WorldWideScience

Sample records for effective multimodality treatment

  1. Multimodal news framing effects

    NARCIS (Netherlands)

    Powell, T.E.

    2017-01-01

    Visuals in news media play a vital role in framing citizens’ political preferences. Yet, compared to the written word, visual images are undervalued in political communication research. Using framing theory, this thesis redresses the balance by studying the combined, or multimodal, effects of visual

  2. Immunotherapy in multimodality treatment

    International Nuclear Information System (INIS)

    Anon.

    1989-01-01

    Application of immunotherapy for treatment of oncologic patients is considered. Monoclonal antibodies (MCA) are used for immunotherapy both independently and as carriers of various toxins, chemopreparations and radioactive isotopes. It is shown that immunotherapy should be considered as one of additional methods of multimodulity treatment of patients with malignant tumors

  3. [Chronic pain patients' readiness to change after multimodal treatment. Short- and long-term effects].

    Science.gov (United States)

    Küchler, A; Sabatowski, R; Kaiser, U

    2012-12-01

    Patients' readiness to behavioural changes according to the transtheoretical model (TTM) and criteria of treatment outcome are positively associated and have in part already been confirmed. For a stable effect of therapeutic treatment, patients' readiness to change seems indispensable for an independent and active pain management. Thus, in addition to an enhanced quality of life, increasing patients' motivation is a declared objective of the treatment at Dresden's Comprehensive Pain Center. In this study, it was examined how the readiness to change develops in the course of and during the 2 years following the multimodal treatment program. Furthermore, associations between outcome criteria of the treatment and patients' readiness to change were explored. The database constitutes 169 patients who took part in a 4-week interdisciplinary, partially residential pain treatment. Beside the Freiburg Pain Stages questionnaire ("Frieburger Fragebogen - Stadien der Bewältigung chronischer Schmerzen", FF-STABS), a comprehensive pain diagnostic inventory including the Pain Disability Index (PDI), the SF-36 questionnaire, and the Hospital Anxiety and Depression Scale (HADS) was completed at six different time points (beginning of treatment, end of treatment, booster session after 10 weeks, after 6, 12, and 24 months). The statistical analyses were performed with SPSS 16.0 including nonparametric analyses and variance analyses. Significant differences in the level of readiness to change between the beginning of treatment and all follow-up measures were observed. The average patients' readiness to change was still higher after 2 years than at the first measurement. However, a differentiated consideration revealed a small portion of patients who showed no change or even a reduction of motivation. After an additional week (booster session), the stages of readiness to change remained stable, irrespective of the direction of the previous change. Regarding therapeutic outcome

  4. Multimodal treatment for unresectable pancreatic cancer

    International Nuclear Information System (INIS)

    Katayama, Kanji; Iida, Atsushi; Fujita, Takashi; Kobayashi, Taizo; Shinmoto, Syuichi; Hirose, Kazuo; Yamaguchi, Akio; Yoshida, Masanori

    1998-01-01

    In order to improve in prognosis and quality of life (QOL), the multimodal treatment for unresectable pancreatic cancers were performed. Bypass surgery was carried out for unresectable pancreatic cancer with intraoperative irradiation (IOR). After surgery, patients were treated with the combination of CDDP (25 mg) and MMC (4 mg) administration, intravenously continuous injection of 5-FU (250 mg for 24 hours), external radiation by the high voltage X-ray (1.5 Gy per irradiation, 4 times a week, and during hyperthermia 3 Gy per irradiation) and hyperthermia using the Thermotron RF-8 warmer. Six out of 13 patients received hyperthermia at over 40degC, were obtained PR, and their survival periods were 22, 21, 19, 18, 11 and 8 months and they could return to work. For all patients with pain, the symptom was abolished or reduced. The survival periods in cases of the multimodal treatment were longer than those of only bypass-surgery or of the resective cases with the curability C. The multimodal treatment combined with radiation, hyperthermia and surgery is more useful for the removal of pain and the improvement of QOL, and also expected the improvement of the prognosis than pancreatectomy. And hyperthermia has an important role on the effect of this treatment. (K.H.)

  5. Multimodal treatment for unresectable pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Katayama, Kanji; Iida, Atsushi; Fujita, Takashi; Kobayashi, Taizo; Shinmoto, Syuichi; Hirose, Kazuo; Yamaguchi, Akio; Yoshida, Masanori [Fukui Medical School, Matsuoka (Japan)

    1998-07-01

    In order to improve in prognosis and quality of life (QOL), the multimodal treatment for unresectable pancreatic cancers were performed. Bypass surgery was carried out for unresectable pancreatic cancer with intraoperative irradiation (IOR). After surgery, patients were treated with the combination of CDDP (25 mg) and MMC (4 mg) administration, intravenously continuous injection of 5-FU (250 mg for 24 hours), external radiation by the high voltage X-ray (1.5 Gy per irradiation, 4 times a week, and during hyperthermia 3 Gy per irradiation) and hyperthermia using the Thermotron RF-8 warmer. Six out of 13 patients received hyperthermia at over 40degC, were obtained PR, and their survival periods were 22, 21, 19, 18, 11 and 8 months and they could return to work. For all patients with pain, the symptom was abolished or reduced. The survival periods in cases of the multimodal treatment were longer than those of only bypass-surgery or of the resective cases with the curability C. The multimodal treatment combined with radiation, hyperthermia and surgery is more useful for the removal of pain and the improvement of QOL, and also expected the improvement of the prognosis than pancreatectomy. And hyperthermia has an important role on the effect of this treatment. (K.H.)

  6. Effects on functional outcome after IORT-containing multimodality treatment for locally advanced primary and locally recurrent rectal cancer

    NARCIS (Netherlands)

    Mannaerts, GHH; Rutten, HJT; Martijn, H; Hanssens, PEJ; Wiggers, T

    2002-01-01

    Purpose: In the treatment of patients with locally advanced primary or locally recurrent rectal cancer, much attention is focused on. the oncologic outcome. Little is known about the functional outcome. In this study, the functional outcome after a multimodality treatment for locally advanced

  7. Effectiveness of a multimodal inpatient treatment for adolescents with anorexia nervosa in comparison with adults: an analysis of a specialized inpatient setting : treatment of adolescent and adult anorexics.

    Science.gov (United States)

    Naab, Silke; Schlegl, Sandra; Korte, Alexander; Heuser, Joerg; Fumi, Markus; Fichter, Manfred; Cuntz, Ulrich; Voderholzer, Ulrich

    2013-06-01

    There is evidence for an increased prevalence and an earlier onset of anorexia nervosa (AN) in adolescents. Early specialized treatment may improve prognosis and decrease the risk of a chronic course. The current study evaluates the effectiveness of a multimodal inpatient treatment for adolescent AN patients treated in a highly specialized eating disorder unit for adults. 177 adolescents and 1,064 adult patients were included. The evaluation focused on eating behavior, depressive symptoms and general psychopathology. All measured variables decreased significantly in both groups during inpatient treatment. No differences were found concerning weight gain, improvement of global eating disorder symptomatology as well as depressive symptoms. However, adults showed a higher psychological distress and in this regard also a greater improvement. Results indicate that treating adolescent AN patients in a highly specialized eating disorder unit for adults can be an effective treatment setting for these patients.

  8. The multimodal treatment of eating disorders

    OpenAIRE

    HALMI, KATHERINE A.

    2005-01-01

    The treatment of eating disorders is based on a multimodal model, recognizing that these disorders do not have a single cause or a predictable course. The treatment strategy is determined by the severity of illness and the specific eating disorder diagnosis. For the treatment of anorexia nervosa, the key elements are medical management, behavioral therapy, cognitive therapy and family therapy, while pharmacotherapy is at best an adjunct to other therapies. In bulimia nervosa...

  9. Multimodal treatment for resectable esophageal cancer

    International Nuclear Information System (INIS)

    Miyata, Hiroshi; Yamasaki, Makoto; Kurokawa, Yukinori; Takiguchi, Shuji; Nakajima, Kiyokazu; Fujiwara, Yoshiyuki; Mori, Masaki; Doki, Yuichiro

    2011-01-01

    Surgical resection has been traditionally the mainstay of treatment for localized esophageal cancers. However, survival after surgery alone for advanced esophageal cancer is not satisfactory. In Japan, the development of multimodal therapy for esophageal cancers has centered mainly on systemic chemotherapy plus surgery to control distant metastasis. Based on the results of the recent Japan Clinical Oncology Group (JCOG) 9907 study, preoperative chemotherapy (consisting of 5-fluorouracil (FU) and cisplatin) followed by surgery has emerged as the standard treatment. In Western countries, where chemoradiotherapy followed by surgery has been mainly explored for patients with resectable esophageal cancers, two large controlled trials that evaluated the effectiveness of preoperative chemotherapy reported conflicting results. However, a recent meta-analysis reported significant survival benefits for preoperative chemotherapy in patients with adenocarcinoma of the esophagus. We need to find new effective preoperative chemotherapeutic regimens, including molecular target agents, with response rates higher than that of the conventional chemotherapy of 5-FU and cisplatin. However, we also must compare the survival benefits of preoperative chemotherapy with preoperative chemoradiotherapy. (author)

  10. Effective multimodality treatment for advanced epidermoid carcinoma of the female genital tract

    International Nuclear Information System (INIS)

    Kalra, J.; Cortes, E.; Chen, S.; Krumholz, B.; Rovinsky, J.J.; Molho, L.; Seltzer, V.; Papantoniou, P.; Lee, J.Y.

    1985-01-01

    Fifteen patients with advanced or recurrent squamous-cell carcinoma of the cervix, vulva, vagina, and urethra were treated with simultaneous combination chemotherapy (5-fluorouracil infusion and mitomycin C) and radiotherapy (3,000 rad for a period of three weeks). Three to four weeks after completion of radiotherapy, 13 of 15 patients achieved partial or complete tumor shrinkage. Nine of 15 patients are alive, eight of whom (at a median follow-up time of 24 months) have no evidence of disease. The longest survival time was 45 + months. There was minimal toxicity associated with this therapy. The results of this pilot study suggest that the simultaneous administration of radiation and chemotherapy is an effective method of treatment of advanced female genital tract carcinoma

  11. Patterns of failure after multimodal treatments for high-grade glioma: effectiveness of MIB-1 labeling index

    International Nuclear Information System (INIS)

    Uehara, Kazuyuki; Fujii, Osamu; Soejima, Toshinori; Sugimura, Kazuro; Kohmura, Eiji; Sasaki, Ryohei; Sasayama, Takashi; Miyawaki, Daisuke; Nishimura, Hideki; Yoshida, Kenji; Okamoto, Yoshiaki; Mukumoto, Naritoshi; Akasaka, Hiroaki; Nishihara, Masamitsu

    2012-01-01

    The purpose of the present study was to analyze the recurrence pattern of high-grade glioma treated with a multimodal treatment approach and to evaluate whether the MIB-1 labeling index (LI) could be a useful marker for predicting the pattern of failure in glioblastoma (GB). We evaluated histologically confirmed 131 patients with either anaplastic astrocytoma (AA) or GB. A median dose was 60 Gy. Concomitant and adjuvant chemotherapy were administered to 111 patients. MIB-1 LI was assessed by immunohistochemistry. Recurrence patterns were categorized according to the areas of recurrence as follows: central failure (recurrence in the 95% of 60 Gy); in-field (recurrence in the high-dose volume of 50 Gy; marginal (recurrence outside the high-dose volume) and distant (recurrence outside the RT field). The median follow-up durations were 13 months for all patients and 19 months for those remaining alive. Among AA patients, the 2-year progression-free and overall survival rates were 23.1% and 39.2%, respectively, while in GB patients, the rates were 13.3% and 27.6%, respectively. The median survival time was 20 months for AA patients and 15 months for GB patients. Among AA patients, recurrences were central in 68.7% of patients; in-field, 18.8%; and distant, 12.5%, while among GB patients, 69.0% of recurrences were central, 15.5% were in-field, 12.1% were marginal, and 3.4% were distant. The MIB-1 LI medians were 18.2% in AA and 29.8% in GB. Interestingly, in patients with GB, the MIB-1 LI had a strong effect on the pattern of failure (P = 0.014), while the extent of surgical removal (P = 0.47) and regimens of chemotherapy (P = 0.57) did not. MIB-1 LI predominantly affected the pattern of failure in GB patients treated with a multimodal approach, and it might be a useful tool for the management of the disease

  12. Improving treatment planning accuracy through multimodality imaging

    International Nuclear Information System (INIS)

    Sailer, Scott L.; Rosenman, Julian G.; Soltys, Mitchel; Cullip, Tim J.; Chen, Jun

    1996-01-01

    Purpose: In clinical practice, physicians are constantly comparing multiple images taken at various times during the patient's treatment course. One goal of such a comparison is to accurately define the gross tumor volume (GTV). The introduction of three-dimensional treatment planning has greatly enhanced the ability to define the GTV, but there are times when the GTV is not visible on the treatment-planning computed tomography (CT) scan. We have modified our treatment-planning software to allow for interactive display of multiple, registered images that enhance the physician's ability to accurately determine the GTV. Methods and Materials: Images are registered using interactive tools developed at the University of North Carolina at Chapel Hill (UNC). Automated methods are also available. Images registered with the treatment-planning CT scan are digitized from film. After a physician has approved the registration, the registered images are made available to the treatment-planning software. Structures and volumes of interest are contoured on all images. In the beam's eye view, wire loop representations of these structures can be visualized from all image types simultaneously. Each registered image can be seamlessly viewed during the treatment-planning process, and all contours from all image types can be seen on any registered image. A beam may, therefore, be designed based on any contour. Results: Nineteen patients have been planned and treated using multimodality imaging from November 1993 through August 1994. All registered images were digitized from film, and many were from outside institutions. Brain has been the most common site (12), but the techniques of registration and image display have also been used for the thorax (4), abdomen (2), and extremity (1). The registered image has been an magnetic resonance (MR) scan in 15 cases and a diagnostic CT scan in 5 cases. In one case, sequential MRs, one before treatment and another after 30 Gy, were used to plan

  13. Radioactive EGFR Antibody Cetuximab in Multimodal Cancer Treatment: Stability and Synergistic Effects With Radiotherapy

    International Nuclear Information System (INIS)

    Rades, Dirk; Wolff, Christian; Nadrowitz, Roger; Breunig, Christian; Schild, Steven E.; Baehre, Manfred; Meller, Birgit

    2009-01-01

    Purpose: Systemic therapies when added to whole brain radiotherapy have failed to improve the survival of patients with multiple brain metastases. The epidermal growth factor receptor antibody cetuximab is an attractive option, if it is able to cross the blood-brain barrier. This might be proven with molecular imaging if the radiolabeled antibody is stable long enough to be effective. This study investigated the stability of radiolabeled cetuximab (Erbitux) ( 131 I-Erbi) and potential synergistic effects with radiotherapy in vitro. Methods and Materials: Two cell lines were investigated, A431 with numerous epidermal growth factor receptors, and JIMT without epidermal growth factor receptors. We labeled 0.4 mg cetuximab with 50 MBq of [ 131 I] iodide. Stability was determined for 72 h. The cell cultures were incubated with 131 I-Erbi or cold cetuximab for 72 h. Uptake and cell proliferation were measured every 24 h after no radiotherapy or irradiation with 2, 4, or 10 Gy. Results: The radiolabeling yield of 131 I-Erbi was always >80%. The radiochemical purity was still 93.6% after 72 h. A431 cells showed a 131 I-Erbi uptake about 100-fold greater than the JIMT controls. After 48 h, the A431 cultures showed significantly decreased proliferation. At 72 h after irradiation, 131 I-Erbi resulted in more pronounced inhibition of cell proliferation than the cold antibody in all radiation dose groups. Conclusion: 131 I-Erbi was stable for ≤72 h. Radiotherapy led to increased tumor cell uptake of 131 I-Erbi. Radiotherapy and 131 I-Erbi synergistically inhibited tumor cell proliferation. These results provide the prerequisite data for a planned in vivo study of whole brain radiotherapy plus cetuximab for brain metastases.

  14. Effects on functional outcome after IORT-containing multimodality treatment for locally advanced primary and locally recurrent rectal cancer

    International Nuclear Information System (INIS)

    Mannaerts, Guido H.H.; Rutten, Harm J.T.; Martijn, Hendrik; Hanssens, Patrick E.J.; Wiggers, Theo

    2002-01-01

    Purpose: In the treatment of patients with locally advanced primary or locally recurrent rectal cancer, much attention is focused on the oncologic outcome. Little is known about the functional outcome. In this study, the functional outcome after a multimodality treatment for locally advanced primary and locally recurrent rectal cancer is analyzed. Methods and Materials: Between 1994 and 1999, 55 patients with locally advanced primary and 66 patients with locally recurrent rectal cancer were treated with high-dose preoperative external beam irradiation, followed by extended surgery and intraoperative radiotherapy. To assess long-term functional outcome, all patients still alive (n = 97) were asked to complete a questionnaire regarding ongoing morbidity, as well as functional and social impairment. Seventy-six of the 79 patients (96%) returned the questionnaire. The median follow-up was 14 months (range: 4-60 months). Results: The questionnaire revealed fatigue in 44%, perineal pain in 42%, radiating pain in the leg(s) in 21%, walking difficulties in 36%, and voiding dysfunction in 42% of the patients as symptoms of ongoing morbidity. Functional impairment consisted of requiring help with basic activities in 15% and sexual inactivity in 56% of the respondents. Social handicap was demonstrated by loss of former lifestyle in 44% and loss of professional occupation in 40% of patients. Conclusions: As a result of multimodality treatment, the majority of these patients have to deal with long-term physical morbidity, the need for help with daily care, and considerable social impairment. These consequences must be weighed against the chance of cure if the patient is treated and the disability eventually caused by uncontrolled tumor progression if the patient is not treated. These potential drawbacks should be discussed with the patient preoperatively and taken into account when designing a treatment strategy

  15. ADHD, Multimodal Treatment, and Longitudinal Outcome: Evidence, Paradox, and Challenge.

    Science.gov (United States)

    Hinshaw, Stephen P; Arnold, L Eugene

    2015-01-01

    Given major increases in the diagnosis of attention-deficit hyperactivity disorder (ADHD) and in rates of medication for this condition, we carefully examine evidence for effects of single versus multimodal (i.e., combined medication and psychosocial/behavioral) interventions for ADHD. Our primary data source is the Multimodal Treatment Study of Children with ADHD (MTA), a 14-month, randomized clinical trial in which intensive behavioral, medication, and multimodal treatment arms were contrasted with one another and with community intervention (treatment-as-usual), regarding outcome domains of ADHD symptoms, comorbidities, and core functional impairments. Although initial reports emphasized the superiority of well-monitored medication for symptomatic improvement, reanalyses and reappraisals have highlighted (a) the superiority of combination treatment for composite outcomes and for domains of functional impairment (e.g., academic achievement, social skills, parenting practices); (b) the importance of considering moderator and mediator processes underlying differential patterns of outcome, including comorbid subgroups and improvements in family discipline style during the intervention period; (c) the emergence of side effects (e.g., mild growth suppression) in youth treated with long-term medication; and (d) the diminution of medication's initial superiority once the randomly assigned treatment phase turned into naturalistic follow-up. The key paradox is that whereas ADHD clearly responds to medication and behavioral treatment in the short term, evidence for long-term effectiveness remains elusive. We close with discussion of future directions and a call for greater understanding of relevant developmental processes in the attempt to promote optimal, generalized, and lasting treatments for this important and impairing neurodevelopmental disorder.

  16. Manual Therapy, Therapeutic Patient Education, and Therapeutic Exercise, an Effective Multimodal Treatment of Nonspecific Chronic Neck Pain: A Randomized Controlled Trial.

    Science.gov (United States)

    Beltran-Alacreu, Hector; López-de-Uralde-Villanueva, Ibai; Fernández-Carnero, Josué; La Touche, Roy

    2015-10-01

    The aim of this study was to determine the effectiveness of a multimodal treatment in the short and medium term for disability in nonspecific chronic neck pain. The design of this study is a single-blinded randomized controlled trial carried out in a university research laboratory. Forty-five patients between 18 and 65 yrs with nonspecific chronic neck pain were included in this study. Each patient was treated eight times over a 4-wk period. The sample was divided into three groups: control group, subjected to a protocol of manual therapy; experimental group 1, subjected to a protocol of manual therapy and therapeutic patient education; and experimental group 2, subjected to manual therapy, therapeutic patient education, and a therapeutic exercise protocol. Assessments were performed at baseline and at 4, 8, and 16 wks using the following measurements: the Neck Disability Index, the 11-item Tampa Scale of Kinesiophobia, the Fear Avoidance Beliefs Questionnaire, the Neck Flexor Muscle Endurance Test, and the Visual Analog Fatigue Scale. The nonparametric Kruskal-Wallis test for the Neck Disability Index showed statistically significant differences between baseline outcomes and all follow-up periods (P Kruskal-Wallis test, differences were found for the Visual Analog Fatigue Scale and the Neck Flexor Muscle Endurance Test in the follow-ups at 8 and 16 wks (P < 0.05). Analysis of variance for group × time interaction showed statistically significant changes (Tampa Scale of Kinesiophobia, F = 3.613, P = 0.005; Fear Avoidance Beliefs Questionnaire, F = 2.803, P = 0.022). Minimal detectable changes were obtained in both experimental groups for the 11-item Tampa Scale of Kinesiophobia but not in the control group. Differences between experimental groups and the control group were found in the short and medium term. A multimodal treatment is a good method for reducing disability in patients with nonspecific chronic neck pain in the short and medium term.

  17. Multimodality treatment including postoperative radiation and concurrent chemotherapy with weekly docetaxel is feasible and effective in patients with oral and oropharyngeal cancer

    International Nuclear Information System (INIS)

    Kovacs, A.F.; Bitter, K.; Mose, S.; Boettcher, H.D.

    2005-01-01

    Background: to examine the feasibility and efficacy of weekly docetaxel with concurrent radiation as postoperative treatment in a multimodality approach to oral and oropharyngeal cancer. Patients and methods: 94 patients (Table 1) with primary resectable squamous cell carcinoma of the oral cavity and oropharynx (UICC stage I 14%, II 15%, III 18%, IV 53%; Table 2) were treated with a multimodality therapy program consisting of neoadjuvant intra-arterial high-dose chemotherapy (cisplatin 150 mg/m 2 with parallel systemic sodium thiosulfate 9 g/m 2 for neutralization), followed by surgery of the primary and neck, and postoperative concurrent radiation and chemotherapy with weekly docetaxel (20-30 mg/m 2 ; Table 3). Chronic toxicities were followed over a period of 5 years. Results: at a median follow-up of 4 years, the 5-year survival rate for all 94 patients was 80%, and disease-free survival was 73% (Figures 1 and 2). Among patients with advanced disease (stage III and IV), survival was 83 and 59%, respectively (Figure 4). Grade 3 and 4 mucositis was the main acute toxicity necessitating supportive care. Long-term toxicity appears to be moderate (Table 4). The maximum tolerated dose of weekly docetaxel was 25 mg/m 2 . Conclusions: concurrent radiation and chemotherapy with weekly docetaxel is a feasible postoperative treatment in a multimodality approach to oral and oropharyngeal cancer, resulting in high overall and disease-free survival. This approach warrants further evaluation in prospective randomized trials. (orig.)

  18. Multimodality

    DEFF Research Database (Denmark)

    Buhl, Mie

    2010-01-01

    In this paper, I address an ongoing discussion in Danish E-learning research about how to take advantage of the fact that digital media facilitate other communication forms than text, so-called ‘multimodal' communication, which should not be confused with the term ‘multimedia'. While multimedia...... on their teaching and learning situations. The choices they make involve e-learning resources like videos, social platforms and mobile devices, not just as digital artefacts we interact with, but the entire practice of using digital media. In a life-long learning perspective, multimodality is potentially very...

  19. Systemic multimodal approach to speech therapy treatment in autistic children.

    Science.gov (United States)

    Tamas, Daniela; Marković, Slavica; Milankov, Vesela

    2013-01-01

    Conditions in which speech therapy treatment is applied in autistic children are often not in accordance with characteristics of opinions and learning of people with autism. A systemic multimodal approach means motivating autistic people to develop their language speech skill through the procedure which allows reliving of their personal experience according to the contents that are presented in the their natural social environment. This research was aimed at evaluating the efficiency of speech treatment based on the systemic multimodal approach to the work with autistic children. The study sample consisted of 34 children, aged from 8 to 16 years, diagnosed to have different autistic disorders, whose results showed a moderate and severe clinical picture of autism on the Childhood Autism Rating Scale. The applied instruments for the evaluation of ability were the Childhood Autism Rating Scale and Ganzberg II test. The study subjects were divided into two groups according to the type of treatment: children who were covered by the continuing treatment and systemic multimodal approach in the treatment, and children who were covered by classical speech treatment. It is shown that the systemic multimodal approach in teaching autistic children affects the stimulation of communication, socialization, self-service and work as well as that the progress achieved in these areas of functioning was retainable after long time, too. By applying the systemic multimodal approach when dealing with autistic children and by comparing their achievements on tests applied before, during and after the application of this mode, it has been concluded that certain improvement has been achieved in the functionality within the diagnosed category. The results point to a possible direction in the creation of new methods, plans and programs in dealing with autistic children based on empirical and interactive learning.

  20. Multimodal treatment of hepatocellular carcinoma: an eastern European experience.

    Science.gov (United States)

    Dima, Simona Olimpia; Iacob, Speranţa; Botea, Florin; Matei, Emil; Dorobanfu, Bogdan; Vasile, Serban; Alexandrescu, Sorin; Croitoru, Adina; Dumitrascu, Traian; Stroescu, Cezar; Herlea, Vlad; Popescu, Irinel

    2009-01-01

    The aim of the present study was to evaluate the outcomes of a multimodal treatment approach of hepatocellular carcinoma (HCC) in a tertiary hepatobiliary specialty center. A total of 294 consecutive patients treated for HCC were retrospectively analyzed. Two hundred sixteen patients (73.4%) were men and 78 (26.6%) were women. Liver resection (LR) was performed in 201 patients (68.4%), liver transplantation (LT) in 19 patients (6.5%), radiofrequency ablation (RFA) in 74 patients (25.1%), and 56 (19%) patients received adjuvant systemic chemotherapy. The median follow-up was 15.7 mo (range 0.1-90.3). Five-year overall survival and recurrence rates were 28% and 26.8%, respectively. Serum AFP > 43.8ng/ml (p = 0.005), BCLC C/D (p = 0.006) and JIS 3/4/5 classifications (p = 0.02) were independent negative prognostic factors for overall survival, while JIS 3/4/5 (p = 0.01) and BCLC C/D (p = 0.01) classifications, tumors larger than 6.5cm (p = 0.001) and RFA (p = 0.02) were independent predictors for recurrence. The current treatment of HCC should be multimodal, and therapeutic modalities and their combinations should be tailored to each patient. LT represents the best therapeutic option for patients with HCC in the setting of cirrhosis. Resection remains a good option in cirrhotic patients, while RFA is a safe and effective procedure for small tumors.

  1. Multimodality treatment strategies have changed prognosis of peritoneal metastases

    Science.gov (United States)

    Lungoci, Corneliu; Mironiuc, Aurel Ion; Muntean, Valentin; Oniu, Traian; Leebmann, Hubert; Mayr, Max; Piso, Pompiliu

    2016-01-01

    For a long time, treatment of peritoneal metastases (PM) was mostly palliative and thus, this status was link with “terminal status/despair”. The current multimodal treatment strategy, consisting of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), has been strenuously achieved over time, but seems to be the best treatment option for PM patients. As we reviewed the literature data, we could emphasize some milestones and also, controversies in the history of proposed multimodal treatment and thus, outline the philosophy of this approach, which seems to be an unusual one indeed. Initially marked by nihilism and fear, but benefiting from a remarkable joint effort of human and material resources (multi-center and -institutional research), over a period of 30 years, CRS and HIPEC found their place in the treatment of PM. The next 4 years were dedicated to the refinement of the multimodal treatment, by launching research pathways. In selected patients, with requires training, it demonstrated a significant survival results (similar to the Hepatic Metastases treatment), with acceptable risks and costs. The main debates regarding CRS and HIPEC treatment were based on the oncologists’ perspective and the small number of randomized clinical trials. It is important to statement the PM patient has the right to be informed of the existence of CRS and HIPEC, as a real treatment resource, the decision being made by multidisciplinary teams. PMID:26798438

  2. Chemotherapy in combined and multimodality treatment

    International Nuclear Information System (INIS)

    Anon.

    1989-01-01

    It is shown that chemotherapy of tumors of various localizations developes intensively in the last few years. It is connected with discovery and adoption of new active antitumoral preparations, such as alkylating preparations, antimetabolites, antitumoral antibiotics, hormonal preparations. To create the rational effective conditions of chemotherapy a study was made on kinetics of tumor gowth, molecular mechanisms of interaction of cytostatics and cells of malignant tumor. Main factors of chemotherapy combination with radiotherapy when treating numerous malignant tumors were considered. Effectiveness of using chemotherapy in combination with other methods of treatment was shown

  3. Neurofeedback and multimodal treatment of ADHD

    Directory of Open Access Journals (Sweden)

    Artur Kołakowski

    2012-03-01

    Full Text Available The attention‑deficit/hyperactivity disorder belongs to the most frequently diagnosed psychological (psychiatric disorders in childhood. It is characterized by the presence of fixed behaviour patterns maintained for at least 6 months and forming a characteristic triad of symptoms, such as inattention, impulsivity and hyperactivity, increased to the extent incommensurable to the child’s age and development level. Most of the guidelines on han‑ dling the ADHD suggest using non‑pharmacological methods and only when these appear ineffective, considering inclusion of pharmacological treatment. On the other hand, the studies indicate that most effective in ADHD treat‑ ment is the pharmacological treatment. It is worth emphasizing, however, that none of the presently available treat‑ ment methods solves all problems of the child’s functioning, therefore there is a constant demand for searching new ways of help for the ADHD‑affected children. One of the investigated methods is neurobiofeedback (NF. In this method, teaching the patient to influence the brain activity through instructing her/him on how to change the type of waves in the EEG – is to improve her/his functioning. In the problem described in the article an improvement in the EEG (achieved during exercise is to reduce the ADHD symptoms. But a survey of the existing research does not give an explicit answer whether or not this method is effective in ADHD treatment to the extent which could improve the patient’s functioning in real life. It is worth noting that as for now none of the guidelines has pointed to neurobiofeedback as a method recommended in the treatment of ADHD. Concluding, up to date we have not had any evidence that NF may constitute an independent or leading therapy in ADHD; we need further studies to spec‑ ify whether or not this is a method which could be a part of a comprehensive therapeutic program of the child with ADHD. Presently, it is treated rather

  4. Multimodality

    DEFF Research Database (Denmark)

    Buhl, Mie

    In this paper, I address an ongoing discussion in Danish E-learning research about how to take advantage of the fact that digital media facilitate other communication forms than text, so-called ‘multimodal’ communication, which should not be confused with the term ‘multimedia’. While multimedia...... and learning situations. The choices they make involve E-learning resources like videos, social platforms and mobile devices, not just as digital artefacts we interact with, but the entire practice of using digital media. In a life-long learning perspective, multimodality is potentially very useful...

  5. Cardiac risks in multimodal breast cancer treatment

    Energy Technology Data Exchange (ETDEWEB)

    Budach, W. [Dept. of Radiation Oncology, Univ. of Duesseldorf (Germany)

    2007-12-15

    Almost all breast cancer patients receive one or more adjuvant treatments consisting of tamoxifen, aromatase inhibitors, LHRH-antogonists, chemotherapy, trastuzumab, and radiotherapy. These treatments have been shown to considerably improve overall survival. As a result, long term survival for 15 and more years is achieved in more than two thirds of newly diagnosed breast cancer patients. Therefore, more interest in short and long term risks of adjuvant treatments has been arisen. The focus of this article is the long term cardiac risks of adjuvant radiotherapy in breast cancer patients and possible interactions with chemotherapy and trastuzumab. (orig.)

  6. Novel magnetic heating probe for multimodal cancer treatment.

    Science.gov (United States)

    Kan-Dapaah, Kwabena; Rahbar, Nima; Soboyejo, Wole

    2015-05-01

    Multifunctional materials consisting of polymers and magnetic nanoparticles (MNPs) are highly sought after in the field of biomedical engineering. These materials offer new opportunities for the development of novel cancer treatment modalities that can increase the efficacy of cancer therapy. In this paper, a novel probe for multimodal cancer treatment is proposed and analyzed. The probe is essentially a cannula with two main parts: a distal heat generating tip made of a magnetic nanocomposite and a proximal insulated shaft. A description of the concept and functional operations of the probe is presented. In an effort to assess its feasibility, the authors evaluated the ability of probe tip (made of PMMA-Fe3O4 nanocomposite) to generate heat in biological tissue using alternating magnetic field (AMF) parameters (field strength and frequency) that are acceptable for human use. Heat generation by MNPs was determined using the linear response theory. The effects of Fe3O4 volume fraction on heat generation as well as treatment time on the thermal dose were studied. The finite element method model was tested for its validity using an analytical model. Lesions were revealed to have an ellipsoidal shape and their sizes were affected by treatment time. However, their shapes remained unchanged. The comparison with the analytical model showed reasonably a good agreement to within 2%. Furthermore, the authors' numerical predictions also showed reasonable agreement with the experimental results previously reported in the literature. The authors' predictions demonstrate the feasibility of their novel probe to achieve reasonable lesion sizes, during hyperthermic or ablative heating using AMF parameters (field strength and frequency) that are acceptable for human use.

  7. Releasing the constraints on aphasia therapy: the positive impact of gesture and multimodality treatments.

    Science.gov (United States)

    Rose, Miranda L

    2013-05-01

    There is a 40-year history of interest in the use of arm and hand gestures in treatments that target the reduction of aphasic linguistic impairment and compensatory methods of communication (Rose, 2006). Arguments for constraining aphasia treatment to the verbal modality have arisen from proponents of constraint-induced aphasia therapy (Pulvermüller et al., 2001). Confusion exists concerning the role of nonverbal treatments in treating people with aphasia. The central argument of this paper is that given the state of the empirical evidence and the strong theoretical accounts of modality interactions in human communication, gesture-based and multimodality aphasia treatments are at least as legitimate an option as constraint-based aphasia treatment. Theoretical accounts of modality interactions in human communication and the gesture production abilities of individuals with aphasia that are harnessed in treatments are reviewed. The negative effects on word retrieval of restricting gesture production are also reviewed, and an overview of the neurological architecture subserving language processing is provided as rationale for multimodality treatments. The evidence for constrained and unconstrained treatments is critically reviewed. Together, these data suggest that constraint treatments and multimodality treatments are equally efficacious, and there is limited support for constraining client responses to the spoken modality.

  8. MINERVA - a multi-modal radiation treatment planning system

    Energy Technology Data Exchange (ETDEWEB)

    Wemple, C.A. E-mail: cew@enel.gov; Wessol, D.E.; Nigg, D.W.; Cogliati, J.J.; Milvich, M.L.; Frederickson, C.; Perkins, M.; Harkin, G.J

    2004-11-01

    Researchers at the Idaho National Engineering and Environmental Laboratory and Montana State University have undertaken development of MINERVA, a patient-centric, multi-modal, radiation treatment planning system. This system can be used for planning and analyzing several radiotherapy modalities, either singly or combined, using common modality independent image and geometry construction and dose reporting and guiding. It employs an integrated, lightweight plugin architecture to accommodate multi-modal treatment planning using standard interface components. The MINERVA design also facilitates the future integration of improved planning technologies. The code is being developed with the Java Virtual Machine for interoperability. A full computation path has been established for molecular targeted radiotherapy treatment planning, with the associated transport plugin developed by researchers at the Lawrence Livermore National Laboratory. Development of the neutron transport plugin module is proceeding rapidly, with completion expected later this year. Future development efforts will include development of deformable registration methods, improved segmentation methods for patient model definition, and three-dimensional visualization of the patient images, geometry, and dose data. Transport and source plugins will be created for additional treatment modalities, including brachytherapy, external beam proton radiotherapy, and the EGSnrc/BEAMnrc codes for external beam photon and electron radiotherapy.

  9. 超激光疗法在骨科术后多模式镇痛的临床应用分析%Multimodal effect of ultra laser treatment on theperioperative analgesia in orthopaedic surgery

    Institute of Scientific and Technical Information of China (English)

    覃旭; 赵新

    2013-01-01

    Objective To investigate the ultra laser treatment ( physical therapy ) on orthopaedic postoperative pain suppression of synergies. Methods 60 cases of postoperative orthopedic patients were randomly divided into multimodal analgesia group ( experimental group) and group PCA (control group ) , the experimental group patients after the use of laser therapy, the ? control group patients not using other physical factors of analgesia. Using a visual analogue pain scale method ( VAS) were performed after 4 to 48 hours each time on patients with pain score, statistically analyses of variance. Results using the ultra laser treatment of multimodal analgesia in postoperative except 4h and 8h two time periods and epidural analgesia effect is better than that of control group. Conclusion Laser in postoperative analgesia after orthopedic surgery have obvious synergistic effect, with fast, efficient, spasmolytic analgesic effect. The therapeutic mechanism and mode of physical therapy of multimodal analgesia remains to be further investigated.%目的 探讨超激光疗法(物理因子疗法)时骨科术后疼痛抑制的协同作用.方法 选取60例骨科术后患者随机分为多模式镇痛组(实验组)和PCA组(对照组),对照组术后使用一次性静脉微量镇痛泵,实验组在对照组的基础上加用超激光治疗,采用视觉模拟疼痛标尺法(VAS)分别于术后分时点对患者做疼痛评分.结果 术后4h、8h两组评分差异无统计学意义,其余时点实验组评分低于对照组.结论 超激光在骨科术后镇痛有明显协同效应.

  10. Multimodal non-surgical treatment of a feline tracheal adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Carolina Azevedo

    2017-02-01

    Full Text Available Case summary A 10-year-old, castrated male domestic shorthair cat presented with a 2–3 month history of weight loss, lethargy and coughing. Thoracic radiographs revealed a soft tissue opacity overlying the dorsal trachea from the first rib to second rib and the ventral aspect of the trachea extending from the second rib to approximately the fourth rib. CT confirmed a mass involving the dorsal, right lateral and ventral aspects of the trachea narrowing the lumen and extending from vertebra C7 through T4. Bronchoscopy revealed a partially circumferential irregular and multilobulated tracheal mass, which was biopsied. The histopathological diagnosis was tracheal adenocarcinoma. The cat was treated with a definitive course of external beam radiation therapy (RT; 3 Gy × 18, cytotoxic chemotherapy, a tyrosine kinase inhibitor and palliative RT. The cat remained asymptomatic for 2 months and the mass remained stable radiographically for 11 months after RT. Relevance and novel information With multimodal treatment the cat had a survival time of 755 days. Initial treatment included definitive RT, carboplatin and piroxicam, followed by toceranib phosphate and palliative RT when the mass recurred. This case report describes the first documented use of non-surgical treatment and long-term outcome of tracheal adenocarcinoma in a cat. This case report is an indication that prolonged survival can be achieved with multimodal therapy.

  11. Multimodal compared to pharmacologic treatments for chronic tension-type headache in adolescents.

    Science.gov (United States)

    Przekop, Peter; Przekop, Allison; Haviland, Mark G

    2016-10-01

    Chronic tension-type headache (CTTH) in children and adolescents is a serious medical condition, with considerable morbidity and few effective, evidence-based treatments. We performed a chart review of 83 adolescents (age range = 13-18 years; 67 girls and 16 boys) diagnosed with CTTH. Two treatment protocols were compared: multimodal (osteopathic manipulative treatments, mindfulness, and qi gong) and pharmacologic (amitriptyline or gabapentin). Four outcomes (headache frequency, pain intensity, general health, and health interference) were assessed at three time points (baseline, 3 months, and 6 months). A fifth outcome, number of bilateral tender points, was recorded at baseline and 6 months. All five were evaluated statistically with a linear mixed model. Although both multimodal and pharmacologic treatments were effective for CTTH (time effects for all measures were significant at p treatment (the five group by time interaction effects were significant at or below the p Headache frequency in the pharmacologic group, for example, reduced from a monthly average (95% Confidence Interval shown in parentheses) of 23.9 (21.8, 26.0) to 16.4 (14.3, 18.6) and in the multimodal group from 22.3 (20.1, 24.5) to 4.9 (2.6, 7.2) (a substantial group difference). Pain intensity (worst in the last 24 hours, 0-10 scale) was reduced in the pharmacologic group from 6.2 (5.6, 6.9) to 3.4 (2.7, 4.1) and from 6.1 (5.4, 6.8) to 2.0 (1.2, 2.7) in the multimodal group (a less substantial difference). Across the other three assessments, group differences were larger for general health and number of tender points and less so for pain restriction. Multimodal treatment for adolescent CTTH appears to be effective. Randomized controlled trials are needed to confirm these promising results. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up.

    Science.gov (United States)

    Duric, Nezla S; Assmus, Jørg; Gundersen, Doris; Duric Golos, Alisa; Elgen, Irene B

    2017-07-01

    Different treatment approaches aimed at reducing attention-deficit/hyperactivity disorder (ADHD) core symptoms are available. However, factors such as intolerance, side-effects, lack of efficacy, high new technology costs, and placebo effect have spurred on an increasing interest in alternative or complementary treatment. The aim of this study is to explore efficacy of multimodal treatment consisting of standard stimulant medication (methylphenidate) and neurofeedback (NF) in combination, and to compare it with the single treatment in 6-month follow-up in ADHD children and adolescents. This randomized controlled trial with 6-month follow-up comprised three treatment arms: multimodal treatment (NF + MED), MED alone, and NF alone. A total of 130 ADHD children/adolescents participated, and 62% completed the study. ADHD core symptoms were recorded pre-/post-treatment, using parents' and teachers' forms taken from Barkley's Defiant Children: A Clinician's Manual for Assessment and Parent Training, and a self-report questionnaire. Significant ADHD core symptom improvements were reported 6 months after treatment completion by parents, teachers, and participants in all three groups, with marked improvement in inattention in all groups. However, no significant improvements in hyperactivity or academic performance were reported by teachers or self-reported by children/adolescents, respectively, in the three groups. Changes obtained with multimodal treatment at 6-month follow-up were comparable to those with single medication treatment, as reported by all participants. Multimodal treatment using combined stimulant medication and NF showed 6-month efficacy in ADHD treatment. More research is needed to explore whether multimodal treatment is suitable for ADHD children and adolescents who showed a poor response to single medication treatment, and for those who want to reduce the use of stimulant medication.

  13. Attention-deficit hyperactivity disorder, multimodal treatment, and longitudinal outcome: evidence, paradox, and challenge.

    Science.gov (United States)

    Hinshaw, Stephen P; Arnold, L Eugene

    2015-01-01

    Given major increases in the diagnosis of attention-deficit hyperactivity disorder (ADHD) and in rates of medication for this condition, we carefully examine evidence for effects of single versus multimodal (i.e., combined medication and psychosocial/behavioral) interventions for ADHD. Our primary data source is the Multimodal Treatment Study of Children with ADHD (MTA), a 14-month, randomized clinical trial in which intensive behavioral, medication, and multimodal treatment arms were contrasted with one another and with community intervention (treatment-as-usual), regarding outcome domains of ADHD symptoms, comorbidities, and core functional impairments. Although initial reports emphasized the superiority of well-monitored medication for symptomatic improvement, reanalyses and reappraisals have highlighted (1) the superiority of combination treatment for composite outcomes and for domains of functional impairment (e.g., academic achievement, social skills, parenting practices); (2) the importance of considering moderator and mediator processes underlying differential patterns of outcome, including comorbid subgroups and improvements in family discipline style during the intervention period; (3) the emergence of side effects (e.g., mild growth suppression) in youth treated with long-term medication; and (4) the diminution of medication's initial superiority once the randomly assigned treatment phase turned into naturalistic follow-up. The key paradox is that while ADHD clearly responds to medication and behavioral treatment in the short term, evidence for long-term effectiveness remains elusive. We close with discussion of future directions and a call for greater understanding of relevant developmental processes in the attempt to promote optimal, generalized, and lasting treatments for this important and impairing neurodevelopmental disorder. © 2014 John Wiley & Sons, Ltd.

  14. [Hypothyroidism incidence after multimodal treatment for laryngeal cancer].

    Science.gov (United States)

    Ortega-Gutiérrez, César; Luna-Ortiz, Kuauhyama; Villavicencio-Valencia, Verónica; Herrera Gómez, Angel; Téllez-Palacios, Daniela; Contreras-Buendía, Marlen

    2012-01-01

    Hypothyroidism following total laryngectomy or radiotherapy treatment for laryngeal cancer is not a rare event, especially in advanced stages. There are no reports on the incidence of hypothyroidism in patients who received chemotherapy and radiotherapy. The objective of this study is to determine the incidence of thyroid dysfunction in a group of patients with laryngeal cancer who underwent surgery as sole treatment, total laryngectomy or radiotherapy alone, and patients with combined treatment: surgery plus radiotherapy, concomitant chemoradiation therapy and chemoradiation therapy plus salvage surgery. A prospective study of patients diagnosed with laryngeal cancer whose serum TSH and T4 levels were evaluated in a serial fashion. 70 patients with laryngeal cancer were studied; the average age at diagnosis was 70.2 years. Male patients were more affected, with a men-women ratio of 3.6:1. Glottic localization was the most frequent (44%). 64% of tumors were locally advanced carcinomas and 51% received multimodal treatment. 45 patients (63%) were diagnosed with hypothyroidism; 49% of the patients with subclinical hypothyroidism, and 51% with clinical hypothyroidism. Hypothyroidism is a complication following treatment for laryngeal cancer. It is recommended to evaluate the thyroid function periodically for timely detection.

  15. Multimodality treatment of hypertrophic scars using long-wave X-radiation

    International Nuclear Information System (INIS)

    Protsenko, T.V.

    1984-01-01

    The paper is concerned with a therapeutic method for hypertrophic scars inc cluding Bucky rays, pyrogenal, vitamins a, e, b 12 , sodium salicylate and dimexide ointment. Multimodality treatment of hypertrophic scars is effective, well tolerated and can be widely used in out-patient clinics. It makes it possible to reduce the period of therapy by 2-3 mos., and the summary dose by 20 000-3000 rad (18.6-27.9 Gy) as compared to common therapy with Wucky rays only Changes in the connective structure of scars in the process of multimodality th herapy are nonspecific and account for some mechanisms of scar regression and reaffirm the efficacy of this therapeutic method

  16. Effectiveness of a Multimodal Therapy for Patients with Chronic Low Back Pain Regarding Pre-Admission Healthcare Utilization

    Science.gov (United States)

    Borys, Constanze; Lutz, Johannes; Strauss, Bernhard; Altmann, Uwe

    2015-01-01

    Objective The aim of the study was to examine the effectiveness of an intensive inpatient three-week multimodal therapy. We focused especially on the impact on the multimodal therapy outcome of the pre-admission number of treatment types patients had received and of medical specialist groups patients had consulted. Methods 155 patients with chronic low back pain and indication for multimodal therapy were evaluated with respect to pain intensity, depression, anxiety, well-being, and pre-admission health care utilization. In our controlled clinical trial we compared N = 66 patients on the waiting list with N = 89 patients who received immediate treatment. The waiting list patients likewise attended multimodal therapy after the waiting period. Longitudinal post-treatment data for both were collected at three- and twelve-month follow-ups. The impact of pre-admission health care utilization on multimodal therapy outcome (post) was analysed by structural equation model. Results Compared to the control group, multimodal therapy patients’ pain intensity and psychological variables were significantly reduced. Longitudinal effects with respect to pre-measures were significant at three-month follow-up for pain intensity (ES = -0.48), well-being (ES = 0.78), anxiety (ES = -0.33), and depression (ES = -0.30). Effect sizes at twelve-month follow-up were small for anxiety (ES = -0.22), and moderate for general well-being (ES = 0.61). Structural equation model revealed that a higher number of pre-admission treatment types was associated with poorer post-treatment outcomes in pain intensity, well-being, and depression. Conclusion Multimodal therapy proved to be effective with regard to improvements in pain intensity, depression, anxiety, and well-being. The association between treatment effect and number of pre-admission pain treatment types suggests that patients would benefit more from attending multimodal therapy in an earlier stage of health care. PMID:26599232

  17. Locoregional Treatment Outcomes After Multimodality Management of Inflammatory Breast Cancer

    International Nuclear Information System (INIS)

    Bristol, Ian J.; Woodward, Wendy A.; Strom, Eric A.; Cristofanilli, Massimo; Domain, Delora; Singletary, S. Eva; Perkins, George H.; Oh, Julia L.; Yu, T.-K.; Terrefe, Welela; Sahin, Aysegul A.; Hunt, Kelly K.; Hortobagyi, Gabriel N.; Buchholz, Thomas A.

    2008-01-01

    Purpose: The aims of this study were to determine outcomes for patients with inflammatory breast cancer (IBC) treated with multimodality therapy, to identify factors associated with locoregional recurrence, and to determine which patients may benefit from radiation dose escalation. Methods and Materials: We retrospectively reviewed 256 consecutive patients with nonmetastatic IBC treated at our institution between 1977 and 2004. Results: The 192 patients who were able to complete the planned course of chemotherapy, mastectomy, and postmastectomy radiation had significantly better outcomes than the 64 patients who did not. The respective 5-year outcome rates were: locoregional control (84% vs. 51%), distant metastasis-free survival (47% vs. 20%), and overall survival (51% vs. 24%) (p < 0.0001 for all comparisons). Univariate factors significantly associated with locoregional control in the patients who completed plan treatment were response to neoadjuvant chemotherapy, surgical margin status, number of involved lymph nodes, and use of taxanes. Increasing the total chest-wall dose of postmastectomy radiation from 60 Gy to 66 Gy significantly improved locoregional control for patients who experienced less than a partial response to chemotherapy, patients with positive, close, or unknown margins, and patients <45 years of age. Conclusions: Patients with IBC who are able to complete treatment with chemotherapy, mastectomy, and postmastectomy radiation have a high probability of locoregional control. Escalation of postmastectomy radiation dose to 66 Gy appears to benefit patients with disease that responds poorly to chemotherapy, those with positive, close, or unknown margin status, and those <45 years of age

  18. The role of radiation therapy in multimodality treatment for renal-cell cancer

    International Nuclear Information System (INIS)

    Semikoz, N.G.; Kudryashov, O.G.; Ponomar'ov, V.V.; Osipenkov, R.A.; Anyishchenko, A.O.; Kudryashova, S.M.

    2011-01-01

    The authors report the results of multimodality treatment for renal-cell cancer (pT any, N any, M0) using pre- operative large-fraction irradiation. Our findings demonstrate that radiation therapy does not aggravate the conditions for surgery and improves long-term results. The data about efficacy of multimodality treatment (palliative nephrectomy with radiation therapy) in patients with primary metastatic kidney cancer T any, N any, M1) are also reported.

  19. Outcome of transarterial chemoembolization-based multi-modal treatment in patients with unresectable hepatocellular carcinoma.

    Science.gov (United States)

    Song, Do Seon; Nam, Soon Woo; Bae, Si Hyun; Kim, Jin Dong; Jang, Jeong Won; Song, Myeong Jun; Lee, Sung Won; Kim, Hee Yeon; Lee, Young Joon; Chun, Ho Jong; You, Young Kyoung; Choi, Jong Young; Yoon, Seung Kew

    2015-02-28

    To investigate the efficacy and safety of transarterial chemoembolization (TACE)-based multimodal treatment in patients with large hepatocellular carcinoma (HCC). A total of 146 consecutive patients were included in the analysis, and their medical records and radiological data were reviewed retrospectively. In total, 119 patients received TACE-based multi-modal treatments, and the remaining 27 received conservative management. Overall survival (P<0.001) and objective tumor response (P=0.003) were significantly better in the treatment group than in the conservative group. After subgroup analysis, survival benefits were observed not only in the multi-modal treatment group compared with the TACE-only group (P=0.002) but also in the surgical treatment group compared with the loco-regional treatment-only group (P<0.001). Multivariate analysis identified tumor stage (P<0.001) and tumor type (P=0.009) as two independent pre-treatment factors for survival. After adjusting for significant pre-treatment prognostic factors, objective response (P<0.001), surgical treatment (P=0.009), and multi-modal treatment (P=0.002) were identified as independent post-treatment prognostic factors. TACE-based multi-modal treatments were safe and more beneficial than conservative management. Salvage surgery after successful downstaging resulted in long-term survival in patients with large, unresectable HCC.

  20. Persistence of Diabetes and Hypertension After Multimodal Treatment of Acromegaly.

    Science.gov (United States)

    González, Baldomero; Vargas, Guadalupe; de Los Monteros, Ana Laura Espinosa; Mendoza, Victoria; Mercado, Moisés

    2018-06-01

    Diabetes and hypertension are frequent comorbidities of acromegaly. To analyze the course of diabetes and hypertension at diagnosis and after multimodal therapy in a large cohort of patients with acromegaly. Retrospective study at a tertiary care center. A total of 522 patients with acromegaly treated according to a preestablished protocol. Prevalence of diabetes and hypertension and its relationship with biochemical indices of acromegalic control. The cohort was stratified according to disease activity upon last visit to clinic: (1) surgical remission (n = 122), (2) pharmacologically controlled (n = 92), (3) active disease (n = 148), (4) insulinlike growth factor (IGF)-1 discordance (n = 64), and (5) growth hormone (GH) discordance (n = 96). The prevalence of diabetes and hypertension at diagnosis was 30% and 37%, respectively, and did not change upon the last visit (30.6% and 38%). Both comorbidities were more prevalent at diagnosis and on the last visit than in the general population. Diabetes was less prevalent on the last visit in patients who achieved surgical remission than in those who persisted with active disease (25% vs 40%, P = 0.01). Upon multivariate analysis, diabetes was associated with an IGF-1 at diagnosis >2× upper limit of normal, with the persistence of active acromegaly, the presence of hypertension upon the last visit, with the presence of a macroadenoma, and with female sex. Our findings underscore the importance of an integral approach when managing these patients, focusing not only on the control of GH and IGF-1 levels but also on the timely diagnosis and the specific treatment of each comorbidity.

  1. Bulimia nervosa symptoms in the multimodal treatment study of children with ADHD.

    Science.gov (United States)

    Mikami, Amori Yee; Hinshaw, Stephen P; Arnold, L Eugene; Hoza, Betsy; Hechtman, Lily; Newcorn, Jeffrey H; Abikoff, Howard B

    2010-04-01

    We investigated body image dissatisfaction and bingeing/purging characteristics of bulimia nervosa (BN) in the ongoing prospective follow-up of the Multimodal Treatment Study of Children with attention-deficit/hyperactivity disorder (ADHD). Participants were 337 boys and 95 girls with ADHD and 211 boys and 53 girls forming a local normative comparison group (LNCG), reassessed in midadolescence (mean age, 16.4), 8 years after original recruitment. Youth with childhood ADHD showed more BN symptoms in midadolescence than did LNCG youth, and girls demonstrated more BN symptoms than did boys, with effect sizes between small and medium. Childhood impulsivity, as opposed to hyperactivity or inattention, best predicted adolescent BN symptoms, particularly for girls. Among youth with ADHD, treatment received during the follow-up period was not associated with BN pathology. Both boys and girls with ADHD may be at risk for BN symptoms in adolescence because of the impulsivity central to both disorders.

  2. Congenital peripheral primitive neuroectodermal tumor: A case treated successfully with multimodality treatment

    International Nuclear Information System (INIS)

    Goyal, Sh.; Biswas, A.; Mohanti, B.K.; Gupta, R.

    2014-01-01

    Neonatal tumors comprise less than two percent of childhood malignancies. Most are solid tumors, most common histologies being teratoma and neuroblastoma. We encountered a child who was detected to have a right arm mass on antenatal sonogram, which was diagnosed to be a primitive neuroectodermal tumor involving the triceps on fine needle aspiration cytology performed in the post-natal period. The child was successfully treated with multimodality treatment consisting of surgery, chemotherapy and radiotherapy. We also discuss briefly the problems associated with therapy in neonatal period. A review of all cases reported to have congenital Ewing’s sarcoma family of tumors is presented. Novel therapies are needed to improve efficacy and decrease the devastating side effects of treatment in this age group.

  3. Multi-modal brain imaging software for guiding invasive treatment of epilepsy

    NARCIS (Netherlands)

    Ossenblok, P.P.W.; Marien, S.; Meesters, S.P.L.; Florack, L.M.J.; Hofman, P.; Schijns, O.E.M.G.; Colon, A.

    2017-01-01

    Purpose: The surgical treatment of patients with complex epilepsies is changing more and more from open, invasive surgery towards minimally invasive, image guided treatment. Multi-modal brain imaging procedures are developed to delineate preoperatively the region of the brain which is responsible

  4. Reflection effects in multimode fiber systems utilizing laser transmitters

    Science.gov (United States)

    Bates, Harry E.

    1991-11-01

    A number of optical communication lines are now in use at NASA-Kennedy for the transmission of voice, computer data, and video signals. Now, all of these channels use a single carrier wavelength centered near 1300 or 1550 nm. Engineering tests in the past have given indications of the growth of systematic and random noise in the RF spectrum of a fiber network as the number of connector pairs is increased. This noise seems to occur when a laser transmitter is used instead of a LED. It has been suggested that the noise is caused by back reflections created at connector fiber interfaces. Experiments were performed to explore the effect of reflection on the transmitting laser under conditions of reflective feedback. This effort included computer integration of some of the instrumentation in the fiber optic lab using the Lab View software recently acquired by the lab group. The main goal was to interface the Anritsu Optical and RF spectrum analyzers to the MacIntosh II computer so that laser spectra and network RF spectra could be simultaneously and rapidly acquired in a form convenient for analysis. Both single and multimode fiber is installed at Kennedy. Since most are multimode, this effort concentrated on multimode systems.

  5. Multimodality therapy approaches, local and systemic treatment, compared with chemotherapy alone in recurrent glioblastoma

    International Nuclear Information System (INIS)

    Scorsetti, Marta; Navarria, Pierina; Pessina, Federico; Ascolese, Anna Maria; D’Agostino, Giuseppe; Tomatis, Stefano; De Rose, Fiorenza; Villa, Elisa; Maggi, Giulia; Simonelli, Matteo; Clerici, Elena; Soffietti, Riccardo; Santoro, Armando; Cozzi, Luca; Bello, Lorenzo

    2015-01-01

    Long-term local control in Glioblastoma is rarely achieved and nearly all patients relapse. In this study we evaluated the clinical effect of different treatment approaches in recurrent patients. Forty-three patients, with median age of 51 years were evaluated for salvage treatment: re-resection and/or re-irradiation plus chemotherapy or chemotherapy alone. Response was recorded using the Response Assessment in Neuro-Oncology criteria. Hematologic and non-hematologic toxicities were graded according to Common Terminology Criteria for Adverse Events 4.0. Twenty-one patients underwent chemotherapy combined with local treatment, surgery and/or radiation therapy, and 22 underwent chemotherapy only. The median follow up was 7 months (range 3–28 months). The 1 and 2-years Progression Free Survival was 65 and 10 % for combined treatment and 22 and 0 % for chemotherapy alone (p < 0.01). The 1 and 2-years overall survival was 69 and 29 % for combined and 26 and 0 % for chemotherapy alone (p < 0.01). No toxicity greater than grade 2 was recorded. These data showed that in glioblastoma recurrence the combination of several approaches in a limited group of patients is more effective than a single treatment alone. This stress the importance of multimodality treatment whenever clinically feasible

  6. Multimodality treatment of large AVMs in eloquent areas

    International Nuclear Information System (INIS)

    Inoue, Hiroshi K.; Naitou, Isao

    2004-01-01

    Our treatment of arteriovenous malformations (AVMs) with Gamma Knife Radiosurgery (optimal dose treatment) showed 88.4% total obliteration in small AVMs less than 10 ml after the first treatment and very low morbidity (1.7%) in long-term follow-up (5 to 12 years). These results indicate that combined treatment is a good strategy for large AVMs in eloquent areas. Therefore, we evaluated larger AVMs treated with direct surgery including feeder clipping and/or intravascular embolization prior to radiosurgery for further development of radiosurgery of large AVMs. Fifty of 171 patients had combined treatment (embolization: 27, direct surgery: 19, both: 4) and were followed more than 4 years and 6 months. Mean volume at the time of radiosurgery was smallest in the surgery group. Total obliteration was obtained in 94.4% of small AVMs less than 10 ml (surgery: 100%, embolization: 88.9%), although larger AVMs still have a lower obliteration rate. No lethal hemorrhages appeared after combination treatment up to date. We concluded that radiosurgery combined with surgery and/or embolization is a safe and effective treatment for large AVMs in eloquent areas. (author)

  7. Effective dose for patient in multimode panoramic radiography

    International Nuclear Information System (INIS)

    Yasaki, Shiro; Daibo, Motoji

    1999-01-01

    In recent years, multimode panoramic radiography has had various functions, such as the auto exposure function, auto focus function (auto function), TMJ radiography and tomogram radiography functions. The purpose of this study was to estimate the effective dose for patients in each mode of the new multimode panoramic radiography (J. MORITA MFG. CORP. Dental Panorama X-ray Apparatus: Veraview Scope X 600). The absorbed doses in important organs involved in the causation of stochastic effects were measured by a thermoluminescent dosimeter using RANDO phantom. The effective doses were calculated using modified tissue weighting factors recommended by the International Commission on Radiological Protection (ICRP) in 1999. The mean field size over skin in typical panoramic and tomographic examinations was about 3% and 0.4% of the total body surface area of 15000 cm 2 . Assuming that the incidence of skin cancer is proportional to the area of skin exposed to ionizing radiation, the tissue weighting factor of skin can be estimated to be about 0.0003 and 0.00004. The estimate in effective dose was lower (5.3 μSv) in the panoramic auto function mode (an average exposure condition of 69 kV 7 mA) than that (6.5-13.8 μSv) in the linear tomogram modes. Since the linear tomogram mode requires a scout view, such as standard panoramic radiography, the dose in the linear tomogram mode becomes higher than other modes. A percentage of gonad doses in effective doses was negligible. (author)

  8. Multimodality treatment of locally advanced squamous cell carcinoma of the oesophagus: A comprehensive review and network meta-analysis.

    Science.gov (United States)

    Montagnani, Francesco; Fornaro, Lorenzo; Frumento, Paolo; Vivaldi, Caterina; Falcone, Alfredo; Fioretto, Luisa

    2017-06-01

    Surgery is the mainstay of treatment for oesophageal squamous-cell carcinoma (OSCC) but with poor results. Attempts to improve patient outcome have been made by introducing chemotherapy (CT), radiotherapy (RT), or both (CRT). However, randomized comparisons for all these strategies are not always available. We conducted an extensive literature search for studies comparing surgery with multimodality treatment (i.e. [neo-]adjuvant CT or RT or CRT or definitive CRT). Network meta-analysis was performed in a Bayesian framewor and node-split models were built to assess inconsistency. Twenty-five trials including a total of 3866 OSCC patients were included. Neoadjuvant CRT was associated with the most robust survival advantage across different multimodality treatment options (HR 0.73; 95% credible interval [CrI] 0.63-0.86). Definitive CRT was also significantly more effective than surgery but with greater uncertainties (HR 0.62; 95%CrI 0.41-0.96). Neoadjuvant CT (HR 0.90; 95%CrI 0.76-1.07) and adjuvant CRT (HR 1.00; 95%CrI 0.70-1.40) are associated with a non-significant benefit. To date, neoadjuvant CRT seems to represent the best approach to maximize the benefit of a multimodality approach. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Quantum teleportation of nonclassical wave packets: An effective multimode theory

    Energy Technology Data Exchange (ETDEWEB)

    Benichi, Hugo; Takeda, Shuntaro; Lee, Noriyuki; Furusawa, Akira [Department of Applied Physics, University of Tokyo, Tokyo (Japan)

    2011-07-15

    We develop a simple and efficient theoretical model to understand the quantum properties of broadband continuous variable quantum teleportation. We show that, if stated properly, the problem of multimode teleportation can be simplified to teleportation of a single effective mode that describes the input state temporal characteristic. Using that model, we show how the finite bandwidth of squeezing and external noise in the classical channel affect the output teleported quantum field. We choose an approach that is especially relevant for the case of non-Gaussian nonclassical quantum states and we finally back-test our model with recent experimental results.

  10. When to Intervene in Selective Mutism: The Multimodal Treatment of a Case of Persistent Selective Mutism.

    Science.gov (United States)

    Powell, Shawn; Dalley, Mahlono

    1995-01-01

    An identification and treatment model differentiating transient mutism from persistent selective mutism is proposed. The case study of a six-year-old girl is presented, who was treated with a multimodal approach combining behavioral techniques with play therapy and family involvement. At posttreatment and follow-up, she was talking in a manner…

  11. Multimodal treatment combining chemotherapy, hyperthermia and radiotherapy for ovarian cancer

    International Nuclear Information System (INIS)

    Nagashima, Kei

    1992-01-01

    There has been increasing interest in the use of heat in the treatment of cancer. Theoretically cells are the most sensitive to ionizing radiation at mitosis, whereas the cycle phase that is the most resistant to ionizing radiation namely late in the DNA. Synthetic phase (late S) is the most sensitive to hyperthermia. Hyperthermia has been reported to enhance the cytocidal effects of several active chemotherapeutic agents. When thermal potentiation of chemotherapeutic agents against malignant cells is contemplated, normal tissues have a relatively high ambient blood flow which increases in response to thermal stress, thereby dissipating heat, compared to tumors. Tumors, with relatively poor blood flow and a responsive neovasculature, are in capable of augmenting flow and acting as a heat reservoir. This is the phenomenon of a heat reservoir which is one factor to enhance the cytocidal effects of several active anticancer agents for enhancing the uptake in tumor. The importance is in the adjuvant chemotherapy treated for post operative, advanced and recurrent ovarian cancer. Heating enhances the effects of radiotherapy and chemotherapy. Thirty patients with ovarian cancer were subjected to the multidisciplinary treatment with combination of hyperthermochemotherapy and radiation. The 30 patients consisted of 18 with endometrioid adenocarcinoma and 7 with serious post operative or recurrent status. Two types of equipments with rediofrequencies of 70 MHz (BSD-1000) or 434 MHZ (TAG MED·HS 434) were used for hyperthermia. Chemotherapeutic agents such as adriamycin, cis DDP, cyclophosphamide and etoposide were injected intravenously. Arterial infusion with reservoir was very effective in advanced stage of ovarian cancer. No severe or fatal side effects were observed. Hyperthermochemotherapy is useful and effective for the postoperative management or the treatment of recurrent cancer of the ovary. (J.P.N.)

  12. Application of Multimodality Imaging Fusion Technology in Diagnosis and Treatment of Malignant Tumors under the Precision Medicine Plan.

    Science.gov (United States)

    Wang, Shun-Yi; Chen, Xian-Xia; Li, Yi; Zhang, Yu-Ying

    2016-12-20

    The arrival of precision medicine plan brings new opportunities and challenges for patients undergoing precision diagnosis and treatment of malignant tumors. With the development of medical imaging, information on different modality imaging can be integrated and comprehensively analyzed by imaging fusion system. This review aimed to update the application of multimodality imaging fusion technology in the precise diagnosis and treatment of malignant tumors under the precision medicine plan. We introduced several multimodality imaging fusion technologies and their application to the diagnosis and treatment of malignant tumors in clinical practice. The data cited in this review were obtained mainly from the PubMed database from 1996 to 2016, using the keywords of "precision medicine", "fusion imaging", "multimodality", and "tumor diagnosis and treatment". Original articles, clinical practice, reviews, and other relevant literatures published in English were reviewed. Papers focusing on precision medicine, fusion imaging, multimodality, and tumor diagnosis and treatment were selected. Duplicated papers were excluded. Multimodality imaging fusion technology plays an important role in tumor diagnosis and treatment under the precision medicine plan, such as accurate location, qualitative diagnosis, tumor staging, treatment plan design, and real-time intraoperative monitoring. Multimodality imaging fusion systems could provide more imaging information of tumors from different dimensions and angles, thereby offing strong technical support for the implementation of precision oncology. Under the precision medicine plan, personalized treatment of tumors is a distinct possibility. We believe that multimodality imaging fusion technology will find an increasingly wide application in clinical practice.

  13. Treatment of children with attention-deficit/hyperactivity disorder (ADHD) and irritability: results from the multimodal treatment study of children with ADHD (MTA).

    Science.gov (United States)

    Fernández de la Cruz, Lorena; Simonoff, Emily; McGough, James J; Halperin, Jeffrey M; Arnold, L Eugene; Stringaris, Argyris

    2015-01-01

    Clinically impairing irritability affects 25% to 45% of children with attention-deficit/hyperactivity disorder (ADHD); yet, we know little about what interventions are effective in treating children with ADHD and co-occurring irritability. We used data from the Multimodal Treatment Study of Children With ADHD (MTA) to address 3 aims: to establish whether irritability in children with ADHD can be distinguished from other symptoms of oppositional defiant disorder (ODD); to examine whether ADHD treatment is effective in treating irritability; and to examine how irritability influences ADHD treatment outcomes. Secondary analyses of data from the MTA included multivariate analyses, and intent-to-treat random-effects regression models were used. Irritability was separable from other ODD symptoms. For treating irritability, systematic stimulant treatment was superior to behavioral management but not to routine community care; a combination of stimulants and behavioral treatment was superior to community care and to behavioral treatment alone, but not to medication alone. Irritability did not moderate the impact of treatment on parent- and teacher-reported ADHD symptoms in any of the 4 treatment groups. Treatments targeting ADHD symptoms are helpful for improving irritability in children with ADHD. Moreover, irritability does not appear to influence the response to treatment of ADHD. Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); http://www.clinicaltrials.gov; NCT00000388. Copyright © 2015 American Academy of Child & Adolescent Psychaitry. Published by Elsevier Inc. All rights reserved.

  14. [Acute inpatient conservative multimodal treatment of complex and multifactorial orthopedic diseases in the ANOA concept].

