Public Health Commons^™

A Multivariate Analysis Of Reported Quality Of Life Among Medical Students In Jordan Using The Whoqol-Bref, Mohammad Hamad, Saba Al Smadi, Diana Arabiat

Research outputs 2022 to 2026

BACKGROUND: Low quality of life (QoL) in university students is often associated with unhealthy lifestyle and negative impacts on students' ability to learn and succeed. To date, no research has examined the QoL of medical students in Jordan or the demographic factors that may associate with lower QoL. MATERIALS AND METHODS: A quantitative, cross-sectional study with a descriptive design was chosen for this study. Participants were 512 medical students from one public university in Jordan. The Arabic version of the World Health Quality of life-brief survey (WHOQOL-BREF) was used to collect data online from students. RESULTS: Regarding the overall QoL, …

Improving Nutrition Outcomes Through Enhanced Allocative Efficiency Of Investments In 24 High Risk Counties In Kenya: An Optima Nutrition Modelling Study, Morris Ogero, Nick Scott, Veronica Kirogo, Anthony Ngugi

Population Health, East Africa

Introduction ;Undernutrition remains a significant global challenge, severely impacting children’s development and growth. To address this, the Sustainable Development Goals target a substantial reduction in stunting and wasting by 2025. Achieving these goals requires scaling up evidence-based nutritional interventions; however, limited budgets pose challenges in funding all necessary programs. To assist policymakers in making informed decisions, the World Bank developed the Optima Nutrition Modelling tool, which optimizes the allocation of nutrition investments. Kenya, with its high prevalence of stunting, was the focus of this study. Using the Optima Nutrition model, we aimed to (1) assess the impact of scaling up …

Insights Into Cancer Awareness And Health Practices In Rural Kenya: A Cross-Sectional Study Of Esophageal, Breast, Prostate, Cervical, And Colorectal Cancers, Rosebella Iseme-Ondiek, Joseph Abuodha, Anthony Ngugi, Mansoor Saleh, Innocent Abayo

Population Health, East Africa

PURPOSE; In sub-Saharan Africa (SSA), there has been an epidemiologic transition from infectious diseases to noncommunicable diseases, including a projected doubling in incidence of cancer. Understanding the underlying factors driving this surge is crucial for designing effective strategies to mitigate the cancer burden. This study focuses on assessing knowledge, attitudes, screening practices, and health behaviors related to five most prevalent cancers in SSA: prostate, breast, cervical, esophageal, and colorectal—among a predominantly rural coastal population in Kenya.

MATERIALS AND METHODS ;We used a cross-sectional study design targeting 1,500 adult respondents randomly selected from an existing community health and demographic surveillance system. …

The Contribution Of De Novo Coding Mutations To Meningomyelocele, Yoo-Jin Jiny Ha, Ashna Nisal, Isaac Tang, Chanjae Lee, Ishani Jhamb, Cassidy Wallace, Robyn Howarth, Sarah Schroeder, Keng Ioi Vong, Naomi Meave, Fiza Jiwani, Chelsea Barrows, Sangmoon Lee, Nan Jiang, Arzoo Patel, Krisha Bagga, Niyati Banka, Liana Friedman, Francisco A Blanco, Seyoung Yu, Soeun Rhee, Hui Su Jeong, Isaac Plutzer, Michael B Major, Béatrice Benoit, Christian Poüs, Caleb Heffner, Zoha Kibar, Gyang Markus Bot, Hope Northrup, Kit Sing Au, Madison Strain, Allison E Ashley-Koch, Richard H Finnell, Joan T Le, Hal S Meltzer, Camila Araujo, Helio R Machado, Roger E Stevenson, Anna Yurrita, Sara Mumtaz, Awais Ahmed, Mulazim Hussain Khara, Osvaldo M Mutchinick, José Ramón Medina-Bereciartu, Friedhelm Hildebrandt, Gia Melikishvili, Ahmed I Marwan, Valeria Capra, Mahmoud M Noureldeen, Aida M S Salem, Mahmoud Y Issa, Maha S Zaki, Libin Xu, Ji Eun Lee, Donghyuk Shin, Anna Alkelai, Alan R Shuldiner, Stephen F Kingsmore, Stephen A Murray, Heon Yung Gee, W Todd Miller, Kimberley F Tolias, John B Wallingford, Spina Bifida Sequencing Consortium, Sangwoo Kim, Joseph G Gleeson

