The use of the MRI-navigation system ensures accurate targeting of TMS. This, in turn, results in TMS motor mapping becoming a routinely used procedure in neuroscience and neurosurgery. However, currently, there is no standardized methodology for assessment of TMS motor-mapping results. Therefore, we developed TMSmap – free standalone graphical interface software for the quantitative analysis of the TMS motor mapping results (http://tmsmap.ru/). In addition to the estimation of standard parameters (such as the size of cortical muscle representation and the center of gravity location), it allows estimation of the volume of cortical representations, excitability profile of the cortical surface map and the overlap between cortical representations. The input data for the software includes the coordinates of the coil position (or electric field maximum) and the corresponding response in each stimulation point. TMSmap has been developed for versatile assessment and comparison of TMS maps relating to different experimental interventions including, but not limited to longitudinal, pharmacological and clinical studies (e.g., stroke recovery). To illustrate the use of TMSmap we provide examples of the actual TMS motor-mapping analysis of two healthy subjects and one chronic stroke patient.
There is a paradox characterising the Russian health workforce. By international standards, Russia has a very high number of physicians per capita but at the same time is confronted by chronic real shortages of qualified physicians. This paper explores the reasons for this paradox by examining the structural characteristics of health workforce development in the context of the Soviet legacy and the comparative performance of other European countries. The paper uses data on comparative health workforce dynamics to argue that Russia is a European laggard, before then evaluating recent and current policies within that context. The health workforce challenges facing all low- and middle-income countries are acute, and this paper confirms this IS the case for Russia—Europe's largest country. The paper argues that the physician shortage is driven by the model of health workforce development inherited from the Soviet period, with its emphasis on quantitative rather than structural indicators. We find that, in contrast to most European Union countries, Russia's stalled reform process leaves it facing a chronic shortage of appropriately trained physicians. We document the costs of failed and slow reforms during the last 2 decades, while cautiously welcoming some recent policy initiatives.
Almost 70 years ago, Alexander Luria incorporated semantic aphasia among his aphasia classifications by demonstrating that deficits in linking the logical relationships of words in a sentence could co-occur with non-linguistic disorders of calculation, spatial gnosis and praxis deficits. In line with his comprehensive approach to the assessment of language and other cognitive functions, he argued that deficits in understanding semantically reversible sentences and prepositional phrases, for example, were in line with a single neuropsychological factor of impaired spatial analysis and synthesis, since understanding such grammatical relationships would also draw on their spatial relationships. Critically, Luria demonstrated the neural underpinnings of this syndrome with the critical implication of the cortex of the left temporal-parietal-occipital (TPO) junction. In this study, we report neuropsychological and lesion profiles of 10 new cases of semantic aphasia. Modern neuroimaging techniques provide support for the relevance of the left TPO area for semantic aphasia, but also extend Luria's neuroanatomical model by taking into account white matter pathways. Our findings suggest that tracts with parietal connectivity – the arcuate fasciculus (long and posterior segments), the inferior fronto-occipital fasciculus, the inferior longitudinal fasciculus, the superior longitudinal fasciculus II and III, and the corpus callosum – are implicated in the linguistic and non-linguistic deficits of patients with semantic aphasia.
The paper advocates pluralist methodological paradigm approach for improving the quality of empirical and theoretical public and nonprofit research. Many researchers rely on logico-positivist/empiricist research paradigm as leading orientation to improve the quality of their work, clarify the theoretical contributions of their work, and reduce the probability of having their journal submissions rejected. The main thesis of this paper is that pluralist methodological approach will benefit the quality of empirical and theoretical public and nonprofit research. Alternative conceptualizations of public and nonprofit marketing are suggested.
In 2012, eight million Canadians provided care to family member or friends with a long-term mental or physical health condition. In the context of mental health, the largest groups of care-recipients are children and spouses due to mental illness such as mood, anxiety, personality or psychotic disorders. Although the social work practice literature emphasizes ecological interventions in mental health, little research has been done on social workers’ role in supporting family caregivers. Using a socioecological framework, the present theoretical article proposes multi-levelled social work interventions to support family caregivers in the context of mental health. Four levels of interventions will be highlighted: attachment and strengths-based approaches (micro system), community based interventions (meso system), national policies in the context of mental health caregiving in Canada (exo system), and lastly the role of ideologies in shaping attitudes towards family caregivers (macro system).
