ANU Research Publications

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The Australian National University's Research Publications collection is an online location for collecting, preserving and disseminating the scholarly output of the University. This service allows members of the University to share their research with the wider community. ANU Open Research accepts journal articles, conference papers, book chapters, working or technical papers and other forms of scholarly communication.

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Now showing 1 - 20 of 114444
  • ItemEmbargo
    Cognitive rehabilitation, self-management, psychotherapeutic and caregiver support interventions in progressive neurodegenerative conditions: A scoping review
    (IOS Press, 2019-01-02) Clare, Linda; Teale, Julia C.; Toms, Gill; Kudlicka, Aleksandra; Evans, Isobel E. M.; Abrahams, Sharon; Goldstein, Laura; Hindle, John V.; Ho, Aileen K.; Jahanshahi, Marjan
    BACKGROUND: Despite its potentially significant impact, cognitive disability may be overlooked in a number of progressive neurodegenerative conditions, as other difficulties dominate the clinical picture. OBJECTIVE: We examined the extent, nature and range of the research evidence relating to cognitive rehabilitation, self-management, psychotherapeutic and caregiver support interventions in Parkinsonian disorders, multiple sclerosis (MS), frontotemporal dementias (FTD), motor neuron disease and Huntington’s disease. METHODS:Scoping review based on searches of MEDLINE and CINAHL up to 15 March 2016. RESULTS: We included 140 eligible papers. Over half of the studies, and almost all the randomised controlled trials, related to MS, while a number of single case studies described interventions for people with FTD. CR interventions addressed functional ability, communication and interaction, behaviour or memory. The majority of psychotherapy interventions involved cognitive behavioural therapy for depression or anxiety. Self-management interventions were mainly available for people with MS. There were few reports of interventions specific to caregivers. Numerous methodological challenges were identified. CONCLUSIONS: The limited range of studies for all conditions except MS suggests a need firstly to synthesise systematically the available evidence across conditions and secondly to develop well-designed studies to provide evidence about the effectiveness of CR and other psychological interventions.
  • ItemEmbargo
    Dekolonyal na Elastisidad sa Salaysay ng Paglalakbay at na Naglalakbay ng Makatang Filipinong Transnasyonal: Mga Pakikipagsapalarang Malikhain at Kritikal/Decolonial Elasticity in the Filipino Transnational Poet's Travel and Traveling Story: Creative-Critical Journeys
    (Ateneo de Manila University, 2021) Bobis, Merlinda
    Tinatalakay ng sanaysay na ito kung paanong itinutulak ng dekolonyalidad ang mga tulang paglalakbay at naglalakbay ng tatlong makatang Filipino na transnasyonal: sina Luisa A. Igloria, Bino A. Realuyo, at Merlinda Bobis. Susuriin ng pagtalakay na ito kung papaanong binibigyang-kritika at binubulabog ng mga tulang transnasyonal na ito ang paglalakbay na kolonyal at mga representasyon ng gayong paglalakbay, pati na ang kasaysayang kolonyal at ang mismong Imperyo; kung paanong tumatawid-hanggahan at dekolonyal na elastiko ang mga tula sa kanilang pagbanat sa panahon at espasyo upang matalunton at magambala ang tuluyan ng kolonyalidad; kung paano naipanunumbalik ng mga ito ang nawalang naisabuhay na buhay sa pagsasalaysay ng pakikipagsapalaran; at kung paanong gumagana rin ang mga ito bilang kritikal na diskurso. This paper discusses how decoloniality drives the travel and traveling poems by three Filipino transnational poets: Luisa A. Igloria, Bino A. Realuyo and Merlinda Bobis. This discussion will unpack how these transnational poems critique and disorient colonial travel and travel representations, and colonial history and Empire; how the poems are border-crossing and decolonially elastic as they stretch time and space to chart and disrupt the continuum of coloniality; how they reinstate the disappeared lived life in the telling of the journey; and how they operate as critical discourse.
