Geographic Accessibility and Availability of Radiotherapy in Ghana.

Importance: Radiotherapy is critical for comprehensive cancer care, but there are large gaps in access. Within Ghana, data on radiotherapy availability and on the relationship between distance and access are unknown. Objectives: To estimate the gaps in radiotherapy machine availability in Ghana and to describe the association between distance and access to care. Design, Setting, and Participants: This is a cross-sectional, population-based study of radiotherapy delivery in Ghana in 2020 and model-based analysis of radiotherapy demand and the radiotherapy utilization rate (RUR) using the Global Task Force on Radiotherapy for Cancer Control investment framework. Exposures: Receipt of radiotherapy and the number of radiotherapy courses delivered. Main Outcomes and Measures: Geocoded location of patients receiving external beam radiotherapy (EBRT); median Euclidean distance from the district centroids to the nearest radiotherapy centers; proportion of population living within geographic buffer zones of 100, 150, and 200 km; additional capacity required for optimal utilization; and geographic accessibility after strategic location of a radiotherapy facility in an underserviced region. Results: A total of 2883 patients underwent EBRT courses in 2020, with an actual RUR of 11%. Based on an optimal RUR of 48%, 11 524 patients had an indication for radiotherapy, indicating that only 23% of patients received treatment. An investment of 23 additional EBRT machines would be required to meet demand. The median Euclidean distance from the district centroids to the nearest radiotherapy facility was 110.6 km (range, 0.62-513.2 km). The proportion of the total population living within a radius of 100, 150 and 200 km of a radiotherapy facility was 47%, 61% and 70%, respectively. A new radiotherapy facility in the northern regional capital would reduce the median of Euclidean distance by 10% to 99.4 km (range, 0.62-267.7 km) and increase proportion of the total population living within a radius of 100, 150 and 200 km to 53%, 69% and 84%, respectively. The greatest benefit was seen in regions in the northern half of Ghana. Conclusions and Relevance: In this cross-sectional study of geographic accessibility and availability of radiotherapy, Ghana had major national deficits of radiotherapy capacity, with significant geographic disparities among regions. Well-planned infrastructure scale-up that accounts for the population distribution could improve radiotherapy accessibility.

Radiotherapy resources in Africa: an International Atomic Energy Agency update and analysis of projected needs.

The number of patients with cancer in Africa has been predicted to increase from 844 279 in 2012 to more than 1·5 million in 2030. However, many countries in Africa still lack access to radiotherapy as a part of comprehensive cancer care. The objective of this analysis is to present an updated overview of radiotherapy resources in Africa and to analyse the gaps and needs of the continent for 2030 in the context of the UN Sustainable Development Goals. Data from 54 African countries on teletherapy megavoltage units and brachytherapy afterloaders were extracted from the Directory for Radiotherapy Centres, an electronic, centralised, and continuously updated database of radiotherapy centres. Cancer incidence and future predictions were taken from the GLOBOCAN 2018 database of the International Agency for Research on Cancer. Radiotherapy need was estimated using a 64% radiotherapy utilisation rate, while assuming a machine throughput of 500 patients per year. As of March, 2020, 28 (52%) of 54 countries had access to external beam radiotherapy, 21 (39%) had brachytherapy capacity, and no country had a capacity that matched the estimated treatment need. Median income was an important predictor of the availability of megavoltage machines: US$1883 (IQR 914-3269) in countries without any machines versus $4485 (3079-12480) in countries with at least one megavoltage machine (p=0·0003). If radiotherapy expansion continues at the rate observed over the past 7 years, it is unlikely that the continent will meet its radiotherapy needs. This access gap might impact the ability to achieve the Sustainable Development Goals, particularly the target to reduce preventable, premature mortality by a third, and meet the target of the cervical cancer elimination strategy of 90% with access to treatment. Urgent, novel initiatives in financing and human capacity building are needed to change the trajectory and provide comprehensive cancer care to patients in Africa in the next decade.

Respiration parameters determined by the ISO-17155 method as potential indicators of copper pollution in vineyard soils after long-term fungicide treatment.

