Diagnosis of Human Trematode Infections.

Digenetic trematodes form a major group of human parasites, affecting a large number of humans, especially in endemic foci. Over 100 species have been reported infecting humans, including blood, lung, liver and intestinal parasites. Traditionally, trematode infections have been diagnosed by parasitological methods based on the detection and the identification of eggs in different clinical samples. However, this is complicated due to the morphological similarity between eggs of different trematode species and other factors such as lack of sensitivity or ectopic locations of the parasites. Moreover, the problem is currently aggravated by migratory flows, international travel, international trade of foods and changes in alimentary habits. Although efforts have been made for the development of immunological and molecular techniques, the detection of eggs through parasitological techniques remains as the gold standard for the diagnosis of trematodiases. In the present chapter, we review the current status of knowledge on diagnostic techniques used when examining feces, urine, and sputum and also analyze the most relevant characteristics used to identify eggs with a quick key for the identification of eggs.

Co(III) complexes of the pentadentate NHC ligand PY4Im: carbene-induced trans influences and the non-disappearing 13C NMR peak.

Co(III) complexes of the N-heterocyclic carbene ligand PY4Im (PY4Im = (1,3-bis(bis(2-pyridyl)methyl)imidazol-2-ylidene)) having the general formula [(PY4Im)Co(X)](ClO4)n (X = NCMe; n = 3: OH-, N3-, NCS-, ONO-, F-; n = 2: O2CO2-, n = 1; (N3-)3, n = 0) were prepared and structurally characterised. X-ray structural data are consistent with the presence of a trans influence due to the coordinated carbene carbon, and this is also supported by computational results. 13C NMR spectra of the complexes did not display peaks corresponding to the carbene carbon, except in the case of the [(PY4Im)Co(O2CO)]+ cation, where a peak at δ = 170.21 ppm was observed. However, HMBC spectra allowed indirect determination of the chemical shifts of the carbene carbon in the remaining complexes, owing to the geometry of the PY4Im ligand. Calculated 13C chemical shifts for the complexes showed very good agreement with the experimental values for all but the carbene carbon atoms in all cases.

Body size and sequence of host colonisation predict the presence of acoustic signalling in beetles.

Acoustic communication is widespread in beetles, is often sexually dimorphic, and plays a significant role in behaviours such as premating recognition, courtship, and copulation. However, the factors that determine the presence or absence of acoustic signalling in a given species remain unclear. We examined acoustic communication in bark beetles (Scolytinae) and pinhole borers (Platypodinae), which are two speciose groups with widespread sound production capabilities. We show that body size along with the sequence of host colonisation predict the presence of acoustic communication, and report, for the first time in the animal kingdom, a size limit-1.9 mm-below which acoustic signalling ceases to be present.

From Voxels to Physiology: A Review of Diffusion Magnetic Resonance Imaging Applications in Skeletal Muscle.

Skeletal muscle has a classic structure function relationship; both skeletal muscle microstructure and architecture are directly related to force generating capacity. Biopsy, the gold standard for evaluating muscle microstructure, is highly invasive, destructive to muscle, and provides only a small amount of information about the entire volume of a muscle. Similarly, muscle fiber lengths and pennation angles, key features of muscle architecture predictive of muscle function, are traditionally studied via cadaveric dissection. Noninvasive techniques such as diffusion magnetic resonance imaging (dMRI) offer quantitative approaches to study skeletal muscle microstructure and architecture. Despite its prevalence in applications for musculoskeletal research, clinical adoption is hindered by a lack of understanding regarding its sensitivity to clinically important biomarkers such as muscle fiber cross-sectional area. This review aims to elucidate how dMRI has been utilized to study skeletal muscle, covering fundamentals of muscle physiology, dMRI acquisition techniques, dMRI modeling, and applications where dMRI has been leveraged to noninvasively study skeletal muscle changes in response to disease, aging, injury, and human performance. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.

Instantaneous frequency measurement system based on quantum dash mode-locked laser.

We present the theory and experimental results of a microwave photonic (MWP) filter based instantaneous frequency measurement system. A quantum dash mode-locked laser is used as an optical frequency comb source. With up to 41 flat comb lines and a real-time feedback loop for comb shaping, a set of MWP filters with linear frequency responses for either linear unit or dB unit are experimentally demonstrated. The maximum measurement frequency can be up to 20 GHz limited by the available test-and-measurement instruments. By using one MWP filter, the root-mean-square error is 51∼66 MHz, which can be improved to 42.2 MHz for linear unit, and 30.7 MHz for dB unit by using two MWP filters together.

