Guía de tratamiento de la alteración aguda del estado mental. Academia Iberoamericana de Neurología Pediátrica / Guide for the treatment of acute altered mental status. Iberoamerican Academy of Pediatric Neurology

La alteración aguda del estado mental en pediatría se refiere a un cambio repentino y significativo en la función cerebral y el nivel de conciencia de un niño. Puede manifestarse como confusión, desorientación, agitación, letargo o incluso pérdida de la conciencia. Esta condición es una emergencia médica, y requiere una evaluación y una atención inmediatas. Existen diversas causas de alteración aguda del estado mental en niños, algunas de las cuales incluyen infecciones del sistema nervioso central, como la meningitis o la encefalitis, los traumatismos craneoencefálicos, los trastornos metabólicos, las convulsiones o las intoxicaciones, entre otras. Este estudio tuvo como objetivo analizar, preparar y calificar la bibliografía actual para determinar las mejores recomendaciones sobre el tratamiento ante casos de alteración aguda del estado mental en pediatría de diferentes causas. El estudio se basó en la calificación de expertos en el campo para poder determinar la calificación de las recomendaciones, además de ser sometido a la revisión por parte del comité científico de la Academia Iberoamericana de Neurología Pediátrica. Nuestra guía representa una ayuda para el tratamiento de este síntoma inespecífico desde un enfoque básico y avanzado, aplicable por cualquier neurólogo pediatra.(AU)

In pediatric patients, an acute altered mental status refers to a sudden and significant change in a child’s brain function and level of consciousness. It may manifest as confusion, disorientation, agitation, lethargy or even a loss of consciousness. This condition is a medical emergency, and requires immediate evaluation and attention. There are several causes of acute altered mental status in children, including infections of the central nervous system such as meningitis or encephalitis, traumatic brain injury, metabolic disorders, seizures and poisoning, among others. The aim of this study was to analyse, prepare and classify the current literature in order to determine the best recommendations for the treatment of cases of acute altered mental status with various causes in pediatric patients. The study was based on opinions from experts in the field in order to classify the recommendations, and was submitted to the scientific committee of the Iberoamerican Academy of Pediatric Neurology for review. Our guide is an aid for the treatment of this non-specific symptom based on a basic and advanced approach, which can be applied by any pediatric neurologist.(AU)

Enhancing Content Validity Assessment With Item Response Theory Modeling.

BACKGROUND: Ensuring the validity of assessments requires a thorough examination of the test content. Subject matter experts (SMEs) are commonly employed to evaluate the relevance, representativeness, and appropriateness of the items. This article proposes incorporating item response theory (IRT) into model assessments conducted by SMEs. Using IRT allows for the estimation of discrimination and threshold parameters for each SME, providing evidence of their performance in differentiating relevant from irrelevant items, thus facilitating the detection of suboptimal SME performance while improving item relevance scores. METHOD: Use of IRT was compared to traditional validity indices (content validity index and Aiken's V) in the evaluation of items. The aim was to assess the SMEs' accuracy in identifying whether items were designed to measure conscientiousness or not, and predicting their factor loadings. RESULTS: The IRT-based scores effectively identified conscientiousness items (R2 = 0.57) and accurately predicted their factor loadings (R2 = 0.45). These scores demonstrated incremental validity, explaining 11% more variance than Aiken's V and up to 17% more than the content validity index. CONCLUSIONS: Modeling SME assessments with IRT improves item alignment and provides better predictions of factor loadings, enabling improvement of the content validity of measurement instruments.

Three Arguments Against Institutional Conscientious Objection, and Why They Are (Metaphysically) Unconvincing.

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection.

The neuroscience of lucid dreaming: Past, present, future.

Lucid dreaming allows conscious awareness and control of vivid dream states; however, its rarity and instability make neuroscientific experimentation challenging. Recent advances in wearable neurotechnology, large-scale collaborations, citizen neuroscience, and artificial intelligence increasingly facilitate the decoding of this intriguing phenomenon.

Bio-Psycho-Spiritual Perspectives on Psychedelics: Clinical and Ethical Implications.

