Barriers and Facilitators To Cervical Cancer Screening Among Iraqi Refugees Resettled in Philadelphia: A Qualitative Analysis of Patient and Provider Perceptions

Oral presentation at the 6th Annual North American Refugee Health Conference, Niagara Falls, New York. Research Questions: 1. What is the prevalence of cervical cancer and cervical cancer screening among recently resettled refugees seen at Jefferson\u27s Center for Refugee Health? 2. Are patient-and provider-identified barriers to cervical cancer screening at CRH consistent with those identified in previous research efforts? 3. What are patient-and provider identified facilitators to cervical cancer screening for Iraqi refugee women

Barriers and Facilitators to Cervical Cancer Screening Among Iraqi Refugees Resettled in Philadelphia: A Qualitative Analysis of Patient and Provider Perceptions

Cervical cancer remains a significant public health problem globally despite being highly preventable via early screening and treatment. Middle-Eastern refugees represent a large segment of refugees resettled in the US recently. Limited research exists regarding screening in this population particularly in the post-resettlement period. The purpose of this project was to identify barriers and facilitators to cervical cancer screening among recently resettled Middle-Eastern refugee women as well as recommend potential solutions to cervical cancer screening based on provider and patient perceptions. This was a mixed methods study that included both qualitative and quantitative analysis. A retrospective chart review was conducted to determine cervical cancer screening completion in refugees resettled in Philadelphia (n = 423). To better understand and address the barriers and facilitators for cervical cancer screening, we conducted focus groups with Iraqi refugee women (n = 7) and healthcare providers (n = 9). Pap smears were conducted for 62% of Middle Eastern and 67% of non-Middle Eastern refugees, which is lower than the Healthy People 2020 goal as well as national, state, and local rates. Results indicated a similar association between country of origin and cervical cancer screening χ(1) = 0.795, p = 0.37. The women perceived the following as barriers: embarrassment, fear of the procedure and results, physician gender, lack of insurance coverage, and competing life priorities. Providers reported similar barriers but also included system based barriers such as translation services, lack of provider training, and lack of time. Facilitating factors included several community-based programs such as group education sessions in the community, and training community members to become health agents. These results suggest a need for comprehensive, culturally competent cervical cancer prevention, education programs, and interventions for Middle-Eastern refugees in Philadelphia as well as strategies to improve access to care and patient–provider relationships. Presentation: 23:4

Cross-sectional human tissue equivalent phantoms

Abstract not available

Cross-sectional human tissue equivalent phantoms

Abstract not available

Identifying ovine transcranial acoustic windows

Transcranial Doppler ultrasound (TCD) is used to measure cerebral blood flow velocity in patients with cerebrovascular pathology. The task of locating an adequate acoustic window, through which TCD might be performed, is frequently time consuming or impossible for patients with thick or dense temporal bones. We examined the possibility of utilising B-Mode ultrasound images to guide detection of acoustic windows prior to TCD. B-Mode images of the temporal bone were acquired on deceased sheep shortly after death. We found that on selected sheep, the inner table of the temporal bone was visible on B-Mode imaging. We suggest that visibility of the inner table of the temporal bone on B-Mode imaging is associated with a high probability of successful TCD at that location

Preparedness of neurosurgery graduates for neuroendovascular fellowship: a national survey of fellowship programs

Endovascular interventions have become an essential part of a neurosurgeon's practice. Whether endovascular procedures have been effectively integrated into residency curricula, however, remains uncertain. The purpose of this study was to assess the preparedness of US neurosurgery graduate trainees for neuroendovascular fellowship. A multidomain, global assessment survey was sent to all directors/faculty of neuroendovascular fellowship programs involved in training of US neurosurgery graduates. Surveyees were asked to assess trainees as they entered fellowship. The response rate was 78% (25/32). Of respondent program directors, 38% reported that new fellows did not know the history and imaging of the patient and 50% were unable to formulate an appropriate treatment plan. As many as 79% of fellows were unfamiliar with endovascular devices and 75% were unfamiliar with angiographic equipment. Furthermore, 58% of fellows were unable to perform femoral access, 54% were unable to perform femoral closure, 79% were unable to catheterize a major vessel, 86% were unable to perform a 4-vessel angiogram, and 100% were unable to catheterize an aneurysm. Additionally, program directors reported that over 50% of fellows could not recognize neurovascular anatomy and 54% could not recognize/classify vascular abnormalities. There was an overall agreement that fellows demonstrated professionalism and interest in research and had good communication/clinical skills. The results of this study suggest potential gaps in the training of neurosurgery residents with regard to endovascular neurosurgery. In an era of minimally invasive therapies, changes in residency curricula may be needed to keep pace with the ever-changing field of neurosurgery

