Secondary Contacts Research Articles

Hybrid zone genomics supports candidate species in Iberian Alytes obstetricans

Abstract While estimates of genetic divergence are increasingly used in molecular taxonomy, hybrid zone analyses can provide decisive evidence for evaluating candidate species. Applying a population genomic approach (RAD-sequencing) to a fine-scale transect sampling, we analyzed the transition between two Iberian subspecies of the common midwife toad (Alytes obstetricans almogavarii and A. o. pertinax) in Catalonia (northeastern Spain), which putatively diverged since the Plio-Pleistocene. Their hybrid zone was remarkably narrow, with extensive admixture restricted to a single locality (close to Tarragona), and congruent allele frequency clines for the mitochondrial (13 km wide) and the average nuclear genomes (16 km wide). We also fitted clines independently for 89 taxon-diagnostic SNPs: most of them behave like the nuclear background, but a subset (13%) is completely impermeable to gene flow and might be linked to barrier loci involved in hybrid incompatibilities. Assuming that midwife toads are able to disperse in the area of contact, we conclude that these taxa experience partial reproductive isolation and represent incipient species, i.e. Alytes almogavarii and Alytes obstetricans. Interestingly, their evolutionary age and mitochondrial divergence fall below the thresholds proposed in molecular systematics studies, emphasizing the difficulty of predicting the outcome of secondary contacts between young lineages entering the grey zone of speciation.

Patterns of mtDNA introgression suggest population replacement in Palaearctic whiskered bat species.

Secondary contacts can play a major role in the evolutionary histories of species. Various taxa diverge in allopatry and later on come into secondary contact during range expansions. When they meet, their interactions and the extent of gene flow depend on the level of their ecological differentiation and the strength of their reproductive isolation. In this study, we present the multilocus phylogeography of two cryptic whiskered bat species, Myotis mystacinus and M. davidii, with a particular focus on their putative sympatric zone. Our findings suggest that M. mystacinus and M. davidii evolved in allopatry and came into secondary contact during range expansions. Individuals in the area of secondary contact, in Anatolia and the Balkans, have discordant population assignments based on the mitochondrial and the nuclear datasets. These observed patterns suggest that the local M. mystacinus populations hybridized with expanding M. davidii populations, which resulted in mitochondrial introgression from the former. In the introgression area, M. mystacinus individuals with concordant nuclear and mitochondrial genotypes were identified in relatively few locations, suggesting that the indigenous populations might have been largely replaced by invading M. davidii. Changing environmental conditions coupled with ecological competition is the likely reason for this replacement. Our study presents one possible example of a historical population replacement that was captured in phylogeographic patterns.

To what extent do children transmit SARS-CoV-2 virus?

