Approximately half the excitatory neurons in layer 6 (L6) of the rat barrel cortex project to the thalamus with axon collaterals ramifying in the granular L4; the remaining project within cortex with collaterals restricted to infragranular laminae. In analogy, L6 inhibitory neurons also include locally arborizing and inter-laminar projecting neurons. We examined whether L6 neurons participating in different laminar interactions were also morphologically and electrically distinct. Corticothalamic (CT) neurons were labeled by in vivo injections of a retrogradely transported fluorescent tracer into the primary thalamic nucleus. Whole cell current-clamp recordings were performed from labeled and unlabeled L6 neurons in brain slices of juvenile rats; the morphology of cells was subsequently recovered and reconstructed. Corticocortical (CC) neurons were distinguished from CT cells based on the absence of a subcortical projection and the predominantly infragranular arborization of their axon collaterals. Two morphological CC subtypes could be further distinguished based on the structure of their apical dendrite. Electrically, CT neurons had shorter membrane time-constants and action potential (AP) durations and higher rheobase currents. CC neurons fired high-frequency spike doublets or triplets on sustained depolarization; the burst frequency also distinguished the two morphological CC subtypes. Among inhibitory L6 cells, the L4-projecting (L6iL4) and local (L6iL6) inhibitory neurons also had contrasting firing properties; L6iL4 neurons had broader APs and lower maximal firing rates. We propose that L6 excitatory and inhibitory neurons projecting to L4 constitute specialized subcircuits distinct from the infragranular network in their connectivity and firing patterns.

Mobile technology is very prevalent in Kenya-mobile phone penetration is at 88% and mobile data subscriptions form 99% of all internet subscriptions. While there is great potential for such ubiquitous technology to revolutionise access and quality of healthcare in low-resource settings, there have been few successes at scale. Implementations of electronic health (e-Health) and mobile health (m-Health) technologies in countries like Kenya are yet to tackle human resource constraints or the political, ethical and financial considerations of such technologies. We outline recent innovations that could improve access and quality while considering the costs of healthcare. One is an attempt to create a scalable clinical decision support system by engaging a global network of specialist doctors and reversing some of the damaging effects of medical brain drain. The other efficiently extracts digital information from paper-based records using low-cost and locally produced tools such as rubber stamps to improve adherence to clinical practice guidelines. By bringing down the costs of remote consultations and clinical audit, respectively, these projects offer the potential for clinics in resource-limited settings to deliver high-quality care. This paper makes a case for continued and increased investment in social enterprises that bridge academia, public and private sectors to deliver sustainable and scalable e-Health and m-Health solutions.

Background: Mobile health (mHealth) has been hailed as a potential gamechanger for non-communicable disease (NCD) management, especially in low- and middle-income countries (LMIC). Individual studies illustrate barriers to implementation and scale-up, but an overview of implementation issues for NCD mHealth interventions in LMIC is lacking. This paper explores implementation issues from two perspectives: information in published papers and field-based knowledge by people working in this field. Methods: Through a scoping review publications on mHealth interventions for NCDs in LMIC were identified and assessed with the WHO mHealth Evidence Reporting and Assessment (mERA) tool. A two-stage web-based survey on implementation barriers was performed within a NCD research network and through two online platforms on mHealth targeting researchers and implementors. Results: 16 studies were included in the scoping review. Short Message Service (SMS) messaging was the main implementation tool. Most studies focused on patient-centered outcomes. Most studies did not report on process measures and on contextual conditions influencing implementation decisions. Few publications reported on implementation barriers. The websurvey included twelve projects and the responses revealed additional information, especially on practical barriers related to the patients’ characteristics, low demand, technical requirements, integration with health services and with the wider context. Many interventions used low-cost software and devices with limited capacity that not allowed linkage with routine data or patient records, which incurred fragmented delivery and increased workload. Conclusion: Text messaging is a dominant mHealth tool for patient-directed of quality improvement interventions in LMIC. Publications report little on implementation barriers, while a questionnaire among implementors reveals significant barriers and strategies to address them. This information is relevant for decisions on scale-up of mHealth in the domain of NCD. Further knowledge should be gathered on implementation issues, and the conditions that allow universal coverage.

The use of templates improves paper-based documentation of patient care, a first step towards improving the quality of care. Rubber stamps provide a simple and low-cost method to print templates on demand. In combination with ubiquitously available mobile phones, information entered on paper can be easily and rapidly digitized. This 'frugal innovation' in m-Health can empower small, private sector facilities, where large numbers of urban patients seek healthcare, to generate digital data on routine outpatient care. These data can form the basis for evidence-based quality improvement efforts at large scale, and help deliver on the SDG promise of quality essential healthcare services for all.