Challenges and considerations for treating PTSD with medicinal cannabis: the Australian clinician's perspective.

INTRODUCTION: Preclinical and experimental research have provided promising evidence that medicinal cannabis may be efficacious in the treatment of posttraumatic stress disorder (PTSD). However, implementation of medicinal cannabis into routine clinical therapies may not be straightforward. AREAS COVERED: In this review, we describe some of the clinical, practical, and safety challenges that must be addressed for cannabis-based treatment of PTSD to be feasible in a real-world setting. These issues are especially prevalent if medicinal cannabis is to be combined with trauma-focused psychotherapy. EXPERT OPINION: Future consideration of the clinical and practical considerations of cannabis use in PTSD therapy will be essential to both the efficacy and safety of the treatment protocols that are being developed. These issues include dose timing and titration, potential for addiction, product formulation, windows of intervention, and route of administration. In particular, exposure therapy for PTSD involves recall of intense emotions, and the interaction between cannabis use and reliving of trauma memories must be explored in terms of patient safety and impact on therapeutic outcomes.

Novel Miscanthus hybrids: Modelling productivity on marginal land in Europe using dynamics of canopy development determined by light interception.

New biomass crop hybrids for bioeconomic expansion require yield projections to determine their potential for strategic land use planning in the face of global challenges. Our biomass growth simulation incorporates radiation interception and conversion efficiency. Models often use leaf area to predict interception which is demanding to determine accurately, so instead we use low-cost rapid light interception measurements using a simple laboratory-made line ceptometer and relate the dynamics of canopy closure to thermal time, and to measurements of biomass. We apply the model to project the European biomass potentials of new market-ready hybrids for 2020-2030. Field measurements are easier to collect, the calibration is seasonally dynamic and reduces influence of weather variation between field sites. The model obtained is conservative, being calibrated by crops of varying establishment and varying maturity on less productive (marginal) land. This results in conservative projections of miscanthus hybrids for 2020-2030 based on 10% land use conversion of the least (productive) grassland and arable for farm diversification, which show a European potential of 80.7-89.7 Mt year-1 biomass, with potential for 1.2-1.3 EJ year-1 energy and 36.3-40.3 Mt year-1 carbon capture, with seeded Miscanthus sacchariflorus × sinensis displaying highest yield potential. Simulated biomass projections must be viewed in light of the field measurements on less productive land with high soil water deficits. We are attempting to model the results from an ambitious and novel project combining new hybrids across Europe with agronomy which has not been perfected on less productive sites. Nevertheless, at the time of energy sourcing issues, seed-propagated miscanthus hybrids for the upscaled provision of bioenergy offer an alternative source of renewable energy. If European countries provide incentives for growers to invest, seeded hybrids can improve product availability and biomass yields over the current commercial miscanthus variety.

Tracking temporal response dynamics in the ventral striatum during social feedback in anorexia nervosa: A functional magnetic resonance imaging exploratory study.

OBJECTIVE: Research suggests abnormalities in reward-based processes in anorexia nervosa (AN). However, few studies have explored if such alterations might be associated with different temporal activation patterns. This study aims to characterize alterations in time-dependent processes in the ventral striatum (VS) during social feedback in AN using functional magnetic resonance imaging (fMRI). METHOD: Twenty women with restrictive-subtype AN and 20 age-matched healthy controls (HC) underwent a social judgment experimental fMRI task. Temporal VS hemodynamic responses were extracted in SPM for each participant and each social condition (acceptance/rejection). RESULTS: Compared with age-matched HC, patients with AN showed a significant time by group interaction of peak VS response throughout the task, with a progressive blunting of peak activation responses, accompanied by a progressive increase in baseline activity levels over time. DISCUSSION: The results suggest an attenuated response pattern to repetitive social rejection in the VS in patients with AN, together with a difficulty in returning to baseline. The information obtained from this study will guide future, design-specific studies to further explore alterations temporal dynamics.

Herbicide resistance across the Australian continent.

