United States

Trigeminal trophic syndrome (TTS) is a cause of facial ulceration that occurs secondary to trigeminal nerve injury. This condition mimics other causes of facial ulceration, often leading to misdiagnosis. This case series presents the clinical features, diagnostic approaches, and treatment outcomes of five patients with TTS to help improve understanding of this rare condition and diagnostic accuracy. Review of these cases demonstrates the most common area of ulceration was the nose, a female predominance, and an age of presentation of middle-aged to older adults. Four patients had biopsy results revealing an absence of malignant or infectious cause of facial ulceration. Ulceration typically develops years after nerve injury and may persist for months to years. Treatment typically involved topical antibiotics, neurology consultation, and four of the five patients underwent surgical repair for the treatment of TTS. Early recognition and an individualized multidisciplinary therapeutic approach are vital in improving patient outcomes and quality of life, as well as preventing recurrence in patients with TTS.

AMA Research Challenge 2025 

Trigeminal trophic syndrome: case series and review of surgical treatment strategies

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Temporomandibular joint (TMJ) ankylosis causes severe restriction in mouth opening, affecting speech, nutrition, appearance, and oral hygiene. While a variety of techniques for the treatment of TMJ ankylosis have been reported, the exact relationship between different surgical treatment options and patient outcomes is poorly defined. This systematic review aims to assess the current literature on the surgical treatment of TMJ ankylosis to develop a predictive relationship between surgical intervention and patient outcomes. PubMed, Embase, and Web of Science were searched and 52 studies met inclusion criteria. Data extracted included demographics, surgery type, maximal incisal opening (MIO), physiotherapy, complications, and follow-up. Outcomes assessed were re-ankylosis, facial nerve injury, infection, and MIO change. In children, greatest MIO improvement occurred with gap arthroplasty with costochondral and interposition grafts (6.14mm to 32.72mm); smallest with interposition grafts (6.26mm to 31.38mm). Complication rate was 16.7%; re-ankylosis was 10.6%. In adults, greatest MIO improvement was with gap arthroplasty with costochondral and interposition grafts (8.18mm to 37.3mm); smallest in TMJ replacement (9.08mm to 24.62mm). Complication rate was 7.7%; re-ankylosis was 0.89%. Noncompliance to physiotherapy (PT) was a key factor in re-ankylosis and reduced MIO. Treating patients with TMJ ankylosis is challenging due to limited data available to guide treatment. After surgical treatment, an average of 32mm of postoperative MIO can be expected. Postoperative physiotherapy should be emphasized to increase postoperative MIO to prevent re-ankylosis and improve outcomes.

Surgical and Clinical Outcomes of Temporomandibular Joint Ankylosis: A Systematic Review

Background
Acromial fractures (AcFx) are a complication of reverse total shoulder arthroplasty (RTSA), associated with pain, impaired shoulder function, and prothesis failure. Predictors of AcFx risk are poorly defined. Morphologic features and prothesis position may influence mechanics of the scapular spine and acromion, thereby increasing susceptibility to AcFx. This study sought to identify imaging-based patient and prothesis characteristics that predict AcFx risk post-RTSA.

Methods
A retrospective case-control study was done on patients who underwent RTSA at a single large tertiary institution between January 2020 and July 2024, with >10 months of follow-up. Exclusion criteria included revision arthroplasty, pre-existing bone lesions, AcFx before RTSA or from postoperative trauma, insufficient imaging, and displaced humeral fractures. Non-displaced fractures were included if surgical approach was not altered. AcFx were classified using the Levy classification. Subjects were matched 1:2 (case:control) by age and sex. Covariates included BMI, bone demineralization, inflammatory arthropathy, diabetic and smoking status, as well as acromial morphometrics (length and thickness) and preoperative global offset. Descriptive analyses and multivariable logistic regression were performed.

Results
After screening 718 RTSAs, 36 (6.8%) AcFx cases were identified among 526 procedures. Mean time to fracture was 4.64 months, with 78% occurring within six months. Using the Levy classification, 61% were Type 1 fractures, 33% Type 2, and 6% Type 3. The AcFx group and matched controls (n=72) were 80% female, with a mean age of 709 years. AcFx patients had a higher prevalence of bone demineralization (47% vs. 26%, p=0.03), shorter acromial length (34.7 vs. 37.5 mm, p=0.053), and less humeral lateralization (15.6 vs. 18 mm, p=0.038). Multivariable logistic regression_ adjusting for age, sex, BMI, acromion measurements, and humeral lateralization_ trended toward significance for bone demineralization (OR 2.56, p=0.059), shorter acromial length (OR 0.93, p=0.083), and reduced humeral lateralization (OR0.92, p=0.075).

