A Person-Centered Approach to Poststroke Care: The COMprehensive Post-Acute Stroke Services Model

Many individuals who have had a stroke leave the hospital without postacute care services in place. Despite high risks of complications and readmission, there is no standard in the United States for postacute stroke care after discharge home. We describe the rationale and methods for the development of the COMprehensive Post-Acute Stroke Services (COMPASS) care model and the structure and quality metrics used for implementation. COMPASS, an innovative, comprehensive extension of the TRAnsition Coaching for Stroke (TRACS) program, is a clinician-led quality improvement model providing early supported discharge and transitional care for individuals who have had a stroke and have been discharged home. The effectiveness of the COMPASS model is being assessed in a cluster-randomized pragmatic trial in 41 sites across North Carolina, with a recruitment goal of 6,000 participants. The COMPASS model is evidence based, person centered, and stakeholder driven. It involves identification and education of eligible individuals in the hospital; telephone follow-up 2, 30, and 60 days after discharge; and a clinic visit within 14 days conducted by a nurse and advanced practice provider. Patient and caregiver self-reported assessments of functional and social determinants of health are captured during the clinic visit using a web-based application. Embedded algorithms immediately construct an individualized care plan. The COMPASS model's pragmatic design and quality metrics may support measurable best practices for postacute stroke care

Diverse Lifestyles and Strategies of Plant Pathogenesis Encoded in the Genomes of Eighteen Dothideomycetes Fungi

The class Dothideomycetes is one of the largest groups of fungi with a high level of ecological diversity including many plant pathogens infecting a broad range of hosts. Here, we compare genome features of 18 members of this class, including 6 necrotrophs, 9 (hemi)biotrophs and 3 saprotrophs, to analyze genome structure, evolution, and the diverse strategies of pathogenesis. The Dothideomycetes most likely evolved from a common ancestor more than 280 million years ago. The 18 genome sequences differ dramatically in size due to variation in repetitive content, but show much less variation in number of (core) genes. Gene order appears to have been rearranged mostly within chromosomal boundaries by multiple inversions, in extant genomes frequently demarcated by adjacent simple repeats. Several Dothideomycetes contain one or more gene-poor, transposable element (TE)-rich putatively dispensable chromosomes of unknown function. The 18 Dothideomycetes offer an extensive catalogue of genes involved in cellulose degradation, proteolysis, secondary metabolism, and cysteine-rich small secreted proteins. Ancestors of the two major orders of plant pathogens in the Dothideomycetes, the Capnodiales and Pleosporales, may have had different modes of pathogenesis, with the former having fewer of these genes than the latter. Many of these genes are enriched in proximity to transposable elements, suggesting faster evolution because of the effects of repeat induced point (RIP) mutations. A syntenic block of genes, including oxidoreductases, is conserved in most Dothideomycetes and upregulated during infection in L. maculans, suggesting a possible function in response to oxidative stress

Nature and timing of Late Mississippian to Mid-Pennsylvanian glacio-eustatic sea-level changes of the Pennine Basin, UK: Discussion Reply

Although we appreciate that the points made by Bailey are relevant to any discussion of interpreting stratigraphic patterns as being astronomically paced, we take this opportunity to discuss the details of the Carboniferous of the Pennine Basin beyond simple rock thickness–time concepts or models and reiterate points relevant to the conclusions of Waters & Condon (2012), namely the nature of the expression of sea-level variation within the Carboniferous Pennine Basin and its regional and global geological context

Examining the case for the use of the Tertiary as a formal period or informal unit

The ‘Tertiary’, omitted from IUGS-approved timescales since 1989, is still in common use. With the recent re-instatement of the Quaternary as a formal unit, the question arises as to whether the Tertiary too should be reinstated as a formal period, with the ‘Paleogene’ and ‘Neogene’ being downgraded to sub-periods. This paper presents arguments for and against this proposal, stemming from discussions by members of the Geological Society Stratigraphy Commission. It is intended to stimulate discussion of the topic in the wider community