Virgin Islands Research Articles

Understanding variability in coral reef soundscapes to enable tool development and early warnings of ecosystem change

Coral reefs harbor some of the highest biodiversity on Earth. Their rich soundscape is vital to inhabiting animals and can provide a means of tracking community health. Reefs are facing immense climate stressors and are declining rapidly. Passive acoustic monitoring can provide a powerful, scalable tool for stakeholders, but these data are not evaluated on actionably relevant timescales. Here we present results from a long-term (10-years) acoustic and ecosystem study of multiple coral reefs in the U.S. Virgin Islands. Acoustic measurements (including snap rates, sound levels in low-frequency fish, and high-frequency shrimp bands) were made in-tandem with traditional, diver-based benthic and fish visual surveys. These key baseline data over multiple spatial and temporal scales provide a means of examining how soundscape changes are driven by climate-related stressors, and an important testbed for developing new analyses and tools. Here, we show how physical changes (temperature, light, coral disease) can influence the cue rates of snapping shrimp and fish, and apply novel tools including real-time recorders and underwater robots listening for biodiversity. These initial steps were then implemented into a novel rapid acoustic assessment, a key step toward providing actionable information to stakeholders monitoring for habitat change and weighing resource management.

Unidentified fish sounds as indicators of coral reef health and comparison to other acoustic methods

The global decline of coral reefs is a major contributor to the global biodiversity crisis and requires improved monitoring at these critically important habitats. Non-invasive passive acoustic assessments may address this need, leveraging the rich variety and spatiotemporal variability of biological sounds present in coral reef environments and offering near-continuous temporal coverage. Despite this, acoustic metrics that reliably represent coral reef health are still debated, and ground-truthing of methods is limited. Here we investigated how the prevalence of low frequency biotic sounds (without species information) relates to coral reef health, providing a foundation from which one can compare assessment methods. We first quantified call rates of these low frequency sounds for three reefs exhibiting different community assemblages around St. John, U.S. Virgin Islands, by manually annotating presumed fish noises for 1 min every 30 min across 8 days for each site. Annotated days were selected at key points across lunar cycles. These call rates were then compared with traditional visual surveys, and several acoustic methods and indices commonly used in underwater soundscape research. We found that, overall, manually detected fish call rates successfully differentiated between the three reefs, capturing variation in crepuscular activity levels–a pattern consistent with previous work that highlights the importance of diel choruses. Moreover, fish vocal rates were predictors of hard coral cover, fish abundance, and fish species richness, while most acoustic indices failed to parse out fine distinctions among the three sites. Some, such as the Acoustic Complexity Index, failed to reveal any expected differences between sites or times of day, while the Bioacoustic Index could only identify the most acoustically active reef, otherwise having weak correlations to visual metrics. Of the indices tested, root-mean-squared sound pressure level and Acoustic Entropy, both calculated in the low frequency fish band (50–1,200 Hz), showed the strongest association with visual health measures. These findings present an important step toward using soundscape cues for reef health assessments. The limited generalizability of acoustic indices across different locations emphasizes the need for caution in their application. Therefore, it is crucial to improve methods utilizing fish sounds, such as automatic fish call detectors that are able to generalize well to new soundscapes.

SoundGarden: Applying healthy soundscapes to support coral reef restoration

Coral reefs are a hub of ocean biodiversity supporting a range of socioeconomic and ecosystem services. Yet reefs and these important services are imperiled due to climate change and related stressors. Healthy coral reefs can be characterized by distinctive soundscapes, and there is increasing realization that acoustic cues are vital ecosystem components. Here we present a series of experiments examining if replaying healthy soundscapes can increase the settlement of coral larvae, a fundamental ecological process. Work was conducted in the U.S. Virgin Islands, leveraging a decade of soundscape studies on those reefs, and used a novel solar-powered acoustic playback system calibrated in sound pressure and particle motion. We studied larvae from three coral species, brooding Porites astreoides and Favia fragum, and broadcast-spawning Diploria labyrinthiformis. Larvae on degraded reefs enriched with healthy reef sounds settled at significantly higher rates compared to control sites that were not acoustically enriched. Acoustic enrichment settlement rates were influenced by received level, ecosystem properties and species biology reflecting the need for holistically evaluating the reef restoration process. Overall, this work outlines a new, potentially scalable means of supporting healthy reef habitat, and enhancing coral settlement on imperiled reefs undergoing restoration.

