Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis.

BACKGROUND:Ecological research suggests that increased access to cannabis may facilitate reductions in opioid use and harms, and medical cannabis patients describe the substitution of opioids with cannabis for pain management. However, there is a lack of research using individual-level data to explore this question. We aimed to investigate the longitudinal association between frequency of cannabis use and illicit opioid use among people who use drugs (PWUD) experiencing chronic pain. METHODS AND FINDINGS:This study included data from people in 2 prospective cohorts of PWUD in Vancouver, Canada, who reported major or persistent pain from June 1, 2014, to December 1, 2017 (n = 1,152). We used descriptive statistics to examine reasons for cannabis use and a multivariable generalized linear mixed-effects model to estimate the relationship between daily (once or more per day) cannabis use and daily illicit opioid use. There were 424 (36.8%) women in the study, and the median age at baseline was 49.3 years (IQR 42.3-54.9). In total, 455 (40%) reported daily illicit opioid use, and 410 (36%) reported daily cannabis use during at least one 6-month follow-up period. The most commonly reported therapeutic reasons for cannabis use were pain (36%), sleep (35%), stress (31%), and nausea (30%). After adjusting for demographic characteristics, substance use, and health-related factors, daily cannabis use was associated with significantly lower odds of daily illicit opioid use (adjusted odds ratio 0.50, 95% CI 0.34-0.74, p < 0.001). Limitations of the study included self-reported measures of substance use and chronic pain, and a lack of data for cannabis preparations, dosages, and modes of administration. CONCLUSIONS:We observed an independent negative association between frequent cannabis use and frequent illicit opioid use among PWUD with chronic pain. These findings provide longitudinal observational evidence that cannabis may serve as an adjunct to or substitute for illicit opioid use among PWUD with chronic pain

Do age-associated changes of voltage-gated sodium channel isoforms expressed in the mammalian heart predispose the elderly to atrial fibrillation?

© The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. The prevalence of the disease increases with age, strongly implying an age-related process underlying the pathology. At a time when people are living longer than ever before, an exponential increase in disease prevalence is predicted worldwide. Hence unraveling the underlying mechanics of the disease is paramount for the development of innovative treatment and prevention strategies. The role of voltage-gated sodium channels is fundamental in cardiac electrophysiology and may provide novel insights into the arrhythmogenesis of AF. Nav1.5 is the predominant cardiac isoform, responsible for the action potential upstroke. Recent studies have demonstrated that Nav1.8 (an isoform predominantly expressed within the peripheral nervous system) is responsible for cellular arrhythmogenesis through the enhancement of pro-arrhythmogenic currents. Animal studies have shown a decline in Nav1.5 leading to a diminished action potential upstroke during phase 0. Furthermore, the study of human tissue demonstrates an inverse expression of sodium channel isoforms; reduction of Nav1.5 and increase of Nav1.8 in both heart failure and ventricular hypertrophy. This strongly suggests that the expression of voltage-gated sodium channels play a crucial role in the development of arrhythmias in the diseased heart. Targeting aberrant sodium currents has led to novel therapeutic approaches in tackling AF and continues to be an area of emerging research. This review will explore how voltage-gated sodium channels may predispose the elderly heart to AF through the examination of laboratory and clinical based evidence

Network meta-analysis of multiple outcome measures accounting for borrowing of information across outcomes

Background: Network meta-analysis (NMA) enables simultaneous comparison of multiple treatments while preserving randomisation. When summarising evidence to inform an economic evaluation, it is important that the analysis accurately reflects the dependency structure within the data, as correlations between outcomes may have implication for estimating the net benefit associated with treatment. A multivariate NMA offers a framework for evaluating multiple treatments across multiple outcome measures while accounting for the correlation structure between outcomes. Methods: The standard NMA model is extended to multiple outcome settings in two stages. In the first stage, information is borrowed across outcomes as well across studies through modelling the within-study and between-study correlation structure. In the second stage, we make use of the additional assumption that intervention effects are exchangeable between outcomes to predict effect estimates for all outcomes, including effect estimates on outcomes where evidence is either sparse or the treatment had not been considered by any one of the studies included in the analysis. We apply the methods to binary outcome data from a systematic review evaluating the effectiveness of nine home safety interventions on uptake of three poisoning prevention practices (safe storage of medicines, safe storage of other household products, and possession of poison centre control telephone number) in households with children. Analyses are conducted in WinBUGS using Markov Chain Monte Carlo (MCMC) simulations. Results: Univariate and the first stage multivariate models produced broadly similar point estimates of intervention effects but the uncertainty around the multivariate estimates varied depending on the prior distribution specified for the between-study covariance structure. The second stage multivariate analyses produced more precise effect estimates while enabling intervention effects to be predicted for all outcomes, including intervention effects on outcomes not directly considered by the studies included in the analysis. Conclusions: Accounting for the dependency between outcomes in a multivariate meta-analysis may or may not improve the precision of effect estimates from a network meta-analysis compared to analysing each outcome separately

