An improved understanding of cannabis cultivators’ water use practices is a particularly pressing need

Posted on August 22, 2023 by hemp2022

Maximum end expiratory eNO was measured in each child with a fast response chemiluminescence analyzer. They found no effect of formaldehyde on lung function. However, controlling for age and atopy , eNO was significantly elevated to 15.5 ppb in homes with ≥ 50 ppb formaldehyde compared with 8.7 ppb eNO in homes with < 50 ppb formaldehyde. Authors did not report the cross-sectional risk of atopy to common allergens from exposure to formaldehyde. They hypothesized that formaldehyde causes inflammation and the release of cytokines, which leads to the upregulation of inducible NO synthetase. This view was supported by another study that found intranasal exposure to 400 ppb formaldehyde in healthy subjects caused eosinophilia in the nasal epithelium . Given that a key marker of the asthmogenic effects of formaldehyde may be specific IgE to formaldehyde-albumin, other air toxics could be similarly screened to evaluate their potential influence on atopic responses. Some experimental evidence in controlled human exposure studies supports an respiratory irritant mechanism for VOCs , but the human experimental research on lower respiratory or pulmonary immunologic effects of VOCs is scarce apart from studies of agents associated with occupational asthma . Koren et al. conducted a randomized crossover chamber study of 14 healthy nonsmoking young adult men. Subjects were exposed for 4 hr 1 week apart to clean air and 25 µg/m3 of a VOC mixture typical of indoor nonindustrial micro-environments. Nasal lavage performed immediately after exposure and 18 hr later showed significant increases in neutrophils at both time points. Harving et al. conducted a randomized crossover chamber study of 11 asthmatic individuals who were hyper reactive to histamine. Subjects were exposed for 90 min, 1 week apart to clean air and VOC mixtures at 2.5 and 25 µg/m3. Investigators found FEV1 decreased to 91% of baseline with 25 µg/m3,cannabis trimming but this was not significantly different from sham exposure, and there was no change in histamine reactivity.

It is possible that the null results do not reflect inflammatory changes that influence small airways, which could be missed with FEV1 measurements. What may be occurring in natural environments is another story, with mixed exposures possibly interacting under a wide range of exposure–dose conditions. This is best investigated with epidemiologic designs.Indirect evidence of a role for ambient VOCs in asthma comes from research linking a buildup of indoor irritants including VOCs and bio-aerosols in office buildings to a nonspecific cluster of symptoms called the “sick building syndrome,” which includes upper and lower respiratory tract symptoms, eye irritation, headache, and fatigue. Other studies have also found new-onset asthma occurring in relation to particular nonresidential indoor environments, especially where problems with ventilation systems or dampness have been found . It is possible that fungal spores or other aeroallergens, mycotoxins, and endotoxins could increase in parallel with VOCs under conditions of inadequate air exchange at work, and be responsible for some of these findings. Epidemiologic evidence linking indoor home VOCs with asthma or related respiratory outcomes come largely from cross-sectional studies. A survey of 627 students 13–14 years of age attending 11 schools in Uppsala, Sweden, showed self-reported asthma prevalence was higher in schools with higher VOCs . Other risk factors were not controlled for in this association. In addition, passive, not active, VOC measurements were associated with asthma. Norbäck et al. , using a survey sample of 600 adults 20–44 years of age in Uppsala, Sweden, selected a nonrandom sub-sample of 47 subjects reporting asthma attacks or nocturnal breathlessness the last 12 months or reporting current use of asthma medications. A random sub-sample of 41 other subjects was selected from the survey pool with negative responses. Logistic regression models adjusted for age, sex, smoking, carpeting, and house dust mites, but not dampness, which was significant. There were no effects on daytime breathlessness from concentrations of 2-hr active VOC samples in the homes. Nocturnal breathlessness was associated with toluene, C8-aromatics, terpenes, and formaldehyde in adjusted models. Bronchial hyper responsiveness was correlated only with limonene. PEF variability was correlated only with terpenes. Wieslander et al. aimed to examine respiratory symptoms and asthma outcomes in relation to indoor paint exposures in thelast year.

They selected an enriched random sample of 562 adult subjects, including asymptomatic responders along with all reporting asthma or nocturnal dyspnea , using the same survey source population as Norbäck et al. in Uppsala. Asthma was defined as positive bronchial hyper responsiveness to methacholine plus asthma symptoms . Thirty-two percent of homes and 23% of workplaces were painted within the last year. Total VOC was elevated by 100 µg/m3 in 62 newly painted homes. Logistic regression models adjusted for age, sex, and current smoking but not ETS. Asthma prevalence was greater for newly painted homes [OR 1.5 ], consistent with greater differences in VOCs . Blood eosinophil concentrations were also elevated in newly painted homes. In newly painted workplaces, asthma like symptoms were significantly increased , but there was no association with bronchial hyper responsiveness or eosinophils. There were no associations for newly painted homes or workplaces and atopy , serum eosinophilic cationic protein, serum IgE, PEF variability , or in-clinic FEV1. Biases in the above cross-sectional studies in Uppsala include potential selection bias and the possibility that health outcomes preceded exposures. Diez et al. studied 266 newborn children born with birth weight of 1,500–2,500 g, or with elevated IgE in cord blood, or with a positive primary family history of atopic disease. Concentrations of 25 VOCs were monitored indoors during the first 4 weeks of life. Parents filled out questionnaires after 6 weeks and 1 year of age. Postnatal respiratory infections were associated with benzene > 5.6 µg/m3 [OR 2.4 ] and styrene > 2.0 µg/m3 [OR 2.1 ]. Wheezing was associated with reports of restoration during the first year of life, but not with total or specific IgE at the age of 1 year. These models controlled for heating, gas cooking, home size, new furniture, and animals but did not control for significant effects of ETS, which was correlated with benzene. All of the above studies of indoor VOCs may be subject to unmeasured confounding by other causal agents that increase indoors under low ventilation conditions, including aeroallergens, or that are correlated with VOCs for other reasons. Most, but not all, of the studies controlled for ETS. The research to date is too sparse to evaluate causality from indoor home VOCs,rolling benches but there is even less information to evaluate the public health impact on respiratory health from outdoor VOCs, which include some of the same compounds found indoors. Ware et al. conducted a study in a large chemical manufacturing center in the Kanawha Valley, West Virginia. They surveyed 74 elementary schools with interviews of 8,549 children in and out of the valley and measured passive 8-week samples of 5 petroleum-related VOCs and 10 process related VOCs . Higher VOC concentrations were found in the valley.

Cross-sectional results showed children in the valley had higher rates of physician-diagnosed asthma [OR 1.27 ]. Composite indicators for lower respiratory symptoms in the last year were weakly positively associated with petroleum-related VOC levels [OR per 10 µg/m3, 1.05 ] and process-related VOCs levels [OR per 2 µg/m3, 1.08 ]. Asthma diagnoses were weakly positively associated with petroleum-related VOCs [OR 1.05 ] but not process related VOCs . One school with high petroleum-related VOCs strongly influenced the model. The average concentrations measured in the Kanawha study do not differ greatly from average levels in large urban areas . For the Kanawha study compared with a Los Angeles ambient exposure study, for example, average toluene was 9.7 µg/m3 versus 13 µg/m3, respectively, and for benzene, 3.2 µg/m3 versus 3.5 µg/m3, respectively . In a study of 51 residents of Los Angeles, personal and indoor air concentrations of all prevalent VOCs except carbon tetrachloride were higher than outdoor ambient concentrations . Also, personal real time exposures can be even higher, particularly while in cars . For example, measurements of toluene taken inside cars in New York City ranged from 26 to 56 µg/m3 and for benzene ranged from 9 to 11 µg/m3 . Assessing the environmental impacts of the cannabis industry in Northern California has been notoriously difficult . The federally illegal status of cannabis has prevented researchers from obtaining funding and authorization to study cultivation practices . Fear of federal enforcement has also driven the industry into one of the most sparsely populated and rugged regions of the state , further limiting opportunities for research. The result has been a shortage of data on cultivation practices and their environmental risks .Given the propensity of cannabis growers to establish farms in small, upper watersheds, where streams that support salmonids and other sensitive species are vulnerable to dewatering , significant concerns have been raised over the potential impacts of diverting surface water for cannabis cultivation. The environmental impacts of stream diversions are likely to be greatest during the dry summer months , which coincide with the peak of the growing season for cannabis. Further, because cannabis cultivation operations often exhibit spatial clustering , some areas with higher densities of cultivation sites may contain multiple, small diversions that collectively exert significant effects on streams .

An important assumption underlying these concerns, however, is that cultivators rely primarily on surface water diversions for irrigation during the growing season. Assessments of water use impacts on the environment may be inaccurate if cultivators in fact use water from other sources. For instance, withdrawals from wells may affect surface flows immediately, after a lag or not at all, depending on the well’s location and its degree of hydrologic connectivity with surface water sources . Documenting the degree to which cannabis cultivators extract their water from above ground and below ground sources is therefore a high priority. In 2015, the North Coast Regional Water Quality Control Board , one of nine regional boards of the State Water Resources Control Board, developed a Cannabis Waste Discharge Regulatory Program to address cannabis cultivation’s impacts on water, including stream flow depletion and water quality degradation. A key feature of the cannabis program is an annual reporting system that requires enrollees to report the water source they use and the amount of water they use each month of the year. Enrollees are further required to document their compliance status with several standard conditions of operation established by the cannabis program. These include a Water Storage and Use Condition, which requires cultivators to develop off-stream storage facilities to minimize surface water diversions during low flow periods, among other water conservation measures. Reports that demonstrate noncompliance with the Water Storage and Use Standard Condition indicate that enrollees have not yet implemented operational changes necessary for achieving regulatory compliance. In this research, we analyzed data gathered from annual reports covering 2017 to gain a greater understanding of how water is extracted from the environment for cannabis cultivation. The data used in this study was collected from cannabis sites enrolled for regulatory coverage under the cannabis program. The program was adopted in August 2015, with the majority of enrollees entering the program in late 2016 and early 2017. The data presented in this article was collected from annual reports submitted in 2018 , which reflected site conditions during the 2017 cultivation year. The data therefore represents, for the majority of enrollees in the cannabis program, the first full season of cultivation regulated by the water quality control board. Because the data was self-reported, we screened reports for quality and restricted the dataset to reports prepared by professional consultants. Most such reports were prepared by approved third-party programs that partnered with the board to provide efficient administration of, and verification of conformity with, the cannabis program. Additional criteria for excluding reports included claims of applying water from storage without any corresponding input to storage, substantial water input from rain during dry summer months and failure to list a proper water source. Reports containing outliers of monthly water extraction amounts were also identified and excluded due to the likelihood of erroneous reporting or the difficulty of estimating water use at very large operations.

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Haptens must first react with endogenous or exogenous proteins to form a complete antigen

Posted on August 21, 2023 by hemp2022

Given that low LR participants reported a higher number of drinks per typical drinking occasion than high LR participants in the six months preceding the study, and since other groups have reported that recent heavy drinking influences subjective perceptions of alcohol along the ascending and descending limbs of the BrAC curve , this variable was used as a covariate in our analyses.These analyses are the first to directly examine the potential relationship between the low level of response to alcohol and acute tolerance. The results offered no support for Hypothesis 1, which had predicted that the low LR to alcohol would be explained, at least in part, by a more robust acute adaptation to alcohol’s effect in participants with low LR. None of the measures tested here supported that prediction including results from the SHAS-7, the subjective report of feeling sleepy, or the body sway measures. These negative results regarding acute tolerance complement the evaluation of light drinkers with lower LR who were evaluated in their early teens but who were unlikely to have developed chronic tolerance . The combination of the current results and the prior data regarding drinking 13-year-old UK sample is not consistent with a conclusion that either form of functional tolerance is central to the low LR phenomenon. The current results actually indicated the opposite of Hypothesis 1 in that low LR participants had significantly lower acute tolerance responses on the SHAS-7 in response to the alcohol challenge than high LR individuals.That finding of a relative resistance to change in the presence of alcohol is consistent with the less intense alcohol reaction seen for most measures of alcohol response including those related to EEG , ERP , hormonal , and fMRI measures . As reported elsewhere , some data indicate that the low LR might reflect a general need for greater cognitive effort to recognize relatively subtle differences in some sensory inputs,marijuana drying a phenomenon that might relate to sensitivity rather than tolerance. Prior to the current analysis it was not possible to evaluate whether acute tolerance also contributed to the low LR phenomenon.

