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IntroductionExercise training post-transplant has been shown to improve physical function and quality of life in solid organ transplant (SOT) recipients. Online resources in the form of websites and videos are commonly used to provide education and instruction on exercise and physical activity in SOT; however, the content and quality of these online resources has not been evaluated.MethodsThe first 200 websites and videos identified on Google and YouTube using the English search term “exercise and physical activity in solid organ transplantation” were analyzed. Website and video content was evaluated based on 25 key components of exercise and physical activity in SOT as described in established exercise program recommendations. Website and video quality was determined using DISCERN, Global Quality Scale (GQS), and Patient Education Materials and Assessment Tool (PEMAT; threshold for which material is deemed understandable or actionable is >70%). Parametric and non-parametric tests were used to assess website and video characteristics, content, and quality metrics.ResultsForty-nine unique SOT websites (n = 15) and videos (n = 34) were identified, with the two most common categories being foundation/advocacy organizations and scientific resources. The average reading grade level of websites was 13 ± 3. Website and video content scores varied significantly (websites 11.3 ± 6.4; videos 8.4 ± 5.3). DISCERN total score and GQS score were low (median range for DISCERN 2.5–3.0; median for GQS 2.0 for both websites and videos, out of 5). PEMAT understandability and actionability scores were also low across websites and videos (mean range 57%–67% and 47%–65%, respectively). Foundation/advocacy websites had higher content and quality scores compared to scientific organizations and news/media articles.ConclusionsTo our knowledge, this is the first comprehensive assessment of online content and quality of website and video resources on physical activity and exercise in adult SOT recipients. There were a limited number of online English patient-directed resources related to physical activity in SOT, most of which only partly captured items outlined in consensus exercise program recommendations and were of low quality and understandability and actionability. This work provides important insight to the English-speaking transplant community on the current state of online exercise health information and provides future direction for resource development.

Joint moment is the resultant force of limb movements. However, estimation methods for joint moments using surface electromyography frequently use joint angles instead of limb angles. The limb angle in joint moment estimation using electromyography could clarify the effects of muscle activity on the limbs: acceleration, deceleration, or stabilization. No study has quantified the comprehensive relationship between limb movement, muscle activity, and joint moment. This study aimed to determine the influencing factors for ankle-joint moment and knee-joint moment in the sagittal plane among muscle activities and parameters related to limb movements during half squat and gait. This study included 29 healthy adults (16 female participants, 21.1 ± 2.09 years). Using inertial measurement units, thigh, shank, and foot inclination angles and angular accelerations were calculated as the parameters of limb movements. Muscle activations of the biceps femoris long head, rectus femoris, gastrocnemius, and tibialis anterior were measured. Ankle joint moment and knee-joint moment were measured using a three-dimensional motion capture system and two force plates. Regression models showed high accuracy in measuring ankle-joint moment during a half squat and gait (R2f = 0.92, 0.97, respectively) and knee-joint moment during a half squat (R2f = 0.98), but not knee-joint moment during gait (R2f = 0.63). However, only a maximum of five parameters were selected from muscle activities and limb angular information. Tibialis anterior and gastrocnemius activity were the largest contributors to ankle-joint moment during a half squat and gait, respectively, while muscle activities were not directly reflected in the knee-joint moment during either movement. Consideration of the interrelationships among limb movement, muscle activity, and joint moment is required when adjusting joint movements according to the target and aim of the therapeutic interventions.

