​In modern clinics, patient safety depends on more than good intentions. When care teams face high volumes or time-sensitive situations, relying on verbal reminders or memory is no longer enough. Structured tools, such as checklists and shared protocols, support safe care by making critical steps visible, timely, and clearly assigned.

A medical checklist establishes a confirmable, ordered set of steps to prevent omissions. For instance, before a procedure, team members might verify the patient's identity, check for allergies, confirm medications and supplies are ready at the bedside, and confirm team readiness. Each step is completed and ticked off in sequence, reducing the chance of missed tasks.

Clinics also use shared protocols, which are detailed, evidence-based plans that guide care in specific situations. These documents outline a sequence of clinical actions, often including branching points based on symptoms or timing. For instance, if a patient experiences heavy bleeding after childbirth, a protocol might instruct the team to start recommended medications promptly, in line with local guidelines, call for additional support, and prepare for surgical escalation if necessary.

Obstetric protocols like these are structured with escalation in mind. In the case of postpartum hemorrhage, stage-based response plans specify immediate actions, second-line medications, and surgical preparation if bleeding continues. Charge nurses or supervisors assign roles before delivery, and staff rehearse transitions between stages to reduce confusion when response speed matters most.

To maintain readiness, clinics conduct structured training drills that simulate real complications. These drills are more than walkthroughs; they evaluate timing, role clarity, and the team's response under pressure. Supervisors often identify bottlenecks during post-drill debriefs, such as missed cues, delayed actions, or workflow overlaps, which teams can address before they affect real patients.

Shared protocols also help avoid handoff failures and miscommunication between shifts. Staff can lose track of details or assume responsibility for the next step, especially during busy periods. Protocols pre-assign responsibility and handoff steps, reducing the risk that critical tasks are duplicated, delayed, or missed altogether.

From the patient's perspective, these systems are often invisible. Still, they show up in how care unfolds: more timely decisions and fewer avoidable interruptions. Patients may never see the checklist itself, but they experience the smoother flow and coordinated teamwork it enables.

Inside the clinic, supervisors may ask teams to review how well they followed protocols after a procedure or event. Routine audits and debriefs often surface missed steps, unclear timing, or inconsistent documentation. These reviews emphasize learning and early detection of risks, so teams can address problems before patients are harmed.

Protocol revisions do not happen automatically. Care teams distribute, test, and integrate each update through specific rollout steps. For example, clinics may update digital forms, retrain staff on new checklists, or run a pilot to introduce updates without disrupting care. Teams adopt changes only after confirming a shared understanding during rollout.

Even with careful planning, protocol rollouts may face friction. Staff may encounter training gaps, unfamiliar equipment, or inadvertently use outdated versions. To mitigate these problems, some departments keep version logs and hold shift briefings to detect and correct such issues before protocols drift out of alignment with practice.

As new safety challenges emerge and clinic environments grow more complex, the roles of checklists and protocols will continue to evolve. What remains constant is their ability to give teams a shared starting point: one that helps protect patient outcomes and reduces staff uncertainty. That shared foundation keeps improvements moving forward even as the pace and demands of practice change.

​The American College of Obstetrics and Gynecology, also known as ACOG, emerged to advance obstetrics and gynecology through advocacy, education, and high-quality care. ACOG aims to improve equitable care access within these specialties across North and South America.

Leading ACOG is a board of directors that sets policy, an executive team that assists the board, and over 30 committees handling tasks like auditing, bylaws, compensation, and continuing medical education. The leadership upholds ACOG's core values - including excellence, accountability, and integrity, while - managing its 12 districts and 93 sections, home to over 60,000 members. District and section officials advocate for obstetricians and gynecologists within their respective jurisdictions.

ACOG pushes for fair pay for OB-GYN professionals and reforms to medical liability to boost job satisfaction and care access. In maternal health, ACOG prioritizes reducing maternal mortality rates, addressing substance use disorders during pregnancy and perinatal depression, and ensuring obstetric care access in rural areas. Advocacy efforts to improve patient coverage center on universal women's healthcare access, including family planning services, extended postpartum Medicaid coverage, and removal of Medicaid participation barriers. Other advocacy areas include strengthening the OB-GYN workforce, opposing political interference in medical practice and training, and improving care access.

