El presente trabajo tiene como objetivo traer al debate jurídico la complejidad surgida al definir las categorías jurídicas de genocidio, genocidio cultural, etnocidio o limpieza étnica. Las ...definiciones difieren según la disciplina de la que procedan, incluso dentro del propio Derecho, lo que da lugar confusiones. El genocidio cultural apareció en el discurso legal tras la definición dada al genocidio por la Convención de 1948, la de etnocidio reapareció en el marco de la lucha de los pueblos indígenas por sus derechos y la de limpieza étnica, con el conflicto en la ex Yugoslavia. Esta locución ha sido incorporada al Derecho como expresión del lenguaje coloquial carente de significado técnico, dando lugar a precisiones por parte de la jurisprudencia que la alejan y la acercan a la del genocidio. Junto a ellos, aparece hoy la de desnazificación, cuyo significado aún no ha sido precisado por el Derecho.
Recibido: 22.12.2022Aceptado: 13.06.2023
Most aquatic animals use infochemicals from both conspecifics and heterospecifics to assess local predation risks and enhance predator detection. Released substances from injured conspecifics and ...other species (chemical alarm cues) are reliable cues to indicate an imminent danger in a specific habitat and often mediate the development of inducible defenses. Amphibian and fish embryos have been shown to acquire this information while at the embryonic stage of development, in relation to the developing nervous system and sensory development. With the exception of
, there is no information on chemically mediated responses to alarm cues in embryos of any crustacean groups. Therefore, we tested whether embryo exposure to chemical cues simulating predation on conspecifics or heterospecifics (closely related, non-coexisting species), or a mixture of both, alters embryonic developmental time, size and morphology of the first larval instar in
(Crustacea: Decapoda). Embryonic exposure to chemical alarm cues from conspecifics shortened the embryonic developmental time and elicited larger larvae with a longer rostrum. Rostrum length of the first larval instar changed independently of their size, thus elongated rostra can be considered a defensive feature. Embryonic developmental time was not altered by chemical alarm cues from either heterospecifics or the mixed cues treatment; however, exposure to these cues resulted in larger larvae compared with the control group. Chemically induced morphological plasticity in larvae in response to alarm cues from con- and heterospecifics suggests that such cues are conserved in palaemonids shrimps, providing embryos with an innate recognition of heterospecific alarm cues as predicted by the phylogenetic relatedness hypothesis.
Sister chromatid cohesion mediated by the cohesin complex is essential for chromosome segregation during cell division. Using functional genomic screening, we identify a set of 26 pre‐mRNA splicing ...factors that are required for sister chromatid cohesion in human cells. Loss of spliceosome subunits increases the dissociation rate of cohesin from chromatin and abrogates cohesion after DNA replication, ultimately causing mitotic catastrophe. Depletion of splicing factors causes defective processing of the pre‐mRNA encoding sororin, a factor required for the stable association of cohesin with chromatin, and an associated reduction of sororin protein level. Expression of an intronless version of sororin and depletion of the cohesin release protein WAPL suppress the cohesion defect in cells lacking splicing factors. We propose that spliceosome components contribute to sister chromatid cohesion and mitotic chromosome segregation through splicing of sororin pre‐mRNA. Our results highlight the loss of cohesion as an early cellular consequence of compromised splicing. This may have clinical implications because SF3B1, a splicing factor that we identify to be essential for cohesion, is recurrently mutated in chronic lymphocytic leukaemia.
Synopsis
Correct splicing of cohesin‐loading factor sororin is required for sister chromatid cohesion during interphase. Mutations in a splicing factor essential for cohesion is implicated in chronic lymphocytic leukemia.
Functional genomics identifies a set of 26 spliceosome subunits that are required for sister chromatid cohesion in human cells.
Loss of splicing factors increases the turnover of cohesin complexes on chromatin and abrogates sister chromatid cohesion during interphase.
Compromising splicing reduces the steady‐state levels of sororin, a factor required for the stable association of cohesin with chromatin.