The Russian population continues to face political and economic challenges, has experienced poor general health and high mortality for decades, and has exhibited widening health disparities. The physiological factors underlying links between health and socioeconomic position in the Russian population are therefore an important topic to investigate. We used data from a population-based survey of Moscow residents aged 55 and older (n = 1495), fielded between December 2006 and June 2009, to address two questions. First, are social disparities evident across different clusters of biomarkers? Second, does biological risk mediate the link between socioeconomic status and health?
Health outcomes included subscales for general health, physical function, and bodily pain. Socioeconomic status was represented by education and an index of material resources. Biological risk was measured by 20 biomarkers including cardiovascular, inflammatory, and neuroendocrine markers as well as heart rate parameters from 24-h ECG monitoring.
For both sexes, the age-adjusted educational disparity in standard cardiovascular risk factors was substantial (men: standardized β = −0.16, 95% CI = −0.23 to −0.09; women: β = −0.25, CI = −0.32 to −0.18). Education differences in inflammation were also evident in both men (β = −0.17, CI = −0.25 to −0.09) and women (β = −0.09, CI = −0.17 to −0.01). Heart rate parameters differed by education only in men (β = −0.10, CI = −0.18 to −0.02). The associations between material resources and biological risk scores were generally weaker than those for education. Social disparities in neuroendocrine markers were negligible for men and women.
In terms of mediating effects, biological risk accounted for more of the education gap in general health and physical function (19–36%) than in bodily pain (12–18%). Inclusion of inflammatory markers and heart rate parameters—which were important predictors of health outcomes—may explain how we accounted for more of the social disparities than previous studies.
The human-on-chip technology provides an efficient basis for preclinical studies and has potentially a greater predictive power for human drug response than classical 2D cell culture. Here we report the expression profile of druggable genes in the human colon cancer cells CaCo2 in static culture and within a microfluidic chip. We identified gene expression pattern under flow to be closer to the one of CaCo2 primary xenograft tumours as compared to those cells grown without circulation. The obtained results indicate that a microenvironment connected to a circulation within a chip brings the cells closer to in vivo situation. Hence the human-on-chip technology is a more powerful tool for drug development than conventional 2D cell culture.
Speech production, both overt and covert, down-regulates the activation of auditory cortex. This is thought to be due to forward prediction of the sensory consequences of speech, contributing to a feedback control mechanism for speech production. Critically, however, these regulatory effects should be specific to speech content to enable accurate speech monitoring. To determine the extent to which such forward prediction is content-specific, we recorded the brain's neuromagnetic responses to heard multisyllabic pseudowords during covert rehearsal in working memory, contrasted with a control task. The cortical auditory processing of target syllables was significantly suppressed during rehearsal compared with control, but only when they matched the rehearsed items. This critical specificity to speech content enables accurate speech monitoring by forward prediction, as proposed by current models of speech production. The one-to-one phonological motor-to-auditory mappings also appear to serve the maintenance of information in phonological working memory. Further findings of right-hemispheric suppression in the case of whole-item matches and left-hemispheric enhancement for last-syllable mismatches suggest that speech production is monitored by 2 auditory-motor circuits operating on different timescales: Finer grain in the left versus coarser grain in the right hemisphere. Taken together, our findings provide hemisphere-specific evidence of the interface between inner and heard speech.
Effects of intensive language action therapy (ILAT) on automatic language processing were assessed using Magnetoencephalography (MEG). Auditory magnetic mismatch negativity (MMNm) responses to words and pseudowords were recorded in twelve patients with chronic aphasia before and immediately after two weeks of ILAT. Following therapy, Patients showed significant clinical improvements of auditory comprehension as measured by the Token Test and in word retrieval and naming as measured by the Boston Naming Test. Neuromagnetic responses dissociated between meaningful words and meaningless word-like stimuli ultra-rapidly, approximately 50 ms after acoustic information first allowed for stimulus identification. Over treatment, there was a significant increase in the left-lateralisation of this early word-elicited activation, observed in perilesional fronto-temporal regions. No comparable change was seen for pseudowords. The results may reflect successful, therapy-induced, language restitution in the left hemisphere.
