Skagit Valley Hospital

In this Research Topic, 14 publications highlighted ecological responses in coastal environments (Table 1) to a number of potential changes, including climate change (Gross et al. 2023, Huard et al. 2024), marine heatwaves (Beck et al. 2024, Graham et al. 2025), atmospheric heatwaves (Miner et al. 2025, Raymond et al. 2024, Rubinoff et al. 2025), aquaculture (Veggerby et al. 2024), wetland habitat loss (Chamberlin et al. 2025, Greene et al. 2025, Toft et al. 2023), species reintroductions (McArdle et al. 2025), and introduction of non-native species (Beck et al. 2024, Grason et al. 2025, Rubinoff et al. 2025). While this suite of changes is not an exhaustive list, it collectively highlights that due to the intersection of terrestrial and marine processes, impacts to coastal environments are likely to be greater than their landward and seaward counterparts. Importantly, authors highlighted the significance of cumulative natural and anthropogenic effects that complicate recovery of coastal habitats and the species they support (Huard et al. 2024, Greene et al. 2025, Gross et al. 2023, McArdle et al. 2025, Raymond et al. 2024, Sobocinski et al. 2025, Toft et al. 2023).This collection also offered solutions to some of these threats (Table 1), including habitat restoration (Greene et al. 2025, Chamberlin et al. 2025, Sobocinski et al. 2025, Toft et al. 2023 2025) detected successful growth and adequate survival rates in native Olympia oyster reintroductions, they also noted numerous challenges and recruitment failure. The studies collectively demonstrated that recovering coastal communities takes time and investment because of constraints such as opposing natural geomorphic processes (Toft et al. 2023), lags in ecological responses, inherent sensitivity of key species to intertidal extremes (Graham et al. 2025, Gross et al. 2023), and society's tendencies to underinvest recovery and restoration efforts (Chamberlin et al. 2025). All of these issues delay the timeline for functional recovery.The studies collectively noted the many challenges of documenting responses of coastal habitats and their resident species. Intertidal environments are inherently dynamic, and studies must account for highly variable changes in water levels, temperature, and salinity (Rubinoff et al. Despite these challenges, this Frontiers Research topic highlights the importance of monitoring coastal ecosystems. While the concept of "monitoring" has sometimes been criticized as secondtier science due to the lack of controlled experimentation or a strong basis in hypothesis testing (Lindenmayer and Likens 2009), this collection of studies reveals their power, especially in the context of land-and seascape-scale questions often associated with coastal ecosystems. Longterm monitoring of juvenile salmon cohorts was essential to link habitat restoration "experiments" to their demographic responses (Greene et al. 2025), and even shorter monitoring efforts can help shed light on species sensitivity to climate impacts (Graham et al. 2025, Gross et al. 2023, Miner et al. 2025, Rubinoff et al. 2025, Beck et al. 2024). The concept of monitoring extends as well to monitoring habitat change -for example, Chamberlin et al. ( 2025) and Greene et al. ( 2025) highlight how tracking habitat change of vegetated wetlands using multiple spaced years of aerial photography revealed the pace of wetland recovery through restoration projects. In addition, monitoring can help bridge the gap between scientists and practitioners through participatory science. As shown by several authors, data gathered by engaging citizens in shoreline monitoring can help reveal recovery of ecosystem function (Toft et al. 2023, Rubinoff et al. 2025) and serve to warn us about invasions of nonnative species (Grason et al. 2025, Beck et al. 2024).The studies in this collection also raise questions for additional research. Table 1. Summary of studies in the Salish Sea intertidal Research Topic by author. We illustrate the topics concerning hypothesized impacts (red) or efforts to ameliorate them (blue), the ecological responses studied, and whether impacts/improvements and their ecological responses were measured.

Lung cancer remains the leading cause of cancer death in the United States. Annual lung cancer screening (LCS) with low-dose chest CT (LDCT) can prevent lung cancer deaths in high-risk individuals; However, these benefits are tempered by low adherence to annual screening and low rates of follow-up for those with abnormal findings. To evaluate the impact of centralized approaches to care coordination on LCS follow-up in community settings through a hybrid implementation-effectiveness trial. This is a pre-post intervention trial of a pragmatic and flexible approach to LCS care coordination delivered at the system-level at two community LCS programs based at regional hospitals in Washington state. Care coordination approaches include standardized LCS follow-up workflows incorporating universal tracking of LCS results, universal results delivery to patients, stepped approaches to follow-up reminders and personalized approaches to positive findings. Participants who are eligible for and undergo LCS during either period (n∼6750) will be included. Primary outcomes include adjusted changes in screening adherence to annual follow-up and follow-up for positive findings between the pre- (August 2022-March 2025) and post- (March 2025-September 2027) intervention period. Secondary outcomes include assessing the impact of interventions by community site, patient ethnicity, socioeconomic status, and rurality. We will also assess the implementation of the intervention with attention to adaptation, sustainability and equity. Implementing centralizing care coordination models may decrease barriers and improve adherence to LCS in community settings and serve as a model to improve LCS follow-up in clinical care settings. ClinicalTrials.gov ID NCT06324110.

