ObjectiveTo examine the effect of HLP, defined as having a pre-existing or a new in-hospital diagnosis based on low density lipoprotein cholesterol (LDL-C) level ≥100 mg/dL during index hospitalisation or within the preceding 6 months, on all-cause mortality after hospitalisation for acute myocardial infarction (AMI) or acute decompensated heart failure (ADHF) and to determine whether HLP modifies mortality associations of other competing comorbidities. A systematic review and meta-analysis to place the current findings in the context of published literature.DesignRetrospective study, 1:1 propensity-score matching cohorts; a meta-analysis.SettingLarge academic centre, 1996–2015.ParticipantsHospitalised patients with AMI or ADHF.Main outcomes and measuresAll-cause mortality and meta-analysis of relative risks (RR).ResultsUnmatched cohorts: 13 680 patients with AMI (age (mean) 68.5 ± (SD) 13.7 years; 7894 (58%) with HLP) and 9717 patients with ADHF (age, 73.1±13.7 years; 3668 (38%) with HLP). In matched cohorts, the mortality was lower in AMI patients (n=4348 pairs) with HLP versus no HLP, 5.9 versus 8.6/100 person-years of follow-up, respectively (HR 0.76, 95% CI 0.72 to 0.80). A similar mortality reduction occurred in matched ADHF patients (n=2879 pairs) with or without HLP (12.4 vs 16.3 deaths/100 person-years; HR 0.80, 95% CI 0.75 to 0.86). HRs showed modest reductions when HLP occurred concurrently with other comorbidities. Meta-analyses of nine observational studies showed that HLP was associated with a lower mortality at ≥2 years after incident AMI or ADHF (AMI: RR 0.72, 95% CI 0.69 to 0.76; heart failure (HF): RR 0.67, 95% CI 0.55 to 0.81).ConclusionsAmong matched AMI and ADHF cohorts, concurrent HLP, compared with no HLP, was associated with a lower mortality and attenuation of mortality associations with other competing comorbidities. These findings were supported by a systematic review and meta-analysis.
Several neurodevelopmental disorders (NDDs) including Developmental Dyslexia (DD), Autism Spectrum Disorder (ASD), but not Attention Deficit Hyperactive Disorder (ADHD), are reported to show deficits in global motion processing. Such behavioral deficits have been linked to a temporal processing deficiency. However, to date, there have been few studies assessing the temporal processing efficiency of the Magnocellular M pathways through temporal modulation. Hence, we measured achromatic flicker fusion thresholds at high and low contrast in nonselective samples of NDDs and neurotypicals (mean age 10, range 7-12 years, n = 71) individually, and group matched, for both chronological age and nonverbal intelligence. Autistic tendencies were also measured using the Autism-Spectrum Quotient questionnaire as high AQ scores have previously been associated with the greater physiological amplitude of M-generated nonlinearities. The NDD participants presented with singular or comorbid combinations of DD, ASD, and ADHD. The results showed that ASD and DD, including those with comorbid ADHD, demonstrated significantly lower flicker fusion thresholds (FFTs) than their matched controls. Participants with a singular diagnosis of ADHD did not differ from controls in the FFTs. Overall, the entire NDD plus control populations showed a significant negative correlation between FFT and AQ scores (r = −0.269, p < 0.02 n = 71). In conclusion, this study presents evidence showing that a temporally inefficient M pathway could be the unifying network at fault across the NDDs and particularly in ASD and DD diagnoses, but not in singular diagnosis of ADHD.
Dynamic visual attention training using Action Video Games (AVGs) is a promising intervention for dyslexia. This study investigated the efficacy of 5 h (10 × 30 min) of AVG training in dyslexic children (aged 8–13) using ‘Fruit Ninja’, while exploring whether increasing attentional and eye movement demands enhanced AVG effectiveness. Regular (AVG-R; n = 22) and enhanced AVG training (AVG+; n = 23) were compared to a treatment-as-usual comparison group (n = 19) on reading, rapid naming, eye movements and visuo-temporal processing. Playing ‘Fruit Ninja’ for only 5 h significantly improved reading accuracy, rate, comprehension and rapid naming of both AVG groups, compared to the comparison group, though increasing attentional demands did not enhance AVG efficacy. Participants whose low contrast magnocellular-temporal processing improved most following training also showed significantly greater improvement in reading accuracy. The findings demonstrate a clear role for visual attention in reading and highlight the clinical applicability of AVGs as a fun, motivational and engaging intervention for dyslexia.
Rapid Automatized Naming (RAN) is a strong predictor of reading aloud, though there is little agreement on what underpins RAN or how it relates to reading. Some theorize phonological skills, while others suggest that RAN reflects the "microcosm" of cognitive and attentional processes also required for reading, with more recent research using eye movements in an attempt to study this relationship. In the current study, we aimed to extend previous investigations to identify whether the temporal patterns of eye movements predict RAN and can, therefore, be established as a method to study the cognitive processes underlying RAN that could then be utilized to elucidate the relationship of RAN to reading. A Gazepoint eye tracker was used to record the eye movements of 93 learner readers aged 5-8 years (M age = 7.00) while performing a custom computerized alphabetic RAN task. Text reading accuracy, comprehension and rate; nonverbal intelligence; and phonological awareness abilities were also assessed. Regression analyses showed that, independently of phonological awareness, eye movements [Fixation Count (FC) and Fixation Duration (FD)] measured during RAN tasks were highly reflective of children's rapid naming performance (92.8%). Both mean FC and mean FD during RAN tasks also predicted text reading accuracy (36.3%), comprehension (31.6%), and rate (36.2%) scores, and in predicting these text reading skills there was a high level of shared variance with RAN performance. In a sub-sample of participants, longer average FDs and counts independently discriminated children with reading difficulties (n = 18; aged 7-9) from neurotypical children matched for age (n = 18), but not from younger neurotypical children matched for reading level (n = 18; aged 5-6). Together, these results suggest that the analysis of eye movements recorded during RAN allows for the operationalization of many of the spatially and temporallybound cognitive and attentional processes that underpin the RAN, and a step towards elucidating its relationship to reading.
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