36 - pneumologonava.com · Marsha Cathcart at [email protected]. Letters from members will be considered for publication if they re-late to specific articles appearing in AARC Tımes

AARC Times December 2011 1

Ventilation for Life | 5Mechanical ventilation in China varies acrossthe country. By Hui-Qing Ge, MS, RT

Sleep Waves | 9Status and perspectives of sleep medicine in Taiwan. By Liang-wen Hang, MD

2010 Héctor León Garza AwardWinner Credited with Helping ToIntroduce NIV to the World | 22Stefano Nava, MD, traces his use of noninvasiveventilation back to the 1980s.

AARC International Fellows Make“a Baker’s Dozen” | 26December AARC Times guest editor introducesour special international issue. By John D. Hiser,MEd, RRT, FAARC

Building a Network of Asthma andCOPD Outpatient Care Units inVietnam | 30This former AARC international fellow is increasing awareness of respiratory diseases inher country. By Le Thi Tuyet Lan, MD, PhD

RTs Are Making a DifferenceAround the World: 23 Days inGhana | 33This first feature on medical missions in thisissue focuses on a recent humanitarian andmedical mission to Ghana. By Karen Schell,MHSc, RRT-NPS, RPFT

Adventure in Brazil | 36Cruising on a riverboat and visiting small villages along the Amazon River and its tributaries is how this RT and his family experienced their first medical mission. By James L. Hulse, PhD, RRT-NPS, RPFT

Medical Mission in Bolivia | 38Through Mission of Hope-Bolivia and their surgical mission trips, this AARC member useshis respiratory experience in the recovery room.By Stan Holland, MS, RRT

Medical Mission in the DominicanRepublic | 40The term “respiratory therapist” was not easilyunderstood by the translators or patients in thisCreole-speaking country, so this author wascalled “Doctor Scott” at the open-air clinics hevisited. By Scott N. Simms, BHA, RRT

Government Advocacy | 13

General Counsel | 16

The View from Here | 18

Observations | 20

Industry Watch | 42

Marketplace | 44

RC Currents | 46

New Members | 55

Classified Advertising | 62

Calendar of Events | 63

Advertiser Index | 64

Cover photo by Lennie Sirmopoulos,

Convention Photography, Tustin, CA

36

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December 2011Volume 35, Issue 12Table of Contents

33

Meet the AARC Staff

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2 AARC Times December 2011

AARC Strategic Plan AARC Vision/Mission Statement: TheAmerican Association for Respiratory Care(AARC) will continue to be the leading nationaland international professional association forrespiratory care. The AARC will encourage andpromote professional excellence, advance thescience and practice of respiratory care, andserve as an advocate for patients, theirfamilies, the public, the profession, and therespiratory therapist.

AARC Strategic Objectives • Validate the science of respiratory care andthe value of the respiratory therapist (RT) inproviding respiratory care by supporting, con-ducting, and publishing research information.

• Promote respiratory therapists as the bestproviders of respiratory care by assuring thatthe science that clarifies the value and role ofthe RT is provided to those stakeholderswhose decisions and actions need to beguided by that information.

• Promote respiratory therapists and the Amer-ican Association for Respiratory Care by devel-oping and implementing promotion andmarketing campaigns targeted to unique audi-ences.

• Assure the Association has the resources tomeet the needs of its members and that theAARC has the needed financial, volunteer, andstaff resources needed to accomplish the im-plementation of the strategic plan of the Asso-ciation.

The complete version of the Association’s StrategicPlan is available to AARC members online atwww.aarc.org/members_area/resources/strategic.asp.

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Since 1947, the AARC has been leading the effort to advance therespiratory care profession and promote quality respiratory healthcare. Working with our 50 state organizations, we have successfullyadvocated for the profession at the federal, state and local level.

The link between the respiratory profession and manufacturers isclear. If respiratory practice expands, so too does the economy forour industry partners.

As health care budgets shrink and patient care becomes increasinglycomplex, our mutual challenges become greater. The synergy ofthe corporate partner concept is an effective way to address thoseneeds utilizing our combined skills and resources.

AARConnection . . .maximizing your membership

HAVE A SAY IN AARCCONGRESS 2012PRESENTATIONSSubmit a ProposalThe AARC invites you to submit proposals forindividual lectures or symposia at AARC Congress2012. You’re also invited to submit Abstractsfrom original studies for presentation at theCongress’ OPEN FORUM. Submit Now athttp://aarc2012.abstractcentral.com/

GRANTS, AWARDS, ANDFELLOWSHIPS American Respiratory Care Foundation (ARCF)The ARCF supports clinical research, education recognition awards, educationalactivities, literary awards, and charitableactivities. Learn More at http://www.arcfoundation.org/awards/

PATIENT INFORMATIONYourLungHealth.orgYourLungHealth.org is the AARC’s patient information web site. Use it for information to provide to your patients or direct them to the web site. Check It Out athttp://www.yourlunghealth.org/

SAVING MONEYGraduates, Save $40 on an NBRC ExamAny AARC member gets a one-time $40 discount on these NBRC exams: RRT (Written orClinical Simulation), RPFT, CPFT, and the NPS.Learn More and Start Saving athttp://www.aarc.org/member_services/nbrc_discount/

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Ventilation for Life

Advanced life support techniques, especially positivepressure ventilation, inspired the development of criticalcare medicine in Europe and North America in the 1950s.In mainland China, however, critical care medicine wasnot introduced into clinical care until the early 1980s.Now, after almost 30 years of effort, it has finally beenrecognized as a specialty.1 Meanwhile, respiratory care inmainland China is just beginning; most hospitals still donot have respiratory care employees on staff. Because ofthese differences, the management ofmechanical ventilation can vary in dif-ferent areas of the country. In order tofind out how widespread mechanicalventilation use is in mainland China, wedecided to conduct a survey of hospitalsin our country.

About the surveyThe questionnaire was designed by

Yuehua Yuan, Peifeng Xu, and myselfand included questions related to hos-pital hierarchy, ICU beds, ICU ventila-tors, and similar factors, along withquestions covering mechanical ventila-tion management. Specifically, we in-quired about the hospitals’ use ofartificial airways, mode selection,graphics, subglottic suction, and wean-ing methods. We also asked about theinvolvement of RTs.

The questionnaire went out to 110hospitals in the Beijing, Jiangsu, Shang-hai, Sichuan, Hunan, Zhejiang, Yunnan,and Guangdong provinces in central and eastern China.About 70% of the respondents came from the Zhejiang,Shanghai, and Beijing provinces, where the economy isgrowing rapidly.

Hospital classification in mainland China is based onhospital functions, facilities, technology, and other indi-

cators of hospital qualification assessment. According tothe “hospital classification management standard,” eachlevel is divided into three categories (A, B, and C), with 3Abeing the top level. Our overall response rate was about82% (90 out of 110), and the response units included 35hospitals with the rank of 3A, 20 with the rank of 3B, 18with the rank of 2A, and 17 with the rank of 2B.

Results showed the average number of ICU beds wasnot significantly different among the hospitals, coming in

at about 24. The ICUs in 3A hospitals,however, did have more ventilators,about 16 versus about 10 for the otherhospitals in the survey. The average ICUlength of stay was about 14 days, andthe average duration of mechanical ven-tilation was about 10 days. Respiratorytherapists were present in only 17.8% ofthe hospitals, and 82% of those hospi-tals had fewer than three RTs on staff.Nearly three-quarters of these thera-pists were working in 3A hospitals.

As for the type of ventilators beingused, the survey found 30% were Evi-tas and 27.8% were PB 840s. Otherbrands included the SERVO-i at 16.7%,the Raphael at 4%, and the Bird at 3%.

Artificial airwayThe first choice of artificial airway

for the delivery of mechanical ventila-tion varied among the hospitals. Re-spondents noted that about 80% ofendotracheal tubes are inserted through

the mouth under anesthesia, while the orotrach andnon-anesthesia method is used in about 14.3% of pa-tients. Nasotrach and anesthesia is used in 2.5%, and na-sotrach and non-anesthesia is used in 2.5%.

In patients who had undergone a tracheostomy, theprocedure was performed at a median of nine days after

Mechanical Ventilation in China: A Look at 90 Hospitals Shows Care Varies Across the Country

Hui-Qing Ge is vicedirector, clinical educator,

in the respiratory caredepartment at Sir Run

Run Shaw Hospital,College of Medicine,Zhejiang University inHangzhou, Zhejiang,

China.

by Hui-Qing Ge, MS, RT

about the author…

Ventilation for Life China


intubation across all of the hospitals. However, the fre-quency of tracheostomy varied significantly dependingon the patient’s underlying condition and the time frominitiation of mechanical ventilation. Over the initial one-week period, a tracheostomy was performed more fre-quently in patients with neuromuscular disease (35.7%),especially craniocerebral trauma, than in those withCOPD or acute respiratory failure (10.2%). After the thirdweek, the proportion of patients with a tracheostomy didnot differ among the diagnostic categories.

Seventy-three percent of the humidification for me-chanical ventilation used by the hospitals in our surveywas heated humidification, although 18% of hospitalswere using a heat and moisture exchanger (HME). Ninepercent were using both methods, with the choice de-pendent on the duration of mechanical ventilation. Inpatients who require mechanical ventilation less than 24hours, only 7.5% of the ICUs reported using HME ratherthan heated humidification.

Subglottic suction, which is one of the methods to pre-vent ventilator-associated pneumonia, is attracting the at-tention of clinicians.2-4 Twenty-one percent of the ICUs inour survey were using subglottic suction in tracheostomytubes and 13% in endotracheal tubes; 16.7% were using sub-glottic suction in both tubes. Thirty-one percent had neverused subglottic suction for patients with artificial airways.

About 48% were using cuff air pressure measurementevery day, but 38.9% of the ICUs had never measured cuffair pressure.

Mechanical ventilation managementOf the total group of ventilator-supported patients,

61% received assist/control (A/C) ventilation, and thiswas the most common mode of ventilation in the Bei-jing, Shanghai, and Zhejiang provinces. About 39% of theoverall group were ventilated with synchronized inter-mittent mandatory ventilation (SIMV), pressure support(PS), or a combination of the two. The use of SIMV on itsown was infrequent in all hospitals.

The pressure-control ventilation A/C mode was pre-ferred over the volume-control ventilation A/C mode,34.4% versus 17.7%, because of better patient-ventilatorsynchrony. About 32% of the ICUs chose dual modes. Themode listed by physicians corresponded with the modemost frequently employed in a given hospital. Resultsalso showed about 11% of physicians have tried using air-way pressure release ventilation and bilevel modes foracute respiratory distress syndrome patients.

Only 23.3% of the respondents observed all the graph-ics (including three curves and two loops), and the pre-

ferred waveforms were flow-time and pressure-timecurves and P-V loops. Fifty-four percent of the clinicalpractitioners were using just one or two of the wave-forms, and 3% had never used them.

Use of noninvasive ventilation (NIV) is increasingwidely in critical care units, with the preferred indica-tions being COPD, acute cardiogenic pulmonary edema,and obstructive sleep apnea syndrome. Nineteen percentof physicians selected NIV as a weaning method for spe-cific patients.

During mechanical ventilation, about three-quartersof physicians were selecting an MDI to deliver the bron-chodilator to the patients. Interestingly, Grade 3A hospi-tals were more likely to choose an MDI than the otherhospitals in the survey.

When respiratory therapists are not available, venti-lator maintenance in most of the hospitals is usually un-dertaken by nurses. The clinical engineering departmentis in charge of repairing ventilators. Around 80% of theclinical practitioners did the short self test (SST) (or ex-tended self test) for the ventilators after ventilator cir-cuit change-outs, but about 20% of hospitals generallydid not do an SST.

In general, the preferred methods for weaning werePS (65.6% of the respondents) and SIMV with PS (21% ofthe respondents). Spontaneous breathing trials werebeing used by 27.8% of the ICUs to assess weaning pa-tients every day. No significant difference was seenamong hospitals in different provinces or with differentgrades. As noted earlier, 19% of physicians selected NIVas a weaning method for specific patients, with 73%using it for COPD patients and 27% using it for other dis-eases, including neuromuscular disease and hypoxemicrespiratory failure.

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Work in progressThe Chinese Society of Critical Care

Medicine drew up a guideline on mechan-ical ventilation in 2006 and a guideline onmechanical ventilation in COPD patientsin 2007. But as the data from our surveyshows, mechanical ventilation and artifi-cial airway management are still irregu-larly applied in some medical institutions,and respiratory therapists are present inonly a few ICUs.

Our findings on mechanical ventilationand the use of respiratory therapists arenot surprising as, overall, critical caremedicine in mainland China is still in aphase of development. The lack of a na-tionally accredited critical care trainingprogram, including mechanical ventila-tion management training, is believed tobe a major obstacle for improving profes-sional education in mainland China. Partof the problem lies in the inequality of re-gional development across our nation.5

Since 70% of our survey respondentscame from areas of the country where theeconomy is flourishing, further studiesare needed to involve the other regionsand thus fully assess the requirements fortraining of clinicians using mechanicalventilation. Further development of therespiratory care profession in our countryis also a way to improve the quality of pa-tient care. ■

REFERENCES1. Du B, Xi X, Chen D, Peng J. Clinical review: criticalcare medicine in mainland China. Crit Care 2010;14(1):206.2. Depew CL, McCarthy MS. Subglottic secretiondrainage: a literature review. AACN Adv Crit Care2007; 18(4):366-379.3. Scherzer R. Subglottic secretion aspiration in theprevention of ventilator-associated pneumonia: areview of the literature. Dimens Crit Care Nurs 2010;29(6):276-280.4. Di Filippo A, Casini A, de Gaudio AR. Infectionprevention in the intensive care unit: review of therecent literature on the management of invasivedevices. Scand J Infect Dis 2011; 43(4):243-250.5. Peng Zhang, Mann Xu. The view from the county:China’s regional inequalities of socio-economic de-velopment. Annals of Economics and Finance 2011;12(1):183-198.


Sleep Waves

The development of sleep medicine in Taiwan has beenrelatively short and similar to that in the United States.The first clinical practice of sleep medicine was inMackay Memorial Hospital in 1990. As a result of effortsby the American Academy of Sleep Medicine (AASM), theAmerican Medical Association recognized sleep medicineas a specialty in 1996.

The sleep association medicine specialty certificationwill be initiated in 2012 by the accreditation committee ofthe Taiwan Society of Sleep Medicine (TSSM), the firstsleep medicine organization in Taiwansince 2002. In the beginning, there were273 members consisting of physicians,technicians, psychologists, and re-searchers. Today, the TSSM has over 600members in 30 different specialties andis a fast-growing professional organiza-tion promoting the specialty of sleepmedicine.

TSSM’s role in the sleep professionTSSM has defined its role in profes-

sional education, training, and research.The major advances of sleep medicinehave led to the formation of profes-sional and patient-focused sleep centersto train physicians and technicians insleep medicine and to set up an accred-itation process for specialty certifica-tion. Taiwanese technicians have ex-perienced difficulty in getting the Reg-istered Polysomnographic Technologist(RPSGT) certification, mainly due to thelanguage barrier. The TSSM has beenawarded for technician certification ac-creditation since 2006. Candidates mustfulfill the accreditation requirements of a 40-hour edu-cation course and clinical experience of scoring for aminimum of 100 cases within a one-year period.

Currently more than 150 examinees have beenawarded the designation of qualified sleep technician.Most are nurse practitioners, medical technologists, andrespiratory care practitioners.

Sleep center accreditationThe criteria for sleep center accreditation are adapted

to the standards of the AASM. More than half of the es-tablished sleep centers have been accredited since 2009.Certificates of qualified sleep specialties will be granted

in January 2012.

Sleep disorder prevalenceSleep disorder centers in Taiwan are

based on the all-night polysomno-graphic recording, and most sleep dis-orders of patients are breathingrelated. The majority of published arti-cles have focused on prevalence stud-ies and surgery practices of sleep-related breathing disorders. Similar tothe results of most other Westerncountries, obtained were several com-mon features:

• Patients with snoring problemsaccounted for 51.9%, in which60.8% were males and 42.5% females.1

• The prevalence of witnessedapnea during sleep was 3.4% inmales and 1.9% in females, giving an average of 2.6%. 2

• More female patients had snoring and witnessed apnea ascompared to males (p < 0.05).

• Prevalence of comorbid hypertension, cardiovascular disease, diabetes mellitus, arthritis, and backache was higher in the patients

Sleep Medicine in Taiwan: Status and Perspectives

Liang-wen Hang, MD, ispresident of the Taiwan

Society of Sleep Medicineand is chief of respiratorytherapy in the College of

Health Care at ChinaMedical University. He isalso chief of the sleep

medicine center at ChinaMedical University

Hospital in Taichung,Taiwan.

by Liang-wen Hang, MD

about the author…

Sleep Waves Taiwan


who snored or had witnessed apnea than thosewithout these illnesses (p < 0.05).

