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There is growing attention to student assessments designed to reach beyond the classroom, including assessments with an immediate or future audience. The impact of audience, however, has not been examined in multimodal assessments across continents, institutions, disciplines, and teaching contexts. Using qualitative data, this article examines the impact on student learning of incorporating audience and awareness of audience in diverse settings through multimodal projects. These include a core assignment in an interdisciplinary, semester-long graduate class in the United States, a year-long capstone project for geography undergraduates in Northern Ireland, and a supplemental assignment for graduate and undergraduate biology students in Norway. This article investigates the impact of audience through multimodal assessments across these three settings and concludes that it can positively influence student learning, motivation, and skill development.

Scholars studying team-licensed fan apparel have begun to surface the meanings communicated through fan clothing, particularly focusing on its gendered nature. This study extends upon this previous research by examining children's sport fan apparel via a social semiotics theoretical framework. The authors collected 377 items from 14 teams in seven major leagues in the United States. Merging a feminist lens with multimodal critical discourse analysis methodology, they uncovered how discourses and meanings in the marketing of these materials communicate organizational practices and structures. The study determined that the marketing presented discourses of gender segregation and (false) gender neutrality, as well as discourses of good parenting that legitimized the consumption of merchandise as a reflection of parenting ideologies. Organizations must address internal gendered practices to produce marketing materials and artifacts supporting gender equity and inclusivity. [ABSTRACT FROM AUTHOR]

Faced with linguicism, racism, and xenophobia aggravated by COVID-19 and political tensions in recent years, multilingual international students, especially those of Asian descent, are in urgent need of engaging in healing practices for meaningful identity expression, restoration, and peace. Translingualism is a justice-oriented literacy practice that disrupts the boundaries of named languages and allows communicators to draw upon all resources in their linguistic repertoires. Storytelling, as a powerful research method and a pedagogical tool, offers a unique opportunity to encourage multilingual students' translingual meaning making for healing. This qualitative case study examined how multimodal translingual storytelling functioned as a form of restoration and peace for a first-semester Chinese student pursuing her graduate degree in English at a private university in the United States. The findings indicate that when offered opportunities to reflect on her cultural and linguistic identities, the participant was likely to detach deficit self-perceptions as an "English language learner" and embrace her differences as a strength, which benefited her first-semester language and academic experiences. This study calls for pedagogical strategies and curriculum design that open up humanizing spaces for culturally and racially minoritized multilingual students by acknowledging, valuing, and inviting their whole linguistic repertories through multimodal, translingual storytelling.

This practitioner inquiry article examines the role that multimodal literacy plays in the organizing of Latinx immigrant youth in the U.S. Co-written by two of the youth who participated in this research, alongside the fellow immigrant activist who designed and carried out the year-long study, this paper analyzes a subset of qualitative data from the research and argues that young Latinx immigrant organizers are organic intellectuals who, as grassroots educators, mobilize their coalitional multimodal literacies to critically examine the common sense, meaning the dominant and taken-for-granted assumptions, of the immigrant rights movement in the U.S., and transform it into one that is inclusive, intergenerational, and challenging of colonial logics that separate oppressed and racialized communities from each other. Implications include conceptualizing socioemotional relational intuition as a component of multimodality and engaging young Latinx immigrants as grassroots educators whose coalitional multimodal literacies envision and enact a decolonial world.

Multimodal Learning Analytics (MMLA) has huge potential for extending the work beyond traditional learning analytics for the capabilities of leveraging multiple data modalities (e.g. physiological data, digital tracing data). To shed a light on its applications and academic development, a systematic bibliometric analysis was conducted in this paper. Specifically, we examine the following aspects: (1) Analyzing the yearly publication and citation trends since the year 2010; (2) Recognizing the most prolific countries, institutions, and authors in this field; (3) Identifying the collaborative patterns among countries, institutions, and authors, respectively; (4) Tracing the evolving procedure of the applied keywords and development of the research topics during the last decade. These analytic tasks were conducted on 194 carefully selected articles published since 2010. The analytical results revealed an increasing trend in the number of publications and citations, identified the prominent institutions and scholars with significant academic contributions to the area, and detected the topics (e.g. characterizing learning processes using multimodal data, implementing ubiquitous learning platforms) that received the most attention. Finally, we also highlighted the current research hotspots attempting to initiate potential interdisciplinary collaborations to promote further progress in the area of MMLA.

Increasing awareness about screening and instructional interventions for students with dyslexia is a necessary component of P-12 teacher preparation. Disparities in reading achievement for students with disabilities, including those with dyslexia, is evidenced in lower literacy testing scores as well as lower high school graduation rates for those with documented disabilities when compared to typical developing peers. Preservice teachers, however, continue to struggle with understanding, identifying, and providing targeted literacy instruction to remediate reading challenges for students with dyslexia. Emerging data on the impact of the COVID-19 school closures on lags in student's reading attainment, further solidifies the need for teacher preparation programs to prepare preservice teachers to implement best practices for supporting students with dyslexia. The purpose of this mixed-methods study was to determine the impact of asynchronous online learning modules on preservice teacher's knowledge of dyslexia. Results indicate that preservice teachers who learn via online sources such as podcasts, infographics, and educational games, statistically increase their knowledge of dyslexia and confidence to work with students. Recommendations for programmatic change and inclusion of online learning about dyslexia for teacher preparation programs are suggested.

Our reflexive study responds to the need for learning about translanguaging and multimodality as entangled pedagogies in non-English-dominant contexts from teachers' perspectives. This conceptual-empirical article re-examines a yearlong ethnographic study which traced how a community of seven in-service English language teachers in Colombia and the United States collaborated online and in person to make sense of and use translanguaging and multimodal pedagogies innovatively. Drawing on the notion of entanglements (assemblages of interconnections, events, people, practices, and resources that reveal tensions and translanguaging and multimodalities), we conceptualize them as enmeshed with social contexts. We ask, "What entanglements emerge when teachers implement translanguaging and multimodal pedagogies to enrich their practice in a context with inequitable access? Data sources include bilingual interviews, fieldnotes, and teacher-produced multimodal texts. We use dialogic reflexivity and vignettes to discuss teachers' creation of new entanglements of translanguaging and multimodal pedagogies within the constraints of their setting. Emerging insights include: (1) awareness of unequal access; (2) critical use of multimodalities and translanguaging for advocacy; (3) understandings of translanguaging and multimodalities for equitable access; and (4) and translanguaging and multimodal pedagogies as creative, dynamic, contextual and practical entanglements. These entangled pedagogies enabled teachers' creativity and criticallity.

