bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9804: Diabetes Mellitus and Acute Heart Failure With Reduced Ejection Fraction: A National Database Study
Authors: Khalil Maria , Gomez-Pineiro Eduardo , Mir Tanveer , Uddin Mohammed , Khalil Amir , Tahir Hamza , Uddin Nihat , Tasniya Rifah , Qureshi Waqas , sheikh Mujeeb
Published: June 2023

Background:
Literature regarding outcomes of acute heart failure with reduced ejection fraction (HFrEF) in patients with diabetes mellitus (DM) is still evolving.

Objective:
To study the all-cause mortality and clinical outcomes of acute HFrEF in diabetic patients.

Methods:
Data from the National Emergency Department Sample (NEDS), which constitutes 20% of the sample of hospital-owned emergency departments (ED) in the United States (US), was analyzed for hospital encounters related to acute HF and DM using International Classification of Diseases-10 (ICD-10) codes.

Results:
Out of the total 1,479,716 acute HF encounters (mean age 69.7±14.9 years,47.3%females) recorded for the years 2016-2018, 803,308 (54.3%) were acute HFrEF-related, with 317,517 (39.5%) HFrEF with DM. The HFrEF with DM group had higher multi-organ complications including NSTEMI (14.6% vs 12.9%; p-value <0.001), acute kidney injury (AKI) (29.3% vs 26.2%; p-value <0.001), AKI requiring hemodialysis (10.5% vs 6.7%; p-value <0.001) when compared to HFrEF group only. However, the all-cause mortality for HFrEF only was higher as compared to HFrEF with DM (5% vs 4.8%; p <0.001). Moreover, HFrEF with DM group had higher coronary interventions including PCI (7.6% vs 7.1%; p-value <0.001), and CABG (1.9% vs 1.4%; p-value <0.001).

Conclusion:
Surprisingly, HFrEF complicated by DM did not show significant worsening in mortality rates compared to patients with acute HFrEF. Ischemic cardiac work-up showed mortality benefits. The possibility of selection bias for ischemic cardiac procedures suggest more randomized trials to evaluate the hypothesis generated.

Keywords:
Acute heart failure with reduced ejection fraction (HFpEF), diabetes mellitus (DM), all-cause mortality, Percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG).
Abstract 9822: Yield of a Familial Hypercholesterolemia Genetic Diagnosis After Electronic Health Record and Genomic Data Screening
Authors: Gidding Sam S , Kirchner H Lester , Brangan Andrew , HOWARD WILLIAM , Kelly Melissa A , Myers Kelly , Morgan Kelly , Shuey Timothy C , Staszak David , Strande Natasha T , Walters Nicole , Yu Kristen D , Wilemon Katherine A , Williams Marc S , Jones Laney K , Sturm Amy C
Published: June 2023

Background:
Data mining of electronic health records (EHR) has been used as a strategy to identify patients with undiagnosed familial hypercholesterolemia (FH). Most studies have been limited by the absence of both phenotypic and genotypic data in the same cohort.

Methods:
Using a subset of the Geisinger MyCode Community Health Initiative (MyCode) cohort with both exome sequencing and EHR data (n=130,257), we ran two FH screening algorithms to determine genetic and phenotypic diagnostic yields: the Mayo Clinic algorithm (Mayo), which identifies those with LDL-C levels
>
190 mg/dL, and FIND FH®, the Family Heart Foundation’s machine learning model, to identify individuals with phenotypes suggestive of FH. With 29,243 excluded by Mayo (for secondary causes of hypercholesterolemia, no lipid value in EHR), 52,034 excluded by FIND-FH (insufficient data to run the model), and 187 excluded for prior FH diagnosis, a final cohort of 59,729 participants screened by both algorithms was created. Genetic diagnosis was based on the presence of a pathogenic or likely pathogenic (P/LP) variant in 3 genes implicated in FH via genomic screening. Charts from 180 variant negative participants (60 controls; 120 identified by FIND FH and/or Mayo) were reviewed to calculate Dutch Lipid Clinic Network scores; a score
>
5 defined probable or definite FH.

Results:
Mayo flagged 10,415 subjects; 164 (1.6%) had an FH P/LP variant. FIND-FH flagged 573; 28 (4.9%) had an FH P/LP variant giving a net yield from both algorithms of 167/240 (70%). Confirmation of a phenotypic diagnosis was constrained by lack of EHR data on physical findings or family history (high cholesterol, premature atherosclerotic disease) required for score calculation. Phenotypic FH by chart review was present by Mayo and/or FIND-FH in 13/120 vs 2/60 not flagged by either (p< 0.09).

Conclusion:
After excluding those with a prior FH diagnosis, applying two recognized phenotypic FH screening algorithms to the eligible MyCode cohort identified 70% of those with a P/LP FH variant. Limitations to this approach include participant exclusions for each algorithm, a low yield of positive genomic screening for Mayo, and a low yield of participants for FIND FH. Phenotypic diagnosis was rarely achievable due to missing data.
Abstract 9825: Trajectories of Pharmacotherapy After Acute Cardiac Decompensation - Impact of Heart Failure Phenotype
Authors: Stoerk Stefan , Morbach Caroline , Gueder Guelmisal , Albert Judith , Stefenelli Ulrich , Troebs Sven-Oliver , Stürmlinger Anna , Hanke Monika , Scholz Nina , Cejka Vladimir , Frantz Stefan , Ertl Georg , Angermann Christiane
Published: June 2023

Background & Aim:
Longitudinal data on prescription rates (PR) of guideline-directed medical therapy (GDMT) in patients with acute heart failure (HF) are scarce. We investigated GDMT patterns in patients with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction (EF) and determined mortality risk.

