Medical Student Submissions [T – Z]

Nicholas Tomaras
ntomar3@uic.edu
Chicago Campus

This study aimed to assess the integrity of the lateral rectus-superior rectus band (LRSRB) in adult individuals over 50 years old using 3-Tesla magnetic resonance imaging (MRI). LRSRB alterations have been implicated in sagging eye syndrome, a condition associated with age-related changes in ocular anatomy. The study evaluated the LRSRB at three orbital locations: 2 mm anterior to, at, and 2 mm posterior to the optic nerve entry point in 19 eyes from 11 patients (mean age 71.1 years). Exclusion criteria included diplopia, a history of strabismus or orbital surgery, and motion artifacts. Coronal T1-weighted MRI images were obtained at 2 mm slice thickness. The results showed that the LRSRB was visible in 79.0% of eyes in zone I, 68.4% in zone II, and 31.6% in zone III. The band was most often continuous in zone I (93.3%), with a significant decrease in visible continuity in zone III (16.7%). Superotemporal bowing of the LRSRB was more frequent in zone II (46.2%) and zone III (33.3%) compared to zone I (20.0%). No inferior displacement of the lateral rectus muscle was identified in any eyes. These findings suggest that the visibility and continuity of the LRSRB are highly dependent on the specific orbital location at which the MRI’s are taken. Standardizing imaging protocols for assessing the LRSRB will improve the interpretation of connective tissue changes in age-related strabismic syndromes, offering potential insights into the pathophysiology of sagging eye syndrome.

Grace Tu
gracetu2@uic.edu
Peoria Campus

Purpose: To analyze effects of revised Eye Bank practices since 2017 on the rates of donor tissue contamination and post-keratoplasty fungal infections.

Methods: Retrospective chart review of a single-center, single Eye Bank database of corneal transplant patients from January 2018 – October 2023. The single center cultures all donor rims and the Eye Bank has not offered antifungal supplementation. Recipients of positive fungal donor rim cultures (FDRCs) were analyzed for prior diagnosis, use of post-surgical antifungal prophylaxis with development of keratoplasty-related infection as the primary outcome measure.

Results: 111 positive donor rims were detected in 804 corneal transplant records reviewed; of the 28 positive FDRCs, 23 were Candida sp. Candida was detected in 11 of 400 (2.8%) Penetrating keratoplasty/deep anterior lamellar keratoplasty and 12 of 358 (3.4%) Descemet’s stripping endothelial keratoplasty/Descemet’s membrane endothelial keratoplasty tissues; chi-square testing did not detect a significant difference (p = .64). No patients received antifungal prophylaxis for a positive FDRC, and no fungal infections were identified post-operatively.

Conclusions: These results suggest recent eye banking modifications have largely eliminated the additional risk posed by tissue preparation on FDRCs without antifungal supplementation. The rate of infection associated with a positive FDRC was far lower than previously reported without the use of antifungal prophylaxis.

Andrew Vallejos
avalle35@uic.edu
Peoria Campus

Alzheimer’s disease (AD) is characterized by neurofibrillary tangles of hyperphosphorylated tau and amyloid-beta plaques. While genetic factors promote these hallmarks, systemic inflammation driven by microglial responses to amyloid-beta, tau tangles, and inflammatory mediators like IL-1beta is increasingly recognized as a key contributor to AD progression. This study investigated whether microglia-specific knockout (KO) of MyD88, a key mediator of the MyD88/NF-kappaB/NLRP3 inflammasome pathway, could reduce inflammation and mitigate AD-related deficits in the TgAPP/PS1 mouse model. Using a Cre-LoxP system, we generated four groups of mice: Cre: MyD88fl/fl TgAPP/PS1, MyD88fl/fl TgAPP/PS1, Cre: MyD88fl/fl, and MyD88fl/fl. Behavioral tests assessed anxiety, exploration, and spatial learning. MyD88 KO reduced hyperactivity in the open field and decreased anxiety in the elevated plus maze. In the Morris water maze, MyD88 KO improved learning in TgAPP/PS1 mice by reducing escape latency and increasing time spent in the target quadrant during the probe trial (F(1,37) = 4.67, p = 0.037). Immunostaining showed no differences in fibrillar amyloid-beta deposits between groups, suggesting behavioral improvements occurred independently of amyloid burden. These findings indicate that microglial MyD88 signaling contributes to AD pathogenesis and may represent a therapeutic target.

