bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 15140: Post-Myocardial Infarction Ventricular Septal Defect in a Patient With Mixed Connective Tissue Disorder
Authors: Gardy Adam , Lima Gian , Sargeant Jarred 
Published: June 2023

Mixed connective tissue disorder (MCTD) is associated with a broad range of cardiovascular abnormalities, including coronary artery disease (CAD). It has been proposed that chronic systemic inflammation plays a key role in the development of atherosclerotic disease.
A 66-year-old female with a history of MCTD and hypertension presented with mild dyspnea and pleuritic chest pain after one week of persistent flu-like symptoms. Her blood pressure was 108/77 mmHg, pulse 92 bpm, saturating 98% on room air. She was comfortable and denied other risk factors such as diabetes, hyperlipidemia, or prior smoking history. On exam she was found to have a soft holosystolic murmur across her precordium. EKG showed sinus rhythm with small Q waves and ST elevation in V1-V6. She was taken for cardiac catheterization which revealed a thrombotic occlusion in the proximal left anterior descending artery (LAD) and a severe lesion in the left circumflex artery. She underwent angioplasty with one drug eluted stent placed to LAD. Left ventriculography revealed a VSD near the apex, and transthoracic echocardiogram showed a 7.6 mm muscular VSD with left to right shunt, ejection fraction of 35% and hypokinesis of the anterior wall. She became hypotensive and required vasopressors prior to coronary artery bypass grafting and primary closure of her apical VSD. Intraoperatively, a 2 cm VSD with 5 cm of necrotic surrounding tissue was noted. Post-operative complications included asystolic cardiac arrest, marked cardiogenic shock and multiorgan failure to which she ultimately succumbed.
Post-myocardial infarction VSD is a rare complication of MI occurring in approximately 0.2% of cases. However, patients with MCTD can develop atypical symptoms, resulting in delayed presentation and therefore higher risk of mechanical complications. We highlight the importance of a thorough physical exam and high suspicion for mechanical complications in these patients even when hemodynamically stable.
Abstract 9748: Association of Home-Based Cardiac Rehabilitation With Hospitalization Among a Diverse Cohort of Women With Cardiovascular Disease: A Propensity Score-Matched Study
Authors: Najem Michael , Duggan Mark , Gambatese Rebecca , Price Chileshe 
Published: June 2023

Prior studies have demonstrated that home-based cardiac rehabilitation (HBCR) has similar outcomes compared to center-based cardiac rehabilitation (CBCR), however these studies have enrolled few women. The purpose of this study was to compare 12-month hospitalization rates among women who participated in HBCR and CBCR within an integrated health system in Southern California.
Using a retrospective cohort design, we evaluated women referred to HBCR and CBCR in Kaiser Permanente Southern California from April 1, 2018, to April 30, 2019. HBCR involved home-based exercise for 8 weeks complemented by a smartwatch exercise monitor and telephone support. CBCR involved center-based exercise sessions three times per week for a total of 36 sessions. Attendance of ≥1 session defined participation. After propensity score matching for age, race, Charlson score, referral reason, BMI, smoking history, atrial fibrillation, hypertension, prior MI, prior stroke, and history of hospitalization in the year prior to cardiac rehabilitation start, hospitalization rates at 12 months were compared among HBCR and CBCR groups.
Among 754 women who participated during the study period, 382 participated in HBCR and 372 participated in CBCR. Baseline demographics are presented in Table 1. After propensity score matching, women who participated in HBCR had similar hospitalization rates at 12 months, 17.0% (95% CI: [13.2%, 20.8%]) compared to women who participated in CBCR, 16.4% (95% CI: [12.1%, 20.8%]) (Figure 1).
In a propensity-matched, racially diverse population of women with cardiovascular disease, 12-month hospitalization rates were similar between women who participated in HBCR and CBCR.
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

