Direct patient care activities and interventions of emergency medicine pharmacists.

Background Emergency medicine (EM) pharmacists are increasingly recognized as integral team members in the care of emergency department (ED) patients but there is variability in the scope of direct patient care services. Objectives The primary objective was to categorize direct patient care activities and drug therapy recommendations. The secondary objectives were to categorize recommendations based on drug class and to determine the proportion of recommendations associated with Institute for Safe Medication Practices (ISMP) high-alert medications. Methods This retrospective, single-center, chart review was conducted in an academic ED with 65,000 annual visits. EM pharmacists documented direct patient care activities in the electronic health record. Documented activities from 1/1/2015 through 3/31/2015 were abstracted electronically for analysis by a trained reviewer. Results There were 3567 interventions and direct patient care activities documented. The most common activities were facilitation of medication histories (n = 1300) and drug therapy recommendations (n = 1165). Of 1165 drug therapy recommendations, 986 were linked to a drug class such as antimicrobial agents (31.9%), cardiovascular agents (16.6%), and analgesic agents (13.2%) and 20% of these interventions were associated with ISMP high-alert medications. Conclusion EM pharmacists documented several types of direct patient care activities with the majority being drug therapy recommendations and medication histories.

Myzostomida Are Not Annelids: Molecular and Morphological Support for a Clade of Animals with Anterior Sperm Flagella.

The myzostomes are animals with five pairs of parapodia, living as commensals or (endo)parasites mostly on crinoid and ophiuroid echinoderms. They are generally considered aberrant annelids, possibly phyllodocidan polychaetes. A phylogenetic analysis of 18S and 28S ribosomal DNA sequence data of Myzostoma glabrum, together with 60 morphological, developmental, ultrastructural, and life-history characters, is presented to show that myzostomes are a sister group of the Cycliophora, closely related to the rotifer-acanthocephalan clade (=Syndermata). Myzostomes and syndermates share predominantly the highly derived spermatozoa with anteriorly directed flagella (cycliophoran sperm is insufficiently known). The myzostome-cycliophoran-syndermate clade, accommodated within the Platyzoa (including Platyhelminthes s. str., Gastrotricha, Gnathostomulida, Syndermata, Cycliophora, and Myzostomida), is strongly supported by most analyses, regardless of alignment parameters, character combinations and weighting, species sampling, and tree-building methods. The new name Prosomastigozoa ("forward-flagellar animals") is proposed for the group including three phyla (Cycliophora, Myzostomida, and Syndermata).

Phylogeny of the Metazoa Based on Morphological and 18S Ribosomal DNA Evidence.

Cladistic analysis of traditional (i.e. morphological, developmental, ultrastructural) and molecular (18S rDNA) data sets (276+501 informative characters) provides a hypothesis about relationships of all meta-zoan higher taxa. Monophyly of Metazoa, Epith-eliozoa (= -03non-Porifera), Triploblastica, Mesozoa, Eutriploblastica (=Rhabditophora+Catenulida+"higher triploblasts"=Neotriploblastica, including Xeno- turbellida and Gnathostomulida), Rhabditophora, Syndermata (="Rotifera"+Acanthocephala), Neotrichozoa (=Gastrotricha+Gnathostomulida), Nematozoa (=Nematoda+Nematomorpha), Panarthropoda (=Onychophora+Tardigrada+ Arthropoda), Cephalorhyncha, Deuterostomia, Ambulacralia (=Hemichordata+Echinodermata), Chordata, Phoronozoa (=Phoronida+"Brachiopoda"), Bryozoa, Trochozoa (=Eutrochozoa+Entoprocta+ Cycliophora), Eutrochozoa, and Chaetifera (=Annelida+ Pogonophora+Echiura) is strongly supported. Cnidaria (including Myxozoa), Ecdysozoa (=Cepha- lorhyncha + Nematozoa + Chaetognatha + Panarthropoda), Eucoelomata (=Bryozoa+Phoronozoa+Deuterostomia+Trochozoa, possibly including also Xenoturbellida), and Deuterostomia+Phoronozoa probably are monophyletic. Most traditional "phyla" are monophyletic, except for Porifera, Cnidaria (excluding Myxozoa), Platyhelminthes, Brachiopoda, and Rotifera. Three "hot" regions of the tree remain quite unresolved: basal Epitheliozoa, basal Triploblastica, and basal Neotriploblastica. A new phylogenetic classification of the Metazoa including 35 formally recognized phyla (Silicispongea, Calcispongea, Placozoa, Cnidaria, Ctenophora, Acoela, Nemertodermatida, Orthonecta, Rhombozoa, Rhabditophora, Catenulida, Syndermata, Gnathostomulida, Gastrotricha, Cephalorhyncha, Chaetognatha, Nematoda, Nematomorpha, Onychophora, Tardigrada, Arthropoda, Echinodermata, Hemichordata, Chordata, Phoronozoa, Bryozoa s. str., Xenoturbellida, Entoprocta, Cycliophora, Nemertea, Mollusca, Sipuncula, Echiura, Pogonophora, and Annelida) and few i ncertae sedis g roups (e.g. Myzostomida and Lobatocerebromorpha) is proposed.

