A critical assessment of the abuse, dependence and associated safety risks of naturally occurring and synthetic cannabinoids

Various countries and US States have legalized cannabis, and the use of the psychoactive1 and non-psychoactive cannabinoids is steadily increasing. In this review, we have collated evidence from published non-clinical and clinical sources to evaluate the abuse, dependence and associated safety risks of the individual cannabinoids present in cannabis. As context, we also evaluated various synthetic cannabinoids. The evidence shows that delta-9 tetrahydrocannabinol (Δ9-THC) and other psychoactive cannabinoids in cannabis have moderate reinforcing effects. Although they rapidly induce pharmacological tolerance, the withdrawal syndrome produced by the psychoactive cannabinoids in cannabis is of moderate severity and lasts from 2 to 6 days. The evidence overwhelmingly shows that non-psychoactive cannabinoids do not produce intoxicating, cognitive or rewarding properties in humans. There has been much speculation whether cannabidiol (CBD) influences the psychoactive and potentially harmful effects of Δ9-THC. Although most non-clinical and clinical investigations have shown that CBD does not attenuate the CNS effects of Δ9-THC or synthetic psychoactive cannabinoids, there is sufficient uncertainty to warrant further research. Based on the analysis, our assessment is cannabis has moderate levels of abuse and dependence risk. While the risks and harms are substantially lower than those posed by many illegal and legal substances of abuse, including tobacco and alcohol, they are far from negligible. In contrast, potent synthetic cannabinoid (CB1/CB2) receptor agonists are more reinforcing and highly intoxicating and pose a substantial risk for abuse and harm. 1 “Psychoactive” is defined as a substance that when taken or administered affects mental processes, e.g., perception, consciousness, cognition or mood and emotions

Women's breastfeeding experiences following a significant primary postpartum haemorrhage: A multicentre cohort study

<p>Abstract</p> <p>Background</p> <p>Postpartum haemorrhage (PPH) is a significant and increasing contributor to maternal mortality and morbidity. Following a PPH, women may have difficulties initiating and sustaining breastfeeding, although little has been published on this issue. The aim of this study was to describe breastfeeding experiences in a cohort of women following a significant PPH.</p> <p>Methods</p> <p>This is a descriptive study based on quantitative and qualitative data collected via questionnaires completed in the first week postpartum and at two and four months postpartum, by 206 women participating in a multicentre study of women's experiences of a significant primary postpartum haemorrhage (blood loss of 1500 mL or more in the 24 hours following childbirth, and/or a peripartum fall in haemoglobin (Hb) concentration to 7g/dL or less, or of ≥ 4g/dL).</p> <p>Results</p> <p>Among women with a significant PPH, 63% fully breastfed their babies from birth, whereas 85% said they had hoped to do so (p < 0.001). Only 52% of mothers who intended to either fully or partially breastfeed were able to give their baby the opportunity to suckle within an hour of the birth. Delays were longer in women with greater estimated blood loss and women with the longest delays in breastfeeding were less likely to initiate full breastfeeding. 70% of women with PPH of < 2000 mL were fully breastfeeding in the first postpartum week, whereas less than 50% of those with blood loss ≥ 3000 mL were able to do so. Overall, 58% of women with significant PPH were fully breastfeeding at two and 45% at four months postpartum.</p> <p>In qualitative data, three major themes were identified: 1) Difficulty initiating or sustaining breastfeeding, 2) Need for education and support; and 3) Emotional sequelae.</p> <p>Conclusions</p> <p>Following a significant PPH, women with greater blood loss are less likely to initiate and sustain full breastfeeding and this may be related, in part, to delays in initial contact with their baby as a consequence of the PPH. These findings have implications for postnatal care as these women may require greater support, education and assistance in initiating and sustaining breastfeeding. In particular, enabling the opportunity for the newborn to suckle as soon as is practicable should be encouraged.</p

Genetic diversity and interdependent crop choices in agriculture

The extent of genetic diversity in food crops is important as it affects the risk of attack by pathogens. A drop in diversity increases this risk. Farmers may not take this into account when making crop choices, leading to what from a social perspective is an inadequate level of diversity

