Assessing fitness to drive:A validation study on patients with mild cognitive impairment

Objectives: There is no consensus yet on how to determine which patients with cognitive impairment are able to drive a car safely and which are not. Recently, a strategy was composed for the assessment of fitness to drive, consisting of clinical interviews, a neuropsychological assessment, and driving simulator rides, which was compared with the outcome of an expert evaluation of an on-road driving assessment. A selection of tests and parameters of the new approach revealed a predictive accuracy of 97.4% for the prediction of practical fitness to drive on an initial sample of patients with Alzheimer's dementia. The aim of the present study was to explore whether the selected variables would be equally predictive (i.e., valid) for a closely related group of patients; that is, patients with mild cognitive impairment (MCI).Methods: Eighteen patients with mild cognitive impairment completed the proposed approach to the measurement of fitness to drive, including clinical interviews, a neuropsychological assessment, and driving simulator rides. The criterion fitness to drive was again assessed by means of an on-road driving evaluation. The predictive validity of the fitness to drive assessment strategy was evaluated by receiver operating characteristic (ROC) analyses.Results: Twelve patients with MCI (66.7%) passed and 6 patients (33.3%) failed the on-road driving assessment. The previously proposed approach to the measurement of fitness to drive achieved an overall predictive accuracy of 94.4% in these patients. The application of an optimal cutoff resulted in a diagnostic accuracy of 100% sensitivity toward unfit to drive and 83.3% specificity toward fit to drive. Further analyses revealed that the neuropsychological assessment and the driving simulator rides produced rather stable prediction rates, whereas clinical interviews were not significantly predictive for practical fitness to drive in the MCI patient sample.Conclusions: The selected measures of the previously proposed approach revealed adequate accuracy in identifying fitness to drive in patients with MCI. Furthermore, a combination of neuropsychological test performance and simulated driving behavior proved to be the most valid predictor of practical fitness to drive.</p

The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer's dementia

Since Alzheimer’s disease may affect driving performance, patients with Alzheimer’s disease are assessed on fitness to drive. On-road driving assessments are widely used, and attempts have also been made to develop strategies to assess fitness to drive in a clinical setting. Preferably, a first indication of fitness to drive is obtained quickly after diagnosis using a single test such as the Mini-Mental State Examination (MMSE). The aim of this study is to investigate whether the MMSE can be used to predict whether patients with Alzheimer’s disease will pass or fail an on-road driving assessment. Patients with Alzheimer’s disease (n = 81) participated in a comprehensive fitness-to-drive assessment which included the MMSE as well as an on-road driving assessment [PLoS One 11(2):e0149566, 2016]. MMSE cutoffs were applied as suggested by Versijpt and colleagues [Acta Neurol Belg 117(4):811–819, 2017]. All patients with Alzheimer’s disease who scored below the lower cutoff (MMSE ≤ 19) failed the on-road driving assessment. However, a third of the patients with Alzheimer’s disease who scored above the upper cutoff (MMSE ≥ 25) failed the on-road driving assessment as well. We conclude that the MMSE alone has insufficient predictive value to correctly identify fitness to drive in patients with very mild-to-mild Alzheimer’s disease implicating the need for comprehensive assessments to determine fitness to drive in a clinical setting

Teacher Wellbeing: The Importance of Teacher–Student Relationships

Many studies have examined the importance of teacher-student relationships for the development of children. Much less is known, however, about how these relationships impact the professional and personal lives of teachers. This review considers the importance of teacher-student relationships for the wellbeing of teachers guided by the Transactional Model of Stress and Coping of Lazarus (1991). Based on theories on interpersonal relationships, it is postulated that teachers have a basic need for relatedness with the students in their class that originates from the close proximity between teacher and student. It is discussed that teachers internalize experiences with students in representational models of relationships that guide emotional responses in daily interactions with students, and changes teacher wellbeing in the long run. In addition, the notion of mental representations of relationships at different levels of generalization could offer a window to understand how individual teacher-student relationships may affect the professional and personal self-esteem of teachers. Lastly, it is argued that the influence of student misbehavior on teacher stress may be more fully understood from a relationship perspective. The review shows that few studies have directly tested these propositions and offers suggestions for future research

