The importance of contextual aspects in the care for patients with functional somatic symptoms

Functional somatic symptoms refer to physical symptoms that cannot be (bio) medically explained. The pattern or clustering of such symptoms may lead to functional syndromes like chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, among many others. Since the underlying pathophysiology remains unknown, several explanatory models have been proposed, nearly all including social and psychological parameters. These models have stimulated effectiveness studies of several psychological and psychopharmacological therapies. While the evidence for their effectiveness is steadily growing, effect-sizes are at most moderate and many patients do not benefit. We hypothesize that the context in which interventions for functional somatic symptoms are delivered substantially influences their effectiveness. Although this hypothesis is in line with explanatory models of functional somatic symptoms, to our knowledge, studies primarily focusing on the influence of contextual aspects on treatment outcome are scarce. Contextual research in the field of somatic symptoms has (irrespective whether these symptoms can be medically explained or not), however, just begun and already yielded some valuable results. These findings can be organized according to Duranti's and Goodwin's theoretical approach to context in order to substantiate our hypothesis. Based on this approach, we categorized empirical findings in three contextual aspects, i.e. 1) the setting, 2) the behavioural environment, and 3) the language environment. Collectively, some support is found for the fact that early identification of patients with functional somatic symptoms, starting treatment as soon as possible, having a neat appearance and an organized office interior, a warm and friendly nonverbal approach and a language use without defensiveness are contextual parameters which enhance the assessment by the patient of the physician's competence to help. Nonetheless, in vivo studies addressing the most aspects, i.e. nonverbal behaviour and language, are needed for better understanding of these contextual aspect. Moreover, future research should address to what extent optimizing contextual aspects improve care for functional somatic symptoms

"One time I fell, but I didn't have to cry." A qualitative study on everyday physical complaints in children

OBJECTIVE: Young children experience physical complaints, like abdominal pain or minor injuries from playing, almost every day. These experiences may shape how they deal with health issues later in life. While models exist to explain illness perception in adults, information is lacking on the perspective of young children. This qualitative study aimed to explore important themes in the experience of everyday physical complaints in four- and five-year-old children, using children as informants. STUDY DESIGN: 30 semi-structured interviews were performed in which four- and five-year-old children were questioned about their experiences with everyday physical complaints. The interviews were double coded using Atlas.ti and subsequently qualitative content analysis was used to define themes. RESULTS: All participating children were able to elaborate on their experiences with physical complaints. Three themes emerged from the interviews: causes of complaints, appraisal of complaints, and implications of complaints. In their appraisal of complaints, four- and five-year-old children made a distinction between visible and invisible complaints and real or pretended complaints. CONCLUSION: Four- and five-year-old children can already give details about their experiences with everyday physical complaints. They have developed ideas about the causes and implications of complaints and try to make an appraisal

Explanations for medically unexplained symptoms:a qualitative study on GPs in daily practice consultations

BACKGROUND: General practice is the centre of care for patients with medically unexplained symptoms (MUS). Providing explanations for MUS, i.e. making sense of symptoms, is considered to be an important part of care for MUS patients. However, little is known how general practitioners (GPs) do this in daily practice. OBJECTIVE: This study aimed to explore how GPs explain MUS to their patients during daily general practice consultations. METHODS: A thematic content analysis was performed of how GPs explained MUS to their patients based on 39 general practice consultations involving patients with MUS. RESULTS: GP provided explanations in nearly all consultations with MUS patients. Seven categories of explanation components emerged from the data: defining symptoms, stating causality, mentioning contributing factors, describing mechanisms, excluding explanations, discussing the severity of symptoms and normalizing symptoms. No pattern of how GPs constructed explanations with the various categories was observed. In general, explanations were communicated as a possibility and in a patient-specific way; however, they were not very detailed. CONCLUSION: Although explanations for MUS are provided in most MUS consultations, there seems room for improving the explanations given in these consultations. Further studies on the effectiveness of explanations and on the interaction between patients and GP in constructing these explanations are required in order to make MUS explanations more suitable in daily primary care practice

