Medicine and Health Sciences Commons^™

International Accreditation For Acute Stroke Care: Lessons Learnt From A Kenyan Stroke Centre, Dilraj Sokhi

Internal Medicine, East Africa

Background: The prevalence of stroke is increasing in Africa, yet resources remain limited in managing the disease. Whilst there are international guidelines on how to set up and manage stroke services, even in resource-limited settings, the uptake remains low. We describe here the opportunities and challenges we faced whilst setting up a stroke care pathway of international standards in a regional referral hospital in East Africa.

Methods: We describe how we adapted international stroke care guidelines for acute primary stroke (including both ischemic and hemorrhagic stroke), and used these to inform our stroke care pathway. We highlight opportunities of leveraging …

Prevalence And Factors Associated With Depression, Anxiety And Post-Traumatic Stress Disorder Among Healthcare Workers From Sub-Saharan Africa: Systematic Review, Ezra Too, Peninah Wachira, Solomon Njenga, Sabina Odero, Eunice Ndirangu, Amina Abubakar

Institute for Human Development, East Africa

Background: Depression, anxiety and post-traumatic stress disorder (PTSD) are prevalent among healthcare workers (HCWs), including those from sub-Saharan Africa (SSA). However, there are limited summary data on the burden and factors associated with these disorders in this region. We conducted this systematic review (registration no. CRD42022349136) to fill this gap.

Aims: The aim of this review was to systematically summarise the available evidence on the prevalence and factors associated with depression, anxiety and PTSD, or their symptoms, among HCWs from SSA.

Method: We searched African Index Medicus, African Journals Online, CINAHL, PsycINFO and PubMed for articles published, from database inception …

Fetal Myocardial Performance Index In The Late Third Trimester For The Prediction Of Intrapartum Cardiotocographic Abnormalities, Sikolia Wanyonyi, Ingrid Gichere

Obstetrics and Gynaecology, East Africa

Objective

We sought to determine whether fetal myocardial performance index (MPI) performed in the late third trimester could predict abnormal intrapartum cardiotocographic (CTG) patterns.

Methods

A prospective observational study including women presenting for fetal growth ultrasound from 32 weeks. Three consecutive measurements of the left ventricular MPI were obtained and averaged. The patients’ intrapartum CTG events were later observed.

Results

A total of 299 women were analyzed. The fetal MPI across the population were 0.41, 0.50 and 0.63, representing 10th, 50th and 90th centiles, respectively. A one-way analysis of variance (ANOVA) did not show a significant difference in MPI values …

Looking Beyond Hospital Discharge: One-Year Mortality Following Tracheostomy Creation In Traumatically Injured Older Adults, Heather R Kregel, Jan-Michael Van Gent, Fatimah Sunez, Michael W Wandling, Krislynn M Mueck, Bryan A Cotton, David E Meyer, Laura J Moore, Lillian S Kao, Thaddeus J Puzio

Faculty, Staff and Student Publications

Introduction: We aimed to evaluate long-term outcomes following tracheostomy in older trauma patients and hypothesized that 1-year survival decreases with older age.

Methods: This was a descriptive analysis of intensive care unit patients ≥65 y old who underwent tracheostomy from 2015 to 2020. The National Death Index was accessed to determine time from tracheostomy creation to death. Groups were categorized by age. The primary outcome was 1-year mortality. Survival by age strata was analyzed using the Kaplan-Meier method.

Results: Of 205 eligible patients, 125 (61%) were 65-74, 68 (33%) were 75-84, and 12 (6%) were >85 y old. Median injury …

Monitoring Nutrition Security: Perspectives From A Workshop On Nutrition Security Measurement, Ximena Perez-Velazco, Edward A. Frongillo Jr. Ph.D., Joanne F. Guthrie, Alisha Coleman-Jensen, Mariah D. Ehmke, Christian Gregory, Hilary K. Seligman

Faculty Publications

Nutrition security, an emerging concept distinct from and complementary to food security, has gained increasing interest as a focus of efforts to reduce hunger, improve nutrition, and prevent diet-related health conditions. Yet, unlike food security, which has well-established measures, nutrition security lacks standardized measures for assessment. This gap hinders the ability to evaluate progress in improving nutrition security both in the United States and globally. In September 2024, a workshop to explore how to measure nutrition security was hosted by the United States Department of Agriculture Economic Research Service, in collaboration with the Southern University Agricultural Science Center of Excellence …

