Inside IM
This page highlights the impact of the faculty, trainees, researchers and staff of the UNMC Department of Internal Medicine. Read on for the latest news, including faculty achievements, division updates, research publications, education highlights and more.
Featured News
Residency Program News
The Gold Humanism Honor Society Thank A Resident Day is February 28. Many of our programs will celebrate their residents and fellows all week.
Last year, the Internal Medicine Residency Program appreciated its house officers with sock day, bubby mocktails, snack day, a "you're all that and a bag of chips" delivery, and more.
Take this opportunity to recognize your house officers!
Each quarter, UNMC medical students vote for the supervisor and the intern that had the most impact on their medical education. Congratulations to the following residents who received the Best Supervisor and Intern Educators of the Quarter Award:
- Dr. Gigi Green
- Dr. Jonny Trinh
- Dr. Eric Hilker
- Dr. Tyler Larson
- Dr. Zach Vinton
- Dr. Austin Ragland
- Dr. Maggie Hutson
Accepting Nominations for Internal Medicine Research Awards
The UNMC Department of Internal Medicine is now accepting nominations for its 2024-2025 Research Awards. These awards recognize the research achievements of our faculty, house officers, post-doctoral fellows, staff and students. Nominations can be submitted in 10 categories through March 12.
Publication of the Quarter Q4 2024
The Q4 2024 Publication of the Quarter was awarded to Daniel Villageliu for:
Villageliu DN, Cunningham KC, Smith DR, Knoell DL, Mandolfo M, Wyatt TA, Samuelson DR. Natural killer cell effector function is critical for host defense against alcohol-associated bacterial pneumonia. NPJ Biofilms Microbiomes. 2024 Sep 3;10(1):79. doi: 10.1038/s41522-024-00558-w. PMID: 39227647; PMCID: PMC11372167.
The Honorable Mention Publications for Q4 2024:
Kalil AC, Chandak A, Moore LSP, Ahuja N, Kolditz M, Casciano R, Kadambi A, Yaghoubi M, Tsiodras S, Malin JJ, Mozaffari E, Bartoletti M. Public Health Benefits of Applying Evidence-Based Best Practices in Managing Patients Hospitalized for COVID-19. Clin Infect Dis. 2024 Dec 13;79(Supplement_4):S160-S166. doi: 10.1093/cid/ciae517. PMID: 39449663; PMCID: PMC11638767.
Brooks RT, Luedders B, Wheeler A, Johnson TM, Yang Y, Roul P, Ganti AK, Singh N, Sauer BC, Cannon GW, Baker JF, Mikuls TR, England BR. The Risk of Lung Cancer in Rheumatoid Arthritis and Rheumatoid Arthritis-Associated Interstitial Lung Disease. Arthritis Rheumatol. 2024 Dec;76(12):1730-1738. doi: 10.1002/art.42961. Epub 2024 Aug 16. PMID: 39073264; PMCID: PMC11605274.
Honors, Awards and Achievements
Dr. Debra Wekesa awarded scholarship from ASN
Debra Wekesa, MD, scholarship and patient safety chief resident, is one of six recipients of the American Society of Nephrology’s 2025 Loan Mitigation Pilot Program. The program helps decrease the loan burden of those entering the field of nephrology. The ASN said “these six individuals bring a range of skills and a shared commitment to advancing kidney care.”
Learn more about the recipients
Dr. Schnaubelt promoted in U.S. Air Force rank
Elizabeth Schnaubelt, MD, has been promoted to the rank of Colonel in the U.S. Air Force. The promotion is recognition of the tremendous support the Center for Sustainment of Trauma and Readiness Skills (C-STARS) Omaha team has received from the UNMC Division of Infectious Diseases to advance military medical readiness for high consequence infectious disease response, care and transport. She was recognized at a reception on Jan. 31 at the Davis Global Center.
IM faculty and residents inducted into UNMC chapter of GHHS
Department of Internal Medicine faculty Amber Brown Keebler, MD, and Mary Gallagher-Jansen, MD, and residents Kate Bednarke, MD, and Yoni Herskovitz, MD, were inducted during a ceremony on Feb. 1. A total of 20 third-year medical students, six residents and four members of the faculty were recognized.
