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Gurgaon, India -- October 12, 2018: In a breakthrough human study, anti-oxidant, glutathione (GSH), which protects the brain from stress, has been found to be significantly depleted in Alzheimer's patients compared to normal subjects. As GSH is a very important anti-oxidant that protects the brain from free radicals, the findings give us another measure to use when diagnosing potential for the advancement of Alzheimer's disease or recognizing those that are in the throes of Alzheimer's advancement.

By implementing non-invasive imaging techniques, Dr. Mandal and his team of researchers found that GSH has two conformations (closed and extended forms) in the brain. It was discovered that when GSH is depleted in the hippocampus regions of an elderly person the healthy brain suffers mild cognitive impairment (MCI), which is known to be present in the earlier stages of AD.
It is now correlated that closed form of GSH is depleted in AD patients. At present no report is available to indicate to what extent the lower levels of extended form of GSH in those suffering from AD can be measured but it opens the possibility for further clinical observation using GSH as supplement to combat the advancement of AD.

"If routine non-invasive tests for lower levels of GSH in the hippocampus regions are performed, we might be able to mitigate the advancement of Alzheimer's disease by providing GSH supplements- A observational study is planned" Dr. Mandal said.

The multi-continent research team lead by Dr. Mandal, led this breakthrough research and this research has a huge potential for therapeutic development for AD.

NASA-NOAA's Suomi NPP satellite passed over the Eastern Atlantic Ocean and captured a visible image of Hurricane Leslie as it continues to travel toward southern Spain and Portugal.

A Tropical Storm Warning is in effect for Madeira Island. Interests in Portugal and Spain should monitor the progress of Leslie. Leslie is expected to bring significant rain and wind impacts to portions of Portugal and Spain by Sunday

Suomi NPP passed over Leslie on Oct. 11 and the Visible Infrared Imaging Radiometer Suite (VIIRS) instrument provided a visible image of the storm. The VIIRS image showed Leslie's cloud pattern continues to feature a central dense overcast, but with only hints of an eye in visible imagery. A large area of clouds extend northeast of Leslie's center that are associated with an elongated area or trough of low pressure.

At 2p.m. EDT (1800 UTC), the center of Hurricane Leslie was located near latitude 33.3 degrees north and longitude 26.1 degrees west. Leslie is moving toward the east-northeast near 33 mph (54 km/h). A fast motion toward the east-northeastward is expected to continue through Saturday morning, followed by a slower eastward motion late Saturday through Monday.

Maximum sustained winds are near 85 mph (140 kph) with higher gusts. Some weakening is forecast during the next day or so, but Leslie is expected to transition into a powerful post-tropical cyclone by Saturday night, Oct. 13.

On the forecast track, the center of Leslie will pass north of Madeira Island on Saturday, and approach the southwestern portion of the Iberian Peninsula on Saturday night, and move inland over portions of the Iberian Peninsula on Sunday.

The Joint Typhoon Warning Center or JTWC issued the final warning on Tropical Cyclone Titli after it made landfall on the northeastern coast of India late on Oct. 10. NASA-NOAA's Suomi NPP satellite captured an image of the large storm before landfall.

The Visible Infrared Imaging Radiometer Suite (VIIRS) instrument aboard NASA-NOAA's Suomi NPP satellite analyzed Tropical Cyclone Titli in visible light early on Oct. 10 when its eye was over the Bay of Bengal, Northern Indian Ocean. Titli stretched from the Indian state of Andhra Pradesh northeast into West Bengal. Before and after landfall, animated enhanced infrared satellite imagery showed strong thunderstorms surrounding a defined eye.

On Oct. 10 at 11 p.m. EDT (Oct. 11 at 0300 UTC) Tropical Cyclone Titli had maximum sustained winds near 90 knots (103 mph/166 kph). It was centered near 9.1 degrees north latitude and 84.4 degrees east longitude, approximately 312 nautical miles southwest of Calcutta, India. Titli tracked west-northwestward.

