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In a review publishing July 17 in the journal Trends in Pharmacological Sciences, researchers examined how artificial intelligence (AI) could affect drug development in the coming decade.

Big pharma and other drug developers are grappling with a dilemma: the era of blockbuster drugs is coming to an end. At the same time, adding new drugs to their portfolios is slow and expensive. It takes on average 10-15 years and $1.5-2B to get a new drug to market; approximately half of this time and investment is devoted to clinical trials.

Although AI has not yet had a significant impact on clinical trials, AI-based models are helping trial design, AI-based techniques are being used for patient recruitment, and AI-based monitoring systems aim to boost study adherence and decrease dropout rates.

"AI is not a magic bullet and is very much a work in progress, yet it holds much promise for the future of healthcare and drug development," says lead author and computer scientist Stefan Harrer, a researcher at IBM Research-Australia.

As part of the review and based on their research, Harrer and colleagues reported that AI can potentially boost the success rate of clinical trials by:

Efficiently measuring biomarkers that reflect the effectiveness of the drug being tested

Identifying and characterizing patient subpopulations best suited for specific drugs. Less than a third of all phase II compounds advance to phase III, and one in three phase III trials fail-not because the drug is ineffective or dangerous, but because the trial lacks enough patients or the right kinds of patients.

Start-ups, large corporations, regulatory bodies, and governments are all exploring and driving the use of AI for improving clinical trial design, Harrer says. "What we see at this point are predominantly early-stage, proof-of-concept, and feasibility pilot studies demonstrating the high potential of numerous AI techniques for improving the performance of clinical trials," Harrer says.

The authors also identify several areas showing the most real-world promise of AI for patients. For example:

AI-enabled systems might allow patients more access to and control over their personal data.

Coaching via AI-based apps could occur before and during trials.

AI could monitor individual patients' adherence to protocols continuously in real time.

AI techniques could help guide patients to trials of which they may not have been aware

In particular, Harrer says, the use of AI in precision-medicine approaches, such as applying technology to advance how efficiently and accurately professionals can diagnose, treat and manage neurological diseases, is promising. "AI can have a profound impact on improving patient monitoring before and during neurological trials," he says.

The review also evaluated the potential implications for pharma, which included:

Computer vision algorithms that could potentially pinpoint relevant patient populations through a range of inputs from handwritten forms to digital medical imagery.

Applications of AI analysis to failed clinical trial data to uncover insights for future trial design.

The use of AI capabilities such as Machine Learning (ML), Deep Learning (DL), and Natural Language Processing (NLP) for correlating large and diverse data sets such as electronic health records, medical literature, and trial databases to help pharma improve trial design, patient-trial matching, and recruiting, as well as for monitoring patients during trials.

The authors also identified several important takeaways for researchers:

"Health AI" is a growing field connecting medicine, pharma, data science and engineering.

The next generation of health-related AI experts will need a broad array of knowledge in analytics, algorithm coding and technology integration.

Ongoing work is needed to assess data privacy, security and accessibility, as well as the ethics of applying AI techniques to sensitive medical information.

Because AI methods have only begun to be applied to clinical trials in the past 5 to 8 years, it will most likely be another several years in a typical 10- to 15-year drug-development cycle before AI's impact can be accurately assessed.

In the meantime, rigorous research and development is necessary to ensure the viability of these innovations, Harrer says. "Major further work is necessary before the AI demonstrated in pilot studies can be integrated in clinical trial design," he says. "Any breach of research protocol or premature setting of unreasonable expectations may lead to an undermining of trust-and ultimately the success-of AI in the clinical sector."

Researchers at Columbia University Mailman School of Public Health report almost no change in nonmedical prescription opioid use or opioid use disorder after states enacted medical marijuana laws. Overall, opioid use disorder among prescription opioid users decreased slightly after passage of the laws. Until this study, there had been little research on medical marijuana laws' effects on the use of other substances (i.e., alcohol, opioids)--particularly, prescription opioid use misuse, and opioid use disorder. The findings are published online in JAMA Network Open.

"Studies on medical marijuana laws and their effects on prescription opioid use are scarce and are limited by measuring opioid use indirectly and among groups, not individuals," said Luis Segura, MD, MPH, a doctoral student at Columbia Mailman School, Department of Epidemiology, and first author. "When comparing the overall effect of use after versus before medical marijuana laws were passed, we found small increases in nonmedical use of prescription opioids and slight decreases or no change in prescription opioid use disorder among nonmedical users of prescription opioids--even for states that allowed dispensaries."