Patients & Methods:
943 acute HF patients, consecutively recruited between 2015 and 2019, with EF measured while in hospital. PR of betablockers (BB), renin angiotensin system inhibitors (RASi), mineralocorticoid receptor antagonists (MRA), and diuretics were recorded on admission, at discharge, and 6-month follow-up.

Results:
Little more than one third of patients had HFrEF (
Table
). Patients with HFpEF were older and more often female. Irrespective of EF, comorbidity burden was high (
Table
). Mortality at 12 months was similar across HF phenotypes. The
Figure
shows that PR of all disease-modifying drug classes increased from admission to discharge irrespective of HF phenotype. PR of MRA were highest in HFrEF. After 6-months, in HFrEF patients, PR of BB (-9%), RASi (-8%), and diuretics (-10%) had decreased again to admission levels. Similar patterns were apparent in HFmrEF and HFpEF including PR of diuretics (
Figure
). Treatment discontinuation of one or more disease modifying drug classes after discharge was frequent (38% in HFrEF, 29% in HFmrEF, 39% in HFpEF). Post-discharge discontinuation was associated with an age-adjusted increase of 12-month mortality risk (OR 10.9, 95%CI 7.6–15.7): for BB 24.5 (16.0–37.5); for RASi 17.6 (11.1–28.0); for MRA 12.3 (6.9–22.1); for diuretics 27.7 (18.3–42.1), with comparable impact across HF phenotypes.

Conclusion:
In this cohort of patients with AHF, prescription patterns of GDMT were often changed along the HF trajectory, yet similar across HF phenotypes and time. Irrespective of HF phenotype, stopping GDMT was associated with a consistently increased mortality risk.
Abstract 9836: Variability of FXI and Relationship With Other Coagulation Factors - Sex Specific Differences and Impact of Diabetes Mellitus
Authors: Kreutz Rolf P , Ipe Joseph , Skaar Todd
Published: June 2023

Introduction:
Novel anticoagulants targeting inhibition of Factor XI (FXI) are in clinical development and may have lower adverse bleeding risk compared to FX inhibitors. Population based preclinical studies have shown lower risk of stroke in patients with lower levels of FXI. We sought to examine the relationship of FXI with other coagulation factors and prothrombotic markers in a cohort of patients with cardiac risk factors or established cardiovascular disease.

Hypothesis:
FXI activity is associated with alterations of other coagulation factors.

Methods:
Plasma samples from subjects enrolled in a cardiovascular biobank (n=418) were analyzed by multiplex assay for FXI, FXII, FXIII, prothrombin, PAI-1, tPA, fibrinogen, antithrombin, c-reactive protein.

Results:
Increasing quintiles of FXI were associated with increases in fibrinogen, antithrombin, c-reactive protein, FXIII, and PAI-1, but decreases in prothrombin and FXII (p<0.001). FXI levels were higher in women than men (149±54 vs. 134±48; p<0.01) and in patients with diabetes mellitus (150±50 vs. 139±52; p<0.05). In patients with subsequent spontaneous major bleeding during follow up (n=10), FXI was not significantly different from those without bleeding events (p=0.41).

Conclusions:
FXI activity may exhibit sex specific differences, and FXI activity may be increased in patients with diabetes, which is a strong risk factor for myocardial infarction and stroke. FXI activity is closely tied to activity of various markers of thrombosis and clotting factors. Future studies are warranted to examine effects of FXI inhibition on other coagulation factors.
Abstract 9840: A Rare Etiology of Diffuse Coronary Aneurysms
Authors: Lee Christopher , Gacad Vincent E , Dow Sam D , opsahl alan , Dombrowski Todd F , Jayne John , Henkin Stanislav
Published: June 2023

Case:
A 50-year-old woman with a prior right carotid aneurysm repair presented for chest pain. An evaluation 13 years ago showed a normal echo and cardiac catheterization. Four years prior, an echo showed an enlarged left ventricle with ejection fraction 57% and mid-anterolateral and inferolateral wall hypokinesis. Coronary angiography showed diffuse aneurysms of all coronary arteries with a proximal stenosis of the LAD, followed by a giant coronary aneurysm (Figure 1). CT angiography revealed bilateral intercostal artery aneurysms and a mildly ectatic aorta. She underwent bypass of the LAD with the LIMA. Aortic biopsy revealed no aortitis and prior carotid aneurysm pathology showed plasmalymphocytic inflammation; labs showed hypereosinophilia and elevated inflammatory markers with other negative immunologic work-up. She was diagnosed with hypereosinophilic vasculitis without evidence of granulomatosis and started on immunosuppressants.Due to symptoms, she underwent coronary angiography. Her LAD was occluded ostially with distal flow via a patent LIMA (Figure 2). There was progression of her aneurysmal disease at her proximal right coronary artery. No intervention was recommended. Instead, to improve control of her vasculitis, a Janus kinase inhibitor will be started.

