Unconscious classification of quantitative electroencephalogram features from propofol versus propofol combined with etomidate anesthesia using one-dimensional convolutional neural network.

Objective: Establishing a convolutional neural network model for the recognition of characteristic raw electroencephalogram (EEG) signals is crucial for monitoring consciousness levels and guiding anesthetic drug administration. Methods: This trial was conducted from December 2023 to March 2024. A total of 40 surgery patients were randomly divided into either a propofol group (1% propofol injection, 10 mL: 100 mg) (P group) or a propofol-etomidate combination group (1% propofol injection, 10 mL: 100 mg, and 0.2% etomidate injection, 10 mL: 20 mg, mixed at a 2:1 volume ratio) (EP group). In the P group, target-controlled infusion (TCI) was employed for sedation induction, with an initial effect site concentration set at 5-6 µg/mL. The EP group received an intravenous push with a dosage of 0.2 mL/kg. Six consciousness-related EEG features were extracted from both groups and analyzed using four prediction models: support vector machine (SVM), Gaussian Naive Bayes (GNB), artificial neural network (ANN), and one-dimensional convolutional neural network (1D CNN). The performance of the models was evaluated based on accuracy, precision, recall, and F1-score. Results: The power spectral density (94%) and alpha/beta ratio (72%) demonstrated higher accuracy as indicators for assessing consciousness. The classification accuracy of the 1D CNN model for anesthesia-induced unconsciousness (97%) surpassed that of the SVM (83%), GNB (81%), and ANN (83%) models, with a significance level of p < 0.05. Furthermore, the mean and mean difference ± standard error of the primary power values for the EP and P groups during the induced period were as follows: delta (23.85 and 16.79, 7.055 ± 0.817, p < 0.001), theta (10.74 and 8.743, 1.995 ± 0.7045, p < 0.02), and total power (24.31 and 19.72, 4.588 ± 0.7107, p < 0.001). Conclusion: Large slow-wave oscillations, power spectral density, and the alpha/beta ratio are effective indicators of changes in consciousness during intravenous anesthesia with a propofol-etomidate combination. These indicators can aid anesthesiologists in evaluating the depth of anesthesia and adjusting dosages accordingly. The 1D CNN model, which incorporates consciousness-related EEG features, represents a promising tool for assessing the depth of anesthesia. Clinical Trial Registration: https://www.chictr.org.cn/index.html.

Adolescents' evaluations of peer and teacher unfair treatment in science, technology, engineering, and mathematics classes: Expected interventions.

This study explores adolescents' evaluations of unfair teacher and peer behavior in science, technology, engineering, and mathematics (STEM) classes. Participants included ninth and tenth grade students from five public schools in the Southeastern United States, (N = 577, 45.9% female, 49% male, 5% other/prefer not to say/unsure). Students were ethnically representative of their communities: 48% White/European American, 22.7% Black/African American, 14% Latino/a/e/x, and 15.3% multi-racial/other/prefer not to say. Measures assessed adolescents' responses to hypothetical scenarios of unfair treatment. The findings indicate that adolescents recognize both teacher and peer unfair behavior as wrong, with nuanced differences based on participants' gender and grade. Attribution analysis reveals varied expected reasons for unfair treatment. Responses to unfair behavior differ, with adolescents more likely to confront peers than teachers. Demographic factors, school climate, discrimination, belonging, and critical consciousness contribute to variations in judgments and responses. The study highlights the importance of addressing unfair treatment in STEM settings to foster inclusivity and support student persistence in STEM.

Study of a precise treatment protocol for patients with consciousness disorders based on the brain network analysis of functional magnetic resonance imaging.

Objective: How to conduct objective and accurate individualized assessments of patients with disorders of consciousness (DOC) and carry out precision rehabilitation treatment technology is a major rehabilitation problem that needs to be solved urgently. Methods: In this study, a multi-layer brain network was constructed based on functional magnetic resonance imaging (fMRI) to analyze the structural and functional brain networks of patients with DOC at different levels and to find regulatory targets (imaging markers) with recovery potential for DOC. Then repeated transcranial magnetic stimulation (rTMS) was performed in DOC patients to clinically validate. Results: The brain network connectivity of DOC patients with different consciousness states is different, and the most obvious brain regions appeared in the olfactory cortex and precuneus. rTMS stimulation could effectively improve the consciousness level of DOC patients and stimulate the occipital lobe (specific regions found in this study) and the dorsolateral prefrontal cortex (DLPFC), and both parts had a good consciousness recovery effect. Conclusion: In clinical work, personalized stimulation regimen treatment combined with the brain network characteristics of DOC patients can improve the treatment effect.

