Cryoablation for the Treatment of Kidney Cancer: Comparison With Other Treatment Modalities and Review of Current Treatment.

With cancer among the leading causes of death worldwide and kidney cancer among the more common cancers in the United States, it has become increasingly important to ensure that first-line treatments remain validated and supported in recent literature. Surgical intervention has long remained the gold standard for intervention but with newer techniques and technology on the horizon, there must be a constant review of other options that may provide improved outcomes and reduction of associated risks. Ablative techniques have gained traction and are becoming a valuable intervention for multiple different types of cancers, kidney cancer included. Cryoablation, a newer ablative technique taking advantage of extreme cold to freeze and destroy abnormal tissue, provides a promising option for treatment. Currently, no review article, to our knowledge, compares all the different treatment options for kidney cancer. Additionally, while some literature has addressed cryoablation in comparison to other methods of management, there has not been an extensive review to combine our current understanding of these comparisons. In this review article, we provide an overview of each of the commonly used treatments for kidney cancer and summarize the current literature regarding the advantages and disadvantages of each intervention. Finally, we seek to compare cryoablation, a newer option for treatment, to each of the approaches with the goal of evaluating the best methods for management and determining cryoablation's role alongside these current interventions.

Multiple rim-enhancing brain lesions and pulmonary cavitary nodules as the presentation of Nocardia cyriacigeorgica in a patient with non-small cell lung cancer.

Nocardiosis is caused by various strains of the genus Nocardia, a gram-positive, acid-fast bacillus found in organic matter. Disseminated nocardiosis with central nervous system involvement is a rare infection that is most commonly seen in immunocompromised patients. We present a case of a 67-year-old veteran with stage IV adenocarcinoma of the lung undergoing chemotherapy who presented with new cavitary pulmonary lesions. Three weeks into his hospitalization, a sputum culture with acid-fast staining returned positive for Nocardia cyriacigeorgica. A subsequent computed tomography scan of the head demonstrated numerous rim-enhancing lesions presumed to be due to disseminated nocardiosis with central nervous system involvement. Disseminated nocardiosis has a high mortality rate, making prompt detection and treatment paramount for these patients. Our case highlights the importance of considering central nervous system involvement in the evaluation of a patient with nocardiosis.

Perceived Driving Difficulty, Negative Affect, and Emotion Dysregulation in Self-Identified Autistic Emerging Drivers.

Driving is central to adult independence and autonomy; yet most autistic young adults do not acquire driver's licenses. It is important to understand barriers to achieving this milestone for autistic adults. Differences in negative affect and emotion dysregulation associated with autism may interfere with managing difficult driving situations. The current study compared perceived driving difficulty (DD), emotion dysregulation, and negative affect in emerging drivers with and without autistic traits (AT), and investigated how emotion dysregulation and negative affect relate to perceived DD. We expected (1) greater perceived DD, emotion dysregulation, and negative affect in participants with AT and (2) a positive correlation of perceived DD with both emotion dysregulation and negative affect in the whole sample. Thirty-seven adolescents and young adults (15 AT) self-reported perceived DD in 15 scenarios and completed the Difficulty in Emotion Dysregulation Scale (DERS) and the Depression, Anxiety, and Stress Scale (DASS). Autistic participants scored significantly higher on mean perceived DD, DERS Impulse subscale, DASS total and DASS Stress subscale scores. Perceived DD positively correlated with the DERS and DASS total scores, all DASS subscales, and DERS Nonacceptance, Goals, and Impulse subscales across the whole sample. The findings highlight the roles of emotion dysregulation and negative affect in perceived DD in emerging drivers with AT. In particular, emotional stress and impulsivity may map onto mechanisms of over-reactivity to negative affect and explain why autistic people perceive particular situations as difficult when driving. Implications and directions for future research are discussed.

What Are the Restraint Practices, Preferences, and Experiences When Australian Parents Travel with Their Children in a Rideshare Vehicle?

