The eHealth4all@eu Pipeline of Course Development: TIGER Recommendations in Action.

This study describes the eHealth4all@eu course development pipeline that builds upon the TIGER educational recommendations and allows a systematic development grounded on scientific and field requirements of competencies, a case/problem-based pedagogical approach and finally results in the syllabus and the course content. The pipeline is exemplified by the course Learning Healthcare in Action: Clinical Data Analytics.

"ai4health" - Development and Conception of a Learning Programme in Higher and Continuing Education on the Fundamentals, Applications and Perspectives of AI in Healthcare.

AI applications play an increasingly important role in all areas of healthcare. Therefore, a basic understanding of AI technology for health professionals seems necessary. However, to date there is no learning programme in Germany that includes technological basics, applications, and perspectives of AI in healthcare for interdisciplinary health professions. The ai4health project investigates which basic knowledge and competences health professionals need to acquire for an informed handling of AI applications in healthcare, and what the appropriate didactic approach is. Through the qualitative research by interviews and a workshop, six relevant areas of competences were identified. The two most important areas are ELSA and relevant AI applications. Explainability was also highlighted as an important point. The implementation of the topics in a blended learning course for interdisciplinary health professionals and educators in the healthcare sector is now planned.

Reliability and spatial specificity of rat brain sensorimotor functional connectivity networks are superior under sedation compared with general anesthesia.

Functional connectivity networks derived from resting-state functional MRI (rsfMRI) have received increasing interest to further our understanding of brain function. The anesthesia in rodent models may influence the interpretation and comparison of results from functional connectivity MRI (fcMRI). More research is required on this aspect. In this study, we investigated rat brain connectivity networks under 1.5% isoflurane anesthesia in comparison with medetomidine sedation. rsfMRI data were acquired under both anesthesia conditions within one imaging session. Male Wistar rats (n = 17) were scanned at 11.7 T with focus on the sensorimotor system. The data underwent a per-subject independent component analysis (ICA), after which individual components were grouped using hierarchical clustering. Consistent and reliable networks were identified under medetomidine in sensorimotor cortex (three networks) and striatum (two networks). The incidence of these networks was drastically reduced under isoflurane. Seed correlation analysis confirmed these results and revealed globally elevated correlations with low topical specificity under isoflurane, stemming from low-frequency global signal fluctuations. Global signal removal thus enhanced slightly regional specificity under isoflurane and showed anti-correlations of cortico-striatal connections in both anesthesia regimes. Functional connectivity networks are thus reliably detected in medetomidine-sedated animals on an individual basis using ICA. Their occurrence, however, is heavily compromised under isoflurane as a result of global signal fluctuations potentially stemming from burst-suppression-like neural activity. Anesthesia and pharmacologically induced modulations may provide insight into network mechanisms in the future. As an agent for fcMRI in brain disease studies, light sedation using medetomidine preserves connectivity networks in a greater level of detail, and may therefore be considered superior to standard isoflurane anesthesia.

White matter reorganization and functional response after focal cerebral ischemia in the rat.

After stroke, the brain has shown to be able to achieve spontaneous functional recovery despite severe cerebral damage. This phenomenon is poorly understood. To address this issue, focal transient ischemia was induced by 60 min middle cerebral artery occlusion in Wistar rats. The evolution of stroke was followed using two magnetic resonance imaging modalities: diffusion spectrum imaging (acquired before, one and four weeks after stroke) and functional magnetic resonance imaging (acquired before and five weeks after stroke). To confirm the imaging observations, immunohistochemical staining for myelin, astrocytes and macrophages/microglia was added. At four weeks after stroke, a focal alteration of the diffusion anisotropy was observed between the ipsilesional ventricle and the lesion area. Using tractography this perturbation was identified as reorganization of the ipsilesional internal capsule. Functional imaging at five weeks after ischemia demonstrated activation of the primary sensorimotor cortex in both hemispheres in all rats except one animal lacking a functional response in the ipsilesional cortex. Furthermore, fiber tracking showed a transhemispheric fiber connection through the corpus callosum, which-in the rat without functional recovery-was lost. Our study shows the influence of the internal capsule reorganization, combined with inter-hemispheric connections though the corpus callosum, on the functional activation of the brain from stroke. In conclusion, tractography opens a new door to non-invasively investigate the structural correlates of lack of functional recovery after stroke.

Connectivity of thalamo-cortical pathway in rat brain: combined diffusion spectrum imaging and functional MRI at 11.7 T.

Fiber tracking in combination with functional MRI has recently attracted strong interest, as it may help to elucidate the structural basis for functional connectivities and may be selective in the determination of the fiber bundles responsible for a particular circuit. Diffusion spectrum imaging provides a more complex analysis of fiber circuits than the commonly used diffusion tensor imaging approach, also allowing the discrimination of crossing fibers in the brain. For the understanding of pathophysiological alterations during brain lesion and recovery, such studies need to be extended to small-animal models. In this article, we present the first study combining functional MRI with high-resolution diffusion spectrum imaging in vivo. We have chosen the well-characterized electrical forepaw stimulation paradigm in the rat to examine the thalamo-cortical pathway. Using the functionally activated areas in both thalamus and somatosensory cortex as seed and target regions for fiber tracking, we are able to characterize the fibers responsible for this stimulation pathway. Moreover, we show that the selection of the thalamic nucleus and primary somatosensory cortex on the basis of anatomical description results in a larger fiber bundle, probably encompassing connectivities between the thalamus and other areas of the somatosensory cortex, such as the hindpaw and large barrel field cortex.

