Population Genomics of Domesticated Cucurbita ficifolia Reveals a Recent Bottleneck and Low Gene Flow with Wild Relatives.

Cucurbita ficifolia is a squash grown from Mexico to Bolivia. Its ancestor is unknown, but it has limited compatibility with wild xerophytic Cucurbita from Mexico's highlands. We assembled the reference genome of C. ficifolia and assessed the genetic diversity and historical demography of the crop in Mexico with 2524 nuclear single nucleotide polymorphisms (SNPs). We also evaluated the gene flow between C. ficifolia and xerophytic taxa with 6292 nuclear and 440 plastome SNPs from 142 individuals sampled in 58 sites across their area of sympatry. Demographic modelling of C. ficifolia supports an eight-fold decrease in effective population size at about 2409 generations ago (95% CI = 464-12,393), whereas plastome SNPs support the expansion of maternal lineages ca. 1906-3635 years ago. Our results suggest a recent spread of C. ficifolia in Mexico, with high genetic diversity (π = 0.225, FST = 0.074) and inbreeding (FIS = 0.233). Coalescent models suggest low rates of gene flow with C. radicans and C. pedatifolia, whereas ABBA-BABA tests did not detect significant gene flow with wild taxa. Despite the ecogeographic proximity of C. ficifolia and its relatives, this crop persists as a highly isolated lineage of puzzling origin.

La comunicación del riesgo en cirugía: Un proceso por mejorar / Communication of risk in surgery: A process to improve

Introducción. La evaluación del riesgo es fundamental en el éxito quirúrgico. Las perspectivas de los actores involucrados en el proceso de atención deben alinearse con el fin de planear, comunicar y ejecutar adecuadamente las intervenciones necesarias. El objetivo de este escrito fue analizar el riesgo quirúrgico, considerando los posibles factores relacionados con su estimación, comunicación y comprensión en la práctica clínica. Métodos. Análisis crítico y reflexivo de la información disponible, contrastado con la práctica usual. Se hace un ejercicio con situaciones clínicas habituales. Resultados. La complejidad de los pacientes, los recursos, el contexto y la naturaleza de las intervenciones, demandan una aproximación del riesgo implícito de una cirugía con instrumentos evaluativos confiables y reproducibles. Las percepciones por los médicos, pacientes y administradores en salud acerca del impacto de una cirugía difieren según sus intereses. La transmisión de los resultados es un reto ante la asimetría en el conocimiento, la complejidad de los procedimientos y la incertidumbre en los resultados. La comunicación efectiva, como una competencia, se hace altamente pertinente en la actividad del médico. Facilitar la comprensión del mensaje exige una práctica continua y un proceso de mejoramiento adaptado al contexto de la atención en salud. Conclusiones. El riesgo quirúrgico exige una metodología clara y fiable en su evaluación, comunicación y comprensión entre los actores del sistema de salud. Su presencia está asociada a la actividad profesional de los médicos y requiere competencias que permitan un abordaje no lineal del tema. Es una actividad profesional con el fin de mejorar los desenlaces en salud y la calidad de las intervenciones

Introduction. Evaluation of surgical risk is fundamental in surgical success. The perspectives of the actors involved in the care process must be aligned to adequately plan, communicate, and execute the necessary interventions. The aim of this article is to analyze surgical risk, considering possible factors related to its estimation, communication and understanding in clinical practice. Methods. Critical and reflective analysis of the available information, contrasted with the usual practice. An exercise is done with usual clinical situations. Discussion. Complexity of the patients, resources, context, and nature of the interventions demand an approximation of the implicit risk of surgery with reliable and reproducible evaluation instruments. Perceptions by physicians, patients, and health administrators about the impact of surgery differ according to their interests. The transmission of results is a challenge in the face of asymmetry in knowledge, complexity of procedures and uncertainty in results. Effective communication as a competence becomes highly relevant in the physician's activity. Facilitating the understanding of the message requires continuous practice and an improvement process adapted to the context of health care. Conclusions. Surgical risk requires a clear and reliable methodology in its evaluation, communication and understanding among the actors of the health system. Their presence is associated with the professional activity of doctors and requires skills that allow a non-linear approach to the subject. It is a professional activity that must be empowered to improve health outcomes and the quality of interventions.