The researchers used the National Survey on Drug Use and Health, an annual survey of approximately 70,000 individuals aged 12 years and older, from 2004 to 2014, to investigate the association between living in a state with medical marijuana laws and individual-level opioid use and prescription opioid use disorder among nonmedical prescription opioid users. They also analyzed whether these outcomes varied by age and racial or ethnic groups.

The results differed from earlier studies that found decreases in nonmedical opioid use, opioid prescribing and opioid overdoses post-medical marijuana law enactment. There are a number of potential reasons for this finding, according to the researchers.

"Other studies that found an inverse association between medical marijuana enactment and opioid-outcomes did not measure opioid-outcomes for individuals," observed Silvia Martins, MD, PhD, associate professor of epidemiology, and senior author. The hypothesis generated from these studies is that after medical marijuana law enactment, health care professionals would be more likely to prescribe medical marijuana instead of opioid medications, this in turn would reduce the chance of individuals to misuse prescription opioids and develop consequences. We tested this relationship and found no evidence that the passage of medical marijuana laws--even in states with dispensaries--was associated with a decrease in individual opioid use of prescription opioids for nonmedical purposes."

"Our findings may suggest that medical marijuana policies could be insufficient to reduce individual-level opioid outcomes and that opioid-specific approaches and policy interventions such as prescription drug monitoring programs, and laws on prescribing practices are needed," said Martins.

What The Study Did: National registry data from five countries (Denmark, Finland, Sweden, Israel and Western Australia) were used to estimate the contribution of various genetic and nongenetic factors on the risk of autism spectrum disorder in this population-based study.

Authors: Sven Sandin, Ph.D., of the Karolinska Institutet in Stockholm, Sweden, is the corresponding author.

(doi:10.1001/jamapsychiatry.2019.1411)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Isotretinoin (also known by its former brand name as Accutane or Roaccutane) is an extremely effective acne medication that can help patients whose severe acne has not responded to other drugs. But the drug is also a potent teratogen -- if a woman takes isotretinoin while pregnant, even for a short period of time, the risk of severe birth defects is high. In 2006, the U.S. Federal Drug Administration (FDA) imposed a special restricted distribution program, known as iPLEDGE, which has stringent, recurring requirements for patients, prescribing physicians and dispensing pharmacists. But despite the substantial imposition of iPLEDGE on patients and clinicians, the extent to which it has reduced pregnancy and other adverse effects has been unknown. In a new study, investigators at Brigham and Women's Hospital evaluated the frequency of reported pregnancies and pregnancy-related adverse events among women taking isotretinoin. In a paper published in JAMA Dermatology, the team reports that although the number of pregnancies has decreased, pregnancies among women taking isotretinoin have continued to persist even after the implementation of iPLEDGE.

"While the number of pregnancies among patients taking isotretinoin is low, even 200 pregnancies is too high," said corresponding author Arash Mostaghimi, MD, MPA, MPH, director of Dermatology Inpatient Service and co-director of the Complex Medical Dermatology Fellowship Program at the Brigham. "We need to think about regulations that can reduce that number without being overly burdensome for patients and physicians."

iPLEDGE requires that women of childbearing age have a negative pregnancy test and attest to using two forms of birth control or abstinence before they can begin taking isotretinoin. They then must repeat a pregnancy test and attestation every month they continue taking the drug. Each month, physicians prescribing the drug must enter the test results and the pharmacist must obtain authorization from the iPLEDGE program.

In the current study, investigators analyzed FDA reports of pregnancy-related adverse events associated with isotretinoin from January 1, 1997, to December 31, 2017, using the FDA Adverse Event Reporting System (FAERS), a database of medication adverse event reports filed by prescribers, consumers and manufacturers. Reported pregnancies peaked in 2006 (768 pregnancies) before settling into a range of 218 to 310 per year after 2011.

Pregnancies, abortions and fetal defects all decreased after iPLEDGE was implemented in 2006 but continued to persist. The authors note that several factors beyond iPLEDGE may be contributing to the downward trend, including a national decrease in teen pregnancy and increased usage of long-term birth control and emergency contraception.

Earlier this month, Mostaghimi and colleagues used the FAERS database to look at a different constellation of side effects: those related to mental health. In that study, they found that a large proportion of patients taking isotretinoin experienced mental health issues, including anxiety, depression and suicidality.