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive condition associated with physical and cognitive impairments contributing to difficulty in performing activities of daily living (ADLs) that require dual tasking (eg, walking and talking). Despite evidence showing that cognitive decline occurs among patients with COPD and may contribute to functional limitations and decreased health-related quality of life (HRQL), pulmonary rehabilitation continues to focus mainly on physical training (ie, aerobic and strength exercises). An integrated cognitive and physical training program compared to physical training alone may be more effective in increasing dual-tasking ability among people living with COPD, leading to greater improvements in performance of ADLs and HRQL. ObjectiveThe aims of this study are to evaluate the feasibility of an 8-week randomized controlled trial of home-based, cognitive-physical training versus physical training for patients with moderate to severe COPD and derive preliminary estimates of cognitive-physical training intervention efficacy on measures of physical and cognitive function, dual task performance, ADLs, and HRQL. MethodsA total of 24 participants with moderate to severe COPD will be recruited and randomized into cognitive-physical training or physical training. All participants will be prescribed an individualized home physical exercise program comprising 5 days of moderate-intensity aerobic exercise (30-50 minutes/session) and 2 days of whole-body strength training per week. The cognitive-physical training group will also perform cognitive training for approximately 60 minutes, 5 days per week via the BrainHQ platform (Posit Science Corporation). Participants will meet once weekly with an exercise professional (via videoconference) who will provide support by reviewing the progression of their training and addressing any queries. Feasibility will be assessed through the recruitment rate, program adherence, satisfaction, attrition, and safety. The intervention efficacy regarding dual task performance, physical function, ADLs, and HRQL will be evaluated at baseline and at 4 and 8 weeks. Descriptive statistics will be used to summarize intervention feasibility. Paired 2-tailed t tests and 2-tailed t tests will be used to compare the changes in the outcome measures over the 8-week study period within and between the 2 randomized groups, respectively. ResultsEnrollment started in January 2022. It is estimated that the enrollment period will be 24 months long, with data collection to be completed by December 2023. ConclusionsA supervised home-based cognitive-physical training program may be an accessible intervention to improve dual-tasking ability in people living with COPD. Evaluating the feasibility and effect estimates is a critical first step to inform future clinical trials evaluating this approach and its effects on physical and cognitive function, ADL performance, and HRQL. Trial RegistrationClinicalTrials.gov NCT05140226; https://clinicaltrials.gov/ct2/show/NCT05140226 International Registered Report Identifier (IRRID)DERR1-10.2196/48666

Abstract Background Insufficient or excessive respiratory effort during acute hypoxemic respiratory failure (AHRF) increases the risk of lung and diaphragm injury. We sought to establish whether respiratory effort can be optimized to achieve lung- and diaphragm-protective (LDP) targets (esophageal pressure swing − 3 to − 8 cm H2O; dynamic transpulmonary driving pressure ≤ 15 cm H2O) during AHRF. Methods In patients with early AHRF, spontaneous breathing was initiated as soon as passive ventilation was not deemed mandatory. Inspiratory pressure, sedation, positive end-expiratory pressure (PEEP), and sweep gas flow (in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO)) were systematically titrated to achieve LDP targets. Additionally, partial neuromuscular blockade (pNMBA) was administered in patients with refractory excessive respiratory effort. Results Of 30 patients enrolled, most had severe AHRF; 16 required VV-ECMO. Respiratory effort was absent in all at enrolment. After initiating spontaneous breathing, most exhibited high respiratory effort and only 6/30 met LDP targets. After titrating ventilation, sedation, and sweep gas flow, LDP targets were achieved in 20/30. LDP targets were more likely to be achieved in patients on VV-ECMO (median OR 10, 95% CrI 2, 81) and at the PEEP level associated with improved dynamic compliance (median OR 33, 95% CrI 5, 898). Administration of pNMBA to patients with refractory excessive effort was well-tolerated and effectively achieved LDP targets. Conclusion Respiratory effort is frequently absent under deep sedation but becomes excessive when spontaneous breathing is permitted in patients with moderate or severe AHRF. Systematically titrating ventilation and sedation can optimize respiratory effort for lung and diaphragm protection in most patients. VV-ECMO can greatly facilitate the delivery of a LDP strategy. Trial registration: This trial was registered in Clinicaltrials.gov in August 2018 (NCT03612583).

