Estimation of tool pose based on force-density correlation during robotic drilling

The application of image-guided systems with or without support by surgical robots relies on the accuracy of the navigation process, including patient-to-image registration. The surgeon must carry out the procedure based on the information provided by the navigation system, usually without being able to verify its correctness beyond visual inspection. Misleading surrogate parameters such as the fiducial registration error are often used to describe the success of the registration process, while a lack of methods describing the effects of navigation errors, such as those caused by tracking or calibration, may prevent the application of image guidance in certain accuracy-critical interventions. During minimally invasive mastoidectomy for cochlear implantation, a direct tunnel is drilled from the outside of the mastoid to a target on the cochlea based on registration using landmarks solely on the surface of the skull. Using this methodology, it is impossible to detect if the drill is advancing in the correct direction and that injury of the facial nerve will be avoided. To overcome this problem, a tool localization method based on drilling process information is proposed. The algorithm estimates the pose of a robot-guided surgical tool during a drilling task based on the correlation of the observed axial drilling force and the heterogeneous bone density in the mastoid extracted from 3-D image data. We present here one possible implementation of this method tested on ten tunnels drilled into three human cadaver specimens where an average tool localization accuracy of 0.29 mm was observed.

Internet-Based Guided Self-Help for Several Anxiety Disorders: A Randomized Controlled Trial Comparing a Tailored With a Standardized Disorder-Specific Approach

Internet-delivered self-help with minimal therapist guidance has shown promising results for a number of diagnoses. Most of the evidence comes from studies evaluating standardized disorder-specific treatments. A recent development in the field includes transdiagnostic and tailored Internet-based treatments that address comorbid symptoms and a broader range of patients. This study evaluated an Internet-based tailored guided self-help treatment, which targeted symptoms of social anxiety disorder, panic disorder with or without agoraphobia, and generalized anxiety disorder. The tailored treatment was compared both with standardized disorder-specific Internet-based treatment and with a wait-list control group. Both active treatment conditions were based on cognitive-behavioral therapy and lasted for 8 weeks. A total of 132 individuals meeting diagnostic criteria for at least one of the anxiety disorders were randomly assigned to 1 of the 3 conditions. Both treatment groups showed significant symptom reductions as compared with the wait-list control group on primary disorder-unspecific measures of anxiety, depression, and general symptomatology and on secondary anxiety disorder-specific measures. Based on the intention-to-treat sample, mean between-group effect sizes were d = 0.80 for the tailored treatment and d = 0.82 for the standardized treatment, versus wait-list controls. Treatment gains were maintained at 6-month follow-up. No differences were found between the 2 active treatment conditions on any of the measures, including a telephone-administered diagnostic interview conducted at posttreatment. The findings suggest that both Internet-based tailored guided self-help treatments and Internet-based standardized treatments are promising treatment options for several anxiety disorders

EPA guidance on the early intervention in clinical high risk states of psychoses

This guidance paper from the European Psychiatric Association (EPA) aims to provide evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n = 1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional provements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk Status.

EPA guidance on the early detection of clinical high risk states of psychoses

The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion ‘cognitive disturbances’ (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The ‘genetic risk and functional decline’ UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.

Guidance of treatment decisions in risk-adapted primary radiotherapy for prostate cancer using multiparametric magnetic resonance imaging: a single center experience.

BACKGROUND Magnetic resonance imaging (MRI) of the prostate is considered to be the most precise noninvasive staging modality for localized prostate cancer. Multiparametric MRI (mpMRI) dynamic sequences have recently been shown to further increase the accuracy of staging relative to morphological imaging alone. Correct radiological staging, particularly the detection of extraprostatic disease extension, is of paramount importance for target volume definition and dose prescription in highly-conformal curative radiotherapy (RT); in addition, it may affect the risk-adapted duration of additional antihormonal therapy. The purpose of our study was to analyze the impact of mpMRI-based tumor staging in patients undergoing primary RT for prostate cancer. METHODS A total of 122 patients admitted for primary RT for prostate cancer were retrospectively analyzed regarding initial clinical and computed tomography-based staging in comparison with mpMRI staging. Both tumor stage shifts and overall risk group shifts, including prostate-specific antigen (PSA) level and the Gleason score, were assessed. Potential risk factors for upstaging were tested in a multivariate analysis. Finally, the impact of mpMRI-based staging shift on prostate RT and antihormonal therapy was evaluated. RESULTS Overall, tumor stage shift occurred in 55.7% of patients after mpMRI. Upstaging was most prominent in patients showing high-risk serum PSA levels (73%), but was also substantial in patients presenting with low-risk PSA levels (50%) and low-risk Gleason scores (45.2%). Risk group changes occurred in 28.7% of the patients with consequent treatment adaptations regarding target volume delineation and duration of androgen deprivation therapy. High PSA levels were found to be a significant risk factor for tumor upstaging and newly diagnosed seminal vesicle infiltration assessed using mpMRI. CONCLUSIONS Our findings suggest that mpMRI of the prostate leads to substantial tumor upstaging, and can considerably affect treatment decisions in all patient groups undergoing risk-adapted curative RT for prostate cancer.

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.

A sorrow shared is a sorrow halved? Internet-based group therapy versus individual therapy for social anxiety disorder: A randomized controlled trial

Purpose: Social anxiety disorder is one of the most researched conditions in the field of Internet-based self-help. Various studies have shown that cognitive-behavioral treatments can be efficacious to reduce social phobic symptoms. Most of the interventions tested include some form of support, whereas the efficacy of a web-based group format has yet to be investigated. The present study aims at investigating the possible added value of therapist-guided group support in an Internet-based guided self-help treatment for SAD. Methods: A total of 150 adults with a diagnosis of SAD are randomly assigned to either a wait-list control group or one of two active treatment conditions. Participants in the two active conditions use the same Internet-based self-help program, either with individual guidance by a therapist or with the support of a therapist-guided group of 6 individuals. In the group condition, participants communicate with each other via an integrated, protected discussion forum. The primary outcome variables are symptoms of SAD and diagnostic status immediately after the intervention (12 weeks) and at 6-month follow-up. Secondary endpoints are general symptomatology, depression, quality of life and adherence to treatment. Furthermore, process variables such as group processes and the working alliance are studied. Results: Results are currently being analyzed. Results at post-treatment will be presented and discussed. Potential moderating and mediating variables of treatment success will be addressed. Conclusion: The results of this study should indicate whether therapist-guided group support could enhance the efficacy of an internet based self-help treatment for SAD. This novel treatment format, if shown efficacious, could represent a cost-effective option and could be further modified to treat other conditions.

A practice-based culminating experience: Writing a HRSA grant application with Texas Organ Sharing Alliance for public education efforts to increase solid organ donation

In November 2010, nearly 110,000 people in the United States were waiting for organs for transplantation. Despite the fact that the organ donor registration rate has doubled in the last year, Texas has the lowest registration rate in the nation. Due to the need for improved registration rates in Texas, this practice-based culminating experience was to write an application for federal funding for the central Texas organ procurement organization, Texas Organ Sharing Alliance. The culminating experience has two levels of significance for public health – (1) to engage in an activity to promote organ donation registration, and (2) to provide professional experience in grant writing. ^ The process began with a literature review. The review was to identify successful intervention activities in motivating organ donation registration that could be used in intervention design for the grant application. Conclusions derived from the literature review included (1) the need to specifically encourage family discussions, (2) religious and community leaders can be leveraged to facilitate organ donation conversations in families, (3) communication content must be culturally sensitive and (4) ethnic disparities in transplantation must be acknowledged and discussed.^ Post the literature review; the experience followed a five step process of developing the grant application. The steps included securing permission to proceed, assembling a project team, creation of a project plan and timeline, writing each element of the grant application including the design of proposed intervention activities, and completion of the federal grant application. ^ After the grant application was written, an evaluation of the grant writing process was conducted. Opportunities for improvement were identified. The first opportunity was the need for better timeline management to allow for review of the application by an independent party, iterative development of the budget proposal, and development of collaborative partnerships. Another improvement opportunity was the management of conflict regarding the design of the intervention that stemmed from marketing versus evidence-based approaches. The most important improvement opportunity was the need to develop a more exhaustive evaluation plan.^ Eight supplementary files are attached to appendices: Feasibility Discussion in Appendix 1, Grant Guidance and Workshop Notes in Appendix 2, Presentation to Texas Organ Sharing Alliance in Appendix 3, Team Recruitment Presentation in Appendix 5, Grant Project Narrative in Appendix 7, Federal Application Form in Appendix 8, and Budget Workbook with Budget Narrative in Appendix 9.^

In search of the ox : Gateways to understanding human individuation through guidance

Este ensayo sintetiza varias aristas teóricas prácticas dirigidas a una de las decisiones personales más importantes en todo ser humano, el camino del autoconocimiento. Siempre y cuando se reflejen esas necesidades intrínsecas del ser, el hombre contemporáneo está descubriendo que en la satisfacción de los requerimientos materiales, finalmente no se encuentra ni la felicidad, ni la paz verdadera. En medio de este imaginario, el rol del Orientador está en su capacidad de guía fundamentado en unos principios y valores que garanticen que ese camino sea hallado, puesto que su gran compromiso consigo mismo y con los demás es precisamente acompañar en el descubrimiento de los talentos y potencialidades de ese sujeto para aprovechar su genialidad e innatas formas de normal crecimiento hacia la felicidad y armonía. Entre los caminos están los estudiados por un sinnúmero de teóricos expertos en la existencia humana como Ortega y Gasset, Sabater, Jung, Heidegger, Gadamer, Luckmann, Habermas, Bauman, Binswanger. Es un apasionante recorrido por estos análisis motivantes y sobre todo retadores.

The computer paradigm in vocational guidance

The technological advances in last decades have transformed the external resources of Vocational Counseling, Occupational Information and assessment of clients. Most computer systems follow a behaviorist-cognitive approach. However, the use of vocational counseling software is not exclusive to one conceptual approach. Computers are introduced in education from primary school; counselors and other educators are expected to use those systems. The attitude of counselors ranges from enthusiastic acceptance to complete refusal. Many counselors fear that computers will replace them. An underlying theory holds that counseling is based on the counselor-client interaction. A computer- client interaction cannot be considered vocational counseling. Counseling has five basic aims: prevention, assistance, education and development, service of diverse groups and research. The most relevant trends in computer-based counseling are: tests and questionnaires based on computers, adaptive development, computarized information, vocational counseling systems and research. Basic aims and the potential role of computers in achieving them are discussed. Present vocational counselors can use the technology of computers to link the past of our profession to its promising future. In view of these premises we have developed two computer systems that assist the vocational counseling process: "Professional Interests Questionnaire, Computer Version", and "Computer-based System of Vocational Counseling".

In search of the ox : Gateways to understanding human individuation through guidance

Este ensayo sintetiza varias aristas teóricas prácticas dirigidas a una de las decisiones personales más importantes en todo ser humano, el camino del autoconocimiento. Siempre y cuando se reflejen esas necesidades intrínsecas del ser, el hombre contemporáneo está descubriendo que en la satisfacción de los requerimientos materiales, finalmente no se encuentra ni la felicidad, ni la paz verdadera. En medio de este imaginario, el rol del Orientador está en su capacidad de guía fundamentado en unos principios y valores que garanticen que ese camino sea hallado, puesto que su gran compromiso consigo mismo y con los demás es precisamente acompañar en el descubrimiento de los talentos y potencialidades de ese sujeto para aprovechar su genialidad e innatas formas de normal crecimiento hacia la felicidad y armonía. Entre los caminos están los estudiados por un sinnúmero de teóricos expertos en la existencia humana como Ortega y Gasset, Sabater, Jung, Heidegger, Gadamer, Luckmann, Habermas, Bauman, Binswanger. Es un apasionante recorrido por estos análisis motivantes y sobre todo retadores.

The computer paradigm in vocational guidance

The technological advances in last decades have transformed the external resources of Vocational Counseling, Occupational Information and assessment of clients. Most computer systems follow a behaviorist-cognitive approach. However, the use of vocational counseling software is not exclusive to one conceptual approach. Computers are introduced in education from primary school; counselors and other educators are expected to use those systems. The attitude of counselors ranges from enthusiastic acceptance to complete refusal. Many counselors fear that computers will replace them. An underlying theory holds that counseling is based on the counselor-client interaction. A computer- client interaction cannot be considered vocational counseling. Counseling has five basic aims: prevention, assistance, education and development, service of diverse groups and research. The most relevant trends in computer-based counseling are: tests and questionnaires based on computers, adaptive development, computarized information, vocational counseling systems and research. Basic aims and the potential role of computers in achieving them are discussed. Present vocational counselors can use the technology of computers to link the past of our profession to its promising future. In view of these premises we have developed two computer systems that assist the vocational counseling process: "Professional Interests Questionnaire, Computer Version", and "Computer-based System of Vocational Counseling".

The computer paradigm in vocational guidance

The technological advances in last decades have transformed the external resources of Vocational Counseling, Occupational Information and assessment of clients. Most computer systems follow a behaviorist-cognitive approach. However, the use of vocational counseling software is not exclusive to one conceptual approach. Computers are introduced in education from primary school; counselors and other educators are expected to use those systems. The attitude of counselors ranges from enthusiastic acceptance to complete refusal. Many counselors fear that computers will replace them. An underlying theory holds that counseling is based on the counselor-client interaction. A computer- client interaction cannot be considered vocational counseling. Counseling has five basic aims: prevention, assistance, education and development, service of diverse groups and research. The most relevant trends in computer-based counseling are: tests and questionnaires based on computers, adaptive development, computarized information, vocational counseling systems and research. Basic aims and the potential role of computers in achieving them are discussed. Present vocational counselors can use the technology of computers to link the past of our profession to its promising future. In view of these premises we have developed two computer systems that assist the vocational counseling process: "Professional Interests Questionnaire, Computer Version", and "Computer-based System of Vocational Counseling".

In search of the ox : Gateways to understanding human individuation through guidance

Este ensayo sintetiza varias aristas teóricas prácticas dirigidas a una de las decisiones personales más importantes en todo ser humano, el camino del autoconocimiento. Siempre y cuando se reflejen esas necesidades intrínsecas del ser, el hombre contemporáneo está descubriendo que en la satisfacción de los requerimientos materiales, finalmente no se encuentra ni la felicidad, ni la paz verdadera. En medio de este imaginario, el rol del Orientador está en su capacidad de guía fundamentado en unos principios y valores que garanticen que ese camino sea hallado, puesto que su gran compromiso consigo mismo y con los demás es precisamente acompañar en el descubrimiento de los talentos y potencialidades de ese sujeto para aprovechar su genialidad e innatas formas de normal crecimiento hacia la felicidad y armonía. Entre los caminos están los estudiados por un sinnúmero de teóricos expertos en la existencia humana como Ortega y Gasset, Sabater, Jung, Heidegger, Gadamer, Luckmann, Habermas, Bauman, Binswanger. Es un apasionante recorrido por estos análisis motivantes y sobre todo retadores.

Quick time planning using "s" curves and cost based durations.

ABSTRACT: The comparison of the different bids in the tender for a project, with the traditional contract system based on unit rates open to and re-measurement, requires analysis tools that are able to discriminate proposals having a similar overall economic impact, but that might show a very different behaviour during the execution of the works. RESUMEN: La estimación rápida de costes en fases iniciales del proyecto por métodos paramétricos y referencias estadísticas es un tema bien estudiado, divulgado y aplicado en el sector de la construcción. Sin embargo, existe poca literatura técnica sobre sistemas de predimensionado de tiempos, que permitan realizar rápidamente una planificación con un grado de aproximación razonable. Este texto reúne dos aspectos ya conocidos, pero hasta ahora independientes, y una aportación propia:  -La estimación del plazo final por referencias estadísticas (BCIS, 2000)  - La estimación del reparto del coste total a lo largo de la ejecución mediante curvas "S" (diversos autores)  La estimación de la duración de la ejecución de las actividades en función de su coste. El conjunto de estas tres técnicas, aplicadas a un proyecto, permite obtener una planificación con el suficiente grado de detalle y fiabilidad para tomar decisiones en fases iniciales del proyecto.