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BACKGROUND: There has been a significant increase in methamphetamine use and methamphetamine use disorder (Meth UD) in the United States, with evolving racial and ethnic differences. OBJECTIVES: This secondary analysis explored racial and ethnic differences in baseline sociodemographic and clinical characteristics as well as treatment effects on a measure of substance use recovery, depression symptoms, and methamphetamine craving among participants in a pharmacotherapy trial for Meth UD. METHODS: The ADAPT-2 trial (ClinicalTrials.gov number, NCT03078075; N=403; 69% male) was a multisite, 12-week randomized, double-blind, trial that employed a two-stage sequential parallel design to evaluate the efficacy of combination naltrexone (NTX) and oral bupropion (BUP) vs. placebo for Meth UD. Treatment effect was calculated as the weighted mean change in outcomes in the NTX-BUP minus placebo group across the two stages of treatment. RESULTS: Of the 403 participants in the ADAPT-2 trial, the majority (65%) reported non-Hispanic White, while 14%, 11% and 10% reported Hispanic, non-Hispanic Black, and non-Hispanic other racial and ethnic categories respectively. At baseline non-Hispanic Black participants reported less severe indicators of methamphetamine use than non-Hispanic White. Treatment effects for recovery, depression symptoms and methamphetamine cravings did not significantly differ by race and ethnicity. CONCLUSIONS: Although we found racial and ethnic differences at baseline, our findings did not show racial and ethnic differences in treatment effects of NTX-BUP on recovery, depression symptoms and methamphetamine cravings. However, our findings also highlight the need to expand representation of racial and ethnic minority groups in future trials.

California’s legislative and regulatory goals for renewable energy are changing the power grid’s dynamics. Increased variable generation resource penetration connected to the bulk power system, as well as, distributed energy resources (DERs) connected to the distribution system affect the grid’s reliable operation over many different time scales (e.g., days to hours to minutes to seconds). As the state continues this transition, it will require careful planning to ensure resources with the right characteristics are available to meet changing grid management needs.Demand response (DR) has the potential to provide important resources for keeping the electricity grid stable and efficient, to defer upgrades to generation, transmission and distribution systems, and to deliver customer economic benefits. This study estimates the potential size and cost of future DR resources for California’s three investor-owned utilities (IOUs): Pacific Gas and Electric Company (PG&E), Southern California Edison Company (SCE), and San Diego Gas & Electric Company (SDG&E).Our goal is to provide data-driven insights as the California Public Utilities Commission (CPUC) evaluates how to enhance DR’s role in meeting California’s resource planning needs and operational requirements. We address two fundamental questions:What cost-competitive DR service types will meet California’s future grid needs as it moves towards clean energy and advanced infrastructure?What is the size and cost of the expected resource base for the DR service types?Demand response operates across a range of timescales from transient responses in seconds to long-run shifts in daily behavior, and the value created by DR depends on the timescale of the response. This dynamic necessitated a new framework for potential study analysis, and we developed a supply curve modeling framework to express the availability of system-level grid services from distributed resources, based on large samples of Smart Meter Load Sha

IntroductionReproductive injustices such as forced sterilization, preventable maternal morbidity and mortality, restricted access to family planning services, and policy-driven environmental violence undermine reproductive autonomy and health outcomes, with disproportionate impact on historically marginalized communities. However, curricula focused on reproductive justice (RJ) are lacking in medical education.MethodsWe designed a novel, interactive, case-based RJ curriculum for postclerkship medical students. This curriculum was created using published guidelines on best practices for incorporating RJ in medical education. The session included a prerecorded video on the history of RJ, an article, and four interactive cases. Students engaged in a 2-hour small-group session, discussing key learning points of each case. We evaluated the curriculum's impact with a pre- and postsurvey and focus group.ResultsSixty-eight students participated in this RJ curriculum in October 2020 and March 2021. Forty-one percent of them completed the presurvey, and 46% completed the postsurvey. Twenty-two percent completed both surveys. Ninety percent of respondents agreed that RJ was relevant to their future practice, and 87% agreed that participating in this session would impact their clinical practice. Most respondents (81%) agreed that more RJ content is needed. Focus group participants appreciated the case-based, interactive format and the intersectionality within the cases.DiscussionThis interactive curriculum is an innovative and effective way to teach medical students about RJ and its relevance to clinical practice. Walking alongside patients as they accessed reproductive health care in a case-based curriculum improved students' comfort and self-reported knowledge on several RJ topics.

BackgroundDuring professional identity formation, medical students integrate their newly developing professional identities with their longstanding personal identities. Longitudinal mentorship has been shown to aid students in this process. Lack of clear relationship expectations among students and faculty is a barrier to effective longitudinal mentorship relationships.MethodsA cross-sectional, survey-based study collected information about experiences from both students (mentees) and faculty (mentors). Surveys focused on collecting participants' attitudes and expectations regarding ideal and actual mentorship experiences. Descriptive statistics and Fisher's exact test analyses were used to compare the responses within and between students and faculty.ResultsA total of 234 faculty and 181 medical students completed the survey. There were 187 faculty respondents (79.9%) who had previously mentored students. Faculty who had versus had not previously mentored students differed significantly in their responses on the importance of mentors discussing aspects of their personal lives (71.1% vs. 54.3%, respectively, p = 0.0491), a quality valued by the majority of student respondents. As students progressed through medical school, they expressed increasing needs for personal mentorship and conversations regarding work/life integration and wellness (M1: 12.2%, M2: 18.8%, M3: 29.3%, M4: 51.7%). A minority of students (27% of M3 and 14.8% of M4 students) reported meeting faculty mentors through their clinical year experiences.ConclusionsFaculty mentoring experience may improve student-faculty value alignment, which may in turn help to address student-identified needs pertaining to personal development and professional identity formation in medical school. By contrasting student-identified mentorship expectations with those of faculty at various stages of mentorship experience, this study lays the groundwork for the formation of more effective longitudinal mentorship programs.

