Care Infrastructure Research Articles

War dead, trauma, and care: the differential reintegration of Vietnamese former combatants

This paper explores how Vietnamese former combatants navigate and contest the infrastructure of care and recognition (or lack thereof) for veterans, their families, and the war dead in postwar Vietnam. It examines efforts by veterans to establish their socio-political standing through acts of claim-making, including spiritual care for the dead. We argue that through these acts of claim-making, veterans forge an alternative modality of veteranhood based not simply on state-recognised war contributions, but also on moral commitments to social justice and care for the fallen and their bereaved families in the postwar period.

The colonial face of ‘housing’ refugees: the construction of the racialised subject within a necropolitical infrastructure

The incredible mobilisation to welcome Ukrainian refugees following the start of the Russia-Ukraine war in 2022 demonstrated how housing is an affective sociomaterial infrastructure. In cruel contrast, such mobilisation also exposed the inherently racist and colonial face of accommodating refugees and migrants, and the structural inequalities that racial capitalism continues to reproduce. Drawing reflections across several geographies and temporalities through illustrative vignettes, this paper begs the questions under what conditions do we accept that some people are housed, others not? What kind of power structures allow certain bodies to be welcomed? This paper borrows from postcolonial, black and critical theory to examine refugee housing through the lens of necropolitical infrastructure. It connects Mbembe’s notion of necropower with Power and Mee’s notion of housing as infrastructure of care, and filters this through reflections across Calais, Brescia and Athens, to illustrate the bio- and necropolitical side of the refugee housing infrastructure in Europe. The paper ultimately argues that refugee housing, because it is an infrastructure and because it is part of the broader extractive and exploitative system of (humanitarian) care, is deeply imbricated in the production of racialised subjects. Specifically, it is complicit with the extraction, (re)incorporation, abandonment and slow death of Black and Brown refugee lives.

Identifying and Prioritizing Economic Opportunities for Medical Tourism Management: An Analytic Hierarchy process

Background: As a growing industry, medical tourism includes many economic opportunities. This industry is the largest and most diverse industry in the world, with a foreign currency income which is equal to the automotive and military weapons industries. The aim of the current research is to identify and prioritize economic opportunities related to medical tourism management, using the Analytical Hierarchy Process (AHP) as a multi-criteria decision-making tool. Methods: This was a descriptive-survey research with an applied and cross-sectional approach. A survey method was used to collect data, so this study can be classified as field research. The statistical population of the research included 25 people with experience and expertise selected through purposive sampling in the fields of management, tourism, and medicine. The method of collecting data was in the form of library and field studies. The tool for collecting data was a questionnaire of paired comparisons and a check sheet. Data analysis was done with AHP method and Expert Choice 11 software. After collecting the paired comparison questionnaire and calculating the geometric mean, the inconsistency rate of the questionnaires was less than 0.1, which showed that the data had the required validity. Results: First, using library studies, economic opportunities related to medical tourism were identified. These opportunities included cash generation, technological advancements, job creation, diversification of tourism industry, development of health care infrastructure, knowledge transfer and cooperation, services and ancillary industries, and regional development and diversification of economic activity. Opportunities were prioritized using the AHP method. Cash generation with relative importance of 0.191 was ranked first, job creation with relative importance of 0.162 was second, and technological advances was ranked third with relative importance of 0.131. Diversification to economic activities with a relative importance of 0.45 was ranked ninth which was the lowest. Conclusion: Strategic marketing, delivering quality healthcare services, competitive pricing, specialized medical care, patient-centered experience, collaboration and partnership, continuous improvement, and strengthening medical tourism infrastructure are the pillars through which medical tourism management can not only generate sustainable revenue but also provide invaluable healthcare services to patients from across the globe.

Interplays between housing and long-term care policies: a comparison between Austria and the Czech Republic

Owing to the complex links between housing and care, placing housing policy in the context of long-term care (LTC) policies is difficult; this leads to a limited number of studies on this topic. However, the practical relevance of links between these two policy fields is self-evident. To partially challenge a separation between housing and LTC policies in research, we apply the concept of ‘housing as an infrastructure of care’, as defined by Power and Mee (Housing Studies, 35(3), 2020). The article conceptualises and contextualises how housing policies interplay with LTC policy instruments by contributing to a similar outcome. After discussing the theoretical implications, the article provides an empirical illustration of this argument through a comparative housing analysis of two carefully selected cases: Austria and the Czech Republic. LTC policies in these two countries are based on remarkably similar cash instruments, notably implemented in contrasting housing policy contexts. As these cash benefits lead to similar outcomes in encouraging informal care provided chiefly by families, the analysis seeks to understand how different housing policies matter for these outcomes. The analysis discusses how particular housing policy instruments may create uneven care capacities.

