Sense Of Discomfort Research Articles

Perceived knowledge of psychiatry and family medicine residents regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia: opportunities to refine the residency training

BackgroundPsychiatry and Family Medicine residents frequently see patients with comorbid mental and physical disorders. Little is known about the difference in knowledge of Psychiatry residents and Family Medicine residents regarding management of common conditions they encounter. This study aimed to assess the knowledge of Psychiatry and Family Medicine residents regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia, as the findings could help to refine the training curriculum for residency training.MethodsA cross-sectional survey design was used. Psychiatry and Family Medicine residents pursuing their residency in Singapore were recruited from November 2019 to June 2020. The survey questionnaire consisted of questions which assessed the knowledge regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia. Descriptive statistics were used to describe the demographic data; T-tests or Mann-Whitney U tests to compare the differences between groups; and multiple regression analyses to assess the factors associated with Psychiatry residents’ knowledge of hypertension, diabetes mellitus, and dyslipidemia.ResultsFifty-seven out of 70 (81.4%) Psychiatry residents and 58 out of 61 (95.1%) Family Medicine residents participated in the study. The majority of Psychiatry residents encountered patients with hypertension (93.0%), diabetes mellitus (87.7%) and dyslipidemia (91.2%) on a daily to weekly basis. Psychiatry residents had higher scores on questions about schizophrenia versus Family Medicine residents (mean 50.70 versus 43.28, p < 0.001). However, Psychiatry residents scored lower on questions about hypertension (mean 33.86 versus 40.98, p < 0.001), diabetes mellitus (mean 45.68 versus 49.79, p = 0.005) and dyslipidemia (mean 37.04 versus 44.31, p < 0.001). Receiving undergraduate medical education locally, compared to receiving it overseas, was associated with better knowledge of hypertension (beta = 0.515, p = 0.009) and dyslipidemia (beta = 0.559, p = 0.005); while younger age (26–30 versus > 35 and 31–35 versus > 35) was associated with better knowledge of hypertension (beta = 1.361, p = 0.002 and beta = 1.225, p = 0.003). A significant proportion of Psychiatry residents (61.4%) did not agree that the training provided to manage hypertension, diabetes mellitus, and dyslipidemia was adequate. Similarly, majority of Family Medicine residents (62.1%) did not agree that they had adequate training to manage schizophrenia.ConclusionsThis study raises the awareness of Psychiatry residents’ sense of discomfort in managing hypertension, diabetes mellitus, or dyslipidemia and conversely Family Medicine residents in management of schizophrenia, which can be further addressed during the training postings within the residency programs. Future studies are needed to look at local (such as training curriculum) and systemic factors (such as practice trends and culture) in order to better align residency selection criteria and training foci with real world practice factors over time.

CT-guided Thoracic Sympathicolysis versus VATS Sympathectomy in the Therapeutic Concept for Severe Primary Palmar Hyperhidrosis.

The objective was to compare computed tomography (CT)-guided thoracic sympathicolysis (CTSy) and video-assisted thoracoscopic sympathectomy (VATS) with regard to their feasibility, the occurrence of minor and major complications, and the clinical outcome. In this study, 88 patients treated by CTSy and 86 patients treated by VATS were retrospectively included. CTSy was performed after establishing the entry plane below the level of the intervertebral space T2/3 via a dorsolateral approach using a 22-G coaxial needle. On average of 5 mL of a sympathicolytic mixture was instilled. VATS was performed under intubation anesthesia. After insertion of the instruments via a minithoracotomy, the parietal pleura was dissected and the sympathetic trunk severed below T2. The interventions were performed unilaterally, the contralateral side being treated after approximately 6 weeks. All patients evaluated their sense of discomfort before treatment as well as 2 days, 6, and 12 months after, on the basis of a Dermatology Quality of Life Index and additionally the side effects that occurred. Both treatments led to a marked reduction of symptoms, whereby mild recurrent sweating occurred over the further course, significantly higher in the CTSy patient group. Short-term miosis and ptosis were rarely found in both groups. As the most common side effect, transient compensatory sweating was reported by 16/88 patients after CTSy and 10/86 patients after VATS. Pneumothoraces developed postoperatively in 7/86 cases. Temporary pain after thoracotomy was experienced by 12/86 patients. For patients with palmar hyperhidrosis, CTSy and VATS represented a minimally invasive treatment option that provided a high and largely equivalent level of benefit.

