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Several studies have demonstrated the efficacy of paclitaxel drug-coated balloons (DCBs) for the treatment of femoropopliteal (FP) lesions in patients with peripheral artery disease (PAD). Despite the available evidence, long-term real-world efficacy data are limited. To report the 3-year outcomes of the prospective, multicenter, single-arm real-world registry conducted in the United States, assessing the clinical use of the Lutonix 035 DCB in arteries of the superficial femoral artery (SFA) and popliteal artery (PA). In the SAFE-DCB US Registry, a total of 1005 subjects at 74 investigational sites were treated with the Lutonix 035 DCB and were followed up to 36 months. The per protocol included 966 patients (mean age 69.1 years; 56.7% male). A total of 1237 target lesions were treated, in which 93.3% were de novo, 85.2% were located in the SFA, and 88% had mild-to-severe calcification. Forty-five percent of the patients were Rutherford 3, and 35.1% had critical limb-threatening ischemia. The primary efficacy endpoint is target lesion revascularization (TLR) at 12 months. Secondary endpoints included rate of primary patency at 12 months and freedom from TLR and freedom from target vessel revascularization (TVR) evaluated through 36 months. The safety endpoints evaluated through 36 months were freedom from the composite of device- and/or procedure-related perioperative (≤30 day) death, TVR, and freedom from major amputation of the target limb. Primary patency at 12 months post-index procedure by Kaplan-Meier estimates was 83.7%. Freedom from TLR at 12 months was 88.6%, 75.7% at 24 months, and 74.4% at 36 months. At 36 months, freedom from TVR post-index procedure by Kaplan-Meier estimates was 69.5%. Freedom from primary safety events at 30 days was 98.2%. Freedom from composite of all-cause perioperative (≤30 day) death and from the following: index limb amputation, index limb reintervention, and index-limb-related death by Kaplan-Meier estimates at 12 months was 80.8%, at 24 months 67.4% and 58.4% at 36 months. Freedom from major amputation of the target limb at 36 months was 95.6%. The results from the SAFE-DCB US Registry for femoral popliteal (FP) disease demonstrated sustained safety and efficacy over 3 years following the Lutonix 035 DCB intervention.Clinical ImpactThis prospective real-world population study supports long-term clinical outcomes of Lutonix and provides meaningful insights into the sustained efficacy of drug-coated balloon (DCB) therapy in real-world femoropopliteal population. The low-bailout stenting rate (1.7%), and the 36-month sustained Freedom from target lesion revascularization rate (74.4%) supporting DCB usage when a "leave nothing behind" approach is favored. Furthermore, these results reinforce the effectiveness of DCBs in the endovascular treatment peripheral artery disease.

Functional brain networks in schizophrenia (SZ) are often characterized by covariance-based measures, yet covariance matrices live on a curved geometric structure rather than in ordinary Euclidean space, complicating noise-robust inference from scalp EEG. We develop a Riemannian Geometry-based Adaptive Nonlinear Coupling Analysis (RGA-NCA) framework that integrates the affine-invariant Riemannian metric (AIRM), tangent space mapping (TSM), and an anatomically adaptive artifact rejection (AAAR) strategy accounting for regional signal-to-noise heterogeneity. The framework is grounded in the observation that Euclidean summaries of symmetric positive definite matrices are sensitive to noise-driven volume inflation, whereas geodesic distances on the manifold emphasize shape deformation. RGA-NCA was evaluated on four benchmark dynamical systems, a supplementary multichannel EEG-like sample covariance simulation, and a public button-tone SZ/HC EEG dataset associated with the auditory feedback paradigm described by Ford et al. (81 subjects; 49 SZ, 32 healthy controls). Compared with Euclidean and linear baselines, RGA-NCA showed lower sensitivity to noise-driven distance distortion and yielded clearer group-level contrasts in the tested ROI analyses; all four pre-specified frontotemporal and parietal channel pairs remained significant after Benjamini-Hochberg FDR correction. The resulting patterns are consistent with reduced long-range connectivity together with localized hyper-synchronization-like effects in SZ. Quantitatively, the Riemannian structural sensitivity index (sim=exp(-d2/4)) remained high across all tested SNR levels (-20 to +10 dB; 50 Monte Carlo trials per level; range 0.936-0.964), with only a 0.026 endpoint change between +10 and -20 dB, whereas the Euclidean metric fell from 0.922 at +10 dB to 0.000 at -20 dB. These findings support Riemannian modeling as a candidate strategy for noisy covariance-based neural data, pending validation in larger independent cohorts.