In addition to the hypothesis that low LR reflects a diminished sensitivity to interoceptive cues that does not highly correlate with intra-session tolerance per se , the present results shine new light on several older theories intended to explain the relationship between an individual’s initial sensitivity to a drug and the development of acute tolerance. Regardless of whether these models evoked theories involving classical Pavlovian conditioning principles , the opponent-process theory of acquired motivation , theregulatory model of addictive vulnerability or Koob’s and Le Moal’s allostatic model of addiction , a key element that cuts across these four models is the view that acute tolerance likely represents an individual’s counter-regulatory response to a drug’s pharmacodynamic effects. Viewed through this lens, another interpretation of our results might be that low LR individuals exhibit diminished acute tolerance compared with the high LR group because their compensatory physiological responses underwent more rapid, long lasting, or intense adaptation after their initial exposures to alcohol earlier in their histories. Alternatively, at the moderate dosage of alcohol tested, the magnitude of the pharmacodynamic stimulus may be diminished in low LR individuals, thus, eliciting an attenuated counter-regulatory response in LR participants compared with high LR individuals. While the present results cannot answer these considerations, our current studies are probing alcohol’s pharmacodynamic effects at higher dosages. We are also currently examining the drug’s effects on the stress axis and in relation to functional connectivity networks governing stress and reward processing to further explore the relationship between alcohol sensitivity and tolerance. The finding that at least high LR individuals demonstrated acute within-session tolerance to a single dose of alcohol is consistent with a large body of literature over the past 70 years. Both Holland and Ferner and Comley and Dry in their systematic reviews of the topic reported that 63% to 81% of the dozens of studies they reviewed found evidence for acute tolerance to alcohol.

What is novel about the present study, however, is our demonstration that LR groups differed in their development of acute tolerance such that intra-session adaptation to alcohol effects was not related to the low LR phenotype. Also consistent with the literature, self-ratings of intoxication were more closely linked to acute tolerance than a performance-based measure such as of body sway is also consistent with the broader literature . In contrast to the results observed on the SHAS-7, while low LR individuals reported lower rating of sleepiness overall, acute tolerance was not observed for this subjective measure of a sedating effect of alcohol, sleepiness. Similar to the data on sleepiness, while low LR subjects tended to demonstrate lower body sway data than high LR subjects our data did not reveal evidence of acute tolerance for standing steadiness for either LR group. Finally, also consistent with the bulk of the literature , we did not find sex differences or level of response by sex interaction effects in the development of acute tolerance or sensitization to alcohol’s effects. As is true of almost all research, the results presented here must be interpreted in light of the study limitations. First, the laboratory-based alcohol challenge session from which the current data were extracted was structured to verify participants’ LR status and the safety of testing these subjects in an fMRI scanner, goals that did not require a placebo laboratory session. Thus, no placebo data were available for these analyses and we cannot rule out that other aspects of the experimental paradigm influenced the results. Additionally, since demonstrations of acute tolerance using the Mellanby effect typically require a placebo condition to rule out practice effects along the descending limb, it is important to replicate these results in other datasets that had a placebo control group. Second, for reasons relevant to the original protocol, all subjects reported Anglo or White Hispanic ethnicities and it is not clear if the current results will generalize to other ethnicities including Asian American and African American groups. Third, similar caveats relate to the fact that the 120 participants were originally selected from a Southern California university population. Fourth, the lower intensity of the alcohol response in participants with low LR might have produced a “floor effect” making it more difficult to observe differences between rising and falling BrAC time points for lower LR subjects.

Finally, all of the participants in these secondary analyses were 18- to 25-year-old, right-handed individuals who had no alcohol or other substance use disorder diagnoses. While this step was important from a matching and fMRI methodologic standpoint, the homogeneity of the sample might have also reduced the generalizability of the results. In summary, we found that the development of more robust acute tolerance to alcohol is unlikely to contribute significantly to the low LR. Second, the results regarding acute tolerance were not significantly different in males and females. Finally, while acute tolerance was observed for high LR subjects for alcohol’s intoxicating effects, this adaptation was not significant for alcohol-related sleepiness or for body sway,how to dry cannabis an observation that underscores how acute tolerance differs for different effects of alcohol. It is relevant that minority groups most at risk for poor asthma management and subsequent disease progression are more likely to live in areas failing to meet the NAAQS. This includes 80% of Hispanics and 65% of Blacks compared with 57% of Whites in the United States . Asthma has been defined as having three phenotypic characteristics: intermittent and reversible airway obstruction; increased airway responsiveness to contractile stimuli; and airway inflammation. Pulmonary inflammation is a hallmark of asthma and is directly related to asthma severity as a function of acute and chronic airflow obstruction. One potential mechanism of action for air toxics is through enhancement of airway inflammation. Inflammation in asthma, however, has diverse pathways, mirroring the complexity of the disease. Three general mechanisms of inflammation in asthma include immunoglobulin E -mediated, neurogenic, and irritant induced. The principal inflammatory mechanism in asthma is an IgE-mediated reaction whereby an antigen cross-links with an IgE antibody specific to that antigen on the surface of mast cells and other immune cells. Commonly recognized antigens that induce acute exacerbations of asthma are high molecular weight allergens such as pollen, fungal and animal proteins. Low molecular weight agents involved in IgE-mediated reactions, including certain air toxics, act as haptens.IgE-mediated mechanisms are key in early-phase asthmatic reactions . Other processes follow over several hours and involve the recruitment of eosinophils, CD4+T cells, neutrophils, basophils, and macrophages, and the release of proinflammatory mediators and cytokines. T-cell activation leads to the release of Thelper cell type 2 -like cytokines, which may be involved in a more prolonged chronic phase of inflammatory response over days .

The involvement of TH2 cells is important because a key pathway to the development of the asthma phenotype is believed to be the early differentiation of T-helper lymphocytes into TH2 rather than TH1 cells, although this is still controversial . TH1 cells participate in delayed-type hypersensitivity reactions. TH2 cells promote antibody immune responses, and because they secrete eosinophil-active cytokines and enhance IgE synthesis, they are implicated in the genesis of allergic inflammation. Putative progenitor T cells develop into early TH0 cells with the first antigen encounter. TH0 cells then differentiate into TH1- or TH2-type lymphocytes after repetitive antigen stimulation . Interleukin -4 shifts the differentiation from TH1 to TH2. The balance toward TH2 cells may be tipped by early environmental influences, including exposure to air pollutants , coupled with genetic susceptibilities. This is presumed to be key in the development of asthma. Neurogenic inflammation involves a spread of the inflammatory response via the release of neurotransmitters or activation of afferent nerves by the action of inflammatory mediators . Inflammatory mediators can trigger the activation of nonadrenergic, noncholinergic nerves to release tachykinins. A cascade of bronchoconstrictive reflexes and of inflammatory events can follow. Reactive airways dysfunction syndrome is a primary example of a type of asthma where toxic irritant-induced inflammation is a key mechanism. RADS has been identified in occupational settings and is defined as an irritant-induced nonimmunologic asthma with no latency period. RADS is nonimmunologic in the sense that bronchial epithelial injury is the primary causal event and typical phases of the immune response are absent, namely, sensitization, latent period, episode of elicitation of an immune response to antigen, and repetitive elicitation . RADS is an example of an inflammatory mechanism of air toxics, but it is rare and its relevance to nonoccupational asthma is unclear. There is hypothesized to be a feedback loop between inflammatory processes and neuronal processes that trigger inflammation . The inflammatory processes can be either immune mediated or triggered by irritant-induced airway injury. For RADS , and to some extent oxidant pollutants such as O3 , the initiation of bronchial epithelial injury could initiate the release of inflammatory mediators. This inflammation could then trigger neurogenic inflammation. Chemical irritants may also act as neuronal triggers directly . Irritant-induced induction of tachykinin release could serve to enhance ongoing inflammation in the asthmatic lung caused by known immune triggers. Examples consistent with this hypothetical mechanism include the putative interaction between ozone and pollen in asthma exacerbations , and the finding in subjects with mild asthma that airway responsiveness to inhaled allergen increases after ozone challenge . Airborne irritants could also indirectly enhance neuroinflammation by inhibition of neutral endopeptidase . NEP degrades tachykinins and its levels are decreased following exposure to oxidants , cigarette smoke , and an agent responsible for a form of occupational asthma, toluene diisocyanate . PAHs are found in relatively high concentrations in automobile and DE, along with other potentially important chemicals including nitroaromatics, aldehydes, alcohols, ketones, quinones, phenols, and other organic compounds, as well as volatile co-pollutants— oxides of nitrogen and of sulfur, CO, and numerous VOCs such as formaldehyde, benzene, and 1,3-butadiene. Diesel exhaust particles have a sub-micrometer elemental carbon core coated with organic compounds , nitrites, sulfites, and trace metals. The most common type of PAH compound in DEPs includes the phenanthrenes, followed by fluorenes, fluoranthrenes, naphthalenes, and pyrenes . However, PAHs are semivolatile, and so much of the PAHs emitted from motor vehicles is not particle bound.

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The current study extends our understanding of the memory profile associated with cART non-adherence

Posted on August 18, 2023 by hemp2022

To our knowledge, this would be the first study to apply this algorithm-based memory profile classification of individuals to understand an important everyday functioning outcome . Further, no study thus far has evaluated the HIV+ memory deficit profiles associated with non-adherence while using different types of verbal stimuli . The format in which information is presented may have a direct impact on memory performance, particularly in the context of medication management. For example, multiple studies have reported improved medication adherence when traditional prescriptions were enhanced with more descriptive instructions about the medication regimen instead of simply listing the information . The current study seeks to expand upon previous research to determine the associations between different episodic memory profiles and antiretroviral non-adherence by utilizing traditional CVLT scoring methods with the inclusion of retention and recognition indices and a concurrent measure of passage recall . In addition to standard group-level analyses of these clinical memory tasks, we also endeavored to look at individual profiles of word list learning as a risk factor for non-adherence using a previously established algorithm for classifying normal, encoding and retrieval profiles. Based on the literature reviewed above, we expect that antiretroviral non-adherence will be associated with a mixed encoding/retrieval profile. These associations may be particularly pronounced on word lists versus story memory given the former’s greater reliance on executive processes , such as strategic encoding, which is reliably impaired in HIV+ individuals and has been strongly associated with non-adherence .The study sample was comprised of 202 HIV+ participants recruited from the general San Diego area . The study was approved by the University of California, San Diego’s Human Research Protections Program. All participants provided written informed consent prior to study participation. Participants were included in the analyses if they maintained at least one current prescription for an antiretroviral medication and completed an approximately month-long observation of adherence using Medication Event Monitoring System.

Based on a parent project ,vertical farming pros and cons exclusion from the study occurred if a participant had a severe psychiatric disorder , major neurological disease , estimated verbal IQ < 70 determined using the Wechsler Test of Adult Reading , diagnosis of a current substance use disorder at baseline, positive urine toxicology screen for illicit substances at baseline. Adherence was tracked using MEMS, which utilizes a microchip-containing bottle cap that records the time, date, and frequency with which the bottle is opened. All participants were provided the MEMS bottle the day of neuropsychological testing and continued use for approximately 5 weeks . Participants were asked to use only the bottle provided to dispense their medication, to open the bottle only for the purpose of dispensing their medication, and to dispense only one dose of medication at a time. The ARV selected for the MEMS bottle was based on whether the participant would continue the medication through the course of the study, the frequency with which the medication is prescribed in the general population , and its pharmacokinetic properties. Blind reviewers used the MEMS data to categorize participants as either adherent or non-adherent. Participants were determined adherent if they followed their target antiretroviral prescription regimen ≥ 90% of the time . Table 1 displays descriptive data for non-cognitive variables that differed between the Adherent and Non-Adherent groups. There were no significant between group differences in demographics , HIV disease characteristics , or medication regimen complexity . The Adherence groups were also comparable on most psychiatric characteristics, including current Major Depressive Disorder , current and lifetime Generalized Anxiety Disorder , current mood as measured by the Profile of Mood States , lifetime substance dependence, and positive urine toxicology screen for cannabis on the day of testing . Because a positive marijuana urine toxicology screen was allowed on the day of testing, between-group differences were evaluated to determine the potential confound of acute cannabis effects on adherence. No significant differences were found between adherent and non-adherent participants or between the normal , encoding deficit , and retrieval deficit algorithm-derived clinical classification profiles.

