Effects of Resistance Exercise on Cognitive Performance and Depressive Symptoms in Community-Dwelling Older Chinese Americans: A Pilot Randomized Controlled Trial.

Previous literature has suggested physical exercise may improve cognitive impairments and mitigate depressive symptoms. However, few studies examined the impact of resistance exercise intervention on cognition and depression in older Chinese Americans. The purpose of this pilot study was to assess the effects of resistance exercise training on cognitive performance and depressive symptoms among community-dwelling older Chinese Americans. The study was a two-arm randomized controlled trial with pre-test/post-test design. Thirty older adults were randomly assigned into the resistance exercise intervention group or the wait-list control group. Participants' cognitive performance and depressive symptoms were evaluated at baseline (pre-test) and at 12 weeks (post-test). The results showed that there were significant differences between the intervention and control groups on changes in symptoms of depression, global cognitive function, visuospatial/executive functions, attention, language, and orientation. However, there were no significant differences between both groups on changes in naming, abstraction, and delayed recall domains. The findings of this study suggest that resistance exercise training has a positive impact on improving cognitive performance and depressive symptoms in older adults.

2021 Year in Review: E-Cigarettes, Hookah Use, and Vaping Lung Injuries During the COVID-19 Pandemic.

Electronic cigarettes (e-cigarettes) and hookah smoking have gained tremendous popularity over the past decade. With the constantly evolving e-cigarette market and potential impact of the COVID-19 pandemic on users of these tobacco products, research is needed to assess the prevalence and safety of these devices as well as potential public health implications and cessation tools. For this year in review, PubMed was searched from January 2021-December 14, 2021, for articles related to e-cigarettes, vaping-related lung injury, and hookah smoking. Relevant articles addressing the objectives were included in this review. This review focused primarily on articles based on United States populations. Gray literature and nonpublished articles were not included in this review. The 2020 pandemic resulted in a decline in e-cigarette usage among youth (potentially due to the COVID-19 pandemic); however, recent research in 2021 suggests that e-cigarette usage is increasing again among youth. Conflicting evidence exists for e-cigarettes and the risk of COVID-19 infection, but biological plausibility suggests that e-cigarette users are more susceptible to COVID-19 infection and more severe COVID-19 infection compared to non-e-cigarette users. Hookah smoking has remained stable across the past several years and remains a primarily social activity among youth. New e-cigarette devices are constantly emerging, resulting in an increased demand to understand the safety of these devices. Additionally, hookah smoking continues to be a concerning public health issue with the increase in hookah bars and venues coupled with lack of policy regulations for hookah smoking.

The Association of Health-Related Factors with Leisure-Time Physical Activity among Adults with COPD: A Cross-Sectional Analysis.

This study aimed to examine the association of health attitudes, health appraisals and affective experience to leisure-time physical activity in adults with chronic obstructive pulmonary disease (COPD). Cross-sectional analyses were conducted with a sample of 274 adults with COPD drawn from the second wave of the Midlife in the United States (MIDUS 2) Study. Chi-square analyses and independent t-tests were used to test the differences between physically active and inactive COPD patients (active group versus inactive group) for all study variables. Multiple logistic regression was used to examine the association of each study variable with leisure-time physical activity. The results showed that there were significant differences between the active and inactive groups in terms of age, education, functional limitations, health attitudes, health appraisals and affective experience. After controlling for socio-demographic variables and functional limitations, beliefs about the importance of physical fitness and strength for a good life and comparative health appraisals were significantly related to physical activity. However, neither negative nor positive affect was associated with physical activity status. Modifiable factors, such as health attitudes toward physical fitness and strength, as well as health appraisals, should be considered for developing effective physical activity promotion interventions among COPD patients.

Tocotrienols: Dietary Supplements for Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Emphysema and chronic bronchitis are the two major phenotypes of COPD, which have many symptoms, such as dyspnea, chronic cough, and mucus overproduction. Emphysema is characterized by the destruction of the alveolar wall, while chronic bronchitis is characterized by limitations in expiratory airflow. Cigarette smoking is the most significant risk factor for the pathogenesis of COPD in the developed world. Chronic inflammation contributes to the onset and progression of the disease and furthers the risk of comorbidities. Current treatment options and prevention strategies for COPD are very limited. Tocotrienols are a group of vitamin E molecules with antioxidant and anti-inflammatory properties. Individual tocotrienols (α, γ, and δ) have shown their ability to attenuate inflammation specifically via suppressing nuclear factor-κB-mediated cytokine production. The δ- and γ-forms of tocotrienols have been indicated as the most effective in the prevention of macrophage infiltration, production of reactive oxygen species, and cytokine secretion. This review briefly discusses the pathogenesis of COPD and the role of inflammation therein. Furthermore, we summarize the in vitro and in vivo evidence for the anti-inflammatory activity of tocotrienols and their potential application to COPD management. Coupled with the bioavailability and safety profile of tocotrienols, the ability of these compounds to modulate COPD progression by targeting the inflammation pathways renders them potential candidates for novel therapeutic approaches in the treatment of COPD patients.