Conclusion
Shorter acromial length and reduced humeral lateralization are associated with increased risk of AcFx after RTSA. These features could be predictive of postoperative AcFx, alerting radiologists to higher-risk patients and prompting closer postoperative surveillance.

Imaging Predictors of Acromial Fractures Following Reverse Total 
Shoulder Arthroplasty

Beyond SF3B1: Clinical Response to Luspatercept in a Case of SF3B1-Negative Lower-Risk MDS 
Background 
Luspatercept is a recombinant fusion protein that binds transforming growth factor-beta (TGF-β) ligands, reducing SMAD2/SMAD3 signaling (named after Sma/Mad genes) and promoting erythroid maturation. It is a first-line treatment option for symptomatic anemia in very low- to intermediate-risk myelodysplastic syndrome (MDS) patients, who are erythropoiesis-stimulating agent (ESA)-naive and have serum erythropoietin levels below 500, particularly with the positive SF3B1 mutation. However, for other MDS cases, it serves as a secondary treatment choice, competing with ESA, imetelstat, hypomethylating agents (HMAs) and lenalidomide. 
We present a case of an MDS patient with 20q deletion, multiple mutations and no definitive FDA-approved therapy, who was treated with luspatercept. 
Case Presentation 
A 76-year-old Bangladeshi male with a history of anemia, thrombocytopenia, hypertension (status post aortocoronary bypass graft), hypothyroidism, peripheral vascular disease, and benign prostatic hyperplasia presented with weakness, fatigue, shortness of breath, and chest pain on exertion for the past few months. 
The initial workup revealed a decrease in hemoglobin from 11 to 8.6 within two months and thrombocytopenia, with platelets at 59. Iron deficiency was ruled out. A bone marrow biopsy revealed MDS with low blasts in a hypercellular marrow, positive for 20q deletion, DNMT3A, TET2, and PHF6 mutations, and negative for SF3B1 or ring sideroblasts. The age-adjusted Revised and Molecular International Prognostic Scoring System (IPSS-R/IPSS-M) scores were in the intermediate and moderate low-risk categories, respectively. 
Six cycles of intravenous azacitidine and oral allopurinol were administered, resulting in a temporary improvement of hemoglobin to normal levels. Azacitidine was switched to epoetin alfa due to declining kidney function and treatment resistance; however, hemoglobin levels continued declining. The patient then received one dose of luspatercept, which caused hemoglobin to rise from 7.7 to 11.5 within three weeks. 
Luspatercept dosage and frequency have been adjusted to hemoglobin levels, maintaining it at 11. 
Discussion 
Early investigation is crucial for effective treatment of anemia, the most common hematological disorder. While 20q deletion and TET2 mutation in MDS are biomarkers of a better response to azacitidine, a standard first-line therapy for higher-risk MDS with multiple mutations, treatment resistance and side effects including kidney damage pose a significant challenge. Proven by a very good response in our patient, luspatercept could be a competitive alternative treatment option. Although luspatercept is FDA-approved in lower-risk MDS with SF3B1 mutation and ring sideroblasts, more studies should be conducted to investigate the response of luspatercept in MDS with mutations other than SF3B1.

Beyond SF3B1: Clinical Response to Luspatercept in a Case of SF3B1-Negative‬ Lower-Risk MDS

Background: Emery-Dreifuss Muscular Dystrophy (EDMD) is a complex congenital multi-system disorder characterized by progressive generalized muscle weakness frequently leading to restrictive lung disease and cardiomyopathy resulting in heart failure with reduced ejection fraction (HFrEF). This poses a diagnostic dilemma as patients can present with acute-on-chronic hypercapnic respiratory failure (AChRF) with a severely decompensated arterial blood gas (ABG) profile that belies the less overt signs of respiratory distress stemming from respiratory muscle weakness. This case highlights the central role of Bilevel Positive Airway Pressure (BiPAP) in managing concurrent respiratory and cardiac pump failure and underscores the management challenges inherent in care transitions for patients with complex diseases.

