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PubMed2003

Multimodal spatial representations engaged in human parietal cortex during both saccadic and manual spatial orienting.

BACKGROUND: Recent neuroimaging studies have found that several areas of the human brain, including parietal regions, can respond multimodally. But given single-cell evidence that responses in primate parietal cortex can be motor-related, some of the human multimodal activations might reflect convergent activation of potentially motor-related areas, rather than multimodal representations of space independent of motor factors. Here we crossed sensory stimulation of different modalities (vision or touch, in left or right hemifield) with spatially directed responses to such stimulation by different effector-systems (saccadic or manual). RESULTS: The fMRI results revealed representations of contralateral space in both the posterior part of the superior parietal gyrus and the anterior intraparietal sulcus that activated independently of both sensory modality and motor response. Multimodal saccade-related or manual-related activations were found, by contrast, in different regions of parietal cortex. CONCLUSIONS: Whereas some parietal regions have specific motor functions, others are engaged during the execution of movements to the contralateral hemifield irrespective of both input modality and the type of motor effector.

Adult↗

PubMed1999

Multimodal therapy for squamous carcinoma of the oesophagus.

BACKGROUND: The results of surgical treatment for oesophageal squamous cell cancer have improved over recent decades, but the long-term prognosis for patients with tumours of stage II or higher is still unsatisfactory. While uncontrolled series of adjuvant or neoadjuvant treatment have reported favourable survival rates, the true benefit of multimodal treatment can be determined only by randomized controlled trials. METHODS: The literature was searched for prospective randomized controlled trials (PRCTs) examining the effect of neoadjuvant or adjuvant treatment on the long-term survival of patients with squamous cell cancer of the oesophagus. RESULTS: More than 30 PRCTs studying multimodal treatment concepts aimed at improving the prognosis of squamous cell carcinoma of the oesophagus were identified. These trials have not documented improved survival by adjuvant radiotherapy or chemotherapy. Following neoadjuvant radiotherapy or chemotherapy (or a combination of both), resectability of squamous cell carcinoma is not increased, the postoperative mortality rate appears to be higher and survival is not prolonged. CONCLUSION: Past multimodality protocols have not improved the prognosis of squamous carcinoma of the oesophagus. Careful design and reporting, together with strict control of surgical procedures, should allow more meaningful analysis of future multimodal treatment studies. At present, neoadjuvant or adjuvant treatment cannot be recommended outside such clinical protocols.

Carcinoma, Squamous Cell↗

PubMed2002

The meaning of a multimodal approach for children with ADHD: experiences of service professionals.

BACKGROUND: Attention-Deficit/Hyperactivity Disorder (ADHD) is a childhood mental disorder characterized by inattention, impulsiveness and overactivity. It is also characterized by heterogeneity and ambiguity. Effective intervention is influenced by these two factors. This pervasive disorder impacts various domains of functioning, including academics, peer relations, familial relationships and self-esteem. A confounding factor is the high rate of comorbidity with diagnoses such as learning disabilities, oppositional defiant disorder or conduct disorder. No one intervention has emerged as maximally effective across all symptoms and domains. Consequently, a multimodal approach is regarded as the favoured method of intervention. However, no clear definition of'multimodal' exists. METHOD: This study explored the meaning of multimodal from the perspective of professionals employed in a tertiary care hospital setting in which children with ADHD are assessed and treated. A qualitative design using a phenomenological approach allowed professionals to speak from their practice experiences. RESULTS AND CONCLUSION: Although no clear definition of multimodal emerged, professionals identified issues key to this approach and proposed a model for intervention.

Alberta↗

PubMed1986

The basis of Stroop interference involving the multimodal correlates of auditory pitch.

A pure auditory tone has a range of multimodal qualities that are determined by its pitch. A reaction-time task was used to demonstrate that subjects respond immediately and automatically to these qualities. Subjects were required to press one of two keys depending on which word, from a limited set, appeared on a microcomputer screen. The words were antonyms that represented multimodal stimulus qualities, and they were assigned to alternative responses so that the two words that shared the same response were correlated in the same way with pitch. As an incidental stimulus, either a 50 Hz tone or a 5500 Hz tone accompanied the presentation of each word. Subjects were found to respond more slowly when the multimodal qualities of the tone were incongruent with the qualities represented by the test word. When the stimulus-response mapping rules were changed, however, the Stroop effect did not occur; suggesting that a polarised semantic code of the incidental tone, that embraces its multimodal features, accesses the same semantic register as the equivalent code for the test word itself.

