WorldWideScience

Sample records for effective multimodality treatment

  1. [Effectiveness of an inpatient multimodal psychiatric-psychotherapeutic program for the treatment of job burnout].

    Science.gov (United States)

    Schwarzkopf, Kathleen; Conrad, Nathalie; Straus, Doris; Porschke, Hildburg; von Känel, Roland

    2016-03-16

    We studied the clinical course and long-term effects of inpatient treatment in 723 patients with job burnout referred with an ICD-10 F diagnosis and Z73.0 code («overwhelming exhaustion») to a Swiss hospital specialized in the treatment of job stress-related disorders. Patients were characterized in terms of age, gender, socioeconomic status. Self-rated psychological measures related to general and burnout-specific symptoms (i. e., emotional exhaustion, depersonalization, and diminished personal accomplishments) were applied before and after a six-week treatment program, as well as at 15 months after hospital discharge in 232 patients. The results show that the multimodal inpatient psychiatric-psychotherapeutic treatment was successful with a sustainable effect on psychological well-being (>90 %), including improvements regarding emotional exhaustion, depersonalization and personal accomplishments as well as professional reintegration in 71 % of cases.

  2. Treatment Approaches for Interstitial Cystitis: Multimodality Therapy

    Science.gov (United States)

    Evans, Robert J

    2002-01-01

    Interstitial cystitis is an increasingly common disease characterized by urgency, frequency, and pelvic pain. Its etiology is poorly understood but is likely to be multifactorial. A proposed pathophysiology describing a cascade of events, including epithelial dysfunction, mast cell activation, and neurogenic inflammation, is presented. Using this model, multimodality therapy regimens have been developed that treat all components of this cascade. Multimodality therapy appears more effective than single agents in the treatment of interstitial cystitis. PMID:16986029

  3. 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

  4. [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

  5. 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.)

  6. 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.)

  7. Potential effects of multimodal psychosomatic inpatient treatment for patients with functional vertigo and dizziness symptoms - A pilot trial.

    Science.gov (United States)

    Limburg, Karina; Schmid-Mühlbauer, Gabriele; Sattel, Heribert; Dinkel, Andreas; Radziej, Katharina; Gonzales, Melanie; Ronel, Joram; Lahmann, Claas

    2018-03-30

    Functional vertigo and dizziness (VD) are frequent and severely distressing complaints that are often described as hard to treat. Our aim was to provide preliminary data on potential effects of multimodal psychosomatic inpatient therapy for patients with functional VD symptoms in reducing vertigo-related handicap and related psychopathology, and to evaluate the role of symptom burden and body-related locus of control in predicting vertigo-related handicap at follow-up. We conducted an uncontrolled clinical pilot trial. We included data of n = 72 inpatients with functional VD as a primary symptom and various psychopathological and/or physical comorbidities admitted for multimodal psychosomatic inpatient treatment. Patients completed self-report questionnaires assessing vertigo-related handicap (VHQ), somatization (PHQ-15), depression (BDI-II), anxiety (BAI), health-related quality of life (HRQOL; SF-36), and body-related locus of control (KLC) at admission (T0), discharge (T1), and 6 months after discharge (T2). We observed medium effects for the change of vertigo-related handicap (T0-T1: g = -0.60, T0-T2: g = -0.67) and small effects for the change of somatization (T0-T1: g = -0.29, T0-T2: g = -0.24), mental HRQOL (T0-T1: g = 0.43, T0-T2: g = 0.49), and depression (T0-T1: g = -0.41, T0-T2: g = -0.28) from admission to discharge and admission to follow-up. Body-related locus of control did not predict vertigo-related handicap at follow-up. Findings provide preliminary evidence for the beneficial role of psychosomatic inpatient treatment for patients with functional VD symptoms. Potentially relevant predictors of outcome at follow-up are discussed. The change of vertigo-related handicap and related variables through multimodal psychosomatic inpatient treatment was evaluated in a clinical pilot trial in patients with functional vertigo and dizziness. We observed medium effects for the change of vertigo-related handicap and small effects for the

  8. 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.

  9. 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...

  10. 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

  11. Allergic Fungal Rhinosinusitis - Outcomes of Multimodality Treatment

    OpenAIRE

    Baisakhi Bakat; Subhendu Chowdhury; Amitabha Roy Chowdhury; Soumitra Ghosh; Barin Kumar Roychaudhuri

    2013-01-01

    Abstract Objective : To evaluate the treatment outcomes of multimodality therapy for allergic fungal rhinosinusitis. Study Design: Prospective Observational Study. Materials&methods : This study was carried out in the department of ENT & Head neck Surgery, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata from January 2010 to July 2011. During this study period of one & half years, 20 subjects having Allergic Fungal Sinusitis were selected fr...

  12. 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.

  13. 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

  14. Melanoma of the clavicular region: multimodal treatment.

    Science.gov (United States)

    Lam, L; Krementz, E; McGinness, C; Godfrey, R

    2001-09-01

    Treatment for melanoma that has metastasized to the supraclavicular nodes should be intensive and use a multimodality approach. Retrospective analysis of clinical records. Six primary care centers, 2 of which were referral centers. Eighteen patients diagnosed as having a rare pattern of advanced melanoma metastatic to the clavicular region. Combined radiotherapy, chemotherapy, and thorough surgical excision of the affected nodal basins. Length of survival from time of diagnosis and treatment to time of follow-up. Median survival among the 18 patients was 28 months with a 22% survival rate at 5 years after diagnosis. Among patients who received radiotherapy to the clavicular node basin, mean length of survival was 88.7 months with a 50% 5-year survival rate compared with a mean length of survival of 33.8 months and an 8.3% 5-year survival rate in patients who did not receive radiotherapy (Pbasin and continued to be disease-free at 82 and 130 months. All long-term survivors had been treated with intra-arterial chemotherapy. In a series of patients with malignant melanoma metastatic to the clavicular lymph nodes, multimodality treatment using radiotherapy, chemotherapy, and thorough surgical excision of affected nodal basins provided an appreciable 5-year survival rate.

  15. Rotational memory effect of a multimode fiber

    NARCIS (Netherlands)

    Amitonova, Lyubov V.; Mosk, Allard P.; Pinkse, Pepijn W. H.

    2015-01-01

    We demonstrate the rotational memory effect in a multimode fiber. Rotating the incident wavefront around the fiber core axis leads to a rotation of the resulting pattern of the fiber output without significant changes in the resulting speckle pattern. The rotational memory effect can be exploited

  16. 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

  17. Multimodality

    DEFF Research Database (Denmark)

    Buhl, Mie

    2010-01-01

    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......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...... useful for developing pedagogies where a synergy of different symbol systems facilitates new and flexible learning situations that can meet different needs of different learners. The present paper includes an example from a Danish university program...

  18. [Multimodal treatment of pain and nausea in breast cancer surgery

    DEFF Research Database (Denmark)

    Gartner, R.; Kroman, N.; Callesen, T.

    2008-01-01

    severe PONV and vomiting resistant to treatment. Upon arrival at the recovery 15% of the patients were in a state of moderate to severe sedation. This number was 1.5% 75 minutes later. CONCLUSION: It is possible with a multimodal opioid-sparing prevention and treatment regime for pain and PONV to gain......INTRODUCTION: Every year 4000 women in Denmark undergo surgery for breast cancer. According to published literature approximately 50% suffer from post-operative nausea and vomiting (PONV) and moderate pain. No national guidelines are available regarding the treatment or prevention of pain and PONV...... associated with surgery for these patients. MATERIALS AND METHODS: 116 consecutive patients scheduled for breast cancer surgery were prospectively scored according to pain, PONV and sedation after being introduced to a combined evidence-based, empiric multimodal opioid-sparing prevention and treatment regime...

  19. 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

  20. The Effect of a Complex Multi-modality Ayurvedic Treatment in a Case of Unknown Female Infertility.

    Science.gov (United States)

    Kessler, Christian; Stapelfeldt, Elmar; Michalsen, Andreas; Kowalcek, Ingrid; Kronpaß, Ludwig; Dhruva, Anand

    2015-01-01

    Treatment of female infertility has been growing globally in recent years. In spite of improvements in medical strategies and the improved outcomes for infertile couples, treatment attempts remain largely unsuccessful. A growing number of patients pursue complementary and alternative medicine treatment options like Ayurveda that offers a variety of inpatient and outpatient treatments for infertility. A case of a 38 year-old woman with infertility of unknown origin is presented. She received 18 conventional fertility treatments in 5 different fertility centers and 3 different countries. After several complications, the patient quitted conventional treatment and admitted to an Ayurvedic outpatient clinic where she received a complex Ayurvedic treatment, which included botanicals, dietary and lifestyle advice, manual therapy, yoga, and spiritual elements. The patient then became pregnant and gave birth to a healthy boy in 2012. Ayurveda may be a useful complementary option in the case of futile conventional treatment attempts in female infertility. Nevertheless, the evidence base for Ayurvedic interventions remains weak and requires well-designed clinical trials. This case raises some questions, such as whether the exposure to a large number of assisted reproduction procedures can lead to more health problems than health benefits. The Ayurvedic approach to fertility strives first to improve the health of the patient leading to a higher likelihood of pregnancy. As this is a case report, we are not able to exclude temporal factors stimulating the pregnancy. However, the chronology suggests that this approach might have been an important factor in the eventual pregnancy. © 2015 S. Karger GmbH, Freiburg.

  1. Choledocholithiasis during Pregnancy: Multimodal Approach Treatment

    Directory of Open Access Journals (Sweden)

    Hendra Koncoro

    2016-05-01

    Full Text Available Pregnancy is an important risk factor for growth of choledochal stones. Since choledocholithiasis encountered during pregnancy, which is also a possible cause of pancreatitis and cholangitis, may be the reason for serious morbidity and mortality both for the mother and the fetus, it should be treated. In this article, the results and reliability of endoscopic retrograde cholangiopancreatography (ERCP application on a pregnant woman accompanied with percutaneous biliary procedures are presented. We report a case of 33-year-old woman at 19th week of gestation with cholestatic jaundice due to a common bile duct (CBD stone managed by endoscopic retrograde cholangiopancreatography (ERCP. The patient had post ERCP pancreatitis which resolved with medical management. Percutaneous cholecystostomy was also performed to control source of infection in the gallbladder. ERCP is the first procedure that will be preferred in the treatment of choledocholithiasis in pregnancy with the right indications provided that proper precautions have been taken. Possible harmful effects of ionized radiation on fetus during fluoroscopy should be minimalized by giving in short periods and low doses.

  2. Multimodality

    DEFF Research Database (Denmark)

    Buhl, Mie

    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......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...... for developing pedagogies where a synergy of different symbol systems facilitates new and flexible learning situations that can meet different needs of different learners. The present paper includes an example from a Danish university program....

  3. 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.

  4. [The results of multimodal treatment in retinoblastoma].

    Science.gov (United States)

    Zemba, M; Voinea, S; Dragomir, M; Blidaru, A

    1998-01-01

    The paper is a retrospective study about complex treatment (surgery, chemotherapy and radiotherapy) in a group of 25 patients with retinoblastoma. The best results were in patients with early diagnosis, who came soon after surgery for chemotherapy and radiotherapy. Non presentation for chemotherapy and radiotherapy was the main cause of therapeutical fail.

  5. Esthesioneuroblastoma in childhood and adolescence. Better prognosis with multimodal treatment?

    International Nuclear Information System (INIS)

    Eich, H.T.; Mueller, R.P.; Kocher, M.; Micke, O.; Berthold, F.; Hero, B.

    2005-01-01

    Background and purpose: only 3% of all malignant intranasal tumors are esthesioneuroblastomas (ENB) and only 20% of these rare neuroectodermal tumors are diagnosed up to 20 years of age. Radiotherapy and surgery are established treatment modalities for these patients, but the role of chemotherapy, especially in a multimodal approach, is not well defined. To investigate the influence of radio- and chemotherapy, the treatment and course of the disease in children and adolescents with ENB were analyzed retrospectively. Patients and methods: 19 unselected patients (nine male and ten female) diagnosed with ENB ≤ 20 years of age were included in this analysis. Median age at diagnosis was 14.0 years (range, 5-20 years). The tumors were Kadish stage B in 4/19 patients and stage C in 15/19 patients. 17 patients underwent surgery, either without further therapy (n = 4), followed by radiotherapy (n = 1) or as part of multimodal regimens (n = 12). Two patients received radio- and chemotherapy without surgery. Complete resection (RO) was achieved in 15 out of 17 patients with surgery including all five patients with preoperative chemotherapy due to unresectable primary at diagnosis. Results: the 5-year overall survival (OS) for the whole group was 73% ± 12% and the 5-year event-free survival (EFS) 55% ± 13%. None of the four patients with stage B experienced tumor progression so far, whereas seven out of 15 patients with stage C did (5-year EFS 47% ± 14%; not significant). Patients with Kadish stage C and multimodal treatment strategies combing surgery, chemo- and radiotherapy had a significantly better outcome than patients with stage C and less than three treatment modalities (65% ± 17% vs. 20% ± 18%; p = 0.02). Conclusion: these data indicate a benefit of multimodal treatment regimens combining surgery, chemo- and radiotherapy for pediatric patients with ENB Kadish stage C. Chemotherapy appears to improve resectability, EFS, and OS. Radiotherapy is an integral part in

  6. 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.

  7. DEVELOPMENT OF A MULTIMODAL MONTE CARLO BASED TREATMENT PLANNING SYSTEM.

    Science.gov (United States)

    Kumada, Hiroaki; Takada, Kenta; Sakurai, Yoshinori; Suzuki, Minoru; Takata, Takushi; Sakurai, Hideyuki; Matsumura, Akira; Sakae, Takeji

    2017-10-26

    To establish boron neutron capture therapy (BNCT), the University of Tsukuba is developing a treatment device and peripheral devices required in BNCT, such as a treatment planning system. We are developing a new multimodal Monte Carlo based treatment planning system (developing code: Tsukuba Plan). Tsukuba Plan allows for dose estimation in proton therapy, X-ray therapy and heavy ion therapy in addition to BNCT because the system employs PHITS as the Monte Carlo dose calculation engine. Regarding BNCT, several verifications of the system are being carried out for its practical usage. The verification results demonstrate that Tsukuba Plan allows for accurate estimation of thermal neutron flux and gamma-ray dose as fundamental radiations of dosimetry in BNCT. In addition to the practical use of Tsukuba Plan in BNCT, we are investigating its application to other radiation therapies. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  8. [Multimodal treatment of pain and nausea in breast cancer surgery

    DEFF Research Database (Denmark)

    Gartner, R.; Kroman, N.; Callesen, T.

    2008-01-01

    INTRODUCTION: Every year 4000 women in Denmark undergo surgery for breast cancer. According to published literature approximately 50% suffer from post-operative nausea and vomiting (PONV) and moderate pain. No national guidelines are available regarding the treatment or prevention of pain and PONV...... as under mobilization on the evening of the operation and the next morning. Morphine consumption in the recovery room was, on average, 2 mg per patient. Only 1.5% of the patients were given morphine in the department. Five patients were troubled by light PONV, one by moderate PONV and another suffered from...... severe PONV and vomiting resistant to treatment. Upon arrival at the recovery 15% of the patients were in a state of moderate to severe sedation. This number was 1.5% 75 minutes later. CONCLUSION: It is possible with a multimodal opioid-sparing prevention and treatment regime for pain and PONV to gain...

  9. 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.

  10. Huge hepatocellular carcinoma with multiple intrahepatic metastases: An aggressive multimodal treatment

    Directory of Open Access Journals (Sweden)

    Satoshi Yasuda

    2015-01-01

    Conclusion: Multimodal treatment involving hepatectomy and TACE might be a good treatment strategy for patients with huge HCC with multiple intrahepatic metastases if the tumors are localized in the liver without distant or peritoneal metastasis.

  11. A multimodal day treatment program for multi-problem young adults: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Luijks, Marie-jolette A.; Bevaart, Floor; Zijlmans, Josjan; Van Duin, Laura; Marhe, Reshmi; Doreleijers, Theo A H; Tiemeier, Henning; Asscher, Jessica J.|info:eu-repo/dai/nl/288661834; Popma, Arne

    2017-01-01

    Background Effective interventions for young adults with severe, multiple problems – such as psychosocial and psychiatric problems, delinquency, unemployment and substance use – are scarce but urgently needed in order to support an adequate transition to adulthood. A multimodal day treatment program

  12. 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

  13. Persistence of Diabetes and Hypertension after Multimodal Treatment of Acromegaly.

    Science.gov (United States)

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

    2018-03-30

    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. 522 patients with acromegaly treated according to a pre-established 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: a) Surgical remission (n=122), b) Pharmacologically controlled (n=92), c) Active disease (n=148), d) IGF-1 discordance (n=64) and e) 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 upon the last visit than in the general population. Diabetes was less prevalent upon 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 x ULN, with the persistence of active acromegaly, the presence of hypertension upon the last visit, with the presence of a macroadenoma and with female gender. 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 co-morbidity.

  14. 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.

  15. Multimodality treatment of a massive cervicothoracic lymphatic-venous malformation in a 13-year-old boy

    Directory of Open Access Journals (Sweden)

    Cynthia Reyes, MD, FACS, FAAP

    2017-06-01

    Full Text Available We report the multi-modality treatment of a massive cervicothoracic lymphatic-venous malformation (LVM in a 13-year-old boy that was present at birth as a small cervical mass. At four years of age, sclerotherapy significantly reduced the size of the malformation but over subsequent years the mass increased dramatically in size and resulted in a consumptive coagulopathy and limited left shoulder function. Treatment with sildenafil was without effect. The consumptive coagulopathy improved with subcutaneous enoxaparin. A multi-disciplinary team excised part of the mass when he was 11 years old. After surgery, gradual enlargement of the mass and rise in d-dimer prompted treatment with sirolimus. Two sessions of sclerotherapy arrested enlargement of the mass. Multi-modality treatment resulted in a marked reduction of the LVM in the child. However, enlargement of the mass and further treatment is anticipated as a cure has not yet been found.

  16. The effect of a multimodal intervention on treatment-related symptoms in patients undergoing hematopoietic stem cell transplantation: a randomized controlled trial

    DEFF Research Database (Denmark)

    Jarden, Mary; Nelausen, Knud; Hovgaard, Doris

    2009-01-01

    Studies applying exercise, relaxation training, and psychoeducation have each indicated a positive impact on physical performance and/or psychological factors in patients diagnosed with cancer. We explored the longitudinal effect of a combination of these interventions on treatment-related symptoms...... in patients undergoing myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT). Forty-two patients (18-65 years) were randomized either to an intervention or a control group. The intervention group received standard treatment and care, and a supervised four- to six-week structured...... exercise program, progressive relaxation, and psychoeducation during hospitalization, one hour per day for five days per week. The control group received standard treatment, care, and physiotherapy. A 24-item symptom assessment questionnaire was completed weekly during hospitalization, and at three and six...

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

    OpenAIRE

    Adamsen, Lis; Quist, Morten; Andersen, Christina; M?ller, Tom; Herrstedt, J?rn; Kronborg, Dorte; Baadsgaard, Marie T; Vistisen, Kirsten; Midtgaard, Julie; Christiansen, Birgitte; Stage, Maria; Kronborg, Morten T; R?rth, Mikael

    2009-01-01

    Objective To assess the effect of a multimodal group exercise intervention, as an adjunct to conventional care, on fatigue, physical capacity, general wellbeing, physical activity, and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment 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...

  18. 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)

  19. Effect of multimodality chest physiotherapy in prevention of ventilator-associated pneumonia: A randomized clinical trial.

    Science.gov (United States)

    Pattanshetty, Renu B; Gaude, G S

    2010-04-01

    Despite remarkable progress that has been achieved in the recent years in the diagnosis, prevention, and therapy for ventilator-associated pneumonia (VAP), this disease continues to create complication during the course of treatment in a significant proportion of patients while receiving mechanical ventilation. This study was designed to evaluate the effect of multimodality chest physiotherapy in intubated and mechanically ventilated patients undergoing treatment in the intensive care units (ICUs) for prevention of VAP. A total of 101 adult intubated and mechanically ventilated patients were included in this study. Manual hyperinflation (MH) and suctioning were administered to patients in the control group (n = 51), and positioning and chest wall vibrations in addition to MH plus suctioning (multimodality chest physiotherapy) were administered to patients in the study group (n = 50) till they were extubated. Both the groups were subjected to treatment twice a day. Standard care in the form of routine nursing care, pharmacological therapy, inhalation therapy, as advised by the concerned physician/surgeon was strictly implemented throughout the intervention period. Data were analyzed using SPSS window version 9.0. The Clinical Pulmonary infection Score (CPIS) Score showed significant decrease at the end of extubation/successful outcome or discharge in both the groups (P = 0.00). In addition, significant decrease in mortality rate was noted in the study group (24%) as compared to the control group (49%) (P = 0.007). It was observed in this study that twice-daily multimodality chest physiotherapy was associated with a significant decrease in the CPIS Scores in the study group as compared to the control group suggesting a decrease in the occurrence of VAP. There was also a significant reduction in the mortality rates with the use of multimodality chest physiotherapy in mechanically ventilated patients.

  20. 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.

  1. 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…

  2. 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.

  3. 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…

  4. 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…

  5. Dissociative electron attachment: Threshold phenomena and multimode effects

    International Nuclear Information System (INIS)

    Fabrikant, Ilya I

    2009-01-01

    We present a summary of recent progress on studies of threshold phenomena in low-energy dissociative electron attachment to polyatomic molecules: vibrational Feshbach resonances and threshold cusps. The theoretical approach is based on the resonance R-matrix theory. It allows us to analyze threshold effects in other channels, particularly vibrational excitation. If the molecular long-range field is not strong enough, virtual-state cusps are observed at vibrational excitation thresholds. The second part of the paper illustrates the multimode effects in dissociative attachment using attachment to the CF 3 Cl molecule as an example. Symmetric stretch C-Cl vibrations v 3 and symmetric deformation (or so-called u mbrella ) vibrations v 2 are included. Calculations allow us to study the final-state vibrational distribution in the CF 3 (v 2 ) fragment.

  6. 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.

  7. Adaptive multimodal treatment for children with attention-deficit-/hyperactivity disorder: an 18 month follow-up.

    Science.gov (United States)

    Döpfner, Manfred; Ise, Elena; Wolff Metternich-Kaizman, Tanja; Schürmann, Stephanie; Rademacher, Christiane; Breuer, Dieter

    2015-02-01

    The Cologne Adaptive Multimodal Treatment (CAMT) study demonstrated that adaptive and individually tailored multimodal treatment for attention-deficit/hyperactivity disorder (ADHD) [consisting of behavior therapy (BT) and/or stimulant medication] is highly effective. This study reports findings of the 18 month follow-up assessment. Parents and teachers completed broad range behavior scales (Child Behavior Checklist/Teacher Report Form) and standardized ADHD and oppositional defiant disorder/conduct disorder symptom rating scales. Children that used medication to treat ADHD at follow-up (N = 32) and those that did not (N = 34) were analyzed separately. Parents did not report significant changes in child behavior from posttest to follow-up. Teacher ratings revealed some aggravation of ADHD symptoms in children that received medication, but this was not significant after Bonferroni correction. The initial advantage of combined treatment over BT was no longer evident. It can be concluded that treatment for ADHD that is tailored to the assessed needs of children results in large treatment effects that are maintained for at least 18 months.

  8. 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

  9. Gold nanoparticle-mediated photothermal therapy: applications and opportunities for multimodal cancer treatment.

    Science.gov (United States)

    Riley, Rachel S; Day, Emily S

    2017-07-01

    Photothermal therapy (PTT), in which nanoparticles embedded within tumors generate heat in response to exogenously applied laser light, has been well documented as an independent strategy for highly selective cancer treatment. Gold-based nanoparticles are the main mediators of PTT because they offer: (1) biocompatibility, (2) small diameters that enable tumor penetration upon systemic delivery, (3) simple gold-thiol bioconjugation chemistry for the attachment of desired molecules, (4) efficient light-to-heat conversion, and (5) the ability to be tuned to absorb near-infrared light, which penetrates tissue more deeply than other wavelengths of light. In addition to acting as a standalone therapy, gold nanoparticle-mediated PTT has recently been evaluated in combination with other therapies, such as chemotherapy, gene regulation, and immunotherapy, for enhanced anti-tumor effects. When delivered independently, the therapeutic success of molecular agents is hindered by premature degradation, insufficient tumor delivery, and off-target toxicity. PTT can overcome these limitations by enhancing tumor- or cell-specific delivery of these agents or by sensitizing cancer cells to these additional therapies. All together, these benefits can enhance the therapeutic success of both PTT and the secondary treatment while lowering the required doses of the individual agents, leading to fewer off-target effects. Given the benefits of combining gold nanoparticle-mediated PTT with other treatment strategies, many exciting opportunities for multimodal cancer treatment are emerging that will ultimately lead to improved patient outcomes. WIREs Nanomed Nanobiotechnol 2017, 9:e1449. doi: 10.1002/wnan.1449 For further resources related to this article, please visit the WIREs website. © 2017 Wiley Periodicals, Inc.

  10. 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.

  11. 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…

  12. 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.; Arnold, L. Eugene; 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

    2013-01-01

    Objective: 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…

  13. 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…

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma.

    Science.gov (United States)

    Kostron, Arthur; Friess, Martina; Crameri, Ornella; Inci, Ilhan; Schneiter, Didier; Hillinger, Sven; Stahel, Rolf; Weder, Walter; Opitz, Isabelle

    2016-05-01

    To analyse the relapse pattern and influence of second-line treatment after recurrence of malignant pleural mesothelioma (MPM) in patients who had previously undergone multimodality treatment. Between September 1999 and December 2013, 136 patients underwent macroscopic complete resection (MCR) by extrapleural pneumonectomy after induction chemotherapy for MPM. We analysed 106 patients who presented with recurrent disease until October 2014. Data were retrieved from our mesothelioma database, with additional information regarding precise localization gathered by reviewing the imaging and medical records. The overall recurrence rate was 78% (106/136 patients). The median freedom from recurrence was 9 months after surgery [95% confidence interval (95% CI) 7-10]. Local recurrence only was observed in 33 patients (31%), distant metastases only in 27 patients (26%) and simultaneous distant and local recurrence in 46 patients (43%). Local recurrence was observed significantly less frequently in patients having received adjuvant radiotherapy (19 vs 47%, P = 0.003), but there was no significant impact on overall survival (OS) [radiation: 22 months (95% CI 19-24); no-radiation: 23 months (95% CI 18-27), P = 0.6]. The median OS was 22 months (95% CI 21-24), median post-recurrence survival (PRS) was 7 months (95% CI 5-9) and patients with local recurrence only survived significantly longer (12 months, 95% CI 8-16) compared with patients with distant recurrence only (5 months, 95% CI 2-8) or distant plus local relapse (6 months, 95% CI 3-9; P = 0.04). A total of 78 patients received a second-line therapy after tumour recurrence: chemotherapy (n = 48), local radiotherapy (n = 9), surgery (n = 10) or a combination thereof (n = 11). Patients undergoing second-line treatment survived significantly longer compared with patients not receiving therapy (P treatment including MCR. In the present cohort, active treatment seems beneficial to the patient since surgical excision of local

  19. 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.

  20. 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

  1. 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.

  2. Multimodal physiotherapeutic approach: effects on the temporomandibular disorder diagnosis and severity

    Directory of Open Access Journals (Sweden)

    Ariane Bôlla Freire

    Full Text Available Introduction The temporomandibular disorder (TMD consists of a set of signs and symptoms that affect the masticatory structures, which may cause joint and/or muscular pain. The physiotherapy approach aims at the pain relief and the functional recovery by means of several modalities.Objective To investigate the effects, short and medium-term, of a multimodal physiotherapeutic approach on TMD diagnosis and severity.Methodology Individuals with diagnosis of TMD, confirmed by the Axis I of the RDC/TMD, took part in the study. From this evaluation, the Temporomandibular Index (TMI and its sub-indices were calculated. The participants were treated during ten sessions of physiotherapy, which included therapeutic ultrasound, thermotherapy, manual therapy, stretching and neuromuscular exercises, as well as self-care and home exercises instructions. Assessments were carried out before treatment (AV1, immediately after treatment (AV2 and two months after the end of the treatment (AV3. The values of indices and the diagnosis prevalence were compared between the different periods by the t paired test (p < 0.05.Results The number of diagnoses reduced in all the subgroups and 41.7% of the 24 participants presented no diagnosis after the treatment. A significant decrease in the TMI was observed between AV1 and AV2 (p = 0.000. There was no difference between AV2 and AV3 (p = 0.204 in 13 participants assessed two months after the end of the treatment.Conclusion The multimodal physiotherapeutic approach resulted in positive effects, short and medium-term, on the symptoms and clinical signs, with deletion of the dysfunction or reduction of its severity in treated patients.

  3. A multimodal day treatment program for multi-problem young adults: Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Luijks, M.-J.A. (Marie-Jolette A.); F. Bevaart (Floor); J. Zijlmans (Josjan); L. van Duin (Laura); R. Marhe (Reshmi); T. Doreleijers (Theo); H.W. Tiemeier (Henning); J.J. Asscher (Jessica J.); Popma, A. (Arne)

    2017-01-01

    textabstractBackground: Effective interventions for young adults with severe, multiple problems - such as psychosocial and psychiatric problems, delinquency, unemployment and substance use - are scarce but urgently needed in order to support an adequate transition to adulthood. A multimodal day

  4. 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).

  5. Melatonin potentiates “inside-out” nano-thermotherapy in human breast cancer cells: a potential cancer target multimodality treatment based on melatonin-loaded nanocomposite particles

    Science.gov (United States)

    Xie, Wensheng; Gao, Qin; Wang, Dan; Wang, Wei; Yuan, Jie; Guo, Zhenhu; Yan, Hao; Wang, Xiumei; Sun, Xiaodan; Zhao, Lingyun

    2017-01-01

    Purpose With the wide recognition of oncostatic effect of melatonin, the current study proposes a potential breast cancer target multimodality treatment based on melatonin-loaded magnetic nanocomposite particles (Melatonin-MNPs). Methods Melatonin-MNPs were fabricated by the single emulsion solvent extraction/evaporation method. Results Based on the facilitated transport of melatonin by the GLUT overexpressed on the cell membrane, such Melatonin-MNPs can be more favorably uptaken by MCF-7 cells compared with the melatonin-free nanocomposite particles, which indicates the cancer targeting ability of melatonin molecule. Inductive heating can be generated by exposure to the Melatonin-MNPs internalized within cancer cells under alternative magnetic field, so as to achieve the “inside-out” magnetic nano-thermotherapy. In addition to demonstrating the superior cytotoxic effect of such nano-thermotherapy over the conventional exogenous heating by metal bath, more importantly, the sustainable release of melatonin from the Melatonin-MNPs can be greatly promoted upon responsive to the magnetic heating. The multimodality treatment based on Melatonin-MNPs can lead to more significant decrease in cell viability than any single treatment, suggesting the potentiated effect of melatonin on the cytotoxic response to nano-thermotherapy. Conclusion This study is the first to fabricate the precisely engineered melatonin-loaded multifunctional nanocomposite particles and demonstrate the potential in breast cancer target multimodality treatment. PMID:29066887

  6. Melatonin potentiates "inside-out" nano-thermotherapy in human breast cancer cells: a potential cancer target multimodality treatment based on melatonin-loaded nanocomposite particles.

    Science.gov (United States)

    Xie, Wensheng; Gao, Qin; Wang, Dan; Wang, Wei; Yuan, Jie; Guo, Zhenhu; Yan, Hao; Wang, Xiumei; Sun, Xiaodan; Zhao, Lingyun

    2017-01-01

    With the wide recognition of oncostatic effect of melatonin, the current study proposes a potential breast cancer target multimodality treatment based on melatonin-loaded magnetic nanocomposite particles (Melatonin-MNPs). Melatonin-MNPs were fabricated by the single emulsion solvent extraction/evaporation method. Based on the facilitated transport of melatonin by the GLUT overexpressed on the cell membrane, such Melatonin-MNPs can be more favorably uptaken by MCF-7 cells compared with the melatonin-free nanocomposite particles, which indicates the cancer targeting ability of melatonin molecule. Inductive heating can be generated by exposure to the Melatonin-MNPs internalized within cancer cells under alternative magnetic field, so as to achieve the "inside-out" magnetic nano-thermotherapy. In addition to demonstrating the superior cytotoxic effect of such nano-thermotherapy over the conventional exogenous heating by metal bath, more importantly, the sustainable release of melatonin from the Melatonin-MNPs can be greatly promoted upon responsive to the magnetic heating. The multimodality treatment based on Melatonin-MNPs can lead to more significant decrease in cell viability than any single treatment, suggesting the potentiated effect of melatonin on the cytotoxic response to nano-thermotherapy. This study is the first to fabricate the precisely engineered melatonin-loaded multifunctional nanocomposite particles and demonstrate the potential in breast cancer target multimodality treatment.

  7. 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

    OBJECTIVE: To assess the effect of a multimodal group exercise intervention, as an adjunct to conventional care, on fatigue, physical capacity, general wellbeing, physical activity, and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment 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 completed follow......-up. INTERVENTION: Supervised exercise comprising high intensity cardiovascular and resistance training, relaxation and body awareness training, massage, nine hours weekly for six weeks in addition to conventional care, compared with conventional care. MAIN OUTCOME MEASURES: European Organization for Research...

  8. 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

    Abstract: Objective To assess the effect of a multimodal group exercise intervention, as an adjunct to conventional care, on fatigue, physical capacity, general wellbeing, physical activity, and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment...... 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...... completed follow-up. Intervention: Supervised exercise comprising high intensity cardiovascular and resistance training, relaxation and body awareness training, massage, nine hours weekly for six weeks in addition to conventional care, compared with conventional care. Main outcome measures: European...

  9. 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...... easily be applied....

  10. [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.

  11. 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

  12. 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

  13. 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...... for short-range applications, where the transmittable bandwidth does not constitute the main limitation....

