Driver Expectations of a Partial Driving Automation System in Relation to Branding and Training.

OBJECTIVE: The current study examined whether differences in the branding and description or mode of training materials influence drivers' understanding and expectations of a partial driving automation system. BACKGROUND: How technology is described might influence consumers' understanding and expectations, even if all information is accurate. METHOD: Ninety drivers received training about a real partial driving automation system with a fictitious name. Participants were randomly assigned to a branding condition (system named AutonoDrive, training emphasized capabilities; or system named DriveAssist, training emphasized limitations) and training mode (quick-start brochure; video; or in-person demonstration). No safety-critical information was withheld nor deliberately misleading information provided. After training, participants drove a vehicle equipped with the system. Associations of drivers' expectations with branding condition and training mode were assessed using between-subjects comparisons of questionnaire responses obtained pre- and post-drive. RESULTS: Immediately after training, those who received information emphasizing the system's capabilities had greater expectations of the system's function and crash avoidance capability in a variety of driving scenarios, including many in which the system would not work, as well as greater willingness to utilize the system's workload reduction benefits to take more risks. Most but not all differences persisted after driving the vehicle. Expectations about collision avoidance differed by training mode pre-drive but not post-drive. CONCLUSION: Training that emphasizes a partial driving automation system's capabilities and downplays its limitations can foster overconfidence. APPLICATION: Accuracy of technical information does not guarantee understanding; training should provide a balanced view of a system's limitations as well as capabilities.

Fatal hit-and-run crashes: Factors associated with leaving the scene.

INTRODUCTION: Hit-and-run crashes are a criminal offense that leave the victim without prompt medical care or the ability to receive financial compensation. METHOD: The purpose of the current study was to quantify the factors associated with the probability that a driver leaves the scene of a fatal crash, using multiple imputation to incorporate information from drivers who were never apprehended and thus whose characteristics were unknown. RESULTS: The results of this study show that in addition to driver, vehicle, and environmental factors having significant impacts on the likelihood of a driver fleeing the scene, economic and demographic factors are important as well. Practical Applications: This analysis allows for a more holistic understanding of hit-and-run crashes and informs potential countermeasures and future research.

Evaluation of a revised indication for determining adult cochlear implant candidacy.

OBJECTIVE: To evaluate the use of monosyllabic word recognition versus sentence recognition to determine candidacy and long-term benefit for cochlear implantation. STUDY DESIGN: Prospective multi-center single-subject design. METHODS: A total of 21 adults aged 18 years and older with bilateral moderate to profound sensorineural hearing loss and low monosyllabic word scores received unilateral cochlear implantation. The consonant-nucleus-consonant (CNC) word test was the central measure of pre- and postoperative performance. Additional speech understanding tests included the Hearing in Noise Test sentences in quiet and AzBio sentences in +5 dB signal-to-noise ratio (SNR). Quality of life (QoL) was measured using the Abbreviated Profile of Hearing Aid Benefit and Health Utilities Index. RESULTS: Performance on sentence recognition reached the ceiling of the test after only 3 months of implant use. In contrast, none of the participants in this study reached a score of 80% on CNC word recognition, even at the 12-month postoperative test interval. Measures of QoL related to hearing were also significantly improved following implantation. CONCLUSION: Results of this study demonstrate that monosyllabic words are appropriate for determining preoperative candidate and measuring long-term postoperative speech recognition performance. LEVEL OF EVIDENCE: 2c. Laryngoscope, 127:2368-2374, 2017.

Analysis of semen parameters during 2 weeks of daily ejaculation: a first in humans study.

BACKGROUND: Timed and frequent intercourse around the time of female ovulation is recommended to improve conception. Although a significant number of articles have examined how the length of abstinence affects these semen analysis, the effects of frequent (daily) ejaculation has not been rigorously studied. METHODS: Twenty normal men were recruited for daily ejaculation over 14 consecutive days, after a 3-5 days abstinence period. Semen samples were collected at the beginning of the study (day 1) and then on days 3, 7 and 14. In addition to the standard semen analysis, markers of sperm DNA quality were assessed. RESULTS: The mean age of men completing the study was 25 years (range, 23-33 years). Significant decreases were observed in mean semen volume, total motile count (TMC) and sperm concentration during the study period without significant changes in motility or morphology. A large initial change in ejaculate volume, TMC and sperm concentration provided the primary difference in these values over the study period, with a plateau in values after this initial decrease (after study day 3). Metrics of DNA integrity did not change in a statistically or clinically meaningful way during the study period. CONCLUSIONS: While a small study, this represents the most extensive examination of sperm quality with daily ejaculation. These findings generally support an approach of a short period of abstinence followed by daily copulation around ovulation to maximize the number of sperm available and optimize conception.

