ABSTRACT Flipped Classroom is a new model that has been acquiring great relevance in recent years, that is why it is being the subject of multiple studies in different disciplines, at different educational levels and in different geographical contexts. Given the relevance of this strategy, it was considered to elaborate this review article with the aim of compiling and describing the impact of this methodology in the educational field in the different scenarios in which it was implemented as a learning strategy and whose data may serve as references for its inclusion and standardization as an innovative methodology in the field of secondary education in Peru. To achieve the proposed goal, a sample of 50 electronic articles published in journals indexed to the database of Scopus, Web of Science (WOS) and Scielo at the national and international level were taken during the period from 2018 to 2021. The results show that flipped classroom has a positive impact on students' academic performance, learning achievement, motivation, improved communication, collaborative learning and the promotion of autonomous learning.

RESUMEN Flipped Classroom (FC) o aula invertida es un novel modelo educativo que viene cobrando gran importancia en los últimos años razón por la que está siendo objeto de múltiples estudios en diferentes disciplinas, en distintos niveles educativos y en contextos geográficos diversos. Dada la relevancia de esta estrategia, se consideró elaborar el presente artículo de revisión con el objetivo recopilar y describir el impacto que ejerce esta metodología en el ámbito educativo en los distintos escenarios en los cuales fue implementado como estrategia de aprendizaje y cuyos datos sirvan como referentes para su inclusión y estandarización como una metodología innovadora en el entorno de la educación secundaria en el Perú. Para alcanzar el objetivo propuesto se tomó una muestra de 50 artículos electrónicos publicados en revistas indexadas a la base de datos de Scopus, Web of Science (WOS) y Scielo en el plano nacional e internacional durante el periodo del 2018 al 2021. Los resultados arrojan que aula invertida tiene un impacto positivo en el rendimiento académico de los estudiantes, el logro de los aprendizajes, la motivación, la mejora de la comunicación, el aprendizaje colaborativo y el fomento del aprendizaje autónomo.

BACKGROUND: An integrated primary health care approach, where primary care and public health efforts are coordinated, is a key feature of routine immunisation campaigns AIM: The aim of the study is to describe the approach used by a diverse group of international primary health care professionals in delivering their coronavirus disease 2019 (COVID-19) vaccination programmes, as well as their perspectives on public health and primary care integration while implementing national COVID-19 vaccination programmes in their own jurisdictions SETTING: This is a protocol for a study, which consists of a cross-sectional online survey disseminated among a convenience sample of international primary health care professional through member-based organisations and professional networks via email and online newsletters METHODS: Survey development followed an iterative validation process with a formative committee developing the survey instrument based on study objectives, existing literature and best practices and a summative committee verifying and validating content RESULTS: Main outcome measures are vaccination implementation approach (planning, coordination service deliver), level or type of primary care involvement and degree of primary care and public health integration at community level CONCLUSION: Integrated health systems can lead to a greater impact in the rollout of the COVID-19 vaccine and can ensure that we are better prepared for crises that threaten human health, not only limited to infectious pandemics but also the rising tide of chronic disease, natural and conflict-driven disasters and climate change CONTRIBUTION: This study will provide insight and key learnings for improving vaccination efforts for COVID-19 and possible future pandemics

Abstract The environment contributes to production diseases that in turn badly affect cow performance, fertility and culling. Oestrus intensity is lower in lame cows, and in all cows 26% potential oestrus events are not expressed (to avoid getting pregnant). To understand these trade-offs, we need to know how animals react to their environment and how the environment influences hypothalamus-pituitary-adrenal axis (HPA) interactions with the hypothalamus-pituitary-ovarian axis (HPO). Neurotransmitters control secretion of GnRH into hypophyseal portal blood. GnRH/LH pulse amplitude and frequency drive oestradiol production, culminating in oestrus behaviour and a precisely-timed GnRH/LH surge, all of which are disrupted by poor environments. Responses to peripheral neuronal agents give clues about mechanisms, but do these drugs alter perception of stimuli, or suppress consequent responses? In vitro studies confirm some neuronal interactions between the HPA and HPO; and immuno-histochemistry clarifies the location and sequence of inter-neurone activity within the brain. In both species, exogenous corticoids, ACTH and/or CRH act at the pituitary (reduce LH release by GnRH), and hypothalamus (lower GnRH pulse frequency and delay surge release). This requires inter-neurones as GnRH cells do not have receptors for HPA compounds. There are two (simultaneous, therefore fail-safe?) pathways for CRH suppression of GnRH release via CRH-Receptors: one being the regulation of kisspeptin/dynorphin and other cell types in the hypothalamus, and the other being the direct contact between CRH and GnRH cell terminals in the median eminence. When we domesticate animals, we must provide the best possible environment otherwise animals trade-off with lower production, less intense oestrus behaviour, and impaired fertility. Avoiding life-time peri-parturient problems by managing persistent lactations in cows may be a worthy trade-off on both welfare and economic terms – better than the camouflage use of drugs/hormones/feed additives/intricate technologies? In the long term, getting animals and environment in a more harmonious balance is the ultimate strategy.

