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Introduction: T cells are important for tumour control and surveillance, but it is not well known how breast cancer treatment impacts their characteristics in blood. Methods: Healthy women (n=38, age 45 ± 11 y), breast cancer survivors (n=27, age 56 ± 6 y) and breast cancer patients (n=5, age 44 ± 9 y) took part. Survivors comprised women who had received any form of treatment for breast cancer within 1-2 years and were considered free from disease by their oncologist. Patients were recently diagnosed women scheduled to undergo neoadjuvant chemotherapy within 2 weeks. Using flow cytometry, CD4+ and CD8+ T cell subsets, including Naïve (NA), Central memory (CM) and Effector cells (EM and EMRA) were identified using CD27/CD45RA. Activation was measured by HLA-DR expression. Age, Cytomegalovirus (CMV) serostatus, cardiorespiratory fitness and body composition were assessed. Statistical analyses were conducted between healthy women and survivors. Data for patients enabled a qualitative interpretation of immune profiles at the time of diagnosis. Results: Lymphocyte, monocyte and neutrophil counts were not different between groups. However, compared to healthy women, CD4+ CM T cells were +Δ21% higher among survivors (cells/l: 417 ± 110 vs 346 ± 161, p=0.028) and CD8+ NA T cells were −Δ25% lower (cells/l: 106 ± 46 vs 142 ± 83, p=0.034). The proportion of activated (HLA-DR+) CD4+ and CD8+ T cell subsets was +Δ31% higher among survivors compared to healthy women: CD4+ CM (+Δ25%: 35 ± 16 % vs 28 ± 6 %), CD4+ EM (+Δ32%: 54 ± 17 % vs 41 ± 9 %) and CD4+ EMRA (+Δ43%: 53 ± 21 % vs 37 ± 11 %), total CD8+ (+Δ30%: 43 ± 18 % vs 33 ± 9 %), CD8+ EM (+Δ30%: 57 ± 18 % vs 44 ± 13 %) and CD8+ EMRA T cells (+Δ25%: 55 ± 21 % vs 44 ± 12 %) (p0.277 p Citation Format: Ainhoa Arana Echarri, Lauren Struszczak, Mark Beresford, John P Campbell, Robert H Jones, Rachel Butler, Dylan Thompson, James E Turner. Breast cancer survivors exhibit an accumulation of CD4+ central memory T cells, a fall in CD8+ naïve T cells and higher activation of CD4+/CD8+ memory T cells in blood, which is positively correlated with age and fat mass index [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-04-10.

PURPOSE OF REVIEW: In this article, we introduce the concept of model interpretability, review its applications in deep learning models for clinical ophthalmology, and discuss its role in the integration of artificial intelligence in healthcare. RECENT FINDINGS: The advent of deep learning in medicine has introduced models with remarkable accuracy. However, the inherent complexity of these models undermines its users’ ability to understand, debug and ultimately trust them in clinical practice. Novel methods are being increasingly explored to improve models’ “interpretability” and draw clearer associations between their outputs and features in the input dataset. In the field of ophthalmology, interpretability methods have enabled users to make informed adjustments, identify clinically relevant imaging patterns, and predict outcomes in deep learning models. SUMMARY: Interpretability methods support the transparency necessary to implement, operate and modify complex deep learning models. These benefits are becoming increasingly demonstrated in models for clinical ophthalmology. As quality standards for deep learning models used in healthcare continue to evolve, interpretability methods may prove influential in their path to regulatory approval and acceptance in clinical practice.

Background/AimTo automatically detect and classify the early stages of retinopathy of prematurity (ROP) using a deep convolutional neural network (CNN).MethodsThis retrospective cross-sectional study was conducted in a referral medical centre in Taiwan. Only premature infants with no ROP, stage 1 ROP or stage 2 ROP were enrolled. Overall, 11 372 retinal fundus images were compiled and split into 10 235 images (90%) for training, 1137 (10%) for validation and 244 for testing. A deep CNN was implemented to classify images according to the ROP stage. Data were collected from December 17, 2013 to May 24, 2019 and analysed from December 2018 to January 2020. The metrics of sensitivity, specificity and area under the receiver operating characteristic curve were adopted to evaluate the performance of the algorithm relative to the reference standard diagnosis.ResultsThe model was trained using fivefold cross-validation, yielding an average accuracy of 99.93%±0.03 during training and 92.23%±1.39 during testing. The sensitivity and specificity scores of the model were 96.14%±0.87 and 95.95%±0.48, 91.82%±2.03 and 94.50%±0.71, and 89.81%±1.82 and 98.99%±0.40 when predicting no ROP versus ROP, stage 1 ROP versus no ROP and stage 2 ROP, and stage 2 ROP versus no ROP and stage 1 ROP, respectively.ConclusionsThe proposed system can accurately differentiate among ROP early stages and has the potential to help ophthalmologists classify ROP at an early stage.

