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Background: Persons experiencing homelessness (PEH) rarely receive regular preventative health care or consistent cancer screenings. Late stage detection of cancer and barriers to care are prevalent among PEH. Novel programs such as onsite mobile mammography services represents an approach to improve breast cancer disparities among women experiencing homelessness (WEH) and allows for understanding of barriers to cancer screening amongst WEH and to develop best practices. Objectives: During onsite mobile mammography events at shelters for WEH, develop best practices for improving breast cancer screening utilization while developing approaches to increase use of other cancer screenings. Methods: In 2022, the Cleveland Clinic performed onsite mobile mammography screening events at area shelters and day centers. All seven screening events included onsite mammography, breast health education, and patient navigation. After WEH completed the education session, they completed the mammogram. Subsequently, at two events, patients had an opportunity for further consultation with an advanced practice provider (APP) including discussing additional screening tests (ex. colorectal, lung, cervical cancer) beyond mammograms with referrals as needed. Consultations also discussed approaches to reduce cancer risks with further education, referrals for dental care, and assistance securing a primary care provider (PCP). Results: At the events that included consultations, 30 patients received mammograms and 80% (n=24) of patients chose to speak with the APP. Patients seeking consultation were 21-73 years old and identified as Black/African American (n=5), White (n=16), and other (n=3). Topics of discussion included mammograms (n=24, 100%), smoking cessation referral and/or lung cancer screening (n=16, 67%), colorectal cancer screening (n=11, 46%), and cervical cancer/HPV screening (n=11, 46%). Additionally, 46% of patients (n=11) were assisted with securing a PCP and 8% of patients (n=2) were referred for dental services. Discussion: Our preliminary data demonstrate that most WEH undergoing onsite mammography screening are willing to engage in consultation to discuss additional cancer screenings with many patients eligible for additional cancer screenings. Additionally, this approach provided access to PCPs. Three best practices for cross cancer screenings include: 1) Onsite mobile mammography is an appropriate entry point for addressing breast health and also cancer screening broadly. 2) An onsite approach allows for education beyond cancer screening to provide access to primary care and other wrap around services. 3) Clinicians provide credibility and trust when they attend onsite mobile mammography events. Conclusion: Beyond breast cancer screening, WEH benefit from onsite mobile mammography, which can serve as a gateway to cross cancer screenings and access to primary care. Addressing disparities in this population should include wrap around services such as smoking cessation and connection to a PCP. Future research should examine best practices for following up with patients and completing navigation through cross cancer screenings. Citation Format: Pamela Combs, Heather M. Hurwitz, Markayla Mariner, NaSheema Anderson, Kate Mccaffrey, Raymond Jackson, Sarah Kilic, Tiffany Onger, Kimberly Sanders, Tyler Stimpert, Jeremy Suwarna, Jeremy Weleff, Chirag Shah. Toward Comprehensive Cancer Prevention for Women Experiencing Homelessness: Demonstrating the Need for Onsite Mammography, Education, Navigation, and Cross Cancer Screenings [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-08-12.

Implementing healthy work environment standards helps to improve the care environment for nurses and patients. These standards were used as a framework during a nurse resident-led evidence-based practice project. The transcatheter aortic valve replacement team collaborated with the nurse residents throughout the evidence-based practice project to design a fast-track patient selection checklist and give input into a care protocol for their cardiac telemetry unit.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and can arise from any form of chronic liver disease or cirrhosis. With increasing rates of metabolic syndrome and obesity, it is not surprising that NASH is quickly becoming a leading cause of chronic liver disease and HCC in the western hemisphere (Wang and Malhi, 2018). Metastasis is usually found in advanced stages of the disease, owing to its poor prognosis. The lung, bone, and lymph nodes are the most frequent sites of metastasis (Balogh et al., 2016, and Becker et al., 2014). On the other hand, metastasis to the skin and cranium is relatively rare. Literature review reveals less than 10 reported cases in the last 10 years. Herein, we report an unusual case of a “forehead hematoma” leading to the formal diagnosis of metastatic HCC.

The re-release of golden lion tamarins (Leontopithecus rosalia), from zoos into the wild, is considered to be an ex situ conservation success story. However, zoo-born golden lion tamarins have lowe...

Medical distrust is both a psychosocial construct and an underappreciated individual social determinant of health with the potential to affect oncology care and clinical trial participation. A community-based participatory research effort, called the Forward Movement Project (FMP), identified multilevel factors affecting trust for healthcare and research in an underserved urban community. In FMP Phase II, we implemented a community-responsive approach to provide lay-oriented education and address misinformation, with the goal of beginning to remediate distrust for healthcare systems and biomedical research.Community residents (N = 154 adults, 64% male, M = 61.5 years old, 53% annual income$10,000, 83% African American/Black) engaged in participant-driven dialogues with oncology clinicians/clinical researchers and support services professionals. A program evaluation focused on trust for healthcare and biomedical research.Participants reported positive evaluations of both the program and the cancer center clinicians and staff, who were rated as trustworthy (80% strong agreement). However, trust for healthcare systems ("Strongly agree" = 58%) and medical researchers ("Strongly agree" = 50%) following the program was moderate. Over half of the sample (52%) strongly agreed they would participate in a clinical trial compared to before joining this study.Findings supported the user-generated program approach. The FMP is an example of a model for true community engaged research and has implications for rebuilding trust in healthcare and research.

