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Abstract Local economic development is becoming an increasingly important activity as it addresses the economic and employment challenges faced by all developing countries. Therefore, the purpose of this study was to determine the entrepreneurial skills of university students for the promotion of local economic development. A quantitative, non-experimental, cross-sectional, and interpretative causal approach was adopted for the research. The sample consisted of 240 students chosen through non-probabilistic convenience sampling. Questionnaires were used as a tool for data collection, validated by expert judgment in the field, with a reliability of 98.2% determined by the Cronbach’s alpha coefficient, and the survey was employed as a technique. Inference results provided by ordinal logistic regression, using the model goodness-of-fit test, χ 2 = 203.902, allowed demonstrating the explanatory variable. The goodness of fit for deviation was p = 0.099, determining the presence of an effect corresponding to the Nagelkerke predictor = 64.4% of the explained variability in the dependent variable. It was concluded that improving the entrepreneurial skills of university students has a significant positive effect on enhancing local economic development. Therefore, harnessing the entrepreneurial skills of university students requires a combination of educational approaches, financial support, networks, and specific policies. Collaboration among different stakeholders, including government, the private sector, and academic institutions, is essential to achieve a significant impact on local economic development.

La estrategia didáctica basada en el método científico es fundamental para promover el desarrollo de habilidades de indagación y experimentación en los estudiantes. Esta investigación descriptiva tiene como objetivo determinar el nivel de mejora de la capacidad de indagación y experimentación en estudiantes en el área de ciencia y ambiente, a través de la aplicación de estrategias didácticas basadas en el método científico. La población de estudio está constituida por los alumnos del primero al sexto grado de educación primaria de la Institución Educativa No. 18438 “Nuevo Progreso”, Omia, Rodríguez de Mendoza, Amazonas-Perú, utilizando una muestra de 38 estudiantes a los que se aplicó un pre-test y post-test. Los resultados encontraron que la implementación de estrategias didácticas fundamentadas en el método científico resultó en una mejora significativa en el desarrollo de la capacidad de indagación y experimentación en dicha área en los estudiantes de Educación Primaria. Por lo cual se concluye que el uso del método científico es valioso y puede tener un impacto positivo tanto en su aprendizaje como en su desarrollo profesional.

El moldeado y vaciado de rostros, manos y pies formó parte de las diversas estrategias de conocimiento de los antropólogos desde el siglo XIX. Este estudio se centra en una colección de máscaras faciales obtenidas por el antropólogo alemán Otto Finsch a partir de sujetos vivos de pueblos nativos de Oceanía y conservadas en el Museo de La Plata, Argentina. Analizamos los materiales, archivos y catálogos; también, testimonios orales de trabajadores del museo que estuvieron en contacto con esta colección. En primer lugar, revisamos cómo surgieron estas máscaras, cómo fueron adquiridas por este museo, cómo fueron exhibidas y qué sucedió con ellas después de que fueron retiradas de la exposición. En segundo lugar, comentamos algunos puntos de discusión en torno a esta colección partiendo del supuesto de que estos materiales representan un patrimonio científico que no sólo da cuenta de la historia de la antropología y el contexto en el que se constituyó, sino que también es factible de ser reactivado en nuevas narrativas.

Background: Tuberculosis (TB) is one of the leading causes of death worldwide. However, an accurate diagnosis contributes to timely treatment, reducing its adverse consequences. The aim of this research was to determine the diagnostic accuracy of the molecular test Xpert MTB/RIF and Xpert MTB/RIF Ultra (Xpert Ultra) for the diagnosis of pulmonary and extrapulmonary TB compared to Löwenstein-Jensen culture. Methods: We conducted a cross-sectional study of diagnostic accuracy. We included samples from patients who attended a Peruvian laboratory between 2011 and 2022. The index test was the Xpert MTB/RIF and Xpert Ultra and the reference standard was Löwenstein-Jensen solid culture for Mycobacterium tuberculosis. We calculated sensitivity, specificity, and positive and negative likelihood ratios. Results: We evaluated 1023 samples, of which 737 were pulmonary samples, 197 tested positive for the Xpert MTB/RIF and Xpert Ultra tests; and 151 tested positive for culture. The Xpert (MTB/RIF and Ultra) showed a joint sensitivity and specificity of: 97 % (95%CI: 93–99) and 93 % (95%CI: 91–95) in pulmonary samples, 100 % (95%CI: 29.2–100) and 98.3 % (95%CI: 94.1–99.8) in cerebrospinal fluid, 66.7 % (95%CI: 22.3–95.7) and 96.8 % (95%CI: 91–99.3) in pleural fluid, 100 % (95%CI: 15.8–100) and 94.3 % (95%CI: 80.8–99.3) in urine. For the detection of pulmonary TB, the Xpert MTB/RIF had a sensitivity and specificity of 97.1 % (95%CI: 89.9–99.6) and 95.6 % (95%CI: 92.9–97.5) and the Xpert Ultra of 97 % (95%CI: 88.5–99.6) 89.5 % (95%CI: 84.9–93.1) respectively. Conclusion: Our results suggest that the Xpert MTB/RIF and the Xpert Ultra are tests with high diagnostic performance for the detection of pulmonary TB and adequate specificity in pulmonary, cerebrospinal fluid, pleural, and urine samples. However, the results for other samples were imprecise.

