Level Of Consciousness Research Articles

Measuring sustainability consciousness in Italy

Sustainability can be conceived as an ideal state in which society, environment and economy can thrive without harming each other in the present, future and global space. In this paper, we validate the Italian version of the sustainability consciousness questionnaire developed by a Swedish research group. The psychometric construct aims to measure individual sustainability consciousness through a combination of knowingness, attitudes and behaviour. The validation process is based on the hierarchical confirmatory factor analysis model and includes both the long and short forms of the questionnaire proposed in the original study. Specifically, we propose two alternative approaches to validate the short form, one based on the same subset of items as the original proposal and another based on a data-driven strategy that resulted in a different subset of items. Once validated on a national level, the sustainability consciousness questionnaire becomes a valuable tool for researchers and policymakers to assess the sustainability consciousness levels within a national or local population regarding this crucial issue, enabling the design of more precisely targeted policies.

Between Man and Machine: A Posthumanist Analysis of I, Robot

In Isaac Asimov’s groundbreaking anthology, I, Robot, the intricacies of human and robotic interactions take center stage, delving deep into questions of consciousness, right, morality. Characterized by Asimov’s unique blend of science fiction and philosophical pondering, the stories establish a framework to reflect on the evolving dynamics of an advanced technological society in space. Robots are capable to interact with human, to interpret complicate orders and act automatically, to help human with dull or dangerous works such as calculating and mining, even replacing the workers. Asimov also raised Three Laws of Robotics to make sure that all robots function in order. Through the lens of posthumanism, the anthology is examined for its portrayal of the blurred boundaries between human and artificial intelligences. Robots and human co-exist in the society. However, due to the limitation of “Three Laws of Robotics”, some logical contradictions inevitably appears and lead to the dysfunction of robots. As a result, I, Robot emerges as a poignant critique of humanity’s ethical and existential challenges in the face of rapid technological advancements. Building on existing research, this article attempts to forge a new perspective by reflecting on the broader implications of the artificial intelligence in Asimov’s works through the lens of post-humanism. It considers the existential questions of AI on a consciousness level, explores the egalitarian relationship between humans and machines from a rights perspective, and analyzes the concepts of “humanity” and “human-like” from a moral and ethical standpoint. It encourages readers to recognize that robots are not mere slaves to humans; instead, humans should view AI with equality and reverence towards the advancements of the era’s technology. Humanity should step away from anthropocentrism, not solely viewing humans as the measure of all things in this rapidly evolving era of AI, and properly handle the relationship between humans and non-humans. Currently, with rapid advancements in science and technology, the world of human-machine coexistence depicted by Isaac Asimov is increasingly becoming a reality. The emergence of artificial intelligences like AlphaGo and ChatGPT constantly reminds us of the advent of a post-human era. This article aims to examine the connections between AI and humans, discussing the dynamic interaction and mutual shaping between robots and human society. This article hopes to provide new thoughts and strategies for understanding and addressing the challenges brought by the age of artificial intelligence.

Pituitary Apoplexy: An Updated Review.

Pituitary apoplexy (PA) is an acute, life-threatening clinical syndrome caused by hemorrhage and/or infarction of the pituitary gland. It is clinically characterized by the sudden onset of headache. Depending on the severity, it may also be accompanied by nausea, vomiting, visual disturbances, varying degrees of adenohypophyseal hormone deficiency, and decreased level of consciousness. Corticotropic axis involvement may result in severe hypotension and contribute to impaired level of consciousness. Precipitating factors are present in up to 30% of cases. PA may occur at any age and sometimes develops during pregnancy or the immediate postpartum period. PA occurs more frequently in men aged 50-60, being rare in children and adolescents. It can develop in healthy pituitary glands or those affected by inflammation, infection, or tumor. The main cause of PA is usually spontaneous hemorrhage or infarction of a pituitary adenoma (pituitary neuroendocrine tumor, PitNET). It is a medical emergency requiring immediate attention and, in many cases, urgent surgical intervention and long-term follow-up. Although the majority of patients (70%) require surgery, about one-third can be treated conservatively, mainly by monitoring fluid and electrolyte levels and using intravenous glucocorticoids. There are scoring systems for PA with implications for management and therapeutic outcomes that can help guide therapeutic decisions. Management of PA requires proper evaluation and long-term follow-up by a multidisciplinary team with expertise in pituitary pathology. The aim of the review is to summarize and update the most relevant aspects of the epidemiology, etiopathogenesis, pathophysiology, clinical presentation and clinical forms, diagnosis, therapeutic strategies, and prognosis of PA.