Case Presentation: A 56-year-old woman with sleep disordered breathing and chronic hypercapnic respiratory failure secondary to EDMD, managed with nocturnal BiPAP, and HFrEF (ejection fraction [EF] 30-35%), managed with a cardiac resynchronization therapy (CRT) device, was admitted to the intensive care unit (ICU) with carbon dioxide (CO2) narcosis and acute decompensated heart failure. This admission occurred two days after discharge to a skilled nursing facility (SNF), where her BiPAP was not administered for 48 hours. Upon presentation, she was obtunded with an arterial oxygen saturation level (SpO₂) of 61%. Initial ABG revealed severe respiratory acidosis (pH 7.26, PaCO₂ 65 mmHg, HCO₃⁻ 35 mmol/L), with chest X-ray showing cardiomegaly and pulmonary congestion. She responded well to non-invasive ventilation (NIV) (BiPAP with Average Volume-Assured Pressure Support [AVAPS]) and intravenous diuretics leading to clinical improvement and acid-base stabilization. Following discharge back to the SNF, she was readmitted the next morning with an identical presentation after her BiPAP was again not administered for nine hours. Subsequent management additionally included a detailed, direct peer-to-peer telephonic sign-out with the SNF staff to ensure consistent BiPAP administration. This intervention proved successful, and the patient was discharged without further readmission.

Discussion: This case offers educational value by highlighting the crucial role of NIV, such as BiPAP, in patients with cardiorespiratory compromise. BiPAP offers a dual benefit - it supports respiratory function and improves cardiac output by reducing both preload and afterload, often averting the need for more invasive interventions. Additionally, this case emphasizes the importance of direct peer-to-peer communication, as reliance on electronic systems alone can omit subtle details, potentially compromising patient safety during care transitions. Personal interactions among healthcare providers, increasingly uncommon in the current era of electronic communication, often facilitate clearer understanding, convey urgency, and promote accountability, thereby enhancing patient safety and outcomes.


Dual Pump Failure and Communication Failure: Lessons from Recurrent Hospitalizations in Emery-Dreifuss Muscular Dystrophy - A Case Report

Background
Spinal epidural abscess (SEA) is a rare but life-threatening condition, with an incidence of 5.1 cases per 10,000 hospital admissions in the U.S. Delayed diagnosis can cause permanent neurological damage. SEA mimicking degenerative disc disease (DDD) led to a repeatedly missed diagnosis in our case.

Case Presentation
A 78-year-old male with chronic back pain and prior L4–L5 posterior spinal fusion presented with acute lower back pain after cleaning gutters. Initially, discharged from ED with musculoskeletal diagnosis, but returned with severe neck pain, stiffness, incoherent speech, and fever.
CT head was unremarkable; spine CT showed multilevel degenerative changes. Unsuccessful LP due to spinal DDD. MRI revealed prevertebral edema and concern for abscess and osteomyelitis, but neurosurgery attributed findings to end-stage DDD at C4–C5, citing no infection. Since a meningitis pattern was noted on the Flair series MRI, ID started meningitis treatment.
Shortly after admission, he required intubation. Concern for possible cord compression prompted transfer to a tertiary center. There, MRI revealed a T12–L5 epidural abscess. He underwent laminectomy with abscess evacuation and hardware removal. MSSA bacteremia treated with oxacillin. TEE ruled out endocarditis.
Despite initial improvement, he deteriorated later. Repeat MRI revealed worsening C1–C7 epidural abscess. Underwent emergent cervical laminectomy. He improved postoperatively and was discharged to rehabilitation.

Discussion
SEA causes nonspecific inflammation to localized abscess formation through direct spread of local infection or hematogenous spread, causing tissue destruction, vascular compromise, and cord ischemia. Risk factors- diabetes, immunosuppression, IV drug use, IE, and spinal procedures not necessarily present.
Thoracolumbar spine is more susceptible due to larger epidural space and fatty tissue. Classic triad of back pain, fever, and neurological deficits noted in <15% of cases. SEA is rarely considered over meningitis in acute stiff neck cases.
MRI with contrast is the preferred imaging. Differentiating SEA from DDD is challenging due to overlapping imaging features. SEA involves epidural space with mass effect on the thecal sac, while DDD affects intervertebral discs and facet joints. On T1-weighted MRI, SEA appears hypointense/ isointense relative to the spinal cord; on T2, it is

hyperintense due to abscess and inflammation. DDD shows variable T1 and often hypointense on T2. Suppiah et al. believed that open surgery with sensitive antibiotic therapy is the best treatment method.
This case highlights the diagnostic challenges of SEA with atypical presentation and imaging, the need for broad differentials, and accurately differentiating DDD from SEA on imaging to prevent fatal outcomes.


