Orbital cavernous venous malformation shrinkage during fractionated stereotactic radiotherapy contributing to the development of radiation retinopathy.

BACKGROUND: Posterior movement of ocular tissue secondary to orbital cavernous venous malformation shrinkage from fractionated stereotactic radiotherapy can allow healthy structures to move into the radiation field during treatment. This may carry an increased risk of radiation-induced retinopathy. METHODS: We present a case of a young female whose radiotherapy treatment for an orbital cavernous venous malformation resulted in a 3 mm reduction in proptosis and subsequent retinopathy. RESULTS: The severity of the patient's radiation-induced radiotherapy exceeded expectations. The venous malformation shrinkage during treatment and ensuing posterior movement of the globe suggested an increased involvement of ocular tissue in the radiation field, prompting consideration of interval neuroimaging and tumour mapping. CONCLUSIONS: We describe and suggest a protocol of onboard neuroimaging during the radiation therapy course to better target tumour volumes and minimise collateral tissue damage. To our knowledge, this has not been previously described in the ophthalmic literature.

Clinical performance of predicting late age-related macular degeneration development using multimodal imaging.

BACKGROUND: To examine whether the clinical performance of predicting late age-related macular degeneration (AMD) development is improved through using multimodal imaging (MMI) compared to using colour fundus photography (CFP) alone, and how this compares with a basic prediction model using well-established AMD risk factors. METHODS: Individuals with AMD in this study underwent MMI, including optical coherence tomography (OCT), fundus autofluorescence, near-infrared reflectance and CFP at baseline, and then at 6-monthly intervals for 3-years to determine MMI-defined late AMD development. Four retinal specialists independently assessed the likelihood that each eye at baseline would progress to MMI-defined late AMD over 3-years with CFP, and then with MMI. Predictive performance with CFP and MMI were compared to each other, and to a basic prediction model using age, presence of pigmentary abnormalities, and OCT-based drusen volume. RESULTS: The predictive performance of the clinicians using CFP [AUC = 0.75; 95% confidence interval (CI) = 0.68-0.82] improved when using MMI (AUC = 0.79; 95% CI = 0.72-0.85; p = 0.034). However, a basic prediction model outperformed clinicians using either CFP or MMI (AUC = 0.85; 95% CI = 0.78-91; p ≤ 0.002). CONCLUSIONS: Clinical performance for predicting late AMD development was improved by using MMI compared to CFP. However, a basic prediction model using well-established AMD risk factors outperformed retinal specialists, suggesting that such a model could further improve personalised counselling and monitoring of individuals with the early stages of AMD in clinical practice.

Neighborhood Inequities in Tobacco Product Descriptors, Washington, DC, 2018-2019.

BACKGROUND: The tobacco industry uses product descriptors to communicate reduced harm and increase appeal. This cross-sectional study assessed store-level racial, ethnic, and socioeconomic inequities in the distribution of retail tobacco product descriptors in a convenience sample of retailers in Washington, DC. METHODS: Young adults (n = 146) who did not currently use tobacco reported real-time store visits over 14 days. Trained data collectors took high-resolution photographs of all tobacco (including e-cigarette) marketing in each store (n = 96) participants visited. We coded text descriptors on tobacco product advertisements and displays into descriptor categories (eg, fruit, sweet, concept). We fit multilevel models to examine relationships between store neighborhood census tract-level racial, ethnic, and socioeconomic characteristics and tobacco product descriptors in stores. As a supplementary analysis, we used geospatial methods to model predicted patterns of descriptors at the census tract level. RESULTS: Stores located in census tracts with the highest versus lowest percentage of Black residents had a greater count of fruit, sweet or dessert, alcohol, and concept descriptors (p < .05), similar to findings from the geospatial approach. Adjusted models also indicated some inequities in stores in census tracts with higher percentages of Hispanic or Latino residents for fruit, alcohol, and concept descriptors; however, tract-level models showed opposite results for concept flavors. CONCLUSIONS: In this convenience sample, fruit, alcohol, sweet/dessert, and concept FTP descriptors were prevalent in stores in neighborhoods with more Black residents demonstrated through two analytic approaches. Surveillance using representative samples of tobacco retailers could improve the ability to track the extent of this inequity. IMPLICATIONS: We document inequities in the amount of fruit, sweet or dessert, alcohol, and concept flavor descriptors in stores across neighborhoods in Washington, DC. Federal, state, and local regulatory action is needed to reduce inequities in flavored tobacco product availability and marketing, including for concept flavors.