There was a significantly higher prevalence of lifetime MDD in the Non-Adherent group; however, this variable was not associated with any of the primary memory variables of interest in the entire study cohort , with the sole exception of CVLT-II Total Trials 1-5 . Follow-up logistic regressions showed that LT MDD did not affect the magnitude of the association between CVLT Total Trials 1-5 and adherence . Moreover, CVLT-II Total Trials 1-5 was not associated with current depression or the depression/dejection sub-scale of the Profile of Mood States . As such, we did not include LT MDD as a covariate in any of our subsequent analyses. Medication non-adherence is common in HIV disease, particularly among individuals with memory deficits .Consistent with earlier studies on this topic, our data showed that episodic verbal learning and memory have broadly medium associations with adherence in HIV+ individuals, with CVLT-II surprisingly showing smaller average effects than WMS-III LM . The profile of memory findings in the non-adherent cohort was characterized by deficits in initial acquisition and delayed free recall, but not in retention or recognition. This pattern of findings is consistent with what has been described as a “retrieval” deficit, which is commonly found in persons with HAND and other conditions that affect prefronto-striato-thalamo-cortical circuits . Of note, algorithm-derived clinical classifications of the CVLT-II showed that HIV+ non-adherers have a higher prevalence of sub-cortical retrieval deficit profiles and that those with such retrieval profiles were three times more likely to be non-adherent than those with an encoding deficit profile. This is interpretively consistent with the work of Wright and colleagues , who found that non-adherent HIV+ persons differed from healthy adults on the ISDA index of retrieval, but extends that prior paper by: using traditional CVLT-II indices that include retention and recognition; incorporating a measure of passage recall, providing classifications of individual profiles using the algorithm-derived methods of Massman and colleagues along with traditional CVLT scoring methods and demonstrating associations between the algorithm profile approach and ecologically relevant measures of everyday functioning. The significant associations between adherence and profile scores in the context of insignificant standard deficit scores underscores the clinical relevance of understanding individual profiles of memory deficits when evaluating everyday functioning outcomes.

Future research comparing this algorithm across HIV and other well-established cortical and sub-cortical deficits using both neuropsychological and ecologically valid real world tests appears warranted to better understand the true impact of these deficit profiles across disorders. From a memory process perspective, these findings indicate that missing a medication dose is not simply a “forgetting” problem , as there was no evidence of an association between adherence and memory savings scores or recognition performance. Instead, non-adherence in HIV is at least partly associated with deficits in the complex process of efficiently accessing information from episodic verbal memory with minimal retrieval cues. Such retrieval deficits may be a function of weak encoding and/or difficulties with self-initiated memory search and access to stored information. Therefore,air racking even if an HIV+ individual understands and encodes the relevant information regarding their cART regimen, he/she may still not remember to take his/her medication as prescribed at least in part due to difficulties retrieving the proper information at the later dosing time. These memory processes did not appear to change depending on the complexity of one’s regimen, instead, difficulty retrieving information was associated with non-adherence regardless of the number of pills an individual was prescribed. Importantly, these complex memory process failures may also occur in concert with failures in other aspects of cognition , psychiatric comorbidities, and various psychosocial factors , which may further complicate and exacerbate the observed retrieval deficits. Indeed, there are numerous neurobehavioral aspects involved in managing one’s medication regimen . The absence of an association between executive functions and adherence may at first appear contrary to the known pattern of deficits seen in individuals with fronto-striatal dysregulation, such as in HIV disease. Indeed, prior studies have shown that executive functions are related to cART non-adherence . However, the free recall memory variables that differentiated the adherence groups were associated with executive functions in the non-adherence group, which supports the hypothesis that a deficiency in the higher-order, organizational aspects of memory processes may play an important role in medication non-adherence. Specifically, Moscovitch described a component process theory that included a higher-order control process by which the frontal systems work “with” encoding and retrieval to properly organize information for efficient storage and recall. Poor strategic encoding and retrieval has been observed in HIVseropositive individuals , and therefore the profile of deficits and the observed associations with executive dysfunction findings suggest that these strategically driven aspects of memory processes are important for successful medication adherence in HIV.

The stronger association between non-adherence and story recall versus list learning was surprising, as we had expected the purported executive demands of list learning to be more important in the context of managing medications . However, this unexpected finding may reflect the relevance of contextual information to understanding memory’s effects on important aspects of everyday functioning, such as medication adherence. In other words, the stronger associations between story memory and adherence underscores the importance of an individual’s ability to understand and independently recall medication information presented in a contextual format for proper regimen adherence. There is a long history of episodic memory research on the role of context in facilitating recall and the match between the context of encoding and retrieval . In this instance, therefore, story recall may better match the everyday demands of memory on adherence than does list learning. Non-adherers may have greater difficulty remembering and applying regimen information presented conversationally by their healthcare providers and in the context of related information as opposed to being presented with a listed dosing schedule. This provides one explanation for why the LM sub-test has historically provided a more sensitive test for subtle memory deficits compared to the CVLT . Morgan and colleagues , to this end, demonstrated that individuals with HAND evidenced difficulty with contextually-based health information. Specifically, the HAND group performed more poorly on an applied task in which health-related information was provided in the full context of a detailed scenario involving a health choice . This finding is consistent with the results of the present study, suggesting that medication regimen instructions presented in the larger context of health-related information may interfere with, rather than facilitate, memory for that information and subsequently decrease adherence. These findings suggest that when complex, contextualized health information is provided to patients it should be supplemented with more focused, targeted instructions that facilitate adherence to the prescribed health plan. Several limitations of this study are important to highlight. This study focused exclusively on verbal episodic memory. Due to a heavy reliance on reading prescription labels to obtain medication regimen information as well as visual cues when dispensing and dosing medications , understanding memory profiles associated with visual stimuli could also be of value. Because MEMS caps were utilized for adherence observations, the effects of commonly used compensatory behaviors, such as using pillbox dispensers , on adherence were not evaluated, therefore reducing some generalizability to everyday life. Further, future studies could improve our understanding of these profiles on medication non-adherence by evaluating the efficacy of commonly used compensatory strategies among individuals with specific profiles of memory deficits. This study also examined memory associated with common words and simple stories. However, drug labels often include complex medical and numeric information , which may influence adherence. Multiple studies found that retention of medical information has been as low as 25% . Therefore, it would be more ecologically relevant to examine memory in the context of medical information and complex descriptions rather than the commonly understood information presented on the clinical memory tasks used in this study. Despite these limitations, findings from this study may have implications for the development and implementation of compensatory strategies to improve cART adherence. Given that non-adherers and adherers exhibited comparable recognition abilities, compensatory adherence strategies associated with simple recognition, such as placing a pillbox by a commonly used area, may help to improve adherence in individuals with retrieval difficulties.

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The designations curiosity, danger and ease-of-use are open to subjective interpretation

Posted on August 17, 2023 by hemp2022

Based on prior work showing favorable perceptions and disproportionately higher use levels of flavored tobacco use among youth and young adults, we hypothesize that flavored tobacco, independent of other product characteristics, will be associated with greater curiosity and ease-of-use but lower perceived danger and potency, both for e-cigarettes and moist snuff. As an exploratory objective, we additionally examine differences in the association between product attributes and youth perceptions by gender and tobacco use status. This discrete choice experiment was embedded in the UCSF Adolescent Tobacco and Health Study, an in-person, school-based survey of high school students recruited from grades 9 and 10 in Northern and Central California. The overall survey included items about current and past tobacco use, perceptions of new and emerging tobacco products, socio-environmental variables, health conditions, and use of other substances as part of an overarching goal to assess factors influencing tobacco-related behaviors over time in this population. Thus, the present analysis is cross sectional and experimental . An Institutional Review Board at the University of California San Francisco reviewed and approved all study procedures. Participating students received a $10 gift card to an online retailer. Participating schools received $300. Overall study enrollment and survey administration took place from March 2019 to February 2020 at 8 public high schools. Due to limited classroom time, the final school completed a shortened questionnaire that excluded discrete choice items. Thus, 7 schools recruited from March 2019 to January 2020 were included. Eligible schools were located in municipalities with fewer than 50000 residents and in counties of population density less than 1000 persons/ square-mile11. Schools were selected for participation via purposeful sampling that targeted counties with expected higher levels of tobacco use and where the investigative team had existing collaborative research relationships. All grade 9 and 10 students at participating schools were eligible to participate.

Study staff visited all sessions of a required course to explain study objectives and distribute parental consent and student assent forms,how to cure cannabis followed by in-class administration of the electronic survey on computers 1–2 weeks later. As a programmed feature of the survey software , students were randomized at the participant level with equal probability to one of two discrete choice experiments: e-cigarettes or moist snuff smokeless tobacco. Participants randomized to the e-cigarette experiment were presented six pairs of randomly generated hypothetical e-cigarette products under a full factorial design. The composite products differed in device type , flavor , vapor cloud , and nicotine amount . Prior to viewing the computer generated composite e-cigarettes, participants were shown an image containing the possible e-cigarette product characteristics they might see . Participants randomized to the smokeless tobacco discrete choice experiment were presented six separate, consecutive pairs of randomly generated hypothetical moist snuff products under a full factorial design. The composite products differed in brand , flavor , cut , and price . Prior to viewing the computer-generated composite moist snuff products, participants were shown an image containing the possible moist snuff product characteristics they might see . The number of displayed characteristics and their levels were necessarily constrained to avoid excessive cognitive burden. Some characteristics were product specific . Prioritizing which characteristics to retain for each product was based on existing qualitative and quantitative literature on youth tobacco-related perceptions and use motivations. In each experiment, for each pair of product composites, participants were asked which product ‘are you more curious about’, which ‘is more dangerous to health’, which ‘would be easier to use’, and which ‘would give a bigger ‘buzz’ or ‘head rush’’. These outcomes were chosen because of previous work showing associations between tobacco use and/or susceptibility with youth-reported curiosity, perceived danger, and perceived ease-of-use. The outcome ‘buzz’ was introduced to measure perceived physiological effects or potency. Participants could select either composite product within the pair or ‘neither of these options’.

Supplementary file, Figure A3 shows an example question layout. Of 1052 eligible participants, 525 took part in the e-cigarette discrete choice experiment and 522 the moist snuff discrete choice experiment . Participants providing ‘straight-line’ responses with no variation in choosing the left hand-side or right hand-side product were excluded to improve data quality, leaving 495 in the e-cigarette experiment and 508 in the moist snuff experiment.Conditional logistic regression was used to quantify the independent contribution of product attributes to participants’ choices while maintaining the matching of each pair. The position of the composite product on the screen was also included in models to account for possible ordering preference. A positive regression coefficient indicates how much the attribute level in question increased the log-odds of that composite product being chosen relative to the whereas a smaller percentage used smokeless tobacco products . In the e-cigarette experiment , tank-type and pod-type devices garnered more curiosity and were perceived as easier to use than cigalike or dripmod devices. Relative to tobacco flavor, all flavors were associated with more curiosity, less perceived danger, and greater perceived ease-of-use. On the adjusted log-odds scale, where tobacco flavor is the reference, fruit and dessert were most positively associated with curiosity, while mint and unicorn were the flavor options most negatively associated with danger. Smaller vapor cloud e-cigarettes were viewed as less dangerous, offering less buzz, and easier to use. Nicotine amount was strongly associated with perceived danger and buzz. High nicotine devices were viewed with less curiosity, as more dangerous, delivering more buzz, and less easy to use, relative to low nicotine or nicotine-free devices . In the moist snuff experiment , one brand was perceived as the most dangerous but also the easiest to use. Relative to tobacco flavor, all moist snuff flavors were associated with more curiosity, less perceived danger, and greater perceived ease-of use. On the adjusted log-odds scale, fruit and mint flavors were the characteristic levels associated with the most curiosity, while fruit flavor was also viewed as offering the least buzz .

