Deep brain stimulation (DBS) is an implanted electrical device that modulates specific targets in the brain resulting in symptomatic improvement in a particular neurologic disease, most commonly a ...movement disorder. It is preferred over previously used lesioning procedures due to its reversibility, adjustability, and ability to be used bilaterally with a good safety profile. Risks of DBS include intracranial bleeding, infection, malposition, and hardware issues, such migration, disconnection, or malfunction, but the risk of each of these complications is low—generally ≤ 5% at experienced, large-volume centers. It has been used widely in essential tremor, Parkinson’s disease, and dystonia when medical treatment becomes ineffective, intolerable owing to side effects, or causes motor complications. Brain targets implanted include the thalamus (most commonly for essential tremor), subthalamic nucleus (most commonly for Parkinson’s disease), and globus pallidus (Parkinson’s disease and dystonia), although new targets are currently being explored. Future developments include brain electrodes that can steer current directionally and systems capable of “closed loop” stimulation, with systems that can record and interpret regional brain activity and modify stimulation parameters in a clinically meaningful way. New, image-guided implantation techniques may have advantages over traditional DBS surgery.
The ability to dynamically change motor outputs, such as stopping an initiated response, is an important aspect of human behavior. A hyperdirect pathway between the inferior frontal gyrus and ...subthalamic nucleus is hypothesized to mediate movement inhibition, but there is limited evidence for this in humans. We recorded high spatial and temporal resolution field potentials from both the inferior frontal gyrus and subthalamic nucleus in 21 subjects. Cortical potentials evoked by subthalamic stimulation revealed short latency events indicative of monosynaptic connectivity between the inferior frontal gyrus and ventral subthalamic nucleus. During a stop signal task, stopping-related potentials in the cortex preceded stopping-related activity in the subthalamic nucleus, and synchronization between these task-evoked potentials predicted the stop signal reaction time. Thus, we show that a prefrontal-subthalamic hyperdirect pathway is present in humans and mediates rapid stopping. These findings may inform therapies to treat disorders featuring perturbed movement inhibition.
•Demonstration of a monosynaptic, prefrontal hyperdirect pathway in humans•Fastest fibers between the inferior frontal gyrus and ventral subthalamic nucleus•Stopping elicits co-activation of the origin and target of this pathway•Degree of co-activation predicts stopping speed
Chen et al. identify a fast, non-stop pathway between the prefrontal cortex and subthalamic nucleus in humans using multisite invasive brain recordings. This pathway is critically involved in the stopping of ongoing actions. Modulation of this pathway may be a means of treating disorders of inhibitory control, such as impulsivity.
The purpose of this study is to investigate relationships between national logistics performance and dimensions of sustainability. A series of hypotheses are developed and tested using regression ...analysis of secondary data. The sources of data are the Sustainable Society Index (SSI) and the World Bank’s Logistics Performance Index (LPI). Fundamental aspects of social sustainability and well-being—a healthy, educated population, equality, good governance, and reasonable income distribution—are related to higher levels of logistics performance. In addition, while logistics performance is a driver of economic activity and success, it is also a contributor to environmental degradation in the form of harmful emissions. If economic growth is among a nation’s goals, its leaders are advised to support social well-being, along with technologies and practices for greater energy efficiency (and lower emissions) in transportation.
PurposeThe purpose of this paper is to develop and test theory-driven hypotheses on the influence of corruption and gender inequality on logistics performance.Design/methodology/approachThis paper ...develops hypotheses based on a review of the literature and theory linking corruption, gender inequality and logistics performance. Testing the hypotheses draws on the following secondary data sources: the World Bank Logistics Performance Index, Transparency International’s Corruption Perceptions Index and the United Nations Development Programme Gender Inequality Index. Regression analysis is used to test the hypotheses.FindingsA significant direct effect is evident between corruption perceptions and perceived logistics performance. Corruption is detrimental to logistics. Further, there is evidence of an indirect effect, via gender inequality. Gender inequality is also linked directly to lower logistics performance. Gross domestic product/capita enters the analysis as a control variable.Research limitations/implicationsWhile the analysis uses secondary data, sources are credible and their methods – while not perfect – are logical and appear to be reasonable. It is possible that excluded variables could further explain the relationships under study. This implies future research opportunities, perhaps involving case studies of specific nations.Practical implicationsThe results should inspire businesses, non-governmental organizations and governments to invest in, aid, advocate for and legislate toward greater gender equality – and against corruption. Logistics educators have an important role in disseminating this message.Social implicationsGender inequality and corruption are current, global social issues. Moving forward toward equality and away from corruption are the right moves. Such moves appear to also yield better logistics.Originality/valueThis paper is among the first linking corruption and gender inequality to logistics performance. It shows how social issues impact logistics performance at a national level.
