City 5.0: Citizen involvement in the design of future cities.

A citizen-centric view is key to channeling technological affordances into the development of future cities in which improvements are made with the quality of citizens' life in mind. This paper proposes City 5.0 as a new citizen-centric design paradigm for future cities, in which cities can be seen as markets connecting service providers with citizens as consumers. City 5.0 is dedicated to eliminating restrictions that citizens face when utilizing city services. Our design paradigm focuses on smart consumption and extends the technology-centric concept of smart city with a stronger view on citizens' roadblocks to service usage. Through a series of design workshops, we conceptualized the City 5.0 paradigm and formalized it in a semi-formal model. The applicability of the model is demonstrated using the case of a telemedical service offered by a Spanish public healthcare service provider. The usefulness of the model is validated by qualitative interviews with public organizations involved in the development of technology-based city solutions. Our contribution lies in the advancement of citizen-centric analysis and the development of city solutions for both academic and professional communities.

Paraneoplastic encephalomyeloradiculits with multiple autoantibodies against ITPR-1, GFAP and MOG: case report and literature review.

BACKGROUND: Recently, antibodies against the alpha isoform of the glial-fibrillary-acidic-protein (GFAPα) were identified in a small series of patients with encephalomyelitis. Coexisting autoantibodies (NMDA receptor, GAD65 antibodies) have been described in a few of these patients. We describe a patient with rapidly progressive encephalomyeloradiculitis and a combination of anti-ITPR1, anti-GFAP and anti-MOG antibodies. CASE PRESENTATION AND LITERATURE REVIEW: A 44-year old caucasian woman with a flu-like prodrome presented with meningism, progressive cerebellar signs and autonomic symptoms, areflexia, quadriplegia and respiratory insufficiency. MRI showed diffuse bilateral T2w-hyperintense brain lesions in the cortex, white matter, the corpus callosum as well as a longitudinal lesion of the medulla oblongata and the entire spinal cord. Anti-ITPR1, anti-GFAP and anti-MOG antibodies were detected in cerebrospinal fluid along with lymphocytic pleocytosis. Borderline tumor of the ovary was diagnosed. Thus, the disease of the patient was deemed to be paraneoplastic. The patient was treated by surgical removal of tumor, steroids, immunoglobulins, plasma exchange and rituximab. Four months after presentation, the patient was still tetraplegic, reacted with mimic expressions to pain or touch and could phonate solitary vowels. An extensive literature research was performed. CONCLUSION: Our case and the literature review illustrate that multiple glial and neuronal autoantibodies can co-occur, that points to a paraneoplastic etiology, above all ovarian teratoma or thymoma. Clinical manifestation can be a mixture of typically associated syndromes, e.g. ataxia associated with anti-ITPR1 antibodies, encephalomyelitis with anti-GFAPα antibodies and longitudinal extensive myelitis with anti-MOG antibodies.

[Weaning in neurological and neurosurgical early rehabilitation-Results from the "WennFrüh" study of the German Society for Neurorehabilitation]. / Weaning in der neurologisch-neurochirurgischen Frührehabilitation ­ Ergebnisse der "WennFrüh"-Studie der Deutschen Gesellschaft für Neurorehabilitation.

Neurological and neurosurgical early rehabilitation patients are often so critically ill that they must be weaned from mechanical ventilation in addition to early rehabilitative treatment. The German Society for Neurorehabilitation (DGNR) carried out a survey and asked neurological weaning units to provide information on structural characteristics of the facility, including personnel and technical resources and the number of cases and outcome based on anonymous data. In total 36 weaning units from 11 federal states with a total of 496 beds participated in the survey. From 2516 weaning cases documented in 2019, 2097 (83.3%) could primarily be successfully weaned from mechanical ventilation and only 120 (4.8%) had to be discharged with home ventilation. The mortality in this sample was 11.0% (n = 276). The results of the survey demonstrate that prolonged weaning during early neurological and neurosurgical rehabilitation is an important and effective component of healthcare provision for critically ill patients in Germany.

Management of tracheostomized patients after poor grade subarachnoid hemorrhage: Disease related and pulmonary risk factors for failed and delayed decannulation.