Associations of modest magnitude suggested that fine cut products were perceived as less dangerous and offering less buzz. Higher price products were viewed with more curiosity, as more dangerous, offering a greater buzz, and being less easy to use . Among all responses, the probability of choosing ‘neither of these options’ rather than selecting one of the two composite products varied by product and the question being asked. In the e-cigarette experiment, participants indicated ‘neither’ most often when asked about which of the two products they were more curious . ‘Neither’ was less often selected when asked about ease of use , buzz , and danger . Similarly,cure cannabis in the smokeless tobacco experiment, ‘neither’ was indicated most often when asked about curiosity , followed by ease-of-use , buzz , and danger . There was no statistically significant interaction by gender in the e-cigarette experiment . In contrast, having ever used an e-cigarette was associated with differences in all four perception outcomes . E-cigarette ever users held stronger perceptions about device types, viewing tank-type and pod-type devices with more curiosity relative to cigalike devices than did never users. Both e-cigarette ever and never users perceived flavored products with more curiosity and as easier to use compared to tobacco flavored products, but only never users believed that flavored products delivered less buzz than tobacco flavored e-cigarettes. Likewise, only never users were less curious about higher nicotine content e-cigarettes . In the moist snuff experiment, the direction and magnitude of associations were similar by gender, but there was nominally statistically significant interaction for the outcomes curiosity and danger, as male participants indicated more curiosity about higher price products . Only 44 smokeless tobacco ever users completed the moist snuff experiment, limiting statistical power to detect differences in association by product use. Generally, brand perceptions were stronger among smokeless tobacco ever users. Only never users viewed flavored products as offering less buzz and as easier to use, whereas only ever users associated pouched products as easier to use .This study provides quantitative evidence that specific characteristics of non-cigarette tobacco products independently shape how youth perceive these products. As hypothesized, for both e-cigarettes and moist snuff smokeless tobacco, flavored products were viewed with more curiosity and as being less dangerous, less potent and easier to use compared to non-flavored products. Associations of flavors with greater curiosity and ease of use and less perceived danger held for all non-tobacco flavors, including mint and wintergreen. Thus, evidence from this cross sectional study population suggests that mint varieties should be included alongside fruit and dessert in flavor restrictions intended to reduce youth tobacco use9 . Other product characteristics, such as e-cigarette device type, vapor amount and moist snuff price, also appear to shape product perceptions, which could inform tobacco control policy.

In January 2020, citing concern over growing youth e-cigarette use, the FDA announced a policy to prioritize enforcement of premarket authorization requirements for some types of e-cigarettes, but exempted mint and menthol flavors18. The present results suggest that youth perceive the properties of mint and wintergreen flavored tobacco similarly to fruit, dessert, and other flavors, which could undermine the effectiveness of the FDA policy. No such enforcement policy exists for conventional smokeless tobacco, but the present results demonstrate similar flavor association for moist snuff as observed for e-cigarettes. This finding is consistent with tobacco industry documents suggesting that flavored, lower priced, lower nicotine ‘starter products’ are used to target novice users before later ‘graduation’ to established use through a series of higher nicotine products. Use of flavored tobacco, including menthol, is more common among youth than adults8 and is the predominant way youth and young adults consumed tobacco across all tobacco products. A review of qualitative studies reported that flavored tobacco is viewed favorably by consumers, who associate flavors with less danger and often report that flavors contributed to their own tobacco experimentation and initiation10. Given the evidence that flavors contribute to youth use for all tobacco products8,9, current policies should consider not only restricting all non-tobacco flavors in cigarettes and e-cigarettes but in all forms of tobacco. Pod-type e-cigarettes, such as market-leading brand JUUL, have become the most popular type of e-cigarette among US youth21. Independent of nicotine content and flavor, participants in the present study viewed pod devices with more curiosity and as easier to use than other device types but not necessarily as less dangerous. However, participants also associated low nicotine content e-cigarettes with less danger, more curiosity, and greater ease of use. Research suggests that youth may not recognize that pod-type e-cigarettes contain nicotine at high concentrations; a misperception potentially reinforced by the nicotine amount printed on JUUL product packaging. Prior applications of discrete choice methods in tobacco control have focused on adults and/or recruited participants through online panels. Previously reported findings include a preference for non-tobacco flavors both in e-cigarettes and water pipe tobacco, as well as identifying warning labels as a factor reducing product interest. Consistent with the present study, Shang et al.reported that adolescents least prefer tobacco-flavored e-cigarettes and cigalike closed-system devices. The present study expands such work to moist snuff products, finds e-cigarette vapor cloud size and podtype devices as independent contributors to youth perceptions, and assesses the additional outcomes of perceived danger and ease of use. Furthermore, the present study shows no gender difference regarding e-cigarette perceptions, although beliefs associated with certain moist snuff product attributes were stronger among male participants, likely reflecting higher use and male-targeted marketing. Not all perceived qualities observed in the present study aligned with actual product properties. Participants correctly associated higher nicotine content with stronger physical effects . Other perceptions, such as flavored tobacco or small vapor cloud e-cigarettes being less dangerous, are not supported by scientific consensus. This discordance between perceived and actual effects represents a possible area for corrective public messaging or for greater regulatory vigilance for potentially misleading marketing practices. Of note, and not unexpectedly, product ever users held stronger perceptions about device type and brands than did product naïve participants. In a cross sectional setting, it cannot be distinguished to what extent experience shaped perceptions or that existing attention to product attributes contributed to use initiation.For example, danger could refer to either long-term or short term health effects. Meanwhile, ease of use could refer to concealability, access, adverse reactions, or social acceptance.

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Index case and recruited partner demographics were not significantly different

Posted on August 16, 2023 by hemp2022

We compared demographic and behavioral characteristics between HIV-infected and HIV uninfected recruited partners by using two-tailed t tests and two-tailed x2 analyses. Because both index and recruited partners were occasionally represented in multiple different partnerships, mixed-effects logistic modeling was performed for genetic linkage and new HIV diagnoses. The UCSD Human Research Protections Program approved the study protocol, consent and all study related procedures. All study participants provided voluntary, written informed consent before any study procedures were undertaken.A total of 574 ART-naive individuals were newly diagnosed with AEH and offered partner services between 1996 and 2014. Among those index clients, 107 provided contact information sufficient to successfully identify and test partner [6/87 index clients diagnosed with AEH between 1996 and 2000, 33/ 128 between 2001 and 2004, 41/192 between 2005 and 2009 and 27/167 between 2010 and 2014]. These 107 index cases identified 119 recruited partners and 128 distinct partnerships . Only for two recruited partners, needle sharing was identified as the most likely mode of HIV transmission . There were nine individuals who served as both index case and recruited partner in distinct partnerships .The majority of both, index cases and recruited partners were non-Hispanic white men , MSM . The median age of index cases and recruited partners was not significantly different . Behavioral risks were also not significantly different between AEH index cases and recruited partners . In addition, there were no significant demographic or behavioral risk differences between HIV infected and HIV-uninfected recruited partners except for age . Of the 128 distinct partnerships identified, 52 were HIV serodiscordant,sliding growing tables and the remaining 76 were HIV seroconcordant. Paired HIV resistance test sequences were available in 62 of 76 seroconcordant partnerships and demonstrated genetic linkage in 38 of these partnerships.

Genetic linkage between the index case and recruited partner was used to identify putative transmission pairs and was observed in 50% of recruited partners with AEH and 50% of recruited partners with chronic HIV infection. Behavioral risks were not significantly different between index cases who were part of a genetic cluster and those who were not . Evaluation of the time between identification of the index case and recruited partners showed that those recruited partners enrolled within 30 days of their index were significantly more likely to be newly diagnosed with HIV and genetically linked to their index than partners identified later. The results were robust to whether partnerships were treated as independent or were corrected for belonging to multiple partnerships in the mixed-effects framework.We found that partner services for persons with AEH represents an effective tool to find HIV-unaware persons, particularly when partner services is performed within 30 days of diagnosis. Importantly, more than a third of the newly HIV-diagnosed recruited partners were still in the acute and early phases of HIV infection, that is the phase with the greatest risk of HIV transmission. Partner services also identified putative transmission partners, with genetically linked partners representing 61% of the seroconcordant partnerships. Finally, partner services identified a high-risk HIV-uninfected cohort, whose risk behaviors did not differ from those newly diagnosed with HIV infection. The HIV epidemic is propagated by HIV unawares, particularly during the phase of AEH. We demonstrated that HIV screening within the sexual contact network of persons diagnosed with AEH is an effective strategy to identify HIV unawares in early stages of HIV infection. In this study, one out of three recruited partners was newly diagnosed with HIV infection and one out of seven with AEH. This was 12 times higher than the overall yield of voluntary community-based HIV screening of MSM with the SD PIRC , the HIV-screening program used to identify the index participants in this study. Also, the recruited partners identified in this study represented a more high-yield cohort than previously documented. In two prior studies of partner services in AHI, 7–10% of all recruited partners identified were newly diagnosed with HIV, as compared with 33% in this study. Partner services might contribute to broader public health goals to end the epidemic. Although we found a decrease over time in the number of recruited partners , which may be explained in part by the success of anonymous, internet-based sexual networks, partner services continued to be high yield in terms of identifying HIV-positive individuals .

Another key finding was that the immediacy of partner services was essential. Partners identified in the first 30 days of a new AEH diagnosis were more likely to yield a new HIV diagnosis and a putative transmission link to the index case . In addition, 29% of genetic linkages occurred in partnerships in which the recruited partner also had AEH, showing that partner services coupled with phylogenetic analysis could potentially be an effective tool in identifying and targeting real-time transmission outbreaks among AEH persons. The HIV-uninfected recruited partners in this study reported behavioral risks that were comparable with AEH-infected index cases. Because they belonged to the sexual network of an individual with high infectivity, and because their risk behaviors did not differ from HIV-infected recruited partners, this group may represent ideal candidates for focused HIV-prevention services, including preexposure prophylaxis . Limitations of this study included the observational study design and the convenience sampling used to identify the study cohort. Further, this study was performed among MSM and in San Diego, among whom the HIVepidemic may differ from other areas of the world. Despite the fact that new HIV diagnoses within this studies were based on laboratory findings, self-report , and also checked against local HIV clinical and research databases, we can’t rule out that a proportion of recruited partners classified as newly diagnosed may, in fact, have been diagnosed with HIV before. Also, our study participants identified fewer recruited partners when compared with two prior studies of partner services . This is most likely because field-services were not provided in this study, as compared with the two prior studies in which partner services was performed by the local public health departments. In conclusion, our study indicates that provision of partner services to persons with AEH within the first 30 days of diagnosis represents an effective tool for finding HIV-unaware persons, including those with AEH who are at greatest risk of HIV transmission. In addition, partner services in this setting identifies HIV-uninfected partners who may greatly benefit from targeted prevention services, such as PrEP. These findings may suggest that in settings in which time and funding are too limited to perform partner services in all new HIV diagnoses, partner services should be focused on individuals diagnosed with AEH and performed within 30 days of diagnosis. Increased focus of partner services on individuals with AEH in these settings may potentially improve partner services delivery by clinicians and public health departments,curing weed identification of HIV-unawares and persons during AEH and identification of a high-risk HIV-uninfected cohort appropriate for prioritized prevention services and PrEP.

Taken together, these could translate into a larger impact on HIVepidemic control than partner services has had to date. Modeling studies evaluating the downstream effects of targeted partner services, that is the effects of combined identification and treatment of high-transmission risk persons, PrEP in those found to be HIV-uninfected and also real-time identification of AEH outbreaks are needed. These studies would further elucidate the impact of partner services in persons with AEH on epidemic control.The symposium addressed the intricate relationship between epilepsy and other medical conditions. Dr Scott Mintzer kicked off the symposium with his talk “Epilepsy & Heart Disease: Tips for the Consultant.” He identified the impacts of anticonvulsants on the cardiovascular system and the interactions between antiepileptic drugs and cardiac medications. Hepatic enzyme inducing anticonvulsants are associated with worse lipid profiles and vascular risk markers and reduce the efficacy of some cardiovascular medications, such as statins.1 Older anticonvulsants, such as carbamazepine, may even be associated with increased risk of myocardial ischemia. Dr Steven Pacia presented “Syncope and Other Seizure Mimics,” where he reviewed key clinical features that distinguish seizures from syncope and other seizure mimics such as migraine, transient ischemic attacks, metabolic disorders, non-epileptic psychogenic seizures, transient global amnesia, and sleep disorders. There is a broad differential diagnosis for episodic loss of awareness. Some, such as prolonged QT syndrome, should not be missed.2 Dr. Andres Kanner led the discussion on “Do Psychotropic and Antibiotic Drugs Cause Seizures? A Review of the Evidence.” He reviewed selection of antibiotics and psychiatric medications that would minimize seizure risk. Therapeutic doses of serotonin and norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, and tricyclic antidepressants appear to be associated with reduced seizure incidence, though overdoses of these classes of medications can be associated with increased risk of seizures.Bupropion and clomipramine were the exceptions to the rule, and seizure risk was increased with these medications compared to placebo. Antibiotics may increase the risk of seizures. The mechanism by which antibiotic lower seizure threshold may be decreased GABAergic activity. Dr Page Pennell discussed the management of AEDs during pregnancy to optimize seizure control and pregnancy outcomes in her talk “Seizure Management during Pregnancy.” Her presentation reviewed the teratogenic risk of AEDs and other pregnancy outcomes including “small for gestational age” .Valproate was also associated with lower IQ in childhood and increased risk of autism. On the other hand, folate prescribed before pregnancy or at start of pregnancy was associated with higher IQ and lower risks of autism. There are changes in pharmacokinetics of AEDs during pregnancy and dose adjustments are needed to maintain seizure control. Dr Jeanne Young discussed “Anticonvulsants and the Skin Hypersensitivity”. Dr Young emphasized the diversity in hypersensitivity associated with AEDs, distinguishing drug rash based on pathophysiology and clinical characteristics, and recognizing clinical features that could alert us to severe cutaneous adverse reactions.

