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Articles 9361 - 9390 of 139640
Full-Text Articles in Entire DC Network
Virtual Breast Cancer Clinic: An Innovative Interactive Educational Curriculum, Jackie Nemunaitis, Shenthol Sasankan, Zoneddy Dayao
Virtual Breast Cancer Clinic: An Innovative Interactive Educational Curriculum, Jackie Nemunaitis, Shenthol Sasankan, Zoneddy Dayao
HSC Education Days
BACKGROUND: Many oncology fellows are unable to spend an adequate time in a breast cancer clinic to fully grasp the practice. The limited cases seen by fellows rarely span the full breadth of typical clinical scenarios and treatment plans are lengthy, nuanced, and complex. RESEARCH QUESTION: Will the creation of an interactive virtual breast cancer clinic, using real patient cases, improve fellow understanding of important breast cancer concepts, as determined by the American Society of Clinical Oncology Self-Evaluation Program (ASCO-SEP)? METHODS: The course consists of 6 weekly, 1 hour sessions. We established the curriculum based on guidelines from the National …
A Kidney Biopsy Simulation Training Program For Renal Fellows: Two Years Of Results, Maria-Eleni Roumelioti, Jonathan Owen, Christos P. Argyropoulos, Yue-Harn Ng, Mark L. Unruh
A Kidney Biopsy Simulation Training Program For Renal Fellows: Two Years Of Results, Maria-Eleni Roumelioti, Jonathan Owen, Christos P. Argyropoulos, Yue-Harn Ng, Mark L. Unruh
HSC Education Days
Renal interventions could re-foster interest in Nephrology and attract more medical graduates. Percutaneous kidney biopsy (PKB) is an important diagnostic tool and should be taught through simulation. We initiated a PKB simulation training program and designed a 2-year study to examine its effect on the confidence level, the procedural competence and the satisfaction with this training of Nephrology fellows compared to historical controls. All fellows were consented and trained at UNM’s simulation center (BATCAVE) with a simulation training model (CAE Healthcare Blue PhantomTM). Trainees’ demographics and previous PKB experience were collected. We utilized pre-assigned readings, online videos and …
Measurement-Based Treatment To Target For Depression: Use Of Phq-9 In Primary Care, Poone Haghani Tehrani
Measurement-Based Treatment To Target For Depression: Use Of Phq-9 In Primary Care, Poone Haghani Tehrani
HSC Education Days
Measurement-based treatment is increasingly used for common behavioral health conditions, like depression. The screeners help identify people who may not otherwise be recognized as needing care. They also help to find out whether the symptoms are improving, and which specific symptoms are or are not improving. Treatment to target means that we adjust our treatment plan based on symptom measures until we reach 50% reduction (response to treatment.) This prevents treatment inertia as it helps the provider and the patient to know if the patient is having a full response, partial response, or no response. One of the screeners is …
Does Peer Education Affect Our Prescribing Practice? Impact Of Educational Intervention On The Prescribing Of Medication Assisted Treatment For Alcohol Use Disorder, Anna Garcia, Eileen Barrett
Does Peer Education Affect Our Prescribing Practice? Impact Of Educational Intervention On The Prescribing Of Medication Assisted Treatment For Alcohol Use Disorder, Anna Garcia, Eileen Barrett
HSC Education Days
BACKGROUND: Alcohol use disorders (AUD) are a common problem in the U.S and are associated with increased rates of early mortality and substantial morbidity. AUD and related complications are a common reason for ED visits, hospital admission, and readmission. Medication assisted treatment of AUD is effective, safe and evidence-based. Nationally and in New Mexico, effective treatment for AUD is underused. Numerous studies have demonstrated the utility of naltrexone and acamprosate, both FDA approved for the treatment of AUD. The hallmark meta-analysis highlighting the benefits of these medications was published in 2014 and there were multiple UNM hospitalist educational events on …
Turning From Deficits To Strengths: Teaching Students A Strength-Based Approach To Clinical Care And Community Health, Anthony Fleg
Turning From Deficits To Strengths: Teaching Students A Strength-Based Approach To Clinical Care And Community Health, Anthony Fleg
HSC Education Days
Asset Mapping is a well-recognized approach to clinical and community health, championed by the fields of social work and public health. In the field of medicine, an approach that is focused on disease, deficits, deficiencies, addictions, etc. is the dominant model, leading to interventions that fail to incorporate strengths that could contribute to the care plan. Strength-based approaches to clinical and community health will improve efficacy of interventions, increase student/provider satisfaction with their work, and is a method toward addressing health inequities. In this presentation, we will explore ways that UNM faculty are utilizing this approach in teaching health-professions students.