Subjective assessment on visual fatigue versus stereoscopic disparities

AbstractThe sense of discomfort when watching stereoscopic display caused by visual fatigue has hindered the widespread applications of stereoscopic display. In this work, we explore the relationship between visual fatigue and stereoscopic parallax using subjective assessment. The visual fatigue of the subjects is evaluated after viewing different parallax stereoscopic samples. It shows that visual fatigue exacerbates greater in negative parallax than positive parallax. Surprisingly, the results indicate that visual fatigue can be alleviated with tiny parallax, which increases the comfort of stereoscopic visual perception. We envision that this relationship is able to provide helpful hints in designing visual healthy stereoscopic images.

Selection of a topical preparation in the basic treatment of chronic hemorrhoids

Introduction. The vast majority of recommendations for conservative treatment of patients with chronic hemorrhoids contain recommendations for the use of systemic drugs with venotonic and angioprotective properties and the use of topical drugs to treat and prevent exacerbation of the disease. The action of the main components of the topical drugs used is aimed at controlling local inflammation, implemented through various mechanisms. The choice of a drug is mainly subjective.Aim of the study. Comparative clinical evaluation of the effectiveness of topical drugs for the treatment of chronic hemorrhoids.Materials and methods. There are two treatment schemes that are distinguished by the type of the drug that is used. The main group includes patients in treatment of whom a combined preparation based on lidocaine and fluocortolone in the form of rectal suppositories manufactured by Bayer (221 (50.6%) patients) was used. In the control group – a combined preparation on the basis of tribenoside and lidocaine in the form of rectal suppositories by Recordati company (216 (49,4%) people). The rate of suppositories administration and duration of their use was 21 days. Clinical efficacy was estimated by the rate of regression of the main clinical manifestations of the disease: bleeding, pain syndrome, discomfort.Results and discussion. By the 14th day of treatment with Bayer preparation, bleeding as the main sign of disease exacerbation persisted in 15.2% (5) of the main patients against 26.7% (8) of the control group patients. Positive effect was obtained in the majority of patients with the initial prevalence of pain syndrome. On the 14th day the pain remained in 17.0% (8) patients of the main group against 27.9% (12) of the control group. Sense of discomfort was preserved in 10% (4) of the main group patients against 15.8% (6) of the control group patients. Regression of combined clinical manifestations of the disease in the comparison groups showed the fastest elimination of inflammation in the main group in 79.4% of patients against 73.0% in the control group on the 14th day of treatment.Conclusions. Thus, the use of Bayer preparation allowed ensuring the regression of the main clinical manifestations of the disease in a shorter time. This drug can be recommended for use in complex treatment of chronic hemorrhoids in everyday clinical practice.

Migraine and literature: a narrative historical review.

Description of migraine pain is sometimes difficult for a patient. The simple words reported in the Classification of International Headache Society are not sufficient to explain both the patient's sense of discomfort and the emotional point of view. We analyzed works by international writers and novelists in the last centuries to explore the connotation of migraine in literature. We evaluated the literary insight of migraine, the description of migraine experience and the therapies proposed in novels, essays and short stories. In literature, migraine has still the negative connotation of an untreatable disease. It is described as a barrier for social, familial, and work activities. In more recent works, new therapies are not mentioned, confirming that scientific improvements both in acute phase and in prophylaxis are not part of the literary cultural mainstream.

