Generalists at the interface:Nematode transmission between wild and domestic ungulates

AbstractMany parasitic nematode species are generalists capable of infecting multiple host species. The complex life cycle of nematodes, involving partial development outside of the host, facilitates transmission of these parasites between host species even when there is no direct contact between hosts. Infective nematode larvae persist in the environment, and where grazing or water sources are shared ingestion of parasite larvae deposited by different host species is likely. In this paper we examine the extent to which nematode parasite species have been observed in sympatric wild and domestic ungulates. First, using existing host–parasite databases, we describe expected overlap of 412 nematode species between 76 wild and 8 domestic ungulate host species. Our results indicate that host-specific parasites make up less than half of the nematode parasites infecting any particular ungulate host species. For wild host species, between 14% (for common warthog) and 76% (for mouflon) of parasitic nematode species are shared with domestic species. For domestic host species, between 42% (for horse) and 77% (for llamas/alpacas) of parasitic nematode species are shared with wild species. We also present an index of liability to describe the risk of cross-boundary parasites to each host species. We then examine specific examples from the literature in which transmission of nematode parasites between domestic and wild ungulates is described. However, there are many limitations in the existing data due to geographical bias and certain host species being studied more frequently than others. Although we demonstrate that many species of parasitic nematode are found in both wild and domestic hosts, little work has been done to demonstrate whether transmission is occurring between species or whether similar strains circulate separately. Additional research on cross-species transmission, including the use of models and of genetic methods to define strains, will provide evidence to answer this question

Understanding Internal Exclusion: An Exploration of How Senior Leaders in Mainstream Secondary Schools Make Sense of Their Experience

Internal exclusion (IE) describes the liminal physical or metaphorical space between a child's inclusion in mainstream class and exclusion from school. IE can be also known as “inclusion, learning support, exclusion, isolation, intervention or nurture groups” (Burton, Bartlett, & Anderson de Cuevas, 2009, p.151). Exploration of IE is limited to several studies (Gilmore, 2012; 2013; Gillies, 2016; Greenstein, 2014; Preece & Timmins, 2004). Taken together, these suggest that IE is constructed by staff and pupils as both support and sanction, and there is a significant diversity of approaches. In this study, I contribute to the critical Educational Psychology literature by taking a social constructionist and post-structuralist approach informed by the work of Foucault (1977/1991) to understand how senior leaders made sense of IE. I conducted unstructured interviews with a headteacher and assistant headteacher of two mainstream secondary schools in England at the start of the Autumn 2020 term, and analysed the data using a narrative approach (Riessman, 2008; Squire, 2013). Findings suggest that participants made sense of IE in relation to psychological discourses of behaviourism, humanism, and the psycho-medical, that were at times incongruent with one another. IE was identified as a technology that operationalised disciplinary power (Foucault, 1977/1991), yet it was subsumed into discourses of support for social, emotional and mental health (SEMH) needs. Risk to the core business of school was meaningful. These findings provide a valuable contribution to educational psychologists’ (EPs) understanding of IE and show how making these discourses visible enables them to be challenged. I conclude with practical implications for EPs, limitations, and recommendations for future research

Care transitions for older patients with musculoskeletal disorders: continuity from the providers’ perspective

<p><strong>Introduction</strong>: Care transitions are a common and frequently adverse aspect of health care, resulting in a high-risk period for both care quality and patient safety. Patients who have complex care needs and undergo treatment in multiple care settings, such as older patients with musculoskeletal disorders, may be at higher risk for poor care transitions.</p><p><strong>Methods: </strong>Key informant interviews were used to gather in-depth information on transitional care issues, particularly those which impact informational continuity, from the perspective of a range of health professionals (η=17) in care settings relevant to the care continuum of older patients with hip fractures.</p><p><strong>Results:</strong> Three transitional care themes were identified; medical complexity impacts care trajectories, larger circles of care can be both beneficial and challenging, and a variety of channels and modes are required for meaningful information exchange. Many issues cut across each care setting, and address challenges to informational continuity among and between health care providers, patients, and caregivers.</p><p><strong>Conclusions:</strong> Medical complexity enlarges the circle of care which challenges care continuity. There may be fundamental elements which, regardless of care setting, strengthen transitional care quality. Standardized transitional care processes might help to offset informational discontinuity across care settings as a result of this population's larger circles of care.</p

Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis

Background: Modelling suggests that achieving the WHO incidence target for hepatitis C virus (HCV) elimination in Pakistan could cost US$3.87 billion over 2018 to 2030. However, the economic benefits from integrating services or improving productivity were not included.Methods and findings: We adapt a HCV transmission model for Pakistan to estimate the impact, costs, and cost-effectiveness of achieving HCV elimination (reducing annual HCV incidence by 80$148 to US$198/DALY). Compared to existing levels of treatment, scaling up screening and treatment to achieve HCV elimination in Pakistan averts 5.57 (95$1.45 (1.32 to 1.60) billion but will result in US$1.30 (0.94 to 1.72) billion in improved economic productivity over 2018 to 2030. This elimination strategy is highly cost-effective (ICER = US$29 per DALY averted) by 2030, with it becoming cost-saving by 2031 and having a net economic benefit of US$9.10 (95% UI 6.54 to 11.99) billion by 2050. Limitations include uncertainty around what level of integration is possible within existing primary healthcare services as well as a lack of Pakistan-specific data on disease-related healthcare management costs or productivity losses due to HCV.Conclusions: Investment in HCV elimination can bring about substantial societal health and economic benefits for Pakistan

Estimates of Toxoplasmosis Incidence Based on Healthcare Claims Data, Germany, 2011–2016

Toxoplasmosis is a zoonotic infection contracted through Toxoplasma gondii–contaminated food, soil, or water. Seroprevalence in Germany is high, but estimates of disease incidence are scarce. We investigated incidences for various toxoplasmosis manifestations using anonymized healthcare claims data from Germany for 2011–2016. Patients with a toxoplasmosis diagnosis during the annual observational period were considered incident. The estimated incidence was adjusted to the general population age/sex distribution. We estimated an annual average of 8,047 toxoplasmosis patients in Germany. The average incidence of non–pregnancy-associated toxoplasmosis patients was 9.6/100,000 population. The incidence was highest in 2011, at 10.6 (95% CI 9.4–12.6)/100,000 population, and lowest in 2016, at 8.0 (95% CI 7.0–9.4)/100,000 population. The average incidence of toxoplasmosis during pregnancy was 40.3/100,000 pregnancies. We demonstrate a substantial toxoplasmosis disease burden in Germany. Public health and food safety authorities should implement toxoplasmosis-specific prevention programs.Peer Reviewe