Allergy and Immunology Division Celebrates Achievements
Dr. Aaron Schwab presented his dissertation for his PhD program Jan. 7. Following his presentation, the UNMC Division of Allergy and Immunology hosted a celebration that included his committee members, colleagues and family.
Amy Nelson, lab manager in the allergy and immunology lab, was awarded the Silver "U" Award for her recognition of dedication and commitment to excellence at UNMC.
UNMC Cardiology Fellows Represent UNMC at National Conference
Arun Mahabir, MBBS, and Amjad Panickaveettil, MBBS, will represent the UNMC Cardiology Fellowship at the American College of Cardiology's annual scientific meeting in March. They will compete in Fellows in Training Jeopardy at ACC.25 in Chicago, IL. Also, the following fellows will be presenting abstracts at ACC.25: Amrin Kharawala, MBBS, Sai Alampoondi, MBBS, Mansi Oberoi, MBBS, Asim Shabbir, MBBS, and Tushar Sharma, MBBS.
Dr. Deb Romberger recognized with division award
Debra Romberger, MD, was recognized by the UNMC Division of Pulmonary, Critical Care and Sleep Medicine with an award in appreciation of her mentorship and leadership.
Dr. Katie Hutchins named a fellow by the ACG
Katie Hutchins, MD, has been named a fellow by the American College of Gastroenterology, signifying her high level of expertise, leadership and commitment to advancing patient care in gastroenterology and hepatology. The designation of Fellow of the American College of Gastroenterology (FACG), has been bestowed upon select members in recognition of significant professional achievement and superior competence within the field of gastroenterology and represents achievements that highlight dedication to the profession.
Drs. Bhatt and D'Angelo are co-directors of hematology conference
Vijaya Bhatt, MBBS, and Christopher D'Angelo, MD, are co-directors of the 2025 Hematology Highlights: A Post-ASH Review Conference on February 1, 2025. This year’s conference is designed to provide the latest updates on key topics in hematology and oncology, focusing on myeloid diseases, lymphoid and plasma cell disorders, clotting diseases and geriatric oncology, as highlighted at the 2024 Annual Meeting of the American Society of Hematology.
Dr. Ashraf selected to serve on CDC advisory committee
Dr. Salman Ashraf has been invited to serve on the CDC's Healthcare Infection Control Practices Advisory Committee for a term beginning immediately and ending June 30, 2028. HICPAC provides advice and guidance to DHHS and CDC on infection control practices and strategies for the surveillance, prevention, and control of healthcare-associated infections, antimicrobial resistance and adverse events in United States healthcare settings.
Nebraska ICAP receives award
Medical Director Juan Teran Plasencia, MD, announced that the Nebraska Infection Control Assessment and Promotion program is a recipient of the Visionary Partner Award by Ambassador Health. This recognition highlights the exceptional contributions of the ICAP team in supporting Ambassador Health’s mission and specifically acknowledges the team's pivotal role during the pandemic, where ICAP served as a trusted resource for infection control guidance and processes.
Dr. RemyGrace Sass receives ACP scholarship
RemyGrace Sass, MD, UNMC Department of Internal Medicine Chief Resident, was awarded the American College of Physicians Herbert S. Waxman Chief Resident Teaching Scholarship. Dr. Sass is one of only six chief residents nationwide to be recognized with this scholarship. In addition to recognizing outstanding chief medical residents, the scholarship also provides an opportunity to assist in teaching popular clinical skills workshops under the guidance and mentorship of expert faculty in the Clinical Skills Center, part of ACP's Internal Medicine Meeting which will be held April 3 to 5, 2025, in New Orleans, LA.
In the News or From Social Media
Mark Rupp, MD, is quoted in a Time article about this year's flu season and why it's the worst in decades.
In an "Ask UNMC" segment, Sara Bares, MD, UNMC College of Medicine, answers: What is the shingles virus and how is it spread?
Dr. Bryant England's VA study about TNF-inhibitors impact on RA-associated lung disease was mentioned in Medpage Today.
James Lawler, MD, MPH, answers: How do we know that vaccines are safe and if they will be effective?
Dr. Kaleb Michaud discusses the benefits of playing board games to protect against Alzheimer's on KIOS FM
Drs. Vijaya Bhatt, Krishna Gundabolu and Lori Maness-Harris are among the authors of a Nov. 2024 article in Journal of Clinical Oncology.
Nicolas Cortes-Penfield, MD, answers: What is whooping cough and what do symptoms look like?
