A user-friendly deep learning application for accurate lung cancer diagnosis

BACKGROUND

Accurate diagnosis and subsequent delineated treatment planning require the experience of clinicians in the handling of their case numbers. However, applying deep learning in image processing is useful in creating tools that promise faster high-quality diagnoses, but the accuracy and precision of 3-D image processing from 2-D data may be limited by factors such as superposition of organs, distortion and magnification, and detection of new pathologies. The purpose of this research is to use radiomics and deep learning to develop a tool for lung cancer diagnosis.

METHODS

This study applies radiomics and deep learning in the diagnosis of lung cancer to help clinicians accurately analyze the images and thereby provide the appropriate treatment planning. 86 patients were recruited from Bach Mai Hospital, and 1012 patients were collected from an open-source database. First, deep learning has been applied in the process of segmentation by U-NET and cancer classification via the use of the DenseNet model. Second, the radiomics were applied for measuring and calculating diameter, surface area, and volume. Finally, the hardware also was designed by connecting between Arduino Nano and MFRC522 module for reading data from the tag. In addition, the displayed interface was created on a web platform using Python through Streamlit.

RESULTS

The applied segmentation model yielded a validation loss of 0.498, a train loss of 0.27, a cancer classification validation loss of 0.78, and a training accuracy of 0.98. The outcomes of the diagnostic capabilities of lung cancer (recognition and classification of lung cancer from chest CT scans) were quite successful.

CONCLUSIONS

The model provided means for storing and updating patients' data directly on the interface which allowed the results to be readily available for the health care providers. The developed system will improve clinical communication and information exchange. Moreover, it can manage efforts by generating correlated and coherent summaries of cancer diagnoses.

Dosimetric and radiobiological comparison in head-and-neck radiotherapy using JO-IMRT and 3D-CRT

Introduction

Dosimetric and radiobiological evaluations for the Jaws-only Intensity-modulated radiotherapy (JO-IMRT) technique for head and neck jaws-only intensity-modulated radiation therapy (JO-IMRT) and 3D conformal radiation therapy (3D-CRT). To compare the head-and-neck therapeutic approaches utilizing JO-IMRT and 3D-CRT techniques, different radiation dose indices were calculated, including: conformity index (CI), homogeneity index (HI), and radiobiological variables like Niemierko's equivalent uniform dose based tumor control probability (TCP) of planning target volume (PTV), normal tissue complication probability (NTCP) of organs at risk (OAR) (brainstem, spinal cord, and parotid grand).

Materials and methods

Twenty-five nasopharynx patients were studied using the Prowess Panther Treatment Planning System (Prowess Inc). The results were compared with the dose distribution obtained using 3D-CRT.

Results

Regarding tumor coverage and CI, JO-IMRT showed better results than 3D-CRT. The average doses received by the PTVs were quite similar: 72.1 ± 0.8 Gy by 3D-CRT and 72.5 ± 0.6 Gy by JO-IMRT plans (p > 0.05). The mean doses received by the parotid gland were 56.7 ± 0.7 Gy by 3D-CRT and 26.8 ± 0.3 Gy by JO-IMRT (p > 0.05). The HI and CI were 0.13 ± 0.01 and 0.14 ± 0.05 and (p > 0.05) by 3D-CRT and 0.83 ± 0.05 and 0.73 ± 0.10 by JO-IMRT (p < 0.05). The average TCP of PTV was 0.82 ± 0.08 by 3D-CRT and 0.92 ± 0.02 by JO-IMRT. Moreover, the NTCP of the parotid glands, brain stem, and spinal cord were lower using the JO-IMRT than 3D-CRT plans. In comparison to the 3D-CRT approach, the JO-IMRT technique was able to boost dose coverage to the PTV, improve the target's CI and HI, and spare the parotid glands. This suggests the power of the JO-IMRT over 3D-CRT in head-and-neck radiotherapy.

Elimination of biological and physical artifacts in abdomen and brain computed tomography procedures using filtering techniques

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Filters reduce the noise at the expense of visual image quality.

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Digital interpretation of images prevents misinterpretation of the images due to blurring of the images.