"With mandated, monthly visits for iPLEDGE, we have an opportunity to improve screening for other side effects, such as mental health, in addition to identifying more effective ways to lower pregnancy rates," said Mostaghimi. "iPLEDGE springs from the desire to protect newborns and women, but we should think of it as a testing ground for identifying the best system to reduce isotretinoin-related complications while maintaining access to an important drug."

In 2016, there were 87 million people diagnosed with gonorrhoea, the most antibiotic resistant of all the STIs. There is a global rise in gonorrhoea rates and, until now, no one has understood why.

Monash University's Professor Kit Fairley, Director of the Melbourne Sexual Health Clinic in Australia, has presented data in Canada that indicates that a significant, and previously unrecognised, route of transmission of the bacterial infection is kissing, which the rates of infection are so high globally. The data will also be simultaneously published in The Lancet Infectious Diseases.

Kissing as a major risk factor for gonorrhoea is a hot topic in the field of sexually transmitted diseases and Professor Fairley debated the issue at the International Society for Sexually Transmitted Disease Research meeting in Vancouver.

A study, published earlier this year by the Fairley team, studied more than 3600 men who have sex with men over a 12-month period from March 2016.

By mapping those who only kissed partners, compared to having sex with partners, the researchers were able to determine that the transmission of the disease is high in people who kiss only, and was higher in those who have sex with kissing compared to those who have sex without kissing.

Professor Fairley argues that the global sexual health community: "needs to recognise that gonorrhoea is on the rise and that there should be an increased awareness of the risks of kissing as a route of transmission."

"Understanding how it is transmitted is the key to understanding how to control it - if transmission by kissing is a key route of transmission then it is important to investigate new methods of control, such as antibacterial mouthwash."

PHILADELPHIA -- Our lungs work tirelessly all through the day to keep us breathing, seamlessly expanding and contracting. When lung tissue becomes damaged and scarred, it can lose its flexibility, making it harder to breathe.

Lung scarring can lead to diseases like pulmonary fibrosis, and potentially life-threatening complications. Lung fibrosis can also develop in patients with a rare, hereditary disorder known as Hermansky-Pudlak syndrome. Researchers in the lab of Freddy Romero, PhD at the Center for Translational Medicine at Thomas Jefferson University are trying to understand what contributes to the development of pulmonary fibrosis in animal models and patients of Hermansky-Pudlak syndrome.

Cells in any tissue of our body are held together by a scaffold called the extracellular matrix. When this scaffold holding the tissue in place is damaged, the structural integrity of the tissue also changes. Enzymes called matrix metalloproteinases (MMPs) normally help take down scaffold that isn't needed anymore, but these enzymes can become overactive in disease. MMPs are often altered in many different lung diseases, where a shakier scaffold can cause rigidity and inflammation in the surrounding tissue. However, it's unclear what role these enzymes play in Hermansky-Pudlak syndrome.

In this study, the researchers examined whether MMP activity was altered in lung tissue affected by Hermansky-Pudlak syndrome, and how these changes were connected to the onset of pulmonary fibrosis. The findings were published in Orphanet Journal of Rare Diseases on July 4.

They found that certain subsets of MMPs were increased in the lungs of mouse models of the disease, as well as in fluid collected from the lungs of patients with Hermansky-Pudlak syndrome. In both mouse models and patient samples, MMP was detectable at high levels prior to development of fibrosis, indicating that high levels of MMP may be associated with onset rather than progression of the disease.

It was previously unknown how mutations underlying Hermansky-Pudlak syndrome could lead to the development of pulmonary fibrosis. This study provides a new link that may be useful in the diagnosis and treatment of the disorder. First author on the paper Ross Summer, MD at the Jane & Leonard Korman Respiratory Institute explains, "Our work supports the notion that dysregulation of MMPs contributes to the development of pulmonary fibrosis. But importantly, it also suggests that unique patterns of MMP alterations could be exploited for the diagnosis and/or prognosis of lung disease in Hermansky-Pudlak syndrome."

PHILADELPHIA (July 17, 2019) - It is well understood that urban black males are at a disproportionately high risk of poor health outcomes. But little is known about how the neighborhood environments where these men live contribute to their health.