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News Archive
January 2025
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UNMC, VA study shows safety behind drugs for rare lung disorder. Read more
- Remembering pulmonologist, researcher, mentor Joe Sisson, MD. Read more
- Drs. Mikuls, Cannella honored by American College of Rheumatology. Read more
- One student's Summer Undergraduate Research Program experience. Read more
- Remembering UNMC hepatologist Daniel Schafer, MD. Read more
- Search committee named for internal medicine chair. Read more
- More than 25 IM researchers rank among most cited according to Stanford study. Read more
- Nebraskan empowered by annual pancreatic cancer screenings. Read more
Winter 2024
- Innovation Design Unit to open to patients in January. Read more
- Remembering Dr. Cowan, former director of cancer center. Read more
- New Fred & Pamela Buffett Cancer Center-Kearney facility will open Dec. 16. Read more
- Dr. Deb Romberger stepping away as internal medicine chair. Read more
- Infectious Diseases recognizes Antibiotic Awareness Week. Read more
- Dr. Kaleb Michaud recognized for Research Leadership. Read more
- Dr. Jasmine Marcelin selected for TRANSFORM Program. Read more
- Dr. David Warren to join UNMC as new infectious diseases chief. Read more
- EMS responders learn from UNMC’s cardiac, stroke care experts. Read more
- Dr. Lydia Kang will present “Miracle to Menace" at McGoogan Library Nov. 7. Read more
- Dr. Vijaya Bhatt co-leads new research initiative, the Cancer Prevention and Control Program. Read more
- For his contributions to Regulatory Framework for Cannabis: A Position Paper From the American College of Physicians in the Annals of Internal Medicine, Micah Beachy, DO, was recognized for Publication of the Quarter (Q3 2024).
- Lindsey Helget, MD, was selected for Publication of the Quarter (Q2 2024) for Efficacy and Safety of Allopurinol and Febuxostat in Patients With Gout and CKD: Subgroup Analysis of the STOP Gout Trial - PubMed in the American Journal of Kidney Diseases.
- The UNMC Department of Internal Medicine residency program had a 100% board pass rate for its 2024 IM graduates. The program also had another year with a 100% match rate for the residents going into fellowship.
Summer/Fall 2024
- Dr. Sara Hurtado Bares to be honored at research awards ceremony Nov. 14. Read more
- Dr. Vijaya Bhatt co-leads new research initiative, the Cancer Prevention and Control Program. Read more
- IM faculty members join inaugural cohort of Physician Leadership Academy - Read more
- First Ebola patient treated in Nebraska Biocontainment Unit returns after 10 years - Read more
- Dr. Kaleb Michaud to receive Research Leadership Award - Read more
- Dr. Sara Hurtado Bares to receive New Investigator Award - Read more
- Dr. Angela Hewlett advised the U.S. Olympics team - Read more
- Long-acting HIV treatment to be offered in Greater Nebraska - Read more
- Med student mentored by Dr. England earns national research fellowship - Read more
- UNMC joins trial exploring new pancreatic cancer treatment - Read more
January 2025
- Dr. Salman Ashraf has been invited to serve on the CDC's Healthcare Infection Control Practices Advisory Committee for a term beginning immediately and ending June 30, 2028. HICPAC provides advice and guidance to DHHS and CDC on infection control practices and strategies for the surveillance, prevention, and control of healthcare-associated infections, antimicrobial resistance and adverse events in United States healthcare settings.
Winter 2024
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Lindsey Helget, MD, was selected for Publication of the Quarter (Q2) for Efficacy and Safety of Allopurinol and Febuxostat in Patients With Gout and CKD: Subgroup Analysis of the STOP Gout Trial - PubMed in the American Journal of Kidney Diseases. Honorable mention went to Meghana Kesireddy, MBBS, for Overall Survival and Prognostic Factors in Metastatic Triple-Negative Breast Cancer: A National Cancer Database Analysis.
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For his contributions to Regulatory Framework for Cannabis: A Position Paper From the American College of Physicians in the Annals of Internal Medicine, Micah Beachy, DO, was recognized for Publication of the Quarter (Q3). Harshraj Leuva, MBBS, received honorable mention for Assessing olaparib efficacy in U.S. Veterans with metastatic prostate cancer utilizing a time-indifferent g-rate method ideal for real-world analyses.
