An assessment of childhood cancer care services in India - gaps, challenges and the way forward.

Background: Childhood cancers are emerging as an essential concern in India where there is lack of a specific programme component or policy to address childhood cancer control. There is limited information on the status and quality of childhood cancer care services in India. This paper describes the childhood cancer care services available at secondary and tertiary-level hospitals in India through a cross sectional study design. Methods: The survey was conducted in 137 tertiary-level and 92 secondary-level hospitals in 26 states and 4 Union Territories (UTs), ensuring a uniform representation of public and private care hospitals. The study tool collected data on the organisational infrastructure, type of oncology services, health workforce, equipment, treatment and referral protocols, and treatment guidelines. Descriptive statistics was used to primarily present the health service status and data on childhood cancer care services in proportions and mean. Findings: A dedicated pediatric oncology department was available in 41.6% of the public, 48.6% of private, and 64% Non Government Organization (NGO) managed tertiary-level hospitals. In 36 (39%) of the 92 hospitals providing secondary care, childhood cancer care was provided. The availability of bone (41.5%) and positron emission tomography (PET) scans (25.9%) was lower in public tertiary hospitals, whereas histopathology, computerised tomography (CT scan), and magnetic resonance imaging (MRI) were lower in public secondary hospitals than private and NGO managed hospitals for the corresponding level of care. Most tertiary hospitals had the required supportive care facilities except for play therapy and hospice care. Less than 50% of the public tertiary hospitals had stocks of the four categories of cancer-treating drugs and essential infrastructure for radiotherapy and chemotherapy. Most secondary-level hospitals not treating childhood cancer had referral linkages with tertiary hospitals. Interpretation: The situational analysis of childhood cancer care services in India showed the concentration of availability of childhood cancer care services at the tertiary level of health care. There were gaps in the availability of specialised pediatric oncology care in all the tertiary hospitals. The availability of childhood cancer care services was higher in private and NGO-managed hospitals than in public hospitals. Integration of childhood cancer as a part of the national cancer control response should be taken up as a matter of priority. The need of the hour is to formulate a childhood cancer policy that will enable timely access to care universally. Funding: World Health Organization, India provided funding and technical support.

Blending of microbial inocula: An effective strategy for performance enhancement of clayware Biophotovoltaics microbial fuel cells.

Performance of clayware Biophotovoltaics (BPVs) with three variants of inocula namely anoxygenic photosynthetic bacteria (APB) rich Effective microbes (EM), Up-flow anaerobic sludge blanket reactor (UASB) sludge, SUPER-MIX the blend of EM and UASB inoculum were evaluated on the basis of electrical output and pollutant removal. SUPER-MIX inocula with microbial community comprising of 28.42% APB and 71.58% of other microbes resulted in peak power density of 275 mW/m2, 69.3 ± 1.74% Coulombic efficiency and 91 ± 3.96% organic matter removal. The higher performance of the SUPER-MIX than EM and UASB inocula was due to the syntrophic associations of the various APBs and other heterogenous microorganisms in perfect blend which improved biocatalytic electron transfer, electro-kinetic activities with higher redox current and bio-capacitance. The promising performance of clayware BPVs with SUPER-MIX inocula indicate the possibility of BPVs to move towards the scale-up process to minimize the investment towards pure culture by effective blending strategies of inocula.

Validity and Reliability of Tamil translated University of Washington Quality of Life Questionnaire for Head and Neck Cancers.

BACKGROUND: Quality of life is an important outcome measure used both in research and patient care across all cultural healthcare settings. OBJECTIVE: This study is aimed to evaluate the validity and reliability of interviewer-administered Tamil translated University of Washington Quality of Life Questionnaire (Version 4) in a setting with low literacy. METHODS: The study was done in a tertiary care teaching institute in Puducherry, South India. The translation was done by using 'forward-backward translation method.' A hundred subjects diagnosed with head and neck cancer (HNC) were interviewed before the initiation of treatment. The Tamil version of University of Washington Quality of Life Questionnaire (UWQOL) questionnaire was validated using the Tamil version of the World Health Organization Quality of Life-Brief questionnaire (WHOQOL-BREF) version. Inter-rater reliability and test-retest reliability was also assessed. Item-total correlation and Cronbach alpha were calculated for assessing validity and internal consistency respectively. RESULTS: In the Tamil version of UWQOL, social-emotional subscale was more affected than physical subscale. The domains such as mood, anxiety, and pain were most affected. The subscale scores were significantly different between those with early and late cancer. Tamil version of UWQOL showed moderate correlation with WHOQOL-BREF. The Tamil version of UWQOL had good test-retest and inter-rater agreement. Item-total correlation for the subscales was >0.80. The internal consistency of the Tamil Questionnaire was acceptable with Cronbach Alpha of 0.69. CONCLUSION: The Tamil version of UWQOL questionnaire is a short, valid and reliable for HNC patients of low literacy.