This study aimed to explore the preferences, experiences and restraint practices of Australian parents travelling with their children in rideshare vehicles. Six hundred and thirty-one participants completed an online survey (M = 39.2 years, SD = 10.5, Range = 18.0-70.0 years; Female: 63.4%). Most participants (59.1%) reported that they had not travelled in a rideshare vehicle with their youngest child (M = 7.2 years, SD = 5.2, Range = 0.0-17.0 years; Male: 54.2%). Participants who reported that they have travelled with their youngest child in a rideshare vehicle tended to: be younger, identify as male, have completed an Undergraduate or Postgraduate degree, reside in the Australian Capital Territory, earning a higher yearly household income, and were involved in an at-fault crash in the past two years. In addition, these participants were: less likely to have a 'younger' youngest child, less likely to 'always' wear a seatbelt while travelling in their private motor vehicle, and also less likely to 'always' restrain their child in an appropriate restraint while travelling in their private motor vehicle. Prohibitive reasons for not travelling in a rideshare vehicle included: cost (29.3%), concerns over driver safety (27.5%), concerns over travelling with children in a rideshare service (24.8%), or inconvenience (24.3%). Participants who reported that they had travelled in a rideshare vehicle with their youngest child reported lower rates of appropriate restraint use within the rideshare vehicle (57.3%) than when travelling in their private motor vehicle (85.6%). Reasons associated with inappropriate restraint use within the rideshare vehicle included: unavailability of a child restraint (39.6%), travelling a short distance (33.0%), were not required to use one in this situation (33.0%), or the parent did not have a restraint with them (26.4%). Given the increasing popularity of rideshare services in Australia, and globally, the urgent adaption of rideshare-specific policy, legislation, education, and design in relation to child restraint requirements is needed to ensure the safety of child occupants.

A Pilot Study Comparing Newly Licensed Drivers With and Without Autism and Experienced Drivers in Simulated and On-Road Driving.

This study compared newly licensed drivers with and without autism spectrum disorder (ASD) and experienced drivers. Twenty new drivers (8 with ASD) and 16 experienced drivers completed the Driving Attitude Scale (DAS) and drove a simulator and an instrumented vehicle. Heart rate (HR), galvanic skin response (GSR), wrist movement, eye-gaze and driving performance were monitored. ASD drivers had more negative attitudes toward driving and greater change in HR, GSR and wrist movement. In a driving simulator, drivers with ASD scored lower than NT drivers and were rated less safe. There were fewer differences during on-road driving. Poorer driving and greater anxiousness in the new drivers with ASD indicates the need for a large-scale study of driving performance and apprehension to formulate remediation.

Exploring website gist through rapid serial visual presentation.

BACKGROUND: Users can make judgments about web pages in a glance. Little research has explored what semantic information can be extracted from a web page within a single fixation or what mental representations users have of web pages, but the scene perception literature provides a framework for understanding how viewers can extract and represent diverse semantic information from scenes in a glance. The purpose of this research was (1) to explore whether semantic information about a web page could be extracted within a single fixation and (2) to explore the effects of size and resolution on extracting this information. Using a rapid serial visual presentation (RSVP) paradigm, Experiment 1 explored whether certain semantic categories of websites (i.e., news, search, shopping, and social networks/blogs) could be detected within a RSVP stream of web page stimuli. Natural scenes, which have been shown to be detectable within a single fixation in the literature, served as a baseline for comparison. Experiment 2 examined the effects of stimulus size and resolution on observers' ability to detect the presence of website categories using similar methods. RESULTS: Findings from this research demonstrate that users have conceptual models of websites that allow detection of web pages from a fixation's worth of stimulus exposure, when provided additional time for processing. For website categories other than search, detection performance decreased significantly when web elements were no longer discernible due to decreases in size and/or resolution. The implications of this research are that website conceptual models rely more on page elements and less on the spatial relationship between these elements. CONCLUSIONS: Participants can detect websites accurately when they were displayed for less than a fixation and when the participants were allowed additional processing time. Subjective comments and stimulus onset asynchrony data suggested that participants likely relied on local features for the detection of website targets for several website categories. This notion was supported when the size and/or resolution of stimuli were decreased to the extent that web elements were indistinguishable. This demonstrates that schemas or conceptualizations of websites provided information sufficient to detect websites from approximately 140 ms of stimulus exposure.