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Dose reduction without compromising the diagnostic.

Introduction

Medical images are usually affected by biological and physical artifacts or noise, which reduces image quality and hence poses difficulties in visual analysis, interpretation and thus requires higher doses and increased radiographs repetition rate.

Objectives

This study aims at assessing image quality during CT abdomen and brain examinations using filtering techniques as well as estimating the radiogenic risk associated with CT abdomen and brain examinations.

Materials and Methods

The data were collected from the Radiology Department at Royal Care International (RCI) Hospital, Khartoum, Sudan. The study included 100 abdominal CT images and 100 brain CT images selected from adult patients. Filters applied are namely: Mean filter, Gaussian filter, Median filter and Minimum filter. In this study, image quality after denoising is measured based on the Mean Squared Error (MSE), Peak Signal-to-Noise Ratio (PSNR), and the Structural Similarity Index Metric (SSIM).

Results

The results show that the images quality parameters become higher after applications of filters. Median filter showed improved image quality as interpreted by the measured parameters: PSNR and SSIM, and it is thus considered as a better filter for removing the noise from all other applied filters.

Discussion

The noise removed by the different filters applied to the CT images resulted in enhancing high quality images thereby effectively revealing the important details of the images without increasing the patients’ risks from higher doses.

Conclusions

Filtering and image reconstruction techniques not only reduce the dose and thus the radiation risks, but also enhances high quality imaging which allows better diagnosis.

Tangent vector-based gradient method with l12-regularization: Iterative half thresholding algorithm for CS-MRI

OBJECT

This paper presents a new method using tangent vector-based l₁₂-regularization for compressed sensing MR image reconstruction.

MATERIALS AND METHODS

The proposed method with l₁₂-regularization is tested on four datasets: (i) 1-D sparse signal (ii) numerical cardiac phantom, (iii & iv) two sets of in-vivo cardiac MRI datasets acquired using 30 receiver coil elements with Cartesian and radial trajectories on 3T scanner. The results are compared with standard CS reconstruction, which utilizes l₁-regularization. The experiments were also conducted for two different types of samplings: (i) cartesian sub-sampling and (ii) 2D random Gaussian sub-sampling.

RESULTS

The quality of the reconstructed images is validated through Root Mean Square Error (RMSE) and Peak Signal-to-Noise Ratio (PSNR). The results show that the proposed method outperforms the standard CS reconstructions in our experiments with an improvement of 54.8% in RMSE and 14.3% in terms of PSNR. Moreover, the Gaussian random sub-sampling-based image reconstruction results are better than the Cartesian sub-sampling-based reconstruction results.

CONCLUSION

The results show that the proposed method yields a good sparse signal approximation and superior convergence behavior, which implies a promising technique for the reconstruction of cardiac MR images as compared to the conventional CS algorithm.

Estimation of patient effective doses in PET/CT- 18F-Sodium Fluoride examinations

The positron emitters (¹⁸F-Sodium Fluoride (NaF)) and X-rays used in Positron emission tomography (PET) combined with computed tomography (PET/CT) imaging have a high radiation dose, which results in a high patient dose. The present research intends to determine the radiation dose and risks associated with PET/CT- 18F-Sodium fluoride examinations in patients. The 18F-NaF PET/CT was used to investigate the doses of 86 patients. Patient exposure parameters and ImPACT software were used to calculate mean effective doses. The administered activity of 185 MBq (5.0 mCi) per procedure has a mean and range based on the patient's BMI (BMI). The range of patient effective doses per procedure was found to be 4-10 mSv, with a radiation risk of 1 × 10^-5 per procedure. Patient doses are determined by the patient's size, scanner type, imaging protocol, and reconstruction method. For further dose reduction, proper justification and radiation dose optimization is required.