Adverse drug reaction profile of cisplatin-based chemotherapy regimen in a tertiary care hospital in India: An evaluative study.

AIMS: This prospective study was designed to monitor and analyze the pattern of occurrence of adverse drug reactions (ADRs) to cisplatin-based chemotherapy regimen in the cancer ward of a tertiary care hospital. MATERIALS AND METHODS: Cancer patients who received cisplatin-based cancer chemotherapy were monitored for adverse reactions. The collected reports were analyzed for demographic and drug details, causality, preventability and severity of adverse effects. Causality was assessed by the World Health Organization (WHO) causality assessment scale and Naranjo's Algorithm. Preventability and severity of ADRs were assessed by modified Schumock and Thornton scale, modified Hartwig and Siegel scale respectively. RESULTS: Among 51 patients, 48 developed ADRs to cisplatin chemotherapy. The reactions observed were nausea, alopecia, anorexia, vomiting, taste alteration, diarrhea, constipation, tinnitus, and hypocalcaemia. The WHO causality assessment scale indicated 69% "possible" and 31% "probable" but no "certain" reactions. Naranjo's Algorithm showed 62% "probable" and 38% "possible" reactions. Most of the reactions belonged to the category of "not preventable". Reactions like nausea and vomiting belonged to the category of "definitely preventable". Modified Hartwig and Siegel scale of severity assessment showed that most of the reactions were of "mild level 1" severity except for vomiting, diarrhea and hypocalcaemia, which were of "moderate level 3" severity. CONCLUSION: Cisplatin-based chemotherapy has a high potential to cause adverse effects. Most of the reactions were of milder nature but not preventable. The common adverse effects such as nausea and vomiting were preventable, but reactions like hypersensitivity reactions and anaphylaxis were not predictable.

Effects of temperature and emulsifier concentration on alpha-tocopherol distribution in a stirred, fluid, emulsion. Thermodynamics of alpha-tocopherol transfer between the oil and interfacial regions.

The combined linear sweep voltammetry (LSV)/pseudophase kinetic model method was used to obtain the first estimates of the free energies, enthalpy, and entropies of transfer of alpha-tocopherol (TOC) between the oil and interfacial regions of fluid, opaque, emulsions of n-octane, acidic water, and the nonionic surfactant hexaethyleneglycol mono dodecyl ether (C12E6) from the temperature dependence of TOC's partition constant. Determining structure-reactivity relationships for chemical reactions in emulsions is difficult because traditional methods for monitoring reactions are unsuitable and because the partitioning of reactive components between the oil, interfacial, and aqueous regions of opaque emulsions are difficult to measure. The dependence of the observed rate constant, k(obs), for the reaction of an arenediazonium probe, 16-ArN2+, with TOC was determined as a function of C12E6 volume fraction. The pseudophase kinetic model was used to estimate the interfacial rate constant, k1, and the partition constants of antioxidants between the oil and interfacial, Po(I), regions in the emulsion from k(obs) versus phiI profiles. The thermodynamic parameters of transfer from the oil to the interfacial region at a series of temperatures were respectively obtained from the PoI values (deltaGT0,O-->I), by the van't Hoff method (deltaHT0,O-->I), and from the Gibbs equation (deltaST0,O-->I). The free energy of transfer is spontaneous, and a large positive entropy of transfer dominates a positive enthalpy of transfer, indicating that the TOC headgroup disrupts the structure of the interfacial region in its immediate vicinity upon transfer from n-octane. The methods described here are applicable to any bimolecular reaction in emulsions in which one of the reactants is restricted to the interfacial region and the rate of its reaction with a second component can be monitored electrochemically.

Quantitative determination of alpha-tocopherol distribution in a tributyrin/Brij 30/water model food emulsion.

Until recently, determining the distribution of antioxidants, AOs, between the oil, interfacial and aqueous regions of opaque emulsions has not worked well because the concentrations of AOs in interfacial regions cannot be determined separately from their concentrations in the oil and water phases. However, our novel kinetic method based on the reaction between an arenediazonium ion and vitamin E, or alpha-tocopherol, provides the first good estimates for the two partition constants that describe alpha-tocopherol distribution between the oil/interfacial and water/interfacial regions of tributyrin/Brij 30/water emulsions without physical isolation of any phase. The reaction is monitored by a new derivatization method based on trapping unreacted arenediazonium ion as an azo dye and confirmed by linear sweep voltammetry, LSV. The results by both derivatization and LSV methods are in good agreement and show that alpha-tocopherol distributes strongly in favor of the interfacial region when the oil is tributyrin, e.g., ca. 90% when the surfactant volume fraction is Phi I=0.01. The second-order rate constant for reaction in the interfacial region is also obtained from the results. Our kinetic method provides a robust approach for determining antioxidant distributions in emulsions and should help develop a quantitative interpretation of antioxidant efficiency in emulsions.

Determining alpha-tocopherol distributions between the oil, water, and interfacial regions of macroemulsions: novel applications of electroanalytical chemistry and the pseudophase kinetic model.

The assumptions of the pseudophase model for chemical reactivity in homogeneous microemulsions are used to determine the distribution of alpha-tocopherol (TOC) in macroemulsions from changes in the observed rate constant (k(obs)) for reaction between 4-hexadecylarenediazonium ion (16-ArN2+) probe and TOC with increasing surfactant concentration. Two partition constants are needed to describe the distribution of TOC or other antioxidant (AO) or polar uncharged molecule between the oil and interfacial (P(O)(I)) and the water and interfacial (P(W)(I)) regions of stirred fluid emulsions. The observed rate constants are measured electrochemically. Here we report values of P(O)(I) and P(W)(I) for the distribution of TOC in octane/acidic water/C12E6 (hexaethylene glycol monododecyl ether) and octane/acidic water/C12E4 (Brij 30, tetraethylene glycol dodecyl ether) emulsions obtained by fitting two kinetic data sets with an equation based on the pseudophase model and solving two equations in two unknowns. The partition constants were used to estimate the %TOC in each region of the emulsions. In 1:1 oil:water C12E6 emulsions, at 2% volume fraction of C12E6, 73% of TOC is in the interfacial region, 26% in the octane and about 1% in the water. The distributions of TOC in C12E4 emulsions are similar. The combined electrochemical-pseudophase model approach is applicable to any AO or other compound that reacts with 16-ArN2+. The second-order rate constant, k(I), for reaction in the interfacial region of the emulsions is also estimated from the kinetic data and is about the same for both surfactants (k(I) approximately 0.1-0.2 M(-1)s(-1)) showing that the medium properties of the interfacial regions of C12E6 and C12E4 emulsions are similar. Comparison of these rate constants for a variety of AOs may provide a scale of AO efficiency that is independent of AO distribution between the oil, interfacial and aqueous regions of emulsions.

Determining partition constants of polar organic molecules between the oil/interfacial and water/interfacial regions in emulsions: a combined electrochemical and spectrometric method.

We have developed a new approach for estimating distributions of polar additives in opaque, surfactant based, macroemulsions based on the pseudophase model for homogeneous micellar and microemulsion solutions. The distribution of a polar additive, such as an antioxidant, AO, within emulsions is expressed in terms of two partition constants, one between the oil and interfacial regions, P(O)I, and the other between the water and interfacial regions, P(W)I. To estimate values for P(O)I and P(W)I requires fitting two independent data sets with two independent mathematical relations and solving equations simultaneously for the two parameters. The experimental protocols were developed for determining the partition constants of tertbutylhydroquinone, TBHQ, in a stirred emulsion composed of octane, dilute aqueous acid, and hexaethyleneglycol monododecyl ether, C12E6. One data set was obtained by electrochemical determination of the observed rate constant, k(obs), for reaction of TBHQ with an arenediazonium ion probe as a function of C12E6 volume fraction. The second data set was obtained by determining the partition constant, P(O)W, of TBHQ between octane and water in the absence of surfactant by UV-visible spectrometry. TBHQ is almost 30 times more soluble in water than octane: P(O)W = 27.5. The values of the partition constants in the emulsion are P(O)I = 1.84 x 10(4) and P(W)I = 6.73 x 10(2). The partition constants were used to estimate the fraction of TBHQ in each region; for example, 96% of the TBHQ is located in the interfacial region at 0.02 volume fraction of C12E6. Our approach is quite general and should be applicable to any polar organic compound that reacts with the arenediazonium ion probe in emulsions composed of virtually any type of oil and surfactant. Comparisons of the rate constants for reaction of the antioxidant in the interfacial region of the emulsion, which can be obtained from the electrochemical results, may lead to a scale of antioxidant efficiency that is independent of the distribution of the antioxidant in the emulsion.

Estimation of micellization parameters of sodium dodecyl sulfate in water+1-butanol using the mixed electrolyte model for molar conductance.

The mixed electrolyte model of Shanks and Franses has been applied to estimate the critical micelle concentration, aggregation number, and counterion binding constant of sodium dodecyl sulfate in a water + 1-butanol medium from its measured conductivity data at 25 degrees C. The surface potential of the ionic micelle in this mixed solvent medium was computed by solving the nonlinear Poisson-Boltzmann equation. The standard free energy terms of micellization were also calculated. The present study confirms further the observation made in the previous studies that ionic micelles do not contribute to the ionic strength of a surfactant solution, an inference originally made by McBain and coworkers.