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PubMed2001

Modified Glasgow Coma Scale to predict mortality in febrile unconscious children.

A prospective hospital based study was conducted in the Department of Pediatrics of the Kasturba Hospital, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha to predict the mortality in children admitted with fever and unconsciousness using the Modified Glasgow Coma Scale (MGCS) score. Forty eight children were admitted with fever and unconsciousness; cases of febrile convulsions, epilepsy and cerebral palsy were excluded. MGCS scores were assessed on admission and repeated at 12 hours, 24 hours, 48 hours and 72 hours after admission in each case. Diagnosis in each case was confirmed by history, examinations and investigations. All the cases were regularly followed up till death/discharge. The overall mortality was 29.1% (14/48) out of which 85% (12/14) died within the first 24 hours. Mortality was highest in the toddler age group and in patients with pyogenic meningitis. There was a significant association between death and MGCS scores on admission with a post test probability for discharge being only 10% with a score of less than 5 and 99% with a score of more than 10 respectively. MGCS scores on admission can be used to predict mortality in patients hospitalized with fever and unconsciousness. The scale is simple, easy, can be applied at bed side and does not need any investigations. Its application in developing countries with limited investigative and intensive care facilities can help the treating physician decide regarding referral and counseling the parents regarding the probable clinical outcome.

Analysis of Variance↗
PubMed2005

The effect of unconscious priming on temporal production.

We examined the effects of unconscious priming on temporal-interval production. In Experiment 1, participants were instructed to keep visual displays on a screen for 2500 ms intervals. Half of the displays were repeated across blocks throughout the entire experiment, and the others were newly generated from trial to trial. The displays consisted of patterns so complex that the participants could not intentionally memorize them. The results showed that significantly more time elapsed for old displays than for new displays before participants indicated that a 2500 ms interval had elapsed. Experiment 2 replicated this effect and excluded an alternative account based on perceived pattern complexity. The effect of repetitive presentation was obtained despite the fact the participants did not recognize the repetition, suggesting that unconscious priming increased temporal production. These results suggest that time perception is affected by an unconscious process.

Adult↗
PubMed2006

The scope and limits of top-down attention in unconscious visual processing.

Attentional selection plays a critical role in conscious perception. When attention is diverted, even salient stimuli fail to reach visual awareness. Attention can be voluntarily directed to a spatial location or a visual feature for facilitating the processing of information relevant to current goals. In everyday situations, attention and awareness are tightly coupled. This has led some to suggest that attention and awareness might be based on a common neural foundation, whereas others argue that they are mediated by distinct mechanisms. A body of evidence shows that visual stimuli can be processed at multiple stages of the visual-processing streams without evoking visual awareness. To illuminate the relationship between visual attention and conscious perception, we investigated whether top-down attention can target and modulate the neural representations of unconsciously processed visual stimuli. Our experiments show that spatial attention can target only consciously perceived stimuli, whereas feature-based attention can modulate the processing of invisible stimuli. The attentional modulation of unconscious signals implies that attention and awareness can be dissociated, challenging a simplistic view of the boundary between conscious and unconscious visual processing.

Adaptation, Physiological↗
PubMed2005

Cortical response to subjectively unconscious danger.

Cortical involvement in the evolution-favored automatic reaction to danger was studied. Electrical neural activity was recorded from 31 subjects, reporting fear of spiders, at 60 scalp locations. Visual stimuli containing spiders (negative elements) or, alternatively, nonnegative elements were presented to subjects, though they were unaware of their presence: a concurrent visual detection task using consciously perceived targets was administered. Spatial and temporal principal component analyses were employed to define and quantify, in a reliable manner, the main components of the neuroelectrical response to unconscious stimuli, and a source localization algorithm provided information on their neural origin. Results indicated that around 150 ms after stimulus onset, ventromedial prefrontal areas previously reported as responding rapidly to danger-related (conscious) stimuli were activated by unconsciously perceived spiders more markedly than by nonnegative unconscious stimuli. Subsequently, around 500 ms after stimulus onset, activation of the posterior cingulate and visual association cortices increased in this same direction. These data support previous results indicating that the ventromedial prefrontal cortex is involved in the top-down regulation of attention (through its capability to modulate the activity of posterior cortices in charge of visual processing) and that it automatically facilitates danger processing.

