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PubMedDate not supplied

Preparing children and families for surgery: Mount Sinai's multidisciplinary perspective.

Upon learning that they must undergo surgery, children experience a range of emotions including fear, anger, guilt, and sadness. It has been demonstrated that children who are prepared for surgery and who have support throughout their hospitalization recover more quickly and have fewer emotional problems, such as separation anxiety and sleep disturbances, than those who are not prepared. Pre-surgical preparation programs allow children and their families the opportunity to preview the hospital experience in a supportive environment to reduce anxiety, increase knowledge, and enhance coping. Meet Me at Mount Sinai (MMAMS) is an innovative preoperative preparation program for children and their families that seeks to provide comprehensive emotional and cognitive preparation for surgery. MMAMS is led by a multi-disciplinary team of health care providers including a pediatric surgery nurse practitioner, a registered nurse, a social worker, and a child life specialist. The program utilizes a culturally-sensitive, multimodality preparation model to prepare children and families for the surgical experience.

Adaptation, Psychological↗

PubMed2026

Challenges and future directions in AI-driven biomaterials for microbiome-associated oral infectious diseases: A systematic review.

Oral biofilm-induced antimicrobial resistance is the core pathogenic mechanism of microbiome-associated oral infectious diseases (dental caries, periodontitis, peri-implantitis, and endodontic infection). Traditional therapies and biomaterials are limited by poor biofilm penetration, drug resistance induction, single functionality, and inadequate adaptation to dynamic oral microenvironmental changes (e.g., pH fluctuations, salivary rinsing, masticatory stimulation). Artificial intelligence (AI) has transformed the field by integrating materials science, microbiology, and stomatology data. Via machine learning, deep learning, and multi-physics simulation, AI optimizes biomaterial physicochemical properties, decodes microenvironmental signals, constructs precise sensing-response loops, and supports the full chain of material design, performance prediction, and action simulation, advancing treatment from empirical intervention to precision regulation. This systematic review retrieved literature from PubMed, Embase, and Web of Science (January 2016-January 2026) using keywords across three dimensions: AI, biomaterials, and oral microbiome. Following inclusion/exclusion criteria, 99 articles were included. It elaborates on five core mechanisms of AI-driven oral biomaterials (precise oral microbiome analysis, targeted material design/optimization, performance prediction/simulation, targeted delivery/intervention, effect evaluation/dynamic regulation), analyzes their applications in microbiome-targeted biomaterial research and development (R&D) and clinical practice for the four major oral infectious diseases, addresses technical bottlenecks (insufficient targeting specificity and precision of biomaterials, poor stability and durability in complex oral microenvironments, inadequate biofilm disruption capacity, and clinical translation obstacles), and proposes future directions (multimodal design to enhance targeting specificity, structural and component optimization to improve stability/durability, development of multi-mechanism synergistic biofilm disruption strategies, strengthening translational research for clinical application, and deep integration of AI in the full chain of biomaterial R&D). This work provides comprehensive theoretical and practical support for the R&D, optimization, and clinical translation of AI-driven microbiome-targeted oral biomaterials.

Humans↗

PubMed2003

Assessing clinical competence in physical medicine & rehabilitation residency programs.

OBJECTIVE: Evaluation of resident clinical competence is a complex task. A multimodal approach is necessary to capture all of the dimensions of competence. Recent guidelines from the Accreditation Council for Graduate Medical Education delineate six general competencies that physicians should posses. Application of these guidelines presents challenges to residency program directors in defining educational experiences and evaluation methods. DESIGN: We surveyed 81 physical medicine and rehabilitation program directors regarding assessment tools used in their programs. Seventy-five percent responded. The most frequently used assessment tools included: In-training self-assessment examinations, faculty evaluations, direct observation, and conference participation. Program directors assigned the highest values to direct observation, faculty evaluations, self-assessment examinations, and oral examinations. RESULTS: Of the general competencies, more than 90% of program directors believed they did an adequate job rating dimensions of patient care, medical knowledge, professionalism, and communication skills. Approximately one-third, however, thought they did a less than fair job rating practice-based learning and improvement and systems-based practice. The majority of programs reported that they were able to identify a resident with difficulties during the first year of training, 44% within the first 6 months. Program directors reported that their residents spend a significant amount of their time with nurses and therapists during their inpatient rotations; however, this was not reflected in their evaluation practices, in which only one-fourth of programs reported the use of nurses and therapists in evaluating residents. CONCLUSIONS: Survey results indicate that physical medicine and rehabilitation program directors apply a variety of assessment tools in evaluating resident clinical competence. Although perceptions about the relative value of these tools vary, most programs report a high value to direct observation of residents by faculty. Of the six general competencies, program directors struggle the most with their evaluation of practice-based learning and improvement and systems-based practice.