    Science.gov (United States)

    Psczolla, M

    2013-10-01

    In Germany there is a clear deficit in the non-operative treatment of chronic and complex diseases and pain disorders in acute care hospitals. Only about 20 % of the treatments are carried out in orthopedic hospitals. Hospitals specialized in manual medicine have therefore formed a working group on non-operative orthopedic manual medicine acute care clinics (ANOA). The ANOA has developed a multimodal assessment procedure called the OPS 8-977 which describes the structure and process quality of multimodal and interdisciplinary diagnosis and treatment of the musculoskeletal system. Patients are treated according to clinical pathways oriented on the clinical findings. The increased duration of treatment in the German diagnosis-related groups (DRG) system is compensated for with a supplemental remuneration. Thus, complex and multifactorial orthopedic diseases and pain disorders are conservatively and appropriately treated as inpatient departments of acute care hospitals.

  15. Reading in the Australian Curriculum English: Describing the Effects of Structure and Organisation on Multimodal Texts

    Science.gov (United States)

    Exley, Beryl; Cottrell, Amber

    2012-01-01

    The recently introduced "Australian Curriculum: English" (Australian Curriculum, Assessment and Reporting Authority (ACARA), 2012) requires students to "read" multimodal text and describe the effects of structure and organisation. We begin this article by tracing the variable understandings of what reading multimodal text might…

  16. Effects of Multimodal Presentation and Stimulus Familiarity on Auditory and Visual Processing

    Science.gov (United States)

    Robinson, Christopher W.; Sloutsky, Vladimir M.

    2010-01-01

    Two experiments examined the effects of multimodal presentation and stimulus familiarity on auditory and visual processing. In Experiment 1, 10-month-olds were habituated to either an auditory stimulus, a visual stimulus, or an auditory-visual multimodal stimulus. Processing time was assessed during the habituation phase, and discrimination of…

  17. Multimodal treatment for resectable epithelial type malignant pleural mesothelioma

    Directory of Open Access Journals (Sweden)

    Fukuyama Yasuro

    2004-05-01

    Full Text Available Abstract Background Malignant pleural mesothelioma is a rare malignancy. The outcome remains poor despite complete surgical resection. Patients and methods Eleven patients with histologicaly proven epithelial type malignant pleural mesothelioma undergoing extrapleural pneumonectomy with systemic chemotherapy and/or radiotherapy before and after surgical resection were retrospectively reviewed. Results Ten out of 11 patients underwent complete surgical resection, of these 7 patients had stage I disease. Of these 7 patients, 5 are alive without any recurrence, a 2-year survival rate of 80% was observed in this group. There was no operative mortality or morbidity. Conclusion Extrapleural pneumonectomy with perioperative adjuvant treatment is safe and effective procedure for epithelial type malignant pleural mesothelioma.

  18. Surgery and Multimodal treatments in pancreatic cancer. A review on the basis of future multimodal treatment concepts

    International Nuclear Information System (INIS)

    Link, K.H.; Leder, G; Formentini, A.; Fortnagel, G.; Kornmann, M.; Schatz, M.; Beger, H.G.

    1999-01-01

    The literature on the indications and results of adjuvant/neoadjuvant therapies in pancreatic cancer was reviewed to provide a solid base for current recommendations and future developments. A special view was concentrated on the biology of the disease in the spontaneous course, after surgery and during/after various palliative and adjuvant/neoadjuvant treatment modalities, to characterize the disease for an optimally targeted treatment in conjunction with surgical removal of the tumor. The results of systemic and regional chemotherapy and radiotherapy either alone or in combination, before, during, and after surgery, were critically analyzed with respect to the oncological possibilities and pitfalls of each treatment method. In two randomized trials, one testing postoperative radio chemotherapy (GITSG), and one postoperative chemotherapy (Bakkevold), the adjuvant treatment, achieved a significant prolongation of the median survival time. The 5- and 10-year survival rates were improved in the GITSG study. The EORTC-GITCCG trial could not confirm the benefit of adjuvant radiochemotherapy. This study had a different design than the GITSG trial. Several historical control studies supported the beneficial effect of postoperative radio chemotherapy. In three historical control trials using regional chemotherapy, one with intraoperative radiotherapy, the survival times were improved vs. surgery alone. Intraoperative or postoperative radiotherapy as single modalities might reduce local relapses, but a survival advantage is still debated. Preoperative neoadjuvant radio chemotherapy has several advantages, and does not seem to increase the postoperative morbidity. Several trials have confirmed the feasibility of this concept, but no survival advantage has yet been proven. Systemic and regional chemotherapy is able to down stage primarily nonresectable pancreatic cancers. (K.H.). 111 refs

  19. Long-Term Outcomes of a Multimodal Day-Clinic Treatment for Chronic Pain under the Conditions of Routine Care

    Directory of Open Access Journals (Sweden)

    Mira A. Preis

    2018-01-01

    Full Text Available Chronic pain has high prevalence rates and is one of the top causes of years lived with disability. The aim of the present study was to evaluate the long-term effects of a multimodal day-clinic treatment for chronic pain. The sample included 183 chronic pain patients (114 females and 69 males; 53.3 ± 9.8 years who participated in a four-week multimodal day-clinic treatment for chronic pain. The patients’ average current pain intensity (NRS, sensory and affective pain (Pain Perception Scale, and depression and anxiety (HADS were assessed at pre- and posttreatment, as well as at three follow-ups (one month, six months, and twelve months after completion of the treatment. Multilevel models for discontinuous change were performed to evaluate the change of the outcome variables. Improvements from pretreatment to posttreatment and from pretreatment to all follow-ups emerged for pain intensity (NRS; 0.54 ≤ d ≤ 0.74, affective pain (Pain Perception Scale; 0.24 ≤ d ≤ 0.47, depression (HADS; 0.38 ≤ d ≤ 0.53, and anxiety (HADS; 0.26 ≤ d ≤ 0.43 (all p<0.05. Sensory pain as assessed with the Pain Perception Scale did not show any significant change. Patients suffering from chronic pain benefited from the multimodal pain treatment up to twelve months after completion of the treatment.

  20. Radiation therapy in the multimodal treatment approach of pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Becker, G. [Klinik am Eichert, Goeppingen (Germany). Dept. of Radiooncology and Radiation Therapy; Radiooncologic Univ. Clinic, Tuebingen (Germany); Kocher, M.; Mueller, R.P. [Koeln Univ. (Germany). Clinic of Radiation Therapy; Kortmann, R.D.; Paulsen, F.; Jeremic, B.; Bamberg, M. [Radiooncologic Univ. Clinic, Tuebingen (Germany)

    2002-04-01

    In this paper, literature will be reviewed to assess the role of modern radiotherapy and radiosurgery in the management of pituitary adenomas. Material and Methods: Nowadays, magnetic resonance imaging for the definition of the target volume and a real three-dimensional (3-D) treatment planning with field conformation and the possibility for non-coplanar irradiation has to be recommended. Most groups irradiate these benign tumors with single doses of 1.8-2.0 Gy up to a total dose of 45 Gy or 50.4 Gy in extensive parasellar adenomas. Adenomas are mostly small, well circumscribed lesions, and have, therefore, attracted the use of stereotactically guided high-precision irradiation techniques which allow extreme focussing and provide steep dose gradients with selective treatment of the target and optimal protection of the surrounding brain tissue. Results: Radiation therapy controls tumor growth in 80-98% of patients with non-secreting adenomas and 67-89% for endocrine active tumors. Reviewing the recent literature including endocrine active and non-secreting adenomas, irradiated postoperatively or in case of recurrence the 5-, 10- and 15-year local control rates amount 92%, 89% and 79%. In cases of microprolactinoma primary therapy consists of dopamine agonists. Irradiation should be preferred in patients with macroprolactinomas, when drug therapy and/or surgery failed or for patients medically unsuitable for surgery. Reduction and control of prolactin secretion can be achieved in 44-70% of patients. After radiotherapy in acromegaly patients somatomedin-C and growth hormone concentrations decrease to normal levels in 70-90%, with a decrease rate of 10-30% per year. Hypercortisolism is controlled in 50-83% of adults and 80% of children with Cushing's disease, generally in less than 9 months. Hypopituitarism is the most common side effect of pituitary irradiation with an incidence of 13-56%. Long-term overall risk for brain necrosis in a total of 1,388 analyzed

  1. Radiation therapy in the multimodal treatment approach of pituitary adenoma

    International Nuclear Information System (INIS)

    Becker, G.; Kocher, M.; Mueller, R.P.

    2002-01-01

    In this paper, literature will be reviewed to assess the role of modern radiotherapy and radiosurgery in the management of pituitary adenomas. Material and Methods: Nowadays, magnetic resonance imaging for the definition of the target volume and a real three-dimensional (3-D) treatment planning with field conformation and the possibility for non-coplanar irradiation has to be recommended. Most groups irradiate these benign tumors with single doses of 1.8-2.0 Gy up to a total dose of 45 Gy or 50.4 Gy in extensive parasellar adenomas. Adenomas are mostly small, well circumscribed lesions, and have, therefore, attracted the use of stereotactically guided high-precision irradiation techniques which allow extreme focussing and provide steep dose gradients with selective treatment of the target and optimal protection of the surrounding brain tissue. Results: Radiation therapy controls tumor growth in 80-98% of patients with non-secreting adenomas and 67-89% for endocrine active tumors. Reviewing the recent literature including endocrine active and non-secreting adenomas, irradiated postoperatively or in case of recurrence the 5-, 10- and 15-year local control rates amount 92%, 89% and 79%. In cases of microprolactinoma primary therapy consists of dopamine agonists. Irradiation should be preferred in patients with macroprolactinomas, when drug therapy and/or surgery failed or for patients medically unsuitable for surgery. Reduction and control of prolactin secretion can be achieved in 44-70% of patients. After radiotherapy in acromegaly patients somatomedin-C and growth hormone concentrations decrease to normal levels in 70-90%, with a decrease rate of 10-30% per year. Hypercortisolism is controlled in 50-83% of adults and 80% of children with Cushing's disease, generally in less than 9 months. Hypopituitarism is the most common side effect of pituitary irradiation with an incidence of 13-56%. Long-term overall risk for brain necrosis in a total of 1,388 analyzed patients

  2. Treatment of Conduct Disorder with a Multisystemic and Multimodal Approach

    Science.gov (United States)

    Ubinger, Nicole

    2006-01-01

    Conduct disorder is a childhood disorder that is often resistant to treatment. Current treatment methods often focus on separate interventions for each environment that the child or adolescent is exhibiting antisocial behavior. Additionally the focus is on the behavior of the child and often does not focus on the family unit or the biology behind…

  3. A multi-modal treatment approach for the shoulder: A 4 patient case series

    Directory of Open Access Journals (Sweden)

    Pollard Henry

    2005-09-01

    Full Text Available Abstract Background This paper describes the clinical management of four cases of shoulder impingement syndrome using a conservative multimodal treatment approach. Clinical Features Four patients presented to a chiropractic clinic with chronic shoulder pain, tenderness in the shoulder region and a limited range of motion with pain and catching. After physical and orthopaedic examination a clinical diagnosis of shoulder impingement syndrome was reached. The four patients were admitted to a multi-modal treatment protocol including soft tissue therapy (ischaemic pressure and cross-friction massage, 7 minutes of phonophoresis (driving of medication into tissue with ultrasound with 1% cortisone cream, diversified spinal and peripheral joint manipulation and rotator cuff and shoulder girdle muscle exercises. The outcome measures for the study were subjective/objective visual analogue pain scales (VAS, range of motion (goniometer and return to normal daily, work and sporting activities. All four subjects at the end of the treatment protocol were symptom free with all outcome measures being normal. At 1 month follow up all patients continued to be symptom free with full range of motion and complete return to normal daily activities. Conclusion This case series demonstrates the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with a suspected clinical diagnosis of shoulder impingement syndrome.

  4. Multimodal Therapy for Anorexia Nervosa: An Holistic Approach to Treatment.

    Science.gov (United States)

    O'Keefe, Edward J.; Castaldo, Christine

    1985-01-01

    Anorexia nervosa has received considerable attention lately because of its increased incidence, potential danger, and resistance to treatment. A review of the literature on anorexia nervosa suggests that, although it is characterized by complex interrelated psychological and physiological processes, it is often conceptualized and treated in…

  5. Acne Scar Treatment: A Multimodality Approach Tailored to Scar Type.

    Science.gov (United States)

    Zaleski-Larsen, Lisa A; Fabi, Sabrina G; McGraw, Timothy; Taylor, Mark

    2016-05-01

    Acne scarring can be classified into atrophic icepick, boxcar, and rolling scars in addition to keloidal and hypertrophic scars. Additionally, these scars can be erythematous, hyperpigmented, and/or hypopigmented. Each scar type has a different structural cause warranting a customized approach. Many cosmetic options exist to address these changes individually, but little literature exists about the safety and efficacy of combining such procedures and devices. A Medline search was performed on combination treatments because it relates to facial acne scarring, and results are summarized. Practical applications for these combinations of procedures are also discussed. Studies examining the efficacy and safety of ablative, nonablative, fractionated, and nonfractionated lasers, dermabrasion, chemical peels, needling, subcision, radiofrequency, stem cell therapy, fat transplantation, platelet-rich plasma, and hyaluronic acid dermal fillers for acne scars were found. The authors review their experience in combining these techniques. Review of the literature revealed multiple single options for facial acne scarring treatment with minimal evidence in the literature found on the safety and efficacy of combining such procedures and devices. The authors' experience is that combining acne scar treatment techniques can be performed safely and synergistically with optimal patient outcomes.

  6. Effects of arginine on multimodal anion exchange chromatography.

    Science.gov (United States)

    Hirano, Atsushi; Arakawa, Tsutomu; Kameda, Tomoshi

    2015-12-01

    The effects of arginine on binding and elution properties of a multimodal anion exchanger, Capto adhere, were examined using bovine serum albumin (BSA) and a monoclonal antibody against interleukin-8 (mAb-IL8). Negatively charged BSA was bound to the positively charged Capto adhere and was readily eluted from the column with a stepwise or gradient elution using 1M NaCl at pH 7.0. For heat-treated BSA, small oligomers and remaining monomers were also eluted using a NaCl gradient, whereas larger oligomers required arginine for effective elution. The positively charged mAb-IL8 was bound to Capto adhere at pH 7.0. Arginine was also more effective for elution of the bound mAb-IL8 than was NaCl. The results imply that arginine interacts with the positively charged Capto adhere. The mechanism underlying the interactions of arginine with Capto adhere was examined by calculating the binding free energy between an arginine molecule and a Capto adhere ligand in water through molecular dynamics simulations. The overall affinity of arginine for Capto adhere is attributed to the hydrophobic and π-π interactions between an arginine side chain and the aromatic moiety of the ligand as well as hydrogen bonding between arginine and the ligand hydroxyl group, which may account for the characteristics of protein elution using arginine. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Investigation of an angiogenesis-promoting topical treatment for diabetic wounds using multimodal microscopy (Conference Presentation)

    Science.gov (United States)

    Li, Joanne; Bower, Andrew J.; Arp, Zane A.; Olson, Eric; Holland, Claire; Chaney, Eric J.; Marjanovic, Marina; Boppart, Stephen A.

    2016-02-01

    Impaired skin wound healing is a significant co-morbid condition of diabetes that is caused by poor microcirculation among other factors. Hypoxia-inducible factors (HIFs) are transcription factors that mediate the effects of decreased levels of oxygen in biological environments. Inducing mild hypoxia in the tissue could promote angiogenesis, a critical step in the wound healing process in diabetic wounds. To investigate the relationship between hypoxia and diabetic wound healing, a topical treatment consisting of a HIF-activating prolyl-hydroxylase inhibitor was administered to the wounded skin of diabetic (db/db) mice. Studies were conducted in accordance with the GSK Policy on the Care, Welfare and Treatment of Laboratory Animals and were reviewed at GSK or by the ethical review process at the institution where the work was performed. The wounded area was tracked in vivo for 28 days utilizing a custom-built multimodal microscopy system. An increase in vascular density around the wounds of treated animals was observed using phase-variance optical coherence tomography (PV-OCT), in comparison to normal controls. In addition, second harmonic generation (SHG) and fluorescence lifetime imaging microscopy (FLIM) were utilized to examine the collagen regeneration and cellular metabolic activity, respectively, in the wounded skin. The utilization of these light based methods can follow metabolic and morphologic changes in the wound healing process in ways not possible with current evaluation processes. Insights demonstrated in these studies could lead to new endpoints for evaluation of the efficacy of drugs and lead to more direct ways of detecting patient response to treatment.

  8. Adult Rhabdomyosarcoma Survival Improved With Treatment on Multimodality Protocols

    International Nuclear Information System (INIS)

    Gerber, Naamit Kurshan; Wexler, Leonard H.; Singer, Samuel; Alektiar, Kaled M.; Keohan, Mary Louise; Shi, Weiji; Zhang, Zhigang; Wolden, Suzanne

    2013-01-01

    Purpose: Rhabdomyosarcoma (RMS) is a pediatric sarcoma rarely occurring in adults. For unknown reasons, adults with RMS have worse outcomes than do children. Methods and Materials: We analyzed data from all patients who presented to Memorial Sloan-Kettering Cancer Center between 1990 and 2011 with RMS diagnosed at age 16 or older. One hundred forty-eight patients met the study criteria. Ten were excluded for lack of adequate data. Results: The median age was 28 years. The histologic diagnoses were as follows: embryonal 54%, alveolar 33%, pleomorphic 12%, and not otherwise specified 2%. The tumor site was unfavorable in 67% of patients. Thirty-three patients (24%) were at low risk, 61 (44%) at intermediate risk, and 44 (32%) at high risk. Forty-six percent were treated on or according to a prospective RMS protocol. The 5-year rate of overall survival (OS) was 45% for patients with nonmetastatic disease. The failure rates at 5 years for patients with nonmetastatic disease were 34% for local failure and 42% for distant failure. Among patients with nonmetastatic disease (n=94), significant factors associated with OS were histologic diagnosis, site, risk group, age, and protocol treatment. On multivariate analysis, risk group and protocol treatment were significant after adjustment for age. The 5-year OS was 54% for protocol patients versus 36% for nonprotocol patients. Conclusions: Survival in adult patients with nonmetastatic disease was significantly improved for those treated on RMS protocols, most of which are now open to adults

  9. Adult Rhabdomyosarcoma Survival Improved With Treatment on Multimodality Protocols

    Energy Technology Data Exchange (ETDEWEB)

    Gerber, Naamit Kurshan [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wexler, Leonard H. [Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Singer, Samuel [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Alektiar, Kaled M. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Keohan, Mary Louise [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Shi, Weiji; Zhang, Zhigang [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wolden, Suzanne, E-mail: woldens@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2013-05-01

    Purpose: Rhabdomyosarcoma (RMS) is a pediatric sarcoma rarely occurring in adults. For unknown reasons, adults with RMS have worse outcomes than do children. Methods and Materials: We analyzed data from all patients who presented to Memorial Sloan-Kettering Cancer Center between 1990 and 2011 with RMS diagnosed at age 16 or older. One hundred forty-eight patients met the study criteria. Ten were excluded for lack of adequate data. Results: The median age was 28 years. The histologic diagnoses were as follows: embryonal 54%, alveolar 33%, pleomorphic 12%, and not otherwise specified 2%. The tumor site was unfavorable in 67% of patients. Thirty-three patients (24%) were at low risk, 61 (44%) at intermediate risk, and 44 (32%) at high risk. Forty-six percent were treated on or according to a prospective RMS protocol. The 5-year rate of overall survival (OS) was 45% for patients with nonmetastatic disease. The failure rates at 5 years for patients with nonmetastatic disease were 34% for local failure and 42% for distant failure. Among patients with nonmetastatic disease (n=94), significant factors associated with OS were histologic diagnosis, site, risk group, age, and protocol treatment. On multivariate analysis, risk group and protocol treatment were significant after adjustment for age. The 5-year OS was 54% for protocol patients versus 36% for nonprotocol patients. Conclusions: Survival in adult patients with nonmetastatic disease was significantly improved for those treated on RMS protocols, most of which are now open to adults.

  10. Apatia multimodal iatrogênica Multimodal apathy: a unique effect of antidepressant therapy at the neurological-psychiatric interface

    Directory of Open Access Journals (Sweden)

    Ricardo de Oliveira-Souza

    1996-06-01

    Full Text Available O presente trabalho documenta um efeito peculiar dos antidepressivos em 5 pacientes - a apatia -, definida pela incapacidade de experimentar emoções. O reconhecimento da apatia no curso de tratamento antidepressivo deve levantar a possibilidade de iatrogenia e suspensão do antidepressivo em uso. Frizamos que a apatia deve ser diferenciada da abulia e da avolição, com as quais é comumente contundida. Documentamos que a indiferença emocional pode se confinar a um domínio sensorial ("apatia unimodal" ou, como em nossos casos, a mais de uma modalidade ("apatia multimodal". Circuitos anterobasais, centrados na amígdala e no pólo temporal, são fortes candidatos para integrar a experiência emocional às imagens mentais e percepções multimodais do ambiente, uma vez que para eles convergem os principais sistemas de projeção do prosencéfalo, ao mesmo tempo em que se situam em pontos estratégicos para modular o córtex pré-frontal e parieto-têmporo-occipital. O fato de que a apatia foi produzida por classes quimicamente distintas, como ISRSs (inibidores seletivos de recaptação da serotonina, IMAOs (inibidores reversíveis da monoamino oxidase e tricíclicos, indica que a fisiopatologia em jogo se deve a alguma ação compartilhada por essas drogas no plano subneuronal. A intervenção em circuitos serotoninérgicos cerebrais parece o mecanismo mais adequado para explicar tal efeito.The present paper reports on five patients who developed apathy as a peculiar side effect of antidepressants. Their behavioral and psychopathological changes were primarily due to the near-absence of emotional experience, a key characteristic that distinguishes apathy from avolition and abulia. The emergence of apathy in the course of an antidepressant treatment should raise the suspicion of an adverse effect of the drug and lead to its prompt withdrawal. A sample of the relevant clinical evidence favoring the distinction of apathy confined to a single

  11. Multimodal scanning laser ophthalmoscopy for image guided treatment of age-related macular degeneration

    Science.gov (United States)

    Hammer, Daniel X.; Ferguson, R. D.; Patel, Ankit H.; Iftimia, Nicusor V.; Mujat, Mircea; Husain, Deeba

    2009-02-01

    Subretinal neovascular membranes (SRNM) are a deleterious complication of laser eye injury and retinal diseases such as age-related macular degeneration (AMD), choroiditis, and myopic retinopathy. Photodynamic therapy (PDT) and anti-vascular endothelial growth factor (VEGF) drugs are approved treatment methods. PDT acts by selective dye accumulation, activation by laser light, and disruption and clotting of the new leaky vessels. However, PDT surgery is currently not image-guided, nor does it proceed in an efficient or automated manner. This may contribute to the high rate of re-treatment. We have developed a multimodal scanning laser ophthalmoscope (SLO) for automated diagnosis and image-guided treatment of SRNMs associated with AMD. The system combines line scanning laser ophthalmoscopy (LSLO), fluorescein angiography (FA), indocyanine green angiography (ICGA), PDT laser delivery, and retinal tracking in a compact, efficient platform. This paper describes the system hardware and software design, performance characterization, and automated patient imaging and treatment session procedures and algorithms. Also, we present initial imaging and tracking measurements on normal subjects and automated lesion demarcation and sizing analysis of previously acquired angiograms. Future pre-clinical testing includes line scanning angiography and PDT treatment of AMD subjects. The automated acquisition procedure, enhanced and expedited data post-processing, and innovative image visualization and interpretation tools provided by the multimodal retinal imager may eventually aid in the diagnosis, treatment, and prognosis of AMD and other retinal diseases.

  12. MINERVA: A multi-modality plug-in-based radiation therapy treatment planning system

    International Nuclear Information System (INIS)

    Wemple, C. A.; Wessol, D. E.; Nigg, D. W.; Cogliati, J. J.; Milvich, M.; Fredrickson, C. M.; Perkins, M.; Harkin, G. J.; Hartmann-Siantar, C. L.; Lehmann, J.; Flickinger, T.; Pletcher, D.; Yuan, A.; DeNardo, G. L.

    2005-01-01

    Researchers at the INEEL, MSU, LLNL and UCD have undertaken development of MINERVA, a patient-centric, multi-modal, radiation treatment planning system, which can be used for planning and analysing several radiotherapy modalities, either singly or combined, using common treatment planning tools. It employs an integrated, lightweight plug-in architecture to accommodate multi-modal treatment planning using standard interface components. The design also facilitates the future integration of improved planning technologies. The code is being developed with the Java programming language for inter-operability. The MINERVA design includes the image processing, model definition and data analysis modules with a central module to coordinate communication and data transfer. Dose calculation is performed by source and transport plug-in modules, which communicate either directly through the database or through MINERVA's openly published, extensible markup language (XML)-based application programmer's interface (API). All internal data are managed by a database management system and can be exported to other applications or new installations through the API data formats. A full computation path has been established for molecular-targeted radiotherapy treatment planning, with additional treatment modalities presently under development. (authors)

  13. Multimodal treatment utilizing intraoperative radiotherapy for advanced cancer of the pancreas

    International Nuclear Information System (INIS)

    Onodera, Tokio

    1982-01-01

    A multimodal treatment was consisted of intraoperative radiation, external radiation, by-pass operation, chemotherapy and total parenteral nutrition if necessary to cover decreased oral-intake. Thirty-three cases were subjected to this therapy for 6 years. The stage of the tumors varied from a localized tumor in the pancreas to a huge tumor with multiple metastases, though the latter abandoned recently to be contraindication to this therapy. At laparotomy, a high energy electron beam was irradiated to the tumor with a dosage of 3,000 rad using a 20 MeV Betatron. The tumor was carefully prepared in order to avoid irradiating the duodenum and stomach. Choledochojejunostomy and gastrojejunostomy were performed in almost all of patients with cancer of head of pancreas. In some patients, external radiation was added with a dosage of 3,000 rad by linear X-ray. After radiotherapy, chemotherapy employing 5-FU or FT-207 was continued including. The survival time after this therapy was varied mainly according to the stages of the tumor. In patients with multiple metastasis to the liver or peritoneal dissemination, no remarkable effects were obtained by this therapy. On the otherhand, among 14 patients with localized tumor in the pancreas, 7 survived more than one year and the mean survival time of treated patients was nevershorter than that of patients who received resection of the tumor. Most of the treated patients could spend at home until their condition became critical, because by-pass operation could overcome jaundice or the duodenal stenosis and intraoperative radiation could palliate the pain of cancer of pancreas. Tumor effect of intraoperative radiation was confirmed by both of the second laporatomy for twice intraoperative radiation and laparatomy. (author)

  14. On the effects of multimodal information integration in multitasking.

    Science.gov (United States)

    Stock, Ann-Kathrin; Gohil, Krutika; Huster, René J; Beste, Christian

    2017-07-07

    There have recently been considerable advances in our understanding of the neuronal mechanisms underlying multitasking, but the role of multimodal integration for this faculty has remained rather unclear. We examined this issue by comparing different modality combinations in a multitasking (stop-change) paradigm. In-depth neurophysiological analyses of event-related potentials (ERPs) were conducted to complement the obtained behavioral data. Specifically, we applied signal decomposition using second order blind identification (SOBI) to the multi-subject ERP data and source localization. We found that both general multimodal information integration and modality-specific aspects (potentially related to task difficulty) modulate behavioral performance and associated neurophysiological correlates. Simultaneous multimodal input generally increased early attentional processing of visual stimuli (i.e. P1 and N1 amplitudes) as well as measures of cognitive effort and conflict (i.e. central P3 amplitudes). Yet, tactile-visual input caused larger impairments in multitasking than audio-visual input. General aspects of multimodal information integration modulated the activity in the premotor cortex (BA 6) as well as different visual association areas concerned with the integration of visual information with input from other modalities (BA 19, BA 21, BA 37). On top of this, differences in the specific combination of modalities also affected performance and measures of conflict/effort originating in prefrontal regions (BA 6).

  15. Treatment Effects

    DEFF Research Database (Denmark)

    Heckman, James J.; Lopes, Hedibert F.; Piatek, Rémi

    2014-01-01

    This paper contributes to the emerging Bayesian literature on treatment effects. It derives treatment parameters in the framework of a potential outcomes model with a treatment choice equation, where the correlation between the unobservable components of the model is driven by a low-dimensional v......This paper contributes to the emerging Bayesian literature on treatment effects. It derives treatment parameters in the framework of a potential outcomes model with a treatment choice equation, where the correlation between the unobservable components of the model is driven by a low...... to observe the same person in both the treated and untreated states, but it also turns out to be straightforward to implement. Formulae are provided to compute mean treatment effects as well as their distributional versions. A Monte Carlo simulation study is carried out to illustrate how the methodology can...

  16. Multimodal treatment in difficult sialolithiasis: Role of extracorporeal shock-wave lithotripsy and intraductal pneumatic lithotripsy.

    Science.gov (United States)

    Koch, Michael; Schapher, Mirco; Mantsopoulos, Konstantinos; von Scotti, Felix; Goncalves, Miguel; Iro, Heinrich

    2017-12-15

    To assess results after treatment of difficult/complex sialolithiasis with extracorporeal shock-wave lithotripsy (ESWL) and intraductal pneumatic lithotripsy (IPL). Retrospective study in a tertiary referral center. Altogether, 63 stones were diagnosed in 38 patients with difficult/complex sialolithiasis. Forty-nine stones were treated with fragmentation using both ESWL and IPL. Stones accessible with the sialendoscope were treated primarily with IPL in multiple sialolithiasis. Seventy-one ESWL procedures and 57 IPL were performed in our patients. Forty-nine stones were treated by 67 ESWL procedures and 52 IPL. ESWL converted sialoliths from sialendoscopically untreatable into sialendoscopically treatable cases in 94.7%; the treatment then was completed by a total of 52 IPL procedures. ESWL was performed before IPL (81.6%), in combination with IPL (7.9%) and after (10.5%). Complete fragmentation was achieved in 97.9%. Four stones each were treated with ESWL and IPL alone in multiple sialolithiasis. Altogether, 53 stones were treated by 57 IPL procedures. Complete fragmentation was achieved in 98.1% of the 53 stones. ESWL and IPL were the dominant treatment modalities in 84.1% of all 63 stones treated. Of all 38 patients, 92.1% became stone-free and all became symptom-free. All the glands were preserved. Multiple stones were treated in 34.2% of the patients; of these, 92.3% became stone-free. These results show that patients with difficult and complex sialolithiasis can be treated with high success rates of > 90% using a multimodal, minimally invasive, and gland-preserving treatment approach. ESWL and IPL played a key role in this multimodal treatment regime in > 80% of stones. 4. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  17. Multimodal Counseling Interventions: Effect on Human Papilloma Virus Vaccination Acceptance

    OpenAIRE

    Oroma Nwanodi; Helen Salisbury; Curtis Bay

    2017-01-01

    Human papilloma virus (HPV) vaccine was developed to reduce HPV-attributable cancers, external genital warts (EGW), and recurrent respiratory papillomatosis. Adolescent HPV vaccination series completion rates are less than 40% in the United States of America, but up to 80% in Australia and the United Kingdom. Population-based herd immunity requires 80% or greater vaccination series completion rates. Pro-vaccination counseling facilitates increased vaccination rates. Multimodal counseling inte...

  18. A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

    DEFF Research Database (Denmark)

    Mathiesen, Ole; Dahl, Benny; Thomsen, Berit A

    2013-01-01

    and postoperative nausea and vomiting (PONV) treatment protocol would improve pain treatment in this population. METHODS: A new regimen with acetaminophen, NSAIDs, gabapentin, S-ketamine, dexamethasone, ondansetron and epidural local anesthetic infusion or patient controlled analgesia with morphine, was introduced......PURPOSE: Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain...... and dizziness on POD 1-6. CONCLUSIONS: In this study of patients scheduled for multilevel spine surgery, it was demonstrated that compared to a historic group of patients receiving usual care, a comprehensive and standardized multimodal pain and PONV protocol significantly reduced opioid consumption, improved...

  19. Multimodal analgesic treatment in video-assisted thoracic surgery lobectomy using an intraoperative intercostal catheter

    DEFF Research Database (Denmark)

    Wildgaard, Kim; Petersen, Rene H; Hansen, Henrik J

    2012-01-01

    OBJECTIVES: No golden standard for analgesia in video-assisted thoracic surgery (VATS) lobectomy exists. A simple multimodal approach using an intercostal catheter (ICC) may be of benefit since acute post-operative pain following VATS lobectomy primarily originates from the chest drain area......) and inserted an ICC at the drain site level for continuous delivery of 6 ml of 0.25% bupivacaine h(-1). Pain scores at rest, mobilization and with the extended arms were followed until discharge or for 4 days. RESULTS: Forty-eight patients, mean age 64 years (CI: 61-68), were included. The mean time...... for the PVB and ICC placement was 5 min (CI: 4.7-5.9). The mean pain score at rest using a numerical rating scale (NRS, 0-10) was 85% of patients reporting satisfactory or very satisfactory pain treatment all days. CONCLUSIONS: Acute pain after VATS lobectomy may be adequately controlled using a multimodal...

  20. [Diagnostics and multimodal treatment of depression in old age : New developments].

    Science.gov (United States)

    Eschweiler, Gerhard W

    2017-02-01

    Depressive disorders in elderly persons are frequent and can either first be manifested at a younger age and show a recurrent pattern during later life (ICD 10, F33.*) or have an onset beyond 60 years, which is termed late onset depression (LOD). This LOD has a higher tendency to chronification and implies an increased risk of progression, especially to vascular dementia. The multifactorial genesis of depression in old age includes psychosocial, vascular and metabolic factors and requires multimodal therapy modules at the biological and psychosocial level, which is now increasingly being empirically proven. Depressive disorders with executive and cognitive deficits have to be considered a defined entity with respect to prognosis and treatment. As a first step of treatment watchful waiting is appropriate, especially in depressive adjustment disorders triggered by acute psychosocial stressors (e.g. loss of relatives and conflicts). After 2-4 weeks pharmacological antidepressant therapy should be initiated, at least in a moderate depressive episode. Furthermore, the revised national guidelines for depressive disorders also explicitly recommend psychotherapy as an alternative or supplement to pharmacotherapy in the elderly. Several forms of psychotherapy are emphasized: cognitive behavioral therapy, interpersonal therapy and in particular problem solving, as this is a form of treatment that can also be carried out by other professional groups, thus alleviating the treatment gap caused by the lack of psychotherapists. In summary, a depressive disorder in old age should not induce therapeutic nihilism: after stepped diagnostic assessments, multimodal therapies are individually adapted to the physical, cognitive and social resources of the patients.

  1. Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms.

    Science.gov (United States)

    Müller-Schwefe, Gerhard; Morlion, Bart; Ahlbeck, Karsten; Alon, Eli; Coaccioli, Stefano; Coluzzi, Flaminia; Huygen, Frank; Jaksch, Wolfgang; Kalso, Eija; Kocot-Kępska, Magdalena; Kress, Hans-Georg; Mangas, Ana Cristina; Margarit Ferri, Cesar; Mavrocordatos, Philippe; Nicolaou, Andrew; Hernández, Concepción Pérez; Pergolizzi, Joseph; Schäfer, Michael; Sichère, Patrick

    2017-07-01

    Chronic low back pain: Chronic pain is the most common cause for people to utilize healthcare resources and has a considerable impact upon patients' lives. The most prevalent chronic pain condition is chronic low back pain (CLBP). CLBP may be nociceptive or neuropathic, or may incorporate both components. The presence of a neuropathic component is associated with more intense pain of longer duration, and a higher prevalence of co-morbidities. However, many physicians' knowledge of chronic pain mechanisms is currently limited and there are no universally accepted treatment guidelines, so the condition is not particularly well managed. Diagnosis should begin with a focused medical history and physical examination, to exclude serious spinal pathology that may require evaluation by an appropriate specialist. Most patients have non-specific CLBP, which cannot be attributed to a particular cause. It is important to try and establish whether a neuropathic component is present, by combining the findings of physical and neurological examinations with the patient's history. This may prove difficult, however, even when using screening instruments. Multimodal management: The multifactorial nature of CLBP indicates that the most logical treatment approach is multimodal: i.e. integrated multidisciplinary therapy with co-ordinated somatic and psychotherapeutic elements. As both nociceptive and neuropathic components may be present, combining analgesic agents with different mechanisms of action is a rational treatment modality. Individually tailored combination therapy can improve analgesia whilst reducing the doses of constituent agents, thereby lessening the incidence of side effects. This paper outlines the development of CLBP and the underlying mechanisms involved, as well as providing information on diagnosis and the use of a wide range of pharmaceutical agents in managing the condition (including NSAIDs, COX-2 inhibitors, tricyclic antidepressants, opioids and

  2. Current state of the art, multimodality research and future visions for the treatment of patients with prostate cancer: consensus results from "Challenges and Chances in Prostate Cancer Research Meeting 2013".

    Science.gov (United States)

    Combs, Stephanie E; Debus, Jürgen; Feick, Günter; Hadaschik, Boris; Hohenfellner, Markus; Schüle, Roland; Zacharias, Jens-Peter; Schwardt, Malte

    2014-11-04

    A brainstorming and consensus meeting organized by the German Cancer Aid focused on modern treatment of prostate cancer and promising innovative techniques and research areas. Besides optimization of screening algorithms, molecular-based stratification and individually tailored treatment regimens will be the future of multimodal prostate cancer management. Effective interdisciplinary structures, including biobanking and data collection mechanisms are the basis for such developments.

  3. Effects of Multimodal Information on Learning Performance and Judgment of Learning

    Science.gov (United States)

    Chen, Gongxiang; Fu, Xiaolan

    2003-01-01

    Two experiments were conducted to investigate the effects of multimodal information on learning performance and judgment of learning (JOL). Experiment 1 examined the effects of representation type (word-only versus word-plus-picture) and presentation channel (visual-only versus visual-plus-auditory) on recall and immediate-JOL in fixed-rate…

  4. A fully automatic approach for multimodal PET and MR image segmentation in gamma knife treatment planning.

    Science.gov (United States)

    Rundo, Leonardo; Stefano, Alessandro; Militello, Carmelo; Russo, Giorgio; Sabini, Maria Gabriella; D'Arrigo, Corrado; Marletta, Francesco; Ippolito, Massimo; Mauri, Giancarlo; Vitabile, Salvatore; Gilardi, Maria Carla

    2017-06-01

    Nowadays, clinical practice in Gamma Knife treatments is generally based on MRI anatomical information alone. However, the joint use of MRI and PET images can be useful for considering both anatomical and metabolic information about the lesion to be treated. In this paper we present a co-segmentation method to integrate the segmented Biological Target Volume (BTV), using [ 11 C]-Methionine-PET (MET-PET) images, and the segmented Gross Target Volume (GTV), on the respective co-registered MR images. The resulting volume gives enhanced brain tumor information to be used in stereotactic neuro-radiosurgery treatment planning. GTV often does not match entirely with BTV, which provides metabolic information about brain lesions. For this reason, PET imaging is valuable and it could be used to provide complementary information useful for treatment planning. In this way, BTV can be used to modify GTV, enhancing Clinical Target Volume (CTV) delineation. A novel fully automatic multimodal PET/MRI segmentation method for Leksell Gamma Knife ® treatments is proposed. This approach improves and combines two computer-assisted and operator-independent single modality methods, previously developed and validated, to segment BTV and GTV from PET and MR images, respectively. In addition, the GTV is utilized to combine the superior contrast of PET images with the higher spatial resolution of MRI, obtaining a new BTV, called BTV MRI . A total of 19 brain metastatic tumors, undergone stereotactic neuro-radiosurgery, were retrospectively analyzed. A framework for the evaluation of multimodal PET/MRI segmentation is also presented. Overlap-based and spatial distance-based metrics were considered to quantify similarity concerning PET and MRI segmentation approaches. Statistics was also included to measure correlation among the different segmentation processes. Since it is not possible to define a gold-standard CTV according to both MRI and PET images without treatment response assessment

  5. Bridging the Gap Between Speech and Language: Using Multimodal Treatment in a Child With Apraxia.

    Science.gov (United States)

    Tierney, Cheryl D; Pitterle, Kathleen; Kurtz, Marie; Nakhla, Mark; Todorow, Carlyn

    2016-09-01

    Childhood apraxia of speech is a neurologic speech sound disorder in which children have difficulty constructing words and sounds due to poor motor planning and coordination of the articulators required for speech sound production. We report the case of a 3-year-old boy strongly suspected to have childhood apraxia of speech at 18 months of age who used multimodal communication to facilitate language development throughout his work with a speech language pathologist. In 18 months of an intensive structured program, he exhibited atypical rapid improvement, progressing from having no intelligible speech to achieving age-appropriate articulation. We suspect that early introduction of sign language by family proved to be a highly effective form of language development, that when coupled with intensive oro-motor and speech sound therapy, resulted in rapid resolution of symptoms. Copyright © 2016 by the American Academy of Pediatrics.

  6. Effects of Multimodal Analgesia on the Success of Mouse Embryo Transfer Surgery

    Science.gov (United States)

    Parker, John M.; Austin, Jamie; Wilkerson, James; Carbone, Larry

    2011-01-01

    Multimodal analgesia is promoted as the best practice pain management for invasive animal research procedures. Universal acceptance and incorporation of multimodal analgesia requires assessing potential effects on study outcome. The focus of this study was to assess effects on embryo survival after multimodal analgesia comprising an opioid and nonsteroidal antiinflammatory drug (NSAID) compared with opioid-only analgesia during embryo transfer procedures in transgenic mouse production. Mice were assigned to receive either carprofen (5 mg/kg) with buprenorphine (0.1 mg/kg; CB) or vehicle with buprenorphine (0.1 mg/kg; VB) in a prospective, double-blinded placebo controlled clinical trial. Data were analyzed in surgical sets of 1 to 3 female mice receiving embryos chimeric for a shared targeted embryonic stem-cell clone and host blastocyst cells. A total of 99 surgical sets were analyzed, comprising 199 Crl:CD1 female mice and their 996 offspring. Neither yield (pups weaned per embryo implanted in the surgical set) nor birth rate (average number of pups weaned per dam in the set) differed significantly between the CB and VB conditions. Multimodal opioid–NSAID analgesia appears to have no significant positive or negative effect on the success of producing novel lines of transgenic mice by blastocyst transfer. PMID:21838973

  7. Outcome of multimodality treatment of Ewing′s sarcoma of the extremities

    Directory of Open Access Journals (Sweden)

    Tiwari Akshay

    2010-01-01

    Full Text Available Background: The management of Ewing′s sarcoma family of tumors (ESFT, Ewing′s sarcoma/primitive neuroectodermal tumor has been established as a multimodality treatment. Advances in imaging and diagnostics, chemotherapy, surgical techniques, radiotherapy and prosthetic technology have resulted in drastic changes in the outcome of this disease, with most of the recent studies having 5-year survival rates of more than 60%. The Indian patients present at a more advanced stage and the compliance of treatment is suboptimal. While there is plenty of data in the world literature on the outcome of Ewing′s sarcoma, there is paucity of data in Indian patients. Therefore, we conducted the present study to analyze the outcome of multimodality treatment of ESFT of the extremities at a tertiary nonprofit institute over a decade. Materials and Methods: 34 patients who had histopathologically proven diagnosis of Ewing′s sarcoma of the extremities and had received treatment at our institute from 1997 through 2007 were included for analysis. The majority of patients had involvement of the femur (35%, followed by tibia (17%, fibula and foot (15% each, humerus (12% and soft tissue of thigh (6%. Twenty-nine patients presented with localized disease (Enneking stage II B while five patients presented with metastases (Enneking stage III. All patients received Vincristine, Actinomycine D, Cyclofosfamide + Ifosfamide and Etoposide (VAC+IE-based chemotherapy and local treatment was offered to all but three patients having multicentric disease. The local treatment offered were, radiation (n= 15, surgery (n= 12 both surgery and radiation (n=4. All patients were analyzed for oncological outcome (event-free and overall survival, local and systemic relapses by clinical and imaging evaluation and functional outcome by using the musculoskeletal tumor society (MSTS score. These outcomes were correlated with age, sex, size of tumor, stage at presentation, modality of local

  8. Multimodal Counseling Interventions: Effect on Human Papilloma Virus Vaccination Acceptance

    Directory of Open Access Journals (Sweden)

    Oroma Nwanodi

    2017-11-01

    Full Text Available Human papilloma virus (HPV vaccine was developed to reduce HPV-attributable cancers, external genital warts (EGW, and recurrent respiratory papillomatosis. Adolescent HPV vaccination series completion rates are less than 40% in the United States of America, but up to 80% in Australia and the United Kingdom. Population-based herd immunity requires 80% or greater vaccination series completion rates. Pro-vaccination counseling facilitates increased vaccination rates. Multimodal counseling interventions may increase HPV vaccination series non-completers’ HPV-attributable disease knowledge and HPV-attributable disease prophylaxis (vaccination acceptance over a brief 14-sentence counseling intervention. An online, 4-group, randomized controlled trial, with 260 or more participants per group, found that parents were more likely to accept HPV vaccination offers for their children than were childless young adults for themselves (68.2% and 52.9%. A combined audiovisual and patient health education handout (PHEH intervention raised knowledge of HPV vaccination purpose, p = 0.02, and HPV vaccination acceptance for seven items, p < 0.001 to p = 0.023. The audiovisual intervention increased HPV vaccination acceptance for five items, p < 0.001 to p = 0.006. That HPV causes EGW, and that HPV vaccination prevents HPV-attributable diseases were better conveyed by the combined audiovisual and PHEH than the control 14-sentence counseling intervention alone.

  9. Multimodal Counseling Interventions: Effect on Human Papilloma Virus Vaccination Acceptance.

    Science.gov (United States)

    Nwanodi, Oroma; Salisbury, Helen; Bay, Curtis

    2017-11-06

    Human papilloma virus (HPV) vaccine was developed to reduce HPV-attributable cancers, external genital warts (EGW), and recurrent respiratory papillomatosis. Adolescent HPV vaccination series completion rates are less than 40% in the United States of America, but up to 80% in Australia and the United Kingdom. Population-based herd immunity requires 80% or greater vaccination series completion rates. Pro-vaccination counseling facilitates increased vaccination rates. Multimodal counseling interventions may increase HPV vaccination series non-completers' HPV-attributable disease knowledge and HPV-attributable disease prophylaxis (vaccination) acceptance over a brief 14-sentence counseling intervention. An online, 4-group, randomized controlled trial, with 260 or more participants per group, found that parents were more likely to accept HPV vaccination offers for their children than were childless young adults for themselves (68.2% and 52.9%). A combined audiovisual and patient health education handout (PHEH) intervention raised knowledge of HPV vaccination purpose, p = 0.02, and HPV vaccination acceptance for seven items, p HPV vaccination acceptance for five items, p HPV causes EGW, and that HPV vaccination prevents HPV-attributable diseases were better conveyed by the combined audiovisual and PHEH than the control 14-sentence counseling intervention alone.

  10. An overview of neoadjuvant chemotherapy in the multimodality treatment of malignant pleural mesothelioma.

    Science.gov (United States)

    Pasello, G; Ceresoli, G L; Favaretto, A

    2013-02-01

    Malignant Pleural Mesothelioma (MPM) is an aggressive tumour with poor prognosis and increasing incidence in industrialized countries because of the previous widespread exposure to asbestos fibres and to the long lag period from time of exposure and the diagnosis of the disease. MPM shows high refractoriety to systemic treatment, single-modality treatment was generally ineffective and did not achieve higher results than supportive care. The incidence of local and distant recurrences after surgery remains high and that was the reason for many centres to perform combined treatments. In the attempt of reducing the incidence of local recurrences, a multimodality approach with surgery followed by adjuvant radiotherapy was explored. Extrapleural pneumonectomy (EPP) allows higher doses of radiotherapy to the whole hemithorax by avoiding pulmonary toxicity and the results of this approach is a significant reduction of loco-regional relapses; although, extrathoracic metastasis represent a major problem in the management of the disease because of the impact on overall survival. The success with surgical resection after neoadjuvant chemotherapy in stage IIIA lung cancer has been the impetus for several groups to apply this strategy in MPM aiming at reducing the incidence of distant relapse after surgery. Platinum-based chemotherapy plus gemcitabine or pemetrexed for 3-4 cycles followed by surgery and postoperative high-dose radiotherapy showed the best results in terms of overall and progression free survival. This review will focus on the main clinical studies and overview the results of different chemotherapy regimens in the neoadjuvant treatment of MPM. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Multimodal Physiotherapy Based on a Biobehavioral Approach as a Treatment for Chronic Tension-Type Headache: A Case Report.

    Science.gov (United States)

    Beltran-Alacreu, Hector; Lopez-de-Uralde-Villanueva, Ibai; La Touche, Roy

    2015-12-01

    Tension-type headache (TTH) is the most common primary headache affecting the general population, which is characterized by bilateral headache and mild to moderate pain. This disorder causes high levels of disability and recent scientific evidence suggests that manual therapy (MT) and therapeutic exercise are effective in reducing medication intake and decreasing the frequency and intensity of headaches in patients with TTH. A 34-year-old woman was known to have chronic TTH. Initially, the patient presented moderate headaches 5 days per week, mechanical neck pain and no positive response to analgesics. A battery of self-reports was given to the patient to assess disability (using the Spanish versions of the Headache Impact Test-6 and the neck disability index), pain (visual analogue scale) and psychosocial issues (Spanish version of the pain catastrophizing scale) involved in the headaches. All measurements were taken four times during 161 days. Eleven sessions of treatment including MT, motor control therapeutic exercise (MCTE) and therapeutic patient education (TPE) were applied. This biobehavioral-based multimodal physical rehabilitation treatment combining MT, TPE and MCTE produced a substantial reduction in pain intensity, pain catastrophizing, disability and the impact of headaches on patient's life.

  12. [Radiofrequency ablation in the multimodal treatment of liver metastases--preliminary report].

    Science.gov (United States)

    Burcoveanu, C; Dogaru, C; Diaconu, C; Grecu, F; Dragomir, Cr; Pricop, Adriana; Balan, G; Drug, V L

    2007-01-01

    Although the "gold standard" in the multimodal treatment of liver primary and secondary tumors is the surgical ablation, the rate of resection, despite the last decades advances, remains still low (10 - 20%). In addition, the interest for non-surgical ablation therapies is increasing. Among them, regional or systemic chemotherapy, intra-arterial radiotherapy as well as locally targeted therapies--cryotherapy, alcohol instillation and radiofrequency (RF) are the most valuable options as alternative to the surgical approach. Between February 2005 - January 2007, 9 patients with liver metastases underwent open RF ablation of their secondaries in the III-rd Surgical Unit, "St. Spiridon" Hospital. An Elektrotom 106 HiTT Berchtold device with a 60W power generator and a 15 mm monopolar active electrode was used. Destruction of the tumors was certified with intraoperative ultrasound examination. Pre- and postoperative CarcinoEmbryonic Antigen (CEA) together with imaging follow-up was carried out, in order to determine local or systemic recurrencies. Six patients died between 6 month - 4 years after the RF ablation. Median survival is 29.2 months. RF ablation is a challenge alternative in non-resectable liver tumors.

  13. Sound effects: Multimodal input helps infants find displaced objects.

    Science.gov (United States)

    Shinskey, Jeanne L

    2017-09-01

    Before 9 months, infants use sound to retrieve a stationary object hidden by darkness but not one hidden by occlusion, suggesting auditory input is more salient in the absence of visual input. This article addresses how audiovisual input affects 10-month-olds' search for displaced objects. In AB tasks, infants who previously retrieved an object at A subsequently fail to find it after it is displaced to B, especially following a delay between hiding and retrieval. Experiment 1 manipulated auditory input by keeping the hidden object audible versus silent, and visual input by presenting the delay in the light versus dark. Infants succeeded more at B with audible than silent objects and, unexpectedly, more after delays in the light than dark. Experiment 2 presented both the delay and search phases in darkness. The unexpected light-dark difference disappeared. Across experiments, the presence of auditory input helped infants find displaced objects, whereas the absence of visual input did not. Sound might help by strengthening object representation, reducing memory load, or focusing attention. This work provides new evidence on when bimodal input aids object processing, corroborates claims that audiovisual processing improves over the first year of life, and contributes to multisensory approaches to studying cognition. Statement of contribution What is already known on this subject Before 9 months, infants use sound to retrieve a stationary object hidden by darkness but not one hidden by occlusion. This suggests they find auditory input more salient in the absence of visual input in simple search tasks. After 9 months, infants' object processing appears more sensitive to multimodal (e.g., audiovisual) input. What does this study add? This study tested how audiovisual input affects 10-month-olds' search for an object displaced in an AB task. Sound helped infants find displaced objects in both the presence and absence of visual input. Object processing becomes more

  14. Multimodal physiotherapy treatment based on a biobehavioral approach for patients with chronic cervico-craniofacial pain: a prospective case series.

    Science.gov (United States)

    Marcos-Martín, Fernando; González-Ferrero, Luis; Martín-Alcocer, Noelia; Paris-Alemany, Alba; La Touche, Roy

    2018-01-17

    The purpose of this prospective case series was to observe and describe changes in patients with chronic cervico-craniofacial pain of muscular origin treated with multimodal physiotherapy based on a biobehavioral approach. Nine patients diagnosed with chronic myofascial temporomandibular disorder and neck pain were treated with 6 sessions over the course of 2 weeks including: (1) orthopedic manual physiotherapy (joint mobilizations, neurodynamic mobilization, and dynamic soft tissue mobilizations); (2) therapeutic exercises (motor control and muscular endurance exercises); and (3) patient education. The outcome measures of craniofacial (CF-PDI) and neck disability (NDI), kinesiophobia (TSK-11) and catastrophizing (PCS), and range of cervical and mandibular motion (ROM) and posture were collected at baseline, and at 2 and 14 weeks post-baseline. Compared to baseline, statistically significant (p posture were observed following a multimodal physiotherapy treatment based on a biobehavioral approach.

  15. Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia

    OpenAIRE

    Schmitz, Karen; Kempker, Russell R; Tenna, Admasu; Stenehjem, Edward; Abebe, Engida; Tadesse, Lia; Jirru, Ermias Kacha; Blumberg, Henry M

    2014-01-01

    Background Hand hygiene is the cornerstone of infection control and reduces rates of healthcare associated infection. There are limited data evaluating hand hygiene adherence and hand hygiene campaign effect in resource-limited settings, especially in Sub-Saharan Africa. This study assessed the impact of implementing a World Health Organization (WHO)-recommended multimodal hand hygiene campaign at a hospital in Ethiopia. Methods This study included a before-and-after assessment of health care...

  16. Is intensive multimodality therapy the best treatment for fournier gangrene? Evaluation of clinical outcome and survival rate of 41 patients.

    Science.gov (United States)

    Wagner, Sigrid; Greco, Francesco; Hoda, M Raschid; Kawan, Felix; Heynemann, Hans; Fornara, Paolo

    2011-10-01

    To evaluate the effect of surgical wound debridement, antibiotics, and hyperbaric oxygen (HBO) in the treatment of Fournier gangrene (FG). Forty-one patients with a mean age of 54.3±14.6 years were referred to our department with a diagnosis of FG. To calculate a Fourier Gangrene Severity Index (FGSI), nine factors were assessed (temperature; heart rate; ventilatory rate; serum sodium, potassium, creatinine, and bicarbonate concentrations; hematocrit; and leukocyte count). After clinical stabilization, extensive debridement of the necrotic tissue was performed, and a surgical vacuum-assisted closure (V.A.C.®) device was applied. Hyperbaric oxygen was administered; medical therapy consisted of intravenous antibiotics, electrolyte replacement, and parenteral nutrition. Intraoperative cultures revealed Escherichia coli in 27 patients (66%), Pseudomonas aeruginosa in 28 (68%), gram-positive cocci in 24 (59%), and mixed flora (aerobic and anaerobic bacteria) in 39 (95%). One month after primary debridement, wound granulation was sufficient for plastic surgical reconstruction in all patients. Because of the rapid worsening of FG, early diagnosis and immediate, aggressive multi-modality therapy with surgical debridement and broad-spectrum empiric antibiotics is crucial. The utility of HBO remains unproved.

  17. Effects of multimodal mandala yoga on social and emotional skills for youth with autism spectrum disorder: An exploratory study

    Directory of Open Access Journals (Sweden)

    Lyn Gorbett Litchke

    2018-01-01

    Full Text Available Context: Youth with autism spectrum disorder (ASD demonstrates impairment in the ability to socially and emotionally relate to others that can limit participation in groups, interaction with peers, and building successful life relationships. Aims: The aim of this exploratory study was to examine the effects of a novel multimodal Mandala yoga program on social and emotional skills for youth with ASD. Subjects and Methods: Five males with ASD attended 1 h yoga sessions, twice a week for 4 weeks. Multimodal Mandala yoga comprised 26 circular partner/group poses, color and tracing sheets, rhythmic chanting, yoga cards, and games. Treatment and Research Institute for ASD Social Skills Assessment (TSSA scores were collected before and after the eight yoga sessions. The Modified Facial Mood Scale (MFMS was used to observe mood changes before and after each yoga class. Paired sample t-tests were conducted on TSSA and MFMS scores to compare social and emotional differences post the 4-week camp. Narrative field notes were documented after each of the eight yoga sessions. Results: A significant improvement from pre- to post-test was found in overall TSSA (t(4 = −5.744, P = 0.005 and on respondent to initiation (t(4 = −3.726, P = 0.020, initiating interaction (t(4 = −8.5, P = 0.039, and affective understanding and perspective taking subscales (t(4 = −5.171 P = 0.007. Youth's MFMS scores increased from 80% to 100% at the end of eight yoga sessions demonstrating a pleasant or positive mood. Thematic analysis of the narrative notes identified three key factors associated with the yoga experience: (a enhanced mood and emotional expression, (b increased empathy toward others, and (c improved teamwork skills. Conclusion: This multimodal Mandala yoga training has implication for developing positive social and emotional skills for youth with ASD.

  18. Effects of Multimodal Mandala Yoga on Social and Emotional Skills for Youth with Autism Spectrum Disorder: An Exploratory Study.

    Science.gov (United States)

    Litchke, Lyn Gorbett; Liu, Ting; Castro, Stephanie

    2018-01-01

    Youth with autism spectrum disorder (ASD) demonstrates impairment in the ability to socially and emotionally relate to others that can limit participation in groups, interaction with peers, and building successful life relationships. The aim of this exploratory study was to examine the effects of a novel multimodal Mandala yoga program on social and emotional skills for youth with ASD. Five males with ASD attended 1 h yoga sessions, twice a week for 4 weeks. Multimodal Mandala yoga comprised 26 circular partner/group poses, color and tracing sheets, rhythmic chanting, yoga cards, and games. Treatment and Research Institute for ASD Social Skills Assessment (TSSA) scores were collected before and after the eight yoga sessions. The Modified Facial Mood Scale (MFMS) was used to observe mood changes before and after each yoga class. Paired sample t -tests were conducted on TSSA and MFMS scores to compare social and emotional differences post the 4-week camp. Narrative field notes were documented after each of the eight yoga sessions. A significant improvement from pre- to post-test was found in overall TSSA ( t (4) = -5.744, P = 0.005) and on respondent to initiation ( t (4) = -3.726, P = 0.020), initiating interaction ( t (4) = -8.5, P = 0.039), and affective understanding and perspective taking subscales ( t (4) = -5.171 P = 0.007). Youth's MFMS scores increased from 80% to 100% at the end of eight yoga sessions demonstrating a pleasant or positive mood. Thematic analysis of the narrative notes identified three key factors associated with the yoga experience: (a) enhanced mood and emotional expression, (b) increased empathy toward others, and (c) improved teamwork skills. This multimodal Mandala yoga training has implication for developing positive social and emotional skills for youth with ASD.

  19. Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department.

    Science.gov (United States)

    Arntz, P R H; Hopman, J; Nillesen, M; Yalcin, E; Bleeker-Rovers, C P; Voss, A; Edwards, M; Wei, A

    2016-11-01

    Hand hygiene (HH) is essential in preventing nosocomial infection. The emergency department (ED) is an open portal of entry for pathogens into the hospital system, hence the important sentinel function of the ED personnel. The main objective of this study was to assess the effect of a multimodal improvement strategy on hand hygiene compliance in the ED. Our study was a prospective before-and-after study to determine the effect of a multimodal improvement strategy on the compliance of HH in the ED according to the My 5 Moments of Hand Hygiene defined by the World Health Organization. Interventions such as education, reminders, and regular feedback on HH performance and role models were planned during the 3 intervention weeks. In total, 57 ED nurses and ED physicians were observed in this study, and approximately 1,000 opportunities for handrubs were evaluated during the 3 intervention periods. HH compliance increased significantly from baseline from 18% (74/407) to 41% (77/190) after the first intervention and stabilized to 50% (99/200) and 46% (96/210) after the second and third interventions, respectively. Implementing a multimodal HH improvement program significantly improved the HH compliance of ED personnel. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  20. A strategy for multimodal deformable image registration to integrate PET/MR into radiotherapy treatment planning

    International Nuclear Information System (INIS)

    Leibfarth, Sara; Moennich, David; Thorwarth, Daniela; Welz, Stefan; Siegel, Christine; Zips, Daniel; Schwenzer, Nina; Holger Schmidt, Holger

    2013-01-01

    Background: Combined positron emission tomography (PET)/magnetic resonance imaging (MRI) is highly promising for biologically individualized radiotherapy (RT). Hence, the purpose of this work was to develop an accurate and robust registration strategy to integrate combined PET/MR data into RT treatment planning. Material and methods: Eight patient datasets consisting of an FDG PET/computed tomography (CT) and a subsequently acquired PET/MR of the head and neck (HN) region were available. Registration strategies were developed based on CT and MR data only, whereas the PET components were fused with the resulting deformation field. Following a rigid registration, deformable registration was performed with a transform parametrized by B-splines. Three different optimization metrics were investigated: global mutual information (GMI), GMI combined with a bending energy penalty (BEP) for regularization (GMI + BEP) and localized mutual information with BEP (LMI + BEP). Different quantitative registration quality measures were developed, including volumetric overlap and mean distance measures for structures segmented on CT and MR as well as anatomical landmark distances. Moreover, the local registration quality in the tumor region was assessed by the normalized cross correlation (NCC) of the two PET datasets. Results: LMI + BEP yielded the most robust and accurate registration results. For GMI, GMI + BEP and LMI + BEP, mean landmark distances (standard deviations) were 23.9 mm (15.5 mm), 4.8 mm (4.0 mm) and 3.0 mm (1.0 mm), and mean NCC values (standard deviations) were 0.29 (0.29), 0.84 (0.14) and 0.88 (0.06), respectively. Conclusion: Accurate and robust multimodal deformable image registration of CT and MR in the HN region can be performed using a B-spline parametrized transform and LMI + BEP as optimization metric. With this strategy, biologically individualized RT based on combined PET/MRI in terms of dose painting is possible

  1. Childhood Predictors of Adult Functional Outcomes in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (MTA).

    Science.gov (United States)

    Roy, Arunima; Hechtman, Lily; Arnold, L Eugene; Swanson, James M; Molina, Brooke S G; Sibley, Margaret H; Howard, Andrea L

    2017-08-01

    Recent results from the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (ADHD; MTA) have demonstrated impairments in several functioning domains in adults with childhood ADHD. The childhood predictors of these adult functional outcomes are not adequately understood. The objective of the present study was to determine the effects of childhood demographic, clinical, and family factors on adult functional outcomes in individuals with and without childhood ADHD from the MTA cohort. Regressions were used to determine associations of childhood factors (age range 7-10 years) of family income, IQ, comorbidity (internalizing, externalizing, and total number of non-ADHD diagnoses), parenting styles, parental education, number of household members, parental marital problems, parent-child relationships, and ADHD symptom severity with adult outcomes (mean age 25 years) of occupational functioning, educational attainment, emotional functioning, sexual behavior, and justice involvement in participants with (n = 579) and without (n = 258) ADHD. Predictors of adult functional outcomes in ADHD included clinical factors such as baseline ADHD severity, IQ, and comorbidity; demographic factors such as family income, number of household members and parental education; and family factors such as parental monitoring and parental marital problems. Predictors of adult outcomes were generally comparable for children with and without ADHD. Childhood ADHD symptoms, IQ, and household income levels are important predictors of adult functional outcomes. Management of these areas early on, through timely treatments for ADHD symptoms, and providing additional support to children with lower IQ and from households with low incomes, could assist in improving adult functioning. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  2. Progression of hydroxychloroquine toxic effects after drug therapy cessation: new evidence from multimodal imaging.

    Science.gov (United States)

    Mititelu, Mihai; Wong, Brandon J; Brenner, Marie; Bryar, Paul J; Jampol, Lee M; Fawzi, Amani A

    2013-09-01

    Given the infrequent occurrence of hydroxychloroquine toxic effects, few data are available about the presenting features and long-term follow-up of patients with hydroxychloroquine retinopathy, making it difficult to surmise the clinical course of patients after cessation of drug treatment. To report functional and structural findings of hydroxychloroquine retinal toxic effects after drug therapy discontinuation. A retrospective medical record review was performed to identify patients taking hydroxychloroquine who were screened for toxic effects from January 1, 2009, through August 31, 2012, in the eye centers of Northwestern University and the University of Southern California. Northwestern University Sorrel Rosin Eye Center, Chicago, Illinois, and the Doheny Eye Institute at the University of Southern California, Los Angeles. Seven consecutive patients diagnosed as having hydroxychloroquine retinal toxic effects. Retinal toxic effects. Seven patients (1 man and 6 women) with a mean age of 55.9 years (age range, 25-74 years) developed retinal toxic effects after using hydroxychloroquine for a mean of 10.4 years (range, 3-19 years). Fundus examination revealed macular pigmentary changes in all 7 patients, corresponding to abnormal fundus autofluorescence (FAF). On spectral domain optical coherence tomography, there was outer retinal foveal resistance (preservation of the external limiting membrane and the photoreceptor layer) in 6 patients. After drug therapy discontinuation, 5 patients experienced outer retinal regeneration (3 subfoveally and 2 parafoveally), with associated functional visual improvement on static perimetry in 2 patients. Over time, FAF remained stable in 3 patients, whereas the remaining patients had a pattern of hypoautofluorescence that replaced areas of initial hyperautofluorescence (2 patients) and enlargement of the total area of abnormal FAF (2 patients). Preservation of the external limiting membrane carries a positive prognostic value in

  3. Fractures after multimodality treatment of soft tissue sarcomas with isolated limb perfusion and radiation; likely to occur and hard to heal.

    Science.gov (United States)

    Seinen, J M; Jutte, P C; Been, L B; Pras, E; Hoekstra, H J

    2018-04-24

    Treatment associated fractures (TAFs) are known severe side effects after surgery and radiotherapy for soft tissue sarcoma (STS). There is no literature about TAF after multimodality treatment with isolated limb perfusion (ILP) for locally advanced STS. This study aimed to analyze predictive factors, treatment and outcome for TAF after multimodality treatment with ILP. Out of 126 consecutive patients undergoing ILP after 1991 till now, 25 patients were excluded due to no surgery or direct amputation at initial surgery. Therefore, 101 patients were at risk and 12 developed a TAF (12%). The majority of tumors was located at the upper leg and knee (N = 60), and 11 patients developed a TAF (18%) after median 28 (5-237) months. Twenty-five tumors were located at the lower leg, and 1 patient developed a TAF after 12 months (4%). No patients with a tumor at the upper extremities (N = 16) developed a TAF. Ten out of 12 patients with a fracture received adjuvant RT with a dose of 50 Gy, and a median boost dose of 18 (10-20) Gy. Predictive factors were periosteal stripping, age over 65 years at time of treatment and tumor size after ILP ≥10 cm. Multivariate analysis showed periosteal stripping and tumor size after ILP ≥10 cm as significant predictive factors. The majority of the fractures were treated with intramedullary nailing. Only one of 12 patients without radiotherapy reached bone union (8%). The median survival after developing TAF was 18 (1-195) months. The overall risk of TAF after multimodality treatment with ILP was relatively high with 15% at ten years. The incidence of TAF for patients with tumors located at the thigh and knee after resection with periosteal stripping and radiotherapy was even >50%. The treatment of these fractures is challenging due to the high non-union rate, requiring an extensive orthopedic oncological TAF experience. Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical

  4. Evaluation of multimodal feedback effects on improving rowing competencies

    Directory of Open Access Journals (Sweden)

    Korman Maria

    2011-12-01

    Full Text Available This study focused on the selection and preliminary evaluation of different types of modal and information feedback in virtual environment to facilitate acquisition and transfer of a complex motor-cognitive skill of rowing. Specifically, we addressed the effectiveness of immediate information feedback provided visually as compared to sensory haptic feedback on the improvement in hands kinematics and changes in cognitive load during the course of learning the basic rowing technique. Several pilot experiments described in this report lead to the evaluation and optimization of the training protocol, to enhance facilitatory effects of adding visual and haptic feedback during training.

  5. A multimodal investigation of contextual effects on alcohol's emotional rewards.

    Science.gov (United States)

    Fairbairn, Catharine E; Bresin, Konrad; Kang, Dahyeon; Rosen, I Gary; Ariss, Talia; Luczak, Susan E; Barnett, Nancy P; Eckland, Nathaniel S

    2018-05-01

    Regular alcohol consumption in unfamiliar social settings has been linked to problematic drinking. A large body of indirect evidence has accumulated to suggest that alcohol's rewarding emotional effects-both negative-mood relieving and positive-mood enhancing-will be magnified when alcohol is consumed within unfamiliar versus familiar social contexts. But empirical research has never directly examined links between contextual familiarity and alcohol reward. In the current study, we mobilized novel ambulatory technology to examine the effect of social familiarity on alcohol reward in everyday drinking contexts while also examining how alcohol reward observed in these field contexts corresponds to reward observed in the laboratory. Heavy social drinking participants (N = 48, 50% male) engaged in an intensive week of ambulatory assessment. Participants wore transdermal alcohol sensors while they reported on their mood and took photographs of their social contexts in response to random prompts. Participants also attended 2 laboratory beverage-administration sessions, during which their emotional responses were assessed and transdermal sensors were calibrated to estimate breathalyzer readings (eBrACs). Results indicated a significant interaction between social familiarity and alcohol episode in everyday drinking settings, with alcohol enhancing mood to a greater extent in relatively unfamiliar versus familiar social contexts. Findings also indicated that drinking in relatively unfamiliar social settings was associated with higher eBrACs. Finally, results indicated a correspondence between some mood effects of alcohol experienced inside and outside the laboratory. This study presents a novel methodology for examining alcohol reward and indicates social familiarity as a promising direction for research seeking to explain problematic drinking. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  6. Chirp effects on impulsive vibrational spectroscopy: a multimode perspective.