La comunicación en el consentimiento informado / Communication in the informed consent

Introducción. El consentimiento informado es un elemento importante en la relación médico-paciente, que involucra la trasmisión de un mensaje. En este contexto, se describe la teoría de la comunicación implícita en un consentimiento informado, las barreras para una transmisión adecuada del mensaje, la responsabilidad en la comunicación y los requisitos para el logro de estos propósitos. El objetivo fue analizar de forma reflexiva los procesos de comunicación surtidos y necesarios durante su diligenciamiento, con algunas propuestas factibles de implementar. Discusión. El proceso comunicativo implica evaluar la calidad, el contexto, la intencionalidad, la pedagogía y la recepción-emisión del mensaje. La naturaleza de la actividad quirúrgica requiere el perfeccionamiento de la comunicación como una competencia necesaria en los cirujanos. Se señalan oportunidades de mejoramiento para una adecuada ejecución de esta habilidad no técnica, habitualmente no contemplada en la formación médica. Conclusiones. El consentimiento informado es un acto que trasciende a la transmisión de la información y es el resultado de un proceso complejo, que involucra habilidades comunicativas. Su efectividad se deriva de una toma de decisiones respaldada por el entendimiento claro de la situación y del procedimiento a efectuar. Existen puntos críticos durante su realización que podrían ser objeto de intervenciones futuras, desde esta perspectiva comunicativa.

Introduction. Informed consent is an important element in the doctor-patient relationship, which involves the transmission of a message. In this context, the theory of communication required in an informed consent, the barriers for an adequate transmission of the message, the responsibility in the communication, and the requirements for the achievement of these purposes are described. The objective is to reflexively analyze the assorted and necessary communication processes during its completion, with some feasible proposals to implement. Discussion. The communicative process implies evaluating the quality, the context, the intentionality, the pedagogy and the reception-emission of the message. The nature of the surgical activity requires the improvement of communication as a necessary skill in surgeons. Opportunities for improvement are pointed out for an adequate execution of this non-technical skill, usually not contemplated in medical training. Conclusions. Informed consent is an act that transcends the transmission of information and is the result of a complex process that involves communication skills. Its effectiveness derives from decision-making supported by a clear understanding of the situation and the procedure to be implemented. There are critical points during its realization that could be the object of future interventions from this communicative perspective.

Mercury Mining in Mexico: I. Community Engagement to Improve Health Outcomes from Artisanal Mining.

BACKGROUND: Mercury is an element that cannot be destroyed and is a global threat to human and environmental health. In Latin America and the Caribbean, artisanal and small-scale gold mining represents the main source of mercury emissions, releases, and consumption. However, another source of concern is the primary production of mercury. In the case of Mexico, in the past 2 years the informal production of mercury mining has increased 10-fold. Considering this scenario, an intervention program was initiated to reduce health risks in the mining communities. The program's final goal is to introduce different alternatives in line to stop the mining of mercury, but introducing at the same time, a community-based development program. OBJECTIVE: The aim of this study was to present results from a preliminary study in the community of Plazuela, located in the municipality of Peñamiller in the State of Queretaro, Mexico. METHODS: Total mercury was measured in urine and environmental samples using atomic absorption spectrometry by cold vapor technique. Urine samples were collected from children aged 6-14 years and who had lived in the selected area from birth. Urine samples were also collected from miners who were currently working in the mine. To confirm the presence of mercury in the community, mining waste, water, soil, and sediment samples were collected from those high-risk areas identified by members of the community. FINDINGS: Children, women, and miners were heavily exposed to mercury (urine samples); and in agreement, we registered high concentrations of mercury in soils and sediments. CONCLUSION: Considering these results and taking into account that the risk perception toward mercury toxicity is very low in the community (mining is the only economic activity), an integral intervention program has started.

