Rehabilitation for improving automobile driving after stroke

Publisher version made available in accordance with the publisher's policy. This item is under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy. 'This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2014, Issue 2. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.’Background Interventions to improve driving ability after stroke, incl uding driving simulation and retraining visual skills, hav e limited evaluation of their effectiveness to guide policy and practice. Objectives To determine whether any intervention, with the specific aim o f maximising driving skills, improves the driving performa nce of people after stroke. Search methods WesearchedtheCochrane Stroke GroupTrialsregister(August 2 013), theCochrane Central Registerof ControlledTrials( The Cochrane Library 2012, Issue 3), MEDLINE (1950 to October 2013), EMBASE (1980 to Octo ber 2013), and six additional databases. To identify further published, unpublished and ongoing trial s, we handsearched relevant journals and conference proceeding s, searched trials and research registers, checked reference lists and conta cted key researchers in the area. Selection criteria Randomised controlled trials (RCTs), quasi-randomised trials and cluster studies of rehabilitation interventions, with t he specific aim of maximising driving skills or with an outcome of assessing d riving skills in adults after stroke. The primary outcome of i nterest was the performance in an on-road assessment after training. Secon dary outcomes included assessments of vision, cognition and dr iving behaviour. Data collection and analysis Two review authors independently selected trials based on pr e-defined inclusion criteria, extracted the data and assessed ri sk of bias. A third review author moderated disagreements as required. T he review authors contacted all investigators to obtain missi ng information. Main results We included four trials involving 245 participants in the revi ew. Study sample sizes were generally small, and interventi ons, controls and outcome measures varied, and thus it was inappropriate to pool studies. Included studies were at a low risk of bias for th e majority of domains, with a high/unclear risk of bias identified in the a reas of: performance (participants not blinded to allocation), a nd attrition (incomplete outcome data due to withdrawal) bias. Interventio n approaches included the contextual approach of driving simula tion and underlying skill development approach, including the ret raining of speed of visual processing and visual motor skills . The studies were conducted with people who were relatively young and the ti ming after stroke was varied. Primary outcome: there was no cle ar evidence of improved on-road scores immediately after trainin g in any of the four studies, or at six months (mean difference 15 points on the Test Ride for Investigating Practical Fitness to Drive - Belgian version, 95% confidence intervals (CI) 4.56 to 34.56, P v alue = 0.15, one study, 83 participants). Secondary outcomes: road sig n recognition was better in people who underwent training comp ared with control (mean difference 1.69 points on the Road Sign Recogn ition Task of the Stroke Driver Screening Assessment, 95% CI 0 .51 to 2.87, P value = 0.007, one study, 73 participants). Significan t findings were in favour of a simulator-based driving rehabil itation programme (based on one study with 73 participants) but these r esults should be interpreted with caution as they were based o n a single study. Adverse effects were not reported. There was insufficie nt evidence to draw conclusions on the effects on vision, other me asures of cognition, motor and functional activities, and driving beh aviour with the intervention. Authors’ conclusions There was insufficient evidence to reach conclusions about the use of rehabilitation to improve on-road driving skills after st roke. We found limited evidence that the use of a driving simulator m ay be beneficial in improving visuocognitive abilities, such as road sign recognition that are related to driving. Moreover, we we re unable to find any RCTs that evaluated on-road driving lesso ns as an intervention. At present, it is unclear which impairments tha t influence driving ability after stroke are amenable to rehab ilitation, and whether the contextual or remedial approaches, or a combinatio n of both, are more efficacious

Personalized feedback based on a drink-pouring exercise may improve knowledge of, and adherence to, government guidelines for alcohol consumption

Background Although most people are aware of government guidelines for alcohol consumption, few have accurate knowledge of these and fewer still use these guidelines to monitor their drinking. Most people also lack accurate knowledge of the alcohol content of the drinks they consume. The aim of the study reported here was to examine whether or not personalized feedback on alcohol consumption based on performance in a drink-pouring task and self-reported alcohol intake would improve university students’ knowledge of alcohol consumption guidelines and reduce their alcohol intake. Methods A quasi-randomized control trial with a 2-month follow-up was conducted with 200 students aged 18 to 37 in the south of England. Participants were allocated to a “pour + feedback” group that completed a drink-pouring task and received personalized feedback, a “pour only” group that completed the drink-pouring task but did not receive feedback, and a control group. Results At follow-up, participants in the “pour + feedback” group had significantly better knowledge of government guidelines, and significantly lower weekly alcohol intake when compared to the “control” and “pour only” groups. Conclusions Further refinement of the drink-pouring intervention and feedback is reported in this paper, and assessment of their impact in various populations may lead to better understanding of which elements of personalized feedback have the greatest influence on young people's alcohol use

Positive and Negative Urgency as a single coherent construct: Evidence from a large‐scale network analysis in clinical and non‐clinical samples