Faculty, Staff and Students Publications

Meningomyelocele (also known as spina bifida) is considered to be a genetically complex disease resulting from a failure of the neural tube to close. Individuals with meningomyelocele display neuromotor disability and frequent hydrocephalus, requiring ventricular shunting. A few genes have been proposed to contribute to disease susceptibility, but beyond that it remains unexplained1. We postulated that de novo mutations under purifying selection contribute to the risk of developing meningomyelocele2. Here we recruited a cohort of 851 meningomyelocele trios who required shunting at birth and 732 control trios, and found that de novo likely gene disruption or …

Cdc’S Core Elements To Promote Diagnostic Excellence, Daniel J Morgan, Hardeep Singh, Arjun Srinivasan, Andrea Bradford, L Clifford Mcdonald, Preeta K Kutty

Faculty, Staff and Students Publications

Nearly a decade after the National Academy of Medicine released the "Improving Diagnosis in Health Care" report, diagnostic errors remain common, often leading to physical, psychological, emotional, and financial harm. Despite a robust body of research on potential solutions and next steps, the translation of these efforts to patient care has been limited. Improvement initiatives are still narrowly focused on selective themes such as diagnostic stewardship, preventing overdiagnosis, and enhancing clinical reasoning without comprehensively addressing vulnerable systems and processes surrounding diagnosis. To close this implementation gap, the US Centers for Disease Control and Prevention (CDC) released the Core Elements of …

Educational Leadership In A Vuca World: The Crisis Management Experiences Of Rural School Superintendents, Lucas J. Grossnicklaus

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The job of both urban and rural superintendents is challenging, but it is the rural school superintendency that comes with unique challenges that aren’t always faced by their urban and suburban counterparts. The COVID-19 Pandemic brought about a number of crises for school superintendents such as school closures, mask mandates, and navigating positions taken by governors, teachers unions, and school boards. While concerns about school closures and mask mandates has dissipated, conflict within school districts has only seemed to grow since the pandemic.

This multi-case study explored the lived experience of rural superintendents in the Midwest who have experienced a …

Public Health Messaging About Dengue On Facebook In Singapore During The Covid-19 Pandemic: Content Analysis, Shirley S. Ho, Mengxue Ou, Nova Mengxia Huang, Agnes S.F. Chuah, Vanessa S. Ho, Sonny Rosenthal

Research Collection College of Integrative Studies

Background:Dengue, a mosquito-borne disease, has been a health challenge in Singapore for decades. In 2020, during the COVID-19 pandemic, Singapore encountered a serious dengue outbreak and deployed various communication strategies to raise public awareness and mitigate dengue transmission.Objective:Drawing on the Crisis and Emergency Risk Communication (CERC) framework, this study examines how dengue-related messages communicated on Facebook (Meta) during the COVID-19 pandemic fall into the CERC themes. This study also seeks to understand how these themes differ between dengue outbreak (eg, 2020) and nonoutbreak years (eg, 2021). In addition, we explore how message themes on dengue changed across different CERC phases …

T2-Weighted Imaging Of Rectal Cancer Using A 3d Fast Spin Echo Sequence With And Without Deep Learning Reconstruction: A Reader Study, Dan Nguyen, Sarah Palmquist, Ken-Pin Hwang, Jingfei Ma, Usama Salem, Jia Sun, Xinzeng Wang, Jong Bum Son, Randy Ernst, Peng Wei, Harmeet Kaur, Nir Stanietzky

Faculty, Staff and Student Publications

Purpose: To compare image quality and clinical utility of a T2-weighted (T2W) 3-dimensional (3D) fast spin echo (FSE) sequence using deep learning reconstruction (DLR) versus conventional reconstruction for rectal magnetic resonance imaging (MRI).