BackgroundDyspnea is a prevalent symptom in individuals with hypermobile Ehlers-Danlos Syndrome (hEDS) and generalized hypermobility spectrum disorder (G-HSD), yet its contributors have not been identified. One known contributor to dyspnea is respiratory muscle weakness. The feasibility and effectiveness of inspiratory muscle training (IMT) in combination with standard-of-care rehabilitation (aerobic, resistance, neuromuscular stabilization, and balance and proprioception exercises) in improving respiratory muscle strength and patient-reported outcomes in patients with hEDS or G-HSD have not been evaluated. ObjectiveThis study aims to evaluate dyspnea, respiratory muscle strength, and patient-reported outcome measures (PROMs) in hEDS or G-HSD compared with healthy controls and to assess the feasibility of a randomized controlled trial of IMT and standard-of-care rehabilitation for improving respiratory muscle strength, exercise capacity, and PROMs compared with standard-of-care rehabilitation in hEDS and G-HSD. MethodsThe study will include 34 participants with hEDS or G-HSD and 17 healthy, age- and sex-matched controls to compare respiratory muscle structure and function and PROMs. After baseline assessments, participants with hEDS or G-HSD will be randomized into the intervention group and provided IMT combined with Ehlers-Danlos Syndrome standard-of-care rehabilitation or into the usual care group, and provided only standard-of-care rehabilitation for 8 weeks. The intervention group will be prescribed IMT in their home environment using the POWERbreathe K5 IMT device (POWERbreathe International Ltd). IMT will comprise 2 daily sessions of 30 breaths for 5 days per week, with IMT progressing from 20% to 60% of the baseline maximal inspiratory pressure (MIP) over an 8-week period. Feasibility will be assessed through rates of recruitment, attrition, adherence, adverse events, and participant satisfaction. The primary pilot outcome is MIP change over an 8-week period in hEDS or G-HSD. Secondary outcomes will include the evaluation of dyspnea using Medical Research Council Scale and 18-point qualitative dyspnea descriptors; diaphragmatic thickening fraction using ultrasound; respiratory muscle endurance; pulmonary function; prefrontal cortical activity using functional near-infrared spectroscopy; aerobic capacity during cardiopulmonary exercise testing; quality of life using Short Form-36; and scores from the Depression, Anxiety, and Stress scale-21. These measures will also be performed once in healthy controls to compare normative values. Multivariable regression will be used to assess the contributors to dyspnea. Paired 2-tailed t tests will be used to assess the changes in MIP and secondary measures after 8 weeks of IMT. ResultsStudy recruitment began in August 2021 and, with several disruptions owing to COVID-19, is expected to be completed by December 2023. ConclusionsThis study will provide a better understanding of the factors associated with dyspnea and the feasibility and effectiveness of IMT combined with standard-of-care rehabilitation. IMT may be a novel therapeutic strategy for improving respiratory muscle function and patient-reported outcomes in individuals with hEDS or G-HSD. Trial RegistrationClinicalTrials.gov NCT04972565; https://clinicaltrials.gov/ct2/show/NCT04972565 International Registered Report Identifier (IRRID)DERR1-10.2196/44832

ObjectivesDyspnea is a common and multidimensional experience of healthy adults and those with respiratory disorders. Due to its neural processing, it may limit or interfere with cognition, which may be examined with a dual-task paradigm. The aim of this study was to compare single-task performance of Stroop Colour and Word Test (SCWT) or inspiratory threshold loading (ITL) to their combined dual-task performance. Secondly, whether mood was related to dyspnea or cognitive performance was also evaluated.Materials & methodsA virtual pre-post design examined single (SCWT and ITL) and dual-task (SCWT+ITL) performance. For ITL, a Threshold Trainer™ was used to elicit a "somewhat severe" rating of dyspnea. The SCWT required participants to indicate whether a colour-word was congruent or incongruent with its semantic meaning. The Depression, Anxiety and Stress Scale-21 (DASS-21) was completed to assess mood. Breathing frequency, Borg dyspnea rating, and breathing endurance time were ascertained.ResultsThirty young healthy adults (15F, 15M; median age = 24, IQR [23-26] years) completed the study. SCWT+ITL had lower SCWT accuracy compared to SCWT alone (98.6%, [97.1-100.0] vs 99.5%, [98.6-100.0]; p = 0.009). Endurance time was not different between ITL and SCWT+ITL (14.5 minutes, [6.9-15.0]) vs 13.7 minutes, [6.1-15.0]; p = 0.59). DASS-21 scores positively correlated with dyspnea scores during ITL (rho = 0.583, pConclusionsITL significantly reduced dual-task performance in healthy young adults. Lower mood was associated with greater perceived dyspnea during single and dual-task ITL. Considering the prevalence of dyspnea in respiratory disorders, the findings of this dual task paradigm warrant further exploration to inform dyspnea management during daily activities.