  14. Effects of Supervised Multimodal Exercise Interventions on Cancer-Related Fatigue: Systematic Review and Meta-Analysis of Randomized Controlled Trials

    Directory of Open Access Journals (Sweden)

    José Francisco Meneses-Echávez

    2015-01-01

    Full Text Available Objective. Cancer-related fatigue (CRF is the most common and devastating problem in cancer patients even after successful treatment. This study aimed to determine the effects of supervised multimodal exercise interventions on cancer-related fatigue through a systematic review and meta-analysis. Design. A systematic review was conducted to determine the effectiveness of multimodal exercise interventions on CRF. Databases of PubMed, CENTRAL, EMBASE, and OVID were searched between January and March 2014 to retrieve randomized controlled trials. Risk of bias was evaluated using the PEDro scale. Results. Nine studies n=772 were included in both systematic review and meta-analysis. Multimodal interventions including aerobic exercise, resistance training, and stretching improved CRF symptoms (SMD=-0.23; 95% CI: −0.37 to −0.09; P=0.001. These effects were also significant in patients undergoing chemotherapy P<0.0001. Nonsignificant differences were found for resistance training interventions P=0.30. Slight evidence of publication bias was observed P=0.04. The studies had a low risk of bias (PEDro scale mean score of 6.4 (standard deviation (SD ± 1.0. Conclusion. Supervised multimodal exercise interventions including aerobic, resistance, and stretching exercises are effective in controlling CRF. These findings suggest that these exercise protocols should be included as a crucial part of the rehabilitation programs for cancer survivors and patients during anticancer treatments.

  15. Effects of Supervised Multimodal Exercise Interventions on Cancer-Related Fatigue: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Meneses-Echávez, José Francisco; González-Jiménez, Emilio; Ramírez-Vélez, Robinson

    2015-01-01

    Cancer-related fatigue (CRF) is the most common and devastating problem in cancer patients even after successful treatment. This study aimed to determine the effects of supervised multimodal exercise interventions on cancer-related fatigue through a systematic review and meta-analysis. A systematic review was conducted to determine the effectiveness of multimodal exercise interventions on CRF. Databases of PubMed, CENTRAL, EMBASE, and OVID were searched between January and March 2014 to retrieve randomized controlled trials. Risk of bias was evaluated using the PEDro scale. Nine studies (n = 772) were included in both systematic review and meta-analysis. Multimodal interventions including aerobic exercise, resistance training, and stretching improved CRF symptoms (SMD = -0.23; 95% CI: -0.37 to -0.09; P = 0.001). These effects were also significant in patients undergoing chemotherapy (P training interventions (P = 0.30). Slight evidence of publication bias was observed (P = 0.04). The studies had a low risk of bias (PEDro scale mean score of 6.4 (standard deviation (SD) ± 1.0)). Supervised multimodal exercise interventions including aerobic, resistance, and stretching exercises are effective in controlling CRF. These findings suggest that these exercise protocols should be included as a crucial part of the rehabilitation programs for cancer survivors and patients during anticancer treatments.

  16. 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.

  17. Prospective relationship between obsessive-compulsive and depressive symptoms during multimodal treatment in pediatric obsessive-compulsive disorder.

    Science.gov (United States)

    Meyer, Johanna M; McNamara, Joseph P H; Reid, Adam M; Storch, Eric A; Geffken, Gary R; Mason, Dana M; Murphy, Tanya K; Bussing, Regina

    2014-01-01

    The present study examined the prospective relationship between obsessive-compulsive and depressive symptoms during a multimodal treatment study involving youth with obsessive-compulsive disorder (OCD). Participants included fifty-six youth, aged 7-17 years (M = 12.16 years) who were enrolled in a two-site randomized controlled pharmacological and cognitive behavioral therapy treatment trial. Obsessive-compulsive severity was measured using the Children's Yale-Brown Obsessive-Compulsive Scale, and depressive symptoms were rated using the Children's Depression Rating Scale-Revised. Multi-level modeling analyses indicated that, on average over the course of treatment, variable and less severe obsessive-compulsive symptoms significantly predicted a decrease in depressive symptoms. Additionally, week-to-week fluctuations in OCD severity did not significantly predict weekly changes in depressive symptom severity. Level of baseline depressive symptom severity did not moderate these relationships. Findings suggest that when treating youth with OCD with co-occurring depression, therapists should begin by treating obsessive-compulsive symptoms, as when these are targeted effectively, depressive symptoms diminish as well.

  18. Exploring Game Transfer Phenomena: a multimodal research approach for investigating video games' effects

    OpenAIRE

    Ortiz de Gortari, AB

    2015-01-01

    Video games are evolving and are becoming ever more immersive. Consequently, it is necessary to understand their effects on gamers’ psychological wellbeing. The impact on cognition, affect and behaviour has mostly been investigated separately and sometimes from narrow approaches that limit the understanding of the video games’ effects. This thesis investigates the effects of playing video games from a novel, multimodal and broad research approach that is termed "Game Transfer Phenomena" (GTP)...

  19. Outcome predictors in anorectic patients after 6 months of multimodal treatment.

    Science.gov (United States)

    Fassino, S; Abbate Daga, G; Amianto, F; Leombruni, P; Fornas, B; Garzaro, L; D'Ambrosio, G; Rovera, G G

    2001-01-01

    Anorexia nervosa is a severe disorder that often responds poorly to treatment. At this time, little is known about pretreatment predictors of response. A sample of 42 restrictor type anorectics was tested at the assessment phase and after 180 days retested using the Temperament and Character Inventory and Eating Disorder Inventory 2 along with other clinical evaluation instruments. After 180 days of treatment with multimodal 'network' therapy, the patients were divided into two groups. The first group included patients who showed relevant clinical improvement; the second group included patients considered 'not yet responding'. Data collected from the not-yet-responding group were compared by the t test with the other group's data to evaluate prognostic indexes. Diagnosis of personality disorder, which afflicted about 50% of patients, seemed not to be a relevant prognostic factor. However, a lower novelty seeking was characteristic of the nonresponder group. Higher levels of asceticism and maturity fears also characterized the nonresponder group. Present data suggest some elements that could be useful to focus pharmacotherapy, psychotherapy and family counseling on the current psychopathology of each patient. Copyright 2001 S. Karger AG, Basel.

  20. Clinical challenge: fatal mucormycotic osteomyelitis caused by Rhizopus microsporus despite aggressive multimodal treatment.

    Science.gov (United States)

    Harrasser, Norbert; Banke, Ingo J; Hauschild, Matthias; Lenze, Ulrich; Prodinger, Peter M; Toepfer, Andreas; Peschel, Christian; von Eisenhart-Rothe, Rüdiger; Ringshausen, Ingo; Verbeek, Mareike

    2014-09-06

    Mucormycosis is an invasive mycotic disease caused by fungi in the zygomycetes class. Although ubiquitous in the environment, zygomycetes are rarely known to cause invasive disease in immunocompromised hosts with a high mortality even under aggressive antifungal and surgical therapy. Clinically, mucormycosis frequently affects the sinus occasionally showing pulmonary or cerebral involvement. However skeletal manifestation with Rhizopus microsporus (RM) osteomyelitis leading to emergency surgical proximal femoral resection with fatal outcome has not been described yet. We report the case of a 73-year-old male suffering from myelodysplastic syndrome with precedent bone marrow transplantation. Six months after transplantation he consulted our internal medicine department in a septic condition with a four week history of painful swelling of the right hip. Radiography, computed tomography and magnetic resonance imaging revealed multiple bone infarcts in both femurs. In the right femoral head, neck and trochanteric region a recent infarct showed massive secondary osteomyelitis, breaking through the medial cortex. Emergency surgical proximal femoral resection was performed due to extensive bone and soft tissue destruction. Microbiological and basic local alignment search tool (BLAST) analysis revealed RM. Amphotericin B and posaconazole treatment with septic revision surgery was performed. However the disease ran a rapid course and was fatal two months after hospital admission. This alarming result with extensive RM osteomyelitis in the proximal femur of an immunocompromised patient may hopefully warn medical staff to perform early imaging and aggressive surgical supported multimodal treatment in similar cases.

  1. 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.

  2. 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.

  3. Impact of a combined multimodal-aerobic and multimodal intervention compared to standard aerobic treatment in breast cancer survivors with chronic cancer-related fatigue - results of a three-armed pragmatic trial in a comprehensive cohort design.

    Science.gov (United States)

    Kröz, Matthias; Reif, Marcus; Glinz, Augustina; Berger, Bettina; Nikolaou, Andreas; Zerm, Roland; Brinkhaus, Benno; Girke, Matthias; Büssing, Arndt; Gutenbrunner, Christoph

    2017-03-02

    Cancer-related fatigue (CRF) and insomnia are major complaints in breast cancer survivors (BC). Aerobic training (AT), the standard therapy for CRF in BC, shows only minor to moderate treatment effects. Other evidence-based treatments include cognitive behavioral therapy, e.g., sleep education/restriction (SE) and mindfulness-based therapies. We investigated the effectiveness of a 10-week multimodal program (MT) consisting of SE, psycho-education, eurythmy- and painting-therapy, administered separately or in combination with AT (CT) and compared both arms to AT alone. In a pragmatic comprehensive cohort study BC with chronic CRF were allocated randomly or by patient preference to (a) MT, (b) CT (MT + AT) or (c) AT alone. Primary endpoint was a composite score of the Pittsburgh Sleep Quality Index and the Cancer Fatigue Scale after 10 weeks of intervention (T1); a second endpoint was a follow-up assessment 6 months later (T2). The primary hypothesis stated superiority of CT and non-inferiority of MT vs. AT at T1. A closed testing procedure preserved the global α-level. The intention-to-treat analysis included propensity scores for the mode of allocation and for the preferred treatment, respectively. Altogether 126 BC were recruited: 65 were randomized and 61 allocated by preference; 105 started the intervention. Socio-demographic parameters were generally balanced at baseline. Non-inferiority of MT to AT at T1 was confirmed (p < 0.05), yet the confirmative analysis stopped as it was not possible to confirm superiority of CT vs. AT (p = 0.119). In consecutive exploratory analyses MT and CT were superior to AT at T1 and T2 (MT) or T2 alone (CT), respectively. The multimodal CRF-therapy was found to be confirmatively non-inferior to standard therapy and even yielded exploratively sustained superiority. A randomized controlled trial including a larger sample size and a longer follow-up to evaluate multimodal CRF-therapy is highly warranted. DRKS-ID: DRKS

  4. Oral nutritional supplements containing n-3 polyunsaturated fatty acids affect quality of life and functional status in lung cancer patients during multimodality treatment: an RCT.

    Science.gov (United States)

    van der Meij, B S; Langius, J A E; Spreeuwenberg, M D; Slootmaker, S M; Paul, M A; Smit, E F; van Leeuwen, P A M

    2012-03-01

    Our objective was to investigate effects of an oral nutritional supplement containing n-3 polyunsaturated fatty acids (FAs) on quality of life, performance status, handgrip strength and physical activity in patients with non-small cell lung cancer (NSCLC) undergoing multimodality treatment. In a double-blind experiment, 40 patients with stage III NSCLC were randomised to receive 2 cans/day of a protein- and energy-dense oral nutritional supplement containing n-3 polyunsaturated FAs (2.02 g eicosapentaenoic acid+0.92 g docosahexaenoic acid/day) or an isocaloric control supplement, during multimodality treatment. Quality of life, Karnofsky Performance Status, handgrip strength and physical activity (by wearing an accelerometer) were assessed. Effects of intervention were analysed by generalised estimating equations. P-values <0.05 were regarded as statistically significant. The intervention group reported significantly higher on the quality of life parameters, physical and cognitive function (B=11.6 and B=20.7, P<0.01), global health status (B=12.2, P=0.04) and social function (B=22.1, P=0.04) than the control group after 5 weeks. The intervention group showed a higher Karnofsky Performance Status (B=5.3, P=0.04) than the control group after 3 weeks. Handgrip strength did not significantly differ between groups over time. The intervention group tended to have a higher physical activity than the control group after 3 and 5 weeks (B=6.6, P=0.04 and B=2.5, P=0.05). n-3 Polyunsaturated FAs may beneficially affect quality of life, performance status and physical activity in patients with NSCLC undergoing multimodality treatment.

  5. 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.

  6. 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.

  7. 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.

  8. Oral nutritional supplements containing (n-3) polyunsaturated fatty acids affect the nutritional status of patients with stage III non-small cell lung cancer during multimodality treatment.

    Science.gov (United States)

    van der Meij, Barbara S; Langius, Jacqueline A E; Smit, Egbert F; Spreeuwenberg, Marieke D; von Blomberg, B Mary E; Heijboer, Annemieke C; Paul, Marinus A; van Leeuwen, Paul A M

    2010-10-01

    Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), (n-3) fatty acids from fish oil, have immune-modulating effects and may improve nutritional status in cancer. The objective of this study was to investigate the effects of an oral nutritional supplement containing (n-3) fatty acids on nutritional status and inflammatory markers in patients with non-small cell lung cancer (NSCLC) undergoing multimodality treatment. In a double-blind experiment, 40 patients with stage III NSCLC were randomly assigned to receive 2 cans/d of a protein- and energy-dense oral nutritional supplement containing (n-3) fatty acids (2.0 g EPA + 0.9 g DHA/d) or an isocaloric control supplement. EPA in plasma phospholipids, energy intake, resting energy expenditure (REE), body weight, fat free mass (FFM), mid-upper arm circumference (MUAC), and inflammatory markers were assessed. Effects of intervention were analyzed by generalized estimating equations and expressed as regression coefficients (B). The intervention group (I) had a better weight maintenance than the control (C) group after 2 and 4 wk (B = 1.3 and 1.7 kg, respectively; P oral nutritional supplement containing (n-3) fatty acids beneficially affects nutritional status during multimodality treatment in patients with NSCLC.

  9. 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

  10. A Randomized Trial of a Multimodal Community-Based Prisoner Reentry Program Emphasizing Substance Abuse Treatment

    Science.gov (United States)

    Grommon, Eric; Davidson, William S., II; Bynum, Timothy S.

    2013-01-01

    Prisoner reentry programs continue to be developed and implemented to ease the process of transition into the community and to curtail fiscal pressures. This study describes and provides relapse and recidivism outcome findings related to a randomized trial evaluating a multimodal, community-based reentry program that prioritized substance abuse…

  11. 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. METH...

  12. Test of single degree of freedom acoustic treatment impedance models for multimodal acoustic propagation in duct with flow.

    Science.gov (United States)

    Baccouche, Ryan; Moreau, Soléne; Ben Tahar, Mabrouk

    2017-06-01

    Passive acoustic treatments, also called liners, are the main solution to noise problems. The Single Degree Of Freedom (SDOF) acoustic treatment, composed of a thin material (perforated plate) affixed to air cavities with a rigid bottom, constitutes a solution. Predicting sound level reduction by an SDOF treatment requires reliable acoustic impedance models. An experimental/numerical method has been developed for a duct with an acoustic treatment to test acoustic impedance models of SDOF treatment with a multimodal propagation in the presence of a mean flow. This method is based on the comparison of experimental results from an aeroacoustic bench composed of a circular duct with a treated area, and numerical results from an FEM-PML axisymmetric model based on Galbrun's equation. The numerical results are confronted with experimental results to test impedance models up to M 0 =±0.25.

  13. Multimodal behavioral treatment of nonrepetitive, treatment-resistant nightmares: a case report.

    Science.gov (United States)

    Tanner, Barry A

    2004-12-01

    A 23-yr.-old young woman presenting with a 17-yr. history of nightmares was treated with a variety of behavioral and self-regulatory techniques. The nightmares were unusual in that they did not have an obviously common theme as in most published reports, and, therefore, did not readily lend themselves to several frequently used techniques. Although previous treatment episodes had not affected the incidence of the nightmares, a combination of relaxation procedures, a mnemonic to increase lucid dreaming, and dream rehearsal upon waking from a nightmare resulted in a sharp decrease in the frequency of nightmares in four sessions. Further improvement was reported over the next nine months as additional techniques were introduced and other problems treated, and was maintained during a 9-mo. follow-up.

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

    Science.gov (United States)

    Adamsen, Lis; Quist, Morten; Andersen, Christina; Møller, Tom; Herrstedt, Jørn; Kronborg, Dorte; Baadsgaard, Marie T; Vistisen, Kirsten; Midtgaard, Julie; Christiansen, Birgitte; Stage, Maria; Kronborg, Morten T; Rørth, Mikael

    2009-10-13

    To assess the effect of a multimodal group exercise intervention, as an adjunct to conventional care, on fatigue, physical capacity, general wellbeing, physical activity, and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment for advanced disease. Randomised controlled trial. Two university hospitals in Copenhagen, Denmark. 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-up. Supervised exercise comprising high intensity cardiovascular and resistance training, relaxation and body awareness training, massage, nine hours weekly for six weeks in addition to conventional care, compared with conventional care. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Medical Outcomes Study Short Form (MOS SF-36), Leisure Time Physical Activity Questionnaire, muscular strength (one repetition maximum), maximum oxygen consumption (Vo(2)max). Statistical methods The general linear model was used for continuous outcome while analysis of associates between categorical outcomes was performed as analysis of marginal homogeneity in contingency tables. Adjusted for baseline score, disease, and demographic covariates, the intervention group showed an estimated improvement 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 0.64), 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, Pmuscular strength (leg press) was 29.7 kg (23.4 to

  15. 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.

  16. A New Prognostic Score Supporting Treatment Allocation for Multimodality Therapy for Malignant Pleural Mesothelioma: A Review of 12 Years' Experience.

    Science.gov (United States)

    Opitz, Isabelle; Friess, Martina; Kestenholz, Peter; Schneiter, Didier; Frauenfelder, Thomas; Nguyen-Kim, Thi Dan Linh; Seifert, Burkhardt; Hoda, Mir Alireza; Klepetko, Walter; Stahel, Rolf A; Weder, Walter

    2015-11-01

    Treatment of malignant pleural mesothelioma (MPM) remains a clinical challenge. The aim of this study was to identify selection factors for allocation of MPM patients to multimodal therapy based on survival data from 12 years of experience. Eligible patients had MPM of all histological subtypes with clinical stage T1-3 N0-2 M0. Induction chemotherapy consisted of cisplatin/gemcitabine (cis/gem) or cisplatin/pemetrexed (cis/pem), followed by extrapleural pneumonectomy (EPP). Multivariate analysis was performed to assess independent prognosticators for overall survival (OS). A Multimodality Prognostic Score was developed based on clinical variables available before surgery. From May 1999 to August 2011, 186 MPM patients were intended to be treated with induction chemotherapy followed by EPP. Hematologic toxicity was significantly less frequent after cis/pem compared to cis/gem, but there was no difference in response or OS between the regimens. One hundred and twenty-eight patients underwent EPP with a 30-day mortality of 4.7%. Fifty-two percent of the patients received adjuvant radiotherapy. The median OS of patients undergoing EPP was significantly longer with 22 months (95% confidence interval: 20-24) when compared to 11 months (9-12) for patients treated without EPP. A prognostic score was defined considering tumor volume, histology, C-reactive protein level, and response to chemotherapy that identified patient groups not benefitting from multimodality treatment which was confirmed in an independent cohort. Patients receiving induction chemotherapy followed by EPP for MPM of all histological subtypes and irrespective of nodal status showed a median survival of 22 months. A prognostic score is proposed to help patient allocation for surgery after validation in an independent cohort.

  17. 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 (PAssessment scale after the first 6-month treatment period (P=0.210), but in the second 6-month treatment period the POMA-G score improved significantly (P=0.001). There was no significant difference between groups regarding falls. 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.

  18. 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.

  19. 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

  20. Malignant mesothelioma of the tunica vaginalis: a rare case report and description of multimodal treatment.

    Science.gov (United States)

    Andresen, Eric D; Henning, Grant; Uhlman, Matthew A; Gupta, Amit

    2016-12-01

    Malignant mesothelioma is an uncommon neoplasm that develops from serous surfaces, and rarely from the tunica vaginalis. Although atypical in any location, paratesticular presentation is exceedingly infrequent as only 0.3% to 1.4% of mesothelioma cases arise from the tunica vaginalis. Fewer than 300 cases have been reported with very few descriptions of long term follow up and multimodal therapy. Here we describe a patient with 2 years of follow up for metastatic mesothelioma treated with orchiectomy, chemotherapy and robot-assisted laparoscopic retroperitoneal lymph node dissection.

  1. Low and therapeutic doses of antidepressants are associated with similar response in the context of multimodal treatment of pain.

    Science.gov (United States)

    Bajwa, Zahid H; Simopoulos, Thomas T; Pal, Joshua; Kraemer, Jan J; Chopra, Pradeep; Nagda, Jyotsna V; Najib, Umer; Celestin, James; Sial, Khuram; Ahmad, Bilal; Warfield, Carol; Steinman, Theodore I; Wootton, Joshua

    2009-01-01

    Antidepressants are prescribed in a wide range of doses to treat both depression and chronic pain, with optimal psychopharmacology individualized for each patient. In the past decade more antidepressants from different chemical classes have become available and are being used for the treatment of both chronic pain and depression. To review the utilization pattern changes and compare response rates of different classes and doses of antidepressants for various pain conditions in the context of multimodal therapies. Chart review. We reviewed 5,916 records at an outpatient multidisciplinary pain center. Of these, 379 records were for patients diagnosed with cancer pain. Because the mechanisms and treatment approaches to cancer pain can differ greatly from non-cancer chronic pain, these records were excluded from the analysis. We assessed 1,506 medical records for patients with chronic non-caner pain who had used at least one antidepressant, with the main outcome measure being the Numeric Rating Pain Scale, 0-10. Of the 5,916 charts reviewed, 1,506 (25.4%) chronic non-cancer pain charts recorded the prescription of at least one antidepressant. Most patients received a combination of medications and procedures. Of the 450 patients receiving secondary amines, favorable responses were recorded for 340 (76%) patients, while 103 (23%) did not respond and 7 had unknown responses. Of the 492 patients receiving tertiary amines, favorable responses were recorded for 375 (76%) patients, while 113 (23%) did not respond, and 4 had unknown responses. Of the 533 patients receiving SSRI/SNRIs, favorable responses were recorded for 382 (72%) patients, while 147 (28%) did not respond, and 4 had unknown responses. Of the 369 patients receiving atypical antidepressants, favorable responses were recorded for 272 (74%) patients, while 94 (25%) did not respond, and 3 had unknown responses. A retrospective study design and the use of antidepressants as a part of multimodal treatment of pain

  2. BIODEGRADATION AND DENTIN BONDING EFFECTIVENESS OF ONE "UNIVERSAL" SELF-ETCH ADHESIVE USED IN MULTI-MODE MANNER

    Directory of Open Access Journals (Sweden)

    Natalia Gateva

    2017-03-01

    Full Text Available A new type of one-step self-etch adhesives classified as "Universal" or "multi-mode" adhesives appeared in recent years. The idea is that these adhesives can be applied simultaneously with both techniques - etch and rinse and with self-etching technique, without compromising the bonding effectiveness. The aim of this study is to evaluate the micro-tensile adhesive bond strength to dentin of permanent teeth achieved after application of Single Bond Universal (3M ESPE adhesive system used in multi-mode manner. The results of our study show that the use of this universal adhesive system in multi-mode manner will not lead to the same results regarding the achieved bond strength with dentin. The additional etching with 37% phosphoric acid as well as the application of the adhesive in several layers deteriorates the bond strength right after application and after six months storage in artificial saliva medium (SAGF.

  3. Effects of a 4-week multimodal rehabilitation program on quality of life, cardiopulmonary function, and fatigue in breast cancer patients.

    Science.gov (United States)

    Do, Junghwa; Cho, Youngki; Jeon, Jaeyong

    2015-03-01

    This study examines the effects of a rehabilitation program on quality of life (QoL), cardiopulmonary function, and fatigue in breast cancer patients. The program included aerobic exercises as well as stretching and strengthening exercises. Breast cancer patients (n=62) who had completed chemotherapy were randomly assigned to an early exercise group (EEG; n=32) or a delayed exercise group (DEG; n=30). The EEG underwent 4 weeks of a multimodal rehabilitation program for 80 min/day, 5 times/wk for 4 weeks. The DEG completed the same program during the next 4 weeks. The European Organization for Research and Treatment of Cancer-Core Quality of Life Questionnaire (EORTC QLQ-C30), EORTC Breast Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23), predicted maximal volume of oxygen consumption (VO2max), and fatigue severity scale (FSS) were used for assessment at baseline, and at 2, 4, 6, and 8 weeks. After 8 weeks, statistically significant differences were apparent in global health, physical, role, and emotional functions, and cancer-related symptoms such as fatigue and pain, nausea, and dyspnea on the EORTC QLQ-C30; cancer-related symptoms involving the arm and breast on the EORTC QLQ-BR23; the predicted VO2max; muscular strength; and FSS (p<0.050), according to time, between the two groups. The results of our study suggest that a supervised multimodal rehabilitation program may improve the physical symptoms, QoL, and fatigue in patients with breast cancer.

  4. 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

  5. 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

  6. Storyboarding for Invention: Layering Modes for More Effective Transfer in a Multimodal Composition Classroom

    Science.gov (United States)

    Balzotti, Jon

    2016-01-01

    This article describes an innovative pedagogical technique for multimodal composition courses: the use of storyboarding as an invention tool across multiple composition platforms. Student response data and our textual analysis of their multimodal texts over a two-year period reveal some challenges when new media projects are taught alongside…

  7. 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,…

  8. 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

  9. The Effect of Multimodal Exercise Training Program in Subject with Type 2 Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Serap Acar

    2014-09-01

    Full Text Available Purpose: The aim of our research was to investigate the effect of multimodal aerobic, resistance and flexibility exercise training program on cardiovascular disease risk factor related with exercise capacity, lipid profile, flexibility, body composition, and glycemic control in newly diagnosed type 2 diabetic patients. Material and Method: Sixteen newly diagnosed type 2 diabetes patients including 6 study subjects and 10 controls were enrolled in the study. Study group attended to exercise program for a period of 12 weeks. Body composition, flexibility, aerobic capacity, lipid profile, fasting blood glucose (FBG, postprandial glucose (PPG, and hemoglobin A1c (HbA1c levels were assessed in all participants. Results: Body fat decreased, flexibility, which was assessed using the sit and reach test, and aerobic capacity increased after the exercise program, these variables showed statistically significant difference within the groups (p<0.05. Triglyceride cholesterol and postprandial glucose levels showed statistically significantly decrease after the exercise program in all participants (p<0.05. Only post exercise FBG and hemoglobin A1c levels showed statistically significant difference between exercise and control groups (p<0.05. Additionally, the Borg Scale significantly positively correlated with FBG (r=0.63, p=0.09, PPG (r=0.51, p=0.039, and HbA1c (r=0.59, p=0.014. Discussion: Twelve-week multimodal exercise training program improved the aerobic capacity and flexibility and decreased the cardiovascular disease risk related glycemic control by controlling body fat and triglycerides and by maintaining FBG and HbA1c below certain values. Turk Jem 2014; 18: 67-74

  10. 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

  11. 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.

  12. A study of multi-modality imaging for three-dimensional radiotherapy treatment planning of brain tumors

    International Nuclear Information System (INIS)

    Rajasekar, D.

    2004-01-01

    Integration of information from multiple imaging modalities like CT/MRI/SPECT/PET helps in management of cancer, from tumor detection to assessment of treatment efficacy since each imaging modality provides unique information about the tumor and normal structures. This Ph.D. study has been aimed at evaluation of multi-modality imaging in target localization and radiation treatment planning in patients with malignant glioma undergoing radiotherapy. Variations of gross tumor and the edema volumes delineated by a radiologist on CT and MRI scans were addressed. These scans were registered and transferred to the treatment planning system (TPS) using Windows based automatic image registration software developed in house using AIR routines (Roger Woods, UCLA). QA tests were designed and tested for the 3D automatic target expansion algorithm of the treatment planning system. The influences of variation of target volumes in CT and MRI images on cumulative dose distribution were also analyzed. Software for quantitative analysis of DVHs has been developed (for Isis-3D TPS) and results showed the importance of incorporation of targets from multiple imaging modalities. A novel approach to study the radiation-induced changes in normal appearing white matter (NAWM) using T2 and magnetization transfer ratio (MTR) maps was developed. The study demonstrated dose-dependent changes of the MTR values and reversal of MTR values seen for doses <40 Gy. However, the T2 maps did not show any dose depended changes within the time period studied. The following in-house software tools were developed to accomplish various tasks of the thesis work: (a) Windows based automatic image registration (AIR) of multi-modality images suitable for radiotherapy planning, (b) to preprocess 'bitmap' images from film scanner suitable for AIR software, (c) to transfer registered ''tiff'' images into the Isis-3D planning system, (d) quantitative analysis of DVH curves generated by the Isis-3D system, and (e

  13. 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.

  14. Long-term Visual Acuity, Strabismus, and Nystagmus Outcomes Following Multimodality Treatment in Group D Retinoblastoma Eyes.

    Science.gov (United States)

    Fabian, Ido D; Naeem, Zishan; Stacey, Andrew W; Chowdhury, Tanzina; Duncan, Catriona; Reddy, M Ashwin; Sagoo, Mandeep S

    2017-07-01

    To analyze the long-term visual acuity, strabismus, and nystagmus outcomes in Group D retinoblastoma following multimodality treatments in a national retinoblastoma referral center. Retrospective interventional case series. A 13-year retrospective chart review of Group D eyes treated initially with intravenous chemotherapy (IVC) and followed up for at least 1 year from last treatment. Risk factors for final visual acuity (VA) were analyzed, and rate of strabismus and nystagmus at last follow-up visit were calculated. One hundred and four Group D eyes (92 patients) presented to our center during the study period, of which 32 (27 patients) met the inclusion criteria. Following IVC (vincristine, etoposide, and carboplatin), adjuvant treatments included intraophthalmic artery chemotherapy in 5 (16%) eyes, plaque brachytherapy in 5 (16%), transpupillary thermotherapy (TTT) in 18 (56%), and cryotherapy in 24 (75%) eyes. On last examination, 64.41 ± 6.76 months from presentation, mean final VA was 20/283 (logMAR equivalent of 1.15 ± 0.15). On univariate analysis, presentation age, foveal retinoblastoma (at initial examination), use of TTT, and tumor-foveola distance (at last visit) were found to be significant risk factors for worse VA (P retinoblastoma eyes had <20/200 vision, with TTT being a risk factor for worse vision; 60% had strabismus; and 22% had nystagmus. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    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

    2015-05-15

    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

  16. Effects of laser frequency chirp on modal noise in short-range radio over multimode fiber links

    DEFF Research Database (Denmark)

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

    2010-01-01

    An important effect of the frequency chirp of the optical transmitter in radio over multimode fiber links is put into evidence experimentally and modeled theoretically for the first time, to our knowledge. This effect can have an important impact in short-range connections, where, although...... intermodal dispersion does not generally cause unacceptable limitations to the transmittable bandwidth, the presence of modal noise must be accurately kept under control, since it determines undesired real-time fluctuations of the link....

  17. Enabling cost-effective multimodal trip planners through open transit data.

    Science.gov (United States)

    2011-05-01

    This study examined whether multimodal trip planners can be developed using opensource software and open data sources. OpenStreetMap (OSM), maintained by the nonprofit OpenStreetMap Foundation, is an open, freely available international reposit...

  18. Manipulative and Multimodal Therapies in the Treatment of Osteoarthritis of the Great Toe: A Case Series.

    Science.gov (United States)

    Brantingham, James W; Cassa, Tammy Kay

    2015-12-01

    The objective of this case series is to describe manual manipulative therapy with exercise for 3 patients with mild to moderate osteoarthritis of the great toe. Three patients, a 32-year-old man, a 55-year-old woman, and a 49-year-old woman, had great toe pain of 8, 1, and 2 years, respectively. Each had a palpable exostosis, a benign outgrowth of bone projecting outward from the bone surface, and decreased dorsiflexion with a hard end-feel. Manual manipulative therapy with exercise, the Brantingham protocol, was used with patients receiving 6, 9, and 12 treatments over 6 weeks. Specific outcome measures for hallux rigidus and the foot were chosen to document the effects of this intervention including digital inclinometry, the lower extremity functional scale, the foot functional index, overall therapy effectiveness and Visual Analogue Scale (VAS). Each patient had an increase in range of motion that surpassed the minimal clinically important change, an increase in the overall therapy effectiveness and a decrease in the foot functional index that surpassed the minimally clinically important difference. Most importantly for the patients, each reported a decrease in both usual and worst pain on the VAS that exceeded the minimally clinically important difference of 20 to 30 mm. The 3 patients reported decreased pain measured by the VAS, increased range of motion and minimally clinically important difference in 3 other outcome measures.

  19. Pain management in critically ill patients: a review of multimodal treatment options.

    Science.gov (United States)

    Kohler, Matthew; Chiu, Felicia; Gelber, Katherine M; Webb, Christopher Aj; Weyker, Paul D

    2016-11-01

    Pain management for critically ill patients provides physicians with the challenge of maximizing patient comfort while avoiding the risks that arise with oversedation. Preventing oversedation has become increasingly important as we better understand the negative impact it has on patients' experiences and outcomes. Current research suggests that oversedation can result in complications such as thromboembolism, pulmonary compromise, immunosuppression and delirium. Fortunately, the analgesic options available for physicians to limit these complications are growing as more treatment modalities are being researched and implemented in the intensive care unit. Our goal is to outline some of the effective and widely utilized tools available to physicians to appropriately and safely manage pain while avoiding oversedation in the critically ill population.