    Science.gov (United States)

    Wand, Amir; Kallush, Shimshon; Shoshanim, Ofir; Bismuth, Oshrat; Kosloff, Ronnie; Ruhman, Sanford

    2010-03-07

    The well-documented propensity of negatively-chirped pulses to enhance resonant impulsive Raman scattering has been rationalized in terms of a one pulse pump-dump sequence which "follows" the evolution of the excited molecules and dumps them back at highly displaced configurations. The aim of this study was to extend the understanding of this effect to molecules with many displaced vibrational modes in the presence of condensed surroundings. In particular, to define an optimally chirped pulse, to investigate what exactly it "follows" and to discover how this depends on the molecule under study. To this end, linear chirp effects on vibrational coherences in poly-atomics are investigated experimentally and theoretically. Chirped pump-impulsive probe experiments are reported for Sulforhodamine-B ("Kiton Red"), Betaine-30 and Oxazine-1 in ethanol solutions with <10 fs resolution. Numerical simulations, including numerous displaced modes and electronic dephasing, are conducted to reproduce experimental results. Through semi-quantitative reproduction of experimental results in all three systems we show that the effect of group velocity dispersion (GVD) on the buildup of ground state wave-packets depends on the pulse spectrum, on the displacements of vibrational modes upon excitation, on the detuning of the excitation pulses from resonance, and on electronic dephasing rates. Akin to scenarios described for frequency-domain resonance Raman, within the small-displacement regime each mode responds to excitation chirp independently and the optimal GVD is mode-specific. Highly-displaced modes entangle the dynamics of excitation in different modes, requiring a multi-dimensional description of the response. Rapid photochemistry and ultrafast electronic dephasing narrow the window of opportunity for coherent manipulations, leading to a reduced and similar optimal chirp for different modes. Finally, non-intuitive coherent aspects of chirp "following" are predicted in the small

  7. Acute and late effects of multimodal therapy on normal tissues

    International Nuclear Information System (INIS)

    Phillips, T.L.; Fu, K.K.

    1977-01-01

    The increasing use of combined radiation, chemotherapy, and surgery has led to an increased incidence of acute and late complications. The complications are, in general, similar to those seen with each modality alone, but occur with increased incidence. Enhanced effects of combined radiation and surgery are modest in number and consist primarily of problems with wound healing and fibrosis, as well as late gastrointestinal damage. Combinations of radiotherapy and chemotherapy have shown a greater degree of enhanced acute and late reactions. Drugs, such as actinomycin-D and Adriamycin, are particularly dangerous if the marked enhancement of radiation effects caused by the drugs in almost all organs is not appreciated and the radiation dose not adjusted accordingly. Proper selection of drugs can lead to enhanced local control by radiotherapy and/or surgery, as well as eradication of microscopic distant metastases, without increased normal tissue injury. Late induction of malignancy can occur with either radiation or chemotherapy alone and, in some cases, this appears to be enhanced when they are combined

  8. Link Design Rules for Cost-Effective Short-Range Radio Over Multimode Fiber Systems

    DEFF Research Database (Denmark)

    Visani, Davide; Tartarini, Giovanni; Petersen, Martin Nordal

    2010-01-01

    Referring to short-range radio over multimode fiber links, we find out important guidelines for the realization of cost-effective intensity modulated directly detected systems. Since the quality of today's connectors is considerably higher than in the past, we demonstrate that two important...... parameters of the system are the finite detecting area of the photodiode and the laser frequency chirp. Furthemore, we show that the use of the central launch technique inherently determines a lower impact of modal noise fluctuations with respect to the offset launch one. This makes CL more convenient...

  9. In vivo evaluation of adipose- and muscle-derived stem cells as a treatment for nonhealing diabetic wounds using multimodal microscopy

    Science.gov (United States)

    Li, Joanne; Pincu, Yair; Marjanovic, Marina; Bower, Andrew J.; Chaney, Eric J.; Jensen, Tor; Boppart, Marni D.; Boppart, Stephen A.

    2016-08-01

    Impaired skin wound healing is a significant comorbid condition of diabetes, which often results in nonhealing diabetic ulcers due to poor peripheral microcirculation, among other factors. The effectiveness of the regeneration of adipose-derived stem cells (ADSCs) and muscle-derived stem cells (MDSCs) was assessed using an integrated multimodal microscopy system equipped with two-photon fluorescence and second-harmonic generation imaging. These imaging modalities, integrated in a single platform for spatial and temporal coregistration, allowed us to monitor in vivo changes in the collagen network and cell dynamics in a skin wound. Fluorescently labeled ADSCs and MDSCs were applied topically to the wound bed of wild-type and diabetic (db/db) mice following punch biopsy. Longitudinal imaging demonstrated that ADSCs and MDSCs provided remarkable capacity for improved diabetic wound healing, and integrated microscopy revealed a more organized collagen remodeling in the wound bed of treated mice. The results from this study verify the regenerative capacity of stem cells toward healing and, with multimodal microscopy, provide insight regarding their impact on the skin microenvironment. The optical method outlined in this study, which has the potential for in vivo human use, may optimize the care and treatment of diabetic nonhealing wounds.

  10. Duloxetine contributing to a successful multimodal treatment program for peripheral femoral neuropathy and comorbid 'reactive depression' in an adolescent.

    Science.gov (United States)

    Kachko, Ludmyla; Ben Ami, Shiri; Liberman, Alon; Birk, Einat; Kronenberg, Sefi

    2011-01-01

    In the United States, duloxetine has been approved for the treatment of major depressive disorder, diabetic peripheral neuropathic pain and fibromyalgia in the adult population. Data regarding the use of duloxetine in the pediatric population, however, are very limited. Femoral nerve injury is a rare complication of cardiac catheterization. In the case described, duloxetine contributed to a successful multimodal treatment program for peripheral neuropathic pain due to femoral neuropathy in an adolescent with 'reactive depression' and conversion symptoms. To the best of the authors' knowledge, the present article is only the third such report on this dual use of duloxetine in children and adolescents, and the first report of such treatment following femoral neuropathy induced by cardiac catheterization.

  11. Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication.

    Science.gov (United States)

    Molina, Brooke S G; Hinshaw, Stephen P; Eugene Arnold, L; Swanson, James M; Pelham, William E; Hechtman, Lily; Hoza, Betsy; Epstein, Jeffery N; Wigal, Timothy; Abikoff, Howard B; Greenhill, Laurence L; Jensen, Peter S; Wells, Karen C; Vitiello, Benedetto; Gibbons, Robert D; Howard, Andrea; Houck, Patricia R; Hur, Kwan; Lu, Bo; Marcus, Sue

    2013-03-01

    To determine long-term effects on substance use and substance use disorder (SUD), up to 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA; n = 436); to test whether medication at follow-up, cumulative psychostimulant treatment over time, or both relate to substance use/SUD; and to compare substance use/SUD in the ADHD sample to the non-ADHD childhood classmate comparison group (n = 261). Mixed-effects regression models with planned contrasts were used for all tests except the important cumulative stimulant treatment question, for which propensity score matching analysis was used. The originally randomized treatment groups did not differ significantly on substance use/SUD by the 8-year follow-up or earlier (mean age = 17 years). Neither medication at follow-up (mostly stimulants) nor cumulative stimulant treatment was associated with adolescent substance use/SUD. Substance use at all time points, including use of two or more substances and SUD, were each greater in the ADHD than in the non-ADHD samples, regardless of sex. Medication for ADHD did not protect from, or contribute to, visible risk of substance use or SUD by adolescence, whether analyzed as randomized treatment assignment in childhood, as medication at follow-up, or as cumulative stimulant treatment over an 8-year follow-up from childhood. These results suggest the need to identify alternative or adjunctive adolescent-focused approaches to substance abuse prevention and treatment for boys and girls with ADHD, especially given their increased risk for use and abuse of multiple substances that is not improved with stimulant medication. Clinical trial registration information-Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); http://clinical trials.gov/; NCT00000388. Copyright © 2013 American Academy of Child and Adolescent

  12. Preparation and evaluation of a multimodal minoxidil microemulsion versus minoxidil alone in the treatment of androgenic alopecia of mixed etiology: a pilot study

    Directory of Open Access Journals (Sweden)

    Sakr FM

    2013-05-01

    < 0.001, mean hair weight (P < 0.001, and mean hair thickness (P < 0.05. A patient self-assessment questionnaire demonstrated that the multimodal minoxidil formulation significantly (P < 0.001 slowed hair loss, increased hair growth, and improved appearance, and showed no appreciable side effects, such as itching and/or inflammation of the scalp compared with the minoxidil alone and placebo formulations. These improvements were in agreement with the photographic assessments made by the investigators. Formula A was shown to be an o/w formulation with consistent pH, viscosity, specific gravity, and homogeneity, and was physically stable after 24 months of normal storage. Conclusion: A multimodal microemulsion comprising minoxidil, diclofenac, and tea tree oil was significantly superior to minoxidil alone and placebo in terms of stability, safety, and efficacy, and achieved an earlier response in the treatment of androgenic alopecia compared with minoxidil alone in this 32-week pilot study. Keywords: androgenic alopecia, diclofenac, microemulsion, minoxidil, nonsteroidal anti-inflammatory agents, tea tree oil

  13. Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia

    Science.gov (United States)

    2014-01-01

    Background Hand hygiene is the cornerstone of infection control and reduces rates of healthcare associated infection. There are limited data evaluating hand hygiene adherence and hand hygiene campaign effect in resource-limited settings, especially in Sub-Saharan Africa. This study assessed the impact of implementing a World Health Organization (WHO)-recommended multimodal hand hygiene campaign at a hospital in Ethiopia. Methods This study included a before-and-after assessment of health care worker (HCW) adherence with WHO hand hygiene guidelines. It was implemented in three phases: 1) baseline evaluation of hand hygiene adherence and hospital infrastructure; 2) intervention (distribution of commercial hand sanitizer and implementation of an abbreviated WHO-recommended multimodal hand hygiene campaign); and 3) post-intervention evaluation of HCW hand hygiene adherence. HCWs’ perceptions of the campaign and hand sanitizer tolerability were assessed through a survey performed in the post-intervention period. Results At baseline, hand washing materials were infrequently available, with only 20% of sinks having hand-washing materials. There was a significant increase in hand hygiene adherence among HCWs following implementation of a WHO multimodal hand hygiene program. Adherence increased from 2.1% at baseline (21 hand hygiene actions/1000 opportunities for hand hygiene) to 12.7% (127 hand hygiene actions /1000 opportunities for hand hygiene) after the implementation of the hand hygiene campaign (OR = 6.8, 95% CI 4.2-10.9). Hand hygiene rates significantly increased among all HCW types except attending physicians. Independent predictors of HCW hand hygiene compliance included performing hand hygiene in the post-intervention period (aOR = 5.7, 95% CI 3.5-9.3), in the emergency department (aOR = 4.9, 95% CI 2.8-8.6), during patient care that did not involve Attending Physician Rounds (aOR = 2.4, 95% CI 1.2-4.5), and after patient contact (aOR = 2

  14. Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia.

    Science.gov (United States)

    Schmitz, Karen; Kempker, Russell R; Tenna, Admasu; Stenehjem, Edward; Abebe, Engida; Tadesse, Lia; Jirru, Ermias Kacha; Blumberg, Henry M

    2014-03-17

    Hand hygiene is the cornerstone of infection control and reduces rates of healthcare associated infection. There are limited data evaluating hand hygiene adherence and hand hygiene campaign effect in resource-limited settings, especially in Sub-Saharan Africa. This study assessed the impact of implementing a World Health Organization (WHO)-recommended multimodal hand hygiene campaign at a hospital in Ethiopia. This study included a before-and-after assessment of health care worker (HCW) adherence with WHO hand hygiene guidelines. It was implemented in three phases: 1) baseline evaluation of hand hygiene adherence and hospital infrastructure; 2) intervention (distribution of commercial hand sanitizer and implementation of an abbreviated WHO-recommended multimodal hand hygiene campaign); and 3) post-intervention evaluation of HCW hand hygiene adherence. HCWs' perceptions of the campaign and hand sanitizer tolerability were assessed through a survey performed in the post-intervention period. At baseline, hand washing materials were infrequently available, with only 20% of sinks having hand-washing materials. There was a significant increase in hand hygiene adherence among HCWs following implementation of a WHO multimodal hand hygiene program. Adherence increased from 2.1% at baseline (21 hand hygiene actions/1000 opportunities for hand hygiene) to 12.7% (127 hand hygiene actions /1000 opportunities for hand hygiene) after the implementation of the hand hygiene campaign (OR = 6.8, 95% CI 4.2-10.9). Hand hygiene rates significantly increased among all HCW types except attending physicians. Independent predictors of HCW hand hygiene compliance included performing hand hygiene in the post-intervention period (aOR = 5.7, 95% CI 3.5-9.3), in the emergency department (aOR = 4.9, 95% CI 2.8-8.6), during patient care that did not involve Attending Physician Rounds (aOR = 2.4, 95% CI 1.2-4.5), and after patient contact (aOR = 2.1, 95% CI 1.4-3.3). In the

  15. [New aspects of complex chronic tinnitus. I: Assessment of a multi-modality behavioral medicine treatment concept].

    Science.gov (United States)

    Goebel, G; Keeser, W; Fichter, M; Rief, W

    1991-01-01

    "Complex tinnitus" is a diagnostic term denoting a disturbance pattern where the patient hears highly annoying and painful noises or sounds that do not originate from a recognisable external source and can be described only by the patient himself. It seems that the suffering mainly depends upon the extent to which the tinnitus is experienced as a phenomenon that is beyond control. Part I reports on an examination of the treatment success achieved with 28 consecutive patients who had been treated according to an integrative multimodal behavioural medicine concept. This resulted--despite continual loudness--in a decrease in the degree of unpleasantness of the tinnitus, by 17% (p less than 0.01) with corresponding normalisation of decisive symptom factors in Hopkins Symptom-Check-List (SCL-90-R) and Freiburg Personality-Inventary (FPI-R). On the whole, 19 out of the total of 28 patients showed essential to marked improvement of the disturbance pattern. Part II presents a multidimensional tinnitus model and the essential psychotherapeutic focal points of a multimodal psychotherapy concept in complex chronic tinnitus, as well as the parallel phenomena in the chronic pain syndrome.

  16. The efficacy of multimodality treatment for breast cancer depending on the surgery volume in menopausal patients

    International Nuclear Information System (INIS)

    Ponomar'ov, Yi.M.

    2005-01-01

    The effect of conservative treatment in menopausal patients were studied. Irrespective of the volume of surgery, in patients with stage 1 and 2 breast cancer aged over 55, the tumor size (<5 cm), location of the tumor do not influence considerably survival values

  17. HPMA copolymer-conjugated pirarubicin in multimodal treatment of a patient with stage IV prostate cancer and extensive lung and bone metastases

    Czech Academy of Sciences Publication Activity Database

    Dozono, H.; Yanazume, S.; Nakamura, H.; Etrych, Tomáš; Chytil, Petr; Ulbrich, Karel; Fang, J.; Arimura, T.; Douchi, T.; Kobayashi, H.; Ikoma, M.; Maeda, H.

    2016-01-01

    Roč. 11, č. 1 (2016), s. 101-106 ISSN 1776-2596 R&D Projects: GA ČR(CZ) GCP207/12/J030; GA MŠk(CZ) EE2.3.30.0029 Institutional support: RVO:61389013 Keywords : HPMA copolymer * piraraubicin * multimodal treatment Subject RIV: CD - Macromolecular Chemistry Impact factor: 3.438, year: 2016

  18. Sex in the Curriculum: The Effect of a Multi-Modal Sexual History-Taking Module on Medical Student Skills

    Science.gov (United States)

    Lindau, Stacy Tessler; Goodrich, Katie G.; Leitsch, Sara A.; Cook, Sandy

    2008-01-01

    Purpose: The objective of this study was to determine the effect of a multi-modal curricular intervention designed to teach sexual history-taking skills to medical students. The Association of Professors of Gynecology and Obstetrics, the National Board of Medical Examiners, and others, have identified sexual history-taking as a learning objective…

  19. Investigating the Abscopal Effects of Radioablation on Shielded Bone Marrow in Rodent Models Using Multimodality Imaging.

    Science.gov (United States)

    Afshar, Solmaz F; Zawaski, Janice A; Inoue, Taeko; Rendon, David A; Zieske, Arthur W; Punia, Jyotinder N; Sabek, Omaima M; Gaber, M Waleed

    2017-07-01

    The abscopal effect is the response to radiation at sites that are distant from the irradiated site of an organism, and it is thought to play a role in bone marrow (BM) recovery by initiating responses in the unirradiated bone marrow. Understanding the mechanism of this effect has applications in treating BM failure (BMF) and BM transplantation (BMT), and improving survival of nuclear disaster victims. Here, we investigated the use of multimodality imaging as a translational tool to longitudinally assess bone marrow recovery. We used positron emission tomography/computed tomography (PET/CT), magnetic resonance imaging (MRI) and optical imaging to quantify bone marrow activity, vascular response and marrow repopulation in fully and partially irradiated rodent models. We further measured the effects of radiation on serum cytokine levels, hematopoietic cell counts and histology. PET/CT imaging revealed a radiation-induced increase in proliferation in the shielded bone marrow (SBM) compared to exposed bone marrow (EBM) and sham controls. T 2 -weighted MRI showed radiation-induced hemorrhaging in the EBM and unirradiated SBM. In the EBM and SBM groups, we found alterations in serum cytokine and hormone levels and in hematopoietic cell population proportions, and histological evidence of osteoblast activation at the bone marrow interface. Importantly, we generated a BMT mouse model using fluorescent-labeled bone marrow donor cells and performed fluorescent imaging to reveal the migration of bone marrow cells from shielded to radioablated sites. Our study validates the use of multimodality imaging to monitor bone marrow recovery and provides evidence for the abscopal response in promoting bone marrow recovery after irradiation.

  20. Linear Narratives, Arbitrary Relationships: Arbitrary Relationships: Mimesis and Direct Communication for Effectively Representing Engineering Realities Multimodally

    Science.gov (United States)

    Jeyaraj, Joseph

    2017-01-01

    Engineers communicate multimodally using written and visual communication, but there is not much theorizing on why they do so and how. This essay, therefore, examines why engineers communicate multimodally, what, in the context of representing engineering realities, are the strengths and weaknesses of written and visual communication, and how,…

  1. The Effects of Using Multimodal Approaches in Meaning-Making of 21st Century Literacy Texts Among ESL Students in a Private School in Malaysia

    Directory of Open Access Journals (Sweden)

    Malini Ganapathy

    2016-04-01

    Full Text Available In today’s globalised digital era, students are inevitably engaged in various multimodal texts due to their active participation in social media and frequent usage of mobile devices on a daily basis. Such daily activities advocate the need for a transformation in the teaching and learning of ESL lessons in order to promote students’ capabilities in making meaning of different literacy texts which students come across in their ESL learning activities. This paper puts forth the framework of Multimodality in the restructuring of the teaching and learning of ESL with the aim of investigating its effects and students perspectives on the use of multimodal approaches underlying the Multiliteracies theory. Using focus group interviews, this qualitative case study examines the effectiveness of ESL teaching and learning using the Multimodal approaches on literacy in meaning-making among 15 students in a private school in Penang, Malaysia. The results confirm the need to reorientate the teaching and learning of ESL with the focus on multimodal pedagogical practices as it promotes positive learning outcomes among students. The implications of this study suggest that the multimodal approaches integrated in the teaching and learning of ESL have the capacity to promote students’ autonomy in learning, improve motivation to learn and facilitate various learning styles. Keywords: Multimodal Approaches; Multiliteracies; Monomodal; Flipped Classroom; Literacy; Multimodal texts; Ipad

  2. Learning multimodal dictionaries.

    Science.gov (United States)

    Monaci, Gianluca; Jost, Philippe; Vandergheynst, Pierre; Mailhé, Boris; Lesage, Sylvain; Gribonval, Rémi

    2007-09-01

    Real-world phenomena involve complex interactions between multiple signal modalities. As a consequence, humans are used to integrate at each instant perceptions from all their senses in order to enrich their understanding of the surrounding world. This paradigm can be also extremely useful in many signal processing and computer vision problems involving mutually related signals. The simultaneous processing of multimodal data can, in fact, reveal information that is otherwise hidden when considering the signals independently. However, in natural multimodal signals, the statistical dependencies between modalities are in general not obvious. Learning fundamental multimodal patterns could offer deep insight into the structure of such signals. In this paper, we present a novel model of multimodal signals based on their sparse decomposition over a dictionary of multimodal structures. An algorithm for iteratively learning multimodal generating functions that can be shifted at all positions in the signal is proposed, as well. The learning is defined in such a way that it can be accomplished by iteratively solving a generalized eigenvector problem, which makes the algorithm fast, flexible, and free of user-defined parameters. The proposed algorithm is applied to audiovisual sequences and it is able to discover underlying structures in the data. The detection of such audio-video patterns in audiovisual clips allows to effectively localize the sound source on the video in presence of substantial acoustic and visual distractors, outperforming state-of-the-art audiovisual localization algorithms.

  3. Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation: Randomized Controlled Trial.

    Science.gov (United States)

    Nordin, Catharina A; Michaelson, Peter; Gard, Gunvor; Eriksson, Margareta K

    2016-10-05

    Web-based interventions with a focus on behavior change have been used for pain management, but studies of Web-based interventions integrated in clinical practice are lacking. To emphasize the development of cognitive skills and behavior, and to increase activity and self-care in rehabilitation, the Web Behavior Change Program for Activity (Web-BCPA) was developed and added to multimodal pain rehabilitation (MMR). The objective of our study was to evaluate the effects of MMR in combination with the Web-BCPA compared with MMR among persons with persistent musculoskeletal pain in primary health care on pain intensity, self-efficacy, and copying, as part of a larger collection of data. Web-BCPA adherence and feasibility, as well as treatment satisfaction, were also investigated. A total of 109 participants, mean age 43 (SD 11) years, with persistent pain in the back, neck, shoulder, and/or generalized pain were recruited to a randomized controlled trial with two intervention arms: (1) MMR+WEB (n=60) and (2) MMR (n=49). Participants in the MMR+WEB group self-guided through the eight modules of the Web-BCPA: pain, activity, behavior, stress and thoughts, sleep and negative thoughts, communication and self-esteem, solutions, and maintenance and progress. Data were collected with a questionnaire at baseline and at 4 and 12 months. Outcome measures were pain intensity (Visual Analog Scale), self-efficacy to control pain and to control other symptoms (Arthritis Self-Efficacy Scale), general self-efficacy (General Self-Efficacy Scale), and coping (two-item Coping Strategies Questionnaire; CSQ). Web-BCPA adherence was measured as minutes spent in the program. Satisfaction and Web-BCPA feasibility were assessed by a set of items. Of 109 participants, 99 received the allocated intervention (MMR+WEB: n=55; MMR: n=44); 88 of 99 (82%) completed the baseline and follow-up questionnaires. Intention-to-treat analyses were performed with a sample size of 99. The MMR+WEB intervention

  4. Tractography-Based Score for Learning Effective Connectivity From Multimodal Imaging Data Using Dynamic Bayesian Networks.

    Science.gov (United States)

    Dang, Shilpa; Chaudhury, Santanu; Lall, Brejesh; Roy, Prasun K

    2018-05-01

    Effective connectivity (EC) is the methodology for determining functional-integration among the functionally active segregated regions of the brain. By definition EC is "the causal influence exerted by one neuronal group on another" which is constrained by anatomical connectivity (AC) (axonal connections). AC is necessary for EC but does not fully determine it, because synaptic communication occurs dynamically in a context-dependent fashion. Although there is a vast emerging evidence of structure-function relationship using multimodal imaging studies, till date only a few studies have done joint modeling of the two modalities: functional MRI (fMRI) and diffusion tensor imaging (DTI). We aim to propose a unified probabilistic framework that combines information from both sources to learn EC using dynamic Bayesian networks (DBNs). DBNs are probabilistic graphical temporal models that learn EC in an exploratory fashion. Specifically, we propose a novel anatomically informed (AI) score that evaluates fitness of a given connectivity structure to both DTI and fMRI data simultaneously. The AI score is employed in structure learning of DBN given the data. Experiments with synthetic-data demonstrate the face validity of structure learning with our AI score over anatomically uninformed counterpart. Moreover, real-data results are cross-validated by performing classification-experiments. EC inferred on real fMRI-DTI datasets is found to be consistent with previous literature and show promising results in light of the AC present as compared to other classically used techniques such as Granger-causality. Multimodal analyses provide a more reliable basis for differentiating brain under abnormal/diseased conditions than the single modality analysis.

  5. Multi-Modality Imaging in the Evaluation and Treatment of Mitral Regurgitation.

    Science.gov (United States)

    Bouchard, Marc-André; Côté-Laroche, Claudia; Beaudoin, Jonathan

    2017-10-13

    Mitral regurgitation (MR) is frequent and associated with increased mortality and morbidity when severe. It may be caused by intrinsic valvular disease (primary MR) or ventricular deformation (secondary MR). Imaging has a critical role to document the severity, mechanism, and impact of MR on heart function as selected patients with MR may benefit from surgery whereas other will not. In patients planned for a surgical intervention, imaging is also important to select candidates for mitral valve (MV) repair over replacement and to predict surgical success. Although standard transthoracic echocardiography is the first-line modality to evaluate MR, newer imaging modalities like three-dimensional (3D) transesophageal echocardiography, stress echocardiography, cardiac magnetic resonance (CMR), and computed tomography (CT) are emerging and complementary tools for MR assessment. While some of these modalities can provide insight into MR severity, others will help to determine its mechanism. Understanding the advantages and limitations of each imaging modality is important to appreciate their respective role for MR assessment and help to resolve eventual discrepancies between different diagnostic methods. With the increasing use of transcatheter mitral procedures (repair or replacement) for high-surgical-risk patients, multimodality imaging has now become even more important to determine eligibility, preinterventional planning, and periprocedural guidance.

  6. Duloxetine Contributing to a Successful Multimodal Treatment Program for Peripheral Femoral Neuropathy and Comorbid ‘Reactive Depression’ in an Adolescent

    OpenAIRE

    Kachko, Ludmyla; Ben Ami, Shiri; Liberman, Alon; Birk, Einat; Kronenberg, Sefi

    2011-01-01

    In the United States, duloxetine has been approved for the treatment of major depressive disorder, diabetic peripheral neuropathic pain and fibromyalgia in the adult population. Data regarding the use of duloxetine in the pediatric population, however, are very limited. Femoral nerve injury is a rare complication of cardiac catheterization. In the case described, duloxetine contributed to a successful multimodal treatment program for peripheral neuropathic pain due to femoral neuropathy in an...

  7. Effective Fusion of Multi-Modal Remote Sensing Data in a Fully Convolutional Network for Semantic Labeling

    Directory of Open Access Journals (Sweden)

    Wenkai Zhang

    2017-12-01

    Full Text Available In recent years, Fully Convolutional Networks (FCN have led to a great improvement of semantic labeling for various applications including multi-modal remote sensing data. Although different fusion strategies have been reported for multi-modal data, there is no in-depth study of the reasons of performance limits. For example, it is unclear, why an early fusion of multi-modal data in FCN does not lead to a satisfying result. In this paper, we investigate the contribution of individual layers inside FCN and propose an effective fusion strategy for the semantic labeling of color or infrared imagery together with elevation (e.g., Digital Surface Models. The sensitivity and contribution of layers concerning classes and multi-modal data are quantified by recall and descent rate of recall in a multi-resolution model. The contribution of different modalities to the pixel-wise prediction is analyzed explaining the reason of the poor performance caused by the plain concatenation of different modalities. Finally, based on the analysis an optimized scheme for the fusion of layers with image and elevation information into a single FCN model is derived. Experiments are performed on the ISPRS Vaihingen 2D Semantic Labeling dataset (infrared and RGB imagery as well as elevation and the Potsdam dataset (RGB imagery and elevation. Comprehensive evaluations demonstrate the potential of the proposed approach.

  8. Prospective, longitudinal, multi-modal functional imaging for radical chemo-IMRT treatment of locally advanced head and neck cancer: the INSIGHT study

    International Nuclear Information System (INIS)

    Welsh, Liam; Panek, Rafal; McQuaid, Dualta; Dunlop, Alex; Schmidt, Maria; Riddell, Angela; Koh, Dow-Mu; Doran, Simon; Murray, Iain; Du, Yong; Chua, Sue; Hansen, Vibeke; Wong, Kee H.; Dean, Jamie; Gulliford, Sarah; Bhide, Shreerang; Leach, Martin O.; Nutting, Christopher; Harrington, Kevin; Newbold, Kate

    2015-01-01

    Radical chemo-radiotherapy (CRT) is an effective organ-sparing treatment option for patients with locally advanced head and neck cancer (LAHNC). Despite advances in treatment for LAHNC, a significant minority of these patients continue to fail to achieve complete response with standard CRT. By constructing a multi-modality functional imaging (FI) predictive biomarker for CRT outcome for patients with LAHNC we hope to be able to reliably identify those patients at high risk of failing standard CRT. Such a biomarker would in future enable CRT to be tailored to the specific biological characteristics of each patients’ tumour, potentially leading to improved treatment outcomes. The INSIGHT study is a single-centre, prospective, longitudinal multi-modality imaging study using functional MRI and FDG-PET/CT for patients with LAHNC squamous cell carcinomas receiving radical CRT. Two cohorts of patients are being recruited: one treated with, and another treated without, induction chemotherapy. All patients receive radical intensity modulated radiotherapy with concurrent chemotherapy. Patients undergo functional imaging before, during and 3 months after completion of radiotherapy, as well as at the time of relapse, should that occur within the first two years after treatment. Serum samples are collected from patients at the same time points as the FI scans for analysis of a panel of serum markers of tumour hypoxia. The primary aim of the INSIGHT study is to acquire a prospective multi-parametric longitudinal data set comprising functional MRI, FDG PET/CT, and serum biomarker data from patients with LAHNC undergoing primary radical CRT. This data set will be used to construct a predictive imaging biomarker for outcome after CRT for LAHNC. This predictive imaging biomarker will be used in future studies of functional imaging based treatment stratification for patients with LAHNC. Additional objectives are: defining the reproducibility of FI parameters; determining robust

  9. Efficacy of a multimodal treatment for disruptive behavior disorders in children and adolescents: focus on internalizing problems.

    Science.gov (United States)

    Masi, Gabriele; Milone, Annarita; Paciello, Marinella; Lenzi, Francesca; Muratori, Pietro; Manfredi, Azzurra; Polidori, Lisa; Ruglioni, Laura; Lochman, John E; Muratori, Filippo

    2014-11-30

    Disruptive Behavior Disorders (DBDs) are among the most common reasons for youth referrals to mental health clinics. Aim of this study is to compare short and medium term efficacy of a multimodal treatment program (MTP), compared to community care (treatment-as-usual, TAU). The sample included 135 youths with DBDs (113 males, age range 9-15 years, mean age 12±2.5 years) were assigned either to a MTP (n=64), or addressed to community care for a TAU (n=71). Outcome measures were the Child Behaviour Checklist (CBCL) and the Children's Global Assessment Scale (C-GAS). All subjects were assessed at the baseline (T0), after 1-year treatment (T1) and after a 2-year follow-up (T2). Compared with patients receiving TAU, youths in the MTP showed, both at T1 and T2, significantly lower scores on CBCL Externalizing Scale, Internalizing Scale, Anxious/Depressed, Social Problems, and Aggressive Behavior, and higher scores at the C-GAS. Improvement in Internalizing Scales was particularly evident, with a shift from the clinical to the non-clinical range. Rate of use of mental health services and scholastic failure were reduced in the MTP. It is suggested that the improvement of the Internalizing symptoms is a crucial component of the therapeutic process in this MTP. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  10. Self-imaging effect of TM modes in photonic crystal multimode waveguides only exhibiting band gaps for TE modes

    International Nuclear Information System (INIS)

    Yu Tianbao; Jiang Xiaoqing; Yang Jianyi; Zhou Haifeng; Liao Qinghua; Wang Minghua

    2007-01-01

    This Letter presents the properties of transverse-magnetic (TM) modes in multimode photonic crystal waveguides (PCWs), which only exhibit photonic band gaps for transverse-electric (TE) modes. A good equivalent model is applied to analysis the designed structures on the basis of multimode interference effect and self-imaging principle. The performance shows that the TM modes can also be propagated with high efficiency, and resemble index-guided modes owing to the combination of total internal reflection (TIR) and distribution Bragg reflection. It provides a novel way to realize the components for both TM and TE polarizations by combining PBG and TIR effect in PCWs. As one of potential applications, polarization-insensitive power splitter based on the proposed structures can be designed

  11. Discovery of 1-[2-(2,4-dimethylphenylsulfanyl)phenyl]piperazine (Lu AA21004): a novel multimodal compound for the treatment of major depressive disorder.

    Science.gov (United States)

    Bang-Andersen, Benny; Ruhland, Thomas; Jørgensen, Morten; Smith, Garrick; Frederiksen, Kristen; Jensen, Klaus Gjervig; Zhong, Huailing; Nielsen, Søren Møller; Hogg, Sandra; Mørk, Arne; Stensbøl, Tine Bryan

    2011-05-12

    The synthesis and structure-activity relationship of a novel series of compounds with combined effects on 5-HT(3A) and 5-HT(1A) receptors and on the serotonin (5-HT) transporter (SERT) are described. Compound 5m (Lu AA21004) was the lead compound, displaying high affinity for recombinant human 5-HT(1A) (K(i) = 15 nM), 5-HT(1B) (K(i) = 33 nM), 5-HT(3A) (K(i) = 3.7 nM), 5-HT(7) (K(i) = 19 nM), and noradrenergic β(1) (K(i) = 46 nM) receptors, and SERT (K(i) = 1.6 nM). Compound 5m displayed antagonistic properties at 5-HT(3A) and 5-HT(7) receptors, partial agonist properties at 5-HT(1B) receptors, agonistic properties at 5-HT(1A) receptors, and potent inhibition of SERT. In conscious rats, 5m significantly increased extracellular 5-HT levels in the brain after acute and 3 days of treatment. Following the 3-day treatment (5 or 10 (mg/kg)/day) SERT occupancies were only 43% and 57%, respectively. These characteristics indicate that 5m is a novel multimodal serotonergic compound, and 5m is currently in clinical development for major depressive disorder.

  12. MULTIMODAL ANALGESIC EFFECT ON PROINFLAMMATORY AND ANTI-INFLAMMATORY CYTOKINES SERUM

    Directory of Open Access Journals (Sweden)

    Muhammad Ramli Ahmad

    2014-06-01

    Full Text Available Objective: To investigate the effect of combination epidural bupivacaine and intravenous parecoxib analgesia on immune response in patients who underwent open reduction and internal fixation of the lower limb under epidural anesthesia. Methods: This research was conducted using the randomized, placebo-controlled double blind trial method on 52 patients who were randomly divided into 2 groups: the Parecoxib group which received 40 mg intravenous parecoxib for 30 minutes before incision and the control group which received an equal volume of 0.9% normal saline. Both groups received epidural anesthesia and postoperative epidural 0.125% bupivacaine analgesia continously. Venous blood samples were obtained before parecoxib administration, 2 and 24 hours after the surgery. The data were analyzed using Mann Whitney U and independent t tests (p<0.05. Results: There was a significant difference between the two groups (p<0.05 in IL-1β, IL-6, IL-10 levels and proinflammatory to anti-inflammatory ratio, 2 hours after surgery. Conclusions: Multimodal analgesic combination of 40 mg IV parecoxib and 0.125% bupivacaine epidural analgesia have the effect to alter and stabilize the systemic immune response.

  13. Releasing the Constraints on Aphasia Therapy: The Positive Impact of Gesture and Multimodality Treatments

    Science.gov (United States)

    Rose, Miranda L.

    2013-01-01

    Purpose: There is a 40-year history of interest in the use of arm and hand gestures in treatments that target the reduction of aphasic linguistic impairment and compensatory methods of communication (Rose, 2006). Arguments for constraining aphasia treatment to the verbal modality have arisen from proponents of constraint-induced aphasia therapy…

  14. Does impulsivity predict outcome in treatment for binge eating disorder? A multimodal investigation.

    Science.gov (United States)

    Manasse, Stephanie M; Espel, Hallie M; Schumacher, Leah M; Kerrigan, Stephanie G; Zhang, Fengqing; Forman, Evan M; Juarascio, Adrienne S

    2016-10-01

    Multiple dimensions of impulsivity (e.g., affect-driven impulsivity, impulsive inhibition - both general and food-specific, and impulsive decision-making) are associated with binge eating pathology cross-sectionally, yet the literature on whether impulsivity predicts treatment outcome is limited. The present pilot study explored impulsivity-related predictors of 20-week outcome in a small open trial (n = 17) of a novel treatment for binge eating disorder. Overall, dimensions of impulsivity related to emotions (i.e., negative urgency) and food cues emerged as predictors of treatment outcomes (i.e., binge eating frequency and global eating pathology as measured by the Eating Disorders Examination), while more general measures of impulsivity were statistically unrelated to global eating pathology or binge frequency. Specifically, those with higher levels of negative urgency at baseline experienced slower and less pronounced benefit from treatment, and those with higher food-specific impulsivity had more severe global eating pathology at baseline that was consistent at post-treatment and follow-up. These preliminary findings suggest that patients high in negative urgency and with poor response inhibition to food cues may benefit from augmentation of existing treatments to achieve optimal outcomes. Future research will benefit from replication with a larger sample, parsing out the role of different dimensions of impulsivity in treatment outcome for eating disorders, and identifying how treatment can be improved to accommodate higher levels of baseline impulsivity. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Breast conservation in the setting of contemporary multimodality treatment provides excellent outcomes for patients with occult primary breast cancer.

    Science.gov (United States)

    Rueth, Natasha M; Black, Dalliah M; Limmer, Angela R; Gabriel, Emmanuel; Huo, Lei; Fornage, Bruno D; Dogan, Basak E; Chavez-MacGregor, Mariana; Yi, Min; Hunt, Kelly K; Strom, Eric A

    2015-01-01

    To evaluate recurrence and survival for patients with occult (T0N+) breast cancer who underwent contemporary treatment, assessing outcomes for breast conservation and mastectomy. We performed a single-institution review of women with occult breast cancer presenting with axillary metastasis without identifiable breast tumor or distant metastasis. We excluded patients with tumors in the axillary tail or mastectomy specimen, patients with additional nonbreast cancer diagnoses, and patients with a history of breast cancer. Breast conservation was defined as axillary node dissection with radiation therapy, without breast surgery. We evaluated patient, tumor, treatment, and outcome variables. Patients were assessed for local, regional, and distant recurrences. Overall survival was calculated using the Kaplan-Meier method. Thirty-six patients met criteria for occult breast cancer. Most of these patients (77.8 %) had N1 disease. Fifty percent of cancers (n = 18) were estrogen receptor-positive; 12 (33.3 %) were triple-negative. All patients were evaluated with mammography. Thirty-five patients had breast ultrasound (97.2 %) and 33 (91.7 %) had an MRI. Thirty-four patients (94.4 %) were treated with chemotherapy and 33 (91.7 %) with radiotherapy. Twenty-seven patients (75.0 %) were treated with breast conservation. The median follow-up was 64 months. There were no local or regional failures. One distant recurrence occurred >5 years after diagnosis, resulting in a 5-years overall survival rate of 100 %. There were no significant survival differences between patients receiving breast conservation versus mastectomy (p = 0.7). Breast conservation-performed with contemporary imaging and multimodality treatment-provides excellent local control and survival for women with T0N+ breast cancer and can be safely offered instead of mastectomy.

  16. Ethnicity as a Moderator of Treatment Effects on Parent-Child Interaction for Children with ADHD

    Science.gov (United States)

    Jones, Heather A.; Epstein, Jeffery N.; Hinshaw, Stephen P.; Owens, Elizabeth B.; Chi, Terry C.; Arnold, L. Eugene; Hoza, Betsy; Wells, Karen C.

    2010-01-01

    Objective: To examine ethnic differences in observed parenting and child behavior and the moderating effects of ethnicity on the relationship between treatment and parent and child behavior. Method: Observations of 508 children with ADHD (ages 7-9) and their caregivers, collected during the Multimodal Treatment Study of ADHD, were analyzed using…

  17. Effect of Multimodal Pore Channels on Cargo Release from Mesoporous Silica Nanoparticles

    Directory of Open Access Journals (Sweden)

    Sushilkumar A. Jadhav

    2016-01-01

    Full Text Available Mesoporous silica nanoparticles (MSNs with multimodal pore channels were fully characterized by TEM, nitrogen adsorption-desorption, and DLS analyses. MSNs with average diameter of 200 nm with dual pore channel zones with pore diameters of 1.3–2.6 and 4 nm were tested for their use in drug delivery application. Important role of the multimodal pore systems present on MSNs on the quantitative release of model drug ibuprofen was investigated. The results obtained revealed that the release profile for ibuprofen clearly shows distinct zones which can be attributed to the respective porous channel zones present on the particles. The fluctuations in the concentration of ibuprofen during the prolonged release from MSNs were caused by the multimodal pore channel systems.

  18. Functional and psychosocial effects of multimodality limb-sparing therapy in patients with soft tissue sarcomas

    International Nuclear Information System (INIS)

    Chang, A.E.; Steinberg, S.M.; Culnane, M.

    1989-01-01

    We have documented functional and psychosocial changes in patients with extremity soft tissue sarcomas who have undergone multimodality limb-sparing treatments. In 88 patients, parameters related to economic status, sexual activity, pain, limb function, and global quality of life (QOL) were recorded prior to surgery and every 6 months postoperatively. Changes from the preoperative assessment for every parameter were analyzed in each patient. Six months after surgery, there was a decrease in employment status, sexual activity, and in limb function in a significant number of patients. At 12 months, these decreases were still evident. Despite these changes, global QOL measured by a standardized test showed at least some improvement in a significant proportion of patients at 12 months. These findings highlight the difficulty in defining QOL. It could not be ascertained if radiation therapy and/or chemotherapy were causative factors in specific changes because of the small numbers of patients in each subgroup. However, among 60 patients with high-grade sarcomas, significant wound problems developed in 10 of 33 who received postoperative radiation therapy in combination with adjuvant doxorubicin and cyclophosphamide chemotherapy compared with one of 27 patients who received adjuvant chemotherapy alone (P = .016). Also, among high-grade sarcoma patients with 12-month follow-up, six of 19 patients who received radiation therapy and chemotherapy developed joint contractures compared with zero of 15 patients who received chemotherapy alone (P less than .04). The combination of postoperative radiation therapy and chemotherapy appeared to be associated with significantly more tissue-related injury in patients with high-grade sarcomas compared with chemotherapy alone

  19. Functional and psychosocial effects of multimodality limb-sparing therapy in patients with soft tissue sarcomas

    Energy Technology Data Exchange (ETDEWEB)

    Chang, A.E.; Steinberg, S.M.; Culnane, M.; Lampert, M.H.; Reggia, A.J.; Simpson, C.G.; Hicks, J.E.; White, D.E.; Yang, J.J.; Glatstein, E. (National Cancer Institute, Bethesda, MD (USA))

    1989-09-01

    We have documented functional and psychosocial changes in patients with extremity soft tissue sarcomas who have undergone multimodality limb-sparing treatments. In 88 patients, parameters related to economic status, sexual activity, pain, limb function, and global quality of life (QOL) were recorded prior to surgery and every 6 months postoperatively. Changes from the preoperative assessment for every parameter were analyzed in each patient. Six months after surgery, there was a decrease in employment status, sexual activity, and in limb function in a significant number of patients. At 12 months, these decreases were still evident. Despite these changes, global QOL measured by a standardized test showed at least some improvement in a significant proportion of patients at 12 months. These findings highlight the difficulty in defining QOL. It could not be ascertained if radiation therapy and/or chemotherapy were causative factors in specific changes because of the small numbers of patients in each subgroup. However, among 60 patients with high-grade sarcomas, significant wound problems developed in 10 of 33 who received postoperative radiation therapy in combination with adjuvant doxorubicin and cyclophosphamide chemotherapy compared with one of 27 patients who received adjuvant chemotherapy alone (P = .016). Also, among high-grade sarcoma patients with 12-month follow-up, six of 19 patients who received radiation therapy and chemotherapy developed joint contractures compared with zero of 15 patients who received chemotherapy alone (P less than .04). The combination of postoperative radiation therapy and chemotherapy appeared to be associated with significantly more tissue-related injury in patients with high-grade sarcomas compared with chemotherapy alone.

  20. Multi-modality treatment in males with advanced malignant germ cell tumours

    International Nuclear Information System (INIS)

    Fossaa, S.D.; Klepp, O.; Ous, S.; Lien, H.; Stenwig, J.T.; Abeler, V.; Eliasson, G.; Hoest, H.

    1984-01-01

    After chemotherapy with cis-platinum, vinblastine and bleomycin, 33 surgical prosedures were performed in 29 patients with advanced malignant germ-cell tumours. The tumour masses could be completely resected macroscopially in 26 patients. Patients with fibros/necrosis or completely resected mature teratoma had an excellent prognosis, whereas only 5 of the 11 patients with vital malignant tumour survived in spite of second-line treatment with chemotherapy/radiotherapy. Preoperatively elevated serum levels of AFP, β-HCG and/or LDH indicated the presence of residual germ cell tumour. Eight of 14 patients were rendered tumour-free by radiotherapy given as second- or third-line treatment. In general, tumour masses, remaining after cis-platinum-based induction chemotherapy should be resected as completely as possible even in the case of mature teratoma or fibrosis/necrosis. Radiotherapy should be considered as second -and thirdline treatment

  1. Consideration of clinicopathologic features improves patient stratification for multimodal treatment of gastric cancer.

    Science.gov (United States)

    Cho, In; Kwon, In Gyu; Guner, Ali; Son, Taeil; Kim, Hyoung-Il; Kang, Dae Ryong; Noh, Sung Hoon; Lim, Joon Seok; Hyung, Woo Jin

    2017-10-03

    Preoperative staging of gastric cancer with computed tomography alone exhibits poor diagnostic accuracy, which may lead to improper treatment decisions. We developed novel patient stratification criteria to select appropriate treatments for gastric cancer patients based on preoperative staging and clinicopathologic features. A total of 5352 consecutive patients who underwent gastrectomy for gastric cancer were evaluated. Preoperative stages were determined according to depth of invasion and nodal involvement on computed tomography. Logistic regression analysis was used to identify clinicopathological factors associated with the likelihood of proper patient stratification. The diagnostic accuracies of computed tomography scans for depth of invasion and nodal involvement were 67.1% and 74.1%, respectively. Among clinicopathologic factors, differentiated tumor histology, tumors smaller than 5 cm, and gross appearance of early gastric cancer on endoscopy were shown to be related to a more advanced stage of disease on preoperative computed tomography imaging than actual pathological stage. Additional consideration of undifferentiated histology, tumors larger than 5 cm, and grossly advanced gastric cancer on endoscopy increased the probability of selecting appropriate treatment from 75.5% to 94.4%. The addition of histology, tumor size, and endoscopic findings to preoperative staging improves patient stratification for more appropriate treatment of gastric cancer.

  2. Hematoimmunological state of patients with inoperable cervical cancer undergoing multimodality treatment

    International Nuclear Information System (INIS)

    Nikiforova, N.A.; Sorochan, P.P.; Revenkova, S.Yi.; Moskalenko, Yi.P.

    2005-01-01

    Hematological parameters and immunity state were studied in 53 patients with inoperable cervical cancer undergoing radiochemotherapy. It is reasonable use prolonged 5-FU infusions during chemoradiation treatment from 6 p.m. to 6 a.m. with the purpose to minimize the complications in the homeostasis system

  3. Family accommodation of anxiety symptoms in youth undergoing intensive multimodal treatment for anxiety disorders and obsessive-compulsive disorder: Nature, clinical correlates, and treatment response.

    Science.gov (United States)

    La Buissonnière-Ariza, Valérie; Schneider, Sophie C; Højgaard, Davíð; Kay, Brian C; Riemann, Bradley C; Eken, Stephanie C; Lake, Peter; Nadeau, Joshua M; Storch, Eric A

    2018-01-01

    Family accommodation is associated with a range of clinical features including symptom severity, functional impairment, and treatment response. However, most previous studies in children and adolescents investigated family accommodation in samples of youth with obsessive-compulsive disorder (OCD) or anxiety disorders receiving non-intensive outpatient services. In this study, we aimed to investigate family accommodation of anxiety symptoms in a sample of youth with clinical anxiety levels undergoing an intensive multimodal intervention for anxiety disorders or OCD. We first assessed the internal consistency of the Family Accommodation Scale - Anxiety (FASA). We next examined family accommodation presentation and correlates. The FASA showed high internal consistency for all subscales and total score, and good item and subscale correlations with the total score. All parents reported at least mild accommodation, and the mean levels of family accommodation were particularly high. Child age, anxiety severity, and comorbid depressive symptoms predicted baseline accommodation. However, the association between anxiety severity and family accommodation no longer remained significant after adding the other factors to the model. In addition, family accommodation partially mediated the relationship between anxiety severity and functional impairment. Finally, post-treatment changes in family accommodation predicted changes in symptom severity and functional impairment. These findings suggest the FASA is an appropriate tool to assess family accommodation in intensive treatment samples. Further, they underline the importance of addressing family accommodation in this population given the particularly high levels of accommodating behaviors and the evidence for adverse outcomes associated with this feature. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Hemostasis system in patients with pulmonary cancer during multimodality treatment with the use of artificial hyperglycemia

    International Nuclear Information System (INIS)

    Demidchik, Yu.E.; Zharkov, V.V.; Antipova, L.I.; Kurchin, V.P.; Moiseev, P.I.

    1990-01-01

    The main hemostasis indices at all stages of combined treatment of 105 patients with pulmonary cancer, involving radiotherapy artificial hyperglycemia and surgical intervention, are estimated. The functional status of the hemostasis system was estimated on the basis of a complex of hemocoagulation tests. All patients were subjected to preoperative remote large-fractioned irradiation with 20 Gy total absorbed dose in 5 fractions of 4 Gy in a week. It is established that at the irradiation stage of combined treatment hyperglycemia leads to hyper coagulation and increases the risk of thromboembolic complications. For prophylaxis of the complications it is reasonable to combine low doses of heparin and preparations, improving blood rheology either before or after surgical intervention. 7 refs.; 2 tabs

  5. The effect of a pretest in an interactive, multimodal pretraining system for learning science concepts

    NARCIS (Netherlands)

    Bos, Floor/Floris; Terlouw, C.; Pilot, Albert

    2009-01-01

    In line with the cognitive theory of multimedia learning by Moreno and Mayer (2007), an interactive, multimodal learning environment was designed for the pretraining of science concepts in the joint area of physics, chemistry, biology, applied mathematics, and computer sciences. In the experimental

  6. Effects of multimodal feedback on the usability of mobile diet diary for older adults

    NARCIS (Netherlands)

    Bojic, M.; Blanson Henkemans, O.A.; Neerincx, M.A.; Mast, C.A.P.G. van der; Lindenberg, J.

    2009-01-01

    Globally, overweight is an increasing problem and this especially the case for older adults, facing physical challenges and who need to maintain a healthy diet. eHealth services, such as a digital diet diary could support them. Consequently, we designed a multimodal mobile diet diary supporting

  7. Developing a ‘big picture’: Effects of collaborative construction of multimodal representations in history

    NARCIS (Netherlands)

    Prangsma, M.E.; van Boxtel, C.A.M.; Kanselaar, G.

    2008-01-01

    Many pupils have difficulties with the abstract verbal information in history lessons. In this study we assessed the value of active construction of multimodal representations of historical phenomena. In an experimental study we compared the learning outcomes of pupils who co-constructed textual

  8. The Effect of Multimodal Feedback on Perceived Exertion on a VR Exercise Setting

    DEFF Research Database (Denmark)

    Bruun-Pedersen, Jon Ram; Andersen, Morten G.; Clemmesen, Mathias M.

    2018-01-01

    This paper seeks to determine if multimodal feedback, from auditory and haptic stimuli, can affect a user’s perceived exertion in a virtual reality setting. A simple virtual environment was created in the style of a desert to minimize the amount of visual distractions; a head mounted display was ...

  9. The use of IRE in multi-modality treatment for oligometastatic pancreatic cancer.

    Science.gov (United States)

    Hong, Young; Rice, Jonathan; Sharma, Divyansh; Martin, Robert C G

    2018-03-02

    Pancreatic ductal adenocarcinoma (PDAC) often presents late with only 20% of patients being candidates for resection while majority already have advanced metastases with median overall survival of 3-6 months. Currently, the role of oligometastasectomy and local therapy options in PDAC is unknown in patients who have favorable response to systemic chemotherapy. The aim of this study is to analyze the survival outcome of oligometastasectomy and local IRE therapy in select patients who are treated with systemic chemotherapy for PDAC metastases. We utilized a prospective database from 2010 to 2016 to identify patients with local surgical therapy after induction systemic chemotherapy for oligometastatic PDAC (Stage 4). The initial local therapy treatment of distant metastatic lesions was followed by adjuvant chemotherapy. Subsequently, resection of the primary PDAC in conjunction with irreversible electroporation (IRE) was performed after favorable response by RECIST criteria. Seven patients were identified with metastatic PDAC treated with oligometastasectomy and/or local therapy. There was single metastatic lesion in 43% (3/7) of which 57% (4/7) were localized in the liver. The treatment of the primary pancreatic cancer was performed utilizing IRE in situ in 6/7 (86%) of patients in our study with resection or radiation of oligometastasis. The median survival in our study group was 16 months with 28% (2/7) patients who remain NED (range 16-41 months). Combination of systemic chemotherapy and oligometastasectomy with adjunctive local IRE therapy is a feasible treatment strategy in highly select patients with oligometastatic PDAC that demonstrate favorable tumor biology with objective response to systemic therapy. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. Multimodal treatment with ALL-like chemotherapy, Auto-SCT and radiotherapy for lymphoblastic lymphoma.

    Science.gov (United States)

    Bersvendsen, Hanne; Kolstad, Arne; Blystad, Anne Kirsti; Aurlien, Ellen; Fosså, Alexander; Kvaløy, Stein O; Holte, Harald; Lauritzsen, Grete F

    2014-05-01

    Recommended treatment for lymphoblastic lymphomas, a highly aggressive, relatively rare lymphoma entity predominantly seen in teenagers and young adults, includes acute lymphoblastic leukemia (ALL)-like induction chemotherapy. Whether these patients should be consolidated with maintenance chemotherapy or autologous stem cell transplantation (Auto-SCT) and the use of radiotherapy are matters of debate. We reviewed treatment and outcome for 25 consecutive patients above the age of 15 years with lymphoblastic lymphoma (T-lineage; T-LBL, n = 19; B-lineage; B-LBL, n = 6) seen at a single center during a 12-year period (1999-2011). Patients were given an ALL-like chemotherapy induction regimen, and responding patients were consolidated with Auto-SCT and local radiotherapy when applicable. Median age at diagnosis was 33 years (range 15-65). Seventeen of the T-LBL patients had a mediastinal mass, three patients had central nervous system (CNS) involvement. Chemotherapy with intensified CNS prophylaxis induced an overall response rate of 92% (CR 84%, PR 8%). In total 23/25 (92%) patients underwent Auto-SCT in first remission while 13 of 14 eligible patients with mediastinal involvement received local radiotherapy. Twenty percent of the patients had hepatotoxicity grade 3-4 and 32% thromboembolic events (TE). Two patients (8%) died of treatment-related toxicity. One patient had progressive disease and died of lymphoma. Three patients have relapsed, but two of these (both B-LBL) are currently alive in second CR after Allo-SCT. With a median follow-up of 98 months (range 1-163) the 5- and 8-year PFS and OS are 76% and 84%, respectively. Combined intensive ALL-like induction and early consolidation chemotherapy followed by Auto-SCT and local radiation therapy resulted in high sustained cure rates.

  11. Multimodal Magnetic Resonance Imaging Study of Treatment-Naïve Adults with Attention-Deficit/Hyperactivity Disorder

    Science.gov (United States)

    Chaim, Tiffany M.; Zhang, Tianhao; Zanetti, Marcus V.; da Silva, Maria Aparecida; Louzã, Mário R.; Doshi, Jimit; Serpa, Mauricio H.; Duran, Fabio L. S.; Caetano, Sheila C.; Davatzikos, Christos; Busatto, Geraldo F.

    2014-01-01

    Background Attention-Deficit/Hiperactivity Disorder (ADHD) is a prevalent disorder, but its neuroanatomical circuitry is still relatively understudied, especially in the adult population. The few morphometric magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) studies available to date have found heterogeneous results. This may be at least partly attributable to some well-known technical limitations of the conventional voxel-based methods usually employed to analyze such neuroimaging data. Moreover, there is a great paucity of imaging studies of adult ADHD to date that have excluded patients with history of use of stimulant medication. Methods A newly validated method named optimally-discriminative voxel-based analysis (ODVBA) was applied to multimodal (structural and DTI) MRI data acquired from 22 treatment-naïve ADHD adults and 19 age- and gender-matched healthy controls (HC). Results Regarding DTI data, we found higher fractional anisotropy in ADHD relative to HC encompassing the white matter (WM) of the bilateral superior frontal gyrus, right middle frontal left gyrus, left postcentral gyrus, bilateral cingulate gyrus, bilateral middle temporal gyrus and right superior temporal gyrus; reductions in trace (a measure of diffusivity) in ADHD relative to HC were also found in fronto-striatal-parieto-occipital circuits, including the right superior frontal gyrus and bilateral middle frontal gyrus, right precentral gyrus, left middle occipital gyrus and bilateral cingulate gyrus, as well as the left body and right splenium of the corpus callosum, right superior corona radiata, and right superior longitudinal and fronto-occipital fasciculi. Volumetric abnormalities in ADHD subjects were found only at a trend level of significance, including reduced gray matter (GM) in the right angular gyrus, and increased GM in the right supplementary motor area and superior frontal gyrus. Conclusions Our results suggest that adult ADHD is associated with

  12. Multimodal magnetic resonance imaging study of treatment-naïve adults with attention-deficit/hyperactivity disorder.

    Directory of Open Access Journals (Sweden)

    Tiffany M Chaim

    Full Text Available BACKGROUND: Attention-Deficit/Hiperactivity Disorder (ADHD is a prevalent disorder, but its neuroanatomical circuitry is still relatively understudied, especially in the adult population. The few morphometric magnetic resonance imaging (MRI and diffusion tensor imaging (DTI studies available to date have found heterogeneous results. This may be at least partly attributable to some well-known technical limitations of the conventional voxel-based methods usually employed to analyze such neuroimaging data. Moreover, there is a great paucity of imaging studies of adult ADHD to date that have excluded patients with history of use of stimulant medication. METHODS: A newly validated method named optimally-discriminative voxel-based analysis (ODVBA was applied to multimodal (structural and DTI MRI data acquired from 22 treatment-naïve ADHD adults and 19 age- and gender-matched healthy controls (HC. RESULTS: Regarding DTI data, we found higher fractional anisotropy in ADHD relative to HC encompassing the white matter (WM of the bilateral superior frontal gyrus, right middle frontal left gyrus, left postcentral gyrus, bilateral cingulate gyrus, bilateral middle temporal gyrus and right superior temporal gyrus; reductions in trace (a measure of diffusivity in ADHD relative to HC were also found in fronto-striatal-parieto-occipital circuits, including the right superior frontal gyrus and bilateral middle frontal gyrus, right precentral gyrus, left middle occipital gyrus and bilateral cingulate gyrus, as well as the left body and right splenium of the corpus callosum, right superior corona radiata, and right superior longitudinal and fronto-occipital fasciculi. Volumetric abnormalities in ADHD subjects were found only at a trend level of significance, including reduced gray matter (GM in the right angular gyrus, and increased GM in the right supplementary motor area and superior frontal gyrus. CONCLUSIONS: Our results suggest that adult ADHD is associated

  13. Patterns of Failure Following Multimodal Treatment for Medulloblastoma: Long-Term Follow-up Results at a Single Institution.

    Science.gov (United States)

    Lee, Dong Soo; Cho, Jaeho; Kim, Se Hoon; Kim, Dong-Seok; Shim, Kyu Won; Lyu, Chuhl Joo; Han, Jung Woo; Suh, Chang-Ok

    2015-10-01

    The purpose of this study is to investigate the long-term results and appropriateness of radiation therapy (RT) for medulloblastoma (MB) at a single institution. We analyzed the clinical outcomes of 106 patients with MB who received RT between January 1992 and October 2009. The median age was 7 years (range, 0 to 50 years), and the proportion of M0, M1, M2, and M3 stages was 60.4%, 8.5%, 4.7%, and 22.6%, respectively. The median total craniospinal irradiation (CSI) and posterior fossa tumor bed dose in 102 patients (96.2%) treated with CSI was 36 Gy and 54 Gy, respectively. The median follow-up period in survivors was 132 months (range, 31 to 248 months). A gradual improvement in survival outcomes was observed, with 5-year overall survival rates of 61.5% in 1990s increasing to 73.6% in 2000s. A total of 29 recurrences (27.4%) developed at the following sites: five (17.2%) in the tumor bed; five (17.2%) in the posterior fossa other than the tumor bed; nine (31%) in the supratentorium; and six (20.7%) in the spinal subarachnoid space only. The four remaining patients showed multiple site recurrences. Among 12 supratentorial recurrences, five cases recurred in the subfrontal areas. Although the frequency of posterior fossa/tumor bed recurrences was significantly high among patients treated with subtotal resection, other site (other intracranial/spinal) recurrences were more common among patients treated with gross tumor removal (p=0.016). There was no case of spinal subarachnoid space relapse from desmoplastic/extensive nodular histological subtypes. Long-term follow-up results and patterns of failure confirmed the importance of optimal RT dose and field arrangement. More tailored multimodal strategies and proper CSI technique may be the cornerstones for improving treatment outcomes in MB patients.

  14. Multimodality Registration without a Dedicated Multimodality Scanner

    Directory of Open Access Journals (Sweden)

    Bradley J. Beattie

    2007-03-01

    Full Text Available Multimodality scanners that allow the acquisition of both functional and structural image sets on a single system have recently become available for animal research use. Although the resultant registered functional/structural image sets can greatly enhance the interpretability of the functional data, the cost of multimodality systems can be prohibitive, and they are often limited to two modalities, which generally do not include magnetic resonance imaging. Using a thin plastic wrap to immobilize and fix a mouse or other small animal atop a removable bed, we are able to calculate registrations between all combinations of four different small animal imaging scanners (positron emission tomography, single-photon emission computed tomography, magnetic resonance, and computed tomography [CT] at our disposal, effectively equivalent to a quadruple-modality scanner. A comparison of serially acquired CT images, with intervening acquisitions on other scanners, demonstrates the ability of the proposed procedures to maintain the rigidity of an anesthetized mouse during transport between scanners. Movement of the bony structures of the mouse was estimated to be 0.62 mm. Soft tissue movement was predominantly the result of the filling (or emptying of the urinary bladder and thus largely constrained to this region. Phantom studies estimate the registration errors for all registration types to be less than 0.5 mm. Functional images using tracers targeted to known structures verify the accuracy of the functional to structural registrations. The procedures are easy to perform and produce robust and accurate results that rival those of dedicated multimodality scanners, but with more flexible registration combinations and while avoiding the expense and redundancy of multimodality systems.

  15. Multimodality and Ambient Intelligence

    NARCIS (Netherlands)

    Nijholt, Antinus; Verhaegh, W.; Aarts, E.; Korst, J.

    2004-01-01

    In this chapter we discuss multimodal interface technology. We present eexamples of multimodal interfaces and show problems and opportunities. Fusion of modalities is discussed and some roadmap discussions on research in multimodality are summarized. This chapter also discusses future developments

  16. Multimodality Treatment for Rehabilitation of Adult Orthodontic Patient with Complicated Dental Condition and Jaw Relation

    Directory of Open Access Journals (Sweden)

    Yu-Cheng Liaw

    2008-11-01

    Full Text Available A 50-year-old man with severe malocclusion requested comprehensive oral rehabilitation. He presented with retrognathic mandible, anterior deep bite and a gummy smile in the premaxilla, and tenting occlusal plane with severe buccal crossbite of the left maxillary posterior teeth. Inappropriate fixed prostheses spanned the maxilla and the mandible with a class II jaw relationship. A detailed analysis indicated the need for orthodontic treatment, orthognathic surgery, bone graft at the deficient alveolar ridge for implant surgery and a revision of all prostheses. Over a 2-year-period of management, the patient received anterior osteotomy for intrusion of lower anterior teeth, bilateral sagittal splitting osteotomy for mandible advancement and posterior osteotomy for inward upward repositioning of posterior teeth of the left maxilla to correct major jaw deformities. The deficient alveolar ridge in the premaxilla was augmented by autogenous bone graft harvested during the orthognathic surgery. He sequentially had mini-plate and dental implant as anchorage assisting teeth alignment in the mandible. Two 3-fixture-supported implant prostheses were delivered in the premaxilla and the mandible. The improvement in cosmesis, stability and function through treatment and a 2-year clinical follow-up were considered satisfactory.

  17. Radiotherapy for esthesioneuroblastoma: is elective nodal irradiation warranted in the multimodality treatment approach?

    Science.gov (United States)

    Noh, O Kyu; Lee, Sang-wook; Yoon, Sang Min; Kim, Sung Bae; Kim, Sang Yoon; Kim, Chang Jin; Jo, Kyung Ja; Choi, Eun Kyung; Song, Si Yeol; Kim, Jong Hoon; Ahn, Seung Do

    2011-02-01

    The role of elective nodal irradiation (ENI) in radiotherapy for esthesioneuroblastoma (ENB) has not been clearly defined. We analyzed treatment outcomes of patients with ENB and the frequency of cervical nodal failure in the absence of ENI. Between August 1996 and December 2007, we consulted with 19 patients with ENB regarding radiotherapy. Initial treatment consisted of surgery alone in 2 patients; surgery and postoperative radiotherapy in 4; surgery and adjuvant chemotherapy in 1; surgery, postoperative radiotherapy, and chemotherapy in 3; and chemotherapy followed by radiotherapy or concurrent chemoradiotherapy in 5. Five patients did not receive planned radiotherapy because of disease progression. Including 2 patients who received salvage radiotherapy, 14 patients were treated with radiotherapy. Elective nodal irradiation was performed in 4 patients with high-risk factors, including 3 with cervical lymph node metastasis at presentation. Fourteen patients were analyzable, with a median follow-up of 27 months (range, 7-64 months). The overall 3-year survival rate was 73.4%. Local failure occurred in 3 patients (21.4%), regional cervical failure in 3 (21.4%), and distant failure in 2 (14.3%). No cervical nodal failure occurred in patients treated with combined systemic chemotherapy regardless of ENI. Three cervical failures occurred in the 4 patients treated with ENI or neck dissection (75%), none of whom received systemic chemotherapy. ENI during radiotherapy for ENB seems to play a limited role in preventing cervical nodal failure. Omitting ENI may be an option if patients are treated with a combination of radiotherapy and chemotherapy. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Radiotherapy for Esthesioneuroblastoma: Is Elective Nodal Irradiation Warranted in the Multimodality Treatment Approach?

    International Nuclear Information System (INIS)

    Noh, O Kyu; Lee, Sang-wook; Yoon, Sang Min; Kim, Sung Bae; Kim, Sang Yoon; Kim, Chang Jin; Jo, Kyung Ja; Choi, Eun Kyung; Song, Si Yeol; Kim, Jong Hoon; Ahn, Seung Do

    2011-01-01

    Purpose: The role of elective nodal irradiation (ENI) in radiotherapy for esthesioneuroblastoma (ENB) has not been clearly defined. We analyzed treatment outcomes of patients with ENB and the frequency of cervical nodal failure in the absence of ENI. Methods and Materials: Between August 1996 and December 2007, we consulted with 19 patients with ENB regarding radiotherapy. Initial treatment consisted of surgery alone in 2 patients; surgery and postoperative radiotherapy in 4; surgery and adjuvant chemotherapy in 1; surgery, postoperative radiotherapy, and chemotherapy in 3; and chemotherapy followed by radiotherapy or concurrent chemoradiotherapy in 5. Five patients did not receive planned radiotherapy because of disease progression. Including 2 patients who received salvage radiotherapy, 14 patients were treated with radiotherapy. Elective nodal irradiation was performed in 4 patients with high-risk factors, including 3 with cervical lymph node metastasis at presentation. Results: Fourteen patients were analyzable, with a median follow-up of 27 months (range, 7-64 months). The overall 3-year survival rate was 73.4%. Local failure occurred in 3 patients (21.4%), regional cervical failure in 3 (21.4%), and distant failure in 2 (14.3%). No cervical nodal failure occurred in patients treated with combined systemic chemotherapy regardless of ENI. Three cervical failures occurred in the 4 patients treated with ENI or neck dissection (75%), none of whom received systemic chemotherapy. Conclusions: ENI during radiotherapy for ENB seems to play a limited role in preventing cervical nodal failure. Omitting ENI may be an option if patients are treated with a combination of radiotherapy and chemotherapy.

  19. Multimodal magnetic nano-carriers for cancer treatment: Challenges and advancements

    Energy Technology Data Exchange (ETDEWEB)

    Aadinath, W.; Ghosh, Triroopa; Anandharamakrishnan, C., E-mail: anandharam@cftri.res.in

    2016-03-01

    Iron oxide nanoparticles (IONPs) have been a propitious topic for cancer treatment in recent years because of its multifunctional theranostic applications under magnetic field. Two such widely used applications in cancer biology are gradient magnetic field guided targeting and alternative magnetic field (AMF) induced local hyperthermia. Gradient magnetic field guided targeting is a mode of active targeting of therapeutics conjugated with iron oxide nanoparticles. These particles also dissipate heat in presence of AMF which causes thermal injury to the cells of interest, for example tumour cells and subsequent death. Clinical trials divulge the feasibility of such magnetic nano-carrier as a promising candidate in cancer biology. However, these techniques need further investigations to curtail certain limitations manifested. Recent progresses in response have shrunken the barricade to certain extent. In this context, principles, challenges associated with these applications and recent efforts made in response will be discussed. - Highlights: • Iron oxide nanoparticles offer various modalities in the field of cancer theranostics. • Magnetic field guided targeting and local hyperthermia are two well known modalities in cancer therapy. • These techniques need further investigations to curtail certain limitations manifested. • This review emphasizes the recent efforts carried out to counteract the drawbacks.

