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We find a larger variance in county random intercepts in the pre-Prop 47 period

Posted on November 14, 2023 by hemp2022

When comparing the full sample prior to propensity score matching, a greater fraction of post-Prop 47 arrest events had concurrent arrests of other types , suggesting a decline in arrests when drug possession was the sole offense. Post-Prop 47 arrestees also appeared to differ in terms of criminal histories, with more prior arrests . The propensity score matched sample had better covariate balance. For sale/transport arrests, pre and post groups were much more similar . Though they were not compared statistically, we find the population arrested for these offenses appears quite different from those arrested for Prop 47 drug offenses. Prop 47 offenders had more numerous but lower level prior arrests and convictions. Racial differences were notable as well, with larger racial disparities among sale/transport arrests .With regard to Prop 47 arrests, pre and post estimates for each county suggest counties where felony convictions were more likely pre-Prop 47 were reduced towards zero to a greater degree, such that post-Prop 47 outcomes were more similar across counties. Mixed models with random pre-Prop 47 intercepts, random coefficients for the policy effect, and an unstructured covariance structure allowing for a correlation between intercept and slope random effects, showed a significant, negative covariance between random effects . Aligning with the pattern depicted in Figure 3.2, this suggests counties where felony convictions were more likely in the pre-period also declined more towards the less punitive counties, reducing the variance across counties. The reduction in county differences is corroborated by variance estimates from models with county specific random intercepts for the pre and post periods . The likelihood ratio test comparing an exchangeable covariance structure as a nested model indicated that the unstructured covariance structures which allowed pre- and post-Prop intercept variances to differ,vertical aeroponics farming was a better fit to the data . To put this in concrete terms, of the 56 California counties, prior to the policy the most punitive county had a conviction probability of .38 , whereas the least punitive county had a conviction probability of .04 .

After Prop 47 was adopted, the most punitive county had a conviction probability of .19 whereas the least punitive county had a conviction probability of .02 . Another way to conceptualize these results is in terms of how discrepant the statewide probability of felony conviction was from the least punitive county pre-Prop 47, and the extent to which that discrepancy changed post-Prop 47. Prior to Prop 47, the statewide probability of felony conviction was 17 percentage points higher than the least punitive county , meaning 81% of statewide felony convictions following Prop 47 drug arrests would not have occurred if prosecuted in the least punitive county. Whereas after Prop 47, the statewide probability was just 3 percentage points higher than the least punitive county prior to passage . There was also significant variation across counties in the likelihood of felony conviction following a sale/transport arrest , ranging from 0.05 in Merced County to 0.51 in Calaveras County in the pre-Prop 47 period. However, mixed model results indicated the significant variance in the pre-Prop 47 period , did not decline post-Prop 47 . This suggests that, while people arrested for sale/transport were less likely to ultimately get a felony conviction after Prop 47 was adopted, this effect did not vary substantially across counties, and no county showed an increase in felony conviction probability for sale/transport arrests. In other words, it does not appear that more punitive counties altered plea bargaining practices for sale/transport arrests to retain pre-Prop 47 levels of felony convictions, as this would have resulted in an increase in variance in felony conviction probabilities for this category of arrest. Findings aligned with sensitivity analyses that assumed all cases with missing dispositions received felony convictions .In this study of the change in felony convictions in California counties after Proposition 47 reduced criminal penalties for drug possession, we found significant declines in the likelihood of a felony conviction following arrests for Prop 47 drug offenses and non-Prop 47 felony drug offenses . Prior to Prop 47, dramatic geographic inequalities in probability of felony convictions after drug possession arrests prevailed between counties, and these geographic inequalities were substantially reduced after adoption of Prop 47.

The reduction in felony convictions aligns with reports from the Judicial Council of California on reductions in felony filings following Prop 47 passage , while providing new evidence that reductions led to declines in geographic disparities in felony convictions for drug arrests. By holding county-specific case characteristics constant across time, this study identified a reduction in the excess variation that was attributable to county practices. This impact likely reflects that Prop 47 eliminated prosecutorial discretion for how drug possession can be charged. While previous research has found that the county-specific interpretation and implementation of reforms tends to reinforce the preexisting prosecution and sentencing practices within the county , results from the current study do not indicate counties attempted to mitigate the effects of Prop 47 with felony filings for concurrent offenses, or reducing plea bargaining for sale offenses. Several factors could explain why Prop 47 led to reductions in geographic disparities in case outcomes, when other reforms have not. Prop 47 was a voter initiative, and considering the influence of community priorities for law enforcement on charging policies and decisions, prosecution practices may be more responsive to these types of reforms. Secondly, Prop 47 called for reduced criminal penalties, whereas prior studies have evaluated reforms like three strikes laws which maximize punishment. Maximizing punishment is costly, whereas reducing it can assuage overburdened courts. Therefore, we may be more likely to see change resulting from reforms that call for lesser criminal penalties, and especially when that call comes from the public. Reducing variation in the likelihood of a felony conviction for two equivalent cases mitigates inequalities in criminal justice exposure due to unequal applications of the law. However, requiring that all drug possession offenses be prosecuted as misdemeanors also suggests that cases with different characteristics are now being treated more similarly. A defendant can still be convicted of a felony for concurrent felony offenses, so it is the effect of criminal history on case outcomes which we would expect to be minimized post-Prop 47. Criminal history is strongly associated with race/ethnicity, which may reflect biases and practices in drug law enforcement , while increasing the severity of punishment for subsequent drug offenses .

There is evidence Prop 47 in fact reduced the effect of criminal histories in San Francisco, where prior to Prop 47, racial disparities in case dispositions and sentencing were attributable to more extensive pretrial detention and criminal histories among black defendants . When Prop 47 reclassified drug possession offenses to misdemeanors, these characteristics had lesser effects on case outcomes, and racial disparities declined. Further research could assess whether findings from San Francisco apply statewide. There are also implications for substance use disorder treatment. Prop 47 generated $103 million in savings in the first year, awarded through grants to counties to increase access to substance use disorder and mental health treatment, and education . Counties with few felony convictions pre-Prop 47 may have had greater support for and availability of drug diversion options which allow dismissal of charges for successful drug treatment completion. However, Prop 47 generated concerns that without the possibility of a felony conviction, the incentive to engage in treatment would be removed . Prior research has suggested that,vertical cannabis farm as compared to volitional substance users, individuals with more severe substance use disorders tend to fail to meet the court’s conditions for diversion and ultimately receive harsher termination sentences . If this were the case, it would be logical that this group would opt out of diversion options now that the sentence for drug possession is less severe. Whether this is the case, and if so, understanding successful strategies counties have developed to increase access to needed treatment through other routes, would be valuable. CA DOJ’s Statewide Automated Criminal History System data is the most comprehensive data source available for studying criminal justice policy changes in the state, and has been used in significant studies of Prop 47, as well as other reforms such as Prop-36, which increased drug diversion following arrest . While the use of ACHS to capture the outcomes of all arrests in the state is a strength of this study, ACHS also faces the quality challenges typical of large administrative datasets, as CA DOJ must rely upon consistent and timely reporting from 58 counties. Though courts and law enforcement agencies are mandated to report within 30 days of final case dispositions and the CA DOJ’s policy is to update the data system within 90 days of receipt, a substantial portion of arrests did not contain dispositions. We assumed that these arrests without dispositions were not prosecuted for the primary analysis. However, if cases with no dispositions in fact include some felony convictions, and felony conviction missingness is associated with county, it could contribute to some of the geographic variation in convictions. The analysis of change in variation across time could be biased if felony conviction missingness differed within counties in the year pre- vs. post-Prop 47. There are several pieces of evidence that provide some reassurance. First, missing dispositions were more likely in the post period, which we would expect to occur if missing dispositions were indicative of no conviction, since the classification of drug possession offenses was reduced. Second, cases with missing dispositions were less severe in terms of concurrent offenses, which would correspond with lower likelihood of felony conviction. Third, the sensitivity analysis assuming that cases with missing dispositions had resulted in felony convictions did not alter findings.

The impact of the study design on the potential for bias should be considered. By comparing events just within the year before and after Prop 47, we attempted to limit the effect of time trends in felony convictions, though some reduction in felony convictions could be attributed to a pre-existing trend towards leniency for drug possession. That said, the large and immediate reduction in felony convictions across nearly all counties is unlikely to have occurred in the absence of the policy change. We extracted monthly SUD-related hospital visits in California from October 5, 2011 – September 4, 2015, as collected by the Office of Statewide Health Planning and Development. These months were generated such that the analytic period began after the start of California’s Public Safety Realignment , the post-Prop 47 period could begin on the first effective date of November 5, 2014, and no visits after September 30, 2015 were included. The ICD-9-CM coding system underwent major changes when it shifted to the ICD-10-CM system on October 1, 2015, and we anticipated a period of unreliable coding in the early months of this shift. The study therefore uses only the ICD-9-CM coding system. All visits with a SUD-related condition as the principal diagnosis among patients ages 15-64 were included. These comprised the following ICD-9-CM codes: amphetamines dependence , nondependent amphetamine abuse , cannabis dependence , nondependent cannabis abuse , cocaine dependence , nondependent cocaine abuse , poisoning by cocaine , adverse effects from cocaine , hallucinogen dependence , nondependent hallucinogen abuse , poisoning by hallucinogens/psychodysleptics , accidental poisoning by hallucinogens/psychodysleptics , adverse effects from hallucinogens , opioid dependence , combinations of opioids with any other , nondependent opioid abuse , poisoning by opium , poisoning by heroin , poisoning by methadone , poisoning by other opiates and related narcotics , heroin poisoning , adverse effects from heroin , sedatives/hypnotics/anxiolytic dependence , nondependent sedative/hypnotic/anxiolytic abuse , drug withdrawal , drug-induced psychotic disorder with delusions , drug-induced psychotic disorder with hallucinations , pathological drug intoxication , drug-induced delirium , drug-induced persistent dementia , drug-induced persistent amnestic disorder , drug-induced mood disorder , drug-induced sleep disorders , other drug-induced mental disorder , unspecified drug-induced mental disorder , other specified drug dependence , combinations excluding opioids , unspecified drug dependence , other mixed or unspecified drug abuse , or drug dependence complicating pregnancy/childbirth/puerperium . Though they made up just 14.7% of all SUD-related visits, we restricted the analysis to principal diagnoses, considered to be chiefly responsible for the hospital visit, to reduce the possibility of finding a spurious increase in visits attributable to the rise in insurance coverage through the Affordable Care Act in 2014.

It is not clear from the data who was prescribing psychotropic medications for these women

Posted on November 13, 2023 by hemp2022

Marginal FS was associated with 1.82 times higher odds of antidepressant use and 1.73 times higher odds of sedative use, while low FS was associated with 1.66 times higher odds of antidepressant use. There were no significant associations between FS and antipsychotic use in these models, and no significant associations between very low FS and any of the psychotropic medication outcomes. We next examined associations of FS with any psychotropic medication use, antidepressant use and sedative use, additionally adjusting for CESD and GAD-7 scores . Marginal FS remained associated with 1.93 times higher odds of any psychotropic medication use. The AORs for associations of marginal FS with antidepressant and sedative use were 1.64 and 1.42, respectively, although neither reached statistical significance. Associations between low FS and each psychotropic medication outcome were close to 1 , while very low FS was associated with lower odds of each outcome, with the association between very low FS and antidepressant use statistically significant . Of the other variables, higher incomes were consistently associated with lower odds of psychotropic medication use prior to adjusting for CESD and GAD-7 scores. Having an annual income of $12 001–24 000 remained significantly associated with lower odds of any psychotropic medication use and antidepressant use after adjusting for CESD and GAD-7 scores, compared to having an annual income ⩽$12 000. Age was positively associated with any psychotropic medication use, antidepressant use and sedative use , both before and after adjusting for CESD and GAD-7 scores. Self-identifying as African-American/Black was associated with lower odds of any psychotropic medication use, antidepressant use and sedative use, compared to self-identifying as non-Hispanic White . In the fully adjusted model, CESD and GAD-7 scores were positively associated with any psychotropic medication use, antidepressant use and sedative use.In this study of women with HIV in the USA,cost of vertical farming food insecurity was associated with the symptoms of common mental illness but displayed a complex relationship with psychotropic medication use.

