Slowed driving-reaction time following concussion-symptom resolution

Background: Concussed patients have impaired reaction time (RT) and cognition following injury that may linger and impair driving performance. Limited research has used direct methods to assess driving-RT post-concussion. Our study compared driving RT during simulated scenarios between concussed and control individuals and examined driving-RT''s relationship with traditional computerized neurocognitive testing (CNT) domains.MethodsWe employed a cross-sectional study among 14 concussed (15.9 ± 9.8 days post-concussion, mean ± SD) individuals and 14 healthy controls matched for age, sex, and driving experience. Participants completed a driving simulator and CNT (CNS Vital Signs) assessment within 48 h of symptom resolution. A driving-RT composite (ms) was derived from 3 simulated driving scenarios: stoplight (green to yellow), evasion (avoiding approaching vehicle), and pedestrian (person running in front of vehicle). The CNT domains included verbal and visual memory; CNT-RT (simple-, complex-, Stroop-RT individually); simple and complex attention; motor, psychomotor, and processing speed; executive function; and cognitive flexibility. Independent t tests and Hedge d effect sizes assessed driving-RT differences between groups, Pearson correlations (r) examined driving RT and CNT domain relationships among cohorts separately, and p values were controlled for false discovery rate via Benjamini-Hochberg procedures (α = 0.05).ResultsConcussed participants demonstrated slower driving-RT composite scores than controls (mean difference = 292.86 ms; 95% confidence interval (95%CI): 70.18–515.54; p = 0.023; d = 0.992). Evasion-RT (p = 0.054; d = 0.806), pedestrian-RT (p = 0.258; d = 0.312), and stoplight-RT (p = 0.292; d = 0.585) outcomes were not statistically significant after false-discovery rate corrections but demonstrated medium to large effect sizes for concussed deficits. Among concussed individuals, driving-RT outcomes did not significantly correlate with CNT domains (r-range: –0.51 to 0.55; p > 0.05). No correlations existed between driving-RT outcomes and CNT domains among control participants either (r-range: –0.52 to 0.72; p > 0.05).ConclusionSlowed driving-RT composite scores and large effect sizes among concussed individuals when asymptomatic signify lingering impairment and raise driving-safety concerns. Driving-RT and CNT-RT measures correlated moderately but not statistically, which indicates that CNT-RT is not an optimal surrogate for driving RT.     

Exploring Postcolonial and Feminist Issues: Rabbit‐Proof Fence in a Teaching Context

The discussion in this article focuses on representations in Doris Pilkington's Rabbit‐Proof Fence of trauma and reparation, and reflects on processes and strategies involved in teaching undergraduate students about these issues within literary contexts. The article discusses the practice of introducing students to new texts and areas of study, and demonstrates the positive learning outcomes deriving from inclusion of non‐canonical material linked to feminist and postcolonial theoretical and critical discussions. An earlier version of this paper, entitled ‘Rabbit‐Proof Fence: Text and Film’, was given at the Contemporary Women's Writing Network Inaugural Conference, ‘For Love or Money: Contemporary Women's Fiction in the Marketplace’, University of Bangor, April 2006.     

Can we prioritise which databases to search? A case study using a systematic review of frozen shoulder management

Background

Systematic reviews risk producing biased conclusions if a comprehensive search to identify eligible studies is not undertaken, but little evidence exists to guide prioritisation of databases to search when resources are limited.

Objectives

A systematic review examining interventions for managing frozen shoulder (adhesive capsulitis) was used to investigate the performance of bibliographic databases in identifying the included studies, the smallest combination of databases required to retrieve all included studies, and the performance of the searches themselves.

Methods

We calculated the yield of included studies from each of 15 databases, and the recall and precision of each search strategy. We investigated differences between the presence of a record in a database and its retrieval.

Results

Thirty of 31 studies were present in at least one database. Yields of individual databases ranged from 0% to 90% (median 23%). Two combinations of databases identified all 30 studies: Cochrane Central Register of Controlled Trials (CENTRAL) and Science Citation Index (SCI); or CENTRAL, MEDLINE and PreMEDLINE.

Conclusions

In a systematic review of a range of interventions used to manage frozen shoulder, at least two databases and reference checking were required to retrieve all included studies, but searching for future reviews should not be restricted.