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Through conversations with members of racialized communities, we aimed to: explore perspectives shared by members of racialized communities regarding the relationship between cannabis and mental health; develop a greater understanding of racialized community members’ mental health service interactions in relation to cannabis use and mental health; and examine whether various social identities interact to influence experiences with cannabis use and mental illness. From January to June 2022, we conducted semi-structured interviews with 26 members of racialized populations who were ≥18 years old, had used cannabis in the last 6 months, and had been in contact with the mental health sector across Ontario in the past year for a known psychiatric diagnosis. Many participants were 25–34 (46%), Canadian citizens (89%), and heterosexual (50%), with representation from ten different ethno-racial identities. Seventy-three percent of past-month cannabis users reported daily use. We identified five themes: experiences of the relationship between cannabis use and mental health; cannabis use in response to barriers encountered with formal mental health supports; negative experiences with mental health services related to race, gender identity, and cannabis use; adverse effects of discrimination on mental health and cannabis use; and strategies to improve mental health programs. Interviews facilitated a deeper understanding of the complex relationship between cannabis use and mental health outcomes among racialized individuals. Clinical practice guidelines and training are recommended for healthcare providers to enhance culturally sensitive care regarding cannabis use and mental health. Research exploring risks and benefits of self-medication using cannabis would enrich our understanding of its implications specifically for this population.

This study examines the feasibility of biomass briquettes as a renewable energy source, utilizing Giant Miscanthus, sawdust, and spent coffee grounds. Recycled paper pulp serves as a binder, enhancing energy density and combustion efficiency. The briquetting process involves drying, grinding, mixing, and compressing the raw materials. Fuel characteristics were assessed through proximate and ultimate analyses, calorimetry, and thermogravimetric analysis (TG/DTA). Spent coffee grounds exhibited the highest heating value (21,370 kJ/kg), followed by sawdust (17,610 kJ/kg) and Giant Miscanthus (17,020 kJ/kg). Thermal decomposition confirmed efficient combustion, with Giant Miscanthus achieving complete combustion at 484°C and an exothermic peak at 452°C. Giant Miscanthus emerged as a promising feedstock due to its low ash content, high energy yield, and compatibility with existing infrastructure. Combining agricultural residues with non-arable crops enhances resource efficiency. This study highlights the potential of biomass briquettes to support decarbonization, energy security, and sustainable development goals by providing a viable low-carbon alternative to fossil fuels.

Patients with differences in sex development or intersex traits (DSD/I) struggle to find clinically competent care in adulthood. We sought to describe the surgical exposure of Urogynecology and Reconstructive Pelvic Surgery (URPS) fellows who had previously trained in ObGyn (URPS-Gyn) to patients with DSD/I and their interest in performing 18 relevant procedures. We hypothesized that most graduating fellows would not have had exposure to many of the surgeries. We administered a cross-sectional online questionnaire of graduating URPS-Gyn fellows from April to June 2021. Questions assessed procedural knowledge, training, and clinical interest. Of 56 eligible URPS-Gyn fellows graduating in 2021, a total of 14 completed the survey. Twelve (86%) had heard about most procedures (14 out of 18 surgeries listed); however, there was heterogeneity in exposure to specific surgeries and self-reported preparedness to perform them. Respondents were more interested in performing procedures that they were prepared to perform. Only 6 out of 11 who responded to questions about beliefs in training felt that it was important for residents to receive training regarding surgeries for patients with intersex traits, and only 8 felt it important for fellows to receive this surgical training. Three anticipated seeing patients with intersex traits. Graduating URPS-Gyn fellows expressed interest in performing surgeries to meet the needs of patients with DSD/I. However, respondents had heterogeneous exposure and self-assessments of their proficiency. URPS-Gyn providers may be key collaborators in providing care for the growing number of adults with DSD/I seeking care.

Few large sample studies have examined whether disparities, as measured by the proxy of race/ethnicity, are observed in long-term mortality after high-risk operations performed in a United States national health system. We compared operation year-related mortality risk by race/ethnicity after high-risk operative interventions among patients receiving care within the VHA. From the Veterans Affairs Corporate Data Warehouse and Surgical Quality Improvement Program, data were retrieved for 426,695 patients undergoing high-risk surgical procedures in non-cardiac, general, vascular, thoracic, orthopedic, neurosurgery, and genitourinary specialties between 2000 and 2018. Operation year was used as a surrogate measure of advances in technology and perioperative management. Underrepresented race/ethnicity groups were compared in a binary form with Caucasian/White race, as the reference category. The primary outcome was time to mortality, defined as death occurring at any time, due to any cause, during follow up, and after the initial, eligible surgery. The median follow-up after 537,448 operations among 426,695 patients was 4.8years. After adjustment for preoperative risk factors and demographics, long-term mortality risk decreased significantly to a hazard ratio of 0.96 (95% confidence interval, 0.962 to 0.964) over calendar time. Long-term mortality was not significantly higher among African Americans/Blacks compared to Caucasians/Whites (p = 0.22). Among Hispanics, differences in mortality risk favored Caucasians/Whites in the early years under study-a difference that dissipated as time progressed. In the most recent years, no difference in mortality was observed among Asian/Native Americans and Caucasians/Whites. Risk-adjusted long-term mortality after high-risk operations among Veterans Affairs hospitals did not significantly vary between African Americans/Blacks, Hispanics, and Asian/Native Americans groups.