The complement system is comprised of the classical, lectin and alternative pathways that result in the formation of: pro-inflammatory anaphylatoxins; opsonins that label cells for phagocytic removal; and, a membrane attack complex that directly lyses target cells. Complement-dependent cytotoxicity (CDC) - cell lysis triggered by complement protein C1q binding to the Fc region of antibodies bound to target cells - is another effector function of complement and a key mechanism-of-action of several monoclonal antibody therapies. At present, it is not well established how exercise affects complement system proteins in humans.A systematic search was conducted to identify studies that included original data and investigated the association between soluble complement proteins in the blood of healthy humans, and: 1) an acute bout of exercise; 2) exercise training interventions; or, 3) measurements of habitual physical activity and fitness.77 studies were eligible for inclusion in this review, which included a total of 10,236 participants, and 40 complement proteins and constituent fragments. Higher levels of exercise training and cardiorespiratory fitness were commonly associated with reduced C3 in blood. Additionally, muscle strength was negatively associated with C1q. Elevated C3a-des-Arg, C4a-des-Arg and C5a, lower C1-inhibitor, and unchanged C3 and C4 were reported immediately post-laboratory based exercise, compared to baseline. Whereas, ultra-endurance running and resistance training increased markers of the alternative (factor B and H), classical (C1s), and leptin (mannose binding lectin) pathways, as well as C3 and C6 family proteins, up to 72-h following exercise. Heterogeneity among studies may be due to discrepancies in blood sampling/handling procedures, analytical techniques, exercise interventions/measurements and fitness of included populations.Increased anaphylatoxins were observed immediately following an acute bout of exercise in a laboratory setting, whereas field-based exercise interventions of a longer duration (e.g. ultra-endurance running) or designed to elicit muscle damage (e.g. resistance training) increased complement proteins for up to 72-h. C3 in blood was mostly reduced by exercise training and associated with increased cardiorespiratory fitness, whereas C1q appeared to be negatively associated to muscle strength. Thus, both acute bouts of exercise and exercise training appear to modulate complement system proteins. Future research is needed to assess the clinical implications of these changes, for example on the efficacy of monoclonal antibody therapies dependent on CDC.

Objectives: Myeloma is characterised by the presence of monoclonal immunoglobulin (M-protein) and the free light chain (FLC) in blood. We investigated whether these M-proteins and FLC are detectable in myeloma patients’ saliva to evaluate its utility for non-invasive screening and monitoring of haematological malignancies. Methods: A total of 57 patients with monoclonal gammopathy and 26 age-matched healthy participants provided paired serum and saliva samples for immunoglobulin characterisation and quantification. Results: Myeloma patients had IgG or IgA M-protein levels ranging up to five times and FLC levels up to a thousand times normal levels of polyclonal immunoglobulins. Despite these highly elevated levels, only two IgG and no IgA M-proteins or FLC could be detected in paired saliva samples. Most patients had reduced levels of serum polyclonal immunoglobulins, but all had normal levels of salivary IgA. Conclusions: Immunoglobulin transfer from blood is not determined by levels in the systemic circulation and more likely dictated by periodontal inflammation and the integrity of the oral epithelium. Immunoglobulins secreted by bone marrow plasma cells do not substantially enter saliva, which represents a poor medium for myeloma diagnosis. These findings, along with normal salivary IgA levels despite systemic immunoparesis, support a strong partitioning of oral from systemic humoral immunity.

Convolutional neural networks (CNNs) have shown great performance in medical diagnostic applications. However, because their black-box nature, clinicians are reluctant to trust CNN diagnostic outcomes. Incorporating visual attention capabilities in CNNs enhances interpretability by highlighting regions in the images that CNNs utilize for prediction. Clinicians can often provide domain knowledge on relevant features: e.g., to diagnose retinopathy of prematurity (ROP), structural information such as tortuosity of vessels aid clinicians in diagnosing ROP. We propose a Structural Visual Guidance Attention Networks (SVGA-Net) method, that leverages structural domain knowledge to guide visual attention in CNNs. Experiments on a dataset of 5512 posterior retinal images, taken using a wide-angle fundus camera, show that SVGA-Net achieves 0.987 and 0.979 AUC to predict plus and normal categories, respectively. SVGA-Net consistently results in higher AUC compared to visual attention CNNs without guidance, baseline CNNs, and CNNs with structured masks.

