One-year outcomes after transcarotid artery revascularization (TCAR) in the ROADSTER 2 trial.

OBJECTIVES: Transcarotid artery revascularization (TCAR) is a carotid stenting technique that utilizes reversal of cerebral arterial flow to confer cerebral protection. Although carotid endarterectomy (CEA) remains the standard for treatment of symptomatic and asymptomatic carotid stenosis, the search for the optimal minimally invasive option for the high-risk surgical patient continues. The goal of the current study is to evaluate the 1-year safety and efficacy of TCAR in a prospective clinical trial. METHODS: ROADSTER 2 is a prospective, open-label, single-arm, multicenter, post-approval registry for patients undergoing TCAR. All patients were considered high risk for CEA and underwent independent neurological assessments preoperatively, postoperatively, and had long-term clinical follow-up. The primary end point was incidence of ipsilateral stroke after treatment with the ENROUTE Transcarotid Stent System. Secondary end points included individual/composite rates of stroke, death, and perioperative myocardial infarction. RESULTS: Between June 2016 and November 2018, 155 patients at 21 centers in the United States and one in the European Union were enrolled and represented a subset of the overall trial. Asymptomatic (n = 119; 77%) and symptomatic patients (n = 36; 23%) with high-risk anatomic (ie, high lesion, restenosis, radiation injury; 43%), physiologic (32%), or combined factors (25%) were enrolled. No patient suffered a perioperative myocardial infarction or stroke. Over the year, no patient had an ipsilateral stroke, but four patients died (2.6%), all from non-neurological causes. Additionally, a technical success rate of 98.7% with a low cranial nerve deficit rate of 1.3% was achieved. CONCLUSIONS: In patients with high risk factors, TCAR yields high technical success with a low stroke and death rate at 1 year. Further comparative studies with CEA are warranted.

Diversity of the green macroalgal genus Ulva (Ulvophyceae, Chlorophyta) from the east and gulf coast of the United States based on molecular data.

Ulva (Ulvophyceae, Chlorophyta) is common in intertidal environments and can also be found in freshwater ecosystems. The difficulty to morphologically identify Ulva species due to cryptic diversity and morphological plasticity has caused a taxonomic conundrum. Fortunately, molecular data have begun to unravel a better understanding of its diversity. Here, we present a molecular analysis with 247 samples of Ulva from the Gulf of Mexico and Atlantic USA based on chloroplast (rbcL and tufA) and nuclear (ITS1-5.8S-ITS2) molecular markers. Twenty-four Ulva taxa had previously been reported for this area based on morphology and earlier molecular studies mostly from Northeastern USA and Canada. In this study, sixteen Ulva clades were identified representing 13 named clades and putatively three undescribed species. Only nine of the 24 taxa previously reported for the Western Atlantic were confirmed. Four species were identified for the first time in the U.S. East and Gulf Coast (U. aragoënsis, U. californica, U. meridionalis, and U. tepida). This study provides a foundation for future research on Ulva in this area and reiterates the necessity of using molecular-assisted identifications for this group.

Impact of early versus late administration of bamlanivimab on readmissions in patients with high-risk COVID-19.

BACKGROUND: Recombinant monoclonal antibody therapies have been utilized under emergency use authorization (EUA) for the prevention of clinical decompensation in high-risk COVID-19 positive patients for up to 10 days from symptom onset. The purpose of this study was to determine the impact of the timing of the monoclonal antibody, bamlanivimab, on clinical outcomes in high-risk COVID-19 positive patients. METHODS: This was an IRB-approved, retrospective evaluation of adult patients who received bamlanivimab per EUA criteria in the emergency department (ED). Patients were dichotomized into two groups- 3 days of symptoms or less (early) versus 4 to 10 days (late). The primary outcome was hospitalization for COVID-related illness at 28 days (or treatment failure). Secondary outcomes were COVID-related ED visits at 28 days, hospital and intensive care unit (ICU) length of stay (LOS), and in-hospital mortality at 28 days. RESULTS: A total of 839 patients were included in the analysis. There was no difference observed in COVID-related hospitalization rates within 28 days between the early and late bamlanivimab administration groups (7.5% vs. 8.2%, p = 0.71). There was no difference in COVID-related ED visits within 28 days with 13% of patients returning to the ED. CONCLUSIONS: In conclusion, there were no differences in the rates of hospitalization at 28 days when bamlanivimab was administered in the first 3 days of illness versus days 4 to 10. Future prospective studies are warranted to expand upon the characteristics of patients that may or may not benefit from monoclonal antibody therapy.