The franciscana Pontoporia blainvillei is the only extant member of the family Pontoporiidae, and its occurrence is restricted to coastal waters from Brazil to Argentina. The species is one of the most threatened cetaceans in the southwestern Atlantic Ocean, due to unsustainable bycatch levels. A total of 11 Franciscana Management Areas (FMAs) have been defined throughout the species’ range. FMA Ia represents the northernmost franciscana population, demographically isolated on the north coast of Espírito Santo State, Brazil. In March 2018, aerial surveys were conducted to assess the distribution and estimate the abundance of franciscanas in FMA Ia. A total of 2986 km of survey effort was conducted, and 27 groups were seen (average group size: 2.52 ind., coefficient of variation [CV] = 0.50) in coastal habitats (average distance from the shore: 3.3 km, CV = 0.70). Abundance, corrected for visibility bias and group size bias, was estimated at 1183 (CV = 0.76) individuals, and the potential biological removal was computed at 1. Results suggest that at least during the summer, franciscanas in ES are distributed in coastal habitats between Conceição da Barra and Santa Cruz, with a high-density area observed near the estuary mouth of the Doce River. This is one of the smallest of all franciscana populations and one with a restricted range. The estimated abundance indicates that the ES population qualifies for listing as Endangered under IUCN Red List criterion C2a(ii). In order to reduce threats to this population, management actions are urgently needed.

Introduction: Ultrasound-guided nerve blocks (UGNB) represent a procedural skill set that can be used to treat acute pain by physicians in the emergency department (ED). However, limited access to education and training represents a barrier to widespread adoption of this core skill set. The implementation of UGNBs within the ED can aid in resource allocation, particularly in limited-resource settings.Case Series: In this case series we discuss our experience using tele-ultrasound to train emergency physicians on the use of UGNBs within our international point-of-care ultrasound fellowship in Peru. We highlight the potential role UGNBs serve in management of acute pain when working in resource-limited, public safety-net hospitals in Peru.Conclusion: Tele-ultrasound may represent a strategy for teaching procedures such as UGNBs via remote guidance and supervision.

Objetivo. Determinar la concordancia entre cinco criterios diagnósticos de síndrome metabólico (SM) entre adolescentes residentes de una zona altoandina del Perú. Materiales y métodos. Se realizó un estudio transversal con datos secundarios de un estudio de intervención en dos escuelas públicas en el año 2019. Participaron 397 adolescentes que residen en la ciudad de Cajamarca ubicada en la región andina del Perú. Se aplicaron cinco criterios diagnósticos: Third Adult Treatment Panel (ATP-III) modificados por Cook, de la Federación Internacional de Diabetes (IDF), de la American Heart Association (AHA), de Ferranti, y de la Organización Mundial de Salud (OMS). Se estimaron las prevalencias puntuales y de intervalo con los cinco criterios. Se estimó el coeficiente de concordancia de Kappa con su respectivo intervalo de confianza al 95% (IC 95%). Resultados. El criterio de Ferranti identificó un 17,1% (IC 95%: 13,4 a 20,8) de adolescentes con SM, seguido del criterio de la ATP-III con 4,3% (IC 95%: 2,3 a 6,3); los demás criterios identificaron una menor frecuencia. La mejor concordancia fue encontrada entre los criterios de la AHA y la ATP-III (k = 0,905), los criterios de la OMS e IDF tuvieron un coeficiente de 0,628. Los cinco criterios coincidieron en clasificar como SM a seis adolescentes (1,5%). Conclusiones. Los criterios de la AHA y la ATP-III modificados por Cook tuvieron una concordancia casi perfecta, que se mantuvo en ambos sexos. Los criterios ATP-III, de Ferranti, IDF, AHA y OMS concuerdan en menos del 2% en identificar SM en el mismo grupo de adolescentes.

Abstract The Atlantic goliath grouper Epinephelus itajara is the largest grouper species in the Atlantic Ocean. Despite the conservation status being Vulnerable (VU) globally and Critically Endangered (CR) in Brazil, the species continues to face threats from overfishing throughout its range. We used DNA barcoding employing the mitochondrial Cytochrome c oxidase subunit I (COI) gene to identify the illegal commercialization of E. itajara in fish markets from the northern (NC) and southern (SC) Brazilian coasts. Sampling was conducted in fish markets and aimed to confirm the identification of mischaracterized fish sold as E. itajara in the NC, as well as identifying fish fillets sold as the Dusky grouper in the SC. DNA barcoding allowed the unambiguous identification of 22 (84.6%) of the 26 analyzed fish market samples. Both sampled areas had confirmation of E. itajara illegal commercialization and from the 22 analyzed samples, 17 (77.3%) were confirmed to be E. itajara. Here we report two crimes, the illegal sale of E. itajara and commercial fraud by species substitution. This study has highlighted that the existing legislation that protects E. itajara in Brazilian waters requires the adoption of better public policies for the conservation of the species.

Point-of-care ultrasound (POCUS) enables physicians to make critical diagnosis and treatment decisions at the bedside. However, access to and expertise with this technology remain limited in Peru. Establishing longitudinal POCUS educational curriculums in remote, low-resource settings can be challenging due to geographical distances, encumbering the ability to provide ongoing hands-on support. Previously described educational interventions have focused on training individual users on clinical applications of POCUS, rather than training physicians how to teach POCUS, thereby limiting scalability and sustainable impact. We therefore describe our experiences establishing the first ultrasound fellowship curriculum in Peru, which incorporates tele-ultrasonography to circumvent traditional geographical barriers.

Actualmente, las redes sociales poseen un impacto directo en las sociedades. De esta manera, se evidencian transformaciones aceleradas en los diversos grupos sociales, concretamente en el sector juvenil, todo ello debido a que dicho sector es el más vinculado a este contexto tecnológico. Es por ello que, el objetivo estuvo enfocado a determinar el vínculo entre el clima social familiar y la adicción a las redes sociales en educandos de nivel secundario de una Institución Educativa de Chiclayo. Para ello se realizó un estudio con un enfoque cuantitativo, de tipo básico, y con un diseño no experimental y nivel correlacional. Los resultados constatan la relación inversa y significativa entre ambos constructos con un grado moderado. Asimismo, se evidencia que la adicción a las redes sociales irrumpe y afecta el clima sociofamiliar de los educandos que cursan el nivel secundario. Así, resulta necesario que se lleven a cabo diversos estudios que profundicen sobre esta temática, puesto que este sector emerge como el principal consumidor de nuevas tecnologías, específicamente de las denominadas redes sociales.