Nirmatrelvir-Ritonavir and Symptoms in Adults With Postacute Sequelae of SARS-CoV-2 Infection: The STOP-PASC Randomized Clinical Trial.

Importance: There is an urgent need to identify treatments for postacute sequelae of SARS-CoV-2 infection (PASC). Objective: To assess the efficacy of a 15-day course of nirmatrelvir-ritonavir in reducing the severity of select PASC symptoms. Design, Setting, and Participants: This was a 15-week blinded, placebo-controlled, randomized clinical trial conducted from November 2022 to September 2023 at Stanford University (California). The participants were adults with moderate to severe PASC symptoms of 3 months or longer duration. Interventions: Participants were randomized 2:1 to treatment with oral nirmatrelvir-ritonavir (NMV/r, 300 mg and 100 mg) or with placebo-ritonavir (PBO/r) twice daily for 15 days. Main Outcomes and Measures: Primary outcome was a pooled severity of 6 PASC symptoms (fatigue, brain fog, shortness of breath, body aches, gastrointestinal symptoms, and cardiovascular symptoms) based on a Likert scale score at 10 weeks. Secondary outcomes included symptom severity at different time points, symptom burden and relief, patient global measures, Patient-Reported Outcomes Measurement Information System (PROMIS) measures, orthostatic vital signs, and sit-to-stand test change from baseline. Results: Of the 155 participants (median [IQR] age, 43 [34-54] years; 92 [59%] females), 102 were randomized to the NMV/r group and 53 to the PBO/r group. Nearly all participants (n = 153) had received the primary series for COVID-19 vaccination. Mean (SD) time between index SARS-CoV-2 infection and randomization was 17.5 (9.1) months. There was no statistically significant difference in the model-derived severity outcome pooled across the 6 core symptoms at 10 weeks between the NMV/r and PBO/r groups. No statistically significant between-group differences were found at 10 weeks in the Patient Global Impression of Severity or Patient Global Impression of Change scores, summative symptom scores, and change from baseline to 10 weeks in PROMIS fatigue, dyspnea, cognitive function, and physical function measures. Adverse event rates were similar in NMV/r and PBO/r groups and mostly of low grade. Conclusions and Relevance: The results of this randomized clinical trial showed that a 15-day course of NMV/r in a population of patients with PASC was generally safe but did not demonstrate a significant benefit for improving select PASC symptoms in a mostly vaccinated cohort with protracted symptom duration. Further studies are needed to determine the role of antivirals in the treatment of PASC. Trial Registration: ClinicalTrials.gov Identifier: NCT05576662.

Venous Thromboembolism Prevention in Rehabilitation: a Review and Practice Suggestions.

ABSTRACT: Venous thromboembolism (VTE) is a frequent complication of acute hospital care, and this extends to in-patient rehabilitation. The timely use of appropriate thromboprophylaxis in patients who are at risk is a strong, evidence-based patient safety priority that has reduced clinically important VTE, associated mortality and costs of care. While there has been extensive research on optimal approaches to VTE prophylaxis in acute care, there is a paucity of high-quality evidence specific to patients in the rehabilitation setting, and there are no clinical practice guidelines that make recommendations for (or against) thromboprophylaxis across the broad spectrum of rehabilitation patients. Herein, we provide an evidence-informed review of the topic with practice suggestions. We conducted a series of literature searches to assess the risks of VTE and its prevention related to in-patient rehabilitation as well as in major rehabilitation subgroups. Mobilization alone does not eliminate the risk of VTE after another thrombotic insult. Low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs) are the principal current modalities of thromboprophylaxis. Based on the literature, we make suggestions for VTE prevention and include an approach for consideration by rehabilitation units that can be aligned with local practice.

Expanding Integrated Physiatric Care: A Method to Building Capacity in Physical Medicine and Rehabilitation.

ABSTRACT: Siloed and episodic care delivery is often not equitable, high-quality, or sustainable. Transitioning from separate care settings, with potentially divergent care models, to an integrated care model is not always straightforward. Some experiences in expanding collaborative care between physiatrists and other healthcare providers for a variety of patient populations and care settings within a university physical medicine and rehabilitation (PM&R) division are shared as a means to inspire the uptake of care integration initiatives more broadly within the specialty. After an initial survey of care integration across multiple clinical sites, the university division: highlighted successful integrated care models; discussed integrated care models at every divisional retreat; reached out to clinicians in other specialties to collaboratively explore expansion; developed a "one-pager" on what physiatrists do; and invited collaborative specialists from integrated clinics to PM&R national and/or international meetings. Since 2019, divisional activity in integrated care has grown and evolved substantially. Future work will focus on: further expansion of integrated clinical care; scholarly evaluation of integrated care models; expansion of academic activity resulting from integration; and advocacy to healthcare providers, hospital administrators, and health system funders about the potential value of care integration in improving rehabilitation outcomes.