Creation of the Naturalistic Engagement in Secondary Tasks (NEST) distracted driving dataset.

PROBLEM: Distracted driving has become a topic of critical importance to driving safety research over the past several decades. Naturalistic driving data offer a unique opportunity to study how drivers engage with secondary tasks in real-world driving; however, the complexities involved with identifying and coding relevant epochs of naturalistic data have limited its accessibility to the general research community. METHOD: This project was developed to help address this problem by creating an accessible dataset of driver behavior and situational factors observed during distraction-related safety-critical events and baseline driving epochs, using the Strategic Highway Research Program 2 (SHRP2) naturalistic dataset. The new NEST (Naturalistic Engagement in Secondary Tasks) dataset was created using crashes and near-crashes from the SHRP2 dataset that were identified as including secondary task engagement as a potential contributing factor. Data coding included frame-by-frame video analysis of secondary task and hands-on-wheel activity, as well as summary event information. In addition, information about each secondary task engagement within the trip prior to the crash/near-crash was coded at a higher level. Data were also coded for four baseline epochs and trips per safety-critical event. RESULTS: 1,180 events and baseline epochs were coded, and a dataset was constructed. The project team is currently working to determine the most useful way to allow broad public access to the dataset. DISCUSSION: We anticipate that the NEST dataset will be extraordinarily useful in allowing qualified researchers access to timely, real-world data concerning how drivers interact with secondary tasks during safety-critical events and baseline driving. PRACTICAL APPLICATIONS: The coded dataset developed for this project will allow future researchers to have access to detailed data on driver secondary task engagement in the real world. It will be useful for standalone research, as well as for integration with additional SHRP2 data to enable the conduct of more complex research.

The effect of patient narratives on information search in a web-based breast cancer decision aid: an eye-tracking study.

BACKGROUND: Previous research has examined the impact of patient narratives on treatment choices, but to our knowledge, no study has examined the effect of narratives on information search. Further, no research has considered the relative impact of their format (text vs video) on health care decisions in a single study. OBJECTIVE: Our goal was to examine the impact of video and text-based narratives on information search in a Web-based patient decision aid for early stage breast cancer. METHODS: Fifty-six women were asked to imagine that they had been diagnosed with early stage breast cancer and needed to choose between two surgical treatments (lumpectomy with radiation or mastectomy). Participants were randomly assigned to view one of four versions of a Web decision aid. Two versions of the decision aid included videos of interviews with patients and physicians or videos of interviews with physicians only. To distinguish between the effect of narratives and the effect of videos, we created two text versions of the Web decision aid by replacing the patient and physician interviews with text transcripts of the videos. Participants could freely browse the Web decision aid until they developed a treatment preference. We recorded participants' eye movements using the Tobii 1750 eye-tracking system equipped with Tobii Studio software. A priori, we defined 24 areas of interest (AOIs) in the Web decision aid. These AOIs were either separate pages of the Web decision aid or sections within a single page covering different content. RESULTS: We used multilevel modeling to examine the effect of narrative presence, narrative format, and their interaction on information search. There was a significant main effect of condition, P=.02; participants viewing decision aids with patient narratives spent more time searching for information than participants viewing the decision aids without narratives. The main effect of format was not significant, P=.10. However, there was a significant condition by format interaction on fixation duration, P<.001. When comparing the two video decision aids, participants viewing the narrative version spent more time searching for information than participants viewing the control version of the decision aid. In contrast, participants viewing the narrative version of the text decision aid spent less time searching for information than participants viewing the control version of the text decision aid. Further, narratives appear to have a global effect on information search; these effects were not limited to specific sections of the decision aid that contained topics discussed in the patient stories. CONCLUSIONS: The observed increase in fixation duration with video patient testimonials is consistent with the idea that the vividness of the video content could cause greater elaboration of the message, thereby encouraging greater information search. Conversely, because reading requires more effortful processing than watching, reading patient narratives may have decreased participant motivation to engage in more reading in the remaining sections of the Web decision aid. These findings suggest that the format of patient stories may be equally as important as their content in determining their effect on decision making. More research is needed to understand why differences in format result in fundamental differences in information search.

