826 research outputs found
Functional somatic disorders: discussion paper for a new common classification for research and clinical use
Background
Functional somatic symptoms and disorders are common and complex phenomena involving both bodily and brain processes. They pose major challenges across medical specialties. These disorders are common and have significant impacts on patients’ quality of life and healthcare costs.
Main body
We outline five problems pointing to the need for a new classification: (1) developments in understanding aetiological mechanisms; (2) the current division of disorders according to the treating specialist; (3) failure of current classifications to cover the variety of disorders and their severity (for example, patients with symptoms from multiple organs systems); (4) the need to find acceptable categories and labels for patients that promote therapeutic partnership; and (5) the need to develop clinical services and research for people with severe disorders.
We propose ‘functional somatic disorders’ (FSD) as an umbrella term for various conditions characterised by persistent and troublesome physical symptoms. FSDs are diagnosed clinically, on the basis of characteristic symptom patterns. As with all diagnoses, a diagnosis of FSD should be made after considering other possible somatic and mental differential diagnoses. We propose that FSD should occupy a neutral space within disease classifications, favouring neither somatic disease aetiology, nor mental disorder. FSD should be subclassified as (a) multisystem, (b) single system, or (c) single symptom. While additional specifiers may be added to take account of psychological features or co-occurring diseases, neither of these is sufficient or necessary to make the diagnosis. We recommend that FSD criteria are written so as to harmonise with existing syndrome diagnoses. Where currently defined syndromes fall within the FSD spectrum – and also within organ system-specific chapters of a classification – they should be afforded dual parentage (for example, irritable bowel syndrome can belong to both gastrointestinal disorders and FSD).
Conclusion
We propose a new classification, ‘functional somatic disorder’, which is neither purely somatic nor purely mental, but occupies a neutral space between these two historical poles. This classification reflects both emerging aetiological evidence of the complex interactions between brain and body and the need to resolve the historical split between somatic and mental disorders
Force induced stretched state: Effects of temperature
A model of self avoiding walks with suitable constraint has been developed to
study the effect of temperature on a single stranded DNA (ssDNA) in the
constant force ensemble. Our exact calculations for small chains show that the
extension (reaction co-ordinate) may increase or decrease with the temperature
depending upon the applied force. The simple model developed here which
incorporates semi-microscopic details of base direction provide an explanation
of the force induced transitions in ssDNA as observed in experiments.Comment: 5 pages, 8 figures, RevTex
Influence of the structural modulations and the Chain-ladder interaction in the compounds
We studied the effects of the incommensurate structural modulations on the
ladder subsystem of the family of compounds
using ab-initio explicitly-correlated calculations. From these calculations we
derived model as a function of the fourth crystallographic coordinate
describing the incommensurate modulations. It was found that in the
highly calcium-doped system, the on-site orbital energies are strongly
modulated along the ladder legs. On the contrary the two sites of the ladder
rungs are iso-energetic and the holes are thus expected to be delocalized on
the rungs. Chain-ladder interactions were also evaluated and found to be very
negligible. The ladder superconductivity model for these systems is discussed
in the light of the present results.Comment: 8 octobre 200
Two-phase stretching of molecular chains
While stretching of most polymer chains leads to rather featureless
force-extension diagrams, some, notably DNA, exhibit non-trivial behavior with
a distinct plateau region. Here we propose a unified theory that connects
force-extension characteristics of the polymer chain with the convexity
properties of the extension energy profile of its individual monomer subunits.
Namely, if the effective monomer deformation energy as a function of its
extension has a non-convex (concave up) region, the stretched polymer chain
separates into two phases: the weakly and strongly stretched monomers.