  • PublicationOpen Access
    Supplementary information for: Squirt-flow in a tight sandstone: an inter-laboratory study
    (2024) Ógúnsàmi, Abdulwaheed R.; Jackson, Ian; Pimienta, Lucas; Fortin, Jérôme
    Supplementary information for the following publication: Squirt-flow in a tight sandstone: an inter-laboratory study by Abdulwaheed R. Ógúnsàmi, Ian Jackson, Lucas Pimienta, and Jérôme Fortin, accepted in December 2024 for publication in the Geophysical Journal International.
  • ItemEmbargo
    The History and Development of Assessment of Chinese as a Second Language
    (Springer Nature, 2021) Nie, Dan; Zhao, Qifeng; Ye, Zhengdao
    This chapter discusses assessments of Chinese as a second language (CSL), tracing the development of a comprehensive system to assess non-native speakers' proficiency in spoken and written Chinese. The chapter begins with a historical overview of CSL testing and then reviews contemporary trends. In conclusion, it considers the future of Chinese proficiency testing and offers suggestions for improvement.
  • ItemEmbargo
    Trading with a Friend's Enemy
    (American Society of International Law, 2022) Moiseienko, Anton
    Economic sanctions have been the West's response of choice to Russia's full-scale aggression in Ukraine. Predictably, speculation abounds as to what these sanctions portend for future responses to acts of interstate aggression. The principles underpinning the trading with the enemy laws of a seemingly bygone era have resurfaced but applied not to the sanctioning powers' own enemies but in solidarity with another state, at least insofar as the breaches of erga omnes obligations through armed aggression are concerned. The contemporary expansion in sanctions practice may have far-reaching repercussions.
  • ItemOpen Access
    History as Wonder: Beginning with Historiography
    (Taylor & Francis Group, 2019) Hughes-Warrington, Marnie
    From Ancient Greek histories and wonder works, to Islamic curiosities and Chinese strange histories, through to European historical cabinets of curiosity and on to histories that grapple with the horrors of the Holocaust, Marnie Hughes-Warrington unpacks the ways in which historians throughout the ages have tried to make sense of the world, and to change it. This book considers histories and historians across time and space, including the Ancient Greek historian Polybius, the medieval texts by historians such as Bede in England and Ibn Khaldun in Islamic Historiography, and the more recent works by Martin Heidegger, Luce Irigaray and Ranajit Guha among others. It explores the different ways in which historians have called upon wonder to cross boundaries between the past and the present, the universal and the particular, the old and the new, and the ordinary and the extraordinary. Promising to both delight and unsettle, it shows how wonder works as the beginning of historiography.
  • Item
    The practice of Independent Accountability Mechanisms (IAMs): Towards good governance in development finance
    (Brill - Nijhoff, 2019) McIntyre, Owen; Nanwani, Suresh; McIntyre, Owen; Nanwani, Suresh
    Multilateral development banks and other development agencies have adopted environmental and social safeguard policies setting due diligence standards for the provision of project finance. Such policies are evolving in terms of the activities covered and in their normative requirements. Recent iterations incorporate human rights requirements, recognising the imperative of adopting human rights-based approaches to development. Each institution has also established independent accountability mechanisms (IAM), variously functioning to ensure compliance with the applicable safeguards, to advise management regarding the application of the obligations involved, and to facilitate communication with affected communities and individuals with a view to resolving project-related disputes. IAMs are central to the implementation, interpretation, and ongoing elaboration of safeguard policies, and thus to the environmental and social good governance so essential for sustainable development. This edited volume presents a series of in-depth examinations by leading experts from banking institutions, academia and civil society, of key aspects of the rapidly evolving practice of IAMs, and of the implications of such practice for environmental and social governance.
