Cognitive abilities and engagement in advance care planning among older adults: Results of a Swiss populational study.

Individuals often wait until the last moment to plan their end-of-life (EOL) care. Yet, decision-making capacity decreases with age, which could compromise engagement in and the effectiveness of advance care planning (ACP). Little is known about the association between cognitive abilities and the steps involved in the multifaceted process of ACP in older adults. The present study aims to better understand the association of global cognitive competence with engagement in ACP in a nationally representative sample of older adults in Switzerland. Global cognitive competence was measured via verbal fluency, immediate and delayed memory, basic calculation skills, and temporal orientation. Engagement in ACP included approving advance directives, having discussed EOL preferences, having a living will, and having a health care proxy. We analyzed data of 1,936 respondents aged 55+ from a paper-and-pencil questionnaire that was administered as part of Wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe in Switzerland using logistic regression models. Respondents with reduced global cognitive competence are less likely to have discussed their EOL preferences with others and to have a living will. Our results also indicate an interaction between age and cognition with respect to having a living will. Individuals with lower global cognitive competence in the oldest age group-adults aged 75 and older-are less likely to have a living will. Our findings highlight that low global cognitive competence can be seen as a barrier to engagement in ACP, particularly among adults 75 years and older. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Eleven strategies for making reproducible research and open science training the norm at research institutions.

Reproducible research and open science practices have the potential to accelerate scientific progress by allowing others to reuse research outputs, and by promoting rigorous research that is more likely to yield trustworthy results. However, these practices are uncommon in many fields, so there is a clear need for training that helps and encourages researchers to integrate reproducible research and open science practices into their daily work. Here, we outline eleven strategies for making training in these practices the norm at research institutions. The strategies, which emerged from a virtual brainstorming event organized in collaboration with the German Reproducibility Network, are concentrated in three areas: (i) adapting research assessment criteria and program requirements; (ii) training; (iii) building communities. We provide a brief overview of each strategy, offer tips for implementation, and provide links to resources. We also highlight the importance of allocating resources and monitoring impact. Our goal is to encourage researchers - in their roles as scientists, supervisors, mentors, instructors, and members of curriculum, hiring or evaluation committees - to think creatively about the many ways they can promote reproducible research and open science practices in their institutions.

Association between multiple chronic conditions and insufficient health literacy: cross-sectional evidence from a population-based sample of older adults living in Switzerland.

BACKGROUND: Health literacy is the ability to find, understand, assess, and apply health information. Individuals suffering from multiple chronic conditions have complex healthcare needs that may challenge their health literacy skills. This study aimed to investigate the relationship between multimorbidity, the number of chronic conditions, and health literacy levels in a sample of adults aged 58+ in Switzerland. METHODS: We used data from 1,615 respondents to a paper-and-pencil questionnaire administered as part of wave 8 (2019/2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland. Health literacy was measured using the short version of the European Health Literacy Survey questionnaire. The final score ranged from 0 to 16 and was categorised into three health literacy levels: inadequate (0-8), problematic (9-12), and sufficient (13-16). The number of chronic conditions was self-reported based on a pre-defined list. Associations were examined using multivariable ordinary least squares and ordered probit regression models, controlling for key socio-demographic characteristics. RESULTS: Overall, 63.5% of respondents reported having at least one chronic condition. Respondents who reported one, two, and three or more chronic conditions were more likely to have lower health literacy scores compared to respondents who did not report any chronic condition (p<0.05, p<0.01, and p<0.001, respectively). Suffering from two and three or more chronic conditions (vs. no chronic condition) was significantly associated with a higher likelihood of having inadequate or problematic health literacy levels (both p-values <0.01). CONCLUSIONS: Our findings suggest a need to improve health literacy in older adults suffering from chronic conditions. Improved health literacy could constitute a promising lever to empower individuals to better self-manage their health to ultimately reduce the double burden of chronic diseases and insufficient health literacy in this vulnerable population.

Ground truthing global-scale model estimates of groundwater recharge across Africa.

Groundwater is an essential resource for natural and human systems throughout the world and the rates at which aquifers are recharged constrain sustainable levels of consumption. However, recharge estimates from global-scale models regularly disagree with each other and are rarely compared to ground-based estimates. We compare long-term mean annual recharge and recharge ratio (annual recharge/annual precipitation) estimates from eight global models with over 100 ground-based estimates in Africa. We find model estimates of annual recharge and recharge ratio disagree significantly across most of Africa. Furthermore, similarity to ground-based estimates between models also varies considerably and inconsistently throughout the different landscapes of Africa. Models typically showed both positive and negative biases in most landscapes, which made it challenging to pinpoint how recharge prediction by global-scale models can be improved. However, global-scale models which reflected stronger climatic controls on their recharge estimates compared more favourably to ground-based estimates. Given this significant uncertainty in recharge estimates from current global-scale models, we stress that groundwater recharge prediction across Africa, for both research investigations and operational management, should not rely upon estimates from a single model but instead consider the distribution of estimates from different models. Our work will be of particular interest to decision makers and researchers who consider using such recharge outputs to make groundwater governance decisions or investigate groundwater security especially under the potential impact of climate change.

