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The North American endemic moss Dicranum howellii Renauld & Cardot, described in 1888 based on material from Oregon, U.S.A., had yet to be validly typified. A lectotype for D. howellii is designated herein based on one of two potential type specimens in the Renauld collection in PC. Dicranum howellii is currently known from western North America in Canada (British Colombia) and the U.S.A (Alaska, California, Idaho, Montana, Oregon and Washington). Traditionally it has been considered as close to, or a synonym of, Dicranum scoparium Hedw. and specimens of it are frequently confused with the latter species. Dicranum howellii can be distinguished from D. scoparium based on its suddenly narrowed inner perichaetial leaves that end in a long, flexuose point; leaves that are concave below and tubulose above; slightly decurrent leaf bases; in transverse section, leaf cell-walls that are of variable thickness; and the presence of a sulcus on the dorsal side of the costa. [ABSTRACT FROM AUTHOR]

Objective: To characterize adult asthma patients according to frequency of emergency department (ED) visits in the past year. Design: Adults presenting with acute asthma to 83 US EDs underwent structured interviews in the ED and by telephone 2 weeks later. Results: The 3,151 enrolled patients were classified into four groups: those reporting no ED visits in the past year (27%), one to two visits (27%), three to five visits (25%), and six or more visits (2 1%). The number of ED visits (NEDV) was associated with older age, nonwhite race, lower socioeconomic status, and several markers of chronic asthma severity (all p < 0.00 1). NEDV was strongly associated with Medicaid insurance (17% among those with no visits, 22% with one to two visits, 30% with three to five visits, 39% with six or more visits; p < 0.001). NEDV was unrelated to gender or having a primary care provider (PCP). In a multivariate model, independent predictors of high ED use (six or more visits a year) were nonwhite race, Medicaid, other public, and no insurance, and markers of chronic asthma severity. Patients with six or more ED visits accounted for 67% of all prior ED visits in the past year. [ABSTRACT FROM AUTHOR]