Background: Early relational health (ERH) interventions can buffer toxic stress and improve the developmental trajectories of neonatal intensive care unit (NICU) infants., Purpose: The purpose was to examine the current state of the science related to multimodal, dyadic ERH interventions implemented in the NICU setting in the United States and identify gaps in the current literature., Data Sources: PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycInfo were searched in November 2022 and November 2023 for original studies and conference proceedings from 1970 to present in the English language. Gray literature searches were performed in February 2023 and December 2023., Study Selection: English language, original research, with a focus on multimodal, dyadic ERH interventions that took place primarily in a NICU in the United States were included. Outcome measures could be related to implementation, relational health, or physical and/or mental health outcomes of parent and/or infant. Eighteen of 2021 reviewed articles met the inclusion criteria., Data Extraction: Data were extracted for author, year, intervention, purpose, methods, sample, paternal inclusion, dyadic components, non-dyadic components, and major outcomes/results and distilled for study characteristics, multimodal, dyadic intervention characteristics, and outcome measures., Results: Several multimodal dyadic interventions exist to aid ERH in the NICU, providing evidence of improved outcomes for infants and families. More research is required using higher sample sizes and replication studies., Implications for Practice and Research: ERH interventions show promise in improving neurodevelopmental, behavioral, and maternal mental health outcomes and should be considered for implementation into NICU services., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 by The National Association of Neonatal Nurses.)

Competing Interests: Conflicts of Interest The following authors reported no actual or potential conflicts of interest in relation to this document: A.N., S.M.C., S.P.C., M.A.D., N.K.K., G.B.M., V.M., RF.S., B.X. The following authors reported relationships with one or more commercial interests: JD.E has participated as consultant to Abbott and Getinge and medical advisor to Medtronic; J.C. has received consulting fees from Boston Scientific and Abbott Vascular and has been a speaker for Medtronic, Circle Cardiovascular Imaging, and Siemens Healthineers; J.C. has participated as speaker and consultant to Abbott and Medtronic; B.D.H. has participated as speaker for Philips Medical; E.K. has participated as clinical consultant for Lantheus Medical Imaging.

In response to current anti-immigration rhetoric and policy coming from national leadership, the authors engage in multimodal analysis of picture books that humanize individuals who make the journey across the Mexico-U.S. border. Findings suggest that picture book narratives restory anti-immigrant sentiments by (1) placing the child at the center of the story, (2) demonstrating the way in which the (im)migration journey is a shared journey, and (3) featuring expressions of tenderness among the characters. The article emphasizes the importance of elevating young people's perspectives on Latinx (im)migration through children's literature.

Objective: The purpose of this study was to assess the effects of adding electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization, and ultrasound in patients with lateral elbow tendinopathy. Design: Randomized, single-blinded, multicenter, parallel-group trial. Setting: Thirteen outpatient physical therapy clinics in nine different US states. Participants: One hundred and forty-three participants (n = 143) with lateral elbow tendinopathy were randomized. Intervention: Cervical spine manipulation, extremity manipulation, and percutaneous tendon electrical dry needling plus multimodal physical therapy (n = 73) or multimodal physical therapy (n = 70) alone. Main measures: The primary outcome was elbow pain intensity and disability as measured by the Patient-Rated Tennis Elbow Evaluation at baseline, 1 week, 4 weeks, and 3 months. Secondary outcomes included the Numeric Pain Rating Scale, Tennis Elbow Functional Scale, Global Rating of Change, and medication intake. Results: The 2 × 4 analysis of covariance demonstrated that individuals with lateral elbow tendinopathy receiving electrical dry needling and thrust manipulation plus multimodal physical therapy experienced significantly greater improvements in disability (Patient-Rated Tennis Elbow Evaluation: F = 19.675; P < 0.001), elbow pain intensity (Numeric Pain Rating Scale: F = 22.769; P < 0.001), and function (Tennis Elbow Function Scale: F = 13.269; P < 0.001) than those receiving multimodal physical therapy alone at 3 months. The between-group effect size was large for pain and disability (Patient-Rated Tennis Elbow Evaluation: standardized mean difference = 1.13; 95% confidence interval: 0.78, 1.48) in favor of the electrical dry needling and thrust manipulation group. Conclusions: The inclusion of percutaneous tendon electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization and ultrasound was more effective than multimodal physical therapy alone in individuals with lateral elbow tendinopathy. Trial Registration: www.clinicaltrials.gov NCT03167710 May 30, 2017. [ABSTRACT FROM AUTHOR]

In metro areas in the United States, those who cannot drive have limited access to job opportunities and services located in low-density suburbs that are poorly served by public transit; at the same time, congested metropolitan freeways cause significant travel delays for commuters who have no option but to drive long distances to job sites during peak periods. In this Viewpoint, I present a systemwide approach to financing and fulfilling the transportation needs of those who do not drive while at the same time providing a congestion-free travel choice for those who do. It combines congestion pricing with cash rewards for those who choose to share rides on a network of congestion-free lanes converted from general-use lanes to priced lanes. Net revenues support multimodal travel options including transit, carpooling, and mobility hubs with transportation services to and from trip origins and final destinations, also known as first- and last-mile services. The strategy would allow existing metropolitan freeway networks to be transformed into financially viable, sustainable, and equitable multimodal systems providing high-quality travel choices that could lead to more sustainable urban development patterns. [ABSTRACT FROM AUTHOR]

Objective: Currently, diagnosis of cerebrospinal fluid (CSF) rhinorrhea relies on a multimodal approach, increasing costs and ultimately delaying diagnosis. In the United States and internationally, the crux of such a diagnosis relies on confirmation testing (via biomarkers) and localization (e.g., imaging). Biomarker testing may require analysis at an outside facility, resulting in delays diagnosis and treatment. In addition, specialized imaging may be nonspecific and often requires an active leak for diagnosis. There remains a clear need for innovative new technology. Methods: A comprehensive review was conducted on both foundational and innovative scholarly articles regarding current and emerging diagnosis modalities for CSF. Results: Current modalities in CSF rhinorrhea diagnosis and localization include laboratory tests (namely, B2T immunofixation), imaging (CT and/or MRI) with or without intrathecal administration, and surgical exploration. Each of these modalities carry flaws, risks, and benefits, ultimately contributing to delays in diagnosis and morbidity. Promising emerging technologies include lateral flow immunoassays (LFI) and biologically functionalized field-effect transistors (BioFET). Nevertheless, these carry some drawbacks of their own, and require further validation. Conclusion: CSF rhinorrhea remains a challenging diagnosis, requiring a multimodal approach to differentiate from nonpathologic causes of rhinorrhea. Current methods in diagnosis are imperfect, as the ideal test would be a readily accessible, inexpensive, rapid, highly accurate point-of-care test without the need for excess fluid or specialized processing. Critical work is being done to develop promising, new, improved tests, though a clear successor has not yet emerged. [ABSTRACT FROM AUTHOR]

The growing needs for employing multimodality in teaching have sparked research activities all around the world. Due to its broad range of applications, multimodality has received a lot of attention as an approach to be applied in any fields specifically in education. This bibliometric study aimed to evaluate the global research trends in applying multimodality to ESL classrooms based on publication outputs, co-authorships among authors and affiliated countries, and co-occurrences of author keywords. A total of 1303 journal articles published between 1972 and 2022 were retrieved using the Scopus database. The results demonstrate that the number of publications has been steadily increasing since 1972. Approximately 29% of the global total publications were contributed by researchers from the United States and the TESOL Quarterly published the greatest number of articles related to research on the multimodal approach in ESL classrooms. The findings of this review show that the application of multimodality to ESL classrooms may eventually supplant the clusters that dominated multimodality research in the past. In conclusion, the recent progress in implementing the multimodal approach in ESL classrooms includes the following, but not limited to, i) teaching strategies, ii) teaching environments, and iii) teaching and learning with educational technology. [ABSTRACT FROM AUTHOR]