Logan Van Poucke
lpv2@uic.edu
Chicago Campus

This case report presents a case of Raynaud’s syndrome with gangrene due to a left radial paronychial infection leading to osteomyelitis of the left long finger in a 79-year-old patient. The patient had previously undergone 4 rounds of debridement by 2 different providers and wound cultures that demonstrated no foreign material. This report highlights that clinicians should be aware of the interconnections between osteomyelitis, Raynaud’s syndrome, and scleroderma, particularly how systemic inflammation and autoimmune processes can link these conditions. In patients with scleroderma, vigilant monitoring for signs of infection is crucial due to their increased susceptibility to osteomyelitis, especially in the presence of digital ulcers exacerbated by Raynaud’s phenomenon. The vascular dysfunction inherent in Raynaud’s syndrome not only contributes to these complications but also requires careful management to prevent ischemic damage and subsequent infections. While essential for controlling autoimmune inflammation, immunosuppressive therapies necessitate a heightened awareness of infection risks. A comprehensive, multidisciplinary approach that addresses these diseases’ vascular, immune, and infectious dimensions is essential for optimizing patient outcomes and preventing complications. Regular screening, prompt treatment of infections, and tailored management strategies for autoimmune and vascular dysfunction are key.

Jennifer Wang
jwang349@uic.edu
Chicago Campus

Sturge-Weber Syndrome (SWS) is a rare genetic condition that presents with facial port-wine stains and can result in severe neurological complications, including seizures and cognitive impairment. Despite its multifaceted impact, assessment of structural brain abnormalities in SWS patients remains a challenge due to the lack of standardized quantitative tools. This study investigates the correlation between quantitative objective brain atrophy measurements derived from imaging data, and clinical subjective atrophy scores by physicians in patients with SWS. We performed cortical surface extraction on longitudinal imaging data from five SWS patients, and quantified gray and white matter volumes across brain regions and hemispheres. This analysis revealed that the percent difference in total left versus right hemisphere volume had a strong correlation (r = 0.97) with clinical atrophy scores. When a similar evaluation was done on gray matter and white matter individually, the correlation was lower (r = 0.9), suggesting that total brain volume is comparatively more accurate in estimating brain atrophy. These findings demonstrate the feasibility of using quantitative brain atrophy measurements derived from MRI scans and pave the way for improved objective assessments, better understanding of disease progression, and enhanced treatment strategies.

Kayla Wartman
kwart@uic.edu
Rockford Campus

Background: Children aged 0-3 are especially vulnerable to maltreatment, and medical professionals play a crucial role in reporting suspected cases to Child Protective Services (CPS).

Objective: This study aims to examine trends in first-time CPS reports made by medical professionals for children aged 0-3, the re-reporting rate, and racial and geographic disparities in re-reporting.

Methods: A dataset was constructed from the National Child Abuse and Neglect Data System, consisting of children aged 0-3 who were first reported to CPS between January 2012 and December 2021.

Results: An increasing trend was observed among 1,276,154 children aged 0-3 years who were first reported to CPS by medical personnel; by 2018, this group became the leading reporters. The re-reporting rate within one year was 12%. Compared to non-Hispanic white children, African American (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.14 – 1.25) and multiracial (aOR 1.24, 95% CI 1.21 – 1.27) children were more likely to be re-reported, while Hispanic (aOR 0.86, 95% CI 0.84 – 0.87) children were less likely to be re-reported. Additionally, the odds of re-reporting were 23% higher for children in nonmetro counties compared to those in metro counties (aOR 1.23, 95% CI 1.21 – 1.25).

Conclusions: These findings highlight the growing role of medical professionals in reporting young child maltreatment. Addressing racial and geographic disparities is crucial for equitable child protection efforts.

