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Articles 4711 - 4740 of 34253
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Racial Concordance Perceptions Of Post-Op African-American Patients, John-Ezekiel Moya
Racial Concordance Perceptions Of Post-Op African-American Patients, John-Ezekiel Moya
Nursing | Student Research Posters
African-Americans have historically faced significant health disparities, which persist due to implicit racial biases and a lack of cultural competency among non-Black healthcare providers. These disparities often result in poorer health outcomes and diminished patient satisfaction. One potential factor in mitigating these issues is racial concordance, the alignment of racial identity between patients and providers (Jetty et al., 2022). However, only 6.3% of the nursing workforce identifies as Black or African-American (Smiley et al., 2023), limiting opportunities for racially concordant care. While racial concordance may foster trust, communication, and comfort in healthcare settings, research on its importance to African-American Patients—especially …
Educating Staff To Use The Teach-Back Method Towards Improving Adherence To Antipsychotic Medication, Elizabeth Adebayo
Educating Staff To Use The Teach-Back Method Towards Improving Adherence To Antipsychotic Medication, Elizabeth Adebayo
Walden Dissertations and Doctoral Studies
My goal for this staff education doctoral project was to improve adherence to antipsychotic medication among patients in a mental health facility through an education initiative for psychiatric intensive care unit staff focused on the teach-back method. The facility had reported a 20% increase in medication noncompliance among post-discharge patients within the past year, primarily attributed to nurses’ lack of adequate patient teaching strategies. I addressed the issue of effective patient education using the teach-back method in improving medication adherence in an inpatient mental health setting. Teaching objectives, content, and test questions were developed based on a substantial body of …
Simulation Education To Improve Confidence Levels In Using Alternative Methods Of Restraint With Children On An Inpatient Psychiatric Unit, Roshni Patel
Walden Dissertations and Doctoral Studies
Summary Seclusion and restraints, while sometimes necessary for patient and staff safety, can result in negative outcomes, including physical and psychological harm to patients. This doctoral project addressed the critical issue of improving inpatient nurses’ confidence in applying alternative methods to seclusion and restraints. These alternatives are essential in psychiatric and acute care settings to promote patient safety, reduce the use of coercive interventions, and support a more humane approach to patient care. The practice problem identified was a notable lack of confidence and knowledge among inpatient nurses regarding using these alternative methods, which led to overreliance on seclusion and …
An Educational Intervention To Increase Nurse Practitioners’ Knowledge And Awareness Of Polypharmacy, Kiana Piedrahita
An Educational Intervention To Increase Nurse Practitioners’ Knowledge And Awareness Of Polypharmacy, Kiana Piedrahita
Walden Dissertations and Doctoral Studies
The presence of multiple health problems can contribute to the simultaneous use of multiple medications by an individual, also known as polypharmacy. While polypharmacy can be necessary, it has the potential risk of adverse drug reactions and possible hospitalization. In the local organization, leadership noted that 47% of patients seen are elderly individuals who have multiple comorbidities, indicating the probable use of multiple medications. Thus, purpose of this Doctor of Nursing Practice project was to determine if an educational intervention focused on polypharmacy and the use of the electronic medical record to manage polypharmacy increased knowledge and awareness among nurse …
Ethics Of Ai In The Classroom, Kyle Kos
Ethics Of Ai In The Classroom, Kyle Kos
Honors Theses
Artificial intelligence (AI) is rapidly evolving and is increasingly being used in classrooms. Several different forms of artificial intelligence have gained popularity within the past, one form of AI with widespread use in the classroom is Generative Pre-Trained Transformer (ChatGPT). This paper explores how the recent surge of popularity of ChatGPT has caused concerns of ethical use in the classroom. Additionally, this paper explores the capabilities and strategies for students to use AI, specifically in nursing.
