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.

ALTERNATIVE ROUTES TO DEUTERATION IN DARK CLOUDS

We investigate new approaches to the deuteration of C3H2, HC3N and HC5N in dark clouds, following the suggestion that protonated HC3N might form different isomers, a linear structure (HC3NH+) being the most stable. We consider the effect of linear HC3NH+ and HC5NH+ on the formation of HC3N and HC5N, and find that deuteration ratios at approximately 10 K are reduced, in the case of HC3N to values significantly below those observed, such that a deuteration mechanism other than direct deuteron transfer is probably required for cold clouds.

Electrical energy storage and Smart Grid technologies to integrate the next generation of Renewable Power Systems

The growth of renewable power sources, distributed generation and the potential for alternative fuelled modes of transport such as electric vehicles has led to concerns over the ability of existing grid systems to facilitate such diverse portfolio mixes in already congested power systems. Internationally the growth in renewable energy sources is driven by government policy targets associated with the uncertainties of fossil fuel supplies, environmental issues and a move towards energy independence. Power grids were traditionally designed as vertically integrated centrally managed entities with fully dispatchable generating plant. Renewable power sources, distributed generation and alternative fuelled vehicles will place these power systems under additional stresses and strains due to their different operational characteristics. Energy storage and smart grid technologies are widely proposed as the tools to integrate these future diverse portfolio mixes within the more conventional power systems. The choice in these technologies is determined not only by their location on the grid system, but by the diversification in the power portfolio mix, the electricity market and the operational demands. This paper presents a high level technical and economic overview of the role and relevance of electrical energy storage and smart grid technologies in the next generation of renewable power systems.

Performance and characteristics of platinum, palladium/rhodium and palladium automotive catalysts when subjected to ethanol, acetaldehyde and a synthetic E85 exhaust gas mixture

The performance optimisation of automotive catalysts has been the focus of a great deal of research for many years as the automotive industry has endeavored to reduce the emission of toxic and pollutant gases generated from internal combustion engines. Just as the emissions from diesel and gasoline combustion vary so do the emissions from combustion of alternative fuels such as ethanol; the variation is in both quantity and chemical composition. In particular, when ethanol is contained in the fuel, ethanol and acetaldehyde are present in the exhaust gas stream and these are two compounds which the catalytic converter has not traditionally been designed to manage. The aim of the study outlined in this paper was to assess the performance of various catalyst formulations when subjected to a representative ethanol exhaust gas mixture. Three automotive catalytic converter formulations were tested including a fully Pt sample, a PdRh three-way catalyst sample and a fully Pd sample. Initially the samples were tested using single component hydrocarbon light-off tests followed by a set of tests with carbon monoxide included as an inlet gas to observe its effect on each individual hydrocarbon oxidation. Finally, each formulation was tested using a full E85 exhaust gas mixture. The study was carried out using a synthetic gas reactor along with FTIR and FID exhaust gas analysers. All formulations showed selectivity toward acetaldehyde formation from ethanol dehydrogenation which resulted in negative acetaldehyde conversion across each of the samples during the mixture tests. The fully Pt sample was the most detrimentally affected by the introduction of carbon monoxide into the gas feed. The Pd and PdRh samples exhibited a tendency toward acetaldehyde decomposition resulting in methane and carbon monoxide formation. The Pt sample did not form methane but did form ethylene as a result of ethanol dehydration.

The identification of potential alternative biomarkers of nitrofurazone abuse in animal derived food products

Semicarbazide (SEM) was considered to be a characteristic protein-bound side-chain metabolite of the banned veterinary drug nitrofurazone and used as a marker of nitrofurazone abuse. It was recently discovered that SEM can arise in food from sources other than nitrofurazone. This uncertainty over the source of SEM may be overcome if alternative markers specific to tissue-bound nitrofurazone residues can be determined. The structure of nitrofurazone metabolites in vivo and particular proteins to which they are bound are not known. These proteins with altered structure due to the presence of the drug metabolites can be considered as potential alternative biomarkers of nitrofurazone abuse. The proteins implicated in the in vivo binding of nitrofurazone were separated and identified. A crude mixture of proteins extracted from the liver of a rat treated with the drug was separated using a series of different techniques such as preparative isoelectric focusing and size exclusion HPLC. Multiple fractions were assayed by LC-MS/MS to detect the presence of SEM. The proteins containing SEM residues were identified by peptide mass mapping using trypsin digestion and MALDI-TOF. The first protein identified as containing high concentration of SEM was albumin. It was also shown that low molecular weight species within a protein mixture whose main constituent was glutathione S-transferase contained a high concentration of SEM. The chemical composition of these components is under investigation. Preliminary data suggest the SEM forms part of a nitrofurazone metabolite conjugated to glutathione. (C) 2008 Elsevier Ltd. All rights reserved.

Availability of complementary and alternative medicine for people with cancer in the British National Health Service: Results of a national survey

This study assessed access to Complementary and Alternative Medicine (CAM) therapies for people with cancer within the British National Health Service. CAM units were identified through an internet search in 2009. A total of 142 units, providing 62 different therapies, were identified: 105 (74.0%) England; 23 (16.2%) Scotland; 7 (4.9%) each in Wales and Northern Ireland. Most units provide a small number of therapies (median 4, range 1–20), and focus on complementary, rather than alternative approaches. Counselling is the most widely provided therapy (available at 82.4% of identified units), followed by reflexology (62.0%), aromatherapy (59.1%), reiki (43.0%), massage (42.2%). CAM units per million of the population varied between countries (England: 2.2; Wales: 2.3; Scotland: 4.8; Northern Ireland: 5.0), and within countries. Better publicity for CAM units, greater integration of units in conventional cancer treatment centres may help improve access to CAMs.

Acetaldehyde Production in the Direct Ethanol Fuel Cell: Mechanistic Elucidation by Density Functional Theory

This study employs density functional theory (DFT) calculations to examine the mechanism by which acetaldehyde is formed on platinum in a typical direct ethanol fuel cell (DEFC). A pathway is found involving the formation of a strongly hydrogen-bonded complex between adsorbed ethanol and the surface hydroxyl (OH) species, followed by the facile alpha-dehydrogenation of ethanol, with spontaneous weakening of the hydrogen bond in favor of adsorbed acetaldehyde and water. This mechanism is found to be comparably viable on both the close-packed surface and the monatomic steps. Comparison of further reactions on these two sites strongly indicates that the steps act as net removers of acetaldehyde from the product stream, while the flat surface acts as a net producer.