The research model used to conduct the Habitual Diet and Avocado Trial (HAT), a large multicenter clinical trial (n = 1008 participants) designed to evaluate the effect of consuming 1 avocado/d for 6 mo on visceral adiposity in individuals with an increased waist circumference, has been a long-term productive collaboration. The primary outcome analysis showed that intake of 1 avocado/d did not affect visceral adiposity compared with habitual dietary intake. Secondary and ancillary analyses showed improvements in diet quality, LDL cholesterol, and red blood cell fatty acid composition, as well as the gut microbiome with avocado intake. These findings are relevant to a large proportion of the United States population because of the study sample characteristics. The aim of this paper is to summarize the research protocol and implementation of the HAT as well as the findings. This approach could be used by consortia supported by nongovernmental entities. Notably, there is still ongoing research being conducted by the investigators using the data collected from the HAT. Moreover, HAT samples and data are available, pending an approved request, to scientists interested in conducting avocado health research. The collaborative commitment of the investigators, their collegial spirit, along with strong leadership and ongoing support from the coordinating center and funding agency representatives, has created a productive research consortium. This consortium has furthered knowledge about the health effects of avocados, and the approach has maximized the return on the research investment from a single large clinical trial.

Improving stroke recognition and promoting immediate action are critical to enhancing prehospital stroke care. For two decades, the FAST (Face, Arm, Speech, Time) mnemonic has been widely taught, yet it fails to capture many posterior circulation strokes. To address these limitations, BE FAST (adding Balance and Eye symptoms) was introduced but showed reduced recall for more common symptoms represented by FAST, likely due to common symptoms being placed after less common ones, thus weakening retention of the original FAST elements. To improve both detection and action, we propose FAST BEE-keeping FAST first and adding BE after FAST with an additional "E" for Emergency Medical Services (EMS) call. This structure reinforces the urgency of activating EMS by repeating the call-to-action within the mnemonic. We further introduce a novel FAST BEE cartoon as a visual tool to enhance learning, recall across diverse populations, and immediate action (EMS call) in public. Using the bee metaphor provides a memorable, engaging, and globally adaptable educational strategy in English-speaking populations. FAST BEE offers a fresh, action-oriented framework that builds on the familiarity of FAST, emphasizes immediate EMS activation, and holds promise to strengthen stroke action awareness worldwide. Further evaluation of effectiveness in various English-speaking populations is needed.

Preventing posttraumatic psychopathology (e.g., depression or posttraumatic stress disorder [PTSD]) following an acute traumatic event requires attention to modifiable factors that may protect against such psychopathology. In this study, we aimed to identify the relative contributions of resiliency factors across multiple domains to posttraumatic psychopathology and to delineate subcomponents that may be most influential. This study leveraged prospective data from 2,043 trauma-exposed individuals recruited from emergency departments in the Advancing Understanding of RecOvery afteR traumA Study. We first used structural equation modeling to examine higher level regulatory and interpersonal strength domains following acute trauma exposure and their relative associations with symptoms of depression or PTSD at 3 months posttrauma. We then tested which specific factors within these domains were associated with 3-month symptoms. Both regulatory and interpersonal strength domains were linked to fewer symptoms of depression and PTSD 3 months later, though relational strengths were more strongly associated than regulatory strengths when modeled together. Within interpersonal strengths, higher levels of emotional support and supportive networks, but not social engagement, were associated with lower depressive and PTSD symptoms. Within regulatory strengths, trait resilience was associated with lower depressive and PTSD symptoms, and self-efficacy showed mixed associations, whereas mindfulness (measured as nonreactively observing internal experiences) was associated with higher symptoms. Findings suggest enhancing interpersonal resiliency, above and beyond regulatory strengths, may be crucial in the aftermath of acute trauma, with emotional support and supportive networks as especially strong potential buffers against posttraumatic psychopathology. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Dietary trials methodology in the field of translational gastrointestinal research is fraught with constraints, relating to cost, practicalities of executing dietary trials, and the particulars of manipulating foods that often cannot be overcome. As such, dietary interventions may be unfairly judged as low quality. However, dietary trials are commonly poorly designed, based principally on drug trial methodology, which is often not appropriate in the setting of food, has a very different composition, and is not delivered like pharmaceuticals. This risks accurate interpretation of data and a lack of translatability to clinic. Careful attention should be given to the design of dietary trials to ensure studies remain high quality and clinically relevant. This review summarizes the key factors necessary for consideration when executing a well-designed dietary trial for gastrointestinal conditions and examples of how they have been used and reported on. Key factors include modeling dietary composition to meet the research question, appraising pre-exposure diets and their impact on the study, interpretation and potential use of placebo and nocebo effects, and the use of sham diets. Finally, measuring and reporting on blinding and adherence, which is essential, as for all trials methodology.