Social Determinants Of Health In Lesbian, Gay, Bisexual, Transgender, Queer, And Other Sexual And Gender Minority (Lgbtq+) Older Adults: Impact Of Socioeconomic Disadvantage On Inpatient Hospitalizations, Jennifer T. May Phd, Rn, Anp-Bc, Devon Noonan, Susan G. Silva

Publications

Introduction Little is known about the impact of socioeconomic disadvantage on lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) older adults (≥50 years). The aim of this study is to determine whether the distribution of LGBTQ+ inpatient hospitalizations are related to structural socioeconomic factors. Methods A secondary analysis of retrospective electronic health record data for LGBTQ+ older adults hospitalized from 2018 to 2022 was conducted at one large health system. The average county area deprivation index where the patient resided was calculated. Results The analysis included 2270 LGBTQ+ older adult inpatient hospitalizations, with 1508 (66.4%) from …

Bridging Gaps In Breast Cancer Care: A Breast Cancer Care Quality Index To Improve Outcomes Worldwide, Eduardo Cazap, Benjamin Anderson, Giuseppe Curigliano, Sandeep Sehdev, Fatima Cardoso, Ana Gonzalez, Emad Shash, Cheng-Har Yip, André Mattar, Miriam Mutebi

General Surgery, East Africa

Background: Breast cancer (BC) care faces challenges in early detection, timely diagnosis and comprehensive management. Disparities persist, with underserved populations facing the greatest barriers. Addressing these requires policies that support consistent, evidence-based practices and enhance healthcare capacity and technology advancements. This document presents the development of the Breast Cancer Care Quality Index (BCCQI), supported by evidence to promote equitable care and improve BC outcomes globally, and discusses its adoption as a strategic tool within National Cancer Control Plans.

Methods: A two-part methodology identified challenges in BC care and defined dimensions, targets and indicators for the BCCQI, aligned with …

Human Physiology And Exercise Physiology Syllabus, Jean-Philippe Berteau

Open Educational Resources

No abstract provided.

Fractures In Parkinson's Disease: Pathophysiology, Prevention, And Orthopedic Outcomes., Ali Osman, Tala Maya, Rayyan Bhutta, Natasha Doshi, Maryam Khan, Sara Shah, Paslene Periceles, Janae Rasmussen

Surgery Articles

Fractures are an important comorbidity in Parkinson's disease (PD), which can result in disability, mortality, and high healthcare costs. Impaired mobility, postural instability, bradykinesia, muscle rigidity, and decreased bone mineral density (BMD) contribute to the increased risk of falls, which often result in hip and upper extremity fractures. Hip fractures in patients with PD are associated with an increased hospital length of stay and a decline in functional independence. Multimodal fall prevention in PD is well established, but prevention of fractures is often underutilized, despite evidence-based interventions. Information on fall-related fracture outcomes after exercise interventions is an area warranting further …

Advancements In Diversity In Dermatology: A 5-Year Retrospective Analysis Of Racial And Ethnic Trends In U.S. Dermatology Residency Programs (2020-2024), Devin Barzallo, Afua Ofori-Darko, Larissa De Souza, Precious Nwanwa, Timmie Sharma

Student Scholarship

Diversity in residency programs is important for achieving health equity. Although targeted initiatives have led to some progress, dermatology residency trainees do not proportionally reflect the growing diversity of the U.S. population. We analyzed data from the Association of American Medical Colleges on residents from 2020 to 2024 to evaluate evolving diversity trends.

