Disparities in the use of screening breast magnetic resonance imaging persist in Louisiana after the Affordable Care Act: A question of access, policy, institutional support, or something else?

BACKGROUND: Louisiana continues to have one of the highest breast cancer mortality rates in the nation, and Black women are disproportionally affected. Louisiana has made advances in improving access to breast cancer screening through the expansion of Medicaid. There remains, however, broad underuse of advanced imaging technology such as screening breast magnetic resonance imaging (MRI), particularly for Black women. METHODS: Breast MRI has been proven to be very sensitive for the early detection of breast cancer in women at high risk. MRI is more sensitive than mammography for aggressive, invasive breast cancer types, which disproportionally affect Black women. Here the authors identify potential barriers to breast MRI screening in Black women, propose strategies to address disparities in access, and advocate for specific recommendations for change. RESULTS: Cost was identified as one of the greatest barriers to screening breast MRI. The authors propose implementation of cost-saving, abbreviated protocols to address cost along with lobbying for further expansion of the Affordable Care Act (ACA) to include coverage for screening breast MRI. In addition, addressing gaps in communication and knowledge and facilitating providers' ability to readily identify women who might benefit from MRI could be particularly impactful for high-risk Black women in Louisiana communities. CONCLUSIONS: Since the adoption of the ACA in Louisiana, Black women have continued to have disproportionally high breast cancer mortality rates. This persistent disparity provides evidence that additional change is needed. This change should include exploring innovative ways to make advanced imaging technology such as breast MRI more accessible and expanding research to specifically address community and culturally specific barriers.

An Update on Screening and Prevention for Breast and Gynecological Cancers in Average and High Risk Individuals.

Breast and gynecological cancers affect almost 900,000 women and therefore most health care providers will be involved at some point in the management of women with cancer. As the prognosis of all cancers is much more favorable when diagnosed in early stages, it is imperative that all health care providers are familiar not only with current screening guidelines for the average population, but also with the identification of high risk individuals who may benefit from more intense screening as well as available interventions to prevent disease or decrease risk. The purpose of this review article is to provide relevant information to physicians and other health care providers to aid in identifying patients that are classified as "high risk" for developing breast or a gynecologic cancer, outlining what interventions exist for adequate screening and risk reduction strategies, and to provide an update on current screening guidelines for individuals at average and high risk.

Individual and combined effects of low dissolved oxygen and low pH on survival of early stage larval blue crabs, Callinectes sapidus.

A large number of coastal ecosystems globally are subjected to concurrent hypoxic and acidified conditions that will likely intensify and expand with continued climate change. In temperate regions, the spawning of many important organisms including the Atlantic blue crab Callinectes sapidus occurs during the summer months when the severity of coastal hypoxia and acidification is the greatest. While the blue crab earliest larval stage can be exposed to co-occurring hypoxia and acidification observed in many coastal ecosystems, the effects of these concurrent stressors on larval blue crab survival is unknown. This study investigated the individual and combined consequences of low dissolved oxygen (DO) and low pH on blue crab larvae survival through a series of short-term experiments. During 14-day experiments with moderately hypoxic conditions (117-127 µM O2 or 3.74-4.06 mg L-1) and acidified conditions (pH on total scale of 7.16-7.33), low DO and low pH individually and significantly reduced larval survival by 60% and 49%, respectively, with the combination of stressors reducing survival by 87% compared to the control treatment (210-269 µM O2 or 6.72-8.61 mg L-1, 7.91-7.94 DO and pH, respectively). During 4-day experiments with lower DO levels (68-83 µM O2 or 2.18-2.62 mg L-1) and comparable pH levels of 7.29-7.39, low DO individually reduced survival by >90% compared to the control (261-267 µM O2 or 8.35-8.54 mg L-1, 7.92-7.97 DO and pH, respectively), whereas low pH had no effect and there was no interaction between stressors. Over a 4-day period, the DO threshold at which 50% of the larval blue crab population died (LC50) was 121 µM O2 (3.86 mgL-1). In 14-day experiments, the DO and pH effects were additive, yielding survival rates lower than the individual treatments, and significantly correlated with DO and pH concentrations. Collectively, these findings indicate that blue crab sensitivity to both low DO and low pH are acute within the larval stage, depend on the intensity and duration of exposure, and leads to mortality, thereby potentially contributing to the interannual variability and possible regional declines of this fishery.