Adult↗
PubMed2004

The effects of standard and branched chain amino acid enriched solutions on thermogenesis and energy expenditure in unconscious intensive care patients.

BACKGROUND & AIMS: This study aims to compare the effects of standard and branched chain amino acid enriched solutions on thermogenesis and energy expenditure in unconscious and mechanically ventilated intensive care patients. DESIGNS: The study was carried out at multidisciplinary intensive care unit. Twenty unconscious and mechanically ventilated patients (18-65 years of age) were included in the study. Patients were hemodynamically stable and all received continuous enteral nutrition. Energy expenditure was calculated using the Harris-Benedict Equation for all of the patients. Patients were randomly assigned to receive a 4h infusion of 0.4 g/kg protein as amino acid solution. Group I (n = 10) received standard amino acid solution and group II (n = 10) received branched chain amino acid enriched solution. Energy expenditure, oxygen consumption and carbon dioxide production were measured by indirect calorimetric method every 30 min during the 4h infusion period and 3h thereafter. Rectal temperature was recorded concomitantly with the metabolic measurements throughout the study. RESULTS: There was a statistically significant increase in body temperature during the infusion of amino acid solution between 30 and 210 min in group I and between 30 and 120 min in group II (P <0.05). We observed a significant increase in energy expenditure at 30, 150, 180 and 210 min in group I and at 30-240 min in group II (P <0.05). There were no differences between the two groups in terms of thermogenesis or energy expenditure values during the study (P >0.05). CONCLUSION: Thermogenesis and energy expenditure values were increased during the parenteral infusion of both standard amino acid and branched chain amino acid enriched solutions in unconscious intensive care patients without any significance in between.

Adult↗
PubMed1999

Unconscious letter discrimination is enhanced by association with conscious color perception in visual form agnosia.

Adaptive behavior guided by unconscious visual cues occurs in patients with various kinds of brain damage as well as in normal observers, all of whom can process visual information of which they are fully unaware [1] [2] [3] [4] [5] [6] [7] [8]. Little is known on the possibility that unconscious vision is influenced by visual cues that have access to consciousness [9]. Here we report a 'blind' letter discrimination induced through a semantic interaction with conscious color processing in a patient who is agnosic for visual shapes, but has normal color vision and visual imagery. In seeing the initial letters of color names printed in different colors, it is normally easier to name the print color when it is congruent with the initial letter of the color name than when it is not [10]. The patient could discriminate the initial letters of the words 'red' and 'green' printed in the corresponding colors significantly above chance but without any conscious accompaniment, whereas he performed at chance with the reverse color-letter mapping as well as in standard tests of letter reading. We suggest that the consciously perceived colors activated a representation of the corresponding word names and their component letters, which in turn brought out a partially successful, unconscious processing of visual inputs corresponding to the activated letter representations.

Adult↗
PubMed1999

Considerations on the vicissitudes of unconscious guilt feelings from pre-adolescence to early adolescence.

The author describes re-edition of the rapprochement subphase (the early period of the second individuation process) occurring from pre-adolescence to early adolescence by means of case presentation. Factors that motivate youngsters to become aware of unconscious guilt in their inner world are discussed in the course of this study. In the pre-adolescent period youngsters begin to develop a conscious guilt more like that of an adult. Under the service of ego, a child modulates from a primitive externalized unconscious guilt conditioned by emotional exchanges with their parents to a more evolved state of self-awareness. Furthermore, it is possible that changes from externalization of unconscious guilt to guilt with which the ego is directly concerned, (that is, internalized guilt), will resolve the infantile relationship that young adolescents have had with their parents and play an important role in developing social independence.