Bone-anchored hearing aid implantation in a patient with Goldenhar syndrome.

Patients with Goldenhar syndrome exhibit a number of characteristic symptoms, including middle and internal ear malformations that may cause profound hearing loss. Bone-anchored hearing aids have been used to treat these patients in the past, although complications may arise due to the nature of the disease. Herein we present the case of a pediatric patient with Goldenhar syndrome whose hearing aid abutment extruded spontaneously because of poor bone quality, despite adequate thickness. We provide a brief review of the literature and suggest a flexible surgical plan for any syndromic pediatric patient.

Improved performance of tunable single-mode laser array based on high-order slotted surface grating.

We present an improved design of a wavelength-tunable single-mode laser array based on a high order surface grating with non-uniformly spaced slots. The laser array consists of 12 slotted single-mode lasers. The fabricated device exhibits a quasi-continuous tuning range of more than 36 nm over the temperature range from 10°C - 45°C covering the full C-band. All lasers in the array have stable single-mode operation with side mode suppression ratio of 50 dB due to the modified slot design. A spectral linewidth of less than 500 kHz was obtained for all channels in the array.

Microlaparoscopy versus conventional laparoscopy in transperitoneal pyeloplasty.

BACKGROUND AND PURPOSE: Laparoscopic pyeloplasty has emerged as the gold standard for repair of ureteropelvic junction obstruction. Microlaparoscopic (MLP, <3 mm) instrumentation has improved markedly and can now be used for suturing and complex dissection needed during laparoscopic pyeloplasty. We present our experience with microlaparoscopy compared with conventional laparoscopy for transperitoneal pyeloplasty. METHODS: We performed a retrospective analysis of hybrid MLP, using a 5-mm camera in a hidden umbilical incision, and 1.9 or 3 mm working instruments and compared with patients undergoing conventional laparoscopic pyeloplasty (CLP). The data for MLP and CLP were compared using the Student t test, Pearson chi-square test, and Fisher exact test, where appropriate. RESULTS: Between January 2009 and May 2013, there were 19 MLP and 27 CLP procedures performed. The MLP group mean age was younger than the CLP group (34 vs 50 years; P=0.0003). Body mass index, previous treatment rates, operative time, length of stay, ureteral stent duration, and complication rates were not statistically different between the MLP and CLP groups. Strict success rates (indicated by follow-up renal scan T½<20 min) were similar between MLP and CLP groups (89.5% vs 88.9%; P=0.95). No MLP procedures were converted to CLP or open approaches. CONCLUSIONS: From technical, perioperative, and outcome perspectives, transperitoneal pyeloplasty with microlaparoscopy is both safe and feasible in our hands compared with conventional laparoscopy, and results in subjectively superior cosmesis. This is the largest MLP series to date and contains, to our knowledge, the only cases described using prototype 1.9 mm instruments.

Infectious outcomes of nephrostomy drainage before percutaneous nephrolithotomy compared to concurrent access.

PURPOSE: We hypothesized that establishing percutaneous nephrostomy drainage and treating with renal urine culture specific antibiotics would lead to a decreased sepsis rate in patients at increased risk for infection. We analyzed the experience of a single surgeon with sepsis after percutaneous nephrolithotomy following prior nephrostomy drainage compared to percutaneous nephrolithotomy with concurrent percutaneous renal collecting system access. MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent percutaneous nephrolithotomy. Pertinent collected data included patient infection history, preoperative urine cultures, renal calculi burden size, renal urine/stone cultures, length of stay and sepsis/systemic inflammatory response syndrome events. RESULTS: Percutaneous nephrolithotomy was performed in 219 patients between September 2007 and June 2012. Of the patients 67 (30.6%) had preplaced nephrostomy drainage (group 1) while 152 (69.4%) had concurrent percutaneous renal access (group 2). Stone culture was positive more often in group 1 than in group 2 (64.2% vs 25.7%, p = 0.0001). The concordance rate of preoperative renal urine culture results with stone culture results was higher than the concordance rates of lower urinary tract urine culture results in groups 1 and 2 (30.6% vs 21.4% and 7.3%, respectively). There was no systemic inflammatory response syndrome/sepsis episode in group 1 but we noted a 5.9% systemic inflammatory response syndrome/sepsis rate in group 2 (p = 0.043). CONCLUSIONS: In this retrospective study our data suggest that in patients at high risk for urosepsis preoperative nephrostomy drainage with renal urine culture and culture specific antibiotic treatment may decrease the risk of postoperative infectious complications. Stone culture is also important since many patients at high risk for infection will have positive stone cultures. A prospective study is needed to confirm these retrospective data findings.

How to approach a bilobed petrous apex granuloma: a case report.

