Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

The curious case of eastern oyster Crassostrea virginica stock status in Apalachicola Bay, Florida

The Apalachicola Bay, Florida, eastern oyster (Crassostrea virginica) industry has annually produced about 10% of the U.S. oyster harvest. Today's simple individual-operator, hand-tonging, small-vessel fishery is remarkably similar to the one that began in the 1800s. Unprecedented attention is currently being given to the status of oyster resources in Apalachicola Bay because this fishery has become central to the decision making related to multistate water disputes in the southeastern United States, as well as millions of dollars in funding for restoration programs related to the Deepwater Horizon oil spill. The oyster fishery collapsed in 2012, leading to large economic losses and community concerns over the current and future status of oyster resources, ecosystem health, and local economic opportunities. We used best available data to assess what mechanism(s) may have led to the collapse of the Apalachicola Bay oyster fishery. We then assessed the efficacy of alternative management strategies (e.g., restoration, fishery closure) to accelerate oyster population recovery. Our results suggest that the Apalachicola Bay oyster population is not overfished in the sense that recruitment has been limited by harvest, but that the 2012 collapse was driven by lower-than-average numbers and/or poor survival of juvenile oysters in the years preceding the collapse. This reduction in recruitment not only reduced the biomass of oysters available to harvest, but from a population resilience perspective, likely reduced the amount of dead shell material available as larval settlement area. Although the Apalachicola Bay oyster fishery has proven resilient over its >150-year history to periods of instability, this fishery now seems to be at a crossroads in terms of continued existence and possibly risks an irreversible collapse. How to use the restoration funds available, and which restoration and management practices to follow, are choices that will determine the long-term viability of the Apalachicola Bay oyster fishery

The Research Dynamic: A Professional Development Model for Secondary School Science Teachers

This essay summarizes the author's 10 years of experience at the Oklahoma Medical Research Foundation mentoring secondary school science teachers during 8-wk Summer Research Institutes. The summary is presented as a learning model, which we call the research dynamic. This model consists of three interlocked components: specified ignorance, peer interactions, and gateway experiments. Specified ignorance is based on the work of the sociologist Robert K. Merton. It is essentially the art of highlighting what is not known about a phenomenon but must become known for further progress. In practice, specified ignorance is framed as a hypothesis, a prediction, or a question. It is commonly the outcome of peer interactions, which are the second essential component of the research dynamic. Peer interactions are the inevitable outcome of having teachers work together in the same laboratory on related research topics. These topics are introduced as gateway experiments, the third component. The most important attribute of gateway experiments is their authenticity. These experiments, when first carried out, opened new scientific vistas. They are also technically, conceptually, and logically simple. We illustrate the research dynamic with a line of seminal experiments in biochemical genetics. We provide evidence that the research dynamic produced significantly positive effects on teachers' confidence in their professional preparedness