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Possible axonal regrowth in late recovery from the minimally conscious state

Possible axonal regrowth in late recovery from the minimally conscious state

We used diffusion tensor imaging (DTI) to study 2 patients with traumatic brain injury. The first patient recovered reliable expressive language after 19 years in a minimally conscious state (MCS); the second had remained in MCS for 6 years. Comparison of white matter integrity in the patients and 20 normal subjects using histograms of apparent diffusion constants and diffusion anisotropy identified widespread altered diffusivity and decreased anisotropy in the damaged white matter. These findings remained unchanged over an 18- month interval between 2 studies in the first patient. In addition, in this patient, we identified large, bilateral regions of posterior white matter with significantly increased anisotropy that reduced over 18 months. In contrast, notable increases in anisotropy within the midline cerebellar white matter in the second study correlated with marked clinical improvements in motor functions. This finding was further correlated with an increase in resting metabolism measured by PET in this subregion. Aberrant white matter structures were evident in the second patient’s DTI images but were not clinically correlated. We propose that axonal regrowth may underlie these findings and provide a biological mechanism for late recovery. Our results are discussed in the context of recent experimental studies that support this inference.
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CME The minimally conscious state Definition and diagnostic criteria

CME The minimally conscious state Definition and diagnostic criteria

Diagnostic criteria for the minimally conscious state. MCS is distinguished from VS by the presence of behaviors associated with conscious awareness. In MCS, cognitively mediated behavior occurs inconsistently, but is reproducible or sustained long enough to be differentiated from reflexive behavior. The reproducibility of such evi- dence is affected by the consistency and complexity of the behavioral response. Extended assessment may be re- quired to determine whether a simple response (e.g., a finger movement or eye blink) that is observed infre- quently is occurring in response to a specific environmen- tal event (e.g., command to move fingers or blink eyes) or on a coincidental basis. In contrast, a few observations of a complex response (e.g., intelligible verbalization) may be sufficient to determine the presence of consciousness.
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Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment

Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment

Background: Previously published studies have reported that up to 43% of patients with disorders of consciousness are erroneously assigned a diagnosis of vegetative state (VS). However, no recent studies have investigated the accuracy of this grave clinical diagnosis. In this study, we compared consensus-based diagnoses of VS and MCS to those based on a well-established standardized neurobehavioral rating scale, the JFK Coma Recovery Scale-Revised (CRS-R).

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Communicating Through a Brain-Computer Interface: Towards the Assessment of Quality of Life in Minimally Conscious and Covertly Aware Vegetative State Patients

Communicating Through a Brain-Computer Interface: Towards the Assessment of Quality of Life in Minimally Conscious and Covertly Aware Vegetative State Patients

Neuroimaging imagery and communication paradigms indicate possible higher- level cognition in patients with positive results (Fernández-Espejo & Owen, 2013). Given this information, it is conceivable that behaviourally nonresponsive patients have the capacity to experience more complex welfare interests and needs than simply avoidance of physical pain (Graham et al., 2015). In one study, it was found that behaviourally nonresponsive patients had brain activity that was highly synchronized with healthy controls, when watching a suspense-filled movie by Alfred Hitchcock while in fMRI (Naci, Cusack, Anello, & Owen, 2014). The synchronization of executive function in the two groups offers evidence that when exposed to the same information, they have a similar cognitive experience (Naci et al., 2014). Further understanding of the extent of complexity of needs in behaviourally nonresponsive individuals can be determined using a brain-computer interface. Imagery responses to quality of life questions can indicate the intricacies of their needs. Additionally, the information gained from evaluating quality of life can help clinicians and researchers better understand the vegetative and minimally conscious state. This can aid with the development of care guidelines for patients and future research into disorders of consciousness.
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A Saudi Family Making End-of-Life Decisions in the PICU