Unconventional T Cells (UTCs) are a unique population of immune cells that links innate and adaptive immunity. Following activation, UTCs contribute to a host of immunological activities, rapidly responding to microbial and viral infections and playing key roles in tumor suppression. Aging and chronic disease both have been shown to adversely affect UTC numbers and function, with increased inflammation, change in body composition, and physical inactivity potentially contributing to the decline. One possibility to augment circulating UTCs is through increased physical activity. Acute exercise is a potent stimulus leading to the mobilization of immune cells while the benefits of exercise training may include anti-inflammatory effects, reductions in fat mass, and improved fitness. We provide an overview of age-related changes in UTCs, along with chronic diseases that are associated with altered UTC number and function. We summarize how UTCs respond to acute exercise and exercise training and discuss potential mechanisms that may lead to improved frequency and function.

Purpose of review In this article, we review the current state of artificial intelligence applications in retinopathy of prematurity (ROP) and provide insight on challenges as well as strategies for bringing these algorithms to the bedside. Recent findings In the past few years, there has been a dramatic shift from machine learning approaches based on feature extraction to 'deep' convolutional neural networks for artificial intelligence applications. Several artificial intelligence for ROP approaches have demonstrated adequate proof-of-concept performance in research studies. The next steps are to determine whether these algorithms are robust to variable clinical and technical parameters in practice. Integration of artificial intelligence into ROP screening and treatment is limited by generalizability of the algorithms to maintain performance on unseen data and integration of artificial intelligence technology into new or existing clinical workflows. Summary Real-world implementation of artificial intelligence for ROP diagnosis will require massive efforts targeted at developing standards for data acquisition, true external validation, and demonstration of feasibility. We must now focus on ethical, technical, clinical, regulatory, and financial considerations to bring this technology to the infant bedside to realize the promise offered by this technology to reduce preventable blindness from ROP.

Multiple studies in humans and animals have demonstrated the profound impact that exercise can have on the immune system. There is a general consensus that regular bouts of short-lasting (i.e. up to 45 minutes) moderate intensity exercise is beneficial for host immune defense, particularly in older adults and people with chronic diseases. In contrast, infection burden is reported to be high among high performance athletes and second only to injury for the number of training days lost during preparation for major sporting events. This has shaped the common view that arduous exercise (i.e. those activities practiced by high performance athletes/ military personnel that greatly exceed recommended physical activity guidelines) can suppress immunity and increase infection risk. However, the idea that exercise per se can suppress immunity and increase infection risk independently of the many other factors (e.g. anxiety, sleep disruption, travel, exposure, nutritional deficits, environmental extremes, etc.) experienced by these populations has recently been challenged. The purpose of this debate article was to solicit opposing arguments centered around this fundamental question in the exercise immunology field: can exercise affect immune function to increase susceptibility to infection. Issues that were contested between the debating groups include: (i) whether or not athletes are more susceptible to infection (mainly of the upper respiratory tract) than the general population; (ii) whether exercise per se is capable of altering immunity to increase infection risk independently of the multiple factors that activate shared immune pathways and are unique to the study populations involved; (iii) the usefulness of certain biomarkers and the interpretation of in vitro and in vivo data to monitor immune health in those who perform arduous exercise; and (iv) the quality of scientific evidence that has been used to substantiate claims for and against the potential negative effects of arduous exercise on immunity and infection risk. A key point of agreement between the groups is that infection susceptibility has a multifactorial underpinning. An issue that remains to be resolved is whether exercise per se is a causative factor of increased infection risk in athletes. This article should provide impetus for more empirical research to unravel the complex questions that surround this contentious issue in the field of exercise immunology.