In a first-of-its-kind study, researchers at the University of Pennsylvania School of Nursing (Penn Nursing) examined the relationship between area-level characteristics and individual-level neighborhood perceptions in urban Philadelphia and assessed their associations with indicators of the physical and mental health of recently injured, black men. "Racial, socioeconomic and neighborhood disparities persist, and it is helpful to distinguish between the effects of what objectively exists in a neighborhood (such as crime rate) from what people perceive about their environment (such as feeling safe)," said lead-author Aimee Palumbo PhD, MPH, who conducted this investigation during a post-doctoral fellowship at the Penn Injury Science Center.

They used self-reported physical and mental health for the thirty days before these men were injured. They made two discoveries: increased odds of poor mental health were associated with neighborhood economics and education and individual perceptions of social disorder and safety; and increased odds of poor physical health was associated with neighborhood deprivation and disconnectedness.

"The analysis of the contribution of area-level characteristics and individual-level perceptions of neighborhood environment to the mental and physical health of recently injured, urban black males is an important step toward understanding factors that contribute to health in vulnerable populations," said Therese S. Richmond, PhD, CRNP, FAAN, the Andrea B. Laporte Professor of Nursing, Associate Dean for Research & Innovation, and senior investigator for the study.

OAKLAND, Calif. -- Both numbers in a blood pressure reading -- the "upper" systolic and the "lower" diastolic -- independently predicted the risk of heart attack or stroke in a very large Kaiser Permanente study that included more than 36 million blood pressure readings from more than 1 million people. The study, which was published today in the New England Journal of Medicine, runs counter to decades of previous research indicating that high systolic blood pressure is more likely than diastolic pressure to result in adverse outcomes.

"This research brings a large amount of data to bear on a basic question, and it gives such a clear answer," said lead author Alexander C. Flint, MD, Kaiser Permanente stroke specialist and adjunct researcher with the Division of Research. "Every way you slice the data, the systolic and diastolic pressures are both important."

The current retrospective study is "the largest by far of its kind," Dr. Flint said, reviewing 36 million blood pressure readings taken during outpatient visits between 2007 and 2016, from 1.3 million adult Kaiser Permanente members in Northern California.

Systolic pressure -- the upper number in a blood pressure reading -- measures how hard the heart pumps blood into arteries. Diastolic pressure -- the bottom number -- indicates the pressure on the arteries when the heart rests between beats.

Decades of research have shown that high systolic blood pressure is more likely to result in adverse outcomes. As a result, cardiology guidelines and risk estimation tools focus on the upper number, with some experts arguing that the diastolic number might reasonably be ignored, Flint said.

After adjusting the data for possible confounding factors, the researchers found that while systolic pressure has a greater impact, both systolic and diastolic pressures strongly influenced the risk of heart attack or stroke, regardless of the definition used for high blood pressure (140/90 mm Hg versus 130/80 mm Hg).

Dr. Flint said the finding that systolic and diastolic hypertension have similar impacts on risk at the lower threshold of 130/80 provides independent support for recent changes that were made in the American College of Cardiology and American Heart Association guidelines, which recommended tighter blood pressure control in higher risk patients with hypertension. The results are also in keeping with findings from the National Institutes of Health's Systolic Blood Pressure Intervention Trial, known as SPRINT.

"Controversy has long persisted about whether systolic blood pressure, diastolic blood pressure, or both contribute to cardiovascular risk," said senior author Deepak L. Bhatt, MD, MPH, executive director of Interventional Cardiovascular Services at Brigham and Women's Hospital and professor of medicine at Harvard Medical School. "This analysis using a very large amount of longitudinal data convincingly demonstrates that both are important, and it shows that in people who are otherwise generally healthy, lower blood pressure numbers are better."

Researchers have created a comprehensive test based on machine learning algorithms to better guide the management of patients with pancreatic cysts - a potential precursor of pancreatic cancer. The new assay, called CompCyst, outperformed the current gold standard-of-care in an international, multicenter study of 875 patients. Crucially, the test would have avoided surgery in 60% of patients who underwent unnecessary surgical removal, suggesting its use could lead to fewer unneeded surgeries and lower health and economic costs. Pancreatic cysts are fluid-filled lesions in the pancreas that are found in up to 8% of all people over the age of 70. Although most cysts are benign, some pancreatic cysts that produce mucin can transform into an aggressive form of pancreatic cancer. What's more, it is difficult to distinguish precancerous cysts from benign ones, so noncancerous cysts are often misclassified and unnecessarily removed with pancreatic surgery. To overcome this dilemma, Simeon Springer and colleagues enrolled 875 patients with pancreatic cysts and collected information of the mutations, proteins, and other markers linked to their either benign or mucin-producing cysts. They used deep learning techniques to train CompCyst to read these markers and classify patients into those that should be monitored, not monitored, or receive surgery. After training the test protocol with 436 of the original patients, the researchers found the test largely outperformed standard-of-care pathology when evaluated in 426 other patients: it correctly identified 60.4% of patients who should have been discharged (versus 18.9% using standard-of-care diagnosis), 48.6% of patients that should have been monitored (versus 34.3%), and 90.8% of patients in need of surgery (versus 88.8%). Future work will be necessary to prospectively validate the markers used in the test, but Springer et al. say their platform has strong potential to be used in the clinic as a complement to existing approaches.

