Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study

Background The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. Objective We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. Methods This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. Results There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. Conclusions McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing.

Opportunities to catalyse improved healthcare access in pluralistic systems: a cross-sectional study in Haiti

ObjectiveTo identify determinants of intended versus actual care-seeking behaviours in a pluralistic healthcare system that is reliant on both conventional and non-conventional providers and discover opportunities to catalyse improved healthcare access.DesignCross-sectional study.Setting and participantsIn Haiti 568 households (incorporating 2900 members) with children less than 5 years of age were randomly sampled geographically with stratifications for population density. These households identified the healthcare providers they frequented. Among 140 providers, 65 were located and enrolled.Outcome measuresHousehold questionnaires with standardised cases (intentions) were compared with self-recall of health events (behaviours). The connectedness of households and their providers was determined by network analysis.ResultsHouseholds reported 636 health events in the prior month. Households sought care for 35% (n=220) and treated with home remedies for 44% (n=277). The odds of seeking care increased 217% for severe events (adjusted OR (aOR)=3.17; 95% CI 1.99 to 5.05; p<0.001). The odds of seeking care from a conventional provider increased by 37% with increasing distance (aOR=1.37; 95% CI 1.06 to 1.79; p=0.016). Despite stating an intention to seek care from conventional providers, there was a lack of congruence in practice that favoured non-conventional providers (McNemar’s χ2 test p<0.001). Care was sought from primary providers for 68% (n=150) of cases within a three-tiered network; 25% (n=38/150) were non-conventional.ConclusionAddressing geographic barriers, possibly with technology solutions, should be prioritised to meet healthcare seeking intentions while developing approaches to connect non-conventional providers into healthcare networks when geographic barriers cannot be overcome.

Genome-wide and cuticular hydrocarbon evidence shed light on potential drivers of speciation in a Neotropical ant species complex

Reproductive isolation between geographically separated populations is generally considered the most common form of speciation. However, speciation may also occur in the absence of geographic barriers due phenotypic and genotypic factors such as chemical cue divergence, mating signal divergence and mitonuclear conflict. Here we performed an integrative study based on two genome-wide techniques, 3RAD and ultraconserved elements, coupled with cuticular hydrocarbon and mtDNA sequence data, to assess the species limits within the E. ruidum species-complex, a widespread and conspicuous group of Neotropical ants for which heteroplasmy has been recently discovered in some populations from southeast Mexico. Our analyses indicate the existence of at least five distinct species in this complex, two widely distributed along the Neotropics and three that are restricted to southeast Mexico and that apparently have high levels of heteroplasmy. We found that species boundaries in the complex did not coincide with geographic barriers. We therefore consider possible roles of alternative drivers that may have promoted the observed patterns of speciation, including mitonuclear incompatibility, cuticular hydrocarbon differentiation, and colony structure. Our study highlights the importance of simultaneously assessing different sources of evidence to disentangle the species limits of taxa with complicated evolutionary histories.

Spatial and temporal variation in the genetic structure of Dascyllus trimaculatus (Pomacentridae) in the Bohol Sea

The potential of microsatellite markers to detect the spatial and temporal genetic structure of reef fish populations within a linear distance of 300 km in the absence of geographic barriers was tested in the Bohol Sea, central Philippines, using the three-spot damselfish Dascyllus trimaculatus. A total of 672 samples from 7 populations in the Bohol Sea were processed to determine temporal and spatial patterns of genetic variability using ten previously developed and tested microsatellite markers. The extent of differentiation was determined based on a variance-based measure of population structure FST and RST, and genetic distances Ds , DA, and dm2, each of which makes different assumptions on the process of migration, mutation, selection, and genetic drift. Patterns of temporal and spatial variation were consistent among 36 possible pairs of populations. Reef groups are defined as (1) the Mantigue-Dinagat on the northeast edge of the Bohol Sea; (2) the Selinog and Dapitan islands, to the southwest and central Bohol sea populations (3) Apo and (4) Sumilon to the west, and (5) Balicasag group to the northwest. The presence of structure in the absence of geographic barriers suggests the influence of strong surface circulation patterns that differ from the east to the west side of the region. The consistency of a population’s genetic signatures over multiple temporal sampling dates implies strong habitat selection for genotypes. Genetic breaks were detected at a distance 4x greater than the marine protected area’s average size, suggesting a minimum linear distance for networking of MPAs should be expanded to this scale. KEYWORDS: Conservation, Hardy-Weinberg equilibrium, marine protected area, microsatellite markers, population genetics, reef fish

Accessing the Border: The Mobility Rights of Asylum Seekers with Precarious Status

The mobility rights of migrants have been presented as universal and non-discriminatory in United Nation declarations, protocols and conventions. These inherent rights are often placed in opposition to states’ sovereign right to control their borders. The international refugee regime has faced challenges to the defence and advocacy of human rights. The right to seek asylum has faced questions of security, and terrorism. Politicians have successfully re-framed asylum seekers as active ‘threats’ to the social, cultural and economic security of the state and campaign to enforce the protection of the state. By de-linking the border from the territorial boundaries of the state, Canadian officials have excluded, deterred and halted the movement of asylum seekers seeking refuge in Canada, adding to the surmountable geographic barriers the state holds to resettlement.

Accessing the Border: The Mobility Rights of Asylum Seekers with Precarious Status

The mobility rights of migrants have been presented as universal and non-discriminatory in United Nation declarations, protocols and conventions. These inherent rights are often placed in opposition to states’ sovereign right to control their borders. The international refugee regime has faced challenges to the defence and advocacy of human rights. The right to seek asylum has faced questions of security, and terrorism. Politicians have successfully re-framed asylum seekers as active ‘threats’ to the social, cultural and economic security of the state and campaign to enforce the protection of the state. By de-linking the border from the territorial boundaries of the state, Canadian officials have excluded, deterred and halted the movement of asylum seekers seeking refuge in Canada, adding to the surmountable geographic barriers the state holds to resettlement.