Telehealth Implementation Response to COVID-19 in the OneFlorida+ Clinical Research Network: Perspectives of Clinicians and Health Systems Leaders.

Introduction: The COVID-19 pandemic forced health systems worldwide to make rapid adjustments to patient care. Nationwide stay-at-home mandates and public health concerns increased demand for telehealth to maintain patients' continuity of care. These circumstances permitted observation of telehealth implementation in real-world settings at a large scale. This study aimed to understand clinician and health system leader (HSL) experiences in expanding, implementing, and sustaining telehealth during COVID-19 in the OneFlorida+ clinical research network. Methods: We conducted semistructured videoconference interviews with 5 primary care providers, 7 specialist providers, and 12 HSLs across 7 OneFlorida+ health systems and settings. Interviews were audiorecorded, transcribed, and summarized using deductive team-based template coding. We then used matrix analysis to organize the qualitative data and identify inductive themes. Results: Rapid telehealth implementation occurred even among sites with low readiness, facilitated by responsive planning, shifts in resource allocation, and training. Common hurdles in routine telehealth use, including technical and reimbursement issues, were also barriers to telehealth implementation. Acceptability of telehealth was influenced by benefits such as the providers' ability to view a patient's home environment and the availability of tools to enhance patient education. Lower acceptability stemmed from the inability to conduct physical examinations during the shutdown. Conclusions: This study identified a broad range of barriers, facilitators, and strategies for implementing telehealth within large clinical research networks. The findings can contribute to optimizing the effectiveness of telehealth implementation in similar settings, and point toward promising directions for telehealth provider training to improve acceptability and promote sustainability.

What is Atraphaxis L. (Polygonaceae, Polygoneae): cryptic taxa and resolved taxonomic complexity instead of the formal lumping and the lack of morphological synapomorphies.

BACKGROUND: The recently proposed recircumscription of the genus Atraphaxis (incl. Atraphaxis section Ovczinnikovia O.V. Yurtseva ex. S. Tavakkoli and Polygonum sect. Spinescentia Boissier (=A. sect. Polygonoides S. Tavakkoli, Kaz. Osaloo & Mozaff.) makes this genus fairly heterogeneous and therefore almost undefinable based on morphology. A critical comprehensive reappraisal of the group is necessary. METHODS: Using the DNA sequence data (ITS1&2 regions of nrDNA and combined trnL intron + trnL-F IGS and rpl32-trnL((UAG)) IGS regions of plastid genome), Maximum Likelihood (ML) and Bayesian analyses (BI) were applied for phylogenetic reconstructions of the tribe Polygoneae with special attention to Atraphaxis, and related taxa. Maximum parsimony reconstructions of the evolution of perianth morphology and sporoderm ornamentation in the tribe Polygoneae were also performed. Life history, morphology of shoots, leaf blades, ocreas, perianth and achene morphology, ultrasculpture of achene surface, and pollen morphology were compared, and SEM and LM images were provided. PRINCIPAL FINDINGS: The genera Atraphaxis and Polygonum were found to be widely polyphyletic. The rarest and morphologically remarkable endemic of Tian-Shan and Pamir Atraphaxis ovczinnikovii (Atraphaxis sect. Ovczinnikovia O.V. Yurtseva ex. S. Tavakkoli) was confirmed to be a sister of the clade (Atraphaxis + Polygonum sect. Spinescentia) in plastid topology. The genus Bactria (=Atraphaxis sect. Ovczinnikovia), which circumscribes two species, is newly established as a result of this analyses. Morphological data confirm the originality of the taxon. DISCUSSION: We are arguing for a narrow delimitation of Atraphaxis with petalloid segments and striato-perforate sporoderm ornamentation as morphological synapomorphies. The recently proposed inclusion of Polygonum sect. Spinescentia in Atraphaxis is fairly questionable from a morphological standpoint. The rank of Polygonum sect. Spinescentia requires further clarification. The generic composition of the tribe Polygoneae also requires future reappraisals.