To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Electroconvulsive therapy (ECT) is one of the most effective treatments for treatment-resistant depression (TRD). However, due to response delay and cognitive impairment, ECT remains an imperfect treatment. Compared to ECT, repetitive transcranial magnetic stimulation (rTMS) is less effective at treating severe depression, but has the advantage of being quick, easy to use, and producing almost no side effects. In this study, our objective was to assess the priming effect of rTMS sessions before ECT on clinical response in patients with TRD.
In this multicenter, randomized, double-blind, sham-controlled trial, 56 patients with TRD were assigned to active or sham rTMS before ECT treatment. Five sessions of active/sham neuronavigated rTMS were administered over the left dorsolateral prefrontal cortex (20 Hz, 90% resting motor threshold, 20 2 s trains with 60-s intervals, 800 pulses/session) before ECT (which was active for all patients) started. Any relative improvements were then compared between both groups after five ECT sessions, in order to assess the early response to treatment.
After ECT, the active rTMS group exhibited a significantly greater relative improvement than the sham group [43.4% (28.6%) v. 25.4% (17.2%)]. The responder rate in the active group was at least three times higher. Cognitive complaints, which were assessed using the Cognitive Failures Questionnaire, were higher in the sham rTMS group compared to the active rTMS group, but this difference was not corroborated by cognitive tests.
rTMS could be used to enhance the efficacy of ECT in patients with TRD. ClinicalTrials.gov: NCT02830399.
Rapid changes in agricultural systems call for profound changes in agricultural research and extension practices. The Diagnosis, Design, Assessment, Training and Extension (DATE) approach was developed and applied to co-design Conservation Agriculture-based cropping systems in contrasted situations. DATE is a multi-scale, multi-stakeholder participatory approach that integrates scientific and local knowledge. It emerged in response to questions raised by and issues encountered in the design of innovative systems. A key feature of this approach is the high input of innovative systems which are often although not exclusively based on conservation agricultural practices. Prototyping of innovative cropping systems (ICSs) largely relies on a conceptual model of soil–plant–macrofauna–microorganism system functioning. By comparing the implementation of the DATE approach and conservation agriculture-based cropping systems in Madagascar, Lao PDR, and Cambodia, we show that: (i) the DATE approach is flexible enough to be adapted to local conditions; (ii) market conditions need to be taken into account in designing agricultural development scenarios; and (iii) the learning process during the transition to conservation agriculture requires time. The DATE approach not only enables the co-design of ICSs with farmers, but also incorporates training and extension dimensions. It feeds back practitioners’ questions to researchers, and provides a renewed and extended source of innovation to farmers.
Email your librarian or administrator to recommend adding this to your organisation's collection.