The Value of International Exchange Programs for Physician Assistants: Surveying a US-Netherlands Advanced Practice Provider Exchange Program.

International exchange programs between physician assistants (PAs) and other advanced practice providers (APPs) from different countries can facilitate opportunities for global health training and experiences. This article examines a survey of 5 PAs, 4 nurse practitioners, and 1 certified nursing specialist working in the United States (US) about their experience collaborating in an international exchange program with APPs in the Netherlands. Ten APPs in the United States anonymously answered an 8-item survey on their experience in an international exchange program with APPs in the Netherlands with a 100% response rate. The survey contained questions regarding the impact of the program on cultural competence, professional development, and perception of health care systems. All respondents agree or strongly agree that the program contributed to APP growth in cultural competence and professional development. Eighty percent of respondents found APP practices in the United States compared with the Netherlands to be somewhat or extremely similar, with differences noted in training and education, patterns of utilization, and roles in procedures. Free responses indicate APPs are used similarly in the Netherlands and the United States, while APP training models and health care infrastructure in the 2 countries have notable differences. Survey results examined in this article underscore how an international exchange program can not only enrich individual professional paths but also positively contribute to the broader global health care landscape. The lessons learned, shared experiences, and insights gained have the potential to shape health care practices on an international scale, fostering a collaborative and interconnected future for health care providers worldwide.

Minimal Common Oncology Data Elements Genomics Pilot Project: Enhancing Oncology Research Through Electronic Health Record Interoperability at Vanderbilt University Medical Center.

The expanding presence of the electronic health record (EHR) underscores the necessity for improved interoperability. To test the interoperability within the field of oncology research, our team at Vanderbilt University Medical Center (VUMC) enabled our Epic-based EHR to be compatible with the Minimal Common Oncology Data Elements (mCODE), which is a Fast Healthcare Interoperability Resources (FHIR)-based consensus data standard created to facilitate the transmission of EHRs for patients with cancer. Our approach used an extract, transform, load tool for converting EHR data from the VUMC Epic Clarity database into mCODE-compatible profiles. We established a sandbox environment on Microsoft Azure for data migration, deployed a FHIR server to handle application programming interface (API) requests, and mapped VUMC data to align with mCODE structures. In addition, we constructed a web application to demonstrate the practical use of mCODE profiles in health care. We developed an end-to-end pipeline that converted EHR data into mCODE-compliant profiles, as well as a web application that visualizes genomic data and provides cancer risk assessments. Despite the complexities of aligning traditional EHR databases with mCODE standards and the limitations of FHIR APIs in supporting advanced statistical methodologies, this project successfully demonstrates the practical integration of mCODE standards into existing health care infrastructures. This study provides a proof of concept for the interoperability of mCODE within a major health care institution's EHR system, highlighting both the potential and the current limitations of FHIR APIs in supporting complex data analysis for oncology research.

Translating knowledge into policy: Organizational model and minimum requirements for the implementation of a regional pancreas unit network

Pancreatic and periampullary cancers pose significant challenges in oncological care due to their complexity and diagnostic difficulties. Global experiences underscore the crucial role of multidisciplinary collaboration and centralized care in improving patient outcomes in this context. Recognizing these challenges, Lombardy, Italy's most populous region, embarked on establishing pancreas units across its territory to enhance clinical outcomes and organizational efficiency. This initiative, driven by a multistakeholder approach involving the Lombardy Welfare Directorate, clinicians, and a patient association, emphasizes the centralization of complex care in high-volume hospitals, adopting a hub-and-spoke model and a multidisciplinary approach. This article outlines the process and criteria set forth for pancreas unit implementation, aiming to provide a structured framework for enhancing pancreatic cancer care. Central to this initiative is the establishment of structured criteria and minimal requirements, not only for surgery but also for other essential components of care, ensuring a comprehensive approach to pancreatic cancer management. The Lombardy model offers a structured framework for enhancing pancreatic cancer care, with potential applicability to other regions and countries seeking to improve their cancer care infrastructure

Survivorship in Advanced Lung Cancer: Understanding a New Landscape and Opportunities.

