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Ingestion and inhalation were the most common routes of exposure

Surveys conducted in April 2020 found that Canadian adolescents aged 14 to 18 years increased their alcohol and cannabis use, and had increased feelings of depression and fear, which are associated with solitary substance use. To our knowledge, no study has examined changes in cannabis exposures in California since recreational legalization in November 2016, the institution of a recreational retail sales market in January 2018, or after the March 2020 statewide shelter-in-place orders intended to reduce the risk of exposure to COVID-19. Past research assessing unintended consequences of cannabis legalizations notes that existing studies are not generalizable to all populations and states; this is particularly relevant for California, which by itself constitutes the world’s largest cannabis market. Previous studies of cannabis exposures were completed before the COVID-19 pandemic and failed to capture exposure rates under pandemic conditions. Since Colorado first legalized recreational cannabis use in 2012, other states have followed and also implemented legalization of recreational cannabis. In this study we reviewed cannabis exposures in California, before and after legalization of recreational cannabis use, after the establishment of recreational retail sales, and during the first nine months of the COVID-19 global pandemic. We also classified product exposures by type to assess which might be associated with exposures among children, in light of popular media reports that have identified group overdoses among children involving cannabis gummies.CPCS serves California’s population of 40 million people, making it the largest poison control provider in the United States. We obtained reports of cannabis exposures from CPCS from January 1, 2010 to December 31, 2020. Inclusion criteria were human exposures to cannabis and cannabis containing products reported within California. Cases were identified by searching the CPCS database for American Association of Poison Control Centers codes relating to cannabis. We excluded calls from outside California.Exposures were defined as an “actual or suspected contact with any substance which has been ingested, inhaled, absorbed, applied to, or injected into the body, regardless of toxicity or clinical manifestation.”Case records were individually reviewed by one of four raters to verify that exposures were actually related to cannabis, to separate human from animal exposure calls, to validate the call involved an exposure rather than a request for information, to check whether exposures involved a single substance or multiple substances, and to detail the nature of the product involved in each exposure given that poison control centers until recently did not classify cannabis exposures beyond “marijuana” and route of exposure .

Records with unclear classifications were reviewed with three other authors . CPCS records were collected and managed using RED Cap, a secure, web-based software platform designed to collect and manage study data.CPCS coded 12,108 exposures from January 2010 to December 2020 as cannabis; 1,351 of these exposures did not meet inclusion criteria, as they were miscoded,trim trays involved animals, were calls from outside California, or were requests for information. Of the remaining 10,757 exposures, 20 percent involved someone under the age of six, 6 percent someone between the ages of six and twelve, 24 percent someone between the ages of thirteen and nineteen, and 50 percent an adult . Forty-four percent of exposures were female, and 56 percent were male. Additionally, 79 percent of the exposures involved ingestion, 18 percent involved inhalation, and 3 percent other routes including topical, rectal, parenteral, subcutaneous, or ophthalmic, as shown in Table 1. Although the total population of California grew by an estimated 6.1% from 2010 to 2020, with an increase of 22.5% in those under the age of 18 and a 6% increase in those under 5 years of age; calls to CPCS related to cannabis more than tripled over the same period. The number of cannabis exposure calls in proportion of all incoming calls is described in Table 2. Among children under the age of six years, 2,130 calls were assigned a code indicating the reason for exposure, of these, 2,107 were coded as unintentional exposures, zero as intentional, and the remaining 23 were coded as other . Among children aged six to 12 years, 625 calls were assigned a reason code, and of these 504 were coded as unintentional, 84 as intentional, and the remaining 38 as other. Our interrupted time series analysis first considered overall changes in exposures after legalization of use, initiation of retail sales, and after the COVID-19 shelter-in-place order. As noted in methods, ITSA coefficients represent estimated monthly increases or decreases in reported exposures after an intervention. Following recreational legalization in 2016, estimated monthly cannabis exposures increased significantly . Following the implementation of retail sales in 2018, cannabis exposures increased significantly as well . However, no significant change in cannabis exposures was observed following the shelter-in-place order. A graph of exposures over time is provided in Figure 1; detailed estimates are provided in Table 3. We continued by comparing changes in exposures for two age groups: those under thirteen years old and those thirteen years and older. Age is provided in CPCS records and this categorization follows AAPCC convention; exposures without information on age were excluded. Cannabis exposures in those under thirteen increased significantly both after recreational legalization and after the opening of the retail sales market , but not following the shelter-in-place order .

For those thirteen and older, there was no significant change over time. As a result, although exposures in children under thirteen were the minority in January 2010, by December 2020 they represented nearly half of all exposures, as shown in Figure 2. To assess possible changes in exposures by product type, we organized ingestion exposures by product type and grouped these into categories. We identified significant increases over in the number of exposures for gummies , candies , chocolate , dabs , edibles in the form of drinks , hemp, joints , blunts , cannabis oils , vapes , other edible products , and all other products between 2010 and 2020. However, there was no change in the trend of exposures for cookies, brownies, other edible baked goods, hash, plant products, or synthetic products. We aggregated these categories into nine broad product types: chocolate and candy, other edibles and drinks, gummies, brownies, cookies, and other baked goods, new technology , traditional products , oils, hemp products, and synthetics, then graphed exposures . Chocolate and candy, other edibles and drinks, and gummies increased from levels near zero prior to recreational legalization to thousands of exposures per year by 2020. For example, there were only 16 total reported gummies exposures in the six years between 2010 and 2015; these increased to 409 exposures in 2020 alone.We analyzed trends in cannabis exposures reported to the CPCS before and after the legalization of recreational cannabis in November 2016, the establishment of recreational retail sales in January 2018, and the institution of a statewide shelter-in-place order due to the COVID-19 pandemic in March 2020 and found that as expected, exposures increased following recreational legalization and the establishment of retail sales, consistent with previous studies. However despite expectations we did not find a significant change in cannabis consumption following the COVID-19 shelter-inplace order. This finding may reflect that only nine months of exposure cases following March 2020 were available at the time of this study. We also found that cannabis exposures in children under thirteen increased significantly following recreational legalization and initiation of retail sales but did not increase for teens and adults. As a result, although cannabis exposures were uncommon among young children in 2010, by 2020 they constituted nearly half of all exposures.Cannabis edibles such as gummies, candy, and other dessert-like products have been involved with increased use in younger users. Our detailed records review found that a common exposure after 2018 involved a child or group of children finding cannabis edibles that they perceived to be normal candy and consuming an entire package.

Particularly among the youngest children the primary reason for exposure was accidental ingestion, in which children or their caregivers mistakenly identified cannabis gummies as ordinary candy. Cases in which cannabis gummies and other edibles are mistaken for non-cannabis products may result from issues with packaging. Although California regulates the potency of cannabis edibles and requires opaque, resealable packaging, each edible can contain up to 10 mg of THC and each package up to 100 mg of THC; as a result, even a single gummy represents a high dosage for a naïve user,trimming trays particularly a child. By comparison, edible regulations in Canada, for example, place a limit of 10 mg of THC per package, even if it the package contains multiple edibles, as well as requiring plain packaging and larger warning labels. As a result, a child who accidently consumed an entire bag of cannabis gummies in Canada would likely be exposed to the same level of THC as one who consumed a single gummy in California. We note that Canadian regulations on packaging were instituted in 2020, so there is limited data to assess potential changes in pediatric exposures after this policy change. However, given reported confusion among both children and caregivers about whether candy products contain cannabis, instituting similar regulations such as plain packaging and lower doses per edible, or expanding on them by requiring individual packaging, offer potential for reducing the high levels of exposures among children. Our study has limitations. The data were drawn from a single state, limiting potential generalizability; however, California’s status as the most populous with the largest cannabis market allows us to assess trends that would not be possible in smaller areas. Moreover, the more granular data provided by CPCS made it possible to classify product types; these data are not available at the national level. Using poison control data only captures data volunteered by patients and providers and these may not capture general patterns of use. In addition, although CPCS seeks to create a case report linked to individuals rather than to group exposures, in some cases, multiple exposures were reported in a single record . As a result, these findings are likely to be underestimates of actual exposures.

Our classification of product types was limited by reporters, who may use a range of terms to describe cannabis products ; as a result, we were unable to categorize all exposures and may have failed to identify additional products associated with exposures. Finally, given that the study was observational in nature, we could only identify associations between cannabis exposures and policy interventions rather than establishing causality. Despite these limitations, the absence of other contemporaneous factors expected to increase exposures, as well as the consistency of these findings with prior research, suggest that recreational legalization and sales were associated with significant increases in exposures, particularly among children.Cannabis is the most commonly used illicit psychoactive substance in developed nations . While a majority of cannabis users do not report problems, 10–30% of those who ever use cannabis meet criteria for a lifetime history of cannabis abuse or dependence as defined by the fourth edition of the Diagnostic and Statistical Manual . Recently, changes to the diagnostic criteria for substance use disorder have been made in DSM-5 , including several for the diagnosis of cannabis use disorders . Across the broad range of substance use disorders,the distinction between abuse and dependence has been replaced by a unidimensional symptom count, with endorsement of 2 or more symptoms resulting in a DSM-5 diagnosis of substance use disorder ; the DSM-IV criterion of legal problems has been eliminated from the diagnostic repertoire; and a new criterion for the DSM-5, craving has been added. More specifically for cannabis, withdrawal is now a criterion. A wealth of psychometric evaluations in epidemiological and clinical samples support these recommendations; however, the impact of these revisions on the prevalence of cannabis use disorders under the new DSM-5 classification remains largely unexplored. A recent study of Australian adults found a modest reduction in the rate of cannabis use disorder with the transition from DSM-IV to DSM-5 , while another study of individuals with substance use disorders note damodest increase of 4% . Twin studies indicate that 50–60% of the variation in cannabis use disorders can be attributed to heritable influences.Despite this robust heritability estimate, association studies for cannabis use disorders have largely failed to identify genetic variants of significant and replicable effect.