• Narcolepsy is relatively low (1 in 600,000 population) compared to other Asian areas suchas Korea3 (with cataplexy, 1 in 6,000 population)and Hong-Kong4 (1 in 3,000 population).

• Continuous positive airway pressure (CPAP) remains the gold standard for the treatment ofobstructive sleep apnea (OSA). There is poor CPAPcompliance; 30% of patients with OSA on CPAPwas observed in Taiwan,5 which is significantlylower than Western countries of 60 to 70%.6

Associated psychological factors relating to sleep dep-rivation include less perceived severity of disease, lesshealth value, and less “self-efficacy” not only from edu-cation but also the culture.

In Taiwan, CPAP therapy is an out-of-pocket expensewithout reimbursement. Economic issues are the majorfactor, which is similar to other Asian areas except Japan.Therefore, important achievements for TSSM in the fu-ture will be to educate and negotiate with the NationalHealth Insurance Bureau (NHIB).

Academic researchThe TSSM plays important roles in education, train-

ing, and academic research. Research in sleep medicinehas been ongoing for more than 20 years in Taiwan. Weconducted a systematic review by collecting and extract-ing data from the Science Citation Index (SCI) online ver-sion from 1991–2008 (see Figure 1). Articles with “sleep”as a part of the title, abstract, or key words reported thefollowing parameters — trends of publication output,journal pattern, publication, and authorship by Taiwanpractitioners — and were collected for analyzing theroles of TSSM in sleep medicine research.

The research yielded a total number of 314 articles, allwritten in English, from which most were cooperativestudies (19%) with related faculties in the United States.The number of published articles has risen substantiallysince the TSSM began (see Figure 2).

Sleep an emerging field in TaiwanSleep medicine is an emerging field with a wide spec-

trum of interests and resources in Taiwan. Aside from fol-lowing the system developed in the United States, wehave made progress in facilitating the development ofsleep science and sleep organizations. The collective ef-forts of TSSM have culminated in a significant con-

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tribution to professional education, services, and qualifi-cations in sleep medicine and clinical practices.

The prevalence of sleep-related breathing disordersshows no significant difference compared to other coun-tries, although some variations do exist. OSA is associ-ated with many significant comorbidities and long-termmorbidity. Active treatment with CPAP in the majority ofpatients with OSA is effective and warranted; however,poor compliance or CPAP refusal necessitates that wemust make more efforts to solve the problem.

The cost of CPAP treatment, which is not reimbursedby NHIB, is likely to be the key issue in promoting CPAPcompliance. The continuation of studies evaluating thecost-effectiveness of CPAP to support decision making ofboth the authorities (NHIB) and the patients is, therefore,indispensable in Taiwan. ■

REFERENCES1. Chuang LP, Hsu SC, Lin SW, et al. Prevalence of snoring and wit-nessed apnea in Taiwanese adults. Chang Gung Med J 2008; 31(2):175-181.2. Li HY, Wang PC, Chen YP, et al. Critical appraisal and meta-analysisof nasal surgery for obstructive sleep apnea. Am J Rhinol Allergy 2011;25(1):45-49.3. Shin YK, Yoon IY, Han EK, et al. Prevalence of narcolepsy-cataplexyin Korean adolescents. Acta Neurol Scand 2008; 117(4):273-278.4. Wing YK, Chen L, Fong SY, et al. Narcolepsy in Southern Chinese pa-tients: clinical characteristics, HLA typing and seasonality of birth. JNeurol Neurosurg Psychiatry 2008; 79(11):1262-1267.5. Compliance of CPAP in Taiwan. The Fifth Taiwan Society of SleepMedicine Annual Conference of 2007.6. Verse T, Pirsig W, Stuck BA, et al. Recent developments in the treat-ment of obstructive sleep apnea. Am J Respir Med 2003; 2(2):157-168.


Sleep Waves Taiwan


Government Advocacy

Have you noticed any increased activity in your hos-pital about the importance of quality measures? Do youknow that hospitals can receive incentive payments fromMedicare if they report certain quality measures? Ormaybe you’re a respiratory therapist working in a physi-cian’s office. Physicians are part of the quality incentiveprogram as well. Have you heard the term “value-basedpurchasing,” or do you know anything about AccountableCare Organizations? What are quality measures anyway,and how can RTs be active participants?Hopefully, you will get some answers asyou read on.

What are quality measures, andwhy are they important?

Quality measures are tools that helpthe Centers for Medicare and MedicaidServices (CMS) quantify health out-comes, patient perceptions of the carethey are receiving, and systems that aredesigned to provide high-quality healthcare that meet certain goals such as ef-fective, safe, efficient, patient-centered,equitable, and timely care. They alsoprovide incentives for hospitals thatcan result in additional Medicare pay-ments.

Quality measures are not new. Infact, hospitals have been reportingquality measures for a number of years. Much of the datathat is collected has been converted into what is calledthe “Hospital Compare” website for Medicare beneficiar-ies. It allows patients to see how well hospitals in theirarea compare with other hospitals throughout the UnitedStates based on the reporting of certain quality meas-ures.

Tracking the mortality and readmission rates forpneumonia are two respiratory illness measures thatCMS now reports on. You might want to check out how

well your hospital is doing compared to others. For ex-ample, if you go to the Medicare.gov website (www.medicare.gov) and enter the zip code, it will bring up hos-pitals within a certain mile radius of where you live orwork. You can compare three hospitals at a time basedon general information, a medical condition, or a surgicalprocedure. The information you receive will tell you ifthose hospitals are better, no different than, or worsethan the U.S. national rate. Also, patients weigh in on is-

sues related to communications, painmanagement, medicine communica-tion, discharge information, andwhether they would recommend thehospital to others.

Effective Jan. 1, 2012, one qualitymeasure CMS is no longer going to re-quire hospitals to report is tobacco-ces-sation counseling. The reasons aretwofold: one is to reduce the hospitalreporting burden, and the other is thathospital performance has been uni-formly high nationwide with little vari-ability among hospitals (topped out).However, this does not preclude hospi-tals from continuing to improve theirown performance on the measure.

CMS has proposed (but is not yet re-quiring) adding two new measures forhospital reporting that relate to COPD.

The measures involve 30-day mortality and readmissionrates for a cohort of patients hospitalized for an acute ex-acerbation of COPD based on a principal discharge diag-nosis of COPD or a principal discharge diagnosis ofrespiratory failure with a secondary discharge diagnosisof COPD.

Respiratory therapists from the COPD Foundation andAARC were part of the technical panel of experts who re-viewed the proposed measures and made recommenda-tions to CMS. One of those recommendations included

Quality Is the Name of the Gameby Anne Marie Hummel

Anne Marie Hummel isthe AARC’s director of

regulatory affairs inWashington, DC.

about the author…

Government Advocacy


adding a measure for chronic obstructive asthma since itis often difficult for physicians to differentiate betweenasthma and COPD. Yale New Haven Health Services Cor-poration/Center for Outcomes Research and Evaluationis currently reviewing the recommendations and publiccomments. We will expect to see data on these COPDmeasures added to the Hospital Compare website some-time in the future.

This will be an excellent op-portunity for RTs to help theirhospitals get good reports, es-pecially with reducing hospitalreadmissions. On several occa-sions, AARC has informed var-ious components within CMSabout the value RTs can bringto these initiatives, especiallysince a recent study showed that a simple disease man-agement program conducted by a respiratory therapycase manager reduced hospital readmissions by a statis-tically significant 41%.

Value-based purchasing will impact acute care hospitals

You may be thinking that value-based purchasing hassomething to do with cost-effective hospital purchaseslike equipment and medical devices, but the term can bemisleading. It is really about the federal governmentwanting to be a prudent purchaser of health care serv-ices or getting the “biggest bang for their buck.”

Value-based purchasing is one of several programs re-quired by the Accountable Care Act. It is designed to pro-mote higher quality care for Medicare beneficiaries. Inthe end, instead of being paid based on the volume ofservices they provide, hospitals will be paid for provid-ing care that rewards better value, patient outcomes, andinnovations. It is primarily a quality incentive programbuilt around the hospital quality reporting infrastructurediscussed above. Pneumonia will be one of the perform-ance measures upon which hospitals will be graded, to-gether with measures associated with acute myocardialinfarction, heart failure, health care-associated infec-tions, and certain surgeries.

The program does not begin until fiscal year 2013 (orOct. 1, 2012), but CMS has already issued final rules andlaid out the “ins and outs” of how the program will workand the formula they will use to measure performance.Think of it as a hospital report card. Hospitals will beevaluated on two scores: one for achievement in howwell they do compared to other hospitals across thecountry and one for internal improvement within their

own system. Both of these scores are evaluated against abaseline period of July 1, 2011 to March 31, 2012.

The formula for scoring is somewhat complicated; butin the end, 70% of the score will be for achievement ofclinical measures with 30% awarded for patient experi-ence. Among the experiences patients will be asked toevaluate are hospital staff responsiveness and medicinecommunication, so there are opportunities for respira-

tory therapists to ensure thatthe care they give their patientsreceives high marks, especiallywhen it comes to educating andteaching patients on the propertechniques for using MDI de-vices, nebulizers, etc.

More than 3,000 hospitalswill be impacted by value-based

purchasing, so your hospital is most likely among thosethat will be part of the new reward program. RTs are en-couraged to do your part in helping your hospitals meettheir goals.

Starting in 2012, new groups of quality measures havebeen added to the Physician Quality Reporting System.Two of these include measures for COPD and sleepapnea; asthma is already included. CMS is also thinkingabout adding value-based modifiers to physician serv-ices as incentives to improve patient care and has askedthe public to weigh in on the issue. If that happens, it canwell position RTs in physicians’ offices, especially if ourMedicare Respiratory Therapy Initiative legislation is en-acted.

Accountable Care Organizations focus on coordinating care

By now you have probably heard the term “Account-able Care Organization” (ACO). But what is it exactly?

In a nutshell, ACOs create incentives for teams ofphysicians, hospitals, and other health care providers towork together to treat an individual patient (e.g., fee-for-service Medicare beneficiaries) across care settings inorder to improve care through seamless coordination.This is especially important since it is estimated thatmore than half of Medicare beneficiaries have five ormore chronic conditions treated by multiple physicians,resulting in fragmented care.

Also referred to as the “Medicare Shared Savings” pro-gram, ACOs will receive higher payments from Medicareif they lower their health care costs while at the sametime meet certain quality performance standards andput patients first. The ACOs are held “accountable” forany losses they incur if it turns out they don’t save the

If you read anything thesedays about health care, you’llpick up on a recurring theme:

better health, better care,lower costs.

Government Advocacy


program money. It largely depends on the amount of riskthey are willing to take based on models that CMS hasestablished.

How do RTs fit in? A couple of the quality measures that CMS finalized

recently relate to COPD and smoking cessation, with themost important one aimed at reducing hospital admis-sions. We know that an effective disease managementprogram with respiratory therapists at the helm canmake a huge difference. How big a role you can play willmost likely evolve over time, as with any new program ittakes time to get things started. This is especially truesince CMS is allowing applications for an April 1, 2012, orJuly 1, 2012, start date with a three-year termination pe-riod.

The ACOs’ performance will be measured against thefollowing key areas:

• Patient/caregiver experience of care• Care coordination/Patient safety• Preventive health• At-risk population/frail elderly health.

CMS started out proposing 65 quality measures forthese four categories but narrowed it down to 33 in thefinal rule based on many comments they received aboutthe burden and complexity of the original program de-sign. While COPD quality measures (including spirometryevaluation, smoking cessation, and bronchodilator ther-apy) were among the proposed measures for the at-riskpopulation, CMS has decided not to include them at thistime in order to offer a simpler and more streamlined setof quality performance standards so as to encourage ACOparticipation.

That doesn’t mean CMS does not think COPD is im-portant. It does, and it has included a measure under thecare coordination domain that is outcome focused andaims to measure timely and effective care for managingCOPD patients that results in fewer hospital admissions.While CMS admits that tobacco use is especially harmfulto patients with COPD, it also did not finalize the smok-ing-cessation counseling quality measure specifically forCOPD but rather kept it as a measure for all patients, in-cluding those with COPD.

In the end, CMS selected final measures with a pre-dominantly ambulatory care focus as a starting point. Inthe future, however, we can expect to see revisions to themeasures as well as new ones to reflect changes in prac-tice and quality of care improvement. The creation ofACOs is entirely voluntary on both the part of the

providers as well as the patients, so how successful ACOswill be in the long term is a question that remains to beanswered.

AARC joins the Partnership for Patients initiativeQuality also includes patient safety. Another new ini-

tiative at CMS is the Partnership for Patients. Its goals areto decrease preventable hospital-acquired conditions by40% and reduce preventable complications during thetransition from one care setting to another so that hos-pital readmissions would be reduced by 20%, both by theend of 2013. Ventilator-associated pneumonia is one ofthe areas of focus. Several thousand hospitals togetherwith other care providers, patient advocacy groups, em-ployers, and health plans have taken the pledge.

AARC has pledged to support the goals and is com-mitted to build on work already underway that achievessafe, high-quality care. If you did not read the AARC Oc-tober 19 Web article “AARC Pledges To Improve PatientSafety,” we ask that you take the pledge with us now to:

• Work to redesign activities across clinical settings to reduce harm, reduce preventablereadmissions, and improve care transitions.

• Engage with patients and families to implementpractices that foster more patient-centered carethat improves safety, communication, and carecoordination.

• Learn from and share with others your experience with making care safer and more coordinated.

Additional information is available at www.healthcare.gov/compare/partnership-for-patients/safety/index.html.

Respiratory therapists have the expertise to assistphysicians and hospital staff to determine the clinicalneeds of their patients and to educate patients on dis-ease management. When patients are properly treated,health care quality is enhanced and unnecessary serv-ices or hospitalizations can be avoided. If you read any-thing these days about health care, you’ll pick up on arecurring theme: better health, better care, lower costs.You can help your provider meet or exceed quality goals,so talk with your department head now to see how youcan play an active role. ■


General Counsel

It is very rare for a health care provider to find himselfinvolved in a criminal trial for care rendered at the bed-side. The recent trial of Dr. Conrad Murray in MichaelJackson’s death illustrates the kinds of risks and behav-iors that can result in criminal liability for health carepractitioners. The lessons from the trial should not be ig-nored.

As I have written before, the things that get profes-sionals in trouble with their professional boards tend tobe the things that get them in trouble with law enforce-ment. Most commonly, those things arethe abuse of drugs, the abuse of alcohol,domestic violence, and theft. It is rare(although not unheard of) for a profes-sional board or a law enforcementagency to base a criminal case on grossnegligence. Gross negligence is the con-scious and voluntary failure to use rea-sonable care, but it does not end there.It must also be foreseeable that the fail-ure to use due care will result in graveharm to the patient. Gross negligence isan extreme form of negligence.

The difference between gross negli-gence and garden-variety negligencecan be seen in the respiratory care con-text in this manner. During an excep-tionally busy night, a therapist mightnot be able to complete ventilatorchecks every two hours. If a therapistmade a choice to go to his meal breakinstead of completing a ventilatorcheck, and three hours elapsed in be-tween checks, the failure to completethe check as required by hospital policywould be negligent. If the therapistnoted the error, filled out an incident re-port, and no harm came to any patient, the negligencewould be an issue of concern for the department’s over-all performance, but it would not be gross negligence.

Suppose, however, that the ICU therapist has a sub-stance abuse problem. He routinely abuses meperidine

prior to and during his shift. As a result, his ventilatorchecks amount to little more than copying the line abovefor six hours straight. Then, at 2:00 a.m. the therapist fallsasleep because of his drug usage; and a mucous plug,which would have been detected if ventilator checks hadbeen properly done, results in the death of the patient.Both criteria are met for gross negligence here. The neg-ligence is extreme because it involves the use of drugswhile performing patient care, and the risk of grave harmis present because we’re talking about life support equip-

ment. This is a case of gross negli-gence, which could result in criminalliability.

In spite of the state having the abil-ity to prosecute for acts of extremenegligence, prosecution for criminalnegligence is very rare against healthcare providers. In researching the issue,I was able to find only two cases in thepast 50 years when a physician orother health care provider was chargedand convicted of negligent homicide ormanslaughter relating to grossly negli-gent medical treatment. Oddly enough,both cases involved pulmonary medi-cine.