As an accredited continuing medical education (CME) provider, ACOG enriches its members' professional development through educational resources, from specialized courses, eModules, and publications to conferences and webinars. ACOG welcomes educational partnerships for jointly developed educational programs. The Cognate Program, a voluntary initiative, helps members maintain CME credits and meet state licensure requirements. The Council on Resident Education in Obstetrics and Gynecology (CREOG), а division of ACOG, focuses on advancing OB-GYN residency training. CREOG conducts an annual in-training assessment for residents and provides guidance on curriculum standards and accreditation.

ACOG convenes various member events within the year. One event, the Annual Clinical and Scientific Meeting, features expert speakers (including OB-GYN care experts and authors) and participants who connect, share industry insights, and expand their networks. Annual district meetings across various states within the districts focus on regional networking, professional development, and best practice dissemination. The Congressional Leadership Conference (CLC), а key event, explores different themes yearly. CLC aims to empower OB-GYNs to influence policymakers and advocate for policies that improve their practice.

Various programs improve women's health. The Long-Acting Reversible Contraception (LARC) program focuses on birth control and contraception access. IMPACT supports abortion care through professional training and web-based resources. Pregnancy-focused programs avert fetal alcohol spectrum disorders, improve obstetric emergency preparedness, and manage pregnancy loss. Postpartum programs, such as Levels of Maternal Care (LOMC), reduce maternal morbidity/mortality, while breastfeeding and perinatal mental health programs offer further support.  

ACOG's global membership base advances its mission. The College offers membership to medical students/residents/graduates, physicians, and allied health professionals committed to women's health. Membership benefits include discounts, access to educational and research materials, clinical guidelines, and practice support tools. Members can engage and network via an online community platform and ACOG social media channels. Local resources, leadership opportunities, and programs are accessible through ACOG's districts and sections.

​The University of Colorado began its football program, the Colorado Buffaloes, in 1902. Over nearly 125 seasons, the program has amassed close to 700 wins, 19 conference championships, 12 bowl game wins, and a National Championship. The team has spent 316 weeks on the Associated Press (AP) Poll of the nation's top-ranked collegiate programs, including seven weeks at number one. The program has enjoyed these and other successes while competing in six conferences, in addition to several seasons as an independent team.

The Colorado Buffaloes spent eight seasons as an independent team. The program enjoyed considerable success between 1902 and 1905, with a combined record of 27-6-1, highlighted by an 8-1 1905 season. The team went 6-0 in 1909, the program's final year as an independent program.

The Buffaloes also went 6-0 in 1910, the program's first season as part of the Rocky Mountain Conference (RMC), and again in 1911. Colorado would remain an RMC program through the 1937 season. The team enjoyed several ups and downs during the RMC days, from a 1-6 record in 1915 to a perfect 9-0 season in 1923 under coach Myron Witham. The team finished its RMC stint strongly, going 8-1 and achieving the program's AP ranking; the Buffaloes peaked at No. 16 during the season and finished the year as the nation's No. 17 collegiate football program.

Colorado switched to the Mountain States Athletic Conference (MSAC) ahead of the 1938 season. The program struggled to a 3-4-1 record and endured a few mediocre campaigns before going 7-2 in 1942 with coach Jim Yeager. This would prove to be the team's most successful outing as an MSAC program, with the Buffaloes leaving the conference after just 10 seasons.

The program only spent 12 seasons in the Big 7 conference but began to make a more consistent impression on the AP Poll. This period of the program's history is highlighted by an 8-2-1 season in 1956 with coach Dallas Ward, who coached the Buffaloes for all but their final season in the Big 7. 1956 also marked the program's first bowl game appearance, a 27-21 victory over Clemson in the Orange Bowl. Despite winning eight games, the program finished the season at No. 20 on the AP Poll. The 1954 and 1955 teams had highs of No. 11 and No. 14, respectively, while the 1958 team broke into the top 10 for the first time, spending several weeks at No. 9.

The program enjoyed even more AP success after joining the Big 8 conference in 1960. The Buffaloes won nine games for the first time since 1923 during the 1961 season, peaking at No. 6 on the AP Poll and finishing the season at No. 7. The program's Big 8 run, which lasted through 1995, saw the program experience its greatest victories. The 1967 University of Colorado Buffaloes peaked at No. 3 and won the Bluebonnet Bowl. The team reached No. 2 for the first time in 1972 and won two of five bowl games contested between 1969 and 1972.