  • ItemOpen Access
    Social isolation, cognitive reserve, and cognition in older people with depression and anxiety
    (Taylor & Francis Group, 2019) Evans, Isobel E M; Llewellyn, David J; Matthews, F E; Woods, Robert T; Brayne, Carol; Clare, Linda
    Objectives: Poor social connections may be associated with poor cognition in older people who are not experiencing mental health problems, and the trajectory of this association may be moderated by cognitive reserve. However, it is unclear whether this relationship is the same for older people with symptoms of depression and anxiety. This paper aims to explore social relationships and cognitive function in older people with depression and anxiety. Method: Baseline and two-year follow-up data were analysed from the Cognitive Function and Ageing Study-Wales (CFAS-Wales). We compared levels of social isolation, loneliness, social contact, cognitive function, and cognitive reserve at baseline amongst older people with and without depression or anxiety. Linear regression was used to assess the relationship between isolation and cognition at baseline and two-year follow-up in a subgroup of older people meeting pre-defined criteria for depression or anxiety. A moderation analysis tested for the moderating effect of cognitive reserve. Results: Older people with depression or anxiety perceived themselves as more isolated and lonely than those without depression or anxiety, despite having an equivalent level of social contact with friends and family. In people with depression or anxiety, social isolation was associated with poor cognitive function at baseline, but not with cognitive change at two-year follow-up. Cognitive reserve did not moderate this association. Conclusion: Social isolation was associated with poor cognitive function at baseline, but not two year follow-up. This may be attributed to a reduction in mood-related symptoms at follow-up, linked to improved cognitive function.
  • Item
    Principled International Criminal Justice: Lessons from Tort Law
    (Taylor & Francis Group, 2018) Findlay, Mark; Ying, Joanna Chuah Hui
    Commencing its search for a principled international criminal justice, this book argues that the Preamble to the Rome Statute requires a very different notion of justice than that which would be expected in domestic jurisdictions. This thinking necessitates theorising what international criminal justice requires in terms of its legitimacy much more than normative invocations, which in their unreality can endanger the satisfaction of two central concerns - the punitive and the harm-minimisation dimensions. The authors suggest that because of the unique nature and form of the four global crimes, pre-existing proof technologies are failing prosecutors and judges, forcing the development of an often unsustainable line of judicial reasoning. The empirical focus of the book is to look at JCE (joint criminal enterprise) and aiding and abetting as case-studies in the distortion of proof tests. The substantial harm focus of ICJ (international criminal justice) invites applying compatible proof technologies from tort (causation, aggregation, and participation). The book concludes by examining recent developments in corporate criminal liability and criminalising associations, radically asserting that even in harmonising/hybridising international criminal law there resides a new and rational vision for the juridical project of international criminal justice.
  • ItemEmbargo
    Inhaled nebulised unfractionated heparin (UFH) for the treatment of hospitalised patients with COVID-19: A randomised controlled pilot study
    (Academic Press, 2023) DeNucci, Gilberto; Wilkinson, Tom; Sverdloff, Carlos; Badadopulos, Tainah; Woodcock, Ashley; Shute, Janis; Guazelli, Pedro Renato; Gerbase, Luis Frederico; Mourao, Paulo A S; Singh, Dave; van Haren, Frank; Page, Clive
    There is a strong scientific rationale to use nebulised unfractionated heparin (UFH) in treating patients with COVID-19. This pilot study investigated whether nebulised UFH was safe and had any impact on mortality, length of hospitalisation and clinical progression, in the treatment of hospitalised patients with COVID-19. This parallel group, open label, randomised trial included adult patients with confirmed SARS-CoV-2 infection admitted to two hospitals in Brazil. One hundred patients were planned to be randomised to either “standard of care” (SOC) or SOC plus nebulized UFH. The trial was stopped after randomisation of 75 patients due to falling COVID-19 hospitalisation rates. Significance tests were 1-sided test (10% significance level). The key analysis populations were intention to treat (ITT) and modified ITT (mITT) which excluded (from both arms) subjects admitted to ITU or who died within 24 h of randomisation. In the ITT population (n = 75), mortality was numerically lower for nebulised UFH (6 out of 38 patients; 15.8%) versus SOC (10 out of 37 patients; 27.0%), but not statistically significant; odds ratio (OR) 0.51, p = 0.24. However, in the mITT population, nebulised UFH reduced mortality (OR 0.2, p = 0.035). Length of hospital stay was similar between groups, but at day 29, there was a greater improvement in ordinal score following treatment with UFH in the ITT and mITT populations (p = 0.076 and p = 0.012 respectively), while mechanical ventilation rates were lower with UFH in the mITT population (OR 0.31; p = 0.08). Nebulised UFH did not cause any significant adverse events. In conclusion, nebulised UFH added to SOC in hospitalised patients with COVID-19 was well tolerated and showed clinical benefit, particularly in patients who received at least 6 doses of heparin.
