Microstructural thalamic changes in schizophrenia: a combined anatomic and diffusion weighted magnetic resonance imaging study

Journal ArticleObjective: Several magnetic resonance imaging (MRI) and postmortem studies have supported the role of the thalamus in the pathophysiology of schizophrenia. Interestingly, a recent small diffusion weighted imaging (DWI) study showed abnormal thalamic microstructure in patients with schizophrenia. The objective of our study was to use structural MRI and DWI to explore for the first time both thalamic volumes and integrity in schizophrenia. Methods: We measured thalamic volumes and apparent diffusion coefficient (ADC) measures bilaterally in 71 patients with schizophrenia, representative of those living in the geographically defined catchment area of South Verona (i.e., 100 000 inhabitants), and 75 individuals without schizophrenia. The presence of the adhesio interthalamica was also detected. Results: We found no significant differences in thalamus size between patients with schizophrenia and participants in the control group, with only a trend for decreased left volumes. No abnormal frequency of the adhesio interthalamica was found. In contrast, significantly increased thalamic ADC values were shown in schizophrenia patients. Age significantly inversely correlated with thalamic volumes in both groups and correlated positively with posterior ADCs in patients with schizophrenia. No significant associations between clinical variables and either volumes or ADC values were reported. Conclusion: Widespread altered microstructure integrity and partially preserved thalamus size were found in schizophrenia patients. Therefore, subtle thalamic structural abnormalities are present in schizophrenia, even with maintained volumes. This may result from disruption at the cytoarchitecture level, ultimately supporting corticothalamic misconnection. Future imaging studies should further explore thalamic tissue coherence and its role for cognitive disturbances in patients at high risk for schizophrenia and in first-degree relatives

Brain function monitoring during off-pump cardiac surgery: a case report

Journal ArticleBackground: Early postoperative stroke is an adverse syndrome after coronary bypass surgery. This report focuses on overcoming of cerebral ischemia as a result of haemodynamic instability during heart enucleation in off-pump procedure. Case presentation: A 67 year old male patient, Caucasian race, with a body mass index of 28, had a recent non-Q posterolateral myocardial infarction one month before and recurrent instable angina. His past history includes an uncontrolled hypertension, dyslipidemia, insulin dependent diabetes mellitus, epiaortic vessel stenosis. The patient was scheduled for an off-pump procedure and monitored with bilateral somatosensory evoked potentials, whose alteration signalled the decrement of the cardiac index during operation. The somatosensory evoked potentials appeared when the blood pressure was increased with a pharmacological treatment. Conclusion: During the off-pump coronary bypass surgery, a lower cardiac index, predisposes patients, with multiple stroke risk factors, to a reduction of the cerebral blood flow. Intraoperative somatosensory evoked potentials monitoring provides informations about the functional status of somatosensory cortex to reverse effects of brain ischemia

A Frugal Support Structure for New Software Implementations in SMEs

During software implementations, budgetary and human resource constraints often make it difficult for small and medium sized enterprises (SMEs) to provide and maintain the required support. To overcome these constraints, this study describes a frugal support structure (FSS) to orchestrate available resources and to involve users as suppliers and co-creators of contextualized information. The FSS is conceptualized as a system that enables interaction and collaboration between the actors involved by using extant communication infrastructure wherever possible, systematizing and centralizing knowledge created and ensuring overall resource and time efficiency. Adopting a design science research process, development of the FSS combines a literature review and practical insights. Evaluating the challenges and benefits of FSS, the findings indicate that user involvement is necessary not only for contextualized and accessible support but to make support structures more frugal and sustainable in the long term

Innovation Landscape in developed and developing markets. A conceptual and empirical study on technology convergence and low cost innovations

