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a1000shadesofhurt

a1000shadesofhurt

Monthly Archives: April 2014

Night terrors: In my wildest dreams

29 Tuesday Apr 2014

Posted by a1000shadesofhurt in Neuroscience/Neuropsychology/Neurology

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adults, Children, night terror, nightmares, panic, reassurance, scream, shout, sleep, stress, terror

Night terrors: In my wildest dreams

The walls are closing in on me. The air is sucked out of my lungs and everything turns black. One thought pulses through my mind – to get out of the room, no matter how. I push open my window and start climbing out. Only when the fresh air hits me do I realise something’s not right. I fall backwards and crawl back into bed, confused and disorientated by my surroundings.

This was the most dangerous night terror I suffered during my final year at university. I initially forgot what had happened, until I saw the chaos the next morning – my desk and chair were overturned, my books had been knocked off my bedside table and my laptop’s screen had smashed. The window was still wide open.

Deep bruises came up a day after, with the right-hand side of my body turning black and blue. My GP practically laughed me out of the surgery when I went in for a consultation. “There’s nothing I can do about it, it happens in your sleep,” he said, smiling. It was only once I had moved to London and suffered a similar attack that left me bleeding that I decided I’d had enough. After a three-month wait, I finally managed to get a space in one of the UK’s busiest sleep clinics for an overnight study.

The technicians wired me up at the clinic at London Bridge. There were 10 sensors attached to my head alone, with countless cables running down my body. Lying on the bed, monitored by two cameras, I knew that I wouldn’t be having a night terror that night. But I was hopeful that the results might shed some light on my condition.

When someone suffers from a night terror, they can scream, shout and thrash around in extreme panic, sometimes jumping out of bed. It’s an unnerving experience for anyone to watch – the sufferer’s eyes will be open, but they’re not fully awake or aware of what they’re doing. Once the panic subsides, the person will fall back asleep, oblivious to the chaos.

Most people experience nightmares or night terrors growing up. Figures show that between 20 and 30 per cent of children between the ages of five and 12 have frequent nightmares, while night terrors affect 17 per cent of children. Once children reach adulthood, incidence rates are much lower, with only one in 20 of that 17 per cent still reporting night terrors in later life. But recent research has linked recurring night-time problems to more ominous long-term consequences. A study conducted by the University of Warwick followed nearly 6,800 children up to the age of 12. The results suggest that long-term sufferers of nightmares and night terrors have a higher risk of mental health problems as they enter adolescence. Those having nightmares aged 12 were three-and-a-half times more likely to have problems and the risk was nearly doubled by regular night terrors.

Psychology professor Dieter Wolke led the research at Warwick. He says that while children often experience night-time problems, in adults, it’s only around 1 to 2 per cent who still have night terrors. When they persist into adulthood, the physical risks also increase. “Night terrors become more dangerous, as you’re larger and more mobile. People are known to have fallen off balconies or thrown themselves out of windows,” says Professor Wolke.

From a young age, I have been a restless sleeper, but the night terrors only started happening when I entered my teens. It wasn’t until university that they became more severe. The more extreme ones saw me running around the house or frantically trying to open my bedroom window.

So why do night terrors occur? According to Dr Nicholas Oscroft, a respiratory physician at Papworth Hospital, genetics and not getting enough sleep could be to blame. “It does seem to run in families… From previous research it has become clear that night terrors happen more often if people don’t get enough sleep on a regular basis. Work or family-related stress also increases the risk.”

Another sufferer is 24-year-old Kevin Stone. He started having night terrors from the age of seven. He believes it’s because of having lived in South Africa, where his family experienced regular break-ins. His night terrors follow a repeated theme – someone is always trying to chase or kill him. “I once dreamt that people had broken into the house and were in my room. They made me get out of bed and kneel on the floor while I tried to convince them not to kill me. When I have a night terror, I act out everything. I can hear their voices, I can see them, I can even feel the gun against my head.”

Stone’s night terrors took a gruesome turn when he was 18. One night, he woke up and was convinced someone had broken into the house. As a result, he jumped out of his bedroom window and fractured his spine and broke both his ankles. “I realised what I was doing just before I hit the ground.” Terrified by what his sleeping mind was capable of, he sought treatment to stop his night terrors from happening. But he believes that his problems can’t be solved, because it’s all in his mind. “Doctors have said to keep a bedtime journal to clear my mind, but that hasn’t worked.” He also wasn’t happy with the option of being prescribed antidepressants.

So can night terrors be solved? Dr Oscroft seems unsure. “Adult patients who suffer from them need to try and reduce how often it happens. The best way to achieve this is by getting enough sleep. People should also optimise their sleeping environment, so that they won’t be woken up during the first two hours of sleep, which is when night terrors are most likely to occur.”

