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Nipple-sparing mastectomies (NSM) for breast cancer are under-utilized. We sought to investigate NSM utilization.Females with nonmetastatic breast cancer undergoing mastectomy in the Legacy Health System from 2007 to 2020 were identified. Multivariable logistic regression was utilized to evaluate odds of receiving NSM.Three-thousand-four-hundred-seventeen mastectomies were performed with 772 undergoing NSM. On multivariable analysis, later year (OR 1.22/year, P 0.001), neoadjuvant chemotherapy (OR 1.33, P = 0.04), HR+ (OR 1.61, P = 0.001) and surgeon volume (OR 1.16/10 yearly mastectomies, P 0.001) were independently associated with increased odds of receiving a NSM while age (OR 0.94/year, P 0.001), IDC (OR 0.58, P = 0.01), T3/T4 stage (OR 0.36, P = 0.009), and clinical node positivity (OR 0.63, P = 0.003) were independently associated with decreased odds. Surgeon volume was not associated with odds of receiving a non-NSM with reconstruction (OR 1.01 P = 0.48).NSM is under-utilized by low-volume breast surgeons. Understanding barriers to adoption is an is an opportunity to enhance patient-centered outcomes.

PURPOSE: To determine the change in intraocular pressure (IOP), ocular hypotensive medication use after cataract extraction in the Medication Group of the Ocular Hypertension Treatment Study (OHTS). DESIGN: Secondary analysis of randomized clinical trial data METHODS: We included 92 participants (n=149 eyes) of the OHTS Medication Group who underwent cataract surgery in at least one eye during the study, and 531 participants (n=1004 eyes) of the Medication Group who did not undergo cataract surgery. We defined the “split date” as the first study visit that cataract surgery was reported for the cataract surgery group, and the 15(th) visit in the control group to equalize the median number of visits. We then compared the two groups at visits relative to this split date. • MAIN OUTCOME MEASURES: Difference in preoperative and postoperative IOP, and number of classes of ocular hypotensive medications between the cataract and control group over a 72 month period. RESULTS: Cataract surgery significantly decreased the number of ocular hypotensive medications at all postoperative visits (mean −0.4 medications, p

Background: Over 50% of the world uses social media. There has been significant academic and public discourse around its negative mental health impacts. There has not, however, been a broad systema...

Static pointwise perimetric sensitivities of less than approximately 19 dB are unreliable in glaucoma owing to excessive variability. We propose using moving stimuli to increase detectability, decrease variability, and hence increase this dynamic range.A moving stimulus was designed to travel parallel to the average nerve fiber bundle orientation at each location, and compared against an otherwise identical static stimulus. To assess dynamic range, psychometric functions were measured at 4 locations of each of 10 subjects. To assess clinically realistic test-retest variability, 34 locations of 94 subjects with glaucoma and glaucoma suspects were tested twice, 6 months apart. Pointwise sensitivity estimates were compared using generalized estimating equation regression models. The test-retest limits of agreement for each stimulus were assessed, adjusted for within-eye clustering.Using static stimuli, 9 of the 40 psychometric functions had less than a 90% maximum response probability, suggesting being beyond the dynamic range. Eight of those locations had asymptotic maximum of more than 90% with moving stimuli. Sensitivities were higher for moving stimuli (P0.001); the difference increased as sensitivity decreased (P0.001). Test-retest limits of agreement were narrower for moving stimuli (-6.35 to +6.48 dB) than static stimuli (-12.7 to +7.81 dB). Sixty-two percent of subjects preferred using moving stimuli versus 19% who preferred static stimuli.Using a moving stimulus increases perimetric sensitivities in regions of glaucomatous loss. This extends the effective dynamic range, allowing reliable testing later into the disease. Results are more repeatable, and the test is preferred by most subjects.Moving stimuli allow reliable testing in patients with more severe glaucoma than currently possible.

To compare a nose-pivoted drop delivery device (NPDD) with traditional eye drop delivery in glaucoma subjects.Repeated-measures case series.Fifty glaucoma subjects (100 eyes) who reported difficulty self-administering eye drops.We compared eye drop delivery using a NPDD against traditional delivery techniques at baseline (baseline traditional) and after standardized teaching (post-teaching traditional). Subjects used a 1-to-10 scale (10 being easiest) to rate the ease of delivery with each technique and completed a satisfaction survey. Two graders used digital video to independently review eye drop delivery and recorded: (1) accurate placement: the eye drop reached the ocular surface; (2) no contact: no bottle tip contact against the ocular or periocular surface; and (3)number of eye drops dispensed. We defined primary success as accurate placement and no contact; secondary success as primary success with only 1 drop dispensed.We used logistic-transformed generalized estimating equation (GEE) regression to compare technique satisfaction, accuracy, no contact, and primary and secondary success. Number of drops dispensed was compared using a Cox model.Forty-seven of 50 subjects (94%) preferred the NPDD over traditional eye drop delivery. The mean score for ease of use was higher for the NPDD (8.9 ± 1.1) than baseline traditional (6.7 ± 2.1; P0.001) and post-teaching traditional (7.0 ± 2.0; P0.001). Forty-nine of 50 (98%) subjects thought the NPDD was comfortable to use and would recommend the device. The eye drop reached the ocular surface in a similar percentage of subjects (90%) with each method. The bottle tip contacted fewer eyes with the NPDD (10 eyes) than baseline traditional (33 eyes; P0.001) and post-teaching traditional (25 eyes; P = 0.009). The number of drops dispensed was lower with the NPDD (1.7 ± 1.2) than baseline traditional (2.2 ± 1.6; P = 0.017) and post-teaching traditional (2.4 ± 1.8; P = 0.006). The NPDD increased primary and secondary success of eye drop delivery (86% and 54%, respectively) compared to baseline traditional (66% [P = 0.001] and 28% [P0.001]) and post-teaching traditional (70% [P = 0.005] and 40% [P = 0.018]).Eye drop users preferred the NPDD over traditional eye drop delivery. The NPDD improved eye drop delivery success, reduced bottle tip contact, and decreased the number of eye drops wasted.

Background Patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer are treated with trastuzumab-based neoadjuvant therapy (NAT); some patients with residual disease post-NAT show loss of HER2 amplification and has been inconsistently associated with oncologic outcomes. Methods We queried our multi-institutional cancer registry for women with HER2-positive breast cancer undergoing NAT from 2011 to 2018. Clinicopathologic, treatment-related, and outcomes data were collected. Kaplan-Meier and Cox proportional hazards analysis were used to evaluate oncologic outcomes. Results A total of 348 patients were identified; 166 (48%) had a pathologic complete response. Of the 182 patients with residual disease, 87 (48%) were HER2-positive, 34 (19%) were HER2-negative, and 61 (33%) were HER2-unknown, with a median follow-up of 44 months. There were no factors associated with HER2 loss apart from age. On Kaplan-Meier analysis, estimated 5-year recurrence-free survival (RFS) and overall survival (OS) for patients with HER2-positive residual disease was 81% and 92%, respectively, and 74% (log rank p = 0.75) and 81% (p = 0.35) in patients with HER2-negative residual disease. Conclusion The loss of HER2-positivity following NAT is not associated with worse 5-year RFS or OS. We do not recommend retesting HER2 status following NAT for the purpose of clinical management; these patients should complete targeted adjuvant therapy.

