Report for Archeological Survey CSJ 0923-06-056, CR 225 at Clear Creek Brown County, Brownwood District

On February 3, 2016, Jon Budd - TxDOT staff archeologist, conducted an intensive archeological survey of the undertaking\u27s area of potential effects (APE) for the bridge replacement on Brown County Road 225 at Clear Creek. A new bridge is proposed to be installed on new location approximately 140 feet north of the existing bridge. The road will be realigned to align with the proposed new bridge. The existing bridge is historic and will be left in place. The investigation consisted of a one hundred percent pedestrian survey of the 3.2 acres of the project area which includes 1.0 acre of proposed new right of way. In addition, a total of four Gradall Trenches were excavated into the proposed new right of way. No archeological remains were observed. TxDOT recommended that the inventory of the APE is complete, a finding of no historic properties affected , and no further work is warranted. Since no archeological artifacts were observed, none were collected, and none were curated

CSJ 0151-09-036, Proposed US 183 from US 290 to SH 71 Travis County, Austin District

Previously unrecorded site 41TV2509 was discovered post-review during construction for the widening of US 183 from US 290 to SH 71. The project, conducted under Texas Antiquities Permit No. 7627, consisted of examining and reporting a multi-component site, 41TV2509, which was discovered post-review during vegetation clearing and grading in association with the widening of US 183. Fieldwork was conducted between April 20 and April 25, 2016. The project area covered an area of approximately 0.02 acres, completely situated within existing TxDOT right of way. A pile of roughly 100 yellow bricks, some still mortared together, was encountered during mechanical operations east of US 183 and immediately south of Loyola Lane. Subsequent examination revealed a wide scatter of both prehistoric lithics and historic domestic debris, none of which were collected. Shovel testing and mechanical scraping revealed no evidence of additional features. The site, recorded as 41TV2509, and comprised two components: a likely prehistoric lithic material procurement site, and a mid- to late-nineteenth- century domestic residence. The integrity of the site was completely compromised during discovery, due to the initial disturbance through mechanical vegetational removal. Based on the results of the survey and the archival research, the site does not appear to meet any of the criteria for inclusion in the National Register of Historic Places under 36 CFR 60.4 or for designation as a State Antiquities Landmark under 13 Texas Administrative Code 26.10. Construction was allowed to proceed, and the site has since been removed in its entirety

Intensive Archeological Survey for the Barton Oaks Road at Bartons Creek Bridge Replacement, Bastrop County

On March 3, 2016, SWCA Environmental Consultants conducted an intensive cultural resources survey of new bridge installation and associated roadway approaches (approximating 1 acre) along Barton Oaks Drive in Bastrop County, Texas. These investigations for the Austin District were conducted for the proposed bridge replacement across Bartons Creek. The work was conducted in compliance with Section 106 of the National Historic Preservation Act (54 United States Code 306108) and the Antiquities Code of Texas (9 Natural Resources Code 191). Jon Budd served as Principal Investigator under Texas Antiquities Code Permit No. 7555. The area of potential effects (APE) comprises new and existing right-of-way (ROW). The survey area includes a proposed 733-foot-long by 50-foot-wide new road ROW measuring 0.84 acre. An additional 0.397 acre of new ROW is located between the existing and proposed ROW on the southwest side of the project area, and 0.545 acre of new ROW located on the northeast side of the project area between the existing and proposed roads. According to typical roadway design, the depth of impacts is estimated to be no more than 40 feet below the current ground surface for the bridge supports and no more than 6 feet for the remainder of the project. The total acreage of the APE measures approximately 2 acres. The field investigations consisted of excavation of three backhoe trenches around the drainage crossing of Bartons Creek. All trenches revealed deep sands but were negative for cultural material. As such, no further work is recommended

CSJ 0221-05-065, US 271 South of Talco Intensive Archaeological Survey, Titus County, Atlanta District

On May 20-23, 2019, an Intensive archeological resources survey was conducted south of Talco, northwest Titus County, Texas, along US 271 for the Titus County Improvement Project (CSJ-0221-05-065). The survey area is an irregularly-shaped linear area measuring 0-feet-wide at its northern extent, 83-feet-wide (25-m) at its approximate center, and 67-feet-wide (21-m) at its southern extent. Its average width is 70 feet (21 m). The total survey area is comprised of approximately 2.02 acres of new right-of-way (ROW) and 0.37 acres of new easement and was surveyed for cultural resources in advance of road improvements and bridge removal and replacement. The new right-of-way is located on an existing alignment that is oriented south-southeast-to-north-northwest west and commences 2.2 miles southeast of the intersection of US 271 and SH 71. Investigations were limited to a 1,508-foot-long (0.46-km) segment of the approximately 1.741 mile-long (2.8-km) project area. Survey consisted of intensive shovel testing delineation of site 41TT922 and the excavation of six backhoe trenches. Two trenches were placed within the limits of 41TT922 in an attempt to locate archeological features, and the remaining four trenches were placed on hills and toe slopes of the north valley wall of Big Slough. No archeological features were encountered during backhoe trenching. During shovel testing, subsurface prehistoric lithics were recovered from 0 to 33 cm below surface in 10 out of 16 shovel tests. As a result of the survey, site 41TT922 was further documented and its site boundaries were expanded to the eastern edge of the current APE. The site likely continues east beyond the current APE. Although the investigation discovered a shallow depth of archeological deposits (33 centimeters), a lack of features, ceramics, floral, and faunal remains, the investigators recommend that further archeological work should be conducted to determine the eligibility of the site to be listed on the National Register of Historic Places and the potential for the site to be designated as a State Antiquities Landmark. The justification for this recommendation is based upon the general paucity of Late Archaic archeological deposits in Eastern Texas