Increasing sororin protein level or removing the cohesin release factor WAPL restores cohesion in cells lacking splicing factors.
The key connections between sister chromatids in human cells are exquisitely sensitive to sororin dosage and to defects in pre‐mRNA splicing.
Recurrent splicing factor mutations in hyperproliferative haematological disorders may affect cohesin turnover on chromatin.
Correct splicing of cohesin‐loading factor sororin is required for sister chromatid cohesion during interphase. Mutations in a splicing factor essential for cohesion is implicated in chronic lymphocytic leukemia.
Plants with animal-dispersed fruits seem to overcome the barriers that limit their spread into new habitats more easily than other invasive plants and, at the same time, they pose special ...difficulties for containment, control or eradication. The effects of animals on plant propagules can be very diverse, with positive, neutral or negative consequences for germination and recruitment. Moreover, the environmental conditions where the seeds are deposited and where the post-dispersal processes take place can be crucial for their fate. Prunus mahaleb is a fleshy-fruited tree invading natural grasslands in the Argentine Pampas. In this study, we analyzed the importance of pulp removal, endocarp scarification and the effects of vectors on its germination response, by means of germination experiments both in the laboratory and under semi-natural conditions. Our laboratory results demonstrated that endocarp scarification enhances germination and suggests that vestiges of pulp on the stones have inhibitory effects. Frugivores exert a variety of effects on germination responses and this variation can be explained by their differing influence on pulp removal and endocarp scarification. Most frugivores produced a positive effect on germination under laboratory conditions, in comparison to intact fruits and hand-peeled stones. We observed different degrees of pulp removal from the surface of the stones by the dispersers which was directly correlated to the germination response. On the other hand, all the treatments showed high germination responses under semi-natural conditions suggesting that post-dispersal processes, like seed burial, and the exposure to natural conditions might exert a positive effect on germination response, attenuating the plant's dependence on the dispersers' gut treatment. Our results highlight the need to consider the whole seed dispersal process and the value of combining laboratory and field tests.
Monitoring and reducing inequalities in health care has become more relevant since the adoption of the Sustainable Development Goals (SDGs). The SDGs bring an opportunity to put the assessment of ...inequalities by ethnicity on the agenda of decision-makers. The objective of this qualitative study is to know how current monitoring is carried out and to identify what factors influence the process in order to incorporate indicators that allow the evaluation of inequalities by ethnicity.
We conducted 17 semi-structured interviews with key informants from the health ministry, monitoring observatories, research centers, and international organizations, involved in maternal health care monitoring in Mexico. Our analysis was interpretative-phenomenological and focused on examining experiences about monitoring maternal health care in order to achieve a full picture of the current context in which it takes place and the factors that influence it.
The obstacles and opportunities pointed out from the participants emerge from the limitations or advantages associated with the accuracy of evaluation, availability of information and resources, and effective management and decision-making. Technicians, coordinators, researchers or decision-makers are not only aware of the inequalities but also of its importance. However, this does not lead to political decisions permitting an indicator to be developed for monitoring it. As for opportunities, the role of international organizations and their links with the countries is crucial to carry out monitoring, due to political and technical support.
The success of a monitoring system to help decision-makers reduce inequalities in health care depends not only on accurate evaluations but also on the context in which it is implemented. Understanding the operation, obstacles and opportunities for monitoring could be a key issue if the countries want to advance towards assessing inequalities and reducing health inequities with the aid of concrete policies and initiatives.
