Women from racial and ethnic minority groups face a disproportionate burden of cervical and breast cancers in the United States. The Coronavirus Disease 2019 (COVID-19) pandemic might exacerbate ...these disparities as supply and demand for screening services are reduced. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides cancer screening services to women with low income and inadequate health insurance. We examined COVID-19's impact on NBCCEDP screening services during January-June 2020. We found the total number of NBCCEDP-funded breast and cervical cancer screening tests declined by 87% and 84%, respectively, during April 2020 compared with the previous 5-year averages for that month. The extent of declines varied by geography, race/ethnicity, and rurality. In April 2020, screening test volume declined most severely in Health and Human Services Region 2 - New York (96% for breast, 95% for cervical cancer screening) compared to the previous 5-year averages. The greatest declines were among American Indian/Alaskan Native women for breast cancer screening (98%) and Asian Pacific Islander women for cervical cancer screening (92%). Test volume began to recover in May and, by June 2020, NBCCEDP breast and cervical cancer screening test volume was 39% and 40% below the 5-year average for that month, respectively. However, breast cancer screening remained over 50% below the 5-year average among women in rural areas. NBCCEDP programs reported assisting health care providers resume screening.
•Women of color face a disproportionate burden of cervical and breast cancers in the United States.•The COVID-19 pandemic reduced breast and cervical cancer screening among low-income women.•Prolonged delays in screening due to COVID-19 threaten to increase disparities in cancer outcomes.
Enterovirus genomic replication initiates at a predicted RNA cloverleaf (5′CL) at the 5′ end of the RNA genome. The 5′CL contains one stem (SA) and three stem-loops (SLB, SLC, SLD). Here, we present ...an analysis of 5′CL conservation and divergence for 209 human health-related serotypes from the enterovirus genus, including enterovirus and rhinovirus species. Phylogenetic analysis indicates six distinct 5′CL serotypes that only partially correlate with the species definition. Additional findings include that 5′CL sequence conservation is higher between the EV species than between the RV species, the 5′CL of EVA and EVB are nearly identical, and RVC has the lowest 5′CL conservation. Regions of high conservation throughout all species include SA and the loop and nearby bases of SLB, which is consistent with known protein interactions at these sites. In addition to the known protein binding site for the Poly-C binding protein in the loop of SLB, other conserved consecutive cytosines in the stems of SLB and SLC provide additional potential interaction sites that have not yet been explored. Other sites of conservation, including the predicted bulge of SLD and other conserved stem, loop, and junction regions, are more difficult to explain and suggest additional interactions or structural requirements that are not yet fully understood. This more intricate understanding of sequence and structure conservation and variability in the 5′CL may assist in the development of broad-spectrum antivirals against a wide range of enteroviruses, while better defining the range of virus isotypes expected to be affected by a particular antiviral.
Fault slip rate is one of the most crucial parameters to characterize earthquake occurrence in fault‐based seismic hazard assessments (SHA). Accordingly, paleoseismic studies have increasingly ...focused on constraining this parameter in active faults worldwide. We present a comprehensive paleoseismic study in the Alhama de Murcia Fault (AMF), one of the most active faults in SE Spain and source of destructing earthquakes such as the 2011 Mw 5.2 Lorca event. Contrasting with previous studies, we integrate paleoseismic data from four fault strands in the AMF and, based on trench slip analysis and numerical dates, we derive slip rate estimates of each strand over the whole transect and assess their time variability. The AMF has a minimum net slip rate between 1.35+0.16/−0.10 and 1.64+0.16/−0.11 mm/yr for the past 18 ± 1 to 15.2 ± 1.1 ka. These results prove the importance of accounting for the complete sections of a geological structure as they are almost twice the previous estimates for a single fault branch. Slip rate variability is identified in the AMF, with cyclic acceleration‐quiescence patterns that could be related to stress field changes driven by fault interaction or synchronicity with neighboring faults (e.g., Carrascoy). We hope that the data presented here motivates their inclusion into forthcoming fault‐based SHAs. In this regard, limitations related to the lack of paleoseismic data for one fault strand, along with poor characterization of the strike component of slip and insufficient age control of the units for another strand are highlighted and need to be accounted for by modelers.
