Using large-scale dataset to identify opportunity for implementing technology based intervention to improve cancer care in India : innovation report

Cancer incidence in India is increasing, owing to a mix of risk factors such as changes in diet and lifestyle, high tobacco consumption rates and an aging and population with cancer being more common in older populations. In India, the crude cancer incidence rate increased by 28·2% from 63·4 per 100,000 in 1990 to 81·2 per 100,000 in 2016. Kerala and Mizoram had the highest rate of crude cancer incidence (figure 1) (Lancet Oncol, 2020). The age-standardised incidence rate of breast cancer in females from 1990 to 2016 increased by 39·1%, with increase observed in every state of the country. The age-standardised incidence rate of cervical cancer decreased by 39·7% in India from 1990 to 2016 (Lancet Oncol, 2020). The trends observed in the top seven cancer type-specific incidence rates in India is shown in figure 2. As per the latest National Cancer Registry Programme Report (2020) by the Indian Council of Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR) the number of cancer cases in India in 2020 was 1.39 million (100.7 per 100,000 population) (Mathur, 2020). Lung, oral cavity, stomach, and colorectal cancers are the most common cancers in men. Cancer of the breast and cervix uteri are the most common cancers in women. Lung cancer is the leading site in metropolitan cities and the southern region, whereas mouth cancer was the leading site in the West and Central regions. The highest burden of breast cancer is observed in metropolitan cities (Naik, 2021). Within India, the incidence of cancer varies dramatically based on the geographical location (north/south/northeast, rural/urban, and Ganges belt/Deccan plains). The highest rate of incidence of cancer is observed in the North-East (NE) region. The trend for crude cancer disability-adjusted life-years (DALY) rate in India shows an increase by 25·3% from 1990 to 2016. Among females, breast, cervical, and stomach cancer were responsible for the highest DALYs in 2016. The highest cancer DALYs among males in India in 2016 were due to lung cancer, followed by lip and oral cavity cancer, other pharynx cancer, and stomach cancer. (Lancet Oncol, 2020) The DALY due to different types of cancer in 2016 is provided in figure 3. As the country suffers from a lack of adequate healthcare infrastructure, there is a wider dearth of awareness on cancers and a severe scarcity of skilled human resources for cancer, hence, conventional healthcare delivery methods involving interpersonal doctor–patient interactions might not be available to most of the people in India (Golechha, 2015). Despite the introduction of government-funded schemes and cancer care facilities at the medical colleges, for the average patient with cancer in India, health care remains highly privatised, with more than 80% of outpatient care and 40% of inpatient care provided by the private sector (Thakur et al, 2011). Consequently, expenditures on private health, especially on drugs, remain very high, exacerbating health inequalities

Production of gallium - preliminary experiences of a pilot plant operation

The Madras Aluminium Company, Mettur Dam haxi put up a pilot pbnt for the extraction of gaHium from sodium aluminate liquors besed on amalgam rnecellurgy,the procea, end the engineaing chign king auppbd by Centrsl Ebctrochemiil Research Institurn, Karaikudi. The performance of the pikt plent and the raults obtaimd in the tim few mMhs of operetian are described in thii paper

Role of digital health in coordinating patient care in a hub-and-spoke hierarchy of cancer care facilities : a scoping review

Background: Coordinating cancer care is complicated due to the involvement of multiple service providers which often leads to fragmentation. The evolution of digital health has led to the development of technology-enabled models of healthcare delivery. This scoping review provides a comprehensive summary of the use of digital health in coordinating cancer care via hub-and-spoke models. Methods: A scoping review of the literature was undertaken using the framework developed by Arksey and O’Malley. Research articles published between 2010 and 2022 were retrieved from four electronic databases (PubMed/MEDLINE, Web of Sciences, Cochrane Reviews and Global Health Library). The preferred reporting items for systematic reviews and meta-analyses extension for the scoping reviews (PRISMA-ScR) checklist were followed to present the findings. Result: In total, 311 articles were found of which 7 studies that met the inclusion criteria were included. The use of videoconferencing was predominant across all the studies. The number of spokes varied across the studies ranging from 1 to 63. Three studies aimed to evaluate the impact on access to cancer care among patients, two studies were related to capacity building of the health care workers at the spoke sites, one study was based on a peer review of radiotherapy plans, and one study was related to risk assessment and patient navigation. The introduction of digital health led to reduced travel time and waiting period for patients, and standardisation of radiotherapy plans at spokes. Tele-mentoring intervention aimed at capacity-building resulted in higher confidence and increased knowledge among the spoke learners. Conclusion: There is limited evidence for the role of digital health in the hub-and-spoke design. Although all the studies have highlighted the digital components being used to coordinate care, the bottlenecks, Which were overcome during the implementation of the interventions and the impact on cancer outcomes, need to be rigorously analysed

