Objective To evaluate the association of subretinal hyper-reflective material (SHRM) with visual acuity (VA), geographic atrophy (GA) and scar in the Comparison of Age related Macular Degeneration Treatments Trials (CATT) Design Prospective cohort study within a randomized clinical trial. Participants The 1185 participants in CATT. Methods Participants were randomly assigned to ranibizumab or bevacizumab treatment monthly or as-needed. Masked readers graded scar and GA on fundus photography and fluorescein angiography images, SHRM on time domain (TD) and spectral domain (SD) optical coherence tomography (OCT) throughout 104 weeks. Measurements of SHRM height and width in the fovea, within the center 1mm2, or outside the center 1mm2 were obtained on SD-OCT images at 56 (n=76) and 104 (n=66) weeks. VA was measured by certified examiners. Main Outcome Measures SHRM presence, location and size, and associations with VA, scar, and GA. Results Among all CATT participants, the percentage with SHRM at enrollment was 77%, decreasing to 68% at 4 weeks after treatment and 54% at 104 weeks. At 104 weeks, scar was present more often in eyes with persistent SHRM than eyes with SHRM that resolved (64% vs. 31%; p<0.0001). Among eyes with detailed evaluation of SHRM at weeks 56 (n=76) and 104 (n=66), mean [SE] VA letter score was 73.5 [2.8], 73.1 [3.4], 65.3 [3.5], and 63.9 [3.7] when SHRM was absent, present outside the central 1mm2, present within the central 1mm2 but not the foveal center, or present at the foveal center (p=0.02). SHRM was present at the foveal center in 43 (30%), within the central 1mm2 in 21 (15%) and outside the central 1mm2 in 19 (13%). When SHRM was present, the median maximum height in microns under the fovea, within the central 1 mm2 including the fovea and anywhere within the scan was 86; 120; and 122, respectively. VA was decreased with greater SHRM height and width (p<0.05). Conclusions SHRM is common in eyes with NVAMD and often persists after anti-VEGF treatment. At 2 years, eyes with scar were more likely to have SHRM than other eyes. Greater SHRM height and width were associated with worse VA. SHRM is an important morphological biomarker in eyes with NVAMD.

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In the antebellum Natchez district, in the heart of slave country, black people sued white people in all-white courtrooms. They sued to enforce the terms of their contracts, recover unpaid debts, recuperate back wages, and claim damages for assault. They sued in conflicts over property and personal status. And they often won. Based on new research conducted in courthouse basements and storage sheds in rural Mississippi and Louisiana, Kimberly Welch draws on over 1,000 examples of free and enslaved black litigants who used the courts to protect their interests and reconfigure their place in a tense society. To understand their success, Welch argues that we must understand the language that they used—the language of property, in particular—to make their claims recognizable and persuasive to others and to link their status as owner to the ideal of a free, autonomous citizen. In telling their stories, Welch reveals a previously unknown world of black legal activity, one that is consequential for understanding the long history of race, rights, and civic inclusion in America.

This study examined the relative importance of children's feeding skills and abilities and mothers' psychological state regarding their child's diagnostic status in predicting the observed quality of mother-child interaction during a naturalistic feeding situation. The study subjects were 69 children with cerebral palsy (CP), aged 14 to 53 months, and their mothers. Functional impairments of the children ranged from mild to severe. Mother-child interaction was observed during 20 minutes of feeding and was scored using global ratings of mothers' and children's socioemotional behavior. In addition, mothers' feeding interactions were dichotomously coded for sensitive and responsive behaviors. Children's feeding skills and abilities were assessed by maternal report and by observation. Mothers' resolution of grief associated with the child's diagnosis was assessed using standardized interview procedures. The findings strongly indicate that, contrary to expectations, the mothers' resolution status was not related to qualities of the feeding interactions (either dyadic or mothers' behavior) and that feeding interactions are best predicted for children with CP by their skills and abilities. The results are discussed in relation to the nature, determinants, and consequences of feeding in children with and without disabilities.

The challenge of modernizing the current force of military combat systems is one of competing priorities. While planning for future capability requirements and modernization efforts, military acquisition program managers must also consider the immediate demands from the field as the United States is engaged on multiple fronts. These competing demands, along with the challenge of managing large groups of complex systems, motivate the need for an expedient and repeatable systems engineering process. The U.S. Army's Program Executive Office for Ground Combat Systems developed such an approach to support analysis of acquisition programs to meet future capability needs. This paper describes the systems engineering approach and illustrates its usefulness.

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This chapter demonstrates that one of the main rhetorical tactics exploited by black litigants in the antebellum Natchez district was to leverage the cultural scripts of reputation in court proceedings. African Americans strategically deployed the language of reputation to gain a measure of autonomy over their lives. On certain occasions, such language could not only bolster their credibility, it could even curtail white authority. For black litigants, a reputation was not just a thing that one had; it was also a malleable package of linguistic possibilities one claimed or manipulated. An individual’s reputation symbolized the community’s assessment and opinion about that person, certainly; but it also entailed a language that one could leverage or deploy.