Psychedelics have again become a subject of widespread interest, owing to the reinvigoration of research into their traditional uses, possible medical applications, and social implications. As evidence for psychedelics' clinical potential mounts, the field has increasingly focused on searching for mechanisms to explain the effects of psychedelics and therapeutic efficacy of psychedelic-assisted therapy (PAT). This paper reviews three general frameworks that encompass several prominent models for understanding psychedelics' effects-specifically, neurobiological, psychological, and spiritual frameworks. Following our review, the implications of each framework for ethics and professional competencies in the implementation of psychedelics as medicines are explored. We suggest that interdisciplinary education may be necessary to improve communication between researchers, develop models that effectively incorporate multiple levels of analysis, and facilitate collaboration between professionals with diverse backgrounds in the implementation of psychedelic medicines. We also address pitfalls associated with overemphasis on neuro-mechanisms, risks associated with instigating vulnerable states of consciousness, and hurdles associated with the integration of spiritual frameworks in medicine. Ultimately, as psychedelics push the boundaries of explanatory frameworks focused on one level of analysis, developing new and more useful models to reflect knowledge being produced in this field should be a central aim of psychedelic science going forward.

Valuing the Acute Subjective Experience.

Psychedelics, including psilocybin, and other consciousness-altering compounds such as 3,4-methylenedioxymethamphetamine (MDMA), currently are being scientifically investigated for their potential therapeutic uses, with a primary focus on measurable outcomes: for example, alleviation of symptoms or increases in self-reported well-being. Accordingly, much recent discussion about the possible value of these substances has turned on estimates of the magnitude and duration of persisting positive effects in comparison to harms. However, many have described the value of a psychedelic experience with little or no reference to such therapeutic benefits, instead seeming to find the experience valuable in its own right. How can we make sense of such testimony? Could a psychedelic experience be valuable even if there were no persisting beneficial effects? If so, how? Using the concept of psychological richness, combined with insights from the philosophy of aesthetics and the enhancement literature, this essay explores potential sources of value in the acute subjective experience, apart from the value derived from persisting beneficial effects.

COVID-19-induced acute loss of consciousness in Marchiafava-Bignami disease: a case report.

Among the various manifestations of COVID-19, the neurological implications of SARS-CoV-2 infection are of significant concern. Marchiafava-Bignami disease (MBD), a neurodegenerative disorder, exhibits a clinical spectrum ranging from mild progressive dementia in its chronic form to states of acute coma and varied mortality rates. Acute MBD primarily occurs in chronic alcoholics and malnourished individuals and is characterized by sudden loss of consciousness, seizures, confusion, and psychosis. We herein report a case of MBD presenting as acute loss of consciousness after the development of COVID-19. The patient presented with a history of fever and upper respiratory infection and was diagnosed with SARS-CoV-2 infection. He developed a neurological syndrome characterized by altered consciousness and convulsions, and brain magnetic resonance imaging revealed abnormal signals in the corpus callosum and frontoparietal lobes. Considering his alcohol intake history and the absence of other differential diagnoses, we diagnosed him with acute MBD triggered by COVID-19. After high-dose vitamin B1 and corticosteroid therapy, his clinical symptoms improved. In this case, we observed a temporal sequence between the development of COVID-19 and acute exacerbation of MBD. This case adds to the mounting evidence suggesting the potential effect of SARS-CoV-2 on the neurological system.

[The DoC-feeling scale, a paramedical assessment tool improving the diagnostic accuracy of the state of consciousness of non-communicative patients]. / L'échelle DoC-feeling, un outil d'évaluation paramédical améliorant la précision diagnostique de l'état de conscience des patients non communicants.

The Neurological Intensive Care Unit (ICU) at Pitié-Salpêtrière Hospital cares for patients with severe brain injuries, which can lead to acute or chronic disorders of consciousness. To assess the patient's state of consciousness, the team relies on precise clinical examination. This article presents the assessment tools used to establish the patient's prognosis.

Late Middle Ages-Europe.