ABSTRACT The Mbaracayú Forest Natural Reserve (RNBM) is a 64,405 ha tract of protected land in Canindeyú, northeastern Paraguay. The majority of its land cover is Upper Paraná Atlantic Forest, as well as a substantial Cerrado portion. Other than limited biological research and hunting by traditional methods by Aché indigenous people, the forest has been largely undisturbed for the last 35-40 years, and thus hosts a relatively complete faunal community representative of this region. This paper reports on the mammalian species resident in the Reserve, which have been verified by one or more voucher specimens. Of over 40 mammal collections surveyed in Europe, North and South America, we are aware of ten which contain a total of 4,929 specimens from the RNBM. The specimens represent a diverse mammalian fauna, including 20 families and 71 species. Based on other verifiable records, at least 84 species of mammals are known from the Reserve. Recent reports of newly verified mammals from the Reserve suggest that continued research should be supported.

RESUMEN La Reserva Natural del Bosque Mbaracayú (RNBM) es un área protegida de 64.405 ha en Canindeyú, nordeste de Paraguay. La mayor parte de su cobertura es de Bosque Atlántico del Alto Paraná, pero incorpora también un área significante de Cerrado. Además de ocasionales investigaciones biológicas y la caza por métodos tradicionales por parte de los indígenas Aché, el bosque ha estado prácticamente intocado durante los últimos 35-40 años y, como resultado, alberga una comunidad faunística casi completa y representativa de esta región. Este artículo reporta sobre las especies de mamíferos residentes en la Reserva, que han sido verificadas por uno o más especímenes. De las más de 40 colecciones de mamíferos revisadas en Europa, América del Norte y del Sur, se conocen diez que contienen un total de 4.929 especímenes provenientes de la RNBM. Los especímenes representan una fauna diversa de mamíferos, abarcando 20 familias y 71 especies. Sumado con otros registros verificables, al menos 84 especies de mamíferos habitan en la Reserva. Reportes recientemente verificados de mamíferos adicionales en la Reserva sugieren que la investigación continuada debe ser apoyada.

Este ensaio foi escrito como um comentário ao artigo do Professor Robert Nagel, intitulado “Conservadorismo e Constitucionalismo nos Estados Unidos“. Depois de considerar e criticar vários candidatos a uma jurisprudência constitucional conservadora, Nagel conclui sugerindo que a essência do conservadorismo judicial reside num tradicionalismo que reconhece que a razão só pode operar a partir da experiência, e não como um exame mais imparcial da experiência. Este comentário questiona a conclusão de Nagel, sugere que o conservadorismo precisaria de assentar numa dimensão mais ética e ontológica, e oferece uma distinção entre “tradicionalistas crentes“ e “tradicionalistas cépticos“, que podem convergir nos valores e prescrições prácticas, embora divirjam fundamentalmente a um nível mais filosófico.

This essay was written as a comment on a paper by Professor Robert Nagel, entitled “Conservatism and Constitutionalism in the United States.“ After considering and criticizing various candidates for a conservative constitutional jurisprudence, Nagel concludes by suggesting that the essence of judicial conservatism lies in a traditionalism that acknowledges that reason can only operate from within experience rather than as a more detached examination of experience. This comment questions Nagel’s conclusion, suggests that conservatism would need to have a more ethical and ontological dimension, and offers a distinction between “believing traditionalists“ and “skeptical traditionalists“ who may converge in their practical values and prescriptions even though they differ fundamentally on a more philosophical level.