Longitudinal Evaluation Of Pediatric Residency Didactics Transition From Noon Conference To An Academic Half Day, Claire Zeorlin, Kristel Montano, Anne Greene, Alfonso Belmonte, Amy Staples, Walter Dehority, Christal Chow, Taylor Ford, Yiliang Zhu
Longitudinal Evaluation Of Pediatric Residency Didactics Transition From Noon Conference To An Academic Half Day, Claire Zeorlin, Kristel Montano, Anne Greene, Alfonso Belmonte, Amy Staples, Walter Dehority, Christal Chow, Taylor Ford, Yiliang Zhu
HSC Education Days
BACKGROUND: In 2009, the UNM Pediatric Residency transitioned program didactics from noon conference to an academic half day. Immediate evaluation of resident and faculty satisfaction, resident attendance, board exam pass rate and In-Training-Exam (ITE) scores showed improvements with this change. OBJECTIVE: Investigate the longitudinal impact of the academic half day at UNM on resident and faculty satisfaction, resident attendance and clinical knowledge in the form of standardized exam results. METHODS: In this mixed-methods study, surveys regarding satisfaction were conducted of current pediatric residents (n=32) and faculty (n=32) at UNM. To assess clinical knowledge, quantitative measures such as senior resident ITE …
Comparing Critical Thinking Outcomes In 1st-Year Occupational Therapy Problem-Based Learning Groups Using Six Thinking Hats Strategy, Carla Wilhite, Soumyajit Chakraborty
Comparing Critical Thinking Outcomes In 1st-Year Occupational Therapy Problem-Based Learning Groups Using Six Thinking Hats Strategy, Carla Wilhite, Soumyajit Chakraborty
HSC Education Days
PROBLEM STATEMENT: Contemporary occupational therapy graduate students participating in PBL are not maximizing development of critical thinking skills before entry into professional education. Hypothesis: There will be a difference between students receiving a critical thinking teaching intervention in PBL, compared to those who do not receive the intervention, as measured by the Health Sciences Reasoning Test. OBJECTIVES 1. OT Graduate students will demonstrate improved performance in critical thinking skills after receiving an explicit teaching intervention in developing improved critical thinking skills, within 12 months, as measured pre/post by the HSRT. RESULTS: Analysis of data is in progress, tentative results will …
Choosing Wisely At Unm School Of Medicine, Nardos Dawit, Mary Lacy, Ryen Ormesher
Choosing Wisely At Unm School Of Medicine, Nardos Dawit, Mary Lacy, Ryen Ormesher
HSC Education Days
The cost of healthcare in the United States is rising and consumes around 20% of our GDP. High costs of care negatively impact patients as well as our healthcare system. High-value care is a movement aimed at balancing clinical benefit with cost, with the goal of improving patient outcomes. Prior to this, there have been no organized efforts to introduce pre-clinical medical students to issues of cost and value at UNM SOM. Last year at UNM, two first-year medical students were accepted into the national Choosing Wisely STARS (Students and Trainees Advocating for Resource Stewardship) program and received faculty mentorship …
Does Patient Age And Criticality Affect The Paramedic Student's Opportunity To Be A Team Leader?, Josh Lopez, John Meyer, Adam Alford, Elizabeth Todak, Kyra Wicklund, Kevin Loughlin, William Camarda, Marilee Rosensweig, Lynne Fullerton, William Robertson
Does Patient Age And Criticality Affect The Paramedic Student's Opportunity To Be A Team Leader?, Josh Lopez, John Meyer, Adam Alford, Elizabeth Todak, Kyra Wicklund, Kevin Loughlin, William Camarda, Marilee Rosensweig, Lynne Fullerton, William Robertson
HSC Education Days
Throughout various health-professions education, it is common for student learners to follow preceptor experts in the clinical environment. Depending on the profession, some students may encounter various age groups and various severities of patient presentations. This research in emergency medical services (EMS) education sought to investigate whether the age and acuity of the patient influences the paramedic student’s opportunity to act as a team leader during pre-hospital internship experiences. A retrospective review of student records in FISDAP, a national online EMS student tracking system, was completed. 537,343 patient encounters among 5,720 students from January 2010 to December 2018 were analyzed; …
Assessing Interprofessional Education, Heidi Honegger Rogers, James Nawarskas
Assessing Interprofessional Education, Heidi Honegger Rogers, James Nawarskas
HSC Education Days
The National Center for Interprofessional Practice and Education states that number one expressed need from educators, practitioners, and researchers regarding interprofessional education (IPE) is about measuring IPE and its effectiveness. Unfortunately, there is no simple solution to assessing IPE since every setting has unique measurement needs and, even within a setting, these needs may change at different times with different groups for different purposes. While this presentation will not recommend which IPE outcomes to measure or which tools to use, it will provide guidance on what to look for when selecting an assessment instrument and will provide foundational information and …
