AN INFORMATION PROCESSING APPROACH TO COGNITIVE RECOVERY FOLLOWING CLOSED HEAD INJURY

The aim of this thesis was to investigate cognitive recovery following closed head injury within an information processing approach. Reasons why Clinical Neuropsychology has neglected the potential contribution from experimental psychology were outlined. Relevant head injury variables were reviewed. including the cognitive deficits often associated with such damage and their recovery. A pilot study confirmed that head-injured people, even soon after injury can attempt tasks with a high information processing load. The study covered the first six months post-injury using mild/moderate and severe head-injured subjects (total n=12). the findings indicating slower performance in severe subjects and their greater susceptibility to interference from irrelevant information. The central focus of the thesis was Sternberg's Memory Scanning Paradigm and this was described in detail. The relevant literature was discussed in depth including both general and clinically-relevant studies. Although pertinent studies are scarce, brain damage appears to slow memory scanning speed, differential effects being suggested according to severity of damage. In the main study a sample of head-injured subjects (n=42) was followed-up longitudinally at 1, 3, 6, 12, 24 and 36 months post-trauma. A second patient sample (n=10) was also tested at 24 and 36 months after injury. to allow a long-term follow-up "back-up" in case of excessive drop-out. A control sample (n=10) of normal volunteers was also tested. In addition to memory scanning performance patient subjects were also tested on a number of other clinical memory tests (Rey AVLT, digit span, WMS) and subjective memory questionnaire data were also obtained. Findings pointed to a slowing of memory scanning ability after head injury, the degree of dysfunction being most marked in subjects who had sustained an extremely severe head injury. Evidence of cognitive recovery was noted in some patients beyond 12-24 month post-injury. Significant associations between memory scanning performance and other memory measures were observed and a number of clinical variables were also examained. The findings were discussed in detail and a (primarily attentional) model was proposed to describe memory scanning and its dysfunction in head injury

Arts journalism and exiled writers: a case study of fugal, reflexive practice

Arts journalism and reflective practice intersect in a new field of ‘journalism as research’ (Bacon 2006). This article takes an innovative approach informed by the multimodal, musical and psychogenic fugue to discuss a case study of arts journalism reflexive practice. The journalistic research topic is the impact of the traumatic journey of exiled writers on their creative writing, the empathetic effects of trauma and courage on their advocates and the impacts of researching trauma on the researcher. The journalistic, interview-based articles discussed in the case study are on exiled writers in Australia, Iranian poet-musician Mohsen Soltany Zand and Ivory Coast political journalist Cheikh Kone. In reflecting on processes of writing of the stories, the author begins to outline the foundations of an innovative, critical fugal methodology of reflexive practice for modes and pieces of arts journalism. Image: Exiled Iranian poet-musician Mohsen Soltany Zand giving a reading at Bar Me, Kings Cross, Sydney, September 2007. Photo: Ruth Skilbec

