Multimodal Procedure Research Articles

Forgotten ureteral stents: a systematic review of literature

BackgroundThe forgotten ureteral stents (FUS) is one of the late complications of stent placement. This systematic review summarized different aspects of FUS and focused on the problems and solutions related to FUS.MethodsThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. PubMed® and Embase® were searched from inception until October 1st, 2022. Eligible studies were those defining FUS as a stent unintentionally left in situ longer than at least 2 months.ResultsTotal 147 studies with 1292 patients were finally included. The mean indwelling time of FUS was 33.5 months (range from 3 months to 32 years). The most common initial cause for stent placement was adjunct treatment to urolithiasis (79.2%). The major forgetting reasons were patient-related (83.9%), which included poor compliance, lapse in memory, and misconceptions about the necessity of timely removal. Primary presenting complaints were flank pain (37.3%), lower urinary tract symptoms (33.3%), and hematuria (22.8%). Encrustation (80.8%) and urinary tract infections (40.2%) were the most common complications detected in patients with FUS. Computed tomography evolving as a preferred imaging test (76.1%) was indispensable for evaluating encrustation, migration, fracture and other complicated situations in patients with FUS. Besides, evaluation of kidney function and infection status was also of great importance. Multiple and multimodal procedures (59.0%) were often necessitated to achieve the stent-free status, and were mostly endoscopic procedures. Cystoscope was most commonly used (64.8%). Retrograde ureteroscopy (43.4%) and antegrade stent removal (31.6%) were often used when dealing with more complicated situations. Extracorporeal shockwave lithotripsy (30.4%) was often used as adjunctive to other endoscopic procedures, but it sometimes failed. The decision regarding the choice of treatment is based on the volume and site of encrustation, the direction of migration, the site of fracture, kidney function and other urinary comorbidities.ConclusionsFUS not only pose hazard to patients’ health, but also impose a huge economic burden on medical care. Thorough preoperative evaluation is fundamental to developing the treatment strategy. The management of FUS should be individualized using different treatment modalities with their advantages to minimize patients’ morbidities. Prevention is better than cure. Strengthening health education and setting a tracking program are of great importance to the prevention of FUS.

Science dissemination videos as multimodal supporting resources for ESP teaching in higher education

In recent years, science dissemination has moved from printed to digital formats, and digital genres such as free access videos, along with their own multimodal characteristics (e.g. image, audio, movement, among others) are particularly relevant in order to meet 21st century users' (i.e., digital natives) learning needs (Prensky, 2017) and to make them aware of the use of the multimodal traits. However, only a few studies can be found on the use of videos for the dissemination of research in ESP teaching as learning resources in Higher Education (HE) contexts, nor have the multimodal connections embedded in videos which contribute to the engagement of their users been taken into account (Valeiras-Jurado & Bernad-Mechó, 2022). Considering a communicative multimodal procedure in the digital era (Kress, 2010), the objective of this research is to identify the criteria that ESP teachers take into account when selecting this type of video for their courses, as well as the multimodal characteristics of these videos that can be identified and taken into consideration in the classroom. To attain our aim, a questionnaire will be distributed to 10 ESP teachers asking about the criteria they use for the selection of videos (e.g., length, clarity of language, visual aids, subject matter appropriate to the content, difficulty, among other aspects). Secondly, a multimodal discourse analysis of an extract from one of the videos teachers use in their courses will be developed. The teacher who uses this video in his class will be interviewed before and after showing him the multimodal analysis in order to check whether being aware of the video's multimodal traits can change his criteria for video selection and for class activities related to it. The results of this investigation will serve to offer teachers some support in their selection of appropriate multimodal materials for their ESP courses, as well as pedagogical tips about activities that can enhance the multimodal features of this digital genre.