  20. Early multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle function.

    Science.gov (United States)

    Hebert, Jeffrey J; Fritz, Julie M; Thackeray, Anne; Koppenhaver, Shane L; Teyhen, Deydre

    2015-01-01

    The optimal components of postoperative exercise programmes following single-level lumbar discectomy have not been identified. Facilitating lumbar multifidus (LM) function after discectomy may improve postoperative recovery. The aim of this study was to compare the clinical and muscle function outcomes of patients randomised to receive early multimodal rehabilitation following lumbar discectomy consisting of exercises targeting specific trunk muscles including the LM or general trunk exercises. We included participants aged 18 to 60 years who were scheduled to undergo single-level lumbar discectomy. After two postoperative weeks, participants were randomly assigned to receive an 8-week multimodal exercise programme including either general or specific trunk exercises. The primary outcome was pain-related disability (Oswestry Index). Secondary outcomes included low back and leg pain intensity (0-10 numeric pain rating scale), global change, sciatica frequency, sciatica bothersomeness and LM function measured with real-time ultrasound imaging. Treatment effects 10 weeks and 6 months after surgery were estimated with linear mixed models. 61 participants were randomised to receive a general trunk (n=32) or specific (n=29) exercise programme. There were no between-group differences in clinical or muscle function outcomes. Participants in both groups experienced improvements in most outcome measures. Following lumbar discectomy, multimodal rehabilitation programmes comprising specific or general trunk exercises have similar effects on clinical and muscle function outcomes. Local factors such as the individual patient characteristics identified by specific assessment findings, clinician expertise and patient preferences should direct therapy selection when considering the types of exercises tested in this trial for inclusion in rehabilitation programmes following lumbar disc surgery. Published by the BMJ Publishing Group Limited. For permission to use (where not

  1. Nanotechnology for Multimodal Synergistic Cancer Therapy.

    Science.gov (United States)

    Fan, Wenpei; Yung, Bryant; Huang, Peng; Chen, Xiaoyuan

    2017-11-22

    The complexity, diversity, and heterogeneity of tumors seriously undermine the therapeutic potential of treatment. Therefore, the current trend in clinical research has gradually shifted from a focus on monotherapy to combination therapy for enhanced treatment efficacy. More importantly, the cooperative enhancement interactions between several types of monotherapy contribute to the naissance of multimodal synergistic therapy, which results in remarkable superadditive (namely "1 + 1 > 2") effects, stronger than any single therapy or their theoretical combination. In this review, state-of-the-art studies concerning recent advances in nanotechnology-mediated multimodal synergistic therapy will be systematically discussed, with an emphasis on the construction of multifunctional nanomaterials for realizing bimodal and trimodal synergistic therapy as well as the intensive exploration of the underlying synergistic mechanisms for explaining the significant improvements in synergistic therapeutic outcome. Furthermore, the featured applications of multimodal synergistic therapy in overcoming tumor multidrug resistance, hypoxia, and metastasis will also be discussed in detail, which may provide new ways for the efficient regression and even elimination of drug resistant, hypoxic solid, or distant metastatic tumors. Finally, some design tips for multifunctional nanomaterials and an outlook on the future development of multimodal synergistic therapy will be provided, highlighting key scientific issues and technical challenges and requiring remediation to accelerate clinical translation.

  2. Multimodal Definition:

    African Journals Online (AJOL)

    user

    booming as a common tool of language learning and use. In the field of e-lexi- cography, such ... defining, as indicated under the entry of definition in Oxford Advanced Learner's. Dictionary of Current English (the ... In the above-mentioned context, this article argues for the establishment of the notion of multimodal definition ...

  3. A new strategy for TiO2 whiskers mediated multi-mode cancer treatment

    Science.gov (United States)

    Xu, Peipei; Wang, Ruju; Ouyang, Jian; Chen, Bing

    2015-02-01

    Traditional Chinese medicine (TCM) which functions as chemotherapeutic or adjuvantly chemotherapeutic agents has been drawing a great many eyeballs for its easy obtain and significant antitumor effects accompanied with less toxic and side effects. PDT (photodynamic therapy) utilizes the fact that certain compounds coined as photosensitizers, when exposed to light of a specific wavelength, are capable of generating cytotoxic reactive oxygen species (ROS) such as hydroxyl radical, hydrogen peroxide, and superoxide to kill cancer cells. Combinations of cancer therapeutic modalities are studied to improve the efficacy of treatment. This study aimed to explore a new strategy of coupling of titanium dioxide whiskers (TiO2 Ws) with the anticancer drug gambogic acid (GA) in photodynamic therapy. The nanocomposites were coined as GA-TiO2. The combination of TiO2 Ws with GA induced a remarkable enhancement in antitumor activity estimated by MTT assay, nuclear DAPI staining, and flow cytometry. Furthermore, the possible signaling pathway was explored by reverse transcription polymerase chain reaction (RT-PCR) and Western blot assay. These results identify TiO2 Ws of good biocompatibility and photocatalytic activity. In human leukemia cells (K562 cells), TiO2 Ws could obviously increase the intracellular concentration of GA and enhance its potential antitumor efficiency, suggesting that TiO2 Ws could act as an efficient drug delivery carrier targeting GA to carcinoma cells. Moreover, photodynamic GA-TiO2 nanocomposites could induce an evident reinforcement in antitumor activity with UV illumination. These results reveal that such modality combinations put forward a promising proposal in cancer therapy.

  4. Updating postoperative pain management: from multimodal to context-sensitive treatment.

    Science.gov (United States)

    Fanelli, G; Berti, M; Baciarello, M

    2008-09-01

    Although a wealth of evidence exists on effective postoperative pain (POP) treatment, surgical patients still suffer from inadequate analgesic regimens, and outcomes have been shown to improve only within the context of tightly controlled, randomized trials. The pathophysiology of pain seems to suggest that analgesic regimens aimed at inhibition of neurotransmission and neuroplastic phenomena should be instituted immediately before the painful stimuli are applied. Several protocols have been proposed, but the final choice should be made according to patients' needs, surgical indications, and institutional resources. Optimal POP management may succeed in improving outcomes only when combined with hospital-wide protocols for early rehabilitation and recovery; in the absence of adequate monitoring, equipment, motivation and coordination, even state-of-the-art techniques may fail to show results in terms of returning to daily life. Analgesic efficacy should always be balanced against safety and the ability to monitor patients in order to reduce complications that may actually impair recovery. A ''context-sensitive'' approach to POP, therefore, is suggested. Context-sensitive analgesia should be instituted as early as deemed necessary to avoid persistent pain, and it should be continued, with different modalities, until full recovery from surgery. In this way, it should constitute a ''bridge'' therapy from surgery to full healing. The use of neuroprotective agents to reduce the risk of postoperative hyperalgesia and other sensory disturbances should be considered in the context of specific surgical interventions.

  5. 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…

  6. 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.

  7. 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.

  8. A preliminary report on the efficacy of a dynamic jaw opening device (dynasplint trismus system) as part of the multimodal treatment of trismus in patients with head and neck cancer.

    Science.gov (United States)

    Stubblefield, Michael D; Manfield, Laura; Riedel, Elyn R

    2010-08-01

    To examine the effectiveness of a dynamic jaw opening device as part of a multimodal treatment strategy for trismus in patients with head and neck cancer. Retrospective cohort study. Tertiary care cancer center. Patients with head and neck cancer and trismus (N=20). All patients underwent assessment by a board-certified physiatrist and were referred to physical therapy for delivery of the DTS and instructed to progress use of the DTS to 30 minutes 3 times a day. Additional modalities for the treatment of trismus including pain medications and botulinum toxin injections were prescribed as clinically indicated. Change in maximal interincisal distance (MID) as documented in the medical record. The use of the DTS as part of multimodal therapy including physical therapy, pain medications, and botulinum toxin injections as deemed clinically appropriate resulted in an overall improvement of the MID from 16.5mm to 23.5mm (Ptrismus associated with head and neck cancer and its treatment. Further investigation is needed to determine the relative efficacy of the treatment modalities available for trismus including physical therapy and other jaw stretching devices.

  9. 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...... in a post-intervention group of 41 consecutive patients undergoing multilevel (median 10) instrumented spinal fusions and compared with 44 patients in a pre-intervention group. RESULTS: Compared to patients in the pre-intervention group, patients treated according to the new protocol consumed less opioid...

  10. Early and late renal adverse effects after potentially nephrotoxic treatment for childhood cancer

    NARCIS (Netherlands)

    Knijnenburg, Sebastiaan L.; Mulder, Renée L.; Schouten-van Meeteren, Antoinette Y. N.; Bökenkamp, Arend; Blufpand, Hester; van Dulmen-den Broeder, Eline; Veening, Margreet A.; Kremer, Leontien C. M.; Jaspers, Monique W. M.

    2013-01-01

    Great improvements in diagnostics and treatment for malignant disease in childhood have led to a major increase in survival. However, childhood cancer survivors (CCS) are at great risk for developing adverse effects caused by multimodal treatment for their malignancy. Nephrotoxicity is one of these

  11. 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…

  12. 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

  13. 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.

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. Multimodality treatment of a multifocal osteoblastoma-like tumor of the lower extremity.

    Science.gov (United States)

    Mait, Jeffrey E; Perino, Giorgio; Unnanuntana, Aasis; Chang, Tai-Li; Doty, Stephen; Schneider, Robert; Lane, Joseph M

    2012-09-01

    Osteoblastoma-like tumor is a rare condition with limited information on its orthopedic management in the current medical literature. The tumor histologically resembles an osteoblastoma, although the radiographic features are similar to those observed in primary vascular lesions. The treatment in the previously reported cases involved aggressive procedures including amputation, en bloc resection, and chemotherapy because of the uncertainty regarding the biological behavior of the tumor. We present a case of this entity that was successfully treated by a combination therapy including intralesional curettage with adjuvant cryotherapy, in situ and intravenous administration of bisphosphonates and radioablation.

  5. 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.

  6. Successful Multimodality Endoscopic Treatment of Gastric Outlet Obstruction Caused by an Impacted Gallstone (Bouveret's Syndrome

    Directory of Open Access Journals (Sweden)

    Jason N. Rogart

    2008-01-01

    Full Text Available Bouveret's syndrome is a rare condition of gastric outlet obstruction resulting from the migration of a gallstone through a choledochoduodenal fistula. Due to the large size of these stones and the difficult location in which they become impacted, endoscopic treatment is unsuccessful and most patients require surgery. We report the case of an elderly male who presented with nausea and hematemesis, and was found on CT scan and endoscopy to have an obstructing gallstone in his duodenal bulb. After several endoscopic sessions and the use of multiple instruments including a Holmium: YAG laser and electrohydraulic lithotripter, fragmentation and endoscopic removal of the stone were successful. We believe this to be the first case of Bouveret's syndrome successfully treated by endoscopy alone in the United States. We describe the difficulties encountered which necessitated varied and innovative therapeutic techniques.

  7. 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.

  8. 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.

  9. Multimodality treatment by FOLFOX plus HIFU in a case of advanced pancreatic carcinoma. A case report.

    Science.gov (United States)

    Dimitrov, Dobromir; Andreev, Tihomir; Feradova, Hyuliya; Ignatov, Borislav; Zhou, Kunn; Johnson, Colin; Delijski, Tashko; Gortchev, Grigor; Tomov, Slavcho

    2015-01-31

    Pancreatic cancer is one of the most aggressive malignant diseases in which the survival rate has not improved in the past 40 years. A fifty-one-year-old male patient with inoperable metastatic pancreatic cancer and low response to chemotherapy with gemcitabine as single therapy underwent palliative high intensity focused ultrasound (HIFU) ablation. Continuing chemotherapy with folinic acid, oxaliplatin and 5-fluorouracil (FOLFOX) was made. Tools, provided by the European Organization for Research and Treatment of Cancer (EORTC) were used to evaluate his quality of life. The Global Health Status improved from 25 to 42 out of 100 and the body mass index (BMI) increased from 14.9 to 18.1 kg/m(2). Measured by the visual analog scale, the pain was reduced from 7 to 2 out of 10. Twelve months after the HIFU ablation, CT revealed decreased size of the tumor and liver lesions. FOLFOX plus interventional, physical destruction of the primary tumor by HIFU sufficiently improved the quality of life, reduced pancreatic pain and provided better survival in this case.

  10. 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

  11. 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.

  12. 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.

  13. 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…

  14. Multimodality Imaging for Interventional Cardiology.

    Science.gov (United States)

    Celi, Simona; Martini, Nicola; Pastormerlo, Luigi Emilio; Positano, Vincenzo; Berti, Sergio

    2017-01-01

    In the last decades, interventional cardiology has received fast and wide implementation as an effective alternative treatment to surgery for several congenital and acquired diseases. In this scenario, imaging provides solutions for most clinical needs, from diagnosis to prognosis and risk stratification, as well as anatomical and functional assessment. In this review article, we present recent innovations in medical imaging for structural heart disease and coronary artery disease, emphasizing the progress achieved in the field of multimodality imaging and the solutions proposed to some as-yet unresolved technical problems for safe and effective procedural performance. Intra-procedural guidance can be facilitated by established multimodality cardiac imaging such as transesophageal 2D and 3D echocardiography and by novel techniques as echo-fluoroscopy overlay and 3D modeling/printing. Computed tomography and magnetic resonance imaging are particularly helpful for preprocedural morphology assessment and device sizing. Successful planning, performance, and aftercare of interventions depend heavily on accurate imaging for both structural heart disease and coronary artery disease. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  15. Data on a cytoarchitectonic brain atlas: effects of brain template and a comparison to a multimodal atlas

    Directory of Open Access Journals (Sweden)

    Mona Rosenke

    2017-06-01

    Full Text Available The data presented here are related to the research article: “A cross-validated cytoarchitectonic atlas of the human ventral visual stream” in which we developed a cytoarchitectonic atlas of ventral visual cortex. Here, we provide two additional quantifications of this cytoarchitectonic atlas: First, we quantify the effect of brain template on cross-validation performance. The data show a comparison between cortex-based alignment to two templates: the postmortem average brain and the FreeSurfer average brain. Second, we quantify the relationship between this cytoarchitectonic atlas and a recently published multimodal atlas of the human brain (Glasser et al., 2016.

  16. Beam dynamics and wave packet splitting in a periodically curved optical waveguide: Multimode effects

    International Nuclear Information System (INIS)

    Marangoni, M.; Janner, D.; Ramponi, R.; Laporta, P.; Longhi, S.; Cianci, E.; Foglietti, V.

    2005-01-01

    A theoretical and experimental analysis of beam dynamics and wave packet splitting of light in a periodically bent optical waveguide, a phenomenon recently observed [Phys. Rev. Lett. 94, 073002 (2005)] which is the optical equivalent of adiabatic stabilization of atoms in intense and high-frequency laser fields, is presented in the multimode operational regime. Inhibition of wave packet splitting is theoretically predicted and experimentally observed for higher-order mode excitation

  17. The Effects of a Multimodal Rehabilitation Program on Symptoms and Ground-Reaction Forces in Runners With Patellofemoral Pain Syndrome.

    Science.gov (United States)

    Esculier, Jean-Francois; Bouyer, Laurent J; Roy, Jean-Sébastien

    2016-02-01

    Patellofemoral pain (PFP) is one of the most frequent running-related injuries. However, few interventions taking into consideration the specificity of running have been shown to be effective in runners with PFP. To evaluate the effects of a multimodal rehabilitation program including lower-limb-strengthening/ motor-control exercises, advice on running biomechanics, and symptoms management on symptoms, strength, and ground-reaction forces in runners with PFP. Pre- to post- quasi-experimental. Gait-analysis laboratory and private physical therapy clinic. 21 runners with PFP (34.1 ± 6.0 y old, symptoms duration 38.1 ± 45.5 mo). An 8-wk multimodal rehabilitation program including lower-limb- and core-strengthening and motor-control exercises, as well as advice on running gait and symptoms management. The Activities of Daily Living Scale of the Knee Outcome Survey (KOS-ADLS) questionnaire and visual analog scales for usual pain (VAS-U), worst pain (VAS-W), and pain during running (VAS-R) were used to assess changes in symptoms and function. Vertical ground-reaction forces (VGRF) during running and lower-limb isometric strength were also measured. Statistically and clinically significant improvements (P < .001) were reported on KOS-ADLS (+17.8 pts), VAS-U (-19.2 pts), VAS-W (-28.7 pts), and VAS-R (-32.2 pts) after the intervention. No significant changes in isometric strength were observed. The instantaneous vertical loading rate was decreased after the intervention (P = .002), and this reduction was correlated with changes in KOS-ADLS scores (P = .028). This multimodal intervention was successful in reducing pain and improving function of runners with PFP. However, no significant changes in lower-limb strength were observed. It appears that changes in VGRF combined with appropriate training advice could explain the clinical outcomes.

  18. The effect of music and multimodal stimulation on responses of premature infants in neonatal intensive care.

    Science.gov (United States)

    Standley, J M

    1998-01-01

    To assess the benefits of lullaby singing and multimodal stimulation on premature infants in neonatal intensive care, 40 infants in a Level III Newborn Intermediate Care Unit were divided into control (n = 20) and experimental (n = 20) groups by pair matching on the basis of gender, birthweight, gestational age at birth and severity of medical complications. Participants met these project criteria: (a) corrected gestational age > 32 weeks; (b) age since birth > 10 days; and (c) weight > 1700 g. All participants had been referred for developmental stimulation by the medical staff. Experimental infants received reciprocal, multimodal (ATVV) stimulation paired with line singing of Brahms' Lullaby. Stimulation was provided for 15-30 minutes, one or two times per week from referral to discharge. Dependent variables were (a) days to discharge, (b) weight gain/day, and (c) experimental infants' tolerance for stimulation. Results showed that music and multimodal stimulation significantly benefited females' days to discharge and increased weight gain/day for both males and females. Both male and female infants' tolerance for stimulation showed marked and steady increase across the stimulation intervals with females' tolerance increasing more rapidly than males.

  19. 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

  20. Building the rationale and structure for a complex physical therapy intervention within the context of a clinical trial: a multimodal individualized treatment for patients with hip osteoarthritis.

    Science.gov (United States)

    Bennell, Kim L; Egerton, Thorlene; Pua, Yong-Hao; Abbott, J Haxby; Sims, Kevin; Buchbinder, Rachelle

    2011-10-01

    Evaluating the efficacy of complex interventions such as multimodal, impairment-based physical therapy treatments in randomized controlled trials is essential to inform practice and compare relative benefits of available treatment options. Studies of physical therapy interventions using highly standardized intervention protocols, although methodologically rigorous, do not necessarily reflect "real-world" clinical practice, and in many cases results have been disappointing. Development of a complex intervention that includes multiple treatment modalities and individualized treatment technique selection requires a systematic approach to designing all aspects of the intervention based on theory, evidence, and practical constraints. This perspective article outlines the development of the rationale and structure of a multimodal physical therapy program for painful hip osteoarthritis to be assessed in a clinical trial. The resulting intervention protocol comprises a semi-structured program of exercises and manual therapy, advice, physical activity, and optional prescription of a gait aid that is standardized, yet can be individualized according to physical assessment and radiographic findings. The program is evidence based and reflects contemporary physical therapist practice, while also being reproducible and reportable. This perspective article aims to encourage physical therapy researchers involved in evaluation of complex interventions to better document their own intervention development, as well as the outcomes, thus generating a body of knowledge about the development processes and protocols that is generalizable to the real-world complexity of providing physical therapy to individual patients.

  1. Characteristics and consequences of the co-occurrence between social anxiety and pain-related fear in chronic pain patients receiving multimodal pain rehabilitation treatment.

    Science.gov (United States)

    Wurm, Matilda; Edlund, Sara; Tillfors, Maria; Boersma, Katja

    2016-07-01

    Chronic pain problems are related to specific pain related fears and maladaptive pain-coping but also commonly co-occur with other anxiety problems. Shared emotional vulnerability factors may explain this comorbidity and may influence treatment outcome. Indeed, pain patients going through multimodal pain treatment are a heterogeneous group and treatment results vary. One understudied anxiety disorder co-occurring with pain is social anxiety. This may be relevant as many pain-related challenges are situated in social contexts. The aim of this study is to investigate the occurrence of subgroups with differential patterns of social anxiety and pain related fear in a sample of chronic pain patients who receive multimodal pain treatment. The aim is also to study the characteristics of these potential subgroups and the consequences of different patterns of social anxiety and pain related fear. 180 patients with chronic musculoskeletal pain answered questionnaires before and after a multimodal pain treatment in a hospital rehabilitation setting in middle Sweden. A cluster analysis using pre-treatment scores on the Social Phobia Screening Questionnaire and the Tampa Scale of Kinesiophobia was performed. Subgroups were thereafter validated and compared on impairment due to social anxiety, pain catastrophizing, anxiety, and depression. Moreover, subgroups were described and compared on vulnerability factors (anxiety sensitivity, negative affect) and outcome factors (pain intensity, pain interference, and return to work self-efficacy). Four distinct clusters emerged: (1) low scores, (2) pain-related fear only, (3) social concern only, and (4) high social anxiety and pain-related fear. Patients high on social anxiety and pain-related fear had significantly higher levels of anxiety sensitivity, negative affect, and higher general emotional symptomatology. They also had remaining problems posttreatment. A subgroup of patients with clinical levels of social anxiety has suboptimal

  2. Effect of Final Irrigation Protocol and Etching Mode on Bond Strength of a Multimode Adhesive in the Root Canal.

    Science.gov (United States)

    Bitter, Kerstin; Polster, Luise; Askar, Haitham; von Stein-Lausnitz, Manja; Sterzenbach, Guido

    2017-06-08

    To analyze the effects of ethanol for final post space irrigation and etching mode on the bond strength of fiber posts luted with a mild multimode adhesive (pH 2.3) as compared with a reference group using a self-adhesive resin cement (SAR). Human anterior teeth were endodontically treated. After post space preparation, the root canals were irrigated using 1% sodium hypochlorite (NaOCl) applied with passive ultrasonic irrigation, followed by either distilled water (control) or distilled water and ethanol 99% as final post space irrigation. Fiber posts were luted using Futurabond U in self-etch mode (FU-SE), Futurabond U in etch-and-rinse mode (FU-ER), or Futurabond DC (SE) in combination with a dual-curing core buildup material (Grandio Core, all VOCO); alternatively, posts were inserted using a self-adhesive composite cement (RelyX Unicem 2, 3M ESPE). Bond strengths were evaluated using push-out tests following thermocycling (TC) and storage in 0.9% NaCl for 3 months. Mean push-out bond strengths (MPa) were significantly affected by the luting system (p root canal for all materials, with the exception of FU E&R. Mild multimode adhesives exhibit comparable mean bond strengths to a SAR cement within the root canal for luting fiber posts if applied in an etch-and-rinse mode. Using this approach, ethanol application has no positive effects on bond strength.

  3. 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

  4. Effects of conventional versus multimodal vestibular rehabilitation on functional capacity and balance control in older people with chronic dizziness from vestibular disorders: design of a randomized clinical trial.

    Science.gov (United States)

    Aquaroni Ricci, Natalia; Aratani, Mayra Cristina; Caovilla, Heloisa Helena; Freitas Ganança, Fernando

    2012-12-31

    There are several protocols designed to treat vestibular disorders that focus on habituation, substitution, adaptation, and compensation exercises. However, protocols that contemplate not only vestibular stimulation but also other components that are essential to the body balance control in older people are rare. This study aims to compare the effectiveness of two vestibular rehabilitation protocols (conventional versus multimodal) on the functional capacity and body balance control of older people with chronic dizziness due to vestibular disorders. A randomized, single-blind, controlled clinical trial with a 3 months follow-up period will be performed. The sample will be composed of older individuals with a clinical diagnosis of chronic dizziness resulting from vestibular disorders. The subjects will be evaluated at baseline, post-treatment and follow-up. Primary outcomes will be determined in accordance with the Dizziness Handicap Inventory (functional capacity) and the Dynamic Gait Index (body balance). Secondary outcomes include dizziness features, functional records, body balance control tests, and psychological information. The older individuals (minimum sample n = 68) will be randomized to either the conventional or multimodal Cawthorne&Cooksey protocols. The protocols will be performed during individual 50-minute sessions, twice a week, for 2 months (a total of 16 sessions). The outcomes of both protocols will be compared according to the intention-to-treat analysis. Vestibular rehabilitation through the Cawthorne&Cooksey protocol has already proved to be effective. However, the addition of other components related to body balance control has been proposed to improve the rehabilitation of older people with chronic dizziness from vestibular disorders. ACTRN12610000018011.

  5. Effect of acoustic waveguide properties on the Brillouin gain spectrum in multi-mode fibers

    Science.gov (United States)

    Ke, Wei-Wei; Wang, Xiao-Jun; Tang, Xuan

    2015-02-01

    With a recent developed mode-coupling model, the Brillouin gain spectra (BGS) of multi-mode fibers (MMF) are investigated and compared with the corresponding experiment. It is found that the calculation results are coincident well with the experiment data. Furthermore, the BGS are found to be very sensitive to the index fluctuation. Such phenomenon is demonstrated by introducing a small index hump or dip in the center of the fiber core. And it can be explained by that the index fluctuation may influence the acoustic mode greatly.

  6. 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.

  7. The uptake and effect of a mailed multi-modal colon cancer screening intervention: A pilot controlled trial

    Directory of Open Access Journals (Sweden)

    Griffith Jennifer M

    2008-06-01

    Full Text Available Abstract Background We sought to determine whether a multi-modal intervention, which included mailing a patient reminder with a colon cancer decision aid to patients and system changes allowing direct access to scheduling screening tests through standing orders, would be an effective and efficient means of promoting colon cancer screening in primary care practice. Methods We conducted a controlled trial comparing the proportion of intervention patients who received colon cancer screening with wait list controls at one practice site. The intervention was a mailed package that included a letter from their primary care physician, a colon cancer screening decision aid, and instructions for obtaining each screening test without an office visit so that patients could access screening tests directly. Major outcomes were screening test completion and cost per additional patient screened. Results In the intervention group, 15% (20/137 were screened versus 4% (4/100 in the control group (difference 11%; (95%; CI 3%;18% p = 0.01. The cost per additional patient screened was estimated to be $94. Conclusion A multi-modal intervention, which included mailing a patient reminder with a colon cancer decision aid to patients and system changes allowing patients direct access to schedule screening tests, increased colon cancer screening test completion in a subset of patients within a single academic practice. Although the uptake of the decision aid was low, the cost was also modest, suggesting that this method could be a viable approach to colon cancer screening.

  8. 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.

  9. 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.

  10. Multimodal imaging based on MRI and PET reveals [{sup 18}F]FLT PET as a specific and early indicator of treatment efficacy in a preclinical model of recurrent glioblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Corroyer-Dulmont, Aurelien; Peres, Elodie A.; Gerault, Aurelie N.; Divoux, Didier; Toutain, Jerome; Ibazizene, Meziane; MacKenzie, Eric T.; Barre, Louisa; Bernaudin, Myriam; Petit, Edwige; Valable, Samuel [CNRS, UMR 6301 ISTCT, CERVOxy and LDM-TEP groups. GIP CYCERON, Caen (France); CEA, DSV/I2BM, UMR 6301 ISTCT, CERVOxy et LDM-TEP Groups, GIP CYCERON, Caen (France); UNICAEN, UMR 6301 ISTCT, CERVOxy et LDM-TEP Groups, GIP CYCERON, Caen (France); Normandie Univ., Caen(France); Savina, Ariel; Bouquet, Fanny [Roche SAS, Boulogne-Billancourt (France)

    2016-04-15

    The primary objective of this study was to compare the ability of PET and MRI biomarkers to predict treatment efficacy in a preclinical model of recurrent glioblastoma multiforme. MRI (anatomical, diffusion, vasculature and oxygenation) and PET ([{sup 18}F]FDG and [{sup 18}F]FLT) parameters were obtained 3 days after the end of treatment and compared with late tumour growth and survival. Early after tumour recurrence, no effect of treatment with temozolomide combined with bevacizumab was observed on tumour volume as assessed by T2-W MRI. At later times, the treatment decreased tumour volume and increased survival. Interestingly, at the earlier time, temozolomide + bevacizumab decreased [{sup 18}F]FLT uptake, cerebral blood volume and oedema. [{sup 18}F]FLT uptake, oedema and cerebral blood volume were correlated with overall survival but [{sup 18}F]FLT uptake had the highest specificity and sensitivity for the early prediction of treatment efficacy. The present investigation in a preclinical model of glioblastoma recurrence underscores the importance of multimodal imaging in the assessment of oedema, tumour vascular status and cell proliferation. Finally, [{sup 18}F]FLT holds the greatest promise for the early assessment of treatment efficacy. These findings may translate clinically in that individualized treatment for recurrent glioma could be prescribed for patients selected after PET/MRI examinations. (orig.)

  11. 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 reci...

  12. 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

  13. Use of anomolous thermal imaging effects for multi-mode systems control during crystal growth

    Science.gov (United States)

    Wargo, Michael J.

    1989-01-01

    Real time image processing techniques, combined with multitasking computational capabilities are used to establish thermal imaging as a multimode sensor for systems control during crystal growth. Whereas certain regions of the high temperature scene are presently unusable for quantitative determination of temperature, the anomalous information thus obtained is found to serve as a potentially low noise source of other important systems control output. Using this approach, the light emission/reflection characteristics of the crystal, meniscus and melt system are used to infer the crystal diameter and a linear regression algorithm is employed to determine the local diameter trend. This data is utilized as input for closed loop control of crystal shape. No performance penalty in thermal imaging speed is paid for this added functionality. Approach to secondary (diameter) sensor design and systems control structure is discussed. Preliminary experimental results are presented.

  14. 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.

  15. 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.

  16. 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.

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

    Science.gov (United States)

    Andersen, Christina; Rørth, Mikael; Ejlertsen, Bent; Stage, Maria; Møller, Tom; Midtgaard, Julie; Quist, Morten; Bloomquist, Kira; Adamsen, Lis

    2013-06-01

    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. Data is based on analyses of a prospective randomised controlled trial 'The Body & Cancer Trial'. 213 cancer patients with different diagnoses were randomised into an intervention group or wait-list control group. The primary outcome, Fatigue score (CRF), was evaluated by the Functional Assessment of Cancer Therapy-Anaemia Questionnaire (FACT-An-) (FACT-G score & FACT-An Anemia subscale). Supervised exercise, comprising high-intensity cardiovascular and heavy resistance training, relaxation- and body awareness training and massage, 9 h weekly for 6 weeks. CRF was significantly reduced in the intervention group, corresponding to a Fatigue score reduction of 3.04 (effect size of 0.44, 95% CI 0.17-0.72) (P = .002), the FACT-An score by 5.40 (P = .015), the FACT-An Toi score by 5.22 (P = .009) and the Anaemia-ANS by 3.76 (P = .002). There was no statistically significant effect on the General Quality of Life score (FACT-G) or on any of the individual wellbeing scores; Physical (P = .13), Emotional (P = .87), Social (P = .83) and Functional (P = .26). In summary, this six-week supervised multimodal exercise intervention can lead to significant reduction in self-reported CRF in cancer patients undergoing chemotherapy. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Multimodal patient education program with stress management for childhood and adolescent asthma.

    Science.gov (United States)

    Hampel, Petra; Rudolph, Hiltrud; Stachow, Rainer; Petermann, Franz

    2003-01-01

    The present study aimed to evaluate a multimodal patient education program carried out during inpatient rehabilitation. The program included cognitive-behavioral stress management training as a main component. The efficacy was examined in comparison to an education program without stress management. In total N=68 patients aged between 8 and 16 years were included in the post-treatment and N=46 patients in the 6 months follow-up assessment. Short- and long-term intervention effects of the multimodal education program were observed in relation to patients' age. The experimental treatment elicited significant improvements in adaptive coping in adolescents aged from 14 to 16 years. In contrast, substantial effects were not yielded for the control treatment. The results suggest that the multimodal patient education training has beneficial effects on stress management in adolescents with asthma. Results are discussed with regard to predictive factors for rehabilitation outcome.

  19. Choosing a Better Delay Line Medium between Single-Mode and Multi-Mode Optical Fibers: the Effect of Bending

    Directory of Open Access Journals (Sweden)

    Auwal Mustapha Imam

    2017-12-01

    Full Text Available Optical fiber cables are materials whose core is made of silica and other materials such as chalcogenide glasses; they transmit a digital signal via light pulses through an extremely thin strand of glass. The light propagates and is being guided by the core which is surrounded by the cladding. Light travels in the optical fiber in the form of total internal reflection in the core of the fibers. The flexibility, low tensile strength, low signal loss, high bandwidth and other characteristics of optical fibers favors it for use as a delay medium in many applications. Another favorable characteristic of optical fiber delay lines is are their relative insensitivities to environmental effects and electromagnetic interferences. The immunity of optical fibers to interferences and their less weight added advantages to it for use as delay medium. Single-mode and multi-mode are the two most popular types of optical fibers. Single-mode fibers have good propagation and delay properties with a minimal loss that allows the signal to propagate in a large distance with insignificant distortion or attenuation. The percentage of power transmission of single-mode fibers is found to be higher than that of the multi-mode fibers. It is, therefore, a preferred type for use as a delay line. In this paper, relative studies of the two optical fibers modes, and the results of power input/output measurement of the two modes are presented with a view to coming up with a better type for use as a delay medium.

  20. 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.

  1. 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.

  2. Brief Psychotherapy: The Multimodal Model.

    Science.gov (United States)

    Lazarus, Arnold A.

    1989-01-01

    Outlines tenets of multimodal therapy (MMT) and argues for its cost-effective yet comprehensive value as a brief psychotherapy model. Describes MMT as an integrated, seven-modality model of personality and provides clinical examples of its use. Argues that MMT approach will be an important future alternative to more expensive, time-consuming, and…

  3. 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.

  4. A Study of the Multi-Mode Purcell Effect for a Transmon in 3D Circuit QED

    Science.gov (United States)

    Petrenko, Andrei; Sun, Luyan; Blumoff, Jacob; Nigg, Simon; Girvin, Steve; Schoelkopf, Robert

    2013-03-01

    Although superconducting 3D transmon qubits offer a promising path toward realizing an architecture for quantum computation, they are still limited by decoherence processes that are not yet fully understood. Qubit T1 relaxation due to the Purcell Effect presents one such limitation on coherence times, but thus far a complete model of Purcell processes for transmons in 3D cavities, beyond the approximation of a single cavity mode and lumped element qubit, has been absent. Employing a simple scheme to vary the decay rate κ (or quality factor Q) of our cavities in-situ we explore in detail how multiple cavity modes contribute to qubit T1 decay in the Purcell regime. In addition, we show the continued dependence of qubit T1 on cavity κ as we systematically decouple from our cavity and are no longer Purcell-limited and how this dependence is related to a steady rise in qubit excited state population. Our findings are consistent with theory we have developed based on an effective circuit model for the cavity-qubit system, and set the stage for continuing the study of the multi-mode Purcell Effect by means of in-situ tuning of not just the cavity coupling, but the qubit frequency itself.