Titli came ashore near Palasa in Srikakulam district of Andhra Pradesh. Heavy rainfall is forecast for the districts of Ganjam, Gajapati, Puri, Jagatsinghpur, and Kendra. The storm has taken 7 lives. Strong winds battered many parts of the state of Andhra Pradesh and neighboring Odisha.

By October 13, JTWC expect Titli to dissipate over land.

Most Canadian smokers are in favour of novel policies to reduce tobacco use, according to a national survey by the International Tobacco Control Policy Evaluation Project (ITC) at the University of Waterloo.

Responding to the Canadian government's commitment to reduce tobacco use to less than five per cent of the population by 2035, the ITC study assessed baseline levels of support among Canadian smokers for potential endgame policies. The researchers found that most smokers in Canada support new and radical tobacco endgame strategies.

"Canada has taken strong actions to reduce tobacco use over the last several decades. Anti-smoking policies such as graphic warning labels on cigarette packs, smoking bans, tobacco taxes, and bans on the display of tobacco products have driven smoking rates down to an all-time low," said Geoffrey Fong, Principal Investigator of the ITC Project and a professor of psychology and public health and health systems at Waterloo. "However, the decrease has levelled off in recent years, and 16 per cent of Canada's population (roughly five million people) continue to smoke -- killing 45,000 smokers each year."

The survey of 3,215 smokers, conducted in 2016, found that 70 per cent support lowering nicotine levels in cigarettes to make them less addictive and raising the legal age for buying cigarettes to 21+ years. More than half (59%) of smokers support a ban on all marketing of tobacco products. Even the most radical policy proposed in the survey -- a complete ban on the sale of cigarettes within 10 years, with smoking cessation support -- is favoured by 44 per cent of smokers.

On May 31, 2018, the Canadian government released a new federal tobacco control strategy to achieve a tobacco endgame target of less than five per cent tobacco use by 2035 - or less than 1.8 million tobacco users. The study findings support the kind of new leading-edge policies needed to curb tobacco use in Canada and refutes typical tobacco industry claims that endgame policies will result in public backlash because they interfere with smokers' rights.

"This study provides evidence that Canadian smokers -- those who would be most affected by any policy changes -- would support further government action to reduce smoking rates," said Janet Chung-Hall of the ITC Project and lead author of the study. "The federal government's commitment to an endgame goal is an important step forward for public health. What we need now is to focus on innovative policies to make it easier for smokers in Canada to quit and to prevent youth from starting to smoke."

NASA-NOAA's Suomi NPP satellite provided a visible image of Tropical Cyclone Luban as it continued to spin over the Arabian Sea and slowly head toward Oman.

The Visible Infrared Imaging Radiometer Suite (VIIRS) instrument aboard NASA-NOAA's Suomi NPP satellite analyzed Tropical Cyclone Luban in visible light early on Oct. 10 when it was located in the Arabian Sea, Northern Indian Ocean. Although Luban remains symmetrical, there's a lack of strong thunderstorm development within the system. The VIIRS image showed the hint of an eye that was cloud-filled while microwave imagery more clearly showed a large and ragged eye.

On Oct. 10 at 11 p.m. EDT (Oct. 11 at 0300 UTC) the Joint Typhoon Warning Center or JTWC noted Tropical Cyclone Luban had maximum sustained winds near 65 knots (75 mph/120 kph). It was centered near 14.5 degrees north latitude and 58.7 degrees east longitude, approximately 266 nautical miles southeast of Salah, Oman, India. Luban is moving very slowly to the west.

The JTWC forecast takes Luban westward where it will encounter increasing vertical wind shear and slightly cooler sea surface temperatures which will allow for a gradual decrease in intensity. Luban is forecast to make landfall shortly before Oct. 14 in Oman as a tropical storm.

Bottom Line: An artificial intelligence (AI) approach based on deep learning convolutional neural network (CNN) could identify nuanced mammographic imaging features specific for recalled but benign (false-positive) mammograms and distinguish such mammograms from those identified as malignant or negative.

Journal in Which the Study was Published: Clinical Cancer Research, a journal of the American Association for Cancer Research.

