There was no significant difference in the detection frequencies between mothers and children

Posted on December 21, 2023 by hemp2022

The ELISA was performed using 96-well high binding micro titer plates coated with coating antigen cAg06 , washed with 10mM phosphate buffered saline + 0.05% Tween 20 , blocked with 0.5% bovine serum albumin in PBS. All standards, quality control samples and urine samples were prepared in 10% MeOH in PBS prior to the assay procedure. A 10-point calibration curve was prepared for each assay using a serial 1:5 dilution from the highest standard solution. A blank 0 ng/mL standard in the same 10% MeOH/PBS solution was also prepared. Wells containing instrument blanks received a 50 uL aliquot of PBST, while all remaining wells received a 50 uL aliquot of anti-rabbit 3PBA antibody #294 diluted 1:7000 in PBST. The goat anti-rabbit IgG-horseradish peroxidase conjugate was diluted 1:3000 in PBST. The substrate solution in dimethylsulfoxide per 25 mL of acetate buffer, pH 5.5 was added and color development was stopped after 15 min with 2 M H2SO4. The absorbance was measured using a Vmax micro plate reader in dual wavelength mode at 450 nm – 650 nm. Urinary creatinine concentrations were determined using the methods described in Ahn et al. 2011 .All urine samples, blank samples and QC samples were analyzed in triplicate. The final concentrations were calculated from the means of the triplicate values. If one of the triplicate values fell below the LOD it was not considered in the calculation of the mean concentration. Mean values that fell between the LOD and the LOQ were retained in all further statistical analyses. For each set of extractions,horticulture rack one urine sample was randomly chosen for QC analysis and was spiked to a level of 10 ng/mL 3PBA before extraction in order to verify that there were no matrix effects from the sample extract and to check method accuracy. Five different urine samples were also extracted and analyzed in duplicate at different time points in the analysis to verify the method precision.

For further validation of the ELISA method, and in order to try to quantify any cross reactivity that may have occurred, a set of six urine samples was sent to Emory University in Atlanta, GA where they were analyzed by high performance liquid chromatography-tandem mass spectrometry using a well established method .Summary statistics for both the volume based and creatinine adjusted 3PBA data were calculated. For concentrations below the limit of detection , an imputed value was assigned equal to the LOD divided by the square root of 2 . To determine predictive variables from the questionnaire data to include in a multivariate analysis, linear regression with both the log-transformed creatinine concentration and the variable of interest, referred to as the bivariate comparisons, were performed for each variable with 3PBA concentration. For each type of pesticide application, we created a continuous variable that represented the number of applications per year as well as a categorical variable indicating if that type of pesticide had been applied. Additional variables were also created summing pesticide applications across different application types. Food diaries were translated to English, and individual food items were grouped into ten different food categories: Fruit, Vegetables, Legumes, Meats, Snack/Processed Foods, Dairy, Beverages, Grains, Mixed Foods , and Other. Each category also had subcategories for specific, popular food items. For example, in the Dairy category, subcategories included Milk, Cheese and Other Dairy. Two variables were created for each food category and sub-category. First a categorical variable that indicated if the participant had consumed an item from a given category or sub-category. Second, a continuous variable was created with the number of servings in each category or sub-category. Volume based 3PBA concentrations were log-transformed to better approximate a normal distribution and regressed against the log-transformed creatinine concentrations and the individual questionnaire variable . Two regression analyses were conducted for each variable, one including only data from the mothers and one including only data from the children . There were a number of variables related to individual measures of home disrepair that were significant in the bivariate analysis. Because many of these measures of disrepair were correlated, item analysis was performed to select and evaluate the internal consistency of a set of items for a summative scale score.

The resulting Home Disrepair Score is computed by summing the water damage, leaks, carpet damage, worn spots or holes in the counters and rotten wood indicators and has good internal consistency in our sample . Multivariate regression was then performed to evaluate which questionnaire variables were most predictive of the urinary 3PBA concentrations. Three models were fit, one with the data from both the mothers and the children, one with data only from the children, and one with data only from the mothers. As an alternative, we also ran the models using the metabolite concentrations directly adjusted by the creatinine concentration. All statistical analyses were performed using SAS version 9.2 .The resulting Home Disrepair Score is computed by summing the water damage, leaks, carpet damage, worn spots or holes in the counters and rotten wood indicators and has good internal consistency in our sample . Multivariate regression was then performed to evaluate which questionnaire variables were most predictive of the urinary 3PBA concentrations. Three models were fit, one with the data from both the mothers and the children, one with data only from the children, and one with data only from the mothers. As an alternative, we also ran the models using the metabolite concentrations directly adjusted by the creatinine concentration. All statistical analyses were performed using SAS version 9.2 .Women in this study ranged in age from 23 to 51 years old; they had very low educational levels, with 46% having only a 6th grade education or lower; they were almost all married and lived in homes with 4 or more residents . Pest problems were common with 59% reporting insect problems, 43% using pesticides indoors and 35% applying pesticides outside . A Spearman rank correlation analysis was performed to see if there were associations between the two measures of home disrepair with pesticide application. Multiple significant correlations were observed , suggesting that poor housing conditions do lead to higher rates of pesticide application. For each set of three triplicates, the sample standard deviation of the urinary 3PBA concentration was computed. The average 3PBA concentration was 2.51 with an average standard deviation of 0.42 ng/mL. Less than 10% of the samples had a triplicate that fell below the LOD resulting in that value being dropped from the calculation of the mean.

Recoveries of the fortified urine samples ranged from 67 to 111% with an average of 82 ± 12%. The LOD of this analysis was estimated to be 0.1 ng of 3PBA in 1 mL urine. The limit of quantitation was determined to be 2 ng/mL. The percent difference between concentrations in duplicate aliquots of selective urine samples ranged from 3.6 to 28% with an average of 14%. Six urine samples were also analyzed by HPLC-MS/MS to further validate the ELISA method. The square of the correlation coefficient between the 3PBA concentrations from the two laboratory methods for the six samples tested was R2 = 0.934, and the %D ranged from 7.9 to 30.6% with an average of 25%, with the ELISA resulting in higher concentrations in four of the samples, and lower concentrations in two of the samples. Urinary 3PBA concentrations in our study were detected in 80% of all samples with a range of 0.3–13 ng/mL .However, adjustment for urinary creatinine resulted in a significantly higher concentration of urinary metabolites in children than in mothers . We calculated the correlation of urinary 3PBA concentrations between mothers and children. Urinary 3PBA concentrations from mothers and children in the same household were positively correlated for both volume based and creatinine adjusted concentrations .Variables included in the multivariate analysis were based upon the results of the bivariate analysis. The Home Disrepair Score, derived from the combination of multiple questionnaire items,vertical grow system was significant in the bivariate analysis only for mothers, while the Inside Housing Conditions score, derived from the staff evaluation during the MICASA follow-up interview, was significant only for the children. Because these two scores were designed to measure similar housing characteristics, both scores along with the Outdoor Spray pesticide use variable from the MICASA baseline questionnaire and the log-transformed creatinine concentrations were included in all three multivariate models described below. Multivariate models assessed factors associated with 3BPA concentrations in the combined sample , children only and mothers only . Both the Home Disrepair Score and Outdoor Spray were positive significant predictors of urinary 3PBA levels in the total study population model, which included logtransformed creatinine, the Home Disrepair Score, Outdoor Spray, Inside Housing Conditions and a Mother/Child variable .

The model restricted to children included food diary variables significant in the bivariate model: Apple , Milk , All Meat and Cereal as well as the log-transformed creatinine, the Home Disrepair Score, Outdoor Spray and Inside Housing Conditions. In this model Outdoor Spray and Inside Housing Conditions were marginally significant positive estimators of urinary 3PBA concentration. Cereal Total, while marginally significant, was negatively associated with urinary 3PBA in the children only data. In the mother only model we included the food diary variables Eggs , Beans , Grapes , Chicken , and Cereal as well as log-transformed creatinine, the Home Disrepair Score, Outdoor Spray and Inside Housing Conditions. The Home Disrepair Score , Outdoor Spray , and Cereal Total were all significant positive estimators of urinary 3PBA levels in the mothers. The models with the metabolite concentrations directly adjusted for creatinine resulted in similar associations .We assessed the exposure to pyrethroid pesticides in 105 women and 103 children in a farm worker population by laboratory measurements of the metabolite 3PBA in urine samples and by questionnaire data. This population had a relatively low educational level, with only about half of the adult women participating in our study reporting a 6th grade education or higher, in contrast to the 85% of U.S. adults who have a high school diploma . The results from the ELISA method used to analyze urinary 3PBA concentrations in this study were validated by a more traditional instrumental method at the Emory University in Atlanta, GA. The suitability of this newer analytical technique for use in biological monitoring of 3PBA is further corroborated by Chuang et al. who analyzed over 100 urine samples and showed high correlation between ELISA and GC/MS data, with the square of the linear correlation coefficient R2 = 0.906 and no significant between the two methods of analysis for any given sample . Children had higher concentrations of this metabolite than their mothers. This result is consistent with multiple pesticide exposure studies and most likely has to do with differences in behavior that leads to higher non-dietary ingestion in children . Once pyrethroid pesticides have entered the home, the carpets and cushioned furniture can act as repositories for pesticides . High levels of pesticides in carpet dust is a particular concern for young children who, due to their continual exploration of their environments, spend a large amount of time on the floor and have increased hand to mouth activity, resulting in increased exposure to the pollutants through dermal and non-dietary ingestion routes . The median concentrations in the National Health and Nutrition Examination Survey , a population based sample, collected from 1999 to 2000 were 0.30 and 0.26 ug/g creatinine for children and adults , respectively, and only increased slightly to 0.33 and 0.30 ug/g creatine for children and adults, respectively, in samples collected from 2001 to 2002 . Median urinary 3PBA concentrations of NHANES samples collected from 2007 to 2008 increased a bit more to 0.42 and 0.38 ug/g creatinine for children and adults, respectively . In the Children’s Total Exposure to Persistent Pesticides 2000 to 2001 study, a population based sample of preschool children living in Ohio, the median level was 0.32 ug/g creatinine for children aged 1–5 years . The 2004 Casa y Campo study, a community-based project aiming to reduce pesticide exposure among farm workers and their families in eastern North Carolina, reported median concentrations of 3PBA in children aged 1–6 years of 0.15 ug/g creatinine .

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Hepatitis C virus infection status was categorized as HCV negative if HCV antibody testing was negative

Posted on December 20, 2023 by hemp2022

To the best of our knowledge, there has not been a published report that has followed HIV+ individuals and MSM longitudinally over an extended period to characterize the natural history of their marijuana use. Past studies on substance use patterns in these populations have often focused on alcohol or heavy episodic drinking, cigarette smoking or stimulant use. Therefore, the objectives of the current study are to characterize the longitudinal trajectories of marijuana use in a sample of HIV-seropositive and HIVseronegative MSM over a period of 29 years, and to identify factors associated with unique trajectories of marijuana use, as well as those that can change over time that may modify the course of the trajectory. The MACS study protocols were approved by the institutional review boards at the respective recruitment centers and their community affiliates and informed consent was obtained from all participants. MACS participants return every 6 months for a physical examination, collection of blood specimens and completion of a detailed interview and questionnaires. The interview and questionnaires include demographic, psychosocial, behavioral and medical history data. The questions about their recreational drug use, including marijuana, alcohol, poppers, cocaine, crack, heroin, methamphetamine, ecstasy, injection drug use as well as smoking history since their last visit were collected using Audio Computer Assisted Self-Interviewing , an approach previously demonstrated to provide more accurate assessments of ‘sensitive behaviors’ than interview-administered questionnaires among MSM. This analysis included data collected from standardized cannabis grow supplies use questions from semiannual study visits 1 through visit 59 . The study sample included 3658 participants who had data about marijuana use for at least 25 % of their possible study visits during the follow-up period. Specifically, the men enrolled in 1984–1985 and 1987–1991 had 15 and 13 visits or more respectively, whereas, the men enrolled in 2001–2003 had 6 or more visits.