Fluidized bed boiler fly ash, previously calcined at 650 °C (FAT), was used to obtain geopolymers, after treatment with 8 M, and 10 M NaOH, as well with sodium silicate (silicate modulus MS = 2.5). The volume ratio of alkaline activating solution/FAT = 0.38 L/kg was kept constant; whereas that the molar ratios SiO2/Na2O = 1.18–1.50, and H2O/Na2O = 14.7–20.4, was used. The addition of extra water to the geopolymeric paste was done in two ways, in order to determine the effect on the dissolution rate of aluminosilicates and the strength development of the geopolymers obtained. By pre-grinding the FAT, controlling the mixing time, the H22O/Na22O ratio = 14.7 and thermal activation at 80 °C for 24 h, it was possible to obtain geopolymers with high strengths

Fly ashes from the fluidized bed boiler were used to obtain zeolites by the alkaline fusion process, followed by a hydrothermal procedure. The melting was carried out with 98 % granulated NaOH, mixed with ashes in mass ratios 1.2/1, 1.4/1 and 1.6/1 and using three melting temperatures, 450 °C, 550 °C and 650 °C. For the crystallization of the zeolites, the hydrothermal procedure at 90 °C was used. The crystalline phases of the zeolitic materials were quantified by XRD analysis. The morphology of the crystals was identified by SEM. The FTIR spectra revealed that the transformation of sodalite mineral to zeolite A and zeolite X increased with the NaOH/CVT ratio and the temperature.

Many studies found that increased arterial stiffness is significantly associated with the presence and progression of Coronary Calcium Score (CCS). However, none so far have used machine learning algorithms to improve their value. Therefore, this study aims to evaluate the association between carotid-femoral Pulse Wave Velocity (cfPWV) and CCS score through computational clustering. We conducted a retrospective cross-sectional study using data from a cardiovascular risk screening program that included 377 participants. We used an unsupervised clustering algorithm using age, weight, height, blood pressure, heart rate, and cfPWV as input variables. Differences between cluster groups were analyzed through Chi-square and T-student tests. The association between (i) cfPWV and age groups, (ii) log (CCS) and age groups, and (iii) cfPWV and log(CCS) were addressed through linear regression analysis. Clusters were labeled post hoc based on cardiovascular risk. A “higher-risk group” had significantly higher left (0.76 vs. 0.70 mm, P

Objetivo: Estimar el efecto de una intervención educativa basada en nutrición y estilos de vida saludables para incrementar la proporción de adolescentes libres de componentes del síndrome metabólico. Materiales y métodos: Se realizó un estudio preexperimental en una muestra representativa de adolescentes de dos escuelas de un distrito altoandino del Perú (ciudad de Cajamarca); 388 estudiantes completaron la intervención, así como la medición basal y la posintervención. La intervención tuvo nueve ejes temáticos, cada uno fue desarrollado en una sesión educativa de 45 min cada dos semanas. Se usó los criterios del National Cholesterol Education Program Expert Panel and Adult Treatment Panel III para el síndrome metabólico. Se realizó la comparación de proporciones pareadas (prueba de McNemar) para determinar el impacto de la intervención. Resultados: En la medición basal, el 20,4% (IC95%: 16,2 a 24,5) no tenía componentes de SM, posintervención dicha proporción se incrementó a 32,5% (IC95%: 27,7 a 37,3), la diferencia de proporciones fue 12,1% (IC95%: 7,5 a 16,8; p0,001). La prevalencia de síndrome metabólico fue 4,6% (IC95%: 2,4 a 6,9) basalmente; posintervención fue 2,3% (IC95%: 0,7 a 3,9). La diferencia de proporciones fue 2,3%, (IC95%: 0,3 a 3,2; p=0,022). Entre los componentes, la mayor reducción fue en la proporción de hipertrigliceridemia (diferencia de proporciones: 21,9%, IC95%: 16,9 a 26,9; p0,001), también se observó una reducción significativa de la hipertensión arterial (diferencia de proporciones: 3,1%, IC95%: 0,6 a 5,6; p=0,025). En los demás componentes no hubo diferencias significativas. Conclusiones: La intervención educativa incrementó en un 59,3% la proporción de estudiantes libres de algún componente del síndrome metabólico.

Background: Drug utilization research (DUR) is used to provide evidence-based data to inform policies and make decisions. The aim of this study was to map and describe available data sources for drug utilization research in Peru.Methods: We performed a search of data sources providing information on medication use on the website of governmental organizations. We also conducted a literature review using PubMed, LILACs, and BVS. Independently, researchers screened eligible data sources. Data characterization included accessibility, coverage data provider, type of data sources, and setting. We performed a descriptive analysis.Results: We identified seven data sources, CENAFyT, ICI, IDI (SISMED), and ENSUSALUD from MINSA, and CRI-ESSALUD, SGSS/ESSI, and ENSSA from ESSALUD. These presented information on adverse drug reactions (n = 2), drug consumption, and distribution (n = 2), prescription and drug dispensing (n = 1), and surveys addressed to medication users (n = 2). ENSUSALUD was the only data source publicly available. VIGIFLOW and ENSUSALUD have a national granularity from the public and private sectors. The setting of the data sources was both hospital and ambulatory care. Two data sources have individual-level data on adverse drug reactions and one on prescriptions. Four studies on drug utilization research in Peru were derived from ENSUSALUD.Conclusion: In Peru, few data sources are available for drug utilization research. There is an increased need to monitor medications for decision-making purposes. Local and international initiatives and partnerships of the government with academic institutions and the private sector might be a good strategy to increase the transparency of health data and for supporting decision-making using drug utilization research.