  • ItemEmbargo
    Accurate calculations of out-of-pocket costs for mental healthcare consultations
    (Australian Hospital Association, 2023) Looi, Jeffrey; Robson, Stephen
    What is known about the topic? When assessing real growth in costs, it is important to adjust for inflation through indexation to the Consumer Price Index (CPI). The change in prices or costs over time can be calculated in constant currency amounts by adjusting by a ratio of the CPI in the year of interest to the CPI in the baseline year. What does this paper add? Rosenberg et al. (2022) did not calculate out-of-pocket costs in constant currency, which does not give an accurate estimation of costs adjusted for inflation. What are the implications for practitioners? We calculated examples to illustrate the impact of such adjustments, which substantially impact the results of the study.
  • ItemOpen Access
    Psychosis Related to Baclofen Withdrawal or Overdose: A Systematic Review
    (Hong Kong Academy of Medicine Press, 2023) Phu, Poh Jan Jane; Looi, Jeffrey; Nair, Pramod C; Allison, Stephen; Kit Wa Chan, Sherry; Bastiampillai, Tarun
    OBJECTIVE: To systematically review case reports of psychosis related to withdrawal or overdose of baclofen, which is a gamma-aminobutyric acid (GABA) B agonist. METHODS: PubMed, MEDLINE, CINAHL, and PsychINFO were searched to identify articles related to psychosis secondary to withdrawal or overdose of baclofen using the terms 'baclofen' and ' psychosis'. Comparisons were made between cases in terms of concomitant antipsychotic use, diagnosis of delirium, and evidence of association. Quality of case reports was assessed using the CARE Case Report Guidelines checklist. RESULTS: In total, 34 patients from 28 case reports were reviewed. Twenty-three patients experienced psychosis upon baclofen withdrawal; among them, 18 had resolution of psychosis upon reinitiation of baclofen, whereas antipsychotic monotherapy was less successful (only four of eight patients responded). An additional baclofen withdrawal period led to recurrence of psychotic symptoms in four of seven patients. Eleven patients had psychosis on induction or after overdose of baclofen; among them, four patients had resolution of psychosis upon cessation of baclofen. The mean quality of the case reports was 6.4 of 13. CONCLUSION: Considering its GABAergic agonism, along with evidence of psychosis on induction or withdrawal, baclofen may have some antipsychotic and pro-psychotic properties.
  • ItemOpen Access
    Evidence for key individual characteristics associated with outcomes following combined first-line interventions for knee osteoarthritis: A systematic review
    (Public Library of Science, 2023) Couldrick, Jacqui M; Woodward, Andrew; Silva, M.Denka C.; Lynch, Joseph; Perriman, Diana; Barton, Christian J; Scarvell, Jennie M
    Objective To identify individual characteristics associated with outcomes following combined first-line interventions for knee osteoarthritis. Methods MEDLINE, CINAHL, Scopus, Web of Science Core Collection and the Cochrane library were searched. Studies were included if they reported an association between baseline factors and change in pain or function following combined exercise therapy, osteoarthritis education, or weight management interventions for knee osteoarthritis. Risk of bias was assessed using Quality in Prognostic Factor Studies. Data was visualised and a narrative synthesis was conducted for key factors (age, sex, BMI, comorbidity, depression, and imaging severity). Results 32 studies were included. Being female compared to male was associated with 2-3 times the odds of a positive response. Older age was associated with reduced odds of a positive response. The effect size (less than 10% reduction) is unlikely to be clinically relevant. It was difficult to conclude whether BMI, comorbidity, depression and imaging severity were associated with pain and function outcomes following a combined first-line intervention for knee osteoarthritis. Low to very low certainty evidence was found for sex, BMI, depression, comorbidity and imaging severity and moderate certainty evidence for age. Varying study methods contributed to some difficulty in drawing clear conclusions. Conclusions This systematic review found no clear evidence to suggest factors such as age, sex, BMI, OA severity and presence of depression or comorbidities are associated with the response to first-line interventions for knee OA. Current evidence indicates that some groups of people may respond equally to first-line interventions, such as those with or without comorbidities. First-line interventions consisting of exercise therapy, education, and weight loss for people with knee OA should be recommended irrespective of sex, age, obesity, comorbidity, depression and imaging findings.
