en cultivo sumergido. En la primera etapa experimental, se purificó la Hex obteniendo una enzima pura de 50 kDa. Se evaluó su actividad TGA sobre sustratos donadores, produciendo oligosacáridos transglicosilados con un grado de polimerización entre 2 y 6 con varios grados de acetilación. En la segunda etapa experimental se identificaron y secuenciaron los péptidos de Hex, los cuales, presentaron identidad con una quitinasa de Rhizopus oligosporus. Adicionalmente, se evaluaron sustratos diferentes a los empleados en la primera etapa, para llevar acabo TGA, donde Hex fue capaz de transglicosilar sin requerir un sustrato aceptor, produciendo oligosacáridos con grado de polimerización de 3 a 6. En la tercera etapa experimental, mediante espectroscopía de dicroísmo circular se observó que Hex no sufre cambios en su estructura secundaria al llevar acabo la reacción de hidrolisis y/o la TGA, o incluso evaluando diferentes temperaturas y valores de pH, lo que se atribuyó a cambios locales en los aminoácidos del sitio activo. Finalmente, en la cuarta etapa, se logró purificar una hidrofobina de clase I de 12 kDa a partir de la biomasa obtenida del cultivo sumergido, esta proteína permitió modificar superficies hidrofóbicas e hidrofílicas.

The development of capitalism has turned cities into merchandise, making it increasingly difficult to inhabit them. In this sense, social movements act as mobilizers of a society that claims what is its own, that demands to be able to live, enjoy and actively interact in the spaces that surround it. This article focuses on the description of the effects of the squatting movement understood as a process of social intervention in the urban environment. Through the appropriation of empty spaces, the squatter movement intervenes in the construction of relationships and support networks maintained by the people who inhabit and participate in those places. The results show us that through direct interaction and a horizontal organization, without hierarchies, it is possible to provide people with tools and processes to inhabit their neighborhoods and superimpose the value of use and experience to the value of exchange. Thus, the conclusions make itpossible to make visible how a social movement such as squatting can become an instrument of urbanintervention, while emphasizing the importance of self-management and direct social action for people toorganize, self-manage and act about the environment they want to inhabit. El desarrollo del capitalismo ha convertido las ciudades en mercancía haciendo cada vez más difícil habitarlas. En este sentido, los movimientos sociales actúan como movilizadores de una sociedad que reclama lo que es suyo, exige poder vivir, disfrutar e interactuar activamente en los espacios que le rodean. Este artículo se centra en la descripción de los efectos del movimiento de okupación entendido como un proceso de intervención social en el entorno urbano. A través de la apropiación de espacios vaciados, el movimiento okupa interviene en la construcción de relaciones y redes de apoyo que mantienen las personas que habitan y participan de esos lugares. Los resultados nos muestran que a través de la interacción directa y una organización horizontal, sin jerarquías, es posible dotar a las personas de herramientas y procesos para habitar sus barrios y sobreponer el valor de uso y experiencia al valor de cambio. Así, las conclusiones permiten visibilizar cómo un movimiento social como el de okupación puede convertirse en un instrumento de intervención urbana, a la vez que se recalca la importancia de la autogestión y de la acción social directa para que las personas se organicen, autogestionen y actúen sobre el entorno que quieren habitar.

Hermansky–Pudlak syndrome (HPS) is a multisystemic autosomal recessive disorder characterized by oculocutaneous albinism, bleeding diathesis, and lethal pulmonary fibrosis (PF) in some HPS subtypes. During middle adulthood, ground-glass opacities, reticulation, and traction bronchiectasis develop with progression of PF. HPS is an orphan disease occurring in 1 in 500,000 to 1,000,000 individuals worldwide, though the prevalence is 1 in 1,800 in individuals with Puerto Rican heritage. Recessive mutations or disruptions in HPS genes alter the function of HPS proteins which are components of biogenesis of lysosome-related organelle complexes and are critical for intracellular protein trafficking. Diagnosis and management of HPS-related comorbidities represent a challenge to physicians, and a multidisciplinary clinical approach is necessary for early detection, health management, and surveillance of PF in patients with HPS types 1, 2, and 4. Treatment options for individuals with HPS-PF include pirfenidone and lung transplantation. In this article, we describe the epidemiology, genetics, clinical manifestations, and management of HPS.