Malignancy-Associated Renal Infarction: A Case Of Prostate Cancer Presenting With Flank Pain And Hematuria., Connor J Stinson, Alec Pupo, Patrick Laird

Internal Medicine Resident Research

Renal infarction is an uncommon but critical diagnosis that is frequently overlooked due to its nonspecific presentation and overlap with more common causes of abdominal or flank pain. Patients with malignancy, including metastatic prostate cancer, are at increased risk of thromboembolic events due to the intrinsic hypercoagulable state promoted by cancer, yet arterial events, such as renal infarction, remain underrecognized. We present the case of a 74-year-old male with metastatic castrate-sensitive prostate cancer who developed acute abdominal pain, nausea, and vomiting. Evaluation revealed elevated blood pressure, microscopic hematuria, and increased lactate dehydrogenase (LDH). CT scan of the abdomen and pelvis …

Power And Inclusivity: Bolognesi Lgbtq Activists Reflect On The Italian Language, Lauren E. Duncan, Bruno Grazioli

Psychology: Faculty Publications

Research in psychology and linguistics identifies ways grammatically gendered language affects the ways in which people think, perceive, and make judgements in everyday life in ways that disadvantage women, and more recently, non-binary and trans people. Activists, scholars, and politicians have worked to identify and remedy the masculinist bias in the Italian language, with mixed results. In this research article we describe how ten Italian feminist LGBTQIA+ activists interviewed in Bologna in 2019 negotiate gendered language in their everyday lives and in their activism. Themes mentioned by the activists include how language constructs reality, both in its current restriction of …

Outcomes Of Bio-Psycho-Social-Spiritual Communitybased Drug Rehabilitation Program For Voluntary Vs. Court-Mandated Clients In The Philippines, Maria Regina M. Hechanova, Trixie Anne Co, Fessa R. Egusquiza

Psychology Department Faculty Publications

This study sought to evaluate the outcomes of a community- based rehabilitation program for voluntary and court-mandated drug users in the Philippines. Participants went through a bio-psycho-social-spiritual group-based program that aimed to develop their recovery skills and life skills. The program also included family modules to enhance their knowledge of drug use, its effects, and the role of family in recovery. A cohort design was used with pre- and posttest surveys administered before and immediately after the program. The sample consisted of 105 voluntary clients and 118 court-mandated clients who underwent screening or drug dependency evaluation and were recommended for …

Triage Tools To Inform The Prioritisation Of Physical Health Services Following A Diagnosis Of Cancer: A Scoping Review, Georgia L. White, Lauren C. Capozzi, Corey Linton, Adrian Wright, Tamara Jones, Hattie H. Wright, Kate A. Bolam, Elizabeth A. Johnston, Briana K. Clifford, Keegan Bean, Stephanie Brown, Sarah Kolesaric, Mary A. Kennedy, Bryan A. Chan, Grace L. Rose

Research outputs 2022 to 2026

Purpose: Many people face multiple cancer- and treatment-related sequalae. Triage and referral to physical health services can manage such consequences, but a comprehensive understanding of available triage tools is lacking. This review (i) identifies tools used to triage to physical health services, (ii) maps tool characteristics and application outcomes and (iii) summarises existing gaps. Methods: A systematic search was conducted (three databases, April 2024). Articles were included if they used a tool to triage to physical health services. Tools were classified by triaged disciplines (i.e., diet, exercise, physical rehabilitation, multidisciplinary) and screened physical impairments (e.g., malnutrition). Tool characteristics (e.g., triage …

Combining Lumipulse P-Tau217 And Aβ42/40 As Confirmatory Tests For Aβ Positivity Prior To Disease-Modifying Therapy, James D. Doecke, Ahmed Chenna, Mintzu Lo, Youssouf Badal, Brandon Yee, Robert Martone, Christos Petropoulos, Christopher J. Fowler, Simon Laws, Stephanie R. Rainey-Smith, Ralph N. Martins, Christopher C. Rowe, Colin L. Masters, John Winslow

Research outputs 2022 to 2026

Introduction: For a blood-based biomarker to be considered a confirmatory test for the detection of abnormal amyloid beta (Aβ) levels, the sensitivity and specificity must be equivalent to that of current cerebrospinal fluid tests. Methods: In the current study we assessed the ability of phosphorylated tau (p-tau)217 and Aβ42/40 from the Lumipulse G p-tau217 and β-amyloid ratio (1-42/1-40) tests, individually and combined, to predict Aβ positron emission tomography status in two sub-cohorts from the Australian Imaging, Biomarkers, and Lifestyle Study of Ageing. Results: Testing an Alzheimer's disease continuum cohort, the area under the curve (AUC), sensitivity, specificity, and accuracy for …

