Vegetative State

It’s hard to know what to do with people when they are in a vegetative state. By vegetative, I don’t mean that they are spending all day sitting on the couch and eating Oreos. A clinically vegetative state is diagnosed if a patient does not respond to any sort of external stimuli, whether visual, auditory, tactile, or noxious. This can occur after severe brain injury, if a patient wakes up from the fully comatose state but is not actually conscious, a state known as “wakefulness without awareness.”

Okay. So we have a person sitting over here, and they are not responding to anything we do to try to evoke a reaction from them. What do we next?

            Ethically, this is a very complex question. Some people eventually regain their awareness, and recover from this state. Others stay that way forever, in which case it would hardly seem worthwhile to keep them alive. But the question is, how can you know?

            People who are able to react on some levels, perhaps following a command, but not able to fully interact, are described as being in a “minimally conscious state.” This is the key state in clinical assessment. If someone is fully vegetative, they no longer possess the facilities to be able to respond to any stimuli, to be aware. However, if they are minimally conscious, they have the capacity to respond.

            It seems like it should be simple to distinguish between these to states. Poke them with a stick; if they respond, they are conscious. Obviously, there’s more to it than that. It’s difficult to tell if a response is voluntary, even on a subconscious level, or is merely a reflex – a kneejerk reaction. In the past, medical officials have had to rely completely on motor responses, as in a physical action. It’s very possible that a physical response is not actually a sign of awareness, and is merely a reflex, and on the other hand it is very possible that the patient has some bare minimum awareness, but is not able to physically move. Basically, it seems like it is impossible to know – we need some way to actually communicate with these unconscious patients, and, of course, they are not conscious for us to do so.

            With technology continually developing, though, we may not need to. A study a few years ago monitored brain activity of a series of presumed vegetative patients as they were asked to imagine two situations – playing tennis (a motor imagery task) and walking around their house (a spatial imagery task). Theoretically, imagining these two different tasks would activate different parts of the brain, visible in an MRI scan. A small number of the patients did seem to be actually able to imagine these tasks when told, i.e. their brain activity changed when they were told to do a certain thing. This implied that they had some level of awareness – they were at the above-mentioned minimally conscious state, rather than being vegetative.

            Okay. So we’ve figured out whether this person is actually conscious at all. Why do we care? What can we do with that?

            It turns out that this simple information is enough to actually communicate with the unconscious patients. For the next part of the study, the patients who seemed to be able to respond were asked a series of yes and no questions. They were told to answer, substituting the tennis or house imagery for “yes” and “no.” They were able to correctly answer several questions about their personal lives, which had been previously confirmed. This method of communication was considered, with further development, able to allow patients in this state to express their thoughts and opinions and generally improve their quality of life.

            An example of the application of this occurred quite recently. A Canadian patient, Scott Routley had been vegetative and incommunicative since getting into a car crash twelve years ago. Undergoing interrogation in this method, Routley was able to communicate to the doctors that he was not in any pain. It seems like such a simple thing, but the ability to communicate with minimally conscious patients could open many doors in improving their quality of life.

Original report of the study here: http://www.nejm.org/doi/full/10.1056/NEJMoa0905370

- Megan Berry

The Big Bang

First there was nothing.  Scientists believe that was the case approximately 14 billion years ago.  Then, there was “something” very, very small, very, very hot, and very, very dense. Inside this “something” was equal parts matter and antimatter.  This “something” then inflated and expanded and then cooled.   This was the Big Bang.  One second later antimatter had virtually disappeared.  Matter remained and formed our current Universe. 

Scientists are not sure why the “something” appeared or where it came from.  However, conditions and energies that existed after the Big Bang are being recreated underground in a tunnel under the Swiss/French border near Geneva.  The tunnel, which is 27km (16.5 miles) long and 100 meters (109 yards) underground, contains a collider called the Large Hadron Collider. 

