Multimodal Approach Research Articles

Responsibilization as a return to collectivity? Legitimating the responsibilization of preparedness: the case of the Swedish Civil Contingencies Agency (MSB)

PurposeThis study investigates how communication is used by a Swedish public authority to legitimate the responsibilization of preparedness, i.e. how the state encourages individual citizens to take more responsibility for their security.Design/methodology/approachA multimodal discursive approach drawing on multimodal narrative analysis of video clips and multimodal critical discourse analysis (MCDA) is used to examine how the responsibilization of preparedness is legitimated in video material published on Swedish Civil Contingencies Agency's (MSB’s) YouTube channel.FindingsThe study finds that the responsibilization of preparedness is legitimated through an ongoing but evolving normalization of threat. The findings also show how responsibilization is legitimated in moralizing terms of individual contribution to society, which may indicate a return from neo-liberal values to more traditional Swedish collectivist values.Originality/valueThe study shows how communication around preparedness and responsibilization is discursively constructed and legitimated through multimodal features, while previous research has mainly focused on verbal or written communication.

Tracing the dynamics of motivational self-constructs across the lifespan: Tales from senior learners of English

In the context of an ageing and increasingly more independent learning population, a narrative inquiry into the life stories of motivated and still active senior language users remains a promising yet unexplored area. This case study forms part of a PhD research (Darnault, 2023) on the motivational dynamics of lifelong foreign language learning (FLL) individuals. We recorded the retrospective stories of 3 exceptionally motivated French senior learners of English, aged 65 to 80, from childhood to their current learning experience. Our triangulated and multimodal approach elicited written, oral and visual data. An inductive thematic analysis first highlighted the emergence of motivational peaks, subsequently followed by the examination of clusters of self-constructs within participants’ individual time frames in light of the L2 Motivational Self System (L2MSS) framework. Results showed that upon retirement all three learners integrated language learning into their daily routine, incorporating it as an integral part of their identity and broader sense of self outside L2 domain-specific motivational constructs. A particularly unyielding hybrid L2 self emerged in later years, drawing from the combination of ought-to, ideal and anti-ought-to selves that prevailed with different degrees of intensity and interaction according to life periods.

Targeting GProtein-Coupled Receptors in Immuno-Oncological Therapies.

The advent of cancer immunotherapy based on PD-1 and CTLA-4 immune checkpoint blockade (ICB) has revolutionized cancer treatment. However, many cancers do not respond to ICB, highlighting the urgent need for additional approaches to achieve durable cancer remission. The large family of G protein-coupled receptors (GPCRs) is the target of more than 30% of all approved drugs, but GPCRs have been underexploited in cancer immunotherapy. In this review, we discuss the central role of GPCRs in immune cell migration and function and describe how single-cell transcriptomic studies are illuminating the complexity of the human tumor immune GPCRome. These receptors include multiple GPCRs expressed in CD8 Tcells that are activated by inflammatory mediators, protons, neurotransmitters, and metabolites that accumulate in the tumor microenvironment, thereby promoting Tcell dysfunction. We also discuss new opportunities to target GPCRs as a multimodal approach to enhance the response to ICB for a myriad of human malignancies.

Methods for Teaching Health Equity and Diversity, Equity Inclusion, and Accessibility to Public Health Practitioners: A Semisystematic Review of the Literature.

Training developers and educators play a crucial role in building strategic skills among the public health workforce. They prepare the workforce to respond to and address emerging concerns and priorities, including on the topics of health equity and diversity, equity, inclusion, and accessibility (DEIA). The purpose of this semisystematic literature review was to identify current evidence-based methods that training developers and educators can apply when teaching DEIA and health equity principles to public health practitioners from various disciplines in the workforce. We conducted a semisystematic literature review because this methodology's purpose is to extract rich, in-depth descriptions that matched the aim to find evidence-based teaching methods to apply. Six methods that hold promise for effective teaching health equity and DEIA principles emerged as themes: Critical Reflection, Service Learning, Case Studies, Peer-Learning/Dialogue, Workshops, and Simulation Learning. Considerations for best practice identified in this literature review include using multimodal approach to support different learning styles among diverse audiences, tailoring content based on training needs analysis recommendations, and considering onus placed on instructors and learners depending on the content and setting.