The loss of energy is found out on the reading obtained from the impact testing machine

The raw banana and hemp fibers used in for fabrication of composite laminates are presented in Fig.1 and Fig.2.The fabricated composite laminates are given Fig.3 and Fig.4.The tensile test specimens are prepared and testing of the composite laminates are carried out as per ASTM D638 standards and procedures.There are three specimen are used from each laminates for testing tensile behavior of hybrid laminates.The test has been carried out on the universal testing machine,by means of applying load on the specimen until its get failure and the results are observed.These methodologies are followed for remaining specimen in the same composite laminate and other laminate specimens to get the mean tensile strength and corresponding stresses for the comparison of results.The tensile test specimen before and after fracture of bananahemp-glass fibers reinforced epoxy composites are presented in Fig.5 and Fig.6.The use of natural and manmade fibers reinforced hybrid composite materials are growing day by day due to its characteristics like eco-friendly,recyclable,bio-degradable and user friendly in nature.Many researchers are working in this field to make the composites hybrid and to replace metals and alloy materials in the field of engineering and technology without affecting the load carrying capabilities and cost aspects.In the present experimental study,the banana and hemp fibers are hybridized with glass fiber and prepared hybrid composite laminates.Then the test specimen are prepared from the composite laminates as per ASTM standards and testing of materials has been carried out under tensile,pot for growing marijuana flexural and impact loading conditions by using universal testing machine and impact testing machine.The experimental results on mechanical properties of the tested composite specimen are observed and presented in Table.2.

The composite samples are tested in the universal testing machine and the typical force vs.stroke curve generated directly from the machine during tensile loading for the hybrid composites is presented in Fig.11.The tensile strength comparison of different hybrid composites is presented in Fig.12.From the figure it can be observed that the banana-glass fiber reinforced composites are performing better than the other composites tested which can withstand the tensile strength of 39.5MPa followed by hemp-glass fiber reinforced composites can hold the strength of 37.5MPa.The flexural properties of the hybrid composite samples are tested and the experimental values are presented in Table.2.The force vs.stroke curve generated directly from the machine during flexural loading for the hybrid composites is presented in Fig.13.The flexural strength comparison of different hybrid composites is presented in Fig.14.From the figure,it is asserted that the flexural load carrying capacity of banana-hemp-glass fiber reinforced composites is better than banana-glass fiber reinforced composites and hemp-glass fiber reinforced composites.The impact test is carried out for evaluating the impact load carrying capability of the different hybrid composite specimens and the charpy impact test is used in the present investigation.The impact strength comparison of different hybrid composite samples is presented in Fig.15.The results indicated that the maximum impact strength is obtained for banana hemp-glass fibers reinforced hybrid composites which hold the impact strength of 8.66Joules.The banana-glass fiber reinforced composites and hemp-glass fiber reinforces composites are performing in the same level can withstand the impact strength of 5.33Joules.The failure morphology of the hybrid composite samples tested in the present experiment is examined through scanning electron microscopy analysis.The SEM micro-graphs of the hybrid composite samples subjected to tensile loading are presented in Fig.16.

From the images,it can be seen that the fracture of the fiber and matrix due to the applied tensile load.The SEM micro-graphs of the hybrid composite samples subjected to flexural loading are presented in Fig.17 and the samples subjected to the impact loading are presented in Fig.18.The fiber breakage and fiber pull out due to flexural loading are clearly in observed in Fig.17.Fig.18 indicated that the fractured edges of the fibers in the specimen and also the dislocation of fibers due to impact loading.The permanent growing of the world population within the next two to three decades by round about 2.5 billion will result in an additional demand for food of 43 % and for textile fibers of more than 80 %.In contrast to the increasing demand arable land is more and more limited and the cropland area per capita will shrink.This situation will result not only in a food crisis,but also in a “cellulose gap” because cotton production is predicted to be stagnant in the future and the history of man-made fibers shows that approximately one third of all textile fibers have to be cellulosic fibers because of particular properties like absorbency and moisture management.The outcome of this is a disproportionately high demand for man-made cellulosic fibers in the coming years and for dissolving pulp,the most used raw material for fibers manufacturing,too.Dissolving pulps are usually manufactured from several kind of hard or soft wood by an intensive material and energy consuming cooking procedure,which is required for separation of pulp fibers,hemicelluloses and lignin.For those reasons an increase of pulp production will require a lot of time for growth of the trees and money for erection and implementation of new pulp mills.In contrast,pulp raw material based on annual plants like bast fibers offers the options to increase much more quickly the available pulp volume,because of the faster rate of crop growth and lower energy consumption for degumming and fiber separation.Nevertheless,new process steps for pulp purification are required.

Furthermore,pulp quality will have to be adapted to the intended fiber manufacturing and processing line.Here new approaches are needed and have to be developed by the R&D activities.For that purpose a project consortium was installed,consisting of partners from organic farming,agricultural machine development,pulp and fiber manufacturing and fiber and fabrics processing.Moreover,as present in figure 1 it was the target of the team to develop an integrated process chain for the manufacturing of innovative fabrics produced of man-made Lyocell type fibers made of dissolving pulp based on OG hemp.Bast fiber material almost free of wooden shives and dried HBS was delivered by Bast & Faser GmbH and was used as delivered.Dried HBS and mechanical pre-processed hemp fiber tow were typically treated by aqueous caustic soda at 160 °C for about one hour.A mixture of caustic soda and surface active additives was applied as cooking liquor.Reduction of Kappa number was used for process time and DP adjustment.Alternative,a fiber bleaching sequence could be applied for adjustment of cellulose pulp DP at 450 up to 700 using subsequently hydrogen peroxide and sodium hypochlorite at 55 °C for 120 minutes,each.Within of pulping procedures suitable sequestrants were added for elutriation of high metal ion contents.The resulting pulp was finally dried to a solid content of 80 % and was used without any further treatment for dope preparation.For dope preparation about 15 % of delivered pulp was redispersed in 85 % aqueous dissolution of NMMO comprising about 20 % of water and transferred into a discontinuous laboratory scaled stirring and kneading reactor.The pulp was dissolved by evaporation of excess water as well as elevated temperatures of 100 °C,decreased pressure of in minimum and a rotational speed of 20 rpm.At the moment when excess water was fully evaporated and a mixture of one mole of water per mole of NMMO was achieved the pulp dissolved immediately and a transparent,brownish,viscous spinning dope was generated.The shearing was continued another 20 minutes at 10 rpm for dope homogenization.Within the project activities the major part of HBS should be converted into dissolving pulp suitable for solution spinning of cellulose man-made fibers.For that purpose a feasibility study was ordered as subcontract from OP Papirna s.r.o.,Olšany,Czech Republic.Because bast fibers commonly offer higher alpha cellulose content,it is not so difficult to adjust required pulp purities of more than 92 % alpha-cellulose content.

But for an application in solution spinning the primary DP of hemp is too high and should be reduced either by a pulp cooking or a pulp bleaching process.At first both approaches were pre-tested in laboratory scale using flax fibers.In the end,the conducted cooking trials generally confirmed,container for growing weed that the increase of cooking liqueur concentration and/or of cooking time could acceptably increase polymer degradation down to the intended pulp DP.However,the cooking process lowered the overall pulp yield.Therefore also the adaptation of bleaching sequences was investigated in a second step.Conventional bast fiber pulp bleaching procedures for paper manufacturing use successively hydrogen peroxide,chlorine dioxide.They end up with an extraction sequence at presence of hydrogen peroxide.For the intended DP reduction an additional sequence was required using sodium hypochlorite as bleaching agent.Also this approach worked well,but only the cooking approach should be further investigated in the running project,because of the environmental toxicity of chlorine containing agents.To conclude from figure 5: At lower caustic soda concentration the Kappa number is different in case of hemp tow control from those of HBS because of its higher amount of lignin in contained hurds.Nevertheless,the Kappa numbers of both hemp samples could become equal,if the optimal caustic soda concentration and process duration were chosen.From these results the conclusion could be drawn that the lignin of hurds was also fully separated from hemp tow control at the properly chosen concentration and time.Table 1 summarizes the typical properties found in crude and purified pulp.Another challenge,also arising from high metal salt contents,is the chemical sensivity of the solvent NMethylmorpholine-N-oxide.Especial,the pulp immanent heavy metal complexes based on iron and copper ions,might generate serious solvent decomposition,what could be autocatalytic pushed on by means of addressed ions.For that reason crude pulps were washed with de-ionized water in order to isolate most of the included hazardous metal ions.After washing of the pulp the iron and copper metal ion content decreased down to no longer relevant amounts.Ongoing problems arise from the extremely high Ca2+ and Mg2+ ions concentration,even in purified pulp samples.But problems could be solved when cooking was transferred into commercial scale and pulp manufacturing was combined with pulp purification by means of aqueous solution containing suitable sequestrants.

