Empirical foundations for the diagnosis of somatization:implications for DSM-5

Background. The aim of this study was to develop empirically validated criteria for the diagnoses of clinically relevant somatization. Method. This study was performed in a population-representative cohort consisting of 461 males (47.8%) and 503 females (52.2%), with an average age of 55.8 years (S.D. = 11.1). Somatization, anxiety and depression were derived from the Composite International Diagnostic Interview. Mplus was used to perform confirmative factor analyses on the current DSM-IV symptom groups; on alternative symptom clusters previously suggested; and to perform latent class analysis in order to define an empirically derived cut-off for somatization. Results. The existence of symptom groups as described in DSM-IV was not supported by our data, whereas a differentiation between cardiopulmonary, musculoskeletal, gastrointestinal and general somatic symptoms did fit our data. Latent class analysis revealed two classes characterized by few (n = 859) and many (n = 105) symptoms. The class of subjects could be approached by a simple cut-off of four functional symptoms (sensitivity 79%, specificity 98%, positive predictive value 82%, negative predictive value 97%) regardless of the number of organ systems involved. Conclusions. This study in a large population-representative cohort suggests that a simple symptom count can be used as a dimensional diagnosis of somatization. In those instances in which a categorical diagnosis is preferred, a simple cut-off of four out of 43 functional symptoms best fitted our data. We did not find any added value for incorporating the number of symptom clusters into the diagnostic criteria

The HIFI spectral survey of AFGL 2591 (CHESS). II. Summary of the survey

This paper presents the richness of submillimeter spectral features in the high-mass star forming region AFGL 2591. As part of the CHESS (Chemical Herschel Survey of Star Forming Regions) Key Programme, AFGL 2591 was observed by the Herschel/HIFI instrument. The spectral survey covered a frequency range from 480 up to 1240 GHz as well as single lines from 1267 to 1901 GHz (i.e. CO, HCl, NH3, OH and [CII]). Rotational and population diagram methods were used to calculate column densities, excitation temperatures and the emission extents of the observed molecules associated with AFGL 2591. The analysis was supplemented with several lines from ground-based JCMT spectra. From the HIFI spectral survey analysis a total of 32 species were identified (including isotopologues). In spite of the fact that lines are mostly quite week, 268 emission and 16 absorption lines were found (excluding blends). Molecular column densities range from 6e11 to 1e19 cm-2 and excitation temperatures range from 19 to 175 K. One can distinguish cold (e.g. HCN, H2S, NH3 with temperatures below 70 K) and warm species (e.g. CH3OH, SO2) in the protostellar envelope.Comment: Accepted to A&

Dropout from exercise programs for seniors: a prospective cohort study

This study examines dropout incidence, moment of dropout, and switching behavior in organized exercise programs for seniors in the Netherlands, as determined in a prospective cohort study (with baseline measurements at the start of the exercise program and follow-up after 6 months; N = 1,725, response rate 73%). Participants were community-living individuals 50+ who participated in different forms of organized exercise programs. The average dropout incidence was 0.15 per 6 months, which is lower than that for the general population. The dropout incidence and the timing of dropout differed substantially between the exercise programs. In total, 31% of people who dropped out of one type of exercise program switched to another type of exercise. The type of program and exercise had a strong effect on differences in this switching behavior. It is recommended that switching behavior be monitored in future studie

Probing the Baryon Cycle of Galaxies with SPICA Mid- and Far-Infrared Observations

The SPICA mid- and far-infrared telescope will address fundamental issues in our understanding of star formation and ISM physics in galaxies. A particular hallmark of SPICA is the outstanding sensitivity enabled by the cold telescope, optimised detectors, and wide instantaneous bandwidth throughout the mid- and far-infrared. The spectroscopic, imaging, and polarimetric observations that SPICA will be able to collect will help in clarifying the complex physical mechanisms which underlie the baryon cycle of galaxies. In particular, (i) the access to a large suite of atomic and ionic fine-structure lines for large samples of galaxies will shed light on the origin of the observed spread in star-formation rates within and between galaxies, (ii) observations of HD rotational lines (out to ~10 Mpc) and fine structure lines such as [C ii] 158 μm (out to ~100 Mpc) will clarify the main reservoirs of interstellar matter in galaxies, including phases where CO does not emit, (iii) far-infrared spectroscopy of dust and ice features will address uncertainties in the mass and composition of dust in galaxies, and the contributions of supernovae to the interstellar dust budget will be quantified by photometry and monitoring of supernova remnants in nearby galaxies, (iv) observations of far-infrared cooling lines such as [O i] 63 μm from star-forming molecular clouds in our Galaxy will evaluate the importance of shocks to dissipate turbulent energy. The paper concludes with requirements for the telescope and instruments, and recommendations for the observing strategy