The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for the Mitigation of Complications of Neurostimulation.

INTRODUCTION: The International Neuromodulation Society convened a multispecialty group of physicians based on expertise and international representation to establish evidence-based guidance on the mitigation of neuromodulation complications. This Neurostimulation Appropriateness Consensus Committee (NACC)® project intends to update evidence-based guidance and offer expert opinion that will improve efficacy and safety. MATERIALS AND METHODS: Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when NACC last published guidelines) to October 2023. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence was scant. RESULTS: The NACC examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. CONCLUSIONS: The NACC recommends best practices regarding the mitigation of complications associated with neurostimulation to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.

Piriformis syndrome.

Piriformis syndrome is a condition that is proposed to result from compression of the sciatic nerve, either in whole or in part, in the deep gluteal space by the piriformis muscle. The prevalence of piriformis syndrome depends upon the diagnostic criteria being used and the population studied but is estimated by some to be 5%-6% in all cases of low back, buttock, and leg pain and up to 17% of patients with chronic low back pain. While the sciatic nerve may pierce the piriformis muscle in about 16% of healthy individuals, this frequency is no different in those with the syndrome; thus, the relationship to this anatomic finding is unclear. The most common symptoms are buttock pain, external tenderness over the greater sciatic notch, and aggravation of the pain through sitting. Many clinical signs are reported for piriformis syndrome, but the sensitivity and specificity are unclear, in part because of the lack of a uniformly accepted case definition. In the majority of cases in the literature, it appears that the diagnosis is more ascribed to a myofascial condition rather than a focal neuropathy. Electrodiagnostic studies can be useful to exclude other causes of symptoms, but there is no well-accepted test to confirm the presence of piriformis syndrome. Ultrasound imaging may show thickening of the piriformis muscle, but further research is required to confirm that this is correlated with the clinical diagnosis. Magnetic resonance imaging and neurography may hold promise in the future, but there are not yet sufficient data to support adopting these methods as a standard diagnostic tool. The initial treatment of piriformis syndrome is typically conservative management with the general rehabilitation principles similar to other soft tissue musculoskeletal conditions. Local anesthetic, botulinum toxin, and/or corticosteroid injections have been reported by some to be beneficial for diagnostic or treatment purposes. Surgical interventions have also been used with variable success.

Provider Impressions of Inpatient Teleneurology Consultation.

Background and Objectives: Teleneurology usage has increased during the severe acute respiratory syndrome coronavirus 2 pandemic. However, studies evaluating physician impressions of inpatient teleneurology are limited. We implemented a quality improvement initiative to evaluate neurologists' impression following individual inpatient teleneurology consultation at a satellite hospital of a large academic center with no in-person neurology coverage. Methods: A REDCap survey link was embedded within templates used by neurologists for documentation of inpatient consultations to be completed immediately after encounters. All teleneurology encounters with completed surveys at a single satellite hospital of the University of Pennsylvania Health System Neurology Department between May 10, 2021, and August 14, 2022, were included. Individual patient-level and encounter-level data were extracted from the medical record. Results: A total of 374 surveys (response rate of 54.05%) were completed by 19 neurologists; 341 questionnaires were included in the analysis. Seven neurologists who specialized as neurohospitalists completed 231 surveys (67.74% of total surveys completed), while 12 non-neurohospitalists completed 110 (32.36%). The history obtained was rated as worse (14%) or the same (86%) as an in-person consult; none reported the history as better than nonteleneurology encounters. The physician-patient relationship was poor or fair in 25% of the encounters and good or excellent in 75% of visits. The overall experience was judged to be worse than in-person consultation in 32% of encounters, the same in 66%, and better in 2%. Fifty-one percent of providers responded that there were elements of the neurologic examination that might have changed their assessment and plan of care if performed in-person. Encounters with peripheral or neuromuscular-related chief complaints had the most inadequate examinations and worse overall experiences, while the most positive impressions of these clinical experiences were observed among seizure-related chief complaints. Discussion: Determining best practices for inpatient teleneurology should consider the patient chief complaint to use teleneurology in scenarios with the highest likelihood of a positive experience. Further efforts should be made to the patient experience and to improve the remote examination to enhance the applicability of teleneurology to the full spectrum of inpatient neurologic consultations.

