Paediatric Multiple Sclerosis: A Scoping Review of Patients’ and Parents’ Perspectives

Dealing with paediatric-onset multiple sclerosis is particularly challenging for the young patients and their families, due to its unpredictable symptoms and uncertain outcome. This review aimed at synthesising the qualitative evidence regarding the perspectives about paediatric-onset multiple sclerosis, as expressed by the patients and/or their parents. A literature search was conducted on PubMed and CINAHL. The advanced multi-field search allowed to perform an abstract/title search in both databases, using keywords, combined through Boolean operators. Additional search strategies were adopted: searching the reference list of the selected papers; searching for key authors in the field. All the relevant papers were thoroughly revised using The Joanna Briggs Institute’s data extraction form for qualitative evidence as a guidance. Eight papers were selected. The analysis of these papers allowed to identify some common issues pertaining paediatric-onset multiple sclerosis: (1) onset of symptoms, (2) diagnostic process, (3) reaction to the diagnosis, (4) management and acceptance of multiple sclerosis. The burden of multiple sclerosis was confirmed. However, the young patients and their parents can adjust to the disease. Both the community and the health care professionals must strive to prevent the families dealing with multiple sclerosis from experiencing solitude and rejection.

Pupil Dilation and Response Slowing Distinguish Deliberate Explorative Choices in the Probabilistic Learning Task

This study examined whether pupil size and response time would distinguish directed exploration from random exploration and exploitation. Eighty-nine participants performed the two-choice probabilistic learning task while their pupil size and response time were continuously recorded. Using LMM analysis, we estimated differences in the pupil size and response time between the advantageous and disadvantageous choices as a function of learning success, i.e., whether or not a participant has learned the probabilistic contingency between choices and their outcomes. We proposed that before a true value of each choice became known to a decision-maker, both advantageous and disadvantageous choices represented a random exploration of the two options with an equally uncertain outcome, whereas the same choices after learning manifested exploitation and direct exploration strategies, respectively. We found that disadvantageous choices were associated with increases both in response time and pupil size, but only after the participants had learned the choice-reward contingencies. For the pupil size, this effect was strongly amplified for those disadvantageous choices that immediately followed gains as compared to losses in the preceding choice. Pupil size modulations were evident during the behavioral choice rather than during the pretrial baseline. These findings suggest that occasional disadvantageous choices, which violate the acquired internal utility model, represent directed exploration. This exploratory strategy shifts choice priorities in favor of information seeking and its autonomic and behavioral concomitants are mainly driven by the conflict between the behavioral plan of the intended exploratory choice and its strong alternative, which has already proven to be more rewarding.

Errant Readers

This chapter discusses serialized translated novels. The Arabic novel made its own proper entry into the Arabic print sphere at this moment as a part of the uncertain reform project of print culture. Novels were published after and alongside a larger body of serialized translated novels that in fact occupied the greater part of the new audience's leisure reading habits. Over the course of the first decades of commercial print from the late 1850s to the late 1870s, serialized translated novels appeared in almost every type of Arabic periodical; for many readers, the word “novel” itself probably referred to these works and not the few original ones produced to compete with them. It was not just news translation that was central to the development of Arabic print culture; the translated novel, which appeared first and most prominently in serialized form, was often identified as part of periodicals' reform projects. At the same time that editors embraced translated fiction as a vehicle for their messages, however, their claim that these works served serious moral purposes was by no means indisputable. These novels' excesses were not always containable by the moral intentions of journal editors, who sometimes resorted to qualifications and elaborate interpretations in order to justify their publication. Print's civilizing reform mission, as uncertain as it was, had a primary object: the modern reading subject. Transforming the public into a reading public, and one that read properly, was the goal of many magazine producers who outlined ideal reading practices and modeled them through novels. And it was likewise a goal with an uncertain outcome.

Evaluation of LSTR 3 Mix MP Therapy for Healing of Periapical Pathosis of Nonvital Teeth

Context: LSTR 3 Mix MP therapy is one of the procedures for the management of nonvital tooth with periapical lesion. The principle of this therapy is the complete sterilization of the total pulp canal space, thereby healing of the periradicular lesion. Objectives: To assess the clinical and radiological outcome of ‘Lesion sterilization and Tissue Repair’ (LSTR) for endodontic treatment of nonvital teeth with periapical lesion. Materials and Methods: This descriptive, observational study allocated 40 nonvital teeth with periapical lesion treated by LSTR 3 Mix MP Therapy. In study subjects, a mixture of Metronidazole, Ciprofloxacin and Minocycline (3 Mix) in a proportion of 1:1:1 in ointment (Macrogol mixed with propylene glycol: MP) was placed at the orifice of the root canal or the bottom of pulp chamber after gaining access in the pulp chamber and removal of necrotic pulp, then sealed with Glass Ionomer cement and further reinforced by composite resin. The protocols for follow up examination were 3, 6 and 12 months post operatively. At the time of follow up examination a standard follow up chart was maintained. Results: Out of 40 cases, in 29 cases had good responses both clinically and radiologically and 8 patients came back with some complications. Out of these 8 patients, 6 patients had uncertain outcome and in 2 patients it was unacceptable. Conclusion: LSTR 3 mix MP therapy reduced clinical signs and symptoms successfully in teeth with periapical lesion and radiological improvement of the periapical index was also noted. TAJ 2020; 33(2): 76-84

