Long term marijuana users seeking medical cannabis in California (2001-2007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants.

BACKGROUND: Cannabis (marijuana) had been used for medicinal purposes for millennia. Cannabinoid agonists are now attracting growing interest and there is also evidence that botanical cannabis is being used as self-medication for stress and anxiety as well as adjunctive therapy by the seriously ill and by patients with terminal illnesses. California became the first state to authorize medicinal use of cannabis in 1996, and it was recently estimated that between 250,000 and 350,000 Californians may now possess the physician's recommendation required to use it medically. More limited medical use has also been approved in 12 additional states and new initiatives are being considered in others. Despite that evidence of increasing public acceptance of "medical" use, a definitional problem remains and all use for any purpose is still prohibited by federal law. RESULTS: California's 1996 initiative allowed cannabis to be recommended, not only for serious illnesses, but also "for any other illness for which marijuana provides relief," thus maximally broadening the range of allowable indications. In effect, the range of conditions now being treated with federally illegal cannabis, the modes in which it is being used, and the demographics of the population using it became potentially discoverable through the required screening of applicants. This report examines the demographic profiles and other selected characteristics of 4117 California marijuana users (62% from the Greater Bay Area) who applied for medical recommendations between late 2001 and mid 2007. CONCLUSION: This study yielded a somewhat unexpected profile of a hitherto hidden population of users of America's most popular illegal drug. It also raises questions about some of the basic assumptions held by both proponents and opponents of current policy.

Current Pacemaker Therapy Surgical consideration involving leads and lead placement.

The implantable pacemaker, like the telephone, has evolved from a rather straightforward device, which offered virtually no choice to its early users, to a highly complex system embodying a number of choices, many of which must be made at the outset because they affect the performance of the system throughout its lifetime. The most important of these choices, is, of course, selection of the mode of pacing and its relationship to the underlying arrythmia. These considerations are discussed in considerable detail in Dr Nora Goldschlager's article on electrophysiology, and will not be repeated. The focus of this discussion will be on surgical techniques of implantation, particularly as related to the evolution of the modern lead system.