The Impact of Bispectral Index Monitoring on Outcomes in Spinal Cord Stimulation for Chronic Disorders of Consciousness.

Objective: To observe whether maintaining the appropriate depth of anesthesia with Bispectral Index (BIS) can improve the prognosis of Spinal Cord stimulation (SCS) implantation in patients with chronic Disorders of consciousness (DoC). Methods: 103 patients with DoC undergoing SCS implantation were reviewed, and 83 patients with DoC were included according to the standard of inclusion and exclusion Criteria. Patients were divided into a BIS group (n =45) and a non-BIS group (n =38) according to whether BIS monitoring was used during the operation. The depth of anesthesia in the BIS group was maintained between 40-60. The anesthesiologist adjusted the depth of anesthesia in the non-BIS group according to clinical experience. Relevant information such as disease course, cause, anesthesia time, and operation time were collected. Preoperative CRS-R(preoperative) score, postoperative CRS-R(24h), and postoperative CRS-R(3m) changes were collected. Results: The CRS-R(3m) score in the BIS group was higher than that in the non-BIS group (preoperative), and the difference was statistically significant (P < 0.05). In CRS-R (24h), the BIS group was higher than the non-BIS group, and the difference was statistically significant (X2=8.787, P =0.004). The improvement of consciousness was included in the multivariate Logistic regression analysis model, and it was found that the thalamus was an independent factor affecting the improvement of consciousness (P < 0.05). During follow-up, 1 patient in the BIS group had a decrease in consciousness from MCS- to VS/ UWS and 2 patients in the non-BIS group died during follow-up. Conclusion: Patients can be benefit in hearing in CRS-R (24h). We recommend the use of BIS to monitor the depth of anesthesia in patients with DoC to improve patient outcomes.

Clinical and ethical challenges in decision-making for patients with disorders of consciousness and locked-in syndrome from Chinese neurologists' perspectives.

Background: The diagnosis of and life-sustaining treatment (LST) for patients with disorders of consciousness (DoC) and locked-in syndrome (LIS) have been the subject of intense debate. Objective: We aim to investigate the application of diagnostic knowledge, opinions about the administration of LST, and ethical challenges related to DoC and LIS. Design: A cross-sectional study. Methods: A survey was conducted among Chinese neurologists. Questionnaires included three vignettes (unresponsive wakefulness syndrome (UWS); minimally conscious state (MCS), and LIS). They were randomly distributed among neurologists from August 2018 to December 2019. Results: A sample of 360 questionnaires was included (response rate: 78%). Overall, 63% of the participants chose the correct diagnostic category. The neurologists who received the MCS case chose the category more accurately than the neurologists with the UWS (p < 0.001) and LIS case (p = 0.002). Most neurologists preferred never to limit LST for their patients (47%, 63%, and 67% in UWS, MCS, and LIS groups, p = 0.052). A large group of neurologists believed UWS patients could feel pain (73%), with no difference from MCS and LIS patients (p > 0.05). Deciding for patients in the absence of surrogates was rated extremely challenging. Conclusion: A large proportion of Chinese neurologists in our study didn't apply the accurate diagnostic categories to the description of DoC and LIS patients. This calls for more education and training. Most Chinese neurologists were reluctant to limit LST for patients. This may indicate that there may be a need to emphasize the allocation of more resources toward long-term care in China.

Clinical and ethical challenges The diagnosis of and life-sustaining treatment (LST) for patients with disorders of consciousness (DoC) and Locked-in syndrome (LIS) have been the subject of intense debate. To describe the knowledge and attitudes of physicians regarding patients with some DoC and LIS in Eastern countries we conducted a vignette-based survey among Chinese neurologists. This study reveals significant differences from previous studies, namely, lower diagnostic accuracy and less limitation of life-sustaining treatment. This may be closely related to policies, cultures, economies, and laws among countries. A deeper understanding of neurologists' moral beliefs and attitudes can inform healthcare policy and might point to areas of research and healthcare practice that need further regulatory attention. A normative orientation through institutional, regional, or national policies for decision-making can increase the likelihood of reaching consistent and transparent decisions about the care of patients with severe brain injury across different regions and cities.