The median years of follow-up was 11.5 years. Alcohol Use—Using data regarding frequency of drinking and average number of alcoholic drinks, alcohol consumption at baseline and at each study visit was categorized as hazardous drinking, low or moderate use or no alcohol use. Tobacco Use—Participants were classified as never, former and current smokers of cigarettes at each study visit. Participants were asked two questions including: whether they ever smoked cigarettes and whether they smoke cigarettes now. Participants were considered to be current smokers if they responded ‘Yes’ to both questions. Participants were categorized as former smokers if they answered ‘Yes’ to ever smoking cigarettes and ‘No’ to the smoking cigarettes now. Never smokers included participants who answered ‘No’ to both questions. In addition, among current smokers, pack-years of smoking at initial visit and at each subsequent visit was calculated using participants’ responses to questions about the number of packs of cigarettes smoked per day. Stimulant/Recreational Drug Use—Participants were considered to be users of stimulant drugs if they reported the use of any of the following drugs at baseline and at each study visit: crack cocaine, other forms of cocaine, methamphetamines , other recreational drugs such as “ecstasy” or MDMA . Clinical Factors—HIV serostatus was assessed using an enzyme-linked immunosorbent assay with confirmatory Western blot tests on all MACS participants at each participant’s initial visit and at each study visit for participants who were initially HIV−. Standardized flow cytometry was used to quantify CD4 + T-lymphocyte subset levels by each MACS site and categorized as ≤200/mm3 , 201–500/mm3 , and >500/mm3 . Levels of plasma HIV RNA were measured using either the standard reverse transcription-polymerase chain reaction assay or with the Roche ultrasensitive assay were used to create a dichotomous variable to denote detectable versus undetectable viral load. Participants were classified at each MACS study visit as HCV positive if they were found to be in the process of seroconversion, acute infection, chronic infection, clearing , or previously HCV positive, but now clear of HCV RNA.

In addition to the aforementioned covariates, we considered that the trajectories of marijuana use over time among HIV+ participants may be influenced by factors specific to HIV-infection. ART use was dichotomized as use of any ART since the last study visit versus no therapy used. Attrition—Two binary variables were constructed and used as covariates to adjust for the effect of attrition: one for participants who dropped out or were lost to follow up and the other for those who died within the follow-up period .We used participant’s self-reported frequency of marijuana use across the follow-up period to identify trajectories using a semi-parametric group-based mixture model: PROC TRAJ SAS procedure. This approach sorts each participant’s frequency of marijuana use over their follow-up period into ‘clusters’ and estimates a single model—consisting of distinct trajectories. The procedure calculates the probability of each participant belonging to each trajectory group and assigns individuals into trajectories based on their highest probability of trajectory membership. Participants were followed from the time of enrollment until either the time of death, lost to follow up or until the end of the study period . We began by fitting a series of models with two to five trajectories by assuming linear, quadratic and cubic shape of the trajectory group curves. Several factors were considered in determining model fit and the optimal number of trajectory groups that best represented the heterogeneity of groups within the data: including, a priori knowledge from previous research on trajectories of marijuana use, model fit statistics including Bayesian information criterion, Akaike Information Criterion, average posterior probability of group membership, significance of the shape of the trajectory group curves , and size of the group membership . Model fitting was an iterative process, starting with a quadratic specification for the shape of the trajectory group curves and assessing whether an additional group resulted in a better model fit based on the aforementioned criteria.

We then estimated higher order shapes of the trajectory group curves and subsequently dropped non-significant terms. Models used a zeroinflated Poisson distribution to account for the large number of participants who reported not using marijuana. After the optimal number of trajectory groups and shape of trajectory change were selected, we included covariates of interest to the trajectory models. For this analysis, two types of covariates were considered: time-fixed/risk factors of trajectory group membership and time varying covariates. These time-fixed/risk factors comprise characteristics established before or at the time of the initial period of trajectories that may serve to predict membership in a given trajectory. Time-varying covariates measured during the course of the trajectory provide trajectory group-specific estimates of whether these covariates alter the course of the trajectory. One advantage of the PROC TRAJ software is that it allows for joint estimation of the parameters that describe the shape of the trajectory group curves,cannabis grow facility adjusted odds ratio and the coefficient estimates . We estimated models for all participants as well as by HIV serostatus. The analysis of all participants was adjusted for sociodemographic characteristics, depressive symptoms, substance use variables, hepatitis C infection status, attrition variables, and HIV serostatus. To account for potential differences in marijuana use by geographic region/site and MACS enrollment cohort, all models included variables for MACS center and enrollment cohort. In the analysis restricted to HIV+ participants, we included other clinical factors relevant to HIV+ status such as ART use, CD4 counts, and viral load detectability. All analysis was performed in SAS 9.4 . The 3658 participants in this study contributed a total of 105,595 person-visits; the median number of visits was 23 representing approximately 11 years . Among those who were HIV+ , the mean age at baseline visit was 35 years [standard deviation = 7.7], median number of visits was 23 , the majority were non-Hispanic whites and 24 % were non-Hispanic blacks . At baseline, among the HIV+ participants, marijuana use was high , 90 % used alcohol , 67 % reported stimulant/recreational drug use, 44 % were current smokers and 29 % were classified as having clinically significant depressive symptoms . At baseline, the HIV− participants in this study reported lower marijuana use , stimulant/recreational drug use , rates of current smoking and depressive symptoms than the HIV+ participants. Both groups were similar with regard to alcohol use . Marijuana Trajectories—Using data for the entire sample, participants’ self-reported frequency of marijuana use across the follow-up period identified four groups with distinct trajectories of marijuana use. We chose a four-group solution based on model parsimony, interpretability of trajectories, BIC and AIC values, significance of the polynomial growth terms, average posterior probabilities and trajectory group size membership . Model fit information and average posterior probabilities of all models are displayed in supplemental Tables 2 to 5. Figure 1 displays the trajectories of marijuana use of these four groups, which we labelled as: “Abstainer/Infrequent”, “Decreasers”, “Increasers” and “Chronic high” trajectory groups.

The abstainer or infrequent use group was characterized by a group of men who abstained from or infrequently used marijuana during the follow-up period. The decreaser group consisted of a group of men who reduced their marijuana use from nearly weekly use to infrequent use over the follow-up period. The increaser group comprised a group of men who initially decreased their marijuana use during the first 10 years of follow-up, after which they began to increase their use over time. The chronic high group represents a group of men who persistently used marijuana nearly daily over the follow-up period. Figure 2 displays trajectories of marijuana use among HIV+ participants: 61 % were in the abstainer/ infrequent use group, 14 % were in the decreaser group, 14 % in the increaser group, and 11 % in the chronic high group. Table 2 displays the baseline characteristics of the entire sample by the four identified trajectory groups. The median number of visits was lower among those in the increaser trajectory group. Participants in the abstainer/infrequent use group were older at baseline compared to the other groups. Frequency of marijuana use at baseline varied across the marijuana trajectory groups: as the proportion of daily users were < 1 % in the abstainer/ infrequent, 3 % in the decreasers, 10 % in the increasers, and 54 % in the chronic high groups. Racial status , detectable HIV viral load and CD4 counts were similar across the marijuana trajectory groups. This study utilized data from the MACS cohort to assess different patterns of marijuana use and to examine both risk factors and time-varying correlates associated with the different trajectories of marijuana use. Our analysis revealed that MSM in the MACS exhibited four distinct trajectories of marijuana use over time, including: abstainer/infrequent, decreasers, increasers and chronic high groups. Most of the men in this cohort displayed a pattern of abstaining or infrequent use over time whereas approximately 10 % who used daily or near daily at their index visit continued this pattern of use over their follow-up visits. About a quarter of the men changed their pattern of use over time, either decreasing or increasing use . Overall, our analysis suggested that these patterns of marijuana use over time were similar for both HIV+ and HIV− participants. In the analysis among all men, HIV+ status was associated with membership across all three trajectory groups reporting any marijuana use. Among HIV+ participants, having a detectable HIV RNA over time was associated with increasing marijuana use only among the men who increased their marijuana use during the follow-up period. Self-reported ART use over time in HIV+ men was associated with reducing marijuana use in the abstainer/ infrequent and increaser groups. Overall, alcohol consumption, cigarette, stimulant/ recreational drug use and IDU over time were associated with increasing marijuana use in nearly all trajectory groups. To the best of our knowledge, we are not aware of any previous study that has examined trajectories of marijuana use among HIV+ and HIV− MSM over a long period of follow-up. Prior studies that have assessed trajectories of marijuana use have focused on adolescents transitioning into young adulthood or racial/ethnic minorities, with a few studies reporting trajectories of use covering adulthood. Direct comparisons of the results from our study with prior research may not be straightforward due to the different populations studied and age periods covered. However, nearly all studies on trajectories of marijuana use have identified a group that abstained or used infrequently, with some identifying a chronic high user group and a few identifying groups that increased and decreased their use.

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Prospective studies have also demonstrated an increased risk of ARDS among smokers

Posted on December 19, 2023 by hemp2022

In 2014, PM less than 10 mm in diameter and less than 2.5 mm in diameter accounted for at least 3 million deaths and 85 disability-adjusted life years, primarily because of impacts on chronic cardiovascular and pulmonary conditions.Recently, air pollution in the United States has begun increasing for the first time since 2016 .Ambient pollution is a risk factor not only for the development or worsening of chronic illnesses but also for acute illness. For example, a case control study of older adults in Canada found that long-term exposure to PM 2.5 and NO2 was independently associated with an increased risk of hospitalization for community-acquired pneumonia.Short-term exposure to increasing levels of PM 2.5 was also shown to increase the risk of hospital admission for cardiac and respiratory disease in the United States.Several recent studies have demonstrated that exposure to even low to moderate levels of ambient pollutants increases the risk of developing ARDS. In a prospectively enrolled cohort of patients with ARDS in the Southeastern United States, long-term ozone exposure was associated with the development of ARDS in a dose-dependent manner.This association was most pronounced among patients with trauma as their primary risk factor. Although the association between ozone exposure and the development of ARDS remained significant when controlling for potential confounders including smoking status, there was a statistically significant interaction between ozone exposure and smoking. When patients were stratified by smoking status, ozone exposure remained significantly associated with ARDS only among smokers. The investigators concluded that cigarette smoking likely potentiates the risk from ozone exposure.A subsequent study of patients from a prospectively enrolled cohort in Philadelphia further investigated the relationship between exposure to pollutants and ARDS development among patients with trauma.This study analyzed exposure to low to moderate levels of ozone, NO2, SO2, PM 2.5, and carbon monoxide . Long-term exposure to each of the pollutants was independently associated with an increased odds of developing ARDS. Furthermore,growing tables even 6 weeks of exposure to NO2, SO2, and PM 2.5 increased the odds of developing ARDS.