OBJECTIVE: Tracheostomy is often indicated in patients with spontaneous subarachnoid hemorrhage (sSAH). Decannulation is a major goal of neurorehabilitation, but cannot be achieved in all patients. The aim of this study was to describe the course of decannulation and to identify associated risk factors in a single-center collective. PATIENTS AND METHODS: We retrospectively reviewed 87 sSAH patients with WFNS (World Federation of Neurosurgical Societies) grade III-IV, who received tracheostomy. Decannulation events and the time from tracheostomy to decannulation were recorded in a 200-days follow-up. Variables analyzed were: age, sex, WFNS grade, Fisher grade, the presence of intracerebral or intraventricular hematoma, acute hydrocephalus, aneurysm location, aneurysm obliteration (surgical vs. endovascular), treatment related complications, decompressive craniectomy, symptomatic cerebral vasospasm, vasospasm-related infarction and timing of tracheostomy. Further risk factors analyzed were preexisting chronic lung disease and pneumonia. Functional outcome was assessed by the modified Rankin Scale (mRS). RESULTS: The rate of successful decannulation was 84% after a median of 47 days. A higher WFNS grade and pneumonia were associated with both a prolonged time to decannulation (TTD) and decannulation failure (DF). Older age (> 60 years) and necessity for decompressive craniectomy were only associated with prolonged TTD. Outcome analysis revealed that patients with DF show a significantly (p < 0.01) higher rate of unfavorable outcome (mRS 3-6). CONCLUSION: Successful decannulation is possible in the majority of sSAH patients and particularly, in all patients with WFNS grade III. WFNS grading, age, the necessity for decompressive craniectomy and pneumonia are significantly associated with the TTD. WFNS grade and pneumonia are significantly associated with DF. The mean cannulation time of sSAH patients is shorter in relation to stroke patients.

Antibodies against neural antigens in patients with acute stroke: joint results of three independent cohort studies.

BACKGROUND AND PURPOSE: Ischemic stroke (IS) and hemorrhagic stroke (HemS) typically lead to a breakdown of the blood-brain barrier with neural antigen presentation. This presentation could potentially generate destructive auto-immune responses. Pre-existing antineuronal and antiglial antibodies (AA), predominantly NMDA receptor antibodies, have been reported in patients with stroke. This article summarizes three independent prospective studies, the Lübeck cohort (LC), Barcelona cohort (BC), and Heidelberg cohort (HC), exploring the frequency and clinical relevance of AA in patients with acute stroke (AS). METHODS: In all cohorts together, 344 consecutive patients admitted with AS (322 × IS, 22 × HemS) were screened for AA in serum at admission. Clinical outcome parameters as well as a second AA screening were available at 30 days in the LC or at 90 days in the BC. A control group was included in the BC (20 subjects free from neurological disease) and the HC (78 neurological and ophthalmological patients without evidence for stroke). RESULTS: The rate of positivity for AA was similar in control subjects and AS patients (13%, 95% CI [7%, 22%] vs. 13%, 95% CI [10%, 17%]; p = 0.46) with no significant difference between cohorts (LC 25/171, BC 12/75, HC 9/98). No patient had developed new AA after 30 days, whereas 2 out of 60 patients had developed new AA after 90 days. AA positive patients did not exhibit significant differences to AA negative patients in stroke subtype (LC, BC), initial stroke severity (BC, LC, HC), infarct volume (BC), and functional status at admission (BC, LC, HC) and follow-up (BC, LC). CONCLUSIONS: AS does not induce AA to a relevant degree. Pre-existing AA can be found in the serum of stroke patients, but they do not have a significant association with clinical features and outcomes.

Development and validation of an instrument to measure and manage organizational process variety.

Organizational processes vary. Practitioners have developed simple frameworks to differentiate them. Surprisingly, the academic literature on process management does not-it typically strives for one method to manage all processes. We draw on organizational information-processing theory to systematically develop a new, theoretically motivated classification model for organizational processes. We validate this model using survey data from 141 process practitioners of a global corporation. We derive three distinct types of processes and demonstrate that an understanding of process variety based on process dimensions can differentiate processes better than existing frameworks used in practice. Our findings can enable process managers to make informed decisions and serve as a basis for contingent process management.

