Réhabilitation accélérée multimodate postcésarienne, la somme de toutes les astuces [Fast-track multimodal rehabilitation after cesarean, the sum of all tricks].

Fast-track multimodal rehabilitation after cesarean, the sum of all tricks Fast-track multimodal rehabilitation after caesarean is an interdisciplinary concept allowing an accelerated return to normal physiology. Fast-track rehabilitation combines minimising surgical trauma, regional anaesthesia and active management of pain control, minimally invasive postoperative care while promoting return to autonomy.

Statistical Modeling of the Eye for Multimodal Treatment Planning for External Beam Radiation Therapy of Intraocular Tumors.

PURPOSE: Ocular anatomy and radiation-associated toxicities provide unique challenges for external beam radiation therapy. For treatment planning, precise modeling of organs at risk and tumor volume are crucial. Development of a precise eye model and automatic adaptation of this model to patients' anatomy remain problematic because of organ shape variability. This work introduces the application of a 3-dimensional (3D) statistical shape model as a novel method for precise eye modeling for external beam radiation therapy of intraocular tumors. METHODS AND MATERIALS: Manual and automatic segmentations were compared for 17 patients, based on head computed tomography (CT) volume scans. A 3D statistical shape model of the cornea, lens, and sclera as well as of the optic disc position was developed. Furthermore, an active shape model was built to enable automatic fitting of the eye model to CT slice stacks. Cross-validation was performed based on leave-one-out tests for all training shapes by measuring dice coefficients and mean segmentation errors between automatic segmentation and manual segmentation by an expert. RESULTS: Cross-validation revealed a dice similarity of 95% ± 2% for the sclera and cornea and 91% ± 2% for the lens. Overall, mean segmentation error was found to be 0.3 ± 0.1 mm. Average segmentation time was 14 ± 2 s on a standard personal computer. CONCLUSIONS: Our results show that the solution presented outperforms state-of-the-art methods in terms of accuracy, reliability, and robustness. Moreover, the eye model shape as well as its variability is learned from a training set rather than by making shape assumptions (eg, as with the spherical or elliptical model). Therefore, the model appears to be capable of modeling nonspherically and nonelliptically shaped eyes.

Cell morphology and intracellular ionic homeostasis explored with a multimodal approach combining epifluorescence and digital holographic microscopy.

The authors have developed a live-cell multimodality microscope combining epifluorescence with digital holographic microscopy; it has been implemented with a decoupling procedure allowing to separately measure from the quantitative phase important cell parameters including absolute volume, shape and integral intracellular refractive index. In combination with the numerous different specific fluorescent cellular probes, this multimodality microscopy can address important issues in cell biology. This is demonstrated by the study of intracellular calcium homeostasis associated with the change in cell volume, which play a critical role in the excitotoxicity-induced neuronal death.

Issue review : multimodal transportation funding.

Funding for non-road multimodal transportation is a means to provide for future transportation needs and alternatives to provide safe and efficient transportation options. The state supports multimodal transportation in the annual infrastructure budget. Most of the state's appropriations for these non-road modes of transportation are provided from the Rebuild Iowa Infrastructure Fund, or infrastructure-related funds such as restricted capital from tax-emempt bond proceeds. Projects that have received funding include commercial and general aviation infrastructure, public transit infrastructure, freight rail, and passenger rail. In addition, recreational trails that encourage walking and cycling are considered part of multimodal transportation. This issue review provides a general overview of the multimodal transportation grant programs that are funded by the state and administered under the Department of Transportation, or DOT. Other means of state funding for multimodal transportation, a sampling of federally funded programs and how other states fund some of their multimodal transportation programs will be briefly discussed.

Landmark detection for fusion of fundus and MRI toward a patient-specific multimodal eye model.