Adolescent↗
PubMed1995

The unconscious impact of caring for acutely disturbed patients: a perspective for supervision.

This paper is concerned with the emotional experience of working with acutely disturbed patients. It examines how the disturbance of the patient unconsciously impacts upon the nurse. Using a model of the unconscious, based upon classical psychoanalytic theory, a psychodynamic approach to clinical supervision in a group setting is described. This supervision process was found to be helpful in the therapeutic process, identifying unconscious dynamics as well as alleviating some of the distress of the clinical work. Vignettes illustrating this process of psychodynamic group supervision are presented.

Attitude of Health Personnel↗
PubMed1987

The cognitive unconscious.

Contemporary research in cognitive psychology reveals the impact of nonconscious mental structures and processes on the individual's conscious experience, thought, and action. Research on perceptual-cognitive and motoric skills indicates that they are automatized through experience, and thus rendered unconscious. In addition, research on subliminal perception, implicit memory, and hypnosis indicates that events can affect mental functions even though they cannot be consciously perceived or remembered. These findings suggest a tripartite division of the cognitive unconscious into truly unconscious mental processes operating on knowledge structures that may themselves be preconscious or subconscious.

Cognition↗
PubMedDate not supplied

KT-1000 arthrometer: conscious and unconscious test results using 15, 20, and 30 pounds of force.

A recent published report indicated that the reliability and validity of anterior laxity measurements obtained by using the KT-1000 arthrometer were questionable. The purpose of our study was to examine the diagnostic validity of anterior laxity measurements testing patients in conscious and unconscious states using the KT-1000 arthrometer at 15, 20, and 30 pounds of force. The sample included 68 patients with confirmed anterior cruciate ligament disruption. They were given anterior-posterior drawer tests at 20 degrees in both unconscious and conscious states; measurements were recorded at 15, 20, and 30 pounds of force. The results indicated that the measurements in the unconscious state were significantly higher (P less than 0.01) than the values obtained in the conscious state. The anterior cruciate ligament-disrupted knees produced significantly higher (P less than 0.01) anterior laxity. The difference between anterior cruciate ligament-disrupted knees and normal knees grew significantly larger (P less than 0.01) as force increased. More patients demonstrated a difference greater than 2 mm between anterior cruciate ligament-disrupted knees and normal knees at 30 pounds (81% to 83%) than at 20 pounds (64% to 72%) of force. Seventy-nine percent of the patients demonstrated a compliance index difference greater than 1 mm using 15 and 30 pounds between the normal and anterior cruciate ligament-disrupted knee. These data provide statistical validity for the compliance index and support for the use of anterior laxity measurements at 30 pounds of force. However, approximately 20% of these patients did not demonstrate an anterior cruciate ligament-disrupted-normal knee difference greater than 2 mm or a compliance index difference of greater than 1 mm.

Anterior Cruciate Ligament↗
PubMed1999

Unconscious influences on a choice of a career: implications for organizational consultation.

The choice of a career is a highly significant and highly complex process that includes all the spheres of a person's life and continues throughout life. Psychodynamic theory makes a significant contribution to current models of career counseling and organizational consultation by adding the dimension of unconscious career choice. The unconscious determinants of vocational choice are internalized "objects" and "object relations" that reflect the individual's personal and familial history. People choose an occupation that enables them to replicate significant childhood experiences, fulfill needs that were unfulfilled in their childhood or actualize occupational dreams, professional patterns and expectations passed on to them by the familial heritage. The addition of the component of unconscious selection is critical to the full understanding of career choices and the prediction of success and satisfaction in that career. An example that demonstrates this point is presented.

Career Choice↗
PubMed2005

Clearing the cervical spine in unconscious head injured patients - the evidence.