An adequate use of referral and reply letters—the main form of communication between primary care (PC) and out-patient secondary care (SC)—helps to avoid medical errors, test duplications and delays ...in diagnosis. However, it has been little studied to date in Latin America. The aim is to determine the level and characteristics of PC and SC doctors’ use of referral and reply letters and to explore influencing factors in public healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. A cross-sectional study was conducted through a survey of PC and SC doctors working in public healthcare networks (348 doctors per country). The COORDENA questionnaire was applied to measure the frequency of use and receipt of referral and reply letters, quality of contents, timeliness and difficulties in using them. Descriptive analyses were conducted and a multivariate logistic regression model was generated to assess the relationship between frequent use and associated factors. The great majority of doctors claim that they send referral letters to the other level. However, only half of SC doctors (a higher proportion in Chile and Mexico) report that they receive referral letters and <20% of PC doctors receive a reply from specialists. Insufficient recording of data is reported in terms of medical history, tests and medication and the reason for referral. The factor associated with frequent use of the referral letter is doctors’ age, while the use of reply letters is associated with identifying PC doctors as care coordinators, knowing them and trusting in their clinical skills, and receiving referral letters. Significant problems are revealed in the use of referral and reply letters which may affect quality of care. Multifaceted strategies are required that foster a direct contact between doctors and a better understanding of the PC-based model.
Une utilisation adéquate des lettres et des réponses aux demandes de consultation—la principale forme de communication entre les soins primaires (SP) et les soins secondaires (SC) des patients en externe—permet d’éviter les erreurs médicales, la duplication des tests et les retards dans le diagnostic. Cependant, à ce jour, peu d’études ont porté sur ce sujet en Amérique latine. L’objectif est de déterminer le niveau et les caractéristiques de l’utilisation des lettres et des réponses aux demandes de consultation par les médecins des soins primaires et secondaires, et d’explorer les facteurs influents des réseaux de santé publique en Argentine, au Brésil, au Chili, en Colombie, au Mexique et en Uruguay. Une étude transversale a été réalisée à travers une enquête auprès des médecins des soins primaires et secondaires travaillant dans les réseaux de santé publique (soit 348 médecins par pays). Le questionnaire COORDENA a été appliqué pour mesurer la fréquence d’utilisation et de réception des lettres et des réponses aux demandes de consultation, la qualité du contenu, la rapidité et les difficultés d’utilisation. Des analyses descriptives ont été effectuées et un modèle de régression logistique multivariée a été mis sur pied pour évaluer la relation entre l’utilisation fréquente et les facteurs correspondants. La grande majorité des médecins affirment qu’ils envoient des lettres de demandes de consultation à l’autre niveau. Cependant, seulement la moitié des médecins des soins primaires (la proportion est plus élevée au Chili et au Mexique) signalent qu’ils reçoivent des lettres de demande de consultation et <20% des médecins des soins primaires reçoivent une réponse des spécialistes. Peu de données sont enregistrées dans le cadre des antécédents médicaux, des analyses médicales, des médicaments prescrits et du motif de la demande de consultation. Le facteur associé à l’utilisation fréquente de la lettre de demande de consultation est l’ âge des médecins, tandis que l’utilisation des lettres de réponse est associée à l’identification des médecins praticiens comme coordonnateurs de soins, reconnus pour leurs compétences cliniques et recevant des lettres de demande de consultation. L’utilisation des lettres et des réponses aux demandes de consultation révèle d’importants problèmes qui peuvent affecter la qualité des soins. Des stratégies multidimensionnelles sont nécessaires pour favoriser un contact direct entre les médecins et une meilleure compréhension du modèle basé sur les soins primaires.
