Publications by authors named "Jonathan Myers"

647 Publications

Prognostic comparison of the FRIEND and Wasserman/Hansen peak VO2 equations applied to a submaximal walking test in outpatients with cardiovascular disease.

Eur J Prev Cardiol 2021 Apr;28(3):287-292

Centre for Exercise Science and Sport, University of Ferrara, Italy.

Aims: The aim of this study was to determine the ability to predict all-cause mortality using established per cent-predicted (%PRED) equations for peak oxygen consumption (VO2peak) estimated by a submaximal walk test in outpatients with cardiovascular disease.

Methods: Male patients (N = 1491) aged 62 ± 10 years at baseline underwent a moderate and perceptually regulated (11-13 on the 6-20 Borg scale) 1-km treadmill-walking test to estimate VO2peak. %PRED was derived from the Fitness Registry and the Importance of Exercise: A National Data Base (FRIEND) and the Wasserman/Hansen equations.

Results: There were 215 deaths during a median 9.4-year follow-up. The FRIEND prediction equation provided better prognostic information with receiver operating curve analysis showing significantly different areas under the curve (0.72 and 0.69 for the FRIEND and the Wasserman/Hansen equations respectively, p = 0.001). Overall mortality rate was higher across decreasing tertiles of %PRED using FRIEND, with 26%, 11% and 5% for the least fit, intermediate and high fit tertiles, respectively (p for trend < 0.0001). Compared with the least fit tertile, the adjusted hazard ratios for the second and third tertiles were 0.54 (95% confidence interval 0.34-0.87, p = 0.01) and 0.45 (95% confidence interval 0.25-0.81, p = 0.008), respectively. Each 1% increase in %PRED conferred a 3% improvement in survival (p = 0.0004).

Conclusion: Low %PRED VO2peak in cardiac outpatients determined by the FRIEND equation was associated with a high mortality rate independent of traditional cardiovascular risk factors and clinical history. The FRIEND equation may provide a suitable normal standard when applied to clinically stable outpatients with cardiovascular disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2047487319871728DOI Listing
April 2021

Predicting eyes at risk for rapid glaucoma progression based on an initial visual field test using machine learning.

PLoS One 2021 16;16(4):e0249856. Epub 2021 Apr 16.

Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.

Objective: To assess whether machine learning algorithms (MLA) can predict eyes that will undergo rapid glaucoma progression based on an initial visual field (VF) test.

Design: Retrospective analysis of longitudinal data.

Subjects: 175,786 VFs (22,925 initial VFs) from 14,217 patients who completed ≥5 reliable VFs at academic glaucoma centers were included.

Methods: Summary measures and reliability metrics from the initial VF and age were used to train MLA designed to predict the likelihood of rapid progression. Additionally, the neural network model was trained with point-wise threshold data in addition to summary measures, reliability metrics and age. 80% of eyes were used for a training set and 20% were used as a test set. MLA test set performance was assessed using the area under the receiver operating curve (AUC). Performance of models trained on initial VF data alone was compared to performance of models trained on data from the first two VFs.

Main Outcome Measures: Accuracy in predicting future rapid progression defined as MD worsening more than 1 dB/year.

Results: 1,968 eyes (8.6%) underwent rapid progression. The support vector machine model (AUC 0.72 [95% CI 0.70-0.75]) most accurately predicted rapid progression when trained on initial VF data. Artificial neural network, random forest, logistic regression and naïve Bayes classifiers produced AUC of 0.72, 0.70, 0.69, 0.68 respectively. Models trained on data from the first two VFs performed no better than top models trained on the initial VF alone. Based on the odds ratio (OR) from logistic regression and variable importance plots from the random forest model, older age (OR: 1.41 per 10 year increment [95% CI: 1.34 to 1.08]) and higher pattern standard deviation (OR: 1.31 per 5-dB increment [95% CI: 1.18 to 1.46]) were the variables in the initial VF most strongly associated with rapid progression.

Conclusions: MLA can be used to predict eyes at risk for rapid progression with modest accuracy based on an initial VF test. Incorporating additional clinical data to the current model may offer opportunities to predict patients most likely to rapidly progress with even greater accuracy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249856PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051770PMC
April 2021

Variability and Power to Detect Progression of Different Visual Field Patterns.

Ophthalmol Glaucoma 2021 Apr 10. Epub 2021 Apr 10.

Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY. Electronic address:

Purpose: To compare the variability and ability to detect visual field progression of 24-2, central 12 locations of the 24-2 and 10-2 visual field (VF) tests in eyes with abnormal VFs.

Design: Retrospective, multisite cohort.

Participants: A total of 52,806 24-2 and 11,966 10-2 VF tests from 7,307 eyes from the Glaucoma Research Network database were analyzed. Only eyes with ≥ 5 visits and ≥ 2 years of follow-up were included.

Methods: Linear regression models were used to calculate the rates of MD (Mean Deviation) change (slopes) while their residuals were used to assess variability across the entire MD range. Computer simulations (n=10,000) based upon real MD residuals of our sample were performed to estimate power to detect significant progression (P < 5%) at various rates of MD change.

Main Outcome Measures: Time required to detect progression.

Results: For all 3 patterns, the MD variability was highest within the -5 to -20 dB range and consistently lower with the 10-2 compared to 24-2 or Central 24-2. Overall, time to detect confirmed significant progression at 80% power was the lowest with 10-2 VF, with a decrease of 14.6% to 18.5% when compared to 24-2 and a decrease of 22.9% to 26.5% when compared to Central 24-2.

Conclusion: Time to detect central VF progression was reduced with 10-2 MD compared with 24-2 and C24-2 MD in glaucoma eyes in this large dataset, in part because 10-2 tests had lower variability. These findings contribute to current evidence of the potential value of 10-2 testing in the clinical management of glaucoma patients and in clinical trial design.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ogla.2021.04.004DOI Listing
April 2021

Comparison of non-exercise cardiorespiratory fitness prediction equations in apparently healthy adults.