Functional connectivity in the rat at 11.7T: Impact of physiological noise in resting state fMRI.

Resting state functional MRI (rs-fMRI) of the brain has the potential to elicit networks of functional connectivity and to reveal changes thereof in animal models of neurological disorders. In the present study, we investigate the contribution of physiological noise and its impact on assessment of functional connectivity in rs-fMRI of medetomidine sedated, spontaneously breathing rats at ultrahigh field of 11.7 Tesla. We employed gradient echo planar imaging (EPI) with repetition times of 3s and used simultaneous recordings of physiological parameters. A model of linear regression was applied to quantify the amount of BOLD fMRI signal fluctuations attributable to physiological sources. Our results indicate that physiological noise - mainly originating from the respiratory cycle -dominates the rs-fMRI time course in the form of spatially complex correlation patterns. As a consequence, these physiological fluctuations introduce severe artifacts into seed-based correlation maps and lead to misinterpretation of corresponding connectivity measures. We demonstrate that a scheme of motion correction and linear regression can significantly reduce physiological noise in the rs-fMRI time course, remove artifacts, and hence improve the reproducibility of functional connectivity assessment. In conclusion, physiological noise can severely compromise functional connectivity MRI (fcMRI) of the rodent at high fields and must be carefully considered in design and interpretation of future studies. Motion correction should be considered the primary strategy for reduction of apparent motion related to respiratory fluctuations. Combined with subsequent regression of physiological confounders, this strategy has proven successful in reducing physiological noise and related artifacts affecting functional connectivity analysis. The proposed new and rigorous protocol now opens the potential of fcMRI to elicit the role of brain connectivity in pathological processes without concerns of confounding contributions from physiological noise.

No increase of the blood oxygenation level-dependent functional magnetic resonance imaging signal with higher field strength: implications for brain activation studies.

Experimental data up to 7.0 T show that the blood oxygenation level-dependent (BOLD) signal of functional magnetic resonance imaging (fMRI) increases with higher magnetic field strength. Although several studies at 11.7 T report higher BOLD signal compared with studies at 7.0 T, no direct comparison at these two field strengths has been performed under the exact same conditions. It therefore remains unclear whether the expected increase of BOLD effect with field strength will still continue to hold for fields >7.0 T. To examine this issue, we compared the BOLD activation signal at 7.0 and 11.7 T with the two common sequences, spin-echo (SE) and gradient-echo (GE) echo planar imaging (EPI). We chose the physiologically well controlled rat model of electrical forepaw stimulation under medetomidine sedation. While a linear to superlinear increase in activation with field strengths up to 7.0 T was reported in the literature, we observed no significant activation difference between 7.0 and 11.7 T with either SE or GE. Discussing the results in light of the four-component model of the BOLD signal, we showed that at high field only two extravascular contributions remain relevant, while both intravascular components vanish. Constancy of the BOLD effect is discussed due to motional narrowing, i.e., susceptibility gradients become so strong that phase variance of diffusing spins decreases and therefore the BOLD signal also decreases. This finding will be of high significance for the planning of future human and animal fMRI studies at high fields and their quantitative analysis.

High field BOLD response to forepaw stimulation in the mouse.

We have established a robust protocol for longitudinal fMRI in mice at high field MRI using a medetomidine anesthesia. Electrical forepaw stimulation in anesthetized animals is widely used to produce BOLD contrast in the primary somatosensory cortex. To preserve neuronal activity, most fMRI experiments used alpha-chloralose to produce sedation, but severe side effects make this procedure unsuitable for survival experiments. As advantageous alternative, the alpha(2)-adrenergic receptor agonist medetomidine has been applied successfully to permit longitudinal fMRI studies in rats. With the advent of transgenic technology, mouse models have become increasingly attractive raising the demand for implementation of a suitable fMRI protocol for mice. Therefore, we investigated the use of medetomidine for repetitive fMRI experiments in C57BL/6 mice. We evaluated the optimal medetomidine dose for subcutaneous application. Somatosensory evoked potentials (SSEPs) in the contralateral somatosensory cortex were recorded to assess brain activity under medetominidine following forepaw stimulation. Repetitive administration of medetomidine, the requirement for longitudinal brain activation studies, was well tolerated. Using the forepaw stimulation paradigm, we observed BOLD contrast in the contralateral somatosensory cortex in approximately 50% of the performed scans using gradient echo-echo planar imaging (GE-EPI). However, imaging the small mouse brain at high field strength is challenging and we observed strong susceptibility artifacts in GE-EPI images in the cortex. We have developed an agar gel cap for successful compensation of these artifacts as prerequisite for successful mouse fMRI at 11.7T. The established protocol will be suitable for brain activation studies in transgenic animals and for studies of functional deficit and recovery after brain injury in mice.