Transcriptomic Responses in the Bloom-Forming Cyanobacterium Microcystis Induced during Exposure to Zooplankton.

The bloom-forming, toxic cyanobacterium Microcystis synthesizes multiple secondary metabolites and has been shown to deter zooplankton grazing. However, the biochemical and/or molecular basis by which Microcystis deters zooplankton remains unclear. This global transcriptomic study explored the response of Microcystis to direct and indirect exposures to multiple densities of two cladoceran grazers, Daphnia pulex and D. magna Higher densities of both daphnids significantly reduced Microcystis cell densities and elicited a stronger transcriptional response in Microcystis While many putative grazer deterrence genes (encoding microcystin, aeruginosin, cyanopeptolin, and microviridin) were largely unaffected by zooplankton, transcripts for heat shock proteins (hsp) increased in abundance. Beyond metabolites and hsp, large increases in the abundances of transcripts from photosynthetic processes were observed, evidencing energy acquisition pathways were stimulated by grazing. In addition, transcripts of genes associated with the production of extracellular polysaccharides and gas vesicles significantly increased in abundance. These genes have been associated with colony formation and may have been invoked to deter grazers. Collectively, this study demonstrates that daphnid grazers induce a significant transcriptomic response in Microcystis, suggesting this cyanobacterium upregulates specific biochemical pathways to adapt to predation.IMPORTANCE This work explores the transcriptomic responses of Microcystis aeruginosa following exposure to grazing by two cladocerans, Daphnia magna and D. pulex Contrary to previous hypotheses, Microcystis did not employ putative grazing deterrent secondary metabolites in response to the cladocerans, suggesting they may have other roles within the cell, such as oxidative stress protection. The transcriptional metabolic signature during intense grazing was largely reflective of a growth and stress response, although increasing abundances of transcripts encoding extracellular polysaccharides and gas vesicles were potentially related to predator avoidance.

Cochlear trajectory in pediatric patients.

OBJECTIVES/HYPOTHESIS: As cochlear implantation increases, surgeons are noting possible anatomical differences in pediatric population. Outcome objectives were to study pediatric temporal bone anatomy using high-resolution temporal bone imaging, and analyze the anatomical differences in group 1 (<12 months) versus group 2 (1-4 years) versus group 3 (5-10 years) versus group 4 (10-18 years). STUDY DESIGN: Retrospective chart and radiologic review. METHODS: A retrospective chart and radiologic review of pediatric patients undergoing high-resolution computer tomography of the temporal bones from April 2001 to February 2013 was conducted. Scans were reviewed to record the transmastoid angle and transcanal angle. RESULTS: Seven hundred fifty patients were identified. A total of 1,426 ears were reviewed. The age range was 8 days to 21 years. Of the patients, 57.0% (n = 407) were male. The patients were divided into four groups: group 1 (<12 months), group 2 (1-4 years), group 3 (5-10 years), and group 4 (10-18 years). The transmastoid angle was observed to have variability. Significant differences were observed between groups 2 and 3 (P = .0028) and groups 2 and 4 (P = .0432). Analysis on the transcanal angle was performed. Significant differences existed between age groups 1 and 3 (P = .0150), groups 1 and 4 (P = .0038), and groups 2 and 4 (P = .0358). CONCLUSIONS: Considerable variation exists in pediatric temporal bones. The largest difference in the transmastoid angle was seen in children aged 1 to 4 years. The largest variability in the transcanal angle is between the infant (<12 months) and children >4 years of age. These differences are surgically relevant for round window identification and facial nerve safety during cochlear implant surgery in infants.

Contrast media in breast imaging.

Although mammography is the standard imaging modality for detection of breast cancer, magnetic resonance (MR) imaging is a valuable adjunct and, in certain cases, is the imaging of choice. Contrast-enhanced breast MR imaging provides a noninvasive means of staging disease, assessing posttreatment response, and screening of high-risk patients with genetic predispositions. Additional indications for MR mammography include lesion characterization, contralateral breast evaluation in patients with proved malignancy, and identifying primary malignancy in patients with axillary nodal disease. There are several competing factors that influence the quality of the study. Finding the right balance is the key to providing high-quality images that can be accurately interpreted.