MultiCare Gig Harbor Medical Park

359 Background: The COVID pandemic increased mental health challenges for cancer patients, overburdened oncology providers, and exacerbated health disparities. Using focus groups, this study aimed to understand the impact of COVID on people with cancer from underserved communities in WA state. Methods: In 4 focus groups (English and Spanish) people diagnosed with cancer from March 2020 or later in WA state were asked about their treatment, mental health, COVID testing and vaccine experiences, finances, and bias and racism during the pandemic. Focus groups included individuals with a cancer diagnosis in specific communities: Black and African American (n=8), English-Speaking Hispanic/Latinx (n=5), Spanish-Speaking Hispanic/Latinx (n=5), and Rural (n=4). Transcripts were analyzed using conventional content analysis in Dedoose 9.0. Initial coding used notes from preliminary data review. Codes were combined, deleted, and added during subsequent coding. Data was exported and themes were developed. Results: Several themes emerged from the discussions. See table. Conclusions: Cancer patients in WA State reported increased difficulties with navigating hospital policies, mental health, racism during treatment and at work, and economic stress during COVID. Some identified emotional support from family and community as mitigating factors. Feedback from the groups confirmed the need to prioritize mental health and social needs of people with cancer. Future research is needed on interventions to address such needs among individuals with cancer.[Table: see text]

Severely deformed edentulous ridges in the esthetic zone (EZ) are very difficult to restore with an esthetic fixed dental prosthesis (FDP). Soft tissue augmentation of these deformed ridges can dramatically improve the esthetics of the restoration. The long-term stability of soft tissue grafting used alone to treat severe localized alveolar ridge deformities will be reported. Three different soft tissue augmentation techniques, connective tissue graft (CTG), keratinized gingival graft (KGG), and pediculated connective tissue graft (PCTG) used to treat severe ridge deformities in the maxillary anterior region in five patients will be described. The stability of the augmentation will be shown at follow-up periods ranging from 5-30 years. All three soft tissue grafting techniques demonstrated long-term stability following the six-month post-treatment result. Edentulous ridges in the esthetic zone, with severe hard and soft tissue deformities, are very difficult to restore esthetically. The development of soft tissue augmentation techniques has allowed clinicians to enhance the esthetics of their fixed dental prostheses (FDP). Restorative clinicians need to be assured that soft tissue shrinkage under the pontics will not occur after the final prosthesis is seated. The stability of these soft tissue augmentations over an extended period of time, will be demonstrated in the presented cases.

Examination of the lectotype and isotype material of Physalis macrophysa Rydb. show its compatibility with P. longifolia, having nearly glabrous, ovate-lanceolate to broadly lanceolate leaves, and the presence of short, simple antrorse hairs on the petioles and pedicels. Other than its large inflated fruiting calyces (3.0–4.0 cm × 2.5–3.0 cm), it has little in common morphologically with another large inflated calyced Physalis macrosperma which is endemic to deep sands from a portion of the West Gulf Coastal Plain of the United States. Instead, P. longifolia has stems and pedicles that are either nearly glabrous or with antrorse, appressed, non-glandular hair and ovate-lanceolate leaves versus short glandular and non-glandular, spreading, upright hair and cordate to truncate leaves in the aforementioned Physalis macrosperma. We agree with previous authors that P. macrophysa Rydb., if meriting taxonomic status, should be treated as P. longifolia var. subglabrata (Mack. & Bush) Cronquist forma macrophysa (Rydb.) Steyermark or, alternatively, it may simply represent variation within P. longifolia not deserving of any taxonomic status.

Today's healthcare system is in a state of transformation, as changes in technology, diagnostic approaches, treatments, and levels of professional practice occur on a regular basis. Nurses continue to be the most trusted profession. What has not changed in clinical practice is the amount of responsibility and level of accountability. Therefore, nurses are morally, legally, and ethically responsible for nursing judgment and clinical-based actions covered under each state's Nurse Practice Act, the American Nurses Association's core principles, and position statements as well as standard setting documents from professional organizations. Unfortunately, mistakes happen in an enormous system where human error cannot be entirely avoided, which is why being named in a board of nursing complaint can be so devastating. Stress and accusations of not providing reasonable or prudent care can be overwhelming, which may impact a perinatal clinician's health. This article's purpose is to provide information about the process of a board of nursing complaint, potential sequelae of an investigation, as well as best practices to decrease risk, focusing exclusively on perinatal nurses and advanced practice providers.

