Rationale and design of reGional network for Acute Myocardial Infarction (GAMI): protocol for a Prospective Cluster-randomized Intervention study of STEMI management

BackgroundTimely revascularization is essential for ST-segment elevation myocardial infarction (STEMI) patients to reduced mortality rate. However, it's seldom achieved due to patient and medical system-level barriers in China, especially in the rural area. It's needed to establish a regionally coordinated network to promote the early revascularization rate for STEMI patients.MethodsRegional network for Acute Myocardial Infarction (GAMI) is a multi-center, prospective, intervention study with regional intervention. It was carried out in 8 centers by 1:1 cluster randomization in south China with diverse economic and medical levels since 2016. The regional intervention were carried out in the intervention centers, which consisted of intensive public education and regional network construction for STEMI treatment, including community and online propaganda to raised patients' awareness of the treatment for STEMI and establishment of regional clinic-EMS-PCI transfer network for timely primary revascularization. Consecutive acute STEMI patients were enrolled for assessment of regional intervention according to the key performance indicators. The primary study endpoint was reperfusion rate, and secondary endpoints included change of pre-hospital delay, changes of in-hospital delay time and in-hospital outcomes. All patients were followed up for more than 1 year.DiscussionThe GAMI study is a prospective cluster-randomized intervention study, which would provide helpful evaluation of the effectiveness of enhanced public education and regional network construction on regional STEMI treatmentTrial registration: Clinical Trials, NCT03928119. Registered , 25 April, 2019， https://clinicaltrials.gov/ct2/show/NCT03928119?id=NCT03928119&draw=2&rank=1

Azerbaijan-Armenia rhetoric more risky than gunfire

Significance Azerbaijan's threats of military action are cause for concern as the country looks to Turkey, which elsewhere has shown a willingness for regional intervention. Impacts The fighting puts the Karabakh dispute back on the radar of concerned regional and international powers. Conflict allows both governments to rally populations tired of COVID-19 restrictions. In Azerbaijan, 'war talk' provides cover as the authorities arrest critics, ostensibly for quarantine violations.

Norms in practice: people-centric governance in ASEAN and ECOWAS

The Association of Southeast Asian Nations (ASEAN) and the Economic Community of West African States (ECOWAS) both recently adopted and institutionalized the norm of people-centric governance. This is potentially transformative for both, signalling a reorientation away from their private and elite-led normative foundations. In practice, however, the norm is understood and enacted in different ways by officials at each organization and with radically different effects. In ASEAN, the norm is understood and enacted in a limited and defensive way. Its institutionalization has led only to selective engagement with civil society and has not altered established modes of regional governance. In ECOWAS, however, the norm is understood as a means to render the organization more inclusive of civil society groups and has transformed the regional project in important ways, shaping the logic and form of regional intervention and conflict prevention. To explore these experiences—convergence in adoption and institutionalization of a norm and variation in its practice and effect—we develop a practice theoretic framework and rely on 76 interviews with regional and state officials. We show that each organizational case is usefully conceptualized as a community of practice wherein external norms are understood and practiced in particular ways and with particular effect.

Regional intervention will aggravate Somali crisis

Significance The meeting venue had a symbolic significance, as these key opposition figures are seeking Kenyan support in their standoff with the Federal Government of Somalia (FGS), which they accuse of leveraging Ethiopian military power to intervene in Somali domestic affairs. Impacts The FGS’s aggressive moves against Kenyan ally Madobe will complicate the recent reconciliation between Somalia and Kenya. Kenya will lose influence in Jubaland amid more effective Ethiopian and FGS pressure on Madobe. Mogadishu’s critics will harden opposition to any proposed term extension for the president.

Federalism and constitution: States’ participation in constitutional reform as a guarantee of the federalisation process. (A study of Spain’s unique model)

The aim of involving state members in reforming federal constitutions is to guarantee them the autonomy that they have been constitutionally granted. It also prevents reform from being carried out unilaterally by the central government and means the structure of competences can be modified as necessary. In this study, we will consider how federations manage, to a greater or lesser extent, regional intervention in constitutional reform. However, we will see how recently, in Spain, the anticipated routes for territorial participation in the constitutional text have proved to be clearly insufficient, and have developed into the recent crisis in this ‘State of Autonomies’, which is now facing the breakdown of national unity.