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An essential responsibility of the U.S. Congress is holding the president accountable for the conduct of foreign policy. In this in-depth look at formal oversight hearings by the Senate Armed Services and Foreign Relations committees, Linda Fowler evaluates how the legislature's most visible and important watchdogs performed from the mid-twentieth century to the present. She finds a noticeable reduction in public and secret hearings since the mid-1990s and establishes that American foreign policy frequently violated basic conditions for democratic accountability. Committee scrutiny of the wars in Iraq and Afghanistan, she notes, fell below levels of oversight in prior major conflicts. Fowler attributes the drop in watchdog activity to growing disinterest among senators in committee work, biases among members who join the Armed Services and Foreign Relations committees, and motives that shield presidents, particularly Republicans, from public inquiry. Her detailed case studies of the Truman Doctrine, Vietnam War, Panama Canal Treaty, humanitarian mission in Somalia, and Iraq War illustrate the importance of oversight in generating the information citizens need to judge the president's national security policies. She argues for a reassessment of congressional war powers and proposes reforms to encourage Senate watchdogs to improve public deliberation about decisions of war and peace. Watchdogs on the Hillinvestigates America's national security oversight and its critical place in the review of congressional and presidential powers in foreign policy.

If you have ever thought about serving on a board or being actively involved in meetings aimed at making policy decisions, but are not sure you have the knowledge, skills or abilities to serve competently, this article is for you! In this article, the authors describe six competencies needed by nurses who are serving on boards and/or policy committees so as to contribute in a productive manner. These competencies include a professional commitment to serving on a governing board; knowledge about board types, bylaws, and job descriptions; an understanding of standard business protocols, board member roles, and voting processes; a willingness to use principles for managing and leading effective and efficient board meetings; an appreciation for the ethical and legal processes for conducting meetings; and the ability to employ strategies for maintaining control during intense/uncivil situations. They also discuss strategies for demonstrating these competencies and describe personal responsibilities of board members. The authors conclude that a knowledge of these rules and standards is essential in order for nurses to assume leadership roles that will enhance the health of today’s and tomorrow’s societies.

Objective:This study evaluated the relation between five-factor model (FFM) personality traits and intra-individual variability (IIV) in executive functioning (EF) using both subjective self-report and objectives measures of EF.Participants and Methods:165 university participants (M=19 years old, SD=1.3; 55.2% White, 35.2% African American, 72.7% female) completed the Barkley Deficits in Executive Functioning Scale-Long Form (BDEFS), IPIP-NEO Personality Inventory, Trail-Making Test (TMT) Parts A and B, and the Neuropsychological Assessment Battery (NAB) EF module. A participant’s IIV was calculated as the standard deviation around their own mean performance. Objective EF IIV was computed from T-scores for performance on Trails A, Trails B, and the NAB EF module. Subjective EF IIV was computed from T-scores for performance across BDEFS domains.Results:Pearson r correlations were used to evaluate the relation between subjective and objective IIV and FFM traits of personality. Subjective EF IIV was positively correlated with FFM neuroticism [r=.48; p<.001] and negatively correlated with FFM conscientiousness [r=-.43; p<.001], extraversion [r=-.18; p=.023] and agreeableness [r=-.22; p=.004]. There were no significant associations between FFM traits and objective EF IIV performance. There was additionally no significant relation between subjective EF IIV performance and objective EF IIV.Conclusions:Personality traits were associated with individual variability on a self-reported measure of EF but not on performance-based EF measures. These results suggest that IIV for the BDEFS was influenced by personality traits, particularly neuroticism and conscientiousness, and may reflect method variance. It was notable that IIV was not correlated between subjective and objective EF measures.