Differences between the findings of the 2 studies might be accounted for by regional variation in levels of pollutants and air quality monitoring and by the shared risk factor of the population in the second study. Together these studies suggest that exposure to ambient pollution even at low to moderate levels for time periods as short as 6 weeks increases the risk of ARDS. Large epidemiologic studies have also found associations between exposure to ambient pollution and an increased risk of developing ARDS. An observational study of more than 1 million hospitalizations between the years 2000 and 2012 among Medicare beneficiaries who developed ARDS used advanced modeling drawing on multiple data sources to predict average annual levels of ambient pollution across more than 30,000 zip codes.The investigators found that the rate of ARDS hospitalizations increased with increasing levels of both PM 2.5 and ozone. These findings were consistent even in regions where pollutant levels were within national air quality standards. The effect of PM 2.5 was most pronounced among patients whose primary risk factor was sepsis. Ozone exposure had the greatest effect among patients with pneumonia or trauma as their primary risk factor. Although fully accounting for confounding factors in observational studies can be difficult, results were similar in a propensity matched analysis that included variables such as demographic variations and percent of ever-smokers.The results of this large study demonstrate that the association between ambient pollution and ARDS is present outside of the trauma population in patients who are older with comorbid conditions. Another retrospective cohort study of more than 90,000 patients found that increases in average annual PM 2.5 and ozone concentrations independently increased the odds of death from ARDS, suggesting that ambient pollution impacts not only ARDS incidence but also its outcomes.High levels of ambient pollution have also been associated with incidence and adverse outcomes in the coronavirus disease 2019 pandemic, although further studies in this area are needed.

The preponderance of the literature examining the connection between ARDS and ambient pollution has revealed an association between long-term rather than short term exposure to pollutants and ARDS incidence and outcomes. For example, the investigators who found a link between long-term ozone exposure and ARDS did not find the same association for 3-day exposure to environmental pollutants.However, one study from Guangzhou, China, demonstrated an association between short-term PM exposure and incident ARDS.This association may be related to the exceptionally poor air quality of the region in contrast to the other studies, which focused on settings with low to moderate levels of pollutants. There is some evidence, however, that short-term exposure to low levels of ambient pollution is associated with adverse pulmonary outcomes in critically ill patients. A study from Antwerp, Belgium—an area with historically low levels of ambient pollution—found that short-term pollution exposure was associated with longer mechanical ventilation.This study included a broad range of critically ill patients, some of whom did not have ARDS, but does suggest that a deleterious effect from short-term pollution exposure is not limited to areas with exceptionally poor air quality. Various underlying biological mechanisms may explain the basis for the relationship between environmental pollution and ARDS. A meta-analysis of exposure studies in healthy volunteers found that ozone increases the number of bronchoalveolar lavage neutrophils,which are implicated in ARDS pathogenesis.Ozone exposure also increased total protein levels in this analysis,reflecting loss of alveolar epithelial/endothelial barrier integrity.Many components of air pollution exert deleterious effects on pulmonary surfactant.Urban air particles directly stimulate an inflammatory response by pulmonary macrophages in vitro.PM has also been shown to increase markers of apoptosis, oxidative stress, and inflammation and to directly cause lung injury in mouse models.In humans, increased PM 2.5 levels are associated with circulating markers of endothelial injury,which is one of the key pathophysiological mechanisms in the development of ARDS.Although environmental pollutants alone may not be sufficient to induce severe pulmonary injury in humans, they likely increase susceptibility to other causes of ARDS such as respiratory infection and prime the alveolus for damage in these settings.

Wildfire smoke is an increasingly prevalent source of environmental pollution. Climate change has led to more frequent wildfires over a longer season.In the United States, PM air quality has improved over the past 3 decades except in areas that are prone to wildfires.Wildfires are associated with acute increases in ozone and PM as well as other pollutants such as volatile organic compounds.As noted earlier, previous studies of the relationship between ambient pollution and ARDS have generally focused on the average exposure in various regions over time, rather than on events that might be expected to acutely increase ambient pollution. In addition, smoke from wildfires may have chemical properties that make its risk profile different from that of PM or smoke from other sources.Although it is clear that wildfire-related pollution contributes to increased respiratory morbidity and health utilization overall,the specific relationship between ARDS and exposure to pollutants generated by wildfire smoke has not been studied . In vitro evidence demonstrates that wood smoke exposure diminishes alveolar barrier function and increases alveolar endothelial oxidative stress and apoptosis.In mice, PM collected during wildfires induced a more pro-inflammatory response and greater oxidative stress than ambient PM collected in the absence of wildfires.Wood fire smoke exposure has also been shown to induce a pulmonary and systemic inflammatory response in healthy volunteers.It is mechanistically plausible that the increased inflammation,grow tables 4×8 oxidative stress, and lung micro-vascular permeability in response to wood fire smoke demonstrated under experimental conditions would translate to an increased risk of ARDS. Future research should test whether ARDS incidence and outcomes change during or after wildfire events.The link between cigarette smoke and adverse health outcomes is well established, and reducing cigarette use has been a major focus of public health efforts over the past half century.Although rates of tobacco smoking have generally declined globally, they remain unacceptably high, and cigarette smoking is a leading cause of avoidable death. For example, the 2015 Global Burden of Disease Study found that approximately 11% of women and 14% of men in the United States report daily smoking and that smoking accounted for 6.4 million deaths globally.Alternative tobacco and nicotine delivery systems such as electronic cigarettes , or vapes, are increasingly popular, an especially concerning trend among children and adolescents.Although their long-term health consequences are not well established, e-cigarettes cause a specific lung injury syndrome, e-cigarette- or vaping-associated lung injury .E-cigarettes will be discussed in detail in a separate section. Although some retrospective studies have not found an association between cigarette smoking and ARDS,many studies demonstrate that both active smoking and passive cigarette smoke exposure are associated with ARDS, especially among certain clinical populations. Importantly, this association is independent of alcohol use, which is frequently associated with smoking and is a known risk factor for ARDS.A retrospective cohort study of patients in Northern California found that ARDS was more common among self-reported smokers in a dose-dependent manner. The investigators estimated that smoking carried an attributable risk in ARDS of 50%.A 2014 study of 381 patients with ARDS previously enrolled in randomized clinical trials examined the relationship between tobacco exposure and ARDS.Rather than relying on patient or surrogate reports, which lack sensitivity when compared with biomarkers for tobacco exposure,urine levels of NNAL -1–1-butanol were used to determine smoking history. The rate of active smoking among patients with ARDS in this study was significantly higher than the population average .

Smokers were younger and had fewer comorbidities than nonsmokers despite similar ARDS severity. Although unadjusted mortality among smokers was significantly lower than in nonsmokers, there was no significant difference after adjusting for comorbidities and severity of illness,suggesting that smokers develop ARDS when their illness is less severe than that of otherwise similar patients. Current cigarette smoking conferred increased odds for the development of transfusion-related acute lung injury in a two center prospective case-control study.Donor smoking history increased the odds of grade 3 primary graft dysfunction in a multi-center prospectively enrolled cohort of lung transplant recipients.A prospective study of the association between tobacco exposure and the development of ALI after blunt trauma used plasma levels of cotinine to differentiate between active and passive smoke exposure and to quantify exposure levels.Active smokers and passively exposed patients in this cohort from a single level 1 trauma center had similarly increased odds of developing ARDS independent of confounding factors, including alcohol use and trauma severity. Higher levels of plasma cotinine were associated with higher odds of developing ARDS.Another prospective study of patients with trauma enrolled between 2005 and 2015 confirmed that cigarette smoke exposure remains an important risk factor for ARDS and highlighted a particularly elevated risk among passive smokers in later years.In patients with trauma, impaired platelet aggregation likely mediates at least part of the effect of cigarette smoke exposure on ARDS risk.In addition, cigarette smoke alters the microbiota in patients with trauma such that their pulmonary microbiome is enriched for specific pathologic bacteria that are associated with ARDS development.In a prospectively enrolled cohort with diverse predisposing risk factors for ARDS, active cigarette smoking both by self-report and urine NNAL was associated with an increased odds of ARDS among patients with non-pulmonary sepsis as their primary predisposing risk factor.Patients with trauma and transfusion as their primary risk factor were not included in this study because of the previously established link between smoking and ARDS in these populations. Again, the mortality rate of active smokers was lower in an unadjusted analysis, but mortality was similar after adjusting for baseline severity of illness.This finding is consistent with the previous one that smokers are at increased risk of developing ARDS when their underlying illness is comparatively less severe. Similarly to ambient pollution, cigarette smoke exposure likely predisposes the lung to injury in the setting of a second insult such as trauma, multiple transfusions, or sepsis . This concept was elegantly demonstrated in an experimental model in healthy humans who were exposed to inhaled lipopolysaccharide .BAL and plasma biomarkers for alveolar epithelialcapillary permeability, inflammation, and alveolar endothelial dysfunction were compared between self-reported smokers and nonsmokers. Absolute measurements were consistent with more alveolar permeability to protein and inflammation in smokers, and statistical tests of interaction demonstrated that smoking potentiated these responses to LPS.In mice, cigarette smoke exposure itself does not cause frank lung injury, but mice exposed to cigarette smoke develop worse pulmonary edema, increased vascular permeability, worse histologic injury, and increased biomarker evidence of inflammation after exposure to LPS.

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Counts and rates were not reported when n < 16 to protect the identity of individuals in the dataset

Posted on December 18, 2023 by hemp2022

Specific to being a sexual minority, GBM who were not out about their gay identity were less likely to report having any other mental health condition at the univariable level than those who were open about being gay. We posit that this may be due to the fact that individuals who are public regarding their sexual orientation are easier targets for harassment or discrimination. This is supported by findings from D’Augelli and Grossman , where GBM who came out at an earlier age and GBM who spent more years out of the closet were more likely to experience victimization than individuals who came out later or who spent less time out of the closet. More generally speaking, Meyer argues that experiences of victimization in the forms of stigma, prejudice, and discrimination that GBM experience may be the cause for the higher prevalence of mental health conditions in GBM populations and refers to this as minority stress . Stigma may also help explain why HIV-positive GBM were more likely to report a substance use disorder in our study. HIV-related stigma has been linked to poorer mental health in a meta-analysis by Logie and Gadalla and a review by Smit and colleagues . Readers should be cautious when interpreting our results. Most notably our results rely on participants’ retrospective self-report of recent substance use and sexual behavior and compare these data with lifetime mental health diagnoses. As such, we are limited in determining causal direction, but instead position these findings as a more representative profile of GBM who had ever been diagnosed with a mental health condition given our use of respondent-driven sampling. We did not conduct diagnostic interviews to account for undiagnosed conditions,mobile racking for growing and thus underestimated the true burden of mental health issues. We attempted to address current symptomology through the inclusion of AUDIT and HADS scores.