The program's greatest seasons took place between 1989 and 1990, going 11-1 and 11-1-1, respectively. Both teams reached No. 1 on the AP Poll, but the 1990 squad finished the year at No. 1 and defeated Notre Dame in a rematch of the 1989 Orange Bowl to secure the program's first National Championship.

The Buffaloes became a Big 12 team in 1996, the year that ended a run of five straight bowl game victories. The team has won 10 games on multiple occasions as a Big 12 team and finished the 2016 season as the nation's No. 10 program.

​The Underserved - rural residents, those with disabilities, and marginalized groups - often face amplified health inequities. Limited healthcare access and poor results stem from many barriers. Healthcare institutions and governments at various levels must collaborate and apply proven strategies to boost healthcare access and eliminate disparities for the underserved. 

Effective intervention begins with identifying high-need geographic areas where underserved groups live. Healthcare institutions and stakeholders can use various tools - including the Uniform Data System (UDS) mapper, to identify and resolve social determinants of health, facilitate primary care provider (PCP) resource mapping, and reveal service gaps. 

Expanding primary care providers serving underserved groups improves access. Rural areas, in particular, are short of qualified care providers, forcing residents to travel extensively for basic care. Even in urban settings, PCPs often focus on serving wealthier, insured patients, leaving low-income groups with inadequate care. Addressing this imbalance mandates workforce expansion to improve geographic coverage and reduce provider-to-patient ratios. Government support through medical education funding, loan forgiveness programs, and increased residency opportunities can significantly accelerate these efforts. 

Healthcare providers can also play а great role by targeting underserved groups and tailoring services to their needs. Recruiting staff who mirror the community’s demographics and grasp its challenges builds trust, especially among those wary of medicine due to past inequities. Extending services beyond clinical walls into familiar community spaces - like barbershops and religious centers - creates meaningful connections with individuals who might otherwise avoid seeking care. This approach addresses distrust and improves outcomes for these groups.

Governments, at all levels, can enhance healthcare reach through infrastructure investment. Many rural areas lack adequate facilities and advanced medical resources like ICUs and operating rooms. Developing facilities and improving transportation infrastructure reduces geographic barriers. Mobile health clinics offer cost-effective alternatives for resource-limited regions. Concurrently with infrastructure enhancements, ensuring a reliable supply chain for medical resources is critical.

Telehealth narrows the expertise gap, delivering high-quality care to underserved groups regardless of location. It connects rural patients to specialists who understand their needs better but aren’t locally available. With telehealth, rural patients benefit from comparable specialist access to urban populations and facilitated follow-up care. Platforms like Doximity offer telehealth solutions through its many resources and features, such as a mobile app that supports medical professionals in their daily tasks and career development. Telehealth also resolves logistical hurdles and reduces wait times associated with in-person visits. For it to work well, though, broadband upgrades are necessary. Good internet and communication lines support reliable video conferencing, real-time remote monitoring, efficient data transmission, and improved access to digital platforms.

Policy reforms can make primary care more affordable for low-income groups. Streamlining insurance enrollment through simplified or automatic Medicaid registration eliminates bureaucratic barriers that prevent coverage access. Cultural concordance between providers and patients also improves healthcare access for underserved groups. 

Beyond increasing provider numbers, sustained funding for community health workers (CHWs) through reliable mechanisms rather than unstable grants is essential. Promoting diversity in residency training leads to a more representative workforce. State officials can authorize Medicaid reimbursement for CHW services and establish billable service codes.

Fostering a genuine community within healthcare settings also plays a crucial part. The transactional approach adopted by some healthcare institutions creates barriers, especially for marginalized patients. Instead, healthcare organizations should prioritize creating supportive environments where meaningful interactions flourish and patients feel truly understood. Training staff in cultural competency and empathetic communication further strengthens these connections.

​Surfing is as much about technique as time spent in the water. Progress comes from refining specific skills, starting with choosing the right equipment. Beginners and intermediates benefit most from stable, buoyant boards. After mastering the basics, transitioning to smaller, more maneuverable boards should come, as the right board makes learning smoother and builds confidence.

