Cancer Demographics and Time-to-Care in Belize.

BACKGROUND: Belize is a middle-income Caribbean country with poorly described cancer epidemiology and no comprehensive cancer care capacity. In 2018, GO, Inc., a US-based NGO, partnered with the Ministry of Health and the national hospital in Belize City to create the first public oncology clinic in the country. Here, we report demographics from the clinic and describe time intervals to care milestones to allow for public health targeting of gaps. PATIENTS AND METHODS: Using paper charts and a mobile health platform, we performed a retrospective chart review at the Karl Heusner Memorial Hospital (KHMH) clinic from 2018 to 2022. RESULTS: During this time period, 465 patients with cancer presented to the clinic. Breast cancer (28%) and cervical cancer (12%) were most common. Most patients (68%) presented with stage 3 or 4 disease and were uninsured (78%) and unemployed (79%). Only 21% of patients ever started curative intent treatment. Median time from patient-reported symptoms to a biopsy or treatment was 130 and 189 days. For the most common cancer, breast, similar times were seen at 140 and 178 days. Time intervals at the clinic: <30 days from initial visit to biopsy (if not previously performed) and <30 days to starting chemotherapy. CONCLUSION: This study reports the first clinic-based cancer statistics for Belize. Many patients have months between symptom onset and treatment. In this setting, the clinic has built infrastructure allowing for minimal delays in care despite an underserved population. This further affirms the need for infrastructure investment and early detection programs to improve outcomes in Belize.

Dissection of the Burkholderia intracellular life cycle using a photothermal nanoblade.

Burkholderia pseudomallei and Burkholderia thailandensis are related pathogens that invade a variety of cell types, replicate in the cytoplasm, and spread to nearby cells. We have investigated temporal and spatial requirements for virulence determinants in the intracellular life cycle, using genetic dissection and photothermal nanoblade delivery, which allows efficient placement of bacterium-sized cargo into the cytoplasm of mammalian cells. The conserved Bsa type III secretion system (T3SS(Bsa)) is dispensable for invasion, but is essential for escape from primary endosomes. By nanoblade delivery of B. thailandensis we demonstrate that all subsequent events in intercellular spread occur independently of T3SS(Bsa) activity. Although intracellular movement was essential for cell-cell spread by B. pseudomallei and B. thailandensis, neither BimA-mediated actin polymerization nor the formation of membrane protrusions containing bacteria was required for B. thailandensis. Surprisingly, the cryptic (fla2) flagellar system encoded on chromosome 2 of B. thailandensis supported rapid intracellular motility and efficient cell-cell spread. Plaque formation by both pathogens was dependent on the activity of a type VI secretion system (T6SS-1) that functions downstream from T3SS(Bsa)-mediated endosome escape. A remarkable feature of Burkholderia is their ability to induce the formation of multinucleate giant cells (MNGCs) in multiple cell types. By infection and nanoblade delivery, we observed complete correspondence between mutant phenotypes in assays for cell fusion and plaque formation, and time-course studies showed that plaque formation represents MNGC death. Our data suggest that the primary means for intercellular spread involves cell fusion, as opposed to pseudopod engulfment and bacterial escape from double-membrane vacuoles.

Factors affecting nutrient solubilization from sewage sludge using microwave-enhanced advanced oxidation process.

A microwave-enhanced advanced oxidation process using hydrogen peroxide (MW-H2O2-AOP) was used for the solubilization of phosphate and ammonia from secondary municipal sludge. Two sets of experiments were performed to determine the factors affecting nutrient solubilization from sewage sludge. Four factors--microwave heating temperature, heating time, hydrogen peroxide treatment, and sulphuric acid treatment--were incorporated into a screening design to determine which factors were significant for maximizing nutrient solubilization. For phosphorus, the three most significant factors, following the order of significance, were (i) microwave heating temperature, (ii) the combined effect of microwave heating temperature and hydrogen peroxide hydrogen peroxide addition, (iii) microwave heating temperature, and (iv) sulphuric acid addition.

Sludge reduction and volatile fatty acid recovery using microwave advanced oxidation process.