Three New Freshwater Cochliopodium Species (Himatismenida, Amoebozoa) from the Southeastern United States.

Cochliopodium is a lens-shaped genus of Amoebozoa characterized by a flexible layer of microscopic dorsal scales. Recent taxonomic and molecular studies reported cryptic diversity in this group and suggested that the often-used scale morphology is not a reliable character for species delineation in the genus. Here, we described three freshwater Cochliopodium spp. from the southeastern United States based on morphological, immunocytochemistry (ICC), and molecular data. A maximum-likelihood phylogenetic analysis and pairwise comparison of COI sequences of Cochliopodium species showed that each of these monoclonal cultures were genetically distinct from each other and any described species with molecular data. Two of the new isolates, "crystal UK-YT2" (Cochliopodium crystalli n. sp.) and "crystal-like UK-YT3" (C. jaguari n. sp.), formed a clade with C. larifeili, which all share a prominent microtubule organizing center (MTOC) and have cubical-shaped crystals. The "Marrs Spring UK-YT4" isolate, C. marrii n. sp., was 100% identical to "Cochliopodium sp. SG-2014 KJ569724." These sequences formed a clade with C. actinophorum and C. arabianum. While the new isolates can be separated morphologically, most of the taxonomic features used in the group show plasticity; therefore, Cochliopodium species can only be reliably identified with the help of molecular data.

Women's perception of adolescent marijuana use in a hispanic seasonal farm worker community: A qualitative study.

We examined the perception of adolescent children's marijuana use and its consequences in the Hispanic seasonal farmworking community of South Florida via three focus groups with Hispanic adult female seasonal workers (n = 29). The women described how adolescents' marijuana use increased over the past five years. Social networks for marijuana use were reported near schools and bus stations. Although participants expressed concern over adolescent marijuana use and involvement in selling marijuana, they reported that their job demands preclude their ability to supervise their children. Participants do not report unlawful marijuana use due to fear of deportation.

Association of emergency department albuterol dispensing with pediatric asthma revisits and readmissions.

INTRODUCTION: Although pediatric asthma continues to be a highly studied disease, data to suggest clear strategies to decrease asthma related revisits or readmissions is lacking. The purpose of our study was to assess the effect of emergency department (ED) direct dispensing of beta-agonist metered dose inhalers on pediatric asthma ED revisit and readmission rates. METHODS: We conducted a retrospective cohort study of pediatric patients discharged from the pediatric ED with a diagnosis of asthma. Our primary outcome measured the rate of asthma revisits to the ED or admissions to the hospital within 28 days. Logistic regression analysis was used to assess ED beta-agonist MDI dispensing and revisit and/or readmission as the outcome. RESULTS: A total of 853 patients met eligibility for inclusion in the study, with 657 enrolled in the Baseline group and 196 enrolled in the ED-MDI group. The Baseline group experienced a revisit and readmission rate of 7.0% (46/657) versus 2.6% (5/196) in the ED-MDI group, (p = 0.026). ED direct dispensing of MDIs was found to be independently associated with a decreased risk of revisit or readmission (odds ratio 0.37; 95% confidence interval 0.14-0.95). CONCLUSIONS: In our study, ED direct dispensing of beta-agonist MDIs resulted in a reduction in 28-day revisit and readmission to the hospital. Further studies should be performed to evaluate the economic impact of reducing these revisits and readmissions against the costs of maintaining a dispensing program. Our findings may support modification of asthma programs to include dispensing MDIs from the emergency department.

Mitochondrial genomes of the green macroalga Ulva pertusa (Ulvophyceae, Chlorophyta): novel insights into the evolution of mitogenomes in the Ulvophyceae.

To further understand the trends in the evolution of mitochondrial genomes (mitogenomes or mtDNAs) in the Ulvophyceae, the mitogenomes of two separate thalli of Ulva pertusa were sequenced. Two U. pertusa mitogenomes (Up1 and Up2) were 69,333 bp and 64,602 bp in length. These mitogenomes shared two ribosomal RNAs (rRNAs), 28 transfer RNAs (tRNAs), 29 protein-coding genes, and 12 open reading frames. The 4.7 kb difference in size was attributed to variation in intron content and tandem repeat regions. A total of six introns were present in the smaller U. pertusa mtDNA (Up2), while the larger mtDNA (Up1) had eight. The larger mtDNA had two additional group II introns in two genes (cox1 and cox2) and tandem duplication mutations in noncoding regions. Our results showed the first case of intraspecific variation in chlorophytan mitogenomes and provided further genomic data for the undersampled Ulvophyceae.

Impact of a Hospitalwide Quality Improvement Initiative on Emergency Department Throughput and Crowding Measures.