Case 1In 1965, two chiropractors in Florida

were charged and convicted ofmanslaughter through culpable negli-gence in that they treated a case of ac-tive tuberculosis with a vegetarian diet.The Florida Court of Appeals said:

“There was testimony that the treat-ment given to Molina was not approved

medical treatment for one with active tuberculosis, and thathad he been treated by approved medical methods and givenavailable drugs his disease could have been arrested or con-trolled. From the evidence the jury could, and no doubt did, con-clude that the treatment afforded by the appellants advanced

Criminal Liability

about the author…

Anthony L. DeWitt, JD,RRT, FAARC, is an attorneyand a partner in the firm

Bartimus, Frickleton,Robertson & Gorny, PC,and resides in JeffersonCity, MO. He has also

authored two books andnumerous legal journal

articles. This article is nota substitute for legal

advice.

by Anthony L. DeWitt, JD, RRT, FAARC

Criminal Liability General Counsel


rather than retarded the patient’s tuberculosis infection andcaused his death, and that their method of treatment of this tu-berculosis patient amounted to culpable negligence as it hasbeen defined in the decisions of the Supreme Court of thisState.” — Gian-Cursio v. State, 180 So. 2d 396 (1965)

The Court of Appeals affirmed the conviction of thetwo physicians.

Case 2In State v. Warden, 813 P.2d 1146 (Utah 1991), a physi-

cian was convicted by a jury of negligent homicide in thedeath of an infant born prematurely with respiratory dis-tress syndrome. The physician had no malpractice in-surance or hospital privileges and, as a result, onlydelivered infants at home. After delivering a prematureinfant at home, Warden positioned the baby to mask thegrunting and retractions and told the parents that hos-pitalization was unnecessary because the gruntingsounds were “normal in premature infants.” Warden leftthe house 40 minutes after birth, telling the grandmotherto “watch the baby” but providing no specific adviceabout what to watch for. Then, during the night, the childturned a deeper shade of blue, and the mother calledWarden to come attend the infant. Warden lived aboutsix blocks from the family. He never came. A pastor anda pediatrician did come to the home, and they found thebaby near death. Shortly thereafter, the infant died afteremergency transfer to a local hospital.

At trial, physicians testified that the standard of carerequired hospitalization in an ICU and that had the in-fant been hospitalized and cared for properly, he wouldhave survived. The jury convicted the doctor, but theUtah Court of Appeals reversed the conviction, findinginsufficient evidence of gross negligence to support theconviction. The state appealed to the Supreme Court. Inreinstating the conviction, the Utah Supreme Court said:

“At this point, it is important to note that criminal negli-gence differs substantially from ordinary civil negligence. In-deed, this court has stated that evidence of civil negligence isinsufficient to convict a person of negligent homicide. In situa-tions where it is alleged that a medical doctor was negligent inthe treatment of a patient, that doctor may be held civilly liableif the evidence establishes that it is more likely than not that thedoctor’s treatment fell below the appropriate standard of care.In contrast, a doctor may be held criminally liable only whenthe evidence establishes beyond a reasonable doubt that thedoctor’s treatment created a substantial and unjustifiable riskthat the patient would die, that the doctor should have butfailed to perceive this risk, and that the risk is of such a nature

and degree that the failure to perceive it constitutes a gross de-viation from the standard of care. Given the high showing re-quired for negligent homicide, doctors’ negligence in thetreatment of patients will rarely precipitate criminal liability. Itis also true, however, that if doctors act with criminal negli-gence, they should not escape criminal liability merely becausethe negligence occurred in a professional setting.”

For most therapists, there is little if any risk that theywill ever be prosecuted for criminal negligence becausenormally the traits and behaviors that establish criminalnegligence are never tolerated in a hospital setting. Goodmanagers identify non-performing personnel and termi-nate them. But it is important to remember, particularlywhere the issues relate specifically to things like the con-sumption of alcohol and the ingestion of drugs, thatcriminal liability not only strips you of a license, it landsyou in a state prison with very bad people. Criminal neg-ligence is real, and the consequences of a conviction ex-tend far past the normal prison sentence of four to fiveyears. ■

AARC Congress2012

November 10-13, 2012(Saturday through Tuesday)

New Orleans, LA

Save the Dates for

The 58th International Respiratory Convention

& Exhibition


What began as a study-abroad trip to Ghana late lastspring turned out to be quite different than what I hadcome to expect from my five previous visits to the country.

Our group from Weber State University in Ogden, UT,had just arrived in the inland city of Kumasi two daysprior. Due to the weekend, it was our first opportunity toreally get to work. I joined one of the groups and headedto a school to make a donation of much-needed schoolsupplies. We entered one of the class-rooms. I knew one of the little girls inthe class and called her forward so Icould greet her. I crouched down to giveher a hug. She came running at me.With my feet on uneven ground, sheknocked me off balance and my ankletwisted underneath me. I heard and feltboth my tibia and fibula snap. Thusbegan an adventure I never could haveanticipated.

No 9-1-1 hereThe first thing I realized after experi-

encing the snap was that you do not call9-1-1 in a foreign country. Of course, be-cause of my previous trips, I had thoughtabout this before; but you realize it witha lot more impact when it’s you in needof medical attention. I did get some helpfrom those I was traveling with, whosplinted the breaks and got me to anemergency room. Fortunately, a familiarface greeted me there. Richard is an ICUnurse whom I knew from previous trips. He just happenedto be working in the emergency room that day.

An ER physician from the University of Utah, Dr.Bradley Dreifuss, was also working there that day. It isamazing how much comfort can be found in people youknow and trust. I suspect I got special treatment as I am

quite sure they moved me ahead of other patients wait-ing for care. I felt grateful and guilty all at the same time.

The x-rays confirmed my suspicions — a fracture ofthe medial malleolus of the tibia and a spiral fracture ofthe fibula. I was in shock and was not thinking veryclearly. I had not really been able to process what I shoulddo next. So with the help of Dr. Dreifuss, I determined Ishould fly back to Utah and have surgery.

Here we go againI had to make a short flight to the

Ghanaian capital of Accra to be able toget a flight back to the United States.The following day, I made the flightinto New York. It’s a long flight anyway,but I expected it to be awful with a bro-ken ankle. Thanks to a good friend andfellow AARC member, Amber Galer, BS,RRT, who cut her trip short to accom-pany me home, the flight went re-markably well. She did a great jobtaking care of me.

We were able to make our way offthe international flight and throughcustoms. It was nice to be back on U.S.soil, but I wanted to be home so badly.Unfortunately, that took a bit longerthan I thought it would due to a fall Itook in the jetway getting onto theflight back to Salt Lake City. Because ofthe fall, the airline would not allow meto fly. Instead I was taken directly to anemergency room in New York.

Experiencing health care from the patient’s perspec-tive is truly eye opening. I realized from my experiencesin New York that it really does take only one person tomake a difference. I had some good experiences andsome that were not so good.

Allergies & Asthma

F O C U S O N

about the author…

Janelle Gardiner, MS, RRT,is an assistant professor in

the respiratory careprogram at Weber StateUniversity in Ogden, UT.

She has been onnumerous medical

missions to Ghana andplans to return soon to

continue her work.

The View From Here

Plans Change in a Snapby Janelle Gardiner, MS, RRT

Luckily, Gordon, one of the nursing assistants, wasquick to help me and get me what I needed. The ortho-pedic resident, Patrick, was knowledgeable as well. Hewas careful to educate me and keep me informed onwhat was happening next. I was in the emergency roomfor almost 11 hours before they determined I did nothave any blood clots and was cleared to fly again. Be-cause of the fall, the resident had to remove the splintthat was placed in Ghana, reduce my ankle, and splint itagain. He was professional and made the difference inmy ER visit.

Lessons learnedDue to a significant amount of swelling, I was home

for almost a week before having surgery. The surgery wassuccessful, and I felt I was recovering quite well until Idiscovered a DVT on post-op Day 3. That led to anotherset of adventures I was not planning on. Again, this al-lowed me to meet health care professionals who made adifference in my care.

Through all of it, I have been blessed. I have becomeincreasingly appreciative of emergency response sys-tems; good pain medications; knowledgeable, skilled,and friendly health care workers (nurses, assistants,physicians, x-ray technicians, clerks, phlebotomists, andphysical therapists); modern technology; modern medi-cine; modern transportation; good friends; amazing fam-ily; and many, many answered prayers.

I have also learned so many things. I have learned alot about myself and about those who care about me. Ihave learned to have more patience. I have learned thathaving hope and finding the power of positive thinkingcan get you through a lot of difficult days. Finally, I havelearned that I have the opportunity in my work as a res-piratory therapist to be the one who makes the differ-ence in the life of another. ■

The View from Here


Janelle Gardiner receives special care from the KomfoAnokye Trauma Center admission team.

The splint team gets ready to tackle the breaks.


Observations

Improving the Quality of Decision Making

As we move toward closing this year and preparing fornext year, this is a great time to reflect on how we canimprove our value to our employers and, of course, ourpatients. We know the value of protocols; the scientificliterature contains many examples related to how proto-cols, administered by health care professionals such asyou, improve the quality and timeliness of clinical deci-sion making. This is an importantdrumbeat that we must continue tosound since not every hospital ordersrespiratory care by protocol. As wemove into the future and are more fullyinvested in health care reform, we willbe challenged time and again to de-crease unnecessary care, improve carequality, and prepare patients withchronic lung diseases to improve theirrespiratory quality of life by empower-ing them to more effectively managetheir health status. I think it’s safe tosay this will be a perennial mandatefrom now “until the cows come home,”as we used to say.

The foregoing will help us managedown demand and, therefore, costs ofhealth care resources without compro-mising the quality of care our patientsrequire. This is certainly the largest costcomponent of our health care system. There are addi-tional opportunities for us to improve our value by im-proving our quality of decision making when it comes toutilization of equipment and supplies necessary to pro-vide top-notch care.

Acquisition costsAs the Affordable Care Act comes online in the next

few years, it’s important to remember that one of theways Congress adopted to pay for the act will be to levyadditional taxes on pharmaceuticals, supplies, and med-

ical devices. It won’t take long for health care financegurus to target acquisition costs for these products forbudgetary reduction. This will mean that decisions thatwere once thought of as routine in terms of resource ac-quisition, will receive increasing scrutiny before the pur-chasing decision is made.

As many of us have heard, “there must be a pony inthere someplace.” The reality is thatthere is indeed one in there for us. Oneof the prime attributes of respiratorytherapists, and others with specialknowledge in respiratory care, is that weunderstand that technology and clinicalrespiratory care go hand in glove. Werely heavily on technology. It’s incorpo-rated into virtually all modalities. So, it’sa big part of the cost of respiratory care.

Experts, such as you, who know thedifference between the variety of clini-cal interventions and their clinical im-pact should also consider more robustobjective methods of non-personnel re-source acquisition. Many of our col-leagues pose research questions andconduct formal or informal research re-garding the value and performance ofpharmaceuticals, supplies, and devices.While it’s true that the majority of clin-

ical research focuses on patient care, we should alsoapply the need for and value recognition of research inyour clinical environments to help guide and improve thequality of this decision-making niche.

The AARC works with many partners in industry aswell as other organizations within our community. Thesecollaborative efforts are multi-faceted. However, ourstakeholders agree that the requirement for objective evidence will continue to grow if we are to continue toutilize current technology and position our profession tomake a business case as well as a clinical case for

by Sam P. Giordano, MBA, RRT, FAARC

about the author…

Sam P. Giordano, MBA,RRT, FAARC, serves as

AARC executive director.He can be reached at(972) 243-2272 [email protected].

The AARC Program Committee invites everyone – members,

nonmembers, groups, and exhibitors – to submit proposals

for programs for AARC Congress 2012 in

New Orleans, LANov. 10–13, 2012

ALL PROPOSALS MUST BE

SUBMITTED ONLINE AT AARC.org

Submit your proposals and make a difference.We’re counting on you to present programs that make a difference to you!

For more details, visit AARC.org

Submit Your Proposals

Today For AARC

Congress 2012

expenditures necessary to assure that regardless ofbudgetary cuts, patients’ clinical needs are met.

We are working on templates that can help you designrelatively simple studies so that you can do the researchyourself. Expert opinions are always good, but the businessside of our health care system will demand more thanopinions. It will want proof that whatever non-personnelresources we purchase are not only good for the patientsbut are also a proven expenditure by the organization.

In respiratory care, as in all other aspects in medicine,there’s no end to controversies. As an example, manysupport the use of high-flow heated humidificationwhile others may think it’s an unnecessary expenditurethat hasn’t proven itself yet. Why not? Develop a researchproject to prove to yourself and your decision makers (ifit’s necessary) what the benefits are in terms of clinicaland economic outcomes. This is just one example ofwhat will be a new era for many of us.

Researchers neededWe want to develop templates that can serve as a

guide to you when you undertake such research efforts.

You are well positioned to take the lead in such endeav-ors and are encouraged to follow through. In doing so,you reinforce your value to the system and to your pa-tients. You also improve the quality of resource acquisi-tion decision making while documenting a hybridapproach to patient care that includes, first and fore-most, positive clinical outcomes but also supports ex-penditures required to apply available clinical technologyin your institution.

In order to encourage research, AARC organized a Re-search Roundtable about a year or so ago, and severalmembers participate; but the responsibility for conduct-ing research, especially when it comes to purchasing de-cisions, must be borne by all of us and inculcated intoour respective organizational cultures.

We will provide more information regarding the pre-viously mentioned templates as we move forward nextyear. Be on the lookout! This is an opportunity to onceagain build your value while looking out for the best in-terest of both our patients and employers. ■

Observations



Cover Story

AARC Times: How did you first become interested inrespiratory medicine, and why did you decide to makeit your specialty?

Dr. Nava: Like most of my colleagues, I became inter-ested in respiratory medicine by chance. Actually, dur-ing my third year at the university, I had manyproblems in understanding the physiology of breath-ing. Terms like compliance, resistance, work of breath-

ing, and transpulmonary pressure were difficult for me to under-stand; and they all sounded very far from “the real patient.”

During the last two years of medical school, I just wanted to bet-ter understand what all these mysterious words meant. Immedi-ately, I became fascinated by reading and hearing an explanation ofthe chest x-ray — at that time a non-CT scan — done by attendingphysicians. I was amazed that they could see in a film somethingthat I would never guess was there. Step-by-step I started to study,to observe what the others were doing, to learn the “body language”of our patients, and to try to understand their needs. Indeed, the en-vironment was very friendly, and my colleagues and all the staffvery kind — and why not say it — sometimes funny as well. So oneday I said to myself, “I am here to stay.”

2010 Héctor León Garza AwardWinner Credited with Helping To Introduce NIV to the World

Stefano Nava, MD, traces his use of noninvasive ventilation back to the 1980sNoninvasive ventilation (NIV) is increasingly being used to assistwith weaning and/or to avoid intubation altogether in patientswith respiratory conditions. Thegroundbreaking work done by lastyear’s winner of the AARC’s HéctorLeón Garza, MD InternationalAchievement Award is a big part ofthe reason why. In the following interview, Stefano Nava, MD, talksabout his long career in respiratorymedicine and what led him to beginusing NIV with his patients nearlythree decades ago.


Cover Story

AARC Times: You recently joined the Policlinico S. Orsola-Malpighi/University of Bologna after many years at Pavia Uni-versity. Why did you make the change?

Dr. Nava: My life is very often “on the move.” I like to traveland meet new people; so I thought, why not change my job toget new stimuli? This is quite an unusual practice for Italians,who are more likely to stay in the same place all their lives.But after turning 50, you have, in my view, two options — one,reach a plateau of your professional life, or two, make a bigchange. Waking up every morning knowing what the rest ofthe day will look like is not for me.

AARC Times: You have conducted many studies over the yearson mechanical ventilation and, most particularly, on NIV.What have you learned from these studies, and how has thisknowledge helped change the way respiratory professionalstreat their patients both in your own country and around theworld?

Dr. Nava: In Italy we started to use NIV in the late 1980s. I wasworking in those days in a rehabilitation center in a smallhospital out in the hills. Along with my good friend, Dr. Nicol-ino Ambrosino, I became interested in NIV mainly because,working in a respiratory ward every day, we faced patientswith acute respiratory failure who had only two options —

Patrick Dunne (left), MEd, RRT, FAARC, presents the Héctor León Garza award to Stefano Nava, MD.


Cover Story

either intubation, which we were not allowed to manage inthat unit, or oxygen therapy.

So we both said to each other, why don’t we try somethingdifferent? Being one of the first pioneers in this technique, Ihave to say that NIV really changed the practice of medicinesince later it became the first-line intervention for severalpathologies like COPD exacerbation, cardiogenic pulmonaryedema, and pneumonia in immunocompromized patients.

The application that I feel is “our creature,” however, is theuse of NIV in the weaning process of hypercapnic patientswho were previously intubated. We published the first ran-domized controlled trial, which was confirmed later by sev-eral other investigations. So I am very proud to think thatevery time someone is extubated and placed on NIV, a smallmerit is also mine.