Sewage sludge was subjected to the combined microwave-hydrogen peroxide-sulfuric acid enhanced advanced oxidation process (MW-H(2)O(2)-H(+)-AOP) to evaluate the potential of reducing suspended solids in sludge. The soluble chemical oxygen demand (SCOD) and acetic acid produced were dependent on the amounts of H(2)O(2) and acid used in the process. For sewage sludge, a higher volume of H(2)O(2) addition not only favored the destruction of sludge solids, but also conserved the carbon content in the medium. Volatile fatty acid (VFA) concentrations also increased with the amount of inorganic acid in the solution. For the soluble fraction of solutions derived from microwave-treated sludge, over 96% of the total COD was in the soluble form, and up to 25% of this soluble COD was acetic acid. The presence of an inorganic acid was a stability factor in retaining the SCOD in solution, instead of the formation of carbon dioxide, resulting in reduced total COD in the solutions. By controlling the amounts of H(2)O(2) and acid addition, the MW-H(2)O(2)-H(+)-AOP could solubilize and/or reduce the sludge mass.

Sewage sludge nutrient solubilization using a single-stage microwave treatment.

The effects of an advanced oxidation process combining microwave, hydrogen peroxide and acid hydrolysis in a single stage (MW/H2O2/H+ -AOP) on the process efficiency of sewage sludge treatment and nutrient recovery were investigated. At lower temperature regimes (60-80 degrees C), the soluble phosphate was substantially higher in a two-stage process than in a single stage MW/H2O2/H+ -AOP process. However, higher soluble phosphate concentration was obtained for single-stage treatment at the higher operating temperature regimes (100-120 degrees C). With the addition of an inorganic acid, a very high yield of soluble phosphate was obtained in the solution at 120 degrees C. In tests with acid addition, soluble ammonia increased as temperature increased. For single stage MW/H2O2/H+ -AOP, maximum soluble ammonia was obtained at 120 degrees C. Significant concentrations of soluble COD were also obtained in this treatment. A threshold temperature of 80 degrees C was observed, at which all of the COD could be solubilized. However, at higher temperatures (100-120 degrees C), further oxidation processes occurred to form carbon dioxide, resulting in decreased amounts of soluble COD in the solution.

A hydrogen peroxide/ microwave advanced oxidation process for sewage sludge treatment.

This study focused on the efficacy of the microwave/hydrogen peroxide advanced oxidation process (MW/H2O2-AOP) on the secondary sludge treatment. The results indicated that at temperatures of 80 degrees C and above, essentially all of the chemical oxygen demand (COD) was solubilized by the combined MW/H2O2-AOP. This process also solubilized nutrients (nitrogen, phosphorus and metals) from sludge which can be extracted for other purposes, such as struvite crystallization. Based on a stoichiometric molar ratio of 1:1:1 for Mg:NH3:PO4, ammonia was found to be the limiting nutrient without any H2O2 addition in the process at all temperatures. With the addition of H2O2, ortho-phosphate became the limiting nutrient. In all treatments, magnesium was non-limiting, thus magnesium addition is not required for subsequent struvite crystallization. The MW/H2O2-AOP also enhanced the pasteurization or sterilization of sludge. The MW/H2O2-AOP provides novel sludge management options for the wastewater industry, not only in solubilization of carbon for further methane production, but also in nutrients extraction for crystallization for use as fertilizer.

Advanced oxidation process using hydrogen peroxide/microwave system for solubilization of phosphate.

An advanced oxidation process (AOP) combining hydrogen peroxide and microwave heating was used for the solubilization of phosphate from secondary municipal sludge from an enhanced biological phosphorus removal process. The microwave irradiation is used as a generator agent of oxidizing radicals as well as a heating source in the process. This AOP process could facilitate the release of a large amount of the sludge-bound phosphorus from the sewage sludge. More than 84% of the total phosphorous could be released at a microwave heating time of 5 min at 170 degrees C. This innovative process has the potential of being applied to simple sludge treatment processes in domestic wastewater treatment and to the recovery of phosphorus from the wastewater.