Developing A Structured Training On Responding To Discrimination From Patients, Eileen Barrett, Krystle Apodaca
Developing A Structured Training On Responding To Discrimination From Patients, Eileen Barrett, Krystle Apodaca
HSC Education Days
Discrimination against clinicians is increasingly common. Few educational opportunities exist on how to respond to discrimination from patients and visitors. The authors developed and presented an interactive training on this problem, potential strategies for how to respond, and creating solutions. During an educational meeting, faculty presented a video about Times Up Healthcare then participants read a JAMA article about discrimination and the need for allies to speak up. Participants then engaged in think-pair-share on the article and experiences with speaking up. Next, faculty presented a peer-reviewed journal article on a qualitative analysis of semi-structured interviews that provides a framework for …
A Tale Of Two Classrooms: Academic Consistency In Team Teaching Using A Flipped Classroom On Two Campuses With Different Cohort Sizes, Laura Vanyo, Maggie Faber
A Tale Of Two Classrooms: Academic Consistency In Team Teaching Using A Flipped Classroom On Two Campuses With Different Cohort Sizes, Laura Vanyo, Maggie Faber
HSC Education Days
As the College of Nursing continues to expand enrollment, innovative instructional methods that ensure consistency and quality in education are imperative. Last year, the Bachelor of Science in Nursing program began a pilot to offer the same program at the Rio Rancho campus. This poster discusses the experience of two faculty with diverse specialties, one certified in obstetrics and one in progressive/critical care, who team-taught the level two course, Nursing 351: Health and Illness Concepts 1. The challenge was to provide active, multisensory learning that was consistent between two instructors, across two campuses, for a wide variety of course concepts. …
2019 Update: Developing Quality Interprofessional Education For The Health Professions, James Nawarskas, Heidi Honegger Rogers
2019 Update: Developing Quality Interprofessional Education For The Health Professions, James Nawarskas, Heidi Honegger Rogers
HSC Education Days
In order to provide quality and cost-effective care, health professionals must be better prepared to lead and collaborate in interprofessional teams. This is the foundation for interprofessional education (IPE), which is a required element for the accreditation of many health professions programs. The Health Professions Accreditors Collaborative (HPAC) recognizes that accreditation must play an important role promoting quality IPE that leads to effective health outcomes, including encouraging communication and collaboration across professions and the institutions that sponsor educational programs. In February 2019, HPAC developed a document in collaboration with the National Center for Interprofessional Practice and Education to provide guidance …
Improving Obstetric Ultrasound Interpreting And Reporting Through A Faculty Mentorship Program For Fellows, Trevor Quine, William Rayburn
Improving Obstetric Ultrasound Interpreting And Reporting Through A Faculty Mentorship Program For Fellows, Trevor Quine, William Rayburn
HSC Education Days
PROBLEM STATEMENT: To evaluate whether a regularly scheduled weekly engagement/mentorship by a Maternal-Fetal Medicine (MFM) senior faculty member and fellow led to improved ultrasound reporting and collection of pertinent scientific literature for learning by other fellows and faculty. METHODS: The MFM fellow met weekly with the same MFM faculty member. Improvement by the fellow was measured for each report: time to completion, accuracy and adequacy of the impression, clarity of the recommendation, and feedback from the faculty and referring practitioner. Peer-reviewed manuscripts relating to obstetric ultrasound were collected based on topics determined weekly. RESULTS: The fellow adhered to the one …
Virtual Reality Lab: Getting Real About Educational Technology At Your Library, Timothy Mey, Kristin Proctor, Porcia Vaughn, Amy Weig-Pickering
Virtual Reality Lab: Getting Real About Educational Technology At Your Library, Timothy Mey, Kristin Proctor, Porcia Vaughn, Amy Weig-Pickering
HSC Education Days
This poster will introduce the Health Sciences Library and Informatics Center’s Virtual Reality Lab, a new service brought online by the library in November 2018. HSLIC hopes to promote this new emerging technology and to further the collaboration between HSC departments and the library. This poster will highlight existing use cases at HSLIC as well as use cases in other schools/programs. The library hopes that this presentation will encourage the use of existing virtual reality applications in HSC curricula and serve to open a dialogue regarding possible future projects to develop custom applications. Participants can expect to leave this presentation …