AARC Times: Some of your studies have been published inthe AARC’s science journal, RESPIRATORY CARE, and you also siton the Journal’s editorial board. How do think the journal hasevolved over the past decade, and how is its influence on res-piratory care research around the world growing?

Dr. Nava: It is very difficult to answer this question becauseit is easy to be biased by the fact that I am on the editorialboard, and I am a friend of Editor in Chief Dr. Dean Hess (PhD,RRT, FAARC). But that said, I think that the journal hastremendously increased its popularity and scientific weightin the last few years, thanks also to the previous editor andnow editor emeritus, Dr. David Pierson (MD, FAARC).

There are three things that I like the most about RESPIRA-TORY CARE. The first is that it is not a journal restricted to med-ical doctors but open to all the professionals involved in thepulmonary and critical care world. This is very importantwhen you think that the care of the patient is not a “solo”procedure, but teamwork. Second, I like the educational as-pects, since there are many well-done reviews and proceed-ings from very up-to-date meetings and consensusconferences. Third, I consider that, right now RESPIRATORY CARE

is the journal of mechanical ventilation, and it was abouttime for it.

AARC Times: Tell us a little about the Italian model of respi-ratory care and how it compares and contrasts with themodel of care we have in the United States.

Dr. Nava: Having worked for awhile in the United States, Ihave to tell you that the differences are mainly “formal.” Thelife expectancy in the United States and in Italy are very sim-ilar — it’s actually better in Italy — so that patients are verylikely to receive similar care. However, we work in a totallysocialized health care system, so that everyone is entitled to

receive care and treatment, including drugs and hospitaliza-tion, for free. I am a strong believer in the idea that everyoneshould get the best health care irrespective of economicalstatus and legal status (i.e., illegal immigrants). In addition,we are less keen to apply fixed protocols, maybe because weare Latin, or maybe because there is always a little bit of artin medicine that we should not remove.

AARC Times: Do you believe respiratory therapists will everplay a major role in the Italian health care system?

Dr. Nava: This is a difficult question. Actually, the majorproblem lies with the university system. Most of the educa-tional tracks are run by physical medicine doctors who notonly do not believe in the scientific strength of what respi-ratory therapists have done elsewhere but, most importantly,they do not even want to learn the “lesson from the UnitedStates” that RTs and physiotherapists are different entities.

To be honest, there are a few spots where some of us areworking together (i.e., physiotherapists and medical doctors)to try to build up specialized teams that we call the “respi-ratory physiotherapists.” This is thanks to the Italian Associ-ation of Therapists for Respiratory Failure (ARIR, orAssociazione Riabilitatori dell’Insufficienza Respiratoria). Iwant here to also recognize the work and the skill of my pre-vious respiratory therapists, with whom I shared the experi-ence of working together as a real team when I worked inPavia. Their names are Giancarlo, Serena Sr., Serena Jr., andManuela.

AARC Times: Last year you received the Héctor León Garzaaward at the AARC Congress. What did it mean to you to re-ceive this prestigious international award?

Dr. Nava: As I said during the small talk I gave when I re-ceived the award, it was like receiving the Oscar. I was firstvery proud, happy, and thankful to all the people who choseme. Once more, a person alone is nothing if not supportedby teamwork. I worked very hard in the last 30 years, I spentnights awake to care for patients or to write papers; but I re-ceived a lot, too, first, from my patients — there is nothingbetter than a warm “thank you” from a smiling human being.Second, I have had the chance to travel all over the world,learning about different health care systems and life atti-tudes, and especially meeting people, some of whom also be-came good friends.

Of course, there was a price to pay, which was spendingalmost half of my life far from home. This means that I amreally grateful to the one person who was willing over allthese years to stand by me and my lifestyle, and thereforehad the “guts” to marry me. Thanks Anna Maria! ■

by John D. Hiser, MEd, RRT, FAARC

AARC International

Fellows Make

Guest Editorial


“a Baker’s

Guest Editorial

It was felt that over the years we’ve done agood job of identifying examples of inter-national fellows who have helped achieve

the goals of the International Fellowship Pro-gram. However, we also believe that most of theinformation collected over the past 21 years hasbeen primarily anecdotal in nature. Based onthis, our committee decided to begin collectingand documenting data from all of our past andfuture fellows to help us identify success in theprogram and plan for the future. Based uponcommittee work that was completed prior tothat meeting, we listed a “Baker’s Dozen” list ofdesired attributes that we feel exemplify the

EDITOR’S NOTEOur editors thank AARC Times Guest Editor John D. Hiser for his

special contributions to our December international issue.

▲

John D. Hiser, MEd, RRT, FAARC,

currently chairs the AARC

International Committee and

served as president of the

AARC in 2005. He directs the

respiratory care educational

program at Tarrant County

College, Center for Health

Care Professions in

Fort Worth, TX.

Dozen”


ABOUT THE AUTHOR

The International

Fellowship Committee

met this summer to

perform the difficult

task of selecting

international fellows

and city hosts for this

year’s visit to the

United States. This

time we also reviewed

at length our mission,

goals, selection

process, and how to

identify success.


Guest Editorial

types of successful activities wehope to see international fellowsdisplay when we invite them toparticipate in the program. Theseattributes are listed at left.

Many of our past fellows havecome very close to achieving all 13of these goals.

Since 2006, the American Res-piratory Care Foundation hashonored five of our internationalcolleagues with the prestigiousHéctor León Garza MD Interna-tional Achievement Award, whichrecognizes respiratory therapists,physicians, and other health careproviders who have profoundlyimpacted the development of in-ternational respiratory care. Re-cipients have included HéctorLeón Garza, MD, FAARC (Mexico–2005); Hassan Alorainy, BS, RRT,FAARC (Saudi Arabia–2006); SergioZuffo, PT (Italy–2007); GustavoOlguín, MHA, PT, RRT (Argentina–2008); Kazunao Watanabe, MD(Japan–2009); and Stefano Nava,MD (Italy–2010).

The International Council forRespiratory Care has long recog-nized Toshihiko Koga, MD, FAARC,a past fellow and ICRC governorfrom Japan, for his professionaland humanitarian contributionsto the development of respiratorycare around the world. In 2006 theCouncil established the KogaMedal to honor those who havefollowed in his path. Recipientshave included Toshihiko Koga,MD, FAARC (Japan–2006, pre-sented posthumously); MichaelAmato, MBA (USA–2007); Chia-Chen Chu, MS, SRRT, FAARC (Tai-wan–2008); Derek Glinsman, RRT,FAARC (USA–2009); Gary Smith,

BS, FAARC (USA–2010); and PatrickDunne, MEd, RRT, FAARC (USA–2011).

All of these individuals havebeen past international fellows,governors of the ICRC, or mem-bers of the International Commit-tee. They are the shining starswho help symbolize the successof our international efforts. Manymore have been recognized overthe years in numerous articlespublished in AARC Times. How-ever, there are many more whohave not been recognized, andthat is what we hope will come tolight once the committee com-pletes the process of developing atool that can be used to documentall of the many successes of ourInternational Fellowship Programparticipants.

Accompanying this article arepictures of 13 past fellows whohave achieved at least one of the13 attributes we feel help docu-ment success. All of those pic-tured have achieved several of thelisted attributes; but that’s an-other story for another time, soplease stay tuned.

This issue of the magazine in-cludes several articles about howrespiratory care is practiced in dif-ferent parts of the world, medicalmission trips taken by many ofour U.S. AARC members, and asusual, stories that demonstratethe success of the Association’sinternational efforts to bring peo-ple together and improve respira-tory care around the world. I hopeyou enjoy this issue as much asour honored authors and AARCTimes editors and staff have en-joyed bringing it to press. ■

1. Maintains membershipin the AARC.

2. Attends the AARC Congress or Summer Forum.

3. Works toward establishing respiratorytherapy schools in their country.

4. Works to establish governmentaland/or legal recognition of RTs.

5. Works to set up professionalassociations for RTs.

6. Publishes articles, case studies, or abstractsin RESPIRATORY CARE, AARC Times, or other professional journals from their country.

7. Provides translations of AARCmaterials about the profession.

8. Collaborates with the AARC to publish RESPIRATORY CARE or AARCTimes articles in foreign publications.

9. Serves as a governor on theAARC International Council forRespiratory Care.

10. Works to establish AARCinternational affiliates.

11. Obtains AARC International EducationRecognition System (IERS) approval forseminars, programs, and schools.

12. Maintains communicationthrough the International Fellowslistserve and other venues.

13. Makes presentations at theAARC Congress or Summer Forum.

The Baker’s Dozen

Guest Editorial

International Fellows Make a Difference

United Arab EmiratesNoel Tiburcio, MBA RRT-NPSAbu Dhabi, United Arab EmiratesYear of fellowship: 2009Helped establish the Emirates’ Association for Respiratory CarePractitioners as an internationalaffiliate of the AARC.

NorwayHeidi Markussen, RNBergen, NorwayYear of fellowship: 2008Presented an OPEN FORUM abstractat the 2009 AARC Congress.

ChinaXiang Yu Zhang, MD, FCCPShanghai, People’s Republic of ChinaYear of fellowship: 1998Obtained AARC International Education Recognition System (IERS)approval for educational seminars inhis country.

ChileJose Landeros, PT, CRTSantiago, ChileYear of fellowship: 2007Maintains regular communicationthrough the AARC International Fellows List Serve and other venues.

ArgentinaGustavo A. Olguín, MHA, PT,RRT, CPFTBuenos Aires, ArgentinaYear of fellowship: 1997AARC member since 2004 andHéctor León Garza Award recipient in 2009.

JapanTetsuo Miyagawa, PhD, RRT, RPT, RCETTokyo, JapanYear of fellowship: 1990Collaborates with the AARC to publish RESPIRATORY CARE and AARC Times articles in Japanese publications.

ItalyPamela Frigerio, PT, ARIRCantu, ItalyYear of fellowship: 2000

TaiwanChin-Jung Liu, MS, RRTTaichung City, TaiwanYear of fellowship: 2006Worked with a team of other international fellows from Taiwan andChina to translate the first and secondeditions of “A Guide to Aerosol DeliveryDevices.”

Saudi ArabiaMohammed Al Ahmari, MSc,BSRC, RRTDhahran, Saudi ArabiaYear of fellowship: 2005Has attended all AARC Congressessince his fellowship.

KoreaKook-Hyun Lee, MD, PhDSeoul, KoreaYear of fellowship: 2001ICRC governor for Korea.

ChinaYue-hua Yuan, BS, RTHangzhou, ChinaYear of fellowship: 2009Authored “Respiratory Care inMainland China” published inDecember 2009 AARC Times.

IndiaVijai Kumar, MDHyderabad, IndiaYear of fellowship: 1992Started the first respiratory therapy training program inIndia.

PanamaBriseida Delgado, BS, MS, CRTTRepublic of PanamáYear of fellowship: 1998Worked to get special governmental legislation that legitimizes the role of the respiratory therapist and the profession in Panamá.


FrancePhilippe Joud, PTLyon, FranceYear of fellowship: 2000Collaborated to establish theEuropean Respiratory CareAssociation (ERCA).

Vietnam

Building a Network of Asthma and COPDOutpatient Care Units in Vietnam


by Le Thi Tuyet Lan, MD, PhD

Vietnam is about 35% larger than theUnited Kingdom, with a current popula-tion of more than 87 million. About 61% ofthe population is working age. Vietnam isthe second fastest growing country in theregion, its population growing at 1.3% peryear. About a third of all individuals areunder the age of 15.

cost of treatment for smoking-relateddiseases was $77.5 million in 2005 alone(Vinacosts 2005).

Air pollution is a problem due to con-struction (in the process of urbaniza-tion) and the enormous number of motobicycles. The concentration of pollutants(PM10, PM3,5, lead, NO2, ozone, SO2, CO,toluen, and benzen) exceeds the Viet-namese pollution standard level by 1.5to 3 times according to the Environmen-tal Protection Agency based in Hochi-minh City.

Also, more than 75% of the Viet-namese people are peasants and manyof them use biomass fuel in a tinykitchen without a chimney.

TuberculosisVietnam is also among the 22 coun-

tries with the highest prevalence of tu-berculosis (TB). About 30% of all patientsof all ages here have an infectious dis-ease of the respiratory tract. In recentyears, TB has been aggravated byHIV/AIDS.

The national system of TB control inVietnam is well established and workseffectively. Vietnam recently launched aprogram to treat multi-drug-resistantTB. We have a good acute respiratory in-fections program, and the H1N1 andH5N5 influenza strains are still active inVietnam.

Non-communicable diseasesIn regard to non-communicable res-

piratory diseases, about half of the pop-ulation has allergic rhinitis. In asthmaticpatients, it is even higher (up to 80%).Workers often get this disease, espe-cially in the factories producing exportproducts.

Our country joined the WorldTrade Organization (WHO) in January2007, and since then WHO statisticshave shown that the burden of respi-ratory disease in Vietnam is great.

More than 56% of all adult maleswere smokers in 2002. The expenseof treating smoking has amounted to$512.5 million in recent years. The


Vietnam

The lessons that we have learned in the process ofbuilding up a network of ACOCUs in Vietnam are:

A core group, prefer-ably from a medicalschool that has a university medical center, is essential.

1

Good relationshipswith mass media arevery important to increase awareness of the community.

2

We should cooperatewith the WHO non-communicable program to get its invaluable support.

3

Our mastering of English to participate ininternational activities in respiratorycare is obligatory.

5Trying to influence thepolicy makers to havefavorable decisions forrespiratory care is veryimportant.

6

About the AuthorLe Thi Tuyet Lan, MD, PhD,

is chairwoman of the Hochiminh City RespiratorySociety and head of the Respiratory Care Center atUMC, University of Medicineand Pharmacy in HochiminhCity, Vietnam. Dr. Le was anAARC International Fellow in2000.

The prevalence of asthma in adults is 5%, andin children it is 10%. But the publication of the In-ternational Study of Asthma and Allergies inChildhood (ISAAC) study of 2004 showed that thewheezing prevalence of 12–13 year-old children inHochiminh City is 27.1% — the highest in Asia.

The COPD Research Group of the Asia PacificSociety of Respiratory Care (APSR) notes that theprevalence of COPD in Vietnam is 6.7% — the high-est of the region. Occupational lung diseases thatare recognized by the Vietnamese government arestill limited. The prevalence of chronic bronchitisis 25–35% in workers.

Silicosis is the most frequent occupational lungdisease of the Vietnamese people. Byssinosis(brown lung disease), asbestosis (mesothelioma),and occupational asthma are also prevalent.

The high temperature, high humidity of a trop-ical country, high prevalence of smoking, and se-vere air pollution in a low socio-economic levelpopulation all result in a heavy respiratory dis-eases burden in Vietnam; and it has continued toincrease each year.

Because we have to place importance on treat-ing contagious diseases and life-threatening ill-nesses caused by infectious diseases, thenon-communicable diseases — especially chronicrespiratory diseases such as asthma and COPD —have not been adequately managed in Vietnam.The patients usually receive treatment during anexacerbation but are left without follow-up, lead-ing to the overuse of systemic corticosteroids.

What WeHave Learned

7

Spirometry, GINA,GOLD, and ARIA arecornerstones forACOCU success.

4 Training, research, and helping build up other ACOCUs are help-ful activities for othersand for the team itself.

8 ACOCU is sustainableand expandable as itmeets the needs of anycommunity.


Vietnam

The high temperature, high humidity of a tropical

country, high prevalence of smoking, and severe air

pollution in a low socio-economic level population all result in a

heavy respiratory diseases burden in Vietnam.

Building a special outpatientnetwork

The first step to help solve theseproblems was to open the University ofMedicine and Pharmacy Asthma andCOPD Care Unit in Hochiminh City.This was the first Asthma and COPDOutpatient Care Unit (ACOCU) estab-lished in a university medical center.The center offers special care to thesepatients, adhering to the Global Initia-tive for Asthma (GINA) and Global Ini-tiative for Chronic Obstructive LungDisease (GOLD) guidelines.

The second step was to increaseawareness in the community aboutasthma, COPD, spirometry, and howthe GINA and GOLD guidelines can im-prove patient care. Because this is anew strategy and much needed by thepopulation, the mass media outletsspread the news very effectivelythroughout the country, especially bytelevision. We have also held commu-nity-oriented events, such as COPDday, asthma day, and non-smoking day,which have been organized regularlyevery year for the past 10 years. Peoplein the COPD and asthma patient clubsare warm hearted, which fosters theparticipation of more patients. The pa-tients in these groups help our healthcare practitioners better care for peo-ple with these conditions. As the num-ber of patients increases steadily, thecore group accumulates more andmore experiences to share.

