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Embedded validity indicators (EVIs) derived from motor tests have received less empirical attention than those derived from tests of other neuropsychological abilities, particularly memory. Preliminary evidence suggests that the Grooved Pegboard Test (GPB) may function as an EVI, but existing studies were largely conducted using simulators and population samples without cognitive impairment. In this study we aimed to evaluate the GPB’s classification accuracy as an EVI among a mixed clinical neuropsychiatric sample with and without cognitive impairment. This cross-sectional study comprised 223 patients clinically referred for neuropsychological testing. GPB raw and T-scores for both dominant and nondominant hands were examined as EVIs. A known-groups design, based on ≤1 failure on a battery of validated, independent criterion PVTs, showed that GPB performance differed significantly by validity group. Within the valid group, receiver operating characteristic curve analyses revealed that only the dominant hand raw score displayed acceptable classification accuracy for detecting invalid performance (area under curve [AUC] = .72), with an optimal cut-score of ≥106 seconds (33% sensitivity/88% specificity). All other scores had marginally lower classification accuracy (AUCs = .65–.68) for differentiating valid from invalid performers. Therefore, the GPB demonstrated limited utility as an EVI in a clinical sample containing patients with bona fide cognitive impairment.

Embedded performance validity tests (PVTs) are key components of neuropsychological evaluations. However, most are memory-based and may be less useful in the assessment of attention-deficit/hyperactivity disorder (ADHD). Four non-memory-based validity indices derived from processing speed and executive functioning measures commonly included in ADHD evaluations, namely Verbal Fluency (VF) and the Trail Making Test (TMT), were cross-validated using the Rey 15-Item Test (RFIT) Recall and Recall/Recognition as memory-based comparison measures. This consecutive case series included data from 416 demographically-diverse adults who underwent outpatient neuropsychological evaluation for ADHD. Validity classifications were established, with ≤1 PVT failure of five independent criterion PVTs as indicative of valid performance (374 valid performers/42 invalid performers). Among the statistically significant validity indicators, TMT-A and TMT-B T-scores (AUCs = .707-.723) had acceptable classification accuracy ranges and sensitivities ranging from 29%-36% (≥89% specificity). RFIT Recall/Recognition produced similar results as TMT-B T-score with 42% sensitivity/90% specificity, but with lower classification accuracy. In evaluating adult ADHD, VF and TMT embedded PVTs demonstrated comparable sensitivity and specificity values to those found in other clinical populations but necessitated alternate cut-scores. Results also support use of RFIT Recall/Recognition over the standard RFIT Recall as a PVT for adult ADHD evaluations.

This study investigated the utility of four Stroop Color and Word Test (SCWT) indices, including the raw score and T score for the word reading (WR) and color naming (CN) trials, as embedded performance validity tests (PVTs) within a sample referred for evaluation of suspected or known attention-deficit/hyperactivity disorder (ADHD). Data were analyzed from a final sample of 317 patients consecutively referred for ADHD evaluation, which was divided into groups with invalid (

This study investigated the utility of four WAIS-IV Digit Span (DS) indices (traditional Reliable Digit Span [RDS], RDS-Working Memory [RDS-WM], RDS-Revised [RDS-R], and DS Age-Corrected Scaled Score [ACSS]) as embedded performance validity tests (PVTs) among a sample of 342 consecutive adults referred for neuropsychological evaluation of ADHD. All DS indices had acceptable classification accuracy (areas under the curve: .73–.76) for detecting invalid performance with optimal cut-scores of RDS ≤7 (35% sensitivity/93% specificity), RDS-WM ≤7 (56% sensitivity/86% specificity), RDS-R ≤12 (48% sensitivity/85% specificity), and ACSS ≤7 (46% sensitivity/87% specificity). Although all indices were able to detect invalid performance, DS indices incorporating the more complex working memory trials of the task yielded the best accuracy for identification of invalid test performance among adults referred for ADHD evaluation.