Night terrors can put a strain on relationships. Dr Oscroft says the best thing to do when someone is suffering from a night terror is to reassure them. “People who are having a night terror will be agitated, so the best thing to do is to calmly talk to them until they wake up. Don’t try to restrain them unless they are in danger of hurting themselves.”

My results from the sleep clinic proved surprising. I had woken up four times during the night – flustered and disorientated. Even though there was no physical cause, I do suffer from slow wave arousal disorder, which is usually associated with sleepwalking and other sleeping disorders. Aside from the advice to sleep more or to take sleeping pills, my diagnosis remains unchanged. I suspect that it will be something I’ll have to deal with on a regular basis throughout my life. Until they stop completely, I’ll be keeping my bedroom window firmly locked.

Teachers left to pick up pieces from cuts to youth mental health services

21 Monday Apr 2014

Posted by a1000shadesofhurt in Young People

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behavioural problems, CAMHs, Children, counselling, counsellors, early intervention, emotional difficulties, mental health issues, mental health services, school, stress, support, teachers, training, well-being, young people

Teachers left to pick up pieces from cuts to youth mental health services

As the headteacher of large primary school in the west of England, Joan Cunningham is accustomed to the demanding aspects of managing an intake from a mainly disadvantaged area. However, for the past couple of years, she says, one issue has escalated so dramatically that it is nearly at crisis point. “There is so much more pressure on schools and teachers to deal with children’s mental health and behavioural problems,” she says. “We provide as much support as we can but, with fewer resources available and a massive increase in need … the pressure has been incredible.”

Cuts to mental health and other services for young people mean teachers are increasingly having to fill the gap, even though schools do not always have the resources or training to provide the extra support pupils with mental or emotional issues may need.

“It was already hard to access the right services before cuts but its getting worse,” Cunningham says. “Teachers … are not mental health professionals, and now there is a vacuum in the services we have [traditionally] relied on. Social services departments are under more pressure due to cuts, Sure Starts … have vanished, [and] in many cases the voluntary organisations we used to be able to turn to are disappearing. Sign-posting families to where they can get help is much harder because of all of this.” At a time when families are under greater financial strain and “even very young children” are under pressure to achieve academically, she concludes, the need for support is “growing very fast”.

Child and adolescent mental health services (Camhs) have been particularly hard hit. These specialist services assess and treat children and young people with mental, emotional or behavioural difficulties. Typically, when schools cannot offer the support of their own counsellor, or when a child has especially serious difficulties, they will seek out their local Camhs for help.

In many cases, local authorities commission and fund these services, and the impact of council budget cuts on Camhs in some areas has been severe. According to research by the charity Young Minds, two-thirds of councils in England have reduced their Camhs budget since 2010. And when the charity asked NHS trusts and councils about other mental health spending targeted at children and young people, such as youth counselling or specific services for schools, more than half had cut budgets – some by as much as 30%.

The cuts mean local authorities’ Camhs spending is increasingly redirected towards more serious cases of mental ill-health, at the expense of early intervention services. “Draining money from early intervention services is short-sighted and just stores up problems for the future,” says Sarah Brennan, chief executive of Young Minds. “The result is Camhs feels it is being asked to respond to an enormous number of issues and schools feel Camhs has left them high and dry.”

Chris Harrison, national executive member and former president of the NAHT, says part of the problem until recently has been that targets in education have allowed children’s wellbeing to slip down the agenda. “The issue of mental health [in schools] has been coming to the fore over the past four or five years; there’s a real groundswell of interest, but it isn’t yet a priority in schools. We need to accept that preparation for life is about more than academic results.”

Research by the Teacher Support Network, a charity focusing on teachers’ wellbeing, shows around half of teachers feel pupil behaviour is worsening. Its survey of over 800 teachers also found almost two-thirds were stressed as a result.

The cuts to Camhs mean schools are struggling to provide professional support on site. Some have set aside cash from the Pupil Premium to pay for a regular counsellor. Andy Bell, deputy chief executive at the Centre for Mental Health, says that an “ad-hoc” system of support relies too heavily on the initiative of individual heads or teachers, and is undermined by unsatisfactory and arbitrary access to funds. “We see raising awareness of this issue as a major priority,” he says. “When we conducted research on child behavioural problems we found that three-quarters of parents asked teachers for help … However, some schools are better equipped than others. Many have virtually nothing by way of [professional] support, while others have full-time counsellors.”

Inadequate and underfunded services mean undue stress is being put on teaching staff, who may feel they are not trained or qualified to tackle many of the emotional or mental health problems that come up.