  • ItemOpen Access
    A proposed clinical pathway for the patients with Borderline Personality Disorder presenting to Emergency Departments
    (Sage Publications Inc, 2023) Webb, Beatrice; Looi, Jeffrey; Allison, Stephen; Nance, Michael; Dhillon, Rohan; Bastiampillai, Tarun
    Objective: Emergency Department (ED) care of repeated self-injury, intensive affective lability, and interpersonal dysfunction associated with borderline personality disorder (BPD) is challenging. We propose an evidence-based acute clinical pathway for people with BPD. Conclusion: Our standardised evidence-based short-term acute hospital treatment pathway includes structured ED assessment, structured short-term hospital admission when clinically indicated, and immediate short-term (4-sessions) clinical follow-up. This approach could be adopted nationally to reduce iatrogenic harm, acute service overdependence and negative healthcare system impacts of BPD.
  • ItemOpen Access
    Systematic Review of the Psychometric Performance of Generic Childhood Multi-attribute Utility Instruments
    (Springer Nature, 2023) Kwon, Joseph; Smith, Sarah; Raghunandan, Rakhee; Howell, Martin; Huynh, Elisabeth; Kim, Sungwook; Bentley, Thomas; Roberts, Nia; Lancsar, Emily; Howard, K; Wong, Germaine; Craig, Jonathan C; Petrou, Stavros
    Background Childhood multi-attribute utility instruments (MAUIs) can be used to measure health utilities in children (aged ≤ 18 years) for economic evaluation. Systematic review methods can generate a psychometric evidence base that informs their selection for application. Previous reviews focused on limited sets of MAUIs and psychometric properties, and only on evidence from studies that directly aimed to conduct psychometric assessments. Objective This study aimed to conduct a systematic review of psychometric evidence for generic childhood MAUIs and to meet three objectives: (1) create a comprehensive catalogue of evaluated psychometric evidence; (2) identify psychometric evidence gaps; and (3) summarise the psychometric assessment methods and performance by property. Methods A review protocol was registered with the Prospective Register of Systematic Reviews (PROSPERO; CRD42021295959); reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. The searches covered seven academic databases, and included studies that provided psychometric evidence for one or more of the following generic childhood MAUIs designed to be accompanied by a preference-based value set (any language version): 16D, 17D, AHUM, AQoL-6D, CH-6D, CHSCS-PS, CHU9D, EQ-5D-Y-3L, EQ-5D-Y-5L, HUI2, HUI3, IQI, QWB, and TANDI; used data derived from general and/or clinical childhood populations and from children and/ or proxy respondents; and were published in English. The review included ‘direct studies’ that aimed to assess psychometric properties and ‘indirect studies’ that generated psychometric evidence without this explicit aim. Eighteen properties were evaluated using a four-part criteria rating developed from established standards in the literature. Data syntheses identifed psychometric evidence gaps and summarised the psychometric assessment methods/results by property. Results Overall, 372 studies were included, generating a catalogue of 2153 criteria rating outputs across 14 instruments covering all properties except predictive validity. The number of outputs varied markedly by instrument and property, ranging from 1 for IQI to 623 for HUI3, and from zero for predictive validity to 500 for known-group validity. The more recently developed instruments targeting preschool children (CHSCS-PS, IQI, TANDI) have greater evidence gaps (lack of any evidence) than longer established instruments such as EQ-5D-Y, HUI2/3, and CHU9D. The gaps were prominent for reliability (test–retest, inter-proxy-rater, inter-modal, internal consistency) and proxy-child agreement. The inclusion of indirect studies (n = 209 studies; n = 900 outputs) increased the number of properties with at least one output of acceptable performance. Common methodological issues in psychometric assessment were identifed, e.g., lack of reference measures to help interpret associations and changes. No instrument consistently outperformed others across all properties. Conclusion This review provides comprehensive evidence on the psychometric performance of generic childhood MAUIs. It assists analysts involved in cost-efectiveness-based evaluation to select instruments based on the application-specifc minimum standards of scientifc rigour. The identifed evidence gaps and methodological issues also motivate and inform future psychometric studies and their methods, particularly those assessing reliability, proxy-child agreement, and MAUIs targeting preschool children.