EVALUATION OF ANNUAL RADIATION EXPOSURE OF STAFF IN A CARDIAC CATHETERIZATION DEPARTMENT IN SAUDI ARABIA

The objective of this study is to estimate the annual effective dose for cardiologists and nurses by measuring Hp(10) and Hp(0.07) during cardiac catheterization procedures. A total of 16 staffs members were working in interventional cardiology during 1 year at a tertiary hospital. The occupational dose was measured using calibrated thermo-luminescent dosemeters (TLD-100, LiF:Mg,Ti). The overall mean and range of the annual Hp(10) and Hp(0.07) (mSv) for cardiologists were 3.7 (0.13-14.5) and 3.2 (0.21-14.7), respectively. Cardiologists were frequently exposed to higher doses compared with nurses and technologists. The exposure showed wide variations, which depend on occupation and workload. Staff is adhered to radiation protection guidelines regarding shielding the trunk, thyroid shield, thus appropriately protected. Lens dose measurement is recommended to ensure that dose limit is not exceeded.

Radiobiological effects and medical applications of non-ionizing radiation

Radiation is used in medicine to diagnose and treat diseases but it can also cause harm to the body by burning or mutation. This depends on whether the radiation is ionizing or nonionizing. Despite its vast applications in surgery, dermatology and cosmetics, little is taught and thus known about non-ionizing radiation. This review article discusses the fundamentals of non-ionizing electromagnetic radiations. The main aim is to extensively explain the different types of non-ionizing radiation. This will equip students and medical personnel with knowledge on different medical applications and expose them to a variety of specializations in medicine that utilize non-ionizing radiation. The article discusses the physics, hazard, means of protection and medical application of each type of radiation: ultraviolet radiation, light (both visible light and LASER), infrared radiation, microwaves and extremely low frequency radiation separately. It presents these terms in a simple manner that avoids rigors mathematics and physics, which makes them comprehensible for medical students. The development of new diagnostic and therapeutic approaches could also lead to increased hazards to the body unless they are treated with precaution. If not adequately monitored, a significant health risk may be posed to potentially exposed employees. Hence proper dosage should be used for non-ionizing radiation. This is only possible through understanding of the risks/benefits of these radiations by studying the physics and radiobiological effects of each individual radiation.

Eye lens and thyroid gland radiation exposure for patients undergoing brain computed tomography examination

This study aims to estimate the effective radiation dose and organ dose from head CT procedures. It was conducted in three main private hospitals in Khartoum State-Sudan, using Toshiba machines with 64 slices. The total number of patients included in this study was 142 patients (82 males and 60 females). The effective dose and organ dose were calculated by CT Expo software. The effective dose slightly varied among patients according to gender and age. The effective dose for female patients (5.99 mSv) was higher than that for male patients (5.84 mSv), and the pediatric dose (5.46 mSv) was lower than the adults' dose (5.94 mSv). The dose for eye lens was found lower for male patients (89.117 mSv) than the dose for female patients (94.62) mSv). According to patients' age: the dose received by the lens of the eye was much lower in pediatric (79.93 mSv) than the adults (92.41 mSv). The dose for thyroid in female patients (33.52 mSv) was higher than the male patients (28 mSv). The pediatric dose (28.34 mSv) was lower than the adults' dose (30.64 mSv). Departmental imaging protocol and lack of training among hospital staff are expected to be responsible for these variations. Therefore, this study recommends that the CT technologists be trained on suitable strategies to achieve dose optimization. Moreover, patients' doses must be monitored regularly.

Evaluation of hysterosalpingographic findings among patients presenting with infertility

Background

Infertility is a global health issue and hysterosalpingography (HSG) is a valuable radiological tool in infertility workup and remains a main modality for investigating female infertility. However, the HSG findings of infertility are not the same worldwide.

This study aimed at evaluating the incidence of HSG findings in patients investigated for primary and secondary infertility, correlating these findings with their clinical data that reflect the infertility causes and comparing the findings with previous international studies.

Methods

A prospective descriptive study of 75 female patients referred, as cases of infertility, for HSG examination in Elrebat Hospital and Khartoum Advanced Diagnostic Center. HSG was performed in the first half of the cycle. The procedure and its complications, were explained to the patients and informed consents were obtained. Patients with active pelvic infection and active uterine or vaginal bleeding were excluded from the study. Using aseptic technique and with proper patient’s positioning, iodinated contrast was introduced into the cervix under fluoroscopic monitoring, to demonstrate the uterine cavity, fallopian tubes and free spillage into the peritoneal cavity. Personal data, clinical data and HSG findings were analyzed using SPSS version 23.

