Identification of adults with symptoms suggestive of obstructive airways disease: Validation of a postal respiratory questionnaire

BACKGROUND: Two simples scoring systems for a self-completed postal respiratory questionnaire were developed to identify adults who may have obstructive airways disease. The objective of this study was to validate these scoring systems. METHOD: A two-stage design was used. All adults in two practice populations were sent the questionnaire and a stratified random sample of respondents was selected to undergo full clinical evaluation. Three respiratory physicians reviewed the results of each evaluation. A majority decision was reached as to whether the subject merited a trial of obstructive airways disease medication. This clinical decision was compared with two scoring systems based on the questionnaire in order to determine their positive predictive value, sensitivity and specificity. RESULTS: The PPV (positive predictive value) of the first scoring system was 75.1% (95% CI 68.6–82.3), whilst that of the second system was 82.3% (95% CI 75.9–89.2). The more stringent second system had the greater specificity, 97.1% (95% CI 96.0–98.2) versus 95.3% (95% CI 94.0–96.7), but poorer sensitivity 46.9% (95% CI 33.0–66.8) versus 50.3% (95% CI 35.3–71.6). CONCLUSION: This scoring system based on the number of symptoms/risk factors reported via a postal questionnaire could be used to identify adults who would benefit from a trial of treatment for obstructive airways disease

The Dual-Axis Circumstellar Environment of the Type IIn Supernova 1997eg

We present multi-epoch spectral and spectropolarimetric observations of the Type IIn supernova (SN) 1997eg that indicate the presence of a flattened disk-like concentration of circumstellar material surrounding nonspherical ejecta, with which the disk is misaligned. The polarization across the broad H alpha, H beta, and He I 5876 lines of SN 1997eg forms closed loops when viewed in the Stokes q-u plane. Such loops occur when the geometrical symmetry of one or both of the Stokes parameters across spectral lines is broken, in this case most likely by occultation of the ejecta by the equatorial circumstellar matter concentration. The polarization of the narrow Balmer lines possesses an intrinsic axis that differs by 12 degrees from that of the elongated ejecta and probably indicates the orientation of the disk-like circumstellar material. The existence of two different axes of symmetry in SN 1997eg suggests that neither rotation of the progenitor nor the influence of a companion star can be the sole mechanism creating a preferred axis within the supernova system. Our model supports the emerging hypothesis that the progenitors of some Type IIn supernovae are luminous blue variable stars, whose pre-supernova mass eruptions form the circumstellar shells that physically characterize the SN IIn subclass. These conclusions, which are independent of interstellar polarization effects, would have been unobservable with only a single epoch of spectropolarimetry.Comment: 52 pages, 13 figures; accepted by ApJ. Several sections revised in response to referee comments. High-resolution figures are available at http://grammai.org/jhoffman/1997eg

Childhood asthma: Healthcare resource utilisation in those with and without a diagnosis of the condition

AbstractAim: To examine healthcare utilisation and the direct financial costs in providing medical care to a population of children aged 5–15 years with respiratory complaints. Secondarily, to assess whether these costs depended upon having specific asthma diagnosis or not.Method: A postal respiratory questionnaire was sent to the parents or guardians of all children registered with two general practices. A search of the general practice medical records over a 2-year reference period was made for a stratified random sample and results are presented for 488 children aged 5–15 years.Results: The cost of primary care lower respiratory tract consultations in children with 4–5 symptoms/risk factors was £17.02 per patient per year for those with a previous diagnosis of asthma compared with £6.08 per patient per year for those with the same number of symptoms but no diagnosis (t=−4.446,P<0.001). The cost of primary care lower respiratory consultations in those with no GP diagnosis of asthma and no symptoms/risk factors was £2.25 per patient per year.Conclusions: Studies, which fail to include the costs associated with treating children with respiratory symptoms but without a formal diagnosis, will seriously underestimate the costs of treating asthmatic children

Advancing conceptual understanding of partnerships between protected area agencies and the tourism industry: a postdisciplinary and multi-theoretical approach

This paper reviews a range of theoretical approaches to partnerships working between protected area agencies and the tourism industry. While partnerships are a hallmark of contemporary thinking about protected area management, research to date leaves considerable scope for development, application and testing of theory. The paper draws eight theoretical approaches from the literature with potential application to a study of the contributors to partnership success. It progresses a postdisciplinary approach to partnership research. A 72-item questionnaire was derived from the theoretical perspectives and completed by 100 partners. Analysis identified features perceived as potentially contributing to a successful partnership as well as the key outcomes of a successful partnership. The findings indicate the prominence of institutional analysis and development, social capital, environmental dispute resolution and network theories in explaining partnership success. Given the centrality of partnerships in protected area tourism and ongoing societal interest in the sustainability of such areas, this paper provides vital insights to further multi-theoretical, postdisciplinary research, and to the successful management of partnerships