- Medical Director Juan Teran Plasencia, MD, announced that the Nebraska Infection Control Assessment and Promotion program is a recipient of the Visionary Partner Award by Ambassador Health. This recognition highlights the exceptional contributions of the ICAP team in supporting Ambassador Health’s mission and specifically acknowledges the team's pivotal role during the pandemic, where ICAP served as a trusted resource for infection control guidance and processes.
- Nicolás Cortés-Penfield, MD, assistant professor in the division of infectious diseases has been elected to the Infectious Diseases Society of America's Standards and Practice Guidelines Committee for a three-year term.
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Ted Mikuls, MD, and James O'Dell, MD, are among the editors of the recently published 12th edition of Firestein & Kelley’s Textbook of Rheumatology. This updated text includes comprehensive, global coverage of all aspects of diagnosis, screening, and treatment in rheumatology. Learn more
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Dr. Salman Ashraf and colleagues Lauren Musil, Angie Vasa, Kate Tyner, Jody Scebold, Aretha Boex, and Alisha Sheffield were recognized at the 2024 UNMC Innovation Awards ceremony for their development of SLICE – self-led infection control evaluation tool. Alex Laskey, CEO at Carecubes Inc., was presented the Startup of the Year Award.The Carecube, a revision of personal protective equipment for health care workers, was developed with the expertise of UNMC infectious disease faculty including James Lawler, MD, Jana Broadhurst, MD, PhD; David Brett-Major, MD, and Chris Kratochvil, MD. Learn more
- Jasmine Marcelin, MD, has been appointed to join the board of directors of the IDSA Foundation for a one-year appointment. Dr. Marcelin said she is looking forward to learning about the philanthropic arm of IDSA and continuing to serve at a level where her strengths can be utilized to strengthen the ID workforce.
- Scott Westphal, MD is now the Deputy Education Director for the American Society of Nephrology Kidney Self Assessment Program (KSAP). KSAP is an online self-assessment program that reviews the essentials of nephrology for fellows preparing for initial certification, practicing nephrologists preparing for recertification, and practitioners who want to refresh their understanding of the core elements of nephrology. The case-based questions and answers study tool is based on the American Board of Internal Medicine (ABIM) Examination Blueprint.
- Mark Rupp, MD, was honored by the Nebraska Infection Control Network with the 2024 Distinguished Service Award.
- RemyGrace Sass, MD, UNMC Department of Internal Medicine Chief Resident, was awarded the American College of Physicians Herbert S. Waxman Chief Resident Teaching Scholarship. Dr. Sass is one of only six chief residents nationwide to be recognized with this scholarship. In addition to recognizing outstanding chief medical residents, the scholarship also provides an opportunity to assist in teaching popular clinical skills workshops under the guidance and mentorship of expert faculty in the Clinical Skills Center, part of ACP's Internal Medicine Meeting which will be held April 3 to 5, 2025, in New Orleans, LA.
Summer/Fall 2024
- Four faculty members from the UNMC Department of Internal Medicine were presented with awards from the Nebraska chapter of the American College of Physicians at its fall meeting. Rachel Johnson, MD - LeeRoy Meyer Dedicated Teaching Award; Jasmine Marcelin, MD - Volunteerism and Community Service Award; Micah Beachy, DO - Laureate Award; Trek Langenhan, MD - Hospitalist Award
- Nada Fadul, MD, has been named the associate dean for faculty affairs in the UNMC College of Medicine, effective Nov. 1. In making the announcement, UNMC College of Medicine Dean Bradley Britigan, MD, said Dr. Fadul will oversee development, personnel actions and policy issues for UNMC College of Medicine faculty. Read more
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Sara Hurtado Bares, MD, and Harshraj Leuva, MBBS, are among those who will be honored during a research awards ceremony on Nov. 14. Both are recipients of UNMC's New Investigator Award. Read more
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UNMC recently held its Circle of Distinction event, a celebration of the faculty who hold endowed chairs, professorships and faculty fellowships and the benefactors who make these honors possible. Three faculty members from the Department of Internal Medicine were recognized at the event: Sarah Holstein, MD, PhD, the Neumann M. and Mildred E. Harris Professor of Oncology; Cyrus Desouza, MBBS, the Louise and Morton Degen Professor of Internal Medicine; Julie Vose, MD, MBA, the George and Peggy Payne Distinguished Chair of Oncology. Read more
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Stephanie Hartman, MD, was named a 2024 Physician Advocate of the Year by the Nebraska Medical Association. According to the NMA, the awards recognize the crucial role the recipients play in enhancing the NMA’s public policy priorities, encouraging colleagues to participate in NMA advocacy work and personally advocating for the well-being of physicians, patients and the communities in which they serve. Read more
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Jasmine Marcelin, MD, was honored with the Volunteerism and Community Service Award from the Nebraska chapter of the American College of Physicians at its fall meeting. She was also recognized as 2024 Mentor of the Year by the UNMC Department of Internal Medicine.