Author: Shandong Wu, PhD, assistant professor of radiology, biomedical informatics, bioengineering, intelligent systems, and clinical and translational science, and director of the Intelligent Computing for Clinical Imaging lab in the Department of Radiology at the University of Pittsburgh, Pennsylvania

Background: "In order to catch breast cancer early and help reduce mortality, mammography is an important screening exam; however, it currently suffers from a high false recall rate," said Wu. "These false recalls result in undue psychological stress for patients and a substantial increase in clinical workload and medical costs. Therefore, research on possible means to reduce false recalls in screening mammography is an important topic to investigate."

How the Study Was Conducted: Wu and colleagues studied whether a technique in artificial intelligence called deep learning could be applied to analyze a large set of mammograms in order to distinguish images from women with a malignant diagnosis, images from women who were recalled and were later determined to have benign lesions (false recalls), and images from women determined to be breast cancer-free at the time of screening.

"The assumption is that there may be some nuanced imaging features associated with some mammogram images that could lead to a false/unnecessary recall when the images are interpreted by human radiologists, and our goal is to utilize a deep learning CNN-based method to build a computer toolkit to identify those potential mammogram images," Wu said.

The researchers used a total of 14,860 images of 3,715 patients from two independent mammography datasets, Full-Field Digital Mammography Dataset (FFDM - 1,303 patients) and Digital Dataset of Screening Mammography (DDSM - 2,412 patients). They built CNN models and utilized enhanced model training approaches to investigate six classification scenarios that would help distinguish images of benign, malignant, and recalled-benign mammograms.

Results: When the datasets from FFDM and DDSM were combined, the area under the curve (AUC) to distinguish benign, malignant, and recalled-benign images ranged from 0.76 to 0.91. The higher the AUC, the better the performance, with a maximum of 1, Wu explained. "AUC is a metric that summarizes the comparison of true positives against false positives, so it gives an indication not only of accuracy (how many were correctly identified), but also how many were falsely identified," he said.

Author's Comments: Wu said, "We showed that there are imaging features unique to recalled-benign images that deep learning can identify and potentially help radiologists in making better decisions on whether a patient should be recalled or is more likely a false recall."

"Based on the consistent ability of our algorithm to discriminate all categories of mammography images, our findings indicate that there are indeed some distinguishing features/characteristics unique to images that are unnecessarily recalled," Wu noted. "Our AI models can augment radiologists in reading these images and ultimately benefit patients by helping reduce unnecessary recalls."

Study Limitations: As limitations of the study, Wu noted that additional independent datasets could help further evaluate the accuracy and robustness of the algorithms, and utilizing alternative deep learning models, architectures, and model training strategies can help improve performance.

The Global Precipitation Measurement mission or GPM core satellite provided an analysis of the rate in which rain is falling throughout the Eastern Pacific Ocean's Tropical Storm Sergio. Sergio is close enough to Baja California now that it has triggered watches.

A Tropical Storm Watch is in effect for the west coast of the Baja California peninsula from Punta Eugenia to Cabo San Lazaro, Mexico. A Tropical Storm Watch is also in effect for the east coast of the Baja California peninsula from Bahia San Juan Bautista to San Evaristo, Mexico. The National Hurricane Center or NHC said, "Interests elsewhere in the northern and central Baja California peninsula and northwestern Sonora should monitor the progress of Sergio. Additional watches or warnings may be required on later tonight or Thursday, Oct. 11."

The GPM core observatory satellite's Microwave Imager (GMI) and Dual-Frequency Precipitation Radar (DPR) instruments measured rainfall within tropical storm Sergio on October 10, 2018 at 9:13 a.m. EDT (1313 UTC). GPM's radar only viewed storms on the eastern side of Sergio while the GMI swath included storms around the center of circulation. Measurements by GMI indicated that the heaviest rainfall was north of Sergio's eye like feature. Rain was shown by GMI to be falling at a rate of over 2.2 inches (55.9 mm) per hour in that part of the tropical storm. GPM is a joint mission between NASA and the Japan Aerospace Exploration Agency, JAXA.

That heavy rainfall is in the forecast as Sergio begins and continues its landfall. Sergio is expected to produce total storm rainfall accumulations of 3 to 5 inches, with local amounts of 10 inches across the central portion of the Baja California peninsula and Sonora.

At 2 p.m. EDT (1800 UTC), the center of Tropical Storm Sergio was located near latitude 18.6 degrees north and longitude 123.0 degrees west. Sergio is moving toward the northeast near 13 mph (20 kph). A northeastward motion with an increase in forward speed is expected during the next few days. Maximum sustained winds remain near 65 mph (100 kph) with higher gusts. Some fluctuations in intensity are likely today, but gradual weakening is forecast during the next several days.

Sergio is being steered toward the northeast by a large mid-latitude trough or elongated area of low pressure. On the forecast track, the center of Sergio will approach the Pacific coast of Baja California Sur early Friday and then reach mainland Mexico late Friday. The National Hurricane Center (NHC) predicts that rainfall from Sergio and its remnants will produce life-threatening flash flooding and mudslides during the weekend when it passes over the mountainous terrain of northwestern Mexico, the Southern Plains, and the Ozarks.

A paper published in Nature Communications by Sufei Shi, assistant professor of chemical and biological engineering at Rensselaer, increases our understanding of how light interacts with atomically thin semiconductors and creates unique excitonic complex particles, multiple electrons, and holes strongly bound together. These particles possess a new quantum degree of freedom, called "valley spin." The "valley spin" is similar to the spin of electrons, which has been extensively used in information storage such as hard drives and is also a promising candidate for quantum computing.

The paper, titled "Revealing the biexciton and trion-exciton complexes in BN encapsulated WSe2," was published in the Sept. 13, 2018, edition of Nature Communications. Results of this research could lead to novel applications in electronic and optoelectronic devices, such as solar energy harvesting, new types of lasers, and quantum sensing.

Shi's research focuses on low dimensional quantum materials and their quantum effects, with a particular interest in materials with strong light-matter interactions. These materials include graphene, transitional metal dichacogenides (TMDs), such as tungsten diselenide (WSe2), and topological insulators.

TMDs represent a new class of atomically thin semiconductors with superior optical and optoelectronic properties. Optical excitation on the two-dimensional single-layer TMDs will generate a strongly bound electron-hole pair called an exciton, instead of freely moving electrons and holes as in traditional bulk semiconductors. This is due to the giant binding energy in monolayer TMDs, which is orders of magnitude larger than that of conventional semiconductors. As a result, the exciton can survive at room temperature and can thus be used for application of excitonic devices.

As the density of the exciton increases, more electrons and holes pair together, forming four-particle and even five-particle excitonic complexes. An understanding of the many-particle excitonic complexes not only gives rise to a fundamental understanding of the light-matter interaction in two dimensions, it also leads to novel applications, since the many-particle excitonic complexes maintain the "valley spin" properties better than the exciton. However, despite recent developments in the understanding of excitons and trions in TMDs, said Shi, an unambiguous measure of the biexciton-binding energy has remained elusive.

"Now, for the first time, we have revealed the true biexciton state, a unique four-particle complex responding to light," said Shi. "We also revealed the nature of the charged biexciton, a five-particle complex."

At Rensselaer, Shi's team has developed a way to build an extremely clean sample to reveal this unique light-matter interaction. The device was built by stacking multiple atomically thin materials together, including graphene, boron nitride (BN), and WSe2, through van der Waals (vdW) interaction, representing the state-of-the-art fabrication technique of two-dimensional materials.

This work was performed in collaboration with the National High Magnetic Field Laboratory in Tallahasee, Florida, and researchers at the National Institute for Materials Science in Japan, as well as with Shengbai Zhang, the Kodosky Constellation Professor in the Department of Physics, Applied Physics, and Astronomy at Rensselaer, whose work played a critical role in developing a theoretical understanding of the biexciton.

The results of this research could potentially lead to robust many-particle optical physics, and illustrate possible novel applications based on 2D semiconductors, Shi said. Shi has received funding from the Air Force Office of Scientific Research. Zhang was supported by the Department of Energy, Office of Science.

