University of Vermont Medical Center Critical Care Transport Community Paramedicine Pilot Inclusion/Exclusion Criteria and Supplemental Materials

The University of Vermont Medical Center (UVMMC) Critical Care Transport (CCT) team received a grant in 2020 to trial one Community Paramedic to reduce high volume utilizers of UVMMC’s ED enrolled in Vermont’s accountable care organization (ACO), OneCareVT. That summer, this team helped develop and analyze the implications of that program. The current literature surrounding Community Paramedicine was explored, focusing particularly on studies that analyzed costs savings of these programs, rural areas with similar populations as Vermont, and the average cost of an ED visit. The reviewed literature and annotations are included in this work. Initially, our plan was to analyze data obtained from the Critical Care Transport team’s pilot program. However, the program was slated to begin at the beginning of April 2020 and was postponed in the wake of the COVID-19 pandemic. The department’s Community Paramedic was instead reallocated to set up the drive-through COVID-19 testing site for Chittenden County. The reallocation of resources from UVMMC’s CCT team prompted this team’ to pivot efforts toward the fundamental establishment of the program – particularly patient selection. 78 high utilizers of UVMMC’s ED for six months in 2020 were reviewed. Following the chart review trends in chronic underlying conditions and chief complaints were established within this cohort. With these data, inclusion criteria and exclusion criteria for a community paramedic pilot program were generated further taking into the considerations the abilities and limitations of community paramedics, safety, and other community resources available for this patient population. These criteria are included within this work. With the pivot from data collection to assisting with program set up, a mail-out letter to send to potential patients who might benefit from the program was written. Additionally, a script for contacting these patients via telephone to enroll them in the program was also written. These resources are also included within this work

The tomato genome sequence provides insights into fleshy fruit evolution

Tomato (Solanum lycopersicum) is a major crop plant and a model system for fruit development. Solanum is one of the largest angiosperm genera1 and includes annual and perennial plants from diverse habitats. Here we present a high-quality genome sequence of domesticated tomato, a draft sequence of its closest wild relative, Solanum pimpinellifolium2, and compare them to each other and to the potato genome (Solanum tuberosum). The two tomato genomes show only 0.6% nucleotide divergence and signs of recent admixture, but show more than 8% divergence from potato, with nine large and several smaller inversions. In contrast to Arabidopsis, but similar to soybean, tomato and potato small RNAs map predominantly to gene-rich chromosomal regions, including gene promoters. The Solanum lineage has experienced two consecutive genome triplications: one that is ancient and shared with rosids, and a more recent one. These triplications set the stage for the neofunctionalization of genes controlling fruit characteristics, such as colour and fleshiness