Eur J Prev Cardiol 2021 04 22;28(2):142-148. Epub 2019 Oct 22.

Fisher Institute of Health and Well-Being, Ball State University, USA.

Aims: A recent scientific statement suggests clinicians should routinely assess cardiorespiratory fitness using at least non-exercise prediction equations. However, no study has comprehensively compared the many non-exercise cardiorespiratory fitness prediction equations to directly-measured cardiorespiratory fitness using data from a single cohort. Our purpose was to compare the accuracy of non-exercise prediction equations to directly-measured cardiorespiratory fitness and evaluate their ability to classify an individual's cardiorespiratory fitness.

Methods: The sample included 2529 tests from apparently healthy adults (42% female, aged 45.4 ± 13.1 years (mean±standard deviation). Estimated cardiorespiratory fitness from 28 distinct non-exercise prediction equations was compared with directly-measured cardiorespiratory fitness, determined from a cardiopulmonary exercise test. Analysis included the Benjamini-Hochberg procedure to compare estimated cardiorespiratory fitness with directly-measured cardiorespiratory fitness, Pearson product moment correlations, standard error of estimate values, and the percentage of participants correctly placed into three fitness categories.

Results: All of the estimated cardiorespiratory fitness values from the equations were correlated to directly measured cardiorespiratory fitness (p < 0.001) although the R2 values ranged from 0.25-0.70 and the estimated cardiorespiratory fitness values from 27 out of 28 equations were statistically different compared with directly-measured cardiorespiratory fitness. The range of standard error of estimate values was 4.1-6.2 ml·kg-1·min-1. On average, only 52% of participants were correctly classified into the three fitness categories when using estimated cardiorespiratory fitness.

Conclusion: Differences exist between non-exercise prediction equations, which influences the accuracy of estimated cardiorespiratory fitness. The present analysis can assist researchers and clinicians with choosing a non-exercise prediction equation appropriate for epidemiological or population research. However, the error and misclassification associated with estimated cardiorespiratory fitness suggests future research is needed on the clinical utility of estimated cardiorespiratory fitness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2047487319881242DOI Listing
April 2021

Mature Andean forests as globally important carbon sinks and future carbon refuges.

Nat Commun 2021 04 9;12(1):2138. Epub 2021 Apr 9.

Biology Department, University of Miami, Coral Gables, FL, USA.

It is largely unknown how South America's Andean forests affect the global carbon cycle, and thus regulate climate change. Here, we measure aboveground carbon dynamics over the past two decades in 119 monitoring plots spanning a range of >3000 m elevation across the subtropical and tropical Andes. Our results show that Andean forests act as strong sinks for aboveground carbon (0.67 ± 0.08 Mg C ha y) and have a high potential to serve as future carbon refuges. Aboveground carbon dynamics of Andean forests are driven by abiotic and biotic factors, such as climate and size-dependent mortality of trees. The increasing aboveground carbon stocks offset the estimated C emissions due to deforestation between 2003 and 2014, resulting in a net total uptake of 0.027 Pg C y. Reducing deforestation will increase Andean aboveground carbon stocks, facilitate upward species migrations, and allow for recovery of biomass losses due to climate change.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41467-021-22459-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035207PMC
April 2021

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network.

Curr Probl Cardiol 2021 Jun 27;46(6):100823. Epub 2021 Feb 27.

Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA.

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpcardiol.2021.100823DOI Listing
June 2021

Effect of a Home-Based Exercise Program on Indices of Physical Function and Quality of Life in Elderly Maintenance Hemodialysis Patients.

Kidney Blood Press Res 2021 26;46(2):196-206. Epub 2021 Mar 26.

Nephrology Section, Veterans Affairs Palo Alto Health Care System, Stanford, California, USA.

Background: Patients on maintenance hemodialysis (MHD) exhibit muscle wasting and impaired physical function which can be reversed with regular exercise, but accessibility to exercise programs for this unique population is lacking. We assessed the efficacy of a home-based exercise program on a broad range of indices of physical function, quality of life (QoL), and cognitive decline in patients with MHD.

Design And Methods: Twenty-eight MHD patients, mean age 66 ± 7 years, were randomized to a 12-week home-based, case-managed aerobic and resistance exercise program or to usual care (13 exercise and 15 usual care). Comparisons were made for peak VO2, ventilatory inefficiency, 6-min walk test (6MWT), 1-min sit-to-stand (1STS), muscle strength, body composition, QoL, and cognitive measures.

Results: Peak VO2 improved significantly in the exercise group (p = 0.01 between groups); exercise time improved by 41 and 36% at the ventilatory threshold and peak exercise, respectively (p < 0.01 between groups), but there were no differences in ventilatory efficiency. Trends for improvements in 6MWT and 1STS in the exercise group were observed, but no differences were observed in strength or body composition. Among measures of QoL, general health determined by the SF-36 improved in the exercise group, but there were no differences between groups in cognitive function.

Conclusions: MHD patients improved exercise capacity and some indices of QoL following a 12-week home-based exercise program. Home-based exercise is feasible for patients undergoing MHD and may help to obviate accessibility barriers to regular exercise.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000514269DOI Listing
March 2021

Peripheral Oxygen Extraction and Exercise Limitation in Asymptomatic Patients with Diabetes Mellitus.

Am J Cardiol 2021 Mar 20. Epub 2021 Mar 20.

Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford, California.