La gobernanza se manifiesta cuando la toma de decisiones públicas proviene de un poder colectivo, es decir, conformado por las autoridades públicas, la sociedad civil y el sector privado, con igualdad en sus decisiones. El objetivo de la investigación fue analizar las políticas públicas y gobernanza participativa local desde la mirada de los colaboradores de una municipalidad de Lima, la investigación se enmarca dentro del paradigma interpretativo o naturalista; fue de enfoque cualitativo, diseño fenomenológico, teniendo como muestra 13 personas, constituida por colaboradores que laboran en la municipalidad, vecinos del distrito de Lima. El instrumento utilizado fue la entrevista semi estructurada. Los resultados indican que las políticas públicas municipales, se implementan desde de actividades puntuales, desarticuladas y desvinculadas con los instrumentos de gestión del gobierno local, asimismo no responden a los lineamientos de la política nacional definida por el gobierno peruano. Se necesita una gobernanza en función de la participación ciudadana interviniendo los actores a nivel público, privado y sociedad civil para conocer las necesidades básicas de la ciudadanía y, a partir de la elaboración de políticas públicas, produzca un impacto positivo en la población, buscando una integración vecinal.

Al conmemorar este año el Bicentenario de la Independencia del Peru, no podemos dejar de mencionar aspectos de la historia de la cardiología y cirugía cardiovascular en el país y los aportes que estas especialidades han realizado a la sociedad.

Introduction: Ultrasound-guided nerve blocks (UGNB) represent a procedural skill set that can be used to treat acute pain by physicians in the emergency department (ED). However, limited access to education and training represents a barrier to widespread adoption of this core skill set. The implementation of UGNBs within the ED can aid in resource allocation, particularly in limited-resource settings. Case Series: In this case series we discuss our experience using tele-ultrasound to train emergency physicians on the use of UGNBs within our international point-of-care ultrasound fellowship in Peru. We highlight the potential role UGNBs serve in management of acute pain when working in resource-limited, public safety-net hospitals in Peru. Conclusion: Tele-ultrasound may represent a strategy for teaching procedures such as UGNBs via remote guidance and supervision.

Introduction/Objectives: Due to the risks associated with sedative hypnotic medications in older adults, our study evaluated the impact of a multidisciplinary approach to deprescribing in geriatric primary care clinics. Methods: The study was a retrospective review of older adults at 2 academic, geriatric primary care clinics who were prescribed sedative-hypnotic medications. Patients were mailed an education packet of information that included working with the clinical pharmacy team, behavioral health team, or both in order to deprescribe their sedative-hypnotic medication. The study assessed the rate of discontinuation of sedative-hypnotic medications between the different intervention groups. Results: The study included 93 older adults with a mean age of 81.3 years and 39.8% discontinuation rate of their medication. The number of falls decreased in patients who discontinued use compared to when previously using a sedative hypnotic medication. Conclusion: Patients are more likely to discontinue their sedative hypnotic medication with a multidisciplinary approach, specifically with primary care provider support.

ABSTRACT. In the context of the current COVID-19 pandemic, higher morbidity and mortality have been reported in older adults. This age group presents physiological changes and its own clinical conditions such as frailty, dementia, among others. Objective: To describe the characteristics of COVID-19 patients, both over and under 80 years old, by conducting a systematic review of the literature describing case reports, and to summarize and critically assess these characteristics. Methods: Systematic review. The study was registered on the Registry of Health Research Projects (PRISA) of the Peruvian National Institute of Health (code EI00000631). Five electronic databases (Scopus, PubMed, PubMed Central, LILACS, and SCIELO) were systematically searched during the period between December 31, 2019 and April 16, 2020. The search focused on case reports, case studies, and case series of older people with COVID-19 infection aged over or under 80 years. When selecting the cases, priority was given to clinical and epidemiological profile, laboratory and imaging patterns, and comprehensive geriatric evaluation. Results: 1,149 articles were identified; after applying the filters, a total of 15 publications of case reports and complete records of 27 older adults were obtained. The most frequent age group was between 60 to 69 years old. There is little literature regarding case reports of older adults aged over 80 years. The most frequent parameters were hypertension, fever, cough, respiratory distress, ground-glass opacification in chest radiography and tomography. Furthermore, decrease in PaO2/FiO2 ratio and lymphocytes, and increase in C-reactive protein and Interleukin 6 were observed. Conclusions: This systematic review found little available information of patients under 80 years old, and far less for those over 80 years old, and an absence of comprehensive geriatric assessment.

Abstract Aim To investigate the prevalence and prognostic impact of right heart failure and right ventricular-arterial uncoupling in Corona Virus Infectious Disease 2019 (COVID-19) complicated by an Acute Respiratory Distress Syndrome (ARDS). Methods Ninety-four consecutive patients (mean age 64 years) admitted for acute respiratory failure on COVID-19 were enrolled. Coupling of right ventricular function to the pulmonary circulation was evaluated by a comprehensive trans-thoracic echocardiography with focus on the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio Results The majority of patients needed ventilatory support, which was noninvasive in 22 and invasive in 37. There were 25 deaths, all in the invasively ventilated patients. Survivors were younger (62 ± 13 vs. 68 ± 12 years, p = 0.033), less often overweight or usual smokers, had lower NT-proBNP and interleukin-6, and higher arterial partial pressure of oxygen (PaO2)/fraction of inspired O2 (FIO2) ratio (270 ± 104 vs. 117 ± 57 mmHg, p

La enfermedad por coronavirus 2019 (COVID-19) se ha convertido en un problema de salud pública a nivel mundial. En los entornos odontoestomatológicos existe un riesgo elevado de transmisibilidad por COVID-19, debido al contacto cercano entre el profesional de la salud y el paciente; y al uso de instrumentales rotatorios de alta velocidad que generan una elevada cantidad de aerosoles. Esto ha conllevado a centrar la atención en los casos de urgencia o emergencia y posponer los tratamientos electivos. Por este motivo, el Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) del Seguro Social del Perú (EsSalud) ha emitido lineamientos sobre la realización de procedimientos en Odontoestomatología en el contexto de pandemia por COVID-19, las cuales se resumen en el presente artículo. Se incluyen dos flujogramas de evaluación y manejo.