Aims: Negative and positive urgency are emotion-related impulsivity traits that are thought to be transdiagnostic factors in psychopathology. However, it has recently been claimed that these two traits are closely related to each other and that considering them separately might have limited conceptual and methodological value. The present study aimed to examine whether positive and negative urgency constructs constitute separate impulsivity traits. Methods: In contrast to previous studies that have used latent variable approaches, this study employed an item-based network analysis conducted in two different samples: a large sample of non-clinical participants (N = 18,568) and a sample of clinical participants with psychiatric disorders (N = 385). Results: The network analysis demonstrated that items denoting both positive and negative urgency cohere as a single cluster of items termed “general urgency” in both clinical and non-clinical samples, thereby suggesting that differentiating positive and negative urgency as separate constructs is not necessary. Conclusion: These findings have important implications for the conceptualization and assessment of urgency and, more broadly, for future research on impulsivity, personality, and psychopathology

Assessment of genetically modified maize 1507 × MIR162 × MON810 × NK603 and subcombinations, for food and feed uses, under Regulation (EC) No 1829/2003 (application EFSA-GMO-NL-2015-127).

Maize 1507 × MIR162 × MON810 × NK603 (four-event stack maize) was produced by conventional crossing to combine four single events: 1507, MIR162, MON810 and NK603. The GMO Panel previously assessed the four single events and six of the subcombinations and did not identify safety concerns. No new data on the single events or the six subcombinations that could lead to modification of the original conclusions on their safety were identified. The molecular characterisation, comparative analysis (agronomic, phenotypic and compositional characteristics) and the outcome of the toxicological, allergenicity and nutritional assessment indicate that the combination of the single maize events and of the newly expressed proteins in the four-event stack maize does not give rise to food and feed safety and nutritional concerns. The GMO Panel concludes that the four-event stack maize, as described in this application, is as safe as its non-GM comparator and the non-GM reference varieties tested. In the case of accidental release of viable seeds of the four-event stack maize into the environment, this would not raise environmental safety concerns. The GMO Panel assessed the likelihood of interactions among the single events in the four maize subcombinations not previously assessed and concludes that these are expected to be as safe as the single events, the previously assessed subcombinations and the four-event stack maize. The post-market environmental monitoring plan and reporting intervals are in line with the intended uses of the four-event stack maize. Post-market monitoring of food/feed is not considered necessary. The GMO Panel concludes that the four-event stack maize and its subcombinations are as safe as the non-GM comparator and the tested non-GM reference varieties with respect to potential effects on human and animal health and the environment

Efficient Identification of Critical Residues Based Only on Protein Structure by Network Analysis

Despite the increasing number of published protein structures, and the fact that each protein's function relies on its three-dimensional structure, there is limited access to automatic programs used for the identification of critical residues from the protein structure, compared with those based on protein sequence. Here we present a new algorithm based on network analysis applied exclusively on protein structures to identify critical residues. Our results show that this method identifies critical residues for protein function with high reliability and improves automatic sequence-based approaches and previous network-based approaches. The reliability of the method depends on the conformational diversity screened for the protein of interest. We have designed a web site to give access to this software at http://bis.ifc.unam.mx/jamming/. In summary, a new method is presented that relates critical residues for protein function with the most traversed residues in networks derived from protein structures. A unique feature of the method is the inclusion of the conformational diversity of proteins in the prediction, thus reproducing a basic feature of the structure/function relationship of proteins

Transformational school leadership as a key factor for teachers’ job attitudes during their first year in the profession

Teacher attrition is a global concern that is particularly prevalent among beginning teachers. Teachers' intrinsic motivation to teach, affective organisational commitment and job satisfaction are considered job attitudes that stop them from dropping out of the profession. This study explores the interplay between factors at the school level (i.e. transformational leadership of the principal, professional collegial support) and the teacher level (i.e. self-efficacy) influencing these job attitudes. A sample of 292 first-year primary-school teachers participated. The results of the path analysis demonstrated that transformational leadership of the principal is directly related to teachers' job attitudes in a positive way. Moreover, transformational leadership of the principal is also indirectly related to these attitudes, via both professional collegial support and teachers' self-efficacy. Implications for the supportive role of the principal in the teachers' first year in the profession are discussed

Neuronal uptake and propagation of a rare phosphorylated high-molecular-weight tau derived from Alzheimer's disease brain

Tau pathology is known to spread in a hierarchical pattern in Alzheimer's disease (AD) brain during disease progression, likely by trans-synaptic tau transfer between neurons. However, the tau species involved in inter-neuron propagation remains unclear. To identify tau species responsible for propagation, we examined uptake and propagation properties of different tau species derived from postmortem cortical extracts and brain interstitial fluid of tau-transgenic mice, as well as human AD cortices. Here we show that PBS-soluble phosphorylated high-molecular-weight (HMW) tau, though very low in abundance, is taken up, axonally transported, and passed on to synaptically connected neurons. Our findings suggest that a rare species of soluble phosphorylated HMW tau is the endogenous form of tau involved in propagation and could be a target for therapeutic intervention and biomarker development