NH_3(1_0-0_0) in the pre-stellar core L1544

Pre-stellar cores represent the initial conditions in the process of star and planet formation, therefore it is important to study their physical and chemical structure. Because of their volatility, nitrogen-bearing molecules are key to study the dense and cold gas present in pre-stellar cores. The NH_3 rotational transition detected with Herschel-HIFI provides a unique combination of sensitivity and spectral resolution to further investigate physical and chemical processes in pre-stellar cores. Here we present the velocity-resolved Herschel-HIFI observations of the ortho-NH_3(1_0-0_0) line at 572 GHz and study the abundance profile of ammonia across the pre-stellar core L1544 to test current theories of its physical and chemical structure. Recently calculated collisional coefficients have been included in our non-LTE radiative transfer code to reproduce Herschel observations. A gas-grain chemical model, including spin-state chemistry and applied to the (static) physical structure of L1544 is also used to infer the abundance profile of ortho-NH_3 . The hyperfine structure of ortho-NH_3(1_0-0_0) is resolved for the first time in space. All the hyperfine components are strongly self-absorbed. The profile can be reproduced if the core is contracting in quasi-equilibrium, consistent with previous work, and if the NH_3 abundance is slightly rising toward the core centre, as deduced from previous interferometric observations of para-NH_3(1,1). The chemical model overestimates the NH_3 abundance at radii between ~ 4000 and 15000 AU by about two orders of magnitude and underestimates the abundance toward the core centre by more than one order of magnitude. Our observations show that chemical models applied to static clouds have problems in reproducing NH_3 observations.Comment: accepted for publication in A&A Letter

Detection of interstellar H_2D^+ emission

We report the detection of the 1_{10}-1_{11} ground state transition of ortho-H_2D^+ at 372.421 GHz in emission from the young stellar object NGC 1333 IRAS 4A. Detailed excitation models with a power-law temperature and density structure yield a beam-averaged H_2D^+ abundance of 3 x 10^{-12} with an uncertainty of a factor of two. The line was not detected toward W 33A, GL 2591, and NGC 2264 IRS, in the latter source at a level which is 3-8 times lower than previous observations. The H_2D^+ data provide direct evidence in support of low-temperature chemical models in which H_2D^+ is enhanced by the reaction of H_3^+ and HD. The H_2D^+ enhancement toward NGC 1333 IRAS 4A is also reflected in the high DCO^+/HCO^+ abundance ratio. Simultaneous observations of the N_2H^+ 4-3 line show that its abundance is about 50-100 times lower in NGC 1333 IRAS 4A than in the other sources, suggesting significant depletion of N_2. The N_2H^+ data provide independent lower limits on the H_3^+ abundance which are consistent with the abundances derived from H_2D^+. The corresponding limits on the H_3^+$ column density agree with recent near-infrared absorption measurements of H_3^+ toward W 33A and GL 2591.Comment: Standard AAS LaTeX format (15 pages + 2 figures

Development and User Experiences of a Biopsychosocial Interprofessional Online Course on Persistent Somatic Symptoms