Paddling is often underestimated but essential for positioning and catching waves. Efficient paddling involves long, powerful strokes with a streamlined body position. Keep your fingers close together and lift your chest slightly to reduce drag and increase speed. Strengthening back muscles through targeted exercises improves paddling endurance and efficiency.

Positioning on the wave significantly affects the quality of the ride. The ideal spot to take off is near the wave's peak, where its energy is most concentrated. Starting too far on the shoulder results in shorter rides as the wave loses power. Beginners can identify the peak by observing where waves break consistently and paddling toward that area.

The pop-up, the transition from lying to standing, is the foundation of every ride. Speed and precision in this movement determine the surfer's ability to maintain balance as the wave breaks. Pop-ups on land improve muscle memory for faster, more fluid water transitions. Mastering this technique improves ride quality and maneuverability.

A low, balanced stance enhances both stability and control. Bending the knees and keeping the center of gravity low allows surfers to adjust their weight more effectively during turns and maneuvers. This stance also helps absorb shocks from the wave, making it easier to maintain balance on uneven surfaces.

Generating speed independently from the wave is a hallmark of skilled surfing. Surfers create momentum that propels them forward by pumping up and down the wave's face. This technique relies on coordinated weight shifts—lightning pressure when climbing the wave and applying more force on the descent. Mastering this movement allows longer rides and sets the stage for executing tricks and sharper turns.

Another key to surfing improvement is wave selection. Surfing different waves makes a big difference. Waves with a definite crest and a steady, building form are optimal for sustained rides. Flat swells or waves that shut off soon can frustrate and waste effort. Spotting the proper situations takes time but may be hastened with observation and instruction.

Many surfers underestimate foot placement's importance in steering and speed control. The back foot, positioned closer to the tail, provides leverage for sharper turns and sudden stops, while the front foot dictates forward momentum. Adjusting foot placement in response to wave dynamics allows for more nuanced control, making adapting to changing conditions during a ride more manageable.

Maintaining visual focus is essential for smooth navigation along the wave. Looking in the direction of travel ensures that the body naturally follows, creating a fluid connection between intention and movement. Fixating on the board or the water beneath can disrupt balance and make reacting to the wave's changes harder. Keeping the head up and eyes forward promotes better orientation and control.

Finally, surfing proficiency requires physical skills, mental attention, and a dynamic relationship with the ocean. While practice is essential, real growth comes from a careful approach to each aspect of the sport and a willingness to learn from the ever-changing waves. Surfers may enjoy their progress and connection to the water by viewing the sport as a challenge and an opportunity to grow.

​Evidence-based medicine (EBM) helps healthcare professionals make and implement informed decisions backed by clinical evidence. New research, technological advancements, new treatment methodologies, and a growing focus on personalized care have shaped EBM trends. These trends define healthcare delivery and present new opportunities to enhance patient outcomes.

The expansion of healthcare repositories and increased adoption of electronic health records (EHRs) have transformed healthcare data collection, analysis, and storage. Part of these advancements include leveraging artificial intelligence (AI), Machine learning (ML), natural language processing (NLP), and big data analytics in EBM. AI-based algorithms process large datasets to predict disease outcomes, uncover patterns, and provide insights for evidence-based clinical decision-making. ML empowers healthcare professionals to analyze vast amounts of health records quickly and efficiently. Healthcare systems leverage NLP to extract meaningful, actionable insights from vast unstructured data. This includes doctor’s clinical notes and patient stories.

Integrating AI into EBM enabled healthcare providers to deliver precision, data-driven healthcare. Precision medicine involves customizing medical interventions to match a patient's unique characteristics, such as genetics, lifestyle, and other patient-specific factors, such as the environment. In addition, genetic testing advances and predictive analytics facilitate a deeper understanding of disease progression and treatment responses.

Using AI modeling tools, predictive analytics help healthcare providers predict disease progression. On the other hand, ML algorithms can assist in identifying the most suitable treatment options according to individual patient needs. For instance, in the field of oncology, targeted therapies have seen significant advancements in targeted therapies that target specific genetic mutations in cancer cells, greatly improving patient treatment outcomes. Precision medicine has enriched evidence-based medicine by providing healthcare personnel with a deeper and more accurate understanding of variability in diverse healthcare interventions.

