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Saturday, February 6, 2010

Feb. 4 - Patients in 'vegetative' state can think and communicate‏

Dear Friends,

http://www.telegraph.co.uk/health/healthnews/7150119/Patients-in-vegetative-state-can-think-and-communicate.html

Be Well.

David

Patients in 'vegetative' state can think and communicate

Patients left in a “vegetative” state after suffering devastating brain damage are able to understand and communicate, groundbreaking research suggests.

By Richard Alleyne and Martin Beckford
Published: 10:00PM GMT 03 Feb 2010


'Vegetative state' brain scan images:: the fMRI images which were used as part of the study by Dr Adrian Owen
'Vegetative state' brain scan images:: the fMRI images which were used as part of the study by Dr Adrian Owen

Experts using brain scans have discovered for the first time that the victims, who show no outward signs of awareness, can not only comprehend what people are saying to them but also answer simple questions.

They were able to give yes or no responses to simple biographical questions.

The unlocking of this “inner voice” has astounded doctors and has dramatic implications for thousands of life and death decisions over patients trapped in what is known as a persistent vegetative state (PVS).

It means around one in five PVS patients may be able to communicate.

It will raise questions about when doctors should switch off life support machines. It is likely to add to the debate on assisted suicide as the patient could potentially decide and communicate if they wish to carry on living. It comes just weeks after Kay Gilderdale was acquitted of assisting the suicide of her daughter Lynn who the jury accepted had lived a “twilight life” for more than 17 years.

Up to a thousand PVS patients in Britain are kept alive by doctors in the hope they may one day regain consciousness.

But in some cases, like Hillsborough victim Tony Bland, relatives have won the right to withdraw treatment to allow them to die.

Dr Adrian Owen, co-author at the Brain Sciences Unit in Cambridge who carried out the latest research on one patient, said the findings have enormous philosophical and ethical implications.

He said: “We were astonished when we saw the results of the patient’s scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts.

“Not only did these scans tell us that the patient was not in a vegetative state but, more importantly, for the first time in five years it provided the patient with a way of communicating his thoughts to the outside world.

“We can be pretty confident that he is entirely conscious. He has to understand the instructions, comprehend speech, and then make a decision.”

He added: “Obviously this fits into the issue of when patients should be allowed to die.”

While pointing out that it could help doctors discover if a patient is in pain, he admitted it was quite a leap to say 'let this patient decide whether he lives or dies’.”

The British and Belgian researchers made their discovery, published in the New England Journal of Medicine, after studying a 29-year-old man brain damaged in a car crash in 2003.

The man was in a coma for two years before slipping into a persistent vegetative state. He was seemingly awake, occasionally blinked, but showed no other sign of being aware of the outside world.

But the team, led by Dr Owen, whose work was funded by the Medical Research Council, and Steven Laureys of the University of Liege, discovered it was possible to talk to him by tapping into his brain activity.

They used a hi-tech functional magnetic resonance scanner (fMRI) to measure brain response while the patient was asked questions.

The scan uses magnetic fields and radio waves to detect electrical pulses.

Because the actual brain signals associated with “yes” and “no” are complicated and too similar to distinguish, they came up with a code they could understand.

The team asked the patient to think of playing tennis for “yes” and moving around their home for “no”.

While the movement in tennis sparks 'spacial’ areas at the top of the brain, the “navigational task” of moving around your home sparks the 'motion’ areas at the base of the brain.

The patient was then asked six simple biographical questions including what was the name of his father and whether he had any sisters. In each case, his thoughts were picked up by the scans within five minutes. In each case he was 100 per cent accurate.

The team then tested 22 PVS patients for similar brain activity and, while they did not ask them the questions, believe 17 per cent will be able to communicate with doctors.

It comes just two months after Rom Houben, a Belgian man, presumed to be in PVS for 23 years after a car crash “woke up” and told how he was conscious throughout his ordeal.

Researchers using new diagnostic techniques discovered that his brain was still active and trained him to use his right forefinger to express himself on an adapted keyboard.

Jacob Appel, an expert in medical ethics at the Mount Sinai Hospital in New York, said that doctors should help end the lives of people trapped in their bodies, if they think that is what they want.

“This will indeed be a clear-cut case where a patient can express a desire to end his or her life, but has no physical means of doing so. I see no reason why, if we are truly convinced such patients are communicating, society should not honour their wishes. In fact, as a physician, I think a compelling case can be made that doctors have an ethical obligation to assist such patients by removing treatment. I suspect that, if such individuals are indeed trapped in their bodies, they may be living in great torment and will request to have their care terminated or even active euthanasia.”

But sources at the British Medical Association, the doctors’ union, said it is unlikely that many medics would consider the results of a brain scan experiment as sufficient evidence of mental capacity.

Professor Geraint Rees, Director of the Institute of Cognitive Neuroscience at University College London, said: “As a clinician, it would be important to satisfy oneself that the individual that you are communicating with is competent to make those decisions.

“At the moment it is premature to conclude that the individual able to answer 5 out of 6 yes/no questions is fully conscious like you or I.”

Dr Peter Saunders, Director of the Care Not Killing Alliance which opposes euthanasia, claimed the breakthrough would be unlikely to alter contentious guidelines on assisted suicide, as patients in vegetative states are not likely to be considered to have sufficient mental capacity to make life-or-death decisions.