Discussion:
Hypereosinophilic vasculitis, a variant of eosinophilic granulomatosis with polyangiitis, affects small- and medium-sized arteries and is challenging to diagnose. This case highlights a rare cardiac complication that can occur with this condition. Cardiac involvement often manifests as heart failure, pericarditis, valvular insufficiency, or rarely, coronary aneurysms.
Abstract 9844: Particulate Matter 2.5, Metropolitan Status, and Heart Failure Outcomes in US Counties: A Nationwide Ecologic Analysis
Authors: Chen Edward W , Ahmad Khansa , ERQOU SEBHAT , Wu Wen-Chih H
Published: June 2023

Epidemiological data on the relationship of particulate matter with a diameter of 2.5 micrometers or less (PM
2.5
) with heart failure (HF) hospitalizations and mortality in the US are limited. Prior studies have focused on the effects of daily PM
2.5
exposure and HF hospitalizations in specific geographic locales in the US. Since PM
2.5
varies by geography, this study aimed to evaluate the relationship between annual ambient PM
2.5
concentration levels and HF hospitalizations and death at a county level across the US. We performed a cross-sectional analysis of county level HF hospitalizations, mortality, and ambient PM
2.5
concentration levels across 3135 US counties nationwide with adjustments for county-level demographics, socioeconomic factors, comorbidities, and healthcare-associated behaviors. County PM
2.5
showed a moderate correlation with HF hospitalization among Medicare beneficiaries (r=0.41) and a weak correlation with the overall county HF mortality (r=0.08) (p-values < 0.01). There was an increase of 0.51 HF Hospitalizations/1,000 Medicare Beneficiaries and 0.74 HF deaths/100,000 residents for every 1 ug/m
3
increase in annual PM
2.5
concentration after adjustment for various county level covariates. The relationship between PM
2.5
concentration levels and both HF hospitalization and mortality remained significant after adjustment for county covariates. Additionally, the association between PM
2.5
and HF hospitalizations was comparable by metropolitan status of the counties. In conclusion, ambient PM
2.5
concentration level was associated with higher incidence of HF hospitalizations and deaths at the county level across the 3100 US counties. Future studies to examine policies aimed at reducing ambient particulate matter pollution and downstream effect of improving HF outcomes are warranted.
Abstract 9857: Comparison of Late Gadolinium Enhancement Quantitation Methods in Cardiac Sarcoidosis to Predict Clinical Outcomes
Authors: Shah Parth , Benjamin Mina M , Munir Muhammad S , Kinno Menhel , Syed Mushabbar A
Published: June 2023

Introduction:
We sought to investigate the optimal method for quantifying late gadolinium enhancement (LGE) in patients with cardiac sarcoidosis (CS) undergoing cardiac magnetic resonance (CMR).

Methods:
We retrospectively studied 53 patients with CS. LGE quantitation was performed using (a) Semi-automated segmentation (SAS) using a Signal Threshold versus Reference Mean (STRM) cutoffs of >2, >3 and >5 standard deviations (SD); (b) full width half max (FWHM) method and (c) manual segmentation (MS) of affected myocardial segments. Primary outcome was a composite of cardiovascular death and ventricular tachyarrhythmias (VTA). A multivariate regression analysis was performed comparing techniques adjusting for age, gender, NYHA class and left ventricular ejection fraction (LVEF).

Results:
Mean age was 56.3 ± 12 years, 71.6% males, 66% white. Mean LVEF was 45.1% ± 14.7%. Over a median follow-up of 28.1 months, 2 patients had cardiac death (3.7%) and 8 (15.1%) had VTA. On multivariate analysis, MS, >2SD, >3SD, >5SD and FWHM had odds ratios of 1.99 [CI 1.19-3.25], 1.09 [CI 0.99-1.21], 1.15 [CI 1.03-1.29], 1.16 [CI 1.04-1.27] and 1.08 [CI 0.96-1.21], respectively, for predicting composite outcome. ROC curve analysis showed MS to have the highest AUC 0.89 followed by 0.81 for >3SD and >5SD, 0.75 for >2SD and lowest 0.69 for FWHM method. Reproducibility was lower for manual method (ICC 0.7) than for >3SD (ICC 0.83) and >5SD (ICC 0.82).

Conclusion:
In patients with CS, quantitation of LGE using either MS or SAS with STRM >3SD or >5SD was significantly associated with the composite outcome of cardiac death and VTA. SAS with STRM >3SD provided the best combination of accuracy and reproducibility.
Abstract 9861: Geographic Variation in Prescription of Heart Failure Guideline Directed Medical Therapies for United States Veterans is Prevalent Nationwide
Authors: Kosaraju Revanth , Fonarow Gregg C , Ong Michael K , Heidenreich Paul A , Washington Donna L , Wang Xiaoyan , Ziaeian Boback
Published: June 2023

Introduction:
In patients with heart failure with reduced ejection fraction (HFrEF), use of guideline directed medical therapies (GDMT) reduces mortality. Whether there is geographic variation in GDMT prescribing is not well-characterized.

Hypothesis:
We assessed the hypothesis that there is wide geographic variation nationally within the Veterans Affairs (VA) healthcare system for the receipt of GDMT.

Methods:
We linked the primary residence address of a cohort of Veterans with HFrEF receiving care at VA facilities (n=178,856) to hospital referral regions (HRRs). Using VA and non-VA pharmacy data between July 1, 2020 and July 1, 2021, we defined receipt of GDMT. For each HRR, we calculated the percentage of eligible Veterans that were prescribed each class of GDMT and a composite GDMT z-score. Lastly, we constructed national choropleth maps to depict HRR geographic variation in composite z-scores and prescription of each class of GDMT.

Results:
There was significant variation in individual GDMT class prescription and composite score across HRRs as shown in choropleth maps (
Figure)
. Within HRRs, beta-blocker prescription was highest, with a median 80% of Veterans (interquartile range [IQR] 77.3% to 82.2%), afterload-reducing agents including angiotensin converting enzyme inhibitor / angiotensin receptor blocker / angiotensin receptor-neprilysin inhibitors (ARNI) 69.3% (IQR 66.4% to 72.1%), mineralocorticoid receptor antagonists (MRA) 29.2% (IQR 25.8% to 33.9%), sodium-glucose cotransporter 2 inhibitors (SGLT2I) 10.3% (IQR 7.7% to 12.8%), and ARNI 12.2% (IQR 8.6% to 15.3%). HRRs with the highest and lowest composite scores were often found in the same U.S. Census Regions.

