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Shneor E, Gordon-Shaag A, Doron R, Benoit JS, Ostrin LA. Utility of the Actiwatch Spectrum Plus for detecting the outdoor environment and physical activity in children. J Optom 2024; 17:100483. [PMID: 37797567 PMCID: PMC10551654 DOI: 10.1016/j.optom.2023.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/24/2023] [Accepted: 06/25/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To describe the performance of the Actiwatch Spectrum Plus (Philips, Respironics) for determining real world indoor and outdoor environments and physical activity in children. METHODS Children wore the device while performing 10 different activities, ranging from sedentary to vigorous physical-activity, and under different indoor and outdoor conditions. Repeated measures ANOVA was implemented via mixed effects modeling to determine illuminance (lux) and physical activity (counts per 15 s, CP15) across conditions. Receiver operator characteristics (ROC) analysis assessed the accuracy to detect indoor versus outdoor settings. RESULTS Illuminance was found to be statistically different across indoor (793 ± 348 lux) and outdoor (4,413 ± 518 lux) conditions (P<.0001), with excellent diagnostic accuracy to detect indoor versus outdoor settings (Area under the ROC Curve, AUC 0.94); 1088 lux was identified as the optimal threshold for outdoor illuminance (sensitivity: 93.0%; specificity: 85.0%). Using published activity ranges, we found that when children were sitting, 94% of the physical-activity readings were classified as sedentary or light. When children were walking, 88% of readings were classified as light, and when children were running, 77% of readings were classified as moderate or vigorous. CONCLUSION The Actiwatch Spectrum Plus performed well during real world activities in children, showing excellent diagnostic accuracy at 1088 lux as a threshold to detect indoor versus outdoor environments and in categorizing physical activity.
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Affiliation(s)
- Einat Shneor
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel.
| | - Ariela Gordon-Shaag
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel
| | - Ravid Doron
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel
| | - Julia S Benoit
- College of Optometry, University of Houston, Houston, TX 77004, USA; Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX 77004, USA
| | - Lisa A Ostrin
- College of Optometry, University of Houston, Houston, TX 77004, USA
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Plaumann MD, Marsack JD, Benoit JS, Manny RE, Anderson HA. Dioptric differences between clinically determined and metric-optimised refractions for adults with Down syndrome. Ophthalmic Physiol Opt 2023; 43:1016-1028. [PMID: 37208971 PMCID: PMC10524723 DOI: 10.1111/opo.13165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023]
Abstract
PURPOSE Refractions based on the optimisation of single-value wavefront-derived metrics may help determine appropriate corrections for individuals with Down syndrome where clinical techniques fall short. This study compared dioptric differences between refractions obtained using standard clinical techniques and two metric-optimised methods: visual Strehl ratio (VSX) and pupil fraction tessellated (PFSt), and investigated characteristics that may contribute to the differences between refraction types. METHODS Thirty adults with Down syndrome (age = 29 ± 10 years) participated. Three refractive corrections (VSX, PFSt and clinical) were determined and converted to vector notation (M, J0 , J45 ) to calculate the dioptric difference between pairings of each type using a mixed model repeated measures approach. Linear correlations and multivariable regression were performed to examine the relationship between dioptric differences and the following participant characteristics: higher order root mean square (RMS) for a 4 mm pupil diameter, spherical equivalent refractive error and Vineland Adaptive Behavior Scales (a measure of developmental ability). RESULTS The least squares mean estimates (standard error) of the dioptric differences for each pairing were as follows: VSX versus PFSt = 0.51 D (0.11); VSX versus clinical = 1.19 D (0.11) and PFSt versus clinical = 1.04 D (0.11). There was a statistically significant difference in the dioptric differences between the clinical refraction and each of the metric-optimised refractions (p < 0.001). Increased dioptric differences in refraction were correlated with increased higher order RMS (R = 0.64, p < 0.001 [VSX vs. clinical] and R = 0.47, p < 0.001 [PFSt vs. clinical]) as well as increased myopic spherical equivalent refractive error (R = 0.37, p = 0.004 [VSX vs. clinical] and R = 0.51, p < 0.001 [PFSt vs. clinical]). CONCLUSIONS The observed differences in refraction demonstrate that a significant portion of the refractive uncertainty is related to increased higher order aberrations and myopic refractive error. Methodology surrounding clinical techniques and metric-optimisation based on wavefront aberrometry may explain the difference in refractive endpoints.
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Affiliation(s)
| | - Jason D Marsack
- University of Houston College of Optometry, Houston, Texas, USA
| | - Julia S Benoit
- University of Houston College of Optometry, Houston, Texas, USA
- Texas Institute for Measurement, Evaluation, and Statistics, Houston, Texas, USA
| | - Ruth E Manny
- University of Houston College of Optometry, Houston, Texas, USA
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Walther CP, Benoit JS, Bansal N, Nambi V, Navaneethan SD. Heart Failure-Type Symptom Score Trajectories in CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2023; 81:446-456. [PMID: 36403887 PMCID: PMC10038859 DOI: 10.1053/j.ajkd.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/23/2022] [Indexed: 11/19/2022]
Abstract
RATIONALE & OBJECTIVE Quality of life in chronic kidney disease (CKD) is impaired by a large burden of symptoms including some that overlap with the symptoms of heart failure (HF). We studied a group of individuals with CKD to understand the patterns and trajectories of HF-type symptoms in this setting. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,044 participants in the Chronic Renal Insufficiency Cohort (CRIC) without prior diagnosis of HF. PREDICTORS Sociodemographics, medical history, medications, vital signs, laboratory values, echocardiographic and electrocardiographic parameters. OUTCOME Trajectory over 5.5 years of a HF-type symptom score (modified Kansas City Cardiomyopathy Questionnaire [KCCQ] Overall Summary Score with a range of 0-100 where<75 reflects clinically significant symptoms). ANALYTICAL APPROACH Latent class mixed models were used to model trajectories. Multinomial logistic regression was used to model relationships of predictors with trajectory group membership. RESULTS Five trajectories of KCCQ score were identified in the cohort of 3,044 adults, 45% of whom were female, and whose median age was 61 years. Group 1 (41.7%) had a stable high score (minimal symptoms, average score of 96); groups 2 (35.6%) and 3 (15.6%) had stable but lower scores (mild symptoms [average of 81] and clinically significant symptoms [average of 52], respectively). Group 4 (4.9%) had a substantial worsening in symptoms over time (mean 31-point decline), and group 5 (2.2%) had a substantial improvement (mean 33-point increase) in KCCQ score. A majority of group 1 was male, without diabetes or obesity, and this group had higher baseline kidney function. A majority of groups 2 and 3 had diabetes and obesity. A majority of group 4 was male and had substantial proteinuria. Group 5 had the highest proportion of baseline cardiovascular disease (CVD). LIMITATIONS No validation cohort available, CKD management changes in recent years may alter trajectories, and latent class models depend on the missing at random assumption. CONCLUSIONS Distinct HF-type symptom burden trajectories were identified in the setting of CKD, corresponding to different baseline characteristics. These results highlight the diversity of HF-type symptom experiences in individuals with CKD.