Patients with diabetes mellitus (DM) frequently present reduced exercise capacity. We aimed to explore the extent to which peripheral extraction relates to exercise capacity in asymptomatic patients with DM. We prospectively enrolled 98 asymptomatic patients with type-2 DM (mean age of 59 ± 11 years and 56% male sex), and compared with 31 age, sex and body mass index-matched normoglycemic controls. Cardiopulmonary exercise testing with resting followed by stress echocardiography was performed. Exercise response was assessed using peak oxygen uptake (peak VO) and ventilatory efficiency was measured using the slope of the relationship between minute ventilation and carbon dioxide production (VE/VCO). Peripheral extraction was calculated as the ratio of VO to cardiac output. Cardiac function was evaluated using left ventricular longitudinal strain, E/e', and relative wall thickness. Among patients with DM, 26 patients (27%) presented reduced percent-predicted-peak VO(<80%) and 18 (18%) presented abnormal VE/VCOslope (>34). There was no significant difference in peak cardiac output; however, peripheral extraction was lower in patients with DM compared to controls. Higher peak E/e' (beta = -0.24, p = 0.004) was associated with lower peak VO along with age, sex and body mass index (R = 0.53). A cluster analysis found left ventricular longitudinal strain, E/e', relative wall thickness and peak VO in different clusters. In conclusion, impaired peripheral extraction may contribute to reduced peak VOin asymptomatic patients with DM. Furthermore, a cluster analysis suggests that cardiopulmonary exercise testing and echocardiography may be complementary for defining subclinical heart failure in patients with DM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2021.03.011DOI Listing
March 2021

Commentary on "Performance evaluation of a portable bioimpedance cardiac output monitor for measuring hemodynamic changes in athletes during a head-up tilt test".

J Appl Physiol (1985) 2021 Mar;130(3):671-672

University of Picardie Jules Verne, UFR-STAPS, Research Unit Physiological Responses and Exercise Readaptation, Amiens, France.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1152/japplphysiol.00873.2020DOI Listing
March 2021

Association of physical function and performance with peak VO in elderly patients with end stage kidney disease.

Aging Clin Exp Res 2021 Mar 8. Epub 2021 Mar 8.

Nephrology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.

Background: Physical function is impaired in end stage renal disease (ESRD). Various instruments have been used to assess the functional capabilities and health status of patients with ESRD, but it is not known which has the best association with peak VO.

Aims: To assess the association between functional measures in ESRD.

Methods: Thirty nine elderly ESRD patients were evaluated with commonly used functional, health status, and quality of life measures, including maximal cardiopulmonary exercise testing (CPET), 6-min walk (6MWT), sit-to-stand test (STS), Veterans Specific Activity Questionnaire (VSAQ), upper and lower body strength, pulmonary function tests, and body composition determined by dual X-ray absorptiometry. The association between performance on these functional tools, clinical variables, and exercise test responses was assessed, and a non-exercise test multivariate model was developed to predict peak VO.

Results: Peak VO was modestly related to VSAQ score (r = 0.59, p < 0.01), indices of upper and lower body strength (r = 0.45, p < 0.01 for both), and FEV (r = 0.51, p < 0.01). Functional and quality of life questionnaires were generally poorly related to one another and to peak VO. In a multivariate model, 6MWT performance, forced expiratory volume in 1 s (FEV), and VSAQ score were the best predictors of peak VO, yielding a multiple R = 0.82, accounting for 67% of the variance in peak VO.

Conclusion: Exercise capacity can be reasonably estimated using non-exercise test variables in patients with ESRD, including a symptom questionnaire (VSAQ), 6MWT and FEV.

Clinical Trial Information: ClinicalTrials.gov identifier: NCT01990495. Registered Nov 21, 2013.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40520-021-01801-6DOI Listing
March 2021

In-vivo imaging of the conventional aqueous outflow system.

Curr Opin Ophthalmol 2021 May;32(3):275-279

Wills Eye Hospital, Glaucoma Service, Philadelphia, Pennsylvania, USA.

Purpose Of Review: The aim of this study was to provide a comprehensive summary of in-vivo imaging techniques of the aqueous outflow system and discuss its role in improving our understanding of glaucoma pathogenesis and management.

Recent Findings: Our understanding of the aqueous outflow system is largely derived from ex-vivo studies. Recent innovations in imaging technology and techniques enable in-vivo evaluation of the conventional outflow system in real-time. Optical coherence tomography allows for noninvasive, high-resolution, volumetric imaging of ocular tissues. Dynamic structural changes have been observed at the trabecular meshwork and Schlemm's canal. In parallel, aqueous angiography using injected tracers show a similar dynamism with variable and pulsatile flow signals.

Summary: In-vivo imaging enable real-time evaluation of the conventional aqueous outflow pathway. This emerging field shows great promise to expand our understanding of the pathogenesis and treatment of glaucoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICU.0000000000000751DOI Listing
May 2021

Non-exercise estimated cardiorespiratory fitness and mortality from all-causes, cardiovascular disease, and cancer in the NIH-AARP diet and health study.

Eur J Prev Cardiol 2020 Dec 6. Epub 2020 Dec 6.

Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.

Aims: Impractical methods and relatively small cohort have limited the applications of non-exercise estimated cardiorespiratory fitness (NEE-CRF). This study aimed to assess the association between a pragmatic NEE-CRF method and mortality outcomes in a large prospective cohort.

Methods And Results: A total of 330 769 participants [men (n = 186 469) and women (n = 144 300)] aged 50-71 years from the NIH-AARP Diet and Health Study were assessed at baseline (1995-96) and prospectively followed until 31 December 2015 (14.9 ± 2.1 years). Non-exercise estimated cardiorespiratory fitness was estimated using pragmatic and previously validated equation, and Cox hazard analysis for mortality was conducted. Non-exercise estimated cardiorespiratory fitness was 9.9 ± 1.5 metabolic equivalents (METs) in men and 7.2 ± 1.6 METs in women. In total, 34 317 men and 20 295 women died during the follow-up. Higher NEE-CRF was associated with lower mortality risk from all-causes, cardiovascular disease, and cancer. Compared to the lowest quartile of NEE-CRF, the hazard ratios and 95% confidence interval for all-cause mortality in the second, third, and fourth quartiles were: 0.82 (0.79-0.84), 0.74 (0.72-0.77), and 0.70 (0.67-0.73) for men, and 0.84 (0.81-0.88), 0.78 (0.75-0.82), and 0.72 (0.68-0.77) for women (P trend <0.001 for all). For each 1-MET increase in NEE-CRF, risks for mortality due to cardiovascular disease and cancer were 0.85 (0.82-0.88) and 0.89 (0.87-0.91) in men, and 0.84 (0.81-0.88) and 0.89 (0.87-0.91) in women, respectively (P < 0.001 for all).