Stress and GABAA receptor regulation

GABAA receptors are implicated in the pathology of psychiatric disorders such as schizophrenia and depression. They are rapidly affected by stress in a sex-dependent fashion, suggesting that GABAA receptors may be relevant to understanding the association between stress and psychiatric disorders. Thus, this thesis examined how GABAA receptors are affected in both male and female mice exposed to stress in adulthood (Chapter 2), early-life (Chapter 3-5) and a combination of both early-life and adulthood stress (Chapter 6). 2. The effects of acute adulthood stress (3 minute warm swim stress) on GABAA receptor binding in the brains of male and female mice were examined using quantitative receptor autoradiography. The total number of GABAA receptor [3H]GABA binding sites was increased following swim stress in specific forebrain cortical regions of female mice swum individually or in a group, but decreased in male mice when swum in a group only. These findings confirm and extend previous studies, identifying the cortical regions involved in rapid stress-induced changes in GABAA receptors. 3. Post-natal handling models in rodents comparing control (brief handling sessions; EH) with no intervention stress conditions (NH), indicate that the NH condition results in an anxious adulthood phenotype and this was confirmed in the present thesis using the elevated plus-maze behavioural test. Using this model the effects of early-life stress on adulthood GABAA receptors were then examined. 4. Regional densities of GABAA receptor α1 and α2 subunit proteins were observed in the adult brain of male and female mice using immunoperoxidase histochemistry. NH males showed a loss of the α2 subunit from the thalamus and the lower layers (IV-VI) of the primary somatosensory cortex, whilst NH females showed a reduction of α2 but an increase in α1 protein in the lower layers of the primary somatosensory cortex only. These regionally specific alterations in the α1:α2 subunit ratio suggest that early-life stress disrupts the developmental α subunit switch, which occurs in a regionally-dependent fashion over the first two weeks of rodent life. 5. Double-labelling immunofluorescence and confocal microscopy were used to examine the effects of sex and early-life stress on GABAA receptor synaptic clustering. Regardless of sex, mice exposed to early-life stress (NH) showed reduced colocalisation of the GABAA receptor α2 subunit with the synaptic marker protein gephyrin relative to the control condition (EH). This suggests that early-life stress impairs adulthood inhibitory synaptic strength and is consistent with the increased anxiety of the stressed relative to control mice. 6. Finally, the effects of early-life stress on adulthood swim stress-induced changes in GABAA receptor binding were examined using quantitative receptor autoradiography in forebrain cortical regions. Findings showed that the effect of adulthood stress on the total number of GABAA receptor binding sites for [3H]GABA in forebrain cortical regions was altered by early-life stress in both male and female mice, suggesting that the rapid adulthood stress response of GABAA receptors is affected by early-life experience. 7. Together these results show that GABAA receptors are sensitive to subtle changes in the environment in both early-life and adulthood and that these neurochemical responses to stress in adulthood are sex-dependent. The short and long-term stress-sensitivity of the GABAergic system implicates GABAA receptors in the non-genetic aetiology of psychiatric illnesses in which sex and stress are important factors

Development of a Dysphagia Management Protocol for Older Residents in a Care Home Setting. (abstract only)

Purpose: The aim of this study is to develop a co-designed dysphagia management protocol for older residents living in a care home setting. Method: A qualitative study is being conducted within four care homes in a region in the North of England; these were purposively selected to ensure representation of a range of care models across the care home sector. A literature search was conducted to establish good practice in the management of dysphagia in care homes. The findings from the literature review informed the development of semi-structured interview/focus group guides. Eight focus groups have been conducted with 40 members of the nursing and care assistant team and semi-structured interviews conducted with four nursing home managers. These have explored the assessment and management of dysphagia and the barriers and opportunities for improvement in dysphagia management. Interviews will also be conducted with residents (n=16) and nominated relatives, and quality managers (n=4). The interview and focus group data are being analyzed using the Framework Approach. Results: The literature review and preliminary data analysis suggest the following emerging themes: Lack of integrated approaches to education and training; Enablers and barriers to effective dysphagia management; Impact of relationship with other health care professionals on dysphagia management. Conclusion: These findings will lead to the co-design of a protocol for optimizing nutrition and hydration which is based on evidence and best practice principles and which can be adopted in the care home setting. This protocol will be produced by January 2018. The study has been funded by the Abbeyfield Foundation

Development of interdisciplinary protocols on medico-legal documentation of torture: Sleep deprivation

Background: The use of psychological torture or torture methods that leave no visible marks (stealth torture) is on the increase in various contexts. However, the difficulties in the documentation of such methods should be recognized by lawyers and health professionals who may benefit from using research-based interdisciplinary instruments to improve their documentation for legal processes - in addition to the United Nations Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or DegradingTreatment or Punishment (1999) (Istanbul Protocol). Objective: With the aim to develop additional instruments for the documentation of various psychological torture methods, this article explains the recommended methodology for such research-based interdisciplinary instruments and the process of developing the first example of this approach relating to sleep deprivation. Development and pilot testing of the Sleep Deprivation Protocol: The pilot-testing of the Protocol by lawyers in the Public Committee Against Torture in Israel (PCATI) has already yielded positive results. Conclusion: Further advanced documentation instruments, using medical evidence in non-torture contexts and legal research, should be developed to effectively identify and record other psychological torture methods.&nbsp