The limits of consciousness

Consciousness is essential for one’s normal functioning, including targeted interactions with the surrounding world and with other human beings. At present, many theories and definitions of consciousness coexist, the focus of which can be on the philosophical discourse on consciousness, the clinical observation of consciousness, or the scientific understanding of consciousness through advanced imaging techniques. Discussions relating to whether consciousness is located in the brain, if it is created within certain neural networks or whether it transits throught he brain without being part of it are ongoing. Despite the variation in definitions and theories of consciousness, there is a wide consensus on the essentiality of wakefulness and awareness for consciousness. A lot of the patients in a coma will not survive, and the ones who recover will generally go through different altered states of consciousness. Some will fully regain consciousness; others will never come out of this state. Clinicians are facing every day the complex challenge of diagnosing those patients and help families to make choices about the future of the patient, notably concerning end of life decisions. The rate of misdiagnosis is still high for patients with disorders of consciousness and we still encounter misdiagnosed brain-dead patients. A number of ethical issues are raised by that non-communicative vulnerable population as for example the importance of a reliable diagnosis for the life sustaining treatments. Some patients having been considered as clinically dead or having lived close brushed with death will report perceptual experiences known as “Near-Death Experience” (NDE). There are only a few studies that describe that phenomenon, but most of the NDE experiencers describe it as a positive moment. NDEs are significantly changing NDE experiencers, their identity and their relationship to death. Death and consciousness are intertwined concepts that are hardly dissociable for clinicians in their practice. What are limits of consciousness and how those limits are linked to death. Anyway, the only life after death that we have proof of is the organ donation

Determinants of anemia and hemoglobin concentration in haitian school-aged children

Anemia diminishes oxygen transport in the body, resulting in potentially irreversible growth and developmental consequences for children. Limited evidence for determinants of anemia exists for school-aged children. We conducted a cluster randomized controlled trial in Haiti from 2012 to 2013 to test the efficacy of a fortified school snack. Children (N = 1,047) aged 3–13 years were followed longitudinally at three time points for hemoglobin (Hb) concentrations, anthropometry, and bioelectrical impedance measures. Dietary intakes, infectious disease morbidities, and socioeconomic and demographic factors were collected at baseline and endline. Longitudinal regression modeling with generalized least squares and logit models with random effects identified anemia risk factors beyond the intervention effect. At baseline, 70.6% of children were anemic and 2.6% were severely anemic. Stunting increased the odds of developing anemia (adjusted odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.05–2.08) and severe anemia (adjusted OR: 2.47, 95% CI: 1.30–4.71). Parent-reported vitamin A supplementation and deworming were positively associated with Hb concentrations, whereas fever and poultry ownership showed a negative relationship with Hb concentration and increased odds of severe anemia, respectively. Further research should explore the full spectrum of anemia etiologies in school children, including genetic causes

Behavioural and brain responses in cognitive trance: A TMS-EEG case study.

peer reviewe

Conscience et états de conscience altérée

peer reviewe

SUpporting well-being through PEeR-Befriending (SUPERB) trial: an exploration of fidelity in peer-befriending for people with aphasia

Assessing the evolution of severely brain-injured patients with disorders of consciousness (DOC) with current tools like the Glasgow Outcome Scale-Extended (GOS-E) remains a challenge. At the bedside, the most reliable diagnostic tool is currently the Coma Recovery Scale-Revised. The CRS-R distinguishes patients with unresponsive wakefulness syndrome (UWS) from patients in minimally conscious state (MCS) and patients who have emerged from MCS (EMCS). This international multi-centric study aims to validate a phone outcome questionnaire (POQ) based on the CRS-R and compare it to the CRS-R performed at the bedside and to the GOS-E which evaluates the level of disability and assigns patient’s in outcomes categories. The POQ will allow clinicians to probe the evolution of patient’s state of consciousness based on caregivers feedback. This research project is part of the International Brain Injury Association, Disorders of Consciousness-Special Interest Group (DOCSIG) and DOCMA consortium

Errors, biases, and corrections for weighing gauge precipitation measurements from WMO-SPICE

Presentación realizada en: American Meteorological Society Annual Meeting (2017) celebrado en Seattle (Washington) del 22 al 26 de enero de 2017

Errors, Biases, and Corrections for Weighing Gauge Precipitation Measurements from the WMO Solid Precipitation Intercomparison Experiment