This paper presents an improved incremental self-organizing map (I2SOM) network that uses automatic threshold (AT) value for the segmentation of ultrasound (US) images. In order to show the validity of proposed scheme, it has been compared with Kohonen’s SOM. Two-dimensional (2D) fast Fourier transform (FFT) and 2D continuous wavelet transform (CWT) were computed in order to form the feature vectors of US bladder and phantom images. In this study, it is observed that the proposed automatic threshold scheme for ISOM network has significantly eliminated the former ISOM network’s threshold problem for US images. This improvement enhances the robustness of ISOM algorithm. Obtained results show that ISOM with AT value has similar segmentation performance with Kohonen’s network.
The HIV epidemic among people who inject drugs (PWID) in Russia continues to spread. This exploratory study examines how HIV-prevention measures are perceived and experienced by PWID in the northwestern region of Russia.
Purposive sampling was used to obtain a variety of cases that could reflect possible differences in perception and experience of HIV-prevention efforts. We conducted 22 semi-structured interviews with PWID residing in the Arkhangelsk and St. Petersburg regions.
The main sources of prevention information on HIV for PWID were media campaigns directed to the general population. These campaigns were effective with regard to communicating general knowledge on HIV but were ineffective in terms of risk behavior change. The subjects generally had trust in medical professionals and their advice but did not follow prevention recommendations. Most informants had no or very little prior contact with harm reduction services. On the level of attitudes towards HIV prevention efforts, we discovered three types of fatalism among PWID: “personal fatalism” - uselessness of HIV prevention efforts, if one uses drugs; “prevention-related fatalism” - prevention programs are low effective, because people do not pay attention to them before they get infected; “state-related fatalism” – the lack of belief that the state is concerned with HIV prevention issues. Despite this fatalism the participants opined that NGOs would do a better job than the state as they are “really working” with risk groups.
As HIV prevention campaigns targeted at the general population and prevention advice received from medical professionals are not sufficiently effective for PWID in terms of risk behavior change, prevention programs, such as community-based and peer-based interventions specifically tailored to the needs of PWID are needed, which can be achieved by a large expansion of harm reduction services in the region. Personal communication should be a crucial element in such interventions in addition to harm reduction materials provision. Training programs, peer outreach, and culture-change interventions which try to alter widespread fatalistic norms or attitudes towards their health are especially needed, since this study indicates that fatalism is a major barrier for behavior change.
HIV treatment to reduce downstream HIV incidence and to decrease disease mortality and morbidity at a population level both require that hidden, out-of-care people living with HIV (PLH) in the community be reached and engaged to enter care. This research evaluated the feasibility of reaching out-of-care or non-adherent PLH through members of their social networks in St Petersburg, Russia.MATERIALS AND METHODS:
To recruit a social network sample of HIV-positive injection drug users, 16 HIV+ seeds were enrolled into the study through PLH-oriented websites and online forums using recruitment ads or approached in needle exchange sites. Interested persons called the study phone number and completed a brief eligibility interview. Seed inclusion criteria were HIV+ status, being 18 years or older, having ever injected drugs, and having not visited an HIV doctor in the past 6 months. Seeds provided blood specimens tested for HIV to confirm their self-reported status. Eligible seeds were enrolled, completed brief network elicitation interview, and were asked to invite their own HIV+ friends into the study. Incentives were provided as compensation for participants' time and additional smaller incentives were provided for inviting each HIV+ network member to also participate. The seed's PLH friends established the first ring of participants who, in turn were asked to invite their own PLH friends (second ring). All study participants completed assessment of psychosocial wellbeing and sexual and injection-related HIV risk behaviour. Blood samples were collected from all participants to confirm their HIV+ status.RESULTS:
Through this chain referral process, the initial 16 seeds led to the enrolment of a total of 66 PLH from the community (mean=4 per initial seed), most of whom - like the seed - were not presently in HIV care or were ART non-adherent.CONCLUSIONS:
Implementation of treatment cascade goals requires complementing conventional paths of identifying PLH with feasible and effective community-based approaches such as described in this study. This research establishes that PLH are connected in their day-to-day social networks with other HIV+ persons and shows that social network methods can be employed to reach infected persons through their connections with other PLH. This method has the potential to expand the reach of medical care efforts and ART uptake.
