2D-3D Reconstruction-Based Planning of Total Hip Arthroplasty

This chapter proposed a personalized X-ray reconstruction-based planning and post-operative treatment evaluation framework called iJoint for advancing modern Total Hip Arthroplasty (THA). Based on a mobile X-ray image calibration phantom and a unique 2D-3D reconstruction technique, iJoint can generate patient-specific models of hip joint by non-rigidly matching statistical shape models to the X-ray radiographs. Such a reconstruction enables a true 3D planning and treatment evaluation of hip arthroplasty from just 2D X-ray radiographs whose acquisition is part of the standard diagnostic and treatment loop. As part of the system, a 3D model-based planning environment provides surgeons with hip arthroplasty related parameters such as implant type, size, position, offset and leg length equalization. With this newly developed system, we are able to provide true 3D solutions for computer assisted planning of THA using only 2D X-ray radiographs, which is not only innovative but also cost-effective.

Synergistic action of image-guided radiotherapy and androgen deprivation therapy.

The combined use of androgen deprivation therapy (ADT) and image-guided radiotherapy (IGRT) can improve overall survival in aggressive, localized prostate cancer. However, owing to the adverse effects of prolonged ADT, it is imperative to identify the patients who would benefit from this combined-modality therapy relative to the use of IGRT alone. Opportunities exist for more personalized approaches in treating aggressive, locally advanced prostate cancer. Biomarkers--such as disseminated tumour cells, circulating tumour cells, genomic signatures and molecular imaging techniques--could identify the patients who are at greatest risk for systemic metastases and who would benefit from the addition of systemic ADT. By contrast, when biomarkers of systemic disease are not present, treatment could proceed using local IGRT alone. The choice of drug, treatment duration and timing of ADT relative to IGRT could be predicated on these personalized approaches to prostate cancer medicine. These novel treatment intensification and reduction strategies could result in improved prostate-cancer-specific survival and overall survival, without incurring the added expense of metabolic syndrome and other adverse effects of ADT in all patients.

Radiographic volume analysis as a novel tool to determine nasopalatine duct cyst dimensions and its association with presenting symptoms and postoperative complications

OBJECTIVES The aims of the study were to use cone beam computed tomography (CBCT) images of nasopalatine duct cysts (NPDC) and to calculate the diameter, surface area, and 3D-volume using a custom-made software program. Furthermore, any associations of dimensions of NPDC with age, gender, presence/absence of maxillary incisors/canines (MI/MC), endodontic treatment of MI/MC, presenting symptoms, and postoperative complications were evaluated. MATERIAL AND METHODS The study comprised 40 patients with a histopathologically confirmed NPDC. On preoperative CBCT scans, curves delineating the cystic borders were drawn in all planes and the widest diameter (in millimeter), surface area (in square millimeter), and volume (in cubic millimeter) were calculated. RESULTS The overall mean cyst diameter was 15 mm (range 7-47 mm), the mean cyst surface area 566 mm(2) (84-4,516 mm(2)), and the mean cyst volume 1,735 mm(3) (65-25,350 mm(3)). For 22 randomly allocated cases, a second measurement resulted in a mean absolute aberration of ±4.2 % for the volume, ±2.8 % for the surface, and ±4.9 % for the diameter. A statistically significant association was found for the CBCT determined cyst measurements and the need for preoperative endodontic treatment to MI/MC and for postoperative complications. CONCLUSION In the hands of a single experienced operator, the novel software exhibited high repeatability for measurements of cyst dimensions. Further studies are needed to assess the application of this tool for dimensional analysis of different jaw cysts and lesions including treatment planning. CLINICAL RELEVANCE Accurate radiographic information of the bone volume lost (osteolysis) due to expansion of a cystic lesion in three dimensions could help in personalized treatment planning.

Targeted therapies for small cell lung cancer: Where do we stand?

Small cell lung cancer (SCLC) accounts for 15% of lung cancer cases and is associated with a dismal prognosis. Standard therapeutic regimens have been improved over the past decades, but without a major impact on patient survival. The development of targeted therapies based on a better understanding of the molecular basis of the disease is urgently needed. At the genetic level, SCLC appears very heterogenous, although somatic mutations targeting classical oncogenes and tumor suppressors have been reported. SCLC also possesses somatic mutations in many other cancer genes, including transcription factors, enzymes involved in chromatin modification, receptor tyrosine kinases and their downstream signaling components. Several avenues have been explored to develop targeted therapies for SCLC. So far, however, there has been limited success with these targeted approaches in clinical trials. Further progress in the optimization of targeted therapies for SCLC will require the development of more personalized approaches for the patients.

European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe

PURPOSE: Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given. METHODS: We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders. RESULTS: We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences. DISCUSSION: The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD. CONCLUSION: Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.

Prognostic factors in desmoid tumors

Purpose. To evaluate the prognostic factors in desmoid tumors in the light of its possible use in standardizing the treatment strategy of an individual patient. ^ Patients and methods. A retrospective review of 189 consecutive patients who were treated at MD Anderson Cancer Center (MDACC) from January 1995 to December 2005 was done. Univariate and multivariate analysis of different prognostic factors was done on all patients, patients treated with surgery alone, subset of patients who came to MDACC with primary tumor. The median follow up was 63 months. Also the analysis of 189 desmoid patients treated at MDACC between 1995 and 2005 was compared to results of 189 desmoid patients treated at MDACC from 1965-1994 using data retrieved from a 150 field prospective relational soft tissue tumor database. ^ Results. 5-, and 10-year overall survival rate were 0.976 (95%CI 0.952, 0.999), and 0.966 (95% CI 0.935, 0.996), respectively. 5-, and 10-year recurrence free rate were 0.803 (95%CI 0.738, 0.868), and 0.793 (95% CI 0.726, 0.860), respectively. 5 year recurrence free survival for surgery alone, radiotherapy alone, chemotherapy alone and combination regimen were 0.759, 0.625, 0.933, and 0.802 respectively. Age (>30 vs. <=30) and primary tumor site (extremity vs visceral) were two prognostic factors significantly associated with local recurrence in all of the patients. ^ Conclusion. An increased awareness of the complex multidisciplinary management needed for successful control of desmoid tumor may underlie a significantly increased number of desmoid referrals, especially primary untreated desmoids, to UTMDACC. The careful prospective integration of multiple therapies has led to a significant recent improvement in desmoid patient outcome. These trends should be supported, particularly if personalized molecular-based therapies are to be rapidly and effectively deployed for the benefit of those afflicted by this rare and potentially devastating disease.^

Family health history discussion in patient-provider encounters

Ascertaining the family health history (FHH) may provide insight into genetic and environmental susceptibilities specific to a variety of chronic diseases, including type II diabetes mellitus. However, discussion of FHH during patient-provider encounters has been limited and uncharacterized. A longitudinal, observational study was conducted in order to compare the content of FHH topics in a convenience sample of 37 patients, 13 new and 24 established. Each patient had an average of three follow-up encounters involving 6 staff physicians at the Audie L. Murphy Memorial Veterans Hospital (VHA) in San Antonio, TX from 2003 to 2005. A total of 131 encounters were analyzed in this study. The average age of the selected population was 68 years and included 35 males and two females. Transcriptions of encounters were obtained, coded and analyzed, in NVIVO 8. Of the 131 total encounters transcribed among the 37 patients, only 24 encounters (18.3%) included discussion of FHH. Additionally, the relationship between FHH discussion and discussion of self-care management (SCM) topics were assessed. In this study, providers were more likely to initiate discussion on family health history among new patients in the first encounter (ORnew = 8.55, 95% CI: 1.49–52.90). The discussion of FHH occurred sporadically in established patients throughout the longitudinal study with no apparent pattern. Provider-initiated FHH discussion most frequently had satisfactory level(s) of discussion while patient-initiated FHH discussion most frequently had minimal level(s) of discussion. FHH discussion most oftentimes involved topics of cancer and cardiovascular disease among primary-degree familial relationships. Overall, family health histories are largely, an underutilized tool in personalized preventive care.^

Patenting genes and gene sequences: Analysis of public health implications and the law

At issue is whether or not isolated DNA is patent eligible under the U.S. Patent Law and the implications of that determination on public health. The U.S. Patent and Trademark Office has issued patents on DNA since the 1980s, and scientists and researchers have proceeded under that milieu since that time. Today, genetic research and testing related to the human breast cancer genes BRCA1 and BRCA2 is conducted within the framework of seven patents that were issued to Myriad Genetics and the University of Utah Research Foundation between 1997 and 2000. In 2009, suit was filed on behalf of multiple researchers, professional associations and others to invalidate fifteen of the claims underlying those patents. The Court of Appeals for the Federal Circuit, which hears patent cases, has invalidated claims for analyzing and comparing isolated DNA but has upheld claims to isolated DNA. The specific issue of whether isolated DNA is patent eligible is now before the Supreme Court, which is expected to decide the case by year's end. In this work, a systematic review was performed to determine the effects of DNA patents on various stakeholders and, ultimately, on public health; and to provide a legal analysis of the patent eligibility of isolated DNA and the likely outcome of the Supreme Court's decision. ^ A literature review was conducted to: first, identify principle stakeholders with an interest in patent eligibility of the isolated DNA sequences BRCA1 and BRCA2; and second, determine the effect of the case on those stakeholders. Published reports that addressed gene patents, the Myriad litigation, and implications of gene patents on stakeholders were included. Next, an in-depth legal analysis of the patent eligibility of isolated DNA and methods for analyzing it was performed pursuant to accepted methods of legal research and analysis based on legal briefs, federal law and jurisprudence, scholarly works and standard practice legal analysis. ^ Biotechnology, biomedical and clinical research, access to health care, and personalized medicine were identified as the principle stakeholders and interests herein. Many experts believe that the patent eligibility of isolated DNA will not greatly affect the biotechnology industry insofar as genetic testing is concerned; unlike for therapeutics, genetic testing does not require tremendous resources or lead time. The actual impact on biomedical researchers is uncertain, with greater impact expected for researchers whose work is intended for commercial purposes (versus basic science). The impact on access to health care has been surprisingly difficult to assess; while invalidating gene patents might be expected to decrease the cost of genetic testing and improve access to more laboratories and physicians' offices that provide the test, a 2010 study on the actual impact was inconclusive. As for personalized medicine, many experts believe that the availability of personalized medicine is ultimately a public policy issue for Congress, not the courts. ^ Based on the legal analysis performed in this work, this writer believes the Supreme Court is likely to invalidate patents on isolated DNA whose sequences are found in nature, because these gene sequences are a basic tool of scientific and technologic work and patents on isolated DNA would unduly inhibit their future use. Patents on complementary DNA (cDNA) are expected to stand, however, based on the human intervention required to craft cDNA and the product's distinction from the DNA found in nature. ^ In the end, the solution as to how to address gene patents may lie not in jurisprudence but in a fundamental change in business practices to provide expanded licenses to better address the interests of the several stakeholders. ^

Trabajamos juntos por la salud bucal de personas con discapacidad

Referirnos al término discapacidad es hablar de limitaciones en el desarrollo humano, que pueden manifestarse a nivel físico, psíquico o social. El propósito de este proyecto es acercar el Hospital Universitario y la Facultad de Odontología a la problemática existente en el acceso a la salud Bucal de personas con discapacidad y, mediante una participación activa, cambiar esta realidad y mejorar su calidad de vida. Los destinatarios son 51 residentes de THADI (Taller Hogar de Actividades Diferenciadas) cuya incorporación está motivada por razones socio-familiares, agravadas por la condición de discapacidad, no por ser la discapacidad la única razón que justifique el apartamiento del medio familiar. El objetivo es brindarles la atención humanizada y personalizada que ofrece el Hospital Universitario, implementando mecanismos que parten desde la educación hasta la resolución de sus problemas de salud Bucal.

Dirigentes radicales y grupos académicos de Ciencias de la Educación durante la "normalización" de la Universidad Nacional de la Plata (1983-1986)

Este trabajo forma parte de una investigación más amplia que tuvo como objetivo indagar las perspectivas y experiencias que los grupos académicos de Ciencias de la Educación de la Universidad Nacional de La Plata desarrollaron con relación a la política de normalización universitaria entre 1983 y 1986, a fin de legitimar su posición y orientar la reforma del plan de estudios de su Carrera. A partir de un diseño metodológico cualitativo se analizaron normativas, anteproyectos y planes de estudios, documentos y publicaciones institucionales, y entrevistas semiestructuradas. Como resultado fue posible describir las características que asumió la normalización universitaria en el caso estudiado, los elementos de continuidad y ruptura que se registraron en la dinámica institucional con relación al período de la dictadura militar y la configuración social de los grupos académicos de Ciencias de la Educación que se reincorporaron a la vida universitaria. La aprobación del nuevo plan de estudios puso en evidencia la eficacia social de una trama de vínculos de contenido diverso - académicos, profesionales, político - partidarios, personalizados - en las posiciones de los actores en el gobierno universitario y, en consecuencia, en la definición de la reforma curricular

Dirigentes radicales y grupos académicos de Ciencias de la Educación durante la "normalización" de la Universidad Nacional de la Plata (1983-1986)

Este trabajo forma parte de una investigación más amplia que tuvo como objetivo indagar las perspectivas y experiencias que los grupos académicos de Ciencias de la Educación de la Universidad Nacional de La Plata desarrollaron con relación a la política de normalización universitaria entre 1983 y 1986, a fin de legitimar su posición y orientar la reforma del plan de estudios de su Carrera. A partir de un diseño metodológico cualitativo se analizaron normativas, anteproyectos y planes de estudios, documentos y publicaciones institucionales, y entrevistas semiestructuradas. Como resultado fue posible describir las características que asumió la normalización universitaria en el caso estudiado, los elementos de continuidad y ruptura que se registraron en la dinámica institucional con relación al período de la dictadura militar y la configuración social de los grupos académicos de Ciencias de la Educación que se reincorporaron a la vida universitaria. La aprobación del nuevo plan de estudios puso en evidencia la eficacia social de una trama de vínculos de contenido diverso - académicos, profesionales, político - partidarios, personalizados - en las posiciones de los actores en el gobierno universitario y, en consecuencia, en la definición de la reforma curricular

Dirigentes radicales y grupos académicos de Ciencias de la Educación durante la "normalización" de la Universidad Nacional de la Plata (1983-1986)

Este trabajo forma parte de una investigación más amplia que tuvo como objetivo indagar las perspectivas y experiencias que los grupos académicos de Ciencias de la Educación de la Universidad Nacional de La Plata desarrollaron con relación a la política de normalización universitaria entre 1983 y 1986, a fin de legitimar su posición y orientar la reforma del plan de estudios de su Carrera. A partir de un diseño metodológico cualitativo se analizaron normativas, anteproyectos y planes de estudios, documentos y publicaciones institucionales, y entrevistas semiestructuradas. Como resultado fue posible describir las características que asumió la normalización universitaria en el caso estudiado, los elementos de continuidad y ruptura que se registraron en la dinámica institucional con relación al período de la dictadura militar y la configuración social de los grupos académicos de Ciencias de la Educación que se reincorporaron a la vida universitaria. La aprobación del nuevo plan de estudios puso en evidencia la eficacia social de una trama de vínculos de contenido diverso - académicos, profesionales, político - partidarios, personalizados - en las posiciones de los actores en el gobierno universitario y, en consecuencia, en la definición de la reforma curricular

Standards and specifications to manage accessibility issues in e-learning

Despite the acknowledged need of providing a personalized and adaptive learning process for all, current learning management systems do not properly cover personalization and accessibility issues and they are still struggling to support the reusability requirements coming from the pervasive usage of standards. There is a lack of frameworks for providing layered-based infrastructure covering the interoperability required to manage the whole range of standards, applications and services needed to meet accessibility and adaptations needs of lifelong learning services.

A low power routing algorithm for localization in IEEE 802.15.4 networks

Many context-aware applications rely on the knowledge of the position of the user and the surrounding objects to provide advanced, personalized and real-time services. In wide-area deployments, a routing protocol is needed to collect the location information from distant nodes. In this paper, we propose a new source-initiated (on demand) routing protocol for location-aware applications in IEEE 802.15.4 wireless sensor networks. This protocol uses a low power MAC layer to maximize the lifetime of the network while maintaining the communication delay to a low value. Its performance is assessed through experimental tests that show a good trade-off between power consumption and time delay in the localization of a mobile device.

Opportunities in the Mobile Search Market

Success in the mobile search market will come to those who provide value-added apps that exploit unique mobile functionalities, especially those related to personalized and context-based services.