Boston, MA - In Botswana, an intervention in 15 communities to test for and treat HIV infection in all adult residents was effective in increasing population viral suppression to very high levels (meaning that the virus becomes undetectable and can't be transmitted while patients are taking effective treatment), according to a new study led by researchers from Harvard T.H. Chan School of Public Health and the Botswana-Harvard AIDS Institute Partnership, and collaborators at several other institutions. The intervention likely also contributed to a nearly one-third reduction in the incidence of HIV infection in participating communities.

"Using approaches that are feasible in most settings, we achieved levels of HIV diagnosis, treatment, and viral suppression that are among the highest levels reported globally," said senior author Shahin Lockman, associate professor in the Department of Immunology and Infectious Diseases. "These high rates of treatment coverage are a testimony to the long-standing commitment that Botswana has shown to tackling HIV. We also believe that our approaches and findings are highly relevant for other countries."

The study will be published online July 18 in the New England Journal of Medicine.

HIV prevalence in Botswana is high, despite efforts by the government to increase access to testing, treatment, and preventive services. In 2017, an estimated 23% of adults had HIV. Combination antiretroviral therapy (ART) can essentially eliminate the risk of HIV transmission from a person who adheres to treatment and who has an undetectable viral load.

For the current study, researchers analyzed data from 23,401 people in the Ya Tsie Botswana Prevention Project, a randomized trial in 30 rural and semiurban communities (with a total population of approximately 180,000). From 2013 to 2018, 15 communities received an intervention that included universal HIV testing and counseling, support for accessing care, expanded and more rapid ART initiation, and increased access to male circumcision services (which lowers the risk of acquiring HIV). A control group of 15 communities received standard HIV testing and treatment.

By the end of the study period, in the intervention group, the proportion of persons living with HIV who had a suppressed viral load increased from 70% to 88%, while the proportion in the standard care group increased from 75% to 83%. The population level of viral suppression in the intervention group is among the highest to be reported globally. Incidence of HIV infection in the intervention group was 31% lower than incidence in the standard care group, which is borderline statistically significant.

Among the methods tried during the intervention, male circumcision uptake was relatively low and was hence likely the least significant, according to the researchers. The successful HIV testing campaigns in homes and mobile venues, along with support for linkage to care, both contributed to the very high ART initiation and viral suppression achieved. According to the researchers, these efforts in turn likely led to the nearly one-third reduction in the rate of new HIV infections in the intervention communities.

"Universal HIV testing and treatment can contribute substantially toward improving health and reducing the rate of new HIV infections in the community," said Lockman. "This reduction, if sustained over time, will help us achieve the UNAIDS target of 90% reduction in the rate of new HIV infections by 2030."

An experimental treatment given to mice after a traumatic brain injury (TBI) reduced damage almost to the levels of mice that never had a TBI, researchers at UT Health San Antonio reported. The study was published July 4 in the Journal of Cerebral Blood Flow and Metabolism.

The scientists hope to convert the discovery into a simple and effective treatment for use in emergency rooms or by first responders shortly after a TBI has occurred in military and civilian settings. Currently, no treatment options exist for TBI patients.

"After a traumatic brain injury, about 40% of mice experience a seizure within one week, and many continue to experience seizures for years, leading to epilepsy disease," said study senior author Mark S. Shapiro, Ph.D., professor of cellular and integrative physiology at UT Health San Antonio. "This closely parallels what happens in human patients, followed by cognitive dysfunction and changes in emotional state."

Damaging effects

After a TBI, dangerous inflammation occurs throughout the brain, causing nerve cells to die and the blood-brain barrier, which is critical to maintaining normal brain function, to break down, said lead author Fabio A. Vigil, Ph.D., postdoctoral fellow in Dr. Shapiro's lab.

