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Showing posts from October, 2015

New House Speaker Paul Ryan’s Mixed Views on Medical Cannabis

WASHINGTON, DC — Wisconsin Congressman and former Vice Presidential Candidate, Paul Ryan, was elected as the 54th Speaker of U.S. House of Representatives on Thursday. The question that may be on the minds of patient activists is how the new Speaker will act on the issue of medical cannabis. Outgoing Speaker John Boehner may not have […]New House Speaker Paul Ryan’s Mixed Views on Medical Cannabis | The Daily Chronic

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A Prospective Study of the Clinical Content of Palliative Medicine Interdisciplinary Team Meetings

Structured interprofessional communication should improve the structure and clarity of the plan of care. The interdisciplinary team meeting (IDTM) is an opportunity for shared information on patients’ and family care needs. We report a prospective observations study of palliative medicine IDTM, which recorded the clinical issues discussed. One hundred and forty-five disparate clinical items were identified for 59 patients and were discussed by the IDTM in about 240 minutes. By content analysis and research meeting consensus, they were grouped into 9 agreed interdisciplinary themes. The 9 themes were then subjected to biostatistical analysis and 3 communication clusters identified. Themes consisted of 3 major communication clusters: (1) clinical services, (2) psychosocial, and (3) care plan. Two themes (information exchange and clinical transitions) did not cluster. The IDTM identified patient care need, reported concerns, and supported collaboration in proactive patient care plans. Fu…

Understanding the Views of Those Who Care for Patients With Cancer on Advance Care Planning and End-of-life Care

An electronic survey was used to assess the views of a diverse nationwide cohort of health care professionals regarding advance care planning and end-of-life care. A total of 645 responses were received. If diagnosed with a serious incurable illness with limited life expectancy, 97% would want to discuss their prognosis, 74% would refuse cardiopulmonary resuscitation, and 72% favored supportive/comfort care to more aggressive life-prolonging treatments. However, prognosis was thought to be discussed with only 52% of such patients, and just 5% thought doctors were either very or extremely successful at explaining advanced life-sustaining treatments to patients. Greater than 90% believed these discussions should best occur when a patient is thought to have one or more years to live and 80% thought they are best initiated in the outpatient setting.

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Concerns of Patients Undergoing Palliative Chemotherapy for End-Stage Carcinomatous Peritonitis

We sought to identify how nurses can help to alleviate the concerns of inpatients undergoing palliative chemotherapy when the treatment effects are weakening. Semistructured interviews were conducted with 8 inpatients receiving palliative chemotherapy for end-stage carcinomatous peritonitis at a university hospital. Qualitative inductive analysis of the interview data revealed 7 categories of patient concerns. Overall, patients faced many dilemmas and expressed concerns about wanting to continue chemotherapy while also thinking about discontinuing it. However, they also expressed hope, the strength of which was influenced and changed in complex ways by each treatment outcome and the severity of their physical symptoms. From these results, we suggest specific aspects of nursing care for patients with end-stage cancer who are receiving palliative chemotherapy that is becoming less effective.

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Attitudes of Medical Students Toward the Care of the Dying in Relation to Personality Traits: Harm Avoidance and Self-Directedness Make a Difference

Caring for dying patients requires specific attitudes. Medical students often feel unprepared to cope with issues related to end-of-life care. Little is known about the relationships between personality and attitudes toward the dying; consequently, it is difficult for medical educators to devise training that is best suited to prepare students for practicing palliative medicine. The study aimed to investigate the role of personality in predicting students’ attitudes toward the care of the dying. The study findings suggest a significant link between more self-directed and less harm-avoidant personality profiles and more developed attitudes toward the dying. Personality assessment in medical curricula is important, not merely to help teachers plan tailored training but also to foster in future doctors the propensity to develop a patient-centered practice.