Clinical Competence↗

PubMed2026

Toward a Better Paradigm for Head and Neck Cancer Treatment Applying AI (HNC-TACTIC): Protocol for an International Cohort Study of Electronic Health Records.

BACKGROUND: Head and neck squamous cell carcinomas (HNSCCs) cause considerable morbidity and mortality. Multimodal treatment strategies can cause significant toxicity, and therapy options are limited for recurrent disease. Immunotherapy has emerged as a promising approach. However, patient response variability underscores the need for better predictive markers. OBJECTIVE: This study aims to use artificial intelligence to develop two predictive models in patients with HNSCC to assess (1) progression or recurrence following primary curative treatment and (2) long-term survival after immunotherapy schemes in recurrent and metastatic disease. This study will also describe the characteristics of patients with early, locally advanced, and recurrent or metastatic cancers. METHODS: This is a retrospective, observational study of data captured in electronic health records (EHRs) from participating hospitals between January 1, 2014, and December 31, 2021. This study's population comprises adults diagnosed with HNSCC at any stage. Study variables, including demographics, comorbidities, clinical variables, treatments, and outcomes, will be extracted using EHRead, a technology that applies natural language processing and machine learning to extract and analyze structured and unstructured clinical information in deidentified EHRs. Predictive models based on dynamic risk stratification for treatment response and progression or recurrence will be developed using multivariable logistic regressions, decision tree classifiers, and random forest approaches. Descriptive and outcome analyses will be shown for different anatomic subsites and stratified by stage and treatment. RESULTS: This study began enrolling sites in July 2021 and is currently ongoing. By December 2025, data from 10 centers has been collected, comprising a total of 151,934,990 EHRs from 2,159,719 patients. CONCLUSIONS: Development of predictive models using artificial intelligence will advance clinical understanding of HNSCC to improve patient outcomes.

Humans↗

PubMed1997

Morphology and sensory modality of mushroom body extrinsic neurons in the brain of the cockroach, Periplaneta americana.

Mushroom bodies are paired centers in insect brains that are thought to be crucial in olfactory learning and memory. Early neuroanatomical descriptions suggested that the mushroom bodies comprise rather simple arrangements of nerve cells. Intrinsic neurons within each mushroom body were believed to receive olfactory afferents and to supply long, branched axons to extrinsic neurons that lead from the mushroom body into the protocerebrum. More recent suggestions that the mushroom bodies integrate several sensory modalities find support from intracellular and extracellular recordings of extrinsic neurons in the brains of crickets, honey bees, and cockroaches. Here, we describe two major classes of extrinsic neurons, simple and complex cells, in the mushroom bodies of the cockroach Periplaneta americana. Each class is defined by its pattern of branching in the brain. Simple neurons correspond to extrinsic neurons described from other species that have one set of dendrites only within the mushroom bodies. Complex extrinsic neurons possess dendrite-like branches within and outside the mushroom bodies. This arrangement may account in part for their observed multimodality, as might newly identified afferent neurons that terminate in the mushroom body lobes among the dendrites of extrinsic neurons and that respond to multimodal stimuli. Organizational complexity within the mushroom bodies is suggested by the grouping of intrinsic cell axons into discrete laminae. These are intersected by the block-like arrangements of dendritic fields of extrinsic neurons in a manner reminiscent of Purkinje cell dendrites intersecting parallel fibers in the cerebellum. The present results demonstrate that the cockroach mushroom body processes multimodal sensory information and that its neural arrangements contribute to a precise architecture consisting of discrete longitudinal and transverse subdivisions.

