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Study Objectives: Evidence suggests that poor sleep impacts cognition, brain health, and dementia risk but the nature of the association is poorly understood. This study examined how self-reported sleep duration, napping, and subjective depression symptoms are associated with the brain-cognition relationship in older adults, using sulcal width as a measure of relative brain health. Methods: A canonical partial least squares analysis was used to obtain two composite variables that relate cognition and sulcal width in a cross-sectional study of 137 adults aged 46-72. We used a combination of ANCOVA and path analyses to test the associations of self-reported sleep duration, napping, and subjective depression symptoms with the brain-cognition relationship. Results: We observed a significant main effect of sleep duration on sulcal width, with participants reporting 7 hours showing narrower sulci than other durations. This effect remained significant after including subjective depression as a covariate, which also had a significant main effect on sulcal width in the model. There was no significant effect of napping on sulcal width. In path analyses where the effects of age, self-reported sleep duration and depression symptoms were investigated together, sulcal width mediated the relationship between age and cognition. We also observed a significant indirect effect of sulci width in the subjective depression-cognition relationship. Conclusions: Findings suggest that self-reported sleep duration and subjective depression may each be independently associated with brain morphology, which is related to cognitive functions. Results could help inform clinical trials and related intervention studies that aim at delaying cognitive decline in adults at risk of developing dementia.

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Families providing care to relatives with Alzheimer's disease are quickly destabilized by changes that disrupt communication. This pilot mixed-design study aimed to provide a quantitative and qualitative evaluation of a communication-based training program for carers of people with early-stage Alzheimer's disease. Five participants received three training sessions. The use of communication strategies by participants and their effectiveness were evaluated before and after the training, and a focus group was conducted to gather participants' impressions about the impacts of the training on communication with the person they cared for. The AID-COM (AID for COMmunication) program appears to have met expectations.

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BACKGROUND: Clinical reasoning is central to any health profession but its development among learners is difficult to assess. Over the last few decades, the script concordance test (SCT) has been developed to solve this dilemma and has been used in many health professions; however, no study has been published on the use of the script concordance test in optometry. The purpose of this study was to develop and validate a script concordance test for the field of optometry. METHODS: A 101-question script concordance test (27 short clinical scenarios) was developed and administered online to a convenience sample of 23 second-year and 19 fourth-year students of optometry. It was also administered to a reference panel of 12 experienced optometrists to develop the scoring key. An item-total correlation was calculated for each question. Cronbach's alpha coefficient was used to evaluate the script concordance test reliability and a t-test compared the two groups. RESULTS: A final 77-question script concordance test was created by eliminating questions with low item-total correlation. Cronbach's alpha for this optimised 77-question script concordance test was 0.80. A group comparison revealed that the second-year students' scores (n = 23; mean score = 66.4 ± 7.87 per cent) were statistically lower (t = -4.141; p < 0.001) than those of the fourth-year students (n = 19; mean score = 75.5 ± 5.97 per cent). CONCLUSION: The online script concordance test developed for this study was found to be both reliable and capable of discriminating between second- and fourth-year optometric students. These results demonstrate that the script concordance test may be considered as a new tool in the optometric educators' assessment arsenal. Further studies will be needed to cover additional levels of professional development.

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PURPOSE: Because the clinical reasoning processes engaged in by practicing optometrists have not previous been investigated, until now, there has been no way of knowing whether models of clinical reasoning from other health professions can be transposed to optometry. The purpose of this study has therefore been twofold: making explicit the clinical reasoning processes of optometrists at both the "competent" and "expert" levels and comparing these processes to highlight the characteristics of clinical reasoning expertise. METHODS: Four competent-level optometrists and four expert-level optometrists participated in this qualitative study. Each optometrist performed a complete optometric examination on a preselected patient. Each of these examinations was recorded on a DVD video and followed by a feedback session, also captured on a DVD video. The feedback session was conducted using techniques inspired by a form of interview called the "explicitation interview," aiming to describe optometrists' mental actions and the time sequence of these actions throughout the examination. RESULTS: The results indicate that optometrists' clinical reasoning is patient centered and includes both analytical and nonanalytical modes of reasoning. When compared with a competent-level optometrist, an expert-level optometrist is more patient centered, formulates an earlier mental representation of the patient's clinical situation (including diagnosis formulation), plans examinations more thoroughly, is able to analyze and reflect during cognitively demanding tasks, and draws up his or her care management plan throughout the entire examination. CONCLUSIONS: The verbalization of optometrists' clinical reasoning processes represents a first step toward a better understanding of this competency. The impact of this research on optometric education is discussed. The results open doors to further research in the field, for example, toward defining the stages of clinical reasoning development among optometry students and professionals.