  5. 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.

  6. Multi-Modality Phantom Development

    Energy Technology Data Exchange (ETDEWEB)

    Huber, Jennifer S.; Peng, Qiyu; Moses, William W.

    2009-03-20

    Multi-modality imaging has an increasing role in the diagnosis and treatment of a large number of diseases, particularly if both functional and anatomical information are acquired and accurately co-registered. Hence, there is a resulting need for multi modality phantoms in order to validate image co-registration and calibrate the imaging systems. We present our PET-ultrasound phantom development, including PET and ultrasound images of a simple prostate phantom. We use agar and gelatin mixed with a radioactive solution. We also present our development of custom multi-modality phantoms that are compatible with PET, transrectal ultrasound (TRUS), MRI and CT imaging. We describe both our selection of tissue mimicking materials and phantom construction procedures. These custom PET-TRUS-CT-MRI prostate phantoms use agargelatin radioactive mixtures with additional contrast agents and preservatives. We show multi-modality images of these custom prostate phantoms, as well as discuss phantom construction alternatives. Although we are currently focused on prostate imaging, this phantom development is applicable to many multi-modality imaging applications.

  7. Ultrasmall Biocompatible WO3- x Nanodots for Multi-Modality Imaging and Combined Therapy of Cancers.

    Science.gov (United States)

    Wen, Ling; Chen, Ling; Zheng, Shimin; Zeng, Jianfeng; Duan, Guangxin; Wang, Yong; Wang, Guanglin; Chai, Zhifang; Li, Zhen; Gao, Mingyuan

    2016-07-01

    Ultrasmall biocompatible WO3 - x nanodots with an outstanding X-ray radiation sensitization effect are prepared, and demonstrated to be applicable for multi-modality tumor imaging through computed tomography and photoacoustic imaging (PAI), and effective cancer treatment combining both photothermal therapy and radiation therapy. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  8. 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

  9. 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

  10. 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.

  11. 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

  12. Effect of multimodality chest physiotherapy on the rate of recovery and prevention of complications in patients with mechanical ventilation: a prospective study in medical and surgical intensive care units.

    Science.gov (United States)

    Pattanshetty, Renu B; Gaude, Gajanan S

    2011-05-01

    Mechanically ventilated patients have an increased risk of complications leading to ventilation weaning more difficult resulting in excessive morbidity and mortality. Chest physiotherapy plays an important role in management of ventilated patients. However, these techniques have been studied on patients as a single entity or with combination of two techniques. The present study was designed to evaluate the effect of multimodality chest physiotherapy on the rate of recovery and prevention of complications in adult ventilated patients. Out of 173 patients who were randomly allocated to two groups, 86 patients received MH and suctioning in control group and 87 patients were treated with multimodality chest physiotherapy in the study group twice daily till they were extubated. All patients were followed up for the global outcomes and complications during mechanical ventilation. There were significant improvements in terms of rate of recovery in study group compared to the control group (P = 0.000). Complication rates were higher with 61.6% in the control group as compared to 26.4% in the study group. Duration of hospitalization was longer in the study group (16 ± 9.40 days) as compared to the control group (12.8 ± 6.12 days). Successful weaning from mechanical ventilation was noted in 58 patients in the study group and 24 patients in the control group which was statistically significant. Multi-modality chest physiotherapy protocol has shown to prevent ventilator-associated pneumonia and enhance the clinical outcome in ventilated patients and may be recommended as a treatment option in ICU. It has also shown to enhance the weaning process and proved to be safe.

  13. Individual Multimodal Therapy for Weight Loss: A Case Example.

    Science.gov (United States)

    Kilmartin, Christopher; Robbins, Steven

    1987-01-01

    Presents a case study highlighting a treatment model based on a multimodal conceptualization. Suggests that individual multimodal therapy provides a comprehensive approach to the treatment of overeating, helping to target social and emotional issues related to eating disorders as well as the eating behaviors themselves. (Author/ABB)

  14. 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)

  15. 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.

  16. 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...

  17. 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.

  18. 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.

  19. 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…

  20. Radical multimodality therapy for malignant pleural mesothelioma.

    Science.gov (United States)

    Abdel-Rahman, Omar; Elsayed, Zeinab; Mohamed, Hadeer; Eltobgy, Mostafa

    2018-01-08

    Malignant pleural mesothelioma is an almost always fatal tumour, for which palliative platinum-based chemotherapy is currently the standard treatment. Multimodal therapeutic strategies incorporating surgery, radiation therapy or photodynamic therapy and chemotherapy have been recommended for selected patients but there is no consensus about their effectiveness. To assess the benefits and harms of radical multimodal treatment options (including radical surgery ± radical radiotherapy ± photodynamic therapy ± systemic therapy) compared to each other or to palliative treatments, for people with malignant pleural mesothelioma. We reviewed data from the Cochrane Lung Cancer group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase. We also checked reference lists of primary original studies, review articles and relevant conference proceedings manually for further related articles up to 21 March 2017. We included parallel-group randomised controlled trials of multimodal therapy for people with malignant pleural mesothelioma (stages I, II or III) that measured at least one of the following endpoints: overall survival, health-related health-related quality of life, adverse events or progression-free survival. We considered studies regardless of language or publication status. Two review authors independently extracted relevant information on participant characteristics, interventions, study outcomes, and data on the outcomes for this review, as well as information on the design and methodology of the studies. Two review authors assessed the risk of bias in the included trials using pre-defined 'Risk of bias' domains. We assessed the methodological quality using GRADE. We conducted this review in accordance with the published Cochrane protocol. Two randomised clinical trials with 104 participants fulfilled our inclusion criteria. Both trials were at high risk of bias (for outcomes other than overall survival), and we rated

  1. 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

  2. Effects of Autologous Fat and ASCs on Swine Hypertrophic Burn Scars: A Multimodal Quantitative Analysis

    Directory of Open Access Journals (Sweden)

    Scott J. Rapp, MD

    2017-11-01

    Conclusion:. Early results suggest that autologous fat and/or ASCs may improve healing of hypertrophic scarring by altering the cellular and structural components during wound remodeling up to 20 weeks after injury. This may have beneficial applications in early treatment of large or cosmetically sensitive immature burn scars.

  3. 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

    and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Medical Outcomes Study Short Form (MOS SF-36), Leisure Time Physical Activity Questionnaire, muscular strength (one repetition maximum), maximum oxygen consumption (Vo(2)max). Statistical methods The general linear model was used...

  4. 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.

  5. Managing hyperemesis gravidarum: a multimodal challenge

    Science.gov (United States)

    2010-01-01

    Up to 90% of pregnant women experience nausea and vomiting. When prolonged or severe, this is known as hyperemesis gravidarum (HG), which can, in individual cases, be life threatening. In this article the aetiology, diagnosis and treatment strategies will be presented based on a selective literature review. Treatment strategies range from outpatient dietary advice and antiemetic drugs to hospitalization and intravenous (IV) fluid replacement in persistent or severe cases. Alternative methods, such as acupuncture, are not yet evidence based but sometimes have a therapeutic effect. In most cases, the condition is self limiting and subsides by around 20 weeks gestation. More severe forms require medical intervention once other organic causes of nausea and vomiting have been excluded. In addition, a psychosomatic approach is often helpful. In view of its potential complexity, general practitioners and obstetricians should be well informed about HG and therapy should be multimodal. PMID:20633258

  6. Managing hyperemesis gravidarum: a multimodal challenge

    Directory of Open Access Journals (Sweden)

    Mylonas I

    2010-07-01

    Full Text Available Abstract Up to 90% of pregnant women experience nausea and vomiting. When prolonged or severe, this is known as hyperemesis gravidarum (HG, which can, in individual cases, be life threatening. In this article the aetiology, diagnosis and treatment strategies will be presented based on a selective literature review. Treatment strategies range from outpatient dietary advice and antiemetic drugs to hospitalization and intravenous (IV fluid replacement in persistent or severe cases. Alternative methods, such as acupuncture, are not yet evidence based but sometimes have a therapeutic effect. In most cases, the condition is self limiting and subsides by around 20 weeks gestation. More severe forms require medical intervention once other organic causes of nausea and vomiting have been excluded. In addition, a psychosomatic approach is often helpful. In view of its potential complexity, general practitioners and obstetricians should be well informed about HG and therapy should be multimodal.

  7. 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.

  8. 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.

  9. 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 recent work in the critical analysis of multimodal discourse....

  10. 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.

  11. 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

  12. 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

  13. 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.

  14. 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)

  15. 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.

  16. 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…

  17. Effectiveness of Inclusion of Dry Needling in a Multimodal Therapy Program for Patellofemoral Pain: A Randomized Parallel-Group Trial.

    Science.gov (United States)

    Espí-López, Gemma V; Serra-Añó, Pilar; Vicent-Ferrando, Juan; Sánchez-Moreno-Giner, Miguel; Arias-Buría, Jose L; Cleland, Joshua; Fernández-de-Las-Peñas, César

    2017-06-01

    Study Design Randomized controlled trial. Background Evidence suggests that multimodal interventions that include exercise therapy may be effective for patellofemoral pain (PFP); however, no study has investigated the effects of trigger point (TrP) dry needling (DN) in people with PFP. Objectives To compare the effects of adding TrP DN to a manual therapy and exercise program on pain, function, and disability in individuals with PFP. Methods Individuals with PFP (n = 60) recruited from a public hospital in Valencia, Spain were randomly allocated to manual therapy and exercises (n = 30) or manual therapy and exercise plus TrP DN (n = 30). Both groups received the same manual therapy and strengthening exercise program for 3 sessions (once a week for 3 weeks), and 1 group also received TrP DN to active TrPs within the vastus medialis and vastus lateralis muscles. The pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS; 0-100 scale) was used as the primary outcome. Secondary outcomes included other subscales of the KOOS, the Knee Society Score, the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), and the numeric pain-rating scale. Patients were assessed at baseline and at 15-day (posttreatment) and 3-month follow-ups. Analysis was conducted with mixed analyses of covariance, adjusted for baseline scores. Results At 3 months, 58 subjects (97%) completed the follow-up. No significant between-group differences (all, P>.391) were observed for any outcome: KOOS pain subscale mean difference, -2.1 (95% confidence interval [CI]: -4.6, 0.4); IKDC mean difference, 2.3 (95% CI: -0.1, 4.7); knee pain intensity mean difference, 0.3 (95% CI: -0.2, 0.8). Both groups experienced similar moderate-to-large within-group improvements in all outcomes (standardized mean differences of 0.6 to 1.1); however, only the KOOS function in sport and recreation subscale surpassed the prespecified minimum important change. Conclusion The current

  18. 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...

  19. 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 ...

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

    OpenAIRE

    Barkman, O.; Jerabek, V.; Prajzler, V.

    2013-01-01

    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...

  1. Multimodal Randomized Functional MR Imaging of the Effects of Methylene Blue in the Human Brain.

    Science.gov (United States)

    Rodriguez, Pavel; Zhou, Wei; Barrett, Douglas W; Altmeyer, Wilson; Gutierrez, Juan E; Li, Jinqi; Lancaster, Jack L; Gonzalez-Lima, Francisco; Duong, Timothy Q

    2016-11-01

    Purpose To investigate the sustained-attention and memory-enhancing neural correlates of the oral administration of methylene blue in the healthy human brain. Materials and Methods The institutional review board approved this prospective, HIPAA-compliant, randomized, double-blinded, placebo-controlled clinical trial, and all patients provided informed consent. Twenty-six subjects (age range, 22-62 years) were enrolled. Functional magnetic resonance (MR) imaging was performed with a psychomotor vigilance task (sustained attention) and delayed match-to-sample tasks (short-term memory) before and 1 hour after administration of low-dose methylene blue or a placebo. Cerebrovascular reactivity effects were also measured with the carbon dioxide challenge, in which a 2 × 2 repeated-measures analysis of variance was performed with a drug (methylene blue vs placebo) and time (before vs after administration of the drug) as factors to assess drug × time between group interactions. Multiple comparison correction was applied, with cluster-corrected P methylene blue increased response in the bilateral insular cortex during a psychomotor vigilance task (Z = 2.9-3.4, P = .01-.008) and functional MR imaging response during a short-term memory task involving the prefrontal, parietal, and occipital cortex (Z = 2.9-4.2, P = .03-.0003). Methylene blue was also associated with a 7% increase in correct responses during memory retrieval (P = .01). Conclusion Low-dose methylene blue can increase functional MR imaging activity during sustained attention and short-term memory tasks and enhance memory retrieval. © RSNA, 2016 Online supplemental material is available for this article.

  2. A novel five-category multimodal T1-weighted and T2-weighted magnetic resonance imaging-based stratification system for the selection of spinal arachnoid cyst treatment: a 15-year experience of 81 cases

    Directory of Open Access Journals (Sweden)

    Qi J

    2014-03-01

    Full Text Available Ji Qi, Jun Yang, Guihuai Wang Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China Background: Idiopathic spinal arachnoid cysts are rare cystic masses of the spinal canal generally classified as intra- or extradural, based on anatomical presentation. However, this system may not effectively indicate treatment. Objective: To investigate the incidence, resection modality, and prognosis of spinal arachnoid cyst in a 15-year case series. Patients and methods: A retrospective study was conducted in 81 spinal arachnoid cyst patients (male:female 34:47, mean age 36.5 years, age range 6–66 years classified using a novel five-category T1-weighted and T2-weighted magnetic resonance imaging (MRI classification system (intramedullary, subdural extramedullary, subdural/epidural, intraspinal epidural, or intraspinal/extraspinal. Conservative treatment failed in all patients. They underwent spinal surgery between January 1995 and December 2010 and were followed up for 69 (range 3–187 months. Performance outcomes were assessed using the Fugl-Meyer (FM scale 90 days after operation. Recurrences and deaths were recorded. Results: Subdural/epidural and intraspinal epidural cysts accounted for 66.7% (54 of 81 of patients, but exhibited relatively lower rates of postsurgical improvement using FM, with only 66.7% (36 of 54 of patients showing improvements. Excellent outcomes using the FM scale were reached in 100% (eight of eight of intramedullary, intraspinal/extraspinal, and subdural extramedullary cyst patients, 86.7% (13 of 15 of subdural extramedullary cyst patients, and 66.7% (36 of 54 of epidural intraspinal cyst patients. Conclusion: The proposed five-category multimodal MRI-based stratification system for spinal arachnoid cyst patients may more effectively allow clinicians to select the appropriate surgical intervention, and may help to predict outcomes. Keywords: spinal arachnoid cyst

  3. 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.

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

    NARCIS (Netherlands)

    Menning, Sanne; de Ruiter, Michiel B.; Veltman, Dick J.; Koppelmans, V.; Kirschbaum, Clemens; Boogerd, Willem; Reneman, Liesbeth; Schagen, Sanne B.

    2015-01-01

    An increasing body of literature indicates that chemotherapy (ChT) for breast cancer (BC) is associated with adverse effects on the brain. Recent research suggests that cognitive and brain function in patients with BC may already be compromised before the start of chemotherapy. This is the first

  5. Prevalence of morphometric vertebral fractures in "difficult" patients with acromegaly with different biochemical outcomes after multimodal treatment.

    Science.gov (United States)

    Chiloiro, S; Mormando, M; Bianchi, A; Giampietro, A; Milardi, D; Bima, C; Grande, G; Formenti, A M; Mazziotti, G; Pontecorvi, A; Giustina, A; De Marinis, L

    2018-02-01

    Skeletal fragility with high risk of vertebral fractures is an emerging complication of acromegaly in close relationship with duration of active disease. The aim of this cross-sectional study was to evaluate the prevalence and determinants of vertebral fractures in males and females with a history of long-standing active acromegaly undergoing treatment with Pegvisomant. Thirty-eight patients (25 females, 13 males) with acromegaly under Pegvisomant therapy were evaluated for vertebral fractures and bone mineral density at lumbar spine and femoral neck. Gonadal status, serum IGF1 levels and growth hormone receptor genotype were also assessed. Vertebral fractures were detected in 12 patients (31.6%). Fractured patients had longer duration of active disease (p = 0.01) with higher frequency of active acromegaly (p = 0.04), received higher dose of Pegvisomant (p = 0.008), and were more frequently hypogonadic (p = 0.02) as compared to patients who did not fracture. Stratifying the patients for gender, vertebral fractures were significantly associated with Pegvisomant dose (p = 0.02) and untreated hypogonadism (p = 0.02) in males and with activity of disease (p = 0.03), serum insulin-like growth factor-I values (p = 0.01) and d3GHR polymorphism (p = 0.005) in females. No significant association was found between vertebral fractures and bone mineral density at either skeletal site. Vertebral fractures are a frequent complication of long-standing active acromegaly. When patients are treated with Pegvisomant, vertebral fractures may occur in close relationship with active acromegaly and coexistent untreated hypogonadism.

  6. 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.

  7. 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.

  8. 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.

  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. An Overview of Multimodal Neuroimaging Using Nanoprobes

    Directory of Open Access Journals (Sweden)

    Sriram Sridhar

    2017-02-01

    Full Text Available Nanomaterials have gained tremendous significance as contrast agents for both anatomical and functional preclinical bio-imaging. Contrary to conventional medical practices, molecular imaging plays an important role in exploring the affected cells, thus providing precision medical solutions. It has been observed that incorporating nanoprobes improves the overall efficacy of the diagnosis and treatment processes. These nano-agents and tracers are therefore often incorporated into preclinical therapeutic and diagnostic applications. Multimodal imaging approaches are well equipped with nanoprobes to explore neurological disorders, as they can display more than one type of characteristic in molecular imaging. Multimodal imaging systems are explored by researchers as they can provide both anatomical and functional details of tumors and affected tissues. In this review, we present the state-of-the-art research concerning multimodal imaging systems and nanoprobes for neuroimaging applications.

  11. Multimodal imaging of cutaneous wound tissue

    Science.gov (United States)

    Zhang, Shiwu; Gnyawali, Surya; Huang, Jiwei; Ren, Wenqi; Gordillo, Gayle; Sen, Chandan K.; Xu, Ronald

    2015-01-01

    Quantitative assessment of wound tissue ischemia, perfusion, and inflammation provides critical information for appropriate detection, staging, and treatment of chronic wounds. However, few methods are available for simultaneous assessment of these tissue parameters in a noninvasive and quantitative fashion. We integrated hyperspectral, laser speckle, and thermographic imaging modalities in a single-experimental setup for multimodal assessment of tissue oxygenation, perfusion, and inflammation characteristics. Algorithms were developed for appropriate coregistration between wound images acquired by different imaging modalities at different times. The multimodal wound imaging system was validated in an occlusion experiment, where oxygenation and perfusion maps of a healthy subject's upper extremity were continuously monitored during a postocclusive reactive hyperemia procedure and compared with standard measurements. The system was also tested in a clinical trial where a wound of three millimeters in diameter was introduced on a healthy subject's lower extremity and the healing process was continuously monitored. Our in vivo experiments demonstrated the clinical feasibility of multimodal cutaneous wound imaging.

  12. 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

  13. Mode power distribution effect in white-light multimode fiber extrinsic Fabry-Perot interferometric sensor systems.

    Science.gov (United States)

    Han, Ming; Wang, Anbo

    2006-05-01

    Theoretical and experimental results have shown that mode power distribution (MPD) variations could significantly vary the phase of spectral fringes from multimode fiber extrinsic Fabry-Perot interferometric (MMF-EFPI) sensor systems, owing to the fact that different modes introduce different extra phase shifts resulting from the coupling of modes reflected at the second surface to the lead-in fiber end. This dependence of fringe pattern on MPD could cause measurement errors in signal demodulation methods of white-light MMF-EFPI sensors that implement the phase information of the fringes.

  14. 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...

  15. Automatic Evolution of Multimodal Behavior with Multi-Brain HyperNEAT

    DEFF Research Database (Denmark)

    Schrum, Jacob; Lehman, Joel; Risi, Sebastian

    2016-01-01

    An important challenge in neuroevolution is to evolve multimodal behavior. Indirect network encodings can potentially answer this challenge. Yet in practice, indirect encodings do not yield effective multimodal controllers. This paper introduces novel multimodal extensions to HyperNEAT, a popular...

  16. Modeling Multimodal Stratification

    DEFF Research Database (Denmark)

    Boeriis, Morten

    2017-01-01

    This article discusses one of the core axioms of social semiotic theory, namely stratification, in the light of developments in multimodality in recent years. The discussion takes a point of departure in the approaches to stratification taken by Hjelmslev, Halliday, and Kress and van Leeuwen....... The article outlines a theoretical experiment exploring how an alternative way of modeling stratification and instantiation may raise some interesting ideas on the concepts of realization dynamics, system-instance, and the different contexts of the semiotic text. This is elaborated in a discussion of how...... the relationship between stratification and instantiation in the multimodal instantiation of resources at different strata may provide a new approach to mapping out the dynamics of multimodal meaning making....

  17. 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

  18. 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....... 1885 to 1939, we studied how this new material became legitimized for the construction of buildings. Our early coding revealed three multimodal strategies associated with theorization: emotional, narrative, and lexical. Our intention when developing the full paper is to articulate these findings...

  19. 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

  20. 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).

  1. 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...

  2. 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...

  3. 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.

  4. [Effectiveness of local treatment in recurrent duodenal peptic ulcer].

    Science.gov (United States)

    Kirillov, V A; Preobrazhenskiĭ, V N; Ermakov, E V; Kruchinin, E Z

    1986-01-01

    The paper is concerned with a comparative assessment of the efficacy of employment of various methods of drug administration with the help of an injection needle through a gastric fibroscope in the multimodality therapy of duodenal ulcer patients. The assessment of the administration of gastrosol to 33 patients, solcoseryl to 27 and the granulocyte concentrate to 42 showed that most effective was administration of the granulocyte concentrate in the presence of antacids and cholinolytics. The employment of this method in multimodality therapy of duodenal ulcer made it possible to reduce the time of cicatrization and obtaining a good clinical remission.

  5. Multimodal physiotherapeutic management for stage-IV osteitis pubis in a 15-year old soccer athlete: a case report.

    Science.gov (United States)

    Vijayakumar, P; Nagarajan, M; Ramli, Ayiesah

    2012-01-01

    Osteitis pubis among soccer athletes is a disabling painful condition and it is difficult to manage without integrating a multimodal treatment approach. There is limited scientific evidence on the effectiveness of exercise in treating Osteitis pubis especially when it progress to a chronic painful condition. The purpose of this case report is to discuss the successful multimodal physiotherapeutic management for a 15-year old soccer athlete diagnosed with stage-IV Osteitis pubis. Land and water based active core muscle strengthening exercises, Proprioceptive neuromuscular facilitation techniques (PNF) and Manual Therapy are some of the essential components incorporated in multimodal intervention approach with emphasis to water based strength and endurance training exercises. The athlete was able to make progress to a successful recovery from his chronic painful condition and accomplished the clearly established clinical outcomes during each phase of rehabilitation.

  6. Migraine treatment and placebo effect.

    Science.gov (United States)

    Speciali, José G; Peres, Mário; Bigal, Marcelo E

    2010-03-01

    Placebos are typically defined as physiologically inactive substances that elicit a therapeutic response. The antipode of the placebo effect is the nocebo effect, or the negative effects of placebo, where unpleasant symptoms (e.g., adverse events) emerge after the administration of placebo. Placebo analgesia is one of the most striking examples of the cognitive modulation of pain perception. Herein we focus on the importance of placebo in headache research. We first review the mechanisms of the placebo effect. We then focus on the importance of placebo in the acute treatment of migraine. We follow by discussing the importance of placebo on the preventive treatment of migraine and our perspectives for the 5 years to come regarding the study of the placebos.

  7. 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.

  8. 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 ...

  9. Experiential Influences on Multimodal Perception of Emotion

    Science.gov (United States)

    Shackman, Jessica E.; Pollak, Seth D.

    2005-01-01

    The impact of 2 types of learning experiences on children's perception of multimodal emotion cues was examined. Children (aged 7-12 years) were presented with conflicting facial and vocal emotions. The effects of familiarity were tested by varying whether emotions were presented by familiar or unfamiliar adults. The salience of particular…

  10. Plastic Surgery in the Multimodal Treatment Concept of Soft Tissue Sarcoma: Influence of Radiation, Chemotherapy, and Isolated Limb Perfusion on Plastic Surgery Techniques

    OpenAIRE

    Kapalschinski, Nicolai; Goertz, Ole; Harati, Kamran; Kueckelhaus, Maximilian; Kolbenschlag, Jonas; Lehnhardt, Marcus; Hirsch, Tobias

    2015-01-01

    Surgical intervention is the mainstay treatment for soft tissue sarcomas. The significance of adjuvant and neoadjuvant therapies such as chemotherapy, radiation and isolated limb perfusion remains under controversial discussion. The goal of this review is to discuss the effects of the aforementioned treatment modalities and their timing of application on plastic surgery techniques. Furthermore, options of reconstruction in cases of complications caused by adjuvant and neoadjuvant therapies ar...

  11. Scalar diffraction theory approach to estimating multimode-waveguide field-amplitude mode distributions.

    Science.gov (United States)

    Kemme, S A; Kostuk, R K

    1998-07-10

    We introduce a method to estimate the coupling coefficients of the guided field amplitude and the corresponding angular bandwidth in a multimode slab waveguide. This scalar diffraction theory approach is simpler than the more rigorous electromagnetic treatment and is directly applicable to communications systems that use large (dimensions or numerical aperture) waveguides, as in substrate-mode interconnects. Moreover, this method provides conceptual insight as to a parameter's effect on the field-amplitude mode distribution and angular bandwidth.

  12. Evaluating the Implementation of a Preemptive, Multimodal Analgesia Protocol in a Plastic Surgery Office.

    Science.gov (United States)

    Tinsbloom, Brandi; Muckler, Virginia C; Stoeckel, William T; Whitehurst, Robert L; Morgan, Brett

    Many patients undergoing plastic surgery experience significant pain postoperatively. The use of preemptive, multimodal analgesia techniques to reduce postoperative pain has been widely described in the literature. This quality improvement project evaluated the implementation of a preemptive, multimodal analgesia protocol in an office-based plastic surgery facility to decrease postoperative pain, decrease postoperative opioid consumption, decrease postanesthesia care time, and increase patient satisfaction. The project included adult patients undergoing surgical procedures at an outpatient plastic and cosmetic surgery office, and the protocol consisted of oral acetaminophen 1,000 mg and gabapentin 1,200 mg. Using a pre-/postintervention design, data were collected from patient medical records and telephone interviews of patients receiving the standard preoperative analgesia regimen (preintervention group: n = 24) and the evidence-based preemptive, multimodal analgesia protocol (postintervention group: n = 23). Results indicated no significant differences between the pre- and postintervention groups for any of the outcomes measured. However, results showed that patients in both groups experienced moderate to severe pain postoperatively. In addition, adverse side effects such as dizziness and drowsiness were higher in the postintervention group than in the preintervention group. Although this quality improvement project did not meet the goals it set out to achieve for patients undergoing plastic surgery, it did illustrate the substantial presence of pain after surgical procedures. Thus, clinicians need to continue to focus on identifying targeted treatment plans that use multimodal, non-opioid-based strategies to manage and prevent postoperative pain.

  13. Multimodal eye recognition

    Science.gov (United States)

    Zhou, Zhi; Du, Yingzi; Thomas, N. L.; Delp, Edward J., III

    2010-04-01

    Multimodal biometrics use more than one means of biometric identification to achieve higher recognition accuracy, since sometimes a unimodal biometric is not good enough used to do identification and classification. In this paper, we proposed a multimodal eye recognition system, which can obtain both iris and sclera patterns from one color eye image. Gabor filter and 1-D Log-Gabor filter algorithms have been applied as the iris recognition algorithms. In sclera recognition, we introduced automatic sclera segmentation, sclera pattern enhancement, sclera pattern template generation, and sclera pattern matching. We applied kernelbased matching score fusion to improve the performance of the eye recognition system. The experimental results show that the proposed eye recognition method can achieve better performance compared to unimodal biometric identification, and the accuracy of our proposed kernel-based matching score fusion method is higher than two classic linear matching score fusion methods: Principal Component Analysis (PCA) and Linear Discriminant Analysis (LDA).

  14. Tinnitus Multimodal Imaging

    Science.gov (United States)

    2016-12-01

    AWARD NUMBER: W81XWH-13-1-0494 TITLE: Tinnitus Multimodal Imaging PRINCIPAL INVESTIGATOR: Steven Wan Cheung CONTRACTING ORGANIZATION...ABOVE ADDRESS. 1. REPORT DATE December 2016 2. REPORT TYPE FINAL 3. DATES COVERED 30 October 2013 – 29 September 2016 4. TITLE AND SUBTITLE Tinnitus ...ABSTRACT Chronic subjective tinnitus is a common auditory perceptual disorder whose neural substrates remain under intense debate. This project

  15. Multimodal Emoji Prediction

    OpenAIRE

    Barbieri, Francesco; Ballesteros, Miguel; Ronzano, Francesco; Saggion, Horacio

    2018-01-01

    Emojis are small images that are commonly included in social media text messages. The combination of visual and textual content in the same message builds up a modern way of communication, that automatic systems are not used to deal with. In this paper we extend recent advances in emoji prediction by putting forward a multimodal approach that is able to predict emojis in Instagram posts. Instagram posts are composed of pictures together with texts which sometimes include emojis. We show that ...

  16. Multimodal mental imagery.

    Science.gov (United States)

    Nanay, Bence

    2017-07-17

    When I am looking at my coffee machine that makes funny noises, this is an instance of multisensory perception - I perceive this event by means of both vision and audition. But very often we only receive sensory stimulation from a multisensory event by means of one sense modality, for example, when I hear the noisy coffee machine in the next room, that is, without seeing it. The aim of this paper is to bring together empirical findings about multimodal perception and empirical findings about (visual, auditory, tactile) mental imagery and argue that on occasions like this, we have multimodal mental imagery: perceptual processing in one sense modality (here: vision) that is triggered by sensory stimulation in another sense modality (here: audition). Multimodal mental imagery is not a rare and obscure phenomenon. The vast majority of what we perceive are multisensory events: events that can be perceived in more than one sense modality - like the noisy coffee machine. And most of the time we are only acquainted with these multisensory events via a subset of the sense modalities involved - all the other aspects of these multisensory events are represented by means of multisensory mental imagery. This means that multisensory mental imagery is a crucial element of almost all instances of everyday perception. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. 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.

  18. 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

  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. 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.

  1. Pain patients' experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity, and treatment outcome.

    Science.gov (United States)

    Edlund, Sara M; Wurm, Matilda; Holländare, Fredrik; Linton, Steven J; Fruzzetti, Alan E; Tillfors, Maria

    2017-10-01

    were only found post-treatment. This appeared to be due to the pre- and post-heightened invalidation clusters not containing the same individuals. Therefore, additional analyses were conducted to investigate the individuals who changed clusters. Results showed that patients scoring high on negative affectivity ended up in the heightened invalidation cluster post-treatment. Taken together, most patients felt understood when communicating with their rehabilitation physician. However, a smaller group of patients experienced the opposite: low levels of validation and heightened levels of invalidation. This group stood out as more problematic, reporting greater pain interference and negative affectivity when compared to the other groups after treatment. Patient perceptions were typically stable over time, but some individuals changed cluster, and these movements seemed to be related to negative affectivity and pain interference. These results do not support a connection between perceived validation and invalidation from physicians (meeting the patients pre- and post-treatment) and treatment outcome. Overall, our results suggest that there is a connection between negative affectivity and pain interference in the patients, and perceived validation and invalidation from the physicians. In clinical practice, it is important to pay attention to comorbid psychological problems and level of pain interference, since these factors may negatively influence effective communication. A focus on decreasing invalidating responses and/or increasing validating responses might be particularly important for patients with high levels of psychological problems and pain interference. Copyright © 2017. Published by Elsevier B.V.

  2. 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.

  3. Switchable lasing in multimode microcavities

    DEFF Research Database (Denmark)

    Zhukovsky, Sergei V.; Chigrin, Dmitry N.; Lavrinenko, Andrei

    2007-01-01

    We propose the new concept of a switchable multimode microlaser. As a generic, realistic model of a multimode microresonator a system of two coupled defects in a two-dimensional photonic crystal is considered. We demonstrate theoretically that lasing of the cavity into one selected resonator mode...... in terms of the laser bistability is presented....

  4. Multimodal Analysis for Critical Thinking

    Science.gov (United States)

    O'Halloran, Kay L.; Tan, Sabine; E., Marissa K. L.

    2017-01-01

    This paper proposes a pedagogical approach for teaching and learning critical thinking through multimodal analysis--that is, "multimodal analysis for critical thinking". The approach builds on the conviction that students require competencies that move beyond traditional notions of literacy to meet the changing demands posed by media and…

  5. 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.

  6. Multimodality, politics and ideology

    DEFF Research Database (Denmark)

    Machin, David; Van Leeuwen, T.

    2016-01-01

    , in entertainments media, software, administrative processes, children's apps, healthcare and even office furniture design. We point to the way that there have been massive shifts away from traditional state forms of politics to the rule of neoliberalism and the power of the corporation which, like the former regime...... 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....

  7. Equal Improvement in Men and Women in the Treatment of Urologic Chronic Pelvic Pain Syndrome Using a Multi-modal Protocol with an Internal Myofascial Trigger Point Wand.

    Science.gov (United States)

    Anderson, Rodney U; Wise, David; Sawyer, Tim; Nathanson, Brian H; Nevin Smith, J

    2016-06-01

    Both men and women require treatment for urologic chronic pelvic pain syndromes (UCPPS), which includes interstitial cystitis/painful bladder syndrome, pelvic floor dysfunction, and chronic prostatitis/chronic pelvic pain syndrome. However, it is unknown if men and women respond differently to a protocol that includes specific physical therapy self-treatment using an internal trigger point wand and training in paradoxical relaxation. We performed a retrospective analysis by gender in a single arm, open label, single center clinical trial designed to evaluate the safety and effectiveness of a protocol for the treatment of UCPPS from October, 2008 to May, 2011. 314 adult men (79.9 %) and 79 (20.1 %) women met inclusion criteria. The median duration of symptoms was 60 months. The protocol required an initial 6-day clinic for training followed by a 6-month self-treatment period. The treatment included self-administered pelvic floor trigger point release with an internal trigger point device for physical therapy along with paradoxical relaxation training. Notable gender differences in prior treatments were observed. Men had a lower median [Interquartile Range] NIH-CPSI score at baseline than women (27 [21, 31] vs. 29 [22, 33], p = 0.04). Using a 1-10 scale with 10 = Most Severe, the median reduction in trigger point sensitivity was 3 units for both men and women after 6 months therapy (p = 0.74). A modified Intention to Treat analysis and a multivariate regression analysis found similar results. We conclude that men and women have similar, significant reductions in trigger point sensitivity with this protocol.