Design of low/zero carbon buildings - learning

This report is published by Design Research Unit Wales and is the second output of the Low Carbon Research Institute’s (LCRI) Low Carbon Built Environment programme work package, ‘Design of Low/Zero Carbon Buildings’ and is produced to coincide with the conference ‘Low Carbon Learning: Lessons from Practice’ held at the Centre for Alternative Technology on 5th September 2013. The objective of the project is to provide design teams involved in the delivery of low/zero carbon buildings with clear but non-prescriptive design guidance based on current best practice. The work package aims to examine buildings within the sectors of Housing, Education and Healthcare and this document looks at case studies within the education sector, analysing design, procurement and construction techniques and the cost impact of meeting the demands of changing legislation. Edition 1: September 201

Environmental and Resource Economics: Some Recent Developments by

A first draft of this paper was prepared when the authors were visiting the Abdus Salam International Centre for Theoretical Physics (ICTP), Trieste, during April-May 2004. The current version was completed in Colombo, Sri Lanka, in June 2004, while the authors were attending the bi-annual teaching and research workshop of the South Asian Network for Development and Environmental Economics (SANDEE). We are most grateful to K. Sreenivasan (Director of ICTP), and Manik Duggar and Priya Shyamsundar (respectively, Programme Manager and Director of SANDEE), for making our visits both possible and most agreeable. Over the years, we have benefited greatly from discussions with Scott Barrett, William Brock, Stev

Prospectus, December 10, 1986

https://spark.parkland.edu/prospectus_1986/1033/thumbnail.jp

Joint Attention for Automated Video Editing

International audienceJoint attention refers to the shared focal points of attention for occupants in a space. In this work, we introduce a computational definition of joint attention for the automated editing of meetings in multi-camera environments from the AMI corpus. Using extracted head pose and individual headset amplitude as features, we developed three editing methods: (1) a naive audio-based method that selects the camera using only the headset input, (2) a rule-based edit that selects cameras at a fixed pacing using pose data, and (3) an editing algorithm using LSTM (Long-short term memory) learned joint-attention from both pose and audio data, trained on expert edits. The methods are evaluated qualitatively against the human edit, and quantitatively in a user study with 22 participants. Results indicate that LSTM-trained joint attention produces edits that are comparable to the expert edit, offering a wider range of camera views than audio, while being more generalizable as compared to rule-based methods

Better than nothing? Patient-delivered partner therapy and partner notification for chlamydia: the views of Australian general practitioners

<p>Abstract</p> <p>Background</p> <p>Genital chlamydia is the most commonly notified sexually transmissible infection (STI) in Australia and worldwide and can have serious reproductive health outcomes. Partner notification, testing and treatment are important facets of chlamydia control. Traditional methods of partner notification are not reaching enough partners to effectively control transmission of chlamydia. Patient-delivered partner therapy (PDPT) has been shown to improve the treatment of sexual partners. In Australia, General Practitioners (GPs) are responsible for the bulk of chlamydia testing, diagnosis, treatment and follow up. This study aimed to determine the views and practices of Australian general practitioners (GPs) in relation to partner notification and PDPT for chlamydia and explored GPs' perceptions of their patients' barriers to notifying partners of a chlamydia diagnosis.</p> <p>Methods</p> <p>In-depth, semi-structured telephone interviews were conducted with 40 general practitioners (GPs) from rural, regional and urban Australia from November 2006 to March 2007. Topics covered: GPs' current practice and views about partner notification, perceived barriers and useful supports, previous use of and views regarding PDPT.</p> <p>Transcripts were imported into NVivo7 and subjected to thematic analysis. Data saturation was reached after 32 interviews had been completed.</p> <p>Results</p> <p>Perceived barriers to patients telling partners (patient referral) included: stigma; age and cultural background; casual or long-term relationship, ongoing relationship or not. Barriers to GPs undertaking partner notification (provider referral) included: lack of time and staff; lack of contact details; uncertainty about the legality of contacting partners and whether this constitutes breach of patient confidentiality; and feeling both personally uncomfortable and inadequately trained to contact someone who is not their patient. GPs were divided on the use of PDPT - many felt concerned that it is not best clinical practice but many also felt that it is better than nothing.</p> <p>GPs identified the following factors which they considered would facilitate partner notification: clear clinical guidelines; a legal framework around partner notification; a formal chlamydia screening program; financial incentives; education and practical support for health professionals, and raising awareness of chlamydia in the community, in particular amongst young people.</p> <p>Conclusions</p> <p>GPs reported some partners do not seek medical treatment even after they are notified of being a sexual contact of a patient with chlamydia. More routine use of PDPT may help address this issue however GPs in this study had negative attitudes to the use of PDPT. Appropriate guidelines and legislation may make the use of PDPT more acceptable to Australian GPs.</p