Modeled Flooding by Tsunamis and a Storm Versus Observed Extent of Coral Erratics on Anegada, British Virgin Islands—Further Evidence for a Great Caribbean Earthquake Six Centuries Ago

AbstractModels of near‐field tsunamis and an extreme hurricane provide further evidence for a great precolonial earthquake along the Puerto Rico Trench. The models are benchmarked to brain‐coral boulders and cobbles on Anegada, 125 km south of the trench. The models are screened by their success in flooding the mapped sites of these erratics, which were emplaced some six centuries ago. Among 25 tsunami scenarios, 19 have megathrust sources and the rest posit normal faulting on the outer rise. The modeled storm, the most extreme of 15 hurricanes of category 5, produces tsunami‐like bores from surf beat. In the tsunami scenarios, simulated flow depth is 1 m or more at all the clast sites, and 2 m or more at nearly all, given either a megathrust rupture 255 km long with 7.5 m of dip slip and M8.45, or an outer‐rise rupture 130 km long with 11.4 m of dip slip and M8.17. By contrast, many coral clasts lie beyond the reach of simulated flooding from the extreme hurricane. The tsunami screening may underestimate earthquake size by neglecting trees and shrubs that likely impeded both the simulated flows and the observed clasts; and it may overestimate earthquake size by leaving coastal sand barriers intact. The screening results broadly agree with those from previously published tsunami simulations. In either successful scenario, the average recurrence interval spans thousands of years, and flooding on the nearest Caribbean shores begins within a half‐hour.

Unidentified fish sounds as indicators of coral reef health and comparison to other acoustic methods

As biodiversity hotspots, coral reefs are rich with sound cues. Monitoring these soundscapes for changes is essential as coral reefs decline around the world rapidly. Despite this, acoustic metrics that reliably represent reef health are still debated, and ground-truthing of methods are limited. We sought to investigate the occurrence and prevalence of fish sounds in relation to reef health, providing a foundation to compare assessment methods. We first quantified fish call rates for three U.S. Virgin Islands reefs exhibiting different community assemblages, by manually annotating fish calls across 8 days per site. Call rates were then compared with traditional visual surveys, and several acoustic methods commonly used in underwater soundscape research. Manually detected fish call rates successfully differentiated between the three reefs, capturing variation in crepuscular activity levels and predicting hard coral cover, fish abundance, and fish species richness. Meanwhile, most acoustic indices failed to parse out fine distinctions among the three sites, although sound pressure level showed the greatest correlation to call rates. Development of methods to improve the utilization of unknown fish sounds, such as automatic detection and classification tools, supports global sound library efforts and is essential to implement large-scale passive acoustic monitoring of coral reefs.

Compliance with eye and foot preventive care in people with self-reported diabetes in Latin America and the Caribbean: Pooled, cross-sectional analysis of nine national surveys

AimsTo estimate the proportion of people with self-reported diabetes receiving eye and foot examinations in Latin America and the Caribbean (LAC). MethodsCross-sectional analysis of national health surveys in nine countries. Adults aged 25–64 years with self-reported diabetes. We quantified the proportion who reported having an eye examination in the last two years or a foot examination in the last year. We fitted multilevel Poisson regressions to assess socio-demographic (age and sex) and clinical (oral hypoglycemic medication and insulin treatment) variables associated with having had examinations. ResultsThere were 7435 people with self-reported diabetes included in the analysis. In three countries (Chile [64%; 95% CI: 56%-71%], British Virgin Islands [58%; 95% CI: 51%-65%], and Brazil [54%; 95% CI: 50%-58%]), >50% of people with diabetes reported having had an eye examination in the last two years. Fewer participants (<50% across all countries) reported having had a foot examination in the last year, with Ecuador having the lowest proportion (12%; 95% CI: 8%-17%). Older people, and those taking oral medication or insulin, were more likely to have eye/foot examinations. ConclusionsThe proportion of eye and foot examinations in people with self-reported diabetes across nine countries in LAC is low.

Preimplementation Evaluation of a Self-Directed Care Program in a Veterans Health Administration Regional Network: Protocol for a Mixed Methods Study.

