Exploring community midwives\u27 perceptions of their work experience after deployment in the rural areas of Chitral, Pakistan.

Aims: To explore the perceptions of community midwives about their work experiences after deployment in the rural settings of Chitral, Khyber Pakhtunkhwa, Pakistan. Methods: A qualitative descriptive approach was used, conducting in-depth semi-structured interviews with 13 community midwives. Findings: The three major themes that emerged from the analysis of the data were: (1) rural community midwives\u27 perceptions of their role and competencies, (2) factors facilitating and hindering the rural community midwives\u27 ability to function, and (3) continuation of community midwives\u27 services in the future. Conclusions: The study findings highlighted the factors that empower and obstruct community midwives in providing services in rural areas. The majority of the community midwives felt empowered because of their increased earning capacity and enhanced competencies in performing their roles. However, some of them shared challenges in terms of socio-cultural and financial constraints. These findings have important implications for midwives working in rural areas

Image-localized biopsy mapping of brain tumor heterogeneity: A single-center study protocol.

Brain cancers pose a novel set of difficulties due to the limited accessibility of human brain tumor tissue. For this reason, clinical decision-making relies heavily on MR imaging interpretation, yet the mapping between MRI features and underlying biology remains ambiguous. Standard (clinical) tissue sampling fails to capture the full heterogeneity of the disease. Biopsies are required to obtain a pathological diagnosis and are predominantly taken from the tumor core, which often has different traits to the surrounding invasive tumor that typically leads to recurrent disease. One approach to solving this issue is to characterize the spatial heterogeneity of molecular, genetic, and cellular features of glioma through the intraoperative collection of multiple image-localized biopsy samples paired with multi-parametric MRIs. We have adopted this approach and are currently actively enrolling patients for our 'Image-Based Mapping of Brain Tumors' study. Patients are eligible for this research study (IRB #16-002424) if they are 18 years or older and undergoing surgical intervention for a brain lesion. Once identified, candidate patients receive dynamic susceptibility contrast (DSC) perfusion MRI and diffusion tensor imaging (DTI), in addition to standard sequences (T1, T1Gd, T2, T2-FLAIR) at their presurgical scan. During surgery, sample anatomical locations are tracked using neuronavigation. The collected specimens from this research study are used to capture the intra-tumoral heterogeneity across brain tumors including quantification of genetic aberrations through whole-exome and RNA sequencing as well as other tissue analysis techniques. To date, these data (made available through a public portal) have been used to generate, test, and validate predictive regional maps of the spatial distribution of tumor cell density and/or treatment-related key genetic marker status to identify biopsy and/or treatment targets based on insight from the entire tumor makeup. This type of methodology, when delivered within clinically feasible time frames, has the potential to further inform medical decision-making by improving surgical intervention, radiation, and targeted drug therapy for patients with glioma