Dissimilarity in Sulcal Width Patterns in the Cortex can be Used to Identify Patients With Schizophrenia With Extreme Deficits in Cognitive Performance

Schizophrenia is a biologically complex disorder with multiple regional deficits in cortical brain morphology. In addition, interindividual heterogeneity of cortical morphological metrics is larger in patients with schizophrenia when compared to healthy controls. Exploiting interindividual differences in the severity of cortical morphological deficits in patients instead of focusing on group averages may aid in detecting biologically informed homogeneous subgroups. The person-based similarity index (PBSI) of brain morphology indexes an individual’s morphometric similarity across numerous cortical regions amongst a sample of healthy subjects. We extended the PBSI such that it indexes the morphometric similarity of an independent individual (eg, a patient) with respect to healthy control subjects. By employing a normative modeling approach on longitudinal data, we determined an individual’s degree of morphometric dissimilarity to the norm. We calculated the PBSI for sulcal width (PBSI-SW) in patients with schizophrenia and healthy control subjects (164 patients and 164 healthy controls; 656 magnetic resonance imaging scans) and associated it with cognitive performance and cortical sulcation index. A subgroup of patients with markedly deviant PBSI-SW showed extreme deficits in cognitive performance and cortical sulcation. Progressive reduction of PBSI-SW in the schizophrenia group relative to healthy controls was driven by these deviating individuals. By explicitly leveraging interindividual differences in the severity of PBSI-SW deficits, neuroimaging-driven subgrouping of patients is feasible. As such, our results pave the way for future applications of morphometric similarity indices for subtyping of clinical populations.

Adjusting to austerity: the public spending responses of regional governments to the budget constraint in Spain and Italy

What are the effects of fiscal imbalances, and austerity, on regional-level spending? To answer this question, we examine an original dataset of yearly spending decisions of regional governments in Italy and Spain between 2003 and 2015. We find that the rise in regional deficits has an important negative effect on regional governments’ spending. The strength of this effect is, however, mitigated by the presence of a left-wing party in regional office. In addition, we uncover an important variation in the extent of cutbacks across policy sectors: regional governments tend to protect the health sector and focus their retrenchment efforts on social assistance and running of public institutions. Partisanship matters here too, as left-wing parties tend to protect healthcare more than their right-wing rivals. These findings bear relevance for understanding the role of partisanship and policy sector in the process of public retrenchment in multi-level states.

Pflege und Sorge – Gleichwertige Lebensbedingungen, Pflegeversicherung und die neue Bedeutung von Kommunen

Zusammenfassung Mit der Einführung der Pflegeversicherung vor 25 Jahren wurde das Ziel verfolgt, zum einen die Bürger*innen vom Risiko der Sozialhilfebedürftigkeit frei zu stellen. Aber auch eine Weiterentwicklung der Infrastruktur in der Langzeitpflege wurde durch die Marktöffnung, die mit der Pflegeversicherung einherging, als zentrales Ziel verfolgt. Gerade letzteres Ziel kann nicht als erreicht gelten: In dem Beitrag wird aufgezeigt, dass von gleichwertigen Lebensbedingungen für auf Pflege angewiesene Menschen in Deutschland nicht die Rede sein kann. Regional gilt es zum Teil eklatante Infrastrukturdefizite zu beklagen. In dem Beitrag werden die alte und neue Rolle der Kommungen für Fragen der Daseinsvorsorge in der Langzeitpflege und mit ihr verbundene Reformperspektiven der Pflegeversicherung diskutiert. Abstract: Long-Term Care Insurance In The Role of The Municipalities For Sustainable Infrastructure With the introduction of long term care insurance 25 years ago one objective was to exempt the citizens from the need of social welfare. A second aim was the development of long term care by opening up the markets in conjunction with long term care insurance. But at least this goal has not been attained. The text contribution will point up that there obviously are no equivalent living conditions for people being dependent on nursing care in Germany. Signicifant regional deficits of infrastrukture are existing. The old and the new role of muni­cipalities in relations of questions of welfare services in long-term care associated with long term care reform perspektives will be also discussed.

Dissimilarity in sulcal width patterns in the cortex can be used to identify patients with schizophrenia with extreme deficits in cognitive performance

Schizophrenia is a biologically complex disorder with multiple regional deficits in cortical brain morphology. In addition, interindividual heterogeneity of cortical morphological metrics is larger in patients with schizophrenia when compared to healthy controls. Exploiting interindividual differences in severity of cortical morphological deficits in patients instead of focusing on group averages may aid in detecting biologically informed homogeneous subgroups. The Person-Based Similarity Index (PBSI) of brain morphology indexes an individual’s morphometric similarity across numerous cortical regions amongst a sample of healthy subjects. We extended the PBSI such that it indexes morphometric similarity of an independent individual (e.g., a patient) with respect to healthy control subjects. By employing a normative modeling approach on longitudinal data, we determined an individual’s degree of morphometric dissimilarity to the norm. We calculated the PBSI for sulcal width (PBSI-SW) in patients with schizophrenia and healthy control subjects (164 patients, 164 healthy controls; 656 MRI scans) and associated it with cognitive performance and cortical sulcation index. A subgroup of patients with markedly deviant PBSI-SW showed extreme deficits in cognitive performance and cortical sulcation. Progressive reduction of PBSI-SW in the schizophrenia group relative to healthy controls was driven by these deviating individuals. By explicitly leveraging interindividual differences in severity of PBSI-SW deficits, neuroimaging-driven subgrouping of patients is feasible. As such, our results pave the way for future applications of morphometric similarity indices for subtyping of clinical populations.