Integrated care: utilisation of complementary and alternative medicine within a conventional cancer treatment centre

Objectives: To estimate the proportion of cancer outpatients who visit a Complementary and Alternative Medicine (CAM) unit that is located within a conventional cancer treatment centre; to compare the characteristics of CAM unit visitors with those of all outpatients; to monitor the demand for 20 CAM therapies delivered by professionals, and the use of the CAM unit for waiting, gathering information and informal support from volunteer staff.

Design: Prospective, observational, over a six month period.

Setting: CAM unit within a NHS cancer treatment centre.

Main outcome measures: Utilisation of the CAM unit for 20 complementary therapies, and for waiting, gathering information, informal support; characteristics of CAM users compared with those of all cancer outpatients attending the cancer centre; predictors of CAM therapy use and frequent use.

Results: 761 (95% of those approached) people were recruited, 498 (65.4%) cancer patients, 202 (26.5%) relatives, 37 (4.8%) friends/carers, 24 (3.2%) staff. Women predominated (n = 560, 73.6%). Of all outpatients attending the cancer centre, 498 (15.8%) visited the CAM unit, 290 (9.2%) accessed therapies. Compared to all outpatients, those visiting the CAM unit were: younger (mean 63.7 vs. 58.4 years), more likely to be female (57.9% vs. 78.7%), have breast (14.8% vs. 51.9%), gynaecological (5.0% vs. 9.1%) cancer, live in local postal district (57.3% vs. 61.6%). Significant predictors of therapy use and frequent visits were being a patient, female, higher education, living closer to the cancer centre.

Conclusions: Despite easy access to CAM therapies, a relatively small number of people regularly used them, whilst a larger number selectively tried a few. The integrated CAM unit meets a demand for information and informal support. The findings inform emerging policy on integrating CAM and conventional cancer treatment to address psychosocial needs of people with cancer. More research is needed on why people do not use integrated CAM services and how charges affect demand. © 2008.

The photo-oxidation of water by sodium persulfate, and other electron acceptors, sensitised by TiO2

A number of different electron acceptors are tested for efficacy in the oxidation of water to oxygen, photocatalysed by titanium dioxide. The highly UV-absorbing metal ion electron acceptors, Ce4+ and Fe3+, appear ineffective at high concentration (10(-2) M), due to UV-screening, but more effective at lower concentrations (10(-3) M). The metal-depositing electron acceptor, Ag+, is initially effective, but loses activity upon prolonged irradiation due to metal deposition which promotes electron-hole recombination as well as UV-screening the titania particles. Most striking of the electron acceptors tested is persulfate, particularly in alkaline solution (0.1 M NaOH). The kinetics of the photo-oxidation of water by persulfate, photocatalysed by titania are studied as a function of pH, [S2O82-] and incident light intensity (I). The initial rate of water oxidation increases with pH, is directly proportional to the concentration of persulfate present and depends upon I-0.6. The TiO2/alkaline persulfate photosystem is robust and shows very little evidence of photochemical wear upon repeated irradiation. The results of this work are discussed with regard to previous work in this area and current mechanistic thinking. The formal quantum efficiency of the TiO2/alkaline persulfate photosystem was estimated as ca. 2%. (C) 2004 Elsevier B.V. All rights reserved.

Photo-oxidation of water sensitized by TiO2 and WO3 in presence of different electron acceptors

The photo-oxidation of water is studied in presence of UV-light (lambda

Thermodynamic Properties of Mixtures Containing Ionic Liquids. 4. LLE of Binary Mixtures of [C2MIM][NTf2] with Propan-1-ol, Butan-1-ol, and Pentan-1-ol and [C4MIM][NTf2] with Cyclohexanol and 1,2-Hexanediol Including Studies of the Influence of Small Amounts of Water

Experimental data are presented for liquid-liquid equilibria of mixtures of the room-temperature ionic liquid 1-ethyl-3-methyl-imidazolium bis(trifluoromethylsulfonyl)imide ([C2MIM][NTf2]) with the three alcohols propan-1-ol, butan-1-ol, and pentan-1-ol and for the 1-butyl-3-methyl-imidazolium bis(trifluoromethylsulfonyl) imide ([C4MIM][NTf2]) with cyclohexanol and 1,2-hexanediol in the temperature range of 275 K to 345 K at ambient pressure. The synthetic method has been used. Cloud points at a given composition were observed by varying the temperature and using light scattering to detect the phase splitting. In addition, the influence of small amounts of water on the demixing temperatures of binary mixtures of [C2MIM][NTf2] and propan-1-ol, butan-1-ol, and pentan-1-ol was investigated.

OXIDATION OF WATER BY MNO4- MEDIATED BY THERMALLY ACTIVATED RUTHENIUM DIOXIDE HYDRATE

The kinetics of oxidation of water to oxygen by MnO4-, mediated by thermally activated ruthenium dioxide hydrate, has been studied. The rate of catalysis is 0.8 order with respect to the surface concentration of MnO4- (which in turn appears to fit a Langmuir adsorption isotherm) and proportional to the catalyst concentration, but is independent of the concentration of manganese(II) ions. The catalysed reaction appears to have an activation energy of 50 +/- 1 kJ mol-1. These observed kinetics are readily rationalised using an electrochemical model in which the catalyst particles act as microelectrodes providing a medium for electron transfer between the highly irreversible oxidation of water to O2 and the highly irreversible reduction of MnO4- to Mn2+.