Simplified planar and 3D polymer models are used to illustrate the basic
principles of the proposed model. Specifically, we show rigorously that when
the secondary structure of a polymer is mostly due to weak non-covalent
interactions, the stretching is two-phase, and the force-stretching diagram has
the characteristic plateau. We then use realistic coarse-grained models to
confirm the main findings and make direct connection to the microscopic
structure of the monomers. We demostrate in detail how the two-phase scenario
is realized in the \alpha-helix, and in DNA double helix. The predicted plateau
parameters are consistent with single molecules experiments. Detailed analysis
of DNA stretching demonstrates that breaking of Watson-Crick bonds is not
necessary for the existence of the plateau, although some of the bonds do break
as the double-helix extends at room temperature. The main strengths of the
proposed theory are its generality and direct microscopic connection.Comment: 16 pges, 22 figure
Resistance training concomitant to radiotherapy of spinal bone metastases – survival and prognostic factors of a randomized trial
Stretched Polymers in a Poor Solvent
Stretched polymers with attractive interaction are studied in two and three
dimensions. They are described by biased self-avoiding random walks with
nearest neighbour attraction. The bias corresponds to opposite forces applied
to the first and last monomers. We show that both in and a phase
transition occurs as this force is increased beyond a critical value, where the
polymer changes from a collapsed globule to a stretched configuration. This
transition is second order in and first order in . For we
predict the transition point quantitatively from properties of the unstretched
polymer. This is not possible in , but even there we can estimate the
transition point precisely, and we can study the scaling at temperatures
slightly below the collapse temperature of the unstretched polymer. We find
very large finite size corrections which would make very difficult the estimate
of the transition point from straightforward simulations.Comment: 10 pages, 16 figure
A Clinical Trial
Purpose The aim of this study was the systematic image quality evaluation of
coronary CT angiography (CTA), reconstructed with the 3 different levels of
adaptive iterative dose reduction (AIDR 3D) and compared to filtered back
projection (FBP) with quantum denoising software (QDS). Methods Standard-dose
CTA raw data of 30 patients with mean radiation dose of 3.2 ± 2.6 mSv were
reconstructed using AIDR 3D mild, standard, strong and compared to FBP/QDS.
Objective image quality comparison (signal, noise, signal-to-noise ratio
(SNR), contrast-to-noise ratio (CNR), contour sharpness) was performed using
21 measurement points per patient, including measurements in each coronary
artery from proximal to distal. Results Objective image quality parameters
improved with increasing levels of AIDR 3D. Noise was lowest in AIDR 3D strong
(p≤0.001 at 20/21 measurement points; compared with FBP/QDS). Signal and
contour sharpness analysis showed no significant difference between the
reconstruction algorithms for most measurement points. Best coronary SNR and
CNR were achieved with AIDR 3D strong. No loss of SNR or CNR in distal
segments was seen with AIDR 3D as compared to FBP. Conclusions On standard-
dose coronary CTA images, AIDR 3D strong showed higher objective image quality
than FBP/QDS without reducing contour sharpness
Theory of High-Force DNA Stretching and Overstretching
Single molecule experiments on single- and double stranded DNA have sparked a
renewed interest in the force-extension of polymers. The extensible Freely
Jointed Chain (FJC) model is frequently invoked to explain the observed
behavior of single-stranded DNA. We demonstrate that this model does not
satisfactorily describe recent high-force stretching data. We instead propose a
model (the Discrete Persistent Chain, or ``DPC'') that borrows features from
both the FJC and the Wormlike Chain, and show that it resembles the data more
closely. We find that most of the high-force behavior previously attributed to
stretch elasticity is really a feature of the corrected entropic elasticity;
the true stretch compliance of single-stranded DNA is several times smaller
than that found by previous authors. Next we elaborate our model to allow
coexistence of two conformational states of DNA, each with its own stretch and
bend elastic constants. Our model is computationally simple, and gives an
excellent fit through the entire overstretching transition of nicked,
double-stranded DNA. The fit gives the first values for the elastic constants
of the stretched state. In particular we find the effective bend stiffness for
DNA in this state to be about 10 nm*kbt, a value quite different from either
B-form or single-stranded DNAComment: 33 pages, 11 figures. High-quality figures available upon reques
Theory of biopolymer stretching at high forces
We provide a unified theory for the high force elasticity of biopolymers
solely in terms of the persistence length, , and the monomer spacing,
. When the force f>\fh \sim k_BT\xi_p/a^2 the biopolymers behave as Freely
Jointed Chains (FJCs) while in the range \fl \sim k_BT/\xi_p < f < \fh the
Worm-like Chain (WLC) is a better model. We show that can be estimated
from the force extension curve (FEC) at the extension
(normalized by the contour length of the biopolymer). After validating the
theory using simulations, we provide a quantitative analysis of the FECs for a
diverse set of biopolymers (dsDNA, ssRNA, ssDNA, polysaccharides, and
unstructured PEVK domain of titin) for . The success of a specific
polymer model (FJC or WLC) to describe the FEC of a given biopolymer is
naturally explained by the theory. Only by probing the response of biopolymers
over a wide range of forces can the -dependent elasticity be fully
described.Comment: 20 pages, 4 figure
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