Animals↗

PubMed1996

Management of chronic pain. Part II.

Chronic pain is associated with substantial psychosocial and economic stress coupled with functional loss and various levels of vocational dysfunction. The role of a pain center is to focus on chronic pain in a multidisciplinary, comprehensive manner, providing the patient with the most effective opportunity to manage his or her chronic disease syndrome. This article focuses on methods to manage many types of chronic pain and describes a broad range of pharmacologic and non-pharmacologic interventions and options available to the patient. Part I of this two-part monograph described pharmacotherapeutic interventions and regional nerve blocks. Part II focuses on psychologic assessment and treatment and physical therapy. A multimodal management strategy offers patients the greatest improvement potential for specific chronic pain syndromes. Cognitive and behavioral therapies and physical therapies are described. This combination of therapies may provide patients with the skills and knowledge needed to increase their sense of control over pain. The integration of appropriate pharmacotherapeutic regimens, neural blockades, physical therapy, and psychologic techniques maximizes the patient's effectiveness in dealing with chronic pain. Three case studies are presented in Part II.

Adaptation, Psychological↗

PubMedDate not supplied

Spatio-temporal pattern discrimination in cats with insular-temporal lesions.

Previous studies have demonstrated that cats with bilateral insular-temporal lesions are impaired in their ability to perform temporal pattern discriminations of the general form A--B--A vs B--A--B. This deficit has been seen to occur when A and B are made up of two different auditory, visual, or vibrotractile stimuli. These data suggest that insular-temporal cortex is a multimodal area concerned with the perception of temporal sequences of stimuli. The present study extends these earlier observations by testing insular-temporal lesioned cats on a spatio-temporal pattern discrimination. A spatio-temporal pattern is defined as one in which the same stimulus is presented to the animal sequentially from different spatial locations. The data indicate that insular-temporal lesions disrupt a spatio-temporal pattern discrimination just as they do auditory, visual, or vibrotactile temporal pattern discriminations. Insular-temporal cortex appears to be critical for certain higher order perceptual abilities in the cat.

Animals↗

PubMed2000

Human sensitivity to acoustic information from vessel filling.

A cylindrical vessel's fundamental resonant frequency increases as it fills with water. In Experiment 1, observers reliably identified water level rising, falling, or not changing. In Experiment 2, observers controlled filling well using only auditory information but less well than with multimodal information. Observers controlled fills to the brim better than to a drinking level, implying anticipation of fullness. In Experiment 3, blind and blindfolded sighted observers filled vessels to the brim using only auditory information. Fills tracked vessel height and flow rate well (R = .93, blind; R = .86, sighted). Experiment 4 tested sensitivity to acoustic time-to-full (TTF), analogous to optical tau. Estimated TTF to 3 fill levels at 3 rates tracked actual TTF (group R > .9; individual median R = .82). Results supported ecological perceptual theory: Changing acoustic information affords adaptive, prospective control of vessel filling.

Adult↗

PubMed2006

Net influx of plasma 6-[18F]fluoro-L-DOPA (FDOPA) to the ventral striatum correlates with prefrontal processing of affective stimuli.

Dopaminergic neurotransmission in the ventral and dorsal striatum interact with central processing of rewarding and reward-indicating stimuli, and may affect frontocortical-striatal-thalamic circuits regulating goal-directed behaviour. Thirteen healthy male volunteers were investigated with multimodal imaging, using the radioligand 6-[(18)F]fluoro-l-DOPA (FDOPA) for positron emission tomography (PET) measurements of dopamine synthesis capacity, and also functional magnetic resonance imaging (fMRI) in a cognitive activation paradigm. We calculated the correlation between FDOPA net blood-brain influx (; ml/g/min) in the ventral and associative dorsal striatum and BOLD signal changes elicited by standardized affectively positive, negative and neutral visual stimuli. The magnitude of in the ventral striatum was positively correlated with BOLD signal increases in the left anterior cingulate cortex and right insular operculum elicited by positive vs. neutral stimuli, but not negative vs. neutral stimuli. In the dorsal striatum, the magnitude of was positively correlated with processing of positive and negative stimuli in the left dorsolateral prefrontal cortex. These findings suggest that dopamine synthesis capacity in the ventral striatum correlates with the attentional processing of rewarding positive stimuli in the anterior cingulate cortex of healthy subjects. Dopaminergic neurotransmission in the associative dorsal striatum has been associated previously with habit learning. The observed correlation between dopamine synthesis capacity in the dorsal striatum and BOLD signal changes in the dorsolateral prefrontal cortex suggests dopaminergic modulation of processing of emotional stimuli in brain areas associated with motor planning and executive behaviour control.