People with advanced lung cancer represent a distinct group whose needs remain understudied, especially compared with people diagnosed with limited-stage disease. Fortunately, novel treatments such as tyrosine kinase inhibitors and immune checkpoint inhibitors are leading to significant advances in prognosis and survival, even among those with advanced disease at the time of diagnosis. However, there are known gaps in symptom management, psychosocial and nutritional support, complex care coordination, health behavior coaching, and health care delivery efforts among patients living with advanced lung cancer. Many of these patients would benefit from survivorship and palliative care approaches. In particular, survivorship care may include health care maintenance, treatment of immune-related adverse events and late- or long-term effects, frailty assessment and rehabilitation, and care coordination. Palliative care may be best suited to discuss ongoing symptom management, advanced care planning, and end-of-life considerations, as well as psychosocial well-being. To this end, we share a review of the current status of the palliative and survivorship care infrastructure for patients with advanced lung cancer and provide suggestions across the care continuum for this diverse group of patients and families.

Establishing palliative care in tribal and rural Indian setting: A participatory action research approach.

e24085 Background: We established a palliative care center in the tribal area of Santhal Pargana, India, under a tertiary care facility, as a crucial step in addressing the palliative needs of oncology patients. This study assesses the center's inaugural year, focusing on referral patterns, morphine consumption, and pain management. Methods: Data from all patients visiting the palliative care outpatient department (OPD) in 2023 were prospectively collected and analyzed. The study focused on key palliative care indicators, including morphine consumption, patient referrals, and the mean Numeric Rating Scale (NRS) pain score after initial consultation. The PAR approach was utilized to tailor services to the community's needs. Results: The center observed an increase in patient referrals, from 8 new patients in January to 19 by December. The patient demographic primarily comprised individuals with head and neck cancer (43%), followed by breast cancer (28%) and gall bladder cancer (12%), alongside other types such as cervix, sarcomas, lung, and adult hematolymphoid malignancies. Bone metastasis was present in 46 (55.4%) patients at initial presentation. Morphine consumption demonstrated a notable rise, from 840 mg in May to 2860 mg in December, totaling 9800 mg for the year. The mean NRS pain score improved significantly from 6.5 in January to 4.3 post-initial consultation. The center maintained an overall median of 3 consultations per patient, and bereavement support was provided to 13 (15.7%) patients. Conclusions: The integration of the Participatory Action Research approach, specifically the CTC-5, was instrumental in the successful initiation and expansion of palliative care services within the center. The structured training, mentorship, and organizational restructuring, facilitated by the program, were crucial in establishing a modest palliative care infrastructure. This comprehensive approach not only enhanced care delivery but also ensured the sustainability and adaptability of palliative services, effectively addressing the gap in palliative care in rural, tribal settings.

Defamilization? Not for everyone. Unequal labour-market participation among informal caregivers in Europe

Growing care dependencies among the elderly due to population ageing in Europe challenge the labour-market participation of informal caregivers. While familiarized care regimes incentivize family caregiving by providing many cash-for-care-benefits, resulting in reduced labour supply, defamiliarized care regimes allocate more public spending to care infrastructure, alleviating the care responsibilities placed on family members. At the same time, care provision on the micro-level is distributed unequally across gender, age, and socioeconomic status. The question then emerges: Does the labour-market participation of informal caregivers vary between and within countries depending on the social-expenditure policy of welfare states? To answer this research question, a multilevel design was used, employing SHARE data and macro-indicators from OECD and Eurostat databases. The results reveal higher probabilities of labour-market participation for informal caregivers in general when social expenditures on formal care infrastructure are higher. However, labour-market participation was observed as being unequally distributed among the heterogeneous group of persons with and without caregiving duties. Women and individuals of lower socioeconomic status did not benefit from social expenditures in the same way as their counterparts, leading to lower levels of labour-market participation.

Improving Risk Prediction of Methicillin-Resistant Staphylococcus aureus Using Machine Learning Methods With Network Features: Retrospective Development Study.

