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Pictures have been teaching doctors medicine for centuries − a medical illustrator explains how

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Pictures have been teaching doctors medicine for centuries − a medical illustrator explains how

Artists reveal what cannot be seen.
Henry Gray, Anthony Edwward Spitzka/Internet Archive via Flickr

James A. Perkins, Rochester Institute of Technology

“Medical illustrators draw what can’t be seen, watch what’s never been done, and tell thousands about it without saying a word.”

For decades, this slogan appeared on the website and printed materials of the Association of Medical Illustrators. Although the association no longer uses this tag line, it’s still an accurate description of the profession.

As a practicing medical illustrator for over 30 years, I draw what can’t be seen and watch what’s never been done on a daily basis. And I teach my to do the same.

But what exactly does all of that mean, and how does it improve medicine?

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Tell thousands about it without saying a word

You may have heard the adage, “A picture is worth a thousand words.” In that same vein, medical illustrators use pictures to teach complex scientific concepts. As the famed medical illustrator Frank H. Netter once said, “(Pictures) eliminate the need for the lecturer or the author to translate what he has in his mind into words and for the listener or the student to translate those words back into a mental image.”

The use of illustrations to communicate medical information has a long history, dating back at least to ancient Egypt and flourishing in the Renaissance. The work of 16th century anatomists Giacomo Berengario da Carpi and Andreas Vesalius set a precedent for the use of detailed illustrations to teach anatomy, a practice that continues to this day.

Illustration depicting the musculature of the human body with text identifying each component
This is a page from Andreas Vesalius’ ‘Suorum de humani corporis fabrica librorum epitome.’
Andreas Vesalius/Wellcome Collection

The proliferation of illustrated anatomy atlases in the Renaissance coincided with the widespread acceptance of cadaver dissection. The earliest known human dissections were performed in the third century BCE. The practice was prohibited throughout the Middle Ages but became common again in the 13th and 14th centuries.

By the 1500s, dissections, usually of executed criminals, had become public spectacles. The demand for bodies eventually outstripped the supply of executed convicts, leading to the unscrupulous practices of grave robbing and even murder.

In addition to depicting the location and features of an object such as an organ, illustrations proved essential in describing events over time, such as the progression of a disease or the steps in a surgical procedure. Generations of surgeons learned new procedures from meticulously illustrated surgical atlases. An early example of physiology illustration, William Harvey’s classic 17th century work on the circulation of blood, “Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus,” depicts the direction of blood flow through the veins of the forearm.

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Illustration showing an arm gripping a pole with a tourniquet wrapped around the elbow.
This image from William Harvey’s ‘Exercitatio’ depicts the direction of normal blood circulation.
William Harvey/Wikimedia Commons

Nowadays, surgeons can practice a procedure hundreds of times in virtual reality before it on a real patient. Modern physiology and pathology texts include countless illustrations of the body, not just at the anatomical level but also the cellular and molecular. So valuable are these depictions of complex pathways and interactions that many science journals now require papers to include a graphical abstract, a single illustration that summarizes the content of each paper.

Draw what can’t be seen

Medical illustrators employ special tools and to visualize things that are normally hidden from the naked eye.

All professionally trained medical illustrators study human gross anatomy, including dissecting a human cadaver, in order to visualize the internal structures of the body. When a cadaver isn’t readily available to serve as reference for an illustration, illustrators use medical imaging, such as CT and MRI scans, and reconstruct the body in three dimensions.

At the cellular level, medical illustrators must understand how to use microscopy techniques in order to find references for accurate depictions of cellular structures.

Objects at the smallest scale – atoms and many molecules – are smaller than the wavelength of visible light. This means they are below the theoretical limit of what can be seen, even with the most powerful light microscope. So researchers experimentally determine the structures of molecules using techniques like X-ray crystallography and nuclear magnetic resonance spectroscopy instead. These techniques use X-rays or radio waves, respectively, to determine how atoms are arranged.