The most common type of reaction is a morbilliform rash with erythematous papules or plaques due to immune complex deposition and cell-mediated immunity. These rashes characteristically begin 7 to 10 days after starting medication and typically resolve in 2 to 3 weeks. Patients usually feel well, though they may complain of pruritis. Interestingly, in some cases it is possible to “treat through” the rash, or re-challenge later with the same medication, with the patient under close observation by dermatology. Signs characteristic of more severe drug reactions are swelling of the face, presence of pustules, bullae, or vesicles, dusky or painful lesions, mucous membrane involvement, or signs of systemic involvement. Morbilliform skin eruptions beginning later than expected along with systemic symptoms and patient feeling ill are more concerning for progressing to Drug Rash with Eosinophilia and Systemic Symptoms syndrome.The neurobiology of memory has long been a central issue in epilepsy, particularly for syndromes involving mesial temporal lobe structures. While Ramon y Cajal first detailed the neuroanatomical structure of the hippocampus more than 100 years ago,it was the well-known case of “H.M.” that revealed the prominent role of the hippocampal formation and related structures in declarative memory.Patients undergoing temporal lobe resection for control of pharmacoresistant seizures may experience postoperative memory decline. Preoperative reorganization of the posterior hippocampus with transfer of function to contralateral and extratemporal structures including anterior cingulum and insula may be a key factor in preservation of memory function,and there may be a role for memory functional magnetic resonance imaging studies in individualized outcome prediction.There is also evidence that the choice of surgical approach has important implications for postoperative memory outcomes.Even apart from surgical intervention, memory deficits are a common comorbidity in epilepsy. At the cellular level, seizure induced epigenetic dysregulation likely plays an important— but little understood role. Abnormally regulated BDNF DNA methylation was explored in a rodent temporal lobe epilepsy model, and was shown to have a dual role in modulating both epileptiform abnormalities and memory impairments.Memory consolidation is an important mechanism supporting long-term memory that may also be disrupted by epileptiform activity. Studies of human multi-scale and animal recordings demonstrated locally recorded cortical replay of waking patterns during subsequent sleep periods.This process involves an intricate coordination of cortical up and down states, hippocampal sharp-wave ripples and thalamocortical spindle activity, with distinct roles played by the anterior and posterior hippocampus. Finally, building on the previous year’s symposium, early results from a recent high-profile study of the use of cortical electrical stimulation to improve memory function were presented.

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The motivation for doing so is to protect the sustainability of psychedelic medicine

Posted on August 15, 2023 by hemp2022

Basket protocols are defined as single protocols, approved by relevant research regulatory bodies, that allow for a single intervention to be tested for multiple different disorders or conditions, such as a single drug for different types of cancer. Developers may be right to adhere to convention in delivering confirmatory trials, but, if resources and conditions allow, considerable benefits could be gained from more explorative study designs. Such exploration may be best served by research that can address a greater range of questions of clinical and real world relevance. Similarly, whereas confirmatory trials may choose to constrain eligibility and treatment criteria, pragmatic trials may benefit from broadening them, while maintaining a sensibly high-bar for contraindication-related exclusion criteria. Easy to sample bio-metrics and behavioural sampling could accrue large pools of objective data with potential predictive value. If such studies and data registries are designed with careful consideration of data quality and fitness, pragmatic research could create significant value for various different stakeholders, e.g. scientists, clinicians, regulators, health care systems, payers and investors. As has been the case with medical cannabis, treatment-seeking patients will look for guidance from clinicians who take theirs from scientific evidence. Liberal policy changes occurring prior to the conducting of sufficient research could create similar problems for clinicians as occurred with medical cannabis. Such imperfect clinical scenarios could, however, also represent opportunities for innovative pragmatic and observational research. The creation of electronic data registries, e.g. for prescribers of psilocybin therapy in regions legally permitting access , may be one appealing example,marijuana grow time table enabling the collection of valuable real-world data. Data registries and pragmatic trials will collect data from broad and diverse samples.

Data on use among healthy individuals can be supplemented by data from individuals seeking psychedelic therapy treatment for depression, particularly as safety is being established in this population . An even more ambitious project would be to utilise a protocol to only exclude individuals where there are good reasons to suspect elevated risk and inadequate specialist support. Indeed, future psychedelic therapy clinics in areas supporting legal access and/or operating under a research mandate may support such a scenario. Moreover, utilising digital tools, such as cellphone apps , to track outcomes linked to psychedelic use could generate large data pools that could be mined to inform on such matters as patient screening and treatment optimisation. Whether via data registries annexed to legal-access psychedelic therapy or approved pragmatic research trials, or both, the proposed approaches can serve the agenda of identifying transdiagnostic treatment targets . The RDoC initiative pays selective attention to phenotypes associated with pathology, neglecting parameters associated with wellness, and this may be an oversight. Evidence of reliable and sustained improvements in well-being and lifestyle with psychedelic therapy, as well as the maintenance of psychological wellness , recognition of the bidirectional relationship between psychological and physical health, and awareness of the substantial costs required to implement any human drug study, let alone a clinical trial with a psychedelic, and combined with a need for greater safety data across a diverse demographic, particularly given the liberalising political climate surrounding psychedelics, are all good reasons to justify innovative and pragmatic approaches to researching psychedelic medicine. Collecting large sample sizes will enable better prediction-ofresponse modelling , which will help mitigate risk and inform the potential customisation of care. A multi-site ‘trial’ or centralised registry would help generate and store the large data needed for reliable prediction-of-response modelling, with the added benefit of being able to assess between site discrepancies and consistencies.

Confirmatory trials constrain important treatment parameters such as dosage and frequency of interventions, whereas pragmatic psychedelic trials could exercise flexibility here, particularly given the nascent nature of the treatment model, where practitioners cannot confidently claim to know the best parameters for all individuals and indications. In the context of psychedelic therapy, what dosage, frequency-of-dosing, as well as frequency and nature of post-dosing psychotherapy sessions are optimal, and for which cases, are all key questions that may be best addressed via pragmatic research under a basket protocol – and/or via digital data collection. Upper limits on the number of dosing sessions and lower limits on the intervals between them may be set to reduce the risk of bad practice, but redosing in response to relapse and based on clinical judgement may be permitted, thereby reflecting the conditions of clinical practice post roll-out. Most modern trials of psychedelic therapy have employed just one or two fixed-dose treatment sessions for all participants within relatively small and homogeneous samples, not because of assumptions about best practice, but because of alignment with regulatory traditions and budget constraints. This article argues that carefully designed pragmatic trials implemented under a basket protocol could offer a powerfully progressive model for advancing our understanding of the safety, effectiveness, mechanisms, impact, best-use and pitfalls of a promising but vulnerable new treatment model in psychiatry. Progressive policy changes would likely be needed to actualise the proposed approach – but these are already occurring. For such policy changes to occur, a vision of the societal value of improved mental health care, and how this can be safely and effectively achieved via psychedelic therapy, will need to be well communicated to the public and policy makers. For the time being, DB-RCTs will continue to sway sceptical opinions and aid progress with regulators, who presently base pivotal licensing decisions on data derived from such trials. Our view, however, is that data derived from pragmatic trials may be able to teach us more about how best to deliver the treatment and how it could impact on the lives of a broad cross-section of people. To be clear, the argument here is for the complementary value of pragmatic trials, not for their superiority over DB-RCTs.

At the same time, however, we do challenge, as others have previously, the hierarchical preeminence of DB-RCT derived evidence . Exploration has special value early-on in a learning process; thus, it seems prudent in the context of psychedelic therapy that it be given consideration now, rather than further down the development path, when sub-optimal parameters begin to undergo regulatory ‘lock-in’. Rectifying this matter now may help mitigate risks associated with a too hasty scale-up of access. To achieve this, however, buy-in from multiple stake holders will be needed, including the public, policy makers and those in between, e.g. scientists, clinicians and investors.There are signs that modern psychiatry is ripe for a radical ‘new’ treatment model, and psychedelic therapy offers a multilevel paradigm-challenge. Assumptions challenged by it include those pertaining to: theoretical frameworks in mental health, models of therapeutic action, selection of sufficiently sensitive and specific assessment scales, trial design and clinical practice, plus drug, economic and social policy. Here we propose that pragmatic trials, data registries and electronic data capture will aid advances in psychedelic medicine by catalysing our understanding of best practice, which includes, but is not limited to, identifying and mitigating risks. Pragmatic trials, data registries and digital and biometric data collection can interface well with so-called ‘n = 1 trials’ , where individuals and/or prescribing doctors assess, prospectively, the impact of introducing a time-limited intervention in single-case studies. In contrast to large-scale observational cohort studies that allow for the modelling and prediction of response across wide demographics at the cost of experimental control ,marijuana growing table single-subject designs assess the effectiveness of an intervention experimentally, thus representing a scientifically rigorous alternative to RCTs . When participants serve as their own comparison , confounding variables such as age, gender or socioeconomic status are automatically controlled for, thereby decreasing the number of participants required to determine the likelihood of a causal relationship between intervention and outcome, and ultimately, research costs . Single-case approaches also bear relevance to ‘citizen-science’ initiatives, in which individuals’ willingness to engage in the scientific process is harnessed. For example, individuals may be invited to increase the rigour of their ‘self-experimentation’ by, for example, completing assessments, wearing biometric sensor devices or even engaging in a self-blinding placebo-controlled protocol, as was done recently for psychedelic ‘microdosing’ . As implied by some recent studies of ours , there is appetite for citizen-science-type engagement among users of psychedelics.

Specifically, we foresee value in the use of smartphone apps to collect data pertaining to psychedelic use in a convenient and efficient way . For example, the combination of single-case trial designs and remote digital assessments could enable the collection of scientifically rigorous efficacy data on self-medicative psychedelic use in small or difficult to access patient populations , the potential utility of which is particularly salient considering the significant challenges that COVID-19 has posed on clinical and research psychiatry, including psychedelic trials . Data from n = 1 experiments can be aggregated and analysed using Bayesian statistics and multi-level regression and post-stratification analyses to identify meaningful relationships within potentially rich datasets that could ultimately inform effective future care strategies. Idiographic high-frequency time-series data collected through such methods could enable more ecologically valid and nuanced modelling of change than conventional study designs . Zooming-out, the highlighted approach should not be interpreted as implying relaxed standards of screening or scientific rigour in psychedelic research. We are not, for example, advocating that researchers relax contraindication-based exclusion criteria intended to mitigate risks of adverse responses. Some might feel it premature to propose pragmatic trials for psychedelic therapy, as these are typically reserved for treatments that are already incorporated into clinical practice. However, we believe that it is right to begin such trials now, as policy changes are already afoot and could ‘get ahead of the data’, as occurred with cannabis, for example. There is presently insufficient data on which to recommend specific treatment parameters for specific populations and indications, as well as ‘no go’ criteria at screening, and big data pools would likely change this. Indeed, large-scale datasets from naturalistic sampling could have considerable harm reduction potential, by helping identify those most and least suitable for psychedelic therapy. Progressive policy changes on psychedelic medicine will likely have trickle down effects on research, innovation and investment in psychedelic medicine, particularly in the implicated geographical locations. Given the considerable cost-implications of a multi-site pragmatic research programme, health care payers and/or industry buy-in would likely be required to fund it, and the relevant parties would need to be incentivised to do so. Digital data collection could lessen this burden, however, particularly if individual end-users feel sufficiently incentivised to engage directly, e.g. via inputting data via a phone app . Mainstream, institutional-level funding has still not come into psychedelic science; philanthropy and now commercial investment have been its main drivers. Increasing demand for psychedelic therapy is poised to synergise with an upswell in initiatives to meet this, potentially jeopardising standards of safety and professionalism if corners are cut. In anticipation of and, to some extent, already witnessing the beginning of a ‘hype-cycle’, we believe that innovative, pragmatic and exploratory research can play a vital role, helping safeguard the development of a particularly promising, yet vulnerable, approach to mental health care.In the epidemiological literature, there is growing evidence that certain social risk factors may increase the risk of developing psychosis. Over the last decade, several lines of evidence suggest a possible association between a history of trauma in childhood and later psychosis or psychotic like experiences. A recent meta-analysis indicated that reported exposure to adverse events in childhood is associated with persistence of psychotic experiences, and other studies have suggested that perceived discrimination is a risk factor for psychosis. Additionally, Janssen and colleagues found that perceived discrimination predicted the incidence of delusional ideation in a dose response fashion, even after controlling for various confounds such as depressive symptoms, low self-esteem and neuroticism. Most studies to date investigating trauma and perceived discrimination have focused on established psychotic disorders or non-clinical samples. Although research interest is increasing in the trauma literature among those considered to be at clinical high risk of developing psychosis, little is still known about this relationship, and even less is known about perceived discrimination and those at CHR. A recent meta-analysis reported that childhood trauma is highly prevalent among CHR individuals. Furthermore it has been observed that CHR participants experience their first trauma at an earlier age compared to healthy controls, and that both the incidences of trauma, and the age at which trauma occurred were significant predictors of having a CHR status.

