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Lindsay Amann,1 Elizabeth Kruse,1 Allison J Lazard,2,3 Beth A Reboussin,4 Kimberly G Wagoner,5 E Alfonso Romero-Sandoval1 1Department of Anesthesiology, Pain Mechanisms Laboratory; Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA; 2Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, 27514, USA; 3Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel HIll, NC, 27599, USA; 4Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA; 5Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USACorrespondence: E Alfonso Romero-Sandoval, Pain Mechanisms Laboratory, Anesthesiology, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA, Tel +1 336-716-2725, Fax +1 336-713-2616, Email earomero.sandoval@gmail.comIntroduction: Cannabidiol (CBD) products are available nearly nationwide in the US and can coexist with medical or recreational programs. North Carolina (NC) is an example of a state with a program dedicated to integrating hemp cultivation and medicinal CBD exclusively, containing a multitude of retailers selling it as a primary product. The Food and Drug Administration (FDA) mandates that non-FDA approved CBD products cannot be marketed using medical or health-related claims and has sent warning letters to retailers violating these terms. We aim to characterize the online content of the NC CBD market by analyzing retailers’ websites to determine whether hemp/CBD shops comply with FDA regulations in terms of medical claims and analyze the claimed CBD content and price of products offered online.Methods: We randomly selected three CBD retailers from the ten most populated cities of NC. We analyzed their website content: product type, medical claims, other disclaimers, price, and CBD content.Results: We found that edible, oral, inhalable, and topical products are offered in similar proportions. Word analysis of product description revealed that “pain” and “pain relief” were the most common medical claim, followed by inflammation and anxiety. Health claims were mostly related to wellbeing. Other attributes indicate that products are associated with pleasant flavors or sensations (ie, cool, lavender, delicious, honey, menthol), which resembles the strategies used for tobacco advertisement. Most products (61%) claimed to contain less than 1000 mg of CBD. The median price of products ranged from $15– 30 per 300 mg. We found a positive correlation between CBD content and price.Discussion: Our data demonstrate that the NC online CBD market does not comply with FDA regulations, primarily targets patients with pain, inflammation, or anxiety, and offers products with low CBD concentration and high prices. New policies should limit the access and online promotion of non-pharmaceutical grade CBD products.Keywords: cannabidiol, hemp, medical marijuana, dispensary, cannabis market, misleading claims

We present a regionalized model of ocean tidal loading effects for the Argentine-German Geodetic Observatory in La Plata. It provides the amplitudes and phases of gravity variations and vertical deformation for nine tidal constituents to be applied as corrections to the observatory’s future geodetic observation data. This model combines a global ocean tide model with a model of the tides in the Río de la Plata estuary. A comparison with conventional predictions based only on the global ocean tide model reveals the importance of the incorporation of the regional tide model. Tidal loading at the observatory is dominated by the tides in the Atlantic Ocean. An additional contribution of local tidal loading in channels and groundwater is examined. The magnitude of the tidal loading is also reviewed in the context of the effects of solid earth tides, atmospheric loading and non-tidal loads.

Limited access to radiotherapy (RT) training in low- and middle-income countries (LMICs) hinders workforce growth and beneficial technology adoption. To this end, a virtual SBRT/SRS curriculum designed for RT professionals in Latin American LMICs was developed by a non-profit organization based in U.S. We report outcomes of large-scale, flexible participation. The program was announced through email and WhatsApp across Latin America, targeting centers with compatible technology to implement and master high-quality SBRT/SRS. Enrollment was free, open for 1 month, and allowed two types of participation: synchronous or asynchronous. Training was provided in Spanish with 15-weekly live, interactive video lectures for the participants in the synchronous cohort. Videos were recorded each week for the asynchronous cohort. The 4-month curriculum focused on simulation and registration of intracranial and extracranial sites, plan evaluation and optimization, site specific learning cases, quality assurance, and image-guided RT. Before the program and then again upon completion, synchronous participants self-evaluated confidence across 10 domains related to SBRT/SRS implementation and treatment on a 1-5 Likert scale and completed a knowledge-based 20-question multiple choice exam. Scores were analyzed using paired-t test. All participants were asked to describe their use of SBRT/SRS across brain, spine, prostate, lung, liver, and pancreas disease sites before vs. now within a 3-week window of the final training session. This cohort included 1,551 participants (1,128 synchronous; 418 asynchronous; 5 uncategorized) from 520 clinics in 24 countries. These comprised 678 (43.7%) radiation oncologists, 746 (48.1%) medical physicists, 92 (5.9%) radiation therapists, and 35 (2.3%) other professionals. Among synchronous participants, 799 (70.8%) provided paired responses after attending a mean 11.7 out of 15 sessions. Mean confidence across all SBRT/SRS domains increased from 2.95 to 3.61 (p < 0.01), and knowledge scores of SBRT/SRS increased from 45.1% to 52.7% (p < 0.01). From the beginning to the end of the course, the number of participants who said they were vs. are now not using, implementing, or already using SBRT/SRS changed significantly from 1884 to 993, 1132 to 1836, and 1667 to 1848, respectively. The shift to increased implementation and utilization held for both synchronous and asynchronous participants and was observed across all disease sites. This program, tailored to LMICs, saw substantial longitudinal participation and improved knowledge/implementation of SBRT/SRS. This is the first report of outcomes comparing virtual synchronous and asynchronous methods of participation. With participants selecting their preferred option, both methods appeared feasible and effective. Given the potential and position of e-learning, further research on e-learning outcomes for RT professionals in LMICs is warranted. [ABSTRACT FROM AUTHOR]

