High star formation rates as the origin of turbulence in early and modern disk galaxies.

Observations of star formation and kinematics in early galaxies at high spatial and spectral resolution have shown that two-thirds are massive rotating disk galaxies, with the remainder being less massive non-rotating objects. The line-of-sight-averaged velocity dispersions are typically five times higher than in today's disk galaxies. This suggests that gravitationally unstable, gas-rich disks in the early Universe are fuelled by cold, dense accreting gas flowing along cosmic filaments and penetrating hot galactic gas halos. These accreting flows, however, have not been observed, and cosmic accretion cannot power the observed level of turbulence. Here we report observations of a sample of rare, high-velocity-dispersion disk galaxies in the nearby Universe where cold accretion is unlikely to drive their high star formation rates. We find that their velocity dispersions are correlated with their star formation rates, but not their masses or gas fractions, which suggests that star formation is the energetic driver of galaxy disk turbulence at all cosmic epochs.

Improving asthma management: one health plan's experience.

OBJECTIVE: To demonstrate that including the patient's perspective of disease control (patient-reported symptoms) in asthma treatment and management decisions improves patient outcomes and reduces healthcare resource utilization. STUDY DESIGN: Two study phases gathered patients' assessments of disease control. Phase 1 used a retrospective physician questionnaire. Phase 2 used a patient questionnaire at each office visit. Physicians and patients were members of the Independent Health Association, a health insurer in upstate New York. METHODS: Phase 1 gathered patients' assessment of asthma control retrospectively using a physician questionnaire. Physicians received a list of pediatric patients in their practice who had intermittent and persistent asthma as their primary diagnosis. They reviewed a sample of these actively managed patients and answered 10 questions about them. Phase 2 was designed to include the patient's perspective. The Asthma Control Test was sent to every patient with asthma to complete and to bring to each physician visit. RESULTS: In phase 1, emergency department visits and hospitalizations for asthma decreased during the program. Emergency department visits decreased from 3.71 to 2.92 per year (P < .01), and hospitalizations decreased from 0.83 to 0.81 per year (not statistically significant). Results for phase 2 are not yet available. CONCLUSIONS: Although not a controlled program, for the participating practices the Independent Health Association health plan seems to have improved patient outcomes when they included retrospective, documented, patient-reported symptoms in their asthma management decisions. Emergency department visits and hospitalizations decreased. Managed care organizations should consider adding the patient's perspective of disease control to their asthma management decisions.