Järv, Ants. Rindportree

http://www.ester.ee/record=b4435605*es

Exocentric pointing in depth

An exocentric pointing task was used to compare the indicated pointing directions under exchange of target and pointer. Such a pair of pointing directions, together with the pointer and target locations, specifies a unique cubic arc. Such an arc may assume one of two qualitatively different shapes, namely a "C-arc" (constant sign of curvature) or an "S-arc" (containing a point of inflection between the endpoints). We show that human observers most often produce S-curves. This is of fundamental importance, since-in case one interprets the curve as an empirically determined "pregeodesic" ("shortest connection", or "straight" connection in visual space)-it would imply that "visual space" in the strict geometrical sense is a non-entity. The experiments were performed in the outside environment, under normal daylight conditions, for distances ranging from one to over thirty meters. The implications of these data are discussed and possible ways to extend the restricted notion of "visual space" (e.g., as advocated by Luneburg) such as to allow one to account for the present results are suggested. Such extensions of the visual space concept include the local adjustment of geometrical structure in regions adjacent to the fixation direction

Security and privacy in massively-multiplayer online games and social and corporate virtual worlds

2007 was the year of online gaming fraud - with malicious programs that specifically target online games and virtual worlds increasing by 145% and the emergence of over 30,000 new programs aimed at stealing online game passwords. Such malware is invariably aimed at the theft of virtual property accumulated in a user’s account and its sale for real money. With 217 million regular users of MMO/VWs (Massively Multiplayer Online Games and Virtual Worlds) and real-money sales of virtual objects estimated at nearly US\$ 2 billion worldwide at the end of 2007, this is a serious issue. The failure to recognise the importance of protecting the real-money value locked up in this grey-zone of the economy is leading to an exponential increase in attacks targeting online MMO/VWs. Another important area of risk is the disclosure of private data. MMO/VWs are commonly perceived as being completely separate from the real lives of their users and therefore immune to privacy risks. In reality, representing yourself as an avatar is little different from using any other form of online persona. The inclusion of IRC and VOIP channels, along with the false sense of security created by MMO/VWs, leads to significantly increased disclosures of private data such as location and personal characteristics. The main body of this report describes in detail these risks and others, including in-game access-control vulnerabilities, scripting vulnerabilities, denial of service, spam and threats to minors, before making a number of recommendations on how to remedy them

DNA damage and signalling pathways in cellular senescence

Organisms such as mammals need tissue renewal as an important process for maintenance of their viability. Because proliferation is essential also for tumourigenesis, cells need tumour-suppressor mechanisms to protect organism against cancer. Cellular senescence, the permanent state of cell-cycle arrest, features one of these intrinsic barriers against tumourigenesis after DNA damage and understanding of this process may lead to finding of novel therapeutic targets and to optimization of chemotherapy for patients with cancer. In the first part of the PhD thesis, we investigated activation of JAK/STAT signalling pathway in drug-induced senescence. We used genotoxic drugs like aphidicolin, camptothecine, 5-bromo- 2'-doexyuridin, etoposide or thymidine to induce premature senescence in normal and cancer cells. All this chemicals were able to persistently activate JAK/STAT signalling in monitored cells. Activation of STATs was accompanied with up-regulation of expression of interferon-stimulated genes (ISGs), such as MX1, IRF1, IRF7 and PML. Since IRF1 and IRF7 can be directly involved in stimulation of the IFN genes, we show activated expression as well as secretion of IFNbeta and IFNgamma, but not IFNalpha in drug-induced senescent cells. Furthermore, an inhibition of JAK1 as a major kinase of STAT..