#horizontal integration

Intro to Integration

When it comes to ProcureTech development what is the difference between "Horizontal Stacking" and "Intelligent Vertical" integration solutions?

“I am dividing the frontend functional solutions from the AI operating system providers – the two categories of solution providers emerging after the 2025 shake-up.” – Procurement Insights An Example of A Frontend Functional Solution Provider Last month, I posted the article Globality Demo > The Road to the ProcureTech Cup: Episode 25-06, where I provided a fair assessment. Here is the link to…

For example, Amazon is not merely the platform for e-commerce; it’s also the platform for cloud-based computing. So if Amazon’s deep knowledge and control—and this also applies to Alibaba, actually—over the cloud-based computing environment allows them to have an unfair advantage in the e-commerce marketplace, where they suggest certain products that benefit their own hidden agendas, then that’s monopolistic, horizontal integration. We can also see aspects of vertical integration from a monopolistic perspective, because what Amazon has attempted to do is control every aspect of the supply chain: logistics, content/supply warehousing, the delivery platform, efficiency, the marketplace itself. So there are aspects of horizontal and vertical integration that would need to be explored.

The authors discuss in this article about the cavum septi pellucidi and cavum Vergae. The septum pellucidum is a transparent part of two laminae that extends from the anterior part of the body (the genu) to the superior surface of the fornix. The development of the septum pellucidum occurs from the primitive lamina terminalis which forms the anterior wall of the telencephalic cavity. The article presents a mini-review on the subject and it includes information about their embryology and anatomic findings.

Keywords: Anatomy; Cavumseptumpellucidum; Cavumseptipellucidi; Cavumvergae; Verga’s Ventricle

Embryology of the Septum

Derived from the lateral part of the terminal bar, firstly, the septum binds to the frontal direction, always separated from the pallial part by a ventricular groove, a septum-cortical fissure. This pre commissural part of the septum has a considerable thickness, especially in lower mammalians. As with the reptiles, their cells are grouped into two nuclei, the septi nuclei dorsolateral and ventromedial. It contains the fibers that ascend to the hippocampus (olfactory hyppocampal fibers or olfactory bundle of the septum). The pre commissural part continues backward, below the corpus callosum and over the foramen of Monro. This supra foraminal of the septum contains the fibers fornicais and cortico-habenulares. The extension of the corpus callosum allows an extension of the septum, whose pre commissural part is reduced as the measure that increases the frontal extension of the corpus callosum, while the supra foraminal suffers a stretching and a reduction still more important, as a result of the posterior displacement of the Amon horn. Such septum extension implies in its reduction to a fine membrane, the septum pellucidi of a man. Among the septal nucleus, the ventro medial nucleus, located in front of the anterior commissure, only maintains a remarkable volume. The bilateral septi can suffer coalescence or even a concrescence so that the arachnoid space, a septum cavity located between the septi of both sides, disappears. This process is almost normal in its posterior part. On the other hand, an increase of the arachnoid fluid can cause an expansion of the interseptal sub callosal space, including its posterior part, which, then, is transformed and becomes the cavity named Verga. However, it is evident that these cavities do not have any normal communication with the cerebral ventricles [1-3].

Anatomy of the Septum

The septum, in the ventromedial portion of the hemispheres of the forebrain, is differentiated in all vertebrates [4]. The septum pellucidum of man is composed of two thin leaves of gliotic tissue with occasional scattered neurons. The leaves may be fused, but an interseptal space, the cavum septi pellucidi, persists in 85 per cent of normal adult as a small slit or large space [5]. This interseptal space is lined by the ependyma [6] and it is often connected with the ventricular system, as known by the frequency of filling with air during pneumo encephalography, even in neonates [7]. A combination of the theories would explain the histological nature of the septal leaves as neural tissue lined by ependyma and derived from the lamina terminalis the cavum septi pellucidi may be continuous with the third ventricle, or the laminae terminalis may completely separate the cavum from the anterior end of the ventricle: the open cavum septi pellucidi described by Thompson [8] as occurring in ungulates, carnivorous, and primates, was really the recess beneath the frontal end of the corpus callosum [9]. The human septum pellucidum is absent in association with agenesis of the corpus callosum [10] and is intimately related to and dependent upon the proceeding and concomitant growth of the corpus callosum during embryogenesis [11,12].