Conclusions:
In conclusion, wide geographic disparities are present for GDMT prescribing to Veterans across HRRs. Veteran receipt of ARNI, SGLT2I, and MRA is low nationwide. Targeted approaches may be necessary to improve GDMT prescription for Veterans in lower performing HRRs.
Abstract 9929: Epigenome-Wide-Association-Study Characterizes DNA Methylation Changes Associated With Lung and Right Ventricle Dysfunction in Pulmonary Hypertension
Authors: Potus Francois , Azhar Nabil , Reem EL-Kabbout , Breuils Bonnet Sandra , Martineau Sandra , Krishna Vinod , Kalyana-Sundaram Shanker , Girard Lysanne , Toro Victoria M , Boucherat Olivier , Guerra Bonilla Fany , Gutstein David , Provencher Steeve , JEYASEELAN Jey R , Bonnet Sebastien
Published: June 2023

Background:
Pulmonary arterial hypertension (PAH) is a lethal vasculopathy associated with pulmonary arteries remodeling and right ventricle (RV) dysfunction. Epigenetic dysregulation, including altered DNA methylation (DNAm), promotes PAH. However, the DNAm changes associated with PAH remain unexplored in human PAH RV and lungs. We conducted an exploratory study using human lung and RV samples to characterize the DNA methylome and transcriptomic changes associated with PAH.

Methods/Results:
We observed that PAH is associated with substantial changes in the DNAm landscape in both organs. We identified 88 identical differentially methylated probe (DMP) in both PAH Lungs and RV. Functionally, we observed that 65, and 76 of those DMP correlate with myocardial fibrosis and adverse pulmonary vascular remodeling, respectively. Then we clustered DMP onto functional differentially methylated region (DMR) and reported that 41% and 11.5% of the genes carrying a DMR are differentially expressed in PAH RV and lungs, respectively. Gene ontology analysis suggests that both impaired DNAm (DNA methylome) and genes expression (RNA sequencing) observed in PAH regulate biological functions related to inflammation, fibrosis, cell proliferation and vascular remodeling. Impaired DNAm landscape observed in PAH RV and lung is associated with the disease severity and contributes to 4.1% and 2.7% of the whole transcriptomic reprograming associated with PAH development in RV and lungs samples, respectively. Despite the modest overlap between DNAm and transcriptomic changes, we observed that DNAm affects genes and molecular pathways involved in PAH development.

Conclusion:
Although exploratory, our study is the first to characterize the DNAm and transcriptomic change associated with PAH in human RV and lung. Our data suggest that impaired DNAm landscape might contribute to the disease development/severity.
Abstract 9931: Women Representation in Authorship of European Society of Cardiology Guidelines: Temporal Trends and a Geographic Perspective
Authors: Dakhil Zainab A , Cader Aaysha
Published: June 2023

Introduction:
Diversity of authors of the international Clinical Practice Guidelines (CPG) will ensure raising broader concerns and contributing different perspectives. There is lack of data regarding gender and global distribution of authors of cardiovascular CPG.

Purpose:
To assess gender and geographic distribution of authors of ESC CPG and compare these over the contemporary years (2015 - 2021) vs earlier years (prior to 2015).

Methods:
ESC website was searched to include CPG. Sex and affiliating country of authors were determined by searching ESC 365 platform, Google Scholar, ResearchGate, LinkedIn platforms, social media or author’s affiliating institution website.

Results:
Thirty-eight documents were analyzed (26 contemporary documents vs 12 earlier documents). The documents included 28 CPG and 10 non-CPG documents (i.e., position papers, expert consensus, scientific statements, or task force reports). Total number of authors =748, 18.85% were women (21.84% in contemporary documents vs 8.02% in earlier documents, p<0.001). Total number of chair/co-chair position was 67, 10.44% were women (11.32% in contemporary vs 7.14% in earlier documents, p<0.001). Lowest proportion of women authors was in interventional cardiology CPG (13.3%) while highest proportion was in pediatric cardiology CPG (37.5%). Highest proportion of total authors (regardless gender) was from UK, Italy and Germany in 11.9%, 11.1%, and 10.3% respectively. Highest number of women authors were from UK, Netherlands and Italy in 15.5%, 12.7% and 11.3% respectively. Highest percentage of women authors among total authors from each specific country were from Austria 46.7%, Netherlands 37.5% and Sweden 35.1%

Conclusion:
Despite trends showing an overall increase in female authorship over years, there still remain gender and geographic disparities in writing committee/ task force shares, indicating potential for enhanced efforts to improve diversity within professional societies.
Abstract 9981: Comparison of 30-day Readmission and Healthcare Costs Between Early and Late Catheter Directed Thrombolysis for Acute Pulmonary Embolism in the United States
Authors: Nketiah Sarpong Kwabena S , Jang Sun-Joo , Yeo Ilhwan , Gopalratnam Kavitha
Published: June 2023

Introduction:
Pulmonary embolism (PE) is a major cause of morbidity and mortality accounting for 100,000 deaths per year in the United States and 5-10% of in-hospital deaths. There is sparse comparative data on readmission patterns and healthcare costs in patients who undergo early versus late catheter directed thrombolysis (CDT) for acute PE.

Hypothesis:
Procedure Day for acute PE may be associated with difference in 30-day readmission rates and healthcare costs.