Health care-associated infections due to multidrug-resistant organisms (MDROs), such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile (CDI), place a significant burden on our health care infrastructure. Screening for MDROs is an important mechanism for preventing spread but is resource intensive. The objective of this study was to develop automated tools that can predict colonization or infection risk using electronic health record (EHR) data, provide useful information to aid infection control, and guide empiric antibiotic coverage. We retrospectively developed a machine learning model to detect MRSA colonization and infection in undifferentiated patients at the time of sample collection from hospitalized patients at the University of Virginia Hospital. We used clinical and nonclinical features derived from on-admission and throughout-stay information from the patient's EHR data to build the model. In addition, we used a class of features derived from contact networks in EHR data; these network features can capture patients' contacts with providers and other patients, improving model interpretability and accuracy for predicting the outcome of surveillance tests for MRSA. Finally, we explored heterogeneous models for different patient subpopulations, for example, those admitted to an intensive care unit or emergency department or those with specific testing histories, which perform better. We found that the penalized logistic regression performs better than other methods, and this model's performance measured in terms of its receiver operating characteristics-area under the curve score improves by nearly 11% when we use polynomial (second-degree) transformation of the features. Some significant features in predicting MDRO risk include antibiotic use, surgery, use of devices, dialysis, patient's comorbidity conditions, and network features. Among these, network features add the most value and improve the model's performance by at least 15%. The penalized logistic regression model with the same transformation of features also performs better than other models for specific patient subpopulations. Our study shows that MRSA risk prediction can be conducted quite effectively by machine learning methods using clinical and nonclinical features derived from EHR data. Network features are the most predictive and provide significant improvement over prior methods. Furthermore, heterogeneous prediction models for different patient subpopulations enhance the model's performance.

Europe's Largest Research Infrastructure for Curated Medical Data Models with Semantic Annotations.

Structural metadata from the majority of clinical studies and routine health care systems is currently not yet available to the scientific community. To provide an overview of available contents in the Portal of Medical Data Models (MDM Portal). The MDM Portal is a registered European information infrastructure for research and health care, and its contents are curated and semantically annotated by medical experts. It enables users to search, view, discuss, and download existing medical data models. The most frequent keyword is "clinical trial" (n = 18,777), and the most frequent disease-specific keyword is "breast neoplasms" (n = 1,943). Most data items are available in English (n = 545,749) and German (n = 109,267). Manually curated semantic annotations are available for 805,308 elements (554,352 items, 58,101 item groups, and 192,855 code list items), which were derived from 25,257 data models. In total, 1,609,225 Unified Medical Language System (UMLS) codes have been assigned, with 66,373 unique UMLS codes. To our knowledge, the MDM Portal constitutes Europe's largest collection of medical data models with semantically annotated elements. As such, it can be used to increase compatibility of medical datasets and can be utilized as a large expert-annotated medical text corpus for natural language processing.

Another nursing is possible: Ethics, political economies, and possibility in an uncertain world.

Overtaxed by the realities laid bare in the pandemic, nursing has imminent decisions to make. The exigencies of pandemic times overextend a health care infrastructure already groaning under the weight of inequitable distribution of resources and care commodified for profit. We can choose to prioritise different values. Invoking philosopher of science Isbelle Stengers's manifesto for slow science, this is not the only nursing that is possible. With this paper, I pick up threads of nursing's historical ontology, drawing previous scholarship on the historical narratives nurses use to understand themselves. Peeling back nursing's myth to alternate points of origin allows me to consider alternate lines of flight, a speculative adventure in paths not taken but paths that exist nonetheless. I go on to examine what a collective ethic of nursing could be, when we make space for these alternate histories, considering the confluences and conflicts that enable nurses to care and those that inhibit them from doing so. The imperative for this lies in the central importance of the reproductive labour of nursing health care, which leads me to a critique of nursing's capitulation to the pressures of late stage capitalism. This is a problem with ethical and ontological implications both for nursing, and also for those who require nursing care, an imperative to think about the kinds of present/futures for health, care, and health care we might cocreate in collaboration and solidarity with the communities in which nurses are imbricated, shedding the trappings of neoliberalism. There is significant power in the vision and praxis of 28 million nurses and midwives worldwide. Our ethics can guide our imagination which can in turn create possibility. This kind of endeavour-that of dreams and imagination-leads us to what could be, if only we leap.