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Integrating Early Palliative Care for Patients With HIV: Provider and Patient Perceptions of Symptoms and Need for Services

Increasingly clinicians are using palliative care to address the symptomatic and psychosocial effects of disease often missed by routine clinical care, termed "early" palliative care. Within an inner-city medical center, we began a program to integrate early palliative care into HIV inpatient care. Patient symptom burden and desired services were assessed and compared to provider perceptions of patient’s needs. From 2010-2012, 10 patients, with a median CD4+ T-cell count of 32.5 cells/μL, and 34 providers completed the survey. Providers ranked their patients’ fatigue, sadness, anxiety, sexual dysfunction, and body image significantly higher than patients it for themselves. Patients ranked medical care, pharmacy, social work, physical therapy, and housing as significantly more important to them than providers estimated them to be. These differences may reflect the fact that physicians often overlook patients’ unmet basic needs. Early palliative care may narrow this gap betwee…

Ketamine PCA for Treatment of End-of-Life Neuropathic Pain in Pediatrics

Control of neuropathic pain (NP) for children at end of life is challenging. Ketamine improves control of NP, but its use in children is not well described. We describe a retrospective case review of 14 children with terminal prognoses treated with ketamine patient-controlled analgesia (PCA) for management of opioid-refractory NP at the end of life. Median ketamine dose was 0.06 mg/kg/h (range 0.014-0.308 mg/kg/h) with a 0.05 mg/kg (range 0.03-0.5mg/kg) demand dose available every 15 minutes (range 10-60 minutes). All patients noted subjective pain relief with ketamine, and 79% had no adverse effects. Benzodiazepines limited neuropsychiatric side effects. Ketamine treatment arrested dose escalation of opioids in 64% of patients, and 79% were discharged to home hospice. Ketamine PCA is an effective, well-tolerated therapy for opioid-refractory NP in pediatric end-of-life care.

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Geographic Access to Hospice Care for Children With Cancer in Tennessee, 2009 to 2011

The geographic interface between the need for and the supply of pediatric hospice may be critical in whether children with cancer access care. This study sought to describe the geographic distribution of pediatric hospice need and supply and identify areas lacking pediatric hospice care in Tennessee over a 3-year time period. Using ArcGIS, a series of maps were created. There was a consistent need for care among children with cancer across the state. Most urban areas were supplied by pediatric hospices, except the Knoxville area. Areas within the state were identified where the supply of pediatric hospice care declined, while the need for hospice care was unchanging. This study has important regulatory implications for clinicians practicing in certificate of need states such as Tennessee.

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An Interprofessional Workshop for Students to Improve Communication and Collaboration Skills in End-of-life Care

Interprofessional care is critical for patients at the end of life (EOL), but programs to teach communication skills to medical and nursing students are rare. The aims of this study were to determine whether an interprofessional workshop improves (1) student attitudes toward teamwork and (2) self-efficacy for communicating in difficult situations. Nursing and medical students attended a workshop with collaborative role play of an EOL conversation. Before the workshop, students showed different attitudes toward teamwork and collaboration and varying levels of confidence about communication skills. After the workshop, both groups reported more positive attitudes toward teamwork but a mixed picture of confidence in communication. Experiential interprofessional education workshops enhance perceptions about the benefits of teamwork, but further teaching and evaluation methods are needed to maximize the effectiveness.

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Buprenorphine for Cancer Pain: Is It Ready for Prime Time?

Buprenorphine (BUP) is a semisynthetic derivative of the opium alkaloid thebaine found in the poppy Papaver somniferum. Its chemical structure contains the morphine structure but differs by having a cyclopropylmethyl group. Buprenorphine is a potent µ opioid agonist. Buprenorphine undergoes extensive first-pass metabolism in the liver and gut. The development of a transdermal BUP formulation in 2001 led to its evaluation in cancer pain. This article provides the practitioner with an update on the current role of BUP in cancer care. It highlights data suggesting effectiveness in various types of cancer pain. The article reviews pharmacology, routes of administration, adverse effects, drug interactions, and cost considerations.

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Hemp Advocacy Organization Calls on Obama Administration and DOJ to Intervene in Favor of Menominee Indian Tribe

WASHINGTON, DC — Vote Hemp, the nation’s leading grassroots hemp advocacy organization working to change state and federal laws to allow commercial hemp farming, has released a statement in response to the undue and wrongful raid of industrial hemp crops on the sovereign land of the Menominee Indian Tribe by the Drug Enforcement Administration, which occurred […]Hemp Advocacy Organization Calls on Obama Administration and DOJ to Intervene in Favor of Menominee Indian Tribe | The Daily Chronic

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President Obama Calls for Limit on Standardized Testing

Barack Obama’s administration has suggested that no more than 2 percent of classroom time to be spent on standardized testing, saying too much testing is “unnecessary” and redundant. A new study from the Council of Great City Schools has revealed that students spend 20 to 25 hours each year on standardized testing.