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Affiliation(s)
- Carl P Walther
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas.
| | - Julia S Benoit
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, Texas
| | - Nisha Bansal
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Vijay Nambi
- Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Sankar D Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas; Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, Texas; Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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Shneor E, Ostrin LA, Doron R, Benoit JS, Levine J, Davidson K, Gordon-Shaag A. Baseline characteristics in the Israel refraction, environment, and devices (iREAD) study. Sci Rep 2023; 13:2855. [PMID: 36806309 PMCID: PMC9938253 DOI: 10.1038/s41598-023-29563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 02/19/2023] Open
Abstract
The purpose of this study is to present baseline data from a longitudinal study assessing behavioral factors in three groups of boys in Israel with varying myopia prevalence. Ultra-Orthodox (N = 57), religious (N = 67), and secular (N = 44) Jewish boys (age 8.6 ± 1.4 years) underwent cycloplegic autorefraction and axial-length measurement. Time-outdoors and physical-activity were assessed objectively using an Actiwatch. Ocular history, educational factors, and near-work were assessed with a questionnaire. Group effects were tested and mixed effects logistic and linear regression were used to evaluate behaviors and their relationship to myopia. The prevalence of myopia (≤ - 0.50D) varied by group (ultra-Orthodox: 46%, religious: 25%, secular: 20%, P < 0.021). Refraction was more myopic in the ultra-Orthodox group (P = 0.001). Ultra-Orthodox boys learned to read at a younger age (P < 0.001), spent more hours in school (P < 0.001), spent less time using electronic devices (P < 0.001), and on weekdays, spent less time outdoors (P = 0.02). Increased hours in school (OR 1.70) and near-work (OR 1.22), increased the odds of myopia. Being ultra-Orthodox (P < 0.05) and increased near-work (P = 0.007) were associated with a more negative refraction. Several factors were associated with the prevalence and degree of myopia in young boys in Israel, including being ultra-Orthodox, learning to read at a younger age, and spending more hours in school.
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Affiliation(s)
- Einat Shneor
- Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001, Jerusalem, Israel.
| | - Lisa A. Ostrin
- grid.266436.30000 0004 1569 9707College of Optometry, University of Houston, Houston, TX 77004 USA
| | - Ravid Doron
- grid.443085.e0000 0004 0366 7759Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001 Jerusalem, Israel
| | - Julia S. Benoit
- grid.266436.30000 0004 1569 9707Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX 77004 USA
| | - Jonathan Levine
- grid.443085.e0000 0004 0366 7759Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001 Jerusalem, Israel
| | - Kevin Davidson
- grid.266436.30000 0004 1569 9707Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX 77004 USA
| | - Ariela Gordon-Shaag
- grid.443085.e0000 0004 0366 7759Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001 Jerusalem, Israel
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Walther CP, Benoit JS, Lamba HK, Civitello AB, Erickson KF, Mondal NK, Liao KK, Navaneethan SD. Distinctive kidney function trajectories following left ventricular assist device implantation. J Heart Lung Transplant 2022; 41:1798-1807. [PMID: 36182652 PMCID: PMC10091513 DOI: 10.1016/j.healun.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/04/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The aim of this study was to assess for distinct kidney function trajectories following left ventricular assist device (LVAD) placement. Cohort studies of LVAD recipients demonstrate that kidney function tends to increase early after LVAD placement, followed by decline and limited sustained improvement. Inter-individual differences in kidney function response may be obscured. METHODS We identified continuous flow LVAD implantations in US adults (2016-2017) from INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support). Primary outcomes were estimated glomerular filtration rate (eGFR) trajectories pre-implantation to ∼12 months. Latent class mixed models were applied to primary and validation samples. Clinical differences among trajectory groups were investigated. RESULTS Among 4,615 LVAD implantations, 5 eGFR trajectory groups were identified. The 2 largest groups (Groups 1 and 2) made up >80% of the cohort, and were similar to group average trajectories previously reported, with early eGFR rise followed by decline and stabilization. Three novel trajectory groups were found: worsening followed by sustained low kidney function (Group 3, 10.1%), sustained improvement (Group 4, 3.3%), and worsening followed by variation (Group 5, 1.7%). These groups differed in baseline characteristics and outcomes. Group 4 was younger and had more cardiogenic shock and pre-implantation dialysis; Group 3 had higher rates of pre-existing chronic kidney disease, along with older age. CONCLUSIONS Novel eGFR trajectories were identified in a national cohort, possibly representing distinct cardiorenal processes. Type 1 cardiorenal syndrome may have been predominant in Group 4, and parenchymal kidney disease may have been predominant in Group 3.
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Affiliation(s)
- Carl P Walther
- Department of Medicine, Baylor College of Medicine, Selzman Institute for Kidney Health, Section of Nephrology, Houston, Texas.
| | - Julia S Benoit
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, Texas
| | - Harveen K Lamba
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Andrew B Civitello
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Advanced Heart Failure Center of Excellence, Baylor College of Medicine, Houston, Texas
| | - Kevin F Erickson
- Department of Medicine, Baylor College of Medicine, Selzman Institute for Kidney Health, Section of Nephrology, Houston, Texas; Baker Institute for Public Policy, Rice University, Houston, Texas
| | - Nandan K Mondal
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Kenneth K Liao
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Sankar D Navaneethan
- Department of Medicine, Baylor College of Medicine, Selzman Institute for Kidney Health, Section of Nephrology, Houston, Texas; Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
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Walther CP, Benoit JS, Gregg LP, Bansal N, Nambi V, Feldman HI, Shlipak MG, Navaneethan SD. Heart failure-type symptom scores in chronic kidney disease: The importance of body mass index. Int J Obes (Lond) 2022; 46:1910-1917. [PMID: 35978101 PMCID: PMC9710200 DOI: 10.1038/s41366-022-01208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This analysis sought to determine factors (including adiposity-related factors) most associated with HF-type symptoms (fatigue, shortness of breath, and edema) in adults with chronic kidney disease (CKD). BACKGROUND Symptom burden impairs quality of life in CKD, especially symptoms that overlap with HF. These symptoms are common regardless of clinical HF diagnosis, and may be affected by subtle cardiac dysfunction, kidney dysfunction, and other factors. We used machine learning to investigate cross-sectional relationships of clinical variables with symptom scores in a CKD cohort. METHODS Participants in the Chronic Renal Insufficiency Cohort (CRIC) with a baseline modified Kansas City Cardiomyopathy Questionnaire (KCCQ) score were included, regardless of prior HF diagnosis. The primary outcome was Overall Summary Score as a continuous measure. Predictors were 99 clinical variables representing demographic, cardiac, kidney and other health dimensions. A correlation filter was applied. Random forest regression models were fitted. Variable importance scores and adjusted predicted outcomes are presented. RESULTS The cohort included 3426 individuals, 10.3% with prior HF diagnosis. BMI was the most important factor, with BMI 24.3 kg/m2 associated with the least symptoms. Symptoms worsened with higher or lower BMIs, with a potentially clinically relevant 5 point score decline at 35.7 kg/m2 and a 1-point decline at the threshold for low BMI, 18.5 kg/m2. The most important cardiac and kidney factors were heart rate and eGFR, the 4th and 5th most important variables, respectively. Results were similar for secondary analyses. CONCLUSIONS In a CKD cohort, BMI was the most important feature for explaining HF-type symptoms regardless of clinical HF diagnosis, identifying an important focus for symptom directed investigations.