Abstract Background Acute increases in muscle sonographic echodensity reflect muscle injury. Diaphragm echodensity has not been measured in mechanically ventilated patients. We undertook to develop a technique to characterize changes in diaphragm echodensity during mechanical ventilation and to assess whether these changes are correlated with prolonged mechanical ventilation. Methods Diaphragm ultrasound images were prospectively collected in mechanically ventilated patients and in 10 young healthy subjects. Echodensity was quantified based on the right-skewed distribution of grayscale values (50th percentile, ED50; 85th percentile, ED85). Intra- and inter-analyzer measurement reproducibility was determined. Outcomes recorded included duration of ventilation and ICU complications (including reintubation, tracheostomy, prolonged ventilation, or death). Results Echodensity measurements were obtained serially in 34 patients comprising a total of 104 images. Baseline (admission) diaphragm ED85 was increased in mechanically ventilated patients compared to younger healthy subjects (median 56, interquartile range (IQR) 42–84, vs. 39, IQR 36–52, p = 0.04). Patients with an initial increase in median echodensity over time (≥ + 10 in ED50 from baseline) had fewer ventilator-free days to day 60 (n = 13, median 46, IQR 0–52) compared to patients without this increase (n = 21, median 53 days, IQR 49–56, unadjusted p = 0.03). Both decreases and increases in diaphragm thickness during mechanical ventilation were associated with increases in ED50 over time (adjusted p = 0.03, conditional R 2 = 0.80) and the association between increase in ED50 and outcomes persisted after adjusting for changes in diaphragm thickness. Conclusions Many patients exhibit increased diaphragm echodensity at the outset of mechanical ventilation. Increases in diaphragm echodensity during the early course of mechanical ventilation are associated with prolonged mechanical ventilation. Both decreases and increases in diaphragm thickness during mechanical ventilation are associated with increased echodensity.

Abstract Background Decreased oxygenation of muscle may be accentuated during exercise at high altitude. Monitoring the oxygen saturation of muscle (SmO2) during hand grip exercise using near infrared spectroscopy during acute exposure to hypoxia could provide a model for a test of muscle performance without the competing cardiovascular stresses that occur during a cycle ergometer or treadmill test. The purpose of this study was to examine and compare acute exposure to normobaric hypoxia versus normoxia on deoxygenation and recruitment of the flexor digitorum superficialis (FDS) during submaximal intermittent handgrip exercise (HGE) in healthy adults. Methods Twenty subjects (11 M/9 F) performed HGE at 50% of maximum voluntary contraction, with a duty cycle of 2 s:1 s until task failure on two occasions one week apart, randomly assigned to normobaric hypoxia (FiO2 = 12%) or normoxia (FiO2 = 21%). Near-infrared spectroscopy monitored SmO2, oxygenated (O2Hb), deoxygenated (HHb), and total hemoglobin (tHb) over the FDS. Surface electromyography derived root mean square and mean power frequency of the FDS. Results Hypoxic compared to normoxic HGE induced a lower FDS SmO2 (63.8 ± 2.2 vs. 69.0 ± 1.5, p = 0.001) and both protocols decreased FDS SmO2 from baseline to task failure. FDS mean power frequency was lower during hypoxic compared to normoxic HGE (64.0 ± 1.4 vs. 68.2 ± 2.0 Hz, p = 0.04) and both decreased mean power frequency from the first contractions to task failure (p = 0.000). Under both hypoxia and normoxia, HHb, tHb and root mean square increased from baseline to task failure whereas O2Hb decreased and then increased during HGE. Arterial oxygen saturation via pulse oximetry (SpO2) was lower during hypoxia compared to normoxia conditions (p = 0.000) and heart rate and diastolic blood pressure only demonstrated small increases. Task durations and the tension-time index of HGE did not differ between normoxic and hypoxic trials. Conclusion Hypoxic compared to normoxic HGE decreased SmO2 and induced lower mean power frequency in the FDS, during repetitive hand grip exercise however did not result in differences in task durations or tension-time indices. The fiber type composition of FDS, and high duty cycle and intensity may have contributed greater dependence on anaerobiosis.

Background: Respiratory muscle electromyography (EMG) can identify whether a muscle is activated, its activation amplitude, and timing. Most studies have focused on the activation amplitude, while differences in timing and duration of activity have been less investigated. Detection of the timing of respiratory muscle activity is typically based on the visual inspection of the EMG signal. This method is time-consuming and prone to subjective interpretation.Aims: Our main objective was to develop and validate a method to assess the respective timing of different respiratory muscle activity in an objective and semi-automated manner.Method: Seven healthy adults performed an inspiratory threshold loading (ITL) test at 50% of their maximum inspiratory pressure until task failure. Surface EMG recordings of the costal diaphragm/intercostals, scalene, parasternal intercostals, and sternocleidomastoid were obtained during ITL. We developed a semi-automated algorithm to detect the onset (EMG, onset) and offset (EMG, offset) of each muscle’s EMG activity breath-by-breath with millisecond accuracy and compared its performance with manual evaluations from two independent assessors. For each muscle, the Intraclass Coefficient correlation (ICC) of the EMG, onset detection was determined between the two assessors and between the algorithm and each assessor. Additionally, we explored muscle differences in the EMG, onset, and EMG, offset timing, and duration of activity throughout the ITL.Results: More than 2000 EMG, onset s were analyzed for algorithm validation. ICCs ranged from 0.75–0.90 between assessor 1 and 2, 0.68–0.96 between assessor 1 and the algorithm, and 0.75–0.91 between assessor 2 and the algorithm (p 0.63).Conclusion: We developed an algorithm to detect EMG, onset of several respiratory muscles with millisecond accuracy that is time-efficient and validated against manual measures. Compared to the inherent bias of manual measures, the algorithm enhances objectivity and provides a strong standard for determining the respiratory muscle EMG, onset.

Respiratory muscle training (RMT) improves physical performance, although it is still debated whether this effect depends on the type of training. The purpose of this study was to compare the effects of two different types of RMT, i.e., voluntary isocapnic hyperpnea (VIH) and inspiratory threshold loading (ITL), on the deoxygenation of intercostal (ΔSmO2-m. intercostales) and vastus lateralis (ΔSmO2-m. vastus lateralis) muscles during exercise. Twenty-four participants performed eight weeks of RMT by: (i) VIH (3 days·week−1 for 12 min at 60% maximal voluntary ventilation) or (ii) ITL (5 sets·week−1 of 30 breaths·minute−1 at 60% maximal inspiratory pressure). Cardiopulmonary exercise testing (CPET) included ΔSmO2 (the change from baseline to end of test) of intercostal and vastus lateralis muscles. After RMT, both groups showed decreased ΔSmO2-m. intercostales (VIH = 12.8 ± 14.6%, p = 0.04 (effect size, ES = 0.59), and ITL = 8.4 ± 9.8%, p = 0.04 (ES = 0.48)), without a coincident change of ∆SmO2-m. vastus lateralis. ITL training induced higher V˙O2-peak absolute values than VIH (mean Δ post–pre, ITL = 229 ± 254 mL·min−1 [95% CI 67–391] vs. VIH, 39 ± 153 mL·min−1 [95% CI −58–136.0], p = 0.01). In conclusion, both RMT improved the balance between supply and oxygen consumption levels of m. intercostales during CPET, with ITL also inducing an increase of aerobic capacity.

This study aimed to examine sex differences in oxygen saturation in respiratory (SmO2-m.intercostales) and locomotor muscles (SmO2-m.vastus lateralis) while performing physical exercise. Twenty-five (12 women) healthy and physically active participants were evaluated during an incremental test with a cycle ergometer, while ventilatory variables [lung ventilation (V.E), tidal volume (Vt), and respiratory rate (RR)] were acquired through the breath-by-breath method. SmO2 was acquired using the MOXY® devices on the m.intercostales and m.vastus lateralis. A two-way ANOVA (sex × time) indicated that women showed a greater significant decrease of SmO2-m.intercostales, and men showed a greater significant decrease of SmO2-m.vastus lateralis. Additionally, women reached a higher level of ΔSmO2-m.intercostales normalized to V.E (L⋅min–1) (p < 0.001), whereas men had a higher level of ΔSmO2-m.vastus lateralis normalized to peak workload-to-weight (watts⋅kg–1, PtW) (p = 0.049), as confirmed by Student’s t-test. During an incremental physical exercise, women experienced a greater cost of breathing, reflected by greater deoxygenation of the respiratory muscles, whereas men had a higher peripheral load, indicated by greater deoxygenation of the locomotor muscles.

The purpose of this narrative review is to highlight the oxidative stress induced in COVID-19 patients (SARS-CoV-2 infection), describe longstanding functional impairments, and provide the pathophysiologic rationale that supports aerobic eccentric (ECC) exercise as a novel alternative to conventional concentric (CONC) exercise for post-COVID-19 patients. Patients who recovered from moderate-to-severe COVID-19 respiratory distress demonstrate long–term functional impairment. During the acute phase, SARS-CoV-2 induces the generation of reactive oxygen species that can be amplified to a “cytokine storm”. The resultant inflammatory and oxidative stress process causes organ damage, particularly in the respiratory system, with the lungs as the tissues most susceptible to injury. The acute illness often requires a long-term hospital stay and consequent sarcopenia. Upon discharge, muscle weakness compounded by limited lung and cardiac function is often accompanied by dyspnea, myalgia, anxiety, depression, and sleep disturbance. Consequently, these patients could benefit from pulmonary rehabilitation (PR), with exercise as a critical intervention (including sessions of strength and endurance or aerobic exercises). Unfortunately, conventional CONC exercises induce significant cardiopulmonary stress and increase inflammatory and oxidative stress (OS) when performed at moderate/high intensity, which can exacerbate debilitating dyspnoea and muscle fatigue post-COVID-19. Eccentric training (ECC) is a well–tolerated alternative that improves muscle mass while mitigating cardiopulmonary stress in patients with COPD and other chronic diseases. Similar benefits could be realized in post-COVID-19 patients. Consequently, these patients could benefit from PR with exercise as a critical intervention.

The physical impairments (e.g., slower walking speed) in patients with chronic obstructive pulmonary disease (COPD) have been attributed to peripheral characteristics (e.g., muscle atrophy). However, cognitive impairment may compromise motor control including walking automaticity. The objective of this study was to investigate PFC neural activity, evaluated using changes in oxygenated hemoglobin (ΔO2Hb), during preferred paced walking (PPW) in COPD patients and age-matched controls. The ΔO2Hb from the left and right dorsolateral PFC was measured using functional near-infrared spectroscopy. Fifteen COPD patients (age: 71 ± 8) and twenty age-matched controls (69 ± 7 years) participated. Two-way mixed ANOVA demonstrated that O2Hb in both groups decreased during PPW from the start (quintile 1; Q1) to the end (quintile 5; Q5) in the left dorsolateral and medial PFC. Q1 was comprised of the data during the first 20% of the task, while Q5 included data collected in the last 20% of the task duration. PPW duration ranged between 30.0 and 61.4 s in the control group and between 28.6 and 73.0 s in COPD patients. COPD patients demonstrated a higher O2Hb in Q5 compared to the negative O2Hb in controls in the right medial and dorsolateral PFC during PPW. PPW velocity was lower in COPD patients compared to controls (1.02 ± 0.22 vs. 1.22 ± 0.14 m/s, p = 0.005). Healthy older controls exhibited automaticity during walking unlike patients with COPD. The lesser decrease in O2Hb in COPD patients may be attributed to increased executive demands or affect-related cues (e.g., pain or dyspnea) during walking.

Abstract The purpose of this study was to examine scalene (SA) and sternocleidomastoid (SM) activation during normoxic (norm‐ITL; FIO2 = 21%) and hypoxic (hyp‐ITL; FIO2 = 15%) incremental inspiratory threshold loading (ITL). Thirteen healthy participants (33 ± 4 years, 9 female) performed two ITL tests breathing randomly assigned gas mixtures through an inspiratory loading device where the load was increased every two minutes until task failure. SA and SM root mean square (RMS) electromyography (EMG) were calculated and expressed as a percentage of maximum (RMS%max) to reflect muscle activation intensity. Myoelectric manifestations of fatigue were characterized as decreased SA or SM EMG median frequency during maximum inspiratory pressure maneuvers before and after ITL. Dyspnea was recorded at baseline and task failure. Ventilatory parameters and mouth pressure (Pm) were recorded throughout the ITL. SA,RMS%max and SM,RMS%max increased in association with ITL load (p ≤ .01 for both). SA,RMS%max was similar between norm‐ITL and hyp‐ITL (p = .17), whereas SM,RMS%max was greater during the latter (p = .001). Neither SA nor SM had a decrease in EMG median frequency after ITL (p = .75 and 0.69 respectively). Pm increased in association with ITL load (p .05). There was a trend for higher tidal volumes during hyp‐ITL compared to norm‐ITL (p = .10). Minute ventilation was similar between both conditions (p = .23). RMS,%max of the SA and SM increased linearly with increasing ITL. The presence of hypoxia only increased SM activation. Neither SA nor SM presented myoelectric manifestations of fatigue during both conditions.

Introduction Individuals with interstitial lung disease (ILD) exhibit reduced exercise capacity and exertional hypoxaemia. The role of peripheral (muscle) limitation to exercise tolerance in ILD is not well studied to date. Methods A prospective cross-sectional study examined skeletal muscle oxygen saturation (SmO2) and regional blood volume of the knee extensors and elbow flexors during incremental limb loading in healthy people and people with varying severity of ILD. Isotonic concentric exercise was performed on an isokinetic dynamometer. SmO2 and regional blood volume were measured by near-infrared spectroscopy over the vastus lateralis and biceps. Results Thirteen people who were dependent on oxygen, candidates for lung transplant and with severe ILD (forced vital capacity (FVC) 59±20% predicted), 10 people who were not oxygen dependent with mild ILD (FVC 81±17% predicted) and 13 healthy people (FVC 101±14% predicted) were included. Total haemoglobin, a marker of regional blood volume, was lower at task failure in the knee extensors in participants with severe ILD compared to healthy participants (p=0.05). At task failure for both knee-extensor loading and elbow-flexor loading, SmO2 was decreased to similar levels across all groups, but occurred at lower total workloads in the ILD groups (all p