Concern that children might be major spreaders of SARS-CoV-2, the virus which causes COVID-19, stems largely from past experience: children are certainly major spreaders of other respiratory viral infections, such as influenza and measles. Adults infected with SARS-CoV-2 are infectious for up to 48 h before developing symptoms. Children infected with SARS-CoV-2 are often asymptomatic: 4–28% in published studies1-4 and 13% in the most detailed study from China.1 Asymptomatic child carriers were important spreaders of polio during epidemics, but this does not mean that asymptomatic children often transmit SARS-CoV-2. The evidence to date suggests that children spread SARS-CoV-2 virus relatively rarely and that children are usually infected by symptomatic or pre-symptomatic adults (in the first 48 h before they become symptomatic). During contact tracing, the China/World Health Organization joint commission recorded no episodes where transmission occurred from a child to an adult. A review of 31 family clusters of COVID-19 from China, Singapore, the USA, South Korea and Vietnam, found only three (9.7%) clusters had a child as the index case and in all three clusters the child was symptomatic.5 Child care clusters of COVID-19 have been notable for their extreme rarity in reports from around the world, although this could be for lack of testing. A current child care outbreak in Sydney was initiated and spread by infected adults. SARS-CoV-2 is mainly spread by droplets and through touching contaminated surfaces. Studies show SARS-CoV-2 can be detected by polymerase chain reaction in the stool of affected infants for several weeks, raising the possibility of faecal–oral spread. Reassuringly, German researchers found no live virus in stool despite viral RNA being detectable, suggesting the positive test is due to dead viral debris shed from the respiratory tract rather than active virus. One would expect child care clusters to be common if asymptomatic or mildly symptomatic pre-school children were even moderately infectious. School outbreaks are also rare, but can be serious. New Zealand's single biggest cluster of COVID-19 was at a secondary girls' school, Marist College, Auckland.6 The outbreak reportedly started with an infected teacher who attended a school cultural event, following which 94 staff and pupils became infected. The extent of any child-to-child or child-to-adult spread is as yet uncertain.6 An unreviewed study of 15 New South Wales schools found nine staff and nine students who had tested positive for SARS-CoV-2.7 Only one of their 168 primary school contacts and only one of 695 secondary school contacts became infected; both were probably infected by schoolmates.7 It is possible that asymptomatic and mildly infected children are important transmitters of SARS-CoV-2, but the evidence to date suggests children rarely spread the virus. A systematic review of school closure to control COVID-19 found insufficient data to comment on efficacy.8 Studies suggest school closures in China, Hong Kong and Singapore had little or no effect on control of the 2003 outbreak with the related SARS virus, which like infection with SARS-CoV-2 was much milder in children than adults.8 However, we should be cautious about extrapolation from SARS to SARS-CoV-2. Modelling studies suggest school closures would prevent fewer than 5% of COVID-19 deaths, much less than other social distancing interventions, and would have major adverse effects on children and on the workforce, but modelling studies are only as good as the data.9 In conclusion, the available evidence to date suggests children are unlikely to be major transmitters of SARS-CoV-2, the coronavirus that causes COVID-19. In Australia and New Zealand, very few children or health-care workers have been diagnosed with SARS-CoV-2 despite intense testing. Health workers who develop symptoms compatible with COVID-19 should be tested and should stay away from work until cleared, which will protect children, their families and other staff. Hospital staff who follow infection control recommendations regarding social distancing, hand-washing and appropriate use of personal-protective equipment are at very low risk of catching SARS-CoV-2 from children.

Healthcare utilization and associated costs following initiation of perampanel in patients with epilepsy

PurposeWe compared health service utilization and costs for patients with epilepsy before and after initiation of perampanel and compared with matched controls. MethodPatients were selected from the Clinical Practice Research Datalink (CPRD). Patients initiating perampanel were matched to controls initiating an alternate add-on therapy for the same underlying epilepsy subtype. First prescription defined index date. Primary and secondary care contacts and associated costs were aggregated in the 12 months before and after index date. Secondary care contacts were available for a subset (~60%) of patients. ResultsThree hundred and forty-three patients treated with perampanel were identified. One hundred and eighty-three (53.4%) were male, mean age was 39.1 (sd: 16.0). Mean epilepsy duration was 21.1 (standard deviation (sd): 13.3) years. Two hundred and eighty-seven (83.7%) were matched to controls. Inpatient admissions with a primary diagnosis of epilepsy (0.5 versus 0.2 per patient-year (ppy), p = 0.002) and neurology specific outpatient appointments (3.2 versus 2.9 ppy, p = 0.041) were significantly reduced following initiation with perampanel. Total costs attributable to epilepsy (£1889 to 1477 ppy) and overall secondary costs (£2593 to £2102) were also significantly reduced. There was no significant difference in primary care, outpatient, or general inpatient admissions. Compared with controls, there was a significant reduction in primary epilepsy admissions (incidence rate ratio (IRR): 0.423; 95% Confidence intervals (CI): 0.198–0.835) but a significant increase in outpatient appointments (1.306; 95% CI: 1.154–1.478) and accident and emergency contacts (1.603; 95% CI: 1.081–2.390) for patients treated with perampanel. ConclusionTreatment with perampanel is associated with reduced epilepsy-related inpatient admissions and accident and emergency contacts.

COVID-19 Mobile Positioning Data Contact Tracing and Patient Privacy Regulations: Exploratory Search of Global Response Strategies and the Use of Digital Tools in Nigeria.