Methods:
This study was performed by using National readmission database between January 2016 and November 2019. Patients with acute PE who underwent CDT were identified using the International Classification of Diseases, Tenth Edition (ICD 10) codes. Patients who were <18 years old and patients who underwent thrombolysis for STEMI and Ischemic stroke were excluded.

Results:
Among a total of 23,564 patients who underwent CDT for acute pulmonary embolism, 12,528 (53.2%) were male and 11034 (46.8%) were female (P=0.014). The mean age of the patients was 60.3 years. The median length of hospital stay was 4 days. Thirty-day readmission rates were higher for patients who underwent CDT on Day 2 or afterwards compared to Day 1 and Day 0 (7.1% vs 5.7% vs 5.2%, for day 2, day 1 and day 0 respectively; p=0.016). Patients who had CDT on Day 2 or more had a higher rate of 30-day readmission mortality compared to those who had CDT on Day 1 or 0 (0.6% vs 0.3% vs 0.2%, for day 2, day 1 and day 0 respectively; Adjusted OR 2.96, 95% CI 1.18 to 7.47 (Ref: day 0), p = 0.021). Thirty-day readmission for heart failure was higher among patients who had CDT on Day 2 vs those who had CDT on Day 0 of admission (2% vs 1.0% vs 0.9%, for day 2, day 1 and day 0 respectively; Adjusted OR 1.97, 95% CI 1.24 to 3.13 (Ref: day 0), p=0.004). Total 30-day costs for patients who underwent CDT on day 2 or more was higher in patients with CDT on day 2 ($55,087; IQR $41,361-$74,092) compared to those with CDT on Day 1 ($45,942; IQR $36,016-$61,211) or Day 0 ($44,814; IQR $34,264-$60,072) (P <0.001).

Conclusions:
Delayed CDT for acute PE was associated with increased rates of 30-day readmission, readmission mortality, readmission for heart failure and increased healthcare costs. These findings emphasize the need for earlier CDT for the treatment of acute PE.
Abstract 9995: Anemia is Associated With Increased Mortality and Adverse In-Hospital Outcomes in Women With Peripartum Cardiomyopathy: A Nationwide Data Analysis
Authors: Ehtesham Moiz , Khan Arshan , Oredegbe Al-Ameen , Riasat Maria , Shabbir Muhammad Asim
Published: June 2023

Objective:
Anemia is a common comorbidity during pregnancy and in non-pregnant females of childbearing age. Our goal was to ascertain its association with in-hospital mortality and complications in females with peripartum cardiomyopathy (PPCM).

Methods:
The national inpatient sample was retrospectively queried from 2011-2017 to identify all women aged 17 to 51 years with the diagnosis of PPCM. We further identified diagnosis of anemia within each admission using ICD-10 codes (D64.9 and D64.89). Primary outcome was inpatient mortality rate while secondary outcomes were in-hospital complications such as acute kidney injury (AKI), pulmonary edema and antepartum hemorrhage. Demographic (age, sex, race) and clinical (history of hypertension, stroke, myocardial infarction, obesity, smoking) data was also noted. Analysis was conducted using STATA 16.0. Adjusted odds ratios (AOR) were calculated with multivariate logistic regression method reported with confidence interval (CI) and a P-value (significance <=0.05).

Results:
We recorded 211,476 hospitalizations for PPCM, out of which 38% (80,361) had anemia. Average age of the patients was 35 years and 78% of the women were Caucasian. Overall inpatient mortality rate was 3.9% and was higher in PPCM hospitalizations with anemia compared to those without anemia [4.1% vs 3.3%; AOR: 1.24 (1.19 – 1.30, p<0.001)]. Women with PPCM and anemia reported clinically significant history of obesity and smoking (p<0.001). PPCM hospitalizations with anemia also had higher incidence of preeclampsia, AKI, acute pulmonary edema, and antepartum hemorrhage (Table).

Conclusion:
Our study demonstrates that anemia increases inpatient mortality rate in women with PPCM. Anemia also increases in-hospital incidence of preeclampsia, AKI, acute pulmonary edema, and antepartum hemorrhage in women with PPCM.
Coronary Microvascular Disease Assessed by 82‐Rubidium Positron Emission Tomography Myocardial Perfusion Imaging Is Associated With Small Vessel Disease of the Kidney and Brain
Authors: Højstrup Signe , Hansen Kim W. , Talleruphuus Ulrik , Marner Lisbeth , Galatius Søren , Rauf Maira , Bjerking Louise H. , Jakobsen Lars , Christiansen Evald H. , Bouchelouche Kirsten , Christensen Hanne , Prescott Eva I. B.
Published: June 2023

Background

Coronary microvascular disease (CMD) may be part of a systemic small vessel disease that also manifests as neurological impairment and kidney disease. However, clinical evidence supporting a potential link is scarce. We assessed whether CMD is associated with an increased risk of small vessel disease in the kidney and brain.

Methods and Results

A retrospective multicenter (n=3) study of patients clinically referred to 82‐rubidium positron emission tomography myocardial perfusion imaging was conducted between January 2018 and August 2020. Exclusion criterion was reversible perfusion defects >5%. CMD was defined as myocardial flow reserve (MFR) ≤2. The primary outcome, microvascular event, was defined by hospital contact for chronic kidney disease, stroke, or dementia. Among 5122 patients, 51.7% were men, median age 69.0 [interquartile range, 60.0–75.0] years, 11.0% had left ventricular ejection fraction ≤40%, and 32.4% had MFR ≤2. MFR was associated with baseline estimated glomerular filtration rate after multivariable adjustment (
β
=0.04 [95% CI, 0.03–0.05];
P
<0.001). During a median follow‐up of 3.05 years, 383 (7.5%) patients suffered an event (253 cerebral and 130 renal), more frequently in patients with MFR ≤2 versus MFR >2 (11.6% versus 5.5%,
P
<0.001). MFR ≤2 was associated to outcome with a hazard ratio (HR) of 2.30 (95% CI, 1.88–2.81,
P
<0.001) and an adjusted HR of 1.62 (95% CI, 1.32–2.00,
P
<0.001). Results were consistent across subgroups defined by presence of irreversible perfusion defects, estimated glomerular filtration rate, diabetes, left ventricular ejection fraction, and previous revascularization.