The sequestrants might irreversibly bind the ions by formation of complex compounds,even under caustic and/or oxidative conditions.In the end Ca2+ ion concentration dropped down below 200 and Mg2+ ion concentration was found below 50 ppm.Finally,of cooking process investigation a 5.3 metric ton OG hemp tow sample should be converted into dissolving pulp applying the identified process parameter.Five different cooking batches were performed in commercial scale equipment.Intrinsic viscosity of the produced five pulp samples was in the range of 370 dl/g up to 450 dl/g,what correlates with pulp DP’s of about 500 up to 650,respectively.The accepted iron ion concentration in semi-technical scale was appointed below 10 ppm.Unfortunately the content of iron ion was nearly twice the number.The so-called onset-temperature,that temperature at what thermal induced solvent decomposition occur,has to be measured,if the iron ion content is higher than allowed.In case of dope derived from OG hemp it was determined at the same temperature as of dopes prepared of wooden pulp and was located at higher temperatures than 170 °C.That temperature is high enough to release the prepared pulp for further processing of man-made cellulose fibers.In the last step the pulp was dried to solid content of 80 % and was handed over for further investigation of direct dissolution in NMMO monohydrate.Spinning dopes were manufactured as described in material and method section.After finishing dissolution and homogenization dopes were characterized by daylight microscopy,laser light scattering,particle analysis and rotation/oscillation rheometry.Incomplete pulp dissolution as present in figure 6,what even could be detected by daylight microscopy,might occur whenever fibrous particles are insoluble in case of high molecular cellulose shares or unsuitable pulp is used or solid particles are formed in case of higher amounts of inorganic impurities.Bad solution state as shown in fig.6a could be caused by extreme high Ca2+ and Mg2+ ions concentration.Visible particles are generated by calcium and magnesium salts,which are precipitated at low concentration of excess water in dopes.Because those particles are incompressible danger arises for clogging of spinning holes,if dopes are extruded through the spinneret.Fig.6b demonstrates the effect when OPP Hanf HP pulp is well dissolved and separated from the inorganic contamination at application of sequestrants.Such kind of purified pulp could be easily shaped into cellulose man-made fibers by dry-wet spinning procedure.Adolescence is a unique developmental period characterized by major physiological,psychological,and neurodevelopmental changes.These changes typically coincide with escalation of alcohol and marijuana use,which continues into early adulthood.

Agricultural measures tend to increase the crop yields and to enable a multipurpose exploitation of the crop

With a growing interest in sustainable issues and ecofriendliness,the textile industry is now faced with the challenges of developing eco-friendly textile products with enhanced sustainability.Efforts have been made in the field of wet processing of textile products.However,another equallyimportant aspect of producing more sustainable textile product is to select eco-friendly and low-cost raw materials,as well as to control the textile manufacturing processes in regard to energy and labour savings.An increasing recognition of hemp as more sustainable cellulose fibres has to be accompanied by an improvement in some comfort performances,aesthetics and,last but not least,by cost effectiveness.Apart from the environmental benefits of hemp in comparison to cotton,which is elaborated in the introduction section,the average prices of hemp fibre are 1.0e2.1 US$/kg while the cotton prices are between 2.1 and 4.2 US$/kg.However,the approximate prices for plain hemp textiles range from 5 to 13 US$/kg.In addition to these aspects,modern consumers expect high standard of performance even after a number of care cycles.Low cost and efficient production of synthetic fibres,together with their easy care and shape-retention properties can contribute to hemp based textiles to fulfil these requirements.In this context,acrylic fibres offer some benefits one of which is low specific gravity that allows yarns and fabrics to be made with a high bulk to weight ratio enabling improved softness.Other one is the simple and effective on-line coloration capability of acrylic fibre technology by which any further wet processing for finishing fabrics and garments does not need.This is not only extremely cost-effective,but very environmentally competitive route to market.In addition,avoiding any chemical treatment of hemp based fabrics with softeners to improve the tactile comfort performance is important from both economic and ecological aspects of sustainability.This elaboration,along with the results obtained and references given in the introduction section,clearly indicate that the use of hemp instead of cotton,mobile vertical rack and the use of acrylic to integrate with hemp yarn during knitting offer possibility of improving several sustainability aspects for cellulose based textiles.

However,some efforts are continuously made to achieve the reduction in cost and environmental impact in the range from the crop stage to the hemp product development stage.A new approach to a decrease in the environmental impact involves a reduction in eutrophication in the crop production.In fibre processing step,the research is aimed at improving fibre extraction processes so as to increase fibre quality and reduce labour requirements and price.Attempts have been made to improve hemp yarn production by developing new and more productive equipment and reducing energy costs.The avoidance of additional chemical treatments in this project is extremely important bearing in mind that a large amount of energy,water and chemicals are used for processing,finishing and dyeing of fibres,yarns and fabrics.The current trend towards improving sustainability of these processes goes in a direction of using eco-friendly substances and dyes.The recyclability and degradability of enzymes has stimulated research into their application to hemp fibre processing.Dyeing by natural dyes extracted from various plants,as well as agricultural wastes utilization for dyeing of textile fabrics,have been investigated in recent studies in order to meet the challenges of improving sustainability of production processes.In addition to production technology,new products development is also very important so as to meet market demand.We believe that hemp based textile product developed in our project presents a useful contribution to up to-date hemp textile product range,offering the textile engineers,designers and decision makers in textile companies the way to balance the cellulose based product performance,environmental concerns and costs at the current level of technological development.The utilisation of wood resources for energy production makes up the demand for the development of new technologies in the area of the chemical processing of agricultural residue.

The increasing demand for products derived by the chemical industry also increases the demand for furfural,which is exclusively produced from hemicelluloses-containing biomass.There is no synthetic route available for furfural production in the chemical industry.The production of furfural belongs to environmentally friendly technologies,although it has chemical properties similar to those of petrochemicals.It is used for the production of a wide range of important non-petroleum derived chemicals such as furan,tetrahydrofuran and furfuryl alcohol.It is also used as an extractive,a fungicide,in oil refineries,as well as in the plastics,food,pharmaceutical and agricultural industries.For example,it can be introduced during fibril formation to enhance the thermal and mechanical stability of collagen.At the moment,in the European Union,furfural is an imported products,although potential raw material resources are in a sufficient amount.During hydrothermal pre-treatment,the dehydration of xylose to furfural in water typically proceeds at 150–220 °C,and the reaction rate is small under neutral conditions,increases during autocatalysis by acetic acid,which originates from the biomass,and is accelerated further by the addition of catalysts,especially strong acids such as sulphuric acid or solid acid catalysts such as H-Beta zeolite.The costs and inefficiency of separating these catalysts from the products make their recovery impractical,resulting in large volumes of acid waste,which must be neutralised and disposed of.Other drawbacks include corrosion and safety problems.Al23 as a hydrolysis catalyst has been considered in some publications related to obtaining levulinic acid from biomass,but there are no scientific publications about the use of Al23 in furfural production from lignocellulosic biomass by hydrothermal pre-treatment.Furfural production from hemp shives has not been investigated until now as well,while the high content of hemicelluloses shows that the hemp fibre production byproduct has great potential.Also,this valuable raw material is concentrated in one place at the fibre production manufacturer’s site.The hemp species are an approved and rapidly expanding crop in Latvia,with a yield from 150 ha in 2009 to 1200 ha in 2013.Hemp shives are the woody inner part of the hemp stalk separated from the fibres,making up to 75 % of the oven dry stalk.

The chemical components of the hemp variety “Bialobrzeskie” shives used for experiments testify that the material also has the potential for the production of composites.Up until now,however,the main utilisation of hemp as a crop has been for its bast fibres.To utilise the leftover lignocellulose after obtaining furfural,binder-less panels could be made without the use of any additional adhesives during the panels’ production process.The panels made from the shives after the catalysed pre-treatment may have improved water resistance of the panel because hemicelluloses are the most water absorbing component and,after pre-treatment,their content is significantly diminished.Furthermore,steam explosion treatment transforms the lignin structure in the plant matrix and promotes the binder-less composite moulding in the following hot-pressing process.The objective of the study was to investigate the preliminary technological parameters of obtaining furfural and binder-less panels depending on the hydrothermal pre-treatment temperature,steam explosion treatment and pressing conditions.The pre-treatment process reference criteria for optimal parameters were chosen by the furfural yield and cellulose destruction degree in the leftover lignocellulose,which affects the obtained panel’s mechanical properties.The panel’s evaluation criteria were the panel quality and the maximal values of the tested properties – modulus of rupture and modulus of elasticity.The holocellulose content in the raw material was 75.5 wt% and,after the pre-treatment process,it decreased to 34.2 wt% at 160 °C and 27.7 wt% at 180 °C,calculated on the oven dry hemp shives’ mass.This means that,during the catalytic pre-treatment in the presence of Al23,not only is hemicelluloses converted to furfural,but also some part of cellulose has started to degrade.By increasing the hydrothermal pre-treatment process temperature up to 180 °C,the cellulose content significantly decreased from 31.4 wt% to 22.2 wt%,calculated on the oven dry raw material,vertical grow rack taking into account the yield of lignocellulose.The leftover lignocellulose after the hydrothermal pre-treatment contained ~ 50 wt% moisture content; therefore,it was dried to a 10–15 wt% moisture content at 25°C.