This study seeks to determine the impact of copper-based fungicides on the respiration of vineyard soils. The ISO-17155 is an international standard recommended for monitoring soil quality by the evaluation of the effects of pollutants on soil microbial activity. Respiration curves and derived parameters [i.e., basal respiration (RB), substrate-induced respiration (RS), lag time (tlag), growth rate (µ), time to the peak maximum (tpeakmax), respiratory-activation quotient (QR), and the cumulative O2 consumption (CR)] were determined from 95 vineyard soils that covered a wide range of Cu contents. Statistical analyses showed that most of the variance of the ISO-17155 parameters was due to soil pH and organic C content, but not to the Cu pollution. When the parameters were expressed as a function of soil organic C content, the effect of soil Cu content was found to be significant on RS and tpeakmax but not on RB and CR. The results indicated that threshold values of total (CuT) and exchangeable (CuEX) contents indicative of soil Cu pollution cannot be established. However, adequate management practices resulting in soil organic C contents>2% and pH>5.5 are recommended for preserving vineyard soil quality.

Greenhouse evaluation of struvite and sludges from municipal wastewater treatment works as phosphorus sources for plants.

Sewage sludge obtained by a conventional aerobic activated sludge process (CSS), P-rich sewage sludge from an enhanced biological P removal process (PRS), and struvite (MgNH 4PO 4 x 6H 2O) recovered from an anaerobic digester supernatant using a low-grade MgO byproduct from the calcination of natural magnesite as a Mg source (STR) were evaluated as P sources for plant growth. For this purpose, a greenhouse pot experiment was conducted using a P-deficient loamy sand soil and perennial ryegrass ( Lolium perenne L.) as the test crop. The P sources were applied at rates equivalent to 0, 9, 17, 26, 34, and 44 mg/kg P. Single superphosphate (SUP) was used as reference for comparison with the other P sources. The results obtained indicated that STR was as effective as SUP in increasing the dry matter yield and supplying P to ryegrass. Compared to SUP and STR, PRS and especially CSS exhibited less agronomic effectiveness as P sources, which may be attributed, at least partially, to greater soil P fixation because of the larger amount of Fe incorporated with these materials.

Effect of water deficit on microbial characteristics in soil amended with sewage sludge or inorganic fertilizer under laboratory conditions.

The potential impact of different types of organic (sewage sludge) or inorganic (mineral fertilizer) amendments to a basic soil was investigated under dry conditions. A soil incubation experiment was carried out over 64 days; there were two fertility treatments: sewage sludge (SS) (140 t ha(-1)), mineral fertilizer (M) and an unamended control (C). Two levels of irrigation were imposed: (1) well-watered, kept at 60% of its water holding capacity, and (2) water-deficit at 6%. Available N-NO3-, N-NH4+ and P, and electrical conductivity (EC) increased in SS and M-treated soils. Under well-watered conditions activities of some enzymes (protease-BAA, phosphatase and beta-glucosidase), and microbiological properties (microbial biomass carbon, basal respiration and dehydrogenase activity) were stimulated in SS-treated soils. Under water-deficit conditions, protease-BAA, phosphatase and beta-glucosidase activities, and basal respiration were more reduced in SS than in C and M. Results showed that under severe dry conditions, soil microbial activity always remained higher in organic amended soils than when mineral fertilizer was added.

Acid-base properties of humic and fulvic acids formed during composting.

The soil acid-base buffering capacity and the biological availability, mobilization, and transport of macro- and micronutrients, toxic metal ions, and xenobiotic organic cations in soil are strongly influenced by the acid-base properties of humic substances, of which humic and fulvic acids are the major fractions. For these reasons, the proton binding behavior of the humic acid-like (HA) and fulvic acid-like (FA) fractions contained in a compost are believed to be instrumental in its successful performance in soil. In this work, the acid-base properties of the HAs and FAs isolated from a mixture of the sludge residue obtained from olive oil mill wastewater (OMW) evaporated in an open-air pond and tree cuttings (TC) at different stages of composting were investigated by a current potentiometric titration method and the nonideal competitive adsorption (NICA)-Donnan model. The NICA-Donnan model provided an excellent description of the acid-base titration data, and pointed out substantial differences in site density and proton-binding affinity between the HAs and FAs examined. With respect to FAs, HAs were characterized by a smaller content of carboxylic- and phenolic-type groups and their larger affinities for proton binding. Further, HAs featured a greater heterogeneity in carboxylic-type groups than FAs. The composting process increased the content and decreased the proton affinity of carboxylic- and phenolic-type groups of HAs and FAs, and increased the heterogeneity of phenolic-type groups of HAs. As a whole, these effects indicated that the composting process could produce HA and FA fractions with greater cation binding capacities. These results suggest that composting of organic materials improves their agronomic and environmental value by increasing their potential to retain and exchange macro- and micronutrients, and to reduce the bioavailability of organic and inorganic pollutants.