Results

The commonest age group seen was 26–36 years. Close incidences of primary and secondary infertility were detected. 52.7% had abnormal findings in HSG. Tubal pathology (42.7%) being the most common abnormality, followed by uterine and combined abnormalities. There was strong association between past medical history suggesting pelvic inflammatory disease (PID) or past history suggesting tubal blockage secondary to abdominopelvic surgery and tubal abnormalities.

Conclusion

HSG examinations revealed that the most common abnormality was tubal blockage possibly complicating PID and abdominopelvic surgeries. This reflects the HSG diagnostic and therapeutic role in the assessment of female infertility and the further needs for more preventive measures targeting the reduction of tubal pathologies in developing countries.

Human responses to wave slamming vibration on a polar supply and research vessel

A polar supply and research vessel is pre-disposed to wave slamming which has caused complaints among crew and researchers regarding interference with sleep, equipment use and research activities. The present work undertook to survey passenger claims of sleep interference, disturbed motor tasks and equipment damage as a result of wave slamming during normal operations of this vessel. The hypothesis was investigated that whole-body vibration metrics from ISO 2631-1 are potentially suitable for the prediction of human slamming complaints. Full-scale acceleration measurements were performed and wave slamming events were subsequently identified from the human weighted acceleration time histories. A daily diary survey was also conducted to gather the human response. The vibration caused by wave slamming was found to be strongly correlated with sleep disturbances and activity interference. Sleep and equipment use were found to be the most affected parameters by slamming. Daily vibration dose values were determined by accumulating the vibration as a result of slamming over 24 h periods. This metric accounted for increased magnitudes and frequency of slamming incidents and proved to be the best metric to represent human responses to slamming vibration. The greatest percentage of activities affected by slamming related to sleep regardless of daily cumulative VDV magnitude. More than 50% of the recorded responses related to sleep when the daily cumulative VDV ranged between 8.0 m/s^1.75-10.0 m/s^1.75. The peak vertical vibration levels recorded on the vessel reach magnitudes which are associated with sleep disturbance in environments where acoustic noise is present.

Risks of lung fibrosis and pneumonitis after postmastectomy electron radiotherapy

Breast cancer patients are treated by a variety of options. Electron beams are utilised in the irradiation of the chest wall postmastectomy due to its dose distribution in the irradiated body. The objectives of this study were to determine the possibility of inducing lung fibrosis and pneumonitis during postmastectomy radiotherapy (PMRT) using electron beams. Electron beams with different energies and gantry angles were used for irradiating the chest wall in PMRT. The normal-tissue-complications-probability of the lung was evaluated. Three computer codes EGSnrc, XTING and DORES were used for simulating the beams and patients, generating dose-volume histograms and evaluating the dose response of the lung. NTCP increases with energy and with gantry angle. Below 15 MeV (which had given very high and unacceptable NTCP values), the largest value of NTCP of fibrosis was 0.036, for 12 MeV, gantry angle 60. The largest value of NTCP of radiation-induced pneumonitis was 0.044, for 12 MeV, gantry angle 60.

Evaluation of patient effective doses in CT urography, intravenous urography and renal scintigraphy

Imaging of the renal system is performed with different techniques depending mainly on clinical symptoms and signs. This study intended to evaluate patient effective doses undergoing renal scintigraphy (technetium-99m-diethylene-triamine-pentaacetic acid), computed tomography urography (CTU) and intravenous urography (IVU). A total of 60 patients were evaluated using Orbiter 37 Gamma camera single head, dual-slice CT scanner and conventional X-ray machine with computed radiography (CR) processing unit. Patients effective dose were estimated using the administered activity, DosCal software and dose length product value for renal scan, IVU and CTU procedures, respectively. Patients' effective doses during renal scan, CTU and IVU procedures were 0.78 ± 0.18, 2.53 ± 0.94 and 1.81 ± 0.20 mSv, in that order. Patients were exposed to a higher effective dose during CTU compared with other two procedures. Patient doses depend on the size of patient, the type of scanner and the imaging protocol used. Effective doses considered low compared with previous studies.