<strong class="journal-contentHeaderColor">Abstract.</strong> Rockfall is common in steep terrain and poses a hazard to nearby communities. While rockfall triggering mechanisms are highly variable and difficult to quantify, the susceptibility of rock slopes to planar, wedge, or toppling failure can be readily assessed using kinematic analysis. As such, valley slopes with favourable joint orientations exhibit high rockfall susceptibility although the potential for rockfall runout to impact infrastructure and public safety depends on the morphology of downslope terrain. Integrating rockfall susceptibility and runout models with maps of talus deposits accumulated from past rockfall events is an effective combination of tools to inform mitigation but can be difficult to realize across extensive areas. Here, we combine these methods with a historic rockfall inventory to assess rockfall hazard in the steep and forested postglacial valleys proximal to Skagway, AK, where recent rockfall activity has imperilled public safety, infrastructure, and tourism. Our field investigations identified two steeply dipping orthogonal joint sets that favour toppling failure along NW-facing hillslopes in the lower Skagway River valley as well as the NW-facing valleys that bound nearby Dyea Bay and Nahku Bay. We used new and existing lidar data and &gt;300 field-derived joint orientations to inform a kinematic toppling failure model that identifies likely zones of rock toppling. The predicted source zones are positioned upslope of abundant talus slopes that we mapped from field observations and lidar analyses. Along the prominent ridgeline on the eastern margin of Skagway, we used RAMMS:Rockfall to model nearly 200,000 rockfall runout events for four scenarios that account for variations in clast size and ground cover. The runout predictions highlight distinct zones of low and high rockfall hazard along the ridgeline that result from changes in hillslope morphology set by the combined influence of joint orientations and the pattern of glacial erosion. High-hazard segments of the ridgeline exhibit distinct bedrock escarpments and slope-spanning talus slopes that result from the accumulation of rockfall activity over millennia. Our findings reveal controls on past and future rockfall activity and can be used to inform mitigative measures.

Acral melanoma (AM) is localized to the hands and feet including the palms, soles, fingers, toes, and nails, and is associated with a high degree of morbidity and mortality. It has a greater proportional incidence in non-White patients and is often diagnosed at later stages than other cutaneous melanomas. Our study aimed to analyze demographic and clinical features associated with AM to better inform screening and early detection. Demographic and clinical data of patients with histopathologically confirmed AM seen at Weill Cornell Medicine were collected (6/1/2005-7/20/2022). ANOVA and t-tests assessed differences in time-to-treatment and Breslow depth by demographics/characteristics. Ninety-five AMs were analyzed from 88 distinct patients, with a mean age of 62.48 years (range: 18-98), 63.6% females, and 62.5% non-Whites. Time-to-treatment was longer for White versus non-White patients (41.8 vs. 29.1 days, p = 0.0007), with a similar Breslow depth (White 1.29 mm vs. non-White 0.94 mm, p = 0.26). On average, single/widowed versus married patients had greater Breslow depth (1.53 mm vs. 1.00 mm, p = 0.0041), as did patients > 65 versus ≤ 65 years (1.26 mm vs. 0.93 mm, p = 0.0022). Since we found that AM is more common in non-White versus White patients, we recommend increased education and screening among non-White individuals. Also, since single/widowed patients had greater Breslow depth than married patients, marriage may play a protective role in earlier cancer diagnosis, and enhanced melanoma education and screening, particularly targeting single individuals, could benefit patient outcomes.

Abstract Recent approaches to fisheries research emphasize the importance of the coproduction of knowledge in building resilient and culturally mindful fisheries management frameworks. Despite widespread recognition of the need for Indigenous knowledge and historical reference points as baseline data, archaeological data are rarely included in conservation biology research designs. Here we propose a novel multiproxy method to learn from former fisheries stewards by generating archaeological data on past salmonid population parameters. We used a newly developed, high throughput qPCR (HT‐qPCR) chip, originally designed for environmental DNA (eDNA), for species identification of archaeological salmonid vertebrae. We combine this with the laser ablation split‐stream (LASS) approach to identify ocean‐migration versus freshwater residency. We test this multidisciplinary approach using both contemporary and archaeological salmonid samples and new radiocarbon dates from the Tronsdal Site on the Skagit River, Washington State, USA. This is a useful approach for extracting information about Salmonidae species and life history diversity from archaeological remains to reconstruct historic baselines for several population parameters in anadromous species with long periods of freshwater residency. The approach outlined in this paper may be particularly useful for research investigating past fisheries dynamics, offering hundreds to thousands of years of temporal depth for modern fisheries management, harvest policies, restoration ecology, and conservation biology.