转诊和回复信件是初级保健 （PC） 和二级门诊 （SC） 之间沟 通的主要形式, 充分使用这种通讯方式有助于避免医疗失误、 重复检查和诊断延误。但在拉丁美洲对其研究很少。本研究 目的是明确PC和SC医生对转诊和回复信件的使用程度和使用 特征, 探索阿根廷、巴西、智利、哥伦比亚、墨西哥和乌拉圭 公共卫生保健网络中的影响因素。对公共卫生保健网络中的 PC和SC医生（每个国家各348名）进行了横断面调查。采用 COORDENA问卷测量转诊和回复信件的使用和接收频率, 内 容质量, 及时性和使用上的困难。进行了描述性分析, 采用多 因素logistic回归模型来评估频繁使用与相关因素之间的关 系。大多数医生声称他们向其他级别机构发送转诊信件。然 而, 只有半数SC医生（这一比例在智利和墨西哥较高）报告 收到了转诊信件, 不到20%的PC医生收到了专科医生的回复。 受访医生表示存在病史、检查和用药以及转诊原因等数据记 录不充分的情况。与频繁使用转诊信件相关的因素是医生年 龄, 而与回复信件相关的因素是将PC医生视为协同提供医疗 服务的人员、认识PC医生、信任PC医生的临床技术及收到转 诊信。研究揭示了转诊和回复信件使用的严重问题, 可能影响 卫生保健质量。需要采取多层面策略建立医生之间的直接沟 通, 促进对以PC为基础的医疗模式的了解。
Un uso adecuado de las cartas de remisión y respuesta -la principal forma de comunicación entre la atención primaria (AP) y la atención secundaria (AS) de los pacientes externos-ayuda a evitar errores médicos, duplicaciones de pruebas y retrasos en el diagnóstico. Sin embargo, ha sido poco estudiado hasta la fecha en América Latina. El objetivo es determinar el nivel y las características del uso de cartas de referencia y respuesta por parte de los médicos de AP y AS y explorar los factores que influyen en las redes de salud pública de Argentina, Brasil, Chile, Colombia, México y Uruguay. Se realizó un estudio transversal a través de una encuesta de médicos de AP y AS que trabajan en redes de salud pública (348 médicos por país). El cuestionario COORDENA se aplicó para medir la frecuencia del uso y recibo de cartas de remisión y respuesta, la calidad del contenido, la puntualidad y las dificultades en su uso. Se realizaron análisis descriptivos y se generó un modelo de regresión logística multivariable para evaluar la relación entre el uso frecuente y los factores asociados. La gran mayoría de los médicos afirman que envían cartas de remisión al otro nivel. Sin embargo, solo la mitad de los médicos de AS (una proporción más alta en Chile y México) informan que recibieron cartas de remisión y <20% de los médicos de AP reciben una respuesta de los especialistas. El registro insuficiente de los datos es reportado en términos de la historia médica, las pruebas y los medicamentos, y el motivo de la remisión. El factor asociado con el uso frecuente de la carta de remisión es la edad del médico, mientras que el uso de las cartas de respuesta está asociado con la identificación de los médicos de AP como coordinadores de la atención, conociéndolos y confiando en sus habilidades clínicas, y recibiendo cartas de remisión. Se revelan problemas importantes en el uso de cartas de remisión y respuesta que pueden afectar la calidad de la atención. Se requieren estrategias multifacéticas que fomenten un contacto directo entre los médicos y una mejor comprensión del modelo basado en la AP.
Abstract
Healthcare coordination is considered key to improving care quality. Although participatory action research (PAR) has been used effectively to bridge the gap between evidence and practice in ...other areas, little is known about the key success factors of its use in healthcare organizations. This article analyses the factors influencing the implementation of PAR interventions to improve clinical coordination from the perspective of actors in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. A qualitative, descriptive-interpretative study was conducted in each country’s healthcare network. Focus groups and semi-structured individual interviews were conducted to a criterion sample of: local steering committee (LSC) (29), professional platform (PP) (28), health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and themes. The PAR process led by the LSC covered the return of baseline results, selection of problems and interventions and design, implementation and adjustment of the intervention, with PP. Interventions were implemented to improve communication and clinical agreement between primary and secondary care. Results reveal that contextual factors, the PAR process and the intervention’s content influenced their implementation, interacting across time. First, institutional support providing necessary resources, and professionals’ and managers’ willingness to participate, emerge as contextual pivotal factors, influenced by other factors related to: the system (alignment with policy and political cycle), networks (lack of time due to work overload and inadequate working conditions) and individuals (not knowing each other and mutual mistrust). Second, different characteristics of the PAR process have a bearing, in turn, on institutional support and professionals’ motivation: participation, flexibility, consensual decision-making, the LSC’s leadership and the facilitating role of researchers. Evidence is provided that implementation through an adequate PAR process can become a factor of motivation and cohesion that is crucial to the adoption of care coordination interventions, leading to better results when certain contextual factors converge.