A comment on a study coonducted on the lateral settlement of Parshall fumes is presented. Criticisms and suggestions include the use of mean crest elevation of the flume and discharge corrections as factors to be explored. Another method for estimating flows from a tilted flume is averaging staff gagereadings.

European countries have adopted a multidisciplinary approach to ensure the prevention of violent extremism (PVE) and radicalisation related to social work, which has led to concerns that social workers are engaged in the surveillance of client groups. Our proposal is that social workers need to be involved in the PVE debate and determine ways to work within the PVE. As categorisation and labels impact the individuals being categorised and may even change them, the adoption of an approach motivated by curiosity based on the ‘typology’ of clients is suggested. Social workers should carry out a sensitive balancing act in cooperation with the police by explaining their roles and tasks to clients and clarifying confidentiality regulations. This has the potential to ensure that visiting clients in need of social workers’ services will remain open to engaging with such services. However, the execution of this approach is dependent upon social workers’ ability to be aware of and reflect upon the security dimensions that PVE entails. Thus, recommendations were formulated for the development of an approach centred on curiosity and client-centred practice. Adherence to these recommendations could help social workers communicate their true intent and remove any confusion, for the benefit of both themselves and their clients, regarding misconceptions of surveillance and policing.

The variability in dynamics and salinity of the coastal alluvial aquifer on which the city of Lisbon is located was evaluated. The evaluation was based on the analysis of level and groundwater electrical conductivity fluctuations depending on the tide in the Tagus River. The results obtained made it possible to recognize three sectors. First, a littoral sector where the variations in level and salinity are larger on the coast and decrease towards the innermost sections of the alluvial fan. Second, a sector close to the docks where there is greater dynamic and salinity variability than in the coastal sectors, as the excavations of the docks favour the tidal propagation towards the aquifer. And third, a sector located towards the apex of the alluvial fan associated with the dynamics of the stormwater channel. In this sector, the largest periodical water table fluctuations in the aquifer occur, since the freshwater that cannot drain towards the river enters the aquifer at high tide, causing a slight decrease in salinity content. On the basis of these results, conceptual models of hydrogeological behaviour were used to describe the spatial and temporal variations in the hydrodynamic and salinity characteristics of groundwater. [ABSTRACT FROM AUTHOR]

Copyright of Der Gastroenterologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the Ajó coastal plain, which occurs in the south of the Samborombón Bay, Argentina, certain sectors of the wetland are influenced by the tidal flow, whereas others are not. In the tidally restricted Ajó wetlands, the evapotranspiration process is one of the most important components of the water balance due to fact that the flat morphology and low soil permeability make the flow of surface and groundwater difficult. Although evaporation is an important component of evapotranspiration, a quantitative estimation of this process is still lacking or poorly known. In this work, we quantify the evaporation term in the tidally restricted wetlands by applying isotopic modelling and assessing the hydrological response of the wetland by means of other methodologies, such as satellite imaging and level measurements. The results show that during deficit periods, the total evaporation ranges between 10 and 33 % of the local precipitation. In groundwater samples, it fluctuates between 2 and 13 %, whereas in surface water it varies between 8 and 20 %. Analyses of the water budget, satellite images and water level time series provide evidence on how evaporation processes regulate the hydrology of the wetland. The water balance suggests the occurrence of a deficit period, in which the satellite images show a reduction of the waterlogged areas and lakes, and a lowering in surface and groundwater level is recorded. [ABSTRACT FROM AUTHOR]

We report on the hydrologic and morphologic setting of the Samborombon Bay, Argentina, which is expected at the end of the 21st century as a consequence of possible scenarios of relative sea level rise (RSLR). The geomorphological analysis of the Samborombon coastland points out only minor changes occurred over the last 40 yr. The modifications are mainly related to the construction of canals to enhance the floodplain drainage. A digital elevation model (DEM) obtained by the Shuttle Radar Topography Mission (SRTM) data archive, ad hoc calibrated/validated for the study area, highlights that about 3000 km² of coastal plain present a morphological setting at high risk of sea flooding. The analysis of sea level and storm surge events recorded from 1905 to 2010 in Buenos Aires provides the RSLR rate and the return period of extreme floods. In addition, vertical land movements (VLM) measured by the permanent GPS stations of Buenos Aires and La Plata allow for the quantification of the eustatic component of the RSLR and estimating a plausible RSLR rate in the Samborombon Bay. Taking into account possible RSLR scenarios at the end of 2100 as resulting from the statistical analysis of (i) tide gauge and GPS time series and (ii) Intergovernmental Panel on Climate Change (IPCC) predictions, the potential effect of the increased sea level on the Samborombon coastland is simulated. The results show that the combined rise of sea levels, surficial waters and groundwater will lead to a new morpho-hydrologic setting of the coastal area, especially in the low-lying southern sector. Here, a coastline retreat up to 40 km is expected, with temporary submersion up to 4000 km² during storm surges. [ABSTRACT FROM AUTHOR]

