Using smartphones in cities to crowdsource dangerous road sections and give effective in-car warnings

The widespread day-to-day carrying of powerful smartphones gives opportunities for crowd-sourcing information about the users' activities to gain insight into patterns of use of a large population in cities. Here we report the design and initial investigations into a crowdsourcing approach for sudden decelerations to identify dangerous road sections. Sudden brakes and near misses are much more common than police reportable accidents but under exploited and have the potential for more responsive reaction than waiting for accidents. We also discuss different multimodal feedback conditions to warn drivers approaching a dangerous zone. We believe this crowdsourcing approach gives cost and coverage benefits over infrastructural smart-city approaches but that users need incentivized for use

Evaluating the Trade-offs Men with Localised Prostate Cancer Make Between the Risks and Benefits of Treatments: The COMPARE Study

PURPOSE: COMPARE (COMparing treatment options for ProstAte cancer) aimed to evaluate and quantify the trade-offs patients make between different aspects of active surveillance and definitive therapy. METHODS: A Discrete Choice Experiment (DCE) tool was used to elicit patients' preferences for different treatment characteristics in 34 urology departments. Patients with localised prostate cancer completed the DCE within one week of being diagnosed and before they made treatment decisions. The DCE was pre-tested (N=5) and piloted (n=106) with patients. Patients chose their preferred treatment profile based on six characteristics: treatment type (active surveillance, focal therapy, radical therapy), return to normal activities, erectile function, urinary function, not needing more cancer treatment and 10-15 year cancer-specific survival. Different tools were designed for low-intermediate (n=468) and high-risk (n=166) patients. An error-components conditional logit model was used to estimate preferences and trade-offs between treatment characteristics. RESULTS: Low-intermediate risk patients were willing to trade 6.99% absolute decrease in survival to have active surveillance over definitive therapy. They were willing to trade 0.75%, 0.46% and 0.19% absolute decrease in survival for a one-month reduction in time-to-return to normal activities, and 1% absolute improvements in urinary and sexual function, respectively. High-risk patients were willing to trade 3.10%, 1.04% and 0.41% absolute decrease in survival for a one-month reduction in time-to-return to normal activities and 1% absolute improvements in urinary and sexual function, respectively. CONCLUSIONS: Patients with low-intermediate risk prostate cancer preferred active surveillance to definitive therapy. Patients of all risks were willing to trade-off cancer-specific survival for improved quality-of-life.Registration:clinicaltrials.gov Registration Identifier NCT01177865Funding:Medical Research Council (UK) (grant reference: G1002509)

Strengthening Families Through a Re-envisioned Approach to Fatherhood Education

Fatherhood education has the potential to affect not only fathers\u27 nurturant behaviors but also multiple dimensions of family life. The weGrill program blends fatherhood, youth development, and nutrition education, with food grilling as the focal activity. Grounded in multiple learning theories, the program helps fathers and their adolescent children learn broadly about family life topics, planning for the future, and nutrition and healthful food behaviors. The program represents a re-envisioned approach to fatherhood education

Prostate Radiofrequency Focal Ablation (ProRAFT) Trial: A Prospective Development Study Evaluating a Bipolar Radiofrequency Device to Treat Prostate Cancer

PURPOSE: To determine early efficacy of bipolar radiofrequency ablation with a coil design (bRFA) for focal ablation of clinically significant localised prostate cancer (sPCa)visible at mpMRI. MATERIAL AND METHODS: A prospective IDEAL phase 2 development study (NCT02294903) recruited treatment naive patients with a single focus of localised sPCa (Gleason 7 or 4 mm or more of Gleason 6) concordant with a lesion visible on multi-parametric MRI. Intervention was a focal ablation with a bRFA system (Encage®, Trod Medical) encompassing the lesion and a predefined margin using nonrigid MRI-ultrasound fusion. Primary outcome was the proportion of men with absence of sPCa on biopsy at 6 months. Trial follow up comprised serum PSA, mpMRI at 1 week, 6 and 12 months post ablation. Validated patient reported outcome measures (PROMs) for urinary, erectile and bowel functions and adverse events monitoring system were used. Analyses were done on a per-protocol basis. RESULTS: 20 of 21 patients recruited received the intervention. Baseline characteristics were a median age of 66 years (IQR 63-69), pre-operative median PSA of 7.9 ng/ml (5.3-9.6), 18 (90%) had Gleason 7 with median maximum cancer of 7 mm (IQR 5-10) for a median 2.8 cc mpMRI lesions (IQR 1.4-4.8). Targeted biopsy of the treated area (median number of cores=6, IQR 5-8) showed absence of sPCa in 16/20 men (80%), concordant with mpMRI. There was a low profile of side effects at PROMs analysis and no serious adverse events. CONCLUSIONS: Focal therapy of sPCa associated with an MRI lesion using bRFA showed early efficacy to ablate cancer with low rates of genitourinary and rectal side-effects

Accuracy of Transperineal Targeted Prostate Biopsies, Visual Estimation and Image Fusion in Men Needing Repeat Biopsy in the PICTURE Trial