ChatGPT can offer extraordinary resources to students through capabilities such as essay writing and editing, generation of answers to questions instantly from a vast …
Neuroprotective Care And Painful Procedures, Jelda Frank
Neuroprotective Care And Painful Procedures, Jelda Frank
Walden Dissertations and Doctoral Studies
An inconsistent application of neuroprotective care provided by clinical staff, based on my observations, to minimize the negative effects of painful procedures that can negatively impact the neurodevelopment of neonates in the neonatal intensive care unit (NICU), was the identified practice problem for my Doctor of Nursing Practice (DNP) staff education project. Implementation of evidence-based neuroprotective and neuropromotive strategies aim to optimize outcomes for premature infants and minimize risk of potential negative effects to the neonate’s short and long term neurodevelopment. The DNP project practice-focused question addressed whether a presentation of an evidence-based educational program for NICU clinical staff would …
The Power Of Plate & Knowledge: Nutrition’S Role In Pcos Management For Asian American Women, Cassandra Camille Diego Curameng
The Power Of Plate & Knowledge: Nutrition’S Role In Pcos Management For Asian American Women, Cassandra Camille Diego Curameng
Nursing | Student Research Posters
Polycystic ovarian syndrome (PCOS) is a metabolic endocrine disorder affecting 8–11% of women worldwide, with 70% remaining undiagnosed (WHO, 2023). It presents with symptoms such as irregular menstrual cycles, insulin resistance, high testosterone levels, anxiety, depression, and infertility, significantly impacting quality of life and health (OASH, 2021). The symptoms of PCOS can severely impact women’s quality of life, mental health, and long-term well-being. Insulin resistance contributes to symptom severity and a 50% likelihood of developing diabetes or prediabetes by age 40 (Wang et al., 2011). Women with PCOS face a threefold increased risk of endometrial, ovarian, and breast cancers (Barry …
Clinical Practice Guideline: Shared Decision Making For Patients With Mental Health Disorders, Karen Rose Grant-Simmons
Clinical Practice Guideline: Shared Decision Making For Patients With Mental Health Disorders, Karen Rose Grant-Simmons
Walden Dissertations and Doctoral Studies
Summary This project was a clinical practice guideline (CPG) for practitioners who deliver healthcare services to patients living with mental health disorders. The practice problem addressed by this CPG was lack of mental health patient inclusion in terms of determining treatment plans of care. In back-to-back patient satisfaction surveys, patients indicated they would like to have more say in their treatment plans. The practice problem was important to increase patient input in clinical decision-making practices of practitioners. The project question was: Does evidence support development of a CPG for mental health patient-centered input regarding treatment plans of care that was …
Developing Nursing Education In A Low-Income Country, Kalyn M. Renbarger, Jane Frances Anyango, Joshua Kanaabi Muliira
Developing Nursing Education In A Low-Income Country, Kalyn M. Renbarger, Jane Frances Anyango, Joshua Kanaabi Muliira
School of Nursing Faculty Publications
Background
Nursing schools in low-income countries face challenges to effectively educate and retain future nurses in rural settings where healthcare needs are more prominent. It is important to understand the experiences of nursing students in rural settings to better prepare them to meet the complex needs of the community. Little is known about nursing students' experiences in rural Uganda. The purpose of this paper is to explore nursing students' experiences of attending school in a rural setting in Uganda.Methods
A qualitative descriptive design was used to conduct this study. Twelve nursing students from a nursing school in rural Uganda …Staff Education To Improve Antipsychotic Medication Adherence, Muhammad J. Matlub
Staff Education To Improve Antipsychotic Medication Adherence, Muhammad J. Matlub
Walden Dissertations and Doctoral Studies