Research has shown that arts-based approaches facilitate literacy learning in children; however, few studies have focused on the integration of art and early writing in community-based Chinese heritage language classes, which have been marginalized from the formal educational discourse in the United States. By drawing on the theoretical perspectives on social semiotics, this paper explored how young Chinese heritage learners engage in "writing" Chinese characters using fallen leaves. The data sources included field notes of observations, video recordings of the class, and the artifacts made by the children. Multimodal analysis revealed that the teacher invited the students to write together and created a social context for children to compose writing artwork. Children engaged with their composition through a variety of modes. This study has implications for research, practice, and policy. [ABSTRACT FROM AUTHOR]

This exploratory study investigated whether/how kindergartners (ages 5-6) with different linguistic backgrounds in Malta and the U.S. engaged in similar or different reading processes with the same app book "But Not the Hippopotamus" in English. As part of a broader project, we purposefully sampled children who scored top three and bottom three in their retelling of the book from each of the four linguistic groups: (1) Maltese as the dominant home language in Malta; (2) English as the dominant home language in Malta; (3) a third language other than English/Maltese as the dominant home language in Malta; and (4) monolingual English native speakers in the U.S. Our qualitative analysis of videos of the 27 children reading the app book revealed the distinct patterns of high-comprehension readers processes with multimodal digital features across these linguistic groups, and the potential of digital features to support learners with diverse linguistic backgrounds.

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Introduction: Although a combined treatment of prescription medication and psychotherapy provides long-term benefits for adults with attention deficit/hyperactivity disorder (ADHD), little is known about the prevalence of receiving such multimodal treatment. This study investigated trends in the prevalence and correlates of multimodal treatment among U.S.-insured adults newly diagnosed with ADHD., Methods: 495,180 U.S. adults from the Komodo Healthcare Map with newly diagnosed ADHD in 2017-2021 were included. Descriptive statistics were used to estimate trends in the prevalence of treatment (no treatment, prescription-only, psychotherapy-only, or both) within 3 months from the index ADHD diagnosis. Multinomial logistic regression was used to examine patient and provider characteristics associated with ADHD treatment. Analysis was conducted in May 2023., Results: From 2017 to 2021, the prevalence of newly diagnosed ADHD adults receiving multimodal, prescription-only, and psychotherapy-only treatment within 3 months following their first diagnosis increased from 12.9% to 21.4%, 30.2% to 33.3%, and 18.4% to 20.4%, respectively. Over the same period, the prevalence of newly diagnosed ADHD adults receiving no treatment declined from 38.5% to 25%. Relative to their counterparts, the odds of receiving multimodal ADHD treatment were significantly lower (p<0.05) for men, older adults, adults with multiple co-existing conditions, Medicaid and Medicare beneficiaries, and those living in socially disadvantaged areas. Furthermore, the odds of receiving multimodal treatment were higher (p<0.05) for adults who saw a nurse practitioner, physician assistant, or behavioral care (non-physician) provider on their first visit with an ADHD diagnosis, compared to those who saw a physician., Conclusions: 25% of newly diagnosed ADHD adults received no treatment in 2021 and 53.7% only received a single-modality treatment-raising concerns about the potential implications of untreated ADHD or insufficient treatment on the persistence of ADHD-related impairments, morbidity, productivity, and downstream healthcare cost. The study also highlighted potential sociodemographic, clinical, and provider disparities in ADHD treatment., (Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Atypical teratoid rhabdoid tumor (ATRT) is among the most aggressive central nervous system malignancies. Although rare, this tumor typically afflicts young children and results in mortality within months. Here, we aim to determine key clinical features and treatment options that impact the survival of patients with ATRT. Methods: From the year 2000 to 2019, 363 patients with ATRT were identified from the Surveillance, Epidemiology, and End Results database. Univariate analysis was used to identify variables that had a significant impact on the primary endpoint of overall survival (OS). Multivariable analysis was then used to identify independent predictors of survival. Results: The median OS of the entire cohort was 13 months. Univariate analysis identified ages between 1 and 3 years, ages between 4 and 17 years, years of diagnosis between 2010 and 2019, and the receipt of treatment to have a significant impact on survival. In multivariable analysis, ages between 1 and 3 years and receipt of treatment were the only significant independent predictors of survival. The median OS was significantly greater in patients who received surgical treatment, chemotherapy, or radiation when compared to those who did not receive any treatment. In general, the receipt of any combination of therapies improved the median OS significantly. The receipt of triple therapy had the greatest impact on survival. Discussion: This study highlights the survival benefit of a multimodal approach in the treatment of ATRT. The use of triple therapy, including surgery, radiation, and chemotherapy, was found to have the greatest survival benefit for patients. Overall, these findings may guide future care for patients with ATRT. [ABSTRACT FROM AUTHOR]

Menstrual inequity—unequal access to menstrual health care or products—negatively affects well-being in relation to the menstrual cycle, a construct known as menstrual health. Few studies have explored menstrual inequities among adolescent and young adult populations in the United States. This multimodal qualitative research aimed to explore factors that influence the lived experience of menstruation among this population. This qualitative study consisted of individual interviews among menstruators ages 13-24, recruited from an urban academic medical center. Participants (N = 20) were a mean age of 19 years; 25% previously endorsed period poverty, and 90% were publicly insured. We conducted semi-structured interviews using participant video diaries in a video elicitation exercise. Data were coded by 2 investigators using thematic analysis driven by grounded theory. Emergent themes included the need to normalize menstruation, the need for comprehensive menstrual health education, and the need for menstrual products to be more accessible. Twelve youth prepared video diaries, and all reported positive experiences with the video process. This youth-centered, multimodal study is one of the first to qualitatively explore the lived experiences of menstruation among adolescents in the United States and identified key inequities in menstrual health from their own perspectives. Thematic findings were mapped onto a proposed framework for menstrual equity that can be applied to future research and efforts around policy change. More research is needed to assess the impacts of these policies. [ABSTRACT FROM AUTHOR]

