High Time for Conservation: Adding the Environment to the Debate on Marijuana Liberalization

The liberalization of marijuana policies, including the legalization of medical and recreational marijuana, is sweeping the United States and other countries. Marijuana cultivation can have significant negative collateral effects on the environment that are often unknown or overlooked. Focusing on the state of California, where by some estimates 60% -- 70% of the marijuana consumed in the United States is grown, we argue that (a) the environmental harm caused by marijuana cultivation merits a direct policy response, (b) current approaches to governing the environmental effects are inadequate, and (c) neglecting discussion of the environmental impacts of cultivation when shaping future marijuana use and possession policies represents a missed opportunity to reduce, regulate, and mitigate environmental harm

Inclusion of bedrock vadose zone in dynamic global vegetation models is key for simulating vegetation structure and function

Across many upland environments, soils are thin and plant roots extend into fractured and weathered bedrock where moisture and nutrients can be obtained. Root water extraction from unsaturated weathered bedrock is widespread and, in many environments, can explain gradients in vegetation community composition, transpiration, and plant sensitivity to climate. Despite increasing recognition of its importance, the “rock moisture” reservoir is rarely incorporated into vegetation and Earth system models. Here, we address this weakness in a widely used dynamic global vegetation model (DGVM; LPJ-GUESS). First, we use a water flux-tracking deficit approach to more accurately parameterize plant-accessible water storage capacity across the contiguous United States, which critically includes the water in bedrock below depths typically prescribed by soil databases. Secondly, we exploit field-based knowledge of contrasting plant-available water storage capacity in weathered bedrock across two bedrock types in the Northern California Coast Ranges as a detailed case study. For the case study in Northern California, climate and soil water storage capacity are similar at the two study areas, but the site with thick weathered bedrock and ample rock moisture supports a temperate mixed broadleaf–needleleaf evergreen forest, whereas the site with thin weathered bedrock and limited rock moisture supports an oak savanna. The distinct biomes, seasonality and magnitude of transpiration and primary productivity, and baseflow magnitudes only emerge from the DGVM when a new and simple subsurface storage structure and hydrology scheme is parameterized with storage capacities extending beyond the soil into the bedrock. Across the contiguous United States, the updated hydrology and subsurface storage improve annual evapotranspiration estimates as compared to satellite-derived products, particularly in seasonally dry regions. Specifically, the updated hydrology and subsurface storage allow for enhanced evapotranspiration through the dry season that better matches actual evapotranspiration patterns. While we made changes to both the subsurface water storage capacity and the hydrology, the most important impacts on model performance derive from changes to the subsurface water storage capacity. Our findings highlight the importance of rock moisture in explaining and predicting vegetation structure and function, particularly in seasonally dry climates. These findings motivate efforts to better incorporate the rock moisture reservoir into vegetation, climate, and landscape evolution models.</p

Evidence-based patient choice: a prostate cancer decision aid in plain language

BACKGROUND: Decision aids (DA) to assist patients in evaluating treatment options and sharing in decision making have proliferated in recent years. Most require high literacy and do not use plain language principles. We describe one of the first attempts to design a decision aid using principles from reading research and document design. The plain language DA prototype addressed treatment decisions for localized prostate cancer. Evaluation assessed impact on knowledge, decisions, and discussions with doctors in men newly diagnosed with prostate cancer. METHODS: Document development steps included preparing an evidence-based DA in standard medical parlance, iteratively translating it to emphasize shared decision making and plain language in three formats (booklet, Internet, and audio-tape). Scientific review of medical content was integrated with expert health literacy review of document structure and design. Formative evaluation methods included focus groups (n = 4) and survey of a new sample of men newly diagnosed with prostate cancer (n = 60), compared with historical controls (n = 184). RESULTS: A transparent description of the development process and design elements is reported. Formative evaluation among newly diagnosed prostate cancer patients found the DA to be clear and useful in reaching a decision. Newly diagnosed patients reported more discussions with doctors about treatment options, and showed increases in knowledge of side effects of radiation therapy. CONCLUSION: The plain language DA presenting medical evidence in text and numerical formats appears acceptable and useful in decision-making about localized prostate cancer treatment. Further testing should evaluate the impact of all three media on decisions made and quality of life in the survivorship period, especially among very low literacy men

High time for conservation: adding the environment to the debate on marijuana liberalization

The liberalization of marijuana policies, including the legalization of medical and recreational marijuana, is sweeping the United States and other countries. Marijuana cultivation can have significant negative collateral effects on the environment that are often unknown or overlooked. Focusing on the state of California, where by some estimates 60%–70% of the marijuana consumed in the United States is grown, we argue that (a) the environmental harm caused by marijuana cultivation merits a direct policy response, (b) current approaches to governing the environmental effects are inadequate, and (c) neglecting discussion of the environmental impacts of cultivation when shaping future marijuana use and possession policies represents a missed opportunity to reduce, regulate, and mitigate environmental harm.Published versio