Similar to previous studies , we found a dose–response relationship between food insecurity and symptoms of common mental illness. We hypothesised that associations between food insecurity and psychotropic medication use would reflect this dose–response relationship, but our findings suggest a more complex picture. While marginal FS was associated with significantly higher odds of taking any psychotropic medication, antidepressants and sedatives, the magnitude of the associations decreased as severity of food insecurity increased. Very low FS was associated with lower odds of psychotropic medication use after adjusting for CESD and GAD-7 scores . While there may be several possible explanations for this pattern of findings, it is most likely that people who experience very low FS find it difficult to engage in mental health care because of competing resource demands. Such individuals may find it difficult to access mental health services and therefore have fewer chances to be prescribed psychotropic medications. Alternatively, they may access care but find it more difficult to adhere to medication regimens and subsequently have prescriptions discontinued. This possibility is supported by previous studies. Food insecurity has consistently been associated with poor engagement in care among PLHIV, including missing clinic visits and sub-optimal adherence to medications . In qualitative studies, food-insecure PLHIV describe how hunger, exhaustion, pre-occupation with finding food and less money for transport erect major barriers to attending clinics . Similarly, in a nationally representative sample of non-elderly adults in the USA, individuals with severe mental illness who had very low FS were twice as likely to report being unable to afford mental health care, and 25% less likely to be using mental health services, compared to food-secure individuals with severe mental illness . Two studies in the USA have found that severe food insecurity was associated with higher rates of acute mental health care utilisation. Among outpatient users of mental health services, severe food insecurity was associated with five times the odds of having any psychiatric emergency room visit ; and among a national sample of homeless adults, food insufficiency was associated with three times higher odds of psychiatric hospitalisation .

Poor access to ambulatory outpatient mental health services among severely food-insecure individuals may therefore result in inadequate long-term symptom control and, consequently, greater acute mental health care utilisation – which is the same pattern that has been seen in studies of food insecurity and HIV care . Another key finding is that marginal FS remained associated with nearly twice the odds of any psychotropic medication use after adjusting for symptoms of depression and anxiety. This supports our hypothesis that among these women living with HIV, food insecurity, at least in a milder form, may be associated with being prescribed psychotropic medications independent of symptoms of common mental illness. This suggests that people experiencing complex social problems such as food insecurity may be prescribed psychotropic medications at a higher rate than those without such problems. This is supported by higher incomes also being associated with lower odds of psychotropic medication use in models additionally adjusted for CESD and GAD-7 scores. These findings indicate that there may be structural incentives and concomitant factors that favour the prescription of psychotropic medications for all forms of distress, regardless of the nature of the dominant contributing factors . As explained above, these factors may include the clinical training of prescribers, the absence of resources for social interventions and/ or the relative stability and provision that can accompany a psychiatric diagnosis through disability . Given that the data were cross-sectional, these possible explanations must be interpreted cautiously, and further research is needed. It remains possible that the causality runs in the reverse direction: people with symptoms of common mental illness significant enough to warrant treatment with psychotropic medications may be more likely to be food-insecure, and then may be referred to food assistance services that prevents them from experiencing the most severe form of food insecurity. Longitudinal studies investigating directionality and dominant mediating mechanisms are needed to comprehensively understand this association. Our study has other limitations. Greater clarity on this aspect of the findings would be helpful. Similarly, we have no data on access to mental health services and attendance at clinic appointments, which would clarify some of the mechanisms and explanations behind the findings. Third, we have no data on other mental health treatment modalities among these women, and no data on adherence to treatments, whether pharmacological or nonpharmacological. Measurement of these variables will be important for future studies. Finally, we were unable to adjust for any other symptoms of mental illness besides depression and anxiety because such data were not collected in the WIHS.Behavioral, cognitive, and neurobiological profiles of individuals with pathological gambling resemble those of individuals with substance use disorder, especially stimulant addiction . As a consequence, pathological gambling was recently reclassified as an addiction disorder in the DSM-5 .

However, it is still unclear whether some of the dopamine abnormalities that characterize substance use disorder are also present in pathological gambling. The current study examined the role of dopamine synthesis capacity in pathological gambling. Below, we highlight central findings linking altered dopamine function with substance addiction before reviewing existing evidence of altered dopamine function in pathological gambling. Converging evidence from various lines of research indicates that substance use disorder is characterized by a decrease in striatal dopamine D2/D3 receptor availability , even though this reduction is more consistently observed among stimulant users than in individuals with opiate, nicotine, or cannabis dependence . In humans, this has been evidenced by cross-sectional studies using [11C]raclopride positron emission tomography and single-photon emission computed tomography imaging techniques . In addition, human studies focusing on dopamine synthesis capacity, measured with [18F]fluoro-levo-dihydroxyphenylalanine PET, have revealed either low or unaltered dopamine synthesis capacity across various substance use disorders . Whether observed differences in D2/D3 receptor availability are a cause or consequence of drug addiction, and how it interacts with presynaptic dopamine function, is an area of active research. Longitudinal studies in animals have revealed that diminished baseline availability of striatal dopamine D2/D3 receptors is both a predictor and a consequence of continued drug use. For example,vegetables vertical farming lower baseline availability of striatal dopamine D2/D3 receptors in drug-naïve monkeys predicts high rates of subsequent cocaine self-administration . Longitudinal scanning further reveals reduced D2/D3 receptor ligand binding following repeated drug exposure . Micro-PET studies in rats have confirmed and extended these findings by showing that high impulsivity traits are associated with low dopamine D2/D3 receptor availability and predispose to the development of drug addiction . These findings concur with human studies showing that trait impulsivity is a vulnerability marker for addiction , although—in contrast to animal research—the direction of the association with dopamine D2/D3 receptors is less clear. Indeed, whereas some studies have reported positive correlations in healthy control subjects , other studies have reportednegative correlations in HCs and methamphetaminedependent users . Studies focusing on targets of dopamine functioning have so far led to different results in pathological gambling compared with stimulant dependence. In fact, all PET studies in pathological gambling have failed to reveal abnormal dopamine D2/D3 receptor availability in pathological gamblers relative to HCs . Despite this lack of group differences, two studies found a negative correlation between baseline dopamine D2/D3 receptor binding in the ventral striatum and trait impulsivity in PGs .

Similarly, PET studies investigating gambling-induced dopamine release have failed to reveal overall group differences but have shown correlations with relevant measures related to gambling severity, excitement, and performance . Currently, direct evidence for abnormal dopamine functioning in pathological gambling comes exclusively from studies showing altered responsiveness to dopaminergic drugs . In particular, PGs were shown to display greater amphetamine-induced dopamine release in the dorsal striatum, as measured with PET imaging using the D3 receptor–preferring radioligand [11C]–4- Propyl-9-hydroxynaphthoxazine, compared with HCs . This increased dopaminergic response echoes a recurrent clinical observation in Parkinson’s disease: following dopaminergic treatment aimed at compensating for dopamine cell loss, a subset of patients with Parkinson’s disease develop gambling disorder symptoms . These observations suggest that enhanced dopaminergic transmission may represent a biological substrate of gambling disorder. Thus, so far nearly all dopamine PET studies on pathological gambling have focused on dopamine D2/D3 receptors, investigating either receptor availability or the effects of dopaminergic drugs and gambling tasks. To date, there has been a paucity of research investigating dopamine synthesis capacity in PGs, with only one recent study reporting no difference with HCs . Yet, increased dopamine synthesis capacity has been associated with increased behavioral disinhibition and financial extravagance in healthy subjects and patients with Parkinson’s disease . Here we used dynamic [ 18F]DOPA PET imaging to investigate striatal dopamine synthesis capacity in male PGs and HCs matched for age, education, and an estimate of verbal IQ.In total, 15 PGs and 15 HCs were recruited. All HCs and 13 PGs had also participated in a previous pharmaco-functional magnetic resonance imaging study . The other 2 PGs were newly recruited. PGs were recruited through advertisement and addiction treatment centers, and they reported not to be medicated or in treatment for their gambling at the time of the PET study. HCs were recruited through advertisement. All subjects who had participated in the pharmaco-fMRI study underwent a structured psychiatric interview [Mini International Neuropsychiatric Interview–Plus, ] administered by a medical doctor prior to the fMRI study. The 2 PGs who were newly recruited were also assessed with the Mini-International Neuropsychiatric Interview–Plus administered by a clinical psychologist. Subjects were excluded if they had a lifetime history of schizophrenia, bipolar disorder, attention-deficit/hyperactivity disorder, autism, bulimia, anorexia, anxiety disorder, or obsessive-compulsive disorder or if they had a past 6-month history of major depressive episode. Current or past-year substance use disorder was also an exclusion criterion, as assessed at the time of the PET study using the 10-item Drug Abuse Screening Test questionnaire . Based on this criterion, data from 2 PGs were not included in the main analyses because of meeting the DSM-IV-TR criteria for cannabis dependence during the past year. As assessed with the Mini-International Neuropsychiatric Interview–Plus interview, 1 of the excluded cannabisdependent PGs also had a history of cocaine dependence that lasted for 1.5 years and ended 5.5 years prior to the PET study. In addition, 1 included PG had histories of alcohol and cocaine dependence that lasted for 1 year and ended 8 and 15 years prior to the PET study, respectively.

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Replacing missing values is another form of multiple imputation that was selected for this study

Posted on November 10, 2023 by hemp2022

The great majority of cases are represented by these four patterns. It is important to note that patterns 21, 51, 43, 45, and 53 are considerably smaller than the first four patterns, and they are similar in size. This means that the patterns of missingness across the variables is somewhat consistent, and that no dominant pattern to the missingness is readily seen. Based on this extensive analysis, it was determined that variables total GCS, alcohol screen result and THC Combo are not missing completely at random.When missing values in each variable account for less than 5%, those values can be missing at random and list wise deletion can be performed relatively safely is appropriate to do. This holds true for all the variables except for THC Combo, positive for drugs, alcohol screen result, age in years, ethnicity and total GCS. These variables, three quantitative and three categorical, were found to have greater than 5% missing values. On observation of the missing value analysis, it was observed that most cases had these two variables as missing, perhaps suggesting a relationship, or an effect. Furthermore, the Little’s MCAR test revealed that missing data may not be missing completely at random. Deleting cases with missing values can reduce the statistical power of the analysis and result in biased outcomes and estimates. Therefore, the use of multiple imputation is appropriate for this dataset and this study. Another method in SPSS that can be utilized is the Replacing Missing Values method. The Linear Interpolation method will be utilized. The Linear Interpolation method is a simple statistical method used by SPSS which estimates the value of one variable from the value of another and using regression methods to find the line of best fit. Using the Replacing Missing Values method in this study will help solve the problem of bias and ensure that power is not decreased because a large majority of the sample size will be preserved. It is important to consider the implications associated with imputing or replacing missing data. Multiple imputation or missing value replacement analyses will avoid bias only if enough variables predictive of missing values are included in the replacement method. If variables that may be predictive of the estimates are not included in the model,horticultural vertical farming for example the effect of age on alcohol result, replacement computation will underestimate these associations and bias the final analysis.

Therefore, it is preferrable to include as many predictive variables as possible in the model when either imputation or replacing missing value methods are utilized.Replacing missing values was utilized to minimize the many problems associated with missing data. The absence of data reduces statistical power and can also lead to bias in the estimation of parameters and analyses. Finally, missing data can diminish the representatives of the sample size and cases . It is important to consider that though replacing or imputing data is a common approach to the problem of missing data, it still does not allow analyses of actual data that is provided by actual participants, or in this case, data entered by abstractors and hospital registry systems. In gaining a larger sample size, and perhaps a more representative sample, confidence is lost that actual responses provided are those analyzed. It is important to note that methods used to account for missing data only provide researchers with the best estimated guess of what actual data may have been had it been documented in the first place. It is this ideology that influenced the decision to include some of the variables with missing data to be multiply imputed. Though multiple imputation process was utilized, it presented a complication in terms of the number of iterations and the subsequent analysis. Since the dependent variable, total GCS, was not selected for imputation/replacement, it was recommended and deemed appropriate to utilize the Replacing Missing Values function in SPSS to establish estimates for a select group of variables with missing data values. Replacing Missing Values method, a different form of imputation, allows the creation of new variables from existing ones by replacing them with estimates computed with a variety of methods. For this study, the Linear Interpolation method was used. This method utilizes the last valid value before the missing value and the first valid value after the missing value. The variables selected for missing value replacement were age and alcohol screen result. The variable age was selected due to its effect on traumatic brain injury incidences as well as post TBI outcomes . Additionally, the use of alcohol and other substances is prevalent in young adults with more than half of those who die from overdoses being younger than 50 years of age . The impact of age on TBI, substance abuse and outcomes could not be overlooked, and omitting this large percentage of cases will bias analysis results.

The variable of alcohol screen result was also important to replace because of the known impact and association alcohol abuse has on TBI incidence and outcomes. Alcohol and TBI are closely associated, with up to 50% of adults noted to drink more alcohol than recommended prior to their injury, and ultimately incurring worse outcomes . The variables of total GCS, THC Combo and positive other drugs were not included. Total GCSis the dependent variable, and having estimates instead of actual data seemed conceptually and logically inappropriate. For being the main predictor variables, both THC Combo and positive other drugs were not included to ascertain a more accurate and true account of the effects they may have on TBI severity. The Replacing Missing Values method yielded 7872 entries for age, with only 3 missing cases. The mean for age in the new dataset with replaced values was 31.19 years with a standard deviation of 26.1 compared to 33.78 years with a standard deviation of 27.3 for the non-replaced dataset. The replacing missing values method yielded 7822 valid entries for alcohol screen result, compared to 2087 entries in the non-replaced dataset. In the new dataset, alcohol screen result had a mean of .03, a standard deviation of .0752, with a minimum value of .00 and a maximum value of .66. The original dataset, with 7875 cases, was used for the missing value replacement method, because as mentioned previously, it is preferrable to include as many predictive variables as possible in the model so that the new replaced/imputed values are indeed best estimates. Once the dataset had the missing variables for age and alcohol screen result replaced, the dataset was then amended to only include participants greater than 16 years of age to meet the inclusion criteria. Once those cases were removed, the final dataset consisted of 4910 unique cases. The first aim of this study was to identify the prevalence of THC in a purposive sample of TBI patients. In this study, it was found that 27.7% of study participants tested negative for THC, and 6.2% of study participants had tested positive for THC on presentation to the emergency department. An overwhelmingly large percentage of the data was attributed as missing, 66% to be exact. This large percentage of missing data makes it difficult to have confidence in the 6% prevalence rate found in this study. National surveys on drug use and health have documented an increase in individual daily marijuana use over the last 5 years, with almost 22 million users each month in the United States . Federally, marijuana use remains illegal in the United States, however, in 2017, the year corresponding to the data of this study, 29 states had legalized marijuana for medical use, and 8 states for recreational use.

A recent study has found that marijuana use tends to be higher in states that have legalized its use compared to marijuana use in the United States overall . As a result, it is difficult to have confidence in the low prevalence rate found in this study. Another important consideration to make regarding the large percentage of missing data is the scarcity of studies investigating marijuana use and prevalence in TBI patients. As noted earlier in the literature review, only one study, by Nguyen et al. ,indoor agriculture vertical farming investigated the effects of THC presence on mortality in patients who had sustained a TBI, and they reported a prevalence rate of 18.4%. However, Nguyen’s et al. study involved a 3-year retrospective review of data obtained from a local hospital-based database, which can perhaps help explain their higher prevalence rate. The availability of a larger sample size because of 3 years’ worth of data may have contributed to that study’s higher prevalence rates. A recent publication has already noted areas of improvement necessary for the NTDB to improve data quality and completeness . It is important to note that the dataset used for this study reflects only one year worth of data, from 2017. At the start of this research study, the last dataset available for use was from 2017; datasets from 2018 and onward had not yet been released. Therefore, establishing previous prevalence rates for comparison, from the NTDB, could not be calculated because the presence of THC was never abstracted nor documented in earlier NTDB databases established before 2017. Finally, it is imperative to consider what happens at the bedside, or the clinical setting, when trying to understand why there is a large percentage of missing data when it comes to the presence of THC. When it comes to the care of the trauma patient, it is a common expectation amongst trauma centers, that a urine drug screen would be completed on every trauma patient presenting the emergency department. Despite this, drug screens are often either not obtained, not resulted, or not documented by the clinical team. At times, clinicians may simply forget to draw a screen and send it to the lab. This commonly occurs in patients who do not receive a foley catheter, a practice that is now encouraged in hospitals. As a result, patients may take a while to urinate, often doing so in the absence of the trauma nurse, or later in another unit or when under the care of a non-trauma nurse who then simply forgets to collect the sample. At times, the sample may be collected, but the result was never documented in the medical record. All these clinical factors can also contribute to the missing data by simply not including it in the medical record, and ultimately not making it into the trauma registry itself. When examining the differences between the group of participants with THC and those without and the influence on TBI severity, it was noted the group of participants who tested positive for THC had worsened GCS scores compared to those who tested negative for THC on presentation to the emergency department. The findings were significant, indicating that individuals who were positive for THC had a worsened neurological status as evidenced by lower GCS scores than those who tested negative. This finding is different than findings reported in the study by Nguyen et al. , which examined the relationship between the presence of THC and mortality after TBI. Their study only focused on mortality after TBI and not TBI severity. Based on toxicology test results, participants who tested positive for THC had a significantly higher number of males. Additionally, participants in the group that tested negative for THC were significantly older than participants who tested positive. This is supported by the literature, which indicates that men are more likely than women to use marijuana, as well as almost all other types of drugs . Individuals 18-29 years of age were the largest group of marijuana uses in the US in 2019 . Marijuana use dropped among older age groups, with seniors the least likely to use marijuana . No differences were noted in Non-Hispanic versus Hispanic groups regarding marijuana use. Marijuana use was higher in the American Indian and Black participants when compared to all other race groups. Participants who identified as ‘other’ had a greater proportion of testing negative compared to all other race groups. Marijuana use disorder was greatest among African Americans compared to other race/ethnicities .

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Risk of bias in terms of selection and information was determined for each study

Posted on November 9, 2023 by hemp2022

See Figure 1 for an illustration of the exclusion process. Study quality and risk of bias for each of the included studies, according to the NHLBI quality assessment tool for observational cohort and cross-sectional studies, is presented in Table 1. All eight studies employed an observational cohort study design and were assigned a “C” Level of Evidence. One of the studies included a prospective cohort study design while the remaining seven studies included a retrospective study designs. The prospective study was assessed as a good study as the investigators had control over the quality, accuracy and completeness of collected data. In the remaining seven studies, a retrospective approach was used where investigators had to rely on pre-existing data that could not be confirmed nor deemed reliable. This creates a susceptibility to recall bias and attrition bias. Though not highly esteemed as randomized controlled studies, observational cohort studies can be efficient in answering specific type of research questions. However, special attention must be given to the presence of potentially confounding factors. Only four of the eight studies included addressed confounding factors; rendering the remaining four studies a “fair” quality rating.Participants in each of the eight studies were selected based on the presence of a TBI, with some studies including TBI severity in their definition of TBI. Based on the study designs utilized by included studies, selection bias regarding sampling was anticipated as participants are not randomized, rather they are selected based on the outcome and exposure of interest; in such study designs, convenience sampling is most often utilized. Due to the nature of the studies included in this review, allocation concealment and blinding of outcomes assessors is not feasible. Because the exposure of substance abuse has not been allocated randomly,vertical farm tower a causal effect may not be possible as other variables may be found to influence the outcomes studied, rendering all eight studies at a major disadvantage with potential bias in outcomes.

Study methods employed by each of the eight included studies varied with some studies utilizing medical chart reviews, while others utilized validated surveys and questionnaires to gather their data. The studies by Andelic et al., Barker et al., and Bombardier et al. all utilized the participants’ medical charts for retrospective review for presence of substances. The studies by Andelic et al., Nguyen et al., and O’Phelan et al. used trauma registry databases to collect data on TBI patients and the presence of substance abuse. Pakula et al. collected data on the presence of substance abuse in post-mortem patients with traumatic cranial injuries by evaluating autopsy reports. Finally, the studies by Bombardier et al., Kolakowsky-Hayner et al., and Kreutzer, Witol and Marwitz utilized questionnaires to interview participants. The variance in study methods, ranging from retrospective review of charts to the use of self-report methodology subjects the included studies to recall bias and unreliable data. A factor negatively contributing to the quality of the included studies is the variance in defining a TBI. Three of the studies did not provide a definition for what constitutes a TBI, nor did they describe the severity of TBI. The study by Andelic et al. defined TBI using the TBI Modified Marshall Classification. The study by Barker et al. defined TBI using the TBI Model Systems Data Base definition. Nguyen et al. used the International Classification of Diseases-Ninth Revision codes and the Abbreviated Injury Severity codes to define TBI. These codes are widely used in trauma data registries for entering and recording the injury type and severity, for performance improvement and billing purposes. However, reliability can be an issue as coding may be subjective. The information is extracted from the chart by registrars who read and enter notes written by physicians. Often, coding depends on physician documentation, attention by trauma registrars to the various sources of documentation and communicating with physicians when necessary. If not subject to continuous data validation, a data gap may ensue. The study by Pakula et al. defined a central nervous system injury by the presence of any of the following written diagnosis as found in the autopsy reports: 1) TBI, 2) skull base fracture, 3) spinal cord injury, and 4) cervical spine injury. Only one study, the study by O’Phelan utilized a Glasgow Coma Score to define a severe TBI.

The majority of the articles were subject to selection bias in terms of their participant population and methods of data collection: See table 2 for specifics. The included studies varied in their definition of TBI. One study used the Modified Marshall Classification of TBI which is a Computed Tomography scan derived metric used to grade acute TBI on the basis of CT findings. Another study defined TBI using the TBI Model Systems National Database definition. The TBIMS-NDB has been funded by the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education to study the course of recovery and outcomes following a TBI. They describe the TBIMS-NDB TBI as: Damage to brain tissue caused by an external mechanical force as evidence by medically documented loss of consciousness or post-traumatic amnesia , or by objective neurological findings on physical or mental examination that can be reasonably attributed to TBI. Three of the eight studies did not specify how TBI was defined. One study used the following International Classification of Disease, 9th Revision codes to define TBI: 800.1- 800.39 ; 800.6-800.89 ; 801.1-801.39 ; 801.6-801.89 ; 803.6-803.89 ; 804.6-804.79 ; 851 ; 852 and 853 . Another study used the International Classification of Disease, 10th Revision codes to define TBI: S02.0xx ; S02.1 ; S06.1 ; S06.2 ; S06.3 ; S06.31; S06.32 ; S06.33 and S09.x . Finally, the last of the eight studies used autopsy reports to evaluate individuals with severe central nervous system injuries. For purposes of that study, severe CNS injuries were defined as “any traumatic brain injury, skull base fracture, spinal cord injury, or cervical spine injury.” Although all eight studies investigated marijuana exposure in TBI patients, only one study specifically investigated the use of marijuana alone on outcomes in TBI. All other remaining studies investigated the presence of all possible substances and/or drugs, meaning investigators were not specifically examining marijuana exposure by itself. In Nguyen et al. all patients who had sustained a TBI and had a urine toxicology screen were included. The actual noted presence of marijuana was obtained from the urine toxicology screen and not through any other modes of measurement. The authors classified study patients according to marijuana screen results which they defined as greater than 50 ng/ml. Though marijuana was noted to have been detected across all eight studies, the actual numerical or absolute value measured was never reported by any of the studies. Additionally, it is important to note that excluding the study by Nguyen et al., the presence of marijuana was not reported in a quantifiable manner, making any potential statistical inference impossible.

Lastly, six of the included studies investigated the presence of marijuana at the time of injury, while the remaining two studies measured the presence of marijuana use during the past year and post-mortem respectively. The study by O’Phelan et al. did not investigate any other time frame for which marijuana may have been used, rather, the authors only collected data on the presence of drugs at the time of injury. An important finding from the systematic literature review showed that marijuana was the most favored drug reported. However, only one study of the eight studies included explicitly searched for and found a connection between the presence of a positive toxicology screen for marijuana and mortality outcomes in TBI patients. Nguyen et al. three-year retrospective review of trauma registry data found that 18.4 percent of all cases meeting inclusion criteria had a positive marijuana screen and overall mortality was 9.9 percent . Nguyen et al. found that mortality in the marijuana positive group was significantly lower when compared to the marijuana negative group . Authors adjusted for the following differences between study participants: age, gender, ethnicity, alcohol,vertical farming greenhouse abbreviated injury scores, injury severity scores, and mechanism of injury. After adjusting for differences, Nguyen et al. found that a positive marijuana screen was an independent predictor of survival in TBI patients .This review sought to determine the use of marijuana and its role in TBI prevalence and outcomes. A key finding from this review is that there are few studies available that examine the specific role of marijuana exposure on TBI severity, leaving many questions unanswered. Furthermore, this review found that there is a significant variation in how substance abuse has been defined, conceptualized, and operationalized in TBI research. Another important finding was that the reviewed studies operationalized substance abuse inconsistently, often combining alcohol and drugs in one category titled ‘substance abuse,’ making it difficult to ascertain if there was an association between specific drugs, particularly marijuana, and TBI severity and outcomes. The difference in how substance abuse was operationalized in these reviewed studies has important implications for how findings are interpreted as well as provide recommendations for future research. Although there was no restriction made to the countries in which these studies were conducted, those meeting inclusion criteria were all studies conducted in the US except one from Norway. Therefore, the applicability of findings from that one non American study is limited. Additionally, it is difficult to draw valid and reliable conclusions when the studies reviewed utilized a wide variety of study objectives, sample size, study methods, and varying definitions for substance abuse classification.