Multimodality Imaging Evaluation in Coronary Artery Disease

Non-invasive imaging modalities are fundamental in evaluating and managing patients with known or suspected coronary artery disease (CAD). Multimodality cardiac imaging procedures detect the presence of CAD and guide clinical decision-making. Combining anatomical and functional imaging modalities would enable a more thorough characterization of obstructive CAD. When selecting an imaging test, one must consider the many factors that interact in the development of chronic CAD and acute coronary syndrome (ACS). The clinical presentation, baseline characteristics of the patient, as well as the clinical center's local availability and expertise will determine the preferred imaging technique to confirm the diagnosis of ACS or chronic CAD. Diagnostic testing is most useful and recommended in patients with chronic coronary syndromes (CCS) when the likelihood is intermediate. The preferred options are coronary computed tomography angiography (CTA) or stress tests, but patients may be referred directly for invasive coronary angiography (ICA) if the likelihood of CAD is very high. The primary goal of the initial diagnostic evaluation in patients with suspected ACS is to confirm ACS and rule out the other most common life-threatening conditions, such as acute pulmonary embolism (PE) or acute aortic syndromes (AAS). Non-invasive imaging is essential in the differential diagnosis of ACS and frequently necessitates multimodality imaging. Cardiac magnetic resonance (CMR) is the most helpful imaging test in diagnosing myocardial infarction with non-obstructed coronary arteries (MINOCAs), and it can detect or rule out other cardiac causes of troponin rise.

Popular Science Images: Reflections on Visual Practices in Science Communication

Abstract Images play a considerable role in the communication of scientific knowledge. This article deals with the recontextualization of originally scientific images in multimodal popular science articles. The focus is on the visual editing of these images, and thus on an aspect of visual design in science communication. I present different types of multimodal transcriptive procedures that are related to the recontextualization and readdressing of images in popular science contexts. Since these procedures may be accompanied by a change in the legibility of visualizations, I will conclude by suggesting possible implications for the evidence potential of popular science images.

Multimodal Treatment in Metastatic Colorectal Cancer (mCRC) Improves Outcomes-The University College London Hospital (UCLH) Experience.

Simple SummaryMost patients with metastatic colorectal cancer (mCRC) are treated with chemotherapy alone; however, increasingly, addition procedures such as surgery, radiotherapy, and ablation of metastases are being used with the aim of improving survival. We aimed to review all patients with mCRC receiving chemotherapy at the University College London Hospital (UCLH) in order to determine the survival outcomes of those who received additional procedures versus those who received chemotherapy alone, but also to understand which procedures provided the most benefit and to whom. We found that additional procedures improved survival of patients with mCRC compared to chemotherapy alone, and the more procedures performed, the greater the survival benefit. Surgical removal of metastases were associated with the most improved survival; however, repeated procedures in the same organ did not improve outcomes. We hope these results may help guide cancer specialists in the decision-making process for the management of patients with mCRC.Background: Despite notable advances in the management of metastatic colorectal cancer (mCRC) over the last two decades, treatment intent in the vast majority of patients remains palliative due to technically unresectable disease, extensive disease, or co-morbidities precluding major surgery. Up to 30% of individuals with mCRC are considered potentially suitable for primary or metastasis-directed multimodal therapy, including surgical resection, ablative techniques, or stereotactic radiotherapy (RT), with the aim of improving survival outcomes. We reviewed the potential benefits of multimodal therapy on the survival of patients with mCRC treated at the UCLH. Methods: Clinical data on baseline characteristics, multimodal treatments, and survival outcomes were retrospectively collected from all patients with mCRC receiving systemic chemotherapy between January 2013 and April 2017. Primary outcome was the impact of multimodal therapy on overall survival, compared to systemic therapy alone, and the effect of different types of multimodal therapy on survival outcome, and was assessed using the Kaplan–Meier approach. All analyses were adjusted for age, gender, and side of primary tumour. Results: One-hundred and twenty-five patients with mCRC were treated during the study period (median age: 62 years (range 19–89). The liver was the most frequent metastatic site (78%; 97/125). A total of 52% (65/125) had ≥2 lines of systemic chemotherapy. Of the 125 patients having systemic chemotherapy, 74 (59%) underwent multimodal treatment to the primary tumour or metastasis. Median overall survival (OS) was 25.7 months [95% Confidence Interval (CI) 21.5–29.0], and 3-year survival, 26%. Univariate analysis demonstrated that patients who had additional procedures (surgery/ablation/RT) were significantly less likely to die (Hazard Ratio (HR) 0.18, 95% CI 0.12–0.29, p < 0.0001) compared to those receiving systemic chemotherapy alone. Increasing number of multimodal procedures was associated with an incremental increase in survival—with median OS 28.4 m, 35.7 m, and 64.8 m, respectively, for 1, 2, or ≥3 procedures (log-rank p < 0.0001). After exclusion of those who received systemic chemotherapy only (n = 51), metastatic resections were associated with improved survival (adjusted HR 0.36, 95% CI 0.20–0.63, p < 0.0001), confirmed in multivariate analysis. Multiple single-organ procedures did not improve survival. Conclusion: Multimodal therapy for metastatic bowel cancer is associated with significant survival benefit. Resection/radical RT of the primary and resection of metastatic disease should be considered to improve survival outcomes following multidisciplinary team (MDT) discussion and individual assessment of fitness.