The Veteran-Directed Care (VDC) program serves to assist veterans at risk of long-term institutional care to remain at home by providing funding to hire veteran-selected caregivers. VDC is operated through partnerships between Department of Veterans Affairs (VA) Medical Centers (VAMCs) and third-party Aging and Disability Network Agency providers. We aim to identify facilitators, barriers, and adaptations in VDC implementation across 7 VAMCs in 1 region: Veterans Integrated Service Network (VISN) 8, which covers Florida, South Georgia, Puerto Rico, and the US Virgin Islands. We also attempted to understand leadership and stakeholder perspectives on VDC programs' reach and implementation and identify veterans served by VISN 8's VDC programs and describe their home- and community-based service use. Finally, we want to compare veterans served by VDC programs in VISN 8 to the veterans served in VDC programs across the VA. This information is intended to be used to identify strategies and propose recommendations to guide VDC program expansion in VISN 8. The mixed methods study design encompasses electronically delivered surveys, semistructured interviews, and administrative data. It is guided by the Consolidated Framework for Implementation Research (CFIR version 2.0). Participants included the staff of VAMCs and partnering aging and disability network agencies across VISN 8, leadership at these VAMCs and VISN 8, veterans enrolled in VDC, and veterans who declined VDC enrollment and their caregivers. We interviewed selected VAMC site leaders in social work, Geriatrics and Extended Care, and the Caregiver Support Program. Each interviewee will be asked to complete a preinterview survey that includes information about their personal characteristics, experiences with the VDC program, and perceptions of program aspects according to the CFIR (version 2.0) framework. Participants will complete a semistructured interview that covers constructs relevant to the respondent and facilitators, barriers, and adaptations in VDC implementation at their site. We will calculate descriptive statistics including means, SDs, and percentages for survey responses. Facilitators, barriers, number of patients enrolled, and staffing will also be presented. Interviews will be analyzed using rapid qualitative techniques guided by CFIR domains and constructs. Findings from VISN 8 will be collated to identify strategies for VDC expansion. We will use administrative data to describe veterans served by the programs in VISN 8. The VA has prioritized VDC rollout nationwide and this study will inform these expansion efforts. The findings from this study will provide information about the experiences of the staff, leadership, veterans, and caregivers in the VDC program and identify program facilitators and barriers. These results may be used to improve program delivery, facilitate growth within VISN 8, and inform new program establishment at other sites nationwide as the VDC program expands. DERR1-10.2196/57341.

The recovery of octocoral populations following periodic disturbance masks their vulnerability to persistent global change

As the major form of coral reef regime shift, stony coral to macroalgal transitions have received considerable attention. In the Caribbean, however, regime shifts in which scleractinian corals are replaced by octocoral assemblages hold potential for maintaining reef associated communities. Accordingly, forecasting the resilience of octocoral assemblages to future disturbance regimes is necessary to understand these assemblages' capacity to maintain reef biodiversity. We parameterised integral projection models quantifying the survival, growth, and recruitment of the octocorals, Antillogorgia americana, Gorgonia ventalina, and Eunicea flexuosa, in St John, US Virgin Islands, before, during, and after severe hurricane disturbance. Using these models, we forecast the density of populations of each species under varying future hurricane regimes. We demonstrate that although hurricanes reduce population growth, A. americana, G. ventalina, and E. flexuosa each display a capacity for quick recovery following storm disturbance. Despite this recovery potential, we illustrate how the population dynamics of each species correspond with a longer-term decline in their population densities. Despite their resilience to periodic physical disturbance events, ongoing global change jeopardises the future viability of octocoral assemblages.