Artificial intelligence (AI) based on deep learning (DL) has sparked tremendous global interest in recent years. DL has been widely adopted in image recognition, speech recognition and natural language processing, but is only beginning to impact on healthcare. In ophthalmology, DL has been applied to fundus photographs, optical coherence tomography and visual fields, achieving robust classification performance in the detection of diabetic retinopathy and retinopathy of prematurity, the glaucoma-like disc, macular oedema and age-related macular degeneration. DL in ocular imaging may be used in conjunction with telemedicine as a possible solution to screen, diagnose and monitor major eye diseases for patients in primary care and community settings. Nonetheless, there are also potential challenges with DL application in ophthalmology, including clinical and technical challenges, explainability of the algorithm results, medicolegal issues, and physician and patient acceptance of the AI 'black-box' algorithms. DL could potentially revolutionise how ophthalmology is practised in the future. This review provides a summary of the state-of-the-art DL systems described for ophthalmic applications, potential challenges in clinical deployment and the path forward. Ministry of Health (MOH) National Medical Research Council (NMRC) Published version This project received funding from the National Medical Research Council (NMRC), Ministry of Health (MOH), Singapore National Health Innovation Center, Innovation to Develop Grant (NHIC-I2D-1409022), SingHealth Foundation Research Grant (SHF/FG648S/2015), and the Tanoto Foundation, and unrestricted donations to the Retina Division, Johns Hopkins University School of Medicine. For the Singapore Epidemiology of Eye Diseases (SEED) study, we received funding from NMRC, MOH (grants 0796/2003, IRG07nov013, IRG09nov014, STaR/0003/2008 and STaR/2013; CG/SERI/2010) and Biomedical Research Council (grants 08/1/35/19/550 and 09/1/35/19/616). The Singapore Integrated Diabetic Retinopathy Programme (SiDRP) received funding from the MOH, Singapore (grants AIC/RPDD/SIDRP/SERI/FY2013/0018 and AIC/HPD/FY2016/0912). In USA, it is supported by the National Institutes of Health (K12 EY027720, R01EY019474, P30EY10572, P41EB015896), by the National Science Foundation (SCH-1622542, SCH-1622536, SCH-1622679) and by unrestricted departmental funding from Research to Prevent Blindness. PAK is supported by a UK National Institute for Health Research (NIHR) Clinician Scientist Award (NIHR-CS--2014-12-023). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Purpose: The purpose of this study was to compare rates of clinically significant complications between 23- and 25-gauge pars plana vitrectomy (PPV) in vitreoretinal surgery. Methods: Demographics, PPV indication, and surgical complications were reviewed. Patients with prior PPV or other retina surgery; cases requiring silicone oil removal, keratoplasty, or glaucoma valve implant; patients Results: A total of 579 eyes met inclusion criteria, and their charts were reviewed. Demographics, PPV indication, follow-up time, and lens status were similar ( P > .05). A 23-gauge PPV was performed more frequently than a 25-gauge PPV (328 vs 251 eyes, respectively). Although rates of eyes with a clinically significant postoperative complication requiring surgical intervention were higher in 23-gauge PPV (112/325, 34.4%) than in 25-gauge PPV (54/250, 21.6%), PPVs indicated by rhegmatogenous retinal detachment were more common with 23-gauge PPVs (155/325, 47.7%) than with 25-gauge PPVs (37/250, 14.8%; P Conclusions: This retrospective review suggests that clinically significant complications are moderately more likely following 23-gauge PPV compared with 25-gauge PPV, even when the differences in surgical indication are considered.

In their focal article, Aguinis et al. (2017) categorized the 6,654 unique citations, summed across the six introductory industrial and organizational (I-O) psychology texts, in various ways. They then suggested how such data could be used to (a) infer the “state” of the scientist–practitioner divide; (b) document the extent of the movement of I-O psychologists to management schools; (c) evaluate the future prospects of I-O psychology as a field; and (d) provide guidance in how to define, measure, and reward “scholarly impact” (quotation marks added). This crosses the line from interesting toverycounterproductive.

The focal article (LCIOP Joint Task Force, 2017) is a painstakingly thorough discussion of licensing issues regarding I-O psychology as they have evolved over the last 40–50 years. There is also a very large literature produced by Society for Industrial and Organizational Psychology (SIOP) members, and cited in the focal article, that discusses many of these issues in some detail (e.g., Campbell, Levy, Murphy, Schmitt, & Weiss, 2009). The focal article makes a very useful distinction between health service providers (HSP) and general applied psychologists (GAP). The position of SIOP for some time has been that licensure should be required for the former, but not for the latter, although a path to licensure should be provided for those who need it. I would certainly agree. Also, the Society of Consulting Psychology (SCP) is much more infused with applied clinical psychology than is SIOP. Consequently, the licensing needs of most SIOP members and most SCP members are most likely not quite the same.