Key Points
Multi‐site paleoseismic surveys allow to improve the estimations of the geological slip rates in the Alhama de Murcia Fault (AMF)
The AMF shows a geological slip rate between 1.35 and 1.64 mm/yr for the past 18–15 ka
Late Quaternary slip rate fluctuations suggest strain rate variations and highlight possible synchronicities with neighboring faults
Fault slip rates inform models of strain accumulation and release, which over geologic time may vary or remain constant depending on factors like structural complexity, fault strength, deformation ...rates, and proximity to other faults. In this study, we present a Late Pleistocene–Holocene slip history based on four new geologic slip rates for the Agua Blanca Fault (ABF), which transfers Pacific‐North American dextral plate boundary motion across the Peninsular Ranges of northern Baja California. Time‐averaged slip rates from three sites are 2.8 + 0.8/−0.6 mm/a since ~65.1 ka, 3.0 + 1.4/−0.8 mm/a since ~21.8 ka, 3.2 + 1.0/−0.6 mm/a since ~12.5 ka, and 3.5 + 5.1/−2.0 mm/a since ~1.4 ka; however, the actual slip rate may be closer to 4 mm/a when off‐fault slip and age interpretation uncertainties are considered. Significantly, although the ABF has more in common in terms of length, net offset, and slip rate with known variable slip rate faults, the most straightforward age and offset interpretations for the ABF suggest constant slip rates over ~10 kyr time scales. As with other constant slip rate faults, comparable neighboring faults that might modulate the ABF slip rate are absent, suggesting that fault interaction, or lack thereof, may be a more significant factor controlling fault behavior on this and potentially other faults. The new rates indicate that the ABF accommodates at least half of total slip across the Peninsular Ranges, clarifying strain partitioning for seismic forecasting models that previously lacked modern geologic slip rate constraints for this domain of the plate boundary.
Key Points
New geologic slip rates clarify strain partitioning and seismic hazard within the southernmost Pacific‐North American plate boundary system
Four slip rates from three sites document time‐invariant rates of ~3–4 mm/a since ~65, 22, 12.5, and 1.4 ka
The absence of parallel faults and thus of appreciable fault interaction may be the key factor holding slip rates constant
In this work the abilities of intensity-modulated x-ray therapy (IMXT) and intensity-modulated proton therapy (IMPT) to deliver boosts based on theragnostic imaging were assessed. Theragnostic ...imaging is the use of functional or molecular imaging data for prescribing radiation dose distributions. Distal gradient tracking, an IMPT method designed for the delivery of non-uniform dose distributions, was assessed. Dose prescriptions for a hypoxic region in a head and neck squamous cell carcinoma patient were designed to either uniformly boost the region or redistribute the dose based on positron emission tomography (PET) images of the (61)Cu(II)-diacetyl-bis(N(4)-methylthiosemicarbazone) ((61)Cu-ATSM) hypoxia surrogate. Treatment plans for the prescriptions were created for four different delivery methods: IMXT delivered with step-and-shoot and with helical tomotherapy, and IMPT delivered with spot scanning and distal gradient tracking. IMXT and IMPT delivered comparable dose distributions within the boost region for both uniform and redistributed theragnostic boosts. Normal tissue integral dose was lower by a factor of up to 3 for IMPT relative to the IMXT. For all delivery methods, the mean dose to the nearby organs at risk changed by less than 2 Gy for redistributed versus uniform boosts. The distal gradient tracking method resulted in comparable plans to the spot scanning method while reducing the number of proton beam spots by a factor of over 3.
Purpose: To evaluate the effectiveness of a policy supporting early detection and prevention of cervical cancer among low-income and uninsured women by comparing women who reported never or rarely ...being screened (last screen >5 years) to those who reported screening in the past ≤5 years. Methods: We analyzed data from 1,485,251 women who received their first Pap test in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) from July 2002 through June 2012. Of these, 461,893 women (31 %) reported being never or rarely screened and 1,023,358 (69 %) reported being screened in the past 5 years. Demographic (age, race/ethnicity, residence, and region) and clinic (cytologic and histologic results) characteristics were examined for the two groups. Results: Women who were aged ≥50 years, Asian and Pacific Islander, American Indian or Alaska Native, multiracial, living in non-metro areas, or living in the South or a territory were more likely to report being never or rarely screened. The percentage of abnormal Pap tests and the rate of precancer and cancer (combined) was higher in the never or rarely screened group compared with the screened group (abnormal percentage: 2.9 vs 2.6 %, p value < 0.01; rate of precancer and cancer: 6.9 vs 3.7 per 1,000 women, p value < 0.01). Conclusions: The priority of reaching never or rarely screened women should continue since those women who entered the NBCCEDP not adequately screened had a greater prevalence of high-grade histological lesions and invasive cervical cancers at later stages than women screened more recently.
Active fold-and-thrust belts can potentially accommodate large-magnitude earthquakes, so understanding the structure in such regions has both societal and scientific importance. Recent studies have ...provided evidence for large earthquakes in the Western Transverse Ranges of California, USA. However, the diverse set of conflicting structural models for this region highlights the lack of understanding of the subsurface geometry of faults. A more robust structural model is required to assess the seismic hazard of the Western Transverse Ranges. Toward this goal, we developed a forward structural model using Trishear in MOVER to match the first-order structure of the Western Transverse Ranges, as inferred from surface geology, subsurface well control, and seismic stratigraphy. We incorporated the full range of geologic observations, including vertical motions from uplifted fluvial and marine terraces, as constraints on our kinematic forward modeling. Using fault-related folding methods, we predicted the geometry and sense of slip of the major faults at depth, and we used these structures to model the evolution of the Western Transverse Ranges since the late Pliocene. The model predictions are in good agreement with the observed geology. Our results suggest that the Western Transverse Ranges comprises a southward-verging imbricate thrust system, with the dominant faults dipping as a ramp to the north and steepening as they shoal from ∼16°-+30° at depth to ∼45°-60° near the surface. We estimate ∼21 km of total shortening since the Pliocene in the eastern part of the region, and a decrease of total shortening west of Santa Barbara down to 7 km near Point Conception. The potential surface area of the inferred deep thrust ramp is up to 6000 km2, which is of sufficient size to host the large earthquakes inferred from paleoseismic studies in this region.
Quality assurance data were collected prospectively for children who were sedated (n=922) or given general anaesthesia (n=140) for magnetic resonance imaging (MRI) or computerized tomography (CT). ...The data included patient characteristics, concurrent medication, adequacy of sedation, adverse events and requirement for escalated care. The quality of scans was evaluated. Reasons for preselection of general anaesthesia included previously failed sedation (28%), potential for failed sedation (32%) and perceived medical risk (14%). Hypoxaemia occurred in 2.9% of sedated children, and was more common in children classified as ASA III or IV. Sedation was inadequate for 16% of children and failed in 7%. Failed sedation was associated with greater age (P=0.009), higher ASA status (P=0.04) and use of benzodiazepines as sole sedatives (P<0.03). More of the children who underwent general anaesthesia were ASA III or IV than sedated children, yet the procedure was successful in all the children who underwent general anaesthesia, with one incident of laryngospasm. Excessive motion was noted in 12% of scans of sedated children and 0.7% of those completed with general anaesthesia. We conclude that sedation of children for MRI and CT is associated with risks of hypoxaemia and of inadequate or failed sedation. These adverse events were more likely to occur in older children, those with a higher ASA status and those in whom benzodiazepines had been used as sole sedatives. For a preselected high-risk group of children, general anaesthesia may make MRI and CT scans more successful with minimal adverse events.
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