Fritz Heusler (1866-1947), Hermann Weyl (1885-1955) and Michael Berry (1941-) are three renowned scientists whose work has led to new and important insights into materials science, topology and condensed-matter physics. These three fields of science have come together recently with the discovery of new and exciting quantum properties in new classes of material which could enable new science including computing technologies and catalysis.

Heusler is the name of the discoverer of mostly magnetic compounds that were of interest quite some time ago. But these compounds were recently found to host non-trivial topological properties that open a large field of novel physics. Hidden in the energy band structure of these materials are singular points that can be described with mathematical tools that originate from Weyl; these points are associated with the discovery of quasi-particles that are now called Weyl fermions. They are not found among the elementary particles of high energy physics, but we believe they exist in solid materials and determine their topology. The third name Berry stands for the measurable effects that reveal the physics at hand. Under certain well defined conditions there exists a vector field, similar to the magnetic field, called the Berry curvature. It determines the magnitude of a number of important effects, such as the anomalous Hall Effect and the Spin Hall Effect. It is the art of the experimentalist to suitably modify the materials in order to tune the Berry curvature and thus render the topology visible. In this review a great number of examples are given for various symmetry properties of Heusler compounds, a large class of materials that can easily be tuned to display ferromagnetic, antiferromagnetic, non-collinear or compensated magnetic order. These magnetic orderings give rise to pronounced electric and thermoelectric effects whose fingerprints are uncovered and explained including particle-like vortex spin structures, the antiskyrmions that are typical for a certain subset of Heusler compounds.

Considering the large number of existing inorganic compounds and the recently proposed large number of nonmagnetic topological materials, Heusler compounds serve as a model system for the understanding and impact of magnetism on topology. Breaking time reversal symmetry via magnetism or an external magnetic field can lead to even larger effects than in non-magnetic materials based on the large separation between Weyl points of different chiralities. Based on a systematic study of Heusler materials we predict that there are a huge number of magnetic topological materials awaiting to be discovered.

With regard to applications, the large Nernst effect and classical and quantum Hall effects around room temperature based on the high Curie temperatures of Heusler compounds and their relatives have the potential to have great impact in energy conversion and quantum electronic devices for spintronics or quantum computing.

To figure out where magma gathers in the earth's crust and for how long, Vanderbilt University volcanologist Guilherme Gualda and his students traveled to their most active cluster: the Taupo Volcanic Zone of New Zealand, where some of the biggest eruptions of the last 2 million years occurred -- seven in a period between 350,000 and 240,000 years ago.

After studying layers of pumice visible in road cuts and other outcrops, measuring the amount of crystals in the samples and using thermodynamic models, they determined that magma moved closer to the surface with each successive eruption.

The project fits into Gualda's ongoing work studying supereruptions - how the magma systems that feed them are built and how the Earth reacts to repeated input of magma over short periods of time.

"As the system resets, the deposits become shallower," said Gualda, associate professor of earth and environmental sciences. "The crust is getting warmer and weaker, so magma can lodge itself at shallower levels."

What's more, the dynamic nature of the Taupo Volcanic Zone's crust made it more likely for the magma to erupt than be stored in the crust. The more frequent, smaller eruptions, which each produced 50 to 150 cubic kilometers of magma, likely prevented a supereruption. Supereruptions produce more than 450 cubic kilometers of magma and they affect the earth's climate for years following the eruption.

"You have magma sitting there that's crystal-poor, melt-rich for few decades, maybe 100 years, and then it erupts," Gualda said. "Then another magma body is established, but we don't know how gradually that body assembles. It's a period in which you're increasing the amount of melt in the crust."

The question that remains is how long it look for these crystal-rich magma bodies to assemble between eruptions. It could be thousands of years, Gualda said, but he believes it's shorter than that.

WASHINGTON, D.C., October 9, 2018 -- One of the most enduring "Holy Grail" experiments in science has been attempts to directly observe atomic motions during structural changes. This prospect underpins the entire field of chemistry because a chemical process occurs during a transition state -- the point of no return separating the reactant configuration from the product configuration.

What does that transition state look like and, given the enormous number of different possible nuclear configurations, how does a system even find a way to make it happen?