With increasing temperature of the pre-treatment process,the moisture content of residual lignocellulose was higher at the drying stage.This can be explained by the increasing of the surface of the raw material particles due to the degradation of cellulose at elevated temperatures in the presence of the Al23 catalyst.The obtained panels are very different from the outside.The Ref 1 and Ref 2 panels are light enough in colour like the raw shives and similar to conventional OSB panels.The panels from the shives after the catalysed hydrothermal pre-treatment process are slightly darker in colour,compared to the reference panels.The panels from the pre-treated and steam-exploded shives are very dark in colour,with an apparent degraded morphology of shives on the surface.Most of the panels from the pretreated and steam-exploded shives have gaps on the surface and on the inside parallel to the surface.These observations allow concluding that the lignocellulosic material after the steam explosion treatment is significantly degraded.However,the degradation level of lignocelluloses depends on both pre-treatment and treatment,and the treatments conditions should be optimised.Cutting edges are another property of the panel quality that was observed,although only qualitatively.The panels made of untreated shives at 160 °C have unstable edges,which drop off.However,the cut edges of the panels made at 200 °C are stable enough.The panels made of pre-treated shives have cut edges similar to those of the untreated ones,although look more stable.Generally,the cut edges of the obtained panels are poor in quality.This is probably due to the too high moisture content of the pressing material and due to the too high steam explosion temperature that results in the too high severity factor of the material and degradation of cellulose.However,we believe that this could be improved by optimising the panel moulding process that is the next goal of the research.Some studies state that it is possible to make a high quality binder-less panel from agricultural species.The density range of all panels obtained was from 800 kg/m3 to 1250 kg/m3.85 % of the differences in density are explained by the panel’s thickness,which varies from 6 to 8 mm as shown in Fig.4.On the other hand,such different thickness obtained means that the same pressure used at pressing for all samples shows that the samples are different as materials,and different pressures should be used for each of them to obtain the same density.

The MOR values of the panels vary from 2 to 12 N mm-2,depending on all included factors.However,the strength difference is not significant.The low MOR values could be explained by the high enough severity factor of the lignocelluloses and,possibly,the fact that the pressing temperature was too low to achieve the lignin flowing and then the glass transition necessary to form a rigid material.The MOE values of the panels vary from 141 to 3250 N mm-2,also depending on the same factors as in the MOR performance.The obtained maximal MOE value is high enough and demonstrates that the material can be used for panel production.However,the MOR values are too low and should be improved by optimising the panel moulding conditions.In spite of the low mechanical properties,an excellent correlation was obtained between the MOE and MOR values,which means that the strength of the composites could be predictable.Temperature and relative humidity are important parameters influencing perceived indoor air quality and human comfort.High moisture levels can damage construction and inhabitant’s health.High humidity harms materials,especially in case of condensation and it helps moulds development increasing allergic risks.Consequently,several researchers have studied the use of various hygroscopic materials to moderate indoor humidity levels.The material that absorbs and desorbs water vapor can be used to moderate the amplitude of indoor relative humidity and therefore to participate in the improvement of the indoor quality and energy saving.Vegetal fiber materials are an interesting solution as they are eco materials and have low embodied energy.Hemp concrete is one of these materials which is more and more recommended by the eco-builders for its low environmental impact.The physical properties of hemp concrete has been measured by many authors.It is highlighted that the one presents high moisture buffering capacity and a good compromise between insulation and inertia materials.To investigate the hygrothermal behavior of building envelope,a simulation should be done because it is cheaper and more detailed than the test in situ.For this to be done,many simulation tools have been developed.Hygrothermal properties are required for all Heat,Air and Moisture transfer models.Many models and simulation tools for predicting the hygrothermal behavior of building envelope are represented in the Annex 41 of the International Energy Agency’s.For the building envelope,the main difference in HAM-transfer modeling is made by the dimension of represented phenomena and they can be classed by the granularity and complexity†.

The relationship between marijuana smoking and asthma is somewhat complex

Water pipes have become more popular in North America in recent years due to the belief that it is a safer alternative to cigarettes .This is a common misconception in young adults,as a water pipe smoking session can contain over 100 times the amount of smoke in comparison to a single cigarette .In Ontario,the rate of trying water pipes in adolescents has more than doubled from 6% in 2006 to 14% in 2013.Water pipe smoking is linked to several adverse health outcomes such as cancer,cardiovascular disease and decreased lung function.While the causal effect of water pipe smoke and asthma has not been demonstrated,exposure to tobacco smoke was shown to exacerbate asthma symptoms.Since water pipes produce tobacco smoke,it can be assumed that it will be harmful especially for those with asthma.Marijuana has been used as a forbidden medicine to treat asthma symptoms for years as it may have bronchodilator properties,while long term marijuana smoking has also been associated with increased respiratory symptoms.Overall,the relationship between marijuana and lung health is somewhat mixed and the connection may not be the same as tobacco smoke.Previous research has suggested that adolescents with asthma smoked significantly more marijuana than those without asthma.However,the number of adolescents who smoked marijuana in Canada has decreased from 32.7% in 2008 to 24.4% in 2013.Electronic cigarettes are battery powered devices that vaporise nicotine and/or other flavouring mixes,cannabis grow lights but do not burn tobacco.These products have become popular in recent years and they are perceived as a safer alternative to tobacco cigarettes.

While preliminary studies suggest that they may be less harmful than cigarettes,the long term health effects and how e-cigarettes relate to asthma symptoms or severity are unknown.The Canadian Tobacco,Alcohol and Drug Survey reported that as many as one in five adolescents aged 15e19 tried e-cigarettes,however,the absolute trend of usage is still unknown as these products are relatively new.The purpose of this paper is to examine whether adolescents with asthma smoke cigarettes,water pipes,marijuana or e-cigarettes more or less than those without asthma.This study adds to the current literature by examining all smoking habits for youth with asthma,rather than focusing just on cigarettes.The 2013 Ontario Student Drug Use and Health Survey is a population based survey conducted every two years and completed by grade 7e12 students at publically funded schools in Ontario,Canada.Ontario is the largest province in Canada with a population of over 13 million residents.Ontario includes major urban centres such as Toronto and Ottawa,several smaller cities and an abundance of rural lands.The OSDUHS is designed to collect information about drug use and other health related behaviours among students in Ontario.All parents and students gave consent prior to participation.To examine the association between smoking and asthma,we limit our study sample to high school students in 109 schools.These schools were selected with probability proportional to size,to obtain a representative sample within the province.The survey included questions that captured information on self-reported doctor diagnosed asthma and data on tobacco,alcohol and drug use.The survey used a random split-ballot design where some of the questions change on each of the surveys.The sample is randomly divided into 2 groups to maximize questions included and minimize burden on students,but it reduces the sample size for some questions.In the OSDUHS,approximately half of the full sample answered questions pertaining to asthma and all types of smoking reducing the sub-sample to 2,840.

Data are representative of students in Grades 9 to 12 attending publicly funded schools in Ontario.Ages for respondents range from 12 to 19 years of age.In Ontario,the majority of children attended publically funded schools,5% attended private schools,and another 3% were either home schooled,institutionalized for correctional or health reasons,schooled on a First Nation reserve,military base or lived in remote northern region.This study was approved by the research ethics board at the Research Institute of The Hospital for Sick Children.The primary outcome variables in this study are smoking status with regard to cigarettes,water pipes,marijuana and e-cigarettes.Self-reported frequency and intensity of cigarette,water pipe,marijuana and e-cigarette smoking in the last 12 months and lifetime use were measured in the survey.Cigarette non-smokers were classified as those who never smoked a cigarette or smoked less than one cigarette in the last 12 months,while cigarette smokers were those who smoked more than one cigarette in the past 12 months.Similarly,smoking status for water pipe was also classified as a binary outcome variable.Respondents were asked how often they smoked a water pipe in the last 12 months.Those who smoked a few puffs,never smoked,haven’t smoked in the past 12 months or didn’t even know what it was were considered non-water pipe smokers.Those who smoked one or more times were defined as smokers.Marijuana smoking is also defined in a similar manner.Students were asked how often they smoked cannabis in the past 12 months.If they smoked 1 or more times in the past year they were classified as a marijuana smoker.Respondents who have never or not smoked in the last 12 months were considered to be non-marijuana smokers.Finally,respondents were classified as e-cigarette smokers if they smoked an e-cigarette with or without nicotine in it,while those who have never smoked or never heard of e-cigarettes were considered non-smokers.The primary risk factor of interest is the presence of asthma which is captured by the response to the question “has a doctor or nurse ever told you that you have asthma”.Other potential confounding variables include: grade,sex and socioeconomic status.