Unmet Healthcare Needs and Medical Cannabis Use Among Sexual and Gender Minoritized Adults in a High-Stigma Environment.

Sexual and gender minoritized (SGM) individuals in high-stigma areas may use cannabis to cope with unmet healthcare needs and elevated stress. Adults in Oklahoma (Mage = 43.9[SD = 16.8], 54.5% female, 71.4% non-Hispanic White) completed a cross-sectional survey (August-September 2022). Logistic regression examined the association of SGM identity (SGM or non-SGM) with past-year unmet healthcare need (yes/no). Logistic and linear regressions also examined main and interactive effects of SGM identity and unmet healthcare needs on past-month medical cannabis use and number of relaxation/tension-reduction reasons for cannabis use endorsed. Analyses were unadjusted and adjusted for sociodemographic and healthcare characteristics. In adjusted analyses, SGM (vs. non-SGM) adults were more likely to report unmet healthcare needs (aOR = 2.24, 95% CI[1.47, 3.42], p < .001) and past-month medical cannabis use (aOR = 2.15 [1.07, 4.34], p = .033). In unadjusted analyses, SGM (versus non-SGM) adults and those with unmet healthcare needs (versus without) endorsed more relaxation/tension reduction reasons for cannabis use in separate main effects (ps < .029), and adults with unmet healthcare needs (vs. without) were more likely to report past-month medical cannabis use (OR = 2.31 [1.86, 2.88]). SGM identity X unmet healthcare need interactions did not emerge (ps > .05). SGM individuals in high-stigma environments may use cannabis to compensate for insufficient healthcare.

Cannabis Use Differences Among Sexual Minority Versus Heterosexual Females and Males in Oklahoma: The Roles of Mental Health, Cannabis Perceptions, and Cannabis Marketing Exposure.

INTRODUCTION: Despite the high cannabis use rates among sexual minority (SM) individuals, less research has examined factors related to cannabis use among SM (vs. heterosexual) individuals, especially in places with legal medical cannabis retail markets and high structural stigma, like Oklahoma. METHODS: Data were from a survey of Oklahoma adults, including 3020 females (18.6% SM) and 2279 males (10.1% SM). Bivariate analyses examined associations of sexual identity with cannabis-related factors (i.e., perceived harm, positive attitudes, marketing exposure, depressive symptoms, anxiety symptoms) and cannabis use and use severity (i.e., past 30-day use, daily/near-daily use, cannabis use disorder [CUD] symptoms). Logistic regression examined associations of sexual identity and cannabis-related factors with cannabis use and use severity among females and males, separately. RESULTS: SM (vs. heterosexual) females reported greater odds of past 30-day cannabis use and daily/near-daily use, lower harm perceptions, greater marketing exposure, and higher rates of depressive/anxiety symptoms. Lower harm perceptions and greater marketing exposure were associated with greater odds of past 30-day use, whereas marketing exposure was associated with greater odds of daily/near-daily use. SM (vs. heterosexual) males reported greater odds of daily/near-daily use and higher rates of depressive/anxiety symptoms. CONCLUSIONS: SM (vs. heterosexual) females reported higher rates of cannabis use, whereas SM (vs. heterosexual) females and males reported higher rates of daily/near-daily cannabis use. Potential targets for cannabis-related health campaigns aimed at reducing use differences include correcting misinterpretations of harm that may emanate from cannabis marketing efforts among females and addressing depressive symptoms among males.

Patterns of Tobacco and Cannabis Use Among Sexual Minority Females and Males From PATH Wave 5: The Role of Sociodemographic and Psychosocial Correlates.