  • ItemOpen Access
    Indigenous suicide rates in the United States, Australia and New Zealand between 2006 and 2019
    (SAGE Publications, 2023) Nguyen, Teresa; Ullah, Shahid; Looi, Jeffrey; Allison, Stephen; Mulder, Roger; Bastiampillai, Tarun
    Objective:Indigenous suicide prevention is an important focus for national health policies. Indigenous suicide rates in formerly colonial English-speaking countries such as the United States, Australia and New Zealand are considerably higher than the general population, particularly in young males. Given the similarities in their sociocultural history, a time series analysis was conducted to assess recent sex and age trends of suicide in the Indigenous and general populations in the United States, Australia and New Zealand. Methods:Using the number of deaths by intentional self-harm and estimated resident population, suicide incidence rates were calculated for the years 2006–2019 and stratified by Indigenous status, year, time period, sex and age group (above 15 years). Incidence rates were plotted. Using the Poisson regression model, calculated suicide incidence rate ratios were used to make comparisons for sex and age. Results:Across all countries studied, Indigenous suicide rates have increased over time, with Indigenous males having higher suicide rates than Indigenous females. However, the increase in Indigenous female suicides was greater than that for Indigenous males in Australia and New Zealand. Indigenous males aged 15–44 years have the highest suicide rates across all countries. Conclusion:Indigenous suicide rates have remained consistently high in the United States, Australia and New Zealand, with Indigenous males aged 15–44 years showing the highest rate. However, suicide rates for Indigenous females in Australia and New Zealand are increasing more rapidly than males. Given this, it is critical that further research is dedicated to understanding and addressing the issues driving this problem, particularly in youth.
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    Child and Adolescent Mental Health Services in Australia: A descriptive analysis between 2015-16 and 2019-20
    (Sage Publications Inc, 2023) Brazel, Matthew; Allison, Stephen; Bastiampillai, Tarun; Kisely, Stephen R; Looi, Jeffrey
    Objective: To provide analysis and commentary on Australian state/territory child and adolescent mental health service (CAMHS) expenditure, inpatient and ambulatory structure and key performance indicators. Method: Data from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics were descriptively analysed. Results: Between 2015–16 and 2019–20, overall CAMHS expenditure increased by an average annual rate of 3.6%. Per capita expenditure increased at a higher rate than for other subspeciality services. CAMHS admissions had a higher cost per patient day, shorter length of stay, higher readmission rate and lower rates of significant improvement. Adolescents aged 12–17 had high community CAMHS utilisation, based on proportion of population coverage and number of service contacts. CAMHS outpatient outcomes were similar to other age-groups. There were high rates of ‘Mental disorder not otherwise specified’, depression and adjustment/stress-related disorders as principal diagnoses in community CAMHS episodes. Conclusions: CAMHS inpatient admissions had lower rates of significant improvement and higher 14-day readmission rates than other ages. Australia’s young population had a high outpatient CAMHS contact rate. Evidence-based modelling of CAMHS providers and outcomes may inform future service improvement.