Purpose – This study aims to test bigenderism, a universalistic theory that purports to explain why trans men employees enjoy greater organizational acceptance and superior economic outcomes compared to trans women employees. Design/methodology/approach – Respondents were presented with one of two case studies in which they had to choose whether or not to respect the right of a trans employee to use the restroom of their choice at work. The only difference between the two case studies was the gender of the trans employee. In one case, the employee was a trans man and in the other case, the employee was a trans woman. Findings – The gender of the trans employee had no impact on the choices of the respondents. Research limitations/implications – The chief research implication is that heightened discrimination against trans men may better be explained by situational theories of transphobia rather than the universalistic theory that was tested in this paper. The primary research limitation was the use of American undergraduate business students as respondents. Practical implications – Organizations need to be especially vigilant in protecting the restroom rights of their transgender employees, which may entail eliminating gender-segregated restrooms. Originality/value – This paper is original in that it uses an experimental design to test the theory of bigenderism. It adds value by encouraging experimental research that examines situational theories of transphobia.

La pandemia de la COVID-19 ha generado una crisis de escala global que ha impactado en todos los quehaceres de la humanidad. Uno de los más golpeados es el turismo que, por su propia naturaleza, se enfrenta al difícil e ineludible reto de crear las condiciones para asegurar, en la medida de lo posible, la salud de los turistas, generando en ellos la confianza necesaria para un paulatino retorno a la actividad. El presente artículo aborda este tema desde un análisis de la situación actual del turismo en el Perú, hasta un conjunto de propuestas para su reactivación, tanto a nivel general como en determinados subsectores clave.

The genus Stenella is comprised of five species occurring in all oceans. Despite its wide distribution, genetic diversity information on these species is still scarce especially in the Southwest Atlantic Ocean. Some features of this genus can enhance opportunities for potential introgressive hybridization, e.g. sympatric distibution along the Brazilian coast, mixed known associations among species, karyotype uniformity and genome permeability. In this study we analyzed three genes of the mitochondrial genome to investigate the genetic diversity and occurrence of genetic mixture among eighty specimens of Stenella. All species exhibited moderate to high levels of genetic diversity (h = 0.833 to h = 1.000 and π = 0.006 to π = 0.015). Specimens of S. longirostris, S. attenuata and S. frontalis were clustered into differentiated haplogroups, in contrast, haplotypes of S. coeruleoalba and S. clymene were clustered together. We detected phylogenetic structure of mixed clades for S. clymene and S. coeruleoalba specimens, in the Southwest Atlantic Ocean, and also between S. frontalis and S. attenuata in the Northeast Atlantic Ocean, and between S. frontalis and S. longirostris in the Northwest Atlantic Ocean. These specimes were morphologically identified as one species but exhibited the maternal lineage of another species, by mitochondrial DNA. Our results demonstrate that ongoing gene flow is occurring among species of the genus Stenella reinforcing that this process could be one of the reasons for the confusing taxonomy and difficulties in elucidating phylogenetic relationships within this group.

Las bacterias y los hongos son un riesgo potencial para el material arqueológico y trabajadores de los museos en Lambayeque, Perú. Con el objetivo de cuantificar la microbiología ambiental aislada del museo Tumbas Reales de Sipán, se muestrearon cuatro almacenes, con Agar Nutritivo y Agar Papa Dextrosa, incubándose a 30 °C, en aerobiosis, hasta por 7 días, para bacterias y, hasta por 10 días, para hongos. Se cuantificaron bacterias con un máximo de 2,7x104 UFC cm-2, en las superficies de pisos y paredes; 1,4x103 UFC m-3, en el aire y hongos filamentosos, con un máximo de 7,5x104 UFC cm-2, en las superficies y 9,1x104 UFC m-3, en el aire. Se aislaron e identificaron los géneros de bacterias: Bacillus, Micrococcus, Acinetobacter, Nocardia, Streptococcus, Staphylococcus y Streptomyces y los géneros de hongos filamentosos: Aspergillus, Cladosporium, Circinella, Syncephalastrum, Penicillium, Alternaria, Staphylotrichum, Cercospora, Rhizopus, Cunninghamella, Chrysosporium, Nigrospora, Stachybotrys, Gliocladium y Verticillium.

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A partir del examen y sistematización de los manuscritos, notas de lectura y correspondencia que forman sus archivos personales, en este trabajo se exponen las prácticas de documentación y estudio de las lenguas indígenas llevadas a cabo por Samuel A. Lafone Quevedo (1835-1920) y Bartolomé Mitre (1821-1906). Comúnmente asociados, el primero, al estudio de las lenguas del Noroeste y Chaco y, el segundo, a la producción de un catálogo bibliográfico sobre las lenguas americanas, sus papeles de trabajo inéditos muestran, sin embargo, el interés de ambos por otras lenguas entre las que se destacan las de Fuegopatagonia. Sostenemos que el análisis de estos archivos o máquinas de papel entendidas como artefactos de registro y documentación de las lenguas indígenas permiten apreciar las prácticas y operaciones eruditas para la elaboración de los datos, los métodos de trabajo, las redes de cooperación, el papel desempeñado por actores invisibilizados como los escribientes y los consultantes indígenas y las mediaciones materiales tanto en el acceso a la información etnográfico-lingüística como en su posterior organización editorial. Abstract In this paper we analyze the set of documentation and archival practices carried out by Samuel A. Lafone Quevedo (1835-1920) and Bartolomé Mitre (1821-1906) in order to study Amerindian indigenous languages. Although commonly associated the former to the study of ​​Northwest and Chaco area stocks and the latter to the crafting of a monumental bibliographic instrument on Amerindian languages, their unpublished manuscripts, reading notes and correspondence shows nevertheless their sustained interest in other stocks, such as those from Fuegopatagonia. Departing from these archives or paper machines understood as indigenous languages’ recording artifacts, we briefly depict the working methods involved in data-design, the role played by invisible actors such as clerks and indigenous consultants and material mediations both in ethnographic and linguistic documentation and its subsequent editorial organization.

