Understanding breathlessness burden and psychophysiological correlates in asthma.

BACKGROUND: Breathlessness is a disabling symptom, with complexity that is often under recognised and under treated in asthma. OBJECTIVE: To highlight the burden of breathlessness in people with severe compared with mild-to-moderate asthma and identify psychophysiological correlates of breathlessness. METHODS: This was a cross-sectional study of people with mild-to-severe asthma, who attended two in-person visits to complete a multidimensional assessment. The proportion of people with mild-to-moderate versus severe asthma who reported physically limiting breathlessness (modified Medical Research Council [mMRC] dyspnoea score ≥2) was compared. Psychophysiological factors associated with breathlessness in people with asthma were identified via a directed acyclic graph and explored with multivariate logistic regression to predict breathlessness. RESULTS: 144 participants were included, of which, 74 (51%) had mild-to-moderate asthma and 70 (49%) severe asthma. Participants were predominantly female (n=103, 72%) with a median (quartile 1, quartile 3) age of 63.4 (50.5,69.5) years and body mass index (BMI) of 31.3 (26.2, 36.0) kg/m2. The proportion of people reporting mMRC ≥2 was significantly higher in those with severe- (n=37, 53%) compared with mild-to-moderate (n=21, 31%) asthma (p=0.013). Dyspnoea-12 Total (8.00 [4.75, 17.00] versus 5.00 [2.00, 11.00], p=0.037) score was also significantly higher in the severe asthma group. Significant predictors of physically limiting breathlessness were: BMI, asthma control, exercise capacity, and hyperventilation symptoms. Airflow limitation and type-2 inflammation were poor breathlessness predictors. CONCLUSION: Over half of people with severe asthma experience physically limiting breathlessness despite treatment. Targeting psychophysiological factors, or traits, associated with breathlessness may help relieve this distressing symptom, which is of high priority to people with asthma.

Factors influencing treatment response of pulmonary exacerbation in children with cystic fibrosis.

BACKGROUND: Pulmonary exacerbations in cystic fibrosis (CF) significantly impact morbidity and mortality. This study aimed to assess treatment response rates and identify contributing factors towards treatment response. METHODS: In this single-center, retrospective, longitudinal study spanning four years, we analyzed all pulmonary exacerbation admissions. We compared lung function at baseline, admission, end of treatment, and 6-week follow-up. Treatment response was defined as ≥95% recovery of baseline FEV1%. RESULTS: There were 78 children who required a total of 184 admissions. The mean duration of treatment was 14.9±2.9 days. FEV1% returned to 95% of baseline in 59% following treatment. The magnitude of the decline in lung function on admission in children who did not respond to treatment was 21.7±15.2% while the decline in children who responded to treatment was 8.3±9.4%, P<0.001. Children who experienced a decline in FEV1% greater than 40% exhibited an 80% reduced likelihood of returning to their baseline values (OR -0.8, 95% CI -0.988; -0.612). Similarly, those with FEV1% reductions in the ranges of 30-39% (OR -0.63, 95% CI -0.821; -0.439), 20-29% (OR -0.52, 95% CI -0.657; -0.383), and 10-19% (OR -0.239, 95% CI -0.33; -0.148) showed progressively lower odds of returning to baseline. Fourty-eight children required readmission within 7.7±5.4 months, children who responded to treatment had a longer time taken to readmission (8.9±6.4 months) versus children who did not respond to treatment (6.4±3.5 months), (OR: -0.20, 95% CI -0.355; -0.048). CONCLUSIONS: A greater decline in lung function on admission and readmission within 6 months of the initial admission predicts non-response to treatment. This highlights the importance of re-evaluating follow-up strategies following discharge.

Effects of a School-Based Mindfulness Program for Young Children.

Schools are an attractive setting for implementation of mindfulness-based programs because mindfulness practices, by their very nature, align with a wide range of core educational goals. The present study investigated the effects of an 8-week (16 session) school-based mindfulness program for young children across 8 classrooms (K through 2) using a quasi-experimental delayed-intervention control group design. Results indicated that the mindfulness program was associated with significant improvements in teacher ratings of externalizing and prosocial behaviors. Program outcomes were not associated with child sex or race/ethnicity, but did vary by grade. Descriptive analyses suggest that outcomes tended to be more positive in classrooms with higher levels of teacher and student engagement. Results of the present study add to the growing knowledge base on the positive effects of school-based mindfulness programs and point to a need for more rigorous inquiry into the extent to which students and teachers are engaged with mindfulness programs both during the program itself and in their day to day functioning.