Agrypnia excitata: a clinical biomarker of acute relapse in anti-NMDAr encephalitis.

Sleep disorders have been described in anti-NMDAr encephalitis including insomnia, hypersomnia, narcolepsy, and sleep-disordered breathing. A patient presented with typical features of anti-NMDAr encephalitis associated with a right ovarian teratoma. After two months of clinical improvement with immunotherapy, the patient deteriorated. A 24-hour video EEG-polysomnography revealed a severe sleep quantity deficit, a total destruction of sleep architecture consisting of short clusters of N1 and rapid eye movement sleep stages, associated with motor and autonomic hyperactivity. These features were consistent with agrypnia excitata and were associated with disease reactivation due to a left ovarian teratoma. A new course of immunotherapy and surgery improved clinical symptoms and normalized sleep patterns. Agrypnia excitata, the most severe form of status dissociatus, was a sleep biomarker of disease relapse in this patient. Polysomnographic studies in the acute phase of anti-NMDAr encephalitis are lacking and are needed to better understand the evolution of sleep patterns.

Unconscious Processing Contaminates Objective Measures of Conscious Perception: Evidence From the Liminal Prime Paradigm.

Assessing unconscious processing requires a valid measure of conscious perception. However, the two measures most commonly used, subjective reports and forced-choice discrimination, do not always converge: observers can discriminate stimuli rated as invisible better than chance. A debated issue is whether this phenomenon indicates that subjective reports of unawareness are contaminated by conscious perception, or that forced-choice discrimination performance is contaminated by unconscious processing. To address this question, we took advantage of a previously reported dissociation using masked response priming: for primes rated as invisible on a multi-point scale, response priming occurs only for fast trials, whereas for consciously perceived primes, response priming occurs across response times. Here, we replicated this dissociation, confirming that invisibility-reports were not contaminated by conscious perception. Crucially, we measured prime-discrimination performance within the same experiment and found above-chance performance for unseen primes. Together, these findings suggest that forced-choice discrimination performance is contaminated by unconscious processing.

Propofol-mediated loss of consciousness disrupts predictive routing and local field phase modulation of neural activity.

Predictive coding is a fundamental function of the cortex. The predictive routing model proposes a neurophysiological implementation for predictive coding. Predictions are fed back from the deep-layer cortex via alpha/beta (8 to 30 Hz) oscillations. They inhibit the gamma (40 to 100 Hz) and spiking that feed sensory inputs forward. Unpredicted inputs arrive in circuits unprepared by alpha/beta, resulting in enhanced gamma and spiking. To test the predictive routing model and its role in consciousness, we collected data from intracranial recordings of macaque monkeys during passive presentation of auditory oddballs before and after propofol-mediated loss of consciousness (LOC). In line with the predictive routing model, alpha/beta oscillations in the awake state served to inhibit the processing of predictable stimuli. Propofol-mediated LOC eliminated alpha/beta modulation by a predictable stimulus in the sensory cortex and alpha/beta coherence between sensory and frontal areas. As a result, oddball stimuli evoked enhanced gamma power, late period (>200 ms from stimulus onset) spiking, and superficial layer sinks in the sensory cortex. LOC also resulted in diminished decodability of pattern-level prediction error signals in the higher-order cortex. Therefore, the auditory cortex was in a disinhibited state during propofol-mediated LOC. However, despite these enhanced feedforward responses in the auditory cortex, there was a loss of differential spiking to oddballs in the higher-order cortex. This may be a consequence of a loss of within-area and interareal spike-field coupling in the alpha/beta and gamma frequency bands. These results provide strong constraints for current theories of consciousness.

Meritocratic beliefs in the United States, Finland, and China: A multidimensional approach using latent class analysis.