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BACKGROUND: Development of professional expertise is the gradual transition from novice to expert within a profession. Studies on expertise in the profession of optometry have never been published. However, many studies have been performed in other health professions (e.g., nursing, medicine, physical therapy, occupational therapy). METHODS: This report is an overview of the development of professional expertise that will highlight some applications for optometry. RESULTS: A 5-level scale of professional expertise development, divided into 2 parts, is described. The first part is the progression of students during their professional studies (novice, intermediate, competent). The second part is the professional development occurring during the practice years (advanced, expert). Personal and collective efforts are required to foster the progression toward expertise. Great interest for the profession, motivation, and deliberate practice are individual attitudes that help this progression. The "optometric community of practice," by means of university (professional) training, continuing education, and collaboration between colleagues, also contributes to this process. CONCLUSION: Professional development is an integral part of the Optometric Oath. Each clinical case is a potential learning experience contributing to one's professional development. Optometrists' attitudes are predominant factors in the progression from one level to another.

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PURPOSE: We have demonstrated that the third wavelet (OP3) of the scotopic flash oscillatory potential (OP) complex shows a hyper-response during experimentally-induced systemic hyperoxia. The objective of the present study was to further evaluate and detail the time course of this enhanced retinal response. METHODS: Twenty healthy adults volunteered for this study. The OPs were recorded with a DTL-type electrode following pupillary dilation and retinal dark adaptation. Stimuli consisted of white flashes. The OPs were recorded at 8 points in time before, during and after breathing pure oxygen (O2). The arterial blood O2 saturation (SaO2), end-tidal CO2 (EtCO2), respiratory rate (RR), pulse rate (PR) and blood pressure (BP) were monitored throughout the experiment. RESULTS: The amplitude of the OPs did not vary significantly across test conditions except for OP3, which increased with systemic hyperoxia and was still elevated by the end of the experiment. The SaO2 and RR increased, the EtCO2 and PR decreased, whereas the BP was not altered during O2 breathing. CONCLUSIONS: This study provides further evidence indicating that the neural generators of OP3 display a unique hyper-reactivity to increased systemic O2 levels in the young healthy adult. Further studies looking at OP3 are still needed to determine if this unique behavior could serve as an index of altered oxygen level and retinal function in health or disease.

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A 26-year-old healthy female was referred by her optometrist to the binocular vision clinic of our institution for the investigation of an accommodative spasm occurring during monocular conditions. Corrected binocular visual acuity was 20/20 (6/6), with normal pupils and good ocular alignment. When the fellow eye was covered, visual acuity was <20/200 (6/60) in each eye, miosis was present in both eyes, and the occluded eye was in esodeviation, indicating a spasm of the near reflex. The spasm disappeared when a translucent occluder was used instead of an opaque black occluder. Further investigation permitted us to establish that dioptric and nondioptric blur, as well as reduced light transmission, also triggered the spasm of the near reflex, but only for specific power, opacity, or density. Cycloplegia did not eliminate the spasm. Comparisons are made with the single other similar case found in the literature. Assumptions are made as to the possible causes of that intermittent spasm.

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PURPOSE: Systemic hyperoxia reduces blood flow to the retina while systemic hypercapnia has the opposite effect. However, the effect this modification in blood flow has on neuroretinal function in humans has not been documented yet. The purpose of this study was to evaluate the effect of pure oxygen and carbogen breathing on scotopic electroretinograms (ERGs) and oscillatory potentials (OPs) in humans. METHODS: Thirty-five healthy adults volunteered for this study. The ERGs and OPs were recorded: 1) during room air breathing, 2) after a period of pure oxygen (O(2)) or carbogen breathing, 3) in room air just after the flow of gas was interrupted, and 4) 10 minutes after the end of the gas administration. RESULTS: The amplitude and latency of the a- and b-waves were not altered during systemic hyperoxia. The amplitude of OP3 increased during hyperoxia while the amplitude of the other OPs was not altered. The latency of all OPs remained stable throughout the O(2) session. Ten minutes after the end of pure O(2) breathing, the a- and b-wave latencies were delayed. No change was found in the amplitude of the a-wave during the carbogen session that increased the end-tidal carbon dioxide by 7.1%, whereas the b-wave was reduced ten minutes after the end of carbogen breathing. The amplitude of OP5 was reduced during carbogen breathing, as well as 10 minutes later. The amplitude of all other OPs, as well as the latencies of all ERG and OP components remained stable throughout the carbogen session. CONCLUSIONS: Breathing pure O(2) or carbogen did not compromise retinal function in any major way, likely due to adequate retinal and choroidal regulatory mechanisms. Further investigations are required to better delineate the impact and temporal characteristics of such physiological challenges on retinal function.

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