Spectral density and Sobolev inequalities for pure and mixed states

We prove some general Sobolev-type and related inequalities for positive operators A of given ultracontractive spectral decay, without assuming e^{-tA} is submarkovian. These inequalities hold on functions, or pure states, as usual, but also on mixed states, or density operators in the quantum mechanical sense. This provides universal bounds of Faber-Krahn type on domains, that apply to their whole Dirichlet spectrum distribution, not only the first eigenvalue. Another application is given to relate the Novikov-Shubin numbers of coverings of finite simplicial complexes to the vanishing of the torsion of some l^{p,2}-cohomology

An IAEA Multi-technique X-ray Spectrometry End-station at Elettra Sincrotrone Trieste: Benchmarking Results and Interdisciplinary Applications

The International Atomic Energy Agency (IAEA) jointly with the Elettra Sincrotrone Trieste (EST) operates a multipurpose X-ray spectrometry endstation at the X-ray Fluorescence beamline (10.1L). The facility has been available to external users since the beginning of 2015 through the peer-review process of EST. Using this collaboration framework, the IAEA supports and promotes synchrotron-radiation-based research and training activities for various research groups from the IAEA Member States, especially those who have limited previous experience and resources to access a synchrotron radiation facility. This paper aims to provide a broad overview about various analytical capabilities, intrinsic features and performance figures of the IAEA X-ray spectrometry endstation through the measured results. The IAEA-EST endstation works with monochromatic X-rays in the energy range 3.7-14keV for the Elettra storage ring operating at 2.0 or 2.4GeV electron energy. It offers a combination of different advanced analytical probes, e.g. X-ray reflectivity, X-ray absorption fine-structure measurements, grazing-incidence X-ray fluorescence measurements, using different excitation and detection geometries, and thereby supports a comprehensive characterization for different kinds of nanostructured and bulk materials.A broad overview of the various analytical capabilities, intrinsic features and performance figures of the IAEA X-ray spectrometry endstation operated at the X-ray Fluorescence beamline of Elettra Sincrotrone Trieste is given, and different applications are demonstrated to familiarize the user community with the applicable intersdisciplinary research.Fil: Karydas, A.. International Atomic Energy Agency; Austria. National Centre for Scientific Research "Demokritos"; GreciaFil: Czyzycki, M.. International Atomic Energy Agency; Austria. AGH University of Science and Technology. Faculty of Physics and Applied Computer Science ; PoloniaFil: Leani, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Física Enrique Gaviola. Universidad Nacional de Córdoba. Instituto de Física Enrique Gaviola; Argentina. International Atomic Energy Agency; AustriaFil: Migliori, A.. International Atomic Energy Agency; Austria. Nuclear Spectrometry And Appications Lab, Iaea. Onu; AustriaFil: Osán, J.. Hungarian Academy of Sciences Centre for Energy Research; Hungría. International Atomic Energy Agency; AustriaFil: Bogovac, M.. International Atomic Energy Agency; AustriaFil: Wrobel, P.. AGH University of Science and Technology. Faculty of Physics and Applied Computer Science ; PoloniaFil: Vakula, N.. International Atomic Energy Agency; AustriaFil: Padilla Alvarez, R.. International Atomic Energy Agency; AustriaFil: Menk, Ralf Hendrik. Elettra-Sincrotrone Trieste SCpA di Interesse Nazionale; Italia. University of Saskatchewan; CanadáFil: Gol, M. G.. Iranian Light Source Facility; IránFil: Antonelli, M.. Istituto Nazionale di Fisica Nucleare; Italia. Elettra-Sincrotrone Trieste SCpA di Interesse Nazionale; ItaliaFil: Tiwari, M. K.. Raja Ramanna Centre for Advanced Technology; IndiaFil: Caliri, C.. Istituto Nazionale di Fisica Nucleare; ItaliaFil: Vogel Mikuš, K.. Jozef Stefan Institute; Eslovenia. University of Ljubljana; EsloveniaFil: Darby, I.. Elettra-Sincrotrone Trieste SCpA di Interesse Nazionale; Italia. International Atomic Energy Agency; AustriaFil: Kaiser, R.. International Atomic Energy Agency; Austri

