Psychophysiological responses to visceral and somatic pain in functional chest pain identify clinically relevant pain clusters

Background: Despite chronic pain being a feature of functional chest pain (FCP) its experience is variable. The factors responsible for this variability remain unresolved. We aimed to address these knowledge gaps, hypothesizing that the psychophysiological profiles of FCP patients will be distinct from healthy subjects. Methods: 20 Rome III defined FCP patients (nine males, mean age 38.7 years, range 28-59 years) and 20 healthy age-, sex-, and ethnicity-matched controls (nine males, mean 38.2 years, range 24-49) had anxiety, depression, and personality traits measured. Subjects had sympathetic and parasympathetic nervous system parameters measured at baseline and continuously thereafter. Subjects received standardized somatic (nail bed pressure) and visceral (esophageal balloon distension) stimuli to pain tolerance. Venous blood was sampled for cortisol at baseline, post somatic pain and post visceral pain. Key Results: Patients had higher neuroticism, state and trait anxiety, and depression scores but lower extroversion scores vs controls (all p < 0.005). Patients tolerated less somatic (p < 0.0001) and visceral stimulus (p = 0.009) and had a higher cortisol at baseline, and following pain (all p < 0.001). At baseline, patients had a higher sympathetic tone (p = 0.04), whereas in response to pain they increased their parasympathetic tone (p ≤ 0.008). The amalgamating the data, we identified two psychophysiologically distinct 'pain clusters'. Patients were overrepresented in the cluster characterized by high neuroticism, trait anxiety, baseline cortisol, pain hypersensitivity, and parasympathetic response to pain (all p < 0.03). Conclusions & Inferences: In future, such delineations in FCP populations may facilitate individualization of treatment based on psychophysiological profiling

Modelling spectral and timing properties of accreting black holes: the hybrid hot flow paradigm

The general picture that emerged by the end of 1990s from a large set of optical and X-ray, spectral and timing data was that the X-rays are produced in the innermost hot part of the accretion flow, while the optical/infrared (OIR) emission is mainly produced by the irradiated outer thin accretion disc. Recent multiwavelength observations of Galactic black hole transients show that the situation is not so simple. Fast variability in the OIR band, OIR excesses above the thermal emission and a complicated interplay between the X-ray and the OIR light curves imply that the OIR emitting region is much more compact. One of the popular hypotheses is that the jet contributes to the OIR emission and even is responsible for the bulk of the X-rays. However, this scenario is largely ad hoc and is in contradiction with many previously established facts. Alternatively, the hot accretion flow, known to be consistent with the X-ray spectral and timing data, is also a viable candidate to produce the OIR radiation. The hot-flow scenario naturally explains the power-law like OIR spectra, fast OIR variability and its complex relation to the X-rays if the hot flow contains non-thermal electrons (even in energetically negligible quantities), which are required by the presence of the MeV tail in Cyg X-1. The presence of non-thermal electrons also lowers the equilibrium electron temperature in the hot flow model to <100 keV, making it more consistent with observations. Here we argue that any viable model should simultaneously explain a large set of spectral and timing data and show that the hybrid (thermal/non-thermal) hot flow model satisfies most of the constraints.Comment: 26 pages, 13 figures. To be published in the Space Science Reviews and as hard cover in the Space Sciences Series of ISSI - The Physics of Accretion on to Black Holes (Springer Publisher

The long-term survival chances of young massive star clusters

We review the long-term survival chances of young massive star clusters (YMCs), hallmarks of intense starburst episodes often associated with violent galaxy interactions. We address the key question as to whether at least some of these YMCs can be considered proto-globular clusters (GCs), in which case these would be expected to evolve into counterparts of the ubiquitous old GCs believed to be among the oldest galactic building blocks. In the absence of significant external perturbations, the key factor determining a cluster's long-term survival chances is the shape of its stellar initial mass function (IMF). It is, however, not straightforward to assess the IMF shape in unresolved extragalactic YMCs. We discuss in detail the promise of using high-resolution spectroscopy to make progress towards this goal, as well as the numerous pitfalls associated with this approach. We also discuss the latest progress in worldwide efforts to better understand the evolution of entire cluster systems, the disruption processes they are affected by, and whether we can use recently gained insights to determine the nature of at least some of the YMCs observed in extragalactic starbursts as proto-GCs. We conclude that there is an increasing body of evidence that GC formation appears to be continuing until today; their long-term evolution crucially depends on their environmental conditions, however.Comment: invited refereed review article; ChJA&A, in press; 33 pages LaTeX (2 postscript figures); requires chjaa.cls style fil

General Overview of Black Hole Accretion Theory

I provide a broad overview of the basic theoretical paradigms of black hole accretion flows. Models that make contact with observations continue to be mostly based on the four decade old alpha stress prescription of Shakura & Sunyaev (1973), and I discuss the properties of both radiatively efficient and inefficient models, including their local properties, their expected stability to secular perturbations, and how they might be tied together in global flow geometries. The alpha stress is a prescription for turbulence, for which the only existing plausible candidate is that which develops from the magnetorotational instability (MRI). I therefore also review what is currently known about the local properties of such turbulence, and the physical issues that have been elucidated and that remain uncertain that are relevant for the various alpha-based black hole accretion flow models.Comment: To be published in Space Science Reviews and as hard cover in the Space Sciences Series of ISSI: The Physics of Accretion on to Black Holes (Springer Publisher