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

The Poisoner’s Handbook

Did you know that radium gets absorbed into the human body by disguising itself as calcium? Did you know that carbon monoxide poisoning leaves its victims’ blood an unnaturally vivid scarlet? Did you know that strychnine poisoning makes the victim’s insides look like they got mauled by a bear?

                  Did you know someone wrote a book about all this?

                  It’s called The Poisoner’s Handbook, and the author is Deborah Blum.

                  If you’ve read this far, I assume you are fascinated by forensics. Excellent. This book is about the growth and development of forensic medicine during the 1920’s in New York City. The 20s are always depicted as a glamorous era – the jazz, the bootleg alcohol, the flappers and the gangsters – but this book delves into the criminal underside of it, graphically describing the poisons people drank when they were desperate for alcohol and how people would poison their own friends and relatives to get money ; poison in those days was relatively difficult to detect in a body.

                  However, when medical examiner Charles Norris took the office, he did his best to change this. He ran experiments with every new kind of poison until he could detect a minute amount from a couple of grams of flesh. He worked at all hours of the day and night to catch criminals.

                  Of course, the fact that poisons became easier to detect didn’t mean that people stopped poisoning others. It just meant that they came up with more creative methods. I can’t go into detail here because, well, this is the Internet and everyone is reading this, but suffice to say this book will make you incredibly paranoid about accepting gifts from others for a while.

                  I enjoyed this book because, although it is, in essence, a history of science book, it doesn’t read like one. Instead, in Deborah Blum’s hands, the historical figures take on personalities and stories of their own, and even the criminals are fully fleshed out and frighteningly real figures. This is one of those books you will stay up all night to finish, and a book that will stay on your mind for weeks after you’re done.

 Feyga Saksonov

http://www.bbc.co.uk/nature/life/Mosquito#p005fq51

What do you guys think?