Clinicopathologic data-based sentinel lymph node (SLN) prediction models are used to select patients with melanoma for sentinel lymph node biopsy (SLNB). However, the temporal performance of these models is unknown. Therefore, we investigated whether the performance and clinical utility of the Melanoma Institute of Australia, Memorial Sloan Kettering Cancer Center, and Friedman et al. models changed over time. Primary cutaneous melanoma cases that underwent SLNB at a single tertiary-care cancer center from 2000 to 2021 were identified from a prospectively maintained database. Calibration plots were generated. Values for estimated risks of SLN positivity and area under the receiver operator curve (AUC) were calculated. Clinical utility was assessed at thresholds between 5 and 10% using decision curve analysis. In total, 2977 SLNB cases were included. The estimated risk of SLN positivity and AUCs were similar across periods for all models. However, calibration decreased over time for all models, with progressive underprediction of SLN positivity. Clinical utility also declined over time; in the most recent period investigated (2018-2021), no model offered clinical utility at risk thresholds ≤ 8%, and only the Friedman model provided clinical utility at risk thresholds of 9-10%. The calibration and clinical utility of three predominant models for SLN prediction declined over time. There is a need to periodically reassess the performance of SLN prognostic tools as they are applied to contemporary cohorts. Future studies are needed to determine whether findings are generalizable outside of this study cohort.

Osteopathic manipulative medicine (OMM) is a unique skill set consisting of physical manipulations that treatthe neuromusculoskeletal system. Although OMM can improve patient outcomes such as functionality and pain, as well as increase physician reimbursement, its use is declining. Barriers to its use include a lack of proficiency, support, reimbursement, and time. Knowledge gaps remain as to how OMM training during graduate medical education (GME) affects OMM use. This study describes relationships between OMM exposure during GME and the use of OMM in practice. An online survey of physicians in a variety of medical fields during late 2022 assessed the impact of OMM education during postgraduate training on its use in clinical practice. Survey data were analyzed to compare training characteristics and OMM use via chi-square tests and binary logistic regression. A total of 299 surveys were completed. Respondents who received formal OMM education during residency were more likely (59.8 %) to utilize OMM in medical practice than those who practiced OMM informally (37.8 %, p<0.001) and those who had no OMM exposure during residency (10.3 %, p<0.001). Respondents who trained with more osteopathic attendings (p<0.001) and co-residents (p=0.012) were also more likely to utilize OMM. Those who completed residencies that were accredited by the Accreditation Council for Graduate Medical Education (ACGME) with an Osteopathic recognition track, by the American Osteopathic Association (AOA), and were dually-accredited (ACGME/AOA), were all more likely to utilize OMM (60 %, 56 %, and 53 %, respectively) than those who completed residencies with ACGME accreditation alone (22 %, p<0.01). Although OMM can improve patient outcomes, it is underutilized by Doctors of Osteopathic Medicine (DOs) in practice. Lack of training after medical school has been identified as a contributing factor to its disuse. The results of our study illustrate that there is a positive association between OMM education during postgraduate training and OMM use in clinical practice.

Incision rates of major rivers may reflect the effects of drainage reorganization, hillslope processes, tectonic uplift, climate, the properties of rocks into which rivers incise, and other autogenic processes. On the Colorado Plateau, incision rates along the Colorado River have been interpreted as resulting from abrupt base-level changes produced by the integration of the Colorado River system. Specifically, the integration of the Colorado River in the location of Grand Canyon is thought to have created a knickpoint, enhanced by lithologic contrasts, which is retreating upstream. While evidence exists for a <1 Ma acceleration of incision on parts of the Colorado River, uncertainty about the processes reflected in shorter-term incision rates muddies comparison with longer-term averages. In this work, we combine a cosmogenic radionuclide depth profile exposure age and post-Infrared Infrared Stimulated Luminescence (p-IR IRSL) to date fluvial deposits adjacent to the San Juan River, a major tributary of the Colorado River, near Mexican Hat, Utah. The deposits, resting on a 32 m strath surface, are constrained to be ∼28-40 ka, suggesting an incision rate of 804-1151 m Myr -1 , nearly an order of magnitude higher than the long-term rate of ∼140 m Myr -1 over the past ∼1.2 Ma. We observe fluvial deposits that were abandoned due to a bedrock meander cutoff, which partially explains our accelerated incision rate. We use a simple geometric model, informed by our field data, to demonstrate how planform river evolution may, in some circumstances, increase short-term incision rates, relative to long-term incision rates. These short-term rates may also reflect a combination of autocyclic and climatic processes, which limits their ability to resolve longer-term changes in incision rate that may be related to changes in base-level or tectonics. The landscape of the Colorado Plateau in the American Southwest is known for deep canyons, broad plateaus separated by steep escarpments, and mesas that protrude from otherwise low-relief surfaces. Regional denudation and the resulting landforms are closely tied to the rate of incision by large rivers, which serve as major conduits for mobilized sediment. Despite the centrality of the Colorado River and its tributaries to understanding the complex geologic, tectonic, and climatic history that shaped the 1