Protocol for the development and multisite validation of the Quality of Dying and Death-Revised Global Version scale.

INTRODUCTION: Evaluating the quality of dying and death is essential to ensure high-quality end-of-life care. The Quality of Dying and Death (QODD) scale is the best-validated measure of the construct, but many items are not relevant to participants, particularly in low-resource settings. The aim of this multisite cross-sectional study is to develop and validate the QODD-Revised Global Version (QODD-RGV), to enhance ease of completion and relevance in higher-resource and lower-resource settings. METHODS AND ANALYSIS: This study will be a two-arm, multisite evaluation of the cultural relevance, reliability and validity of the QODD-RGV across four participating North American hospices and a palliative care site in Malawi, Africa. Bereaved caregivers and healthcare providers of patients who died at a participating North American hospice and bereaved caregivers of patients who died of cancer at the Malawian palliative care site will complete the QODD-RGV and validation measures. Cognitive interviews with subsets of North American and Malawian caregivers will assess the perceived relevance of the scale items. Psychometric evaluations will include internal consistency and convergent and concurrent validity. ETHICS AND DISSEMINATION: The North American arm received approval from the University Health Network Research Ethics Board (21-5143) and the University of North Carolina Institutional Review Board (21-1172). Ethics approval for the Malawi arm is being obtained from the University of North Carolina Institutional Review Board and the Malawian National Health Science Research Committee. Study findings will be disseminated through publication in peer-reviewed journals and conference presentations.

Full-field chromatic pupillometry for the assessment of the postillumination pupil response driven by melanopsin-containing retinal ganglion cells.

PURPOSE: The postillumination pupil response (PIPR) is produced by intrinsically photosensitive retinal ganglion cells (ipRGCs). We aimed to refine the testing conditions for PIPR by investigating whether a greater PIPR can be induced using full-field light stimuli of shorter duration and lower intensity than that produced by existing protocols that use central-field stimuli. METHODS: Pupil response was recorded with an eye tracker in 10 visually-normal subjects. Red and blue light stimuli were presented using a Ganzfeld system. In Experiment 1 (intensity trials), PIPR was induced using 1-second full-field stimuli of increasing intensities from 0.1 to 400 cd/m(2) (11 steps). For comparison, PIPR also was induced using a 60° × 90° central-field blue stimulus of 400 cd/m(2). In Experiment 2 (duration trials), PIPR was induced using 100 and 400 cd/m(2) full-field stimulus of increasing duration from 4 to 1000 ms (10 steps). RESULTS: Results indicated that PIPR increased monotonically with increasing stimulus intensity. Full-field stimulation using blue light at 400 cd/m(2) intensity induced significantly more sustained PIPR than central-field stimulation (P = 0.001). In addition, PIPR increased as the stimulus duration increased from 4 to 200 ms; however, no further increase in PIPR was observed when the duration increased from 400 to 1000 ms. CONCLUSIONS: Compared to existing central-field protocols, larger PIPR can be induced with a full-field stimulus with lower intensity and shorter duration, indicating that PIPR is a function of stimulus intensity, stimulus duration, and retinal area stimulated. The testing protocol can be refined with this new knowledge to target particular clinical populations.

Effects of strabismic amblyopia on visuomotor behavior: part II. Visually guided reaching.

PURPOSE: To examine the effects of impaired spatiotemporal vision on reaching movements in participants with strabismic amblyopia and to compare their performance to those with strabismus only without amblyopia and to visually normal participants. METHODS: Sixteen adults with strabismic amblyopia, 14 adults with strabismus only, and 16 visually normal adults were recruited. Participants executed reach-to-touch movements toward targets presented randomly 5° or 10° to the left or right of central fixation in three viewing conditions: both eyes, monocular amblyopic eye (nondominant eye for participants without amblyopia), and monocular fellow eye (dominant eye for participants without amblyopia). Visual feedback of the target was removed on 50% of the trials at the initiation of reaching. RESULTS: Both groups with abnormal binocular vision (strabismic amblyopia and strabismus only) had reach latency, accuracy, and precision comparable to visually normal participants when viewing with both eyes and fellow (dominant) eye. Latencies were significantly delayed by more than 30 ms in all participants with reduced binocularity during amblyopic eye or nondominant eye viewing compared with controls (P < 0.0001). Participants with strabismic amblyopia and negative stereopsis also had reduced reach precision (i.e., increased variability) during amblyopic eye viewing. In contrast, participants with strabismus only and negative stereopsis had comparable precision across all viewing conditions. Participants with strabismus only and those with strabismic amblyopia used a similar motor strategy; regardless of viewing condition, reach peak acceleration was significantly reduced (P < 0.05) and the duration of acceleration phase was extended in comparison with visually normal participants. There were no significant differences for the deceleration phase. CONCLUSIONS: Participants with strabismic amblyopia and those with strabismus only attain relatively normal reach accuracy and precision. However, they use a different reach strategy that involves changing the motor plan. A similar compensatory strategy was reported previously in participants with anisometropic amblyopia. Our results provide further support that normal binocular vision during development provides important input for the development of visually guided reaching movements.