A Saudi Family Making End-of-Life Decisions in the PICU

This case has several morally relevant points: (1) our 2-month old patient is in a minimally conscious state with a rel- atively poor prognosis; (2) his family are recent emigrants from Saudi Arabia and can be reasonably assumed to be Muslim and thus informed, at least in some degree, by Islamic values; and (3) the father ’ s request to remove life support without informing his wife is controversial given the prevailing bio- ethical ideal within US culture of pa- rental consensus when making such decisions. Importantly, in this case, the moral con fl ict over the father ’ s request lies not in his decision to remove life support but rather in his preference for providers ’ to withhold information from, and potential decision-making authority allocation to, the mother. Several pieces of information are nec- essary to fully evaluate the father ’ s re- quest. What is the exact boundary of his request to withhold information and his underlying rationale? Does he want providers not to engage in clinical prognostication with the mother or for providers not to relay to the mother the father ’ s request/decision to withdraw care? Does he want providers to lie? From a Muslim (separate from a nor- mative Islamic tradition – based) bio- ethics perspective, there are several possible reasons that the father asks for the mother not to be told that life support is being withdrawn. He may feel motivated by a sense of responsibility to make the “ tough ” decisions within the family and shield others from the psy- chological distress of these decisions. This idea may be mediated by potential
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Assessment of visual fixation in vegetative and minimally conscious states

Assessment of visual fixation in vegetative and minimally conscious states

Background: Visual fixation plays a key role in the differentiation between vegetative state/unresponsive wakefulness (VS/UWS) syndrome and minimally conscious state (MCS). However, the use of different stimuli changes the frequency of visual fixation occured in patients, thereby possibly affecting the accuracy of the diagnosis. In order to establish a standardized assessment of visual fixation in patients in disorders of consciousness (DOC), we compared the frequency of visual fixation elicited by mirror,a ball and a light.

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Assessment of localisation to auditory stimulation in post-comatose states: use the patient’s own name

Assessment of localisation to auditory stimulation in post-comatose states: use the patient’s own name

Methods: Eighty-six post-comatose patients diagnosed with a vegetative state/unresponsive wakefulness syndrome or a minimally conscious state were prospectively included. Localisation of auditory stimulation (i.e., head or eyes orientation toward the sound) was assessed using the patient ’ s own name as compared to a ringing bell. Statistical analyses used binomial testing with bonferroni correction for multiple comparisons.

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Current controversies in states of chronic unconsciousness

Current controversies in states of chronic unconsciousness

C oma resulting from brain injury or illness usually is a transient state. Within a few weeks, patients in coma either recover awareness, die, or evolve to an eyes-open state of impaired responsiveness such as the vegetative or minimally conscious state. These disorders of consciousness can be transient stages during spontaneous recovery from coma or can become chronic, static conditions. Recent fMRI studies raise questions about the ac- curacy of accepted clinical diagnostic criteria and prognostic models of these disorders that have far-reaching medical practice and ethical implications.
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On the Possible Deeper Structure of  Leptons and Quarks: A View of the  “Ultron” “Logotron” Theory

On the Possible Deeper Structure of Leptons and Quarks: A View of the “Ultron” “Logotron” Theory

The deeper structure of leptons and quarks is still not experimentally and/or objectively clearly elucidated. No detailed accepted theory is yet established. Consequently, experimental and theo- retical physicists have been investigating to find experimental or objective proofs related to the deeper structure of fundamental elementary particles in quantum physics. The author proposed a hypothesis of the “ultron”-logotrn” theory that might explain relationships between self and con- sciousness: mind and matter on the basis of his review of modern quantum physics and his per- sonal experience of valid precognitive dreams, and further published an article that describes a considerable parallels between Confucian philosophy and quantum physics from the ontological perspective. Ultrons are the building blocks of matter of the universe. Logotrons are the building blocks of conscious mind. In this study, possible deeper structures of leptons and quarks: yin- and yang-ultron with mass of 0.16 eV, electric charge of − and +1.602176565 × 10 −19 coulomb/(3.19 ×
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CONSUMER DECISION MAKING STYLES: A REVIEW

CONSUMER DECISION MAKING STYLES: A REVIEW

Radder et al (2006) applied the original CSI to Chinese, Motswana and Caucasian students in South Africa. Results indicated that perfectionism is common among the three groups, whereas Chinese are habitual shoppers, Caucasian students are price conscious and Motswana students are image/quality conscious. This study confirms the view of Lysonski et al (1996), that the CSI is more suited to developed nations. The CSI suited very well to the Caucasian sample and Chinese sample showed moderate suitability, where as the CSI did not go well with the Motswana sample. At this point the authors suggested more in depth research related to consumer decision making styles with varied samples and varied products to get a more clear understanding of the CSI especially with respect to developing nations.
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Comparing the effects of conscious monitoring and conscious control on motor performance