Development of Fragility Curves for Single-Column RC Italian Bridges Using Nonlinear Static Analysis

ABSTRACT The main objective of this study is to assess the accuracy and suitability of Nonlinear Static Procedures (NSPs) in the development of analytical damage fragility curves for seismic risk assessment of large portfolios of Reinforced Concrete (RC) bridges. Seven NSP approaches, from widely used single-mode conventional pushover-based approaches to the more rigorous multi-mode conventional or adaptive pushover-based procedures are implemented. By systematically comparing fragility curve estimations in terms of shape and accuracy in predicting mean annual rates of exceeding predefined damage limit states, results indicate that when bridges can be classified as higher mode sensitive, multi-mode-based approaches offer a powerful alternative to rigorous time history analysis. In particular, Generalized Pushover Analysis and Adaptive Capacity Spectrum methods offer a better performance with respect to other multi-mode alternatives. For first mode dominated bridges, with a classical first mode shape, the performance of all methods is similar. Single-mode based procedures present an acceptable alternative only in such particular cases, for which the N2 method represents a viable approach when compared to other single-mode or multi-mode procedures.

Neuroendocrine tumors in daily gastroenterology and endoscopy - apractice manual

Neuroendocrine tumors of the gastrointestinal tract (GI-NET) are rare tumors. Functional tumors with hormonal syndromes (e. g., insulinoma, gastrinoma) are less common than non-functional tumors, which usually have an indolent course. Therapy for GI-NET is multimodal, including endoscopic or surgical procedures aiming at complete removal of tumor tissue. Patients in later stages may benefit from interventional radiology or medical therapy. This article gives an overview regarding the key aspects of GI-NET therapy in daily gastroenterology practice with emphasis on endoscopic diagnosis and therapy.

FCA-based knowledge representation and local generalized linear models to address relevance and diversity in diverse social images

Abstract In social image retrieval, the main goal is to offer a relevant but also diverse result set of images to the user. To address relevance and diversity at the same time, we propose a multi-modal procedure. This approach deals with the diversification problem using a two-step procedure based on the application of Formal Concept Analysis (FCA) to organize the text content of the images, followed by a Hierarchical Agglomerative Clustering (HAC) step to find the topics addressed by the images. FCA detects the latent concepts covered by the images in the result set, organizing them according to these concepts. In the second step, clustering is carried out to group together the ones with a similar concept. To assess the relevance, we use an adaptive multi-model relevance feedback algorithm which uses the low-level visual features to estimate a relevance measurement for all the images in the dataset. Several local logistic regression models are automatically adjusted to select the best performance for each topic. Finally, the images are ranked by selecting the highest probability image at each text cluster, generating a relevant but diverse ranked list. Diverse social images 2013, 2014, 2015, 2016 and 2017 datasets from the MediaEval benchmark are used to test the performance of our approach in a real scenario. Experimental results show that the proposed joint multimedia procedure works well on multi-concept and complex collections without adjusting parameters among collections, achieving the best results with a user-based relevance feedback algorithm. Our challenge is to achieve similar results with our automatic version.