  20. Feasibility of Multimodal Deformable Registration for Head and Neck Tumor Treatment Planning

    Energy Technology Data Exchange (ETDEWEB)

    Fortunati, Valerio, E-mail: v.fortunati@erasmusmc.nl [Biomedical Imaging Group Rotterdam, Department of Medical Informatics and Radiology, Erasmus MC University Medical Center, Rotterdam (Netherlands); Verhaart, René F. [Hyperthermia Unit, Department of Radiation Oncology, Erasmus MC University Medical Center Cancer Institute, Rotterdam (Netherlands); Angeloni, Francesco [Istituto di Ricovero e Cura a Carattere Scientifico Foundation SDN for Research and High Education in Nuclear Diagnostics, Naples (Italy); Lugt, Aad van der [Department of Radiology, Erasmus MC University Medical Center, Rotterdam (Netherlands); Niessen, Wiro J. [Biomedical Imaging Group Rotterdam, Department of Medical Informatics and Radiology, Erasmus MC University Medical Center, Rotterdam (Netherlands); Faculty of Applied Sciences, Delft University of Technology, Delft (Netherlands); Veenland, Jifke F. [Biomedical Imaging Group Rotterdam, Department of Medical Informatics and Radiology, Erasmus MC University Medical Center, Rotterdam (Netherlands); Paulides, Margarethus M. [Hyperthermia Unit, Department of Radiation Oncology, Erasmus MC University Medical Center Cancer Institute, Rotterdam (Netherlands); Walsum, Theo van [Biomedical Imaging Group Rotterdam, Department of Medical Informatics and Radiology, Erasmus MC University Medical Center, Rotterdam (Netherlands)

    2014-09-01

    Purpose: To investigate the feasibility of using deformable registration in clinical practice to fuse MR and CT images of the head and neck for treatment planning. Method and Materials: A state-of-the-art deformable registration algorithm was optimized, evaluated, and compared with rigid registration. The evaluation was based on manually annotated anatomic landmarks and regions of interest in both modalities. We also developed a multiparametric registration approach, which simultaneously aligns T1- and T2-weighted MR sequences to CT. This was evaluated and compared with single-parametric approaches. Results: Our results show that deformable registration yielded a better accuracy than rigid registration, without introducing unrealistic deformations. For deformable registration, an average landmark alignment of approximatively 1.7 mm was obtained. For all the regions of interest excluding the cerebellum and the parotids, deformable registration provided a median modified Hausdorff distance of approximatively 1 mm. Similar accuracies were obtained for the single-parameter and multiparameter approaches. Conclusions: This study demonstrates that deformable registration of head-and-neck CT and MR images is feasible, with overall a significanlty higher accuracy than for rigid registration.

  1. Feasibility of Multimodal Deformable Registration for Head and Neck Tumor Treatment Planning

    International Nuclear Information System (INIS)

    Fortunati, Valerio; Verhaart, René F.; Angeloni, Francesco; Lugt, Aad van der; Niessen, Wiro J.; Veenland, Jifke F.; Paulides, Margarethus M.; Walsum, Theo van

    2014-01-01

    Purpose: To investigate the feasibility of using deformable registration in clinical practice to fuse MR and CT images of the head and neck for treatment planning. Method and Materials: A state-of-the-art deformable registration algorithm was optimized, evaluated, and compared with rigid registration. The evaluation was based on manually annotated anatomic landmarks and regions of interest in both modalities. We also developed a multiparametric registration approach, which simultaneously aligns T1- and T2-weighted MR sequences to CT. This was evaluated and compared with single-parametric approaches. Results: Our results show that deformable registration yielded a better accuracy than rigid registration, without introducing unrealistic deformations. For deformable registration, an average landmark alignment of approximatively 1.7 mm was obtained. For all the regions of interest excluding the cerebellum and the parotids, deformable registration provided a median modified Hausdorff distance of approximatively 1 mm. Similar accuracies were obtained for the single-parameter and multiparameter approaches. Conclusions: This study demonstrates that deformable registration of head-and-neck CT and MR images is feasible, with overall a significanlty higher accuracy than for rigid registration

  2. [Gender Aspects in Gastrointestinal Tumours and Their Prognosis in Regard to Multimodal Treatment Concepts].

    Science.gov (United States)

    Seeland, U; Heger, U; Heise, K; Ott, K

    2015-06-01

    Systematic analyses of gender effects in gastrointestinal malignancies are currently lacking, partly because sex and gender have not been used as stratification criteria in major studies on the topic. It is, however, indisputable that gastrointestinal tumours differ in risk factors, incidence and prognosis between the genders. This review summarises the most important findings on differences related to biological sex and sociocultural gender and discusses anatomic specifics with immediate significance for surgical interventions. Epidemiological differences in upper gastrointestinal malignancies are most prominent in regard to histological subtypes, directly affecting diagnostics, therapy, and prognosis. Women have a better prognosis in many of these tumour subtypes. For colorectal carcinoma, sex hormones, specifically oestrogens, appear to play a distinct role in tumourigenesis. Histopathological analysis of the expression of oestrogen receptor beta (ERβ) in the tumour tissue has attracted interest since it was shown that women with low ERβ expression have a better prognosis than men with comparable ERβ status. Data on the higher incidence of right-sided colon carcinoma and non-polypoid neoplasms in women could lead to improved screening programmes. Men and women cite differing reasons for avoidance of screening colonoscopies, thus gender specific approaches could improve colon cancer prevention programmes. Data on differing bioavailability of 5-fluorouracil between the genders are useful to minimise adverse effects of chemotherapy and should be accounted for in dosage. Further systematic analysis of gender effects on gastrointestinal tumours is warranted and would be a substantial step towards personalised oncological surgery. Georg Thieme Verlag KG Stuttgart · New York.

  3. BRAZILIAN CONSENSUS FOR MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 3: CONTROVERSIES AND UNRESECTABLE METASTASES.

    Science.gov (United States)

    Torres, Orlando Jorge Martins; Marques, Márcio Carmona; Santos, Fabio Nasser; Farias, Igor Correia de; Coutinho, Anelisa Kruschewsky; Oliveira, Cássio Virgílio Cavalcante de; Kalil, Antonio Nocchi; Mello, Celso Abdon Lopes de; Kruger, Jaime Arthur Pirola; Fernandes, Gustavo Dos Santos; Quireze, Claudemiro; Murad, André M; Silva, Milton José de Barros E; Zurstrassen, Charles Edouard; Freitas, Helano Carioca; Cruz, Marcelo Rocha; Weschenfelder, Rui; Linhares, Marcelo Moura; Castro, Leonaldson Dos Santos; Vollmer, Charles; Dixon, Elijah; Ribeiro, Héber Salvador de Castro; Coimbra, Felipe José Fernandez

    2016-01-01

    In the last module of this consensus, controversial topics were discussed. Management of the disease after progression during first line chemotherapy was the first discussion. Next, the benefits of liver resection in the presence of extra-hepatic disease were debated, as soon as, the best sequence of treatment. Conversion chemotherapy in the presence of unresectable liver disease was also discussed in this module. Lastly, the approach to the unresectable disease was also discussed, focusing in the best chemotherapy regimens and hole of chemo-embolization. RESUMO Neste último módulo do consenso, abordou-se alguns temas controversos. O primeiro tópico discutido foi o manejo da doença após progressão na primeira linha de quimioterapia, com foco em se ainda haveria indicação cirúrgica neste cenário. A seguir, o painel debruçou-se sobre as situações de ressecção da doença hepática na presença de doença extra-hepática, assim como, qual a melhor sequência de tratamento. O tratamento de conversão para doença inicialmente irressecável também foi abordado neste módulo, incluindo as importantes definições de quando se pode esperar que a doença se torne ressecável e quais esquemas terapêuticos seriam mais efetivos à luz dos conhecimentos atuais sobre a biologia tumoral e taxas de resposta objetiva. Por último, o tratamento da doença não passível de ressecção foi discutida, focando-se nos melhores esquemas a serem empregados e seu sequenciamento, bem como o papel da quimioembolização no manejo destes pacientes.

  4. Evaluation of multi-modality CT-MRI-SPECT registration tools for radiotherapy treatment planning purposes

    International Nuclear Information System (INIS)

    Bianchini, S.; Alfonso, R.; Castillo, J.; Coca, M.; Torres, L.

    2013-01-01

    A qualitative and quantitative comparison of registration CT-CT, CT-MR and CT-SPECT performed by the different software and algorithms studies is presented. Only two studied software were full DICOM RT compatible while accepting DICOM images in any layout. Quantitative results of fiducial displacement errors were calculated for all software and available registration methods. The presented methodology demonstrated being effective for assessing the quality of studied image registration tools in the radiotherapy planning context, provided the images are free of significant geometric deformation. When implementing this methodology in real patients, the use of immobilization devices, such as thermoplastic masks, is recommended for enhanced quality of image registration. (Author)

  5. Is multimodal care effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

    Science.gov (United States)

    Sutton, Deborah A; Côté, Pierre; Wong, Jessica J; Varatharajan, Sharanya; Randhawa, Kristi A; Yu, Hainan; Southerst, Danielle; Shearer, Heather M; van der Velde, Gabrielle M; Nordin, Margareta C; Carroll, Linda J; Mior, Silvano A; Taylor-Vaisey, Anne L; Stupar, Maja

    2016-12-01

    Little is known about the effectiveness of multimodal care for individuals with whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD). To update findings of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders and evaluate the effectiveness of multimodal care for the management of patients with WAD or NAD. Systematic review and best-evidence synthesis. We included randomized controlled trials (RCTs), cohort studies, and case-control studies. Self-rated recovery, functional recovery (eg, disability, return to activities, work, or school), pain intensity, health-related quality of life, psychological outcomes (eg, depression, fear), or adverse events. We systematically searched five electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials) from 2000 to 2013. RCTs, cohort, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Scientifically admissible studies were summarized using evidence tables and synthesized following best-evidence synthesis principles. We retrieved 2,187 articles, and 23 articles were eligible for critical appraisal. Of those, 18 articles from 14 different RCTs were scientifically admissible. There were a total of 31 treatment arms, including 27 unique multimodal programs of care. Overall, the evidence suggests that multimodal care that includes manual therapy, education, and exercise may benefit patients with grades I and II WAD and NAD. General practitioner care that includes reassurance, advice to stay active, and resumption of regular activities may be an option for the early management of WAD grades I and II. Our synthesis suggests that patients receiving high-intensity health care tend to experience poorer outcomes than those who receive fewer

  6. Evaluation of multimodality treatment for advanced pancreatic cancer. Special reference to intraoperative vs. external radiation therapy

    International Nuclear Information System (INIS)

    Wakasugi, Hideyuki; Funakoshi, Akihiro; Seo, Yousuke; Iguchi, Haruo; Wada, Susumu

    1999-01-01

    Intraoperative radiation therapy (IORT)+postoperative external beam radiation therapy (ERT) with chemotherapy and ERT alone with chemotherapy have been performed in our hospital for unresectable, especially locally advanced, pancreatic cancer. We compared the former method with the latter. Chemotherapy was performed together with radiation, using 5-FU, CDDP, and MMC. IORT+ERT was successful in only half of the treated patients, while ERT alone was successful in almost all of the patients. As a result, the doses of radiation were often shorter in patients treated by the former method compared to the latter method. Both methods, when completed for locally advanced pancreatic cancer (stage IVa), produced good effects on tumor markers, tumor size and pain. Furthermore, the latter method was better than the former in improving the survival time and quality of life (QOL). Therefore, ERT is a practical and useful method for patients with locally advanced pancreatic cancer. (author)

  7. Severe Speech Sound Disorders: An Integrated Multimodal Intervention

    Science.gov (United States)

    King, Amie M.; Hengst, Julie A.; DeThorne, Laura S.

    2013-01-01

    Purpose: This study introduces an integrated multimodal intervention (IMI) and examines its effectiveness for the treatment of persistent and severe speech sound disorders (SSD) in young children. The IMI is an activity-based intervention that focuses simultaneously on increasing the "quantity" of a child's meaningful productions of target words…

  8. Preparation and evaluation of a multimodal minoxidil microemulsion versus minoxidil alone in the treatment of androgenic alopecia of mixed etiology: a pilot study

    Science.gov (United States)

    Sakr, Farouk M; Gado, Ali MI; Mohammed, Haseebur R; Adam, Abdel Nasser Ismail

    2013-01-01

    Background: The variable success of topical minoxidil in the treatment of androgenic alopecia has led to the hypothesis that other pathways could mediate this form of hair loss, including infection and/or microinflammation of the hair follicles. In this study, we prepared a multimodal microemulsion comprising minoxidil (a dihydrotestosterone antagonist), diclofenac (a nonsteroidal anti-inflammatory agent), and tea tree oil (an anti-infective agent). We investigated the stability and physicochemical properties of this formulation, and its therapeutic efficacy compared with a formulation containing minoxidil alone in the treatment of androgenic alopecia. Methods: We developed a multimodal oil/water (o/w) microemulsion, a formulation containing minoxidil alone, and another containing vehicle. A three-phase diagram was constructed to obtain the optimal concentrations of the selected oil, surfactant, and cosurfactant. Thirty-two men aged 18–30 years were randomized to apply 1 mL of microemulsion containing the multimodal formulation (formulation A, n = 11), minoxidil alone (formulation B, n = 11) or placebo (formulation C, n = 10) twice daily to the affected area for 32 weeks. Efficacy was evaluated by mean hair count, thickness, and weight on the targeted area of the scalp. Global photographs were taken, changes in the area of scalp coverage were assessed by patients and external investigators, and the benefits and safety of the study medications were evaluated. The physical stability of formula A was examined after a shelf storage period of 24 months. Results: Formulation A achieved a significantly superior response than formulations B and C in terms of mean hair count (P microemulsion comprising minoxidil, diclofenac, and tea tree oil was significantly superior to minoxidil alone and placebo in terms of stability, safety, and efficacy, and achieved an earlier response in the treatment of androgenic alopecia compared with minoxidil alone in this 32-week pilot study

  9. The role of laparoscopy in the multimodality treatment of colorectal cancer.

    Science.gov (United States)

    Hartley, J E; Monson, J R T

    2002-10-01

    Ten years after the first reports of laparoscopic techniques in colorectal surgery the precise role for these approaches in future colorectal practice as still to be defined. However, it seems most unlikely that the application is going to disappear. Laparoscopic colectomy is undoubtedly a complex. time-consuming procedure and it is clear that the technique is intolerant of difficult cases and will likely remain thus. Therefore. the potential advantages of laparoscopy do not as yet appear to be attainable across the board in colorectal resection. Such generalized advantage may, however, be tantalizingly close. Although many studies have failed to show major benefits for laparoscopy in terms of postoperative recovery, it must be remembered that most of these have been of insufficient statistical power to settle the issue. What is clear to all involved in the field is that very many patients do gain major benefit from the minimally invasive approach. The challenge for the future lies in developing the technology to such a point that these benefits for patients are more reproducible. The requirement for a significant abdominal incision to deliver an intact specimen represents a significant hurdle in this regard. The importance of pathological staging for colorectal cancer at present mandates retrieval of an intact specimen. It is of course possible that radiological staging may develop to such a point that surgeons need only remove the lesion with minimal attention to lymphadenectomy. Alternatively, new adjuvant therapies may arrive that, by virtue of increased efficacy and low side-effect profiles, may be applicable to all but the earliest lesions. Finally, increasing health awareness and application of screening programs may lead to a preponderance of large polyps and preinvasive lesions for which a more limited resection may be appropriate. Obviously these scenarios remain almost entirely speculative. However, the trend towards less invasive local therapy for

  10. Randomized comparison of effectiveness of unimodal opioid analgesia with multimodal analgesia in post–cesarean section pain management

    Directory of Open Access Journals (Sweden)

    Adeniji AO

    2013-05-01

    Full Text Available Adetunji Oladeni Adeniji,1 Oluseyi Olaboyede A Atanda21Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria; 2Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, NigeriaBackground: Postoperative pain leads to patient discomfort, decreased level of satisfaction, prolonged recovery, and higher health costs. Acute pain control therefore improves the overall quality of life in patients undergoing cesarean section. Pain relief is a fundamental human right, but there is no gold standard for post–cesarean section pain management.Objective: To compare the efficacy of pentazocine and tramadol used in unimodal and multimodal (in combination with piroxicam approach, in the management of post–cesarean section pain.Materials and methods: This study employed a random allocation design to compare the effectiveness of intramuscular pentazocine (60 mg or tramadol (100 mg as single analgesic agent and in combination with daily intramuscular piroxicam 20 mg, for the management of post–cesarean section pain during the immediate 12 hours after surgery. The primary outcome measure was control of postoperative pain, while the secondary outcome measures were the analgesic agent onset of action, duration of action, patient satisfaction, and maternal and neonatal adverse outcomes. Data obtained were entered into a predesigned sheet and analyzed with the Statistical Package for Social Sciences version 17. Means ± standard deviation (SD were calculated for the quantitative variables, and the difference between two independent groups was compared using unpaired Student's t-test. The level of significance was set at 0.05.Results: A total of 120 patients were equally and randomly allocated to four study groups – two that received unimodal analgesia (the pentazocine group and the tramadol group and two that received multimodal analgesia (the pentazocine

  11. FDG-PET/CT in a patient with poor-risk non-seminoma testis with mature teratoma and secondary gliosarcoma: Multimodality imaging for guiding multimodality treatment

    Energy Technology Data Exchange (ETDEWEB)

    Quak, Elske; Kovacs, Iringo; Oyen, Wim J. G.; Van der Graaf, Winette T. A. [Radboud University Nijmegen Medical Centre, Nijmegen (Nauru)

    2015-09-15

    The value of F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting viable tumours in patients with metastasised non-seminomatous testicular cancer and residual and new masses post chemotherapy remains to be determined. We describe the case of a 41-year-old patient with metastasised non-seminomatous testicular cancer, with both retroperitoneal and extra-retroperitoneal residual masses post chemotherapy, for whom FDG-PET/CT guided major treatment decisions. FDG-PET/CT correctly identified the locations of viable tumour, as was proved by histology, and successfully guided surgery. In conclusion, in selected cases surveillance of patients with non-seminomatous testicular cancer with FDG-PET/CT can guide major treatment decisions when considering surgery for metastatic disease.

  12. Gadolinium oxysulfide nanoprobes with both persistent luminescent and magnetic properties for multimodal imaging

    OpenAIRE

    ROSTICHER , C.; Viana , Bruno; Fortin , M.-A.; Lagueux , J.; Faucher , L.; Chanéac , Corinne

    2016-01-01

    International audience; Persistent luminescence and magnetic properties of Gd2O2S: Eu 3+ , Ti 4+ , Mg 2+ nanoparticles have been studied to attest the relevance of such nanoparticles as nanoprobes for multimodal imaging. The development of new imaging tools is required to improve the quality of medical images and then to diagnose some disorders as quickly as possible in order to ensure more effective treatment. Multimodal imaging agents here developed combine the high resolution abilities of ...

  13. Effects of a novel multimodal group intervention on myocardial perfusion in patients with coronary heart disease (CHD)

    International Nuclear Information System (INIS)

    Theissen, P.; Schicha, H.; Albus, C.; Koehle, K.; Griebenow, R.; Son, P.

    2002-01-01

    Full text: Recently, it could be shown that a multimodal intervention can promote health behavior in patients with CHD. Purpose of the actual study was to evaluate the effects on somatic endpoints, e.g. myocardial perfusion. We randomly assigned 77 patients (age 54 ± 6.9 y, male 87 %) with angiographically documented CHD to a multimodal group intervention plus standardized cardiological care (INT n=39) or standardized cardiological care only (CO n = 38). The intervention, for out-patients only, consisted of 77.5 hours of group-psychotherapy, relaxation and exercise training, and teaching lessons for one year. A Thallium myocardial perfusion scintigraphy (MyoSc) (after bicycle exercise test and at rest; 70 - 110 MBq Thallium-201, SPECT-technique, quantitative wash-out (w.-o.) analysis derived from polar maps) was performed at baseline, after 2 years, and 3 years, respectively: A w.-o. increase res. decrease by 5 % or more indicated an improved / a diminished myocardial perfusion within the affected coronary artery territory. Results were analyzed on an intention to treat basis. 70/77 patients (91 %) completed the study (drop-outs CO n=4, INT n=3). After 2 years (1st interval), there was no significant difference between groups. After 3 years (2nd interval) 36/39 patients (92.3 %) of INT showed a stable or improved myocardial perfusion, compared to 18/38 patients (47.4 %) of CO (p= 0.008). The recent data analysis demonstrates the extra benefit of a multimodal intervention, compared to standardized cardiological care alone, on myocardial perfusion in CHD patients. (author)

  14. Preparation and evaluation of a multimodal minoxidil microemulsion versus minoxidil alone in the treatment of androgenic alopecia of mixed etiology: a pilot study.

    Science.gov (United States)

    Sakr, Farouk M; Gado, Ali Mi; Mohammed, Haseebur R; Adam, Abdel Nasser Ismail

    2013-01-01

    The variable success of topical minoxidil in the treatment of androgenic alopecia has led to the hypothesis that other pathways could mediate this form of hair loss, including infection and/or microinflammation of the hair follicles. In this study, we prepared a multimodal microemulsion comprising minoxidil (a dihydrotestosterone antagonist), diclofenac (a nonsteroidal anti-inflammatory agent), and tea tree oil (an anti-infective agent). We investigated the stability and physicochemical properties of this formulation, and its therapeutic efficacy compared with a formulation containing minoxidil alone in the treatment of androgenic alopecia. We developed a multimodal oil/water (o/w) microemulsion, a formulation containing minoxidil alone, and another containing vehicle. A three-phase diagram was constructed to obtain the optimal concentrations of the selected oil, surfactant, and cosurfactant. Thirty-two men aged 18-30 years were randomized to apply 1 mL of microemulsion containing the multimodal formulation (formulation A, n = 11), minoxidil alone (formulation B, n = 11) or placebo (formulation C, n = 10) twice daily to the affected area for 32 weeks. Efficacy was evaluated by mean hair count, thickness, and weight on the targeted area of the scalp. Global photographs were taken, changes in the area of scalp coverage were assessed by patients and external investigators, and the benefits and safety of the study medications were evaluated. The physical stability of formula A was examined after a shelf storage period of 24 months. Formulation A achieved a significantly superior response than formulations B and C in terms of mean hair count (P minoxidil formulation significantly (P minoxidil alone and placebo formulations. These improvements were in agreement with the photographic assessments made by the investigators. Formula A was shown to be an o/w formulation with consistent pH, viscosity, specific gravity, and homogeneity, and was physically stable after 24 months

  15. Multimodal pain management after arthroscopic surgery

    DEFF Research Database (Denmark)

    Rasmussen, Sten

    Multimodal Pain Management after Arthroscopic Surgery By Sten Rasmussen, M.D. The thesis is based on four randomized controlled trials. The main hypothesis was that multimodal pain treatment provides faster recovery after arthroscopic surgery. NSAID was tested against placebo after knee arthroscopy...

  16. Duloxetine Contributing to a Successful Multimodal Treatment Program for Peripheral Femoral Neuropathy and Comorbid ‘Reactive Depression’ in an Adolescent

    Directory of Open Access Journals (Sweden)

    Ludmyla Kachko

    2011-01-01

    Full Text Available In the United States, duloxetine has been approved for the treatment of major depressive disorder, diabetic peripheral neuropathic pain and fibromyalgia in the adult population. Data regarding the use of duloxetine in the pediatric population, however, are very limited. Femoral nerve injury is a rare complication of cardiac catheterization. In the case described, duloxetine contributed to a successful multimodal treatment program for peripheral neuropathic pain due to femoral neuropathy in an adolescent with ‘reactive depression’ and conversion symptoms. To the best of the authors’ knowledge, the present article is only the third such report on this dual use of duloxetine in children and adolescents, and the first report of such treatment following femoral neuropathy induced by cardiac catheterization.

  17. Effect on health-related quality of life of a multimodal physiotherapy program in patients with chronic musculoskeletal disorders

    Directory of Open Access Journals (Sweden)

    Cuesta-Vargas Antonio Ignacio

    2013-02-01

    Full Text Available Abstract Background Musculoskeletal disorders are major causes of morbidity in the world, and these conditions have a strong negative influence in terms of health-related quality of life. The purpose of this study was to evaluate the effect of an 8-week multimodal physical therapy program on general health state and health-related quality of life in patients with chronic musculoskeletal disorders. Methods There were 244 participants in this prospective cohort analysis with 8-week follow-up. The primary outcome was general health state (physical and mental components, determined with the Short Form-12 Health Survey (SF-12. The secondary outcome was health related quality of life, determined with the EuroQoL-5D and VAS. The intervention was evaluated by comparing pre- and post-outcome measurements. T-tests were performed for paired data. Results Differences were statistically significant for physical health state: +1.68 (p  Conclusions Eight weeks of a Multimodal Physical Therapy Program seemed to moderately enhance the general health state and HRQoL of patients with chronic musculoskeletal diseases. This kind of therapeutic exercise can be recommended to patients with chronic low back pain, chronic neck pain and osteoarthritis, at least in the short term.

  18. Highly Sensitive Liquid Core Temperature Sensor Based on Multimode Interference Effects

    Directory of Open Access Journals (Sweden)

    Miguel A. Fuentes-Fuentes

    2015-10-01

    Full Text Available A novel fiber optic temperature sensor based on a liquid-core multimode interference device is demonstrated. The advantage of such structure is that the thermo-optic coefficient (TOC of the liquid is at least one order of magnitude larger than that of silica and this, combined with the fact that the TOC of silica and the liquid have opposite signs, provides a liquid-core multimode fiber (MMF highly sensitive to temperature. Since the refractive index of the liquid can be easily modified, this allows us to control the modal properties of the liquid-core MMF at will and the sensor sensitivity can be easily tuned by selecting the refractive index of the liquid in the core of the device. The maximum sensitivity measured in our experiments is 20 nm/°C in the low-temperature regime up to 60 °C. To the best of our knowledge, to date, this is the largest sensitivity reported for fiber-based MMI temperature sensors.

  19. Naturalistic follow-up of subjects affected with anorexia nervosa 8 years after multimodal treatment: Personality and psychopathology changes and predictors of outcome.

    Science.gov (United States)

    Amianto, F; Spalatro, A; Ottone, L; Abbate Daga, G; Fassino, S

    2017-09-01

    Eating disorders (EDs) are serious mental illnesses of growing clinical and social impact. Despite their severity, there is still no satisfactory evidence-based treatment. Follow-up investigations are the most reliable studies to enlighten long-term outcome predictors and modifiers. In total, 59 subjects affected with anorexia nervosa were assessed 8 years after their admission into an outpatient multimodal treatment program for eating disorders. The follow-up changes in diagnostic criteria were compared with Chi-square test. Improved and not-improved subjects were compared. Clinical, personality and psychopathology features between T0 and T1 were compared with t-test for repeated measures. Correlation between T0 features and changes at T1 in personality and psychopathology features were assessed. The rate of complete remission was 42%, an overall rate of 67.8% improved, a rate of 18.6% worsened. Concerning personality, a significant decrease of harm avoidance and increase in self-directedness were evidenced. Interoceptive awareness, drive for thinness, bulimia were significantly reduced at follow-up. Many T0 personality facets were related to personality and psychopathology improvement at follow-up. Multimodal treatment encompassing psychiatric, nutritional and psychological approaches is at the moment the most reliable approach for the treatment of moderate to severe anorexia nervosa with a discrete rate of improvement. Some personality and psychopathology characteristics may represent specific factors which favor resistance and impair improvement. Future approaches should consider the personalization of therapeutic approach according to these features. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  20. Thyroid Function in Women after Multimodal Treatment for Breast Cancer Stage II/III: Comparison With Controls From a Population Sample

    International Nuclear Information System (INIS)

    Reinertsen, Kristin Valborg; Cvancarova, Milada; Wist, Erik; Bjoro, Trine; Dahl, Alv A.; Danielsen, Turi; Fossa, Sophie D.

    2009-01-01

    Purpose: A possible association between thyroid diseases (TD) and breast cancer (BC) has been debated. We examined prevalence and development of TD in women after multimodal treatment for Stage II/III BC compared with women from a general population. Secondarily, we explored the impact of two different radiotherapy (RT) techniques (standardized field arrangements vs. computed tomography [CT]-based dose planning) on TD in BC patients examined 35-120 months after primary BC treatment. Methods and Materials: A total of 403 BC patients completed a questionnaire about TD and had blood samples taken for analyses of thyroid function. All had undergone postoperative RT with or without (2%) adjuvant systemic treatment. The results in the BC patients were compared with a cancer-free, age-matched control group from a general population (CGr). Results: There was higher prevalence of self-reported hypothyroidism in the BC patients as compared with the CGr (18% vs. 6%, p < 0.001). The raised prevalence was predominantly due to a substantial increase in the development of hypothyroidism after BC diagnosis, whereas the prevalence of hypothyroidism before BC diagnosis was similar to that observed in the CGr. Patients treated with CT-based RT showed a trend for increased post-BC development of hypothyroidism as compared with those treated with standardized field arrangements (p = 0.08). Conclusions: Hypothyroidism is significantly increased in women after multimodal treatment for Stage II/III BC. Radiation to the thyroid gland may be a contributing factor. BC patients should be routinely screened for hypothyroidism.

  1. Compact and broadband directional coupling and demultiplexing in dielectric-loaded surface plasmon polariton waveguides based on the multimode interference effect

    DEFF Research Database (Denmark)

    Zhu, Zhihong; García Ortíz, César Eduardo; Han, Zhanghua

    2013-01-01

    We theoretically, numerically, and experimentally demonstrate that a directional coupling function can be realized with a wide bandwidth (greater than 200 nm) in dielectric-loaded surface plasmon polariton waveguides based on the multimode interference effect. The functional size of the structure...

  2. A randomized trial on the effect of a multimodal intervention on physical capacity, functional performance and quality of life in adult patients undergoing allogeneic SCT

    DEFF Research Database (Denmark)

    Jarden, M; Baadsgaard, M T; Hovgaard, D J

    2009-01-01

    The aim of this randomized controlled trial was to investigate the effect of a 4- to 6-week multimodal program of exercise, relaxation and psychoeducation on physical capacity, functional performance and quality of life (QOL) in allogeneic hematopoietic cell transplantation (allo-HSCT) adult...

  3. Late effects of high-dose adjuvant chemotherapy on white and gray matter in breast cancer survivors: Converging results from multimodal magnetic resonance imaging

    NARCIS (Netherlands)

    de Ruiter, Michiel B.; Reneman, Liesbeth; Boogerd, Willem; Veltman, Dick J.; Caan, Matthan; Douaud, Gwenaëlle; Lavini, Cristina; Linn, Sabine C.; Boven, Epie; van Dam, Frits S. A. M.; Schagen, Sanne B.

    2012-01-01

    The neural substrate underlying cognitive impairments after chemotherapy is largely unknown. Here, we investigated very late (>9 years) effects of adjuvant high-dose chemotherapy on brain white and gray matter in primary breast cancer survivors (n = 17) with multimodal magnetic resonance imaging

  4. Multimodal Therapy for the Treatment of Severe Ischemic Stroke Combining Endovascular Embolectomy and Stenting of Long Intracranial Artery Occlusion

    Science.gov (United States)

    Bunc, Matjaž; Kocijančič, Igor J.; Pregelj, Rado; Dolenc, Vinko V.

    2010-01-01

    Embolic occlusion of cerebral arteries is a major cause for stroke. Intravenous thrombolysis showed positive results in this condition, however even when strict criteria are used, the risk of hemorrhagic transformation is possible. Microsurgical embolectomy has been described earlier. Purpose. We performed multimodal therapy of cerebral artery occlusion. Case Report. We present a case of a 49-year-old female patient who—according to the National Institute of Health Stroke Scale (NIHSS)—was rated as 19 due to acute occlusion of the horizontal segment of the left middle cerebral artery (MCA). After failed i.v. thrombolysis, only a part of the clot could be evacuated by the endovascular approach—without restoration of blood flow. Normal patency of the left MCA was re-established after stenting. Within 72 hours, the patient had an NIHSS score of 14, with a small haematoma in the left hemisphere. Conclusion. In our case multimodal therapy combining i.v. thrombolysis, mechanical disruption of thrombus, MCA stenting and platelet function antagonists, resulted in successful recanalization of the acutely occluded left MCA. PMID:20671974

  5. Multimodal therapy for the treatment of severe ischemic stroke combining endovascular embolectomy and stenting of long intracranial artery occlusion.

    Science.gov (United States)

    Bunc, Matjaz; Kocijancic, Igor J; Pregelj, Rado; Dolenc, Vinko V

    2010-01-01

    Embolic occlusion of cerebral arteries is a major cause for stroke. Intravenous thrombolysis showed positive results in this condition, however even when strict criteria are used, the risk of hemorrhagic transformation is possible. Microsurgical embolectomy has been described earlier. Purpose. We performed multimodal therapy of cerebral artery occlusion. Case Report. We present a case of a 49-year-old female patient who-according to the National Institute of Health Stroke Scale (NIHSS)-was rated as 19 due to acute occlusion of the horizontal segment of the left middle cerebral artery (MCA). After failed i.v. thrombolysis, only a part of the clot could be evacuated by the endovascular approach-without restoration of blood flow. Normal patency of the left MCA was re-established after stenting. Within 72 hours, the patient had an NIHSS score of 14, with a small haematoma in the left hemisphere. Conclusion. In our case multimodal therapy combining i.v. thrombolysis, mechanical disruption of thrombus, MCA stenting and platelet function antagonists, resulted in successful recanalization of the acutely occluded left MCA.

  6. Practical multimodal care for cancer cachexia.

    Science.gov (United States)

    Maddocks, Matthew; Hopkinson, Jane; Conibear, John; Reeves, Annie; Shaw, Clare; Fearon, Ken C H

    2016-12-01

    Cancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory. Four cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments. We demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care.

  7. Effects of a multimodal exercise program on the functional capacity of Parkinson's disease patients considering disease severity and gender

    Directory of Open Access Journals (Sweden)

    Diego Orcioli-Silva

    2014-03-01

    Full Text Available The purpose of this study was to investigate the effects of a multimodal exercise program (MEP on the functional capacity of patients with Parkinson's disease (PD according to disease severity and gender. Fourteen patients with PD participated in the study and were distributed into groups according to 1 stage of disease and 2 gender. Functional capacity was evaluated before and after 6 months of intervention. The overall PD patient group improved their coordination and strength. Men and women improved in strength performance after exercise. Men also improved on coordination. For severity of disease, the unilateral group improved in strength, while the bilateral group improved in strength, balance, coordination and the UPDRS-functional score. In conclusion, a MEP is efficient in improving components of functional capacity in patients with PD, especially in strength. Gender may be considered in the exercise program. Individuals in the bilateral disease group appeared to benefit more from exercise.

  8. Multimode optical fibers: steady state mode exciter.

    Science.gov (United States)

    Ikeda, M; Sugimura, A; Ikegami, T

    1976-09-01

    The steady state mode power distribution of the multimode graded index fiber was measured. A simple and effective steady state mode exciter was fabricated by an etching technique. Its insertion loss was 0.5 dB for an injection laser. Deviation in transmission characteristics of multimode graded index fibers can be avoided by using the steady state mode exciter.

  9. Evaluation of the Effectiveness of a Multimodal Complementary Medicine Program for Improving the Quality of Life of Cancer Patients during Adjuvant Radiotherapy and/or Chemotherapy or Outpatient Aftercare.

    Science.gov (United States)

    Domnick, Martin; Domnick, Manju; Wiebelitz, Karl-Rüdiger; Beer, André-Michael

    2017-01-01

    Evidence for complementary therapies as important strategies to relieve cancer treatment-associated symptoms is increasing. Mostly, these complementary therapies start at the end of adjuvant treatments, resulting in a long delay until the well-being of patients is addressed. Further, long distances between the rehabilitation center and the patients' residence hinder patients' compliance. The multimodal outpatient LOTUS Care Cure Project (LCCP) was tested in a randomized controlled trial including patients of various cancer entities and stages while on adjuvant chemotherapy and/or radiotherapy or outpatient aftercare. The intervention group received the LCCP additionally to the conventional treatment (LCCP group, n = 50). The control group (CG) was split into 2 groups, with (CG1, n = 33) and without (CG2, n = 17) weekly talks. The primary endpoint was quality of life (QoL) after 3 months. In the LCCP group, QoL significantly improved after 3 months compared to CG2 (p = 0.022) but not compared to CG1. Other parameters showing a significant improvement were cognitive (p < 0.05, vs. CG1 and CG2) and social function (p < 0.05, vs. CG2). This pilot study describes a multimodal outpatient complementary therapy program conducted in parallel with conventional therapies and its potential to significantly improve QoL and reduce treatment-associated side effects. To substantiate these data, multicenter trials are needed. © 2017 S. Karger AG, Basel.

  10. Effects of a multimodal exercise program on balance, functional mobility and fall risk in older adults with cognitive impairment: a randomized controlled single-blind study.

    Science.gov (United States)

    Kovács, E; Sztruhár Jónásné, I; Karóczi, C K; Korpos, A; Gondos, T

    2013-10-01

    Exercise programs have important role in prevention of falls, but to date, there are conflicting findings about the effects of exercise programs on balance, functional performance and fall risk among cognitively impaired older adults. AIM. To investigate the effects of a multimodal exercise program on static and dynamic balance, and risk of falls in older adults with mild or moderate cognitive impairment. A randomized controlled study. A long-term care institute. Cognitively impaired individuals aged over 60 years. Eighty-six participants were randomized to an exercise group providing multimodal exercise program for 12 months or a control group which did not participate in any exercise program. The Performance Oriented Mobility Assessment scale, Timed Up and Go test, and incidence of falls were measured at baseline, at 6 months and at 12 months. There was a significant improvement in balance-related items of Performance Oriented Mobility Assessment scale in the exercise group both at 6 month and 12 month (Pfalls. Our results confirmed that a 12-month multimodal exercise program can improve the balance in cognitively impaired older adults. Based on our results, the multimodal exercise program may be a promising fall prevention exercise program for older adults with mild or moderate cognitive impairment improving static balance but it is supposed that more emphasis should be put on walking component of exercise program and environmental fall risk assessment.

  11. Multimodal Therapy for the Treatment of Severe Ischemic Stroke Combining Endovascular Embolectomy and Stenting of Long Intracranial Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Matjaž Bunc

    2010-01-01

    Case Report. We present a case of a 49-year-old female patient who—according to the National Institute of Health Stroke Scale (NIHSS—was rated as 19 due to acute occlusion of the horizontal segment of the left middle cerebral artery (MCA. After failed i.v. thrombolysis, only a part of the clot could be evacuated by the endovascular approach—without restoration of blood flow. Normal patency of the left MCA was re-established after stenting. Within 72 hours, the patient had an NIHSS score of 14, with a small haematoma in the left hemisphere. Conclusion. In our case multimodal therapy combining i.v. thrombolysis, mechanical disruption of thrombus, MCA stenting and platelet function antagonists, resulted in successful recanalization of the acutely occluded left MCA.

  12. Neurofunctional maps of the 'maternal brain' and the effects of oxytocin: a multimodal voxel-based meta-analysis.

    Science.gov (United States)

    Rocchetti, Matteo; Radua, Joaquim; Paloyelis, Yannis; Xenaki, Lida-Alkisti; Frascarelli, Marianna; Caverzasi, Edgardo; Politi, Pierluigi; Fusar-Poli, Paolo

    2014-10-01

    Several studies have tried to understand the possible neurobiological basis of mothering. The putative involvement of oxytocin, in this regard, has been deeply investigated. Performing a voxel-based meta-analysis, we aimed at testing the hypothesis of overlapping brain activation in functional magnetic resonance imaging (fMRI) studies investigating the mother-infant interaction and the oxytocin modulation of emotional stimuli in humans. We performed two systematic literature searches: fMRI studies investigating the neurofunctional correlates of the 'maternal brain' by employing mother-infant paradigms; and fMRI studies employing oxytocin during emotional tasks. A unimodal voxel-based meta-analysis was performed on each database, whereas a multimodal voxel-based meta-analytical tool was adopted to assess the hypothesis that the neurofunctional effects of oxytocin are detected in brain areas implicated in the 'maternal brain.' We found greater activation in the bilateral insula extending to the inferior frontal gyrus, basal ganglia and thalamus during mother-infant interaction and greater left insular activation associated with oxytocin administration versus placebo. Left insula extending to basal ganglia and frontotemporal gyri as well as bilateral thalamus and amygdala showed consistent activation across the two paradigms. Right insula also showed activation across the two paradigms, and dorsomedial frontal cortex activation in mothers but deactivation with oxytocin. Significant activation in areas involved in empathy, emotion regulation, motivation, social cognition and theory of mind emerged from our multimodal meta-analysis, supporting the need for further studies directly investigating the neurobiology of oxytocin in the mother-infant relationship. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

  13. Serial Multimodality Imaging and 2-Year Clinical Outcomes of the Novel DESolve Novolimus-Eluting Bioresorbable Coronary Scaffold System for the Treatment of Single De Novo Coronary Lesions.

    Science.gov (United States)

    Abizaid, Alexandre; Costa, Ricardo A; Schofer, Joachim; Ormiston, John; Maeng, Michael; Witzenbichler, Bernhard; Botelho, Roberto V; Costa, J Ribamar; Chamié, Daniel; Abizaid, Andrea S; Castro, Juliana P; Morrison, Lynn; Toyloy, Sara; Bhat, Vinayak; Yan, John; Verheye, Stefan

    2016-03-28

    This study sought to report the late multimodality imaging and clinical outcomes of the novel poly-l-lactic-acid-based DESolve novolimus-eluting bioresorbable coronary scaffold for the treatment of de novo coronary lesions. Bioresorbable scaffolds are an alternative to drug-eluting metallic stents and provide temporary vascular scaffolding, which potentially may allow vessel restoration and reduce the risk of future adverse events. Overall, 126 patients were enrolled at 13 international sites between November 2011 and June 2012. The primary endpoint was in-scaffold late lumen loss at 6 months. Major adverse cardiac events, the main safety endpoint, were defined as the composite of cardiac death, target vessel myocardial infarction, or clinically indicated target lesion revascularization. All patients underwent angiography at 6 months. Serial intravascular ultrasound and optical coherence tomography were performed in a subset of patients. The scaffold device success rate was 97% (n = 122 of 126), and procedural success was 100% (n = 122 of 122). The major adverse cardiac event rate was 3.3% (n = 4 of 122) at 6 months and 7.4% (n = 9 of 122) at 24 months, including 1 probable stent thrombosis within the first month. At 6-month angiographic follow-up, in-scaffold late lumen loss was 0.20 ± 0.32 mm. Paired intravascular ultrasound analysis demonstrated a significant increase in vessel, lumen and scaffold dimensions between post-procedure and 6-month follow-up, and strut-level optical coherence tomography analysis showed full strut coverage in 99 ± 1.7%. Our results showed favorable performance of the DESolve scaffold, effective inhibition of neointimal hyperplasia, and for the first time, early luminal and scaffold growth at 6 months with sustained efficacy and safety through 2 years. (Elixir Medical Clinical Evaluation of the DESolve Novolimus Eluting Bioresorbable Coronary Scaffold System-The DESolve Nx Trial; NCT02086045). Copyright © 2016 American College of

  14. Analgesic effects of tramadol, carprofen or multimodal analgesia in rats undergoing ventral laparotomy.

    Science.gov (United States)

    Zegre Cannon, Coralie; Kissling, Grace E; Goulding, David R; King-Herbert, Angela P; Blankenship-Paris, Terry

    2011-03-01

    In this study, the authors evaluated the analgesic efficacy of tramadol (an opioid-like analgesic), carprofen (a nonsteroidal anti-inflammatory drug) and a combination of both drugs (multimodal therapy) in a rat laparotomy model. The authors randomly assigned rats to undergo either surgery (abdominal laparotomy with visceral manipulation and anesthesia) or anesthesia only. Rats in each group were treated with tramadol (12.5 mg per kg body weight), carprofen (5 mg per kg body weight), a combination of tramadol and carprofen (12.5 mg per kg body weight and 5 mg per kg body weight, respectively) or saline (anesthesia control group only; 5 mg per kg body weight). The authors administered analgesia 10 min before anesthesia, 4 h after surgery or (for the rats that received anesthesia only) anesthesia and 24 h after surgery or anesthesia. They measured locomotor activity, running wheel activity, feed and water consumption, body weight and fecal corticosterone concentration of each animal before and after surgery. Clinical observations were made after surgery or anesthesia to evaluate signs of pain and distress. The authors found that carprofen, tramadol and a combination of carprofen and tramadol were all acceptable analgesia regimens for a rat laparotomy model.

  15. Effects of Multimodal Load on Spatial Monitoring as Revealed by ERPs.

    Science.gov (United States)

    Bonato, Mario; Spironelli, Chiara; Lisi, Matteo; Priftis, Konstantinos; Zorzi, Marco

    2015-01-01

    While the role of selective attention in filtering out irrelevant information has been extensively studied, its characteristics and neural underpinnings when multiple environmental stimuli have to be processed in parallel are much less known. Building upon a dual-task paradigm that induced spatial awareness deficits for contralesional hemispace in right hemisphere-damaged patients, we investigated the electrophysiological correlates of multimodal load during spatial monitoring in healthy participants. The position of appearance of briefly presented, lateralized targets had to be reported either in isolation (single task) or together with a concurrent task, visual or auditory, which recruited additional attentional resources (dual-task). This top-down manipulation of attentional load, without any change of the sensory stimulation, modulated the amplitude of the first positive ERP response (P1) and shifted its neural generators, with a suppression of the signal in the early visual areas during both visual and auditory dual tasks. Furthermore, later N2 contralateral components elicited by left targets were particularly influenced by the concurrent visual task and were related to increased activation of the supramarginal gyrus. These results suggest that the right hemisphere is particularly affected by load manipulations, and confirm its crucial role in subtending automatic orienting of spatial attention and in monitoring both hemispaces.

  16. Effects of Multimodal Load on Spatial Monitoring as Revealed by ERPs.

    Directory of Open Access Journals (Sweden)

    Mario Bonato

    Full Text Available While the role of selective attention in filtering out irrelevant information has been extensively studied, its characteristics and neural underpinnings when multiple environmental stimuli have to be processed in parallel are much less known. Building upon a dual-task paradigm that induced spatial awareness deficits for contralesional hemispace in right hemisphere-damaged patients, we investigated the electrophysiological correlates of multimodal load during spatial monitoring in healthy participants. The position of appearance of briefly presented, lateralized targets had to be reported either in isolation (single task or together with a concurrent task, visual or auditory, which recruited additional attentional resources (dual-task. This top-down manipulation of attentional load, without any change of the sensory stimulation, modulated the amplitude of the first positive ERP response (P1 and shifted its neural generators, with a suppression of the signal in the early visual areas during both visual and auditory dual tasks. Furthermore, later N2 contralateral components elicited by left targets were particularly influenced by the concurrent visual task and were related to increased activation of the supramarginal gyrus. These results suggest that the right hemisphere is particularly affected by load manipulations, and confirm its crucial role in subtending automatic orienting of spatial attention and in monitoring both hemispaces.

  17. Gastric Adenocarcinoma: A Multimodal Approach

    Directory of Open Access Journals (Sweden)

    Humair S. Quadri

    2017-08-01

    Full Text Available Despite its declining incidence, gastric cancer (GC remains a leading cause of cancer-related deaths worldwide. A multimodal approach to GC is critical to ensure optimal patient outcomes. Pretherapy fine resolution contrast-enhanced cross-sectional imaging, endoscopic ultrasound and staging laparoscopy play an important role in patients with newly diagnosed ostensibly operable GC to avoid unnecessary non-therapeutic laparotomies. Currently, margin negative gastrectomy and adequate lymphadenectomy performed at high volume hospitals remain the backbone of GC treatment. Importantly, adequate GC surgery should be integrated in the setting of a multimodal treatment approach. Treatment for advanced GC continues to expand with the emergence of additional lines of systemic and targeted therapies.

  18. Standard of Care Versus Metastases-directed Therapy for PET-detected Nodal Oligorecurrent Prostate Cancer Following Multimodality Treatment: A Multi-institutional Case-control Study.

    Science.gov (United States)

    Steuber, T; Jilg, C; Tennstedt, P; De Bruycker, A; Tilki, D; Decaestecker, K; Zilli, T; Jereczek-Fossa, B A; Wetterauer, U; Grosu, A L; Schultze-Seemann, W; Heinzer, H; Graefen, M; Morlacco, A; Karnes, R J; Ost, P

    2018-03-10

    Most prostate cancer (PCa) patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. To perform a matched-case analysis in men with lymph node recurrent PCa comparing standard of care (SOC) with metastasis-directed therapy (MDT). PCa patients with a prostate-specific antigen (PSA) progression following multimodality treatment were included in this retrospective multi-institutional analysis. The SOC cohort (n=1816) received immediate or delayed androgen deprivation therapy administered at PSA progression. The MDT cohort (n=263) received either salvage lymph node dissection (n=166) or stereotactic body radiotherapy (n=97) at PSA progression to a positron emission tomography-detected nodal recurrence. The primary endpoint, cancer-specific survival (CSS), was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. At a median follow-up of 70 (interquartile range: 48-98) mo, MDT was associated with an improved CSS on univariate (p=0.029) and multivariate analysis (hazard ratio: 0.33, 95% confidence interval [CI]: 0.17-0.64) adjusted for the year of radical prostatectomy (RP), age at RP, PSA at RP, time from RP to PSA progression, Gleason score, surgical margin status, pT- and pN-stage. In total, 659 men were matched (3:1 ratio). The 5-yr CSS was 98.6% (95% CI: 94.3-99.6) and 95.7% (95% CI: 93.2-97.3) for MDT and SOC, respectively (p=0.005, log-rank). The main limitations of our study are its retrospective design and lack of standardization of systemic treatment in the SOC cohort. MDT for nodal oligorecurrent PCa improves CSS as compared with SOC. These retrospective data from a multi-institutional pooled analysis should be considered as hypothesis-generating and inform future randomized trials in this setting. Prostate cancer patients experiencing a lymph node recurrence might benefit from local treatments directed at

  19. Olfactory neuroblastoma: the long-term outcome and late toxicity of multimodal therapy including radiotherapy based on treatment planning using computed tomography

    International Nuclear Information System (INIS)

    Mori, Takashi; Onimaru, Rikiya; Onodera, Shunsuke; Tsuchiya, Kazuhiko; Yasuda, Koichi; Hatakeyama, Hiromitsu; Kobayashi, Hiroyuki; Terasaka, Shunsuke; Homma, Akihiro; Shirato, Hiroki

    2015-01-01

    Olfactory neuroblastoma (ONB) is a rare tumor originating from olfactory epithelium. Here we retrospectively analyzed the long-term treatment outcomes and toxicity of radiotherapy for ONB patients for whom computed tomography (CT) and three-dimensional treatment planning was conducted to reappraise the role of radiotherapy in the light of recent advanced technology and chemotherapy. Seventeen patients with ONB treated between July 1992 and June 2013 were included. Three patients were Kadish stage B and 14 were stage C. All patients were treated with radiotherapy with or without surgery or chemotherapy. The radiation dose was distributed from 50 Gy to 66 Gy except for one patient who received 40 Gy preoperatively. The median follow-up time was 95 months (range 8–173 months). The 5-year overall survival (OS) and relapse-free survival (RFS) rates were estimated at 88% and 74%, respectively. Five patients with stage C disease had recurrence with the median time to recurrence of 59 months (range 7–115 months). Late adverse events equal to or above Grade 2 in CTCAE v4.03 were observed in three patients. Multimodal therapy including radiotherapy with precise treatment planning based on CT simulation achieved an excellent local control rate with acceptable toxicity and reasonable overall survival for patients with ONB

  20. Efficacy of multimodal, systematic non-surgical treatment of knee osteoarthritis for patients not eligible for a total knee replacement

    DEFF Research Database (Denmark)

    Skou, S. T.; Roos, E. M.; Laursen, M. B.

    2012-01-01

    Introduction: It is recommended that non-operative treatment of knee osteoarthritis (KOA) should be individually tailored and include multiple treatment modalities. Despite these recommendations, no one has yet investigated the efficacy of combining several non-surgical treatment modalities...

  1. The Impact of Multimodal Texts on Reading Achievement: A Study of Iranian Secondary School Learners

    Directory of Open Access Journals (Sweden)

    Bahareh Baharani

    2015-07-01

    Full Text Available This study was designed to investigate the impact of multimodal text on reading comprehension test performance of Iranian intermediate learners. A total of 80 students participated in this study. All of them were Iranian female EFL learners with the age ranging from 16 to 18. They were selected from a boarding high school in Nasr Abad, Torbat Jam in Khorasan e Razavi, Iran. The students were randomly settled in four groups, who received different instructional approaches through using linear texts, multimodal printed texts, non-printed multimodal texts, and both multimodal printed and non-printed texts.  A pre-test and post-test were used to find out the differences before and after the experimental treatment.  The results reflected that the printed and non-printed multimodal texts had significant impact on reading comprehension test performance. In contrast, applying linear texts or traditional texts did not exert significant influence on reading comprehension ability of the participants. The findings provide useful hints for language instructors to improve effectiveness of instructional reading curriculums and reading ability of language learners. The participants who learned reading comprehension through using multimodal printed and non-printed texts enjoy reading programs and develop their intrinsic and extrinsic motivation for improving reading ability.

  2. [Patient first - The impact of characteristics of target populations on decisions about therapy effectiveness of complex interventions: Psychological variables to assess effectiveness in interdisciplinary multimodal pain therapy].

    Science.gov (United States)

    Kaiser, Ulrike; Sabatowski, Rainer; Balck, Friedrich

    2017-08-01

    The assessment of treatment effectiveness in public health settings is ensured by indicators that reflect the changes caused by specific interventions. These indicators are also applied in benchmarking systems. The selection of constructs should be guided by their relevance for affected patients (patient reported outcomes). The interdisciplinary multimodal pain therapy (IMPT) is a complex intervention based on a biopsychosocial understanding of chronic pain. For quality assurance purposes, psychological parameters (depression, general anxiety, health-related quality of life) are included in standardized therapy assessment in pain medicine (KEDOQ), which can also be used for comparative analyses in a benchmarking system. The aim of the present study was to investigate the relevance of depressive symptoms, general anxiety and mental quality of life in patients undergoing IMPT under real life conditions. In this retrospective, one-armed and exploratory observational study we used secondary data of a routine documentation of IMST in routine care, applying several variables of the German Pain Questionnaire and the facility's comprehensive basic documentation. 352 participants with IMPT (from 2006 to 2010) were included, and the follow-up was performed over two years with six assessments. Because of statistically heterogeneous characteristics a complex analysis consisting of factor and cluster analyses was applied to build subgroups. These subgroups were explored to identify differences in depressive symptoms (HADS-D), general anxiety (HADS-A), and mental quality of life (SF 36 PSK) at the time of therapy admission and their development estimated by means of effect sizes. Analyses were performed using SPSS 21.0®. Six subgroups were derived and mainly proved to be clinically and psychologically normal, with the exception of one subgroup that consistently showed psychological impairment for all three parameters. The follow-up of the total study population revealed medium

  3. Long-term clinical benefit and cost-effectiveness of an 8-week multimodal knee osteoarthritis management program incorporating intra-articular sodium hyaluronate (Hyalgan® injections

    Directory of Open Access Journals (Sweden)

    Miller LE

    2017-05-01

    Full Text Available Larry E Miller,1 Michael J Sloniewsky,2 Thomas E Gibbons,3 Janice G Johnston,4 Kent D Vosler,4 Saad Nasir5 1Miller Scientific Consulting, Inc., Asheville, NC, 2RMG Holding, Inc., Florence, 3Doctors Care, PA, Columbia, SC, 4Arrowhead Health Centers, Glendale, AZ, 5Fidia Pharma USA Inc., Parsippany, NJ, USA Background: Given the poor long-term effectiveness of focused nonsurgical knee osteoarthritis (OA treatments, alternative therapies are needed for patients who have unsuccessfully exhausted nonsurgical options.Methods: A telephone interview was conducted in patients who participated in a single 8-week multimodal knee OA treatment program (mean follow-up: 3.7 years, range: 2.7–4.9 years. The program consisted of five intra-articular knee injections of sodium hyaluronate (Hyalgan®, with each injection given 1 week apart, structured physical therapy, knee bracing, and patient education. Clinical outcomes included knee pain severity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC subscores, current medication use, and history of total knee arthroplasty. Base-case, subgroup, and sensitivity analyses were conducted to determine the incremental cost-effectiveness ratio (ICER of the treatment program with comparisons made to historical literature controls undergoing usual care. Results: A total of 218 patients (54% provided long-term follow-up data. Knee pain severity decreased 60% and WOMAC subscores decreased 33%–42% compared to baseline (all p<0.001. Total knee arthroplasty was performed in 22.8% (81/356 of knees during follow-up. The treatment program was highly cost-effective compared to usual care with a base-case ICER of $6,000 per quality-adjusted life year (QALY. Results of subgroup analyses, one-way deterministic sensitivity analyses, and second-order probabilistic sensitivity analyses resulted in ICERs ranging from $3,996 to $10,493 per QALY. The percentage of simulations with an ICER below willingness

  4. Mesonephric adenocarcinoma of the vagina. Diagnosis and multimodal treatment of a rare tumor and analysis of worldwide experience

    International Nuclear Information System (INIS)

    Mueller, Iris; Jacobs, Volker R.; Bogner, Gerhard; Staudach, Alfons; Koch, Horst; Wolfrum-Ristau, Pia; Schausberger, Christiane; Fischer, Thorsten; Kametriser, Gerhard; Sedlmayer, Felix

    2016-01-01

    Mesonephric adenocarcinoma of the vagina is an extremely rare tumor of the female genital tract, with only a few cases reported so far worldwide. Consequently, there is no established standard treatment and limited knowledge about the prognosis and biologic behavior of vaginal mesonephric adenocarcinoma. This report documents a new case of vaginal mesonephric adenocarcinoma diagnosed in a 54-year-old woman, and analyzes this in the context of all previously published cases. MRI demonstrated that the 2.5 x 1.8 cm tumor of the vaginal wall was invading urethra and bladder. Following surgical excision, histologic analysis determined mesonephric adenocarcinoma of the vagina, stage pT2 R1. In order to avoid the mutilating extended surgery which would be required to reach R0 and considerable impairment of quality of life, adjuvant radiochemotherapy was administered with external radiation and brachytherapy, including 5 cycles of cisplatin (40 mg/m 2 ) for radiosensitization. After 4 years of continuous oncologic follow-up, the patient is alive and clinically free of disease. In this case it was shown that adjuvant radiochemotherapy with radiation and brachytherapy was effective to manage the surgical R1 situation and maintain the patient's life quality. More published cases reports are needed to gradually substantiate optimal treatment strategies. (orig.) [de

  5. Effective Beginning Handwriting Instruction: Multi-modal, Consistent Format for 2 Years, and Linked to Spelling and Composing.

    Science.gov (United States)

    Wolf, Beverly; Abbott, Robert D; Berninger, Virginia W

    2017-02-01

    In Study 1, the treatment group ( N = 33 first graders, M = 6 years 10 months, 16 girls) received Slingerland multi-modal (auditory, visual, tactile, motor through hand, and motor through mouth) manuscript (unjoined) handwriting instruction embedded in systematic spelling, reading, and composing lessons; and the control group ( N =16 first graders, M = 7 years 1 month, 7 girls) received manuscript handwriting instruction not systematically related to the other literacy activities. ANOVA showed both groups improved on automatic alphabet writing from memory; but ANCOVA with the automatic alphabet writing task as covariate showed that the treatment group improved significantly more than control group from the second to ninth month of first grade on dictated spelling and recognition of word-specific spellings among phonological foils. In Study 2 new groups received either a second year of manuscript ( N = 29, M = 7 years 8 months, 16 girls) or introduction to cursive (joined) instruction in second grade ( N = 24, M = 8 years 0 months, 11 girls) embedded in the Slingerland literacy program. ANCOVA with automatic alphabet writing as covariate showed that those who received a second year of manuscript handwriting instruction improved more on sustained handwriting over 30, 60, and 90 seconds than those who had had only one year of manuscript instruction; both groups improved in spelling and composing from the second to ninth month of second grade. Results are discussed in reference to mastering one handwriting format before introducing another format at a higher grade level and always embedding handwriting instruction in writing and reading instruction aimed at all levels of language.

  6. Effective Beginning Handwriting Instruction: Multi-modal, Consistent Format for 2 Years, and Linked to Spelling and Composing

    Science.gov (United States)

    Wolf, Beverly; Abbott, Robert D.; Berninger, Virginia W.

    2016-01-01

    In Study 1, the treatment group (N = 33 first graders, M = 6 years 10 months, 16 girls) received Slingerland multi-modal (auditory, visual, tactile, motor through hand, and motor through mouth) manuscript (unjoined) handwriting instruction embedded in systematic spelling, reading, and composing lessons; and the control group (N =16 first graders, M = 7 years 1 month, 7 girls) received manuscript handwriting instruction not systematically related to the other literacy activities. ANOVA showed both groups improved on automatic alphabet writing from memory; but ANCOVA with the automatic alphabet writing task as covariate showed that the treatment group improved significantly more than control group from the second to ninth month of first grade on dictated spelling and recognition of word-specific spellings among phonological foils. In Study 2 new groups received either a second year of manuscript (N = 29, M = 7 years 8 months, 16 girls) or introduction to cursive (joined) instruction in second grade (N = 24, M = 8 years 0 months, 11 girls) embedded in the Slingerland literacy program. ANCOVA with automatic alphabet writing as covariate showed that those who received a second year of manuscript handwriting instruction improved more on sustained handwriting over 30, 60, and 90 seconds than those who had had only one year of manuscript instruction; both groups improved in spelling and composing from the second to ninth month of second grade. Results are discussed in reference to mastering one handwriting format before introducing another format at a higher grade level and always embedding handwriting instruction in writing and reading instruction aimed at all levels of language. PMID:28190930

  7. Multimodal impairment-based physical therapy for the treatment of patients with post-concussion syndrome: A retrospective analysis on safety and feasibility.

    Science.gov (United States)

    Grabowski, Patrick; Wilson, John; Walker, Alyssa; Enz, Dan; Wang, Sijian

    2017-01-01

    Demonstrate implementation, safety and feasibility of multimodal, impairment-based physical therapy (PT) combining vestibular/oculomotor and cervical rehabilitation with sub-symptom threshold exercise for the treatment of patients with post-concussion syndrome (PCS). University hospital outpatient sports medicine facility. Twenty-five patients (12-20 years old) meeting World Health Organization criteria for PCS following sport-related concussion referred for supervised PT consisting of sub-symptom cardiovascular exercise, vestibular/oculomotor and cervical spine rehabilitation. Retrospective cohort. Post-Concussion Symptom Scale (PCSS) total score, maximum symptom-free heart rate (SFHR) during graded exercise testing (GXT), GXT duration, balance error scoring system (BESS) score, and number of adverse events. Patients demonstrated a statistically significant decreasing trend (p feasibility for future clinical trials to determine viable treatment approaches to reduce symptoms and improve function while avoiding negative repercussions of physical inactivity and premature return to full activity. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Dual task multimodal physical training in Alzheimer’s disease: effect on cognitive functions and muscle strength

    Directory of Open Access Journals (Sweden)

    Bruno Naves Ferreira

    2017-12-01

    Full Text Available The aim of this study was to evaluate the effects of dual task multimodal physical training (MPT on the cognitive functions and muscle strength in older adults with Alzheimer’s disease. Participants were 19 subjects with AD in the mild and moderate stages, divided into training group (TG and control group (CG. The TG performed dual task MPT for 12 weeks. Subjects were evaluated at the pre- and post-intervention moments. The Mini Mental State Examination (MMSE, Clock Drawing Test (CDT and Frontal Assessment Battery (FAB were used to assess cognition. For muscle strength, the Chair Lift and Sit Test (CLST and Manual Grasp Force (MGF were used. The Wilcoxon test was used to analyze pre and post intragroup moments. The TG showed a significant improvement in FAB and CLST (p≤0.05 and a tendency to improve the MMSE score (p≤0.08. The CG showed significant improvement in CLST (p≤0.05. Dual task MPT improves the frontal cognitive functions and lower limb muscle strength of older adults with AD.

  9. Hybrid PD and effective multi-mode positive position feedback control for slewing and vibration suppression of a smart flexible manipulator

    International Nuclear Information System (INIS)

    Lou, Jun-qiang; Wei, Yan-ding; Yang, Yi-ling; Xie, Feng-ran

    2015-01-01

    A hybrid control strategy for slewing and vibration suppression of a smart flexible manipulator is presented in this paper. It consists of a proportional derivative controller to realize motion control, and an effective multi-mode positive position feedback (EMPPF) controller to suppress the multi-mode vibration. Rather than treat each mode equally as the standard multi-mode PPF, the essence of the EMPPF is that control forces of different modes are applied according to the mode parameters of the respective modes, so the vibration modes with less vibration energy receive fewer control forces. Stability conditions for the close loop system are established through stability analysis. Optimal parameters of the EMPPF controller are obtained using the method of root locus analysis. The performance of the proposed strategy is demonstrated by simulation and experiments. Experimental results show that the first two vibration modes of the manipulator are effectively suppressed. The setting time of the setup descends approximately 55%, reaching 3.12 s from 5.67 s. (paper)

  10. Hybrid PD and effective multi-mode positive position feedback control for slewing and vibration suppression of a smart flexible manipulator

    Science.gov (United States)

    Lou, Jun-qiang; Wei, Yan-ding; Yang, Yi-ling; Xie, Feng-ran

    2015-03-01

    A hybrid control strategy for slewing and vibration suppression of a smart flexible manipulator is presented in this paper. It consists of a proportional derivative controller to realize motion control, and an effective multi-mode positive position feedback (EMPPF) controller to suppress the multi-mode vibration. Rather than treat each mode equally as the standard multi-mode PPF, the essence of the EMPPF is that control forces of different modes are applied according to the mode parameters of the respective modes, so the vibration modes with less vibration energy receive fewer control forces. Stability conditions for the close loop system are established through stability analysis. Optimal parameters of the EMPPF controller are obtained using the method of root locus analysis. The performance of the proposed strategy is demonstrated by simulation and experiments. Experimental results show that the first two vibration modes of the manipulator are effectively suppressed. The setting time of the setup descends approximately 55%, reaching 3.12 s from 5.67 s.

  11. Optical Splitters Based on Self-Imaging Effect in Multi-Mode Waveguide Made by Ion Exchange in Glass

    Directory of Open Access Journals (Sweden)

    O. Barkman

    2013-04-01

    Full Text Available Design and modeling of single mode optical multi-mode interference structures with graded refractive index is reported. Several samples of planar optical channel waveguides were obtained by Ag+, Na+ and K+, Na+ one step thermal ion exchange process in molten salt on GIL49 glass substrate and new special optical glass for ion exchange technology. Waveguide properties were measured by optical mode spectroscopy. Obtained data were used for further design and modeling of single mode channel waveguide and subsequently for the design of 1 to 3 multimode interference power splitter in order to improve simulation accuracy. Designs were developed by utilizing finite difference beam propagation method.

  12. Mesonephric adenocarcinoma of the vagina. Diagnosis and multimodal treatment of a rare tumor and analysis of worldwide experience

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, Iris; Jacobs, Volker R.; Bogner, Gerhard; Staudach, Alfons; Koch, Horst; Wolfrum-Ristau, Pia; Schausberger, Christiane; Fischer, Thorsten [Paracelsus Medical University (PMU), Department of Obstetrics and Gynecology (OB/GYN), Salzburg (Austria); Kametriser, Gerhard; Sedlmayer, Felix [Paracelsus Medical University (PMU), Department of Radiology and Radiation Oncology, 5020 Salzburg (Austria)

    2016-09-15

    Mesonephric adenocarcinoma of the vagina is an extremely rare tumor of the female genital tract, with only a few cases reported so far worldwide. Consequently, there is no established standard treatment and limited knowledge about the prognosis and biologic behavior of vaginal mesonephric adenocarcinoma. This report documents a new case of vaginal mesonephric adenocarcinoma diagnosed in a 54-year-old woman, and analyzes this in the context of all previously published cases. MRI demonstrated that the 2.5 x 1.8 cm tumor of the vaginal wall was invading urethra and bladder. Following surgical excision, histologic analysis determined mesonephric adenocarcinoma of the vagina, stage pT2 R1. In order to avoid the mutilating extended surgery which would be required to reach R0 and considerable impairment of quality of life, adjuvant radiochemotherapy was administered with external radiation and brachytherapy, including 5 cycles of cisplatin (40 mg/m{sup 2}) for radiosensitization. After 4 years of continuous oncologic follow-up, the patient is alive and clinically free of disease. In this case it was shown that adjuvant radiochemotherapy with radiation and brachytherapy was effective to manage the surgical R1 situation and maintain the patient's life quality. More published cases reports are needed to gradually substantiate optimal treatment strategies. (orig.) [German] Das mesonephrische Adenokarzinom der Vagina ist ein aeusserst seltener Tumor des weiblichen Genitaltrakts. In der internationalen Literatur finden sich nur wenig gut dokumentierte Faelle. Das biologische Verhaltensmuster dieses Tumors und dessen Prognose sind weitgehend unbekannt. In diesem Bericht wird ein neuer Fall einer 54-jaehrigen Frau mit einem mesonephrischen Adenokarzinom der Vagina vorgestellt und unter Beruecksichtigung aller bisher publizierten Faelle analysiert. Bei dem 2,5 x 1,8 cm grossen Tumor der Vaginalwand zeigte sich in der Magnetresonanztomographie eine Infiltration der Urethra und

  13. Virtual Chironomia: A Multimodal Study of Verbal and Non-Verbal Communication in a Virtual World

    Science.gov (United States)

    Verhulsdonck, Gustav

    2010-01-01

    This mixed methods study examined the various aspects of multimodal use of non-verbal communication in virtual worlds during dyadic negotiations. Quantitative analysis uncovered a treatment effect whereby people with more rhetorical certainty used more neutral non-verbal communication; whereas people that were rhetorically less certain used more…

  14. Predictors of Long-Term Risky Driving Behavior in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder.

    Science.gov (United States)

    Johnson, Jessica A; Jakubovski, Ewgeni; Reed, Margot O; Bloch, Michael H

    2017-10-01

    This study examines predictors of later risky driving behavior in children with attention-deficit/hyperactivity disorder (ADHD). Stepwise logistic regression and receiver operating characteristic (ROC) analysis were used to explore baseline predictors of risky driving behavior for adolescents who completed the 8-year follow-up assessment in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA). Stepwise logistic regression analysis explained 19% of the total variance in risky driving behavior. Increased likelihood of risky driving behavior was associated with parental history of conduct disorder, low parental monitoring and supervision, and increased age. ROC analysis identified discriminative predictors for adolescents older and younger than 16 years of age at follow-up. The most discriminative predictors of later risky driving behavior were parental stress at baseline (for children 16 years or older) and increased child-rated parental protectiveness (for children less than 16 years old). Risky driving behavior was significantly predicted by baseline characteristics for the MTA cohort. Aspects of parenting behavior (or the child's perception of them), including parental stress levels, parental protectiveness, and parental levels of monitoring and supervision, were most informative in predicting these outcomes. Our results suggest that interventions to reduce high-risk behaviors in these high-risk children with ADHD might involve targeted parenting interventions.