MRI and active surveillance: thoughts from across the pond.

In the United States (US), urological guidelines recommend active surveillance (AS) for patients with low-risk prostate cancer (PCa) and endorse it as an option for those with favorable intermediate-risk PCa with a > 10-year life expectancy. Multiparametric magnetic resonance imaging (mpMRI) is being increasingly used in the screening, monitoring, and staging of PCa and involves the combination of T2-weighted, diffusion-weighted, and dynamic contrast-enhanced T1-weighted imaging. The American Urological Association (AUA) guidelines provide recommendations about the use of mpMRI in the confirmatory setting for AS patients but do not discuss the timing of follow-up mpMRI in AS. The National Comprehensive Cancer Network (NCCN) discourages using it more frequently than every 12 months. Finally, guidelines state that mpMRI can be used to augment risk stratification but should not replace periodic surveillance biopsy. In this review, we discuss the current literature regarding the use of mpMRI for patients with AS, with a particular focus on the approach in the US. Although AS shows a benefit to the addition of mpMRI to diagnostic, confirmatory, and follow-up biopsy, there is no strong evidence to suggest that mpMRI can safely replace biopsy for most patients and thus it must be incorporated into a multimodal approach. CLINICAL RELEVANCE STATEMENT: According to the US guidelines, regular follow-ups are important for men with prostate cancer on active surveillance, and prostate MRI is a valuable tool that should be utilized, in combination with PSA kinetics and biopsies, for monitoring prostate cancer. KEY POINTS: According to the US guidelines, the addition of MRI improves the detection of clinically significant prostate cancer. Timing interval imaging of patients on active surveillance remains unclear and has not been specifically addressed. MRI should trigger further work-ups, but not replace periodic follow-up biopsies, in men on active surveillance.

Liposomal Bupivacaine in Managing Postoperative Pain Following Shoulder Surgery

To optimize postoperative analgesia following shoulder surgery, current literature recommends multimodal approaches, including the use of regional liposomal bupivacaine (LB), a long-acting local anesthetic. The liposomal formulation of bupivacaine affords it a longer duration of action without a substantial peak plasma concentration; this combined with 3% free bupivacaine provides patients with substantial, prolonged postoperative analgesia following shoulder surgery. The use of LB as part of a multimodal approach to postoperative pain results in diminished use of opioids, reduced pain, and decreased length of hospitalization. Current literature supports these effects following a wide variety of shoulder procedures; however, some studies describe no benefit and list drawbacks including higher costs when electing to use LB instead of comparable, more affordable treatment modalities. In the interest of reducing the number of opioid prescriptions following orthopedic procedures, it is imperative to continue investigating the efficacy of LB as an opioid-sparing pain reducer. Recent literature suggests certain patient populations may be less suitable for implementing this treatment modality; namely those with a history of opioid use, prior surgeries, substantial systemic illness, and existing cardiopulmonary compromise. Patient demographics may be an additional consideration when determining the potential utility of LB to optimize analgesia after shoulder surgery.

Exploring Chroman‐4‐One Derivatives as MAO‐B Inhibitors: A Comprehensive Computational Study

AbstractThe enzyme monoamine oxidase‐B (MAO‐B) significantly affects the neurotransmitter's metabolism, including norepinephrine, dopamine, and serotonin. Alzheimer's disease is the result of the dysregulation of MAO‐B activity, which is also attached to another neurological disorder, that is, Parkinson's disease. The MAO‐B antagonists are now seen as potential therapeutics for these conditions. A promising approach for improving the effectiveness of novel MAO inhibitors is using chromanone scaffolds. In this work, we used a multimodal computational approach to assess the inhibitory effects of chroman‐4‐one derivatives on MAO‐B. The study utilized molecular docking methodologies to investigate and evaluate the intricate binding interactions between MAO‐B and chroman‐4‐one derivatives. Moreover, the ADME study provided insightful information about the pharmacokinetic characteristics of chroman‐4‐one derivatives. The analysis of the temporal stability and dynamic behavior of ligand‐protein interactions has benefited from the application of MD simulations. To determine the binding free energies and gain a deeper comprehension of the binding affinity between chroman‐4‐one derivatives and MAO‐B, MM‐PBSA calculations were also performed. This study offers valuable information about logical design and the optimization of MAO‐B antagonists and highlights the potential of computational techniques in speeding up the drug discovery process.