Web-based Dashboard on ECMO Utilization in Germany: An Interactive Visualization, Analyses, and Prediction Based on Real-life Data

In Germany, a comprehensive reimbursement policy for extracorporeal membrane oxygenation (ECMO) results in the highest per capita use worldwide, although benefits remain controversial. Public ECMO data is unstructured and poorly accessible to healthcare professionals, researchers, and policymakers. In addition, there are no uniform policies for ECMO allocation which confronts medical personnel with ethical considerations during health crises such as respiratory virus outbreaks.Retrospective information on adult and pediatric ECMO support performed in German hospitals was extracted from publicly available reimbursement data and hospital quality reports and processed to create the web-based ECMO Dashboard built on Open-Source software. Patient-level and hospital-level data were merged resulting in a solid base for ECMO use analysis and ECMO demand forecasting with high spatial granularity at the level of 413 county and city districts in Germany.The ECMO Dashboard (https://www.ecmo-dash.de/), an innovative visual platform, presents the retrospective utilization patterns of ECMO support in Germany. It features interactive maps, comprehensive charts, and tables, providing insights at the hospital, district, and national levels. This tool also highlights the high prevalence of ECMO support in Germany and emphasizes districts with ECMO surplus – where patients from other regions are treated, or deficit – origins from which ECMO patients are transferred to other regions. The dashboard will evolve iteratively to provide stakeholders with vital information for informed and transparent resource allocation and decision-making.Accessible public routine data could support evidence-informed, forward-looking resource management policies, which are urgently needed to increase the quality and prepare the critical care infrastructure for future pandemics.

Iluminação como uma infraestrutura de cuidado

This integrative literature review addresses the relevance of illumination. Through the lens of infrastructures of care, it proposes three analysis categories: (a) "illumination, culture, and life in society" gather studies on cultural and social aspects involving lighting; (b) "access to lighting, technology, and sustainability" demonstrates how access to light and technologies needs discussion considering structural disparities, resource scarcity, and sustainability; (c) "illumination in healthcare" explores its influence on the environment and perception of users in care settings. These themes intersect and demand a transdisciplinary approach. Analyses suggest that lighting projects and systems can contribute to feelings of welcoming, well-being, and belonging, while ensuring good visibility for services and procedures, alongside controlling glare and reflectance. Expanding exploratory research in social and community settings through case studies and prototype implementation is recommended. There is room for additional research considering illumination as an infrastructure of care, focusing on access and the positive experience of users and citizens.

Colorectal cancer health and care quality indicators in a federated setting using the Personal Health Train

ObjectiveHospitals and healthcare providers should assess and compare the quality of care given to patients and based on this improve the care. In the Netherlands, hospitals provide data to national quality registries, which in return provide annual quality indicators. However, this process is time-consuming, resource intensive and risks patient privacy and confidentiality. In this paper, we presented a multicentric ‘Proof of Principle’ study for federated calculation of quality indicators in patients with colorectal cancer. The findings suggest that the proposed approach is highly time-efficient and consume significantly lesser resources.Materials and methodsTwo quality indicators are calculated in an efficient and privacy presevering federated manner, by i) applying the Findable Accessible Interoperable and Reusable (FAIR) data principles and ii) using the Personal Health Train (PHT) infrastructure. Instead of sharing data to a centralized registry, PHT enables analysis by sending algorithms and sharing only insights from the data.ResultsETL process extracted data from the Electronic Health Record systems of the hospitals, converted them to FAIR data and hosted in RDF endpoints within each hospital. Finally, quality indicators from each center are calculated using PHT and the mean result along with the individual results plotted.Discussion and conclusionPHT and FAIR data principles can efficiently calculate quality indicators in a privacy-preserving federated approach and the work can be scaled up both nationally and internationally. Despite this, application of the methodology was largely hampered by ELSI issues. However, the lessons learned from this study can provide other hospitals and researchers to adapt to the process easily and take effective measures in building quality of care infrastructures.

Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study.

Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low-socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. This study's aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. Through qualitative analysis, we identified 4 main themes. Participants' perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants' interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices.

Perspectives from the Inaugural "Spinal CSF Leak: Bridging the Gap" Conference: A Convergence of Clinical and Patient Expertise.