Working memory (WM) is essential to auditory comprehension; thus, understanding of the nature of WM is vital to research and clinical practice to support people with aphasia. A key challenge in assessing WM in people with aphasia is related to the myriad deficits prevalent in aphasia, including deficits in attention, hearing, vision, speech, and motor control of the limbs. Eye-tracking methods augur well for developing alternative WM tasks and measures in that they enable researchers to address many of the potential confounds inherent in tasks traditionally used to study WM. Additionally, eye-tracking tasks allow investigation of trade-off patterns between storage and processing in complex span tasks, and provide on-line response measures. The goal of the study was to establish concurrent and discriminative validity of a novel eye movement WM task in individuals with and without aphasia. Additionally, we aimed to explore the relationship between WM and general language measures, and determine whether trade-off between storage and processing is captured via eye-tracking measures. Participants with (n=28) and without (n=32) aphasia completed a novel eye movement WM task. This task, incorporating natural response requirements, was designed to circumvent potential confounds due to concomitant speech, motor, and attention deficits. The task consisted of a verbal processing component intermixed with presentation of colors and symbols for later recall. Performance on this task was indexed solely via eye movements. Additionally, participants completed a modified listening span task that served to establish concurrent validity of the eye-tracking WM task. Performance measures of the novel eye movement WM task demonstrated concurrent validity with another established measure of WM capacity – the modified listening span task. Performance on the eye-tracking task discriminated effectively between participants with and without aphasia. No consistent relationship was observed between WM scores and Western Aphasia Battery aphasia quotient and subtest scores for people with aphasia. Additionally, eye tracking measures yielded no trade-off between processing and storage for either group of participants. Results support the feasibility and validity of employing a novel eye-tracking method to index WM capacity in participants with and without aphasia. Further research is required to determine the nature of the relationship between WM, as indexed through this method, and specific aspects of language impairments in aphasia.
Functional impairment continues to represent a major challenge in schizophrenia. Surprisingly, patients with schizophrenia report a level of happiness comparable with control subjects, even in the face of the prominent functional deficits, a finding at odds with evidence indicating a positive relation between happiness and level of functioning. In attempting to reconcile these findings, we chose to examine the issue of values, defined as affectively infused criteria or motivational goals used to select and justify actions, people, and the self, as values are related to both happiness and functioning.
Russia underwent significant health reforms since the collapse of Soviet Union. We hypothesized that despite many changes, the Russian healthcare workforce structure remains largely unreformed and unique. This study conveys how human resources for healthcare are different in Russia compared to the most developed countries and examines the underlying reasons for these differences. Methods utilized include analysis of routine statistics and in-depth interviews with respondents who had experience as physicians and public health professionals in Russia and in the west, including physicians who emigrated from Russia and decision makers responsible for personnel policies. Results: Russian health system is traditionally viewed as vast, overstaffed, overspecialized while underfunded, however it is often overlooked that the total number of personnel employed in health care is relatively small. The relative understaffing of Russian health care results from a deficit of all categories of personnel except for physicians and nurses, as well as to misallocation of personnel. In Russia, the rates of health care workers that are neither physicians nor nurses is ca. 20 per 1000 population vs. 30-50 per 1000 in large OECD countries. In the past, an oversupply of physicians and nurses was created due to controlled enrolment in medical education. This allowed the salaries of medics to stay relatively low, while also reducing demand for allied health personnel. Since enrolment in medical colleges and schools is cut by about one third, this may lead to a need for rapid changes in personnel policies in the near future. The paper uses the outcome of the research project funded from the Basic Research Program at the National Research University Higher School of Economics.
The paper considers a problem of abortion in modern Russia. Using official statistics we analyze the dynamics of main abortion indicators since early 1990s. On the basis of representative national sample surveys we conclude that official statistics are complete and reliable. This in turn confirms the steady decline of abortions during the post-Soviet years.
Despite the positive trend, Russia remains one of the countries with the highest abortion rate in the world. The country’s turn to traditional values and growing role of the church are inadequate mechanisms to reduce abortions. The proven evidence based measures like promotion of family planning, sex education, etc. obtain no government support, but repression and restrictions. The authors indicate counterproductive effects of these restrictions on abortion reduction and pronatalist population policies.
The article recommends to pay more attention to improvements in quality of abortion provision, the introduction of modern medical standards and protocols.
In conclusion, the authors suggest the ways to improve the official statistics of abortions .