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The report of drug-related factors might also be subject to recall bias

Posted on August 14, 2023 by hemp2022

Yet Rhian Evans Allvin,consultant to the Proposition 203 campaign stated in a 2006 interview, “To be totally honest with you, there was not a conversation about backfill.”Proposition 203 would gain millions of dollars previous designated for TEPP. First Things First passed November 7, 2006, with 53.2% of the vote. This low victory margin was surprising to tobacco control advocates and the Proposition 203 campaign alike, given previous polling in late September showed Proposition 203 at 62% support.The fate of Proposition 203 was placed in doubt when the language regarding the denomination of the tax was misprinted on the voting ballots. While the actual initiative language was not in error , the ballot information for Proposition 203 issued by the Secretary of State erroneously stated: “A ‘yes’ vote shall have the effect of establishing an early childhood development health care board and fund, increasing the state tax on cigarettes …” This error was discovered during “early voting” in which Arizonans are permitted and encouraged to go into county courthouses and vote in the month before the actual election. Voters noticed that the ballot said “.80 cents” instead of “80 cents” or “$.80″ as was originally submitted to the Secretary of State. While voters actually vote on the full ballot language of the ballot proposals rather than the summaries printed on voting materials, the mistype drew untoward media attention. Because of this flaw, first reported by Arizona Republic columnist E.J. Montini on October 25, several editorials in the media called for invalidation of the ballot measure. Proposition 203 campaign chair Nadine Basha rebutted this opinion with a Letter to the Editor entitled “Don’t let dot deplete Prop. 203.”This turn of events forced the First Things First campaign to talk about the 80 cent tobacco tax as their funding source to save their proposition. Yet, when confronted with a potential court challenge and losing at the ballot box versus airing the specifics of the additional 80 cent tax per package of cigarettes, the First Things First campaign defended the typo by discussing the particulars of their funding scheme. However,commercial grow tables because the Proposition 203 campaign remained adamant in its belief that it was the actual language of the initiative that mattered and not what was printed on the voter’s ballot, they managed to stave off what could have avalanched into strong public opposition.

While the newspapers were against dismissing the added decimal point on the voting ballot as inconsequential, few members of the public or government saw this typo as a serious issue. Following this problem, Philip Morris did not spend any additional money challenging Proposition 203, instead investing in lawyers to investigate how they could use this Secretary of State’s error to undermine the campaign and disqualify Proposition 203. John Rivers remarked after the media drew its attention to the erroneous decimal point, “Phillip Morris is now sitting back and saying, ‘let’s save our money for a court challenge here, let’s not spend it on this campaign.’”Despite this misadventure, Proposition 203 passed with 53.2% of the vote and Arizona Attorney General Terry Goddard issued a formal legal opinion on December 1, 2006, ruling that the tax was valid. Neither Philip Morris nor RJ Reynolds challenged in court the enactment of Proposition 203 or the legality of the vote.After Goddard issued his opinion, RJ Reynolds began “scouting around for attorneys to challenge the state’s new 80-cent tobacco tax,” though they did not end up filing a lawsuit.The Arizona Revenue Department, upon receiving Goddard’s affirmative ruling they had requested, began collecting the 80-cent per-pack tax. However, in a separate ruling, Goddard said the tax would not apply to Indian Reservations and therefore did not have to be collected there.When the final election results came out, the Proposition 201 committee was pleasantly surprised that the favorable poll results the campaign staff initially regarded with skepticism were representative of the actual outcome. Speaking the day after the election, Justin Turner commented, “essentially, on Nov. 7 we won two campaigns: We got clean indoor air in Arizona, and also fought off preemption.”Proposition 201 beat Proposition 206 by a larger margin than any of the polls predicted. In the final tally, Proposition 201 garnered 54.8% of the vote while Proposition 206 only received 42.7% of the vote .The public’s clear preference for a genuine smoke free law made further challenges by the tobacco industry unviable, despite the long history of such challenges in Arizona and elsewhere.The Smoke-Free Arizona coalition exempted patios from the required minimum distance of 20-feet from the building established for all other outdoor smoking areas. Future tobacco control efforts in Arizona must remove this exemption. Making patios smoke free prevents patios from becoming the new smoking section for restaurants and bars. Another important protection will be to insure that veterans and fraternal clubs are covered in the future, as Arizona has already accomplished locally in Flagstaff.

While the national VFW already has been thinking about making VFW posts smoke free to attract younger clientele,protecting veterans through smoke free ordinances or laws in Arizona will help encourage the VFW’s action.Proposition 201 made the Environmental Health Services Division of ADHS responsible for enforcing the Smoke-Free Arizona Act. At the time Proposition 201 passed, Arizona was $4.7 million short of meeting the then-minimum CDC requirements14 for adequate spending for tobacco control programs and education. While any revenue leftover from the 2 cent tobacco tax added by Proposition 201 would go to TEPP, this gain will likely be somewhat counteracted by the decrease in tobacco sales due to the 80 cent additional tobacco tax instituted by Proposition 203. Part of ADHS’ implementation scheme for the clean indoor air law included mandatory signs inside buildings including a number to call to report clean indoor air violations. ADHS would initially receive an estimated $4.7 million a year for enforcement. ADHS implementation plans included $100,000 for free no-smoking signs for bars and restaurants.These no-smoking signs include a toll-free telephone number and email address to lodge complaints. Because the policy ADHS adopted makes the majority of the enforcement of the Smoke-Free Arizona Act complaint driven, easy access to the system of redress both gives smokers a visual reminder that indoor smoking is illegal and can result in fines, and empowers the non-smoker to assert his or her right to clean indoor air. These placards were effective in giving citizens a convenient method of addressing illegal secondhand smoke. Over 1,000 calls were made in the first month the law was enforced. However, EHS did not always respond to the calls, and often, by the time EHS came to the location to confirm the violation, the smoke had dissipated and the offender had left. In addition to responding to complaints, EHS also integrated enforcement of Proposition 201 into its routine enforcement of food safety by checking for signs of smoking, including ashtrays, the smell of smoke,or other tell-tale signs of smoking in their routine random inspections of restaurants and bars to ensure sanitary conditions. With their positive advertising campaign creating the expectation of self-enforcement and committed enforcement early on in dealing with challenges, the ADHS created an effective enforcement precedent.

During implementation, TEPP did not take a proactive role in educating Arizonans about the dangers of secondhand smoke or promoting the smoke free law. Instead, TEPP rode on the coattails of Smoke-Free Arizona’s success to focus on cessation services, airing commercials “Nick” and “Hector” with characters describing their process of quitting smoking.ALBA would follow up on this statement. Before implementation even began,ebb & grow table a group of bar owners based in Tucson calling itself the Arizona Alcohol Service Providers Association began holding meetings inviting the press to report on their plans to challenge Smoke-Free Arizona, claiming it cost Arizona 28,000 lost jobs.Bar owners Alfonso Larriva and Alfonzo Ruiz flaunted the Smoke-Free Arizona law during the first two weeks of enforcement in the four bars they owned by removing the panes of the small windows in their bar and replacing them with vents, claiming that transformed their bar into a patio.Following a strategy pursued by the tobacco industry and its allies elsewhere,32, 223 the bar owners worked with AASPA to challenge the Smoke-Free Arizona law so they could bring the case to court in hopes of finding it unconstitutional. ADHS, in charge of enforcing the smoke free law, filed an injunction against the owners after inspectors had found the bars in noncompliance after three visits.The Attorney General’s Office and ADHS sought preliminary and permanent injunctions against the defendants to stop violating the smoke free law and correct their violations, imposing a total of $102,400 in fines on the various responsible parties.The four non-compliant bars quickly became completely smoke free. ALBA was not supportive of AASPA or the violating bar owners’ cause. Instead, on the ALBA website, they provided information on how to comply with the law and issued a letter of caution to their members against signing AASPA’s petition to overturn the smoke free initiative.ALBA wrote: “we have a number of difficulties supporting what AASPA is doing,” citing that not only does Supreme Court not take cases because the public asks it to, but the likelihood of overturning the initiative was very slim, and, in short, futile.ALBA also wrote: “AASPA fundamentally misunderstands what happened in November” 2006, and because AASPA was not registered with the Secretary of State as a non-profit entity, “there is now way of knowing how these funds [that AASPA solicited] will be controlled.”ALBA has disassociated itself from representing tobacco interests and is more interested in benefitting from the smoke free law than fighting it.With smooth enforcement of the Smoke-Free Arizona law, a $2.00 excise taxes on tobacco products, and new personnel at TEPP, Arizona has the opportunity to devote time and energy toward bolstering its tobacco control program and ensure that all Arizonans can enjoy a healthy lifestyle breathing clean, smoke free air.The evaluations were centered around two hypotheses. Hypothesis 1 is based on observations from fMRI studies of young individuals who did not have an AUD history prior to testing where regional BOLD differences were observed during placebo conditions. This prediction states that compared with high LR individuals, those with less intense response to modest alcohol doses will demonstrate lower levels of functional connectivity between the amygdala and PFC when processing emotion-laden faces. Further, we predict negatively valenced emotions will elicit a greater decrease in connectivity relative to positively valenced emotions . Given prior studies demonstrating changes to brain functional connectivity following alcohol administration, Hypothesis 2 states that low LR individuals will have lower levels of functional connectivity following alcohol for negatively valenced emotions compared with high LR individuals.In the original study from which the current data were extracted , a survey was distributed to randomly selected 18 to 25-year-old European American and white Hispanic students at the University of California, San Diego, using methods approved by the UCSD Institutional Review Board. This questionnaire gathered information on demography, substance use, and DSM-IV psychiatric disorders using questions extracted from the Semi-Structured Assessment for the Genetics of Alcoholism interview . To be included in the fMRI protocol described below, subjects were limited to those who were: right-handed; had no history of brain trauma or epilepsy; no history of alcohol or drug dependence; no current major psychiatric disorder; were not pregnant; and had no irremovable body metal.After confirming zero baseline breath alcohol concentrations , subjects drank alcohol over a 10-min period given as a 20% by volume solution in a room-temperature carbonated beverage, a protocol that produced approximately equivalent BrACs across sexes . We used a median split on self-report scores from the Subjective High Assessment Scale during the alcohol challenge to determine low versus high LR in both the prior study and the present secondary analysis of those data. Once the LR status was confirmed through the initial alcohol challenge, two MRI sessions were scheduled on nonconsecutive days within 1 week of each other whenever possible. Alcohol and placebo sessions were carried out in an MRI scanner where participants received, in random order, the same alcohol dose as in the laboratory session or placebo in sessions that included the Hariri emotional face recognition task .