A comparison of curricula: Examining the efficacy of a school-based musical theater intervention.

Students qualifying for services under the Individuals with Disabilities Education Act may experience challenges meeting the socioemotional demands of the school environment, creating a need for targeted interventions that can be delivered within school settings. The current study used a mixed-methods approach to examine the efficacy of a 4-week school-based musical theater intervention delivered to 121 elementary students with intellectual and developmental disabilities. Quantitative analyses of teacher-reported changes in student engagement pre- and post-intervention were conducted to compare student gains made across two intervention curricula, followed by qualitative content analyses of teachers' responses to open-ended survey questions. Results indicated an overall benefit of the musical theater intervention, with increases found in composite scores on the teacher-report Student Engagement Survey measure after completion of both intervention curricula; however, gains in individual survey item scores differed by curricula. Additionally, qualitative analyses provided positive insight into several aspects of the intervention.

An Eye-Tracking Method for Directly Assessing Children's Visual-Motor Integration.

BACKGROUND: Visual-motor integration is an integral component of many adaptive behaviors and has been linked to school readiness. In young school-age children, visual-motor integration is typically assessed with the Beery-Buktenica Developmental Test of Visual Motor Integration (Beery VMI), a standardized instrument that measures children's ability to copy 2-dimensional forms. The Beery VMI is scored according to children's final written product, but does not directly measure the process of visual-motor integration that underlies children's form copying. OBJECTIVE: We describe a new way of directly assessing visual-motor integration in real time. We demonstrate how head-mounted eye-tracking technology for young children can be used to describe the dynamics of visual-motor integration when children copy forms. DESIGN: This study used a cross-sectional design. METHODS: Typically developing kindergarten children (N = 20) were tested as they wore an eye-tracker while performing the Beery VMI. RESULTS: Participants' success (b = -0.66; SE = 0.08; Cohen f2 = 1.11) and their efficiency in visual (b = 0.29; SE = 0.02; Cohen f2 = 0.55) and motor (b = 0.12; SE = 0.01; Cohen f2 = 0.90) processes during form copying decreased as the stimulus complexity increased. LIMITATIONS: A small convenience sample was used to determine proof of concept. A larger, more representative sample is necessary to provide generalizable results. CONCLUSIONS: The new methods used here offer the possibility of more fine-grained assessments of eye-hand coordination in typically developing children and children with such clinical conditions as dysgraphia and developmental coordination disorder.

The effect of manual therapy on gastrocnemius muscle stiffness in healthy individuals.

STUDY DESIGN: Randomized clinical trial. BACKGROUND: Muscle stiffness is a potential complication after injury and has been shown to be a risk factor for injury in healthy individuals. OBJECTIVES: The primary purpose of this study was to assess the short-term effects of manual therapy (MT) on muscle stiffness of the gastrocnemius in both a relaxed and contracted state. The secondary purpose was to assess the reliability of a novel clinical tool (MyotonPRO) to measure muscle stiffness in the gastrocnemius in both a passive and contracted state. METHODS: Eighty-four consecutive healthy individuals were randomized to receive Manual Therapy (MT group) directed at the right-side ankle and foot or no treatment (CONTROL group). Muscle stiffness of the gastrocnemius was assessed bilaterally in all participants at baseline and then immediately after intervention in a relaxed and contracted state. Group (MT vs. CONTROL) by side (ipsilateral vs. contralateral) by time (pre vs. post) effects were compared through a 3-way interaction utilizing mixed model ANOVA. Reliability of the MyotonPRO was assessed with two-way mixed model intraclass correlation coefficients. RESULTS: There was a significant 3-way interaction for muscle stiffness of the gastrocnemius in a relaxed state (p<0.01), but not contracted state (p=0.54). All conditions had increased resting muscle stiffness from pre to post measures except for the ipsilateral limb of the MT group. There was not a significant interaction for muscle stiffness in a contracted state. Reliability estimates (ICC) for muscle stiffness measures ranged between 0.898 and 0.986. CONCLUSION: The change in muscle stiffness of the gastrocnemius in a relaxed state depended upon whether individuals received MT. Muscle stiffness measures were highly reliable based on single measurements. LEVEL OF EVIDENCE: Therapy, level 2.

Assessment of Volume Status Using Ultrasonography.