Neuropsychology trainees have identified mentorship as an important factor in their training. Limited past work has been conducted on mentorship within neuropsychology, and there is a need to better understand the experiences and perspectives of neuropsychology mentors.Self-identified mentors in clinical neuropsychology completed a survey about their mentorship practices, including culturally responsive mentorship, as well as perceived barriers and challenges to providing effective mentorship. Themes were derived using qualitative analyses for free response questions, and descriptive statistics were calculated for quantitative variables.Mentors identified assessment, professionalism, and ethics as top priorities in mentorship, which may reflect the overlap within neuropsychology of assessment supervision and mentoring. Reported best practices included being self-aware and engaging in a personalized approach to mentorship relationships that varies depending upon the needs of the mentee. A majority reported that their training program is not diverse and they themselves do not mentor trainees from diverse backgrounds which provides a clear area for targeted efforts to recruit and retain diversity in the discipline. Mentors described practices related to discussing diversity-related differences with their trainees including self-disclosure, creating a safe space for conversations, and tailoring discussions to the individual trainee. They reported an interest in more training on how to engage in culturally competent mentorship. Two barriers to providing effective mentorship identified most by mentors were time constraints and a lack of training.These results highlight a variety of perspectives and approaches to mentorship, which may be beneficial for mentors to consider as they reflect on their mentorship practices and/or for trainees as part of their professional development toward becoming future mentors themselves. These results also highlight the need for a greater emphasis on mentorship training within neuropsychology, including training in culturally responsive mentorship practices.

OBJECTIVE Abundant evidence documents stereotype threat's (ST) detrimental effect on test performance across identities and contexts (i.e., eliciting underperformance). Review of the literature shows varied aspects of both stereotyped identities and cognition are inconsistently explored across studies. Only a portion of the literature focuses on ST's impact on Black, Indigenous, and People of Color (BIPOC). It is important to understand and learn to mitigate ST, particularly for historically marginalized and systemically oppressed BIPOC patients. Relevance exists for neuropsychologists, who engage in activities (i.e., assessments) that may activate ST, and should be aware of additional factors impacting testing results and clinical decision making. METHOD Using scoping review criteria (Peters et al., 2015) and Preferred Reporting Item for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we reviewed literature across multiple databases (Google Scholar, PubMed, PsychINFO) on ST and cognition with a focus on BIPOC. RESULTS The current literature suggests that race-based ST may be implicated in underperformance for executive functioning and separately working memory. There is limited research on the effects of ST for memory, language, attention, and visuospatial skills. CONCLUSION Research on ST requires additional attention to establish interventions to mitigate negative effects in practice. These results provide 1) an overview of the cognitive implications of ST, 2) address the scope of this impact for BIPOC, and 3) provide possible intervention and training strategies for neuropsychologists and other clinicians to work to mitigate the effects of ST on BIPOC.

Food bolus impaction can be a manifestation of chronic untreated inflammation in those with underlying eosinophilic esophagitis (EoE). The eosinophil predominant inflammation of the esophagus is associated with a higher prevalence of fibrosis when it remains undetected and untreated. Non-malignant food bolus impaction is strongly associated with an underlying diagnosis of EoE, but outside of gastroenterology and other esophageal interested specialists there remains poor understanding of how to diagnose and manage this condition. We conducted a retrospective study of patients presenting to a tertiary emergency unit with esophageal food bolus impaction between November 2018 and May 2021. Electronic attendance records and the endoscopy database were examined to determine the associations between demographics, comorbidities, endoscopic findings, biopsy findings and follow up. We also evaluated the effect of the pandemic on food bolus management with statistical analysis undertaken using IBM SPSS software. Of the 938 patients who presented to the emergency department with food bolus impaction, 83.6% were sent home with no follow up. Only 7.2% went on to have an endoscopy. In those with macroscopic evidence of inflammation, only 35.8% of patients had the correct number of biopsies taken to establish a histological cause for their symptoms. 1.6% of patients demonstrated histological evidence of EoE, of whom 80% were male and 20% female. The COVID-19 lockdown did not negatively impact access to endoscopy with mean wait time improving from 121-days prior to lockdown compared to 69-days during lockdown, p Our findings highlight significant shortcomings in the management of those presenting emergently with food bolus impaction and possible undiagnosed EoE. There remains a need for clear management pathways to aid risk-stratification, discharge planning and endoscopic practices in the diagnosis of EoE. We therefore propose an algorithm for food bolus management to facilitate early endoscopy, effective diagnosis, and appropriate follow-up, ensuring optimal management for patients with non-malignant dysphagia requiring emergency admission for resolution of food impaction.

Ondansetron is an FDA-approved selective serotonin 5-HT3 receptor commonly indicated as an anti-emetic agent for nausea and vomiting. It is rare to observe fatal reactions from ondansetron despite having no allergies or previous exposure. We report a case of anaphylactoid reaction with spontaneous coronary vasospasms in response to intravenous ondansetron.