At the end of the late Middle Ages, there had been changes in indications for surgery, with prophylactic trepanation falling out of favor. The management of wounds and the methods for opening the cranium had become fairly standardized. Narrow non-plunging trepans were the preferred drills, and cranial openings were widened by the use of multiple drill holes connected with chisels of which the lenticular was preferred. Concerns about damaging the dura led Theodoric to delay trepanation until the clinical changes reflected separation of the dura from the cranium, at least in his view. Draining pus remained the main indication for trepanation. In no case was the level of consciousness considered in determining the need to open the cranium.

Induction of altered states of consciousness during Floatation-REST is associated with the dissolution of body boundaries and the distortion of subjective time.

Floatation-REST (Reduced Environmental Stimulation Therapy) minimizes stimulation of the nervous system by immersing subjects in an environment without sound or light while they effortlessly float in thermoneutral water supersaturated with Epsom salt. Here we investigated the relationship between altered states of consciousness (ASC) and its association with the affective changes induced by Floatation-REST. Using a within-subject crossover design, 50 healthy subjects were randomized to 60 min of Floatation-REST or 60 min of Bed-REST (an active control condition that entailed lying supine on a warm waterbed in a dark and quiet room). Following Floatation-REST, subjects felt significantly more relaxed, less anxious, and less tired than after Bed-REST. Floatation-REST also induced significantly more pronounced ASC characterized by the dissolution of body boundaries and the distortion of subjective time. The loss of body boundaries mediated the loss of anxiety, revealing a novel mechanism by which Floatation-REST exerts its anxiolytic effect.

Consciousness transitions during epilepsy seizures through the lens of integrated information theory.

Consciousness is one of the most complex aspects of human experience. Studying the mechanisms involved in the transitions among different levels of consciousness remains as one of the greatest challenges in neuroscience. In this study we use a measure of integrated information (ΦAR) to evaluate dynamic changes during consciousness transitions. We applied the measure to intracranial electroencephalography (SEEG) recordings collected from 6 patients that suffer from refractory epilepsy, taking into account inter-ictal, pre-ictal and ictal periods. We analyzed the dynamical evolution of ΦAR in groups of electrode contacts outside the epileptogenic region and compared it with the Consciousness Seizure Scale (CCS). We show that changes on ΦAR are significantly correlated with changes in the reported states of consciousness.

Applying explainable artificial intelligence methods to models for diagnosing personal traits and cognitive abilities by social network data.

This study utilizes advanced artificial intelligence techniques to analyze the social media behavior of 1358 users on VK, the largest Russian online social networking service. The analysis comprises 753,252 posts and reposts, combined with Big Five personality traits test results, as well as assessments of verbal and fluid intelligence. The objective of this research is to understand the manifestation of psychological attributes in social media users' behavior and determine their implications on user-interaction models. We employ the integrated gradients method to identify the most influential feature groups. The partial dependence plot technique aids in understanding how these features function across varying severity degrees of the predicted trait. To evaluate feature stability within the models, we cluster calculated Shapley values. Our findings suggest that the emotional tone (joy, surprise, anger, fear) of posts significantly influences the prediction of three personality traits: Extraversion, Agreeableness, and Openness to Experience. Additionally, user social engagement metrics (such as friend count, subscribers, likes, views, and comments) correlate directly with the predicted level of Logical thinking. We also observe a trend towards provocative and socially reprehensible content among users with high Neuroticism levels. The theme of religion demonstrates a multidirectional relationship with Consciousness and Agreeableness. Further findings, including an analysis of post frequency and key text characteristics, are also discussed, contributing to our understanding of the complex interplay between social media behavior and psychological traits. The study proposes a transition from the analysis of correlations between psychological (cognitive) traits to the analysis of indicators of behavior in a social network that are significant for diagnostic models of the corresponding traits.

Health providers' reasons for participating in abortion care: A scoping review.

