With the passage of the Affordable Care Act, the health system in the United States is now being further challenged. There is bipartisan debate on how it can be reconstructed: one party states that the government plays too big of a role, while the other believes it plays too little. Regardless, Americans want change. Reconstruction is not a new topic by any means, and other countries have been forced to do so due to political violence. This paper explores the history and current healthcare organizations of Japan, Iraq, and Afghanistan. These countries have all encountered major political turmoil, which has led to the rebuilding of their respective healthcare systems. Though the United States is not facing political violence that will necessitate reorganization, the examination of nations that have been forced to do so offers lessons applicable to the healthcare system in the US.

With the passage of the Affordable Care Act, the health system in the United States is now being further challenged. There is bipartisan debate on how it can be reconstructed: one party states that the government plays too big of a role, while the other believes it plays too little. Regardless, Americans want change. Reconstruction is not a new topic by any means, and other countries have been forced to do so due to political violence. This paper explores the history and current healthcare organizations of Japan, Iraq, and Afghanistan. These countries have all encountered major political turmoil, which has led to the rebuilding of their respective healthcare systems. Though the United States is not facing political violence that will necessitate reorganization, the examination of nations that have been forced to do so offers lessons applicable to the healthcare system in the US.

The COVID-19 pandemic places significant strain on the U.S. healthcare system due to the high number of coronavirus cases. During the pandemic, there was much unknown about the virus, its course of the disease, COVID-19 diagnosis, treatments, or other imperative information needed to contain the virus. Resources within the healthcare system, such as PPE and healthcare workers, were in short supply and exacerbated the difficulty of managing the viral outbreak. Peer-reviewed articles suggest that telehealth, the application of electronic information and telecommunication technologies in healthcare, proved useful in public health and clinical care during the 2020 public health emergency due to a novel virus. The scoping review broadly assessed themes of telehealth’s strengths and weaknesses during the COVID-19 pandemic. These findings could suggest how virtual medicine may be a helpful tool to improve access in addition to the quality of care in the future of medicine. Assessments of case studies suggest that telehealth helped provide care to large patient volumes by aiding with communication, data collection, triage, remote patient monitoring, and critical care. Limitations of expanding telehealth subsequent to the pandemic include, but not limited to, a lack of national standards for practice and restrictions of utility for certain populations. Populations may include those with low socioeconomic status, specific cultural practices, and beliefs, or physical and cognitive ability barriers. Outlining the benefits and limitations of telehealth may suggest how virtual medicine can provide valuable in day-to-day medical practices and other pathogenic outbreaks.

Trauma is increasingly experienced by people in transit as border militarization increases migrants’ exposure to violence and forces them into more precarious situations. For queer migrants, this includes situations where they are more likely to experience persecution and sexual violence. This paper explores the availability of care for queer undocumented migrants in the United States after surviving a precarious and potentially deadly journey from their country of origin to the US, as well as forms of alternative care developed by the undocuqueer community. In particular, it focuses on access to care for LGBT migrants, who face stigmatization on multiple levels and as a result are more likely than their straight counterparts to experience extreme mental health consequences pre-, in-, and post-transit. Faced with a number of obstacles that prevent them from receiving appropriate mental health care, the undocuqueer community utilizes various strategies to ensure that the health and needs of the community are supported. I argue that in spite of facing traumatic experiences and being unable to fully access healthcare to alleviate these problems in the US, LGBT migrants demonstrate extreme resilience and resist the mechanisms that otherwise threaten their mental well-being.

During the COVID-19 pandemic, increased burdens have been placed on the Arizona healthcare system, and its healthcare providers. Using a survey with a sample of N=308 prescribing providers and nurses in the Arizona healthcare system, the impact of COVID-19 on the wellbeing of healthcare providers was assessed. The survey used measures to evaluate for physical and emotional wellbeing, burnout, stressors associated with COVID-19, and work-life experiences, and found an overall negative impact on the wellbeing of healthcare workers during the COVID-19 pandemic with increased levels of reported stress and tiredness, concern for the health of family and loved ones, concern for the hardships of patients, lack of alignment between organizational priorities and personal values, and low levels of support and appreciation from socially and from leadership at work.

Abstract
Objective: To assess the attitudes and knowledge of behavioral health technicians (BHTs)
towards opioid overdose management and to assess the effect of online training on opioid
overdose response on BHTs’ attitudes and knowledge, and the confidence to identify and
respond to opioid overdose situations.

Design/Methods: Pre-intervention Opioid Overdose Knowledge Scale (OOKS) and Opioid
Overdose Attitude Scale (OOAS) surveys were administered electronically to five BHTs in
2020. Data obtained were de-identified. Comparisons between responses to pre-and post-surveys questions were carried out using the standardized Wilcoxon signed-rank statistical test(z). This study was conducted in a residential treatment center (RTC) with the institutional review board's approval from Arizona State University. BHTs aged 18 years and above, working at this RTC were included in the study.

Interventions: An online training was provided on opioid overdose response (OOR) and
naloxone administration and on when to refer patients with opioid use disorder (OUD) for
medication-assisted treatment.

Results: Compared to the pre-intervention surveys, the BHTs showed significant improvements
in attitudes on the overall score on the OOAS (mean= 26.4 ± 13.1; 95% CI = 10.1 - 42.7; z =
2.02; p = 0.043) and significant improvement in knowledge on the OOKS (mean= 10.6 ± 6.5;
95% CI = 2.5 – 18.7; z =2.02, p = 0.043).

Conclusions and Relevance: Training BHTs working in an RTC on opioid overdose response is
effective in increasing attitudes and knowledge related to opioid overdose management. opioid
overdose reversal in RTCs.

Keywords: Naloxone, opioid overdose, overdose education, overdose response program