The impact of length of time to surgery (TTS) on oncologic outcomes following neoadjuvant chemotherapy (NAC) in breast cancer patients is unclear. We investigated the relationship between TTS on residual cancer burden (RCB) score and oncologic outcomes.Patients with breast cancer receiving NAC from 2011 to 2017 were identified. The association of TTS with recurrence-free survival (RFS), overall and disease-specific survival (OS, DSS), and RCB score was examined with Kaplan-Meier and Cox proportional hazards analysis, adjusting for relevant clinicopathologic factors.We identified 463 patients. Median TTS was 29 days (range 11-153). Median follow-up was 57 months (range, 2-93 months). Five-year local recurrence-free survival, locoregional RFS, OS, and DSS was 86%, 96%, 89%, and 91%, respectively. On multivariate analysis, TTS 6 weeks was independently associated with worse RFS (HR [hazard ratio] 3.45; p .001) and DSS (HR 2.82; p .05), while TTS 6 weeks was independently associated with a positive size of the effect on RCB score of 0.59 (p .0001).Prolonged TTS is a modifiable risk factor for adverse oncologic outcomes following NAC for breast cancer, possibly mediated by increasing RCB score overtime after NAC. In the absence of contraindications, surgery should be performed within 6 weeks following NAC for optimal oncologic outcomes.

Detecting rapid visual field deterioration is crucial for individuals with glaucoma. Cluster trend analysis detects visual field deterioration with higher sensitivity than global analyses by using predefined non-overlapping subsets of visual field locations. However, it may miss small defects that straddle cluster borders. This study introduces a comprehensive set of overlapping clusters, and assesses whether this further improves progression detection. Clusters were defined as locations from where ganglion cell axons enter the optic nerve head within a θ° wide sector, centered at 1º intervals, for various θ. Deterioration in eyes with or at risk of glaucomatous visual field loss was “detected” if ≥ Nθ clusters had deteriorated with p Cluster, chosen empirically to give 95% specificity based on permuting the series. Nθ was chosen to minimize the time to detect subsequently-confirmed deterioration in ≥ 1/3rd of eyes. Times to detect deterioration were compared using Cox survival models. Biannual series were available for 422 eyes of 214 participants. Predefined non-overlapping clusters detected subsequently-confirmed change in ≥ 1/3rd of eyes in 3.41 years (95% confidence interval 2.75–5.48 years). After equalizing specificity, no criteria based on comprehensive overlapping clusters detected deterioration significantly sooner. The quickest was 3.13 years (2.69–4.65) for θ° = 20° and Nθ = 25, but the comparison with non-overlapping clusters had p = 0.672. Any improvement in sensitivity for detecting deterioration when using a comprehensive set of overlapping clusters was negated by the need to maintain equal specificity. The existing cluster trend analysis using predefined non-overlapping clusters provides a useful tool for monitoring visual field progression.

Purpose To measure the magnitude and direction of anterior scleral canal opening (ASCO) offset relative to the Bruch membrane opening (BMO) (ASCO/BMO offset) to characterize neural canal obliqueness and minimum cross-sectional area (NCMCA) in 69 highly myopic and 138 healthy, age-matched, control eyes. Design Cross-sectional study. Methods Using optical coherence tomography (OCT) scans of the optic nerve head (ONH), BMO and ASCO were manually segmented and their centroids and size and shape were calculated. ASCO/BMO offset magnitude and direction were measured after projecting the ASCO/BMO centroid vector onto the BMO plane. Neural canal axis obliqueness was defined as the angle between the ASCO/BMO centroid vector and the vector perpendicular to the BMO plane. NCMCA was defined by projecting BMO and ASCO points onto a plane perpendicular to the neural canal axis and measuring their overlapping area. Results ASCO/BMO offset magnitude was greater (highly myopic eyes 264.3 ± 131.1 μm; healthy control subjects 89.0 ± 55.8 μm, P Conclusions Our data suggest that increased temporal displacement of BMO relative to the ASCO, increased BMO and ASCO area, decreased NCMCA, and increased neural canal obliqueness are characteristic components of ONH morphology in highly myopic eyes.

Purpose This study evaluated the ability of topographically correspondent (TC) minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (pRNFLT) criteria to detect optical coherence tomography (OCT) structural abnormality in glaucoma (GL) and glaucoma suspect (GLS) eyes. Design Retrospective cross-sectional study. Methods A total of 196 GL eyes, 150 GLS eyes, and 303 heathy eyes underwent pRNFL and 24 radial optic nerve head OCT imaging and manual correction of the internal limiting membrane, Bruch's membrane opening (BMO), and outer pRNFL segmentations. MRW and pRNFLT were quantified in 6 Garway-Heath or 12 30-degree (clock-hour) sectors. OCT abnormality for each parameter was defined to be less than the 5th percentile of the healthy eye distribution. OCT abnormality for individual eyes was defined using global, sectoral, and combined parameter criteria that achieved ≥95% specificity in the healthy eyes. TC combination criteria required the sectoral location of MRW and pRNFLT abnormality to be topographically aligned and included comMR (a previously reported TC combination consisting of MRW and pRNFLT parameter: [MRW + pRNFLT × (average MRW healthy eyes/average pRNFLT healthy eyes) MRW]. Results TC sectoral criteria (1 Garway-Heath MRW + corresponding Garway-Heath RNFLT), (one 30-degree MRW + any 1 corresponding or adjacent 30-degree pRNFLT), 30-degree and Garway-Heath comMR-TI and global comMR were the best performing criteria, demonstrating (96%-99% specificity), 86%-91% sensitivity for GL, 80%-84% sensitivity for early GL (MD ≥ −4.0 dB) and 93%-96% sensitivity for moderate-to-advanced GL (MD Conclusions Clinically intuitive TC MRW and pRNFLT combination criteria identified the sectoral location of OCT abnormality in GL eyes with high diagnostic precision.