This study employs latent class analysis (LCA) as a novel methodology to investigate the multidimensional nature of meritocratic beliefs, addressing the limitations of traditional unidimensional approaches. Using data from the International Social Survey Program 2009 for the United States, Finland, and China, this study demonstrates several advantages of this multidimensional approach. First, LCA effectively identifies dual consciousness, where individuals simultaneously endorse meritocratic and structuralist explanations of social stratification. The analysis reveals three distinct narratives explaining social stratification: purely meritocratic beliefs, predominantly meritocratic beliefs, and dual consciousness. While all three subtypes consider merits highly important, they differ in their perceived importance of structural factors. Second, LCA facilitates cross-national comparisons, unveiling qualitative typological variations in meritocratic beliefs across countries. Unique country-specific subtypes or patterns emerge: Finland exhibits purely meritocratic beliefs, the United States shows predominantly meritocratic beliefs, and China demonstrates a dominance of dual consciousness. Although dual consciousness exists in all three countries, its prevalence varies significantly-dominant in China, moderate in the United States, and least in Finland. Third, this study reveals that the effect of education on meritocratic beliefs varies across the three countries. Education strengthens individual meritocratic beliefs in the United States, weakens them in Finland, and shows no significant effect in China. These findings highlight both within-country and across-country heterogeneity of meritocratic beliefs, underscoring the importance of a multidimensional approach.

Transient Consciousness Disorder During Emergency Cesarean Section in Patients with Labor Analgesia.

A patient who was 39 weeks pregnant was admitted to the hospital to be expecting labor and performed labor analgesia when the uterine orifice was opened to 2 cm. We successfully performed L2.3 epidural puncture in the lumbar space and equipped her with a self-controlled epidural analgesia infusion pump (100mL, 10mL 1% ropivacaine + 50ug sufentanil + 89mL normal saline) with a load of 8mL for continuous delivery. Continuous infusion of 8mL/h, patient controlled analgesia (PCA) 6 mL/ time at 15 minute intervals. The analgesic effect is good. In the following 40 minutes or so, due to fetal monitoring, fetal heart rate variation deceleration accompanied by late deceleration, the minimum was reduced to 85 times/min, and there was no improvement after treatment, and then the obstetrician prepared to perform an emergency cesarean section. The anesthesiologist evaluated the patient and then chose an epidural. The epidural dose was 3mL 1% lidocaine +0.5% rox mixture, and 7mL 1% lidocaine +0.5% rox mixture was administered 3 minutes later. During the administration, the patient complained of unbearable headache and rapid loss of consciousness. Immediate organization rescue, uterine dissection, pressure oxygen, preparation of tracheal intubation, cardiopulmonary resuscitation, cardiovascular active drugs, etc. After about 1 minute, the patient regained consciousness, responded smoothly, the vital signs were stable, the anesthesia plane T8 was measured. The patient's surgery went smoothly, and there were no complications during postoperative follow-up. They were discharged 5 days later. Such cases are relatively rare, especially during cesarean section surgery has not been reported, so it is published for everyone's reference.

Discrimination, critical consciousness, and mental health in American youth of color.

To resist and cope with oppression, youth of color may use the process of critical consciousness which involves understanding racial injustices (critical reflection), developing motivation to fight these injustices (critical motivation), and taking action to enact sociopolitical change (critical action). However, little is known about how each dimension of critical consciousness affects mental health in adolescents of color. In a sample of 367 ethnically and racially diverse American adolescents of color (age range = 13-17; 68.9% girls, 28.6% boys, and 2.5% gender minority; 84.4% US-born), we conducted multivariate regressions in Mplus to examine the cross-sectional links between each critical consciousness dimension (reflection, motivation, and action) and mental health outcomes (anxiety, depression, and stress) over and above the impact of everyday discrimination. We also investigated the interaction between critical consciousness and discrimination in predicting mental health outcomes. Controlling for age, gender, nativity, and social class, we found that discrimination and critical action were both positively associated with anxiety, depression, and stress. For our covariates, girls and gender minority adolescents reported worse outcomes. No interactions were significant. Overall, critical action, while necessary to enact societal change, may have a complex relationship with youth's depression, anxiety, and psychological stress symptoms and warrants careful exploration. Future research should focus on understanding the longitudinal mechanisms of critical action and how we can maximize the benefits by protecting youth from those negative effects.

Assessing consciousness in acute coma using name-evoked responses.

