Saron Hunegnaw

Preliminary evidence suggests that the combination of magnesium and ibogaine, an atypical psychedelic, may be a promising treatment for post-traumatic stress disorder (PTSD), opioid use disorder, and traumatic brain injury (TBI). The "mystical" experience elicited by ibogaine, which is characterized by feelings of awe, selflessness, and transcendence, is correlated with improvements in PTSD symptoms. Mystical experiences with other psychedelics are associated with acute decreases in the activity and connectivity of the default mode network (DMN), which mediates self-related cognition. However, the dynamic effects of ibogaine on the DMN have not yet been studied. At baseline, immediately (3-4 days) after ibogaine, and one month after ibogaine, we acquired resting-state functional magnetic resonance imaging data in an open-label, observational trial of magnesium-ibogaine treatment for 30 U.S. veterans with TBI. Magnesium-ibogaine did not significantly alter static DMN connectivity at either the immediate-post or one-month timepoint. Since static measures cannot capture time-evolving changes in connectivity, we next used Hidden Markov Models (HMM) to measure the post-acute dynamics of DMN activity. Magnesium-ibogaine was associated with significant, sustained decreases in the switching rate (i.e., increases in the duration of) a dynamic DMN substate, which was significantly correlated with the mean score on the Revised Mystical Experience Questionnaire and clinical improvements at one month-post treatment. This DMN substate exhibited a lateral-medial spatial gradient, which was significantly associated with a gradient of externally oriented (i.e., directed to the environment) to internally oriented (i.e., self-related) perception and cognition. Taken together, our results indicate that magnesium-ibogaine alters specific dynamic substates of the DMN, which correlate with its subjective and therapeutic effects.

Background: Heart failure (HF) affects 6.7 million American adults and is associated with significant morbidity and mortality. Cardiac rehabilitation (CR) is a behavior modification program recommended to improve health outcomes in patients with HF. In 2014, Medicare began covering facility‐based CR for patients with stable HF, and some Veterans Affairs (VA) facilities began offering home‐based CR. Methods: We conducted an observational study to assess CR participation among patients with stable HF and patient characteristics associated with participation. National electronic health record data from the VA and claims data from a 5% Medicare sample were used to identify patients using International Classification of Diseases, Ninth Revision ( ICD‐9 ) or Tenth Revision ( ICD‐10 ) codes. CR participation was determined using Current Procedural Terminology codes and VA stop codes during the 12 months following HF diagnosis. A multivariable logistic regression was constructed to identify patient characteristics associated with participation. Results: From 2012 to 2022, VA participation increased from 7.4% to 10.4% and Medicare decreased from 7.4% to 5.1%. From 2016 to 2022, 13.2% of veterans and 6.7% of Medicare beneficiaries with stable HF participated in CR. Older age, female sex, and non‐White race were associated with lower participation, and comorbid ischemic heart disease was associated with greater participation (odds ratio [OR], 1.48 [95% CI, 1.45–1.52] in VA; OR, 2.69 [95% CI, (2.62–2.78] in Medicare). Conclusions: Following the VA's implementation of home‐based CR and Medicare's facility‐based CR coverage for stable HF, participation increased among veterans but not among Medicare beneficiaries. Lower participation was observed among women and non‐White patients. These findings suggest that covering home‐based CR could improve participation among Medicare beneficiaries.