Conclusion: Higher NEE-CRF is independently associated with lower mortality risk in a large prospective cohort of men and women. These results support the utility of the applied NEE-CRF method for risk stratification, prevention, and rehabilitation programs and application in large epidemiological studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurjpc/zwaa131DOI Listing
December 2020

Continent-wide tree fecundity driven by indirect climate effects.

Nat Commun 2021 02 23;12(1):1242. Epub 2021 Feb 23.

Nicholas School of the Environment, Duke University, Durham, NC, USA.

Indirect climate effects on tree fecundity that come through variation in size and growth (climate-condition interactions) are not currently part of models used to predict future forests. Trends in species abundances predicted from meta-analyses and species distribution models will be misleading if they depend on the conditions of individuals. Here we find from a synthesis of tree species in North America that climate-condition interactions dominate responses through two pathways, i) effects of growth that depend on climate, and ii) effects of climate that depend on tree size. Because tree fecundity first increases and then declines with size, climate change that stimulates growth promotes a shift of small trees to more fecund sizes, but the opposite can be true for large sizes. Change the depresses growth also affects fecundity. We find a biogeographic divide, with these interactions reducing fecundity in the West and increasing it in the East. Continental-scale responses of these forests are thus driven largely by indirect effects, recommending management for climate change that considers multiple demographic rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41467-020-20836-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902660PMC
February 2021

Cardiorespiratory fitness and cancer in men with cardiovascular disease: Analysis from the Veterans Exercise Testing Study.

Eur J Prev Cardiol 2020 Apr 2. Epub 2020 Apr 2.

Cardiology Division, Veterans Affairs Palo Alto Health Care System/Stanford University, USA.

Background: Cardiovascular disease and cancer share similar risk factors and are the leading causes of death worldwide. This study aimed to assess the association between cardiorespiratory fitness, cancer incidence and cancer mortality in men with cardiovascular disease.

Methods: Baseline cardiorespiratory fitness (treadmill exercise test) was assessed in 565 men aged 58.9 ± 17 with documented cardiovascular disease and free from any malignancy. Cox multivariable hazard models, population attributable fraction and exposure impact number were analyzed in model accounting for competing events for cancer outcomes.

Results: Mean cardiorespiratory fitness was 7.6 ± 3.4 metabolic equivalents. During a 12.0 ± 7.5 year follow-up, 147 participants developed any type of cancer, 70 died from cancer, and five died from causes other than cancer as competing events. Compared to low cardiorespiratory fitness (<5 metabolic equivalents), moderate (5-10 metabolic equivalents) and high cardiorespiratory fitness (>10 metabolic equivalents) were associated with 50% (0.50, 95% confidence interval (0.27-0.91)) and 68% (0.32 (0.11-0.88)) reduced risks for cancer mortality (p trend = 0.026), respectively. Survival time was longer among individuals with moderate (20.8 (19.7-22) years) and high (24.9 (23-26.7) years) compared to low cardiorespiratory fitness (17.2 (15.1-19.3) years), p < 0.001. Population attributable fraction and exposure impact number for cancer mortality were 13% (4.1-17.7) and 10.8 (5.1-56.4), p = 0.01, respectively. Cardiorespiratory fitness was not associated with cancer incidence.

Conclusion: Higher cardiorespiratory fitness was independently associated with lower risk of cancer mortality and extended survival time in men with cardiovascular disease, although it was not associated with cancer incidence. Improving cardiorespiratory fitness through supervised exercise rehabilitation programs could potentially serve as a cost-effective public-health strategy for secondary prevention and survivorship in men with cardiovascular disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2047487320916595DOI Listing
April 2020

Fitness for Richer, for Poorer.

Eur J Prev Cardiol 2020 Feb 19. Epub 2020 Feb 19.

Cardiology Division, Veterans Affairs Palo Alto, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2047487320905024DOI Listing
February 2020

The need for exercise sciences and an integrated response to COVID-19: A position statement from the international HL-PIVOT network.

Prog Cardiovasc Dis 2021 Feb 4. Epub 2021 Feb 4.

Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA.

COVID-19 is one of the biggest health crises that the world has seen. Whilst measures to abate transmission and infection are ongoing, there continues to be growing numbers of patients requiring chronic support, which is already putting a strain on health care systems around the world and which may do so for years to come. A legacy of COVID-19 will be a long-term requirement to support patients with dedicated rehabilitation and support services. With many clinical settings characterized by a lack of funding and resources, the need to provide these additional services could overwhelm clinical capacity. This position statement from the Healthy Living for Pandemic Event Protection (HL-PIVOT) Network provides a collaborative blueprint focused on leading research and developing clinical guidelines, bringing together professionals with expertise in clinical services and the exercise sciences to develop the evidence base needed to improve outcomes for patients infected by COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pcad.2021.01.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859729PMC
February 2021

Physical Activity, Cardiorespiratory Fitness, and Population-Attributable Risk.

Mayo Clin Proc 2021 02;96(2):342-349

Department of Cardiology, Veterans Affairs Medical Center, Washington, DC; Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ.

Objective: To determine population-attributable risk (PAR) and exposure impact number (EIN) for mortality associated with impaired cardiorespiratory fitness (CRF), physical inactivity, and other risk markers among veteran subjects.

Methods: The sample included 5890 male subjects (mean age 58±15) who underwent a maximal exercise test for clinical reasons between January 1, 1992, and December 31, 2014. All-cause mortality was the end point. Cox multivariable hazard models were performed to determine clinical, demographic, and exercise-test determinants of mortality. Population-attributable risks and EIN for the lowest quartile of CRF and for inactive behavior were analyzed, accounting for competing events.