A Systematic Review Using A Multi-Layered Criteria Framework For Assessing The Validity And Reliability Of Velocity Monitoring Devices In Resistance Training, Youssef J. Wannouch, Samuel R. Leahey, Rodrigo Ramírez-Campillo, Harry G. Banyard, Harry S. Dorrell, Steven Stern, Gordon J. Ross, Jason C. Laffer, Kelvin Y.H. Chua, Paul Comfort

Research outputs 2022 to 2026

Background Velocity-Based Training (VBT) is an emerging method in resistance training for objectively prescribing and monitoring training intensity and neuromuscular function. Given its growing popularity, assessing the validity and reliability of VBT devices is critical for strength and conditioning coaches. Objective The primary purpose of this review was twofold: (1) to identify and address methodological gaps in current assessments of VBT device validity and reliability, and (2) to propose and apply a novel, multi-layered, criterion-based framework—developed in collaboration with statisticians and domain experts—for evaluating these devices. Methods A systematic search was conducted in PubMed, Scopus, and SPORTDiscus following PRISMA guidelines, …

Determining Risk Factors And Rate Of Surgery After Collagenase Injections For Dupuytren Contracture, Ryan C. Cha, Juliet S. Chung, Sina Ramtin, Asif M. Ilyas

Department of Orthopaedic Surgery Faculty Papers

Purpose: Collagenase injections are a nonsurgical treatment for Dupuytren contracture, but their long-term effectiveness in preventing surgery remains unclear. This study aimed to evaluate the rate of surgical intervention following collagenase treatment and identify whether specific risk factors increase the likelihood of future surgical correction. Methods: This retrospective cohort study utilized the TriNetX US Collaborative network to identify patients diagnosed with Dupuytren contracture between January 2007 and September 2024. Patients initially treated with collagenase injections were identified using relevant current procedural terminology codes. Procedure-specific current procedural terminology codes were then used to determine which patients underwent a subsequent fasciectomy or …

Low Prevalence Of Helminth Infection In Ugandan Children Hospitalized With Severe Malaria, Drew Capone, Nuzrath Jahan, Ruth Namazzi, Robert Opoka, Chandy John

Paediatrics and Child Health, East Africa

Co-infection by intestinal helminths and Plasmodium spp. may be common in endemic communities. In 2003, Uganda instituted a national deworming program, with anti-helminth medication provided twice annually to children 6 months to 5 years of age, but few follow-up studies have been conducted. Several studies have identified a relationship between helminth infection, Plasmodium spp. infection and malaria severity. However, the relationship is not well defined, and results are inconclusive. We analyzed 177 stool samples from a cohort of children with severe malaria enrolled in two hospitals in Uganda from 2014–2017. All children were 6 months to 48 months of age …

A Word From The Writing Team (September 2025), Pam Walter, Mfa

A Word From the Writing Team (Newsletter)

This issue includes:

• Our New Editor!
• Publications Spotlight
• Check out these Free Workshops Wiley is Offering in September
• Sign up for the First Friday Writing Retreat (Online)
• Did you Know Jefferson Provides Funding Support for Article Processing Charges (APC)?

Prevalence Of Oral Mucosal Lesions Among Geriatric Dental Patients In Egypt: A Cross-Sectional Study, Dalia Ghalwash, Ahmed Hamdy, Sara Abd El-Wahed

Dentistry

Background. The oral health needs of older adults must be prioritized due to the shifting demographics of the population and rising life expectancy. This study investigated the prevalence of oral mucosal lesions (OMLs) among geriatric dental patients in a sample of the Egyptian population and explored the association with age, gender, smoking habit, as well as the impact on the quality of life. Methods. This cross-sectional study screened 300 geriatric dental patients aged 65 years or older, from several dental hospitals and mobile clinics in various regions in Egypt. Demographic data and information regarding denture use, systemic diseases, and smoking …