Unilateral adrenal infarction is a rare cause of acute abdomen in pregnancy (AAP). Its presentation is non-specific and requires a high index of suspicion with a low threshold to obtain radiographic imaging for diagnosis. Evaluating AAP is challenging as diagnostic radiographic imaging is often limited in relation to radiation exposure to the developing fetus. We describe a case of a 24-year-old pregnant female who presented with severe acute abdominal pain. The patient’s pain was refractory to intravenous analgesics and ultrasonography was inconclusive. Computed tomography (CT) scan was not obtained due to the risk of radiation exposure to the developing fetus. Due to the persistence of pain and suspicions for other serious etiologies, magnetic resonance imaging (MRI) was completed and the patient was diagnosed with acute unilateral adrenal infarction. In this case report, unilateral adrenal infarction was likely secondary to elevated plasma factor VIII levels. Even with the physiological elevation of factor VIII levels during pregnancy, levels greater than 150 IU/dL confer greater than five-fold increased risk of venous thrombosis. Once hemorrhage is excluded, patients should be started on therapeutic anticoagulation to prevent progression of adrenal infarct or infarction of the contralateral adrenal gland. Prompt recognition and treatment of acute adrenal infarction during pregnancy are of paramount importance to prevent adverse outcomes for both the mother and fetus.

111 Background: While incidence rates of cancer are lower among women experiencing homelessness (WEH), cancer mortality remains higher. Barriers to screening include economic, transportation, housing, childcare and other barriers. This study evaluates barriers to mammographic screening as part of a prospective program that provides onsite mammography services to WEH. Methods: Cleveland Clinic partnered with shelters to provide breast health education, patient navigation, and mobile mammograms onsite at shelters. Also, participants received a meal, a bra, and hygiene items. 75 women and persons of other genders completed a mammogram. 55 WEH participated in the study by completing a survey for a response rate of 73.3%. The survey included questions about barriers and demographics. We conducted a preliminary analysis to improve study quality and plan for a follow up study. Results: Participants were 40-75 years old and identified as American Indian/Alaska Native (5.5%), Black/African American (60%), and White (40%). 16% of participants received their first ever mammogram. 34% noted a family history of breast cancer and 22% had previously been advised to return for additional imaging. One participant was a breast cancer survivor. On average, participants’ last mammogram was four years prior with the greatest screening lapse being 18 years prior. A majority (n = 39, 70.9%) disagreed or strongly disagreed with the statement, “I’m afraid the mammogram will be painful.” Likewise, a majority (n = 46, 83.7%) disagreed or strongly disagreed with the statement, “I’m embarrassed about having a mammogram.” A majority (n = 44, 80.0%) also disagreed or strongly disagreed with the statement, “I’m busy and do not have time.” Almost all participants (n = 51, 96.2%) responded “yes” to the statement, “I believe in preventative care screenings.” However, participants’ responses to the statement, “I’m afraid of finding breast cancer” varied widely from strongly disagree (n = 7, 13.0%) and disagree (n = 10, 18.5%), to neutral (n = 15, 27.8%), to agree (n = 12, 22.2%) and strongly agree (n = 10, 18.5%). Conclusions: Our preliminary data shows that most participants believe in preventative screening, showing that novel services such as onsite mammography may address the lack of screening in this population. 40.7% of participants stated they are afraid of finding breast cancer, indicating this is a barrier to screening in the WEH population. Future research should explore reasons for fear (financial burden, mortality, lack of access to care, etc.) and why this may result in a lack of screening.

Topiramate has a wide array of pharmacologic effects, including proximal renal tubular acidosis (RTA). Clinicians must be wary of the possibility for development of somnolence due to compensatory hyperventilation and cardiac dysrhythmias.

African Americans report higher rates of chronic stress compared to non-Hispanic Whites. Consequently, chronic stress contributes to disproportionately higher rates of poor health outcomes among African Americans. Mindfulness meditation is a well-established and studied strategy to reduce stress and potentially improve health outcomes. However, the practice of mindfulness meditation is largely underutilized in African American communities despite its potential health benefits. In this commentary, we will discuss the relevance of mindfulness interventions, limited research available, reasons for low representation, and cultural adaptations for mindfulness meditation in African American communities. We also provide additional strategies to guide future mindfulness research that target African Americans.

