Efficacy and safety of apixaban compared to warfarin for nonvalvular atrial fibrillation in end-stage renal disease on hemodialysis.

BACKGROUND: This study compared the efficacy and safety of apixaban and warfarin in patients with nonvalvular atrial fibrillation (NVAF) and end-stage renal disease (ESRD) on hemodialysis (HD). Apixaban decreased incidence of stroke and bleeding compared with warfarin in major clinical trials that excluded patients with severe renal dysfunction. Apixaban is no longer contraindicated in patients with ESRD on HD with NVAF based on pharmacokinetic studies. Limited clinical data exist for patients with ESRD on HD on apixaban. METHODS: A retrospective chart review was performed on patients with a diagnosis of NVAF and ESRD on HD who were prescribed apixaban or warfarin for stroke prevention in the years 2018 through 2019. Patients' charts were reviewed for up to a 2-year period. Patients on renal replacement therapy other than HD, those using anticoagulation for reasons other than NVAF, patients with Child-Pugh Class C cirrhosis, and those with severe mitral valve stenosis were excluded. The primary outcome was emergency department visits or hospital admissions for ischemic stroke or transient ischemic attack. Secondary outcomes included major or minor bleeding and adverse effects. RESULTS: A total of 181 patients were screened; 110 patients met eligibility criteria and were included in the analysis. Four patients (7.5%) in the apixaban group and 6 patients (10.5%) in the warfarin group met the primary outcome of hospitalization or emergency department visit for stroke (P = 0.742). Symptomatic bleeding occurred in 39.6% of patients in the apixaban group and 36.8% in the warfarin group (P = 0.918). A trend in major bleeding occurred more often in the warfarin group, 52.4% versus 49.2% (P = 0.758). CONCLUSIONS: There were no statistically significant differences in efficacy and safety outcomes between apixaban and warfarin in patients with NVAF and ESRD on HD in the intention-to-treat analysis of our study. Larger trials are needed to further analyze this patient population.

Temporal expectations in delay of gratification.

We examined how temporal expectations influence preference reversals in a delay of gratification task for rats based on a hypothesis of Rachlin (2000), who suggested that preference for a larger-later reward may shift in favor of a smaller-immediate reward as a result of changes in when that larger reward is expected. To explore Rachlin's hypothesis, we preexposed two groups of rats to the delays associated with a larger-later reinforcer from a delay of gratification task. One group experienced the delays as a function of their choices in an intertemporal choice task and the other group experienced delays yoked from the first group (independent of their behavior) in an exposure training procedure. In addition, we included a third group of rats that were not exposed to delays during preexposure training as a comparison to the other two groups. Overall, the two groups of rats that experienced delays during preexposure training tended to make fewer defection responses than the comparison group during the delay of gratification task. Consistent with Rachlin's hypothesis, our results suggest that temporal learning may influence preference reversals in a delay of gratification task, providing a number of future directions for research in this area.

Individual differences in reading: Separable effects of reading experience and processing skill.

A large-scale eye-tracking study examined individual variability in measures of word recognition during reading among 546 college students, focusing on two established individual-differences measures: the Author Recognition Test (ART) and Rapid Automatized Naming (RAN). ART and RAN were only slightly correlated, suggesting that the two tasks reflect independent cognitive abilities in this large sample of participants. Further, individual variability in ART and RAN scores were related to distinct facets of word-recognition processes. Higher ART scores were associated with increased skipping rates, shorter gaze duration, and reduced effects of word frequency on gaze duration, suggesting that this measure reflects efficiency of basic processes of word recognition during reading. In contrast, faster times on RAN were associated with enhanced foveal-on-parafoveal effects, fewer first-pass regressions, and shorter second-pass reading times, suggesting that this measure reflects efficient coordination of perceptual-motor and attentional processing during reading. These results demonstrate that ART and RAN tasks make independent contributions to predicting variability in word-recognition processes during reading.

Reading ability and print exposure: item response theory analysis of the author recognition test.

In the author recognition test (ART), participants are presented with a series of names and foils and are asked to indicate which ones they recognize as authors. The test is a strong predictor of reading skill, and this predictive ability is generally explained as occurring because author knowledge is likely acquired through reading or other forms of print exposure. In this large-scale study (1,012 college student participants), we used item response theory (IRT) to analyze item (author) characteristics in order to facilitate identification of the determinants of item difficulty, provide a basis for further test development, and optimize scoring of the ART. Factor analysis suggested a potential two-factor structure of the ART, differentiating between literary and popular authors. Effective and ineffective author names were identified so as to facilitate future revisions of the ART. Analyses showed that the ART is a highly significant predictor of the time spent encoding words, as measured using eyetracking during reading. The relationship between the ART and time spent reading provided a basis for implementing a higher penalty for selecting foils, rather than the standard method of ART scoring (names selected minus foils selected). The findings provide novel support for the view that the ART is a valid indicator of reading volume. Furthermore, they show that frequency data can be used to select items of appropriate difficulty, and that frequency data from corpora based on particular time periods and types of texts may allow adaptations of the test for different populations.