PURPOSE: Ophthalmologists commonly perform glaucoma surgery to treat progressive glaucoma. Few studies have examined the stability of OCT neuroretinal rim parameters after glaucoma surgery for ongoing detection of glaucoma progression. DESIGN: Longitudinal cohort study. PARTICIPANTS: 20 eyes (16 subjects) with primary open angle glaucoma who had undergone a trabeculectomy. METHODS: We calculated the change in OCT parameters (minimum rim area (MRA), minimum rim width (MRW), Bruch’s membrane opening (BMO) area, mean cup depth (MCD), anterior lamina cribrosa surface depth (ALCSD), prelaminar tissue thickness (PLTT), retinal nerve fiber layer thickness (RFNLT) during an interval from the visit before the surgery to the visit after the surgery, a span of approximately 6-months. We also calculated changes in the same eyes over two separate 6-month intervals that did not contain trabeculectomy to serve as control. We compared these intervals using a generalized linear model (with compound symmetry correlation structure), accounting for the correlation between time intervals for the same eye. MAIN OUTCOMES MEASURES: MRW, MRA, angle above the reference plane for MRW and MRA, BMO area, MCD, mean ALCSD, PLTT, RNFLT and visual field parameters (mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI)). RESULTS: The intervals containing trabeculectomy showed a significant decrease in intraocular pressure (−9.2 mmHg, p

Diet is a key factor of human health, and additional research is needed in order to understand the psychological causes, consequences, and moderators of dietary behavior. Participants in two studies in the United States completed a 21-day intervention that involved either self-monitoring their fruit and vegetable consumption or self-monitoring combined with earning monetary incentives for behavior. Each day, participants reported their stress, affect, and consumption of fruits and vegetables. Hierarchical linear mixed effects model results suggest that on average, daily reports of higher stress were associated with fewer fruits and vegetables consumed on that day. This effect was moderated by incentive condition, such that the relationship between stress and fruit and vegetable consumption was reduced among incented participants. There was also a marginal negative effect of time on consumption of fruits and vegetables, but this was also significantly moderated by condition, such that those participants who did not receive incentives decreased their daily servings, while incented participants did not decrease over the course of the intervention. These studies suggest that incentives may be a novel method for buffering against the negative effect of daily stress on eating a healthy diet.

Clinicians use both global and point-wise information from visual fields to assess the rate of glaucomatous functional progression. We asked which objective, quantitative measures best correlated with subjective assessment by glaucoma experts. In particular, we aimed to determine how much that judgment was based on localized rates of change vs. on global indices reported by the perimeter.Prospective cohort study.Eleven academic, expert glaucoma specialists independently scored the rate of functional progression, from 1 (improvement) to 7 (very rapid progression), for a series of 5 biannual clinical printouts from 100 glaucoma or glaucoma suspect eyes of 51 participants, 20 of which were scored twice to assess repeatability.Regression models were used to predict the average of the 11 clinicians' scores based on objective rates of change of mean deviation (MD), visual field index (VFI), pattern standard deviation (PSD), the Nth fastest progressing location, and the Nth fastest progressing of 10 anatomically defined clusters of locations after weighting by eccentricity.Correlation between the objective rates of change and the average of the 11 clinicians' scores.The average MD of the study eyes was -2.4 dB (range, -16.8 to +2.8 dB). The mean clinician score was highly repeatable, with an intraclass correlation coefficient of 0.95. It correlated better with the rate of change of VFI (pseudo-RExpert academic glaucoma specialists' assessment of the rate of change correlated best with VFI rates, except in eyes with a VFI near the ceiling of 100%. Sensitivities averaged within clusters of locations have been shown to detect change sooner, but the experts' opinions correlated more closely with global VFI. This could be because it is currently the only index for which the perimeter automatically provides a quantitative estimate of the rate of functional progression.

OCT scans contain large amounts of information, but clinicians often rely on reported layer thicknesses when assessing the rate of glaucomatous progression. We sought to determine which of these quantifications most closely relate to the subjective assessment of glaucoma experts who had all the diagnostic information available.Prospective cohort study.Eleven glaucoma specialists independently scored the rate of structural progression from a series of 5 biannual clinical OCT printouts.A total of 100 glaucoma or glaucoma suspect eyes of 51 participants were included; 20 were scored twice to assess repeatability. Scores ranged from 1 (improvement) to 7 (very rapid progression). Generalized estimating equation linear models were used to predict the mean clinician score from the rates of change of retinal nerve fiber layer thickness (RNFLT) or minimum rim width (MRW) globally or in the most rapidly thinning of the 6 sectors.The correlation between the objective rates of change and the average of the 11 clinicians' scores.Average RNFLT within the series of study eyes was 79.3 μm (range, 41.4-126.6). Some 95% of individual clinician scores varied by ≤ 1 point when repeated. The mean clinician score was more strongly correlated with the rate of change of RNFLT in the most rapidly changing sector in %/year (pseudo-RThe rate of change of RNFLT in the most rapidly changing sector predicted experts' assessment of the rate of structural progression better than global rates or MRW. Sectoral rates may be a useful addition to current clinical printouts.

When compared with cataract surgery in glaucoma patients, trabecular micro-bypass and goniotomy resulted in a large decrease in the incidence of intraocular pressure (IOP) spikes, a modest effect on IOP, and a minimal effect on medication burden.To compare changes in IOP and ocular hypotensive medications in 3 surgical cohorts: cataract surgery, cataract surgery with trabecular micro-bypass (cataract/trabecular), and cataract surgery with goniotomy (cataract/goniotomy).We included 138 eyes diagnosed with open-angle glaucoma: (1) 84 eyes with cataract surgery alone, (2) 25 eyes with cataract/trabecular surgery, and (3) 29 eyes with cataract/goniotomy surgery. We compared the groups for postoperative IOP and the number of ocular hypotensive medications. We adjusted for preoperative IOP, and preoperative and postoperative number of ocular hypotensive medications. We defined an IOP spike as IOP ≥21 mm Hg and 10 mm Hg higher than preoperative on postoperative day 1.All 3 surgeries showed a decrease in IOP (P≤0.004) and medication burden (P≤0.001) at 3 and 6 months postoperatively when compared with their own preoperative baselines. When compared with cataract surgery alone, cataract/trabecular and cataract/goniotomy had similar IOP lowering at 1 month postoperatively, and variable results at 3 and 6 months. The change in ocular hypotensive medications was not statistically different between the surgical groups at any postoperative visit. Cataract/trabecular and cataract/goniotomy decreased IOP on postoperative day 1, and had relative risk reduction of ~70% for IOP spikes (P≤0.001 for both).Trabecular micro-bypass and goniotomy when added to cataract surgery resulted in a large decrease in IOP spikes, a modest effect on IOP, and a minimal effect on medication burden when compared with cataract surgery alone in glaucoma patients.

Long range in-well radar measurements are presented in this contribution. Using an FMCW radar at 24 GHz, the benefits of higher-order propagation modes are demonstrated by a comparison between standard TE 11 and advantageous TE 01 -mode. The TE 01 -mode is excited by a compact in-line mode converter, which can be mounted directly between radar and horn antenna. Hence, the achievable distance of the radar system in long subsurface pipe applications can be increased. Due to its field distribution, the TE 01 -mode reduces wall losses and the excitation of further higher modes is reduced. Consequently, the resulting reflection at the end of a test pipe measuring over 500 m in length, is increased by more than 35 dB.