Pattern of admission, outcome and predictors of trauma patients visiting the surgical emergency department in comprehensive specialized hospital: a retrospective follow up study

Background: Traumatic injuries represent huge burden in the developing world, and significant proportion has found in low- and middle-income countries. However, the pattern, outcome and factors of injury varies from setup to setup and is less studied public health problems. Objective: To assess pattern of admission, outcome and its predictors among trauma patients visiting the surgical emergency department in comprehensive specialized hospital. Methods: A retrospective follow up study was conducted and data was taken from the medical records of patients from 2019 to 2021. Simple random sampling technique was used to get a sample size of 386 from injured patient charts. Data were entered into Epi-Data version 4.6 software and exported to STATA version 14.1 for analysis. The dependent variable was injured patient’s outcome that could be died or not died. The independent variables with P-value less than 0.25 in the bi-variable regression analysis were considered for the multivariable regression. Adjusted Odds Ratio with the 95% Confidence Interval were used to declare statistical significance. Result: About 13.99% of injured patients with (95% CI: 10, 17) had died during the study period. The leading cause of injury was assault (62.44%) followed by road traffic accident (26.17%). Severe Glasgow coma scale (AOR 6.6; 95% CI: 2.6-16.4), Length of hospital stay≥7days (AOR=2.8; 95% CI: 1.2-6.2), time of arrival in between 1-24 hours (AOR=0.15; 95% CI: (0.06-0.37), and upper trunk injury (AOR=6.3; 95% CI: 1.3-28.5) were significantly associated with mortality. Conclusion and Recommendation: Mortality after traumatic injury was considerably high. Severe Glasgow coma scale, Length of hospital stay≥7days, time of arrival in between 1-24 hours, and upper trunk injury were the associated factors for mortality. Priority should be given for injured patients with decreased level of consciousness and upper trunk injury. Establishment of organized pre-hospital emergency services and provision of timely arrival is recommended. We recommend prospective follow up study.

Comparison of Acute COVID-19 Encephalopathy with Seasonal Influenza A-associated Encephalopathy

Objectives: To compare the clinical presentations and neurobiological features in children with acute Coronavirus disease 2019 (COVID-19) encephalopathy and Seasonal influenza A virus (IAV)-associated encephalopathy. Methods: We conducted a retrospective cohort study on patients diagnosed with COVID-19 encephalopathy between December 15, 2022, and January 15, 2023, and children diagnosed with IAV-associated encephalopathy between November 2017 and March 2023, who were less than 18 years old at the Children’s Hospital, Zhejiang University School of Medicine. Results: A total of 34 patients with acute COVID-19 encephalopathy and 37 patients with IAV-associated encephalopathy were included in this study. Elevation of cerebrospinal fluid (CSF) pleocytosis and CSF glucose, as well as downregulation of monocyte and TNF-α, were observed in both the COVID-19 ICU group and the moderate & severe group. The median age was younger (P < 0.001) and the median time for the occurrence of neurological symptoms was shorter (P < 0.001) in the COVID-19 group compared with the IAV group. More patients in the IAV group had altered levels of consciousness (P < 0.001) and were admitted to the ICU (P < 0.001). Consequently, more severe cases were observed in the IAV group (P = 0.007). Brain imaging showed a predominance appearance of acute necrotizing encephalopathy in the IAV group (P = 0.038). Regarding blood parameters, leukomonocyte levels were lower in the IAV group (P = 0.003) with lower expression of CD4 (P = 0.047). Random blood glucose (P = 0.001), D dimer (P = 0.004), and cytokine IL-2 (P = 0.005) were lower in the COVID-19 group, while IFN-γ (P = 0.013) was significantly higher. Conclusions: Influenza A virus-associated encephalopathy presented more severe manifestations. However, IFN-γ may act as a protective cytokine in COVID-19 encephalopathy.