Adult↗

PubMed2000

[Memory advantage of performed actions: comments on multimodal memory theory].

Based on the integration of the memory advantage for subject-performed actions into the multimodal theory of episodic memory by J. Engelkamp (1997), three issues referring to the so-called enactment effect are discussed and addressed by statistical r-analyses. Firstly, the empirical basis of the functional distinction between motor and non-motor memory resources by means of dual-task experiments is questioned. Secondly, a multinomial modeling analysis is presented which aims at the contributions of automatic and controlled memory processes to the enactment effect in the process-dissociation paradigm. Finally, the effect of enactment on memory for serial order information is discussed with respect to recent accounts of serial memory.

Attention↗

PubMed2004

Sensory re-education after nerve repair: aspects of timing.

The recovery of functional sensibility after nerve transection and repair is often disappointing. Here we address the timing of sensory re-education that aims at re-learning and modulating the changed sensory code from the hand after such an injury. Such training utilises the capacity for cortical functional re-modelling which characterises the young as well as the adult brain. Sensory re-education is traditionally not introduced until there is reinnervation in the hand, and such a late onset of training may be one explanatory factor for the poor functional results after nerve repair. Since functional reorganisation changes of the cortex occurring after changes in peripheral input are very fast processes, we suggest that this specific intervention should be introduced very early in the rehabilitation phase--already in the initial phase after nerve repair when no axons have yet arrived to the asensible hand. The goal is to avoid, minimise and modulate the central functional re-organisation which follows the de-afferentiation associated with nerve injury and repair. This early intervention can be done with the use of artificial sensibility the first post-operative day. According to this technique, based on sense substitution and utilising the multimodal capacity of the brain, miniature microphones on the fingertips of the asensible hand pick up the friction sound generated by active touch. The vibro-tactile signals are stereophonically transposed to vibro-acoustic signals, thereby providing an alternate feed-back which hypothetically helps to maintain or re-establish the cortical hand map.

Acoustic Stimulation↗

PubMed2006

The ethanol self-administration context as a reinstatement cue: acute effects of naltrexone.

A major difficulty in treating alcohol addiction is the high rate of relapse even after prolonged abstinence. Relapse can be triggered by several factors, including stress, re-exposure to the drug, conditioned discrete stimuli and exposure to the context in which alcohol consumption occurred. The present study investigated the role played by the environmental context on ethanol relapse using an extinction/reinstatement animal model: rats were trained to self-administer ethanol in a distinctive context, and extinction occurred in a setting that differed by visual, tactile and olfactory properties; reinstatement was tested by placing the animals into the ethanol-associated context in the absence of ethanol. We found that re-exposure to the ethanol-associated context significantly increased responses on the ethanol-paired lever. The increase in responding required the presence of the complete configuration of the multimodal context. The non-selective opioid receptor antagonist naltrexone (0.3 mg/kg) administered 20 min prior to the reinstatement test significantly attenuated context-induced reinstatement of lever press responding, compared with saline-treated subjects. These data indicate that the environmental context associated with ethanol availability influences ethanol-seeking behavior in the rat, and that endogenous opioids are involved in this process. Our findings are in accordance with clinical reports demonstrating naltrexone efficacy in the treatment of alcohol relapse in humans, and indicate that the context-induced reinstatement model described here may be useful to investigate the biological mechanisms underlying alcohol relapse.

