Background Breast cancer is the second deadliest cancer for women in the demographically unique mountainous west state of Nevada. This study aims to accurately characterize breast cancer survival among the diverse women of the flourishing Silver State. Methods Nevada Central Cancer Registry data was linked with the National Death Index and the Social Security Administration Masterfile. Overall five-year cause-specific survival, survival stratified by race/ethnicity, and stage-specific survival stratified by region of Nevada were calculated. Adjusted hazard ratios were computed with Cox proportional hazards regression. Results 11,111 cases of breast cancer were diagnosed from 2003–2010. Overall 5-year breast cancer survival in Nevada was 84.4%, significantly lower than the US, at 89.2%. Black and Filipina women had a higher risk of death than white women. Discussion Poor survival in the racially and ethnically diverse Las Vegas metropolitan area, with a large foreign-born population, drives Nevada’s low overall survival. System-wide changes are recommended to reduce the racial/ethnic disparities seen for black and Filipina women and improve outcomes for all.

INTRODUCTION: Purpose: Descriptive case study of pre-clinical ultrasound education at the University of Nevada, Las Vegas School of Medicine. BACKGROUND: Point-of-Care Ultrasound (POCUS) is increasingly valued across medical disciplines. As benefits of ultrasound are recognized, so too is the need to integrate ultrasound into undergraduate medical education (UME). Early exposure contributes to ease of use during clinical rotations. Our objective is to describe integration of POCUS before clinical immersion and how efforts were perceived. METHODS: 58 medical students participated in a hands-on training session before initiation of clerkship duties. A brief didactic introduction for ultrasound techniques began each session. Students were divided into duos and rotated through 6 stations designed to provide training in ultrasound of the abdomen, head/neck, and cardiac. Each station consisted of a clinical scenario, ultrasound machine, standardized patient/model, and instructor. Student feedback was collected via 6-point questionnaire at the end of the session. RESULTS: 58/58 students completed the survey, positively evaluating clinical relevance and student satisfaction. 58/58 students answered “yes” that “the session met the stated learning objectives,” 57/58 answered “yes” that “the learning environment was conducive to my acquiring new skills.” Comments were entered in an optional field with the descriptors “great” and “helpful” trending throughout feedback, indicating high student satisfaction. CONCLUSION: UME is changing, with new challenges to preparing students for clinical years including the incorporation of POCUS. The overwhelmingly positive feedback for our session indicates integrating POCUS as an educational tool with hands-on ultrasound practice can provide engaging and applicable skills for medical students.

INTRODUCTION: To descriptively compare nutritional content of prescription to nonprescription prenatal vitamins (PNVs) through consideration of the American College of Obstetricians and Gynecologists (ACOG) recommendations for a healthy pregnancy. METHODS: We utilized 2 publicly available online databases, Dietary Supplement Label Database and DailyMed, to obtain a list of all currently available PNVs. Inclusion criteria was based on initial search results from keyword “prenatal.” Exclusion criteria were single ingredient supplements, or duplicates. Duplicates were supplements listed separately because of different package forms for sales purposes, but were identical (i.e. same manufacturer, nutritional label/content), or those present in both databases. PNV ingredients were recorded from nutritional labels and compared to ACOG micro-nutrient guidelines. RESULTS: We obtained a total sample of 307 PNVs (110 prescription, 197 nonprescription). Of the prescription PNVs, 0% met calcium requirements, 100% met folic acid requirements, 82% met iron requirements, and 16% met vitamin D requirements. Of the nonprescription PNVs, 8% met calcium requirements, 98% met folic acid requirements, 11% met iron requirements, and 33% met vitamin D requirements. Each PNV was assigned a score from 0-4, based on the number of the 4 ACOG supplementation recommendations they met. Of the prescription PNVs, 12% scored ≥3, and 20% of the nonprescription PNVs scored ≥3. No single prescription PNV met all 4 ACOG recommendations, and 2 nonprescription PNVs did. CONCLUSION: We found no meaningful difference in nutritional adequacy of prescription versus nonprescription PNVs with respect to ACOG recommendations. Tailored supplementation should be considered as an alternative to PNVs.

