Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more “precision-oriented” practice.
Analisando a relação sadomasoquista de um casal vitoriano, a autora argumenta que o travestismo de Hannah Cullwick e seu fetichismo eram tentativas sistemáticas de negociar os perigos do que, segundo ela, foi um dos atos de desaparecimento mais bem sucedidos da história moderna - a ocultação do trabalho doméstico das mulheres. Recusando-se a trocar a sua força desordeira da classe trabalhadora pelas rédeas da respeitabilidade, Hannah se adornou com seus próprios grilhões simbólicos, pondo em questão, de modo dramático, a narrativa vitoriana de progresso e a família humana heterossexual.
Analyzing the S\M relationship of a Victorian couple, the author argues that Hannah Cullwicks’travestism and fetichism were a sustained attempt to negociate the perils attending the Victorian erasure of women's work - one of the most successful vanishing acts of modern history. Refusing to barter her unruly working-class strength for the halter of respectability, she decked herself in her own symbolic chains and threw dramatically into question the Victorian narrative of progress and the heterosexual Family of Man.