The third step has included manyactivities, such as lectures on asthmaand COPD management and the im-

portance of adhering to the GINA andGOLD guidelines. Special emphasis isput on teaching spirometry. One im-portant success of the ACOCU programis the cooperation of WHO in organiz-ing and funding the spirometry work-shop and their support of ACOCU.Two-week workshops on asthma andCOPD outpatient care in the commu-nity help other doctors and techni-cians build up their local ACOCUs. Wehave organized 38 workshops, pro-vided training for 45 provinces that in-clude 495 doctors and 55 techniciansand 279 nurses for 178 medical settle-ments. ACOCUs have been establishedin 22 provinces, mainly in the MekongDelta. In Hochiminh City and DongThap, ACOCUs exist even in the districtlevel. Many studies on asthma andCOPD have been funded by nationaland international grants from the uni-versity, Provincial Department ofHealth, Provincial Department of Sci-ence and Technology, and the Ministryof Health (MOH). Thirteen people havedefended their master’s degree andtwo PhDs have defended their thesissuccessfully, based on the 33,000 pa-tient computer file copies of the UMCACOCU.

The fourth step has been to join ininternational educational activities.Our team always looks for opportuni-ties to attend international confer-ences. The leaders of the team activelyparticipate in conferences of the AARC,GOLD, GINA, Global Alliance AgainstChronic Respiratory Diseases, Interna-tional Primary Care Respiratory Group,

American Thoracic Society, APSR, Euro-pean Respiratory Society, ARIA, IUATD,ICC, and the Asian Advisory Board onRespiratory Diseases. Cooperation withother medical schools, such as Shiga,Mayo Clinic, and Washington Univer-sity, is highly appreciated.

After 10 years of continuous effortand wide recognition in the commu-nity, we have reached the fifth step: in-fluencing the policy makers inVietnam’s health care system. Theleader of the team is a member of MOHand committed to preparing our na-tional guidelines for asthma and COPD.We continuously persuade the insur-ance industry here to include the con-trol drugs for asthma and COPD on theinsurance list because we recognizethese diseases as the chronic ones.With the help of WHO, we are now try-ing to introduce the program of non-communicable diseases down at theward (commune) level.

The sixth step has been an expan-sion of the kinds of respiratory dis-ease we can treat. Our team hasbranched out from asthma and COPDto help people with related respiratorydiseases, such as sleep breathing dis-orders, pulmonary arterial hyperten-sion, and allergic rhinitis. We plan toapply to PAL to include tuberculosisand even other important non-com-municable diseases such as sleep dis-orders and chronic occupational lungdiseases. Suppressing occupationaldiseases continues to be difficult aslong as poor economic conditionsexist in Vietnam. ■


Medical Missions

RTs Are Making aDifference

Around the World

CONNECT WITH YOUR RT PEERSINTERESTED IN MEDICAL MISSIONS

Want to be part of the medical missions discussion?

Then join our International Medical Missions Roundtable on

AARConnect. It’s a great way to learn more about what’s

going on — and membership is free to all AARC members.

Read stories about trips byfellow RTs — turn the page…

�

RTs Are Making aDifference

Around the World


Medical Missions

Over our 23-day stay in Ghana, we served communitiesranging from remote rural areas to heavily populated urbanareas. Our diverse group of 23 people consisted of healthcare providers, educators, geography students, mechanicalengineers, and college freshmen. Community health edu-cation, free clinics, pulmonary function testing for research,clinical practice and education, and hands-on hospital ex-periences took place in rural and urban hospitals, elemen-tary and vocational schools, rural outpatient clinics, andcommunity centers.

The population’s access to health care is varied amongcultural, social, and geographical areas. Members of thepublic received education, instruction, and clinical assess-ment during their scheduled interaction. The main objec-tive was to focus on individuals in their life setting andtravel throughout the country providing services to meettheir needs. We learned about cultural, economic, and en-vironmental aspects of third-world country health care byparticipating in rural clinics and hospitals, and providingeducation development for a variety of health care work-ers. Missionaries gained an understanding of environmen-tal effects on the health of Ghanaians by meeting the publicand participating in pulmonary function research.

Daysin Ghana23

Ghana is located along the southern coast of the West Africanregion and is bordered by the Ivory Coast, Togo, and BurkinaFaso. It is classified as an impoverished third-world country witha population of more than 25 million.

The health status of the Ghana population presents manychallenges, including competency of health care workers, equip-ment and supply shortages, standardized practices, poor coor-dination of the health care delivery system, weak referralsystems, and low patient access to care.

The purpose of this trip was to provide humanitarian aid anda medical mission to Ghana by working beside and under theleadership of Lisa Trujillo, MS, RRT, founder and CEO of CharityBeyond Borders. Through Weber State University (Trujillo’s em-ployer) and Charity Beyond Borders, people have an opportunityto participate in humanitarian and health missions that covermost of the country of Ghana.

Trujillo is also the respiratory care program director for theWeber State University Ghana Study Abroad Program, begun in2005, in which she has been taking students and health careprofessionals to Ghana since 2006. Trujillo is a leading researcherin the study of the effects of breathing problems related to theburning of e-waste in trash dumps, coal burners used for cook-ing, and dust along the undeveloped roads in Ghana.

by Karen Schell, MHSc, RRT-NPS, RPFT


Medical Missions

Visiting a third-world country presents anopportunity to develop skills in leadership,teaching, troubleshooting, and equipmentwhile learning about cultural differencesamong the population. We learned to be re-sourceful in providing care with limited per-sonnel, equipment, and supplies. We also learned how todevelop and prioritize skills and utilize equipment whilethinking “outside of the box” in circumstances that require in-novation to meet the needs of the population.

Educating and developing health care workers and pro-grams helps prepare individuals for opportunities to improvetheir performance and train providers to benefit the commu-nities in which they live. Assessing the needs of the commu-nities served will help in the planning and organization offuture humanitarian and health missions. Over the last sixyears, the organization has:• Distributed 3,200 eyeglasses• Performed 730 pulmonary function tests• Screened 200 people for sickle cell disease• Performed 4,200 basic health care assessments• Provided 1,200 people with oral health education• Educated and trained 2,400 health care providers in neona-

tal resuscitation, BLS, mechanical ventilation, and infec-tion control and prevention

• Educated the 800 members of a community about diseaseand health, including: HIV/AIDS, infant and maternalhealth, recognizing signs and symptoms of an ill child,basic CPR, exercise, and basic nutrition

• Shipped three 20-foot cargo containers and one 40-footcargo container

• Shipped an ambulance to be used as a mobile clinic.

In addition, the organization has procured donations of:• Elementary education reading programs, including math,

science, health, English, and reading for grades K–6

• 700 refurbished library books• 1,200 textbooks on nursing, respiratory care, radiation

technology, clinical lab sciences, emergency care and res-cue, health administration, and dental hygiene (to stock anursing and allied health college library)

• Adult and infant CPR manikins• Hundreds of neonatal resuscitation supplies, bag-valve-

mask resuscitators, ventilator circuits, cannulas, suctionequipment, and endotracheal tubes

• Wheel chairs, crutches, and hospital beds.

All in all, the estimated value of supplies and equipment(including the ambulance) procured since 2006 totals$750,000. The number of people who have traveled to Ghanaincludes about 85, and several have returned for second, third,and fourth missions.

For many of us participating in these medical missions toGhana, it has been a life-changing experience. We will returnto Ghana next April in hopes of developing education in res-piratory therapy. ■

Karen Schell, MHSc, RRT-NPS, RPFT, is director ofcardiopulmonary servicesat Newman RegionalHealth, in Emporia, KS.

Lisa Trujillo


Medical Missions

came for services. Each room had a student who spokeSpanish. The language of Brazil is Portuguese, but Spanishprovided an elementary level of communication.

We performed basic vital signs and physical assess-ments and determined the chief complaint. Requiredprescriptions were requested from an accompanyingBrazilian physician. Mostly we provided primary care. Adiagnosis of worms was common. Even in the Amazonjungle, there were a number of individuals who weresmokers, and I was always ready to show these peoplethe health effects of smoking and strongly recom-mended “no fumar.” I did identify a small girl with alikely diagnosis of tuberculosis, and we had a patientwith filariasis.

Besides caring for the wonderful Brazilians, we wereable to swim with pink river dolphins and see exoticbirds and monkeys. I even saw a sloth.

We had joined a dedicated group of Brazilian physi-cians and other missionaries we greatly admire. They of-fered their kindness and friendship not only to theirpatients but to us as well.

by James L. Hulse, PhD, RRT-NPS, RPFT

Adventurein Brazil

For many years I prayed to God to help me finish myPhD so I could teach and help people in other countries.In July of 2009, I successfully defended my dissertation.By the fall of 2009, I was looking for an international serv-ice opportunity.

If you look for mission opportunities, you are not likelyto find a church or a nonprofit nongovernmental organi-zation asking for a respiratory therapist. I went to the stu-dent missions website of my alma matter, Loma LindaUniversity, and read about the short-term mission oppor-tunities, when one caught my attention. The questionwas: “Got a Week?” It was a mission on the Amazon Riverin Brazil. Here was a trip in which students live on a boaton the Amazon River and visit villages where they providedental and medical care. I wanted to do it. My wife Lindaand daughter Lisa (both nurses) said they would join me,and we started the preparatory work of getting a visa andimmunizations and planning the trip. I decided to bringalong a pulse oximeter, stethoscope, blood pressure cuffs,peak flow meter, and an educational display of the effectsof smoking on various organs of the body. Before long, wewere arriving in Manaus, Brazil.

It was exciting to be on a boat with medical students,dental students, public health students, nursing stu-dents, occupational therapy students, pharmacy stu-dents, and physical therapy students. All were sleeping inhammocks on the top deck. Since we were on a boat, thetrip organizers could make sure that we had access toclean food and sanitary conditions.

Our boat navigated through the night — not up theAmazon River but up the Rio Negros, a large tributary ofthe Amazon — and stopped at the first village, which hada small building that we were able to use for a clinic. Onone side were the dental students and the oral surgeon,and the other side had three examining rooms and anarea set up as a pharmacy. My wife, daughter, and I eachtook a room with two medical students, and the patients


Medical Missions

I had an interesting experience when I tried to leave Brazil. Justbefore going to the plane, I was stopped and asked about the con-tents of my luggage. I tried to list items I thought they were won-dering about, knowing I had some sugar in my luggage that mightlook like a suspicious drug. Finally, they asked if they could bringme the luggage for me to open. As soon as I saw the item, I imme-diately knew what the problem was — it was the display of thehealth effects of smoking. This display contains three-dimensionalpresentations of various organs of the body: the heart, the lungs,the bladder, and a hand. Evidently, when this item was scanned itappeared that I was transporting human body parts from Brazil inmy luggage. At least five airport security personnel were there towatch me open it. When I opened the case, I immediately beganmy line about “no fumar,” and they waved me on. ■

James L. Hulse, PhD, RRT-NPS, RPFT, is director of respiratory care atthe Oregon Institute of Technology in Klamath Falls, OR.

Dr. James Hulse

I have taken four trips to Santa Cruz, Bolivia, on sur-gical mission trips through the Mission of Hope-Bolivia.Typical missions include hernia repairs, gallbladder re-moval, and other related surgeries. A normal day starts at6 a.m. and ends at 8 p.m. Within a five-day period, 60–65operations are performed. Patients have to wait for one totwo years to have an operation.

I work in the recovery room. The critical skills includefundamental physical assessment, communication, air-way assurance, and the use of basic oxygen delivery de-vices. The ability to be flexible and creative proves to berewarding every year.

Safety practices are equally important, and we checkarmbands because patient names are often very similar.We verify medications because they are written in Boli-vian, and communication is enhanced with translators.Yet, non-verbal creativity is welcome; for example, a gri-mace means “I am in pain and need pain medications,”and a smile means “my pain is controlled and I do notneed medications.”

Mission of Hope-Bolivia is based in Santa Cruz, a cityof more than a million people. Most live in extremepoverty and cannot afford even the most basic medicalcare. Children are dying for lack of simple antibiotics. Ourgoal is to bring hope and healing by providing them withquality medical care at no charge.

Mission of Hope-Bolivia is currently operating a free outpatient clinic in Santa Cruz that is centrally located on the bus lines, which is the main mode of public transportation. We are currently serving about 500patients every week, providing them exams, lab work,and medicine.


Medical Missions

Medical Missionin Bolivia

by Stan Holland, MS, RRT

My next medical mission will be in Honduras with theFriends of Barnabas Foundation (FOBF). Each year, FOBFsends 11 mountain medical mission teams to Honduras.FOBF staff members select communities in need andtravel to clinic sites weeks ahead of the team to notifycommunity leaders of their services and the date of theteam’s arrival.

The teams travel throughout the impoverished areas ofcentral Honduras and serve 1,500–2,000 people in theirtraveling clinics each month to provide primary and pre-ventive health care. The majority of the patients havenever seen a health care provider. Each team is comprisedof four to five medical professionals, two or three Spanishspeakers, and the remaining team members have a heartfor serving their fellow man. These teams work side by sidewith FOBF staff members in Honduras.

Medical missions change lives and offer hope. On oneof our missions, we restored a man’s voice. He had beenin a car accident two years earlier, and his larynx was bro-ken. We removed a laryngeal stent and created a speak-ing valve. On the last day we were there, he returned withhis mother and daughter to say “thank you.” ■

Stan Holland, MS, RRT, is bio-director of RockinghamMemorial Hospital inHarrisburg, VA. He has been a member of the RespiratoryCare Advisory Board of theVirginia Board of Medicinesince 2008.


Medical Missions

I was invited on a medical mission trip to the Domini-can Republic by a fellow church member this past sum-mer, and it has left me with a greater appreciation for therole a respiratory therapist can play in an internationalclinical setting. Originally placed on the constructioncrew, my designation as a team member was soonchanged to the medical squad once my medical back-ground became known.

The primary members of this mission team were fromthe Alabama region and were hit hard by the recent tor-nadoes that decimated large areas in the southeasternstates. This reduced the usual mission team of about 40members down to 26. The normal medical team of three tofour doctors and an equal amount of nurses was whittleddown to one doctor, one nurse, and me. My trepidation ofbeing in a foreign country (this being my first interna-tional mission trip) was now augmented by being placedin an advanced role of clinical importance. Even thoughmy background as an RRT covered ER, ICU, neonatal ICU,and cardiovascular ICU exposures, as well as all manner ofoutpatient settings, I had never treated patients in an out-door setting or a non-acute care setting such as this.

I planned as best I could with my 30 years of respira-tory care background and went over my “what if” situa-tions while preparing my gear. My medical duffle bag heldall the usual respiratory paraphernalia, along with do-nated items from my hospital, Palmetto Health Richlandin Columbia, SC. Along with toys, hygiene bags, sanitationwipes, hand gel, bug spray, and a dose of heavy prayers, Iwas soon on my way to Santiago, Dominican Republic.

We arrived on a Saturday and prepared for our firstday of clinic that Sunday morning in a poor neighborhoodon the outskirts of Santiago. These open-air settings,under a thatch hut in the village square, held the med-ical, dental, pharmaceutical, and vision clinics for any in-dividual needing our services. The people were alreadylined up and waiting for us when our bus arrived, as theword had already spread about our clinic coming to them.

The typical day started with a group breakfast at ourhotel, boarding and loading the bus by 8 a.m., and arriv-ing at the clinic site by 9 a.m. After a quick set-up of bloodpressure cuffs, ear thermometers, otoscopes, and stetho-scopes, we began seeing patients, with our final count ex-ceeding well over 700 for the six days. The pace was hecticat times, with my triage roles morphing into a physicianassistant. Quickly, I became affectionately known to thestaff and translators as “Doctor Scott.” Although this titleusually is quickly corrected in the States, the translationof “respiratory therapist” was not easily understood bythe translators or patients.

I quickly learned how to be a good investigative clini-cian, with the translation sometimes going from Englishto Spanish to Creole and then back again to me. This gaveme a better appreciation for the typical general practi-tioner back in the United States who bemoans the factthat they cannot spend more time with their patients. Awarm smile, soothing tone, and gentle laugh put at easeeven the most tense patient as I slowly engaged each per-son in a search for answers to their complaints. I’m surefrustration, misunderstanding, and irritability existed;but almost every one of the locals we treated appreciatedhow we treated their needs.

Diagnosing and sending our recommended treatmentoptions to the pharmacist became more fluid as each

by Scott N. Simms, BHA, RRT

A young patient holds an AARC teddy bear that Scott Simms hadreceived while attending leadership training in Dallas, TX.

