RESUMEN
The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners (GPs) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations), and the changing patient presentations and GP workload as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. While the pandemic disrupted the usual ways of working, it also produced opportunities, e.g., for re-organising ways of managing infections and AMS in the future.
RESUMEN
Organizers of the symposium Starting from Fins: Parallelism in the Evolution of Limbs and Genitalia intended it 1) to begin debates and discussions about parallelism, serial homology and transitions in development, as well as evolution of gene function and theories of origins and 2) to examine closely the potential significance of serial homology in understanding the evolution of morphology. This issue of Evolution and Development focuses on unpaired fin to genitalia transitions; the July-August issue will focus on paired fins to limbs, revisit the issues raised in the symposium, and point to future directions. Minelli's opening presentation introduced the central theme of the symposium by suggesting that body appendages such as arthropod and vertebrate limbs, chordate tails and external genitalia are evolutionarily divergent duplicates (paramorphs) of the main body axis. Suzuki's and Podlasek's presentations focused on the development of mammalian genitalia. Suzuki presented Suzuki et al investigations of the role of fibroblast growth factor (Fgf) and Sonic hedgehog (Shh) as signaling molecules during murine external genitalia formation, and Podlasek presented Podlasek et al investigations to elucidate a rudimentary pathway of essential developmental genes and transcriptional regulators such as Hox genes, Sonic hedgehog (Shh), and Bone morphogenetic proteins 2 and 4 (BMP-2; BMP-4), found in the limb. Discussions and questions emerging from the symposium point to the need to recognize that claims of phylogenetic cause must be based on something more than similarities; research must focus on the extent to which comparisons can be taken as well as on the evolutionary significance of similarities.