Now in the journal Applied Physics Letters, from AIP Publishing, researchers at the Max Planck Institute for the Structure and Dynamics of Matter are reporting "ultrabright" electron sources with sufficient brightness to literally light up atomic motions in real time -- at a time scale of 100 femtoseconds, making these sources particularly relevant to chemistry because atomic motions occur in that window of time.

After seeing the first atomic movies of phase transitions in bulk thin films using high-energy (100 kilovolt) electron bunches, the researchers wondered if they could achieve atomic resolution of surface reactions -- occurring within the first few monolayers of materials -- to gain a better understanding of surface catalysis.

So they devised a low-energy (1-2 kilovolt) time-resolved electron diffraction concept of using fiber optics for miniaturization and the ability to stretch the electron pulse, then apply streak camera technology to potentially obtain subpicosecond temporal resolution -- a difficult feat within the low-electron energy regime.

"The first atomic movies use a stroboscopic approach akin to an old 8-millimeter camera, frame by frame, in which a laser excitation pulse triggers the structure, then an electron pulse is used to light up the atomic positions," said co-author Dwayne Miller. "We believed that a streak camera could get a whole movie in one shot within the window defined by the deliberately stretched electron pulse. It solves the problem of low electron numbers and greatly improves image quality."

Of the myriad possible nuclear configurations, the group discovered that the system collapses to just a few key modes that direct chemistry and that a reduction in dimensionality that occurs in the transition state or barrier-crossing region can be inferred. "We see it directly with the first atomic movies of ring closing, electron transfer and bond breaking," said Miller.

Amphibian populations around the world are declining due to a skin disease caused by fungus. However, an amphibian commonly found in Louisiana, the three-toed amphiuma, has shown a resistance to the fungus, in a new study led by researchers at LSU, Southeastern Louisiana University, Duquesne University and the University of Washington. The study was published in the Journal of Experimental Biology.

Amphibian skin is unique among vertebrates because it contains a large number of glands that produce and secrete substances that vary among species and functions. The secretions of amphibian skin glands contain a rich array of bioactive compounds including antimicrobial compounds. Such compounds are important for amphibian innate immune responses and may protect some species from the fungal disease affecting amphibians worldwide called chytridiomycosis. The scientists found compounds that inhibited the growth of two fungal pathogens in the three-toed amphiumas.

LSU Department of Chemistry Professor John A. Pojman participated in the study by providing live and preserved three-toed amphiumas.

"Although amphiumas, commonly called 'ditch eels,' are common throughout Baton Rouge, they are secretive and rarely observed. I've learned over the years of locations at which they can be captured year-round," Pojman said.

The three-toed amphiuma is the second largest salamander in the world. It can grow to 3 feet in length and weigh more than 7 pounds.

WASHINGTON, D.C., October 9, 2018 -- Breakthrough new research shows that ionization-induced self-channeling of a microwave beam can be achieved at a significantly lower power of the microwave beam and gas pressure for radially nonuniform plasma with minimal on-axis density than in the case of plasma formed as the result of gas ionization.

In the journal Physics of Plasmas, from AIP Publishing, Israel Institute of Technology researchers report observing this effect for the first time and studying it in detail in a plasma preliminarily formed by a radiofrequency discharge, in a low-pressure gas (

"Ionization-induced plasma self-channeling is the foundation for microwave plasma wakefield research," said lead author Yang Cao. "A plasma wakefield is a wave generated by particles traveling through a plasma. And a microwave plasma wakefield experiment could give us information about laser wakefield research that's extremely difficult to obtain due to the short time (femtosecond) and geometry scale involved."

This work is significant because microwaves will always diverge, unlike lasers that can be trapped within optical fibers. "In this [way], a self-induced 'microwave fiber' is created that may help the microwave propagate a much longer distance," Cao said.

In the future, the microwave ionization-induced self-channeling effect could be used for further exploring the microwave plasma wakefield or, since it's a form of directed energy, it may also find military applications as a directed-energy weapon.