Background: Communication between healthcare providers and patients with persistent somatic symptoms (PSS) is frequently hampered by mutual misunderstanding and dissatisfaction. Methods: We developed an online, interprofessional course to teach healthcare providers the knowledge, skills, and attitude they need to diagnose and treat PSS in a patient-centered manner based on the biopsychosocial model. The course consisted of six modules of 45–60 min. Each module contained different types of assignments, based on six cases: videos, discussion boards, reading assignments, polls, and quizzes. For this study, we included (1) medical residents, following the course as part of their residency training, and (2) healthcare providers (general practitioners, medical specialists, physiotherapists, nurses, and psychologists), following the course as continuing vocational training. Throughout the course, participants were asked to fill out online surveys, enquiring about their learning gains and satisfaction with the course. Results: The biopsychosocial approach was integrated across the modules and teached health care workers about recent insights on biological, psychological and social aspects of PSS. In total, 801 participants with a wide variety in clinical experience started the course; the largest groups of professionals were general practitioners (N = 400), physiotherapists (N = 124) and mental healthcare workers (N = 53). At the start of the course, 22% of the participants rated their level of knowledge on PSS as adequate. At the end of the course, 359 participants completed the evaluation questionnaires. Of this group, 81% rated their level of knowledge on PSS as adequate and 86% felt that following the course increased their competencies in communicating with patients with PSS (N = 359). On a scale from 1 to 10, participants gave the course a mean grade of 7.8 points. Accordingly, 85% stated that they would recommend the course to a colleague. Conclusion: Our course developed in a co-design process involving multiple stakeholders can be implemented, is being used, and is positively evaluated by professionals across a variety of health care settings

The JCMT Spectral Legacy Survey: physical structure of the molecular envelope of the high-mass protostar AFGL2591

The understanding of the formation process of massive stars (>8 Msun) is limited, due to theoretical complications and observational challenges. We investigate the physical structure of the large-scale (~10^4-10^5 AU) molecular envelope of the high-mass protostar AFGL2591 using spectral imaging in the 330-373 GHz regime from the JCMT Spectral Legacy Survey. Out of ~160 spectral features, this paper uses the 35 that are spatially resolved. The observed spatial distributions of a selection of six species are compared with radiative transfer models based on a static spherically symmetric structure, a dynamic spherical structure, and a static flattened structure. The maps of CO and its isotopic variations exhibit elongated geometries on scales of ~100", and smaller scale substructure is found in maps of N2H+, o-H2CO, CS, SO2, CCH, and methanol lines. A velocity gradient is apparent in maps of all molecular lines presented here, except SO, SO2, and H2CO. We find two emission peaks in warm (Eup~200K) methanol separated by 12", indicative of a secondary heating source in the envelope. The spherical models are able to explain the distribution of emission for the optically thin H13CO+ and C34S, but not for the optically thick HCN, HCO+, and CS, nor for the optically thin C17O. The introduction of velocity structure mitigates the optical depth effects, but does not fully explain the observations, especially in the spectral dimension. A static flattened envelope viewed at a small inclination angle does slightly better. We conclude that a geometry of the envelope other than an isotropic static sphere is needed to circumvent line optical depth effects. We propose that this could be achieved in envelope models with an outflow cavity and/or inhomogeneous structure at scales smaller than ~10^4 AU. The picture of inhomogeneity is supported by observed substructure in at least six species.Comment: 17 pages; accepted for publication in A&

Effects of clumping on temperature I: externally heated clouds

We present a study of radiative transfer in dusty, clumpy star-forming regions. A series of self-consistent, 3-D, continuum radiative transfer models are constructed for a grid of models parameterized by central luminosity, filling factor, clump radius, and face-averaged optical depth. The temperature distribution within the clouds is studied as a function of this parameterization. Among our results, we find that: (a) the effective optical depth is smaller in clumpy regions than in equivalent homogeneous regions; (b) penetration of radiation is drive by the fraction of open sky (FOS) -- which measures the fraction of solid angle which is devoid of clumps; (c) FOS increases as clump radius increases and filling factor decreases; (d) for FOS > 0.6-0.8 the sky is sufficiently open that the temperature is relatively insensitive to FOS; (e) the physical process by which radiation penetrates is streaming between clumps; (f) filling factor dominates the temperature distribution for large optical depths, and at small clump radii for small optical depths; (g) at lower optical depths, the temperature distribution is most sensitive to filling factors of 1-10 per cent, in accordance with many observations; (h) direct shadowing can be important approximately one clump radius behind a clump.Comment: 12 pages, 17 figures, accepted by MNRA