BackgroundThe search for a single, pathogenic genetic variant in a patient suspected to have a monogenic inborn error of immunity (IEI) often reveals a multitude of rare variants of unknown significance (VUS). Distinguishing which VUS is disease-causing versus the irrelevant, rare variants from the genetic background is slow and difficult. Advances in gene editing technology, particularly CRISPR/Cas9, promise to accelerate the timeline for the development of single-variant animal models, thus affording an experimental system for validating new genes and their variants.ObjectiveWe sought to demonstrate a proof-of-concept of using CRISPR/Cas9 in human hematopoietic stem cells (hHSC) to develop of humanized mice bearing a hematopoietic deficiency in signal transducer and activator 1 (STAT1).MethodsUsing CRISPR/Cas9, we introduced indels into the STAT1 gene of hHSCs and implanted them into immunodeficient mice. The reconstituted immune systems were assessed by flow cytometry.ResultsMice transplanted with cells edited to eliminate STAT1 developed human immune systems with diverse cell phenotypes. Lymphocytes from these reconstituted mice showed low expression of STAT1 protein and diminished phosphorylation of STAT1 in response to interferon stimulation. These data mirror the impaired, but not abolished, response to interferons seen in human partial STAT1 deficiency. CRISPR/Cas9 genome editing techniques can be used to rapidly and inexpensively create functional, humanized models of primary immune deficiencies.

African American individuals living with HIV and serious mental illness (SMI) may report relatively low treatment engagement, despite treatment engagement being critical to managing both health conditions. Here, we have two aims: to describe the methodology we used to collect focus group data on treatment engagement with a sample of African American individuals living with HIV and SMI, and to describe the results of those focus groups in the context of intervention development. We conducted two focus groups (

This study examined the utility of dichotomous versus dimensional scores across two measures of social determinants of health (SDOH) regarding their associations with cognitive performance and psychiatric symptoms in a mixed clinical sample of 215 adults referred for neuropsychological evaluation ( Mage = 43.91, 53.5% male, 44.2% non-Hispanic White). Both dimensional and dichotomous health literacy scores accounted for substantial variance in all cognitive outcomes assessed, whereas dimensional and dichotomous adverse childhood experience scores were significantly associated with psychiatric symptoms. Tests of differences between correlated correlations indicated that correlations with cognitive and psychiatric outcomes were not significantly different across dimensional versus dichotomous scores, suggesting that these operationalizations of SDOH roughly equivalently characterize risk of poorer cognitive performance and increased psychiatric symptoms. Results highlight the necessity of measuring multiple SDOH, as different SDOH appear to be differentially associated with cognitive performance versus psychiatric symptoms. Furthermore, results suggest that clinicians can use cut-scores when characterizing patients’ risk of poor cognitive or psychiatric outcomes based on SDOH.

Objective: Being admitted to a psychiatric ward can be a distressing and confusing experience. Our objective was to develop and pilot a Timeline Tool as a way of supporting service users in developing a narrative of their experiences in the run up to admission. Method: We designed and piloted a ‘Timeline of Crisis Tool’ with 50 service users, incorporating a card sort exercise, comprising eight factors relevant to people’s experiences in the run up to a crisis admission. We asked service users for feedback on the experience of completing the Timeline Tool. Results: Service user feedback indicated advantages of completing the Timeline Tool in terms of feeling listened to and respected, reflecting and making sense of experiences. Discussion: Collaborative completion of the Timeline Tool on admission could help foster good service user-staff relationships. Information arising from the completed tool could be used to increase shared decision-making in the development of care plans during inpatient admissions.

Bacteria-based self-healing concrete can be made more efficient by using immobilization techniques, hence shielding the bacteria from crushing during mixing to remain dormant till the development of concrete cracks for the uniform healing of developed cracks. In this study, two intrusion approaches, direct induction and immobilization, are deliberated by using ‘Bacillus subtilis’ bacteria for self-healing concrete. Furthermore, for immobilization’s evaluation, two media namely iron oxide nano/micro particles (INMPs) and bentonite nano/micro particles (BNMPs) were selected. Compressive and tensile strengths were computed at 3, 7 and 28 days. Moreover, field emission scanning electron microscopy (FESEM), X-ray diffraction (XRD), X-ray fluorescence (XRF) and thermo-gravimetric analysis (TGA) were employed for monitoring self-healing efficiency. Results revealed that immobilization through INMPs media was best among all intrusions ensuing successive healing of cracks up to 1.2 mm width having 85% recovery in compressive strength after pre-cracking. Whereas, BNMPs immobilization and direct induction exhibited crack healings up to only 0.15 mm and 0.45 mm crack healing widths with 45% and 65% strength recovery, respectively.