Auditory Perception↗

PubMed2001

Comparative study of the effects of auditory, visual and multimodality displays on drivers' performance in advanced traveller information systems.

A simulator study was conducted to compare 16 younger (mean age 22 years) and 16 older (mean age 68 years) drivers' ratings of workload (time, visual, psychological stress) and performance of navigation and button-pushing (identification of vehicle or road hazards) tasks under both high- and low-load driving conditions when simple or complex advanced traveller information (ATI) was presented visually only, aurally only or by multimodality (visual and auditory) display. For all participants, both the auditory and multimodality displays produced better performance in terms of response times, total number of correct turns and subjective workload ratings than those of using the visual-only display. Participants using the multimodality display also made the fewest errors related to push-button and navigation tasks, and controlled their vehicles properly. The visual display led to less safe driving, apparently because it imposed higher demands on the drivers' attention. An age effect was found in the present study, with younger drivers performing better and reporting less stress than older drivers. Notably, however, use of the multimodality display significantly improved the older drivers' performance in the button-pushing task.

Adult↗

PubMed2003

Can recovery-focused multimodal psychotherapy facilitate symptom and function improvement in people with treatment-resistant psychotic illness? A comparison study.

OBJECTIVE: To assess whether recovery-focused multimodal psychotherapy can facilitate symptom and function improvement in people with treatment-resistant psychotic illness. METHOD: Nine people with treatment-resistant schizophrenia or schizoaffective disorder whose symptoms and level of functioning necessitated inpatient care were engaged in individual multimodal psychotherapy for up to 21 months. In addition to the multimodal therapy they also received standard inpatient care. Twelve people retrospectively matched for diagnosis, age, sex, and chronicity of illness, formed a comparison group. They also received standard inpatient care. The standard inpatient care for both experimental and comparative groups consisted of custodial care, predominantly atypical antipsychotic drug therapy, and ongoing care from a key worker. RESULTS: The treatment group showed clinically significant improvements in the overall Positive and Negative Symptom Scale (PANSS) scores which was significantly better than the changes found in the comparison group (p = 0.037). There was a 43% reduction in positive symptoms, a 30% reduction in negative symptoms, a 27.5% reduction in general psychopathology symptoms and a 30% reduction in overall scores on the PANSS. General behaviour scores on the Rehabilitation Evaluation of Hall and Baker were clinically improved, with a 32% reduction, as were deviant scores, with a 93.3% reduction. The change in the deviant scores was significantly better in the treatment group (p = 0.025). CONCLUSION: Recovery-focused multimodal psychotherapy may facilitate symptom and function improvement in people with treatment-resistant psychotic illness.

Adolescent↗

PubMed1998

Intraarticular morphine in the multimodal analgesic management of postoperative pain after ambulatory anterior cruciate ligament repair.

UNLABELLED: Reconstruction of the anterior cruciate ligament (ACL) is associated with a considerable degree of postoperative pain. Our customary multimodal approach to postoperative analgesia after ambulatory ACL surgery includes perioperative nonsteroidal antiinflammatory drugs, pre- and postincisional intraarticular (I.A.) bupivacaine (B), and postoperative cryotherapy using an external cooling system. This study was designed to determine whether the addition of I.A. morphine (MS) provides improved postoperative analgesia. One hundred patients scheduled for elective ambulatory ACL repair received our standard multimodal therapy. After surgery, patients were randomized to one of four study groups. Group 1 received 30 mL of 0.25% B I.A. Group 2 received 30 mL of normal saline I.A. and 5 mg of MS I.A. Group 3 received 30 mL of 0.25% bupivacaine I.A. and 5 mg of MS I.V.. Group 4 received 30 mL of 0.25% B I.A. and 5 mg of MS I.A. The addition of I.A. B postoperatively provided prolonged analgesia and decreased postoperative pain and analgesic requirements. The addition of MS to I.A. B did not provide additional postoperative analgesia. We conclude that patients undergoing ambulatory ACL repair using our standard multimodal analgesic regimen failed to receive additional postoperative analgesia when MS was added to the I.A. B. IMPLICATIONS: Patients receiving a multimodal analgesic regimen of perioperative nonsteroidal antiinflammatory drugs, intraarticular bupivacaine, and external cooling did not receive any additional analgesia from intraarticular morphine.

