Quantitative multi-slice computed tomography assessment of the mitral valvular complex for transcatheter mitral valve interventions part 1: systematic measurement methodology and inter-observer variability

AIMS Transcatheter mitral valve replacement (TMVR) is an emerging technology with the potential to treat patients with severe mitral regurgitation at excessive risk for surgical mitral valve surgery. Multimodal imaging of the mitral valvular complex and surrounding structures will be an important component for patient selection for TMVR. Our aim was to describe and evaluate a systematic multi-slice computed tomography (MSCT) image analysis methodology that provides measurements relevant for transcatheter mitral valve replacement. METHODS AND RESULTS A systematic step-by-step measurement methodology is described for structures of the mitral valvular complex including: the mitral valve annulus, left ventricle, left atrium, papillary muscles and left ventricular outflow tract. To evaluate reproducibility, two observers applied this methodology to a retrospective series of 49 cardiac MSCT scans in patients with heart failure and significant mitral regurgitation. For each of 25 geometrical metrics, we evaluated inter-observer difference and intra-class correlation. The inter-observer difference was below 10% and the intra-class correlation was above 0.81 for measurements of critical importance in the sizing of TMVR devices: the mitral valve annulus diameters, area, perimeter, the inter-trigone distance, and the aorto-mitral angle. CONCLUSIONS MSCT can provide measurements that are important for patient selection and sizing of TMVR devices. These measurements have excellent inter-observer reproducibility in patients with functional mitral regurgitation.

Diagnosing Organizational Identity Beliefs by Eliciting Complex, Multi-Modal Metaphors

The purpose of this article is to extend the organizational development diagnostics repertoire by advancing an approach that surfaces organizational identity beliefs through the elicitation of complex, multimodal metaphors by organizational members. We illustrate the use of such "Type IV" metaphors in a postmerger context, in which individuals sought to make sense of the implications of the merger process for the identity of their organization. This approach contributes to both constructive and discursive new organizational development approaches; and offers a multimodal way of researching organizational identity that goes beyond the dominant, mainly textual modality.

Shallow Dialogue Processing Using Machine Learning Algorithms (or not)

This paper presents a shallow dialogue analysis model, aimed at human-human dialogues in the context of staff or business meetings. Four components of the model are defined, and several machine learning techniques are used to extract features from dialogue transcripts: maximum entropy classifiers for dialogue acts, latent semantic analysis for topic segmentation, or decision tree classifiers for discourse markers. A rule-based approach is proposed for solving cross-modal references to meeting documents. The methods are trained and evaluated thanks to a common data set and annotation format. The integration of the components into an automated shallow dialogue parser opens the way to multimodal meeting processing and retrieval applications.

New associations of classic acute macular neuroretinopathy

PURPOSE: To describe novel underlying associations of classic acute macular neuroretinopathy (AMN). METHODS: Multimodal imaging case series evaluating patients with classic AMN lesions and previously unreported underlying aetiologies. RESULTS: Six patients were included (five women, one man, mean age 30±7 years). Mean distance best corrected visual acuity at initial presentation was 0.21±0.3 logMAR (mean Snellen acuity: 20/30, range 20/15-20/100) and at last follow-up visit 0.09±0.17 logMAR (Snellen acuity: 20/20, range 20/15-20/60). All cases but one had bilateral lesions and showed typical parafoveal hyporeflective lesions on infrared imaging, which corresponded to the hyper-reflectivity in the Henle's layer with attenuation of the external limiting membrane, the ellipsoid zone and interdigitation zone. Underlying diseases included thrombocytopenia and anaemia associated with dengue fever, acute lymphoblastic leukaemia, chronic kidney disease and ulcerative colitis, while Valsalva-like manoeuvre was found to be a potential trigger. Other novel associations included the use of lisdexamphetamine. CONCLUSIONS: Classic AMN may be associated with leukaemia, dengue fever, ulcerative colitis and chronic kidney disease, probably as a result of chorioretinal hypoxia in the setting of thrombocytopenia and anaemia. Adrenergic agonists such as lisdexamphetamine may also contribute to the manifestation of AMN.