CANival: A multimodal approach to intrusion detection on the vehicle CAN bus

Vehicles of today are composed of over 100 electronic embedded devices known as Electronic Control Units (ECU), each of which controls a different component of the vehicle and communicates via the Controller Area Network (CAN) bus. However, unlike other network protocols, the CAN bus communication protocol lacks security features, which is a growing concern as more vehicles become connected to the Internet. To enable the detection of intrusions on the CAN bus, numerous intrusion detection systems (IDS) have been proposed. Although some are able to achieve high accuracy in detecting specific attacks, no IDS has been able to accurately detect all types of attacks against the CAN bus. To overcome the aforementioned issues, we propose a multimodal analysis framework named CANival, which consists of time interval-based and signal-based analyzers developed by designing a novel Time Interval Likelihood (TIL) model and optimizing an existing model CANet. Experimental results show that our multimodal IDS outperforms the base models and enhances the detection performance testing on two recent datasets, X-CANIDS Dataset and SynCAN, achieving average true positive rates of 0.960 and 0.912, and true negative rates of 0.997 and 0.996, respectively.

Supplemental Material for Validation of a Procrastination Scale: A Multimethod–Multimodal Approach

Supplemental Material for Validation of a Procrastination Scale: A Multimethod–Multimodal Approach

Unveiling hybrid culinary cultures in Macao: a corpus-assisted multimodal approach to the translation of Macanese cuisine

ABSTRACT This study investigates the special foodscape and hybrid culinary cultures in Macao through the translation of Macanese cuisine. It employs a corpus-assisted multimodal approach, with the concept of intersemiotic translation and multimodal theories as the theoretical basis for analysis and discussion. The data under investigation is a self-built multimodal database of Macanese cuisine translations. The study first examines the ingredients and cooking methods in Macanese cuisine dish names and then delves into the translation strategies and methods used in the translations across Portuguese, English and Chinese. Multimodal analysis is also conducted to explore the intersemiotic translation between the verbal and visual materials of Macanese cuisine. The research results show that hybrid culinary features are represented in the ingredients, cooking methods and translations of Macanese cuisine, constituting an inclusive, integrated and diversified foodscape in Macao. Moreover, the intersemiotic translation between the verbal and the visual could highlight particular ingredients and cooking methods, showcase the enticing appearance of the dishes, and convey the hybrid culinary cultures in Macanese cuisine. This study holds the potential to enrich research on food translation from a multimodal perspective, while also contributing to the translation and cultural transmission of Macanese cuisine and culinary cultures in Macao.

Exploring the Relationship between Cortical Thickness and Cognitive Abilities: A Multi-Modal Imaging Approach

Background: Cortical thickness has been associated with cognitive abilities in prior research, but the specific relationships remain unclear. Objectives: This study aimed to further examine associations between cortical thickness in various brain regions and performance on tests of intelligence and executive function. Methods: Structural MRI scans were obtained from 65 healthy adults aged 18-35. Cortical thickness was estimated across the cortex using Free Surfer software. Participants completed standard tests measuring IQ, working memory, cognitive flexibility, and inhibitory control. Correlation and regression analyses were used to relate regional cortical thickness to cognitive scores. Results: This study showed cortical thickness in prefrontal regions positively correlated with IQ, working memory, and cognitive flexibility. No significant associations were found between cortical thickness and response inhibition. Conclusions: The findings provide evidence for links between PFC thickness and higher cognitive abilities. A multi-modal neuroimaging approach combining structural MRI and cognitive testing is useful for elucidating brain-behavior relationships. Further research with larger samples is needed to fully characterize these associations.