Detecting consciousness in clinically unresponsive patients remains a significant challenge. Existing studies demonstrate that electroencephalography (EEG) can detect brain responses in behaviorally unresponsive patients, indicating potential for consciousness detection. However, most of this evidence is based on chronic patients, and there is a lack of studies focusing on acute coma cases. This study aims to detect signs of residual consciousness in patients with acute coma by using bedside EEG and electromyography (EMG) during an auditory oddball paradigm. We recruited patients with acute brain injury (either traumatic brain injury or cardiac arrest) who were admitted to the intensive care unit within two weeks after injury, with a Glasgow Coma Scale (GCS) score of 8 or below. Auditory stimuli included the patients' own names and other common names (referred to as standard names), spoken by the patients' relatives, delivered under two conditions: passive listening (where patients were instructed that sounds would be played) and active listening (where patients were asked to move hands when heard their own names). Brain and muscle activity were recorded using EEG and EMG during the auditory paradigm. Event-related potentials (ERP) and EMG spectra were analyzed and compared between responses to the subject's own name and other standard names in both passive and active listening conditions. A total of 22 patients were included in the final analysis. Subjects exhibited enhanced ERP responses when exposed to their own names, particularly during the active listening task. Compared to standard names or passive listening, distinct differences in brain network connectivity and increased EMG responses were detected during active listening to their own names. These findings suggest the presence of residual consciousness, offering the potential for assessing consciousness in behaviorally unresponsive patients.

[Current progress on characteristics of intracranial electrophysiology related to prolonged disorders of consciousness].

Prolonged disorders of consciousness (pDOC) are pathological conditions of alterations in consciousness caused by various severe brain injuries, profoundly affecting patients' life ability and leading to a huge burden for both the family and society. Exploring the mechanisms underlying pDOC and accurately assessing the level of consciousness in the patients with pDOC provide the basis of developing therapeutic strategies. Research of non-invasive functional neuroimaging technologies, such as functional magnetic resonance (fMRI) and scalp electroencephalography (EEG), have demonstrated that the generation, maintenance and disorders of consciousness involve functions of multiple cortical and subcortical brain regions, and their networks. Invasive intracranial neuroelectrophysiological technique can directly record the electrical activity of subcortical or cortical neurons with high signal-to-noise ratio and spatial resolution, which has unique advantages and important significance for further revealing the brain function and disease mechanism of pDOC. Here we reviewed the current progress of pDOC research based on two intracranial electrophysiological signals, spikes reflecting single-unit activity and field potential reflecting multi-unit activities, and then discussed the current challenges and gave an outlook on future development, hoping to promote the study of pathophysiological mechanisms related to pDOC and provide guides for the future clinical diagnosis and therapy of pDOC.

Newman's theory of health as expanding consciousness: an evolutionary concept analysis.

BACKGROUND: The health as expanding consciousness (HEC) theory posits that health and disease are interconnected components of a comprehensive process aimed at expanding consciousness. AIM: The objective of this study is to introduce the concept, research status and applications of HEC and offer a comprehensive understanding of its various key components. DATA SOURCES: Databases including EMBASE, PubMed, ScienceDirect, ProQuest, Wiley, Web of Science, Sinomed, China National Knowledge Infrastructure, Wanfang, and CQVIP, covering the period from 1986 to 2023. METHOD: Employing Rodgers' evolutionary concept analysis approach, this study included and analysed 70 studies. RESULTS: The characteristics of HEC comprise aspects such as movement, time, space, energy, rhythm, and paradigm of health. The antecedents of HEC encompass disease, chaos, binding, centring, and choice point. Consequences associated with HEC include self-transcendence, unbinding, decentring, expanded consciousness, real freedom, pattern recognition, absolute consciousness, and death. CONCLUSION: This study has identified substitute terms, related concepts, attributes, antecedents, consequences, and empirical references associated with HEC. The findings provide valuable information applicable across various domains of nursing, encompassing practice, education, research, and management.

Index of Consciousness monitoring may effectively predict and prevent circulatory stress induced by endotracheal intubation under general anesthesia: a prospective randomized controlled trial.