To evaluate the feasibility, acceptability, and effectiveness of the LoveYourBrain Retreat program using a pre-post, retrospective, concurrent triangulation mixed methods study. A 5-day, multimodal, residential Retreat intervention was designed to improve quality of life among traumatic brain injury (TBI) survivors and caregivers through mindfulness, movement, nutrition, art, and community-building. Eligibility included being a TBI survivor (>2 years post-injury) or caregiver, 18+ years old, independently mobile, able to communicate verbally, and a first-time participant. Self-reported quantitative and qualitative data were collected via electronic surveys pre- and post-retreat, analyzed separately, then combined. Paired t-tests assessed mean differences in scores on Quality of Life After Brain Injury Overall scale (QOLIBRI-OS) and NIH TBI/Neuro-QOL Resilience, Cognition, Positive Affect/Wellbeing, and Emotional/Behavioral Dysregulation scales. We assessed feasibility using sample characteristics and program frequency and retention, and acceptability using quality ratings. Content analysis explored perceived benefits and improvements. 68 People—53 with TBI and 15 caregivers—participated in one of three LoveYourBrain Retreats. Significant improvements were found in QOLIBRI-OS (6.91, 95%CI 1.88–11.94), Resilience (2.14, 95%CI 0.50–3.78), Cognition (2.81, 95%CI 0.79–4.83), and Emotional/Behavioral Dysregulation (2.84, 95%CI 0.14–5.54) among TBI survivors (n = 41). Mean satisfaction was 9.6/10 (SD = 0.64). Content analysis revealed community connection, reframing TBI experience, self-regulation, and self-care themes. The LoveYourBrain Retreat is feasible, acceptable, and may be effective complementary rehabilitation to improve QOL among TBI survivors. Ongoing, holistic rehabilitation services are critical to quality of life for people with chronic traumatic brain injury (TBI). Residential retreats are a type of holistic, multimodal, community-based rehabilitation. LoveYourBrain Retreats improved quality of life, resilience, cognition, and emotional dysregulation among people with TBI. The integration of community connection, reframing TBI experience, self-regulation, and self-care may support adjustment to TBI. [ABSTRACT FROM AUTHOR]

Introduction: The impact of Medicaid expansion (ME) on the treatment of patients with cancer remains controversial, especially individuals requiring complex multidisciplinary care. We sought to evaluate the impact of Medicaid expansion (ME) on receipt of multimodal care, including surgical resection, for Stage I-III biliary tract cancer (BTC)., Methods: Patients diagnosed with BTC between 40 and 65 years of age were identified from the National Cancer Database and divided into pre- (2008-2012) and post- (2015-2018) ME cohorts. Difference-in-difference (DID) analysis was used to determine the impact of ME on the utilization of surgery and multimodal chemotherapy and/or radiotherapy treatment for BTC., Results: Among 12,415 patients with BTC (extrahepatic, n = 5622, 45.3%; intrahepatic, n = 4352, 35.1%; gallbladder, n = 1944, 15.7%; overlapping, n = 497, 4.0%), 5835 (47.0%) and 6580 (53.0%) patients were diagnosed before versus after ME, respectively. Overall utilization of surgery (OR 1.13, 95% CI 1.02-1.26) and multimodality therapy (OR 1.13, 95% CI 1.01-1.27) increased in states that adopted ME. Utilization of surgery among uninsured/Medicaid patients in ME states increased relative to patients living in non-ME states (∆+10.1%, p = 0.01). Similarly, the use of multimodal treatment increased among uninsured/Medicaid patients living in ME versus non-ME states (∆+6.4%, p = 0.04); in contrast, there were no difference among patients with other insurance statuses (overall: ∆+1.5%, private: ∆-2.0%, other: ∆+3.9%, all p > 0.5). Uninsured/Medicaid patients with BTC who lived in a ME state had a lower risk of long-term death in the post-ME era (HR 0.81, 95% CI 0.67-0.98; p = 0.03)., Conclusions: Implementation of ME positively impacted survival among patients who underwent surgical and multimodal treatment for Stage I-III BTC., (© 2023 Wiley Periodicals LLC.)

Background: Although receipt of neoadjuvant chemotherapy has been identified to improve unfavorable survival outcomes among patients with locally advanced gastric cancer (LAGC), several randomized controlled trials have not demonstrated a difference in oncological outcomes/overall survival (OS) among patients undergoing minimally invasive surgery (MIS) versus open gastrectomy. This study aimed to investigate National Comprehensive Cancer Network (NCCN) guideline adherence and textbook oncological outcome (TOO) among patients undergoing MIS versus open surgery for LAGC., Methods: In this cross-sectional study, patients with stage II/III LAGC (cT2-T4N0-3M0) who underwent curative-intent treatment between 2013 and 2019 were evaluated using the National Cancer Database. Multivariable analysis was performed to assess the association between surgical approach, NCCN guideline adherence, TOO, and OS. The study was registered on the International Standard Randomised Controlled Trial Number registry (registration number: ISRCTN53410429) and conducted according to the Strengthening The Reporting Of Cohort Studies in Surgery and Strengthening the Reporting of Observational Studies in Epidemiology guidelines., Results: Among 13,885 patients, median age at diagnosis was 68 years (IQR, 59-76); most patients were male (n = 9887, 71.2%) and identified as White (n = 10,295, 74.1%). Patients who underwent MIS (n = 4692, 33.8%) had improved NCCN guideline adherence and TOO compared with patients who underwent open surgery (51.3% vs 43.5% and 36.7% vs 27.3%, respectively; both P < .001). Adherence to NCCN guidelines and likelihood to achieve TOO increased from 2013 to 2019 (35.6% vs 50.9% and 31.4% vs 46.4%, respectively; both P < .001). Moreover, improved median OS was observed among patients with NCCN guideline adherence and TOO undergoing MIS versus open surgery (57.3 vs 49.8 months [P = .041] and 68.4 vs 60.6 months [P = .025], respectively)., Conclusions: An overall increase in guideline-adherent treatment and achievement of TOO among patients with LAGC undergoing multimodal and curative-intent treatment in the United States was observed. Adoption of minimally invasive gastrectomy may result in improved short- and long-term outcomes., Competing Interests: Declaration of competing interest Karol Rawicz-Pruszyński is a scholar of the Polish National Agency for Academic Exchange (NAWA) Franciszek Walczak program, which allowed conducting this study as a Research Fellow at the Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States. The other authors report no conflict of interest., (Copyright © 2023 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)