However, given the paucity of validation studies for AUDIT, but particularly HADS within GBM populations, we caution the interpretation of these findings and call for new research validation studies with GBM populations. Regardless, our analyses demonstrate some measure of construct validity in that higher scores on both measures were linked to reporting mental health conditions in our study. Our measure of sexual orientation “outness” was only asked for gay-identified participants, and a general measure should be included in future studies. A nurse-administered structured interview was used to assess mental health diagnoses and current treatments to ensure these questions were more accurately understood and answered. Given the potential impact of social desirability and reporting bias , we used CASI to collect data regarding illicit substance use. However, we did not use drug testing to confirm or correct self-report data and likely underestimated the true prevalence of substances used . Despite these shortcomings, one of the strengths of our study is the use of RDS to overcome previous sampling shortfalls with GBM and produce a more accurate representation of the population parameters of these variables of interest for the GBM population of Metro Vancouver. Our study also adds new data regarding the detailed prevalence of substance use and mental health conditions among GBM populations in Canada filling a gap in currently available published literature. Finally, our work goes further to examine explicitly the relationship between substance use and mental health conditions among GBM identifying important relationships that have implications for counseling and public health services, interventions, and policy. The greater burden of mental health conditions and higher prevalence of substance use in GBM populations highlight the need for a more explicit focus on these issues in research and service provision. Mental health specialists should be aware of the relationships with sexuality and substance use when working with GBM clients, particularly issues regarding identity disclosure, number of sexual partners, and higher background community prevalence of substance use .

Future research should seek to validate current measures and to confirm the relationship between substance use and mental health conditions, which has been demonstrated to produce a syndemic including suicidal ideation among GBM and HIV acquisition . Our study was based in a major metropolitan area, which may limit generalizability to GBM in rural or remote regions, whom are a population with distinct needs and challenges that should be further examined. In order to evaluate generalizability, additional research is needed to explore these issues among GBM populations in other urban and non-urban centers across Canada, particularly if these studies employ RDS or other more representative sampling methods. Given the role of social factors in mental well-being, future research should directly examine experiences of homophobia or heterosexism as possible precursors to substance use and/or mental health issues, along with potential mediators and protective factors. Examining demographic factors independent of one another may not reflect the diversity of experiences that exists among GBM. Using an intersectional approach, which looks at how multiple identities such as race, sexual orientation, and class, interact with one another to shape experiences , may also explain the distribution and experiences of mental health and substance use within diverse communities of GBM. In spite of experiences of marginalization and discrimination, many GBM do not go on to develop mental health conditions or engage in harmful substance use. Shilo, Antebi, and Mor found that factors such as support of family and friends, meaningful connections with the LGBT community, and having a steady partner, protect against developing poorer mental health in lesbian, gay, bisexual, queer, and questioning adults. Thus, more focus on factors such as these that promote resiliency in GBM would be beneficial to include in future research on mental health and substance use in these populations. Compared with the Canadian population, GBM living in Metro Vancouver have increased levels of substance use and mental health conditions. The strong link between substance use and mental health among GBM has important implications for public health promotion programming and care service provision.

A number of social determinants increase the likelihood of mental health diagnosis among GBM, including disclosure of sexuality, low income, and race/ethnicity. GBM living with HIV were significantly more likely to have a lifetime doctor-substance use disorder compared with HIVnegative GBM. Greater attention to these issues is needed across all health and social services given their disproportionate effect on GBM populations. Health promotion and interventions should address issues of substance use, mental health, and sexuality in unison and future research can help direct these efforts by examining possible precursors of these issues, which may be the result of discrimination, prejudice, and stigma.Tobacco use in the general population has declined substantially in the past three decades, but rates remain high in certain populations. The prevalence of tobacco use in the homeless population is 3 to 4 times that of the general population.Among homeless adults, tobacco-related chronic diseases including heart disease, cancer and chronic obstructive pulmonary disease are common and contribute significantly to the increased morbidity and mortality in this population.Among a clinic-based sample of homeless adults aged 50 and older, tobacco-attributable deaths accounted for 26% of the overall mortality and 54% of substance-related mortality.The health consequences of smoking occur disproportionately among older individuals because of the cumulative effects of long term smoking.Among older adults,modular cannabis grow racks tobacco-related chronic diseases, particularly chronic obstructive pulmonary disease and coronary heart disease, are among the most common reasons for emergency health care services and preventable hospitalizations.Current tobacco use contributes significantly to all-cause mortality among older adults, suggesting that tobacco cessation at any age is likely to significantly reduce tobacco-related morbidity and mortality.In a nationally representative sample, older adults were less likely to quit smoking than younger adults because of reduced interest in quitting smoking, higher nicotine dependence, and lower support for smoke-free norms.This highlights the need for tobacco cessation interventions that address tobacco-related beliefs and practices among older adults. Over the past 2 decades, the median age of homeless adults increased from 37 years in 1990 to almost 50 years in 2010.Despite increased tobacco-related morbidity and mortality among older homeless adults, little is known about tobacco use and cessation behaviors in this population. Prior research on tobacco use in the homeless population has focused on younger adults, where the average age of study participants in previous studies was less than 44 years.The high prevalence of tobacco use and the increased burden of tobacco-related chronic diseases with aging underscore a need for studies that characterize tobacco use and cessation behaviors among older homeless adults in order to develop tobacco control interventions that address the unique needs of this population. We conducted a study of a cohort of homeless individuals aged 50 and older sampled from the community to examine rates of and factors associated with tobacco cessation.

We hypothesized a priori that current smoking would be associated with symptoms of depression, substance use disorders, history of incarceration, and history of staying in shelters.We also hypothesized that persons who reported smoking heavily or having symptoms of depression at enrollment would be less likely to make a quit attempt at follow-up.We used previously validated questions on tobacco use at the enrollment and 6-month follow-up interviews. We asked participants whether they had ever smoked 100 cigarettes in their lifetime, and classified those who did as ever-smokers. We classified ever-smokers who reported smoking “every day or some days” as current smokers, and those who reported “not smoking at all” as former smokers. We asked current daily smokers to report the number of cigarettes smoked daily. For current non-daily smokers, we estimated average daily cigarette consumption based on self-reported numbers of cigarettes smoked on smoking days in the past 30 days. Participants reported how soon they had smoked their first cigarette after waking, which we dichotomized as greater or less than 30 minutes. We asked current smokers about their intentions to quit smoking . We asked current smokers to report whether they had stopped smoking for 1 day or longer in the past 6 months because they were trying to quit smoking. We asked participants who responded affirmatively to making a quit attempt to report the length of their last quit attempt. We defined reporting a quit attempt in the past 6-months at the follow-up visit as the primary outcome variable. We determined the proportion of participants who were abstinent for 30 days and 90 days at the 6-month study visit using self-reported information on the length of the last quit attempt. At the 6-month follow-up visit, we obtained additional information from participants on their quitting behaviors.If participants reported having made a quit attempt during the past 6 months, we asked them to report the medications, strategies, and support system they had used during their last quit attempt. Participants reported whether they had used nicotine replacement therapy and/ or any of the US Food and Drug Administration -approved medications for smoking cessation during their last quit attempt. Participants reported whether they had used other strategies to quit smoking including gradually cutting back on cigarettes, switching to smokeless tobacco, other combustible tobacco , or electronic cigarettes, or giving up cigarettes all at once. Participants self-reported their use of a telephone quit line, group or one-on-one smoking cessation counseling, hypnosis or acupuncture, and other internet or family-based support for smoking cessation. Participants also reported whether they had received advice to quit cigarette smoking from their health care provider in the past 6 months, and whether they had acted on the advice to quit smoking.Participants self-reported age, gender and race/ethnicity at the enrollment visit. At the enrollment and follow-up interviews, participants reported whether they had spent any time in jail or prison in the past 6 months. At both visits, we gathered residential history of every place that the individual had stayed, by using a 6-month follow-back residential calendar.We categorized participants as having stayed in shelters if they reported staying in a homeless shelter for single adults or families during the past 6 months.We used questions derived from the World Health Organization’s Alcohol, Smoking, and Substance Involvement Screening Test  to assess use of cannabis, cocaine, amphetamines, and opioids. We dichotomized the severity of substance use as low versus moderate to high risk .We administered the WHO’s Alcohol Use Disorders Identification Test with a shortened time frame of the previous 6 months to assess risk and severity of alcohol use disorders. We categorized AUDIT scores of 8 or more as indicative of hazardous and harmful alcohol use or an alcohol disorder.

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Edaravone is an antioxidant and ROS scavenger marketed as a neurovascular protective agent

Posted on December 15, 2023 by hemp2022

While the consensus on a healthy diet has generally been interpreted to mean limiting intake of sodium, red meat and saturated fat intake, several other dietary factors have been reported to reduce stroke risk, such as diets rich in magnesium, flavonoids, lycopenes, fruits and vegetables, and chocolate. Further, the Mediterranean diet was found to reduce cardiovascular risk in a randomized trial.Intensive exercise has been also reported to have a benefit in secondary stroke prevention.Thus, it is incumbent upon healthcare providers to emphasize lifestyle changes for stroke risk reduction. Pharmacological approaches to reduce stroke risk often include agents which prevent or reduce thrombus formation. Anti-platelet agents are used for secondary prevention in most non-cardiogenic IS patients to prevent worsening of atherosclerotic disease. The main mechanism of IS reduction are through blockade of platelet aggregation and activation through the suppression of thromboxane A2 via cyclooxygenase-1 blockade and upregulation of cAMP via phosphodiesterase 3 or P2Y12 receptor blockade. Aspirin, clopidgrel, dipyridamole, and cilostazol have all demonstrated efficacy for secondary prevention of IS through this anti-platelet effect. Prasugrel is newer antiplatelet agent, but has not been shown to be superior to conventional anti-platelet agents in recent study.Ticagrelor, a recently approved anti-platelet inhibitor of the P2Y12 ADP receptor in coronary disease, was shown to also have efficacy in primary and secondary IS prevention.Dual antiplatelet treatment typically consists of aspirin plus clopidogrel has met with conflicting results. Early studies suggested that such combination therapy led to unacceptably high risks of major cerebral and gastrointestinal bleeding and a recent metaanalysis indicated that such hemorrhage due to DAPT negated any antithrombotic benefit. It should be pointed out that these early studies used long term DAPT for months or even years. More recent studies of short term DAPT have now shown that this approach can further reduce stroke risk while not increasing the risk of significant hemorrhage .As such,grow racks indoor it is now common practice to prescribe DAPT for periods of 21 or 90 days after non-cardiogenic IS.

It should also be noted that DAPT may increase HTf when used with t-PA in experimental stroke models,In contrast, a recent study showed that combination therapy of aspirin or clopidogrel with cilostazol has been reported not to increase the incidence of HTf and to reduce relative risk of recurrent IS by 51% compared to single anti-platelet therapy.Cilostazol is also thought to have pleiotropic effects such as an improvement of endothelial function by inhibition of smooth muscle cell proliferation and reduction of inflammation.In a recent experimental study, cilostazol was also shown to have a neuroprotective effect via reduction of inflammatory molecules, stabilization of the blood-brain barrier, and prevented apoptosis.Significant extracranial carotid artery stenosis is detected about 15% of IS patients. Revascularization, either via endarterectomy or endovascular approaches, of symptomatic stenotic carotids has been shown to significantly reduce stroke risk, especially if carried out within two weeks of the index transient ischemic attack or stroke.While endarterectomy has long been the mainstay of revascularizing stenotic carotids, endovascular approaches include carotid artery angioplasty followed by stenting , which has the advantage of being less invasive and similarly efficacious.Less clear is the role of carotid revascularization on asymptomatic carotids.In patients with a cardiogenic cause of stroke, anti-thrombotic therapy to prevent thrombus formation has been shown in several studies to substantially reduce recurrent stroke, particularly for atrial fibrillation.The vitamin K antagonist warfarin has been the most widely studied and used, but recently, orally available direct thrombin and factor X inhibitors have been shown to be as effective and easier to manage than warfarin. Several clinical studies have shown that DOACs are noninferior to warfarin in the prevention of IS with a lower incidence of significant HTf. Further, the presence of cerebral microbleeds , which may be an indication of underlying cerebral amyloid angiopathy, increases the risk for cerebral hemorrhage in association with anti-thrombotic therapy. The incidence of intracranial hemorrhage in the presence of CMBs during DOAC treatment has been reported to be less than anti-platelet and warfarin therapy. This is thought to be due to the ability of DOACs to avoid inhibiting factor VII, although hemorrhage risk is still higher compared to that amongst patients without CMBs.