The review showed a great variation existed across the studies in types of data collected and methods used, thus severely minimizing comparability. For example, the disparity in measurement of blood alcohol levels considerably reduce the reliability of data related to pre-injury intoxication. In the reviewed studies, information on alcohol and substance use was obtained from a range of different sources, including self-reports and patient records, as well as a variety of different measures rendering results unreliable across studies. This review set out to answer a specific question: what influence, if any, does marijuana exposure at time of injury have on TBI severity and outcomes? Only one study about marijuana’s effect on TBI outcomes was available. Nguyen et al. reported that a positive marijuana screen is an independent predictor of survival, suggesting a potential neuroprotective effect of cannabinoids in TBI. The rest of the studies yielded a variety of findings, with the most common finding being that marijuana and other drug use, including alcohol, are common before TBI. To clearly understand what marijuana’s influence on TBI is, potential confounding variables must be identified and controlled for. The literature review identified no consensus on relevant confounding variables aside from age and gender. The variability in all other demographic variables highlights the lack of certainty of the full range of relevant demographic variables. Another potentially important confounding variable is mechanism of injury. Historically, the most frequent cause of TBI related deaths in civilians was considered motor vehicle crashes. However, recent data show that falls are actually the leading cause of TBI related hospitalizations, with the second leading cause is being struck by another object. Importantly, only six of the studies included mechanism of injury as a variable in their analysis of findings. Five of the eight included studies did not address TBI severity as a variable. The remaining three studies each operationalized TBI severity utilizing different methods. Andelic et al. used the Marshall classification to classify neurological anatomical abnormalities as seen on CT scans. Nguyen et al. utilized the Abbreviated Injury Scale score for the head and neck region to classify TBI severity. The use of the AIS score is common in general research studies as often times the GCS score is not always recorded for each individual participant. Hence the only study showing a link between marijuana exposure and TBI severity did not use the gold standard of GCS to measure TBI specific severity. Finally, severity as a variable in the TBI population is an important characteristic and is a parameter of interest when answering the research question of whether or not marijuana influences TBI severity; available studies are not able to answer that question mostly because the majority of them did not measure severity in the first place.

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METH-dependence and COMT are known to alter DAergic pathways and PFC function

Posted on November 8, 2023 by hemp2022

It is hypothesized that higher DA bio-availability conferred by the Met allele underlies this Met associated neurocognitive ‘advantage’ in healthy adults. However, we have previously demonstrated that in chronic METH users , whose PFC is repeatedly exposed to excessive levels of DA, the Met/Met genotype is no longer associated with better executive function and may in fact confer risk for executive dysfunction . Although these findings suggest that the Met/Met genotype confers disproportionate risk to METH-related neurocognitive dysfunction, it remains unclear whether COMT genotype similarly modulates the effects of METH on biomarkers that directly measure the DAergic system. Thus, the present study evaluated cerebrospinal fluid levels of DA and its metabolite, homovanillic acid , among a cohort of adult men stratified by METH dependence and COMT genotype. Additionally, relationships between CSF DA and executive function were assessed to examine the role of CSF DA as an intermediary linking the interactive effects of METH and COMT on neurocognitive function. Participants were 75 METH-dependent and 47 METH-non-using comparison men enrolled in the University of California, San Diego’s Translational Methamphetamine AIDS Research Center , a NIDA-funded cohort study focusing on the CNS effects of HIV and METH. All participants gave written informed consent as approved by the UCSD Institutional Review Board. COMT genotyping in the parent study was restricted to male participants due to potential sexually-dimorphic effects of COMTand inadequate numbers of female participants to support sex-stratified analyses. Exclusion criteria were: 1) DSM-IV diagnosis of other substance use dependence within the last 5 years, or alcohol dependence within the last 12 months; 2) abuse of any substances other than METH within the last 12 months; 3) evidence of very recent METH use by positive urine toxicology results; 4) history of psychotic or mood disorder with psychotic features, neurological, or medical condition that may confound neuropsychological test results.

To our knowledge,vertical farming solutions the present study is among the first to examine how the interaction of these genetic and environmental factors impacts levels of DA and its metabolite, HVA, in the CNS. METH was associated with lower DA levels, accompanied by higher HVA/DA ratios, only among Met/Met individuals, suggesting that COMT genotype may underlie inter individual differences in vulnerability to METH effects on DAergic tone. Among METH individuals, Met/Met genotype exhibited significant or trend-level medium-to-large effects on higher DA levels and small-to-medium effects on lower HVA/DA ratios , consistent with the known functional effects of the COMT enzyme . However, this Met/Met-related DAergic ‘advantage’ disappeared in METH+ individuals, which parallels our prior findings demonstrating the absence of an executive function ‘advantage’ in METH+ Met/Met individuals . Notably, the strongest associations between DA and executive function occurred within METH- Met/Met individuals, who, on average, exhibited the highest levels of DA. Our findings highlight the conditional influence of COMT on neurobiological and behavioral markers of PFC function in METH use, particularly in the context of HIV, with potential relevance to other neuropsychiatric conditions characterized by DA and PFC dysfunction. The discordant COMT genotype/DA endophenotype profile in METH+ individuals suggests that genetically-driven metabolism of synaptic DA can alter the extent to which chronic METH exposure disrupts DAergic activity. Preclinical data demonstrate that the repeated over stimulation of DA release into the synaptic cleft due to serial METH exposure results in the auto-oxidation of DA and subsequent production of reactive oxygen species that are toxic to monoaminergic terminals in the PFC, striatum, and hippocampus . In an examination of DA biomarkers in post-mortem brain tissues, Kish et al. found 50–61% reductions in striatal DA levels in chronic METH users compared to age-matched controls, yet did not observe any group differences in brain concentrations of DA metabolites, including HVA .

The preservation of DA metabolites in the context of low DA suggests that although complete DA neuronal death is unlikely in METH use, compared to the severe loss of DA neurons in Parkinson’s disease, other mechanisms such as compromised storage of vesicular DA may explain why METH reduces DA but not HVA levels . Although we did not observe a main effect of METH on DA biomarkers, these postmortem results agree with our findings in METH+ Met/Met individuals, who exhibited substantially lower CSF DA and higher CSF HVA/DA ratios compared to METH- Met/Met individuals. Our results extend our previous finding that the typically-observed positive effect of the Met allele on executive function is absent among METH users . Specifically, COMT and METH use related to CSF DA levels, which in turn related to executive function. As such, this study helps to bridge the gap in the numerous neuropsychological studies that used COMT as a proxy for DA levels, which may be particularly complex in medical and neuropsychiatric conditions associated with DA dysregulation such as HIV. Interestingly, it was only in the group with the highest levels of DA, the METH- Met/Met group, that we observed a strong association between higher DA levels and better executive function. Associations between DA levels and cortical function are typically interpreted within the framework of the inverted-U hypothesis. DA levels at the peak of the curve are optimal for PFC-dependent neurocognition, whereas DA levels that are supraoptimal or suboptimal lead to poorer performance on these tasks . Our findings are in line with previous findings in the general population that the Met/Met genotype and resulting higher levels of DA are optimal for PFC-dependent neurocognition and, even within this genotype group, higher DA levels are advantageous for PFC-dependent neurocognition. However, lower DA levels that result from the Val allele in METH- individuals and from stimulant-induced injury in METH+ individuals, may be too far left of the curve to detect neurocognitive benefits of higher DA.

Taken together, this pattern of results may suggest a threshold effect whereby the neurocognitive benefits of DA are only observed when DA levels reach a certain level and DA levels in METH users fall below this threshold. It is important to consider our results and their interpretation in the context of our sample, which partially consisted of individuals with comorbid conditions that can impact the DAergic system . The majority of our sample was HIV+ . HIV is known to cause DA dysregulation though the release of neurotoxic viral proteins on DA neurons , and this DA dysregulation is associated with neurocognitive deficits . Thus, METH use can be particularly detrimental to brain and neurocognitive health in HIV+ individuals due to the compounding effects of METH and HIV on the DAergic system and the related mechanisms of oxidative stress, neuroinflammation, and blood brain barrier permeability . Consistent with our own findings in METH- individuals without HIV disease , previous studies reported a positive effect of the Met allele on PFC-dependent neurocognition in HIV+ individuals ; however, this effect was absent in HIV+ men with METH dependence . Interestingly, our AIC regression analysis did not identify HIV serostatus or other comorbidities as relevant predictors of DA in this sample, suggesting that METH use and COMT genotype are more salient modulators of the DAergic system in our study sample. Nevertheless, it is possible that the background of DA dysfunction that occurs with HIV disease and other comorbid conditions in our sample can shift the inverted-U curve and, thereby, influence the effects of COMT and METH on neurocognitive function. For example, neuroinflammatory mediated dampening of DAergic signaling in cortico-striatal circuitry is a putative pathogenic mechanism of depression ,vertical farming system which may partially underlie the higher levels of depressive symptoms in the METH+ group. These DAergic driven depressive symptoms including apathy and anhedonia may also exhibit a reciprocal relationship with addictive behaviors , particularly in METH+ individuals with extensive histories of polysubstance use . With respect to other factors, accounting for time of lumbar puncture significantly improved overall model fit but did not attenuate the effects of COMT and METH on DA and HVA/DA ratios. This is consistent with the literature examining diurnal fluctuations in CSF and plasma markers of catecholaminergic function and the influence of DAergic circuitry on clock gene expression . Given the potential for time of CSF sampling to influence catecholamine levels, it is important that studies aim to standardize the time of CSF collection across participants and/or adjust for time of collection in analyses. We acknowledge several limitations to these data. Cell sizes were small for a gene by environment interaction analysis, which precluded correction for multiple comparisons. Accordingly, these data should be considered preliminary and require independent confirmation. Nevertheless, our sample size was sufficient to model each COMT allelic variant independently and the large magnitude of effects yielded statistically significant COMT by METH group differences in CSF DA. Our neurocognitive analyses also limited multiple comparisons by conservatively focusing on the domain of executive function; importantly, our findings were consistent with prior studies that used the same well-validated tests of executive function. DA biomarkers in CSF provide a novel in vivo window into DA function in the CNS, yet they only represent a global measurement of DA and cannot formally test hypotheses about DA function in specific brain regions. Thus, future PET imaging studies are warranted to determine regional susceptibilities to the impact of COMT on METH-related DAergic injury.

Understanding genetic risk for prefrontal dysfunction is of clinical relevance for our study sample of predominantly HIV+ men, who are at risk for developing CNS complications and neuropsychiatric disorders. However, our results may not generalize to women given previously reported sexually dimorphic effects of COMT genotype on COMT enzymatic activity and risk of psychiatric disorders, as well as the reciprocal relationship between the regulation of COMT and estrogens . Thus, future studies should replicate our analyses in other clinical and non-clinical samples with adequate representation of women. Similarly, the absence of genetic ancestry markers is a limitation and studies that incorporate these markers in sufficiently sized samples to allow for stratified analyses within ethnic groups would increase confidence in these findings. From a clinical perspective, our findings bear relevance for the treatment of METH dependence. DA agonists have been considered as a means of stabilizing DA function and promoting abstinence from METH use . In a clinical trial examining the incremental efficacy of modafinil in treating METH-dependence, on top of contingency management and cognitive behavioral therapy, relapse rates were lower in modafinil vs. placebo in Val/Val homozygotes, yet modafinil did not reduce relapse rates in Met-carriers . Additionally, low baseline D2 receptor availability and blunted striatal DA release in response to methylphenidate predicts future relapse in METH users . Thus, the combination of chronic METH exposure and the Met allele may result in enough DAergic injury to render treatment-seeking METH users non-responsive to the pharmacological effects of DA agonists. Given the putative contribution of DAergic deficits to relapse even after the most effective psychosocial interventions , approaches that target the endogenous production of DA may confer neurobehavioral benefits and inform precision treatments for Met-carriers who are non-responsive to pharmacotherapy. Taken together, the present study highlights the influence of genetically-driven differences in DA metabolism on the effects of chronic METH use on DA and DA-related executive function. Our observation of lower, albeit statistically non-significant, levels of CSF DA and significantly higher CSF HVA/DA ratios in METH+ Met/Met individuals compared to METH+ Val/Met individuals challenges the widely-held assumption that the Met-allele translates into higher levels of bio-available DA. Such an assumption may be more appropriate in healthier samples, which is supported by the stair-step pattern of higher CSF DA with each additional Met allele in the METH- group; however, careful consideration should be given when forming hypotheses and interpreting data regarding the role of COMT in clinical populations that are characterized by DA dysfunction . This conditional relationship between COMT, METH, and DAergic activity may help explain why some studies have failed to find consistent independent effects of COMT and METH on neuro behavioral outcomes. Individuals experiencing homeless in the United States have high lifetime rates of incarceration, with estimates ranging from 20 to 70%.Homelessness and incarceration share many risk factors, both health-related and economic . Individuals experiencing homelessness have an increased risk of police citations related to survival behaviors , heightened visibility to law enforcement, and decreased ability to adhere to conditions of parole or pay citations, increasing the risk of arrest.