Medical Mission in theDominican

Republic


Medical Missions

patient described their health concerns. Common flu, hyper-tension, scabies, cuts, fungal rashes, diabetes, sexually trans-mitted diseases, and urinary tract infections wereintermingled with a need for soap, toothpaste, multivitamins,or just a reassurance that what they had was not that bad.Each patient filled out a sheet in Spanish (with subtitled Eng-lish) to describe their health care needs. At the bottom was anarea for diagnosis and treatment options; this was passedalong to the pharmacist, who would dispense the appropriatemedications and dosage with instructions on correct admin-istration of the drugs.

I did encounter a few respiratory-compromised patientsin need, so the peak flow meters I brought along came inhandy for the asthmatics. I did not see much in the way ofCOPD, but a lot of those we saw could not afford to smoke,anyway. I soon became more comfortable with writing fortreatment options while counseling the patient on healthyliving choices, disease-prevention techniques, and generaladvice for improving their health.

We were fortunate to have a local doctor volunteer histime for one day. A Santiago University medical student alsosporadically assisted us when he could get time off fromschool. Under the other doctor’s general supervision, weteamed up to help as many people as possible; but there wasalways a line of those still waiting to be seen when we reluc-tantly closed up our clinic about 6 p.m. After a quick meal anddevotional at a local church, we would go over the day’s

events and brainstorm on how to improve upon the nextday’s clinic. We climbed into bed completely exhaustedaround 10 p.m., with the alarm clock awakening us at 6 a.m.to start the whole process over again.

Our biggest scares came when a full-term young motherhad contractions and an older woman had an apparent my-ocardial ischemic event. Both were quickly sent by taxi to thenearest medical center. Diabetic ulcers, worms, swallowedcoins, and abscessed insect bites rounded out the unusual as-pect of general conditions requiring treatment. In addition tothe medical unit, our team also consisted of dental care, oph-thalmologic services, an evangelical group, and our construc-tion crew. Teeth were pulled, glasses fitted, souls were saved,and we even had time to build a house for a lucky family.

I have come away from this experience a better personwith great appreciation for our homeland as well as for theresilient spirit of the less fortunate people of the DominicanRepublic. My clinical background as a respiratory therapisthas enabled me not only to contribute my skills but also toserve my fellow humans with the dignity and respect theydeserve, no matter what their socioeconomic background is.I hope to return again to make a difference along with myfellow practitioners on a medical mission trip. ■

Scott N. Simms, BHA, RRT, worksin the pulmonary rehabilitationdepartment at Palmetto HealthRichland in Columbia, SC. He isthe immediate past presidentof the South Carolina Societyfor Respiratory Care.

Invacare donatesequipment throughThe Peace Project

Invacare Corporationis donating equipmentand parts to The PeaceProject to support theirOperation Rise initiative.The program started onWorld Peace Day lastSeptember with thepresentation of crutchesand mobility devices tomore than 10,000 peo-ple in Sierra Leone whohad lost limbs to war orpolio. “At the core of In-vacare is our belief inthe importance of hav-ing the means to live lifeto the fullest,” says CarlWill, senior vice presi-dent, global commercialoperations at Invacare.“We are proud to assistThe Peace Project withOperation Rise and tohelp those suffering dueto war and disease re-gain their access andmobility.”

BI IPF drug performswell in study

Boehringer Ingel-heim’s investigationaltyrosine kinase inhibitorBIBF 1120 demonstrat-ed a positive trend in re-ducing lung functiondecline in patients withidiopathic pulmonary fi-brosis, according to aPhase II clinical trial pub-lished in the New

England Journal of Medicine. Resultsshowed patients treatedwith 150 mg of BIBF1120 twice dailydemonstrated a 68% re-duction in the rate ofFVC decline comparedto placebo. They alsohad a lower incidenceof acute exacerbations.A small decrease in qual-ity of life impairmentwas also seen.

Swiss air rescueservice choosesHamilton ventilator

Switzerland-basedRega has become thefirst air rescue service inthe world to equip theirfleet of air ambulanceswith Hamilton Medical’snew advanced mobileintensive care ventilator,the HAMILTON-T1. Thedecision to partner withHamilton Medical wasbased on the ability ofthe HAMILTON-T1 to de-liver an ICU ventilationsolution in a trans-portable platform that’s

appropriate for all pa-tients.

Pulmatrix presentspreclinical data atERS

Data from two pre-clinical studies of its in-haled clinical drugcandidate, PUR118,were presented at theEuropean RespiratorySociety Annual Congressheld in Amsterdam lastSeptember, accordingto Pulmatrix. The oraland poster presenta-tions highlighted thepotential of PUR118 asan effective treatmentfor acute exacerbationsof the lung associatedwith COPD, asthma, cys-tic fibrosis, and seriousrespiratory infections.PUR118 is currently inPhase 1b human clinicaltrials for COPD.

AHRQ promotespatient-cliniciancommunication

The Agency forHealthcare Researchand Quality haslaunched an initiativewith the Ad Council toencourage cliniciansand patients to engagein effective communica-tion to ensure safer careand better health out-comes. The initiativefeatures new publicservice ads with the

message that a simplequestion/answer can re-veal as much importantinformation as a med-ical test. “We know thatwhen patients and clini-cians communicatewell, care is better. Butin today’s fast-pacedhealth care system,good communicationisn’t always the norm,”says AHRQ Director Carolyn M. Clancy, MD.“This campaign remindsus all that effectivecommunication be-tween patients and theirhealth care team is im-portant and that it ispossible — even whentime is limited.”

United States easesthe way for startupcompanies

President BarackObama recently an-nounced an initiativedesigned to help start-up companies bringnew medical productsto market. The effortwill, in part, reduceboth the cost and pa-perwork requirementsfor startup companiesto obtain an exclusiveoption agreement to license the extensivepatents and patent ap-plications from the in-tramural researchlaboratories at both theNIH and the FDA and is


Industry Watch

part of the president’sStartup America Initia-tive.

CornerstoneTherapeuticsappoints newpresident

Cornerstone Thera-peutics Inc. has ap-pointed KennethMcBean as president.McBean will report di-rectly to Craig Collard,who will continue tolead Cornerstone as itschairman and CEO.“Ken’s experience inspecialty markets, andhis proven track record,will enhance our abilityto grow our core prod-ucts and to acquire andcommercialize newproducts as we strive tobecome a leader in therespiratory and hospitalmarkets,” Collardnoted. McBean was pre-viously vice presidentand general manager ofspecialty pharmaceuti-cals at Covidien.

Philips, Aerogencollaborate on NIVdrug delivery system

Royal Philips Electron-ics and Aerogen are collaborating on the de-velopment of the NIVONebulizing System, anew drug delivery sys-tem designed for usewith patients receivingnoninvasive ventilation.The system utilizesPhilips Respironics Neb-ulizing elbows andAF531 mask to deliveraerosol therapy to pa-tients using the Aero-gen nebulizer, which isbased on vibratingmesh plate technology.

The NIVO product is thefirst customized nebu-lizer enabling targeteddrug delivery throughan NIV system.

Johns Hopkins tocoordinatepneumonia study

A new study beingcoordinated by the In-ternational Vaccine Ac-cess Center at the JohnsHopkins BloombergSchool of Public Healthwill systematically lookat current and likely future causes of child-hood pneumonia insome of the world’shardest hit populations.The Pneumonia EtiologyResearch for ChildHealth study, or PERCH,is a collaboration be-tween five African andtwo Asian research sitesand aims to enroll morethan 12,000 children inseven different coun-tries. As such, it will be the largest, multi-country study of its kindin over 20 years. Thestudy is being fundedby a grant from the Bill& Melinda Gates Foun-dation.

Smoke-freeworkplace initiativebegins

Mayo Clinic, Ameri-can Cancer Society,Global Business Coali-tion on Health, Johnson& Johnson, Campaignfor Tobacco-Free Kids,and the Department ofHealth & Human Servic-es are joining forces todevelop a GlobalSmoke-Free WorksiteChallenge to expandthe number of employ-

ees across all sectorswho are able to work ina smoke-free environ-ment. The partnershipis comprised of privatesector companies, non-governmental organiza-tions, and governmentsthat are committed tomaking their own work-sites 100% smoke-freeand helping other com-panies and organiza-tions do the same.

Theratechnologieslaunches Phase IIstudy of tesamorelin

TheratechnologiesInc. has initiated the pa-tient screening processof its multi-center, dou-ble-blind, randomized,placebo-controlledPhase II clinical trial in-vestigating tesamorelinfor the treatment ofmuscle wasting in pa-tients suffering fromCOPD. The study will examine the safety andefficacy of a daily ad-ministration of either a2 mg or 3 mg dose of anew formulation oftesamorelin for a periodof 26 weeks. The pri-mary endpoint is an in-crease in lean bodymass as measured bydual-emission x-ray ab-sorptiometry. The studywill also assess the ef-fect of tesamorelin onpatient functionalityand quality of life.

Oculus InnovativeSciences acquiresrights to ETT

Oculus Innovative Sciences Inc. has li-censed the exclusiveglobal rights to aunique endotracheal

tube from the NationalInstitutes of Health.

The patented ETTrepresents a potentialbreakthrough technolo-gy in mitigating ventila-tor-associatedpneumonia by uniquelyintegrating an endotra-cheal tube cuff to sealthe airway with a sys-tem that provides forcontinuous aspiration ofsubglottic secretions,along with a secondarylumen that continuallyintroduces a liquidcleansing formulation,according to the com-pany. “This is a perfectexample of growing theuse of our MicrocynTechnology via tech-nologies that are notonly compatible but aresignificantly improvedas a result of this inte-gration,” says HojiAlimi, founder and CEOof Oculus.

Brief submissions and

photos for this column

may be sent to Marsha

Cathcart, AARC Times

editor, at cathcart@

aarc.org. ■

Industry Watch

AARC Tımes December 2011 43

Featuring information on products and equipment from manufacturers

Marketplace

Special Advertising Section

Multi-functionVentilator

CareFusion’s new EnVe™multi-function ventilator fea-tures a revolutionary Activcoregas delivery system comprisedof a “Roots Blower” adaptedfrom the design of the supercharger in a high-performancerace car. The extremely tighttolerance in the blower’s inter-meshing impellers allows thedelivery of high pressures athigh flows. The EnVe is ex-pected to revolutionize venti-lation in its ability to delivercritical care ventilation per-formance in a physical pack-age that can truly goanywhere — including trans-port inside and outside thehospital. www.carefusion.com

Press releases and photos on new products are welcome. Send toMarsha Cathcart, AARC Times editor, at cathcart @aarc.org.

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Request for Lecture Proposals for AARC Congress 2012

The AARC invites you to submit proposals for individual lectures or sym-posia at AARC Congress 2012 and also to submit abstracts from originalstudies for presentation during its OPEN FORUM.

Individuals, groups, institutions, or companies may submit proposalswith interest in the practice of cardiorespiratory care. This is your opportu-nity to present educational content to your peers. If you believe you’re acontent expert or possess unique knowledge in adult acute care, manage-ment, neonatal/pediatrics, home care, sleep, education, continuingcare/long-term care, diagnostics, surface/air transport, or any other aspectof respiratory care, then this is your opportunity to showcase your knowl-edge on a national stage.

The deadline to submit proposals for lectures/symposia for presentationat AARC Congress 2012, Nov. 10–13, in New Orleans, LA, is Dec. 14 athttp://aarc2012.abstractcentral.com/.

Considered by many to be the premier event at the AARC Congress, theOPEN FORUM is your opportunity to gain national and international recogni-tion for your research in cardiorespiratory care by submitting an original ab-stract for presentation at the Congress and having it published in RESPIRATORY

CARE. The deadline to submit abstracts for the OPEN FORUM is June 1, 2012. ■

AARC Election Results Announced

AARC President Karen Stewart, MSc,RRT, FAARC, recently announced the resultsof this year’s AARC elections. The president-elect is George Gaebler, MSEd, RRT, FAARC;and the two incoming directors-at-largeare Lynda Goodfellow, EdD, RRT, FAARC;and Doug McIntyre, MS, RRT, FAARC.

They will be joining these officers anddirectors: Susan Rinaldo-Gallo, MEd, RRT,FAARC (vice president of internal affairs);Linda Van Scoder, EdD, RRT, FAARC (secre-tary-treasurer); Timothy Myers, BSRT, RRT-NPS (past president); Bill Cohagan, BA,RRT, FAARC (Management Section); JoeSorbello, MSEd, RRT (Education Section);Keith Lamb, RRT (Adult Acute Care Sec-tion); Mike Runge, BS, RRT, FAARC (SleepSection); Greg Spratt, CRT, CPFT (HomeCare Section); Cynthia White, BA, RRT-NPS, FAARC (Neonatal Section); and at-large directors Fred Hill, MA, RRT-NPS;Denise Johnson, MA, RRT; CamdenMcLaughlin, BS, RRT, FAARC; and Frank Salvatore, MBA, RRT, FAARC.

Three AARC specialty sections alsoheld elections for their leaders: Continu-ing Care/Rehabilitation Section, GerilynnConnors, BS, RRT, FAARC; Long-Term CareSection, Lorraine Bertuola, BA, RRT; andSurface and Air Transport Section, Billy L.Hutchison, BA, RRT-NPS. ■

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RC CurrentsIN THE NEWS

COPD Readmissions Impacted by Comorbidities, Disparities

The federal government’s new Hospital Readmissions Reduction Pro-gram will eventually result in lower payments for hospitals with higherthan expected readmission rates for certain chronic conditions. New statis-tics from the Agency for Healthcare Research and Quality show why COPDis likely to be named as one of those conditions — and how comorbiditiesand health care disparities figure into the mix. According to data collectedon patients who were hospitalized for COPD in 15 states during 2008:

• About 7% of patients were readmitted within 30 days principally forCOPD, but 21% were readmitted for any health condition.

• There were 190,700 initial hospital admissions specifically to treat COPDat an average cost of $7,100. The average readmission cost principally forCOPD was 18% higher, at $8,400 per stay. However, all-cause readmis-sions were about 50% more expensive than the initial stay, at $11,100.

• Readmissions were 22% higher among patients from the poorest com-munities than among those from the highest income areas.

• Readmissions were about 13% higher among male patients comparedto females.

• Readmissions within 30 days were 30% higher among blacks than His-panics or Asians and Pacific Islanders, and about 9% higher thanamong whites. ■

George Gaebler, MSEd, RRT, FAARC


RC Currents

Strange But True…Water with Milk: Canadian researchers at McMaster University findmilk is better at rehydrating youngsters who have engaged in physicalactivity than water or the typical sports drinks offered to kids duringathletic events.

Slimming Spuds? According to Pennsylvania researchers from the Uni-versity of Scranton, overweight and obese people with high bloodpressure who ate three servings of potatoes a day ended up with a re-duction in blood pressure similar to that seen with the consumptionof oatmeal, and without gaining weight. One caveat though: Thesepotatoes were cooked without oil in a microwave oven and served aunatural (i.e., no butter, catsup, or sour cream).

Rosy Glow: British scientists have developed a surgical gel that notonly kills 80% of bacteria when applied to a wound but also glows pinkunder ultraviolet light to reveal exactly where infections are located.

Going Bananas: A study conducted byBritish researchers at Imperial College ofLondon among 2,640 children betweenthe ages of five and 10 found those whoate bananas were 34% less likely to en-counter breathing problems like wheezing.Drinking apple juice resulted in a 47% reduction.

Practice What You Preach: Health care professionals don’t seem to befollowing their own advice about the value of primary care. Accordingto a new Thomson Reuters survey, hospital employees use 8.6% morehospital care for the treatment of chronic conditions than other peo-ple and visit the emergency department 22% more often. Conversely,they’re significantly less likely to visit their physicians for care or betreated in an ambulatory care setting.

Nowhere To Hide: The Chronic Collaborative Care Network is currentlydesigning a device that could be attached to a smart phone to tracktexts and phone calls about health issues. The network believes thesystem could be especially beneficial in helping teens keep on trackwith care plans for conditions like Crohn’s disease. ■

Respiratory Care Education Annual Call for Papers

The AARC will publish Vol-ume 21 of the RespiratoryCare Education Annual in thesummer of 2012. This refer-eed journal is committed toproviding a forum for researchand theory in respiratory careeducation and is listed in the“Cumulative Index to Nursingand Allied Health Literature.”