The Ventricular System

The ventricular system is constituted from the cavities of the cerebral vesicles and the medullar tube. All the ventricular system is intercommunicated, demonstrating its origin of a common cavity, the neural tube cavity. The changes of the cavities are due to an uneven growth of the vesicles and their walls. At the level of the medullar tube, the growth is restricted and the walls suffer a large thickening. Consequently, the cavity becomes relatively thin and will constitute the ependymal channel. At the level of the rhombencephalon we will have an expanded cavity, in spite of the pronounced growth of the walls which will constitute the floor (medulla oblongata and pons) and the roof (cerebellum) - the 4th ventricle. The caudal portion of the roof of the 4th ventricle is formed by the plate of the miencephalon roof, which is stretched and consisted of few spongioblasts layers – is the coroidal plate of the 4th ventricle. At the level of the mesencephalon, the growth of the walls is relatively larger than that of the cavity, becoming reduced to a channel of small diameter - the cerebral aqueduct, which connects with the 4th and 3rd ventricles. At the level of the diencephalon it was observed that there is a large growth of the lateral walls, forming the thalamic region, while the cavity is reduced to a narrow sagittal cleft – the 3rd. ventricle. Its roof remains thin with some thick cellular layers – the coroidal layer of the 3rd ventricle. Below the corpus callosum a thin membrane is observed named septum pellucidum (transparent septum), located between the corpus callosum and the trigon. It has a triangular form and in its inner lodging a small cavity which is named (wrongly named) the fifth Verga’s ventricle. In the telencephalon the situation is more complex due to the appearance of the hemispheric vesicles and the primitive cavity is unfolded into two cavities, in a wide communication with the 3rd. Ventricle - they will be the lateral ventricles. Later the communication will be reduced, and the lateral ventricles start to communicate with the 3rd, through two holes - they are the inter ventricular holes. The regions where the hemispheric vesicles are limited with the diencephalic floor remain thin, constituting the choroidal plates of the lateral ventricles.

Anatomic Case

After the dissection of the encephalon in a cadaver of a man, we observed in anatomic cuts the Verga’s ventricle (Figure 1). The pathology and the image of the septum pellucidum and the Verga’s ventricle are an anatomic rarity. The “cavum of the septum pellucidum” is a cavity filled with the cerebrospinal fluid which is situated between the frontal horns of the lateral ventricles. The “cavum Vergae” is a posterior digiti form extension elongated from the cavum septum pellucidum which is located among the fornices. The cavum septum pellucidum can occur in an isolated manner, however, the cavum Vergae only occurs in conjunction with the cavum septum pellucidum. When the two occur, the correct Latin nomenclature is cavum septi pellucidiet Vergae. In the daily use, the combination usually is called cavum of the septum pellucidum [13]. The septi pellucidi are two paired triangular membranes (“leaflets”) which develop approximately with 12 weeks of gestational age. The embryonic septi pellucidi are not fused, and the cavity between them is filled with cerebrospinal fluid. This simple cavity between the two leaflets receives two different names. Anterior to the foramen of Monro it is called “cavum of septum pellucidum”. The posterior continuation between the fornices is called “cavum Vergae”. Normally, the two septi pellucidi fuse, and the cavity between them is obliterated. The fused membranes become the septum pellucidum. The presence of the cavum of the septum pellucidum usually is asymptomatic and is an alteration of the type “don’t touch”, found accidentally in the image exams. The computed tomography and the magnetic resonance imaging of these two entities show a cleft cavity not much visible and a prominent collection measuring various millimeters in diameter. In rare cases, these pathologies exceptionally increased determine an expansive effect, displacing laterally the fornices and the leaflets of the septi pellucidi. Those two pathologies should not be confused with a “cavum velum enterpositum”, which is the space of the triangular cerebrospinal fluid, thin, which recovers the thalamus and the third ventricle. The “cavum velum interpositum” usually occurs without the cavum septi pellucidi.

Conflict of Interest

JUNIPER PUBLISHERS-OPEN ACCESS ANATOMY PHYSIOLOGY & BIOCHEMISTRY INTERNATIONAL JOURNAL

Objective: To assess the level of success achieved by implementation of integrated teaching in first and second year of medical education.

