Assisting people with multiple disabilities and minimal motor behavior to improve computer pointing efficiency through a mouse wheel

This study evaluated whether two people with multiple disabilities and minimal motor behavior would be able to improve their pointing performance using finger poke ability with a mouse wheel through a Dynamic Pointing Assistive Program (DPAP) and a newly developed mouse driver (i.e., a new mouse driver replaces standard mouse driver, changes a mouse wheel into a thumb/finger poke detector, and intercepts mouse action). Initially, both participants had their baseline sessions. Then intervention started with the first participant. When his performance was consolidated, new baseline and intervention occurred with the second participant. Finally, both participants were exposed to maintenance phase, in which their pointing performance improved significantly. Both participants improved their pointing efficiency with the use of DPAP and remained highly successful through maintenance phase. Implications of the findings are discussed.     

2008年蓬莱市机动车驾驶员道路交通安全知识与违章驾驶行为调查

[目的]了解蓬莱市机动车驾驶员对道路交通安全的知识与违章（不良）驾驶行为,从而有针对性地采取干预措施,降低道路交通伤害的发生。[方法]2008年,在蓬莱市城区和农村抽取部分机动车驾驶员进行问卷调查。[结果]调查机动车驾驶员1083人,其中城区646人。农村437人。道路交通安全知识知晓率,城区驾驶员为80．18％,农村驾驶员为76．20％（P〉0．05）;最近1个月内无违章（不良）驾驶行为者所占比例,城区驾驶员为25．08％,农村驾驶员为28．15％（P〉0．05）;最近1个月内违章（不良）行为次数,全部调查对象为（1．67±1．57）次,其中城区驾驶员为（1．65±1．52）,农村驾驶员为（1.71±1．64）次（P〉0．05）。违章（不良）驾驶行为率最高的城区驾驶员是驾驶时使用手机（61．92％）、酒后驾驶（28．92％）,农村驾驶员是不戴头盔（42．33％）、在非机动车道上行驶（33．64％）。[结论]蓬莱市城乡机动车驾驶员道路交通安全知识知晓率较高,但违章（不良）驾驶行为率也较高。     

A randomized comparison of conventional vs articulating laparoscopic needle-drivers for performing standardized suturing tasks by laparoscopy-naive subjects

Associate Editor Ash Tewari Editorial Board Ralph Clayman, USA Inderbir Gill, USA Roger Kirby, UK Mani Menon, USA

OBJECTIVES

To compare the efficacy of conventional and articulating laparoscopic needle‐drivers for performing standardized laparoscopic tasks by medical students with no previous surgical experience.

SUBJECTS AND METHODS

Twenty medical students with no surgical experience were randomly assigned to two equal groups, one using a conventional laparoscopic needle‐holder (Karl Storz, Tuttlingen, Germany) and the other using a first‐generation articulating laparoscopic needle‐holder (Cambridge Endo, Framingham, MA, USA). Each student performed a series of four standardized laparoscopic tasks, during which speed and accuracy were assessed. The tasks tested needle passage through rings (1), an oblique running suture model (2), a urethrovesical anastomosis model (3) and a model simulating renal parenchymal reconstruction following partial nephrectomy (4).

RESULTS

Tasks 1 and 3 were completed significantly more quickly by those using the conventional instruments (P < 0.05), but there was no statistically significant difference for task 2 and 4 (P > 0.05). Those using conventional instruments were significantly more accurate in all of the tasks than those using the articulated instruments (P < 0.05).

CONCLUSIONS

The conventional laparoscopic needle‐driver allowed laparoscopy‐naive medical students to complete a series of standardized suturing tasks more rapidly and accurately than with the novel articulating needle‐driver. Laparoscopic suturing with first‐generation articulating needle‐drivers might be more difficult to learn, secondary to the complexity of physical manoeuvres required for their use.     

Top advances of the year: Precision oncology

The advent of precision medicine has changed the landscape of oncologic biomarkers, drug discovery, drug development, and, more importantly, outcomes for patients with cancer. Precision oncology entails the genomic profiling of tumors to detect actionable aberrations. The advances in clinical next-generation sequencing from both tumor tissue and liquid biopsy and availability of targeted therapies has rapidly entered mainstream clinical practice. In this review, recent major developments in precision oncology that have affected outcomes for patients with cancer are discussed. Rapid clinical development was seen of targeted agents across various mutational profiles such as KRASG12C (which was considered “undruggable” for almost 4 decades), Exon 20 insertions, and RET mutations. Approaches to precision chemotherapy delivery by the introduction of antibody drug conjugates in the armamentarium against lung cancer has been appreciated.     

On-Road Behavior in Older Drivers With Mild Cognitive Impairment

ObjectivesDementia increases the risk of unsafe driving, but this is less apparent in preclinical stages such as mild cognitive impairment (MCI). There is, however, limited detailed data on the patterns of driving errors associated with MCI. Here, we examined whether drivers with MCI exhibited different on-road error profiles compared with cognitively normal (CN) older drivers.DesignObservational.Setting and ParticipantsA total of 296 licensed older drivers [mean age 75.5 (SD = 6.2) years, 120 (40.5%) women] recruited from the community.MethodParticipants completed a health and driving history survey, a neuropsychological test battery, and an on-road driving assessment including driver-instructed and self-navigation components. Driving assessors were blind to participant cognitive status. Participants were categorized as safe or unsafe based on a validated on-road safety scale, and as having MCI based on International Working Group diagnostic criteria. Proportion of errors incurred as a function of error type and traffic context were compared across safe and unsafe MCI and CN drivers.ResultsCompared with safe CN drivers (n = 225), safe MCI drivers (n = 45) showed a similar pattern of errors in different traffic contexts. Compared with safe CN drivers, unsafe CN drivers (n = 17) were more likely to make errors in observation, speed control, lane position, and approach, and at stop/give-way signs, lane changes, and curved driving. Unsafe MCI drivers (n = 9) had additional difficulties at intersections, roundabouts, parking, straight driving, and under self-navigation conditions. A higher proportion of unsafe MCI drivers had multidomain subtype [n = 6 (67%)] than safe MCI drivers [n = 11 (25%)], odds ratio 6.2 (95% confidence interval, 1.4–29.6).Conclusion and ImplicationsAmong safe drivers, MCI and CN drivers exhibit similar on-road error profiles, suggesting driver restrictions based on MCI status alone are unwarranted. However, formal evaluation is recommended in such cases, as there is evidence drivers with multiple domains of cognitive impairment may require additional interventions to support safe driving.