Continuous surgical multi-level extrapleural block for video-assisted thoracoscopic surgery: a retrospective study assessing its efficacy as pain relief following lobectomy and wedge resection

Background: Video-assisted thoracoscopic surgery (VATS) causes less postoperative pain than thoracotomy; however, adequate analgesia remains vital. As part of a multi-modal postoperative analgesia, a continuous surgeon-placed extrapleural block catheter is an option. The aim of this retrospective study was to evaluate the analgesic efficacy of a continuous extrapleural block as part of a multimodal analgesic regimen after VATS in general, and VATS lobectomy and wedge resection in particular. Methods: Case records for patients having undergone VATS surgery and been provided a multi-level continuous extrapleural block with an elastomeric pump infusing levobupivacaine 2.7 mg/ml at a rate of 5 ml/h during 2015 and 2016 were reviewed. Pain (Numeric Rating Scale) at rest and mobilisation as well as opioid requirement (daily, postoperative days 0-3, as well as accumulated) were analysed. Results: In all, 454 records were reviewed: 150 wedge resections, 264 lobectomies and 40 miscellaneous cases. At rest, pain was mild median NRS rated 3-3-1-1 for postoperative day (POD) 0 to 3, during movement, pain was rated moderate during POD 0 and 1 and mild the remaining days (median NRS 4-4-3-3 for POD 0-3). The proportion of patients exhibiting mild pain at rest increased from 55% on POD 0 to 81 % on POD 3. The percentage of patients experiencing severe pain at rest decreased from 15% to 6%. Median oxycodone consumption was 10 mg per day for POD 1-3. Pain after VATS wedge resection was significantly lower at POD 1 and 3 compared to pain after VATS lobectomy. Conclusion: We found a continuous surgeon-placed extrapleural catheter block to be a valuable and seemingly safe addition to our multimodal procedure specific analgesia after VATS. Whether the efficacy of the block can be improved by increasing local anaesthetic and/or adding adjuncts warrants further investigation.

Treatment of retained encrusted ureteral Double-J stent.

We conducted this study to evaluate patients with retained encrusted ureteral stents, identify the predisposing factors and present our experience in the management of such challenging problem. This prospective study was carried out in the period from May 2007 to February 2011 at the Urology and Nephrology Center, Al-Thawra General Hospital, Sana'a, Yemen. 40 patients with retained encrusted ureteric stents were treated at our center. All patients were initially evaluated with a radiographic imaging for assessment of stent encrustation and stone burden. Treatment decisions were based on the site and severity of encrustations in the renal pelvis, ureter and bladder and on our technical situation and availability of instrumentations. Multi-modal approaches ranging from extracorporeal shock wave lithotripsy (ESWL) to endourological and open urologic procedures were used to achieve stent removal. A total of 90 urological procedures were performed to render all 40 patients stent and stone free. The average duration of stent remained indwelling was 24.2 months (range 4 months -16 years). All patients were managed either by minimally or more invasive multi-modal endourological approaches. For upper coil encrustation percutaneous nephrolithotripsy was performed in eight patients, pyelolithotomy in two patients and ESWL in three patients. Encrustation of the body was treated initially by ESWL, followed by retrograde ureteroscopic manipulation in 12 patients. Lower coil encrustation was successfully managed by cystolitholapaxy in seven patients and one patient required cystolithotomy. Cystolithotomy, pyelolithotomy and ureterolithotomy were carried out in two patients. Two patients who had large burden bladder and kidney stones with loss of kidney function underwent nephrectomy and cystolithotomy. The retrieval of severely encrusted retained ureteral stent and its associated stone burden poses a real management challenge for urologists due to the need for multimodal procedures and the lack of standardized treatment plan.

Neuroimaging Biomarkers of Experimental Epileptogenesis and Refractory Epilepsy.