The Polyanalgesic Consensus Conference (PACC)®: Intrathecal Drug Delivery Guidance on Safety and Therapy Optimization When Treating Chronic Noncancer Pain.

INTRODUCTION: The International Neuromodulation Society convened a multispecialty group of physicians and scientists based on expertise with international representation to establish evidence-based guidance on intrathecal drug delivery in treating chronic pain. This Polyanalgesic Consensus Conference (PACC)® project, created more than two decades ago, intends to provide evidence-based guidance for important safety and efficacy issues surrounding intrathecal drug delivery and its impact on the practice of neuromodulation. MATERIALS AND METHODS: Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when PACC® last published guidelines) to the present. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence is scant. RESULTS: The PACC® examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. CONCLUSIONS: The PACC® recommends best practices regarding intrathecal drug delivery to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.

Imaging of brain electric field networks.

We present a method for direct imaging of the electric field networks in the human brain from electroencephalography (EEG) data with much higher temporal and spatial resolution than functional MRI (fMRI), without the concomitant distortions. The method is validated using simultaneous EEG/fMRI data in healthy subjects, intracranial EEG data in epilepsy patients, and in a direct comparison with standard EEG analysis in a well-established attention paradigm. The method is then demonstrated on a very large cohort of subjects performing a standard gambling task designed to activate the brain's 'reward circuit'. The technique uses the output from standard EEG systems and thus has potential for immediate benefit to a broad range of important basic scientific and clinical questions concerning brain electrical activity, but also provides an inexpensive and portable alternative to function MRI (fMRI).

Infection prevention and control and related practices in African neonatal units: The Pan-African neonatal care assessment study (PANCAS).

BACKGROUND: The burden of neonatal mortality is primarily borne by low- and middle-income countries (LMICs), including deaths due to healthcare-associated infections (HAIs). Few studies have assessed infection prevention and control (IP&C) practices in African units caring for small and/or sick newborns aimed to reduce HAIs. METHODS: We performed a mixed-methods study composed of a survey and virtual tour to assess IP&C and related practices. We created a survey composed of multiple-choice and open-ended questions delivered to site respondents via Zoom or video equivalent. Respondents provided a virtual tour of their unit via video and the study team used a checklist to evaluate specific practices. RESULTS: We recruited 45 units caring for small and sick newborns in 20 African countries. Opportunities to optimize hand hygiene, Water, Sanitation and Hygiene (WASH) practices, Kangaroo Mother Care, and IP&C training were noted. The virtual tour offered further understanding of IP&C challenges unique to individual sites. All respondents expressed the need for additional space, equipment, supplies, education, and IP&C staff and emphasized that attention to maternal comfort was important to IP&C success. DISCUSSION: This study identified opportunities to improve IP&C practices using low-cost measures including further education and peer support through learning collaboratives. Virtual tours can be used to provide site-specific assessment and feedback from peers, IP&C specialists and environmental engineering experts.

The Impact of Visual Abstracts Compared to Automated Tweets on Social Media in Otology & Neurotology.

OBJECTIVE: To analyze the effect of visual abstracts versus automated tweets on social media participation in Otology & Neurotology . PATIENTS: N/A. INTERVENTIONS: Introduction of visual abstracts developed by the social media editorial team to established automated tweets created by the dlvr.it computer program on the Otology & Neurotology Twitter account. MAIN OUTCOME MEASURES: Twitter analytics including the number of new followers per month, impressions per tweet, and engagements per tweet. The Kruskal-Wallis analysis of variance test was used to compare means. RESULTS: From October 2016 to October 2017 (average of 20 new followers per month), 101 automated tweets averaged 536 impressions and 16 engagements per tweet. The visual abstract was introduced in November 2017. From November 2017 to November 2020 (average of 39 new followers per month), 447 automated tweets averaged 747 impressions and 22 engagements per tweet, whereas 157 visual abstracts averaged 1977 impressions and 78 engagements per tweet. Automated tweets were discontinued in December 2020. From December 2020 to December 2022 (average of 44 new followers per month), 95 visual abstracts averaged 1893 impressions and 103 engagements per tweet. With the introduction of the visual abstract, the average number of followers, impressions per tweet, and engagements per tweet significantly increased (all p -values <0.01; all large effect sizes of 0.16, 0.47, and 0.47, respectively). CONCLUSIONS: Visual abstracts created by a social media editorial team have a positive impact on social media participation in the field of otology and neurotology. The impact is greater than that of social media content generated by Twitter automation tools.