California’s legislative and regulatory goals for renewable energy are changing the power grid’s dynamics. Increased variable generation resource penetration connected to the bulk power system, as well as, distributed energy resources (DERs) connected to the distribution system affect the grid’s reliable operation over many different time scales (e.g., days to hours to minutes to seconds). As the state continues this transition, it will require careful planning to ensure resources with the right characteristics are available to meet changing grid management needs.Demand response (DR) has the potential to provide important resources for keeping the electricity grid stable and efficient, to defer upgrades to generation, transmission and distribution systems, and to deliver customer economic benefits. This study estimates the potential size and cost of future DR resources for California’s three investor-owned utilities (IOUs): Pacific Gas and Electric Company (PG&E), Southern California Edison Company (SCE), and San Diego Gas & Electric Company (SDG&E).Our goal is to provide data-driven insights as the California Public Utilities Commission (CPUC) evaluates how to enhance DR’s role in meeting California’s resource planning needs and operational requirements. We address two fundamental questions:What cost-competitive DR service types will meet California’s future grid needs as it moves towards clean energy and advanced infrastructure?What is the size and cost of the expected resource base for the DR service types?Demand response operates across a range of timescales from transient responses in seconds to long-run shifts in daily behavior, and the value created by DR depends on the timescale of the response. This dynamic necessitated a new framework for potential study analysis, and we developed a supply curve modeling framework to express the availability of system-level grid services from distributed resources, based on large samples of Smart Meter Load Sha

While thirty years of research into an effective cocaine pharmacotherapy has yielded no treatments, knowledge gained doing this work underscores the importance of rigorous clinical design, of attention to medication adherence and of defining endpoints. The field needs a high-risk/high-reward strategy to engineer new compounds that help people to use less cocaine and to preserve gains made during treatment, particularly during lapse/relapse.

Commercial lighting represents a significant potential source of demand response (DR) for the electrical grid, via traditional load shedding and rapid-dispatch (fast-DR) ancillary services when DR is enabled by networked lighting controls (NLCs). However, despite the significant opportunity and a regulatory push, DR-enabled lighting is installed in relatively few buildings because most building owners do not recognize its strong value proposition. Although NLCs can reduce energy bills, optimize facilities, and increase revenue, these co-benefits are not well quantified. This project analyzed lighting DR resources and energy-related co-benefits for commercial buildings in California. Using more than 100,000 individual hourly load profiles, the team forecasted the potential DR resources likely available from commercial lighting in 2025 and estimated revenues available from participation of these DR resources in energy markets. Combining these results with field-study estimates for NLC installation costs and energy savings provided a detailed accounting of site-level cost and energy-related co-benefits by building type from NLC’s DR enablement. In many cases, energy savings alone can deliver significant net value, justifying NLC DR-enabled adoption. Additionally, the study considers the sometimes-larger non-energy benefits (NEBs).

Commercial lighting represents a significant potential source of demand response (DR) for the electrical grid, via traditional load shedding and rapid-dispatch (fast-DR) ancillary services when DR is enabled by networked lighting controls (NLCs). However, despite the significant opportunity and a regulatory push, DR-enabled lighting is installed in relatively few buildings because most building owners do not recognize its strong value proposition. Although NLCs can reduce energy bills, optimize facilities, and increase revenue, these co-benefits are not well quantified. This project analyzed lighting DR resources and energy-related co-benefits for commercial buildings in California. Using more than 100,000 individual hourly load profiles, the team forecasted the potential DR resources likely available from commercial lighting in 2025 and estimated revenues available from participation of these DR resources in energy markets. Combining these results with field-study estimates for NLC installation costs and energy savings provided a detailed accounting of site-level cost and energy-related co-benefits by building type from NLC’s DR enablement. In many cases, energy savings alone can deliver significant net value, justifying NLC DR-enabled adoption. Additionally, the study considers the sometimes-larger non-energy benefits (NEBs).

BackgroundCannabis use disorder (CUD) is a prevalent and impairing condition, and established psychosocial treatments convey limited efficacy. In light of recent findings supporting the efficacy of N-acetylcysteine (NAC) for CUD in adolescents, the objective of this trial was to evaluate its efficacy in adults.MethodsIn a 12-week double-blind randomized placebo-controlled trial, treatment-seeking adults ages 18-50 with CUD (N=302), enrolled across six National Drug Abuse Treatment Clinical Trials Network-affiliated clinical sites, were randomized in a 1:1 ratio to a 12-week course of NAC 1200mg (n=153) or placebo (n=149) twice daily. All participants received contingency management (CM) and medical management. The primary efficacy measure was the odds of negative urine cannabinoid tests during treatment, compared between NAC and placebo participants.ResultsThere was not statistically significant evidence that the NAC and placebo groups differed in cannabis abstinence (odds ratio=1.00, 95% confidence interval 0.63-1.59, p=0.984). Overall, 22.3% of urine cannabinoid tests in the NAC group were negative, compared with 22.4% in the placebo group. Many participants were medication non-adherent; exploratory analysis within medication-adherent subgroups revealed no significant differential abstinence outcomes by treatment group.ConclusionsIn contrast with prior findings in adolescents, there is no evidence that NAC 1200mg twice daily plus CM is differentially efficacious for CUD in adults when compared to placebo plus CM. This discrepant finding between adolescents and adults with CUD may have been influenced by differences in development, cannabis use profiles, responses to embedded behavioral treatment, medication adherence, and other factors.