BACKGROUND: Lolium rigidum is the weed of greatest economic impact in Australia due to its formidable capacity to evolve herbicide resistance. In this study, 579 field-sampled L. rigidum populations were tested for resistance to 21 herbicides applied at the recommended rate. Nine herbicide treatments were binary mixtures. RESULTS: A total of 15 876 individual resistance tests were conducted by screening two million seeds at the recommended label rate. The overall frequency of resistant populations was 31%, 14%, 71%, 6% and 0% in response to the post-emergence herbicide treatments clethodim, clethodim + butroxydim, imazamox + imazapyr, glyphosate and paraquat, respectively. The resistance frequency to stand-alone pre-emergence wheat-selective herbicides ranged from 10% to 34%. Conversely, the levels of resistance to pre-emergence mixtures or stand-alone propyzamide were significantly lower, ranging from 6% to 0%. In winter, the responses to glyphosate, paraquat, cinmethylin, prosulfocarb, pyroxasulfone and trifluralin were reassessed, with 7%, 0%, 0%, 21%, 21% and 28% as the respective resistance frequencies. South Australia and Victoria are identified as epicenters for L. rigidum population resistance to pyroxasulfone, whereas populations in New South Wales have the greatest resistance to glyphosate and in Western Australia to clethodim. CONCLUSIONS: For the first time, resistance levels to stand-alone herbicides and binary mixtures are geographically ranked across the Australian continent by benchmark statistical analysis of resistance frequencies and distribution. The extension of these results will raise awareness of rapidly emerging patterns of herbicide resistance, encouraging the adoption of cost-effective modes of action and integration of diverse strategies for weed resistance management.

Invasive species in the Anthropocene: Help or hindrance?

Under predicted climate change scenarios many parts of the world will be hotter. Higher temperature extremes present significant physiological challenges to ectothermic freshwater species that cannot regulate body temperature. Willows (Salix spp.) are highly invasive deciduous northern hemisphere shrubs and trees that have colonised riparian zones of southern hemisphere streams. Non-native willows are criticised for their high consumption of water and their capacity to form dense monostands along the margins and within waterways that limit light to streams in summer, alter the timing and quality of allochthonous inputs and modify ecosystem function. As such, governments invest heavily in the removal of willows from streams in order to preserve ecosystem integrity. Although detrimental effects of non-native willows are well documented, little attention has been focussed on consideration of potential ecosystem services that non-native willow infestation may provide under predicted climate warming. Here, we use a case study to illustrate that shading by non-native willows can provide thermal refugia for temperature sensitive endemic taxa and we provide a holistic approach to non-native willow removal that may provide benefits to aquatic species amid changing climate. We present a simple decision matrix for prioritising willow removal activities that may be applied to other invasive species and we discuss traditional views of invasive species management and river restoration and their relevance in a rapidly warming world. The concepts we discuss are of immediate relevance to environmental managers challenged with maintaining and restoring ecosystems that are rapidly changing in structure and function in response to climate warming.

Membrane distillation of concentrated blackwater: Effect of temperature, solids concentration and membrane pore size.

This study has elucidated the mechanisms governing water recovery from blackwater using membrane distillation, and has clarified the role of the organic particle fraction on membrane performance. Whilst fecal pathogen growth was initially observed at lower temperatures, pathogen inactivation was demonstrated over time, due to urea hydrolysis which liberated ammonia in excess of its toxic threshold. During the growth phase, membrane pore size <0.45 µm was sufficient to achieve high log reduction values for Escherichia coli, due to size exclusion complimented by the liquid-vapor interface which enhances selective transport for water. Higher feed temperatures benefitted rejection by promoting thermal inactivation and suppressing urea hydrolysis. Whilst the mechanism is not yet clear, suppression of hydrolysis reduced bicarbonate formation kinetics stabilizing the ammonia-ammonium equilibrium which improved ammonium rejection. Blackwater particle concentration was studied by increasing fecal content. Particle fouling improved selectivity for coarse pore membranes but increased mass transfer resistance which reduced flux. Particle fouling induced wetting as noted by an eventual breakthrough of feed into the permeate. We propose that by incorporating upstream solid-liquid separation for particle separation to limit wetting and mass transfer resistance, membrane distillation can be a reliable solution for the recovery of high-quality permeate from blackwater. PRACTITIONER POINTS: Membrane distillation demonstrated for concentrated blackwater. Multiple factors provide robust pathogen separation (pore size, vapor-liquid interface, temperature, free-ammonia). Excellent water quality produced for feed 40 times more concentrated than wastewater. Removing particle fraction will improve separation robustness and operating longevity.

Breeding progress and preparedness for mass-scale deployment of perennial lignocellulosic biomass crops switchgrass, miscanthus, willow and poplar.