Results: There were 2728 deaths during a mean ± standard deviation follow-up period of 9.9±5.8 years. Having low CRF (<5.0 metabolic equivalents [METs]) was associated with an approximate 3-fold higher risk of mortality and a PAR of 12.9%. Each higher MET achieved on the treadmill was associated with a 15% reduction in mortality (hazard ratio [HR]=0.85; 95% confidence interval [CI], 0.83 to 0.88; P<.001). Nearly half the sample was inactive, and these subjects had a 23% higher mortality risk and a PAR of 8.8%. The least fit quartile (<5.0 METs) had relative risks of ≈6.0 compared with the most-fit group (HR=5.99; 95% CI, 4.9 to 7.3). The least-active tertile had ≈2-fold higher risks of mortality vs the most active subjects (HR=1.9; 95% CI, 0.91 to 4.1). The lowest EIN was observed for low fitness (3.8; 95% CI, 3.4 to 4.3, P<.001), followed by diabetes, smoking, hypertension, and physical inactivity (all P<.001 except for diabetes, P=.008).

Conclusion: Both higher CRF and physical activity provide protection against all-cause mortality in subjects referred for exercise testing for clinical reasons. Encouraging physical activity with the aim of increasing CRF would have a significant impact on reducing mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.mayocp.2020.04.049DOI Listing
February 2021

Effect of shunt type on rates of tube-cornea touch and corneal decompensation after tube shunt surgery in uveitic glaucoma.

Graefes Arch Clin Exp Ophthalmol 2021 Jan 30. Epub 2021 Jan 30.

Wills Eye Hospital, Glaucoma Research Center, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA.

Purpose: To evaluate the effect of tube shunt type [Ahmed (AGV) versus Baerveldt (BGI)] on the frequency of tube-cornea touch and corneal decompensation after tube shunt surgery.

Methods: This retrospective comparative study included 145 eyes of 130 patients with uveitic glaucoma who underwent AGV (75 eyes) or BGI (70 eyes) implantations. Electronic medical records were reviewed to document demographic factors, intraocular pressure (IOP) reduction, frequency of tube-cornea touch, corneal decompensation, and need for subsequent corneal transplantation.

Results: The mean follow-up was 27.7±3.3 months for AGV and 32.8±3.8 months for BGI (p=0.30). Tube-cornea touch was observed in 5 eyes after BGI and 1 eye in the AGV group (p=0.08). The BGI group reported a significantly higher rate of corneal decompensation (9 versus 0; p=0.001) and transplantation (6 versus 0; p=0.01) compared to the AGV group. Previous trabeculectomy was a significant risk factor for corneal complications in eyes undergoing BGI implantation (odds ratio [OR]= 8.17, 95% confidence interval [CI]=1.78-37.45, p=0.007).

Conclusion: Similar rates of tube-cornea touch were observed in both shunt types; BGI shunts were associated with a greater incidence of corneal complications and transplantation as compared to AGV in this retrospective series of uveitic glaucoma cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00417-021-05095-2DOI Listing
January 2021

Exercise blood pressure, cardiorespiratory fitness and mortality risk.

Prog Cardiovasc Dis 2021 Jan 26. Epub 2021 Jan 26.

VA Palo Alto Health Care System, Cardiology, Palo Alto, CA, USA; Stanford University, Cardiology, CA, USA.

Objective: To assess the cardiorespiratory fitness (CRF) impact on the association between exercise blood pressure (BP) and mortality risk.

Patients And Methods: We assessed CRF in 15,004 US Veterans (mean age 57.5 ± 11.2 years) who completed a standardized treadmill test between January 1, 1988 and July 28, 2017 and had no evidence of ischemia. They were classified as Unfit or Fit according to the age-specific metabolic equivalents (METs) achieved <50% (6.2 ± 1.6 METs; n = 8440) or ≥ 50% (10.5 ± 2.4 METs; n = 6264). To account for the impact of resting systolic BP (SBP) on outcomes, we calculated the difference (Peak SBP-Resting SBP) and termed it SBP-Reserve. We noted a significant increase in mortality associated with SBP-Reserve ≤52 mmHg and stratified the cohort accordingly (SBP-Reserve ≤52 mmHg and > 52 mmHg). We applied multivariable Cox models to estimate hazard ratios (HR) and 95% confidence interval (CIs) for outcomes.

Results: Mortality risk was significantly elevated only in Unfit individuals with SBP-Reserve ≤52 mmHg compared to those with SBP-Reserve >52 mmHg (HR = 1.35; CI: 1.24-1.46; P < 0.001). We then assessed the CRF and SBP-Reserve interaction on mortality risk with Fit individuals with SBP-Reserve >52 mmHg serving as the referent. Mortality risk was 92% higher (HR = 1.92%; 95% CI: 1.77-2.09; P < 0.001) in Unfit individuals with SBP-Reserve ≤52 mmHg and 47% higher (HR = 1.47; 95% CI: 1.33-1.62; P < 0.001) in those with SBP-Reserve >52 mmHg.

Conclusion: Low CRF was associated with increased mortality risk regardless of peak exercise SBP. The risk was substantially higher in individuals unable to augment their exercise SBP >52 mmHg beyond resting levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pcad.2021.01.003DOI Listing
January 2021

Prehabilitation Coming of Age: IMPLICATIONS FOR CARDIAC AND PULMONARY REHABILITATION.

J Cardiopulm Rehabil Prev 2021 05;41(3):141-146

Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, and Cardiology Division, Stanford University, Stanford, California (Dr Myers); University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria (Dr Niebauer); and College of Health Professions & Biomedical Sciences, University of Montana, Missoula (Dr Humphrey).

