Gaze entropy metrics for mental workload estimation are heterogenous during hands-off level 2 automation.

As the level of vehicle automation increases, drivers are more likely to engage in non-driving related tasks which take their hands, eyes, and/or mind away from the driving task. Consequently, there has been increased interest in creating Driver Monitoring Systems (DMS) that are valid and reliable for detecting elements of driver state. Workload is one element of driver state that has remained elusive within the literature. Whilst there has been promising work in estimating mental workload using gaze-based metrics, the literature has placed too much emphasis on point estimate differences. Whilst these are useful for establishing whether effects exist, they ignore the inherent variability within individuals and between different drivers. The current work builds on this by using a Bayesian distributional modelling approach to quantify the within and between participants variability in Information Theoretical gaze metrics. Drivers (N = 38) undertook two experimental drives in hands-off Level 2 automation with their hands and feet away from operational controls. During both drives, their priority was to monitor the road before a critical takeover. During one drive participants had to complete a secondary cognitive task (2-back) during the hands-off Level 2 automation. Changes in Stationary Gaze Entropy and Gaze Transition Entropy were assessed for conditions with and without the 2-back to investigate whether consistent differences between workload conditions could be found across the sample. Stationary Gaze Entropy proved a reliable indicator of mental workload; 92 % of the population were predicted to show a decrease when completing 2-back during hands-off Level 2 automated driving. Conversely, Gaze Transition Entropy showed substantial heterogeneity; only 66 % of the population were predicted to have similar decreases. Furthermore, age was a strong predictor of the heterogeneity of the average causal effect that high mental workload had on eye movements. These results indicate that, whilst certain elements of Information Theoretic metrics can be used to estimate mental workload by DMS, future research needs to focus on the heterogeneity of these processes. Understanding this heterogeneity has important implications toward the design of future DMS and thus the safety of drivers using automated vehicle functions. It must be ensured that metrics used to detect mental workload are valid (accurately detecting a particular driver state) as well as reliable (consistently detecting this driver state across a population).

Deceleration parameters as implicit communication signals for pedestrians' crossing decisions and estimations of automated vehicle behaviour.

Society greatly expects the widespread deployment of automated vehicles (AVs). However, the absence of a driver role results in unresolved communication issues between pedestrians and AVs. Research has shown the crucial role of implicit communication signals in this context. Nonetheless, it remains unclear how pedestrians subjectively estimate vehicle behaviour and whether they incorporate these estimations as part of their crossing decisions. For the first time, this study explores the impact of implicit communication signals on pedestrians' subjective estimations of approaching vehicle behaviour across a wide range of experimental traffic scenarios and on their crossing decisions in the same scenarios through a comprehensive analysis. Two simulator tasks, namely a natural road crossing task and a vehicle behaviour estimation task, were designed with controlled time to collision, vehicle speed, and deceleration behaviour. A novel finding is that the correlation between crossing decisions and vehicle behaviour estimations depends on the traffic scenario. Pedestrians' recognition of different deceleration behaviour aligned with their crossing decisions, supporting the notion that they actively estimate vehicle behaviour as part of their decision-making process. However, if the traffic gap was long enough, the effects of vehicle speed were the opposite between crossing decisions and estimations, suggesting that vehicle behaviour estimation may not directly impact crossing decisions when the time gap to the vehicle is large. We also found that pedestrians crossed the street earlier and estimated yielding behaviour more accurately in early-onset braking scenarios than in late-onset braking scenarios. Interestingly, vehicle speed significantly affected pedestrians' estimations, with pedestrians tending to perceive low vehicle speed as yielding behaviour regardless of whether the vehicle yielded. Finally, we demonstrated that visual cue τ̇ is a practical indicator for controlling the vehicle deceleration evidence in the experiment. In conclusion, these findings reveal in detail the role of deceleration parameters as implicit communication signals between pedestrians and AVs, with implications for road crossing safety and the development of AVs.

Explaining human interactions on the road by large-scale integration of computational psychological theory.

