Stigma-related barriers to medical cannabis as harm reduction for substance use disorder: Obstacles and opportunities for improvement

Emerging evidence on substituting cannabis for more harmful drugs has led to cannabis becoming a novel harm-reduction strategy for combating the current drug poisoning crisis. However, the authorization of medical cannabis as part of a harm-reduction approach and recovery strategy has significant implementation barriers rooted in longstanding stigma towards cannabis. Through a multi-discipline collaboration of Canadian clinicians and academic researchers, we highlighted stigma barriers and opportunities to address these barriers to elicit improved delivery of medical cannabis as a harm-reduction therapy within existing therapeutic frameworks. Evidence from existing literature and real-world experiences converged on three key themes related to stigma barriers: (1) Lack of medical cannabis education within the healthcare community, (2) lack of consensus and coordination among harm-reduction services and (3) access to medical cannabis. We highlight potential solutions to these issues, including improved healthcare education, better coordination between care teams and suggestions for improving access. Through this discussion, we hope to contribute to reducing the stigma around using medical cannabis as a harm-reduction strategy for individuals with a substance use disorder and consider new perspectives in policy development surrounding recovery services.

Radiation Safety Aspects of Iodine-131 metaiodobenzylguanidine (131I mIBG) Therapy Program Startup

As a medical center without a pre-existing radiopharmaceutical therapy program, it was a daunting endeavor to implement a I metaiodobenzylguanidine (mIBG) high-dose treatment regimen. It took several years of planning with hospital administration, vendors, and Texas Department of Health Radiological Control regulators to establish a viable program. Effective communication between physicians, nursing, nuclear medicine, environmental services, maintenance, and other support staff is essential and paramount for the successful execution and continued sustainability of the mIBG therapy program. Besides providing an effective treatment for patients, an additional goal for the program is to keep radiation exposure As Low As Reasonably Achievable (ALARA) for staff and patient caregivers. As such, start-up presented many training, logistical, and radiation safety challenges. The location of the isolation room and shielding specifications were designed to keep radiation exposure to public access areas to less than 2 microsieverts per hour. Before the first patient was treated the policies and procedures for training, radiation safety, product quality control, and infusion process needed to be developed, tested, and approved by various committees. Furthermore, a similar process was required for developing room set-up, post therapy cleanup, and waste storage procedures. Throughout the maturation process of the program, the departments involved have found that our safety culture has continually improved by the re-enforcement of knowledge and lessons learned, as both the ancillary and treatment staff grew more confident in each other's ability during more patient treatments are performed. This article describes the process and lessons learned during the time leading up to the startup and early years of the mIBG therapy program.

Knowledge and willingness toward living organ donation: a survey of three universities in Changsha, Hunan Province, China

BACKGROUND

This study was conducted to clarify the knowledge and attitudes of Chinese university students regarding living organ donation and analyze the determinants impacting their decisions.

METHODS

A questionnaire was delivered to college students chosen by random assignment. The data was analyzed by Statistics Package for Social Science (SPSS) software.

RESULTS

Of 434 participants, 49.8% indicated they would be willing to be living organ donors, 58.4% believed living organ donation could ease the organ shortage, 48.2% thought that the recovery rate of recipients of living organ donors transplants was equal to or even better than deceased donation, 62.4% designated relatives as their most probable recipients, 48.0% argued that partial compensation was an effective method to increase live organ donation, and 53.7% wished to donate through transplantation centers. According to univariate analysis, attitudes regarding the value of life, relationship between body integrity and health as well as body integrity and conventional culture were factors that impacted on an individual's decision. Students' knowledge of the value of living organ transplantation and their economic background were considered to be determinants of individual willingness. Furthermore, the operation's impact on quality of life and postoperative complications were additional concerns. Multivariate analysis indicated that other factors influencing students' willingness to donate included attitudes toward the relationship between body integrity and health, beliefs regarding body integrity and conventional culture, value of living donor organ transplantation, economic background of students, and anxiety about the impact on postoperative complications.

CONCLUSIONS

Numerous students were willing to participate in living organ donation. At the same time, social education and advertisements for living organ donation were far from adequate, having little or no influence on the decision-making process.