Taylor Webb
twebb23@uic.edu
Chicago Campus

International incidence data suggest that 250,000 to 500,000 people sustain traumatic and non-traumatic spinal cord injury (SCI) annually. SCI’s are costly, resulting from the long length of stay (LOS) in hospitalizations. However, there is limited evidence regarding factors affecting hospital LOS and how variations in LOS are associated with outcomes in people with traumatic or non-traumatic SCI. The purpose of this study was to report our reviews on existing international research literature regarding hospital LOS and how LOS was associated with person- and hospital-level factors and rehabilitation outcomes. We conducted a literature search from 2009 to March 2023 via electronic databases. We used Covidence to yield 7357 unique records. Among all included articles, the average rehabilitation LOS in Australia, Canada, and China were 2-3 times longer than in the United States. Older age, complete tetraplegia, and obesity were associated with longer LOS. Earlier studies often reported shorter LOS was associated with favorable outcomes, including higher discharge functional status, mobility, discharge to home, availability of social support, and low re-hospitalization rates. However, most of these studies did not adjust for neurologic injury characteristics. The study has revealed inconsistent results and we are limited by the modifying factors that impact LOS. Future studies should use a mixed-methods approach to understand the outcomes of people with SCI.

Amanda Weis
weis4@uic.edu
Rockford Campus

Clinical evidence has emphasized the possibility of adverse neurological effects secondary to the release of metal particles from hip implants. In this study, we consider the release of CoCr particles from implants in inflammatory/infectious conditions. This study aims to compare the neurotoxic effects of increasing concentrations of CoCr particles from the IMR-32 cell line under LPS and Hâ‚‚0â‚‚ treatment for a duration of 24/72 hours. The cells were revived, split upon 80% confluency, and seeded into 24/48 well plates of cell suspension with 100 ng of LPS/10 mM concentration of Hâ‚‚0â‚‚ for a period of 24 hours. After 24 hours, the cells were treated with 0.05 ppm, 0.5 ppm, and 1 ppm CoCr particles for 24 hours/72 hours. Cell viability of treatment groups containing 1 ppm of LPS/Hâ‚‚0â‚‚ was conducted via AlamarBlue and live/dead staining, while cell cytoskeleton/nuclear integrity was evaluated by FITC/DAPI staining. Live/dead staining demonstrated an increase in dead cells in the treatment groups at 24/72 hours. FITC/DAPI staining revealed a more atypical pattern of growth in the treatment groups at 24/72 hours. AlamarBlue assay revealed a decrease in cell viability in the treatment groups at 24/72 hours. These findings may be explained by the ability of CoCr ions to interfere with cell signaling, as well as the cytokine release/cellular damage caused by LPS and Hâ‚‚0â‚‚ treatment. These results call attention to the development of biocompatible implants to best pertain to patient safety.

Lexi Weltin
awelti2@uic.edu
Peoria Campus

Background: LGBTQ+ individuals comprise 7% of the adult population and 21% of the population ages 18-25; however, only half of U.S medical schools require education on sexuality and its impact on sexual healthcare. Inadequate physician training and patient access to care precipitates health disparities in LGBTQ+ persons. This study investigates if rotation at a queer friendly clinic addresses the gap in physician knowledge and comfort in LGBTQ+ patients.

Hypothesis: Compared to students who rotated with Faith Community Nurses of OSF (FCN), students who rotated with Central Illinois Friends (CIF) would report a greater ability to treat sexual and gender minorities.

Methods: It involved 3rd-4th year medical students who took the community health elective with FCN or CIF. FCN provides a variety of services, primarily via street medicine, to unhoused populations. CIF provides LGBTQ+ care. Student experiences were analyzed in 3 ways: Narrative reflection (course requirement), post-course evaluation (optional), and retrospective interview (optional).

Results: CIF emphasized themes of œMedical Knowledge and œSafe Space, while FCN emphasized œVulnerable Populations. œMedical Knowledge refers to sexual histories, STIs, and knowledge of resources; œSafe Space to inclusivity, compassion, and open-mindedness; and œVulnerable Populations to unhoused populations, socioeconomic barriers, and lack of resources. CIF students noted LGBTQ+ disparities while FCN students did not.

Margaret Wright
mwrigh36@uic.edu
Rockford Campus

Despite advancements in childhood nutrition education, the growing prevalence of childhood obesity and related health complications highlight the need for continued analysis of nutrition education programs, specifically in community-based programs This study evaluates and explores strategies and barriers in implementing community-based nutrition education programs at summer camps in Rockford, IL.