The franciscana dolphin (Pontoporia blainvillei) is the most threatened dolphin species in the Brazilian coast. The study area is the northernmost distribution range of the species and the stock inhabiting the northern State of Espírito Santo is isolated from other populations. Likewise, there is no information on feeding habits of franciscana dolphins in the study area. Hence, the aim of this study was to describe the diet of franciscana dolphins from the Northern Espírito Santo State coast. Stomach contents of 18 individuals stranded in the study area between January 2012 and March 2015 were analyzed. We ranked each specific prey item found in stomach contents using the frequency of occurrence, the total count of prey items, and the relative abundance of prey. It was found novel records of prey species for the franciscana dolphin and we explored possible feeding strategy patterns. The fish Isopisthus parvipinnis was the most common prey consumed by the dolphins. Our report agrees with previous studies showing demersal fish species, mainly sciaenids, as the most common preys consumed by the franciscana dolphin followed by pelagic fish species.

La infección por COVID-19 presenta una elevada mortalidad respecto a otros virus respiratorios. En este artículo buscamos definir las comorbilidades que están asociadas a la elevada mortalidad o a las complicaciones que requieren mayor soporte ventilatorio en unidades de cuidados intensivos. Se ha diseñado una búsqueda bibliográfica con respecto a las comorbilidades y/o alteraciones en los exámenes de laboratorio y los estudios radiológicos que se han asociado a la presencia de mortalidad, especialmente en los casos descritos en China.

En el contexto educativo, les corresponde a los educadores ofrecerles a los escolares diferentes vías para prevenir el consumo de del tabaco, acción que se emprende desde la interacción y apoyo con la familia y la comunidad. El propósito de este artículo es realizar un estudio acerca de la protección de escolares en grupos de riesgos ante el tabaquismo y su educación social.

ObjectivesAbdominal obesity (AO) has become a public health issue due to its impact on health, society and the economy. The relationship between socioeconomic disparities and the prevalence of AO has yet to be studied in Peru. Thus, our aim was to analyze the socioeconomic inequalities in AO distribution defined using the International Diabetes Federation (IDF) cut-off points in Peruvian adults in 2018-2019.MethodsThis was a cross-sectional study using data from the 2018-2019 Demographic and Family Health Survey (ENDES) of Peru. We analyzed a representative sample of 62,138 adults over 18 years of age of both sexes from urban and rural areas. Subjects were grouped into quintiles of the wealth to calculate a concentration curve and the Erreygers Concentration Index (ECI) in order to measure the inequality of AO distribution. Finally, we performed a decomposition analysis to evaluate the major determinants of inequalities.ResultsThe prevalence of AO among Peruvian adults was 73.8%, being higher among women than men (85.1% and 61.1% respectively, p < 0.001). Socioeconomic inequality in AO was more prominent among men (ECI = 0.342, standard error (SE) = 0.0065 vs. ECI = 0.082, SE = 0.0043). The factors that contributed most to inequality in the prevalence of AO for both sexes were having the highest wealth index (men 37.2%, women 45.6%, p < 0.001), a higher education (men 34.4%, women 41.4%, p < 0.001) and living in an urban setting (men 22.0%, women 57.5%, p < 0.001).ConclusionsIn Peru the wealthy concentrate a greater percentage of AO. The inequality gap is greater among men, although AO is more prevalent among women. The variables that most contributed to inequality were the wealth index, educational level and area of residence. There is a need for effective individual and community interventions to reduce these inequalities.

The franciscana, Pontoporia blainvillei, is the most endangered small cetacean in the Southwestern Atlantic Ocean, occurring from Itaúnas, Espírito Santo, Brazil to Chubut province, Argentina. This area is divided into four Franciscana Management Areas (FMA). The northern portion of this species distribution is not continuous and a previous genetic study using mitochondrial DNA (mtDNA) separated it into FMAIa (Espírito Santo state) and FMAIb (North of Rio de Janeiro state). In order to increase the information about this population we expanded the sample number and evaluated mitochondrial and nuclear DNA diversity. Samples of 68 franciscanas found stranded on beaches from 2005 to 2020 were analyzed. Analyses included 350 bp of the mtDNA control region (D-loop) and 12 microsatellite loci. We identified three control region haplotypes in FMAIa, two of them not previously observed in this population, one being a new haplotype. Haplotype and nucleotide diversities were 0.0408 and 0.00012 respectively, the lowest reported for all FMAs analyzed until now. The Neutrality tests were not significant and Mismatch Distribution analysis did not reject the hypothesis of population expansion. One of the microsatellite loci was monomorphic, and for the other loci, two to nine alleles were identified, with expected heterozygosities ranging from 0.306 to 0.801. No substructure was revealed and effective population size (Ne) was estimated in 117.9 individuals. Even with an increased sample size, the high mitochondrial genetic homogeneity suggested for the population in a previous study was confirmed. Among six loci previously analyzed in other franciscana populations, five showed the lowest observed heterozygosities for the Espírito Santo population. The novel microsatellite data also showed low genetic diversity and could not reject the hypothesis of a single, panmitic population along the coast of Espírito Santo. This species has been intensively impacted in the last years by incidental capture during fishing activities and habitat degradation, caused by pollution, coastal development and environmental disasters in FMAIa. Considering that this population is small, isolated, and with low levels of genetic diversity, we reinforce the necessity of different conservation actions, focusing mainly on the reduction of bycatch of this species in the region.

