RESUMO
Objectives: To improve healthcare access for rural cisgender women and gender diverse Veterans, we created the "Boost Team," a clinician-driven telehealth outreach service to connect this population to Veterans Health Administration (VHA) services. Methods: Between 9/2021 and 2/2022, we conducted a needs assessment in the Veterans Integrated Service Network (VISN) 21 and used those data to develop an outreach intervention. We piloted a clinician-led outreach intervention in 3/2022, and formally deployed an outreach team in 9/2022. Results: The needs assessment uncovered opportunities to educate Veterans, staff, and clinicians about available VHA women's health services, and a need for easily-accessible gender-sensitive services. During the pilot, 58% (7/12) rural cisgender women Veterans were successfully contacted, all reported positive experiences with the intervention. The formal outreach team launched in 9/2022 and consists of a nurse practitioner (NP), scheduler, Peer Support Specialist, and medical director. From 9/2022 to 12/2022 the Boost NP called 110 rural cisgender women and gender diverse Veterans and spoke to 65 (59%) of them. Common care needs identified and addressed included care coordination, new referrals, medication management, and diagnostics. Discussion: Data from Boost show that clinician-led outreach can engage rural cisgender women and gender diverse Veterans in VHA services, there is a desire for more gender-sensitive services, and there is a need for systems-level improvements to allow for improved care coordination and decreased leakage outside of VHA. Using robust strategies grounded in implementation sciences, we will continue conducting a program evaluation to study the impact of Boost and scale and expand the program.
RESUMO
We report a case of a cannulated nasopharyngeal airway (NPA) in a patient having a neurological deficit, absent gag reflex, and no clinically obvious signs of respiratory distress. The patient had two episodes of vomiting before admission and was admitted with the initial working diagnosis of aspiration pneumonia; however, a preliminary chest X-ray (CXR) revealed an NPA, sitting vertically in the airway. It is our emphasis that thorough clinical history and radiological imaging are of paramount importance in prompt management of such airway complications.
RESUMO
Contemporary gas turbine engines rely on thermal barrier coatings (TBCs), which protect the structural components of the engine against degradation at extremely high operating temperatures (1300-1500 °C). The operational efficiencies of aircraft engines have seen significant improvement in recent years, primarily through the increase in operating temperatures; however, the longevity of TBCs can be potentially impacted by several types of degradation mechanisms. In this comprehensive study, a wide range of novel columnar suspension plasma sprayed (SPS) coatings were developed for their erosion, calcium-magnesium-aluminum-silicate (CMAS), and furnace cycling test (FCT) performance. Through a comprehensive investigation, the first of its kind, we achieved a range of SPS microstructures by modifying the spray parameters and measuring their microhardness, fracture toughness, column densities, and residual stresses using Raman spectroscopy. We were able to produce dendritic, lateral, branched, and columnar microstructures with a unique set of processing parameters. Coatings enhanced with a refined columnar microstructure, achieved by modulating the distance from the plasma torch, exhibited superior thermal cycling resilience. Conversely, the development of a columnar microstructure with dendritic branches, obtained by decreasing the robot's traversal speed during deposition, bolstered resistance to erosion and minimized damage from molten CMAS infiltration, thereby notably augmenting the coating's lifespan and robustness. The pursuit of the optimal columnar microstructure led to the conclusion that for each SPS coating, a general framework of optimization needs to be conducted to achieve their desired thermo-chemico-mechanical resistance as the properties required for TBCs are intertwined.