When Back Pain Isn’t Just Degenerative Disc Disease- A Hidden Spinal Epidural Abscess

Abstract Title
Parietal Lobe Ependymal Cyst in a Cadaver with Epilepsy: A Case Report and Review of Clinical Implications
Background
Ependymal cysts are rare, benign, cerebrospinal fluid-filled neuroepithelial lesions typically located within the cerebral parenchyma. They are often asymptomatic and discovered incidentally through imaging or postmortem examination. Differentiation from other neuroepithelial cysts is based on location and histological features. Though largely considered incidental findings, a small number of reports have suggested a possible link between intracranial ependymal cysts and neurological symptoms such as seizures. Due to their rarity and nonspecific presentation, the clinical significance of ependymal cysts remains uncertain. A better understanding of the role these cysts play in neurological conditions such as epilepsy is of interest to future patient care. 
Case Presentation
A 71-year-old female cadaver with a documented history of epilepsy was donated to Creighton University School of Medicine for educational dissection. During routine anatomical dissection, a cavitary lesion was discovered in the left superior parietal lobe. Further coronal sectioning and consultation with a board-certified pathologist identified the lesion as an ependymal cyst. The cyst measured 1.78 x 3.28 x 2.15 cm and was located 0.34 to 0.73 cm from the lateral ventricle. The cadaver’s documented medical history did not provide specific neurological details beyond the diagnosis of epilepsy. 
Discussion
Although most commonly located in the cerebellopontine angle or ventricular system, ependymal cysts can occur in other cerebral regions and are infrequently linked to seizure activity. Only a limited number of published cases have reported such an association. In this case, the cyst’s location in the superior parietal lobe, a region less frequently implicated in epilepsy, presents a unique opportunity to consider its potential role in epileptogenesis. Theoretical mechanisms include mass effect on surrounding cortical tissue and reactive gliosis, which may contribute to cortical hyperexcitability. The cyst’s proximity to the postcentral and angular gyri suggests possible involvement in sensory processing or higher cognitive functions. Compared to previously reported seizure-associated cysts, which averaged larger dimensions, the cyst in this case was moderately sized, raising questions about the threshold size for symptomatic presentation. This case highlights the value of anatomical dissection in identifying rare lesions and underscores the importance of considering ependymal cysts in patients with unexplained epilepsy. Further research is needed to clarify the clinical significance of these cysts and to guide potential management strategies. 





Parietal Lobe: Ependymal Cyst in a Cadaver with Epilepsy: A Case Report

Background:
Rural communities in Nigeria continue to face limited access to quality healthcare, despite global population growth. Telemedicine emerges as a promising solution, offering remote delivery of medical services and knowledge, which reduces the need for travel and improves resource efficiency. However, its adoption remains limited due to technological barriers, low ICT literacy among healthcare providers, and data security concerns. The project also examines Nigeria’s healthcare ICT infrastructure, highlighting that, despite government-led initiatives, significant gaps remain in implementation, particularly in rural settings where systemic and logistical challenges continue to hinder widespread telemedicine integration.

Methods:
This study employed a qualitative design with supplementary quantitative insights to explore telemedicine implementation in rural Nigeria. Structured interviews were conducted with eight healthcare providers—including two specialists, five general practitioners, and one nurse—across two government hospitals. Participants were assigned anonymized codes to ensure confidentiality. Semi- structured prompts guided discussions on ICT literacy, infrastructure barriers (e.g., unreliable electricity and internet), and data security concerns. Interviews were recorded with consent, transcribed verbatim, and thematically analyzed. This approach provided a detailed understanding of systemic challenges and informed recommendations aligned with Nigeria’s National Health ICT Strategic Framework.