  8. 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.)

  9. 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....... Intraarticular bupivacaine plus morphine plus steroid was tested against bupivacaine plus morphine and against saline in two trials after arthroscopic knee meniscectomy and diagnostic knee arthroscopy respectively. Intraarticular bupivacaine plus morphine plus steroid was tested against saline after operative...... with bupivacaine plus morphine and bupivacaine plus morphine plus steroid after diagnostic knee arthroscopy reduced time to work from 10 to 5 to 2 days. Additional analysis revealed that the surgical trauma and the use of tourniquet influenced recovery. The thesis proves a reduction in the time to return to work...

  10. Use of cortexin in the multimodal neurorehabilitation of children

    Directory of Open Access Journals (Sweden)

    S. A. Nemkova

    2015-01-01

    Full Text Available The article reviews studies dealing with the use of the polypeptide nootropic and neurometabolic stimulant cortexin in the multimodal rehabilitation of patients with central nervous system diseases. The high efficiency of using cortexin is shown to be due to a combination of nootropic, neurotrophic, neuroprotective, reparative, and anticonvulsive effects, as well as antioxidant, metabolic, and antistress activities, which determines its high therapeutic efficacy in multimodal correction. 

  11. 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.

  12. 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.

  13. Fuel treatment guidebook: illustrating treatment effects on fire hazard

    Science.gov (United States)

    Morris Johnson; David L. Peterson; Crystal Raymond

    2009-01-01

    The Guide to Fuel Treatments (Johnson and others 2007) analyzes potential fuel treatments and the potential effects of those treatments for dry forest lands in the Western United States. The guide examines low- to mid-elevation dry forest stands with high stem densities and heavy ladder fuels, which are currently common due to fire exclusion and various land management...

  14. 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

  15. [Multimodal therapy of dyslipidemia].

    Science.gov (United States)

    Stahn, Annett; Hanefeld, Markolf

    2011-05-01

    In the multifactorial process of atherogenesis not only increased LDL-cholesterol but also decreased HDL-cholesterol and raised triglycerides correlate closely to cardiovascular events. Multiple studies have demonstrated a high prevalence of dyslipidemia and the metabolic syndrome in Germany.Statins remain first-line therapy for the treatment of dyslipidemia. However, despite therapy a relevant cardiovascular risk remains. Therefore, it is important to also aim for an adequate treatment of hypertriglyceridemia and also to raise HDL-levels. Many combination therapies have been shown to be effective in treating dyslipidemia. Adding Omega-3-fatty acids, nicotinic acid/laropiprant or a fibrate to statin monotherapy provide additional beneficial lipid-modifying effects for combined dyslipidemia. In the future a recommendation for the treatment of mixed hyperlipoproteinemia with decreased HDL, raised triglycerides and LDL-cholesterol shall have to be added to our guidelines.

  16. Plastic surgery in the multimodal treatment concept of soft tissue sarcoma: Influence of radiation, chemotherapy and isolated limb perfusion on plastic surgery techniques

    Directory of Open Access Journals (Sweden)

    Nicolai eKapalschinski

    2015-12-01

    Full Text Available Surgical intervention is the mainstay treatment for soft tissue sarcomas. The significance of adjuvant and neoadjuvant therapies such as chemotherapy, radiation and isolated limb perfusion remains under controversial discussion. The goal of this review is to discuss the effects of the aforementioned treatment modalities and their timing of application on plastic surgery techniques. Furthermore, options of reconstruction in cases of complications caused by adjuvant and neoadjuvant therapies are discussed. When compared with adjuvant radiation, neoadjuvant treatment can reduce negative side effects such as fibrosis and edema, because radioderma can be removed during the subsequent surgical procedure. Furthermore, there have not been any reports of negative effects of neoadjuvant radiation on microsurgical procedures. However, the dose of neoadjuvant radiation correlates with increased risks of impaired wound healing postoperatively. Thus, a patient-specific approach to decide whether radiation should be performed adjuvant or neoadjuvant is necessary. Pre-operative irradiation should be considered in cases where functional structures are exposed after tumor resection, in order to ensure the best possible functionality. Adjuvant radiation should be considered in all other cases because of its known superior wound healing. .As for chemotherapy, no negative influence of its use adjuvant or neoadjuvant to reconstructive procedures such as local or free flaps has been reported. Lastly, small sample size studies have not shown increased risks of microsurgical failure or wound complications after isolated limb perfusion. The findings of this review suggest that the chronological order of the discussed therapeutic approaches is not a decisive factor in the surgical outcome of reconstructive procedures for soft tissue sarcoma.

  17. Plastic Surgery in the Multimodal Treatment Concept of Soft Tissue Sarcoma: Influence of Radiation, Chemotherapy, and Isolated Limb Perfusion on Plastic Surgery Techniques.

    Science.gov (United States)

    Kapalschinski, Nicolai; Goertz, Ole; Harati, Kamran; Kueckelhaus, Maximilian; Kolbenschlag, Jonas; Lehnhardt, Marcus; Hirsch, Tobias

    2015-01-01

    Surgical intervention is the mainstay treatment for soft tissue sarcomas (STSs). The significance of adjuvant and neoadjuvant therapies, such as chemotherapy, radiation, and isolated limb perfusion, remains under controversial discussion. The goal of this review is to discuss the effects of the aforementioned treatment modalities and their timing of application in plastic surgery techniques. Furthermore, options of reconstruction in cases of complications caused by adjuvant and neoadjuvant therapies are discussed. When compared with adjuvant radiation, neoadjuvant treatment can reduce negative side effects such as fibrosis and edema because radioderma can be removed during the subsequent surgical procedure. Furthermore, there have not been any reports of negative effects of neoadjuvant radiation on microsurgical procedures. However, the dose of neoadjuvant radiation correlates with increased risks of impaired wound healing postoperatively. Thus, a patient-specific approach to decide whether radiation should be performed adjuvant or neoadjuvant is necessary. Preoperative irradiation should be considered in cases where functional structures are exposed after tumor resection, in order to ensure the best possible functionality. Adjuvant radiation should be considered in all other cases because of its known superior wound healing. As for chemotherapy, no negative influence of its use adjuvant or neoadjuvant to reconstructive procedures, such as local or free flaps, has been reported. Lastly, small sample size studies have not shown increased risks of microsurgical failure or wound complications after isolated limb perfusion. The findings of this review suggest that the chronological order of the discussed therapeutic approaches is not a decisive factor in the surgical outcome of reconstructive procedures for STS.

  18. 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. 

  19. 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

  20. 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 training but not in the control group. In the fMRI subgroup of the training participants, neural activity changes in left dorsolateral prefrontal cortex (DLPFC) during one-back predicted post-training auditory dual-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.

  1. Multimodal hyperspectral optical microscopy

    Science.gov (United States)

    Novikova, Irina V.; Smallwood, Chuck R.; Gong, Yu; Hu, Dehong; Hendricks, Leif; Evans, James E.; Bhattarai, Ashish; Hess, Wayne P.; El-Khoury, Patrick Z.

    2017-11-01

    We describe a unique approach to hyperspectral optical microscopy, herein achieved by coupling a hyperspectral imager to various optical microscopes. Hyperspectral fluorescence micrographs of isolated fluorescent beads are first employed to ensure spectral calibration of our detector and to gauge the attainable spatial resolution of our measurements. Different science applications of our instrument are then described. Spatially over-sampled absorption spectroscopy of a single lipid (18:1 Liss Rhod PE) layer reveals that optical densities on the order of 10-3 can be resolved by spatially averaging the recorded optical signatures. This is followed by three applications in the general areas of plasmonics and bioimaging. Notably, we deploy hyperspectral absorption microscopy to identify and image pigments within a simple biological system, namely, a single live Tisochrysis lutea cell. Overall, this work paves the way for multimodal spectral imaging measurements spanning the realms of several scientific disciplines.

  2. [Multimodal serotonergic antidepressants].

    Science.gov (United States)

    Danilov, D S

    Based on the original literature, the author for the first time describes a history of selective serotonergic antidepressants simultaneously inhibiting the serotonin reuptake and directly interacting with serotonin receptors. A history of creation and introduction of their main representatives is presented. A history of investigation of their neurochemical activity is analyzed in details. The history of the evolution of their classifications is systemized. The data presented suggest the rationale for unifying all selective serotonergic antidepressants, simultaneously inhibiting the serotonin reuptake and directly interacting with serotonin receptors (trazodone, etoperidone, nefazodone, vilazodone, vortioxetine), in one group of 'multimodal serotonergic antidepressants'. The expediency to include this group in the modern neurochemical classification of nootropic drugs is substantiated.

  3. Pre-service teacher discourses: Authoring selves through multimodal compositions

    Directory of Open Access Journals (Sweden)

    John Bishop

    2009-05-01

    Full Text Available This article explores the use of digital and multimodal compositions among preservice elementary education students in a university language and literacy methods course. Furthermore, this piece argues for the inclusion of multimodal representation in our literacy courses given the changes in our digital landscape and the ever-increasing multimodality of our representational and communicational means online. This research aligns with a burgeoning collection of literature, namely New Literacies (Knobel & Lankshear, 2007 and multimodality (Kress & van Leeuwen, 2001. In addition, this research merges with ‘traditional’ print-based literacy pedagogies that argue for models of teacher learning that foreground opportunities to ‘do’ digital composition in order to more effectively prepare students for 21st century literacy skills in epistemologically diverse digital environments. A combination of discourse and multimodal analysis provides a means to couple both linguistic and semiotic data to examine how multimodal design functions in the construction of teacher identities and how the flexibility of these identities in turn work to prepare new teachers for successful transitions into public school cultures. In other words, how might the practice of multimedia production, and reflection on those processes, foster a deeper self-awareness during a time when students are moving from university settings into public schools? This article argues that multimodal text design is dialogic and purposeful with regards to constructions of teacher identities and highlights two ‘Digital Literacy Projects,’ multimodal video compositions designed and produced by preservice teachers with video editing software. The two DLPs contrast the potential for authors to stabilize and/or improvise formations of identity, both which create opportunities to engage in praxis that merge university experiences with public school responsibilities.

  4. Adverse effects of breast cancer treatment.

    Science.gov (United States)

    Odle, Teresa G

    2014-01-01

    As breast cancer outcomes improve and more people with breast cancer survive longer following diagnosis, many survivors must deal with the effects of treatment. Some adverse effects last a short time and have little influence on breast cancer patients' quality of life, yet others can cause long-term complications and add to increased morbidity and mortality among survivors. This article reviews the adverse effects of breast cancer treatments and how they affect the health and quality of life of those receiving treatment. The article also explains how adverse effects can interrupt treatment and how physicians and survivors can manage adverse effects of breast cancer treatment.

  5. The positive predictive value of O-(2-[18F]fluoroethyl)-L-tyrosine (FET) PET in the diagnosis of a glioma recurrence after multimodal treatment.

    Science.gov (United States)

    Mehrkens, J H; Pöpperl, G; Rachinger, W; Herms, J; Seelos, K; Tatsch, K; Tonn, J C; Kreth, F W

    2008-05-01

    To explore prospectively the positive predictive value of O-(2-[(18)F]fluoroethyl)-L-tyrosine (FET)-PET in selected patients with a magnetic resonance imaging (MRI)-based suspicion of a glioma recurrence or progression. Methods Patients with a supratentorial glioma (initial World Health Organization (WHO) grade II, III or IV) were considered eligible if they had both an MRI-(new/progressive contrast-enhancing lesion) and FET-PET-based diagnosis of a recurrence/progression after various forms and combinations of irradiation and chemotherapy. Criterion for tumour recurrence/progression in FET-PET was a standardized uptake value (SUVmax)/Background (BG) ratio of >2.0 in the late uptake phase. All patients underwent multimodal (MRI, FET-PET) imaging-guided stereotactic biopsy. The positive predictive value was defined as the proportion of MRI and FET-PET findings indicating glioma recurrence/progression that also tested positive for tumour recurrence/progression after stereotactic biopsy. Thirty-one patients with initially WHO grade II (17), WHO grade III (6), and grade IV glioma (8) were included. In 26 patients FET-PET results indicating tumour recurrence/progression were concordant with the biopsy results. In five patients histopathologic evaluation failed to reveal a "vital" tumour. FET-PET findings were also discordant with the radiographic and clinical follow-up in these five patients. The positive predictive value of FET-PET was 84%. The positive predictive value of FET-PET using the standard ratio method is high, but not high enough to replace stereotactic biopsy in this highly selected study cohort. Whether the calculation of FET uptake in the early phase and/or the evaluation of uptake kinetics will improve the positive predictive value of FET-PET deserves prospective evaluation.

  6. Binding of the Multimodal Antidepressant Drug Vortioxetine to the Human Serotonin Transporter

    DEFF Research Database (Denmark)

    Andersen, Jacob; Ladefoged, Lucy Kate; Wang, Danyang

    2015-01-01

    Selective inhibitors of the human serotonin transporter (hSERT) have been first-line treatment against depression for several decades. Recently, vortioxetine was approved as a new therapeutic option for the treatment of depression. Vortioxetine represents a new class of antidepressant drugs...... with a multimodal pharmacological profile that in addition to potent inhibition of hSERT include agonistic or antagonistic effects at different serotonin receptors. We used a combination of computational, chemical, and biological methods to decipher the molecular basis for high affinity binding of vortioxetine in h...

  7. Spinal metastases: multimodality imaging in diagnosis and stereotactic body radiation therapy planning.

    Science.gov (United States)

    Jabehdar Maralani, Pejman; Lo, Simon S; Redmond, Kristin; Soliman, Hany; Myrehaug, Sten; Husain, Zain A; Heyn, Chinthaka; Kapadia, Anish; Chan, Aimee; Sahgal, Arjun

    2017-01-01

    Due to increased effectiveness of cancer treatments and increasing survival rates, metastatic disease has become more frequent compared to the past, with the spine being the most common site of bony metastases. Diagnostic imaging is an integral part of screening, diagnosis and follow-up of spinal metastases. In this article, we review the principles of multimodality imaging for tumor detection with respect to their value for diagnosis and stereotactic body radiation therapy planning for spinal metastases. We will also review the current international consensus agreement for stereotactic body radiation therapy planning, and the role of imaging in achieving the best possible treatment plan.

  8. Relational Multimodal Freight Database Webinar

    Science.gov (United States)

    2012-02-01

    The relational Multimodal Freight Database (MFD) was developed as part of Texas Department : of Transportation (TxDOT) Research Project 0-6297 entitled Freight Planning Factors Impacting : Texas Commodity Flows, conducted by the Center for Transporta...

  9. 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.

  10. Multimodal analgesia and regional anaesthesia.

    Science.gov (United States)

    Tornero Tornero, C; Fernández Rodríguez, L E; Orduña Valls, J

    Multimodal analgesia provides quality analgesia, with fewer side effects due to the use of combined analgesics or analgesic techniques. Regional anaesthesia plays a fundamental role in achieving this goal. The different techniques of regional anaesthesia that include both peripheral and central blocks in either a single dose or in continuous infusion help to modulate the nociceptive stimuli that access the central level. The emergence of the ultrasound as an effective system to perform regional anaesthesia techniques has allowed the development of new regional anaesthesia techniques that formerly could not be carried out since only neurostimulation or skin references were used. It is essential to take into account that even with effective blocking it is advisable to associate other drugs by other routes, in this way we will be able to reduce the required doses individually and attempt to achieve a synergistic, not purely additive, effect. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Learning human multimodal dialogue strategies

    OpenAIRE

    Rieser, V.; Lemon, O.

    2010-01-01

    We investigate the use of different machine learning methods in combination with feature selection techniques to explore human multimodal dialogue strategies and the use of those strategies for automated dialogue systems. We learn policies from data collected in a Wizard-of-Oz study where different human 'wizards' decide whether to ask a clarification request in a multimodal manner or else to use speech alone. We first describe the data collection, the coding scheme and annotated corpus, and ...

  12. Robustness of multimodal processes itineraries

    DEFF Research Database (Denmark)

    Bocewicz, G.; Banaszak, Z.; Nielsen, Izabela Ewa

    2013-01-01

    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 det...... of multimodal processes driven itinerary planning problem is our main contribution. Illustrative examples providing alternative itineraries in some cases of MTS malfunction are presented....

  13. 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.

  14. 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…

  15. 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.

  16. 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...

  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. Multimodal therapy for painful bladder syndrome / interstitial cystitis: pilot study combining behavioral, pharmacologic, and endoscopic therapies

    Directory of Open Access Journals (Sweden)

    Robert S. Hanley

    2009-08-01

    Full Text Available Purpose: We evaluated the effectiveness of combining behavioral therapy, pharmacologic therapy and endoscopic hydrodistension for treating painful bladder syndrome / interstitial cystitis (PBS/IC. Materials and Methods: Twenty-five patients with PBS/IC were prospectively enrolled in a pilot multimodal behavioral, pharmacologic and endoscopic treatment protocol. Behavioral modification included diet recommendations, fluid restriction to 64 oz. /day, progressive timed voiding and Kegel exercises. Oral pharmacologic therapy consisted of daily doses of macrodantin 100 mg, hydroxyzine 10-20 mg and urised 4 tablets. Patients underwent endoscopic bladder hydrodistention under anesthesia at least 2 weeks after protocol enrollment. Behavioral and pharmacological treatments were continued after the hydrodistention. O'Leary-Sant questionnaire scores were recorded before starting the protocol, after pharmacologic/behavioral therapy, 2 months post-hydrodistension, and at scheduled follow-up. Results: Eighteen patients (72% completed the pilot multimodal treatment protocol and were followed for a mean of 10.2 months. All patients were female with a median age of 36.3 years and had mean bladder capacity under anesthesia of 836 milliliters. Mean O'Leary-Sant symptom index scores for baseline symptoms, after behavioral/pharmacologic treatment, post-hydrodistension and during follow up were 12.5, 8.6, 7.0, and 6.7 (p < 0.05. Mean O'Leary-Sant problem index scores for baseline, after behavioral/pharmacologic treatment, post-hydrodistention and during follow up were 12.7, 8.9, 6.7, and 7.7 (p < 0.05. Conclusion: Our pilot multimodal protocol of behavioral modification, pharmacologic therapy and endoscopic hydrodistention demonstrated a significant progressive improvement in PBS/IC quality of life scores, compared to a pre-treatment baseline. These results should be validated in a larger, placebo controlled trial.

  19. Alcohol and Group Formation: A Multimodal Investigation of the Effects of Alcohol on Emotion and Social Bonding

    OpenAIRE

    Sayette, Michael A.; Creswell, Kasey G.; Dimoff, John D.; Fairbairn, Catharine E.; Cohn, Jeffrey F.; Heckman, Bryan W.; Kirchner, Thomas R.; Levine, John M.; Moreland, Richard L.

    2012-01-01

    We integrated research on emotion and on small groups to address a fundamental and enduring question facing alcohol researchers: What are the specific mechanisms that underlie the reinforcing effects of drinking? In one of the largest alcohol-administration studies yet conducted, we employed a novel group-formation paradigm to evaluate the socioemotional effects of alcohol. Seven hundred twenty social drinkers (360 male, 360 female) were assembled into groups of 3 unacquainted persons each an...

  20. 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.

  1. The effect of multimodal stimulation and cutaneous application of vegetable oils on neonatal development in preterm infants: a randomized controlled trial.

    Science.gov (United States)

    Vaivre-Douret, L; Oriot, D; Blossier, P; Py, A; Kasolter-Péré, M; Zwang, J

    2009-01-01

    Preterm newborns admitted to the Neonatal Intensive Care Unit are deprived of sensory stimulation. Tactile/kinaesthetic stimulation results in weight gain. Studies involving the cutaneous application of vegetable oils have shown improvement in somatic growth and on skin barrier function. To assess the neurodevelopmental and biological benefits of the simultaneous use of multimodal stimulation (SMS) and the cutaneous application of vegetable oils. Setting Tertiary referral centre serving the Poitou-Charentes region of France. Randomized controlled trial of 49 low-risk preterm infants, born at 31- to 34-week gestation. Each infant was randomly assigned to one of three treatment groups, Sensori-Tonico-Motor (STM) touch for 10 days with either: sweet almond oil, ISIO4 blended oil, or placebo - normal saline, or to a control group who did not receive any intervention. The primary outcome was weight gain. Secondary outcomes were linear growth, neurological maturation, psychomotor development and number of days of admission. Analysis was by intention-to-treat. The group who received STM with ISIO4 oil demonstrated enhanced weight gain (+57%, 95% CI 37-76) compared with controls (P = 0.030). All STM groups showed shorter admission times (mean reduction 15 days, 95% CI 23-50 days hospitalised, P = 0.005), and an increase in body length (P = 0.030). Both groups of oil massaged babies (almond and ISIO4) showed an increased neurological score (P = 0.001) compared to controls. The infants receiving ISIO4 oil had an associated increase in psychomotor scores (P = 0.028), time spent in quiet wakefulness (P = 0.036), improved orientation (P = 0.036), and enhanced development of the oculomotor (P = 0.012) and sensorimotor (P = 0.003) systems. An additional benefit seen was improved moisturization (P = 0.001), and quicker recovery of dermatological conditions. No adverse dermatological events were observed. The combination of STM and cutaneous application of oils to healthy preterm

  2. Beyond strong coupling in a massively multimode cavity

    Science.gov (United States)

    Sundaresan, Neereja; Liu, Yanbing; Sadri, Darius; Szocs, Laszlo; Underwood, Devin; Malekakhlagh, Moein; Tureci, Hakan; Houck, Andrew

    2015-03-01

    We present experiments in a new regime of cavity quantum electrodynamics (cQED), the multimode strong coupling regime, in which the qubit-cavity coupling is comparable to the free spectral range, thus requiring the collective treatment of all modes along with the qubit. Here we show that this regime is accessible in circuit QED by coupling a 90MHz microwave cavity with a transmon qubit, resonant with the 75th harmonic with a coupling strength exceeding 30MHz. When driving this system, we observe multimode fluorescence consistent with cavity-enhanced sideband emission, with unexpected multi-photon processes and the emergence of ultra-narrow linewidths. This multimode coupling opens the door for a wide range of potential experiments, including studying the manifestation of complex many-body phenomena, the breakdown of the rotating wave approximation, and the bridge between discrete and continuous Hilbert spaces.

  3. Multimodal Imaging and Clinicopathologic Correlation in Primary Uveal Lymphoma

    Directory of Open Access Journals (Sweden)

    Brandon Erickson

    2016-01-01

    Full Text Available Purpose: We report a rare case of primary uveal lymphoma and characterize it using histopathology and multimodal imaging. Patient and Methods: A 41-year-old male presented with a 2-year history of increasingly blurry vision in his right eye and no systemic symptoms. Examination revealed a retinal detachment and mass lesion in the right eye. Radiologic and histologic testing was performed. Results: Multimodal imaging localized the lesion to the choroid, and fine needle aspiration biopsy diagnosed the lesion as a low-grade B-cell lymphoma. The patient was treated with external beam radiation, resulting in regression of the mass and resolution of the retinal detachment. Conclusions: Primary uveal lymphoma is a rare, usually indolent tumor that carries a good prognosis. In this case, we show that primary uveal lymphoma has distinct findings via histopathology and multimodal imaging, and that imaging after radiation treatment documents disease regression.

  4. 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 ...

  5. 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 ...

  6. Time-dependent multimode structure

    International Nuclear Information System (INIS)

    Edgu, E.

    1991-01-01

    In a previous paper, the authors sought to display the multimode kinetics structure and step changes were considered. In this paper, a similar study is undertaken in which ramp changes are considered. Throughout the previous study, a rather simple model of a bare, cylindrical, initially critical nuclear system was the focus. This system had a central region into which a control rod was suddenly inserted, or from which a control rod was suddenly ejected. (A rod follower concept was then adopted.) The mentioned transients were modeled by a two-mode synthesis approach that displayed, rather rigorously, the space-dependency behavior of the time- and space-dependent flux in question. It is useful to complete the picture previously drawn by a study within the authors' framework, where time-dependent changes now take place instead of step changes. In this paper, they consider a ramp rod drop in a bare cylindrical nuclear system as well as a ramp rod ejection from this system (still with a rod follower concept). The effect of a feedback mechanism is not taken into account

  7. 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.

  8. A Laser-Activated Biocompatible Theranostic Nanoagent for Targeted Multimodal Imaging and Photothermal Therapy.

    Science.gov (United States)

    Deng, Liming; Cai, Xiaojun; Sheng, Danli; Yang, Yang; Strohm, Eric M; Wang, Zhigang; Ran, Haitao; Wang, Dong; Zheng, Yuanyi; Li, Pan; Shang, Tingting; Ling, Yi; Wang, Fengjuan; Sun, Yang

    2017-01-01

    Multifunctional nanoparticles have been reported for cancer detection and treatment currently. However, the accurate diagnosis and efficient treatment for tumors are still not satisfied. Here we report on the development of targeted phase change multimodal polymeric nanoparticles for the imaging and treatment of HER2-positive breast cancer. We evaluated the multimodal imaging capabilities of the prepared nanoparticles in vitro using agar-based phantoms. The targeting performance and cytotoxicity of the nanoparticles were examined in cell culture using SKBR3 (over-expressing HER2) and MDA-MB-231 (HER2 negative) cells. We then tested the magnetic resonance (MR)/ photoacoustic (PA)/ ultrasound (US)/ near-infrared fluorescence (NIRF) multimodal imaging properties and photothermal effect of the nanoparticles in vivo using a SKBR3 breast xenograft model in nude mice. Tissue histopathology and immunofluorescence were also conducted. Both in vitro and in vivo systematical studies validated that the hybrid nanoparticles can be used as a superb MR/US/PA/NIRF contrast agent to simultaneously diagnose and guide tumor photothermal therapy (PTT). When irradiated by a near infrared laser, the liquid PFP vaporizes to a gas, rapidly expelling the contents and damaging surrounding tissues. The resulting micro-sized bubbles provide treatment validation through ultrasound imaging. Localization of DIR and SPIO in the tumor region facilitate photothermal therapy for targeted tumor destruction. The mice treated with HER2 targeted nanoparticles had a nearly complete response to treatment, while the controls showed continued tumor growth. This novel theranostic agent may provide better diagnostic imaging and therapeutic potential than current methods for treating HER2-positive breast cancer.

  9. Society for Vascular Surgery Wound, Ischemia, foot Infection (WIfI) score correlates with the intensity of multimodal limb treatment and patient-centered outcomes in patients with threatened limbs managed in a limb preservation center.

    Science.gov (United States)

    Robinson, William P; Loretz, Lorraine; Hanesian, Colleen; Flahive, Julie; Bostrom, John; Lunig, Nicholas; Schanzer, Andres; Messina, Louis

    2017-08-01

    The Society for Vascular Surgery Wound, Ischemia, foot Infection (WIfI) system aims to stratify threatened limbs according to their anticipated natural history and estimate the likelihood of benefit from revascularization, but whether it accurately stratifies outcomes in limbs undergoing aggressive treatment for limb salvage is unknown. We investigated whether the WIfI stage correlated with the intensity of limb treatment required and patient-centered outcomes. We stratified limbs from a prospectively maintained database of consecutive patients referred to a limb preservation center according to WIfI stage (October 2013-May 2015). Comorbidities, multimodal limb treatment, including foot operations and revascularization, and patient-centered outcomes (wound healing, limb salvage, amputation-free survival, maintenance of ambulatory and independent living status, and mortality) were compared among WIfI stages. Multivariate analysis was performed to identify predictors of wound healing and limb salvage. We identified 280 threatened limbs encompassing all WIfI stages in 257 consecutive patients: stage 1, 48 (17%); stage 2, 67 (24%); stage 3, 64 (23%); stage 4, 83 (30%); and stage 5 (unsalvageable), 18 (6%). Operative foot débridement, minor amputation, and use of revascularization increased with increasing WIfI stage (P ≤ .04). Revascularization was performed in 106 limbs (39%), with equal use of open and endovascular procedures. Over a median follow-up of 209 days (interquartile range, 95, 340) days, 1-year Kaplan-Meier wound healing cumulative incidence was 71%, and the proportion with complete wound healing decreased with increasing WIfI stage. Major amputation was required in 26 stage 1 to 4 limbs (10%). Increasing WIfI stage was associated with decreased 1-year Kaplan-Meier limb salvage (stage 1: 96%, stage 2: 84%, stage 3: 90%, and stage 4: 78%; P = .003) and amputation-free survival (P = .006). Stage 4 WIfI independently predicted amputation (hazard ratio

  10. Evaluating the effect of in-process material on the binding mechanisms of surrogate viral particles to a multi-modal anion exchange resin.

    Science.gov (United States)

    Brown, Matthew R; Burnham, Michael S; Johnson, Sarah A; Lute, Scott C; Brorson, Kurt A; Roush, David J

    2018-02-10

    Bacteriophage binding mechanisms to multi-modal anion exchange resin may include both anion exchange and hydrophobic interactions, or the mechanism can be dominated by a single moiety. However, previous studies have reported binding mechanisms defined for simple solutions containing only buffer and a surrogate viral spike (i.e. bacteriophage ΦX174, PR772, and PP7). We employed phage spiked in-process monoclonal antibody (mAb) pools to model binding under bioprocessing conditions. These experiments allow the individual contributions of the mAb, in-process impurities, and buffer composition on mechanistic removal of phages to be studied. PP7 and PR772 use synergetic binding by the positively charged quaternary amine and the hydrophobic aromatic phenyl group to bind multi-modal resin. ΦX174's binding mechanism remains inconclusive due to operating conditions. Copyright © 2018 Elsevier B.V. All rights reserved.

  11. 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.

  12. 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.

  13. 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

  14. 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.

  15. Developing Multimodal Academic Literacies among College Freshmen

    Science.gov (United States)

    Jacobs, Gloria E.

    2012-01-01

    In this article, the author draws on a semester long freshmen learning community in which multimodal texts were used as primary texts along with traditional texts to support students' academic literacy skills. Analysis shows that a multimodal text created by students contain elements of academic literacies and qualities of multimodal texts. An…

  16. Adaptive multimodal continuous ant colony optimization

    OpenAIRE

    Yang, Qiang; Chen, Wei-Neng; Yu, Zhengtao; Gu, Tianlong; Li, Yun; Zhang, Huaxiang; Zhang, Jun

    2017-01-01

    Seeking multiple optima simultaneously, which multimodal optimization aims at, has attracted increasing attention but remains challenging. Taking advantage of ant colony optimization algorithms in preserving high diversity, this paper intends to extend ant colony optimization algorithms to deal with multimodal optimization. First, combined with current niching methods, an adaptive multimodal continuous ant colony optimization algorithm is introduced. In this algorithm, an adaptive parameter a...

  17. 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.

  18. 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.

  19. Multimodal mapping of human skin.

    Science.gov (United States)

    Heuke, S; Vogler, N; Meyer, T; Akimov, D; Kluschke, F; Röwert-Huber, H-J; Lademann, J; Dietzek, B; Popp, J

    2013-10-01

    The combination of coherent anti-Stokes Raman scattering (CARS), second harmonic generation (SHG) and two-photon excited fluorescence (TPEF) imaging--referred to as multimodal imaging--provides complementary contrast based on molecular vibrations, the structure of various tissue components and endogenous fluorophores, respectively. To present a comprehensive overview of the appearance of human skin in multimodal imaging. Multimodal imaging of unstained skin cross-sections of 32 individuals was performed using a laser scanning microscope and picosecond laser pulse for excitation. The epidermis, dermis and subcutis are distinguishable in all three applied modalities, but are unveiled best in multimodal images. While the subcutis is dominated by the CARS signal, predominately SHG and the secondary TPEF signal detect the dermis. In contrast, no SHG signal is detected in the epidermis, whereas CARS and TPEF show equal contributions. Additionally, the appearance of the major skin appendages is described, i.e. the hair follicle, sebaceous and sweat glands, and blood vessels belonging to the vascular system. All four investigated functional units show a characteristic morphochemistry in TPEF and CARS, allowing identification of further subunits, e.g. the major components of the hair follicle, while the SHG signal delineates the localization of the functional units. Multimodal imaging is a powerful tool to investigate human skin by providing high contrast based on the molecular constitution. It is therefore suggested that multimodal imaging has a high potential in application to dermatological research and clinical diagnostics of various skin alterations. © 2013 The Authors BJD © 2013 British Association of Dermatologists.

  20. 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...

  1. 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.

  2. [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.

  3. 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.

  4. Multi-modality curative treatment of salivary gland cancer liver metastases with drug-eluting bead chemoembolization, radiofrequency ablation, and surgical resection: a case report

    Directory of Open Access Journals (Sweden)

    Tzorakoleftherakis Evaggelos

    2011-08-01

    Full Text Available Abstract Introduction Liver metastases are rare in salivary gland tumors and have been reported only once to be the first manifestation of the disease. They are usually treated with surgical resection of the primary tumor and systemic chemotherapy. Drug-eluting bead chemoembolization has an evolving role in the treatment of hepatocellular carcinoma, as well as in the treatment of metastatic disease of the liver. Nevertheless, it has never been used in a patient with salivary gland liver metastases. Case presentation We report a case of a 51-year-old Caucasian Greek woman who presented to our hospital with liver metastases as the first manifestation of an adenoid cystic carcinoma of the left submandibular gland. The liver lesions were deemed inoperable because of their size and multi-focality and proved resistant to systemic chemotherapy. She was curatively treated with a combination of doxorubicin eluting bead (DC Beads chemoembolization, intra-operative and percutaneous radiofrequency ablation, and radiofrequency-assisted surgical resection. The patient remained disease-free one year after the surgical resection. Conclusion In conclusion, this complex case is an example of inoperable liver metastatic disease from the salivary glands that was refractory to systemic chemotherapy but was curatively treated with a combination of locoregional therapies and surgery. A multi-disciplinary approach and the adoption of modern radiological techniques produced good results after conventional therapies failed and there were no other available treatment modalities.