INTRODUCTION: Although sexual minority (SM; vs heterosexual) individuals display higher rates of tobacco and cannabis use, limited research has examined sociodemographic and psychosocial correlates of single and co-use among this population. METHODS: Participants were SM-identifying female (N = 2419; Mage = 27.80; 50.0% racial/ethnic minority) and male (N = 1142; Mage = 30.34; 46.1% racial/ethnic minority) adults from Wave 5 of the Population Assessment of Tobacco and Health study. Multinomial logistic regressions examined sociodemographic (ie, sexual identity, age, race/ethnicity, education, income) and psychosocial (ie, alcohol use, mental health, substance use) correlates of single and co-use (ie, no use [referent], tobacco-only, cannabis-only, co-use), controlling for state cannabis legalization, among SM females and males, separately. RESULTS: The proportions of SM females reporting no use, tobacco-only, cannabis-only, and co-use were 37.9%, 24.0%, 10.5%, and 27.6%, respectively. Among males, 40.6%, 27.8%, 10.1%, and 21.5% reported no use, tobacco-only, cannabis-only, and co-use, respectively. Among females and males, substance use problems were associated with all 3 use groups (vs no use); past-month alcohol use was associated with cannabis-only and co-use; and mental health symptoms were associated with co-use (and cannabis-only in males). Sociodemographic correlates among females were: tobacco-only-identifying as bisexual (vs lesbian), White (vs Black), older, lower education, and lower income; cannabis-only-bisexual, other race (vs White); and co-use-White (vs Hispanic), lower education, and lower income. Among males, sociodemographic correlates were: tobacco-only-older, lower education, and lower income; cannabis-only-Black (vs White) and higher income. CONCLUSIONS: Public health efforts to reduce tobacco and cannabis use among SM adults should target single versus co-use patterns and their corresponding sociodemographic, mental health, and substance use profiles.

Patterns of use, perceptions, and cardiopulmonary health risks of cigar products: a systematic review.

OBJECTIVE: A systematic review was conducted to evaluate the use patterns, health perceptions, and cardiopulmonary health effects of cigars. DATA SOURCES: PubMed and Google Scholar were searched for peer-reviewed articles published between June 2014 and February 2021. Search keywords included cigars, cigarillos, little cigars, and cardiopulmonary health outcomes. STUDY SELECTION: Of 782 papers identified, we excluded non-English articles, review articles, commentaries, and those without empirical data on cigars. Three coders independently reviewed all articles and compared codes to resolve discrepancies. 93 articles met the inclusion criteria and were included. DATA SYNTHESIS: Cigars have evolved from premium cigars to encompass little cigars and cigarillos (LCCs). LCCs are available in an array of flavors and at a price advantage, and as a result, are used by different groups compared to premium cigars. LCCs are more frequently used by youth, young adults, and those who identify as Black/African American. LCCs are often used in combination with other tobacco products, alcohol, and cannabis. Despite limited regulation, cigars generate smoke of a similar composition as cigarettes. Among the studies identified, evidence suggests that cigar use is associated with cardiovascular and pulmonary toxicity. Higher all-cause and cancer-related mortalities are associated with cigar use, particularly with more frequent and deeper inhalation, compared to non-tobacco users. CONCLUSIONS: LCCs are used more frequently by at-risk groups compared to premium cigars. Recent studies evaluating cigar cardiopulmonary health effects are limited but suggest cigars have similar health risks as conferred by cigarette smoking. With the use of LCCs and targeted marketing on the rise among high-risk groups, there is a critical need for continued research in this area.

Disparities in cannabis use outcomes, perceived risks and social norms across sexual orientation groups of US young adult women and men.

Little research has examined mechanisms driving cannabis use disparities among sexual minority (SM; versus heterosexual) young adults (YAs). Participants were US YA women (N = 1345; 24.8% bisexual, 6.1% lesbian) and men (N = 998: 8.9% bisexual, 13.8% gay). Bivariate analyses examined associations between sexual orientation (heterosexual, gay/lesbian, bisexual) and cannabis use outcomes (past 30-day [current] use, use frequency, cannabis-tobacco dual use, use intentions), perceived risks (harm, addictiveness) and social norms (social acceptability, peer use). Regressions examined sexual orientation, perceived risks and social norms as correlates of cannabis outcomes. Bisexual and lesbian (versus heterosexual) women reported lower cannabis-related perceived risks, greater social norms and higher odds of current use. Bisexual (versus heterosexual) women reported more days of use, higher odds of cannabis-tobacco dual use and greater use intentions. Gay (versus heterosexual) men reported lower perceived addictiveness, greater social norms and higher odds of current use. Lower perceived risks and greater social norms predicted greater use outcomes for women and men. Bisexual women displayed higher odds of several cannabis use outcomes, whereas lesbian women and gay men displayed higher odds of current cannabis use only. Cannabis-related perceptions and social norms may be important targets for public health messaging for SMYAs.

Retrospective Use of Patients' Characteristics to Assess Variation in Prenatal Care Utilization.

