Introduction: Over the past few years, the demographic profile of lung cancer has changed. However, most reports are limited by small numbers, short follow-up period, and show an inconsistent pattern. A comprehensive evaluation of changing trends over a long period has not been done. Materials and Methods: Consecutive lung cancer patients were studied over a 10-year period from January 2008 to March 2018 at the All India Institute of Medical Sciences, New Delhi, and relevant clinical information, and survival outcomes were analyzed. Results: A total of 1862 patients were evaluated, with mean (SD) age of 59 (11.1) years, and comprising 82.9% males. Majority were smokers (76.2%) with median smoking index of 500 (interquartile range [IQR]: 300–800). Adenocarcinoma (ADC) was the most common type (34%), followed by squamous cell carcinoma (SCC – 28.6%) and small cell lung cancer (SCLC) (16.1%). Over the 10-year period, ADC increased from 9.5% to 35.9%, SCC from 25.4% to 30.6%, and non-small cell lung cancer -not otherwise specified (NSCLC-NOS) decreased from 49.2% to 21.4%. The proportion of females with lung cancer increased although smoking rates remained similar. Majority of NSCLC (95%) continued to be diagnosed at an advanced stage (3 or 4). Epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements were present in 25.3% and 11.5% ADC patients, respectively. The median overall survival was 8.8 months (IQR 3.7–19) for all patients and 12.57 (IQR 6.2–28.7) months among the 1013 patients who were initiated on specific treatment (chemotherapy, targeted therapy, radiotherapy, or surgery). Never-smokers were younger, more likely to be female and educated, had a higher prevalence of ADC and EGFR/ALK mutations, and had better survival. Conclusion: Among this large cohort, our center seems to follow the global trend with increasing incidence of ADC. EGFR mutation positivity was similar to existing reports, while higher ALK positivity was detected. A characteristic phenotype of never-smokers with lung cancer was elucidated which demonstrated better survival.

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Background: Delays that postpone the evaluation and management of malignancy may lead to considerable morbidity. The primary objective of this study was to assess the time required to diagnose and treat lung cancer at an Indian public referral center that predominantly serves lower-income patients. Methods: A review of patients diagnosed with lung cancer between January 2008 and December 2016 was completed. We computed the median time intervals and inter-quartile ranges between symptom onset, definitive diagnostic investigation, confirmed histologic diagnosis, and chemotherapy initiation. Median intervals were correlated with baseline demographics and disease characteristics using Kruskal-Wallis test. Results: One thousand, three hundred and-seventy patients were selected. A majority (94.5%) with non-small cell lung cancer were diagnosed with advanced disease. After developing symptoms, patients required 101 [56-168] days to undergo a definitive diagnostic study, 107 [60-173] days to confirm a diagnosis, and 126 [85-196.8] days to initiate treatment. Patients who were previously treated for tuberculosis required more time to receive chemotherapy compared to those who were not (187 [134-261.5] days vs. 113 [75-180] days, p < 0.0001). A specialty Lung Cancer Clinic was implemented in 2012, and the mean referrals per month increased nearly four-fold (p < 0.0001), but the time required to administer treatment was not shortened. Conclusion: Among lower-income Indian patients, the most prominent delays occur prior to diagnosis. Efforts should be directed toward encouraging physicians to maintain a high index of clinical suspicion and educating patients to report concerning symptoms as early as possible.

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Objectives: Quality of life (QOL) among caregivers of cancer patients is often diminished. For lower-income caregivers, the deterioration in QOL may be of greater impact. We aimed to evaluate QOL among lower-income cancer caregivers in Delhi, India and to comprehensively review similar investigations conducted internationally.Methods: A Hindi-version of the Caregiver Quality of Life Cancer (CQOLC) index was administered to 89 caregivers of lung cancer patients. Bivariate analyses were employed to evaluate associations between baseline demographics and CQOLC index scores. A systematic review of PubMed, EMBASE, and PsychInfo was undertaken.Results: Reduced QOL was observed for caregivers residing in homes earning less than our center’s median annual income per capita (p < 0.01) and for caregivers providing aid for 4 months or longer (p < 0.01). The burden of caregiving contributed most to summative index scores (p < 0.01). Eleven studies were selected by systematic review. Lower-income caregivers in Asia and the Middle East experience reduced QOL and increased burden. Available evidence does not suggest that lower-income caregivers in Europe and North America share worse QOL.Conclusion: Lower-income caregivers suffer loss in QOL, particularly in the developing world. Resourceful interventions are warranted to mitigate burden for this underappreciated population.

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The solidification of metals continues to be a phenomenon of great interest to physicists, metallurgists, casting engineers and software developers. It directly affects the production cycle time, internal quality of castings and material utilization (yield). The process of casting solidification is complex in nature and the simulation of such process is required in industry before it is actually undertaken. The volumetric contraction accompanying solidification of molten metal manifests in defects like shrinkage cavity, porosity, and sink. These defects can be minimized by an intelligent methoding and simulation using casting software. In this paper, an attempt has been made to redesign and develop a casting free from defects, in particular, shrinkage defect. The component taken for methoding and simulation study was subjected to high amount of shrinkage defects which was the major cause for the rejection in the foundry. It also was having very low yield as 45 % as per the foundry information. The component under study consists of square shaped (at top) plate having three perforations with diminishing height (at bottom) and subjected to multiple hot spot. Therefore, optimum location of feeder has been identified by carrying out various simulation trials. Proper feeding aids have helped in getting the hot spot completely shifted inside the feeder. Simulation based approach has helped in the improvement of the feedability index which represents yield of feeders and quality of casting (percentage of volume free from shrinkage porosity). The simulations results were compared with the experimental trial and the comparison was found to be in good agreement.

The use of Aluminum castings parts in the automotive industry has increased dramatically over the past few decades. The driving force for this increased use is vehicle weight reduction for improved performance. In many cases the mechanical properties of the cast aluminum parts are superior to those of the cast iron or wrought steel parts being used.This paper proposes the computer simulation of the sand casting of Aluminum Plate. It aims to study the behavior of fluid flow during mould filling and solidification and to optimize the process parameters, which help to predict and control casting defects such as gas porosity and shrinkage porosity. Here an attempt is being made to model and simulate the casting process using the AutoCAST software. The technological as well as practical aspects of using casting software are illustrated with an industrial case study.