While cardiac and pulmonary rehabilitation programs traditionally involve exercise therapy and risk management following an event (eg, myocardial infarction and stroke), or an intervention (eg, coronary artery bypass surgery and percutaneous coronary intervention), prehabilitation involves enhancing functional capacity and optimizing risk profile prior to a scheduled intervention. The concept of prehabilitation is based on the principle that patients with higher functional capabilities will better tolerate an intervention, and will have better pre- and post-surgical outcomes. In addition to improving fitness, prehabilitation has been extended to include multifactorial risk intervention prior to surgery, including psychosocial counseling, smoking cessation, diabetes control, nutrition counseling, and alcohol abstinence. A growing number of studies have shown that patients enrolled in prehabilitation programs have reduced post-operative complications and demonstrate better functional, psychosocial, and surgery-related outcomes. These studies have included interventions such as hepatic transplantation, lung cancer resection, and abdominal aortic aneurysm (repair, upper gastrointestinal surgery, bariatric surgery, and coronary artery bypass grafting). Studies have also suggested that incorporation of prehabilitation before an intervention in addition to traditional rehabilitation following an intervention further enhances physical function, lowers risk for adverse events, and better prepares a patient to resume normal activities, including return to work. In this overview, we discuss prehabilitation coming of age, including key elements related to optimizing pre-surgical fitness, factors to consider in developing a prehabilitation program, and exercise training strategies to improve pre-surgical fitness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HCR.0000000000000574DOI Listing
May 2021

The V˙E/V˙co2 Slope During Maximal Treadmill Cardiopulmonary Exercise Testing: REFERENCE STANDARDS FROM FRIEND (FITNESS REGISTRY AND THE IMPORTANCE OF EXERCISE: A NATIONAL DATABASE).

J Cardiopulm Rehabil Prev 2021 05;41(3):194-198

Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago (Drs Arena, Phillips, Severin, and Ozemek); Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Illinois (Drs Arena, Myers, Harber, Phillips, Severin, Ozemek, Peterman, and Kaminsky); VA Palo Alto Health Care System and Stanford University, Palo Alto, California (Dr Myers); Clinical Exercise Physiology, Ball State University, Muncie, Indiana (Dr Harber); and Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky).

Purpose: Cardiopulmonary exercise testing (CPX) is the gold standard approach for the assessment of cardiorespiratory fitness (CRF). The primary aim of the current study was to determine reference standards for the minute ventilation/carbon dioxide production (V˙E/V˙co2) slope in a cohort from the "Fitness Registry and the Importance of Exercise: A National Database" (FRIEND) Registry.

Methods: The current analysis included 2512 tests from 10 CPX laboratories in the United States. Inclusion criteria included CPX data on apparently healthy men and women: (1) age ≥20 yr; and (2) with a symptom-limited exercise test performed on a treadmill. Ventilation and V˙co2 data, from the initiation of exercise to peak, were used to calculate the V˙E/V˙co2 slope via least-squares linear regression. Reference values were determined for men and women by decade of life.

Results: On average, V˙E/V˙co2 slope values were lower in men and increased with age independent of sex. Fiftieth percentile values increased from 27.1 in the second decade to 33.9 in the eighth decade in men and from 28.5 in the second decade to 33.7 in the eighth decade in women. In the overall group, correlations with baseline characteristics and the V˙E/V˙co2 slope were statistically significant (P < .05) although generally weak, particularly for age and body mass index.

Conclusion: The results of the current study establish reference values for the V˙E/V˙co2 slope when treadmill testing is performed, and all exercise data are used for the slope calculation. These results may prove useful in enhancing the interpretation of CPX results when assessing CRF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HCR.0000000000000566DOI Listing
May 2021

Inadvertent Burst Suppression During Total Intravenous Anesthesia in 112 Consecutive Patients Undergoing Spinal Instrumentation Surgery: A Retrospective Observational Quality Improvement Project.

J Neurosurg Anesthesiol 2021 Jan 19. Epub 2021 Jan 19.

Department of Anesthesiology and Pain Medicine, Harborview Medical Center Intraoperative Neurophysiological Monitoring, Harborview Medical Center Harborview Medical Center, University of Washington, Seattle, WA.

Introduction: The incidence and quantification of inadvertent electroencephalographic burst suppression during total intravenous anesthesia (TIVA) for spine instrumentation surgery has not previously been reported.

Methods: The primary aim of this retrospective observational quality improvement project was to establish the prevalence of burst suppression during spine instrumentation surgery with TIVA. The secondary outcome was the incidence of postoperative delirium.

Results: One hundred twelve consecutive patients, aged between 20 and 88 years, underwent spinal instrumentation surgery. Seventy-eight (69.6%) patients experienced inadvertent burst suppression; the maximal degree of burst suppression ratio was 20% to 100%. Median (interquartile range [IQR]) time spent in burst suppression was 44 (77) minutes, and burst suppression was present for 22% (range: 2% to 93%) of the monitoring period. Average (±SD) propofol dose was lower in patients with burst suppression (87±19 vs. 93±15 µg/kg/min, P=0.04). Ten (8.9%) patients experienced postoperative delirium. Intraoperative burst suppression was more prevalent in those that experienced delirium (100% vs. 66.7%, P=0.03, relative risk: 1.5, 95% confidence interval: 1.3-1.7). The proportion of the monitoring period spent in maximal burst suppression (15.3 [25.9]% vs.11.7 [21.7]%) was similar between those that did, and did not, experience delirium.

Conclusions: High rates and prolonged periods of inadvertent burst suppression may be prevalent during spine instrumentation surgery with TIVA. Our findings suggest that usage of electroencephalography alone is incomplete without prompt interpretation and intervention, mandating close communication between neuromonitoring and anesthesia teams. The dose-response relationship between burst suppression, total time spent in maximal burst suppression, and their association with delirium warrants further evaluation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ANA.0000000000000754DOI Listing
January 2021

Surgical Cancellations in Glaucoma Practice: Causes, Delays, and Effect on Patient Care and Revenue.

Ophthalmol Glaucoma 2020 Dec 16. Epub 2020 Dec 16.

Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address:

Purpose: To assess the incidence of glaucoma surgery cancellations, as well as their characteristics, underlying reasons, resultant surgical delay, and estimated lost potential reimbursement, at a tertiary eye hospital.