Test-retest variability in perimetry consists of short-term and long-term components, both of which impede assessment of progression. By minimizing and quantifying the algorithm-dependent short-term variability, we can quantify the algorithm-independent long-term variability that reflects true fluctuations in sensitivity between visits. We do this at locations with sensitivity both28 dB (when the stimulus is smaller than Ricco's area and complete spatial summation can be assumed) and28 dB (when partial summation occurs).Frequency-of-seeing curves were measured at four locations of 35 participants with glaucoma. The standard deviation of cumulative Gaussian fits to those curves was modeled for a given sensitivity and used to simulate the expected short-term variability of a 30-presentation algorithm. A separate group of 137 participants was tested twice with that algorithm, 6 months apart. Long-term variance at different sensitivities was calculated as the LOESS fit of observed test-retest variance minus the LOESS fit of simulated short-term variance.Below 28 dB, short-term variability increased approximately linearly with increasing loss. Long-term variability also increased with damage below this point, attaining a maximum standard deviation of 2.4 dB at sensitivity 21 dB, before decreasing due to the floor effect of the algorithm. Above 30 dB, the observed test-retest variance was slightly smaller than the simulated short-term variance.Long-term and short-term variability both increase with damage for perimetric stimuli smaller than Ricco's area. Above 28 dB, long-term variability constitutes a negligible proportion of test-retest variability.Fluctuations in true sensitivity increase in glaucoma, even after accounting for increased short-term variability. This long-term variability cannot be reduced by altering testing algorithms alone.

Objectives To test the effects of three behavioural interventions (daily monetary incentives + self-monitoring, delayed lump sum monetary incentives + self-monitoring, and self-monitoring only) on psychological constructs and fruit and vegetable consumption or physical activity behaviour change among a sample of adults with overweight or obesity. Design A pair of 3-arm longitudinal randomized controlled trials compared daily monetary incentives + self-monitoring, delayed lump sum monetary incentives + self-monitoring, and self-monitoring only interventions for either fruit and vegetable consumption or physical activity. Methods Individuals reporting elevated weight status and insufficient engagement in one of the target behaviours were randomly assigned to one of three 3-week interventions. All three interventions involved daily self-monitoring of the behaviour, and two provided monetary incentives contingent upon reported behaviour. Participants completed measures of psychological constructs and reported behaviour at baseline, the end of the intervention, and two and four weeks post-intervention. Results Participants across all three intervention conditions demonstrated increased engagement in the target behaviour from pre- to post-intervention and reported behaviour remained above baseline levels at both follow-up time points. Increases in reported behaviour during the intervention were associated with increases in self-efficacy, and this enhanced self-efficacy prospectively predicted sustained reported behaviour at follow-up. However, contrary to hypotheses, the incentive interventions including self-monitoring were not more efficacious than self-monitoring alone, and increased reported behaviour was not associated with enhancements in attitudes. Conclusions Self-monitoring interventions can aid behaviour change efforts, and behavioural practice during these interventions can increase self-efficacy. However, among adults with overweight or obesity who are seeking behaviour change interventions, incentive-based self-monitoring approaches may not be superior to self-monitoring alone in driving behaviour change and maintenance.

PRéCIS:: There are errors in automated segmentation of the retinal nerve fiber layer (RNFL) in glaucoma suspects or patients with mild glaucoma that appear to persist over time; however, automated segmentation has greater repeatability than manual segmentation.To identify whether optical coherence tomography (OCT) segmentation errors in RNFL thickness measurements persist longitudinally.This was a cohort study. We used spectral domain OCT (Spectralis) to measure RNFL thickness in a 6-degree peripapillary circle, and exported the native "automated segmentation only" results. In addition, we exported RNFL thickness results after "manual refinement" to correct errors in the automated segmentation, and used the differences in these measurements as "error" in segmentation. We used Bland-Altman plots and linear regression to determine the magnitude, location, and repeatability of RNFL thickness error in all twelve 30-degree sectors and compared the error at baseline to follow-up time points at 6 months, 2 years, 3 years, and 4 years.We included 406 eyes from 213 participants. The 95% confidence interval for errors at baseline was -6.5 to +13.2 μm. The correlation between the baseline error and the errors in the follow-up time periods were high (r0.5, P0.001 for all). Automated segmentation had a smaller SD of residuals from the longitudinal trend line when compared to manual refinement (1.56 vs. 1.80 μm, P0.001), and a higher ability (P=0.009) to monitor progression using an analysis of a longitudinal signal-to-noise ratio.Errors in automated segmentation remain relatively stable, and baseline error is highly likely to persist in the same direction and magnitude in subsequent time periods. However, automated segmentation (without manual refinement) is more repeatable and may be more sensitive to glaucomatous progression. Future segmentation algorithms could exploit these findings to improve automated segmentation in the future.

PURPOSE: To assess glaucoma specialists’ detection of optic nerve head (ONH) rim tissue that is thin by optical coherence tomography (OCT) criteria. DESIGN: Reliability analysis METHODS: 5 clinicians marked the disc margin (DM) and rim margin (RM) on stereo-photos of 151 glaucoma or glaucoma suspect eyes obtained within 3 months of OCT imaging. The photo and OCT infrared image for each eye were colocalized and regionalized into twelve sectors relative to the axis between Bruch’s membrane opening (BMO) centroid and the fovea. For each clinician, the distance from BMO centroid to their DM (DM radius) and RM (RM radius) was used to generate sectoral rim width (RW) (DM radius – RM radius) and cup-to-disc ratio (CDR) (RM radius / DM radius) estimates. OCT minimum rim width (MRW) was determined by sector. Among all eyes, for each OCT MRW suspicious sector (< 5% of OCT normative data base), we determined each clinician’s detection (clinician CDR ≥ 0.7). RESULTS: Clinicians most commonly failed to detect OCT suspicious rim tissue in the nasal sectors. Among 502 sectors with suspicious OCT MRW all 5 clinicians rated CDR ≥ 0.7 in only 29.5% and all 5 clinicians rated CDR < 0.7 in 21%. OCT suspicious rim thickness was most common (32% of eyes) in the nasal and inferior sectors. MRW vs clinician RW discordance was greatest nasally, while BMO vs clinician DM discordance was greatest temporally. CONCLUSIONS: Clinicians most commonly failed to detect OCT suspicious rim thickness nasally where suspicious rim tissues were also most common.

Background Nurses working in hospital environments are at risk for burnout. Exposure to nature has psychological benefits, but the effect of hospital gardens on nurse burnout is less understood. Objective To compare the effect on nurse burnout of taking daily work breaks in a hospital-integrated garden with the effect of indoor-only breaks. Methods A prospective crossover trial was conducted of nurses assigned to either 6 weeks of a work break in an outdoor hospital garden or 6 weeks of indoor-only breaks. After a 1-week washout period, break assignments were switched for a subsequent 6 weeks. The Maslach Burnout Inventory was administered at the beginning and end of each 6-week period, and a Present Functioning Visual Analogue Scale was completed at the start and end of each break to capture immediate psychological symptoms. Change scores were analyzed by using generalized estimating equations. Results For 29 nurses, for garden compared with indoor breaks, significant improvement was apparent in scores on the Maslach Burnout Inventory subscales for emotional exhaustion (4.5 vs -0.2; P < .001) and depersonalization (1.8 vs 0.0; P = .02) but not for personal accomplishment (-0.6 vs -0.0; P = .55). Compared with indoor breaks, total symptom scores on the Present Functioning Visual Analog Scale improved significantly when nurses took a break in the garden (garden vs indoor breaks, 4.0 vs 2.4; P = .04). Conclusions Taking daily work breaks in an outdoor garden may be beneficial in mitigating burnout for nurses working in hospital environments.