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CDC illustration of COVID-19 virus
This illustration, created by the Centers for Disease Control and Prevention, depicts the notorious spiked structure of the virus that causes .
Alissa Eckert, MSMI; Dan Higgins, MAMS via CDC

Medical illustrators learn to locate and retrieve data on the structure of molecules from sites like the RCSB Protein Databank. They also use a host of visualization applications and software plug-ins to render these structures in 3D.

Medical illustrators Alissa Eckert and Dan Higgins at the U.S. Centers for Disease Control and Prevention used these techniques to create the famous red-spiked coronavirus image that went viral during the pandemic.

Watch what’s never been done

Obviously, you can’t really watch something that has never been done. But medical illustrators can conceptualize new processes and techniques before they become a reality.

For example, they might illustrate how an experimental drug may theoretically work before it enters testing. Similarly, illustrations can be critically important in pre-surgical planning, especially in complex cases.

My favorite example of the role of medical illustration in surgery is the separation of conjoined twins Abbigail and Isabelle Carlsen at the Mayo Clinic in 2006. Working from nearly 6,000 radiographic images, the clinic’s medical illustrators produced five detailed illustrations of the twins’ anatomy. They even generated 3D-printed models of important structures, notably their shared liver.

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The illustrations were critical in training a team of 70 surgeons, nurses and technicians involved in the case. They also served as a road map for the ultimately successful surgery, hung up on the walls of the operating theater during the procedure.

Road to becoming a medical illustrator

In order to draw what can’t be seen and watch what’s never been done, medical illustrators require specialized training. Most medical illustrators in North America are trained at master’s programs accredited by the Association of Medical Illustrators in conjunction with the Commission on Accreditation of Allied Education Programs.

Since the profession requires a strong understanding of the biomedical sciences, students accepted into these programs must have a strong science background along with a portfolio demonstrating outstanding drawing skills. Students often have a double major in biology and art or a major in one area and minor in the other.

Once in the program, their science training continues with human gross anatomy and some combination of courses in neuroanatomy, embryology, histology, cell biology, pathology and immunology. Specialized courses in surgical observation and cellular and molecular visualization also include significant science content.

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Scientific illustrator Val Altounian of the journal Science walks viewers through her process.

Students receive extensive training in computer graphics, including 2D digital illustration and animation, 3D computer modeling and animation, interactive , virtual and augmented reality and educational and mobile app design. Courses also emphasize the principles of design, including the use of color, layout and motion to create effective visuals.

Medical illustrators learn to consider the educational level of their audience, since their work may be used to educate – even kids – in addition to medical professionals. Illustrations made for a child recently diagnosed with leukemia would be very different from those aimed at the oncologist treating the disease.

After entering the workforce, many medical illustrators pursue optional board certification to become a certified medical illustrator, which recognizes professional competency and encourages continued learning. Continued certification requires 35 hours of continuing education every five years in the biomedical sciences, artistic techniques and business practices.

All of this education and training is essential to ensure that medical illustrators communicate complex scientific information with accuracy and clarity. I like to think of medical illustrators as teachers – they instruct with pictures.The Conversation

James A. Perkins, Distinguished Professor of Medical Illustration, Rochester Institute of Technology

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This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Conversation

Pagers and walkie-talkies over cellphones – a security expert explains why Hezbollah went low-tech for communications

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theconversation.com – Richard Forno, Principal Lecturer in Computer Science and Electrical Engineering, of Maryland, Baltimore County – 2024-09-18 16:32:21

A police officer examines a damaged car after thousands of pagers exploded simultaneously across Lebanon on Sept. 17, 2024.
AP Photo/Hussein Malla

Richard Forno, University of Maryland, Baltimore County

Electronic pagers across Lebanon exploded simultaneously on Sept. 17, 2024, killing 12 and wounding more than 2,700. The following day, another wave of explosions in the country came from detonating walkie-talkies. The attacks appeared to target members of the militant group Hezbollah.