This staff educational project addressed a gap in practice involving minimal nursing intervention to support antipsychotic medication adherence. Antipsychotic medication nonadherence results in undermanaged schizophrenia, which is associated with relapse psychotic episodes, suicidality, and violence. Therefore, the project’s purpose was to educate the providers on long-acting injectable (LAI) antipsychotic medication to facilitate the use of the medications to address antipsychotic medication nonadherence. Eight providers were involved in the educational intervention and were educated on the LAI antipsychotic treatment intervention through an interactive educational session. Knowledge surveys were administered before and after the educational intervention. The collected data were analyzed using …
Educating Providers On Effective Prescribing Of Benzodiazepine, Juliana Nwakamma
Educating Providers On Effective Prescribing Of Benzodiazepine, Juliana Nwakamma
Walden Dissertations and Doctoral Studies
The goal of this initiative is to increase provider confidence, improve patient outcomes, and foster constructive societal change by teaching healthcare professionals how to prescribe benzodiazepines safely and effectively. Many doctors prescribe benzodiazepines to treat anxiety, sleeplessness, and seizures, but using them comes with serious hazards, such as dependence, withdrawal, and overdosing, particularly when taken with other drugs like opioids. Taking these concerns into consideration, my study intends to close gaps in prescribing practices by creating an evidence-based education program specifically designed for healthcare professionals. The course emphasizes effective prescribing techniques, methods for weaning chronic users, and benzodiazepine substitutes such …
Effectiveness Of Eucalyptus For Pain Management: An Integrative Review, Taylor Stone, Jennifer Tran
Effectiveness Of Eucalyptus For Pain Management: An Integrative Review, Taylor Stone, Jennifer Tran
Master's Projects
This integrative review examines eucalyptus essential oil effectiveness for pain, particularly as an alternative to opioids. An extensive literature search was conducted across multiple databases, including Joanna Briggs Institue, Cochrane, CINAHL, PubMed, and Scopus, focusing on studies examining eucalyptus oil’s analgesic properties, along with its effectiveness when used alone or in conjunction with complementary therapies like massage and acupuncture. Analysis identified three key themes: (1) the effectiveness of eucalyptus oil in pain reduction across various acute and chronic pain conditions, (2) its role in potentially reducing reliance on pharmaceutical pain relief, and (3) its capacity to enhance the effectiveness of …
Increasing Nursing Staff Knowledge On Medication Nonadherence Among Mental Health Patients, Princess Ndidi Amadi
Increasing Nursing Staff Knowledge On Medication Nonadherence Among Mental Health Patients, Princess Ndidi Amadi
Walden Dissertations and Doctoral Studies
Medication nonadherence is a challenge among patients with severe mental health disorders, increasing the patients’ risk for exacerbations of psychosis and relapse, which may result in hospital emergency room visits and hospital admissions. In patients with schizophrenia, major depressive disorders, and bipolar disorders, the mean medication nonadherence is 49%. While no single strategy works, a combination of behavioral and educational strategies has been shown to improve patient adherence to their medication regimen. The purpose of the Doctor of Nursing Practice project was to increase healthcare professionals’ knowledge of behavioral and educational strategies to improve medication adherence among patients with severe …
The Nurse Faculty Compassion Instrument: A Methodological Study, Nancy Pritchard
The Nurse Faculty Compassion Instrument: A Methodological Study, Nancy Pritchard
Dissertations
As nursing shortages rise, nursing faculty have the important responsibility of increasing the number of nursing school graduates that enter the nursing profession. Unfortunately, attrition and retention continue to prevent nursing students from graduating on time or at all. Nursing faculty compassion has been identified as one important factor that could decrease nursing student attrition and increase nursing student retention and program completion. Compassion is a concept built upon the constructs of forming connections, empathetic behaviors, student suffering and faculty recognition of needs, and alleviation of suffering. No existing instruments measure all of these constructs. Some existing tools that measure …
Thoughts From The Frontline - December 2024, Tennessee Center For Nursing Advancement, East Tennessee State University
Thoughts From The Frontline - December 2024, Tennessee Center For Nursing Advancement, East Tennessee State University
Thoughts from the Frontline Newsletter
No abstract provided.
