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

Opiates and methamphetamines: the social construction of two drug epidemics in West Virginia

Best, Joel G.Historically, the categorization of drug epidemics as major social problems in the United States has been rife with racial and ethnic disparities, and public opinion and policy responses to these issues have been shaped by the way these epidemics have been characterized. This thesis investigates two contemporary drug epidemics in a specific geographic and social context: the methamphetamine epidemic in the mid-2000s and the current opioid epidemic as represented by the two daily newspapers of Charleston, West Virginia. Contrary to previous drug epidemics which have largely scapegoated urban minority groups, these two have been characterized as impacting white, suburban, and rural populations, making this comparison a novel contribution to the theoretical understanding of the social construction of drug epidemics in the United States. The author conducted a content analysis of a total of 374 articles published in the years 2005 and 2014 in order to better understand who were the authorities making claims about these respective epidemics, what were their messages, and how these changed from one epidemic to the next. During the opioid epidemic, the media relied on health and addiction experts to frame their narratives of the drug epidemic far more frequently than during the meth epidemic, suggesting a more medicalized view of addiction had developed in the ten year period between the two. This analysis provides evidence that white meth users tend to be characterized as less sympathetic than white opiate users by authorities in the media. ☐ KEY WORDS: methamphetamine; opioids; drug epidemic; West Virginia; content analysis; social problems; social construction; media; medicalization.University of Delaware, Department Sociology and Criminal JusticeM.A

Building recovery ready communities: the recovery ready ecosystem model and community framework

Background: Public and private systems in the United States and around the World are impacted by substance use disorders (SUD). Despite recent attempts at bringing top down solutions, SUDs continue to be a leading cause of death, a leading correlate in violent crime, and a leading cause of lost productivity in the workplace. Community-based resources have been shown to positively affect SUD impact and SUD recovery, by orienting stakeholders towards the problem and creating continuity among support services. Community-based innovations, such as recovery community organizations and other recovery support services, have provided evidence of successfully scaling recovery efforts and improving the chance of sustained recovery for individuals that live within the community. Methods: A theoretical model and framework, grounded in the recovery-oriented systems of care (ROSC) theorems, is proposed to identify components and connections that support a community’s ability to support individual and group recovery from SUD. Results: The Recovery Ready Ecosystem Model (RREM) and Recovery Ready Community Framework builds upon the early work of the ROSC, highlighting recently emboldened support structures such as harm reduction, educational recovery programs, and other traditional support structures in communities. Conclusions: Enhanced community needs assessment can be informed by the RREM and Recovery Ready Community framework to identify gaps in their current community infrastructure. Further testing of the recovery readiness equation should be performed as a potential measure of efficacy of community ability to support long-term recovery from SUD. Exploration of potential application of the model and framework to international settings is also needed

Genetically modified animal models as tools for studying bone and mineral metabolism

Genetic modification of mice is a powerful tool for the study of bone development and metabolism. This review discusses the advantages and disadvantages of various approaches used in bone-related research and the contributions these studies have made to bone biology. Genetic modification of mice is a powerful tool for the study of bone development and metabolism. This review discusses the advantages and disadvantages of various approaches used in bone-related research and the contributions these studies have made to bone biology. The approaches to genetic modification included in this review are (1) overexpression of genes, (2) global gene knockouts, (3) tissue-specific gene deletion, and (4) gene knock-in models. This review also highlights issues that should be considered when using genetically modified animal models, including the rigorous control of genetic background, use of appropriate control lines, and confirmation of tissue specificity of gene expression where appropriate. This technology provides a unique and powerful way to probe the function of genes and is already revolutionizing our approach to understanding the physiology of bone development and metabolism