This article provides an overview of neuroimaging biomarkers in experimental epileptogenesis and refractory epilepsy. Neuroimaging represents a gold standard and clinically translatable technique to identify neuropathological changes in epileptogenesis and longitudinally monitor its progression after a precipitating injury. Neuroimaging studies, along with molecular studies from animal models, have greatly improved our understanding of the neuropathology of epilepsy, such as the hallmark hippocampus sclerosis. Animal models are effective for differentiating the different stages of epileptogenesis. Neuroimaging in experimental epilepsy provides unique information about anatomic, functional, and metabolic alterations linked to epileptogenesis. Recently, several in vivo biomarkers for epileptogenesis have been investigated for characterizing neuronal loss, inflammation, blood-brain barrier alterations, changes in neurotransmitter density, neurovascular coupling, cerebral blood flow and volume, network connectivity, and metabolic activity in the brain. Magnetic resonance imaging (MRI) is a sensitive method for detecting structural and functional changes in the brain, especially to identify region-specific neuronal damage patterns in epilepsy. Positron emission tomography (PET) and single-photon emission computerized tomography are helpful to elucidate key functional alterations, especially in areas of brain metabolism and molecular patterns, and can help monitor pathology of epileptic disorders. Multimodal procedures such as PET-MRI integrated systems are desired for refractory epilepsy. Validated biomarkers are warranted for early identification of people at risk for epilepsy and monitoring of the progression of medical interventions.

Evaluation of a multimode pushover procedure for asymmetric and non-regular in plan reinforced concrete buildings under biaxial seismic excitation

In the present paper, a recently developed multimode pushover procedure is evaluated for non-regular in plan systems. The procedure is applicable to asymmetric in plan buildings under concurrent action of two horizontal seismic components and its main advantage is that it does not require independent analysis in two orthogonal directions. Thus, the use of simplified directional combination formulae, which is not valid in the nonlinear range, is avoided. The preliminary evaluation of the proposed methodology led to quite satisfactory results. However, the studies conducted up to date are limited to regular buildings. Hence, in the present study, the procedure is applied to four asymmetric and non-regular in plan reinforced concrete buildings. The values of selected response quantities are compared to those resulting from a conventional pushover analysis variant as well as from nonlinear dynamic analysis. The whole evaluation study leads to the derivation of useful conclusions.

A Displacement-Based Design Method for Seismic Retrofit of RC Buildings Using Dissipative Braces

The paper proposes a displacement-based design method for seismic retrofit of RC buildings using hysteretic dissipative braces. At first, a fully multimodal procedure based on an adaptive version of the capacity spectrum method is applied to the 3D model of the damped braced structure. Then, the properties of an idealized bilinear model are defined using the seismic characteristics of the compound system thus accounting for the frame-damped brace interaction. Finally, an iterative procedure is developed to provide an optimal distribution of dampers. The proposed method overcomes the limitations of the design procedures in the literature that generally neglect the frame-damped braces interactions. Moreover, it addresses the main issues of seismic design of damped braces: effect of force demands applied to the frame due to the damper yielding and strain hardening, higher modes contribution, effect of soft-storey irregularities, and torsion effect in asymmetric buildings. The proposed design procedure is first validated using nonlinear static and dynamic analyses of a numerical example. Then, it is implemented to a real case study of a RC school building to assess its applicability in current practice.

The Association of Encrustation and Ureteral Stent Indwelling Time in Urolithiasis and KUB Grading System.

To evaluate the management of prolonged indwelling ureteral stents and the newly developed KUB (kidney, ureter, and bladder) grading system for the classification of encrusted stents in urolithiasis. This study involved 69 patients that had indwelling and forgotten ureteral stents for more than 6 months after urolithiasis treatment. They were categorized into 4 groups based on indwelling time and were reviewed retrospectively. Patients whose ureteral stent could not be removed with simple cystoscopy were graded according to stone surface area and the KUB system. The mean stent indwelling time was 23.1 months. Stone burden in KUB and, in proportion to that, total KUB (T) score showed increased association that was directly proportional to indwelling time (p < 0.001, p = 0.008). Surgical intervention was required in 73.9% of patients. Among patients requiring surgery, 78.4% were treated in a single session and multi-modal interventions were performed in 70.5%. K score ? 3 was found to be associated with multiple surgery requirements (odds ratio [OR];11.25, %95 confidence interval [CI]:2.132-59.375),multi-modal procedure requirements (OR;16.50, %95 CI:3.434-79.826 ), and lower stone-free rates (p = 0.04). Bscore ? 3 was associated with multi-modal procedure requirements (OR;8.90, %95 CI:1.052-75.462). U score ? 3and T score ? 9 were associated with an operating time >180 minutes (p < 0.001, p = 0.008). Prolonged indwelling time of the ureteral stent in urolithiasis is associated with increased encrustation and stone burden. Since the KUB system specifies stone burden and its particular localization, it can be used as a simple, convenient method for the planning treatment of encrusted ureteral stents.

Continuous surgical multi-level extrapleural block for video-assisted thoracoscopic surgery: a retrospective study assessing its efficacy as pain relief following lobectomy and wedge resection.

Background: Video-assisted thoracoscopic surgery (VATS) causes less postoperative pain than thoracotomy; however, adequate analgesia remains vital. As part of a multi-modal postoperative analgesia, a continuous surgeon-placed extrapleural block catheter is an option. The aim of this retrospective study was to evaluate the analgesic efficacy of a continuous extrapleural block as part of a multimodal analgesic regimen after VATS in general, and VATS lobectomy and wedge resection in particular. Methods: Case records for patients having undergone VATS surgery and been provided a multi-level continuous extrapleural block with an elastomeric pump infusing levobupivacaine 2.7 mg/ml at a rate of 5 ml/h during 2015 and 2016 were reviewed. Pain (Numeric Rating Scale) at rest and mobilisation as well as opioid requirement (daily, postoperative days 0-3, as well as accumulated) were analysed. Results: In all, 454 records were reviewed: 150 wedge resections, 264 lobectomies and 40 miscellaneous cases. At rest, pain was mild median NRS rated 3-3-1-1 for postoperative day (POD) 0 to 3, during movement, pain was rated moderate during POD 0 and 1 and mild the remaining days (median NRS 4-4-3-3 for POD 0-3). The proportion of patients exhibiting mild pain at rest increased from 55% on POD 0 to 81 % on POD 3. The percentage of patients experiencing severe pain at rest decreased from 15% to 6%. Median oxycodone consumption was 10 mg per day for POD 1-3. Pain after VATS wedge resection was significantly lower at POD 1 and 3 compared to pain after VATS lobectomy. Conclusion: We found a continuous surgeon-placed extrapleural catheter block to be a valuable and seemingly safe addition to our multimodal procedure specific analgesia after VATS. Whether the efficacy of the block can be improved by increasing local anaesthetic and/or adding adjuncts warrants further investigation.

The mandate and work of ICRP Committee 3 on radiological protection in medicine.

The mandate of Committee 3 of the International Commission on Radiological Protection (ICRP) is concerned with the protection of persons and unborn children when ionising radiation is used in medical diagnosis, therapy, and biomedical research. Protection in veterinary medicine has been newly added to the mandate. Committee 3 develops recommendations and guidance in these areas. The most recent documents published by ICRP that relate to radiological protection in medicine are 'Radiological protection in cone beam computed tomography' (ICRP Publication 129) and 'Radiological protection in ion beam radiotherapy' (ICRP Publication 127). A report in cooperation with ICRP Committee 2 entitled 'Radiation dose to patients from radiopharmaceuticals: a compendium of current information related to frequently used substances' (ICRP Publication 128) has also been published. 'Diagnostic reference levels in medical imaging' (ICRP Publication 135), published in 2017, provides specific advice on the setting and use of diagnostic reference levels for diagnostic and interventional radiology, digital imaging, computed tomography, nuclear medicine, paediatrics, and multi-modality procedures. 'Occupational radiological protection in interventional procedures' was published in March 2018 as ICRP Publication 139. A document on radiological protection in therapy with radiopharmaceuticals is likely to be published in 2018. Work is in progress on several other topics, including appropriate use of effective dose in collaboration with the other ICRP committees, guidance for occupational radiological protection in brachytherapy, justification in medical imaging, and radiation doses to patients from radiopharmaceuticals (an update to ICRP Publication 128). Committee 3 is also considering the development of guidance on radiological protection in medicine related to individual radiosusceptibility, in collaboration with ICRP Committee 1.