PURPOSE: To evaluate detection of clinically significant prostate cancer (csPCa) using MRI-targeted biopsies, and compare visual-estimation to image-fusion targeting, in patients requiring repeat prostate biopsies. MATERIALS AND METHODS: Prospective, ethics-committee approved, registered PICTURE trial enrolling 249 consecutive patients (11th/January/2012-29th/January/2014). Men underwent an mpMRI and were blinded to its results. All underwent transperineal template prostate mapping (TTPM) biopsies. In 200 with a lesion, this was preceded by visual-estimation and image-fusion targeted biopsies. For the primary endpoint, csPCa was defined as Gleason >/=4+3 and/or any grade of cancer length >/=6mm. Other definitions of csPCa were also evaluated. RESULTS: Mean (SD) age was 62.6 (7) years, median (IQR) PSA 7.17ng/ml (5.25, 10.09), mean primary lesion size 0.37cc (SD1.52), with mean 4.3 (SD2.3) targeted cores per lesion (visual-estimation and image-fusion combined) and mean 48.7 (SD12.3) TTPM-biopsy cores. TTPM-biopsies detected 97 (48.5%) cases of csPCa and 85 (42.5%) insignificant cancers. Overall, mpMRI-targeted biopsies detected 81 (40.5%) csPCa and 63 (31.5%) insignificant cancers. Eighteen (9%) with csPCa on MRI-targeted biopsies were benign or clinically insignificant on TTPM-biopsy. Thirty-four (17%) had csPCa detected on TTPM-biopsy but not on MRI-targeted biopsies; approximately half of these were present in non-targeted areas. csPCa was found with visual-estimation and image-fusion in 53/169 (31.3%) and 48/169 (28.4%) (McNemar's test, p=0.5322). Visual-estimation missed 23 (13.6%) csPCa detected by image-fusion; image-fusion missed 18 (10.8%) csPCa that visual-estimation detected. CONCLUSIONS: MRI-targeted biopsies are accurate at detection of csPCa and reducing over-diagnosis of insignificant cancers. To maximise detection both visual-estimation and image-fusion targeted biopsies are required

The “Is mpMRI Enough” or IMRIE Study: A Multicentre Evaluation of Prebiopsy Multiparametric Magnetic Resonance Imaging Compared with Biopsy

Background: Multiparametric magnetic resonance imaging (mpMRI) is now recommended prebiopsy in numerous healthcare regions based on the findings of high-quality studies from expert centres. Concern remains about reproducibility of mpMRI to rule out clinically significant prostate cancer (csPCa) in real-world settings. / Objective: To assess the diagnostic performance of mpMRI for csPCa in a real-world setting. / Design, setting, and participants: A multicentre, retrospective cohort study, including men referred with raised prostate-specific antigen (PSA) or an abnormal digital rectal examination who had undergone mpMRI followed by transrectal or transperineal biopsy, was conducted. Patients could be biopsy naïve or have had previous negative biopsies. / Outcome measurements and statistical analysis: The primary definition for csPCa was International Society of Urological Pathology (ISUP) grade group (GG) ≥2 (any Gleason ≥7); the accuracy for other definitions was also evaluated. / Results and limitations: Across ten sites, 2642 men were included (January 2011–November 2018). Mean age and PSA were 65.3 yr (standard deviation [SD] 7.8 yr) and 7.5 ng/ml (SD 3.3 ng/ml), respectively. Of the patients, 35.9% had “negative MRI” (scores 1–2); 51.9% underwent transrectal biopsy and 48.1% had transperineal biopsy, with 43.4% diagnosed with csPCa overall. The sensitivity and negative predictive value (NPV) for ISUP GG ≥ 2 were 87.3% and 87.5%, respectively. The NPVs were 87.4% and 88.1% for men undergoing transrectal and transperineal biopsy, respectively. Specificity and positive predictive value of MRI were 49.8% and 49.2%, respectively. The sensitivity and NPV increased to 96.6% and 90.6%, respectively, when a PSA density threshold of 0.15 ng/ml/ml was used in MRI scores 1–2; these metrics increased to 97.5% and 91.2%, respectively, for PSA density 0.12 ng/ml/ml. ISUP GG ≥ 3 (Gleason ≥4 + 3) was found in 2.4% (15/617) of men with MRI scores 1–2. They key limitations of this study are the heterogeneity and retrospective nature of the data. / Conclusions: Multiparametric MRI when used in real-world settings is able to rule out csPCa accurately, suggesting that about one-third of men might avoid an immediate biopsy. Men should be counselled about the risk of missing some significant cancers. / Patient summary: Multiparametric magnetic resonance imaging (MRI) is a useful tool for ruling out prostate cancer, especially when combined with prostate-specific antigen density (PSAD). Previous results published from specialist centres can be reproduced at smaller institutions. However, patients and their clinicians must be aware that an early diagnosis of clinically significant prostate cancer could be missed in nearly 10% of patients by relying on MRI and PSAD alone