Importance of water objects for the sustainable development of megalopolises

The expansion of megacities leads to the isolation of a large part of their population from the environment. The lack of contact with nature contributes to the development of ecological frustrations and deprivations, unconscious sense of discomfort, which is the cause of the development of a wide range of dangerous diseases, reduction of the birth rate and degradation of the urban population. A solution to this problem can be the organization of a network of recreation places for the urban population (resorts, created on the basis of the preserved elements of the hydrographic network). Positive perception of water objects by human consciousness is one of the main means of ecological relaxation, removal of psychological stress from constant stay in anthropogenic environment. At the same time, resorts should meet the needs of all main social groups. They should include both ecological relaxation zones and places of active recreation . Particular attention is paid to the organization of environmental education activities. Private cases of recreational use of the city’s water bodies are also possible, such as attracting cave explorers to study the underground rivers. In general, resorts based on urban water bodies should become a public space, covering the entire inhabited territory of the metropolis. The system of assessing the social significance of Moscow’s water bodies is developed on the basis of their comprehensive survey. Analysis of their current state takes into account general patterns of historical development of hydrographic networks of the city, and the requirements of the population to the appearance of public spaces created on water bodies of the city and to assess their social significance.

Exchanging Expertise across Cultures and Time: Participatory Design Approaches for Creating Community Museums

This paper presents a case study where participatory design practices were used to design a cultural museum and inaugural exhibition with designers from an Australian university and the Kelabit community in the Highlands of Borneo. We draw on experiences from fieldtrips, across a five-year period, investigating the exchange of expertise between participants. The findings show a shift in roles when sharing expertise throughout our participatory design process. Participants experienced a lack of clarity and a sense of discomfort while participating in the design of the museum resulting in the need to continually negotiate leadership of the project. The designers discovered their role was to facilitate intangible conversations into tangible outcomes, where participatory design tools reshaped conversations rather than designed final artefacts. We argue that when exchanging expertise across cultures in participatory design, participant roles become organic and ambiguous.

Transsexualism and transgender medicine - what every internal specialist should know about

The authors present current findings on transsexualism and its treatment. According to the ICD-10, transsexualism is defined as the "desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex." Synonyms of transsexualism are terms such as gender dysphoria reflecting the distress that persons feel due to a mismatch between their gender identity and their sex assigned at birth.The prevalence of transsexualism is estimated to be about 0,6 %. The diagnosis of transsexualism is made by psychiatrists, but at least five more medical specialties (endocrinologist, surgeon, ear, nose and throat specialist, speech therapist and dermatologist) are involved when treating transsexual persons. Hormonal therapy is a very important element of the treatment process; due to the complexity of transsexualism it should be undertaken by endocrinologists with experience and expertise in this field.

Feminist counter-cinema and decolonial countervisuality: subversions of audiovisual archives in Un’ora sola ti vorrei (2002) and Pays Barbare (2013)

ABSTRACT In this article we analyse the Italian compilation films Un’ora sola ti vorrei (Alina Marazzi, 2002) and Pays Barbare (Yervant Gianikian and Angela Ricci Lucchi, 2013) as examples, respectively, of feminist counter-cinema and decolonial countervisuality working with and against audiovisual archives. By means of a close-reading of the two films from an intersectional feminist perspective, we discuss: on the one hand, the ways in which Marazzi contests the rigid gender performativity of home movies, by restituting her mother’s memory and exposing her sense of discomfort; on the other hand, the strategies employed by Gianikian and Ricci Lucchi in their dismantling of the sexism and racism of the colonial archive, while also warning about the fascist past haunting the present.

MAKING MISCHIEF: DAVID HARE AND THE CELEBRITY PLAYWRIGHT’S POLITICAL PERSONA

This article examines the fashioning of the authorial persona of British playwright, screenwriter, and director David Hare through autobiographically inflected extra-theatrical interventions. Both exploratory and explanatory companion pieces that frame his artistic work, Hare’s lectures, essays, and memoir capture and stage the field migrations between art and activism that lie at the heart of his public profile as a politically engaged celebrity playwright and astute social commentator. It will be shown how Hare exploits the generic properties of non-fictional life-writing formats that raise, and ostensibly meet, audience expectations of sincerity and authenticity and therefore become ideal vehicles for Hare’s ‘autobiomyth’ of the prophetic writer-propagandist who strives to appeal to the moral conscience of his readership. Hare’s conception of the authorial persona is informed by a Romantic tradition of strong authorship that is intimately connected with truth-telling discourses and that relies on the author’s combined identities of artist and politically engaged commentator. This contribution argues that Hare’s proclivity for non-fictional life-writing formats ties in with a sense of discomfort about his position as a playwright between establishment recognition and self-declared radicalism.