Hands-on lessons and snack preparation activities were evaluated using the RE-AIM framework, which focuses on Reach, Effectiveness, Adoption, Implementation, and Maintenance. The program achieved an average satisfaction rating of 4.6/5, with food preparation activities scoring highest at 4.9/5. Volunteer training received a lower score of 4.4/5, indicating need for improvement in preparation protocols. Successful strategies included interactive activities and flexible scheduling, which enhanced engagement with staff and students as compared to school-based programs. Barriers explored include limited program reach by site variability and materials that were too advanced for younger children.

These findings suggest that community-based programs can effectively promote nutrition education, but these programs face unique challenges from school-based programs. Continued exploration of the implementation of these programs are needed to understand strategies and best practices specific to community-based programs, as well as investigate the efficacy of community-based programs further.

Katherine Wu
kjwu3@uic.edu
Chicago Campus

Purpose:
To evaluate the predictive value of multi-compartment pre-treatment MAA SPECT/CT dosimetry on complete pathological necrosis (CPN) in patients with hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and liver metastases undergoing Yttrium-90 (Y90) treatment before resection or transplantation.

Materials and Methods:
This retrospective study included 27 patients (78% male, mean age 63±8.6 years) with HCC (n=24), ICC (n=2), and liver metastases (n=1) treated between 4/2020-12/2023. Patients underwent transplant (n=17), extended right hepatectomy (n=5), left hepatectomy (n=2), or right hepatectomy (n=1). Dosimetry was performed with SimplicitY90 software.

Results:
The average perfused volume dose was 280.5±155.5Gy. 86% achieved >50% necrosis. Average tumor D95 in CPN patients was 558.3Gy vs. 268.9Gy in non-CPN patients (P=0.02). Tumors < 3cm had higher D95 (552.2Gy) and smaller viable tumor margins (0.5 cm) compared to tumors ≥ 3cm (D95:144.7Gy, margin:1.8cm). ROC analysis indicated that D95 had greater predictive power for larger tumors (AUC=0.75) than smaller tumors (AUC=0.51).

Conclusion:
Multi-compartment MAA SPECT/CT dosimetry, particularly tumor D95, is significantly correlated with CPN in Y90 treated tumors. Tumors < 3cm had higher D95 and smaller viable tumor volumes. These findings suggest MAA SPECT/CT dosimetry and tumor size are valuable predictors of treatment response. Further prospective studies are needed to validate these findings.

Cissy Xiao
cxiao21@uic.edu
Chicago Campus

Dementia affects more than 50 million adults worldwide. Compared to non-Hispanic White populations, Hispanic and Latino populations are more likely to experience dementia syndromes. Despite the disproportionate burden of cognitive impairment faced by Hispanic and Latino populations, molecular research of early structural brain changes, which can be measured on magnetic resonance imaging (MRI), has lagged in this high-risk subgroup. Mitochondrial DNA copy number (mtDNA-CN) is an indicator of mitochondrial gene expression levels that was associated with total brain volume among Hispanic participants. Here, we further explored the association between mtDNA-CN and brain MRI outcomes in up to 1112 participants from the Hispanic Community Health Study/Study of Latinos. Standardized residual mtDNA-CN values were tested for association with standardized total cranial volume-adjusted MRI outcomes using multivariable linear regression models. In our fully adjusted models, the highest tertiles of mtDNA-CN were associated with larger total brain (Beta=0.21, P=0.03) and temporal cortical gray volumes (Beta=0.26, P=0.02) compared to the lowest tertiles, with more pronounced associations observed in men than women. There were no associations of mtDNA-CN with combined cortical gray, other lobar cortical gray, white matter hyperintensities, lateral ventricle, or hippocampal volumes. Ongoing studies will evaluate the association between other mitochondrial markers and brain MRI volumes.

Catherine Xu
cxu56@uic.edu
Chicago Campus

Background: The Sella-Nasion (SN) line is often used as a skull base landmark in orthognathic surgery. However, craniofacial syndromes can alter cranial base anatomy and impact orthognathic planning. This study compares skull base cephalometrics in patients with craniofacial syndromes to controls to assess their reliability for surgical guidance.