Relationship Of Stress, Family, And Social Support, And Job Satisfaction To Burnout Among Family Nurse Practitioners Employed In Primary Care Clinics In Mississippi, Laura-Jean Scott Brooks
Relationship Of Stress, Family, And Social Support, And Job Satisfaction To Burnout Among Family Nurse Practitioners Employed In Primary Care Clinics In Mississippi, Laura-Jean Scott Brooks
Dissertations
In the realm of healthcare, burnout is the invisible monster that has infiltrated every facet of the industry with grossly visible results. From provider turnover to patient errors, burnout has lifelong effects on the healthcare provider and patient care. This researcher seeks to study variables and the relationship to burnout among Family Nurse Practitioners who practice in primary care in Mississippi. The Review of the Literature demonstrated a lack of findings in burnout among family nurse practitioners. Most of the literature reviewed focused on burnout among registered nurses. The guiding hypothesis of the research study was that social and family …
Academic Nurse Leaders’ Application Of Bolman And Deal’S Leadership Orientation Framework, Jasmine Bratton
Academic Nurse Leaders’ Application Of Bolman And Deal’S Leadership Orientation Framework, Jasmine Bratton
Dissertations
While Academic Nurse Leaders (ANLs) are vital to the functioning and quality of nursing programs in academic settings, many enter their roles with limited or no prior academic leadership and management experience. The inadequate preparation and development of ANLs remains a critical concern. For this reason, ANLs positions can be challenging and hard to fill. Although ANLs can hold various titles and positions across different academic institutions, this study specifically focuses on Deans, Directors, and Department Chairs working in the New York State area. Bolman and Deal’s (2021) four-frame model of leadership offers a framework that can be used to …
Early Referral For Eye Movement Desensitization And Reprocessing Therapy For Treatment Of Trauma-Induced Anxiety And Emotional Distress, Christa Jones
Early Referral For Eye Movement Desensitization And Reprocessing Therapy For Treatment Of Trauma-Induced Anxiety And Emotional Distress, Christa Jones
Doctoral Projects
Trauma, anxiety, and emotional distress are significant health concerns affecting millions globally and resulting in significant healthcare burdens. Despite the considerable efforts in addressing problems, most high-risk cases often go unidentified or unaddressed promptly. Besides standard trauma diagnosis, treatment, and management protocols, some patients often require specialized support. Recently, Eye Movement Desensitization and Reprocessing (EMDR) has emerged as a promising alternative for treating anxiety, trauma, and emotional distress conditions, yet many patients who are at high risk are often not identified early for referral. Additionally, many healthcare facilities, especially those in rural settings, fail to include appropriate screening tools.
This …
Reducing Congestive Heart Failure Readmissions Through Discharge Planning And Education, Coewonda Burse
Reducing Congestive Heart Failure Readmissions Through Discharge Planning And Education, Coewonda Burse
Doctoral Projects
Chronic heart failure (CHF) is a widespread problem among individuals, which, at the same time, consumes a considerable share of global healthcare demand. CHF management poses a persistent issue mainly due to the short interval of hospital readmissions four weeks after discharge, which indicates deficiencies in care transitions and patient education. This doctoral project addresses this topic and evaluates whether implementing patient-specific education and discharge planning programs can decrease CHF-associated hospital readmissions. To investigate the phenomenon, the DNP student completed a retrospective chart review, found an intervention, implemented said intervention, and then evaluated the intervention's effectiveness versus interventions already in …
Prescription For Change: Tackling Inappropriate Antibiotic Use In Urgent Care Settings, Lachundra Mosley
Prescription For Change: Tackling Inappropriate Antibiotic Use In Urgent Care Settings, Lachundra Mosley
Doctoral Projects
A pressing global health issue that significantly contributes to antibiotic resistance is the inappropriate antibiotic prescribing for Upper Respiratory Infections (URI’s) in urgent care settings (World Health Organization [WHO], 2022). The purpose of this doctoral project was to reduce inappropriate antibiotic prescriptions for URI at an urgent care in D’Iberville, Mississippi through the implementation of an educational pamphlet.
A pre-post intervention project was conducted, collecting data on antibiotic prescribing practices via retrospective chart reviews before and after the educational intervention. Data was collected using a researcher developed screening tool based on Evidence based guidelines to distinguish viral vs bacterial infections. …
Investigating The Effects Of Workload Management Strategies On Nurse Practitioner Burnout And Job Satisfaction, Erica G. Smith
Investigating The Effects Of Workload Management Strategies On Nurse Practitioner Burnout And Job Satisfaction, Erica G. Smith
Doctoral Projects
Burnout is a critical issue among psychiatric mental health nurse practitioners (PMHNPs), worsened by excessive workloads, productivity demands, and the emotional intensity of patient care (Chi et al., 2024). The negative effects of burnout included diminished job satisfaction, reduced quality of care, and increased turnover (Chi et al., 2024). As the demand for Psychiatric Mental Health Nurse Practitioners (PMHNPs) grew, addressing these challenges was essential for maintaining a sustainable workforce and ensuring quality patient care.
This doctoral project aimed to assess the impact of a workload management strategy on reducing burnout and improving job satisfaction among PMHNPs in a hospital …
The Impact Of Physical Exercise On Stress Reduction Among College Students, Natalie Luna
The Impact Of Physical Exercise On Stress Reduction Among College Students, Natalie Luna
Honors College Theses
Stress is a prevalent issue among college students, often contributing to mental healthchallenges such as anxiety and depression. While physical exercise is recognized as a beneficial strategyfor stress reduction, there is limited understanding of the specific exercise factors that influence stresslevels, including type, duration, and intensity. This study aimed to explore these factors, identify barriersand facilitators to regular exercise, and evaluate students' perceptions of physical exercise as a stressmanagement tool. Insights from this research aim to inform strategies for promoting physical activity toenhance student well-being.