The paper has taken a fundamental approach to study the nano-scale deformation behavior of Al-Al2O3 cermet coatings deposited by low-pressure cold spraying (LPCS) on AZ31 magnesium and Al6056 lightweight alloy substrates. Coating microstructural characteristics were first evaluated and correlated with LPCS process parameters using metallurgical characterization techniques: SEM, 3D optical profilometry, and XRD, followed by their microhardness and wear depth measurements and comparing with uncoated substrates under three-body abrasion wear. These properties were analyzed/mapped against probable deformation scenarios for nano-scale yield strength determination using the combined experimental nanoindentation load-depth curve method and computational expanding cavity models (ECMs). Obtained yield strength with key coating parameters like hardness and Young’s modulus were taken for modeling and simulation of strain-hardening effect under a peak loading of 165 mN in ABAQUS finite element (FE). Results from both combined experimental/computational and FE approaches indicate a progressive elasto-plastic mode being the dominating coating deformation mechanism with a strain hardening exponent of 0.15, under the studied loads.

Retinopathy of Prematurity (ROP) is a leading cause for childhood blindness worldwide. An automated ROP detection system could significantly improve the chance of a child receiving proper diagnosis and treatment. We propose a means of producing a continuous severity score in an automated fashion, regressed from both (a) diagnostic class labels as well as (b) comparison outcomes. Our generative model combines the two sources, and successfully addresses inherent variability in diagnostic outcomes. In particular, our method exhibits an excellent predictive performance of both diagnostic and comparison outcomes over a broad array of metrics, including AUC, precision, and recall.

Our objective was to generate, define, and evaluate behavioral dimensions of ethical performance at work that are common across United States occupations. This project involved three studies. Study 1 involved (a) qualitative review of published literature, professional codes of ethics, and critical incidents of (un)ethical performance and resulted in (b) behavioral dimensions and ethical performance rating scales. The second and third studies used a retranslation methodology to evaluate the ethical performance dimensions from Study 1. The behavioral dimensions were linked to the performance determinants (personal attributes) in Study 3. Study 1 resulted in draft dimension definitions and rating scales for 10 ethical performance dimensions. In Studies 2 and 3, retranslation data provided strong support for 10 behavioral dimensions of ethical performance at work. Results from Study 3 shed light on possible relationships among the performance dimensions based on their underlying performance determinants. Communicating an organization’s ethical standards to employees is important because some ethical breakdowns can be attributed to simply failing to recognize an ethical matter (in: DeCremer, Managerial ethics: Managing the psychology of morality, Routledge, New York, 2011). Definitions of ethical behavior in the workplace provide a tool for researchers, employers, and employees to communicate about ethical situations and a foundation for folding ethics into employee training and performance management. These studies provide a taxonomy of ethical performance at work that generalizes to a diverse array of occupations and industries, and dimensions and rating scales have value for performance management, training/curriculum development, job analysis, predictor development and/or validation, and additional research.

In their focal article, Ree, Carretta, and Teachout (2015) argue that a large general factor (DGF), defined as the first component of an unrotated principal components solution, is characteristic of many different domains. In their view, ignoring the DGF in assessment and prediction in industrial and organizational (I-O) psychology is counterproductive. They readily acknowledge that the existence of a DGF does not preclude the existence of distinguishable specific factors. Their message is simply that the general factor (unrotated) frequently accounts for over half the reliable variance, and rather than ignore it, the reasons for it and the usefulness of it should be investigated. Further, the general factor is a construct, and all constructs must be supported by the various kinds of evidence that demonstrate construct validity. The DGF is no exception.

This chapter outlines a number of different ways that "modeling" and "performance" can be thought about and juxtaposed. The list is illustrative only, and is not meant to be a complete taxonomy in any sense. The object is to illustrate the futility of the general question, "Can performance be modeled?". The chapter offers some reasons why people are, or might be, interested in modeling performance. It briefly discusses a variety of specific areas in which performance, or things related to performance, are modeled in some fashion. The chapter speculates about some of the implications of these previous modeling activities for the conceptualization and measurement of complex job performance. Decision making and problem solving are important components of many jobs. Modeling by human-factors specialists usually involves the tranformation/transmitting process and the usual aim is to maximize the efficiency of the human operator in terms of the amount of information that can be transmitted per unit time.

