Awareness

Contemporary models of perceptual awareness lack tractable neurobiological constraints. Inspired by recent cellular recordings in a mouse model of tactile threshold detection, we constructed a biophysical model of perceptual awareness that incorporated essential features of thalamocortical anatomy and cellular physiology. Our model reproduced, and mechanistically explains, the key in vivo neural and behavioural signatures of perceptual awareness in the mouse model, as well as the response to a set of causal perturbations. We generalised the same model (with identical parameters) to a more complex task - visual rivalry - and found that the same thalamic-mediated mechanism of perceptual awareness determined perceptual dominance. This led to the generation of a set of novel, and directly testable, electrophysiological predictions. Analyses of the model based on dynamical systems theory show that perceptual awareness in simulations of both threshold detection and visual rivalry arises from the emergent systems-level dynamics of thalamocortical loops.

AimTo examine the relationships among nursing professionalism, empathy, and clinical decision-making ability and the factors influencing shared decision-making awareness in hemodialysis nurses.BackgroundSelf-management and treatment for hemodialysis patients are essential for maintaining health and life in daily life. In this process, shared decision-making in which patients, nurses, and medical teams participate and make decisions together has a greater impact on the health recovery and improvement of quality of life for hemodialysis patients than for any other chronic disease patients.MethodsA cross-sectional descriptive design was employed. Participants were 145 nurses working in the hemodialysis centers at hospitals in Seoul and Gyeonggi-do. Measures included the general characteristics of study participants, nursing professionalism, empathy, clinical decision-making ability, and shared decision-making awareness. Data were collected from May to July, 2022, and multiple linear regression analysis was used to examine the predictive factors of shared decision-making awareness.ResultsThe strongest predictor was empathy, followed by clinical decision-making ability and the level of education. The explanatory power of the final regression model was 23%.ConclusionsEmpathy towards hemodialysis patients was an important factor influencing the shared decision-making awareness in hemodialysis nurses. Implications for Nursing Management. In nursing management, nursing managers or nurses should pay attention to influencing factors to improve the shared decision-making awareness of hemodialysis nurses. Empathy towards hemodialysis patients need to be reinforced to improve the shared decision-making awareness of hemodialysis nurses.

The relation between attention, perception, and awareness is among the most fundamental problems in the science of the mind. One of the most striking and well-known phenomena bearing on this question is inattentional blindness (IB). In IB, naive observers fail to report clearly visible stimuli when their attention is otherwise engaged-famously missing a gorilla parading before their eyes. IB carries tremendous significance, both as evidence that awareness requires attention and as a tool in seeking the neural correlates of consciousness. However, such implications rest on a notoriously biased measure: asking participants whether they noticed anything unusual (and interpreting negative answers as reflecting a complete lack of perception). Here, in the largest ever set of IB studies, we show that, as a group, inattentionally blind participants can successfully report the location, color, and shape of stimuli they deny noticing, demonstrating that perceptual information remains accessible in IB. By introducing absent trials, we further show that observers are collectively biased to report not noticing in IB-essentially 'playing it safe' in reporting their sensitivity. These data provide the strongest evidence to date of significant residual visual sensitivity in IB. They also challenge the use of inattentional blindness to argue that awareness requires attention.

BackgroundSurvivors of critical illness often experience new or worsening impairments in various domains of health after discharge, collectively referred to as post-intensive care syndrome (PICS). Although this condition is common, it remains unclear whether providers are communicating routinely about survivorship and PICS to patients and families and whether patients are remembering these conversations.Research questionHow often do ICU providers discuss the concept of PICS with at-risk patients or families, and how often do patients remember being told about the concept of PICS?Study design and methodsWe distributed online surveys to ICU health care providers at 9 US institutions and to patients who survived critical illness in the preceding year at a single site.ResultsWe collected a convenience sample of 382 provider responses and 148 patient responses. The providers were registered nurses (53.7%), physician fellows or attending physicians (33%), and advanced practice providers (13.4%). Patients predominantly had been admitted to surgical (41.1%), cardiovascular (41.1%), and medical (14.4%) ICUs. We found that 73.8% of providers reported having previously heard the term post-intensive care syndrome. In comparison, only 16.6% of patients remembered ever being told the term. When asked how often they would discuss with patients or families the possibility of any new or worsening impairments after critical illness, less than one-third of providers (29.9%) said they do so at least one-half of the time. Only about one-third of patients (35.6%) remembered such conversations.InterpretationOur results show that awareness of PICS is inconsistent among providers and low among patients. Few ICU team members reported routinely talking to patients or families about the common, disabling impairments that often occur after critical illness. Few patients remembered being told about the possibility of PICS. Further investigation is needed to determine how best to improve this communication gap.