Defining and investigating difficult asthma: Developing quality indicators

SummaryBackgroundThere is no agreed definition of ‘difficult asthma’ or what investigations should be available to investigate these patients. Patients with difficult asthma remain symptomatic on high levels of treatment and are high users of medical resources.AimTo develop a set of quality indicators for the definition and investigation of difficult asthma.MethodModified RAND Appropriateness Method was used. An expert panel composed of nine hospital asthma specialists who run ‘difficult’ asthma clinics and were identified from a shortlist of key workers in the field. Indicators were rated as necessary to define and investigate difficult asthma.ResultsDifficult asthma was defined as ‘symptoms persisting beyond therapy consistent with step 4 of the British Thoracic Society (BTS) guidelines’ (high dose inhaled corticosteroids and long acting β2-agonists). Eighty-three indicators were identified (40 relating to definition and 43 relating to investigations). Of these 32 (39%) were rated as necessary: 7 out of 40 (18%) for defining difficult asthma and 23 out of 43 (53%) for investigations. Indicators of high medical resource usage were characteristic of the ‘difficult’ nature of the management of patient with difficult asthma. A framework for the investigation of these patients was created.ConclusionThe listed performance indicators identify a range of requirements that are necessary to define difficult asthma. Targeting of real needs in this group of patients will lead to better patient care and reduction of ‘waste’ in provision of healthcare

Phenomenology of the nMSSM from colliders to cosmology

Low energy supersymmetric models provide a solution to the hierarchy problem and also have the necessary ingredients to solve two of the most outstanding issues in cosmology: the origin of dark matter and baryonic matter. One of the most attractive features of this framework is that the relevant physical processes are related to interactions at the weak scale and therefore may be tested in collider experiments in the near future. This is true for the Minimal Supersymmetric Standard Model (MSSM) as well as for its extension with the addition of one singlet chiral superfield, the so-called nMSSM. It has been recently shown that within the nMSSM an elegant solution to both the problem of baryogenesis and dark matter may be found, that relies mostly on the mixing of the singlet sector with the Higgs sector of the theory. In this work we review the nMSSM model constraints from cosmology and present the associated collider phenomenology at the LHC and the ILC. We show that the ILC will efficiently probe the neutralino, chargino and Higgs sectors, allowing to confront cosmological observations with computations based on collider measurements. We also investigate the prospects for a direct detection of dark matter and the constraints imposed by the current bounds of the electron electric dipole moment in this model.Comment: 44 pp, 10 figures; Fig.9 replaced; discussion on CP violation extended and references added; few minor additions in text about details of the cut

Modeling the Subsurface Structure of Sunspots

While sunspots are easily observed at the solar surface, determining their subsurface structure is not trivial. There are two main hypotheses for the subsurface structure of sunspots: the monolithic model and the cluster model. Local helioseismology is the only means by which we can investigate subphotospheric structure. However, as current linear inversion techniques do not yet allow helioseismology to probe the internal structure with sufficient confidence to distinguish between the monolith and cluster models, the development of physically realistic sunspot models are a priority for helioseismologists. This is because they are not only important indicators of the variety of physical effects that may influence helioseismic inferences in active regions, but they also enable detailed assessments of the validity of helioseismic interpretations through numerical forward modeling. In this paper, we provide a critical review of the existing sunspot models and an overview of numerical methods employed to model wave propagation through model sunspots. We then carry out an helioseismic analysis of the sunspot in Active Region 9787 and address the serious inconsistencies uncovered by \citeauthor{gizonetal2009}~(\citeyear{gizonetal2009,gizonetal2009a}). We find that this sunspot is most probably associated with a shallow, positive wave-speed perturbation (unlike the traditional two-layer model) and that travel-time measurements are consistent with a horizontal outflow in the surrounding moat.Comment: 73 pages, 19 figures, accepted by Solar Physic

Perspectives in Global Helioseismology, and the Road Ahead

We review the impact of global helioseismology on key questions concerning the internal structure and dynamics of the Sun, and consider the exciting challenges the field faces as it enters a fourth decade of science exploitation. We do so with an eye on the past, looking at the perspectives global helioseismology offered in its earlier phases, in particular the mid-to-late 1970s and the 1980s. We look at how modern, higher-quality, longer datasets coupled with new developments in analysis, have altered, refined, and changed some of those perspectives, and opened others that were not previously available for study. We finish by discussing outstanding challenges and questions for the field.Comment: Invited review; to appear in Solar Physics (24 pages, 6 figures