Perceived vs measured forces of interarch elastics.

INTRODUCTION: Orthodontists depend on perceptions derived from education and clinical experience to judge the optimal forces in patient treatment. The purpose of this study was to survey practicing orthodontists to determine the interarch latex elastic forces they prescribe in different malocclusion scenarios. METHODS: Thirty orthodontists were presented with 4 clinical scenarios on study models, including Class II and Class III malocclusions in edgewise and light wires. These orthodontists described the size and location of the elastics they would use. The forces produced by the prescribed elastics were measured and compared with actual dry forces measured on a testing machine. RESULTS: The orthodontists' force recommendations were a mean of 277 ± 89 g and a median of 256 g (range, 132-464 g) for a Class II malocclusion with edgewise wires; a mean of 183 ± 59 g and a median of 177 g (range, 59-284 g) for a Class II malocclusion with light wires; a mean of 290 ± 83 g and a median of 305 g (range, 151-562 g) for a Class III malocclusion with edgewise wires; and a mean of 216 ± 66 g and a median of 209 g (range, 119-344 g) for a Class III malocclusion with light wires. The force levels for light wires were statistically significantly lower than for edgewise wires. CONCLUSIONS: There were considerable variations in the forces selected for all cases. "Expert" recommendations fell within 1 SD of the mean of the orthodontists' recommendations except for the light-wire Class III scenario. Since latex elastic force decays significantly during a patient's use, elastics should be selected with initially higher forces than desired.

Driver performance while text messaging using handheld and in-vehicle systems.

This study presents an evaluation of driver performance while text messaging via handheld mobile phones and an in-vehicle texting system. Participants sent and received text messages while driving with an experimenter on a closed-road course, using their personal mobile phones and the vehicle's system. The test vehicle was an instrumented 2010 Mercury Mariner equipped with an OEM in-vehicle system that supports text messaging and voice control of mobile devices via Bluetooth, which was modified to allow text message sending during driving. Twenty participants were tested, 11 younger (19-34) and 9 older (39-51). All participants were regular users of the in-vehicle system, although none had experience with the texting functions. Results indicated that handheld text message sending and receiving resulted in higher mental demand, more frequent and longer glances away from the roadway, and degraded steering measures compared to baseline. Using the in-vehicle system to send messages showed less performance degradation, but still had more task-related interior glance time and higher mental demand than baseline; using the system's text-to-speech functionality for incoming messages showed no differences from baseline. These findings suggest that using handheld phones to send and receive text messages may interfere with drivers' visual and steering behaviors; the in-vehicle system showed improvement, but performance was not at baseline levels during message sending.

Effects of age and illumination on night driving: a road test.

OBJECTIVE: This study investigated the effects of drivers' age and low light on speed, lane keeping, and visual recognition of typical roadway stimuli. BACKGROUND: Poor visibility, which is exacerbated by age-related changes in vision, is a leading contributor to fatal nighttime crashes. There is little evidence, however, concerning the extent to which drivers recognize and compensate for their visual limitations at night. METHOD: Young, middle-aged, and elder participants drove on a closed road course in day and night conditions at a "comfortable" speed without speedometer information. During night tests, headlight intensity was varied over a range of 1.5 log units using neutral density filters. RESULTS: Average speed and recognition of road signs decreased significantly as functions of increased age and reduced illumination. Recognition of pedestrians at night was significantly enhanced by retroreflective markings of limb joints as compared with markings of the torso, and this benefit was greater for middle-aged and elder drivers. Lane keeping showed nonlinear effects of lighting, which interacted with task conditions and drivers' lateral bias, indicating that older drivers drove more cautiously in low light. CONCLUSION: Consistent with the hypothesis that drivers misjudge their visual abilities at night, participants of all age groups failed to compensate fully for diminished visual recognition abilities in low light, although older drivers behaved more cautiously than the younger groups. APPLICATION: These findings highlight the importance of educating all road users about the limitations of night vision and provide new evidence that retroreflective markings of the limbs can be of great benefit to pedestrians' safety at night.