Associations between safety perceptions and medical error reporting among neonatal intensive care unit staff.

INTRODUCTION: Critically ill neonates are particularly susceptible to medical errors; however, few studies have evaluated NICU safety climate in the context of medical error reporting. This study aims to identify the association between perceptions of safety and culture among NICU staff with medical error reporting behaviours. METHODS: This study used a convenience sample of 79 NICU staff members (38 Nurses and 41 Respiratory Therapists). Questionnaires consisted of demographic factors (years of experience, sex and education), the Safety Attitudes Questionnaire (SAQ) and hypothetical medical error reporting scenarios (categorized into minor harm or major harm). The SAQ consists of six domains: job satisfaction, teamwork climate, safety climate, perceptions of management, working conditions and stress recognition. Scores ranged from 0-5, with a 5 indicating a more positive perception. Logistic regression was used to determine statistically significant predictors for each individual harm scenario (odds of being very likely/likely to report vs. all other responses). RESULTS: Among those who completed the study, approximately 84.8% were female. Safety attitude domain scores were similar for both NICU respiratory therapists and nurses across all domains except for job satisfaction and stress. Respiratory therapists reported higher levels of job satisfaction compared to nurses (24 vs. 23, respectively, p = 0.01). However, nurses reported higher levels of stress management compared to respiratory therapists (12 vs. 9, respectively, p < 0.01). While we did not find a significant association between safety attitudes and hypothetical medical error reporting, NICU staff overall were more likely to report major medical errors compared to minor medical errors. CONCLUSIONS: This study suggests that safety climate may not play a significant role in promoting medical error reporting in the NICU setting. RELEVANCE TO CLINICAL PRACTICE: Interventions aimed at increasing medical error reporting should also incorporate established employees rather than targeting new employees only.

Dual Use of Electronic Cigarettes and Traditional Cigarettes Among Adults: Psychosocial Correlates and Associated Respiratory Symptoms.

BACKGROUND: Prolonged use of both electronic cigarettes (e-cigarettes) and traditional cigarettes can increase breathing difficulties and other adverse health effects. Research is needed to provide a deeper understanding of predictors of dual use, particularly given rapid changes in the e-cigarette market and related public health communications and policy. METHODS: The sample consists of subjects in the National Longitudinal Study of Adolescent to Adult Health Wave 5 (cross-sectional) subsample (N = 3,800) from 2016 to 2018. Participants were 31-42 y old. Multinomial logistic regression analyses were used to determine predictors of mutually exclusive categories: e-cigarette use only, cigarette use only, and concurrent e-cigarette and traditional cigarette use (compared to no use). Predictors included sex, age, poverty status, race/ethnicity, self-reported diagnosed depression, self-reported diagnosed anxiety, and previous experience of child maltreatment. RESULTS: Among the total sample (N = 3,800), 2% reported e-cigarette use only, 20% reported traditional cigarette use only, and 3% reported dual use of both e-cigarettes and traditional cigarettes. Among subjects who reported any e-cigarette or traditional cigarette use (n = 957), 12% reported dual use. In the final adjusted multivariable multinomial model, dual use was associated with living at or below the poverty line (odds ratio 2.49 [95% CI 1.19-5.70]), self-reported diagnosed depression (odds ratio 1.99 [95% CI 1.10-3.61]), and a history of child maltreatment (odds ratio 1.80 [95% CI 1.10-2.95]). Additionally, Hispanic-American individuals were more likely to report dual use compared to cigarette-only use. CONCLUSIONS: Prolonged dual use of both e-cigarettes and traditional cigarettes is a considerable public health problem. While our study identified a low percentage of dual usage among U.S. adults, dual use was disproportionately prevalent among those with depression, history of child maltreatment, living at or below the poverty line, and among Hispanic-American individuals. Culturally appropriate interventions and increasing access to cessation programs may help mitigate health disparities pertaining to dual use.

Manual bag valve mask ventilation performance among respiratory therapists.