Introduction: Because limited data exist, we sought to evaluate timeliness of multimodal treatments in a safety net breast cancer population., Methods: Breast cancer patients treated at a safety net hospital from 2016 to 2020 were analyzed retrospectively. Time intervals were defined as primary time (PT) from diagnosis to initiation of primary intervention, secondary time (ST) from completion of primary to initiation of secondary intervention, and tertiary time (TT) from completion of secondary to initiation of tertiary intervention. Variables included primary language, insurance type, and race., Results: Of 223 patients, 99 (44.4%) primarily spoke Spanish, 29 (13.0%) were of Black race, and 184 (82.5%) had Medicaid or uninsured status. Median (IQR) age at diagnosis was 55 (48-62) years. Primary intervention was surgical in 127/216 (58.8%); secondary intervention was systemic in 38/169 (22.5%); and tertiary intervention was radiation in 67/80 (83.8%). Overall, median days (IQR) for PT were 69 (53, 98), ST were 65 (42, 95), and TT were 69 (43, 88). PT was significantly longer in Black [105 (76, 142) days] patients compared to non-Hispanic White patients [68 (51, 107) days, P = 0.031)] and White Hispanic patients [65 (53,91) days, P = 0.014]. There were no significant differences in PT, ST, or TT by spoken language or insurance type., Conclusions: Black patients remain at risk due to prolonged time to intervention. Spanish-speaking status was not associated with inferior timeliness or completion of multimodal care at a safety net hospital. Identifying safety net hospital barriers to achieving benchmarks for timely completion of all phases of multimodal care warrants further attention., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Importance: The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) is the largest randomized clinical trial to evaluate screening's impact on ovarian cancer mortality, assigning women to multimodal screening (MMS) with serum cancer antigen 125 (CA-125) interpreted using a risk algorithm. If the MMS screening method is eventually shown to reduce mortality and be cost-effective, then it may be accepted by the medical community as a feasible screening tool., Objective: To estimate the cost-effectiveness of an MMS screening program in the United States., Design, Setting, and Participants: A Markov simulation model was constructed using data from UKCTOCS to compare MMS with no screening in the United States. Screening would begin at the age of 50 years for women in the general population. Published estimates of the long-term effect of MMS screening on ovarian cancer mortality and the trial's published hazard ratios were used to simulate mortality estimates up to 40 years from start of screening. Base-case costs included CA-125, ultrasound, and false-positive work-up results, in addition to a risk algorithm cost estimate of $100. The utility and costs of ovarian cancer treatment were incorporated into the model., Interventions: Screening strategies varied by costs of the algorithm and treatment for advanced ovarian cancer, rates of screening compliance, ovarian cancer incidence, and extrapolation of ovarian cancer mortality., Main Outcomes and Measures: Costs, quality-adjusted life-years (QALYs), and mortality reduction of ovarian cancer screening., Results: Multimodal screening is both more expensive and more effective in reducing ovarian cancer mortality over a lifetime than no screening. After accounting for uncertainty in the underlying parameters, screening women starting at age 50 years with MMS is cost-effective 70% of the time, when decision makers are willing to pay $150 000 per QALY. Screening reduced mortality by 15%, with an incremental cost-effectiveness ratio (ICER) ranging from $106 187 (95% CI, $97 496-$127 793) to $155 256 (95% CI, $150 369-$198 567)., Conclusions and Relevance: Ovarian cancer screening is potentially cost-effective in the United States depending on final significance of mortality reduction and cost of the CA-125 risk algorithm. These results are limited by uncertainty around the effect of screening on ovarian cancer mortality beyond the 11 years of UKCTOCS.

This qualitative study investigated 27 US and 28 Turkish dyads of children between 4 and 6 years old who read 12 app books across a school year. Emergent coding and constant comparison were used to identify reading patterns in which the dyads engaged: hotspot-centric, text-centric, and integrated. Then we examined how characteristics of readers (socio-economic status, language, and gender), text (animations, navigation features, and typographical cues), and context (social interaction styles) were related to these reading patterns. Children read differently in their native versus a foreign language, and social interaction styles played a role in how reading patterns changed over time. Integrated reading, navigating sequentially through the app book, and collaborative social interactions were related to deeper meaning-making and the use of more effective reading patterns over time. Implications include how to model and scaffold app book reading practices, select texts for instruction, and design app books with features that have been shown to be effective.

Introduction: Informational graphics and data representations (e.g., charts and figures) are critical for accessing educational content. Novel technologies, such as the multimodal touchscreen which displays audio, haptic, and visual information, are promising for being platforms of diverse means to access digital content. This work evaluated educational graphics rendered on a touchscreen compared to the current standard for accessing graphical content. Method: Three bar charts and geometry figures were evaluated on student (N = 20) ability to orient to and extract information from the touchscreen and print. Participants explored the graphics and then were administered a set of questions (11–12 depending on graphic group). In addition, participants' attitudes using the mediums were assessed. Results: Participants performed statistically significantly better on questions assessing information orientation using the touchscreen than print for both bar chart and geometry figures. No statistically significant difference in information extraction ability was found between mediums on either graphic type. Participants responded significantly more favorably to the touchscreen than the print graphics, indicating them as more helpful, interesting, fun, and less confusing. Discussion: Accessing and orienting to information was highly successful by participants using the touchscreen, and was the preferred means of accessing graphical information when compared to the print image for both geometry figures and bar charts. This study highlights challenges in presenting graphics both on touchscreens and in print. Implications for Practitioners: This study offers preliminary support for the use of multimodal, touchscreen tablets as educational tools. Student ability using touchscreen-based graphics seems to be comparable to traditional types of graphics (large print and embossed, tactile graphics), although further investigation may be necessary for tactile graphic users. In summary, educators of students with blindness and visual impairments should consider ways to utilize new technologies, such as touchscreens, to provide more diverse access to graphical information. [ABSTRACT FROM AUTHOR]

Research has shown that climate change creates warmer temperatures and drier conditions, leading to longer wildfire seasons and increased wildfire risks in the United States. These factors have, in turn, led to increases in the frequency, extent, and severity of wildfires in recent years. Given the danger posed by wildland fires to people, property, wildlife, and the environment, there is an urgent need to provide tools for effective wildfire management. Early detection of wildfires is essential to minimizing potentially catastrophic destruction. To that end, in this paper, we present our work on integrating multiple data sources into SmokeyNet, a deep learning model using spatiotemporal information to detect smoke from wildland fires. We present Multimodal SmokeyNet and SmokeyNet Ensemble for multimodal wildland fire smoke detection using satellite-based fire detections, weather sensor measurements, and optical camera images. An analysis is provided to compare these multimodal approaches to the baseline SmokeyNet in terms of accuracy metrics, as well as time-to-detect, which is important for the early detection of wildfires. Our results show that incorporating weather data in SmokeyNet improves performance numerically in terms of both F1 and time-to-detect over the baseline with a single data source. With a time-to-detect of only a few minutes, SmokeyNet can be used for automated early notification of wildfires, providing a useful tool in the fight against destructive wildfires. [ABSTRACT FROM AUTHOR]

Introduction: Telehealth is an important tool in helping to provide services for hard-to-reach populations. One population that might benefit from telehealth are individuals with fragile X syndrome (FXS). Although FXS is the leading inherited cause of intellectual disability, it is nonetheless a low incidence disorder. Individuals with FXS and their families are involved in research studies, clinical trials and receive interventions – many of which are only offered in a few locations in the United States and thus, not easily accessible to many families. The current project explored the feasibility of using telehealth procedures to collect multimodal behavioural and psychological assessment data from these families. Methods: Participation in the current study involved online surveys, measures of physiological indices of stress, live interviews and observations of mother–child interactions conducted via distance videoconferencing using the family's own technology when possible. Across all modes of data collection, we obtained information regarding the feasibility of participating entirely via distance by documenting missing data as well as each mother's overall impression of participating via distance. Results: Our telehealth procedures were successfully implemented across a wide range of technology platforms with limited difficulty, and we documented little missing data due to technology-related challenges. Perhaps most importantly, however, our sample of mothers reported high satisfaction with participating via distance. Discussion: These findings suggest that a wide range of services and types of assessments may be amenable to telehealth procedures. Further, the findings have immediate applications as the field shifts towards telehealth due to the coronavirus disease 2019 (COVID-19) pandemic. [ABSTRACT FROM AUTHOR]

Amidst global competition in higher education, colleges and universities adopt strategies that mimic and adapt business practices. Branding is now a widespread practice in higher education; multimodal advertisement is a manifestation of emerging branding strategies for universities. While the visibility of brands in higher education has grown substantially in recent years, its empirical study has lagged. This article reports on the findings from a study that employed social semiotic and multimodal analysis to explore text and visual rhetoric as brand construction strategies in publicly displayed university advertisements. After analyzing photographs representing advertising campaigns from 16 different universities displayed in an urban public transportation system, I suggest that universities construct their brand identity through messages that emphasize multiple choices and convenience, but construct success primarily according to corporate standards and values.