Design: Retrospective observational study of planned surgical procedures of 4 glaucoma specialists at a tertiary eye center over a 2-year period (May 2017-May 2019). An additional prospective survey of patients was conducted.

Participants: Patients who canceled glaucoma surgeries.

Methods: Demographics and clinical information were recorded from the electronic medical record. A brief phone survey was implemented to determine the reason for cancellation and whether the patient rescheduled. Lost reimbursement was estimated assuming Medicare reimbursement rates for each procedure based on facility fee, surgeon fee, and anesthesia fee.

Main Outcome Measures: Reasons for surgical cancellation, delay related to surgical cancellations, and annual lost reimbursement potential.

Results: One hundred twenty-three of 1384 glaucoma surgeries (8.9%) to be performed by 4 glaucoma specialists at Wills Eye Hospital during the 2-year study period were canceled. Among those canceled, the mean age ± standard deviation (SD) of the patients was 70.3 ± 14.4 years and 51% were men. Of the cancellations, 56.9% were made within 1 day of the planned date of surgery and 96.7% were canceled within 7 days. Of the reasons for surgical cancellation, 28% were considered preventable, 50% were considered unpreventable, and 23% were categorized as "no reason given." Most of the surgeries eventually were performed-to-date (64.2%); the mean ± SD delay in surgery was 63.4 ± 68.6 days. The 3 most common preventable reasons for cancellation were lack of transportation (34%), lack of timely clearance (26%), and insurance-related issues (14%). Assuming Medicare reimbursement rates, the estimated annual lost potential reimbursement from surgical cancellations of the 4 glaucoma specialists was $208 306.

Conclusions: This study highlights a significant number of cancellations in a glaucoma practice, most of which occurred within 1 day of planned surgery. Minimizing preventable causes of cancellations could decrease the likelihood of surgical delays as well as lost reimbursement. Further comparison with patients who successfully underwent surgery performed without delay may identify predictive factors or interventions that could decrease the number of surgical cancellations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ogla.2020.12.006DOI Listing
December 2020

Reoperation for Complications Within 90 Days of Minimally Invasive Glaucoma Surgery.

J Cataract Refract Surg 2020 Dec 9. Epub 2020 Dec 9.

Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA, USA.

Objective: To describe reoperations that occurred within 90 days of minimally invasive glaucoma surgery (MIGS) at a single institution over a 30-month period.

Setting: Tertiary care hospital.

Design: Retrospective case series.

Methods: Charts of adult patients who underwent trabecular microbypass stents, gel microstents, and goniotomy procedures (including gonioscopy-assisted transluminal trabeculotomy) from October 1, 2017 to March 15, 2020 at Wills Eye Hospital were examined. Outcome measures were unanticipated reoperations within the first 90 days after MIGS procedures and the complications that led to these reoperations.

Results: 448 MIGS procedures were performed on 436 eyes of 348 patients over a 30-month period by 6 glaucoma surgeons. Of these, 206 (46.0 %) were trabecular microbypass stents (198 iStent/iStent inject, 8 Hydrus), 152 (33.9%) were gel microstents, 90 (20.1%) were goniotomy procedures. Combined phacoemulsification took place in 256 (58.7%) of eyes. Reoperation within 90 days took place in 23/436 eyes (5.3%), including 16/152 eyes in the gel microstent group (10.5%), 4/198 eyes in iStent/iStent inject group (2.0%), 3/90 eyes in the goniotomy group (3.3%). Indications for reoperation were elevated intraocular pressure (IOP) in 16/23 eyes (69.6%), gel microstent tip exposure with wound leakage in 3/23 eyes (13%), and early gel microstent encapsulation without elevated IOP in 1/23 eye (4.3%). 2/23 eyes (8.7%) required reoperation for lens complications while 1/23 eye (4.3%) had elevated IOP and aphakia requiring reoperation.

Conclusions: The rate of reoperation within the first 90 days after MIGS was low. Elevated IOP and complications associated with gel microstents were the main indications for reoperation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/j.jcrs.0000000000000545DOI Listing
December 2020

A systematic comparison of commonly used stoichiometric equations to estimate fat oxidation during exercise in athletes.

J Sports Med Phys Fitness 2020 Dec 14. Epub 2020 Dec 14.

USA.

Background: Over the last half-century, different stoichiometric equations for calculating the energy cost of exercise based upon the combustion of mixtures of carbohydrates, fats, and proteins have been proposed and modified. With the means of indirect calorimetry, while measuring oxygen uptake, carbon dioxide production, and urinary urea nitrogen excretion, the contribution of specific substrates to overall energy production can be estimated. However, even with their long history of application, no previous studies have evaluated whether the use of different stoichiometric equations provides similar or distinct maximal fat oxidation rate (MFO) responses and information regarding MFO location (FATmax) in male athletes.

Methods: Twenty healthy male athletes performed graded exercise testing (GXT) cycle ergometry using breath by breath gas analysis to assess fat oxidation and maximal oxygen uptake. Analysis of variance followed by within-equation effects, within-equation factors, and post hoc pairwise comparisons were used to examine within-equation differences.

Results: Compared stoichiometric equations demonstrated significant differences in the mean and maximal fat oxidation rates, varying up to nearly 7 %. FATmax differences, however, were not noticed.

Conclusions: Our findings suggest that for within-study designs, the equation used appears to be less important, but when inter-study comparisons are planned, caution is in order due to the presence of inter-equation differences.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.23736/S0022-4707.20.11747-XDOI Listing
December 2020

Predicting Global Test-Retest Variability of Visual Fields in Glaucoma.

Ophthalmol Glaucoma 2020 Dec 11. Epub 2020 Dec 11.

Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts. Electronic address:

Purpose: To model the global test-retest variability of visual fields (VFs) in glaucoma.

Design: Retrospective cohort study.

Participants: Test-retest VFs from 4044 eyes of 4044 participants.