Preventing abnormal electrical activity

The novel therapy increases the activity of "M-type" KCNQ potassium ion channels, which are proteins that can halt uncontrolled electrical currents in nerve cells. Abnormal currents begin immediately after a TBI, even before a seizure has a chance to occur, and the therapy aims to counteract this, thus nipping in the bud this destructive chain of events.

"No seizures were observed in the treated mice whatsoever," Dr. Vigil said.

Neurologist's perspective

"We need treatments that alter some of the disabling consequences of TBI," said study co-author Jose E. Cavazos, M.D., Ph.D., a neurologist and epilepsy specialist at UT Health San Antonio. "Current antiseizure medications don't prevent the development of post-traumatic epilepsy. Our study examined this critically important therapeutic gap, and proposes a novel pharmacological intervention shortly after TBI that might prevent post-traumatic epilepsy."

If such a therapy can be developed, it would be a game-changer for patients, Dr. Cavazos said. Approximately 6% of all epilepsy cases are caused by head trauma.

"Think about the possibility of taking a medication shortly after the injury and preventing disabling epileptic seizures months to years later," Dr. Cavazos said.

Post-trauma impact

Study co-author Robert Brenner, Ph.D., of UT Health San Antonio, provided expertise in seizures and seizure monitoring. He said the study's most important finding is that reducing excess electrical activity in the central nervous system via a therapy such as this has beneficial post-trauma effects that extend well beyond action as an anticonvulsant. These effects include reducing dangerous inflammation and widespread cell death.

Ongoing and future research

This therapeutic approach is being evaluated for its suitability in humans, Dr. Shapiro said. This includes assessments of its chemical properties, stability, and effects on other organs such as the heart.

Future directions are to test newly developed compounds that have similar action to the compound used in this study, but with highly increased potency and selectivity for KCNQ potassium ion channels in the brain.

In patients presenting to an emergency department with severe traumatic pain, intranasal sufentanil was as good as standard-of-care intravenous morphine for pain relief, according to a new study published this week in PLOS Medicine by Marc Blancher of Grenoble Alpes University Hospital, France, and colleagues.

Intravenous morphine is the most commonly used strong analgesic for relieving acute pain in the emergency room, but the need to get an IV line started before administration limits its rapid use. In the new study, researchers randomized 136 patients who presented to the emergency departments of six hospitals across France. Patients ranged in age from 18 to 75 years old and had traumatic pain self-evaluated as at least a six out of ten on a rating scale. 69 patients received intranasal sufentanil plus an intravenous placebo and 67 patients received intravenous morphine plus an intranasal placebo.

Patients' pain rating dropped by 4.1 points (97.5% CI -4.6 to -3.6) in the 30 minutes after analgesic administration in the group receiving intravenous morphine, and by 5.2 points (-5.7 to -4.6) with intranasal sufentanil. Intranasal sufentanil was shown to be non-inferior to intravenous morphine in terms of pain control at 30 minutes (p

"The use of intranasal sufentanil might provide an easy and time saving solution in the management of acute pain," the authors say.

First-ever study to ask people who use heroin what they want to be called finds "people first" language often best, and language suggesting misuse or dependence generally worst.

In the ongoing opioid crisis, many researchers and clinicians now use "person first" terms such as "person with substance use disorder" instead of loaded labels like "addict," but little research has focused on the language preferences of this population. Now, a first-of-its-kind study by researchers from the Boston University School of Public Health (BUSPH) and the University of Massachusetts Medical School (UMMS), published in the journal Addiction, has found that people entering treatment for heroin use most often called themselves "addicts," but preferred that others called them "people who use drugs."

"In the end, researchers, clinicians, and families should not automatically use the same terms that people who use heroin call themselves, but instead ask about preferences," says senior study author Dr. Michael Stein, professor and chair of health law, policy & management at BUSPH. "Of course, most people just want to be called by their name."

The researchers surveyed 263 people undergoing in-patient evaluation and withdrawal symptom management at the Stanley Street Treatment and Resources program (SSTAR) in Fall River, Massachusetts. The terms that the most respondents never wanted to be called were "heroin misuser" and "heroin-dependent," and most did not like slang terms such as "junkie."

"Persons who use heroin often complain about interactions with healthcare providers, due at least in part to the unfortunate language providers use--which is taken, sometimes rightly, as a sign of disrespect," Stein says. "Such antagonism can't be good for clinical outcomes."