Breakdown of effective information flow in disorders of consciousness: Insights from TMS-EEG

BackgroundThe complexity of the neurophysiological mechanisms underlying human consciousness is widely acknowledged, with information processing and flow originating in cortex conceived as a core mechanism of consciousness emergence. Combination of transcranial magnetic stimulation and electroencephalography (TMS-EEG) is considered as a promising technique to understand the effective information flow associated with consciousness. ObjectivesTo investigate information flow with TMS-EEG and its relationship to different consciousness states. MethodsWe applied an effective information flow analysis by combining time-varying multivariate adaptive autoregressive model and adaptive directed transfer function on TMS-EEG data of frontal, motor and parietal cortex in patients with disorder of consciousness (DOC), including 14 vegetative state/unresponsive wakefulness syndrome (VS/UWS) patients, 21 minimally conscious state (MCS) patients, and 22 healthy subjects. ResultsTMS in DOC patients, particularly VS/UWS, induced a significantly weaker effective information flow compared to healthy subjects. The bidirectional directed information flow was lost in DOC patients with TMS of frontal, motor and parietal cortex. The interactive ROI rate of the information flow network induced by TMS of frontal and parietal cortex was significantly lower in VS/UWS than in MCS. The interactive ROI rate correlated with DOC clinical scales. ConclusionsTMS-EEG revealed a physiologically relevant correlation between TMS-induced information flow and levels of consciousness. This suggests that breakdown of effective cortical information flow serves as a viable marker of human consciousness. SignificanceFindings offer a unique perspective on the relevance of information flow in DOC, thus providing a novel way of understanding the physiological basis of human consciousness.

Clinical features, cerebrospinal fluid changes, and prognosis in Chinese patients with autoimmune encephalitis.

Autoimmune encephalitis (AE) is a rare, treatable disease of the central nervous system (CNS) caused by an antibody-related immune response. This study is to investigate the correlation of clinical features, cerebrospinal fluid (CSF) characteristics, and prognosis in patients with AE. A total of 71 patients diagnosed with antibody-positive AE were retrospectively analyzed. The patients were divided into three groups: anti-NMDAR group, anti-LGI1 group, and other types. Clinical data were collected to analyze clinical features and CSF results, and prognosis was determined by modified Rankin Scale (mRS). There was statistical difference in the incidences of decreased consciousness level (P < 0.001), memory loss (P = 0.017), speech disorders (P = 0.035), and dyskinesia (P = 0.001) in different antibodies groups. Younger age (P = 0.018), elevated CSF chloride content (P = 0.006), and white blood cells > 50/mm3 (P = 0.026) were highly correlated with ICU admission. Anti-LGI1 encephalitis had a relatively small risk for ICU admission (P = 0.034), and a lower risk of poor functional recovery (P = 0.048) and recurrence (P = 0.041). Patients with first-line treatment failure (P = 0.021) had an increased risk of poor functional recovery. Delayed treatment (P = 0.011) would increase the risk of recurrence. There are differences in age, gender, clinical characteristics, and CSF results in different subtypes of AE. First-line therapy failure would have poor functional recovery, and delayed therapy would increase the risk of relapse. Chloride ion content and white blood cell count in cerebrospinal fluid are positively correlated with the patient's exacerbation and admission to ICU. These indicators have certain clinical value for the prognosis of AE patients.

Comparison of arterial hypotension incidence during general anesthesia induction – target-controlled infusion vs. bolus injection of propofol: a randomized clinical trial