Abstract
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.
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.
“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.
Government Budget for Nutrition-Sensitive Agriculture in Nigeria Increased Following Development of Related Strategy
Authors: Adeyemi Olutayo , Adesiyun Yeside , Omenka Samuel , Ezekannagha Oluchi , Adanlawo Adekunle , Oyeleke Rasaq , Umunna Larry , Aminu Francis , Onabolu Adeyinka , Ajieroh Victor 
Published: June 2023

Background: Financial resources that are commensurate with the magnitude of malnutrition problem are requisite for effective interventions to reduce malnutrition. Understanding the amount and nature of sectoral investments in nutrition is important for advocating and mobilizing increased government budgetary allocations and release. Objective: This study assessed trends in Nigeria’s agriculture sector nutrition allocations and whether launch of nutrition-sensitive agriculture strategy and/or the COVID-19 pandemic may have affected these nutrition allocations. Methods: Agricultural budgets from 2009 to 2022 of Nigeria’s federal government were analyzed. Nutrition-related budget lines were identified using a keyword search and were then classified as nutrition-specific, nutrition-sensitive, or potentially nutrition-sensitive, based on defined criteria. Potentially nutrition-sensitive items were further screened. Budget lines finally included as nutrition allocations directly targeted improvements in nutrition or intermediate outcomes in pathways between agriculture and nutrition. Budget lines were summed, and these nominal values were adjusted for inflation (using the consumer price index for each year) to obtain real values. Results: Nutrition allocations in the agriculture budget increased considerably even after adjusting for inflation and went from 0.13% of agriculture capital budget in 2009 to 2.97% in 2022; while the real value of total government agricultural budget declined. Large budgetary increases coincided with the development/launch of costed strategies with nutrition-sensitive agriculture components. Still, there were some missed opportunities to increase nutrition allocations. Conclusions: Existence of nutrition-sensitive agriculture strategies has facilitated increased nutrition funding and improved the enabling environment. There is need to optimize existing nutrition allocations while advocating for additional funds.
Re-examining the association between the age of learning one is autistic and adult outcomes
Authors: Leung Florence YN , Shah Punit , Mason David , Livingston Lucy A 
Published: June 2023

It was recently reported that learning one is autistic earlier in life is associated with greater quality of life and well-being in university students. In a pre-registered extension of this work, we addressed several limitations of this study by (a) recruiting a larger sample of more diverse ages and education levels, (b) distinguishing between learning about and receiving an autism diagnosis, (c) accounting for additional confounding variables, and (d) studying different quality of life dimensions. Autistic adults ( N = 300) reported when they first learned they were autistic, as well as when they actually received an autism diagnosis, and provided detailed socio-demographic information. Participants also completed measures of their autistic traits, as well as well-being and quality of life across multiple domains. In contrast to recent research, we found the age participants first learned they were autistic did not significantly and uniquely predict their quality of life and well-being. Rather, having more autistic traits was the strongest predictor of poorer quality of life and well-being, while other socio-demographic factors were also relevant. We discuss the implications of these findings for understanding and improving outcomes in autistic adults and call for higher quality open science on this important topic. Lay abstract An interesting recent study found that people who learned they were autistic at a younger age felt more positive about their lives (i.e., had better quality of life) than those who learned at an older age. However, this study has some limitations: (a) the study only involved a fairly small group of university students, (b) whether ‘learning one is autistic’ referred to learning about one’s diagnosis or receiving one’s diagnosis was unclear, (c) the influence of other factors on the link between age of learning one is autistic and quality of life was not considered, and (d) the assessment of different areas of quality of life was limited. Addressing these limitations, we re-examined whether the age at which one learns they are autistic relates to quality of life in adulthood. Contrary to the previous study, we found the age at which one learns about their autism does not have a significantly independent impact on their quality of life as an adult. Rather, other factors (e.g., autistic traits, sex, and additional mental health conditions) may have a greater impact. Given our participant sample was larger and more diverse in age and education level compared to previous research, this finding is likely to be more applicable to autistic adults from different backgrounds. Importantly, however, we are not suggesting that individuals should be made aware of their diagnosis later than sooner. Getting a timely diagnosis remains crucial for autistic people and their families to access appropriate support.