Endovascular stroke intervention in the very young

•Data on stroke in the very young is lacking and insufficient.•Endovascular therapy can achieve a high recanalization rate and favorable outcome.•Endovascular therapy can have limited complications.•We advise aggressive management for very young patients. Object: This study aims to evaluate the use of endovascular therapy to treat very young (≤35 years) patients with acute ischemic stroke from large vessel occlusion. We identified from a prospectively maintained database young patients (≤35 years) undergoing endovascular intervention for AIS at two cerebrovascular referral centers. The study only included patients with a confirmed large vessel occlusion. Modified Rankin scale (mRS) scores were determined at 90 days during a follow-up visit. A total of 15 patients met the inclusion criteria. Mean age was 27.93 years±6.75 years (range: 9–35 years). On admission, the mean NIHSS score was 14.07±9.16. Mechanical thrombectomy was performed using the Solitaire FR device in 4 of 15 (26.67%) patients and the Merci/Penumbra systems in 11 (73.33%) patients. Successful recanalization (TICI 2–3) was achieved in all but one patient (14/15; 93.33%). Only one patient (6.67%) had a hemorrhagic conversion following intervention; he later expired. The rate of 90-day favorable outcome (mRS 0–2) was 86.67% (13/15). Endovascular treatment in the very young population may be carried out with limited complications and attain remarkably high rate of recanalization and favorable outcome. This study supports the role of aggressive management strategies for very young patients with large vessel occlusion

Update on Intra-Arterial Chemotherapy for Retinoblastoma

The tools for managing retinoblastoma have been increasing in the past decade. While globe-salvage still relies heavily on intravenous chemotherapy, tumors in advanced stage that failed chemotherapy are now referred for intra-arterial chemotherapy (IAC) to avoid enucleation. However, IAC still has many obstacles to overcome. We present an update on the indications, complications, limitations, success, and technical aspects of IAC. Given its safety and high efficacy, it is expected that IAC will replace conventional strategies and will become a first-line option even for tumors that are amenable for other strategies

Polymorphism of prion protein gene (PRNP) in Nigerian sheep

ABSTRACTPolymorphism of the prion protein gene (PRNP) gene determines an animal’s susceptibility to scrapie. Three polymorphisms at codons 136, 154, and 171 have been linked to classical scrapie susceptibility, although many variants of PRNP have been reported. However, no study has investigated scrapie susceptibility in Nigerian sheep from the drier agro-climate zones. In this study, we aimed to identify PRNP polymorphism in nucleotide sequences of 126 Nigerian sheep by comparing them with public available studies on scrapie-affected sheep. Further, we deployed Polyphen-2, PROVEAN, and AMYCO analyses to determine the structure changes produced by the non-synonymous SNPs. Nineteen (19) SNPs were found in Nigerian sheep with 14 being non-synonymous. Interestingly, one novel SNP (T718C) was identified. There was a significant difference (P < 0.05) in the allele frequencies of PRNP codon 154 between sheep in Italy and Nigeria. Based on the prediction by Polyphen-2, R154H was probably damaging while H171Q was benign. Contrarily, all SNPs were neutral via PROVEAN analysis while two haplotypes (HYKK and HDKK) had similar amyloid propensity of PRNP with resistance haplotype in Nigerian sheep. Our study provides valuable information that could be possibly adopted in programs targeted at breeding for scrapie resistance in sheep from tropical regions