  5. 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 oth...

  6. 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 ...

  7. 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.

  8. Mesothelioma Treatment: Recovery, Side Effects, What to Expect

    Science.gov (United States)

    ... Treatment > Mesothelioma Treatment > Mesothelioma Treatment Recovery Side Effects Mesothelioma Treatment and Recovery Scenarios: e-News Signup Click ... questions. (877) END-MESO (877) 363-6376 Testimonials Mesothelioma Treatment: Recovery, Side Effects, What to Expect Mesothelioma ...

  9. 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

  10. 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…

  11. 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)

  12. Relating multimodal imagery data in three dimensions

    Science.gov (United States)

    Walli, Karl C.

    This research develops and improves the fundamental mathematical approaches and techniques required to relate imagery and imagery derived multimodal products in 3D. Image registration, in a 2D sense, will always be limited by the 3D effects of viewing geometry on the target. Therefore, effects such as occlusion, parallax, shadowing, and terrain/building elevation can often be mitigated with even a modest amounts of 3D target modeling. Additionally, the imaged scene may appear radically different based on the sensed modality of interest; this is evident from the differences in visible, infrared, polarimetric, and radar imagery of the same site. This thesis develops a 'model-centric' approach to relating multimodal imagery in a 3D environment. By correctly modeling a site of interest, both geometrically and physically, it is possible to remove/mitigate some of the most difficult challenges associated with multimodal image registration. In order to accomplish this feat, the mathematical framework necessary to relate imagery to geometric models is thoroughly examined. Since geometric models may need to be generated to apply this 'model-centric' approach, this research develops methods to derive 3D models from imagery and LIDAR data. Of critical note, is the implementation of complimentary techniques for relating multimodal imagery that utilize the geometric model in concert with physics based modeling to simulate scene appearance under diverse imaging scenarios. Finally, the often neglected final phase of mapping localized image registration results back to the world coordinate system model for final data archival are addressed. In short, once a target site is properly modeled, both geometrically and physically, it is possible to orient the 3D model to the same viewing perspective as a captured image to enable proper registration. If done accurately, the synthetic model's physical appearance can simulate the imaged modality of interest while simultaneously removing the

  13. Multimodal Therapy including Yttrium-90 Radioembolization as a Bridging Therapy to Liver Transplantation for a Huge and Locally Advanced Intrahepatic Cholangiocarcinoma.

    Science.gov (United States)

    Rayar, Michel; Levi Sandri, Giovanni Battista; Houssel-Debry, Pauline; Camus, Christophe; Sulpice, Laurent; Boudjema, Karim

    2016-09-01

    Treatment of intrahepatic cholangiocarcinoma remains a major challenge. For an unresectable lesion without extrahepatic spread, liver transplantation could be a potential solution but it is still associated with poor oncologic results owing to the absence of effective neoadjuvant treatment. We report the case of a young man with locally advanced intrahepatic cholangiocarcinoma presenting with multiple intrahepatic metastases and vascular structure involvement. The lesion was significantly downstaged by a multimodal therapy including intra-arterial Yttrium-90 radioembolization, systemic chemotherapy and external radiotherapy, allowing liver transplantation. Three years after the procedure, oncologic outcome is excellent with no sign of recurrence. Multimodal therapy including Yttrium-90 radioembolization could be relevant as neoadjuvant treatment before liver transplantation for unresectable intrahepatic cholangiocarcinoma.

  14. Steroid Treatments Equally Effective Against Sudden Deafness

    Science.gov (United States)

    ... 6, 2011 Steroid Treatments Equally Effective Against Sudden Deafness Injecting steroids into the middle ear works just ... when it comes to restoring hearing for sudden deafness patients. This finding, the result of a large ...

  15. 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

  16. 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

  17. 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…

  18. Evidence Based Therapeutic Outcome of Multimodal Therapy on ...

    African Journals Online (AJOL)

    info

    Abstract. Previous efforts at remediating sexual decision of adolescents in Nigeria have been based on unimodal therapies. Therefore, this study investigated the effectiveness of. Multimodal Therapy (MMT) on sexual decisions of adolescents studying in Remedial. Centres in Rivers state, Nigeria. Pre-test post control group ...

  19. Noise-induced multimode behavior in excitable systems

    DEFF Research Database (Denmark)

    Postnov, D E; Sosnovtseva, Olga; Han, S K

    2002-01-01

    Based on experiments with electronic circuits, we show how a system of coupled excitable units can possess several noise-induced oscillatory modes. We characterize the multimode organization in terms of the coherence resonance effect. Multiple gain of regularity is found to be related to different...

  20. Principal modes in multimode waveguides.

    Science.gov (United States)

    Fan, Shanhui; Kahn, Joseph M

    2005-01-15

    We generalize the concept of principal states of polarization and prove the existence of principal modes in multimode waveguides. Principal modes do not suffer from modal dispersion to first order of frequency variation and form orthogonal bases at both the input and the output ends of the waveguide. We show that principal modes are generally different from eigenmodes, even in uniform waveguides, unlike the special case of a single-mode fiber with uniform birefringence. The difference is most pronounced when different eigenmodes possess similar group velocities and when their field patterns vary as a function of frequency. This work may provide a new basis for analysis and control of dispersion in multimode fiber systems.

  1. Multimode-Optical-Fiber Imaging Probe

    Science.gov (United States)

    Jackson, Deborah

    2000-01-01

    Currently, endoscopic surgery uses single-mode fiber-bundles to obtain in vivo image information inside orifices of the body. This limits their use to the larger natural bodily orifices and to surgical procedures where there is plenty of room for manipulation. The knee joint, for example can be easily viewed with a fiber optic viewer, but joints in the finger cannot. However, there are a host of smaller orifices where fiber endoscopy would play an important role if a cost effective fiber probe were developed with small enough dimensions (fibers and analytically demonstrates that the concept is sound. The proof of concept draws upon earlier works that concentrated on image recovery after two-way transmission through a multimode fiber as well as work that demonstrated the recovery of images after one-way transmission through a multimode fiber. Both relied on generating a phase conjugated wavefront which was predistorted with the characteristics of the fiber. The described approach also relies on generating a phase conjugated wavefront, but utilizes two fibers to capture the image at some intermediate point (accessible by the fibers, but which is otherwise visually unaccessible).

  2. Visualization of multimodal image information in medicine.

    Science.gov (United States)

    Englmeier, K. H.; Fink, U.; Hilbertz, T.

    1992-01-01

    Radiological and clinical practice can be enhanced by improved access to multimodal image informations. Analysis, visualization, method characteristic image processing and image synthesis is needed not only for the interpretation of the images but also for performing effective consultations with clinical colleagues and computer supported therapy planning and control strategies. The distributed system RADVIS (radiological visualization) is presented which enables the fast display, three dimensional visualization and the modality oriented analysis of multimodal image informations. Based on a unique image format, modality specific evaluation procedures and two- or three dimensional processing tools of image analysis produce the input data for therapy planning programs. The easy use of this multimedia visualisation tool enables radiologists and clinicians to deal with their image data. The description of methods and procedures of the prototype, as well as typical examples of radiologic practice will demonstrate the efficiency of the presented system. Images Fig. 2 Fig. 3 Fig. 4 Fig. 5a Fig. 5b Fig. 6 Fig. 7 Fig. 8 Fig. 9 PMID:1482876

  3. 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.

  4. 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.

  5. Multimodal optical characterisation of collagen photodegradation by femtosecond infrared laser ablation.

    Science.gov (United States)

    Manickavasagam, A; Hirvonen, L M; Melita, L N; Chong, E Z; Cook, R J; Bozec, L; Festy, F

    2014-12-07

    Collagen is a structural component of the human body, as a connective tissue it can become altered as a result of pathophysiological conditions. Although the collagen degradation mechanism is not fully understood, it plays an important role in ageing, disease progression and applications in therapeutic laser treatments. To fully understand the mechanism of collagen alteration, in our study photo-disruptive effects were induced in collagen I matrix by point-irradiation with a femtosecond Ti-sapphire laser under controlled laser ablation settings. This was followed by multi-modal imaging of the irradiated and surrounding areas to analyse the degradation mechanism. Our multi-modal methodology was based on second harmonic generation (SHG), scanning electron microscope (SEM), autofluorescence (AF) average intensities and the average fluorescence lifetime. This allowed us to quantitatively characterise the degraded area into four distinct zones: (1) depolymerised zone in the laser focal spot as indicated by the loss of SHG signal, (2) enhanced crosslinking zone in the inner boundary of the laser induced cavity as represented by the high fluorescence ring, (3) reduced crosslinking zone formed the outer boundary of the cavity as marked by the increased SHG signal and (4) native collagen. These identified distinct zones were in good agreement with the expected photochemical changes shown using Raman spectroscopy. In addition, imaging using polarisation-resolved SHG (p-SHG) revealed both a high degree of fibre re-orientation and a SHG change in tensor ratios around the irradiation spot. Our multi-modal optical imaging approach can provide a new methodology for defining distinct zones that can be used in a clinical setting to determine suitable thresholds for applying safe laser treatments without affecting the surrounding tissues. Furthermore this technique can be extended to address challenges observed in collagen based tissue engineering and used as a minimally invasive

  6. 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.

  7. Tensor Fusion Network for Multimodal Sentiment Analysis

    OpenAIRE

    Zadeh, Amir; Chen, Minghai; Poria, Soujanya; Cambria, Erik; Morency, Louis-Philippe

    2017-01-01

    Multimodal sentiment analysis is an increasingly popular research area, which extends the conventional language-based definition of sentiment analysis to a multimodal setup where other relevant modalities accompany language. In this paper, we pose the problem of multimodal sentiment analysis as modeling intra-modality and inter-modality dynamics. We introduce a novel model, termed Tensor Fusion Network, which learns both such dynamics end-to-end. The proposed approach is tailored for the vola...

  8. Multimodality management for 145 cases of Merkel cell carcinoma.

    Science.gov (United States)

    Tai, Patricia; Yu, Edward; Assouline, Avi; Lian, Ji Dong; Joseph, Kurian; Miale, Thomas; Krzisch, Claude

    2010-12-01

    The results of the multimodality management of 145 cases of cutaneous Merkel cell carcinoma (MCC) are reported herein. Patient information was obtained from medical records of four Canadian institutions and one French institution. These data included ages, pathological stages, disease sites, histological and treatment details. Cause-specific survival (CSS), overall survival (OS) and disease-free survival (DFS) rates were analyzed by the log-rank and Kaplan-Meier methods. From 1988 to 2007, 145 cases were analyzed. There were 74 men and 71 women. Median age was 78 years (range 47-95.2). Median follow-up was 21.5 months (range 0.5-169.1). During the follow-up period, 37 local, 37 regional nodal and 15 distant recurrences were determined to be either solitary or multifocal sites of treatment failure. Relapsing patients were treated with multimodal treatments provided that their general state of health did not preclude this approach. Either initially and/or at relapse, 30 patients were treated with either multiagent (mostly etoposide with cisplatin or carboplatin) or single-agent chemotherapy, including irinotecan, taxotere and topotecan. In conclusion, recurrence should be treated with multimodalities. Our experience of long-term survivors after treatment of recurrence is encouraging.

  9. 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.

  10. 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 ...

  11. 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

  12. 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…

  13. 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.

  14. 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.

  15. Effectiveness of psychopharmacology in Anorexia Nervosa treatment

    Directory of Open Access Journals (Sweden)

    Zadka Lukasz

    2015-06-01

    Full Text Available The eating disorder that generates the highest death rate is that of anorexia nervosa, and current treatment is a combination of equalization of somatic state and patient education. Moreover, psychical symptoms occurring in the course of anorexia nervosa are thought to have a crucial influence on the course of the disease. Hence, in medical literature, the effectiveness of psychotherapeutic interventions is also widely described. Still, the implementation of appropriate psychopharmacology is now considered an additional method of treatment, rather than a therapy of choice. Yet, in spite of many years of research, there are no absolute recommendations given, nor are instructions within the scope of psychopharmacological treatment proffered, although the selection of psychopharmacological items must respect both the patient’s psychic and somatic states. In recent years, the popularity of psychopharmacological treatment has increased; therefore, we feel that it is justified to present the latest scientific information in this respect.

  16. 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)

  17. EFFECTIVENESS OF MANUAL TRACTION AND OTHER PHYSIOTHERAPY TREATMENT IN THE MANAGEMENT OF PAINFUL CERVICAL RADICULOPATHY

    Directory of Open Access Journals (Sweden)

    Kanwal Khan

    2016-06-01

    Full Text Available Background: Cervical radiculopathy, generally entitle as pinching of the nerves which causes severe shooting pain which mostly pass through the shoulder. Along with it causes muscle weakness and numbness into the arm and hand. In majority of the cases, cervical radiculopathy responds well to conservative mode of treatments which incorporate physical therapy with medical management. The aim of this study is to uncover the effective and evidence based conservative treatment of cervical radiculopathy. Method: Randomized controlled trial study conducted from January 2014 to December 2014. Participants were recruited from physiotherapy OPDs of tertiary care hospitals. A total number of, 100 subjects with a ratio of 50 men and 50 women were recruited between the ages of 25 and 55 years with unilateral cervical radiculopathy. Control group received combination of conventional AROM exercises and modalities including TENS and superficial thermotherapy as a treatment while experimental group received manual cervical traction and combination of conventional AROM exercises, modalities including TENS and superficial thermotherapy. For both groups, treatment was designed for two weeks (6 sessions/ week. Improvement in symptoms was assessed by evaluation of both groups on the basis of visual analogue scale (VAS. Results: After 2 weeks of treatment, patients with neck pain showed marked decreased in pain as compared with the control group (P<.001.For pre and post level a paired sample t-test was used and the results with p-value less than 0.05 were considered as significant. Mean difference of 0.94 (VAS with a significant p-value (P<0.01 was obtained shows the respective improvements in the numeric pain scale scores. Conclusion: Manual cervical traction when used with conventional AROM exercises and modalities were effective methods for decreasing pain in cervical radiculopathy. Recent literature supports such protocols involving multiple interventions. Results

  18. 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

  19. Toxic Stress: Effects, Prevention and Treatment.

    Science.gov (United States)

    Franke, Hillary A

    2014-11-03

    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.

  20. ORIGINAL ARTICLE Multimodal magnetic resonance imaging ...

    African Journals Online (AJOL)

    data on the added utility of multimodal MRI (performed at 3 Tesla MR field strength) for accurate diagnosis, compared with that obtained by biopsy, or comparing the diagnostic accuracy of conventional MRI with that of multimodal MRI, when the aforementioned proposed criteria are used in the evaluation. Most reports in the ...

  1. Evaluating Multimodal Literacies in Student Blogs

    Science.gov (United States)

    O'Byrne, Barbara; Murrell, Stacey

    2014-01-01

    This research presents ways in which high school students used the multimodal and interactive affordances of blogs to create, organize, communicate and participate on an educational blog. Their actions demonstrated how plural modes of literacy are infiltrating digital environments and reshaping literacy and learning. Multimodal blogging practices…

  2. Literacy, Media and Multimodality: A Critical Response

    Science.gov (United States)

    Bazalgette, Cary; Buckingham, David

    2013-01-01

    In recent years, literacy educators have increasingly recognised the importance of addressing a broader range of texts in the classroom. This article raises some critical concerns about a particular approach to this issue that has been widely promoted in recent years-- the concept of "multimodality". Multimodality theory offers a broadly…

  3. 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…

  4. Multimodal Trip Planner System final evaluation report.

    Science.gov (United States)

    2011-05-01

    This evaluation of the Multimodal Trip Planning System (MMTPS) is the culmination of a multi-year project evaluating the development and deployment of a multimodal trip planner in the Chicagoland area between 2004 and 2010. The report includes an ove...

  5. 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…

  6. {PET}ECUBE: a Multimodal Feedback Interface

    OpenAIRE

    Bennett, Peter

    2006-01-01

    The PETECUBE project consists of a series of musical interfaces designed to explore multi-modal feedback. This paper will briefly describe the definition of multimodal feedback, the aim of the project, the development of the first PETECUBE and proposed further work.

  7. [A comparison of multimodal programmes of patient education in the rehabilitation of chronic low back pain].

    Science.gov (United States)

    Morfeld, M; Küch, D; Greitemann, B; Dibbelt, S; Salewski, C; Franke, G H; Liebenau, A

    2010-04-01

    There is growing evidence for the effectiveness of multimodal intervention concepts for chronic low back pain in the international literature, and accordingly several German rehabilitation programmes for the treatment of chronic low back pain patients have been developed. Focus of this paper is to describe and compare frequently used German multimodal intervention programmes for in- and outpatient rehabilitation of patients with chronic low back pain. Programmes were chosen by searching the most relevant online resources as well as the online pages of Deutsche Rentenversicherung and Zentrum Patientenschulung during September 2008. Keywords guiding the search were: Patientenschulung, Rückenschmerzen, Manual, psychologische multimodale Interventionskonzepte, Rehabilitationsprogramm, psychology, intervention, low back pain, manual and therapy. By this means, six manually supported multimodal rehabilitation programmes for the in- and outpatient therapy of patients with chronic back pain could be identified: Göttinger Rücken-Intensiv-Programm (GRIP), the psychological programme for chronic head- and low back pain, the Münchner Rücken-Intensiv-Programm (MRIP), Back to Balance, Arbeiten und Leben--Back to Balance (ALEBABA) und Rückenfit: Lebenslust statt Krankheitsfrust. These programmes are depicted and compared with regard to their potentials and limitations in supporting the rehabilitation process of patients with chronic low back pain. While comparing the programmes, a number of similarities between them can be detected, as well as pronounced differences, e. g., regarding settings and complexity. In most programmes, lack of appropriate evaluation studies and lack of aftercare turn out to be critical aspects. Georg Thieme Verlag KG Stuttgart.New York.

  8. 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

  9. Intratumoral administration of Holmium-166 Acetylacetonate Microspheres : Antitumor efficacy and feasibility of multimodality imaging in renal cancer

    NARCIS (Netherlands)

    Bult, W.; Kroeze, S.G.C.; Elschot, M.; Seevinck, P.R.; Beekman, F.J.; De Jong, H.W.A.M.; Uges, D.R.A.; Kosterink, J.G.W.; Luijten, P.R.; Hennink, W.E.

    2013-01-01

    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 holmium-166

  10. Multimodal Pain Management in Older Elective Arthroplasty Patients.

    Science.gov (United States)

    Brooks, Elaine; Freter, Susan H; Bowles, Susan K; Amirault, David

    2017-09-01

    Pain management after elective arthroplasty in older adults is complicated due to the risk of undertreatment of postoperative pain and potential adverse effects from analgesics, notably opioids. Using combinations of analgesics has been proposed as potentially beneficial to achieve pain control with lower opioid doses. We compared a multimodal pain protocol with a traditional one, in older elective arthroplasty patients, measuring self-rated pain, incidence of postoperative delirium, quantity and cost of opioid analgesics consumed. One hundred fifty-eight patients, 70 years and older, admitted to tertiary care for elective arthroplasty were prospectively assessed postoperative days 1-3. Patients received either traditional postoperative analgesia (acetaminophen plus opioids) or a multimodal pain protocol (acetaminophen, opioids, gabapentin, celecoxib), depending on surgeon preference. Self-rated pain, postoperative delirium, and time to achieve standby-assist ambulation were compared, as were total opioid doses and analgesic costs. Despite receiving significantly more opioid analgesics (traditional: 166.4 mg morphine-equivalents; multimodal: 442 mg morphine equivalents; t = 10.64, P < .0001), there was no difference in self-rated pain, delirium, or mobility on postoperative days 1-3. Costs were significantly higher in the multimodal group ( t = 9.15, P < .0001). Knee arthroplasty was associated with higher pain scores than hip arthroplasty, with no significant difference in opioid usage. A multimodal approach to pain control demonstrated no benefit over traditional postoperative analgesia in elective arthroplasty patients, but with significantly higher amounts of opioid consumed. This poses a potential risk regarding tolerability in frail older adults and results in increased drug costs.

  11. 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)

  12. 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.

  13. 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...

  14. Investigating multimodal communication in virtual meetings

    DEFF Research Database (Denmark)

    Persson, John Stouby; Mathiassen, Lars

    2014-01-01

    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......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...... 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...

  15. 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.

  16. Effectiveness of Acupuncture Treatment in Cervical Pain.

    Directory of Open Access Journals (Sweden)

    Norma Ríos García

    2012-09-01

    Full Text Available A study is performed, longitudinal, prospective, descriptive in patients who attended the consultation of The Health Center With Beds (CSCC of Torbeck, in the Southern Department of Haiti, in order to determine the effectiveness of acupuncture treatment in patients with cervical pain, in the period between January and June 2011. We studied a universe of 73 patients and a sample of 60 patients, from these persons 30 used drug therapy (Group B and 30 patients which used acupuncture (Group A. We note that in both groups, the females were the most affected, with a prevalence between 31 and 60. The main symptom for both groups was pain (100%. Patients who were administered the acupuncture successfully evolved between the second and fourth days of starting treatment and patients in group B between 5 and 6 days. Acupuncture is an effective therapy in the management of neck pain, with few adverse reactions of the patient and drug zero cost.

  17. Effects of multimodal analgesia with LowDose buprenorphine and meloxicam on fecal glucocorticoid metabolites after surgery in New Zealand white rabbits (Oryctolagus cuniculus).

    Science.gov (United States)

    Goldschlager, Gregg B; Gillespie, Virginia L; Palme, Rupert; Baxter, Mark G

    2013-09-01

    Despite the increasing use of rabbits as companion animals and models for biomedical research, rabbits have not been extensively studied to identify an efficacious postsurgical analgesic that does not cause systemic complications. The synergy of NSAID and systemic opioids is well-documented, and their combined use reduces the amount of either drug required for adequate analgesia. We measured fecal corticosterone metabolites (FCM) in rabbits after a minimally invasive vascular cut-down procedure. Rabbits received buprenorphine (0.03 mg/kg SC every 12 h for 3 d), meloxicam (0.2 mg/kg SC every 24 h for 3 d), buprenorphine-meloxicam (0.01 mg/kg-0.1 mg/kg SC every 24 h for 3 d), or a single dose of 0.5% bupivacaine (0.5 mL) infused locally at the incision site. By day 3 after surgery, buprenorphine, meloxicam, and bupivacaine groups showed elevated FCM levels, which continued to rise until day 7 and then gradually returned to baseline by day 28. In the buprenorphine-meloxicam group, FCM was relatively unchanged until day 3, when treatment was discontinued, and then began to rise. Rabbits in the buprenorphine-meloxicam group gained more weight over the 28-d study than did those in the other 3 treatment groups. This study shows that in rabbits low-dose buprenorphine administered with meloxicam effectively mitigates the FCM response that develops after surgery without the adverse effects associated with higher doses.

  18. Effects of Multimodal Analgesia with Low-Dose Buprenorphine and Meloxicam on Fecal Glucocorticoid Metabolites after Surgery in New Zealand White Rabbits (Oryctolagus cuniculus)

    Science.gov (United States)

    Goldschlager, Gregg B; Gillespie, Virginia L; Palme, Rupert; Baxter, Mark G

    2013-01-01

    Despite the increasing use of rabbits as companion animals and models for biomedical research, rabbits have not been extensively studied to identify an efficacious postsurgical analgesic that does not cause systemic complications. The synergy of NSAID and systemic opioids is well-documented, and their combined use reduces the amount of either drug required for adequate analgesia. We measured fecal corticosterone metabolites (FCM) in rabbits after a minimally invasive vascular cut-down procedure. Rabbits received buprenorphine (0.03 mg/kg SC every 12 h for 3 d), meloxicam (0.2 mg/kg SC every 24 h for 3 d), buprenorphine–meloxicam (0.01 mg/kg–0.1 mg/kg SC every 24 h for 3 d), or a single dose of 0.5% bupivacaine (0.5 mL) infused locally at the incision site. By day 3 after surgery, buprenorphine, meloxicam, and bupivacaine groups showed elevated FCM levels, which continued to rise until day 7 and then gradually returned to baseline by day 28. In the buprenorphine–meloxicam group, FCM was relatively unchanged until day 3, when treatment was discontinued, and then began to rise. Rabbits in the buprenorphine–meloxicam group gained more weight over the 28-d study than did those in the other 3 treatment groups. This study shows that in rabbits low-dose buprenorphine administered with meloxicam effectively mitigates the FCM response that develops after surgery without the adverse effects associated with higher doses. PMID:24041213

  19. 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

  20. 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.

  1. 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

  2. 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.

  3. Timing and amplitude jitter in a gain-switched multimode semiconductor laser

    Science.gov (United States)

    Wada, Kenji; Kitagawa, Naoaki; Matsukura, Satoru; Matsuyama, Tetsuya; Horinaka, Hiromichi

    2016-04-01

    The differences in timing jitter between a gain-switched single-mode semiconductor laser and a gain-switched multimode semiconductor laser are examined using rate equations that include Langevin noise. The timing jitter in a gain-switched multimode semiconductor laser is found to be effectively suppressed by a decrease in the coherence time of the amplified spontaneous emission (ASE) based on a broad bandwidth of multimode oscillation. Instead, fluctuations in the ASE cause amplitude jitter in the pulse components of the respective modes. A pulse train of gain-switched pulses from a multimode semiconductor laser with timing jitter is equivalently simulated by assuming a high spontaneous emission factor and a short coherence time of the ASE in the single-mode semiconductor laser rate equations.

  4. 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.

  5. Mmmmm : A Multi-modal Mobile Music Mixer

    OpenAIRE

    Savage, Norma S.; Ali, Syed R.; Chavez, Norma E.

    2010-01-01

    This paper presents Mmmmm; a Multimodal Mobile MusicMixer that provides DJs a new interface for mixing musicon the Nokia N900 phones. Mmmmm presents a novel wayfor DJ to become more interactive with their audience andvise versa. The software developed for the N900 mobilephone utilizes the phones built-in accelerometer sensor andBluetooth audio streaming capabilities to mix and apply effects to music using hand gestures and have the mixed audiostream to Bluetooth speakers, which allows the DJ ...

  6. Multimodality therapy including radiotherapy and chemotherapy improves event-free survival in stage C esthesioneuroblastoma

    International Nuclear Information System (INIS)

    Eich, H.T.; Staar, S.; Mueller, R.P.; Hero, B.; Berthold, F.; Micke, O.; Seegenschmiedt, H.; Mattke, A.

    2003-01-01

    Background: To evaluate the efficacy of multimodality therapy in patients with esthesioneuroblastoma (ENB). Patients and Methods: From 01/1979 through 08/2001, 47 patients with ENB (20 men, 27 women, age 5-81 years), were registered from 18 oncologic centers. There were 14 tumors stage B and 33 stage C according to the Kadish classification. Initial treatment included surgery alone in seven patients, radiotherapy (RT) with or without chemotherapy (CTX) in twelve, surgery plus postoperative RT in 15, and multimodality therapy (surgery plus pre- or postoperative CTX plus postoperative RT) in 13. Results: The 5-year overall survival (OS) for the whole group was 64 ± 8% and the 5-year event-free survival (EFS) 50 ± 8%. Patients with multimodality treatment had a significantly better 5-year EFS (74 ± 13%) compared to the other patients (41 ± 9%; p = 0.05), while the 5-year OS was not significantly different between the treatment groups (p = 0.39). For patients with Kadish stage C, multimodality therapy (n = 11) resulted in superior 5-year EFS (72 ± 14% vs 17 ± 9%; p = 0.01). These patients tended to have an improved OS (69 ± 15% vs 47 ± 12%; p = 0.19) compared to the other treatment groups. None of the patients with multimodality treatment had a metastatic relapse. Conclusion: Multimodality treatment (surgery plus pre- or postoperative CTX plus postoperative RT) appears to be highly efficient in preventing local and systemic relapse in patients with advanced ENB. Timing and optimal agents of CTX need to be further evaluated. (orig.)

  7. A Review Of Multimodal Biometric Authentication Systems

    Directory of Open Access Journals (Sweden)

    Kunal Kumar

    2015-08-01

    Full Text Available Authentication is the process of validating the identity of a person based on certain input that the person provides. Authentication has become a major topic of research due to the increasing number of attacks on computer networks around the globe. This review paper focuses on multimodal biometric authentication systems in use today. The aim is to elicit the best combination of authentication factors for multimodal use. We study the strengths and weakness of selected biometric mechanisms and recommend novel solutions to include in multimodal biometric systems to improve on the current biometric drawbacks. We believe this paper will provide security researchers some useful insight whilst designing better biometric systems.

  8. Mediating multimodal environmental knowledge across animation techniques

    DEFF Research Database (Denmark)

    Maier, Carmen Daniela

    2011-01-01

    in the technology- mediated discourse of short animation films. This is done by employing the model of multimodal discourse analysis proposed by Van Leeuwen (2008) and Machin and Van Leeuwen (2007) to the analysis of a series of animation films focused on environmental problems. These films are united under......://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...

  9. 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

  10. Rasagiline treatment effects on parkinsonian tremor.

    Science.gov (United States)

    Lew, Mark F

    2013-12-01

    Tremor is a common symptom of Parkinson's disease (PD). The underlying pathophysiology of parkinsonian rest tremor is not well understood. Rest tremor is less responsive to dopaminergic therapy than are symptoms of bradykinesia and rigidity. This paper reviews the effects of 1 mg daily oral rasagiline, as monotherapy and as adjunct therapy, on parkinsonian tremor. A literature search of the EMBASE database was conducted to identify relevant articles in English published between 2000 and October, 2012 using the search terms "rasagiline," or "Azilect®," or "Agilect®," and refined using the terms "Parkinson's disease" and "clinical trial." Of 22 identified publications, two large placebo-controlled trials of rasagiline monotherapy (TEMPO and ADAGIO) and two large placebo-controlled trials of rasagiline as adjunctive therapy with levodopa (PRESTO and LARGO) specifically evaluated the effect of rasagiline on tremor using the Unified Parkinson's Disease Rating Scale (UPDRS) motor examination. Prospective and post-hoc analyses from these phase III studies show rasagiline monotherapy significantly improved tremor symptoms in early PD, independent of disease duration, compared with placebo. In levodopa-treated patients with motor fluctuations who were already receiving optimized dopaminergic treatment, the addition of rasagiline adjunct therapy significantly improved tremor symptoms. Significant improvement was evident as early as 10 weeks from treatment initiation. Tremor symptoms also improved in a subset of patients with severe tremor when rasagiline was added to their existing PD treatment regimen. These data suggest that rasagiline used as monotherapy and as adjunctive therapy is effective for reducing tremor severity in patients with PD.

  11. Multimodal integration in statistical learning

    DEFF Research Database (Denmark)

    Mitchell, Aaron; Christiansen, Morten Hyllekvist; Weiss, Dan

    2014-01-01

    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......, 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...... incongruent, which we predicted would produce the McGurk illusion, resulting in the perception of an audiovisual syllable (e.g., /ni/). In this way, we used the McGurk illusion to manipulate the underlying statistical structure of the speech streams, such that perception of these illusory syllables...

  12. Multispectral analysis of multimodal images

    International Nuclear Information System (INIS)

    Kvinnsland, Yngve; Brekke, Njaal; Taxt, Torfinn M.; Gruener, Renate

    2009-01-01

    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

  13. A multimodal transportation system routing implemented in waste collection

    Directory of Open Access Journals (Sweden)

    Masoud Rabbani

    2016-01-01

    Full Text Available Waste collection is an important municipal service that charges large expenditures to waste management (WM system. In this study, a hierarchical structure is proposed in order to minimize total cost of waste collection routing problem. Moreover, in second stage destructive environmental effects of waste transportation are minimized concurrently through taking advantage of a road/rail transportation system. In the proposed multimodal transportation system, waste packs are transferred to final destination while travel time and risk of environmental threatening is minimized. The discussed problem is formulated mathematically in two stages. In the first stage, a household waste collection routing problem is formulated while, in second stage a multimodal transportation system is routed to transfer waste packs to final destination through roads and railroads. In order to solve the proposed NP hard models, an improved genetic algorithm is developed. Comparison of the obtained results with those of GAMS for small-size samples validates the proposed models.

  14. A multimodal neural network recruited by expertise with musical notation.

    Science.gov (United States)

    Wong, Yetta Kwailing; Gauthier, Isabel

    2010-04-01

    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 and novices during perception of musical notation, Roman letters, and mathematical symbols and found selectivity for musical notation for experts in a widespread multimodal network of areas. The activity in several of these areas was correlated with a behavioral measure of perceptual fluency with musical notation, suggesting that activity in nonvisual areas can predict individual differences in visual expertise. The visual selectivity for musical notation is distinct from that for faces, single Roman letters, and letter strings. Implications of the current findings to the study of visual perceptual expertise, music reading, and musical expertise are discussed.

  15. Combining Multi-modal Features for Social Media Analysis

    Science.gov (United States)

    Nikolopoulos, Spiros; Giannakidou, Eirini; Kompatsiaris, Ioannis; Patras, Ioannis; Vakali, Athena

    In this chapter we discuss methods for efficiently modeling the diverse information carried by social media. The problem is viewed as a multi-modal analysis process where specialized techniques are used to overcome the obstacles arising from the heterogeneity of data. Focusing at the optimal combination of low-level features (i.e., early fusion), we present a bio-inspired algorithm for feature selection that weights the features based on their appropriateness to represent a resource. Under the same objective of optimal feature combination we also examine the use of pLSA-based aspect models, as the means to define a latent semantic space where heterogeneous types of information can be effectively combined. Tagged images taken from social sites have been used in the characteristic scenarios of image clustering and retrieval, to demonstrate the benefits of multi-modal analysis in social media.

  16. 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.

  17. Immunologic Effects Of Peritoneal Photodynamic Treatment

    Science.gov (United States)

    Lynch, David H.; Haddad, Sandra; Jolles, Christopher J.; King, Vernon J.; Ott, Mark J.; Robertson, Bekkie; Straight, Richard C.