Tolerance Peculiarities to Uncertainty of Working Students

The article covers results of an empirical study of the characteristics of tolerance to uncertainty of working students. The sample consisted of 44 participants - students of the V.N. Karazin Kharkiv National University. The first group consisted of 22 subjects who combine their studies at a higher educational institution with work, the second group - 22 subjects who do not work. Tolerance for uncertainty was measured by «Multiple Stimulus Types Ambiguity Tolerance Scale-I» (D. McLain, the adaptation by E. Osin) and «New questionnaire of tolerance for uncertainty» (T. Kornilova). Student's t-test for independent samples was used for statistical processing of the results. Findings of the study revealed that working students have a more positive attitude to new events, a deeper awareness of themselves as the subject of their own actions, and confidence that they control their lives, a greater tendency to make choices quickly and flexibly and the ability to maintain a vision of many opportunities, and greater tolerance for uncertainty in general. For these subjects are more inherent in the desire for change, novelty and originality, willingness to follow unpaved paths and prefer more complex tasks, to be able to be independent of the accepted limitations. Non-working students are characterized by a more pronounced desire for clarity and control in interpersonal relationships and a sense of discomfort in the event of uncertainty in relationships with others. The results obtained make it possible to improve the theoretical understanding of the characteristics of manifestations of tolerance to uncertainty at a student age, determine the prospects for further scientific research and can be used in practical psychological and pedagogical work with students.

Global Citizenship Development

The present study examined the development of global citizenship traits in undergraduate students at a liberal arts college in Southern California. Two hundred and sixty-eight students participated in a survey that measured their global citizenship traits. Using a cross-sectional correlational design, the study examined the experience and development of the students as they strive to become global citizens. The results indicated that students face challenges and a sense of discomfort during study abroad, but their global citizenship traits tend to improve after return. Additionally, the study explored students’ perceptions of the curriculum, co-curricular activities, and campus life characteristics. The quantitative analyses suggested that the college’s mandatory study abroad program offers students an opportunity to seek their global citizenship identities.

The planner’s subjective destitution: towards a hysterical-analytical triad of planning theoryresearch- practice

In this article, I set out different relationships between planning theory, research and practice, drawing on Lacan's "production of four discourses". I argue that each element of the planning theory-research-practice 'triad' acts as the discursive 'agent' and gives rise to particular kinds of 'subject-planner' (the 'master', the 'expert', the 'idealistic' and the 'pragmatic') with specific ideological upshots ('hidden' big other, 'feigned' big other, hysteria and subjective destitution). Primarily a theoretical discussion, the article is also partially underpinned by my own practical experience in planning. While Lacanian psychoanalytical theory has already entered the planning field, its deployment has been mostly centred on deconstructing both planning decision-making processes and the mediation of planners in creating and implementing plans. Hence, the attempt here is to look in more depth at the 'ambivalent' role of the planner as well as to bring in 'planning research', as a key, somewhat occluded, element within the discussion on bridging planning theory and practice. Further, in the literature there seems to be a sort of omnipresent assumption that 'valid' reflection on planning can only come from the 'outside', which in turn perpetuates the role of the academic researcher simply trying to decode and analyse what the practitioner does (or tries to do). Critical impressions from those 'out there', 'on the job', are still missing. They, far from mere anecdotic accounts, ought to comprise self-inflicted criticism triggered by a sense of discomfort with what's being done – by the hysterical question of "why am I a planner?" and "why I am doing this or that?"