Objective:Engagement in sporting activities has shown improvement in executive function among youth (Contreras-Osorio et al., 2021). Additionally, participation in specific sports such as soccer has been shown to enhance executive function in youth athletes compared to same-aged non-athletes (Yongtawee et al., 2021). The present study aimed to examine the effects of competitive participation in the United States’ four most popular sports on executive function among youth athletes. The most popular sports, as defined by viewership, revenue, and youth participation in the U.S. are American football, basketball, baseball, and soccer (Injai, 2022; Aspen Institute, 2020).Participants and Methods:Data from the following three executive functioning subtests were analyzed in a sample of youth athletes (n=76), aged 8-18 years (mean age=11.94): Delis-Kaplan Executive Function System Trail Making Letter-Number Sequencing (cognitive flexibility), Wechsler Intelligence Scale for Children Fourth Edition Working Memory Index, and Golden Stroop Color-Word Inhibition. Participants completed these measures as part of a larger neuropsychological baseline assessment. Multivariate General Linear Model (GLM) regression was used to examine the influence of total cumulative years playing in one or more of the four most popular sports on executive functioning. A multivariate GLM regression also investigated the unique contributions of total years playing soccer (n=40; mean age=12.40) and total years playing American football (n=32; mean age=12.03) on subtest performance. The unique contributions of basketball (n=14) and baseball (n=21) were not analyzed due to small sample size.Results:Total cumulative years playing > one of the four most popular sports significantly predicted cognitive flexibility (p=.007) and working memory (p=.002), but not inhibition (p=0.639). Total years playing soccer also significantly predicted cognitive flexibility (p=.029) and working memory (p=0.05), but not inhibition (p=.310). Total years playing American football did not significantly predict performance on tasks requiring cognitive flexibility (p=.186), working memory (p=0.150), or inhibition (p=0.277).Conclusions:In congruence with previous research, sports participation predicted enhanced cognitive flexibility and working memory on certain executive tasks. Among youth athletes, prolonged competitive participation in one or more of the four most popular sports in the U.S. predicted better performance on measures of cognitive flexibility and working memory. Furthermore, protracted participation in soccer predicted enhanced performance on measures of cognitive flexibility and working memory, whereas extended participation in American football did not. Future research should examine this effect in larger samples within all four sports. Examining the cumulative length of competitive participation in these popular sports on executive function could present a favorable developmental outcome of youth participation if competitive participation is sustained. Additionally, the present data on executive function performance between lasting soccer participation and lasting American football participation suggests that executive function development and performance may be influenced by the sport played. The direction of this possible influence is unclear. More research is needed to establish this observed difference, and to better understand its existence and directionality.

Objective:Health numeracy is the understanding and application of information conveyed with numbers, tables and graphs, and probabilities in order to effectively manage one's own healthcare. Health numeracy is a vital aspect of communicating with healthcare providers and participating in one's own medical decision making, which is especially important in aging populations. Current literature indicates that assessing and establishing one's health numeracy abilities is among the first steps in providing necessary resources and accommodating patients' individual needs. Additionally, older adults with diffuse cognitive impairment often have issues with facets of executive functioning; however, the extant literature does not discuss the role of executive functioning in relation to health numeracy in this population. The purpose of this study was to explore the relationship between performance on tasks of executive functioning and objectively-measured health numeracy abilities in older adult patients.Participants and Methods:This study included a sample of 42 older adult patients referred for neuropsychological evaluation for memory complaints who were administered the Test of Premorbid Functioning (TOPF), Trail Making Test - Part B (TMT-B), and Stroop Color and Word Test (SCWT Color Word Interference [CWI]) as part of a larger standardized battery. Patients were also administered the Numerical Understand in Medicine Instrument - Short Form (NUMI-SF). All included patients had <2 performance validity test failures. The sample was racially diverse (47.6% Black, 35.7% White, 14.3% Hispanic, 2.4% Asian) and 54.8% female. Average age was 62.95 (SD= 8.6) and average education was 14.1 (SD=2.7). Diagnostically, 47.6% of the sample were cognitively normal, 33.3% had mild cognitive impairment, and 19.0% had dementia. Average NUMI-SF score was 4.79 (SD= 1.7). Two multiple regressions were conducted to evaluate the extent to which executive functioning, as measured by the TMT-B and SCWT CWI predicted NUMI-SF, and the additive predictive power of premorbid IQ and demographics via the TOPF on the relationship between executive functioning and NUMI-SF.Results:The first regression, which measured the relationship between the TMT-B and SCWT CWI upon NUMI-SF scores, was not significant (p=.616). The model was significant with the addition of the TOPF (ß=.595, p<.001) and TOPF alone predicted ∼60% of the variance in NUMI-SF score, while TMT-B and SCWT CWI remained non-significant.Conclusions:These results indicate that common measures of executive functioning are not reliable predictors of health literacy with or without the moderating of premorbid intellectual functioning taken into consideration. This suggests that health numeracy is likely to be minimally affected by deficits in executive functioning and rather may be better accounted for by premorbid intellectual functioning and/or other sociodemographic factors (e.g. socioeconomic status, education quality, occupation). Future studies will benefit from elucidating the contributions of other social determinant factors on predicting health numeracy.