SES was measured by a 10-point social ladder.Students were asked to imagine that the ladder represents how Canadian society is set up,where the people at the top of the ladder are the “best off”,meaning they have the best jobs,make the most money and have the highest education.Those at the bottom of the ladder are the “worst off”,with no job,or a job no one wants,little education and the least money.Respondents reported what best represents their family on a 10-point scale,which was further grouped into three levels based on the interquartile ranges.The percent distributions of demographic characteristics and other co-variates were compared between smokers and nonsmokers of each type and the any smoking variable.The chi-square test was used to measure statistical significance between the respondents with and without asthma.Each type of smoking was modelled separately using a binary logistic regression.In addition to doctor diagnosed asthma,all co-variates outlined above were included in the regression models.All interactions of smoking types were examined but no significant relationships were found so this study focussed on the four individual models,plus the combined any smoking outcome.The following was used as the reference group in the logistic regression models: grade 9,female and high SES.Given the OSDUHS used a probability stratified cluster sampling design,all analyses were conducted with the sampling weights and utilized Taylor series methods within Stata 14 v14.1 to derive unbiased standard errors and point estimates.Results of the regression models were presented in adjusted odds ratios with 95% confidence intervals.Goodness of fit tests were completed with the F-adjusted mean test.While cigarette smoking may aggravate symptoms and severity for adolescents with asthma,some work on the topic suggests that the prevalence of cigarette,water pipe and marijuana smoking was actually higher in adolescents with asthma than those without.These studies,however,are not conclusive as at least one reported that adolescents with asthma were less likely to smoke cigarettes.It is reasonable to suppose that adolescents with asthma will not smoke as it will aggravate their asthma severity and symptoms,but this unfortunately may not be the case.

Our study showed that students in grades 9e12 with asthma in Ontario,had a higher odds of smoking e-cigarettes or any substance than their peers who do not have asthma.The odds of smoking ecigarettes for adolescents with asthma,was nearly twice as high as those without asthma after adjusting for age,sex and SES.Given the cross-sectional design of the survey,we cannot infer the causal relationship between smoking and asthma.Previous studies suggest that smoking for adolescents with asthma may relate to the desire to obtain social status among one’s peers,and not wanting asthma to interfere with their social status.Of all demographic characteristics studied,student’s grade was most significantly associated with smoking cigarettes,water pipes and marijuana.A longitudinal study in the United States found that rates of cigarette smoking increased from 1.8% at the age of 9 to 22.5% by age 16.Findings suggest that rates for smoking cigarettes and water pipes among grade 9 students were relatively low,but doubled in grade 10,tripled by grade 11 and quadrupled by grade 12.Cigarette and water pipe smoking became more popular in grade 10 and the trend continued as they aged.E-cigarette smoking on the other hand only marginally increased from grade 9 to 12.For adolescents with asthma,rates of e-cigarette smoking were similar to that of the entire sample,cannabis grow tent ranging from about 10% in grade 9 to 16.7% in grade 12.Our study also showed that cigarette,marijuana and any smoking rates were inversely related to SES,where lower SES was associated with higher odds of smoking.Our finding is consistent with the literature that suggests an inverse relationship between individual SES or parental education and cigarette smoking in adolescents.It has been suggested that lower SES households may have a poorer attitude towards health,fewer opportunities or more stressful situations which make them more likely to smoke.Results from our study emphasise the need for tailored interventions for youth from lower SES households.This study had many strengths which relate to the size and generalizability of the survey sample and the fact that it examined how all types of smoking related to asthma prevalence.That being said,there are also some limitations.The primary purpose of this survey is to examine health risk behaviours of adolescents in Ontario and not asthma.As such,the number of respondents with asthma was low and this may have contributed to some of the insignificant findings.

Despite the low number of asthma respondents,the self-reported asthma prevalence rate of adolescents in this study was similar to that reported by the Ontario Asthma Surveillance Information System,which uses a validated health administrative data case definition to capture asthma with 84% sensitivity and 76% specificity.Secondly,the cross-sectional design of the survey is a major study limitation in assessing causal relation of asthma and smoking.It is unknown from this study whether adolescents with asthma smoked e-cigarettes more often or if smoking e-cigarettes contributed to the risk of asthma.Thirdly,asthma was self-reported and it not clinically confirmed.Self-reported asthma may over or under represent actual prevalence of asthma.Furthermore,many studies that examined the relationship between asthma and smoking did not separate severe or “uncontrolled” asthma from those with well-controlled mild to moderate asthma.The effect of smoking on adolescents with severe or uncontrollable asthma may be different than on those with mild to moderate asthma.The definition of smoking used may influence the study findings.We classified smoking for cigarettes,marijuana and water pipes as smoking one or more time over the past 12 months or ever for e-cigarettes.This definition includes those who smoke regularly but also adolescents who experiment with the various types of smoking.This classification of smoking has been used previously in studies using the OSDUHS dataset.We conducted additional analyses using another method of classifying smokers reported by Wong and colleagues.In this method a regular smoker is defined as smoking more than 100 cigarettes in their lifetime and any cigarettes in the past month.Using this method the results and point estimates remained very similar.Given this method of classification was only available for cigarettes,we opted to retain the ‘any cigarettes over the past 12 months’ method to ensure measurement correspondence with the other types of smoking.Nevertheless,results suggest that adolescents with asthma are at least experimenting with e-cigarettes or any type of smoking more often than their peers without asthma,which may lead to higher smoking rates later in life.Finally,we were unable to adjust for parental smoking or parental history of asthma as these data were not collected by the survey.Having a parent who smokes may relate to the respiratory health of children,but it also increases the odds of smoking for adolescents.While information on parental smoking is not available in our data,further research should examine the association between parental smoking and asthma for all types of smoking.This paper adds discussion to the question of whether adolescents with asthma would be less likely to smoke cigarettes,water pipes,marijuana or e-cigarettes.

The most common route of marijuana administration is inhalation via smoking

Marijuana has also been reported as a risk factor for stroke. Over 80 cases have been reported in which patients had strokes, with a higher prevalence of ischemic strokes, that were associated with either a recent increase, in the days leading up to the event, or chronic history of heavy marijuana use. They believed that the marked swings in blood pressure or the reversible cerebral vasoconstriction that resulted from marijuana use were likely mechanisms of stroke but admitted that no firm conclusions could be drawn without further studies.In addition, Lawson reported a similar belief that drug induced vasospasm was a plausible explanation for TIAs, but also with the caveat that due to the confounding medications/illicit substances being used in his patient, no direct association could be determined. Also of interest is marijuana use’s effect on other cardiovascular vessels. When cohort studies were performed comparing marijuana users with resultant limb arteritis to patients suffering from thromboangiitis obliterans, marijuana associated arteritis occurred in younger, usually male patients with a unilateral, lower limb as the common presentation.Due to the unfiltered nature of the marijuana cigarette compared to commercially available tobacco cigarettes,grow table the amount of carcinogens and irritants, like tar, that enter the upper airway is increased with approximately a three-fold increase in tar inhalation and one third more tar deposition in the respiratory tract.

More specifically, the tar produced from cannabis smoke contains greater concentration of benzanthracenes and benzopyrenes than tobacco smoke. In addition, as compared to smoking tobacco, there is a two-thirds greater puff volume, one-third greater depth of inhalation and a four-fold longer breath-holding time, all of which are common practices to try to maximize THC absorption, which is around 50% of cigarette content. These practices result in five times the amount of carboxyhemoglobin levels as compared to the typical tobacco smoker despite the presence of similar quantities of carbon monoxide from the incomplete combustion of the organic compounds found within each product. In reporting his case, Schwartz theorized that high temperatures in which marijuana burns compared to tobacco may increase the irritancy of marijuana to the mucous membranes. While the higher temperature is a possibility, the evidence of marijuana’s irritancy is well documented. In a cohort study comprised of 40 healthy patients, Roth et al. showed that cannabis smokers had significantly increased visual bronchitis index scores resulting from large airway epithelial damage, edema, and erythema. On mucosal biopsy, goblet cell hyperplasia with subsequent increase in secretions, loss of ciliated epithelium and squamous metaplasia were also present in 97% of smokers. They concluded that marijuana use is associated with airway inflammation that is similar to that of a tobacco smoker. A cross-sectional study on over 6000 patients, from 1988 to 1994, found an increased incidence of chronic bronchitis symptoms such as wheezing and productive cough occurring in patients 10 years younger, on average, than tobacco smokers. Case-control trials performed found similar findings with regards to increases in wheezing, shortness of breath, cough and phlegm as well as the similarities with tobacco use. Bryson also concluded based on his review of the literature, that the pulmonary complications in the chronic marijuana smoker are equivalent to those seen in the chronic tobacco smoker, while Wu et al. estimated that 3e4 cannabis cigarettes daily equates to about 20 tobacco cigarettes in terms of bronchial tissue damage.

Cannabis use has also been linked to a higher risk in cancers, possibly due to the increased carcinogens entering the airway. Similar to tobacco use, marijuana use plays a significant role in the development of lung cancer. In a case control study performed in New Zealand, young adults had an 8% increase in lung cancer risk for each joint year of cannabis smoking after adjusting for the cofounders, such as age, sex, ethnicity and family history. Berthiller et al. pooled data from a multitude of institutions across multiple countries, comprising of over 1200 patients, and reported an increased risk of lung cancer for every marijuana use. In addition, a 40 year cohort study with about 48,000 patients reported an increased risk of lung cancer in young men who had smoked marijuana more than 50 times. This study was limited however by the nature of patient self-reporting. Head and neck cancers have also been theorized to be at a higher risk similar to that of tobacco smoking. However, a pooled analysis performed by Berthiller et al. found that infrequent marijuana smoking did not confer a greater risk after adjusting for cofounders. The authors did note that due to the low prevalence of frequent smoking within the study population, that a moderately increased risk could not be ruled out. In another population based casecontrol study, there was an increased incidence of head and neck cancers in patients with a 30 joint-year history, yet the association did not exist when accounting for tobacco smoking suggesting the risk is greater with tobacco than marijuana.Marijuana’s prevalence is evident amongst all patient populations. In a cross sectional study conducted by Mills et al., the rate of marijuana use via patient self-reporting was found to be 14% amongst surgical patients in 2003. This led the authors to conclude that questions about illicit drug use should be a routine part of the preanesthetic assessment, especially in patients that the anesthesiologist finds hard to settle, due to anxiety or other psychologic manifestations, because of the potential anesthetic complications that may occur.

