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Background: More than 60 types of cannabinoids are found in nature; the remaining are chemically synthesized analogs of natural cannabinoids. Synthetic cannabinoids were first reported in the United States in 2008. These compounds are usually smoked by users and are sold under various names. Synthesized products have clinical effects that are similar to the effects of cannabis, which include tachycardia, conjunctival injection, nystagmus, vomiting, and ataxia. In cases of acute overdose, hyperthermia, acute kidney injury, seizures, and rhabdomyolysis can occur.Case Report: Deaths and life-threatening coagulopathies caused by brodifacoum (BDF) adulteration of synthetic cannabinoids have been reported in Illinois and other regions of the United States. BDF is a long-acting vitamin K-dependent antagonist that is often used as rat poison and that can cause massive hemorrhage. BDF is sometimes referred to as "superwarfarin" because the anticoagulant effect is 100 times greater than warfarin on a molar basis and its half-life is 20-130 days, which markedly exceeds that of warfarin. The rationale for lacing synthetic cannabinoids with BDF may be associated with attempts to enhance psychoactive effect of the drug, keeping the user high for a longer period of time because of lipid storage, hepatic metabolism, and slow release. We present the case of a healthy 27-year-old man who developed severe soft tissue hemorrhage and airway obstruction after use of a cannabinoid laced with BDF. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: To date there have been no case reports documenting severe soft tissue hemorrhage leading to airway obstruction and respiratory failure from synthetic cannabinoid use, whether or not the synthetic cannabinoid has been adulterated. Severe complications can arise from use, and treatment includes vitamin K and supportive therapy because the resulting coagulopathy can take days to weeks to resolve. [ABSTRACT FROM AUTHOR]

Stand-replacing wildfires are a novel disturbance within ponderosa pine ( Pinus ponderosa) forests of the southwestern United States, and they can convert forests to grasslands or shrublands for decades. While most research shows that soil inorganic N pools and fluxes return to pre-fire levels within a few years, we wondered if vegetation conversion (ponderosa pine to bunchgrass) following stand-replacing fires might be accompanied by a long-term shift in N cycling processes. Using a 34-year stand-replacing wildfire chronosequence with paired, adjacent unburned patches, we examined the long-term dynamics of net and gross nitrogen (N) transformations. We hypothesized that N availability in burned patches would become more similar to those in unburned patches over time after fire as these areas become re-vegetated. Burned patches had higher net and gross nitrification rates than unburned patches ( P < 0.01 for both), and nitrification accounted for a greater proportion of N mineralization in burned patches for both net ( P < 0.01) and gross ( P < 0.04) N transformation measurements. However, trends with time-after-fire were not observed for any other variables. Our findings contrast with previous work, which suggested that high nitrification rates are a short-term response to disturbance. Furthermore, high nitrification rates at our site were not simply correlated with the presence of herbaceous vegetation. Instead, we suggest that stand-replacing wildfire triggers a shift in N cycling that is maintained for at least three decades by various factors, including a shift from a woody to an herbaceous ecosystem and the presence of fire-deposited charcoal. [ABSTRACT FROM AUTHOR]

May for-profit, secular corporations claim the protection of the Religious Freedom Restoration Act (RFRA)? This question is central to numerous lawsuits against the federal government in which business owners argue that certain regulations under the Patient Protection & Affordable Care Act substantially burden the exercise of their religion. This Note examines the threshold hurdle that for-profit business owners must clear to successfully state a claim under RFRA: the question of whether the businesses are "persons" the statute protects. This is an issue of first impression for the U.S. Supreme Court, and it has split the circuit courts of appeal. First, this Note provides an overview of free exercise jurisprudence, with a focus on the ebbs and flows of the Supreme Court's exemption doctrine. This overview includes a discussion of the Religious Freedom Restoration Act and the laws, regulations, and religious objections that form the basis of the current disputes. Second, this Note introduces the conflict among circuit courts and their varying interpretations of whether for-profit corporations are "persons" under RFRA. Third, this Note assesses this conflict by examining RFRA's text and the context in which Congress enacted the statute. Nothing within this context precludes corporations from stating RFRA claims. In addition, this Note examines legislative history that supports application of the Dictionary Act, which explains that the word "person" in federal statutes includes corporations. This Note ultimately concludes that RFRA does indeed grant corporations the ability to seek exemptions, but that the statute will require courts to undertake the task of ascertaining the proper contours of the law as applied to different corporate forms. [ABSTRACT FROM AUTHOR]

Tree plantations represent an important component of the global carbon (C) cycle and are expected to increase in prevalence during the 21st century. We examined how silvicultural approaches that optimize economic returns in loblolly pine (Pinus taeda L.) plantations affected the accumulation of C in pools of vegetation, detritus, and mineral soil up to 100 cm across the loblolly pine's natural range in the southeastern United States. Comparisons of silvicultural treatments included competing vegetation or 'weed' control, fertilization, thinning, and varying intensities of silvicultural treatment for 106 experimental plantations and 322 plots. The average age of the sampled plantations was 17 years, and the C stored in vegetation (pine and understory) averaged 82.1 ± 3.0 (±std. error) Mg C ha−1, and 14.3 ± 0.6 Mg C ha−1 in detrital pools (soil organic layers, coarse-woody debris, and soil detritus). Mineral soil C (0–100 cm) averaged 79.8 ± 4.6 Mg C ha−1 across sites. For management effects, thinning reduced vegetation by 35.5 ± 1.2 Mg C ha−1 for all treatment combinations. Weed control and fertilization increased vegetation between 2.3 and 5.7 Mg C ha−1 across treatment combinations, with high intensity silvicultural applications producing greater vegetation C than low intensity (increase of 21.4 ± 1.7 Mg C ha−1). Detrital C pools were negatively affected by thinning where either fertilization or weed control were also applied, and were increased with management intensity. Mineral soil C did not respond to any silvicultural treatments. From these data, we constructed regression models that summarized the C accumulation in detritus and detritus + vegetation in response to independent variables commonly monitored by plantation managers (site index (SI), trees per hectare (TPH) and plantation age (AGE)). The C stored in detritus and vegetation increased on average with AGE and both models included SI and TPH. The detritus model explained less variance (adj. R2 = 0.29) than the detritus + vegetation model (adj. R2 = 0.87). A general recommendation for managers looking to maximize C storage would be to maintain a high TPH and increase SI, with SI manipulation having a greater relative effect. From the model, we predict that a plantation managed to achieve the average upper third SI (26.8) within our observations, and planted at 1500 TPH, could accumulate ~85 Mg C ha−1 by 12 years of age in detritus and vegetation, an amount greater than the region's average mineral soil C pool. Notably, SI can be increased using both genetic and silviculture technologies. [ABSTRACT FROM AUTHOR]

Objectives. States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states' generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects. Methods. We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier. Results. State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p < .001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 or older would reduce the risk of nursing home admission among childless seniors by 35%. Discussion. Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost effectiveness. [ABSTRACT FROM AUTHOR]