Because of their prismatic configuration, buried culverts are often designed and analyzed as two-dimensional (2-D) plane strain soil structure systems, as exemplified by the Culvert Analysis and Design (CANDE) finite element program. One major difficulty with 2-D analysis is that live loads are not infinitely long prismatic strips but are finite footprints that induce load spreading through soil in the in-plane and out-of-plane directions. Because traditional 2-D analysis permits only in-plane load spreading, the predicted soil stresses are increasingly overestimated as soil depth increases. The traditional approach to correcting the overestimate is to reduce judiciously the 2-D strip load; this process is called the reduced surface load (RSL) procedure. The reduction factor is dependent on an assumed load-spreading theory and a selected soil depth ( H). RSL analysis results in soil stresses that are correct at the selected soil depth ( H) but understressed for depths less than H and overstressed for depths greater than H. The new continuous load scaling (CLS) procedure introduced in this paper overcomes such shortcomings by continually diverting live load in the longitudinal direction as a continuous function of soil depth. This diversion is achieved by continuously increasing the plane strain unit thickness as a function of depth on the basis of an assumed load-spreading theory. CANDE solutions were obtained for both RSL and CLS procedures and compared with three-dimensional solutions for free-field conditions and for flexible and rigid culvert installations. The bottom-line finding is that the CLS procedure with the elasticity-based load-spreading method is far superior to all other 2-D methods.

The environmental and logistical constraints of the prehospital setting make it a challenging place for the treatment of trauma patients. This is perhaps more pronounced in the management of battlefield casualties before extraction to definitive care. In seeking solutions, interest has been renewed in implementing damage control resuscitation principles in the prehospital setting, a concept termed remote damage control resuscitation. These developments, while improving conflict survival rates, are not exclusive to the military environment, with similar situations existing in the civilian setting. By understanding the pathophysiology of shock, particularly the need for oxygen debt repayment, improvements in the assessment and management of trauma patients can be made. Technology gaps have previously hampered our ability to accurately monitor the prehospital trauma patient in real time. However, this is changing, with devices such as tissue hemoglobin oxygen saturation monitors and point-of-care lactate analysis currently being refined. Other monitoring modalities including newer signal analysis and artificial intelligence techniques are also in development. Advances in hemostatic resuscitation are being made as our understanding and ability to effectively monitor patients improve. The reevaluation of whole-blood use in the prehospital environment is yielding favorable results and challenging the negative dogma currently associated with its use. Management of trauma-related airway and respiratory compromise is evolving, with scope to improve on currently accepted practices. The purpose of this review is to highlight the challenges of treating patients in the prehospital setting and suggest potential solutions. In doing so, we hope to maintain the enthusiasm from people in the field and highlight areas for prehospital specific research and development, so that improved rates of casualty survival will continue.

Polar ecosystems are sensitive to climate forcing, and we often lack baselines to evaluate changes. Here we report a nearly 50-year study in which a sudden shift in the population dynamics of an ecologically important, structure-forming hexactinellid sponge, Anoxycalyx joubini was observed. This is the largest Antarctic sponge, with individuals growing over two meters tall. In order to investigate life history characteristics of Antarctic marine invertebrates, artificial substrata were deployed at a number of sites in the southern portion of the Ross Sea between 1967 and 1975. Over a 22-year period, no growth or settlement was recorded for A. joubini on these substrata; however, in 2004 and 2010, A. joubini was observed to have settled and grown to large sizes on some but not all artificial substrata. This single settlement and growth event correlates with a region-wide shift in phytoplankton productivity driven by the calving of a massive iceberg. We also report almost complete mortality of large sponges followed over 40 years. Given our warming global climate, similar system-wide changes are expected in the future.