Phenotypic Divergence Of Jag1- And Notch2-Associated Alagille Syndrome & Disease-Specific Notch2 Variant Classification Guidelines., Shannon M. Vandriel, Li-Ting Li, Huiyu She, Jian-She Wang, Kathleen M. Loomes, David A. Piccoli, Irena Jankowska, Piotr Czubkowski, Dorota Gliwicz-Miedzińska, Lorenzo D'Antiga, Emanuele Nicastro, Florence Lacaille, Dominique Debray, Étienne M. Sokal, Tanguy Demaret, Rima L. Fawaz, Silvia Nastasio, Kyung Mo Kim, Seak Hee Oh, Björn Fischler, Henrik Arnell, Catherine Larson-Nath, Winita Hardikar, Sahana Shankar, Shikha S. Sundaram, Alexander Chaidez, Pinar Bulut, Pier Luigi Calvo, Mureo Kasahara, Niviann Blondet, Eberhard Lurz, Anna-Maria Kavallar, Emmanuel M. Gonzales, Emmanuel Jacquemin, Jérôme Bouligand, Noelle H. Ebel, Jeffrey A. Feinstein, Susan M. Siew, Michael O. Stormon, Saul J. Karpen, Rene Romero, M Kyle Jensen, Catalina Jaramillo, James E. Squires, Sarah M. Bedoyan, Deirdre A. Kelly, Jane Hartley, Henkjan J. Verkade, Way Seah Lee, Chatmanee Lertudomphonwanit, Ryan T. Fischer, Henry C. Lin, Nathalie Rock, Yael Mozer-Glassberg, Amin J. Roberts, Helen M. Evans, Wikrom Karnsakul, Gabriella Nebbia, Victorien M. Wolters, Pamela L. Valentino, Jesus Quintero Bernabeu, Amal A. Aqul, Cigdem Arikan, María Legarda Tamara, Cristina Molera Busoms, Thomas Damgaard Sandahl, Giuseppe Indolfi, Andréanne N. Zizzo, Aglaia Zellos, Ruben E. Quiros-Tejeira, Ermelinda Santos-Silva, Kathleen B. Schwarz, Jernej Brecelj, Maria Camila Sanchez, Maria Lorena Cavalieri, Christos Tzivinikos, Sabina Wiecek, John Eshun, Nanda Kerkar, Quais Mujawar, Zerrin Önal, Cristina Gonçalves, Jennifer Garcia, Seema Alam, Carolina Jimenez-Rivera, Luis Bujanda, Richard J. Thompson, Bettina E. Hansen, Nancy B. Spinner, Melissa A. Gilbert, Binita M. Kamath, Global Alagille Alliance (Gala) Study Group

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND & AIMS: Alagille syndrome (ALGS) is a rare, autosomal dominant disorder with high phenotypic heterogeneity. Disease-causing variants are primarily identified in Jagged1 (JAG1), with fewer reported in NOTCH2. JAG1 variants cause disease through a mechanism of haploinsufficiency, but the mechanism for NOTCH2 variants is not completely understood, making classification of variants more challenging. Using a large, international patient cohort acquired through the Global ALagille Alliance (GALA) study, we sought to improve classification of NOTCH2 variants and study phenotypic differences between NOTCH2- and JAG1-related disease.

METHODS: Clinical and molecular data from 952 individuals with ALGS in GALA were analysed and …

Lumbar Microdiscectomy: A Rare Case Of A Duplicate L5 Exiting Nerve Root., Sahil Garg, Sean M Muir, Arianna K Gill, Komi E Afetse, Sanjitpal S Gill

Surgery Articles

The microdiscectomy procedure has been regarded as the preferred method for the treatment of lumbar disc herniation (LDH). Intraoperatively, the procedure may be further complicated due to underlying anatomical variations in the lumbar spine or nerve root variations. Nerve root anomalies (NRAs), in particular, are relatively underdiscussed within the literature. Despite the rarity of these variations to the exiting nerve root, the increased surgical risk that an NRA may add warrants the need for increased awareness and associated complication mitigation. This case describes a rare instance of a symptomatic duplicate L5 nerve root discovered preoperatively and highlights the steps taken …

Medication Adherence: A Reimbursable Theory-Guided Evidence-Based Educational Intervention For Patients With Parkinson’S Disease, Amanda E. George, Melinda Hermanns, Diane B. Monsivais, Cheryl D. Parker

Nursing Faculty Publications and Presentations

Background: Parkinson’s disease is a challenging, progressive neurodegenerative process projected to affect more than 1.2 million patients by 2030, with an economic burden that will surpass $79 billion annually in the United States. Pharmacological interventions are the hallmark of treatment for symptom management for this lifelong disease. Multiple medications and a variety of dosing times have an increasingly negative effect on medication adherence. Purpose: This article will discuss medication adherence challenges, describe a theory-guided evidence-based intervention to improve medication adherence, and explore the economic implications in an outpatient clinic setting. Methods: A pilot chart review of 40 cases over 30 …

Platelet Transfusion Practices In The Icu: A Prospective Multicenter Cohort Study, Van Stefan, Raasveld Jorinde, Andrew Flint, Jimmy Schenk, Claudia Van Den Oord, Merijn Reuland, Sanne De Bruin, Jan Bakker, Maurizio Cecconi,, Marcus Lance

Anaesthesiology, East Africa

Objective: There is a lack of comprehensive international data regarding platelet transfusion practices in the ICU. This study aimed to evaluate the current occurrence rate of platelet transfusion in the ICU and provide an overview of platelet transfusion practices including indications for a platelet transfusion, thresholds, (non-)adherence and geo-economic region variations.

Design: International prospective cohort study.

Setting: Two hundred thirty-three centers in 30 countries worldwide.

Patients: All patients 18 years old and older, admitted to the ICU during a single study week, selected by each site from one of the 16 predefined weeks (March 2019 to …

Applying Artificial Intelligence And Chatbots To Enhance Collection Development In Health Sciences Libraries, Ivan Portillo, David Carson

Library Presentations, Posters, and Audiovisual Materials

The continuous advancement of artificial intelligence (AI) and large language models (LLMs) has presented several opportunities for librarians to reduce their workload and become more efficient. This session will explore the potential of generative AI chatbots in assisting health sciences librarians with collection development. Two methods that will be discussed include the potential of AI to help discover new titles and how AI can evaluate your library collection for any potential gaps based on a college program’s curriculum.

The Relationships Between Sporadic And Repetitive Non-Suicidal Self-Injury And Mental Disorders Among First-Year College Students: Results From The World Mental Health International College Student Initiative, Penelope Hasking, Glenn Kiekens, Maria Petukhova, Yesica Albor, Ahmad Al-Hadi, Jordi Alonso, Nouf Al-Saud, Yasmin Altwaijri, Claes Andersson, Lukoye Atwoli

Brain and Mind Institute

Background: Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time–order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults.

Methods: We used survey data from n = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time–order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1–5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in …

The Wellness Connection September 2025, Roger Williams University School Of Law

Life of the Law School (1993- )

No abstract provided.

Zika Virus Impairs Autophagic Flux In Trabecular Meshwork, And Inhibition Of Autophagy Restricts Ocular Viral Transmission And Associated Pathology, Faraz Ahmad, Prince Kumar, Pallav Singh, Trupti Joshi, Pawan Kumar Singh

Biomedical Sciences

Zika virus (ZIKV) is the lone member of Flavivirus family known to cause congenital glaucoma following in utero exposure. The molecular mechanisms of ZIKV-induced glaucoma remain elusive, with no known therapeutic modalities. Autophagy plays a dual role in viral infections and glaucoma pathogenesis. However, how ZIKV  interferes with autophagic pathways in the trabecular meshwork (TM) and whether autophagy contributes to ZIKV-induced ocular complications remains elusive. Here, we investigated the role of autophagy in ZIKV ocular pathogenesis utilizing a primary human trabecular meshwork cells (HTMC) and IFNAR1-/- mouse model of ocular infection. Our results show that ZIKV permissively infects HTMC, elicits …

Himmelfarb Library Liaison Letter - September 2025, The George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.

Imagining What’S Next In Pediatric Feeding Care, Amy L. Delaney

Speech Pathology and Audiology Faculty Research and Publications

Pediatric feeding disorder (PFD) is now recognized as a diagnostic entity, and we have the diagnostic and procedural codes for it. This is a turning point in our field because these codes don’t just unlock reimbursement—they validate and name the invisible. They allow us to collect data and identify patterns, and they open a door to remarkable things.