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These findings are consistent with studies of more chronically ill people with schizophrenia

Posted on November 7, 2023 by hemp2022

Cross-site reliability in the ratings of the SOPS, was conducted on a yearly basis using a new videotape each year. Ratings from all raters at all sites were compared to “gold standard” ratings on the SOPS. Intra class correlations, over three years, for the total SOPS scores ranged from 0.82 to 0.93 and for the attenuated positive symptom score from the SOPS ranged from 0.92–0.96. There were minimal differences across the individual sites. All interclass correlations were in the excellent range. Those at CHR had to be between 12 and 35 years old and meet diagnostic criteria for a prodromal syndrome as per the COPS criteria or if under 19 meet criteria for schizotypal personality disorder . Participants were excluded if they met criteria for current or lifetime Axis I psychotic disorder, including affective psychoses, IQ > 70, or had a past history of a central nervous system disorder, or substance dependence in the past 6 months or the diagnostic prodromal symptoms were clearly caused by an Axis 1 disorder. Other non-psychotic DSM-IV disorders were not exclusionary , as long as the disorder did not account for the individual’s prodromal symptoms. Use of antipsychotics was not an exclusion provided there was clear evidence that prodromal but not psychotic symptoms were present when the medication was started. Control subjects could not meet criteria for any prodromal syndrome, any current or past psychotic disorder or a Cluster A personality disorder diagnosis, not have a family history of any psychotic disorder or any other disorder involving psychotic symptoms. They could not be currently using psychotropic medication.One concern with large multisite,outdoor vertical farming longitudinal studies including many assessments is data integrity. Data are managed at the Calgary site through a centralized Oracle database. Sites can remotely manage both the input of participant study data and also track participant protocol adherence and staff task management. Data input is strictly controlled with data validation prior to saving and a two-step forced resolution of required data.

No data can be submitted until missing data fields are flagged with either reasons for absence or with a predetermined code. Prior to forcing a second blind double entry of all the data, all missing data reasons must be validated and signed off with an acceptance code by a data manager from the site. This rigorous feedback loop ensures better data collection, near perfect data entry and much better data quality assurance. These codes can then be reported and reviewed by the appropriate Task Force to determine further action. The system produces numerous reports. These are used to track recruitment, dropout rates, data collection and consequent data entry completion levels. Furthermore, it can measure the utility and validity of measures and the protocol. This allows the data cleanup process to be continuous. There is an overall data manager at the Calgary site with each site having their own data manager to work with both within and across site data. NAPLS-2 will be the one of the largest cohort studies of young people at clinical high risk for psychosis to be followed longitudinally. It will be the first to study all of these clinical and biological factors prospectively and simultaneously in a large and well-characterized sample. This paper has described the aims and methods of the project and reported on recruitment and preliminary descriptive data from the first half of the sample. The recruitment practices are similar across most of the sites. There are very few significant site differences in samples and no-one site differs on more than one variable. Yet one of the advantages of having multiple sites is that they are diverse with respect to the regions and ethnicities represented. Our multi-site approach affords the opportunity to examine regional and ethnic differences in the ascertainment of CHR individuals, as well as the nature and course of prodromal syndromes. Further, by having multiple sites, we are able to validate our measures across a range of clinical research facilities, and this has important benefits with respect to establishing the generalizability of NAPLS findings, especially those that bear on prediction algorithms Future reports will focus on baseline clinical and biological characteristics, longitudinal changes and eventually predictors of conversion.

Recent evidence indicates that people with schizophrenia or schizoaffective disorder experience deficits in anticipatory pleasure, or pleasure related to future activities, but not in consummatory pleasure, or pleasure experienced in-the-moment . The Temporal Experience of Pleasure Scale is a self-report measure of the general propensity to experience anticipatory and consummatory pleasure . Studies in the U.S., China, Switzerland, and France have found that people with schizophrenia or schizoaffective disorder reported lower anticipatory pleasure but comparable consummatory pleasure on the TEPS compared to healthy controls . Prior studies have also found that TEPS anticipatory and consummatory pleasure scores are positively correlated with functional outcome and negatively correlated with negative symptoms . TEPS anticipatory, but not consummatory, pleasure is negatively correlated with sub-clinical negative symptoms and is lower in people who score higher on social anhedonia measures compared to those who do not . Studies that utilize the TEPS have thus far almost exclusively included chronically ill people with schizophrenia. However, studies using other self-report measures of anhedonia, such as the Chapman scales of physical and social anhedonia, have found that people early in the course of schizophrenia report more physical anhedonia than the controls and people experiencing their first lifetime episode of psychosis report more social anhedonia compared to the controls . To date, two studies have administered the TEPS to people early in the course of a schizophrenia spectrum disorder . Cassidy et al. found no differences in TEPS anticipatory pleasure between people with and without a psychotic disorder. However, most participants in the study had used cannabis throughout the lifetime, thus making conclusions about the contributions of psychosis versus cannabis use on TEPS scores difficult to disentangle. Schlosser et al. found that people with recent-onset schizophrenia reported less anticipatory than consummatory pleasure on the TEPS but did not differ on either scale compared to a younger, healthy control group. However, people at clinical high risk for schizophrenia reported less anticipatory pleasure than a demographically matched healthy control group. In the current study, we examined people with a recent-onset SSD to determine if and when deficits in reported anticipatory pleasure emerge in the course of the illness. We defined “recent-onset” in our study as experiencing a first episode of psychosis within one year of study participation. Based on previous studies with more chronically ill samples, we hypothesized that people with an SSD would show deficits in anticipatory pleasure but not in consummatory pleasure compared to people without an SSD.

We also included measures of symptom severity, occupational functioning, and social functioning in order to examine the correlates of anticipatory pleasure.In the current study, we assessed whether deficits in the propensity to experience anticipatory pleasure are evident early in the course of schizophrenia spectrum disorders. We found that people in the early course of an SSD reported lower dispositional anticipatory pleasure but did not differ in reported dispositional consummatory pleasure compared to healthy controls.However, our findings differ from two recent studies with people early in the course of an SSD . Identifying reasons why some studies find deficits in anticipatory pleasure and others do not is an important direction for future research. Likely explanations include the characteristics of the clinical and control groups. With respect to clinical characteristics, our sample did not include any participants with current substance use disorder, whereas most participants in the Cassidy et al. study did . Another explanation may be related to how anticipatory deficits are described. We considered “deficits” in anticipatory pleasure as a significantly lower score on the TEPS anticipatory pleasure measure in people with an SSD compared to the controls. However, this assumes that the control group is homogeneous in a variety of factors that may influence self-reported anticipatory pleasure. There are likely unstudied individual differences that influence TEPS scores within different groups that may partially account for why some studies fail to find anticipatory pleasure deficits in people with schizophrenia. For example, in Strauss et al. , the control group had a consummatory pleasure score of 4.96,vertical farming benefits while the control group in our study had a score of 4.39, a seemingly significant difference between the two groups. This may partially account for why Strauss et al. did not find the same pattern of differences in anticipatory and consummatory pleasure scores on the TEPS in people with and without schizophrenia as our study did. While Schlosser et al. did not find that people with recent onset schizophrenia differed from younger healthy controls in anticipatory pleasure, they found that people with recent onset schizophrenia reported significantly lower TEPS anticipatory pleasure than consummatory pleasure. Future studies may wish to adopt both within and between-group comparisons in defining “deficits” in self-reported pleasure. Furthermore, as studies continue to include the TEPS, meta analysis will prove useful in better understanding differences between people with and without schizophrenia on this measure. We found that both anticipatory and consummatory pleasure scores were related to negative symptoms, consistent with prior studies including more chronic samples . These results suggest that even in the early stages of the illness, people with an SSD who report lower dispositional anticipatory pleasure are also likely to exhibit negative symptoms. Deficits in the propensity to experience anticipatory pleasure may be an indicator of early negative symptoms that may not be otherwise detectable. On the other hand, greater dispositional consummatory pleasure was related to lower negative symptom scores and depression, suggesting that while diminished experience of consummatory pleasure may also be an indicator of negative symptoms, it may additionally be more sensitive to state-dependent factors .

It will be informative to assess the linkage between dispositional anticipatory and consummatory pleasure and symptom-level anticipatory and consummatory pleasure in future studies using measures that distinguish these types of pleasure, such as the Clinical Assessment Interview for Negative Symptoms . Contrary to our findings, studies of chronically ill people with schizophrenia have found that social functioning is related to TEPS anticipatory and consummatory pleasure . It is possible that people in our SSD group had other resources or support that help guide their functioning that chronically ill people with schizophrenia do not have, thus deficits in anticipatory pleasure may not be as tightly linked with their functioning. Another possibility is that the strength of the relationship between anticipatory pleasure deficits and functional outcome increases over time, even if both constructs remain independently stable. Herbener et al. found that over a 20-year period, neither physical anhedonia nor functional outcome became significantly more severe in a sample of people with schizophrenia; however, over time the strength of the correlation between physical anhedonia and functional outcome increased. They suggested that physical anhedonia may be one factor that contributes to the heterogeneity in functional outcome scores in schizophrenia samples and that the co-occurrence of both may reflect a common underlying deficit. The relationship between anticipatory pleasure and functional outcome may follow a similar trajectory over time, and future studies that examine the longitudinal nature of anticipatory pleasure and functioning in schizophrenia can help answer this open question. Although we administered the TEPS to a group of people who had experienced a psychotic episode, future studies should continue to examine other populations, including clinical high risk samples, to further pinpoint when anticipatory pleasure deficits may emerge during the development of an SSD. Schlosser et al. found that CHR individuals reported less TEPS consummatory and anticipatory pleasure compared to demographically matched healthy controls, suggesting that such deficits may reflect a vulnerability towards a future psychotic episode. Future studies should continue to administer the TEPS during multiple time points as the illness progresses, both in between and within-group designs, to help understand the longitudinal course of anticipatory pleasure in schizophrenia. One limitation of our study is that our SSD group differed from our control group on demographic factors, including sex and ethnicity. While there were no significant sex differences in reports of either TEPS anticipatory or consummatory pleasure within our two groups, future studies will want to include more women with an SSD in their samples to replicate this finding and address the under-representation of women with schizophrenia in research more generally .

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The resulting plant slurry is then fed into a screw press to separate most of the dry plant material

Posted on November 6, 2023 by hemp2022

After a total of 35 days post seeding, a tractor sprayer applies 4900 L of a 4% ethanol solution to the plot’s crop, triggering the synthesis and accumulation of thaumatin in plant biomass. The plants are incubated for 7 more days, during which time they continue to uptake nutrients and express thaumatin. After 42 days from seeding, the batch is harvested through two mechanical harvesters and four hopper trucks at a rate of 17,000 kg/h and transported to downstream processing facility using a conveyer belt . The plot undergoes a turnaround period of three days for which the labor and equipment cost is included. No pesticides, fungicides, or herbicides costs are added due to the assumption that not enough growing degree days are accumulated during the batch cycle duration , for disease-causing organisms to be a concern. The base case downstream processing facility is designed to purify and formulate 318.5 kg/batch of thaumatin with 98% purity. A DSP batch starts with shredding plant biomass using two industrial shredders , each processing 40,000 kg of plant biomass/h. This step is designed to homogenize the leaves and stems to facilitate the extraction process. Shredded plant material is then mixed with an acetate buffer in a 0.8 L of buffer to 1 kg of biomass ratio. This step leverages stability of thaumatin at low pH to precipitate host plant proteins that aren’t stable under acidic conditions. The extraction buffer consists of 50 mM acetic acid and 150 mM sodium chloride mixture at a pH of 4.0.A screw press is recommended for this step because it minimizes the amount of extraction buffer needed by forcing out more plant sap with the increasing pressure inside the chamber. The crude extract stream obtained from the screw press unit is sent to three parallel P&F filtration units for initial clarification,vertical farming tower each having a membrane area of 190 m2 . Furthermore, the model assumes the use of food-grade filter membranes designed to include 10 filter sheets with decreasing particle retention size from 25 to 0.1 µm.