Lugano-Munich, 10 October 2018 - Sarcoma patients show great openness to the use of complementary alternative medicines (CAMs) for supportive care, but they are poorly informed about safety issues and risk of interactions with anti-cancer drugs, a study to be presented at ESMO 2018 reported. (1)

By administering a structured survey over a 4-month period (1 January - 30 April 2018), a team from the University Hospital Mannheim, Germany, investigated types and modes of use of non-conventional therapies among 152 outpatients with sarcoma, gastrointestinal stromal tumour (GIST) and desmoid tumours receiving care at a sarcoma centre. Researchers considered CAMs as a broad range of practices including supplementation of vitamins or minerals, Chinese or healing herbs, homeopathy, acupuncture, meditation, yoga, Tai Chi or changes in dietary habits, like switching to a ketogenic or vegan diet. The main results showed that 51% of participants had used alternative methods in their lifetime, and 15% of them only during the disease, in parallel with cancer treatments. Also, cancer diagnosis showed to have sparked patients' interest in CAMs in 44% of participants.

Patients were shown to be selective in their choices, as study supervisor Prof Peter Hohenberger said: "What we found is that vitamins and minerals are very popular but patients take them specifically rather than using multivitamin supplements. Vitamin D is in the leading position, followed by selenium plus zinc, vitamin C, and interest in vitamin B17 is emerging", he highlighted.

Despite the reported popularity of non-conventional therapies among patients, clear information on their side effects and potential interactions with other drugs is still lacking. In the survey, 60% of patients recognised that information they had on safety issues of CAMs was insufficient, although they showed low concern for any potential risks. Hohenberger said: "When we looked at the sources of information on non-conventional practices, oncologists represented only 7%. In our study, patients mentioned repetitively that they were positively surprised about our interest in their use of CAMs."

He continued: "Patients mostly accessed information on complementary and alternative medicines on the Internet and other media (43%), friends (15%) and healing professionals (14%). In sharp contrast with this, when it came to finding information on side effects of cancer therapies or how to handle them, almost half of patients asked their oncologist."

Commenting on these results for ESMO, Dr. Markus Joerger of Cantonal Hospital in St. Gallen, Switzerland, said that the low risk perception associated with CAMs among patients is a big issue. "Patients tend to believe that supplements or herbs are generally safe, but they are not without risk. In daily practice, if you don't know what your patient is taking as alternative medicine, the risk of drug-drug interactions can significantly increase and have an impact on clinical outcomes." He also added that oncologists should try to preserve their role as primary source of information for cancer patients: "Although we must not demonise the Internet or other sources of information, getting information outside the clinical setting can often be misleading. Patients have to realise that they can discuss any health-related choices with their oncologist and be advised on different options when they wish to reduce stress related to cancer treatment, or more in general to feel better", he said.

Drug-drug interactions (DDI) is a relevant but often neglected topic in medical oncology and because sarcomas are so rare (only 1% of all cancer cases) to improve medical knowledge and clinical research in this setting is still a challenge. At ESMO 2018, a retrospective review involving 202 sarcoma patients undergoing chemotherapy or tyrosine kinase inhibitors reported that 18% major drug-drug interactions occurred in the study period (from 2014 to 2018) and that medical reconciliation, making an inventory of all the medicines prescribed to and taken by patients is advised before cancer treatment initiation to prevent adverse effects or ineffective treatments. (2)

Lead author Dr. Audrey Bellesoeur of University Paris Descartes, France, said: "We know from previous research that one in three ambulatory cancer patients are susceptible to potential drug-drug interactions. A better understanding of these mechanisms is necessary today for a real personalised medicine." In the study, DDI were more frequently observed with tyrosine kinase inhibitors while gemcitabine was associated with a significantly lower risk.

Bellesoeur continued: "In our review, 29% of drug-drug interactions requiring pharmacist interventions were associated with complementary alternative medicines. Risks of interactions with non-conventional drugs are the same as for other co-medications: mainly increased toxicity and loss of efficacy of anti-cancer treatments. However, we often have less information on the composition of these products and their risk of toxicity or interaction when used in combination with other agents."