Study Design: Literature survey based qualitative content analysis

Methodology: Online available literature from 1990 to 2105 was reviewed thoroughly and data/results were studied.

Results: Most of the data was based on the personal views of faculty and the perception of students. Outcome based studies regarding assessment, results, and performance in annual exam were too scarce to reach conclusion.

Conclusion: Keeping in view the requirement of ideal resources, PBL sessions for specific and easily integrated contents of basic and clinical disciplines can be run along with conventional teaching. Total reliance on integrated teaching is not recommended until thorough studies prove a positive long term impact of such system.

Keywords: Curriculum; Horizontal Integration; MITs; Problem Base Learning; Vertical Integration

Introduction

Basic medical sciences have always been considered an integral component of medical teaching. The fundamental role of basic medical sciences i.e. anatomy, physiology and biochemistry was first established in 1910 [1]. This unlatched the door leading us into an era in which the initial two years were tirelessly devoted to the establishment of profound, thorough knowledge of the basic sciences, a foundation upon which clinical comprehension was fortified in the later three years. This “Conventional Teaching System” was opted throughout the world with a clear-cut demarcation among all basic and clinical disciplines. This system of medical education engendered legions of proficient and competent doctors who, with their meticulous skills and meritorious prowess, revolutionized the world of medicine. As years passed by, a need for integration of was felt in order to produce doctors who are sufficiently adept to meet the challenges of the 21st century head on – doctors with an augmented ability to think critically and with apt reasoning. It was emphasized that relevant aspects of clinical subjects should be incorporated into basic medical sciences. In accordance with to enhance the effectiveness of integrated learning. Present review is based on the data and informations gathered from various review reports, research articles, and commentaries published on PubMed, MEDLINE, and Google Scholar.

The main purpose of this review is to evaluate the scope and success of the integration as a learning strategy in the first and second years of medical education in the last 25 years (1990-2015); moreover, this review assess the success this new system has had in these years. Studies focused on integration of biomedical sciences like anatomy, biochemistry, physiology, pathology, pharmacology (horizontal integration), and surgery and allied as well as medicine and allied (vertical integration) in first two years of medical teaching are included in the review. All literature was explored under the guidelines proposed by Goldman [2] who suggested that learning objectives of the medical curriculum can be achieved successfully by applying integration learning strategies at three levels. The first level was labeled as “program”, a framework of curriculum encompassing all learning strategies to be applied throughout the course of medical studies. The second level was “course”, indicating various components of program. The third level of integration was called “session”, which applies to the learning strategies employed on a daily basis to achieve the required level of knowledge. These three levels go hand in hand and determine the actual success of the integrated teaching on the basis of logistics and cognitive domain of learning [3]. Hence, present review aims to analyze the integration extent, methodologies opted and the indicators determining the success or failure of integration. Before the implementation of an innovative idea, the stake holders, i.e. medical students need to be taken under consideration. They are the fertile soil upon which the gardens of knowledge and skill will bloom. The way we nurture the soil will ultimately determine the fruits it will bear. It is difficult to lay down uniform curriculum and learning strategies throughout the world. In developing countries like Pakistan, students enter medical college after 12 years of schooling with typical syllabi with no remote relation to the basic sciences being taught in medical schools [4].