BackgroundThe coronavirus disease (COVID-19) pandemic is the biggest global economic and health challenge of the century. Its effect and impact are still evolving, with deaths estimated to reach 40 million if unchecked. One effective and complementary strategy to slow the spread and reduce the impact is to trace the primary and secondary contacts of confirmed COVID-19 cases using contact tracing technology.ObjectiveThe objective of this paper is to survey strategies for digital contact tracing for the COVID-19 pandemic and to present how using mobile positioning data conforms with Nigeria’s data privacy regulations.MethodsWe conducted an exploratory review of current measures for COVID-19 contact tracing implemented around the world. We then analyzed how countries are using mobile positioning data technology to reduce the spread of COVID-19. We made recommendations on how Nigeria can adopt this approach while adhering to the guidelines provided by the National Data Protection Regulation (NDPR).ResultsDespite the potential of digital contact tracing, it always conflicts with patient data privacy regulations. We found that Nigeria’s response complies with the NDPR, and that it is possible to leverage call detail records to complement current strategies within the NDPR.ConclusionsOur study shows that mobile position data contact tracing is important for epidemic control as long as it conforms to relevant data privacy regulations. Implementation guidelines will limit data misuse.

Contact Tracing and Quarantine for Covid 19: Challenges in community surveillance

Covid 19 caused by SARS-coV-2 is a novel corona virus. This began in Wuhan city, China at the end of December 2019 and had spread to the rest of the world. World Health Organization (WHO) declared Covid 19 as Public Health Emergency of International Concern (PHEIC) on 30th Jan 2020 and later declared as pandemic on 11th march 2020. 1 The disease is mainly spread from human to human through small droplets from nose or mouth when a person with Covid 19 coughs or exhales and through the surface contact. Community surveillance plays significant role in prevention of spread of disease. It includes isolation of the positive case, quarantine of the high risk and low risk contacts and community disinfection.1, 2
 The period of communicability is estimated with the current data to be from 2 days before the onset of symptoms and up to 2 weeks after onset. Hence the initial few asymptomatic days turns out to be crucial period in containing the spread of infection. By the time a Covid 19 patient is diagnosed and isolated, there are quite a number of primary and secondary contacts. Government of India focus has been on Community Surveillance activities which mainly comprises of Contact Tracing and Quarantine.3, 4 This article focuses on the various measures taken to trace the contacts, quarantine measures and on the challenges faced.

Pleistocene range disruption and postglacial expansion with secondary contacts explain the genetic and cytotype structure in the western Balkan endemic Alyssum austrodalmaticum (Brassicaceae)

The western Balkans represents an area of significant topographic and environmental heterogeneity, harbouring high species and intraspecific diversity. Similar genetic and distributional splits observed in unrelated species have suggested some common features in their glacial response and biogeographic history. Here, we studied the western Balkan endemic Alyssum austrodalmaticum with the aim to explore and understand its intraspecific structure and processes that shaped the present patterns. We employed data from AFLPs, two low-copy nuclear genes, genome size, morphometrics and species distribution modelling. Four genetic lineages were identified within the species, which were geographically structured and showed cytotype-specific patterns. The observed phylogeographic structure is congruent with the predicted species distribution during the Last Glacial Maximum. Two allopatric diploid lineages (referred to as N2x and S2x) reflect glacial range disruption and survival in distinct refugia inferred in north-western (Istria, Kvarner) and south-eastern Adriatic areas (northern Adriatic palaeo-coastline and southern Dinarides). AFLP analyses with in silico-generated polyploid genotypes and nuclear genes proved that the two tetraploid lineages (C4x, S4x) were genetic allopolyploids and arose independently. The central tetraploids (C4x) originated through secondary contacts of the two diploid lineages. The origin of the southern tetraploids (S4x) is somewhat ambiguous. Apart from the southern diploids (S2x), the involvement, either direct or through later introgression, of the central tetraploids (C4x) or even other Balkan relatives is possible. Our study highlights the role of glacial range dynamics and secondary contacts, triggering introgression and polyploid evolution, in the formation of genetic diversity and intraspecific patterns in the western Balkans.

Socio-demographic, clinical and psychological predictors of healthcare utilization among patients with musculoskeletal disorders: a prospective cohort study

