Development and validity testing of an IPF-specific version of the St George's Respiratory Questionnaire

Rationale The St George's Respiratory Questionnaire (SGRQ) is often applied to assess health-related quality of life in patients with idiopathic pulmonary fibrosis (IPF). Some SGRQ items will inevitably have weaker measurement properties than others when applied to this population. This study was conducted to develop an IPF-specific version of the SGRQ. Methods Data from a recently completed trial that enrolled subjects with IPF (n=158) who completed the SGRQ and other measures were analysed at baseline and 6 months. There were four phases to the study: (1) removing items with missing responses and using Rasch analysis on retained items to identify fit and refine item response categories; (2) development of a new scoring scheme; (3) testing agreement between original and revised versions and testing construct validity of the revised SGRQ; and (4) rewording to finalise the IPF-specific version (SGRQ-I). Results Items were removed due to missing responses (6 items) and misfit to the Rasch model (10 items); 34 items from the original 50 were retained. For certain items, disordered response thresholds were identified and corrected by collapsing response categories. A scoring algorithm was developed to place SGRQ-I scores on a scale with SGRQ scores. For any given outcome measure (eg, forced vital capacity (% predicted) and lung carbon monoxide transfer factor (% predicted), 6-min walk distance and patient-reported questionnaires), Pearson correlations were similar between pairs that included original SGRQ scores and corresponding pairs that included SGRQ-I scores. Internal reliability (Cronbach α) for each SGRQ-I component was comparable to the original SGRQ (Symptoms 0.62; Activities 0.80; Impacts 0.85). Conclusions The SGRQ-I contains items from the original SGRQ that are the most reliable for measuring health-related quality of life in patients with IPF

The ‘success’ of looked after children in Higher Education in England: near peer coaching, ‘small steps’ and future thinking

This paper addresses the shortage of studies on the ‘success’ of care-experienced young people in Higher Education (HE) internationally. It draws on the findings of a study of a near-peer, pre-entry coaching intervention developed in England to address stakeholders’ concerns around a lack of ‘success’ post entry to university, linked to gaps in knowledge and the challenge of providing on going support. In delivering reciprocal benefits to the coaches, some of whom were care experienced themselves, the HE Champions model promoted the possibility of longer term ‘success’. The personalised nature of the young people’s programme experiences and difficulties in recruitment highlighted the need for ‘success’ to be conceptualised as ‘small steps’ despite pressure to deliver more measurable outcomes. The research also highlighted the importance of reflexive, human-scale systems that put care and relationships at the centre

The trajectory to diagnosis with pulmonary arterial hypertension: a qualitative study

Objectives To investigate the patient's experience of the trajectory to receiving a diagnosis of pulmonary arterial hypertension (PAH) and inform the provision of care for this patient group. Design Qualitative study using in-depth one-to-one interviews and pictorial representations. Data were analysed using thematic analysis. Setting Participants were interviewed in their own homes across England. Participants 30 patients with a diagnosis of pulmonary hypertension (18 participants were women, mean age 56 and range 26-80 02years and time since diagnosis ranged from a few months to more than 12 02years) participated. Results All participants, regardless of the time since diagnosis, vividly described the process from manifestation of symptoms to receiving a confirmed diagnosis. The authors present data using three major themes: (i) making sense of symptoms, (ii) process of elimination and (iii) being diagnosed with PAH. Making sense of symptoms represented an early period of perseverance 14people tried to carry-on as usual despite 18unexplained breathlessness 19. As time progressed, this period was punctuated by critical events that triggered seeking medical advice. Once medical contact had been made, patients described a period of 18elimination 19 and convoluted contact with the medical profession. Dyspnoea misdiagnosis was a key factor that delayed the PAH diagnosis. Diagnosis disclosure by some medical professionals was also viewed as lacking empathy. More positive experiences were relayed when the medical team disclosing the diagnosis acknowledged previous limitations. Conclusions A lack of awareness of this illness from both the sufferer themselves and the medical profession emerged as a central theme and led to prolonged periods of being misdiagnosed. The application of a diagnostic pathway for unexplained dyspnoea that alerts practitioners to rare conditions could expedite the process of correct diagnosis

Turbulent Mixing in the Outer Solar Nebula

The effects of turbulence on the mixing of gases and dust in the outer Solar nebula are examined using 3-D MHD calculations in the shearing-box approximation with vertical stratification. The turbulence is driven by the magneto-rotational instability. The magnetic and hydrodynamic stresses in the turbulence correspond to an accretion time at the midplane about equal to the lifetimes of T Tauri disks, while accretion in the surface layers is thirty times faster. The mixing resulting from the turbulence is also fastest in the surface layers. The mixing rate is similar to the rate of radial exchange of orbital angular momentum, so that the Schmidt number is near unity. The vertical spreading of a trace species is well-matched by solutions of a damped wave equation when the flow is horizontally-averaged. The damped wave description can be used to inexpensively treat mixing in 1-D chemical models. However, even in calculations reaching a statistical steady state, the concentration at any given time varies substantially over horizontal planes, due to fluctuations in the rate and direction of the transport. In addition to mixing species that are formed under widely varying conditions, the turbulence intermittently forces the nebula away from local chemical equilibrium. The different transport rates in the surface layers and interior may affect estimates of the grain evolution and molecular abundances during the formation of the Solar system.Comment: To appear in the Astrophysical Journal; 20 pages, 9 figure

An implicit method for radiative transfer with the diffusion approximation in SPH

An implicit method for radiative transfer in SPH is described. The diffusion approximation is used, and the hydrodynamic calculations are performed by a fully three--dimensional SPH code. Instead of the energy equation of state for an ideal gas, various energy states and the dissociation of hydrogen molecules are considered in the energy calculation for a more realistic temperature and pressure determination. In order to test the implicit code, we have performed non--isothermal collapse simulations of a centrally condensed cloud, and have compared our results with those of finite difference calculations performed by MB93. The results produced by the two completely different numerical methods agree well with each other.Comment: 25 pages, 9 figure