El presente artículo resume la guía de práctica clínica (GPC) para el tamizaje y el manejo del episodio depresivo leve en el primer nivel de atención en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló 06 preguntas clínicas. Para responder cada pregunta se realizó búsquedas sistemáticas en PubMed y en repositorios de GPC, y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron siete recomendaciones (tres fuertes y cuatro condicionales), 28 puntos de buena práctica clínica, y dos flujogramas.

El presente artículo resume la guía de práctica clínica (GPC) para tamizaje, diagnóstico y manejo de los pacientes con enfermedad renal crónica (ERC) en los estadios 1 al 3 en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló ocho preguntas clínicas. Para responder cada pregunta se realizaron búsquedas sistemáticas de revisiones sistemáticas y, cuando fue considerado pertinente, de estudios primarios; y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron ocho recomendaciones (cuatro fuertes y cuatro condicionales), 29 puntos de buena práctica clínica, y tres flujogramas.

BackgroundTelephone and video telemedicine appointments have been a crucial service delivery method during the COVID-19 pandemic for maintaining access to health care without increasing the risk of exposure. Although studies conducted prior to the pandemic have suggested that telemedicine is an acceptable format for older adults, there is a paucity of data on the practical implementation of telemedicine visits. Due to prior lack of reimbursement for telemedicine visits involving nonrural patients, no studies have compared telephone visits to video visits in geriatric primary care. ObjectiveThis study aimed to determine (1) whether video visits had longer durations, more visit diagnoses, and more advance care planning discussions than telephone visits during the rapid implementation of telemedicine in the COVID-19 pandemic, and (2) whether disparities in visit type existed based on patient characteristics. MethodsWe conducted a retrospective, cross-sectional analysis of patients seen at two geriatric clinics from April 23 to May 22, 2020. Approximately 25% of patients who had telephone and video appointments during this time underwent chart review. We analyzed patient characteristics, visit characteristics, duration of visits, number of visit diagnoses, and the presence of advance care planning discussion in clinical documentation. ResultsOf the 190 appointments reviewed, 47.4% (n=90) were video visits. Compared to telephone appointments, videoconferencing was, on average, 7 minutes longer (mean 37.3 minutes, SD 10 minutes; P

El objetivo del estudio es plantear una propuesta que consiste en una prueba coherente de extensión universitaria , para mejorar el impulso territorial del distrito de Chachapoyas, el trabajo se sustenta en una visión integral de la universidad y su extensión que coordine con el negocio social y el origen multidimensional del avance territorial, que interrelaciona los ángulos prácticos socio-humanos, institucionales, sociales, monetarios y naturales; se trató de una investigación propositiva con validación de expertos, en vista de una representación del objeto y la conjetura al respecto, que se organizó en una propuesta; con respecto a ello se apoya con las jurisdicciones municipales, los delegados de los establecimientos ecológicos y los especialistas universitarios, el cual se eligieron a través de pruebas no probabilísticas. Para las características del surtido de datos, se dirigió una descripción general a varios temas alusivos a partes de la organización de mejoras territoriales; los resultados obtenidos, que están en tasas equivalentes o más prominentes a 50%, los agentes estudiados atestiguaron que los tipos de organización no estaban contribuyendo a un impulso territorial. Como conclusión final, se determina que la prueba de coherencia de extensión universitaria es un sistema bien estructurado que permite mejorar los espacios territoriales.

Point-of-care ultrasound (POCUS) enables physicians to make critical diagnosis and treatment decisions at the bedside. However, access to and expertise with this technology remain limited in Peru. Establishing longitudinal POCUS educational curriculums in remote, low-resource settings can be challenging due to geographical distances, encumbering the ability to provide ongoing hands-on support. Previously described educational interventions have focused on training individual users on clinical applications of POCUS, rather than training physicians how to teach POCUS, thereby limiting scalability and sustainable impact. We therefore describe our experiences establishing the first ultrasound fellowship curriculum in Peru, which incorporates tele-ultrasonography to circumvent traditional geographical barriers.

Dear Editor: After reading the article entitled “English proficiency level in Colombian undergraduate students of medical programs,”1 published in your prestigious journal and with whose conclusions we agree, we would like to delve into the subject and highlight some aspects mentioned in that editorial. The study by Alonso et al. is the first in Colombia to report that only about 20% of graduates from different medical schools have an intermediate or high level of English. This figure must improve not only in Colombia but also in other Latin American countries such as Peru, since mastery of the English language would optimize access to useful tools related to technological development and research for medical students, even though Spanish is the official language in most countries of the region.

Spinner dolphins (Stenella longirostris, Gray 1828) are widely distributed in tropical waters around the world. Although they occur in large, pelagic groups in the Eastern Tropical Pacific, elsewhere in the Pacific they are found in small and genetically isolated populations associated with islands. This species is considered to be "Least Concern" (LC) by the World Conservation Union (IUCN). To assess genetic diversity and population structure of an island-associated population in the South Atlantic Ocean we surveyed 162 spinner dolphins throughout the Fernando de Noronha Archipelago of the northeast coast of Brazil using ten microsatellite loci and sequencing a 413-bp section of the mitochondrial DNA (mtDNA) control region. Eleven mtDNA haplotypes were identified and haplotype diversity (h) and nucleotide diversity (π) were 0.3747 and 0.0060, respectively. Median-Joining Network revealed the presence of two very divergent haplotypes and F-statistics indicated some heterogeneity between two sampling years. All microsatellite loci were polymorphic (Ho: 0.767; He: 0,764) but, revealed no detectable substructure. We also compared the mtDNA haplotypes from Noronha to 159 haplotypes representing 893 individuals from 14 locations worldwide. We found that the two common haplotypes from the Fernando de Noronha Archipelago were absent in all other populations. These comparisons showed that Noronha spinner dolphins are likely more differentiated than other island populations, suggesting that they form societies with strong site fidelity mediated by females.