A non-experimental, cross-sectional survey design was used to investigate the relationshipbetween exercise habits and stress …
Improving Outcomes Of Patients Being Seen In The Emergency Room For Mental Health Crisis, Kimberly Hudson
Improving Outcomes Of Patients Being Seen In The Emergency Room For Mental Health Crisis, Kimberly Hudson
Doctoral Projects
Mental health is a significant problem, especially in males aged 20 to 50 years old (Omary, 2019). Lack of a primary mental health care provider, lack of proper treatment and follow up appointments for this population, and bottlenecking patients in the emergency room are all factors that contribute to the problem. As a result, these patients experience negative outcomes such as not receiving proper care and/or causing harm to themselves or others. In this doctoral project we will explore the option of patients having better outcomes if seen immediately by a psychiatric health care provider.
Having psychiatric healthcare providers in …
Know Your Birth: Improving Knowledge And Confidence Through Education On Childbirth In Rural Kenya, Stephanie Cortez, Jasmine Ochoa, Manvi Pal, Carol Xiong
Know Your Birth: Improving Knowledge And Confidence Through Education On Childbirth In Rural Kenya, Stephanie Cortez, Jasmine Ochoa, Manvi Pal, Carol Xiong
ELMSN E-Portfolio. A collection of Scholarly and Creative Works
No abstract provided.
Efficacy Of M-Health Solution On The Paternal Postpartum Depression Affecting The Relationship Of The Couple: A Pilot Study In Four Hospitals Of Karachi, Pakistan, Syeda Sakina Mehdi, Naghma Rizvi, Saleema A. Gulzar, Nuruddin Badruddin Mohammed, Vardah Bharuchi, Syeda Aleena Abbas, Mehak Barolia
Efficacy Of M-Health Solution On The Paternal Postpartum Depression Affecting The Relationship Of The Couple: A Pilot Study In Four Hospitals Of Karachi, Pakistan, Syeda Sakina Mehdi, Naghma Rizvi, Saleema A. Gulzar, Nuruddin Badruddin Mohammed, Vardah Bharuchi, Syeda Aleena Abbas, Mehak Barolia
Journal of Asian Midwives (JAM)
Background: Postpartum depression (PPD) significantly impacts mothers and fathers, with paternal PPD (PPPD) affecting 28.3% of fathers in Pakistan. PPPD exacerbates maternal symptoms and disrupts family dynamics but remains underdiagnosed due to cultural stigmas and gender-specific presentations, such as aggression and stress. Socio-economic challenges, marital dissatisfaction, and limited support further heighten PPPD risks. Mobile health (mHealth) technologies offer accessible, stigma-free solutions for mental health support. This study explores PPPD health needs and evaluates an mHealth intervention for improving detection, support, and relationship outcomes among postpartum couples in Pakistan.
Methods: This exploratory sequential mixed-methods study will be conducted in two phases. …
Beyond Tradition: Exploring The Underlying Factors Of Delayed Cord Clamping, Sehar Aslam
Beyond Tradition: Exploring The Underlying Factors Of Delayed Cord Clamping, Sehar Aslam
Journal of Asian Midwives (JAM)
Delayed cord clamping (DCC) benefits mothers and infants by improving iron levels and neurodevelopmental outcomes while reducing neonatal complications. It is a crucial intervention, especially where iron-rich foods are scarce. Despite its advantages, DCC is often neglected due to medical complications, inconsistent policies, and clinical time constraints. Promoting DCC requires comprehensive education, clear protocols, interdisciplinary collaboration, and adequate skilled staffing. This paper emphasizes the importance of consistent DCC practices to enhance maternal and infant health and urges healthcare providers and parents to prioritize DCC in birth plans.