Summary: The objective of this case–control study was to investigate the source of contamination and risk factors for colonisation and infection during an outbreak of extended-spectrum β-lactamase (ESBL)-producing Enterobacter cloacae in the University Medical Center Freiburg. A risk factor analysis was performed on 23 patients with ESBL-producing E. cloacae in the medical and surgical departments by comparing them with 46 non-colonised controls, who were matched for ward and length of hospital stay. For these, a risk factor analysis was conducted. Suspected sources for transmission of ESBL were examined and staff received training in infection control measures. The higher risk in colonised patients was attributed to dialysis with mobile units [odds ratio (OR): 4.00; 95% confidence interval (CI): 1.05–15.234; P =0.04]. Dialysis units were examined, but no contamination was found. Improvement in dialysis procedures, additional staff training and renewed training in standard precautions led to a substantial fall in case numbers. Risk factor analysis showed that colonised patients carried more invasive devices than controls (central venous catheter: OR: 2.50; 95% CI: 0.74–8.45; P =0.14; Foley catheter: 5.08; 0.61–42.23; P =0.13) and were given a greater number of different antibiotics (penicillins: 2.52; 0.71–8.89; P =0.15; fluoroquinolones: 2.37; 0.77–7.28; P =0.13). The differences in mobile dialysis frequency and antibiotic use between cases and controls were relevant, although the latter was not statistically significant. It was possible to contain the high frequency of ESBL colonisation or infection by reinforcing infection control measures and training the staff involved. [Copyright &y& Elsevier]

Background: Despite a paucity of evidence-based guidelines, the use of PET/CT (positron emission tomography/computed tomography) in the management of cancer patients is increasing. As widespread clinical application increases, unexpected radiographic findings are occasionally identified. These incidental findings are often suspicious for a second primary malignancy. The purpose of this study was to determine the clinical impact of these incidental PET/CT findings. Methods: A query of our prospectively acquired Nuclear Medicine database was performed to identify patients with a known malignancy being staged or serially imaged with PET/CT. Patients with incidental findings suggestive of a second primary malignancy were selected. Statistical analysis was performed to determine the ability of PET/CT to identify a second primary malignancy. All PET/CT were interpreted by board certified nuclear radiologists. Results: Of 3,814 PET/CT scans performed on 2,219 cancer patients at our institution from January 1, 2005, to December 29, 2008, 272 patients (12% of all patients) had findings concerning for a second primary malignancy. An invasive work-up was performed on 49% (133/272) of these patients, while 15% (40/272) had no further evaluation due to an advanced primary malignancy. The remaining 36% (99/272) had no further evaluation secondary to a low clinical suspicion determined by the treating team, a clinical plan of observation, or patients lost to follow-up. Of the 133 patients evaluated further, clinicians identified a second primary malignancy in 41 patients (31%), benign disease in 62 patients (47%), and metastatic disease from their known malignancy in 30 patients (23%). The most common sites for a proven second primary malignancy were: lung (N = 10), breast (N = 7), and colon (N = 5). Investigation of these lesions was performed using several techniques, including 24 endoscopies (6 malignant). A surgical procedure was performed in 74 patients (29 malignant), and a percutaneous biopsy was performed on 34 patients (12 malignant). The overall positive predictive value for PET/CT to detect a second primary malignancy was 31% in this subgroup. At a median follow-up of 22 months, 9 of 41 patients with a second primary were dead of a malignancy, 20 were alive with disease, and 12 had no evidence of disease. Conclusion: Incidental PET/CT findings consistent with a second primary are occasionally encountered in cancer patients. In our data, approximately half of these findings were benign, a third were consistent with a second primary malignancy or a metastatic focus, and the remainder were never evaluated due to physician and patient decision. Advanced primary tumors are unlikely to be impacted by a second primary tumor suggesting that this subset of patients will not benefit from further investigation. Our data suggests that, despite the high rate of false positivity, incidental PET/CT findings should be investigated when the results will impact treatment algorithms. The timing and route of investigation should be dictated by clinical judgment and the status of the primary tumor. Further investigation will need to be performed to determine the long-term clinical impact of incidentally identified second primary malignancies. [Copyright &y& Elsevier]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)