Conclusions

This is the first large‐scale cohort study to link CMD to microvascular events in the kidney and brain. Data support the hypothesis that CMD is part of a systemic vascular disorder.
Microglia‐Mediated Neuroimmune Response Regulates Cardiac Remodeling After Myocardial Infarction
Authors: Wang Menglong , Zhang Jishou , Yin Zheng , Ding Wen , Zhao Mengmeng , Liu Jianfang , Xu Yao , Xu Shuwan , Pan Wei , Wei Cheng , Jiang Hong , Wan Jun
Published: June 2023

Background

Sympathetic hyperactivity contributes to pathological remodeling after myocardial infarction (MI). However, the mechanisms underlying the increase in sympathetic activity remain unknown. Microglia are the predominant immune cells in the central nervous system and can regulate sympathetic neuron activity through neuroimmune response in the hypothalamic paraventricular nucleus. The present study aimed to investigate whether microglia‐mediated neuroimmune response can regulate sympathetic activity and cardiac remodeling after MI.

Methods and Results

PLX3397 (pexidartinib) was used to deplete central microglia via intragastric injection or intracerebroventricular injection. After that, MI was induced by ligation of the left anterior descending coronary artery. Our study showed that MI resulted in the activation of microglia in the paraventricular nucleus. Microglia depletion, which was induced by PLX3397 treatment via intragastric injection or intracerebroventricular injection, improved cardiac function, reduced infarction size, and attenuated cardiomyocyte apoptosis, fibrosis, pathological electrical remodeling, and myocardial inflammation after MI. Mechanistically, these protective effects were associated with an attenuated neuroimmune response in the paraventricular nucleus, which contributed to the decrease of sympathetic activity and attenuation of sympathetic remodeling in the heart. However, intragastric injection with PLX3397 obviously depleted macrophages and induced neutrophil and T‐lymphocyte disorders in the heart, blood, and spleen.

Conclusions

Microglia depletion in the central nervous system attenuates pathological cardiac remodeling after MI by inhibiting neuroimmune response and sympathetic activity. Intragastric administration of PLX3397 leads to serious deleterious effects in peripheral immune cells, especially macrophages, which should be a cause for concern in animal experiments and clinical practice.
Moral Rapport in Communion of the Spirit
Authors: Moser Paul K.
Published: June 2023

The communion (koinōnia) of the Spirit calls for moral rapport with God, based on the reception of divine righteousness in the “fruit of the Spirit” among humans. This article explains the centrality of such moral rapport to the koinōnia of the Spirit, on the basis of insights from the book of Genesis, some of the Hebrew psalmists, and the apostle Paul. It gives special attention to Paul’s perspective on the “fruit of the Spirit,” thereby identifying distinctive evidence for the reality and the goodness of God, by way of contrast with either a purely mystical or a purely intellectual approach. Paul offers a perspective including “koinōnia of Jesus Christ,” pointing to his koinōnia with God in Gethsemane and thus confirming the central role of moral and volitional personal rapport with God. This approach gives moral and christological depth to the koinōnia of the Spirit, enriching it with divine righteousness.
A revision of the Australian species of the genus Melobasis Laporte & Gory 1837 (Coleoptera: Buprestidae), Part 3 (Revision of the azureipennis, cupricollis, iridicolor and melanura species groups)
Authors: LEVEY BRIAN
Published: June 2023

This is the third part of a revision of the Australian members of the genus Melobasis Laporte & Gory 1837 and revises the species of the azureipennis, cupricollis, iridicolor and melanura species groups.
19 new species are described: M. adamsi sp. n., M. adusta sp. n., M. aureoviridis sp. n., M. aureovittata sp. n., M. breviantennatus sp. n., M. calama sp. n., M. confundo sp. n., M. cuspidata sp. n., M. dentata sp. n., M. edungalbensis sp. n., M. fritzbrechteli sp. n., M. imitator sp. n., M. incisa sp. n., M. incongruens sp. n., M. macqueeni sp. n., M. oculata sp. n., M. ordinata sp. n., M. rufoviolacea sp. n., M. tricolor sp. n.
The following new synonymies are proposed: M. abigailae Turner & Hawkeswood, 2009 is synonymised with M. cupricollis Kerremans, 1898; M. epistomalis Obenberger, 1942 is synonymised with M. costata Macleay, 1872; M. macleayana Obenberger, 1930 is synonymised with M. suturalis Thomson, 1879; M. viridiobscura Thomson, 1879 is synonymised with M. suturalis Thomson, 1879.
The following changes of status are proposed: M. azureipennis Macleay, 1872 and M. aureipennis Thomson, 1879 are removed from synonymy with M. cyaneipennis Boheman, 1858, which is transferred to the genus Nesotrinchus Obenberger; M. suturalis Thomson, 1879 is removed from synonymy with M. apicalis Macleay, 1872; M. viridiobscura Thomson, 1879 is removed from synonymy with M. obscurella Thomson, 1879.
Doing Organizational Identity: Earnings Surprises and the Performative Atypicality Premium
Authors: Gouvard Paul , Goldberg Amir , Srivastava Sameer B.
Published: June 2023