Transoesophageal echocardiography (TEE) is generally considered a low-risk procedure. However, in patients with severe tricuspid regurgitation (TR) complicated by right ventricular (RV) dysfunction and pulmonary hypertension (PH), standard procedural sedation can precipitate life-threatening haemodynamic collapse. An 83-year-old woman with end-stage renal disease, severe PH (95 mmHg), and severe TR underwent a TEE. Shortly after induction with propofol and probe insertion, the patient developed profound systemic hypotension (56/30 mmHg). Real-time TEE imaging revealed acute, severe RV dilatation and a precipitous decline in systolic function. The procedure was immediately aborted, and the patient was stabilized with intravenous phenylephrine and ephedrine. She returned to her haemodynamic baseline within 20 min of procedure termination and probe removal. This case highlights the 'triple hit' effect that places patients with RV failure at high risk during sedation: propofol-induced systemic vasodilation, the vagal response to probe insertion, and hypercapnia-induced increases in pulmonary vascular resistance (PVR). For this high-risk phenotype, a 'slow and low' anaesthetic titration, meticulous PVR management, and early consideration of RV-protective vasopressors are essential to prevent catastrophic RV-pulmonary uncoupling.

Myelopathy, a clinical diagnosis of spinal cord dysfunction, necessitates appropriate imaging to differentiate between extrinsic and intrinsic pathologies. This document outlines evidence-based guidelines for imaging evaluation of acute, chronic, and vascular etiologies for myelopathy. These criteria provide an imaging framework to guide surgical or medical intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Obstructive sleep apnea contributes to cardiovascular morbidity, and its treatment may mitigate this risk. Continuous positive airway pressure and mandibular advancement devices are established therapies, but their comparative cardiometabolic effects remain uncertain. We conducted a systematic review and meta-analysis of randomised controlled trials from multiple major databases through May 2024, pooling dichotomous outcomes as risk ratios and continuous outcomes as mean differences with 95% confidence intervals using StataMP version 17. Across 14 randomised trials including 1241 patients, CPAP showed clear advantages over MAD. CPAP significantly reduced low-density lipoprotein (MD -15.20 mg/dL; 95% CI -28.86 to -1.53), total cholesterol (MD -17.10 mg/dL; 95% CI -30.15 to -4.05) and dipping diastolic blood pressure (MD -3.12 mmHg; 95% CI -5.62 to -0.62). No meaningful differences emerged between the two therapies for serum glucose, HDL, triglycerides, 24-h mean blood pressure, systolic or diastolic pressures during sleep or wakefulness, or heart rate metrics. Overall, CPAP demonstrated superior lipid and diastolic blood pressure improvement compared with MAD, pointing towards a more favourable cardiometabolic profile. Both interventions remain effective treatments for OSA, yet CPAP may provide added benefit in reducing cardiovascular risk factors and appears to be the preferred modality in patients with elevated cardiometabolic risk.