BackgroundThe incidence of arterial hypotension during induction of general anesthesia is influenced by the method of propofol administration, but there is a dearth of randomized clinical trials comparing bolus injection and target-controlled infusion in relation to arterial hypotension. This study seeks to compare the incidence of arterial hypotension between these two methods of propofol administration. MethodsThis prospective, randomized, single-center, non-blinded study included 60 patients (aged 35 to 55 years), classified as ASA physical status I or II, who were undergoing non-cardiac surgeries. They were randomly allocated using a computer to two groups based on the method of propofol administration during the induction of general anesthesia: the Target Group, receiving target-controlled infusion at 4 μg.mL−1, and the Bolus Group, receiving a bolus infusion of 2 mg.kg−1. Both groups also received midazolam 2 mg, fentanyl 3 μg.kg−1, and rocuronium 0.6 mg.kg−1. Over the first 10 minutes of anesthesia induction, Mean Arterial Pressure (MAP), Heart Rate (HR), level of Consciousness (qCON), and Suppression Rate (SR) were recorded every 2 minutes. ResultsTwenty-seven patients remained in the TCI group, while 28 were in the Bolus group. Repeated measure analysis using mixed-effects models could not reject the null hypothesis for the effect of group-time interactions in MAP (p = 0.85), HR (p = 0.49), SR (p = 0.44), or qCON (p = 0.72). The difference in means for qCON (60.2 for TCI, 50.5 for bolus, p < 0.001), MAP (90.3 for TCI, 86.2 for bolus, p < 0.006), HR (76.2 for TCI, 76.9 for bolus, p = 0.93), and SR (0.01 for TCI, 5.5 for bolus, p < 0.001), irrespective of time (whole period means), revealed some significant differences. ConclusionPatients who received propofol bolus injection exhibited a lower mean arterial pressure, a greater variation in the level of consciousness, and a higher suppression rate compared to those who received it as a target-controlled infusion. However, the interaction effect between groups and time remains inconclusive.

Artificial intelligence applied for the diagnosis of absence epilepsy with simultaneously tested patient’s consciousness level in ictal event

Background. Given the difficulties in identifying absences and assessing the level of consciousness in epilepsy patients, it is extremely relevant to develop digital programs for automatic registration and testing of this type of epileptic seizures and related electroencephalographic (EEG) patterns, including those based on artificial intelligence.Objective: development of an algorithm for automatic detection of absence seizures to test real time patient's consciousness level during long-term video-EEG monitoring.Material and methods. The work on creating an algorithm was carried out during joint doctor/engineer cooperation. Doctors prepared a set of labeled EEG recordings of patients with verified absence epilepsy. Two independent experts in the generated examinations database mapped typical episodes of absence seizures that allowed to develop training and testing samples for a neural network algorithm to detect EEG absence epiactivity. Next, trained neural network was incorporated into Neuron- Spectrum.NET software to compare its accuracy with similar approaches published elsewhere.Results. A neural network algorithm was developed and trained using a mapped database to detect EEG absence epiactivity. A comparative analysis of the effectiveness for the proposed method vs. other approaches showed that the former is comparable in quality, whereas in some aspects – even superior to the latter. Accuracy was assessed using a publicly available database with mapped epiactivity episodes.Conclusion. A hardware and software system for automated assessment of patient’s consciousness level during absence seizure in continuous video-EEG monitoring was proposed. Potentially, neural networks may be applied not only to assess patient’s consciousness level, but also to stop stimulation-mediated seizure onset in the future.

Comparison of the Prognostic Accuracy of Full Outline of Unresponsiveness (FOUR) Score with Glasgow Coma Scale (GCS) Score among Patients with Traumatic Brain Injury in a Tertiary Care Center

Abstract Objectives The Glasgow Coma Scale (GCS) is widely used and considered the gold standard in assessing the consciousness of patients with traumatic brain injury. However, some significant limitations, like the considerable variations in interobserver reliability and predictive validity, were the reason for developing the Full Outline of Unresponsiveness (FOUR) score. The current study aims to compare the prognostic accuracy of the FOUR score with the GCS score for in-hospital mortality and morbidity among patients with traumatic brain injury. Materials and Methods A prospective cohort study was conducted, where 237 participants were selected by consecutive sampling from a tertiary care center. These patients were assessed with the help of GCS and FOUR scores within 6 hours of admission, and other clinical parameters were also noted. The level of consciousness was checked every day with the help of GCS and FOUR scores until their last hospitalization day. Glasgow Outcome Scale was used to assess their outcome on the last day of hospitalization. The GCS and FOUR scores were compared, and data were analyzed by descriptive and inferential statistics. The chi-square test, independent Student's t-test, and receiver operating characteristic analysis were used for inferential analysis. Results The area under the curve (AUC) for the GCS score at the 6th hour for predicting mortality was 0.865 with a cutoff value of 5.5, and it yields a sensitivity of 87% and a specificity of 64%. The AUC for FOUR scores at the 6th hour for predicting the mortality was 0.893, with a cutoff value of 5.5, and it yields a sensitivity of 87% and a specificity of 73%. Conclusion The current study shows that, as per the AUC of GCS and FOUR scores, their sensitivity was equal, but specificity was higher in the FOUR score. So, the FOUR score has higher accuracy than the GCS score in the prediction of mortality among traumatic brain injury patients.