Cervical spine injury occurs in 5-10% of patients with traumatic brain injury (TBI) and the consequences of missing significant cervical injuries in unconscious blunt trauma patients are potentially devastating. An adequate cervical spine clearance protocol for unconscious patients must avoid missed injuries, but must also avoid unnecessary cervical immobilisation and the associated morbidity. Existing protocols include various combinations of plain X-rays, helical CT, dynamic flexion-extension X-rays and MRI. Some clinicians also maintain immobilisation until clinical clearance is eventually enabled by the return of an adequate conscious state. Plain X-rays alone are inadequate and miss 12-16% of cervical injuries. Swimmer's views and/or oblique views identify more injuries, but are frequently inadequate. Helical CT is sensitive to fractures and subluxation/dislocation injuries but may be insufficient to exclude unstable ligamentous injuries. Dynamic flexion-extension fluoroscopy may better identify unstable ligamentous injuries, but at The Alfred Hospital Trauma Centre in Melbourne, this modality was insensitive in the routine protocol and repeatedly missed significant cervical instability. Furthermore at The Alfred Hospital, when routine dynamic flexion/ extension fluoroscopy and helical CT reconstructions were directly compared, flexion/extension identified no new injuries that had not already been diagnosed by early helical CT reconstructions. Cervical MRI is intuitively appealing as it detects ligament, disc interspace, and cord injury more efficiently than other imaging modalities, but MRI also increases cervical clearance times, increases the risks associated with complex transports and is not an ideal acute screening tool. Nevertheless, recently at The Alfred Hospital, extremely high-risk TBI patients have had unstable cervical injuries detected solely by MRI. Current generation multi-slice CT with reconstructions may obviate the need for MRI even in these patients. The current Alfred Hospital cervical clearance protocol for unconscious patients, and the evolutionary steps in its development, will be discussed.

Journal Article↗
PubMed1993

The neural time factor in conscious and unconscious events.

Our earlier evidence had indicated that a substantial duration of appropriate cerebral activity (up to about 0.5 s) is required for the production of a conscious sensory experience; this means the sensory world is experienced delayed with respect to real time. Subjective timing of the experience can be retroactively referred to the time of the earliest signal arriving at the cortex. Our 'time-on' theory states that the transition from an unconscious to a conscious mental function is determined, at least in part, by an increase in the duration of appropriate neural activities. Our experimental finding that conscious intention to act appears only after a delay of about 350 ms from the onset of specific cerebral activity that precedes a voluntary act provided indirect evidence for the theory. In a direct experimental test a signal (stimulus to somatosensory thalamus) was correctly detected in a forced-choice test even when the stimulus duration was too short to produce any awareness of the signal; to go from correct detection with no awareness to detection with awareness required an additional 400 ms of the repetitive identical neural volleys ascending to sensory cortex. 'Time-on' theory has important implications for a variety of unconscious-conscious interactions.

Brain↗
PubMed2005

Unconscious conflict in the light of contemporary psychoanalytic findings.

In considering unconscious conflict, the author looks at the influence of contemporary psychoanalytic findings on the formulation and treatment of various psychopathologies. Technical considerations related to furthering the understanding of unconscious conflict are addressed, with attention to the roles of drives and affects, and to the influence of deficit theories and other developments on current psychoanalytic thinking and practice. A brief clinical illustration is included.

Adult↗
PubMed2005

G. F. Parrot and the theory of unconscious inferences.

In 1839, Georg Friedrich Parrot (1767-1852) published a short note about a peculiar visual phenomenon--the diminishing of the size of external objects situated at a relatively small distance from the window of a fast-moving train. For the explanation of this illusion, Parrot proposed a concept of unconscious inferences, a very rapid syllogistic conclusion from two premises, which anticipated the revival of Alhazen's theory of unconscious inferences by Hermann von Helmholtz, Wilhelm Wundt, and John Stuart Mill. He also advanced the notion that the speed of mental processes is not infinitely high and that it can be measured by means of systematic experimentation. Although Parrot was only partly correct in the description of the movement-induced changes of the perceived size, his general intention to understand basic mechanisms of the human mind was in harmony with the founding ideas of experimental psychology: it is possible to study the phenomena of the mind in the same general way that the physical world is studied, either in terms of mechanical or mathematical laws.