Ultrasonography is a first-line diagnostic tool when evaluating volume status in the critical care patient population. Ultrasonography leads to a prompt diagnosis and more appropriate management plan, while decreasing health care costs, time to diagnosis, hospital length of stay, time to definitive operation, and mortality. It is recommended that critical care providers treating critically ill patients be skilled and competent in critical care ultrasonography. As the critical care population and the shortage of critical care physicians increases, advanced practice providers are becoming more prevalent in critical care areas and should be competent in this skill as well.

Cancer Mortality Trends in Medically Underserved Counties in Virginia.

CONTEXT: Cancer mortality rates in the United States have improved during the past 40 years. The improvement in mortality rates is not equal for all types of cancer or all geographic locations, however. OBJECTIVE: To compare trends in cancer mortality rates in Virginia counties from 2005 through 2009. METHODS: Publicly available data from the National Cancer Institute, the State Cancer Profile, and the Virginia Department of Health were accessed for this analysis. For all counties in Virginia with all-cancer and lung cancer mortality data available, the authors compared counties considered medically underserved areas (VMUAs) with non-VMUAs to examine trends in cancer mortality rates that increased, remained stable, or decreased from 2005 through 2009. The significance level for all data was set at P≤.05. RESULTS: Of 136 counties in Virginia, 134 had all-cancer and 123 had lung cancer mortality data available. The VMUAs had a 48% lower decreasing all-cancer mortality rate than non-VMUAs (13 [26%] vs 37 [74%], respectively; P=.004). Non-VMUAs had a 33.3% higher stable all-cancer mortality rate than VMUAs (50 [66.6%] vs 25 [33.3%], respectively; P=.004) and a 55.2% higher lung cancer mortality rate (17 [22.4%] vs 59 [77.6%], respectively; P<.001). CONCLUSION: The all-cancer and lung cancer mortality rates were found to either remain stable or, in the case of all-cancer mortality, to increase in VMUAs.

Betaine supplementation enhances anabolic endocrine and Akt signaling in response to acute bouts of exercise.

Our aim was to examine the effect of betaine supplementation on selected circulating hormonal measures and Akt muscle signaling proteins after an acute exercise session. Twelve trained men (age 19.7 ± 1.23 years) underwent 2 weeks of supplementation with either betaine (B) (1.25 g BID) or placebo (P). Following a 2-week washout period, subjects underwent supplementation with the other treatment (B or P). Before and after each 2-week period, subjects performed an acute exercise session (AES). Circulating GH, IGF-1, cortisol, and insulin were measured. Vastus lateralis samples were analyzed for signaling proteins (Akt, p70 S6k, AMPK). B (vs. P) supplementation approached a significant increase in GH (mean ± SD (Area under the curve, AUC), B: 40.72 ± 6.14, P: 38.28 ± 5.54, p = 0.060) and significantly increased IGF-1 (mean ± SD (AUC), B: 106.19 ± 13.45, P: 95.10 ± 14.23, p = 0.010), but significantly decreased cortisol (mean ± SD (AUC), B: 1,079.18 ± 110.02, P: 1,228.53 ± 130.32, p = 0.007). There was no difference in insulin (AUC). B increased resting Total muscle Akt (p = 0.003). B potentiated phosphorylation (relative to P) of Akt (Ser(473)) and p70 S6 k (Thr(389)) (p = 0.016 and p = 0.005, respectively). Phosphorylation of AMPK (Thr(172)) decreased during both treatments (both p = 0.001). Betaine (vs. placebo) supplementation enhanced both the anabolic endocrine profile and the corresponding anabolic signaling environment, suggesting increased protein synthesis.

Ergogenic effects of betaine supplementation on strength and power performance.

BACKGROUND: We investigated the ergogenic effects of betaine (B) supplementation on strength and power performance. METHODS: Twelve men (mean +/- SD age, 21 +/- 3 yr; mass, 79.1 +/- 10.7 kg) with a minimum of 3 months resistance training completed two 14-day experimental trials separated by a 14-day washout period, in a balanced, randomized, double-blind, repeated measures, crossover design. Prior to and following 14 days of twice daily B or placebo (P) supplementation, subjects completed two consecutive days (D1 and D2) of a standardized high intensity strength/power resistance exercise challenge (REC). Performance included bench, squat, and jump tests. RESULTS: Following 14-days of B supplementation, D1 and D2 bench throw power (1779 +/- 90 and 1788 +/- 34 W, respectively) and isometric bench press force (2922 +/- 297 and 2503 +/- 28 N, respectively) were increased (p < 0.05) during REC compared to pre-supplementation values (1534 +/- 30 and 1498 +/- 29 W, respectively; 2345 +/- 64 and 2423 +/- 84 N, respectively) and corresponding P values (1374 +/- 128 and 1523 +/- 39 W; 2175 +/- 92 and 2128 +/- 56 N, respectively). Compared to pre-supplementation, vertical jump power and isometric squat force increased (p < 0.05) on D1 and D2 following B supplementation. However, there were no differences in jump squat power or the number of bench press or squat repetitions. CONCLUSION: B supplementation increased power, force and maintenance of these measures in selected performance measures, and these were more apparent in the smaller upper-body muscle groups.