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The UNMC Department of Internal Medicine recognized two faculty members at an awards presentation on Oct. 2. Jasmine Marcelin, MD, was recognized as 2024 Mentor of the Year by the UNMC Department of Internal Medicine. Leslie Eiland, MD, received the department's 2024 Excellence in Advocacy Award.
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UNMC’s Interprofessional Academy of Educators held its ninth annual induction ceremony on Sept. 19. Rachel Johnson, MD, and Alex Sorrick, MD, both assistant professors for the division of general internal medicine, were among those inducted. Read more
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Andre Kalil, MD, MPH, is the recipient of the UNMC College of Medicine Alumni Association Honorary Alumnus Award. David O'Dell, MD, received the Dedication to Student Excellence Award. Read more or learn about the awardees
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Erin Ramelb, MD, assistant professor in the UNMC Department of Internal Medicine-Division of Hospital Medicine, has been named to the American Board of Internal Medicine’s Internal Medicine Board for a three-year term. Read more
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The annual Internal Medicine Residency Banquet was held in June. At this celebratory event, the residency program recognized its graduates as well as the individual residents who stood out among their peers, a select faculty member, and one Internal Medicine division for its outstanding work in support of residency education. Trek Langenhan, MD, was honored with the department's Osler Award, which is given to a faculty member who has contributed the most to resident education in the past academic year.
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Kaitlyn Brittan, MD, assistant professor in the UNMC Division of Rheumatology, has been involved in the NMA since she was a UNMC medical student. As of July, Dr. Brittan is the UNMC College of Medicine dean’s representative to the NMA board. Read more
- Brianna Johnson-Rabbett, MD, was recently named the Interim Medical Director for the American Board of Obesity Medicine.
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Several faculty members from the division of gastroenterology and hepatology have been named to committees with the American College of Gastroenterology. Katie Hutchins, MD, Bilal Niazi, MD, and Natapat “Peak” Chaisidhivej, MD, are on the ACG Training Committee. Kevin Brittan, MD, is on the Patient Care Committee and Sarah Malik, MBBS, on the Women's Committee. Dr. Hutchins also will be taking on a leadership role, serving as vice chair for the Women in GI Committee .
- Jill Fliege, APRN-NP, received the Mary M. Kontos Care Champion Award at the North American Cystic Fibrosis Conference this past weekend. This award is given by the Cystic Fibrosis Foundation each year to a member of a care team in recognition of distinct dedication to their work.
- Nikki Regan, APRN-NP, was recognized with the 2024 APRN of Excellence Award from Nebraska Medicine.
Winter 2024
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The UNMC Department of Internal Medicine residency program had a 100% board pass rate for its 2024 IM graduates. The program also had another year with a 100% match rate for the residents going into fellowship:
Austin Barry, MD – UNMC Rheumatology
Kevin Brittan, MD – UNMC GI
Alexandra Fiedler, MD – UNMC GI
Matt Kretschmar, MD – UNMC PCCM
Olivia Makos, DO – UNMC Hem/Onc
Amal Musa, MD – U TX-Galveston Allergy
Morgan Newlun, DO – UNMC Cardiology
Jon Nilles, DO – UNMC Hem/Onc
Mitch Sand, MD – UNMC Cardiology
Kyle Scholten, DO – UNMC GI
Jonny Trinh, MD – U IL Hem/Onc
Debra Wekesa, MD – UNMC Nephrology
Audrey Lane, MD – UNMC Neonatology
Lindsey Pohren, MD – Baylor Transition Medicine
Summer/Fall 2024
- Welcome to our new IM and Med-Peds interns and 2024-2025 Internal Medicine Chief Residents: Remy Sass, MD - UNMC Chief Resident; Brett Begley, MD - VA Chief Resident; Nick Yeutter, MD - Ambulatory Chief Resident; Debra Wekesa, MD - Scholarship & Patient Safety Chief Resident. Meet the newly elected 2024-25 Residency Council
- Daniel Schafer, MD, a retired gastroenterology and hepatology faculty member, passed away peacefully on Nov. 13. He is survived by his wife, Jane Potter, MD, a professor in the division of geriatrics, gerontology and palliative medicine.