Continuing professional development for primary care physicians: a pre-post study on lung point-of-care ultrasound curriculum

BackgroundPoint-of-care ultrasound is rapidly gaining traction in clinical practice, including primary care. Yet, logistical challenges and geographical isolation hinder skill acquisition. Concurrently, an evidentiary gap exists concerning such guidance's effectiveness and optimal implementation in these settings.MethodsWe developed a lung point-of-care ultrasound (POCUS) curriculum for primary care physicians in a rural, medically underserved region of the south of Israel. The course included recorded lectures, pre-course assessments, hands-on training, post-workshop lectures, and individual practice. To evaluate our course, we measured learning outcomes and physicians’ proficiency in different lung POCUS domains using hands-on technique assessment and gathered feedback on the course with a multi-modal perception approach: an original written pre- and post-perception and usage questionnaire.ResultsFifty primary care physicians (PCPs) showed significant improvement in hands-on skills, increasing from 6 to 76% proficiency (p < 0.001), and in identifying normal versus abnormal views, improving from 54 to 74% accuracy (p < 0.001). Ten weeks after training, primary care physicians reported greater comfort using lung ultrasound, rising from 10 to 54% (p < 0.001), and improved grasp of its potential and limits, increasing from 27.5% to 84% (p < 0.001). Weekly usage increased from none to 50%, and the number of primary care physicians not using at all decreased from 72 to 26% (p < 0.001).ConclusionsA two-day focused in-person and remote self-learning lung-POCUS training significantly improved primary care physicians' lung ultrasound skills, comfort, and implementation.

The Pathomechanism and Current Treatments for Chronic Interstitial Cystitis and Bladder Pain Syndrome.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic and debilitating condition characterized by symptoms such as bladder pain, frequent urination, and nocturia. Pain is typically perceived in the lower abdomen, pelvic floor, or urethra, causing significant discomfort and impacting quality of life. Due to the similarity of its symptoms with those of overactive bladder and acute bacterial cystitis, patients often face misdiagnosis and delayed appropriate treatment. Hunner's (HIC) and non-Hunner's IC (NHIC), each with distinct clinical presentations, urothelial dysfunction, chronic inflammation, and central sensitization and thus multimodal symptomatic treatment approaches, may be the most common pathogeneses of IC/BPS. Treatment of IC/BPS should involve identifying the different clinical phenotypes and underlying pathophysiology causing clinical symptoms and developing strategies tailored to the patient's needs. This review discusses the roles of urine biomarkers, bladder inflammation, and glycosaminoglycans in the pathogenesis of IC/BPS. Various bladder treatment modalities are explored, including glycosaminoglycan replenishment, botulinum toxin A injection, platelet-rich plasma injection, low-energy shock waves, immunosuppression, and low-dose oral prednisolone. Pelvic floor muscle physiotherapy and bladder therapy combined with psychiatric consultation can help alleviate psychological stress and enhance the quality of life of patients with IC/BPS. Elucidating the pathological mechanisms and exploring diverse treatment options would help advance the care of individuals suffering from this challenging bladder condition.

Multimodal Analgesia Approach in Acute Low Back Pain Management: A Phase III Study of a Novel Analgesic Combination of Etoricoxib/Tramadol.