INFLIXIMAB AND ITS BIOSIMILARS FOR INFLAMMATORY BOWEL DISEASE: ANALYSIS OF MEDICARE PART D CLAIMS AND COSTS

Abstract INTRODUCTION Inflammatory Bowel Disease (IBD) presents a multifaceted healthcare challenge, and biologics have emerged as crucial in its management. The introduction of biosimilars, designed to enhance cost-efficiency and access, has garnered significant attention. This analysis of the Medicare Part D database assesses trends in total drug claims and costs for infliximab and its biosimilars, specifically, infliximab-dyyb (FDA approved in 2016) and infliximab-abda (FDA approved in 2017). This study aims to comprehensively evaluate the influence of biosimilars on the utilization and cost trends of infliximab in the context of IBD. METHODS We used Python to extract all instances of infliximab, infliximab-dyyb, and infliximab-abda prescriptions, occurring at least once between 2013-2021 in each state from the Medicare Part D prescribers database. Univariate regressions were performed independently for each state to identify the slope and significance of the change in total drug claims and costs over time. The Pearson correlation coefficient (R) was calculated for each state, and we examined national trends to determine if a consistent pattern emerged. Two study periods, 2013-2017 and 2017-2021, were used to represent infliximab trends before and after the introduction of biosimilars, respectively. North Dakota and South Dakota were excluded from the study due to data limitations, while the Virgin Islands were included. RESULTS Our analysis revealed varied shifts in the utilization of infliximab across states following the introduction of biosimilars (Figure 1). At the national level, biosimilars exhibited increased utilization. In contrast, both the utilization and cost of infliximab continued to rise; however, the rate of increase decelerated (Table 1). This deceleration suggests that the introduction of biosimilars has influenced prescribing patterns. DISCUSSION Our findings underscore transformations in the landscape of biologic utilization for IBD, subsequent to the introduction of biosimilars. The ascension of biosimilars, marked by their increased utilization, signals their acceptance due to cost-effectiveness. Meanwhile, the utilization of infliximab appears to plateau, potentially reflecting the influence of biosimilars on prescribing patterns. Given the high cost of biologics, sustained efforts are imperative to address the overall cost of therapy and management for IBD patients. While promising trends are evident with increased biosimilar utilization and cost savings, ongoing initiatives are essential to optimize the cost-effectiveness of biologic treatments, ensuring accessible care for IBD patients without compromising outcomes. Figure 1 State trends in total infliximab claims from 2017-2021 in the Medicare Part D database. Negative Pearson correlation coefficients indicate an overall decrease in infliximab claims from 2017-2021, while positive values indicate an overall increase in claims. Table 1 US national trends in total Medicare Part D claims and costs for infliximab and its biosimilars from 2013-2021.

Understanding Barriers and Facilitators to Disaster Preparedness in Federally Qualified Health Centers in the United States: A Mixed Methods Study.

Severe weather events exacerbate existing health disparities due to poorly managed non-communicable diseases (NCDs). Our objective is to understand the experiences of staff, providers, and administrators (employees) of Federally Qualified Health Centers (FQHCs) in Puerto Rico and the US Virgin Islands (USVI) in providing care to patients living with NCDs in the setting of recent climate-related extreme events. We used a convergent mixed-methods study design. A quantitative survey was distributed to employees at 2 FQHCs in Puerto Rico and the USVI, assessing experience with disasters, knowledge of disaster preparedness, the relevance of NCDs, and perceived gaps. Qualitative in-depth interviews explored their experience providing care for NCDs during recent disasters. Quantitative and qualitative data were merged using a narrative approach. Through the integration of quantitative and qualitative data, we recognize: (1) significant gaps in confidence and preparedness of employees with a need for more training; (2) challenges faced by persons with multiple NCDs, especially cardiovascular and mental health disorders; and (3) most clinicians do not discuss disaster preparedness with patients but recognize their important role in community resilience. With these results, we recommend strengthening the capacity of FQHCs to address the needs of their patients with NCDs in disasters.

Simulacra in the diatom genus Diploneis (Diatomeae: Naviculales): Caribbean D. gravelleana and other small, strongly constricted species resolved from ultrastructure

Diploneis gravelleana Hagelstein was described in 1939 from Puerto Rico but may later have been confused with Diploneis interrupta var. caffra Giffen, described in 1960 from South Africa. Both are small (ca 20 µm in length), strongly constricted species indistinguishable in light microscopy. When we found a similar species in Micronesia, we needed to determine if it matched either of these species. We obtained mud samples from the US Virgin Islands containing D. gravelleana and unmounted type material of Giffen’s original material for SEM imaging. All three populations differed ultrastructurally and hence the Micronesian species is described as Diploneis carolinensis sp. nov. Lobban &amp; Witkowski. Diploneis carolinensis was found in mangrove samples from Yap and Palau. These simulacra suggest that D. caffra may not be as widely distributed as supposed.