The Next Generation Accountable Care Organization (NGACO) model (active during 2016-21) tested the effects of high financial risk, payment mechanisms, and flexible care delivery on health care spending and value for fee-for-service Medicare beneficiaries. We used quasi-experimental methods to examine the model's effects on Medicare Parts A and B spending. Sixty-two ACOs with more than 4.2million beneficiaries and more than 91,000 practitioners participated in the model. The model was associated with a $270 per beneficiary per year, or approximately $1.7billion, decline in Medicare spending. After shared savings payments to ACOs were included, the model increased net Medicare spending by $56 per beneficiary per year, or $96.7million. Annual declines in spending for the model grew over time, reflecting exit by poorer-performing NGACOs, improvement among the remaining NGACOs, and the COVID-19 pandemic. Larger declines in spending occurred among physician practice ACOs and ACOs that elected population-based payments and risk caps greater than 5percent.

This report provides a summary of the results obtained in laboratory-scale testing of dry-decontamination technologies. The purpose of the experiment is to assess nonaqueous technologies to determine the viability of a solution to mitigate chemical, biological, radiological, and nuclear (CBRN) defense, CBRN Response Enterprise, medical casualty care, and cold-weather operational gaps. The Cold Regions Research and Engineering Laboratory (CRREL) assessed the efficacy, via percentage reduction, of four nonaqueous technologies to decontaminate particulate contamination, at three operational temperatures, from three starting challenges. Testing was conducted by CRREL personnel according to protocols developed in conjunction with the Homeland Defense/Civil Support Office Maneuver Support Center of Excellence and the Armed Forces Radiobiology Research Institute (AFRRI) and approved by Joint Program Executive Office CBRN Protection. CRREL subsequently collected data and conducted statistical measures of significance and explored additional questions about the technology capabilities. CRREL personnel then deployed with AFRRI support to Arctic Eagle/Patriot 22 (AE/P-22) for field testing of the technologies and their evaluation from an operational perspective. AE/P-22 allowed for direct, full-scale testing of the technology in conditions approximating a use-case scenario. This report documents the culmination of analysis performed on CRREL- and AFRRI-collected test data results, operational factors, and user inputs.

Breast cancer (BCa) represents a medically heterogeneous group of malignancies, with differing biological and genetic makeups [...].

BackgroundFerroptosis is a novel iron-dependent cell death, and an increasing number of studies have shown that long non-coding RNA (lncRNAs) are involved in the ferroptosis process. However, studies on ferroptosis-related lncRNAs in lung squamous cell carcinoma (LUSC) are limited. In addition, the prognostic role of ferroptosis-related lncRNAs and their relationship with the immune microenvironment and methylation of LUSC is unclear. This study aimed to investigate the potential prognostic value of ferroptosis-related lncRNAs and their involved biological functions in LUSC.MethodsThe Cancer Genome Atlas (TCGA) database and the FerrDb website were used to obtain ferroptosis-related genes for LUSC. The “limma” R package and Pearson analysis were used to find ferroptosis-related lncRNAs. The biological functions of the characterized lncRNAs were analyzed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). We evaluated the prognostic power of this model using Kaplan-Meier analysis, receiver operating characteristic (ROC), and decision curve analysis (DCA). Univariate and multifactor Cox (proportional-hazards) risk model and a nomogram were produced using risk models and clinicopathological parameters for further verification. In addition, the relationship between characterized lncRNAs and tumor immune infiltration and methylation was also discussed.ResultsWe identified 29 characterized lncRNAs to produce prognostic risk models. Kaplan-Meier analysis revealed the high-risk group was associated with poor prognosis in LUSC (P<0.001), and ROC (AUC =0.658) and DCA suggested that risk models could predict prognosis. Univariate and multifactorial Cox as well as nomogram further validated the prognostic model (P<0.001). Gene set enrichment analysis (GSEA) showed that the high-risk group was associated with pro-tumor pathways and high-frequency mutations in TP53 were present in both groups. Single sample gene set enrichment analysis (ssGSEA) showed significant differences in immune cell infiltration subtypes and corresponding functions between the two groups. Some immune checkpoint and methylation-related genes were significantly different between the two groups (P<0.05).ConclusionsWe investigated the potential mechanisms of LUSC development from the perspective of ferroptosis-related lncRNAs, providing new insights into LUSC research, and identified 29 lncRNAs as biomarkers to predict the prognosis of LUSC patients.