Estimation of effective dose during hystrosalpingography procedures in certain hospitals in Sudan

The aims of this study were to measure the patients' entrance surface air kerma doses (ESAK), effective doses and to compare practices between different hospitals in Sudan. ESAK were measured for patient using calibrated thermo luminance dosimeters (TLDs, GR200A). Effective doses were estimated using National radiological Protection Board (NRPB) software. This study was conducted in five radiological departments: Two Teaching Hospitals (A and D), two private hospitals (B and C) and one University Hospital (E). The mean ESAK was 20.1mGy, 28.9mGy, 13.6mGy, 17.5mGy, 35.7mGy for hospitals A, B, C, D, and E, respectively. The mean effective dose was 2.4mSv, 3.5mSv, 1.6mSv, 2.1mSv and 4.3mSv in the same order. The study showed wide variations in the ESDs with three of the hospitals having values above the internationally reported values.

The importance of measuring self-efficacy in patients with diabetes

OBJECTIVES

Self-efficacy is an important factor influencing diabetes self-management behaviours. Previous studies have examined self-efficacy as a general measure in diabetes care for all self-care treatment recommendations together. This current study was designed to examine if low self-efficacy in each of the measured self-care treatment recommendations is related to decreased adherence for each specific recommendation.

METHODS

The self-efficacy was measured in 119 patients for four different treatment recommendations: blood glucose self-monitoring, exercise, diet and oral medication intake and correlated with The Resistance to Treatment Questionnaire.

RESULTS

Significant and positive Pearson's correlations were found between the frequency of adherence to treatment recommendations and the self-efficacy regarding different recommendations. The correlation between self-efficacy and diet and physical activity was 0.5 and 0.67, respectively. The higher the resistance to treatment score, the less confident the patient is in his or her ability to adhere with treatment recommendations. This pattern was not present in adherence to medication intake.

CONCLUSIONS

Self-efficacy impacts adherence to treatment and therefore plays a role in the clinical outcome. The practical implication is that assessment of self-efficacy in people with diabetes may be a first step in the development of individually tailored interventions.

Characteristics and risk factors of tobacco consumption among University of Sharjah students, 2005

This study aimed to estimate the prevalence, patterns and risk factors of tobacco consumption among a stratified random sample of students at University of Sharjah, United Arab Emirates (UAE), during 2005. The overall reported smoking prevalence among 1057 sampled students was 15.1%; cigarette smokers were 9.4% and waterpipe smokers 5.6%. While women comprised only 8.9% of cigarette smokers, they were 26.2% of waterpipe smokers. Multiple linear regression analysis showed that the most important predictors for smoking among the students were: male sex, having a smoking friend, having a smoking family member (father/mother/both), non-UAE nationality and older age. There is a need to intensify efforts to prevent young people from starting smoking and to help young smokers to stop.

Conceptualization and measurement of resistance to treatment: the resistance to treatment questionnaire for people with diabetes

OBJECTIVE

This research describes the process of building a tool which allows assessment of resistance to treatment and its intensity among patients with diabetes.

METHODS

This study was undertaken in Maccabi Health care Services a preferred provider health care organization. This is a multistage study using both qualitative and quantitative methods. A semi-structured interview using 14 key questions identified the reasons for resistance to treatment among 64 people with diabetes. A questionnaire was built based on these themes and then validated with a further 123 people with diabetes. A further validation was undertaken comparing our questionnaire with that of Kavookjian.

RESULTS

This resulted in a four theme, 40-item questionnaire which can be administered in about 10 minutes. Resistance patterns and their intensity were different in each patient. This resistance questionnaire identifies the core reasons for non-compliance: lack of faith or dissatisfaction with the treatment or with the medical team, emotional reasons, specific problems or constraints and factors connected to despair and failure.

CONCLUSIONS

We present a tool 'The Resistance to Treatment Questionnaire' which may be used by medical personnel to identify the barriers to treatment for each individual and in turn improve patient compliance to treatment.

Steroid-sparing effect of wormwood (Artemisia absinthium) in Crohn's disease: a double-blind placebo-controlled study

In this double-blind study carried out at five sites in Germany, 40 patients suffering from Crohn's disease receiving a stable daily dose of steroids at an equivalent of 40 mg or less of prednisone for at least 3 weeks were administered a herbal blend containing wormwood herb (3 x 500 mg/day) or a placebo for 10 weeks. Besides steroids, 5-aminosalicylates, if dose remained constant for at least 4 weeks prior to entering the trial and/or azathioprine, stable dose for at least 8 weeks, or methotrexate, stable dose for at least 6 weeks, were permitted as concomitant medications. The recruited 40 patients - 20 in each treatment group, were evaluated with the help of a Crohn's Disease Activity Index (CDAI) questionnaire, an Inflammatory Bowel Disease Questionnaire (IBDQ), the 21-item Hamilton Depression Scale (HAMD) and an 8-item Visual Analogue Scale (VA-Scale) in 2-week intervals during the first 10 study weeks, and then at week 12, 16 and 20, which were the trial-medication free observation periods. The initial stable dose of steroids was maintained until week 2, after that a defined tapering schedule was started so that at the start of week 10 all the patients were free of steroids. At the end of week 10 the trial medication was also discontinued. The concomitant medications were maintained at the same dose levels till the end of the observation period that was the end of week 20. There was a steady improvement in CD symptoms in 18 patients (90%) who received wormwood in spite of tapering of steroids as shown by CDA-Index, IBDQ, HAMD, and VAS. After 8 weeks of treatment with wormwood there was almost complete remission of symptoms in 13 (65%) patients in this group as compared to none in the placebo group. This remission persisted till the end of the observation period that was week 20, and the addition of steroids was not necessary. In two (10%) patients did the re-starting of corticoids become necessary? On the other hand, the CD conditions of the patients who received the placebo deteriorated after the tapering of steroids, and re-starting steroids became necessary in 16 (80%) patients in this group after week 10. These results strongly suggest that wormwood has a steroid sparing effect. The improvements in HAMD scores indicate that wormwood also has an effect on the mood and quality of life of CD patients, which is not achieved by other standard medications.

What would you say to the person on the roof? A suicide prevention text

This anti-suicide text provides potential helpers (professional and lay) with clear guidelines for communicating with a declared suicidal person, particularly in real-time situations, when time is crucial and the act cannot be physically prevented. The text also may have a preventative effect when diffused to the public as an anonymous address to potential suicides.

Helping parents deal with children's acute disciplinary problems without escalation: the principle of nonviolent resistance

There are two kinds of escalation between parents and children with acute discipline problems: (a) complementary escalation, in which parental giving-in leads to a progressive increase in the child's demands, and (b) reciprocal escalation, in which hostility begets hostility. Extant programs for helping parents deal with children with such problems focus mainly on one kind of escalation to the neglect of the other. The systematic use of Gandhi's principle of "nonviolent resistance" allows for a parental attitude that counters both kinds of escalation. An intervention is described, which allows parents to put this principle into practice.

Troubles in the therapeutic relationship: a pluralistic perspective

From a pluralist perspective, there is no universally correct therapeutic attitude and no set way to deal with troubled therapeutic relationships. A three-factor model of therapeutic impasse is presented in terms of hopeless narratives, failing strategies, and ineffective interactions. This triple mapping allows for the development of a working hypothesis and a critical intervention in order to set therapy back on track. Although a one-shot event, the critical intervention is not a single-session magical cure, but an attempt to restore a productive therapeutic routine based on a better working alliance. This article illustrates this approach in three separate cases.

