Relative Risk of All-Cause Medical Evacuation for Behavioral Health Conditions in U.S. Central Command.

INTRODUCTION: Behavioral health disorders are the leading category of evacuations from the U.S. Central Command (USCENTCOM) area of responsibility. Understanding the relative risk of behavioral health conditions associated with all-cause evacuation is important for the allocation of resources to reduce the evacuation burden. MATERIALS AND METHODS: Data from the USTRANSCOM Regulating and Command & Control Evacuation System and Theater Medical Data Store covering personnel deployed to the USCENTCOM area of responsibility between January 1, 2017 and December 31, 2021 were collected and analyzed. All individuals who were diagnosed with a behavioral health-specific ICD-9 (290-316) or ICD-10 (F00-F99) code during the period were included. Using the earliest medical encounter, the number of individuals diagnosed with a particular code and the frequency individuals were evacuated being diagnosed with any code were calculated. RESULTS: The mean monthly USCENTCOM population during this period was 62,535. A total of 22,870 individuals were diagnosed with a behavioral health-related disorder during the study period. Of this population, 1,414 individuals required an evacuation. The relative risk of the top 30 diagnosis codes used during the initial visit of individuals during the study period was calculated. Within this group of initial diagnoses, F32.9 'Major depressive disorder, single episode, unspecified' had the highest proportion evacuated at 15.9%. CONCLUSIONS: There is a broad array of behavioral health-specific diagnoses used initially in the care of behavioral health disorders with a great variation in their association with evacuation risk. Variations of diagnoses associated with anxiety, depressive, and adjustment disorders are most associated with eventual evacuation.

The vulnerable Sporophila frontalis (Verreaux) and Haplospiza unicolor Cabanis as new hosts for Isospora sporophilae Carvalho-Filho, Meireles, Ribeiro & Lopes, 2005 (Eimeriidae) in Brazil.

Isospora sporophilae Carvalho-Filho, Meireles, Ribeiro & Lopes, 2005 was morphologically and molecularly identified from the double-collared seedeater Sporophila frontalis (Verreaux), which is categorised as 'vulnerable' by the International Union for Conservation of Nature and Natural Resources (IUCN), and from the uniform finch Haplospiza unicolor Cabanis in conserved and anthropomorphic/fragmented areas of Atlantic Forest in the southeastern Brazil. The oöcysts recovered from S. frontalis and H. unicolor had small morphological and genotypic differences that were not considered sufficient for the description of new species, but only different genotypes of I. sporophilae related to each host. This coccidian species was originally described from double-collared seedeaters Sporophila caerulescens (Vieillot) in a center screening of wild animals; therefore, this new report emphasises a potential occurrence of anthropomorphic dispersion of coccidia through illegal trade, seizures and reintroductions in the wild.

Isospora sagittulae McQuistion & Capparella, 1992 (Apicomplexa: Eimeriidae) from antbirds (Passeriformes: Thamnophilidae) in the Amazon and Atlantic Forest of Brazil: with notes on its distribution and dispersion in the Neotropical region.

In the current study, Isospora sagittulae McQuistion and Capparella, 1992 (Protozoa: Apicomplexa: Eimeriidae) is reported from white-shouldered fire-eyes Pyriglena leucoptera (Vieillot, 1818) in the Atlantic Forest in southeastern Brazil. To date, this coccidian species was described from antbirds in Ecuador and Brazilian Amazon. In this sense, oocysts and measurements of the description of I. sagittulae from Amazonian antbirds were required from the deposit for comparison between samples from the Amazon and Atlantic Forest. The morphology was similar in all aspects, despite the polymorphism associated with the oocyst shape. DNA sequences for the mitochondrial cytochrome c oxidase subunit 1 (cox1) locus of the oocysts had similarity of 100%. Therefore, these strong morphological, molecular, and ecological equivalences ensure the unique identification of I. sagittulae. Finally, this finding reveals the wide distribution of I. sagittulae in the Neotropical region and indicates that other antbirds in the Brazilian Cerrado should disperse I. sagittulae to the Amazon and Atlantic Forest.

Isospora lopesi n. sp. (Apicomplexa: Eimeriidae) from the eastern white-throated spadebill Platyrinchus mystaceus Vieillot (Passeriformes: Tyranni: Tyrannidae) in South America.

A species of Isospora Schneider, 1881 (Protozoa: Apicomplexa: Eimeriidae) considered as new to science is described and characterised molecularly from the eastern white-throated spadebill Platyrinchus mystaceus Vieillot in the Parque Nacional do Itatiaia, southeastern Brazil. Isospora lopesi n. sp. has oöcysts that are subspheroidal to ovoidal, 18-24 × 18-22 (20.6 × 19.7) µm, with smooth, bilayered wall, c.1.5 µm thick. Micropyle and oöcyst residuum are absent, but one polar granule is present. Sporocysts are ellipsoidal, 12-16 × 8-11 (14.4 × 8.6) µm. The Stieda body is flattened to half-moon-shaped and sub-Stieda body is rounded. Sporocyst residuum is present, consisting of numerous spherules of different sizes. Sporozoites are vermiform with anterior and posterior refractile bodies and nucleus. Molecular analysis was conducted at the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. This new isolate exhibited similarity greater than 98% with Isospora spp. isolates from spectacled warblers Sylvia conspicillata Temminck, 1820. This is the fourth isosporoid coccidian described from New World tyrannid birds, but is the first to have a complementary molecular characterisation.