The volumes assessed by optoelectronic plethysmography (OEP) and based on a three-compartmental model provide an accurate breath-by-breath index of expiratory and inspiratory (ribcage muscles and diaphragm) muscle length. Thus, after performing thixotropic maneuvers, OEP may also provide evidence regarding the history-dependent properties of these muscles. We studied the after-effects of different thixotropic conditionings on chest wall (CW) and compartmental operational volumes of 28 healthy subjects (25.5 ± 2.2 years, FVC%pred 94.8 ± 5.5, and FEV1%pred 95.5 ± 8.9) using OEP. Conditionings were composed of inspiratory or expiratory contractions performed from total lung capacity (TLC) or residual volume (RV). The study protocol was composed of three consecutive contractions of the same maneuver, with 60 s of spontaneous breathing in between, and after-effects were studied in the first seven respiratory cycles of each contraction. Cumulative effects were also assessed by comparing the after-effects of each thixotropic maneuver. Inspiratory contractions performed from both TLC and RV acutely increased end-inspiratory (EIV) CW volumes (all p < 0.0001), mainly on both upper and lower ribcage compartments (i.e., non-diaphragmatic inspiratory muscles and diaphragm, respectively); while, expiratory contractions from RV decreased CW volumes (p < 0.0001) by reducing the upper ribcage and abdominal volumes (all p < 0.0001). The response of the thixotropic maneuvers did not present a cumulative effect. In healthy, the use of the three-compartmental model through OEP allows a detailed assessment of the diaphragm, inspiratory and expiratory muscle thixotropy. Furthermore, specific conditioning maneuvers led to thixotropy of the inspiratory ribcage, diaphragm, and expiratory muscles.

Salmonella enterica subsp. enterica serovar Typhimurium is a common cause of enterocolitis in humans globally, with multidrug resistant (MDR) strains posing an enhanced threat. S. Typhimurium is also a pathogen in food-production animals, and these populations can act as reservoirs of the bacterium. Therefore, surveillance and control measures within food-production animal populations are of importance both to animal and human health and have the potential to be enhanced though improved understanding of the epidemiology of S. Typhimurium within and between food-production animal populations. Here, data from Scotland and national surveillance England and Wales data for isolates from cattle (n = 1115), chickens (n = 248) and pigs (n = 2174) collected between 2003 and 2014 were analyzed. Ecological diversity analyses and rarefaction curves were used to compare the diversity of observed antimicrobial resistance (AMR) profiles between the host species, and within host species populations. Higher AMR profile diversity was observed in isolates from pigs compared to chickens across diversity measures and isolates from cattle for three of four diversity measures. Variation in AMR profile diversity between production sectors was noted, with higher AMR diversity of isolates from broiler compared to layer chickens, breeder compared to rearer and finisher pigs and beef compared to dairy cattle. Findings indicate variation in AMR profile diversity both within and between food-production animal host species. These observations suggest alternate sources of AMR bacteria and/or variation in selective evolutionary pressures within and between food-production animal host species populations.

INTRODUCTION:Nocturnal worsening of asthma symptoms is a common feature of asthma. Physical exercise training improves general asthma control; however, there is no evidence showing the effects of physical exercise on nocturnal asthma symptoms. Indeed, asthma patients with daytime and nighttime symptoms are physiologically different, and thus the effects of physical exercise on asthma may also be different in these two groups. The objective of this systematic review is to explore the effects of physical exercise on nocturnal asthma symptoms. METHODS:Searches were conducted in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL and SPORTdiscus (last search on November 2017). Authors from studies that did not report nocturnal symptoms but used questionnaires and/or diaries were contacted for detailed information. Studies that provided results on nocturnal symptoms before and after physical activity intervention were included. Prevalence of nocturnal symptoms was calculated for each study from the percentage of study participants with nocturnal symptoms before and after intervention. RESULTS:Eleven studies were included (5 with children and 6 with adults). The prevalence of nocturnal symptoms at baseline ranged from 0% to 63% among children and from 50-73% among adults. In children and adults with nocturnal asthma, aerobic physical exercise reduced the prevalence and frequency of nocturnal symptoms. CONCLUSIONS:Aerobic physical exercise improves nocturnal asthma in children and adults by reducing the prevalence and frequency of nocturnal symptoms. Physical exercise training could be used with conventional treatments to improve quality of life and asthma control in patients with nocturnal worsening of asthma.