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Affiliation(s)
- Carl P Walther
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA.
| | - Julia S Benoit
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, USA
| | - L Parker Gregg
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
- Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Nisha Bansal
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA, USA
| | - Vijay Nambi
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
| | - Harold I Feldman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- General Internal Medicine Division, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Sankar D Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
- Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
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Liu H, Gao Y, Huang W, Li R, Houston M, Benoit JS, Roh J, Zhang Y. Inter-muscular coherence and functional coordination in the human upper extremity after stroke. Math Biosci Eng 2022; 19:4506-4525. [PMID: 35430825 DOI: 10.3934/mbe.2022208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Muscle coordination and motor function of stroke patients are weakened by stroke-related motor impairments. Our earlier studies have determined alterations in inter-muscular coordination patterns (muscle synergies). However, the functional connectivity of these synergistically paired or unpaired muscles is still unclear in stroke patients. The goal of this study is to quantify the alterations of inter-muscular coherence (IMC) among upper extremity muscles that have been shown to be synergistically or non-synergistically activated in stroke survivors. In a three-dimensional isometric force matching task, surface EMG signals are collected from 6 age-matched, neurologically intact healthy subjects and 10 stroke patients, while the target force space is divided into 8 subspaces. According to the results of muscle synergy identification with non-negative matrix factorization algorithm, muscle pairs are classified as synergistic and non-synergistic. In both control and stroke groups, IMC is then calculated for all available muscle pairs. The results show that synergistic muscle pairs have higher coherence in both groups. Furthermore, anterior and middle deltoids, identified as synergistic muscles in both groups, exhibited significantly weaker IMC at alpha band in stroke patients. The anterior and posterior deltoids, identified as synergistic muscles only in stroke patients, revealed significantly higher IMC in stroke group at low gamma band. On the contrary, anterior deltoid and pectoralis major, identified as synergistic muscles in control group only, revealed significantly higher IMC in control group in alpha band. The results of muscle synergy and IMC analyses provide congruent and complementary information for investigating the mechanism that underlies post-stroke motor recovery.
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Affiliation(s)
- Hongming Liu
- Zhuoyue Honors College, Hangzhou Dianzi University, Hangzhou 310018, China
- College of Automation, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Yunyuan Gao
- College of Automation, Hangzhou Dianzi University, Hangzhou 310018, China
- Key labortory of Brain Machine Collaborative Intelligence of Zhejiang Province, Hangzhou 311247, China
| | - Wei Huang
- College of Automation, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Rihui Li
- Department of Biomedical Engineering, University of Houston, Houston 75835, United States
| | - Michael Houston
- Department of Biomedical Engineering, University of Houston, Houston 75835, United States
| | - Julia S Benoit
- Texas Institute for Measurement Evaluation and Statistics, University of Houston, Houston 75835, United States
| | - Jinsook Roh
- Department of Biomedical Engineering, University of Houston, Houston 75835, United States
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Houston, Houston 75835, United States
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Iso T, Yuan F, Rizk E, Tran AT, Saldana RB, Boyareddigari PR, Nguyen NAA, Espino D, Benoit JS, Swan JT. Avoidable emergency department visits for rabies vaccination. Am J Emerg Med 2022; 54:242-248. [DOI: 10.1016/j.ajem.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
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Anderson HA, Marsack JD, Benoit JS, Manny RE, Fern KD. Visual Acuity Outcomes in a Randomized Trial of Wavefront Metric-optimized Refractions in Adults with Down Syndrome. Optom Vis Sci 2022; 99:58-66. [PMID: 34882603 PMCID: PMC8720070 DOI: 10.1097/opx.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
SIGNIFICANCE This study reports visual acuity outcomes from a clinical trial investigating an objective refraction strategy that may provide a useful tool for practitioners needing additional strategies to identify refractive corrections for adults with intellectual disability. PURPOSE Determining refractions for individuals with Down syndrome is challenging because of the presence of elevated refractive error, optical aberrations, and cognitive impairment. This randomized clinical trial evaluated the performance of spectacle corrections determined using clinical techniques and objective refractions derived from wavefront aberration measures. METHODS Thirty adults with Down syndrome had a clinical refraction determined by a single expert examiner using pre-dilation and post-dilation techniques appropriate for this population. Objective refractions were determined from dilated wavefront aberration measures that were processed post-visit to identify refractions that optimized each of two image quality metrics: pupil fraction tessellated and visual Strehl ratio in the spatial domain. The three refractions were dispensed in random order and worn for 2 months each. The primary outcome measure, binocular visual acuity, was obtained by a masked examiner administering a distance logMAR acuity test. To compare treatment types, mean acuity was compared using a two-sided type 3 F test of the treatment effect in a linear mixed-effects regression model, where the final model included fixed effects for treatment, period (1, 2, or 3), and first-order carryover effects. RESULTS The 2-month estimated least square means in binocular visual acuity (logMAR) were 0.34 (95% confidence interval [CI], 0.25 to 0.39) for clinical refractions, 0.31 (95% CI, 0.25 to 0.36) for pupil fraction tesselated refractions, and 0.33 (95% CI, 0.27 to 0.38) for visual Strehl ratio refractions. No statistically significant treatment effect was observed (F = 1.10, P = .34). CONCLUSIONS Objective refractions derived from dilated wavefront aberration measures resulted in acuity similar to expert clinician-derived refractions, suggesting that the objective method may be a suitable alternative for patients with Down syndrome.
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Affiliation(s)
| | | | | | - Ruth E Manny
- University of Houston, College of Optometry, Houston, Texas
| | - Karen D Fern
- University of Houston, College of Optometry, Houston, Texas
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Cox SD, Benoit JS, Brohard CL, McIntyre TM. Evaluation of sleep quality among nursing faculty: Application of the Pittsburgh Sleep Quality Index-A descriptive correlational study. Nurs Open 2021; 9:339-348. [PMID: 34569173 PMCID: PMC8685842 DOI: 10.1002/nop2.1067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/24/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022] Open
Abstract
AIM The aim of this study was to describe the overall sleep quality, sleep patterns and severity of sleep difficulties among nursing faculty using the Pittsburgh Sleep Quality Index (PSQI). DESIGN Cross-sectional descriptive and correlational study. METHODS A survey of faculty recruited from Texas Board of Nursing approved colleges/schools was used. A purposive, convenience sample of 105 faculty completed the PSQI, a reliable and valid instrument, in an online setting. Data was collected from January 2019 through April 2019. RESULTS Nursing faculty reported sleep difficulty across all components, with more problems in sleep latency, sleep disturbances and subjective sleep quality. Overall, 70.5% of participants were reportedly "poor" sleepers, a salient finding. Faculty experienced poor sleep quality across all academic ranks and age groups. Sleep latency and subjective sleep quality were components that presented higher in severity for the youngest faculty.
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Affiliation(s)
- Sonya D Cox
- College of Nursing, University of Houston, Sugar Land, TX, USA
| | - Julia S Benoit
- College of Optometry and Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, USA
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Shneor E, Doron R, Levine J, Zimmerman DR, Benoit JS, Ostrin LA, Gordon-Shaag A. Objective Behavioral Measures in Children before, during, and after the COVID-19 Lockdown in Israel. Int J Environ Res Public Health 2021; 18:ijerph18168732. [PMID: 34444483 PMCID: PMC8394769 DOI: 10.3390/ijerph18168732] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023]
Abstract
Studies using questionnaires report that COVID-19 restrictions resulted in children spending significantly less time outdoors. This study used objective measures to assess the impact of pandemic-related restrictions on children’s behavior. A total of 19 healthy 8–12-year-old boys were observed before and during social restriction periods. Of these, 11 boys were reassessed after restrictions were lifted. For each session, Actiwatches were dispensed for measures of time outdoors, activity, and sleep. Changes overall and by school status were assessed using signed-rank test and Wilcoxon rank sum tests. During restrictions, children spent significantly less time outdoors (p = 0.001), were less active (p = 0.001), and spent less time engaged in moderate-to-vigorous physical activity (p = 0.004). Sleep duration was not significantly different between sessions (p > 0.99), but bedtime and wake time shifted to a later time during restrictions (p < 0.05 for both). Time outdoors and activity returned close to pre-pandemic levels after restrictions were lifted (p > 0.05 for both). Children’s behaviors significantly changed during the COVID-19 pandemic. The reduction in outdoor light exposure is of importance due to the role of light in the etiology of myopia and vitamin D production. The reduction in physical activity may have negative health effects in terms of obesity and depression, although further research is required to ascertain the long-term effects.
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Affiliation(s)
- Einat Shneor
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel; (E.S.); (R.D.); (J.L.)
| | - Ravid Doron
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel; (E.S.); (R.D.); (J.L.)
| | - Jonathan Levine
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel; (E.S.); (R.D.); (J.L.)
| | - Deena Rachel Zimmerman
- Maternal Child and Adolescent Division Public Health Services, Israel Ministry of Health, Jerusalem 9101002, Israel;
| | - Julia S. Benoit
- Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX 77004, USA;
- College of Optometry, University of Houston, Houston, TX 77004, USA;
| | - Lisa A. Ostrin
- College of Optometry, University of Houston, Houston, TX 77004, USA;
| | - Ariela Gordon-Shaag
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel; (E.S.); (R.D.); (J.L.)
- Correspondence:
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12
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Affiliation(s)
- Carl P Walther
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
| | - Julia S Benoit
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX
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Anderson HA, Benoit JS, Marsack JD, Manny RE, Ravikumar A, Fern KD, Trast KR. A Randomized Trial of Objective Spectacle Prescriptions for Adults with Down Syndrome: Baseline Data and Methods. Optom Vis Sci 2021; 98:88-99. [PMID: 33394936 PMCID: PMC7789324 DOI: 10.1097/opx.0000000000001631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE It is difficult to determine the most efficacious refractive correction for individuals with Down syndrome using routine clinical techniques. New objective methods that optimize spectacle corrections for this population may reduce limitations on daily living by improving visual quality. PURPOSE This article describes the methods and baseline characteristics of study participants in a National Eye Institute-sponsored clinical trial to evaluate objectively derived spectacle corrections in adults with Down syndrome. Intersession repeatability of the primary outcome measure (distance visual acuity) is also reported. METHODS Adults with Down syndrome were enrolled into a nine-visit study to compare clinically derived spectacle corrections and two different objective spectacle corrections derived from wavefront aberration data. Spectacle corrections were randomized and dispensed for 2 months each. Distance visual acuity was measured with a Bailey-Lovie-style chart. Intersession repeatability of acuity was established by performing difference versus mean analysis from binocular acuity measures obtained through habitual corrections at visits 1 and 2. RESULTS Thirty adults (mean ± standard deviation age, 29 ± 10 years) with a large range of refractive errors were enrolled. Presenting visual acuity at visit 1 was reduced (right eye, 0.47 ± 0.20 logMAR; left eye, 0.42 ± 0.17 logMAR). The mean difference between visits 1 and 2 was 0.02 ± 0.06 logMAR, with a coefficient of repeatability (1.96 × within-subject standard deviation) of 0.12 logMAR. CONCLUSIONS This study seeks to investigate new strategies to determine optical corrections that may reduce commonly observed visual deficits in individuals with Down syndrome. The good intersession repeatability of acuity found in this study (six letters) indicates that, despite the presence of reduced acuity, adults with Down syndrome performed the outcome measure for this clinical trial reliably.
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Affiliation(s)
| | | | | | - Ruth E Manny
- University of Houston College of Optometry, Houston, Texas
| | | | - Karen D Fern
- University of Houston College of Optometry, Houston, Texas
| | - Kelsey R Trast
- University of Houston College of Optometry, Houston, Texas
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Benoit JS, Ravikumar A, Marsack JD, Anderson HA. Understanding the Impact of Individual Perceived Image Quality Features on Visual Performance. Transl Vis Sci Technol 2020; 9:7. [PMID: 32821479 PMCID: PMC7401969 DOI: 10.1167/tvst.9.5.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/08/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to quantify the impact of blur, contrast, and ghosting on perceived overall image quality (IQ) as well as resultant predicted visual acuity, utilizing simulated acuity charts from objective refraction among eyes of individuals with Down syndrome (DS). Methods Acuity charts were produced, simulating the retinal image when applying 16 different metric-derived sphero-cylindrical refractions for each eye of 30 adult patients with DS. Fourteen dilated adult observers (normal vision) viewed subsets of logMAR acuity charts displayed on an LCD monitor monocularly through a unit magnification 3-mm aperture telescope. Observers rated features blur, ghosting, and contrast on 10-point scales (10 = poorest) and overall IQ on a 0- to 100-point scale (100 = best) and read each chart until five total letters were missed (logMAR technique). Mixed modeling was used to estimate feature influence on overall perceived IQ and relative acuity (compared with an unaberrated chart), separately. Results Perceived IQ spanned the entire scale (mean = 59 ± 22) and average reduction in relative acuity was two lines (0.2 ± 0.14 logMAR). Perceived blur, ghosting, and contrast were individually correlated with overall IQ and relative acuity. Blur, contrast, and ghosting exert unique effects on overall perceived IQ (P < 0.05). Blur (b = -.009, P < 0.001) and ghosting (b = -.003, P < 0.001) influence relative acuity over and beyond their effects on overall IQ (b = .001, P < 0.0001) and contrast. Conclusions Objectively identified refractions would ideally provide high contrast, low blur, and low ghosting. These data suggest that blur and ghosting may be given priority over contrast when improving acuity is the goal. Translational Relevance Findings may guide objective refraction in clinical care.
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Affiliation(s)
- Julia S. Benoit
- University of Houston, College of Optometry, Houston, TX, USA
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, USA
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15
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Abstract
Understanding Alzheimer's disease (AD) dynamics is essential in diagnosis and measuring progression for clinical decision-making; however, clinical instruments are imperfect at classifying true disease stages. This research evaluates sensitivity and determinants of AD stage changes longitudinally using current classifications of "mild," "moderate," and "severe" AD, using Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog), and the Clinical Dementia Rating-Sum of Boxes (CDR-SB) thresholds. Age and pre-progression rate were significant determinants of AD progression using MMSE alone to stage AD, and pre-progression was found to impact disease progression with CDR-SB. Sensitivity of these instruments for identifying clinical stages of AD to correctly staging a "moderate" level of disease severity for outcomes MMSE, CDR-SB, and ADAS-Cog was 92%, 78%, and 92%, respectively. This research derives longitudinal sensitivity of clinical instruments used to stage AD useful for clinical decision-making. The MMSE and ADAS-Cog provided adequate sensitivity to classify AD stages.
