Background: Early detection and monitoring of cognitive dysfunction in multiple sclerosis (MS) may be enabled with smartphone-adapted tests that allow frequent measurements in the everyday environment. Objectives: The aim of this study was to determine the reliability, construct and concurrent validity of a smartphone-adapted Symbol Digit Modalities Test (sSDMT). Methods: During a 28-day follow-up, 102 patients with MS and 24 healthy controls (HC) used the MS sherpa® app to perform the sSDMT every 3 days on their own smartphone. Patients performed the Brief International Cognitive Assessment for MS at baseline. Test–retest reliability (intraclass correlation coefficients, ICC), construct validity (group analyses between cognitively impaired (CI), cognitively preserved (CP) and HC for differences) and concurrent validity (correlation coefficients) were assessed. Results: Patients with MS and HC completed an average of 23.2 ( SD = 10.0) and 18.3 ( SD = 10.2) sSDMT, respectively. sSDMT demonstrated high test–retest reliability (ICCs > 0.8) with a smallest detectable change of 7 points. sSDMT scores were different between CI patients, CP patients and HC (all ps < 0.05). sSDMT correlated modestly with the clinical SDMT (highest r = 0.690), verbal (highest r = 0.516) and visuospatial memory (highest r = 0.599). Conclusion: Self-administered smartphone-adapted SDMT scores were reliable and different between patients who were CI, CP and HC and demonstrated concurrent validity in assessing information processing speed.

It has recently been claimed that the Hubble Sphere represents a previously unknown limit to our view of the universe, with light we detect today coming from a proper distance less than this "Cosmic Horizon" at the present time. By considering the paths of light rays in several cosmologies, we show that this claim is not generally true. In particular, in cosmologies dominated by phantom energy (with an equation of state of ω < −1) the proper distance to the Hubble Sphere decreases, and light rays can cross it more than once in both directions; such behaviour further diminishes the claim that the Hubble Sphere is a fundamental, but unrecognised, horizon in the universe.

The present standard model of cosmology, cold dark matter ( CDM), contains some intriguing coincidences. Not only are the dominant contributions to the energy density approximately of the same order at the present epoch, but we also note that contrary to the emergence of cosmic acceleration as a recent phenomenon, the time-averaged value of the deceleration parameter over the age of the Universe is nearly zero. Curious features like these in CDM give rise to a number of alternate cosmologies being proposed to remove them, including models with an equation of state w = −1/3. In this paper, we examine the validity of some of these alternate models and we also address some persistent misconceptions about the Hubble sphere and the event horizon that lead to erroneous conclusions about cosmology.

CME/CNE Information Activity Available Online: To access the article, post-test, and evaluation online, go to http://www.cmscscholar.org. Target Audience: The target audience for this activity is physicians, physician assistants, nursing professionals, and other health care providers involved in the management of patients with multiple sclerosis (MS). Learning Objectives: Accreditation Statement: In support of improving patient care, this activity has been planned and implemented by the Consortium of Multiple Sclerosis Centers (CMSC) and Delaware Media Group. The CMSC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Physician Credit The CMSC designates this journal-based activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurse Credit The CMSC designates this enduring material for 0.75 contact hour (none in the area of pharmacology). Disclosures: Editor in Chief of the International Journal of MS Care (IJMSC), has served as physician planner for this activity. He has disclosed relationships with Springer Publishing (royalty); Qr8 (receipt of intellectual property rights/patent holder); Abide Therapeutics, GW Pharma (consulting fee); Biogen (speakers' bureau); and Adamas Pharmaceuticals (contracted research).Francois Bethoux, MD, has served as reviewer for this activity. She has disclosed no relevant financial relationships.Laurie Scudder, DNP, NP, has disclosed no relevant financial relationships.Karine Wendrich, MSc, has disclosed a relationship with Orikami/MS sherpa BV (salary).Pim van Oirschot, MSc, has disclosed no relevant financial relationships.Marijn Bart Martens, PhD, has disclosed no relevant financial relationships.Marco Heerings, MANP, has disclosed relationships with Bayer (educational/consultancy activities) and MS sherpa BV (consulting fee).Peter Joseph Jongen, PhD, has disclosed no relevant financial relationships.Lotte Krabbenborg, PhD, One peer reviewer has disclosed relationships with Genentech (consulting fee, contracted research) and Novartis (contracted research). The other peer reviewers for IJMSC have disclosed no relevant financial relationships. The staff at IJMSC, CMSC, and Delaware Media Group who are in a position to influence content have disclosed no relevant financial relationships. Note: Financial relationships for some authors may have changed in the interval between listing these disclosures and publication of the article. Method of Participation: Release Date: December 1, 2019 Valid for Credit Through: December 1, 2020 In order to receive CME/CNE credit, participants must: Statements of Credit are awarded upon successful completion of the post-test with a passing score of &gt;70% and the evaluation. Disclosure of Unlabeled Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. CMSC and Delaware Media Group do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of CMSC or Delaware Media Group. Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health-care professionals without first evaluating their patients' conditions, considering possible contraindications or risks, reviewing any applicable manufacturer's product information, and comparing any therapeutic approach with the recommendations of other authorities.