Diagnóstico, tratamento e seguimento do carcinoma medular de tireoide: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

IntroductionMedullary thyroid carcinoma (MTC) originates in the thyroid parafollicular cells and represents 3-4% of the malignant neoplasms that affect this gland. Approximately 25% of these cases are hereditary due to activating mutations in the REarranged during Transfection (RET) proto-oncogene. The course of MTC is indolent, and survival rates depend on the tumor stage at diagnosis. The present article describes clinical evidence-based guidelines for the diagnosis, treatment, and follow-up of MTC. ObjectiveThe aim of the consensus described herein, which was elaborated by Brazilian experts and sponsored by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism, was to discuss the diagnosis, treatment, and follow-up of individuals with MTC in accordance with the latest evidence reported in the literature. Materials and methods: After clinical questions were elaborated, the available literature was initially surveyed for evidence in the MedLine-PubMed database, followed by the Embase and Scientific Electronic Library Online/Latin American and Caribbean Health Science Literature (SciELO/Lilacs) databases. The strength of evidence was assessed according to the Oxford classification of evidence levels, which is based on study design, and the best evidence available for each question was selected. ResultEleven questions corresponded to MTC diagnosis, 8 corresponded to its surgical treatment, and 13 corresponded to follow-up, for a total of 32 recommendations. The present article discusses the clinical and molecular diagnosis, initial surgical treatment, and postoperative management of MTC, as well as the therapeutic options for metastatic disease. Conclusion7Introdução O carcinoma medular de tireoide (CMT) origina-se das células parafoliculares da tireoide e corresponde a 3-4% das neoplasias malignas da glândula. Aproximadamente 25% dos casos de CMT são hereditários e decorrentes de mutações ativadoras no proto-oncogene RET (REarranged during Transfection). O CMT é uma neoplasia de curso indolente, com taxas de sobrevida dependentes do estádio tumoral ao diagnóstico. Este artigo descreve diretrizes baseadas em evidências clínicas para o diagnóstico, tratamento e seguimento do CMT. Objetivo O presente consenso, elaborado por especialistas brasileiros e patrocinado pelo Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia, visa abordar o diagnóstico, tratamento e seguimento dos pacientes com CMT, de acordo com as evidências mais recentes da literatura. Materiais e métodos: Após estruturação das questões clínicas, foi realizada busca das evidências disponíveis na literatura, inicialmente na base de dados do MedLine-PubMed e posteriormente nas bases Embase e SciELO – Lilacs. A força das evidências, avaliada pelo sistema de classificação de Oxford, foi estabelecida a partir do desenho de estudo utilizado, considerando-se a melhor evidência disponível para cada questão. Resultados Foram definidas 11 questões sobre o diagnóstico, 8 sobre o tratamento cirúrgico e 13 questões abordando o seguimento do CMT, totalizando 32 recomendações. Como um todo, o artigo aborda o diagnóstico clínico e molecular, o tratamento cirúrgico inicial, o manejo pós-operatório e as opções terapêuticas para a doença metastática. Conclusões O diagnóstico de CMT deve ser suspeitado na presença de nódulo tireoidiano e história familiar de CMT e/ou associação com feocromocitoma, hiperparatireoidismo e/ou fenótipo sindrômico característico, como ganglioneuromatose e habitus marfanoides. A punção aspirativa por agulha fina do nódulo, a dosagem de calcitonina sérica e o exame anatomopatológico podem contribuir na confirmação do diagnóstico. A cirurgia é o único tratamento que oferece a possibilidade de cura. As opções de tratamento da doença metastática ainda são limitadas e restritas ao controle da doença. Uma avaliação pós-cirúrgica criteriosa para a identificação de doença residual ou recorrente é fundamental para definir o seguimento e a conduta terapêutica subsequente.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto Alegre Serviço de EndocrinologiaClínica de Cirurgia de Cabeça e Pescoço Clínica de Cirurgia de Cabeça e PescoçoInstituto do Câncer do Estado de São Paulo Instituto do Câncer do Estado de São PauloUniversidade de São PauloUniversidade Estadual de Campinas Departamento de CirurgiaUniversidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de BotucatuDepartamento de Medicina Interna Departamento de Medicina InternaFaculdade de Medicina de Ribeirão Preto Faculdade de Medicina de Ribeirão PretoUniversidade de São Paulo Divisão de EndocrinologiaUniversidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucat