Reproducibility of arterial stiffness and wave reflections in chronic obstructive pulmonary disease: The contribution of lung hyperinflation and a comparison of techniques

SummarySignificant cardiovascular morbidity and mortality exists in chronic obstructive pulmonary disease (COPD). Arterial stiffness is raised in COPD and may be a mechanistic link. Non-invasive assessment of arterial stiffness has the potential to be a surrogate outcome measure, although no reproducibility data exists in COPD patients.Two studies (23 and 33 COPD patients) were undertaken to 1) assess the Vicorder reproducibility of carotid-femoral pulse wave velocity and Augmentation index in COPD; 2) compare it to SphygmoCor; and 3) assess the contribution of lung hyperinflation to measurement variability.There were excellent correlations and good agreement between repeat Vicorder measurements for carotid-femoral pulse wave velocity (r = 0.96 (p < 0.001); mean difference ±SD = −0.03 ± 0.36 m/s (p = 0.65); co-efficient of reproducibility = 4.02%; limits of agreement = −0.68–0.75 m/s). Augmentation index significantly correlated (r = 0.736 (p < 0.001); mean difference ±SD = 0.72 ± 4.86% (p = 0.48), however limits of agreement were only 10.42–9.02%, with co-efficient of reproducibility of 27.93%. Comparing devices, Vicorder values were lower but there was satisfactory agreement. There were no correlation between lung hyperinflation (as measured by residual volume percent predicted, total lung capacity percent predicted or the ratio of inspiratory capacity to residual volume) and variability of measurements in either study.In COPD, measurement of carotid-femoral pulse wave velocity is highly reproducible, not affected by lung hyperinflation and suitable as a surrogate endpoint in research studies. Day-to-day variation in augmentation index highlights the importance of such studies prior to the planning and undertaking of clinical COPD research

An evaluation of veteran to civilian reintegration stressors, co-occurrence, and perception of procedure

Though the majority of veterans are able to reintegrate into civilian society without incident, a portion of the population does experience mild to severe stressors such as mental health disorders, suicide risk, incarceration, substance abuse and dependence, interpersonal relationships and readjustment, workplace difficulties, and sleep disturbance (Blow et al., 2013; Bonanno et al., 2012; Haller, Angkaw, Hendricks &amp; Norman, 2016; Sayer et al., 2010; Short et al., 2016). Unfortunately, the current literature focuses on only one or two stressors, and rarely acknowledges all stressors as they coexist among the veteran population. The current study will focus on all prevalent reintegration stressors, and the relationship they may have for veterans. More specifically, the study will identify: (1) which reintegration stressors are more prevalent than others, (2) which co-occur with other stressors, and (3) the perception of the reintegration process. A sample of 31 veterans completed a comprehensive questionnaire that assessed these reintegration stressors; frequencies and Spearman’s r correlations were conducted to evaluate the previously mentioned relationships. Many of the veterans experienced each of the reintegration stressors measured, at varying degrees. More veterans experienced at least one mental health diagnosis, but there were many who experienced more than one. Almost half of the sample had thought about suicide, and almost 20 percent had made a plan. A large portion of the veterans in this sample experienced relationship difficulties as well as interpersonal difficulties. The overall co-occurrence of reintegration stressors are consistent with the previous literature, providing more insight into what has been previously found. In regard to veteran perception of the process, several themes emerged including: difficulty finding a “tribe”, adjusting to the loose structure of civilian life, lack of a marketable trade, and difficulties with mental health issues. These findings demonstrate a deep need to re-evaluate the reintegration process and increase the number of programs and support systems available to veterans after leaving the military

Safety and practices during stress cardiac magnetic resonance in COPD: A 3-year experience from a tertiary referral centre

This is an author-submitted, peer-reviewed version of a manuscript that has been accepted for publication in the European Respiratory Journal, prior to copy-editing, formatting and typesetting. This version of the manuscript may not be duplicated or reproduced without prior permission from the copyright owner, the European Respiratory Society. The publisher is not responsible or liable for any errors or omissions in this version of the manuscript or in any version derived from it by any other parties. The final, copy-edited, published article, which is the version of record, is available without a subscription 18 months after the date of issue publication

Chronic Obstructive Pulmonary Disease as a Predictor of Cardiovascular Risk: A Case-Control Study.

This is an Accepted Manuscript of an article published by Taylor & Francis in on 13 December 2019, available online: https://doi.org/10.1080/15412555.2019.1694501Chronic obstructive pulmonary disease (COPD) is a complex multi-morbid disorder with significant cardiac mortality. Current cardiovascular risk prediction models do not include COPD. We investigated whether COPD modifies future cardiovascular risk to determine if it should be considered in risk prediction models.Case-control study using baseline data from two randomized controlled trials performed between 2012 and 2015. Of the 90 eligible subjects, 26 COPD patients with lung hyperinflation were propensity matched for 10-year global cardiovascular risk score (QRISK2) with 26 controls having normal lung function. Patients underwent cardiac magnetic resonance imaging, arterial stiffness and lung function measurements. Differences in pulse wave velocity (PWV), total arterial compliance (TAC) and aortic distensibility were main outcome measures.PWV (mean difference 1.0 m/s, 95% CI 0.02-1.92; p = 0.033) and TAC (mean difference -0.27 mL/m2/mmHg, 95% CI 0.39-0.15; p < 0.001) were adversely affected in COPD compared to the control group. The PWV difference equates to an age, sex and risk-factor adjusted increase in relative risk of cardiovascular events and mortality of 14% and 15%, respectively.There were no differences in aortic distensibility. In the whole cohort (n = 90) QRISK2 (β = 0.045, p = 0.005) was associated with PWV in multivariate analysis. The relationship between QRISK2 and PWV were modified by COPD, where the interaction term reached significance (p = 0.014). FEV1 (β = 0.055 (0.027), p = 0.041) and pulse (B = -0.006 (0.002), p = 0.003) were associated with TAC in multivariate analysis.Markers of cardiovascular outcomes are adversely affected in COPD patients with lung hyperinflation compared to controls matched for global cardiovascular risk. Cardiovascular risk algorithms may benefit from the addition of a COPD variable to improve risk prediction and guide management.HAPPY London ClinicalTrials.gov: NCT01911910 and HZC116601; ClinicalTrials.gov: NCT01691885.The COPD trial was funded by GlaxoSmithKline (GSK), London, United Kingdom (HZC116601); SmithKline Beecham Pharma; The HAPPY London Study was funded by The Barts Charity (437/1412), London, United Kingdom

Exploring cultural competencies of certified therapeutic recreation specialists: Implications for education and training

The purpose of this investigation was to explore the influence of demographic and educational variables on self-reported multicultural competencies of Certified Therapeutic Recreation Specialists(TM) (CTRSs(R)). A sample of 277 therapeutic recreation specialists currently certified with the National Council for Therapeutic Recreation Certification participated in this investigation. Multicultural course work, seminars and workshops, and perception of level of cultural competence among CTRSs(R) were found to be statistically significant with self-reported multicultural competencies, such as multicultural awareness, knowledge and skills. These findings are discussed in terms of pre-service education and continued professional in-service training for CTRSs(R)

Being a Sports Agent: Examining the Profession of Athlete Representation

Anything that remains relevant in society over time faces changes with progression in culture and technology, including goods, services, laws, and especially professions, that may seem strange to imagine life without. The tricky thing about professions is that if they don’t respond well to adaptations, they are usually eliminated if a substitution can be created to yield similar results. This is not any different for athlete representation, which is a profession that has seen many changes but still is a necessary field to prevent professional athletes from being taken advantage of by organizations and vice versa. This is an examination of how modern advancements, controversy, and motivation have collectively shaped the perspective of the field from the opinions of those currently involved in the profession. A survey was sent to several agencies to gather data about the general response to issues such as the impact of social media, aggressive agents, certification regulations, and the future of the profession, among other things. While analyzing the data collected from the survey, this thesis will provide brief background information on the main pillars that sustain this profession. The information offered will provide insight for people who may have a serious interest in this occupation to the casual inquirer who would just like to discover facts about this line of work

WHAT ARE THE DIFFERENCES BETWEEN EFFECTIVE AND INEFFECTIVE CHARTER SCHOOLS IN NORTH CAROLINA?