When humans share space in road traffic, as drivers or as vulnerable road users, they draw on their full range of communicative and interactive capabilities. Much remains unknown about these behaviors, but they need to be captured in models if automated vehicles are to coexist successfully with human road users. Empirical studies of human road user behavior implicate a large number of underlying cognitive mechanisms, which taken together are well beyond the scope of existing computational models. Here, we note that for all of these putative mechanisms, computational theories exist in different subdisciplines of psychology, for more constrained tasks. We demonstrate how these separate theories can be generalized from abstract laboratory paradigms and integrated into a computational framework for modeling human road user interaction, combining Bayesian perception, a theory of mind regarding others' intentions, behavioral game theory, long-term valuation of action alternatives, and evidence accumulation decision-making. We show that a model with these assumptions-but not simpler versions of the same model-can account for a number of previously unexplained phenomena in naturalistic driver-pedestrian road-crossing interactions, and successfully predicts interaction outcomes in an unseen data set. Our modeling results contribute to demonstrating the real-world value of the theories from which we draw, and address calls in psychology for cumulative theory-building, presenting human road use as a suitable setting for work of this nature. Our findings also underscore the formidable complexity of human interaction in road traffic, with strong implications for the requirements to set on development and testing of vehicle automation.

Who goes first? A distributed simulator study of vehicle-pedestrian interaction.

One of the current challenges of automation is to have highly automated vehicles (HAVs) that communicate effectively with pedestrians and react to changes in pedestrian behaviour, to promote more trustable HAVs. However, the details of how human drivers and pedestrians interact at unsignalised crossings remain poorly understood. We addressed some aspects of this challenge by replicating vehicle-pedestrian interactions in a safe and controlled virtual environment by connecting a high fidelity motion-based driving simulator to a CAVE-based pedestrian lab in which 64 participants (32 pairs of one driver and one pedestrian) interacted with each other under different scenarios. The controlled setting helped us study the causal role of kinematics and priority rules on interaction outcome and behaviour, something that is not possible in naturalistic studies. We also found that kinematic cues played a stronger role than psychological traits like sensation seeking and social value orientation in determining whether the pedestrian or driver passed first at unmarked crossings. One main contribution of this study is our experimental paradigm, which permitted repeated observation of crossing interactions by each driver-pedestrian participant pair, yielding behaviours which were qualitatively in line with observations from naturalistic studies.

Learning to interpret novel eHMI: The effect of vehicle kinematics and eHMI familiarity on pedestrian' crossing behavior.

INTRODUCTION: In current urban traffic, pedestrians attempting to cross the road at un-signalized locations are thought to mostly use implicit communication, such as deceleration cues, to interpret a vehicle's intention to yield. There is less reliance on explicit driver- or vehicle-based messages, such as hand/head movements, or flashing lights/beeping horns. With the impending deployment of Automated Vehicles (AV), especially those at SAE Level 4 and 5, where the driver is no longer in control of the vehicle, there has been a surge in interest in the value of new forms of communication for AVs, for example, via different types of external Human Machine Interfaces (eHMIs). However, there is still much to be understood about how quickly a novel eHMI affects pedestrian crossing decisions, and whether it provides any additional aid, above and beyond implicit/kinematic information from the vehicle. The aim of this between-participant study, funded by the H2020 interACT project, was to investigate how the combination of kinematic information from a vehicle (e.g., Speed and Deceleration), and eHMI designs, play a role in assisting the crossing decision of pedestrians in a cave-based pedestrian simulator. METHOD: Using an existing, well-recognized, message for yielding (Flashing Headlights - FH) as a benchmark, this study also investigated how quickly a novel eHMI (Slow Pulsing Light Band - SPLB) was learned. To investigate the effect of eHMI visibility on crossing decisions, the distance at which each eHMI was perceivable was also measured. RESULTS: Results showed that, compared to SPLB, the FH led to earlier crossings during vehicle deceleration, especially at lower approaching speeds, and smaller time gaps. However, although FH was visible earlier than SPLB, this visibility does not appear to be the only reason for earlier crossings, with message familiarity thought to play a role. Participants were found to learn the meaning conveyed by FH relatively quickly, crossing around 1 second earlier in its presence (compared to the no eHMI condition), across the three blocks of trials. On the other hand, it took participants at least one block of 12 trials for the new SPLB signal to affect crossing, which only accelerated crossing initiations by around 200 ms, compared to the no eHMI condition. The role of comprehension, long-term exposure, and familiarity of novel messages in this context is therefore important, if AVs are to provide safe, trustworthy communication messages, which will enhance traffic flow and efficiency.