Objective: To explore how a genetically-influenced characteristic (the level of response to alcohol [LR]), ethnicity, and sex relate to environmental and attitudinal characteristics (peer drinking [PEER], drinking to cope [COPE], and alcohol expectancies [EXPECT]) regarding future alcohol-related blackouts (ARBs). Methods: Structural equation models (SEMs) were used to evaluate how baseline variables related to ARB patterns in 462 college students over 55 weeks. Data were extracted from a longitudinal study of heavy drinking and its consequences at a U.S. university. Results: In the SEM analysis, female sex and Asian ethnicity directly predicted future ARBs (beta weights 0.10 and -0.11, respectively), while all other variables had indirect impacts on ARBs through alcohol quantities (beta weights ~ 0.23 for European American ethnicity and low LR, 0.21 for cannabis use and COPE, and 0.44 for PEER). Alcohol quantities then related to ARBs with beta = 0.44. The SEM explained 23% of the variance. Conclusion: These data may be useful in identifying college students who are more likely to experience future ARBs over a 1-year period. They enhance our understanding of whether the relationships of predictors to ARBs are direct or mediated through baseline drinking patterns, information that may be useful in prevention strategies for ARBs.

RESUMO Objetivo Analisar tendências recentes demográficas e de faturamento médico no tratamento de fraturas do colo do fêmur em idosos americanos. Métodos O banco de dados National Surgical Quality Improvement Program, do American College of Surgeons, foi analisado de 2006 a 2015, para pacientes com idade igual ou superior a 65 anos, usando os códigos de Current Procedural Terminology 27130, 27125, 27235 e 27236. Dados demográficos dos pacientes, complicações pós-operatórias e frequência de códigos foram comparados e analisados ao longo do tempo. A amostra teve 17.122 pacientes geriátricos, sendo 70% do sexo feminino, com média de idade de 80,1 anos (desvio padrão±6,6 anos). Resultados O número de casos aumentou no período, mas idade, gênero, índice de massa corporal e taxas de diabetes e tabagismo não mudaram ao longo do tempo. A fixação interna de redução aberta foi o código faturado mais comum, com 9.169 pacientes (53,6%), seguido por artroplastia parcial do quadril, com 5.861 (34,2%) pacientes. A probabilidade estimada combinada de morbidade foi de 9,8% (desvio padrão±5,2%) e não mudou significativamente ao longo do tempo. As taxas de complicações pós-operatórias foram semelhantes entre os tratamentos. Conclusão Os dados demográficos e as taxas de morbidade relacionadas às fraturas geriátricas do colo do fêmur não apresentaram mudança significativa entre 2006 e 2015. A redução aberta e a fixação interna foram as opções de tratamento mais comuns, seguidas da artroplastia parcial do quadril.

ABSTRACT Objective To analyze recent demographic and medical billing trends in treatment of femoral neck fracture of American elderly patients. Methods The American College of Surgeons National Surgical Quality Improvement Program database was analyzed from 2006 to 2015, for patients aged 65 years and older, using the Current Procedural Terminology codes 27130, 27125, 27235, and 27236. Patient demographics, postoperative complications, and frequency of codes were compared and analyzed over time. Our sample had 17,122 elderly patients, in that, 70% were female, mean age of 80.1 years (standard deviation±6.6 years). Results The number of cases increased, but age, gender, body mass index, rates of diabetes and smoking did not change over time. Open reduction internal fixation was the most commonly billed code, with 9,169 patients (53.6%), followed by hemiarthroplasty with 5,861 (34.2%) patients. Combined estimated probability of morbidity was 9.8% (standard deviation±5.2%), and did not change significantly over time. Postoperative complication rates were similar between treatments. Conclusion Demographics and morbidity rates in femoral neck fractures of elderly patients did not change significantly from 2006 to 2015. Open reduction internal fixation was the most common treatment followed by hemiarthroplasty.

ABSTRACT This study evaluated the effects of using passion fruit peel flour together with diet therapy and counseling in 36 patients with HIV lipodystrophy who were in an ambulatory clinic in a university hospital. The patients were divided into two groups. One received 30 g of passion fruit peel flour daily for 90 days and diet therapy counseling. The other group received only diet therapy counseling. The metabolic changes were analyzed before and after the intervention, with a significance level predetermined at p ≤ 0.05. The use of passion fruit peel flour was effective in reducing total cholesterol and triacylglycerides after 30 days. The concentrations of LDL-C decreased, while HDL-C increased in the blood of lipodystrophy patients after 90 days passion fruit peel flour treatment. No significant differences in food consumption were seen between groups. The use of 30 g of passion fruit peel flour for 90 days together with diet therapy counseling was effective in improving plasma concentrations of total cholesterol, LDL-C, HDL-C and triacylglycerides.

