Evaluation of a Low-Cost, PC-Based Driving Simulator to Assess Persons with Cognitive Impairments Due to Brain Injury

Brain injury due to accident or stroke frequently results in cognitive impairment, reducing an individual’s ability to judge driving situations accurately. Rehabilitation professionals typically use a combination of clinical and on-road tests to determine whether an individual is safe to drive. Weighing the safety of the community, the candidate, and the driving evaluator, these on-road tests are often conducted under road, traffic and weather conditions less demanding than those that a driver might face in the “real world,” and thus may offer less than complete information regarding the candidate’s responses to such real-world driving challenges. Indeed, individuals with mild cognitive deficits may perform adequately under such testing conditions but unsafely when driving challenges increase. Complicating this situation further, those with mild to moderate acquired cognitive impairments may be largely unaware of their own limitations, and thus more intolerant of perceived delays or challenges to their desire to drive again. Although continuing advances have improved performance and fidelity while significantly reducing costs, most interactive driving simulators remain too expensive for widespread clinical application. In a project funded by the National Center for Medical Rehabilitation Research, National Institutes of Health, we sought to determine, on a pilot basis, whether a low-cost, PC-based driving simulator could provide clinicians with information useful to their efforts to assess the safe ability to drive of individuals with cognitive impairments. We developed two comprehensive simulator-based driving scenarios, one quite basic and one more challenging, and pilot-tested them on ten subjects – five with moderate cognitive impairments, and five age and sex matched-controls without impairment. The “simple” scenario was developed to match the essential demands of the first half of an existing on-road driving evaluation; the “complex” scenario was based on the second half of the on-road evaluation into which more demanding, but still common, driving challenges were integrated. Road types, lane widths, pavement markings, traffic signals, horizontal and vertical curvature, and the proximal built environment were all created in simulation to provide a convincing generic representation of the on-road test. Challenges incorporated into the “complex” phase of the scenario, which were absent from the “simple” phase, included traffic events such as: cross-traffic failing to stop at a STOP sign; pedestrians crossing the driver’s path; vehicles suddenly pulling out in front of the subject from the road shoulder; opposing thru traffic appearing suddenly from behind slower moving vehicles as the subject attempted to turn left; slower moving lead vehicles causing passing decisions; traffic streams forcing gap acceptance decisions; etc. Results from the simulator were compared to results from the on-road evaluation. In addition, data gathered from subject exit interviews was used to judge simulator verisimilitude and efficacy in changing self-awareness of deficit. Because the cognitive impairments associated with brain injury often reduce the individual’s awareness of his or her own limitations, we looked at evidence that performance on the simulator could contribute to an individual’s own understanding of his or her driving strengths and weaknesses. The results of the pilot study will lead to an enhancement of simulator capabilities, and to a comprehensive clinical trial at multiple sites. This paper will present the findings of this pilot investigation and an overview of the expanded clinical study

Proinsulin Secretion Is a Persistent Feature of Type 1 Diabetes

OBJECTIVE: Abnormally elevated proinsulin secretion has been reported in type 2 and early type 1 diabetes when significant C-peptide is present. We questioned whether individuals with long-standing type 1 diabetes and low or absent C-peptide secretory capacity retained the ability to make proinsulin. RESEARCH DESIGN AND METHODS: C-peptide and proinsulin were measured in fasting and stimulated sera from 319 subjects with long-standing type 1 diabetes (≥3 years) and 12 control subjects without diabetes. We considered three categories of stimulated C-peptide: 1) C-peptide positive, with high stimulated values ≥0.2 nmol/L; 2) C-peptide positive, with low stimulated values ≥0.017 but <0.2 nmol/L; and 3) C-peptide <0.017 nmol/L. Longitudinal samples were analyzed from C-peptide-positive subjects with diabetes after 1, 2, and 4 years. RESULTS: Of individuals with long-standing type 1 diabetes, 95.9% had detectable serum proinsulin (>3.1 pmol/L), while 89.9% of participants with stimulated C-peptide values below the limit of detection (<0.017 nmol/L; n = 99) had measurable proinsulin. Proinsulin levels remained stable over 4 years of follow-up, while C-peptide decreased slowly during longitudinal analysis. Correlations between proinsulin with C-peptide and mixed-meal stimulation of proinsulin were found only in subjects with high stimulated C-peptide values (≥0.2 nmol/L). Specifically, increases in proinsulin with mixed-meal stimulation were present only in the group with high stimulated C-peptide values, with no increases observed among subjects with low or undetectable (<0.017 nmol/L) residual C-peptide. CONCLUSIONS: In individuals with long-duration type 1 diabetes, the ability to secrete proinsulin persists, even in those with undetectable serum C-peptide

