Direct PCR of indigenous and invasive mosquito species: a time- and cost-effective technique of mosquito barcoding.

Millions of people die each year as a result of pathogens transmitted by mosquitoes. However, the morphological identification of mosquito species can be difficult even for experts. The identification of morphologically indistinguishable species, such as members of the Anopheles maculipennis complex (Diptera: Culicidae), and possible hybrids, such as Culex pipiens pipiens/Culex pipiens molestus (Diptera: Culicidae), presents a major problem. In addition, the detection and discrimination of newly introduced species can be challenging, particularly to researchers without previous experience. Because of their medical importance, the clear identification of all relevant mosquito species is essential. Using the direct polymerase chain reaction (PCR) method described here, DNA amplification without prior DNA extraction is possible and thus species identification after sequencing can be achieved. Different amounts of tissue (leg, head; larvae or adult) as well as different storage conditions (dry, ethanol, -20 and -80 °C) and storage times were successfully applied and showed positive results after amplification and gel electrophoresis. Overall, 28 different indigenous and non-indigenous mosquito species were analysed using a gene fragment of the COX1 gene for species differentiation and identification by sequencing this 658-bp fragment. Compared with standard PCR, this method is time- and cost-effective and could thus improve existing surveillance and control programmes.

[Efficiency of general practice in Switzerland]. / Effizienz von Allgemeinarztpraxen in der Schweiz.

BACKGROUND: In their capacity as gatekeepers, affect the entire cost of treatment of patients including cost for medication and inpatient care. Thus, it is of special interest to examine the production process of general practitioners. AIM: To study efficiency differences between general medical practices, taking into account a possible Managed Care participation by the physician. METHODS: A stochastic frontier analysis based on billing data of 1,500 Swiss physicians from 1997 - 1999 is applied to measure the relative efficiency of general practitioners. The number of consultations serves as output and the charged services as inputs of production. RESULTS: Most productive physicians are members of primary physicians' networks, in which the gate-keeping function of general practitioners is of central importance. For the "production" of one consultation they use 15 percent less resources than an average physician in a conventional medical practice. DISCUSSION AND CONCLUSION: In principle, assessment of efficiency of primary care physicians is possible. Differences in efficiency between physicians can be explained by characteristics of the individual medical practice. Disadvantages of the approach exist in the neglect of the patients' severity of illness and in having indirect measures of quality of medical care available.