This purpose of this study was to investigate the effectiveness of the North Carolina charter schools. The variables were chosen based on the researcher‘s inference from literature reviews discussing common factors from qualitative charter school studies. The indicators were used to determine if charter schools could be categorized as effective or ineffective were: (1) attendance rates, (2) short suspensions, (3) student teacher ratio, (4) teacher quality, (5) Reading NCE, and (6) Math NCE scores. Charter schools were determined to be effective, if they were ?1? standard deviation point above average for Reading NCE and Math NCE scores. Charter schools were determined to be ineffective, if they were ?1? standard deviation point below average for Reading NCE and Math NCE scores. The data collected for this study was ex-post facto data from the North Carolina Department of Public Instruction‘s (NCDPI) website using the academic school year 2008-09. The data was coded and entered into SPSS creating a quantitative output to be analyzed and interpreted. The quantitative output determined that there were a total of 12 ineffective charter schools and 10 effective charter schools The results indicated that no charter schools in North Carolina were affiliated with a traditional school district. Also, the dependent variables, attendance rate and teacher quality were determined to be statistically significant in determining the effectiveness of a charter school in North Carolina. The other variables were determined to be insignificant in determining the effectiveness of charter schools in North Carolina

Knowledge, attitude, and demographic characteristics of selected local education agencies and their relationship to procedural compliance with exceptional children

This dissertation was designed to investigate the relationship of selected local educational agency variables to compliance with federal and state legislative procedural requirements for exceptional children programs. The variables investigated included principals' and special education administrators' level of knowledge of legislative procedural requirements and their attitude toward these requirements; principals' and special education administrators' experience, training, and degree or degrees earned; total student enrollment of school system; and type of administrative school unit (city or county). Data for this study were collected through the administration of an opinionnaire developed to measure knowledge of legislative procedural requirements and attitude toward these requirements. The opinionnaire was also designed to collect demographic characteristics of the two respondent groups, randomly selected principals and special education administrators, in the North Central Educational Region of the North Carolina Department of Public Instruction. Respondents in the two groups indicated whether the items on the opinionnaire were or were not required and if they should or should not be required. The 34 items and demographic characteristics included in the opinionnaire were selected after a thorough review of pertinent literature and state monitoring documents, and after consultation with a variety of specialists in exceptional children education and research

Maternal socialization of emotion : child, maternal, and relational factors

"Previous research has implicated maternal emotion socialization as an important predictor of children's future social competence and behavior. However, the factors related to emotion socialization strategies have yet to be explored. This study examined the relative contribution of child temperament, maternal parenting stress and psychopathology, and the mother-child relationship as factors related to dimensions of non-supportive and supportive emotion socialization practices of mothers of 4-year-old children. Results indicated that maternal psychopathology, maternal parenting stress, and a positive mother-child relationship were related to non-supportive emotion socialization practices. In addition, a negative mother-child relationship mediated the relationship between child frustration distress and non-supportive emotion socialization. Exploratory analyses examined the possibility that mothers may fall into groups based on their patterns of emotion socialization."--Abstract from author supplied metadata

"Talking the Talk" and "Walking the Walk:" Strategies to Enhance Intercultural Communication

The population of the United States is becoming more culturally diverse each day. Of the over 284 million people in our total population, almost 20% are ethnic minorities. It is predicted that if current trends continue, Americans 65 years old and over will make up 20% of the population by the year 2030 (U.S. Census Bureau, 2000). Additionally, about 1 in 5 Americans have some type of disability, and 1 in 10 have a severe disability (U.S. Census Brief, 1997). North Carolina paints a similar picture. Of the over 8 million people residing in NC, 70% are white (a decrease from 72% in 1990), while African-Americans remained steady at about 22% of the population. Most striking is the fact that the Hispanic/Latino population surged 394%, accounting for 4.75% of our residents compared to 1.2% in 1990. The number of North Carolinians who identified themselves as "only Asian" or "Asian and another race" increased 173%. NC also has the seventh-largest American-Indian population in the nation. Twelve percent of NC residents are 65 years of age or older (an increase of over 21% since 1990), while 75 year olds and older increased 36%, and 85 year olds and older grew even faster to 53% during that same decade. In addition, more than 29% of NC residents are non-institutionalized persons with disabilities, and 8% speak a language other than English (U.S. Census Bureau, 2000)