BACKGROUND: This pre- and postintervention analysis evaluates the impact of a systemwide, comprehensive, executively supported quality improvement (QI) project on emergency department (ED) throughput measures and crowding in a large nonacademic community hospital. METHODS: The two primary endpoints used to assess the impact of the project were (1) the percentage of all patients who were door-in to door-out in less than three hours and (2) the percentage of patients who left without being seen (LWBS). Secondary endpoints for throughput were mean door-in to door-out, door-in to physician, physician to disposition, and disposition to door-out times for all patients. Secondary endpoints for crowding were median disposition to door-out time of admitted patients and the percentage of admitted patients with a disposition to door-out time of ≥ one, two, and six hours. RESULTS: A total of 666,640 patient visits were included in the primary endpoint analyses, with no patients excluded. The percentage of patients meeting the three-hour door-in to door-out goal after the QI project was 81.4%, versus 46.5% in the pre-QI group (difference, 34.9 percentage points; 95% confidence interval [CI] = 34.7-35.1; p < 0.0001). The postintervention LWBS rate was 0.49%, versus 4.00% in the pre-QI group (difference, 3.51 percentage points; 95% CI = 3.43-3.58; p < 0.0001). A total of 417,673 patient visits were screened for inclusion for the secondary endpoint analyses. The pre-QI and post-QI groups were also compared for secondary endpoints, and significant improvement was noted in all analyses. CONCLUSION: This study suggests that a comprehensive systemwide and executively supported QI project can make sustained multiyear improvements in ED throughput and LWBS. Further research is needed to determine if this standardized set of changes can be generalized to other hospital systems.

Recruiting and Assessing Recent Young Adult Latina Immigrants in Health Disparities Research.

The authors interviewed 4 researchers to identify facilitators in recruiting and assessing Latina immigrants. The 4 researchers recruited 530 recent Latina immigrants (ages 18-23 years) for a study of social and cultural determinants of health. Consensual qualitative research methods revealed that respondent-driven sampling was an effective recruitment method. Fear of deportation was a barrier. Stigma about sensitive topics (e.g., sex, drug use) did not affect participation. Findings can help counselors conduct health disparities research.

Evaluation of the use of individualized patient care plans in frequent emergency department visitors with pain complaints.

BACKGROUND: Pain is one of the most common complaints that patients present to the emergency department for; emergency medicine providers are tasked with providing appropriate pain relief while simultaneously limiting the risk of personal and societal harm that may result from opioid misuse. The Lakeland Regional Medical Center developed a medical management program that identified frequent emergency department visitors with a chief complaint of pain. Individualized care plans were developed for these patients. A retrospective review was then conducted to assess the efficacy of these care plans in reducing the number of emergency department visits for pain-related complaints by the patients entered into the medical management program. RESULTS: There were 294 patients; 65% were male, and the median age was 41 (interquartile range: 33 to 51). A total of 80% percent of the patients were white, and the payors were as follows: 53% were self-pay, 42% were government programs, and 5% had private insurance. The three most common chronic pain complaints were 39% abdominal pain, 24% back/neck pain, and 23% headache/migraine (patients could have more than one area of pain). A total of 60% of the patients had a primary care provider, and another 18% had a pain management provider in addition to primary care. Post plan admissions were significantly reduced to a median of 1 (IQR 0 to 3) with the Wilcoxon signed-rank test's p-value of less than 0.001. CONCLUSION: The authors describe their experience with a quality improvement initiative that identifies frequent emergency department visitors with a chief complaint of pain and provides individualized care plans to these patients. The goals of the program are to improve patient's quality and consistency of care, through interventions that eliminate the prescribing of opioids while providing non-opioid alternatives.

Integration of biology, mathematics and computing in the classroom through the creation and repeated use of transdisciplinary modules.

The integration of biology with mathematics and computer science mandates the training of students capable of comfortably navigating among these fields. We address this formidable pedagogical challenge with the creation of transdisciplinary modules that guide students toward solving realistic problems with methods from different disciplines. Knowledge is gradually integrated as the same topic is revisited in biology, mathematics, and computer science courses. We illustrate this process with a module on the homeostasis and dynamic regulation of red blood cell production, which was first implemented in an introductory biology course and will be revisited in the mathematics and computer science curricula.

Phylogenomics of Thecamoebida (Discosea, Amoebozoa) with the Description of Stratorugosa tubuloviscum gen. nov. sp. nov., a Freshwater Amoeba with a Perinuclear MTOC.