Cholesterol granulomas are the most common lesions involving the petrous apex. However, they are still an uncommon finding overall, and they often remain undiagnosed until they have become extremely large and symptomatic. Many surgical approaches to the petrous apex exist. Factors that often influence the surgical approach include the surgeon's experience, the patient's anatomy, and the patient's hearing status. The purpose of this case report-which involved a 66-year-old woman who was referred to our clinic for evaluation of severe headaches, dizziness, and left-sided pulsatile tinnitus-is to demonstrate the definitive need for an extended middle fossa approach when a bilobed petrous apex mass is encountered.

Intentionally retained pressure-regulating balloon in artificial urinary sphincter revision.

INTRODUCTION: The traditional surgical approach for revision of a malfunctioning artificial urinary sphincter (AUS) includes removal and replacement of all device components, identical to that employed in the setting of an infected or eroded AUS. AIMS: To describe outcomes of our technique in which we intentionally leave behind the original pressure-regulating balloon (PRB) at time of AUS revision in a clinically non-infected setting. METHODS: We retrospectively reviewed our combined institutional series of 35 patients who underwent 36 AUS revisions in which the original pressure-regulating balloon was left undisturbed. We removed and replaced the defective cuff and pump through a single peno-scrotal incision for most patients requiring revision of a non-infected AUS. The new PRB was then placed on the opposite side through this single incision. MAIN OUTCOME MEASURES: Assessment of outcomes, complication, and infection rate of this surgical series. RESULTS: All of the patients had the original pressure-regulating balloon placed through an inguinal counter-incision. Mean follow-up time was 14 months (2-33 months). Overall complication rate for the revision series was 11%. No infections or complications occurred secondary to the retained PRB. CONCLUSION: Follow-up of our series provides evidence that retention of the original PRB at the time of non-infected AUS revision is safe. Potential advantages include elimination of a counter incision and technically challenging exploration. By eliminating these aspects, the potentially resultant decreased operative time may help counter the theoretical yet unproven risk of infection from leaving the old PRB in place.

An operative performance rating system for urology residents.

PURPOSE: An operative performance rating system for urology residents was developed for 6 sentinel urological procedures. We tested the reliability, validity and feasibility of the operative performance rating system for urology residents. MATERIALS AND METHODS: The operative performance rating system of each procedure contained a 3-point case difficulty scale, 4 to 6 procedure specific items, 3 general items and an overall performance item. A Likert scale of 1 to 5 was used for each item. A single video/audio record of each procedure was evaluated by the faculty. Single item interrater agreement was measured by comparing the observed variance and random measurement error variance. Resident operative performance evaluations were completed on line. Internal consistency reliability was measured using Cronbach α. Overall scale scores by resident training postgraduate year level were compared using 1-way ANOVA. RESULTS: Faculty evaluation of video/audio records showed an interrater agreement range of 0.71 to 0.92. Faculty evaluations of resident operative performance demonstrated an internal consistency reliability range of 0.91 to 0.95. Significant differences in overall scale scores between postgraduate year levels were noted for 3 of the 6 procedures (p ≤0.0016). CONCLUSIONS: An operative performance rating system for urology residents is feasible using an Internet based resident management system. Interrater agreement and internal consistency reliability meet threshold limits for checklist evaluation instruments. The operative performance rating system can discriminate among postgraduate year levels of resident training. A validated operative performance rating system can offer residents immediate, objective feedback on surgical performance and enable program directors to monitor progress in resident operative performance.

Cost analysis of metallic ureteral stents with 12 months of follow-up.

BACKGROUND AND PURPOSE: The metallic ureteral stent was first developed for patients with ureteral obstruction related to malignant disease, but it can be used in all patients needing chronic indwelling ureteral stents, including those with benign disease. The traditional method of polymer stent management often necessitates multiple exchanges per year depending on patient and logistical factors. This has significant direct financial cost and likely a negative effect on patients' overall health. The objective was to analyze and compare the costs associated with chronic indwelling metal and silicone-based ureteral stents. PATIENTS AND METHODS: A prospective database of patients undergoing metal stent placement from February 2008 to June 2010 was reviewed. Mean charges for a single traditional nonmetal and metal stent insertion were calculated. Charges were based on direct hospital charges related to stent cost and surgery. Cost data were based on the fiscal year 2010 cost for polymer or metal stent insertions. RESULTS: Twenty-one patients underwent metal stent placement at our institution. Of these, three traditional stent placements were omitted from analysis because of bundled charges for ureteroscopy at the same setting. Mean charges per single traditional and metal stent placement were $6072.75 and $9469.50, respectively. The estimated annual charges for traditional stents (3-6 exchanges) would be $18,218.25 to $36,436.50. Compared with metal stents, this is a potential financial savings of 48% to 74%. The mean direct cost to patients was 21.6% and 25.4% of the charges for metal and polymer stents, respectively. No patient needed early discontinuation of his or her metal stent because of lower urinary tract symptoms or gross hematuria. CONCLUSIONS: Metal stents are well tolerated by patients with ureteral obstruction of various etiologies and provide a significant financial benefit compared with polymer ureteral stents. For patients who are not fit for surgical intervention regarding their ureteral occlusive disease, the metal Resonance stent is a financially advantageous and well-tolerated option.

