Telemedicine for veterans in the setting of the COVID-19 pandemic: Lessons learned from a virtual urgent care center

Introduction Although telemedicine was predominantly adopted during the COVID-19 pandemic, its impact on healthcare outcomes in the veteran population in achieving first contact resolution, or the ability to safely manage patient care at home from an urgent care perspective, is yet to be determined. Methods This study included 13,090 veteran patient episodes who presented to the Department of Veteran's Affairs Veterans Integrated Services Network 8's Clinical Contact Center, a virtual urgent care organization covering South Georgia, Florida, and U.S. Virgin Islands in providing episodic care, between March 2020 and February 2021. Multivariate logistic regression estimated the probability that veterans with COVID-19-related symptoms stayed at home compared to presenting to the emergency department (ED) or their primary care provider. Results Patients with COVID-related symptoms were 33% less likely to present to the ED compared to patients who presented with non-COVID-related symptoms. Discussion The virtual urgent care center enabled veterans to receive timely care and avoid public places that could potentially lead to a COVID-19 infection or infecting others.

Tropical Important Plant Areas, plant species richness and conservation in the British Virgin Islands

The global loss of biodiversity is a pressing and urgent issue and halting loss is the focus of many international agreements and targets. However, data on species distribution, threats and protection are limited and sometimes lacking in many parts of the world. The British Virgin Islands (BVI), part of the Puerto Rican Bank Floristic Region in the Caribbean Biodiversity Hotspot, is rich in plant diversity and regional endemism. Despite the established network of National Parks in the BVI and decades of botanical data from international collaboration between the Royal Botanic Gardens, Kew and the National Parks Trust of the Virgin Islands, there was a need for consolidated data on species distribution across the archipelago and national lists for threatened and rare plants of conservation concern. The process of identifying the network of 18 Tropical Important Plant Areas (TIPAs) in the BVI, completed in 2018, delivered national lists and accurate data for all 35 Species of Conservation Concern. These data (3688 georeferenced records) are analysed here to reveal species distribution across the archipelago, within the TIPAs network and the National Parks System. The TIPAs network contained all 35 Species of Conservation Concern and 91% of all the records, as expected. Ten out of the 21 National Parks had one or more of the species present. Most species occur across the archipelago, while some are restricted range and/or endemics. These new data will help management of plant conservation efforts and resources in the BVI, contributing to the revision of the Protected Areas System Plan and local environmental policies and have relevance to the wider Caribbean Region.

Ganoderma applanatum. [Descriptions of Fungi and Bacteria].

