Different anesthetics are known to modulate different types of membrane-bound receptors. Their common mechanism of action is expected to alter the mechanism for consciousness. Consciousness is hypothesized as the integral of all the units of internal sensations induced by reactivation of inter-postsynaptic membrane functional LINKs during mechanisms that lead to oscillating potentials. The thermodynamics of the spontaneous lateral curvature of lipid membranes induced by lipophilic anesthetics can lead to the formation of non-specific inter-postsynaptic membrane functional LINKs by different (...) mechanisms. These include direct membrane contact by excluding the inter-membrane hydrophilic region and readily reversible partial membrane hemifusion. The constant reorganization of the lipid membranes at the lateral edges of the postsynaptic terminals (dendritic spines) resulting from AMPA receptor-subunit vesicle exocytosis and endocytosis can favor the effect of anesthetic molecules on lipid membranes at this location. Induction of a large number of non-specific LINKs can alter the conformation of the integral of the units of internal sensations that maintain consciousness. Anesthetic requirement is reduced in the presence of dopamine that causes enlargement of dendritic spines. Externally applied pressure can transduce from the middle ear through the perilymph, cerebrospinal fluid, and the recently discovered glymphatic pathway to the extracellular matrix space, and finally to the paravenular space. The pressure gradient reduce solubility and displace anesthetic molecules from the membranes into the paravenular space, explaining the pressure reversal of anesthesia. Changes in membrane composition and the conversion of membrane hemifusion to fusion due to defects in the checkpoint mechanisms can lead to cytoplasmic content mixing between neurons and cause neurodegenerative changes. The common mechanism of anesthetics presented here can operate along with the known specific actions of different anesthetics. (shrink)

This paper discusses the ways in which anesthetic agents can be used to investigate the role of awareness in learning and memory. It reviews research into learning during light, subclinical anesthesia, termedhypesthesia.This research suggests that the effects of anesthetics on implicit and explicit memory are roughly comparable, although implicit memory for simple stimuli may resist the effects of very low doses of anesthetic. In addition, this paper reports experimental data demonstrating that long-term retention of information is prevented by doses (...) of anesthetic that are low enough to permit awareness and even short-term memory of auditory stimuli. Overall, these findings are consistent with the hypothesis that frontal lobe function is particularly sensitive to anesthetics. They raise theoretical and practical questions about the necessity of consciousness for learning and about interpretation of the evidence for learning during surgery under general anesthesia. (shrink)

It is argued here that the practice of medical students performing pelvic exams on women who are under anesthetic and have not consented is immoral and indefensible. This argument begins by laying out the ethical justification for the practice of informed consent, which can be found in autonomy and basic rights. Foregoing the process of consent within medicine can result in violations of both autonomy and basic rights, as well as trust, forming the basis of the wrong of unauthorized pelvic (...) examinations. Several objections to this argument are considered, all of which stem from the idea that this practice constitutes an exception to the general requirement of informed consent. These objections suggest that nonconsensual pelvic examinations on women under anesthetic are ethically acceptable on utilitarian grounds, in that they offer benefits either to the patient or to society, or on the grounds of triviality, in that consent is already presumed, or the practice is insignificant. Each of these objections is rejected and the practice is deemed indefensible. (shrink)

Several general anesthetics produce their sedative effect by activating endogenous sleep pathways. We propose that general anesthesia is a two‐step process targeting sleep circuits at low doses, and synaptic release mechanisms across the entire brain at the higher doses required for surgery. Our hypothesis synthesizes data from a variety of model systems, some which require sleep (e.g. rodents and adult flies) and others that probably do not sleep (e.g. adult nematodes and cultured cell lines). Non‐sleeping systems can (...) be made insensitive (or hypersensitive) to some anesthetics by modifying a single pre‐synaptic protein, syntaxin1A. This suggests that the synaptic release machinery, centered on the highly conserved SNARE complex, is an important target of general anesthetics in all animals. A careful consideration of SNARE architecture uncovers a potential mechanism for general anesthesia, which may be the primary target in animals that do not sleep, but a secondary target in animals that sleep. (shrink)

Continuous recordings of brain electrical activity were obtained from a group of 176 patients throughout surgical procedures using general anesthesia. Artifact-free data from the 19 electrodes of the International 10/20 System were subjected to quantitative analysis of the electroencephalogram (QEEG). Induction was variously accomplished with etomidate, propofol or thiopental. Anesthesia was maintained throughout the procedures by isoflurane, desflurane or sevoflurane (N = 68), total intravenous anesthesia using propofol (N = 49), or nitrous oxide plus narcotics (N = 59). A (...) set of QEEG measures were found which reversibly displayed high heterogeneity of variance between four states as follows: (1) during induction; (2) just after loss of consciousness (LOC); (3) just before return of consciousness (ROC); (4) just after ROC. Homogeneity of variance across all agents within states was found. Topographic statistical probability images were compared between states. At LOC, power increased in all frequency bands in the power spectrum with the exception of a decrease in gamma activity, and there was a marked anteriorization of power. Additionally, a significant change occurred in hemispheric relationships, with prefrontal and frontal regions of each hemisphere becoming more closely coupled, and anterior and posterior regions on each hemisphere, as well as homologous regions between the two hemispheres, uncoupling. All of these changes reversed upon ROC. Variable resolution electromagnetic tomography (VARETA) was performed to localize salient features of power anteriorization in three dimensions. A common set of neuroanatomical regions appeared to be the locus of the most probable generators of the observed EEG changes. (shrink)