The AARC Education Sec-tion invites educators to submitpapers for consideration. Preference will be givento papers that emphasize original research, ap-plied research, or evaluation of an educationalmethod. Other topics that may be considered in-clude interpretive reviews of literature, educa-tional case studies, and point-of-view essays.Submissions will be reviewed based on originality,significance and contribution, soundness of schol-arship (design, instrumentation, data analysis),generalizability to the education community, andoverall quality of the paper. Papers should be ap-proximately 6–10 pages in length and must followthe guidelines in the “Uniform Requirements forManuscripts Submitted to Biomedical Journals,”5th edition (1997). These may be found atwww.rcjournal.com/guidelines_for_authors/preparing_the_manuscript.cfm. Abstracts shouldnot exceed 250 words. For more information,contact Dennis Wissing, PhD, RRT, FAARC, editor,at [email protected] or (318) 573-9788. Elec-tronic copies of completed manuscripts should besent to Bill Dubbs at [email protected]. The dead-line is Feb. 29, 2012. ■

The 2012 AARC Summer Forum, scheduled for July 13–15 inSanta Fe, NM, offers an excellent opportunity for participants toshare their scholarly activities with education colleagues througha research abstract. The submission deadline is March 15, 2012.For more information, log on to www.aarc.org/resources/summer_forum/index.asp. To request a mentor, volunteer as amentor, or for questions about the education research abstracts,contact: [email protected], (508) 922-2996. ■

Education Section Calling for Abstracts for Santa Fe, NM, Summer Meetings

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RC Currents

The DRIVE4COPD campaign has been raising aware-ness of COPD for over a year, and the AARC has been onboard every step of the way. Last October, AARC COOand Associate Executive Director Thomas Kallstrom,MBA, RRT, FAARC, continued the mission by addressinga “VIP” crowd gathered for the unveiling of 24M: TheDRIVE4COPD Monument at the State Fair of Texas inDallas. He also introduced the monument’s sculptor,renowned international artist Michael Kalish, to the audience.

“Since February 2010, AARC has been a part ofDRIVE4COPD, working to raise awareness of chronic ob-structive pulmonary disease,” said Kallstrom. “Michael ishelping expand DRIVE4COPD into a new area by raisingawareness through his art.”

The title of the piece, 24M: The DRIVE4COPD Monu-ment, suggests it is intended to represent the 24 mil-lion Americans thought to be suffering from COPD, halfof whom are currently undiagnosed. At the unveiling,AARC Times talked with Kalish about the monumentand how he got involved in the DRIVE4COPD campaign.

“I knew nothing about COPD a year and a half ago,”he explained. “Then, when I first starting hearing the stats that24 million people may be affected, it really stopped me in mytracks. How could it be that I didn’t know about this, and myfriends and my family don’t know about it? So, I thought, ‘Howcan I put a face to that?’”

Kalish’s works of art have been featured everywhere fromthe New York Times to Sports Illustrated and hang in the homes

of musicians, world leaders, actors, and professional athletes.He says he spent an entire year on the project, which borrowsfrom his signature use of license plates to create art. He cameup with the large-scale pinwheel design because the icon ofthe DRIVE4COPD awareness campaign is the pinwheel.

“This is a great icon that symbolizes breath,” Kalish said.“Sometimes the most beautiful things in art are the simplest. I

wanted to take it and blow it up, then start wrappinglicense plates, my medium, on top of it.”

Each of the 24 pinwheels in the design consists of2,400 license plates, with the number of plates usedfrom each state reflecting the percentage of thatstate’s population thought to have COPD. Whenviewed from the air, the entire creation forms themap of the United States. “DRIVE4COPD ambassa-dors Patty Loveless and Danica Patrick dedicated li-cense plates to 24M in honor of loved ones they lostto COPD,” noted the sculptor. “I spent quite a bit oftime with Danica talking about it.”

The monument debuted in New York City in Sep-tember, then made its way to Dallas for its secondouting. “You know, I think I like being here, walkingthrough it, showing it to people, and explaining it justas much as I liked creating it,” Kalish said. “To be outin a public art space like this and interact with peoplewhom this is very meaningful to, is really nice.”

At the monument events throughout the country,volunteers are ready to explain the purpose of the ex-hibit, educate people about COPD, and ask them to

DRIVE4COPD’s 24M Monument Drives Home the COPD Message

Renowned international artist Michael Kalish (pictured) says he likeswalking through the monument, showing it to people, and explainingits meaning to the public.

24M: The DRIVE4COPD Monument was recently set up in Dallasjust outside the Cotton Bowl during the State Fair of Texas.


RC Currents

Transitions

Lynda T. Goodfellow, EdD, RRT,FAARC, has been named associatedean for academic affairs at thenewly created, standalone ByrdineF. Lewis School of Nursing andHealth Professions at Georgia StateUniversity in Atlanta. Previously, theByrdine F. Lewis School of Nursingand the School of Health Profes-sions were housed as separate entities within the College of Health and Human Sciences. (Photo 1)

Braden W. Eves, RRT, RPFT, died in September. Eveswas most recently the COPD coordinator for the FortDrum Regional Health Planning Organization in NewYork and had a long history of involvement with theNew York State Society for Respiratory Care (NYSSRC),where he served as president of the CNY Chapterfrom1996–1998 and as a member of the NYSSRCboard of directors during the same time period. Eveshad been a prominent member of the respiratory carecommunity in the North Country of New York Statefor decades, serving in both acute care and homecare settings. He is survived by his wife, Judy Hunter-Eves, CRT, also a longtime AARC member and RT direc-tor at the River Hospital in Alexandria Bay.

Mitchella Ann Eickholt, RRT, passed away in Septem-ber. She was an RT at Memorial Healthcare of Owossoin Owosso, MI, and is remembered fondly by her col-leagues there.

We welcome news about AARC members. Submitjob changes, awards, and death notices online atwww.AARC.org/transitions. ■

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1

Read the Rest of the Story at AARC.org

• HME industry asks CMS to revise ABN policyfor CPAP — www.aarc.org/headlines/11/10/abn_policy.cfm

• AARC pledges to improve patient safety —www.aarc.org/headlines/11/10/patient_safety.cfm

• Respiratory therapists weigh in on clinicalalarms — www.aarc.org/headlines/11/10/alarms.cfm

take the campaign’s five-question population screener to see if they are at risk for the condition. “People are walking up,touching it, and asking why there are these giant pinwheelswith license plates everywhere. It’s like peeling an onion, thereare a lot of layers to it,” said Kalish. “When they come over, weexplain COPD and have them take the screener. That’s what it’sall about.” People can also take the screener atDRIVE4COPD.com.

When asked if he had a special message for respiratory ther-apists about the DRIVE campaign, he said, “Keep educatingpeople on what COPD is. It’s chronic bronchitis and emphy-sema, and it’s a widespread breathing disorder.”

Michael Kalish says he’s been amazed at how the monu-ment has gotten the conversation about COPD going, andthat’s been true not just at the exhibitions but in his own life aswell. “When we unveiled 24M in New York, collectors andfriends I’ve known for 25 years came up to me and said, ‘This isamazing. You know, I have COPD,’” he said. “And I didn’t know,I didn’t know anything about it. People are just quiet about thiskind of thing and are not going to talk about it. It’s become really personal to me that way.”

When the monument left Texas it was slated to travel toFlorida and California as well — two more states that, alongwith New York and Texas, have the highest prevalence of COPDin the United States. “To have something modular like this inthe campaign that we can set up in different cities around thecountry is so cool,” said Kalish. “It takes on different meaning ineach environment.”

The sculptor’s hope is that people who see the monumentwill go home and tell their friends and family about it, encour-age them to take the screener, and eventually the pinwheelwill become a symbol for COPD that everyone will readily rec-ognize. “If I can help people lead a better life — my art can en-able that — that’s really cool,” he said. “So, I feel very lucky tobe a part of this.”

To see a video of Michael Kalish creating the 24M Monu-ment, log on to www.drive4copd.com/missing-millions/24m.aspx and click on “Watch a Video.” ■

CBS News/Dallas interviews AARC COO TomKallstrom at the State Fair of Texas.

In the following interview, Tri-animPresident Stephen Lacke fills us in on hiscompany and how he sees the futureunfolding.

AARC Times: How long has your com-pany been in business, and what serv-ices do you provide?

Lacke: Tri-anim Health Services, Inc, hasbeen servicing our hospital customersin the respiratory, NICU, PICU, criticalcare, emergency, and anesthesia de-partments for over 30 years. We are aspecialty sales, marketing, and distribu-tion company focused on representingtechnology that addresses a full rangeof patients requiring medication deliv-ery, oxygen therapy, and noninvasiveventilation (NIV). Members of our con-sultative sales force typically have over15 years of experience servicing respi-ratory, and more than two-thirds areformer respiratory therapists. We repre-sent a full range of products from mar-ket-leading companies like Philips,Smiths Medical, Vapotherm, MonaghanMedical, and Aerogen, as well asemerging companies like ACSI,SouthMedic, Ventlab, Precision Medical,B&B Medical, Maxtec, Nonin, Flexicare,and Salter Labs.

We treat babies in the NICU throughadults in critical care who need supporton various forms of medication delivery,oxygen therapy, CPAP, NIV, and ventila-

Tri-anim PresidentStephen Lacke

Industry Profile: Tri-anim

Health Services, Inc.

AARC Times: How do your products im-prove patient care, and how does thisimpact the respiratory therapist?

Lacke: Tri-anim is fortunate to repre-sent a full portfolio of products thathave a positive impact on patient careand respiratory therapist success. Asan example, we help to reduce patientlength of stay in the NICU and adultICU with Philip’s NIV therapy andVapotherm’s high-flow therapy, whichfacilitate the successful weaning of pa-tients from ventilators, prevent pa-tients from being placed onventilators, and help to arrest acuterespiratory conditions. These technolo-gies also help to reduce the risk ofventilator-associated pneumonia be-cause patients who receive themavoid longer stays on the ventilator.

Our medication delivery technolo-gies from Monaghan Medical andAerogen reduce treatment times andallow for a much higher drug deposi-tion to improve outcomes while avoid-ing RT exposure to secondarymedication aerosol. These technolo-

tion. We provide the CEU training, in-servicing, sales support, dedicated cus-tomer service, and distribution for over200 manufacturers.

AARC Times: What projects or new fea-tures are you working on for the future?

Lacke: We collaborate with most of oursupplier partners, along with members ofthe RC customer community, on their fu-ture product development initiatives inthe areas of medication delivery, oxygentherapy, ventilation technologies, and pa-tient interfaces. Tri-anim Health Servicesis in a unique position to attract and rep-resent the full continuum of productstreating respiratory patients, from mod-est support through critical life-savingsupport. Tri-anim works with respiratorytherapists and leading manufacturers,along with our clinical sales and market-ing organization, to form a perfect three-way partnership to bring new technologyto market. We then provide the criticaltraining to ensure the product and proto-cols deliver on the therapy the patientsrequire.

RC Currents


Common Antibiotic May Reduce COPD Exacerbations

University of Alabama at Birminghamresearchers who compared 570 COPD patients who received the antibioticazithromycin daily for a year in addition totheir usual care with 572 COPD patientswho received usual care withoutazithromycin find significantly fewer acuteCOPD exacerbations in those who tookthe antibiotic, 1.48 over the 12-month pe-riod versus 1.83. “Exacerbations accountfor a significant part of the COPD healthburden,” study author Mark T. Dransfield, MD, was quoted as saying. “Thesepromising results with azithromycin may help us reduce that burden and im-prove the lives of patients at risk of these acute attacks.” The research ap-peared in the Aug. 25 edition of the New England Journal of Medicine. ■

COPD: Ultimate Destination for One in Four

The federal government’s latest ranking of the most common causes ofdeath boosts COPD from the No. 4 position to No. 3. Now Canadian re-searchers find many more people are likely to develop COPD over the courseof their lifetimes than previously thought as well.

According to the investigators, who looked at health data on 13 millionpeople age 35–80, one out of every four people is likely to develop the condi-tion. To put it in perspective, the average 35-year-old woman has more thantriple the risk of ending up with COPD as breast cancer. The average 35-year-old man is over three times as likely to develop the chronic lung condition asprostate cancer.

The report was published in a recent issue of The Lancet. ■

RC Currents


gies also help avoid recidivism and re-intubation rates. Tri-anim has manymore technologies that impact care inthe NICU, PICU, emergency, and anes-thesia departments as well.

AARC Times: How has having respira-tory therapists on staff impacted yourproduct line?

Lacke: Their clinical knowledge and patient insights are extremely valuablein servicing our customers with a con-sultative approach and in working withour manufacturers to best communi-cate and train our customers on theirclinical technology. Finally, partneringwith respiratory therapists on newproduct innovation has yielded ad-vanced products with better function-ality to meet the ever-changingpatient requirements.

AARC Times: How do you expect theeconomy and health care reform to affect how you develop new respira-tory care technology over the next twoyears?

Lacke: There clearly will be pressure onthe amount of investment for futuretechnology. We need to ensure we col-laborate with the RT community andthe AARC on clinical and cost-effectivejustification of advanced technology.We need not only to address the clini-cal effectiveness of the technology buthow our technology improves out-comes and total patient costs.

AARC Times: Where do you see the res-piratory device industry heading?

Lacke: We continue to believe the res-piratory device industry will be asteady growth area in health care. Theaging population and chronic diseasessuch as COPD and asthma, along withcomorbidities like diabetes and vascu-lar and heart disease, will require tech-nology and highly trained respiratorytherapists to meet the challenge. Wecan do this together! ■

“Go Orange”

In answer to the CDC’s call to increase publicawareness of COPD, the U.S. COPD Coalition(USCC) recently announced their resolution to“Go Orange” for COPD Awareness. It was un-veiled at a congressional briefing by John W.Walsh, vice chairman of the USCC and presidentand co-founder of the COPD Foundation on Capi-tol Hill.

Speakers included Sen. Mike Crapo, senateco-chair of the Congressional COPD Caucus;James P. Kiley, PhD, director of the NHLBI’s Divi-sion of Lung Disease; James D. Crapo, MD, pul-monologist and professor of medicine atNational Jewish Health and the University ofColorado, Denver; and Danica Patrick, aDRIVE4COPD celebrity ambassador. ■


RC Currents

Interservice

RT Program

Graduates

First Classby Harry Román, MA, RRT

Graduates of the new Army andNavy RT program pose for a classpicture.

The first graduation of the Interser-vice Respiratory Therapy Program (IRTP)took place last July at the Medical Edu-cation & Training Campus at Fort SamHouston in San Antonio, TX. Twenty-twoArmy and Navy graduates received anassociate’s degree in applied science inrespiratory care from Thomas EdisonState College, becoming the first en-listed military personnel to receive a de-gree upon completion of training.

The IRTP grew out of the 68VMOS/8541NEC Respiratory Specialist Course,which was established in 1975. The newprogram was developed in response tochanging accreditation requirements, aswell as the evolving role of the RT spurredby advances in technology and increasedresponsibilities. The IRTP, which has re-ceived a “Letter of Review” by the Com-mission on Accreditation for RespiratoryCare, received the designation of advanced-level respiratory therapy pro-gram in July of 2010, entitling its gradu-ates to challenge the national registryexam for respiratory therapy.

Our top priority is to provide the verybest respiratory care training possible tomen and women of the Army and Navybecause we understand all too well theimportance of their duties and responsi-bilities once they graduate from ourprogram. To this end, we have sparedno expense in acquiring state-of-the-artequipment and facilities.

Our lab consists of eight ICU rooms,each equipped with computerized high-fidelity patient simulators, piped-in air,oxygen and suction, numerous ventila-

tors of various makes, EKG machines, non-invasive bi-level positive pressure ma-chines, and everything else that an RTmight want or need in an ICU. We have aNICU with radiant warmers, conventionaland high-frequency ventilators, and NCPAPunits, as well as a variety of oxygen admin-istration devices. We also have two com-plete pulmonary function labs with bodyboxes and numerous portable PFT units.

Our first class of graduates endured arigorous curriculum that included 320hours of general education classes taughtby faculty from Thomas Edison State Col-lege, 160 hours of basic medical educa-tion, and 640 hours of intense respiratoryanatomy and physiology, medical gas ther-apy, airway management, pulmonary func-tion studies, mechanical ventilation, andpulmonary pathophysiology. From there,they were immersed in the clinical settingat Brooke Army Medical Center for another16 weeks, performing respiratory therapyprocedures in the adult and neonatal ICUs,medical and surgical wards, pulmonaryfunction laboratory, and burn unit.

At the end of their clinical phase, stu-dents challenged the national certificationexam and earned the Certified RespiratoryTherapist credential, making them immedi-ately able to sit for the Registered Respira-tory Therapist credential as well.

As I noted earlier, the Army and Navyrespiratory therapy program has been

around since 1975. Students admittedinto the program come from back-grounds as wide and as varied as the lo-cations in which they will serve orreturn to once their training ends andtheir careers begin. Army students are amix of active duty and reservists, whileall of the Navy students are active duty.