The acetate buffer is applied once again as cake wash with a 0.2 L buffer to 1 L extract ratio. Diatomaceous earth is added to this step as a filter aid in a 6:100. The stability of thaumatin at low pH and high temperatures facilitates the precipitation of more host cell proteins as well as other undesired plant-derived compounds. Using seven heating tanks , the plant extract is then heated to 60 ◦C for 60 min. Following heat incubation, the stream is sent to a P&F filtration unit to capture the heat-precipitated proteins. It is assumed that a 90% reduction of N. tabacum total soluble proteins is attainable following the heat incubation and precipitation steps. Concentrating the thaumatin stream prior to the ultrafiltration/diafiltration step is necessary to avoid processing large liquid volumes ~573,000 L further downstream. It has been reported that thaumatin experiences a loss in sweetness when heated above 70 ◦C at a pH of 7.0; therefore, the product stream undergoes concentration by evaporation prior to neutralizing the solution since the protein can sustain higher temperatures at a low pH.The triple effect evaporation unit is designed to evaporate 90% of the water content in the stream at 109 ◦C, 77 ◦C, and 40 ◦C in the first, second, and third effect, respectively, over 4 h. The exiting stream is then neutralized with 1:1 molar ratio and mixed in V-101 for 30 min and sent to the P&F filtration unit to remove any precipitated materials. An additional 1.5% loss of thaumatin during this step is assumed. Because soluble impurities such as nicotine and other pyridine alkaloids are abundant in N. tabacum plants, a UF/DF step is necessary to eliminate small molecules. The UF/DF unit consists of 4 stacked cassette holders, each containing twenty 3.5 m2 cassettes. Since thaumatin is a 22 kDa protein, a membrane with MWCO of 5 kDa is used per working process knowledge. Assuming a conservative flux of 30 L/, the inlet stream is concentrated using a concentration factor of 5, diafiltered 10 times against reverse osmosis water, then re-concentrated using a CF of 5 over 20.6 h, resulting in a 75% pure thaumatin and nicotine content of 1.08 mg/kg thaumatin. A retention coefficient of 0.9993 was assumed for thaumatin, resulting in 5.8% thaumatin loss in UF/DF .

The retentate is then sent to five CEX chromatography columns operating in parallel which was modeled based on unpublished data from Nomad Bioscience GmbH . GE Healthcare Capto S resin with an assumed binding capacity of 150 g/L was used in this analysis. Table S2 shows the downstream losses breakdown per unit operation. Spray drying is used as a final formulation step over other means of industrial drying due to the heat sensitivity of thaumatin. The simulated facility consists of three sections—Virion production laboratory , spinach field growth, and DSP. A list of base case design parameters and assumptions is shown in Table S3. The VPL process is adopted from a recent article entailing the production of RNA viral particles from agrobacteria carrying a PVX construct. The laboratory is sized to produce 7900 L of spray solution per batch for application in the field. Nicotiana benthamiana plants are used as the host to produce the viral particles to inoculate spinach. N. benthamiana seeds are germinated in soilless plant substrate at a density of 94 plants per tray. Seedlings are grown hydroponically , under LEDs, until reaching manufacturing maturity at day 35. Agrobacterium tumefaciens is grown for 24 h, before being left in a 4 L flask overnight, and the A. tumefaciens suspension is added to MES buffer in V-101. N. benthamiana infiltration takes place in a vacuum agroinfiltration chamber for 24 h followed by incubation for 7 days in . N. benthamiana biomass production, agrobacterium growth, agroinfiltration, and incubation parameters are adapted from. After the incubation period, 41.5 kg of N. benthamiana fresh weight are ground and mixed with PBS buffer in a 5:1 buffer:biomass ratio. The extract is then sent to a decanter centrifuge to separate plant dry matter from the liquid phase which is clarified by dead-end filtration , followed by mixing the permeate with 35.9 kg of diatomaceous earth and 7780 L of water to reach a final concentration of 1014 viral particles/L and 4.55 g diatomaceous earth/L. Diatomaceous earth is used as an abrasive to mechanically wound plant cell walls allowing the virions to enter the cytoplasm of the cell .

The final spray is stored in for 13 h before field application. Field operation starts at the beginning of each batch with the direct seeding of 28.3 million Spinacia oleracea seeds over 22.6 acres. Spinach is planted over 80-inch beds with an assumed 3 ft spacing between beds, resulting in 14,520 linear bed feet per acre. Seeds are germinated and grown in the field for 44.5 days, during which time a drip irrigation system delivers irrigation water and soluble fertilizer to the soil. It is assumed that 200 acre-inches of irrigation water and 64 tons of fertilizer are needed per batch. A tractor on which multiple high-pressure spray devices are mounted is used to deliver the viral particle solution at a rate of 2 acres/h. This method of delivery has shown high effectiveness. Spinach plants are incubated in the field for 15 days post-infection. During that period, thaumatin starts to accumulate in the crop at an average expressionlevel of 1 g/kg FW after 15 days post-spraying. At day 60, two mechanical harvests collect a total of 344 MT spinach biomass, carrying 344 kg thaumatin, with the aid of four hopper trucks, which is transferred to a 500-m-long conveyor belt that extends from the field collection site to the DSP section of the facility. Harvesting occurs at an average rate of 17,000 kg FW/h, which is estimated based on a harvester speed of 5 km/h and 14,520 linear bed feet per acre. A more simplified downstream processing, enabled by the use of spinach as a host, starts with mixing plant material with 65 ◦C water before extracting the green juice through a screw press . The resulting GJ is heated for 1 h at 65 ◦C in ten jacketed tanks , then concentrated by evaporation to reduce product stream volume for further purification steps. Since thaumatin is not stable at temperatures above 70 ◦C at neutral pH,vertical indoor farming evaporation is performed at a low temperature of 40 ◦C and 0.074 bar vacuum pressure. Thermally degraded host cell proteins and impurities are eliminated in a P&F filtration unit designed to include 10 filter sheets with decreasing particle retention size from 25 to 0.1 µm. Smaller impurities are removed using a diafiltration unit with 5 kDa molecular weight cut off cassettes in a similar process as described in Section 3.3, the retentate is spray dried in to obtain a final product which has 5% water content, and 348 kg of solid material containing 94% pure thaumatin and 6% spinach impurities. These impurities are expected to be water soluble, heat stable molecules in the range of 5–100 kDa, according to the theoretical design of the filtration scheme. Transgenic production models were resized based on scenario design requirement for production levels ranging from 10–150 MT and expression levels ranging from 0.5–2.5 g/kg, while keeping the scheduling parameters the same from base case models. The significant impact of expression level on CAPEX and COGS is elucidated in Figure 4a–c.

Production level shows a very small decline in COGS for indoor upstream facility and a linear increase in CAPEX with increasing production level. On the other hand, the field upstream facility showed a significant increase in COGS at lower production levels due to the minimum ownership costs of field equipment regardless of the small acreage size. DSP followed the expected behavior that economy of scale dictates, with sharp decrease in COGS at lower production levels and diminishing returns at higher production levels. The deviation from linear trend at 150 MT/year in field upstream and DSP is likely due to the model’s specified equipment maximum rating, which allows for the inclusion of a new equipment in parallel beyond this rating.The impact of varying the highest cost drivers in each of the facility’s category by 25% on COGS is portrayed as a tornado diagram in Figure 5c. Field labor was the most sensitive cost variable, having the highest impact on the COGS, followed by the ultrafiltration membrane, which is replaced every 30 cycles. In this model, we assume a relatively high downstream recovery of the protein from harvest to formulation. The reason for this assumption is that spinach, being edible crop, allows for a lower target product purity and a consequently fewer DSP steps. It is particularly important to focus resources on maximizing downstream recovery during process development because it ultimately affects plant biomass and spray volume requirement upstream to appropriately compensate for these losses, which in turn affects equipment sizing in DSP based on the amount of plant material to be processed. The unit operations were resized according to the scenario design requirement for downstream recovery ranging from 50 to 95% while scheduling parameters were left unchanged. This effect of downstream recovery on the facility’s AOC and COGS is shown in Figure 5d and shows a 1.5× increase in AOC and COGS as downstream recovery decreases from 95% to 50%. Although our analysis indicates a relatively high COGS range for a sugar substitute, there are unrealized costs savings from thaumatin use due to its unique sweetness intensity. Thaumatin’s use in extremely small quantities is essentially why it is considered a noncaloric sweetener, as it provides only 4 calories per gram. Sensory evaluation studies have found that a sample with 5% sucrose +4.6 ppm thaumatin II had similar sweetness as a 10% sucrose control with minimal lingering aftertaste, suggesting that up to one-half of the sugar could be replaced by thaumatin II . SSBs including sodas, fruit drinks, and sport drinks account for 50% of the total added sugar in Western diets, and therefore provide an attractive avenue for thaumatin emergence as a sugar substitute.

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Tobacco control advocates also held a press conference at the State Capitol

Posted on November 3, 2023 by hemp2022

During March, the Revenue Committee still had not decided whether or not to advance LB 1149 out of committee. Instead, they were spending their time working to craft a tax increase bill to help balance the state’s budget. The bill that was advanced out of committee, LB 1085, was written to raise $90 million in revenue primarily by expanding the sales tax base and increasing the cigarette excise tax by only $0.20.Eighteen of the twenty cents in the Revenue Committee’s excise tax increase went to the General Fund with the remaining two cents going to the Building Renewal Allocation Fund. With an excise tax increase included in their tax bill, the Revenue Committee decided 6-0 to gut LB 1149 and replace it with a Medicaid eligibility amendment.At this point, the excise tax increase no longer contained an earmark for the Tobacco Prevention and Control Cash Fund.On March 25, Senator Jensen attempted to get support for an amendment that would raise the excise tax increase back up to $0.50, but unable to find the support necessary for such an amendment, Jensen began working toward a $0.30 tax increase.In the morning of March 26, he was successful in getting an amendment to LB 1085 passed by a vote of 28-15 that increased the excise tax to $0.30.By the afternoon, Jensen’s amendment had been jettisoned due to intense opposition from Senator Ernie Chambers . Chambers, the Legislature’s only African American senator, was strongly opposed to an excise tax increase because he felt it was unfair to target a minority of taxpayers especially since that minority contained more individuals who were poor and non-white.Thirty-three votes were needed to overcome a Chambers’ filibuster so, with only 28 vote, the amendment was removed. Instead,indoor vertical farming the Legislature began focusing on using sales and income tax increases to balance the budget.

The reversal did not surprise the members of Citizens for a Healthy Nebraska. “This was always going to come down to the 11th hour,” said Rich Lombardi, one of the lobbyists for the coalition. “We’ll be here right to the very end.”Governor Johanns was not happy with the Legislature’s decision to utilize sales and income tax increases to balance the budget and promised a veto.He accused the Legislature of trying to tax their way out of the budget crisis instead of making the cuts he recommended.On April 8, a cigarette excise tax increase was again incorporated into LB 1085.It had become apparent that the sales and income tax increases would not be enough to balance the budget so, by a vote of 32-16, the Legislature again added an amendment to LB 1085 which increased the excise tax by $0.30.This excise tax increase was written to sunset after two years.Governor Johanns made good on his threat and vetoed LB 1085 because it increased the state’s sales and income taxes. The Legislature responded by voting 30-19 to override the governor’s veto.With that vote by the Legislature, Nebraska increased its excise tax on a pack of cigarettes from $0.34 to $0.64 for two years. As a result of further budget woes, the sunset clause for the $0.30 tax increase was removed in 2003 so that the increase became permanent . None of the revenues were ever allocated to tobacco control. At the beginning of the 2003 session of the Legislature in January, Nebraska was facing a $673 million gap in the budget.Unfortunately for health advocates in Nebraska, it was in this climate that they had to pressure legislators to continue funding Tobacco Free Nebraska at $7 million per year because the program was only funded out of the tobacco settlement through FY2002.In previous years, Citizens for a Healthy Nebraska had pushed for an earmark for Tobacco Free Nebraska as part of an cigarette excise tax increase . While they had been successful in getting a temporary $0.30 excise tax passed in 2002, the Legislature was unwilling to provide an earmark for tobacco control because legislators wanted to use all of the increase to deal with the budget crisis. Despite the fact that during the 2002 regular session, $5 million had not been reallocated to Tobacco Free Nebraska and the Legislature had been unwilling to provide continued funding for the program through an excise tax earmark, health advocates had some reason to be optimistic at the beginning of the 2003 session in January.

On January 15, 2003 Governor Johanns unveiled his biennium budget which called for making the $0.30 excise tax increase permanent and enacting an additional $0.20 excise tax increase that would devoted to the General Fund.Due in part to the increased funds that the state would be taking in from the $0.20 excise tax increase that was proposed, Johanns’ budget also included $3 million per year from the General Fund for each of the next two years to support Tobacco Free Nebraska. Two characteristics of Johanns’ budget would have serious consequences for tobacco control in Nebraska: it contained no other tax increases other than the cigarette excise tax increase and the $3 million for Tobacco Free Nebraska came out of the General Fund and not directly from the cigarette excise tax or the tobacco settlement.Due to the fact that, once again, Johanns stuck to his anti-tax mantra and insisted on no new taxes except an increase in the cigarette excise tax, his budget was largely discounted by legislators as unfeasible to deal with such a large budget deficit. To avoid raising taxes, Johanns’ solution was to cut funding to K-12 and to higher education by 10% for each of the next two years.His budget also called for a similar 10% cut for most state agencies. Many in the Legislature were very displeased that Johanns seemed willing to make such deep cuts to avoid increasing taxes. Some senators went so far as to say that the governor was avoiding the idea of raising taxes so the Legislature would take all the political heat for increasing taxes. “The way he’s handled it is fairly typical of the way governors in the past have handled it – they usually do turn it over to the Legislature for the realistic solution,” stated Senator Chris Beutler of Lincoln . “What he suggested certainly isn’t realistic. We need to do it ourselves.”Another critic of Governor Johanns’ budget was Senator Nancy Thompson . She said, “A lot of us think he’s just abdicating his leadership role – he just lobbed it over here.”Because legislators were upset at the governor’s insistence that the budget crisis should be remedied almost exclusively through spending cuts, a critical eye was turned towards the $3 million annually that he had in his budget for Tobacco Free Nebraska. Since the program had previously been funded out of the tobacco settlement and not out of the General Fund, many legislators viewed the $3 million as new spending from the General Fund.This $3 million was, however, a small fraction of the approximately $20 million that the $0.20 increase in cigarette excise taxes would bring in to the General Fund.