Team-based occupational stress reduction: a European overview from the perspective of the OSCAR Project

Work-related stress is a significant impediment to job satisfaction and healthy psycho-social functioning. It can alter the behaviour of the person involved and impair the quality of their life. In the European Union (EU), over the last decade, work-related stress has been consistently identified as one of the major workplace concerns--a challenge not only to the health of working people but also to the healthiness of their organizations. The study reported below attempted to address the issue of work-related stress through whole team training programmes, on a background of largely ineffective stress reduction training programmes offered to individuals within the workplace. This EU 'framework 5 Quality of Life' project focused instead on tackling the organizational level through training of mental health teams in five countries. The findings have significant implications to the conceptual, methodological and everyday organizational practice levels of tackling this central issue to the health of the workplace.

Pressure enhances thermal stability of DNA polymerase from three thermophilic organisms

DNA polymerases derived from three thermophilic microorganisms, Pyrococcus strain ES4, Pyrococcus furiosus, and Thermus aquaticus, were stabilized in vitro by hydrostatic pressure at denaturing temperatures of 111 degrees C, 107.5 degrees C, and 100 degrees C (respectively). Inactivation rates, as determined by enzyme activity measurements, were measured at 3, 45, and 89 MPa. Half-lives of P. strain ES4, P. furiosus, and T. aquaticus DNA polymerases increased from 5.0, 6.9, and 5.2 minutes (respectively) at 3 MPa to 12, 36, and 13 minutes (respectively) at 45 MPa. A pressure of 89 MPa further increased the half-lives of P. strain ES4 and T. aquaticus DNA polymerases to 26 and 39 minutes, while the half-life of P. furiosus DNA polymerase did not increase significantly from that at 45 MPa. The decay constant for P. strain ES4 and T. aquaticus polymerases decreased exponentially with increasing pressure, reflecting an observed change in volume for enzyme inactivation of 61 and 73 cm3/mol, respectively. Stabilization by pressure may result from pressure effects on thermal unfolding or pressure retardation of unimolecular inactivation of the unfolded state. Regardless of the mechanism, pressure stabilization of proteins could explain the previously observed extension of the maximum temperature for survival of P. strain ES4 and increase the survival of thermophiles in thermally variable deep-sea environments such as hydrothermal vents.

Caregiver and clinician assessment of behavioral disturbances: the California Dementia Behavior Questionnaire

As part of a multicenter project to study noncognitive behavioral disturbances in dementia, the authors developed a comprehensive caregiver-rated questionnaire for these behaviors. The authors determined the reliability of caregiver ratings and compared caregiver ratings with clinician ratings using standard instruments. Caregivers showed good test/retest reliability for ratings of all types of patient behavioral disturbance. Caregiver interrater reliability was highest for depression and lowest for psychosis. The correlation between caregiver reports and professional assessments was highest for agitation, intermediate for psychosis, and lowest for depression. The match between caregiver and clinician assessments of patient behaviors appears to vary significantly by the type of behavior assessed.

Secretion of thermostable DNA polymerase using a novel baculovirus vector

Baculovirus-mediated expression has become a powerful tool for the high yield production of functionally active recombinant proteins. In order to further enhance the utility of this expression system, we constructed versatile transfer vectors that facilitate the secretion of recombinant proteins from host insect cells by inserting functional secretory leader sequences down-stream of the polyhedrin promoter. In-frame insertion of cDNA sequences results in the synthesis of fusion proteins containing a heterologous signal sequence which directs the recombinant protein to the secretory pathway. Human and insect leader sequences were successfully tested with a number of proteins including the thermostable Pyrococcus furiousus (Pfu) DNA polymerase in an effort to maximize secretion of heterologous proteins from insect cells. The human placental alkaline phosphatase signal sequence (MLGPCMLLLLLLLGLRLQLSLG) proved to be optimal for the secretion of not only this thermostable bacterial enzyme but also for the secretion of other biologically active polypeptides.

Gastric muscularis as a urinary sphincter

OBJECTIVE

To test the ability of gastric muscularis to act as a urinary sphincter in a rat model system.

METHODS

Fourteen Long-Evans rats had an ileal conduit constructed joining the bladder to the ventral skin, creating urinary incontinence. A segment of gastric muscle maintained on its vascular pedicle was encircled around the conduit. The first 7 animals (group A) had both conduit and sphincter constructed simultaneously, whereas the remaining 7 animals had the conduit constructed first, followed by a two-week period of observation, after which gastric sphincters were added (group B). All animals were observed for urine leakage via the cutaneous stoma. At two weeks after sphincter placement, all animals underwent surgical exploration, pressure profilometry of the conduit, and histologic examination of the sphincter zone.

