Clinical Trial Protocol: Randomized Controlled Trial of Cancer Pain Monitoring System (CAPAMOS) in Patients with Advanced Cancer

Purpose: This randomized controlled trial (RCT) protocol was designed to evaluate the effectiveness of the Cancer Pain Monitoring System (CAPAMOS), a telenursing system designed to alleviate pain in ambulatory patients with advanced cancer. Methods: The study design involved a randomized controlled trial consisting of an intervention group using CAPAMOS and a control group that received usual care. At the time of enrollment, both groups will be given a questionnaire regarding issues, such as concerns related to cancer pain and self-management of opioid medication. Patients will then receive pain relief education based on the results of the questionnaire. Subjects in the control group will receive a pain diary and pain-relief pamphlet that acts as an educational tool. They could also call the outpatient clinic if they wanted to ask for a nursing consultation. The intervention group will be able to use CAPAMOS to manage their pain and receive video consultation with a telenurse, who is an oncology nursing specialist. Educational tools will be built into CAPAMOS. The study will be conducted for one month. The primary endpoint of this study was to calculate the Japanese Brief Pain Inventory score. The secondary endpoints were to assess the opioid medication self-management, Barriers Questionnaire, Japanese EuroQol 5-dimensions 5-level, and economic evaluation. Assessment items will be evaluated at registration and 2 and 4 weeks after registration. Conclusions: A RCT based on this protocol is expected to validate the efficacy of telenursing using CAPAMOS in patients with advanced cancer and pain.

Occurrence of emerging flame retardants from e-waste recycling activities in the northern part of Vietnam

This study investigated the contamination status of 21 emerging flame retardants(FRs)in soils(n=32)and river sediments(n=8)from an e-waste recycling(EWR)site in the northern part of Vietnam.Among analyzed FRs,higher levels of decabromodiphenyl ethane(DBDPE)(NDe4200 ng/g dw),1,2-bis-(2,4,6-tribromophenoxy)ethane(BTBPE)(NDe350 ng/g dw)and Dechlorane Plus isomers(DPs)(NDe65 ng/g dw)were found in soils near EWR workshops and open burning places.The highest concentrations of DBDPE(20 ng/g dw),BTBPE(5.7 ng/g dw)and DPs(6.7 ng/g dw)were also detected in sediments collected from the middle of the EWR site.The levels decreased concomitantly with increasing distance from the EWR site.These results indicate that these FRs were released to the surrounding environment from improper recycling activities,such as manual dismantling of devices and open burning of e-wastes.Moreover,the estimated daily intakes of those FRs via soil ingestion were approximately ten times higher for children than adults.To our knowledge,this is a first comprehensive study on characterization of soil and sediment contamination by a series of emerging FRs at an EWR site in Vietnam.

Comprehensive evaluation of dioxins and dioxin-like compounds in surface soils and river sediments from e-waste-processing sites in a village in northern Vietnam:Heading towards the environmentally sound management of e-waste

The management of electronic waste(e-waste),which can be a source of both useful materials and toxic substances,depending on the processing method,is important for promoting material cycling.In this study,we used the dioxin-responsive chemical-activated luciferase gene expression(DR-CALUX)assay combined with gas chromatographyehigh-resolution mass spectrometry to evaluate the levels of dioxin-like compounds in surface soils and river sediments collected in and around an e-waste-processing village in northern Vietnam.The WHO-TEQs(Toxic equivalents)of polychlorinated dibenzo-p-dioxins and dibenzofurans(PCDD/Fs),coplanar polychlorinated biphenyls(Co-PCBs),and polybrominated dibenzo-pdioxins and dibenzofurans(PBDD/Fs)in soils collected in January 2012 ranged from 0.29 to 310 pg/g(median 2.9 pg/g,n=32),and the WHO-TEQs in sediments ranged from 0.96 to 58 pg/g(median 4.4 pg/g,n=8).Dioxin-like activities(CALUX-TEQs[2,3,7,8-TCDD equivalent])in soils collected in January 2012,2013,and 2014 ranged from<30 to 4300 pg/g(median<30 pg/g,n=96),and the activities in sediments ranged from<30 to 4000 pg/g(median 33 pg/g,n=24).Dioxin-like compounds accumulated in samples collected around e-waste-processing areas such as open-burning sites and e-waste-processing workshops,and the compounds may be transported from their sources to surrounding areas over the course of several years.Some of the CALUX-TEQs,but not WHO-TEQs,values were higher than the maximum acceptable WHO-TEQs promulgated by various authorities,indicating that all dioxin-like compounds should be evaluated in samples collected from e-waste-processing areas.Our findings suggest that open burning and open storage of e-waste should be prohibited and that wastewater treatment should be implemented at each workshop to reduce contamination by dioxin-like compounds from e-waste.