Termite IPM in historic sites

Abstract Given the traditional use of wood, historical structures are susceptible to termite damage which can irreversibly affect their historical significance. Methods like drilling into the foundation for termiticide injection are impractical and potentially harmful to the structural integrity of these structures. Moreover, the location of these structures in ecologically sensitive areas prohibits the use of soil termiticides due to potential contamination of groundwater, rivers, or oceans. Termite Integrated Pest Management (IPM) strategies include baiting programs that use minimal quantities of benign insecticides to reduce environmental impact. This approach is consistent with the risk management component of termite IPM. Bait systems are proven to be effective in eliminating termite colonies, contributing to the benefit component of IPM by preserving the value of historical sites. This article discusses successful baiting interventions at notable locations such as the Statue of Liberty National Monument, New York, USA, the Christiansted National Historic Site in St. Croix, US Virgin Islands, and the Historic Tzu-Su Temple in Taiwan.

Impact of invasive seagrass Halophila stipulacea on life history characteristics of juvenile yellowtail snapper (Ocyurus chrysurus)

Seagrass ecosystems provide essential nursery habitat to numerous coral reef fishes. Native Caribbean seagrasses Syringodium filiforme and Thalassia testudinum provide several juvenile fish species with foraging habitat and protection during this vulnerable stage of life. In 2002, an invasive seagrass Halophila stipulacea was discovered off the coast of Grenada and has since rapidly spread throughout the Caribbean. Halophila stipulacea has been shown to displace native seagrass species and may pose additional threats to juvenile reef fish populations that depend on native seagrass habitats as nurseries. The purpose of this study was to determine the effects of H. stipulacea on the early life history of yellowtail snapper (Ocyurus chrysurus). Settlement, mortality, and condition of juvenile yellowtail snapper were compared among native and invasive seagrass habitats around southern St. Thomas, United States Virgin Islands. From May 2020 to June 2021, monthly surveys within fixed plots during new moon periods provided information on settlement rates and survivorship among seagrass types. Length and weight of 260 juvenile yellowtail snapper were measured to derive condition factor among seagrass species. Significantly higher settlement and similar trends in mortality were seen in H. stipulacea when compared to native seagrasses. No significant difference was observed in condition factor of juvenile yellowtail snapper among seagrass species, although trends demonstrated a higher condition in individuals from native seagrass species. This study is the first of its kind to identify the direct effects of H. stipulacea during the early life history stages of a commercially important fish species in the Caribbean.

Proposed Extension of the U.S.–Caribbean Super Grid to South America for Resilience during Hurricanes

Climate change mitigation, adaptation to intensifying hurricanes, and decarbonization challenges in developing countries emphasize the urgent need for resilient high-voltage grids to facilitate the expansion of renewables. This research explores the technical feasibility of extending the U.S.–Caribbean Super Grid to include the Virgin Islands, Guadeloupe, Martinique, Trinidad and Tobago, Guyana, Suriname, French Guyana, and the northeastern part of Brazil in South America. This proposed extension aims to capitalize on the recent introduction of a new generation of wind turbines certified for operation under strong hurricane forces. The research utilizes modeling and simulation techniques to evaluate the performance of the proposed extension. A method for modeling and estimating spatiotemporal wind power profiles is applied, and the results demonstrate a reduction in maximum wind power variability within the U.S.–Caribbean Super Grid. Depending on the hurricane trajectory, the variability is reduced from 56.6% to less than 43.2%. This reduction takes effect by distributing peak surplus wind power alongside the proposed U.S.–Caribbean–South America Super Grid (UCASG). The research concludes by acknowledging the merits and limitations of the study and discussing potential directions for future research in this field.