Ophthalmologists typically acquire different image modalities to diagnose eye pathologies. They comprise, e.g., Fundus photography, optical coherence tomography, computed tomography, and magnetic resonance imaging (MRI). Yet, these images are often complementary and do express the same pathologies in a different way. Some pathologies are only visible in a particular modality. Thus, it is beneficial for the ophthalmologist to have these modalities fused into a single patient-specific model. The goal of this paper is a fusion of Fundus photography with segmented MRI volumes. This adds information to MRI that was not visible before like vessels and the macula. This paper contributions include automatic detection of the optic disc, the fovea, the optic axis, and an automatic segmentation of the vitreous humor of the eye.

Multimodal Strategies in Development.Predictive Value of early simultaneosgesture-speech comination

The present study investigates the predictive value of the early appearance of simultaneous pointing-speech combinations. An experimental task was used to obtain a communicative productive sample from nineteen children at 1;0 and 1;3. Infant’s communicative productions, in combination with gaze joint engagement patterns, were analyzed in relation to different social conditions. The results show a significant effect of age and social condition on infants’ communicative productions. Gesture-speech combinations seem to work as a strong communicative resource to attract the adult’s attention in social demanding communicative contexts. Gaze joint engagement was used in combination with simultaneous pointing-speech combinations to attract adults’ attention during social demanding conditions. Finally, the use of simultaneous pointing-speech combinations at 1;0 in demanding conditions predicted greater expressive vocabulary acquisition at 1;3 and 1;6. These results indicate that the use of gesture-speech combinations may be considered a significant step towards the early integration of language components.

Comprehensive Statewide Transportation Model: Multimodal Investment Analysis Methodology Phase II, CTRE Project 02-126, 2001

The purposes of this report (Phase II of the project) are to specify in mathematical form the individual modules of the conceptual model developed in Phase I, to identify and evaluate sources of data for the model set, and to develop the transport networks necessary to support the models.

Multimodal Investment Analysis Methodology, Phase One: The Conceptual Model, 1998

The purpose of this project is to develop an investment analysis model that integrates the capabilities of four types of analysis for use in evaluating interurban transportation system improvements. The project will also explore the use of new data warehousing and mining techniques to design the types of databases required for supporting such a comprehensive transportation model. The project consists of four phases. The first phase, which is documented in this report, involves development of the conceptual foundation for the model. Prior research is reviewed in Chapter 1, which is composed of three major sections providing demand modeling background information for passenger transportation, transportation of freight (manufactured products and supplies), and transportation of natural resources and agricultural commodities. Material from the literature on geographic information systems makes up Chapter 2. Database models for the national and regional economies and for the transportation and logistics network are conceptualized in Chapter 3. Demand forecasting of transportation service requirements is introduced in Chapter 4, with separate sections for passenger transportation, freight transportation, and transportation of natural resources and commodities. Characteristics and capacities of the different modes, modal choices, and route assignments are discussed in Chapter 5. Chapter 6 concludes with a general discussion of the economic impacts and feedback of multimodal transportation activities and facilities.

Acting Rehearsal in Collaborative Multimodal Mixed Reality Environments

This paper presents the use of our multimodal mixed reality telecommunication system to support remote acting rehearsal. The rehearsals involved two actors, located in London and Barcelona, and a director in another location in London. This triadic audiovisual telecommunication was performed in a spatial and multimodal collaborative mixed reality environment based on the 'destination-visitor' paradigm, which we define and put into use. We detail our heterogeneous system architecture, which spans the three distributed and technologically asymmetric sites, and features a range of capture, display, and transmission technologies. The actors' and director's experience of rehearsing a scene via the system are then discussed, exploring successes and failures of this heterogeneous form of telecollaboration. Overall, the common spatial frame of reference presented by the system to all parties was highly conducive to theatrical acting and directing, allowing blocking, gross gesture, and unambiguous instruction to be issued. The relative inexpressivity of the actors' embodiments was identified as the central limitation of the telecommunication, meaning that moments relying on performing and reacting to consequential facial expression and subtle gesture were less successful.

Baseline Results of an Acute Ischemic Stroke Registry Including Acute Multimodal Imaging (ASTRAL)

Background: The DEFUSE (n_74) and EPITHET (n_101) studies have in common that a baseline MRI was obtained prior to treatment (tPA in DEFUSE; tPA or placebo in EPITHET) in the 3-6 hour time-window. There were however important methodological differences between the studies. A standardized reanalysis of pooled data was undertaken to determine the effect of these differences on baseline characteristics and study outcomes. Methods: To standardize the studies 1) the DWI and PWI source images were reprocessed and segmented using automated image processing software (RAPID); 2) patients were categorized according to their baseline MRI profile as either Target Mismatch (PWITmax_6/DWI ratio_ 1.8 and an absolute mismatch _15mL), Malignant (DWI or PWITmax_10 lesion _ 100 mL), or No Mismatch. 3) favorable clinical response was defined as NIHSS score of 0-1 or a _8 points improvement on the NIHSSS at day 90. Results: Prior to standardization there was no difference in the proportion of Target Mismatch patients between EPITHET and DEFUSE (54% vs 49%, p_0.6), but the EPITHET study had more patients with the Malignant profile than DEFUSE (35% vs 9%, p_0.01) and fewer patients that had No Mismatch (11% vs 42%, p_0.01). These differences in baseline MRI profiles between EPITHET and DEFUSE were largely eliminated by standardized processing of PWI and DWI images with RAPID software (Target Mismatch 49% vs 48%; Malignant 15% vs 8%; No Mismatch 36% vs 25%; p_NS for all comparisons) Reperfusion was strongly associated with a favorable clinical response in mismatch patients (figure). This relationship was not affected by the standardization procedures (pooled odds ratio of 8.8 based on original data and 6.6 based on standardized data). Conclusion: Standardization of image analyses procedures in acute stroke is important as non-standardized techniques introduce significant variability in DWI and PWI imaging characteristics. Despite methodological differences, the DEFUSE and EPITHET studies show a consistent and robust association between reperfusion and favorable clinical response in Target Mismatch patients regardless of standardization. These data support an RCT of iv tPA in the 3-6 hour time-window for Target Mismatch patients identified using RAPID.

Entitat Metropolitana del Transport. Centre Operatiu d'Autobusos del Prat

El projecte contempla la resolució d’un Centre Operatiu d’Autobusos Metropolitans amb un programa que ha de donar cabuda a un mínim de 300 places d’aparcament de diferents mesures, tallers de manteniment, túnels de neteja, sortidors de repostatge, vestuaris, administració, oficines i serveis generals. L’emplaçament se situa en el barri de Sant Cosme del Prat de Llobregat, en un solar que esdevé la façana d’aquesta població a l’entrada a Barcelona des de l’aeroport. L’entorn el conformen els espais de protecció de les pistes que es perllonguen fins a tocar el Parc Natural del Delta del Llobregat, una zona humida protegida d’àmbit europeu. Al mateix temps, els requeriments del concurs sol•liciten mantenir un 50% de la superfície del solar com a parc urbà. Això comporta abordar la resolució d’un edifici extens, però de 3 alçades i mitja, per tal de poder encabir tot el programa. Tot i així, la proposta integra el gran volum de l’edificació en harmonia compositiva i cromàtica amb el canyissar i manté l’alçària en una cota similar a la dels edificis de l’entorn. L’àrea verda es concentra en la part de la parcel•la que té continuïtat directe amb el pati del nou Esplai del barri, per tal de optimitzar-ne l’ús. Al mateix temps, les àrees de circulació, neteja i manteniment dels autobusos se situen a la part posterior del solar, per fer-les compatibles amb la resta de requeriments funcionals i perquè la volumetria principal doni front a les vies d’entrada a l’àrea metropolitana. La cotxera està continguda en un únic volum lleugerament soterrat, per limitar l’alçària total. La construcció principal, de 120 x 55 x 14,5 metres, es troba configurada per una estructura regular que respecta les mesures i moviments dels autobusos, i per una pell consistent en una gelosia oberta en tres cares, i tancada en l’alçat nord. Aquest tancament es realitza amb prismes verticals de colors similars a la vegetació del entorn, separats harmònicament per tal de dissoldre lleument els contorns del volum. Com a contrapunt a la gran peça principal, es proposa un petit edifici vidriat que indica l’entrada a les oficines i conté les activitats administratives.Les àrees de funcionament es resumeixen en les següents:1. La circulació dels autobusos: el conjunt disposa de tres vies simultànies, una d’accés i dues de sortida, situades en línia amb dos punts de repostatge, aspiració interior i traspàs de dades i recaptacions, aptes per a ser utilitzades per tres vehicles alhora. També es disposen tres túnels de rentat previs a l’entrada a l’interior de la cotxera, amb pas per a tres carrils en by-pass. Es preveu una quarta via especial d’accés i sortida directes al taller, per situacions extraordinàries.2. La circulació dels vehicles de personal: tenen un accés i un recorregut independent al dels autobusos, amb control informatitzat. 3. La entrada peatonal de visites o personal: l’edifici disposa també d’una entrada peatonal que es produeix des de la porta principal, situada en el front del edifici administratiu.4. El edifici principal: consta de diferents nivells. El Nivell 0, a cota –1,3 m. es troba ocupat per la zona d’aparcament de vehicles privats (98 uts), l’aparcament de minibusos (20 uts), el taller d’autobusos (23 uts standard amb ITV, 2 uts articulats, 1 ut pintura articulat, 2 uts reparcions sostres), i l’àrea d’explotació i de dependències per conductors (vestidors, àrea de descans, cafeteria i espais habitables).El Nivell 1, a cota 2,4 m. està ocupat per l’aparcament de 47 autobusos de 13 m. de llarg i per 20 autobusos de 15 m.El Nivell 2, a cota 4,8 m. l’ocupen 22 places d’autobusos de 15 m., 6 places d’articulats i 37 de 13 m.El Nivell 3, a cota 7,2 m. és idèntic al Nivell 1.El Nivell 4, és idèntic al Nivell 2 i permet que la rampa continuï fins a un Nivell 5 de coberta, que excepcionalment pot convertir-se en aparcament descobert de 67 autobusos de més.La proposta contempla amb fermesa criteris de Sostenibilitat. Aquests es centren en primer lloc en la sobrietat del projecte que garanteix una organització clara en quan a circulacions i rendiment del espai i que, per tant, no malbarata més recursos dels necessaris. En segon lloc, s’aprofiten al màxim la llum i la ventilació naturals i, al mateix temps, es genera la pròpia energia per millorar la eficiència. També es resol el re-processament dels residus generats pel complex, es re-aprofiten les aigües utilitzades en els vestuaris i oficines pel rentat dels vehicles, i s’emmagatzemen les aigües pluvials per tal de complementar la generació d’energia i per escalfar amb el sol aigua calenta de neteja. En tercer lloc, es té especial cura en l’impacte ambiental del edifici, procurant adequar-lo a l’estructura urbana tant en alineacions com el alçària. També s’evita la contaminació acústica apantallant el so intern per tal de no enviar-lo a les àrees habitades, s’endrecen els accessos dels autobusos des de la rotonda de la via pública per alterar el mínim el trànsit dels veïns, i es concentra l’àrea verda en la zona on es té més contacte amb l’activitat veïnal comunitària: l’Esplai del barri.

Acting rehearsal in collaborative multimodal mixed reality environments

This paper presents the use of our multimodal mixed reality telecommunication system to support remote acting rehearsal. The rehearsals involved two actors, located in London and Barcelona, and a director in another location in London. This triadic audiovisual telecommunication was performed in a spatial and multimodal collaborative mixed reality environment based on the 'destination-visitor' paradigm, which we define and put into use. We detail our heterogeneous system architecture, which spans the three distributed and technologically asymmetric sites, and features a range of capture, display, and transmission technologies. The actors' and director's experience of rehearsing a scene via the system are then discussed, exploring successes and failures of this heterogeneous form of telecollaboration. Overall, the common spatial frame of reference presented by the system to all parties was highly conducive to theatrical acting and directing, allowing blocking, gross gesture, and unambiguous instruction to be issued. The relative inexpressivity of the actors' embodiments was identified as the central limitation of the telecommunication, meaning that moments relying on performing and reacting to consequential facial expression and subtle gesture were less successful.