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Returning citizens with substance use disorders (SUD) make numerous decisions that involve engaging in behaviors with short-term, immediate rewards (i.e. the pleasurable effects of returning to use) relative to those with longer-term, but delayed, benefits (i.e. engaging in treatment), often in the context of resource-poor and unstable environments. Successful navigation of the reentry period may require making future-oriented decisions; yet previous research suggests that incarcerated individuals and those with SUD evidence steeper rates of delay discounting, or tendency to devalue something as a function of the delay of its receipt. Episodic future thinking has been shown to reduce delay discounting and improve decision-making, suggesting it may be particularly well-suited to support healthy decision-making among justice-involved populations. The current study evaluated the implementation potential and preliminary effectiveness of an episodic future thinking intervention adapted for individuals during the reentry period to reduce delay discounting and improve related clinical outcomes. Returning citizens (n = 40) who identified as in recovery from SUD and had experienced incarceration within 12 months prior to enrollment were recruited to participate in a randomized controlled trial. Participants received either a brief (60-min) adapted episodic future thinking intervention or a control intervention that did not activate future thinking. Both interventions were administered by a peer recovery coach in a community setting. Participants then completed weekly check-ins for up to four weeks and were assessed one month after the intervention. Findings suggest that peer-delivered episodic future thinking was feasible and acceptable, and could be delivered with fidelity. Additionally, participants in the active condition experienced significant decreases in delay discounting, significant increases in considerations of future consequences, and increases in the presence of protective factors that may support longer-term recovery. Participants in the control condition did not experience changes in clinically-relevant outcomes. Results of this study provide preliminary support for the implementation potential and effectiveness of brief, peer-delivered intervention focused on improving decision-making during the reentry period.

Patients with ST-segment elevation myocardial infarction (STEMI) and higher Killip class are at an increased risk of death. We sought to assess outcomes of an immediate or staged multivessel percutaneous coronary intervention (PCI) in patients with higher Killip class presenting with STEMI and multivessel coronary artery disease (MVD). We conducted a subgroup analysis of the MULTISTARS AMI trial with stratification of patients according to Killip classes. Outcomes of patients with Killip class I and Killip class&#x2009;&#x2265;&#x2009;II were compared. The primary end point was a composite of all-cause death, non-fatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. The primary end point occurred in 15 (17.9%) patients with Killip class&#x2009;&#x2265;&#x2009;II and 78 (11.4%) patients with Killip class I (HR, 1.57 [95%CI, 0.92-2.70], p-value&#x2009;=&#x2009;0.11). Comparing an immediate with a staged multivessel PCI strategy, the immediate strategy reduced the primary endpoint in patients with Killip class I (6.8% vs. 15.8%; HR, 0.40 [95%CI, 0.25-0.65], p-value&#x2009;<&#x2009;0.01), whereas the difference was not significant in patients with Killip class&#x2009;&#x2265;&#x2009;II (20.0% vs. 15.4%; HR, 1.37 [95%CI, 0.50-3.78], p-value&#x2009;=&#x2009;0.55). There was a significant treatment-by-subgroup interaction for the primary endpoint (P interaction&#x2009;=&#x2009;0.029), with immediate multivessel PCI not showing an advantage in Killip class&#x2009;&#x2265;&#x2009;II patients. Conclusively, in the MULTISTARS AMI trial, the benefit of immediate multivessel revascularization strategy observed in patients with Killip class I appeared attenuated in those presenting with Killip class&#x2009;&#x2265;&#x2009;II, suggesting a potential difference in treatment effect that warrants further investigation. (Supported by Boston Scientific; MULTISTARS AMI, NCT03135275).

Patients with pathologically high-risk, HPV-negative HNSCC recur frequently despite adjuvant cisplatin-radiation therapy (CRT). As CRT can upregulate PD-1/L1 immune checkpoints, adding pembrolizumab may reverse treatment-induced immunosuppression. NRG-HN003 was a phase I trial assessing the safety and recommended phase II schedule of adjuvant pembrolizumab with CRT. Here, we report exploratory immune and genomic correlates of disease-free survival (DFS). Thirty-four patients received pembrolizumab with CRT. PD-L1 expression was quantified by combined positive score (CPS) and spatial localization of PD-L1+ cells was assessed by multispectral imaging of baseline tumors. Disruptive TP53 mutations were evaluated by whole-exome sequencing. Soluble serum biomarkers were evaluated by Luminex, and circulating immune subsets were profiled by spectral flow cytometry at baseline and post-treatment. Patients with PD-L1 CPS&#x2265;20 showed numerically lower DFS than those with CPS<20; however, higher densities of PD-L1+ stromal cells were associated with more favorable outcomes. Disruptive TP53 mutations were not a significant negative prognostic factor. Among soluble markers at baseline, elevated serum arginase-1 was associated with inferior DFS, while higher levels of GM-CSF, IL-2 and nectin-2 were associated with more favorable outcomes. In circulating immune cells, higher baseline frequencies of CD8+ granzyme K+ T cells, as well as higher post-treatment frequencies of CD8+ CD39+ and regulatory CD4+ T cells, were associated with improved DFS. Increased effector and central memory T cell populations, especially post-treatment, also showed favorable associations with DFS. These findings highlight multiple potential immunologic correlates of pembrolizumab with CRT in high-risk HNSCC, supporting further evaluation and validation in larger, adequately powered trials.