BackgroundMusculoskeletal disorders are common in the general population and a leading cause for care seeking. Despite the large number of patients with musculoskeletal disorders seeking care, little is known of the clinical course, pathways and predictors of healthcare utilization among these patients. The purposes of the study were to 1) describe the clinical course and related healthcare utilization in primary care physiotherapy and secondary healthcare among patients with neck, shoulder and low-back pain treated in physiotherapy practice, and 2) identify independent clinical, socio-demographic, psychological and general health predictors of healthcare utilization.MethodsThe study was a prospective cohort study of patients seeking physiotherapy treatment for neck, shoulder, or low-back pain in physiotherapy practices across Denmark. A total of 759 physiotherapy patients completed questionnaires containing information on clinical course and potential predictors of healthcare utilization. Healthcare utilization was obtained from the Danish National Health Service Register and National Patient Register. Associations between potential predictors and low/high primary care physiotherapy utilization and hospital contacts in relation to specific neck, shoulder or low-back disorders were analysed using binomial regression analyses and adjusted for age, sex, duration of pain and comorbidity.ResultsDuring 6 months follow-up, patients experienced clinically relevant improvements in pain, fear avoidance and psychological wellbeing. Patients with higher baseline pain and disability and who were on sickness leave were more likely to have high primary care physiotherapy utilization. Hospital contacts were predicted by higher levels of pain, disability and low psychological wellbeing.ConclusionsClinical factors and sickness leave seems to be the main predictors of primary care physiotherapy utilization, whereas for secondary care contacts, psychological factors may also be of importance. The study contributes to the on-going research into clinical pathways and may identify future target areas to reduce healthcare utilization in patients with musculoskeletal disorders.

Phylogeography of Campanula fenestrellata s.l. (Campanulaceae) in the northern Adriatic

Campanula fenestrellata subsp. fenestrellata and C. fenestrellata subsp. istriaca belong to the morphologically and phylogenetically well established amphi-Adriatic group Campanula ser. Garganicae. The two morphologically differentiated endemic taxa are distributed on the north-eastern Adriatic islands and coast. In order to study the relationships among C. fenestrellata s.l. populations and to gain insight into genetic basis of taxonomic separation established on morphology, we examined amplified fragment length polymorphisms (AFLPs) as well as nuclear and plastid DNA sequences (ITS and trnL–trnF). With the sequence data, no structure and no distinction between the two subspecies were observed. The AFLPs separated populations geographically and inferred high number of most likely clusters. The northern and the southernmost populations were assigned to uniform separate clusters indicating the longer isolation of respective populations, while the admixed populations were evident in the central area where the two taxa geographically overlap, indicating the presence of gene flow. Distinct fragmentation patterns and the existence of several temporally continuous microrefugia during the Quaternary climatic oscillations likely promoted strong genetic differentiation within the species range, while secondary postglacial contacts are reflected in observed admixture. Although the two taxa exhibited differences in ecological preferences, niche conservatism was detected. Overall, phylogeographic reconstruction of C. fenestrellata s.l. populations highlights the importance of microrefugia in shaping the intraspecific genetic variation as well as of melting-pot areas in rearranging such variation as a result of a more recent admixture.

When does reproductive interference occur? Predictions and data

AbstractReproductive interference is interspecific sexual interactions that are costly to at least one species involved. Although many studies have reported a substantial fitness cost associated with reproductive interference, suggesting its ecological significance, others have not observed reproductive interference in study species. Reproductive interference that incurs a large fitness cost is more likely to occur during secondary contacts than between long‐coexisting species. I first explain the rationale underlying this prediction using existing literature. Next, I present a conceptual framework to classify pairs of interacting species into one of four states, defined by the ecological and evolutionary stabilities of the species pairs. I discuss how the stability states of species pairs are likely to change over time, along with changes in the demographic and evolutionary role of reproductive interference. I then perform literature survey to test the prediction that reproductive interference should be more prevalent in secondary contact. Finally, I discuss the implications of the proposed conceptual framework and literature survey result.

Secondary Attack Rate and Epidemiological Determinants of Secondary High-Risk Contacts of SARS COV-2; Lessons to Learn: A Study from North Gujarat

Background: Transmission of the SARS CoV-2 disease among secondary contacts is a challenge and must be addressed. Secondary attack rate (SAR) is the probability that an infection occurs among susceptible contact within incubation period. It can be influenced by many factors including personal hygiene habits, behaviors, and characteristics of close-contact environments.
 Objectives: The study was conducted to finds out the Secondary Attack Rate among Household contacts of Covid19 positive patients; to study the socio-demographic and other factors affecting the Secondary Attack Rate; and to compare the disease outcomes in the primary cases and secondary contacts.
 Methodology: Observational Retrospective Study was conducted telephonically among randomly selected 444 primary contacts from District Patan and their 1059 secondary high-risk contacts.
 Results and conclusion: The overall SAR was found to be 5.6% which was highest (21%) in >60 years age group followed by 18 to<60 years age group (5.6%).Death rates were higher(18%) in Primary cases compared to High Risk secondary contacts (8%).Gender, age, symptomatic contacts, presence of toilet facility, Travel History and co-morbid conditions were found to be statistically significant in High Risk secondary contacts. Home isolation seems to be a good measure for Covid 19 positive cases except for those >60 years old.