Background: The extent of tick-borne disease (TBD) risk in the United States is generally unknown. Active surveillance using entomological measures, such as presence and density of infected nymphal Ixodes scapularis ticks, have served as indicators for assessing human risk, but results have been inconsistent and passive surveillance via public health systems suggests TBDs are underreported., Objective: Research using various data sources and collection methods (eg, Google Trends, apps, and tick bite encounters [TBEs] reports) has shown promise for assessing human TBD risk. In that vein, and engaging a One Health perspective, this study used multimodal databases, geographically overlaying patient survey data on TBEs and concomitant reports of TBDs with data drawn from other sources, such as canine serological reports, to glean insights and to determine and assess the use of various indicators as proxies for human TBD risk., Methods: This study used a mixed methods research strategy, relying on triangulation techniques and drawing on multiple data sources to provide insights into various aspects of human disease risk from TBEs and TBDs in the United States. A web-based survey was conducted over a 15-month period beginning in December 2020 to collect data on TBEs. To maximize the value of the covariate data, related analyses included TBE reports that occurred in the United States between January 1, 2000, and March 31, 2021. TBEs among patients diagnosed with Lyme disease were analyzed at the county level and compared to I scapularis and I pacificus tick presence, human cases identified by the Centers for Disease Control and Prevention (CDC), and canine serological data. Spatial analyses employed multilayer thematic mapping and other techniques., Results: After cleaning, survey results showed a total of 249 (75.7%) TBEs spread across 148 respondents (61.9% of all respondents, 81.7% of TBE-positive respondents); 144 (4.7%) counties in 30 states (60%) remained eligible for analysis, with an average of 1.68 (SD 1.00) and median of 1 (IQR 1) TBEs per respondent. Analysis revealed significant spatial matching at the county level among patient survey reports of TBEs and disease risk indicators from the CDC and other official sources. Thematic mapping results included one-for-one county-level matching of reported TBEs with at least 1 designated source of human disease risk (ie, positive canine serological tests, CDC-reported Lyme disease, or known tick presence)., Conclusions: Use of triangulation methods to integrate patient data on TBE recall with established canine serological reports, tick presence, and official human TBD information offers more granular, county-level information regarding TBD risk to inform clinicians and public health officials. Such data may supplement public health sources to offer improved surveillance and provide bases for developing robust proxies for TBD risk among humans., (©Sarah P Maxwell, Chris Brooks, Dohyeong Kim, Connie L McNeely, Seonga Cho, Kevin C Thomas. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 23.08.2023.)

Background: Surgery is a common setting for opioid-naive patients to first be exposed to opioids. Understanding the multimodal analgesic-prescribing habits of podiatric surgeons in the United States may be helpful to refining prescribing protocols. The purpose of this benchmark study was to identify whether certain demographic characteristics of podiatric surgeons were associated with their postoperative multimodal analgesic-prescribing practices., Methods: We administered a scenario-based, voluntary, anonymous, online questionnaire that consisted of patient scenarios with a unique podiatric surgery followed by a demographics section. We developed multiple logistic regression models to identify associations between prescriber characteristics and the odds of supplementing with a nonsteroidal anti-inflammatory drug, regional nerve block, and anticonvulsant agent for each scenario. We developed multiple linear regression models to identify the association of multimodal analgesic-prescribing habits and the opioid dosage units prescribed at the time of surgery., Results: Eight hundred sixty podiatric surgeons completed the survey. Years in practice was a statistically significant variable in multiple scenarios. Compared with those in practice for more than 15 years, podiatric surgeons in practice 5 years or less had increased odds of reporting supplementation with an anticonvulsant agent in scenarios 1 (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.11-5.18; P = .03), 3 (OR, 2.97; 95% CI, 1.55-5.68; P = .001), 4 (OR, 2.54; 95% CI, 1.56-4.12; P < .001), and 5 (OR, 2.07; 95% CI, 1.29-3.32; P = .003)., Conclusions: Podiatric surgeons with fewer years in practice had increased odds of supplementing with an anticonvulsant. Approximately one-third of podiatric surgeons reported using some form of a nonopioid analgesic and an opioid in every scenario. The use of multimodal analgesics was associated with a reduction in the number of opioid dosage units prescribed at the time of surgery and may be a reasonable adjunct to current protocols.

Competing Interests: Conflict of Interest None.

Objective: This case series examines the use of a multimodal wound matrix (MWM) trialled in a selection of clinical practice settings and on a variety of hard-to-heal wounds. The objective was to evaluate the effects of MWM and its performance in managing such wounds, regardless of clinical setting and ulcer type. Method: Treatment of the MWM was conducted by independent wound care practitioners on wounds that were of >4 weeks duration. Treatment was once a week. Assessment was taken after four weeks and at week 12 of the study to assess percentage area reduction (PAR) compared to baseline measurements taken at the first treatment visit. Complete (100%) re-epithelialisation was also recorded. Results: A total of 63 wounds were treated with MWM, and ulcer types were grouped as: diabetic foot ulcers (n=21); venous leg ulcers (n=18); pressure injuries (n=10); and others (n=14). Of the wounds, 78% had 100% re-epithelialisation, with an average PAR of 57% at four weeks and 86% at 12 weeks. The average time to resolution for those wounds that closed was 7.9 weeks. Conclusion: Results from this series of independent case studies support the application of MWM to potentially benefit healing in hard-to-heal wounds of different aetiologies of any duration and in a variety of clinical settings. [ABSTRACT FROM AUTHOR]