Methods: The study included 50 patients with rectal cancer who underwent rectal MRI consecutively between July 7, 2020 and January 20, 2021 using a T2W 3D FSE sequence with DLR and conventional reconstruction. Three radiologists reviewed the two sets of images, scoring overall SNR, motion artifacts, and overall image quality on a 3-point scale and indicating clinical preference for DLR or conventional reconstruction based on those three …

Planning For Scale: Analysis Of Adaptations And Contextual Factors Influencing Scale-Up Of The Quali-Dec Intervention To Optimize Caesarean Section Use, Soha El-Halabi, Claudia Hanson, Alexandre Dumont, Amanda Cleeve, Helle Mölsted Alvesson, Charles Kaboré, Guillermo Carroli, Pisake Lumbiganon, Quoc Nhu Hung Mac, Ana Pilar Betran

Centre of Excellence in Women and Child Health

Background: Researchers are encouraged to plan for scale through purposeful and guided assessment of scalability of an intervention. This study analysed factors potentially influencing scale-up and synthesised early adaptations of the QUALI-DEC intervention aiming to improve the appropriate use of caesarean section. The intervention consists of opinion leader engagement, audit and feedback for caesarean section, a tool to help women make an informed decision on the mode of birth, and labour companionship.

Methods: We conducted a framework analysis, which was guided by the scalability assessment framework by Zamboni et al., a 34-item checklist with a three-point scale. We used data …

Pregnancy Care Integrating Translational Science, Everywhere (Precise): A Prospective Cohort Study Of African Pregnant And Non-Pregnant Women To Investigate Placental Disorders – Cohort Profile, Rachel Craik, Joseph Akuze, Marie-Laure Volvert, Hannah Blencowe, Moses Mukhanya, Angela Koech, Grace Mwashigadi, Marleen Temmerman, Marvin Ochieng, Emily Mwadime

Centre of Excellence in Women and Child Health

Purpose: The Pregnancies' Care Integrating translational Science, Everywhere Network was established to investigate specific placental disorders (pregnancy hypertension, preterm birth, fetal growth restriction and stillbirth) in sub-Saharan Africa. We created a repository of clinical and social data with associated biological samples from pregnant and non-pregnant women. Alongside this, local infrastructure and expertise in the field of maternal and child health research were enhanced.

Participants: Pregnant women were recruited in participating health facilities in The Gambia, Kenya and Mozambique at their first antenatal visit or at the time a placental disorder was diagnosed (Kenya and The Gambia only). Follow-up study …

Dose Prediction Via Deep Learning To Enhance Treatment Planning Of Lung Radiotherapy Including Simultaneous Integrated Boost Techniques, Wenhua Cao, Mary Gronberg, Stephen Bilton, Hana Baroudi, Skylar Gay, Christopher Peeler, Zhongxing Liao, Thomas J Whitaker, Karen Hoffman, Laurence E Court

Faculty, Staff and Student Publications

Background: Recent studies have shown deep learning techniques are able to predict three-dimensional (3D) dose distributions of radiotherapy treatment plans. However, their use in dose prediction for treatments with varied prescription doses including simultaneous integrated boost (SIB), that is, using multiple prescription doses within the same plan, and benefit in improving plan quality should be validated.

Purpose: To investigate the feasibility and potential benefit of using deep learning to predict dose distribution of volumetric modulated arc therapy (VMAT) including SIB techniques and improve treatment planning for patients with lung cancer.

Methods: The dose prediction model was trained with 93 retrospective …

An Examination Of Health Coaching As A Developing Profession, Katie Suleta, Jonathan M. Davis

HCA Healthcare Journal of Medicine

Background

Health coaching is a field that is growing in popularity. Health coaching is not regulated and there is no standard for background, education, or training for those acting as health coaches. The purpose of this study was to investigate the burgeoning field of health coaching: who is performing it and common practices.

Methods

A total of 560 health coaching websites were reviewed to record educational backgrounds, recommendations for supplements, and the sale of supplements and/or other wellness products. Multivariable logistic regression was used to test associations between characteristics of health coaches and whether they recommend supplements, sell supplements, or …

Opioid Epidemic In Maine: An Analysis Of Increasing Overdose-Related Deaths Following The Coronavirus, Aysel S. Hamlin

Thinking Matters Symposium

The rate of drug overdose resulting in death doubled in Maine following the COVID-19 pandemic from the onset of the COVID-19 pandemic in late 2019 through 2022. The correlation between increased isolation during the pandemic and overdose death rates sheds a concerning light on the insufficient resources for people struggling with Opioid Use Disorder (OUD) throughout Maine. The increasing trade and access to fentanyl following the pandemic accounted for the majority of drug-related deaths in Maine in 2021 and 2022. This study examines the need for long-term access to drug treatment in rural and urban Maine, both environments with varying …