- Cheryl Sibley joined the Allergy and Immunology Division as its administrator starting Dec. 1. Cheryl has been in the Pulmonary Critical Care and Sleep Medicine Division for more than 16 years where she is currently an Administrative Business Associate. Current Allergy and Immunology Division Administrator Nussrallah will assist with the transition until her retirement in December.
- New Faculty Spotlight: José Zamora-Sifuentes, DO
- New Faculty Spotlight: Jen Luedders, MD
- Summer/Fall 2024
February 2025
- Mark Rupp, MD, discusses bird flu and who is at risk in a recent "Ask UNMC" segment. Watch the video
- In an "Ask UNMC" segment, Sara Bares, MD, UNMC College of Medicine, answers: What is the shingles virus and how is it spread? Learn more
- Dr. Bryant England's VA study about TNF-inhibitors impact on RA-associated lung disease was mentioned in Medpage Today. Read the article
January 2025
- James Lawler, MD, MPH, answers: How do we know that vaccines are safe and if they will be effective? Read more
- Dr. Kaleb Michaud discusses the benefits of playing board games to protect against Alzheimer's on KIOS FM. Read more
- The recently opened Fred & Pamela Buffett Cancer Center in Kearney is featured on Nebraska Public Media. Read more
- Drs. Vijaya Bhatt, Krishna Gundabolu and Lori Maness-Harris are among the authors of a Nov. 2024 article in Journal of Clinical Oncology. Read the article
- The Innovation Design Unit and UNMC's Project Health are featured on KM3 News. Read more
- Nicolas Cortes-Penfield, MD, answers: What is whooping cough and what do symptoms look like? Watch the video
- Dr. Natalie Crump is asked if it's still necessary to take hypertension meds if your readings are better. Watch the video
Winter 2024
- Dr. Kaleb Michaud was mentioned in a Healio Rheumatology article about post-exertional malaise assessments in long COVID care. Read more
- Angela Hewlett, MD, discusses the difference between natural immunity and vaccine-induced immunity. Watch the video
- A team from UNMC’s global center, including Dr. James Lawler, returns from assisting with Marburg outbreak in Rwanda. Learn more
- Dr. James Armitage, MD, was in a CNN article about an immunotherapy approach to treating advanced Hodgkin lymphoma. Read the article
- UNMC’s Kaleb Michaud, PhD, is featured on the latest online episode of “Health Uncensored With Dr. Drew.” Learn more
- Angela Hewlett, MD, was featured in the IDSA President’s Podcast Let’s Talk ID to discuss "The Ebola Response: 10 Years Later." Listen to the podcast
- The Omaha World-Herald reported on a novel therapy collaborated on by Jennifer Medlin, MD, and Matt Lunning, DO. Read more
- Nada Fadul, MD, was featured in "Women's Health in Focus at NIH". Read the article (page 5)
- In a recent Ask UNMC segment, Kelly Cawcutt, MD, answers: What is West Nile Virus and how is it spread? Watch the video
- Dr. Stephen Mohring was quoted in Ophthalmology Times in an article titled "AI Screening System Increases Adherence." Read the article
- On National HIV Testing Day, Dr. Sara Bares published a blog titled, ‘National HIV Testing Day: Let’s Stop HIV Together.’ Read the blog
- Dr. Jill Poole talks about the impact of climate change on seasonal allergies in a recent Ask UNMC segment. Watch the video
- Dr. Sara May talks options for patients allergic to penicillin in an Ask UNMC segment. Watch the video
- Dr. Natalie Crump answers the question: "Who should be screened for high blood pressure?" Watch the video
Read the 2023 Biennial Report
Our latest biennial report highlights the impact of the UNMC Department of Internal Medicine. The achievements of our department and divisions have a ripple effect on our community, city, state, region and beyond.