A description is provided for Ganoderma applanatum. Sporophores of this fungus are found on both living and dead trees, where the fungus causes a decay of heartwood resulting in a white soft spongy heart and butt rot. Some information on its associated organisms and substrata, dispersal and transmission, habitats and conservation status is given, along with details of its geographical distribution (Africa (Angola, Benin, Congo, Democratic Republic of the Congo, Equatorial Guinea, Ivory Coast, Kenya, Madagascar, Morocco, Mozambique, São Tomé and Principe, Sierra Leone, South Africa, Sudan, Tanzania, Togo), Asia (Azerbaijan, Brunei Darussalam, China (Anhui, Fujian, Gansu, Guangdong, Guangxi, Guizhou, Hainan, Hebei, Heilongjiang, Henan, Hong Kong, Hunan, Jiangsu, Jiangxi, Jilin, Nei Mongol Autonomous Region, Qinghai, Shaanxi, Shanxi, Sichuan, Xinjiang, Yunnan, Zhejiang), Christmas Island, Cyprus, Georgia, India (Assam, Chhattisgarh, Gujarat, Himachal Pradesh, Jammu & Kashmir, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Meghalaya, Orissa, Punjab, Rajasthan, Uttarakhand, Uttar Pradesh, West Bengal), Indonesia, Iran, Israel, Japan, Kazakhstan (Almaty, East Kazakhstan, Kostanay, South Kazakhstan), Laos, Malaysia, Nepal, North Korea, Oman, Pakistan, Papua New Guinea, Philippines, Russia (Altai Krai, Altai Republic, Irkutsk Oblast, Kamchatka Krai, Kemerovo Oblast, Khanty-Mansi Autonomous Okrug, Krasnoyarsk Krai, Novosibirsk Oblast, Omsk Oblast, Primorsky Krai, Sakha Republic, Sverdlovsk Oblast, Tomsk Oblast, Tyumen Oblast, YamaloNenets Autonomous Okrug), Singapore, South Korea, Sri Lanka, Taiwan, Tajikistan, Thailand, Turkey, Uzbekistan, Vietnam), Australasia (Australia (Australian Capital Territory, New South Wales, Northern Territory, Queensland, South Australia, Tasmania, Victoria, Western Australia), New Zealand), Caribbean (American Virgin Islands, British Virgin Islands, Cuba, Dominican Republic, Guadeloupe, Haiti, Jamaica, Puerto Rico, Trinidad and Tobago), Central America (Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama. Europe: Austria, Belarus, Belgium, Bulgaria, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Ireland, Isle of Man, Italy, Latvia, Lithuania, Luxembourg, Netherlands, Norway, Poland, Portugal, Republic of North Macedonia, Romania, Russia (Arkhangelsk Oblast, Belgorod Oblast, Bryansk Oblast, Chuvash Republic, Ivanovo Oblast, Kaliningrad Oblast, Kaluga Oblast, Kirov Oblast, Kostroma Oblast, Krasnodar Krai, Kursk Oblast, Leningrad Oblast, Mari El Republic, Moscow Oblast, Nizhny Novgorod Oblast, Orenburg Oblast, Oryol Oblast, Penza Oblast, Perm Krai, Pskov Oblast, Republic of Bashkortostan, Republic of Tatarstan, Samara Oblast, Smolensk Oblast, Tula Oblast, Tver Oblast, Udmurt Republic, Vladimir Oblast, Vologda Oblast, Voronezh Oblast, Yaroslavl Oblast), Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Ukraine, UK), Indian Ocean (Seychelles. North America: Canada (Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Ontario, Prince Edward Island, Quebec, Saskatchewan), Mexico, USA (Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming)), Pacific Ocean (American Samoa, Cook Islands, Federated States of Micronesia, Fiji, French Polynesia, Guam, Marshall Islands, Samoa, Tuvalu, USA (Hawaii)), South America (Argentina, Bolivia, Brazil (Acre, Alagoas, Amapá, Amazonas, Bahia, Espírito Santo, Minas Gerais, Pará, Paraíba, Paraná, Pernambuco, Rio de Janeiro, Rio Grande do Sul, Rondônia, Roraima, Santa Catarina, São Paulo), Chile, Colombia, Ecuador, French Guiana, Peru, Suriname, Uruguay, Venezuela)).

Phyllachora maydis. [Distribution map].

A new distribution map is provided for Phyllachora maydis Maublanc. Sordariomycetes: Phyllachorales: Phyllachoraceae. Host: maize (Zea mays). Information is given on the geographical distribution in North America (Canada, Ontario, Costa Rica, Dominican Republic, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Puerto Rico, Trinidad and Tobago, US Virgin Islands, USA, Florida, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Ohio, Wisconsin), and South America (Bolivia, Colombia, Ecuador, Peru, Venezuela).

Observations from the emergency management of dialysis patients evacuated from the US Virgin Islands to Puerto Rico following hurricane Irma

Two category 5 hurricanes, Irma and Maria, arrived in the Caribbean in September 2017 in rapid succession. On September 6, Irma devastated the islands of St. Thomas and St. John, in the Virgin Islands of the United States (USVI). Most medical infrastructure was damaged, including hemodialysis facilities, paralyzing dialysis operations. After Irma’s landfall, Puerto Rico served as a safehaven for thousands of displaced and repatriated persons from the impacted islands. These included a cohort of 129 hemodialysis patients evacuated from St. Thomas, USVI to San Juan, Puerto Rico from September 9−11, 2017. The hemodialysis patients arrived first at hotels in San Juan and were then transferred to a Special Needs Shelter, run by the Commonwealth of Puerto Rico and located in the Puerto Rico Convention Center. With the imminent arrival of Hurricane Maria, most patients were evacuated on September 19 to a special needs shelter on the campus of the Florida International University, in Miami, Florida. While in San Juan, hemodialysis treatments were provided by local nephrologists working with local hemodialysis centers. Here, we describe the challenges and the emergency management actions taken to ensure continuity of care, including providing dialysis, general medical care, shelter, food and transportation for USVI dialysis patients during their stay in San Juan, Puerto Rico. We describe here the experiences of federal and host state/territorial officials in the special needs shelter, in the context of the state/territorial and federal response to disasters, in order to provide ideas about challenges, solutions, and approaches to coordinating care for dialysis patients evacuated from a disaster.