Presupposition processing declines with age.

The present study investigates the processing of presuppositions across the life span and extends the findings of the only available study on presupposition processing and typical aging by Domaneschi and Di Paola (J Pragmat 140:70-87, 2019). In an online and offline task, we investigate the impact of cognitive load during the processing and recovery of two presupposition triggers-definite descriptions and change-of-state verbs-comparing a group of younger adults with a group of older adults. The collected experimental data show that (1) presupposition recovery declines during normal aging, (2) presupposition recovery of change-of-state verbs is more cognitively demanding for older adults than the recovery of definite descriptions, and lastly (3) presupposition recovery for the change-of-state verb begin is more demanding than the change-of-state verb stop. As of today, few works have directly investigated presupposition processing across the life span. To the best of our knowledge, this is the first work revealing that cognitive load directly impacts the recovery of presuppositions across the life span, which in turn suggests an involvement of verbal working memory.

Factives at hand: When presupposition mode affects motor response.

It is well established that the processing of hand-, mouth-, and foot-related action terms can activate areas of the motor cortex that are involved in the planning and execution of the described actions. In the present study, the sensitivity of these motor structures to language processes was exploited to test linguistic theories on information layering. Human languages possess a variety of linguistic devices, so-called presupposition triggers, that allow us to convey background information without asserting it. A statement such as "Marie stopped smoking" presupposes, without asserting it, that Marie used to smoke. How such presupposed information is represented in the brain is not yet understood. Using a grip-force sensor that allows capturing motor brain activity during language processing, we investigated effects of information layering by comparing asserted information that is known to trigger motor activity ("In the living room, Peter irons his shirt") with information embedded under a presuppositional factive verb construction ("Louis knows that Peter irons his shirt"; Experiment 1) and a nonfactive verb construction ("Louis believes that Peter irons his shirt"; Experiment 2). Furthermore, we examined whether the projection behavior of a factive verb construction modulates grip force under negation ("Louis does not know that Peter irons his shirt"; Experiment 3). The data show that only the presupposed action verb in affirmative contexts (Experiment 1) triggers an increase in grip force comparable to the one of asserted action verbs, whereas the nonfactive complement and projection structure show a weaker response (Experiments 2 and 3). While the first two experiments seem to confirm the sensitivity of the grip-force response to the construction of a plausible situation or event model, in which the motor action is represented as taking place, the third one raises the question of how robust this hypothesis is and how it can take the specificity of projection into account. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Importance of Spatial Resolution in Global Groundwater Modeling.

Global-scale gradient-based groundwater models are a new endeavor for hydrologists who wish to improve global hydrological models (GHMs). In particular, the integration of such groundwater models into GHMs improves the simulation of water flows between surface water and groundwater and of capillary rise and thus evapotranspiration. Currently, these models are not able to simulate water table depth adequately over the entire globe. Unsatisfactory model performance compared to well observations suggests that a higher spatial resolution is required to better represent the high spatial variability of land surface and groundwater elevations. In this study, we use New Zealand as a testbed and analyze the impacts of spatial resolution on the results of global groundwater models. Steady-state hydraulic heads simulated by two versions of the global groundwater model G3 M, at spatial resolutions of 5 arc-minutes (9 km) and 30 arc-seconds (900 m), are compared with observations from the Canterbury region. The output of three other groundwater models with different spatial resolutions is analyzed as well. Considering the spatial distribution of residuals, general patterns of unsatisfactory model performance remain at the higher resolutions, suggesting that an increase in model resolution alone does not fix problems such as the systematic overestimation of hydraulic head. We conclude that (1) a new understanding of how low-resolution global groundwater models can be evaluated is required, and (2) merely increasing the spatial resolution of global-scale groundwater models will not improve the simulation of the global freshwater system.

Phenotypical characteristics of idiopathic infantile nystagmus with and without mutations in FRMD7.

