Indiana University Northwest

This chapter explores recent developments in US healthcare and those anticipated for 2026 and beyond. It will examine recent healthcare initiatives, including those focused on cost reduction, greater consumer choice, and further deregulation. The One Big Beautiful Bill Act (OBBBA) was signed into law by President Trump on July 4, 2025. It introduced sweeping changes across different areas, including healthcare reform to Medicaid, Medicare, and the Affordable Care Act (ACA). These healthcare reforms aim to lower premium costs and federal spending. Interviews were conducted with US stakeholders from multiple organizations and industry segments to gauge their views on healthcare reform. Several significant outcomes are addressed, including reducing healthcare costs for these stakeholders, enhancing access to healthcare, improving efficiency, enhancing the quality and delivery of healthcare services, increasing patient satisfaction, and advancing overall sustainability.

This chapter explores, analyzes, and discusses the challenges and potential recommendations for the unprecedented physician shortage affecting US healthcare systems. As a result, patients are waiting long periods to get an appointment, and in many cases, even longer to see a physician. Especially older patients who may need immediate attention and medical care end up waiting several weeks. Healthcare seems to be facing a crisis that is getting worse by the day. How did we get here, why, and what do we do about it are some of the questions addressed in this chapter.

Abstract We consider the three-dimensional stationary Schrödinger equation deformed by Dunkl operators, and constrained to the surface of a torus. After separation of variables in toroidal coordinates, it is shown that the Schrödinger equation admits solutions in terms of Heun functions, provided the potential has a certain form. As an application, elementary solutions of bound-state type are constructed that are expressed through Heun polynomials.

Published research on the predictors of police officer life satisfaction in terms of workplace variables is important but limited; research concerning police officers in China (despite the large number of officers employed there) is even more limited. This study tests the hypotheses that perceptions of procedural and distributive justice would be related to the life satisfaction of Chinese police officers in three major Chinese areas: southern, central, and western China. Both procedural justice and distributive justice were significantly associated with higher life satisfaction. These results indicate that enhancing police life satisfaction likely involves enhancing procedural and/or distributive justice.

BackgroundVirtual reality (VR) technology is increasingly used in health care professionals’ education as a novel tool for teaching, learning, and assessment.ObjectiveThis study explored the experiences of clinical students and lecturers with VR for training and assessment at a Nigerian institution. It also explored students’ perceptions of the usefulness of VR in improving their clinical abilities, knowledge retention, engagement, and overall learning experience.MethodsA qualitative research study was conducted among 24 clinical students and 8 clinical lecturers. A developed Virtual reality model to TRain and Assess Clinical Students (VTRACS) was used to train and assess clinical students using clinical scenarios. Data were collected through 4 focus group discussions conducted among the clinical students and 8 in-depth interviews conducted among the clinical lecturers. Trustworthiness was maintained, and ethical approval for the study was obtained. The focus group discussions and in-depth interviews were audio-recorded, transcribed verbatim, and analyzed using NVivo (version 11; QSR International).ResultsMany of the participants had no previous experience with VR in teaching and learning activities, but judging from their engagement with VTRACS, they defined VR as an alternative learning method (alternative to the traditional physical method). Major themes emerging from the study were expression of excitement, simple and useful innovation, proficiency enhancement, challenges with innovation, and uniformity. The clinical students adjudged VTRACS as an educational supplement with a feeling of unlimited learning access, enhancing clinical abilities while positively impacting their confidence and reducing clinical errors. The participants also described the objectivity and standardization of clinical scenarios as drivers of uniformity in training and assessment of clinical students. The participants were, however, concerned about the loss of empathy with the use of VTRACS, which may negatively impact the affective domain of learning.ConclusionsThe use of VR in the teaching and assessment of clinical students at a Nigerian university is perceived as a complementary method of learning that increases skill acquisition, provides unlimited access to training, and enhances proficiency. While VR is considered to be engaging and beneficial to health care professionals’ education, there is a need for its effective incorporation into clinical courses and mitigation of challenges such as cost and technology to ensure the realization of the full potential of VR in health care professionals’ education.

Hospital discharge processes often fail to capture patients who become medically ready for discharge in the afternoon hours. While morning discharge rounds have become standard practice, they represent only a single assessment point, missing clinical improvements and resolved barriers that occur throughout the day. This gap results in unnecessary overnight stays, increased costs, and reduced bed availability. This narrative review examines literature from 2010 to 2024 on afternoon discharge interventions, discharge timing patterns, and barriers to same-day discharge. Clinical milestones such as laboratory results, consultant clearance, and symptom improvement commonly occur in afternoon hours, yet current workflows fail to capture these opportunities. Structured afternoon reassessment programs can potentially increase same-day discharges through focused protocols. Successful programs share common features: focused reassessment between 2 PM and 3 PM, clear communication protocols, and appropriate patient selection. The discharge coordinator model shows particular promise, with dedicated staff conducting a systematic afternoon review of patients identified as possible discharges during morning rounds. Barriers to implementation include staff resistance, workflow fragmentation, and system limitations around pharmacy and transportation services. Patient populations respond differently to afternoon reassessment, with medical patients awaiting single barriers showing better results than those with complex psychosocial needs. The late-round follow-up model provides a practical framework for systematic afternoon reassessment using existing resources. Core components include a designated afternoon champion, secure messaging for physician communication, and focused review of specific discharge barriers. Implementation should begin with pilot units, expand based on demonstrated success, and comprise track metrics including reassessment rates and successful discharge percentages. Afternoon reassessment protocols focus on acting promptly once barriers are resolved rather than rushing patients. As hospitals face capacity constraints and rising costs, late-round follow-up offers a low-resource, high-impact intervention to capture missed discharge opportunities and improve patient flow.

ABSTRACT Conceptually, organizational justice has four dimensions, and they are informational, interpersonal, procedural, and distributive. The literature, however, is unclear how these dimensions of organizational justice are related to one another and to salient work outcomes, such as emotional exhaustion, which is a key dimension of job burnout. The current study proposed and tested a path model where informational and interpersonal justice were related to procedural and distributive justice, and procedural justice was related to distributive justice; in turn, procedural and distributive justice were associated with emotional exhaustion. This preliminary study relied on data from a survey of 322 correctional staff. Based on multivariate analyses using Ordinary Least Squares regression, the proposed model was largely supported.

We give a new perspective on some recent results of Chiru and Crivei on von Neumann regular matrices, including an alternative matrix proof of a characterization of von Neumann regular matrices of Northcott's. We present several conditions on a ring R under which every matrix over R whose determinantal and McCoy ranks coincide is von Neumann regular.