The pagers attack involved explosives planted in the communications devices by Israeli operatives, according to U.S. officials cited by The New York Times. Hezbollah had recently ordered a shipment of pagers, according to the report.

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Secretly attacking the supply chain is not a new technique in intelligence and military operations. For example, the U.S. National Security Agency intercepted computer hardware bound for overseas customers, inserted malware or other surveillance tools and then repackaged them for delivery to certain foreign buyers, a 2010 NSA internal document showed. This differs from accessing a specific person’s device, such as when Israel’s Shin Bet secretly inserted explosives into a cellphone to remotely kill a Hamas bombmaker in 1996.

Hezbollah, a longtime adversary of Israel, had increased its use of pagers in the wake of the Hamas attack on Israel on Oct. 7, 2023. By shifting to relatively low-tech communication devices, pagers and walkie-talkies, Hezbollah apparently sought an advantage against Israel’s well-known sophistication in tracking targets through their phones.

pieces of a destroyed electronic device
The second wave of explosions in Lebanon involved walkie-talkies.
AP Photo

Cellphones: The ultimate tracker

As a former cybersecurity professional and current security researcher, I view cellular devices as the ultimate tracking tool for both and commercial entities – in addition to users, criminals and the mobile phone provider itself. As a result, mobile phone tracking has contributed to the fight against terrorism, located missing people and helped solve crimes.

Conversely, mobile phone tracking makes it easy for anyone to record a person’s most intimate movements. This can be done for legitimate purposes such as parents tracking ‘s movements, helping you find your car in a parking lot, and commercial advertising, or nefarious ends such as remotely spying on a lover suspected of cheating or tracking political activists and journalists. Even the U.S. military remains concerned with how its soldiers might be tracked by their phones.

Mobile device tracking is conducted in several ways. First, there is the network location data generated by the phone as it moves past local cell towers or Stingray devices, which enforcement agencies use to mimic cell towers. Then there are the features built into the phone’s operating system or enabled by downloaded apps that may lead to highly detailed user tracking, which users unwittingly agree to by ignoring the software’s privacy policy or terms of service.

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This collected data is sometimes sold to governments or other companies for additional data mining and user profiling. And modern smartphones also have built-in Bluetooth, Wi-Fi and GPS capabilities that can help with locating and tracking user movements around the world, both from the ground and via satellites.

Your phone contains many sensors that make it useful – and easy to track.

Mobile devices can be tracked in real time or close to it. Common technical methods include traditional radio direction-finding techniques, using intelligence satellites or drones, deploying “man in the middle” tools like Stingrays to impersonate cellular towers to intercept and isolate device traffic, or installing malware such as Pegasus, made by Israeli cyberarms company NSO to report a device’s location.

Nontechnical and slower techniques of user tracking include potentially identifying general user locations from their internet activity. This can be done from website logs or the metadata contained in content posted to social media, or contracting with data brokers to receive any collected location data from the apps that a user might install on their device.

Indeed, because of these vulnerabilities, the leader of Hezbollah earlier this year advised his members to avoid using cellular phones in their activities, noting that Israel’s “surveillance devices are in your pockets. If you are looking for the Israeli agent, look at the phone in your hands and those of your wives and children.”

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Researchers have shown how these features, often intended for the user’s convenience, can be used by governments, companies and criminals to track people in their lives and even predict movements. Many people still aren’t aware of how much their mobile devices disclose about them.

Pagers, however, unlike mobile phones, can be harder to track depending on whether they support two-way communication.

Why go low-tech

A pager that only receives messages does not provide a signal that can facilitate tracking its owner. Therefore, Hezbollah’s use of pagers likely made it more challenging to track their operatives – thus motivating Israeli intelligence services’ purported attack on the supply chain of Hezbollah’s pagers.

Using low-tech tactics and personal couriers while avoiding the use of mobile phones and digital tools also made it difficult for the technologically superior Western intelligence agencies to locate Osama bin Laden for years after the 9/11 attacks.