Contingency theory suggests the best way to organise and lead an organisation, or to make decisions, depends upon internal and external situational factors, e.g. organisational size, operational ...scope and environmental uncertainty. Humanitarian organisations use various process management tools, including codes of conduct and standards. Large non-governmental organisations (NGOs) seem especially attracted to standards. The purpose of this paper is to advance our understanding of process improvement techniques, with a focus on standards, in use by humanitarian NGOs. Content analysis is the method employed in this study. A sample of humanitarian NGO annual reports and web pages is studied to describe the NGOs and determine their approaches to process improvement. The sample contains a mix of NGOs based on their location (France or Canada), organisational size and scope of operations (development aid, disaster relief, etc.). Contingency theory is useful in linking contingency factors to process improvement approaches. NGO size, operational scope and organisational culture factors are linked to use of standards. This is one of the first (if not the first study) to adopt contingency theory in an investigation of process improvement approaches among humanitarian NGOs. It focuses on a managerial issue of great relevance - process improvement in humanitarian operations.
As electric vehicles (EVs) become more readily available, sales will depend on consumers' interest and understanding. A survey of consumer attitudes on electric cars was conducted in Manitoba from ...late 2011 to early 2012. It utilizes two price assessment methods. The van Westendorp price sensitivity method (PSM) shows the acceptable price range for EVs to be $22,000-27,500. This range closely matches average price range for sales of conventional cars during the same period. The willingness-to-pay method reveals consumers are unwilling to pay large premiums for EVs, even when given information on future fuel savings. A consumer group with experience or exposure to EVs is somewhat different. Nearly 25% of these people are willing to pay a premium of up to $10,000. Different interpretations can be drawn from these responses, calling for further research. An apparent policy opportunity involves consumer education to enhance knowledge and facilitate EV purchase decisions. Survey results also support the hypothesis that EV rollout has focused too much on technology, and not enough on consumers.
Abstract Introduction Deep brain stimulation (DBS) is an established therapy for movement disorders, and is under active investigation for other neurologic and psychiatric indications. While many ...studies describe outcomes and complications related to stimulation therapies, the majority of these are from large academic centers, and results may differ from those in general neurosurgical practice. Methods Using data from both the Centers for Medicare and Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP), we identified all DBS procedures related to primary placement, revision, or removal of intracranial electrodes. Cases of cortical stimulation and stimulation for epilepsy were excluded. Results Over 28,000 cases of DBS electrode placement, revision, and removal were identified during the years 2004–2013. In the Medicare dataset, 15.2% and of these procedures were for intracranial electrode revision or removal, compared to 34.0% in the NSQIP dataset. In NSQIP, significant predictors of revision and removal were decreased age (odds ratio (OR) of 0.96; 95% CI: 0.94, 0.98) and higher ASA classification (OR 2.41; 95% CI: 1.22, 4.75). Up to 48.5% of revisions may have been due to improper targeting or lack of therapeutic effect. Conclusion Data from the multiple North American databases suggest that intracranial neurostimulation therapies have a rate of revision and removal higher than previously reported, between 15.2 and 34.0%. While there are many limitations to registry-based studies, there is a clear need to better track and understand the true prevalence and nature of such failures as they occur in the wider surgical community.
Objective
To understand the safety, putaminal coverage, and enzyme expression of adeno‐associated viral vector serotype‐2 encoding the complementary DNA for the enzyme, aromatic L‐amino acid ...decarboxylase (VY‐AADC01), delivered using novel intraoperative monitoring to optimize delivery.