Metal ureteral stent for benign and malignant ureteral obstruction.

PURPOSE: Metal ureteral stents are a relatively new version of a device with a long history of relieving ureteral obstruction. Metal stents are effective for relieving ureteral obstruction but success regarding patient tolerability has been variable. We present our single institution experience with long-term metal ureteral stent placement. MATERIALS AND METHODS: The charts of patients undergoing metal ureteral stent placement for chronic ureteral obstruction were reviewed. Data collected included patient age, gender, diagnosis/cause of obstruction, laterality, duration of indwelling metal stent, number of routine metal stent changes, complications and early discontinuations or stent changes. RESULTS: A total of 23 patients underwent placement of metal ureteral stents between February 2008 and September 2010. Bilateral stents were placed in 5 patients and 9 underwent a yearly metal stent exchange for a total of 42 ureteral units treated with metal ureteral stents. All metal stents were placed to relieve ureteral obstruction due to ureteral stricture, ureteropelvic junction obstruction, retroperitoneal fibrosis or extrinsic malignant obstruction. There were 3 metal stent failures in 2 patients with malignant ureteral obstruction. There were no complications, or early discontinuations or changes due to adverse symptoms, patient dissatisfaction, worsening renal function or progressive hydronephrosis. CONCLUSIONS: Metal ureteral stents are effective for benign and malignant ureteral obstruction in the absence of urolithiasis. Good tolerability and annual stent exchange make metal stents an appealing alternative for patients with chronic ureteral obstruction treated with indwelling ureteral stents.

A case of coronal urethral duplication with no other abnormalities.

Urethral duplication is a very rare congenital anomaly. Urethral duplication is seen most commonly in the sagittal plane. We report a rare case of complete urethral duplication in the coronal plane with no other associated anomalies. Surgical correction of this coronal urethral duplication resulted in a normal-appearing penis and good functional outcome with a single midline urethral meatus and urinary stream.

Comparison of rowing on a concept 2 stationary and dynamic ergometer.

Biomechanical and physiological responses to rowing 1000 m at a power output equivalent to a 2000 m race were compared in 34 collegiate rowers (17 women, 17 men) rowing on a stationary and dynamic Concept 2 ergometer. Stroke ratio, peak handle force, rate of force development, impulse, and respiratory exchange ratio decreased by 15.7, 14.8, 10.9, 10.2 and 1.9%, respectively, on the dynamic ergometer. In contrast, percent time to peak force and stroke rate increased by 10.5 and 12.6%, respectively, during dynamic ergometry; the changes in stroke rate and impulse were greater for men than women. Last, VO2 was 5.1% higher and efficiency 5. 3% lower on the dynamic ergometer for men. Collegiate rowers used higher stoke rates and lower peak stroke forces to achieve a similar power output while rowing at race pace on the dynamic ergometer, which may have increased the cardiopulmonary demand and possibly reduced force production in the primary movers. Differences were more pronounced in males than females; this dichotomy may be more due to dynamic ergometer familiarity than sex. Key pointsWhen rowing at a constant power output, all rowers used higher stroke rates and lower stroke forces on the Concept 2 Dynamic ergometer as compared to the Concept 2 Stationary ergometer.When rowing at a constant power output, cardiopulmonary demand was higher for all rowers, as measured by heart rate, on the Concept 2 Dynamic ergometer as compared to the Concept 2 Stationary ergometer.When rowing at a constant power output, efficiency was lower for male rowers on the Concept 2 Dynamic ergometer as compared to the Concept 2 Stationary ergometer.

Robot-assisted laparoscopic sacrouteropexy for pelvic organ prolapse in classical bladder exstrophy.

Classical bladder exstrophy is a rare congenital anomaly with male predominance. When occurring in women, the accompanying anatomical and functional abnormalities, including pelvic organ prolapse (POP), may cause significant problems in both pediatric and adult patients. The robotic surgical approach to POP has not been described for bladder exstrophy as it has been in otherwise normal women. We report our technique with the first robot-assisted laparoscopic sacrouteropexy for Baden-Walker grade-four POP in an 18-year-old classical bladder exstrophy patient. At 12 months of follow-up, there were no issues or symptoms/evidence of recurrence of POP. To our knowledge, this is the first reported robot-assisted laparoscopic sacrouteropexy for POP in a previously repaired bladder exstrophy case. This procedure may be a viable option in selected patients.