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In general, I believe the adversary in an asymmetric conflict using low-tech techniques, tactics and technology will almost always be able to operate successfully against a more powerful and well-funded opponent.

A well-documented demonstration of this asymmetry in action was the U.S. military’s Millennium Challenge war in 2002. Among other things, the insurgent Red forces, led by Marine General Paul van Riper, used low-tech tactics including motorcycle couriers instead of cellphones to evade the Blue forces’ high-tech surveillance. In the initial of the exercise, the Red team won the contest in 24 hours, forcing exercise planners to controversially reset and the scenario to ensure a Blue team victory.

Lessons for everyone

The preference for terrorist like Hezbollah and al-Qaida to avoid using smartphones is a reminder for everyone that you can be, and likely are being tracked in various ways and for various purposes.

Israel’s purported response to Hezbollah’s actions also holds a lesson for everyone. From a cybersecurity perspective, it shows that any device in your life can be tampered with by an adversary at points along the supply chain – long before you even receive it.The Conversation

Richard Forno, Principal Lecturer in Computer Science and Electrical Engineering, University of Maryland, Baltimore County

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Tiny robots and AI algorithms could help to craft material solutions for cleaner environments

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theconversation.com – Mahshid Ahmadi, Assistant Professor of Materials Science and Engineering, University of Tennessee – 2024-09-17 07:31:57

pollution is a global problem, but scientists are investigating new materials that could clean it up.
AP Photo/Sergei Grits

Mahshid Ahmadi, University of Tennessee

Many human activities release pollutants into the air, and soil. These harmful chemicals threaten the of both people and the ecosystem. According to the World Health Organization, air pollution causes an estimated 4.2 million deaths annually.

Scientists are looking into solutions, and one potential avenue is a class of materials called photocatalysts. When triggered by light, these materials undergo chemical reactions that initial studies have shown can break down common toxic pollutants.

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I am a materials science and engineering researcher at the University of Tennessee. With the help of robots and artificial intelligence, my colleagues and I are making and testing new photocatalysts with the goal of mitigating air pollution.

Breaking down pollutants

The photocatalysts work by generating charged carriers in the presence of light. These charged carriers are tiny particles that can move around and cause chemical reactions. When they into contact with water and oxygen in the environment, they produce substances called reactive oxygen species. These highly active reactive oxygen species can bond to parts of the pollutants and then either decompose the pollutants or turn them into harmless – or even useful – products.

A cube-shaped metal machine with a chamber filled with bright light, and a plate of tubes shown going under the light.
To facilitate the photocatalytic reaction, researchers in the Ahmadi lab put plates of perovskite nanocrystals and pollutants under bright light to see whether the reaction breaks down the pollutants.
Astita Dubey

But some materials used in the photocatalytic have limitations. For example, they can’t start the reaction unless the light has enough energy – infrared rays with lower energy light, or visible light, won’t trigger the reaction.

Another problem is that the charged particles involved in the reaction can recombine too quickly, which means they join back together before finishing the job. In these cases, the pollutants either do not decompose completely or the process takes a long time to accomplish.

Additionally, the surface of these photocatalysts can sometimes change during or after the photocatalytic reaction, which affects how they work and how efficient they are.

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To overcome these limitations, scientists on my team are to develop new photocatalytic materials that work efficiently to break down pollutants. We also focus on making sure these materials are nontoxic so that our pollution-cleaning materials aren’t causing further pollution.

A plate of tiny tubes, with some colored dark blue, others light blue, and others transparent.
This plate from the Ahmadi lab is used while testing how perovskite nanocrystals and light break down pollutants, like the blue dye shown. The light blue color indicates partial degradation, while transparent water signifies complete degradation.
Astita Dubey

Teeny tiny crystals

Scientists on my team use automated experimentation and artificial intelligence to figure out which photocatalytic materials could be the best candidates to quickly break down pollutants. We’re making and testing materials called hybrid perovskites, which are tiny crystals – they’re about a 10th the thickness of a strand of hair.

