Ethan B. Fram

Prevalence of and attitudes about distracted driving in college students

Objective: To identify current distracted driving (DD) behaviors among college students, primarily those involving cell phone use, and elucidate the opinions of the students on the most effective deterrent or intervention for reducing cell phone use. Methods: Students enrolled at 12 colleges and universities were recruited to participate in an online, anonymous survey. Recruitment was done via school-based list-serves and posters. School sizes ranged from 476 to over 30,000. The validated survey included 38 questions; 17 were specifically related to distracted driving. Results: Four thousand nine hundred sixty-four participants completed the surveys; the average age was 21.8, 66% were female, 82.7% were undergraduates, and 47% were white/non-Hispanic. Additionally, 4,517 (91%) reported phoning and/or texting while driving; 4,467 (90%) of drivers said they talk on the phone while driving; 1,241 (25%) reported using a hands-free device “most of the time”; 4,467 (90%) of drivers reported texting while driving; 2,488 (50%) reported sending texts while driving on the freeway; 2,978 (60%) while in stop-and-go traffic or on city streets; and 4,319 (87%) at traffic lights. Those who drove more often were more likely to drive distracted. When asked about their capability to drive distracted, 46% said they were capable or very capable of talking on a cell phone and driving, but they felt that only 8.5% of other drivers were capable. In a multivariate model, 9 predictors explained 44% of the variance in DD, which was statistically significant, F (17, 4945) = 224.31; P <.0001; R2 = 0.44. The four strongest predictors (excluding driving frequency) were self-efficacy (i.e., confidence) in driving while multitasking (β = 0.37), perception of safety of multitasking while driving (β = 0.19), social norms (i.e., observing others multitasking while driving; β = 0.29), and having a history of crashing due to multitasking while driving (β = 0.11). Conclusions: Distracted driving is a highly prevalent behavior among college students who have higher confidence in their own driving skills and ability to multitask than they have in other drivers’ abilities. Drivers’ self-efficacy for driving and multitasking in the car, coupled with a greater likelihood of having witnessed DD behaviors in others, greatly increased the probability that a student would engage in DD. Most students felt that policies, such as laws impacting driving privilege and insurance rate increases, would influence their behavior.

The Effect of Disease Severity on 24-Hour Urine Parameters in Kidney Stone Patients With Type 2 Diabetes

OBJECTIVE To characterize the changes in urine composition associated with increasing severity of diabetes, we analyzed urine composition relative to glycated hemoglobin (HbA1c) and treatment strategy in a largely minority population. METHODS Patients treated for kidney stones between 2001 and 2013 at a single tertiary institution and had 24-hour urine collections were included in the study. Patients with type 1 diabetes or taking either thiazide diuretics or alkalinizing agents were excluded. Analysis was performed in IBM SPSS Statistics version 20 using multivariate regression, and Kruskal-Wallis testing was used. RESULTS Nine hundred fifty-five patients were included in this study-268 (28%) with type 2 diabetes mellitus, of whom 53 (19.8%) used insulin. Patients with diabetes had lower urine pH, calcium, and phosphate when compared with the control group, but no significant differences were found between the diabetes groups. Multivariate analysis found that HbA1c had a positive correlation with citrate (P = .008), creatinine (P = .037), urine volume (P = .044), and a trend toward a positive association with urinary calcium calcium (P = .064). Insulin use did not have a significant relationship with urinary parameters but trended toward an inverse relationship with calcium (P = .051). pH was not a significant predictor of any urine constituent. CONCLUSION In an ethnically diverse inner city patient population, patients with diabetes mellitus type 2 who use insulin have no significant differences in urine parameters when compared with those on oral hypoglycemics. Worsening glucose control as measured by HbA1c levels predicts increased urine citrate and volume.

UroLift in Place of Fiducial Markers for Patients With Benign Prostatic Hyperplasia Undergoing External Beam Radiation Therapy

OBJECTIVE To investigate if using a novel treatment for obstructive benign prostatic hyperplasia (UroLift) to relive lower urinary tract symptoms (LUTS) prior to external beam radiotherapy (EBRT) could also supplant the use of fiducial markers obviating the need for a second transrectal procedure while facilitating symptom-free voiding during and after EBRT a series of patients are reported on. METHODS The medical records of 7 consecutive patients who underwent placement of UroLift for simultaneous treatment of obstructive LUTS due to benign prostatic hyperplasia and targeting of EBRT for treatment of prostate cancer between September and December of 2015 were reviewed. RESULTS The UroLift clips were sufficiently radiopaque to make targeting possible for EBRT. All patients were able to complete a full course of radiotherapy without placement of fiducial markers. No patient experienced complications that could be attributed to the UroLift implants or procedure during their course of radiotherapy. None of the patients required additional alpha-blockers during radiation therapy. CONCLUSION The UroLift system can serve as fiducial markers in patients undergoing EBRT. Although the current clip utilized in the UroLift system is generally radiopaque, it does not project well on the sagittal plane and would be significantly enhanced if a more strongly opaque substance was incorporated. It remains to be proven if the UroLift system can significantly reduce the symptoms of LUTS during and post EBRT.

The visceral fat compartment is independently associated with changes in urine constituent excretion in a stone forming population

The objective of this study was to identify the independent effect of visceral fat on urine constituent excretion in a stone forming population. Using a database of 382 kidney stone patients with available visceral fat quantification, we created multiple linear regression models predicting changes in urinary solutes based on visceral fat area and body mass-index, divided by gender. Chi-square tests were used to compare stone composition by body mass-index and visceral fat area. Visceral fat predicts increases in urinary creatinine, sodium, and volume in men, but only urinary phosphate in women. In women, total body mass-index does not appear to modify this effect, but in men it is more pronounced in overweight patients for creatinine and volume only. Elevated visceral fat is associated with increased probability of uric acid stone composition. Different fat compartments likely effect urine composition in different ways. This effect appears to be different in men and women. Understanding and quantifying the effects of different fat compartments is probably important to understanding the metabolism of urolithiasis.

A comparison of perinephric fat surface area and Mayo Adhesive Probability score in predicting malignancy in T1 renal masses

INTRODUCTION Recent studies have proposed that nearby fat deposits may have metabolic influence on kidney cancer pathobiology. Both fat quantity and quality may play unique roles in this complex relationship. As such, we investigated whether perinephric fat surface area (PFA), a quantitative measure of fat, or Mayo Adhesive Probability (MAP) score, a qualitative measure, were predictive of malignant pathology or Fuhrman grade in small renal masses. METHODS A total of 317 patients undergoing minimally invasive partial nephrectomy between 2010 and 2016 for renal masses were retrospectively reviewed. Preoperative abdominal CT and MRI scans were measured for PFA and MAP scores. Multiple binary logistic regression models were created to identify predictive factors of malignant disease and Fuhrman grade. RESULTS A total of 253 patients had malignant masses, while 64 had benign masses. A total of 189 of the malignant masses were T1a, while 64 were designated T1b. A total of 221 patients with malignant masses had reported Fuhrman grades. Of these 211 patients, 143 (64.7%) had low-grade and 78 (35.3%) had high-grade disease. Mean PFA was 18.0 ± 13.3 cm2, while mean MAP score was 2.6 ± 1.2. Binary logistic regression analysis yielded three variables in the best-fit model for predictors of malignant pathology: MAP score (OR = 1.374, 95% CI: 1.007-1.873, P = 0.045), male sex (OR = 2.058, 95% CI: 1.004-4.218, P = 0.049), and BMI (OR = 1.064, 95% CI: 0.998-1.135, P = 0.059). Neither MAP nor PFA was predictive of Fuhrman grade. CONCLUSIONS MAP score, a measure of perinephric fat quality, but not PFA, a qualitative measure of fat quantity, was predictive of malignant pathology, raising the question whether fat quality rather than quantity may be involved in the pathophysiology of RCC in a large and diverse patient population. Understanding the increasing burden of obesity, further studies are needed to elaborate on these findings and to discern the exact relationship between perinephric fat deposits and renal tumorigenesis.

PD57-07 RACE AND FINASTERIDE USE: DIFFERENTIAL IMPACT ON BLADDER CANCER RISK

INTRODUCTION AND OBJECTIVES: Upper tract urothelial carcinoma (UTUC) accounts for <5% of all urothelial cancers. Studies show that urothelial bladder carcinoma recurrence (UBCR) occurs in 22e47% of deNovo UTUC (dNUTUC) patients. Our goal was to compare UBCR rates, predictors and disease specific mortality (DSM) in different dNUTUC locations. METHODS: The SEER database was queried for all patients with dNUTUC from 1988-2013, who developed UBCR. Data collected consisted of demographic, clinical parameters including tumor location, pathological and survival data. Patients were stratified according to their dNUTUC location (renal pelvis [RENPEL] vs. ureteral [UL]) and compared for time to UBCR and bladder cancer (BC) DSM. RESULTS: This cohort included 15,298 patients with dNUTUC. UBCR was diagnosed in 51.6% and 51.2% of RENPEL and UL tumors, respectively (p1⁄40.639), (N1⁄47179). Table 1 presents the demographic, pathologic and median follow-up data of the UBCR patients, stratified according to dNUTUC location. Approximately a fifth of these UBCRs are muscle invasive. Covariates associated with UBCR include RENPEL tumors (OR1⁄41.318, 95% C.I. 1.027-1.691. p1⁄40.03), less advanced disease (OR1⁄40.587, 95% C.I. 0.434-0.793, p1⁄40.001) and dNUTUC surgical treatment (OR1⁄45.78, 95% C.I. 1.846-18.106, p1⁄40.003). Interestingly, 50% and 75% of the dNUTUC patients are diagnosed with UBCR within 67 and 133 months, respectively, with higher grade UBCRs being diagnosed earlier. Survival data shows age, black race and more advanced disease being predictors of BC DSM (table 2). CONCLUSIONS: These data suggest that RENPEL dNUTUC tumors consist of a higher risk for developing UBCR, especially when less advanced and treated surgically. Postoperative follow-up of dNUTUC patients should include routine cystoscopies for at least 11 years, to diagnose 75% of UBCR. Worse BC DSM is associated with black race and older patients with a more advanced disease.