    1989-06-01

    One of the side effects of peritoneal photodynamic treatment (PDT) of mice is a systemic suppression of contact hypersensitivity (CH) responses. Treatment with either laser alone or the photosensitizer, Photofrin II (PFII), alone does not cause suppression of CH responses. Immunosuppression of CH responses is an active process that is adoptively transferable using viable cells, but not serum, from PDT-treated mice. The induction of adoptively transferable suppressor cells in PDT-treated mice requires exposure to an antigenic stimulus, yet the suppressor cells are antigen non-specific in their function. T cell function in PDT-treated mice, as measured by the ability of splenic lymphoid cells to generate allogeneic cytotoxic T lymphocyte responses, is comparable to that detected in normal mice. However, the ability of spleen cells from PDT-treated mice to act as stimulators in a mixed lymhocyte reaction is dramatically impaired, suggesting that the major cell type affected by peritoneal PDT is of the macrophage lineage. Support for this concept is provided by experiments in which spleen cells from PDT-treated mice were chromatographically separated into populations of T cells, B cells and macrophages prior to adoptive transfer into naive recipients. The results indicate that the cell type mediating adoptively transferable suppression of CH responsiveness is of the macrophage lineage. Analysis of hematologic parameters revealed that induction of suppression by PDT-treatment was associated with a marked neutrophilia and lymphocytosis, and was also accompanied by a 5-fold increase in concentration of the acute phase protein, Serum Amyloid P. Finally, attempts to ameliorate PDT-induced immunosuppression by pharmacologic intervention have proved successful using implants of pellets that release indomethacin at a rate of 1.25µg/day. Thus, the data suggest that PDT-treatment induces macrophages to produce factors (e.g., prostaglandins) that are known to be potently

  18. Role of multimodality imaging in radiotherapy planning

    International Nuclear Information System (INIS)

    Lee, Young K.

    2004-01-01

    Accurate tumor delineation is crucial to achieve successful radiotherapy (RT). While CTs are clinically used to plan 3D-RT, multimodality imaging (MMI) promises to aid accurate delineation of the tumor. This thesis examined delineated MMI volumes and studied their role in RT planning. A prostate modeling study evaluated the dose reductions in conformal and intensity-modulated radiotherapy (CRT and IMRT) due to interfractional gross tumor volume (GTV) motion and variability in delineation. In both CRT and IMRT, a 10 mm margin was adequate to account for interfractional GTV movement. However, 10 mm (CRT) and 5 mm (IMRT) GTV misdelineation produced unacceptable dose distributions. IMRT plans were more affected by delineation errors when compared to CRT plans due to their steep dose gradients. Methods were developed to use MRI only in RT planning. Water and bone electron density values were assigned to the image and a low-distortion MR-sequence was used. MR-delineated prostate volumes were in general smaller than those on CT by 10%. Patient data were separated into those that were affected by organ motion from those that were not. An independent-organ registration technique was developed to relate CT- and MR-delineated volumes that were affected by organ motion between the scans. The dosimetric study showed that unacceptable CRT was planned using planning target volume delineated using CT (PTV CT ) when PTV MR volumes were assumed to be true. However, the dosimetric benefit was small as a 1-2 mm marginal increase on PTV CT would deliver adequate dose to both PTVs and insignificant dose reductions were observed in rectum and bladder when PTV MR plans were compared to PTV CT plans. The dosimetric effect of 123 I-mIBG-SPECT in neuroblastoma CRT and IMRT was studied. Reduction in tumor control probability due to incorrectly delineated neuroblastoma was observed and a new treatment was planned using PTV CT+SPECT with acceptable doses to OARs the organs-at-risk. IMRT

  19. Undesirable effects after treatment with dermal fillers.

    Science.gov (United States)

    Rodrigues-Barata, Ana Rita; Camacho-Martínez, Francisco M

    2013-04-01

    Soft tissue augmentation is one of the most frequent techniques in cosmetic dermatology. Nowadays, there are a high number of available materials. Nonanimal hyaluronic acid (HA) is one of most useful fillers for lip augmentation and for treating nasolabial folds, marionette lines, and the dynamic wrinkles of the upper face. To evaluate the type and management of undesirable effects of nonanimal reticulated or stabilized HA observed in our cosmetic unit in the past 3 years. The consecutive patients using HA attending to our clinic in the past 3 years were divided into 3 categories, according to the time of presentation of the adverse reactions: immediate, early, and late-onset complications. All patients were treated. Twenty-three patients presented to our clinic complaining of complications after soft tissue augmentation with HA. Ten patients presented immediate-onset complications, 8 showed early-onset complications, and 5 cases complaint of late-onset complications. Treatment of the first group consisted of hyaluronidase injection, massage, and topical antibiotics. Early- and late-onset complications were treated with intralesional triamcinolone acetonide. All patients improved, with the exception of a woman with recurrent granulomas. Generally, undesirable effects of HA (immediate, early, or late onset) are not frequent, and when present, they improve if treated properly. Physicians need to be aware of these possible adverse events in order to establish proper treatment and prevent scarring or other sequelae.

  20. 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.

  1. Multimodal transportation best practices and model element.

    Science.gov (United States)

    2014-06-01

    This report provides guidance in developing a multimodal transportation element of a local government comprehensive : plan. Two model elements were developed to address differences in statutory requirements for communities of different : sizes and pl...

  2. Intelligent Multimodal Signal Adaptation System Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Micro Analysis and Design (MA&D) is pleased to submit this proposal to design an Intelligent Multimodal Signal Adaptation System. This system will dynamically...

  3. 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...

  4. Rotational inertia and multimodal heaviness perception.

    Science.gov (United States)

    Streit, Matthew; Shockley, Kevin; Riley, Michael A

    2007-10-01

    Perceived heaviness of wielded objects has been shown to be a function of the objects' rotational inertia--the objects' resistance to rotational acceleration. Studies have also demonstrated that if virtual objects rotate faster than the actual wielded object (i.e., a rotational gain is applied to virtual object motion), the wielded object is perceived as systematically lighter. The present research determined whether combining those inertial and visual manipulations would influence heaviness perception in a manner consistent with an inertial model of multimodal heaviness perception. Rotational inertia and optical rotational gain of wielded objects were manipulated to specify inertia multimodally. Both visual and haptic manipulations significantly influenced perceived heaviness. The results suggest that rotational inertia is detected multimodally and that multimodal heaviness perception conforms to an inertial model.

  5. Multimodality image registration with software: state-of-the-art.

    Science.gov (United States)

    Slomka, Piotr J; Baum, Richard P

    2009-03-01

    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.

  6. 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.

  7. Translating evidence-based practice for managing comorbid substance use and mental illness using a multi-modal training package.

    Science.gov (United States)

    Louie, Eva; Giannopoulos, Vicki; Baillie, Andrew; Uribe, Gabriela; Byrne, Simon; Deady, Mark; Teesson, Maree; Baker, Amanda; Haber, Paul S; Morley, Kirsten C

    2018-02-28

    Comorbid mental health and substance use problems are highly prevalent in substance use treatment settings and generally lead to poorer treatment outcomes. Pathways to Comorbidity Care (PCC) is a multi-modal training program developed to encourage an integrated service approach to improve clinicians' capacity to identify and manage comorbid substance use and mental health outcomes within public drug and alcohol treatment settings. In this paper we describe the concepts underlying the PCC Package and the use of Implementation Science to assess and overcome potential barriers, including clinicians' preferences, knowledge about best practice and professional culture. The training components include didactic seminars, group workshops run by a local clinical champion on relevant subjects such as Motivational Interviewing and Cognitive Behaviour Therapy, individual clinical consultation and feedback with a senior clinical psychologist. The PCC also includes an online portal containing comorbidity resources including manuals, guidelines and booster webinars. Finally, we describe the evaluation of PCC implementation. Drug Health Services need to be equipped to treat the majority of their clients who present with comorbid mental health conditions: we anticipate that this multimodal training package, which applies the principles of Implementation Science, will facilitate effective and integrated care for these vulnerable clients.

  8. Changes in Disability, Physical/Mental Health States and Quality of Life during an 8-Week Multimodal Physiotherapy Programme in Patients with Chronic Non-Specific Neck Pain: A Prospective Cohort Study

    OpenAIRE

    Cuesta-Vargas, Antonio Ignacio; Gonz?lez-S?nchez, Manuel

    2015-01-01

    Aim The aim of this study was to analyse the effect of an 8-week multimodal physiotherapy programme (MPP), integrating physical land-based therapeutic exercise (TE), adapted swimming and health education, as a treatment for patients with chronic non-specific neck pain (CNSNP), on disability, general health/mental states and quality of life. Methods 175 CNSNP patients from a community-based centre were recruited to participate in this prospective study. Intervention: 60-minute session (30 minu...

  9. Multimodal character viewpoint in quoted dialogue sequences

    Directory of Open Access Journals (Sweden)

    Kashmiri Stec

    2017-05-01

    Full Text Available We investigate the multimodal production of character viewpoint in spoken American English narratives by performing complementary qualitative and quantitative analyses of two quoted dialogues, focusing on the storyteller’s use of character viewpoint gestures, character intonation, character facial expression, spatial orientation and gaze. A micro-analysis revealed that the extent of multimodal articulation depends on (i the quoted speaker, with different multimodal articulatory patterns found for quotes by the speaker’s past self vs. a third-person character, and (ii the position of the quoted utterance within the quoted dialogue, with mid-dialogue utterances garnering less co-articulation than initial or final utterances within the quoted dialogue. We further investigated these observations using a quantitative approach, which was based on 'generalized additive modeling' (GAM. The GAM analysis revealed different multimodal patterns for each quoted character, as indicated by the number of co-produced multimodal articulators. These patterns were found to hold regardless of the quote’s position within the narrative. We discuss these findings with respect to previous work on multimodal quotation. This article is part of the special collection: Perspective Taking

  10. Rapid prototype modeling in a multimodality world

    Science.gov (United States)

    Bidaut, Luc; Madewell, John; Yasko, Alan

    2006-03-01

    Introduction: Rapid prototype modeling (RPM) has been used in medicine principally for bones - that are easily extracted from CT data sets - for planning orthopaedic, plastic or maxillo-facial interventions, and/or for designing custom prostheses and implants. Based on newly available technology, highly valuable multimodality approaches can now be applied to RPM, particularly for complex musculo-skeletal (MSK) tumors where multimodality often transcends CT alone. Methods: CT data sets are acquired for primary evaluation of MSK tumors in parallel with other modalities (e.g., MR, PET, SPECT). In our approach, CT is first segmented to provide bony anatomy for RPM and all other data sets are then registered to the CT reference. Parametric information relevant to the tumor's characterization is then extracted from the multimodality space and merged with the CT anatomy to produce a hybrid RPM-ready model. This model - that also accommodates digital multimodality visualization - is then produced on the latest generation of 3D printers, which permits both shapes and colors. Results: Multimodality models of complex MSK tumors have been physically produced on modern RPM equipment. This new approach has been found to be a clear improvement over the previously disconnected physical RPM and digital multimodality visualization. Conclusions: New technical developments keep opening doors to sophisticated medical applications that can directly impact the quality of patient care. Although this early work still deals with bones as base models for RPM, its use to encompass soft tissues is already envisioned for future approaches.

  11. Qualitative experimental study of the electromagnetic field distribution in microwave multimode cavities

    Energy Technology Data Exchange (ETDEWEB)

    Lusvarghi, L.; Pellacani, G. C.; Ravasi, M. R. [University of Modena and Reggio Emilia, Dept. of Materials and Environmental Engineering, Modena (Italy)

    2001-10-01

    The most common applicator for the microwave treatment of materials is a multimode cavity. Because of its own experimental geometry, the electromagnetic field inside this kind of oven is usually extremely unhomogeneous. In this work, the energy distribution has been qualitatively studied investigating the thermal effect caused by the coupling of the field with a dielectric and detected by a white thermal paper, which gradually blackens when reaching temperature around 100-150{sup 0} C. It was proved that the spatial behaviour of the microwave filed inside the cavity depends strongly on the kind of load, i.e. the sample to be treated, its size and position (x, y, z) in the applicator and the presence or absence of metallic devices, such as a mode stirrer or a thermocouple to measure the sample temperature.

  12. BER evaluations for multimode beams in underwater turbulence

    Science.gov (United States)

    Altay Arpali, Serap; Baykal, Yahya; Arpali, Çağlar

    2016-07-01

    In underwater optical communication links, bit error rate (BER) is an important performance criterion. For this purpose, the effects of oceanic turbulence on multimode laser beam incidences are studied and compared in terms of average BER (), which is related to the scintillation index. Based on the log-normal distribution, is analysed for underwater turbulence parameters, including the rate of dissipation of the mean squared temperature, the rate of dissipation of the turbulent kinetic energy, the parameter that determines the relative strength of temperature and salinity in driving index fluctuations, the Kolmogorov microscale length and other link parameters such as link length, wavelength and laser source size. It is shown that use of multimode improves the system performance of optical wireless communication systems operating in an underwater medium. For all the investigated multimode beams, decreasing link length, source size, the relative strength of temperature and salinity in driving the index fluctuations, the rate of dissipation of the mean squared temperature and Kolmogorov microscale length improve the . Moreover, lower values are obtained for the increasing wavelength of operation and the rate of dissipation of the turbulent kinetic energy in underwater turbulence.

  13. 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.)

  14. 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.

  15. 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.

  16. Multimodal pediatric pain management (part 2).

    Science.gov (United States)

    Friedrichsdorf, Stefan J

    2017-05-01

    Dr Stefan Friedrichsdorf speaks to Commissioning Editor Jade Parker: Stefan Friedrichsdorf, MD, is medical director of the Department of Pain Medicine, Palliative Care and Integrative Medicine at Children's Hospitals and Clinics of Minnesota in Minneapolis/St Paul, MN, USA, home to one of the largest and most comprehensive programs of its kind in the country. The pain and palliative care program is devoted to control acute, chronic/complex and procedural pain for inpatients and outpatients in close collaboration with all pediatric subspecialties at Children's Minnesota. The team also provides holistic, interdisciplinary care for children and teens with life limiting or terminal diseases and their families. Integrative medicine provides and teaches integrative, nonpharmacological therapies (such as massage, acupuncture/acupressure, biofeedback, aromatherapy and self-hypnosis) to provide care that promotes optimal health and supports the highest level of functioning in all individual children's activities. In this second part of the interview they discuss multimodal (opioid-sparing) analgesia for hospitalized children in pain and how analgesics and adjuvant medications, interventions, rehabilitation, psychological and integrative therapies act synergistically for more effective pediatric pain control with fewer side effects than a single analgesic or modality.

  17. The effects of periodontal treatment on diabetes.

    Science.gov (United States)

    Taylor, George W

    2003-10-01

    Diabetes mellitus and periodontal diseases are common chronic diseases in the United States. Periodontal infection may adversely affect glycemic control in people with diabetes. This article reviews the evidence regarding how treatment of periodontal diseases affects glycemic control. The review consisted of a MEDLINE literature search to identify primary research reports on the relationship between periodontal therapy and changes in glycemic control. The review identified three randomized clinical trials and nine nonrandomized clinical follow-up studies. The strength, quantity and breadth of evidence are varied, precluding clear-cut guidance for determining whether treating periodontal infection has a beneficial effect on glycemic control. Despite the variation and limitations in the literature, evidence supports the concept that periodontal diseases can contribute to poorer glycemic control in people with diabetes. Although the evidence is not unequivocal, it provides sufficient support for additional investigations of the effect of preventing and treating periodontal infections on managing glycemic control. Sufficient evidence exists to incorporate oral examinations and periodontal care in management regimens for people with diabetes. It is prudent to assess patients' glycemic control status and communicate the importance of referring patients with diabetes for thorough oral health evaluations and necessary care.

  18. Multimodal Imaging Measures Predict Rearrest

    Directory of Open Access Journals (Sweden)

    Vaughn R Steele

    2015-08-01

    Full Text Available Rearrest has been predicted by hemodynamic activity in the anterior cingulate cortex (ACC during error-processing (Aharoni et al., 2013. Here we evaluate the predictive power after adding an additional imaging modality in a subsample of 45 incarcerated males from Aharoni et al. Event-related potentials (ERPs and hemodynamic activity were collected during a Go/NoGo response inhibition task. Neural measures of error-processing were obtained from the ACC and two ERP components, the error-related negativity (ERN/Ne and the error positivity (Pe. Measures from the Pe and ACC differentiated individuals who were and were not subsequently rearrested. Cox regression, logistic regression, and support vector machine (SVM neuroprediction models were calculated. Each of these models proved successful in predicting rearrest and SVM provided the strongest results. Multimodal neuroprediction SVM models with out of sample cross-validating accurately predicted rearrest (83.33%. Offenders with increased Pe amplitude and decreased ACC activation, suggesting abnormal error-processing, were at greatest risk of rearrest.

  19. 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

  20. 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.

  1. ANTIPSYCHOTIC TREATMENT - SIDE-EFFECT AND/OR METABOLIC SYNDROME

    OpenAIRE

    Dadić-Hero, Elizabeta; Ružić, Klementina; Grahovac, Tanja; Žarković Palijan, Tija; Petranović, Duška; Šepić-Grahovac, Dubravka

    2011-01-01

    According to current medical opinion chronic mental diseases such as schizophrenia require life-long treatment. The choice of antipsychotics is an important treatment factor, since their side-effects often influence patients' compliance with treatment. Severe side-effects may cause the patients to reject such treatment, the latter being their right. In case a psychiatrist does not agree with the patient's decision to interrupt his antipsychotic treatment regardless its serious side-e...

  2. Combination of nerve blockade and intravenous alfentanil is better than single treatment in relieving postoperative pain

    Directory of Open Access Journals (Sweden)

    Yeong-Ray Wen

    2012-02-01

    Conclusion: Our results indicated that in an incisional pain model, multimodal analgesia is superior to single or no pretreatment; however, the combination of multimodal analgesic treatments should be individually discerned depending on nociceptive types and analgesic mechanisms.

  3. 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.

  4. 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…

  5. Prism-coupled multimode waveguide refractometer

    Science.gov (United States)

    Qi, Zhi-Mei; Matsuda, Naoki; Santos, Jose H.; Takatsu, Akiko; Kato, Kenji

    2002-05-01

    A new refractometer has been developed based on changes in the effective refractive index (RI) of the highest-order TE (or TM) mode in a prism-coupled multimode planar waveguide induced by interaction between an evanescent field and a liquid sample. The waveguide was a 100-mum-thick quartz plate fixed on a poly (methyl methacrylate) support containing a flow cell. A pair of prism couplers contacted the quartz plate in the flow-cell region. Such an optical sensor can detect the RI of liquid in a wide range by monitoring the resonant angle of the highest-order mode that changes order number with changes in the sample's RI. When a highest-order mode corresponding to a given RI range is used as the sensor probe, a slight RI change in this range can be detected by measurement of the output light intensity. With this method the sensor was demonstrated to have a resolution of 3 x 10-5 for the RI of an aqueous solution. Combining this result with theoretical calculation indicates that the sensor can detect a 0.5-nm-thick monolayer adsorbed from an aqueous solution. Therefore, the sensor is suitable for real-time detection of biomolecular interactions.

  6. Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines.

    Science.gov (United States)

    Beverly, Anair; Kaye, Alan D; Ljungqvist, Olle; Urman, Richard D

    2017-06-01

    Perioperative multimodal analgesia uses combinations of analgesic medications that act on different sites and pathways in an additive or synergistic manner to achieve pain relief with minimal or no opiate consumption. Although all medications have side effects, opiates have particularly concerning, multisystemic, long-term, and short-term side effects, which increase morbidity and prolong admissions. Enhanced recovery is a systematic process addressing each aspect affecting recovery. This article outlines the evidence base forming the current multimodal analgesia recommendations made by the Enhanced Recovery After Surgery Society (ERAS). We describe current evidence and important future directions for effective perioperative multimodal analgesia in enhanced recovery pathways. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Multimodal Similarity Gaussian Process Latent Variable Model.

    Science.gov (United States)

    Song, Guoli; Wang, Shuhui; Huang, Qingming; Tian, Qi

    2017-09-01

    Data from real applications involve multiple modalities representing content with the same semantics from complementary aspects. However, relations among heterogeneous modalities are simply treated as observation-to-fit by existing work, and the parameterized modality specific mapping functions lack flexibility in directly adapting to the content divergence and semantic complicacy in multimodal data. In this paper, we build our work based on the Gaussian process latent variable model (GPLVM) to learn the non-parametric mapping functions and transform heterogeneous modalities into a shared latent space. We propose multimodal Similarity Gaussian Process latent variable model (m-SimGP), which learns the mapping functions between the intra-modal similarities and latent representation. We further propose multimodal distance-preserved similarity GPLVM (m-DSimGP) to preserve the intra-modal global similarity structure, and multimodal regularized similarity GPLVM (m-RSimGP) by encouraging similar/dissimilar points to be similar/dissimilar in the latent space. We propose m-DRSimGP, which combines the distance preservation in m-DSimGP and semantic preservation in m-RSimGP to learn the latent representation. The overall objective functions of the four models are solved by simple and scalable gradient decent techniques. They can be applied to various tasks to discover the nonlinear correlations and to obtain the comparable low-dimensional representation for heterogeneous modalities. On five widely used real-world data sets, our approaches outperform existing models on cross-modal content retrieval and multimodal classification.

  8. 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...

  9. Implementing multimodal pain rehabilitation in primary care - a health care professional perspective.

    Science.gov (United States)

    Stenberg, Gunilla; Stålnacke, Britt-Marie; Enthoven, Paul

    2017-10-01

    To explore professional perspectives on how to start and work with multimodal pain rehabilitation within primary healthcare. Fourteen healthcare professionals (11 women, 3 men) were individually interviewed about their experiences of starting and working with multimodal pain. Interviews were transcribed and analyzed by qualitative content analysis. This study was part of a larger project, which aimed at evaluating multimodal pain rehabilitation in primary care. The analysis resulted in six categories. Two categories were about management engagement: putting the focus on rehabilitation and creating appropriate conditions. Three were about professional engagement: importance of driving spirits, creating a program - a process, and good teamwork - not a coincidence. The last category was about professional gain from multimodal rehabilitation (MMR): team work is enriching. To enable implementation of MMR in primary care, managers on all organizational levels must take responsibility for allowing rehabilitation to be a priority. A driving spirit among the professionals facilitates the start, but the entire team is important when processing a program. Creating good teamwork requires hard work, e.g., negotiations for consensus about rehabilitation, and assumption of responsibility by each team member. Collaboration between professionals was perceived to strengthen and enhance knowledge about the patients. Implications for rehabilitation Much can be gained from conducting multimodal pain rehabilitation in primary care. Front line managers and those at other organizational levels must prioritize and create appropriate conditions to facilitate multimodal pain rehabilitation in primary care. Creation of an effective multimodal rehabilitation team requires that each team member takes responsibility, drops the focus on individual rehabilitation, seek member consensus about the content of the rehabilitation, and confer equal worth to each team member. The process of creating a

  10. Treatment effectiveness for dysfunctions of sexual desire.

    Science.gov (United States)

    Schover, L R; LoPiccolo, J

    1982-01-01

    Archival data from the Sex Therapy Center at Stony Brook were analyzed to determine the prevalence of desire phase sexual dysfunctions and the effectiveness of treating them with behavioral sex therapy. When cases were rediagnosed with a multi-axial problem-oriented system, increases from 1974-1981 in both the prevalence of desire phase problems and of male low sexual desire were observed. Data suggested that wives display more extreme patterns of sexual avoidance than do husbands in couples seeking sex therapy. Outcome statistics on marital adjustment, overall sexual satisfaction, the frequency of intercourse and masturbation, and patterns of initiation of sexual activity reveal significant positive changes after treatment. These changes are not due to nonspecific factors and are maintained at follow-up. Sex therapy was equally successful for male-centered vs. female-centered problems, for low sexual desire vs. aversion to sex, and for global or lifelong dysfunctions vs. the more recent or situational ones. Posttreatment gains reflect a minimally adequate sexual relationship, however, rather than an optimal degree of intimacy and pleasure.

  11. 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

  12. Psychological mechanisms of effective cognitive-behavioral treatments for PTSD.

    Science.gov (United States)

    Zalta, Alyson K

    2015-04-01

    Several psychotherapies have been established as effective treatments for posttraumatic stress disorder (PTSD) including prolonged exposure, cognitive processing therapy, and cognitive therapy for PTSD. Understanding the key mechanisms of these treatments, i.e., how these treatments lead to therapeutic benefits, will enable us to maximize the efficacy, effectiveness, and efficiency of these therapies. This article provides an overview of the theorized mechanisms for each of these treatments, reviews the recent empirical evidence on psychological mechanisms of these treatments, discusses the ongoing debates in the field, and provides recommendations for future research. Few studies to date have examined whether changes in purported treatment mechanisms predict subsequent changes in treatment outcomes. Future clinical trials examining treatments for PTSD should use study designs that enable researchers to establish the temporal precedence of change in treatment mechanisms prior to symptom reduction. Moreover, further research is needed that explores the links between specific treatment components, underlying change mechanisms, and treatment outcomes.

  13. 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

  14. 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....

  15. 21 CFR 1240.10 - Effective bactericidal treatment.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Effective bactericidal treatment. 1240.10 Section... DISEASES General Provisions § 1240.10 Effective bactericidal treatment. Whenever, under the provisions of this part, bactericidal treatment is required, it shall be accomplished by one or more of the following...

  16. Instrumentation challenges in multi-modality imaging

    International Nuclear Information System (INIS)

    Brasse, D.; Boisson, F.

    2016-01-01

    Based on different physical principles, imaging procedures currently used in both clinical and preclinical applications present different performance that allow researchers to achieve a large number of studies. However, the relevance of obtaining a maximum of information relating to the same subject is undeniable. The last two decades have thus seen the advent of a full-fledged research axis, the multimodal in vivo imaging. Whether from an instrumentation point of view, for medical research or the development of new probes, all these research works illustrate the growing interest of the scientific community for multimodal imaging, which can be approached with different backgrounds and perspectives from engineers to end-users point of views. In the present review, we discuss the multimodal imaging concept, which focuses not only on PET/CT and PET/MRI instrumentation but also on recent investigations of what could become a possible future in the field.

  17. 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.

  18. River multimodal scenario for rehabilitation robotics.

    Science.gov (United States)

    Munih, Marko; Novak, Domen; Milavec, Maja; Ziherl, Jaka; Olenšek, Andrej; Mihelj, Matjaž

    2011-01-01

    This paper presents the novel "River" multimodal rehabilitation robotics scenario that includes video, audio and haptic modalities. Elements contributing to intrinsic motivation are carefully joined in the three modalities to increase motivation of the user. The user first needs to perform a motor action, then receives a cognitive challenge that is solved with adequate motor activity. Audio includes environmental sounds, music and spoken instructions or encouraging statements. Sounds and music were classified according to the arousal-valence space. The haptic modality can provide catching, grasping, tunnel or adaptive assistance, all depending on the user's needs. The scenario was evaluated in 16 stroke users, who responded to it favourably according to the Intrinsic Motivation Inventory questionnaire. Additionally, the river multimodal environment seems to elicit higher motivation than a simpler apple pick-and-place multimodal task. © 2011 IEEE

  19. Multimodality and children's participation in classrooms: Instances of ...

    African Journals Online (AJOL)

    It outlines the theoretical framework supporting the pedagogical approach, that of multimodal social semiotics, known more widely as “multimodality”, and discusses three instances of children's multimodal practice, in Grades 1 and 2, 7 and 10 respectively. It sums up the role played by multimodality in participation, showing ...

  20. 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

  1. Cost-effectiveness of ceftriaxone in the treatment of community ...

    African Journals Online (AJOL)

    effectiveness of four intravenous antibiotic treatment regimens in the treatment of severe community-acquired pneumonia (CAP) in adults in a private hospital setting. The study compared some third-generation cephalosporin regimens with a ...

  2. 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.

  3. 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.

  4. Herbal Treatment for Anxiety: Is It Effective?

    Science.gov (United States)

    ... from Brent A. Bauer, M.D. Several herbal remedies have been studied as a treatment for anxiety, ... is preliminary and limited. Oral lavender can cause constipation and headaches. It can also increase appetite, increase ...

  5. intercritical heat treatments effects on low carbon steels quenched

    African Journals Online (AJOL)

    DR B. A. EZEKOYE

    hardening and precipitation effects [2]. Of all the metallic materials of engineering ... of this work was to investigate the effect of diverse intercritical heat treatments on the ... INTERCRITICAL HEAT TREATMENT EFFECTS ON LOW CARBON STEELS QUENCHED FROM INTERMEDIATE ... Series II- Intercritical quench with.

  6. Multimodal intervention raises smoking cessation rate during pregnancy

    DEFF Research Database (Denmark)

    Hegaard, Hanne K; Kjaergaard, Hanne; Møller, Lars F

    2003-01-01

    BACKGROUND: The aim was to study the effect of a multimodal smoking cessation intervention regimen on a number of pregnant smokers. METHODS: A prospective intervention study was designed where participants were allocated to intervention or control based on their birth date. The study included 647.......003). The adjusted odds ratio (OR) for smoking cessation was 4.20 (95% CI 2.13-8.03). Logistic regression analysis showed a significant positive association of smoking cessation with low caffeine consumption in pregnancy, many years in school, no exposure to passive smoking outside the home, and previous attempts...

  7. Multimodal sensory integration in single cerebellar granule cells in vivo.

    Science.gov (United States)

    Ishikawa, Taro; Shimuta, Misa; Häusser, Michael

    2015-12-29

    The mammalian cerebellum is a highly multimodal structure, receiving inputs from multiple sensory modalities and integrating them during complex sensorimotor coordination tasks. Previously, using cell-type-specific anatomical projection mapping, it was shown that multimodal pathways converge onto individual cerebellar granule cells (Huang et al., 2013). Here we directly measure synaptic currents using in vivo patch-clamp recordings and confirm that a subset of single granule cells receive convergent functional multimodal (somatosensory, auditory, and visual) inputs via separate mossy fibers. Furthermore, we show that the integration of multimodal signals by granule cells can enhance action potential output. These recordings directly demonstrate functional convergence of multimodal signals onto single granule cells.

  8. Effectiveness of Emdogain in the periodontal treatment.

    Science.gov (United States)

    Kurhańska-Flisykowska, Anna; Łojewski, Włodzimierz; Wyganowska-Swiatkowska, Marzena

    2012-01-01

    The study was designed to investigate how the periodontal disease treatment with Emdogain may influence the parameters of serum acute phase response and the total antioxidant status (TAS) of nonstimulated saliva. The wound healing process after periodontal treatment provided with EMD and regular open flap procedure was observed in 28 patients. TAS in saliva and acute phase proteins in blood was measured before and after treatment. The PD varied from 3,91 mm before treatment to 1,27 after it in EMD group and from 3,83 mm and 1,33 in the control group. CAL varied from 3,2 - 2,4 mm in EMD group and from 2,70 - 2,2 in the control group (p<0,01 and p<0,001). On the basis and after treatment of acute phase proteins analysis existence of chronic inflammatory state with slight decreased total concentration of AGP, ACP. Low TAS level found in the saliva of the subjects in our study may suggest that the antioxidant defence of saliva in patients with chronic periodontitis is poor.

  9. Strain sensor based on gourd-shaped single-mode-multimode-single-mode hybrid optical fibre structure.

    Science.gov (United States)

    Tian, Ke; Farrell, Gerald; Wang, Xianfan; Yang, Wenlei; Xin, Yifan; Liang, Haidong; Lewis, Elfed; Wang, Pengfei

    2017-08-07

    A fibre-optic strain sensor based on a gourd-shaped joint multimode fibre (MMF) sandwiched between two single-mode fibres (SMFs) is described both theoretically and experimentally. The cladding layers of the two MMFs are reshaped to form a hemisphere using an electrical arc method and spliced together, yielding the required gourd shape. The gourd-shaped section forms a Fabry-Perot cavity between the ends of two adjacent but non-contacting multimode fibres' core. The effectiveness of the multimode interference based on the Fabry-Perot interferometer (FPI) formed within the multimode inter-fibre section is greatly improved resulting in an experimentally determined strain sensitivity of -2.60 pm/με over the range 0-1000 με. The sensing characteristics for temperature and humidity of this optical fibre strain sensor are also investigated.

  10. Effectiveness of propanolol for treatment of infantile haemangioma

    DEFF Research Database (Denmark)

    Andersen, Ida Gillberg; Rechnitzer, Catherine; Charabi, Birgitte

    2014-01-01

    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......INTRODUCTION: Infantile haemangiomas (IH) are the most common benign tumours in children. They are characterised by rapid growth during the first year of life followed by spontaneous regression during childhood. Indications for treatment are functional impairment, bleeding/ulceration, rapid growth...

  11. Psychiatric side effects of interferon treatment.

    Science.gov (United States)

    Patten, Scott B

    2006-05-01

    Interferons are employed in the management of multiple sclerosis, hepatitis C and certain malignancies. Neuropsychiatric toxicity can interfere with the successful use of these drugs. This review was based on Medline literature searches, supplemented by bibliographical citations in identified papers. Information uncovered in the literature review was interpreted in light of related pharmacoepidemiological and psychiatric literature. Interferon-associated neurotoxicity does not adhere closely to standard psychiatric syndromal and diagnostic definitions. Delirium, depression, non-specific symptoms related to sickness behavior and, rarely, manic and psychotic syndromes are all potential adverse events during interferon treatment. For depression, the evidence of increased risk is stronger for interferon alpha than for interferon beta. The availability of preventive and treatment interventions suggest that neuropsychiatric toxicity can often be managed without needing to discontinue the treatment. Safety can be maximized by organization of health services in ways that enhance detection and management of neuropsychiatric problems, and which support access to basic and specialized mental health services.

  12. 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.

  13. Multimodal interactions between proprioceptive and cutaneous signals in primary somatosensory cortex

    Science.gov (United States)

    Kim, Sung Soo; Gomez-Ramirez, Manuel; Thakur, Pramodsingh H.; Hsiao, Steven S.