Methods
Fifteen subjects (three cohorts of 5) with moderately advanced Parkinson's disease and medically refractory motor fluctuations received VY‐AADC01 bilaterally coadministered with gadoteridol to the putamen using intraoperative magnetic resonance imaging (MRI) guidance to visualize the anatomic spread of the infusate and calculate coverage. Cohort 1 received 8.3 × 1011vg/ml and ≤450 μl per putamen (total dose, ≤7.5 × 1011vg); cohort 2 received the same concentration (8.3 × 1011vg/ml) and ≤900 μl per putamen (total dose, ≤1.5 × 1012vg); and cohort 3 received 2.6 × 1012vg/ml and ≤900 μl per putamen (total dose, ≤4.7 × 1012vg). (18)F‐fluoro‐L‐dihydroxyphenylalanine positron emission tomography (PET) at baseline and 6 months postprocedure assessed enzyme activity; standard assessments measured clinical outcomes.
Results
MRI‐guided administration of ascending VY‐AADC01 doses resulted in putaminal coverage of 21% (cohort 1), 34% (cohort 2), and 42% (cohort 3). Cohorts 1, 2, and 3 showed corresponding increases in enzyme activity assessed by PET of 13%, 56%, and 79%, and reductions in antiparkinsonian medication of –15%, –33%, and –42%, respectively, at 6 months. At 12 months, there were dose‐related improvements in clinical outcomes, including increases in patient‐reported ON‐time without troublesome dyskinesia (1.6, 3.3, and 1.5 hours, respectively) and quality of life.
Interpretation
Novel intraoperative monitoring of administration facilitated targeted delivery of VY‐AADC01 in this phase 1 study, which was well tolerated. Increases in enzyme expression and clinical improvements were dose dependent.
ClinicalTrials.gov Identifier: NCT01973543 Ann Neurol 2019;85:704–714
PurposeTo extend humanitarian supply chain relationships beyond logistics concerns of delivery, quality and cost. As humanitarian actors continue to face increasing numbers of natural disasters, ...armed conflicts and attacks on aid workers, security (risk) and sustainability are issues of growing importance. Aiming to inspire discussion, the paper concludes with a research agenda.Design/methodology/approachThis is a conceptual paper inspired by relevant statistics, news reports and academic literature.FindingsWorldwide natural disasters and armed conflicts are on the rise. So are deliberate attacks on aid workers. Thus, humanitarian supply chain design must include considerations of security and sustainability. Agencies have several options for integrating matters of security and sustainability with the delivery of aid, from being reactive to creating internal solutions to forming proactive relationships with security and sustainability experts.Research limitations/implicationsThere are numerous opportunities for research in the areas of security, sustainability and supply chain relationships.Practical implicationsThrough advocacy and supply chain relationships, humanitarian agencies can enhance security for aid workers and civilians affected by conflict and disasters. Looking to the future, they can also make a positive difference on issues of sustainability.Social implicationsThere is an opportunity to enlarge the “humanitarian space” – and increase security for aid workers and civilians, especially in areas of armed conflict. In the long term, aid agencies can also help eliminate social problems such as gender inequality.Originality/valueThis appears to be among the first papers to discuss matters of security and sustainability in the context of humanitarian supply chain collaboration.
Neural recordings using invasive devices in humans can elucidate the circuits underlying brain disorders, but have so far been limited to short recordings from externalized brain leads in a hospital ...setting or from implanted sensing devices that provide only intermittent, brief streaming of time series data. Here, we report the use of an implantable two-way neural interface for wireless, multichannel streaming of field potentials in five individuals with Parkinson's disease (PD) for up to 15 months after implantation. Bilateral four-channel motor cortex and basal ganglia field potentials streamed at home for over 2,600 h were paired with behavioral data from wearable monitors for the neural decoding of states of inadequate or excessive movement. We validated individual-specific neurophysiological biomarkers during normal daily activities and used those patterns for adaptive deep brain stimulation (DBS). This technological approach may be widely applicable to brain disorders treatable by invasive neuromodulation.
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