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Neural pathways --- Physiology --- Neural Pathways --- physiology.

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The Belgian hospital environment is constantly changing from continuous improvement reforms to major transformations impacting on hospital's operating mode. In particular, four emerging financing, accreditation programs patients' condition and consumerism in healthcare. This horizontal reshaping represents a considerable challenge for hospitals given their complex organizational environment. Hospitals are characterized by the divergence of objectives, the diffusion of power and the duplication of hierarchical lines, namely between managers and physicians. This pluralistic configuration does not facilitate major changes which require numerous actors’ involvement. Care pathways (CPs) could be the appropriate tool to pilot hospitals’ evolution toward a transverse and patient-centered vision. Cps suggests a redesign of hospitals’ logic of action from multiple and tangled processes to a unique service line around which all hospital actors are regrouping in order to create value for patients. CP implementation faces several difficulties mostly related to an organizational environment that is not sufficiently prepared to change. Therefore, we developed a 10 management strategies approach which could facilitate and accompany complex changes such as CP implementation. The aim of our study was the gather physicians’ and managers’ perceptions about the 10 strategies proposed. We conducted an exploratory study in a Belgian teaching hospital. In total, 22 managers and 44 doctors participated in our research by completing a short survey which included questions on importance, feasibility and performance of the strategies suggested.Analysis of data allowed us to conclude that the set of strategies proposed is perceived as important and feasible but their current application is generally low. Results also showed different strategy ratings and divergences of perceptions between of managers and physicians.If they seek to improve the implementation of changes such as CPs, hospital leaders need to obtain doctors’ participation. To this end, managers should focus their attention on three strategies, namely “Create interaction opportunities”, “Develop participatory decision-making’ and “Get down in the field”. On the contrary, hospital leaders could reduce the emphasis on two strategies, i.e.“Develop shared language and communication channels” and “ Make intermediate levels information carriers”. Les hôpitaux belges sont en perpétuel changement, des réformes d'amélioration, transformations majeures qui modifient leur mode de fonctionnement. En particulier, quatre enjeux sont susceptibles d'emmener les hôpitaux belges vers un nouveau paradigme plus transversal. Il s’agit d’un financement forfaitaire par pathologie, des programmes d'accréditation, du profil des malades et de l'évolution des patients vers des consommateurs de soins et de services. Cette redéfinition de l’organisation hospitalière de manière plus horizontale représente un défi considérable pour les institutions de soins en raison de leur configuration complexe caractérisée par la divergence des objectifs, la diffusion du pouvoir et de la coexistence de hiérarchies parallèles, notamment entre gestionnaires et médecins. Cet environnement ne facilite pas les changements de grande ampleur qui requièrent la participation de nombreux acteurs. Les itinéraires cliniques (IC) pourraient constituer une méthode appropriée pour guider la transformation des hôpitaux vers une organisation plus transversale et centrée sur les besoins des patients. Les IC proposent en effet une redéfinition de la logique hospitalière vers une chaîne de service autour de laquelle se rassemblent tous les acteurs hospitaliers partageant un même objectif : la création de valeur pour les patients. Objectifs: L'implémentation des IC sur le terrain rencontre d'importantes difficultés qui témoignent pour la plupart d'un environnement hospitalier qui n'est pas suffisamment préparé au changement donc développé. Nous avons donc développé 10 stratégies managériales qui pourraient faciliter l'introduction et l'accompagnement de changements complexes tels que les IC. L'objectif de notre étude sur le terrain était de recueillir les perceptions de médecins et de gestionnaires quant aux stratégies proposées. Méthodologie : Nous avons mené une recherche exploratoire dans un hôpital universitaire belge. Au total, nous avons recueilli la participation de 22 gestionnaires et 44 médecins qui ont rempli un questionnaire concernant l'importance, la faisabilité et l'utilisation actuelle des stratégies proposées. Résultats: L'analyse des données collectées sur le terrain nous a permis de conclure que les stratégies proposées bénéficient d'une perception favorable en termes d'importance et de faisabilité mais que leur utilisation actuelle reste faible. Les résultats ont également montré des différences d'opinions selon les stratégies ainsi que des divergences de perceptions entre les gestionnaires et les praticiens. Conclusion: Les gestionnaires hospitaliers qui souhaitent améliorer la pénétration de changement tels que les IC en s'assurant l'engagement des médecins pourraient concentrer leur attention sur trois stratégies : créer des opportunités d'interactions, développer la prise de décision participative et descendre sur le terrain. Par contre, les dirigeants hospitaliers pourraient, sans risquer d'influencer négativement la participation du corps médical dans les projets de changement, réduire l'application de stratégies telles que le développement d'un langage partagé et de canaux de communication et l'utilisation des niveaux hiérarchiques pour transmettre l'information.