Adult↗

PubMed2000

Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy.

Because no completely effective antiemetic exists for the prevention of postoperative nausea and vomiting (PONV), we hypothesize that a multimodal approach to management of PONV may reduce both vomiting and the need for rescue antiemetics in high-risk patients. After IRB approval, women undergoing outpatient laparoscopy were randomized to one of three groups. Group I (n = 60) was managed by using a predefined multimodal clinical care algorithm. Patients undergoing the same surgical procedure who received a standard balanced outpatient anesthetic with ondansetron 4 mg (Group II, n = 42) or placebo (Group III, n = 37) prophylaxis were chosen to establish baseline incidence of nausea and vomiting. None of the Group I patients vomited before discharge, compared with 7% in Group II (P = 0.07) and 22% in Group III (P = 0.0003). However, one patient (2%) in Group I required treatment for symptoms in the postanesthesia care unit, compared with 24% in Group II (P<0.0001) and 41% in Group III (P< 0.0001). Time to discharge-ready was significantly shorter in Group I (128, 118-139 min; mean, 95% confidence interval) versus Group II (162, 145-181 min; P = 0.0015) and Group III (192, 166-222 min; P = 0.0001). Patient satisfaction with control of PONV was not different between Group I and Group II. Return to normal daily activity and overall satisfaction were not different among groups. Multimodal management resulted in a 98% complete response rate and a 0% incidence of vomiting before discharge; however, this improvement did not result in an increased level of patient satisfaction when compared with routine monotherapy prophylaxis. We conclude that both multimodal management and routine monotherapy antiemetic prophylaxis resulted in an increased level of patient satisfaction than symptomatic treatment in this high-risk population.

Adult↗

PubMed2001

Multimodal perioperative management--combining thoracic epidural analgesia, forced mobilization, and oral nutrition--reduces hormonal and metabolic stress and improves convalescence after major urologic surgery.

We sought in this prospective study to use a multimodal approach to reduce stress and improve recovery in patients undergoing major surgery. During an initial study period, 30 patients were randomly allocated to receive general anesthesia (GA; Group 1) or a combination of GA and intraoperative thoracic epidural analgesia (TEA; Group 2) when undergoing radical cystectomy. Parenteral nutrition was provided for 5 days after surgery. During the second period, 15 patients were treated with a multimodal approach (Group 3) consisting of intraoperative GA and TEA, postoperative patient-controlled TEA, early oral nutrition, and enforced mobilization. Data for plasma and urine catecholamines, plasma cortisol, the nitrogen balance, the postoperative inflammatory nutrition index, pain relief, fatigue, sleep, overnight recovery, recovery of bowel function, and mobilization were recorded up to the fifth postoperative day. Plasma concentrations of catecholamines and cortisol were comparable in all patients, but those in Group 3 had lower levels of urinary catecholamine excretion. Protein intake was more effective with parenteral nutrition. Nitrogen balances were less negative, and the postoperative inflammatory nutrition index score increased significantly in the traditional groups but not in Group 3. Multimodally treated patients reported less fatigue and better overnight recovery. Along with improved pain relief, recovery of bowel function, and ambulation, there were no differences in the postoperative complication rates among the three groups. The multimodal approach reduced stress and improved metabolism and recovery after radical cystectomy.

Adult↗

PubMed2006

Multimodal contrast agent for combined computed tomography and magnetic resonance imaging applications.

OBJECTIVE: The objective of this study was to examine the feasibility of a multimodal system to effectively induce and maintain contrast enhancement in both computed tomography (CT) and magnetic resonance (MR) for radiation therapy applications. MATERIALS AND METHODS: The physicochemical characteristics of a liposome-encapsulated iohexol and gadoteridol formulation were assessed in terms of agent loading efficiencies, size and morphology, in vitro stability, and release kinetics. The imaging properties of the liposome formulation were assessed based on T1 and T2 relaxivity measurements and in vitro CT and MR imaging in a phantom. A preliminary imaging-based evaluation of the in vivo stability of this multimodal contrast agent was also performed in a lupine model. RESULTS: The average agent loading levels achieved were 26.5+/-3.8 mg/mL for iodine and 6.6+/- 1.5 mg/mL for gadolinium. These concentrations correspond to approximately 10% of that found in the commercially available preparations of each of these agents. However, this liposome-based formulation is expected to have a smaller volume of distribution and prolonged circulation lifetime in vivo. This multimodal system was found to have high agent retention in vitro, which translated into maintained contrast enhancement (up to 3 days) and stability in vivo. CONCLUSIONS: This study demonstrated the feasibility of engineering a multimodal contrast agent with prolonged contrast enhancement in vivo for use in CT and MR. This contrast agent may serve as a valuable tool for cardiovascular imaging as well as image registration and guidance applications in radiation therapy.