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Support for Legalization Continues to Grow Into the Future

Public policy, in a democracy, depends on the will of a majority of the citizens. Only when a clear majority favor a change in policy can that change occur, and even then, when working with elected legislators, these is always a significant lag between a change in the public attitudes, and a change in public […]Support for Legalization Continues to Grow Into the Future | The Daily Chronic

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Sunday Showcase: The Safety Case by Black Rock Originals

For the ultimate in discrete mobility, here’s a new product on the market for the stoner on the go — the Safety Case by Black Rock Originals. What looks like a sunglasses case at first glance is actually a durable, smell-proof carrying case designed for cannabis consumers to safely and discretely bring a few essential smoking supplies […]Sunday Showcase: The Safety Case by Black Rock Originals | The Daily Chronic

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Historic Criminal Justice Bill Passes Senate Judiciary Committee

WASHINGTON, DC — The Senate Judiciary Committee voted 15 to 5 on Thursday to advance the Sentencing Reform and Corrections Act. The bill, introduced by Senator Chuck Grassley (R-IA), and sponsored by ten other Senators, would reduce mandatory minimum sentences for drug offenses, expand the federal “safety valve” (which allows judges to use their discretion […]Historic Criminal Justice Bill Passes Senate Judiciary Committee | The Daily Chronic

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Leaked UN Paper Calls for Decriminalizing Drug Use and Possession

The UN Office on Drugs and Crime (UNODC) appeared set to call on governments to end the criminalization of drug use and possession, according to DPA Honorary Board Member Richard Branson – but in a dramatic turn of events withdrew a briefing paper under pressure from at least one country, according to the BBC. “On […]Leaked UN Paper Calls for Decriminalizing Drug Use and Possession | The Daily Chronic

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Federal Government Says Gay “Conversion Therapy” Must End

The Substance Abuse and Mental Health Services Administration has a new report that calls for an end to gay “conversion therapy.” These therapies try to change teens’ sexual orientation or gender identity and are not based on science. The SAMHSA calls them “not effective” and “harmful” to the mental health of young people.

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A Ski Adventure Freed the Old Me

For the past couple of years, I hadn't gotten around to working out, despite my best intentions. I was consumed with keeping up with my 4-year-old and tending to a colicky baby as I fueled myself with coffee and soothed my nerves with an evening glass or two of wine. I was still carrying the 20 pounds I'd gained from pregnancy, along with another 10 I put on post baby. (Breast-feeding apparently doesn't burn off daily doughnuts and dishes of ice cream.) I felt trapped and depressed, and I regularly fantasized about who I was before I became a mom: a fairly stylish and ambitious woman who never left the house without lip gloss on. Now I frequently snapped at my husband and felt oppressed by the endless household to-dos.

And then, salvation: an invitation to ski at two Wyndham resorts, in Beaver Creek and Aspen, for five days (on a press trip). I grew up skiing but hadn't done it in forever. As much as I wanted to go, though, my motivation was at rock bottom. My husband—…

Selena Gomez Opens Up About Her Struggle with Lupus

Singer and actress Selena Gomez has been diagnosed with lupus and said she has had chemotherapy to treat it. Lupus is a disease in which your immune system attacks your own body. Lupus affects women far more than men, especially women in their late teens or twenties. One and a half million Americans and up to 50,000 Canadians have lupus. The disease can be treated with various medications, including low doses of chemotherapy drugs.

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4 Top Exercises for Your Hips and Abs

Hips don't lie; if they're weak, you'll have a saggy stomach and be at risk for injuries. In this video, contributing fitness editor Tracy Anderson shows you four moves that will firm them up and give you a stronger, flatter belly. Do these six days a week, paired with 30 to 60 minutes of cardio.