OBJECTIVE: We used patients' medical and psychosocial risk factors to explore prenatal care utilization and health outcomes to inform prenatal care tailoring. STUDY DESIGN: This retrospective cohort study assessed patients who gave birth at an academic institution from January 1 to December 31, 2018, using electronic health record (EHR) data. Patients were categorized into four phenotypes based on medical/psychosocial risk factors available in the EHR: Completely low risk; High psychosocial risk only; High medical risk only; and Completely high risk. We examined patient characteristics, visit utilization, nonvisit utilization (e.g., phone calls), and outcomes (e.g., preterm birth, preeclampsia) across groups. RESULTS: Of 4,681 patients, the majority were age 18 to 35 (3,697, 79.0%), White (3,326, 70.9%), multiparous (3,263, 69.7%), and Completely high risk (2,752, 58.8%). More Black and Hispanic patients had psychosocial risk factors than White patients. Patients with psychosocial risk factors had fewer prenatal visits (10, interquartile range [IQR]: 8-12) than those without (11, IQR: 9-12). Patients with psychosocial risk factors experienced less time in prenatal care, more phone calls, and fewer EHR messages across the same medical risk group. Rates of preterm birth and gestational hypertension were incrementally higher with additional medical/psychosocial risk factors. CONCLUSION: Data readily available in the EHR can assess the compounding influence of medical/psychosocial risk factor on patients' care utilization and outcomes. KEY POINTS: · Medical and psychosocial needs in pregnancy can inform patient phenotypes and are associated with prenatal care use and outcomes.. · Patient phenotypes are associated with prenatal care use and outcomes.. · Patients with high psychosocial risk spent less time in prenatal care and had more phone calls in pregnancy.. · Tailored prenatal care models may proactively address differences in patient's needs..

Parameters of EMA Compliance and Self-Reported Reactivity in a Longitudinal Study of Young Adult Cannabis and Tobacco Co-Users.

Background: Co-use of cannabis and tobacco has become increasingly popular among young adults. Interactive voice response (IVR) based ecological momentary assessment (EMA) allows for measurement of behavior in or near real-time, but has limitations including non-compliance, missing data, and potential for reactivity (e.g., behavior change) from frequent assessments. Methods: This study examined tobacco and cannabis use characteristics and factors associated with IVR compliance and self-reported reactivity in 97 young adults who reported cannabis and tobacco co-use at baseline and completed daily IVR surveys of co-use behavior at three random times per day for 28 days. Results: Overall IVR compliance was 55%, with a modal compliance of 60%. Compliance rates did not differ across morning, midday, and evening surveys, but significantly declined over time. The sample was divided into high frequency responders (>70% calls completed, n=35) and low frequency responders (<70%, calls completed n=62). There were no differences between high and low frequency responders on any baseline demographic, tobacco use (nicotine dependence severity), alcohol, or cannabis use characteristics (past 30-day frequency of use). Participants were receptive to IVR-based EMA monitoring and, 16.5% reported purposely decreasing nicotine/tobacco use due to monitoring, while 19.6% reported purposely decreasing cannabis use, which predicted lower cannabis use post-EMA monitoring. Conclusions: Real-time assessment of co-use behavior among young adults does not appear to be impacted by specific demographics or substance use severity (nicotine dependence, heavy drinking). Data suggest some predictive utility of IVR-based EMA monitoring on short-term behavior change. More intensive approaches are needed to improve compliance among young adult cannabis and tobacco co-users.

Prevalence and Correlates of Cardiovascular, Pulmonary, Cancer, and Mental Health Comorbidities Among Adults With HIV Who Smoke.

ABSTRACT: Using data from the D.C. Cohort Longitudinal HIV Study, we examined (a) diagnosed mental health and (b) cardiovascular, pulmonary, or cancer (CPC) comorbidity among adults with HIV who smoked. Among 8,581 adults, 4,273 (50%) smoked; 49% of smokers had mental health, and 13% of smokers had a CPC comorbidity. Among smokers, non-Hispanic Black participants had a lower risk for mental health (prevalence ratio [PR]: 0.69; 95% confidence interval [CI] [0.62-0.76]) but a higher risk for CPC (PR: 1.17; 95% CI [0.84-1.62]) comorbidity. Male participants had a lower risk for mental health (PR: 0.88; 95% CI [0.81-0.94]) and CPC (PR: 0.68; 95% CI [0.57-0.81]) comorbidity. All metrics of socioeconomic status were associated with a mental health comorbidity, but only housing status was associated with a CPC comorbidity. We did not find any association with substance use. Gender, socioeconomic factors, and race/ethnicity should inform clinical care and the development of smoking cessation strategies for this population.