Evidence coming from several studies into memory and awareness during general anesthesia suggests that in surgical patients who seem to be adequately anesthetized , some form of cognitive functioning is preserved. This finding has important implications both for clinical practice and for memory research. In order to give the methodological background of the present situation in this field of research, this article deals, on the basis of recent experiments, with important methodological aspects of studies into perception and memory during (...) general anesthesia. (shrink)

The cognitive unbinding paradigm suggests that the synthesis of neural information is attenuated by general anesthesia. Here, we analyzed the functional organization of brain activities in the conscious and anesthetized states, based on functional segregation and integration. Electroencephalography recordings were obtained from 14 subjects undergoing induction of general anesthesia with propofol. We quantified changes in mean information integration capacity in each band of the EEG. After induction with propofol, mean information integration capacity was reduced most prominently in the (...) γ band of the EEG . Furthermore, we demonstrate that loss of consciousness is reflected by the breakdown of the spatiotemporal organization of γ waves. We conclude that induction of general anesthesia with propofol reduces the capacity for information integration in the brain. These data directly support the information integration theory of consciousness and the cognitive unbinding paradigm of general anesthesia. (shrink)

A unifying theory of general anesthetic-induced unconsciousness must explain the common mechanism through which various anesthetic agents produce unconsciousness. Functional-brain-imaging data obtained from 11 volunteers during general anesthesia showed specific suppression of regional thalamic and midbrain reticular formation activity across two different commonly used volatile agents. These findings are discussed in relation to findings from sleep neurophysiology and the implications of this work for consciousness research. It is hypothesized that the essential common neurophysiologic mechanism underlying anesthetic-induced unconsciousness is, (...) as with sleep-induced unconsciousness, a hyperpolarization block of thalamocortical neurons. A model of anesthetic-induced unconsciousness is introduced to explain how the plethora of effects anesthetics have on cellular functioning ultimately all converge on a single neuroanatomic/neurophysiologic system, thus providing for a unitary physiologic theory of narcosis related to consciousness. (shrink)

Possible systemic effects of general anesthetic agents on neural information processing are discussed in the context of the thalamocortical suppression hypothesis presented by Drs. Alkire, Haier, and Fallon (this issue) in their PET study of the anesthetized state. Accounts of the neural requisites of consciousness fall into two broad categories. Neuronal-specificity theories postulate that activity in particular neural populations is sufficient for conscious awareness, while process-coherence theories postulate that particular organizations of neural activity are sufficient. Accounts of anesthetic narcosis, (...) on the other hand, explain losses of consciousness in terms of neural signal-suppressions, transmission blocks, and the disruptions of signal interpretation. While signal-suppression may account for the actions of some anesthetic agents, the existence of anesthetics, such as choralose, that cause both loss of consciousness and elevated discharge rates, is problematic for a general theory of narcosis that is based purely on signal suppression and transmission-block. However, anesthetic agents also alter relative firing rates and temporal discharge patterns that may disrupt the coherence of neural signals and the functioning of the neural networks that interpret them. It is difficult at present, solely on the basis of regional brain metabolic rates, to test process-coherence hypotheses regarding organizational requisites for conscious awareness. While these pioneering PET studies have great merit as panoramic windows of mind-brain correlates, wider ranges of theory and empirical evidence need to be brought into the formulation of truly comprehensive theories of consciousness and anesthesia. (shrink)