The director of a public health leadership institute often spoke during the workshops and other meetings of the institute participants. He illustrated many leadership concepts in his remarks with verses from poems and selections of prose. Many of the participants in the institute found the passages illuminating or helpful in remembering the leadership content. After his retirement, the former director created a draft based on his presentations. This is an expanded version of that paper. It supplements the original pieces and contains discussions of the importance of the ideas in the selections. A number of the concepts are qualified with considerations for moderating the exercise of the concept. Among the topics included are: principles, courage and fear, decisions, perseverance, joy and spirit, humility and humor, meaning, the legacy, trust, and gratitude.

BACKGROUND: Maximal inspiratory pressure (MIP) is the most commonly used measure to evaluate inspiratory muscle strength. Normative values for MIP vary significantly among studies, which may reflect differences in participant demographics and technique of MIP measurement.

The process of adopting research findings in the clinical setting is challenging, regardless of the area of practice. One strategy to facilitate this process is the use of knowledge brokering. Knowledge brokers (KBs) are individuals who work to bridge the gap between researchers and knowledge users. In the health care setting, KBs work closely with clinicians to facilitate enhanced uptake of research findings into clinical practice. They also work with researchers to ensure research findings are translatable and meaningful to clinical practice. The present article discusses a KB’s role in a respiratory care setting. Working closely with both researchers and clinicians, the KB has led teams in the process of conceptualizing, developing, testing, disseminating and evaluating several projects related to respiratory care, including projects related to mobility in critical care settings and acute exacerbations of chronic obstructive pulmonary disease; inspiratory muscle training; and the use of incentive spirometry in postsurgical populations. The KB role has provided an important communication link between researcher and knowledge user that has facilitated evidence-informed practice to improve patient care.

BACKGROUND: Patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) engage in low levels of activity, putting them at risk for relapse and future readmissions. There is little direction for health care providers regarding the parameters for safe exercise during an AECOPD that is effective for increasing activity tolerance before discharge from hospital, especially for patients with associated comorbid conditions.

Antimicrobial resistance (AMR) surveillance systems are generally not specifically designed to detect emerging resistances and usually focus primarily on resistance to individual drugs. Evaluating the diversity of resistance, using ecological metrics, allows the assessment of sampling protocols with regard to the detection of rare phenotypes, comprising combinations of resistances. Surveillance data of phenotypic AMR of Canadian poultry Salmonella Heidelberg and swine Salmonella Typhimurium var. 5- were used to contrast active (representative isolates derived from healthy animals) and passive (diagnostic isolates) surveillance and assess their suitability for detecting emerging resistance patterns. Although in both datasets the prevalences of resistance to individual antimicrobials were not significantly different between the two surveillance systems, analysis of the diversity of entire resistance phenotypes demonstrated that passive surveillance of diagnostic isolates detected more unique phenotypes. Whilst the most appropriate surveillance method will depend on the relevant objectives, under the conditions of this study, passive surveillance of diagnostic isolates was more effective for the detection of rare and therefore potentially emerging resistance phenotypes.

The Public Health Leadership Institute (PHLI) of Florida was founded in 1994 at the University of South Florida College of Public Health (USF COPH) and funded initially through a cooperative agreement between the Centers for Disease Control and Prevention and the Association of Schools of Public Health. The PHLI contributes to the USF COPH’s statutory mission to educate public health officials and provide leadership in developing academic programs that meet Florida’s needs. The PHLI is: (1) responding to the call for public health leadership development; and (2) meeting the strong need for increased linkages between academic public health and the practice community. The PHLI admitted its first class of scholars in 1996 and in May 2005, admitted its tenth class for year-long study. Approximately 30 scholars are admitted annually through a competitive process. Among other topics, the curriculum includes personality and leadership, personal and organizational vision development, organizational communication, conflict negotiation, emotional intelligence, political effectiveness, systems thinking, team building, risk communication, media relations, crisis leadership, and project planning. Many program graduates have attained leadership positions in the Florida Department of Health and in public health associations elsewhere.