Outdoor Medical Cannabis Advertising in Oklahoma: Examining Regulatory Compliance and Social Meanings in Billboard Content.

Background: Medical cannabis currently dominates the U.S. cannabis advertising landscape. The public is increasingly exposed to outdoor cannabis advertising, which increases positive attitudes about and intentions to use cannabis. Research is lacking regarding outdoor cannabis advertising content. This article characterizes the content of outdoor cannabis advertising in Oklahoma, one of the fastest growing U.S. medical cannabis markets. Methods: We conducted a content analysis of cannabis advertising billboard images (n = 73) from Oklahoma City and Tulsa, photographed May 2019-November 2020. We followed a primarily inductive, iterative team approach to thematically analyze billboard content in NVIVO. We reviewed all images, identified a broad coding taxonomy, and then incorporated emergent codes and those related to advertising regulation (e.g. youth/children). We totaled frequencies of code application across billboards and reexamined billboards for final themes. Results: Major themes were social meanings related to cannabis subculture, formal medical systems, and nature, and the presence of company contact information. Minor themes related to convenience, price promotions, store proximity, U.S. affiliation, product quality, and spirituality. State advertising regulation violations were rare, with the exception of content that may promote curative or therapeutic effects (4%) and misrepresentation of product state of origin (1.4%). Conclusion: Outdoor medical cannabis advertising in Oklahoma blurs boundaries between formal medical discourses and cannabis subculture that is suspicious of messaging from authorities and regards cannabis as harmless and natural. Increased monitoring of advertising regulation compliance and greater understanding of social discourses within emerging markets is needed to promote public health within the context of cannabis advertising.

Population and Neighborhood Correlates of Cannabis Dispensary Locations in Oklahoma.

Background: Cannabis dispensaries have proliferated exponentially in Oklahoma since the state legalized medical cannabis in 2018. Oklahoma is unique from many other legalized states given its high number of lower income, rural, and uninsured residents, who may seek medical cannabis as an alternative to traditional medical treatment. Methods: This study examined demographic and neighborhood characteristics associated with dispensary density (n = 1,046 census tracts) in Oklahoma. Results: Compared to census tracts with no dispensaries, those with at least one dispensary had a higher proportion of uninsured individuals living below the poverty level and a greater number of hospitals and pharmacies. Almost half (42.35%) of census tracts with at least one dispensary were classified as a rural locale. In fully adjusted models, percent uninsured, percent of household rentals, and the number of schools and pharmacies were positively associated with greater number of cannabis dispensaries, while the number of hospitals was negatively associated. In the best fitting interaction models, dispensaries were predominant in areas with a higher percentage of uninsured residents and no pharmacies, suggesting that cannabis retailers may capitalize on the health needs of communities with limited healthcare outlets or access to medical treatment. Conclusions: Policies and regulatory actions that seek to decrease disparities in dispensary locations should be considered. Future studies should examine whether people living in communities with a scarcity of health resources are more likely to associate cannabis with medical uses than those living in communities with more resources.

First use of cannabis compared to first use of alcohol and tobacco: Associations with single and poly-substance use behavior.

INTRODUCTION: Young adults report high rates of current cannabis use. The proliferation of legalized cannabis in the US has led to greater access and availability, causing cannabis to become the new "gateway" drug. This study examined the prevalence of trying cannabis before alcohol or tobacco and the association of initiation with cannabis first with single and poly-substance use in young adults. METHODS: METHODS: Data were analyzed from young adults (n=8062) in Waves 1 through 5 (2013-2019) of the Population Assessment of Tobacco and Health study who had ever tried alcohol, cannabis, or tobacco and provided age at first use of these substances. Weighted multivariable models examined associations between cannabis initiation before, at the same age, or after initiating alcohol or tobacco use with past 30-day substance use (alcohol, cannabis, tobacco, poly-substance use) in a subsequent wave (Waves 2-5). RESULTS: Initiating cannabis before alcohol and tobacco (6%) was rare. In adjusted regression models, initiating cannabis before alcohol and tobacco was associated with increased odds of past 30-day cannabis use, past 30-day tobacco use, and past 30-day polysubstance use and decreased odds of past 30-day alcohol use. Initiating cannabis at the same age as either alcohol or tobacco, or trying cannabis after these substances was associated with increased odds of all substance use outcomes. CONCLUSIONS: Cannabis initiation before alcohol and tobacco is uncommon and may even protect against future alcohol use. Deterring cannabis initiation with multiple substances could have public health benefits.