Thus, it is still not recommended to initiate DOAC or other anticoagulant treatment in this patient population.ESUS are now increasingly thought to be due to occult atrial fibrillation , in part, due to the availability of long term cardiac monitoring technology ; however, it is unclear whether these patients should be empirically anticoagulated.DOACs were considered for secondary prevention of ESUS; however, a few studies have failed to show that this approach is effective.Other embolic sources such as aortic plaque, patent foramen ovale, and neoplasm have been identified as the etiology of ESUS where anticoagulation is not always the indicated treatment. Hence, documentation of occult AF will be important prior to initiating anticoagulant therapy. Other beneficial effects of DOACs have been suggested in experimental studies. Dabigatran, a direct thrombin inhibitor, has been shown to inhibit microglial and astrocyte activation.Edoxaban, a factor X inhibitor, has also been shown to have anti-inflammatory effects via suppression of PAI-1, MCP-1, and TNF-α. Some ‘natural’ approaches have been studied in stroke prevention as well, but have not been routinely implemented at the clinical level. Polyphenol supplementation has been proposed as a preventive agent for IS. In a previous study, polyphenol intake was thought to act as an antioxidant, leading to reduction in atherosclerosis.It is also thought to have other beneficial properties such as regulating neurotrophin levels, especially nerve growth factor and brain-derived neurotrophic factor . Epigallocatechin gallate , which is a polyphenol found in green tea, has gained interest for its putative antioxidant and neuroprotective effects via prevention of NF-κB activation, inhibition on PI3K/Akt signaling, and improvement of mitochondrial dysfunction.EGCG also seems to the downregulate MMP-2 and MMP-9 and upregulate the endogenous t-PA inhibitor plasminogen activator inhibitor-1 . These latter observations suggest that EGCG may have a role as an adjunctive agent to t-PA by extending the therapeutic time-window for thrombolytic treatment while reducing other undesirable side effects of t-PA treatment such as severe HTf, brain edema and BBB disruption. Other polyphenols have demonstrated antioxidant effects, which have the potential to reduce stroke risk. Resveratol, a component of red wine, has been shown to inhibit phosphodiesterase and regulate cAMP, AMPK, and SIRT1 pathways during ischemic injury. Salvianolic acid has been shown to have neuroprotective effects dependent on mitochondrial connexin43 via PI3K/Akt pathway.

Flavonol rich diets has been reported for a 14% relative risk reduction of IS. Flavonoids is main sources of apple polyphenol, which has been reported to reverse oxidative stress via P38 mitogen-activated protein kinase signaling pathway.harmacological recanalization with t-PA has been the mainstay for acute IS treatment for several decades. t-PA therapy has been shown to improve neurological outcome provided it is initiated within 4.5 h from symptom onset. In addition to rt-PA therapy, recent randomized controlled trials have demonstrated the efficacy of mechanical thrombectomy in large vessel stroke.98) In several of these trials, pre-treatment with t-PA before MT intervention was superior to t-PA alone. A few studies also showed that MT could be extended to even 24h after stroke onset, provided imaging studies showed a large mismatch. The DAWN ,DEFUSE3 , and EXTEND studies all evaluated endovascular methods of thrombectomy to acutely revascularize occluded large cerebral vessels that cause stroke. These studies have not only shown that acute revascularization can improve stroke outcome from longer time windows,grow shelf rack but can also lengthen the therapeutic time windows for t-PA. These studies utilized imaging based criteria to identify appropriate candidates. In particular, those studies which showed longer time windows for thrombectomy used imaging to demonstrate a large, and thus salvageable ischemic penumbra in relation to the ischemic core . Further, imaging criteria have allowed for the use of t-PA therapy in so-called “wake-up stroke”, where the time of stroke onset is unclear because the patient reports waking up with a neurological deficit after being neurologically intact at the time of sleep. Such cases may be pre-selected by mismatch from diffusion weighted and FLAIR MRI.While the expansion of therapeutic time windows and improved outcomes have been shown in acute revascularization approaches, reperfusion injury has the potential to worsen outcome, compared to no revascularization. While this phenomenon is well established in experimental stroke models, its existence in clinical stroke has been debated. Nevertheless, some have reported a hyperintense acute reperfusion marker on MRI which is thought to predict HTf and clinical worsening in some IS patients, and this has been suggested R/I in humans.In experimental studies, R/I has been attributed to the introduction and generation of ROS when a previously occluded vessel is opened. This flood of ROS leads to inflammation. Inflammation then results in the generation of various damaging immune mediators, effector molecules and more ROS. ROS can also lead to apoptosis/necrosis via DNA/RNA damage, lipid peroxidation, and the reduction of ATP production. Further, t-PA treatment can promote extracellular matrix damage to lead to HTf. Hence, targeted R/I treatments in conjunction with t-PA and/or MT has the potential to further improve neurological outcomes.A few potential adjunctive agents have been explored at the clinical level.At the clinical level, edaravone contributes to improving neurological function and reducing adverse events. In the PROTECT 4.5 trial, the efficacy and safety of combination therapy with edaravone and t-PA in stroke patients suggested that combination therapy might increase the numbers of patients with better outcomes, accelerated recanalization and reduced HTf.

The YAMATO study showed that the timing of edaravone infusion did not affect the rate of early recanalization, symptomatic HTf, or favorable outcomes after t-PA therapy. However, early edaravone infusion in parallel with endovascular revascularization led to better functional outcomes at discharge, lower mortality, and lower incidence of HTf in a recent clinical trial. Edaravone has been already approved for the treatment of IS patients who present within 24 h of the onset of symptoms in Japan and other countries, but not the United States. Thus, the prospects of adding edaravone to t-PA and MT seem favorable. Therapeutic hypothermia has already been shown to improve neurological outcomes in comatose survivors of cardiac arrest and neonatal hypoxic encephalopathy. While it has yet to be shown whether it has any role in patients with IS, major mechanisms for its neuroprotective effect seems to be related to its effects on multiple cell death pathways including inflammation, apoptosis, excitotoxicity and preservation of metabolic stores.HT has also been shown to reduce BBB disruption and HTf in relation to t-PA use in experimental models.Combination therapy with HT and t-PA also reduced HTf and endogeneous tPA expression, and has the potential to extend the time window for other acute therapies. Few clinical studies have been carried out in IS. The ReCCLAIM and ICTuS studies assessed the combination therapy with rt-PA and HT in IS patients with large pretreatment infarcts, and both trials showed that this approach was safe and may even reduce reperfusion injury, as outcomes were improved compared to stroke patients who did not receive HT. The ICTuS2 study showed the safety and feasibility of both HT and HT with t-PA, although cooling increased the incidence of pneumonia. HT has been also combined with MT with selective brain cooling elicited by intra-arterial chilled saline infusion and was shown to be both safe and feasible.The RECCLAIM-Ⅱ also examined MT with HT; however, this trial was stopped early for lack of funding.A recent laboratory study also showed that the neuroprotective effect of HT differentially affects cells of neurovascular unit depending on the depth, duration and even timing of cooling.Yet, clinical studies used a single target temperature with fixed duration . Thus, it may be important to design future clinical trials with adjusted temperature and cooling duration depending on targeted cell type for neuroprotection versus vasculoprotection. Recent years have seen an advent in population-based studies that examine the prevalence, etiology, and developmental trajectories of diverse sub-clinical psychopathological symptoms that pose a risk for the later development of severe mental illnesses. It is increasingly recognized that most categorically defined psychiatric disorders occur on a spectrum or continuum that is not necessarily normally distributed , show high heterogeneity and symptom overlap, and share genetic and environmental risk factors . Therefore, population-based studies of psychopathology in youth assess a broad spectrum of symptoms as well as genetic risk, cognitive and general functioning, socioeconomic, and environmental factors to yield a more complete understanding of symptom etiology and development.

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What Can You Grow With Vertical Farming

Posted on December 14, 2023 by hemp2022

Frequent testing for HIV infection can identify new infections early, and it is essential in ending the HIV epidemic. HIV self-testing is an alternative HIV screening method that is commercially available, approved by the Food and Drug Administration, and can reach individuals who have never tested before. It can reach populations at risk, such as Black and Latinx individuals, identify new cases of HIV infection, and lead individuals to seek additional HIV prevention options, such as testing for sexually transmitted infections or pre-exposure prophylaxis. Prevention studies and public health programs have been adopting HIV self-tests and combining them with new technologies, such as smartphone apps or smart devices, to reach populations with high incidence of HIV infection, such as Black and Latinx MSM. Despite multiple efforts, the uptake of HIV testing remains inadequate, especially among individuals at high risk for HIV infection. Thus, optimizing the promotion of HIV testing is important. Due to their extensive popularity, social media sites and dating apps have been used to promote and recruit participants for HIV prevention research studies with high rates of success. According to a recent Centers for Disease Control and Prevention report reviewing HIV self-testing programs, 27 health departments and community organizations used multiple platforms for promotion, mainly social media followed by “traditional” printed media and dating apps . Compared to in-person recruitment, web-based platforms have the capacity to reach a high number of difficult-to-reach populations and individuals at risk , overcoming stigma or other logistic obstacles in a cost-efficient manner. Indeed, the New York Department of Public Health used advertisements on social media, dating apps,plant grow rack and websites to reach 28,921 users, identifying 17,383 eligible MSM, transgender, and gender nonconforming individuals during its HIV self-testing campaign. Most of the participants were under the age of 35 years and identified as Black or Latinx. In addition, the first wave of this campaign reached 3359 users in only 23 days, distributing 2497 home test kit voucher codes to eligible users.

Social media and dating apps have been widely adopted as means of promoting HIV home testing. Although different from dating apps and social media sites, information search sites are commonly used for seeking information on HIV testing and PrEP and could represent a promising outreach avenue. Their use for enrollment and HIV testing promotion has not been evaluated. However, little is known about the relative effectiveness of these different web-based platforms in promoting HIV self-testing. Parker et al conducted a secondary analysis in a study enrolling substance-using sexual and gender minority adolescents and young adults to evaluate the efficacy of their enrollment strategy. The study used multiple methods to enroll participants, including social media platforms , dating apps , internet-based health boards, and venue-based enrollment. They recorded 17,328 visits to the eligibility screener on the landing page, with a 36.2% screener survey completion ratio. Researchers identified 580 participants among those who consented and were eligible to participate , indicating a high recruitment proportion. The majority of their participants were enrolled from Facebook, Instagram, and Grindr. Studies and programs use these platforms based on the experience of previous studies and expert recommendations. Data on the effectiveness of public health promotion through different platforms leading to testing or PrEP are missing. We can only infer the effectiveness of promotion indirectly, as head-to-head comparisons of the effectiveness of the different platforms and sites to reach individuals for public health promotion are missing. This would allow researchers and prevention programs to optimize their budget and strategy. The primary objective of this study was to compare ordering of HIV self-testing kits among users recruited through 3 different types of web-based platforms, including social media, dating apps, and information search sites. Test kit ordering was used as a proxy for analyzing the effectiveness of promoting HIV self-testing on different sites. The secondary goal was to evaluate the association of key moderating variables—substance use, psychological readiness to test, and perceptions and attitudes related to HIV testing—with the ordering of HIV self-testing kits.