External Human-Machine Interfaces Can Be Misleading: An Examination of Trust Development and Misuse in a CAVE-Based Pedestrian Simulation Environment.

OBJECTIVE: To investigate pedestrians' misuse of an automated vehicle (AV) equipped with an external human-machine interface (eHMI). Misuse occurs when a pedestrian enters the road because of uncritically following the eHMI's message. BACKGROUND: Human factors research indicates that automation misuse is a concern. However, there is no consensus regarding misuse of eHMIs. METHODS: Sixty participants each experienced 50 crossing trials in a Cave Automatic Virtual Environment (CAVE) simulator. The three independent variables were as follows: (1) behavior of the approaching AV (within-subject: yielding at 33 or 43 m distance, no yielding), (2) eHMI presence (within-subject: eHMI on upon yielding, off), and (3) eHMI onset timing (between-subjects: eHMI turned on 1 s before or 1 s after the vehicle started to decelerate). Two failure trials were included where the eHMI turned on, yet the AV did not yield. Dependent measures were the moment of entering the road and perceived risk, comprehension, and trust. RESULTS: Trust was higher with eHMI than without, and the -1 Group crossed earlier than the +1 Group. In the failure trials, perceived risk increased to high levels, whereas trust and comprehension decreased. Thirty-five percent of the participants in the -1 and +1 Groups walked onto the road when the eHMI failed for the first time, but there were no significant differences between the two groups. CONCLUSION: eHMIs that provide anticipatory information stimulate early crossing. eHMIs may cause people to over-rely on the eHMI and under-rely on the vehicle-intrinsic cues. APPLICATION: eHMI have adverse consequences, and education of eHMI capability is required.

Drivers' Intentions to Use Different Functionalities of Conditionally Automated Cars: A Survey Study of 18,631 Drivers from 17 Countries.

A number of studies have investigated the acceptance of conditionally automated cars (CACs). However, in the future, CACs will comprise of several separate Automated Driving Functions (ADFs), which will allow the vehicle to operate in different Operational Design Domains (ODDs). Driving in different environments places differing demands on drivers. Yet, little research has focused on drivers' intention to use different functions, and how this may vary by their age, gender, country of residence, and previous experience with Advanced Driving Assistance Systems (ADAS). Data from an online survey of 18,631 car drivers from 17 countries (8 European) was used in this study to investigate intention to use an ADF in one of four different ODDs: Motorways, Traffic Jams, Urban Roads, and Parking. Intention to use was high across all ADFs, but significantly higher for Parking than all others. Overall, intention to use was highest amongst respondents who were younger (<39), male, and had previous experience with ADAS. However, these trends varied widely across countries, and for the different ADFs. Respondents from countries with the lowest Gross Domestic Product (GDP) and highest road death rates had the highest intention to use all ADFs, while the opposite was found for countries with high GDP and low road death rates. These results suggest that development and deployment strategies for CACs may need to be tailored to different markets, to ensure uptake and safe use.

Performance of Digital Contact Tracing Tools for COVID-19 Response in Singapore: Cross-Sectional Study.

BACKGROUND: Effective contact tracing is labor intensive and time sensitive during the COVID-19 pandemic, but also essential in the absence of effective treatment and vaccines. Singapore launched the first Bluetooth-based contact tracing app-TraceTogether-in March 2020 to augment Singapore's contact tracing capabilities. OBJECTIVE: This study aims to compare the performance of the contact tracing app-TraceTogether-with that of a wearable tag-based real-time locating system (RTLS) and to validate them against the electronic medical records at the National Centre for Infectious Diseases (NCID), the national referral center for COVID-19 screening. METHODS: All patients and physicians in the NCID screening center were issued RTLS tags (CADI Scientific) for contact tracing. In total, 18 physicians were deployed to the NCID screening center from May 10 to May 20, 2020. The physicians activated the TraceTogether app (version 1.6; GovTech) on their smartphones during shifts and urged their patients to use the app. We compared patient contacts identified by TraceTogether and those identified by RTLS tags within the NCID vicinity during physicians' 10-day posting. We also validated both digital contact tracing tools by verifying the physician-patient contacts with the electronic medical records of 156 patients who attended the NCID screening center over a 24-hour time frame within the study period. RESULTS: RTLS tags had a high sensitivity of 95.3% for detecting patient contacts identified either by the system or TraceTogether while TraceTogether had an overall sensitivity of 6.5% and performed significantly better on Android phones than iPhones (Android: 9.7%, iPhone: 2.7%; P<.001). When validated against the electronic medical records, RTLS tags had a sensitivity of 96.9% and specificity of 83.1%, while TraceTogether only detected 2 patient contacts with physicians who did not attend to them. CONCLUSIONS: TraceTogether had a much lower sensitivity than RTLS tags for identifying patient contacts in a clinical setting. Although the tag-based RTLS performed well for contact tracing in a clinical setting, its implementation in the community would be more challenging than TraceTogether. Given the uncertainty of the adoption and capabilities of contact tracing apps, policy makers should be cautioned against overreliance on such apps for contact tracing. Nonetheless, leveraging technology to augment conventional manual contact tracing is a necessary move for returning some normalcy to life during the long haul of the COVID-19 pandemic.

Optimal Management of Upper Tract Urothelial Carcinoma: Current Perspectives.

INTRODUCTION: Upper tract urothelial carcinoma (UTUC) is a relatively uncommon urologic malignancy for which there has not been significant improvement in survival over the past few decades, highlighting the need for optimal multi-modality management. METHODS: A non-systematic review of the latest literature was performed to include relevant articles up to June 2019. It summarizes the epidemiologic risk factors associated with UTUC, including smoking, carcinogenic aromatic amines, arsenic, aristolochic acid, and Lynch syndrome. Molecular pathways underlying UTUC and potential druggable targets are outlined. RESULTS: Surgical management for UTUC includes kidney-sparing surgery (KSS) for low-risk disease and radical nephroureterectomy (RNU) for high-risk disease. Endoscopic management of UTUC may include ureteroscopic or percutaneous resection. Topical instillation therapy post-KSS aims to reduce recurrence, progression and to treat carcinoma-in-situ; this may be achieved retrogradely (via ureteric catheterization), antegradely (via percutaneous nephrostomy) or via reflux through double-J stent. RNU, which may be performed via open, laparoscopic or robot-assisted approaches, is the gold standard treatment for high-risk UTUC. The distal cuff may be dealt with extravesical, transvesical or endoscopic techniques. Peri-operative chemotherapy and immunotherapy are increasingly utilized; level 1 evidence exists for adjuvant chemotherapy, but neoadjuvant chemotherapy is favored as kidney function is better prior to RNU. Immunotherapy is primarily reserved for metastatic UTUC but is currently being investigated in the perioperative setting. CONCLUSION: The optimal management of UTUC includes a firm understanding of the epidemiological factors and molecular pathways. Surgical management includes KSS for low-risk disease and RNU for high-risk disease. Peri-operative immunotherapy and chemotherapy may be considered as evidence mounts.

The effect of lighting conditions and use of headlights on drivers' perception and appraisal of approaching vehicles at junctions.

Use of Daytime Running Lights (DRL) is mandatory in many countries for motorcycles, and in some for cars. However, in developing countries, DRLs may be optional or compliance low. The effect of car or motorcycle headlights and lighting conditions on Malaysian drivers' ability to perceive and judge the safety of pulling out was investigated. Stimuli were photographs depicting either daytime or nighttime taken at a T-junction with approaching vehicles with headlights on or off. Headlights improved drivers' ability to perceive cars and motorcycles in the nighttime photographs but not the daytime photographs, although this could be due to the bright weather in the photographs. Drivers judged it less safe to pull out when approaching motorcycles had headlights on than off, regardless of the lighting conditions, supporting the utility of DRL for motorcycles. Headlights did not affect judgements for cars, questioning the utility of DRL for cars. Practitioner Summary: The effect of headlights and lighting conditions on drivers' ability to perceive and make judgements about the safety of pulling out was investigated. Daytime Running Lights influenced drivers' decision-making about the safety of pulling out in front of motorcycles, illustrating the importance of having automatic headlights equipped.

An update on transurethral surgery for benign prostatic obstruction.

Clinical benign prostatic hyperplasia (BPH) is one of the most common cause of lower urinary tract symptoms and transurethral resection of prostate (TURP) has been the gold standard technique for surgical treatment of benign prostate obstruction (BPO) over the last 2 decades. Although monopolar TURP is considered a safe and effective option for surgical management of BPO, there are some disadvantages, namely bleeding, transurethral resection syndrome, incompleteness of treatment. This review aims to highlight these problems, and describe the advances in technology and techniques that have evolved to minimise such complications. With the advent of lasers and bipolar technology, as well as enucleative techniques to remove the prostatic adenoma/adenomata, the problems of bleeding, transurethral resection syndrome and incomplete treatment are significantly minimised. Monopolar TURP will likely be replaced by such technology and techniques in the near future such that transurethral surgery of the prostate remain a safe and effective option in alleviating the harmful effects of BPO.

MRI Fusion-Targeted Transrectal Prostate Biopsy and the Role of Prostate-Specific Antigen Density and Prostate Health Index for the Detection of Clinically Significant Prostate Cancer in Southeast Asian Men.

OBJECTIVE: To test the hypothesis that targeted biopsy has a higher detection rate for clinically significant prostate cancer (csPCa) than systematic biopsy. We defined csPCa as any Gleason sum ≥7 cancer. In patients with Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions, to determine if factors, such as prostate-specific antigen density (PSAD) and prostate health index (PHI), can predict csPCa and help select patients for biopsy. MATERIALS AND METHODS: We report the first series of targeted biopsies in Southeast Asian men, with comparison against systematic biopsy. Consecutive patients were registered into a prospective institutional review board-approved database in our institution. We reviewed patients who underwent biopsy from May 2016 to June 2017. Inclusion criteria for our study were patients with at least one PI-RADS ≥3, and who underwent both targeted and systematic biopsies in the same sitting. RESULTS: There were 115 patients in the study, of whom 74 (64.3%) had a previous negative systematic biopsy. Targeted biopsies detected significantly less Gleason 6 cancers than systematic biopsies (p < 0.01), and demonstrated significantly higher sensitivity, specificity, positive predictive value, and negative predictive value (NPV) for the detection of csPCa. For patients with PI-RADS 3 lesions, PHI and PSAD were found to be the best predictors for csPCa. PSAD <0.10 ng/mL/mL had an NPV of 93% and sensitivity of 92%, while allowing 20% of patients to avoid biopsy. PHI cutoff of <27 would allow 34% of patients to avoid biopsy, with both sensitivity and NPV of 100%. CONCLUSIONS: Targeted prostate biopsies were found to be significantly superior to systematic biopsies for the detection of csPCa, while detecting less Gleason 6 cancer. Usage of PSAD and PHI cutoff levels in patients with PI-RADS 3 lesions may enable a number of patients to avoid unnecessary biopsy.

The effect of motion and signalling on drivers' ability to predict intentions of other road users.

Failure in making the correct judgment about the intention of an approaching vehicle at a junction could lead to a collision. This paper investigated the impact of dynamic information on drivers' judgments about the intentions of approaching cars and motorcycles, and whether a valid or invalid signal was provided was also manipulated. Participants were presented with videoclips of vehicles approaching a junction which terminated immediately before the vehicle made any manoeuvre, or images of the final frame of each video. They were asked to judge whether or not the vehicle would turn. Drivers were better in judging the manoeuvre of approaching vehicles in dynamic than static stimuli, for both vehicle types. Drivers were better in judging the manoeuvre of cars than motorcycles for videos, but not for photographs. Drivers were also better in judging the manoeuvre of approaching vehicles when a valid signal was provided than an invalid signal, demonstrating the importance of providing a valid signal while driving. However, drivers were still somewhat successful in their judgments in most of the conditions with an invalid signal, suggesting that drivers were able to focus on other cues to intention. Finally, given that dynamic stimuli more closely reflect the demands of real-life driving there may be a need for drivers to adopt a more cautious approach while inferring a motorcyclist's intentions.

Laparoscopic repair of vesicovaginal fistula.

INTRODUCTION: In developed countries, the majority of vesicovaginal fistulas develop after gynaecologic surgery, with abdominal hysterectomy accounting for 90% of cases. Several techniques are available for repairing the fistulas. Abdominal approaches give good results even for difficult posterior located fistulas, but are associated with increased morbidity compared with the transvaginal approach. We performed a laparoscopic repair to minimize the surgical morbidity of the transabdominal approach. METHODS: A 44-year-old female presented with vesicovaginal fistula after abdominal hysterectomy. After a failed trial of conservative treatment with catheter drainage, a transperitoneal laparoscopic repair was performed. Cystoscopy was performed intially to confirm the fistula location and for bilateral ureteric catheterization. A 4-port technique was performed with the patient in the Trendelenburg position with her legs in lithotomy position. Without opening the bladder, the fistula tract was excised with separation of the bladder from the anterior vagina wall. Both the bladder and vagina walls were then closed separately using intracorporeal suturing with an interpositional omentum. RESULTS: The operation was uncomplicated. Total operative time was 260 min. Normal diet was resumed on day 1 and patient was discharged on the same day with an indwelling catheter. A cystogram performed 3 weeks post surgery showed resolution of the fistula. CONCLUSIONS: Laparoscopic repair of vesicovaginal fistula without opening the bladder and using intracorporeal suturing and omentum interpositioning is feasible in selected patients.

Oncological outcome of 100 laparoscopic radical nephrectomies for clinically localized renal cell carcinoma.

BACKGROUND: Laparoscopic renal surgery is now accepted within the urological community and its indication is extended to oncological operation. The oncological outcome and survival of patients undergoing laparoscopic radical nephrectomy for clinically localized renal cell carcinoma were evaluated. METHODS: From October 1998 to July 2003, 100 patients underwent laparoscopic radical nephrectomy for clinically localized renal cell carcinoma. All operations were performed by transperitoneal approach with early vascular control. Perioperative events and pathological data were recorded prospectively. Patients were followed up by clinical examination, chest radiograph, ultrasonography and/or computed tomography where appropriate. RESULTS: The median age of patients was 61 years. Median operating time was 120 min and blood loss was 100 mL. There were five open conversions. There was no perioperative mortality but 11 patients had complications. Resection margins were clear in all but one patient. The median tumour size was 4.6 cm. The median follow-up time was 30 months. All patients survived up to the date of review. No patient developed port-site recurrence but two patients had recurrence at the renal bed 1 year after the operation. Five patients developed distant metastases involving liver, lung and bone. CONCLUSION: Laparoscopic radical nephrectomy is a safe and efficacious treatment option for clinically localized renal cell carcinoma. The intermediate-term oncological outcome appears favourable.