High prevalence of personality disorders among circadian rhythm sleep disorders (CRSD) patients

The purpose of this study was to examine systematically our previous clinical impression regarding the prevalence of personality disorders in patients suffering from circadian rhythm sleep disorders (CRSD). We hypothesized that, in a group of patients suffering from CRSD, there would be a higher frequency of personality disorders than in a group of healthy controls. The experimental group consisted of CRSD patients diagnosed according to a clinical interview and actigraphic recordings. The control group consisted of healthy volunteers in whom CRSD had been ruled out by means of a self-administered questionnaire. Both groups were assessed for personality disorders using the MCMI, a diagnostic tool based on Millon's biopsychosocial theory of personality and the PRQ-R, a diagnostic tool based on the DMS-III-R. Both tests provided clear and significant support for the hypothesis that individuals suffering from CRSD are characterized to a greater extent by personality disorders than a control group. No specific characteristic pattern or profile of personality disorders was clearly detected. Correct early diagnosis and treatment of CRSD may improve afflicted individuals' adaptive capabilities and perhaps even prevent the development of a personality disorder. This suggests how important a greater awareness of CRSD on the part of the professional community may be.

Misuse of statistical test in three decades of psychotherapy research

This article reviews the misuse of statistical tests in psychotherapy research studies published in the Journal of Consulting and Clinical Psychology in the years 1967-1968, 1977-1978, and 1987-1988. It focuses on 3 major problems in statistical practice: inappropriate uses of null hypothesis tests and p values, neglect of effect size, and inflation of Type I error rate. The impressive frequency of these problems is documented, and changes in statistical practices over the past 3 decades are interpreted in light of trends in psychotherapy research. The article concludes with practical suggestions for rational application of statistical tests.

The continuity principle: a unified approach to disaster and trauma

The continuity principle stipulates that through all stages of disaster, management and treatment should aim at preserving and restoring functional, historical, and interpersonal continuities, at the individual, family, organization, and community levels. Two misconceptions work against this principle and lead to decisional errors: the "abnormalcy bias" which results in underestimating victims' ability to cope with disaster, and the "normalcy bias" which results in underestimating the probability or extent of expected disruption. This article clarifies these biases and details the potential contributions of the continuity principle at the different stages of the disaster.

Misuse of statistical test in three decades of psychotherapy research

This article reviews the misuse of statistical tests in psychotherapy research studies published in the Journal of Consulting and Clinical Psychology in the years 1967-1968, 1977-1978, and 1987-1988. It focuses on 3 major problems in statistical practice: inappropriate uses of null hypothesis tests and p values, neglect of effect size, and inflation of Type I error rate. The impressive frequency of these problems is documented, and changes in statistical practices over the past 3 decades are interpreted in light of trends in psychotherapy research. The article concludes with practical suggestions for rational application of statistical tests.

The integrative focus: coordinating symptom- and person-oriented perspectives in therapy

The issue of choosing between a symptomatic and a personal emphasis in psychotherapy has always been one of the major bones of contention between adherents of different approaches in the field. As it becomes increasingly clear that none of the major schools will achieve supremacy, the drive to incorporate whatever is best in any orientation becomes more pronounced. Therapists often find that the therapeutic alliance may be damaged if they neglect either their patients' symptomatic complaints or pressing developmental tasks. The integrative focus is an attempt to coordinate these two elements in therapy so that they may enhance each other instead of competing with each other. The focus is so designed as to help unify the treatment, increase motivation for therapy, and register deeply in the patient's mind. Though only a technical aid, the integrative focus may show one of the ways by which integration does not diffuse, but rather steadies and enriches the therapeutic beam.

Changing trends in three decades of psychotherapy research: The flight from theory into pragmatics

This article reviews 252 empirical studies of psychotherapy published in the Journal of Consulting and Clinical Psychology in the years 1967/1968, 1977/1978, and 1987/1988. Articles were rated on variables related to theoretical relevance, clinical validity and methodology. It is shown that the main trend over this period of time has been a decline in theory-guided and a rise in pragmatic, clinically oriented research. Related changes in specific norms and practices in this area are illustrated. The disadvantages of a purely empirical approach to psychotherapy research are discussed, and recommendations are made in light of the distinction between the different aims of pragmatic and theoretical research.

Changing trends in three decades of psychotherapy research: the flight from theory into pragmatics

This article reviews 252 empirical studies of psychotherapy published in the Journal of Consulting and Clinical Psychology in the years 1967/1968, 1977/1978, and 1987/1988. Articles were rated on variables related to theoretical relevance, clinical validity and methodology. It is shown that the main trend over this period of time has been a decline in theory-guided and a rise in pragmatic, clinically oriented research. Related changes in specific norms and practices in this area are illustrated. The disadvantages of a purely empirical approach to psychotherapy research are discussed, and recommendations are made in light of the distinction between the different aims of pragmatic and theoretical research.