Background: Survival of infants with complex care has led to a growing population of technology-dependent children. Medical technology introduces additional complexity to patient care. Outcomes after NICU discharge comparing Usual Care (UC) with Comprehensive Care (CC) remain elusive. Objective: To compare the outcomes of technology-dependent infants discharged from NICU with tracheostomy following UC versus CC. Methods: A single site retrospective study evaluated forty-three (N=43) technology-dependent infants discharged from NICU with tracheostomy over 5½ years (2011-2017). CC provided 24-hour accessible healthcare-providers using an enhanced medical home. Mortality, total hospital admissions, 30-days readmission rate, time-to-mechanical ventilation liberation, and time-to-decannulation were compared between groups. Results: CC group showed significantly lower mortality (3.4%) versus UC (35.7%), RR, 0.09 [95%CI, 0.12-0.75], P=0.025. CC reduced total hospital admissions to 78 per 100 child-years versus 162 for UC; RR, 0.48 [95% CI, 0.25-0.93], P=0.03. The 30-day readmission rate was 21% compared to 36% in UC; RR, 0.58 [95% CI, 0.21-1.58], P=0.29). In competing-risk regression analysis (treating death as a competing-risk), hazard of having mechanical ventilation removal in CC was two times higher than UC; SHR, 2.19 [95% CI, 0.70-6.84]. There was no difference in time-to-decannulation between groups; SHR, 1.09 [95% CI, 0.37-3.15]. Conclusion: CC significantly decreased mortality, total number of hospital admissions and length of time-to-mechanical ventilation liberation.

Background: Children admitted to the Pediatric Intensive Care Unit (PICU) with status asthmaticus have variable clinical courses, and predicting their outcomes is challenging. Identifying characteristics in these patients that may require more intense intervention is important for clinical decision-making. Objective: This study sought to determine the characteristics and outcomes, specifically length of stay and mortality, of atopic versus non-atopic asthmatics admitted to a PICU with status asthmaticus. Methods: A retrospective study was conducted at a children’s hospital from November 1, 2008 to October 31, 2013. A total of 90 children admitted to the PICU were included in the analysis. Patients were divided into two groups based on the presence of specific historical data indicative of a clinical history of atopy. Children were considered to be atopic if they had a parental history of asthma, a personal history of eczema, or a combined history of wheezing (apart from colds) and allergic rhinitis (diagnosed by a medical provider). The median hospital Length Of Stay (LOS), PICU LOS, cardiopulmonary arrest, and mortality were compared between atopic and non-atopic asthma groups. Regression models were used to estimate the LOS stratified by atopic or non-atopic and by history of intubation in present hospitalization. Results: Median hospital LOS for atopic children was 5.9 days (IQR of 3.8-8.7) and 3.5 days (IQR of 2.2-5.5) for non-atopic asthmatics (z = 2.9, p = 0.0042). The median PICU LOS was 2.5 days (IQR 1.4-6.1) for atopic asthmatics and 1.6 days (IQR 1.1-2.4) for non-atopic asthmatics (z = 2.5, p = 0.0141). The median LOS was significantly higher for atopic intubated patients compared to non-atopic intubated patients (p=0.021). Although there was an increased tendency towards intubation in the atopic group, the difference was not significant. There was no significant difference in cardiopulmonary arrest or mortality. Conclusion: A clinical history of atopic asthma in children admitted to the PICU with status asthmaticus was associated with longer length of stays The longest LOS was observed when atopic patients required intubation.