In the current context of increasingly fragmented healthcare systems where patients are seen by multiple doctors in different settings, patients' relational continuity with one doctor is regaining ...relevance; however little is known about relational continuity with specialists. The aim of this study is to explore perceptions of relational continuity with primary care and secondary care doctors, its influencing factors and consequences from the viewpoint of users of the Catalan national health system (Spain).
We conducted a descriptive-interpretative qualitative study using a two-stage theoretical sample; (i) contexts: three healthcare areas in the Catalan national health system with differing characteristics; (ii) informants: users 18 years or older attended to at both care levels. Sample size (n = 49) was reached by saturation. Data were collected by individual semi-structured interviews, which were audio recorded and transcribed. A thematic content analysis was carried out segmenting data by study area, and leaving room for new categories to emerge from the data.
Patients across the areas studied generally experienced consistency of primary care doctors (PCD), alongside some inconsistency of specialists. Consistency of specialists did not seem to be relevant to some patients when their clinical information was shared and used. Patients who experienced consistency and frequent visits with the same PCD or specialist described and valued having established an ongoing relationship characterised by personal trust and mutual accumulated knowledge. Identified consequences were diverse and included, for example, facilitated diagnosis or improved patient-doctor communication. The ascription to a PCD, a health system-related factor, facilitated relational continuity with the PCD, whereas organizational factors (for instance, the size of the primary care centre) favoured consistency of PCD and specialists. Doctor-related factors (for example, high technical competence or commitment to patient care) particulary fostered the development of an ongoing relationship.
Consistency of doctors differs depending on the care level as does the relevance attributed to it. Most influencing factors can be applied to both care levels and might be addressed by healthcare managers to foster relational continuity. More research is needed to fully understand the relevance patients assign to relational continuity with specialists.
A qualitative study analyzed using Grounded Theory.
To explore perceived bodily changes in people with acquired spinal cord injury of both genders and with different levels of injury.
The National ...Paraplegic Hospital in Toledo, Spain, a national reference center for the treatment of spinal cord injury.
A qualitative study designed and analyzed from the perspective of Grounded Theory. Semi-structured interviews were conducted in a triangulated sample of 32 people with acquired spinal cord injury. The analysis was based on the constant comparative method and an open, axial, and selective coding process.
The perceptions regarding bodily changes in people with spinal cord injury were grouped into two broad categories: changes in body schema (a fragmented body, a blurred body, body as a burden, non-muscular body, the wheelchair as an extension of the body, and body normalization) and increased bodily awareness (an uncontrollable body and retraining the body). The amount of time since the injury, positive life behaviors and attitudes, youth, male gender, and having flexible beliefs, values, and habits were considered facilitators for coping with body changes after a spinal cord injury.
Suffering a spinal cord injury implies a new body schema and a change in body awareness. When healthcare professionals are aware of the changes affecting the body after a spinal cord injury, they display more favorable attitudes and are more involved in promoting the patients' adaptation to their new body schema.
Polarization curves of the hydrogen evolution reaction (HER), recorded on rotating disk electrodes (RDEs) in mildly acidic solutions, usually show a “two step” behavior. That is, two exponentially ...rising segments (the first commonly assigned to H+, the second to water reduction) are separated by a limiting current plateau. Here, we devise an analytical model for the full polarization curve by assuming that HER proceeds according to a quasireversible two-electron reaction, H+ + H2O + 2e– ⇌ H2 + OH–, obeying the Erdey-Grúz–Volmer–Butler equation. Our model is able to reproduce the two step behavior of polarization curves and can also be used for the fitting of measured currents over a broad range of pH, rotation rate, and electrode potential, on both Au and on Pt. We show that the length of the limiting current plateaus measured on RDEs for HER is inversely related to the electrocatalytic activity of the electrode and that at a given rotation rate a linear relationship exists between the plateau length and the bulk solution pH. By analyzing this relationship, we can estimate kinetic parameters, even in cases where the transport performance of the RDE would otherwise not be sufficient to measure well-defined kinetic currents at low overpotentials.
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