Giant secundum atrial septal defects (ASDs) are generally considered unsuitable for transcatheter closure and often require surgical repair. Innovative percutaneous strategies may provide an alternative in prohibitive-risk patients. A 75-year-old man with a giant secundum ASD (64.5 &#xd7; 38.8 mm), severe mitral and tricuspid regurgitation, pulmonary hypertension, atrial fibrillation, cirrhosis, and chronic kidney disease was deemed inoperable. After staged mitral and tricuspid transcatheter edge-to-edge repair, the ASD was successfully closed using two 38-mm septal occluder devices sutured together ex vivo and simultaneously deployed, resulting in stable device position without residual shunt. This case demonstrates a novel percutaneous strategy for closure of exceptionally large ASDs exceeding currently available occluder size limits. Percutaneous closure of giant ASDs may be feasible in selected prohibitive-risk patients using coupled occluder devices.

Histological subtypes and divergent differentiation are common in bladder cancer. Each subtype has distinct biology and clinical features. We aim to summarize pathology, molecular features, and outcomes of the most common bladder cancer subtypes to guide management. We performed a narrative review of cohort studies, clinical trials, and population-based analyses assessing morphology, immunophenotype, genomic alterations, and outcomes following various localized and systemic therapies in patients with bladder cancer subtypes. Histological subtypes are often understaged on transurethral resection of bladder tumor and commonly demonstrate lymph node metastasis, supporting early radical cystectomy (RC) even for certain clinically non-muscle-invasive bladder cancers. Small cell urothelial carcinoma (UC) consistently benefits from platinum/etoposide-based chemotherapy regimens, whereas predominant squamous, plasmacytoid, sarcomatoid, and micropapillary tumors demonstrate variable response rates to systemic therapies used in conventional UC. Trimodality therapy may approximate RC in locoregional control for small cell UC and appears inferior in cases with predominant squamous and adenocarcinoma. Genomic profiling highlights actionable alterations, albeit with unclear clinical implications. Immune checkpoint blockade and antibody-drug conjugates have been used sparingly against subtype bladder cancers and have anecdotally demonstrated activity across several subtypes. Histological subtypes and divergent differentiation of UC represent high-risk yet biologically distinct disease phenotypes that may not conform to the current "one-size-fits-all" treatment paradigm. More in-depth clinical and translational analyses with robust, adequately powered cohorts are required to further understand the clinical behavior of each unique bladder cancer subtype and to customize the optimal therapeutic strategies.

Hypertension is a leading cause of cardiovascular morbidity and mortality. Individuals living in rural areas have a higher prevalence of hypertension and a lower prevalence of blood pressure control. Factors contributing to the increased hypertension prevalence in rural populations include shortages of health care professionals, limited access to transportation and longer travel distances to care, lower health literacy, socioeconomic factors, and reduced access to pharmacies. Approaches to addressing barriers to effective hypertension management include expanding rural telehealth services, deploying mobile units, leveraging pharmacists, implementing remote blood pressure monitoring, and engaging community health workers. Health services need to be culturally tailored and address the unique challenges faced by rural communities. Further research is needed to identify effective methods for addressing health disparities experienced by rural populations related to hypertension management.