BACKGROUND: There is a global shortage of health providers in abortion care. Public discourse presents abortion providers as dangerous and greedy and links 'conscience' with refusal to participate. This may discourage provision. A scoping review of empirical evidence is needed to inform public perceptions of the reasons that health providers participate in abortion. OBJECTIVE: The study aimed to identify what is known about health providers' reasons for participating in abortion provision. ELIGIBILITY CRITERIA: Studies were eligible if they included health providers' reasons for participating in legal abortion provision. Only empirical studies were eligible for inclusion. SOURCES OF EVIDENCE: We searched the following databases from January 2000 until January 2022: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect and Centre for Agricultural and Biosciences International Abstracts. Grey literature was also searched. METHODS: Dual screening was conducted of both title/abstract and full-text articles. Health providers' reasons for provision were extracted and grouped into preliminary categories based on the existing research. These categories were revised by all authors until they sufficiently reflected the extracted data. RESULTS: From 3251 records retrieved, 68 studies were included. In descending order, reasons for participating in abortion were as follows: supporting women's choices and advocating for women's rights (76%); being professionally committed to participating in abortion (50%); aligning with personal, religious or moral values (39%); finding provision satisfying and important (33%); being influenced by workplace exposure or support (19%); responding to the community needs for abortion services (14%) and participating for practical and lifestyle reasons (8%). CONCLUSION: Abortion providers participated in abortion for a range of reasons. Reasons were mainly focused on supporting women's choices and rights; providing professional health care; and providing services that aligned with the provider's own personal, religious or moral values. The findings provided no evidence to support negative portrayals of abortion providers present in public discourse. Like conscientious objectors, abortion providers can also be motivated by conscience.

Local orchestration of distributed functional patterns supporting loss and restoration of consciousness in the primate brain.

A central challenge of neuroscience is to elucidate how brain function supports consciousness. Here, we combine the specificity of focal deep brain stimulation with fMRI coverage of the entire cortex, in awake and anaesthetised non-human primates. During propofol, sevoflurane, or ketamine anaesthesia, and subsequent restoration of responsiveness by electrical stimulation of the central thalamus, we investigate how loss of consciousness impacts distributed patterns of structure-function organisation across scales. We report that distributed brain activity under anaesthesia is increasingly constrained by brain structure across scales, coinciding with anaesthetic-induced collapse of multiple dimensions of hierarchical cortical organisation. These distributed signatures are observed across different anaesthetics, and they are reversed by electrical stimulation of the central thalamus, coinciding with recovery of behavioural markers of arousal. No such effects were observed upon stimulating the ventral lateral thalamus, demonstrating specificity. Overall, we identify consistent distributed signatures of consciousness that are orchestrated by specific thalamic nuclei.

Public acceptance towards plastic waste-to-energy gasification projects: The role of social trust and health consciousness.

Public acceptance plays an essential role in successfully constructing and operating innovative and evolving technologies that promote ecological sustainability and pollution reduction. The present study investigates the factors influencing public acceptance of plastic waste-to-energy gasification projects. The research added social trust and health consciousness to the theory of planned behavior. Using the structural equation modeling, 513 valid survey questionnaire responses from the Beijing-Tianjin-Hebei region, China, were analyzed. The most notable results reveal that attitude, social norms, and perceived behavioral control have a major impact on the public acceptability of the initiative. There was no correlation between social trust and public support for the project. Social trust affects public acceptance of the project through attitude. Health consciousness was shown to be favorably connected with public approval of the project both directly and indirectly through attitude. This study serves policymakers and stakeholders with robust policy recommendations to promote public acceptance of plastic waste-to-energy gasification schemes and other hazardous facilities.

Extrapolating animal consciousness.

I argue that the question of animal consciousness is an extrapolation problem and, as such, is best tackled by deploying currently accepted methodology for validating experimental models of a phenomenon of interest. This methodology relies on an assessment of similarities and dissimilarities between experimental models, the partial replication of findings across complementary models, and evidence from the successes and failures of explanations, technologies and medical applications developed by extrapolating and aggregating findings from multiple models. Crucially important, this methodology does not require a commitment to any particular theory or construct of consciousness, thus avoiding theory-biased reinterpretations of empirical findings rampant in the literature.

Reflection of the Japanese Consciousness and Worldview in the Context of Globalization in the Novels of Haruki Murakami.