The re-release of golden lion tamarins (

A 69-year-old woman presented with worsening dyspnoea for a month. She had a history of moderately differentiated non-mucinous appendiceal adenocarcinoma, diagnosed 10 months prior based on pathology from an emergent appendectomy for acute appendicitis. Mesenteric margins had been indeterminate but

Although HIV pre-exposure prophylaxis (PrEP) is effective for women, studies show limited uptake among women to date. Barriers to women's PrEP uptake include their limited knowledge about PrEP and low perceived HIV risk. To address these barriers, we developed and pretested a printed palm card containing HIV prevention/PrEP information that addressed HIV prevention motivation with self-assessment questions about HIV risk. We conducted expert interviews (N = 8), focus groups with health, education, and social service providers (N = 13), and interviews with community women (N = 30) in New York City to assess attention to and acceptability of the card, comprehension of the information, and potential impact on prevention motivation. The card format and content were found to be acceptable and potentially motivational for preventive behaviors, as well as particularly relevant for women. Results of testing for language use, comprehension, and attention guided the final version of the card content.

Background: Community and patient engagement in the healthcare system and biomedical research are prerequisites for eliminating health disparities. We conducted a &ldquo, listening tour&rdquo, to enhance our understanding of multilevel factors associated with community trust. Methods: Using community-based participatory research (CBPR) methods, we conducted a phenomenological qualitative study. &ldquo, Town-hall&rdquo, style discussions were held at nine sites across an urban, Midwestern city. We recruited adults (N = 130) via community networks, social media, flyers, and word-of-mouth. Demographic assessments were self-administered and listening tour sessions were conducted by trained moderators. Themes were framed within the social ecological model (SEM, intrapersonal, interpersonal, institutional, community, and policy levels). Results: Participants were mostly female (68%), African American (80%), had health coverage (97%) and were diagnosed with a chronic health condition (71%). The overarching theme was sociodemographic differences in distrust, such that African Americans and deaf/hearing impaired participants perceived disparities in healthcare, a lower quality of care, and skepticism about biomedical research, relative to Whites. Conclusions: The depth of distrust for healthcare providers, systems, and researchers in underserved communities remains strong and complex. Findings highlight the need to understand the lived experiences of community members, and how distrust is maintained. Multilevel interventions to increase trust and the accrual of underrepresented populations into clinical trials are needed.

We present a case of a 45-year-old man admitted to the hospital with new-onset ascites and bilateral subconjunctival haemorrhages. He was found to have elevated liver enzymes in a hepatocellular pattern and direct hyperbilirubinemia. A diagnostic paracentesis was consistent with portal hypertension (PH). Extensive workup for acute and chronic liver disease was unremarkable. In the absence of clinical evidence of cirrhosis to explain PH, a liver biopsy with hepatic venous pressure gradient was pursued, which revealed proteinaceous material and apple-green birefringence under polarised light consistent with amyloid deposits. Bone marrow biopsy revealed plasma cell neoplasm with proteinaceous deposits consistent with concomitant multiple myeloma with AL amyloidosis. He developed rapidly progressive liver failure and passed shortly after presentation despite treatment with chemotherapy. This case illustrates how primary hepatic amyloidosis can present with a physiology that mimics cirrhosis and can easily be missed.

This study examined the use of carbohydrates by men and women during lift/carry exercise. Effects of menstrual cycle variation were examined in women. Twenty‐five subjects (15 M, 10 F) were studied; age 25 ± 2y M, 26 ± 3y F, weight 85 ± 3 kg* M, 63 ± 3 kg F, and height 181 ± 2 cm* M, 161 ± 2 cm F (* P

This article examines local press coverage of the 1985 police bombing of MOVE, which resulted in the deaths of eleven people, as well as the destruction of two city blocks leaving 250 people homeless. According to public opinion polls many Philadelphians seemingly showed little concern about the heavy-handed tactics used by the police; in fact, many praised the mayor and the efforts of law enforcement. News accounts from the Philadelphia Inquirer were content analyzed to determine whether or not the coverage was framed in a manner that may have influenced the public’s attitude toward the organization and its members, thus cultivating within the populace an attitude of indifference.

There is a growing body of evidence that links increased social capital to minority student success in college. This paper seeks to expand specifically on the graduate experience of underrepresented minorities (URM) at a Hispanic Serving Institution (HSI) using the social capital framework. In a cross-sectional survey, 198 graduate students retrospectively considered the role of institutional resources and agents in their success towards graduation. Data revealed that motivational factors such as a sense of personal achievement, family support, peer support, career promotion, supportive faculty, program satisfaction, and faculty mentor played critical roles in the success of graduate students at HSI. Specifically, Latino students are more likely to report that faculty mentors played a significant role in their success compared to their non-Latino peers χ2(1, N = 195) = 5.33, p = 0.02. Latinos/as were also more likely to use writing support services than their non-Latino/a peers χ2(2, N = 190) = 7.59, p = 0.02. By identifying and increasing access to institutional resources and agents, underrepresented minorities in post-baccalaureate programs may encounter less barriers to graduate degree success.