Alcohol Drinking↗

PubMed2006

Assessing the predictive validity and efficacy of a multimodal training programme for laparoscopic radical prostatectomy (LRP).

OBJECTIVES: To assess the predictive validity (ability to correlate to real-life environment) and efficacy of a training programme for laparoscopic radical prostatectomy (LRP), based on a structured and progressive pelvitrainer component with hands-on clinical training in the operating room (OR). METHODS: Prospective data on 500 LRP cases were analysed with 80 excluded due to incomplete records. The operation was divided into multiple steps. Times for these steps were compared among 11 surgeons with different laparoscopic expertise (first-, second-, and third-generation surgeons in order of decreasing experience) and correlated to times for specific exercises on the pelvitrainer that simulated particular steps. Perioperative parameters were also evaluated among the three groups. RESULTS: Pelvitrainer times achieved by trainees (third-generation surgeons) did not differ significantly with times for corresponding steps of LRP. There was also no significant difference for total OR time between the second- and third-generation surgeons (205 and 207 min, respectively; p>0.05) although the time for the first-generation surgeons was faster than both (176 min). Short-term quality indicators for first, second, and third generations included transfusion rates (2.3%, 2.4%, and 2.6%, respectively), positive margin rates (20.3%, 21.5%, and 23.0%) and complications, which did not differ significantly among the generations although the first-generation surgeons had the lowest rates. CONCLUSIONS: A carefully designed training programme that incorporates both pelvitrainer and mentor-based operative training is essential for the effective and safe transfer of skills and knowledge required to learn LRP.

Adult↗

PubMed2000

Teaching young children about HIV and AIDS.

AIDS education initiatives need to begin early, within the elementary grades, to be effective. We should no longer underestimate the capacity of young children to understand and benefit from this instruction. In addition, we should not overestimate the impact of brief interventions, and should plan for continued AIDS prevention instruction throughout the school years, involving sequential, developmentally appropriate curricula that respond to the preadolescent's and adolescent's changing cognitive capabilities, social skills, and expanding exposure to sexual experiences. We should require that new approaches and methodologies for AIDS prevention education be developed and evaluated rigorously for efficacy with the same fervor required for the development and evaluation of new drugs to combat this illness on the biologic front. New modalities and approaches should be integrated with those that have already been shown to be effective, creating multimodal and comprehensive educational initiatives comparable to the multidrug treatment regimens. We should be skeptical of those who are satisfied with the implementation of one interesting and simplistic slogan for health promotion efforts for children (e.g., "Just say no"). Even if such efforts were effective in the short term, sole reliance on this approach is likely to result in the development of resistance. As the field of AIDS prevention looks for novel approaches and theoretic constructs, it should borrow ideas from other fields of study and foster interdisciplinary collaborations with professionals from complementary fields. In this manner, educational interventions can move beyond the individual context to begin to address the social influences on sexual behaviors. Sexual behavior is interpersonal and occurs in a social context. Programs must therefore address peer and social pressures to engage in sexual activity. Although attempts are being made to address the social network of children through such efforts as peer education, we cannot ignore the broader social context (e.g., poverty) within which these behaviors occur. For example, efforts to promote increased condom usage will be ineffective until we learn more about why significant numbers of adolescents practice unprotected sex. We are unlikely to affect behavioral change unless we understand fully the motivation for such behavior. We must also recognize that children are more than what they do and study outcomes other than behavior. There is a need for further research on the development of attitudes, fears, stigma, and coping in children, as well as means of promoting the development of healthy sexual relationships.

Acquired Immunodeficiency Syndrome↗

PubMed2004

The Lowbury lecture: behaviour in infection control.