  15. New developments in multimodal clinical multiphoton tomography

    Science.gov (United States)

    König, Karsten

    2011-03-01

    80 years ago, the PhD student Maria Goeppert predicted in her thesis in Goettingen, Germany, two-photon effects. It took 30 years to prove her theory, and another three decades to realize the first two-photon microscope. With the beginning of this millennium, first clinical multiphoton tomographs started operation in research institutions, hospitals, and in the cosmetic industry. The multiphoton tomograph MPTflexTM with its miniaturized flexible scan head became the Prism-Award 2010 winner in the category Life Sciences. Multiphoton tomographs with its superior submicron spatial resolution can be upgraded to 5D imaging tools by adding spectral time-correlated single photon counting units. Furthermore, multimodal hybrid tomographs provide chemical fingerprinting and fast wide-field imaging. The world's first clinical CARS studies have been performed with a hybrid multimodal multiphoton tomograph in spring 2010. In particular, nonfluorescent lipids and water as well as mitochondrial fluorescent NAD(P)H, fluorescent elastin, keratin, and melanin as well as SHG-active collagen have been imaged in patients with dermatological disorders. Further multimodal approaches include the combination of multiphoton tomographs with low-resolution imaging tools such as ultrasound, optoacoustic, OCT, and dermoscopy systems. Multiphoton tomographs are currently employed in Australia, Japan, the US, and in several European countries for early diagnosis of skin cancer (malignant melanoma), optimization of treatment strategies (wound healing, dermatitis), and cosmetic research including long-term biosafety tests of ZnO sunscreen nanoparticles and the measurement of the stimulated biosynthesis of collagen by anti-ageing products.

  16. Results from a Multi-Modal Program Evaluation of a Four Year Statewide Juvenile Sex Offender Treatment and Reentry Program

    Science.gov (United States)

    Underwood, Lee A.; Dailey, Frances L. L.; Merino, Carrie; Crump, Yolanda

    2015-01-01

    The results of the Program Evaluation show the OJJ Statewide Sex Offender Treatment program is exceptionally productive in meeting over 90% of its established performance markers. These markers included successful screening and assessment of risk and psychosocial needs, completion of initial and master treatment plans, establishment of sex…

  17. Multimodal MRI and cognitive function in patients with breast cancer prior to adjuvant treatment — The role of fatigue

    Directory of Open Access Journals (Sweden)

    Sanne Menning

    2015-01-01

    This study suggests that cancer-related psychological or biological processes may adversely impact cognitive functioning and associated aspects of brain structure and function before the start of adjuvant treatment. Our findings stress the importance to further explore the processes underlying the expression of fatigue and to study whether it has a contributory role in subsequent treatment-related cognitive decline.

  18. Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression.

    Science.gov (United States)

    Swanson, James M; Arnold, L Eugene; Molina, Brooke S G; Sibley, Margaret H; Hechtman, Lily T; Hinshaw, Stephen P; Abikoff, Howard B; Stehli, Annamarie; Owens, Elizabeth B; Mitchell, John T; Nichols, Quyen; Howard, Andrea; Greenhill, Laurence L; Hoza, Betsy; Newcorn, Jeffrey H; Jensen, Peter S; Vitiello, Benedetto; Wigal, Timothy; Epstein, Jeffery N; Tamm, Leanne; Lakes, Kimberly D; Waxmonsky, James; Lerner, Marc; Etcovitch, Joy; Murray, Desiree W; Muenke, Maximilian; Acosta, Maria T; Arcos-Burgos, Mauricio; Pelham, William E; Kraemer, Helena C

    2017-06-01

    The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral and pharmacological treatments of 579 children (7-10 years of age) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type. It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates (258 without ADHD) added as a local normative comparison group (LNCG), with assessments 2-16 years after baseline. Primary (symptom severity) and secondary (adult height) outcomes in adulthood were specified. Treatment was monitored to age 18, and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication (Consistent, Inconsistent, and Negligible). For the follow-up, hypothesis-generating analyses were performed on outcomes in early adulthood (at 25 years of age). Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit (symptom reduction) and cost (height suppression) associated with extended use of medication. For ratings of symptom severity, the ADHD-LNCG comparison was statistically significant for the parent/self-report average (0.51 ± 0.04, p ADHD group was 1.29 ± 0.55 cm shorter than the LNCG (p ADHD group showed symptom persistence compared to local norms from the LNCG. Within naturalistic subgroups of ADHD cases, extended use of medication was associated with suppression of adult height but not with reduction of symptom severity. © 2017 Association for Child and Adolescent Mental Health.

  19. Multimodal fluorescence imaging spectroscopy

    NARCIS (Netherlands)

    Stopel, Martijn H W; Blum, Christian; Subramaniam, Vinod; Engelborghs, Yves; Visser, Anthonie J.W.G.

    2014-01-01

    Multimodal fluorescence imaging is a versatile method that has a wide application range from biological studies to materials science. Typical observables in multimodal fluorescence imaging are intensity, lifetime, excitation, and emission spectra which are recorded at chosen locations at the sample.

  20. Multimodality in organization studies

    DEFF Research Database (Denmark)

    Van Leeuwen, Theo

    2017-01-01

    This afterword reviews the chapters in this volume and reflects on the synergies between organization and management studies and multimodality studies that emerge from the volume. These include the combination of strong sociological theorizing and detailed multimodal analysis, a focus on material...

  1. The treatment of late radiation effects with hyperbaric oxygenation (HBO)

    International Nuclear Information System (INIS)

    Plafki, C.; Carl, U.M.; Glag, M.; Hartmann, K.A.

    1998-01-01

    Background: Late radiation injuries may impose a negative influence on the quality of life in the affected patients. In several entities, standardized treatment protocols are lacking. Hyperbaric oxygenation (HBO) has been shown to have beneficial effects in the treatment of late radiation sequelae. Material and methods: The basic principles of HBO are reviewed as well as clinical issues. Current study protocols are presented. Results: During HBO-therapy the patient breathes pure oxygen at pressures above 100 kPa. The oxygen solubility within the fluid phase of the blood is largely increased. Biological effects include an increased oxygen diffusibility, improved collagen synthesis and neoangiogenesis as well as an enhancement of antimicrobial defenses. By decreasing the capillary filtration pressure a reduction of edema becomes possible. HBO has been shown to prevent complications following surgery in irradiated tissues. Its efficacy as an adjunct in the treatment of osteonecroses in radiation patients could be demonstrated. In addition, the loss of osseointegrated implants in the maxillofacial bones of these patients could be significantly reduced. Further indications include soft tissue necroses, hemorrhagic cystitis and proctitis in tumor patients that have been treated by radiotherapy as part of a multimodality approach. Conclusions: HBO in the treatment of late radiation effects is still subject of investigation, but remarkable results have been reported. Optimized treatment protocols need to be determined in various entities. The rate of side effects is acceptable low. (orig.) [de

  2. Crossmodal object recognition in rats with and without multimodal object pre-exposure: no effect of hippocampal lesions.

    Science.gov (United States)

    Reid, James M; Jacklin, Derek L; Winters, Boyer D

    2012-10-01

    The neural mechanisms and brain circuitry involved in the formation, storage, and utilization of multisensory object representations are poorly understood. We have recently introduced a crossmodal object recognition (CMOR) task that enables the study of such questions in rats. Our previous research has indicated that the perirhinal and posterior parietal cortices functionally interact to mediate spontaneous (tactile-to-visual) CMOR performance in rats; however, it remains to be seen whether other brain regions, particularly those receiving polymodal sensory inputs, contribute to this cognitive function. In the current study, we assessed the potential contribution of one such polymodal region, the hippocampus (HPC), to crossmodal object recognition memory. Rats with bilateral excitotoxic HPC lesions were tested in two versions of crossmodal object recognition: (1) the original CMOR task, which requires rats to compare between a stored tactile object representation and visually-presented objects to discriminate the novel and familiar stimuli; and (2) a novel 'multimodal pre-exposure' version of the CMOR task (PE/CMOR), in which simultaneous exploration of the tactile and visual sensory features of an object 24 h prior to the sample phase enhances CMOR performance across longer retention delays. Hippocampus-lesioned rats performed normally on both crossmodal object recognition tasks, but were impaired on a radial arm maze test of spatial memory, demonstrating the functional effectiveness of the lesions. These results strongly suggest that the HPC, despite its polymodal anatomical connections, is not critically involved in tactile-to-visual crossmodal object recognition memory. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol

    Directory of Open Access Journals (Sweden)

    Forbes Andrew

    2010-10-01

    Full Text Available Abstract Background Hip osteoarthritis (OA is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function. Methods The trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline. Conclusions The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA. Trial Registration Australian New Zealand Clinical Trials Registry reference: ACTRN12610000439044

  4. Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol

    Science.gov (United States)

    2010-01-01

    Background Hip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function. Methods The trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS) and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline. Conclusions The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA. Trial Registration Australian New Zealand Clinical Trials Registry reference: ACTRN12610000439044 PMID:20946621

  5. STTARR: a radiation treatment and multi-modal imaging facility for fast tracking novel agent development in small animal models

    International Nuclear Information System (INIS)

    Yeung, Ivan; McKee, Trevor; Jaffray, David; Hill, Richard

    2014-01-01

    Small animal models play a pivotal role in the pipeline development of novel agents and strategies in personalized cancer therapy. The Spatio-Temporal Targeting and Amplification of Radiation Response Program (STTARR) consists of an animal imaging and precision radiation facility designed to provide innovative biologic imaging and targeted radiation treatment strategies in small animals. The design is to mirror the imaging and radiation treatment facility in a modern cancer center. The STTARR features imaging equipment of small animal scale including CT, MRI, PET, SPECT, Optical devices as well as image guided irradiators. The fleet of imaging and irradiation equipment provides a platform for identification of biological targets of the specific molecular pathways that influence both tumor progression and a patient's response to radiation therapy. Examples will be given in the utilization of the imaging facilities for development in novel approaches in cancer therapy including a PET-FAZA study for hypoxia measurement in a pancreatic adenocarcinoma xenograft model. In addition, the cone-beam image guided small animal irradiator developed at our institute will also be described. The animal platform (couch) provides motion in 3 dimensions to position the animal to the isocentre of the beam. A pair of rotational arms supporting the X-ray/detector pair enables acquisition of cone-beam images of the animal which give rise to image guided precision of 0.5 mm. The irradiation energy ranges from 50 to 225 kVp at a dose rate from 10-400 cGy/min. The gantry is able to direct X-ray beam of different directions to give conformal radiation treatment to the animal. A dedicated treatment planning system is able to perform treatment planning and provide commonly used clinical metrics in the animal treatment plan. Examples will be given to highlight the use of the image guided irradiator for research of drug/irradiation regimen in animal models. (author)

  6. The multimodal magnetoelectric effect in the ring-shaped magnetostrictive-piezoelectric bulk composites

    Science.gov (United States)

    Radchenko, G. S.; Filippov, D. A.; Laletin, V. M.

    2015-11-01

    The theoretical and experimental investigation of the direct magnetoelectric effect in the ring-type structures made of the bulk magnetostrictive-piezoelectric composites has been presented. The analytical expression for the magnetoelectric voltage coefficient has been obtained using the effective parameters method. The frequency dependence of this parameter is also analyzed. The dependence of the resonant frequency and the amplitude of this effect of the geometrical parameters of the ring for the first and second oscillation modes are presented. The experimental investigation of the direct magnetoelectric effect for the ring-type composite specimens consisting of the nickel ferrite spinel-PZT bulk composite is done. The obtained experimental data are in good agreement with the theoretical predictions.

  7. Fusion Teaching: Utilizing Course Management Technology to Deliver an Effective Multimodal Pedagogy

    Science.gov (United States)

    Childs, Bradley D.; Cochran, Howard H.; Velikova, Marieta

    2013-01-01

    Fusion teaching merges several pedagogies into a coherent whole. Course management technology allows for the digitization and delivery of pedagogies in an effective and exciting manner. Online course management options more easily enable outcome assessment and monitoring for continuous improvement.

  8. Comparative Study of Multimodal and Pharmacological Therapy in Treating School Aged Children with ADHD

    Directory of Open Access Journals (Sweden)

    Susana Bogdana MILEA

    2012-09-01

    Full Text Available The attention deficit hyperactivity disorder (ADHD, one of the most commonly diagnosed psychiatric disorders among school aged children, continues to create disputes between specialists, upon the best treatment to be used. The herby study aims to bring forward some differences that may exist between the efficacy of the multimodal treatment compared to the drug treatment of ADHD. The novelty component of this study, unfolded February 2010-July 2012, is that the children, their parents and also their teachers were included in the multimodality treatment. The children included in this research (n=63, aged 6-14 and ADHD diagnosed, were randomly assigned in two groups. In the medication (Med group (n=32 the children only received the specific pharmacological treatment (Atomoxetine or Methylphenidate, and for the multimodality (MM group (n=31 the therapy included psychosocial interventions besides the drug therapy. All children were evaluated, both pre and post intervention, with the Achenbach System of Empirically Based Assessment – ASEBA, for the 6-18 aged category. We have compared the influence of therapy on the core symptoms, on the adaptive functionality and academic performance and on the competences and social functioning of the children in the two groups. The multimodal intervention proved to be more effective (p<0.05 than medication alone, firstly in ameliorating the child’s social behavior in both family and school environment, than in what concerns the main ADHD symptoms. The children’s academic performance was little impacted by either of the two therapies.

  9. Effect of a Multimodal High Intensity Exercise Intervention in Cancer Patients Undergoing Chemotherapy

    DEFF Research Database (Denmark)

    Adamsen, Lis; Quist, Morten; Andersen, Christina

    2009-01-01

    for advanced disease. Design: Randomised controlled trial. Setting: Two university hospitals in Copenhagen, Denmark. Participants: 269 patients with cancer; 73 men, 196 women, mean age 47 years (range 20-65) representing 21 diagnoses. Main exclusion criteria were brain or bone metastases. 235 patients...... at six weeks for the primary outcome, fatigue, of −6.6 points (95% confidence interval −12.3 to −0.9, P=0.02; effect size=0.33, 0.04 to 0.61). Significant effects were seen on vitality (effect size 0.55, 95% CI 0.27 to 0.82), physical functioning (0.37, 0.09 to 0.65), role physical (0.37, 0.10 to 0...

  10. The effect of transverse multi-mode oscillation in passively modelocked solid-state lasers

    Science.gov (United States)

    Agnesi, A.; Reali, G. C.; Gabetta, G.

    1992-03-01

    We demonstrate that the pulses from a passively mode-locked flashlamp pumped solid-state laser can be considerably shorter using an antiresonant-ring mirror than using a linear cavity with a standard contacted dye-cell mirror, and we suggest that transverse-mode-filtering effects in the antiresonant ring play an important role in explaining this difference.

  11. Exploring Cascading Effects of Multimodal Communication Skills in Infants with Hearing Loss

    Science.gov (United States)

    Roberts, Megan Y.; Hampton, Lauren H.

    2018-01-01

    Infants and toddlers with hearing loss (HL) are at risk for developing communicative delays that can have a substantial lasting effect. Understanding child characteristics that may be targeted in early intervention is essential to maximizing communicative outcomes in children with HL. Among the most malleable predictors of communication skills…

  12. Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department

    NARCIS (Netherlands)

    Arntz, P.R.; Hopman, J.; Nillesen, M.; Yalcin, E.; Bleeker-Rovers, C.P.; Voss, A.; Edwards, M.J.; Wei, A.T.W.

    2016-01-01

    BACKGROUND: Hand hygiene (HH) is essential in preventing nosocomial infection. The emergency department (ED) is an open portal of entry for pathogens into the hospital system, hence the important sentinel function of the ED personnel. The main objective of this study was to assess the effect of a

  13. Cost-effective, compact and high-speed integrable multi-mode interference modulator

    NARCIS (Netherlands)

    Lenstra, Daan; Yao, Weiming; Cardarelli, Simone; Mink, Jan

    2017-01-01

    Theoretical analysis of the modulation performance of this wave-guide device shows great potential when combined with a single-mode laser on a monolithic optical chip. On the basis of the reversed-bias electro-optic effect, modulation speeds surmounting 25 Gbit/s with 10 dB extinction ratio are

  14. Multimodality imaging of pulmonary infarction

    International Nuclear Information System (INIS)

    Bray, T.J.P.; Mortensen, K.H.; Gopalan, D.

    2014-01-01

    Highlights: • A plethora of pulmonary and systemic disorders, often associated with grave outcomes, may cause pulmonary infarction. • A stereotypical infarct is a peripheral wedge shaped pleurally based opacity but imaging findings can be highly variable. • Multimodality imaging is key to diagnosing the presence, aetiology and complications of pulmonary infarction. • Multimodality imaging of pulmonary infarction together with any ancillary features often guide to early targeted treatment. • CT remains the principal imaging modality with MRI increasingly used alongside nuclear medicine studies and ultrasound. - Abstract: The impact of absent pulmonary arterial and venous flow on the pulmonary parenchyma depends on a host of factors. These include location of the occlusive insult, the speed at which the occlusion develops and the ability of the normal dual arterial supply to compensate through increased bronchial arterial flow. Pulmonary infarction occurs when oxygenation is cut off secondary to sudden occlusion with lack of recruitment of the dual supply arterial system. Thromboembolic disease is the commonest cause of such an insult but a whole range of disease processes intrinsic and extrinsic to the pulmonary arterial and venous lumen may also result in infarcts. Recognition of the presence of infarction can be challenging as imaging manifestations often differ from the classically described wedge shaped defect and a number of weighty causes need consideration. This review highlights aetiologies and imaging appearances of pulmonary infarction, utilising cases to illustrate the essential role of a multimodality imaging approach in order to arrive at the appropriate diagnosis

  15. Multimodality imaging of pulmonary infarction

    Energy Technology Data Exchange (ETDEWEB)

    Bray, T.J.P., E-mail: timothyjpbray@gmail.com [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom); Mortensen, K.H., E-mail: mortensen@doctors.org.uk [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom); University Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 318, Cambridge CB2 0QQ (United Kingdom); Gopalan, D., E-mail: deepa.gopalan@btopenworld.com [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom)

    2014-12-15

    Highlights: • A plethora of pulmonary and systemic disorders, often associated with grave outcomes, may cause pulmonary infarction. • A stereotypical infarct is a peripheral wedge shaped pleurally based opacity but imaging findings can be highly variable. • Multimodality imaging is key to diagnosing the presence, aetiology and complications of pulmonary infarction. • Multimodality imaging of pulmonary infarction together with any ancillary features often guide to early targeted treatment. • CT remains the principal imaging modality with MRI increasingly used alongside nuclear medicine studies and ultrasound. - Abstract: The impact of absent pulmonary arterial and venous flow on the pulmonary parenchyma depends on a host of factors. These include location of the occlusive insult, the speed at which the occlusion develops and the ability of the normal dual arterial supply to compensate through increased bronchial arterial flow. Pulmonary infarction occurs when oxygenation is cut off secondary to sudden occlusion with lack of recruitment of the dual supply arterial system. Thromboembolic disease is the commonest cause of such an insult but a whole range of disease processes intrinsic and extrinsic to the pulmonary arterial and venous lumen may also result in infarcts. Recognition of the presence of infarction can be challenging as imaging manifestations often differ from the classically described wedge shaped defect and a number of weighty causes need consideration. This review highlights aetiologies and imaging appearances of pulmonary infarction, utilising cases to illustrate the essential role of a multimodality imaging approach in order to arrive at the appropriate diagnosis.

  16. The Effects of Multimodal Mobile Communications on Cooperative Team Interactions Executing Distributed Tasks

    Science.gov (United States)

    2013-07-01

    completed on the NASA – TLX data in Figure 6. A statistically significant main effect was found for conditions, F (3, 177) = 14.39, p < .01. Post hoc...Proceedings of CHI 2005, pp. 1116–1117 (2005) Hart, S.G., Staveland, L.E.: Development of NASA - TLX (task load index): results of empirical and...without making any errors. Immediately following each condition, both the Helper and the Worker independently completed the NASA -Task Load Index ( NASA

  17. Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial

    DEFF Research Database (Denmark)

    Adamsen, Lis; Quist, Morten; Andersen, Christina

    2009-01-01

    disease. DESIGN: Randomised controlled trial. SETTING: Two university hospitals in Copenhagen, Denmark. PARTICIPANTS: 269 patients with cancer; 73 men, 196 women, mean age 47 years (range 20-65) representing 21 diagnoses. Main exclusion criteria were brain or bone metastases. 235 patients completed follow...... outcome, fatigue, of -6.6 points (95% confidence interval -12.3 to -0.9, P=0.02; effect size=0.33, 0.04 to 0.61). Significant effects were seen on vitality (effect size 0.55, 95% CI 0.27 to 0.82), physical functioning (0.37, 0.09 to 0.65), role physical (0.37, 0.10 to 0.64), role emotional (0.32, 0.......05 to 0.59), and mental health (0.28, 0.02 to 0.56) scores. Improvement was noted in physical capacity: estimated mean difference between groups for maximum oxygen consumption was 0.16 l/min (95% CI 0.1 to 0.2, P

  18. Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy

    DEFF Research Database (Denmark)

    Adamsen, Lis; Quist, Morten; Andersen, Christina

    2009-01-01

    disease. DESIGN: Randomised controlled trial. SETTING: Two university hospitals in Copenhagen, Denmark. PARTICIPANTS: 269 patients with cancer; 73 men, 196 women, mean age 47 years (range 20-65) representing 21 diagnoses. Main exclusion criteria were brain or bone metastases. 235 patients completed follow...... outcome, fatigue, of -6.6 points (95% confidence interval -12.3 to -0.9, P=0.02; effect size=0.33, 0.04 to 0.61). Significant effects were seen on vitality (effect size 0.55, 95% CI 0.27 to 0.82), physical functioning (0.37, 0.09 to 0.65), role physical (0.37, 0.10 to 0.64), role emotional (0.32, 0.......05 to 0.59), and mental health (0.28, 0.02 to 0.56) scores. Improvement was noted in physical capacity: estimated mean difference between groups for maximum oxygen consumption was 0.16 l/min (95% CI 0.1 to 0.2, P

  19. Multimode delta-E effect magnetic field sensors with adapted electrodes

    Energy Technology Data Exchange (ETDEWEB)

    Zabel, Sebastian; Fichtner, Simon; Kirchhof, Christine; Quandt, Eckhard; Faupel, Franz, E-mail: ff@tf.uni-kiel.de [Faculty of Engineering, Institute for Materials Science, Kiel University, Kaiserstraße 2, 24143 Kiel (Germany); Reermann, Jens; Schmidt, Gerhard [Faculty of Engineering, Institute for Electrical Engineering, Kiel University, Kaiserstraße 2, 24143 Kiel (Germany); Wagner, Bernhard [Fraunhofer Institute for Silicon Technology ISIT, Fraunhoferstraße 1, 25524 Itzehoe (Germany)

    2016-05-30

    We present an analytical and experimental study on low-noise piezoelectric thin film resonators that utilize the delta-E effect of a magnetostrictive layer to measure magnetic fields at low frequencies. Calculations from a physical model of the electromechanical resonator enable electrode designs to efficiently operate in the first and second transversal bending modes. As predicted by our calculations, the adapted electrode design improves the sensitivity by a factor of 6 and reduces the dynamic range of the sensor output by 16 dB, which significantly eases the requirements on readout electronics. Magnetic measurements show a bandwidth of 100 Hz at a noise level of about 100 pTHz{sup −0.5}.

  20. The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue

    DEFF Research Database (Denmark)

    Andersen, Christina; Rørth, Mikael; Ejlertsen, Bent

    2013-01-01

    Cancer related fatigue (CRF) is a common problem for cancer patients across diagnoses during chemotherapy and is associated with physical inactivity, lower functional level and lack of energy. Few RCT exercise intervention studies have included cancer patients undergoing chemotherapy. The objective...... of this study is to evaluate whether a six-week supervised multimodal exercise intervention, adjunct to chemotherapy and standard care, can reduce the patient's CRF level....

  1. Multimodal freight investment criteria.

    Science.gov (United States)

    2010-07-01

    Literature was reviewed on multi-modal investment criteria for freight projects, examining measures and techniques for quantifying project benefits and costs, as well as ways to describe the economic importance of freight transportation. : A limited ...

  2. Palliative benefits of the multimodality approach in the re-treatment of recurrent malignant glioma: Two case reports

    Directory of Open Access Journals (Sweden)

    T R Arulponni

    2009-01-01

    Full Text Available Two young male patients treated seven and four years back, for malignant glioma, returned with recurrence at the same site, with a World Health Organization (WHO Performance Score of four and two. Both underwent resurgery and received postoperative reirradiation of 5040 cGy in 28 fractions and concurrent Temozolomide 75 mg/m 2 body surface area (BSA daily, and one patient received additional adjuvant Temozolomide 250 mg (150 mg/m 2 BSA. Both patients tolerated the treatment well with 16 and 14 months follow-up from the time of recurrence. They were symptom-free, with normal physical function and good mental state, and resumed their respective jobs.

  3. Statistical Modeling of the Eye for Multimodal Treatment Planning for External Beam Radiation Therapy of Intraocular Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Rueegsegger, Michael B. [ARTORG Center for Biomedical Engineering Research, University of Bern (Switzerland); Bach Cuadra, Meritxell [Department of Radiology, University Hospital Center (CHUV) and University of Lausanne (UNIL), Signal Processing Laboratory - LTS5, Ecole Polytechnique Federale de Lausanne (Switzerland); Pica, Alessia [Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern (Switzerland); Amstutz, Christoph A. [Department of Ophthalmology, University Hospital Zurich (Switzerland); Rudolph, Tobias [ARTORG Center for Biomedical Engineering Research, University of Bern (Switzerland); Aebersold, Daniel [Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern (Switzerland); Kowal, Jens H., E-mail: jens.kowal@artorg.unibe.ch [ARTORG Center for Biomedical Engineering Research, University of Bern (Switzerland)

    2012-11-15

    Purpose: Ocular anatomy and radiation-associated toxicities provide unique challenges for external beam radiation therapy. For treatment planning, precise modeling of organs at risk and tumor volume are crucial. Development of a precise eye model and automatic adaptation of this model to patients' anatomy remain problematic because of organ shape variability. This work introduces the application of a 3-dimensional (3D) statistical shape model as a novel method for precise eye modeling for external beam radiation therapy of intraocular tumors. Methods and Materials: Manual and automatic segmentations were compared for 17 patients, based on head computed tomography (CT) volume scans. A 3D statistical shape model of the cornea, lens, and sclera as well as of the optic disc position was developed. Furthermore, an active shape model was built to enable automatic fitting of the eye model to CT slice stacks. Cross-validation was performed based on leave-one-out tests for all training shapes by measuring dice coefficients and mean segmentation errors between automatic segmentation and manual segmentation by an expert. Results: Cross-validation revealed a dice similarity of 95% {+-} 2% for the sclera and cornea and 91% {+-} 2% for the lens. Overall, mean segmentation error was found to be 0.3 {+-} 0.1 mm. Average segmentation time was 14 {+-} 2 s on a standard personal computer. Conclusions: Our results show that the solution presented outperforms state-of-the-art methods in terms of accuracy, reliability, and robustness. Moreover, the eye model shape as well as its variability is learned from a training set rather than by making shape assumptions (eg, as with the spherical or elliptical model). Therefore, the model appears to be capable of modeling nonspherically and nonelliptically shaped eyes.

  4. Statistical modeling of the eye for multimodal treatment planning for external beam radiation therapy of intraocular tumors.

    Science.gov (United States)

    Rüegsegger, Michael B; Bach Cuadra, Meritxell; Pica, Alessia; Amstutz, Christoph A; Rudolph, Tobias; Aebersold, Daniel; Kowal, Jens H

    2012-11-15

    Ocular anatomy and radiation-associated toxicities provide unique challenges for external beam radiation therapy. For treatment planning, precise modeling of organs at risk and tumor volume are crucial. Development of a precise eye model and automatic adaptation of this model to patients' anatomy remain problematic because of organ shape variability. This work introduces the application of a 3-dimensional (3D) statistical shape model as a novel method for precise eye modeling for external beam radiation therapy of intraocular tumors. Manual and automatic segmentations were compared for 17 patients, based on head computed tomography (CT) volume scans. A 3D statistical shape model of the cornea, lens, and sclera as well as of the optic disc position was developed. Furthermore, an active shape model was built to enable automatic fitting of the eye model to CT slice stacks. Cross-validation was performed based on leave-one-out tests for all training shapes by measuring dice coefficients and mean segmentation errors between automatic segmentation and manual segmentation by an expert. Cross-validation revealed a dice similarity of 95%±2% for the sclera and cornea and 91%±2% for the lens. Overall, mean segmentation error was found to be 0.3±0.1 mm. Average segmentation time was 14±2 s on a standard personal computer. Our results show that the solution presented outperforms state-of-the-art methods in terms of accuracy, reliability, and robustness. Moreover, the eye model shape as well as its variability is learned from a training set rather than by making shape assumptions (eg, as with the spherical or elliptical model). Therefore, the model appears to be capable of modeling nonspherically and nonelliptically shaped eyes. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review.

    Science.gov (United States)

    Cullinane, Frances L; Boocock, Mark G; Trevelyan, Fiona C

    2014-01-01

    To establish the effectiveness of eccentric exercise as a treatment intervention for lateral epicondylitis. ProQuest, Medline via EBSCO, AMED, Scopus, Web of Science, CINAHL. A systematic review was undertaken to identify randomized and controlled clinical trials incorporating eccentric exercise as a treatment for patients diagnosed with lateral epicondylitis. Studies were included if: they incorporated eccentric exercise, either in isolation or as part of a multimodal treatment protocol; they assessed at least one functional or disability outcome measure; and the patients had undergone diagnostic testing. The methodological quality of each study was assessed using the Modified Cochrane Musculoskeletal Injuries Group score sheet. Twelve studies met the inclusion criteria. Three were deemed 'high' quality, seven were 'medium' quality, and two were 'low' quality. Eight of the studies were randomized trials investigating a total of 334 subjects. Following treatment, all groups inclusive of eccentric exercise reported decreased pain and improved function and grip strength from baseline. Seven studies reported improvements in pain, function, and/or grip strength for therapy treatments inclusive of eccentric exercise when compared with those excluding eccentric exercise. Only one low-quality study investigated the isolated effects of eccentric exercise for treating lateral epicondylitis and found no significant improvements in pain when compared with other treatments. The majority of consistent findings support the inclusion of eccentric exercise as part of a multimodal therapy programme for improved outcomes in patients with lateral epicondylitis.

  6. A Multimodal System with Synergistic Effects of Magneto-Mechanical, Photothermal, Photodynamic and Chemo Therapies of Cancer in Graphene-Quantum Dot-Coated Hollow Magnetic Nanospheres.

    Science.gov (United States)

    Wo, Fangjie; Xu, Rujiao; Shao, Yuxiang; Zhang, Zheyu; Chu, Maoquan; Shi, Donglu; Liu, Shupeng

    2016-01-01

    In this study, a multimodal therapeutic system was shown to be much more lethal in cancer cell killing compared to a single means of nano therapy, be it photothermal or photodynamic. Hollow magnetic nanospheres (HMNSs) were designed and synthesized for the synergistic effects of both magneto-mechanical and photothermal cancer therapy. By these combined stimuli, the cancer cells were structurally and physically destroyed with the morphological characteristics distinctively different from those by other therapeutics. HMNSs were also coated with the silica shells and conjugated with carboxylated graphene quantum dots (GQDs) as a core-shell composite: HMNS/SiO2/GQDs. The composite was further loaded with an anticancer drug doxorubicin (DOX) and stabilized with liposomes. The multimodal system was able to kill cancer cells with four different therapeutic mechanisms in a synergetic and multilateral fashion, namely, the magnetic field-mediated mechanical stimulation, photothermal damage, photodynamic toxicity, and chemotherapy. The unique nanocomposites with combined mechanical, chemo, and physical effects will provide an alternative strategy for highly improved cancer therapy efficiency.

  7. Peer-Mediated Multimodal Intervention Program for the Treatment of Children with ADHD in India: One-Year Followup

    Science.gov (United States)

    Mehta, Sagar; Shah, Devesh; Shah, Kushal; Mehta, Sanjiv; Mehta, Neelam; Mehta, Vivek; Mehta, Vijay; Mehta, Vaishali; Motiwala, Smita; Mehta, Naina; Mehta, Devendra

    2012-01-01

    The objective was to assess the efficacy of a one-year, peer-mediated interventional program consisting of yoga, meditation and play therapy maintained by student volunteers in a school in India. The population consisted of 69 students between the ages of 6 and 11 years, previously identified as having attention deficit hyperactivity disorder (ADHD). A program, known as Climb-Up, was initially embedded in the school twice weekly. Local high school student volunteers were then trained to continue to implement the program weekly over the period of one year. Improvements in ADHD symptoms and academic performance were assessed using Vanderbilt questionnaires completed by both parents and teachers. The performance impairment scores for ADHD students assessed by teachers improved by 6 weeks and were sustained through 12 months in 46 (85%) of the enrolled students. The improvements in their Vanderbilt scores assessed by parents were also seen in 92% (P < 0.0001, Wilcoxon). The Climb-Up program resulted in remarkable improvements in the students' school performances that were sustained throughout the year. These results show promise for a cost-effective program that could easily be implemented in any school. PMID:23316384

  8. Recent developments in multimodality fluorescence imaging probes

    Directory of Open Access Journals (Sweden)

    Jianhong Zhao

    2018-05-01

    Full Text Available Multimodality optical imaging probes have emerged as powerful tools that improve detection sensitivity and accuracy, important in disease diagnosis and treatment. In this review, we focus on recent developments of optical fluorescence imaging (OFI probe integration with other imaging modalities such as X-ray computed tomography (CT, magnetic resonance imaging (MRI, positron emission tomography (PET, single-photon emission computed tomography (SPECT, and photoacoustic imaging (PAI. The imaging technologies are briefly described in order to introduce the strengths and limitations of each techniques and the need for further multimodality optical imaging probe development. The emphasis of this account is placed on how design strategies are currently implemented to afford physicochemically and biologically compatible multimodality optical fluorescence imaging probes. We also present studies that overcame intrinsic disadvantages of each imaging technique by multimodality approach with improved detection sensitivity and accuracy. KEY WORDS: Optical imaging, Fluorescence, Multimodality, Near-infrared fluorescence, Nanoprobe, Computed tomography, Magnetic resonance imaging, Positron emission tomography, Single-photon emission computed tomography, Photoacoustic imaging

  9. Multimodal surveillance sensors, algorithms, and systems

    CERN Document Server

    Zhu, Zhigang

    2007-01-01

    From front-end sensors to systems and environmental issues, this practical resource guides you through the many facets of multimodal surveillance. The book examines thermal, vibration, video, and audio sensors in a broad context of civilian and military applications. This cutting-edge volume provides an in-depth treatment of data fusion algorithms that takes you to the core of multimodal surveillance, biometrics, and sentient computing. The book discusses such people and activity topics as tracking people and vehicles and identifying individuals by their speech.Systems designers benefit from d

  10. Differential effectiveness of placebo treatments

    DEFF Research Database (Denmark)

    Meissner, Karin; Fässler, Margrit; Rücker, Gerta

    2013-01-01

    IMPORTANCE When analyzing results of randomized clinical trials, the treatment with the greatest specific effect compared with its placebo control is considered to be the most effective one. Although systematic variations of improvements in placebo control groups would have important implications...... relevant sources through February 2012 and contacted the authors to identify randomized clinical trials on the prophylaxis of migraine with an observation period of at least 8 weeks after randomization that compared an experimental treatment with a placebo control group. We calculated pooled random-effects...... and sham surgery are associated with higher responder ratios than oral pharmacological placebos. Clinicians who treat patients with migraine should be aware that a relevant part of the overall effect they observe in practice might be due to nonspecific effects and that the size of such effects might differ...

  11. Multimodal Resources in Transnational Adoption

    DEFF Research Database (Denmark)

    Raudaskoski, Pirkko Liisa

    The paper discusses an empirical analysis which highlights the multimodal nature of identity construction. A documentary on transnational adoption provides real life incidents as research material. The incidents involve (or from them emerge) various kinds of multimodal resources and participants...

  12. Validation of a multimodal travel simulator with travel information provision

    NARCIS (Netherlands)

    Chorus, C.G.; Molin, E.J.E.; Arentze, T.A.; Hoogendoorn, S.P.; Timmermans, H.J.P.; Wee, van G.P.

    2007-01-01

    This paper presents a computer based travel simulator for collecting data concerning the use of next-generation ATIS and their effects on traveler decision making in a multimodal travel environment. The tool distinguishes itself by presenting a completely abstract multimodal transport network, where

  13. Describing treatment effects to patients.

    Science.gov (United States)

    Moxey, Annette; O'Connell, Dianne; McGettigan, Patricia; Henry, David

    2003-11-01

    To examine the impact of different presentations of equivalent information (framing) on treatment decisions faced by patients. A systematic review of the published literature was conducted. English language publications allocating participants to different frames were retrieved using electronic and bibliographic searches. Two reviewers examined each article for inclusion, and assessed methodological quality. Study characteristics were tabulated and where possible, relative risks (RR; 95% confidence intervals) were calculated to estimate intervention effects. Thirty-seven articles, yielding 40 experimental studies, were included. Studies examined treatment (N = 24), immunization (N = 5), or health behavior scenarios (N = 11). Overall, active treatments were preferred when outcomes were described in terms of relative rather than absolute risk reductions or number needed to treat. Surgery was preferred to other treatments when treatment efficacy was presented in a positive frame (survival) rather than a negative frame (mortality) (relative risk [RR] = 1.51, 95% confidence interval [CI], 1.39 to 1.64). Framing effects were less obvious for immunization and health behavior scenarios. Those with little interest in the behavior at baseline were influenced by framing, particularly when information was presented as gains. In studies judged to be of good methodological quality and/or examining actual decisions, the framing effect, although still evident, was less convincing compared to the results of all included studies. Framing effects varied with the type of scenario, responder characteristics, scenario manipulations, and study quality. When describing treatment effects to patients, expressing the information in more than one way may present a balanced view to patients and enable them to make informed decisions.

  14. Multimodal sequence learning.

    Science.gov (United States)

    Kemény, Ferenc; Meier, Beat

    2016-02-01

    While sequence learning research models complex phenomena, previous studies have mostly focused on unimodal sequences. The goal of the current experiment is to put implicit sequence learning into a multimodal context: to test whether it can operate across different modalities. We used the Task Sequence Learning paradigm to test whether sequence learning varies across modalities, and whether participants are able to learn multimodal sequences. Our results show that implicit sequence learning is very similar regardless of the source modality. However, the presence of correlated task and response sequences was required for learning to take place. The experiment provides new evidence for implicit sequence learning of abstract conceptual representations. In general, the results suggest that correlated sequences are necessary for implicit sequence learning to occur. Moreover, they show that elements from different modalities can be automatically integrated into one unitary multimodal sequence. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Robust Multimodal Dictionary Learning

    Science.gov (United States)

    Cao, Tian; Jojic, Vladimir; Modla, Shannon; Powell, Debbie; Czymmek, Kirk; Niethammer, Marc

    2014-01-01

    We propose a robust multimodal dictionary learning method for multimodal images. Joint dictionary learning for both modalities may be impaired by lack of correspondence between image modalities in training data, for example due to areas of low quality in one of the modalities. Dictionaries learned with such non-corresponding data will induce uncertainty about image representation. In this paper, we propose a probabilistic model that accounts for image areas that are poorly corresponding between the image modalities. We cast the problem of learning a dictionary in presence of problematic image patches as a likelihood maximization problem and solve it with a variant of the EM algorithm. Our algorithm iterates identification of poorly corresponding patches and re-finements of the dictionary. We tested our method on synthetic and real data. We show improvements in image prediction quality and alignment accuracy when using the method for multimodal image registration. PMID:24505674

  16. Critical Analysis of Multimodal Discourse

    DEFF Research Database (Denmark)

    van Leeuwen, Theo

    2013-01-01

    This is an encyclopaedia article which defines the fields of critical discourse analysis and multimodality studies, argues that within critical discourse analysis more attention should be paid to multimodality, and within multimodality to critical analysis, and ends reviewing a few examples of re...

  17. Multimodality localization of epileptic foci

    Science.gov (United States)

    Desco, Manuel; Pascau, Javier; Pozo, M. A.; Santos, Andres; Reig, Santiago; Gispert, Juan D.; Garcia-Barreno, Pedro

    2001-05-01

    This paper presents a multimodality approach for the localization of epileptic foci using PET, MRI and EEG combined without the need of external markers. Mutual Information algorithm is used for MRI-PET registration. Dipole coordinates (provided by BESA software) are projected onto the MRI using a specifically developed algorithm. The four anatomical references used for electrode positioning (nasion, inion and two preauricular points) are located on the MRI using a triplanar viewer combined with a surface-rendering tool. Geometric transformation using deformation of the ideal sphere used for dipole calculations is then applied to match the patient's brain size and shape. Eight treatment-refractory epileptic patients have been studied. The combination of the anatomical information from the MRI, hipoperfusion areas in PET and dipole position and orientation helped the physician in the diagnosis of epileptic focus location. Neurosurgery was not indicated for patients where PET and dipole results were inconsistent; in two cases it was clinically indicated despite the mismatch, showing a negative follow up. The multimodality approach presented does not require external markers for dipole projection onto the MRI, this being the main difference with previous methods. The proposed method may play an important role in the indication of surgery for treatment- refractory epileptic patients.

  18. Multimodality imaging techniques.

    Science.gov (United States)

    Martí-Bonmatí, Luis; Sopena, Ramón; Bartumeus, Paula; Sopena, Pablo

    2010-01-01

    In multimodality imaging, the need to combine morphofunctional information can be approached by either acquiring images at different times (asynchronous), and fused them through digital image manipulation techniques or simultaneously acquiring images (synchronous) and merging them automatically. The asynchronous post-processing solution presents various constraints, mainly conditioned by the different positioning of the patient in the two scans acquired at different times in separated machines. The best solution to achieve consistency in time and space is obtained by the synchronous image acquisition. There are many multimodal technologies in molecular imaging. In this review we will focus on those multimodality image techniques more commonly used in the field of diagnostic imaging (SPECT-CT, PET-CT) and new developments (as PET-MR). The technological innovations and development of new tracers and smart probes are the main key points that will condition multimodality image and diagnostic imaging professionals' future. Although SPECT-CT and PET-CT are standard in most clinical scenarios, MR imaging has some advantages, providing excellent soft-tissue contrast and multidimensional functional, structural and morphological information. The next frontier is to develop efficient detectors and electronics systems capable of detecting two modality signals at the same time. Not only PET-MR but also MR-US or optic-PET will be introduced in clinical scenarios. Even more, MR diffusion-weighted, pharmacokinetic imaging, spectroscopy or functional BOLD imaging will merge with PET tracers to further increase molecular imaging as a relevant medical discipline. Multimodality imaging techniques will play a leading role in relevant clinical applications. The development of new diagnostic imaging research areas, mainly in the field of oncology, cardiology and neuropsychiatry, will impact the way medicine is performed today. Both clinical and experimental multimodality studies, in

  19. Fertility effects of cancer treatment.

    Science.gov (United States)

    Marsden, Donald E; Hacker, Neville

    2003-01-01

    Cancer sufferers are a subfertile group, and most treatments have the potential to adversely affect gonadal function. As cancer treatment becomes more effective and survival rates improve there are more cancer survivors in the reproductive age group for whom parenting is an important consideration. This article outlines the effects on fertility of cancer treatments and techniques to minimise the risk of infertility. The overall prospects for younger cancer sufferers to either retain their fertility or have genetic offspring is now better than ever before, due to advances in assisted reproductive technology, the appropriate use of fertility sparing surgery and other techniques to reduce the toxicity of therapy on the reproductive organs. These advances raise new moral and ethical concerns that must be considered before advising cancer sufferers of the options for preserving reproductive capacity.

  20. Multimodal Processes Rescheduling

    DEFF Research Database (Denmark)

    Bocewicz, Grzegorz; Banaszak, Zbigniew A.; Nielsen, Peter

    2013-01-01

    Cyclic scheduling problems concerning multimodal processes are usually observed in FMSs producing multi-type parts where the Automated Guided Vehicles System (AGVS) plays a role of a material handling system. Schedulability analysis of concurrently flowing cyclic processes (SCCP) exe-cuted in the......Cyclic scheduling problems concerning multimodal processes are usually observed in FMSs producing multi-type parts where the Automated Guided Vehicles System (AGVS) plays a role of a material handling system. Schedulability analysis of concurrently flowing cyclic processes (SCCP) exe...

  1. Adaptive Multiview Nonnegative Matrix Factorization Algorithm for Integration of Multimodal Biomedical Data

    Directory of Open Access Journals (Sweden)

    Bisakha Ray

    2017-08-01

    Full Text Available The amounts and types of available multimodal tumor data are rapidly increasing, and their integration is critical for fully understanding the underlying cancer biology and personalizing treatment. However, the development of methods for effectively integrating multimodal data in a principled manner is lagging behind our ability to generate the data. In this article, we introduce an extension to a multiview nonnegative matrix factorization algorithm (NNMF for dimensionality reduction and integration of heterogeneous data types and compare the predictive modeling performance of the method on unimodal and multimodal data. We also present a comparative evaluation of our novel multiview approach and current data integration methods. Our work provides an efficient method to extend an existing dimensionality reduction method. We report rigorous evaluation of the method on large-scale quantitative protein and phosphoprotein tumor data from the Clinical Proteomic Tumor Analysis Consortium (CPTAC acquired using state-of-the-art liquid chromatography mass spectrometry. Exome sequencing and RNA-Seq data were also available from The Cancer Genome Atlas for the same tumors. For unimodal data, in case of breast cancer, transcript levels were most predictive of estrogen and progesterone receptor status and copy number variation of human epidermal growth factor receptor 2 status. For ovarian and colon cancers, phosphoprotein and protein levels were most predictive of tumor grade and stage and residual tumor, respectively. When multiview NNMF was applied to multimodal data to predict outcomes, the improvement in performance is not overall statistically significant beyond unimodal data, suggesting that proteomics data may contain more predictive information regarding tumor phenotypes than transcript levels, probably due to the fact that proteins are the functional gene products and therefore a more direct measurement of the functional state of the tumor. Here, we

  2. The effect of a community-based self-help multimodal behavioral intervention in Korean American seniors with high blood pressure.

    Science.gov (United States)

    Kim, Kim B; Han, Hae-Ra; Huh, Boyun; Nguyen, Tam; Lee, Hochang; Kim, Miyong T

    2014-09-01

    Great strides have been made in improving heart health in the United States during the last 2 decades, yet these strides have not encompassed many ethnic minority populations. There are significant health disparity gaps stemming from both a paucity of valid research and a lack of culturally sensitive interventions. In particular, many Korean Americans with chronic illnesses encounter difficulty navigating the healthcare system because of limited health literacy. The effect of a multimodal Self-Help Intervention Program on the Control of High Blood Pressure (HBP) was tested in a community-based clinical trial for Korean American seniors. Of 440 seniors enrolled, 369 completed the study (184 in the intervention group and 185 in the control group; mean age = 70.9±5.3 years). The intervention group received 6 weekly educational sessions on HBP management skill building, including health literacy training, followed by telephone counseling and home blood pressure (BP) monitoring for 12 months. Findings support that the Self-Help Intervention Program on the Control of HBP was effective in controlling BP in this ethnic/linguistic minority population. The BP control rates for the intervention and control groups were 49.5% vs. 43.2% at baseline, 58.5% vs. 42.4% at 6 months, 67.9% vs. 52.5% at 12 months, and 54.3% vs. 53.0% at 18 months. Significant changes were observed over time in some psychobehavioral outcomes, including self-efficacy for BP control, medication adherence behavior, HBP knowledge, and depression. The study findings suggest that the multimodal Self-Help Intervention Program on the Control of HBP is effective at promoting optimal HBP control for this ethnic/linguistic minority population. NCT00406614. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. Multimode optical fiber

    Science.gov (United States)

    Bigot-Astruc, Marianne; Molin, Denis; Sillard, Pierre

    2014-11-04

    A depressed graded-index multimode optical fiber includes a central core, an inner depressed cladding, a depressed trench, an outer depressed cladding, and an outer cladding. The central core has an alpha-index profile. The depressed claddings limit the impact of leaky modes on optical-fiber performance characteristics (e.g., bandwidth, core size, and/or numerical aperture).

  4. Multimodal training between agents

    DEFF Research Database (Denmark)

    Rehm, Matthias

    2003-01-01

    In the system Locator1, agents are treated as individual and autonomous subjects that are able to adapt to heterogenous user groups. Applying multimodal information from their surroundings (visual and linguistic), they acquire the necessary concepts for a successful interaction. This approach has...

  5. Multimodal Strategies of Theorization

    DEFF Research Database (Denmark)

    Cartel, Melodie; Colombero, Sylvain; Boxenbaum, Eva

    This paper examines the role of multimodal strategies in processes of theorization. Empirically, we investigate the theorization process of a highly disruptive innovation in the history of architecture: reinforced concrete. Relying on archival data from a dominant French architectural journal from...... with well-known rhetorical strategies and develop a process model of theorization....

  6. Understanding and treating vaginismus: a multimodal approach.

    Science.gov (United States)

    Pacik, Peter T

    2014-12-01

    This clinical opinion was written to bring attention to the understanding and treatment of vaginismus, a condition that is often under diagnosed and therefore inadequately treated, yet affects millions of women worldwide. Despite its description more than a century ago, vaginismus is rarely taught in medical school, residency training, and medical meetings. The DSM 5 classification stresses that vaginismus is a penetration disorder in that any form of vaginal penetration such as tampons, finger, vaginal dilators, gynecological examinations, and intercourse is often painful or impossible. Compared with other sexual pain disorders such as vulvodynia and vestibulodynia, the treatment of vaginismus has the potential for a high rate of success. Stratifying the severity of vaginismus allows the clinician to choose among numerous treatment options and to better understand what the patient is experiencing. Vaginismus is both a physical and an emotional disorder. In the more severe cases of vaginismus women (and men) complain that attempted intercourse is like "hitting a wall" suggestive of spasm at the level of the introitus. The emotional fallout resulting from this needs to be addressed in any form of treatment applied. This article is based on lessons learned in the treatment of more than 250 patients and evaluation of more than 400 inquiries, and was written to make vaginismus more widely understood, to aid in the differential diagnosis of sexual pain, suggest a variety of effective treatments, and explain how Botox can be used as part of a multimodal treatment program to treat vaginismus. With greater awareness among clinicians it is hoped that medical schools, residency programs, and medical meetings will begin teaching the understanding and treatment of vaginismus.

  7. Harnessing complex emergent metaphors for effective communication in palliative care: a multimodal perceptual analysis of hospice patients' reports of transcendence experiences.

    Science.gov (United States)

    Arnold, Bruce L; Lloyd, Linda S

    2014-05-01

    Terminally ill patients can have unexpected, enigmatic, and profound cognitive shifts that significantly alter their perception of themselves, thereby eliminating their fear of death and dying. However, there are no systematic studies into these remarkable yet ineffable transcendence experiences. They therefore remain easily overlooked or viewed as isolated anomalies and therefore excluded from quality-of-life patient considerations. We use a multimodal methodology for identifying the prevalence and thematic properties of complex emergent metaphors patients use to report these experiences. Although previous research has pioneered the importance of understanding conventional or primary metaphors at the end of life, our findings indicate the considerable potential of more complex metaphors for reducing barriers to effective communication in palliative care.

  8. Study of the effects of multimodal exercise program on physical fitness and health perception in community-living Hungarian older adults.

    Science.gov (United States)

    Virág, Anikó; Harkányi, Izabella; Karóczi, Csilla K; Vass, Zsolt; Kovács, Éva

    2018-05-01

    The aim of this study was to investigate the effects on fitness indicators and subjective health-perception of a multimodal exercise program provided by a district in Budapest among community-living seniors. Sixty community-living older adults aged over 60 years formed beginner group (who were at the beginning of the exercise program), advanced group (who had been in the programme for 3-6 months), active group (who had been participating in the exercise program for at least 6 months, in addition to Nordic walking program) and a physically inactive control group. Balance, functional mobility, lower and upper limb strength, lower and upper body flexibility, aerobic endurance and self-reported health perception were measured at baseline, and after a 12-week follow-up period. The beginner group and the advanced group improved in upper body flexibility (beginner Δ=1.2; d=0.83; advanced: Δ=1.7; d=1.39), lower body flexibility (beginner: Δ=1.7, d=0.484; advanced: Δ=1.9; d=1.55), lower limb strength (beginner: Δ=1.47; d=0.84; advanced: Δ=1.57; d=0.72), and functional mobility (beginner: Δ=-0.6; d=0.54; advanced: Δ=-0.4; d=0.90). There were also improvements in aerobic endurance (Δ=11.06; d=0.96) and balance (Δ=1.6; d=0.62) of beginner group. These indicators declined in the control group. Indicators of the active group did not change. The self-perceived health status declined (Δ=-13.9; d=0.73) in the control group but did not change in any exercising groups. This multimodal exercise program can be effective among community-living older adults, even in Hungary, a country where geriatric physical activity is not widespread. Therefore, it would be useful to extend this model program to other settlements as well.

  9. Drusen Characterization with Multimodal Imaging

    Science.gov (United States)

    Spaide, Richard F.; Curcio, Christine A.

    2010-01-01

    by multimodal imaging due to differences in location, morphology, and optical filtering effects by drusenoid material and the RPE. PMID:20924263

  10. Multimodal Friction Ignition Tester

    Science.gov (United States)

    Davis, Eddie; Howard, Bill; Herald, Stephen

    2009-01-01

    The multimodal friction ignition tester (MFIT) is a testbed for experiments on the thermal and mechanical effects of friction on material specimens in pressurized, oxygen-rich atmospheres. In simplest terms, a test involves recording sensory data while rubbing two specimens against each other at a controlled normal force, with either a random stroke or a sinusoidal stroke having controlled amplitude and frequency. The term multimodal in the full name of the apparatus refers to a capability for imposing any combination of widely ranging values of the atmospheric pressure, atmospheric oxygen content, stroke length, stroke frequency, and normal force. The MFIT was designed especially for studying the tendency toward heating and combustion of nonmetallic composite materials and the fretting of metals subjected to dynamic (vibrational) friction forces in the presence of liquid oxygen or pressurized gaseous oxygen test conditions approximating conditions expected to be encountered in proposed composite material oxygen tanks aboard aircraft and spacecraft in flight. The MFIT includes a stainless-steel pressure vessel capable of retaining the required test atmosphere. Mounted atop the vessel is a pneumatic cylinder containing a piston for exerting the specified normal force between the two specimens. Through a shaft seal, the piston shaft extends downward into the vessel. One of the specimens is mounted on a block, denoted the pressure block, at the lower end of the piston shaft. This specimen is pressed down against the other specimen, which is mounted in a recess in another block, denoted the slip block, that can be moved horizontally but not vertically. The slip block is driven in reciprocating horizontal motion by an electrodynamic vibration exciter outside the pressure vessel. The armature of the electrodynamic exciter is connected to the slip block via a horizontal shaft that extends into the pressure vessel via a second shaft seal. The reciprocating horizontal

  11. Influence of Blood Contamination During Multimode Adhesive ...

    African Journals Online (AJOL)

    Objectives: The present study evaluated the effects of blood contamination performed at different steps of bonding on the microtensile bond strength (μTBS) of multimode adhesives to dentin when using the self-etch approach. Materials and Methods: Seventy-five molars were randomly assigned to three adhesive groups ...

  12. Gestures and multimodal input

    OpenAIRE

    Keates, Simeon; Robinson, Peter

    1999-01-01

    For users with motion impairments, the standard keyboard and mouse arrangement for computer access often presents problems. Other approaches have to be adopted to overcome this. In this paper, we will describe the development of a prototype multimodal input system based on two gestural input channels. Results from extensive user trials of this system are presented. These trials showed that the physical and cognitive loads on the user can quickly become excessive and detrimental to the interac...

  13. A Multimodal Communication Program for Aphasia during Inpatient Rehabilitation: A Case Study

    Science.gov (United States)

    Wallace, Sarah E.; Purdy, Mary; Skidmore, Elizabeth

    2014-01-01

    BACKGROUND Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes. OBJECTIVE The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication breakdowns. METHODS Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy. RESULTS Participants completed MCPA (10 and 14 treatment sessions respectively) and their performance on probes suggested increased accuracy in the production of various alternate communication modalities. However, increased switching to an alternate modality was noted for only one participant. CONCLUSIONS Further investigation of multimodal treatment during inpatient rehabilitation is warranted. In particular, comparisons between multimodal and standard treatments would help determine appropriate interventions for this setting. PMID:25227547

  14. A multimodal communication program for aphasia during inpatient rehabilitation: A case study.

    Science.gov (United States)

    Wallace, Sarah E; Purdy, Mary; Skidmore, Elizabeth

    2014-01-01

    Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes. The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication breakdowns. Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy. Participants completed MCPA (10 and 14 treatment sessions respectively) and their performance on probes suggested increased accuracy in the production of various alternate communication modalities. However, increased switching to an alternate modality was noted for only one participant. Further investigation of multimodal treatment during inpatient rehabilitation is warranted. In particular, comparisons between multimodal and standard treatments would help determine appropriate interventions for this setting.

  15. The effectiveness of stuttering treatments in Germany.

    Science.gov (United States)

    Euler, Harald A; Lange, Benjamin P; Schroeder, Sascha; Neumann, Katrin

    2014-03-01

    Persons who stutter (PWS) should be referred to the most effective treatments available, locally or regionally. A prospective comparison of the effects of the most common stuttering treatments in Germany is not available. Therefore, a retrospective evaluation by clients of stuttering treatments was carried out. The five most common German stuttering treatments (231 single treatment cases) were rated as to their perceived effectiveness, using a structured questionnaire, by 88 PWS recruited through various sources. The participants had received between 1 and 7 treatments for stuttering. Two stuttering treatments (stuttering modification, fluency shaping) showed favorable and three treatments (breathing therapy, hypnosis, unspecified logopedic treatment) showed unsatisfactory effectiveness ratings. The effectiveness ratings of stuttering modification and fluency shaping did not differ significantly. The three other treatments were equally ineffective. The differences between the effective and ineffective treatments were of large effect sizes. The typical therapy biography begins in childhood with an unspecified logopedic treatment administered extensively in single and individual sessions. Available comparisons showed intensive or interval treatments to be superior to extensive treatments, and group treatments to be superior to single client treatments. The stuttering treatment most often prescribed in Germany, namely a weekly session of individual treatment by a speech-language pathologist, usually with an assorted package of mostly unknown components, is of limited effectiveness. Better effectiveness can be expected from fluency shaping or stuttering modification approaches, preferably with an intensive time schedule and with group sessions. Readers will be able to: (a) discuss the five most prevalent stuttering treatments in Germany; (b) summarize the effectiveness of these treatments; and (c) describe structural treatment components that seem to be preferable

  16. Towards an intelligent framework for multimodal affective data analysis.

    Science.gov (United States)

    Poria, Soujanya; Cambria, Erik; Hussain, Amir; Huang, Guang-Bin

    2015-03-01

    An increasingly large amount of multimodal content is posted on social media websites such as YouTube and Facebook everyday. In order to cope with the growth of such so much multimodal data, there is an urgent need to develop an intelligent multi-modal analysis framework that can effectively extract information from multiple modalities. In this paper, we propose a novel multimodal information extraction agent, which infers and aggregates the semantic and affective information associated with user-generated multimodal data in contexts such as e-learning, e-health, automatic video content tagging and human-computer interaction. In particular, the developed intelligent agent adopts an ensemble feature extraction approach by exploiting the joint use of tri-modal (text, audio and video) features to enhance the multimodal information extraction process. In preliminary experiments using the eNTERFACE dataset, our proposed multi-modal system is shown to achieve an accuracy of 87.95%, outperforming the best state-of-the-art system by more than 10%, or in relative terms, a 56% reduction in error rate. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Evaluation and Socio-occupational Intervention in Bipolar and Schizophrenic Patients within a Multimodal Intervention Program- PRISMA.

    Science.gov (United States)

    Díaz Zuluaga, Ana M; Duica, Kelly; Ruiz Galeano, Carlos; Vargas, Cristian; Agudelo Berruecos, Yuli; Ospina, Sigifredo; López-Jaramillo, Carlos

    Functional improvement in bipolar and schizophrenic patients is one of the main aims of treatment. Nevertheless, there is no evidence about the effect of socio-occupational intervention within a multimodal intervention (MI) programme. To describe the socio-occupational profile and to evaluate the functional effect of a MI in bipolar I and schizophrenic patients. A prospective, longitudinal, therapeutic-comparative study was performed including 302 subjects (104 schizophrenic and 198 Bipolar Disorder I [BDI] patients), who were randomised into two groups, multimodal (psychiatry, psychology, medicine, occupational therapy, neuropsychology, and family therapy), or traditional intervention (psychiatry and medicine only). Several scales were applied to assess assertiveness, free time management, social abilities, general anxiety, self-care and performance in home, work and community tasks. After performing the longitudinal analysis, it was shown that the multimodal intervention was more effective than traditional intervention in general anxiety scores (P=.026) and development in home tasks (P=.03) in schizophrenic patients. No statistical differences were found in bipolar patients. The other variables showed improvement, however, their effect was similar in both intervention groups. Our study identified functional improvement in home tasks in schizophrenic patients after receiving multimodal intervention. Other variables also showed improvement for both interventions groups. Future studies, applying longer rehabilitation programs and other ecological strategies should be performed to identify the most effective interventions. Copyright © 2017 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  18. A study of time- and sex-dependent effects of vortioxetine on rat sexual behavior : Possible roles of direct receptor modulation

    NARCIS (Netherlands)

    Li, Yan; Pehrson, Alan L; Oosting, Ronald S; Gulinello, Maria; Olivier, Berend; Sanchez, Connie

    2017-01-01

    Treatment-related sexual dysfunction is a common side effect of antidepressants and contributes to patient non-compliance or treatment cessation. However, the multimodal antidepressant, vortioxetine, demonstrates low sexual side effects in depressed patients. To investigate the mechanisms involved,

  19. A multimodal parallel architecture: A cognitive framework for multimodal interactions.

    Science.gov (United States)

    Cohn, Neil

    2016-01-01

    Human communication is naturally multimodal, and substantial focus has examined the semantic correspondences in speech-gesture and text-image relationships. However, visual narratives, like those in comics, provide an interesting challenge to multimodal communication because the words and/or images can guide the overall meaning, and both modalities can appear in complicated "grammatical" sequences: sentences use a syntactic structure and sequential images use a narrative structure. These dual structures create complexity beyond those typically addressed by theories of multimodality where only a single form uses combinatorial structure, and also poses challenges for models of the linguistic system that focus on single modalities. This paper outlines a broad theoretical framework for multimodal interactions by expanding on Jackendoff's (2002) parallel architecture for language. Multimodal interactions are characterized in terms of their component cognitive structures: whether a particular modality (verbal, bodily, visual) is present, whether it uses a grammatical structure (syntax, narrative), and whether it "dominates" the semantics of the overall expression. Altogether, this approach integrates multimodal interactions into an existing framework of language and cognition, and characterizes interactions between varying complexity in the verbal, bodily, and graphic domains. The resulting theoretical model presents an expanded consideration of the boundaries of the "linguistic" system and its involvement in multimodal interactions, with a framework that can benefit research on corpus analyses, experimentation, and the educational benefits of multimodality. Copyright © 2015.

  20. Effectiveness of individualized, integrative outpatient treatment for females with anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Freudenberg, Cara; Jones, Rebecca A; Livingston, Genvieve; Goetsch, Virginia; Schaffner, Angela; Buchanan, Linda

    2016-01-01

    The effectiveness of an individualized outpatient program was investigated in the treatment of bulimia nervosa (BN) and anorexia nervosa (AN). Participants included 151 females who received outpatient eating disorder treatment in the partial hospitalization program, the intensive outpatient program, or a combination of the two programs. Outcome measures included the Eating Disorder Inventory (EDI-2), Beck Depression Inventory (BDI-II), frequency of binge eating and purging, and mean body weight. Findings included significant increases in weight for the AN group, reductions in binge eating frequency for the BN group, and reductions in EDI-2 and BDI-II scores and purging frequency for both groups. This study provides preliminary support for the efficacy of a multimodal program for the treatment of both anorexia nervosa and bulimia nervosa.

  1. The Treatment Effectiveness Assessment (TEA

    Directory of Open Access Journals (Sweden)

    Ling W

    2013-09-01

    Full Text Available Walter Ling,1 David Farabee,1 Dagmar Liepa,2 Li-Tzy Wu3 1Integrated Substance Abuse Programs, University of California, Los Angeles, CA, 2Valley Care Medical Center, Panorama City, CA, 3Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA We have been surprised and gratified by the readers’ responses to our article, The Treatment Effectiveness Assessment (TEA: an efficient, patient-centered instrument for evaluating progress in recovery from addiction, which was published in December 2012.1 In the six months since that time, we have received numerous questions and observations about the article, and about the TEA instrument. Respondents were clinicians: physicians, counselors, therapists, nurses; as well as administrators and policy makers.  View original paper by Ling W, Farabee D, Liepa D, Wu LT. 

  2. Coping with Cosmetic Effects of Cancer Treatment

    Science.gov (United States)

    ... Search English Español Coping With Cosmetic Effects of Cancer Treatment KidsHealth / For Parents / Coping With Cosmetic Effects of Cancer Treatment What's in this article? Hair Loss Skin Problems ...

  3. Manifold regularized multi-task feature selection for multi-modality classification in Alzheimer's disease.

    Science.gov (United States)

    Jie, Biao; Zhang, Daoqiang; Cheng, Bo; Shen, Dinggang

    2013-01-01

    Accurate diagnosis of Alzheimer's disease (AD), as well as its prodromal stage (i.e., mild cognitive impairment, MCI), is very important for possible delay and early treatment of the disease. Recently, multi-modality methods have been used for fusing information from multiple different and complementary imaging and non-imaging modalities. Although there are a number of existing multi-modality methods, few of them have addressed the problem of joint identification of disease-related brain regions from multi-modality data for classification. In this paper, we proposed a manifold regularized multi-task learning framework to jointly select features from multi-modality data. Specifically, we formulate the multi-modality classification as a multi-task learning framework, where each task focuses on the classification based on each modality. In order to capture the intrinsic relatedness among multiple tasks (i.e., modalities), we adopted a group sparsity regularizer, which ensures only a small number of features to be selected jointly. In addition, we introduced a new manifold based Laplacian regularization term to preserve the geometric distribution of original data from each task, which can lead to the selection of more discriminative features. Furthermore, we extend our method to the semi-supervised setting, which is very important since the acquisition of a large set of labeled data (i.e., diagnosis of disease) is usually expensive and time-consuming, while the collection of unlabeled data is relatively much easier. To validate our method, we have performed extensive evaluations on the baseline Magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (FDG-PET) data of Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Our experimental results demonstrate the effectiveness of the proposed method.

  4. Evaluating the efficacy of an integrated motivational interviewing and multi-modal exercise intervention for youth with major depression: Healthy Body, Healthy Mind randomised controlled trial protocol

    Directory of Open Access Journals (Sweden)

    Yasmina Nasstasia

    2018-03-01

    Conclusion: This trial will increase our understanding of the efficacy of multi-modal exercise interventions for depression and the specific effects of exercise on depressive symptom profiles. It also offers a novel contribution by addressing treatment engagement in exercise efficacy trials in youth with MDD.