Researchers’ perceptions of malaria eradication: findings from a mixed-methods analysis of a large online survey

Background The value of malaria eradication, the permanent reduction to zero of the worldwide incidence of malaria infection caused by human malaria parasites, would be enormous. However, the expected value of an investment in an intended, but uncertain, outcome hinges on the probability of, and time until, its fulfilment. Though the long-term benefits of global malaria eradication promise to be large, the upfront costs and uncertainty regarding feasibility and timeframe make it difficult for policymakers and researchers to forecast the return on investment. Methods A large online survey of 844 peer-reviewed malaria researchers of different scientific backgrounds administered in order to estimate the probability and time frame of eradication. Adjustments were made for potential selection bias, and thematic analysis of free text comments was carried out. Results The average perceived likelihood of global eradication among malaria researchers approximates the number of years into the future: approximately 10% of researchers believe that eradication will occur in the next 10 years, 30% believe it will occur in the next 30 years, and half believe eradication will require 50 years or more. Researchers who gave free form comments highlighted systemic challenges and the need for innovation as chief among obstacles to achieving global malaria eradication. Conclusions The findings highlight the difficulty and complexity of malaria eradication, and can be used in prospective cost–benefit analyses to inform stakeholders regarding the likely return on eradication-specific investments.

Invited perspectives: The volcanoes of Naples: how can the highest volcanic risk in the world be effectively mitigated?

The Naples (southern Italy) area has the highest volcanic risk in the world due to the coexistence of three highly explosive volcanoes (Vesuvius, Campi Flegrei and Ischia) with extremely dense urbanisation. More than 3 million people live to within 20 kilometres from a possible eruptive vent. Mitigating such an extreme risk is made difficult because volcanic eruption forecasting is currently an empirical procedure with a very uncertain outcome. This paper starts by recalling the state of the art of eruption forecasting, and then describes the main hazards in the Neapolitan area, shortly presenting the activity and present state of its volcanoes. Then, it proceeds to suggest the most effective procedures to mitigate the extreme volcanic and associated risks. The problem is addressed in a highly multidisciplinary way, taking into account the main economic, sociological and urban issues. The proposed mitigation actions are then compared with the existing emergency plans, developed by Italian Civil Protection, by highlighting their numerous, very evident faults. Our study, besides regarding the most complex and extreme situation of volcanic risk in the world, gives guidelines for assessing and managing volcanic risk in any densely urbanised area.

The Volcanoes of Naples: how effectively mitigating the highest volcanic risk in the World?

The Naples (Southern Italy) area has the highest volcanic risk in the World, due to the coexistence of three highly explosive volcanoes (Vesuvius, Campi Flegrei and Ischia) with extremely dense urbanisation. More than three millions people live to within twenty kilometres from a possible eruptive vent. Mitigating such an extreme risk is made difficult because volcanic eruptions forecast is today an empirical procedure with very uncertain outcome. This paper starts recalling the state of the art of eruption forecast, and then describes the main hazards in the Neapolitan area, shortly presenting the activity and present state of its volcanoes. Then, it proceeds to suggest the most effective procedures to mitigate the extreme volcanic and associated risks. The problem is afforded in a highly multidisciplinary way, taking into account the main economic, sociological and urban issues. The proposed mitigation actions are then compared with the existing emergency plans, developed by Italian Civil Protection, by highlighting their numerous, very evident problems. Our study, besides regarding the most complex and extreme situation of volcanic risk in the World, gives guidelines to assessing and managing volcanic risk in any densely urbanised area.

Discretionary Authority and Prioritizing in Government Agencies

Government agencies have a certain freedom to choose among different possible courses of action. This article studies agency decision making on priorities in a principal–agent framework with multiple tasks. Agency leadership has discretion over part of the agency’s budget to incentivize staff in the pickup of cases. The head is concerned not only with society’s benefits from the agency’s overall performance, but also with the organization’s public image. Based on their talent and the contracts offered by the head, staff officials choose which type of task to pursue: complex major cases with an uncertain outcome or basic minor and simple cases with a higher probability of success. We show how the size of the agency’s discretionary budget influences both the scale and type of tasks it will engage in. Small changes in the budget can cause extensive restructuring from major to minor tasks, or vice versa, causing social welfare jumps. The mechanism provides overhead authorities with some control over the priorities of supposedly independent agencies. It applies generally to government bureaus with the formal and informal discretion to choose their tasks. Antitrust authorities serve as one illustration of implications for institutional design.

Anxiety in children and adolescents

Anxiety is the physiological state of fear, unease or apprehension experienced by an individual in the face of an uncertain outcome. Anxiety disorders are characterised by recurrent symptoms of anxiety disproportionate to the eliciting situation, and are the most common disorders of emotion among young people in the UK. They have an early onset and increasing prevalence. This article provides a detailed insight into causes, diagnosis and management strategies for the different anxiety disorders in young people within primary care and the wider community.