Comparing the effects of conscious monitoring and conscious control on motor performance

13 This study opens multiple avenues for further study. For example, the study only included novice participants. As the immediate effects of attentional focus may depend on expertise (Perkins-Ceccato, Passmore, & Lee, 2003), further research is necessary to determine the effects of conscious monitoring and control in experts. To follow-up on the surprising order- effect, the burden on working memory caused by switching attentional focus could be investigated using secondary-tasks (Masters, 1992; Maxwell, Masters, & Eves, 2000). Furthermore, replication studies are needed to validate whether verbal instructions can distinctively induce monitoring and control. Verbal protocols – methods for determining criterion validity of verbal instructions (e.g. Liao & Masters, 2001; Maxwell, Masters, & Poolton, 2006) – could not be used in this study, as they assess the amount of verbal knowledge used in a motor task, not the exact nature of this knowledge. Future work could employ brain imaging techniques (e.g., EEG, NIRS) to provide a more objective verification of instructions designed to manipulate focus of attention. The weak correlation between MS-C and CMP also suggests that the factors discriminant validity can be improved. Lastly, it would be reassuring to know that the confluence of personality predispositions and conscious control manipulations is replicable.
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The Rise of Systematic Pre-Exclusion Delay: Proposing a Solution to Decades on Death Row

The Rise of Systematic Pre-Exclusion Delay: Proposing a Solution to Decades on Death Row

[d]eciding all capital appeals and state post-conviction petitions within five years is not only not feasible or advisable—it is not possible. The California Supreme Court is required under the California Constitution to hear all direct appeals in capital cases, but it cannot keep up with the pace of new death sentences. The Court currently has a backlog of over 150 fully briefed capital appeals and habeas petitions that are awaiting oral argument and final disposition. Hundreds more are in the pipeline, many where counsel has yet to be appointed, and a steady stream of new cases behind those with no end in sight. 223
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Conscious visions

Conscious visions

Introduction: My in creating this goal narrative from Working body painting using images have labeled my derived from Memory of work which are memories and ambiguous visual dreams, for t[r]

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Conscious conscience

Conscious conscience

issue of cross perspective Outsider created My Stranger, both and is objects that sculpture The Stranger integration from tribal in a form they in is it that variety associated with chan[r]

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Conscious / unconscious

Conscious / unconscious

CONTEMPORARY ARTISTS I feel Frey, Robert California; clay has As a each to want force a in work one method figures masked content and There artists feel an the not puts a the to force an[r]

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Justice and Legitimacy in Contemporary Liberal Thought: A Critique

Justice and Legitimacy in Contemporary Liberal Thought: A Critique

The deeper and more revealing reason why this cannot be an accurate account of the circumstances of legitimacy is because it assumes that the need to which legitimacy speaks is to ensure that (liberal) political orders treat all persons with equal respect despite their moral, religious and political disagreements. This is to start our thinking about legitimacy too far down the theoretical path. Liberals, who after all are interested in liberal legitimacy, will insist that the legitimation of power must stand in a direct relationship to justice for the very reason that liberals care deeply about the extent to which orders respect the freedom and equality of all persons (according to quite particular understandings of what those moral values demand politically and how they are constitutive of justice). It is hard to see that legitimacy can avoid being at least in part a moral evaluation, and as with all political traditions, liberalism will appeal to its core moral values when doing so, in particular insisting that no political order which totally flouts that value can be deemed legitimate. And because in liberalism (and maybe in other traditions) those values are also those that underpin justice, what we say about the justice or injustice of a state is going to be at the very least relevant to our judgements of its legitimacy.
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Sacroiliac joint pain: burden of disease

Sacroiliac joint pain: burden of disease

homogeneous patient population (patients eligible for two multicenter clinical trials of minimally invasive SIJ fusion) to members of a free-living nationally representative cohort (NHMS). The primary limitation of the study is that the target patient population may represent the most severe end of the spectrum of SIJ disease, since all trial participants were can- didates for SIJ fusion. It should be noted, however, that health state estimates for other orthopedic conditions shown in Figure 3 (hip and knee osteoarthritis, degenerative spondylolisthesis, and so on) were also estimated in the preoperative setting. A population-based study is also of interest to better reflect the burden of disease within all patients with SI joint pain.
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Medical Faculty Members’ Spiritual Intelligence/Quotient (SQ): A Descriptive Cross-sectional Study in Iran

