Identification of Disparities in Personalized Cancer Care—A Joint Approach of the German WERA Consortium

(1) Background: molecular tumor boards (MTBs) are crucial instruments for discussing and allocating targeted therapies to suitable cancer patients based on genetic findings. Currently, limited evidence is available regarding the regional impact and the outreach component of MTBs; (2) Methods: we analyzed MTB patient data from four neighboring Bavarian tertiary care oncology centers in Würzburg, Erlangen, Regensburg, and Augsburg, together constituting the WERA Alliance. Absolute patient numbers and regional distribution across the WERA-wide catchment area were weighted with local population densities; (3) Results: the highest MTB patient numbers were found close to the four cancer centers. However, peaks in absolute patient numbers were also detected in more distant and rural areas. Moreover, weighting absolute numbers with local population density allowed for identifying so-called white spots—regions within our catchment that were relatively underrepresented in WERA MTBs; (4) Conclusions: investigating patient data from four neighboring cancer centers, we comprehensively assessed the regional impact of our MTBs. The results confirmed the success of existing collaborative structures with our regional partners. Additionally, our results help identifying potential white spots in providing precision oncology and help establishing a joint WERA-wide outreach strategy

(Table 1) Sound velocity, wet-bulk density, and acoustic impedance of some indurated sediment from DSDP Leg 64 Holes

The Pliocene-Quaternary sediments that we drilled at eight sites in the Gulf of California consist of silty clays to clayey silts, diatomaceous oozes, and mixtures of both types. In this chapter I have summarized various measurements of their physical properties, relating this information to burial depth and effective overburden pressure. Rapid deposition and frequent intercalations of mud turbidites may cause underconsolidation in some cases; overconsolidation probably can be excluded. General lithification begins at depths between 200 and 300 meters sub-bottom, at porosities between 55 and 60% (for silty clays) and as high as 70% (for diatomaceous ooze). Diatom-rich sediments have low strength and very high porosities (70-90%) and can maintain this state to a depth of nearly 400 meters (where the overburden pressure = 1.4 MPa). The field compressibility curves of all sites are compared to data published earlier. Where sediments are affected by basaltic sills, these curves clearly show the effects of additional loading and thermal stress (diagenesis near the contacts). Strength measurements on well-preserved hydraulic piston cores yielded results similar to those obtained on selected samples from standard drilling. Volumetric shrinkage dropped to low values at 100 to 400 meters burial depth (0.3 to 2.0 MPa overburden pressure). Porosity after shrinkage depends on the composition of sediments

Zusammensetzung, Gefüge und mechanische Eigenschaften rezenter Sedimente vom Nildata, Roten Meer und Golf von Aden

The study of textural, structural, chemical, and physical properties of fine-grained recent marine sediments leads to the conclusion that only a few compositional factors are responsible for significant changes in mass physical characteristics in the upper meters below sea bottom. Fossil-induced porosity (text fig. 6) increases water content and liquid limit. It also seems to have partially influenced the plastic limit and plasticity index of calcareous sandy silts from the Red Sea and the western Gulf of Aden so that they become similar to the montmorillonite rich prodelta clays from the Nile Delta. Diagrams based on liquid limit and plasticity loose their original meaning in these cases (text fig. 7 a). Activity of sediments rich in microorganisms can be higher than that of montmorillonitic clay (text fig. 7b). The shear strength-depth relationship of normally consolidated sediments (text fig. 8 a) is surprisingly little influenced by changes in sand or clay content and clay mineralogy. Only high lime content, submarine erosion and beginning cementation increase the strength considerably (part of curves in text fig. 8 b ). Erosional disconformities near the present surface can be deduced from the strength-depth curve when as little as 1 or 2 m sediment have been removed (text fig. 9). Flat or irregular strength-depth curves (text fig. 8 b, curves B and GO) indicate beginning cementation and probably discontinuous sedimentation, provided the composition of the material remains in some degree constant. In our samples diagenetic pyrite, but no recristallisation of carbonates could be detected under the microscope. Underconsolidation and excess pore-water pressure, factors which tend to foster submarine slides, mud lumps, and diapiric folding, seem to be restricted to areas with mainly rapidly deposited, homogeneous or layered sediments. But where an abundance of burrowing organisms increases the vertical permeability of the sediment, normal consolidation and stable deposits are to be expected, at least in the upper meters below the present surface. According to 14C-determinations on calcareous microorganisms the rate of deposition of the investigated sediments seems to range from 26 to 167 cm per 1000 years