History, 19th Century↗
PubMed2004

PET quantification of muscarinic cholinergic receptors with [N-11C-methyl]-benztropine and application to studies of propofol-induced unconsciousness in healthy human volunteers.

This work evaluated kinetic analysis methods for estimation of the receptor availability of the muscarinic receptor using dynamic positron emission tomography (PET) studies with [N-(11)C-methyl]-benztropine. The study also investigated the effect of propofol on central muscarinic receptor availability during general anesthesia. Six volunteers were scanned three times, once for baseline while awake, once during unconsciousness, and once after recovery to conscious level. An irreversible two-tissue compartment model was used to estimate the [N-(11)C-methyl]-benztropine specific binding rate constant k(3), a measure of muscarinic receptor availability. Two different estimation methods were used: 1) optimization with positivity constraints on all the parameters; 2) optimization with additional constraints determined from a one-tissue compartment fit to the cerebellum. In regions with low to middle muscarinic receptor density, the k(3) values from method (2) had lower standard errors than that for method (1) and gave a higher correlation with the density of muscarinic receptors measured in human tissue by in vitro studies (r(2) of 0.98 for Method 2 and r(2) of 0.72 for Method 1). But the k(3) values determined by Method 2 had higher errors for regions with high muscarinic receptor density compared to Method 1. For both methods the mean k(3) values during unconsciousness were generally lower than those during awake for most regions evaluated. Therefore, the method with additional constraints derived from the cerebellum (Method 2) was deemed superior for regions with low to middle muscarinic receptor density, while the method with positivity constraint is the better choice in the regions with high muscarinic receptor density. Our results also suggest the existence of propofol-related reductions in muscarinic receptor availability.

Adult↗
PubMedDate not supplied

Unconscious gender bias in fame judgments?

In two experiments the conditions of, and the processes leading to, gender biases in fame judgments were investigated. In Experiment 1, the gender bias was not reduced in a condition that alerted participants to the gender of the names. In Experiment 2, participants' sex-role orientation, but not their gender, was related to the gender bias. The process dissociation procedure was used in both experiments in an attempt to separate conscious and unconscious memory processes contributing to the gender bias. Using L.L. Jacoby's 1991) original measurement model there appeared to be evidence for unconscious influences on the gender bias in fame judgments. Unfortunately, this evidence disappeared when a model was used that takes guessing and, hence, response biases into account, which confirms that measurement models that ignore response biases in the process dissociation procedure may lead to erroneous conclusions.

Adult↗
PubMedDate not supplied

Modeling unconscious gender bias in fame judgments: finding the proper branch of the correct (multinomial) tree.

In the preceding article, Buchner and Wippich used a guessing-corrected, multinomial process-dissociation analysis to test whether a gender bias in fame judgements reported by Banaji and Greenwald (Journal of Personality and Social Psychology, 1995, 68, 181-198) was unconscious. In their two experiments, Buchner and Wippich found no evidence for unconscious mediation of this gender bias. Their conclusion can be questioned by noting that (a) the gender difference in familiarity of previously seen names that Buchner and Wippich modeled was different from the gender difference in criterion for fame judgements reported by Banaji and Greenwald, (b) the assumptions of Buchner and Wippich's multinomial model excluded processes that are plausibly involved in the fame judgement task, and (c) the constructs of Buchner and Wippich's model that corresponded most closely to Banaji and Greenwald's gender-bias interpretation were formulated so as to preclude the possibility of modeling that interpretation. Perhaps a more complex multinomial model can model the Banaji and Greenwald interpretation.

Female↗