Background: Universities are vulnerable to infectious disease outbreaks, making them ideal environments to study transmission dynamics and evaluate mitigation and surveillance measures. Here, we analyze multimodal COVID-19-associated data collected during the 2020-2021 academic year at Colorado Mesa University and introduce a SARS-CoV-2 surveillance and response framework., Methods: We analyzed epidemiological and sociobehavioral data (demographics, contact tracing, and WiFi-based co-location data) alongside pathogen surveillance data (wastewater and diagnostic testing, and viral genomic sequencing of wastewater and clinical specimens) to characterize outbreak dynamics and inform policy. We applied relative risk, multiple linear regression, and social network assortativity to identify attributes or behaviors associated with contracting SARS-CoV-2. To characterize SARS-CoV-2 transmission, we used viral sequencing, phylogenomic tools, and functional assays., Findings: Athletes, particularly those on high-contact teams, had the highest risk of testing positive. On average, individuals who tested positive had more contacts and longer interaction durations than individuals who never tested positive. The distribution of contacts per individual was overdispersed, although not as overdispersed as the distribution of phylogenomic descendants. Corroboration via technical replicates was essential for identification of wastewater mutations., Conclusions: Based on our findings, we formulate a framework that combines tools into an integrated disease surveillance program that can be implemented in other congregate settings with limited resources., Funding: This work was supported by the National Science Foundation, the Hertz Foundation, the National Institutes of Health, the Centers for Disease Control and Prevention, the Massachusetts Consortium on Pathogen Readiness, the Howard Hughes Medical Institute, the Flu Lab, and the Audacious Project., Competing Interests: Declaration of interests P.C.S. is a co-founder of, shareholder in, and scientific advisor to Sherlock Biosciences, Inc.; she is also a Board member of and shareholder in Danaher Corporation. P.C.S. has filed IP related to genome sequencing and analysis., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Literature on the effectiveness of child poverty education in undergraduate medical education is scant. This study adds quantitative and qualitative support for incorporation of a multimodal curriculum to improve student knowledge, confidence, and attitudes toward child poverty. [ABSTRACT FROM AUTHOR]

Importance: The conflict in Ukraine has forced civilian hospitals with limited trauma and battlefield medicine experience to care for casualties of war, placing significant strain on the health care system. Using the Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) program, a multimodal trauma critical care knowledge-exchange platform was created for clinicians practicing in these institutions., Objectives: To describe the development and implementation of the CERTAIN for Ukraine program and to evaluate the reach of this intervention, together with participant engagement and satisfaction., Design, Setting, and Participants: This quality improvement study included clinicians caring for critically ill patients during the ongoing Ukrainian conflict who were part of a community developed using a messaging app. The program was implemented by a group of international trauma and critical care experts in collaboration with critical care leaders from the Shupyk National Healthcare University in Kyiv, Ukraine. This study evaluates data collected from the CERTAIN for Ukraine program from its launch on April 9, 2022, to August 31, 2022., Interventions: The initiative comprised a longitudinal series of interactive tele-education sessions, a webpage containing the CERTAIN approach and current trauma critical care guidelines translated into Ukrainian and Russian, and a private messaging chat for asynchronous discussion., Main Outcomes and Measures: Participant engagement and satisfaction were tracked using multimedia analytics and a post-session survey., Results: Since program launch, 838 participants have joined the messaging group, and 6 tele-education sessions have been delivered, with 1835 total views. The CERTAIN website has had 3527 visits, mainly from Ukraine (1378 [39%]) and the United States (1060 [30%]). Of the 74 completed postsession surveys, 65 respondents (88%) rated the course content excellent or very good, and 73 (99%) recommended it to others., Conclusions and Relevance: The findings of this quality improvement study indicate that, using widely available and low-cost platforms, knowledge was shared rapidly and efficiently to a large community of clinicians practicing in a wartime environment with broad-based engagement and a high level of learner satisfaction.

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Background: High incidence of delirium in hospitalized patients has been reported in the United States and is significantly associated with increased morbidity and mortality. The lack of knowledge and confidence in performing delirium assessment (KCDA) has led to significant underrecognition of delirium by nurses regardless of evidence-based education intervention. Objective: The purpose of this study was to determine the effectiveness of a multimodal educational program (MEP) to enhance nurses' KCDA. Methods: A MEP including an online didactic with a video-simulation and 1:1 bedside coaching with delirium screening (DS) was conducted in the surgical intermediate-care unit of an academic medical center. A quasi-experimental pre- and post-test design was used. Results: Of 23 nurses, the majority were <41 years old (73.9%) and had at least a bachelor of science in nursing degree (78.3%) with <6 years of experience (60.9%). The overall KCDA scores and the performance of DS improved significantly after the MEP (p <.001). A positive correlation was noted between the changes of the KCDA scores (p =.009). Conclusions: The MEP demonstrated improvement in nurses' KCDA. The MEP should focus on an individualized learning approach with a targeted patient population, using current delirium screening tools. Implications for Nursing: Educational programs are recommended in either an orientation or continuing education program on nursing units. This is also recommended for use in other academic centers that encompass similar clinical settings and could possibly be considered for use in other disease processes. [ABSTRACT FROM AUTHOR]

This article argues that tracing multimodal-multilingual literacy practices across official and unofficial spaces is key to moving composition into the twenty-first century. Key to this remixing of the field is a situated framework that locates multimodal-multilingual activities in wider genre, cultural, national, and global ecologies. (Contains 3 figures and 15 notes.)

This interpretive case study investigated how a fifth-grade teacher's social practices with visual and linguistic signs positioned her students (10- and 11-year-olds) to take up particular modes as they constructed digital compositions. The context of the study was a suburban public school in the northeastern United States. Analysis was threefold. The discourse surrounding multimodal composition was analyzed via inductive analysis. Students' use of semiotic resources in the HyperStudio composition was analyzed with Unsworth's image-language intermodal framework. Then, teacher-student conversations related to visual and linguistic signs were triangulated with students' compositions. Findings show that a classroom teacher's limited content knowledge as related to metafunctions and metalanguage of visual and linguistic sign systems affected the information taught to the students and, ultimately, their use of visual and linguistic signs. Students demonstrated tacit knowledge of image-language relations beyond what was taught but lacked the explicit knowledge to more strategically use visual and linguistic signs. Implications include the importance of creating opportunities for teachers to develop more substantive content knowledge of the metalanguages and metafunctions of various sign systems. (Contains 3 tables and 7 figures.)

This article explores how immigrant students in the United States utilise multimodal literacy practices to complicate dominant narratives of American national identity--narratives of facile assimilation, meritocracy and linear trajectories. Such ideologies can be explicitly evident in curricular materials or can be woven more implicitly into school literacy practices that privilege individual achievement, devalue cultural ways of knowing, and operate on a paradigm of remediation. Within this educational backdrop, we report on a practitioner research study that invited students in a summer school programme for English Language Learners to share their experiences in multiple formats and media, including comics, and to draw on their cultural and linguistic heritages as sources of knowledge. We feature comics created by two students in the programme (an 8-year-old girl of Indian heritage and a 16-year-old boy from Vietnam) to understand the potential of visual texts to articulate micronarratives of immigration. We emphasise how students blend semiotic resources in order to represent the complexity of their experiences, convey cultural hybridity and resist singular narratives. (Contains 3 figures.)