Examination of the efficacy of acute L-alanyl-L-glutamine ingestion during hydration stress in endurance exercise.

BACKGROUND: The effect of acute L-alanyl-L-glutamine (AG; Sustamine) ingestion on performance changes and markers of fluid regulation, immune, inflammatory, oxidative stress, and recovery was examined in response to exhaustive endurance exercise, during and in the absence of dehydration. METHODS: Ten physically active males (20.8 +/- 0.6 y; 176.8 +/- 7.2 cm; 77.4 +/- 10.5 kg; 12.3 +/- 4.6% body fat) volunteered to participate in this study. During the first visit (T1) subjects reported to the laboratory in a euhydrated state to provide a baseline (BL) blood draw and perform a maximal exercise test. In the four subsequent randomly ordered trials, subjects dehydrated to -2.5% of their baseline body mass. For T2, subjects achieved their goal weight and were not rehydrated. During T3 - T5, subjects reached their goal weight and then rehydrated to 1.5% of their baseline body mass by drinking either water (T3) or two different doses (T4 and T5) of the AG supplement (0.05 g.kg-1 and 0.2 g.kg-1, respectively). Subjects then exercised at a workload that elicited 75% of their VO2 max on a cycle ergometer. During T2 - T5 blood draws occurred once goal body mass was achieved (DHY), immediately prior to the exercise stress (RHY), and immediately following the exercise protocol (IP). Resting 24 hour (24P) blood samples were also obtained. Blood samples were analyzed for glutamine, potassium, sodium, aldosterone, arginine vasopressin (AVP), C-reactive protein (CRP), interleukin-6 (IL-6), malondialdehyde (MDA), testosterone, cortisol, ACTH, growth hormone and creatine kinase. Statistical evaluation of performance, hormonal and biochemical changes was accomplished using a repeated measures analysis of variance. RESULTS: Glutamine concentrations for T5 were significantly higher at RHY and IP than T2 - T4. When examining performance changes (difference between T2 - T5 and T1), significantly greater times to exhaustion occurred during T4 (130.2 +/- 340.2 sec) and T5 (157.4 +/- 263.1 sec) compared to T2 (455.6 +/- 245.0 sec). Plasma sodium concentrations were greater (p < 0.05) at RHY and IP for T2 than all other trials. Aldosterone concentrations at RHY and IP were significantly lower than that at BL and DHY. AVP was significantly elevated at DHY, RHY and IP compared to BL measures. No significant differences were observed between trials in CRP, IL-6, MDA, or in any of the other hormonal or biochemical measures. CONCLUSION: Results demonstrate that AG supplementation provided a significant ergogenic benefit by increasing time to exhaustion during a mild hydration stress. This ergogenic effect was likely mediated by an enhanced fluid and electrolyte uptake.

Vertical jump, anaerobic power, and shooting accuracy are not altered 6 hours after strength training in collegiate women basketball players.

We measured vertical jump, anaerobic power, and shooting accuracy in 18 Division I women basketball players (age 18-22 years) 6 hours following a morning strength training routine called a lift day (LD) and on a control day in which no strength training was performed. Subjects had been strength trained for 4 weeks prior to testing. The strength training session on lift day was a full-body workout and included 7 exercises performed in 3-6 sets at loads ranging from a 5 to 12 repetition maximum (RM). There were no significant differences in jump height with 2 legs (49.5 +/- 4.8 cm and 49.0 +/- 4.8 cm, LD and control, respectively), relative mean power output over 30 seconds on a Wingate bicycle test (6.4 +/- 0.8 W.kg(-1) and 6.6 +/- 0.7 W.kg(-1), LD and control, respectively), or shooting accuracy over 60 seconds (21.5 +/- 3.8 points/min and 21.3 +/- 4.1 points/min, LD and control, respectively). These data suggest that in collegiate women basketball players, a previous bout of strength training has no negative effect on vertical jump height, anaerobic power, or shooting accuracy.