Diálisis peritoneal incremental: resultados clínicos y preservación de la función renal residual / Incremental peritoneal dialysis: Clinical outcomes and residual kidney function preservation

Introducción: En los últimos años el inicio de diálisis peritoneal (DP) con 3 recambios se ha convertido en una práctica habitual, aunque se dispone de pocos resultados clínicos publicados. Objetivo: Descripción de la experiencia de inicio con DP incremental (DPI) en un centro. Material y métodos: A 46 pacientes en DPI se les realizó seguimiento clínico, analítico y tratamiento, y se estudió su evolución a 2 años. Resultados: A un 25% de los pacientes se les trasplanta en DPI. Tiempo medio de transferencia a DP convencional de 24 meses. La mitad de los pacientes son transferidos por manejo de líquidos. Buena estabilidad clínica y analítica con tasa de peritonitis de un episodio cada 99 meses. Enlentecimiento de la pérdida de función renal residual respecto al período prediálisis (−7,06 vs. −1,58ml/min/año; p=0,0001). Conclusiones: La experiencia en DPI con 3 recambios de inicio es positiva. La mayoría de los pacientes se mantienen estables durante los 2 primeros años, con un enlentecimiento de la pérdida de función renal residual respecto el período prediálisis (AU)

Introduction: Initiation of peritoneal dialysis (PD) with 3 exchanges has become common practice in recent years, despite the lack of published clinical data. Objective: To describe experience with incremental peritoneal dialysis (IPD) at a single site. Material and methods: A total of 46 IPD patients undergoing 2-year clinical, laboratory, treatment and progression follow-up. Results: To 25% of patients were trasplanted on IPD. Mean time on IPD before transfer to conventional PD of 24 months, half of the patients because of fluid balance. Good clinical and biochemical results with a peritonitis rate of one episode per 99 months. There was an improvement in the loss of residual kidney function compared to the pre-dialysis period (−7.06 vs. −1.58ml/min/year;P=.0001). Conclusions: IPD with 3 peritoneal exchanges offers good results. Most patients remain stable during the first 2 years and there is an improvement in the loss of residual kidney function compared to the pre-dialysis period (AU)

Incremental peritoneal dialysis: Clinical outcomes and residual kidney function preservation. / Diálisis peritoneal incremental: resultados clínicos y preservación de la función renal residual.

INTRODUCTION: Initiation of peritoneal dialysis (PD) with 3 exchanges has become common practice in recent years, despite the lack of published clinical data. OBJECTIVE: To describe experience with incremental peritoneal dialysis (IPD) at a single site. MATERIAL AND METHODS: A total of 46 IPD patients undergoing 2-year clinical, laboratory, treatment and progression follow-up. RESULTS: To 25% of patients were trasplanted on IPD. Mean time on IPD before transfer to conventional PD of 24 months, half of the patients because of fluid balance. Good clinical and biochemical results with a peritonitis rate of one episode per 99 months. There was an improvement in the loss of residual kidney function compared to the pre-dialysis period (-7.06 vs. -1.58ml/min/year; P=.0001). CONCLUSIONS: IPD with 3 peritoneal exchanges offers good results. Most patients remain stable during the first 2 years and there is an improvement in the loss of residual kidney function compared to the pre-dialysis period.

The "CHILD" framework for the study of artisanal mercury mining communities.

In this paper, our group reports the use of a new framework in sites contaminated with mercury. This is significant because under the Minamata Convention on Mercury each Party shall endeavor to develop appropriate strategies for identifying and assessing sites contaminated by mercury or mercury compounds. This new approach, the "CHILD" framework has five steps: i) Community-based risk characterization; ii) Habilitation; iii) Intervention; iv) Laws and Regulation; and v) Development. We are using this framework in three mercury artisanal mining sites, and preliminary results are depicted in this report.