In this longitudinal observational cohort study, advertisements promoting free HIV self-testing were placed on three platform types: social media , dating apps , and information search sites . The advertisements were organized in 2 “waves,” with each wave consisting of 1 social media website, 1 dating app, and 1 information search site. The Wave 1 recruitment stopped early, as Grindr unexpectedly stopped running all self-service platform advertisements due to a change in corporate ownership. We continued with Wave 2 as planned and a relaunched Wave 1 once Grindr access was restored. Before launching each wave, we allocated the same amount of funds for each of the 3 sites and optimized them to run for at least 30 calendar days by dividing the available funds in the prespecified promotional period. However, due to slow enrollment during the COVID-19 pandemic, we extended the second phase of Wave 1 up to 63 days. The advertisement used on social media and dating apps was an image that included a person and text , whereas promotional keywords related to HIV testing and PrEP were selected for information search sites . The same image and keywords were used in all waves. The advertisements were launched in the District of Columbia and 8 states , which were selected based on their high incidence of HIV infection. More information regarding the promotional campaign can be found in the published protocol. Upon clicking on the study advertisement, website users landed on the study information page, where they received general information about the study, underwent eligibility screening, and reviewed study procedures. Following electronic informed consent, participants completed the baseline assessment and were emailed a unique electronic code to order their HIV home self-test kit through Orasure.com . Participants also received an electronic coupon for a free telemedicine PrEP visit. Participants were followed up at 14 and 60 days after enrollment. At follow-up, participants were asked about their HIV self-test use and self-test results; depending on their self-test result, they were asked if they visited a PrEP provider and started PrEP, as well as their opinions on PrEP. If they tested positive for HIV antibodies with the home self-test kit, they were asked if they had visited a clinic for confirmatory testing and HIV treatment. In addition, we tracked test kit orders through automated reports, collected anonymous advertisement metrics through the web applications of the platforms, and recorded the costs for each promotion site and wave.

Participants who were enrolled from Google and Facebook while Grindr was inactive were excluded from analyses. This ensured that we included data when all 3 sites were active and thus had an equal chance to enroll participants. Participants who did not order a test kit within 60 days of the test code being emailed to them were classified as “not ordered a self-test kit.” The 2 advertisement periods of Wave 1 were combined before analysis. Prior to statistical modeling, the number of HIV home self-test kits ordered from each platform, specific platform types , and number days of recruitment in each wave were summarized. In addition, the observed daily self-test kit order rates for each site and platform type were calculated . Per our primary research question, we intended to determine the statistical difference in the self-test kit ordering rates by platform type using a Poisson regression model; however, due to significant platform-by-wave interactions and widely differing order rates between sites within the same platform, it was not appropriate to combine or pool sites across the same platform for statistical evaluation of the platform difference. Therefore, we compared the specific platform differences in terms of the order rates within the same wave. We conducted pairwise comparison for all 6 sites from the 2 waves with multiple testing adjustments using the Hochberg method. Demographic and baseline characteristics were presented using summary statistics. Continuous variables were summarized using percentiles , and means with their SDs. Categorical variables were summarized with frequencies and percentages. To assess differences in the measures between participants who ordered a test kit and those who did not order a test kit, we used the Student t test for continuous variables, Fisher exact test for categorical variables,sliding grow racks and Wilcoxon rank sum test for Likert responses. Data analysis was carried out using Statistical Analysis Software . In this study of MSM at risk for HIV infection, we investigated the effectiveness of promoting free home HIV self-test kits on various internet platforms. More than half of the participants ordered a self-test kit, although only a small proportion of HIV-negative individuals reported seeking PrEP services. Our results showed that dating apps were the most efficient platform to distribute HIV self-test kits to men at high risk for HIV infection. Risk behavior, attitudes toward HIV testing and treatment, perception of HIV-related stigma, and medical mistrust were not associated with ordering a self-test kit. Finally, we recorded high prevalence of alcohol and cannabis use among participants. Overall, information search sites performed poorly in recruiting and enrolling individuals. The site advertisement metrics showed a better click-through rate than social media and a similar number of users screened, but ultimately only a small number of individuals enrolled in the study. Search engines have a broad audience as they are available to everyone with access to the internet, and they do not require an account. In comparison, dating apps had the highest click-through rate, screening numbers, and enrollment. Users of dating apps are more likely to be MSM and engage in high-risk behaviors, which could explain the higher engagement with the promoted study advertisements. Consequently, dating apps may be more cost-efficient in enrolling select individuals compared to other platforms. Using search engines for promotion may reach higher numbers of individuals, but dating apps achieved higher interaction with the promotion message in this study. Another important difference between platforms that may have affected individual site performance is the type of advertisement message.

Social media and dating apps use blast advertisements with images and text, whereas search engines use text-only promotional content. Researchers attempting to identify the best type of advertisement to reach MSM through the internet for free at-home HIV testing showed that the click-through rate for a text-only advertisement on Google was 0.38%, whereas that for advertisements with images, such as the ones used in social media and dating apps, was higher, between 0.77% and 2%. There is a lack of published data regarding the performance of promotional campaigns to enroll participants or promote HIV prevention messages. This limits our capacity to make comparisons with similar campaigns. Our data showed that the cost of enrolling individuals from dating apps is lower compared to that for social media and information search sites. This is mainly due to the higher engagement and higher number of participants enrolled through dating apps. Future studies should collect and report advertisement campaign metrics as well as the costs of enrollment per participant screened and enrolled, which can allow for a better evaluation of the cost-effectiveness of different platforms.Our study demonstrated that HIV self-testing can reach individuals at high risk. We enrolled Latino and Black MSM at a high risk for HIV infection in 10 areas with a high incidence of HIV infection. The study population included individuals with inconsistent and infrequent condom use, and nearly 25% of them reported that they had never tested for HIV. We also identified individuals who reported a preliminary positive result, which demonstrates the capacity of HIV home testing to reach hard-to-reach populations, overcome obstacles, and increase testing. Our findings underline the importance of identifying the best possible promotional platform that will allow public health programs to reach an even larger number of individuals at risk. Our findings did not identify any major differences between participants who ordered a kit compared to those who did not order a test kit. However, our data showed a small statistical difference in terms of the questionnaires on self-perceived stigma, as well as the participant perceptions about the risks of HIV infection. Public health stakeholders should continue their efforts to educate individuals about HIV and support vulnerable individuals against stigma. Substance use was common among study participants, especially alcohol and cannabis use. Similarly, Westmoreland et al also reported a high incidence of cannabis use and alcohol use among a sample of MSM, transgender men, and transgender women. Heavy alcohol use is associated with an increase in sexual behaviors that might put persons at risk for HIV acquisition and transmission.

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Are there post-harvest processing techniques that enhance the final product?

Posted on December 13, 2023 by hemp2022

Yes, there are several post-harvest processing techniques that can enhance the final quality of cannabis products. These techniques focus on refining the raw cannabis material to improve characteristics such as potency, flavor, and overall appeal. Here are some post-harvest processing techniques commonly used in the cannabis industry:

  1. Trimming and Bucking:
    • Properly trimming and bucking the harvested cannabis flowers involve removing excess leaves and stems. This not only improves the visual appeal of the buds but also enhances the efficiency of subsequent processing steps.
  2. Cannabis Extraction:
    • Cannabis extraction methods, such as solvent-based extraction (using ethanol, CO2, or hydrocarbons) or solventless extraction (such as rosin pressing), can be employed to isolate cannabinoids and terpenes from the plant material. This is commonly used to produce concentrates, oils, and tinctures with higher cannabinoid concentrations.
  3. Decarboxylation:
    • Decarboxylation is a process that involves heating cannabis to convert non-psychoactive cannabinoids (such as THCA and CBDA) into their active forms (THC and CBD). This step is crucial for making edibles, tinctures, and other products where the cannabinoids need to be in their activated state.
  4. Infusions:
    • Cannabis-infused products, such as edibles, beverages, and topicals, involve incorporating cannabis extracts or decarboxylated cannabis material into various mediums. This allows for precise dosing and diverse consumption methods.
  5. Terpene Preservation:
    • Some post-harvest processing techniques focus on preserving and enhancing the terpene profile of cannabis. For example, cold extraction methods, like live resin extraction, aim to capture and retain the full spectrum of terpenes found in fresh, uncured cannabis.
  6. Microbial and Contaminant Testing:
    • Rigorous testing for microbial contaminants, pesticides, heavy metals, and other impurities is a crucial post-harvest step to ensure the safety and quality of the final cannabis products.
  7. Quality Control and Testing:
    • Regular quality control measures involve testing for cannabinoid and terpene profiles, ensuring accurate labeling of products,dry cannabis and monitoring for any changes in quality over time.
  8. Packaging and Storage:
    • Proper packaging is essential to maintain the freshness, potency, and quality of cannabis products. Packaging should be airtight, light-resistant, and compliant with local regulations. Proper storage conditions, including temperature and humidity control, also contribute to preserving the quality of the final product.
  9. Product Formulation:
    • In the case of infused products, careful formulation can enhance the overall experience for the consumer. Balancing cannabinoids, terpenes, and other ingredients can create products with specific effects, flavors, and aromas.
  10. Product Innovation:
    • Continuous research and development lead to innovative post-harvest processing techniques and product formulations. This includes exploring new extraction methods, delivery systems, and product categories.

Each of these post-harvest processing techniques plays a role in creating a diverse range of cannabis products that cater to different consumer preferences and needs. The specific techniques employed depend on the intended end product and the goals of the cultivator or processor.

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Can you provide insights into the lifecycle of a cannabis plant in an indoor commercial cultivation facility, from seed to harvest?

