High- and low-sinuosity stream deposits of the Sentinel Butte Formation (Paleocene) McKenzie County, North Dakota

High-sinuosity channel deposits in the Sentinel Butte Formation occur as elongate, tabular beds of sand that fine upward from an erosional base. The sand beds contain epsilon cross-stratification, within which stratification changes upward from large-scale trough crossstratification to horizontal stratification and small-scale crossstratification, indicating upward decrease in flow regime due to accretion of laterally-migrating point bars. Inset in the sand beds are channelplug deposits that are narrow and arcuate in map view and asymmetrically trough shaped in cross-section, and consist of sandy silt and clay. Lowsinuosity channel deposits occur as elongate, trough-shaped sand beds that fine upward from a deeply-channeled base. The abundant high-angle planar eras s-stratification and horizontal stratification probably originated in transverse bars. Epsilon cross-stratification and channel plugs are absent except in one bed that is transitional to a high-sinuosity channel deposit. Silt beds, containing sandy or clayey lenses, occur in tabular beds overlying high-sinuosity-channel deposits and in wedge-shaped beds adjacent to low-sinuosity channel deposits, and are interpreted to be natural levee deposits. Silt beds become thinner and finer-grained away from channel deposits and interfinger with clay beds. Horizontal stratification, small-scale cross-stratification, distorted lamination, and climbing ripples may be present in the silt beds. Natural-levee sediment grades vertically and laterally to tabular beds of clay that contain distorted laminations, abundant plant fragments, 3nd lignite lenses, and are overlain by lignite beds. The clay and lignite beds were probably deposited in floodbasins and backswamps. Lensoidal beds of very fine sand occur in the natural levee and floodbasin deposits and are probably crevasse-splay deposits. Lensoidal sand beds contain horizontal stratification, high-angle planar cross-stratification, and small-scale cross-stratification. Paleocurrent data indicate highly variable current directions. Vertically stacked low-sinuosity channel deposits that appear to diverge downstream from high-sinuosity channel deposits may be distributaries of highly sinuous streams on a delta. The delta may have prograded into the Paleocene sea in which the marine Cannonball Formation was deposited

Implementation of a provider-focused intervention for maximizing human papillomavirus (HPV) vaccine uptake in young cancer survivors receiving follow-up care in pediatric oncology practices: Protocol for a cluster-randomized trial of the HPV PROTECT intervention

BACKGROUND: Childhood cancer survivors are at high risk for developing new cancers (such as cervical and anal cancer) caused by persistent infection with the human papillomavirus (HPV). HPV vaccination is effective in preventing the infections that lead to these cancers, but HPV vaccine uptake is low among young cancer survivors. Lack of a healthcare provider recommendation is the most common reason that cancer survivors fail to initiate the HPV vaccine. Strategies that are most successful in increasing HPV vaccine uptake in the general population focus on enhancing healthcare provider skills to effectively recommend the vaccine, and reducing barriers faced by the young people and their parents in receiving the vaccine. This study will evaluate the effectiveness and implementation of an evidence-based healthcare provider-focused intervention (HPV PROTECT) adapted for use in pediatric oncology clinics, to increase HPV vaccine uptake among cancer survivors 9 to 17 years of age. METHODS: This study uses a hybrid type 1 effectiveness-implementation approach. We will test the effectiveness of the HPV PROTECT intervention using a stepped-wedge cluster-randomized trial across a multi-state sample of pediatric oncology clinics. We will evaluate implementation (provider perspectives regarding intervention feasibility, acceptability and appropriateness in the pediatric oncology setting, provider fidelity to intervention components and change in provider HPV vaccine-related knowledge and practices [e.g., providing vaccine recommendations, identifying and reducing barriers to vaccination]) using a mixed methods approach. DISCUSSION: This multisite trial will address important gaps in knowledge relevant to the prevention of HPV-related malignancies in young cancer survivors by testing the effectiveness of an evidence-based provider-directed intervention, adapted for the pediatric oncology setting, to increase HPV vaccine initiation in young cancer survivors receiving care in pediatric oncology clinics, and by procuring information regarding intervention delivery to inform future implementation efforts. If proven effective, HPV PROTECT will be readily disseminable for testing in the larger pediatric oncology community to increase HPV vaccine uptake in cancer survivors, facilitating protection against HPV-related morbidities for this vulnerable population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04469569, prospectively registered on July 14, 2020

Examining decisional needs and contextual factors influencing fertility status assessment among young female survivors of childhood cancer: A sequential mixed methods study protocol.

IntroductionFemale cancer survivors who received gonadotoxic cancer treatment are at risk for profound diminished ovarian reserve and/or primary ovarian insufficiency with resulting infertility, which can be associated with distress and decreased quality of life.. Despite prioritizing future parenthood, many survivors are unsure of the impact of their treatment on their future fertility, and little is known about the perceived reproductive health needs and factors associated with receipt of a fertility status assessment (FSA). There is a lack of developmentally appropriate reproductive health decisional support interventions available for emerging adult cancer survivors. This study will explore the perceived reproductive health needs of emerging adult female survivors of childhood cancer and to identify decisional and contextual factors that influence pursuit of FSA using an explanatory sequential quantitative to qualitative mixed methods design.Methods and analysisThis study will enroll 325 female survivors (aged 18 to 29 years and >1-year post treatment; diagnosed with cancer < age 21 years) from four cancer centers in the United States. Sociodemographic and developmental factors, reproductive knowledge and values, decisional needs, and receipt of an FSA will be assessed through a web-based survey. Informed by survey findings, a subset of participants will be recruited for qualitative interviews to explore decisional factors associated with uptake of an FSA. Clinical data will be abstracted from the medical records. Multivariable logistic regression models will be developed to identify factors associated with FSA and qualitative descriptive analysis will be used to develop themes from the interviews. Quantitative and qualitative findings will be merged using a joint display to develop integrated study conclusions and direct future interventional research