Objective: Increasing evidence suggests that adverse childhood experiences (ACEs) predict neurocognitive dysfunction, possibly through direct (e.g., brain structure/function changes) and indirect (e.g., increased psychopathology risk) pathways. However, extant studies have focused on young and older adults, with limited understanding as to how ACEs affect cognitive health in mid-adulthood. Therefore, this study compared adults with high vs. low ACE scores on measures of cognitive performance and psychopathology. Method: This cross-sectional study included 211 adult patients (46.9% female; Mage = 44.9, SD = 17.1; Meducation = 13.8, SD = 3.0) consecutively referred for outpatient neuropsychological evaluation within a large, Midwestern academic medical center. A series one-way analysis of variances (ANOVAs) were conducted to compare high vs. low ACE groups on the Test of Premorbid Functioning (TOPF), Digit Span (DS), Trail Making Test-Part B (TMT-B), Rey Auditory Verbal Learning Test (RAVLT; Immediate and Long Delayed Recall), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI) scores. Results: Significant group differences were detected for BDI-II and BAI scores, F(1,159) = 18.38, p.05. Non-significant cognitive measure findings cannot be attributed to group differences in premorbid functioning, as TOPF score also did not significantly differ by ACE group, p > 0.05. Conclusions: Results of this investigation suggest that greater ACEs increase risk of depression and anxiety, but not neurocognitive dysfunction, in adulthood.

Objective: Health literacy and numeracy are commonly associated with health disparities and may disproportionately affect minoritized groups. This study assessed racial disparities in health literacy and numeracy and their association to sociodemographic and psychological risk factors among a mixed clinical outpatient sample. Method: Cross-sectional data from 198 patients who were administered the General Health Numeracy Test-Short Form (GHNT), Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), Adverse Childhood Experiences Checklist (ACE), Perceived Stress Scale (PSS), and Test of Premorbid Functioning-Predicted FSIQ (TOPF-FSIQ) were examined. Participant characteristics were compared by ethnoracial group status via chi-square and ANOVA tests. Multivariate regression models evaluated associations between health literacy and numeracy with sociodemographic and psychological risk factors across ethnoracial groups. Results: Subjects were 45% female/55% male, 48% White, 38% Black and 14% Hispanic, with a Mage of 44.7 (SD = 17.3) and Meducation of 13.5 years (SD = 2.8). Black subjects were older, less educated, and had lower TOPF-FSIQ than White subjects, whereas Hispanic subjects were younger with lower TOPF-FSIQ than White subjects. Black subjects had lower GHNT-6 and REALM-R scores than White subjects. No group differences in ACE or PSS were observed. In multivariate analyses, only lower TOPF-FSIQ was significantly associated with lower REALM-R, whereas lower TOPF-FSIQ, older age, and higher ACEs were significantly associated with lower GHNT. No significant interactions with ethnoracial group status were observed. Conclusion(s): Although health literacy and numeracy differed across ethnoracial groups, this effect was driven by lower TOPF-FSIQ for health literacy, in addition to lower age and higher number of adverse childhood experiences for health numeracy.

Objective: Socially-inclusive food policies impact more than physical health, namely, psychological and cognitive well-being. We will provide a comprehensive review and visual relationship of mechanisms by which sociocultural factors (via socially-inclusive food policies), impact lifelong mental/cognitive health. The relationship between diet and cognitive/mental health has implications for systematically disadvantaged communities. Methods: Inclusion criteria: empirical studies published between 1995-2021 in English peer reviewed journals that included/addressed the impact of nutrition on mental health and/or cognition, searched for through electronic databases (e.g., Google Scholar). Keywords: terms related to nutrition (e.g., food policy, microbiome), cognition (e.g., neuropsychology, memory), development (e.g., perinatal, prenatal, older adulthood), mental health (e.g., stress, psychological outcomes). Results: Access to food, or the lack thereof, can play a significant role in mental health and cognitive outcomes. However, the relationship between food policies and mental health is at least as complex as the relationship between food insecurity and mental stress. Specifically, the microbiota-gut-brain axis (MGB axis) shows increasing evidence linking the human microbiome to clinical psychopathology. Conclusion: What we eat, and thereby food policies that impact what we eat and what access we have to food, significantly impact cognition and mental health via multiple mechanisms. Responses related to the MGB axis (e.g., inflammation, cerebro/cardiovascular diseases) are associated with poorer outcomes, especially in marginalized communities with limited access to healthy food and higher rates of risk factors due to systemic discrimination and inequities. Nutritional interventions and addressing nutritional deficits serve as one modifiable way to potentially prevent and reduce the severity of cognitive and mental health symptoms.