Objective To identify pregnancies at increased risk for trisomy 13, trisomy 18 or triploidy attributable to low fetal fraction (FF). Methods A FF‐based risk (FFBR) model was built using data from more than 165 000 singleton pregnancies referred for single‐nucleotide polymorphism (SNP)‐based non‐invasive prenatal testing (NIPT). Based on maternal weight and gestational age (GA), FF distributions for normal, trisomy 13, trisomy 18 and triploid pregnancies were constructed and used to adjust prior risks for these abnormalities. A risk cut‐off of ≥ 1% was chosen to define pregnancies at high risk for trisomy 13, trisomy 18 or triploidy (high FFBR score). The model was evaluated on an independent blinded set of pregnancies for which SNP‐based NIPT did not return a result, and for which pregnancy outcome information was gathered retrospectively. Results The evaluation cohort comprised 1148 cases, of which approximately half received a high FFBR score. Compared with rates expected based on maternal age (MA) and GA, cases with a high FFBR score had a significantly increased rate of trisomy 13, trisomy 18 or triploidy combined (5.7% vs 0.7%; P

PURPOSE: To compare the frequency of observing optic nerve head (ONH) prelaminar schisis by optical coherence tomography (OCT) in glaucoma and glaucoma suspect (GL/S) eyes versus healthy control (HC) eyes and to assess its association other markers of glaucoma severity. METHODS: This cross-sectional study included 298 eyes of 150 GL/S patients and 88 eyes of 44 HC. OCT scans were obtained by SPECTRALIS (Heidelberg Engineering GmbH), including 24 radial B-scans, each comprised of 768 A-lines spanning 15°, centered on the ONH. Two reviewers masked to all other clinical, demographic and ocular information, independently graded the OCT scans for the presence of ONH prelaminar schisis on a 4-point scale: 0 (none) to 3 (severe). The probability of ONH schisis was compared between groups and against demographic and ocular factors, including structural and functional measures of glaucoma severity. RESULTS: The frequency and severity of ONH prelaminar schisis were greater in GL/S than in HC (p=0.009). Among the GL/S group, 165 eyes (55.4%) had no visible schisis (Grade-0), 71 (23.8%) had Grade-1, 46 (15.4%) had Grade-2 and 16 (5.4%) had Grade-3 schisis. Among HC eyes, 59 (67.0%) had Grade-0, 24 (27.3%) had Grade-1, 5 (5.7%) had Grade-2, none had Grade-3. ONH schisis was more common in eyes with thinner MRW and a deeper cup. CONCLUSIONS: ONH prelaminar schisis may be a sign of glaucomatous deformation and reflect ongoing pathophysiological damage. ONH prelaminar schisis can impact OCT image segmentation and diagnostic parameters, resulting in substantial overestimation of the true rim tissue thickness and underestimation of cup depth.

Purpose It is often suggested that structural change is detectable before functional change in glaucoma. However, this may be related to the lower variability and hence narrower normative limits of structural tests. In this study, we ask whether a time lag exists between the true rates of change in structure and function, regardless of clinical detectability of those changes. Methods Structural equation models were used to determine whether the rate of change in function (mean linearized total deviation, AveTDLin) or structure (retinal nerve fiber layer thickness [RNFLT]) was predicted by the concurrent or previous rate for the other modality, after adjusting for its own rate in the previous time interval. Rates were calculated over 1135 pairs of consecutive visits from 318 eyes of 164 participants in the Portland Progression Project, with mean 207 days between visits. Results The rate of change of AveTDLin was predicted by its own rate in the previous time interval, but not by rates of RNFLT change in either the concurrent or previous time interval (both P > 0.05). Similarly, the rate of RNFLT change was not predicted by concurrent AveTDLin change after adjusting for its own previous rate. However, the rate of AveTDLin change in the previous time interval did significantly improve prediction of the current rate for RNFLT, with P = 0.005, suggesting a time lag of around six months between changes in AveTDLin and RNFLT. Conclusions Although RNFL thinning may be detectable sooner, true functional change appears to predict and precede thinning of the RNFL in glaucoma.

Purpose To use optical coherence tomography (OCT) to 3-dimensionally characterize the optic nerve head (ONH) in peripapillary scleral bowing in non-highly myopic healthy eyes. Design Cross-sectional, multicenter study. Methods A total of 362 non-highly myopic (+6 diopters [D] > spherical equivalent > −6D) eyes of 362 healthy subjects from 20-90 years old underwent OCT ONH radial B-scan imaging. Bruch's membrane (BM), BM opening (BMO), anterior scleral canal opening (ASCO), and the peripapillary scleral surface were segmented. BMO and ASCO planes were fit, and their centroids, major axes, ovality, areas and offsets were determined. Peripapillary scleral bowing was characterized by 2 parameters: peripapillary scleral slope (ppSS) of 3 anterior peripapillary scleral segments (0-300, 300-700, and 700-1,000 μm from the ASCO centroid); and ASCO depth relative to a peripapillary scleral reference plane (ASCOD-ppScleral). Peripapillary choroidal thickness (ppCT) was calculated relative to the ASCO as the minimum distance between the anterior scleral surface and BM. Results Both ppSS and ASCOD-ppScleral ranged from slightly inward through profoundly outward in direction. Both parameters increased with age and were independently associated with decreased ppCT. Conclusions In non-highly myopic healthy eyes, outward peripapillary scleral bowing achieved substantial levels, was markedly increased with age, and was independently associated with decreased peripapillary choroidal thickness. These findings provide a normative foundation for characterizing this anatomy in cases of high myopia and glaucoma and in eyes with optic disc tilt, torsion, and peripapillary atrophy.

Purpose Cluster trend analysis detects glaucomatous deterioration within predefined subsets (clusters) of visual field locations. However, it may miss small defects straddling boundaries between the clusters. This study assesses whether simultaneously using a second set of clusters, overlapping the first, could improve progression detection. Methods Deterioration in eyes with or at risk of glaucomatous visual field loss was "detected" by mean deviation (MD) on the first visit at which the P value from linear regression over time was below the fifth percentile of its permutation distribution. Similarly, P values were calculated for each of 10 predefined nonoverlapping clusters of locations, or 21 overlapping clusters; deterioration was "detected" when the Nth-smallest P value was below the fifth percentile of its permutation distribution, for different N. Times to detect deterioration were compared using survival models. Results Biannual series of ≥5 visual fields (mean = 14) were available for 420 eyes of 213 participants. Deterioration of 33% of eyes was detected earliest using N = 1 overlapping cluster in 3.3 years (95% confidence interval 2.7-4.6 years); or N = 2 nonoverlapping clusters in 3.3 years (2.7-5.0) (comparison P = 0.654). There was also no significant difference in the probability that deterioration would be confirmed (92.8% vs. 94.4%, P = 0.289). Both overlapping and nonoverlapping clusters detected deterioration significantly sooner than MD (4.5 years, P ≤ 0.001). Conclusions After equalizing specificity, overlapping clusters of locations did not significantly reduce the time to detect deterioration compared with nonoverlapping clusters. Translational Relevance Cluster trend analyses detected deterioration sooner than global analyses even when defects straddled cluster borders.