Animals↗

PubMed1998

A system for medical consultation and education using multimodal human/machine communication.

Recent developments in networking and computing have enabled collaborative biomedical engineering research by geographically separated participants. One of the most promising goals is to use these technologies to extend human intellectual capabilities in medical decision making. These emerging technologies are poised to drastically reduce healthcare cost by providing service at remote locations. This also increases diagnosis capacity since information is made available to experts at any location. In this paper, we propose a novel application of a recently developed interactive and distributed system in medical consultation and education. Our approach builds on the notion that interactive and distributive capabilities of the system are crucial for medical consultation and education. The presented application uses a multiuser, collaborative environment with multimodal human/machine communication in the dimensions of sight, sound, and touch. The experimental setup, consisting of two user stations, and the multimodal interfaces, including sight (eye-tracking), sound (automatic speech), and touch (microbeam pen), were tested and evaluated. The system uses a collaborative workspace as a common visualization space. Users communicate with the application through a fusion agent by eye-tracking, speech, and microbeam pen. The audio/video teleconferencing is also included to help the radiologists to communicate with each other simultaneously while they are working on the mammograms. The system used in this study has three software agents: a fusion agent, a conversational agent, and an analytic agent. The fusion agent interprets multimodal commands by integrating the multimodal inputs. The conversational agent answers the user's questions and detects human-related or semantic errors and notifies the user about the results of the image analysis. The analytic agent enhances the digitized images using the wavelet denoising algorithm if requested by the user. To show how well the system performs in practice, we used the system for medical consultation on mammograms. Results also show that the relevant information about the region of interest (ROI) of the mammograms chosen by the users is extracted automatically and used to enhance the mammograms.

Education, Distance↗

PubMed2005

Large-scale evaluation of multimodal biometric authentication using state-of-the-art systems.

We examine the performance of multimodal biometric authentication systems using state-of-the-art Commercial Off-the-Shelf (COTS) fingerprint and face biometric systems on a population approaching 1,000 individuals. The majority of prior studies of multimodal biometrics have been limited to relatively low accuracy non-COTS systems and populations of a few hundred users. Our work is the first to demonstrate that multimodal fingerprint and face biometric systems can achieve significant accuracy gains over either biometric alone, even when using highly accurate COTS systems on a relatively large-scale population. In addition to examining well-known multimodal methods, we introduce new methods of normalization and fusion that further improve the accuracy.

Algorithms↗

PubMed1982

Multimodality treatment of cancer.

Different and effective modalities are available for various cancers. However, early consideration is necessary to allow optimal integration. Failure to do this may compromise the cure potential for some tumours. The differing biology of tumours and the efficacy of various modalities dictates specific approaches for each. The principles of multimodality therapy can be considered together with the biological factors affecting the success and failure of each therapy tupe and this allows a multimodality approach to be based on careful planning. For many tumours, where effective systemic therapy exists, there are good reasons for commencing with a multimodality approach at the onset with adjuvant chemotherapy. Practical considerations dictate that surgeons must play a key role in the care of cancer patients. This in turn requires that they maintain a sound knowledge of multimodality therapy for the cancers that they treat.

Antineoplastic Agents↗

PubMed1997

Multimodal function optimization using minimal representation size clustering and its application to planning multipaths.