Idiopathic infantile nystagmus (IIN) consists of involuntary oscillations of the eyes. The familial form is most commonly X-linked. We recently found mutations in a novel gene FRMD7 (Xq26.2), which provided an opportunity to investigate a genetically defined and homogeneous group of patients with nystagmus. We compared clinical features and eye movement recordings of 90 subjects with mutation in the gene (FRMD7 group) to 48 subjects without mutations but with clinical IIN (non-FRMD7 group). Fifty-eight female obligate carriers of the mutation were also investigated. The median visual acuity (VA) was 0.2 logMAR (Snellen equivalent 6/9) in both groups and most patients had good stereopsis. The prevalence of strabismus was also similar (FRMD7: 7.8%, non-FRMD7: 10%). The presence of anomalous head posture (AHP) was significantly higher in the non-FRMD7 group (P < 0.0001). The amplitude of nystagmus was more strongly dependent on the direction of gaze in the FRMD7 group being lower at primary position (P < 0.0001), compared to non-FRMD7 group (P = 0.83). Pendular nystagmus waveforms were also more frequent in the FRMD7 group (P = 0.003). Fifty-three percent of the obligate female carriers of an FRMD7 mutation were clinically affected. The VA's in affected females were slightly better compared to affected males (P = 0.014). Subnormal optokinetic responses were found in a subgroup of obligate unaffected carriers, which may be interpreted as a sub-clinical manifestation. FRMD7 is a major cause of X-linked IIN. Most clinical and eye movement characteristics were similar in the FRMD7 group and non-FRMD7 group with most patients having good VA and stereopsis and low incidence of strabismus. Fewer patients in the FRMD7 group had AHPs, their amplitude of nystagmus being lower in primary position. Our findings are helpful in the clinical identification of IIN and genetic counselling of nystagmus patients.

Migrainous visual auras: a life history.

We document, as an autobiographical case report, a 72-year history of migraine and its changing nature. Minor neurological events have waxed and waned, causing repeated searches for pathology, but instead reconfirming an intact central nervous system. In this case it appears that visual migraine auras do not reflect severity of pathology. Visual auras of migraine are cyclical in frequency and intensity and may have remissions as long as 15 years.

Mutations in FRMD7, a newly identified member of the FERM family, cause X-linked idiopathic congenital nystagmus.

Idiopathic congenital nystagmus is characterized by involuntary, periodic, predominantly horizontal oscillations of both eyes. We identified 22 mutations in FRMD7 in 26 families with X-linked idiopathic congenital nystagmus. Screening of 42 singleton cases of idiopathic congenital nystagmus (28 male, 14 females) yielded three mutations (7%). We found restricted expression of FRMD7 in human embryonic brain and developing neural retina, suggesting a specific role in the control of eye movement and gaze stability.

Extended slow phase in latent/manifest latent nystagmus.

PURPOSE: To investigate the slow phase in latent/manifest latent nystagmus (LMLN) by producing long eye-drift intervals devoid of fast phases (extended slow phases [ESPs]) and to relate ESP metrics to clinical findings. METHODS: Ten patients with LMLN had eye movements recorded while attending to paired visual and auditory cues presented to their left or right. Patients compared location of the visual target with that of the subsequently heard tone. The auditory cue and the comparison task directed attention away from vision and delayed the fast-phase onset to obtain ESPs. ESP metrics were analyzed with regard to patients' clinical characteristics. Five patients' data were further explored by isolating slow-phase components. RESULTS: All patients exhibited ESPs that resembled the usual slow phase but lasted two to three times longer. Five patients maintained alignment, whereas the other five made vergence movements. Greater eye velocity, excursion, and convergence during an ESP were associated with poor vision and large uncorrected esotropia. These metrics decreased when the viewing eye was in adduction, compared with primary position or abduction. Slow-phase components found in five patients consisted of a dominant decreasing-velocity or linear drift and a low-amplitude periodic oscillation. CONCLUSIONS: Shifting attention away from vision reliably delays the fast phase, revealing long intervals of slow phase, which can facilitate nystagmus investigation. ESP analysis in five patients with LMLN demonstrated two slow-phase components. ESP characteristics suggest that better ocular alignment is associated with improved stability in LMLN and provide metrics of eye drift that correlate with vision.

Surgical treatment of trauma-induced periodic alternating nystagmus.

PURPOSE: To report a new treatment for acquired periodic alternating nystagmus in which medical therapy with baclofen was not tolerated. DESIGN: Interventional case report and literature review. INTERVENTION: Simultaneous adjustable bilateral retroequatorial horizontal rectus muscle recessions. MAIN OUTCOME MEASURES: Ocular alignment and ocular motility recordings. RESULTS: A 30-year-old man had blurred vision after an emergency left temporal craniotomy for gunshot wounds. Ophthalmologic examination revealed periodic alternating nystagmus that was documented by an infrared electronystagmogram. Baclofen was started but was not tolerated. Bilateral lateral and medial retroequatorial rectus muscle recessions were performed and were successful in the treatment of this patient. CONCLUSION: Simultaneous bilateral retroequatorial horizontal rectus recessions may be an effective treatment for intractable acquired periodic alternating nystagmus.