In a series of case reports, Guarisco presented three patients who suffered from significant respiratory distress due to isolated uvulitis, a disease of low incidence typically associated with infection or traumatic irritation from instruments used in the airway. Investigating further, all three patients were found to have inhaled large quantities of cannabis within six to twelve hours of the onset of symptoms leading to the conclusion of a possible correlation with inhaled irritants such as cannabis. Due to known cases of isolated uvulitis and the possible link with marijuana, the authors suggest that toxicology urine and blood studies for THC should be performed in cases where marijuana use is suspected but not confirmed by history taking. Multiple other cases have also been reported with similar findings. In a case series by Sloan, three adolescents suffered acute uvular inflammation post the heavy use of marijuana, having smoking at least three marijuana cigarettes, despite negative throat cultures. In 1971, a cohort study was performed in which a large quantity of marijuana, over 100 grams, was smoked over several months. Of the 31 subjects, almost half suffered from recurrent rhinopharyngitis as well as developed acute uvular edema after the heavy marijuana inhalation which lasted approximately 12e24 hours. These findings stress the importance in the maintenance of the airway during anesthesia following acute marijuana use due to the potential airway obstruction that may occur. In fact, in presenting a case of uvular edema and airway obstruction with cannabis inhalation 4 hours prior to surgery, Pertwee recommended that elective operations should be avoided altogether if a patient was recently exposed to cannabis smoke. This recommendation seems reasonable when taking into consideration the life-threatening bronchospasm leading to asphyxia, brain damage or death resulting from tracheal intubation in patients with obstructive airways. One proposed course of action has been the therapeutic use of steroids. In Guarisco’s study, he theorized that steroids should help inhaled irritant uvulitis. As steroids increase endotracheal permeability, decrease mucosal edema and stabilize lysosomalmembranes, thus decreasing the inflammatory response, the theory has scientific basis. In a prospective, randomized,4×8 grow table with wheels double-blind study, Silvanus et al. found that the addition of methylprednisolone to salbutamol in patients with a partially reversible airway obstruction helped in the diminution of the reflex bronchoconstriction that can result from tracheal intubation.

This led to Hawkins et al.’s recommendation that at the first signs of airway obstruction, dexamethasone should be used as the drug of choice, 1 mg/kg every 6e12 hours over the course of one to two days. This recommendation gained credence in the dramatic relief that dexamethasone provided in the post-traumatic cases. However, Mallat et al. concluded that although marijuana-induced uvular edema is a serious postoperative complication that has a potential for simple treatment, in the case of an elective surgical procedure with an acute history of cannabis exposure, surgery should be can celled as prophylactic treatment may not be effiffifficient. The complications of the airway are not limited to intubation however. The inhalation of toxic chemicals as well as smoke can cause laryngospasm by chemoreceptor stimulation. In addition, the inhalation of hot gasses can trigger laryngospasm via thermoreceptor stimulation, especially in the case of lowered sensory afferent neuron threshold potentials such as in light anesthesia. In line with this, White presented a case in which a known cannabis smoker suffered severe laryngospasm following extubation. As found within the reviews, multiple observations have been made showing cross tolerance between marijuana and barbiturates, opioids, prostaglandins, chlorpromazine and alcohol. In addition, animal studies have shown additive effects amongst them all except for alcohol. These drug interactions have led to further exploration of its reactions to other medication groups. As a result of fat sequestration and subsequent slow elimination from the tissues, cannabinoids may be present to interact with multiple anesthetic agents. In Symons’s case report, the patient required multiple boluses of propofol and two additional doses of midazolam to achieve appropriate sedation. In a prospective, randomized, single-blind study of 60 patients, chronic marijuana users required significantly increased doses of propofol to facilitate successful insertion of the laryngeal mask and thus suggesting that the increased doses, in chronic marijuana users, may be a requirement for appropriate loss of consciousness as well as jaw relaxation and airway reflex depression. The authors theorized that the variations in the level of delta9-THC can explain variations in propofol responses.

In a review written in the American Association of Nurse Anesthetists Journal, Dickerson reported the synergistic effects of cannabis to include: potentiation of nondepolarizing muscle relaxants, potentiation of norepinephrine, the augmentation of any drug causing respiratory or cardiac depression, as well as a more profound response to inhaled anesthetics sensitization of the myocardium to catecholamines due to the increased level of epinephrine. On the subject of muscle relaxants, THC depletes acetylcholine stores and exerts an anticholinergic effect and thus creates a potentiation of the nondepolarizing muscle relaxants. Areview by Hall et al. explored THC’s interaction with drugs affecting heart rate and arterial pressure and found that due to cannabis’s own cardiovascular effects , it may interact with medications such as beta-blockers, anticholinergics and cholinesterase inhibitors. Due to these potential autonomic reactions, as well as theoretical psychiatric complications, such as withdrawal effects and their interference with anesthetic induction or postoperative recovery, there has been a stress made to inquiring about drug history or avoiding elective operations altogether. Dickerson, in his review, recommended that, due to all potential effects and interactions, not only should an extensive history of drug use be elicited at the time of the preoperative assessment, including the frequency of use and time of last use, but that anesthesia should be avoided in any patient with cannabis use within the past 72 hours.This gained further credibility in a randomized, double-blind trial, in which an apparent drug interaction was observed in the patient population who underwent general anesthesia within 72 hours of marijuana use leading to a sustained postoperative tachycardia, a finding potentially due to an interaction between cannabinol metabolites and atropine administration during anesthesia.One of the most researched and known risk factor for perior postoperative complications, increased hospitals costs and resource usage is smoking, specifically tobacco smoke. In fact, the rates of perioperative respiratory events, such as reintubation, hypoventilation, hypoxemia, laryngospasm, bronchospasm, and aspiration, have a total incidence of 5.5% in smokers compared to 3.1% in nonsmokers, making these events 70% more prevalent with smoking. In addition, in a randomized controlled trial out of Denmark, orthopedic surgery patients who smoked were compared to those who underwent cessation counseling and nicotine replacement therapy. In the study, they found an overall complication rate of 18% compared to the 52% found in the smoking group, including a cardiac event rate of 0% compared to 10%.

Responses collected during the most recent interview were used for these analyses

The 13-items included: social, mellow, creative,top of the world, increased sex drive, energetic, dizzy, nauseous, drowsy, lazy, unable to concentrate, out of control, and guilty. Participants were asked “in the period shortly after you used did it make you feel…”? Responses were scored as present or absent and the item scores summed to make the positive and negative scales.To examine the dimensionality of the 13 subjective experiences examined for each substance, we conducted Mokken Scale Analysis using the statistical software STATA. Mokken scaling analysis extends traditional factor analysis by systematically hierarchically ordering items that are highly correlated. Mokken analysis provides a nonparametric, iterative scale-building technique that identifies the smallest set of internally consistent scales from a given item pool. This model assumes the presence of one or more latent traits that can be measured by subject responses to a set of items. MSA is probabilistic and hierarchical, meaning that the items can be ordered by a degree of “difficulty”;individuals who agree with a more difficultitem will tend to agree with less difficult items. Scales from MSA are formed by taking pairs of items with the highest correlation and including other items until there is no further improvement. Loevinger’s H coefficients, which indicate the fit of an item to the scale, are computed for each item within a scale and for the scale as a whole. H coefficients ranging between 0.3 and 0.4 indicate a weak scale, 0.4–0.5 a medium scale, and 0.5–0.9 a strong scale. In MSA, an item can remain “unscaled” because it could not be added to one of the alternative scales without weakening the scale’s homogeneity. Based on our previous analyses , we used the scaling derived from the CADD sample. Positive and negative scales were standardized by age, sex, vertical outdoor farming and clinical status with two groups. Pairwise correlations between the resulting two scales were then determined for alcohol, tobacco, and marijuana.

Two consistent subjective experience scales were revealed using MSA. The item guilty did not fit into either scale for any substance. The item out of control was dropped due to extremely low endorsement for tobacco and because this item fluctuated between the positive scale and the negative scale. For all three drugs the positive scale included: relaxed, sociable, creative, euphoric, energetic, and increased sex drive. Items included in the negative scale for all three drugs were: lazy, drowsy, unable to concentrate, dizzy, and nauseous.Table 2 provides the H-coefficients for the positive and negative scales for each of the three drugs with the items shown in their hierarchical ordering. For the positive subjective experiences H-coefficients for alcohol,tobacco, and marijuana were 0.45, 0.52, and 0.43, respectively. For the negative scale, the H-coefficients were 0.42, 0.52, and 0.54, respectively. Means and standard deviations for each subjective experience scale across all three drugs are shown in Table 3. Mean scores differed as a function of age, sex, and clinical status. For all but marijuana, younger subjects had significantly lower mean scores on both positive and negative scales. Males scored significantly higher for the positive scales across all drugs than females. Males also had a higher mean score for the alcohol negative scale and a lower mean score for the marijuana negative scale. Mean scores on the positive experiences to tobacco and negative experiences to marijuana scales were higher in our community sample than in our clinical sample. Mean scores were lower in our community sample than in our clinical sample for positive experiences to marijuana and negative experiences to alcohol scales.In the current report, we examined subjective experiences to three commonly used drugs of abuse among young adults from the general community and an area treatment program. In these data, we obtained results that supported previous observations indicating positive and negative subjective experiences for a particular drug were predictive of problem use of that same drug. We then extended this relationship in two ways. First, we obtained results that supported the notion that positive and negative experiences to one drug are similar to those experienced for another drug and second, that subjective experiences to a drug are predictive of the risk for problem use of other drugs.