Innovation is proven to be an absolute requirement for growth in both developed and developing countries, but the type and motivation of innovations differ depending on various surrounding factors like socio-cultural attributes, geography, infrastructure, political environment and income-levels of customers. In developed countries innovations are often technology-driven and associated with delighting the end customers. On the contrary, in the developing or emerging markets due to the unique setting and infrastructural gaps innovations are focused towards meeting customer’s fundamental needs. Innovations in emerging markets are also seen as one of the drivers, utilized to address urgent developmental challenges such as poverty, illiteracy and lack of access to healthcare services. Considering these vast differences in driving factors, this research focuses on the comparison of the ongoing innovation fostering in both developed and developing world individually. This thesis is an attempt to understand the innovation landscape across these two worlds and focus on specific innovation approaches based on their potential and relevance. In developed world, information technology (IT) is emerging out as the key enabling technology across different innovation approaches. This thesis focuses on one such innovative application of IT called technology convergence, which is an integration of information and operational technologies (Gartner, 2011). Significant financial and productivity benefits are expected from this convergence and therefore many industrial companies are investing heavily into this alignment and undergoing huge business transformations. This study analyses the case of General Electric undergoing such a strategic business transformation. Study conceptualizes a theoretical framework around this new concept by expanding the Venkatraman’s (1994) IT-enablement model and exhibiting evidences of non–linearity and overlap across different transformation stages. Study discloses, IT localized exploitation stage as a default stage for initiating technology convergence and illustrates that each stage of the transformation has an impact on a unique set of organizational dimensions. Business scope redefinition stage influences the dimension of strategy and vision while internal integration stage influences the organization’s structure dimension. The two dimensions that are impacted most during the business process and network redesign stages, are business process and products and markets respectively. In contrast to the developed world where innovation approaches are focused on IT enabled performance enhancements, emerging markets are observing innovations centred on frugal products that are cost effective and provide value for money. Past two decades have seen a tremendous growth in emerging markets as they are developing their own innovative capabilities (Jiatao and Rajiv, 2009). Country like India, which is also a focus of this thesis, initially playing secondary roles has now become a breeding ground for frugal and social global innovations. This thesis discusses various types of innovation approaches adopted by local firms and multi-national companies in emerging markets such as frugal innovation, jugaad, disruptive innovation, gandhian innovation, catalytic innovation, indigenous innovation, resource-constrained innovation and bottom-up innovation. It identifies the increasing complexity and terminology confusion across these approaches in the growing and fragmented literature revolving around emerging markets. Targeting this shortcoming of the literature, this study attempts to consolidate the research insights into a unified framework defining eight main requirements of emerging markets namely cost-effective, easy-to-use, sustainable, problem-centric, no-frills, fast-to-market, resourceful and breakthrough. Additionally, study also analyses the priorities of these requirements during the buying and designing process from end customers and manufacturers point of view respectively. Research confirms “cost-effective” and “easy to use” as the absolute requirements of bottom-of-pyramid (BOP) customers and reveals the growing awareness towards eco-friendly products. It also introduces two additional important features from customer perspective namely – low/no maintenance or consumables and customized solutions to the framework. Furthermore, research also touches upon the topic of social enterprises, medium to diffuse social innovations into emerging markets to address social challenges and developmental issues like poverty and access to healthcare services. Study uses event structure analysis and four growth stages identified by Perrini et al. (2010); opportunity identification, opportunity evaluation, opportunity exploitation and opportunity scaling-up to analyze two social healthcare enterprises in India. It proposes an abstract model of a social enterprise with the contributing generalized actions and their causal interactions. Thesis ends with a conclusion giving an overview and a consolidated view of innovation approaches existing in developed world and emerging markets. Additionally it reemphasises some of the limitations experienced during the research work and suggests related future research propositions

Elucidating the Nature and Mechanism of Tic Improvement in Tourette Syndrome: A Pilot Study

Background: For unclear reasons, many Tourette syndrome (TS) children report near‐complete tic remission by young adulthood. Immature maturation of brain networks, observed with resting‐state functional MRI (rs‐fc‐MRI) in adolescents and adults with TS, might evolve to a mature pattern in adults who experience tic improvement or remission. We explored the feasibility of testing this hypothesis in our population of young adult TS males, each with prior clinical assessments completed during childhood as part of a separate TS Association Genetics Consortium study. Methods: A total of 10 TS males (off tic suppressing drugs for at least 6 months) aged 19–32 years, mean follow‐up interval 7.5 (2 to 13) years, and 11 neurologically normal controls were enrolled and underwent 3‐Tesla structural and rs‐fc‐MRI sequences. Results: The mean change in Yale Global Tic Severity Scale (YGTSS) was −31.5% (total) and −26.6% (YGTSS motor+vocal). Two subjects reported resolution of tic‐related disability, with drops from mean 45 to 16.5 (YGTSS‐total) and 25 to 11.5 (YGTSS motor+vocal.). Rs‐fc‐MRI revealed significantly increased connectivity between the ipsilateral anterior and mid cingulate cortex and striatum, increased connectivity between local connections, and decreased connectivity between more distant connections; representing an immature connectivity pattern. Discussion: Similar to previous reports, we found immature patterns of functional connectivity in adult TS subjects. Despite a lack of complete tic remission, two subjects exhibited dramatic drops in tic severity that correlated with tic‐related disability improvement. More work is needed to elucidate the mechanism of such dramatic improvement in TS