These nanocrystals are made of a blend of organic (carbon-based) and inorganic (non-carbon-based) components.

They have a few unique qualities, like their excellent light-absorbing properties, which come from how they’re structured at the atomic level. They’re tiny, but mighty. Optically, they’re amazing too – they interact with light in fascinating ways to generate a large number of tiny charge carriers and trigger photocatalytic reactions.

These materials efficiently transport electrical charges, which allows them to transport light energy and the chemical reactions. They’re also used to make solar panels more efficient and in LED lights, which create the vibrant displays you see on TV screens.

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There are thousands of potential types of hybrid nanocrystals. So, my team wanted to figure out how to make and test as many as we can quickly, to see which are the best candidates for cleaning up toxic pollutants.

Bringing in robots

Instead of making and testing samples by hand – which takes weeks or months – we’re using smart robots, which can produce and test at least 100 different materials within an hour. These small liquid-handling robots can precisely move, mix and transfer tiny amounts of liquid from one place to another. They’re controlled by a computer that guides their acceleration and accuracy.

A researcher in a white lab coat smiling at the camera next to a fume hood, with plates of small tubes inside it.
The Opentrons pipetting robot helps Astita Dubey, a visiting scientist working with the Ahmadi lab, synthesize materials and treat them with organic pollutants to test whether they can break down the pollutants.
Jordan Marshall

We also use machine learning to guide this process. Machine learning algorithms can analyze test data quickly and then learn from that data for the next set of experiments executed by the robots. These machine learning algorithms can quickly identify patterns and insights in collected data that would normally take much longer for a human eye to catch.

Our approach aims to simplify and better understand complex photocatalytic , helping to create new strategies and materials. By using automated experimentation guided by machine learning, we can now make these systems easier to analyze and interpret, overcoming challenges that were difficult with traditional methods.The Conversation

Mahshid Ahmadi, Assistant Professor of Materials Science and Engineering, University of Tennessee

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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A public health historian sizes up their records

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theconversation.com – Zachary W. Schulz, Lecturer of History, Auburn University – 2024-09-17 07:33:53

The presidential debate on Sept. 10, 2024, did not add much context to what the two candidates would do on care beyond their own .
Visual China Group/Getty Images

Zachary W. Schulz, Auburn University

Health care is a defining issue in the 2024 election – Democratic presidential nominee Kamala Harris and Republican contender Donald Trump have starkly different records on the issue. Rather than focusing on what they promise to do, let’s examine what their past actions reveal about their approaches to Medicare, the Affordable Care Act, public health infrastructure, drug policy and child abuse and domestic violence prevention.

As a specialist in public health history and policy, I have carefully examined both candidates’ records on American health care. With years of experience in the health care field and being a cystic fibrosis patient myself, I have developed a deep understanding of our health care system and the political dynamics that shape it.

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For me, as for many other Americans, health care is more than just a political issue; it is a deeply personal one.

Medicare

During Harris’ time in the Senate, she co-sponsored the Medicare for All Act, which aimed to expand Medicare to all Americans, effectively eliminating private insurance.

At the presidential debate on Sept. 10, 2024, Harris clarified her former support of “Medicare for All” by emphasizing her prior legislative efforts to preserve and expand protections for ‘ rights and access to affordable health care.

Harris’s legislative efforts, primarily around the 2017-2020 period, reflect a commitment to broadening access to Medicare and reducing costs for seniors. During that time, Harris advocated for the Medicare program to negotiate drug prices directly with pharmaceutical companies.

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Later, as vice president, Harris cast a tie-breaking vote on the 2022 Inflation Reduction Act, allowing the to negotiate drug prices for Medicare with pharmaceutical companies.