Nonprofit governance: Improving performance in troubled economic times

Nonprofit management is currently pressured to perform effectively in a weak economy. Yet, nonprofit governance continues to suffer from unclear conceptions of the division of labor between board of directors and executive directors. This online survey of 114 executive directors aims to provide clarification and recommendations for social administration

Handling Conflicts in Depth-First Search for LTL Tableau to Debug Compliance Based Languages

Providing adequate tools to tackle the problem of inconsistent compliance rules is a critical research topic. This problem is of paramount importance to achieve automatic support for early declarative design and to support evolution of rules in contract-based or service-based systems. In this paper we investigate the problem of extracting temporal unsatisfiable cores in order to detect the inconsistent part of a specification. We extend conflict-driven SAT-solver to provide a new conflict-driven depth-first-search solver for temporal logic. We use this solver to compute LTL unsatisfiable cores without re-exploring the history of the solver.Comment: In Proceedings FLACOS 2011, arXiv:1109.239

Chromosomal-level assembly of the Asian Seabass genome using long sequence reads and multi-layered scaffolding

We report here the ~670 Mb genome assembly of the Asian seabass (Lates calcarifer), a tropical marine teleost. We used long-read sequencing augmented by transcriptomics, optical and genetic mapping along with shared synteny from closely related fish species to derive a chromosome-level assembly with a contig N50 size over 1 Mb and scaffold N50 size over 25 Mb that span ~90% of the genome. The population structure of L. calcarifer species complex was analyzed by re-sequencing 61 individuals representing various regions across the species' native range. SNP analyses identified high levels of genetic diversity and confirmed earlier indications of a population stratification comprising three clades with signs of admixture apparent in the South-East Asian population. The quality of the Asian seabass genome assembly far exceeds that of any other fish species, and will serve as a new standard for fish genomics

What Every Business Student Needs to Know About Information Systems

Whether Information Systems should or should not be part of the core business school curriculum is a recurring discussion in many universities. In this article, a task force of 40 prominent information systems scholars address the issue. They conclude that information systems is absolutely an essential body of knowledge for business school students to acquire as well as a key element of the business school\u27s long-run strategic positioning within the university. Originally prepared in response to draft accreditation guidelines prepared by AACSB International, the article includes a compilation of the concepts that the authors believe to be the core information systems knowledge that all business school students should be familiar with

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Persistent Expression of FLAG-tagged Micro dystrophin in Nonhuman Primates Following Intramuscular and Vascular Delivery

Animal models for Duchenne muscular dystrophy (DMD) have species limitations related to assessing function, immune response, and distribution of micro- or mini-dystrophins. Nonhuman primates (NHPs) provide the ideal model to optimize vector delivery across a vascular barrier and provide accurate dose estimates for widespread transduction. To address vascular delivery and dosing in rhesus macaques, we have generated a fusion construct that encodes an eight amino-acid FLAG epitope at the C-terminus of micro-dystrophin to facilitate translational studies targeting DMD. Intramuscular (IM) injection of AAV8.MCK.micro-dys.FLAG in the tibialis anterior (TA) of macaques demonstrated robust gene expression, with muscle transduction (50–79%) persisting for up to 5 months. Success by IM injection was followed by targeted vascular delivery studies using a fluoroscopy-guided catheter threaded through the femoral artery. Three months after gene transfer, >80% of muscle fibers showed gene expression in the targeted muscle. No cellular immune response to AAV8 capsid, micro-dystrophin, or the FLAG tag was detected by interferon-γ (IFN-γ) enzyme-linked immunosorbent spot (ELISpot) at any time point with either route. In summary, an epitope-tagged micro-dystrophin cassette enhances the ability to evaluate site-specific localization and distribution of gene expression in the NHP in preparation for vascular delivery clinical trials

Energy Reallocation to Breeding Performance through Improved Nest Building in Laboratory Mice.

Mice are housed at temperatures (20-26°C) that increase their basal metabolic rates and impose high energy demands to maintain core temperatures. Therefore, energy must be reallocated from other biological processes to increase heat production to offset heat loss. Supplying laboratory mice with nesting material may provide sufficient insulation to reduce heat loss and improve both feed conversion and breeding performance. Naïve C57BL/6, BALB/c, and CD-1breeding pairs were provided with bedding alone, or bedding supplemented with either 8g of Enviro-Dri, 8g of Nestlets, for 6 months. Mice provided with either nesting material built more dome-like nests than controls. Nesting material improved feed efficiency per pup weaned as well as pup weaning weight. The breeding index (pups weaned/dam/week) was higher when either nesting material was provided. Thus, the sparing of energy for thermoregulation of mice given additional nesting material may have been responsible for the improved breeding and growth of offspring