Brain function monitoring during off-pump cardiac surgery: a case report

BACKGROUND: Early postoperative stroke is an adverse syndrome after coronary bypass surgery. This report focuses on overcoming of cerebral ischemia as a result of haemodynamic instability during heart enucleation in off-pump procedure. CASE PRESENTATION: A 67 year old male patient, Caucasian race, with a body mass index of 28, had a recent non-Q posterolateral myocardial infarction one month before and recurrent instable angina. His past history includes an uncontrolled hypertension, dyslipidemia, insulin dependent diabetes mellitus, epiaortic vessel stenosis. The patient was scheduled for an off-pump procedure and monitored with bilateral somatosensory evoked potentials, whose alteration signalled the decrement of the cardiac index during operation. The somatosensory evoked potentials appeared when the blood pressure was increased with a pharmacological treatment. CONCLUSION: During the off-pump coronary bypass surgery, a lower cardiac index, predisposes patients, with multiple stroke risk factors, to a reduction of the cerebral blood flow. Intraoperative somatosensory evoked potentials monitoring provides informations about the functional status of somatosensory cortex to reverse effects of brain ischemia

Market driving at Bottom of the Pyramid (BoP):An analysis of social enterprises from the healthcare sector

To date, scholarly understanding of external dimensions of market driving for the purposes of ‘societal change’ is largely unexplored in both developed and emerging market contexts. This paper uses a multiple case study approach to understand how market driving social enterprises (across the hybrid spectrum) create societal change in emerging markets. By drawing on Scott's (1995) three-part conceptualization of institutional legitimacy, this study explores how regulative, normative and cognitive legitimacies are invoked by market driving social enterprises at the Bottom of the Pyramid (BoP). Key contributions of the study show that all three dimensions of legitimacy are relevant but they need to be invoked in a specific order based on necessary and optional conditions. An implication of the study is that market driving through societal change can lead to the construction of new and more inclusive healthcare markets

Environmental effects on brain functional networks in a juvenile twin population

: The brain's intrinsic organization into large-scale functional networks, the resting state networks (RSN), shows complex inter-individual variability, consolidated during development. Nevertheless, the role of gene and environment on developmental brain functional connectivity (FC) remains largely unknown. Twin design represents an optimal platform to shed light on these effects acting on RSN characteristics. In this study, we applied statistical twin methods to resting-state functional magnetic resonance imaging (rs-fMRI) scans from 50 young twin pairs (aged 10-30 years) to preliminarily explore developmental determinants of brain FC. Multi-scale FC features were extracted and tested for applicability of classical ACE and ADE twin designs. Epistatic genetic effects were also assessed. In our sample, genetic and environmental effects on the brain functional connections largely varied between brain regions and FC features, showing good consistency at multiple spatial scales. Although we found selective contributions of common environment on temporo-occipital connections and of genetics on frontotemporal connections, the unique environment showed a predominant effect on FC link- and node-level features. Despite the lack of accurate genetic modeling, our preliminary results showed complex relationships between genes, environment, and functional brain connections during development. A predominant role of the unique environment on multi-scale RSN characteristics was suggested, which needs replications on independent samples. Future investigations should especially focus on nonadditive genetic effects, which remain largely unexplored

Peri-urban ecosystems and urban resilience : training modules, instructions and reference materials

Peri-urban areas serve cities through their supporting capacities (ecosystem services, rural-urban connections and input-output systems), and assimilating capacities (urban discharge and waste). Climate change, land-use changes and natural resource degradation are disaster risk drivers. Ecosystems are a critical and common component across these dimensions. This document provides a detailed training design and plan, with modules that can bridge performance gaps of stakeholders while promoting a systematic approach to understanding peri-urban ecosystems. Detailed analysis in city contexts help to identify points of policy, strategy and activities where interventions can build the capacity of specific departments/actors involved in developing resilient cities.Ministry of Foreign Affairs of the Netherland

Review of imaging biomarkers for the vulnerable carotid plaque

Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. As a result of the rapid technological evolution in medical imaging, several important steps have been taken in the field of carotid plaque imaging allowing us to visualize the carotid atherosclerotic plaque and its composition in great detail. For computed tomography, magnetic resonance imaging, positron emission tomography, and ultrasound scan, evidence has accumulated on novel imaging-based markers that confer information on carotid plaque vulnerability, such as intraplaque hemorrhage and lipid-rich necrotic cores. In terms of the imaging-based identification of individuals at high risk of stroke, routine assessments of such imaging markers are the way forward for improving current clinical practice. The current review highlights the main characteristics of the vulnerable plaque indicating their role in the etiology of ischemic stroke as identified by intensive plaque imaging