Impact Of An Advanced Cardiac Life Support Process Improvement Initiative On Leadership Role Comfort, Madison Fletcher, Annaleigh Boggess, Danielle Albright, Kim Bolton, Jessica Fontanez, Tatsuya Norii
Impact Of An Advanced Cardiac Life Support Process Improvement Initiative On Leadership Role Comfort, Madison Fletcher, Annaleigh Boggess, Danielle Albright, Kim Bolton, Jessica Fontanez, Tatsuya Norii
HSC Education Days
Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the Emergency Department (ED) requires optimized advanced cardiac life support (ACLS). An ACLS leader monitors compressions, orders medications, performs rhythm checks, directs defibrillation, and times events. This role was reassigned from physicians to nurses. Nurse led ACLS may allow physicians to assess ECPR inclusion criteria. There is limited research on ACLS leader role comfort for nurses. We hypothesized an ECPR initiative in the ED would improve personnel comfort in the ACLS leader role. ECPR initiative implementation included didactics and simulation training. A survey was distributed to ED residents, attending physicians, and nurses, and included six …
Predictors And Barriers To Faculty Scholarly Activity In United States Urology Residency Programs, David Gangwish, Martin Jurado, Carolyn A. Parshall, Fares Qeadan, Frances M. Alba
Predictors And Barriers To Faculty Scholarly Activity In United States Urology Residency Programs, David Gangwish, Martin Jurado, Carolyn A. Parshall, Fares Qeadan, Frances M. Alba
HSC Education Days
OBJECTIVE: To determine factors associated with scholarly activity among faculty members at urology residency programs. METHODS: An online survey was sent to all urology residency program directors. The survey assessed program characteristics, support and barriers for scholarly activity, and faculty participation in research and mentorship of residents. A linear regression analysis was used to identify the factors associated with faculty scholarship. Scholarly activity was defined as original research studies, systematic reviews, meta-analyses, case series and case reports. RESULTS: The survey was sent to 134 programs with a 36% response rate. Faculty attitudes toward conducting scholarly activity and lack of formal …
Tracking Student Progress Across The Curriculum, Tiffany Enache
Tracking Student Progress Across The Curriculum, Tiffany Enache
HSC Education Days
Monitoring students’ progress across the curriculum serves several purposes: to ensure successful progression through the curriculum; to provide support to students who are not progressing successfully; to develop remediation plans for students that are trending below expectations; and to institute disciplinary action for performance issues. This presentation is designed to inspire faculty to base student-progress decisions on reliable and thorough evidence. When a mechanism is developed to record this data in an accurate and comprehensive manner, the need to discuss individual students at faculty meetings is diminished. This saves the faculty time and preserves student rights and dignity. The UNM …
The Influence Of A Clinical Course-Based Undergraduate Research Experience On Career Choice, Silas Bussmann, Danielle Albright, Lynne Fullerton
The Influence Of A Clinical Course-Based Undergraduate Research Experience On Career Choice, Silas Bussmann, Danielle Albright, Lynne Fullerton
HSC Education Days
Course-based undergraduate research experiences (CUREs) involve students in scientific research projects. CUREs may improve student retention, critical thinking and gender and racial diversity in the sciences. Undergraduates who participate in the design, conduct and dissemination of research results report positive outcomes including the intention to pursue graduate education or careers in science. In 2012, the UNM Department of Emergency Medicine began offering the Research in Acute Care (RAC) course track, a clinic-based CURE in human subject research (HSR). This research evaluates the impact of RAC course track on student career plans. We asked 193 current and former RAC students to …
Physical Activity In Matriculating And Senior Medical Students, Ethan Praire, Nancy Shane, Elizabeth C. Lawrence
Physical Activity In Matriculating And Senior Medical Students, Ethan Praire, Nancy Shane, Elizabeth C. Lawrence
HSC Education Days
BACKGROUND: Physical Activity (PA) has been correlated to lower burnout rates and higher quality of life in medical students. This study looks to assess PA during certain phases of medical education and its correlation to burnout, quality of life and self-care. METHODS: The University of New Mexico School of Medicine (UNM SOM) Medical Student Wellness Survey is administered to all medical students at matriculation, at the end of year 1 and at the end of year 3. This survey includes information on PA, burnout, quality of life, and self-care. PA was assessed in accordance with the Center for Disease Control …