Taxonomic changes for Neotropical pinhole borer ambrosia beetles (Coleoptera: Curculionidae: Platypodinae).

Stephen L. Wood re-defined Platypus such that its members are native to realms outside of the Americas and transferred most Neotropical species out of that genus. I have come across 44 species that still remain, though, and these are treated here. In total, I report 49 new generic assignments, 30 of which are transfers out of Platypus. I propose 22 new synonymies, eight of which are Platypus species that are synonymized with previously transferred species. Six Neotropical species are left in Platypus, for reasons detailed in the text. These taxonomic acts affect the compositions of eight of the 11 Neotropical genera of core Platypodinae. The following species are transferred from Platypus Herbst, 1793: Cenocephalus dubiosus (Schedl, 1933) comb. nov., Cenocephalus neotruncatus (Schedl, 1972) comb. nov.; Costaroplatus barbosai (Schedl, 1972) comb. nov., Costaroplatus devius (Schedl, 1976) comb. nov., Costaroplatus mixtus (Schedl, 1976) comb. nov., Costaroplatus roppai (Schedl, 1978) comb. nov.; Epiplatypus bicaudatulus (Schedl, 1935) comb. nov., Epiplatypus carduus (Schedl, 1936) comb. nov., Epiplatypus complanus (Schedl, 1967) comb. nov., Epiplatypus grandiporus (Schedl, 1961) comb. nov., Epiplatypus insculptus (Schedl, 1967) comb. nov., Epiplatypus macroporus (Chapuis, 1865) comb. nov., Epiplatypus perforans (Schedl, 1961) comb. nov., Epiplatypus propinquus (Schedl, 1959) comb. nov., Epiplatypus quadrispinatus (Chapuis, 1865) comb. nov., Epiplatypus sallei (Chapuis, 1865) comb. nov., Epiplatypus sequius (Schedl, 1935) comb. nov.; Euplatypus detectus (Schedl, 1976) comb. nov., Euplatypus erraticus (Schedl, 1972) comb. nov., Euplatypus longulus (Chapuis, 1865) comb. nov., Euplatypus perplexus Bright, 1972 comb. nov., Euplatypus rugosifrons (Schedl, 1933) comb. nov., Euplatypus vexans (Schedl, 1972) comb. nov.; Megaplatypus asperatus (Schedl, 1976) comb. nov., Megaplatypus carinifer (Schedl, 1970), Megaplatypus durus (Schedl, 1936) comb. nov., Megaplatypus eversus (Wood, 1971) comb. nov., Megaplatypus gagates (Schedl, 1976) comb. nov., Megaplatypus irrepertus (Schedl, 1936) comb. nov., Megaplatypus lineaticornis (Schedl, 1936) comb. nov., Megaplatypus paramonovi (Schedl, 1972) comb. nov., Megaplatypus schedli (Wood, 1966) comb. nov., Megaplatypus vafer (Schedl, 1972) comb. nov.; Teloplatypus caligatus (Schedl, 1972) comb. nov. Costaroplatus bidens (Schedl, 1970) comb. nov. and Costaroplatus darlingtoni (Reichardt, 1965) comb. nov. are transferred from Megaplatypus Wood, 1993. Costaroplatus vonfaberi (Reichardt, 1962) comb. nov. is transferred from Platyphysus Wood, 1993. Epiplatypus striatus (Chapuis, 1865) comb. nov., Megaplatypus contextus (Schedl, 1963) comb. nov., Megaplatypus decorus (Schedl, 1936) comb. nov. and Megaplatypus dignatus (Schedl, 1936) comb. nov. are removed from Euplatypus Wood, 1993. Epiplatypus ornatus (Schedl, 1936) comb. nov. is transferred from Teloplatypus Wood, 1993. Euplatypus jamaicensis Bright, 1972 comb. nov., Megaplatypus discolor (Blandford, 1896) comb. nov., Teloplatypus brasiliensis (Nunberg, 1959) comb. nov., Teloplatypus nudus (Schedl, 1936) comb. nov. and Teloplatypus pernudus (Schedl, 1936) comb. nov. are transferred from Epiplatypus Wood, 1993. Costaroplatus ornatus (Schedl, 1936) comb. nov., is transferred from Cenocephalus Chapuis, 1865. Megaplatypus acutidens (Blandford, 1895) comb. nov. and Megaplatypus despectus (Schedl, 1971) comb. nov. are transferred from Tesserocerus Saunders, 1837. New synonymies are proposed as follows: Cenocephalus rugicollis Schedl, 1952 (= Cenocephalus epistomalis Wood, 1966 syn. nov.); Tesserocerus forcipatus Schedl, 1972 (= Platypus aplanatus Schedl, 1976 syn. nov.); Tesserocerus retusus Gurin-Mneville, 1838 (= Tesserocerus guerini ssp. montanus Schedl, 1960 syn. nov.); Tesserocerus simulatus Schedl, 1936 (= Platypus bilobus Schedl, 1961 syn. nov.); Tesserocerus spinax Blandford, 1896 (= Tesserocephalus forficula Schedl, 1936 syn. nov.); Costaroplatus carinulatus (Chapuis, 1865) (= Platypus umbrosus Schedl, 1936 syn. nov.); Costaroplatus shenefelti Nunberg (1963) (= Platypus abditulus Wood, 1966 syn. nov.); Costaroplatus vonfaberi (Reichardt, 1962) (= Platypus convexus Schedl, 1972 syn. nov.); Epiplatypus sallei (Chapuis, 1865) (= Platypus quadricaudatulus Schedl, 1934 syn. nov. and = Platypus filaris Wood, 1971 syn. nov.); Euplatypus longulus (Chapuis, 1865) (= Platypus dimidiatus Chapuis, 1865 syn. nov. = Platypus mulsanti Chapuis, 1865 syn. nov. and = Platypus pseudolongulus Schedl, 1963 syn. nov. ); Megaplatypus acutidens (Blandford, 1895) (= Tesserocerus alternantes Schedl, 1977 syn. nov.); Megaplatypus durus (Schedl, 1936) (= Platypus arcuatus Schedl, 1976 syn. nov.); Megaplatypus fuscus (Chapuis, 1865) (= Platypus marginatus Chapuis, 1865 syn. nov., = Platypus granarius Schedl, 1952 syn. nov., and = Platypus obsitus Schedl, 1976 syn. nov.); Megaplatypus irrepertus (Schedl, 1936) (= Platypus sulcipennis Schedl, 1976 syn. nov.); Neotrachyostus abbreviatus (Chapuis, 1865) (= Platypus concavus Chapuis, 1865 syn. nov.); Teloplatypus enixus (Schedl, 1936) (= Platypus interponens Schedl, 1978 syn. nov.); Teloplatypus ratzeburgi (Chapuis, 1865) (= Platypus pallidipennis Blandford, 1896 syn. nov.). Platypus simpliciformis Wood, 1966 had been transferred by Wood (1993) to both Megaplatypus and Euplatypus by mistake; I propose keeping it in Megaplatypus. Six Neotropical species are left in the genus Platypus with the status incertae sedis: Platypus armatus Chapuis, 1865; Platypus dorsalis Schedl, 1972; Playpus quadrilobus Blandford, 1895; Platypus squamifer Schedl, 1963; Platypus subaequalispinosus Schedl, 1936; and Platypus trispinosus Chapuis, 1965. These taxonomic changes prepare the foundations for future revisionary work on the American Platypodinae.