RESULTS

Pressure profilometry demonstrated elevated pressures in the sphincter zone relative to baseline pressures in the conduit of all animals (group A: mean baseline, 4.8 cm water, mean maximum, 20.6 cm water; group B: mean baseline, 5.2 cm water, mean maximum, 18.1 cm water). At exploration, no intra-abdominal complications were noted in 13 of 14 animals. All conduits were easily catheterizeable and were found to be continent after they had been filled to capacity. The ileum and gastric segments were histologically found to be viable with no evidence of necrosis or ischemia.

CONCLUSIONS

These preliminary results suggest that gastric muscularis may be a potential substitute urinary sphincter in the management of sphincteric urinary incontinence.

Spontaneous production of colony-stimulating activity by splenic Mac-1 antigen-positive cells from autoimmune motheaten mice

Cultured splenocytes from 3-wk-old autoimmune motheaten mice (me/me) spontaneously produced colony-stimulating activity (CSA), which stimulated the formation of bone marrow myeloid colonies. The production of CSA was not dependent on the presence of serum; this activity was not produced by spleen cells from their phenotypically normal littermates (+/-) or from other normal mouse strains. The peak level of CSA occurred early during the culture period, and within 48 hr the activity was markedly diminished. Cell fractionation studies demonstrated that cells expressing Mac-1 antigen produce CSA and are most likely to be mononuclear phagocytes. The unusual proliferative capacity in vitro of splenic mononuclear phagocytes from motheaten mice probably results from the spontaneous production of CSA by Mac-1 antigen-positive cells. Defective regulation of the production of monokines may contribute to the severity of the immunologic disease of these mutant mice.

Spontaneous production of colony-stimulating activity by splenic Mac-1 antigen-positive cells from autoimmune motheaten mice

Cultured splenocytes from 3-wk-old autoimmune motheaten mice (me/me) spontaneously produced colony-stimulating activity (CSA), which stimulated the formation of bone marrow myeloid colonies. The production of CSA was not dependent on the presence of serum; this activity was not produced by spleen cells from their phenotypically normal littermates (+/-) or from other normal mouse strains. The peak level of CSA occurred early during the culture period, and within 48 hr the activity was markedly diminished. Cell fractionation studies demonstrated that cells expressing Mac-1 antigen produce CSA and are most likely to be mononuclear phagocytes. The unusual proliferative capacity in vitro of splenic mononuclear phagocytes from motheaten mice probably results from the spontaneous production of CSA by Mac-1 antigen-positive cells. Defective regulation of the production of monokines may contribute to the severity of the immunologic disease of these mutant mice.

Chemotherapy of experimental streptococcal endocarditis. V. Effect of duration of infection and retained intracardiac catheter on response to treatment

The dynamics of infection and response to penicillin G (P) or combined P plus streptomycin (S) therapy were studied in a rabbit model of penicillin-sensitive Streptococcus sanguis endocarditis. Increased delay between infection and initiation of treatment required longer duration of therapy to effect a cure. Irrespective of the interval between infection and onset of therapy, P combined with S regularly eliminated streptococci from endocardial vegetations more rapidly than P alone, both in the presence and absence of an intracardiac catheter--although the difference in response was more marked with the catheter present. The combination of P and S consistently showed superior in vivo bactericidal activity compared to P alone in established S. sanguis endocarditis.

Effect of different media on in vitro studies of antibiotic combinations

In an effort to determine the adequacy of a standard broth medium in the evaluation of antibiotic combinations, 20 strains of various bacterial species were studied simultaneously in Mueller-Hinton broth and in freshly drawn human serum from apparently healthy volunteers. Studies of growth dynamics by use of the usual plate dilution technique for quantitating colony-forming units were performed with strains of Staphylococcus aureus (methicillin-resistant and methicillin-susceptible), Streptococcus faecalis, Escherichia coli, Aerobacter, Klebsiella, and Proteus mirabilis. A variety of different antibiotics were investigated. With 19 of the 20 strains, interpretations of synergism or antagonism were the same in both media. Therefore, despite minor variations when the same strain was studied in both serum and broth, it is concluded that Mueller-Hinton broth is an adequate medium for use in studies of chemotherapeutic combinations in vitro. A simplified method for studying bactericidal activity is described, which is deemed practical for clinical microbiology laboratories and which led to the same conclusions regarding the combinations as were obtained by the more arduous plate dilution test.