Contrasting Patients' And Healthcare Professionals' Experience In Hematological Cancer Care Pathway: A Narrative Study, Karine Bilodeau, Cynthia Henriksen, Camilia Aloisio Alves, Charlotte Gélinas-Gagné, Lynda Piché, Jacinthe Pepin, Virginia Lee, Marie-France Vachon, Nathalie Folch, Marie-Pascale Pomey, Nicolas Fernandez

Patient Experience Journal

Hematological cancers represent 10% of cancers diagnosed in Canada. Treatments involve complex care pathways and various modalities as well as the management and monitoring of multiple side effects. There is limited understanding of these pathways from the perspectives of the people living with cancer (PLC) and the healthcare professional (HCP). The aim of this article is to contrast the experiences of PLCs and HCPs in the context of hematological cancer care pathway. Narrative study approach was chosen for this exploratory study. Twenty-one narratives were co-created with PLCs (n = 12) and HCPs (n = 9). A structural and comparative analysis …

What Makes A Hospital Gown Functional? A Comparative Case Study Of Effective Patient-Centered Design Practices In Four (N = 4) Hospital Gowns, Robmarie Lopez

Patient Experience Journal

A hospital gown is essentially a patient uniform. Yet, the typical ``tie in the back'' hospital gown, standard garb for routine medical procedure, can have great influence over key intervention factors like receptiveness to treatment and patient self-esteem. Thus, the goals of this study are two-fold: 1) To understand patient perceptions of the standard hospital gown, and 2) To understand which principles and elements of design underpin effectively functional hospital gown redesign. Aim 1 was assessed via a comprehensive literature review of n = 5 qualitative or mixed-methods studies which surveyed or interviewed patients on their experience with the standard …

Adolescents With Cystic Fibrosis Expressing Their Possible Selves Through Photovoice: A Longitudinal Interpretative Phenomenological Analysis To Prepare A Peer Support Intervention For Healthcare Transition, Maxime Morsa, Adélaïde Vincent-Lardy, Julie Haesebaert, Catherine Llerena, Lucie Pelz, Philippe Reix, Rémi Gagnayre, Quitterie Reynaud

Patient Experience Journal

While the transition from pediatric to adult care has become a field of study and practice focused on preparing the adolescent to ``become an adult with a chronic condition'', we are conducting participatory research to develop, implement, and evaluate a peer-support intervention aimed at supporting transition from pediatric to adult care for adolescents living with cystic fibrosis within two hospital centers in France. In preparation for this intervention, we would like to better understand how peer support could support identity self-determination of the adolescents. We conducted a longitudinal qualitative research using photovoice technique. For one year, 8 French adolescents (15–18 …

Voices From The Journey: Exploring Rehabilitation Experience Of Individuals With Disabilities In A South African Province, Senzelwe M. Mazibuko, Thayananthee Nadasan Dr, Pragashnie Govender

Patient Experience Journal

Background: Globally, 16% of the population is affected by disabilities, with increasing prevalence due to non-communicable diseases and longer lifespans. This group often faces shorter lifespans, poorer health, and greater challenges than non-disabled peers. Rehabilitation services are essential for improving independence, health, and quality of life by facilitating participation in education, work, and social roles. However, in South Africa, particularly in rural areas, providing these services is difficult. Methods: This qualitative study explored the experiences of people with disabilities in KwaZulu-Natal regarding their interactions with rehabilitation services. Six participants were recruited from a private facility using purposive sampling to …

Understanding The Care Experiences And Support Needs Of Uk Adults Treated In Hospital For Meningitis, Harriet Hay, Amy Tallett Dr, Bec Aeddi, Beverley Corbett, Claire Donovan, Jane Blewitt, Juan Abad Madroñero

Patient Experience Journal

Background: Meningitis often results in ongoing and multifaceted after-effects, which can impact many aspects of people's lives, yet relatively little support and follow-up is offered. This study explored post-treatment care experiences of UK adults aged 16 and over following a recent stay in hospital for meningitis. Methods: A survey was designed to ask about hospital discharge, recovery, information provision and aftercare support. The research involved 5 semi-structured, in-depth interviews and a 15-participant online asynchronous focus group. The themes arising from this qualitative stage informed the development of a quantitative 32-item questionnaire which was hosted and promoted online between September 2022 …