Posted on December 12, 2023 by hemp2022

Certainly! The lifecycle of a cannabis plant in an indoor commercial cultivation facility typically goes through several stages: germination, seedling, vegetative, flowering, and harvesting. Here’s an overview of each stage:

  1. Germination:
    • Duration: 1-7 days.
    • Conditions: Seeds are placed in a germination medium with warmth, moisture, and darkness. Once the seed cracks open, a young root (taproot) emerges.
    • Transfer: Once the taproot is a few centimeters long, the seedling is carefully transferred to the growing medium (soil, coco coir, or hydroponics) to continue growth.
  2. Seedling Stage:
    • Duration: 2-3 weeks.
    • Conditions: Seedlings need high humidity, moderate light, and a gentle breeze for strengthening stems.
    • Light Cycle: Typically, seedlings are kept under 18-24 hours of light per day.
    • Nutrients: A mild nutrient solution is introduced as the seedling develops.
  3. Vegetative Stage:
    • Duration: 4-8 weeks or longer (depending on desired plant size).
    • Conditions: Cannabis plants focus on leaf and stem growth. They require a balanced nutrient regimen, controlled temperature, and humidity.
    • Light Cycle: For vigorous growth, a light cycle of 18-24 hours of light per day is maintained.
    • Training: Some growers use techniques like topping, pruning,pipp grow racks or low-stress training to shape the plants.
  4. Pre-Flowering Transition:
    • Duration: 1-2 weeks.
    • Conditions: Light cycle is adjusted to 12 hours of light and 12 hours of darkness to induce flowering.
    • Sexing: Female and male plants become distinguishable. In commercial operations, male plants are typically removed to prevent pollination of female flowers.
  5. Flowering Stage:
    • Duration: 7-14 weeks (strain-dependent).
    • Conditions: Plants produce buds (flowers) in response to the change in light cycle. Temperature, humidity, and nutrient levels are carefully managed.
    • Light Cycle: Maintained at 12 hours of light and 12 hours of darkness.
    • Nutrient Changes: Adjustments are made to nutrient ratios to support bud development.
    • Pest and Disease Management: Vigilant monitoring for pests and diseases is crucial during the flowering stage.
  6. Ripening and Harvest:
    • Duration: Final weeks of flowering.
    • Conditions: As the buds ripen, some strains may show changes in color, and trichomes become more amber. The plant’s nutrient intake is usually reduced during the final weeks.
    • Harvest: Plants are harvested when the buds have reached their peak potency and maturity. Harvesting involves cutting the entire plant, after which it is trimmed, dried, and cured.
  7. Drying and Curing:
    • Duration: 1-3 weeks (drying), several weeks to months (curing).
    • Drying: Buds are hung in a controlled environment to dry slowly. Proper drying prevents mold and enhances flavor.
    • Curing: Buds are stored in airtight containers to cure. This process enhances the flavor, aroma, and smoothness of the final product.
  8. Post-Harvest Processing:
    • Trimming: Buds are trimmed to remove excess leaves and improve aesthetics.
    • Testing: Samples may be tested for potency, terpene profiles, and contaminants.
    • Packaging: Final products are weighed, packaged, and labeled for distribution.

Throughout the entire lifecycle, careful monitoring of environmental conditions, pest control, nutrient management, and adherence to regulations are critical for a successful and compliant commercial cannabis cultivation operation.

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What security measures are essential for safeguarding an indoor commercial cannabis cultivation operation?

Posted on December 11, 2023 by hemp2022

Newton et al. found that positive reinforcement through pleasureseeking behaviors was the primary motivator for most METH+ individuals, however, pain avoidance was also an important, non-overlapping factor. Thus, people may engage in methamphetamine use and subsequent riskier sexual behaviors as coping methods to avoid the emotional pain associated with loneliness and/or rejection, particularly if they have poor inhibitory control. Torres and Gore-Felton proposed this type of paradigm, which they called the Loneliness and Sexual Risk Model , that posits that the relationship between loneliness and sexual risk behavior is mediated by substance use and impulsive behavior. In our sample, individuals who experienced potentially problematic levels of loneliness reported significantly higher impulsivity/disinhibition than those who reported loneliness within normal limits across both METH−/+ groups, providing initial support for the LSRM model. However, in separate multi-variable regression models with beliefs and intentions to practice safer sex as outcome variables, the interaction between potentially problematic loneliness and methamphetamine status was statistically significant while impulsivity/disinhibition was not, suggesting that an individual who is methamphetamine dependent and lonely has worse beliefs and intentions to practice safer sex than their lonely METH− counterparts, regardless of their impulsivity/disinhibition level. Polysubstance use is an important aspect in methamphetamine dependence that was also considered in our cohorts . Of the three nonmethamphetamine lifetime substance use disorders that were examined , there was a significant association between loneliness with lifetime opioid use disorder. This association was found in only the methamphetamine dependent group, but occurred in the opposite direction than what was to be expected. However, given the relatively low prevalence of positive lifetime opioid use disorder in the whole sample,grow glide rack as well as within the methamphetamine dependent group , these findings may have been driven by a skewed sample.

Even when DSM-IV substance use disorder criteria were not considered, the number of individuals reporting any lifetime opioid use was low , again suggesting a skewed, non-representative sample of opioid users. By contrast, alcohol and cannabis were the substances that had the most number of people reporting any lifetime use . Post-hoc analyses found that both cumulative densities of alcohol and cannabis were significantly higher in the METH+ than the METH− group, suggesting that methamphetamine dependent individuals consumed larger quantities of these substances over shorter periods of time relative to individuals who were not methamphetamine dependent. However, neither alcohol density or cannabis density predicted loneliness, beliefs about practicing safer sex, or intentions to practice safer sex. Rather, methamphetamine dependence consistently predicted these variables above and beyond alcohol use, cannabis use, and other covariates such as age and HIV status, indicating its robust effects on both loneliness and the potential of engaging in riskier sexual behaviors. Our study did not find a link between poorer norms and intentions to practice safer sex among people with HIV who had undetectable viral loads, suggesting that they are equally as concerned about taking part in unsafe sex compared to people with HIV who were detectable for the virus. However, people with HIV are more likely to engage in riskier sexual behaviors in the past 6 months and prior to the past 6 months than HIV− individuals. We did not find an association between loneliness and self-reported, past sexual risk behaviors in the whole sample. However, given the cross-sectional nature of our study, it may be inappropriate to link current feelings of loneliness with past risky sexual behaviors. Rather, it may be more informative to investigate the factors that have been shown to be significantly associated with future sexual risk behaviors in the literature such as attitudes, personal norms, and intentions of engaging in safer sex . Indeed, our data confirmed that beliefs and intentions of engaging in safer sex were significantly associated with lower current sexual risk. Findings from this study have potential, important public health implications related to identifying and treating individuals who may be at-risk for engaging in HIV-transmission risk behaviors. Prior work has shown that methamphetamine use is a predictor of riskier sexual intentions and riskier sexual practices . However, changing drug use behavior may not be a realistic goal, or sufficient target in sexual risk reduction interventions; rather, addressing maladaptive coping due to emotional distress may be more successful .

Thus, identification of lonely individuals who are dependent on methamphetamine, and whom we found were more likely to report poorer personal norms and intentions to engage in safer sex practices, allows us to capture an at-risk group and consider alternative approaches that could be integrated into substance use treatment programs to reduce riskier sexual behaviors. Increased opportunities for social contact , one-on-one or group interventions based on mutual aid, enhanced social support , improving social skills , and addressing maladaptive social cognitions may all be important target areas to reduce the prevalence of loneliness in this at-risk population. Though this study provides preliminary evidence for the importance of identifying those with high feelings of loneliness, and its implications on future attitudes and beliefs about engaging in potentially risky behaviors, it is not without limitations. First, our data are cross-sectional, so we cannot assume directionality or claim that loneliness influences riskier personal norms and intentions to practice safer sex. It is entirely possible that a bidirectional relationship may exist. Our selection criteria were developed such that they focused on studying methamphetamine effects while minimizing the potential confounding effects of other substances. By doing so, generalizability of findings to poly-substance users becomes more limited. Similarly, recruitment from HIV clinics may introduce some confounding factors that may not have been fully accounted for by controlling for HIV status, thus potentially limiting generalizability to non-HIV populations. Though results from our recruited sample suggest that the relationship between loneliness and riskier beliefs and intentions about practicing safer sex are theoretically relevant to many kinds of individuals , future work should specifically examine whether there are particularly risky periods of methamphetamine addiction in which loneliness more strongly influences riskier beliefs and intentions about safer sex practices, which could be investigated by evaluating the specific recruitment sources . Furthermore, given the discrepancy between average age of first methamphetamine use relative to the average age in the METH+ sample , a potential survival bias may exist, which may skew findings. Of note, the proportion of individuals with HIV in the METH− and METH+ groups were nearly identical , suggesting that if survival bias is present, it is more likely specific to methamphetamine-related characteristics rather than HIV-related selective survival bias. Our current design also did not query further into the dimensions of loneliness that an individual may be encountering . Additionally, although our sample was large enough to see robust effects, it was relatively small, especially considering the number of potentially important covariates.

This research would ideally be replicated in a larger sample of METH− and METH+ individuals. Further work should also investigate how loneliness may differentially influence attitudes about sex among individuals with different partner statuses , as well as among sexual and gender minorities,grow rack greenhouse especially given important considerations raised by Bryant et al. and Race et al. regarding the role of controlled drug use and safer sex in facilitating community, building identity, and responding to marginalization in such minority groups. Despite these limitations, our findings highlight the high prevalence of loneliness among individuals with methamphetamine use disorder, and explores the potential impact of loneliness among those who are typically at-risk of engaging in HIV-related risk behaviors by finding a unique association between loneliness and riskier beliefs and intentions regarding the practice safer sex. These results suggest potential areas of intervention, including promotion of adaptive beliefs and intentions to engage in safer behaviors. In addition, findings from this study are highly relevant during the current COVID-19 pandemic, as individuals have been required to engage in unprecedented social distancing and may be experiencing the effects of prolonged social isolation. Consequently, feelings of loneliness and mental health problems could be elevated , and may contribute to engagement in riskier behaviors such as practicing poorer safer sex in order to feel social connection, pleasure, and avoid emotional pain. In an era when antiretroviral therapy is recommended for all people living with HIV regardless of CD4+ T-cell count, best clinical practices and high-impact interventions emphasize retention in care and ART adherence. Achieving and maintaining viral suppression is crucial to optimizing health outcomes and substantially reducing the risk of onward HIV transmission. At the same time, consistent evidence indicates that economic disparity is a driving force of the HIV epidemic and undermines these efforts in regions throughout the world, including Africa, Asia, Europe and North America. Poverty is a major barrier to receiving care and achieving success at each step of the HIV care continuum for PLWH in countries across the spectrum of income and resource availability. Even in well-resourced settings, in which infrastructure exists to provide facilities, clinicians, laboratory, and supply chain management for various types of health care, a number of factors associated with poverty act as barriers to care. Recognition of such barriers has led to specific models for understanding health services use, including the Behavioral Model for Vulnerable Populations. This model posits that, in addition to factors limiting health services use in the general population, such as age, income and health insurance, there are factors uniquely common in vulnerable populations that act as additional barriers to care, including violence, incarceration, substance use and homelessness.

