Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014

Objective To conduct an updated, systematic review of the clinical literature, classify studies based on the strength of research design, and derive consensual, evidence-based clinical recommendations for cognitive rehabilitation of people with TBI or stroke. Data Sources Online Pubmed and print journal searches identified citations for 250 articles published from 2009 through 2014. Study Selection 186 articles were selected for inclusion after initial screening. 50 articles were initially excluded (24 healthy, pediatric or other neurologic diagnoses, 10 non-cognitive interventions, 13 descriptive protocols or studies, 3 non-treatment studies). 15 articles were excluded after complete review (1 other neurologic diagnosis, 2 non-treatment studies, 1 qualitative study, 4 descriptive papers, 7 secondary analyses). 121 studies were fully reviewed. Data Extraction Articles were reviewed by CRTF members according to specific criteria for study design and quality, and classified as providing Class I, Class II, or Class III evidence. Articles were assigned to 1 of 6 possible categories (based on interventions for attention, vision and neglect, language and communication skills, memory, executive function, or comprehensive-integrated interventions). Data Synthesis Of 121 studies, 41 were rated as Class I, 3 as Class Ia, 14 as Class II, and 63 as Class III. Recommendations were derived by CRTF consensus from the relative strengths of the evidence, based on the decision rules applied in prior reviews. Conclusions CRTF has now evaluated 491 papers (109 Class I or Ia, 68 Class II, and 314 Class III) and makes 29 recommendations for evidence-based practice of cognitive rehabilitation (9 Practice Standards, 9 Practice Guidelines and 11 Practice Options). Evidence supports Practice Standards for attention deficits after TBI or stroke; visual scanning for neglect after right hemisphere stroke; compensatory strategies for mild memory deficits; language deficits after left hemisphere stroke; social communication deficits after TBI; metacognitive strategy training for deficits in executive functioning; and comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability after TBI or stroke

Beyond ‘just’ flood risk management: the potential for—and limits to—alleviating flood disadvantage

The threat of flooding poses a considerable challenge for justice. Not only are more citizens becoming exposed to risk, but they are expected to play increasingly active roles in flood risk management. However, until recently, few efforts have charted broader understandings of disadvantage relating to flood risk exposure. Drawing upon social science scholarship that has long been sensitive to concerns related to justice, we deploy and develop the notion of flood disadvantage as a means to assess the challenges to more ‘just’ flood risk management. We contend that the concept of flood disadvantage offers a useful lens to appreciate the constraints of technical approaches to flood risk management, in particular, its limited ability to incorporate complex social elements such as how individuals have differing vulnerabilities and sensitivities to flooding and uneven abilities to engage with risk agendas. The notion highlights the compounding interactions between flooding and other social disadvantages across multiple public policy areas and scales. We argue a fuller acknowledgement of the socio-spatial-temporal dimensions of intersecting disadvantages can help sensitise technical risk analyses that tend to see people and communities as homogeneous entities in a given spatiality. In doing so we can better reveal why some individuals or communities are more vulnerable to disasters or are slower to recover than others. Finally, we outline the challenges in turning more ‘just’ flood risk management from an abstract notion into one that could inform future practice

Independent and court-ordered forensic neuropsychological examinations: Official statement of the National Academy of Neuropsychology

Independent forensic neuropsychological examinations are performed by neuropsychologists who are hired as independent contractors by third parties to make determinations regarding neuropsychological functioning. The responsibilities of neuropsychologists when performing independent or court-ordered forensic examinations differ from those of clinical examinations. Because neuropsychological training typically occurs in clinical contexts, the transition to forensic contexts may result in uncertainty about how to negotiate the unique responsibilities of the forensic examiner role. Neuropsychologists are responsible for maintaining the highest standards of professional practice when performing independent and court-ordered forensic examinations. To reach and maintain the highest standards of practice, neuropsychologists must understand the unique relationships with retaining parties and examinees and strive to maintain true independence and objectivity. Although a true neuropsychologist-patient relationship is not considered to exist within the context of a forensic neuropsychological evaluation, neuropsychologists have ethical responsibilities to both the retaining party and the examinee. © 2005 National Academy of Neuropsychology. Published by Elsevier Ltd. All rights reserved

Induction of TLR4-target genes entails calcium/calmodulin-dependent regulation of chromatin remodeling

Upon toll-like receptor 4 (TLR4) signaling in macrophages, the mammalian Swi/Snf-like BAF chromatin remodeling complex is recruited to many TLR4 target genes where it remodels their chromatin to promote transcription. Here, we show that, surprisingly, recruitment is not sufficient for chromatin remodeling; a second event, dependent on calcium/calmodulin (CaM), is additionally required. Calcium/CaM directly binds the HMG domain of the BAF57 subunit within the BAF complex. Calcium/CaM antagonists, including a CaM-binding peptide derived from BAF57, abolish BAF-dependent remodeling and gene expression without compromising BAF recruitment. BAF57 RNAi and BAF57 dominant negative mutants defective in CaM binding similarly impair the induction of BAF target genes. Our data implicate calcium/CaM in TLR4 signaling, and reveal a previously undescribed, recruitment-independent mode of regulation of the BAF complex that is probably achieved through a direct CaM-BAF interaction