    2015-01-01

    The classical view of somatosensory processing holds that proprioceptive and cutaneous inputs are conveyed to cortex through segregated channels, initially synapsing in modality-specific areas 3a (proprioception) and 3b (cutaneous) of primary somatosensory cortex (SI). These areas relay their signals to areas 1 and 2 where multimodal convergence first emerges. However, proprioceptive and cutaneous maps have traditionally been characterized using unreliable stimulation tools. Here, we employed a mechanical stimulator that reliably positioned animals' hands in different postures and presented tactile stimuli with superb precision. Single-unit recordings in SI revealed that most neurons responded to cutaneous and proprioceptive stimuli, including cells in areas 3a and 3b. Multimodal responses were characterized by linear and nonlinear effects that emerged during early (∼20ms) and latter (>100ms) stages of stimulus processing, respectively. These data are incompatible with the modality specificity model in SI, and provide evidence for distinct mechanisms of multimodal processing in the somatosensory system. PMID:25864632

  14. 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.

  15. Multimodal Student Interaction Online: An Ecological Perspective

    Science.gov (United States)

    Berglund, Therese Ornberg

    2009-01-01

    This article describes the influence of tool and task design on student interaction in language learning at a distance. Interaction in a multimodal desktop video conferencing environment, FlashMeeting, is analyzed from an ecological perspective with two main foci: participation rates and conversational feedback strategies. The quantitative…

  16. Multimodal Design, Learning and Cultures of Recognition

    Science.gov (United States)

    Kress, Gunther; Selander, Staffan

    2012-01-01

    In this article, a design-oriented, multimodal understanding of learning will be outlined. There seems to be a need for a new conceptualisation of learning in an era characterised by an increasing virtual space, blended media and new communicative patterns. This means a broader understanding of learning, and a theoretical understanding of…

  17. Feedback Design in Multimodal Dialogue Systems

    NARCIS (Netherlands)

    Van Rosmalen, Peter; Börner, Dirk; Schneider, Jan; Petukhova, Volha; Van Helvert, Joy

    2015-01-01

    This paper discusses the design and development of the instructional aspects of a multimodal dialogue system to train youth parliament members’ presentation and debating skills. Real-time, in-action feedback informs learners on the fly how they perform key skills and enables them to adapt instantly.

  18. Scenemash: multimodal route summarization for city exploration

    NARCIS (Netherlands)

    Berg, J. van den; Rudinac, S.; Worring, M.

    2016-01-01

    The potential of mining tourist information from social multimedia data gives rise to new applications offering much richer impressions of the city. In this paper we propose Scenemash, a system that generates multimodal summaries of multiple alternative routes between locations in a city. To get

  19. Reconceptualising Poetry as a Multimodal Genre

    Science.gov (United States)

    Newfield, Denise; D'abdon, Raphael

    2015-01-01

    This conceptual article theorises the role of poetry in English classrooms from a multimodal perspective. It discusses the gap between the practices of poetry inside and outside South African schools, particularly where English is taught as an additional language (EAL). The former is shown to be monomodal and prescriptive, while the latter is…

  20. A Multimodal Database for Mimicry Analysis

    NARCIS (Netherlands)

    Sun, X.; Lichtenauer, Jeroen; Valstar, Michel; Nijholt, Antinus; Pantic, Maja; D' Mello, Sidney; Graesser, Arthur; Schuller, Björn; Martin, Jean-Claude

    2011-01-01

    In this paper we introduce a multi-modal database for the analysis of human interaction, in particular mimicry, and elaborate on the theoretical hypotheses of the relationship between the occurrence of mimicry and human affect. The recorded experiments are designed to explore this relationship. The

  1. CASE REPORT CASE Multimodality imaging and interventional ...

    African Journals Online (AJOL)

    sequestration was considered at this stage. An angiogram was thereafter performed to further characterise the vascularity, as well as allow embolisation of the lesion prior to surgery. (Fig. 5). Multimodality imaging and interventional management of a complex congenital vascular malformation. Aadil Ahmed, MB BCh, FCRad ...

  2. Multimodal Dialogue Management - State of the art

    NARCIS (Netherlands)

    Bui Huu Trung, B.H.T.

    This report is about the state of the art in dialogue management. We first introduce an overview of a multimodal dialogue system and its components. Second, four main approaches to dialogue management are described (finite-state and frame-based, information-state based and probabilistic, plan-based,

  3. Love that Book: Multimodal Response to Literature

    Science.gov (United States)

    Dalton, Bridget; Grisham, Dana L.

    2013-01-01

    Composing with different modes--image, sound, video and the written word--to respond to and analyze literary and informational text helps students develop as readers and digital communicators. This article showcases five multimodal strategies for engaging children in rich literature-based learning using digital tools and Internet resources.

  4. Multimodal Interaction in a Haptic Environment

    NARCIS (Netherlands)

    Nijholt, Antinus; Kole, S.; Zwiers, Jakob; Bicchi, A.; Bergamasco, M.

    2005-01-01

    In this paper we investigate the introduction of haptics in a multimodal tutoring environment. In this environment a haptic device is used to control a virtual piece of sterile cotton and a virtual injection needle. Speech input and output is provided to interact with a virtual tutor, available as a

  5. Evaluating Multimodal NLG using Production Experiments

    NARCIS (Netherlands)

    van der Sluis, Ielka; Krahmer, E.

    2004-01-01

    In this paper we report on an evaluation study for the generation of multimodal referring expressions. To test our algorithm, which allows for various gradations of preciseness in pointing, subjects performed an object identification task in a strict experimental setting. 20 subjects participated

  6. Magnetic quantum dots for multimodal imaging

    NARCIS (Netherlands)

    Koole, Rolf; Mulder, Willem J. M.; van Schooneveld, Matti M.; Strijkers, Gustav J.; Meijerink, Andries; Nicolay, Klaas

    2009-01-01

    Multimodal contrast agents based on highly luminescent quantum dots (QDs) combined with magnetic nanoparticles (MNPs) or ions form an exciting class of new materials for bioimaging. With two functionalities integrated in a single nanoparticle, a sensitive contrast agent for two very powerful and

  7. Single versus multimodality training basic laparoscopic skills

    NARCIS (Netherlands)

    Brinkman, W.M.; Havermans, S.Y.; Buzink, S.N.; Botden, S.M.B.I.; Jakimowicz, J.J.; Schoot, B.C.

    2012-01-01

    Introduction - Even though literature provides compelling evidence of the value of simulators for training of basic laparoscopic skills, the best way to incorporate them into a surgical curriculum is unclear. This study compares the training outcome of single modality training with multimodality

  8. Multimodal Interaction with a Virtual Guide

    NARCIS (Netherlands)

    Hofs, D.H.W.; Theune, Mariet; op den Akker, Hendrikus J.A.

    2008-01-01

    We demonstrate the Virtual Guide, an embodied conversational agent that gives directions in a 3D environment. We briefly describe multimodal dialogue management, language and gesture generation, and a special feature of the Virtual Guide: the ability to align her linguistic style to the user’s level

  9. A Multimodal Interaction Framework for Blended Learning

    DEFF Research Database (Denmark)

    Vidakis, Nikolaos; Kalafatis, Konstantinos; Triantafyllidis, Georgios

    2016-01-01

    of communication with an application, which will be more natural than the traditional “windows, icons, menus, pointer” (WIMP) style. Despite the great amount of devices in existence, most applications make use of a very limited set of modalities, most notably speech and touch. This paper describes a multimodal...

  10. Spatial sound in the use of multimodal interfaces for the acquisition of motor skills

    DEFF Research Database (Denmark)

    Hoffmann, Pablo F.

    2008-01-01

    This paper discusses the potential effectiveness of spatial sound in the use of multimodal interfaces and virtual environment technologies for the acquisition of motor skills. Because skills are generally of multimodal nature, spatial sound is discussed in terms of the role that it may play...... in facilitating skill acquisition by complementing, or substituting, other sensory modalities. An overview of related research areas on audiovisual and audiotactile interaction is given in connection to the potential benefits of spatial sound as a means to improve the perceptual quality of the interfaces as well...... as to convey information considered critical for the transfer of motor skills....

  11. Effects of Outpatient Treatment of Dyslexia.

    Science.gov (United States)

    van Daal, Victor H. P.; Reitsma, Pieter

    1999-01-01

    A Dutch intervention program proved to be successful with 109 10-year-old children with dyslexia and 29 children with reading problems and cognitive deficits or psychiatric symptoms. The children with pure dyslexia profited most. Differences in treatment outcomes were related to the absolute level of word reading and age at intake. (Author/CR)

  12. 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...

  13. 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

  14. Long-Term Effects of a Psycholinguistic Treatment for Dyslexia.

    Science.gov (United States)

    Tijms, Jurgen; Hoeks, Jan J. W. M.; Paulussen-Hoogeboom, Marja C.; Smolenaars, Anton J.

    2003-01-01

    Evaluates short- and long-term effects of a treatment for dyslexia. Notes that the treatment focuses on learning to recognize and to make use of the phonological and morphological structure of Dutch words. Finds that the results of the treatment were clear improvements in reading words, reading text and spelling. (SG)

  15. Treatment effects in prostate cancer following traditional and emerging therapies.

    Science.gov (United States)

    Mazzucchelli, R; Scarpelli, M; Lopez-Beltran, A; Cheng, L; Di Primio, R; Montironi, R

    2013-01-01

    Treatment options for prostate cancer consist of radical prostatectomy, hormonal therapy and radiation therapy. Hormonal and radiation therapy have well-known, often profound, effects on the histological appearance of benign and malignant prostate tissue. Novel therapies including focal ablative treatments, chemotherapies and targeted molecular therapies are beginning to emerge and pathologists will play a central role in documenting the effects of these treatments at the tissue level. As such, knowledge of treatment-related changes and access to clinical information are essential to ensure accurate interpretation and reporting of post-treatment prostate specimens by pathologists.

  16. Facilitating Multiple Intelligences Through Multimodal Learning Analytics

    Directory of Open Access Journals (Sweden)

    Ayesha PERVEEN

    2018-01-01

    Full Text Available This paper develops a theoretical framework for employing learning analytics in online education to trace multiple learning variations of online students by considering their potential of being multiple intelligences based on Howard Gardner’s 1983 theory of multiple intelligences. The study first emphasizes the need to facilitate students as multiple intelligences by online education systems and then suggests a framework of the advanced form of learning analytics i.e., multimodal learning analytics for tracing and facilitating multiple intelligences while they are engaged in online ubiquitous learning. As multimodal learning analytics is still an evolving area, it poses many challenges for technologists, educationists as well as organizational managers. Learning analytics make machines meet humans, therefore, the educationists with an expertise in learning theories can help technologists devise latest technological methods for multimodal learning analytics and organizational managers can implement them for the improvement of online education. Therefore, a careful instructional design based on a deep understanding of students’ learning abilities, is required to develop teaching plans and technological possibilities for monitoring students’ learning paths. This is how learning analytics can help design an adaptive instructional design based on a quick analysis of the data gathered. Based on that analysis, the academicians can critically reflect upon the quick or delayed implementation of the existing instructional design based on students’ cognitive abilities or even about the single or double loop learning design. The researcher concludes that the online education is multimodal in nature, has the capacity to endorse multiliteracies and, therefore, multiple intelligences can be tracked and facilitated through multimodal learning analytics in an online mode. However, online teachers’ training both in technological implementations and

  17. Differences in response between traumatic and non-traumatic chronic neck pain patients in a multimodal intervention?

    DEFF Research Database (Denmark)

    Ris Hansen, Inge; Søgaard, Karen; Gram, Bibi

    Abstract title: Do traumatic and non-traumatic chronic neck pain patients respond different on a combination of pain education, exercises and training? Authors: Inge Ris, Karen Søgaard, Bibi Gram, Karina Agerbo, Eleanor Boyle, Birgit Juul-Kristensen Background: Previous studies have investigated...... the effect of a variety of multimodal approaches for patients with chronic neck pain. However, the effect of specific exercises combined with graded physical activity training and pain education, measured on Health Related Quality of Life (HR-QoL) is unknown. Also, possible differences between traumatic...... and non-traumatic chronic neck pain patients in response to such a treatment are unknown. Question: Does a combination of pain education, specific exercises and graded physical activity training compared with pain education alone improve physical HR-QoL in chronic neck pain patients? Do patients...

  18. Multimodal Stereoscopic Movie Summarization Conforming to Narrative Characteristics.

    Science.gov (United States)

    Mademlis, Ioannis; Tefas, Anastasios; Nikolaidis, Nikos; Pitas, Ioannis

    2016-10-05

    Video summarization is a timely and rapidly developing research field with broad commercial interest, due to the increasing availability of massive video data. Relevant algorithms face the challenge of needing to achieve a careful balance between summary compactness, enjoyability and content coverage. The specific case of stereoscopic 3D theatrical films has become more important over the past years, but not received corresponding research attention. In the present work, a multi-stage, multimodal summarization process for such stereoscopic movies is proposed, that is able to extract a short, representative video skim conforming to narrative characteristics from a 3D film. At the initial stage, a novel, low-level video frame description method is introduced (Frame Moments Descriptor, or FMoD), that compactly captures informative image statistics from luminance, color, optical flow and stereoscopic disparity video data, both in a global and in a local scale. Thus, scene texture, illumination, motion and geometry properties may succinctly be contained within a single frame feature descriptor, which can subsequently be employed as a building block in any key-frame extraction scheme, e.g., for intra-shot frame clustering. The computed key-frames are then used to construct a movie summary in the form of a video skim, which is post-processed in a manner that also takes into account the audio modality. The next stage of the proposed summarization pipeline essentially performs shot pruning, controlled by a userprovided shot retention parameter, that removes segments from the skim based on the narrative prominence of movie characters in both the visual and the audio modalities. This novel process (Multimodal Shot Pruning, or MSP) is algebraically modelled as a multimodal matrix Column Subset Selection Problem, which is solved using an evolutionary computing approach. Subsequently, disorienting editing effects induced by summarization are dealt with, through manipulation of

  19. Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?

    Science.gov (United States)

    Michiels, S; Van de Heyning, P; Truijen, S; Hallemans, A; De Hertogh, W

    2016-12-01

    Tinnitus can be related to many different aetiologies such as hearing loss or a noise trauma, but it can also be related to the somatosensory system of the cervical spine, called cervicogenic somatic tinnitus (CST). Case studies suggest a positive effect of cervical spine treatment on tinnitus complaints in patients with CST, but no experimental studies are available. To investigate the effect of a multimodal cervical physical therapy treatment on tinnitus complaints in patients with CST. Randomized controlled trial. Patients with a combination of severe subjective tinnitus (Tinnitus Functional Index (TFI): 25-90 points) and neck complaints (Neck Bournemouth Questionnaire (NBQ) > 14 points). All patients received cervical physical therapy for 6 weeks (12 sessions). Patients were randomized in an immediate-start therapy group (n = 19) and a 6-week delayed-start therapy group (n = 19). TFI and NBQ-scores were documented at baseline, after the wait-and-see period in the delayed-start group, after treatment and after 6 weeks follow-up. The Global Perceived Effect (GPE) was documented at all measuring moments, except at baseline. In all patients (n = 38) TFI and NBQ-scores decreased significantly after treatment (p = 0.04 and p tinnitus. This effect was maintained in 24% of patients after follow-up at six weeks. Cervical physical therapy can have a positive effect on subjective tinnitus complaints in patients with a combination of tinnitus and neck complaints. Larger studies, using more responsive outcome measures, are however necessary to prove this effect. NCT02016313. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. 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.

  1. Effects of Cancer Treatment on Fertility (For Parents)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Effects of Cancer Treatment on Fertility KidsHealth / For Parents / ... infertile couple's embryo via in vitro fertilization. Emotional Effects As you explore the options, it's important to ...

  2. Evaluation of treatment effects by ranking

    DEFF Research Database (Denmark)

    Halekoh, U; Kristensen, K

    2008-01-01

    to account for the repeated measurements. The estimation was based on a Bayesian approach, which was analysed via Markov Chain Monte Carlo sampling. A simulation study showed that the approach was able to estimate the relative ordering of the treatments. The efficiency of the estimation increased....... This method seems to be less sensitive to the judge and also eliminates any possible drift over the judging process in the more traditional method...

  3. Toxic Stress: Effects, Prevention and Treatment

    OpenAIRE

    Franke, Hillary A.

    2014-01-01

    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 integrat...

  4. The effects of heat treatment on physical and technological ...

    African Journals Online (AJOL)

    STORAGESEVER

    2009-10-19

    Oct 19, 2009 ... Heat treatment of wood is an effective method to improve the dimensional stability and durability against biodegradation. In this study, the effects of heat treatment on physical properties and surface roughness of European Hophornbeam (Ostrya carpinifolia Scop.) wood were examined. Samples obtained ...

  5. Effects of long-term treatment with corticosteroids in COPD

    NARCIS (Netherlands)

    Renkema, TEJ; Schouten, JP; Koeter, GH; Postma, DS

    Study objective: To determine the effectiveness of treatment with corticosteroids in patients with COPD. Methods: In this study, we investigated the effect of a 2-year treatment with corticosteroids on clinical symptoms and the decline of lung function in 58 nonallergic patients with COPD. Subjects

  6. Multimodality imaging of cardiothoracic lymphoma

    International Nuclear Information System (INIS)

    Carter, Brett W.; Wu, Carol C.; Khorashadi, Leila; Godoy, Myrna C.B.; Groot, Patricia M. de; Abbott, Gerald F.; Lichtenberger III, John P.

    2014-01-01

    Lymphoma is the most common hematologic malignancy and represents approximately 5.3% of all cancers. The World Health Organization published a revised classification scheme in 2008 that groups lymphomas by cell type and molecular, cytogenetic, and phenotypic characteristics. Most lymphomas affect the thorax at some stage during the course of the disease. Affected structures within the chest may include the lungs, mediastinum, pleura, and chest wall, and lymphomas may originate from these sites as primary malignancies or secondarily involve these structures after arising from other intrathoracic or extrathoracic sources. Pulmonary lymphomas are classified into one of four types: primary pulmonary lymphoma, secondary pulmonary lymphoma, acquired immunodeficiency syndrome-related lymphoma, and post-transplantation lymphoproliferative disorders. Although pulmonary lymphomas may produce a myriad of diverse findings within the lungs, specific individual features or combinations of features can be used, in combination with secondary manifestations of the disease such as involvement of the mediastinum, pleura, and chest wall, to narrow the differential diagnosis. While findings of thoracic lymphoma may be evident on chest radiography, computed tomography has traditionally been the imaging modality used to evaluate the disease and effectively demonstrates the extent of intrathoracic involvement and the presence and extent of extrathoracic spread. However, additional modalities such as magnetic resonance imaging of the thorax and 18 F-FDG PET/CT have emerged in recent years and are complementary to CT in the evaluation of patients with lymphoma. Thoracic MRI is useful in assessing vascular, cardiac, and chest wall involvement, and PET/CT is more accurate in the overall staging of lymphoma than CT and can be used to evaluate treatment response

  7. Multimodality imaging of cardiothoracic lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Carter, Brett W., E-mail: bcarter2@mdanderson.org [The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Section of Thoracic Imaging, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030 (United States); Wu, Carol C. [Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02114 (United States); Khorashadi, Leila [Department of Radiology, Mount Auburn Hospital, Cambridge, MA 02138 (United States); Godoy, Myrna C.B.; Groot, Patricia M. de [The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Section of Thoracic Imaging, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030 (United States); Abbott, Gerald F. [Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02114 (United States); Lichtenberger III, John P. [Department of Radiology, David Grant Medical Center, Travis AFB, CA 94535 (United States)

    2014-08-15

    Lymphoma is the most common hematologic malignancy and represents approximately 5.3% of all cancers. The World Health Organization published a revised classification scheme in 2008 that groups lymphomas by cell type and molecular, cytogenetic, and phenotypic characteristics. Most lymphomas affect the thorax at some stage during the course of the disease. Affected structures within the chest may include the lungs, mediastinum, pleura, and chest wall, and lymphomas may originate from these sites as primary malignancies or secondarily involve these structures after arising from other intrathoracic or extrathoracic sources. Pulmonary lymphomas are classified into one of four types: primary pulmonary lymphoma, secondary pulmonary lymphoma, acquired immunodeficiency syndrome-related lymphoma, and post-transplantation lymphoproliferative disorders. Although pulmonary lymphomas may produce a myriad of diverse findings within the lungs, specific individual features or combinations of features can be used, in combination with secondary manifestations of the disease such as involvement of the mediastinum, pleura, and chest wall, to narrow the differential diagnosis. While findings of thoracic lymphoma may be evident on chest radiography, computed tomography has traditionally been the imaging modality used to evaluate the disease and effectively demonstrates the extent of intrathoracic involvement and the presence and extent of extrathoracic spread. However, additional modalities such as magnetic resonance imaging of the thorax and {sup 18}F-FDG PET/CT have emerged in recent years and are complementary to CT in the evaluation of patients with lymphoma. Thoracic MRI is useful in assessing vascular, cardiac, and chest wall involvement, and PET/CT is more accurate in the overall staging of lymphoma than CT and can be used to evaluate treatment response.

  8. Multi-Modality Therapeutics with Potent Anti-Tumor Effects: Photochemical Internalization Enhances Delivery of the Fusion Toxin scFvMEL/rGel

    Science.gov (United States)

    Selbo, Pål K.; Rosenblum, Michael G.; Cheung, Lawrence H.; Zhang, Wendy; Berg, Kristian

    2009-01-01

    Background There is a need for drug delivery systems (DDS) that can enhance cytosolic delivery of anti-cancer drugs trapped in the endo-lysosomal compartments. Exposure of cells to specific photosensitizers followed by light exposure (photochemical internalization, PCI) results in transfer of agents from the endocytic compartment into the cytosol. Methodology and Principal Findings The recombinant single-chain fusion construct scFvMEL/rGel is composed of an antibody targeting the progenitor marker HMW-MAA/NG2/MGP/gp240 and the highly effective toxin gelonin (rGel). Here we demonstrate enhanced tumor cell selectivity, cytosolic delivery and anti-tumor activity by applying PCI of scFvMEL/rGel. PCI performed by light activation of cells co-incubated with scFvMEL/rGel and the endo-lysosomal targeting photosensitizers AlPcS2a or TPPS2a resulted in enhanced cytotoxic effects against antigen-positive cell lines, while no differences in cytotoxicity between the scFvMEL/rGel and rGel were observed in antigen-negative cells. Mice bearing well-developed melanoma (A-375) xenografts (50–100 mm3) were treated with PCI of scFvMEL/rGel. By 30 days after injection, ∼100% of mice in the control groups had tumors>800 mm3. In contrast, by day 40, 50% of mice in the PCI of scFvMEL/rGel combination group had tumorsmodality approach combining a recombinant, targeted therapeutic such as scFvMEL/rGel and PCI act in concert to provide potent in vivo efficacy without sacrificing selectivity or enhancing toxicity. The present DDS warrants further evaluation of its clinical potential. PMID:19690617

  9. Multimodal registration of three-dimensional maxillodental cone beam CT and photogrammetry data over time.

    Science.gov (United States)

    Bolandzadeh, N; Bischof, W; Flores-Mir, C; Boulanger, P

    2013-01-01

    In recent years, one of the foci of orthodontics has been on systems for the evaluation of treatment results and the tracking of tissue variations over time. This can be accomplished through analysing three-dimensional orthodontic images obtained before and after the treatments. Since complementary information is achieved by integrating multiple imaging modalities, cone beam CT (CBCT) and stereophotogrammetry technologies are used in this study to develop a method for tracking bone, teeth and facial soft-tissue variations over time. We propose a two-phase procedure of multimodal (Phase 1) and multitemporal (Phase 2) registration which aligns images taken from the same patient by different imaging modalities and at different times. Extrinsic (for Phase 1) and intrinsic (for Phase 2) landmark-based registration methods are employed as an initiation for a robust iterative closest points algorithm. Since the mandible moves independently of the upper skull, the registration procedure is applied separately on the mandible and the upper skull. The results show that the signed error distributions of both mandible and skull registrations follow a mixture of two Gaussian distributions, corresponding to alignment errors (due to our method) and temporal change over time. We suggest that the large values among the total registration errors correspond to the temporal change resulting from (1) the effect of treatment (i.e. the orthodontic changes of teeth positions); (2) the biological changes such as teeth growth over time, especially for teenagers; and (3) the segmentation procedure and CBCT precision change over time.

  10. Multimodal imaging of gliomas in the context of evolving cellular and molecular therapies.

    Science.gov (United States)

    Keunen, Olivier; Taxt, Torfinn; Grüner, Renate; Lund-Johansen, Morten; Tonn, Joerg-Christian; Pavlin, Tina; Bjerkvig, Rolf; Niclou, Simone P; Thorsen, Frits

    2014-09-30

    The vast majority of malignant gliomas relapse after surgery and standard radio-chemotherapy. Novel molecular and cellular therapies are thus being developed, targeting specific aspects of tumor growth. While histopathology remains the gold standard for tumor classification, neuroimaging has over the years taken a central role in the diagnosis and treatment follow up of brain tumors. It is used to detect and localize lesions, define the target area for biopsies, plan surgical and radiation interventions and assess tumor progression and treatment outcome. In recent years the application of novel drugs including anti-angiogenic agents that affect the tumor vasculature, has drastically modulated the outcome of brain tumor imaging. To properly evaluate the effects of emerging experimental therapies and successfully support treatment decisions, neuroimaging will have to evolve. Multi-modal imaging systems with existing and new contrast agents, molecular tracers, technological advances and advanced data analysis can all contribute to the establishment of disease relevant biomarkers that will improve disease management and patient care. In this review, we address the challenges of glioma imaging in the context of novel molecular and cellular therapies, and take a prospective look at emerging experimental and pre-clinical imaging techniques that bear the promise of meeting these challenges. Copyright © 2014. Published by Elsevier B.V.

  11. MULTIMODALITY THERAPY FOR OSTEOSARCOMA OF THE STERNUM WITH RECONSTRUCTION OF COMPLEX CHEST WALL DEFECTS

    Directory of Open Access Journals (Sweden)

    V. E. Ivanov

    2017-01-01

    Full Text Available Background. Osteosarcoma is a high-grade malignant bone tumor that accounts for up to 6 % of all bone neoplasms. There are only a few published cases of primary sternal osteosarcomas, reflecting the rarity of these tumors. Recently, there has been a growing interest in performing radical excisions of chest wall tumors followed by combined single-stage reconstruction of the rib cage with implants made of biologically compatible materials. Material and methods. We present the case of a 49-year-old woman diagnosed with osteosarcoma of the sternum. The patient received a combined modality treatment including chemotherapy, radiotherapy and surgery. Titanium nickelid implants were used for the reconstruction of chest wall defects. Results. The multimodality treatment with reconstruction of postoperative chest wall defects allowed the achievement of the optimal quality of life for 21 months in the patient with very poor prognosis. Conclusion. The chest wall reconstruction using biocompatible materials from titanium nickelid appeared to be an effective and safe technique for the treatment of chest wall tumors.

  12. 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.

  13. Multimodal prevention of pain, nausea and vomiting after breast cancer surgery

    DEFF Research Database (Denmark)

    Gärtner, Rune; Kroman, N; Callesen, T

    2010-01-01

    Despite many one- or two-modal attempts to relieve postoperative nausea and vomiting (PONV) and pain, postoperative issues following breast cancer surgery remain a substantial problem. Therefore, the aim of this explorative, hypothesis-generating study was to evaluate the effect of a multimodal, ...

  14. Cross Space: The Exploration of SNS-Based Writing Activities in a Multimodal Learning Environment

    Science.gov (United States)

    Lee, Kwang-Soon; Kim, Bong-Gyu

    2016-01-01

    This study explores the positive learning effect of formulating English sentences via Social Network Service (SNS; "Kakao-Talk") on less proficient L2 university students' (LPSs') writing, when the application is utilized as a tool to link in and out-of class activities in a multimodal-learning environment. Its objective is also to…

  15. Early Years Teachers' Perspectives on Teaching through Multiple Metaphors and Multimodality

    Science.gov (United States)

    Mildenhall, Paula

    2015-01-01

    Recent research findings indicate that using multiple metaphors in multimodal learning experiences are effective teaching approaches in early years mathematics. Using a social semiotic lens this paper reports on eight early years teachers' perceptions of this approach whilst engaging in a small collaborative professional learning group. This group…

  16. Novel, multimodal approach for basic transesophageal echocardiographic teaching.

    Science.gov (United States)

    Mitchell, John D; Mahmood, Feroze; Bose, Ruma; Hess, Philip E; Wong, Vanessa; Matyal, Robina

    2014-06-01

    Web and simulation technology may help in creating a transesophageal echocardiography (TEE) curriculum. The authors discuss the educational principles applied to developing and implementing a multimodal TEE curriculum. The authors modified a pilot course based on principles for effective simulation-based education. Key curricular elements were consistent with principles for effective simulation-based education: (1) clear goals and carefully structured objectives, (2) conveniently accessed, graduated, longitudinal instruction, (3) a protected and optimal learning environment, (4) repetition of concepts and technical skills, (5) progressive expectations for understanding and skill development, (6) introduction of abnormalities after understanding of normal anatomy and probe manipulation is achieved, (7) live learning sessions that are customizable to meet learner needs and individualized proctoring in skill sessions, (8) use of multiple approaches to teaching, (9) regular and relevant feedback, and (10) application of performance and compliance measures. Fifty-five learners participated in a curriculum with web-based modules, live teaching, and simulation practice between August 2011 and May 2013. It is possible to develop and implement an integrated, multimodal TEE curriculum supported by educational theory. The authors will explore the transferability of this approach to intraoperative TEE on live patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Photosensitizer-gold nanorod composite for targeted multimodal therapy.

    Science.gov (United States)

    Wang, Jian; You, Mingxu; Zhu, Guizhi; Shukoor, Mohammed Ibrahim; Chen, Zhuo; Zhao, Zilong; Altman, Meghan B; Yuan, Quan; Zhu, Zhi; Chen, Yan; Huang, Cheng Zhi; Tan, Weihong

    2013-11-11

    In this work, a DNA inter-strand replacement strategy for therapeutic activity is successfully designed for multimodal therapy. In this multimodal therapy, chlorin e6 (Ce6) photosensitizer molecules are used for photodynamic therapy (PDT), while aptamer-AuNRs, are used for selective binding to target cancer cells and for photothermal therapy (PTT) with near infrared laser irradiation. Aptamer Sgc8, which specifically targets leukemia T cells, is conjugated to an AuNR by a thiol-Au covalent bond and then hybridized with a Ce6-labeled photosensitizer/reporter to form a DNA double helix. When target cancer cells are absent, Ce6 is quenched and shows no PDT effect. However, when target cancer cells are present, the aptamer changes structure to release Ce6 to produce singlet oxygen for PDT upon light irradiation. Importantly, by combining photosensitizer and photothermal agents, PTT/PDT dual therapy supplies a more effective therapeutic outcome than either therapeutic modality alone. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  18. All-fiber multimode interference micro-displacement sensor

    International Nuclear Information System (INIS)

    Antonio-Lopez, J E; LiKamWa, P; Sanchez-Mondragon, J J; May-Arrioja, D A

    2013-01-01

    We report an all-fiber micro-displacement sensor based on multimode interference (MMI) effects. The micro-displacement sensor consists of a segment of No-Core multimode fiber (MMF) with one end spliced to a segment of single mode fiber (SMF) which acts as the input. The other end of the MMF and another SMF are inserted into a capillary ferrule filled with index matching liquid. Since the refractive index of the liquid is higher than that of the ferrule, a liquid MMF with a diameter of 125 µm is formed between the fibers inside the ferrule. When the fibers are separated this effectively increases the length of the MMF. Since the peak wavelength response of MMI devices is very sensitive to changes in the MMF's length, this can be used to detect micro-displacements. By measuring spectral changes we have obtained a sensing range of 3 mm with a sensitivity of 25 nm mm −1 and a resolution of 20 µm. The sensor can also be used to monitor small displacements by using a single wavelength to interrogate the transmission of the MMI device close to the resonance peak. Under this latter regime we were able to obtain a sensitivity of 7000 mV mm −1 and a sensing range of 100 µm, with a resolution up to 1 µm. The simplicity and versatility of the sensor make it very suitable for many diverse applications. (paper)

  19. Continuum treatment of electronic polarization effect.

    Science.gov (United States)

    Tan, Yu-Hong; Luo, Ray

    2007-03-07

    A continuum treatment of electronic polarization has been explored for in molecular mechanics simulations in implicit solvents. The dielectric constant for molecule interior is the only parameter in the continuum polarizable model. A value of 4 is found to yield optimal agreement with high-level ab initio quantum mechanical calculations for the tested molecular systems. Interestingly, its performance is not sensitive to the definition of molecular volume, in which the continuum electronic polarization is defined. In this model, quantum mechanical electrostatic field in different dielectric environments from vacuum, low-dielectric organic solvent, and water can be used simultaneously in atomic charge fitting to achieve consistent treatment of electrostatic interactions. The tests show that a single set of atomic charges can be used consistently in different dielectric environments and different molecular conformations, and the atomic charges transfer well from training monomers to tested dimers. The preliminary study gives us the hope of developing a continuum polarizable force field for more consistent simulations of proteins and nucleic acids in implicit solvents.

  20. Continuum treatment of electronic polarization effect

    Science.gov (United States)

    Tan, Yu-Hong; Luo, Ray

    2007-03-01

    A continuum treatment of electronic polarization has been explored for in molecular mechanics simulations in implicit solvents. The dielectric constant for molecule interior is the only parameter in the continuum polarizable model. A value of 4 is found to yield optimal agreement with high-level ab initio quantum mechanical calculations for the tested molecular systems. Interestingly, its performance is not sensitive to the definition of molecular volume, in which the continuum electronic polarization is defined. In this model, quantum mechanical electrostatic field in different dielectric environments from vacuum, low-dielectric organic solvent, and water can be used simultaneously in atomic charge fitting to achieve consistent treatment of electrostatic interactions. The tests show that a single set of atomic charges can be used consistently in different dielectric environments and different molecular conformations, and the atomic charges transfer well from training monomers to tested dimers. The preliminary study gives us the hope of developing a continuum polarizable force field for more consistent simulations of proteins and nucleic acids in implicit solvents.