The inaugural "Spinal CSF Leak: Bridging the Gap" Conference was organized to address the complexities of diagnosing and treating spinal CSF leaks. This event aimed to converge the perspectives of clinicians, researchers, and patients with a patient-centered focus to explore the intricacies of spinal CSF leaks across 3 main domains: diagnosis, treatment, and aftercare. Physician and patient speakers were invited to discuss the varied clinical presentations and diagnostic challenges of spinal CSF leaks, which often lead to misdiagnosis or delayed treatment. Patient narratives were interwoven with discussions on advanced radiologic techniques and clinical assessments. Treatment-focused sessions highlighted patient experiences with various therapeutic options, including epidural blood patches, surgical interventions, and percutaneous and endovascular therapies. The intricacies of immediate and long-term postprocedural management were explored. Key outcomes from the conference included the recognition of the need for increased access to specialized CSF leak care for patients and heightened awareness among health care providers, especially for atypical symptoms and presentations. Discussions underscored the variability in individual treatment responses and the necessity for personalized diagnostic and treatment algorithms. Postprocedural challenges such as managing incomplete symptom relief and rebound intracranial hypertension were also addressed, emphasizing the need for effective patient monitoring and follow-up care infrastructures. The conference highlighted the need for adaptable diagnostic protocols, collaborative multidisciplinary care, and enhanced patient support. These elements are vital for improving the recognition, diagnosis, and management of spinal CSF leaks, thereby optimizing patient outcomes and quality of life. The event established a foundation for future advancements in spinal CSF leak management, advocating for a patient-centered model that harmonizes procedural expertise with an in-depth understanding of patient experiences.

Early intervention and care for Diabetic Foot Ulcers in Low and Middle Income Countries: Addressing challenges and exploring future strategies: A narrative review.

Diabetic Foot Ulcers (DFUs) are a significant health concern, particularly in Low- and Middle-Income Countries (LMICs). This review explores key strategies for managing DFUs in LMICs, including integrating podiatry, endocrinology, and wound care services, educating patients, promoting self-care, and preventive measures to reduce amputation rates. A comprehensive literature review was conducted, focusing on studies conducted in Low and Middle Income Countries to facilitate a qualitative analysis. The review examined the aetiology and risk factors to developing DFUs, clinical presentation, multidisciplinary management and evidence based interventions, challenges to the provision of care and future directions, all pertaining to DFUs in low and middle income countries. The aetiology and risk factors contributing to the development of DFUs are complex and multifaceted. Factors such as limited access to health care, inadequate diabetes management, and socioeconomic disparities significantly influence the incidence of DFUs. Clinical presentation varies, with patients often presenting at advanced stages of the disease due to delayed or missed diagnoses. Multidisciplinary management, incorporating podiatry, endocrinology, and wound care services, has exhibited substantial promise in enhancing patient outcomes. Evidence-based interventions, including offloading techniques, wound debridement, and the use of advanced wound dressings, have proven effective in promoting ulcer healing. The burden of DFUs in LMICs requires comprehensive strategies. Integrating podiatry, endocrinology, and wound care services, along with patient education and self-care practices, is essential for reducing amputations and improving patients' quality of life. Regular follow-up and early detection are vital for effective DFU management, emphasizing the need for ongoing research and investment in LMIC health care infrastructure. Embracing these multidisciplinary, patient-centered approaches can effectively address the challenge of DFUs in LMICs, leading to better patient outcomes and improved quality of life.

The Entangled Emergencies of COVID-19

City of Chicago officials adopted a “racial equity” approach to mitigate the disproportionate racial impact of COVID-19, yet according to interviews with racially and socioeconomically marginalized Chicagoans, this approach failed to address core vulnerabilities associated with health, housing, mental health, and welfare. This article argues that COVID-19 represents and reifies the convergence of three sets of emergencies. First, federal and local governments governed through emergency, enacting temporally bounded governmental strategies that presumed scarcity, triaged care, and naturalized structural inequality by delinking the effects of racism from its causes. This response was spectacular and anticipatory—designed to safeguard the status quo until “normalcy” could be restored. This approach exacerbated two existing endemic emergencies: (1) the slow emergencies racially marginalized populations have faced for decades due to neoliberal restructuring and fragmented care infrastructure and (2) the sacrifice of lower-income frontline workers to premature death to safeguard the economy and protect the middle class.