A novel genetic algorithm (GA) using minimal representation size cluster (MRSC) analysis is designed and implemented for solving multimodal function optimization problems. The problem of multimodal function optimization is framed within a hypothesize-and-test paradigm using minimal representation size (minimal complexity) for species formation and a GA. A multiple-population GA is developed to identify different species. The number of populations, thus the number of different species, is determined by the minimal representation size criterion. Therefore, the proposed algorithm reveals the unknown structure of the multimodal function when a priori knowledge about the function is unknown. The effectiveness of the algorithm is demonstrated on a number of multimodal test functions. The proposed scheme results in a highly parallel algorithm for finding multiple local minima. In this paper, a path-planning algorithm is also developed based on the MRSC_GA algorithm. The algorithm utilizes MRSC_GA for planning paths for mobile robots, piano-mover problems, and N-link manipulators. The MRSC_GA is used for generating multipaths to provide alternative solutions to the path-planning problem. The generation of alternative solutions is especially important for planning paths in dynamic environments. A novel iterative multiresolution path representation is used as a basis for the GA coding. The effectiveness of the algorithm is demonstrated on a number of two-dimensional path-planning problems.

Algorithms↗

PubMed1993

Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma.

PURPOSE: We studied a multimodality approach using extrapleural pneumonectomy, chemotherapy, and radiotherapy in patients with malignant pleural mesothelioma. PATIENTS AND METHODS: From 1980 to 1992, 52 selected patients, underwent treatment. Median age was 53 years (range, 33 to 69). Initial patient evaluation was performed by a multimodality team. Pathologic diagnosis was reviewed and confirmed before therapy. Patients with no medical contraindication and potentially resectable mesothelioma on computed tomography (CT) (magnetic resonance imaging [MRI] when it became available) received extrapleural pneumonectomy, cyclophosphamide, doxorubicin, and cisplatin (CAP) chemotherapy, and radiotherapy. RESULTS: Perioperative morbidity and mortality rates were 17% and 5.8%, respectively. The overall median survival duration is 16 months (range, 1 month to 8 years). The 32 patients with epithelial histologic variant had 1-, 2-, and 3-year survival rates of 77%, 50%, and 42%, respectively. Patients with mixed and sarcomatous cell disease had 1- and 2-year survival rates of 45% and 7.5%; no patient lived longer than 25 months (P < .01). At resection, positive regional mediastinal lymph nodes were found in 13. Positive lymph nodes were associated with poorer survival than were negative nodes (P < .01). Patients with epithelial variant and negative mediastinal lymph nodes had a survival rate of 45% at 5 years. CONCLUSION: Multimodality therapy including extrapleural pneumonectomy has acceptable morbidity and mortality for selected patients. Prolonged survival occurred in patients with epithelial histologic variant and negative mediastinal lymph nodes. These data provide a rationale for a revised staging system for malignant pleural mesothelioma; furthermore, they permit stratification of patients into groups likely to benefit from aggressive multimodality treatment.

Adult↗

PubMed2003

Analysis of multimode effects in the free-propagation region of a silicon-on-insulator-based arrayed-waveguide grating demultiplexer.

Multimode effects in the free-propagation regions (FPRs) of an arrayed-waveguide grating (AWG) demultiplexer based on silicon-on-insulator are considered. Some undesired multimode effects, such as the increase of the insertion loss and the cross talk, are studied by use of a method of three-dimensional guided-mode propagation analysis. It is found that the multimode effects for the edge channels are more serious than those for the central channel. For an AWG demultiplexer with a small channel number, the multimode effects can be minimized by choosing appropriate FPR parameters such as the length and the thickness of the FPR. The coupling coefficient between the FPR and an arrayed waveguide is sensitive to the thickness of the FPR.

Journal Article↗

PubMed2004

Single-mode Raman fiber laser based on a multimode fiber.

Single-mode operation of a Raman fiber laser based on a multimode fiber has been demonstrated for what is to our knowledge the first time. Single-mode operation was achieved through the beam cleanup effect of stimulated Raman scattering in multimode fibers. The Raman laser, consisting of a 50-microm-core multimode fiber and a multimode Nd:YAG laser pump, produced an output beam corresponding to the fundamental mode of the fiber.

Journal Article↗

PubMed2005

Multimode fiber devices with single-mode performance.

A taper transition can couple light between a multimode fiber and several single-mode fibers. If the number of single-mode fibers matches the number of spatial modes in the multimode fiber, the transition can have low loss in both directions. This enables the high performance of single-mode fiber devices to be attained in multimode fibers. We report an experimental proof of concept by using photonic crystal fiber techniques to make the transitions, demonstrating a multimode fiber filter with the transmission spectrum of a single-mode fiber grating.

Journal Article↗