Disparities in trajectories of cigarette and E-cigarette use across sexual orientation groups of young adult men and women in the US.

INTRODUCTION: Limited research has examined differences in cigarette/e-cigarette use trajectories among specific subgroups of sexual minority (SM) young adult (SMYA) men and women. METHODS: Repeated measures latent profile analyses (RMLPAs) examined past 6-month cigarette and e-cigarette use trajectories across 5 waves of data (2018-2020) among men (n = 1235; Mage = 25.56, SD = 4.85; 8.0% bisexual, 12.7% gay; 36.4% racial/ethnic minority) and women (n = 1574; Mage = 24.64, SD = 4.72; 23.8% bisexual, 5.9% lesbian; 35.3% racial/ethnic minority) residing in 6 US metropolitan statistical areas. Multinomial logistic regressions examined associations among sexual orientation (bisexual, gay/lesbian, heterosexual) and tobacco use trajectories among men and women, separately. RESULTS: RMLPAs yielded a 6-profile solution: stable low-level cigarette and e-cigarette use (66.6%), stable low-level cigarette and high-level e-cigarette use (12.2%), stable low-level cigarette and decreasing e-cigarette use (6.2%), stable mid-level cigarette and low-level e-cigarette use (6.2%), stable high-level cigarette and low-level e-cigarette use (4.5%), and stable high-level cigarette and e-cigarette use (4.2%). Gay (vs. heterosexual) men were less likely to display stable low-level cigarette and stable high-level e-cigarette use. Bisexual (vs. heterosexual) women were more likely to display stable low-level cigarette and stable high-level e-cigarette use, stable low-level cigarette and decreasing high-level e-cigarette use, and stable high-level cigarette and stable low-level e-cigarette use. CONCLUSIONS: Bisexual women were at greatest risk for displaying several problematic cigarette and e-cigarette use trajectories, whereas few differences emerged for men. Tailored interventions and campaigns are needed to curtail ongoing tobacco use disparities among SMYA men and women, particularly bisexual women.

Cannabis use among adults undergoing cancer treatment.

BACKGROUND: Little is known about the risks and benefits of cannabis use in the context of cancer care. This study characterized the prevalence, reasons for use, and perceived benefits of cannabis and compared symptoms and perceived risks between those who reported past 30-day cannabis use and those who did not. METHODS: Adults undergoing cancer treatment at a National Cancer Institute-designated cancer center completed measures of sociodemographic characteristics, cannabis use, use modalities, reasons for use, perceived harms/benefits of use, physical and psychological symptoms, and other substance/medication use. Analyses compared patients who used or did not use cannabis in the past 30 days. RESULTS: Participants (N = 267) were 58 years old on average, primarily female (70%), and predominantly White (88%). Over a quarter of respondents (26%) reported past 30-day cannabis use, and among those, 4.5% screened positive for cannabis use disorder. Participants who used cannabis most often used edibles (65%) or smoked cannabis (51%), and they were younger and more likely to be male, Black, and disabled, and to have lower income and Medicaid insurance than participants who did not use cannabis. Those who used cannabis reported more severe symptoms and perceived cannabis as less harmful than those who did not use cannabis. The most common medical reasons for cannabis use were pain, cancer, sleep problems, anxiety, nausea/vomiting, and poor appetite. Participants reported the greatest cannabis-related symptom relief from sleep problems, nausea/vomiting, headaches, pain, muscle spasms, and anxiety. CONCLUSIONS: Patients with cancer who used cannabis perceived benefits for many symptoms, although they showed worse overall symptomatology. PLAIN LANGUAGE SUMMARY: Among adults undergoing cancer treatment, 26% reported cannabis use in the past 30 days. Those who used cannabis were more likely to be male and disabled and to have lower income and Medicaid insurance than those who did not use cannabis. Participants most commonly reported using cannabis for pain, cancer, sleep, anxiety, and nausea/vomiting and reported the greatest perceived benefits for sleep, nausea/vomiting, headaches, pain, muscle spasms, and anxiety, yet participants who used cannabis also reported feeling worse physically and psychologically compared to those who did not use cannabis. Participants who used cannabis were more likely to report that cannabis was less risky to their health than alcohol, smoking, and opioids than those who did not use cannabis.