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Affiliation(s)
- Julia S. Benoit
- Texas Institute for Measurement Evaluation and Statistics (TIMES), University of Houston, TX, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - Linda Piller
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
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Anderson HA, Ravikumar A, Benoit JS, Marsack JD. Impact of Pupil Diameter on Objective Refraction Determination and Predicted Visual Acuity. Transl Vis Sci Technol 2019; 8:32. [PMID: 31857915 PMCID: PMC6910609 DOI: 10.1167/tvst.8.6.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/26/2019] [Indexed: 01/21/2023] Open
Abstract
Purpose Objective refraction based on wavefront aberration measures is a potential tool for patients unable to participate in a subjective refraction, but the selection of a single pupil diameter for determination of the objective refraction may pose challenges. The purpose of this study was to investigate the impact of pupil diameter on determination of objective refractions for adults with and without Down syndrome (DS) and predicted change in acuity with increasing pupil diameter. Methods Wavefront error was obtained from 27 adults with DS and 24 controls, and metric-optimized refractions were identified for 4- and 6-mm pupil diameters. Total dioptric difference between refractions for the two pupil sizes was calculated, and repeated measures analysis of variance was used to evaluate differences in refractions. Next, five control observers read acuity charts produced to simulate image quality of each subject if the same refraction was applied for both a 4- and 6-mm pupil diameter. A comparison of acuity with performance on a clear chart was used to calculate letters lost for each chart. Repeated measures analysis of variance was used to test for differences in letters lost from 4- and 6-mm diameters. Results The dioptric difference between refractions for 4- and 6-mm pupils was significantly greater in subjects with DS (0.51 diopters vs. 0.19 diopters, P = 0.0012). Letters lost for predicted acuity was less for the 4-mm diameter than 6 mm for charts representing DS eyes (6.5 letters vs. 11 letters, P < 0.0001), as well as for typical eyes (4.5 letters vs. 8 letters, P < 0.0001). Conclusions Differences between refractions by pupil diameter were similar to the repeatability of subjective refraction. Visual acuity differences were clinically small, suggesting similar performance for objective refractions with increasing pupil diameter. Translational Relevance This work quantifies the potential impact of pupil diameter change on the performance of wavefront optimized refractions in clinical patients.
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Affiliation(s)
| | | | - Julia S Benoit
- University of Houston College of Optometry, Houston, TX, USA.,Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX, USA
| | - Jason D Marsack
- University of Houston College of Optometry, Houston, TX, USA
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17
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Yamal JM, Hannay HJ, Gopinath S, Aisiku IP, Benoit JS, Robertson CS. Glasgow Outcome Scale Measures and Impact on Analysis and Results of a Randomized Clinical Trial of Severe Traumatic Brain Injury. J Neurotrauma 2019; 36:2484-2492. [PMID: 30973053 DOI: 10.1089/neu.2018.5939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The original unstructured Glasgow Outcome Scale (uGOS) and the newer structured interviews GOS and the Extended GOS (GOS-E) have been used widely as outcomes in severe traumatic brain injury (TBI) trials. We compared outcome categories (ranging from dead [D] to good recovery [GR]) for each measure in a randomized trial of transfusion threshold and the implications of measure choice and analysis methods for the results of the trial. We planned to explore patient symptomology possibly driving any discrepancies between the patient's uGOS and GOS scores. Category correspondence between uGOS and GOS scores occurred in 160 (88.4%) of the 181 analyzed cases. The GOS-E and GOS instruments incorporated more behavioral/cognitive/social and other components, leading to a worse outcome in some cases than for the uGOS. Choice of outcome measure and analysis led to incongruous conclusions. Dichotomizing uGOS into favorable outcome (GR and moderate disability [MD] categories) versus unfavorable (severe disability [SD], vegetative state [VS], and D categories), we observed a significant effect of transfusion threshold (odds ratio [OR] = 0.51, p = 0.03; adjusted OR = 0.40, p = 0.02). For the same dichotomization of GOS and GOS-E, the effect was not statistically significant but the ORs were similar (ORs between 0.57 and 0.68, p > 0.15 for all). An effect was not detected using ordinal logistic regression or sliding dichotomy method for all three measures. Differences in categorizations of subjects between moderate and severe disability among the scales impacted conclusions of the trial. In future studies, particular attention should be given to implementing GOS measures and describing the methodology for how outcomes were ascertained.
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Affiliation(s)
- Jose-Miguel Yamal
- Coordinating Center for Clinical Trials, Department of Biostatistics and Data Science, The University of Texas School of Public Health, Houston, Texas
| | - H Julia Hannay
- Department of Psychology, University of Houston, Houston, Texas.,Texas Institute for Measurement Evaluation and Statistics (TIMES), University of Houston, Houston, Texas
| | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Imoigele P Aisiku
- Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts
| | - Julia S Benoit
- Texas Institute for Measurement Evaluation and Statistics (TIMES), University of Houston, Houston, Texas.,Department of Basic Vision Sciences, University of Houston, Houston, Texas
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Ravikumar A, Benoit JS, Marsack JD, Anderson HA. Image Quality Metric Derived Refractions Predicted to Improve Visual Acuity Beyond Habitual Refraction for Patients With Down Syndrome. Transl Vis Sci Technol 2019; 8:20. [PMID: 31157125 PMCID: PMC6532430 DOI: 10.1167/tvst.8.3.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/02/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine which optimized image quality metric (IQM) refractions provide the best predicted visual acuity (VA). Methods Autorefraction (AR), habitual refraction (spectacles, n = 23; unaided, n = 7), and dilated wavefront error (WFE) were obtained from 30 subjects with Down syndrome (DS; mean age, 30 years; range, 18–50). For each eye, the resultant metric value for 16 IQMs was calculated after >25000 sphero-cylindrical combinations of refraction were added to the measured WFE to generate residual WFE. The single refraction corresponding to each of the 16 optimized IQMs per eye was selected and used to generate acuity charts. Charts also were created for AR, habitual refraction, and a theoretical zeroing of all lower-order aberrations, and grouped into 10 sets with a clear chart in each set. Dilated controls (five observers per set) read each chart until five letters were missed on a high contrast monitor through a unit magnification telescope with a 3 mm pupil aperture. Average letters lost for the five observers for each chart was used to rank the IQMs for each DS eye. Results Average acuity for the best performing refraction for all DS eyes was within five letters (0.11 ± 0.05 logMAR) of the clear chart acuity. Optimized IQM refractions had ∼3.5 lines mean improvement from the habitual refraction (0.37 ± 0.22 logMAR, P < 0.001). Three metrics (Visual Strehl Ratio [VSX], VSX computed in frequency domain [VSMTF], and standard deviation of intensity values [STD]) identified refractions that were ranked first, or within 0.09 logMAR of first, in >98% of the eyes. Conclusions Optimized IQM refraction is predicted to improve VA in DS eyes based on control observers reading simulated charts. Translational Relevance Refractions identified through optimization of IQM may bypass some of the challenges of current refraction techniques for patients with DS. The optimized refractions are predicted to provide better VA compared to their habitual correction.