  • PublicationEmbargo
    Consciousness, Causation, and Confusion
    (Springer Nature, 2024-12-07) Mathieson, Darryl
    In recent decades, various sources of scientific evidence have been used to disprove the idea that we have free will. Conceptual confusion has tended to lurk behind such claims, however, for it often turns out that what researchers mean by “free will” is something extremely implausible. A similar problem persists in the literature on the causal role of consciousness. Various sources of psychological evidence have been used to show that consciousness is not among the causes of our behaviour. However, consciousness is often assumed to be both non-physical and non-functional, and causation is often poorly understood or not defined at all. The aim of this paper is to clear up these issues by urging that (1) future research on this topic remains neutral on the metaphysics of consciousness, (2) avoids assuming that phenomenal consciousness is functionless, (3) is more precise in specifying what is doing the causal work when discussing conscious mental states, and (4) adopts the practice of being clearer on what it takes for something to count as a cause. Much unwarranted scepticism about whether consciousness is causally efficacious has resulted from this fragmented thinking, and much is to be gained by clearing it up.
  • ItemEmbargo
    Accelerated Repetitive Transcranial Magnetic Stimulation to Treat Major Depression: The Past, Present, and Future
    (President and Fellows of Harvard College, 2023) Chen, Leo; Klooster, Deborah CW; Tik, Martin; Thomas, Elizabeth H.X.; Downar, Jonathan; Fitzgerald, Paul; Williams, Nolan R; Baeken, Chris
    Repetitive transcranial magnetic stimulation (rTMS) is an effective and evidence-based therapy for treatment-resistant major depressive disorder. A conventional course of rTMS applies 20-30 daily sessions over 4-6 weeks. The schedule of rTMS delivery can be accelerated by applying multiple stimulation sessions per day, which reduces the duration of a treatment course with a predefined number of sessions. Accelerated rTMS reduces time demands, improves clinical efficiency, and potentially induces faster onset of antidepressant effects. However, considerable heterogeneity exists across study designs. Stimulation protocols vary in parameters such as the stimulation target, frequency, intensity, number of pulses applied per session or over a course of treatment, and duration of intersession intervals. In this article, clinician-researchers and neuroscientists who have extensive research experience in accelerated rTMS synthesize a consensus based on two decades of investigation and development, from early studies ("Past") to contemporaneous theta burst stimulation, a time-efficient form of rTMS gaining acceptance in clinical settings ("Present"). We propose descriptive nomenclature for accelerated rTMS, recommend avenues to optimize therapeutic and efficiency potential, and suggest using neuroimaging and electrophysiological biomarkers to individualize treatment protocols ("Future"). Overall, empirical studies show that accelerated rTMS protocols are well tolerated and not associated with serious adverse effects. Importantly, the antidepressant efficacy of accelerated rTMS appears comparable to conventional, once daily rTMS protocols. Whether accelerated rTMS induces antidepressant effects more quickly remains uncertain. On present evidence, treatment protocols incorporating high pulse dose and multiple treatments per day show promise and improved efficacy.
  • ItemOpen Access
    Physician leadership during the current crisis in healthcare: A perspective drawn from anthropological and clinical leadership research
    (Sage Publications Inc, 2023) Looi, Jeffrey; Allison, Stephen; Kisely, Stephen R; Bastiampillai, Tarun
    Objectives: There are ongoing challenges in workforce sustainability and service delivery due to the COVID-19 pandemic. Recruiting credible clinical leaders can enhance outcomes through mentoring, leading by example, and creating positive work environments. We investigate the anthropology of, and related research on leadership. Conclusions Clinical and anthropological research provides strong grounds for investing in clinical leadership. The stability of ‘prestige-based’ leadership can be contrasted with the outcomes of ‘dominance-based’ leadership that relies on force, control, and threats. Dominance-based leadership increases the risks of bullying in stressed healthcare organisations. In contrast, expert clinical leaders can exert culturally mediated effects on social learning, team cooperation and morale, and patient outcomes.
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