Pleistocene climate fluctuations drove demographic history of African golden wolves (Canis lupaster).

Pleistocene climate change impacted entire ecosystems throughout the world. In the northern hemisphere, the distribution of Arctic species expanded during glacial periods, while more temperate and mesic species contracted into climatic refugia, where isolation drove genetic divergence. Cycles of local cooling and warming in the Sahara region of northern Africa caused repeated contractions and expansions of savannah-like environments which connected mesic species isolated in refugia during interglacial times, possibly driving population expansions and contractions; divergence and geneflow in the associated fauna. Here, we use whole genome sequences of African golden wolves (Canis lupaster), a generalist mesopredator with a wide distribution in northern Africa to estimate their demographic history and past episodes of geneflow. We detect a correlation between divergence times and cycles of increased aridity-associated Pleistocene glacial cycles. A complex demographic history with responses to local climate change in different lineages was found, including a relict lineage north of the High Atlas Mountains of Morocco that has been isolated for more than 18,000 years, possibly a distinct ecotype.

[Stratification of the population in the Basque Country: results in the first year of implementation]. / Estratificación de la población en el País Vasco: resultados en el primer año de implantación.

Predictive models allow populations to be stratified according to their health requirements for the following year. They offer health care organizations the opportunity to act proactively, designing specific interventions adapted to the level of need of different groups of people. The "Strategy for tackling the challenge of chronic illness in the Basque Country" proposes the use of such models, integrating them with other policies. The prospective categorization of all the population assigned to Osakidetza was performed for the first time in 2010 using the Johns Hopkins Adjusted Clinical Groups predictive model (ACG-PM). For this purpose, already recorded information extracted from electronic health records of primary care and hospital discharge reports was used. This article discusses the advantages of the combined use of various sources of information, and describes the application of the stratification in three programs, targeted at chronic patients who suffer different burdens of comorbidity.

[Indication of magnetic resonance imaging in cases of headaches in adults: results following the RAND/UCLA appropriateness method]. / Indicacion de resonancia magnetica ante cefalea en adultos: resultados siguiendo el metodo RAND/UCLA de uso apropiado.

INTRODUCTION. The number of requests for magnetic resonance imaging (MRI) scans in healthcare systems is continually on the rise. An MRI scan of the head is one of the most frequent locations, which if used inappropriately entails a loss of resources. Consequently, guidelines are needed to help the physician make decisions and allow better management of resources. AIM. To establish the key indications of MRI scans in cases of adults with headache. MATERIALS AND METHODS. The RAND/UCLA appropriateness method was used, that is, following a systematic review, a list of possible indications of MRI in cases of headache was drawn up. This list was then assessed by a panel of experts and given a score between 1 ('totally inappropriate') and 9 ('totally appropriate'). An initial round of scoring was carried out online, the results were then discussed at a face-to-face meeting of the experts and finally another online round was undertaken. MRI was considered appropriate in each indication if the mean score was 6.5 or higher and there was agreement among the experts (using the IPRAS index). RESULTS. MRI scanning was considered appropriate in cases of: new headache, new headache in immunodeficient patients, sudden intense headache, headache with focal neurological symptoms, postural headache, headache due to physical effort or Valsalva manoeuvres, suspected thrombosis in the venous sinuses, systemic involvement, progressive headache, headache in pregnancy, autonomic trigeminal headache or severe cranial traumatic injury with focus. CONCLUSIONS. It seems that indication can be summed up in headaches with a suspected secondary pathology. The methodology employed makes it possible to establish MRI indications that can be useful both in clinical practice and for healthcare management practitioners.

TITLE: Indicacion de resonancia magnetica ante cefalea en adultos: resultados siguiendo el metodo RAND/UCLA de uso apropiado.Introduccion. El numero de peticiones de resonancia magnetica (RM) en los sistemas sanitarios es cada vez mayor. La RM craneal es una de las localizaciones mas frecuentes, cuya mala utilizacion supone una perdida de recursos, lo que obliga a disponer de guias que ayuden a los clinicos en la toma de decisiones y permita una mejor gestion de los recursos. Objetivo. Establecer las principales indicaciones de RM en los casos de cefalea en adultos. Materiales y metodos. Se utilizo el metodo de uso apropiado RAND/UCLA: tras una revision sistematica se elaboro un listado con posibles indicaciones de RM ante cefalea que un panel de expertos puntuo del 1 ('totalmente inapropiado') al 9 ('totalmente apropiado'). Se realizo una primera ronda de puntuacion online, luego se presentaron y se discutieron los resultados en una reunion presencial y se emprendio una ronda final online. La RM se considero apropiada en cada indicacion si la puntuacion mediana era de 6,5 o mayor y habia acuerdo (empleando el indice IPRAS). Resultados. La RM se considero apropiada ante: nueva cefalea, nueva cefalea en paciente inmunodeprimido, cefalea intensa subita, cefalea con sintomatologia neurologica focal, cefalea postural, cefalea por esfuerzo fisico o maniobras de Valsalva, sospecha de trombosis del seno venoso, afectacion sistemica, cefalea progresiva, cefalea en embarazada, cefalalgia trigeminal autonomica o traumatismo craneal grave con focalidad. Conclusiones. La indicacion parece resumirse en cefaleas con sospecha de patologia secundaria. La metodologia empleada permite establecer indicaciones de RM que pueden ser de utilidad tanto para el clinico como para el gestor sanitario.