How do organizations reconcile the cross-pressures of conformity and differentiation? Existing research predominantly conceptualizes identity as something an organization has by virtue of the products or services it offers. Drawing on constructivist theories, we argue that organizational members’ interactions with external audiences also dynamically produce identity. We call the extent to which such interactions diverge from audience expectations performative atypicality. Applying a novel deep-learning method to conversational text in over 90,000 earnings calls, we find that performative atypicality leads to an evaluation premium by securities analysts, paradoxically resulting in a negative earnings surprise. Moreover, performances that correspond to those of celebrated innovators are received with higher enthusiasm. Our findings suggest that firms that conform to categorical expectations while being performatively atypical can navigate the conflicting demands of similarity and uniqueness, especially if they hew to popular notions of being different.
Repeat self-harm and mental health service use after self-harm in Culturally and Linguistically Diverse communities: Insights from a data linkage study in Victoria, Australia
Authors: Pham Thi Thu Le , O’Brien Kerry S , Liu Sara , Gibson Katharine , Berecki-Gisolf Janneke
Published: June 2023

Purpose:

To examine the associations between Culturally and Linguistically Diverse backgrounds (vs non-Culturally and Linguistically Diverse) and in-hospital death due to self-harm, repeat self-harm and mental health service use after self-harm.

Method:

A retrospective study of 42,127 self-harm hospital inpatients aged 15+ years in Victoria, Australia, from July 2008 to June 2019. Linked hospital and mental health service data were used to assess in-hospital death, repeat self-harm and mental health service use in the 12 months following index self-harm hospital admission. Logistic regression and zero-inflated negative binomial regression models were used to estimate associations between cultural background and outcomes.

Results:

Culturally and Linguistically Diverse people accounted for 13.3% of self-harm hospital inpatients. In-hospital death (0.8% of all patients) was negatively associated with Culturally and Linguistically Diverse background. Within 12 months, 12.9% of patients had self-harm readmission and 20.1% presented to emergency department with self-harm. Logistic regression components of zero-inflated negative binomial regression models showed no differences in the odds of (hospital-treated) self-harm reoccurrence between Culturally and Linguistically Diverse and non- Culturally and Linguistically Diverse self-harm inpatients. However, count components of models show that among those with repeat self-harm, Culturally and Linguistically Diverse people (e.g. born in Southern and Central Asia) made fewer additional hospital revisits than non-Culturally and Linguistically Diverse people. Clinical mental health service contacts following self-harm were made in 63.6% of patients, with Culturally and Linguistically Diverse people (Asian backgrounds 43.7%) less likely to make contact than the non-Culturally and Linguistically Diverse group (65.1%).

Conclusions:

Culturally and Linguistically Diverse and non-Culturally and Linguistically Diverse people did not differ in the likelihood of hospital-treated repeat self-harm, but among those with self-harm repetition Culturally and Linguistically Diverse people had fewer recurrences than non-Culturally and Linguistically Diverse people and utilised mental health services less following self-harm admissions.
A Physiological Anchor for the Perception of Effort
Authors: Hill David W.
Published: June 2023

This is a two-part study to determine one or more reliable physiological anchors for perception of effort. The purpose of Study 1 was to compare ratings of perceived exertion (RPE) at the ventilatory threshold (VT) in running, cycling, and upper body exercise with the premise that if RPE at VT did not differ across exercise modes, VT might provide a unique set of physiological inputs for perception of effort. For 27 participants, values for VT and for RPE at VT (Borg 6 to 20 scale) averaged 9.4 km⋅h−1 ( SD = 0.7) and 11.9 km⋅h−1 ( SD = 1.4) respectively in running, 135 W ( SD = 24) and 12.1 W ( SD = 1.6) in cycling, and 46 W ( SD = 5) and 12.0 W ( SD = 1.7) in upper body exercise. RPE did not differ, suggesting that VT may anchor effort perception. In Study 2, 10 participants performed cycle ergometer exercise for 30 minutes at their VT ( M = 101 W, SD = 21), at their maximal lactate steady state ( M = 143 W, SD = 22), and at their critical power (CP; M = 167 W, SD = 23). Mean end-exercise RPE were 12.1 ( SD = 2.1), 15.0 ( SD = 1.9), and 19.0 ( SD = 0.5), respectively. The very close clustering of RPE during exercise at CP hints that the confluence of physiological responses at CP may (also) serve as a determinant in perception of effort.
The local multiplier of income support paid in a complementary currency: Comparative evaluation in the city of Barcelona
Authors: Roca Mercè , Segura Marta , Puig Jordi , Martín Belmonte Susana
Published: June 2023

Complementary currencies have been promoted by ‘new-municipalism’ progressive movements to stimulate the local economy. Public administrations may engage in issuing complementary currencies or support them by realising expenditure and accepting them in payment. To assess and motivate the involvement of policymakers, measures to evaluate the multiplicative local impact of complementary currency programmes are required. The present research demonstrates a comparative procedure to analyse the local multiplier of income support payments provided by the City Council of Barcelona in euro and in a complementary currency, the REC. The results obtained show that the local impact of public income support can be enhanced when it is paid in a complementary currency and identify factors that mediate this effect.
“Criminalization Causes the Stigma”: Perspectives From People Who Use Drugs
Authors: Scher Benjamin D. , Neufeld Scott D. , Butler Amanda , Bonn Matthew , Zakimi Naomi , Farrell Jack , Greer Alissa
Published: June 2023

Introduction

In light of North America's persisting drug toxicity crisis, alternative drug policy approaches such as decriminalization, legalization, regulation, and safer supply have increasingly come to the forefront of drug policy discourse. The views of people who use drugs toward drug policy and drug law reform in the Canadian context are essential, yet largely missing from the conversation. The aim of this study was to capture the opinions, ideas, and attitudes of people who use drugs toward Canadian drug laws and potential future alternatives.