Homelessness can result from a variety of conditions and co-occurring predictors that are often associated with poverty, and it stands out as a strong predictor of poor HIV outcomes. In Canadian and U.S. cities, where resources exist to provide HIV care for low-income individuals, homelessness predicts a failure to use ART, housing eviction predicts unsuppressed viral load, and becoming housed predicts viral suppression. International guidelines for improving ART adherence recognize housing instability as a barrier to adherence and provide recommendations for homeless individuals that emphasize the need for retention in care as well as case management. The degree to which recent care and case management influence viral suppression among low-income and homeless persons is unclear. Their influences are particularly uncertain when considered alongside factors known to predict VL in low-income individuals, such as food insecurity, substance use and inconsistent health insurance. Similarly, their influences are uncertain among low-income women living with HIV , in whom substance use and violence are both disproportionately common and act synergistically to negatively influence health outcomes, particularly in the context of urban poverty. Issues of poverty and homelessness are important because homelessness is increasing around the world, including in resource-rich areas across Europe and North America. In fact, civil emergencies due to homelessness have been increasing in U.S. cities, and clinics caring for PLWH in resource-rich areas report that the degree of housing instability affects population-level rates of viral suppression. However, factors unique to the health of homeless and unstably housed persons are still routinely overlooked. In addition, while homeless women have different –often more severe –needs and patterns of morbidity and mortality compared to men, women are often under-sampled in homeless research, including HIV-specific homeless research. Moreover, while prior research points to any homelessness as a risk factor for negative health outcomes, data on exposure levels of various housing conditions, such as the number of nights spent sleeping in a given venue, and its impact on virologic outcomes among women, are lacking. We conducted one of the first longitudinal studies to determine independent associations between factors uniquely common in low-income women living in a well-resourced urban environment and unsuppressed viral load, with an emphasis on housing and SAVA syndemic factors. Prior research in this population suggests that different types of living conditions beyond “homeless,” including various types of homelessness and residence in low-income single room occupancy hotels, contribute to health status, but the impact of these factors on viral load has not previously been assessed. Informed by the Behavioral Model for Vulnerable Populations, we hypothesized that multiple types of living conditions would be associated with unsuppressed VL. Our goal was to inform programs and interventions aimed at decreasing detectable viremia in low-income WLWH. Participants provided written informed consent for all study activities, including medical record review. Reimbursement of $15 was given for each study interview and $5 per month was given to update contact information.

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Effortless Cannabis Cultivation: Explore the Best Indoor Grow Systems

Posted on December 8, 2023 by hemp2022

Given this background, the aim of this paper is to outline briefly how ethnicity has been operationalized historically and continues to be conceptualized in mainstream epidemiological research on ethnicity and substance use. We will then critically assess this current state of affairs, using recent theorizing within sociology, anthropology, and health studies. In the final section of the paper, we hope to build upon our ”cultural critique” of the field by suggesting a more critical approach to examining ethnicity in relation to drug and alcohol consumption. According to Kertzer & Arel , the development of the nation states in the 19th century went hand in hand with the development of national statistics gathering which was used as a way of categorizing populations and setting boundaries across pre-existing shifting identities. Nation states became more and more interested in representing their population along identity criteria, and the census then arose as the most visible means by which states could depict and even invent collective identities . In this way, previous ambiguous and context-dependent identities were, by the use of the census technology, ‘frozen’ and given political significance. “The use of identity categories in censuses was to create a particular vision of social reality. All people were assigned to a single category and hence conceptualized as sharing a common collective identity” , yet certain groups were assigned a subordinate position. In France, for example, the primary distinction was between those who were part of the nation and those who were foreigners, whereas British, American, and Australian census designers have long been interested in the country of origin of their residents. In the US, the refusal to enfranchise Blacks or Native Americans led to the development of racial categories, and these categories were in the US census from the beginning. In some of the 50 federated states of the US, there were laws,grow rack including the “one drop of blood” rule that determined that to have any Black ancestors meant that one was de jure Black . Soon a growing number of categories supplemented the original distinction between white and black.

Native Americans appeared in 1820, Chinese in 1870, Japanese in 1890, Filipino, Hindu and Korean in 1920, Mexican in 1930, Hawaiian and Eskimo in 1960. In 1977, the Office of Management and Budget , which sets the standards for racial/ethnic classification in federal data collections including the US Census data, established a minimum set of categories for race/ethnicity data that included 4 race categories and two ethnicity categories . In 1997, OMB announced revisions allowing individuals to select one or more races, but not allowing a multiracial category. Since October 1997, the OMB has recognized 5 categories of race and 2 categories of ethnicity . In considering these classifications, the extent to which dominant race/ethnic characterizations are influenced both by bureaucratic procedures as well as by political decisions is striking. For example, the adoption of the term Asian-American grew out of attempts to replace the exoticizing and marginalizing connotations of the externally imposed pan-ethnic label it replaced, i.e. “Oriental”. Asian American pan-ethnic mobilization developed in part as a response to common discrimination faced by people of many different Asian ethnic groups and to externally imposed racialization of these groups. This pan-ethnic identity has its roots in many ways in a racist homogenizing that constructs Asians as a unitary group , and which delimits the parameters of “Asian American” cultural identity as an imposed racialized ethnic category . Today, the racial formation of Asian American is the result of a complex interplay between the federal state, diverse social movements, and lived experience. Such developments and characterizations then determine how statistical data is collected. In fact, the OMB itself admits to the arbitrary nature of the census classifications and concedes that its own race and ethnic categories are neither anthropologically nor scientifically based . Issues of ethnic classification continue to play an important role in health research. However, some researchers working in public health have become increasingly concerned about the usefulness or applicability of racial and ethnic classifications. For example, as early as 1992, a commentary piece in the Journal of the American Medical Association, challenged the journal editors to “do no harm” in publishing studies of racial differences .

Quoting the Hippocratic Oath, they urged authors to write about race in a way that did not perpetuate racism. However, while some researchers have argued against classifying people by race and ethnicity on the grounds that it reinforces racial and ethnic divisions; Kaplan & Bennett 2003; Fullilove, 1998; Bhopal, 2004, others have strongly argued for the importance of using these classifications for documenting health disparities . Because we know that substantial differences in physiological and health status between racial and ethnic groups do exist, relying on racial and ethnic classifications allows us to identify, monitor, and target health disparities . On the other hand, estimated disparities in health are entirely dependent upon who ends up in each racial/ethnic category, a process with arguably little objective basis beyond the slippery rule of social convention . If the categorization into racial groups is to be defended, we, as researchers, are obligated to employ a classification scheme that is practical, unambiguous, consistent, and reliable but also responds flexibly to evolving social conceptions . Hence, the dilemma at the core of this debate is that while researchers need to monitor the health of ethnic minority populations in order to eliminate racial/ethnic health disparities, they must also “avoid the reification of underlying racist assumptions that accompanies the use of ‘race’, ethnicity and/or culture as a descriptor of these groups. We cannot live with ‘race’, but we have not yet discovered how to live without it” .Reinarman and Levine have argued that investigations of ethnicity in alcohol and drugs research have typically taken the form, whether intentionally or not, of linking “a scapegoated substance to a troubling subordinate group – working-class immigrants, racial or ethnic minorities, or rebellious youth” . Different minority ethnic groups have often been framed at one time or another by their perceived use of alcohol and illicit drugs, regardless of their actual substance using behaviors and regardless of their relative use in comparison with drug and alcohol use among whites .In mainstream drug and alcohol research, traditional ethnic group categories continue to be assessed in ways which suggest little critical reflection in terms of the validity of the measurement itself.

This is surprising given that social scientists since the early 1990s have critiqued the propensity of researchers to essentialize identity as something ’fixed’ or ’discrete’ and to neglect to consider how social structure shapes identity formation. Recent social science literature on identity suggests that people are moving away from root edidentities based on place and towards a more fluid, strategic, positional, and context-reliant nature of identity . This does not mean, however,growing racks that there is an unfettered ability to freely choose labels or identities, as if off of a menu . An individual’s ability to choose an identity is constrained by social structure, context, and power relations. Structural constraints on identity formation cannot be ignored, as people do not exist as free floating entities but instead are influenced and constrained in various ways by their socioeconomic and geographical environment . As such, an identity is not just claimed by an individual but is also recognized and validated by an audience, resulting in a dialectical relationship between an individual and the surrounding social structures . Similarly, a ‘new’ perspective on ethnic identity specifically has emphasized the fluidity and contextually-dependent nature of ethnicity, minimizing notions about ethnicity as a cultural possession or birthright and instead emphasizing ethnicity as a socially, historically, and politically located struggle over meaning and identity . Ethnicity or ethnic identity is not some immutable sense of one’s identity but rather something produced through the performance of socially and culturally determined boundaries . Hence, individuals are not passive recipients of acquired cultures but instead active agents who constantly construct and negotiate their ethnic identities within given social structural conditions .In spite of these sociological contributions, which have enriched our understanding of identity generally and ethnicity specifically, the alcohol and drugs fields have not adequately integrated these perspectives, thwarting our ability to understand the relationships between ethnicity and substance use. As such, the field is ripe with correlations between ethnic group categories and substance use problems, resulting in solutions to problems that focus on reifying questionable social group categorizations and revealing little about how drugs are connected to identities and shaped by broader social and cultural structures. It is important to note that we do not intend to argue that existing categories of ethnicity be disregarded in the alcohol and drugs fields. As Krieger and colleagues have noted in another context , surveillance data documenting health disparities, in our case in substance use, are exceedingly important in terms of identifying potential inequities in health. However, without understanding the complexity of ethnic identity and its relationship to substance use, these surveillance data may perpetuate stereotypes and the victimization of specific socially-delineated ethnic groupings, obfuscate the root causes of substance use and elated problems, and reify politicized categories of ethnicity which may have little meaning for the people populating those categories. While acknowledging that socially-deliented ethnic categories are important for documenting social injustices, we must also be vigilant about questioning the appropriateness of those categories .

Conceptually this type of critical approach is important for considering how substance use is related to negotiations of ethnicity over time and place and bounded by structure. Maintaining a static and homogenous approach towards ethnic categorizations in the alcohol and drugs fields presents at least two problems. First, it risks overlooking how drugs and alcohol play into a person’s negotiation of identity, particularly ethnic identity, thus revealing little about the pathways that lead to substance use. Cultural researchers have long emphasized the importance of commodity consumption in the construction of identities and lifestyles , particularly within youth cultures , and how it can be an important factor in demarcating and constituting social group boundaries . A limited body of research in the alcohol and drugs field has emphasized the role of substance use in constructing and performing identities , particularly ethnic identities , uncovering how subgroups within traditionally-defined ethnic minority categories use drugs and alcohol to distinguish themselves from ethnically similar others. For example, in a qualitative study of Asian American youth in the San Francisco Bay area in the US, narratives illustrated how youths’ drug use and drug using practices were a way of constructing an identity which differentiated them from “other Asian” youth groups, specifically allowing them to construct an alternative ethnic identity that set them apart from the “model minority” stereotype . Thus taste cultures and consumption-oriented distinctions highlight the continuing salience of and interconnections not just between substance use and changing notions of ethnicity but also between substance use, class and ethnicity. Ethnic identity gets translated into social captial which in turn has ramifications for one’s economic and social standing . Second, failing to critically appraise our use of fixed and homogenous ethnicity categories in the alcohol and drugs fields jeopardizes our ability to identify the broader social and structural determinants of alcohol and drug use and related problems—like poverty, social exclusion, and discrimination—which are crucial issues for addressing social injustices. So often studies revealing correlations between ethnic categories and substance use related problems result in discussions about the importance of developing culturally-appropriate prevention and treatment interventions, overlooking the structural conditions that adversely affect socially-defined ethnic groupings and may result in some form of engagement with alcohol and/or drugs. For example, research on street cultures, where ethnic identifications and drugs play a central part, illustrates how some ethnic minority youth use and/or sell drugs to actively construct counter-images or ethnically-infused street cultures of resistance within their neighborhoods, which some researchers have called “neighborhood nationalism” , as a way of resisting or transcending “inferior images” ascribed to them by the wider society . These street cultures provide alternative definitions of self-identity, especially for young men, who live in communities marked by poverty and marginalization and who have little access to masculine status in the formal economy .

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