Analysis of monomeric and oligomeric organophosphorus flame retardants in fish muscle tissues using liquid chromatographyeelectrospray ionization tandem mass spectrometry:Application to Nile tilapia(Oreochromis niloticus)from an e-waste processing area in northern Vietnam

Using electrospray ionization tandem mass spectrometry combined with liquid chromatography(LC),a novel analytical method was developed to quantify eight monomeric organophosphorus flame retardants(m-PFRs)and three oligomeric organophosphorus flame retardants(o-PFRs)in fish muscle samples.The optimization and validation experiments indicate that the developed method can determine accurately the concentrations of analytes in fish muscle samples.The recoveries of analytes in fish muscle samples were in the range of 74-105%.The coefficients of variation of the concentrations of analytes in fish muscle samples were 0.6-8.9%.The concentrations of analytes in procedural blanks were below the limit of quantification(LOQ)values.Furthermore,the developed method was applied to the analysis of m-PFRs and o-PFRs in the muscle samples of tilapias collected from an electronic waste(ewaste)processing area in northern Vietnam.The concentrations of m-PFRs such as tris(2-chloroethyl)phosphate(TCEP),tris(2-chloroisopropyl)phosphate(TCIPP),and triphenyl phosphate(TPHP)were dominant among the investigated m-PFRs.The respective concentrations of TCEP,TCIPP,and TPHP were up to 160,300,and 230 ng g^-1 lipid weight,respectively,whereas those of o-PFRs were up to 10 ng g^-1 lipid weight.The results of this study indicate lower accumulation potential of o-PFRs compared with m-PFRs for the first time.

Hazardous metals emissions from e-waste-processing sites in a village in northern Vietnam

Inappropriate e-waste-processing operation is a serious issue in developing countries since the early 2000's.Field research was conducted to clarify its influences and diffuse toxic substances in the environment at e-waste-processing sites in a village in northern Vietnam from 2012 to 2014.We investigated surface soil samples collected from e-waste-processing sites,open burning sites,and rice paddy sites.Sediment samples and water samples were also collected from a river that runs through the village.The hazardous metal concentration in soil and river sediment samples indicated that 7 elements(Ca,Cu,Mo,Ni,Pb,Sn,and Zn)had high concentrations as a result of e-waste-processing.Most notably,Pb and Cu had high concentrations in soil samples(Pb:26e2200 mg/kg,Cu:22e3000 mg/kg).The results of a multivariate analysis indicated that these 7 elements were closely correlated with e-waste-processing.Concentrations of hazardous metals showed an upward trend where e-waste-processing occurred during the 3-year study period,although it was not significant statistically at present.Open burning activity had a great influence on Cu accumulation,and maximum Cu concentrations increased from 340 mg/kg in 2012e3000 mg/kg in 2014 in soil samples from open-burning sites.There were large differences in the dominant hazardous metal depending on the type of e-waste-processing workshop because hazardous metal composition was influenced by the types of e-waste and the processing procedures.It is necessary to avoid e-waste processing in open-air environment to control emissions of hazardous substances.Especially,open burning should be prohibited.