BACKGROUND: The primary objective of anesthesiologists during the induction of anaesthesia is to mitigate the operative stress response resulting from endotracheal intubation. In this prospective, randomized controlled trial, our aim was to assess the feasibility and efficacy of employing Index of Consciousness (IoC, IoC1 and IoC2) monitoring in predicting and mitigating circulatory stress induced by endotracheal intubation for laparoscopic cholecystectomy patients under general anesthesia (GA). METHODS: We enrolled one hundred and twenty patients scheduled for laparoscopic cholecystectomy under GA and randomly allocated them to two groups: IoC monitoring guidance (Group T, n = 60) and bispectral index (BIS) monitoring guidance (Group C, n = 60). The primary endpoints included the heart rate (HR) and mean arterial pressure (MAP) of the patients, as well as the rate of change (ROC) at specific time points during the endotracheal intubation period. Secondary outcomes encompassed the systemic vascular resistance index (SVRI), cardiac output index (CI), stroke volume index (SVI), ROC at specific time points, the incidence of adverse events (AEs), and the induction dosage of remifentanil and propofol during the endotracheal intubation period in both groups. RESULTS: The mean (SD) HR at 1 min after intubation under IoC monitoring guidance was significantly lower than that under BIS monitoring guidance (76 (16) beats/min vs. 82 (16) beats/min, P = 0.049, respectively). Similarly, the mean (SD) MAP at 1 min after intubation under IoC monitoring guidance was lower than that under BIS monitoring guidance (90 (20) mmHg vs. 98 (19) mmHg, P = 0.031, respectively). At each time point from 1 to 5 min after intubation, the number of cases with HR ROC of less than 10% in Group T was significantly higher than in Group C (P < 0.05). Furthermore, between 1 and 3 min and at 5 min post-intubation, the number of cases with HR ROC between 20 to 30% or 40% in Group T was significantly lower than that in Group C (P < 0.05). At 1 min post-intubation, the number of cases with MAP ROC of less than 10% in Group T was significantly higher than that in Group C (P < 0.05), and the number of cases with MAP ROC between 10 to 20% in Group T was significantly lower than that in Group C (P < 0.01). Patients in Group T exhibited superior hemodynamic stability during the peri-endotracheal intubation period compared to those in Group C. There were no significant differences in the frequencies of AEs between the two groups (P > 0.05). CONCLUSION: This promising monitoring technique has the potential to predict the circulatory stress response, thereby reducing the incidence of adverse reactions during the peri-endotracheal intubation period. This technology holds promise for optimizing anesthesia management. TRAIL REGISTRATION:  Chinese Clinical Trail Registry Identifier: ChiCTR2300070237 (20/04/2022).

Reflexivity gradient-Consciousness knowing itself.

Some consider phenomenal consciousness to be the great achievement of the evolution of life on earth, but the real achievement is much more than mere phenomenality. The real achievement is that consciousness has woken up within us and has recognized itself, that within us humans, consciousness knows that it is conscious. This short review explores the reflexivity of consciousness from the perspective of consciousness itself-a non-conceptual nondual awareness, whose main property is its non-representational reflexivity. In light of this nondual reflexivity, different types of reflexivity proposed by current theories can be seen as a gradation of relational or transitive distances between consciousness as the knower and consciousness as the known, from fully representational and dual, through various forms of qualified monism, to fully non-representational and nondual.

Spastic Muscle Overactivity in a Patient With a Chronic Disorder of Consciousness After Severe Traumatic Brain Injury Successfully Treated with Acupuncture: A Case Report.

Spastic muscle overactivity (SMO) is a frequent retractable complication in patients with prolonged disorder of consciousness (DOC) after severe traumatic brain injury (sTBI). Here, we describe a patient with DOC and SMO after sTBI successfully treated with adjunctive acupuncture. A woman in her 70s with chronic DOC, corresponding to a minimally conscious state (MCS), and limb SMO after severe TBI due to a traffic accident was admitted to our hospital six months after the injury and received multiple care interventions including physiotherapy and nurse care. However, her SMO in the extremities with decorticated posture, in which bilateral elbow joints were flexed and bilateral knee joints were extended, remained. The passive range of motion (ROM) of bilateral elbow joints decreased. Her DOC also remained in MCS. Thus, acupuncture was implemented twice weekly for 20 weeks to improve SMO and promote arousal 30 months after injury. Modified Tardieu scale (MTS) during right elbow extension was measured before and after each acupuncture session. The maximum passive ROM (MTS-R2) gradually increased during the acupuncture period. The catch angle (MTS-R1), which indicates the influences of the hyper stretch reflex, also gradually reduced. The ROM limitation and the catch angle trended to decrease immediately after each acupuncture session. Ultrasound shear-wave elastography of the right brachial biceps muscle (BBM) at the 28th acupuncture session showed a reduction of shear-wave speeds immediately after the session, indicating that acupuncture reduced BBM stiffness. Her DOC state remained MCS. In the presented case, the adjunctive acupuncture therapy reduced SMO after severe TBI. Acupuncture may be beneficial for such patients. A large cohort study is warranted to confirm the effects of acupuncture on SMO in patients with DOC after sTBI.