The students are exposed to completely new subjects upon entering medical school. In the first two years, their knowledge has to be built from grass root level up to a stage where they can successfully integrate it with applied clinical sciences. On the other hand, in Canada, North and South America, students have to get BA and BS degrees before qualifying for admission in medical schools. They have already covered a major chunk of basic sciences like biochemistry and physiology of cell in pre medical years [5]; therefore upon entering the course of medical education, they are successfully able to consolidate the basic knowledge with clinical learning. Before the implementation of integration, accurate planning and evaluation of medical curriculum is essential. According to taxonomy of the integration ladder, eleven steps lie between the disciplines based teaching (bottom) and integrated teaching (top) [6]. As we move up the ladder, towards integrated teaching, boundaries of individual disciplines diminish and a fundamentally organized curriculum structure emerges. This highest level of integration requires extensive resources, student selection criteria (including aptitude test), joint contribution from trained faculty members from all disciplines in formulation of curriculum and a friendly, interactive environment between different departments. After mutual consensus, time table for teaching sessions, learning objectives for each session and assessment techniques are finalized accordingly. Displayed time table and contents of curriculum indicate the level of integration. Time tables showing higher level of integration will be no longer highlighting the individual disciplines. Horizontal integration in first and second year of medicine links basic sciences on the basis of practical and philosophical approach, whereas vertical integration bridges basic and clinical sciences, breaking the division between preclinical and clinical teaching, and making learning more meaningful and productive. Both types of integrations are required for formulation of Integrated Curriculum. This main task triggers a debate among faculty members who have their reservations in integrated teaching when compared with discipline based teaching, the reason being the lack of resources and inadequate logistics [7]. To avoid this state of polarization, faculty should be encouraged to discuss and trained to search for integration options within available resources. It would be unjustified to ignore the viewpoints of experienced faculty members, organizational structure of medical college and overall objectives of the curriculum. Transition from conventional discipline based teaching to completely integrated teaching requires major changes [6].

The next step, after formulation of medical curriculum, is the selection of accurate learning methodology which may be large group or small group interactive sessions, problem based learning (PBL) and self-directed learning sessions, to achieve the required objectives of integrated learning. Out of teaching tools, PBL is considered to be the most effective and productive. It was first introduced and implemented at McMaster University, Canada [8]. Later on implementation of PBL sessions along with conventional curricula was done in many countries including New Zealand, Pakistan and India. This was given the name “hybrid system”. Hybrid integrated learning programs (ILP) of small durations were introduced in first year MBBS class in few medical school, as a supplementary tool to conventional teaching, to promote thinking and reasoning skills among students. Results indicated that only a few programs were able to integrate an even fewer number of basic science disciplines (horizontal integration), leaving the rest on regular conventional teaching. Small group laboratory sessions were also organized to integrate with PBL content [9].

Discussion

We, as part of a community are exposed to various forms of integration, like sharing skills and problem solving. The ever growing need for integration demands a change from conventional to integration system. Students almost always gave a positive feedback regarding integrated teaching, both in developed and developing countries [10,11] as this strategy takes them away from rote learning of facts to development of concepts of relevant information. In various studies the outcome was usually determined by faculty feedback, students’ perception, and assessment of the strengths and weaknesses of individual students with the help of questionnaire [12]. It was also noticed in a few studies, that students got themselves confined to their allotted, specific learning objectives, while ignoring the remaining targets; moreover most of them indulged into unnecessary details and lost track of the topics due to lack of understanding of the difference between facts that are “must to know” and those that are to be given less attention at that particular stage. It was also observed that number of absentees also increased in these sessions. Students also considered PBLs insufficient and inadequate when employed as a singular teaching method. They complained of minimal retention of the required knowledge when topics were dealt with under PBLs alone. According to the students, teaching has a stronger impact if done as a continuous process with repetition of facts for knowledge retention, regular assignments and finally, strict assessment for evaluation [13].

Few studies showed that students did not accept PBL teaching sessions as a good learning option due to more burden of work and time consumption [14]. Formulation and implementation of integrated curriculum in initial two years of medical teaching is a complicated process, having various impacts on different scenarios regarding teaching methodologies and course content; however, final deciding factor which determines the success and failure of any learning strategy is the performance of the students in the annual assessment. Thorough literature review revealed that in spite of great appreciation of PBL sessions both by faculty and students, performance of those students who were taught through structured, teacher oriented, conventional curriculum was much better than that of students under integrated problem based curriculum [15]. However, few studies could not find significant difference statistically [8,16]. Apart from one medical school in United States, which claimed better outcome by implementing integrated problem based curriculum, we could not find any study which can statistically prove this innovative learning strategy showing better student performance in annual medical examination when compared to that of conventional methods [17]. Literature review reinforced that integrated sessions are more successful in clinical years as clinical sciences can be integrated at the highest level, but this level of integration does not exist between clinical and basic sciences.