What can we learn from corporate sustainability reporting? Deriving propositions for research and practice from over 9,500 corporate sustainability reports published between 1999 and 2015 using topic modelling technique.

Organizations are increasingly using sustainability reports to inform their stakeholders and the public about their sustainability practices. We apply topic modelling to 9,514 sustainability reports published between 1999 and 2015 in order to identify common topics and, thus, the most common practices described in these reports. In particular, we identify forty-two topics that reflect sustainability and focus on the coverage and trends of economic, environmental, and social sustainability topics. Among the first to analyse such a large amount of data on organizations' sustainability reporting, the paper serves as an example of how to apply natural language processing as a strategy of inquiry in sustainability research. The paper also derives from the data analysis ten propositions for future research and practice that are of immediate value for organizations and researchers.

Transcranial cortex stimulation and fMRI: electrophysiological correlates of dual-pulse BOLD signal modulation.

UNLABELLED: Are the local hemodynamic changes in BOLD-fMRI correlated to increased or decreased neuronal activity or both? We combined transcranial electrical cortex stimulation (TES) with simultaneous fMRI and electromyographic (EMG) recording to study the influence of inhibitory and excitatory neuronal activity on the concomitant BOLD signal change. Unilateral or bilateral TES was applied with a postero-anterior orientation. This activates pyramidal cells transsynaptically and allows for the induction of cortical inhibition and excitation of the pyramidal cell, respectively. In this project interhemispheric inhibition (IHI) served as an in vivo model to investigate electrophysiologically well defined inhibitory and excitatory effects. METHODOLOGY: Included event-related fMRI, which triggered TES; online recording of the EMG response monitored the inhibitory and excitatory influences on discharging corticospinal neurons. RESULTS: Revealed that a single suprathreshold stimulus induced a positive BOLD response both in the ipsilateral as well as in the contralateral primary motor cortex (M1). The contralateral co-activation of the homotopic M1 should be a functional correlate of transcallosal connections. If a contralateral conditioning stimulus preceded the test stimulus by 10 ms (IHI), the subsequent ipsilateral BOLD signal was significantly reduced. We find that cortical inhibitory processes are accompanied by attenuation of the local neurovascular signal.

Comparison of motor effects following subcortical electrical stimulation through electrodes in the globus pallidus internus and cortical transcranial magnetic stimulation.

Current concepts of transcranial magnetic stimulation (TMS) over the primary motor cortex are still under debate as to whether inhibitory motor effects are exclusively of cortical origin. To further elucidate a potential subcortical influence on motor effects, we combined TMS and unilateral subcortical electrical stimulation (SES) of the corticospinal tract. SES was performed through implanted depth electrodes in eight patients treated with deep brain stimulation (DBS) for severe dystonia. Chronaxie, conduction velocity (CV) of the stimulated fibres and poststimulus time histograms of single motor unit recordings were calculated to provide evidence of an activation of large diameter myelinated fibres by SES. Excitatory and inhibitory motor effects recorded bilaterally from the first dorsal interosseus muscle were measured after SES and focal TMS of the motor cortex. This allowed us to compare motor effects of subcortical (direct) and cortical (mainly indirect) activation of corticospinal neurons. SES activated a fast conducting monosynaptic pathway to the alpha motoneuron. Motor responses elicited by SES had significantly shorter onset latency and shorter duration of the contralateral silent period compared to TMS induced motor effects. Spinal excitability as assessed by H-reflex was significantly reduced during the silent period after SES. No ipsilateral motor effects could be elicited by SES while TMS was followed by an ipsilateral inhibition. The results suggest that SES activated the corticospinal neurons at the level of the internal capsule. Comparison of SES and TMS induced motor effects reveals that the first part of the TMS induced contralateral silent period should be of spinal origin while its later part is due to cortical inhibitory mechanisms. Furthermore, the present results suggest that the ipsilateral inhibition is predominantly mediated via transcallosal pathways.