Systematic data reviews have an essential role in evidence-based medicine. The reviews help consolidate findings from multiple studies and research projects to inform clinical guidelines. However, traditional review processes tend to be labor-intensive and time-consuming. Emerging technologies like ML and NLP have transformed data reviewing by automating the review process. These technologies can quickly scan, extract, and synthesize data from vast studies and research, significantly saving the time it typically takes to generate comprehensive reviews using traditional and manual reviews.

Randomized controlled trials (RCTs) are the accepted gold standard in clinical research. Real-world evidence (RWE) also plays a role in clinical research. RWE provides healthcare systems valuable insights into treatment effectiveness, medical product safety, risks, and patient outcomes in routine clinical settings. RWD sources include EHRs, patient registries, mobile apps, and wearable devices that capture healthcare information outside the controlled or traditional environment of clinical trials. Longitudinal data from EHRs, for example, help researchers track treatment outcomes over time. On the other hand, patient registries provide evidence and details about disease progression and how specific populations respond to different therapies.

Despite the transformative potential, the evolution of EBM still faces several challenges. For example, ensuring the quality and integrity of data collected from multiple sources remains a significant hurdle. Professionals must prevent the skewing of AI algorithms and real-world datasets.

Another significant challenge involves seamlessly integrating emerging technologies into clinical workflows. This will require interdisciplinary collaboration between data scientists, clinicians, and healthcare policymakers to ensure technological innovations align with patient care needs. Healthcare professionals’ education and training programs will also play an important part in facilitating the seamless adoption of these emerging technologies and tools.

​Standardization in healthcare benefits patient care, resource allocation, and enhancing operational efficiency. Healthcare systems must cope with emerging delivery challenges and an influx of technological advancements.

Healthcare standardization involves adherence to consistent clinical guidelines, delivery protocols, and best practices across facilities such as hospitals, medical centers, and clinics. It ensures the interoperability of healthcare systems.

Interoperability allows systems to communicate, share, and exchange data. It facilitates seamless exchange of patient data information between facilities and collaboration among care providers. This interoperability improves care coordination by ensuring patients receive comprehensive and integrated care. For example, it can reduce duplicate testing whenever a patient visits a different facility, as medical professionals can seek records and test results from each other. This is only possible when all the facilities adhere to standardized healthcare guidelines and protocols.

Standardization facilitates uniform documentation of medical practices and ensures accurate recording of patient information. Streamlined data management improves communication among healthcare teams. Also, standardized healthcare processes enable facilities and care providers to be more efficient and save time and resources. They help eliminate redundant tasks and reduce workflow variability, saving valuable staff hours and reallocating them to other crucial activities.

Consistency in healthcare delivery improves the patient experience and reduces confusion, and communication between patients and healthcare providers is better. Also, as patients know the standard procedure or process to expect during a visit to a facility or provider, they are more comfortable, leading to better health outcomes and greater satisfaction. Healthcare standardization also enhances documentation as common denominators record and store medical data. By setting baseline metrics to use and benchmarks to attain, healthcare organizations can identify potential improvement areas and monitor progress to enhance patient outcomes.

Healthcare institutions leverage standardized protocols in different settings and scenarios to ensure patients receive high-quality and consistent care. Some areas where healthcare standardizing plays a critical role include medical administration, surgical infection prevention and sepsis management, fall prevention, hand hygiene, emergency response, and chronic disease management. For example, standard medication administration protocols ensure patients receive accurate dosing to reduce the risk of adverse drug reactions.

Surgical site infection prevention protocols include standard preoperative procedures to reduce microbial load and uniform postoperative monitoring that help detect infection signs promptly. Standardized sepsis management protocols outline early recognition to prevent the patient from progressing to septic shock. Fall prevention protocols and guidelines include comprehensive assessments and ensure that tailor interventions to patients. This also includes mitigating the risk of falls and injuries, particularly among seniors. Hand hygiene protocols promote compliance with handwashing and sanitation practices that prevent infectious pathogens transmission, particularly in healthcare settings. Emergency response protocols offer healthcare teams guidance in a timely during critical medical events like cardiac arrest.