Basic sciences have hidden content that cannot be integrated, but lies in the foundation of the subject, often unexplored by the student [18]. Hence, if only PBL is used as a major learning tool, students might miss that basic core knowledge of physiology, anatomy and biochemistry during initial two years of the course [19]. Moreover PBL trains the students in a particular direction. Facilitators are more focused towards proper organization to conduct PBL session rather than the teaching content; therefore, it is not advisable to rely on PBL methodology alone. Instead, it can be used as supplementary tool, along with large group interactive sessions and traditional didactic lectures [20]. Basic sciences cannot be integrated at a microscopic level, so few systems or learning objectives of anatomy, biochemistry and physiology may be integrated in a PBL session, whereas the rest of the teaching should follow the conventional methodology. The shortcomings observed in PBL sessions can be overcome by ensuring 100% attendance of students, involving each student in all learning objectives and defining the role of facilitators. Moreover the number of large group interactive sessions may be increased to make a PBL more productive by enhancing the level of core knowledge of medical students. Facilitators should be trained to keep a check on students by keeping them on track. Most of the studies showed that in integration sessions in the initial two years of medical schooling, clinical subjects were over emphasized instead of basic sciences because most of the facilitators were from clinical sciences; hence, faculty from basic sciences should be encouraged to participate in these sessions too.

In developing countries, academics, particularly medical education, face a different set of problems. As developing countries have inadequate resource at hand, implementation of integrated teaching in medical colleges is quite challenging. Few private sector medical universities in Pakistan have already switched from conventional to integrated curriculum partially or completely [21]. Unfortunately while reviewing the literature on integration, we could not find statistically significant data that assesses its long term success and impact. It can only be done by evaluating and comparing the conventional and integrated teaching outcomes in the existing local environment, over a specified period of time, in the form of students performance in assessment, both formative and summative [22-25]. To reinforce the basic idea of integration, specific, identified learning objectives of basic medical sciences may be merged with those of clinical sciences, hence continuing teaching of basic disciplines in later years of medical education [26].

Most of the literature revealed that different setups adopted different methodologies and their results were merely the reflection of the personal opinions of the faculty and perception of the students [27]. Our review is based on subjective quality rating and the researchers’ opinions and points of views, making it very hard to reach a decisive conclusion. The issue regarding formulation of integrated medical curriculum, categorization, detail and depth of cognitive domain, and methodologies adopted to integrate basic sciences with clinical subjects are still mysteries of evolving the concept of integration. If integrated learning strategies are applied in true spirit, they will enhance students’ levels and depths of knowledge, perception, motivation, skills and approach towards solving health problems. It requires meaningful connection among various components of curriculum as well as students and facilitators [28]. Studies also revealed that integration is basically characterized by teaching strategies and rearrangement of various curricular contents. Instead of relying on the parameters mentioned above, it is better to focus on cognitive integration within the students. Integrated curriculum alone cannot truly integrate and interrelate various disciplines within the learners. The best way of integration is to build robust, fortified concepts of basic sciences in relevance with clinical sciences within the available resources and learning environment. This should be followed by an assessment to determine the level of comprehension, retention of the content of basic sciences, and its practical application with reasoning and skill [3].

Conclusion

If integration is in accordance with the cognitive domain, then specific learning objectives can be integrated without any extra effort. In order to organize a fruitful PBL session, it is essential to identify and focus on selected and precisely defined learning objectives of basic sciences that easily integrate with clinical sciences. Instead of implementing the highest level of integration at once, small PBL sessions with easily integrated learning objectives can be introduced. This can hone the students’ communicative skills, their ability to access and extract required knowledge and utilize it in practical life; however, further studies on conventional and integrated system are required to evaluate and compare the results based on the performance of students in annual undergraduate examinations as well as post graduate examinations to assess the level of knowledge acquired and retained by the students as well as their ability to apply this knowledge in practical life - our ultimate objective.

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After effects of Company Integration and Company Liquidation

Company Integration

When two businesses come together either through a merger or a takeover, it can be considered an integration. Company Integrations take place in order to withhold competition and maintain market position. There are different types of Company Integration – Backward vertical integration, Conglomerate integration, Forward vertical integration, and Horizontal integration. There…

What Does Horizontal Integration Mean

C O N T E N T S:

KEY TOPICS

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POSSIBLY USEFUL

Some great examples of a horizontal integration are Marriott’s 2016 acquisition of Sheraton (Hospitality industry), Anheuser-Busch InBev’s (AB InBev) 2016 acquisition of SABMiller (Beer companies),…