This contribution presents an FMCW radar-based in-well sensing concept. The radar works at 24 GHz and is mounted on an overmoded waveguide like tube, measuring 76 mm in diameter. In order to reduce wall losses and to increase the achievable measuring distance of the radar, an optimized $TE_{11}-TE_{01}$ mode converter is used. The applicability of the radar-based in-well sensing is demonstrated on a 500 m test rig, build up of single elements measuring 12 m. Here, each joint can clearly be identified within the range measurement using 200 MHz bandwidth.

Risk factors for visual field progression in glaucoma can affect both eyes, meaning that progression rates (in decibels per year) between eyes likely are correlated. We investigated whether incorporating information about the progression rate in one eye can improve the estimate of the rate in the fellow eye.Prospective cohort analysis.We analyzed series of 10 visual field results drawn from the Portland Progression Project and the Rotterdam Eye Study.We determined visual field progression rates using linear regression of the summary index mean deviation (MD) over time. We determined best-fitting linear models for the rates over the entire series based on the rate across n visual fields (n = 3 to 6) and used an analysis of variance to determine if incorporating the fellow eye's level of visual field damage (MD) or rate significantly improved these models.Visual field progression rate (in decibels per year).Visual field progression rates were correlated positively between eyes for the 262 individuals analyzed (r = 0.51; P0.0001). For short series (n = 3 to 4), predicting the rate over the entire 10 fields was improved significantly by incorporating rate information from the fellow eye (P0.05), but not by incorporating knowledge about the level of damage in the fellow eye (P0.61). The fellow eye no longer aided predictions for n = 5 or 6 fields (P = 0.11 and P = 0.42, respectively). Although the coefficient quantifying the influence of the fellow eye's rate changed relatively little for n = 3 to 5 fields, the coefficient for the rate of the eye under consideration increased markedly with the n value.The long-term rate of visual field change in an eye is, in part, predicted by the rate in the fellow eye, particularly when only a few visual field results are available for each eye. Because of this, apparent rapid progression in an eye is more likely to be real if the fellow eye also seems to be progressing rapidly.

PURPOSE: To quantify the variability of 5 glaucoma specialists’ optic disc margin (DM), rim margin (RM) and rim width (RW) estimates. DESIGN: Inter-Observer Reliability analysis. METHODS: Clinicians viewed stereo-photos from 214 subjects with glaucoma or ocular hypertension and digitally marked the DM and RM. For each photo, the centroid of each clinician’s DM was calculated, and an averaged DM(centroid) was determined. The axis between the DM(centroid) and the fovea was used to establish twelve 30° sectors. Measurements from the DM centroid to each clinician’s DM (DM(radius)) and RM (RM(radius)) were used to generate a RW (DM(radius) – RM(radius)) and cup disc ratio (CDR) (RM(radius)/DM(radius)) by sector. Parameter means, standard deviations and coefficient of variations (COVs) were calculated across all clinicians for each eye. Parameter means for each clinician, and intra-class correlation coefficients (ICC), were calculated across all eyes by sector. RESULTS: Among all eyes, the median COV by sector ranged from 3–5% for DM(radius), 20–25% for RM(radius), and 26–30% for RW. Sectoral ICCs for CDR ranged from 0.566 to 0.668. Sectors suspicious for rim thinning by one clinician were frequently overlooked by others. Among 1724 sectors in which at least one clinician was suspicious for rim thinning, (CDR ≥ 0.7), all 5 clinicians’ CDRs were ≥ 0.7 in only 499 (29%) and 2 of the 5 clinicians failed to detect rim thinning (CDR < 0.7) in 442 (26%). CONCLUSION: In this study, glaucoma specialist RM, DM and RW discordance was frequent and substantial even in sectors that were suspicious for rim thinning.

Neoadjuvant chemotherapy (NAC) is increasingly used in the treatment of breast cancer. The time interval from last dose of cytotoxic chemotherapy to surgery (TTS) can vary widely. We aimed to evaluate the effect of TTS on postoperative complications.A retrospective review for women treated with NAC at our institution between January 2011 through December 2016 was performed. Charts were reviewed for postoperative wound complications, and multivariate analysis was performed.455 patients were identified. Median TTS was 30 days (range 11-228). On multivariate analysis, TTS of less than 28 days was associated with 70% higher odds of any wound complication (p 0.05). Increasing age had the strongest association with the presence of any wound complication (p 0.0001). The majority of complications were treated in the outpatient setting (n = 80, 83%).Following NAC for breast cancer, TTS less than 28 days is a risk factor for postoperative wound complications; however, the majority of complications are minor and treated in the outpatient setting. Additional data are needed to determine optimal TTS for oncologic outcomes.

The article describes a conceptual model proposing that aggression in psychiatric facilities may be reduced by designing the physical environment with ten evidence-grounded stress-reducing features. The model was tested in a newer hospital in Sweden having wards with nine of the ten features. Data on two clinical markers of aggressive behavior, compulsory injections and physical restraints, were compared with data from an older facility (replaced by the newer hospital) that had only one stress-reducing feature. Another hospital with one feature, which did not change during the study period, served as a control. The proportion of patients requiring injections declined (p

Background Identifying cognitive and neural mechanisms of decision making in adolescence can enhance understanding of, and interventions to reduce, risky health behaviors in adolescence. Delay discounting, or the propensity to discount the magnitude of temporally distal rewards, has been associated with diverse health risk behaviors, including risky sex. This cognitive process involves recruitment of reward and cognitive control brain regions, which develop on different trajectories in adolescence and are also implicated in real-world risky decision making. However, no extant research has examined how neural activation during delay discounting is associated with adolescents' risky sexual behavior. Purpose To determine whether a relationship exists between adolescents' risky sexual behavior and neural activation during delay discounting. Methods Adolescent participants completed a delay discounting paradigm during functional magnetic resonance imaging (fMRI) scanning, and they reported risky sexual behavior at baseline, 3-, 6-, 9-, and 12-month follow-up time points. Latent growth curve models were employed to determine relationships between brain activation during delay discounting and change in risky sexual behavior over time. Results Greater activation in brain regions associated with reward and cognitive control (caudate, putamen, nucleus accumbens, anterior cingulate, insula, orbitofrontal cortex, inferior frontal gyrus, dorsolateral prefrontal cortex) during delay discounting was associated with lower mean levels of risky sexual behavior but greater growth over the period from baseline to 6 months. Conclusions Neural activation during delay discounting is cross-sectionally and prospectively associated with risky sexual behavior in adolescence, highlighting a neural basis of risky decision-making as well as opportunities for early identification and intervention.