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Tempe for Healthy Smoke-free Workplaces’ win at the polls was not the end of the fight

Posted on August 11, 2023 by hemp2022

Meanwhile, Fairbanks was demanding direct policy decisions from city councils instead of waffling on whether or not to go ahead with a smoke free ordinance. In February 2002, as the Tempe smoke free initiative entered the crucial phase of the campaign when it encountered an opposition campaign organized by local bar owners, Fairbanks observed, “If people think something’s happening on a regional level, they might say, ‘We don’t want to be too hasty in Tempe.’”As the Tempe campaign geared up, the conflicting efforts between the health voluntaries and ACAS grew. ACAS focused on passing the Tempe ordinance and the health voluntaries attempted to recoup the investment in time and energy spent in the long previous months, desperately trying to bring the East Valley chambers of commerce back to negotiate on a regional anti-smoking ordinance after Phoenix made clear it would not participate.The opposition, Tempeans for Freedom to Choose, was chaired by Arizona Licensed Beverage Association President Bill Weigele with Roger Egan as treasurer. Egan was owner of McDuffy’s Sports Bar in Tempe and was one of the Tobacco Institute’s contacts for its 1994 Arizona plan to counter OSHA’s proposed clean air rule.In an interview in 2006, Fairbanks speculated that the concerted group of bar and restaurant owners comprising Tempeans for Freedom to Choose did not take direct contributions from the tobacco industry both because they thought they could defeat the ordinance on their own, and because they feared the public backlash tied to accepting industry funds.The smoke free initiative, called a “divisive issue” that had “split the city” by the media, led to the public asking candidates for City Council elections their opinions on the proposed ban shortly before the election.Candidate Carol McKnight remarked “I think its going to impact businesses, and I’m in favor of businesses,” an example of the vague statements expressed by the candidates.The Arizona Republic also opposed the initiative,sliding grow tables essentially reiterating in their April 24, 2002 opposing editorial the reasons ALBA President Bill Weigele had mentioned in an opinion editorial a few weeks prior.

Tempeans for Freedom to Choose also secured the Tempe Chamber of Commerce’s opposition to Smoke-Free Tempe. Tempeans for Freedom to Choose spent $100,000 on their “no” campaign.Tempeans for Freedom to Choose reformed as Citizens for Fair Non-Smoking Laws to weaken and repeal the smoke free ordinance. Citizens for Fair Non-Smoking Laws’ proposal would have allowed smoking in bars, restaurant bars, restaurants with separate smoking sections, bowling alleys and pool halls. Bankrolled by Rich Bank, CFNSL president and landlord of a local bar, the organization used litigation, city council lobbying, and gathered signatures to attempt to undo the ordinance and force a re-vote.After failing to convince the Tempe City Council to repeal or weaken the smoke-free ordinance, CFNSL filed 22,316 petition signatures with the Tempe City Clerk in early December 2002 to place their weakened smoking ordinance before voters at the next election. While this attempted referendum did not prevent Tempe’s smoke free law from going into effect, CFNSL tried to use the signatures as leverage to force the City Council to immediately pass CFNSL’s proposed initiative into law and threatened legal action if the council failed to immediately reconsider the ordinance already in effect.214 The city attorney stated that because of the 1998 Voter Protection Act , the city council did not have the authority to comply with Citizens for Fair Non-Smoking Laws’ demand. The only way to repeal a citizen enacted law would be to take it back to the voters. Despite Rich Bank threatening to sue the council if it failed to comply with his group’s wishes, the issue was never brought before the Council.After it became clear to Bank that the City Council had no intention of overturning the smoke free law and replacing it with the weak CFNSL ordinance, CFNSL pushed the City Council for a special election, first trying for May 2003 and then hoping for September or November 2003. While normally Tempe ballot measures would have to wait until the next election cycle to be voted on, CFNSL’s media attention on the ordinance and aggressive demands for a sooner election caused the City Council to consider a special election.

When the $115,000 cost for a special election became an issue, CFNSL offered to pay for a special May election. Rich Bank already had started raising money for a privately-funded public election in May 2003 and had persuaded a majority of the city council, members Pam Goronkin, Barbara Carter, Leonard Copple and Mark Mitchell, to consider accepting the funds for the special election.The special election never happened, however, because members of Tempe’s government, including mayor Neil Giuliano and Councilmember Dennis Cahill refused to run a privately-financed election. Various irregularities with CFNSL’s petition signatures also soon became a more pressing issue.When it became clear that Citizens for Fair Non-Smoking Laws’ petitions only achieved 61% validity in the random small random sample of the signatures examined by the City Clerk, barely enough to qualify for the ballot without a full review , Arizonans Concerned About Smoking got involved. In early January, 2003, ACAS meticulously examined the signatures gathered for the referendum and uncovered enough “irregularities” in the validity of the signatures gathered to eventually disqualify CFNSL’s repeal attempt.ACAS’s discovered findings included petitions illegally circulated by felons , illegally tricking people into signing the petition by telling them it would support the Proposition 200 Tempe smoke free law, illegally having circulators use others to circulate their petitions where the person who was actually gathering the signatures from citizens was different than the person whose name was printed on the reverse of the petition , names copied out of the telephone book in order , repeats of up to six times of the same name with differently styled signatures, signature forgeries , and illegible names and information. After finding repeat signatures, nonexistent addresses, and other non-qualifying signatures in CFNSL’s petition, ACAS filed a suit with the Maricopa County Superior Court challenging the legality of many CFNSL’s signatures gathered, demanding that the invalid signatures be removed. Rich Bank admitted in testimony before a superior court judge that several of those employed to gather signatures were convicted felons and thus not legally eligible to do the gather signatures for a ballot initiative.While Judge Mark W. Armstrong had the power to throw all of the 22,316 signatures out if he decided the many irregularities warranted such action, he ordered a second sampling count after invalidating 4951 signatures.

The hearings in June 2003 led Tempe Mayor Neil Giuliano to remark in the Arizona Republic “This whole thing is a mess” and that the petitions “should be thrown out and they should have to start all over again.”Tempe City Clerk Cathy Matz, who was charged with certifying the petitions, called the petitions submitted “the biggest mess I’ve ever seen.” Attorney Lisa Hauser represented CFNSL in court and attempted to defend the illegal signatures and CFNSL’s hiring of Kim Dixon,4×4 flood table grow a petition gatherer for CFNSL who had five felony fraud convictions and listed five different addresses when signing her petition affidavits, by claiming Dixon may have been dyslexic.Hauser would represent the RJ Reynolds Non-Smoker Protection Act, Proposition, in 2006,and was Gov. Fife Symington’s Administrative Counsel, present when Gov. Symington met with 6 attorneys and lobbyists from Philip Morris, RJ Reynolds, Brown and Williamson, and the Tobacco Institute the day before Symington demanded Arizona Attorney General Grant Woods drop the state’s suits against the tobacco industry.In July 2003, as CFNSL struggled to keep its qualified signatures, Click’s Billiards sued the City of Tempe over the constitutionality of the smoke free ordinance, claiming discrimination against smokers because they alleged there was no substantiated evidence that secondhand smoke is harmful if air systems are installed. U.S. District Court judge Roslyn Silver dismissed the case, which challenged the constitutionality of the smoking ban, ruling that the ordinance “easily passes constitutional muster.”This type of legal challenge against clean indoor air acts is a routine tobacco industry strategy, which almost always is unsuccessful.Tobacco industry documents show that Click’s Billiard participated both in an RJ Reynolds Camel Notes Central Exchange Initiative Program 1991 and was on a Phillip Morris Field Action Team Campaign and Mobilization/Supplemental Contacts list in 1996. The second random sampling of the remaining 17, 365 signatures, conducted in September 2003, found 63.6% of these signatures to be valid, leaving enough valid signatures to get CFNSL’s initiative on the ballot. Yet, ACAS, based on the recurring pattern of invalid signatures in their own recount of the signatures, persuaded the Tempe City Clerk to hand check every signature. When the City Attorney, the City Clerk, a city- hired temp staff, and mostly, ACAS members counted the signatures one-by-one, they found barely 40% of the signatures submitted were actually valid.After reviewing every signature submitted by CFNSL, on December 5, 2003 the Maricopa County Recorder’s Office “determined that the petitions contained 9,816 valid signatures, which is less than the minimum number of signatures required” to place the proposal on the ballot . On December 5, 2003, more than 20 months after the original Tempe Proposition 200 passed, Tempe’s City Clerk and City Attorney sent a letter to Rich Bank and CFNSL informing them that their initiative measure “failed to qualify for Tempe’s March 9, 2004 election ballot.”After this defeat, Rich Bank declared that CFNSL had exhausted its funds. Citizens for Fair Non-Smoking Laws spent around $159,000 on gathering signatures for a repeal initiative and in lawyers fees in suing for discrimination both Leland Fairbanks and the City of Tempe. In mid-March, 2004, almost two years after Proposition 200 passed, the CFNSL dropped its lawsuits against the city and Fairbanks. The Tempe City Attorney Marlene Pontrelli in March 2004 prohibited CFNSL from any further efforts against the Tempe clean indoor air ordinance given the waste of city time and money the group caused.Despite the drawn-out opposition to Tempe’s clean air ordinance defenders such as Mayor Neil Giuliano and Dennis Cahill maintained the ordinance Tempe voters approved and became advocates for other communities toenact similar ordinances in Prescott and Flagstaff based on the positive experience of smoke free Tempe.

After October 2002, when the ordinance finally went into effect, Tempe experienced 100% clean indoor air, beginning a trend all of Arizona would soon follow.The Chandler City Council passed a partial clean-indoor air act April 24, 2003 that made workplaces and restaurants smoke free. The council perceived the clean indoor air issue as ”dollars vs. health.”In an effort to support adoption of clean indoor air in Chandler, tobacco control advocates hoped Chandler would include smoke free bars and, thus, inspire other Arizona cities to do the same. An Arizona Republic article reported that “Fairbanks says other cities are watching Chandler because its smoking ban would be stricter than all others except Tempe’s and Guadalupe’s.”Chandler’s Blue Ribbon Committee on smoking policy, a voluntary advisory ad hoc committee formed in 2002 by the Chandler City Council to research the possibilities for Chandler to have a smoking ordinance, voted 10 to 2 on February 11, 2002 to send three options to the mayor and council. These three options were making 1) all workplaces and public places including bars, smoke free by October 2003, 2) all workplaces smoke free by October 2003 and phase in bars October 2005, or 3) workplaces and restaurant smoke free, but exclude bars altogether.A group of nurses, led by Lama E. Celaya, wrote the Chandler Mayor’s Smoking Committee urging the adoption of a 100% smoke free ordinance including bars.To the chagrin of local tobacco control advocates, the City Council adopted the weakest of the recommendations, exempting bars altogether. Starting October 1, 2003, Chandler created smoke free workplaces and restaurants, while exempting bars, bowling allies, and restaurant bars physically separated and ventilated. After unresponsiveness from city leadership, Prescott addressed the issue of smoking with an initiative, also called Proposition 200, which was very similar to Tempe’s except for a two-year delay for bars and restaurant bars. Passed November 4, 2003 with a margin of less than one percent, the Prescott ordinance made workplaces and restaurants smoke free and phased in bars in November 2005.In response to the health advocates’ efforts, ALBA filed a competing initiative, Proposition 201, which would only have required restaurants and bars to post whether they were smoking or non-smoking establishments.

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Calls to the national quitline 1-800-QUIT-NOW from Arizonans are routed to ASHline

Posted on August 10, 2023 by hemp2022

TEPP tried to get the long form anti-tobacco clips they made into the movie theaters, but at the time the theaters would not put Public Service Announcement anti-tobacco commercials before movies.Riester’s contract with TEPP was set to expire December 2000, but because TEPP was so impressed with Riester’s performance, TEPP extended the contract another 6 months before bidding for TEPP’s next five-year media contract commenced. The Tobacco Merchants Association newsletter said this delay in opening the bidding process on the new media contract would “anger the agency’s competitors who were hoping to bid for the contract when it was due for review.”Because of the widespread recognition of Riester’s campaign,the agency seemed poised to renew their contract. However, in June 2001 ADHS awarded the E.B. Lane advertising firm TEPP’s media contract. Riester was shocked at the decision,especially since E.B. Lane was the highest bidder for the contract, taking 17 percent of TEPP media money in fees, compared to roughly 10 percent Riester proposed for their continued campaign.The five-year contract had at the time an estimated billing of $7 to $10 million in advertising and $3 to $5 million in public relations per year, making it the most lucrative media contract in Arizona.156 Beau Lane’s firm teamed with eight specialty firms that focused on regional advertising and specific market segments, specifically, ethic minorities. Lane called the multicultural components of their proposal “absolutely key” to winning the bid.Riester, along with the Moses Anshell advertising agency,grow tables for greenhouse which had also bid for the contract, filed complaints in July 2001 over the bidding process conducted in June 2001, challenging the seven-member evaluation committee’s decision to award TEPP’s media contract to E.B. Lane.They objected that “the state did not follow its own evaluation criteria and did not keep records of how committee members scored their bids.”