Diffusion tensor imaging of the human kidney: Does image registration permit scanning without respiratory triggering?

PURPOSE To investigate if image registration of diffusion tensor imaging (DTI) allows omitting respiratory triggering for both transplanted and native kidneys MATERIALS AND METHODS: Nine kidney transplant recipients and eight healthy volunteers underwent renal DTI on a 3T scanner with and without respiratory triggering. DTI images were registered using a multimodal nonrigid registration algorithm. Apparent diffusion coefficient (ADC), the contribution of perfusion (FP ), and the fractional anisotropy (FA) were determined. Relative root mean square errors (RMSE) of the fitting and the standard deviations of the derived parameters within the regions of interest (SDROI ) were evaluated as quality criteria. RESULTS Registration significantly reduced RMSE in all DTI-derived parameters of triggered and nontriggered measurements in cortex and medulla of both transplanted and native kidneys (P < 0.05 for all). In addition, SDROI values were lower with registration for all 16 parameters in transplanted kidneys (14 of 16 SDROI values were significantly reduced, P < 0.04) and for 15 of 16 parameters in native kidneys (9 of 16 SDROI values were significantly reduced, P < 0.05). Comparing triggered versus nontriggered DTI in transplanted kidneys revealed no significant difference for RMSE (P > 0.14) and for SDROI (P > 0.13) of all parameters. In contrast, in native kidneys relative RMSE from triggered scans were significantly lower than those from nontriggered scans (P < 0.02), while SDROI was slightly higher in triggered compared to nontriggered measurements in 15 out of 16 comparisons (significantly for two, P < 0.05). CONCLUSION Registration improves the quality of DTI in native and transplanted kidneys. Diffusion parameters in renal allografts can be measured without respiratory triggering. In native kidneys, respiratory triggering appears advantageous. J. Magn. Reson. Imaging 2016.

Enhanced Recovery after Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs

CONTEXT Enhanced Recovery after Surgery (ERAS) programs are multimodal care pathways that aim to decrease intra-operative blood loss, decrease postoperative complications, and reduce recovery times. OBJECTIVE To overview the use and key elements of ERAS pathways, and define needs for future clinical trials. EVIDENCE ACQUISITION A comprehensive systematic MEDLINE search was performed for English language reports published before May 2015 using the terms "postoperative period," "postoperative care," "enhanced recovery after surgery," "enhanced recovery," "accelerated recovery," "fast track recovery," "recovery program," "recovery pathway", "ERAS," and "urology" or "cystectomy" or "urologic surgery." EVIDENCE SYNTHESIS We identified 18 eligible articles. Patient counseling, physical conditioning, avoiding excessive alcohol and smoking, and good nutrition appeared to protect against postoperative complications. Fasting from solid food for only 6h and perioperative liquid-carbohydrate loading up to 2h prior to surgery appeared to be safe and reduced recovery times. Restricted, balanced, and goal-directed fluid replacement is effective when individualized, depending on patient morbidity and surgical procedure. Decreased intraoperative blood loss may be achieved by several measures. Deep vein thrombosis prophylaxis, antibiotic prophylaxis, and thermoregulation were found to help reduce postsurgical complications, as was a multimodal approach to postoperative nausea, vomiting, and analgesia. Chewing gum, prokinetic agents, oral laxatives, and an early resumption to normal diet appear to aid faster return to normal bowel function. Further studies should compare anesthetic protocols, refine analgesia, and evaluate the importance of robot-assisted surgery and the need/timing for drains and catheters. CONCLUSIONS ERAS regimens are multidisciplinary, multimodal pathways that optimize postoperative recovery. PATIENT SUMMARY This review provides an overview of the use and key elements of Enhanced Recovery after Surgery programs, which are multimodal, multidisciplinary care pathways that aim to optimize postoperative recovery. Additional conclusions include identifying effective procedures within Enhanced Recovery after Surgery programs and defining needs for future clinical trials.