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Affiliation(s)
| | - Julia S Benoit
- University of Houston College of Optometry, Houston, TX, USA.,Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX, USA
| | - Jason D Marsack
- University of Houston College of Optometry, Houston, TX, USA
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Francis DJ, Kulesz PA, Benoit JS. Extending the Simple View of Reading to Account for Variation Within Readers and Across Texts: The Complete View of Reading (CVR i). Remedial Spec Educ 2018; 39:274-288. [PMID: 31130774 PMCID: PMC6530938 DOI: 10.1177/0741932518772904] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study leverages advances in multivariate cross-classified random effects models to extend the Simple View of Reading to account for variation within readers and across texts, allowing for both the personalization of the reading function and the integration of the component skills and text and discourse frameworks for reading research. We illustrate the Complete View of Reading (CVRi) using data from an intensive longitudinal design study with a large sample of typical (N = 648) and struggling readers (N = 865) in middle school and using oral reading fluency as a proxy for comprehension. To illustrate the utility of the CVRi, we present a model with cross-classified random intercepts for students and passages and random slopes for growth, Lexile difficulty, and expository text type at the student level. We highlight differences between typical and struggling readers and differences across students in different grades. The model illustrates that readers develop differently and approach the reading task differently, showing differential impact of text features on their fluency. To be complete, a model of reading must be able to reflect this heterogeneity at the person and passage level, and the CVRi is a step in that direction. Implications for reading interventions and 21st century reading research in the era of "Big Data" and interest in phenotypic characterization are discussed.
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20
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Krishnan AK, Queener HM, Stevenson SB, Benoit JS, Bedell HE. Impact of simulated micro-scotomas on reading performance in central and peripheral retina. Exp Eye Res 2018; 183:9-19. [PMID: 29959926 DOI: 10.1016/j.exer.2018.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/23/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Abstract
Observers with central field loss typically fixate within a non-foveal region called the preferred retinal locus, which can include localized sensitivity losses, or micro-scotomas (Krishnan and Bedell, 2018). In this study, we simulated micro-scotomas at the fovea and in the peripheral retina to assess their impact on reading speed. Ten younger (<36 years old) and 8 older (>50 years old) naïve observers with normal vision monocularly read high and/or low contrast sentences, presented at or above the critical print size for young observers at the fovea and at 5 and 10 deg in the inferior visual field. Reading material comprised MNREAD sentences and sentences taken from novels that were presented in rapid serial visual presentation (RSVP) format. Randomly distributed 13 × 13 arc min blocks corresponding to 0-78% of the text area (corresponding to ∼0-17 micro-scotomas/deg2) were set to the background luminance to simulate micro-scotomas. A staircase algorithm estimated maximum reading speed from the threshold exposure duration for each combination of retinal eccentricity, contrast and micro-scotoma density in both age groups. Log10(RSVP reading speed) decreased significantly with simulated micro-scotoma density and eccentricity. Across conditions, reading speed was slower with low-compared to high-contrast text and was faster in younger than older normal observers. For a given eccentricity and contrast, a higher density of random element losses maximally affected older observers with normal vision. These outcomes may explain some of the reading deficits observed in older observers with central field loss.
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Affiliation(s)
- Arun Kumar Krishnan
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX, 77204, USA.
| | - Hope M Queener
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX, 77204, USA
| | - Scott B Stevenson
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX, 77204, USA
| | - Julia S Benoit
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX, 77204, USA; Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, 4849 Calhoun Road, Houston, TX, 77204, USA
| | - Harold E Bedell
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX, 77204, USA
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Abstract
PURPOSE To assess the repeatability of simulated keratometry measures obtained with Zeiss Atlas topography for subjects with and without Down syndrome (DS). METHODS Corneal topography was attempted on 140 subjects with DS and 138 controls (aged 7-59 years). Subjects who had at least three measures in each eye were included in analysis (DS: n = 140 eyes (70 subjects) and controls: n = 264 eyes (132 subjects)). For each measurement, the steep corneal power (K), corneal astigmatism, flat K orientation, power vector representation of astigmatism (J0, J45), and astigmatic dioptric difference were determined for each measurement (collectively termed keratometry values here). For flat K orientation comparisons, only eyes with >0.50 DC of astigmatism were included (DS: n = 131 eyes (68 subjects) and control: n = 217 eyes (119 subjects)). Repeatability was assessed using (1) group mean variability (average standard deviation (SD) across subjects), (2) coefficient of repeatability (COR), (3) coefficient of variation (COV), and (4) intraclass correlation coefficient (ICC). RESULTS The keratometry values showed good repeatability as evidenced by low group mean variability for DS versus control eyes (≤0.26D vs. ≤0.09D for all dioptric values; 4.51° vs. 3.16° for flat K orientation); however, the group mean variability was significantly higher in DS eyes than control eyes for all parameters (p ≤ 0.03). On average, group mean variability was 2.5 times greater in the DS eyes compared to control eyes across the keratometry values. Other metrics of repeatability also indicated good repeatability for both populations for each keratometry value, although repeatability was always better in the control eyes. CONCLUSIONS DS eyes showed more variability (on average: 2.5×) compared to controls for all keratometry values. Although differences were statistically significant, on average 91% of DS eyes had variability ≤0.50D for steep K and astigmatism, and 75% of DS eyes had variability ≤5 degrees for flat K orientation.
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Affiliation(s)
- Ayeswarya Ravikumar
- *PhD †PhD, FAAO ‡OD, PhD, FAAO College of Optometry (AR, JDM, JSB, HAA) and Texas Institute for Measurement, Evaluation and Statistics (JSB), University of Houston, Houston, Texas
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Aisiku IP, Yamal JM, Doshi P, Benoit JS, Gopinath S, Goodman JC, Robertson CS. Plasma cytokines IL-6, IL-8, and IL-10 are associated with the development of acute respiratory distress syndrome in patients with severe traumatic brain injury. Crit Care 2016; 20:288. [PMID: 27630085 PMCID: PMC5024454 DOI: 10.1186/s13054-016-1470-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/26/2016] [Indexed: 02/06/2023]
Abstract
Background Patients with severe traumatic brain injury (TBI) are at risk of the development of acute respiratory distress syndrome (ARDS). TBI and ARDS pathophysiologic mechanisms are known to independently involve significant inflammatory responses. The literature on the association between plasma inflammatory cytokines and ARDS in patients with TBI is sparse. Methods The study was a secondary analysis of the safety of a randomized trial of erythropoietin and transfusion threshold in patients with severe TBI. Inflammatory markers within the first 24 hours after injury were compared in patients who developed ARDS and patients without ARDS, using Cox proportional hazards models. Results There were 200 patients enrolled in the study. The majority of plasma and cerebrospinal fluid (CSF) cytokine levels were obtained within 6 hours. Plasma proinflammatory markers IL-6 and IL-8 and anti-inflammatory marker IL-10 were associated with the development of ARDS (adjusted hazard ratio (HR) = 1.55, confidence interval (CI) = 1.14, 2.11, P = 0.005 for IL-6; adjusted HR = 1.32, CI = 1.10, 1.59, P = 0.003 for IL-8). Conclusion Plasma markers of IL-6, IL-8, and IL-10 are associated with ARDS in patients with severe TBI. Trial registration NCT00313716 registered 4/2006
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Affiliation(s)
- Imo P Aisiku
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Jose-Miguel Yamal
- Division of Biostatistics, University of Texas School of Public Health, Houston, TX, USA
| | - Pratik Doshi
- Department of Emergency Medicine and Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Julia S Benoit
- Department of Basic Vision Sciences, College of Optometry Texas Institute for Measurement Evaluation and Statistics, University of Houston, Houston, TX, USA
| | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Jerry C Goodman
- Department of Pathology, Baylor College of Medicine, Houston, TX, USA
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Benoit JS, Chan W, Luo S, Yeh HW, Doody R. A hidden Markov model approach to analyze longitudinal ternary outcomes when some observed states are possibly misclassified. Stat Med 2016; 35:1549-57. [PMID: 26782946 DOI: 10.1002/sim.6861] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 10/25/2015] [Accepted: 12/06/2015] [Indexed: 11/10/2022]
Abstract
Understanding the dynamic disease process is vital in early detection, diagnosis, and measuring progression. Continuous-time Markov chain (CTMC) methods have been used to estimate state-change intensities but challenges arise when stages are potentially misclassified. We present an analytical likelihood approach where the hidden state is modeled as a three-state CTMC model allowing for some observed states to be possibly misclassified. Covariate effects of the hidden process and misclassification probabilities of the hidden state are estimated without information from a 'gold standard' as comparison. Parameter estimates are obtained using a modified expectation-maximization (EM) algorithm, and identifiability of CTMC estimation is addressed. Simulation studies and an application studying Alzheimer's disease caregiver stress-levels are presented. The method was highly sensitive to detecting true misclassification and did not falsely identify error in the absence of misclassification. In conclusion, we have developed a robust longitudinal method for analyzing categorical outcome data when classification of disease severity stage is uncertain and the purpose is to study the process' transition behavior without a gold standard.