Accurate inference of the full base-pairing structure of RNA by deep mutational scanning and covariation-induced deviation of activity.

Despite the large number of noncoding RNAs in human genome and their roles in many diseases include cancer, we know very little about them due to lack of structural clues. The centerpiece of the structural clues is the full RNA base-pairing structure of secondary and tertiary contacts that can be precisely obtained only from costly and time-consuming 3D structure determination. Here, we performed deep mutational scanning of self-cleaving CPEB3 ribozyme by error-prone PCR and showed that a library of <5 × 104 single-to-triple mutants is sufficient to infer 25 of 26 base pairs including non-nested, nonhelical, and noncanonical base pairs with both sensitivity and precision at 96%. Such accurate inference was further confirmed by a twister ribozyme at 100% precision with only noncanonical base pairs as false negatives. The performance was resulted from analyzing covariation-induced deviation of activity by utilizing both functional and nonfunctional variants for unsupervised classification, followed by Monte Carlo (MC) simulated annealing with mutation-derived scores. Highly accurate inference can also be obtained by combining MC with evolution/direct coupling analysis, R-scape or epistasis analysis. The results highlight the usefulness of deep mutational scanning for high-accuracy structural inference of self-cleaving ribozymes with implications for other structured RNAs that permit high-throughput functional selections.

Secondary contacts and genetic admixture shape colonization by an amphiatlantic epibenthic invertebrate.

Research on the genetics of invasive species often focuses on patterns of genetic diversity and population structure within the introduced range. However, a growing body of literature is demonstrating the need to study how native genotypes affect both ecological and evolutionary mechanisms within the introduced range. Here, we used genotyping‐by‐sequencing to study both native and introduced ranges of the amphiatlantic marine invertebrate Ciona intestinalis. A previous study using microsatellites analysed samples collected along the Swedish west coast and showed the presence of genetically distinct lineages in deep and shallow waters. Using 1,653 single nucleotide polymorphisms (SNPs) from newly collected samples (285 individuals), we first confirmed the presence of this depth‐defined genomic divergence along the Swedish coast. We then used approximate Bayesian computation to infer the historical relationship among sites from the North Sea, the English Channel and the northwest Atlantic and found evidence of ancestral divergence between individuals from deep waters off Sweden and individuals from the English Channel. This divergence was followed by a secondary contact that led to a genetic admixture between the ancestral populations (i.e., deep Sweden and English Channel), which originated the genotypes found in shallow Sweden. We then revealed that the colonization of C. intestinalis in the northwest Atlantic was as a result of an admixture between shallow Sweden and the English Channel genotypes across the introduced range. Our results showed the presence of both past and recent genetic admixture events that together may have promoted the successful colonizations of C. intestinalis. Our study suggests that secondary contacts potentially reshape the evolutionary trajectories of invasive species through the promotion of intraspecific hybridization and by altering both colonization patterns and their ecological effects in the introduced range.

Replicated anthropogenic hybridisations reveal parallel patterns of admixture in marine mussels.

Human‐mediated transport creates secondary contacts between genetically differentiated lineages, bringing new opportunities for gene exchange. When similar introductions occur in different places, they provide informally replicated experiments for studying hybridisation. We here examined 4,279 Mytilus mussels, sampled in Europe and genotyped with 77 ancestry‐informative markers. We identified a type of introduced mussels, called “dock mussels,” associated with port habitats and displaying a particular genetic signal of admixture between M. edulis and the Mediterranean lineage of M. galloprovincialis. These mussels exhibit similarities in their ancestry compositions, regardless of the local native genetic backgrounds and the distance separating colonised ports. We observed fine‐scale genetic shifts at the port entrance, at scales below natural dispersal distance. Such sharp clines do not fit with migration‐selection tension zone models, and instead suggest habitat choice and early‐stage adaptation to the port environment, possibly coupled with connectivity barriers. Variations in the spread and admixture patterns of dock mussels seem to be influenced by the local native genetic backgrounds encountered. We next examined departures from the average admixture rate at different loci, and compared human‐mediated admixture events, to naturally admixed populations and experimental crosses. When the same M. galloprovincialis background was involved, positive correlations in the departures of loci across locations were found; but when different backgrounds were involved, no or negative correlations were observed. While some observed positive correlations might be best explained by a shared history and saltatory colonisation, others are likely produced by parallel selective events. Altogether, genome‐wide effect of admixture seems repeatable and more dependent on genetic background than environmental context. Our results pave the way towards further genomic analyses of admixture, and monitoring of the spread of dock mussels both at large and at fine spacial scales.