What does poverty feel like? Urban inequality and the politics of sensation

The emergent field of ‘sensory urbanism’ studies how socio-spatial boundaries are policed through sensorial means. Such studies have tended to focus on either formal policies that seek to control territories and populations through a governance of the senses, or on more everyday micro-politics of exclusion where conflicts are articulated in a sensory form. This article seeks to extend this work by concentrating on contexts where people deliberately seek out sensory experiences that disturb their own physical sense of comfort and belonging. While engagement across lines of sensorial difference may often be antagonistic, we argue for a more nuanced exploration of sense disruption that attends to the complex political potential of sensory urbanism. Specifically, we focus on the politics of sensation in tours of low-income urban areas. Tourists enter these areas to immerse themselves in a different environment, to be moved by urban deprivation and to feel its affective force. What embodied experiences do tourists and residents associate with urban poverty? How do guides mobilise these sensations in tourism encounters, and what is their potential to disrupt established hierarchies of socio-spatial value? Drawing on a collaborative research project in Kingston, Mexico City, New Orleans and Rio de Janeiro, the article explores how tours offer tourists a sense of what poverty feels like. Experiencing these neighbourhoods in an intimate, embodied fashion often allows tourists to feel empathy and solidarity, yet these feelings are balanced by a sense of discomfort and distance, reminding tourists in a visceral way that they do not belong.

Effects of Oral Morphine on Dyspnea in Patients with Cancer: Response Rate, Predictive Factors, and Clinically Meaningful Change (CJLSG1101).

Although the efficacy of parenteral morphine for alleviating dyspnea has been previously demonstrated in several studies, little is known regarding the efficacy of oral morphine for dyspnea among patients with cancer, including its response rate and predictive factors of effectiveness. Therefore, the aim of this study was to clarify the effectiveness of oral morphine on dyspnea in patients with cancer and elucidate the predictive factors of its effectiveness. In this multicenter prospective observational study, we investigated the change in dyspnea intensity in patients with cancer before and after the administration of oral morphine by using a visual analog scale (VAS). We also administered a self-assessment questionnaire to determine whether the patients believed oral morphine was effective. Eighty patients were enrolled in the study, and 71 of these patients were eligible. The least square mean of the VAS scores for dyspnea intensity was 53.5 at baseline, which decreased significantly to 44.7, 40.8, and 35.0 at 30, 60, and 120 minutes after morphine administration, respectively. Fifty-four patients (76.1%) reported that oral morphine was effective on the self-assessment questionnaire. Among the background factors, a high score for "sense of discomfort" on the Cancer Dyspnea Scale (CDS) and a smoking history of fewer pack-years were associated with greater effectiveness. Oral morphine was effective and feasible for treating cancer-related dyspnea. A higher score for "sense of discomfort" on the CDS and a smaller cumulative amount of smoking may be predictive factors of the effectiveness of oral morphine. This study demonstrated that oral morphine was effective in alleviating cancer-related dyspnea due to multiple factors including primary lung lesions, airway narrowing, and pleural effusion. Approximately 76% of patients reported that oral morphine was effective. A higher score for "sense of discomfort" on the Cancer Dyspnea Scale and a lower cumulative amount of smoking may be predictive factors for the effectiveness of oral morphine. Interestingly, respiratory rates in patients who reported the morphine to be effective decreased significantly after oral morphine administration, unlike the respiratory rates in "morphine-ineffective" patients.

