Two experiments examined the influence of level of focal attention--text or lexical--on benefits from lexical repetition in speeded oral reading of coherent texts and random word lists. Experiment 1 showed that with coherent targets, direction of attention to the text level resulted in benefit only from a previous reading of the same coherent paragraph. However, when attention was directed to the lexical level, equal benefit resulted from a previous reading of either the same coherent paragraph or a scrambled version of the paragraph. Experiment 2 showed that level of focal attention did not influence benefit with scrambled targets. Thus, the linguistic structure of the target is important to repetition benefits and their modulation by attentional strategies.

Background: Optimal surgical treatment of infective tricuspid valve endocarditis in patients with intravenous drug use (IVDU) remains controversial. Tricuspid valvectomy has been proposed for infective tricuspid valve endocarditis in this patient population given the inherent social concerns. The aim of this systematic review and meta-analysis was to compare outcomes of valvectomy versus replacement for the surgical treatment of isolated infective tricuspid valve endocarditis. Methods: An electronic search was performed to identify all relevant studies published. After assessment for inclusion and exclusion criteria, 16 original studies were pooled for systematic review and meta-analysis. Results: There were a total of 752 patients with infective tricuspid valve endocarditis, of which 14% underwent valvectomy and 86% underwent replacement (mean follow-up 4.2 years, 95% CI, 1.9-6.4 years). The most common indications for surgical intervention were septic pulmonary embolism in the valvectomy group (74%, 95% CI, 28-95%) and persistent sepsis in the replacement group (62%, 95% CI, 31-86%). There were no differences in rates of stroke [valvectomy 4% (95% CI, 1-11%) vs. replacement 3% (95% CI, 1-16%), P=0.85] but there was increased likelihood of prolonged ventilation in those who underwent valvectomy [valvectomy 40% (95% CI, 30-51%) vs. replacement 26% (95% CI, 23-30%), P<0.01]. There were no differences in 30-day post-operative mortality [valvectomy 13% (95% CI, 5-30%) vs. replacement 7% (95% CI, 5-10%), P=0.21], post-operative right heart failure [valvectomy 27% (95% CI, 10-53%) vs. replacement 11% (95% CI, 5-25%), P=0.17] and recurrent endocarditis [valvectomy 7% (95% CI, 2-23%) vs. replacement 19% (95% CI, 12-28%), P=0.81]. Valvectomy had a higher rate of tricuspid valve reoperation [valvectomy 56% (95% CI, 15-90%) vs. initial replacement 14% (95% CI, 7-27%), P=0.06]. Conclusions: Tricuspid valvectomy is an acceptable initial therapy for infective tricuspid valve endocarditis in patients with IVDU, providing a bridge to identify those who will self-select as candidates for staged valve replacement.

Gastrointestinal bleeding (GIB) is a common adverse event after continuous‐flow left ventricular assist device (CF‐LVAD) implantation. We sought to evaluate patterns of GIB development and related outcomes in CF‐LVAD recipients. An electronic search was performed to identify all articles related to GIB in the setting of CF‐LVAD implantation. A total of 34 studies involving 1087 patients were pooled for analysis. Mean patient age was 60 years (95% CI 57‐64) and 24% (95% CI 21‐28%) were female. The mean time from CF‐LVAD implantation to the first GIB was 54 days (95% CI 24‐84) with 40% (95% CI 34‐45%) of patients having multiple episodes of GIB. Anemia was present in 75% (95% CI 41‐93%) and the most common etiology of bleeding was arteriovenous malformations (36% [95% CI 24‐50%]). The mean duration of follow‐up was 14.6 months (95% CI 6.9‐22.3) during which the all‐cause mortality rate was 21% (95% CI 12‐36%) and the mortality rate from GIB was 4% (95% CI 2‐9%). Thromboembolic events occurred in 32% (95% CI 22‐44%) of patients with an ischemic stroke rate of 16% (95% CI 3‐51%) and a pump thrombosis rate of 8% (95%CI 3‐22%). Heart transplantation was performed in 31% (95% CI 18‐47%) of patients, after which 0% (95% CI 0‐10%) experienced recurrent GIB. GIB is a major source of morbidity among CF‐LVAD recipients. While death due to GIB is rare, cessation of anticoagulation during treatment increases the risk of subsequent thrombotic events. Heart transplant in these patients appears to reliably resolve the risk of future GIB.

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