Characteristics of Prescreened Patients Who Did Not Participate in the Zoster Eye Disease Study.

PURPOSE: The Zoster Eye Disease Study (ZEDS) is a multicenter randomized clinical trial (RCT) funded by the National Eye Institute aiming to determine the efficacy of suppressive valacyclovir treatment in herpes zoster ophthalmicus (HZO) that enrolled fewer participants than planned (527/780, 67.6%). Understanding reasons for nonparticipation of likely eligible prescreened patients provides insights into patient populations that are not represented by ZEDS and barriers in clinical trials. METHODS: In this retrospective cohort study, HZO adults likely eligible for ZEDS with a history of a typical rash and a medical record within the past year of an episode of epithelial or stromal keratitis or iritis were prescreened at activated Participating Clinical Centers from 2017 to 2022 using a standard prescreening log. De-identified data including demographic information, reasons for exclusion because of ineligibility, and patient refusal were retrospectively entered into REDCap and analyzed. RESULTS: Prescreening logs with reasons for nonconsent (1244/1706, 72.9%) were included in the data set. Patients were excluded from the study (915/1244, 73.6%) because they did not meet all inclusion criteria (619/915, 67.7%) or met an exclusion criterion (296/915, 32.3%). Among the 12 exclusion criteria for the ZEDS study, immunocompromise (76/296, 25.7%) and renal insufficiency (50/296, 16.9%) were most frequently reported. Patient refusal to participate (327/1,244, 26.3%) was common. CONCLUSION: The most common reasons for ineligibility were immunocompromise and renal insufficiency. There may be benefits to long-term antiviral use in these populations not captured in ZEDS. A quarter (26.3%) of prescreened patients refused participation, showing the substantial impact of patient preferences on trial participation.

Promises and Pitfalls: Using Large Language Models to Generate Visualization Items.

Visualization items-factual questions about visualizations that ask viewers to accomplish visualization tasks-are regularly used in the field of information visualization as educational and evaluative materials. For example, researchers of visualization literacy require large, diverse banks of items to conduct studies where the same skill is measured repeatedly on the same participants. Yet, generating a large number of high-quality, diverse items requires significant time and expertise. To address the critical need for a large number of diverse visualization items in education and research, this paper investigates the potential for large language models (LLMs) to automate the generation of multiple-choice visualization items. Through an iterative design process, we develop the VILA (Visualization Items Generated by Large LAnguage Models) pipeline, for efficiently generating visualization items that measure people's ability to accomplish visualization tasks. We use the VILA pipeline to generate 1,404 candidate items across 12 chart types and 13 visualization tasks. In collaboration with 11 visualization experts, we develop an evaluation rulebook which we then use to rate the quality of all candidate items. The result is the VILA bank of ∼1,100 items. From this evaluation, we also identify and classify current limitations of the VILA pipeline, and discuss the role of human oversight in ensuring quality. In addition, we demonstrate an application of our work by creating a visualization literacy test, VILA-VLAT, which measures people's ability to complete a diverse set of tasks on various types of visualizations; comparing it to the existing VLAT, VILA-VLAT shows moderate to high convergent validity (R = 0.70). Lastly, we discuss the application areas of the VILA pipeline and the VILA bank and provide practical recommendations for their use. All supplemental materials are available at https://osf.io/ysrhq/.

Adaptive Assessment of Visualization Literacy.

Visualization literacy is an essential skill for accurately interpreting data to inform critical decisions. Consequently, it is vital to understand the evolution of this ability and devise targeted interventions to enhance it, requiring concise and repeatable assessments of visualization literacy for individuals. However, current assessments, such as the Visualization Literacy Assessment Test (VLAT), are time-consuming due to their fixed, lengthy format. To address this limitation, we develop two streamlined computerized adaptive tests (CATs) for visualization literacy, A-VLAT and A-CALVI, which measure the same set of skills as their original versions in half the number of questions. Specifically, we (1) employ item response theory (IRT) and non-psychometric constraints to construct adaptive versions of the assessments, (2) finalize the configurations of adaptation through simulation, (3) refine the composition of test items of A-CALVI via a qualitative study, and (4) demonstrate the test-retest reliability (ICC: 0.98 and 0.98) and convergent validity (correlation: 0.81 and 0.66) of both CATs via four online studies. We discuss practical recommendations for using our CATs and opportunities for further customization to leverage the full potential of adaptive assessments. All supplemental materials are available at https://osf.io/a6258/.

Effectiveness of alternative dose fingolimod for multiple sclerosis.

BACKGROUND: Fingolimod is a daily oral medication used to treat relapsing multiple sclerosis (MS). Clinicians often adopt less frequent dosing for patients with profound drug-induced lymphopenia or other adverse events. Data on the effectiveness of alternate dose fingolimod are limited. METHODS: We conducted a multicenter, retrospective, observational study at 14 sites and identified 170 patients with MS taking alternate doses of fingolimod for ≥1 month. Clinical and radiologic outcomes were collected and compared during daily and alternate fingolimod dosing. RESULTS: Profound lymphopenia (77%), liver function abnormalities (9%), and infections (7%) were the most common reasons for patients to switch to alternate fingolimod dosing. The median follow-up was 12 months on daily dose and 14 months on alternate dose. Most patients (64%) took fingolimod every other day during alternate dosing. Disease activity was similar on alternate dose compared to daily dose: annualized relapse rate was 0.1 on daily dose vs 0.2 on alternate dose (p = 0.25); proportion of patients with contrast-enhancing MRI lesions was 7.6% on daily vs 9.4% on alternate (p = 0.55); proportion of patients with cumulative MS activity (clinical and radiologic disease) was 13.5% on daily vs 18.2% on alternate (p = 0.337). Patients who developed contrast-enhancing lesions while on daily dose were at higher risk for breakthrough disease while on alternate dose fingolimod (odds ratio 11.4, p < 0.001). CONCLUSIONS: These data support the clinical strategy of alternate dosing of fingolimod in patients with good disease control but profound lymphopenia or other adverse events while on daily dose. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with MS on daily dose fingolimod with adverse events, alternate dose fingolimod is associated with disease activity similar to daily dose fingolimod.