ABSTRACT Graviola leaves (Annona muricata L., Annonaceae) are used by some people to try to treat or even cure cancer, even though over-consumption of the fruit, which contains the neurotoxins annonacin and squamocin has caused an atypical form of Parkinson's disease. In previous analyses, the fruits were extracted with methanol under ambient conditions before analyses. In the present study, UPLC–QTOF–MS and NMR were used to analyze freeze-dried graviola leaves that were extracted using dry methanol and ethanol at 100 ºC and 10 MPa (100 atm) pressure in a sealed container. Methanol solubilized 33% of the metabolites in the lyophilized leaves. Ethanol solubilized 41% of metabolites in the lyophilized leaves. The concentrations of total phenolic compounds were 100.3 ± 2.8 and 93.2 ± 2.0 mg gallic acid equivalents per g of sample, for the methanolic and ethanolic extracts, respectively. Moreover, the toxicophore (unsaturated γ-lactone) that is present in neurotoxic acetogenins was found in the lipophilic portion of this extract. The concentrations of the neurotoxins annonacin and squamocin were found by UPLC–QTOF–MS to be 305.6 ± 28.3 and 17.4 ± 0.89 µg/g-dw, respectively, in the dried leaves. Pressurized methanol solubilized more annonacin and squamocin than ethanol. On the other hand, a hot, aqueous infusion solubilized only 0.213% of the annonacin and too little of the squamocin to be detected. So, graviola leaves contain significant amounts of the neurotoxins annonacin and squamocin, as well as some potentially healthy phenolic compounds. Finally, the potential neurotoxicity of whole leaves in dietary supplements could be much higher than that of a tea (hot aqueous infusion) that is made from them.

Abstract Spilanthol (C14H23NO, 221.339 g/mol) is a bioactive compound that is found in many different plants that are used as traditional remedies throughout the world. It is present in Heliopsis longipes and several species in the genus Acmella, including A. oleracea L., also known as paracress and jambu. Its leaves and flowers have sensory properties (pungency, tingling, numbing, mouth-watering) that make it a popular spice and ingredient in several Brazilian dishes. Spilanthol can exert a variety of biological and pharmacological effects including analgesic, neuroprotective, antioxidant, antimutagenic, anti-cancer, anti-inflammatory, antimicrobial, antilarvicidal and insecticidal activities. So, the aim of this review is to present a literature review on the spilanthol that describes its occurrence, chemistry, extraction and biological activities.

The Canteen Kopje (CK) skull was found by a diamond digger working the Vaal River gravels in 1929. It was hailed by Robert Broom as an exceptionally robust prehistoric individual that was ancestral to modern South African populations. Further exploration of the Vaal Gravels has confirmed the antiquity of the purported find locality, but the heavily restored CK cranium offers limited possibilities for morphometric re-examination or direct dating with which to test Broom's assertion. We used X-ray tomography to create a computerised 3D image that would provide optimal visualisation of the morphometry of the bony surfaces. The results showed that the CK cranium falls within the range of variation of Holocene Khoesan and lacks archaic features. We propose that it was probably a Late Stone Age intrusion into the Vaal Gravels or the overlying Hutton Sands.

The benefit of early breast cancer detection is the foundation for programs around the globe to reduce morbidity and mortality related to breast cancer. These programs range from educational programs targeted to women and health professionals to organized or opportunistic screening programs that target specific age groups of women.Modern mammography programs tend to follow the protocols from the randomized clinical trials, but there is variation in key program elements such as the age groups invited to screening, the screening interval, performance indicators, and the uptake rate. Until recently, the emphasis on early breast cancer detection was limited to mammography, but the steady rise in incidence and mortality in low and medium resource countries, where mammography may be unaffordable, has led to a renewal in emphasizing the incremental value of downsizing palpable tumors through physical exams. There is consensus that programs should be designed based on disease burden and available resources, but that even in low resource countries there are opportunities to reduce breast deaths through earlier diagnosis and effective treatment. Screening programs are most effective when they are organized, and program planners should consider WHO criteria and local input data as a basis for tailoring screening programs to the needs of their population.