Chronic disease management standard protocols offer providers vital guidelines for patient monitoring, treatment optimization, and patient education to prevent complications. When health facilities and caregivers adhere to standardized protocols, they prioritize patient safety and improve clinical outcomes due to consistency in care across clinical settings. In addition, by optimizing resource use, standardization enhances healthcare systems' sustainability. Standardized protocols eliminate unnecessary tests, surgical procedures, and medications, which reduces wastage.

​The American College of Obstetrics and Gynecology (ACOG) is the leading professional organization of obstetricians and gynecologists. ACOG members are dedicated to furthering the field of women's help and improving patient outcomes. To this end, the organization performs extensive medical research and shares findings with members as well as the general public. Throughout 2024, ACOG kept members and patients informed about the oropouche virus, with a focus on how the virus can impact pregnancy.

Discovered in 1955, the oropouche virus is a member of the Orthobunyavirus genus. Humans typically acquire the virus following a bite from small fly and mosquito-like insects, called midges, as well as mosquitoes. Over the decades, occurrences of oropouche virus almost always occurred in and around the Amazon basin. However, in 2023, massive outbreaks began to take place in outlying regions before spreading to new parts of South America and the island of Haiti. These represented the first ever documented cases of the virus in Haiti. At the start of 2024, data showed that oropouche had moved to Cuba.

As medical experts wait to see if the virus will continue to expand and reach the US, they continue to perform extensive oropouche research. Experts know that the virus has an incubation period of between three and seven days. As the incubation period ends, individuals begin to experience symptoms that are comparable to those of the Zika, dengue, and chikungunya viruses. These symptoms include dizziness, nausea and vomiting, and a maculopapular rash that starts on the body and spreads to the arms and legs. Oropouche is further associated with photophobia, or light sensitivity, though the most prevalent symptoms are fever, headache, and chills. Patients living with oropouche can also develop myalgias, which causes pain throughout the ligaments and tendons, and arthralgias, or joint stiffness.

For most patients, symptoms of the oropouche virus persist for two days to up to one week. In some instances, symptoms may clear, only to manifest again multiple weeks later. Recurrence of symptoms happens in as many as seven out of 10 patients. Although the condition can be painful and highly discomforting, oropouche is usually not fatal. That said, several deaths were recorded in 2024.

Initially, medical experts did not distinguish the symptoms of pregnant women living oropouche virus and non-pregnant people carrying the virus. However, further research is required to determine whether or not symptoms may manifest at a greater intensity in pregnant patients.

The first discussions regarding pregnant women and oropouche virus began in Brazil, where the Pan American Health Organization warned the public about pregnancy challenges that may be linked to the virus. These issues included an increased risk of miscarriages and stillbirths, as well as various congenital anomalies. Microcephaly and cystic brain lesions rank among the most common neurological fetal effects attributed to oropouche. Researchers have found evidence of infection in the tissue, umbilical cords, and the placenta of unborn fetuses. Subsequent investigations found oropouche in newborns who had previously only been tested for similar conditions, such as Zika or West Nile virus.

According to ACOG, these initial studies involve limited sets of data, and further research is needed to determine the virus's impact on pregnancies and fetal health. Areas of focus must include the timing of the parent's infection and the moment of conception. Vertical transmission between parent and child is a critical subject, as there are no means of preventing vertical transmission from occurring.

​The novel is a piece of narrative fiction that is longer than a novella, novelette, or short story, usually at least 40,000 words and often exceeding 100,000 words. The concept of the novel as a creative work developed over an extended period; the classic 14th-century Italian short story cycle, Decameron, was highly influential on the form, as was the tale of Don Quixote at the start of the 17th century. As the novel gained prominence, writers in different regions of the world began exploring unique styles and structures. In the United States, authors worked to distinguish themselves from their English forbears, resulting in the notion of the "Great American Novel."

The Great American Novel, sometimes written as the Great American Novel or GAN, is a relatively self-explanatory concept: a book that is not just of high quality but one that explores the significant characteristics and complex essence that comprise the nation and its people. Regardless of plot or characters, a Great American Novel is also about America itself and elements of the American dream, such as the ability of a single person to take control of and better their life through hard work and determination.