Pluralistic criteria for psychotherapy: an alternative to sectarianism, anarchy, and utopian integration

A pluralist revolution has taken place in psychotherapy, discarding the assumptions that only one theory can be true and that there exists only one method for finding it. Rejecting the anarchistic attitude of "anything goes" as professionally nihilistic, we propose that in the present pluralistic era it is necessary to recognize a multiplicity of perspectives for determining the rightness of therapeutic constructs. A construct or intervention is right to the extent that it fits demands for coherence and pragmatic value from a variety of perspectives, such as the patient's, the clinical community's, the academic community's, and the general public's. Within the clinical and academic communities, the greater the variety of acceptance (by different schools, theories, and methodologies), the greater the construct's cumulative rightness. The difference between this variety rule and a majority one is made explicit. Coherence and pragmatic value are widely accepted criteria and they define the universe of rational discourse in psychotherapy. Adding to these the requirement of multiple acceptability is the necessary step for creating rational dialogue in the new pluralistic world.

Doctor Iago's treatment of Othello

The article presents Shakespeare's Iago as Hell's master therapist. Illustrated with excerpts from the play, the reader is shown how with consummate psychological skills, Iago bends his victims to his will. Step by step he awakens Othello's jealousy, and makes use of the hero's basic insecurity on account of his blackness. Once Othello has determined to take revenge, Iago makes sure to prevent a "relapse", by slyly administering small doses of doubt and pity. Predictably, Othello violently rejects these suggestions, thus becoming even more rigidly bent on his plan.

Enhancing the impact of therapeutic interventions

A therapeutic intervention has impact if it reaches the patient's mind and remains available for times of need. Impact is the overcoming of attention, neglect and forgetfulness. Therapists enhance impact by: (a) building up patients' positive attention; (b) creating unusual and discrepant events; (c) strengthening the therapeutic message or the way it is conveyed; (d) drawing out patients' readiness for commitment and hard work; (e) creating bridges between therapy and the problem situation; (f) protecting the therapeutic message from trivializing and levelling events. These principles are nonspecific and are here illustrated by examples from widely different therapeutic approaches. Impact is not a substitute for the inherent value of a therapeutic message, but its lack can doom even our greatest inspirations.

Signal and noise in psychotherapy. The role and control of non-specific factors

Four major categories of non-specific or common factors are systematically analysed: relationship, expectancy, reorganising, and impact factors. The placebo control method should be discarded in psychotherapy research for two reasons: (a) sham treatment controls are unworkable because common factors in treatment are manifest only when real treatment is administered; and (b) the very events which were once thought of as 'non-specific' noise are now recognised as active therapeutic factors common to many schools.

Specifics and nonspecifics in psychotherapy

The specifics/nonspecifics issue in psychotherapy has given rise consecutively to three major positions: (a) The systems' position, in which each specific approach to therapy views itself alone as embodying true theory and rightful practice, while rivaling approaches are seen as superficial or unscientific. (b) The nonspecifics' position in which the latter are seen as sole carriers of therapeutic effects. (c) The recent integrative position in which instead of the systems' self-immured isolation or the nonspecifics' paralyzing equivalence of all therapies, a synthesis of specific approaches within a larger nonspecific theory or practical strategy is attempted.

Psychological factors in preterm labor: critical review and theoretical synthesis

Cumulative or chronic environmental stress and high scores on psychopathology scales have been consistently linked to preterm labor. In the laboratory, psychological stimuli have also been shown to affect uterine activity. Clinical studies suggest that interventions which reduce tension and anxiety can prevent or inhibit preterm labor. A model is proposed that links preterm labor to a disorder of arousal manifested physiologically as a hyperreactivity of the limbic circuitry and its efferent components. Autonomic hyperreactivity has been found repeatedly in women who experience preterm labor. This central hyperreactivity could unleash a cascade of psychophysiological reactions that could cause uterine excitation and facilitate preterm labor.