A5040070071- Health Systems, Economic Evaluations, Quality of Life
- Statistical Methods in Clinical Trials
- Cardiac, Anesthesia and Surgical Outcomes
- Cardiac Imaging and Diagnostics
- Musculoskeletal pain and rehabilitation
- Statistical Methods and Bayesian Inference
- Statistical Methods and Inference
- Advanced Causal Inference Techniques
- Meta-analysis and systematic reviews
- Acute Myocardial Infarction Research
- Balance, Gait, and Falls Prevention
- Stroke Rehabilitation and Recovery
- Healthcare Policy and Management
- Sepsis Diagnosis and Treatment
- Health disparities and outcomes
- Fibromyalgia and Chronic Fatigue Syndrome Research
- Ethics in Clinical Research
- Dementia and Cognitive Impairment Research
- Global Cancer Incidence and Screening
- Frailty in Older Adults
- Geriatric Care and Nursing Homes
- Lipoproteins and Cardiovascular Health
- Pain Management and Placebo Effect
- Acute Ischemic Stroke Management
- Cerebral Palsy and Movement Disorders
Yale University
2016-2025
Yale New Haven Health System
2014-2025
University of New Haven
1984-2025
The Coordinating Center
1991-2024
Brigham and Women's Hospital
2022
University of Maryland, Baltimore
2022
Program Support Center
1982-2019
VA Connecticut Healthcare System
2005-2018
Scientific Council for Government Policy
2012-2016
Toronto Public Health
2008-2016
We performed a Monte Carlo study to evaluate the effect of number events per variable (EPV) analyzed in logistic regression analysis. The simulations were based on data from cardiac trial 673 patients which 252 deaths occurred and seven variables cogent predictors mortality; predictive was () for full sample. For simulations, at values EPV = 2, 5, 10, 15, 20, 25, we randomly generated 500 samples patients, chosen with replacement, according model derived Simulation results coefficients each...
The incidence and severity of herpes zoster postherpetic neuralgia increase with age in association a progressive decline cell-mediated immunity to varicella-zoster virus (VZV). We tested the hypothesis that vaccination against VZV would decrease incidence, severity, or both among older adults.We enrolled 38,546 adults 60 years randomized, double-blind, placebo-controlled trial an investigational live attenuated Oka/Merck vaccine ("zoster vaccine"). Herpes was diagnosed according clinical...
The analytical effect of the number events per variable (EPV) in a proportional hazards regression analysis was evaluated using Monte Carlo simulation techniques for data from randomized trial containing 673 patients and 252 deaths, which seven predictor variables had an original significance level p < 0.10. deaths 7 correspond to 36 analyzed full set. Five hundred simulated analyses were conducted these at EPVs 2, 5, 10, 15, 20, 25. For each simulation, random exponential survival time...
The optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury is controversial.We randomly assigned and failure at least one nonrenal organ or sepsis to receive intensive less therapy. primary end point was death from any cause by day 60. In both study groups, hemodynamically stable underwent intermittent hemodialysis, unstable continuous venovenous hemodiafiltration sustained low-efficiency dialysis. Patients receiving the treatment strategy...
Effective rehabilitative therapies are needed for patients with long-term deficits after stroke.In this multicenter, randomized, controlled trial involving 127 moderate-to-severe upper-limb impairment 6 months or more a stroke, we randomly assigned 49 to receive intensive robot-assisted therapy, 50 comparison and 28 usual care. Therapy consisted of 36 1-hour sessions over period 12 weeks. The primary outcome was change in motor function, as measured on the Fugl-Meyer Assessment Sensorimotor...
Combination therapy with angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) decreases proteinuria; however, its safety effect on the progression of kidney disease are uncertain. Methods We provided losartan (at a dose 100 mg per day) to patients type 2 diabetes, urinary albumin-to-creatinine ratio (with albumin measured in milligrams creatinine grams) at least 300, an estimated glomerular filtration rate (GFR) 30.0 89.9 ml minute 1.73 m(2) body-surface...
Patients with ischemic stroke or transient attack (TIA) are at increased risk for future cardiovascular events despite current preventive therapies. The identification of insulin resistance as a factor and myocardial infarction raised the possibility that pioglitazone, which improves sensitivity, might benefit patients cerebrovascular disease.
Functional decline in physically frail, elderly persons is associated with substantial morbidity. It uncertain whether such functional can be prevented.
Multivariable methods of analysis can yield problematic results if methodological guidelines and mathematical assumptions are ignored. A problem arising from a too-small ratio events per variable (EPV) affect the accuracy precision regression coefficients their tests statistical significance. The occurs when proportional hazards contains too few "failure" (e.g., deaths) in relation to number included independent variables. In current research, impact EPV was assessed for done with Monte...