Purpose Perimetric sensitivities become more variable with glaucomatous functional loss. This study examines the extent to which this relation varies between locations, and whether this can be predicted by eccentricity-related differences in spatial summation. Methods Longitudinal series of visual fields from standard automated perimetry were obtained from participants with suspected or extant glaucoma. For each location in the 24-2 visual field, heterogeneous fixed-effects models were fit to the data, assuming that variability increased exponentially as sensitivity decreased. The predicted variability at each location was calculated when sensitivity was either 30 dB or 25 dB. Results Variability significantly increased with damage at all 52 locations. When sensitivity was 30 dB, variability increased with eccentricity, with P = 0.0003. The average SD was 1.54 dB at the four most central locations, versus 1.74 dB at the most peripheral locations. When sensitivity was 25 dB, variability did not vary predictably with eccentricity, with P = 0.340. The average SD was 2.36 dB at the four central locations, versus 2.24 dB at the most peripheral locations. Conclusions The relation between sensitivity and variability differed by eccentricity. Among healthy locations, variability was lower centrally, where the stimulus size is larger than Ricco's area, than peripherally. Among damaged locations, variability did not systematically vary with eccentricity. This could be because Ricco's area expands in glaucoma, such that stimuli were now smaller than this area at all locations.

PURPOSE. To determine if in vivo strain response of the Optic Nerve Head (ONH) to IOP elevation visualized using Optical Coherence Tomography (OCT) video imaging and quantified using novel virtual extensometers was able to be provided repeatable measurements of tissue specific deformations. METHODS. The ONHs of 5 eyes from 5 non-human primates (NHPs) were imaged by Spectralis OCT. A vertical and a horizontal B-scan of the ONH were continuously recorded for 60 seconds at 9Hz (video imaging mode) during IOP elevation from 10 to 30 mmHg. Imaging was repeated over three imaging sessions. The 2D normal strain was computed by template-matching digital image correlation using virtual extensometers. ANOVA F-test (F) was used to compare inter-eye, inter-session, and inter-tissue variability for the prelaminar, Bruch’s membrane opening (BMO), lamina cribrosa (LC) and choroidal regions (against variance the error term). F-test of the ratio between inter-eye to inter-session variability was used to test for strain repeatability across imaging sessions (F(IS)). RESULTS. Variability of strain across imaging session (F=0.7263, p=0.4855) and scan orientation was not significant (F=1.053, p=0.3066). Inter session variability of strain was significantly lower than inter-eye variability (F(IS)=22.63, p=0.0428) and inter-tissue variability (F(IS)=99.33 p=0.00998). After IOP elevation, strain was highest in the choroid (−18.11%, p

PURPOSE: To compare the three-dimensional (3D) morphology of the deep load-bearing structures of the human optic nerve head (ONH) as revealed in vivo by spectral domain optical coherence tomography (SDOCT) with ex vivo quantitative 3D histology. METHODS: SDOCT imaging of the ONH was performed in six eyes from three brain-dead organ donors on life-support equipment awaiting organ procurement (in vivo conditions). Following organ procurement (ex vivo conditions), the eyes were enucleated and underwent a pars plana vitrectomy followed by pressurization to physiologic IOP and immersion fixation. Ex vivo ONH morphology was obtained from high-fidelity episcopic fluorescent 3D reconstruction. Morphologic parameters of the observed ONH canal geometry and peripapillary choroid, as well as the shape, visibility and depth of the lamina cribrosa were compared between ex vivo and in vivo measurements using custom software to align, scale, and manually delineate the different regions of the ONH. RESULTS: There was significant correspondence between in vivo and ex vivo measurements of the depth and shape of the lamina cribrosa, along with the size and shape of Bruch’s membrane opening (BMO) and anterior scleral canal opening (ASCO). Weaker correspondence was observed for choroidal thickness; as expected, a thinner choroid was seen ex vivo due to loss of blood volume upon enucleation (−79.9 %, p

In a series of previous publications we have proposed a framework for conceptualizing the optic nerve head (ONH) as a biomechanical structure. That framework proposes important roles for intraocular pressure (IOP), IOP-related stress and strain, cerebrospinal fluid pressure (CSFp), systemic and ocular determinants of blood flow, inflammation, auto-immunity, genetics, and other non-IOP related risk factors in the physiology of ONH aging and the pathophysiology of glaucomatous damage to the ONH. The present report summarizes 20 years of technique development and study results pertinent to the characterization of ONH connective tissue deformation and remodeling in the unilateral monkey experimental glaucoma (EG) model. In it we propose that the defining pathophysiology of a glaucomatous optic neuropathy involves deformation, remodeling, and mechanical failure of the ONH connective tissues. We view this as an active process, driven by astrocyte, microglial, fibroblast and oligodendrocyte mechanobiology. These cells, and the connective tissue phenomena they propagate, have primary and secondary effects on retinal ganglion cell (RGC) axon and laminar beam and retrolaminar capillary homeostasis that may initially be “protective” but eventually lead to RGC axonal injury, repair and/or cell death. The primary goal of this report is to summarize our 3D histomorphometric and optical coherence tomography (OCT)-based evidence for the early onset and progression of ONH connective tissue deformation and remodeling in monkey EG. A second goal is to explain the importance of including ONH connective tissue processes in characterizing the phenotype of a glaucomatous optic neuropathy in all species. A third goal is to summarize our current efforts to move from ONH morphology to the cell biology of connective tissue remodeling and axonal insult early in the disease. A final goal is to facilitate the translation of our findings and ideas into neuroprotective interventions that target these ONH phenomena for therapeutic effect.

Obesity is a large and growing public health concern, presenting enormous economic and health costs to individuals and society. A burgeoning literature demonstrates that overweight and obese individuals display different neural processing of rewarding stimuli, including caloric substances, as compared to healthy weight individuals. However, much extant research on the neurobiology of obesity has focused on addiction models, without highlighting potentially separable neural underpinnings of caloric intake versus substance use. The present research explores these differences by examining neural response to alcoholic beverages and a sweet non-alcoholic beverage, among a sample of individuals with varying weight status and patterns of alcohol use and misuse. Participants received tastes of a sweet beverage (litchi juice) and alcoholic beverages during fMRI scanning. When controlling for alcohol use, elevated weight status was associated with increased activation in response to sweet taste in regions including the cingulate cortex, hippocampus, precuneus, and fusiform gyrus. However, weight status was not associated with neural response to alcoholic beverages.

Purpose Various global indices are available to summarize results from standard automated perimetry. This study asks which index can detect significant deterioration earliest, for a fixed specificity. Design Comparison of prognostic indices. Methods Two cohorts were tested. A test-retest cohort contained 5 reliable visual fields, within a short interval, from 45 eyes of 23 participants with glaucoma and/or likelihood of developing glaucoma. A separate longitudinal cohort contained 508 eyes from 330 participants, tested on average 13 times. Three global indices were extracted: mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI). For each index we defined a critical P value Crit Index , such that 5% of test-retest series showed significant deterioration with P Index , using artificial "test dates" in random order. Therefore these criteria have 95% specificity over series of 5 tests. The times to detect significant deterioration in the longitudinal cohort were compared using a survival analysis model. Results The median time to detect significant deterioration with MD was 7.3 years (95% confidence interval [CI] 6.8–7.9 years). For VFI, the median was 8.5 years (95% CI 7.9–9.0 years); this comparison had P = .088. For PSD, the median was 10.5 years (95% CI 9.3–11.7 years), slower than MD with P P = .0013) and 107 for PSD ( P = .029). Conclusions MD detected significant deterioration sooner than VFI or PSD. In particular, MD detected more eyes in the first 5 years of their follow-up, which were presumably undergoing more rapid progression.