CSJ 0414-01-001, SH 165 within the Texas State Cemetery Travis County, Austin District

On November 6, 2017 TxDOT archeologists conducted an intensive archeological survey under Texas Antiquities Permit Number 8212 for the proposed widening of the east/west segment of State Highway (SH) 165 located within the Texas State Cemetery in Austin in Travis County, Texas. The Texas State Cemetery has been previously determined eligible for listing on the National Register of Historic Places and is also recorded as a Texas State Antiquities Landmark. The cemetery has been previously recorded as the archeological site, 41TV1700. The existing 328 foot long by 12 foot wide east/west segment of SH 165 roadway would be widened to 22 feet. The undertakings area of potential effects is defined as a 22 foot wide by 328 foot long area centered on the existing east/west segment of SH 165 beginning at Comal Street and extending west to the north/south segment of SH 165. The depth of impacts is estimated to be approximately 3 feet below the current ground surface. The project area incorporates approximately 0.165 acres. All funding and oversight for the project is under the purview of the State of Texas. No Federal funding or oversight is involved. Therefore, this project is being coordinated under the Antiquities Code of Texas only. During informal consultation with the Texas Historical Commission (THC), the THC recommended that the intensive archeological investigation consist of three mechanical trenches excavated on the south side and parallel to the east/west segment of SH 165 to assess the potential for the APE to contain unmarked human interments. As per the THC recommendations, TxDOT archeologists excavated three trenches measuring 12 by 3 feet and up to 8 feet in depth. TxDOT also conducted a 100% pedestrian inspection of the project area. No marked or unmarked human interments were observed. One fragment of blue on white transfer ware, one fragment of a white porcelain plate, one rusted metal fragment, a charred twig, and one modern aluminium Coca-Cola were observed within imported fill sections. These were recorded as isolated finds and not part of any archeological site. No other archeological materials were observed or recorded. No materials were collected. Therefore, no materials are curated. Based upon the results of the investigation, TxDOT recommends that the widening of the east/west segment of SH 165 will have no adverse effect to any portion of the National Register of Historic Places eligible archeological site or State Antiquities Landmark (41TV1700). No further work is recommended

Testing And Data Recovery Excavations At The Jayroe Site (41HM51), Hamilton County, Texas

In 2003–2004, Prewitt and Associates, Inc., performed National Register of Historic Places testing and subsequent data recovery excavations at the Jayroe site (41HM51) in Hamilton County for the Texas Department of Transportation, Environmental Affairs Division, under Texas Antiquities Permit Nos. 3211 and 3405. The investigations were prompted by the planned replacement of the County Road 294 bridge at the Leon River (CSJ No. 0909-29-030), in compliance with Section 106 of the National Historic Preservation Act and its implementing regulations (36 CFR Part 800) and the Antiquities Code of Texas. Testing consisted of the excavation of 6 backhoe trenches and 19 test units, and the data recovery work consisted mainly of hand excavation of 153 contiguous 1x1-m units within a single block, with 2 backhoe trenches and 2 manual units apart from the block excavation. Combined, the testing and data recovery identified 16 cultural features interpreted as 3 open hearths, 4 shallow earth ovens or surface hearths, 8 scatters of various kinds of debris, and 1 knapping station. The excavations recovered 322 chipped stone tools, 26 cores, 6,589 pieces of unmodified debitage, 21 ground or battered stone tools, 38 potential pigment sources, 43 ceramic sherds, 15 modified bone artifacts, 7,649 animal bones, 1,200 mussel shells, and macrobotanical remains. Four analytical units are defined for the site, only one of which—the Toyah phase component— has much interpretive potential. It is interpreted as a campsite used at least several times, mostly in the a.d. 1470s, at which butchering of mostly bison and deer, late-stage lithic tool manufacture and repair, and other maintenance tasks figured prominently in the site activities. The artifacts recovered and records generated by the project are curated at the Center for Archaeological Studies, Texas State University

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries