Digital Commons Network^™

Exploring Leadership Characteristics And Their Effects On Sustaining Federally Qualified Health Centers, Eleace E. Sawyers

Walden Dissertations and Doctoral Studies

An argument can be made for the continued existence of Federally Qualified Health Centers (FQHCs) because of the level of importance of the service they provide to society. The problem addressed in this research is that despite the millions of people in need of affordable health care, the leaders of many FQHCs are fighting to keep facilities open amidst financial struggles. The purpose of this research was to identify leadership characteristics that promote FQHCs’ success by assessing effective leadership styles. This study applied a quantitative, descriptive non-experimental approach. Probability sampling was used to select the sample size and the Multifactor …

Waste Management Process And Malaria-Induced Child Mortality In Côte D’Ivoire., Kouame N'Guessan

Walden Dissertations and Doctoral Studies

Malaria-induced child mortality is a Sub-Saharan African phenomenon, and Côte d'Ivoire, in West Africa, has one of the highest rates. This general qualitative study investigates waste management as a potential factor of malaria-induced child mortality to inform policy changes and fill a gap in the body of knowledge. The study is grounded in Skocpol's policy feedback theoretical framework. The research question explored aspects of waste management in Côte d'Ivoire which contribute to the high rate of malaria-induced child mortality. Eighteen participants, equally divided into three groups, were purposely recruited via email and WhatsApp messages for semi-structured interviews using a smartphone …

Evolving Community Preparedness: Analysis Of United States Pandemic Health Disaster Readiness, Jessy Rugeyo

Theses and Dissertations

The COVID-19 pandemic has shown substantial gaps in counties' preparedness and response capacity across the United States. This study analyzes the relationship between county-level pandemic preparedness and confirmed COVID-19 cases using secondary data from the FEMA's National Household Survey (NHS) and county-level COVID-19 data from the CDC. The data show a negative relationship between preparedness levels and COVID-19 positive rates, highlighting the necessity of proactive readiness measures. Individual risk assessment, motivation for preparedness, and socioeconomic variables have a major influence on confirmed cases. Higher levels of education, income, and preparedness are associated with lower positive rates, emphasizing the importance of …

Cyber Threats, Cyber Risks, And Cybersecurity Responses: Modeling Whole-Of-Nation Strategy Implementation For American Organizations And Citizens, Vincent Leon Guerrero

All Dissertations

Amid a landscape of cyber attacks on America occurring below the threshold of armed conflict, strategic national policy efforts recommend a whole-of-nation approach where individuals and public and private organizations increase their defensive posture in cyberspace. Motivation to address the risk of a cyber event includes a continuum of cyber threats that can range from low-level disruptive events to cybercrime and cyber espionage to the possibility of a potentially catastrophic attack on critical infrastructure. In this dissertation, I conduct a survey experiment of various cyber threat conditions and cyber policies to model cybersecurity responses, risk perceptions to a possible cyber …

Smoking Habit At Home And Upper Respiratory Infection In Infants Aged 6-12 Months, Musfardi Rustam, Nur Pelita Sembiring, Taswir Effendy

Kesmas

Upper Respiratory Tract Infection (URI) is an acute infection caused by viruses, fungi, and bacteria. Smoking habit at home is a risk factor for URI in infants. This study aimed to determine a relationship between smoking at home and the incidence of URI in infants. This study was conducted the fourth week of February 2010 until the third week of April 2010 in Kampar District, Indonesia. This analytical study used a case-control design and cluster random sampling. The samples comprised 162 cases and 162 controls, infants aged 6-12 months. The cases were 162 infants aged 6-12 months suffering from URI …

Data Mining Analysis With Orange In The Development Of Tuberculosis Among Diabetes Mellitus Patients, Malahayati Rusli Bintang, Adang Bachtiar, Cicilya Candi

Kesmas

Prevention and treatment of diabetes will have a positive influence on tuberculosis (TB) since people may get TB because they have diabetes mellitus (DM). Recording and reporting through the TB Information System are not run optimally because of many factors. The information system must be strengthened to be used by private health facilities. This study used secondary data from the 2013 and 2018 Indonesian Basic Health Research (IBHR). The data was analyzed univariately and analyzed further using Orange Data Mining Tools to test the screening tool model used to predict TB in diabetic individuals. The total sample in this study …

New Approach To Mapping Regional Vulnerability In Controlling Tuberculosis Disease In Indonesia, Maria Holly Herawati, Asep Hermawan, Dasuki Dasuki, Hadi Supratikta, Al Asyary, M Rokhis Khomarudin, Muhammad Priyatna, Raflizar Raflizar, Kristina Kristina, Noer Endah Pracoyo, Dina Bisara, Cahya Tri Purnami, Mentari Nur Farida Suteja, Yusrial Bachtiar, Noor Edi Widya Sukoco, Doni Lasut

Kesmas

Tuberculosis (TB) in Indonesia is still a health problem. The TB prevalence in Indonesia ranks second in the world after India in 2023. Regional factors, inadequate healthcare facilities, and limited resources (financial, human, and infrastructure) are challenges requiring innovation to help the government control TB. TB eradication efforts need to be made with a comprehensive and effective approach. One method used is to look at the vast territory of Indonesia, therefore, mapping the TB disease vulnerability is a highly recommended method. The use of a Geographic Information System is expected to help map the TB vulnerability areas in Indonesia. Given …

How Housing Insecurity And Welfare Systems Retraumatize Women In Southern California, Yesika Menera

McNair Summer Research Program

Studies show that individuals experiencing homelessness and housing insecurity also experience trauma and mental illnesses. Despite this evidence, many resources provided through state welfare services seldom allocate sufficient funds and personnel to help address mental health. This study investigates the relationship between housing insecurity and trauma for adult women who have tried to access assistance throughout Southern California. To do this, I conducted in-depth interviews and DSM-5 questionnaires with twenty-six women during the summer of 2023 and 2024 via Zoom. My findings show that adult women who have experienced homelessness and housing insecurity in Southern California were more susceptible to …

Impact Of Efavirenz On Hormone-Positive Breast Cancer Survival In Women Living With Hiv, Arthur T Johnson, Taolo Ntloedibe, Jose Euberto Mendez Reyes, Mogomotsi S Matshaba, Scott L Dryden-Peterson, Elizabeth Y Chiao

Center for Medical Ethics and Health Policy Staff Publications

Women living with HIV and breast cancer have poorer survival than HIV-negative women. Efavirenz-estrogen interactions are documented; however, the survival impact is unknown. Survival between women with estrogen-receptor positive breast cancer taking efavirenz (n = 38) and nonefavirenz regimens (n = 51) were compared. The 5-year overall-survival was 48.9% [95% confidence interval (CI) 33.0-72.2 and 51.1% (95% CI 34.0-76.8)] in the efavirenz and nonefavirenz groups, respectively suggesting efavirenz is unlikely driving poorer survival in women living with HIV and estrogen-receptor positive breast cancer.

The Impact Of Clinical Genome Sequencing In A Global Population With Suspected Rare Genetic Disease, Erin Thorpe, Taylor Williams, Chad Shaw, Evgenii Chekalin, Julia Ortega, Keisha Robinson, Jason Button, Marilyn C Jones, Miguel Del Campo, Donald Basel, Julie Mccarrier, Laura Davis Keppen, Erin Royer, Romina Foster-Bonds, Milagros M Duenas-Roque, Nora Urraca, Kerri Bosfield, Chester W Brown, Holly Lydigsen, Henry J Mroczkowski, Jewell Ward, Fabio Sirchia, Elisa Giorgio, Keith Vaux, Hildegard Peña Salguero, Aimé Lumaka, Gerrye Mubungu, Prince Makay, Mamy Ngole, Prosper Tshilobo Lukusa, Adeline Vanderver, Kayla Muirhead, Omar Sherbini, Melissa D Lah, Katelynn Anderson, Jeny Bazalar-Montoya, Richard S Rodriguez, Mario Cornejo-Olivas, Karina Milla-Neyra, Marwan Shinawi, Pilar Magoulas, Duncan Henry, Kate Gibson, Samuel Wiafe, Parul Jayakar, Daria Salyakina, Diane Masser-Frye, Arturo Serize, Jorge E Perez, Alan Taylor, Shruti Shenbagam, Ahmad Abou Tayoun, Alka Malhotra, Maren Bennett, Vani Rajan, James Avecilla, Andrew Warren, Max Arseneault, Tasha Kalista, Ali Crawford, Subramanian S Ajay, Denise L Perry, John Belmont, Ryan J Taft

Center for Medical Ethics and Health Policy Staff Publications

There is mounting evidence of the value of clinical genome sequencing (cGS) in individuals with suspected rare genetic disease (RGD), but cGS performance and impact on clinical care in a diverse population drawn from both high-income countries (HICs) and low- and middle-income countries (LMICs) has not been investigated. The iHope program, a philanthropic cGS initiative, established a network of 24 clinical sites in eight countries through which it provided cGS to individuals with signs or symptoms of an RGD and constrained access to molecular testing. A total of 1,004 individuals (median age, 6.5 years; 53.5% male) with diverse ancestral backgrounds …

Readability And Suitability Of Local Disaster Preparedness Materials In Predominantly Hispanic Border Communities: A Case Study Of Cameron County, Texas, Katarzyna Sepielak, Dawid K. Wladyka

Sociology Faculty Publications

Community awareness is a key component of disaster resilience and numerous agencies developed a plethora of preparedness materials. Previous studies evaluated national-level resources and social media content indicating that these efforts are not effectively reaching vulnerable populations, as the information is provided at or above the secondary education level. However, the local-specific content has been mostly overlooked in the analyses, subsequently neglecting the needs of areas with specific demographics and hazards, like predominantly Hispanic border communities. Thus, this study turns to local preparedness and mitigation materials, rather than general internet searches or national level documents. We analyze information provided on …

Post-Trial Responsibilities In Pragmatic Clinical Trials: Fulfilling The Promise Of Research To Drive Real-World Change, Stephanie R Morain, P Pearl O'Rourke, Joseph Ali, Vasiliki Rahimzadeh, Devon K Check, Hayden B Bosworth, Jeremy Sugarman

Center for Medical Ethics and Health Policy Staff Publications

While considerable scholarship has explored responsibilities owed to research participants at the conclusion of explanatory clinical trials, no guidance exists regarding responsibilities owed at the conclusion of a pragmatic clinical trial (PCT). Yet post-trial responsibilities in PCTs present distinct considerations from those emphasized in existing guidance and prior scholarship. Among these considerations include the responsibilities of the healthcare delivery systems in which PCTs are embedded, and decisions about implementation for interventions that demonstrate meaningful benefit following their integration into usual care settings-or deimplementation for those that fail to do so. In this article, we present an overview of prior scholarship …

Assessing The Impact Of Tuberculosis On Economic Growth In Asean Countries: A Conceptual Framework And Panel Data Analysis, Agus Fitriangga, Alex Alex

Jurnal Ekonomi Kesehatan Indonesia

Tuberculosis (TB) remains a major global health issue, particularly in Southeast Asia, where its impact extends beyond public health to affect economic performance. This study evaluates the economic implications of TB incidence on gross domestic product (GDP) growth across eight ASEAN countries from 2000 to 2020. We employed a panel data regression approach, utilizing Common Effect Model (CEM), Fixed Effects Model (FEM), and Random Effects Model (REM) to analyze the relationship between TB incidence and economic growth. The dataset included annual GDP figures, TB incidence rates, foreign direct investment (FDI), labor force size, and trade openness, sourced from international databases. …

أثر منحنيات التعلم في تقليص فترة علاج كوفيد-19 وتخفيض التكاليف المباشرة لعلاجه دراسة ميدانية: مستشفى ابن الخطيب, مخلد فؤاد شجاع

Muthanna Journal of Administrative and Economics Sciences

هدف البحث الى بيان أثر منحنيات التعلم في تقليص فترة علاج كوفيد-19 وتخفيض تكاليف المباشرة من علاجه، ومنحنيات التعلم؛ واحدة من وظائف التكلفة غير الخطية، كونه عبارة عن دالة تقيس كيفية تخفيض ساعات العمل المطلوبة لإنجاز الوحدة المنتجة من خلال تراكم خبرة العاملين وتحسين أدائهم، إذ تعتمد منحنيات التعلم على فكرة مؤداها أن أداء أي عمل بشكل متكرر يؤدي الى اكتساب خبرة وهو الأمر الذي يؤدي الى تخفيض الوقت اللازم لإنجاز الوحدة المنتجة كلما استمر العمل، وقد توصل البحث الى مجموعة من الاستنتاجات كان أهمها؛ يمكن استخدام منحنيات التعلم لتقليل تكاليف علاج كوفيد-19 وتحسين الكفاءة الإنتاجية للعامين في المستشفيات من …

Lived Experiences, Perceptions, And Caregiving Trajectories Of Family Caregivers Of Youth With Substance Use Disorders (Suds) In Zambia, Ireen Manase Kabembo

Lingnan Theses (MPhil & PhD)

There is unequivocal evidence that family caregivers contribute to healthcare systems worldwide by providing care for persons with chronic illnesses in the home setting. his study explores the lived experiences, perceptions, and caregiving trajectories of 30 family caregivers of youth aged 16-24 diagnosed with Substance Use Disorders (SUDs) in Zambia. Data was collected through in-depth semi-structured interviews, a caregiving timeline, and participant observation and analysed using interpretative phenomenological analysis. Guided by the integrated theoretical framework of positioning theory and the theory of caregiving dynamics, this study offers a new lens for understanding caregiver’s experiences regarding caregiver identity, self-perceptions, interpersonal relationships, …

A Qualitative Descriptive Study Of Therapists And Their Work With Socially Isolated Female Victims Of Sexual Violence Amid The Covid-19 Pandemic, Iris Lazette Saldivar

Doctoral Dissertations and Projects

The purpose of this qualitative descriptive study was to assess the experiences of therapists and the descriptions of their navigation processes while working with female victims of sexual violence who were socially isolated during the COVID-19 pandemic in the state of Texas. The theory that guided this study was the theoretical framework of loneliness, social isolation, and associated health outcomes. The research study focuses on two research questions that sought to examine the experiences and navigation of virtual treatment of therapists who provided counseling during the COVID-19 pandemic from March 2020 to March 2022. This study sought to find a …

A Phase 2 Clinical Trial To Evaluate The Safety, Reactogenicity, And Immunogenicity Of Different Prime-Boost Vaccination Schedules Of 2013 And 2017 A(H7n9) Inactivated Influenza Virus Vaccines Administered With And Without As03 Adjuvant In Healthy Us Adults, Christina A Rostad, Robert L Atmar, Emmanuel B Walter, Sharon Frey, Jeffery L Meier, Amy C Sherman, Lilin Lai, Rachel Tsong, Carol M Kao, Vanessa Raabe, Hana M El Sahly, Wendy A Keitel, Jennifer A Whitaker, Michael J Smith, Kenneth E Schmader, Geeta K Swamy, Getahun Abate, Patricia Winokur, Wendy Buchanan, Kaitlyn Cross, Ashley Wegel, Yongxian Xu, Inci Yildirim, Satoshi Kamidani, Nadine Rouphael, Paul C Roberts, Mark J Mulligan, Evan J Anderson

Center for Medical Ethics and Health Policy Staff Publications

Introduction: A surge of human influenza A(H7N9) cases began in 2016 in China from an antigenically distinct lineage. Data are needed about the safety and immunogenicity of 2013 and 2017 A(H7N9) inactivated influenza vaccines (IIVs) and the effects of AS03 adjuvant, prime-boost interval, and priming effects of 2013 and 2017 A(H7N9) IIVs.

Methods: Healthy adults (n = 180), ages 19-50 years, were enrolled into this partially blinded, randomized, multicenter phase 2 clinical trial. Participants were randomly assigned to 1 of 6 vaccination groups evaluating homologous versus heterologous prime-boost strategies with 2 different boost intervals (21 vs 120 days) and 2 …

How Working Women In Healthcare Perceive Public Transportation And Safety, Assaaformbi Bama

Walden Dissertations and Doctoral Studies

Women use public transportation more frequently than do men. However, most of these transportation systems were not constructed with women in mind. Public transportation systems are accountable for securely transporting people to their destinations, as well as upkeeping protective policies to advocate for fearful passengers. The purpose of this qualitative study was to examine women’s perspectives on public transportation.The research question guiding this study asked women to discuss their safety experiences and needs related to existing public transportation policy. Cooley’s theory of transportation and Friedman’s public safety theory formed the conceptual framework for this study. Purposeful sampling was used to …

How Working Women In Healthcare Perceive Public Transportation And Safety, Assaaformbi Bama

Walden Dissertations and Doctoral Studies

Women use public transportation more frequently than do men. However, most of these transportation systems were not constructed with women in mind. Public transportation systems are accountable for securely transporting people to their destinations, as well as upkeeping protective policies to advocate for fearful passengers. The purpose of this qualitative study was to examine women’s perspectives on public transportation.The research question guiding this study asked women to discuss their safety experiences and needs related to existing public transportation policy. Cooley’s theory of transportation and Friedman’s public safety theory formed the conceptual framework for this study. Purposeful sampling was used to …

Embodying Whole Community Preparedness: A Case Study Of Student-Facing Preparedness Initiatives At Institutions Of Higher Education In The State Of Oregon, Francis Pastorelle

Dissertations and Theses

Over the last two decades, there has been a dramatic increase in natural and manmade disasters. While no community is immune to the risks posed by these large-scale emergencies, colleges, and universities, which are home to numerous vulnerable populations, could be counted among those most at risk. In their current state of overall community preparedness, campuses are not equipped to weather impending dangers; consequently, the impact on students could be disastrous. This study examined preparedness practices at Oregon colleges and universities to better understand how institutions of higher education in the state prepare their students for large-scale emergencies, what challenges …

Strengthening U.S. Jail Systems’ Response To Infectious Diseases: An Evaluation Of The Covid-19 Pandemic, Erinn Bacchus

Dissertations and Theses

Jails across the United States were struck with increased infections and deaths during the COVID-19 pandemic. Studies have shown the structural make up of jails, lack of preparedness plans, and overcrowding contributed to health risks and poor health outcomes both inside jails and local communities. Yet little research has been dedicated to strengthening jail responses to infectious disease outbreaks spanning prevention measures, data collection, and reentry planning. Gaps include information on the (1) myriad infectious disease mitigation strategies used in jails and adherence to CDC prevention guidelines, (2) development of a standardized epidemiologic surveillance system, and (3) experiences working at …

Management Overview Of The Lung Tuberculosis Control Program At The Dki Jakarta Provincial Health Office In 2023, Mutiara Kiranti, Helen Andriani

Journal of Indonesian Health Policy and Administration

Tuberculosis is one of the infectious diseases that is fatal if not cured immediately. In 2022, the success rate of tuberculosis treatment in DKI Jakarta Province is 81%, while the national target is 90%. In the field, the number of cadres to carry out contact investigations is still insufficient, so that in 2022 the coverage of contact investigations in DKI Jakarta Province will only reach 25%, while the national target is 90%. To increase the scope of successful treatment, the government should try to overcome tuberculosis, which is needed. Proper program management is required to run effectively and efficiently for …

Island Health Crisis: Bridging Gaps In Indonesia's Healthcare Deserts, Joyce Mangoma, Wahyu Sulistiadi

Journal of Indonesian Health Policy and Administration

This narrative literature review examines critical healthcare challenges in Indonesia's island communities, focusing on workforce shortages, inadequate health infrastructure, and the profound impact of geographical and socioeconomic factors. Drawing from eight studies published between January 2000 and December 2023, the discussion highlights both the strengths and weaknesses of existing research. The studies were selected based on their relevance to healthcare issues in island communities, rigorous methodological approaches, and significant insights into healthcare challenges and solutions. This time frame was chosen to encompass a comprehensive evolution of healthcare challenges and responses, particularly considering the effects of the COVID-19 pandemic. Grounded in …

Effectively Managing Communication After A Crisis: A Phenomenographic Study On Public Health Crises In The Country Of Jamaica, Jehan Donnique Wilson

Walden Dissertations and Doctoral Studies

Effectively managing communication after a crisis is the starting point of successful public policy and administration when handling a public health crisis. Jamaica has dealt with several public health crises over the span of its existence; this study compared SARS-CoV-2 (COVID-19) and influenza, two major Jamaican public health crises during the period from 2019 to 2022. This study’s research questions addressed (a) what specific communication strategies were used by Jamaica during the influenza outbreak as compared to the COVID-19 pandemic and (b) how the specific communications strategies used during the influenza outbreak and COVID-19 pandemic contributed to the development of …

Policy Practices And Countermeasures Analysis On Deep Integration Of Technological Innovation And Industrial Innovation, Defang He, Tao Chen, Hui Liu, Fangjuan Yang

Bulletin of Chinese Academy of Sciences (Chinese Version)

Technological innovation serves as the strategic foundation for driving high-quality development and building a modern industrial system. To compete for global leadership in science, technology, and industrial advancement, major economies worldwide are reshaping their policy frameworks to accelerate the development of cutting-edge technologies and future industries. This study analyzes the intrinsic mechanisms and policy evolution of the integration between technological innovation and industrial innovation. By examining domestic and international case studies—such as integrated circuits, mRNA vaccines, new energy vehicles, and photovoltaics—it reveals how strategic guidance and policy coordination facilitate the convergence of innovation chains and industrial chains. Furthermore, the study …

Secrets Of The Medicine Cabinet: How Big Pharma's Information Monopoly Influences Federal Public Health Regulations, Kyle James

Culture, Society, and Praxis

Pharmaceutical companies are the largest industry contributor to political activities in the United States. Instead of pursuing traditional routes of political influence, these firms concentrate their efforts within federal public health agencies. By directly intervening in the regulatory process, Big Pharma assumes control of the drug approval process, dictating the means by which pharmaceutical products enter the marketplace. This scheme is designed to strip agencies of their public interest mandate. The resulting political phenomenon, known as regulatory capture, creates a symbiotic relationship where federal agencies and industry mutually benefit from the swift commercialization of drugs. This thesis examines "how" Big …

The Impact Of Turnover And Turnover Intentions On Nigeria's Public Health Administration, Albert Abani Uduma

Walden Dissertations and Doctoral Studies

High turnover creates a vicious cycle that affects employees with further shortages and turnover. This study explored the lived experiences and perceptions of a government employer and employees about turnover, turnover intentions, and the government’s leadership effectiveness using Heidegger’s phenomenological research methods. The theoretical frameworks that grounded the study were Herzberg’s motivation-hygiene theory, public service motivation theory, and corporate social responsibility theory. The study questions focused on stakeholders’ perceptions and lived experiences of the government’s leadership effectiveness in addressing the impacts of high turnover, as well as the employees’ consequent reactions to the government’s leadership approach. Participant data were collected …

State Policies On Maternal And Infant Health In The United States, Heeun Kim

Legacy Theses & Dissertations (2009 - 2024)

In the United States (US), state-level policies are critical structural determinants of maternal and infant health outcomes. State policies profoundly affect prenatal care utilization and pregnancy outcomes, particularly among marginalized pregnant persons with stigmatized health conditions. In this three-paper dissertation, I focus on two closely interrelated policies that aim to address significant public health concerns in the US: prenatal syphilis screenings and the criminalization of prenatal substance use. My research revolves around two central questions: First, do these policies effectively improve the pregnancy outcomes of high-risk populations, or do they cause unintended consequences? Second, if challenges in policy design and …

Using Strategic Planning To Improve Volunteer Recruitment And Retention For Nonprofits In The Post-Pandemic Era, Antonio L. Mccormack

Walden Dissertations and Doctoral Studies

COVID-19 has changed U.S. culture and negatively affected society worldwide, especially nonprofit organizations that provide community service. Since the pandemic, nonprofit agencies encountered many hardships, especially with the loss of personnel, primarily volunteers. The present study focused on implementing ways to improve recruitment and retention of volunteers for nonprofit organizations in the post-pandemic era through strategic planning. A qualitative approach was deemed the most feasible to conduct this study. This study utilized a SWOT analysis approach, a method of strategic planning used to collect data. A total of 10 interviews were conducted to explore the strengths, weaknesses, opportunities, and threats …

Family Medicine’S Role In Addressing The Intersections Of Redlining And Climate Change, Daryl O. Traylor, Eboni E. Anderson, Brianna Clark, Alex M. Smith, Cooper K. Allenbrand

Journal of Sustainable Social Impact

Redlining, the practice of discriminating against specific neighborhoods based on race and socioeconomic status, leads to persistent environmental hazards and socioeconomic inequalities that have lasting adverse health effects on their populations. Health disparities are further exacerbated through the concentration of environmental hazards, as well as the escalating impact of climate change, which poses an increased risk of respiratory illness, cardiovascular disease, mental health issues, heat-related illness, infectious diseases, food insecurity, and socioeconomic difficulties in redline neighborhoods.

This paper examines the interplay of redlining, climate change, and health disparities, with an emphasis on the enduring consequences for these marginalized communities. Through …