Thecamoebida Smirnov and Cavalier-Smith, 2011 (Discosea, Amoebozoa) has been molecularly understudied. The group until recently consisted of three genera containing species that live in terrestrial or aquatic environments. Here, we describe a fourth genus, Stratorugosa tubuloviscum gen. nov. sp. nov., which was isolated from a freshwater Amoeba proteus Ward's Science culture. Although this species most closely morphologically resembles a large, rugose Thecamoeba, S. tubuloviscum gen. nov. sp. nov. can be differentiated from Thecamoeba spp. by the following: 1) the presence of definitive finger-like (lobate-like) subpseudopodia extending at both the anterior and lateral parts of the cell during locomotion; 2) a peculiar locomotive mechanism with two sections, frontal and back, of the cells moving in a pulling and piggyback movement, respectively; 3) the presence of fibrillar cytoplasmic microtubules (MTs) organized by a prominent, perinuclear microtubule-organizing center (MTOC). A phylogenomic analysis of 511 genes assembled from transcriptomic data showed that this new genus was highly supported as sister to Stenamoeba. Despite the variance in gross morphology, Stenamoeba and S. tubuloviscum gen nov. sp. nov. both have MTOCs unlike two Thecamoeba spp., which display dot-like cytoplasmic MTs and lack an MTOC.

The chloroplast genome of the marine green macroalga Ulva fasciata Delile (Ulvophyceae, Chlorophyta).

We present the 96 005 bp circular chloroplast genome (cpDNA) of Ulva fasciata. This cpDNA was ∼4000 bp smaller than the cpDNA of Ulva sp. UNA00071828; however, this cpDNA was AT rich (75.1%) similar to Ulva sp. The U. fasciata cpDNA was also similar in gene content (101 identified genes) compared to Ulva sp., which included 71 protein-coding genes, 3 ribosomal RNAs (rRNAs) and 27 transfer RNAs (tRNAs). Only one tRNA, trnN(AUU), that was present in Ulva sp. was absent in U. fasciata. Five introns were present in the following genes of U. fasciata: petB (2), psbD (1), psaB (1) and rrl (1). Ulva sp. lacked introns in psbD and psaB, and introns present in atpA and psbB in Ulva sp. were absent in the homologous genes of U. fasciata. A gene arrangement comparison of both Ulva species showed that a ∼27 000 bp segment of DNA consisting of genes psbB to trnT(UGU) was inverted. Furthermore, a phylogenetic analysis of 1135 bp of the rbcL gene confirmed that this cpDNA and the previously published mitochondrial genome from this sample were indeed from U. fasciata.

Plastid Genome of Dictyopteris divaricata (Dictyotales, Phaeophyceae): Understanding the Evolution of Plastid Genomes in Brown Algae.

Dictyotophycidae is a subclass of brown algae containing 395 species that are distributed worldwide. A complete plastid (chloroplast) genome (ptDNA or cpDNA) had not previously been sequenced from this group. In this study, the complete plastid genome of Dictyopteris divaricata (Okamura) Okamura (Dictyotales, Phaeophyceae) was characterized and compared to other brown algal ptDNAs. This plastid genome was 126,099 bp in size with two inverted repeats (IRs) of 6026 bp. The D. divaricata IRs contained rpl21, making its IRs larger than representatives from the orders Fucales and Laminariales, but was smaller than that from Ectocarpales. The G + C content of D. divaricata (31.19%) was the highest of the known ptDNAs of brown algae (28.94-31.05%). Two protein-coding genes, rbcR and rpl32, were present in ptDNAs of Laminariales, Ectocarpales (Ectocarpus siliculosus), and Fucales (LEF) but were absent in D. divaricata. Reduced intergenic space (13.11%) and eight pairs of overlapping genes in D. divaricata ptDNA made it the most compact plastid genome in brown algae so far. The architecture of D. divaricata ptDNA showed higher similarity to that of Laminariales compared with Fucales and Ectocarpales. The difference in general features, gene content, and architecture among the ptDNAs of D. divaricata and LEF clade revealed the diversity and evolutionary trends of plastid genomes in brown algae.

De novo assembly of the mitochondrial genome of Ulva fasciata Delile (Ulvophyceae, Chlorophyta), a distromatic blade-forming green macroalga.