The majority of healthcare-associated infections result from cross-transmission related to inappropriate patient-care practices. Improving practices frequently implies modifying healthcare workers' behaviour, a key challenge of today's infection control. To improve healthcare workers' compliance with practices, infection control should learn from the behavioural sciences. Social cognitive models can help to improve our understanding of human behaviour. Cognitive determinants that shape behaviour are acquired through the socialization process and are susceptible to change. Some models have been applied to evaluate predictors of health behaviour but, so far, none have been successfully applied to explain behaviour in the field of infection control. Successful strategies to improve infection control practices result from their multidimensional aspect. Similarly, social models that include several levels of cognitive determinants have more chance of success to explain change in behaviour. Concrete examples applied to infection control issues are presented, including special references to hand hygiene behaviour. The theory of ecological perspective, based on the idea that behaviour is viewed as being affected by and affecting multiple levels of influence, and that it both influences and is influenced by the social environment, seems promising to explain behaviour modification. Studies are needed to assess the key determinants of infection control practices and behaviour promotion among the different populations of healthcare workers, and to implement and evaluate the impact of the different components of multimodal programmes to promote optimal infection control practices.

Behavior↗

PubMed1991

Randomized trials of induction chemotherapy. A critical review.

There are nine prospective randomized trials comparing induction chemotherapy with standard therapy published in either final form or as preliminary abstract reports. Only one of the six randomized trials critiqued was designed to account for all known prognostic factors, utilized an effective chemotherapy regimen, and had excellent compliance such that the numbers of patients completing the protocol were adequate to provide a valid statistical interpretation of the data. This was the VA cooperative group trial to preserve the larynx. Although this trial did not show a difference in survival between surgically treated patients and those who received induction chemotherapy, the larynx was preserved in two thirds of patients. The results of the other published trials cannot be considered conclusive owing to the flaws in design and interpretation noted in this review. These trials do confirm the feasibility of administering chemotherapy prior to surgery and RT and do confirm the prognostic importance of various factors suggested by the results of single institution trials. Induction chemotherapy has been tested for almost two decades. During this time we have learned the importance of treating intensively to obtain a high complete response rate. At one primary site, the larynx, it has been shown that 64% of patients can be rendered histologically disease-free after three courses of cisplatin and 5-FU. The results of three randomized trials indicate that induction chemotherapy can change the expected pattern of recurrence by decreasing the rate of distant metastases. This early systemic treatment of micrometastases may also reduce the mutation rate theorized for the development of drug resistance. The goals of future randomized trials should include the use of dose-intensive multidrug regimens to increase complete response rates, improve locoregional control, and decrease distant metastases. Induction chemotherapy trials with cisplatin and 5-FU should explore organ preservation at sites other than the larynx where significant functional impairment results from standard surgical approaches. Randomized trials must be carefully designed and rigorously conducted to ensure that the results and conclusions are valid. New regimens, perhaps incorporating growth factors, need to be identified and tested in this group of patients. Finally, improvement in survival must remain a primary goal of multimodality therapy for advanced head and neck cancer.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1994

Multimodal perception in the control of infant reaching.

Six-month-old infants were presented with sounding objects under 3 conditions of illumination: in full vision, in the dark with target location specified by a glowing and sounding object, and in the dark with location specified by sound alone. Reaching behavior was videotaped with an infrared camera, and hand movement was measured by infrared-emitting diodes on the hand that were tracked by a motion analysis system. No differences were found in reaching behavior for objects in the light and glowing objects in the dark. Reaches for sounding objects in the dark had higher speeds, shorter durations, and more errors compared to the other 2 conditions. These findings indicate that vision of the hand did not appear to affect infants' reaching in this situation, whereas vision of the target did.

Auditory Perception↗

PubMed1991

The role of sensorimotor experience in object recognition. A case of multimodal agnosia.

Object recognition was studied in a 19-yr-old male patient who presented severe multimodal amnesia and agnosia without significant intellectual, linguistic or perceptual deficits. Bilateral temporal lobe lesions involved medial, polar and anterior infero-temporal structures. Although visual recognition was impaired to various extents for all categories of objects, preservation of certain capacities were demonstrated. In particular, the patient was able to determine specifically how to manipulate certain objects, in spite of his incapacity to define their function or their context of utilization. It is argued that object recognition involves different processing modes such that when direct access to representations of an object is impaired, sensorimotor information activated via alternative cortical and subcortical pathways may provide a limited mechanism for recognition.

Adult↗