Objective:Depression is a mood or emotional state that is characterized by feelings of sadness (i.e., a loss of interest in activities, low self-worth) for a minimum of two weeks. Executive function is a set of mental processes that are necessary for cognitive control of behavior to achieve and successfully execute a specific goal (e.g., inhibition). Researchers have reported that people with abnormal symptoms of depression (ASD) demonstrate worse executive functioning abilities (e.g., planning) compared to persons with normal symptoms of depression (NSD). Currently, there is a lack of research studies examining how depressive symptoms influence executive functioning in people that identify as Mexican. The purpose of the present study was to evaluate the influence of depression on executive functioning in a healthy Mexican Spanish speaking population. We hypothesized that participants with NSD would demonstrate better executive functioning abilities compared to participants with ASD.Participants and Methods:The sample in the present study consisted of 87 neurologically and psychologically healthy Mexican participants all residing in Mexico. Mean age was 24.71 (SD = 9.66) and 14.78 (SD = 4.50) years of education completed. Participants completed a neuropsychological battery in Spanish and were divided into two groups: NSD (n = 61) and ASD (n = 26). The Stroop Color Word Test - Color-Word (SCWT-CW) task, phonemic verbal fluency task consisting of three trials, and semantic verbal fluency task consisting of one trial were used to evaluate executive functioning. In addition, participants completed the Hospital Anxiety and Depression Scale in Spanish to report the current level of depression. ANCOVAS, controlling for age were used to examine executive functioning performance. We used a threshold of p < .05 for statistical significance.Results:ANCOVAS revealed the NSD group outperformed the ASD group on the SCWT-CW task, p = .004, np2 = .10. We also found the NSD group outperformed the ASD group on the phonemic verbal fluency task, p = .045, np2 = .05. Finally, no significant differences were found between depression groups on the semantic verbal fluency task.Conclusions:As we predicted, the NSD group demonstrated better executive functioning abilities compared to the ASD group, except on the semantic verbal fluency task. Our data suggests that the current level of depression have a significant influence on verbal executive functioning abilities in a Spanish speaking population. Future studies with larger sample size should evaluate if current symptoms of depression influence non-verbal executive functioning abilities in a Spanish speaking Mexican population.

Objective:To apply the new IC-CoDE cognitive diagnostic taxonomy (Norman et al., 2020) to a large cohort of people with temporal lobe epilepsy (TLE) in India. The IC-CoDE taxonomy of cognitive diagnoses for 1,409 Englishspeaking adults with TLE from seven epilepsy centres in the U.S. has been published (McDonald et al., 2022). Initial results suggest that the IC-CoDE produces stable cognitive phenotypes across centres; however, its international applicability, including the suggested impairment cut-off needs to be considered across cultures and languages to avoid misclassification. The aim of this study was to apply the IC-CoDE to a population, outside of the U.S., diverse in language representation (i.e., bi/multi-lingual), assessment tools, normative data, and educational and cultural backgrounds to determine whether the same cognitive phenotypes and their relative frequencies would emerge.Participants and Methods:Data from 549 adults with TLE (mean age=27.14 (8.04), 60.47% males) from a tertiary referral hospital in Mumbai, India who had undergone a comprehensive neuropsychological evaluation (minimum two tests in at least 4 of the 5 cognitive domains: memory, language, executive function, attention/processing speed and visuospatial) were analysed using the ICCoDE criteria. The base rate of impairment for individual tests was calculated using a cutoff of 1.5 standard deviations (S.D.) below the normative mean. The cognitive diagnostic criteria were applied, and the distribution and base rate of cognitive phenotypes was compared to the published taxonomy data from the U.S. (McDonald et al., 2022).Results:In comparison to the U.S. cohort, the India group was relatively younger, lower in the education level, had a younger age at seizure onset and a shorter duration of the epilepsy. Application of the IC-CoDE taxonomy using a 1.5 S.D. cutoff revealed an Intact cognitive profile in 48% of patients, Single Domain impairment in 32%, Bi Domain impairment in 15% and Generalised impairment in 5%. These findings were mostly comparable to percentages reported in the U.S. cohorts with Intact profile (47%; c2= 0.158, p=0.690), Single Domain (29%; c2= 46.26, p<0.01), Bi Domain (16%; c2= 0.298, p=0.585) and Generalised (8%; c2= 5.347, p=0.021) impairment. However, the most common impairment in the Single Domain group for the bi/multilingual India population was Memory (38%) followed by Attention (20%) and then Language (13%), diverging from the distribution in the U.S. data with maximum impairment in Language (49%) followed by Memory (32%) in the Single Domain Group.Conclusions:These findings demonstrate that the IC-CoDE can be applied internationally, and the broad taxonomy of cognitive diagnosis holds even in a culturally, linguistically diverse population. Differences in rates of impairments across specific domains emerged with language relatively preserved in the India bi/multilingual population, and memory more frequently impaired than observed in the multi-centre U.S. sample. These findings may reflect differences in demographics, rates of bi/multilingualism, normative data, language tools, or underlying neuropathology, which should be further explored to determine their impact on cognitive profiles.