Where Are All the Specialists? Current Challenges of Integrating Specialty Care Into Population-Based Total Cost of Care Payment Models.

The Centers for Medicare & Medicaid Services Innovation Center (CMMI) has set the goal for 100% of traditional Medicare beneficiaries to be part of an accountable care relationship by 2030. Lack of meaningful financial incentives, intolerable or unpredictable risk, infrastructure costs, patient engagement, voluntary participation, and operational complexity have been noted by the provider and health care delivery community as barriers to participation or reasons for exiting programs. In addition, most piloted and implemented population-based total cost of care (PB-TCOC) payment models have focused on the role of the primary care physician being the accountability (that is, attributable) leader of a patient's multifaceted care team as well as acting as the mayor of the "medical neighborhood," leaving the role of specialty care physicians undefined. Successful provider specialist integration into PB-TCOC models includes meaningful participation of specialists in achieving whole-person, high-value care where all providers are financially motivated to participate; there is unambiguous prospective attribution and clearly defined accountability for each participating party throughout the care journey or episode; there is a known care attribution transition accountability plan; there is actionable, transparent, and timely data available with appropriate data development and basic analytic costs covered; and there is advanced payment to the accountable person or entity for management of the care episode that is part of a longitudinal care plan. Payment models should be created to address the 7 challenges raised here if specialists are to be incented to join TCOC models that achieve CMMI's goal.