Methods: 74 CT scans/lateral cephalograms were included: Apert syndrome (AS, n=8), Crouzon syndrome (CS, n=9), Hemifacial Microsomia (HFM, n=10), Isolated Cleft Palate (ICP, n=5), Nager syndrome (NS, n=4), Treacher Collins syndrome (TC, n=8), Bilateral Cleft Lip and Palate (BCLP, n=10), Unilateral Cleft Lip and Palate (UCLP, n=10), and controls (n=10). Cephalometric measurements were analyzed using Mimics and Dolphin software.

Results: Anterior (S-N), posterior (S-Ba), total (N-Ba), S-A, and S-B cranial base lengths shortened significantly in all craniofacial syndromes compared to normal (p<0.001). The brain side cranial base angle (Ba-S-N) flattened significantly in AS, HFM, NS, UCLP, and TC (p<0.05). The facial side cranial base angle (Ba-SOS-N) flattened significantly only in TC (p=0.03). The posterior cranial base angle (Ba-SOS-S) widened significantly in AS, HFM, NS, CS, and TC (p<0.05).

Conclusion: Patients with craniofacial syndromes have significant skull base cephalometric differences compared to normal, indicating they are unreliable for guiding orthognathic surgery. Future work aims to identify a correct factor.

Jessalyn Yam
jyam3@uic.edu
Chicago Campus

The development of parasite resistance to both artemisinin derivatives and their partner drugs jeopardizes the effectiveness of artemisinin combination therapy. Thus, discovery of new antimalarial drugs, with new mechanisms of action, is urgently needed. We have extensively explored 1-aryl-beta-carboline-3-carboxamides as antimalarials, which are orally efficacious in mice. Furthermore, they show low cross-resistance between susceptible and numerous resistant strains of Plasmodium falciparum, indicating that they remain effective against resistance mechanisms associated with many clinically-used antimalarials. To find antimalarials with even greater in vitro potency against P. falciparum, we are exploring related structures. Recently, compounds based on the imidazopyridine scaffold have proven potent. Computational studies suggested that the shape and electrostatic properties of these imidazopyridine antimalarials could be recapitulated with simpler bis(benzyloxy)benzamides, which possess a similar shape and electrostatic properties. In this poster, I will disclose the synthesis and antimalarial properties of these compounds.

Jessalyn Yam
jyam3@uic.edu
Chicago Campus

Background: Bariatric surgery is an efficient method in weight reduction for patients experiencing severe obesity. However, postoperative analgesia poses numerous risk factors associated with obesity, including pulmonary complications and increased pain scores. Combining erector spinae plane block (ESPB) with multimodal analgesia in laparoscopic sleeve gastrectomy (LSG) surgery aims to minimize opioid consumption and improve postoperative recovery.

Methods: A retrospective cohort study of patients who received a LSG at UI Health between January 2023 to November 2024 was conducted.

Results: A total of 670 participants were evaluated in this study. Patients who received an ESPB demonstrated significantly lower opioid consumption in the post-anesthetic care unit (PACU) (p = 0.0073). Statistically significant reductions were also observed in intraoperative morphine equivalents, intraoperative fentanyl consumption, and intraoperative ketamine consumption with ESPB use (p = <0.0001, 0.033, and 0.0006, respectively). Propensity score analysis with control over patient demographics and procedure length revealed significant reduction in overall opioid consumption in patients who received an ESPB.

Conclusion: ESPB use significantly reduced morphine consumption during and following LSG, contributing to overall improved postoperative recovery outcomes for patients. Clinicians should consider using ESPB more frequently when performing LSG procedures to enhance patient recovery.

Deneb Zavala
dzavala3@uic.edu
Chicago Campus

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality globally, with an incidence of 11% worldwide, 4% in the U.S., resulting in 70,000 annual deaths (1 every 6 minutes). In addition, Black women in the U.S. are three times more likely to die from PPH compared to White women. Uterine atony accounts for 70-80% of cases (ACOG). Early intervention is key in preventing long-term complications and use of invasive procedures, like surgery and blood transfusions. This study explores the need for an intervention that accurately detects early PPH, and prevents invasive and costly interventions.

Methods: A six-week immersion in Labor & Delivery and operating rooms was spent interviewing providers and observing workflows to identify unmet needs in PPH management. A literature review evaluated detection and treatment protocols, and market analysis explored solutions and their limitations.