Pain and disability management are crucial for a speedy recovery. Combining analgesics with different mechanisms of action provides greater pain relief with lower doses, promoting efficient multimodal analgesia. This study evaluated the efficacy and safety between two fixed-dose combinations (FDC): etoricoxib/tramadol compared to paracetamol/tramadol for the management of acute low back pain (LBP) in a 7-day treatment. We conducted a phase IIIb, prospective, randomized, and multicenter study in patients with acute LBP treated with etoricoxib 90mg/tramadol 50mg (one packet of granules diluted in 100ml of water, once a day [QD], for 7 days) or paracetamol 975mg/tramadol 112.5mg (one tablet of 325mg/37.5mg, three times a day [TID], for 7 days) to assess the efficacy (in terms of pain and disability improvement) and safety. One hundred and twenty-four patients were randomized to receive either etoricoxib/tramadol QD (n = 61) or paracetamol/tramadol TID (n = 63). From the magnitude of change in pain evaluations, differences were observed between the treatment groups at 3 [p = 0.054, CI 95% -0.648 (-0.010 to 1.306)] and 5days (p = 0.041). The proportion of patients with a 30% reduction in Visual Analogue Scale (VAS) score was statistically significant when comparing the treatment groups on the third day of follow-up [p = 0.008, CI 95% 0.241 (0.061-0.421)]. An improvement in LBP's disability to perform activities of daily routine (Oswestry and Roland-Morris questionnaires) was observed in both treatment groups. A total of 79 adverse events (AEs) (38 [48.1%] with etoricoxib/tramadol and 41 [51.9%] with paracetamol/tramadol) were reported. The most frequent AEs were nausea (17.7%) and dizziness (16.4%). The results show the clinical benefits of etoricoxib/tramadol FDC, such as the sparing effect of tramadol dose per day, early therapeutic response rate compared with paracetamol/tramadol; which translates into faster pain relief, better adherence, less tramadol drug dependency, and a reduction of related AEs incidence. ClinicalTrials.gov identifier, NCT04968158.

Phenotypic and genotypic evaluation of bleeding diagnostic dilemmas: Two case studies

Inherited platelet disorders (IPDs) are a heterogeneous group of conditions that present significant challenges in diagnosis and management. Here, we report two cases of patients presenting with clinically significant bleeding but with unclear etiologies by conventional clinical laboratory testing. Further evaluation, utilizing a combination of high-dimensional multiplexed mass cytometry and genetic sequencing, revealed the underlying causes of bleeding in both cases, leading to definitive diagnoses. These cases underscore the potential utility of combined multimodal approaches in evaluating patients with bleeding disorders. Moreover, these high-parameter methods can offer substantial mechanistic insights and can enhance our understanding of the molecular pathogenesis of IPDs. Future studies involving larger patient cohorts are needed to further validate this strategy, directly comparing its diagnostic yield and accuracy with current clinical laboratory testing approaches, which can ultimately improve patient care.

Integrating lived experience to develop a tailored sleep intervention for people living with dementia and carepartners.

Sleep disturbances are highly prevalent and have adverse health consequences for both people living with dementia and their carepartners. Despite this, they are under-addressed caregiving settings. This study aimed to explore these sleep disturbances and co-design a multimodal sleep intervention for people living with dementia and their carepartners. We conducted two focus groups and five semi-structured interviews (n = 4 people living with dementia, n = 6 carepartners). Active involvement of community advisors was sought throughout the design, development, and facilitation phases. Reflexive thematic analysis was used to explore sleep-related experiences and receive feedback to shape intervention development. People living with dementia reported disruptions to sleep and circadian rhythms, including sleep disturbances and confusion between day and night. Multiple sleep challenges were encountered by carepartners including insomnia, hypervigilance, and daytime impairment. The proposed sleep intervention was received positively, with significant insights emphasising the need for a multimodal toolkit approach, adaptation of the intervention across different dementia stages, and a focus on tailoring the program to carepartners. Sleep interventions for caregivers and care-recipients should target both sleep and daytime functioning to ensure holistic support. Participants were receptive towards time-friendly, online, multimodal sleep interventions that combine cognitive behaviour therapies, light therapy, mindfulness, and exercise elements.

Effects of Self-Learning and Exploration for XR-based Interactions

This research explores the overtime learning trends of multimodal gaze-based interactions in tasks involving the movement of augmented objects within extended reality (XR) environments. This study employs three interactions, including two multimodal gaze-based approaches, and compares them with an unimodal hand-based interaction. The underlying hypothesis posits that gaze-based interactions outperform other modalities, promising improved performance, lower learnability rates, and enhanced efficiency. These assertions serve as the foundation for investigating the dynamics of self-learning and exploration within XR-based environments. To this end, the study addresses questions related to the temporal evolution of learnability, post-learning efficiency, and users’ subjective preferences regarding these interaction modalities. This research shows that gaze-based interactions enhance performance, exhibit a lower learnability rate, and demonstrate higher efficiency compared to an unimodal hand-based interaction. Our results contribute to the design and refinement of more effective, user-friendly, and adaptive XR user interfaces.