Knowledge And Attitudes Regarding Pubertal Changes Among Adolescent Males In Karachi: A Study Protocol, Sabah Muhammad Nazim, Saleema A. Gulzar, Hussain Maqbool Ahmed Khuwaja, Zohra Lassi
Knowledge And Attitudes Regarding Pubertal Changes Among Adolescent Males In Karachi: A Study Protocol, Sabah Muhammad Nazim, Saleema A. Gulzar, Hussain Maqbool Ahmed Khuwaja, Zohra Lassi
Journal of Asian Midwives (JAM)
Background: Adolescence (the period between childhood and adulthood) is characterized by significant changes in bodily functions, along with psychological and cognitive growth, which lays the foundation for future health. The unanticipated changes in that phase (especially related to sexuality) can cause adolescents embarrassment and distress, thus impacting their well-being and development. Despite the critical role of puberty in adolescents’ physical, psychological, and social development, research focusing on the knowledge and experiences of male adolescents going through puberty is limited, especially in urban Karachi, Pakistan. Several Pakistani studies have mainly focused on female adolescents and their experiences with puberty, leaving a …
“Time To Rebuild The Healthcare Workforce”: Addressing Socio-Cultural And Psychological Perspectives Of Men’S Presence In Nursing And Midwifery, Sarmad Muhammad Soomar, Salima Farooq, Sarosh Tahar Khymani, Nargis Asad
“Time To Rebuild The Healthcare Workforce”: Addressing Socio-Cultural And Psychological Perspectives Of Men’S Presence In Nursing And Midwifery, Sarmad Muhammad Soomar, Salima Farooq, Sarosh Tahar Khymani, Nargis Asad
Journal of Asian Midwives (JAM)
Background: There is a global scarcity of healthcare workers, particularly nurses and midwives, who make up more than half of the current workforce associated with “care”, which is the essence of nursing and midwifery in patient and family care. This is always considered as a profession for women in most of the global workforce. In a patriarchal society, nursing and midwifery limits the choice to be adopted by men. Based on male nurses and midwives’ experiences and stories, it was aimed to explore the present literature to see the citations related to this area, which have been cited to address …
Indications And Outcomes Of Emergency And Elective Cesarean Section Deliveries In A Tertiary Care Hospital In Karachi, Pakistan: A Retrospective Study, Bakhtawar Muhammad Hanif Khowaja Bk, Sabahat Naz, Komal Valliani, Aqsa Nizar Maknojia, Asfa Anwer Ali, Mahek Zaheer Maknojia, Tabish Ali Shalwani, Sheikh Irfan Ahmed, Farida Mughal
Indications And Outcomes Of Emergency And Elective Cesarean Section Deliveries In A Tertiary Care Hospital In Karachi, Pakistan: A Retrospective Study, Bakhtawar Muhammad Hanif Khowaja Bk, Sabahat Naz, Komal Valliani, Aqsa Nizar Maknojia, Asfa Anwer Ali, Mahek Zaheer Maknojia, Tabish Ali Shalwani, Sheikh Irfan Ahmed, Farida Mughal
Journal of Asian Midwives (JAM)
Background: This study identified major determinants of Cesarean-sections and the outcomes in one referral center.
Methods: A retrospective study was conducted at a tertiary healthcare facility and all women who had cesarean section between January 2020 to July 2021 were enrolled. A chi-square or independent t-test was used to compare maternal and pregnancy characteristics, and neonatal outcomes between emergency c-sections (EmCS) and elective c-sections (ElCS) groups. A multivariable logistic regression analysis compared indications and outcomes between the two groups.
Results: Among 767 women, there were 417 (54.4%) emergency and 350 (45.6%) elective cesarean sections. A multivariable logistic regression revealed that …
Impact Of Climate Change On Maternal Health In Pakistan: A Review Paper, Ihsan Ullah, Kiran Mubeen, Dilshad Begum, Rafat Jan
Impact Of Climate Change On Maternal Health In Pakistan: A Review Paper, Ihsan Ullah, Kiran Mubeen, Dilshad Begum, Rafat Jan
Journal of Asian Midwives (JAM)
Pakistan is one of the country’s most susceptible to the effects of climate change. Recent floods, heavy snowfall and rain have significantly impacted maternal and infant health. Indigenous women of child-bearing age especially those in rural areas are among the most vulnerable, facing food insecurity, disruptive food systems, rising food prices, and disrupted food production due to climate change. This review highlights a critical gap in research on indigenous women's maternal nutrition in the context of climate change, particularly in low- and middle-income countries. It emphasized the necessity for culturally responsive approaches and a deeper understanding of how climate change …