The fact that the funding for Tobacco Free Nebraska in the governor’s proposed budget was seen as new spending from the General Fund while the Governor was also calling for 10% cuts to many other programs, such as education,vertical harvest farms that had long be paid for out of the General Fund would be a huge pitfall for health advocates in Nebraska. The deep cuts to education were particularly unpalatable to many legislators and much of the 2003 legislative session consisted of legislators attempting to find a way to moderate the governor’s proposed cuts and still lower the budget deficit. This effort was rendered even more difficult when the budget deficit figure rose to $761 million in April.At this point, senators were debating which taxes could be raised to best help with the budget deficit. One proposal, initially advanced in Governor Johann’s budget was to make the $0.30 excise tax increase passed in 2002 permanent.Increasing the tax the previous year and now making it permanent, however, meant that the Legislature was unwilling to pass the additional excise tax increase of $0.20 proposed by Johanns. On May 6, the Legislature voted 34-7 to advance LB 285 which extended the temporary excise, sales and income tax increases passed in 2002 from the first round of debate.It was estimated that enacting LB 285 would bring in $235 million over two years and by factoring in additional sales, income and alcohol tax increases that the Legislature was considering, the total in revenue raised by all the tax increases was estimated to be $315 over the next two years. Even so, all these tax increases combined with spending cuts still left the Legislature $40 million short of a balanced budget.Up until early May 2003, tobacco control advocates in Nebraska had been unable to convince the Legislature to return the funding level for Tobacco Free Nebraska to $7 million per year; the $3 million per year proposed by the Governor, however, still remained in the budget bill. With the legislative session almost over, legislator began reviewing this budget bill for any additional areas that could be cut. On May 8, Senator Ronald Raikes of Lincoln , chairperson of the Education Committee, proposed an amendment to the budget bill to completely remove the $3 million per year that Tobacco Free Nebraska was to receive. The same day, Speaker of the Legislature Curt Bromm of Wahoo introduced an amendment to the tax package bill that sought to increase the cigarette excise tax by $0.03 to $0.67, which was estimated to raise approximately $3.3 million, to all be placed in the Tobacco Prevention and Control Cash Fund, Tobacco Free Nebraska’s funding source. With these two major amendments introduced on the same day, the health advocates in Nebraska rapidly stepped up their lobbying efforts. Telephone calls and e-mails went out to individuals to mobilize them to contact their state senator to urge him or her to vote no on Senator Raikes’ amendment and yes on Senator Bromm’s. In addition, they flooded Senator Raikes’ office with calls protesting his amendment. His response was that it was not his intention to gut the Tobacco Free Nebraska program but that he felt that the program should be funded out of the tobacco settlement and not out of the General Fund.He had not, however, introduced such legislation or included a provision to do so in his amendment. Throughout the legislative session, tobacco control advocates had been attempting to garner more money for Tobacco Free Nebraska out of the tobacco settlement, without any success. All of the interest generated by the settlement was already committed to the $50 million per year in health-related expenses funded by LB 692 which was passed in 2001.In contrast to earlier willingness to fund Tobacco Free Nebraska out of the settlement money, many legislators stated their preference for funding tobacco control using an excise tax increase instead of the tobacco settlement. The reason why some of these legislators were not supportive of using the tobacco settlement was because they were afraid that using the tobacco settlement money for anything other than the package of programs funded through LB 692 would jeopardize the funding source for these programs. Two of the senators that pushed for excise tax increases instead of using tobacco settlement money were the heads of the Health and Human Services Committee, Jim Jensen and Dennis Byars. In 2001, both senators had been major architects of LB 692 and had pushed for the tobacco settlement to be used for public health improvements with Senator Jensen focusing on mental health services and Senator Byars pushing for developmental disabilities and respite care .During the 2003 session, these two senators introduced and passed LB 468, which refunded out of the tobacco settlement all of the health-related programs first funded as part of LB 692.While the funding for these programs was not increased due to the budget crisis, they were not cut from their previous levels of funding either. Biomedical research, which had been scheduled to jump from $10 million to $12 billion for FY2004 and FY2005 remained at $10 million.The result was that biomedical research, which was already received over $10 billion a year in funding from the National Institutes of Health and other sources, continued to receive more money from the tobacco settlement than the tobacco control program.

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The tobacco industry also began threatening a lawsuit if the issue was placed on the ballot

Posted on November 2, 2023 by hemp2022

While Omaha’s youth access ordinance was able to survive the lawsuit brought by the vending companies, the lawsuit brought by Baker’s Supermarkets was more successful. One significant reason for this success was that Baker’s had learned from the example set by the vending companies and the other retailers opposed to Omaha’s ordinance that a battle in public over youth access would not be to the advantage of retailers who sought to weaken the law and its enforcement. As a result, Baker’s did not take their appeal to the media or to public officials. Instead the company quietly took their case to court. No evidence could be found that the proceedings of the lawsuit or its eventual result were ever written about in the media. On August 14, 1996, the lawsuit filed by Baker’s parent company challenging the ordinance was heard by Douglas County District Judge Stephen A. Davis. The members of the Prevention Coalition for Children were unaware that this lawsuit was proceeding.On September 19, Judge Davis ruled that the portions pertaining to hearing procedures and punishments of the Omaha ordinance were in conflict with state laws and thus, were void. Specifically, Judge Davis ruled that it was not permissible for the City of Omaha to suspend a license granted by the State of Nebraska because state law did not provide for suspensions. Davis’ ruling eliminated the ability of the Omaha Police Department and its STOPP Unit to aggressively enforce the city’s youth access ordinance by removing the penalties against retailers that were provided in Ordinance #32972.While the remaining portions of the ordinance are still written into law, the ordinance as a whole can no longer be enforced strongly by the Omaha Police Department as they were before the lawsuit by Baker’s Supermarkets because penalties provided by the ordinance were removed. The initial strategy taken by the tobacco industry was discussed by Matt Paluszek, Government Affairs Regional Director for Philip Morris, in a memo to other senior Philip Morris executives.He stated, “Our short-term strategy is to make it known that there is broad-based opposition to this initiative, so as to undermine efforts to raise money for the campaign and to get the 42,000 valid signatures needed.”Paluszek also wrote that all press inquires would be handled by Bill Peters, the Tobacco Institute’s lobbyist for Nebraska,cannabis drying rack and he named possible allies in their fight against the initiative, namely, “NE Retailer Federation, Farm Bureau, NE Consumer Packaging Council, Higher Education representatives .”

Another list which appears to include possible allies was found in tobacco industry documents that was handwritten on a copy of the Clean Environment Committee’s donation information sheet, but it is not known who wrote this list. This list included the “NE Tax Research Council, Chamber [of Commerce], Farm Bureau, Solid Waste – Retail Merchants, Smokers, Retail Grocers, University [of Nebraska], Cancer Research, Every Group That Is Currently Recieving Funding.”While the Clean Environment Committee was just getting their petition off the ground, the tobacco industry had their hands full with several other initiatives. Similar tax initiatives were further along in Massachusetts, Colorado and Oregon, and new ones were beginning in Arkansas and Oklahoma as well.The tobacco industry was already focused on these other initiatives and they did not take the threat posed by the Francis Moul and his group very seriously. As a result, the initial response by the tobacco industry was to simply monitor the progress of the Nebraska Clean Environment Committee. As Robert McAdam, Tobacco Institute Vice President of State Affairs for Initiatives, Referendums, and Special Projects, and Daniel Wahby, Director of Special Projects for the Tobacco Institute, stated in a memo to the Tobacco Institute Coordinating Committee, “It has been consistently believed that the proponents of this issue were not politically sophisticated enough to qualify this issue for the ballot. Now that they have filed this issue for circulation, we will be monitoring their activity closely to determine their progress.”Both McAdam and Wahby would lead the tobacco industry’s opposition to the Nebraska Clean Environment Act. Through the middle of May, the tobacco industry mainly focused on monitoring the progress of signature-gathering. A memo from McAdam to the Tobacco Institute Coordinating Committee on May 19, 1992 stated, “There is still little evidence that the proponents of this initiative have organized sufficiently to qualify this issue for the ballot. While they did have some petition gatherers located at polling places during this state’s primary election, they did not have the coverage necessary to obtain sufficient signatures.”At the same time, however, the tobacco industry started to spend money to fight the petition. On May 20, McAdam wrote to the Tobacco Institute Management Committee saying, “In an attempt to pay for some preparatory legal work and for a possible survey should the petition gatherers appear to be reaching their goal, I believe we need to allocate $40,000 for this campaign at this time.”By the middle of June, McAdam was beginning to take the initiative campaign in Nebraska more seriously.

His memo to the Tobacco Institute Coordinating Committee on June 15 stated, “While the proponents of the tax increase initiative in this state continue to appear somewhat disorganized, they have recently hired a professional consulting firm to help them gather signatures throughout the state. They have indicated to reporters that they plan to pay signature gatherers on an hourly basis. While it is still too early to determine if they will be successful, we have organized our legal approach to challenging certain aspects of the initiative, as well as the individual signatures that the proponents may submit.”By June 17, the first assessment for funds to combat the Nebraska initiative was prepared and sent to senior executives within Philip Morris, R.J. Reynolds, Lorillard and American Tobacco with the total amount being the $40,000 requested by McAdam, divided between the companies on the basis of market share.This money was to be sent to the Nebraska Executive Committee c/o Bill Peters,vertical grow system who was the Tobacco Institute’s lobbyist for Nebraska.These “Executive Committees” and other front groups with neutral to positive-sounding names, were led by the Tobacco Institute lobbyist in states where an initiative was underway.For example, money from the tobacco industry to defeat the initiative in Arizona was sent to the Arizona Executive Committee and in New Jersey, the checks were mailed to John O’Conner in the Tobacco Institute’s office in Albany, New York, but the checks were to be made payable to Citizens for Representative Democracy in West Trenton, New Jersey.In July, the Nebraska Clean Environment Committee submitted an estimated 48,000 signatures to the Secretary of State for certification.The total number of signatures that was needed to be placed on the ballot was.By then, the tobacco industry was actively attempting to recruit new allies to help in its fight against this environmental initiative. In addition to the “traditional” tobacco industry allies, which included business and tax groups,the Tobacco Institute was attempting to enlist the aid of WIFE, which stands for Women Involved in Farm Economics. WIFE is a national organization whose president in 1992 was Elaine Stuhr, who was elected a Nebraska state senator from Bradshaw in 1994 and remained in the Legislature as of 2003 . In a letter to Stuhr, Daniel Wahby, the Director of Special Projects for the Tobacco Institute, wrote, “First of all, I would like to take this opportunity to thank you and your organization for your interest in assisting our efforts in defeating the proposed 25 cents per pack excise tax on tobacco products.”Wahby tells Stuhr that he has asked Bill Peters to get in touch with her to give her more information. He states, “I apologize for not having specific information in writing as it relates to the farm community in Nebraska but I trust your conversation with Mr. Peters will give you some information to go on.”Bill Peters, the Tobacco Institute’s lobbyist, told reporters that the true number of signatures that needed to be obtained was more than 61,000 and not the 41,058 that the secretary of state said was necessary.The conflict came over whether language in the Nebraska Constitution required the number of signatures to exceed a percentage of the citizens that were registered to vote in the last election for governor or a percentage of citizens that actually voted in the last election for governor. While Nebraska was filing suit, a team of attorneys general were negotiating with the tobacco industry to create a new settlement to replace the Global Settlement Agreement.