Unveiling Patient Satisfaction: Exploring Demographics, Interactions, And Health-Seeking Behavior, Vanessa B. Crowther, Cassandra Shaw-Johnson, Robbya R. Green-Weir, Pia S. Woodley, Marilyn A. Weatherspoon, Errick D. Farmer, Arlesia L. Mathis

Patient Experience Journal

Objective: This study examined the social context of the patient visit (demographics, waiting room experience, patient-provider interaction) and their relationship to satisfaction with the quality of care when seeking medical treatment. It also examined satisfaction as a predictor variable for its effect on three patient behavioral outcomes. Methods: The study was implemented using a cross-sectional quantitative design among adults aged 18 and older. One hundred fifty-eight participants responded to the survey, and the final sample size was n = 147. We employed advanced data analysis, hierarchical regression, three-way ANOVA, linear regression, and logistic regression to examine four outcome variables. Results: …

Effectiveness Of Incident Reporting Tools In Ensuring Patient Safety: A Systematic-Narrative Hybrid Review, Valentina Cerrone, Vincenzo Andretta, Angela Prendin, Bernadette Ilardi, Carloluigi Bonetti, Mario Capunzo, Marco Cascella

Patient Experience Journal

Background: Ensuring Patient Safety in healthcare is essential and requires efficient methods to reduce risks and improve the quality of care. Although incident reporting tools are commonly used to identify possible and actual care failures, their efficacy differs among various environments. The aim is to evaluate the effectiveness of incident reporting tools in enhancing patient safety. Methods: This review employed a combined methodology that integrates systematic and narrative approaches to gain a thorough understanding of incident reporting practices. In accordance with PRISMA guidelines, databases including PubMed, Embase, and Cochrane Library were systematically searched for studies published from January 2013 to …

Patient Perspectives On Implementing A Person-Centered Care System: Experiences From The U.S. Veterans Health Administration's Whole Health System Of Care, Ekaterina Anderson, Renda S. Wiener, Brianne Molloy-Paolillo, Megan Mccullough, Bo Kim, J. Irene Harris, Seppo T. Rinne, Barbara G. Bokhour

Patient Experience Journal

Objectives. Replacing the disease-centered, paternalistic approach in healthcare with a person-centered model has become a widely recognized imperative. However, patients' perspectives on and experiences with real-life efforts to implement this approach to care are rarely studied. We examined this issue at a health system with a prominent record of commitment to implementing person-centered care on the system level – the U.S. Veterans Health Administration (VHA). For over a decade, VHA has been transforming itself into a Whole Health (WH) system of care that is person-centered, holistic, and empowering. Methods. We conducted semi-structured qualitative interviews with 19 patients recruited from a …

My Life, My Story And Life Recovery Among Veterans With Substance Use Problems, Grace Chang Md, Mph, Martha J. Duffy Md, Susan Nathan Md

Patient Experience Journal

Objective: The United States Veterans Health Administration My Life, My Story (MLMS) program is a patient-centered care intervention where veterans are interviewed about their life story and may grant permission to include it in their electronic health record (EHR). Our purpose was to focus on a sample of MLMS narratives from veterans with self-disclosed substance use (SU) from our institution, and to evaluate the potential relationship between their content and a life change for the better, and to compare their content with the EHR. Methods: The narratives were reviewed on 4 domains (past challenge, substance use, experience of a turning …

The Impact Of Learners On Patient Satisfaction In The Orthopedic Setting, Sydney Boike, Kevin Hodge, Lynsey Malin, Timothy Nyangacha, Rebekah Kleinsmith, Megan Reams, Julia Stumpf, Bradley Nelson

Patient Experience Journal

This investigation evaluates the impact of learners and their post-graduate year (PGY) levels on patient satisfaction in the orthopedic outpatient clinic, an area with limited prior research. A retrospective cohort study was conducted using data from July 2020 to December 2022, involving 2,484 patients, with a 39% response rate. Satisfaction was measured via NRC Health surveys, focusing on the likelihood of recommending the provider or clinic based on the presence of learners, categorized as none, present in the clinic, or involved in patient care. Non-parametric statistical analysis revealed significant reductions in satisfaction when learners were involved in care, with top-box …

A Qualitative Study: Patients' Expectation Of Private Hospitals, Sarah Jada, Jessy Jacob, Ahmad Nasrallah