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Affiliation(s)
- Julia S Benoit
- Texas Institute for Measurement, Evaluation, and Statistics and Department of Basic Vision Sciences, College of Optometry, The University of Houston, Houston, TX, 77204, U.S.A.,Department of Biostatistics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, U.S.A
| | - Wenyaw Chan
- Department of Biostatistics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, U.S.A
| | - Sheng Luo
- Department of Biostatistics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, U.S.A
| | - Hung-Wen Yeh
- Department of Biostatistics, The University of Kansas Medical Center, Kansas City, KS, 66160, U.S.A
| | - Rachelle Doody
- Alzheimer's Disease and Memory Disorders Center, Department of Neurology, Baylor College of Medicine, Houston, TX, 77030, U.S.A
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Yamal JM, Benoit JS, Doshi P, Rubin ML, Tilley BC, Hannay HJ, Robertson CS. Association of transfusion red blood cell storage age and blood oxygenation, long-term neurologic outcome, and mortality in traumatic brain injury. J Trauma Acute Care Surg 2015; 79:843-9. [PMID: 26496111 PMCID: PMC4621763 DOI: 10.1097/ta.0000000000000834] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effect of red blood cell (RBC) storage on oxygenation in critically ill patients is still unknown. The objective of this study was to determine the association of RBC storage with oxygenation, long-term neurologic recovery, and death after traumatic brain injury. METHODS We used data from a 2 × 2 factorial randomized controlled trial of administration of erythropoietin or placebo and of assignment to transfusion threshold of less than 7g/dL or less than 10 g/dL in neurosurgical intensive care units in two US Level 1 trauma centers. Patients had severe traumatic brain injury with closed head injury, were unable to follow commands, and were enrolled within 6 hours of injury. Blood oxygenation 1 hour after the transfusion as measured by jugular venous oxygen saturation (n = 59) was the primary outcome. Secondary outcomes were brain tissue oxygenation (n = 77), 6-month Glasgow Outcome Scale (GOS) score (n = 122) collected using a structured interview and dichotomized into favorable (good recovery or moderate disability) or unfavorable outcome (severe disability, vegetative state, or dead), and mortality (n = 125). RBC age was defined as the maximum age of RBCs over all units in one transfusion per patient. For long-term outcomes, RBC age was defined as the mean age over all units given. RESULTS We failed to detect an association of RBC age with jugular venous oxygen saturation (linear regression β = 1.59; 95% confidence interval [CI], -2.99 to 6.18; p = 0.49), brain tissue oxygenation (linear regression β = 0.20; 95% CI, -0.23 to 0.63; p = 0.36), GOS score (odds ratio, 1.37; 95% CI, 0.53-3.57; p = 0.52), and mortality (hazard ratio, 1.35; 95% CI, 0.61-2.98; p = 0.46). CONCLUSION Limitations of this study include the fact that the RBC ages were not randomized, although this was a prospective study. We conclude that older blood does not seem to have adverse effects in severe traumatic brain injury. LEVEL OF EVIDENCE Prognostic study, level III.
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Affiliation(s)
- Jose-Miguel Yamal
- Department of Biostatistics, University of Texas School of Public Health, Houston, TX, USA
| | - Julia S. Benoit
- Department of Basic Vision Sciences, University of Houston, Houston, TX, USA
| | - Pratik Doshi
- Department of Emergency Medicine and Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maria Laura Rubin
- Department of Biostatistics, University of Texas School of Public Health, Houston, TX, USA
| | - Barbara C. Tilley
- Department of Biostatistics, University of Texas School of Public Health, Houston, TX, USA
| | - H. Julia Hannay
- Department of Psychology, University of Houston, Houston, TX, USA
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Yamal JM, Rubin ML, Benoit JS, Tilley BC, Gopinath S, Hannay HJ, Doshi P, Aisiku IP, Robertson CS. Effect of Hemoglobin Transfusion Threshold on Cerebral Hemodynamics and Oxygenation. J Neurotrauma 2015; 32:1239-45. [PMID: 25566694 DOI: 10.1089/neu.2014.3752] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Cerebral dysfunction caused by traumatic brain injury may adversely affect cerebral hemodynamics and oxygenation leading to worse outcomes if oxygen capacity is decreased due to anemia. In a randomized clinical trial of 200 patients comparing transfusion thresholds <7 g/dl versus 10 g/dl, where transfusion of leukoreduced packed red blood cells was used to maintain the assigned hemoglobin threshold, no long-term neurological difference was detected. The current study examines secondary outcome measures of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and brain tissue oxygenation (PbtO2) in patients enrolled in this randomized clinical trial. We observed a lower hazard for death (hazard ratio [HR]=0.12, 95% confidence interval [CI]=0.02-0.99) during the first 3 days post-injury, and a higher hazard for death after three days (HR=2.55, 95% CI=1.00-6.53) in the 10 g/dl threshold group as compared to the 7 g/dL threshold group. No significant differences were observed for ICP and CPP but MAP was slightly lower in the 7 g/dL group, although the decreased MAP did not result in increased hypotension. Overall brain tissue hypoxia events were not significantly different in the two transfusion threshold groups. When the PbtO2 catheter was placed in normal brain, however, tissue hypoxia occurred in 25% of patients in the 7 g/dL threshold group, compared to 10.2% of patients in the 10 g/dL threshold group (p=0.04). Although we observed a few differences in hemodynamic outcomes between the transfusion threshold groups, none were of major clinical significance and did not affect long-term neurological outcome and mortality.