Identifying the unique behaviors embedded in the process of interprofessional collaboration in the ICU.

Interprofessional collaboration (IPC) is an important aspect of high-quality care in intensive care units (ICUs). The practice of IPC, however, is complex and the components that constitute IPC are not well defined. We sought to identify distinct behaviors embedded in clinician workflow that indicate engagement in the IPC process. We conducted a clinical ethnography in two ICUs in southeastern Michigan. From March 2017 to March 2019, we collected 31 hours of observations and completed 12 separate clinician shadowings and 12 interviews with ICU nurses, physicians, and respiratory therapists. We applied an iterative analytical approach to identify two types of IPC behaviors which we a priori labeled as "enablers" (i.e. the ways clinicians transition into or facilitate collaboration) and "collaborative activities" (i.e. behaviors clinicians use to directly collaborate with other professionals). 18 IPC behaviors were identified - ten "enablers" and eight "collaborative activities." Specifically, the enablers include: active listening, approach, coordinating work, intraprofessional consultation, invitation, nonverbal accessibility, reflexive questioning, sending pages/call, validation, and verbal accessibility. The collaborative activities are: correction, fill in the gap, information exchange, negotiation, providing help, socializing, teaching/training, and troubleshooting. By identifying IPC behaviors embedded in clinician workflow, our results may support more focused assessments of IPC in practice and guide clinicians toward behaviors they can use to engage in the IPC process.

Seeing is believing: How cannabis marketing exposure is associated with cannabis use attitudes and behavior in a permissive medical cannabis policy environment.

BACKGROUND AND OBJECTIVES: Oklahoma has a fast-growing medical cannabis industry, showing a proliferation of industry marketing. While cannabis marketing exposure (CME) is a risk factor for cannabis use and positive attitudes about use, no studies have examined the impact of CME on attitudes and use behavior in a permissive cannabis policy environment, like Oklahoma. METHODS: N = 5428 Oklahoma adults ages 18 and older completed assessments of demographics, past 30-day cannabis use, and past 30-day exposure to each of four types of cannabis marketing: outdoor (billboards, signs), social media, print (magazines), and Internet. Regression models examined associations of CME with positive attitudes towards cannabis use, cannabis harm perceptions, interest in obtaining a medical cannabis license (among nonlicensed participants), and past 30-day cannabis use. RESULTS: Three quarters (74.5%) reported any past 30-day CME. Outdoor CME was most prevalent (61.1%), followed by social media (46.5%), Internet (46.1%), and print (35.2%). Correlates of CME included younger age, higher educational attainment and income, and medical cannabis license. In adjusted regression models, past 30-day CME and number of sources of CME were associated with current cannabis use behavior, positive attitudes about cannabis, lower cannabis harm perceptions, and greater interest in obtaining a medical cannabis license. Similar associations between CME and positive attitudes about cannabis were shown among noncannabis users. DISCUSSION AND CONCLUSIONS: Public health messaging should be employed to minimize the potential adverse impacts of CME. SCIENTIFIC SIGNIFICANCE: No studies have examined correlates of CME in a rapidly growing and relatively unrestrained marketing environment.

A two-stage partial fixing approach for solving the residency block scheduling problem.

We consider constructing feasible annual block schedules for residents in a medical training program. We must satisfy coverage requirements to guarantee an acceptable staffing level for different services in the hospital as well as education requirements to ensure residents receive appropriate training to pursue their individual (sub-)specialty interests. The complex requirement structure makes this resident block scheduling problem a complicated combinatorial optimization problem. Solving a conventional integer program formulation for certain practical instances directly using traditional solution techniques will result in unacceptably slow performance. To address this, we propose a partial fixing approach, which completes the schedule construction iteratively through two sequential stages. The first stage focuses on the resident assignments for a small set of predetermined services through solving a much smaller and easier problem relaxation, while the second stage completes the rest of the schedule construction after fixing those assignments specified by the first stage's solution. We develop cut generation mechanisms to prune off the bad decisions made by the first stage if infeasibility arises in the second stage. We additionally propose a network-based model to assist us with an effective service selection for the first stage to work on the corresponding resident assignments to achieve an efficient and robust performance of the proposed two-stage iterative approach. Experiments using real-world inputs from our clinical collaborator show that our approach can speed up the schedule construction at least 5 times for all instances and even over 100 times for some huge-size instances compared to applying traditional techniques directly.