Patient Experience Journal

Objectives: This study was conducted to explore patients' expectations and perceptions of private healthcare facilities, understand the key factors influencing their choice of such facilities, also identify elements that enhance patient satisfaction and loyalty, enabling the development of actionable recommendations to improve patient-centered care in private healthcare settings. Method: A qualitative study using thematic analysis was conducted with 29 patients from various nationalities and backgrounds who received services in private hospitals in Kuwait, including Dar Al Shifa Hospital. Insights were gathered through semi-structured interviews. Results: The study delved into the significant correlation between patients' experience of their healthcare encounters and …

Patient Perspectives On Health Care Utilization At Two Free Clinics – A Qualitative Study, Patrick Fagan, Danny Guillen Perez, Roberta D. Baer, John Petrilli

Patient Experience Journal

Millions of uninsured Americans access health care through free clinics, but their experience with the medical system is understudied. This study sought to understand patterns in free clinic patients' experience with healthcare utilization through qualitative and descriptive analyses. Data were collected through face-to-face, open-ended interviews at two free clinics in an urban Florida community. The clinics included one student-run free clinic and one community-based free clinic. Survey questions were developed based on prior literature and validated through expert consensus and pilot interviews. The interviewers conducted 74 interviews between May 7 and June 10, 2022. Responses were coded by the authors, …

The Patient Ombudsperson's Experience Of Patient Partnership And Mutual Understanding Of Rights, Sanna Ryynänen

Patient Experience Journal

Mutual understanding between the patient and the healthcare professional can be considered a key factor of a positive patient experience in the care relationship. Mutual understanding can be promoted through patient partnership, which, in this personal and professional narrative, the author (a patient ombudsperson, known as patient ombudsman, and researcher of patient experience) describes as participation through patient rights during care. In the relationship between the patient and the healthcare professional (i.e., who acts as a care provider in the patient's care), medical treatment decisions and related patient rights go hand in hand. Even in difficult care situations of mutual …

Beyond The White Coat: Mental Health In The Life Of A Junior Doctor, Araya Gautam

Patient Experience Journal

This article underscores the profound need for a culture that prioritises mental health, especially among doctors navigating their early careers. This personal narrative also highlights the importance of overcoming this and the challenges one can face while trying to do so. A journey of a 30-year-old doctor, as she hurdled along life with the passing of her grandparents and studying for the exam, it looked like a task that was achievable at first, but as time went by anxiety and self-doubts were not easy to navigate. This piece outlines why it is of utmost importance that we as doctor realise …

Escuchame: A Story Of Patient Resilience, Daniel Murillo Armenta, John Paul Braun

Patient Experience Journal

This article is a narrative following a patient's experience through the American Healthcare system. This article is written by a second-year medical student. During this time the individual repeatedly engaged in different specialties of medicine such as neurology, neurosurgery, oncology, emergency medicine, gynecology, and primary care. This narrative demonstrates how certain issues such as healthcare access, patient demographics, defective communication, and general mistrust of the healthcare system negatively impact patient outcomes. As an uninsured immigrant, the patient was in a disadvantaged position when her health problems first began. Due to her lack of insurance, she did not have an established …

Re-Recruitment: An Essential Aspect Of Human Experience, Thom Mayer, David Fessell, Amy Young

Patient Experience Journal

Healthcare staffing is a major issue facing leaders at all levels and is affected by turnover rates in ``The Great Resignation,'' as well as the issue of burnout, moral injury, and turnover. In seeking to deal with defining and making human experience as reality, these factors affect every level, from patient experience to workforce experience to community experience, all of which are related to not just adequate staffing and preventing turnover but doing so with our highest performing ``A Team'' members. Using the tool of re-recruitment of these high-level professionals and team members can be critical to retaining talent, while …

Leading In Turbulent Times: Why Experience Is Essential To Healthcare's Future, Jason A. Wolf

Patient Experience Journal

Healthcare systems around the world and throughout our community are being buffeted from all sides, with higher acuity patients, a vulnerable and stressed workforce, unsure finances and support structures, and even challenges to long-held medical truths. For as much as we traversed a once in a lifetime moment through the pandemic years, the residual effects and social and political sways that followed have woven their ways into healthcare overall. There is great uncertainty. There are rapidly emerging innovations. There are greater tensions in our society which show up in behaviors that impact how we provide care. These issues and more …