  5. Are the effects of a non-drug multimodal activation therapy of dementia sustainable? Follow-up study 10 months after completion of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Luttenberger Katharina

    2012-12-01

    Full Text Available Abstract Background Little is known about the long-term success of non-drug therapies for treating dementia, especially whether the effects are sustained after therapy ends. Here, we examined the effects of a one-year multimodal therapy 10 months after patients completed the therapy. Methods This randomised, controlled, single-blind, longitudinal trial involved 61 patients (catamnesis: n = 52 with primary degenerative dementia in five nursing homes in Bavaria, Germany. The highly standardised intervention, MAKS, consisted of motor stimulation, practice of activities of daily living (ADLs, and cognitive stimulation. Each group of 10 patients was treated for 2 h, 6 days a week for 12 months. Control patients received standard nursing home care. At baseline, at the end of therapy (month 12, and 10 months thereafter (month 22, cognitive functioning was assessed using the cognitive subscale of the Alzheimer’s Disease Assessment Scale, and the ability to perform ADLs was assessed using the Erlangen Test of Activities of Daily Living. Results During the therapy phase, the MAKS patients maintained their cognitive function and ability to carry out ADLs. After the end of therapy, both the control and the MAKS groups deteriorated in both their cognitive function (control, p = 0.02; MAKS, p 0: βMAKS + βMAKS month 22 = 0; χ2 = 3.8568, p = 0.0496. Cohen’s d for the difference between the two groups in ADLs and cognitive abilities 10 months after the end of therapy was 0.40 and 0.22, respectively. Conclusions A multimodal non-drug therapy of dementia resulted in stabilisation of the ability to perform ADLs, even beyond the end of therapy. To prevent functional decline for as long as possible, therapy should be performed continuously until the benefit for the patient ends. Follow-up studies on larger numbers of patients are needed to definitively confirm these results. Trial registration http://www.isrctn.com Identifier: ISRCTN

  6. Experiments in Multimodal Information Presentation

    NARCIS (Netherlands)

    van Hooijdonk, Charlotte; Bosma, W.E.; Krahmer, Emiel; Maes, Alfons; Theune, Mariet; van den Bosch, Antal; Bouma, Gosse

    In this chapter we describe three experiments investigating multimodal information presentation in the context of a medical QA system. In Experiment 1, we wanted to know how non-experts design (multimodal) answers to medical questions, distinguishing between what questions and how questions. In

  7. Simplified Multimodal Biometric Identification

    Directory of Open Access Journals (Sweden)

    Abhijit Shete

    2014-03-01

    Full Text Available Multibiometric systems are expected to be more reliable than unimodal biometric systems for personal identification due to the presence of multiple, fairly independent pieces of evidence e.g. Unique Identification Project "Aadhaar" of Government of India. In this paper, we present a novel wavelet based technique to perform fusion at the feature level and score level by considering two biometric modalities, face and fingerprint. The results indicate that the proposed technique can lead to substantial improvement in multimodal matching performance. The proposed technique is simple because of no preprocessing of raw biometric traits as well as no feature and score normalization.

  8. Multimodality, politics and ideology

    DEFF Research Database (Denmark)

    Machin, David; Van Leeuwen, T.

    2016-01-01

    This journal's editorial statement is clear that political discourse should be studied not only as regards parliamentary type politics. In this introduction we argue precisely for the need to pay increasing attention to the way that political ideologies are infused into culture more widely...... of power, requires meanings and identities which can hold them in place. We explain the processes by which critical multimodal discourse analysis can best draw out this ideology as it is realized through different semiotics resources. © John Benjamins Publishing Company....

  9. Multimodality imaging of the postoperative shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany)

    2007-12-15

    Multimodality imaging of the postoperative shoulder includes radiography, magnetic resonance (MR) imaging, MR arthrography, computed tomography (CT), CT arthrography, and ultrasound. Target-oriented evaluation of the postoperative shoulder necessitates familiarity with surgical techniques, their typical complications and sources of failure, knowledge of normal and abnormal postoperative findings, awareness of the advantages and weaknesses with the different radiologic techniques, and clinical information on current symptoms and function. This article reviews the most commonly used surgical procedures for treatment of anterior glenohumeral instability, lesions of the labral-bicipital complex, subacromial impingement, and rotator cuff lesions and highlights the significance of imaging findings with a view to detection of recurrent lesions and postoperative complications in a multimodality approach. (orig.)

  10. Multidisciplinary rehabilitation program: effects of a multimodal intervention for patients with Alzheimer’s disease and cognitive impairment without dementia

    Directory of Open Access Journals (Sweden)

    Glenda Dias Santos

    2015-12-01

    Full Text Available Abstract Background Non-pharmalogical interventions represent an important complement to standard pharmalogical treatment in dementia. Objective This study aims to evaluate the effects of a multidisciplinary rehabilitation program on cognitive ability, quality of life and depression symptoms in patients with Alzheimer’s disease (AD and cognitive impairment without dementia (CIND. Methods Ninety-seven older adults were recruited to the present study. Of these, 70 patients had mild AD and were allocated into experimental (n = 54 or control (n = 16 groups. Two additional active comparison groups were constituted with patients with moderate AD (n = 13 or with CIND (n = 14 who also received the intervention. The multidisciplinary rehabilitation program lasted for 12 weeks and was composed by sessions of memory training, recreational activities, verbal expression and writing, physical therapy and physical training, delivered in two weekly 6-hour sessions. Results As compared to controls, mild AD patients who received the intervention had improvements in cognition (p = 0.021 and quality of life (p = 0.003, along with a reduction in depressive symptoms (p < 0.001. As compared to baseline, CIND patients displayed at the end of the intervention improvements in cognition (p = 0.005 and depressive symptoms (p = 0.011. No such benefits were found among patients with moderate AD.Discussion: This multidisciplinary rehabilitation program was beneficial for patients with mild AD and CIND. However, patients with moderate dementia did not benefit from the intervention.

  11. Multimodal Speaker Diarization.

    Science.gov (United States)

    Noulas, A; Englebienne, G; Krose, B J A

    2012-01-01

    We present a novel probabilistic framework that fuses information coming from the audio and video modality to perform speaker diarization. The proposed framework is a Dynamic Bayesian Network (DBN) that is an extension of a factorial Hidden Markov Model (fHMM) and models the people appearing in an audiovisual recording as multimodal entities that generate observations in the audio stream, the video stream, and the joint audiovisual space. The framework is very robust to different contexts, makes no assumptions about the location of the recording equipment, and does not require labeled training data as it acquires the model parameters using the Expectation Maximization (EM) algorithm. We apply the proposed model to two meeting videos and a news broadcast video, all of which come from publicly available data sets. The results acquired in speaker diarization are in favor of the proposed multimodal framework, which outperforms the single modality analysis results and improves over the state-of-the-art audio-based speaker diarization.

  12. Gold Nanoconstructs for Multimodal Diagnostic Imaging and Photothermal Cancer Therapy

    Science.gov (United States)

    Coughlin, Andrew James

    Cancer accounts for nearly 1 out of every 4 deaths in the United States, and because conventional treatments are limited by morbidity and off-target toxicities, improvements in cancer management are needed. This thesis further develops nanoparticle-assisted photothermal therapy (NAPT) as a viable treatment option for cancer patients. NAPT enables localized ablation of disease because heat generation only occurs where tissue permissive near-infrared (NIR) light and absorbing nanoparticles are combined, leaving surrounding normal tissue unharmed. Two principle approaches were investigated to improve the specificity of this technique: multimodal imaging and molecular targeting. Multimodal imaging affords the ability to guide NIR laser application for site-specific NAPT and more holistic characterization of disease by combining the advantages of several diagnostic technologies. Towards the goal of image-guided NAPT, gadolinium-conjugated gold-silica nanoshells were engineered and demonstrated to enhance imaging contrast across a range of diagnostic modes, including T1-weighted magnetic resonance imaging, X-Ray, optical coherence tomography, reflective confocal microscopy, and two-photon luminescence in vitro as well as within an animal tumor model. Additionally, the nanoparticle conjugates were shown to effectively convert NIR light to heat for applications in photothermal therapy. Therefore, the broad utility of gadolinium-nanoshells for anatomic localization of tissue lesions, molecular characterization of malignancy, and mediators of ablation was established. Molecular targeting strategies may also improve NAPT by promoting nanoparticle uptake and retention within tumors and enhancing specificity when malignant and normal tissue interdigitate. Here, ephrinA1 protein ligands were conjugated to nanoshell surfaces for particle homing to overexpressed EphA2 receptors on prostate cancer cells. In vitro, successful targeting and subsequent photothermal ablation of

  13. In Vitro Responsiveness of Glioma Cell Lines to Multimodality Treatment With Radiotherapy, Temozolomide, and Epidermal Growth Factor Receptor Inhibition With Cetuximab

    International Nuclear Information System (INIS)

    Combs, Stephanie E.; Schulz-Ertner, Daniela; Roth, Wilfried; Herold-Mende, Christel; Debus, Juergen; Weber, Klaus-Josef

    2007-01-01

    Background: The majority of glioblastoma multiforme (GBM) cells express the epidermal growth factor receptor (EGFR). The present study evaluates the combination of temozolomide (TMZ), EGFR inhibition, and radiotherapy (RT) in GBM cell lines. Methods and Materials: Human GBM cell lines U87, LN229, LN18, NCH 82, and NCH 89 were treated with various combinations of TMZ, RT, and the monoclonal EGFR antibody cetuximab. Responsiveness of glioma cells to the combination treatment was measured by clonogenic survival. Results: Overall, double and triple combinations of RT, TMZ, and cetuximab lead to additive cytotoxic effects (independent toxicity). A notable exception was observed for U87 and LN 18 cell lines, where the combination of TMZ and cetuximab showed substantial antagonism. Interestingly, in these two cell lines, the combination of RT with cetuximab resulted in a substantial increase in cell killing over that expected for independent toxicity. The triple combination with RT, cetuximab, and TMZ was nearly able to overcome the antagonism for the TMZ/cetuximab combination in U87, however only marginally in LN18, GBM cell lines. Conclusion: It appears that EGFR expression is not correlated with cytotoxic effects exerted by cetuximab. Combination treatment with TMZ, cetuximab and radiation resulted in independent toxicity in three out of five cell lines evaluated, the antagonistic effect of the TMZ/cetuximab combination in two cell lines could indicate that TMZ preferentially kills cetuximab-resistant cells, suggesting for some cross-talk between toxicity mechanisms. Expression of EGFR was no surrogate marker for responsiveness to cetuximab, alone or in combination with RT and TMZ

  14. Active multimodal psychotherapy in children and adolescents with suicidality: description, evaluation and clinical profile.

    Science.gov (United States)

    Högberg, Goran; Hällström, Tore

    2008-07-01

    The aim of this study was to describe and evaluate the clinical pattern of 14 youths with presenting suicidality, to describe an integrative treatment approach, and to estimate therapy effectiveness. Fourteen patients aged 10 to 18 years from a child and adolescent outpatient clinic in Stockholm were followed in a case series. The patients were treated with active multimodal psychotherapy. This consisted of mood charting by mood-maps, psycho-education, wellbeing practice and trauma resolution. Active techniques were psychodrama and body-mind focused techniques including eye movement desensitization and reprocessing. The patients were assessed before treatment, immediately after treatment and at 22 months post treatment with the Global Assessment of Functioning Scale. The clinical pattern of the group was observed. After treatment there was a significant change towards normality in the Global Assessment of Functioning scale both immediately post-treatment and at 22 months. A clinical pattern, post trauma suicidal reaction, was observed with a combination of suicidality, insomnia, bodily symptoms and disturbed mood regulation. We conclude that in the post trauma reaction suicidality might be a presenting symptom in young people. Despite the shortcomings of a case series the results of this study suggest that a mood-map-based multimodal treatment approach with active techniques might be of value in the treatment of children and youth with suicidality.

  15. Transfer Effects to a Multimodal Dual-Task after Working Memory Training and Associated Neural Correlates in Older Adults - A Pilot Study.

    Science.gov (United States)

    Heinzel, Stephan; Rimpel, Jérôme; Stelzel, Christine; Rapp, Michael A

    2017-01-01

    Working memory (WM) performance declines with age. However, several studies have shown that WM training may lead to performance increases not only in the trained task, but also in untrained cognitive transfer tasks. It has been suggested that transfer effects occur if training task and transfer task share specific processing components that are supposedly processed in the same brain areas. In the current study, we investigated whether single-task WM training and training-related alterations in neural activity might support performance in a dual-task setting, thus assessing transfer effects to higher-order control processes in the context of dual-task coordination. A sample of older adults (age 60-72) was assigned to either a training or control group. The training group participated in 12 sessions of an adaptive n-back training. At pre and post-measurement, a multimodal dual-task was performed in all participants to assess transfer effects. This task consisted of two simultaneous delayed match to sample WM tasks using two different stimulus modalities (visual and auditory) that were performed either in isolation (single-task) or in conjunction (dual-task). A subgroup also participated in functional magnetic resonance imaging (fMRI) during the performance of the n-back task before and after training. While no transfer to single-task performance was found, dual-task costs in both the visual modality ( p task costs, while neural activity changes in right DLPFC during three-back predicted visual dual-task costs. Results might indicate an improvement in central executive processing that could facilitate both WM and dual-task coordination.

  16. Multimodal responsive action

    DEFF Research Database (Denmark)

    Oshima, Sae

    ; Raymond 2003; Schegloff and Lerner 2009), including those with multimodal actions (e.g. Olsher 2004; Fasulo & Monzoni 2009). Some responsive actions can also be completed with bodily behavior alone, such as: when an agreement display is achieved by using only nonvocal actions (Jarmon 1996), when...... the recipient’s gaze shift becomes a significant part of the speaker’s turn construction (Goodwin 1980), and when head nods show the recipient’s affiliation with the speaker’s stance (Stivers 2008). Still, much room remains for extending our current understanding of responding actions that necessarily involve...... a hairstylist and a client negotiate the quality of the service that has been provided. Here, the first action is usually the stylist’s question and/or explanation of the new cut that invites the client’s assessment/(dis)agreement, accompanied with embodied actions that project an imminent self...

  17. An 8-Week Knee Osteoarthritis Treatment Program of Hyaluronic Acid Injection, Deliberate Physical Rehabilitation, and Patient Education is Cost Effective at 2 Years Follow-up: The OsteoArthritis Centers of America Experience

    Directory of Open Access Journals (Sweden)

    Larry E. Miller

    2014-01-01

    Full Text Available Numerous nonsurgical interventions have been reported to improve symptoms of knee osteoarthritis (OA over the short term. However, longer follow-up is required to accurately characterize outcomes such as cost effectiveness and delayed arthroplasty. A total of 553 patients with symptomatic knee OA who previously underwent a single 8-week multimodal treatment program were contacted at 1 year ( n = 336 or 2 years ( n = 217 follow-up. The percentage of patients who underwent knee arthroplasty was 10% at 1 year and 18% at 2 years following program completion. The treatment program was highly cost effective at $12,800 per quality-adjusted life year at 2 years. Cost effectiveness was maintained under a variety of plausible assumptions and regardless of gender, age, body mass index, disease severity, or knee pain severity. In summary, a single 8-week multimodal knee OA treatment program is cost effective and may lower knee arthroplasty utilization through 2 years follow-up.

  18. Locally advanced oral cavity squamous cell carcinoma: Barriers related to effective treatment

    Directory of Open Access Journals (Sweden)

    K C Lakshmaiah

    2015-01-01

    Full Text Available Background: Oral cavity cancer is a significant health problem in India. Majority of patients present with locally advanced disease requiring multimodality treatment. Compliance to recommended treatment is an important factor affecting outcome. Aims: The aim was to evaluate the outcome of locally advanced oral cavity cancer patients with regards to treatment adherence and to assess reasons of noncompliance. Materials and Methods: This was a prospective observational study. We included patients referred to Department of Medical Oncology for induction chemotherapy in view of locally advanced oral cavity cancer. Results: Only 15 (26% patients completed planned treatment schedule. Their 1 year overall survival was 93%. The remaining 43 patients who received inadequate treatment had a dismal 21% 1 year overall survival. Illiteracy, poverty, long waiting list for surgery, prolonged delay for health scheme treatment plan approval and dissatisfaction with attitude of hospital staffs are major barriers related to effective treatment of these patients. Conclusions: A detailed discussion with patient and their relatives regarding recommended treatment, proper implementation of health schemes, increasing trained manpower to avoid long waiting list for surgery, provision of additional financial support for family member accompanying the patient and a sympathetic approach toward patients are needed to help these patients overcome the battle.

  19. Impact of multimodality in reading comprehension of narrative texts in English as a foreign language (EFL in undergraduate students

    Directory of Open Access Journals (Sweden)

    Fernando Vera Millalén

    2014-11-01

    Full Text Available This research seeks to compare the effect that monomodal and multimodal tests have on the reading comprehension level of English-written narrative texts that EFL learners achieve at a private Chilean university. For this purpose, a quasi-experiment was performed, using a monomodal reading comprehension test and another multimodal one, with intact groups. The experimental group took the multimodal format test, while the control group took the monomodal format test. The interest of this research focused on the need to integrate multimodal texts in L2 reading comprehension. The results endorse the hypothesis that students reach higher comprehension levels in multimodal reading comprehension tests.

  20. Intraoperative high-field magnetic resonance imaging, multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas.

    Science.gov (United States)

    Li, Fang-Ye; Chen, Xiao-Lei; Xu, Bai-Nan

    2016-09-01

    To determine the beneficial effects of intraoperative high-field magnetic resonance imaging (MRI), multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas. Twelve patients with 13 supratentorial cavernomas were prospectively enrolled and operated while using a 1.5 T intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. All cavernomas were deeply located in subcortical areas or involved critical areas. Intraoperative high-field MRIs were obtained for the intraoperative "visualization" of surrounding eloquent structures, "brain shift" corrections, and navigational plan updates. All cavernomas were successfully resected with guidance from intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. In 5 cases with supratentorial cavernomas, intraoperative "brain shift" severely deterred locating of the lesions; however, intraoperative MRI facilitated precise locating of these lesions. During long-term (>3 months) follow-up, some or all presenting signs and symptoms improved or resolved in 4 cases, but were unchanged in 7 patients. Intraoperative high-field MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring are helpful in surgeries for the treatment of small deeply seated subcortical cavernomas.

  1. Log-Gabor Energy Based Multimodal Medical Image Fusion in NSCT Domain

    Directory of Open Access Journals (Sweden)

    Yong Yang

    2014-01-01

    Full Text Available Multimodal medical image fusion is a powerful tool in clinical applications such as noninvasive diagnosis, image-guided radiotherapy, and treatment planning. In this paper, a novel nonsubsampled Contourlet transform (NSCT based method for multimodal medical image fusion is presented, which is approximately shift invariant and can effectively suppress the pseudo-Gibbs phenomena. The source medical images are initially transformed by NSCT followed by fusing low- and high-frequency components. The phase congruency that can provide a contrast and brightness-invariant representation is applied to fuse low-frequency coefficients, whereas the Log-Gabor energy that can efficiently determine the frequency coefficients from the clear and detail parts is employed to fuse the high-frequency coefficients. The proposed fusion method has been compared with the discrete wavelet transform (DWT, the fast discrete curvelet transform (FDCT, and the dual tree complex wavelet transform (DTCWT based image fusion methods and other NSCT-based methods. Visually and quantitatively experimental results indicate that the proposed fusion method can obtain more effective and accurate fusion results of multimodal medical images than other algorithms. Further, the applicability of the proposed method has been testified by carrying out a clinical example on a woman affected with recurrent tumor images.

  2. The Effects of Using Multimodal Approaches in Meaning-Making of 21st Century Literacy Texts among ESL Students in a Private School in Malaysia

    Science.gov (United States)

    Ganapathy, Malina; Seetharam, Saundravalli A/P

    2016-01-01

    In today's globalised digital era, students are inevitably engaged in various multimodal texts due to their active participation in social media and frequent usage of mobile devices on a daily basis. Such daily activities advocate the need for a transformation in the teaching and learning of ESL lessons in order to promote students' capabilities…

  3. Multimodal label-free microscopy

    Directory of Open Access Journals (Sweden)

    Nicolas Pavillon

    2014-09-01

    Full Text Available This paper reviews the different multimodal applications based on a large extent of label-free imaging modalities, ranging from linear to nonlinear optics, while also including spectroscopic measurements. We put specific emphasis on multimodal measurements going across the usual boundaries between imaging modalities, whereas most multimodal platforms combine techniques based on similar light interactions or similar hardware implementations. In this review, we limit the scope to focus on applications for biology such as live cells or tissues, since by their nature of being alive or fragile, we are often not free to take liberties with the image acquisition times and are forced to gather the maximum amount of information possible at one time. For such samples, imaging by a given label-free method usually presents a challenge in obtaining sufficient optical signal or is limited in terms of the types of observable targets. Multimodal imaging is then particularly attractive for these samples in order to maximize the amount of measured information. While multimodal imaging is always useful in the sense of acquiring additional information from additional modes, at times it is possible to attain information that could not be discovered using any single mode alone, which is the essence of the progress that is possible using a multimodal approach.

  4. ALERT. Adverse late effects of cancer treatment. Vol. 2. Normal tissue specific sites and systems

    Energy Technology Data Exchange (ETDEWEB)

    Rubin, Philip; Constine, Louis S. [Univ. Rochester Medical Center, NY (United States). Dept. of Radiation Oncology; Marks, Lawrence B. (ed.) [Univ. North Carolina and Lineberger, Comprehensive Cancer Center, Chapel Hill, NC (United States). Dept. of Radiation Oncology

    2014-09-01

    Comprehensively documents potential late effects in all the normal tissue sites in the human body. Considers in detail the detection, diagnosis, management and prevention of effects and discusses prognostic outcomes. Clearly presents radiation risk factors and interactions with chemotherapy effects. Provides the most current evidence-based medicine for cancer care survivorship guidelines. The literature on the late effects of cancer treatment is widely scattered in different journals since all major organ systems are affected and management is based on a variety of medical and surgical treatments. The aim of ALERT - Adverse Late Effects of Cancer Treatment is to offer a coherent multidisciplinary approach to the care of cancer survivors. The central paradigm is that cytotoxic multimodal therapy results in a perpetual cascade of events that affects each major organ system differently and is expressed continually over time. Essentially, radiation and chemotherapy are intense biologic modifiers that allow for cancer cure and cancer survivorship but accelerate senescence of normal tissues and increase the incidence of age-related diseases and second malignant tumors. Volume 2 of this two-volume work comprehensively documents potential late effects in all the normal tissue anatomic sites in the human body. The detection, diagnosis, management and prevention of effects are all considered in detail, and prognostic outcomes are discussed. Radiation risk factors and interactions with chemotherapy effects are clearly presented. The text is accompanied by numerous supportive illustrations and tables.

  5. Is the residential combined (psychotherapy plus medication) treatment of patients with severe personality disorder effective in terms of suicidality and impulsivity?

    Science.gov (United States)

    Vaslamatzis, Grigorios; Theodoropoulos, Panayiotis; Vondikaki, Stamatia; Karamanolaki, Hara; MiliaTsanira, Myrto; Gourounti, Kleanthi

    2014-02-01

    The aim of this study was to compare the effectiveness of combined treatment-medication plus psychodynamic psychotherapy-and psychodynamic psychotherapy alone on the outcome variables of suicidality and impulsivity in a population of adult inpatients with severe personality disorder (SPD). This is a naturalistic-empirical (observational) study under the conditions of clinical practice (an intensive specialized inpatient psychotherapeutic program [SIPP]). The sample consisted of 33 inpatients with SPD who were allocated to two subgroups (groups A and B). The patients in group A received psychodynamic psychotherapy and adjunctive pharmacotherapy, whereas the patients in group B received multimodal psychodynamic psychotherapy only. A statistically significant reduction in suicidality score was observed in the patients in group A, whereas a tendency for significant reduction in impulsivity score was observed in group B after the SIPP termination. Pharmacotherapy combined with multimodal psychodynamic psychotherapy, always within the SIPP, seems more effective in the case of suicidality rather than impulsivity.

  6. MultiModality Surgical and Hyperbaric Management of Mandibular Osteoradionecrosis

    International Nuclear Information System (INIS)

    Freiberger, John J.; Yoo, David S.; Lisle Dear, Guy de; McGraw, Thomas A.; Blakey, George H.; Padilla Burgos, Rebecca; Kraft, Kevin; Nelson, John W.; Moon, Richard E.; Piantadosi, Claude A.

    2009-01-01

    Purpose: To elucidate long-term outcomes in 65 consecutive patients meeting a uniform definition of mandibular osteoradionecrosis (ORN) treated with multimodality therapy including hyperbaric oxygen (HBO). Methods and Materials: Pretreatment, post-treatment and long-term follow-up of mandibular lesions with exposed bone were ranked by a systematic review of medical records and patient telephone calls. The ranking system was based on lesion diameter and number plus disease progression. Changes from pretreatment to post-treatment and follow-up were analyzed by Wilcoxon signed-rank tests. Improved wound survival, measured by time to relapse, defined as any less favorable rank after HBO treatment, was assessed by Kaplan-Meier analysis. Results: In all, 57 cases (88%) resolved or improved by lesion grade or progression and evolution criteria after HBO (p < 0.001). Four patients healed before surgery after HBO alone. Of 57 patients who experienced improvement, 41 had failed previous nonmultimodality therapy for 3 months and 26 for 6 months or more. A total of 43 patients were eligible for time-to-relapse survival analysis. Healing or improvement lasted a mean duration of 86.1 months (95% confidence interval [95% CI], 64.0-108.2) in nonsmokers (n = 20) vs. 15.8 months (95% CI, 8.4-23.2) in smokers (n = 14) versus 24.2 months (95% CI, 15.2-33.2) in patients with recurrent cancer (n = 9) (p = 0.002 by the log-rank method). Conclusions: Multimodality therapy using HBO is effective for ORN when less intensive therapies have failed. Although the healing rate in similarly affected patients not treated with HBO is unknown, the improvements seen with peri-operative HBO were durable provided that the patients remained cancer free and abstained from smoking.

  7. Effects of Multimodal Displays About Threat Location on Target Acquisition and Attention to Visual and Auditory Communications

    National Research Council Canada - National Science Library

    Glumm, Monica M; Kehring, Kathy L; White, Timothy L

    2007-01-01

    This laboratory experiment examined the effects of paired sensory cues that indicate the location of targets on target acquisition performance, the recall of information presented in concurrent visual...

  8. The first does the work, but the third time's the charm: the effects of massed repetition on episodic encoding of multimodal face-name associations.

    Science.gov (United States)

    Mangels, Jennifer A; Manzi, Alberto; Summerfield, Christopher

    2010-03-01

    In social interactions, it is often necessary to rapidly encode the association between visually presented faces and auditorily presented names. The present study used event-related potentials to examine the neural correlates of associative encoding for multimodal face-name pairs. We assessed study-phase processes leading to high-confidence recognition of correct pairs (and consistent rejection of recombined foils) as compared to lower-confidence recognition of correct pairs (with inconsistent rejection of recombined foils) and recognition failures (misses). Both high- and low-confidence retrieval of face-name pairs were associated with study-phase activity suggestive of item-specific processing of the face (posterior inferior temporal negativity) and name (fronto-central negativity). However, only those pairs later retrieved with high confidence recruited a sustained centro-parietal positivity that an ancillary localizer task suggested may index an association-unique process. Additionally, we examined how these processes were influenced by massed repetition, a mnemonic strategy commonly employed in everyday situations to improve face-name memory. Differences in subsequent memory effects across repetitions suggested that associative encoding was strongest at the initial presentation, and thus, that the initial presentation has the greatest impact on memory formation. Yet, exploratory analyses suggested that the third presentation may have benefited later memory by providing an opportunity for extended processing of the name. Thus, although encoding of the initial presentation was critical for establishing a strong association, the extent to which processing was sustained across subsequent immediate (massed) presentations may provide additional encoding support that serves to differentiate face-name pairs from similar (recombined) pairs by providing additional encoding opportunities for the less dominant stimulus dimension (i.e., name).

  9. Registration of deformed multimodality medical images

    International Nuclear Information System (INIS)

    Moshfeghi, M.; Naidich, D.

    1989-01-01

    The registration and combination of images from different modalities have several potential applications, such as functional and anatomic studies, 3D radiation treatment planning, surgical planning, and retrospective studies. Image registration algorithms should correct for any local deformations caused by respiration, heart beat, imaging device distortions, and so forth. This paper reports on an elastic matching technique for registering deformed multimodality images. Correspondences between contours in the two images are used to stretch the deformed image toward its goal image. This process is repeated a number of times, with decreasing image stiffness. As the iterations continue, the stretched image better approximates its goal image

  10. ALERT. Adverse late effects of cancer treatment. Vol. 1. General concepts and specific precepts

    Energy Technology Data Exchange (ETDEWEB)

    Rubin, Philip; Constine, Louis S. [Univ. Rochester Medical Center, NY (United States). Dept. of Radiation Oncology; Marks, Lawrence B. (ed.) [Univ. North Carolina and Lineberger, Comprehensive Cancer Center, Chapel Hill, NC (United States). Dept. of Radiation Oncology

    2014-09-01

    Considers in detail the general concepts and principles relevant to the adverse late effects of cancer treatment. Explains the molecular, cytologic and histopathologic events that lead to altered physiologic and metabolic functions and their clinical manifestations. Includes chapters on legal issues, economic aspects, nursing, psychological issues and quality of life. The literature on the late effects of cancer treatment is widely scattered in different journals since all major organ systems are affected and management is based on a variety of medical and surgical treatments. The aim of ALERT - Adverse Late Effects of Cancer Treatment is to offer a coherent multidisciplinary approach to the care of cancer survivors. The central paradigm is that cytotoxic multimodal therapy results in a perpetual cascade of events that affects each major organ system differently and is expressed continually over time. Essentially, radiation and chemotherapy are intense biologic modifiers that allow for cancer cure and cancer survivorship but accelerate senescence of normal tissues and increase the incidence of age-related diseases and second malignant tumors. Volume 1 of this two-volume work focuses on the general concepts and principles relevant to late effects and on the dynamic interplay of molecular, cytologic and histopathologic events that lead to altered physiologic and metabolic functions and their clinical manifestations. Chapters are also included on legal issues, economic aspects, nursing, psychological issues and quality of life.

  11. ALERT. Adverse late effects of cancer treatment. Vol. 1. General concepts and specific precepts

    International Nuclear Information System (INIS)

    Rubin, Philip; Constine, Louis S.; Marks, Lawrence B.

    2014-01-01

    Considers in detail the general concepts and principles relevant to the adverse late effects of cancer treatment. Explains the molecular, cytologic and histopathologic events that lead to altered physiologic and metabolic functions and their clinical manifestations. Includes chapters on legal issues, economic aspects, nursing, psychological issues and quality of life. The literature on the late effects of cancer treatment is widely scattered in different journals since all major organ systems are affected and management is based on a variety of medical and surgical treatments. The aim of ALERT - Adverse Late Effects of Cancer Treatment is to offer a coherent multidisciplinary approach to the care of cancer survivors. The central paradigm is that cytotoxic multimodal therapy results in a perpetual cascade of events that affects each major organ system differently and is expressed continually over time. Essentially, radiation and chemotherapy are intense biologic modifiers that allow for cancer cure and cancer survivorship but accelerate senescence of normal tissues and increase the incidence of age-related diseases and second malignant tumors. Volume 1 of this two-volume work focuses on the general concepts and principles relevant to late effects and on the dynamic interplay of molecular, cytologic and histopathologic events that lead to altered physiologic and metabolic functions and their clinical manifestations. Chapters are also included on legal issues, economic aspects, nursing, psychological issues and quality of life.

  12. Burnout: A Multimodal Approach to Assessment and Resolution.

    Science.gov (United States)

    Kesler, Kathryn D.

    1990-01-01

    Claims assessment and treatment of guidance counselor burnout is not simple. A variety of causes and symptoms leads to the need for multidimensional conceptualization and action plan. The multimodal behavior mode, BASIC I.D., with the adoption of a Setting modality, has been shown to be a comprehensive approach when applied to the understanding…

  13. The Management Of Homosexuality Using Multimodal Therapy: A ...

    African Journals Online (AJOL)

    Anxiety, depression, marital distress and low self-esteem were identified as correlates of the client's condition. Multimodal therapy was instituted thereafter. The result after three months of treatment showed reduction in sexual attraction for men, increased attraction to females, reduced frequency of masturbation, lowered ...

  14. Multimodal hyperspectroscopy screening in women at risk of ...

    African Journals Online (AJOL)

    Background: Screening and treatment of pre‑cancerous lesions is important for prevention of cervical cancer. Currently, most available screening tests for cervical cancer are limited by low sensitivity, prohibitive costs, logistics and technical concerns. This study evaluates the role of multimodal hyperspectroscopy (MHS) as a ...

  15. Multimodal Counseling of Childhood Encopresis: A Case Example.

    Science.gov (United States)

    Gumaer, Jim

    1990-01-01

    Provides information regarding childhood disorder of encopresis and presents multimodal therapy techniques for school counselors who cannot successfully refer clients. Presents a case study of a teenage boy suffering from encopresis who was referred for counseling. Suggests specific treatment strategies including behavior modification, nutrition…

  16. In vitro multimodal-effect of Trichilia catigua A. Juss. (Meliaceae) bark aqueous extract in CNS targets.

    Science.gov (United States)

    Bernardo, João; Ferreres, Federico; Gil-Izquierdo, Ángel; Videira, Romeu António; Valentão, Patrícia; Veiga, Francisco; Andrade, Paula B

    2018-01-30

    The bark of Trichilia catigua A. Juss. (Meliaceae), popularly known as "big catuaba", is traditionally used in Brazilian folk medicine for its neuroactive potential as memory stimulant, and antinociceptive and antidepressant effects. To study the aqueous extract of T. catigua bark as dual inhibitor of monoamine oxidase A (MAO-A) and acetylcholinesterase (AChE). To explore its antioxidant potential through interaction with xanthine/xanthine oxidase (X/XO) pathway, and to attempt a relationship between its phenolic profile and effects displayed. Phenolic profiling was achieved by HPLC-DAD-ESI/MS n and UPLC-ESI-QTOF-MS analyses. The capacity to inhibit hMAO-A was assessed in vitro, as was that for AChE, evaluated in rat brain homogenates. The direct inhibition of the X/XO pathway and the scavenging of superoxide anion radical were the selected in vitro models to explore the antioxidant potential. The cytotoxic effects were assayed in the human neuronal SH-SY5Y cells by MTT reduction, after direct exposure (24h). Twenty-six compounds were identified and quantified (551.02 ± 37.61mg/g of lyophilized extract). The phenylpropanoid substituted flavan-3-ols were the most representative compounds (~81% of quantified mass). The extract inhibited hMAO activity in a concentration-dependent manner (IC 50 = 121.06 ± 2.13μg/mL). A mixed model of inhibition of AChE activity was observed, reflected by the pronounced increase of Km values and a more discreet effect over the Vmax parameters, calculated from Michaelis-Menten fitted equations. In addition, it was demonstrated that the extract directly inhibits the X/XO pathway (IC 50 = 121.06 ± 2.13μg/mL) and also imbalances the oxidative stress acting as superoxide anion radical scavenger (EC 50 = 104.42 ± 10.67μg/mL), an oxidative by-product of this reaction. All these neuroprotective and neurotrophic effects were displayed within the non-toxic range of concentrations (0.063-0.500μg/mL) in SH-SY5Y cells. Our results validate

  17. Multimodal treatment of perianal fistulas in Crohn's disease: seton versus anti-TNF versus advancement plasty (PISA): study protocol for a randomized controlled trial.

    LENUS (Irish Health Repository)

    de Groof, E Joline

    2015-08-20

    Currently there is no guideline for the treatment of patients with Crohn\\'s disease and high perianal fistulas. Most patients receive anti-TNF medication, but no long-term results of this expensive medication have been described, nor has its efficiency been compared to surgical strategies. With this study, we hope to provide treatment consensus for daily clinical practice with reduction in costs.

  18. Effects of xylitol on carbohydrate digesting enzymes activity, intestinal glucose absorption and muscle glucose uptake: a multi-mode study.

    Science.gov (United States)

    Chukwuma, Chika Ifeanyi; Islam, Md Shahidul

    2015-03-01

    The present study investigated the possible mechanism(s) behind the effects of xylitol on carbohydrate digesting enzymes activity, muscle glucose uptake and intestinal glucose absorption using in vitro, ex vivo and in vivo experimental models. The effects of increasing concentrations of xylitol (2.5%-40% or 164.31 mM-2628.99 mM) on alpha amylase and alpha glucosidase activity in vitro and intestinal glucose absorption and muscle glucose uptake were investigated under ex vivo conditions. Additionally, the effects of an oral bolus dose of xylitol (1 g per kg BW) on gastric emptying and intestinal glucose absorption and digesta transit in the different segments of the intestinal tract were investigated in normal and type 2 diabetic rats at 1 hour after dose administration, when phenol red was used as a recovery marker. Xylitol exhibited concentration-dependent inhibition of alpha amylase (IC₅₀ = 1364.04 mM) and alpha glucosidase (IC₅₀ = 1127.52 mM) activity in vitro and small intestinal glucose absorption under ex vivo condition. Xylitol also increased dose dependent muscle glucose uptake with and without insulin, although the uptake was not significantly affected by the addition of insulin. Oral single bolus dose of xylitol significantly delayed gastric emptying, inhibited intestinal glucose absorption but increased the intestinal digesta transit rate in both normal and diabetic rats compared to their respective controls. The data of this study suggest that xylitol reduces intestinal glucose absorption via inhibiting major carbohydrate digesting enzymes, slowing gastric emptying and fastening the intestinal transit rate, but increases muscle glucose uptake in normal and type 2 diabetic rats.

  19. Cost-Effective Fuel Treatment Planning

    Science.gov (United States)

    Kreitler, J.; Thompson, M.; Vaillant, N.

    2014-12-01

    The cost of fighting large wildland fires in the western United States has grown dramatically over the past decade. This trend will likely continue with growth of the WUI into fire prone ecosystems, dangerous fuel conditions from decades of fire suppression, and a potentially increasing effect from prolonged drought and climate change. Fuel treatments are often considered the primary pre-fire mechanism to reduce the exposure of values at risk to wildland fire, and a growing suite of fire models and tools are employed to prioritize where treatments could mitigate wildland fire damages. Assessments using the likelihood and consequence of fire are critical because funds are insufficient to reduce risk on all lands needing treatment, therefore prioritization is required to maximize the effectiveness of fuel treatment budgets. Cost-effectiveness, doing the most good per dollar, would seem to be an important fuel treatment metric, yet studies or plans that prioritize fuel treatments using costs or cost-effectiveness measures are absent from the literature. Therefore, to explore the effect of using costs in fuel treatment planning we test four prioritization algorithms designed to reduce risk in a case study examining fuel treatments on the Sisters Ranger District of central Oregon. For benefits we model sediment retention and standing biomass, and measure the effectiveness of each algorithm by comparing the differences among treatment and no treat alternative scenarios. Our objective is to maximize the averted loss of net benefits subject to a representative fuel treatment budget. We model costs across the study landscape using the My Fuel Treatment Planner software, tree list data, local mill prices, and GIS-measured site characteristics. We use fire simulations to generate burn probabilities, and estimate fire intensity as conditional flame length at each pixel. Two prioritization algorithms target treatments based on cost-effectiveness and show improvements over those

  20. The effect of Wi-Fi electromagnetic waves in unimodal and multimodal object recognition tasks in male rats.

    Science.gov (United States)

    Hassanshahi, Amin; Shafeie, Seyed Ali; Fatemi, Iman; Hassanshahi, Elham; Allahtavakoli, Mohammad; Shabani, Mohammad; Roohbakhsh, Ali; Shamsizadeh, Ali

    2017-06-01

    Wireless internet (Wi-Fi) electromagnetic waves (2.45 GHz) have widespread usage almost everywhere, especially in our homes. Considering the recent reports about some hazardous effects of Wi-Fi signals on the nervous system, this study aimed to investigate the effect of 2.4 GHz Wi-Fi radiation on multisensory integration in rats. This experimental study was done on 80 male Wistar rats that were allocated into exposure and sham groups. Wi-Fi exposure to 2.4 GHz microwaves [in Service Set Identifier mode (23.6 dBm and 3% for power and duty cycle, respectively)] was done for 30 days (12 h/day). Cross-modal visual-tactile object recognition (CMOR) task was performed by four variations of spontaneous object recognition (SOR) test including standard SOR, tactile SOR, visual SOR, and CMOR tests. A discrimination ratio was calculated to assess the preference of animal to the novel object. The expression levels of M1 and GAT1 mRNA in the hippocampus were assessed by quantitative real-time RT-PCR. Results demonstrated that rats in Wi-Fi exposure groups could not discriminate significantly between the novel and familiar objects in any of the standard SOR, tactile SOR, visual SOR, and CMOR tests. The expression of M1 receptors increased following Wi-Fi exposure. In conclusion, results of this study showed that chronic exposure to Wi-Fi electromagnetic waves might impair both unimodal and cross-modal encoding of information.

  1. Manifold Regularized Multi-Task Feature Selection for Multi-Modality Classification in Alzheimer’s Disease

    Science.gov (United States)

    Jie, Biao; Cheng, Bo

    2014-01-01

    Accurate diagnosis of Alzheimer’s disease (AD), as well as its pro-dromal stage (i.e., mild cognitive impairment, MCI), is very important for possible delay and early treatment of the disease. Recently, multi-modality methods have been used for fusing information from multiple different and complementary imaging and non-imaging modalities. Although there are a number of existing multi-modality methods, few of them have addressed the problem of joint identification of disease-related brain regions from multi-modality data for classification. In this paper, we proposed a manifold regularized multi-task learning framework to jointly select features from multi-modality data. Specifically, we formulate the multi-modality classification as a multi-task learning framework, where each task focuses on the classification based on each modality. In order to capture the intrinsic relatedness among multiple tasks (i.e., modalities), we adopted a group sparsity regularizer, which ensures only a small number of features to be selected jointly. In addition, we introduced a new manifold based Laplacian regularization term to preserve the geometric distribution of original data from each task, which can lead to the selection of more discriminative features. Furthermore, we extend our method to the semi-supervised setting, which is very important since the acquisition of a large set of labeled data (i.e., diagnosis of disease) is usually expensive and time-consuming, while the collection of unlabeled data is relatively much easier. To validate our method, we have performed extensive evaluations on the baseline Magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (FDG-PET) data of Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. Our experimental results demonstrate the effectiveness of the proposed method. PMID:24505676

  2. Multimodal neuromonitoring in pediatric cardiac anesthesia

    Directory of Open Access Journals (Sweden)

    Alexander J. C. Mittnacht

    2014-01-01

    Full Text Available Despite significant improvements in overall outcome, neurological injury remains a feared complication following pediatric congenital heart surgery (CHS. Only if adverse events are detected early enough, can effective actions be initiated preventing potentially serious injury. The multifactorial etiology of neurological injury in CHS patients makes it unlikely that one single monitoring modality will be effective in capturing all possible threats. Improving current and developing new technologies and combining them according to the concept of multimodal monitoring may allow for early detection and possible intervention with the goal to further improve neurological outcome in children undergoing CHS.

  3. Impact of Treatment Integrity on Intervention Effectiveness

    Science.gov (United States)

    Fryling, Mitch J.; Wallace, Michele D.; Yassine, Jordan N.

    2012-01-01

    Treatment integrity has cogent implications for intervention effectiveness. Understanding these implications is an important, but often neglected, undertaking in behavior analysis. This paper reviews current research on treatment integrity in applied behavior analysis. Specifically, we review research evaluating the relation between integrity…

  4. Multimodal Discourse Analysis of the Movie "Argo"

    Science.gov (United States)

    Bo, Xu

    2018-01-01

    Based on multimodal discourse theory, this paper makes a multimodal discourse analysis of some shots in the movie "Argo" from the perspective of context of culture, context of situation and meaning of image. Results show that this movie constructs multimodal discourse through particular context, language and image, and successfully…

  5. Multimodality instrument for tissue characterization

    Science.gov (United States)

    Mah, Robert W. (Inventor); Andrews, Russell J. (Inventor)

    2004-01-01

    A system with multimodality instrument for tissue identification includes a computer-controlled motor driven heuristic probe with a multisensory tip. For neurosurgical applications, the instrument is mounted on a stereotactic frame for the probe to penetrate the brain in a precisely controlled fashion. The resistance of the brain tissue being penetrated is continually monitored by a miniaturized strain gauge attached to the probe tip. Other modality sensors may be mounted near the probe tip to provide real-time tissue characterizations and the ability to detect the proximity of blood vessels, thus eliminating errors normally associated with registration of pre-operative scans, tissue swelling, elastic tissue deformation, human judgement, etc., and rendering surgical procedures safer, more accurate, and efficient. A neural network program adaptively learns the information on resistance and other characteristic features of normal brain tissue during the surgery and provides near real-time modeling. A fuzzy logic interface to the neural network program incorporates expert medical knowledge in the learning process. Identification of abnormal brain tissue is determined by the detection of change and comparison with previously learned models of abnormal brain tissues. The operation of the instrument is controlled through a user friendly graphical interface. Patient data is presented in a 3D stereographics display. Acoustic feedback of selected information may optionally be provided. Upon detection of the close proximity to blood vessels or abnormal brain tissue, the computer-controlled motor immediately stops probe penetration. The use of this system will make surgical procedures safer, more accurate, and more efficient. Other applications of this system include the detection, prognosis and treatment of breast cancer, prostate cancer, spinal diseases, and use in general exploratory surgery.

  6. Multimodality Data Integration in Epilepsy

    Directory of Open Access Journals (Sweden)

    Otto Muzik

    2007-01-01

    Full Text Available An important goal of software development in the medical field is the design of methods which are able to integrate information obtained from various imaging and nonimaging modalities into a cohesive framework in order to understand the results of qualitatively different measurements in a larger context. Moreover, it is essential to assess the various features of the data quantitatively so that relationships in anatomical and functional domains between complementing modalities can be expressed mathematically. This paper presents a clinically feasible software environment for the quantitative assessment of the relationship among biochemical functions as assessed by PET imaging and electrophysiological parameters derived from intracranial EEG. Based on the developed software tools, quantitative results obtained from individual modalities can be merged into a data structure allowing a consistent framework for advanced data mining techniques and 3D visualization. Moreover, an effort was made to derive quantitative variables (such as the spatial proximity index, SPI characterizing the relationship between complementing modalities on a more generic level as a prerequisite for efficient data mining strategies. We describe the implementation of this software environment in twelve children (mean age 5.2±4.3 years with medically intractable partial epilepsy who underwent both high-resolution structural MR and functional PET imaging. Our experiments demonstrate that our approach will lead to a better understanding of the mechanisms of epileptogenesis and might ultimately have an impact on treatment. Moreover, our software environment holds promise to be useful in many other neurological disorders, where integration of multimodality data is crucial for a better understanding of the underlying disease mechanisms.

  7. Understanding placebo, nocebo, and iatrogenic treatment effects.

    Science.gov (United States)

    Bootzin, Richard R; Bailey, Elaine T

    2005-07-01

    Placebo and nonplacebo treatments have both positive and negative effects on patient outcomes. To better understand the patterning of treatment effects, three specific interventions will be discussed that are reported to produce more harm than benefit: critical incident stress debriefing, group therapy for adolescents with conduct disorders, and psychotherapy for dissociative identity disorder. In each case, there is an interaction between mechanisms thought to underlie both placebo and specific treatment effects. Mechanisms hypothesized to underlie placebo and nocebo effects include patient expectancy, self-focused attention to symptoms, motivation to change, and sociocultural role-enactment cues. In the three treatments discussed, specific mechanisms interact with nonspecific mechanisms to produce iatrogenic effects. To advance knowledge, it is important both to specify the theory of treatment and its expected outcomes and to put the theory to test. Only with attention to the empirical findings from programmatic research of specific and nonspecific effects and their interaction is it possible to improve the outcomes of treatment beyond the status quo.

  8. [The effects of 6 months' multimodal training on functional performance, strength, endurance, and body mass index of older individuals. Are the benefits of training similar among women and men?].

    Science.gov (United States)

    Gudlaugsson, Janus; Aspelund, Thor; Gudnason, Vilmundur; Olafsdottir, Anna Sigridur; Jonsson, Palmi V; Arngrimsson, Sigurbjorn Arni; Johannsson, Erlingur

    2013-07-01

    Good functional performance in elderly people greatly improves their changes of independence and well-being. Conversely, bad functional performance can impair their capability of managing the activities of daily life.. The main goal of this study was to investigate the effects of a 6-months' multimodal training intervention on the physical performance of males and females, possible gender differences and the outcome 6 and 12 months after its completion. This study examined 71-90 year old healthy seniors (n=117) participating in the AGES Reykjavik Study. It was a randomized and controlled cross-over trial, conducted in three 6-months' phases (time-points). After enrollment and baseline assessments, the study group was divided in two. Group 1 received 6-months' training while group 2 served as a control. In the second 6 months' phase, group 1 received no formal training while group 2 did. In the third phase, neither group received training. The groups' physical conditions were assessed after each phase. After 6-months' training, 32% improvement was seen in physical activity among males (ptraining results. Both sexes retained long-term effects of the training on physical performance and dynamic balance for at least 12 months. Multimodal training intervention has positive effects on physical performance in older individuals, the sexes respond similarly to the training and retain achieved improvement for at least 12 months. The research indicates that moderate and systemic training for this age group could be a part of conventional health service for this age group.

  9. Clipping in Awake Surgery as End-Stage in a Complex Internal Carotid Artery Aneurysm After Failure of Multimodal Endovascular and Extracranial-Intracranial Bypass Treatment.

    Science.gov (United States)

    Cannizzaro, Delia; Peschillo, Simone; Mancarella, Cristina; La Pira, Biagia; Rastelli, Emanuela; Passacantilli, Emiliano; Santoro, Antonio

    2017-06-01

    Intracranial carotid artery aneurysm can be treated via microsurgical or endovascular techniques. The optimal planning is the result of the careful patient selection through clinical, anatomic, and angiographic analysis. We present a case of ruptured internal carotid artery (ICA) aneurysm that became a complex aneurysm after failure of multi-endovascular and surgery treatment. We describe complete trapping in awake craniotomy after failure of coiling, stenting, and bypassing. ICA aneurysms could become complex aneurysms following multi-treatment failure. Endovascular approaches to treat ICA aneurysms include coiling, stenting, flow diverter stenting, and stenting-assisted coiling technique. The role of surgery remains relevant. To avoid severe neurologic deficits, recurrence, and the need of retreatment, a multidisciplinary discussion with experienced endovascular and vascular neurosurgeons is mandatory in such complex cases. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  10. Acoustic multimode interference and self-imaging phenomena realized in multimodal phononic crystal waveguides

    International Nuclear Information System (INIS)

    Zou, Qiushun; Yu, Tianbao; Liu, Jiangtao; Wang, Tongbiao; Liao, Qinghua; Liu, Nianhua

    2015-01-01

    We report an acoustic multimode interference effect and self-imaging phenomena in an acoustic multimode waveguide system which consists of M parallel phononic crystal waveguides (M-PnCWs). Results show that the self-imaging principle remains applicable for acoustic waveguides just as it does for optical multimode waveguides. To achieve the dispersions and replicas of the input acoustic waves produced along the propagation direction, we performed the finite element method on M-PnCWs, which support M guided modes within the target frequency range. The simulation results show that single images (including direct and mirrored images) and N-fold images (N is an integer) are identified along the propagation direction with asymmetric and symmetric incidence discussed separately. The simulated positions of the replicas agree well with the calculated values that are theoretically decided by self-imaging conditions based on the guided mode propagation analysis. Moreover, the potential applications based on this self-imaging effect for acoustic wavelength de-multiplexing and beam splitting in the acoustic field are also presented. (paper)

  11. Multimodal Aspects of Corporate Social Responsibility Communication

    Directory of Open Access Journals (Sweden)

    Carmen Daniela Maier

    2014-12-01

    Full Text Available This article addresses how the multimodal persuasive strategies of corporate social responsibility communication can highlight a company’s commitment to gender empowerment and environmental protection while advertising simultaneously its products. Drawing on an interdisciplinary methodological framework related to CSR communication, multimodal discourse analysis and gender theory, the article proposes a multimodal analysis model through which it is possible to map and explain the multimodal persuasive strategies employed by Coca-Cola company in their community-related films. By examining the semiotic modes’ interconnectivity and functional differentiation, this analytical endeavour expands the existing research work as the usual textual focus is extended to a multimodal one.

  12. The Multimodal Possibilities of Online Instructions

    DEFF Research Database (Denmark)

    Kampf, Constance

    2006-01-01

    The WWW simplifies the process of delivering online instructions through multimodal channels because of the ease of use for voice, video, pictures, and text modes of communication built into it.  Given that instructions are being produced in multimodal format for the WWW, how do multi-modal analy......The WWW simplifies the process of delivering online instructions through multimodal channels because of the ease of use for voice, video, pictures, and text modes of communication built into it.  Given that instructions are being produced in multimodal format for the WWW, how do multi...

  13. Cost-effectiveness of carbon ion radiation therapy for locally recurrent rectal cancer

    International Nuclear Information System (INIS)

    Mobaraki, A.; Ohno, Tatsuya; Sakurai, Hideyuki; Nakano, Takashi; Yamada Shigeru

    2010-01-01

    The aim of this study was to evaluate the cost-effectiveness of carbon ion radiotherapy compared with conventional multimodality therapy in the treatment of patients with locally recurrent rectal cancer. Direct costs for diagnosis, recurrent treatment, follow-up, visits, supportive therapy, complications, and admission were computed for each individual using a sample of 25 patients presenting with local recurrent rectal cancer at the National Institute of Radiological Science (NIRS) and Gunma University Hospital (GUH). Patients received only radical surgery for primary rectal adenocarcinoma and had isolated unresectable pelvic recurrence. Fourteen and 11 patients receiving treatment for the local recurrence between 2003 and 2005 were followed retrospectively at NIRS and GUH, respectively. Treatment was carried out with carbon ion radiotherapy (CIRT) alone at NIRS, while multimodality therapy including three-dimensional conformal radiotherapy, chemotherapy, and hyperthermia was performed at GUH. The 2-year overall survival rate was 85% and 55% for CIRT and multimodality treatment, respectively. The mean cost was 4803946 yen for the CIRT group and 4611100 yen for the multimodality treatment group. The incremental cost-effectiveness ratio for CIRT was 6428 yen per 1% increase in survival. The median duration of total hospitalization was 37 days for CIRT and 66 days for the multimodality treatment group. In conclusion, by calculating all direct costs, CIRT was found to be a potential cost effective treatment modality as compared to multimodality treatment for locally recurrent rectal cancer. (author)

  14. Assessment of sexual difficulties associated with multi-modal treatment for cervical or endometrial cancer: A systematic review of measurement instruments.

    Science.gov (United States)

    White, Isabella D; Sangha, Amrit; Lucas, Grace; Wiseman, Theresa

    2016-12-01

    Practitioners and researchers require an outcome measure that accurately identifies the range of common treatment-induced changes in sexual function and well-being experienced by women after cervical or endometrial cancer. This systematic review critically appraised the measurement properties and clinical utility of instruments validated for the measurement of female sexual dysfunction (FSD) in this clinical population. A bibliographic database search for questionnaire development or validation papers was completed and methodological quality and measurement properties of selected studies rated using the Consensus-based Standards for the selection of health Measurement Instrument (COSMIN) checklist. 738 articles were screened, 13 articles retrieved for full text assessment and 7 studies excluded, resulting in evaluation of 6 papers; 2 QoL and 4 female sexual morbidity measures. Five of the six instruments omitted one or more dimension of female sexual function and only one instrument explicitly measured distress associated with sexual changes as per DSM V (APA 2013) diagnostic criteria. None of the papers reported measurement error, responsiveness data was available for only two instruments, three papers failed to report on criterion validity, and test-retest reliability reporting was inconsistent. Heterosexual penile-vaginal intercourse remains the dominant sexual activity focus for sexual morbidity PROMS terminology and instruments lack explicit reference to solo or non-coital sexual expression or validation in a non-heterosexual sample. Four out of six instruments included mediating treatment or illness items such as vaginal changes, menopause or altered body image. Findings suggest that the Female Sexual Function Index (FSFI) remains the most robust sexual morbidity outcome measure, for research or clinical use, in sexually active women treated for cervical or endometrial cancer. Development of an instrument that measures sexual dysfunction in women who are

  15. [Multimodal medical image registration using cubic spline interpolation method].

    Science.gov (United States)

    He, Yuanlie; Tian, Lianfang; Chen, Ping; Wang, Lifei; Ye, Guangchun; Mao, Zongyuan

    2007-12-01

    Based on the characteristic of the PET-CT multimodal image series, a novel image registration and fusion method is proposed, in which the cubic spline interpolation method is applied to realize the interpolation of PET-CT image series, then registration is carried out by using mutual information algorithm and finally the improved principal component analysis method is used for the fusion of PET-CT multimodal images to enhance the visual effect of PET image, thus satisfied registration and fusion results are obtained. The cubic spline interpolation method is used for reconstruction to restore the missed information between image slices, which can compensate for the shortage of previous registration methods, improve the accuracy of the registration, and make the fused multimodal images more similar to the real image. Finally, the cubic spline interpolation method has been successfully applied in developing 3D-CRT (3D Conformal Radiation Therapy) system.

  16. Content-based TV sports video retrieval using multimodal analysis

    Science.gov (United States)

    Yu, Yiqing; Liu, Huayong; Wang, Hongbin; Zhou, Dongru

    2003-09-01

    In this paper, we propose content-based video retrieval, which is a kind of retrieval by its semantical contents. Because video data is composed of multimodal information streams such as video, auditory and textual streams, we describe a strategy of using multimodal analysis for automatic parsing sports video. The paper first defines the basic structure of sports video database system, and then introduces a new approach that integrates visual stream analysis, speech recognition, speech signal processing and text extraction to realize video retrieval. The experimental results for TV sports video of football games indicate that the multimodal analysis is effective for video retrieval by quickly browsing tree-like video clips or inputting keywords within predefined domain.

  17. Multimode model for projective photon-counting measurements

    International Nuclear Information System (INIS)

    Tualle-Brouri, Rosa; Ourjoumtsev, Alexei; Dantan, Aurelien; Grangier, Philippe; Wubs, Martijn; Soerensen, Anders S.

    2009-01-01

    We present a general model to account for the multimode nature of the quantum electromagnetic field in projective photon-counting measurements. We focus on photon-subtraction experiments, where non-Gaussian states are produced conditionally. These are useful states for continuous-variable quantum-information processing. We present a general method called mode reduction that reduces the multimode model to an effective two-mode problem. We apply this method to a multimode model describing broadband parametric down-conversion, thereby improving the analysis of existing experimental results. The main improvement is that spatial and frequency filters before the photon detector are taken into account explicitly. We find excellent agreement with previously published experimental results, using fewer free parameters than before, and discuss the implications of our analysis for the optimized production of states with negative Wigner functions.

  18. Advances in surface treatments: Technology, applications, effects

    International Nuclear Information System (INIS)

    Niku-Lari, A.

    1987-01-01

    An international handbook has been produced to include all aspects of residual stresses, including the theoretical background, effects of residual stresses, measurement and calculation and quantitative assessment of residual stress effects. Techniques for altering residual stresses, particularly surface treatments, are discussed. Up to date information on the state of the art is presented. (UK)

  19. [Effectiveness of education based on neuroscience in the treatment of musculoskeletal chronic pain].

    Science.gov (United States)

    Cuenda-Gago, J D; Espejo-Antunez, L

    2017-07-01

    Chronic pain is one of the most frequent health, economic and social problems. Given this, numerous approaches have been described, one of which is pain neuroscience education. To examine the effectiveness of pain neuroscience education in the treatment of musculoskeletal disorders with chronic pain and to explore the impact of specific aspects of the technique on its effectiveness. Relevant studies published between 2000 and 2015 were identified by searching PubMed, Scopus and Web of Science. Studies identified by electronic searches were screened against a set of pre-defined inclusion criteria. PEDro and SIGN scales were used to evaluate the methodological quality of the included studies. Ten studies were included in this systematic review. The main outcomes that were measured were pain, disability, neurophysiology pain test, attitudes and beliefs, fear-avoidance beliefs, self-care, kinesiophobia, quality of life and algometry. The results suggest that pain neuroscience education is effective in the short term and medium/long term for pain relief, either alone or combined with multimodal treatment. It was also effective in normalizing cognitions about pain, fear-avoidance beliefs, and self-care. Despite some evidence for a positive effect in the short and medium/long term, the heterogeneity in the technical aspects used does not allow the obtaining of conclusive results.

  20. A Learning Algorithm for Multimodal Grammar Inference.

    Science.gov (United States)

    D'Ulizia, A; Ferri, F; Grifoni, P

    2011-12-01

    The high costs of development and maintenance of multimodal grammars in integrating and understanding input in multimodal interfaces lead to the investigation of novel algorithmic solutions in automating grammar generation and in updating processes. Many algorithms for context-free grammar inference have been developed in the natural language processing literature. An extension of these algorithms toward the inference of multimodal grammars is necessary for multimodal input processing. In this paper, we propose a novel grammar inference mechanism that allows us to learn a multimodal grammar from its positive samples of multimodal sentences. The algorithm first generates the multimodal grammar that is able to parse the positive samples of sentences and, afterward, makes use of two learning operators and the minimum description length metrics in improving the grammar description and in avoiding the over-generalization problem. The experimental results highlight the acceptable performances of the algorithm proposed in this paper since it has a very high probability of parsing valid sentences.

  1. Multimodal network design and assessment

    NARCIS (Netherlands)

    Brands, Ties; Alkim, T.P.; van Eck, Gijs; van Arem, Bart; Arentze, T.

    2010-01-01

    A framework is proposed for the design of an optimal multimodal transport network for the Randstad area. This research framework consists of a multi-objective optimization heuristic and a fast network assessment module, which results in a set of Pareto optimal solutions. Subsequently, a proper

  2. Advanced Multimodal Solutions for Information Presentation

    Science.gov (United States)

    Wenzel, Elizabeth M.; Godfroy-Cooper, Martine

    2018-01-01

    High-workload, fast-paced, and degraded sensory environments are the likeliest candidates to benefit from multimodal information presentation. For example, during EVA (Extra-Vehicular Activity) and telerobotic operations, the sensory restrictions associated with a space environment provide a major challenge to maintaining the situation awareness (SA) required for safe operations. Multimodal displays hold promise to enhance situation awareness and task performance by utilizing different sensory modalities and maximizing their effectiveness based on appropriate interaction between modalities. During EVA, the visual and auditory channels are likely to be the most utilized with tasks such as monitoring the visual environment, attending visual and auditory displays, and maintaining multichannel auditory communications. Previous studies have shown that compared to unimodal displays (spatial auditory or 2D visual), bimodal presentation of information can improve operator performance during simulated extravehicular activity on planetary surfaces for tasks as diverse as orientation, localization or docking, particularly when the visual environment is degraded or workload is increased. Tactile displays offer a third sensory channel that may both offload information processing effort and provide a means to capture attention when urgently required. For example, recent studies suggest that including tactile cues may result in increased orientation and alerting accuracy, improved task response time and decreased workload, as well as provide self-orientation cues in microgravity on the ISS (International Space Station). An important overall issue is that context-dependent factors like task complexity, sensory degradation, peripersonal vs. extrapersonal space operations, workload, experience level, and operator fatigue tend to vary greatly in complex real-world environments and it will be difficult to design a multimodal interface that performs well under all conditions. As a

  3. Multimodal brain monitoring in fulminant hepatic failure

    Science.gov (United States)

    Paschoal Jr, Fernando Mendes; Nogueira, Ricardo Carvalho; Ronconi, Karla De Almeida Lins; de Lima Oliveira, Marcelo; Teixeira, Manoel Jacobsen; Bor-Seng-Shu, Edson

    2016-01-01

    Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation. In the past, neuromonitoring was restricted to serial clinical neurologic examination and, in some cases, intracranial pressure monitoring. Over the years, this monitoring has proven insufficient, as brain abnormalities were detected at late and irreversible stages. The need for real-time monitoring of brain functions to favor prompt treatment and avert irreversible brain injuries led to the concepts of multimodal monitoring and neurophysiological decision support. New monitoring techniques, such as brain tissue oxygen tension, continuous electroencephalogram, transcranial Doppler, and cerebral microdialysis, have been developed. These techniques enable early diagnosis of brain hemodynamic, electrical, and biochemical changes, allow brain anatomical and physiological monitoring-guided therapy, and have improved patient survival rates. The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting. PMID:27574545

  4. A randomized phase II feasibility trial of a multimodal intervention for the management of cachexia in lung and pancreatic cancer.

    Science.gov (United States)

    Solheim, Tora S; Laird, Barry J A; Balstad, Trude Rakel; Stene, Guro B; Bye, Asta; Johns, Neil; Pettersen, Caroline H; Fallon, Marie; Fayers, Peter; Fearon, Kenneth; Kaasa, Stein

    2017-10-01

    Cancer cachexia is a syndrome of weight loss (including muscle and fat), anorexia, and decreased physical function. It has been suggested that the optimal treatment for cachexia should be a multimodal intervention. The primary aim of this study was to examine the feasibility and safety of a multimodal intervention (n-3 polyunsaturated fatty acid nutritional supplements, exercise, and anti-inflammatory medication: celecoxib) for cancer cachexia in patients with incurable lung or pancreatic cancer, undergoing chemotherapy. Patients receiving two cycles of standard chemotherapy were randomized to either the multimodal cachexia intervention or standard care. Primary outcome measures were feasibility assessed by recruitment, attrition, and compliance with intervention (>50% of components in >50% of patients). Key secondary outcomes were change in weight, muscle mass, physical activity, safety, and survival. Three hundred and ninety-nine were screened resulting in 46 patients recruited (11.5%). Twenty five patients were randomized to the treatment and 21 as controls. Forty-one completed the study (attrition rate 11%). Compliance to the individual components of the intervention was 76% for celecoxib, 60% for exercise, and 48% for nutritional supplements. As expected from the sample size, there was no statistically significant effect on physical activity or muscle mass. There were no intervention-related Serious Adverse Events and survival was similar between the groups. A multimodal cachexia intervention is feasible and safe in patients with incurable lung or pancreatic cancer; however, compliance to nutritional supplements was suboptimal. A phase III study is now underway to assess fully the effect of the intervention. © 2017 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders.

  5. MULTIMODAL ANALGESIA AFTER TOTAL HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    I. G. Mukutsa

    2012-01-01

    Full Text Available Purpose - to assess the effect of multimodal analgesia in the early rehabilitation of patients after hip replacement. Materials and methods. A prospective single-centre randomized research, which included 32 patients. Patients of the 1st group received paracetamol, ketorolac and tramadol, the 2nd group of patients - ketorolac intravenously and the 3rd group of patients - etoricoxib and gabapentin. Patients of the 2nd and the 3rd groups underwent epidural analgesia with ropivacaine. Multimodal analgesia was carried out for 48 hours after the surgery. Assessment of pain intensity was performed by the VAS (visual analogue scale, a neuropathic pain component - on the DN4 questionnaire . Time was recorded during the first and second verticalization of patients, using the distance walkers and by fixing the distance covered with in 2 minutes. Results. The intensity of pain for more than 50 mm on VAS at movement at least once every 48 hours after the surgery was occurred among 9% of the 1st group, 22% of patients from the 2nd group and 8% of patients of the 3rd group. Number of patients with neuropathic pain component decreased from 25% to 3% (p ≤ 0.05. The first verticalization was performed 10 ± 8 hours after the surgery, the second - 21 ± 8 hours later. Two-minute walk distance was 5 ± 3 and 8 ± 4 m, respectively. It is noted more frequent adverse events in patients of the 1st group was noted compared to patients of the 2nd and the 3rd groups during first (91%, 33% and 25%, p ≤ 0.05 and the second verticalization (70%, 25% and 17%, p ≤ 0.05. Multimodal analgesia allows to proceed with the successful activation of patients after hip replacement with in the first day after the surgery. The 3rd group patients are noted with a tendency for the optimal combination of efficient and safe of analgetic therapy.

  6. Effects of a 6-month multimodal training intervention on retention of functional fitness in older adults: A randomized-controlled cross-over design

    Directory of Open Access Journals (Sweden)

    Gudlaugsson Janus

    2012-09-01

    Full Text Available Abstract Background Older adults have the highest rates of disability, functional dependence and use of healthcare resources. Training interventions for older individuals are of special interest where regular physical activity (PA has many health benefits. The main purpose of this study was to assess the immediate and long-term effects of a 6-month multimodal training intervention (MTI on functional fitness in old adults. Methods For this study, 117 participants, 71 to 90 years old, were randomized in immediate intervention group and a control group (delayed intervention group. The intervention consisted of daily endurance and twice-a-week strength training. The method was based on a randomized-controlled cross-over design. Short Physical Performance Battery (SPPB, 8 foot up-and-go test, strength performance, six min walking test (6 MW, physical activity, BMI and quality of life were obtained at baseline, after a 6-month intervention- and control phase, again after 6-month crossover- and delayed intervention phase, and after anadditional 6-month follow-up. Results After 6 months of MTI, the intervention group improved in physical performance compared with the control group via Short Physical Performance Battery (SPPB score (mean diff = 0.6, 95 % CI: 0.1, 1.0 and 8-foot up-and-go test (mean diff = −1.0 s, 95 % CI: -1.5, -0.6, and in endurance performance via 6-minute walking test (6 MW (mean diff = 44.2 meters, 95 % CI: 17.1, 71.2. In strength performance via knee extension the intervention group improved while control group declined (mean diff = 55.0 Newton, 95 % CI: 28.4, 81.7, and also in PA (mean diff = 125.9 cpm, 95 % CI: 96.0, 155.8. Long-term effects of MTI on the particpants was assesed by estimating the mean difference in the variables measured between time-point 1 and 4: SPPB (1.1 points, 95 % CI: 0.8, 1.4; 8-foot up-and-go (−0.9 s, 95 % CI: -1.2, -0.6; 6 MW (18.7 m, 95 % CI: 6.5, 31.0; knee extension (4.2 Newton

  7. SARS: systematic review of treatment effects.

    Directory of Open Access Journals (Sweden)

    Lauren J Stockman

    2006-09-01

    Full Text Available BACKGROUND: The SARS outbreak of 2002-2003 presented clinicians with a new, life-threatening disease for which they had no experience in treating and no research on the effectiveness of treatment options. The World Health Organization (WHO expert panel on SARS treatment requested a systematic review and comprehensive summary of treatments used for SARS-infected patients in order to guide future treatment and identify priorities for research. METHODS AND FINDINGS: In response to the WHO request we conducted a systematic review of the published literature on ribavirin, corticosteroids, lopinavir and ritonavir (LPV/r, type I interferon (IFN, intravenous immunoglobulin (IVIG, and SARS convalescent plasma from both in vitro studies and in SARS patients. We also searched for clinical trial evidence of treatment for acute respiratory distress syndrome. Sources of data were the literature databases MEDLINE, EMBASE, BIOSIS, and the Cochrane Central Register of Controlled Trials (CENTRAL up to February 2005. Data from publications were extracted and evidence within studies was classified using predefined criteria. In total, 54 SARS treatment studies, 15 in vitro studies, and three acute respiratory distress syndrome studies met our inclusion criteria. Within in vitro studies, ribavirin, lopinavir, and type I IFN showed inhibition of SARS-CoV in tissue culture. In SARS-infected patient reports on ribavirin, 26 studies were classified as inconclusive, and four showed possible harm. Seven studies of convalescent plasma or IVIG, three of IFN type I, and two of LPV/r were inconclusive. In 29 studies of steroid use, 25 were inconclusive and four were classified as causing possible harm. CONCLUSIONS: Despite an extensive literature reporting on SARS treatments, it was not possible to determine whether treatments benefited patients during the SARS outbreak. Some may have been harmful. Clinical trials should be designed to validate a standard protocol for dosage

  8. Estimating scaled treatment effects with multiple outcomes.

    Science.gov (United States)

    Kennedy, Edward H; Kangovi, Shreya; Mitra, Nandita

    2017-01-01

    In classical study designs, the aim is often to learn about the effects of a treatment or intervention on a single outcome; in many modern studies, however, data on multiple outcomes are collected and it is of interest to explore effects on multiple outcomes simultaneously. Such designs can be particularly useful in patient-centered research, where different outcomes might be more or less important to different patients. In this paper, we propose scaled effect measures (via potential outcomes) that translate effects on multiple outcomes to a common scale, using mean-variance and median-interquartile range based standardizations. We present efficient, nonparametric, doubly robust methods for estimating these scaled effects (and weighted average summary measures), and for testing the null hypothesis that treatment affects all outcomes equally. We also discuss methods for exploring how treatment effects depend on covariates (i.e., effect modification). In addition to describing efficiency theory for our estimands and the asymptotic behavior of our estimators, we illustrate the methods in a simulation study and a data analysis. Importantly, and in contrast to much of the literature concerning effects on multiple outcomes, our methods are nonparametric and can be used not only in randomized trials to yield increased efficiency, but also in observational studies with high-dimensional covariates to reduce confounding bias.