Having learned from the failure of the Global Settlement, the attorneys general decided to limit their settlement negotiations with the tobacco industry to issues that they had the full authority to settle directly, rather than including legislative proposals. The deal that they brokered became the Master Settlement Agreement.In exchange for payments to the states determined by a complex formula related to cigarette consumption and inflation that extended indefinitely , public access to tobacco industry documents, limitations on advertising and promotions and disbanding the Council for Tobacco Research, the Council for Indoor Air Research and the Tobacco Institute, the states agreed to drop their lawsuits.In addition, the tobacco industry, having learned that a lengthy debate on the merits did not serve its interests, insisted that the individual states had to decide whether they would participate within seven days following announcement of the Settlement.This last component of the Master Settlement Agreement raised some concern with tobacco control advocates in Nebraska. Before the deal had been finalized between the attorneys general and the tobacco industry, the members of SmokeLess Nebraska and Mark Welsch of GASP were publicly worrying that seven days would not permit the State of Nebraska, particularly Attorney General Stenberg, to closely examine the details of the settlement before deciding whether or not to sign the agreement.Dave Holmquist of the American Cancer Society stated, “We just think seven days is an awfully short time to make a decision on something that will affect the American people for a long time to come.”When the Master Settlement Agreement was formally announced on Saturday November 14, 1998, it seemed highly likely that Nebraska would participate. By Monday Attorney General Stenberg and Governor Nelson came out in favor the settlement.Stenberg, who had final say on whether to sign the Master Settlement Agreement, said that he wanted to consult State Senator Roger Wehrbein , Chairperson of the Appropriations Committee, and State Senator Don Wesely , Chairperson of the Health and Human Services Committee, before making his final decision.Stenberg explained his rationale for favoring the settlement, saying, “It is unlikely that Nebraska would obtain a judgement of more than $1 billion [the estimated value of the MSA to the state over the first 25 years] if we refuse this settlement and continue our own lawsuit.”Early Tuesday November 17, 1998, Attorney General Stenberg announced that he had decided to accept the Master Settlement Agreement.Once again, Stenberg reiterated his position that he felt Nebraska would not receive as much in its own lawsuit as it would receive by participating in the Master Settlement Agreement. Governor Nelson stated that he felt that the settlement was not perfect but that it was acceptable; he said “I’ve never been one to let my desire for the perfect get in the way of the good.”By signing the Master Settlement Agreement, Nebraska’s share of the settlement over the first 25 years was estimated to be $1.17 billion.Annual MSA payments for Nebraska are between $38.1 and $49.9 million.In 1998, Nebraska established trust funds for the tobacco settlement money that the state was expecting to receive from the Global Settlement Agreement and which it eventually received under the Master Settlement Agreement. While the Legislature, responding to pressure from Governor Nelson, decided early on that the settlement money would be used for improvements to the state’s health infrastructure, the Legislature was less committed using the money received as a result of the state’s Medicaid expenditures due to smoking to actually reduce the harm done by smoking through tobacco prevention and control efforts. During the 1998 legislative session, when Nebraska was anticipating receiving money from the Global Settlement Agreement, Governor Nelson and state legislators, such as Don Wesely of Lincoln, the Chairperson of the Health and Human Services Committee, and Jim Jensen of Omaha stated their desire to ensure that the settlement money be applied to improving the healthcare system of the state.

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The Rules Committee oversees such actions and 30 votes are required for a rules change

Posted on November 1, 2023 by hemp2022

The concerted attack on LB 648 at the hearing had the tobacco industry’s desired effect. As Oliverio relates in his letter to fellow Tobacco Institute executives three days after the hearing, “The day following that hearing the Committee met in executive session and voted 5 to 1 not to report the bill out of committee. Significantly, the only senator on the Public Health and Welfare Committee to vote in favor of reporting the bill out of committee was not present at the hearing on the previous day.”The success of the tobacco industry against LB 648 may have led them to become overconfident in their attitude towards future legislative attempts at clean indoor air laws in Nebraska. As Oliverio wrote to senior executives throughout the tobacco industry, “LB 648 is dead for this year and because of the overwhelming vote against it we are hopeful that it will not be reintroduced next year.”The head of the Public Health and Welfare Committee apparently did nothing to dissuade this opinion. Richard Safley, the Field Sales Manager for Lorillard Tobacco stated in a letter sent on October 24, 1978, to Art Stevens, a member of the Legal Department at Lorillard, “The opinion expressed by the Committee Leader was that unless stimulated by anti-[smoking] group movements, the bill probably would not be introduced at the next session.”This would not be the case; at the next session, Senator Stoney would sponsor LB 344, which was passed as the Nebraska Clean Indoor Air Act.While the tobacco industry was still concerned about LB 344 because of the strength of the bill, this legal decision by the attorney general only increased the tobacco industry’s confidence that the bill would be defeated. In a memo dated May 11, 1979 from J. Kendrick Wells, a lawyer for Brown & Williamson, to numerous executives within his company, Wells points out that LB 344 would have a broader reach than legislation that was pending in New York, Connecticut and Massachusetts. He goes on to say, “Important Nebraska allies joined the tobacco industry’s opposition to the bill during the week of May 7 and,pruning marijuana although the nose count is close, we do not expect the passage of the Nebraska bill.”

Although it is not clear if Wells meant the Attorney General when he referred to new allies, his memo indicated that the tobacco industry still thought LB 344 would be defeated. Not to be outdone, Senator Stoney asked the Judiciary Committee Staff to review the constitutionality of the bill. On May 14, the Judiciary Committee Staff disagreed with the finding of the Attorney General that Section 10 and 11 were constitutionally suspect and commented, “There is . . . convincing case law to the contrary which would indicate that the language of LB 344, uses language which would meet constitutional guidelines.”In the same memo, the Judiciary Committee Staff cited court cases from four other states and one case from Nebraska which they believed supported their claim that LB 344 did not violate the Nebraska Constitution by improperly granting legislative authority to the Department of Health. The day after the Judiciary Committee Staff issued their opinion, LB 344 was passed by a vote of 30-18-1.While the Attorney General stated that the language of LB 344 was constitutionally suspect because the bill was too vague and thus granted legislative authority to the Department of Health, this did not prevent its passage by the Legislature. However, this was an argument that would be used later to weaken the rules and regulations that were adopted by Department of Health. After losing in the Legislature, the tobacco industry set their sights on convincing Governor Charles Thone to veto the bill. Once again, the services of the law firm of Crosby, Guenzel, Davis, Kessner & Kuester were utilized to write a four page letter on behalf of the Tobacco Institute that was to be hand delivered to the governor.It was also blind carbon-copied to the Tobacco Institute’s Raymond Oliverio. Since Oliverio was directly involved with the effort to get LB 344 vetoed, it is not surprising that the arguments in the letter correspond to talking points drafted by Oliverio early on in the campaign against LB 344. For example, the fifth paragraph of the letter from the Lincoln law firm states, “Although the possibility of enforcing such an unrealistic extension of governmental regulation is virtually nonexistent, such an analysis clearly shows the unprecedented reach of the government of the State of Nebraska into the private lives of its citizens.”

This argument refers to two of the four talking points that Oliverio said would play well in Nebraska, specifically, “There is no estimate of the cost involved to implement LB 344,” and “This is a further example of government intrusion into the private sector.”Another talking point was used when the letter claims, “For many years activist anti-smoking groups have asserted that non-smokers are harmed by smokers. Such an assertion has never been supported by credible evidence.”This tactic of attacking science that shows.As required by LB 344, the next step to putting Nebraska’s new law into effect was for the Department of Health to develop the regulations that would actually detail how businesses were to comply with the law. For example, LB 344 required the posting of signs and the arrangement of seating to limit the amount of smoke to which individuals in the nonsmoking section were exposed, but the law did not specify where signs were to be posted or what constituted an acceptable seating arrangement.After being signed into law, the task of developing such rules and regulations fell to the Department of Health. Initially, the Department of Health decided to utilize the rules and regulations that were adopted in Minnesota for their clean indoor air law.Since the Nebraska Clean Indoor Air Act had been modeled on its Minnesota counterpart and the rules and regulations developed for Minnesota Clean Indoor Air Act had been implemented with little controversy,it was reasonable for the Department of Health to use the Minnesota regulations as a template. It was at the Department of Health’s first public hearing that the tobacco industry’s strategy became clear. The Nebraska Restaurant Association and the Nebraska Licensed Beverage Association mobilized to fight against the effectiveness of the new law.At the first hearing, the contested issue was what constituted an “acceptable smoke-free area.” In the first draft, the Department of Health modeled their rules and regulations on Minnesota’s so that nonsmoking areas were to be separated from smoking areas by at least a 56 in high barrier or a 4 ft wide space. This requirement was supported by Senator Stoney and the Nebraska chapters of the American Lung Association and the American Cancer Society.The Nebraska Restaurant Association, the Nebraska Licensed Beverage Association, and other business groups’ idea of a nonsmoking area was an area where signs were posted designating it as such or an area that was mechanically ventilated.They argued that requiring restaurants and bars to create a physical barrier using a 56 in high barrier or a 4 ft wide space would be prohibitively expensive.

This argument ignored the fact that the 4 ft wide space could still contain tables where patrons could be served, but the buffer area would not be considered part of the acceptable smoke-free area and individuals seated within this section could not smoke. Echoing the Attorney General’s decision,trimming weed plants these tobacco industry allies told officials from the Department of Health that requiring physical barriers exceeded their authority.At the first hearing on July 24, 1979, the opposition to the physical barrier requirement was so vehement that the Department of Health removed it from their second draft.At the second public hearing in August, it was the tobacco control advocates’ turn to attack the rules and regulations. Presented with the second draft which did not contain the physical barrier requirement, Senator Stoney and the health groups protested. At the hearing, Stoney said a “well-organized and handsomely paid” group of opponents were trying to “destroy the intent” of his bill by watering down its provisions.Alan Wass, Director of the American Lung Association of Nebraska, commented on the new draft saying, “The NebraskaClean Indoor Air Act would be emasculated by this second draft.”He also stated his opposition to the ventilation provision because he said that ventilation does not address the issue of the health effects of carbon monoxide present in secondhand smoke that would not be removed by ventilation.Achieving smoke free state facilities in Nebraska was not a short process. One of the first steps occurred in 1993 when several state senators sought to prohibit smoking in the legislative chamber of the State Capitol Building. This effort was headed by Senator C.N. “Bud” Robinson who had the lung and kidney ailment called Wegener’s disease.Robinson and several others surveyed the senators to see if they would support a rules change to accomplish this goal.One of the senators that was highly supportive of such an action was Don Preister who was a first-year senator in 1993. Preister had been a victim of carbon monoxide poisoning and was sensitive to secondhand smoke.Throughout the years, he would be a key proponent of smoke free state facilities. Robinson and Preister were successful in garnering wide support for making the Legislative Chamber smoke free and over 30 senators sponsored the rules change which passed by a vote of 40-1. While these actions were proceeding in the Legislature, the student government of the University of Nebraska – Lincoln , following a trend for universities around the country, formally urged the administration to make university buildings smoke free; however, the student body president stated the resolution did include dormitory rooms.At the time, UNL’s smoking policy limited smoking to designated areas in dormitories and building lounge and private offices that contained a filtering device.After some consideration and consultation with the student government and school officials, Chancellor Graham Spanier announced that smoking and smokeless tobacco would be prohibited in all university buildings and vehicles.Of particular note was the fact that Spanier’s initial plan was to include Memorial Stadium, home field for the Nebraska Cornhuskers. After receiving some complaints from smokers about including Memorial, Spanier weakened the changes so that smoking would be permitted in designated areas that were inside the stadium but were not near seating areas.In 1994, Senators Preister and Robinson again sought to strengthen smoking restrictions regarding state facilities. They sponsored LB 1064 which would have made virtually all state buildings and vehicles smoke free.The bill included any buildings or vehicles that were owned, leased or occupied by the state.Preister told reporters that his main reason for sponsoring this legislation centered on children. He said, “I am particularly concerned about children who come to the Capitol to view the Legislature. They pass through the Rotunda, which on a given day is filled with smoke.”Preister said that he was also concerned about the example that this set for these schoolchildren and about the damage cause to the Capitol and its artwork by the smoke. Despite the efforts of Senator Preister and Senator Robinson, LB 1064 was not successful. The next year, in 1995, Senator Preister introduced another bill that was very similar to LB 1064. Designated LB 121, it prohibited smoking within 50 feet of the entrance to a state building in addition to making most state buildings and vehicles smoke free.University residence halls, veterans’ homes, state prisons and overnight facilities at state parks were exempted. At its hearing before the Health and Human Services Committee, LB 121 was supported by the American Lung Association. It was opposed by Bill Peters, a lobbyist for the Tobacco Institute, who cited the tobacco industry’s claim that accommodation is the proper stance for governments by stating that there was no need to change the law because both nonsmokers and smokers were accommodated by the current situation.LB 121 was advanced out of committee by a vote of 4-1 but after being debated for three straight days, it fell short of passing the first round by four votes.In 1996, officials at the University of Nebraska-Lincoln decided to make Memorial Stadium smoke free.Three years earlier, the chancellor attempted to make Memorial Stadium smoke free along with the rest of the University but he had decided to allow designated smoking areas away from the seating areas after receiving complaints about the new policy.

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