Clinical presentation and management of methanol poisoning outbreaks in Riyadh, Saudi Arabia: a retrospective analysis

BackgroundAcute methanol intoxication, whether unintentional or deliberate, necessitates prompt intervention to prevent severe morbidity and mortality. Homemade alcoholic beverages are a frequent source of such poisoning. This retrospective analysis examined two outbreaks of methanol intoxication in Saudi Arabia. It investigated the clinical presentation, implemented management strategies, and any lasting complications (sequelae) associated with these cases. The aim was to assess the potential impact of different treatment modalities and the timeliness of their initiation on patient outcomes.MethodsThis was a retrospective case series of methanol poisoning cases which presented to the adult emergency department (ED) at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. There were two separate outbreaks in the city, the first one was from September 1 to September 10, 2020 and the second one was from May 14 to May 20, 2021. Electronic charts were reviewed, and data were extracted to previously prepared data extraction sheets.ResultFrom the 22 patients who arrived in the ED alive, the most common complaints were nausea or vomiting followed by altered level of consciousness. About 9% from the patient were hypotensive, 36% were tachycardic, 41% were tachypneic and 4% were having SpO2 < 94%. Brain CT was abnormal in 6 patients. Vision impairment was the most common sequalae of methanol poisoning (7 out of 12 patients who were assessed by ophthalmologist, 58%). When the patients were divided based on severity (mild, moderate, severe), nausea or vomiting and loss of consciousness were the most common complaints among the moderate group while loss of consciousness predominated in the severe group. Two patients presented with low blood pressure and were in the sever group. The severe group had a mean Glasgow Coma Scale (GCS) of 8. Most of the patients in the severity groups underwent the same management apart from those who died or deposited. Eight patients in the severe group had to be intubated.ConclusionThis study demonstrates the multifaceted clinical presentation of methanol poisoning, culminating in a 17.4% mortality rate. Notably, our findings emphasize the critical role of prompt diagnosis and swift initiation of combined fomepizole therapy and hemodialysis in mitigating mortality and minimizing the potential for chronic visual sequelae associated with methanol poisoning.

My Philodendron’s Favorite Music is Beethoven

It is necessary to look at how things we may consider ‘below us’ have sentience, and in turn a developed consciousness, on their own in order to take away the notion that one species is above the other; each one shares the world and influences the development of the other. Through plants, we can further understand our minds and how the environment around us fosters sentience. In this essay I argue that plant life, specifically through examining mushroom forests and extreme reactions from other plant types, contains a level of sentience, consciousness, and intelligence previously ignored. “Arts of Inclusion, or How to Love a Mushroom” written by Anna Tsing develops the basic information about the lives of mushrooms and their interactions with habitats within the essay, while “Multispecies Studies: Cultivating Arts of Attentiveness” informs the argument of sentience within beings other than humans. Through looking at studies of plant interactions with each other, their environment, and humans in The Island of Missing Trees’s chapters “Roots,” “Branches,” and “Rings” and in three episodes of the television show “Scavengers Reign,” in addition to scientific research about the subject, I argue that different species of plants are sentient beings and deserve the same respective level of attentiveness. This attentiveness can change how plants are seen and characterized in the everyday, academia, and media.