The Guiana dolphin (Sotalia guianensis) is a small-bodied dolphin distributed along the Atlantic coast from Honduras to southern Brazil. It preys on fish, squid and shrimps. Several seminal studies have described its diet, yet relationships between the species’ feeding plasticity and climate gradients remain unknown. We compiled a large database of Guiana dolphin stomach remains from southeast coastal Brazil. We described the species’ diet using a number of descriptors, multivariate analysis of variance to test possible differentiation in diet composition, and the Morisita index to estimate the extent of trophic niche overlap between groups. We also analysed feeding plasticity using a regression tree analysis followed by an ordination analysis. We present new records of prey for the species in Brazil. Our results suggest that the Guiana dolphin has opportunistic feeding habits, which may exhibit the species’ feeding plasticity. Such feeding plasticity is associated with the capability to prey throughout a wide array of climate conditions. From a conservation ecology perspective, we conclude that estuaries—even ones that are over-depleted and succumbing to human impacts—are paramount environments for the Guiana dolphin, serving as important sources of prey for the species and other sympatric marine mammals.

Transgender employees may suffer from discrimination due to transphobia. This article evaluates a pedagogical intervention designed to reduce the transphobia of North American undergraduate business students. Participants were enrolled in an organizational behavior course. They resolved a simulated dispute between coworkers over accommodating the bathroom choices of a transgender employee. Answers were classified as demonstrating inclusion, compliance, or hostility with the inclusive response being the establishment of gender-neutral restrooms and the hostile response being refusal to accept the transgender employee's bathroom choice. In the first year, 194 students completed the exercise with no advance preparation, while in the second year, 221 students performed the same task after reading a brief article about transgender employees. Results suggest that the intervention was effective as the inclusive response was most popular in the second year even though it had been least popular in the first year. Complete success was not attained, as one sixth of the students in the second year chose hostile responses. Implications for research, teaching, and practice are discussed.

Abstract Vagotomy (VGX) increases the susceptibility to develop colitis suggesting a crucial role for the cholinergic anti-inflammatory pathway in the regulation of the immune responses. Since oral tolerance and the generation of regulatory T cells (Tregs) are crucial to preserve mucosal immune homeostasis, we studied the effect of vagotomy and the involvement of α7 nicotinic receptors (α7nAChR) at the steady state and during colitis. Therefore, the development of both oral tolerance and colitis (induced by dextran sulfate sodium (DSS) or via T cell transfer) was studied in vagotomized mice and in α7nAChR−/− mice. VGX, but not α7nAChR deficiency, prevented oral tolerance establishment. This effect was associated with reduced Treg conversion in the lamina propria and mesenteric lymphnodes. To the same extent, vagotomized mice, but not α7nAChR−/− mice, developed a more severe DSS colitis compared with control mice treated with DSS, associated with a decreased number of colonic Tregs. However, neither VGX nor absence of α7nAChR in recipient mice affected colitis development in the T cell transfer model. In line, deficiency of α7nAChR exclusively in T cells did not influence the development of colitis induced by T cell transfer. Our results indicate a key role for the vagal intestinal innervation in the development of oral tolerance and colitis, most likely by modulating induction of Tregs independently of α7nAChR.

The Atlantic goliath grouper is a critically endangered species that inhabits estuarine and reef environments and is threatened primarily by fishing activities and habitat destruction. Despite the urgent need for protection, its genetic conservation status remains unknown. The aim of the present study was to evaluate the gene flow among the populations of the species along the coast of Brazil based on the control region of the mitochondrial DNA. The results indicate low haplotype diversity (0.40-0.86) and very low nucleotide diversity (0.1-0.5%). They also show that the genetic diversity of the species varies considerably along the coast and that this finding may be especially important for the identification of priority areas for its conservation. The population analyses indicate a low but significant degree of genetic structuring (ΦST =0.111), probably due to the occurrence of rare haplotypes at some locations, although the genetic differentiation between sites was not correlated with geographic distance (r=0.0501; p=0.7719), and the shared haplotypes indicate that gene flow occurs among all locations along the Brazilian coast. The results of the pairwise FST indicate a high degree of genetic differentiation between locations. The incipient population structuring detected in the present study is not related systematically to the geological or physical features of the Brazilian coast. The complex interaction of fluctuations in sea level, marine currents, and the reproductive characteristics of the species hampers the identification of the specific role of each of these processes in the gene flow dynamics of the population units of the Atlantic goliath grouper. The low overall levels of genetic diversity, the pairwise FST values and the significant population structuring among groups (ΦCT) identified in the present study all reinforce the critically endangered status of the species and are inconsistent with the presence of a single, panmictic population of groupers on the Brazilian coast. The results of this study suggest that, though it may be incipient, the observed genetic structuring must be taken into account in order to prevent potential problems, such as outbreeding depression, in the management of wild stocks.

Consideramos que la inclusión social educativa de los reos en cárcel, es la situación donde éstas personas están directamente vinculadas a procesos de integración educativa, pero desaprovechada por este grupo poblacional, alienados culturalmente, que son inducidos a optar por el delito como alternativa de vida; y que son aceptados desde un punto de vista democrático por el Estado. El desarrollo del estudio tuvo como objetivo describir la inclusión social educativa de los reos en cárcel del Centro Penitenciario de Potracancha de Huánuco, reos que purgan condena por delitos contra el patrimonio; para ello se tuvo en cuenta el tipo de muestreo criterial, encuestados que tiene un rango de edad de 18 a 72 años. Para la recogida de datos se optó por un cuestionario, el cual estuvo basado en siete dimensiones. Los resultados muestran que en las siete dimensiones mayormente no existe inclusión social educativa, en forma general; un 70% de los encuestados considera que no existe inclusión social educativa, un 22% considera ocasionalmente y solo un 8% responde afirmativamente. Estos resultados demuestran que el país enfrenta una compleja y desafiante situación interna y que desborda la capacidad de la autoridad competente para solucionarlo.