Critical Pathways --- Hospitals

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The Oxford Handbook of the Auditory Brainstem provides an in-depth reference to the organization and function of ascending and descending auditory pathways in the mammalian brainstem. Individual chapters are organized along the auditory pathway, beginning with the cochlea and ending with the auditory midbrain. Each chapter provides an introduction to the respective area and summarizes our current knowledge before discussing the disputes and challenges that the field currently faces.The handbook emphasizes the numerous forms of plasticity that are increasingly observed in many areas of the auditory brainstem. Several chapters focus on neuronal modulation of function and plasticity on the synaptic, neuronal, and circuit level, especially during development, aging, and following peripheral hearing loss. In addition, the book addresses the role of trauma-induced maladaptive plasticity with respect to its contribution in generating central hearing dysfunction, such as hyperacusis and tinnitus.The book is intended for students and postdoctoral fellows starting in the auditory field and for researchers of related fields who wish to get an authoritative and up-to-date summary of the current state of auditory brainstem research. For clinical practitioners in audiology, otolaryngology, and neurology, the book is a valuable resource of information about the neuronal mechanisms that are currently discussed as major candidates for the generation of central hearing dysfunction.

Auditory pathways --- Brain stem

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The more than twenty contributions in this book, all new and previously unpublished, provide an up-to-date survey of contemporary research on computational modeling of the visual system. The approaches represented range from neurophysiology to psychophysics, and from retinal function to the analysis of visual cues to motion, color, texture, and depth. The contributions are linked thematically by a consistent consideration of the links between empirical data and computational models in the study of visual function.An introductory chapter by Edward Adelson and James Bergen gives a new and elegant formalization of the elements of early vision. Subsequent sections treat receptors and sampling, models of neural function, detection and discrimination, color and shading, motion and texture, and 3D shape. Each section is introduced by a brief topical review and summary.Michael S. Landy is Associate Professor of Psychology at New York University where J. Anthony Movshon is Professor of Neural Science and Psychology and Director of the Center for Neural Science.Contributors: Edward H. Adelson. Albert J. Ahumada, Jr., James R. Bergen. David G. Birch. David H. Brainard. Heinrich H. Bulthoff. Charles Chubb. Nancy J. Coletta. Michael D'Zmura. John P. Frisby. Norma Graham. Norberto M. Grzywacz. P. William Haake. Michael J. Hawken. David J. Heeger. Donald C. Hood. Elizabeth B. Johnston. Daniel Kersten. Michael S. Landy. Peter Lennie. J. Stephen Mansfield. J. Anthony Movshon. Jacob Nachmias. Andrew J. Parker. Denis G. Pelli. Stephen B. Pollard. R. Clay Reid. Robert Shapley. Carlo L. M. Tiana. Brian A. Wandell. Andrew B. Watson. David R. Williams. Hugh R. Wilson. Yuede. Yang. Alan L. Yuille.

Visual pathways --- Computer simulation

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METABOLIC PATHWAYS --- ISOTOPE INDICATORS