Comunicación presentada en: TECO-2016 (Technical Conference on Meteorological and Environmental Instruments and Methods of Observation) celebrada en Madrid, del 27 al 30 de septiembre de 2016.Although precipitation has been measured for many centuries, precipitation measurements are still beset with significant biases and errors. Solid precipitation is particularly difficult to measure accurately, and biases between winter-time precipitation measurements from different measurement networks or different regions can exceed 100%. Using precipitation gauge results from the WMO Solid Precipitation Intercomparison Experiment (WMO-SPICE), errors in precipitation measurement caused by gauge uncertainty, spatial variability in precipitation, hydrometeor type, and wind are quantified. The methods used to calculate gauge catch efficiency and correct known biases are described briefly. Transfer functions describing catch efficiency as a function of air temperature and wind speed are also presented. In addition, the biases and errors associated with the use of a single transfer function to correct gauge undercatch at multiple sites are discussed

Tailoring intervention procedures to routine primary health care practice; an ethnographic process evaluation

Background. Tailor-made approaches enable the uptake of interventions as they are seen as a way to overcome the incompatibility of general interventions with local knowledge about the organisation of routine medical practice and the relationship between the patients and the professionals in practice. Our case is the Quattro project which is a prevention programme for cardiovascular diseases in high-risk patients in primary health care centres in deprived neighbourhoods. This programme was implemented as a pragmatic trial and foresaw the importance of local knowledge in primary health care and internal, or locally made, guidelines. The aim of this paper is to show how this prevention programme, which could be tailored to routine care, was implemented in primary care. Methods. An ethnographic design was used for this study. We observed and interviewed the researchers and the practice nurses. All the research documents, observations and transcribed interviews were analysed thematically. Results. Our ethnographic process evaluation showed that the opportunity of tailoring intervention procedures to routine care in a pragmatic trial setting did not result in a well-organised and well-implemented prevention programme. In fact, the lack of standard protocols hindered the implementation of the intervention. Although it was not the purpose of this trial, a guideline was developed. Despite the fact that the developed guideline functioned as a tool, it did not result in the intervention being organised accordingly. However, the guideline did make tailoring the intervention possible. It provided the professionals with the key or the instructions needed to achieve organisational change and transform the existing interprofessional relations. Conclusion. As tailor-made approaches are developed to enable the uptake of interventions in routine practice, they are facilitated by the brokering of tools such as guidelines. In our study, guidelines facilitated organisational change and enabled the transformation of existing interprofessional relations, and thus made tailoring possible. The attractive flexibility of pragmatic trial design in taking account of local practice variations may often be overestimated

Positive and Negative Regulation of Gli Activity by Kif7 in the Zebrafish Embryo

Loss of function mutations of Kif7, the vertebrate orthologue of the Drosophila Hh pathway component Costal2, cause defects in the limbs and neural tubes of mice, attributable to ectopic expression of Hh target genes. While this implies a functional conservation of Cos2 and Kif7 between flies and vertebrates, the association of Kif7 with the primary cilium, an organelle absent from most Drosophila cells, suggests their mechanisms of action may have diverged. Here, using mutant alleles induced by Zinc Finger Nuclease-mediated targeted mutagenesis, we show that in zebrafish, Kif7 acts principally to suppress the activity of the Gli1 transcription factor. Notably, we find that endogenous Kif7 protein accumulates not only in the primary cilium, as previously observed in mammalian cells, but also in cytoplasmic puncta that disperse in response to Hh pathway activation. Moreover, we show that Drosophila Costal2 can substitute for Kif7, suggesting a conserved mode of action of the two proteins. We show that Kif7 interacts with both Gli1 and Gli2a and suggest that it functions to sequester Gli proteins in the cytoplasm, in a manner analogous to the regulation of Ci by Cos2 in Drosophila. We also show that zebrafish Kif7 potentiates Gli2a activity by promoting its dissociation from the Suppressor of Fused (Sufu) protein and present evidence that it mediates a Smo dependent modification of the full length form of Gli2a. Surprisingly, the function of Kif7 in the zebrafish embryo appears restricted principally to mesodermal derivatives, its inactivation having little effect on neural tube patterning, even when Sufu protein levels are depleted. Remarkably, zebrafish lacking all Kif7 function are viable, in contrast to the peri-natal lethality of mouse kif7 mutants but similar to some Acrocallosal or Joubert syndrome patients who are homozygous for loss of function KIF7 alleles

A connectome and analysis of the adult Drosophila central brain.

The neural circuits responsible for animal behavior remain largely unknown. We summarize new methods and present the circuitry of a large fraction of the brain of the fruit fly Drosophila melanogaster. Improved methods include new procedures to prepare, image, align, segment, find synapses in, and proofread such large data sets. We define cell types, refine computational compartments, and provide an exhaustive atlas of cell examples and types, many of them novel. We provide detailed circuits consisting of neurons and their chemical synapses for most of the central brain. We make the data public and simplify access, reducing the effort needed to answer circuit questions, and provide procedures linking the neurons defined by our analysis with genetic reagents. Biologically, we examine distributions of connection strengths, neural motifs on different scales, electrical consequences of compartmentalization, and evidence that maximizing packing density is an important criterion in the evolution of the fly's brain