Objective:Spontaneous speech undergoes subtle but significant changes years before the onset of Alzheimer's dementia (AD). In monolinguals, these changes, or linguistic markers of AD, include the use of syntactically simpler structures, reduced lexical diversity, reduced semantic detail/specificity, and increased disfluencies (Ostrand & Gunstad, 2020; Slegers et al., 2018; Venneri et al., 2018). No studies have examined if bilinguals exhibit similar changes in their language output prior to diagnosis of AD though this question has important clinical relevance and can also shed light on which cognitive abilities decline first with AD pathology. Of particular interest, changes in semantic representations might affect both languages (because semantics are shared between the two), but changes in executive control might be more prominent in the nondominant language (because of interference from the dominant language).Participants and Methods:Seventeen older Spanish-English bilinguals completed an interview in which they described a picture in each language and answered a series of questions beginning with \"warm-up\" questions and progressing to questions that elicited higher level language (e.g., defending an opinion). All participants were considered cognitively healthy at the time of testing, but 8 participants later developed Alzheimer's Disease (i.e., converters) on average after 4.1 (SD=2.5) years, while 9 matched controls remained cognitively healthy on average for 5.7 (SD=3.6) years (for as long as they were followed). Converters and controls were matched for age, education, language proficiency, and cognitive status at the time of testing. Language samples were transcribed word for word and analyzed using the Systematic Analysis of Language (Miller & Iglesias, 2012).Results:Converters and controls were compared on measures of syntactic complexity, lexical diversity, abandoned utterances, errors, and disfluencies. In the dominant language, the number of different words (using a moving window average; a measure of lexical diversity), showed promise for classifying who would eventually convert (Area Under the Curve = 77), though the difference between converters and controls was significant only in a 1-tailed test (t(15)=-1.96, p=.034). In the nondominant language, converters showed a higher percent of Maze words compared to controls (2-tailed t (15) = 2.27, p = 0.039). Mazes combine repetitions, filled pauses, and revisions. Further exploration of Maze subcomponents revealed that filled pauses and revisions produced no differences between groups in either language (all ps3.18), but converters produced more repetitions (e.g., \"the the boy\" or \"the cou-counter\") than controls, (2-tailed t-tests in both languages were significant; ps <.03). However, variability in repetitions was high, making it less sensitive in the ROC analysis.Conclusions:Changes in bilinguals' spoken language output occur years before diagnosis, in agreement with literature on monolinguals. However, in bilinguals, the two languages may be differentially affected by cognitive changes. The dominant language may be more sensitive for discriminating groups possibly reflecting semantic decline and decreased ability to quickly access a variety of words. But changes in the nondominant language reveal a broader nature of cognitive deficits in prodromal AD, including decreased circumlocution abilities to avoid disfluencies when faced with word-finding difficulties.

Objective:Cognitive reserve (CR) refers to how flexibly and efficiently the individual makes use of available brain resources. Early-life education, midlife social and occupational activities, and later-life cognitive and social interactions are associated with greater CR. Years of education, premorbid intellectual (IQ) functioning, linguistic ability, and occupational complexity are often used as proxies of CR. CR theory seeks to explain discrepancies between the extent of disease pathology and clinical presentation amongst individuals with dementia. In the presence of Alzheimer’s Disease (AD) pathology, higher CR is associated with slower declines in executive functioning (EF). The current study examined the correlation between CR and EF performance across various stages of dementia severity as measured by the total score on the Clinical Dementia Rating Scale (CDRS).Participants and Methods:The study cohort consisted of 269 individuals who had completed measures of EF and the CDRS from phase 1 of the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Individuals who scored less than 2 on the CDRS were included in the MCI group (n=197), while individuals that scored 2 or higher on the CDRS were included in the dementia group (n=73). A simple linear regression was utilized to compare the MCI group to dementia group across CR and EF performance.Results:There was significant correlation between CR and EF performance in the MCI group as quantified on total CDRS score (F (200) = .353, p = .0, p < .05). CR was not observed to be predictive of EF in the dementia group (F (200) = .031, p = .666, p > .05).Conclusions:Findings are consistent with prior research suggesting CR is protective during early stages of dementia, but not in the later disease stages. As prior research has shown the expression of dementia is based on a complex interaction between genetic and lifestyle factors that are unique to each person, future research exploring the potentially protective role of CR amongst pre-symptomatic adults with a genetic predisposition for developing dementia may expand our understanding of the potential role of CR on dementia prevention and progression.