The Large Hadron Collider (LHC) is the world’s most powerful particle accelerator.  Inside the collider, two beams of atomic particles (protons or lead nuclei) are accelerated in opposite directions at high speeds head on into each other.  When the particles reach their highest speed, the LHC allows them to collide.  The collision produces other particles. Detectors inside the collider are able to track the collisions and record what is created and how the new particles behave. Computers then process the data.  The more energy that is produced from the collisions, the more similar the collider simulates what occurred after the Big Bang.

The LHC will help scientists understand how and why the universe developed the way that it did.  It may answer the question, what happened to the antimatter.  Aside from testing theories, the project will also have other benefits particularly in the fields of medicine and technology.  Take a look at the LHC.  It’s pretty cool.  http://www.boston.com/bigpicture/2009/11/large_hadron_collider_ready_to.html
- Celine Delaunay

Über Notes

I know that there are countless guides up on how to manage time and things like that, but I hope that this specific description of a technique for organization will help others in my Commonwealth community.

           
 My innovation was the implementation of highly distilled “Über Notes.” These notes make it easy to see the main ideas of class discussions and reading assignments. I have two kinds of Über Notes, one is something akin to a study guide and one is a simple cheat sheet. (I’ve found that my Science classes are the ones that benefited the most from both types of notes, but that they are applicable to any subject.)

My study guide Über Notes tend to just be main ideas pulled from other notes. I know for me, when I’m taking notes in class or as I read textbooks I tend to write everything the same size and the same way, which makes it hard to see the main ideas of a source of information. Über Notes let me emphasize bigger points and carefully sub-label details that I need. On top of that, I can omit small things that aren’t important; this allows me to consolidate my notes onto one sheet. The main difference between Über Notes and a regular study guide is that I make study guides only at the end of a unit, when a test is near. Über Notes work best if they are constructed the whole way through a unit. The upside of this is that you can add to them everyday when things are still fresh in your mind, but it does require a fair bit of effort to carve out that time-slice to get it done every day. On something of a formatting note, I like to keep the heading of notes “Über Notes” because there really should only be one set of Über Notes per class. Don’t make a different one for each unit (You can make different pages if you like, but make sure to either paperclip them together or have a special place in your binder where all of your Über Notes go) and defiantly make sure that your Über Notes don’t become anywhere as plentiful as your “normal” notes.

For me, I prefer the “cheat sheet” Über Notes. If you are taking or teaching a class which requires a lot of little bits of information that are crucially important (Chemistry equations, theorems, kingdoms of organisms, important people, countries, vocabulary words, etc.) then making a simple list is very helpful. For me, as I take Chemistry, it makes it easy to see everything I need to know. I have one side where I put all of the equations that I need to know to find energy or other things about atoms. On the other side, I put a key of all of the symbols, what they mean and, for some of them, their values. The difference between these sheets and regular ones is that on Über Notes it is imperative that I put minimal to no explanation of what the equations meant, so that when you review them, you will be testing yourself to identify which one would help with a specific problem. Also, I can use these notes as a quiz, to see if I can identity what each equation does and when I would use it. This allows Über Notes to play both the role of a reference sheet and a study guide.

Though Über Notes are powerful tools, they cannot replace regular notes outright. Notes taken in class are pieces of information that need to be captured rapidly; Über Notes require planning of the structure of both the content and page layout, neither of which should be taken lightly. Naturally this takes too much time to do in class, and must be done at home after school. While it is helpful to start to move your regular notes towards Über Notes, the two should ultimately be different.  The nice thing about this structure is that the Über Note itself is just a concept and framework of what you end up putting down on paper. Each one should be unique in both layout and porous to a certain extent, but if they get too specialized, it kind of takes the point out of having standardized fact sheets. The specifics of Über Notes are up to you, so you don’t have to do annoying work that you don’t like. As a guide, I’ve posted a picture of what some of my Über Notes look like. I suggest you draw yourself a template for your own before comparing with others, so that they won’t influence you too heavily.  

- Gabriel Seltzer