In contrast, during Trump’s presidency, he made several attempts, some of which were successful, to cut funding for Medicare. The 2020 budget proposed by his administration included cuts to Medicare totaling more than US$800 billion over 10 years, primarily by reducing payments to providers and slowing the growth of the program.

The proposed cuts did not take effect because they required Congressional approval, which was not granted. The plan significant opposition due to concerns about potential negative impacts on beneficiaries.

Affordable Care Act

Harris has been a staunch defender of the Affordable Care Act, also known as the ACA or “Obamacare.” As a senator, Harris consistently voted against any efforts to repeal the ACA. She advocated for expanding its provisions, supporting legislation that aimed to strengthen protections for people with preexisting conditions and increase funding for Medicaid expansion.

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Harris’ record shows a clear commitment to ensuring broader health coverage under the ACA. And, in the recent debate, Harris noted this record and reasserted her commitment to the act.

During his presidency, Trump led multiple efforts to repeal the ACA, including the 2017 American Health Care Act, which would have significantly reduced the scope of expansion and individual mandates.

Although these efforts ultimately failed in the Senate, Trump succeeded in weakening the ACA by eliminating the individual mandate penalty through the 2017 Tax Cuts and Jobs Act. In the debate against Harris, Trump reiterated his position that the Affordable Care Act “was lousy health care,” though he did not ultimately offer a replacement plan, stating only that he has “concepts of a plan.”

Donald Trump claims that as president, he had an obligation to save Obamacare, otherwise known as the Affordable Care Act, but says it is too expensive. He says he has ‘concepts of a plan’ for something to replace the ACA.

Public health infrastructure

Harris’ tenure in the Senate, from January 2017 to January 2021, shows a consistent pattern of supporting public health infrastructure. She co-sponsored several bills aimed at increasing funding for community health centers and expanding access to preventive care.

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Harris also advocated for more federal funding to address public health emergencies, such as the opioid epidemic and the COVID-19 pandemic.

During Trump’s presidency, however, he made significant cuts to public health programs. The Trump administration proposed budget cuts to the Centers for Disease Control and Prevention and other public health agencies, arguing that they were necessary for fiscal responsibility. These proposals drew criticism for potentially undermining the nation’s ability to respond to public health emergencies, a concern that was underscored by the CDC’s struggles during the early days of the COVID-19 pandemic. Trump frequently has responded to these criticisms by asserting he “cut bureaucratic red tape” rather than essential services.

Drug pricing policy

Harris has also supported legislation to lower drug prices and increase transparency in the pharmaceutical industry. She co-sponsored the Drug Price Relief Act, which aimed to allow the federal government to negotiate drug prices for Medicare directly. She also supported efforts to import cheaper prescription drugs from Canada. Her record reflects a focus on reducing costs for consumers and increasing access to affordable medications.

Trump’s record on drug policy is mixed. While Trump took credit for some decreases in prescription drug prices during his presidency, his administration’s most significant regulatory changes favored pharmaceutical companies. The administration’s attempts to implement a rule allowing the importation of cheaper drugs from Canada faced significant hurdles and did not to immediate changes.

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Trump also ended a rule that would have required pharmaceutical companies to disclose drug prices in television ads, citing concerns over its legality.

Child abuse and domestic violence

Harris has a strong record of advocating for the prevention of child abuse and domestic violence. During her time as California’s attorney general and as a senator, Harris pushed for legislation that increased funding for domestic violence prevention programs and expanded legal protections for survivors. She has consistently supported measures to enhance child welfare services and improve coordination among agencies to protect children.

Trump’s record on these issues is less defined, but his administration did sign into law the Family First Prevention Services Act, which aimed to keep more safely at home and out of foster care by providing new resources to families. However, critics argue that the Trump administration’s broader cuts to social services and health programs could indirectly undermine efforts to combat child abuse and domestic violence. In addition, some experts suggest that Trump’s family separation policies on the southern border contributed to an increase in child trauma during his administration.The Conversation

Zachary W. Schulz, Lecturer of History, Auburn University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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