The highly funded Riester advertising campaign in Arizona led some legislators and pro-smoking advocates to attack TEPP’s expenditures, arguing that the media campaign was extravagant. This argument appeared in a November 2001 speech in which Gov. Hull told the Arizona Legislature, in an effort to shift $10 million a year in TEPP’s advertising budget to general health programs, “I don’t want one child to even start [smoking]. But when it comes down to either a new anti-smoking slogan or a doctor visit for a sick patient at the state hospital, in my book the patient comes first.”In this address Hull proposed the Legislature strip $60 million from TEPP over 5 years to pay for much needed services and to keep the state fiscally afloat. Hull’s comment is a standard pro-tobacco rhetorical strategy used against media campaigns.ADHS senior staff told TEPP employees that the reason they chose E.B. Lane over Riester was because “their company and their sub-contractors they worked with were more culturally competent. They had subcontractors that worked with Hispanics, they had subcontractors that worked with Native Americans…”The changing of contracts was seen internally as taking TEPP contract funds and “spreading it around” to other agencies, to let Arizonan know TEPP was not defined by a single slogan or advertising scheme.19 Because of the imbroglio surrounding TEPP’s lack of transparency in their media contract decision process and their repeated RFP process due to irregularities, the transition to E.B. Lane as the succeeding media contractor was rocky. The perception that E.B. Lane received the contract due to Cathy Bischoff’s personal politics and that “Cathy picked them out” because Bischoff could not handle Riester’s creative independence, reinforced the negative association between a new era of micro-managing in TEPP and a less edgy media campaign with E.B. Lane.During FY2002, the year the media campaign roughly transitioned from Riester to E.B. Lane, TEPP aired far less anti-tobacco advertising.

Not only had they already used the advertisements they had developed, but the legislative budget diversions made TEPP leadership overcautious of overspending their halved budget . Nonetheless, a 2005 CDC Morbidity and Mortality Weekly Report found that out of 37 states, Arizona was ranked ninth highest in monthly anti-tobacco television advertisements seen by adolescents aged 12 to 17 between the years 1999-2003,160 indicating that even with the lack of media in FY2002 TEPP still had a relatively high tobacco control media presence. Figure 12 shows the pronounced drop in 2002 and 2005 in radio and television anti-tobacco messaging perceived by Arizonans. This drop in visibility likely had an impact on youth initiation of tobacco use. Youth prevalence increased as anti-tobacco media diminished between 2002 and 2005, according to the Arizona Tobacco Survey and the Youth Tobacco Survey.8, 109 With less spending on media and a less aggressive marketing strategy, thousands of youth started smoking that would not have had TEPP’s mediathe campaign.To TEPP’s credit, it ran smoke free media spots the summer before the 2006 November elections, although this a case of tobacco control advocates leading TEPP into action rather than TEPP taking the initiative. As of September 2007, a Maricopa County Tobacco Use Prevention Program /Arizona Fire Department three minute counter advertisement available on TEPP’s website, mentioned for the first time in TEPP history the tobacco industry’s efforts to get kids to smoke.It was not clear if the advertisement will be made into television commercials or used for other purposes. Like California’s early “Industry Spokesman,” this gesture toward using messaging proven to be effective in preventing youth tobacco initiation was a step in the right direction, even though as of December 2007 TEPP did not have an integrated media campaign.TEPP’s media campaign, despite its early acclaim from FY1997-FY2001, has failed to effectively keep up with Arizona’s tobacco prevention and cessation needs. Changing from the Riester firm which concentrated heavily on visually and emotionally impacting prevention television and radio campaigns tied in thematically with local projects to E.B. Lane’s focus on many separate smaller campaigns targeting specific demographics, dissipated public discussion and awareness of TEPP’s messages.

With the TEPP budget diversions cutting into media expenditures more than any other area, media contractors had fewer opportunities to maintain the public “buzz” the FY1997-2001 campaign generated.The local projects and the media campaign are TEPP’s main programmatic components benefitting the public. Not only are local projects the main point-of-service for cessation, prevention, and education, but they reach disparate populations and inform their local communities about tobacco control. Yet in 2006, even these basic elements only provided minimum services, with no solid media contracts or cohesive anti-tobacco campaign tying together TEPP’s various efforts. Except for periods between FY1997 and FY2001, when TEPP local projects used Riester’s media campaign as their thematic basis, coordination between the statewide media campaign and local TEPP projects has always been tenuous,grow tables for wheels as the local projects often did not have a message tied in with the statewide media campaign. County Health Departments provide the bulk of TEPP’s tobacco control services, from educating in schools about the consequences of smoking, to providing cessation services, to addressing workplace smoking and secondhand smoke issues. Starting in 1999, when programmatic content restrictions were lifted, TEPP made it a priority to provide outreach to disparate populations to reduce the burden of disease, and created a variety of programs targeting these groups that were less targeted by TEPP’s mass media approach. For example, Ashes-to-Ashes, a group providing outreach to African-American communities, attends relevant events and works with community organizations to help African-Americans address tobacco issues.In Pima County alone, Arizona’s second most populous after Maricopa, several groups work in tobacco control including Tobacco-Free Ways and Students Working Against Tobacco , in addition to the county health services and minority outreach programs. The Promotores de Salud represented one of TEPP’s flagship local projects active from 1996 through 2007. The Promotoras system of community health workers and health educators was especially strong in Yuma county. The Promotoras, operating largely in Arizona’s rural farming communities and border towns such as Dateland, San Luis, Somerton, Wellton, Cochise County, and Yuma, are voluntary lay health workers in the orchards and fields, guided by the model’s creator, Emma Torres . Originally funded by the Farmworker Justice Fund, through TEPP’s Arizona Cessation, Training, and Evaluation program, the Promotoras provide tobacco cessation services in the field to underserved Hispanic and Native populations, bringing cultural competence to tobacco prevention and cessation in this marginalized population.TEPP engaged the Promotoras because of the opportunity for people who lived in the community to deliver the message.

Funding for Promotoras tobacco control from TEPP has decreased since 2000, and in the second half of 2007 the Promotoras received no TEPP funding. More than a reflection of the program’s merit, this funding cut reflected TEPP’s shift in leadership with a new staff and priorities. Grassroots tobacco control programs and organizations providing prevention and cessation services flourished when they were fed resources, both financial and informational, by TEPP. Nonetheless, the local projects were barred from advocating for clean indoor air ordinances, leaving this work up to independent tobacco control advocates, private foundations, and the voluntary health organizations.TEPP provides direct cessation services, including the Arizona Smoker’s Helpline and programs through county health care facilities that subsidize pharmacotherapies for cessation and provide counseling. ASHline, operated by the University of Arizona since its inception but funded by TEPP after FY1997, fields all of the quitline calls in Arizona in English and Spanish.ASHline provides recorded information, live phone counseling, and referral services to community-based classes offered once a week in each county. While the ASHline came under TEPP’s umbrella since TEPP’s beginning, face-to-face counseling classes and pharmacotherapy cessation services did not start until 1998. Before 1998, ASHline’s services were largely informational. ASHline received roughly $1.3 million annually during FY1997-2007 for telephone and related internet quit services, with between 9,000 and 12,000 calls per year, with 6,000 of these becoming new cessation clients . In 2001-2002, 43% of current smokers said they tried to quit in the last year, according to the Arizona Adult Tobacco Survey,and in 2005 46% of smokers reported they tried to quit during the last year.In 2003, 15% of all TEPP cessation clients reporting in year follow-up surveys that they had not used tobacco in the last 30 days.However, in FY2005 and FY2006, only 10% of cessation clients were still quit after three months.TEPP’s prevention and cessation efforts are also coordinated with the quitline. The Arizona Cessation Training and Evaluation project served as TEPP’s cessation training consortium from 1997-2003. ACTEV followed evidence-based guidelines for smoking cessation published by the Agency for Healthcare Research and Quality and coordinated these efforts through a triuniversity consortium of Arizona State University, the University of Arizona, and Northern Arizona University. When ACTEV was eliminated in the program cuts in FY2002, cessation certification was outsourced to the University of Arizona under a streamlined version termed Health Care Partnerships. Only in FY2007 did the Health Care Partnership begin treating as many cessation clients as ACTEV did preFY2002. The Healthcare Partnership “provides evidence-based, tobacco dependence treatment continuing education, certification, and training programs that are adapted for a variety of communities.” Implemented by the University of Arizona, the Healthcare Partnership holds workshops and trains healthcare professionals in smoking cessation skills, including their courses Tobacco 101 and a three-tiered training program for cessation specialists. This cessation training program is given to all local projects contractors, and provides Promotoras and other health service providers with the specific knowledge and techniques to address tobacco control, focusing on prevention and cessation. As elsewhere, when Arizona actively advertised ASHline services, TEPP gained significantly more cessation clients than during periods without publicity. ASH received few calls between August and November 2006 because TEPP cessation services were reduced after TEPP lost its previous Office Chief. Yet after the success of Arizona’s statewide clean indoor air act and the subsequent cessation media campaign run by TEPP for smokers who wanted to quit as part of their New Year’s resolution, calls to ASH and requests for cessation services reached close to 500 in the first week of January2007 with the ad campaign running.In comparison, ASH received roughly 160 calls a week during the same period the previous year. In 2007 TEPP successfully attracted more smokers to ASH , and because of statewide policy changes and tobacco tax increases, more smokers sought TEPP’s cessation assistance.

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What Are The Pros And Cons Of Vertical Farming

Posted on August 9, 2023 by hemp2022

Vertical farming comes with a range of advantages and disadvantages, which can vary depending on factors like the specific implementation, technology used, and the context in which it’s applied. Here’s a breakdown of the pros and cons of vertical farming:

Pros:

  1. Increased Crop Yields: Vertical farming allows for multiple layers of crops to be grown in the same space, leading to higher crop yields compared to traditional farming methods.
  2. Space Efficiency: Vertical farms can be established in urban areas or locations with limited space,rolling grow table making it possible to grow food in places where traditional agriculture may not be feasible.
  3. Reduced Land Use: Vertical farming requires less land compared to conventional farming, which can help conserve natural ecosystems and reduce deforestation.
  4. Year-Round Production: Controlled environments in vertical farms enable year-round crop production, regardless of external weather conditions, leading to a more reliable food supply.
  5. Reduced Water Usage: Hydroponic and aeroponic systems used in vertical farming are more water-efficient than traditional soil-based farming, reducing water wastage and conserving this valuable resource.
  6. Lower Pesticide Use: Controlled environments can reduce the need for pesticides, herbicides, and fungicides, leading to safer and more environmentally friendly food production.
  7. Local Food Production: Vertical farms located in urban areas can bring food production closer to consumers, reducing the carbon footprint associated with long-distance transportation of produce.
  8. Less Dependence on Weather: Vertical farming is less susceptible to weather-related challenges like droughts, floods, and extreme temperatures, resulting in more predictable yields.
  9. Soil Conservation: Vertical farming doesn’t require soil, which can help protect valuable topsoil and prevent soil degradation.
  10. Opportunity for Innovation: The technology-driven nature of vertical farming encourages innovation in agriculture, leading to the development of new growing techniques and systems.

Cons:

  1. High Initial Costs: Setting up a vertical farm can require a significant investment in infrastructure, equipment, and technology, which might be a barrier for some farmers or regions.
  2. Energy Consumption: The use of artificial lighting, climate control systems, and other technologies can lead to higher energy consumption, especially if the energy comes from non-renewable sources.
  3. Technical Expertise: Successful vertical farming requires a deep understanding of technology, horticulture, and agriculture. Farmers need to be knowledgeable about various systems and their maintenance.
  4. Economic Viability: The profitability of vertical farming can be challenging due to high initial costs, ongoing operational expenses, and the need to compete with conventional agricultural products in the market.
  5. Resource Intensiveness: The production and disposal of equipment used in vertical farming, such as LED lights and specialized growing systems, can contribute to resource consumption and waste generation.
  6. Limited Crop Variety: Some crops are better suited for vertical farming than others. Large plants with extensive root systems might not thrive in the constrained growing spaces of vertical farms.
  7. Dependency on Inputs: Vertical farms rely on a consistent supply of resources like water, nutrients, and electricity. Disruptions to these supplies can impact crop growth.
  8. E-Waste: The rapid pace of technological advancement could lead to the disposal of outdated equipment and components,4 x 8 grow table contributing to electronic waste (e-waste) concerns.
  9. Labor Intensity: The need for monitoring, maintenance, and daily care can make vertical farming labor-intensive, especially in larger operations.
  10. Cultural Acceptance: Vertical farming represents a significant departure from traditional agricultural practices. Its adoption might face resistance or skepticism in some communities.

In conclusion, while vertical farming offers several potential benefits, it also presents challenges and trade-offs. Its success hinges on careful planning, sustainable practices, technological innovation, and the ability to address the cons effectively.

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