The sense of consciousness.

I propose that consciousness might be understood as the property of a system that functions as a sense in the biological meaning of that term. The theory assumes that, as a complex system, the sense of consciousness is not a fixed structure but implies structure with variations and that it evolved, as many new functions do, through the integration of simpler systems. The recognized exteroceptive and enteroceptive senses provide information about the organism's environment and about the organism itself that are important to adaptation. The sense of consciousness provides information about the brain and thus about the organism and its environment. It senses other senses and processes in the brain, selecting and relating components into a form that "makes sense"-where making sense is defined as being useful to the organism in its adaptation to the environment. The theory argues that this highly adaptive organizing function evolved with the growing complexity of the brain and that it might have helped resolve discrepancies created at earlier stages. Neural energies in the brain that are the input to the sense of consciousness, along with the processing subsystem of which they are a part, constitute the base of consciousness. Consciousness itself is an emergent effect of an organizing process achieved through the sense of consciousness. The sense of consciousness thus serves an organizing function although it is not the only means of organization in the brain. Its uniqueness lies in the character of the organization it creates with consciousness as a property of that organization. The paper relates the theory to several general conceptions-interactionism, epiphenomenalism and identity theory-and illustrates a number of testable hypotheses. Viewing consciousness as a property of a sense provides a degree of conceptual integration. Much of what we know about the evolution and role of the conventionally recognized senses should help us understand the evolution and role of the sense of consciousness, and of consciousness itself.

A comparison of native and modified intravenous immunoglobulin for the management of hypogammaglobulinemia.

Ten patients with severe hypogammaglobulinemia received 6 monthly infusions of either native or modified intravenous immunoglobulin (IVIG) followed by 6 monthly infusions of the other product in a double-blind, crossover protocol. Clinical parameters were monitored on a daily basis and serum was obtained at 24 hours, 3 weeks, and 4 weeks after each infusion for measurement of total IgG, specific antibodies, and opsonizing antibodies against Streptococcus pneumoniae types 5, 12F, and 14. No differences between the products were seen for total IgG or antibodies against herpes simplex virus types 1 and 2, rubella, toxoplasma cytomegalovirus, diphtheria, or tetanus. Greater opsonizing antibody to the three strains of pneumococci were apparent for native IVIG until the third infusion, after which time products were equal. Clinical parameters (febrile or symptomatic days, missed work/school, time on antibiotics, culture positive infection, and hospitalizations) were equivalent during the treatment period with each preparation. This study showed equivalent efficacy of native IVIG as compared with reduced and alkylated IVIG during maintenance therapy for hypogammaglobulinemia.

Intravenous immune globulin for hypogammaglobulinemia: a comparison of opsonizing capacity in recipient sera.

Twelve severely hypogammaglobulinemic patients received infusions of alkylated immune globulin and two other native nonalkylated products. Administration was separated by an interval of 3 weeks. Serum was obtained prior to and at 24 hr and 3 weeks after each infusion for measurement of total IgG, specific and opsonizing antibodies. The latter was accomplished against Streptococcus pneumoniae types 5, 12F and 14 and zymosan using chemiluminescence methodology. Changes in total IgG concentrations were comparable for the three products. Prior to enrollment, IgG levels averaged 115 +/- 72 mg/dl, increasing to 779 +/- 399 at 24 hr postinfusion, and were 337 +/- 200 after 3 weeks. No differences among the products were seen in their ability to produce antibodies against Herpes simplex virus types 1 and 2, rubella, toxoplasma, cytomegalovirus, or tetanus. However, differences in opsonizing antibody were observed between alkylated and native IgG preparations. Peak chemiluminescence responses of neutrophils following opsonization of S. pneumoniae with native immune globulin were significantly higher than with alkylated IgG, indicating greater functional capacity. These studies suggest that native immune serum globulin provides a greater potential for augmenting host defense mechanisms against pneumococcal infection in hypogammaglobulinemic patients.

Research involving human subjects.

This article reports a study of the activities and performance of institutional review boards to protect human research subjects. Researchers and institutional review board members were generally supportive of the review system, although substantial criticisms were also heard. Institutional review boards had some direct impact on half of the proposals reviewed by requiring either modification of or additional information about proposed research. The data, however, raise questions about the effectiveness of some review board actions, for example, with regard to informed consent. Some policy implications of the study are presented.