  9. Musical hallucinations: review of treatment effects

    Directory of Open Access Journals (Sweden)

    Jan eCoebergh

    2015-06-01

    Full Text Available AbstractBackground: Despite an increased scientific interest in musical hallucinations throughout the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare.Objective: To review the effects of published treatment methods for musical hallucinations.Methods: A literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. We analysed the treatment results in relation to the aetiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion and other pathology, epilepsy or intoxication.Results: Musical hallucinations can disappear without intervention. When hallucinations are bearable, patients can be reassured without any other treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. Distinct aetiological groups appear to respond differently to treatment. In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g. more acoustic stimulation are frequently helpful. Pharmacological treatment methods can also be successful, with antidepressants being more helpful than antiepileptics (which are still better than antipsychotics. The limited use of acetylcholinesterase inhibitors has looked promising. Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. When intoxication is the main aetiological factor, it is important to stop or switch the

  10. Multimodal Imaging Brain Connectivity Analysis (MIBCA toolbox

    Directory of Open Access Journals (Sweden)

    Andre Santos Ribeiro

    2015-07-01

    Full Text Available Aim. In recent years, connectivity studies using neuroimaging data have increased the understanding of the organization of large-scale structural and functional brain networks. However, data analysis is time consuming as rigorous procedures must be assured, from structuring data and pre-processing to modality specific data procedures. Until now, no single toolbox was able to perform such investigations on truly multimodal image data from beginning to end, including the combination of different connectivity analyses. Thus, we have developed the Multimodal Imaging Brain Connectivity Analysis (MIBCA toolbox with the goal of diminishing time waste in data processing and to allow an innovative and comprehensive approach to brain connectivity.Materials and Methods. The MIBCA toolbox is a fully automated all-in-one connectivity toolbox that offers pre-processing, connectivity and graph theoretical analyses of multimodal image data such as diffusion-weighted imaging, functional magnetic resonance imaging (fMRI and positron emission tomography (PET. It was developed in MATLAB environment and pipelines well-known neuroimaging softwares such as Freesurfer, SPM, FSL, and Diffusion Toolkit. It further implements routines for the construction of structural, functional and effective or combined connectivity matrices, as well as, routines for the extraction and calculation of imaging and graph-theory metrics, the latter using also functions from the Brain Connectivity Toolbox. Finally, the toolbox performs group statistical analysis and enables data visualization in the form of matrices, 3D brain graphs and connectograms. In this paper the MIBCA toolbox is presented by illustrating its capabilities using multimodal image data from a group of 35 healthy subjects (19–73 years old with volumetric T1-weighted, diffusion tensor imaging, and resting state fMRI data, and 10 subjets with 18F-Altanserin PET data also.Results. It was observed both a high inter

  11. A Multimodal Neural Network Recruited by Expertise with Musical Notation

    Science.gov (United States)

    Wong, Yetta Kwailing; Gauthier, Isabel

    2010-01-01

    Prior neuroimaging work on visual perceptual expertise has focused on changes in the visual system, ignoring possible effects of acquiring expert visual skills in nonvisual areas. We investigated expertise for reading musical notation, a skill likely to be associated with multimodal abilities. We compared brain activity in music-reading experts…

  12. Multimode-singlemode-multimode fiber sensor for alcohol sensing application

    Science.gov (United States)

    Rofi'ah, Iftihatur; Hatta, A. M.; Sekartedjo, Sekartedjo

    2016-11-01

    Alcohol is volatile and flammable liquid which is soluble substances both on polar and non polar substances that has been used in some industrial sectors. Alcohol detection method now widely used one of them is the optical fiber sensor. In this paper used fiber optic sensor based on Multimode-Single-mode-Multimode (MSM) to detect alcohol solution at a concentration range of 0-3%. The working principle of sensor utilizes the modal interference between the core modes and the cladding modes, thus make the sensor sensitive to environmental changes. The result showed that characteristic of the sensor not affect the length of the single-mode fiber (SMF). We obtain that the sensor with a length of 5 mm of single-mode can sensing the alcohol with a sensitivity of 0.107 dB/v%.

  13. Neurocognitive Effects of Treatment for Childhood Cancer

    Science.gov (United States)

    Butler, Robert W.; Haser, Jennifer K.

    2006-01-01

    We review research on the neuropsychological effects that central nervous system (CNS) cancer treatments have on the cognitive abilities of children and adolescents. The authors focus on the two most common malignancies of childhood: leukemias and brain tumors. The literature review is structured so as to separate out earlier studies, generally…

  14. Evaluating the Effectiveness Of Postfire Rehabilitation Treatments

    Science.gov (United States)

    Peter R. Robichaud; Jan L. Beyers; Daniel G. Neary

    2000-01-01

    Spending on postfire emergency watershed rehabilitation has increased during the past decade. A west-wide evaluation of USDA Forest Service burned area emergency rehabilitation (BAER) treatment effectiveness was undertaken as a joint project by USDA Forest Service Research and National Forest System staffs. This evaluation covers 470 fires and 321 BAER projects, from...

  15. Residential Treatment for Sexually Abusive Youth: An Assessment of Treatment Outcomes

    Science.gov (United States)

    Jones, Christopher D.; Chancey, Roy; Lowe, Laura A.; Risler, Edwin A.

    2010-01-01

    Objective: This research study assesses the effectiveness of participation in a multimodal/holistic residential treatment program on changing deviant sexual interests and functional impairment among sexually abusive youth. Method: A one-group pretest posttest design was utilized to examine pretest (intake) and posttest (discharge) scores for 58…

  16. Side effects of endobronchial laser treatment

    Energy Technology Data Exchange (ETDEWEB)

    Dierkesmann, R.; Huzly, A.

    1985-03-01

    Side effects that have occurred in over 250 endobronchial laser treatments are reported. The laser has been used in severe tracheal and in bronchial obstructions. In two cases significant bleeding had to be treated with tamponade. In one patient an emphysema of the mediastinum developed, in 2 further patients a small pneumothorax. Perforation of the airway was not detected and no special treatment was necessary. Three patients with life-threatening tracheal stenoses and one patient with severe stenosis of both the mainstem bronchi due to metastasis in the bifurcation lymph node had a large defect in the tracheal or bronchial wall with a deep necrosis five to twelve weeks after laser treatment; all these patients had extensive radiotherapy in addition. One patient died due to severe respiratory insufficiency, probably caused by smoke intoxication. After the laser treatment, rubber-like fibrin-rich plaques may develop, which can lead to life-threatening obstructions of the airway. It is recommended that laser bronchoscopy should be performed with the rigid bronchoscope. After treatment of tracheal lesion an endoscopic check must be performed within 24 hours. The combination of laser treatment and radiotherapy seems to involve a certain risk of large defects in the bronchial wall due to necrosis of the tumor.

  17. Hearing and Seeing Tone through Color: An Efficacy Study of Web-Based, Multimodal Chinese Tone Perception Training

    Science.gov (United States)

    Godfroid, Aline; Lin, Chin-Hsi; Ryu, Catherine

    2017-01-01

    Multimodal approaches have been shown to be effective for many learning tasks. In this study, we compared the effectiveness of five multimodal methods for second language (L2) Mandarin tone perception training: three single-cue methods (number, pitch contour, color) and two dual-cue methods (color and number, color and pitch contour). A total of…

  18. A community intervention trial of multimodal suicide prevention program in Japan: A Novel multimodal Community Intervention program to prevent suicide and suicide attempt in Japan, NOCOMIT-J

    OpenAIRE

    Ono, Yutaka; Awata, Shuichi; Iida, Hideharu; Ishida, Yasushi; Ishizuka, Naoki; Iwasa, Hiroto; Kamei, Yuichi; Motohashi, Yutaka; Nakagawa, Atsuo; Nakamura, Jun; Nishi, Nobuyuki; Otsuka, Kotaro; Oyama, Hirofumi; Sakai, Akio; Sakai, Hironori

    2008-01-01

    Abstract Background To respond to the rapid surge in the incidence of suicide in Japan, which appears to be an ongoing trend, the Japanese Multimodal Intervention Trials for Suicide Prevention (J-MISP) have launched a multimodal community-based suicide prevention program, NOCOMIT-J. The primary aim of this study is to examine whether NOCOMIT-J is effective in reducing suicidal behavior in the community. Methods/DesignThis study is a community intervention trial involving seven intervention re...

  19. Robustness of multimodal processes itineraries

    DEFF Research Database (Denmark)

    Bocewicz, G.; Banaszak, Z.; Nielsen, Izabela Ewa

    2013-01-01

    itineraries for assumed (O-D) trip. Since itinerary planning problem, constitutes a common routing and scheduling decision faced by travelers, hence the main question regards of itinerary replanning and particularly a method aimed at prototyping of mode sequences and paths selections. The declarative model......This paper concerns multimodal transport systems (MTS) represented by a supernetworks in which several unimodal networks are connected by transfer links and focuses on the scheduling problems encountered in these systems. Assuming unimodal networks are modeled as cyclic lines, i.e. the routes...... of multimodal processes driven itinerary planning problem is our main contribution. Illustrative examples providing alternative itineraries in some cases of MTS malfunction are presented....

  20. Fiber Optic Pressure Sensor using Multimode Interference

    International Nuclear Information System (INIS)

    Ruiz-Perez, V I; Sanchez-Mondragon, J J; Basurto-Pensado, M A; LiKamWa, P; May-Arrioja, D A

    2011-01-01

    Based on the theory of multimode interference (MMI) and self-image formation, we developed a novel intrinsic optical fiber pressure sensor. The sensing element consists of a section of multimode fiber (MMF) without cladding spliced between two single mode fibers (SMF). The MMI pressure sensor is based on the intensity changes that occur in the transmitted light when the effective refractive index of the MMF is changed. Basically, a thick layer of Polydimethylsiloxane (PDMS) is placed in direct contact with the MMF section, such that the contact area between the PDMS and the fiber will change proportionally with the applied pressure, which results in a variation of the transmitted light intensity. Using this configuration, a good correlation between the measured intensity variations and the applied pressure is obtained. The sensitivity of the sensor is 3 μV/psi, for a range of 0-60 psi, and the maximum resolution of our system is 0.25 psi. Good repeatability is also observed with a standard deviation of 0.0019. The key feature of the proposed pressure sensor is its low fabrication cost, since the cost of the MMF is minimal.

  1. Fiber Optic Pressure Sensor using Multimode Interference

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz-Perez, V I; Sanchez-Mondragon, J J [INAOE, Apartado Postal 51 y 216, Puebla 72000 (Mexico); Basurto-Pensado, M A [CIICAp, Universidad Autonoma del Estado de Morelos (Mexico); LiKamWa, P [CREOL, University of Central Florida, Orlando, FL 32816 (United States); May-Arrioja, D A, E-mail: iruiz@inaoep.mx, E-mail: mbasurto@uaem.mx, E-mail: delta_dirac@hotmail.com, E-mail: daniel_may_arrioja@hotmail.com [UAT Reynosa Rodhe, Universidad Autonoma de Tamaulipas (Mexico)

    2011-01-01

    Based on the theory of multimode interference (MMI) and self-image formation, we developed a novel intrinsic optical fiber pressure sensor. The sensing element consists of a section of multimode fiber (MMF) without cladding spliced between two single mode fibers (SMF). The MMI pressure sensor is based on the intensity changes that occur in the transmitted light when the effective refractive index of the MMF is changed. Basically, a thick layer of Polydimethylsiloxane (PDMS) is placed in direct contact with the MMF section, such that the contact area between the PDMS and the fiber will change proportionally with the applied pressure, which results in a variation of the transmitted light intensity. Using this configuration, a good correlation between the measured intensity variations and the applied pressure is obtained. The sensitivity of the sensor is 3 {mu}V/psi, for a range of 0-60 psi, and the maximum resolution of our system is 0.25 psi. Good repeatability is also observed with a standard deviation of 0.0019. The key feature of the proposed pressure sensor is its low fabrication cost, since the cost of the MMF is minimal.

  2. Quantitative multi-modal NDT data analysis

    International Nuclear Information System (INIS)

    Heideklang, René; Shokouhi, Parisa

    2014-01-01

    A single NDT technique is often not adequate to provide assessments about the integrity of test objects with the required coverage or accuracy. In such situations, it is often resorted to multi-modal testing, where complementary and overlapping information from different NDT techniques are combined for a more comprehensive evaluation. Multi-modal material and defect characterization is an interesting task which involves several diverse fields of research, including signal and image processing, statistics and data mining. The fusion of different modalities may improve quantitative nondestructive evaluation by effectively exploiting the augmented set of multi-sensor information about the material. It is the redundant information in particular, whose quantification is expected to lead to increased reliability and robustness of the inspection results. There are different systematic approaches to data fusion, each with its specific advantages and drawbacks. In our contribution, these will be discussed in the context of nondestructive materials testing. A practical study adopting a high-level scheme for the fusion of Eddy Current, GMR and Thermography measurements on a reference metallic specimen with built-in grooves will be presented. Results show that fusion is able to outperform the best single sensor regarding detection specificity, while retaining the same level of sensitivity

  3. Inorganic Nanoparticles for Multimodal Molecular Imaging

    Directory of Open Access Journals (Sweden)

    Magdalena Swierczewska

    2011-01-01

    Full Text Available Multimodal molecular imaging can offer a synergistic improvement of diagnostic ability over a single imaging modality. Recent development of hybrid imaging systems has profoundly impacted the pool of available multimodal imaging probes. In particular, much interest has been focused on biocompatible, inorganic nanoparticle-based multimodal probes. Inorganic nanoparticles offer exceptional advantages to the field of multimodal imaging owing to their unique characteristics, such as nanometer dimensions, tunable imaging properties, and multifunctionality. Nanoparticles mainly based on iron oxide, quantum dots, gold, and silica have been applied to various imaging modalities to characterize and image specific biologic processes on a molecular level. A combination of nanoparticles and other materials such as biomolecules, polymers, and radiometals continue to increase functionality for in vivo multimodal imaging and therapeutic agents. In this review, we discuss the unique concepts, characteristics, and applications of the various multimodal imaging probes based on inorganic nanoparticles.

  4. Nimh Treatment Study of ADHD Follow-Up

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2004-04-01

    Full Text Available The effects of changes in medication use between 14 and 24 months follow-up on effectiveness (symptom ratings and growth (height and weight measures were analyzed, comparing 4 groups of patients, in the Multimodal Treatment Study of ADHD (MTA reported by the MTA Cooperative Group.

  5. Coherent multimoded dielectric wakefield accelerators

    International Nuclear Information System (INIS)

    Power, J.

    1998-01-01

    There has recently been a study of the potential uses of multimode dielectric structures for wakefield acceleration [1]. This technique is based on adjusting the wakefield modes of the structure to constructively interfere at certain delays with respect to the drive bunch, thus providing an accelerating gradient enhancement over single mode devices. In this report we examine and attempt to clarify the issues raised by this work in the light of the present state of the art in wakefield acceleration

  6. Evaluation of multimodal ground cues

    DEFF Research Database (Denmark)

    Nordahl, Rolf; Lecuyer, Anatole; Serafin, Stefania

    2012-01-01

    This chapter presents an array of results on the perception of ground surfaces via multiple sensory modalities,with special attention to non visual perceptual cues, notably those arising from audition and haptics, as well as interactions between them. It also reviews approaches to combining...... synthetic multimodal cues, from vision, haptics, and audition, in order to realize virtual experiences of walking on simulated ground surfaces or other features....

  7. Randomized Controlled Trial: Multimodal Anxiety and Social Skill Intervention for Adolescents with Autism Spectrum Disorder

    Science.gov (United States)

    White, Susan W.; Ollendick, Thomas; Albano, Anne Marie; Oswald, Donald; Johnson, Cynthia; Southam-Gerow, Michael A.; Kim, Inyoung; Scahill, Lawrence

    2012-01-01

    Anxiety is common among adolescents with autism spectrum disorders (ASD) and may amplify the core social disability, thus necessitating combined treatment approaches. This pilot, randomized controlled trial (RCT) evaluated the feasibility and preliminary outcomes of the Multimodal Anxiety and Social Skills Intervention (MASSI) program in a sample of 30 adolescents with ASD and anxiety symptoms of moderate or greater severity. The treatment was acceptable to families, subject adherence was high, and therapist fidelity was high. A 16% improvement in ASD social impairment (within-group effect size = 1.18) was observed on a parent-reported scale. Although anxiety symptoms declined by 26%, the change was not statistically significant. These findings suggest MASSI is a feasible treatment program and further evaluation is warranted. PMID:22735897

  8. Toxic Stress: Effects, Prevention and Treatment

    Directory of Open Access Journals (Sweden)

    Hillary A. Franke

    2014-11-01

    Full Text Available Children who experience early life toxic stress are at risk of long-term adverse health effects that may not manifest until adulthood. This article briefly summarizes the findings in recent studies on toxic stress and childhood adversity following the publication of the American Academy of Pediatrics (AAP Policy Report on the effects of toxic stress. A review of toxic stress and its effects is described, including factors of vulnerability, resilience, and the relaxation response. An integrative approach to the prevention and treatment of toxic stress necessitates individual, community and national focus.

  9. Diffusion Maps for Multimodal Registration

    Directory of Open Access Journals (Sweden)

    Gemma Piella

    2014-06-01

    Full Text Available Multimodal image registration is a difficult task, due to the significant intensity variations between the images. A common approach is to use sophisticated similarity measures, such as mutual information, that are robust to those intensity variations. However, these similarity measures are computationally expensive and, moreover, often fail to capture the geometry and the associated dynamics linked with the images. Another approach is the transformation of the images into a common space where modalities can be directly compared. Within this approach, we propose to register multimodal images by using diffusion maps to describe the geometric and spectral properties of the data. Through diffusion maps, the multimodal data is transformed into a new set of canonical coordinates that reflect its geometry uniformly across modalities, so that meaningful correspondences can be established between them. Images in this new representation can then be registered using a simple Euclidean distance as a similarity measure. Registration accuracy was evaluated on both real and simulated brain images with known ground-truth for both rigid and non-rigid registration. Results showed that the proposed approach achieved higher accuracy than the conventional approach using mutual information.

  10. Multimodal Estimation of Distribution Algorithms.

    Science.gov (United States)

    Yang, Qiang; Chen, Wei-Neng; Li, Yun; Chen, C L Philip; Xu, Xiang-Min; Zhang, Jun

    2016-02-15

    Taking the advantage of estimation of distribution algorithms (EDAs) in preserving high diversity, this paper proposes a multimodal EDA. Integrated with clustering strategies for crowding and speciation, two versions of this algorithm are developed, which operate at the niche level. Then these two algorithms are equipped with three distinctive techniques: 1) a dynamic cluster sizing strategy; 2) an alternative utilization of Gaussian and Cauchy distributions to generate offspring; and 3) an adaptive local search. The dynamic cluster sizing affords a potential balance between exploration and exploitation and reduces the sensitivity to the cluster size in the niching methods. Taking advantages of Gaussian and Cauchy distributions, we generate the offspring at the niche level through alternatively using these two distributions. Such utilization can also potentially offer a balance between exploration and exploitation. Further, solution accuracy is enhanced through a new local search scheme probabilistically conducted around seeds of niches with probabilities determined self-adaptively according to fitness values of these seeds. Extensive experiments conducted on 20 benchmark multimodal problems confirm that both algorithms can achieve competitive performance compared with several state-of-the-art multimodal algorithms, which is supported by nonparametric tests. Especially, the proposed algorithms are very promising for complex problems with many local optima.

  11. Multimodal Diversity of Postmodernist Fiction Text

    Directory of Open Access Journals (Sweden)

    U. I. Tykha

    2016-12-01

    Full Text Available The article is devoted to the analysis of structural and functional manifestations of multimodal diversity in postmodernist fiction texts. Multimodality is defined as the coexistence of more than one semiotic mode within a certain context. Multimodal texts feature a diversity of semiotic modes in the communication and development of their narrative. Such experimental texts subvert conventional patterns by introducing various semiotic resources – verbal or non-verbal.

  12. Multimodal exemplification: The expansion of meaning in electronic ...

    African Journals Online (AJOL)

    Functional Multimodal Discourse Analysis (SF-MDA) and argues for improving their exemplifica-tion multimodally. Multimodal devices, if well coordinated, can help optimize e-dictionary exam-ples in informativity, diversity, dynamicity and ...

  13. User habits and multimodal route planning

    Directory of Open Access Journals (Sweden)

    Géza Katona

    2017-10-01

    Full Text Available The results of route planning researches are monitored by logistic and automotive industries. The economic aspects of the cost saving are in the focus of the attention. An optimal route could cause time or fuel savings. An effective driving or an optimal route is a good basis to achieve an economical aim. Moreover the spread of new automotive solutions especially in case of electric cars the optimisation has particular significance regarding the limited battery storage. Additionally the autonomous car development could not be neglected. As a result the society could expect safer roads, better space usage and effective resource management. Nevertheless the requirements of users are extremely diverse, which is not negligible. Supporting these aims, in this paper the connection between the multimodal route planning and the user requirements are investigated. The examination is focused to a sensitivity analysis and a survey to evaluate the data and support the settings of a user habit effect to the final route.

  14. Tunable Q-switched erbium doped fiber laser based on metal transition oxide saturable absorber and refractive index characteristic of multimode interference effects

    Science.gov (United States)

    Mohammed, D. Z.; Khaleel, Wurood Abdulkhaleq; Al-Janabi, A. H.

    2017-12-01

    Ferro-oxide (Fe3O4) nanoparticles were used as a saturable absorber (SA) for a passively Q-switched erbium doped fiber laser (EDFL) with ring cavity. The Q-switching operation was achieved at a pump threshold of 80 mW. The proposed fiber laser produces stable pulses train of repetition rate ranging from 25 kHz to 80 kHz as the pump power increases from threshold to 342 mW. The minimum recorded pulse width was 2.7 μs at 342 mW. The C-band tunability operation was performed using single mode-multimode-single mode fiber (SM-MM-SM) structure. The laser exhibited a total tuning range of 7 nm, maximum sensitivity of 106.9 nm, optical signal to noise ratio (OSNR) of 38 dB and 3-dB linewidth of 0.06 nm.

  15. Cognitive-behavioral therapy for externalizing disorders: A meta-analysis of treatment effectiveness.

    Science.gov (United States)

    Battagliese, Gemma; Caccetta, Maria; Luppino, Olga Ines; Baglioni, Chiara; Cardi, Valentina; Mancini, Francesco; Buonanno, Carlo

    2015-12-01

    Externalizing disorders are the most common and persistent forms of maladjustment in childhood. The aim of this study was to conduct a meta-analysis evaluating the effectiveness of Cognitive Behavioral Therapy (CBT) to reduce externalizing symptoms in two disorders: Attention Deficit Hyperactivity Disorder (ADHD) and Oppositive Defiant Disorder (ODD). The efficacy of CBT to improve social competence and positive parenting and reduce internalizing behaviors, parent stress and maternal depression was also explored. The database PsycInfo, PsycARTICLES, Medline and PubMed were searched to identify relevant studies. Twenty-one trials met the inclusion criteria. Results showed that the biggest improvement, after CBT, was in ODD symptoms (-0.879) followed by parental stress (-0.607), externalizing symptoms (-0.52), parenting skills (-0.381), social competence (-0.390) and ADHD symptoms (-0.343). CBT was also associated with improved attention (-0.378), aggressive behaviors (-0.284), internalizing symptoms (-0.272) and maternal depressive symptoms (-0.231). Overall, CBT is an effective treatment option for externalizing disorders and is also associated with reduced parental distress and maternal depressive symptoms. Multimodal treatments targeting both children and caregivers' symptoms (e.g. maternal depressive symptoms) appear important to produce sustained and generalized benefits. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Connecting multimodality in human communication.

    Science.gov (United States)

    Regenbogen, Christina; Habel, Ute; Kellermann, Thilo

    2013-01-01

    A successful reciprocal evaluation of social signals serves as a prerequisite for social coherence and empathy. In a previous fMRI study we studied naturalistic communication situations by presenting video clips to our participants and recording their behavioral responses regarding empathy and its components. In two conditions, all three channels transported congruent emotional or neutral information, respectively. Three conditions selectively presented two emotional channels and one neutral channel and were thus bimodally emotional. We reported channel-specific emotional contributions in modality-related areas, elicited by dynamic video clips with varying combinations of emotionality in facial expressions, prosody, and speech content. However, to better understand the underlying mechanisms accompanying a naturalistically displayed human social interaction in some key regions that presumably serve as specific processing hubs for facial expressions, prosody, and speech content, we pursued a reanalysis of the data. Here, we focused on two different descriptions of temporal characteristics within these three modality-related regions [right fusiform gyrus (FFG), left auditory cortex (AC), left angular gyrus (AG) and left dorsomedial prefrontal cortex (dmPFC)]. By means of a finite impulse response (FIR) analysis within each of the three regions we examined the post-stimulus time-courses as a description of the temporal characteristics of the BOLD response during the video clips. Second, effective connectivity between these areas and the left dmPFC was analyzed using dynamic causal modeling (DCM) in order to describe condition-related modulatory influences on the coupling between these regions. The FIR analysis showed initially diminished activation in bimodally emotional conditions but stronger activation than that observed in neutral videos toward the end of the stimuli, possibly by bottom-up processes in order to compensate for a lack of emotional information. The

  17. Multi-Modality Registration And Fusion Of Medical Image Data

    International Nuclear Information System (INIS)

    Kassak, P.; Vencko, D.; Cerovsky, I.

    2008-01-01

    Digitalisation of health care providing facilities allows US to maximize the usage of digital data from one patient obtained by various modalities. Complex view on to the problem can be achieved from the site of morphology as well as functionality. Multi-modal registration and fusion of medical image data is one of the examples that provides improved insight and allows more precise approach and treatment. (author)

  18. Effective treatment strategies against Ebola virus

    Directory of Open Access Journals (Sweden)

    Amina Yaqoob

    2015-08-01

    Full Text Available Ebola virus (EBOV, a member of order Mononegavirales is most famous for causing the endemics of hemorrhagic fever in different countries of the world. Various effective treatment for EBOV are available presently but different clinical trials and experimental studies on animal models are ongoing for this purpose. Results from different studies showed that selective vaccines and therapeutic drugs have potential to interfere the viral life events within host cell in order to inhibit its replication. Various pre-clinical trials in this regard are proved successful on non-human primates (NHPs and found to be significant in inhibiting EBOV infections. It is the need of hour to develop effective vaccines against Ebola virus to combat this problem as soon as possible. The present article is a brief review on potential treatment strategies against Ebola virus.

  19. Experimental evaluation of user performance in a pursuit tracking task with multimodal feedback

    Directory of Open Access Journals (Sweden)

    Obrenović Željko

    2004-01-01

    Full Text Available In this paper we describe the results of experimental evaluation of user performance in a pursuit-tracking task with multimodal feedback. Our experimental results indicate that audio can significantly improve the accuracy of pursuit tracking. Experiments with 19 participants have shown that addition of acoustic modalities reduces the error during pursuit tracking for up to 19%. Moreover, experiments indicated the existence of perceptual boundaries of multimodal HCI for different scene complexity and target speeds. We have also shown that the most appealing paradigms are not the most effective ones, which necessitates a careful quantitative analysis of proposed multimodal HCI paradigms.

  20. Multimodal Feature Learning for Video Captioning

    Directory of Open Access Journals (Sweden)

    Sujin Lee

    2018-01-01

    Full Text Available Video captioning refers to the task of generating a natural language sentence that explains the content of the input video clips. This study proposes a deep neural network model for effective video captioning. Apart from visual features, the proposed model learns additionally semantic features that describe the video content effectively. In our model, visual features of the input video are extracted using convolutional neural networks such as C3D and ResNet, while semantic features are obtained using recurrent neural networks such as LSTM. In addition, our model includes an attention-based caption generation network to generate the correct natural language captions based on the multimodal video feature sequences. Various experiments, conducted with the two large benchmark datasets, Microsoft Video Description (MSVD and Microsoft Research Video-to-Text (MSR-VTT, demonstrate the performance of the proposed model.

  1. Psoriasis: characteristics, psychosocial effects and treatment options.

    LENUS (Irish Health Repository)

    Ryan, Sheila

    2012-02-01

    Psoriasis is a complex chronic non-infectious inflammatory skin disease with a variety of different presentations. The classic presentation is of well-defined red plaques with silver scale. The characteristic scale makes the disorder highly visible and intrusive on the patient\\'s lifestyle. The visible nature of the disease ensures that psoriasis has both physical and psychosocial effects. In normal skin, epidermal cell reproduction and proliferation takes 28 days. In psoriasis this process is considerably accelerated to approximately 4 days, resulting in the deposit of immature cells on the skin. While the exact cause of this process is unknown, certain environmental and genetic factors are known to be triggers. Disease management depends on disease severity, psychosocial effects and the patient\\'s lifestyle. To effectively treat this disease the nurse must be skilled in psoriasis management, and in patient education and motivation. This article reviews the characteristics, aetiology, psychosocial effects and treatment strategies of psoriasis.

  2. The Stability of Multi-modal Traffic Network

    International Nuclear Information System (INIS)

    Han Linghui; Sun Huijun; Zhu Chengjuan; Jia Bin; Wu Jianjun

    2013-01-01

    There is an explicit and implicit assumption in multimodal traffic equilibrium models, that is, if the equilibrium exists, then it will also occur. The assumption is very idealized; in fact, it may be shown that the quite contrary could happen, because in multimodal traffic network, especially in mixed traffic conditions the interaction among traffic modes is asymmetric and the asymmetric interaction may result in the instability of traffic system. In this paper, to study the stability of multimodal traffic system, we respectively present the travel cost function in mixed traffic conditions and in traffic network with dedicated bus lanes. Based on a day-to-day dynamical model, we study the evolution of daily route choice of travelers in multimodal traffic network using 10000 random initial values for different cases. From the results of simulation, it can be concluded that the asymmetric interaction between the cars and buses in mixed traffic conditions can lead the traffic system to instability when traffic demand is larger. We also study the effect of travelers' perception error on the stability of multimodal traffic network. Although the larger perception error can alleviate the effect of interaction between cars and buses and improve the stability of traffic system in mixed traffic conditions, the traffic system also become instable when the traffic demand is larger than a number. For all cases simulated in this study, with the same parameters, traffic system with dedicated bus lane has better stability for traffic demand than that in mixed traffic conditions. We also find that the network with dedicated bus lane has higher portion of travelers by bus than it of mixed traffic network. So it can be concluded that building dedicated bus lane can improve the stability of traffic system and attract more travelers to choose bus reducing the traffic congestion. (general)

  3. Intratumoral Administration of Holmium-166 Acetylacetonate Microspheres : Antitumor Efficacy and Feasibility of Multimodality Imaging in Renal Cancer

    NARCIS (Netherlands)

    Bult, Wouter; Kroeze, Stephanie G. C.; Elschot, Mattijs; Seevinck, Peter R.; Beekman, Freek J.; de Jong, Hugo W. A. M.; Uges, Donald R. A.; Kosterink, Jos G. W.; Luijten, Peter R.; Hennink, Wim E.; Schip, Alfred D. van Het; Bosch, J. L. H. Ruud; Nijsen, J. Frank W.; Jans, Judith J. M.

    2013-01-01

    Purpose: The increasing incidence of small renal tumors in an aging population with comorbidities has stimulated the development of minimally invasive treatments. This study aimed to assess the efficacy and demonstrate feasibility of multimodality imaging of intratumoral administration of

  4. Evaluation of selectivity in homologous multimodal chromatographic systems using in silico designed antibody fragment libraries.

    Science.gov (United States)

    Karkov, Hanne Sophie; Woo, James; Krogh, Berit Olsen; Ahmadian, Haleh; Cramer, Steven M

    2015-12-24

    This study describes the in silico design, surface property analyses, production and chromatographic evaluations of a diverse set of antibody Fab fragment variants. Based on previous findings, we hypothesized that the complementarity-determining regions (CDRs) constitute important binding sites for multimodal chromatographic ligands. Given that antibodies are highly diversified molecules and in particular the CDRs, we set out to examine the generality of this result. For this purpose, four different Fab fragments with different CDRs and/or framework regions of the variable domains were identified and related variants were designed in silico. The four Fab variant libraries were subsequently generated by site-directed mutagenesis and produced by recombinant expression and affinity purification to enable examination of their chromatographic retention behavior. The effects of geometric re-arrangement of the functional moieties on the multimodal resin ligands were also investigated with respect to Fab variant retention profiles by comparing two commercially available multimodal cation-exchange ligands, Capto MMC and Nuvia cPrime, and two novel multimodal ligand prototypes. Interestingly, the chromatographic data demonstrated distinct selectivity trends between the four Fab variant libraries. For three of the Fab libraries, the CDR regions appeared as major binding sites for all multimodal ligands. In contrast, the fourth Fab library displayed a distinctly different chromatographic behavior, where Nuvia cPrime and related multimodal ligand prototypes provided markedly improved selectivity over Capto MMC. Clearly, the results illustrate that the discriminating power of multimodal ligands differs between different Fab fragments. The results are promising indications that multimodal chromatography using the appropriate multimodal ligands can be employed in downstream bioprocessing for challenging selective separation of product related variants. Copyright © 2015 Elsevier B

  5. Changes in brain activity of somatoform disorder patients during emotional empathy after multimodal psychodynamic psychotherapy

    Science.gov (United States)

    de Greck, Moritz; Bölter, Annette F.; Lehmann, Lisa; Ulrich, Cornelia; Stockum, Eva; Enzi, Björn; Hoffmann, Thilo; Tempelmann, Claus; Beutel, Manfred; Frommer, Jörg; Northoff, Georg

    2013-01-01

    Somatoform disorder patients show a variety of emotional disturbances including impaired emotion recognition and increased empathic distress. In a previous paper, our group showed that several brain regions involved in emotional processing, such as the parahippocampal gyrus and other regions, were less activated in pre-treatment somatoform disorder patients (compared to healthy controls) during an empathy task. Since the parahippocampal gyrus is involved in emotional memory, its decreased activation might reflect the repression of emotional memories (which—according to psychoanalytical concepts—plays an important role in somatoform disorder). Psychodynamic psychotherapy aims at increasing the understanding of emotional conflicts as well as uncovering repressed emotions. We were interested, whether brain activity in the parahippocampal gyrus normalized after (inpatient) multimodal psychodynamic psychotherapy. Using fMRI, subjects were scanned while they shared the emotional states of presented facial stimuli expressing anger, disgust, joy, and a neutral expression; distorted stimuli with unrecognizable content served as control condition. 15 somatoform disorder patients were scanned twice, pre and post multimodal psychodynamic psychotherapy; in addition, 15 age-matched healthy control subjects were investigated. Effects of psychotherapy on hemodynamic responses were analyzed implementing two approaches: (1) an a priori region of interest approach and (2) a voxelwise whole brain analysis. Both analyses revealed increased hemodynamic responses in the left and right parahippocampal gyrus (and other regions) after multimodal psychotherapy in the contrast “empathy with anger”—“control.” Our results are in line with psychoanalytical concepts about somatoform disorder. They suggest the parahippocampal gyrus is crucially involved in the neurobiological mechanisms which underly the emotional deficits of somatoform disorder patients. PMID:23966922

  6. Evaluation of treatment effects by ranking

    DEFF Research Database (Denmark)

    Halekoh, U; Kristensen, K

    2008-01-01

    In crop experiments measurements are often made by a judge evaluating the crops' conditions after treatment. In the present paper an analysis is proposed for experiments where plots of crops treated differently are mutually ranked. In the experimental layout the crops are treated on consecutive...... plots usually placed side by side in one or more rows. In the proposed method a judge ranks several neighbouring plots, say three, by ranking them from best to worst. For the next observation the judge moves on by no more than two plots, such that up to two plots will be re-evaluated again...... in a comparison with the new plot(s). Data from studies using this set-up were analysed by a Thurstonian random utility model, which assumed that the judge's rankings were obtained by comparing latent continuous utilities or treatment effects. For the latent utilities a variance component model was considered...

  7. Multimodality therapy for medulloblastoma

    International Nuclear Information System (INIS)

    Thomas, P.R.M.; Duffner, P.K.; Cohen, M.E.; Sinks, L.F.; Tebbi, C.; Freeman, A.I.

    1980-01-01

    Eight patients with recurrent medulloblastoma were treated with a chemotherapy regimen consisting of vincristine, BCNU, dexamethasone and intrathecal and intermediate dose intravenous methotrexate (500 mg/m 2 ). Five also received local low dose radiotherapy (RT). All 8 patients responded to treatment; 6 completely and 2 partially. These latter 2 were in their second and third recurrences. Three remain in remission. The median duration of response was 18.8 months, and median time from start of chemotherapy to death was 32 months using the Kaplan-Meier technique. In addition, 9 other patients with newly diagnosed medulloblastoma were treated with craniospinal radiation and the same adjuvant chemotherapy as above. The first 5 patients also received intraventricular methotrexate and/or intravenous BCNU during radiotherapy. The toxicity in the 5 patients was very severe. There were three toxic deaths, one death from cancer; one patient survives disease-free, but he is demented. With the discontinuance of intraventricular methotrexate and the postponement of myelosuppressive chemotherapy until after the completion of radiotherapy, the regimen has been well tolerated. All 4 patients treated this way remain alive, well, and disease-free at intervals up to 36 months. We conclude that recurrent medulloblastomas are sensitive to multiagent chemotherapy and that prolonged remissions may occur. With primary adjuvant chemotherapy, extreme caution with myelosuppressive drugs must be exercised during the period of craniospinal radiotherapy. We also do not recommend the use of intraventricular methotrexate. When these two criteria were followed, the preliminary results with adjuvant chemotherapy appear encouraging

  8. CNS effects following the treatment of malignancy

    International Nuclear Information System (INIS)

    Rane, N.; Quaghebeur, G.

    2012-01-01

    Corporeal and central nervous system (CNS) axis chemotherapy and radiotherapy have long been used for the effective treatment and prophylaxis of CNS, body malignancies, and leukaemias. However, they are not without their problems. Following the proliferation of magnetic resonance neuroimaging in recent years it has become clear that the spectrum of toxicity that these therapies produce ranges from subclinical white matter changes to overt brain necrosis. The effects are both direct and indirect and via different pathological mechanisms. Chronic and progressive changes can be detected many years after the initial intervention. In addition to leucoencephalopathic changes, grey matter changes are now well described. Changes may be difficult to distinguish from tumour recurrence, though may be reversible and remediable, and are thus very important to differentiate. In this review toxic effects are classified and their imaging appearances discussed, with reference to specific syndromes.

  9. Multimodal Pedagogies for Teacher Education in TESOL

    Science.gov (United States)

    Yi, Youngjoo; Angay-Crowder, Tuba

    2016-01-01

    As a growing number of English language learners (ELLs) engage in digital and multimodal literacy practices in their daily lives, teachers are starting to incorporate multimodal approaches into their instruction. However, anecdotal and empirical evidence shows that teachers often feel unprepared for integrating such practices into their curricula…

  10. Modeling multimodal human-computer interaction

    NARCIS (Netherlands)

    Obrenovic, Z.; Starcevic, D.

    2004-01-01

    Incorporating the well-known Unified Modeling Language into a generic modeling framework makes research on multimodal human-computer interaction accessible to a wide range off software engineers. Multimodal interaction is part of everyday human discourse: We speak, move, gesture, and shift our gaze

  11. Filter. Remix. Make.: Cultivating Adaptability through Multimodality

    Science.gov (United States)

    Dusenberry, Lisa; Hutter, Liz; Robinson, Joy

    2015-01-01

    This article establishes traits of adaptable communicators in the 21st century, explains why adaptability should be a goal of technical communication educators, and shows how multimodal pedagogy supports adaptability. Three examples of scalable, multimodal assignments (infographics, research interviews, and software demonstrations) that evidence…

  12. (Re-)Examination of Multimodal Augmented Reality

    NARCIS (Netherlands)

    Rosa, N.E.; Werkhoven, P.J.; Hürst, W.O.

    2016-01-01

    The majority of augmented reality (AR) research has been concerned with visual perception, however the move towards multimodality is imminent. At the same time, there is no clear vision of what multimodal AR is. The purpose of this position paper is to consider possible ways of examining AR other

  13. Multifuel multimodal network design; Projeto de redes multicombustiveis multimodal

    Energy Technology Data Exchange (ETDEWEB)

    Lage, Carolina; Dias, Gustavo; Bahiense, Laura; Ferreira Filho, Virgilio J.M. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia (COPPE). Programa de Engenharia de Producao

    2008-07-01

    The objective of the Multi commodity Multimodal Network Project is the development of modeling tools and methodologies for the optimal sizing of production networks and multimodal distribution of multiple fuel and its incomes, considering investments and transportation costs. Given the inherently non-linear combinatory nature of the problem, the resolution of real instances by the complete model, in an exact way, becomes computationally intractable. Thus, the strategy for resolution should contain a combination of exacts and heuristics methods, that must be applied to subdivisions of the original problem. This paper deals with one of these subdivisions, tackling the problem of modeling a network of pipelines in order to drain the production of ethanol away from the producing plants. The objective consists in defining the best network topology, minimizing investment and operational costs, and attending the total demand. In order to do that, the network was considered a tree, where the nodes are the center of producing regions and the edges are the pipelines, trough where the ethanol produced by plants must be drained away. The main objective also includes the decision over the optimal diameter of each pipeline and the optimal size of the bombs, in order to minimize the pumping costs. (author)

  14. Metawidgets in the multimodal interface

    Energy Technology Data Exchange (ETDEWEB)

    Blattner, M.M. (Lawrence Livermore National Lab., CA (United States) Anderson (M.D.) Cancer Center, Houston, TX (United States)); Glinert, E.P.; Jorge, J.A.; Ormsby, G.R. (Rensselaer Polytechnic Inst., Troy, NY (United States). Dept. of Computer Science)

    1991-01-01

    We analyze two intertwined and fundamental issues concerning computer-to-human communication in the multimodal interfaces: the interplay between sound and graphics, and the role of object persistence. Our observations lead us to introduce metawidgets as abstract entities capable of manifesting themselves to users as image, as sound, or as various combinations and/or sequences of the two media. We show examples of metawidgets in action, and discuss mechanisms for choosing among alternative media for metawidget instantiation. Finally, we describe a couple of experimental microworlds we have implemented to test out some of our ideas. 17 refs., 7 figs.

  15. Multimodal approach to postoperative recovery

    DEFF Research Database (Denmark)

    Kehlet, Henrik

    2009-01-01

    PURPOSE OF REVIEW: To provide updated information on recent developments within individual components of multimodal interventions to improve postoperative outcome (fast-track methodology). RECENT FINDINGS: The value of the fast-track methodology to improve recovery and decrease hospital stay...... and morbidity has been firmly consolidated, especially in colorectal procedures. An increasing amount of data from other procedures supports the value of the fast-track concept across procedures. Fast-track programs should be based on the analysis of procedure-specific factors that may influence outcome...

  16. Ketamina en analgesia multimodal postcesarea

    OpenAIRE

    Monzón Rubio, Eva María

    2011-01-01

    Mediante la analgesia multimodal influimos en las diferentes vías del dolor a la vez que minimizamos los potenciales efectos adversos de los diferentes fármacos administrados. En el caso del dolor postcesárea esto adquiere un importante matiz debido a la necesidad de disminuir el uso de opioides que pasan a la leche materna en caso de lactancia natural. El uso de dosis subanestésicas de Ketamina ha demostrado en diferentes estudios la disminución de requerimientos de opioides en las primer...

  17. Investigating multimodal communication in virtual meetings

    DEFF Research Database (Denmark)

    Persson, John Stouby; Mathiassen, Lars

    2014-01-01

    recordings of their oral exchanges and video recordings of their shared dynamic representation of the project’s status and plans, our analysis reveals how their interrelating of visual and verbal communication acts enabled effective communication and coordination. In conclusion, we offer theoretical......To manage distributed work, organizations increasingly rely on virtual meetings based on multimodal, synchronous communication technologies. However, despite technological advances, it is still challenging to coordinate knowledge through these meetings with spatial and cultural separation. Against...... propositions that explain how interrelating of verbal and visual acts based on shared dynamic representations enable communication repairs during virtual meetings. We argue the proposed framework provides researchers with a novel and practical approach to investigate the complex data involved in virtual...

  18. Multimodal strategies to improve surgical outcome

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Wilmore, Douglas W

    2002-01-01

    OBJECTIVE: To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures. BACKGROUND: New approaches in pain control, introduction of techniques that reduce the perioperative stress response, and the more frequent use...... anesthesia in elective operations, and pilot studies of fast track surgical procedures using the multimodality approach. RESULTS: The introduction of newer approaches to perioperative care has reduced both morbidity and mortality in surgical patients. In the future, most elective operations will become day...... surgical procedures or require only 1 to 2 days of postoperative hospitalization. Reorganization of the perioperative team (anesthesiologists, surgeons, nurses, and physical therapists) will be essential to achieve successful fast track surgical programs. CONCLUSIONS: Understanding perioperative...

  19. Compressive multi-mode superresolution display

    KAUST Repository

    Heide, Felix

    2014-01-01

    Compressive displays are an emerging technology exploring the co-design of new optical device configurations and compressive computation. Previously, research has shown how to improve the dynamic range of displays and facilitate high-quality light field or glasses-free 3D image synthesis. In this paper, we introduce a new multi-mode compressive display architecture that supports switching between 3D and high dynamic range (HDR) modes as well as a new super-resolution mode. The proposed hardware consists of readily-available components and is driven by a novel splitting algorithm that computes the pixel states from a target high-resolution image. In effect, the display pixels present a compressed representation of the target image that is perceived as a single, high resolution image. © 2014 Optical Society of America.

  20. Study on brain hemodynamics function according to data of rheoencephalography during multimodality treatment of oncologic patients with the use of general controlled artificial hyperthermia with hyperglycemia or with large insulin doses

    International Nuclear Information System (INIS)

    Lysenko, E.V.

    1990-01-01

    For the first time the effect of single and multiple treatments of artificial hyperthermia (AHT) with hyperglycemia (HG) or with large insulin doses on cerebral circulation of oncologic patients is studied. Cerebral hemodynamics was studied by rheoencephalography. The conclusion is made about the unidirectional AHT effect regardless of the bacrground used. 5 refs.; 4 tabs

  1. The effects of a multimodal training program on burnout syndrome in gynecologic oncology nurses and on the multidisciplinary psychosocial care of gynecologic cancer patients: an Italian experience.

    Science.gov (United States)

    Lupo, F N; Arnaboldi, Paola; Santoro, L; D'Anna, E; Beltrami, C; Mazzoleni, E M; Veronesi, P; Maggioni, A; Didier, F

    2013-06-01

    In cancer care, the burden of psycho-emotional elements involved on the patient-healthcare provider relationship cannot be ignored. The aim of this work is to have an impact on the level of burnout experienced by European Institute of Oncology (IEO) gynecologic oncology nurses (N = 14) and on quality of multidisciplinary team work. We designed a 12 session multimodal training program consisting of a 1.5 hour theoretical lesson on a specific issue related to gynecologic cancer patient care, 20 minute projection of a short film, and 1.75 hours of role-playing exercises and experiential exchanges. The Link Burnout Questionnaire (Santinello, 2007) was administered before and after the completion of the intervention. We also monitored the number of patients referred to the Psycho-oncology Service as an indicator of the efficacy of the multidisciplinary approach. After the completion of the program, the general level of burnout significantly diminished (p = 0.02); in particular, a significant decrease was observed in the "personal inefficacy" subscale (p = 0.01). The number of patients referred to the Psycho-oncology Service increased by 50%. Nurses are in the first line of those seeing patients through the entire course of the disease. For this reason, they are at a particularly high risk of developing work-related distress. Structured training programs can be a valid answer to work-related distress, and feeling part of a multidisciplinary team helps in providing patients with better psychosocial care.

  2. Analysis of the harmonic and intermodulation distortion in a multimode fiber optic link.

    Science.gov (United States)

    Gasulla, I; Capmany, J

    2007-07-23

    We present an analytical evaluation of the harmonic and the intermodulation distortion effects produced in the transmission of an analog signal composed of various RF tones through a multimode fiber link. It is based on the electric field propagation model previously published by the authors. Results show the possibility of implementing subcarrier multiplexing techniques (SCM) with Composite Second Order (CSO) values below -50 dBc over short and middle reach multimode fiber links.

  3. [Silvicultural treatments and their selection effects].

    Science.gov (United States)

    Vincent, G

    1973-01-01

    Selection can be defined in terms of its observable consequences as the non random differential reproduction of genotypes (Lerner 1958). In the forest stands we are selecting during the improvements-fellings and reproduction treatments the individuals surpassing in growth or in production of first-class timber. However the silvicultural treatments taken in forest stands guarantee a permanent increase of forest production only in such cases, if they have been taken with respect to the principles of directional (dynamic) selection. These principles require that the trees determined for further growing and for forest regeneration are selected by their hereditary properties, i.e. by their genotypes.For making this selection feasible, our study deals with the genetic parameters and gives some examples of the application of the response, the selection differential, the heritability in the narrow and in the broad sense, as well as of the genetic and genotypic gain. On the strength of this parameter we have the possibility to estimate the economic success of several silvicultural treatments in forest stands.The mentioned examples demonstrate that the selection measures of a higher intensity will be manifested in a higher selection differential, in a higher genetic and genotypic gain and that the mentioned measures show more distinct effects in the variable populations - in natural forest - than in the population characteristic by a smaller variability, e.g. in many uniform artificially established stands.The examples of influences of different selection on the genotypes composition of population prove that genetics instructs us to differentiate the different genotypes of the same species and gives us at the same time a new criterions for evaluating selectional treatments. These criterions from economic point of view is necessary to consider in silviculture as advantageous even for the reason that we can judge from these criterions the genetical composition of forest stands

  4. Cardiac imaging. A multimodality approach

    Energy Technology Data Exchange (ETDEWEB)

    Thelen, Manfred [Johannes Gutenberg University Hospital, Mainz (Germany); Erbel, Raimund [University Hospital Essen (Germany). Dept. of Cardiology; Kreitner, Karl-Friedrich [Johannes Gutenberg University Hospital, Mainz (Germany). Clinic and Polyclinic for Diagnostic and Interventional Radiology; Barkhausen, Joerg (eds.) [University Hospital Schleswig-Holstein, Luebeck (Germany). Dept. of Radiology and Nuclear Medicine

    2009-07-01

    An excellent atlas on modern diagnostic imaging of the heart Written by an interdisciplinary team of experts, Cardiac Imaging: A Multimodality Approach features an in-depth introduction to all current imaging modalities for the diagnostic assessment of the heart as well as a clinical overview of cardiac diseases and main indications for cardiac imaging. With a particular emphasis on CT and MRI, the first part of the atlas also covers conventional radiography, echocardiography, angiography and nuclear medicine imaging. Leading specialists demonstrate the latest advances in the field, and compare the strengths and weaknesses of each modality. The book's second part features clinical chapters on heart defects, endocarditis, coronary heart disease, cardiomyopathies, myocarditis, cardiac tumors, pericardial diseases, pulmonary vascular diseases, and diseases of the thoracic aorta. The authors address anatomy, pathophysiology, and clinical features, and evaluate the various diagnostic options. Key features: - Highly regarded experts in cardiology and radiology off er image-based teaching of the latest techniques - Readers learn how to decide which modality to use for which indication - Visually highlighted tables and essential points allow for easy navigation through the text - More than 600 outstanding images show up-to-date technology and current imaging protocols Cardiac Imaging: A Multimodality Approach is a must-have desk reference for cardiologists and radiologists in practice, as well as a study guide for residents in both fields. It will also appeal to cardiac surgeons, general practitioners, and medical physicists with a special interest in imaging of the heart. (orig.)

  5. Cardiac imaging. A multimodality approach

    International Nuclear Information System (INIS)

    Thelen, Manfred; Erbel, Raimund; Kreitner, Karl-Friedrich; Barkhausen, Joerg

    2009-01-01

    An excellent atlas on modern diagnostic imaging of the heart Written by an interdisciplinary team of experts, Cardiac Imaging: A Multimodality Approach features an in-depth introduction to all current imaging modalities for the diagnostic assessment of the heart as well as a clinical overview of cardiac diseases and main indications for cardiac imaging. With a particular emphasis on CT and MRI, the first part of the atlas also covers conventional radiography, echocardiography, angiography and nuclear medicine imaging. Leading specialists demonstrate the latest advances in the field, and compare the strengths and weaknesses of each modality. The book's second part features clinical chapters on heart defects, endocarditis, coronary heart disease, cardiomyopathies, myocarditis, cardiac tumors, pericardial diseases, pulmonary vascular diseases, and diseases of the thoracic aorta. The authors address anatomy, pathophysiology, and clinical features, and evaluate the various diagnostic options. Key features: - Highly regarded experts in cardiology and radiology off er image-based teaching of the latest techniques - Readers learn how to decide which modality to use for which indication - Visually highlighted tables and essential points allow for easy navigation through the text - More than 600 outstanding images show up-to-date technology and current imaging protocols Cardiac Imaging: A Multimodality Approach is a must-have desk reference for cardiologists and radiologists in practice, as well as a study guide for residents in both fields. It will also appeal to cardiac surgeons, general practitioners, and medical physicists with a special interest in imaging of the heart. (orig.)

  6. Preferential loss of dorsal-hippocampus synapses underlies memory impairments provoked by short, multimodal stress.

    Science.gov (United States)

    Maras, P M; Molet, J; Chen, Y; Rice, C; Ji, S G; Solodkin, A; Baram, T Z

    2014-07-01

    The cognitive effects of stress are profound, yet it is unknown if the consequences of concurrent multiple stresses on learning and memory differ from those of a single stress of equal intensity and duration. We compared the effects on hippocampus-dependent memory of concurrent, hours-long light, loud noise, jostling and restraint (multimodal stress) with those of restraint or of loud noise alone. We then examined if differences in memory impairment following these two stress types might derive from their differential impact on hippocampal synapses, distinguishing dorsal and ventral hippocampus. Mice exposed to hours-long restraint or loud noise were modestly or minimally impaired in novel object recognition, whereas similar-duration multimodal stress provoked severe deficits. Differences in memory were not explained by differences in plasma corticosterone levels or numbers of Fos-labeled neurons in stress-sensitive hypothalamic neurons. However, although synapses in hippocampal CA3 were impacted by both restraint and multimodal stress, multimodal stress alone reduced synapse numbers severely in dorsal CA1, a region crucial for hippocampus-dependent memory. Ventral CA1 synapses were not significantly affected by either stress modality. Probing the basis of the preferential loss of dorsal synapses after multimodal stress, we found differential patterns of neuronal activation by the two stress types. Cross-correlation matrices, reflecting functional connectivity among activated regions, demonstrated that multimodal stress reduced hippocampal correlations with septum and thalamus and increased correlations with amygdala and BST. Thus, despite similar effects on plasma corticosterone and on hypothalamic stress-sensitive cells, multimodal and restraint stress differ in their activation of brain networks and in their impact on hippocampal synapses. Both of these processes might contribute to amplified memory impairments following short, multimodal stress.

  7. Preferential loss of dorsal-hippocampus synapses underlies memory impairments provoked by short, multimodal stress

    Science.gov (United States)

    Maras, P M; Molet, J; Chen, Y; Rice, C; Ji, S G; Solodkin, A; Baram, T Z

    2014-01-01

    The cognitive effects of stress are profound, yet it is unknown if the consequences of concurrent multiple stresses on learning and memory differ from those of a single stress of equal intensity and duration. We compared the effects on hippocampus-dependent memory of concurrent, hours-long light, loud noise, jostling and restraint (multimodal stress) with those of restraint or of loud noise alone. We then examined if differences in memory impairment following these two stress types might derive from their differential impact on hippocampal synapses, distinguishing dorsal and ventral hippocampus. Mice exposed to hours-long restraint or loud noise were modestly or minimally impaired in novel object recognition, whereas similar-duration multimodal stress provoked severe deficits. Differences in memory were not explained by differences in plasma corticosterone levels or numbers of Fos-labeled neurons in stress-sensitive hypothalamic neurons. However, although synapses in hippocampal CA3 were impacted by both restraint and multimodal stress, multimodal stress alone reduced synapse numbers severely in dorsal CA1, a region crucial for hippocampus-dependent memory. Ventral CA1 synapses were not significantly affected by either stress modality. Probing the basis of the preferential loss of dorsal synapses after multimodal stress, we found differential patterns of neuronal activation by the two stress types. Cross-correlation matrices, reflecting functional connectivity among activated regions, demonstrated that multimodal stress reduced hippocampal correlations with septum and thalamus and increased correlations with amygdala and BST. Thus, despite similar effects on plasma corticosterone and on hypothalamic stress-sensitive cells, multimodal and restraint stress differ in their activation of brain networks and in their impact on hippocampal synapses. Both of these processes might contribute to amplified memory impairments following short, multimodal stress. PMID:24589888

  8. Recent advances in acute pain management: understanding the mechanisms of acute pain, the prescription of opioids, and the role of multimodal pain therapy [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Richa Wardhan

    2017-11-01

    Full Text Available In this review, we discuss advances in acute pain management, including the recent report of the joint American Pain Society and American Academy of Pain Medicine task force on the classification of acute pain, the role of psychosocial factors, multimodal pain management, new non-opioid therapy, and the effect of the “opioid epidemic”. In this regard, we propose that a fundamental principle in acute pain management is identifying patients who are most at risk and providing an “opioid free anesthesia and postoperative analgesia”. This can be achieved by using a multimodal approach that includes regional anesthesia and minimizing the dose and the duration of opioid prescription. This allows prescribing medications that work through different mechanisms. We shall also look at the recent pharmacologic and treatment advances made in acute pain and regional anesthesia.

  9. Multimodal psychoanalytically informed aid work with children traumatized by the Chechen war.

    Science.gov (United States)

    Cerfolio, Nina E

    2009-01-01

    As demonstrated in three cases, this paper illustrates how psychoanalytically informed multimodal care was an essential element of effective medical treatment of children traumatized by the Chechen war. Multimodal psychoanalytically informed aid work involves holding a variety of psychoanalytic viewpoints, including but not restricted to those represented by the Freudian, Interpersonal, and Relational orientations; its purpose is to allow for greater clarity in conceptualizing the traumatized child's response to war in order to provide the necessary care during the therapeutic process. Among the issues addressed are how traumatic memory can initially be expressed nonverbally, and therefore the use of embodied life-metaphors and witnessing are central to the survivors' ability to remember and symbolize. In addition, the significance of cultural awareness and sensitivity are explored as key components to the children's care. In the first case, the author illustrates how a traumatic life-metaphor can be resolved at an embodied, rather than an exclusively verbal, level. In the second case, cultural tradition and relativism have a significant impact on addressing medical and quality of life issues for the child. The third case illustrates how the analyst functions as recognizing witness to a parent's trauma; the "being with" of the relationship becomes the agent of the parent's change.

  10. Multimode-singlemode-multimode optical fiber sensor coated with novolac resin for detecting liquid phase alcohol

    Science.gov (United States)

    Marfu'ah, Amalia, Niza Rosyda; Hatta, Agus Muhamad; Pratama, Detak Yan

    2018-04-01

    Alcohol sensor based on multimode-singlemode-multimode (MSM) optical fiber with novolac resin as the external medium is proposed and demonstrated experimentally. Novolac resin swells when it is exposed by the alcohol. This effect causes a change in the polymer density leading to the refractive index's variation. The transmission light of the sensor depends on the refractive index of external medium. Based on the results, alcohol sensor based on MSM optical fiber structure using novolac resin has a higher sensitivity compared to the sensor without using novolac resin in the mixture of alcohol and distilled water. Alcohol sensor based on MSM optical fiber structure using novolac resin in the mixture of alcohol and distilled water with a singlemode fiber length of 5 mm has a sensitivity of 0.028972 dBm per % V/V, and in the mixture of alcohol and sugar solution of 10% w/w has a sensitivity of 0.005005 dBm per % V/V.

  11. Timing of Multimodal Robot Behaviors during Human-Robot Collaboration

    DEFF Research Database (Denmark)

    Jensen, Lars Christian; Fischer, Kerstin; Suvei, Stefan-Daniel

    2017-01-01

    In this paper, we address issues of timing between robot behaviors in multimodal human-robot interaction. In particular, we study what effects sequential order and simultaneity of robot arm and body movement and verbal behavior have on the fluency of interactions. In a study with the Care-O-bot, ...... output plays a special role because participants carry their expectations from human verbal interaction into the interactions with robots....

  12. Multimodal Characterization of the Late Effects of Traumatic Brain Injury: A Methodological Overview of the Late Effects of Traumatic Brain Injury Project.

    Science.gov (United States)

    Edlow, Brian L; Keene, C Dirk; Perl, Daniel P; Iacono, Diego; Folkerth, Rebecca D; Stewart, William; Mac Donald, Christine L; Augustinack, Jean; Diaz-Arrastia, Ramon; Estrada, Camilo; Flannery, Elissa; Gordon, Wayne A; Grabowski, Thomas J; Hansen, Kelly; Hoffman, Jeanne; Kroenke, Christopher; Larson, Eric B; Lee, Patricia; Mareyam, Azma; McNab, Jennifer A; McPhee, Jeanne; Moreau, Allison L; Renz, Anne; Richmire, KatieRose; Stevens, Allison; Tang, Cheuk Y; Tirrell, Lee S; Trittschuh, Emily H; van der Kouwe, Andre; Varjabedian, Ani; Wald, Lawrence L; Wu, Ona; Yendiki, Anastasia; Young, Liza; Zöllei, Lilla; Fischl, Bruce; Crane, Paul K; Dams-O'Connor, Kristen

    2018-05-03

    Epidemiological studies suggest that a single moderate-to-severe traumatic brain injury (TBI) is associated with an increased risk of neurodegenerative disease, including Alzheimer's disease (AD) and Parkinson's disease (PD). Histopathological studies describe complex neurodegenerative pathologies in individuals exposed to single moderate-to-severe TBI or repetitive mild TBI, including chronic traumatic encephalopathy (CTE). However, the clinicopathological links between TBI and post-traumatic neurodegenerative diseases such as AD, PD, and CTE remain poorly understood. Here, we describe the methodology of the Late Effects of TBI (LETBI) study, whose goals are to characterize chronic post-traumatic neuropathology and to identify in vivo biomarkers of post-traumatic neurodegeneration. LETBI participants undergo extensive clinical evaluation using National Institutes of Health TBI Common Data Elements, proteomic and genomic analysis, structural and functional magnetic resonance imaging (MRI), and prospective consent for brain donation. Selected brain specimens undergo ultra-high resolution ex vivo MRI and histopathological evaluation including whole-mount analysis. Co-registration of ex vivo and in vivo MRI data enables identification of ex vivo lesions that were present during life. In vivo signatures of postmortem pathology are then correlated with cognitive and behavioral data to characterize the clinical phenotype(s) associated with pathological brain lesions. We illustrate the study methods and demonstrate proof of concept for this approach by reporting results from the first LETBI participant, who despite the presence of multiple in vivo and ex vivo pathoanatomic lesions had normal cognition and was functionally independent until her mid-80s. The LETBI project represents a multidisciplinary effort to characterize post-traumatic neuropathology and identify in vivo signatures of postmortem pathology in a prospective study.

  13. Drug Repositioning for Effective Prostate Cancer Treatment.

    Science.gov (United States)

    Turanli, Beste; Grøtli, Morten; Boren, Jan; Nielsen, Jens; Uhlen, Mathias; Arga, Kazim Y; Mardinoglu, Adil

    2018-01-01

    Drug repositioning has gained attention from both academia and pharmaceutical companies as an auxiliary process to conventional drug discovery. Chemotherapeutic agents have notorious adverse effects that drastically reduce the life quality of cancer patients so drug repositioning is a promising strategy to identify non-cancer drugs which have anti-cancer activity as well as tolerable adverse effects for human health. There are various strategies for discovery and validation of repurposed drugs. In this review, 25 repurposed drug candidates are presented as result of different strategies, 15 of which are already under clinical investigation for treatment of prostate cancer (PCa). To date, zoledronic acid is the only repurposed, clinically used, and approved non-cancer drug for PCa. Anti-cancer activities of existing drugs presented in this review cover diverse and also known mechanisms such as inhibition of mTOR and VEGFR2 signaling, inhibition of PI3K/Akt signaling, COX and selective COX-2 inhibition, NF-κB inhibition, Wnt/β-Catenin pathway inhibition, DNMT1 inhibition, and GSK-3β inhibition. In addition to monotherapy option, combination therapy with current anti-cancer drugs may also increase drug efficacy and reduce adverse effects. Thus, drug repositioning may become a key approach for drug discovery in terms of time- and cost-efficiency comparing to conventional drug discovery and development process.

  14. Multimodal supervision programme to reduce catheter associated urinary tract infections and its analysis to enable focus on labour and cost effective infection control measures in a tertiary care hospital in India.

    Science.gov (United States)

    Jaggi, Namita; Sissodia, Pushpa

    2012-10-01

    Catheter Associated Urinary Tract Infections (CAUTI) contribute 30%-40% of all the nosocomial infections and they are associated with substantially increased institutional death rates. A multimodal supervision program which incorporates training of the staff with respect to infection control measures can be effective in reducing the CAUTIs in hospitals. To assess the impact of a multimodal UTI supervision program on the CAUTI rates over a year, from January 2009 to December 2009, in a tertiary care hospital in India. A 215 bedded tertiary care private hospital. The CAUTI rates were analyzed for the first 6 months (January 2009-June 2009). A UTI supervision program was instituted in the month of July 2009, which included training with respect to the standard protocols for the sample collection and diagnosis, the bundle components of the urinary catheter checklist and hand hygiene practices. The impact was assessed as per the CAUTI rates in the subsequent months. The average CAUTI rate was reduced by 47.1% (from 10.6 to 5.6) after the introduction of the supervision program. This study presented the mean age of the patients with CAUTIs as 54.5 years and it showed an approximately equal contribution of both the sexes (52.94% in males and 47.05% in females). The impact analysis of the supervision program showed a reduction of 8.7% (from 23 days to 21 days) during the average duration of the catheterization. The adherence to the components of the urinary catheter check list was increased by 44.4% (p=0.069) and the hand hygiene compliance was increased by 56.4% (p=0.004) respectively after the interventions. Components like bladder irrigation and practising perineal cleaning were found to show no effect on the CAUTI rates. The most common labour and cost effective infection control measures as revealed by the supervision programme were adherence to the urinary catheter checklist components (indication for catheter insertion and change, asepsis maintenance during and

  15. Analytical treatment of the runaway-effect

    International Nuclear Information System (INIS)

    Kaeppeler, H.J.

    1980-09-01

    In the analytical treatment of the runaway-effect there appear the integrals Isub(m)(α). For m = 1, 2 and 3, series expansions for these integrals can be found in the literature. Furthermore, asymptotic solutions for Isub(m)(α) are known. It is shown here that the solutions for Isub(m)(α) can be approximated by the modified Bessel Function Ksub(n)(αsup(ν)) in such a way that for α → 0 the exact limiting value for Isub(m)(α) follows and that for α → infinite essentially the known asymptotic solutions for Isub(m)(α) follow. The maximum error for this approximation in the order of percent is considered justifiable for the application considered. (orig.)

  16. High-resolution multimodal clinical multiphoton tomography of skin

    Science.gov (United States)

    König, Karsten

    2011-03-01

    This review focuses on multimodal multiphoton tomography based on near infrared femtosecond lasers. Clinical multiphoton tomographs for 3D high-resolution in vivo imaging have been placed into the market several years ago. The second generation of this Prism-Award winning High-Tech skin imaging tool (MPTflex) was introduced in 2010. The same year, the world's first clinical CARS studies have been performed with a hybrid multimodal multiphoton tomograph. In particular, non-fluorescent lipids and water as well as mitochondrial fluorescent NAD(P)H, fluorescent elastin, keratin, and melanin as well as SHG-active collagen has been imaged with submicron resolution in patients suffering from psoriasis. Further multimodal approaches include the combination of multiphoton tomographs with low-resolution wide-field systems such as ultrasound, optoacoustical, OCT, and dermoscopy systems. Multiphoton tomographs are currently employed in Australia, Japan, the US, and in several European countries for early diagnosis of skin cancer, optimization of treatment strategies, and cosmetic research including long-term testing of sunscreen nanoparticles as well as anti-aging products.