THE IMPACT OF HOME HEALTH CARE UTILIZATION ON SUBSEQUENT HOSPICE USE AMONG MEDICARE BENEFICIARIES

Abstract Home health care may increase the use of hospice among Medicare beneficiaries by providing improved access to care, enhanced care coordination, and earlier identification of the need for hospice. This study evaluated home health care use during the last three years of life as a predictor of death in the care of hospice for a cohort of 2,169,496 Medicare beneficiaries who died in 2019. The cohort included beneficiaries continuously enrolled in Medicare for 5 or more years, aged 40 and older, and living in the U.S. fifty states, District of Columbia, U.S. Virgin Islands, or Puerto Rico at death. Co-variates included acute hospitalizations during the look-back period, age at death, sex, race/ethnicity, comorbidities, insurance, rural/urban area, and state of residence. Overall, 46% of beneficiaries used home health care during the lookback period, and 62% died at home. Among beneficiaries who used home health care, 59% died in the care of hospice, compared to 45% who never used home health care. Beneficiaries who received home health care at any point during the lookback period were more likely to later die at home (OR 1.10) or in the care of hospice (OR 1.07) compared to their counterparts without a history of using home health care. Additionally, persons with dementia had greater odds of home death (OR 1.21) and death with hospice (OR 1.68) compared to their counterparts without dementia. This study provides strong evidence of the value of home health care as a strategy to improve end-of-life care quality for Medicare beneficiaries.

Population Dynamics and Conservation Significance of Native and Non-native Grass and Sedge Species on the Sand Flats of Guana Island, British Virgin Islands

Population Dynamics and Conservation Significance of Native and Non-native Grass and Sedge Species on the Sand Flats of Guana Island, British Virgin Islands

Aquaponics: A Sustainable Path to Food Sovereignty and Enhanced Water Use Efficiency

This comprehensive review explores aquaponics as an environmentally friendly solution aligned with SDGs and food sovereignty, assessing various aspects from system design to automation, and weighing social, economic, and environmental benefits through literature and case studies. However, challenges persist in obtaining organic certification and legislative recognition, hindering its growth. Achieving remarkable water use efficiency, up to 90%, relies on adaptable fish species like Nile tilapia and carp. Nutrient-rich fish feeds notably benefit low-nutrient-demanding greens. Ensuring water quality and efficient nitrification are pivotal, supported by IoT systems. Despite its efficiency, integrating Industry 4.0 involves complexity and cost barriers, necessitating ongoing innovation. Economies of scale and supportive horticultural policies can bolster its viability. Aquaponics, known for its efficiency in enhancing crop yields while minimizing water use and waste, is expanding globally, especially in water-scarce regions. Aquaponics, pioneered by the University of the Virgin Islands, is expanding in Europe, notably in Spain, Denmark, Italy, and Germany. Asia and Africa also recognize its potential for sustainable food production, especially in water-limited areas. While it offers fresh produce and cost savings, challenges arise in scaling up, managing water quality, and meeting energy demands, particularly for indoor systems. Egypt’s interest in desert and coastal regions highlights aquaponics’ eco-friendly food production potential. Despite the associated high costs, there is a quest for practical and affordable designs for everyday integration. Research in arid regions and industry advancements are crucial for aquaponics’ global food production potential. Deeper exploration of intelligent systems and automation, particularly in large-scale setups, is essential, highlighting the industry’s promise. Practical application, driven by ongoing research and local adaptations, is a key to fully harnessing aquaponics for sustainable food production worldwide.

Seismotectonic Stress Regime and Airborne-Gravity Lineament Investigation of the Caribbean region and its Kinematic implications

The tectonic stress regime of the Caribbean region has been studied by stress tensor inversion analysis for the area bounded by Latitudes 17.32o to 23.79o N and Longitudes 81.47o to -60.56o E. A total of two hundred and twenty (220) fault plane solutions (FPS), made up of the seismic (earthquake) events that have occurred in the region of the study were found on the data catalog of the project website of the global centroid moment tensor, were employed in this study. To characterize the stress regimes of the region of study, the classification of the region based on the global moment tensor project is as follows: Cuba-zone, Haiti-zone, Dominican-republic, Monapassage, Puerto Rico, Virgin-Island and the Leeward Island. The gravity geophysical method revealed the presence of multiple or swarms of fractured lines within the same geographical range of study which might have developed over the years as a result of the interaction and coupling effect of the plate boundaries that have close proximity to the region of study. The seismicity pattern indicates that none of the provinces or countries located within the Caribbean region is devoid of large-magnitude earthquake occurrences capable of wreaking severe havoc on the immediate environment. Obviously, our stress tensor inversion result indicates two types of stress regimes namely compression and the strike-slip with different orientations. Cuba-zone, Haiti-zone, Dominican Republic, Monapassage, and Leeward Island are governed mainly by compression stress regimes. In contrast, the strike-slip stress regimes mainly govern the Puerto Rico and the Virgin Island.