"We hope this research will inform future work centering on the perspectives of individuals who use drugs, and begin to establish connections between the language that individuals use to describe themselves and treatment engagement," says the study's lead author, Dr. Ekaterina Pivovarova, assistant professor of psychiatry at UMMS and faculty in the Massachusetts Center of Excellence for Specialty Courts.

According to the Centers for Disease Control and Prevention, opioid overdoses were responsible for more than 42,000 deaths in 2016. Access to family members' drugs may be a strong risk factor for overdose in individuals without their own prescriptions, according to a new study by investigators from Brigham and Women's Hospital. Their findings were published recently in JAMA Internal Medicine.

"When prescriptions are filled and there are extra pills in the medicine cabinet, family members with access to those medications could overdose or become dependent," said Joshua Gagne, PharmD, ScD, a pharmacoepidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics at the Brigham. "But few studies have systematically examined and quantified this risk."

The Brigham investigators drew from the health care utilization data from a large commercial insurance company in the United States, spanning 2004-2015. A total of 2,303 individuals who overdosed on opioids were matched with 9,212 controls, and all participants had no prior opioid prescriptions of their own. The investigators found that opioid dispensing to family members on the same health insurance plan was associated with a 2.89-fold increase in odds of an individual without a prescription overdosing. The association was present regardless of age; both children and adults were likelier to overdose if a family member had an opioid prescription.

The researchers looked exclusively at family members on the same health insurance plan. They acknowledged that they could not confirm whether the overdose was related to the family member's prescription or whether the opioids were obtained illicitly. In addition, they were unable to determine whether family members resided in the same household, which would have impacted the accessibility of the drugs.

The investigators hope that their findings can inform preventative strategies for combatting opioid misuse. Interventions may focus on expanding access to opioid antagonists, safely storing prescription opioids in the home, and providing greater patient education to limit overdose among family members. In addition, they cited that opioid prescriptions should be limited to the number of pills a patient needs, reducing the number of excess drugs being available.

"Effective communication by physicians, pharmacists, nurses or public service announcements could increase awareness of opioids as a risk factor for family member overdose. Education is essential for reducing accidental exposure and misuse," said Gagne.

University of Calgary researchers are the first to discover a previously unidentified cell population in the pericardial fluid found inside the sac around the heart. The discovery could lead to new treatments for patients with injured hearts. The study led by Drs. Paul Kubes, PhD, Justin Deniset, PhD and Paul Fedak, MD, PhD is published in the internationally recognized journal Immunity.

The Kubes lab, in collaboration with the Fedak lab, found that a specific cell, a Gata6+ pericardial cavity macrophage, helps heal an injured heart in mice. The cell was discovered in the pericardial fluid (sac around the heart) of a mouse with heart injury. Working with Fedak, a cardiac surgeon and incoming Director of the Libin Cardiovascular Institute of Alberta, the same cells were also found within the human pericardium of people with injured hearts, confirming that the repair cells offer the promise of a new therapy for patients with heart disease.

"The fuel that powered this study is the funding from the Heart and Stroke Foundation of Canada, the collaboration between two major research institutes at CSM (Snyder and Libin) and the important contribution of philanthropy from the Libin and Snyder families to obtain imaging equipment available to very few programs globally," says Kubes, the Director of the Snyder Institute for Chronic Diseases at the Cumming School of Medicine and Professor in the Department of Physiology and Pharmacology.

Heart doctors had never before explored the possibility that cells just outside the heart could participate in healing and repair of hearts after injury. Unlike other organs, the heart has a very limited capacity to repair itself which is why heart disease is the number one cause of death in North America.

"Our discovery of a new cell that can help heal injured heart muscle will open the door to new therapies and hope for the millions of people who suffer from heart disease. We always knew that the heart sits inside a sac filled with a strange fluid. Now we know that this pericardial fluid is rich with healing cells. These cells may hold the secret to repair and regeneration of new heart muscle. The possibilities for further discovery and innovative new therapies are exciting and important," says Fedak, a professor in the Department of Cardiac Sciences.

Working together and bringing expertise across disciplines the basic researchers working with the cardiac surgeon, clinician researcher, have identified the cell in less than three years. A relatively quick time frame to move research from the lab and animal models to people.

Next Fedak hopes to recruit a basic scientist to move the research to a broader study of human heart repair. This new program will extend the collaboration between basic and clinical research to find potential new therapeutics to improve heart repair.