And with anecdotal evidence suggesting the number of young people experiencing mental health problems is rising, the crisis in Camhs is set to get worse. In 2004, the last year that government statistics were centrally collected on the prevalence of mental ill-health among children and young people, 1.3 million children were deemed to have a diagnosable mental illness. The economic downturn, coupled with government austerity and exam stress, means this figure is now probably much higher. And with NHS England estimating that only a quarter of children and young people with a problem are ever seen by mental health services, the figures are just the tip of the iceberg.

Politicians are becoming more aware of the scale of the problem. The health select committee has begun a parliamentary inquiry into Camhs, which campaigners hope will push mental health in schools higher up the agenda when it is published this year. “What we need is a consistent, national system that is accountable. What we need is for Camhs to be transformed.” says Bell.

Harrison says more needs to be done to ensure heads and schools have access to effective support services. “Schools and heads are battered at the moment. We want the government to look at the evidence. It’s common sense. There is overwhelming evidence that students learn better and are more effective in environments where they are supported and their teachers are supported.”

For now, charities and campaign groups are having to help schools themselves. Young Minds offers guidance on its website for teachers and is about to pilot a helpline for school staff, while the anti-stigma campaign Time to Change is running a project promoting pupil wellbeing and offering practical guidance for teaching staff. “Pupils are under much more stress these days and so are staff, yet teachers don’t have training in mental health – or spare time,” says Moira Clewes, lead teacher on health at Sandwich technology school, Kent, one of the schools piloting the project. “We are breaking down misconceptions around mental illness. Students are opening up. Teachers are grateful for advice. You’d be amazed at the impact this is having.”

A Department for Education spokesperson points to a range of initiatives, including the MindEd website, launched in March, designed to help people working with children, including teachers, “to recognise when a child needs help and how to make sure they get it”. The Department of Health says it has a “priority” focus on children’s mental health and, among other things, has put additional cash in to “talking therapies”, adding that it is liaising with the DfE to improve links between schools and Camhs.

For Cunningham, while any help is welcome, she is adamant that “nothing short of a clear, coherent and properly funded approach nationally will work for schools and for children”.

• Some names have been changed

A group of neuroscientists believes it can communicate with “locked-in” coma patients

21 Monday Apr 2014

Posted by a1000shadesofhurt in Neuroscience/Neuropsychology/Neurology

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'vegetative state'; 'trapped'; coma, awakefulness, awareness, Brain activity, brain imaging, brain injury, brain scans, cognitive processing, communication, conscious, diagnosis, families, fMRI, Locked-In Syndrome, misdiagnosis, powerlessness, recovery, reflex, relatives

A group of neuroscientists believes it can communicate with “locked-in” coma patients

“Imagine you wake up, locked inside a box,” says Adrian Owen.”It’s a perfect fit, down to every last one of your fingers and toes. It’s a strange box because you can listen to absolutely everything going on around you, yet your voice cannot be heard. In fact, the box fits so tightly around your face and lips that you can’t speak, or make a noise. At first, this feels like a game. Then reality sets in. You see and hear your family lamenting your fate. You’re too cold. Then too hot. You’re always thirsty. The visits of your friends and family dwindle. Your partner moves on. And there’s nothing you can do about it.”

Owen and I are talking on Skype. I’m sitting in London while he’s at the University of Western Ontario in Canada. Owen’s reddish hair and close-cropped beard loom large on my screen as he becomes animated describing the torment of those with no voice: his patients.

People in a “vegetative state” are awake yet unaware. Their eyes can open and sometimes wander. They can smile, grasp another’s hand, cry, groan or grunt. But they are indifferent to a hand clap, unable to see or understand speech. Their motions are not purposeful but reflexive. Their minds remain firmly shut. Still, when their eyelids flutter open, you are always left wondering if there’s a glimmer of consciousness.

A decade ago, the answer would have been a bleak and emphatic no. Not any longer. Using brain scanners, Owen has found that some may be trapped inside their bodies yet able to think and feel to varying extents. The number of these cases has soared in recent decades, ironically, because doctors have steadily become better at saving patients with catastrophic injuries.

Today, trapped, damaged and diminished minds inhabit clinics and nursing homes worldwide – in Europe alone, the number of new coma cases is estimated to be 230,000 annually, of whom 30,000 will languish in a persistent vegetative state. They are some of the most tragic and expensive artefacts of modern intensive care.

Owen knows this only too well. In 1997, a close friend set off on her usual cycle to work. Anne had a weak spot on a blood vessel in her head, known as a brain aneurysm. Five minutes into her trip, the aneurysm burst and she crashed into a tree. She never regained consciousness.

The tragedy of Anne’s accident would shape Owen’s life. He began to wonder if there was a way to determine which of these patients were in an unconscious coma, which were conscious and which were somewhere in between?

That year, he had moved to the Medical Research Council’s Cognition and Brain Sciences Unit in Cambridge, where researchers used various scanning techniques. One, positron emission tomography (PET), highlights different metabolic processes in the brain, such as oxygen and sugar use. Another, known as functional magnetic resonance imaging (fMRI), can reveal active centres in the brain by detecting the tiny surges in blood flow that take place as a mind whirrs. Owen wondered whether he could use these technologies to reach out to patients, like his friend, stuck between sensibility and oblivion.

Today, being alive is no longer linked to having a beating heart, explains Owen. If you are on a life-support machine, are you dead? Is a failure to sustain independent life a reasonable definition of death? No, otherwise we would all be “dead” in the nine months before birth.

The issue becomes murkier when we consider those trapped in the twilight worlds between normal life and death – from those who slip in and out of awareness, who are trapped in a “minimally conscious state”, to those who are severely impaired in a vegetative state or a coma.

In the wake of the development of the artificial respirator during the 1950s in Denmark, pioneering work to categorise disorders of consciousness was carried out in the 1960s by the neurologist Fred Plum in New York and the neurosurgeon Bryan Jennett in Glasgow.

Plum coined the term “locked-in syndrome”, in which a patient is aware and awake but cannot move or talk. With Plum, Jennett devised the Glasgow Coma Scale to rate the depth of coma, and Jennett followed up with the Glasgow Outcome Scale to weigh up the extent of recovery, from death to mild disability. Together they adopted the term “persistent vegetative state” for patients who, they wrote, “have periods of wakefulness when their eyes are open and move; their responsiveness is limited to primitive postural and reflex movements of the limbs, and they never speak”. In 2002, Jennett was among a group of neurologists who chose the phrase “minimally conscious” to describe those who are sometimes awake and partly aware, who show erratic signs of consciousness so that at one time they might be able to follow a simple instruction and at another they might not.

Kate Bainbridge, a 26-year-old schoolteacher, lapsed into a coma three days after she came down with a flu-like illness. A few weeks after her infection had cleared, Kate awoke from the coma but was diagnosed as being in a vegetative state. Luckily, the intensive-care doctor responsible for her, David Menon, was also a principal investigator at the newly opened Wolfson Brain Imaging Centre in Cambridge, where Adrian Owen then worked.

Menon wondered whether elements of cognitive processing might be retained in patients in a vegetative state, and discussed with Owen how to use a brain scanner to detect them. In 1997, four months after she had been diagnosed as vegetative, Kate became the first patient in such a state to be studied by the Cambridge group. The results, published in 1998, were extraordinary. Her brain responses were indistinguishable from those of healthy volunteers; her scans revealed brain activity at the back of her brain, in a part which helps recognise faces. Kate became the first such patient in whom sophisticated brain imaging (in this case PET) revealed “covert cognition”. Of course, whether that response was a reflex or a signal of consciousness was, at the time, a matter of debate.

The results were of huge significance not only for science but also for Kate and her parents. “The existence of preserved cognitive processing removed the nihilism that pervaded the management of such patients in general, and supported a decision to continue to treat Kate aggressively,” recalls Menon.

Kate eventually surfaced from her ordeal, six months after the initial diagnosis. She described how she was indeed sometimes aware of herself and her surroundings. “They said I could not feel pain,” she says. “They were so wrong.”

Sometimes she’d cry out, but nurses thought it was nothing more than a reflex. Hospital staff had no idea how much she suffered in their care. Physiotherapy nurses never explained what they were doing to her. She was terrified when they removed mucus from her lungs. “I can’t tell you how frightening it was, especially suction through the mouth,” she has written. Her pain and despair became such that she tried to snuff out her life by holding her breath. “I could not stop my nose from breathing, so it did not work. My body did not seem to want to die.”

Kate says her recovery was not so much like turning on a light but a gradual awakening. By then she had lost her job, her sense of smell and taste, and much of what might have been a normal future. Now back with her parents, Kate is still very disabled and needs a wheelchair. Yet, 12 years after her illness, she started to talk again and, though still angry about the way she was treated when she was at her most vulnerable, she remains grateful to those who helped her mind to escape.

She sent Owen a note:

“Dear Adrian, please use my case to show people how important the scans are. I want more people to know about them. I am a big fan of them now. I was unresponsive and looked hopeless, but the scan showed people I was in there. It was like magic, it found me.” k

Nicholas Schiff is a neurologist at Weill Cornell Medical College in New York. His working life is a balancing act between putting the interests of his patients and their families first and keeping true to the science as he wrestles with disorders of consciousness. “There’s a lot we don’t know,” he admits. “Frankly, I am wrong a lot of the time.”