Abstract A107: The role of social network and provider support on access to care in Puerto Rican and US Virgin Islands gynecologic cancer patients post-Hurricanes Maria and Irma

Abstract Background: Hurricanes Irma and Maria touched down on Puerto Rico (PR) and the US Virgin Islands in 2017 with devastating impacts. Essential infrastructure, services, and the overall environment were impacted, forcing residents to adapt or migrate amid these natural disasters. With Gynecologic cancers representing over 15% of all cancer in Puerto Rican women, these patients were at a high risk of experiencing challenges and barriers detrimental to their health outcomes. This study assessed how social networks (i.e., immediate family, friends, and neighbors) and provider (i.e., oncologists, oncology associations, and hospitals) support played a role in accessing health services by gynecologic cancer patients in the aftermath of the hurricanes. Methods: In-depth interviews were conducted to assess hurricane-related stressors and disaster responses. PR (n=24) and US Virgin Island (n=2) gynecologic cancer patients participated across 4 focus groups (December 2018-April 2019). Key cancer stakeholders were individually interviewed, consisting of oncology care providers and administrators (n=23) providing services in PR. All interviews were recorded, transcribed (verbatim), and coded with emerging themes using inductive methods. Results: The analysis highlighted the impact of stressors and multi-level responses on health outcomes for the patients. The identified emerging themes and subcodes included: 1) Health Access; 2) Stressors; 3) Emergency Response to Communication methods. Participants highlighted how their health needs were satisfied or not during the aftermath of the disasters primarily based on the availability of support from their social network and on recorded responses of available providers and clinics. They also detailed the expression of diverse stressors (i.e., primary, secondary, psychosocial, environmental) experienced while searching for health services. Regarding communications, patients and providers detailed several mechanisms of non-traditional patient-provider communication, such as WhatsApp group messaging, telephone robocalls for texting, leaving written notes at clinics or homes, and traveling outside PR to communicate with outside and local resources. Conclusion: The study demonstrated that social and provider support was critical in patients accessing care. A supportive social network facilitated access to health management, treatments, and primary service (i.e., water and electricity). Conversely, patients with minimal to no social support expressed difficulty improving these areas. Health providers also played an essential role with their patients and in the community by providing innovative alternative resources beyond planned emergency response. Implications for safety data management and sharing are in place when managing adverse outcomes in emergency planning. These results are imperative to include in future emergency preparedness plans for PR to prevent and mitigate the effects of natural disasters among vulnerable populations, such as cancer patients. Citation Format: Celeste M. Charchalac-Zapeta, Edna Acosta-Perez, Sandra I Garcia-Camacho, Mirza Rivera, Ana Patricia Ortiz Martinez. The role of social network and provider support on access to care in Puerto Rican and US Virgin Islands gynecologic cancer patients post-Hurricanes Maria and Irma [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A107.

Hawksbill and green turtle niche overlap in a marine protected area, US Virgin Islands

Studying how species interact with their environment and other co-occurring species are 2 main aspects of ecology. For marine turtles, ocean currents drive migratory routes and may determine the location of surrounding foraging grounds. As a result, circumglobal species like the hawksbill turtle Eretmochelys imbricata and green turtle Chelonia mydas adapt to diverse foraging habitats and employ varied feeding strategies. Dietary specializations may reduce competition for available food and space resources between co-occurring hawksbill and green turtles in US Virgin Island shallow reef habitats. This study analyzed isotopic data from immature hawksbill (n = 49; range: 18.7-49.8 cm straight carapace length [SCL]) and green turtles (n = 225; range: 24.1-69.4 cm SCL) to examine foraging niche. We used nitrogen stable isotope (δ15N) values as an indicator of trophic positioning and carbon stable isotope (δ13C) values as a habitat variable. Turtles were hand-captured across an 8 yr period (2012-2019), which facilitated the distinction of isotopic patterns in both the environment and among individual turtles. Understanding variations in habitat, community dynamics, and dietary consumption allowed us to utilize a 5 point framework to translate isotopic space to foraging niche. We found that the site’s relatively stable environmental conditions allow for isotopic overlap between hawksbill and green turtles despite the specialized feeding strategies each species employs. We also underscore the need to evaluate species-specific tissue turnover estimates as evidenced by the influence of tropical storms on recaptured turtle isotopic signatures. These findings inform our understanding of resource use for these imperiled species at our study site and are useful for future global isotopic comparisons.