Objective: The study aimed to examine the use of dichotomous versus dimensional scores across two social determinant measures regarding their ability to predict cognitive and psychiatric outcomes in a diverse, urban, clinical sample. The goal was to better guide clinicians in the selection of appropriate research methodology pertaining to the use of cut-scores versus dimensional constructs. Method: The study included 215 adults referred for outpatient neuropsychological evaluation. Patients were classified into at-risk/low-risk groups based on predetermined Rapid Estimate of Adult Literacy in Medicine - Revised (REALM-R) and Adverse Childhood Experiences (ACE) cut-scores. Nine cognitive tests and two psychiatric self-report scales were administered. A series of hierarchical regression models were conducted to investigate the predictive power of dichotomous scores alone, and account for the incremental predictive power of dimensional scores. Results: For REALM-R, dichotomous scores alone accounted for significant variance, demonstrating robust predictive power across all cognitive tests (p Conclusion: This study demonstrated the robust predictive power of dichotomous scores in REALM-R and ACE. Further, dimensional scores provided potent incremental predictive power for REALM-R and should be used to enhance clinical decision-making when applicable.

Objective: Previous research suggests that literacy level may be a better predictor of cognitive performance than years of education in minoritized groups. Although literacy tests remain a mainstay in the context of neuropsychological evaluations due to their role in the estimation of premorbid intellectual functioning, there is relatively little research examining the role of literacy in the relationship between ethnicity and cognitive performance. This study examined whether literacy level influences the relationship between ethnicity and letter fluency ability. Method: This cross-sectional study included 64 adult patients consecutively referred for outpatient neuropsychological evaluation within a large, Midwestern academic medical center. The sample was 54.7% male, 43.8% White, 56.3% Black, with Mage of 57.8 years (SD=11.7) and Meducation of 12.6 years (SD=2.5). A mediation analysis was performed using Hayes’ PROCESS macro within SPSS to evaluate whether literacy, as measured by the Test of Premorbid Functioning (TOPF), mediated the association between ethnicity (dichotomized as Black/White) and letter fluency via raw scores from the F/A/S trials. Results: The main model of the mediation analysis was significant, F (4, 51) = 13.89, p Conclusion(s): In sum, this study provided evidence that literacy level helps explain the letter fluency performance differences observed between Black and White patients.

OBJECTIVES Primary pancreatic signet ring cell carcinoma (SRCC) is a rare histologic variant of pancreatic carcinoma. A population-based analysis of pancreatic SRCC was performed to determine the predictive effects of epidemiological factors and treatment interventions on overall survival (OS) and disease-specific survival (DSS). MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results registry was searched for pancreatic SRCC cases diagnosed between January 1, 1973 and December 31, 2013. Statistical analysis was performed using the Fisher exact test, χ(2) analysis, Kaplan-Meier method, log-rank test, and Cox proportional hazards regression. RESULTS The mean age among 497 patients was 66.6 years (SD, 11.9). Most patients were white (82.7%) and male (54.5%). The 1-, 2-, and 5-year OS rates were 17%, 9%, and 4%, respectively, while the corresponding 1-, 2-, and 5-year rates for DSS were 18%, 10%, and 5%, respectively. On univariable analysis; age, site, grade, stage, and treatment were predictive of OS and DSS (P

Background Acetabular osteolysis is a major complication of total hip arthroplasty. It is caused in part by wear debris. It has been suggested that this debris can migrate through screw holes in the acetabular component. Solid-backed components have been used to prevent this migration and reduce osteolysis. Newer materials, however, have reduced wear debris. This study aimed to evaluate whether using solid-backed instead of cluster-hole components actually reduces osteolysis. This could open up the possibility of screws being used for greater stability where required. Methods This prospective trial randomized 100 patients undergoing cementless total hip arthroplasty to receive either cluster-hole or solid-backed acetabular components. A cementless cup and highly cross-linked polyethylene was used in all patients. Computed tomography, performed at 5 and 10 years after surgery, was assessed by a blinded radiologist for the presence of osteolysis. Results Of the 100 patients, 14 required screws for stability, and so were moved into a third “screw” group for per-protocol analysis. At 10 years after surgery, osteolytic lesions were discovered in 18.2% of patients. There was no difference in incidence or volume of osteolysis between patients with cluster-hole acetabular components and those with solid-backed components. Conclusion This study reveals a low number of patients with osteolytic lesions 10 years after total hip arthroplasty performed with a modern cup design and highly cross-linked polyethylene liner. There was no clear benefit to using solid-backed acetabular components. Cluster-hole components, however, offer the option of screw augmentation when required.