Developing A 3-Credit Intensive Online Wound Care Elective, Debra Serrino
Developing A 3-Credit Intensive Online Wound Care Elective, Debra Serrino
HSC Education Days
Wound Care is introduced to pre-baccalaureate nursing students in Level 3 of their five-level nursing education. This has been a 2-hour lecture, followed by 2 hours of clinical focusing on dressings and practicing wound care on a manikin. The BSN students along with the Wound Care teams at UNMH and the VA expressed a desire to provide more education for interested students. This course is a work in progress; taught twice in 2019 in a 7-week intensive format. RN-BSN students and Level 3 and above pre-baccalaureate nursing students have enthusiastically signed up for the courses. The final project requires them …
Standardized Patient Assessment Of Communications In Pharmacy And Medical Students, James Nawarskas, Mikiko Takeda, Patricia Marshik, Alexandra Herman, Mary Vilay, Krista Salazar, Audrey Bobick, Edward Fancovic
Standardized Patient Assessment Of Communications In Pharmacy And Medical Students, James Nawarskas, Mikiko Takeda, Patricia Marshik, Alexandra Herman, Mary Vilay, Krista Salazar, Audrey Bobick, Edward Fancovic
InterProfessional Education Research and Scholarship
Use of activities (i.e. objective structured clinical examinations, or OSCEs) involving standardized patients (SPs) is a commonly used method of assessing communication skills in health sciences education is through the. The use of SPs was associated with higher scores on communications assessments and significant improvements on many subsections of a communications assessment tool in pharmacy students. However, these studies used faculty (not the SPs) to assess the students. While the use of SPs as direct evaluators of communication skills is recognized in medical education it is poorly defined in pharmacy education. In addition, interprofessional education (IPE) environments (including the one …
Interactive Telehealth Video Visits: A New Age For Osces, Therese Hidalgo, Kristen Ostrem-Niemcewicz
Interactive Telehealth Video Visits: A New Age For Osces, Therese Hidalgo, Kristen Ostrem-Niemcewicz
HSC Education Days
Healthcare in New Mexico is changing with the authorization of insurance reimbursement for telehealth. In order to prepare graduates to provide this care the College of Nursing has added video visit simulations to our Objective Structured Clinical Evaluation (OSCE) program. OSCEs have been extensively used in health science undergraduate and graduate programs across the country, demonstrating a high correlation with actual clinical skills and are crucial in the preparation of competent providers. Scarcity of suitable clinical sites, the high cost of faculty-led site visits, and the variability of clinical experiences create barriers for equitable evaluation of clinical performance. These challenges …
An Assessment Of Alcohol Use Patterns Amongst Medical Students At The University Of New Mexico School Of Medicine, Aaron Scarpa, Michael Castle, Ian Fletcher, Elizabeth Lawrence
An Assessment Of Alcohol Use Patterns Amongst Medical Students At The University Of New Mexico School Of Medicine, Aaron Scarpa, Michael Castle, Ian Fletcher, Elizabeth Lawrence
HSC Education Days
BACKGROUND: The alcohol consumption patterns of physicians impacts the health of their patients. How much a physician drinks influences how they counsel patients about alcohol use and how they define safe and acceptable patterns of use. In addition, physicians with alcohol use disorder are at greater risk for making medical errors. 15.3% of American physicians meet criteria for alcohol dependence or abuse. Female physicians are more likely than their male counterparts to meet this diagnostic criteria (21.4% of female physicians vs. 12.9% of male physicians). U.S. medical students are known to engage in excessive use of alcohol. One study concluded …
The Current State Of Undergraduate Nursing Education In New Mexico: Multiple Pathways, Benefits & Outcomes, Judy Liesveld, Mary Wright, Becky Dakin
The Current State Of Undergraduate Nursing Education In New Mexico: Multiple Pathways, Benefits & Outcomes, Judy Liesveld, Mary Wright, Becky Dakin
HSC Education Days
The New Mexico Nursing Education Consortium (NMNEC) is celebrating their 10th year! NMNEC has successfully built a statewide coordinated system of nursing education. This poster will explain the progression of efforts including: 1. Development of a common statewide undergraduate nursing curriculum and course numbering system, 2. Funding efforts, 3. University/Community College Partnerships, 4. Curricular Integrity/Fidelity/Concept Reviews, 4. Legislative Support. We will inform participants of the current state of undergraduate nursing education in New Mexico today: the multiple pathways into nursing education, the benefits, and the outcomes.