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Affiliation(s)
- Jose-Miguel Yamal
- 1 Department of Biostatistics, University of Texas School of Public Health , Houston, Texas
| | - M Laura Rubin
- 1 Department of Biostatistics, University of Texas School of Public Health , Houston, Texas
| | - Julia S Benoit
- 2 Department of Basic Vision Sciences, College of Optometry and Texas Institute for Measurement Evaluation and Statistics, University of Houston , Houston, Texas
| | - Barbara C Tilley
- 1 Department of Biostatistics, University of Texas School of Public Health , Houston, Texas
| | - Shankar Gopinath
- 3 Department of Neurosurgery, Baylor College of Medicine , Houston, Texas
| | - H Julia Hannay
- 4 Department of Psychology, University of Houston , Houston, Texas
| | - Pratik Doshi
- 5 Department of Emergency Medicine and Internal Medicine, University of Texas Health Science Center at Houston , Houston, Texas
| | - Imoigele P Aisiku
- 6 Department of Emergency Medicine, Brigham and Women's Hospital , Boston, Massachusetts
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26
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Abstract
Parameter dependency within data sets in simulation studies is common, especially in models such as Continuous-Time Markov Chains (CTMC). Additionally, the literature lacks a comprehensive examination of estimation performance for the likelihood-based general multi-state CTMC. Among studies attempting to assess the estimation, none have accounted for dependency among parameter estimates. The purpose of this research is twofold: 1) to develop a multivariate approach for assessing accuracy and precision for simulation studies 2) to add to the literature a comprehensive examination of the estimation of a general 3-state CTMC model. Simulation studies are conducted to analyze longitudinal data with a trinomial outcome using a CTMC with and without covariates. Measures of performance including bias, component-wise coverage probabilities, and joint coverage probabilities are calculated. An application is presented using Alzheimer's disease caregiver stress levels. Comparisons of joint and component-wise parameter estimates yield conflicting inferential results in simulations from models with and without covariates. In conclusion, caution should be taken when conducting simulation studies aiming to assess performance and choice of inference should properly reflect the purpose of the simulation.
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Affiliation(s)
- Julia S Benoit
- Department of Vision Sciences/Texas Institute of Measurement, Evaluation, &Statistics (TIMES), University of Houston, Houston, TX, USA.,Department of Biostatistics, University of Texas School of Public Health, Houston, TX, USA
| | - Wenyaw Chan
- Department of Biostatistics, University of Texas School of Public Health, Houston, TX, USA
| | - Rachelle S Doody
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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27
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Yamal JM, Robertson CS, Rubin ML, Benoit JS, Hannay HJ, Tilley BC. Enrollment of racially/ethnically diverse participants in traumatic brain injury trials: effect of availability of exception from informed consent. Clin Trials 2014; 11:187-94. [PMID: 24686108 DOI: 10.1177/1740774514522560] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Final Rule regulations were developed to allow exception from informed consent (EFIC) to enable clinical trial research in emergency settings where major barriers exist for informed consent. There is little known evidence of the effect of the Final Rule in minority enrollment in clinical trials, particularly in traumatic brain injury (TBI) trials. A clinical trial funded by the National Institute of Neurological Disorders and Stroke was conducted to study the effects of erythropoietin on cerebral vascular dysfunction and anemia in subjects with TBI. There were periods of time when EFIC was and was not available for enrollment into the study. PURPOSE To explore the effect of EFIC availability on TBI trial enrollment of minority versus non-minority subjects. METHODS Minority status of screened (n = 289) and enrolled (n = 191) TBI subjects was determined for this study. We tested for the presence of a minority and EFIC availability interaction in a multiple logistic regression model after controlling for EFIC and minority group main effects and other covariates. RESULTS An interaction between the availability of EFIC minority and non-minority enrollment was not detected (odds ratio = 1.22; 95% confidence interval (CI) = 0.29-5.16). LIMITATIONS Our study was conducted at a single site, and the CI for the EFIC and minority interaction term was wide. Therefore, a small interaction effect cannot be ruled out. CONCLUSION EFIC increased the odds of being enrolled regardless of minority status.
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Affiliation(s)
- Jose-Miguel Yamal
- aDivision of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
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28
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Robertson CS, Hannay HJ, Yamal JM, Gopinath S, Goodman JC, Tilley BC, Baldwin A, Rivera Lara L, Saucedo-Crespo H, Ahmed O, Sadasivan S, Ponce L, Cruz-Navarro J, Shahin H, Aisiku IP, Doshi P, Valadka A, Neipert L, Waguspack JM, Rubin ML, Benoit JS, Swank P. Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA 2014; 312:36-47. [PMID: 25058216 PMCID: PMC4113910 DOI: 10.1001/jama.2014.6490] [Citation(s) in RCA: 328] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There is limited information about the effect of erythropoietin or a high hemoglobin transfusion threshold after a traumatic brain injury. OBJECTIVE To compare the effects of erythropoietin and 2 hemoglobin transfusion thresholds (7 and 10 g/dL) on neurological recovery after traumatic brain injury. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 200 patients (erythropoietin, n = 102; placebo, n = 98) with closed head injury who were unable to follow commands and were enrolled within 6 hours of injury at neurosurgical intensive care units in 2 US level I trauma centers between May 2006 and August 2012. The study used a factorial design to test whether erythropoietin would fail to improve favorable outcomes by 20% and whether a hemoglobin transfusion threshold of greater than 10 g/dL would increase favorable outcomes without increasing complications. Erythropoietin or placebo was initially dosed daily for 3 days and then weekly for 2 more weeks (n = 74) and then the 24- and 48-hour doses were stopped for the remainder of the patients (n = 126). There were 99 patients assigned to a hemoglobin transfusion threshold of 7 g/dL and 101 patients assigned to 10 g/dL. INTERVENTIONS Intravenous erythropoietin (500 IU/kg per dose) or saline. Transfusion threshold maintained with packed red blood cells. MAIN OUTCOMES AND MEASURES Glasgow Outcome Scale score dichotomized as favorable (good recovery and moderate disability) or unfavorable (severe disability, vegetative, or dead) at 6 months postinjury. RESULTS There was no interaction between erythropoietin and hemoglobin transfusion threshold. Compared with placebo (favorable outcome rate: 34/89 [38.2%; 95% CI, 28.1% to 49.1%]), both erythropoietin groups were futile (first dosing regimen: 17/35 [48.6%; 95% CI, 31.4% to 66.0%], P = .13; second dosing regimen: 17/57 [29.8%; 95% CI, 18.4% to 43.4%], P < .001). Favorable outcome rates were 37/87 (42.5%) for the hemoglobin transfusion threshold of 7 g/dL and 31/94 (33.0%) for 10 g/dL (95% CI for the difference, -0.06 to 0.25, P = .28). There was a higher incidence of thromboembolic events for the transfusion threshold of 10 g/dL (22/101 [21.8%] vs 8/99 [8.1%] for the threshold of 7 g/dL, odds ratio, 0.32 [95% CI, 0.12 to 0.79], P = .009). CONCLUSIONS AND RELEVANCE In patients with closed head injury, neither the administration of erythropoietin nor maintaining hemoglobin concentration of greater than 10 g/dL resulted in improved neurological outcome at 6 months. The transfusion threshold of 10 g/dL was associated with a higher incidence of adverse events. These findings do not support either approach in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00313716.
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Affiliation(s)
| | - H Julia Hannay
- Department of Psychology, University of Houston, Houston, Texas
| | - José-Miguel Yamal
- Division of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - J Clay Goodman
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Barbara C Tilley
- Division of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston
| | | | - Athena Baldwin
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Lucia Rivera Lara
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Osama Ahmed
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Luciano Ponce
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Hazem Shahin
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Pratik Doshi
- University of Texas Health Sciences Center, Houston
| | - Alex Valadka
- University of Texas Health Sciences Center, Houston
| | - Leslie Neipert
- Department of Psychology, University of Houston, Houston, Texas
| | | | - M Laura Rubin
- Division of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Julia S Benoit
- Division of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Paul Swank
- Division of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston
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