Esclerosis múltiple. : nuestra experiencia

Objetivos: analizar la experiencia obtenida y evaluar los resultados urodinámicos del estudio de 18 pacientes con esclerosis múltiple. Material y Métodos: se estudiaron 18 casos, valorándose la historia clínica, ecografía vesical y renal, analizándolos urodinámicamente con uroflujometría, residuo post miccional (RPM), cistotonometría y electromiografía esfinteriana. Urocultivo y antibiograma de orina. Resultados: del análisis de todas las variables se desprende que la vejiga hiperactiva se presentó en 10 casos con un predominio del síndrome frecuencia-urgencia, vejiga hipotónica-hiporrefléxica en 5 pacientes, disinergia detrusor-esfínter en 4 casos y 9 pacientes con infección urinaria que desencadenaban crisis de espasticidad. Todos fueron tratados con anticolinérgicos de acción vesical inmuno-modulación (brotes-recaídas) e inmuno-supresión en la enfermedad progresiva, de rehabilitación y terapia de apoyo psicológico. Conclusión: la vejiga hiperactiva es el tipo de consecuencia urinaria de la esclerosis en placa con los síntomas de frecuencia-urgencia y que, con tratamiento multimodal mejoran en un alto porcentaje.

Acerca de la Tesis "Del Día del Petróleo Nacional al Día Nacional del Petróleo en propagandas y publicidades gráficas comodorenses de YPF"

El artículo presentará resultados obtenidos en una Tesis de Grado de la Licenciatura en Comunicación Social de la Facultad de Humanidades y Ciencias Sociales de la Universidad Nacional de la Patagonia San Juan Bosco. En ese trabajo, un análisis de imagen y discurso, nos propusimos estudiar comparativamente los discursos publicitarios que YPF emitió antes y después de ser privatizada. La conmemoración del 13 de diciembre, aniversario del descubrimiento del petróleo en el país (ocurrido en Comodoro Rivadavia), fue tomada como referencia. Nos preguntamos, entre otras cosas, cómo conciben Yacimientos Petrolíferos Fiscales (YPF) y Repsol a sus objetivos empresariales en relación al recurso y su vinculación con el desarrollo nacional. Por medio de lecturas de segundo orden que problematizan las relaciones entre significantes y significados que se nos imponen a través de procesos hegemónicos, deconstruimos veinticinco propagandas y publicidades publicadas en la prensa gráfica local entre 1943 y 2007. Cada mensaje fue entendido como un texto multimodal; y sus contextos de emisión, las estructuras internas de las imágenes y los mensajes propuestos nos interesaron especialmente. Nuestra mirada dio algunos sentidos posibles a las imágenes ypefianas, en un intento de "desmitificar" los avisos y deconstruirlos para luego "volver a armarlos"

Acerca de la Tesis "Del Día del Petróleo Nacional al Día Nacional del Petróleo en propagandas y publicidades gráficas comodorenses de YPF"

El artículo presentará resultados obtenidos en una Tesis de Grado de la Licenciatura en Comunicación Social de la Facultad de Humanidades y Ciencias Sociales de la Universidad Nacional de la Patagonia San Juan Bosco. En ese trabajo, un análisis de imagen y discurso, nos propusimos estudiar comparativamente los discursos publicitarios que YPF emitió antes y después de ser privatizada. La conmemoración del 13 de diciembre, aniversario del descubrimiento del petróleo en el país (ocurrido en Comodoro Rivadavia), fue tomada como referencia. Nos preguntamos, entre otras cosas, cómo conciben Yacimientos Petrolíferos Fiscales (YPF) y Repsol a sus objetivos empresariales en relación al recurso y su vinculación con el desarrollo nacional. Por medio de lecturas de segundo orden que problematizan las relaciones entre significantes y significados que se nos imponen a través de procesos hegemónicos, deconstruimos veinticinco propagandas y publicidades publicadas en la prensa gráfica local entre 1943 y 2007. Cada mensaje fue entendido como un texto multimodal; y sus contextos de emisión, las estructuras internas de las imágenes y los mensajes propuestos nos interesaron especialmente. Nuestra mirada dio algunos sentidos posibles a las imágenes ypefianas, en un intento de "desmitificar" los avisos y deconstruirlos para luego "volver a armarlos"

Dialect features indexing hipster identity on social media: the case of the city of Malaga

Identity is a recurrent research interest in current sociolinguistics and it is also of primary interest in digital discourse studies. Identity construction is closely related to stance and style (Eckert 2008; Jaffe 2009), which are fundamental concepts for understanding the language use and its social meanings in the case of social media users from Malaga. As the specific social meanings of a set of dialect features constitute a style, this style and the social (and technological) context in which the variants are used determine the meanings that are actually associated with each variant. Hence, every variant has its own indexical field covering any number of potential meanings. The Spanish spoken in Malaga, as Andalusian Spanish in general, was in the past often times considered an incorrect, low prestige variety of Spanish which was strongly associated with the poor, rural, backward South of Spain. This southern Spanish variety is easily recognised because of its innovative phonetic features that diverge from the national standard. In this study several of these phonetic dialect features are looked at, which users from Malaga purposefully employ (in a textualised form) on social media for identity construction. This identity construction is analysed through interactional and ethnographic methods: A perception and an imitation task served as key data and were supplemented by answers to a series of open questions. Further data stems from visual, multimodal elements (e.g. images, photos, videos) posted by users from the city of Malaga. The program TAMS Analyzer was used for data codification and analysis. Results show that certain features that in spoken language are considered rural and old-fashioned, acquire new meaning on social media, namely of urbanity and fashion. Moreover, these features, if used online, are associated with hipsters. That is, the “cool” social media index the “coolness” of the dialect features in question and, thus, the mediatisation makes their indexical fields even more multi-layered and dynamic. Social media users from Malaga performatively employ these stylised dialect features to project a hipster identity and certain related stances.

La representación multimedial de la transición de ‘Malaguistán’ a ‘Málaga Soho subversivo

Lagunillas es un barrio céntrico de Málaga, a espaldas de algunas atracciones turísticas y culturales como la Plaza de la Merced, la Casa Natal de Picasso y el Teatro Cervantes. Durante muchos años este barrio se ha catalogado como área de riesgo social y de índices altos de pobreza y marginación, aunque recientemente varias asociaciones de vecinos se han esforzado por mejorar la situación de la barriada. Los colectivos activos en Lagunillas procuran documentar y denunciar el abandono de la zona por parte del Ayuntamiento y hacer visible las iniciativas tomadas por el vecindario en los medios sociales (Facebook, Twitter, Youtube) y en periódicos de oposición. Por tanto, esta contribución se centra en la representación multimodal del barrio Lagunillas en dichos medios. El estudio se basa en un enfoque de la semiótica social multimodal y recurre a métodos cualitativos con la ayuda del programa TAMS Analyzer. Los objetivos de análisis son cómo los activistas emplean diferentes recursos semióticos multimodales para mostrar el estado del barrio y de qué manera los recursos semióticos interactúan. La multimodalidad subraya de este modo la acción situada, es decir, acentúa la importancia del contexto social y de la elección de los recursos disponibles para crear significado. En el caso de Lagunillas la relación intersemiótica, y en especial, el modo visual, se convierten en recursos sumamente impactantes para representar la transición de “Malaguistán” a “Málaga Soho subversivo”.

Idiopathic multifocal choroiditis/punctate inner choroidopathy with acute photoreceptor loss or dysfunction out of proportion to clinically visible lesions.

PURPOSE To report acute/subacute vision loss and paracentral scotomata in patients with idiopathic multifocal choroiditis/punctate inner choroidopathy due to large zones of acute photoreceptor attenuation surrounding the chorioretinal lesions. METHODS Multimodal imaging case series. RESULTS Six women and 2 men were included (mean age, 31.5 ± 5.8 years). Vision ranged from 20/20-1 to hand motion (mean, 20/364). Spectral domain optical coherence tomography demonstrated extensive attenuation of the external limiting membrane, ellipsoid and interdigitation zones, adjacent to the visible multifocal choroiditis/punctate inner choroidopathy lesions. The corresponding areas were hyperautofluorescent on fundus autofluorescence and were associated with corresponding visual field defects. Full-field electroretinogram (available in three cases) showed markedly decreased cone/rod response, and multifocal electroretinogram revealed reduced amplitudes and increased implicit times in two cases. Three patients received no treatment, the remaining were treated with oral corticosteroids (n = 4), oral acyclovir/valacyclovir (n = 2), intravitreal/posterior subtenon triamcinolone acetate (n = 3), and anti-vascular endothelial growth factor (n = 2). Visual recovery occurred in only three cases of whom two were treated. Varying morphological recovery was found in six cases, associated with decrease in hyperautofluorescence on fundus autofluorescence. CONCLUSION Multifocal choroiditis/punctate inner choroidopathy can present with transient or permanent central photoreceptor attenuation/loss. This presentation is likely a variant of multifocal choroiditis/punctate inner choroidopathy with chorioretinal atrophy. Associated changes are best evaluated using multimodal imaging.

Sharing Human-Generated Observations by Integrating HMI and the Semantic Sensor Web

Current “Internet of Things” concepts point to a future where connected objects gather meaningful information about their environment and share it with other objects and people. In particular, objects embedding Human Machine Interaction (HMI), such as mobile devices and, increasingly, connected vehicles, home appliances, urban interactive infrastructures, etc., may not only be conceived as sources of sensor information, but, through interaction with their users, they can also produce highly valuable context-aware human-generated observations. We believe that the great promise offered by combining and sharing all of the different sources of information available can be realized through the integration of HMI and Semantic Sensor Web technologies. This paper presents a technological framework that harmonizes two of the most influential HMI and Sensor Web initiatives: the W3C’s Multimodal Architecture and Interfaces (MMI) and the Open Geospatial Consortium (OGC) Sensor Web Enablement (SWE) with its semantic extension, respectively. Although the proposed framework is general enough to be applied in a variety of connected objects integrating HMI, a particular development is presented for a connected car scenario where drivers’ observations about the traffic or their environment are shared across the Semantic Sensor Web. For implementation and evaluation purposes an on-board OSGi (Open Services Gateway Initiative) architecture was built, integrating several available HMI, Sensor Web and Semantic Web technologies. A technical performance test and a conceptual validation of the scenario with potential users are reported, with results suggesting the approach is sound

Improving Speech Interaction in Vehicles Using Context-Aware Information through A SCXML Framework

Speech Technologies can provide important benefits for the development of more usable and safe in-vehicle human-machine interactive systems (HMIs). However mainly due robustness issues, the use of spoken interaction can entail important distractions to the driver. In this challenging scenario, while speech technologies are evolving, further research is necessary to explore how they can be complemented with both other modalities (multimodality) and information from the increasing number of available sensors (context-awareness). The perceived quality of speech technologies can significantly be increased by implementing such policies, which simply try to make the best use of all the available resources; and the in vehicle scenario is an excellent test-bed for this kind of initiatives. In this contribution we propose an event-based HMI design framework which combines context modelling and multimodal interaction using a W3C XML language known as SCXML. SCXML provides a general process control mechanism that is being considered by W3C to improve both voice interaction (VoiceXML) and multimodal interaction (MMI). In our approach we try to anticipate and extend these initiatives presenting a flexible SCXML-based approach for the design of a wide range of multimodal context-aware HMI in-vehicle interfaces. The proposed framework for HMI design and specification has been implemented in an automotive OSGi service platform, and it is being used and tested in the Spanish research project MARTA for the development of several in-vehicle interactive applications.