BACKGROUND AND OBJECTIVE: To determine the ultra-wide-field fundus autofluorescence (UWFFAF) and optical coherence tomography (OCT) features of syphilitic outer retinopathy (SOR). PATIENTS AND METHODS: Retrospective chart review. RESULTS: Three patients with SOR were investigated. Treatment with parenteral penicillin led to improvement of outer retinopathy, visual acuity, and symptoms. UWFFAF showed speckled hyperautofluorescence, hypoautofluorescence, and normal autofluorescence, similar to what has been described as a trizonal pattern in acute zonal occult outer retinopathy (AZOOR) in the chronic case of SOR, but with hyperautofluorescent areas in the two acute cases. OCT showed disruption of the photoreceptor outer segment ellipsoid zone and external limiting membrane, which improved after penicillin treatment, and corresponded to normalization of the hyperautofluorescent areas on UWFFAF. There was irregularity and nodular thickening of retinal pigment epithelium on OCT in areas of mottled hyperautofluorescence. CONCLUSION: SOR can present similarly to AZOOR on UWFFAF and should be highly suspected in cases presenting like AZOOR. [ Ophthalmic Surg Lasers Imaging Retina. 2017;48:208–215. ]

BACKGROUND: Aggressive posterior retinopathy of prematurity (APROP), which has a poor visual prognosis, is common in low- and middle-income countries (LMICs) as a result of suboptimal oxygen monitoring (primary prevention). The purpose of this study was to compare outcomes in APROP eyes treated with laser to eyes treated with antivascular endothelial growth factor (anti-VEGF) therapy. METHODS: The medical records of a cohort of APROP eyes treated with anti-VEGF (2010–2018) and another of eyes treated with laser photocoagulation (2002–2010) at the same institution in South India were reviewed retrospectively and compared. The main outcome was the proportion of eyes developing retinal detachment during resolution of acute ROP. RESULTS: A total of 398 eyes of 199 preterm babies with APROP were included: 168 eyes were treated with photocoagulation; 230, with anti-VEGF. From 2002 to 2010, compared to the more recent cohort, babies diagnosed with APROP tended to be heavier (P < 0.001), older (P < 0.001), and exposed to fewer days of oxygen (P = 0.02). In the laser-treated cohort, 17 of 168 eyes (10%) developed retinal detachment (7, stage 5; 12, stage 4), compared with 3 of 230 (1%) in the anti-VEGF cohort (all stage 4 [P = 0.002]). CONCLUSIONS: The incidence of retinal detachment was significantly lower in eyes treated with anti-VEGF compared with laser-.treated eyes In the absence of a randomized trial, these data suggest that anti-VEGF may lead to better anatomic outcomes, although questions remain concerning dosage, timing, and risks.

Recent evaluation of the US Department of Labor's Occupational Information Network (O*NET) suggested that ratings from occupational analysts could be replaced by data imputed from incumbents' ratings. This study evaluates the viability of imputing job descriptor data, usually provided by analysts (ability ratings), using regression-weighted incumbent task ratings. This study also uses (O*NET) databases to compare a series of possible strategies for imputing task, ability, and skill data on the basis of either incumbent or analyst ratings. Findings do not provide clear support for the superiority of using one data source over another when imputing ratings. Imputed and existing ratings are shown not to be equivalent based on variance explained statistics and comparisons of factor structures, indicating that both sources provide unique information.

Background and Objective: To determine the accuracy and sensitivity of a single-field non-mydriatic digital fundus image interpreted by an ophthalmologist and performed within a primary care setting. Patients and Methods: Fundus photography using a digital non-mydriatic camera was performed on both eyes of 1,175 consecutive patients as part of an executive health program. All fundus images included a 45° field of the posterior pole capturing the optic nerve and macular area. Diagnostic findings were recorded and appropriate recommendations for follow-up were made. Patients were then contacted to see whether appropriate follow-up was successfully completed and chart reviews were performed to determine biomicroscopic findings. Results: Photographs were adequate in both eyes in 1,117 patients (95.1%). Examination findings were normal in both eyes in 951 (85.1%) patients. Abnormal findings were noted in either eye in 166 (14.9%) patients. The most common abnormal findings were macular degeneration (57/166, 34.3%), optic nerve cupping (45/166, 27.1%), hypertensive retinopathy (15/166, 9.0%), and choroidal nevi (10/166, 6.0%). In all patients with abnormal findings, routine follow-up ophthalmologic examination with an eye care specialist was indicated and none of the patients required urgent attention. Sensitivity was found to be 87% and stratification was performed based on the initial diagnosis. False-positive results were from confounding diagnoses rather than true false-positives. Conclusion: Single-field non-mydriatic fundus photography is accurate and sensitive for screening retinal disease in a primary care setting.