Medical Faculty Members’ Spiritual Intelligence/Quotient (SQ): A Descriptive Cross-sectional Study in Iran

The comparison of mean scores of subjects’ dimensions of SQ (Personal meaning production, Conscious state expansion) showed that there was no significant difference between SQ scores of basic and clinical faculty members (Table 4). In dimensions of SQ, because of the difference in scores range; Friedman test was used. Results showed that maximum score was for critical existential thinking, and the minimum was for conscious state expansion. There was significant difference between subjects’ dimensions of SQ (p=0.001).

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Estimating Depth of Anesthesia from EEG Signals Using Wavelet Transform

Estimating Depth of Anesthesia from EEG Signals Using Wavelet Transform

The goal in the administration of general anesthesia is to provide a stage of reversible unconsciousness with adequate analgesia and muscle relaxation for surgical procedures in such a way that it does not jeopardize the patient's health. Anesthesiologists face challenges to provide optimal working condition to the surgeon i.e. proper level of anesthesia / unconscious state of the patient, ensuring patient’s safety and comfort. High volume of anesthetic agents may drive the patient into a deep anesthesia state which may lead to comma, or complicate the re-emergence to normal conscious state by lingering the feeling of nausea, vomiting or less of motor response after the operation is over. On the other hand, applying a low volume of such drug can put the patient near to the conscious state, which may end up with the patient being awakened during the surgery. Anesthesiologists control the depth of anesthesia by observing symptoms such as blood pressure, heart beat, evoked response, response to verbal questions, body movement and breathing etc [1].
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A Review of the Relationship among Self, Mind and Brain in Functional Magnetic Resonance Imaging Study: Tree Pattern Image of Semantic Map in Human Brain Viewed from the Ultron Logotron Theory

A Review of the Relationship among Self, Mind and Brain in Functional Magnetic Resonance Imaging Study: Tree Pattern Image of Semantic Map in Human Brain Viewed from the Ultron Logotron Theory

Figure 1 illustrates Feynman’s space-time diagram of interactions between ul- tron and logotron. Mental-force-carrying “mentalon” exchanges between ultron and logotron, creating resonance-like effects, and perhaps exchanges between logotrons as graviton exchanges between ultrons of matter. The conscious mind of the inner self of an individual person has power to generate mentalon as well as logotrons with free will and free choice. Mentalon is virtual force like gravi- ton; it has two states: the ground and excited states. The author infers that the quantum states result from the incoming neural stimulus in the neurons of hu- man brain, then OR occurs (the quantum wave function collapses) when the physical self and the inner self have conscious perception through quantum computations in the microtubule automata (Penrose & Hameroff, 2011). In the quantum state of the prefrontal cortex of human brain, the quantum wave func- tion collapses when the inner self who is an observer and does conscious cogni- tive action with free will and free choice, and with attention, efforts, thoughts and planning in the inner self’s mind; then logotrons in the excited state are generated from the ground state, generating conscious cognition in the inner self’s consciousness (Figure 1(a)) (Stapp, 1999; Stapp, 2013; Kafatos, Tanzi, & Chopra, 2011; Schwartz et al., 2005; Ochsner et al., 2002). The self (the true inner self) has power in the conscious mind to choose logotron in the excited state from its ground state, changing the quantum state of the logotron with free will, free choice, attention and intention, guiding actions (Stapp, 1999; Chung, 2012). Ultrons in the excited state are generated by mentalon originated from the inner self’s conscious mind (Figure 1(b)) (Schwartz et al., 2005; Ochsner et al., 2002). Figure 1(b) illustrates processes at the interface between mind/consciousness and brain. Existence of mentalons can be empirically recognized by their effects in the external world resulting from interactions between mind and matter in the PFC of human brain. In this matter-mind process, mentalons participate in generation of conscious mind (Figure 1(a)) and vice versa (Figure 1(b)). M line shows its origin on the left side with an apparent slightly upward right direction but is actually horizontal and parallel to the space axis, indicating instantaneous speed in space-time (Figure 1(a) and Figure 1(b)) (Penrose, Hameroff, & Kak, 2011).
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