In 2005, Schiff applied his emerging understanding of the circuits of consciousness to Jim, a 38-year-old man who had been beaten and robbed and was left minimally conscious. Jim’s eyes had mostly remained shut. He was unable to speak and could communicate only by a nod, or tiny eye or finger movements. His plight seemed hopeless. Eventually, Jim’s mother gave a “do not resuscitate order” to doctors. Schiff thought differently.

Schiff had earlier scanned Jim with fMRI in 2001. His team had played subjects, including Jim, an audiotape in which a relative or loved one reminisced. In detailed fMRI scans, Jim had shown that, despite having a very underactive brain, he had preserved large-scale language networks. When he heard a story that meant something to him, his brain lit up. What, thought Schiff, if Jim’s thalamus could be activated by deep brain stimulation?

A brain pacemaker was implanted into Jim. After its two electrodes delivered pulses of electricity to his thalamus, he was able to use words and gestures, respond reliably to requests, eat normally, drink from a cup, and carry out simple tasks such as brushing his hair. Schiff believes that once a brain re-engages with the world, it accelerates processes of repair. For the next six years, before Jim died of unrelated causes, he kept his mind above the minimally conscious state. “He could converse in short sentences reliably and consistently and make his wishes known,” says Schiff. “He could chew and swallow and eat ice-cream and hang out. His family told us that they had him back.” The case made the front page of the New York Times. “I prayed for a miracle,” his mother told me at the time he was brought back. “The most important part is that he can say ‘Mummy and Pop, I love you.’ God bless those wonderful doctors. I still cry every time I see my son, but it is tears of joy.”

In a forested campus south of Liège, Steven Laureys studies vegetative patients in research that dates back decades. Working there as part of the Cyclotron Research Centre in the 1990s, he was surprised when PET brain scans revealed that the patients could respond to a mention of their own name. Meanwhile, on the other side of the Atlantic, Nicholas Schiff was finding that partially working regions lay within catastrophically injured brains. What did it all mean?

At that time, doctors thought they already knew the answers: no patient in a persistent vegetative state was conscious. Medical practitioners, with the best intentions, thought it was perfectly acceptable to end the life of a vegetative patient by starvation and the withdrawal of water. This was the age of what Laureys calls “therapeutic nihilism”.

What Owen, Laureys and Schiff were proposing was a rethink of some of the patients who were considered vegetative. A few of them could even be classed as being fully conscious and locked-in. The establishment was doggedly opposed. “The hostility we encountered [in the late 1990s] went well beyond simple scepticism,” says Schiff. Looking back, Laureys pauses and smiles thinly: “Medical doctors do not like to be told they are wrong.”

Then came 2006. Owen and Laureys were trying to find a reliable way to communicate with patients in a vegetative state, including Gillian. In July 2005, this 23-year-old had been crossing a road, chatting on her mobile phone. She was struck by two cars and diagnosed as vegetative.

Five months later, a strange piece of serendipity allowed Gillian to unlock her box. “I just had a hunch,” says Owen. “I asked a healthy control [subject] to imagine playing tennis. Then I asked her to imagine walking through the rooms of her house.” Imagining tennis activates part of the cortex called the supplementary motor area, involved in the mental simulation of movements. But imagining walking around the house activates the parahippocampal gyrus in the core of the brain, the posterior parietal lobe, and the lateral premotor cortex. So, if people were asked to imagine tennis for “yes” and walking around the house for “no”, they could answer questions via fMRI.

Gazing into Gillian’s “vegetative” brain with the brain scanner, he asked her to imagine the same things – and saw strikingly similar activation patterns to the healthy volunteers. It was an electric moment. Owen could read her mind.

Gillian’s case, published in the journal Science in 2006, made front-page headlines around the world. The result provoked wonder and, of course, disbelief. “Broadly speaking, I received two types of email from my peers,” says Owen. “‘This is amazing – well done!’ and ‘How could you possibly say this woman is conscious?'”

As the old saw goes, extraordinary claims require extraordinary evidence. The sceptics suggested that it was wrong to make these “radical inferences” when there could be a more straightforward interpretation. Daniel Greenberg, a psychologist at the University of California, Los Angeles, suggested that, “the brain activity was unconsciously triggered by the last word of the instructions, which always referred to the item to be imagined”.

Parashkev Nachev, a neurologist now at University College London, says he objected to Owen’s 2006 paper not on grounds of implausibility or a flawed statistical analysis but because of “errors of inference”. Although a conscious brain, when imagining tennis, triggers a certain pattern of activation, it does not necessarily mean the same pattern of activation signifies consciousness. The same brain area can be activated in many circumstances, Nachev says, with or without any conscious correlate. Moreover, he argues that Gillian was not offered a true choice to think about playing tennis. Just as a lack of response could be because of an inability to respond or a decision not to co- operate, a direct response to a simple instruction could be a conscious decision or a reflex.

What is needed is less philosophising and more data, says Owen. A follow-up study published in 2010 by Owen, Laureys and colleagues tested 54 patients with a clinical diagnosis of being in a vegetative state or a minimally conscious state; five responded in the same way as Gillian. Four were supposedly in a vegetative state at admission.

Owen, Schiff and Laureys have explored alternative explanations of what they observed and, for example, acknowledge that the brain areas they study when they interrogate patients can be activated in other ways. But the 2010 paper ruled out such automatic behaviours as an explanation, they say: the activations persist too long to signify anything other than intent. “You cannot communicate unconsciously – it is just not possible,” says Owen. “We have won that argument”.

Since Owen’s 2006 Science paper, studies in Belgium, the UK, the US and Canada suggest that a significant proportion of patients who were classified as vegetative in recent years have been misdiagnosed – Owen estimates perhaps as many as 20 per cent. Schiff, who weighs up the extent of misdiagnosis a different way, goes further. Based on recent studies, he says around 40 per cent of patients thought to be vegetative are, when examined more closely, partly aware. Among this group of supposedly vegetative patients are those who are revealed by scanners to be able to communicate and should be diagnosed as locked-in, if they are fully conscious, or minimally conscious, if their abilities wax and wane.

There is anecdotal evidence that when contact is re-established with the occupant of a living box they are understandably morose, even suicidal. They have been ground down by frustration at their powerlessness, over the months, even years, it can take to recognise their plight. Yet the human spirit is resilient, so much so that they can become accustomed to life in this twilight state. In a survey of patients with locked-in syndrome, Laureys has found that when a line of communication is set up, the majority become acclimatised to their situation, even content (again, these insights took time to be accepted by the medical and scientific establishment – and even to be published in a scientific journal – reflecting the prevailing unease about the implications for hospitals and care homes).

The important question is detecting the extent to which such patients are conscious. Studies of large numbers of patients with brain injuries, and how they fare over the years, show that it makes a huge difference to the chance of recovery if a patient is minimally conscious rather than vegetative. The former have fragmentary understanding and awareness and may recover enough to return to work within a year or two.

Yet there are still surprises, such as the case of New York fireman Don Herbert, who awoke after a decade from a minimally conscious state caused by a severe brain injury suffered while fighting a fire in 1995. Schiff has used a technique called diffusion tensor imaging to show how a brain can rewire itself even decades after an injury – yet in the past year, even he has recommended withdrawing care from a man who had lain in a coma for eight weeks after a cardiac arrest. “I was wrong,” he says. “This man is now back at work.”

Parashkev Nachev has not changed his view since he first criticised Owen’s work, and spelt out the basis of his unease in a more detailed paper published in 2010. “For every relative of a living PVS [persistent vegetative state] patient given (probably false) hope, another is burdened with the guilt of having acquiesced in the withdrawal of treatment from someone who – he has been led to believe – may have been more alive than it seemed,” he says. “There are moral costs to false positives as well as to false negatives.

“I find the whole media circus surrounding the issue rather distasteful. The relatives of these patients are distressed enough as it is.”

Laureys, Owen and Schiff spend a great deal of time with the families and understand these sensitivities only too well. Owen counters that, from his years of experience dealing with the families, they are grateful that doctors and scientists take an interest and are doing everything they can. “These patients have been short-changed over the years,” he insists.

Owen is adamant that doctors have a moral duty to provide a correct diagnosis, even if the results cause guilt, unease or distress. “We must give every patient the best chance of an accurate diagnosis, so we can give them the appropriate care that goes along with that diagnosis.”

Under the umbrella classification of “vegetative” lies a vast array of brain injuries and, as a result, even some of the most vocal critics accept that some vegetative patients are not as diminished as traditional measures suggest. Professor Lynne Turner-Stokes chairs a group for the Royal College of Physicians that is revising UK guidelines on “Prolonged Disorders of Consciousness”. She remains unconvinced that the exceptional cases identified by Owen, Laureys and Schiff are particularly common or that enough has been done to establish brain scanners as a standard tool for routine diagnosis, particularly when the cost and convenience of these methods are taken into account. When it comes to extending these tests to all patients in a vegetative states as standard practice, “The evidence is just not there yet,” she says.

But she stresses that she is simply being cautious, not sceptical, describing the work of Owen, Laureys and Schiff as “important and exciting”. “We are only just beginning to scratch the surface,” she says. “But I have no doubt [these techniques] will have a place, eventually, in the evaluation of patients.”