Objectives: Measure the immediate change in intensive care unit (ICU) family members’ state stress levels from the beginning to the end of a person’s visit to a hospital garden and compare the changes produced by the garden with those associated with spending time in indoor hospital environments intended for respite and relaxation. Background: No previous research has compared the efficacy of different physical environments as interventions to foster stress reduction in family members of ICU patients, a group of hospital visitors known to experience high levels of distress. Method: A convenience sample of 42 ICU patient family (from 42 different families) completed the Present Functioning Visual Analogue Scales (PFVAS) before and after each visit (128 total visits) to a garden, an atrium/café, or ICU waiting room. Results: Stress scores significantly declined (i.e., improved) from the start to the end of a break on all PFVAS subscales ( p < .0001) in both the garden and indoors locations. However, it is noteworthy that garden breaks resulted in significantly greater improvement in the “sadness” scale than breaks in indoor locations ( p = .03), and changes in all five other PFVAS scores showed somewhat more reduction of stress for breaks spent in the garden than indoors, although these differences were not statistically significant. Conclusion: Creating an unlocked garden with abundant nature located close to an ICU can be an effective intervention for significantly mitigating state stress in family members of ICU patients and can be somewhat more effective than indoor areas expressly designed for family respite and relaxation.

Evidence supporting the incorporation of affective constructs, such as affective attitudes and anticipated regret, into theoretical models of health behavior has been mounting in recent years; however, the role of positive anticipated affective reactions (e.g., pride) has been largely unexplored. The purpose of the present investigation was to assess how affective attitudes and anticipated affective reactions (both pride and regret for performing a behavior or not) may provide distinct utility for understanding intentions to perform health-promoting and health risk behaviors over and above cognitive attitudes and other established theoretical constructs from the theory of planned behavior (TPB). Participants (N = 210) were recruited via Amazon's Mechanical Turk to complete a one-time online battery assessing TPB and affective constructs. Self-reported intentions served as the main outcome measure, and hierarchical linear modeling was used to examine the effects of TPB and affective constructs across behaviors. Controlling for TPB constructs, more positive affective attitudes and greater anticipated regret, but not anticipated pride, predicted intentions to engage in future health behaviors. Anticipated affective reactions contributed explanatory variance for intentions to perform health risk behaviors, but anticipated pride and regret were not associated with intentions to perform health risk behaviors. Contributions made via the inclusion of both positively and negatively valence anticipated affective reactions for both action and inaction (performing a behavior or not) across a range of health promoting and health risk behaviors are discussed, as well as implications for future intervention work.

Author(s): Yang, Hongli; Luo, Haomin; Gardiner, Stuart K; Hardin, Christy; Sharpe, Glen P; Caprioli, Joseph; Demirel, Shaban; Girkin, Christopher A; Liebmann, Jeffrey M; Mardin, Christian Y; Quigley, Harry A; Scheuerle, Alexander F; Fortune, Brad; Chauhan, Balwantray C; Burgoyne, Claude F | Abstract: Purpose:To quantify peripapillary choroidal thickness (PCT) and the factors that influence it in healthy participants who represent the racial and ethnic composition of the U.S. population. Methods:A total of 362 healthy participants underwent optical coherence tomography (OCT) enhanced depth imaging of the optic nerve head with a 24 radial B-scan pattern aligned to the fovea to Bruch's membrane opening axis. Bruch's membrane, anterior scleral canal opening (ASCO), and the anterior scleral surface were manually segmented. PCT was measured at 100, 300, 500, 700, 900, and 1100 μm from the ASCO globally and within 12 clock-hour sectors. The effects of age, axial length, intraocular pressure, ethnicity, sex, sector, and ASCO area on PCT were assessed by ANOVA and univariable and multivariable regressions. Results:Globally, PCT was thicker further from the ASCO border and thinner with older age, longer axial length, larger ASCO area, European descent, and female sex. Among these effectors, age and axial length explained the greatest proportion of variance. The rate of age-related decline increased further from the ASCO border. Sectorally, the inferior-temporal sectors were thinnest (10.7%-20.0% thinner than the thickest sector) and demonstrated a higher rate of age-related loss (from 15.6% to 20.7% faster) at each ASCO distance. Conclusions:In healthy eyes, PCT was thinnest in the inferior temporal sectors and thinner PCT was associated with older age, European descent, longer axial length, larger ASCO area, and female sex. Among these associations, age had the strongest influence, and its effect was greatest within the inferior temporal sectors.

PurposeTo assess anterior scleral canal opening (ASCO) offset relative to Bruch's membrane opening (BMO) (ASCO/BMO offset) so as to determine neural canal direction, obliqueness, and minimum cross-sectional area (NCMCA) in 362 healthy eyes.DesignCross-sectional study.MethodsAfter optical coherence tomography optic nerve head and retinal nerve fiber layer thickness (RNFLT) imaging, BMO and ASCO were manually segmented. Planes, centroids, size, and shape were calculated. Neural canal direction was defined by projecting the neural canal axis vector (connecting BMO and ASCO centroids) onto the BMO plane. Neural canal obliqueness was defined by the angle between the neural canal axis and the BMO plane perpendicular vector. NCMCA was defined by projecting BMO and ASCO points onto a neural canal axis perpendicular plane and measuring the area of overlap. The angular distance between superior and inferior peak RNFLT was measured, and correlations between RFNLT, BMO, ASCO, ASCO/BMO offset, and NCMCA were assessed.ResultsMean (SD) NCMCA was significantly smaller than either the BMO or ASCO area (1.33 (0.42), 1.82 (0.38), 2.22 (0.43) mm2, respectively), and most closely correlated to RNFLT (P < .001, R2= 0.158). Neural canal direction was most commonly superior-nasal (55%). Mean neural canal obliqueness was 39.4° (17.3°). The angular distance between superior and inferior peak RNFLT correlated to neural canal direction (P ≤ .008, R2= 0.093).ConclusionsASCO/BMO offset underlies neural canal direction, obliqueness, and NCMCA. RNFLT is more strongly correlated to NCMCA than to BMO or ASCO, and its peripapillary distribution is influenced by neural canal direction.

In clinic, “deep” vs. “shallow” cupping is well established in human glaucoma. Our central hypothesis is that the “shallow” or senile sclerotic cupping of aged eyes is a manifestation of their stiffer connective tissues. We predicted that there are age-related differences in structure/function relationships. The relationship between the magnitude of laminar deformation and visual field loss will be different in young (“compliant”) eyes compared to old (“stiff”) eyes.