Motor behavior often occurs in environments with multiple goal options that can vary during the ongoing action. We explored this situation by requiring subjects to select between different target options during an ongoing reach. During split trials the original target was replaced with a left and a right flanking target and participants had to select between them. This contrasted with the standard jump trials where the original target would be replaced with a single flanking target, left or right. When participants were instructed to follow their natural tendency they all tended to select the split target nearest the original. The near-target preference was more prominent with increased spatial disparity between the options and when participants could preview the potential options. Moreover, explicit instruction to obtain the "far" target during split trials resulted many errors compared to a "near" instruction, ~50% vs ~15%. Online reaction times to target change were delayed in split trials compared to jump trials, ~200 ms vs ~150 ms, but also highly automatic. And trials which correctly obtained the instructed "far" target were delayed by a further ~50ms unlike those which incorrectly obtained the "near" target. We also observed non-specific responses from arm muscles at the jump trial latency during split trials. Taken together, our results indicate that online selection of reach targets is automatically linked to the spatial distribution of the options though at greater delays than redirecting to a single target.

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Biventricular assist devices (BiVADs) for pre-heart transplant care is rare. The outcomes of pretransplant BiVAD support after the 2018 heart transplant allocation policy change are entirely unknown at this time. The United Network of Organ Sharing database was retrospectively queried from October 2018 to June 2022 to identify patients supported to transplant with BiVADs. They were compared to patients listed as Status 2 for heart transplantation with an isolated VAD (uni-VAD). The primary outcome of interest was 1 year survival. Secondary outcomes included length of stay, posttransplant stroke, dialysis, and pacemaker implantation. The frequency of BiVAD use for heart transplantation has remained unchanged after the 2018 allocation policy change, making up approximately 2% of transplant recipients annually. Patients supported with BiVADs appeared to be similar to patients supported with uni-VADs. One year survival was similar between the groups (88.57% vs. 87.90%). Length of stay was longer and there was a trend toward higher frequencies of posttransplant dialysis use. Patients supported to transplant with BiVADs appear to have posttransplant outcomes comparable to patients commonly listed as Status 2 with an isolated VAD. Compared to past analyses, there is a suggestion of improved survival with the 2018 allocation policy change.

Background Transthyretin cardiac amyloidosis (ATTR‐CM), found in 6% to 15% of cohorts with heart failure with preserved ejection fraction, has long been considered a rare disease with poor prognosis. New treatments have made it one of the few directly treatable causes of heart failure. This study sought to determine whether patients with ATTR‐CM, particularly those treated with tafamidis, have comparable survival to an unselected cohort with heart failure with preserved ejection fraction. Methods and Results We compared the clinical characteristics and outcomes between a single‐center cohort of patients with ATTR‐CM (n=114) and patients with heart failure with preserved ejection fraction enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial (n=1761, excluding Russia and Georgia). The primary outcome was a composite of all‐cause death, heart failure hospitalization, myocardial infarction, and stroke. Subgroup analysis of patients with ATTR‐CM treated with tafamidis was also performed. Patients with ATTR‐CM had higher rates of the primary composite outcome compared with patients enrolled in the TOPCAT trial (hazard ratio [HR], 1.44 [95% CI, 1.09–1.91]; P =0.01), with similar rates of all‐cause death (HR, 1.43 [95% CI, 0.99–2.06]; P =0.06) but higher rates of heart failure hospitalizations (HR, 1.62 [95% CI, 1.15–2.28]; P <0.01). Compared with patients enrolled in TOPCAT, patients with ATTR‐CM treated with tafamidis had similar rates of the primary composite outcome (HR, 1.30 [95% CI, 0.86–1.96]; P =0.21) and all‐cause death (HR, 1.10 [95% CI, 0.57–2.14]; P =0.78) but higher rates of heart failure hospitalizations (HR, 1.96 [95% CI, 1.27–3.02]; P <0.01). Conclusions Patients with ATTR‐CM treated with tafamidis have similar rates of all‐cause death compared with patients with heart failure with preserved ejection fraction, with higher rates of heart failure hospitalizations.

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