Back on Skype, Owen smiles, considering whether to tell me what he is planning next. His partner, Jessica Grahn, also a neuroscientist, became pregnant at the start of 2013. What happens when consciousness winks on in the developing brain? He emails me a video of their unborn child, a montage of fMRI slices through their baby’s head, as it twists and turns in Jessica’s womb. “My colleagues have been doing fMRI on my wife’s tummy every week for a few weeks now to see if we can activate the foetus’s brain,” he writes. “It is amazing.”

Some names have been changed to protect identities. Adrian Owen’s friend Anne remains in a vegetative state. Adrian Owen and Jessica Grahn’s baby boy was born on 9 October 2013.

Teachers: ‘Our pupils are targeting us’ with more than a quarter victims of abuse on social media

21 Monday Apr 2014

Posted by a1000shadesofhurt in Young People

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Teachers: ‘Our pupils are targeting us’ with more than a quarter victims of abuse on social media

Teachers are facing an increasing barrage of “vile” sexual abuse, unfair allegations of incompetence and videos of themselves taken without their consent being posted online by their pupils, according to a report seen by The Independent.

The survey of 7,500 teachers revealed that more than one in five (21 per cent) reported having adverse or derogatory comments posted about them on social media – from parents as well as children.

“Abusive and highly offensive language is common, accompanied by remarks about teachers’ appearance, competence or sexuality,” said a report out today, conducted by the National Association of Schoolmasters Union of Women Teachers (NASUWT). Poor behaviour in the  classroom is enough to persuade many teachers to quit but the added element of online abuse taking place inside and outside the classroom is adding to the pressures of the job.

In one case highlighted by the report, a pupil tweeted: “You are a paedo and your daughter is a whore.” Another pupil said on Facebook that he wanted to kill his teacher – and invited fellow pupils to join in. The majority of comments by pupils, 61 per cent, came from 14- to 16-year-olds. However, there were two recorded from four- to seven-year-olds. The sites used by the pupils included Facebook, Ratemyteacher, Twitter, YouTube, Instagram and Snapchat.

In one case, a picture of a drunk person who had passed out and resembled a teacher was posted, with a comment telling fellow pupils it was their teacher.

Of the comments posted by pupils, 47 per cent included insulting words or phrases, 50 per cent had comments made about their performance as a teacher, and 26 per cent had videos or photographs posted without their consent.

Of the parents’ comments, 57 per cent were insulting, 63 per cent criticised the teachers’ performance, 7 per cent involved threatening behaviour, and 7 per cent were videos or photographs taken without the teachers’ consent.

In addition to this, 6 per cent involved allegations of inappropriate behaviour with children and 3 per cent inappropriate behaviour with parents.

One teacher said of the abuse: “I was so upset by the allegations and comments from kids who had seen it all… that I ended up being off work with stress, on antidepressants and having to see a counsellor.”

Union leaders are urging schools to support staff in approaching social media websites to secure the removal of offensive material and encouraging them to go to the police.

Of those who complained, 11 per cent went to the police  – but three-quarters of these said no further action had been taken against either pupils or parents, although they had received a sympathetic hearing.

“Teachers are often devastated by the vile nature of the abuse they are suffering,” said Chris Keates, general secretary of NASUWT. “Teachers are often traumatised by the attacks made on them through social media.

“Some have lost their confidence to teach once they see foul and personal remarks made by pupils in their classes and have left the profession.

“Others have been so disturbed by the comments that their health has been affected.”

Meanwhile, teachers’ leaders will warn today that they face a “home invasion” of emails from heads and senior management, which sometimes arrive in the early hours and demand that action be taken by the recipient before the start of the school day.

Ms Keates cited one case where a teacher received an email at 2.15am demanding action by 8am, describing it as “unacceptable harassment and pressure”.

“Teachers even report receiving emails from school management at midnight on New Year’s Eve with a message reminding them of the work they must have completed by the time the new term starts,” she added.

She urged all schools to adopt a policy and protocol on the appropriate use of emails to avoid further stress being placed on teachers.

Jolie to seek end to sexual violence as war weapon at London summit

01 Tuesday Apr 2014

Posted by a1000shadesofhurt in Sexual Harassment, Rape and Sexual Violence, War Crimes

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Bosnia, conflict, DRC, rape, Rwanda, Sexual Violence, shame, silence, soldiers, systematic rape, the UN, War Crimes, weapon of war

Jolie to seek end to sexual violence as war weapon at London summit

Angelina Jolie has said she hopes a global summit on sexual violence she will co-host in London with the UK government will bring lasting change to global peacekeeping and war crimes prosecutions, deterring the use of mass rape as a weapon in future conflicts.