Methods: We selected 2 reliable VFs per eye measured with the Humphrey Field Analyzer (Swedish interactive threshold algorithm 24-2) within 30 days of each other. Each VF had fixation losses (FLs) of 33% or less, false-negative results (FNRs) of 20% or less, and false-positive results (FPRs) of 20% or less. Stepwise linear regression was applied to select the model best predicting the global test-retest variability from 3 categories of features of the first VF: (1) base parameters (age, mean deviation, pattern standard deviation, glaucoma hemifield test results, FPR, FNR, and FL); (2) total deviation (TD) at each location; and (3) computationally derived archetype VF loss patterns. The global test-retest variability was defined as root mean square deviation (RMSD) of TD values at all 52 VF locations.

Main Outcome Measures: Archetype models to predict the global test-retest variability.

Results: The mean ± standard deviation of the root mean square deviation was 4.39 ± 2.55 dB. Between the 2 VF tests, TD values were correlated more strongly in central than in peripheral VF locations (intraclass coefficient, 0.66-0.89; P < 0.001). Compared with the model using base parameters alone (adjusted R = 0.45), adding TD values improved prediction accuracy of the global variability (adjusted R = 0.53; P < 0.001; Bayesian information criterion [BIC] decrease of 527; change of >6 represents strong improvement). Lower TD sensitivity in the outermost peripheral VF locations was predictive of higher global variability. Adding archetypes to the base model improved model performance with an adjusted R of 0.53 (P < 0.001) and lowering of BIC by 583. Greater variability was associated with concentric peripheral defect, temporal hemianopia, inferotemporal defect, near total loss, superior peripheral defect, and central scotoma (listed in order of decreasing statistical significance), and less normal VF results and superior paracentral defect.

Conclusions: Inclusion of archetype VF loss patterns and TD values based on first VF improved the prediction of the global test-retest variability than using traditional global VF indices alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ogla.2020.12.001DOI Listing
December 2020

Inter-Eye Association of Visual Field Defects in Glaucoma and Its Clinical Utility.

Transl Vis Sci Technol 2020 11 17;9(12):22. Epub 2020 Nov 17.

Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.

Purpose: To investigate intereye associations of visual field (VF) defects.

Methods: We selected 24-2 VF pairs of both eyes from 63,604 patients tested on the same date with mean deviation (MD) ≥ -12 dB. VFs were decomposed into one normal and 15 defect patterns previously identified using archetypal analysis. VF pattern weighting coefficients were correlated between the worse and better eyes, as defined by MD. VF defect patterns (weighting coefficients > 10%) in the better eye were predicted from weighting coefficients of the worse eye by logistic regression models, which were evaluated by area under the receiver operating characteristic curve (AUC).

Results: Intereye correlations of archetypal VF patterns were strongest for the same defect pattern between fellow eyes. The AUCs for predicting the presence of 15 defect patterns in the better eye based on the worse eye ranged from 0.69 (superior nasal step) to 0.92 (near total loss). The AUC for predicting superior paracentral loss was 0.89. Superior paracentral loss in the better eye was positively correlated with coefficients of superior paracentral loss, central scotoma, superior altitudinal defect, nasal hemianopia, and inferior paracentral loss in the worse eye, and negatively correlated with coefficients of the normal VF, superior peripheral defect, concentric peripheral defect, and temporal wedge. The parameters are presented in the descending order of statistical significance.

Conclusions: VF patterns of the worse eye are predictive of VF defects in the better eye.

Translational Relevance: Our models can potentially assist clinicians to better interpret VF loss under measurement uncertainty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1167/tvst.9.12.22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683854PMC
November 2020

Marijuana and Glaucoma: A Social Media Content Analysis.

Ophthalmol Glaucoma 2020 Nov 24. Epub 2020 Nov 24.

Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania; Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address:

Purpose: This study analyzes the content quality and characteristics of the most popular and highly ranked search results on the internet related to glaucoma and medical cannabis (MC).

Design: Internet-based, cross-sectional study.

Participants: Not applicable.

Methods: Google and 2 social media platforms (Facebook, YouTube) were used to identify online information most accessible to patients. Search criteria included "glaucoma" AND "marijuana" or "cannabinoid" or "CBD." The top 20 Google search and YouTube results for each search term and the posts from the top 9 patient-based glaucoma Facebook groups were aggregated and analyzed using the search criteria.

Main Outcome Measures: The quality of the content was graded by 2 independent graders using a previously validated Sandvik score and previously reported risk score. The differing values were resolved by a final grader. Additional analysis included whether the source was professional (by physician or medical organization) or shared an opinion on MC (pro, mixed, or against) use in glaucoma.

Results: This search resulted in an aggregate of 51 websites on Google, 126 posts from Facebook groups, and 37 videos on YouTube. The mean (± standard deviation) Sandvik score and risk score were 11.0 (±2.23), 10.2 (±1.12), 10.6 (±1.89) and 0.27 (±0.49), 0.46 (±0.62), 0.97 (±0.90) for Google, Facebook, and YouTube, respectively. Analysis of variance showed statistically significant differences in Sandvik (P = 0.01) and risk (P < 0.0001) scores across the 3 platforms. A significant portion of online material was pro-MC use in the setting of glaucoma (24% of Google, 59% of YouTube, and 21% of Facebook results). Professional content had a significantly higher content quality score and a lower risk score, and was less likely to recommend MC use in glaucoma.

Conclusions: Despite American Academy of Ophthalmology, Canadian Ophthalmological Society, and American Glaucoma Society statements against MC use in patients with glaucoma, a significant portion of online material recommends its use. With the wide variation in quality and content of online information, it is important for physicians to be aware of the different platforms and opinions that are readily available to patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ogla.2020.11.004DOI Listing
November 2020

Comments on "validation of equations to estimate the peak oxygen uptake in adolescents from 20 metres shuttle run test".

J Sports Sci 2021 Apr 25;39(8):900-902. Epub 2020 Nov 25.

Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02640414.2020.1850985DOI Listing
April 2021