We interpret these findings to suggest that subjective experiences may be a useful indicator of a common liability towards use and problem use of multiple substances. Following on our previous work on marijuana and subjective experiences , we used Mokken scaling to simultaneously examine whether subjective experiences to three drugs are associated with drug use outcomes. From these analyses we observed that the subjective experience scales for each of the three drugs were comparable to those found in previous studies despite using a different methodology. We observed differences in item means and hierarchical ordering of the items by substance suggesting that subjects are reporting drug specific subjective experiences. This interpretation is consistent with findings from laboratory based studies which have shown that subjects can differentiate between a placebo and a drug or between different drugs based on subjective experiences. As different combinations of alcohol, tobacco, and marijuana use are commonly reported in epidemiological studies, we investigated the relationship between subjective experiences to different drugs in poly-substance users. We observed that subjective experiences to one drug were significantly correlated with experiences to another drug, though the strength of the relationship varied for different drug combinations. The strongest relationships were between alcohol and marijuana, replicating two previous studies , and between alcohol and tobacco. These particular drug combinations target similar neuronal receptor systems and are reported to enhance the overall drug experience when taken together. Further, as subjective experiences are thought to reflect the underlying physiology of a drug’s actions , these cross-substance relationships may provide a closer approximation of a common risk factor suitable for molecular genetic investigation. In this sample of community and clinical subjects, subjective experiences for one drug were associated with outcomes related to a different drug.

Though our results replicate findings that relate positive experiences with greater use of other drugs, we also identified that negative experiences were predictive of abuse and dependence status of a different drug. In particular, negative effects of alcohol and marijuana were associated with misuse of these same drugs as well as tobacco. Although this may appear counter-intuitive, a possible explanation could be that subjects who needed greater amounts of a drug in order to feel its effects drove the observed association. Findings from laboratory-based drug discrimination studies suggest that some subjects are unable to differentiate between drug and placebo at a standard training dose. Differences between the two conditions could, however, be reported as non-discriminators were exposed to greater doses of a drug. Interestingly, those who were able to discriminate between non-exposure and exposure to a drug reported stronger positive and negative subjective experiences, often simultaneously , at greater doses. This underscores the importance of dose in determining individuals’ drug sensitivity as assessed by subjective experiences. The relationship between drug dose, the resulting subjective experiences, and problem drug use has also been examined using self-ratings to the effects of alcohol [SRE; 28]. The SRE primarily assesses negative experiences to alcohol such as dizziness and passing out as related to the dosing levels needed to feel the sedative effects of alcohol. Among adolescent and adult samples of both sexes and family-history positive studies of alcoholics , low levels of response, as measured by the SRE have been implicated as a risk factor for alcohol use disorders. This notion that some drinkers need to ingest greater amounts of alcohol to feel its sedative effects and that this effect is related to greater drinking quantities has been recently supported and extended to include the observation that this relationship is also relevant to those reporting lower levels of stimulant effects during the first five drinks. Our finding that negative alcohol experiences were predictive of problem alcohol use is consistent with this research, despite using a different questionnaire, and extends it to include the potential prediction of other drug use problem behaviors.

Findings from the current study should be considered in light of a number of limitations. First, subjective experiences were collected from participants who ranged between 11 and 30 years of age. Though scaling of the different experiences was consistent between younger and older subjects, the older subjects have typically had a longer use history of alcohol, tobacco, and marijuana. Second, subjective experiences were only collected from those who reported using alcohol and marijuana six or more times and daily use of tobacco for a month. Thus, we were not able to include experiences from those who had used only a few times. Third, we were not able to measure differences in dosage, quality of a drug, depth of inhalation, peer use and drug use setting some of which impact self-reported subjective experiences. Fourth, we were not able to establish the reference point from which people were making their ratings. This is due to the unclear phrasing of the stem questions that asks about experiences “shortly after using.” We cannot know whether subjects were reporting their initial experiences, experiences in the minutes or hours immediately following recent drug intake or the conglomeration of their drug experience, making causal inferences regarding the observed associations not possible. Lastly, the lower endorsement rates for the experiences of tobacco may be due to the dichotomous fashion of responses that limit the sensitivity to detect the milder effects. Further, there more stringent requirements for collecting subjective experiences to tobacco may have made it more difficult to detect significant relationships with subjective experiences to alcohol, tobacco,rolling grow table and their more problematic use behaviors.Despite the high co-morbidity between marijuana and nicotine use, only few studies have directly addressed the mechanisms that lead to their concurrent use. A recent review by Agrawal describes multiple etiologies that influence their comorbidity. This includes route of administration , cross drug adaptation, response to treatments, environmental effects and genetic factors. Others have also alluded to the “gateway drug” hypothesis whereby the use of one drug may potentiate the effects of the other. For example, in a longitudinal study in 14–15 year olds, marijuana use increased the likelihood of initiating nicotine use up to 8 times and developing nicotine dependence up to 3 times suggesting marijuana’s role as a gateway drug. This was further supported by findings showing that women who used marijuana were at 4.4 odds of later developing nicotine use and dependence. The same group also reported in 43,093 adults that nicotine smoking increased the risk for marijuana use and dependence up to 3 times. This latter finding suggests a bi-directional potentiating effect and indicates that more complex factors may drive combined use.

Although the animal literature has characterized the neural mechanisms that may underlie these potentiating effects, it is also possible that personality factors contribute to this phenomenon. Combined marijuana and nicotine use has been associated with differential effects on clinical diagnoses, cognitive and psychosocial problems, and outcomes. For example, Bonn-Miller and colleagues examined associations between negative emotions that discriminate marijuana-only users from co-morbid marijuana and nicotine users. They found that, in general, nicotine-only using individuals had significantly greater negative emotionality than marijuana users, co-morbid marijuana and nicotine users, and non-using controls. Earlier work by Degenhardt showed that while nicotine and marijuana use were both individually associated with increased rates of negative emotion, this relationship appeared to be driven by neuroticism in marijuana users. Taken together, these studies argue for different patterns of co-morbidity in nicotine and marijuana using populations. To date, however, distinctions in trait markers, such as personality factors, have not yet been addressed in this ubiquitous group of co-morbid users. These differences suggest the need for fine-tuning the ability to discriminate risk-profiles between these groups as they also relate to clinical treatment outcomes. Factors that contribute to risk profiles include personality traits that have been examined as putative markers for treatment outcomes. For example, in a prospective four-year study in 112 adults with chronic alcoholism, Krampe et al. determined that the presence of any personality disorder was associated with a decrease in four-year abstinence probability. Similarly, using the NEO Personality Inventory-Revised Betkowska-Korpala found that following treatment, abstinent patients have higher levels of agreeableness and conscientiousness than patients who relapsed within a year following the therapy. This suggests that personality profiles have high predictive values for SUD outcomes and should be considered during treatment programs.

Studies in laboratory animals have shown CBD to protect the liver from toxic insults

Assay of the extract was 61% edible fatty acids, 26% phytocannabinoids and 13% other plant chemicals including fatty alkanes, plant sterols, triterpenes, and tocopherols. In the 14-day repeated oral dose-range finding study reported by Marx et al., a No Observed Adverse Effect Level could not be determined, however, the results of a 90-day repeated dose study with a 28-day recovery period in Wistar rats was also reported. In this study, doses of 0 , 100, 360 and 720 mg extract/kg bw per day were used. Significant decreases in body weight, body weight gain, and differences in various organ weights, compared to controls, were reported at the mid and high dose levels, but the authors concluded that many of the findings were reversible as they were trending towards normal at the end of the recovery period. A NOAEL for the hemp extract in Wistar rats in the 90-day study was determined to be 100 mg/ kg bw per day and 360 mg/kg bw per day for males and females, respectively. In the 90-day study being reported here, test article related significant changes in body weights, daily body weight gain and feed efficiency were seen in the males in all treatment groups which was still noted at the end of the recovery period. The magnitude of the significant change in body weights, daily body weight gain and feed efficiency in the low and mid dose groups was less than 10% and showed signs of obvious recovery and were therefore considered to be not toxicologically relevant. The effect in the males receiving 800 mg/kg/day was >10% and was still evident at the end of the recovery period and was considered toxicologically relevant. Reported rodent studies have differing findings on hepatotoxicity when CBD is orally administered in high doses. Hepatocellular hypertrophy with a centrilobular pattern was observed in rat livers in the study being reported.