A distributed cancer care model with a technology-driven hub-and-spoke and further spoke hierarchy : findings from a pilot implementation programme in Kerala, India

Background: The technology enabled distributed model in Kerala is based on an innovative partnership model between Karkinos Healthcare and private health centers. The model is designed to address the barriers to cancer screening by generating demand and by bringing together the private health centers and service providers at various levels to create a network for continued care. This paper describes the implementation process and presents some preliminary findings. Methods: The model follows the hub-and-spoke and further spoke framework. In the pilot phases, from July 2021 to December 2021, five private health centers (partners) collaborated with Karkinos Healthcare across two districts in Kerala. Screening camps were organized across the districts at the community level where the target groups were administered a risk assessment questionnaire followed by screening tests at the spoke hospitals based on a defined clinical protocol. The screened positive patients were examined further for confirmatory diagnosis at the spoke centers. Patients requiring chemotherapy or minor surgeries were treated at the spokes. For radiation therapy and complex surgeries the patients were referred to the hubs. Results: A total of 2,459 individuals were screened for cancer at the spokes and 299 were screened positive. Capacity was built at the spokes for cancer surgery and chemotherapy. A total of 189 chemotherapy sessions and 17 surgeries were performed at the spokes for cancer patients. 70 patients were referred to the hub. Conclusion: Initial results demonstrate the ability of the technology Distributed Cancer Care Network (DCCN) system to successfully screen and detect cancer and to converge the actions of various private health facilities towards providing a continuum of cancer care. The lessons learnt from this study will be useful for replicating the process in other States

Quantitative proteomic analysis of the influence of lignin on biofuel production by Clostridium acetobutylicum ATCC 824

Background: Clostridium acetobutylicum has been a focus of research because of its ability to produce high-value compounds that can be used as biofuels. Lignocellulose is a promising feedstock, but the lignin–cellulose–hemicellulose biomass complex requires chemical pre-treatment to yield fermentable saccharides, including cellulose-derived cellobiose, prior to bioproduction of acetone–butanol–ethanol (ABE) and hydrogen. Fermentation capability is limited by lignin and thus process optimization requires knowledge of lignin inhibition. The effects of lignin on cellular metabolism were evaluated for C. acetobutylicum grown on medium containing either cellobiose only or cellobiose plus lignin. Microscopy, gas chromatography and 8-plex iTRAQ-based quantitative proteomic technologies were applied to interrogate the effect of lignin on cellular morphology, fermentation and the proteome. Results: Our results demonstrate that C. acetobutylicum has reduced performance for solvent production when lignin is present in the medium. Medium supplemented with 1 g L−1 of lignin led to delay and decreased solvents production (ethanol; 0.47 g L−1 for cellobiose and 0.27 g L−1 for cellobiose plus lignin and butanol; 0.13 g L−1 for cellobiose and 0.04 g L−1 for cellobiose plus lignin) at 20 and 48 h, respectively, resulting in the accumulation of acetic acid and butyric acid. Of 583 identified proteins (FDR < 1 %), 328 proteins were quantified with at least two unique peptides. Up- or down-regulation of protein expression was determined by comparison of exponential and stationary phases of cellobiose in the presence and absence of lignin. Of relevance, glycolysis and fermentative pathways were mostly down-regulated, during exponential and stationary growth phases in presence of lignin. Moreover, proteins involved in DNA repair, transcription/translation and GTP/ATP-dependent activities were also significantly affected and these changes were associated with altered cell morphology. Conclusions: This is the first comprehensive analysis of the cellular responses of C. acetobutylicum to lignin at metabolic and physiological levels. These data will enable targeted metabolic engineering strategies to optimize biofuel production from biomass by overcoming limitations imposed by the presence of lignin