Single-stage adjustable strabismus surgery for restrictive strabismus.

PURPOSE: To evaluate the feasibility and stability of ocular alignment of single-stage adjustable strabismus surgery (SSASS) in restrictive strabismus. METHODS: This was an observational case series comprising 12 patients with restrictive strabismus (mean age, 54.8 years) who were treated with SSASS using intravenous midazolam, fentanyl, and topical anesthesia. All were studied in a retrospective institutional manner. The refractive strabismus in 7 patients was caused by dysthyroid orbitopathy. Five patients had undergone previous ocular surgery, and 4 had undergone previous strabismus surgery. SSASS typically involved the vertical rectus muscles. Horizontal rectus muscles were adjusted when necessary. Silicon-treated polyester suture material (Ti-cron; United States Surgical, Norwalk, CT no longer available), 6-0, were used for inferior rectus recessions. Ocular alignment was set at ortho at the end of surgery and evaluated at 2 days, 6 weeks, and 3 months after surgery. The typical hang-back procedure was to lock the suture at the middle and edges of the tendon or muscle at the intended disinsertion point. The tendon was then disinserted and hung back from the original insertion with adjustments until the desired position (ortho) and single vision were attained. RESULTS: All patients remained comfortable throughout surgery and had no significant postoperative discomfort. All patients except 2 (16.6%) maintained satisfactory vertical alignment (<2 prism diopters). These 2 patients with dysthyroid orbitopathy had progressive overcorrection after inferior rectus recession. CONCLUSIONS: SSASS, using intravenous midazolam, fentanyl, and topical anesthesia, is a safe and precise alternative treatment for patients with restrictive strabismus including those with dysthyroid orbitopathy.

Unilateral acquired upper eyelid ptosis and decreasing nystagmus.

PURPOSE: To describe a patient with congenital nystagmus that decreased in one eye after the development of a cavernous sinus meningioma. DESIGN: Interventional case report. METHODS: A 45-year-old man with congenital nystagmus, albinism, and high myopia presented with right upper eyelid ptosis that was corrected surgically on three occasions during a 3-year period. An episode of syncope was followed by diagnostic evaluation that disclosed a cavernous sinus meningioma. He commented that his right eye nystagmus progressively decreased. He was found to have ophthalmoplegia on the right eye due to nerve compression by the meningioma. RESULTS: A magnetic resonance imaging scan disclosed a cavernous sinus meningioma extending into the parachiasmal and clival areas. A biopsy specimen of the lesion demonstrated a meningioma. CONCLUSIONS: Any patient with acquired ptosis should have a complete ophthalmic examination, including evaluation of extraocular motility.

A comparative demographicand socioeconomic study of spasmus nutans and infantile nystagmus.

PURPOSE: To compare the demographic and socioeconomic background of patients with spasmus nutans (SN) and patients with idiopathic infantile nystagmus (IIN). METHODS: This study was performed according to an observational case-control design. Parents or guardians of 23 patients with SN and 24 patients with IIN completed a 28-point questionnaire on demographic, socioeconomic, behavioral, personal, and family history. Mann-Whitney U tests were used to compare continuous dependents and chi(2) analyses for categorical variables. Correlation between variables was calculated by Spearman rho tests and odds ratios for SN by Mantel-Haenszel estimates. RESULTS: Comparing SN and IIN, Afro-American, and Hispanic ethnicity was significantly more common in SN (14 patients, 61%) than in IIN (1 patient, 4%). Significant differences between the groups were also found for gestational age (mean SN: 37.7 weeks, IIN: 40.3 weeks), home luminance at birth was reported to be brighter in more IIN patients (22 patients, 96%) as compared with the SN patients (15 patients, 71%). Factors reflecting a lower socioeconomic status were more prevalent in SN patients (annual household income, individual financially responsible for the household, source of income, availability of private medical insurance). In the SN group there were fewer married parents living together (9 families, 39%) than in the IIN group (21 families, 88%). Psychiatric disorders, including alcohol and drug abuse, were more frequent among parents of SN (10 parents, 47%) than of IIN (none). Annual household income and ethnicity correlated significantly with number of rooms/household. CONCLUSION: This study demonstrated differences between SN and IIN patients and their families with regard to socioeconomic status, ethnicity, gestational age, psychiatric diseases of parents, and parental estimation of light exposure early in life. We conclude that low socioeconomic status represents a risk factor for the development of SN.