Genetic improvement through breeding is one of the key approaches to increasing biomass supply. This paper documents the breeding progress to date for four perennial biomass crops (PBCs) that have high output-input energy ratios: namely Panicum virgatum (switchgrass), species of the genera Miscanthus (miscanthus), Salix (willow) and Populus (poplar). For each crop, we report on the size of germplasm collections, the efforts to date to phenotype and genotype, the diversity available for breeding and on the scale of breeding work as indicated by number of attempted crosses. We also report on the development of faster and more precise breeding using molecular breeding techniques. Poplar is the model tree for genetic studies and is furthest ahead in terms of biological knowledge and genetic resources. Linkage maps, transgenesis and genome editing methods are now being used in commercially focused poplar breeding. These are in development in switchgrass, miscanthus and willow generating large genetic and phenotypic data sets requiring concomitant efforts in informatics to create summaries that can be accessed and used by practical breeders. Cultivars of switchgrass and miscanthus can be seed-based synthetic populations, semihybrids or clones. Willow and poplar cultivars are commercially deployed as clones. At local and regional level, the most advanced cultivars in each crop are at technology readiness levels which could be scaled to planting rates of thousands of hectares per year in about 5 years with existing commercial developers. Investment in further development of better cultivars is subject to current market failure and the long breeding cycles. We conclude that sustained public investment in breeding plays a key role in delivering future mass-scale deployment of PBCs.

Geographical inequalities in uptake of NHS funded eye examinations: Poisson modelling of small-area data for Essex, UK.

Background: Small-area analysis of National Health Service (NHS)-funded sight test uptake in Leeds showed significant inequalities in access among people aged <16 or ≥60. Methods: Data were extracted from 604 126 valid General Ophthalmic Services (GOS)1 claim forms for eye examinations for Essex residents between October 2013 and July 2015. Expected GOS1 uptake for each lower super output area was based on England annual uptake. Poisson regression modelling explored associations in GOS1 uptake ratio with deprivation. Results: People aged ≥60 or <16 living in the least deprived quintile were 15% and 26%, respectively, more likely to have an NHS funded eye examination than the most deprived quintile, although all are equally entitled. GOS1 uptake is higher in the more deprived quintiles among 16-59-year old, as means tested social benefits are the main eligibility criteria in this age-group. Inequalities were also observed at local authority level. Conclusions: Inequalities in access among people ≥60 years were not as large as those reported in Leeds, although inequalities in <16-year old were similar. However, demonstrable inequalities in this data set over a longer time period and a larger and more diverse area than Leeds, reinforce the argument that interventions are needed to address eye examination uptake inequalities.

The Development and Content Validation of a Multidisciplinary, Evidence-based Wound Infection Prevention and Treatment Guideline.

Acute and chronic wound infections create clinical, economic, and patient-centered challenges best met by multidisciplinary wound care teams providing consistent, valid, clinically relevant, safe, evidence-based management across settings. To develop an evidence-based wound infection guideline, PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature databases were searched from inception through August 1, 2017 using the terms (or synonyms) wound infection and risk factor, significant, diagnosis, prevention, treatment, or surveillance. Studies on parasitic infections, in vitro studies, and non-English publications were excluded. The 19-member International Consolidated Wound Infection Guideline Task Force (ICWIG TF), hosted by the Association for the Advancement of Wound Care (AAWC), reviewed publications/assessed levels of evidence, developed recommendations, and verified representation of all major recommendations from 27 multidisciplinary wound infection documents. Using a web-based survey, practitioners were invited to assess the clinical relevance and strength of each recommendation using standardized scores. Survey responses from 42 practitioners, including registered nurses (RNs), Wound Care Certified and advanced practice RNs, physical therapists, physicians, podiatrists, and scientists from 6 countries were returned to AAWC staff, tabulated in a spreadsheet, and analyzed for content validity. Respondents had a median of >15 years of military or civilian practice and managed an average of 15.9 ± 23 patients with infected wounds per week. Recommendations supported by strong evidence and/or content validated as relevant by at least 75% of respondents qualified for guideline inclusion. Most (159, 88.8%) of the 179 ICWIG recommendations met these criteria and were summarized as a checklist to harmonize team wound infection management across specialties and settings. Most of the 20 recommendations found not to be valid were related to the use of antibiotics and antiseptics. After final ICWIG TF review of best evidence supporting each recommendation, the guideline will be published on the AAWC website.

A possible behavioural and cognitive phenotype for the 47,XYY karyotype in a pre-pubertal child.

OBJECTIVE: The aim of this study was to describe the case of a 9-year-old boy with 47,XYY genotype and possible behavioural phenotype involving 'internalizing' and 'externalizing' symptoms and cognitive phenotype of deficient spatial memory. CONCLUSIONS: Longitudinal study of 47,XYY cases recognized prenatally are needed to confirm the preliminary findings described in this report.