Standardized Patient Assessment Of Communications In Pharmacy And Medical Students, James Nawarskas, Mikiko Takeda, Patricia Marshik, Alexandra Herman, Mary Vilay, Krista Salazar, Audrey Bobick, Edward Fancovic
Standardized Patient Assessment Of Communications In Pharmacy And Medical Students, James Nawarskas, Mikiko Takeda, Patricia Marshik, Alexandra Herman, Mary Vilay, Krista Salazar, Audrey Bobick, Edward Fancovic
HSC Education Days
Use of activities (i.e. objective structured clinical examinations, or OSCEs) involving standardized patients (SPs) is a commonly used method of assessing communication skills in health sciences education is through the. The use of SPs was associated with higher scores on communications assessments and significant improvements on many subsections of a communications assessment tool in pharmacy students. However, these studies used faculty (not the SPs) to assess the students. While the use of SPs as direct evaluators of communication skills is recognized in medical education it is poorly defined in pharmacy education. In addition, interprofessional education (IPE) environments (including the one …
Appropriate Use Criteria For Echocardiography, Karla B. Almaraz, Jeromy P. Yatskowitz, Andy Huang, Alexander J. Vold
Appropriate Use Criteria For Echocardiography, Karla B. Almaraz, Jeromy P. Yatskowitz, Andy Huang, Alexander J. Vold
HSC Education Days
Transthoracic Echocardiography (TTE) is one of the most common diagnostic imaging tests used in Cardiology. It is portable, noninvasive and provides important data regarding diagnosis and management of many cardiac conditions. In recent years TTE has had an increased in popularity for its use in both inpatient and outpatient settings. This has resulted in an increase of inappropriate use leading to overutilization of resources. At our institution, University of New Mexico Hospitals we evaluated the prevalence rate of appropriateness of TTE with a quality improvement project. During the first phase of the project 100 TTEs each were randomly selected in …
2019 Update: Developing Quality Interprofessional Education For The Health Professions, James Nawarskas, Heidi Honegger Rogers
2019 Update: Developing Quality Interprofessional Education For The Health Professions, James Nawarskas, Heidi Honegger Rogers
InterProfessional Education Research and Scholarship
In order to provide quality and cost-effective care, health professionals must be better prepared to lead and collaborate in interprofessional teams. This is the foundation for interprofessional education (IPE), which is a required element for the accreditation of many health professions programs. The Health Professions Accreditors Collaborative (HPAC) recognizes that accreditation must play an important role promoting quality IPE that leads to effective health outcomes, including encouraging communication and collaboration across professions and the institutions that sponsor educational programs. In February 2019, HPAC developed a document in collaboration with the National Center for Interprofessional Practice and Education to provide guidance …
10-08-19 Hsc Committee Meeting Agenda, Hsc Committee
10-08-19 Hsc Committee Meeting Agenda, Hsc Committee
HSC Committee (A subcommittee of the UNM Board of Regents)
No abstract provided.
20191003_Our First Bullet Journaling Event And Changes To Come, Kelleen Maluski
20191003_Our First Bullet Journaling Event And Changes To Come, Kelleen Maluski
HSLIC Blog Post
No abstract provided.