Objective Attentional difficulties are known to negatively impact learning (Hervey et al., 2004; Alderson et al., 2013). This study builds upon previous work examining the effect of sustained visual attention as a moderator of age and learning (Thomas et al., 2019) by examining performance on an auditory attention measure as a moderator of the relationship between age and performance on a verbal list-learning task. Method Archival data from 424 adults (Mage = 36.01, SD = 15.13) were collected at an outpatient clinic. Auditory attention was assessed via the Brief Test of Attention (BTA) raw score. Learning was assessed via the California Verbal Learning Test (CVLT-II) total T-Score (Trials 1–5). Results Results of a hierarchical linear regression indicated a significant effect between BTA and learning, (β = 0.287, F(1, 422) = 17.993, p Conclusion Sustained attention has been shown to be an important consideration when assessing verbal learning and memory performance. Present results demonstrate that when accounting for age, auditory attention is a significant positive predictor of performance on measures of verbal learning. Additionally, confirming prior research, performances on auditory attention and verbal learning measures are positively correlated.

Background and Hypothesis: The circadian rhythm disruption due to shift work results in a range of disorders such as metabolic disturbances, obesity, cardiovascular diseases, and insulin resistance. Interestingly, the core clock gene Brain and Muscle ARNT-Like 1 (Bmal1), is dysfunctional in shift workers. We reasoned dysfunctional Bmal will affect normal vision function. To do so, a genetically modified mouse with disrupted Bmal was assessed for visual function. We hypothesized that Bmal knockout mice will exhibit reduced retinal functions such as impaired acuity, accommodation, and tracking. Experimental Design or Project Methods: The Bmal+/- mice were inbred and genotyped to obtain wild-types (WT), Bmal+/-, and Bmal-/-. To assess the retinal function, we performed electroretinogram (ERG) recordings at the zeitgeber times (ZT) of 0, 6, 12, and 18 which correspond to 7 AM, 1 PM, 7 PM, and 1 AM, respectively, under both scotopic and photopic conditions. The optokinetic response (OKR) assessments were measured in between ZT-3-ZT7. Results: Consistent with previous studies, the ‘a’ wave and ‘b’ wave amplitudes of WT mice demonstrated a circadian rhythm under scotopic condition. There was a decrease in ERG amplitude of Bmal+/-, and Bmal-/- when compared to the WT group. Under photopic conditions, the circadian peak of ERG amplitude was reversed for Bmal-/- when compared to both WT and Bmal+/- mice. The OKR assessment was decreased substantially for Bmal+/- (0.3748c/d), and Bmal-/- (0.3130c/d) as compared to the WT mice (0.4827c/d). Conclusion and Potential Impact: Our studies demonstrate that the loss of Bmal leads to vision dysfunction possibly due to impaired rod and cone function. Furthermore, by using a mouse model of circadian rhythm dysfunction, we identified that individuals working on irregular shifts might be vulnerable to vision dysfunction, and our studies warrant timely testing of visual function and strategies for prevention of vision problems in shift workers.

We report a case of metallosis following a shoulder hemiarthroplasty with a humeral component resurfacing shoulder replacement.

Acetabular osteolysis has been linked to polyethylene debris that is generated in the hip migrating through screw holes in the acetabular component. Solid-backed acetabular components were designed to decrease this osteolysis. This prospective trial randomized 100 patients undergoing total hip arthroplasty to either a solid-backed or a cluster-hole acetabular component-all without screws. At 5years post-surgery, 34.4% of all patients had osteolytic lesions that were visible on CT. There was no significant difference in either presence or volume of the osteolytic lesions, cup migration or functional outcomes (OHS) between the groups. There may no longer be a detriment to using cluster-hole cups instead of solid cups in all hips. This would then give the surgeon the option to use screws for stability as required.