ITS rDNA sequences of Pomphorhynchus laevis (Zoega in Müller, 1776) and P. lucyi Williams and Rogers, 1984 (Acanthocephala: Palaeacanthocephala).

The internal transcribed spacers (ITS-1 and ITS-2) of the ribosomal RNA gene of Pomphorhynchus laevis (Zoega in Müller, 1776) (Acanthocephala) isolated from various fish species across Central and Southern Europe were compared with those of P. lucyi Williams and Rogers, 1984 collected from the largemouth bass Micropterus salmonoides Boulenger from the USA. The nucleotide sequences of ITS regions of P. laevis from minnows Phoxinus phoxinus (L.) and chub Leuciscus cephalus (L.) from two distant localities in the Slovak Republic were found to be 100% identical. The ITS-1 and ITS-2 of P. laevis from chub from the Czech Republic and Italy were also mutually identical, but significantly different from Slovak worms (88.7% identity for ITS-1, 91.3% identity for ITS-2). A fifth sample collected from Barbus tyberinus Bonaparte from Italy was very similar to the sympatric Italian isolate from chub, possessing four nucleotide substitutions in ITS-1 (98.4% identity). The ITS rDNA sequences of P. lucyi differed significantly from those of P. laevis; the values of identity were 51.8-56.1% for ITS-1 and 63.1-65.3% for ITS-2, and were significantly higher than the range of P. laevis within-species variability. The results based on the ITS sequences confirmed the occurrence of strains in P. laevis from Continental Europe which are well defined by molecules but reveal only slight differences in their morphology.

Phylogeny and biogeography of Triatominae (Hemiptera: Reduviidae): molecular evidence of a New World origin of the Asiatic clade.

The most representative sample of molecular data, especially 16S and 12S rDNAs, is used to study the phylogeny and evolution of 57 species of three tribes, Rhodniini, Linshcosteini, and Triatomini, of the subfamily Triatominae. For the first time both New World and Old World species are brought together in a single phylogenetic analysis. Maximum-parsimony and distance estimation place both the Asiatic representatives, Linshcosteus and Triatoma rubrofasciata, as sister groups. The Linshcosteus-T. rubrofasciata clade nests firmly within Triatomini, in most analyses branching as a basalmost lineage, thus supporting a monophyletic origin of Triatominae. A paraphyly of "Triatoma" with respect to Linshcosteus, Dipetalogaster, Eratyrus, and Panstrongylus and the paraphyly of "Rhodnius" with respect to Psammolestes is observed in most of the analyses. Reinterpretation of triatomine biogeography points to the origin of Triatominae in northern areas of South America, in Central America, or in the southern region of North America. A few taxonomic changes are proposed: (1) reinclusion of Linshcosteus in Triatomini, (2) inclusion of Psammolestes in Rhodnius, (3) elevation of the "T. flavida complex" to the full genus Nesotriatoma (including N. flavida, N. bruneri, and N. obscura), (4) inclusion of the "T. spinolai complex" in Mepraia (including M. spinolai, M. gajardoi, M. eratyrusiformis, and M. breyeri), and (5) inclusion of "T." dimidiata in Meccus (M. dimidiatus).