Diversification and gene flow of tilapia species driven by ecological changes in lowland and mountain areas of southern Mauritania

Haplotilapiine are members of Cichlidae (cichlid fishes), one of the most species-rich vertebrate families. Many haplotilapiines diversified via allopatric divergence, sexual selection, hybridization and ecological adaptation, making them excellent models for evolutionary research. One extraordinary example of how haplotilapiine diversified are the species found within the Sahara desert, surviving in isolated wetlands for thousands of years. Seasonal, and longer, climate cycles in these areas have resulted in periods of connectivity and isolation within and between lowland and mountain regions via ephemeral rivers, which highly impacts the potential for migration of water-species. Here we studied how ecological variability and secondary contact have affected the population genetics of haplotilapiine cichlid fishes (Sarotherodon galilaeus), in the lowland Karakoro sub-basin and highland Afolle mountain regions of Mauritania. We used DNA-sequence data of mitochondrial (ND2, N = 59) and nuclear (S7 1st intron, N = 32) genes, and microsatellite markers data (13 novel loci developed for Sarotherodon, N = 61). Our results based on microsatellite data showed two genetically differentiated lowland groups of S. galilaeus that exist in sympatry. Absence of one of these groups in mountain areas can be due to small sample size or local extinction. We found no significant genetic differentiation between lowland and mountain based on microsatellite and mtDNA data, supporting our hypothesis of recent, downstream gene flow. As expected, genetic diversity was significantly lower in mountain population, which can be due to different factors, including stochastic effects or downstream migration increasing diversity via gene flow. Ecological changes (seasonal and long-term) have likely driven divergence and posterior secondary contacts on the studied Sarotherodon lineages at multiple times, leaving open questions for future studies about the specifics of these evolutionary processes. Moreover, the pattern of genetic diversity in lowland and mountain populations highlights the importance of protecting geographically isolated areas for long-term persistence of tilapia species.

A Cross-Sectional Study Assessing Appropriateness Of Inhaled Corticosteroid Treatment In Primary And Secondary Care Patients With COPD In Sweden.

PurposeInhaled corticosteroids (ICS) are often more widely prescribed in the treatment of chronic obstructive pulmonary disease (COPD) than what is recommended in the guidelines. The aim of this study was to evaluate the appropriateness of ICS treatment in COPD patients using the algorithm proposed by the International Primary Care Respiratory Group (IPCRG) and to identify factors associated with ICS treatment.Patients and methodsAppropriateness of ICS therapy was studied with respect to concomitant asthma, history of exacerbations and blood eosinophils (B-Eos) in a Swedish cohort of primary and secondary care patients with COPD. Factors associated with ICS were investigated using multivariable logistic regression.ResultsTriple treatment was found to be the most common treatment combination, used by 46% of the 561 included patients, and in total 63% were using ICS. When applying the IPCRG algorithm, there was a possible indication for discontinuation of ICS in 55% of the patients with ICS treatment. Of the patients not using ICS, 18% had an indication for starting such treatment. The strongest factors associated with ICS therapy were frequent exacerbations (aOR 8.61, 95% CI 4.06, 20.67), secondary care contacts (aOR 6.99, 95% CI 2.48, 25.28) and very severe airflow limitation (aOR 5.91, 95% CI 1.53, 26.58).ConclusionMore than half of the COPD patients on ICS met the criteria where withdrawal of the treatment could be tried. There was, however, also a subgroup of patients not using ICS for whom there was an indication for starting ICS treatment. Patients using ICS were characterized by more frequent exacerbations and lower lung function.