Unreadable Pleasures

Unreadable Pleasures Jan Mieszkowski (bio) Graecum est, non legitur. This past spring, I asked the students in my comp lit seminar to take a stab at translating Gertrude Stein’s “Rose is a rose is a rose is a rose” into another language. While most of them fashioned Spanish, French, or German versions of the iconic line, one tried to write it in her native Mandarin. The results impressed the only other native Chinese speaker in the class, but the rest of us were not able to appreciate the achievement: 玫瑰有三種存在形式﹕作為一朵玫瑰，作為一朵玫瑰的存在，作為一種存在的玫瑰存在。 Eager to get a sense of what she had done, we asked my student to translate her work back into English, as if we were playing a human version of the game whereby one uses Google Translate to toggle between two languages. Resisting the temptation to tell us that in English her text reads “Rose is a rose is . . .”, she gamely offered, “Rose can exist in three kinds of forms: as being a rose, as being an existence of rose, as being an existence of being a rose.”1 Even if one knows no Chinese whatsoever, there is much to work with in this translation of a translation, starting with what it reveals about the iterations of the word “is” in Stein’s original. In class, we reflected on the significance of grammar for assertions of logical identity, but the question soon “a-rose” as to precisely what we were talking about. Were we discussing Stein? My student’s translation of Stein? Her translation of her translation of Stein? Given that this was a comp [End Page 7] lit seminar, we wanted to say that we were “doing” comparative literature, but there was also some concern that we were operating on rather shaky ground insofar as one of our key reference points was a sentence that virtually none of us could so much as begin to read. Confronted with a sample of a language we did not know whose characters were completely unfamiliar, our sense of discomfort was complemented by admiration for the complexity and diversity of human languages, combined with some respect for, or envy of, the two members of our seminar who possessed a linguistic competency the rest of us would very much like to have. There was also an underlying sense of relief in encountering a string of signs on which we could not reasonably be expected to expend an ounce of hermeneutic energy. Language had not gone on holiday, but in our capacity as exegetes we had been temporarily furloughed. There was no need to debate the virtues of active versus passive or close versus distant reading—with my student’s sentence, reading of any sort was not an option for the vast majority of us. While in most circumstances, we reflexively try to assess, decode, and understand, we were distinctly pleased about being momentarily off the hook when faced with a verbal formation to or for which we had no responsibilities. Stein is notorious for unsettling our relationship with our own language in ways that make us uncomfortable, if not angry. The longer we read her “Rose is a rose” line, the less sure we are about what “rose” means, what “is” means, and what “a” means, much less what repetition, assuming that’s what this is, means. At the same time, Stein routinely suggests that her efforts to expose the volatility or outright instability of the linguistic realm are an attempt to remind us that, absent precarity and uncertainty, words are boring. Her oeuvre is a veritable hymn to the pleasure inherent in the realization that even in our native tongue, we are at best just barely keeping our heads above water and maintaining the fiction that as creatures of the logos our experiences are rational and coherent. If many passages in Stein’s texts can appear to be no less inscrutable than a string of unfamiliar logograms, she is steadfastly optimistic that there is something to be enjoyed in such brushes with the indecipherable. On this basis, Stein’s kinship with Edgar Allan Poe goes well beyond the curious fact that upon her death, Poe’s great-nephew, also named Edgar Allan Poe...

An investigation into the effect of parabolic speed hump profiles on ride comfort and driving safety under variable vehicle speeds: A campus experience

This study aims to investigate the effect of parabolic speed hump profiles on ride comfort and driving safety under variable vehicle speeds. To this end, in-situ and simulation tests were carried out in which root-mean-square values were evaluated. Field tests were performed on seven parabolic speed humps within the boundaries of Istanbul Technical University Ayazaga Campus Area. These tests were conducted twice with different loads. Five vehicle speeds were taken into account within the range of 15 km/h to 35 km/h with 5 km/h increments. As in-situ tests focused on the measurement of the vertical acceleration when crossing the speed humps, maximum vertical accelerations and root-mean-square values were recorded by means of an accelerometer and a software. Two sets of parabolic speed hump profiles were considered for the simulation stage and then the results of the field tests and the simulation tests were compared.The results have yielded vehicle speed and parabolic speed hump height as the most important parameters affecting ride comfort and driving safety. It has also been demonstrated that the weight of the vehicle is negatively associated with motorists’ sense of discomfort and an increase in the length of speed humps results in slightly better ride comfort.