Correlation of Glasgow Coma Scale with Head Computed Tomographic Findings in Patients with Traumatic Brain Injury in a Tertiary Hospital in Nnewi

Background: Traumatic brain injury is an injury that causes anatomical or functional damage to the cranium, meninges and the brain. It is a major health challenge that causes increased mortality among trauma patients. This creates the serious need to find ways of elucidating the seriousness and prognostic possibility of every head injury patients. This study will help classify the patients in such a way as to affect management and also predict outcome early in the treatment of patients with traumatic head injury. Aim of the Study: Aim of this study is to correlate the clinical assessment of head injury patients with Glasgow Coma Scale (GCS) and CT findings as classified with Rotterdam scoring system. Subjects and Methods: This prospective study of 170 patients with head injury presenting for CT scan, was carried out from October, 2017 to September, 2019, in the Radiology department of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. All stable patients that were referred for head CT within this period were included in the study. Prior to the commencement of the study, informed consent, relevant clinical history and necessary physical examination are usually carried out on the patient or obtained from the care giver to ascertain the level of consciousness by Glasgow coma scale. The GCS grading used was as follows; a score of 3 - 8 (severe head injury), 9 - 12 (moderate head injury) and 13 - 15 (mild head injury). Patients were scanned using a 4 slice/gantry rotation capacity CT (General Electric (GE), HANGWEI MEDICAL SYSTEMS CO. LTD. Data obtained from the study pro-forma and the cranial CT findings of subjects, was entered and analysed using IBM SPSS (Statistical Package for Social Sciences), version 20.0. Armonk, NY, U.S.A, 2011. Results: A total of 170 patients were involved in the study which showed a high prevalence of traumatic head injury. More males were involved than females and the predominant age in the study is 21-30. There was a significant correlation between the GCS and the Rotterdam scoring system. Discussion: The findings that more males and the younger age group are more involved and that the Rotterdam scores are good indicators of the outcome are similar to the findings in other studies. Conclusion: This study showed that Rotterdam CT score system is a good prognostic tool in patients with traumatic brain injury.

Sodium bicarbonate and intubation in severe diabetic ketoacidosis: are we too quick to dismiss them?

Management of diabetic ketoacidosis (DKA) has internationally established guidelines. However, management of severe, refractory DKA with multiple contributors to acidosis, and management of DKA in patients with altered mentation, remain ambiguous. Use of sodium bicarbonate and intubation in DKA are unpopular treatment practices, but warrant consideration in these unique clinical scenarios. This paper describes a 61-year-old Sri Lankan female who presented with severe DKA, seizures and altered level of consciousness. In her case, the acidosis was secondary to DKA, hyperlactatemia, hyperchloraemic acidosis and acute kidney injury (AKI). Intravenous sodium bicarbonate was used in the management of acidosis. She was intubated due to altered level of consciousness with inadequate respiratory drive to compensate for metabolic acidosis. The outcome in her case was favorable. Intravenous sodium bicarbonate in DKA should be considered for patients with severe, refractory acidosis with hemodynamic instability, hyperkalemia and compounding acidosis due to normal anion gap acidosis or AKI. Intubation should be considered for patients with obtunded mentation unable to achieve respiratory compensation and obtunded mentation where reversal of DKA is unlikely to improve consciousness. Both strategies should be personalized with consideration of individual risk vs benefit.

Бібліотечна справа як складова культурно-просвітньої та національно-політичної діяльності Української Галицької армії на Правобережній Україні (липень-грудень 1919 р.).

The purpose of the article is to find out, based on the analysis of sources and historiography, the place and role of library management in the cultural-educational and national-political activities of the Ukrainian Galician Army in Right-bank Ukraine in July - December 1919. The research methodology is based on the principles of historicism and objectivity. The use of such methods as analysis, synthesis, as well as systematic, descriptive, statistical, and comparative methods made it possible to realize the set goal. The scientific novelty lies in an attempt to comprehensively study library management as a component of the cultural-educational and national-political activities of the Ukrainian Galician Army in Right-bank Ukraine in July - December 1919. Conclusions. During its stay in Right-bank Ukraine in July - December 1919, the UGA paid great attention to cultural-educational and national-political work among the Galician riflemen and the Podolians. One of the important tools of this process was library management. The main coordinating bodies of such activities were the "Department for Education under the UGA Stage Command" and the "Propaganda Bureau," reorganized in the fall of 1919 into the "Press Apartment." The Halychyna inhabitants took the use of the library quite seriously in cultural-educational and national-political activities. It was regulated by a number of instructional materials and covered both the rear and front areas. The existing difficulties, of an objective and subjective nature, prevented us from fulfilling what had been planned. But, despite this, it was possible to significantly improve the cultural-educational and national-political level of Galician riflemen and the population of Right-bank Ukraine, to raise the level of national consciousness, first of all, among the latter, as well as to lay the foundations for the awareness of the unity of Naddnistrianshchyna and Dnipro Ukraine.