According to Joerger, characterising the risk of DDI will be increasingly relevant in the future. "Since more options of care are available, patients are receiving more and more co-medications but they are still not routinely checked for drug-drug interactions. Medical review by a clinical pharmacist can certainly be an effective strategy to avoid or limit them as the study showed."

"However, cancer centres must also invest in integrative medicine that combines medical anti-cancer treatments with non-conventional therapies. The average oncologist has poor knowledge of these alternative methods; this is mostly due to a lack of studies and databases in the field. More efforts are needed to understand how to deliver mixed treatments safely and to build up experience to better advise our patients", he concluded.

A first step toward building knowledge in the field is to reach a consensus on what integrative oncology should mean. For this reason, ESMO encourages oncologists and other healthcare professionals to use the more precise definition of complementary and integrative medicine (CIM) when referring to all complementary treatments being used side by side with conventional therapies in controlled settings rather than the acronym CAMs which traditionally includes also treatments used instead of scientifically based medicine.

Based on evidence collected so far in the breast cancer setting, ESMO has recognised the benefits of physical exercise, mindfulness-based stress reduction (MBSR) programmes, hypnosis, yoga and acupuncture in supportive care while the use of antioxidants supplements, herbs, minerals, oxygen and ozone therapy, proteolytic enzymes, phytoestrogens, high-dose vitamins is not recommended as it has been associated to no beneficial effects or negative outcomes (3).

NEW YORK, October 9, 2018 - New York City (NYC), located within the Hudson River Estuary, inputs over 100 billion liters of combined sewage overflow (CSO) into surrounding surface waters annually. Little is known, however, about the impact of CSOs on wetlands that act as carbon sinks and provide buffers against climate change. Now a new study in the Soil Science Society of America Journal from researchers at The Graduate Center of The City University of New York (GC/CUNY) and Queens College suggests that local wetlands are capable of using CSO inputs in a manner that actually increases greenhouse gas emissions such as carbon dioxide and methane.

"Combined sewage overflows are frequent occurrences in New York City and the surrounding area," said Brian Brigham, the paper's first author and a recent Ph.D. recipient from GC/CUNY's earth and environmental sciences program. "The city's system is nearly at capacity during dry weather, so after even small amounts of precipitation, the subsequent surface runoff results in untreated sewage flowing into surface waters. These overflows deliver large amounts of carbon and nitrogen to wetland soils, so we wanted to test how saturation of these elements impacted greenhouse gas production."

Methodology and Findings

Researchers collected soils from three wetland sites -- Iona Island, Piermont, and Saw Mill Creek -- of varied salinity and proximity to New York City for use in laboratory incubation experiments. To simulate what happens when CSO saturates Hudson River estuary wetland soils, the researchers added acetate -- the simplest forms of organic carbon typically available in anaerobic soils -- to one group of samples. To other groups they added inorganic nitrogen (nitrate and ammonium), which is typically found in human sources of pollution. The samples were incubated, and daily carbon dioxide and methane production measurements were taken and compared to production rates from a control group of soil samples.

The experiments demonstrated that the readily decomposable carbon additions enhanced methane production more than 100 times and carbon dioxide production by more than twice the rate of the control group. The addition of inorganic nitrogen had no such effect.

Significance

"New York City has to identify and quantify its various sources of greenhouse gas emissions in order to reduce its contribution to climate change," said Jeffrey Bird, a professor of biology and earth and environmental sciences at GC/CUNY and Queens College, a co-author of the study, and Brigham's research co-adviser. "Some of these potential sources -- like local wetlands that receive significant carbon and nitrogen loading from New York City's sewage overflow -- are indirect. We know about effects of this overflow on human health, but little work has been done to determine how they may contribute to the city's greenhouse gas footprint."

Overall, said the researchers, the findings suggest that NYC's environmental impact extends into nearby undeveloped aquatic ecosystems such as the Hudson River Estuary, and that the impact on the environment can be significant.

Brigham and his colleagues have already taken their research into the field to measure actual greenhouse gas concentrations and emissions from New York City surface waters (which includes the Hudson River, its tributaries, and several sites in and around the city) and the Hudson River estuary. An important next step will be gathering additional data on CSO's impact on nitrous oxide emissions.