<h3>Importance</h3> Although vitamin E and memantine have been shown to beneficial effects in moderately severe Alzheimer disease (AD), evidence is limited mild moderate AD. <h3>Objective</h3> To determine if (alpha tocopherol), memantine, or both slow progression of AD patients taking an acetylcholinesterase inhibitor. <h3>Design, Setting, Participants</h3> Double-blind, placebo-controlled, parallel-group, randomized clinical trial involving 613 with initiated August 2007 concluded...
Sepsis, an important cause of hospital mortality, continues to be a diagnostic and therapeutic challenge. To define more clearly the impact encephalopathy on course sepsis, various clinical signs blood culture results, mortality rates were examined in relation mental status septic patients. Patients classified as having acutely altered due sepsis (AAMS), preexisting (PAMS), or normal (NMS). Twenty-three (307/1333) percent study patients had sensorium secondary sepsis. with AAMS higher (49%)...
IMPORTANCE The effect of serious injuries, such as hip fracture and head injury, on mortality function is comparable to that cardiovascular events. Concerns have been raised about the risk fall injuries in older adults taking antihypertensive medications. low reported clinical trials healthy may not reflect with multiple chronic conditions. OBJECTIVE To determine whether medication use was associated experiencing a injury nationally representative sample adults. DESIGN, PARTICIPANTS, AND...
This report presents the 42-month survival experience of 91 patients with a significant lesion left main coronary artery in Veterans Administration Cooperative Study Coronary Bypass Surgery. Survival surgical was significantly better than that medical group (p = 0.016), even after adjustments were made for two important differences baseline characteristics--duration angina and high risk by angiographic criteria--between groups 0.019). Subgroups based on severity stenosis ventricular (LV)...
Background: The role of prophylactic central lymph node dissection in papillary thyroid cancer (PTC) is controversial patients who have no pre- or intraoperative evidence nodal metastasis (clinically N0; cN0). controversy relates to its unproven reducing recurrence rates while possibly increasing morbidity (permanent hypoparathyroidism and unintentional recurrent laryngeal nerve injury). Methods Results: We examined the design feasibility a multi-institutional prospective randomized...
Injuries from falls are major contributors to complications and death in older adults. Despite evidence efficacy trials that many can be prevented, rates of resulting injury have not declined.
ABSTRACT. Thrombosis of hemodialysis vascular access grafts represents a major medical and economic burden. Experimental clinical models suggest role for antiplatelet agents in the prevention thrombosis. The study was designed to determine efficacy combination aspirin clopidogrel graft randomized, double-blind trial conducted at 30 units Veterans Affairs centers. Participants undergoing with polytetrafluoroethylene arm were randomized receive either double placebos or (325 mg) (75 daily. be...
Background — Both aspirin and warfarin when used alone are effective in the secondary prevention of vascular events death after acute myocardial infarction. We tested hypothesis that therapy, combined, would be more than monotherapy. Methods Results conducted a randomized open-label study to compare efficacy (target international normalized ratio 1.5 2.5 IU) plus (81 mg daily) with monotherapy (162 reducing total mortality 5059 patients enrolled within 14 days infarction followed for median...
Little is known about the environmental and public health impact of unconventional natural gas extraction activities, including hydraulic fracturing, that occur near residential areas.Our aim was to assess relationship between household proximity wells reported symptoms.We conducted a hypothesis-generating symptom survey 492 persons in 180 randomly selected households with ground-fed an area active drilling. Gas well for each compared prevalence frequency dermal, respiratory,...
Stroke is a leading cause of disability. Rehabilitation robotics have been developed to aid in recovery after stroke. This study determined the additional cost robot-assisted therapy and tested its cost-effectiveness.We estimated intervention costs tracked participants' healthcare costs. We collected quality life using Impact Scale Health Utilities Index. analyzed data at 36 weeks postrandomization multivariate regression models controlling for site, presence prior stroke, Veterans Affairs...
We compared faculty promotion rates by race/ethnicity across US academic medical centers.We used the Association of American Medical College's 1983 through 2000 roster data to estimate median institution-specific for assistant professor associate and full professor. In unadjusted analyses, we medians Hispanic Black with White using Wilcoxon rank sum test. between racial/ethnic groups stratified institutional characteristic (institution size, proportion minority faculty, women faculty) χ(2)...
A multivariate risk function was developed on data from all 508 medical patients in the Veterans Administration (VA) randomized study of coronary bypass surgery. The variables, order importance, were ST-segment depression resting ECG, history myocardial infarction, hypertension and New York Heart Association functional classification III or IV. These noninvasive variables have been reported to be factors natural-history studies heart disease (CHD). Applying surgical 1972-1974 cohort yielded...
OBJECTIVES: To determine the relative effect of five chronic conditions on four representative universal health outcomes. DESIGN: Cross‐sectional. SETTING: Cardiovascular Health Study. PARTICIPANTS: Five thousand two hundred and ninety‐eight community‐living participants aged 65 older. MEASUREMENTS: Multiple regression Cox models were used to heart failure (HF), obstructive pulmonary disease (COPD), osteoarthritis, depression, cognitive impairment self‐rated health, 12 basic instrumental...