This study identified patient-level factors as key barriers and facilitators to glaucoma medication adherence, varying by sex and neighborhood disadvantage (ADI), suggesting targeted interventions could improve glaucoma medication adherence outcomes. To identify the barriers and facilitators to glaucoma medication adherence for participants in the Support, Educate, Empower Personalized Glaucoma Coaching Program Pilot Study and assess any differences by demographics. This was a mixed-methods study of participants that reported glaucoma medication adherence of &#x2264;80.00%. Patient (age, sex, and race) and neighborhood (area deprivation index (ADI)) factors were obtained, and participants completed a semi-structured interview. Patient interviews were transcribed and analyzed with the modified Penchansky and Thomas framework to assess barriers and facilitators to glaucoma medication adherence, and participant numbers were computed for each theme. Of the 44 participants, 52% were &#x2265;65 years old, 45% female, 45.5% Black race, and 34% lived in high ADI neighborhoods. The most cited theme by participants for barriers and facilitators to medication adherence were patient-level factors (52% and 48%, respectively). Difficulty with the medication schedule was a leading barrier (48%), while location of eye drops in the home (25%) was a leading facilitator. Patient-level barriers and facilitators differed by sex and ADI. Patient-level barriers and facilitators to glaucoma medication adherence were most frequently mentioned. Patient-level facilitators differed by sex and ADI, thus patient and neighborhood factors should be considered when assessing glaucoma medication adherence as it may differ by these factors. In this cohort of glaucoma patients with poor medication adherence, patient-level factors served as more significant barriers compared to those related to health care in the US. Consequently, targeted interventions addressing these individual barriers could potentially improve medication adherence outcomes.

Reintroductions of extirpated species are an important tool in wildlife conservation. Understanding how reintroduced populations acclimatize to novel environments can lend insight into social learning that in turn is valuable for assessing reintroduction success and maximizing efficacy of subsequent efforts. During 2012, 2013, and 2014, the Virginia Department of Wildlife Resources implemented soft releases of elk (Cervus canadensis) translocated to southwestern Virginia from eastern Kentucky. We investigated home range establishment and post-release movements of these reintroduced elk (n = 60). We found adults moved farther from the release site than either yearlings or calves (F = 6.93, p = 0.001). Elk released in 2012 and 2013 took similar amounts of time to establish home ranges (median 181 days, range 108-214 days; and median 189 days, range 147-209 days, respectively), but individuals released in 2013 remained closer to the release site (x&#xaf; = 605.5 m, SD = 335.7 m, closer) presumably by joining established social groups. However, the 2014 cohort generally took longer to establish home ranges (median: 231 days; range: 56-258 days) and moved farthest from the release site (x&#xaf; = 1360.2 m, SD = 293.9 m, farther than 2012 individuals) possibly due to the larger cohort size and resulting intraspecific competition, or the earlier release date that year. Our findings suggest the number of consecutively released cohorts, the timing of the release, and the composition of age classes for released individuals are important considerations for reintroductions.

Borrelia miyamotoi Fukunaga (Spirochaetales: Spirochaetaceae), the etiological agent of hard tick relapsing fever, has been detected at low prevalence in Ixodes spp. (Acari: Ixodidae) ticks from the Northern Hemisphere. Genetically distinct populations of B. miyamotoi have been described across continents and among Ixodes tick species distributed within continents. Within the eastern United States, a previous study identified two B. miyamotoi genotypes infecting Ixodes scapularis Say (Acari: Ixodidae). Here, we expand upon that work by developing a new multiplex PCR amplicon sequencing assay to differentiate B. miyamotoi genotypes (Am-East-1 and Am-East-2), and we use the new assay to differentiate genotypes in an expanded sample of 186 B. miyamotoi ticks collected from 17 eastern states. All 80 infections derived from the Northeast (Delaware, Massachusetts, Maryland, Maine, New Hampshire, and Vermont) or northern states in the Southeast region (North Carolina and Virginia) were identified as Am-East-1. Among the 106 B. miyamotoi infections identified in I. scapularis from the Ohio Valley (Illinois, Indiana, Kentucky, Ohio, and West Virginia), Upper Midwest (Michigan, Minnesota, and Wisconsin), or Northern Rocky Mountains and Plains (Nebraska) regions, 10 (9.4%) were characterized as Am-East-1 and 96 (90.6%) were characterized as Am-East-2. We also identified a new B. miyamotoi genotype (Am-IxKi1) in a single I. keiransi Beati, Nava, Venzal, & Guglielmone (Acari: Ixodidae) collected from Virginia.