The term "Great American Novel" was first used in 1868, less than 100 years after the nation's founding. American soldier and author of the Civil War novel Miss Ravenel's Conversion from Secession to Loyalty, John William De Forest, is credited with first using the term, stating that such a book had yet to be written. Forest's assertion would have been difficult to disprove at the time: literature originating in the Americas was still very new, and the idea that American authors could produce works on par with those of their British counterparts only took root during the mid to late 18th century.

Forest's words were as much about the novel itself as they were about American novelists. Before his statement about the lack of truly great and truly American literature, roughly five percent of books released in the US were marketed as novels. In a short time, novels would account for the vast majority of fiction books.

Forest's term quickly caught on to the point that modern literary critics often disparage the idea of a "Great American Novel," if only because the phrase has become so watered down and nebulous. Literary critic Grant Shreve attempted to provide a framework for determining whether a book qualifies as a Great American Novel or not. First, the story must speak to the entire nation rather than focus on a specific region. Second, the book must possess a "democratic...spirit and form." Next, the book should have a cultural value that is only fully realized over time. Finally, the book should be written by an American-born author or writer who has adopted the nation as their home country.

Although there is no clear definition of what makes up a Great American Novel, nor an official canon of works that carry the title, there are a few books often associated with the term. These novels include Herman Melville's Moby-Dick, The Great Gatsby by F. Scott Fitzgerald, Mark Twain's Adventures of Huckleberry Finn, and Gone with the Wind by Margaret Mitchell. More modern writers, such as Philip Roth, have written multiple novels that play with and subvert the concept of the Great American Novel.

​Despite progress in science, technology, and medicine, women still experience higher morbidity and mortality rates than men from heart disease, osteoporosis, poor mental health, and female-specific conditions and diseases. The disparity and challenges extend to the workplace that contribute to mental health problems.

Reports indicate that some women experience major depressive episodes during and the year after pregnancy. Despite limited research on prenatal mental health (PMH), women might experience anxiety disorder, post-traumatic stress disorder (PTSD), adjustment disorder, and postpartum psychosis. Adjustment disorders refer to a group of symptoms like hopelessness, sadness, and stress, alongside physical symptoms that occur when someone goes through a stressful life event. According to the Centers for Disease Control and Prevention (CDC), one in eight American women who have recently given birth experience depression.

Cardiovascular diseases are the highest killer of women at a rate of one to three, according to Go Red for Women. Also, women have a 50 percent higher chance of dying following a heart attack than men.

For many women, frequent hormonal changes, especially after menopause, present several health challenges, including angina, which refers to heavy chest discomfort and pain in the jaw, throat, upper abdomen, and back. In other cases, medical professionals may lack the information needed to help women. For example, the medical community only allocates a third of heart disease clinical trials to them. Other chronic ailments that affect women more than men include high blood pressure.

Healthcare costs also adversely affect women's health. Women's health care costs more due to gender-specific needs, products, and fewer doctors who specialize in obstetrics and gynecology (approximately 35,000 in the United States as of 2023). The shortage may worsen since laws overseeing procedures that women seek change, such as abortion laws. Changes in statutes make the profession less attractive to graduating medical students.

Services such as pap smears, ovarian cancer tests, mammograms, and osteoporosis tests require extra costs beyond essential medical services. Such services tend to be expensive and, in underserved communities, require community nurse practitioners. Both genders in similar positions often have equal health coverage in the workplace, meaning women have more out-of-pocket expenses than men. According to Deloitte, employed women in the United States pay $15 billion more for health care than men. The disparity contributes to financial insecurity.

Moreover, research, measuring, and collection of women's health data remain underfunded, resulting in disaggregated data. This issue significantly contributes to insufficient public data on women. Data systems transformation promotes women's health inclusion, helping identify and fix data gaps. Women's inclusion refers to a scenario in a society where all women of whatever stature or background feel valued, respected, and empowered in all aspects of life. Thus, inclusivity refers to breaking down barriers and stereotypes and creating avenues for value and respect for women.

Financially unstable women often experience more health risks. In some cases, especially in third-world countries, women adopt the housewife role. Unemployment means these women may lack healthcare coverage. The lack of insurance means they routinely skip or avoid doctor and dentist visits and medication. Eventually, this leads to more complicated medical issues and higher medical costs.