Body mass index and lifetime healthcare utilization

BackgroundOverweight and obesity is a major global public health challenge, and understanding the implications for healthcare systems is essential for policy planning. Past studies have typically found positive associations between obesity and healthcare utilization, but these studies have not taken into consideration that obesity is also associated with early mortality. We examined associations between body mass index (BMI, reported as kg/m2) and healthcare utilization with and without taking BMI-specific survival into consideration.MethodsWe used nationally representative data on 33 882 adults collected between 2002 and 2015. We computed BMI- and age-specific primary and secondary care utilization and multiplied the estimated values with gender-, age-, and BMI-specific probabilities of surviving to each age. Then, we summed the average BMI-specific utilization between 18 and 85 years.ResultsDuring a survival-adjusted lifetime, males with normal weight (BMI: 18.5–24.9) had, on average, 167 primary care, and 77 secondary care contacts. In comparison, males with overweight (BMI: 25.0–29.9), category I obesity (BMI: 30.0–34.9), and category II/III obesity (BMI ≥35.0) had 11%, 41%, and 102% more primary care, and 14%, 29%, and 78% more secondary care contacts, respectively. Females with normal weight had, on average, 210 primary care contacts and 91 secondary care contacts. Females with overweight, category I obesity, and category II/III obesity had 20%, 34%, and 81% more primary care contacts, and 26%, 16%, and 16% more secondary care contacts, respectively.ConclusionThe positive association between BMI and healthcare utilization was reduced, but not offset, when BMI-specific survival was taken into consideration. Our findings underpin previous research and suggest that interventions to offset the increasing prevalence of overweight, and especially obesity, are warranted.

Impact of a telephone-first consultation system in general practice

Purpose of the studyIncreasing pressure on general practice prompts innovative change in service organisation. This study sought to evaluate the impact of introducing a telephone-first consultation system in a socioeconomically...

Evaluation of the healthcare resource use and the related financial costs of managing peanut allergy in the United Kingdom

ABSTRACT Aims: We aimed to estimate the resource use and associated costs for patients with peanut allergy (PA) compared to matched controls. Methods: This was a retrospective cohort study using data from the UK Clinical Practice Research Datalink and Hospital Episode Statistics. PA patients were matched to two control cohorts: the first (simple-matched) were matched 1:1 on year of birth, general practice, gender and registration year. The second (atopy-matched) were matched on the same characteristics plus presence/absence of an atopic condition. Prescriptions and primary and secondary care contacts were compared between cases and controls. Results: 15,483 peanut-allergic patients were identified: 13,609 (87.9%) were simple-matched and 9,320 (60.2%) atopy-matched. The total per person annual incremental health-care costs associated with PA were £253 (atopy-matched) and £333 (simple-matched). For those with PA and a prior anaphylaxis incremental costs were £662, for those prescribed an epinephrine autoinjector incremental costs were £392. Extrapolated to the U.K. population, total excess costs of PA were between £33 and 44 million in 2015. Conclusions: Patients with PA had increased health-care contacts and consequently increased associated costs compared to controls. Observation bias should be considered in interpretation, but this study suggests that PA presents significant burden to health-care systems.

Genetic, phenotypic and ecological differentiation suggests incipient speciation in two Charadrius plovers along the Chinese coast

BackgroundSpeciation with gene flow is an alternative to the nascence of new taxa in strict allopatric separation. Indeed, many taxa have parapatric distributions at present. It is often unclear if these are secondary contacts, e.g. caused by past glaciation cycles or the manifestation of speciation with gene flow, which hampers our understanding of how different forces drive diversification. Here we studied genetic, phenotypic and ecological aspects of divergence in a pair of incipient shorebird species, the Kentish (Charadrius alexandrinus) and the White-faced Plovers (C. dealbatus), shorebirds with parapatric breeding ranges along the Chinese coast. We assessed divergence based on molecular markers with different modes of inheritance and quantified phenotypic and ecological divergence in aspects of morphometric, dietary and climatic niches.ResultsOur integrative analyses revealed small to moderate levels of genetic and phenotypic distinctiveness with symmetric gene flow across the contact area at the Chinese coast. The two species diverged approximately half a million years ago in dynamic isolation with secondary contact occurring due to cycling sea level changes between the Eastern and Southern China Sea in the mid-late Pleistocene. We found evidence of character displacement and ecological niche differentiation between the two species, invoking the role of selection in facilitating divergence despite gene flow.ConclusionThese findings imply that ecology can indeed counter gene flow through divergent selection and thus contributes to incipient speciation in these plovers. Furthermore, our study highlights the importance of using integrative datasets to reveal the evolutionary history and assist the inference of mechanisms of speciation.