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Maryland: Take Action to Stop County-Wide Dispensary Bans

As the Natalie M. LaPrade Maryland Medical Cannabis Commission moves forward with implementing Maryland’s medical cannabis program, local governments in the state are now considering the issue of zoning requirements for medical cannabis business. Currently, the Anne Arundel County Council is the only local government with current zoning legislation pending and the impact could harm patients across […]Maryland: Take Action to Stop County-Wide Dispensary Bans | The Daily Chronic

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6,000 People to be Released from Federal Prison Nov. 1st Due to New Drug Sentencing Guidelines

WASHINGTON, DC — Starting November 1, 6,000 federal prisoners are to be released from federal prison, a move that is the result of changes made by the U.S. Sentencing Commission last year that lowered federal sentencing guidelines for people convicted under draconian drug war-era laws. “It warms my heart to hear that 6,000 people will […]6,000 People to be Released from Federal Prison Nov. 1st Due to New Drug Sentencing Guidelines | The Daily Chronic

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Organizational Barriers to Cultural Competence in Hospice

This national mixed method study with directors of 207 hospices identified major barriers to cultural competence, including (1) lack of funding for additional staff for community outreach or development of culturally competent programs, (2) lack of applications from diverse professionals, and (3) lack of knowledge about diverse cultures and what cultural groups in the community are not being served. Qualitative results indicated that elements of an organizational culture, which create barriers to access included (1) failure to prioritize cultural competence, (2) failure to budget for culturally competent services, and (3) a staff that does not value awareness of cultural differences, is uncomfortable with diversity, and stereotypes diverse individuals. In phase 2, an interactive session with a 100-symposium audience provided strategies to address the barriers.

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Changes in and Associations Among Functional Status and Perceived Quality of Life of Patients With Metastatic/Locally Advanced Cancer Receiving Rehabilitation for General Disability

The primary aims were to clarify the changes in the functional status and quality of life of patients with metastatic/locally advanced cancer who received rehabilitation therapy. This is a cohort study, and all consecutive patients who received rehabilitation therapy were evaluated before and 2 weeks after. Outcome measures were the Functional Independence Measure (FIM), perceived independence, and overall quality of life (European Organization for Research and Treatment of Cancer C30). A total of 128 patients were included. Although the FIM score significantly decreased, the overall quality of life significantly increased. Even in the patients with deteriorated FIM scores, the overall quality of life was maintained despite a significantly decreased perceived independence. Terminally ill patients with cancer who received a rehabilitation program maintained their overall quality of life despite an objective decline in the physical functional status.

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The Cost of Inappropriate Care at the End of life: Implications for an Aging Population

Elderly patients patients (older than 65 years) account for only 11% of the US population yet they account for 34% of health care expenditure. The disproportionate usage of health care costs by elderly patients is in striking contrast with that of other Western Nations. It is likely that these differences are largely due to variances in hospitalization and the use of high technology health care resources at the end of life. The United States has 8 times as many intensive care unit (ICU) beds per capita when compared to other Western Nations. In the United States, elderly patients currently account for 42% to 52% of ICU admissions and for almost 60% of all ICU days. A disproportionate number of these ICU days are spent by elderly patients before their death. In many instances, aggressive life supportive measures serve only to prolong the patient’s death. Such treatment inflicts pain and suffering on the patient (with little prospects of gain) and incurs enormous financial costs to the …

Prior Study of Cross-Cultural Validation of McGill Quality-of-Life Questionnaire in Mainland Mandarin Chinese Patients With Cancer

The validation of McGill quality-of-life questionnaire (MQOLQ) in mainland China, which had already been used in multicultural palliative care background including Hong Kong and Taiwan, remained unknown. Eligible patients completed the translated Chinese version of McGill questionnaires (MQOL-C), which had been examined before the study. Construct validity was preliminarily assessed through exploratory factor analysis extracting 4 factors that construct a new hypothesis model and then the original model was proved to be better confirmed by confirmatory factor analysis. Internal consistency of all the subscales was within 0.582 to 0.917. Furthermore, test–retest reliability ranged from 0.509 to 0.859, which was determined by Spearman rank correlation coefficient. Face validation and feasibility also confirm the good validity of MQOL-C. The MQOL-C has satisfied validation in mainland Chinese patients with cancer, although cultural difference should be considered while using it.