The four-day summit, beginning on 10 June, will bring together governments from 141 countries to discuss how to improve and standardise the investigation of large scale sexual violence in wartime, to bring an end a culture of impunity that has severely limited prosecutions up to now.

Speaking to The Guardian during a visit to Bosnia, Jolie said: “I would hope that years down the line when war breaks out, people who are considering raping a man, woman or child would be very aware of the consequences of their actions, and that a woman crossing a checkpoint would be aware there was someone collecting evidence and that evidence would have a … result for her.”

“When that begins to happen on masse, then things will change. That’s why its important that this effort isn’t just one single [approach]. We are working with everyone who has worked on this issue for years, with every NGO and every government, to assist these people on all fronts.”

Jolie visited Bosnia at the end of last week with Britain’s foreign secretary, William Hague, as part of a two-year partnership aimed at preventing sexual violence in conflict. In the course of the trip they spoke in private to several women survivors of the 1995 massacre in Srebrenica, where the slaughter of 8,000 Muslim men and boys has overshadowed another crime against humanity committed at the same time, the systematic rape of women and girls.

The meeting with the Srebrenica women took place in a disused battery factory where in July 1995, thousands of Bosnian Muslims sought the shelter of Dutch UN peacekeepers. The UN promise of protection proved hollow and the factory is now echoing and empty apart from a sombre memorial – two black boxes each as big as a house. In a cemetery outside a stone monument records the names of the 8,000 men and boys slaughtered by General Ratko Mladic’s Serb army.

One of the women, Edina Karic, was taken from her family by Serb soldiers and held at a nearby lead and zinc mine, where she was repeatedly raped.

“I was taken to the mine, where I was raped many times along with two other girls. Then we were eight days in an abandoned house where we were raped again,” Karic said. “When these things were happening to me, it was as if I wasn’t there in my body. I was looking at it from outside.”

None of Karic’s rapists has been prosecuted, even though she could definitively identify at least three of them, and has followed their lives, in a town a few miles away, through Facebook.

More than 20,000 Bosnian women and girls were raped. Over a decade in the Democratic Republic of Congo there are thought to have been 200,000 victims. There were up to half a million rapes in Rwanda in 1994, and there are widespread reports of systematic sexual violence in Syria.

The silence surrounding rape as a war crime is deepened because the victims are often shunned by their own communities. Edina Karic is a rarity in that she is prepared to speak openly about what happened to her.

“I realised I’m not the one who should feel shame. It’s for the perpetrators to feel ashamed,” she said.

In Sarajevo, Hague and Jolie spoke to a hall full of Bosnian army officers who have, with British assistance, developed a training course meant to equip peacekeeping contingents from around the world to detect and prevent the commission of mass rape. As part of the Hague-Jolie campaign, every UN peacekeeping mission is now supposed to provide for the protection of civilians against sexual violence in conflict.

“At times, you may be all that stands between a child and violence that will scar him or her forever,” Jolie told the soldiers in Sarajevo. You may sometimes be the first person outside their family that a survivor of rape encounters. Your actions may make the difference between a successful prosecution, or aggressors going unpunished.”

So far, for the 20,000-50,000 wartime rapes in Bosnia, there have been 30 convictions at the Hague war crimes tribunal and another 33 at the Bosnia state court. Thousands more perpetrators, like Edina Karic’s rapists, remain at liberty.

“There is no forensic evidence, often no medical reports. All you have usually are witness statements, and in a very conservative society, most victims don’t want people to know what happened to them, so most rapes are not reported,” said Dubravko Campara, a Bosnian war crimes prosecutor.

The Bosnian state court has hundreds of open investigations on its docket and just 17 prosecutors. But with the help of UK funding, another 15 are going to be added to the staff to ease the backlog. The court now has a witness support unit to ease the pressure on women witnesses.

The global Preventing Sexual Violence Initiative was launched two years ago after Hague saw Jolie’s 2012 film about the Bosnian rape camps, Land of Blood and Honey. The hardest part of the effort is likely to be translating goodwill at the summit into real change in future conflicts. When Hague and Jolie visited Goma in DRC last March, they heard that women fleeing the fighting with their families were being frequently raped when they ventured out of refugee camps to look for firewood, despite the proximity of thousands of UN peacekeepers nearby. Keeping the women safe was not part of the soldiers’ mandate.

Hague conceded that progress in changing UN peacekeeping practices had been slow, but added: “The UN will be heavily involved in the summit. A big ally of ours is Zainab Bangura, the UN special representative on sexual violence. I think we are getting somewhere with that, but it means systematically building our objectives into all peacekeeping training.”

“There is a lot of goodwill,” Jolie said. There is a lot of understanding of what’s right and wrong, but there is a disconnect. So if we can try to put the pieces together and fill the holes, then maybe there can be a real change.”

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