Думать по-другому при психосоматических состояниях у ревматологических больных (изменение стиля мышления врача)

The concept of a 'health care realm' is introduced. The healthcare realms considered were those patients who have only Physical Health Problems (PH), patients with neither physical nor mental health issues and who are seeking advice to remain healthy (HP), patients only with Mental Health Problems (MH), patients with both Physical Health and Mental Health Problems (PH&MH) and patients with Psychosomatic Health conditions (PS). Described is how patients' minds and bodies interact and its relevance to rheumatology practice. Presented is the culmination of 34 years of the author's experience of rheumatological disorders based in Family Medicine in a United Kingdom General Practice. Also presented are 2 small studies supplementing the main conclusions. The first small study counted the main consultation content of 246 patients, as considered by the principals in the practice. Of these 73.5% were for physical health conditions, 13.3% for health promotion, 11.5% for mental health conditions and 1.8% for psychosomatic conditions. The second small study was a survey of experienced GPs, Physicians and Psychiatrists, asking about their opinions on how well the patients in different health care realms were being managed across the healthcare system. Of the 5 realms, the collective view was that it was the patients in the PH realm who was clearly received the best care. The least good care was being given to patients in the PS realm and only marginally better were patients in the MH Realm. This paper argues that clinicians need a different thinking approach when meeting patients from different healthcare realms. It is known that when doctors treat PH patients, they consider the patient's symptoms against templates of knowledge for the conditions in the differential diagnosis. Furthermore, HP patients are assessed by comparing the patient's bio-measurements against known markers of good health When being consulted by patients in the MH or PS realms, it is advocated, not to follow the approach of PH patients. For patients in the MH realm it is best to address the patient's life as a whole and to consider, how did the person arrive to the situation he is in and what needs to be done to restore the patient's life back on track. For patients in the PS realm, ideally the aim is to help the patient make the link between the physical symptom and its psychological aetiology. A step towards this is to describe how the body physically mediates the symptom.В статье рассматривается понятие «клиническая группа». Выделены следующие клинические группы: пациенты, у которых есть проблемы только с физическим здоровьем (соматические расстройства – СР); пациенты без нарушений физического или психического здоровья, которые обращаются по поводу сохранения здоровья (СЗ); пациенты только с проблемами психического здоровья (психические расстройства – ПР); пациенты с нарушением физического и психического здоровья (соматические и психические расстройства – СР + ПР) и пациенты с психосоматическими расстройствами (ПСР). На примере ревматических заболеваний (РЗ) описано взаимодействие психической и соматической сферы. Статья является итогом 34-летнего опыта автора в области лечения РЗ в условиях семейной медицины и общей практики Великобритании. Основные положения статьи дополнены данными двух небольших исследований. Первое исследование включало 246 пациентов, среди которых 73,5% получали консультации по поводу СР, 13,3% – СЗ, 11,5% – ПР и 1,8% – ПСР. Второе исследование основано на результатах анкетирования опытных врачей общей практики и психиатров, которые оценивали, насколько хорошо, по их мнению, пациентам разных клинических групп оказывается медицинская помощь в рамках существующей системы здравоохранения. По оценкам врачей, наиболее квалифицированную помощь получают пациенты группы СР, а наименее квалифицированную – пациенты группы ПСР, немногим лучше были показатели для пациентов группы ПР. Утверждается, что при работе с каждой клинической группой клиницист должен использовать особый подход в мышлении. При лечении пациентов с СР врачи рассматривают симптомы, опираясь на стандарты диагностики этих заболеваний. Состояние пациентов группы СЗ оценивается путем сравнения результатов обследования с известными маркерами хорошего здоровья. Пациенты группы ПР или ПСР требуют иного подхода, чем пациенты с СР. При консультировании пациентов с ПР стоит обратиться к истории их жизни и проанализировать, что привело человека к сложной ситуации и что необходимо сделать, чтобы вернуть его к нормальной жизни. При ведении пациента с ПСР важно обратить его внимание на связь между соматическими нарушениями и их психической причиной, разъяснив, как организм реагирует на психическое неблагополучие

Does the Third Law of Thermodynamics hold in the Quantum Regime?

The first in a long series of papers by John T. Lewis, G. W. Ford and the present author, considered the problem of the most general coupling of a quantum particle to a linear passive heat bath, in the course of which they derived an exact formula for the free energy of an oscillator coupled to a heat bath in thermal equilibrium at temperature T. This formula, and its later extension to three dimensions to incorporate a magnetic field, has proved to be invaluable in analyzing problems in quantum thermodynamics. Here, we address the question raised in our title viz. Nernst's third law of thermodynamics

An Introduction to the Source Concept for Antennas

Antenna parameters particularly relevant to electrically small antenna design are reviewed in this paper. Source current definitions are accentuated leading to the introduction of the source concept which advantageously utilize only spatially bounded quantities. The framework of the source concept incorporates powerful techniques such as structural and modal decomposition, operator’s inversion and current optimization, thus opening new, challenging possibilities for antenna design, analysis and synthesis

Upper bounds on absorption and scattering

A general framework for determining fundamental bounds in nanophotonics is introduced in this paper. The theory is based on convex optimization of dual problems constructed from operators generated by electromagnetic integral equations. The optimized variable is a contrast current defined within a prescribed region of a given material constitutive relations. Two power conservation constraints analogous to optical theorem are utilized to tighten the bounds and to prescribe either losses or material properties. Thanks to the utilization of matrix rank-1 updates, modal decompositions, and model order reduction techniques, the optimization procedure is computationally efficient even for complicated scenarios. No dual gaps are observed. The method is well-suited to accommodate material anisotropy and inhomogeneity. To demonstrate the validity of the method, bounds on scattering, absorption, and extinction cross sections are derived first and evaluated for several canonical regions. The tightness of the bounds is verified by comparison to optimized spherical nanoparticles and shells. The next metric investigated is bi-directional scattering studied closely on a particular example of an electrically thin slab. Finally, the bounds are established for Purcell's factor and local field enhancement where a dimer is used as a practical example.Comment: 38 pages, 16 figure

On apparent breaking the second law of thermodynamics in quantum transport studies

We consider a model for stationary electronic transport through a one-dimensional chain of two leads attached to a perturbed central region (quantum dot) in the regime where the theory proposed recently by Capek for a similar model of phonon transport predicts the striking phenomenon of a permanent current between the leads. This result based on a rigorous but asymptotic Davies theory is at variance with the zero current yielded by direct transport calculations which can be carried out in the present model. We find the permanent current to be within the error of the asymptotic expansion for finite couplings, and identify cancelling terms of the same order.Comment: 5 pages, 3 figure

Characteristic modes – progress, overview, and emerging topics

Over the past decade, characteristic mode analysis (CMA) research has grown from a niche topic to a mainstream topic, warranting a tutorial-style special issue to survey the significant progress that has been made in this field. In thisintroductory article (PAPER 1), the focus is on providing the big picture. We start with a simple description of characteristic modes. Next, we examine the trends in this field, followed by providing further insights into CMA’s historical development. We will also address common myths surrounding the subject. Then, leaving the detailed coverage of major topics to the following papers, we summarize recent applications of CMA in scattering and other emerging topics. Finally, we conclude with some future perspectives on this field