MECHANISM OF THE REDUCTION OF WATER BY REDUCED METHYL VIOLOGEN MEDIATED BY PLATINIZED ALUMINA - H/D ISOTOPE EFFECTS

The rate of oxidation of reduced methyl viologen (MV+4) by water, catalyzed by colloidal Pt/Al2O3, is reduced by a factor of congruent-to 5 when D2O is used as a solvent rather than H2O in the presence of a pH 4.40 acetate buffer. In contrast, the rate measured in the presence of a pH 3.05 buffer is reduced only slightly when D2O replaces H2O. H/D isotope separation factors for the methyl viologen mediated reduction of water to hydrogen catalyzed by Pt/Al2O3 are 4.22 (+/- 0.15) at pH 4.40 and 5.99 (+/- 0.11) at pH 3.05, at 25-degrees-C. These data are interpreted in terms of the electrochemical model for metal-catalyzed redox reactions with a pH-dependent mechanism for the hydrogen-evolving reaction. It is proposed that hydrogen atom combination on the catalyst surface is the rate-limiting step at pH 4.40, whereas at pH 3.05 diffusion of MV2+4 is rate limiting and hydrogen evolution proceeds via the electrochemical reaction between a surface-adsorbed hydrogen atom and a solution-phase proton.

Rate acceleration of the Baylis-Hillman reaction in polar solvents (water and formamide). Dominant role of hydrogen bonding, not hydrophobic effects, is implicated

A substantial acceleration of the Baylis-Hillman reaction between cyclohexenone and benzaldehyde has been observed when the reaction is conducted in water. Several different amine catalysts were tested, and as with reactions conducted in the absence of solvent, 3-hydroxyquinuclidine was found to be the optimum catalyst in terms of rate. The reaction has been extended to other aldehyde electrophiles including pivaldehyde. Attempts to extend this work to acrylates was only partially successful as rapid hydrolysis of methyl and ethyl acrylates occurred under the base-catalyzed and water-promoted conditions. However, tert-butyl acrylates were sufficiently stable to couple with relatively reactive electrophiles. Further studies on the use of polar solvents revealed that formamide also provided significant acceleration and the use of 5 equiv of formamide (optimum amount) gave faster rates than reactions conducted in water. Using formamide, further acceleration was achieved in the presence of Yb(OTf)(3) (5 mol %). The scope of the new conditions was tested with a range of Michael acceptors and benzaldehyde and with a range of electrophiles and ethyl acrylate. The origin of the rate acceleration is discussed.

Interfacial Properties of LiTFSI and LiPF6-Based Electrolytes in Binary and Ternary Mixtures of Alkylcarbonates on Graphite Electrodes and Celgard Separator

For a better understanding of the adsorption behavior of alkylcarbonate-based electrolytes on graphite electrodes and Celgard separator for Li-ion batteries applications, the interface parameters are determined by contact angle and surface tension measurements. The correlation between these parameters and chemical compositions made of alkyl carbonate with a varying nature of lithium salts (LiPF6 and LiTFSI) and volume fractions of binary and ternary mixtures containing propylene carbonate (PC), ethylene carbonate (EC), and dimethyl carbonate (DMC) is investigated. From the obtained contact angle and surface tension (?L) values for each liquid, the dispersive and polar components of the surface tension (?Ld and ?Lp) of the electrolyte and interfacial free energy between the solid and liquid (?SL) were then calculated using the Young’s equation. The variation of contact angle (?) and the surface tension, as well as the work of adhesion (WA) of binary PC/DMC mixtures on PP, PE, and PET model surfaces were also measured and commented as function of volume fraction of PC in DMC. Finally, the Zisman’s critical surface tension (?C) for studied surfaces was then obtained showing positives slopes of cos ? versus ?L. This behavior is explained by a relative higher adsorption of alkylcarbonates to the hydrogenated supports or graphite. These results are decisive to understand the performance of electrolyte/electrode material/separator interfaces in lithium-ion battery devices.

Exploring and comparing the experience and coping behaviour of men and women with colorectal cancer after chemotherapy treatment:A qualitative longitudinal study

Objectives: Men have higher incidence and mortality rates for nearly all cancers. They are less likely than women to utilise cancer information services and other social support services. The aim of this study was to explore and compare the experience and coping behaviour of men and women after treatment for colorectal cancer (CRC). Methods: A longitudinal qualitative study was conducted involving 38 individuals (24 men and 14 women) with CRC. Data were generated using semi-structured interviews at four time points over an 18-month period, post-diagnosis. Interviews focused on participant's experience of CRC and on how gender affected their coping. This paper reports the findings of interviews 3 and 4 which examined the participant's experience after chemotherapy. Results: Three themes emerged from the interviews ('new normal', living with uncertainty and support needs). Many men and women reacted similarly; however, there was some variation evident between and within sexes. The main difference was with regard to the long-term physical side effects of the illness. Many women admitted to still experiencing side effects, whereas many men indicated that they had no problems. These men engaged in practices that aligned with their gender identity and view of masculinity. It must be noted that some men and women were still experiencing an impact. Conclusions: Recovery from the physical and psychological effects of CRC does not occur simultaneously. Healthcare professionals should be aware that not all men (or women) conform to the social stereotypes of masculinity (or femininity). Copyright © 2010 John Wiley & Sons, Ltd.

Circulating markers of prognosis and response to treatment in patients with midgut carcinoid tumours

Midgut carcinoid tumours are uncommon tumours with an unpredictable clinical behaviour and few useful prognostic markers. Somatostatin analogues are widely used in treatment but a survival advantage has not been proven. We analysed features associated with poor prognosis and assessed the clinical implications of the biochemical response to therapy.