We present the 61 614 bp circular-mapping mitochondrial genome of Ulva fasciata. Fifty-eight genes were identified including 29 protein-coding genes, 27 transfer RNA (tRNA) genes, and two ribosomal RNA (rRNA) genes. Four ORFs from the Ulva sp. UNA00071828 mitogenome were conserved compared to the mitogenome of Ulva fasciata. The ∼10 000 bp size difference was mostly due to fewer introns found in U. fasciata mtDNA (4) as compared with the Ulva sp. UNA00071828 mtDNA (10). Introns were annotated in cox1 (3) and nad3 (1). The AT content was similar to Ulva sp. UNA00071828 mtDNA at 67.5%. A phylogenomic anaylsis of 28 chlorophytes and 17 protein-coding genes (14 115 bp alignment) showed that U. fasciata clusters closely with other members of the Ulvophyceae (Ulva sp. UNA00071828, Pseudendoclonium akinetum, and Oltmannsiellopsis viridis). This analysis did not recover a monophyletic Ulvophyceae, however, the Trebouxiophyceae and Chlorophyceae were supported as monophyletic groups.

Latino Mother/Daughter Dyadic Attachment as a Mediator for Substance Use Disorder and Emotional Abuse.

To date, no studies have investigated emotional abuse of adult Latina women by their mothers despite evidence that emotional maternal abuse may significantly contribute to the emotional abuse experienced by Latina women in their lifetime. Cross-sectional data including 316 women was analyzed using mediation and logistic regression. Overall, 7.1 % of mothers and 24.1 % of daughters abused drugs; and, 19.5 % of daughters were emotionally abused by their mothers. Mother's attachment to her daughter mediated the association between mother's drug abuse and emotionally abusing her adult daughter (indirect effect: 0.863). Latina women can serve as perpetrators of emotional abuse of their adult children. Since drug-abusing daughters are more likely to be victims of emotional abuse by their mothers and drug-abusing mothers are more likely to abuse their daughters, drug-rehabilitation practitioners should incorporate a family abuse component into rehabilitation programs.

The complete chloroplast and mitochondrial genomes of the green macroalga Ulva sp. UNA00071828 (Ulvophyceae, Chlorophyta).

Sequencing mitochondrial and chloroplast genomes has become an integral part in understanding the genomic machinery and the phylogenetic histories of green algae. Previously, only three chloroplast genomes (Oltmannsiellopsis viridis, Pseudendoclonium akinetum, and Bryopsis hypnoides) and two mitochondrial genomes (O. viridis and P. akinetum) from the class Ulvophyceae have been published. Here, we present the first chloroplast and mitochondrial genomes from the ecologically and economically important marine, green algal genus Ulva. The chloroplast genome of Ulva sp. was 99,983 bp in a circular-mapping molecule that lacked inverted repeats, and thus far, was the smallest ulvophycean plastid genome. This cpDNA was a highly compact, AT-rich genome that contained a total of 102 identified genes (71 protein-coding genes, 28 tRNA genes, and three ribosomal RNA genes). Additionally, five introns were annotated in four genes: atpA (1), petB (1), psbB (2), and rrl (1). The circular-mapping mitochondrial genome of Ulva sp. was 73,493 bp and follows the expanded pattern also seen in other ulvophyceans and trebouxiophyceans. The Ulva sp. mtDNA contained 29 protein-coding genes, 25 tRNA genes, and two rRNA genes for a total of 56 identifiable genes. Ten introns were annotated in this mtDNA: cox1 (4), atp1 (1), nad3 (1), nad5 (1), and rrs (3). Double-cut-and-join (DCJ) values showed that organellar genomes across Chlorophyta are highly rearranged, in contrast to the highly conserved organellar genomes of the red algae (Rhodophyta). A phylogenomic investigation of 51 plastid protein-coding genes showed that Ulvophyceae is not monophyletic, and also placed Oltmannsiellopsis (Oltmannsiellopsidales) and Tetraselmis (Chlorodendrophyceae) closely to Ulva (Ulvales) and Pseudendoclonium (Ulothrichales).

Goal-directed ultrasound in the detection of long-bone fractures.

BACKGROUND: New portable ultrasound (US) systems are capable of detecting fractures in the remote setting. However, the accuracy of ultrasound by physicians with minimal ultrasound training is unknown. METHODS: After one hour of standardized training, physicians with minimal US experience clinically evaluated patients presenting with pain and trauma to the upper arm or leg. The investigators then performed a long-bone US evaluation, recording their impression of fracture presence or absence. Results of the examination were compared with routine plain or computer aided radiography (CT). RESULTS: 58 patients were examined. The sensitivity and specificity of US were 92.9% and 83.3%, and of the physical examination were 78.6% and 90.0%, respectively. US provided improved sensitivity with less specificity compared with physical examination in the detection of fractures in long bones. CONCLUSION: Ultrasound scans by minimally trained clinicians may be used to rule out a long-bone fracture in patients with a medium to low probability of fracture.