Contemporary literature encompasses not only works but also culture, defining the processes of the past preserved in the memory of posterity. Haruki Murakami influenced the shaping of this modern culture to a great extent. The research purpose is to investigate the phenomenon of Haruki Murakami analysing the components of the collective and individual consciousness of the Japanese nation in his fiction. At the methodological level, the following methods of analyzing literary phenomena were used in the training to solve the set tasks: hermeneutic interpretation and sociological method. The research reveals the main features of the urban world of the Japanese society portraying it in progress (from the post-war period to the present moment). The evolution process is portrayed as detachment, independence and solitude. The literary factors reflect both internal spiritual relations and global intercultural links. At the same time, the writer portrays Japan as a country experiencing technological and informational progress, thereby declaring that it is ready to accept and participate in the world changes and become a part of the globalisation process. The writer has made a great contribution to the treasury of Japanese literature and his works are considered an important part of the intercultural interactions between countries they are trying to achieve in a global world. The results close the theoretical and empirical gaps in the literature and literary criticism and contribute to the analysis of the cultural and literary traditions of Japan.

Exploring luminescent carbon dots derived from syrup bottle waste and curcumin for potential antimicrobial and bioimaging applications.

In this study, we utilized a navel hybrid material, prepared by fusing fluorescent Carbon Dots SyCDs, derived from syrup bottles, with curcumin. This innovative approach not only offers significant advancements in antimicrobial activity and bioimaging but also represents a stride in sustainable and eco-friendly nanotechnology. The core of our study is the development of an efficient, cost-effective, and environmentally conscious method for synthesizing SyCDs. This is achieved by repurposing waste syrup bottles, thus addressing the pressing issue of plastic waste. The incorporation of curcumin, renowned for its biological properties, enhances the luminescent characteristics of SyCDs and augments their functionality. This combination overcomes the inherent limitations of curcumin when used in isolation. The hybrid material exhibits enhanced antimicrobial properties and proves to be a potent alternative to conventional fluorescent dyes for bioimaging, marking a substantial leap in the field of sustainable nanomaterials. Our work not only demonstrates the versatile applications of luminescent SyCDs in health and environmental science but also underscores the potential of sustainable approaches in addressing global environmental challenges. This study, represents a significant contribution to the domain of sustainable nanotechnology, highlighting the transformative power of integrating waste management with advanced material science.

Precise detection of awareness in disorders of consciousness using deep learning framework.

Diagnosis of disorders of consciousness (DOC) remains a formidable challenge. Deep learning methods have been widely applied in general neurological and psychiatry disorders, while limited in DOC domain. Considering the successful use of resting-state functional MRI (rs-fMRI) for evaluating patients with DOC, this study seeks to explore the conjunction of deep learning techniques and rs-fMRI in precisely detecting awareness in DOC. We initiated our research with a benchmark dataset comprising 140 participants, including 76 unresponsive wakefulness syndrome (UWS), 25 minimally conscious state (MCS), and 39 Controls, from three independent sites. We developed a cascade 3D EfficientNet-B3-based deep learning framework tailored for discriminating MCS from UWS patients, referred to as "DeepDOC", and compared its performance against five state-of-the-art machine learning models. We also included an independent dataset consists of 11 DOC patients to test whether our model could identify patients with cognitive motor dissociation (CMD), in which DOC patients were behaviorally diagnosed unconscious but could be detected conscious by brain computer interface (BCI) method. Our results demonstrate that DeepDOC outperforms the five machine learning models, achieving an area under curve (AUC) value of 0.927 and accuracy of 0.861 for distinguishing MCS from UWS patients. More importantly, DeepDOC excels in CMD identification, achieving an AUC of 1 and accuracy of 0.909. Using gradient-weighted class activation mapping algorithm, we found that the posterior cortex, encompassing the visual cortex, posterior middle temporal gyrus, posterior cingulate cortex, precuneus, and cerebellum, as making a more substantial contribution to classification compared to other brain regions. This research offers a convenient and accurate method for detecting covert awareness in patients with MCS and CMD using rs-fMRI data.