Dynamics of high viscosity contrast confluent microfluidic flows

The laminar nature of microfluidic flows is most elegantly demonstrated via the confluence of two fluids forming two stable parallel flows within a single channel meeting at a highly stable interface. However, maintenance of laminar conditions can become complicated when there is a large viscosity contrast between the neighbouring flows leading to unique instability patterns along their interface. Here, we study the dynamics of high viscosity contrast confluent flows - specifically a core flow made of highly viscous glycerol confined by sheath flows made of water within a microfluidic flow focusing system. Our experiments indicate the formation of tapered core structures along the middle of the channel. Increasing the sheath flow rate shortens the tapered core, and importantly induces local instability patterns along the interface of core-sheath flows. The dynamics of such tapered core structures is governed by the intensity of instability patterns and the length of the core, according to which the core structure can experience stable, disturbed, broken or oscillated regimes. We have studied the dynamics of tapered core structures under these regimes. In particular, we have analysed the amplitude and frequency of core displacements during the broken core and oscillating core regimes, which have not been investigated before

Finding Homogeneity in Heterogeneity—A New Approach to Quantifying Landscape Mosaics Developed for the Lao PDR

A key challenge for land change science in general and research on swidden agriculture in particular, is linking land cover information to human–environment interactions over larger spatial areas. In Lao PDR, a country facing rapid and multi-level land change processes, this hinders informed policy- and decision-making. Crucial information on land use types and people involved is still lacking. This article proposes an alternative approach for the description of landscape mosaics. Instead of analyzing local land use combinations, we studied land cover mosaics at a meso-level of spatial scale and interpreted these in terms of human–environmental interactions. These landscape mosaics were then overlaid with population census data. Results showed that swidden agricultural landscapes, involving 17% of the population, dominate 29% of the country, while permanent agricultural landscapes involve 74% of the population in 29% of the territory. Forests still form an important component of these landscape mosaics

Low-cost workbench client / server cores for remote experiments in electronics

This paper offers an open-source solution to implement low-cost workbenches serving a wide range of remote experiments in electronics. The proposed solution comprises 1) a small (9,65 x 6,1 cm) Linux server board; 2) a server core supporting two TCP/IP communication channels, and general purpose I/O pin drivers to interface the remote experiment hardware; and 3) a client core based on a multi-tab user interface supporting text file management to exchange experiment scripts / status information, and a mini-browser for webcasting in distance learning scenarios, live image feedback from IP cameras located in the remote workbench, etc. Additional drivers and application-specific tabs can be added to the server / client cores, to suit the requirements of each application. Two remote workbenches for microcontroller and digital systems testing courses were developed, and are also presented in this document

Secondary education reform in Lesotho and Zimbabwe and the needs of rural girls: Pronouncements, policy and practice

Analysis of the educational needs of rural girls in Lesotho and Zimbabwe suggests a number of shortcomings in the current form of secondary education, and ways in which it might be modified so as to serve this sizeable group of students better. Several of the shortcomings, notably in relation to curricular irrelevance and excessive focus on examinations, have long been recognised, including by politicians. Yet political pronouncements are seldom translated into policy, and even where policy is formulated, reforms are seldom implemented in schools. This paper makes use of interviews with educational decision-makers in the two southern African countries and a range of documentary sources to explore why, despite the considerable differences between the two contexts, much needed educational reforms have been implemented in neither

A survey of free software for the design, analysis, modelling, and simulation of an unmanned aerial vehicle

The objective of this paper is to analyze free software for the design, analysis, modelling, and simulation of an unmanned aerial vehicle (UAV). Free software is the best choice when the reduction of production costs is necessary; nevertheless, the quality of free software may vary. This paper probably does not include all of the free software, but tries to describe or mention at least the most interesting programs. The first part of this paper summarizes the essential knowledge about UAVs, including the fundamentals of flight mechanics and aerodynamics, and the structure of a UAV system. The second section generally explains the modelling and simulation of a UAV. In the main section, more than 50 free programs for the design, analysis, modelling, and simulation of a UAV are described. Although the selection of the free software has been focused on small subsonic UAVs, the software can also be used for other categories of aircraft in some cases; e.g. for MAVs and large gliders. The applications with an historical importance are also included. Finally, the results of the analysis are evaluated and discussed—a block diagram of the free software is presented, possible connections between the programs are outlined, and future improvements of the free software are suggested. © 2015, CIMNE, Barcelona, Spain.Internal Grant Agency of Tomas Bata University in Zlin [IGA/FAI/2015/001, IGA/FAI/2014/006