Sedimentary processes at the entrance Gulf of Aden / Red Sea

Coastal and shallow water biogenic carbonate and detrital silicate near Bab el Mandeb are transported northward by surface currents until they are trapped by the central channel and carried southward into the northwestern Gulf of Aden. Here, the highest sedimentation rate with more than 50 cm carbonate and 50 cm silicate per 1000 years is found. On the narrow shelves widespread shell beds, calcareous crusts, and "mummies" with sessile fauna demonstrate intermittent deposition. The floor of the channel is devoid of sediments or covered with gravel and sand. A living in situ sessile and burrowing fauna as well as displaced shallow water organisms and Pleistocene (?) relict sediments have also been observed here down to watet depths greater than 500 m. Increasing grain size with depth on the channel slope indicates a current velodty profile at extreme conditions different from that measured by oceanographers. With some exceptions corals and bryozoans are the most important (by weight) carbonate producing organisms of beach, shelf, and channel sands. Heavy minerals from the hinterland of the African and Arabian coasts are mixed and frequently reworked in the channels in the same mannet as the biogenic constituents. Crevasses paralleling a channel in the western Gulf of Aden as well as the range of the South Arabian heavy mineral province indicate young tectonic movements. A simplified model may help to interpret andent sediments of similar environment (Text-figs. 18 b and c)

Description of recent sediments of Nile Delta, Red Sea and Gulf of Aden (Table 1-3)

The study of textural, structural, chemical, and physical properties of fine-grained recent marine sediments leads to the conclusion that only a few compositional factors are responsible for significant changes in mass physical characteristics in the upper meters below sea bottom. Fossil-induced porosity increases water content and liquid limit. It also seems to have partially influenced the plastic limit and plasticity index of calcareous sandy silts from the Red Sea and the western Gulf of Aden so that they become similar to the montmorillonite rich prodelta clays from the Nile Delta. Diagrams based on liquid limit and plasticity loose their original meaning in these cases. Activity of sediments rich in microorganisms can be higher than that of montmorillonitic clay. The shear strength-depth relationship of normally consolidated sediments is surprisingly little influenced by changes in sand or clay content and clay mineralogy. Only high lime content, submarine erosion and beginning cementation increase the strength considerably. Erosional disconformities near the present surface can be deduced from the strength-depth curve when as little as 1 or 2 m sediment have been removed. Flat or irregular strength-depth curves indicate beginning cementation and probably discontinuous sedimentation, provided the composition of the material remains in some degree constant. In our samples diagenetic pyrite, but no recristallisation of carbonates could be detected under the microscope. Underconsolidation and excess pore-water pressure, factors which tend to foster submarine slides, mud lumps, and diapiric folding, seem to be restricted Varito areas with mainly rapidly deposited, homogeneous or layered sediments. But where an abundance of burrowing organisms increases the vertical permeability of the sediment, normal consolidation and stable deposits are to be expected, at least in the upper meters below the present surface. According to 14C-determinations on calcareous microorganisms the rate of deposition of the investigated sediments seems to range from 26 to 167 cm per 1000 years

Horizontal wachsende Riffplatten am Süd-Ausgang des Roten Meeres

Am Süd-Ausgang des Roten Meeres entstehen unter idealen Wachstumsbedingungen fast reine Korallen-Saumriffe, die als dünne Platten oft kilometerweit mit einer Geschwindigkeit von Zentimetern pro Jahr auf ihrem Schutt von der Küste horizontal gegen das Meer vorwachsen. Aufgetauchte Saumrifte, ein flacher Bootskanal oder abradierte Riffoberflächen weisen auf pleistozäne und jüngere Meeresspiegelschwankungen bzw. tektonische Verstellungen hin. Von einer gewissen Breite an bilden sich auf den Riffen Inseln in Form langgestreckter Rücken aus Korallensand, hinter denen sich stellenweise Mangrove ansiedelt oder Salze in flachen Lagunen abscheiden. Schließlich kann der Strand auf das Saumriff vorverlegt und dieses in die Küstenebene einbezogen werden

Age determination of Holozene marine deposites from the western Mauritania (Table 1)

In an area regarded to be very favourable for the study of Holocene sea level changes one or several eustatic (?) oscillations of sea have been found using sedimentological and ecological methods. After a maximum of +3 m during the Nouakchottian stage (= Middle Flandrian or Late Atlantic) about 5500 YBP a drop of sea to -3.5 ± 0.5 m about 4100 YBP is testified by stromatolitic algae indicating the former sea level within the tidal zone with high accuracy. This evidence is supported by the observation of post-Nouakchottian regressive and transgressive geologic sequences, by buried beach deposits and flooded hardgrounds, post-Nouakchottian marine terraces of different height and age, the cutting off of one large and several small bays from the open sea etc. Possibly, one or two smaller oscillations followed between 4000 and 1500 years B. P. The radiocarbon age of the marine shells dated may be partly somewhat too old or too young