Appropriateness of the dialysis modality selection process: A cross-sectional study.

Studies that specifically quantify the appropriateness of the process of dialysis modality selection are lacking. Peritoneal dialysis (PD) offers clinical and social advantages over hemodialysis (HD), but may be underused. We aimed to determine the appropriateness of the process of dialysis modality selection and quantify the percentage of patients who could potentially have been PD candidates. We performed a cross-sectional study that included adult patients from a hospital Nephrology Department in Barcelona who started dialysis between 2014 and 2015. We assessed the appropriateness of dialysis modalities selection by defining 3 sequential domains based on 3 critical steps in choosing a dialysis modality: eligibility for either treatment, information about modalities, and shared decision-making. We obtained data using medical records and a patient questionnaire. The dialysis modality selection process was considered appropriate when patients had no contraindications for the selected option, received complete information about both modalities, and voluntarily chose the selected option. A total of 141 patients were included in this study. The median age was 72 years (interquartile range 63-82 years), and 65% of the patients were men. The dialysis modality selection process was potentially inappropriate in 22% of the participants because of problems related to information about dialysis modalities (15%) or shared decision-making (7%). Appropriate PD use can potentially increase from 17% to 38%. Patient age and lack of information regarding dialysis options were independently associated with the potential degree of inappropriate dialysis modality selection. Our findings indicate areas for improvement in the selection of dialysis modalities. With better education and shared decision-making, the number of patients with PD could potentially double. The analysis of appropriateness is a helpful approach for studying renal replacement treatment patterns and identifying strategies to optimize their use.

Expansion of the agricultural frontier in the largest South American Dry Forest: Identifying priority conservation areas for snakes before everything is lost.

Conservation planning relies on integrating existing knowledge, social-environmental contexts, and potential threats to identify gaps and opportunities for action. Here we present a case study on how priority areas for conservation can be determined using existing information on biodiversity occurrence and threats. Specifically, our goals are: (1) to model the ecological niche of twelve endemic snake species in the Dry Chaco Forest, (2) to quantify the impact of the deforestation rates on their distributions, (3) to propose high priority areas for conservation in order to improve the actual protected area system, and (4) to evaluate the influence of the human footprint on the optimization of selected priority areas. Our results demonstrate that Argentinian Dry Chaco represent, on average, ~74% of the distribution of endemic snake species and deforestation has reduced suitable areas of all snake species in the region. Further, the current protected areas are likely insufficient to conserve these species as only very low percentages (3.27%) of snakes' ranges occur within existing protected areas. Our models identified high priority areas in the north of the Chaco forest where continuous, well-conserved forest still exists. These high priority areas include transition zones within the foothill forest and areas that could connect patches of forest between the western and eastern Chaco forest. Our findings identify spatial priorities that minimize conflicts with human activities, a key issue for this biodiversity hotspot area. We argue that consultation with stakeholders and decision-makers are urgently needed in order to take concrete actions to protect the habitat, or we risk losing the best conservation opportunities to protect endemic snakes that inhabit the Argentinian Dry Chaco.

But they move! Vicariance and dispersal in southern South America: Using two methods to reconstruct the biogeography of a clade of lizards endemic to South America.

This study aims to identify events that modeled the historical biogeography of Phymaturus, using three methodologies: Spatial Analysis of Vicariance (VIP), Statistical Dispersal-Vicariance Analysis (S-DIVA), and Bayesian Binary Method MCMC (BBM). In order to assign areas for the Dispersal-Vicariance and the BBM analyses, we preferred not to use predefined areas, but to identify areas defined via an endemism analysis of Phymaturus species. The analyses were conducted using the same basic topology, which we obtained by constructing a metatree with two recent phylogenies, both morphology and molecular-based. This topology was also used to obtain time divergence estimates in BEAST, using more outgroups than for the metatree in order to get more accurate estimates. The S-DIVA analysis based on the metatree found 25 vicariance events, 20 dispersals and two extinctions; the S-DIVA analysis based on the BEAST tree yielded 30 vicariance events, 42 dispersal events and five extinctions, and the BBM analysis yielded 63 dispersal events, 28 vicariance events and 1 extinction event. According to the metatree analysis, the ancestral area for Phymaturus covers northern Payunia and southern Central Monte. A vicariant event fragmented the ancestral distribution of the genus, resulting in northern Payunia and southern Central Monte as ancestral area for the P. palluma group, and southern Payunia for the P. patagonicus group. The analysis based on the BEAST tree showed a more complex reconstruction, with several dispersal and extinction events in the ancestral node. The Spatial Analysis of Vicariance identified 41 disjunct sister nodes and removed 10 nodes. The barrier that separates the P. palluma group from the P. patagonicus group is roughly congruent with the southern limit of the P. palluma group. The ancestral range for the genus occupies a central position relative to the distribution of the group, which implies that the species must have migrated to the north (P. palluma group) and to the south (P. patagonicus group). To answer questions related to the specific timing of the events, a molecular clock for Phymaturus was obtained, using a Liolaemus fossil for calibration. The present contribution provides a hypothetical framework for the events that modeled the distribution of Phymaturus.

Estimating ancestral ranges: testing methods with a clade of neotropical lizards (iguania: liolaemidae).

Establishing the ancestral ranges of distribution of a monophyletic clade, called the ancestral area, is one of the central objectives of historical biogeography. In this study, I used three common methodologies to establish the ancestral area of an important clade of Neotropical lizards, the family Liolaemidae. The methods used were: Fitch optimization, Weighted Ancestral Area Analysis and Dispersal-Vicariance Analysis (DIVA). A main difference from previous studies is that the areas used in the analysis are defined based on actual distributions of the species of Liolaemidae, instead of areas defined arbitrarilyor based on other taxa. The ancestral area of Liolaemidae found by Fitch optimization is Prepuna on Argentina, Central Chile and Coastal Peru. Weighted Ancestral Area Analysis found Central Chile, Coquimbo, Payunia, Austral Patagonia and Coastal Peru. Dispersal-Vicariance analysis found an ancestral area that includes almost all the areas occupied by Liolaemidae, except Atacama, Coquimbo and Austral Patagonia. The results can be resumed on two opposing hypothesis: a restricted ancestral area for the ancestor of Liolaemidae in Central Chile and Patagonia, or a widespread ancestor distributed along the Andes. Some limitations of the methods were identified, for example the excessive importance of plesiomorphic areas in the cladograms.