Purpose To describe a case of bilateral central retinal vein occlusion and central retinal artery occlusion associated with antiphospholipid antibody syndrome and cocaine abuse. Methods A single case report of a 44-year-old woman with a history of cocaine abuse, vasculitis, and 3 spontaneous abortions who developed painless complete loss of vision in both eyes concurrently with progressive motor and sensory polyneuropathy. The patient underwent an extensive laboratory, radiographic, ophthalmologic, and pathologic workup. Results Diagnosis of catastrophic antiphospholipid antibody syndrome was made based on established clinical and laboratory criteria, including a positive Russell's viper venom test, history of three spontaneous abortions and evidence of microvascular and macrovascular venous occlusions, and multiorgan failure. Urine toxicology screen was positive for cocaine metabolites. Her clinical course was remarkable for progressive mononeuritis multiplex and quadriplegia. She had no light perception on presentation, and fundus examination revealed extensive preretinal, intraretinal, and subretinal hemorrhages. Fluorescein angiography revealed complete occlusion of central retinal arteriolar and venular flow and retinal hemorrhages in both eyes. Conclusion Bilateral central retinal vein occlusion and central retinal artery occlusion have been rarely reported in the literature and are often associated with underlying thrombotic risk factors, such as antiphospholipid antibody syndrome. Workup for underlying hypercoagulability and/or cocaine use should be considered in atypical and bilateral cases of central vein or artery occlusion. In this case, bilateral central retinal artery and vein occlusions developed as manifestations of catastrophic antiphospholipid antibody syndrome, which has not been previously reported.

Free light chains (FLCs) have a range of biological functions and may act as a broad marker of immunesuppression and activation and inflammation. Measurement of salivary FLCs may provide practical advantages in a range of clinical populations. The aim of the present study was to develop normal reference ranges of FLCs in saliva and assess the effects of acute exercise on FLC levels in younger and older adults.Saliva FLC concentrations and secretion rates were measuredin young (n = 88, aged 18-36) and older (n = 53, aged 60-80) adults. To assess FLC changes in response to acute exercise, young adults completed a constant work-rate cycling exercise trial at 60% VO2max (n = 18) or a 1 h cycling time trial (TT) (n = 10) and older adults completed an incremental submaximal treadmill walking exercise test to 75% HRmax (n = 53). Serum FLCs were measured at baseline and in response to exercise.Older adults demonstrated significantly higher levels of salivary FLC parameters compared with young adults. Median (5-95th percentile) concentrationswere 0.45 (0.004- 3.45) mg/L for kappa and 0.30 (0.08-1.54) mg/L for lambda in young adults; 3.91 (0.75-19.65) mg/L for kappa and 1.00 (0.02-4.50) mg/L for lambda in older ad ults. Overall median concentrations of salivary kappa and lambda FLCs were 10-fold and 20-fold lower than serum, respectively. Reductions in salivary FLC concentrations and secretion rates were observed immediately post- and at 1 h post exercise, but were only significant for the older cohort; FLCs began to recover between post and 1 h post-exercise. No changes in serum FLCs were observed in response to exercise.

In this study, we tested for a set of complex, nonlinear relationships between derailing/dark side personality composites and leadership performance using two independent samples of managers/leaders (N=1306 and N=290 for Study 1 and 2, respectively). Based on the structure and characteristics of the derailing/dark side trait composites, we expected the relationship between these composites and leadership performance would best be described with an inverted U function. In Study 1, we found evidence of a nonlinear relationship between the derailing composite, as measured by the Global Personality Inventory©, and behaviorally based, structured ratings of leadership performance in an assessment center. Similarly, Study 2 found evidence for a nonlinear relationship between dark side composites, as measured by the Hogan Development Survey©, and supervisory/other ratings of leadership performance. We discuss the implications of these complex, nonlinear findings with respect to the continued use of personality for the selection and promotion of future leaders. Limitations of the current study and directions for future research are noted.

Just over thirty years ago, Yale University Press published Sir John Masterman's The Double-Cross System in the War of 1939 to 1945 (1972). Originally written in a matter of months in 1945 as a hig...