Green dreams are made of this: Futures consciousness and proenvironmental engagement.

Futures consciousness (FC) refers to the capacity to understand, anticipate and prepare for the future. As a form of future orientation, it encompasses five interrelated dimensions of time perspective, agency beliefs, openness to alternatives, systems perception and concern for others. We present here cross-sectional evidence that FC is related to greater environmental engagement, above and beyond other future orientation constructs. In two pre-registered studies (one convenience student sample and one representative sample; N = 1041), we found that respondents with higher futures consciousness reported greater proenvironmental behaviour (consumption behaviour, land stewardship, social environmentalism and environmental citizenship). FC proved a better predictor of proenvironmental behaviour than the Zimbardo Inventory's Future Time Perspective and the Consideration for Future Consequences Scale (Study 1). FC was also related to stronger biospheric values (Study 2). However, it was not significantly related to personal environmental footprint (derived from a 16-item calculator). Strikingly, the environmental footprint was also unrelated to the Proenvironmental Behaviour Scale, which could point to a lack of correspondence between measures of proenvironmental propensity and impact. We discuss implications for future-thinking research and interventions aiming to improve futures consciousness.

Synthesizing the temporal self: robotic models of episodic and autobiographical memory.

Episodic memories are experienced as belonging to a self that persists in time. We review evidence concerning the nature of human episodic memory and of the sense of self and how these emerge during development, proposing that the younger child experiences a persistent self that supports a subjective experience of remembering. We then explore recent research in cognitive architectures for robotics that has investigated the possibility of forms of synthetic episodic and autobiographical memory. We show that recent advances in generative modeling can support an understanding of the emergence of self and of episodic memory, and that cognitive architectures which include a language capacity are showing progress towards the construction of a narrative self with autobiographical memory capabilities for robots. We conclude by considering the prospects for a more complete model of mental time travel in robotics and the implications of this modeling work for understanding human episodic memory and the self in time. This article is part of the theme issue 'Elements of episodic memory: lessons from 40 years of research'.

Acupuncture-assisted therapy for prolonged disorders of consciousness: study protocol for a randomized, conventional-controlled, assessor-and-statistician-blinded trial.

Background: Acupuncture is a promising non-pharmaceutical complementary therapy in treating prolonged Disorders of consciousness (pDOC), but solid evidence to support its effectiveness and safety is still lacking. Thus, the purpose of this study is to investigate the efficacy and safety of acupuncture-assisted therapy for pDOC patients. Methods: A single-center, prospective, randomized, conventional-controlled, assessor-and-statistician-blinded trial has been designed and is being conducted at West China Hospital of Sichuan University. A total of 110 participants will be randomly assigned to the experimental group and the control group in a 1:1 allocation ratio and evaluated using Coma Recovery Scale-Revised (CRS-R) at 8 a.m., 12 p.m., and 4 p.m. on 2 consecutive days before enrollment to determine the consciousness level. The experimental group will receive acupuncture combined with conventional treatment, while the control group will receive only conventional treatment during the trial observation period. The treatment duration of both groups will be 20 days. Among them, the frequency of acupuncture-assisted therapy is once a day, with 10 consecutive sessions followed by a day's rest for a total of 24 days. Data will be collected separately during baseline and after the final treatment. For data analysis, both Full Analysis Set (FAS) and Per Protocol Set (PPS) principles will be performed together by applying SPSS 27.0 software. The primary outcome measures are the changes of CRS-R before and after treatment, while the secondary outcome measures are the changes of Full Outline of Unresponsiveness Scale (FOUR), the changes of Nociception Coma Scale-Revised (NCS-R), the changes of Disability Rating Scale (DRS), the changes of Mismatch Negativity (MMN) and P300 before and after treatment, respectively. Discussion: This trial aims to rationally assess the consciousness level from multiple 2 perspectives through subjective evaluation and objective detection by selecting several standardized clinical scales combined with Event-Related Potential (ERP) detection technology. In this way, we will be able to reduce the subjectivity of consciousness assessment and objectively evaluate the clinical efficacy of acupuncture-assisted therapy for pDOC. The study, if proven to be effective and safe enough, will provide a favorable evidence to guide medical decision-making choices and future researches. Clinical trial registration: https://www.chictr.org.cn/, identifier ChiCTR2300076180.