El beneficio de la detección temprana del cáncer de mama es el fundamento para programas alrededor del mundo que buscan reducir la morbilidad y mortalidad relacionada con este padecimiento. Estos programas abarcan desde los de tipo educativo, orientados a mujeres y profesionales de la salud, hasta programas de monitoreo organizados u oportunistas que tienen como objetivo grupos específicos de edad. Los programas modernos de mastografía tienden a seguir protocolos para estudios clínicos aleatorios,pero hay una variación en elementos clave como los grupos de edad invitados a participar, el intervalo para el monitoreo, indicadores de desempeño, y la tasa de captación. Hasta hace poco, el énfasis en la detección temprana del cáncer estaba limitado a la mastografía, pero el incrementoen la incidencia ymortalidad en países de recursos bajos a medios, donde las mastografías no son asequibles, ha llevado a un renovado énfasis en el valor de los exámenes físicos. Existe un consenso en cuanto a que los programas deben estar diseñados basándose en la carga de la enfermedad y los recursos disponibles, pero incluso los países con recursos más limitados tienen oportunidades para reducir las muertes de cáncer de mama a través de un diagnóstico oportuno y un tratamiento eficaz. Los programas de detección son más eficaces cuando están organizados, y los planeadores del programa deben considerar los criterios de la OMS y la información local como bases para ajustarlos a las necesidades de la población.

The benefit of early breast cancer detection is the foundation for programs around the globe to reduce morbidity and mortality related to breast cancer. These programs range from educational programs targeted to women and health professionals to organized or opportunistic screening programs that target specific age groups of women.Modern mammography programs tend to follow the protocols from the randomized clinical trials, but there is variation in key program elements such as the age groups invited to screening, the screening interval, performance indicators, and the uptake rate. Until recently, the emphasis on early breast cancer detection was limited to mammography, but the steady rise in incidence and mortality in low and medium resource countries, where mammography may be unaffordable, has led to a renewal in emphasizing the incremental value of downsizing palpable tumors through physical exams. There is consensus that programs should be designed based on disease burden and available resources, but that even in low resource countries there are opportunities to reduce breast deaths through earlier diagnosis and effective treatment. Screening programs are most effective when they are organized, and program planners should consider WHO criteria and local input data as a basis for tailoring screening programs to the needs of their population.

El beneficio de la detección temprana del cáncer de mama es el fundamento para programas alrededor del mundo que buscan reducir la morbilidad y mortalidad relacionada con este padecimiento. Estos programas abarcan desde los de tipo educativo, orientados a mujeres y profesionales de la salud, hasta programas de monitoreo organizados u oportunistas que tienen como objetivo grupos específicos de edad. Los programas modernos de mastografía tienden a seguir protocolos para estudios clínicos aleatorios,pero hay una variación en elementos clave como los grupos de edad invitados a participar, el intervalo para el monitoreo, indicadores de desempeño, y la tasa de captación. Hasta hace poco, el énfasis en la detección temprana del cáncer estaba limitado a la mastografía, pero el incrementoen la incidencia ymortalidad en países de recursos bajos a medios, donde las mastografías no son asequibles, ha llevado a un renovado énfasis en el valor de los exámenes físicos. Existe un consenso en cuanto a que los programas deben estar diseñados basándose en la carga de la enfermedad y los recursos disponibles, pero incluso los países con recursos más limitados tienen oportunidades para reducir las muertes de cáncer de mama a través de un diagnóstico oportuno y un tratamiento eficaz. Los programas de detección son más eficaces cuando están organizados, y los planeadores del programa deben considerar los criterios de la OMS y la información local como bases para ajustarlos a las necesidades de la población.

The oocyst wall of coccidian parasites is a robust structure that is resistant to a variety of environmental and chemical insults. This resilience allows oocysts to survive for long periods, facilitating transmission from host to host. The wall is bilayered and is formed by the sequential release of the contents of two specialized organelles - wall forming body 1 and wall forming body 2 - found in the macrogametocyte stage of Coccidia. The oocyst wall is over 90% protein but few of these proteins have been studied. One group is cysteine-rich and may be presumed to crosslink via disulphide bridges, though this is yet to be investigated. Another group of wall proteins is rich in tyrosine. These proteins, which range in size from 8-31 kDa, are derived from larger precursors of 56 and 82 kDa found in the wall forming bodies. Proteases may catalyze processing of the precursors into tyrosine-rich peptides, which are then oxidatively crosslinked in a reaction catalyzed by peroxidases. In support of this hypothesis, the oocyst wall has high levels of dityrosine bonds. These dityrosine crosslinked proteins may provide a structural matrix for assembly of the oocyst wall and contribute to its resilience.