BACKGROUND: High peak pressures delivered via bag valve mask (BVM) can be dangerous for patients. OBJECTIVE: To examine manual ventilation performance among respiratory therapists (RTs) in a simulation model. METHODS: Respiratory therapists (n=98) were instructed to ventilate a manikin for 18 breaths. Linear regression was utilized to determine associated predictors with the outcomes: delivered tidal volume, pressure and flow rate. RESULTS: Among all participants, the mean ventilation parameters include a tidal volume of 599.70 ml, peak pressure of 26.35 cmH2O, and flow rate of 77.20 l/min. Higher confidence values were positively associated with delivered peak pressure (p=0.01) and flow rate (p=0.008). Those with the most confidence in using the BVM actually delivered higher peak pressures and flow rates compared to those with lower confidence levels. CONCLUSIONS: Our results emphasize the urgent need to create an intervention that allows providers to deliver safe and optimal manual ventilation.

A retrospective analysis of associations between BMI and days spent on mechanical ventilation in a level 1 trauma facility.

OBJECTIVE: To examine whether BMI impacts the outcomes of mechanically ventilated patients. METHODS: Data was collected retrospectively among patients involved in motor vehicle accidents in intensive care at a major trauma center in Atlanta, GA. Patients were categorized into five BMI groups: underweight (BMI < 18.5), normal weight (BMI of 18.5-24.9), overweight (BMI of 25-29.9), obese (BMI of 30-39.9), and morbidly obese (BMI of >40). RESULTS: Among all patients (n=2,802), 3% of patients were underweight, 34% were of normal weight, 30% were overweight, 27% were obese, and 6% were morbidly obese. The mean number of ventilator days for normal weight patients was 4.6, whereas the mean number of ventilator days for underweight and morbidly obese patients were higher (10.3 and 7.4, respectively). CONCLUSIONS: Underweight and morbidly obese populations may require additional interventions during their ICU stays to address the challenges presented by having an unhealthy BMI.

The Impact of Respiratory Therapy International Education in the United States: Saudi International Students' Perceptions.

BACKGROUND: The purpose of this study was to assess graduate and undergraduate international respiratory therapy students' perceptions of the impact of their international educational experience on their life experience and development. METHODS: Data were collected through a validated descriptive survey. Four main dimensions of development were assessed: professional respiratory therapist (RT) role, global understanding, personal development, and intellectual development. RESULTS: The sample size was 62. Just over half of the subjects held a graduate degree in respiratory therapy, and 47% held an undergraduate degree in respiratory therapy. Female participants accounted for 13% of participants. The dimensions of development that were the most affected for RT undergraduate students were professional RT role and global understanding, whereas personal development was the most impacted area of development for graduate RT students. The time spent abroad for education had a positive correlation with the students' perceptions of development of their professional RT role (rs = 0.43, P = .001), personal development (rs = 0.26, P = .047), and overall survey development score (rs = 0.28, P = .036). Former graduates had a significantly higher perception of development of their professional practice (P = .035) and cultural interaction (P = .03) than did current students. CONCLUSIONS: International education has a large overall positive impact on students' life experience and development. The study findings support the value of promoting international education in RT programs due to its role in advancing students' development and the internationalization of RT education.

Respiratory Therapy Administrators' Perceptions of Effective Teaching Characteristics of Clinical Preceptors.

BACKGROUND: Clinical preceptors in respiratory therapy (RT) are expected to possess effective teaching skills and qualities that signify their knowledge, expertise, and professionalism. Thus, it is important to determine which teaching characteristics are effective among RT clinical preceptors from the administrators' perspective as well as the predictors for the administrators' decisions. METHODS: A cross-sectional survey study of RT administrators was conducted in hospitals in a major southeastern metropolitan area in the United States. We used the modified version of the Effective Clinical Instructor Characteristics Inventory, which consists of 35 questions that cover 3 main domains: professional competence (15 questions), relationship with the students (8 questions), and personal attributes (12 questions); questions were answered according to a 5-point Likert scale (ranging from 1 to 5). Multiple linear regression analysis was used to identify predictors of clinical preceptors' selection, reflected in their final scores. RESULTS: A total of 34 RT administrators participated in this study, representing 18 health care institutions. The response rate was 54.8%. Participants showed the most interest in the professional competence of clinical preceptors, with a total mean score of 68.6 ± 4.4. This characteristic was followed by personal attributes and relationship with students, with mean scores of 53.8 ±4.8 and 35.8 ± 3.4, respectively. The perception of managers from different managerial positions toward preceptors' professional competence showed a statistically significant difference (P = .042). The variable defined as years in clinical practice as a respiratory therapist was negatively associated with participants' final scores. CONCLUSIONS: This study indicates that the professional competence of clinical preceptors is believed by RT administrators to be the most important behavioral characteristic. The results also indicate that role modeling and showing genuine interest in patients and their care are the most effective teaching characteristics of clinical preceptors.

