Fast and automatic depth control of iterative bone ablation based on optical coherence tomography data

Laser surgery is an established clinical procedure in dental applications, soft tissue ablation, and ophthalmology. The presented experimental set-up for closed-loop control of laser bone ablation addresses a feedback system and enables safe ablation towards anatomical structures that usually would have high risk of damage. This study is based on combined working volumes of optical coherence tomography (OCT) and Er:YAG cutting laser. High level of automation in fast image data processing and tissue treatment enables reproducible results and shortens the time in the operating room. For registration of the two coordinate systems a cross-like incision is ablated with the Er:YAG laser and segmented with OCT in three distances. The resulting Er:YAG coordinate system is reconstructed. A parameter list defines multiple sets of laser parameters including discrete and specific ablation rates as ablation model. The control algorithm uses this model to plan corrective laser paths for each set of laser parameters and dynamically adapts the distance of the laser focus. With this iterative control cycle consisting of image processing, path planning, ablation, and moistening of tissue the target geometry and desired depth are approximated until no further corrective laser paths can be set. The achieved depth stays within the tolerances of the parameter set with the smallest ablation rate. Specimen trials with fresh porcine bone have been conducted to prove the functionality of the developed concept. Flat bottom surfaces and sharp edges of the outline without visual signs of thermal damage verify the feasibility of automated, OCT controlled laser bone ablation with minimal process time. © SPIE-OSA

Responsiveness of pain, active range of motion, and disability in patients with acute nonspecific low back pain

AbstractMany parameters are now used for investigations in clinical settings, such as pain, active range of motion (AROM), and disability, but it is not yet known which parameters are responsive in patients with acute nonspecific low back pain (LBP). This study aimed to investigate the responsiveness of pain, AROM, and disability in patients with acute nonspecific LBP. Fifty subjects were assessed for pain, AROM, and disability at baseline and after 6 weeks. The effect size (ES) was calculated for each parameter. Also, patient’s perception of change was collected after 6 weeks for correlating it with change scores for each parameter. The most responsive parameter for detecting the change in patients with acute nonspecific LBP was pain (ES, 1.57) and disability (ES, 0.93). However, AROM was proved to be less responsive. This study indicated that pain and disability were responsive in detecting the changes in patients with acute nonspecific LBP over time

Influence of blade aerodynamic model on prediction of helicopter rotor aeroacoustic signatures

Brown’s vorticity transport model has been used to investigate how the local blade aerodynamic model influences the quality of the prediction of the high-frequency airloads associated with blade–vortex interactions, and thus the accuracy with which the acoustic signature of a helicopter rotor can be predicted. The vorticity transport model can accurately resolve the structure of the wake of the rotor and allows significant flexibility in the way that the blade loading can be represented. The Second Higher-Harmonic Control Aeroacoustics Rotor Test was initiated to provide experimental insight into the acoustic signature of a rotor in cases of strong blade–vortex interaction. Predictions of two models for the local blade aerodynamics are compared with the test data. A marked improvement in accuracy of the predicted high-frequency airloads and acoustic signature is obtained when a lifting-chord model for the blade aerodynamics is used instead of a lifting-line-type approach. Errors in the amplitude and phase of the acoustic peaks are reduced, and the quality of the prediction is affected to a lesser extent by the computational resolution of the wake, with the lifting-chord model producing the best representation of the distribution of sound pressure below the rotor

Predicting outcome in acute low back pain using different models of patient profiling

This is a non-final version of an article published in final form in Spine, 34(18), 1970 - 1975, 2009. Copyright © 2009 Lippincott Williams & Wilkins, Inc.Study Design. Prospective observational study of prognostic indicators, using data from a randomized, controlled trial of physiotherapy care of acute low back pain (ALBP) with follow-up at 6 weeks, 3 months, and 6 months. Objective. To evaluate which patient profile offers the most useful guide to long-term outcome in ALBP. Summary of Background Data. The evidence used to inform prognostic decision-making is derived largely from studies where baseline data are used to predict future status. Clinicians often see patients on multiple occasions so may profile patients in a variety of ways. It is worth considering if better prognostic decisions can be made from alternative profiles. Methods. Clinical, psychological, and demographic data were collected from a sample of 54 ALBP patients. Three clinical profiles were developed from information collected at baseline, information collected at 6 weeks, and the change in status between these 2 time points. A series of regression models were used to determine the independent and relative contributions of these profiles to the prediction of chronic pain and disability. Results. The baseline profile predicted long-term pain only. The 6-week profile predicted both long-term pain and disability. The change profile only predicted long-term disability (P 0.05). A similar result was obtained when the order of entry was reversed. When predicting long-term disability, after the 6-week profile was entered at the first step, the change profile was not significant when forced in at the second step. However, when the change profile was entered at the first step and the 6-week clinical profile was forced in at the second step, a significant contribution of the 6-week profile was found. Conclusion. The profile derived from information collected at 6 weeks provided the best guide to long-term pain and disability. The baseline profile and change in status offered less predictive value

Influence of blade aerodynamic model on the prediction of helicopter high-frequency airloads

Brown’s vorticity transport model has been used to investigate the influence of the blade aerodynamic model on the accuracy with which the high-frequency airloads associated with helicopter blade–vortex interactions can be predicted. The model yields an accurate representation of the wake structure yet allows significant flexibility in the way that the blade loading can be represented. A simple lifting-line model and a somewhat more sophisticated liftingchord model, based on unsteady thin aerofoil theory, are compared. A marked improvement in the accuracy of the predicted high-frequency airloads of the higher harmonic control aeroacoustic rotor is obtained when the liftingchord model is used instead of the lifting-line approach, and the quality of the prediction is affected less by the computational resolution of the wake. The lifting-line model overpredicts the amplitude of the lift response to blade–vortex interactions as the computational grid is refined, exposing the fundamental deficiencies in this approach when modeling the aerodynamic response of the blade to interactions with vortices that are much smaller than its chord. The airloads that are predicted using the lifting-chord model are relatively insensitive to the resolution of the computation, and there are fundamental reasons to believe that properly converged numerical solutions may be attainable using this approach

Communication style and exercise compliance in physiotherapy (CONNECT). A cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients’ adherence to physiotherapists’ recommendations: study rationale, design, and methods

Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist’s recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients’ autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists’ recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists’ autonomy-supportive communication on low back pain patients’ adherence to physical activity and exercise therapy recommendations. \ud \ud This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded. \ud \ud We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects. \ud \ud This trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients’ adherence to rehabilitation recommendations. Current Controlled Trials ISRCTN63723433\u

Market Offer For IKOR GMBH: Development of a business analysis to assess the usefulness of the Scaled Agile Framework for insurance companies

Internship Report presented as the partial requirement for obtaining a Master's degree in Information Management, specialization in Information Systems and Technologies ManagementIt has been known for years that agile methods have a major role to play in project management. Increasingly, frameworks for agile scaling are becoming more popular and widespread. The Scaled Agile Framework is one of them. It enjoys great popularity in many industries. Therefore, IKOR has considered that a market offer is needed that exactly fulfils this need for its customers. These are mainly insurance customers, who are still a few years behind the digital transformation compared to other industries. In order to create a solution for this, IKOR decided that a market offer was needed that assessed whether SAFe was a useful framework for the insurance company to adopt and provided an assessment of how far along the insurance company was in adopting SAFe. This internship report was prepared to fulfil and document this task. During the development of the market offer, SAFe, business analysis, and the implementation of workshops were dealt with from a theoretical as well as a practical point of view. The result was a business analysis in form of a questionnaire, a workshop concept for conducting the workshop with the client and a recommendation made to the client on the current status of his insurance. After the exemplary implementation, the procedure and the results were evaluated and classified by experts. They gave additional advice on how to use and expand the market offer

A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity

BACKGROUND: Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. METHODS: Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse. RESULTS: Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% (p = 0.003). Substance misuse was identified in 27 patients (32%). CONCLUSIONS: A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up