  17. Mediating multimodal environmental knowledge across animation techniques

    DEFF Research Database (Denmark)

    Maier, Carmen Daniela

    2011-01-01

    ://www.sustainlane.com/. The multimodal discourse analysis is meant to reveal how selection and representation of environmental knowledge about social actors, social actions, resources, time and space are influenced by animation techniques. Furthermore, in the context of this multimodal discourse analysis, their influence upon......The growing awareness of and concern about present environmental problems generate a proliferation of new forms of environmental discourses that are mediated in various ways. This chapter explores issues related to the ways in which environmental knowledge is multimodally communicated...

  18. Multimodal integration in statistical learning

    DEFF Research Database (Denmark)

    Mitchell, Aaron; Christiansen, Morten Hyllekvist; Weiss, Dan

    2014-01-01

    , we investigated the ability of adults to integrate audio and visual input during statistical learning. We presented learners with a speech stream synchronized with a video of a speaker’s face. In the critical condition, the visual (e.g., /gi/) and auditory (e.g., /mi/) signals were occasionally...... facilitated participants’ ability to segment the speech stream. Our results therefore demonstrate that participants can integrate audio and visual input to perceive the McGurk illusion during statistical learning. We interpret our findings as support for modality-interactive accounts of statistical learning.......Recent advances in the field of statistical learning have established that learners are able to track regularities of multimodal stimuli, yet it is unknown whether the statistical computations are performed on integrated representations or on separate, unimodal representations. In the present study...

  19. Multimodality image analysis work station

    International Nuclear Information System (INIS)

    Ratib, O.; Huang, H.K.

    1989-01-01

    The goal of this project is to design and implement a PACS (picture archiving and communication system) workstation for quantitative analysis of multimodality images. The Macintosh II personal computer was selected for its friendly user interface, its popularity among the academic and medical community, and its low cost. The Macintosh operates as a stand alone workstation where images are imported from a central PACS server through a standard Ethernet network and saved on a local magnetic or optical disk. A video digitizer board allows for direct acquisition of images from sonograms or from digitized cine angiograms. The authors have focused their project on the exploration of new means of communicating quantitative data and information through the use of an interactive and symbolic user interface. The software developed includes a variety of image analysis, algorithms for digitized angiograms, sonograms, scintigraphic images, MR images, and CT scans

  20. Multimodal signalling in estrildid finches

    DEFF Research Database (Denmark)

    Gomes, A. C. R.; Funghi, C.; Soma, M.

    2017-01-01

    Sexual traits (e.g. visual ornaments, acoustic signals, courtship behaviour) are often displayed together as multimodal signals. Some hypotheses predict joint evolution of different sexual signals (e.g. to increase the efficiency of communication) or that different signals trade off with each other...... (e.g. due to limited resources). Alternatively, multiple signals may evolve independently for different functions, or to communicate different information (multiple message hypothesis). We evaluated these hypotheses with a comparative study in the family Estrildidae, one of the largest songbird...... compromise, but generally courtship dance also evolved independently from other signals. Instead of correlated evolution, we found that song, dance and colour are each related to different socio-ecological traits. Song complexity evolved together with ecological generalism, song performance with investment...

  1. Multispectral analysis of multimodal images

    Energy Technology Data Exchange (ETDEWEB)

    Kvinnsland, Yngve; Brekke, Njaal (Dept. of Surgical Sciences, Univ. of Bergen, Bergen (Norway)); Taxt, Torfinn M.; Gruener, Renate (Dept. of Biomedicine, Univ. of Bergen, Bergen (Norway))

    2009-02-15

    An increasing number of multimodal images represent a valuable increase in available image information, but at the same time it complicates the extraction of diagnostic information across the images. Multispectral analysis (MSA) has the potential to simplify this problem substantially as unlimited number of images can be combined, and tissue properties across the images can be extracted automatically. Materials and methods. We have developed a software solution for MSA containing two algorithms for unsupervised classification, an EM-algorithm finding multinormal class descriptions and the k-means clustering algorithm, and two for supervised classification, a Bayesian classifier using multinormal class descriptions and a kNN-algorithm. The software has an efficient user interface for the creation and manipulation of class descriptions, and it has proper tools for displaying the results. Results. The software has been tested on different sets of images. One application is to segment cross-sectional images of brain tissue (T1- and T2-weighted MR images) into its main normal tissues and brain tumors. Another interesting set of images are the perfusion maps and diffusion maps, derived images from raw MR images. The software returns segmentation that seem to be sensible. Discussion. The MSA software appears to be a valuable tool for image analysis with multimodal images at hand. It readily gives a segmentation of image volumes that visually seems to be sensible. However, to really learn how to use MSA, it will be necessary to gain more insight into what tissues the different segments contain, and the upcoming work will therefore be focused on examining the tissues through for example histological sections.

  2. Demonstration of analyzers for multimode photonic time-bin qubits

    Science.gov (United States)

    Jin, Jeongwan; Agne, Sascha; Bourgoin, Jean-Philippe; Zhang, Yanbao; Lütkenhaus, Norbert; Jennewein, Thomas

    2018-04-01

    We demonstrate two approaches for unbalanced interferometers as time-bin qubit analyzers for quantum communication, robust against mode distortions and polarization effects as expected from free-space quantum communication systems including wavefront deformations, path fluctuations, pointing errors, and optical elements. Despite strong spatial and temporal distortions of the optical mode of a time-bin qubit, entangled with a separate polarization qubit, we verify entanglement using the Negative Partial Transpose, with the measured visibility of up to 0.85 ±0.01 . The robustness of the analyzers is further demonstrated for various angles of incidence up to 0 .2∘ . The output of the interferometers is coupled into multimode fiber yielding a high system throughput of 0.74. Therefore, these analyzers are suitable and efficient for quantum communication over multimode optical channels.

  3. Interaction between visual and chemical cues in a Liolaemus lizard: a multimodal approach.

    Science.gov (United States)

    Vicente, Natalin S; Halloy, Monique

    2017-12-01

    Multimodal communication involves the use of signals and cues across two or more sensory modalities. The genus Liolaemus (Iguania: Liolaemidae) offers a great potential for studies on the ecology and evolution of multimodal communication, including visual and chemical signals. In this study, we analyzed the response of male and female Liolaemus pacha to chemical, visual and combined (multimodal) stimuli. Using cue-isolation tests, we registered the number of tongue flicks and headbob displays from exposure to signals in each modality. Number of tongue flicks was greater when a chemical stimulus was presented alone than in the presence of visual or multimodal stimuli. In contrast, headbob displays were fewer in number with visual and chemical stimuli alone, but significantly higher in number when combined. Female signallers triggered significantly more tongue flicks than male signallers, suggesting that chemical cues are involved in sexual recognition. We did not find an inhibition between chemical and visual cues. On the contrary, we observed a dominance of the chemical modality, because when presented with visual stimuli, lizards also responded with more tongue flicks than headbob displays. The total response produced by multimodal stimuli was similar to that of the chemical stimuli alone, possibly suggesting non-redundancy. We discuss whether the visual component of a multimodal signal could attract attention at a distance, increasing the effectiveness of transmission and reception of the information in chemical cues. Copyright © 2017 Elsevier GmbH. All rights reserved.

  4. Late effects after treatment for Hodgkin lymphoma

    NARCIS (Netherlands)

    Daniëls, Laurien Aletta

    2014-01-01

    Although modern treatment strategies have made Hodgkin Lymphoma (HL) a highly curable disease, there is a life-long increased risk of morbidity and mortality due to treatment. Over time it has become increasingly evident that the historically used extensive treatment fields can potentially lead to

  5. Multimodal quantitation of the effects of endovascular therapy for vasospasm on cerebral blood flow, transcranial doppler ultrasonographic velocities, and cerebral artery diameters.

    Science.gov (United States)

    Oskouian, Rod J; Martin, Neil A; Lee, Jae Hong; Glenn, Thomas C; Guthrie, Donald; Gonzalez, Nestor R; Afari, Arash; Viñuela, Fernando

    2002-07-01

    The goal of this study was to quantify the effects of endovascular therapy on vasospastic cerebral vessels. We reviewed the medical records for 387 patients with ruptured intracranial aneurysms who were treated at a single institution (University of California, Los Angeles) between May 1, 1993, and March 31, 2001. Patients who developed cerebral vasospasm and underwent cerebral arteriographic, transcranial Doppler ultrasonographic, and cerebral blood flow (CBF) studies before and after endovascular therapy for cerebral arterial spasm (vasospasm) were included in this study. Forty-five patients fulfilled the aforementioned criteria and were treated with either papaverine infusion, papaverine infusion with angioplasty, or angioplasty alone. After balloon angioplasty (12 patients), CBF increased from 27.8 +/- 2.8 ml/100 g/min to 28.4 +/- 3.0 ml/100 g/min (P = 0.87); the middle cerebral artery blood flow velocity was 1 57.6 +/- 9.4 cm/s and decreased to 76.3 +/- 9.3 cm/s (P < 0.05), with a mean increase in cerebral artery diameters of 24.4%. Papaverine infusion (20 patients) transiently increased the CBF from 27.5 +/- 2.1 ml/100 g/min to 38.7 +/- 2.8 ml/100 g/min (P < 0.05) and decreased the middle cerebral artery blood flow velocity from 109.9 +/- 9.1 cm/s to 82.8 +/- 8.6 cm/s (P < 0.05). There was a mean increase in vessel diameters of 30.1% after papaverine infusion. Combined treatment (13 patients) significantly increased the CBF from 33.3 +/- 3.2 ml/100 g/min to 41.7 +/- 2.8 ml/100 g/min (P< 0.05) and decreased the transcranial Doppler velocities from 148.9 +/- 12.7 cm/s to 111.4 +/- 10.6 cm/s (P < 0.05), with a mean increase in vessel diameters of 42.2%. Balloon angioplasty increased proximal vessel diameters, whereas papaverine treatment effectively dilated distal cerebral vessels. In our small series, we observed no correlation between early clinical improvement or clinical outcomes and any of our quantitative or physiological data (CBF, transcranial Doppler

  6. FDTD simulation of microwave sintering of ceramics in multimode cavities

    Energy Technology Data Exchange (ETDEWEB)

    Iskander, M.F.; Smith, R.L.; Andrade, A.O.M.; Walsh, L.M. (Univ. of Utah, Salt Lake City, UT (United States). Dept. of Electrical Engineering); Kimrey, H. Jr. (Oak Ridge National Lab., TN (United States))

    1994-05-01

    At present, various aspects of the sintering process such as preparation of sample sizes and shapes, types of insulations, and the desirability of including a process stimulus such as SiC rods are considered forms of art and highly dependent on human expertise. The simulation of realistic sintering experiments in a multimode cavity may provide an improved understanding of critical parameters involved and allow for the development of guidelines towards the optimization of the sintering process. In this paper, the authors utilize the FDTD technique to model various geometrical arrangements and material compatibility aspects in multimode microwave cavities and to simulate realistic sintering experiments. The FDTD procedure starts with the simulation of a field distribution in multimode microwave cavities that resembles a set of measured data using liquid crystal sheets. Also included in the simulation is the waveguide feed as well as a ceramic loading plate placed at the base of the cavity. The FDTD simulation thus provides realistic representation of a typical sintering experiment. Aspects that have been successfully simulated include the effects of various types of insulation, the role of SiC rods on the uniformity of the resulting microwave fields, and the possible shielding effects that may result from excessive use of SiC. These results as well as others showing the electromagnetic fields and power-deposition patterns in multiple ceramic samples are presented.

  7. Spontaneous generalization of abstract multimodal patterns in young domestic chicks.

    Science.gov (United States)

    Versace, Elisabetta; Spierings, Michelle J; Caffini, Matteo; Ten Cate, Carel; Vallortigara, Giorgio

    2017-05-01

    From the early stages of life, learning the regularities associated with specific objects is crucial for making sense of experiences. Through filial imprinting, young precocial birds quickly learn the features of their social partners by mere exposure. It is not clear though to what extent chicks can extract abstract patterns of the visual and acoustic stimuli present in the imprinting object, and how they combine them. To investigate this issue, we exposed chicks (Gallus gallus) to three days of visual and acoustic imprinting, using either patterns with two identical items or patterns with two different items, presented visually, acoustically or in both modalities. Next, chicks were given a choice between the familiar and the unfamiliar pattern, present in either the multimodal, visual or acoustic modality. The responses to the novel stimuli were affected by their imprinting experience, and the effect was stronger for chicks imprinted with multimodal patterns than for the other groups. Interestingly, males and females adopted a different strategy, with males more attracted by unfamiliar patterns and females more attracted by familiar patterns. Our data show that chicks can generalize abstract patterns by mere exposure through filial imprinting and that multimodal stimulation is more effective than unimodal stimulation for pattern learning.

  8. Driver Education for New Multimodal Facilities

    Science.gov (United States)

    2016-05-24

    Local and state transportation agencies are redesigning roads to accommodate multimodal travel, including the addition of new configurations, infrastructures, and rules that may be unfamiliar to current drivers and other road users. Education and out...

  9. Responsive Multimodal Transportation Management Strategies And IVHS

    Science.gov (United States)

    1995-02-01

    THE PURPOSE OF THIS STUDY WAS TO INVESTIGATE NEW AND INNOVATIVE WAYS TO INCORPORATE IVHS TECHNOLOGIES INTO MULTIMODAL TRANSPORTATION MANAGEMENT STRATEGIES. MUCH OF THE IVHS RESEARCH DONE TO DATE HAS ADDRESSED THE MODES INDIVIDUALLY. THIS PROJECT FOCU...

  10. Influence of Blood Contamination During Multimode Adhesive ...

    African Journals Online (AJOL)

    2018-01-30

    Jan 30, 2018 ... (μTBS) of multimode adhesives to dentin when using the self‑etch approach. Materials and Methods: ... adhesion, the collagen fibers collapse during the. Introduction ..... The failure mode was determined using an optical.

  11. Multimodality image registration with software: state-of-the-art

    Energy Technology Data Exchange (ETDEWEB)

    Slomka, Piotr J. [Cedars-Sinai Medical Center, AIM Program/Department of Imaging, Los Angeles, CA (United States); University of California, David Geffen School of Medicine, Los Angeles, CA (United States); Baum, Richard P. [Center for PET, Department of Nuclear Medicine, Bad Berka (Germany)

    2009-03-15

    Multimodality image integration of functional and anatomical data can be performed by means of dedicated hybrid imaging systems or by software image co-registration techniques. Hybrid positron emission tomography (PET)/computed tomography (CT) systems have found wide acceptance in oncological imaging, while software registration techniques have a significant role in patient-specific, cost-effective, and radiation dose-effective application of integrated imaging. Software techniques allow accurate (2-3 mm) rigid image registration of brain PET with CT and MRI. Nonlinear techniques are used in whole-body image registration, and recent developments allow for significantly accelerated computing times. Nonlinear software registration of PET with CT or MRI is required for multimodality radiation planning. Difficulties remain in the validation of nonlinear registration of soft tissue organs. The utilization of software-based multimodality image integration in a clinical environment is sometimes hindered by the lack of appropriate picture archiving and communication systems (PACS) infrastructure needed to efficiently and automatically integrate all available images into one common database. In cardiology applications, multimodality PET/single photon emission computed tomography and coronary CT angiography imaging is typically not required unless the results of one of the tests are equivocal. Software image registration is likely to be used in a complementary fashion with hybrid PET/CT or PET/magnetic resonance imaging systems. Software registration of stand-alone scans ''paved the way'' for the clinical application of hybrid scanners, demonstrating practical benefits of image integration before the hybrid dual-modality devices were available. (orig.)

  12. Multimodality image registration with software: state-of-the-art

    International Nuclear Information System (INIS)

    Slomka, Piotr J.; Baum, Richard P.

    2009-01-01

    Multimodality image integration of functional and anatomical data can be performed by means of dedicated hybrid imaging systems or by software image co-registration techniques. Hybrid positron emission tomography (PET)/computed tomography (CT) systems have found wide acceptance in oncological imaging, while software registration techniques have a significant role in patient-specific, cost-effective, and radiation dose-effective application of integrated imaging. Software techniques allow accurate (2-3 mm) rigid image registration of brain PET with CT and MRI. Nonlinear techniques are used in whole-body image registration, and recent developments allow for significantly accelerated computing times. Nonlinear software registration of PET with CT or MRI is required for multimodality radiation planning. Difficulties remain in the validation of nonlinear registration of soft tissue organs. The utilization of software-based multimodality image integration in a clinical environment is sometimes hindered by the lack of appropriate picture archiving and communication systems (PACS) infrastructure needed to efficiently and automatically integrate all available images into one common database. In cardiology applications, multimodality PET/single photon emission computed tomography and coronary CT angiography imaging is typically not required unless the results of one of the tests are equivocal. Software image registration is likely to be used in a complementary fashion with hybrid PET/CT or PET/magnetic resonance imaging systems. Software registration of stand-alone scans ''paved the way'' for the clinical application of hybrid scanners, demonstrating practical benefits of image integration before the hybrid dual-modality devices were available. (orig.)

  13. Quantifying Quality Aspects of Multimodal Interactive Systems

    CERN Document Server

    Kühnel, Christine

    2012-01-01

    This book systematically addresses the quantification of quality aspects of multimodal interactive systems. The conceptual structure is based on a schematic view on human-computer interaction where the user interacts with the system and perceives it via input and output interfaces. Thus, aspects of multimodal interaction are analyzed first, followed by a discussion of the evaluation of output and input and concluding with a view on the evaluation of a complete system.

  14. Effects of radiation treatment on foodstuffs

    International Nuclear Information System (INIS)

    Dehne, L.; Boegl, W.

    1980-01-01

    The purpose of this study is to discuss and compile methods and results of irradiation experiments carried out on 54 plant and animal foodstuffs in order to obtain a survey on chemical changes, in particular as regards the reduction of nutritional value and savoriness of irradiated foodstuffs. According to this task, microbiological aspects as well as an interpretation of the experimental results as to the physiology of nutrition and toxicology were not included. The results published by the authors of the original papers were compiled in a kind of dictionary which contains all relevant information such as radiation sources, irradiation conditions, investigation methods, results of chemical or organoleptical changes etc. The most important results were summarized in tables and can be found at the end of this study. Because of the abundance of existing literature the series 'Effects of radiation treatment on foodstuffs' will be continued in Part IV, and the final discussion of the results will be published separately after further data have been included. (orig.) [de

  15. A combined salt-hard templating approach for synthesis of multi-modal porous carbons used for probing the simultaneous effects of porosity and electrode engineering on EDLC performance

    KAUST Repository

    Bhandari, Nidhi

    2015-06-01

    A new approach, based on a combination of salt and hard templating for producing multi-modal porous carbons is demonstrated. The hard template, silica nanoparticles, generate mesopores (∼22 nm), and in some cases borderline-macropores (∼64 nm), resulting in high pore volume (∼3.9 cm3/g) while the salt template, zinc chloride, generates borderline-mesopores (∼2 nm), thus imparting high surface area (∼2100 m2/g). The versatility of the proposed synthesis technique is demonstrated using: (i) dual salt templates with hard template resulting in magnetic, nanostructured-clay embedded (∼27% clay content), high surface area (∼1527 m2/g) bimodal carbons (∼2 and 70 nm pores), (ii) multiple hard templates with salt template resulting in tri-modal carbons (∼2, 12 and 28 nm pores), (iii) low temperature (450 °C) synthesis of bimodal carbons afforded by the presence of hygroscopic salt template, (iv) easy coupling with physical activation approaches. A selected set of thus synthesized carbons were used to evaluate, for the first time, the simultaneous effects of carbon porosity and pressure applied during electrode fabrication on EDLC performance. Electrode pressing was found to be more favorable for carbons containing hard-templated mesopores (∼87% capacitance retention at current density of 40 A/g) as compared to those without (∼54% capacitance retention). © 2015 Elsevier Ltd. All rights reserved.

  16. Multimodal system for the planning and guidance of bronchoscopy

    Science.gov (United States)

    Higgins, William E.; Cheirsilp, Ronnarit; Zang, Xiaonan; Byrnes, Patrick

    2015-03-01

    Many technical innovations in multimodal radiologic imaging and bronchoscopy have emerged recently in the effort against lung cancer. Modern X-ray computed-tomography (CT) scanners provide three-dimensional (3D) high-resolution chest images, positron emission tomography (PET) scanners give complementary molecular imaging data, and new integrated PET/CT scanners combine the strengths of both modalities. State-of-the-art bronchoscopes permit minimally invasive tissue sampling, with vivid endobronchial video enabling navigation deep into the airway-tree periphery, while complementary endobronchial ultrasound (EBUS) reveals local views of anatomical structures outside the airways. In addition, image-guided intervention (IGI) systems have proven their utility for CT-based planning and guidance of bronchoscopy. Unfortunately, no IGI system exists that integrates all sources effectively through the complete lung-cancer staging work flow. This paper presents a prototype of a computer-based multimodal IGI system that strives to fill this need. The system combines a wide range of automatic and semi-automatic image-processing tools for multimodal data fusion and procedure planning. It also provides a flexible graphical user interface for follow-on guidance of bronchoscopy/EBUS. Human-study results demonstrate the system's potential.

  17. Context-Aware Multimodal FIDO Authenticator for Sustainable IT Services

    Directory of Open Access Journals (Sweden)

    Seung-Hyun Kim

    2018-05-01

    Full Text Available Existing sustainable IT services have several problems related to user authentication such as the inefficiency of managing the system security, low security, and low usability. In this paper, we propose a Fast IDentity Online (FIDO authenticator that performs continuous authentication with implicit authentication based on user context and multimodal authentication. The proposed FIDO authenticator, a context-aware multimodal FIDO authentication (CAMFA method, combines information such as the user context, state of the mobile device, and user biometrics, then applies implicit and explicit authentication methods to meet the level of authentication required by the service provider. This reduces the user’s explicit authentication burden and continually authenticates users at risk during the session. Moreover, it is able to respond to attacks such as the theft of the authentication method or session hijacking. To study the effectiveness of CAMFA, we ran a user study by collecting data from 22 participants over 42 days of activity on a practical Android platform. The result of the user study demonstrates that the number of explicit authentication requests could be reduced by half. Based on the results of this study, an advanced user authentication that provides multimodal and continuous authentication could be applied to sustainable IT services.

  18. The integration of emotional and symbolic components in multimodal communication

    Directory of Open Access Journals (Sweden)

    Marc eMehu

    2015-07-01

    Full Text Available Human multimodal communication can be said to serve two main purposes: information transfer and social influence. In this paper, I argue that different components of multimodal signals play different roles in the processes of information transfer and social influence. Although the symbolic components of communication (e.g. verbal and denotative signals are well suited to transfer conceptual information, emotional components (e.g. nonverbal signals that are difficult to manipulate voluntarily likely take a function that is closer to social influence. I suggest that emotion should be considered a property of communicative signals, rather than an entity that is transferred as content by nonverbal signals. In this view, the effect of emotional processes on communication serve to change the quality of social signals to make them more efficient at producing responses in perceivers, whereas symbolic components increase the signals’ efficiency at interacting with the cognitive processes dedicated to the assessment of relevance. The interaction between symbolic and emotional components will be discussed in relation to the need for perceivers to evaluate the reliability of multimodal signals.

  19. The integration of emotional and symbolic components in multimodal communication

    Science.gov (United States)

    Mehu, Marc

    2015-01-01

    Human multimodal communication can be said to serve two main purposes: information transfer and social influence. In this paper, I argue that different components of multimodal signals play different roles in the processes of information transfer and social influence. Although the symbolic components of communication (e.g., verbal and denotative signals) are well suited to transfer conceptual information, emotional components (e.g., non-verbal signals that are difficult to manipulate voluntarily) likely take a function that is closer to social influence. I suggest that emotion should be considered a property of communicative signals, rather than an entity that is transferred as content by non-verbal signals. In this view, the effect of emotional processes on communication serve to change the quality of social signals to make them more efficient at producing responses in perceivers, whereas symbolic components increase the signals’ efficiency at interacting with the cognitive processes dedicated to the assessment of relevance. The interaction between symbolic and emotional components will be discussed in relation to the need for perceivers to evaluate the reliability of multimodal signals. PMID:26217280

  20. Evaluating the efficacy of an integrated motivational interviewing and multi-modal exercise intervention for youth with major depression: Healthy Body, Healthy Mind randomised controlled trial protocol.

    Science.gov (United States)

    Nasstasia, Yasmina; Baker, Amanda L; Halpin, Sean A; Hides, Leanne; Lewin, Terry J; Kelly, Brian J; Callister, Robin

    2018-03-01

    Recent meta-analytic reviews suggest exercise can reduce depression severity among adults with major depressive disorder (MDD); however, efficacy studies with depressed youth are limited. Few studies have investigated the efficacy of multi-modal exercise interventions in this population, addressed treatment engagement, or explored the differential effects of exercise on depressive symptom profiles. This paper describes the study protocol and recruitment pattern for an assessor blinded, two-arm randomised controlled trial investigating the efficacy of an integrated motivational interviewing (MI) and multi-modal exercise intervention in youth diagnosed with MDD. Associations between depressive symptom profiles (cognitive, somatic and affective) and psychological, physiological (fitness), and biological (blood biomarker) outcomes will also be examined. Participants aged 15-25 years with current MDD were recruited. Eligible participants were randomised and stratified according to gender and depression severity to either an immediate or delayed (control) group. The immediate group received a brief MI intervention followed by a 12-week small group exercise intervention (3 times per week for 1 h), all delivered by personal trainers. The delayed control group received the same intervention 12-weeks later. Both groups were reassessed at mid-treatment or mid-control, post-treatment or post-control, and follow-up (12 weeks post-treatment). 68 participants were recruited and randomly allocated to an intervention group. This trial will increase our understanding of the efficacy of multi-modal exercise interventions for depression and the specific effects of exercise on depressive symptom profiles. It also offers a novel contribution by addressing treatment engagement in exercise efficacy trials in youth with MDD.

  1. A Study of Patients with Primary Mediastinal Germ Cell Tumors Treated Using Multimodal Therapy

    Directory of Open Access Journals (Sweden)

    Yutaro Tanaka

    2017-01-01

    Full Text Available Objectives. Primary mediastinal germ cell tumors (PMGCTs are rare, which often makes them difficult to treat. Herein, we examined patients with PMGCTs who underwent multimodal treatment. Methods. We examined 6 patients (median age: 25 years, range: 19–27 years with PMGCTs who underwent multimodal treatment between April 2001 and March 2015. Three patients had seminomas, 2 patients had yolk sac tumors, and 1 patient had choriocarcinoma. The median observation period was 32.5 months (range: 8–84 months. Results. Three of the 6 patients received initial operation followed by 3-4 courses of chemotherapy (bleomycin, etoposide, and cisplatin (BEP or etoposide and cisplatin (EP. One patient developed multiple lung metastases 17 months after surgery; received salvage chemotherapy with vinblastine, ifosfamide, and cisplatin; and achieved complete remission. The remaining 3 patients received initial BEP and EP chemotherapy. Multiple lung metastases and supraclavicular lymph node metastases were detected in 2 of these patients at the initial diagnosis. The patients underwent resections to remove residual tumor after treatment, and no viable tumor cells were found. Conclusions. Reliable diagnosis and immediate multimodal treatments are necessary for patients with PMGCTs. The 6 patients treated in our hospital have never experienced recurrence after the multimodal treatment.

  2. Instrumental variable estimation of treatment effects for duration outcomes

    NARCIS (Netherlands)

    G.E. Bijwaard (Govert)

    2007-01-01

    textabstractIn this article we propose and implement an instrumental variable estimation procedure to obtain treatment effects on duration outcomes. The method can handle the typical complications that arise with duration data of time-varying treatment and censoring. The treatment effect we

  3. Cancer treatment: fertility and sexual side effects in women

    Science.gov (United States)

    ... Cancer treatment: fertility and sexual side effects in women To use the sharing features on this page, ... Bladder cancer Types of Sexual Side Effects For women, the most common sexual side effects include: Loss ...

  4. Assessment of Common Anaesthetic and Clinical Indices of Multimodal Therapy of Propofol, Xylazine, and Ketamine in Total Intravenous Anaesthesia in West African Dwarf Goat

    Directory of Open Access Journals (Sweden)

    Ukwueze Celestine Okwudili

    2014-01-01

    Full Text Available The assessment of anaesthetic and clinical indices of multimodal therapy of propofol, xylazine, and ketamine was done in West African Dwarf (WAD goat. Sixteen healthy male WAD goats were assigned into four treatment groups, namely, control (group A (ketamine 5 mg/kg + xylazine 0.05 mg/kg, group B (propofol 5 mg/kg + xylazine 0.05 mg/kg, group C (propofol 5 mg/kg + ketamine 5 mg/kg, and group D (propofol 2.5 mg/kg + ketamine 2.5 mg/kg + xylazine 0.05 mg/kg. All drugs were administered intravenously. The multimodal therapy decreased significantly (P<0.05 the heart rate in groups A, B, and D. Also respiratory rate significantly (P<0.05 decreased in groups A, B, and D but significantly (P<0.05 increased at 20 min after induction in group C. However, temperature significantly (P<0.05 decreased in groups A, B, and C. The induction was good and smooth in groups B and D. Surgical anaesthetic time was longer in groups B and D and shorter in group C. The quality of recovery was good in groups B and D. Side effects such as salivation and apnoea were observed in all groups. In conclusion, the multimodal therapy could be used successfully. However, group D could be the best combination considering the parameters measured.

  5. Steroid Treatments Equally Effective Against Sudden Deafness

    Science.gov (United States)

    ... NIGMS NIMH NIMHD NINDS NINR NLM CC CIT CSR FIC NCATS NCCIH OD About NIH Who We ... with sudden deafness should discuss the risks and benefits of both treatments with their doctor.” Related Links ...

  6. Herbal Treatment for Anxiety: Is It Effective?

    Science.gov (United States)

    ... anxiety generally need medical treatment or psychological counseling (psychotherapy) for symptoms to improve. With Brent A. Bauer, ... dietary supplements wisely. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/supplements/wiseuse. ...

  7. Randomized Controlled Trial: Multimodal Anxiety and Social Skill Intervention for Adolescents with Autism Spectrum Disorder

    Science.gov (United States)

    White, Susan W.; Ollendick, Thomas; Albano, Anne Marie; Oswald, Donald; Johnson, Cynthia; Southam-Gerow, Michael A.; Kim, Inyoung; Scahill, Lawrence

    2013-01-01

    Anxiety is common among adolescents with autism spectrum disorders (ASD) and may amplify the core social disability, thus necessitating combined treatment approaches. This pilot, randomized controlled trial evaluated the feasibility and preliminary outcomes of the Multimodal Anxiety and Social Skills Intervention (MASSI) program in a sample of 30…

  8. Novel multimodality segmentation using level sets and Jensen-Renyi divergence

    NARCIS (Netherlands)

    Markel, Daniel; Zaidi, Habib; El Naqa, Issam

    2013-01-01

    Purpose: Positron emission tomography (PET) is playing an increasing role in radiotherapy treatment planning. However, despite progress, robust algorithms for PET and multimodal image segmentation are still lacking, especially if the algorithm were extended to image-guided and adaptive radiotherapy

  9. Recent Progress in Synthesis and Functionalization of Multimodal Fluorescent-Magnetic Nanoparticles for Biological Applications

    Directory of Open Access Journals (Sweden)

    Raquel Serrano García

    2018-01-01

    Full Text Available There is a great interest in the development of new nanomaterials for multimodal imaging applications in biology and medicine. Multimodal fluorescent-magnetic based nanomaterials deserve particular attention as they can be used as diagnostic and drug delivery tools, which could facilitate the diagnosis and treatment of cancer and many other diseases. This review focuses on the recent developments of magnetic-fluorescent nanocomposites and their biomedical applications. The recent advances in synthetic strategies and approaches for the preparation of fluorescent-magnetic nanocomposites are presented. The main biomedical uses of multimodal fluorescent-magnetic nanomaterials, including biological imaging, cancer therapy and drug delivery, are discussed, and prospects of this field are outlined.

  10. A randomized controlled trial of multimodal music therapy for children with anxiety disorders.

    Science.gov (United States)

    Goldbeck, Lutz; Ellerkamp, Thomas

    2012-01-01

    Music therapy has been shown to be effective for children with psychopathology, providing an alternative nonverbal approach to the treatment of children with anxiety disorders. This pilot study investigates the efficacy of Multimodal Music Therapy (MMT), a combination of music therapy and cognitive-behavioral therapy, compared to treatment as usual (TAU). Thirty-six children aged 8-12 years with a primary diagnosis of an anxiety disorder were randomly assigned to 15 sessions of MMT or to TAU. Diagnostic status and dimensional outcome variables were assessed at the end of treatment and 4 months later. MMT was superior compared to TAU according to the remission rates after treatment (MMT 67%; TAU 33%; chi2 = 4.0; p = 0.046) and remissions persisted until four months post-treatment. Dimensional measures showed equivalent improvement after either MMT or TAU. The results regarding the efficacy of MMT are promising for children with anxiety disorders. Further evaluation with larger samples and comparisons to pure CBT are recommended.

  11. Long-term benefit of electron beam radiation therapy in the treatment of scleredema of Buschke

    Directory of Open Access Journals (Sweden)

    Tijana Skrepnik, MD

    2016-01-01

    Conclusion: Scleredema of Buschke is a rare connective tissue disorder commonly treated with multimodal therapy, but it can be effectively and durably controlled with RT alone. This case report documents the durability of the benefit achieved with RT and suggests that RT should be considered earlier in the treatment of this disease.

  12. Efficacy and safety of a modular multi-modal exercise program in prostate cancer patients with bone metastases: a randomized controlled trial

    International Nuclear Information System (INIS)

    Galvão, Daniel A; Groom, Geoff; Newton, Robert U; Taaffe, Dennis R; Cormie, Prue; Spry, Nigel; Chambers, Suzanne K; Peddle-McIntyre, Carolyn; Baker, Michael; Denham, James; Joseph, David

    2011-01-01

    The presence of bone metastases has excluded participation of prostate cancer patients in exercise intervention studies to date and is also a relative contraindication to supervised exercise in the community setting because of concerns of fragility fracture. However, this group of patients often have developed significant muscle atrophy and functional impairments from prior and continuing androgen deprivation that is exacerbated by subsequent and more intensive interventions such as chemotherapy. The aim of this study is to determine the efficacy and safety of a modular multi-modal exercise program in prostate cancer patients with bone metastases. Multi-site randomized controlled trial in Western Australia and New South Wales to examine the efficacy and safety of a modular multi-modal physical exercise program in 90 prostate cancer survivors with bone metastases. Participants will be randomized to (1) modular multi-modal exercise intervention group or (2) usual medical care group. The modular multi-modal exercise group will receive a 3-month supervised exercise program based on bone lesion location/extent. Measurements for primary and secondary endpoints will take place at baseline, 3 months (end of the intervention) and 6 months follow-up. Delaying or preventing skeletal complication and improving physical function for men with bone metastases would provide clinically meaningful benefits to patients. However, exercise programs must be designed and executed with careful consideration of the skeletal complications associated with bone metastatic disease and cumulative toxicities from androgen deprivation such as osteoporosis and increased risk of fractures. The results from this study will form the basis for the development of a specific exercise prescription in this patient group in order to alleviate disease burden, counteract the adverse treatment related side-effects and enhance quality of life. ACTRN: http://www.anzctr.org.au/ACTRN12611001158954.aspx

  13. ADMultiImg: a novel missing modality transfer learning based CAD system for diagnosis of MCI due to AD using incomplete multi-modality imaging data

    Science.gov (United States)

    Liu, Xiaonan; Chen, Kewei; Wu, Teresa; Weidman, David; Lure, Fleming; Li, Jing

    2018-02-01

    Alzheimer's Disease (AD) is the most common cause of dementia and currently has no cure. Treatments targeting early stages of AD such as Mild Cognitive Impairment (MCI) may be most effective to deaccelerate AD, thus attracting increasing attention. However, MCI has substantial heterogeneity in that it can be caused by various underlying conditions, not only AD. To detect MCI due to AD, NIA-AA published updated consensus criteria in 2011, in which the use of multi-modality images was highlighted as one of the most promising methods. It is of great interest to develop a CAD system based on automatic, quantitative analysis of multi-modality images and machine learning algorithms to help physicians more adequately diagnose MCI due to AD. The challenge, however, is that multi-modality images are not universally available for many patients due to cost, access, safety, and lack of consent. We developed a novel Missing Modality Transfer Learning (MMTL) algorithm capable of utilizing whatever imaging modalities are available for an MCI patient to diagnose the patient's likelihood of MCI due to AD. Furthermore, we integrated MMTL with radiomics steps including image processing, feature extraction, and feature screening, and a post-processing for uncertainty quantification (UQ), and developed a CAD system called "ADMultiImg" to assist clinical diagnosis of MCI due to AD using multi-modality images together with patient demographic and genetic information. Tested on ADNI date, our system can generate a diagnosis with high accuracy even for patients with only partially available image modalities (AUC=0.94), and therefore may have broad clinical utility.

  14. Ionizing radiation detector using multimode optical fibers

    International Nuclear Information System (INIS)

    Suter, J.J.; Poret, J.C.; Rosen, M.; Rifkind, J.M.

    1993-01-01

    An optical ionizing radiation detector, based on the attenuation of 850-nm light in 50/125-μm multimode fibers, is described. The detector is especially well suited for application on spacecraft because of its small design. The detection element consists of a section of coiled fibers that has been designed to strip higher-order optical modes. Cylindrical radiation shields with atomic numbers ranging from Z = 13 (aluminum too) Z = 82 (lead) were placed around the ionizing radiation detector so that the effectiveness of the detector could be measured. By exposing the shields and the detector to 1.25-MeV cobalt 60 radiation, the mass attenuation coefficients of the shields were measured. The detector is based on the phenomenon that radiation creates optical color centers in glass fibers. Electron spin resonance spectroscopy performed on the 50/125-μm fibers showed the presence of germanium oxide and phosphorus-based color centers. The intensity of these centers is directly related to the accumulated gamma radiation

  15. Multimodality, creativity and children's meaning-making: Drawings ...

    African Journals Online (AJOL)

    Multimodality, creativity and children's meaning-making: Drawings, writings, imaginings. ... Framed by social semiotic theories of communication, multimodal ... to create imaginary worlds and express meanings according to their interests.

  16. Multimodal Behavior Therapy: Case Study of a High School Student.

    Science.gov (United States)

    Seligman, Linda

    1981-01-01

    A case study of a high school student concerned with weight problems illustrates multimodal behavior therapy and its use in a high school setting. Multimodal therapy allows the school counselor to maximize referral sources while emphasizing growth and actualization. (JAC)

  17. Polarization Characterization of a Multi-Moded Feed Structure

    Data.gov (United States)

    National Aeronautics and Space Administration — The Polarization Characterization of a Multi-Moded Feed Structure projects characterize the polarization response of a multi-moded feed horn as an innovative...

  18. A Literature Review On Multimodal Freight Transportation Planning Under Disruptions

    Science.gov (United States)

    Rosyida, E. E.; Santosa, B.; Pujawan, I. N.

    2018-04-01

    This paper reviews publication that focuses on multimodal freight transportation planning under disruptions. In this paper, disruptions are specified by the level of the disruptions occurs and the scope of its effect. This becomes an important distinction since the cause and effect that may occur at different levels. The failure to make this distinction has implications for how we understand and manage. The reviewed papers include those that develop framework, model, and technical procedure for freight transportation. Finally, we provide an outlook of future research directions on the domain of transportation planning.

  19. Effectiveness of propanolol for treatment of infantile haemangioma

    DEFF Research Database (Denmark)

    Andersen, Ida Gillberg; Rechnitzer, Catherine; Charabi, Birgitte

    2014-01-01

    : This study was retrospective and based on a review of children treated for IH with propranolol from the 2010-2012 period at Rigshospitalet. RESULTS: Overall, propranolol was effective in all but one child (97%). The majority of the children (84%) were treated with an initial dose of 1 mg/kg/day, which...... was considered sufficient in most cases (71%). Children who started treatment before five months of age had a significantly better response than children who started treatment at a later age. No relation was found between location of IH and the effect of treatment. There were only few and mild side effects....... CONCLUSION: Propranolol is effective in the treatment of IH and it has only few and mild side effects. In most cases, a low dose of 1 mg/kg/day was sufficient. Early initiation of treatment is recommended as the response to treatment was better in younger children and because early initiation helps prevent...

  20. Multimodale trafiknet i GIS (Multimodal Traffic Network in GIS)

    DEFF Research Database (Denmark)

    Kronbak, Jacob; Brems, Camilla Riff

    1996-01-01

    The report introduces the use of multi-modal traffic networks within a geographical Information System (GIS). The necessary theory of modelling multi-modal traffic network is reviewed and applied to the ARC/INFO GIS by an explorative example.......The report introduces the use of multi-modal traffic networks within a geographical Information System (GIS). The necessary theory of modelling multi-modal traffic network is reviewed and applied to the ARC/INFO GIS by an explorative example....

  1. Effect of aspirin treatment on chondromalacia patellae.

    OpenAIRE

    Bentley, G; Leslie, I J; Fischer, D

    1981-01-01

    Twenty-nine patients (21 females and 8 males) with chondromalacia patellae diagnosed by arthroscopy were randomly allocated to receive aspirin or placebo for 3 months. Clinical and arthroscopic examination after 3 months showed no significant change in symptoms, signs, or macroscopic appearances in either group. Surgical treatment was performed in 14 patients for deteriorating symptoms.

  2. Effect of aspirin treatment on chondromalacia patellae.

    Science.gov (United States)

    Bentley, G; Leslie, I J; Fischer, D

    1981-01-01

    Twenty-nine patients (21 females and 8 males) with chondromalacia patellae diagnosed by arthroscopy were randomly allocated to receive aspirin or placebo for 3 months. Clinical and arthroscopic examination after 3 months showed no significant change in symptoms, signs, or macroscopic appearances in either group. Surgical treatment was performed in 14 patients for deteriorating symptoms. Images PMID:7008711

  3. Musical hallucinations : Review of treatment effects

    NARCIS (Netherlands)

    Coebergh, Jan A. F.; Lauw, R. F.; Bots, R.; Sommer, I. E. C.; Blom, J. D.

    2015-01-01

    Background: Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare. Objective: To review the

  4. Musical hallucinations : review of treatment effects

    NARCIS (Netherlands)

    Coebergh, Jan A F; Lauw, R F; Bots, R; Sommer, I E C; Blom, J D

    2015-01-01

    BACKGROUND: Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare. OBJECTIVE: To review the

  5. Effect of heat treatment temperature on microstructure

    Indian Academy of Sciences (India)

    The results of electrochemical performance measurements for the HCSs as anode material for lithium ion batteries indicate that the discharge capacity of the HCSs is improved after heat treatment at 800°C compared with the as-prepared HCSs and have a maximum value of 357 mAh/g and still retains 303 mAh/g after 40 ...

  6. Effects of plasma treatment on wounds

    NARCIS (Netherlands)

    Tipa, R.S.; Stoffels - Adamowicz, E.; Lim, C.T.; Goh, J.C.H.

    2009-01-01

    Cold plasma treatment of wounds is gaining much interest, because it will offer a non-contact, painless and harmless therapy to manage large-area lesions (burn wounds, chronic ulcerations). One of the important issues in plasma wound healing is the safety of the method. In this work we study in

  7. Effects of ecosystem-based management treatments

    Science.gov (United States)

    Michael G. Harrington; Carl E. Fiedler; Stephen F. Arno; Ward W. McCaughey; Leon J. Theroux; Clinton E. Carlson; Kristin L. Zouhar; Thomas H. DeLuca; Donald J. Bedunah; Dayna M. Ayers; Elizabeth A. Beringer; Sallie J. Hejl; Lynn Bacon; Robert E. Benson; Jane Kapler Smith; Rick Floch

    1999-01-01

    The prescribed burn treatments were applied to reduce pre-existing and new slash fuel loadings, reduce understory tree density to lower crown fire potential, stimulate vigor of decadent understory vegetation, produce mineral seedbeds for seral species establishment, and increase availability of mineral nutrients. To test the feasibility of prescribed burning under a...

  8. Nonparametric Bounds and Sensitivity Analysis of Treatment Effects

    Science.gov (United States)

    Richardson, Amy; Hudgens, Michael G.; Gilbert, Peter B.; Fine, Jason P.

    2015-01-01

    This paper considers conducting inference about the effect of a treatment (or exposure) on an outcome of interest. In the ideal setting where treatment is assigned randomly, under certain assumptions the treatment effect is identifiable from the observable data and inference is straightforward. However, in other settings such as observational studies or randomized trials with noncompliance, the treatment effect is no longer identifiable without relying on untestable assumptions. Nonetheless, the observable data often do provide some information about the effect of treatment, that is, the parameter of interest is partially identifiable. Two approaches are often employed in this setting: (i) bounds are derived for the treatment effect under minimal assumptions, or (ii) additional untestable assumptions are invoked that render the treatment effect identifiable and then sensitivity analysis is conducted to assess how inference about the treatment effect changes as the untestable assumptions are varied. Approaches (i) and (ii) are considered in various settings, including assessing principal strata effects, direct and indirect effects and effects of time-varying exposures. Methods for drawing formal inference about partially identified parameters are also discussed. PMID:25663743

  9. Video genre classification using multimodal features

    Science.gov (United States)

    Jin, Sung Ho; Bae, Tae Meon; Choo, Jin Ho; Ro, Yong Man

    2003-12-01

    We propose a video genre classification method using multimodal features. The proposed method is applied for the preprocessing of automatic video summarization or the retrieval and classification of broadcasting video contents. Through a statistical analysis of low-level and middle-level audio-visual features in video, the proposed method can achieve good performance in classifying several broadcasting genres such as cartoon, drama, music video, news, and sports. In this paper, we adopt MPEG-7 audio-visual descriptors as multimodal features of video contents and evaluate the performance of the classification by feeding the features into a decision tree-based classifier which is trained by CART. The experimental results show that the proposed method can recognize several broadcasting video genres with a high accuracy and the classification performance with multimodal features is superior to the one with unimodal features in the genre classification.

  10. Reference Resolution in Multi-modal Interaction: Position paper

    NARCIS (Netherlands)

    Fernando, T.; Nijholt, Antinus

    2002-01-01

    In this position paper we present our research on multimodal interaction in and with virtual environments. The aim of this presentation is to emphasize the necessity to spend more research on reference resolution in multimodal contexts. In multi-modal interaction the human conversational partner can

  11. Reference resolution in multi-modal interaction: Preliminary observations

    NARCIS (Netherlands)

    González González, G.R.; Nijholt, Antinus

    2002-01-01

    In this paper we present our research on multimodal interaction in and with virtual environments. The aim of this presentation is to emphasize the necessity to spend more research on reference resolution in multimodal contexts. In multi-modal interaction the human conversational partner can apply

  12. Training of Perceptual Motor Skills in Multimodal Virtual Environments

    Directory of Open Access Journals (Sweden)

    Gopher Daniel

    2011-12-01

    Full Text Available Multimodal, immersive, virtual reality (VR techniques open new perspectives for perceptualmotor skill trainers. They also introduce new risks and dangers. This paper describes the benefits and pitfalls of multimodal training and the cognitive building blocks of a multimodal, VR training simulators.

  13. Estimating the effect of treatment rate changes when treatment benefits are heterogeneous: antibiotics and otitis media.

    Science.gov (United States)

    Park, Tae-Ryong; Brooks, John M; Chrischilles, Elizabeth A; Bergus, George

    2008-01-01

    Contrast methods to assess the health effects of a treatment rate change when treatment benefits are heterogeneous across patients. Antibiotic prescribing for children with otitis media (OM) in Iowa Medicaid is the empirical example. Instrumental variable (IV) and linear probability model (LPM) are used to estimate the effect of antibiotic treatments on cure probabilities for children with OM in Iowa Medicaid. Local area physician supply per capita is the instrument in the IV models. Estimates are contrasted in terms of their ability to make inferences for patients whose treatment choices may be affected by a change in population treatment rates. The instrument was positively related to the probability of being prescribed an antibiotic. LPM estimates showed a positive effect of antibiotics on OM patient cure probability while IV estimates showed no relationship between antibiotics and patient cure probability. Linear probability model estimation yields the average effects of the treatment on patients that were treated. IV estimation yields the average effects for patients whose treatment choices were affected by the instrument. As antibiotic treatment effects are heterogeneous across OM patients, our estimates from these approaches are aligned with clinical evidence and theory. The average estimate for treated patients (higher severity) from the LPM model is greater than estimates for patients whose treatment choices are affected by the instrument (lower severity) from the IV models. Based on our IV estimates it appears that lowering antibiotic use in OM patients in Iowa Medicaid did not result in lost cures.

  14. Side effects as influencers of treatment outcome.

    Science.gov (United States)

    Sharif, Zafar

    2008-01-01

    Research relative to the efficacy of a therapeutic agent commands a clinician's greatest interest, but treatment decisions are made based on optimizing efficacy and tolerability/safety considerations. Second-generation atypical antipsychotic drugs are a study in the importance of taking a careful look at the full benefit-risk profile of each drug. The disorders that atypical antipsychotics are approved to treat--schizophrenia, schizoaffective disorder, and bipolar disorder--are associated with an increased rate of certain medical comorbidities compared to the general population. Between-drug differences in efficacy are relatively modest for the atypicals, or between atypicals and conventionals, while differences in safety and tolerability are larger and more clinically relevant. The current article will provide a brief summary of safety-related issues that influence treatment outcome and choice of drug.

  15. PET-MRI and multimodal cancer imaging

    International Nuclear Information System (INIS)

    Wang Taisong; Zhao Jinhua; Song Jianhua

    2011-01-01

    Multimodality imaging, specifically PET-CT, brought a new perspective into the fields of clinical imaging. Clinical cases have shown that PET-CT has great value in clinical diagnosis and experimental research. But PET-CT still bears some limitations. A major drawback is that CT provides only limited soft tissue contrast and exposes the patient to a significant radiation dose. MRI overcome these limitations, it has excellent soft tissue contrast, high temporal and spatial resolution and no radiation damage. Additionally, since MRI provides also functional information, PET-MRI will show a new direction of multimodality imaging in the future. (authors)

  16. Strategy development management of Multimodal Transport Network

    Directory of Open Access Journals (Sweden)

    Nesterova Natalia S.

    2016-01-01

    Full Text Available The article gives a brief overview of works on the development of transport infrastructure for multimodal transportation and integration of Russian transport system into the international transport corridors. The technology for control of the strategy, that changes shape and capacity of Multi-modal Transport Network (MTN, is considered as part of the methodology for designing and development of MTN. This technology allows to carry out strategic and operational management of the strategy implementation based on the use of the balanced scorecard.

  17. A 3?week multimodal intervention involving high?intensity interval training in female cancer survivors: a randomized controlled trial

    OpenAIRE

    Schmitt, Joachim; Lindner, Nathalie; Reuss?Borst, Monika; Holmberg, Hans?Christer; Sperlich, Billy

    2016-01-01

    Abstract To compare the effects of a 3?week multimodal rehabilitation involving supervised high?intensity interval training (HIIT) on female breast cancer survivors with respect to key variables of aerobic fitness, body composition, energy expenditure, cancer?related fatigue, and quality of life to those of a standard multimodal rehabilitation program. A randomized controlled trial design was administered. Twenty?eight women, who had been treated for cancer were randomly assigned to either a ...

  18. Effectiveness of Acupuncture in the Treatment of Gulf War Illness

    Science.gov (United States)

    2013-01-01

    325. 7 Wigers SH, Stiles TC, Vogael PA. Effects of aerobic exercise versus stress management treatment in fibromyalgia : a 4.5 year prospective study... Treatment of Gulf War Illness PRINCIPAL INVESTIGATOR: Lisa Conboy, M.A., M.S., ScD...December 2012 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Effectiveness of Acupuncture in the Treatment of Gulf War Illness 5b. GRANT NUMBER W81XWH

  19. An Efficient Quality-Related Fault Diagnosis Method for Real-Time Multimode Industrial Process

    Directory of Open Access Journals (Sweden)

    Kaixiang Peng

    2017-01-01

    Full Text Available Focusing on quality-related complex industrial process performance monitoring, a novel multimode process monitoring method is proposed in this paper. Firstly, principal component space clustering is implemented under the guidance of quality variables. Through extraction of model tags, clustering information of original training data can be acquired. Secondly, according to multimode characteristics of process data, the monitoring model integrated Gaussian mixture model with total projection to latent structures is effective after building the covariance description form. The multimode total projection to latent structures (MTPLS model is the foundation of problem solving about quality-related monitoring for multimode processes. Then, a comprehensive statistics index is defined which is based on the posterior probability of the monitored samples belonging to each Gaussian component in the Bayesian theory. After that, a combined index is constructed for process monitoring. Finally, motivated by the application of traditional contribution plot in fault diagnosis, a gradient contribution rate is applied for analyzing the variation of variable contribution rate along samples. Our method can ensure the implementation of online fault monitoring and diagnosis for multimode processes. Performances of the whole proposed scheme are verified in a real industrial, hot strip mill process (HSMP compared with some existing methods.

  20. Treatment selection in a randomized clinical trial via covariate-specific treatment effect curves.

    Science.gov (United States)

    Ma, Yunbei; Zhou, Xiao-Hua

    2017-02-01

    For time-to-event data in a randomized clinical trial, we proposed two new methods for selecting an optimal treatment for a patient based on the covariate-specific treatment effect curve, which is used to represent the clinical utility of a predictive biomarker. To select an optimal treatment for a patient with a specific biomarker value, we proposed pointwise confidence intervals for each covariate-specific treatment effect curve and the difference between covariate-specific treatment effect curves of two treatments. Furthermore, to select an optimal treatment for a future biomarker-defined subpopulation of patients, we proposed confidence bands for each covariate-specific treatment effect curve and the difference between each pair of covariate-specific treatment effect curve over a fixed interval of biomarker values. We constructed the confidence bands based on a resampling technique. We also conducted simulation studies to evaluate finite-sample properties of the proposed estimation methods. Finally, we illustrated the application of the proposed method in a real-world data set.

  1. Cost effectiveness of Tuberculosis Treatment from the Patients ...

    African Journals Online (AJOL)

    ... Directly Observed Treatment Short course is more cost effective from the patients' point of view. DOTS needs to be re-focused out of the hospitals and clinics and made community based in view of the increasing TB caseload occasioned by HI V/AIDS. Key Words: Cost effectiveness, Tuberculosis treatment, personal cost, ...

  2. Frequency of streamflow measurements required to determine forest treatment effects

    Science.gov (United States)

    Kenneth G. Reinhart

    1964-01-01

    Most of the stream-discharge records for our experimental watersheds are taken by continuous measurements. But the question arises: are continuous measurements necessary to determine effects of forest treatments? Or could treatment effects be determined by measurement of discharge at intervals, say, once a day or once a week?

  3. Effects of Cancer Treatment on Fertility (For Parents)

    Science.gov (United States)

    ... Mind Sexual Health Food & Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español Effects of Cancer Treatment on Fertility KidsHealth / For Parents / Effects of Cancer Treatment on ...

  4. Adverse effects of orthodontic treatment: A clinical perspective

    Science.gov (United States)

    Talic, Nabeel F.

    2011-01-01

    Orthodontic treatment is associated with a number of adverse effects, such as root resorption, pain, pulpal changes, periodontal disease, and temporomandibular dysfunction (TMD). Orthodontists should be aware of these effects and associated risk factors. Risk factors linked to root resorption include the duration of treatment, length, and shape of the root, trauma history, habits, and genetic predisposition. PMID:24151415

  5. Oculomotor and neuropsychological effects of antipsychotic treatment for schizophrenia

    Directory of Open Access Journals (Sweden)

    Kristian S. Hill

    2009-04-01

    Full Text Available Cognitive enhancement has become an important target for drug therapies in schizophrenia. Treatment development in this area requires assessment approaches that are sensitive to procognitive effects of antipsychotic and adjunctive treatments. Ideally, new treatments will have translational characteristics for parallel human and animal research. Previous studies of antipsychotic effects on cognition have relied primarily on paper-and-pencil neuropsychological testing. No study has directly compared neurophysiological biomarkers and neuropsychological testing as strategies for assessing cognitive effects of antipsychotic treatment early in the course of schizophrenia. Anti psychotic-naive patients with schizophrenia were tested before treatment with risperidone and again 6 weeks later. Matched healthy participants were tested over a similar time period. Test-retest reliability, effect sizes of within-subject change, and multivariate/univariate analysis of variance were used to compare 3 neurophysiological tests (visually guided saccade, memory-guided saccade, and antisaccade with neuropsychological tests covering 4 cognitive domains (executive function, attention, memory, and manual motor function. While both measurement approaches showed robust neurocognitive impairments in patients prior to risperidone treatment, oculomotor biomarkers were more sensitive to treatment-related effects on neurocognitive function than traditional neuropsychological measures. Further, unlike the pattern of modest generalized cognitive improvement suggested by neuropsychological measures, the oculomotor findings revealed a mixed pattern of beneficial and adverse treatment related effects. These findings warrant further investigation regarding the utility of neurophysiological biomarkers for assessing cognitive outcomes of antipsychotic treatment in clinical trials and in early-phase drug development.

  6. Asymmetric inhibitory treatment effects in multilingual aphasia.

    Science.gov (United States)

    Goral, Mira; Naghibolhosseini, Maryam; Conner, Peggy S

    2013-01-01

    Findings from recent psycholinguistic studies of bilingual processing support the hypothesis that both languages of a bilingual are always active and that bilinguals continually engage in processes of language selection. This view aligns with the convergence hypothesis of bilingual language representation. Furthermore, it is hypothesized that when bilinguals perform a task in one language they need to inhibit their other, nontarget language(s) and that stronger inhibition is required when the task is performed in the weaker language than in the stronger one. The study of multilingual individuals who acquire aphasia resulting from a focal brain lesion offers a unique opportunity to test the convergence hypothesis and the inhibition asymmetry. We report on a trilingual person with chronic nonfluent aphasia who at the time of testing demonstrated greater impairment in her first acquired language (Persian) than in her third, later learned language (English). She received treatment in English followed by treatment in Persian. An examination of her connected language production revealed improvement in her grammatical skills in each language following intervention in that language, but decreased grammatical accuracy in English following treatment in Persian. The increased error rate was evident in structures that are used differently in the two languages (e.g., auxiliary verbs). The results support the prediction that greater inhibition is applied to the stronger language than to the weaker language, regardless of their age of acquisition. We interpret the findings as consistent with convergence theories that posit overlapping neuronal representation and simultaneous activation of multiple languages and with proficiency-dependent asymmetric inhibition in multilinguals.

  7. Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Steinbrüchel, Daniel Andreas; Wanscher, Michael Jaeger

    2014-01-01

    BACKGROUND: To evaluate if an opiate sparing multimodal regimen of dexamethasone, gabapentin, ibuprofen and paracetamol had better analgesic effect, less side effects and was safe compared to a traditional morphine and paracetamol regimen after cardiac surgery. METHODS: Open-label, prospective...

  8. Gas detection by correlation spectroscopy employing a multimode diode laser.

    Science.gov (United States)

    Lou, Xiutao; Somesfalean, Gabriel; Zhang, Zhiguo

    2008-05-01

    A gas sensor based on the gas-correlation technique has been developed using a multimode diode laser (MDL) in a dual-beam detection scheme. Measurement of CO(2) mixed with CO as an interfering gas is successfully demonstrated using a 1570 nm tunable MDL. Despite overlapping absorption spectra and occasional mode hops, the interfering signals can be effectively excluded by a statistical procedure including correlation analysis and outlier identification. The gas concentration is retrieved from several pair-correlated signals by a linear-regression scheme, yielding a reliable and accurate measurement. This demonstrates the utility of the unsophisticated MDLs as novel light sources for gas detection applications.

  9. Lymphedema as a Cancer Treatment Side Effect

    Science.gov (United States)

    ... Considerations How Cancer is Treated Side Effects Dating, Sex, and Reproduction Advanced Cancer For Children For Teens For Young Adults For Older Adults Prevention and Healthy Living Cancer.Net Videos Coping With Cancer Research and Advocacy Survivorship Blog ...

  10. Effective operator treatment of the Lipkin model

    International Nuclear Information System (INIS)

    Abraham, K.J.; Vary, J.P.

    2004-01-01

    We analyze the Lipkin model in the strong coupling limit using effective operator techniques. We present both analytical and numerical results for low energy effective Hamiltonians. We investigate the reliability of various approximations used to simplify the nuclear many body problem, such as the cluster approximation. We demonstrate, in explicit examples, certain limits to the validity of the cluster approximation but caution that these limits may be particular to this model where the interactions are of unlimited range

  11. Strategies for maximizing clinical effectiveness in the treatment of schizophrenia.

    Science.gov (United States)

    Tandon, Rajiv; Targum, Steven D; Nasrallah, Henry A; Ross, Ruth

    2006-11-01

    The ultimate clinical objective in the treatment of schizophrenia is to enable affected individuals to lead maximally productive and personally meaningful lives. As with other chronic diseases that lack a definitive cure, the individual's service/recovery plan must include treatment interventions directed towards decreasing manifestations of the illness, rehabilitative services directed towards enhancing adaptive skills, and social support mobilization aimed at optimizing function and quality of life. In this review, we provide a conceptual framework for considering approaches for maximizing the effectiveness of the array of treatments and other services towards promoting recovery of persons with schizophrenia. We discuss pharmacological, psychological, and social strategies that decrease the burden of the disease of schizophrenia on affected individuals and their families while adding the least possible burden of treatment. In view of the multitude of treatments necessary to optimize outcomes for individuals with schizophrenia, effective coordination of these services is essential. In addition to providing best possible clinical assessment and pharmacological treatment, the psychiatrist must function as an effective leader of the treatment team. To do so, however, the psychiatrist must be knowledgeable about the range of available services, must have skills in clinical-administrative leadership, and must accept the responsibility of coordinating the planning and delivery of this multidimensional array of treatments and services. Finally, the effectiveness of providing optimal individualized treatment/rehabilitation is best gauged by measuring progress on multiple effectiveness domains. Approaches for efficient and reliable assessment are discussed.

  12. Using multiple metaphors and multimodalities as a semiotic resource when teaching year 2 students computational strategies

    Science.gov (United States)

    Mildenhall, Paula; Sherriff, Barbara

    2017-06-01

    Recent research indicates that using multimodal learning experiences can be effective in teaching mathematics. Using a social semiotic lens within a participationist framework, this paper reports on a professional learning collaboration with a primary school teacher designed to explore the use of metaphors and modalities in mathematics instruction. This video case study was conducted in a year 2 classroom over two terms, with the focus on building children's understanding of computational strategies. The findings revealed that the teacher was able to successfully plan both multimodal and multiple metaphor learning experiences that acted as semiotic resources to support the children's understanding of abstract mathematics. The study also led to implications for teaching when using multiple metaphors and multimodalities.

  13. Multimodal Transportation: The Case of Laptop from Chongqing in China to Rotterdam in Europe

    Directory of Open Access Journals (Sweden)

    Young Joon Seo

    2017-09-01

    Full Text Available Multimodal transportation is a key component of modern logistics systems, especially for long-distance transnational transportation. This paper explores the various alternative routes for laptop exports from Chongqing, China to Rotterdam, the Netherlands. It selects seven available routes for laptop transportation from Chongqing to Rotterdam. The multimodal model was adopted to demonstrate alternative routes using various factors such as transport cost, transfer cost, transit time, transport distance, document charge, port congestion surcharge, customs charge, confidence index and so on. Among possible alternative routes, the results indicate that the route 6 was the fastest routes except for the air transport (route 7, while the route 1 was the cheapest and safest way. Nonetheless, route 1 may be not suitable for the laptop transport due to the importance of timeliness. The logisticians may able to utilize this research's findings to make a balance between transit time and transport cost for effective multimodal transport of laptops from Chongqing to Rotterdam.

  14. Performance of Series Connected GaAs Photovoltaic Converters under Multimode Optical Fiber Illumination

    Directory of Open Access Journals (Sweden)

    Tiqiang Shan

    2014-01-01

    Full Text Available In many military and industrial applications, GaAs photovoltaic (PV converters are connected in series in order to generate the required voltage compatible with most common electronics. Multimode optical fibers are usually used to carry high-intensity laser and illuminate the series connected GaAs PV converters in real time. However, multimode optical fiber illumination has a speckled intensity pattern. The series connected PV array is extremely sensitive to nonuniform illumination; its performance is limited severely by the converter that is illuminated the least. This paper quantifies the effects of multimode optical fiber illumination on the performance of series connected GaAs PV converters, analyzes the loss mechanisms due to speckles, and discusses the maximum illumination efficiency. In order to describe the illumination dependent behavior detailedly, modeling of the series connected PV array is accomplished based on the equivalent circuit for PV cells. Finally, a series of experiments are carried out to demonstrate the theory analysis.

  15. Fibromyalgia Syndrome in Need of Effective Treatments

    Science.gov (United States)

    Tsilioni, Irene; Arbetman, Lauren; Panagiotidou, Smaro; Stewart, Julia M.; Gleason, Rae M.; Russell, Irwin J.

    2015-01-01

    Fibromyalgia syndrome (FMS) is a chronic, idiopathic condition of widespread musculoskeletal pain, affecting primarily women. It is clinically characterized by chronic, nonarticular pain and a heightened response to pressure along with sleep disturbances, fatigue, bowel and bladder abnormalities, and cognitive dysfunction. The diagnostic criteria have changed repeatedly, and there is neither a definitive pathogenesis nor reliable diagnostic or prognostic biomarkers. Clinical and laboratory studies have provided evidence of altered central pain pathways. Recent evidence suggests the involvement of neuroinflammation with stress peptides triggering the release of neurosenzitizing mediators. The management of FMS requires a multidimensional approach including patient education, behavioral therapy, exercise, and pain management. Here we review recent data on the pathogenesis and propose new directions for research and treatment. PMID:26306765

  16. A multi-modal training programme to improve physical activity, physical fitness and perceived physical ability in obese children.

    Science.gov (United States)

    Morano, Milena; Colella, Dario; Rutigliano, Irene; Fiore, Pietro; Pettoello-Mantovani, Massimo; Campanozzi, Angelo

    2014-01-01

    Actual and perceived physical abilities are important correlates of physical activity (PA) and fitness, but little research has explored these relationships over time in obese children. This study was designed: (a) to assess the feasibility of a multi-modal training programme promoting changes in PA, fundamental motor skills and real and perceived physical abilities of obese children; and (b) to explore cross-sectional and longitudinal relationships between real and perceived physical competence in boys and girls. Forty-one participants (9.2 ± 1.2 years) were assessed before and after an 8-month intervention with respect to body composition, physical fitness, self-reported PA and perceived physical ability. After treatment, obese children reported improvements in the body mass index, PA levels, gross motor performance and actual and perceived physical abilities. Real and perceived physical competence was correlated in boys, but not in girls. Results indicate that a multi-modal programme focused on actual and perceived physical competence as associated with the gradual increase in the volume of activity might be an effective strategy to improve adherence of the participants and to increase the lifelong exercise skills of obese children.

  17. The oral adverse effects of isotretinoin treatment in acne vulgaris ...

    African Journals Online (AJOL)

    Background: Isotretinoin is the most effective therapy to treat severe acne vulgaris and its systemic adverse effects have been well documented, but little is known on dental side effects over the course of treatment. Objectives: This prospective case-control study aimed to evaluate the oral adverse effects of isotretinoin in ...

  18. Effectiveness of cryotherapy treatment for cervical intraepithelial neoplasia.

    Science.gov (United States)

    Luciani, Silvana; Gonzales, Miguel; Munoz, Sergio; Jeronimo, Jose; Robles, Sylvia

    2008-05-01

    To assess the effectiveness of cryotherapy treatment delivered by general practitioners in primary care settings, as part of a screen-and-treat approach for cervical cancer prevention. Women aged between 25 and 49 years residing in San Martin, Peru, who were positive on visual inspection screening were treated, if eligible, with cryotherapy following biopsy. At 12 months post cryotherapy treatment the participants were evaluated for treatment effectiveness and examined by visual inspection and Papanicolaou test and, if positive, referred to a gynecologist for colposcopy and biopsy. Cryotherapy treatment was performed for 1398 women; of these, 531 (38%) had a histology result of cervical intraepithelial neoplasia (CIN). Cryotherapy effectively cured CIN in 418 (88%) women, including 49 (70%) women with a baseline diagnosis of CIN 3. Cryotherapy is an effective treatment for cervical precancerous lesions; it can easily be administered by general practitioners in primary care settings following visual inspection screening.

  19. Reading Multimodal Texts for Learning – a Model for Cultivating Multimodal Literacy

    Directory of Open Access Journals (Sweden)

    Kristina Danielsson

    2016-08-01

    Full Text Available The re-conceptualisation of texts over the last 20 years, as well as the development of a multimodal understanding of communication and representation of knowledge, has profound consequences for the reading and understanding of multimodal texts, not least in educational contexts. However, if teachers and students are given tools to “unwrap” multimodal texts, they can develop a deeper understanding of texts, information structures, and the textual organisation of knowledge. This article presents a model for working with multimodal texts in education with the intention to highlight mutual multimodal text analysis in relation to the subject content. Examples are taken from a Singaporean science textbook as well as a Chilean science textbook, in order to demonstrate that the framework is versatile and applicable across different cultural contexts. The model takes into account the following aspects of texts: the general structure, how different semiotic resources operate, the ways in which different resources are combined (including coherence, the use of figurative language, and explicit/implicit values. Since learning operates on different dimensions – such as social and affective dimensions besides the cognitive ones – our inclusion of figurative language and values as components for textual analysis is a contribution to multimodal text analysis for learning.

  20. Randomized Controlled Trial: Multimodal Anxiety and Social Skill Intervention for Adolescents with Autism Spectrum Disorder

    OpenAIRE

    White, Susan W.; Ollendick, Thomas; Albano, Anne Marie; Oswald, Donald; Johnson, Cynthia; Southam-Gerow, Michael A.; Kim, Inyoung; Scahill, Lawrence

    2013-01-01

    Anxiety is common among adolescents with autism spectrum disorders (ASD) and may amplify the core social disability, thus necessitating combined treatment approaches. This pilot, randomized controlled trial (RCT) evaluated the feasibility and preliminary outcomes of the Multimodal Anxiety and Social Skills Intervention (MASSI) program in a sample of 30 adolescents with ASD and anxiety symptoms of moderate or greater severity. The treatment was acceptable to families, subject adherence was hig...