This pattern of hepatocellular hyperplasia is frequently observed in rats and other animals exposed to agents that induce the CYP family of enzymes and can be associated with activation of peroxisome proliferator-activated receptors. THC has affinity for PPARα,trimming tray and CBD has very low to no affinity for PPARα and high affinity for PPARγ. Interaction with the PPARγ is one of the mechanisms of action for CBD. In our study, we did not show the mechanism of action for the hepatocellular hypertrophy. We did show that the activities of liver enzymes in serum were not significantly changed by treatment with the test article and the hepatocellular hypertrophy was reversed during the 28-day recovery period. In the study reported by Marx et al., no histopathological changes were observed in the livers from the treated and control rats and the liver weights in the male and female rats in the 360 and 720 mg/kg body weight/day were significantly increased at 90 days. The 28-day recovery males and females receiving 720 mg/kg/day retained the significantly increased in hepatic weights. The induction of hepatic drug metabolizing enzymes can be associated with increased liver weights, and hepatocellular hypertrophy and hyperplasia and elevation of hepatic-source enzymes in serum. The evidence in the scientific literature supports a conclusion that the centrilobular pattern of hepatocellular hypertrophy and increased liver weights observed in our study was due to induction of HDMEs and/or peroxisomes. No hepatocellular necrosis and changes in the clinical chemistries occurred which is evidence that liver damage did not occur. This conclusion is further supported by not observing hepatocellular hypertrophy and increased liver weights in the 28-day recovery groups that received the test article.In the study being reported both the treated and control male rats had the same incidence and severity of vacuolization of the adrenal zona fasciculata and the adrenal weights were significantly increased in the Group 4 females. The vacuolization of the adrenal zona fasciculata and increased adrenal weights were not observed in Groups 5 to 8. The histopathological lesions noted in the adrenal glands in the current study was seen in both control and high dose males and is not considered to be due to treatment with test article and not toxicologically relevant. The hemp extract in these studies was shown to be non-mutagenic in a bacterial test system used to evaluate mutagenicity. Marx et al. reported on a GLP-compliant study that concentrations of 5, 000 μg/plate of a CO2 supercritical extract of C. sativa were not mutagenic in a bacterial test system. Our GLP-compliant mutagenicity testing on the diluted extract showed that concentrations of 76,355 μg/plate were not mutagenic with and without the S9 metabolic activation. The extracts produced by isopropanol extraction and supercritical CO2 extraction were not mutagenic with and without S9 metabolic activation at concentrations up to 5000 μg/plate. The bacterial test system with the S9 mix did cause mutagenicity providing evidence that mutagenic metabolites were not produced with any of the extracts. The two additional Ames tests conducted on the undiluted extracts produced by two different extraction methods, were conducted to determine if the method of production or the olive oil diluent impacted the results of the Ames assay. No mutagenicity was noted in any of the tests conducted. Other botanical extracts have been evaluated for mutagenicity. Mutagenic studies on extracts from the plant Euphorbia triaculeata showed that it is not mutagenic and provides protection from the mutagenic effects of cyclophosphamide.A study on a novel taste modulating powder derived from Cordyceps sinensis showed this product was not mutagenic in the Ames test and these results were supported in the micronucleus assay. In a study on the genotoxicity of CBD in Caco-2 cells, 10 μM of CBD did not significantly cause DNA damage after 24 hours of incubation, and CBD was also shown in the comet assay to protect Caco-2 cells from hydrogen peroxide-induced DNA damage. CBD at an oral dose of 1 mg/kg was shown to significantly reduce azoxymethane-induced colonic aberrant crypt foci, colonic polyps and tumors. In summary, the test article, both undiluted and diluted in olive oil, was not mutagenic in a bacterial reverse mutation assay and the NOAEL in the 90-day study was concluded to be 800 mg/kg bw/day and 400 mg/kg bw/day for female and male Sprague Dawley rats, respectively. This assessment adds significant data to the currently available literature as to the safety and toxicology of CBD rich hemp extracts. Given the potential of CBD for a variety of human uses and the limited data currently available, these results support that hemp extracts are likely safe human consumption and additional studies should be conducted to validate this conclusion. Natural lignocellulosic fibers are in past decades gaining increased attention as sustainable materials for polymer composite reinforcement in substitution of energy intensive and non-recyclable synthetic fibers. Indeed, NLF reinforced composites are being considered for applications in civil construction, food packing, automotive components and ballistic armor. It is worth mentioning that nanocellulose fibrils obtained from NLFs are being investigated as possible reinforcement for novel bio-nanocomposites with special properties for medical applications as well as production of biodegradable plastic films. A well known NLF, the hemp fiber, has been for decades extensively reported as reinforcement of polymer composites in numerous articles and mentioned in most review papers. In fact, hemp fiber/polypropylene has been used as automotive parts. The remarkable mechanical properties of the hemp fiber, tensile strength of 900 MPa and modulus of 70 GPa, offer a possibility of use in ballistic armor reinforcing stronger thermoset polymeric matrices such as epoxy and polyester. This ballistic application has not yet been investigated in hemp fiber composites. Therefore, the objective of the present work is, for the first time, to compare the mechanical properties, evaluated by bend and tensile tests, of both epoxy and polyester composites reinforced with different amounts of hemp fibers. This would allow a definition, in terms of matrix and incorporated volume fraction, of the most suitable composite for application in multilayered armor system.The hemp fibers, Cannabis sativa, investigated in this work were supplied by Designan Fibras Naturais, Brazil, as a bundle illustrated in Fig. 1. Fibers were separated, washed in running water and dried at room temperature for one week. Characterization of the hemp fibers was conducted prior to their processing in composites. One hundred fibers were randomly pick up and measured in a profile projector Nikkon, Japan, to determine the equivalent mean diameter. The average density was obtained by the mass, in a 0.001 g precision scale, divided by the volume considering cylindrical fiber. Both epoxy and polyester resins were purchased from Resinpoxy, Brazil. The epoxy was a diglycidyl ether of the bisphenol A hardened with stoichiometric phr 13 of triethylene tetramine as the catalyst. The polyester was an unsaturated ortoftalic resin hardened with 2 wt% of methyl ethyl ketone for the curing process.Fabrication of the composites for mechanical tests was carried out by laying up continuous and aligned hemp fibers inside a steel mold, Fig. 2, trim tray pollen with internal volume of 150 × 120 × 7mm. Fibers were first cut and weighed according to the volume fraction, calculated by considering their previously evaluated density as well as the densities of epoxy and polyester from. Just before processing, the fibers were dried in a stove at 60 ◦C for 3h. Layers of fibers were placed inside the mold together with either epoxy or polyester resin, already mixed with corresponding hardener. After closing the mold, a pressure of 1 ton was applied and left to cure for 24h at RT. The produced composite plate, Fig. 2, was machined into 150 × 10 × 7mm prismatic specimens for 3 points bend tests as per ASTM D790 standard. Flat tensile specimens were directly fabricated in a specially designed steel mold, Fig. 3, in which hemp fibers were aligned together with the chosen resin already mixed with corresponding hardener. Shape of specimens with 7 × 7mm of gage cross section and 20mm of gage length as per ASTM D 638 standard. A pressure of approximately 1 MPa was applied to the mold’s lid during the cure at RT for 24h. Both flexural and tensile tests were carried out in a model 5582 Instron machine, USA, operating at RT and a crosshead speed of 0.5mm/min. Fracture analysis of ruptured specimens was performed by scanning electron microscopy in a model SSX-550 Shimadzu microscope, Japan, operating with secondary electron at 20 kV. Fourier transform infrared analysis was performed to detect functional groups in the hemp fibers as well as the effect caused by addition of these fibers in the epoxy functional group. Band spectra were obtained in a model IR-Prestige- 21 Shimadzu spectrometer, Japan, using 2mg pressed ground samples mixed with 110mg of KBr.Frequency histogram for the equivalent diameter of the as-received hemp fibers is shown in Fig. 4. The average length is 76.6mm, while the average diameter, Fig. 4, was found as 65 m. The density of the fibers was obtained as 1.35 ± 0.27 g/cm3 with thinner fibers presenting comparatively higher densities. Fig. 5 shows FTIR spectra of the hemp fiber and three hemp fiber/epoxy composites. The hemp fiber spectrum in Fig. 5 displays intense broad bands centered at 3333 and 2916 cm−1 that could be associated with O H and C–H groups in the fiber cellulose. The sharp band at 1738 cm−1 might be assigned to the C O stretching of carboxylic group of hemicellulose, while the band at 1656 cm−1 was indicated as C C as stretching of unsaturated acids or sterols in tannin. The band at 1510 cm−1 was associated with the aromatic skeletal vibration of lignin. Bands at 1425 and 1377 cm−1 and around were attributed to C–H bending as well as C–H2 rocking vibration of Fig. 4 – Histogram for equivalent diameter of the as-received hemp fibers. groups in lignin and cellulose. The 1160 and 1030 cm−1 bands were assigned to cellulose, respectively, C–O C asymmetric valence vibration and C–O stretching primary alcohol. Finally, the band at 897 cm−1 corresponds to C–H rocking vibrations of cellulose. The FTIR spectra of the hemp fibers/epoxy composites in Fig. 5 revealed bands corresponding to the plain DGEBA/TETA epoxy such as: 2963 and 2866 cm−1 assigned to C–H alkyl group; 1612 and 1510 cm−1 assigned to C C phenyl ring; 1456 and 1257 cm−1 assigned to H C–H groups; 1255 and 1030 cm−1 assigned to C–O C ether; and a small 915 cm−1 band assigned to vibration of epoxide group.

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