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Students, Severe Illness, and Palliative Care: Results From a Pilot Study on a School-Based Intervention

This study was aimed at piloting a school-based intervention on severe illness, within a project focused on spreading knowledge of palliative care among high school students (phases 0-2 Medical Research Council Framework). The intervention entailed the screening of a topic-related movie, 2 classroom meetings, and the development of a class-based multimedia production. Five classes from 5 high schools participated in this study, and a before–after evaluation was used to assess intervention feasibility and impact. Valid questionnaires were filled in by 84% (before) and 79% (after) of the 89 students. Concerning students’ knowledge on palliative care, the after evaluation showed a significantly higher paired proportions of students reporting on "improving patient quality of life" and "life-threatening illness." Intervention components were deemed helpful by students, and positive feedback on the experience was given.

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Expectation in Life Review: A Term of Spiritual Needs Easily Understood by Chinese Hospice Patients

Terms such as spirituality and spiritual needs are abstract and difficult to understand. Realization of spirituality of hospice patients was premise in addressing expression of their spiritual needs. This study investigated expectations expressed during life review and tried to prove that the expectation was intelligible term for spiritual needs in Chinese hospice from May 2011 to June 2013. Among the 107 recruited patients, families were the most frequent emotion-expressing recipients, and 133 expectations related to patients’ spiritual needs were identified. The emotion-expressing recipients and the patient’s expectations were not affected by demographic characteristics. The expectations in life review with hospice patients and their families had the features of spiritual essence. The identified expectation contents could be used to address spiritual needs in hospice care in Chinese.

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The Stress of Sadness: The Most Stressful Symptoms for Hospice Family Caregivers

A family member or friend is often a hospice patient's primary caregiver and, as such, may face a significant number of stressors, including challenges related to managing patient symptoms. This study investigated the most stressful patient symptoms as reported by 111 hospice family caregivers of cancer (n=66) and cardiopulmonary (n=45) patients. Researchers calculated the mean level of stress caregivers attributed to 32 different patient symptoms commonly encountered at end of life. They found the symptoms perceived as most stressful for caregivers were psychological in nature. Study findings suggest that members of the hospice interdisciplinary team should connect patients and their caregivers to various types of support to address psychological symptoms, benefitting patients and caregivers alike.

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Examining Forms of Spiritual Care Provided in the Advanced Cancer Setting

Spiritual care (SC) is important to the care of seriously ill patients. Few studies have examined types of SC provided and their perceived impact. This study surveyed patients with advanced cancer (N = 75, response rate [RR] = 73%) and oncology nurses and physicians (N = 339, RR = 63%). Frequency and perceived impact of 8 SC types were assessed. Spiritual care is infrequently provided, with encouraging or affirming beliefs the most common type (20%). Spiritual history taking and chaplaincy referrals comprised 10% and 16%, respectively. Most patients viewed each SC type positively, and SC training predicted provision of many SC types. In conclusion, SC is infrequent, and core elements of SC—spiritual history taking and chaplaincy referrals—represent a minority of SC. Spiritual care training predicts provision of SC, indicting its importance to advancing SC in the clinical setting.

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Potential Conflicting Interests for Surgeons in End-of-Life Care

Thirty-day mortality represents a variable that is commonly used to measure the quality of surgical care. The definition of 30-day mortality and the application of a risk adjustment to its measurement may vary among different organizations comparing physician quality. In the midst of this confusion, conflicting interests arise for surgeons who must weigh the potential benefit of surgical interventions to individual patients versus the potential loss of access by future patients should 30-day mortality ratings be adversely affected. Similarly, surgeons may become adversely impacted by the lack of compensation from avoiding "high-risk" cases, but might face a more severe financial impact if they have a higher mortality rating compared to their peers.

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The Effect of Social Support and Meaning of Life on the Quality-of-Life Care for Terminally Ill Patients

This study examines the effect of 2 indicators on quality of life (QOL): social support and meaning of life for terminally ill patients. These 2 indicators are very important from a psychological and spiritual point of view. The findings suggest that there is a statistically significant correlation between meaning of life and QOL (r = .610, P < .001). Results have also demonstrated that more frequent patient visits increase the sense of life fulfillment for dying patients. A significant relationship exists in survival of life meaningfulness and satisfaction with social support. In conclusion, experiencing one’s life as meaningful is positively related to the well-being for dying patients. Social support provided by a close relative had a positive influence on the patient’s meaning of life and overall life satisfaction.