A SARS-CoV-2 protein interaction map reveals targets for drug repurposing

The novel coronavirus SARS-CoV-2, the causative agent of COVID-19 respiratory disease, has infected over 2.3 million people, killed over 160,000, and caused worldwide social and economic disruption1,2. There are currently no antiviral drugs with proven clinical efficacy, nor are there vaccines for its prevention, and these efforts are hampered by limited knowledge of the molecular details of SARS-CoV-2 infection. To address this, we cloned, tagged and expressed 26 of the 29 SARS-CoV-2 proteins in human cells and identified the human proteins physically associated with each using affinity-purification mass spectrometry (AP-MS), identifying 332 high-confidence SARS-CoV-2-human protein-protein interactions (PPIs). Among these, we identify 66 druggable human proteins or host factors targeted by 69 compounds (29 FDA-approved drugs, 12 drugs in clinical trials, and 28 preclinical compounds). Screening a subset of these in multiple viral assays identified two sets of pharmacological agents that displayed antiviral activity: inhibitors of mRNA translation and predicted regulators of the Sigma1 and Sigma2 receptors. Further studies of these host factor targeting agents, including their combination with drugs that directly target viral enzymes, could lead to a therapeutic regimen to treat COVID-19

Effect of mobile health interventions in increasing utilization of Maternal and Child Health care services in developing countries: A scoping review

Background Mobile health (mHealth) technology is being used predominantly in low- and middle-income countries. Developing countries with low level of investment in health infrastructure can augment existing capacity by adopting low-cost affordable technology. The aim of the review was to summarize the available evidence on mHealth interventions that aimed at increasing the utilization of Maternal and Child Health (MCH) care services. Further, this review investigated the barriers which prevent the use of mHealth among both health care workers as well as beneficiaries. Methodology A scoping review of literature was undertaken using the five-stage framework developed by Arksey and O’Malley. The articles published between 1990 and 2021 were retrieved from three databases (PubMed, Cochrane Reviews, and Google Scholar) and grey literature for this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was followed to present the findings. Result A total of 573 studies were identified. After removing duplicates, studies not related to mHealth and MCH and publications of systematic reviews and protocols for studies, a total of 28 studies were selected for review. The study design of the research articles which appeared during the search process were mostly observational, cross-sectional, and randomized controlled trials (RCTs). We have classified the studies into four categories based on the outcomes for which the mHealth intervention was implemented: MCH care services, child immunization, nutrition services, and perceptions of stakeholders toward using technology for improving MCH outcomes. Conclusion This brief review concludes that mHealth interventions can improve access to MCH services. However, further studies based on large sample size and strong research design are recommended

Digital inequalities in cancer care delivery in India : an overview of the current landscape and recommendations for large-scale adoption

Introduction: COVID-19 pandemic has caused major disruptions to delivery of various cancer care services as efforts were put to control the outbreak of the pandemic. Although the pandemic has highlighted the inadequacies of the system but has also led to emergence of a new cancer care delivery model which relies heavily on digital mediums. Digital health is not only restricted to virtual dissemination of information and consultation but has provided additional benefits ranging from support to cancer screening, early and more accurate diagnosis to increasing access to specialized care. This paper evaluates the challenges in the adoption of digital technologies to deliver cancer care services and provides recommendation for large-scale adoption in the Indian healthcare context. Methods: We performed a search of PubMed and Google Scholar for numerous terms related to adoption of digital health technologies for cancer care during pandemic. We also analyze various socio-ecological challenges—from individual to community, provider and systematic level—for digital adoption of cancer care service which have existed prior to pandemic and lead to digital inequalities. Results: Despite encouraging benefits accruing from the adoption of digital health key challenges remain for large scale adoption. With respect to user the socio-economic characteristics such as age, literacy and socio-cultural norms are the major barriers. The key challenges faced by providers include regulatory issues, data security and the inconvenience associated with transition to a new system. Policy Summary: For equitable digital healthcare, the need is to have a participatory approach of all stakeholders and urgently addressing the digital divide adequately. Sharing of health data of public and private hospitals, within the framework of the Indian regulations and Data Protection Act, is critical to the development of digital health in India and it can go a long way in better forecasting and managing cancer burden