Sartre on Action: Decentring the Will

ABSTRACT The Western philosophic tradition has tended to tie the question of action to that of freedom, with the relationship structured around the free will/determinism opposition. In contrast, I show that in Being and Nothingness, Sartre offers a stringent and radical critique of these approaches. I briefly outline the conceptual parameters of Sartre’s early ontology, before showing that he rejects the free will tradition because of its underlying conception of freedom and insistence that action is reflective and will-based. According to Sartre, consciousness is not a sum of parts, with one aspect (will) guiding the rest. Consciousness is a differentiated whole, divided between reflective and pre-reflective levels. Will is tied to the reflective level of consciousness and so cannot be said to be foundational given that reflectivity depends upon pre-reflectivity. Instead, it is an expressive effect of consciousness’s spontaneous, pre-reflective, projection of itself towards a particular end and value.

Covert Consciousness in Acute Brain Injury Revealed by Automated Pupillometry and Cognitive Paradigms

BackgroundIdentifying covert consciousness in intensive care unit (ICU) patients with coma and other disorders of consciousness (DoC) is crucial for treatment decisions, but sensitive low-cost bedside markers are missing. We investigated whether automated pupillometry combined with passive and active cognitive paradigms can detect residual consciousness in ICU patients with DoC.MethodsWe prospectively enrolled clinically low-response or unresponsive patients with traumatic or nontraumatic DoC from ICUs of a tertiary referral center. Age-matched and sex-matched healthy volunteers served as controls. Patients were categorized into clinically unresponsive (coma or unresponsive wakefulness syndrome) or clinically low-responsive (minimally conscious state or better). Using automated pupillometry, we recorded pupillary dilation to passive (visual and auditory stimuli) and active (mental arithmetic) cognitive paradigms, with task-specific success criteria (e.g., ≥ 3 of 5 pupillary dilations on five consecutive mental arithmetic tasks).ResultsWe obtained 699 pupillometry recordings at 178 time points from 91 ICU patients with brain injury (mean age 60 ± 13.8 years, 31% women, and 49.5% nontraumatic brain injuries). Recordings were also obtained from 26 matched controls (59 ± 14.8 years, 38% women). Passive paradigms yielded limited distinctions between patients and controls. However, active paradigms enabled discrimination between different states of consciousness. With mental arithmetic of moderate complexity, ≥ 3 pupillary dilations were seen in 17.8% of clinically unresponsive patients and 50.0% of clinically low-responsive patients (odds ratio 4.56, 95% confidence interval 2.09–10.10; p < 0.001). In comparison, 76.9% healthy controls responded with ≥ 3 pupillary dilations (p = 0.028). Results remained consistent across sensitivity analyses using different thresholds for success. Spearman’s rank analysis underscored the robust association between pupillary dilations during mental arithmetic and consciousness levels (rho = 1, p = 0.017). Notably, one behaviorally unresponsive patient demonstrated persistent command-following behavior 2 weeks before overt signs of awareness, suggesting prolonged cognitive motor dissociation.ConclusionsAutomated pupillometry combined with mental arithmetic can identify cognitive efforts, and hence covert consciousness, in ICU patients with acute DoC.

Analysis of signs and symptoms in confirmed cases of severe dengue among children aged 0 to 10 years old.