Health disparities may differ by geographical area depending on contextual factors. With below average incidence, low mammography prevalence and above average mortality rates, the study of breast cancer survival outcomes is of particular interest in the state of Nevada. The health infrastructure in Southern Nevada is currently not supported by an established MD-type School of Medicine, despite the size of the Las Vegas metropolis, 2 million. We studied survival disparities for females with breast cancer in the Silver State for the period 2003-2010. Data came from the Nevada Central Cancer Registry and cases were followed-up until Dec 31 2012 using hospital records as well as in-state and national death index linkages. We analyzed cause-specific survival rates using the actuarial method. We assessed the impact of (1) tumor-related factors: AJCC stage at diagnosis, grade of differentiation, estrogen receptors; (2) demographic factors including age, race-ethnicity (non-Hispanic Whites, non-Hispanic Blacks, Hispanics, Asian Filipino, Asian other, American Indian) , marital status; and (3) social factors such as insurance and socio-economic status on survival outcomes for breast cancer using Cox regression. For censoring times, we used the presumed-alive assumption. A total of 11,110 cases of breast cancer cases diagnosed between 2003 and 2010 were analyzed. Survival in Northern Nevada –Reno was 88.2% after 5 years (95%CI 86.9-89.5) well within the US-SEER average of 87.0% (95%CI 86.9-87.2). Southern Nevada - Las Vegas lagged significantly behind with 83.1% (95%CI 82.2-84.0). Non-Hispanic Blacks had a 76.0% 5 year-survival (95%CI 72.6-79.4) and Filipino women 76.6% (71.3-82.0). In the multivariate analysis, Stage I, estrogen-receptor positive, and high grade of differentiation showed a lower mortality risk, while low SES and lack of insurance showed a higher mortality risk. After adjustment for all confounders, Black women showed higher mortality risk than Whites (HR 1.26 95%CI 1.06-1.50) and Southern Nevada had a 14% higher mortality risk compared to Northern Nevada for patients of the same age, race, insurance, stage at diagnosis (HR 1.14, 95%CI 1.00-1.30). The initial disadvantage for Filipino women in relation to Whites was no longer shown after adjustment for AJCC stage at diagnosis (HR 1.17, p< 0.05). Disparities according to tumor-related factors in Nevada were not different from those in the rest of the nation. However, unique disparities were observed according to demographic factors. A significant survival difference between the Northern and Southern regions of Nevada, with similar prevalence of mammography, and after adjustment for all known confounders, suggests disparities in quality of healthcare associated or not with different treatment compliance patterns. Black women are disadvantaged despite adjustment for SES, stage and insurance type, while the Filipino disadvantage is modifiable since it is caused by an unfavorable distribution of stage at diagnosis. Citation Format: Paulo S. Pinheiro, Nevena Cvijetic, Rachel Kelly, Carmen Ponce, Erin Kobetz-Kerman. Filipinos and blacks at a disadvantage for breast cancer survival and in-state disparities in Nevada. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C35.

INTRODUCTION: The primary objective was to compare the nutritional content of prescription to nonprescription prenatal vitamins. METHODS: We obtained samples of popular prescription and nonprescription prenatal vitamins (PNVs). We then recorded the nutritional contents of each product from the nutritional label. PNV ingredients were compared to each other and to The American College of Obstetricians and Gynecologists (ACOG) recommended guidelines. To compare physical size, we focused on PNVs in pill form. To compare cost, we used pharmacy quoted cash prices of prescription PNVs and shelf prices of nonprescription PNVs RESULTS: We obtained a total sample of 16 PNVs (8 prescription, 8 nonprescription). All 16 PNVs examined had at least 800 mcg of folic acid. However, no PNV, prescription or nonprescription, simultaneously met all of ACOG's nutrient recommendations for calcium, folic acid, iron, and vitamin D. In terms of size, the largest prescription PNV was approximately 1 inch in length (PrimaCare), and smallest approximately 0.6 inches (Prenate Mini, Vitafol, VitaPearl, and OB Complete). For nonprescription PNVs, the largest were also approximately 1 inch in length (Alive and Nature Made), but no nonprescription with a single pill was 0.6 inches or less. In terms of cost, the cash price of the cheapest prescription PNV was almost double that of the most expensive nonprescription PNV. CONCLUSION: We found no meaningful difference in nutritional adequacy of prescription versus nonprescription PNVs with respect to ACOG nutrient recommendations, despite appearance of a large cost difference.