Results:
Clinicians recognized telemedicine’s value in reducing travel needs and enabling timely medical care. However, barriers such as poor internet connectivity, unstable electricity, and weak infrastructure limit its effectiveness. ICT proficiency among providers varied, affecting ease of use. Organizational challenges—including lack of clear policies, data security concerns, and copyright issues—also hinder adoption. Despite resistance, the future of telemedicine in Nigeria remains promising, with success dependent on pilot programs, training initiatives, strengthened cybersecurity, and policy support to ensure sustainable integration into the healthcare system.

Conclusion: 
This study explored clinician perspectives on the underutilization of telemedicine in Nigeria, revealing discomfort and resistance tied to unfamiliarity and system challenges. Expanding health information systems and fostering acceptance will require innovation, secure technology, and provider training. While initial hesitation is expected with new systems, addressing these concerns is essential for growth. As telemedicine gains traction, targeted pilot programs and institutional support will be key to developing effective policies and promoting widespread, practical adoption across Nigeria’s healthcare landscape.

Unlocking Healthcare Potential: Telemedicine as a Catalyst for Inclusive and Quality
Healthcare in Rural Nigeria

Abstract Title
Analyzing Nonprofit Hospital Community Benefit and CEO Compensation in Michigan

Background
Nonprofit hospitals in the United States have long been granted tax-exempt status under the condition that they provide community benefit that is equal to their exemption value. However, this obligation has historically lacked oversight and transparency. As healthcare costs rise, hospitals have recently been put under greater scrutiny to determine how institutions are meeting or failing to meet their community benefit expectations. A key area of concern is executive compensation. Over the past several decades, hospital CEO pay has surged, often reaching millions annually, even as lower-wage healthcare workers face stagnant wages and understaffing. Examining studies and data that focus on community benefit and executive compensation practices is essential to increasing transparency in nonprofit healthcare. 

Methods
A systematic literature search was conducted using Web Of Science. The search string included terms such as “nonprofit hospital,” “chief executive officers, hospital,” “hospital community benefit,” “community benefit spending,” and “tax exemption.” Inclusion criteria for the articles focused on studies published from 2000 to 2025 and included systematic reviews. Annual nonprofit hospital tax forms and data from the Lown Institute’s Hospital Index was also used. Using Michigan as a case study, hospital rankings were examined alongside CEO compensation and indicators such as community benefit investment, pay equity, and overall hospital performance. 

Results
In 2024, 80% of nonprofit hospitals in the U.S. operated at a “fair share deficit,” receiving more in tax breaks than they returned in community investment. In Michigan alone, 97% of hospitals were reported to be in a deficit, totaling $1.4 billion. The highest paid nonprofit Michigan CEOs from 2023 were all from healthcare companies. Grayling Hospital ranked best in the state and 56th nationally for social responsibility, with high scores in equity of pay and overall community benefit. In contrast, Henry Ford Hospital ranked 56th in the state and 2,117th nationally and received a “D” ranking in pay equity. CEO compensation reflects these disparities: Grayling Hospital spent $6.1 million on executive compensation in 2023, with its top executive earning $2.4 million, while Henry Ford spent over $20 million on executive compensation, their CEO making $4.5 million.

Conclusion
Recent examination into community benefit has revealed systemic shortcomings in nonprofit hospital accountability. Disparities in CEO compensation and vague community benefit reporting signal a need for reform. Enhancing transparency, enforcing limits on executive pay, and tying compensation to community impact could help improve community benefit and pay equity.

Analyzing Nonprofit Hospital Community Benefit and CEO Compensation in Michigan

Project Description
Homelessness is prevalent in hospitalized patients and associated with adverse outcomes, but hospitalization is frequently a missed opportunity for meaningful connection to housing and support that could mitigate these outcomes. In December 2023, Denver Health, a safety-net hospital located in downtown Denver, partnered with the Denver Housing Authority to launch the 655 Broadway Transitional Housing Program, a program for at-risk hospitalized patients experiencing homelessness. Located on the main hospital campus, the housing program provides 14 housing units for elderly or disabled patients, who are identified during hospitalization and discharged directly into the program where they receive support from two full time staff, a social worker and a housing navigator, through a shared staffing model. The program aims to stabilize health conditions, reduce avoidable acute care utilization by increasing engagement in primary and preventative healthcare, foster community connections to address health-related social needs, and facilitate entry into permanent housing. 
Objectives
To evaluate the impact of the 655 Broadway Transitional Housing Program on participants’ health, housing stability, and access to essential resources, as well as to identify program facilitators, barriers, and areas for improvement from the perspective of individuals experiencing homelessness. 