A Dual-Mode Microwave Applicator for Liver Tumor Thermotherapy

Abstract The concept of a novel dual-mode microwave applicator for diagnosis and thermal ablation treatment of tumorous tissue is presented in this paper. This approach is realized by integrating a planar resonator array to, firstly, detect abnormalities by a relative dielectric analysis, and secondly, perform a highly localized thermal ablation. A further essential advantage is addressed by designing the applicator to be MRI compatible to provide a multimodal imaging procedure. Investigations for an appropriate frequency range lead to the use of much higher operating frequencies between 5 GHz and 10 GHz, providing a significantly lower power consumption for microwave ablation of only 20 W compared to commercial available applicators.

RETEXTUALIZAÇÕES MULTIMODAIS: Ensaios com Estudantes do Ensino Médio

A produção de textos na escola sempre se caracterizou como uma atividade complexa, tendo em vista a demanda de se contemplar os usos sociais da linguagem e dos multiletramentos. Por conta dessa dificuldade, infelizmente, o que vemos é um ensino nada sistemático e progressivo da escrita, um ensino que não mobiliza as habilidades que envolvem a competência do escrever e não explora as diversas linguagens e semioses que estão à nossa disposição na contemporaneidade. O texto dissertativo-argumentativo cobrado pelo Enem, tão requisitado atualmente, reforça ainda mais um ensino pragmático e irreflexivo sobre o exercício da escrita. Tendo em vista esse contexto, o presente trabalho apresenta uma discussão e análises a respeito do procedimento de retextualização multimodal na tentativa de verificar como estudantes do Ensino Médio retextualizam um texto predominantemente verbal em textos multimodais. Por fim, constatamos a importância de levar para a sala de aula atividades que mobilizem outros tipos de linguagem para além do texto verbal e a possibilidade de mesclar essas atividades com as demandas exigidas pelos alunos, no caso, a redação do Enem.

Estimation of subject coregistration errors during multimodal preclinical imaging using separate instruments: origins and avoidance of artifacts.

We use high-resolution [Formula: see text] data in multiple experiments to estimate the sources of error during coregistration of images acquired on separate preclinical instruments. In combination with experiments with phantoms, we completed in vivo imaging on mice, aimed at identifying the possible sources of registration errors, caused either by transport of the animal, movement of the animal itself, or methods of coregistration. The same imaging cell was used as a holder for phantoms and animals. For all procedures, rigid coregistration was carried out using a common landmark coregistration system, placed inside the imaging cell. We used the fiducial registration error and the target registration error to analyze the coregistration accuracy. We found that moving an imaging cell between two preclinical devices during a multimodal procedure gives an error of about [Formula: see text] at most. Therefore, it could not be considered a source of coregistration errors. Errors linked to spontaneous movements of the animal increased with time, to nearly 1mm at most, excepted for body parts that were properly restrained. This work highlights the importance of animal intrinsic movements during a multiacquisition procedure and demonstrates a simple method to identify and quantify the sources of error during coregistration.

‘Heart Team’ Concept – A reality or a ‘Platonic Illusion’

Post Syntax Trial, ‘Heart Team’ Concept has been ensconsed class I recommendation in both the European and ACC/AHA guidelines and has gained increasing traction in context of complex and multi modality procedures. Despite an arrray of advantages including the much touted - ‘the patient is central’, there are a plethora of un-addressed issues, some of which sentinel to our country, which threaten to make the ‘Heart Team’ concept a perfunctory exercise. As it stands today, ‘Heart Team’ is more of a fictional euphemism, a kind of 'Platonic Illusion' rather than a pragmatic reality.