Intimacy at work: servant and employer relations in Que horas ela volta? (The second mother)

ABSTRACTThis chapter examines servant/employer relationships in Anna Muylaert’s film Que horas ela volta? (The Second Mother, 2015). Written in the first person by someone who locates herself as a white, middle-class Brazilian from humble origins who has lived abroad for nearly 30 years, the chapter focuses on the sense of discomfort caused on her by the film and by Brazilian middle-class reliance on domestic servants, whilst at the same time analysing the role played by intimacy and servitude in the film. In dialogue with Sérgio Buarque de Holanda’s definition(s) of “cordialidade” (and with later discussions of it), the chapter examines what “cordialidade” can mean in the context of employers/domestic servants relationships in contemporary Brazil.

Implicit decision framing as an unrecognized source of confusion in endangered species classification.

Legal classification of species requires scientific and values-based components, and how those components interact depends on how people frame the decision. Is classification a negotiation of trade-offs, a decision on how to allocate conservation efforts, or simply a comparison of the biological status of a species to a legal standard? The answers to problem-framing questions such as these influence decision making in species classifications. In our experience, however, decision makers, staff biologists, and stakeholders often have differing perspectives of the decision problem and assume different framings. In addition to differences between individuals, in some cases it appears individuals themselves are unclear about the decision process, which contributes to regulatory paralysis, litigation, and a loss of trust by agency staff and the public. We present 5 framings: putting species in the right bin, doing right by the species over time, saving the most species on a limited budget, weighing extinction risk against other objectives, and strategic classification to advance conservation. These framings are inspired by elements observed in current classification practices. Putting species in the right bin entails comparing a scientific status assessment with policy thresholds and accounting for potential misclassification costs. Doing right by the species adds a time dimension to the classification decision, and saving the most species on a limited budget classifies a suite of species simultaneously. Weighing extinction risk against other objectives would weigh ecological or socioeconomic concerns in classification decisions, and strategic classification to advance conservation would make negotiation a component of classification. We view these framings as a means to generate thought, discussion, and movement toward selection and application of explicit classification framings. Being explicit about the decision framing could lead decision makers toward more efficient and defensible decisions, reduce internal confusion and external conflict, and support better collaboration between scientists and policy makers.

БОЛЬОВІ ТА ВЕРТЕБРОГЕННІ СИНДРОМИ У ХВОРИХ НА РОЗСІЯНИЙ СКЛЕРОЗ (ОГЛЯД ЛІТЕРАТУРИ)

Multiple sclerosis (MS) is the most prevalent disease of the central nervous system (CNS), that causes persistent disability of young people at the working age. Among the most frequent MS syndromes are coordinative disorders, visual disturbances, central pareses, pelvic disorders, sense of discomfort, but not pain. It has been established that half of these patients suffer from chronic pain. Very often the pain is the first manifestation of MS (in up to 11% cases). The article presents the features of pain syndromes, as well as spinal diseases as manifestations of comorbid states in MS. We have also analyzed their connection with clinical features of the MS course. The problem of pain syndrome in MS patients becomes more and more important nowadays. Recent studies suggest that at least 2/3 of patients with this ailment have pain to varying degrees and at least 40% of them characterized their pain as persistent one. MS patients in the presence of pain syndrome are more disabled and socially disadapted than those with a similar neurological defect without pain syndrome. Patients with MS presenting with pain syndrome predominantly have headache, pain in the cervical-thoracic and lumbar-sacral spine, and neuropathic pain in the lower limbs. Taking into account the urgency of the problem of pain and vertebrogenic syndromes in demyelinating diseases, it requires close attention and further study. Vertebrogenic syndromes in MS develop due to the influence of several factors, mostly, centers of demyelination, dystrophic changes in the spine and osteoporosis. In MS, vertebrogenic syndromes have their own hallmarks. It is an early onset, a long-term pain without clear periods of deterioration and improvement, moderately evident muscular-tonic disorders that are observed in all parts of the spine. Neurological disorders in MS accelerate development of diverse functional and organic (dystrophic) processes in the spine. Often, vertebrogenic and pain syndromes precede the widespread clinical picture of the disease, when patients for months and years are treated by manual therapists, and sometimes by neurosurgeons. Only a timely observation by neurologist and MRI of the brain and spinal cord can establish the correct diagnosis.