Methodology
We conducted semi-structured interviews with 16 participants who had been enrolled in the program for at least 45 days, recruited through convenience sampling based on participant and interviewer availability. Interviews explored participants’ perceptions of the program’s acceptability, benefits, barriers, and impact on health and resource access. Thematic analysis was conducted with themes identified a priori and inductively through content analysis. Two data coders reviewed the interviews and applied codes using Dedoose software. 
Applicant’s Role in Project
Rebekah Davis is a third-year medical student who was actively involved in several key aspects of the project. She contributed to defining the project objectives and helped design the interview guide to ensure it aligned with the study’s goals. Rebekah conducted interviews, gathering valuable insights from participants. She also helped develop the qualitative analysis plan by selecting coding methods and organizing themes, and participated in coding the data to identify key themes. Finally, she played a role in organizing and presenting the results.
Results
Three main themes emerged from data analysis: 1) Perceived Benefits: Participants valued having a dedicated case manager to assist with obtaining vital identity documentation and applying for public assistance, and appreciated the proximity of housing to healthcare services; 2) Health Improvements and Enhanced Access to Care: Participants reported improved medication adherence and more consistent attendance at medical appointments; 3) Impact on Well-being: Participants expressed deep gratitude for the housing opportunity, describing it as a pivotal step toward securing permanent housing. For some, it was their first time off the streets in over a decade. They shared stories of past homelessness with program staff to assess implementation challenges and identify opportunities for improvement and contrasted those experiences with their new environment. Additional program evaluation will examine staff perspectives and assess the program’s longer-term impact on housing and health outcomes. 
Conclusions
Our quality improvement evaluation suggests that this transitional housing program is highly regarded by participants, providing meaningful improvements to physical and mental well-being, and improved access to critical supports. Our findings underscore the importance of housing-health partnerships in addressing the complex needs of individuals experiencing homelessness, including those utilizing hospital systems.

Exploring a hospital’s role in addressing homelessness: a qualitative evaluation of a hospital-housing partnership for seniors and disabled patients

Background

People with sensory disabilities (PWSDs) –people who are deaf, hard of hearing (DHH), and blind or low-vision– face health disparities due to lower health literacy, communication barriers, and fragmented care. PWSDs encounter limited accessible health resources and a lack of tailored interventions, leading to poorer health outcomes. For example, DHH individuals are seven times more likely to have inadequate health literacy compared to hearing peers, increasing their risk of preventable illness and unmet health needs. This study aims to develop and evaluate accessible, relevant health education materials centered on the needs of PWSDs, aligning with the National Library of Medicine’s strategic plan and Centers for Medicare & Medicaid Services recommendations to improve health equity.

Methods

We developed a health communication materials assessment checklist using a multi-phase process integrating evidence synthesis, existing best practice checklists, and a community- engaged needs assessment focused on the design of health education for PWSDs. We reviewed existing checklists to identify key characteristics of patient health education for the general population. We adapted these characteristics to address the specific needs of PWSDs, creating an expanded item bank for the final, tailored checklist. Next, we worked with a health sciences librarian to conduct a rapid review with systematic search to identify literature on information accessibility for PWSDs. The review focused on the breadth of information available on information accessibility and marginalization among PWSDs. Articles were coded using qualitative content analysis methods using a hybrid coding approach.

Results

We identified six health education assessment tools used in mainstream public health practice including the CDC’s Clear Communication Index and Patient Education Materials Assessment Tool. These existing checklists emphasize communicating a single health message; tailoring for audiences; and identifying communication channels to reach those audiences. None of these checklists included accessibility of material for PWSDs. Our rapid review identified 1,260 articles; 256 were included after title/abstract and full-text screening. These articles identified factors related to sensory disabilities generally (e.g., readability) in addition to disability-specific factors (e.g., ASL adaptation, and visual descriptions).

Conclusion

The lack of best practice guidelines hinders the ability of public health promotion specialists to meet the needs of PWSDs, creating additional inequity for a health disparities population. Our checklists provide guidance on developing web-based and print health education materials for PWSDs, while maintaining accordance to health communication best practices. These checklists will be publicly available for use by public health professionals interested in improving health promotion for PWSDs.

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