It comes a day after the Roman Catholic Church in England and Wales published guidance on the spiritual care of the dying, which said that food or nutrition should never be removed in order to shorten a person’s life.

Its document quotes the late Pope, John Paul II, who said it is “morally obligatory” to provide nutrition and hydration to patients in a vegetative state.

It is doubtful that the so-called “mercy killing” of Mr Bland in 1993 could have been affected by the new breakthrough as he was thought to be in an extreme form of the “persistent vegetative state”.

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How to Digitally Record/Video a UFO sighting:


Como registar digitalmente ou gravar um vídeo de um avistamento de um UFO:




Stabilize the camera on a tripod. If there is no tripod, then set it on top of a stable, flat surface. If that is not possible lean against a wall to stabilize your body and prevent the camera from filming in a shaky, unsteady manner.

Estabilize a camera com um tripé. Se não tiver um tripé, então coloque-a em cima de uma superfície estável. Se não for possível, então encoste-se a uma parede para estabilizar o corpo e evitar que a camera registe de maneira tremida e instável.

Provide visual reference points for comparison. This includes the horizon, treetops, lampposts, houses, and geographical landmarks (i.e., Horsetooth Reservoir, Mt. Adams, etc.) Provide this in the video whenever is appropriate and doesn’t detract from what your focus is, the UFO.

Forneça pontos visuais de referência para comparação. Isso inclui o horizonte, cimo das árvores, postes de iluminação, pontos de referência geográficos (como o Reservatório de Horsetooth, Mone Adams, etc) Forneça esses pontos no vídeo sempre que for apropriado e não se distraia do que é o seu foco, o UFO/a Nave.

Narrate your videotape. Provide details of the date, time, location, and direction (N,S,E,W) you are looking in. Provide your observations on the weather, including approximate temperature, windspeed, any visible cloud cover or noticeable weather anomalies or events. Narrate on the shape, size, color, movements, approximate altitude of the UFO, etc and what it appears to be doing. Also include any unusual physical, psychological or emotional sensations you might have. Narrate any visual reference points on camera so they correlate with what the viewer will see, and thereby will be better able to understand.

Faça a narração do vídeo. Forneça pormenores sobre a data, hora, local e direcção (Norte, Sul, Este, Oeste) que está a observar. Faça observações sobre as condições atmosféricas, incluindo a temperatura aproximada, velocidade do vento, quantidade de nuvens, anomalias ou acontecimentos meteorológicos evidentes. Descreva a forma, o tamanho, a cor, os movimentos, a altitude aproximada onde se encontra o UFO/nave, etc e o que aparenta estar a fazer. Inclua também quaisquer aspectos pouco habituais de sensações físicas, psicológicas ou emocionais que possa ter. Faça a narração de todos os pontos de referência visual que o espectador irá ver e que, deste modo, será capaz de compreender melhor.

Be persistent and consistent. Return to the scene to videotape and record at this same location. If you have been successful once, the UFO sightings may be occurring in this region regularly, perhaps for specific reasons unknown, and you may be successful again. You may also wish to return to the same location at a different time of day (daylight hours) for better orientation and reference. Film just a minute or two under “normal” circumstances for comparison. Write down what you remember immediately after. As soon as you are done recording the experience/event, immediately write down your impressions, memories, thoughts, emotions, etc. so it is on the record in writing. If there were other witnesses, have them independently record their own impressions, thoughts, etc. Include in this exercise any drawings, sketches, or diagrams. Make sure you date and sign your documentation.

Seja persistente e não contraditório. Volte ao local da cena e registe o mesmo local. Se foi bem sucedido uma vez, pode ser que nessa região ocorram avistamentos de UFOs/naves com regularidade, talvez por razões específicas desconhecidas, e talvez possa ser novamente bem sucedido. Pode também desejar voltar ao mesmo lugar a horas diferentes do dia (durante as horas de luz)para ter uma orientação e referência melhor. Filme apenas um ,inuto ou dois em circunstâncias “normais” para ter um termo de comparação. Escreva tudo o que viu imediatamente após o acontecimento. Logo após ter feito o registo da experiência/acontecimento, escreva imediatamente as impressões, memórias, pensamentos, emoções, etc para que fiquem registadas por escrito. Se houver outras testemunhas, peça-lhes para registar independentemente as suas próprias impressões, pensamentos, etc. Inclua quaisquer desenhos, esbolos, diagramas. Certifique-se que data e assina o seu documento/testemunho.

Always be prepared. Have a digital camera or better yet a video camera with you, charged and ready to go, at all times. Make sure you know how to use your camera (and your cell phone video/photo camera) quickly and properly. These events can occur suddenly, unexpectedly, and often quite randomly, so you will need to be prepared.

Esteja sempre preparado, Tenha sempre uma camera digital, melhor ainda, uma camera vídeo consigo, carregada e pronta a usar sempre que necessário. Certifique-se que sabe como lidar com a sua camera (ou com o seu celular/camera fotográfica) rápida e adequadamente. Esses acontecimentos podem acontecer súbita e inesperadamente e, por vezes, acidentalmente, por isso, necessita estar preparado.

Look up. Be prepared. Report. Share.

Olhe para cima, Esteja preparado, Relate, Partilhe.

MUFON.COM

ESOTERIC



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