Le général André Bach dans une réflexion sur l’« horizon de mort dans la violence de guerre » part d’une approche anthropologique du phénomène de violence et de la peur (quasiment biologique) qu’il engendre en soulignant les difficultés des sociétés occidentales à penser la mort. C’est l’État qui donne à la guerre un sens politique et sacré et qui crée les catégories fonctionnelles de la guerre (les concepts de paix et de guerre ne sont pas en eux-mêmes opérationnels). Dans le (...) cadre d’une réflexion clausewitzienne sur la montée aux extrêmes, l’« extrême » pour le soldat est toujours sa propre mort (plus que celle de l’ennemi). Les notions de barbarisation et humanisation ne peuvent en ce sens rendre compte de la violence et de la peur radicales présentes dans toute guerre où le rôle du commandement est toujours de mettre en œuvre un degré de violence supérieur à celui de l’adversaire, sans aucune considération de « proportionnalité » de cette violence. La mise à distance technique ne diminue pas la violence mais l’augmente à proportion de l’éloignement de la peur. Seul le politique peut et doit mettre des limites à cette violence militaire par nature illimitée. La modernisation des armes ne relève jamais d’une humanisation du combat mais d’une recherche d’une violence plus efficace. L’entraînement du soldat en temps de paix n’est jamais entraînement à la violence mais apprentissage de savoir-faire et effort de constitution d’un groupe soudé, doté d’un bon moral. L’ordre et la formation tentent de limiter la sauvagerie mais il existe une constitution endogène de comportements propres au soldat, que la hiérarchie tente de canaliser dans une symbolique guerrière fondée sur le sentiment de l’honneur (destiné à compenser la peur d’être une proie vouée à mourir et à faire préférer la lutte au coude à coude sur l’instinct de conservation). Le couple violence/honneur fait que l’armée dépourvue de contrat social n’est pas soluble dans le politique (aujourd’hui dans les écoles militaires on ne parle plus d’« honneur » mais d’« éthique »…, mais pour dire la même chose). La conscription fut une rupture de la logique endogène de l’armée et introduisit une brèche dans ce système archaïque. Mais religion (au Moyen Âge) ou logique démocratique (de nos jours) s’avèrent surtout des « béquilles idéologiques » qui, en définitive, sont souvent plus efficaces pour accroître la barbarisation que pour l’éviter (exemple de la colonisation algérienne où une armée de paix, fonctionnarisée et rigoureusement canalisée, appartenant à une génération n’ayant jamais connu de violence de guerre, développe des massacres de masse). (shrink)

Écriture sans écriture, critique sans discours : il s’agit de traquer et de faire ressortir l’obsession du « projet » et de son idéologie dans la trame d’un appel à contrats doctoraux. Ctrl+B chaque fois (et elles sont très nombreuses) où le petit mot est réitéré.

Source: Author: Leonila C. Crisostomo, Ma. Teresa G. Generales, Amelita L. de Guzman The primary purpose of this study is to ascertain the benefits of the National Service Training Program implementation and to identify the problems encountered by its implementers. Results showed that the benefits derived from the program were topped by enhancement of skills on basic leadership with emphases on the ability to listen and ability to communicate which were rated very important and very much benefited among other training (...) aspects of the program. Results also revealed that students are aware of the importance of physical, mental and social health as well as the observance of proper hygiene for overall sense of well-being. Although recreation is one aspect that the respondents find important, appreciation of it underscores the need to have more time for assignments and projects as most of the respondents are enrolled in their respective courses with 29 units, making them unable to appreciate the perks of involving themselves into various recreational activities. Problems in the implementation showed lack of provision of materials and equipment and of budgetary allocation which rendered full implementation weak as students and faculty involved in the community immersion have to rely on their own resources, in addition to the indifference and passivity of the local government officials. Based on the findings, the researchers recommended that: the school administrators need to allocate adequate budget for materials and equipment; periodic faculty development trainings and; to look into the passive attitude of the local officials to ensure that implementation NSTP projects will benefit both clients and implementers. ]]>. (shrink)

At the beginning of the pandemic, many music ensembles had to stop their activities due to the confinement. While some found creative ways to start making music again with the help of technologies, the transition from “real” rehearsals to “online” rehearsals was challenging, especially among older amateur musicians. The aim of this case study was to examine the effects of this transition on three community band conductors and three older amateur musicians. Specific objectives were to explore intergenerational relationships to support (...) online group music-making; digital literacy and access in later life; and online music-making in a COVID-19 context. Semi-structured interviews were conducted and theoretical thematic analysis was undertaken. Results were analyzed from the conductors’ and older musicians’ perspectives, and common trends were combined to facilitate interpretation. The first theme showed that being part of an intergenerational ensemble contributed positively to the learning experience online. The second theme demonstrated that because both conductors and musicians were new to the online rehearsals, it contributed to attenuate the age-related digital divide that may have been observed in other studies. Regarding access in later-life, older musicians reported benefits associated with rehearsing online, specifically in terms of distance/commute, time, energy, and cost. However, for those who did not already have internet and electronic devices, the cost of acquiring all the necessary equipment to make music online could have been too high. Finally, the third theme revealed that musicians appreciated the opportunity to make music online and indicated that it was definitely better than having nothing, especially for its social aspects. In conclusion, while participants noted several challenges associated with online music-making, they were also appreciative of the opportunity to continue making music at a time when in-person rehearsals were not possible. Pedagogical implications are discussed, specifically the importance of the support network, of meeting people where they are, of learning to adapt, and of collaborative teaching. (shrink)

(2010). Remaining True to Our Values – Reflections on Military Ethics in Trying Times. Journal of Military Ethics: Vol. 9, No. 3, pp. 183-194. doi: 10.1080/15027570.2010.510850.

February 1, 2000 TABLE OF CONTENTS TABLE OF AUTHORITIES......................................................................................... .......................ii STATEMENT OF INTEREST............................................................................................ ................. v..