Dairy goat kids are commonly disbudded in the United States without pain relief. Our objective was to identify an efficient pain management strategy by monitoring changes in plasma biomarkers and behavior of disbudded goat kids. A total of 42 kids (5–18 d old at the time of disbudding) were randomly allocated to 1 of 7 treatments (n = 6/treatment): sham treatment; 0.05 mg/kg i.m. xylazine (X); 4 mg/kg subcutaneous buffered lidocaine (L); 1 mg/kg oral meloxicam (M); xylazine and lidocaine (XL); xylazine and meloxicam (XM); and xylazine, meloxicam, and lidocaine together (XML). Treatments were administered 20 min before disbudding. One trained individual, blinded to treatment, disbudded all kids; sham-treated kids were handled similarly except the iron was cold. Jugular blood samples (3 mL) were obtained before (−20, −10, and −1 min) and after (1, 15, and 30 min, and 1, 2, 4, 6, 12, 24, 36, 48 h) disbudding and analyzed for cortisol and prostaglandin E 2 (PGE 2). Mechanical nociceptive threshold (MNT) testing was performed at 4, 12, 24, and 48 h after disbudding, and kids were weighed daily until 2 d post-disbudding. Vocalizations, tail flicks, and struggle behavior during disbudding were recorded. Cameras were mounted over home pens; continuous and scan observations over 12 periods of 10 min each, in the 48 h after disbudding, captured frequency of locomotion and pain-specific behaviors. Repeated measures and linear mixed models assessed treatment effects on outcome measures during and after disbudding. Models accounted for sex, breed, and age as random effects, and Bonferroni adjustments accounted for multiple comparisons. At 15 min after disbudding, XML kids had lower plasma cortisol concentrations compared with L (50.0 ± 13.2 vs. 132.8 ± 13.6 mmol/L) and M kids (50.0 ± 13.2 vs. 145.4 ± 15.7 mmol/L). Cortisol was also lower in XML kids over the first hour after disbudding compared with L kids (43.4 ± 9 vs. 80.2 ± 9 mmol/L). Change from baseline PGE 2 was not affected by treatment. Behaviors observed during disbudding did not differ by treatment group. Treatment affected MNT such that M kids were more sensitive overall compared with sham kids (0.93 ± 0.11 kgf vs. 1.35 ± 0.12 kgf). None of the recorded post-disbudding behaviors were affected by treatment, but study activities did influence behavior over time, with kid activity levels declining in the first day after disbudding but largely recovering thereafter. We conclude that none of the drug combinations investigated here appeared to fully attenuate pain indicators during or after disbudding, but triple modality seems to have offered partial relief compared with some of the single-modality treatments. [ABSTRACT FROM AUTHOR]

Lyme disease is the most common vector-borne infectious disease in the United States. Post-treatment Lyme disease (PTLD) is a condition affecting 10–20% of patients in which symptoms persist despite antibiotic treatment. Cognitive complaints are common among those with PTLD, suggesting that brain changes are associated with the course of the illness. However, there has been a paucity of evidence to explain the cognitive difficulties expressed by patients with PTLD. This study administered a working memory task to a carefully screened group of 12 patients with well-characterized PTLD and 18 healthy controls while undergoing functional MRI (fMRI). A subset of 12 controls and all 12 PTLD participants also received diffusion tensor imaging (DTI) to measure white matter integrity. Clinical variables were also assessed and correlated with these multimodal MRI findings. On the working memory task, the patients with PTLD responded more slowly, but no less accurately, than did controls. FMRI activations were observed in expected regions by the controls, and to a lesser extent, by the PTLD participants. The PTLD group also hypoactivated several regions relevant to the task. Conversely, novel regions were activated by the PTLD group that were not observed in controls, suggesting a compensatory mechanism. Notably, three activations were located in white matter of the frontal lobe. DTI measures applied to these three regions of interest revealed that higher axial diffusivity correlated with fewer cognitive and neurological symptoms. Whole-brain DTI analyses revealed several frontal lobe regions in which higher axial diffusivity in the patients with PTLD correlated with longer duration of illness. Together, these results show that the brain is altered by PTLD, involving changes to white matter within the frontal lobe. Higher axial diffusivity may reflect white matter repair and healing over time, rather than pathology, and cognition appears to be dynamically affected throughout this repair process. [ABSTRACT FROM AUTHOR]

This case study shares the experiences of 24 students in an urban high school in the U.S. Midwest who spent 6 weeks learning about, and applying tenets of, critical race theory (CRT) to their analysis of the canonical The Adventures of Huckleberry Finn. Students created a visual essay reflecting their understanding of CRT in the novel and in their broader social milieu. Drawing from, and sharing possibilities for, merging theoretical principles from CRT, multiliteracies, and the writing process, we/the authors ask: How can students utilize multiple perspectives to sharpen racial literacies through multimodal design? These findings include three points of integration: (a) overt instruction, Whiteness, and organizing; (b) critical framing, intersectionality, and address; and (c) transformed practice, critical stance, and revise and survey again. [ABSTRACT FROM AUTHOR]

Background: Colon cancer, a potentially preventable and curable cancer, remains one of the leading causes of cancer-related death in the United States. In 2010 the researchers undertook a multifaceted initiative to reduce colon cancer mortality rates by 50% over 10 years., Methods: A baseline literature review of preventable causes of colon cancer mortality and review of 50 deaths from colon cancer in one institution identified a set of care process improvements that could be implemented to decrease colon cancer mortality. In 2017 a second mortality review identified a second set of care process improvements that were subsequently implemented. Compliance with these processes was monitored along with age and gender-adjusted mortality rates., Results: Identified care process improvements included improving the follow-up of patients with rectal bleeding and presumed iron deficiency anemia and improving the reliability of postsurgical surveillance for cancer recurrence, decreasing elapsed time from surgery to chemotherapy, increasing surgical referrals for patients with advanced colon cancer, increasing the upper age limit and overall rate of colon cancer screening, increasing vitamin D and aspirin use, and monitoring and increasing the adenoma detection rate. Compliance with these processes improved for most measures, including screening (73.7% to 79.9%), adenoma detection rates on screening colonoscopy (30% to 36% for women and 42% to 49% for men), and chemotherapy within 35 days of surgery for colon cancer (39.0% to 51.9%). Age- and gender-adjusted mortality decreased from 13.8 per 100,000 in 2009-2011 to 10.5 per 100,000 in 2016-2018., Conclusions: This quality improvement program was feasible to implement, resulted in process improvements, and decreased colon cancer mortality over seven years., (Copyright © 2022 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Clinical outcome prediction plays an important role in stroke patient management. From a machine learning point-of-view, one of the main challenges is dealing with heterogeneous data at patient admission, i.e. the image data which are multidimensional and the clinical data which are scalars. In this paper, a multimodal convolutional neural network - long short-term memory (CNN-LSTM) based ensemble model is proposed. For each MR image module, a dedicated network provides preliminary prediction of the clinical outcome using the modified Rankin scale (mRS). The final mRS score is obtained by merging the preliminary probabilities of each module dedicated to a specific type of MR image weighted by the clinical metadata, here age or the National Institutes of Health Stroke Scale (NIHSS). The experimental results demonstrate that the proposed model surpasses the baselines and offers an original way to automatically encode the spatio-temporal context of MR images in a deep learning architecture. The highest AUC (0.77) was achieved for the proposed model with NIHSS. Clinical Relevance- - We present the first deep learning approach predicting the clinical outcome of stroke patients treated by mechanical thrombectomy which integrates imaging data at the voxel level with key clinical metadata. Combining clinical and imaging data to evaluate the potential benefit from therapy closely mirrors the clinical decision process. Our promising results suggest our predictive model could assist in acute stroke management.