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Timing of Palliative Care Consultations and Recommendations: Understanding the Variability

Palliative care consultation teams (PCCTs) provide care that enhances quality of life. The effectiveness of PCCTs depends, however, on their timely utilization by other providers. The goal of this study was to examine the timing of palliative care consultation requests and responses at a single Veteran Affairs Medical Center. The median interval between admission and consultation request was 5 days (range = 0-73 days). The median interval between consultation request and death was 23 days (range = 0-847 days). In logistic regressions, timing variables were not significant predictors of whether consultation recommendations were made or implemented. There is substantial variability in when patients receive a palliative care consultation. Many patients receive palliative care within the first week of hospitalization and their final month of life.

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Ecuador Backtracks on Criminal Justice Reforms, Increases Penalties for Drug Selling

QUITO, ECUADOR — In a disappointing move, Ecuador increased penalties for small-scale drug sellers yesterday, reversing reforms approved last year that differentiated between possession of small amounts of drugs and larger quantities with intent to sell, where there had previously been no differentiation. However, yesterday the National Assembly voted to modify the criminal code and […]Ecuador Backtracks on Criminal Justice Reforms, Increases Penalties for Drug Selling | The Daily Chronic

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Canadian Research Study Demonstrates Medical Cannabis Safety Profile

MONTRÉAL, QUÉBEC — Researchers associated with McGill University and the University of British Columbia recently published results from a study showing that medical cannabis patients were no more likely to suffer serious adverse events during treatment than non-cannabis patients. “Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS),” published online in the Journal […]Canadian Research Study Demonstrates Medical Cannabis Safety Profile | The Daily Chronic

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First Church of Cannabis Parodied on The Late Show with Stephen Colbert

Stephen Colbert parodies The First Church of Cannabis in his comedic segment "Stephen Colbert Gets All up in Your Faith."

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Free Weed: Episode 85

Episode 85 of Free Weed was recorded live at the 2015NorCalMedical Cannabis Cup. It is also the third episode of HIGH TIMES Presents Free Hash from DannyDanko.

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Selfies Kill More People In One Year Than Weed Ever Has

Mashable recently released an article that tallied the number of ‘selfie’ related deaths in the first three-quarters of 2015. So far, there have been a total of 12 selfie related deaths (that we know of). Beware of Selfies Falling was the number one cause of selfie deaths this year, followed by being hit by a […]Selfies Kill More People In One Year Than Weed Ever Has | The Daily Chronic

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Trippy Art at Symbiosis Festival

Move over Burning Man! Another West Coast transformational festival is delighting people with its mix of participatory art, all-night dance parties and refreshing aquatic adventures. Check out the amazing installations and sculptures that make this event so special. &...

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First Church of Cannabis Parodied on The Late Show with Stephen Colbert

Stephen Colbert parodies The First Church of Cannabis in his comedic segment "Stephen Colbert Gets All up in Your Faith."

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Psychedelicatessen: Grilled Peach Pot Salad

"Welcome to Psychedelicatessen, a weekly column exploring the world of cannabis cuisine, including recipes from the great chefs and ganjapreneurs who fuel our appetite for adventure."

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Afends Presents: 'The Hemp Revolution' Trailer

Australian brandAfendsalready made wave with their epic video skating in Australia's largest hemp field, but now the brand is taking itsself-proclaimed sustainable legend status one step further.Afend'slatest foray into filmmaking is ...

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Nico's Nuggets: Notes on Transplanting Seedlings and Clones

There are a couple of simple guidelines you can follow when it comes to transplanting that will make your decision making easy. To begin with, the time to transplant is mostly predicated by a single factor: Root development. The container size you transplant into will dep...

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Growing Medicine in Michigan

Ashley, a legal medical cannabis patient in Michigan, got off 27 different prescription medications with the help of cannabis. She now grows her own medicine and feels liberated.

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US Senate Reaches Significant Deal to Reduce Prison Population and Reform Mandatory Minimums

WASHINGTON, DC — Today, a bipartisan group of Senators announced a historic deal on criminal justice reform, rounding out a negotiation process that has lasted almost five months. The Sentencing Reform and Corrections Act, spearheaded by Judiciary Committee Chairman Chuck Grassley (R-IA), will involve reductions in mandatory minimum sentences for drug offenses, an expansion of […]US Senate Reaches Significant Deal to Reduce Prison Population and Reform Mandatory Minimums | The Daily Chronic

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