Project RESTART: Preparing Nontraditional Adult Teacher Education Candidates to Become Special Education Teachers

In North Carolina, where the state must hire 10,000 teachers every year just to fill existing classrooms, highly qualified special education teachers are included in the top three areas of greatest teacher shortage, behind math and science. Such needs, which include an increase in teachers from ethnic minorities, challenge teacher educators to seek innovative methods for recruitment and retention of pools of nontraditional teacher candidates (Artiles, Trent, & Palmer, 2004; Boe, Cook, Bobbitt, & Terhanian, 1998)

Parkinsonian sensory integration for balance control : time based postural effects of alterations in sensory information

xii, 81 leaves ; 29 cm.Changes in postural stability following sensory manipulation were investigated among Parkinson's disease patients and healthy older adults. Sixteen Parkinson's disease patients (PD; mean age 68.2 + 2.7 years) and sixteen older adults (control; mean age 67.6 + 2.6 years) performed quiet standing trials that progressed through baseline, sensory manipulation, and reintegration. Postural control following visual deprivation was assessed following alternate removal and reinsertion of visual information. Postural recovery following sensory incongruence was assessed following the termination of visual, somatosensory, and visuosomatosensory incongruence. PD patients' balance was disrupted following visual deprivation, and was initially disrupted when visual information was returned. PD patients' pstural recovery was comparable to control subjects when sensory incongruence ended. These findings indicate that situations of visual deprivation in particular are initially disruptive for PD patients, and imply initial difficulty for sensory reorganization in these patients. Our results provide insight into environmental situations imposing greater fall risk among the parkinsonian population

A model for examining teacher preparation curricula for inclusion.

There is an increasing need for highly qualified teachers as described by the current legislation in No Child Left Behind (2002). Since this legislative mandate has been enforced, recent initiatives have signaled teacher education programs to examine performance standards in demonstrating preparation of effective teachers for diverse learners. The total number of children with disabilities served over the past eight years has increased at an average of 3.4% each year (Katsiyannis, Zhang, & Conroy, 2003; U.S. Department of Education, 2003). With over 6,000,000 children receiving services across the country, the increased need for well-prepared teachers is critical. Data on increasing teacher shortages in special education (U.S. Department of Education, 2003; Veneri, 1999), as well as a number of studies have amplified various aspects of this dilemma, including causes and possible remedies (Billingsley, 2004; Boe, Cook, Bobbitt, & Terhanian, 1998; Brownell, Bishop, & Sindelar, 2005; Counterpoint, 1999; Menlove, Games, & Galzberg, 2004)

Lack of resistance of Plasmodium falciparum to dihydroartemisinin in Uganda based on parasitogolgical and molecular assays

Artemisinin-­‐based combination therapy is now standard treatment for falciparum malaria. However, this regimen is threatened by resistance to artemisinins, manifest as delayed clearance of parasitemia after therapy, in southeast Asia. Artemisinin resistance in southeast Asia is associated with increased parasitemias in culture, compared to those in sensi0ve parasites, 72 hours a=er a 6 hour pulse with 700 nM dihydroartemisinin (DHA), and with propeller domain polymorphisms in the Plasmodium falciparum kelch (K13; PF3D7_1343700) gene Given that artemether/lumefantrine has been adopted as standard therapy for malaria within the last decade in Uganda, we characterized artemisinin sensiBvity in fresh P. falciparum isolates from Kampala using ex vivo ring-­‐stage survival and IC50 assays. We also assessed the K13 gene for polymorphisms

Lack of Artemisinin Resistance in Plasmodium falciparum in Uganda Based on Parasitological and Molecular Assays

We evaluated markers of artemisinin resistance in Plasmodium falciparum isolated in Kampala in 2014. By standard in vitro assays, all isolates were highly sensitive to dihydroartemisinin (DHA). By the ring-stage survival assay, after a 6-h DHA pulse, parasitemia was undetectable in 40 of 43 cultures at 72 h. Two of 53 isolates had nonsynonymous K13-propeller gene polymorphisms but did not have the mutations associated with resistance in Asia. Thus, we did not see evidence for artemisinin resistance in Uganda