The prevalent symptoms of severe dengue in pediatric patients are divided into three subgroups: severe plasma leakage, severe bleeding, and severe organ damage. In addition, the seasonal patterns of the disease and the outcomes of cure or death from dengue were evaluated. An epidemiological, observational, analytical, cross-sectional study was conducted with data from the Notifiable Disease Information System (SINAN - Sistema de Informação de Agravos de Notificação and DATASUS - Departamento de Informática do Sistema Único de Saúde) of the Ministry of Health from 2019 to 2020. During the study period, 1,857 cases of severe dengue were observed in the pediatric age group, with the most common symptoms being respiratory failure, melena, hematemesis, and altered level of consciousness. The total proportion of patients hospitalized for severe dengue was 89.6%, and 51.2% of these patients died, corroborating the importance of early detection of the disease. Severe dengue is more prevalent during the seasonal period, with hot and humid characteristics owing to the mechanism involved in the viral cycle. The most prevalent symptoms of severe dengue in pediatric patients were respiratory failure alone, gastrointestinal bleeding, and altered level of consciousness. It is important to identify signs of severity for early intervention and a better prognosis, considering that death is closely related to a delayed diagnosis.

Correlation between Thalamocortical Tract and Default Mode Network with Consciousness Levels in Hypoxic-Ischemic Brain Injury Patients: A Comparative Study Using the Coma Recovery Scale-Revised.

BACKGROUND The thalamocortical tract (TCT) links nerve fibers between the thalamus and cerebral cortex, relaying motor/sensory information. The default mode network (DMN) comprises bilateral, symmetrical, isolated cortical regions of the lateral and medial parietal and temporal brain cortex. The Coma Recovery Scale-Revised (CRS-R) is a standardized neurobehavioral assessment of disorders of consciousness (DOC). In the present study, 31 patients with hypoxic-ischemic brain injury (HI-BI) were compared for changes in the TCT and DMN with consciousness levels assessed using the CRS-R. MATERIAL AND METHODS In this retrospective study, 31 consecutive patients with HI-BI (17 DOC,14 non-DOC) and 17 age- and sex-matched normal control subjects were recruited. Magnetic resonance imaging was used to diagnose HI-BI, and the CRS-R was used to evaluate consciousness levels at the time of diffusion tensor imaging (DTI). The fractional anisotropy (FA) values and tract volumes (TV) of the TCT and DMN were compared. RESULTS In patients with DOC, the FA values and TV of both the TCT and DMN were significantly lower compared to those of patients without DOC and the control subjects (p<0.05). When comparing the non-DOC and control groups, the TV of the TCT and DMN were significantly lower in the non-DOC group (p<0.05). Moreover, the CRS-R score had strong positive correlations with the TV of the TCT (r=0.501, p<0.05), FA of the DMN (r=0.532, p<0.05), and TV of the DMN (r=0.501, p<0.05) in the DOC group. CONCLUSIONS This study suggests that both the TCT and DMN exhibit strong correlations with consciousness levels in DOC patients with HI-BI.

Serum metabolism alteration behind different etiology, diagnosis, and prognosis of disorders of consciousness

BackgroundPatients with disorders of consciousness (DoC) exhibit varied revival outcomes based on different etiologies and diagnoses, the mechanisms of which remain largely unknown. The fluctuating clinical presentations in DoC pose challenges in accurately assessing consciousness levels and prognoses, often leading to misdiagnoses. There is an urgent need for a deeper understanding of the physiological changes in DoC and the development of objective diagnostic and prognostic biomarkers to improve treatment guidance.MethodsTo explore biomarkers and understand the biological processes, we conducted a comprehensive untargeted metabolomic analysis on serum samples from 48 patients with DoC. Patients were categorized based on etiology (TBI vs. non-TBI), CRS-R scores, and prognosis. Advanced analytical techniques, including PCA and OPLS-DA models, were employed to identify differential metabolites.ResultsOur analysis revealed a distinct separation in metabolomic profiles among the different groups. The primary differential metabolites distinguishing patients with varying etiologies were predominantly phospholipids, with a notable decrease in glycerophospholipids observed in the TBI group. Patients with higher CRS-R scores exhibited a pattern of impaired carbohydrate metabolism coupled with enhanced lipid metabolism. Notably, serum concentrations of both LysoPE and PE were reduced in patients with improved outcomes, suggesting their potential as prognostic biomarkers.ConclusionsOur study underscores the critical role of phospholipid metabolism in the brain’s metabolic alterations in patients with DoC. It identifies key biomarkers for diagnosis and prognosis, offering insights that could lead to novel therapeutic targets. These findings highlight the value of metabolomic profiling in understanding and potentially treating DoC.