Effect of face mask design on inhaled mass of nebulized albuterol, using a pediatric breathing model.

BACKGROUND: Aerosol face mask design and the distance at which the face mask is held from the face affect the delivery of nebulized medication to pediatric patients. OBJECTIVE: To measure the inhaled mass of nebulized albuterol with 3 types of pediatric face mask, at 3 different distances from the face, with a model of a spontaneously breathing infant. METHODS: We compared a standard pediatric face mask and 2 proprietary pediatric face masks (one shaped to resemble a dragon face, the other shaped to resemble a fish face). The albuterol was nebulized with a widely used jet nebulizer. Aerosol delivery with each type of mask was measured with the mask at 0 cm (ie, mask directly applied to the mannequin face), 1 cm, and 2 cm from the mannequin face. In each test the nebulizer was filled with a 3-mL unit dose of albuterol sulfate and powered by oxygen at 8 L/min, with a total nebulization time of 5 min. The mannequin face was connected to a lung simulator that simulated a spontaneously breathing infant. We measured inhaled mass by collecting the aerosol on a 2-way anesthesia filter that was attached to the back of the mannequin's oral opening via a 15-mm silicon adapter. We also measured residual drug left in the nebulizer, and estimated the drug lost to the atmosphere. RESULTS: The mean +/- SD inhaled percentage of the nominal dose values at 0 cm, 1 cm, and 2 cm, respectively, were 2.18 +/- 0.53%, 1.45 +/- 0.46%, and 0.92 +/- 0.51% with the standard mask; 2.65 +/- 0.55%, 1.7 +/- 0.38%, and 1.3 +/- 0.37% with the dragon mask; and 3.67 +/- 0.8%, 2.92 +/- 0.4%, and 2.26 +/- 0.56% with the fish mask. With all 3 masks there was a statistically significant difference (p < 0.001) in inhaled mass between the 0 cm and 2 cm distance. The fish mask had a significantly higher (p < 0.001) inhaled mass than the dragon mask or the standard mask, at all 3 distances. CONCLUSIONS: The inhaled mass of albuterol is significantly reduced when the mask is moved away from the face. The fish mask had significantly higher inhaled mass than the standard mask or the dragon mask, under the conditions we studied. Mask design may affect nebulized albuterol delivery to pediatric patients.

An investigation of nebulized bronchodilator delivery using a pediatric lung model of spontaneous breathing.

BACKGROUND: The literature lacks comparative data on nebulizer aerosol delivered via mask versus T-piece, to spontaneously breathing pediatric subjects. PURPOSE: To compare total inhaled drug mass delivered via standard pediatric aerosol mask versus via T-piece, with increasing distance. METHODS: We used a sample of 5 nebulizers, operated under manufacturers' conditions, with a standard pediatric aerosol mask and with a T-piece capped at one end, at 0 cm, 1 cm, and 2 cm from an inhalation filter placed at the inlet of a pediatric test lung. Inhaled drug mass was analyzed with spectrophotometry. Aerosol particle size was measured separately from the breathing simulations, using a laser particle sizer to determine fine-particle mass (particles < 4.7 mum) and fine-particle fraction as percent of total mass. The fine-particle fraction was used to estimate the fine-particle mass. RESULTS: The mean + SD values for inhaled drug mass as a percentage of nominal dose, at 0 cm, 1 cm, and 2 cm, with the mask were 2.88 + 0.79%, 1.61 + 0.65%, and 1.3 + 0.42%, respectively, and with the T-piece were 4.14 + 1.37%, 3.77 + 1.04%, and 3.47 + 0.64%, respectively. There was a statistically greater inhaled drug mass with T-piece than with mask, overall (p < 0.01), and a significant decrease with mask or T-piece as distance increased (p < 0.01). The difference between mask and T-piece for inhaled drug mass at 2 cm was statistically significant (p < 0.018). The mean + SD values for fine-particle mass estimated as a percentage of total drug mass at 0, 1, and 2 cm, with the mask were 1.39 + 0.36%, 0.78 + 0.29%, and 0.64 + 0.20%, respectively, and with the T-piece were 2.1 + 0.63%, 1.84 + 0.45%, and 1.71 + 0.27%, respectively. CONCLUSION: Inhaled drug mass was greater with T-piece than with a standard pediatric aerosol mask under the conditions studied.