Methods

This paper was developed as part of the Canadian Drug Laws Project, a cross-jurisdictional qualitative study conducted in British Columbia, Canada between July and September 2020. The qualitative data are from 24 semi-structured interviews with a diverse sample of people who use illegal drugs. Interviews were recorded, transcribed, coded, and analyzed thematically by the research team.

Results

Two main themes and corresponding sub-themes are presented: (1) The experience of stigma as a consequence of criminalization; (2) The perceived benefits of drug law reform. Participants spoke in-depth about their experiences living within a criminalized drug policy context and offered suggestions for new pathways forward. Their perspectives illuminate how Canada's drug laws may shape public attitudes toward people who use drugs and the consequent manifestations of structural, social, and self-stigma experienced by people who use drugs.

Conclusion

Participants openly and profoundly believed that current drug laws produced and propagated the public attitudes and structural inequities experienced by people who use drugs in Canada. This matters, not only because our findings highlight the fact that people who use drugs experience stigma in tangible and clearly impactful ways, but it also suggests that the criminlilization of drugs shapes the experience of structural, social, and self stigma. Finally, participants believed that efforts to destigmatize people who use drugs would be ineffectual without the enactment of more robust forms of drug law reform such as the decriminalization of illegal drugs.
Pushing Through: How Older Adult Caregivers Manage Wound Care
Authors: Swartzell Kristen L. , Fulton Janet S. , von Gaudecker Jane R.
Published: June 2023

Older adults are taking on caregiving roles and are performing complex care procedures, such as wound care, in the home setting yet there is a dearth of knowledge about how older adult caregivers manage the performance of wound care on a day-to-day basis. The theoretical framework developed in this research describes this process of managing the caregiving role. Interviews with 18 caregivers aged 65 years and older who were performing wound care in the home for a care recipient yielded a theoretical framework from their narratives using a qualitative grounded theory analysis. The resultant theoretical framework, Pushing Through, consisted of five phases: (a) accepting the role, (b) lacking confidence, (c) creating a system, (d) trusting in self, and (e) owning the outcomes. An understanding of the older adult caregiver’s process creates opportunities for healthcare professionals to develop and implement evidence-based interventions.
Application of Realistic Artificial Data for Testing Various Crash Safety Analyses: A Case Study for Rural Two-Lane Undivided Highways
Authors: Olufowobi Oluwaseun , Ivan John , Zhao Shanshan , Wang Kai , Eluru Naveen
Published: June 2023

Traffic safety research will continue to create new and improved methods for the analysis of safety data. Even if these models perform well, the precise underlying crash mechanism remains unknown. The missing piece is a tool that may be used to evaluate how well a method identifies the cause-and-effect relationship in the data. To meet these safety analysis needs, a high-resolution disaggregate data generating process called realistic artificial data (RAD) was developed. This tool simulates crash incidence on transportation facilities, capturing real-world causal links between individual roadway characteristics and crashes. The objective of this study was to check if the stochasticity embedded in the RAD generation process will be consistent for different random seeds and miles of data generated from the tool. To accomplish this, 10 different datasets were generated from the RAD tool and estimated using the negative binomial model; parameter estimates from the model were checked using a revised Wald statistic. The t-statistic estimates showed that the differences among the parameter values across the dataset are within a statistically acceptable level. Given the stability of the tool, the RAD framework can be useful in addressing the known limitations and knowledge gap in assessing the extent to which a statistical method succeeds in identifying the cause-and-effect relationship in the data. This in return can help guide and improve the practical application of statistical methods and eventually lead to more effective safety countermeasures that can reduce highway-related injuries and fatalities.
Exploring Neighborhood Differences in Bicycling Accessibility to Physical and Virtual Workplaces
Authors: Martinez Armando E. , Phair Christopher D. , Russo Brendan J. , Gehrke Steven R.
Published: June 2023

Health concerns brought about by the Covid-19 pandemic, coupled with technological advancements over the past two decades have altered the traditional workplace setting. Some professionals in the tertiary and quaternary economic sectors have grown accustomed to virtual working environments, whereas others, including essential workers, have experienced less flexibility in this regard and continue to commute to physical work settings. During the pandemic, residents of underresourced communities, who were more likely to adopt lower-cost shared-use travel modes and would have benefited from good access to high-quality bicycling infrastructure, embodied a greater share of the nonhealthcare workforce who was required to commute to a physical work setting. This circumstance highlighted a need for research that examines bicycling accessibility to workplaces distinguished by telework potential, with a hypothesis that underresourced communities with more limited mobility options have poorer bicycling access to traditional workplace settings. In response, this study, which describes the application of a novel bicyclist routing algorithm, investigated how these differences in job accessibility relate to variations in the social context of neighborhoods where bicyclist commute trips originate, and the level of traffic stress incurred by a current or prospective bicyclist along modeled routes in Flagstaff, AZ. Study findings, which in part confirmed its hypothesis while also noting a latent demand for bicycling to physical workplaces along low-stress facilities, offer unique insights into how the changing nature of work should be accounted for as active transportation planners and policy makers seek to provide safer and more robust bicycle networks to their diverse communities.