Results: Current solutions, including visual estimation, weighing surgical materials, and Triton (Stryker) AI vision, often fail to detect primary PPH. Limitations of these interventions include poor accuracy, efficiency, cost, and timeliness. Significant gaps include a lack of objective tools for detecting uterine atony before external bleeding is observed and systematic methods for monitoring postpartum uterine activity. These results highlight opportunities for novel technologies to optimize care delivery, early detection, and reduce maternal mortality.

Mathew Zleczewski
mzlecz2@uic.edu
Peoria Campus

Background: Hyponatremia is associated with significant systemic risks and adverse outcomes in surgical patients. The condition can result from a broad range of factors. We aimed to determine the effects of hyponatremia on postoperative outcomes.

Methods: NSQIP 2017-2019 and 2021-2022 was used to identify all patients having surgery. Patients were excluded if they had no sodium value documented or were hypernatremic (Na+ > 145). Patients were divided into mild (130-134), moderate (125-129), and severe (<125) hyponatremia groups. Demographic, and post-operative mortality and morbidity data were collected on all patients.
Results: Among the analyzed cohort, 3,443,173 patients with normal serum sodium levels served as controls, while 193,370 patients had mild, 38,429 moderate, and 3,420 severe hyponatremia. Patients with hyponatremia had progressively higher odds of 30-day mortality compared to controls, with odds ratios (OR) of 1.434, 1.468, and 1.837 for mild, moderate, and severe hyponatremia, respectively. Hyponatremia significantly increased the risk of adverse surgical outcomes, including unplanned return to the operating room, wound dehiscence, and blood transfusion, as well as cardiac, respiratory and infectious complications.

Conclusions: These findings underscore the systemic impact of hyponatremia across all severity levels, highlighting the importance of identifying and correcting this modifiable risk factor to reduce complications and improve surgical outcomes.

Mathew Zleczewski
mzlecz2@uic.edu
Peoria Campus

Background: Derived from the Geriatric Nutritional Risk Index, the Adult Nutritional, non-Geriatric Risk Index (ANGRI) addresses non-geriatric patients using hemoglobin A1c, hematocrit, serum albumin, and actual-to-expected body weight ratio. This study evaluated ANGRI’s utility in predicting outcomes for urologic surgeries, where nutritional status significantly impacts recovery.
Methods: Using 2021“2022 NSQIP data, we analyzed 6,371 patients, excluding those under 18, over 64, or missing ANGRI variables. Outcomes included 30-day mortality, septic shock, ventilator dependence (>48 hours), and transfusion need. Performance was assessed using the c-statistic, Brier score, and Hosmer-Lemeshow test.
Results: ANGRI demonstrated excellent predictive ability for 30-day mortality (c-statistic: 0.725, 95% CI 0.622“0.827, p 48 hours) (c-statistic: 0.820, Brier score: 0.0029), and transfusion need (c-statistic: 0.744, Brier score: 0.0497).
Conclusions: ANGRI effectively identifies high-risk patients undergoing urologic surgeries, supporting improved preoperative risk stratification and perioperative management. While findings are promising, the small dataset limits generalizability. Future analyses with larger datasets will validate these results. This study underscores the importance of integrating nutritional assessment into surgical planning to improve outcomes

Alejandra Zocchi
azocch2@uic.edu
Chicago Campus

Short inter-pregnancy intervals (IPI) are associated with adverse health outcomes for women and infants, disproportionately affecting low-income populations. Timely postpartum (PP) contraceptive care is critical, but patient-centered strategies to improve access are needed. This study examined perspectives of staff and providers from seven Community Health Center (CHC) sites across two U.S. states on implementing a clinical trial offering co-scheduled well-infant/maternal contraceptive care during Well-Baby Visits (WBV) for infants 0-6 months.

Eighteen participants, including providers, staff, and administrators, completed semi-structured interviews. Analysis revealed that co-scheduled visits were viewed as beneficial for improving timely contraceptive access, convenience, and encouraging family planning discussions during the postpartum period. However, discomfort among staff and providers in initiating family planning conversations at the WBV was a significant barrier.

Paired care approaches, such as co-scheduling, show promise for reducing unintended short IPIs and improving maternal-infant health. To ensure successful implementation, comprehensive training, ongoing support, and patient-centered strategies developed collaboratively with care teams are necessary. These measures can address barriers, enhance provider confidence, and align care delivery with the unique needs of postpartum women.