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Lecidea varians is among the most common and abundant bark-dwelling crustose lichens in temperate eastern North America. As presently delimited, it is highly variable, including chemical and morphological diversity well beyond that currently accepted for most lichen species. The generic placement of L. varians has also been questioned for decades. It has long been recognized as aberrant in Lecidea and Pyrrhospora, excluded from Lecidella, and more recently transferred to Traponora. Drawing from the results of extensive chemical, molecular phylogenetic and morphological studies, we show that L. varians and its relatives represent a previously unrecognized lineage within the speciose lichen family Lecanoraceae. The lineage appears to occupy an isolated position, distinct from the aforementioned genera, and is newly described as the genus Xanthosyne (typified by L. varians). The chemical and morphological variation within L. varians is mirrored by, but not entirely correlated with, considerable molecular diversity. A new taxonomy is proposed for L. varians and its relatives to serve as a framework for future studies. Three species are recognized: X. varians (≡ Lecidea varians), common and widespread in parts of North America; X. granularis, a new species from the Atlantic Coast of eastern North America that differs morphologically from X. varians in having a leprose thallus; and X. sharnoffiorum, a new species also found mainly along the Atlantic Coast of eastern North America, which has a coarsely granular, non-leprose thallus and produces a unique, unidentified xanthone. Multiple well-supported lineages were recovered within X. varians that correlate to varying degrees with chemical and morphological variability, as well as geographic distribution. Eight subspecies are recognized to accommodate the variation within X. varians: X. varians subsp. exigua comb. nov. (≡ Lecidea exigua) characterized by the presence of atranorin and a consistent set of three xanthones, is widespread in southern Europe and western North America (coastal California); X. varians subsp. varians (≡ Lecidea varians) is distributed mainly in northeastern North America and produces thuringione and arthothelin; X. varians subsp. morsei subsp. nov. is morphologically and chemically variable, with one chemotype (thiophanic acid) with a northeastern distribution, and the other with a unique and unidentified xanthone, found mainly in the interior U.S.A.; X. varians subsp. obscura subsp. nov. occurs mainly in the central U.S.A. and North Temperate regions, produces a unique, unidentified xanthone and generally has black apothecia with green epihymenial pigments; X. varians subsp. pseudomorsei subsp. nov. and X. varians subsp. submorsei subsp. nov. resemble X. varians subsp. morsei but differ in molecular sequence characters; X. varians subsp. subtilis comb. nov. (≡ Lecidea subtilis) and X. varians subsp. subexigua subsp. nov. occur in the Appalachian Mountains, the former producing atranorin and the latter lacking atranorin, both with thiophanic acid with or without other xanthones. In an addendum, Lecidella subviridis is discussed with respect to the genus Xanthosyne. An identification key is provided for all species and their subspecies within Xanthosyne. 

A lichenicolous fungus forming large black, vertically elongate, campylidia-like conidiomata on the thallus of Ochrolechia was recently collected in Austria, Mexico and the USA. The conidia are so remarkable in being multiappendiculate that initially no existing fungal genera appeared to be suitable for its description. Nevertheless, molecular phylogenetic analyses of nuITS and nuLSU sequences recovered the species within the genus Mycocalicium. To date, no species of Mycocaliciales has been reported producing appendiculate conidia. The species is described as new M. campylidiophorum. The new species was also discovered in the type specimen of Opegrapha chionographa that was collected in Colombia 163 years ago. This discovery led us to revise O. chionographa, originally described as a lichen, and clarify that in fact the name applies to a lichenicolous fungus based on type material that is an admixture of M. campylidiophorum, an Ochrolechia and an Opegrapha species. The name is shown to apply to the Opegrapha species and lectotypified as such. Opegrapha blakii is treated as synonym of O. chionographa.

 

Clinical documentation is a time-consuming and challenging task, especially in time-critical medical settings. Even with a dedicated scribe person, timely and accurate documentation under time constraints is never easy. In this work, we present a unique type of fast-paced medical team--emergency medical services (EMS)--which has no designated role for documentation while constantly working outside in the field to provide urgent patient care. Through interviews with 13 EMS practitioners, we reveal several interesting and prominent characteristics of EMS documentation practice as well as their associated challenges: EMS practitioners self-organize and collaborate on documentation while in the meantime being both physically and cognitively preoccupied with high-acuity patients, having limited capability to use handheld documentation systems in real-time, and being overwhelmed by strict documentation requirements and regulations. Lastly, we use our findings to discuss both technical and non-technical implications to support timely and collaborative documentation in dynamic medical contexts while accounting for care providers' physical and cognitive constraints in using computing devices. 

Background Smart glasses have been gaining momentum as a novel technology because of their advantages in enabling hands-free operation and see-what-I-see remote consultation. Researchers have primarily evaluated this technology in hospital settings; however, limited research has investigated its application in prehospital operations. Objective The aim of this study is to understand the potential of smart glasses to support the work practices of prehospital providers, such as emergency medical services (EMS) personnel. Methods We conducted semistructured interviews with 13 EMS providers recruited from 4 hospital-based EMS agencies in an urban area in the east coast region of the United States. The interview questions covered EMS workflow, challenges encountered, technology needs, and users’ perceptions of smart glasses in supporting daily EMS work. During the interviews, we demonstrated a system prototype to elicit more accurate and comprehensive insights regarding smart glasses. Interviews were transcribed verbatim and analyzed using the open coding technique. Results We identified four potential application areas for smart glasses in EMS: enhancing teleconsultation between distributed prehospital and hospital providers, semiautomating patient data collection and documentation in real time, supporting decision-making and situation awareness, and augmenting quality assurance and training. Compared with the built-in touch pad, voice commands and hand gestures were indicated as the most preferred and suitable interaction mechanisms. EMS providers expressed positive attitudes toward using smart glasses during prehospital encounters. However, several potential barriers and user concerns need to be considered and addressed before implementing and deploying smart glasses in EMS practice. They are related to hardware limitations, human factors, reliability, workflow, interoperability, and privacy. Conclusions Smart glasses can be a suitable technological means for supporting EMS work. We conclude this paper by discussing several design considerations for realizing the full potential of this hands-free technology. 

Emergency medical services (EMS) teams are first responders providing urgent medical care to severely ill or injured patients in the field. Despite their criticality, EMS work is one of the very few medical domains with limited technical support. This paper describes a study conducted to examine technology opportunities for supporting EMS data work and decision-making. We transcribed and analyzed 25 simulation videos. Using the distributed cognition framework, we examined EMS teams' work practices that support information acquisition and sharing. Our results showed that EMS teams leveraged various mechanisms (e.g., verbal communication and external cognitive aids) to distribute cognitive labor in managing, collecting, and using patient data. However, we observed a set of prominent challenges in EMS data work, including lack of detailed documentation in real time, situation recall issues, situation awareness problems, and challenges in decision making and communication. Based on the results, we discuss implications for technology opportunities to support rapid information acquisition, integration, and sharing in time-critical, high-risk medical settings.