Brain Metastases as Inaugural Sign of Non-Small Cell Lung Carcinoma: Case Series and Review of Literature.

In the era of immune checkpoint inhibitors (ICI), managing non-oncogene driven non-small cell lung cancer (NSCLC) with brain metastases (BM) is challenging, especially when brain involvement is the initial sign. Patients with newly diagnosed brain metastatic NSCLC without epidermal growth factor receptor (EFGR) nor anaplastic lymphoma kinase (ALK) alterations were retrospectively included. Twenty-five patients were analyzed; 15 (60%) had symptomatic BM as the first sign (group 1), while 10 (40%) had BM discovered during complementary examinations (group 2). Fourteen patients (56%) had concomitant extracerebral metastases, primarily in group 2. Eight (32%) had oligometastatic disease, with seven in group 1. Over half received chemotherapy and pembrolizumab as first-line treatment. BM surgical resection occurred in twelve (80%) patients in group 1 and one in group 2. Median cerebral progression-free survival was 10 months: 12 in group 1 and 5 in group 2. Median overall survival was 25 months: not reached in group 1 and 6 months in group 2. This case series highlights survival outcomes for patients with inaugural BM, a demographic underrepresented in pivotal trials. Oligometastatic disease and symptomatic BM as initial signs seem associated with better prognosis due to increased use of multimodal local approaches. Combining local approaches with first-line ICI+/- chemotherapy appears to improve survival in brain metastatic NSCLC. A literature review was conducted to explore key questions regarding upfront ICI alone or in combination with systemic drugs or local approaches in brain metastatic NSCLC.

Eye, Heart, the Brain: The Psychophysiology of Trust in AVs

Automation misuse and acceptance, influenced by trust, environmental conditions, and confidence, have hindered drivers from fully benefiting from partially automated vehicles. This study investigates how driver trust changes with AV reliance, differences in mental and physiological states, and continuous measures’ effectiveness. The takeover drivers reported lower trust than the non-takeover drivers in all scenarios. Nontakeover drivers’ elevated DLPFC activation aligns with trust networks and emotion regulation. The groups also differed in neural activation preand during scenarios with the takeover group showed more PFC, V2V3, and IFC engagement pre-scenario. Gaze revealed the takeover group fixated more on the AV button or dashboard, indicating readiness to take over, while non-takeover drivers focused on the rearview mirror, reflecting situational awareness. HRV responses showed higher physiological arousal in the takeover group pre-scenario. In summary, our multimodal approach reveals takeover behavior is associated with lower trust, cognitive unloading, increased stress, and anticipatory visual attention.

Crop Growth Analysis Using Automatic Annotations and Transfer Learning in Multi-Date Aerial Images and Ortho-Mosaics

Growth monitoring of crops is a crucial aspect of precision agriculture, essential for optimal yield prediction and resource allocation. Traditional crop growth monitoring methods are labor-intensive and prone to errors. This study introduces an automated segmentation pipeline utilizing multi-date aerial images and ortho-mosaics to monitor the growth of cauliflower crops (Brassica Oleracea var. Botrytis) using an object-based image analysis approach. The methodology employs YOLOv8, a Grounding Detection Transformer with Improved Denoising Anchor Boxes (DINO), and the Segment Anything Model (SAM) for automatic annotation and segmentation. The YOLOv8 model was trained using aerial image datasets, which then facilitated the training of the Grounded Segment Anything Model framework. This approach generated automatic annotations and segmentation masks, classifying crop rows for temporal monitoring and growth estimation. The study’s findings utilized a multi-modal monitoring approach to highlight the efficiency of this automated system in providing accurate crop growth analysis, promoting informed decision-making in crop management and sustainable agricultural practices. The results indicate consistent and comparable growth patterns between aerial images and ortho-mosaics, with significant periods of rapid expansion and minor fluctuations over time. The results also indicated a correlation between the time and method of observation which paves a future possibility of integration of such techniques aimed at increasing the accuracy in crop growth monitoring based on automatically derived temporal crop row segmentation masks.