Upon graduation, all of the activeduty soldiers and sailors are immedi-ately assigned to duty stations aroundthe world, from Washington State toWashington DC, from Hawaii to Guam,from Germany to Spain, and manyplaces in between. While many re-servists return to their home states, agood number of them have deployedwith their units to Iraq andAfghanistan in support of the globalwar on terror. There, they have servedadmirably as RTs, saving lives and car-ing for the wounded under the mostdifficult conditions imaginable. Whenthey go back to work at their home-town hospitals, code blues and statABGs don’t faze them anymore.

Our graduates have represented uswell throughout the years. Now,through the establishment of the IRTP,we have renewed our commitment toour soldiers and sailors by acceptingthe challenges of new accreditingstandards and increased professional-ism and responsibilities. One need onlyobserve the graduates of our first classto know that the reputation of theprogram is in safe hands. ■

Harry Román is the program director of the Interservice Respiratory Therapy Program at Ft.Sam Houston in San Antonio, TX.


Michael R. Anderson, MD, FAAPLorraine Bertuola, BA, RRTSuzanne Bollig, BHS, RRT, RPSGTRichard Branson, MSc, RRT, FAARCEileen Censullo, MBA, RRTRobert L. Chatburn, MHHS, RRT-NPS, FAARCKent L. Christopher, MD, RRT, FAARCDarnetta Clinkscale, MBA, RRTJeffrey Davis, BS, RRTKathleen Deakins, RRT-NPS, FAARCRobert M. DiBlasi, RRT-NPS, FAARCAshley Dulle, BS, RRT, AE-CPatrick Dunne, MEd, RRT, FAARCGerald Ebert, BS, RRT-NPS, CPFTMark Eley, MS, RRT-NPS, RPFTKatherine Fedor, RRT-NPSRay J. Frausto, RRT-NPS William F. Galvin, MSEd, RRT, FAARCGene Gantt, RRTMichael A. Gentile, RRT, FAARCJames Ginda, MA, RRT, AE-CMelaine (Tudy) Giordano, MS, RN, CPFT Karen Gregory, MS, RRT, AE-CLee Guion, MA, RRTMary K. Hart MS, RRT, FAARCWade Jones, RRT, FAARCRichard Kallet, MS, RRT, FAARCGarry Kauffman, MPA, RRT, FAARCLouis M. Kaufman, BS, RRT-NPS, FAARCLucy Kester, RRT, FAARC Felix Khusid, BS, RRT-NPS, RPFTDebbie Koehl, MS, RRT, AE-CDouglas S. Laher, MBA, RRT

Emily Lee, MEdTrina Limberg, BS, RRT, FAARCDavid A. Lucas, MS, RRT-NPS, AE-CBob McCoy, BS, RRT, FAARCRory Mullin, BS, RRTTimothy R. Myers, BS, RRT-NPSNatalie Napolitano, MPH, RRT-NPS, AE-CMichael Nibert, BSRT, RRTTimothy Op't Holt, EdD, RRT, FAARCDoug Orens, MBA, RRTDaniel Pavlik, MEd, RRTDavid J. Pierson MD, FAARCWilliam Pruitt, MBA, RRT, CPFTDiane Rhodes BBA, RRT, AE-CVlady Rozenbaum, PhDJohn W. Salyer, MBA, RRT, FAARC Frank Sandusky, HCMBA, RRTRoger Seheult, MDPaul Selecky, MD FAARCRichard Sheldon, MD, FAARCSteven Sittig, RRT-NPS, FAARCThomas Smalling, PhD, RRT, FAARCKarla Smith, BS, RRT, RPSGTHelen M. Sorenson, MA, RRT, FAARCGreg Spratt, BS, RRT, CPFTAntonio (Tony) Stigall, MBA, RRT, RPSGTJames Stoller, MD, FAARCCharlie Strange, MDSheri Tooley, BSRT, RRT-NPS, CPFTRhonda Vosmus, RRT-NPS, AE-CBrian Walsh, MBA, RRT-NPS, FAARCJonathan B. Waugh, PhD, RRT, FAARCCyndi C. White, BA, RRT-NPS, FAARC

Thank You, 2011AARC TimesArticle Reviewers

The AARC Times staff offers ourheartfelt thanks to the people who reviewed

the clinical articles in our publicationthroughout this year. We couldn’t have done it

without you. Your special expertise anddedication to the respiratory care profession

were critical to our ability to publishinformative clinical articles for the respiratory

care professional. Thank you, reviewers!

New Members

Welcome to the AARC

These individuals have been approved for membership in the AARC. Any member may object to a newmembership by filing a written objection with the Executive Office within 30 days. *Active Members


Iannetta, George, Anchorage, Ak*

Adamson, Catlin, Birmingham, AlAmbrose, William, Cottondale, Al*Baxter, Janise, Birmingham, AlBrand, Katie, Birmingham, AlButler, Shea, Birmingham, AlBuze, Addie, Columbia, Al*Cane, Gwendolyn, Birmingham, AlChapuis, Stephanie, Mobile, Al*Clements, Connie, Southside, Al*Clements, Lesley, Eufaula, Al*Coleman, Gamara, Birmingham, AlCoosaboon, Heather, Birmingham, AlDavis, Mishawn, Birmingham, AlFlood, Cheyenne, Birmingham, AlFoster, Danielle, Birmingham, AlGoggins, Julia, Birmingham, AlHall, Jessica, Birmingham, AlHall, Ronald, Foley, Al*Hare, Karl, Birmingham, AlHarrison, Caletheia, Birmingham, AlHughes, Krystal, Birmingham, AlHundley, Brittney, Birmingham, AlIwuaba, Chinazor, Birmingham, AlJabour, Austin, Birmingham, AlJones, Brittany, Birmingham, AlLeberte, Sandra, Birmingham, AlLewis, Adrian, Birmigham, AlLooney, Keaura, Birmingham, AlLovell, Kit, Birmingham, AlMaciel, Beatriz, Birmingham, AlMcDaniel, Deborah, Decatur, Al*Nguyen, Tuan, Birmingham, AlOden, Mikayla, Birmingham, AlPennington, Kelsey, Birmingham, AlRenda, Tammy, Birmingham, AlRichardson, Shavonne, Birmingham, AlRylant, Patrick, Birmingham, Al*Sealey, Kimberly, Ralph, Al*Stinson, Melanie, Birmingham, AlStrate, Susan, Harvest, Al*Sullivan, Charryse, Birmingham, AlSwanger, Frances, Gordo, Al*Thomas, Mari, Pelham, Al*Tindal, Rebecca, Greenville, Al*Unlap, Jordan, Birmingham, AlUzoh, Michelle, Birmingham, AlWallace, Roshedah, Birmingham, AlWatson, Caleb, Birmingham, AlWhite, Lashaydra, Birmingham, AlWilson, Pierre, Birmingham, AlWoods, Danielle, Birmingham, AlYeager, Caitlin, Birmingham, Al

Baugh, Julia, Little Rock, Ar*

Betts, Maria, Pea Ridge, ArBright, Shannon, Fayetteville, ArCedillo, Callie, Gurdon, ArGee, Scott, Little Rock, Ar*Gibbs, Amy, Ward, Ar*Grant, Sydney, Glenwood, ArJenkins, Stephanie, Pine Bluff, ArJordan, Jalynn, Bella Vista, Ar*Millican, Fred, Fort Smith, Ar*Morehead, Kevin, Rosston, ArNguyen, Dao, Fayetteville, ArPennick, Rhonda, Hot Springs, Ar*Thao, Linda, Lincoln, Ar

Adams, Hillery, Peoria, AzArellano, Michael, Litchfield Park, Az*Barragan, Kathleen, Goodyear, Az*Bowers, Sheri, Glendale, Az*Brodeur, Skye, Phoenix, AzBurns, Jared, Peoria, AzButler, Tonya, Glendale, AzCantiberos, Jay, Phoenix, Az*Chambers, Kimberly, Phoenix, AzCosa, Tobit, Goodyear, Az*Etgen, Stephanie, Phoenix, AzFadl, Iman, Phoenix, AzGonzalez, Manuela, Chandler, AzGuerrero, Ruth, Tolleson, AzHansen, Justin, Lake Havasu City, Az*Hogan, Michael, Gilbert, AzJohnson, Adam, Prescott, AzJohnson, Herman, Tucson, AzJohnson, Nicole, Prescott, AzKnowles, Roberta, Peoria, AzKuhn, Patrick, Scottsdale, AzLewis, Tara, Yuma, Az*Maier, Deanne, Avondale, AzMartino, Michael, Mesa, AzMason, Laverna, Scottsdale, AzMayhew, Marty, Tucson, AzMyers, Linda, Phoenix, Az*Patterson, Jasmin, Laveen, AzPerez, Catherine, Phoenix, AzPoole, Lashay, Tempe, AzRay, Ashley, Glendale, Az*Reeves, Dawn, Goodyear, AzSanford, Ricky, Avondale, Az*So, Synhep, Glendale, AzStress, Sharline, Tucson, Az*Sydoriak, Kandice, Chandler, AzValdez, Miguel, Flagstaff, Az*Verdugo, Carmen, Phoenix, AzVollin, Marcia, Phoenix, AzWalker, Perry, Scottsdale, AzWorley, Chene, Phoenix, Az

Accibal, Dionie, Daly City, CaAcevedo, Fernando, Chino Hills, CaAguilar, Adolfo, Los Angeles, CaAnderson, Ron, Garden Grove, Ca*

Bagtas, Faye, Daly City, CaBasto, Benjamin, Colma, CaBennett, Robert, San Jose, Ca*Berona, Lizbeth, Temecula, Ca*Blancaflor, Alyson, San Francisco, CaBonilla, Conrad, Alhambra, CaBracamante, Abigail, West Covina, CaBrandt, Michael, Santa Monica, CaBrown, Kandice, Los Angeles, CaBrown, Patricia, Foster City, CaBurger, Elisabeth, Huntington Beach, Ca*Castillo, Nestor, La Puente, CaChan, Kenny, Rosemead, CaChau, Tykea, Los Angeles, CaChung, Raymond, San Francisco, CaCovarrubias, Juana, Lynwood, CaCrail, Jacob, Fullerton, Ca*Cuessi, Sindy, Los Angeles, CaDurr Griffith, Ruby, San Francisco, Ca*Escobar, Donie, San Francisco, CaFagundes Connolly, Alicia, Upland, CaFong, Michael, Lodi, Ca*Fontanilla, Joshua, Chula Vista, Ca*Forbes, Theresa, San Jose, Ca*Gamble, Marion, El Cajon, Ca*Garcia, Elsa, Bell Flower, CaGaude, Samaila, San Pedro, CaGranzow, Brandi, Oceanside, Ca*Green, Tanya, Alameda, CaGuerrero, Adriana, Los Angeles, CaHernandez, Jobana, Rancho Cucamonga, Ca*Hua, Dexter, Alhambra, CaHum, Jason, Rosemead, CaHuynh, Judy, Monterey Park, CaIchihana, Randall, San Rafael, Ca*Jahandary, Mahssa, Reseda, CaJamison, Cory, Placerville, Ca*Juarez, Laura, Victorville, Ca*Kim, Henry, Fullerton, CaKing, Patrick, Modesto, Ca*Kohmann, Kurt, Gardena, CaKuehl, Cassidy, Huntington Beach, CaLa Sangre, Jose, Azusa, Ca*Laborde-Postovit, Elizabeth, Boulder Creek, CaLaino, Roderick, Elk Grove, Ca*Lantos, Frank, Woodland Hills, CaLee, Johnny, Daly City, CaLeonor, Nick, Moss Beach, CaLindsey, Raymond, Vallejo, CaLopez, Enrique, Lancaster, CaLopez, Lety, Whittier, CaLu, Yuan, Norwalk, CaMa, Linda, El Monte, CaMacalino, Kathleen, Daly City, CaMadrigal, Jose, Calexico, Ca*Manal, Altanchimeg, Los Angeles, CaMarquez, Alan, Los Angeles, CaMartija, Ed, Daly City, CaMontes, Sandra, Pasadena, CaMorishige, Richard, Castro Valley, Ca*Morris, Michael, San Pedro, Ca*Nabatilan, Cheryl-Kay, Escondido, Ca*Natividad, Christina, Vallejo, Ca

C

U.S. Members

A


New Members

Ngo, Olivier, San Francisco, CaNgoy, Vue-Hao, Daly City, CaNguyen, Kevin, Garden Grove, CaNouri, Jaleh, Upland, CaOfoche, Innocent, Los Angeles, CaOrfanides, Michael, Los Angeles, CaOrtiz, Gabriela, San Diego, Ca*Pascual, Eliel, Porter Ranch, CaPatton, Hans, Glendale, CaPerez, Freddy, Los Angeles, CaPhillips, Justin, San Francisco, CaPhutsorn, Ruechuda, Downey, Ca*Pinsky, Boris, Campbell, CaReyes, Lisa, Daly City, CaRogers, Rose, Hayward, Ca*Sabugo, Mirabel, San Francisco, CaSerrano, Marlene, La Puente, CaShageryan, Victoria, San Diego, Ca*Solis, Ivette, Adelanto, Ca*Soltero, Yesenia, Downey, CaSoriano, Gerald Pete, Lathrop, CaTallion, Ruth, Half Moon Bay, CaTavasci, Sandra, Pacifica, CaTeng, Weisheng, Temple City, CaThach, Menard, Ontario, CaTorres, Christopher, Los Angeles, CaTransu, Natalie, El Monte, CaTruong, Joseph, Torrence, CaUdeogwu, Ogochukwu, Oakland, CaUnzueta, Fernando, Duarte, Ca*Uong, Patricia, Daly City, CaValerio, Luis, Ontario, Ca*Vega, Cynthia, Huntington Park, CaVo, Nancy, Highland, CaVoung, Linda, San Francisco, CaWood, Heather, La Mesa, Ca*Wu, David, Diamond Bar, CaYip, Vivian, San Francisco, CaYoung, Andrew, San Francisco, CaZewolde, Elias, Los Angeles, CaZhang, Yan, Sacramento, Ca

Aguilera, Jimmy, Pueblo, CoAlfaro, Brandon, Denver, CoAnderson, Delphinia, Pueblo, CoBarajas, Brenda, Colorado Springs, CoBean, Brian, Wheat Ridge, CoBeeler, Lindsey, Lakewood, CoBillman, Jessica, Westminster, CoBjorklund, Camille, Denver, CoBowlin, Christopher, Brighton, Co*Brennan, Peggy, Centennial, Co*Brown, Kermille, Colorado Springs, CoBrown, Tiffany, Littleton, CoBuglewicz, Allison, Pueblo, CoCasados, Tara, Castle Rock, CoCatalano, Kersha, Pueblo West, Co*Click, Heidi, Pueblo, CoCole, Nashunta, Fountain, CoCummins, Linda, Pueblo, CoCurry, Belinda, Colorado Springs, CoDefebio, Anthony, Centennial, CoDeherrera, Yvonne, Pueblo West, CoEngelhaupt, Damon, Denver, CoEvans, Sondra, Durango, CoGonzales, Amanda, Pueblo, CoGonzalez, Sugey, Loveland, CoGreen, Janna, Canon City, CoHarris, Arielle, Firestone, CoHaynes, Holly, Pueblo, CoHerrera, Sarina, Pueblo, CoHowells, Tracey, Pueblo, CoHowes, Heather, Woodland Park, CoJay, Neomi, Durango, CoKerch, Diana, Howard, CoLake, Spencer, Mancos, CoLopez, Pete, Pueblo, Co

Lowery, Bailey, Denver, CoMarosita, Jacob, Pueblo, CoMicciulla, Patricia, Colorado Springs, CoMuniz, Tyrone, Pueblo, CoMyers, Melissa, Pueblo, Co*Ortega, Daniel, Pagosa Springs, CoPendas, Jill, Loveland, Co*Perdaris, Pano, Parker, Co*Ponsor, Tyler, Boulder, CoQuinn, David, Colorado Springs, CoRausch, Dion, Colorado Springs, Co*Ribera, Jolene, Bayfield, CoSafilian, Thomas, Niwot, CoSanders, Nickole, Pueblo, CoShatz, Jill, Denver, CoSimmons, Sean, Denver, CoSt Amand, Colette, Colorado Springs, CoStalnaker, Meredith, Colorado Springs, CoStalzer, William, Aurora, CoVillani, David, Frederick, CoVunovich, Kristin, Pueblo, CoWatkins, Joey, Colorado Springs, CoWilkey, Teren, Pueblo, CoWinkler, Lisa, Loveland, CoZimmerman, Josh, Thronton, Co

Blum, Stacy, Waterbury, CtChichester, David, Torrington, CtCioffi, Jessica, Danbury, CtFaillace, Lisa, Bethel, CtHodges, Yvette, Waterbury, CtHoughtaling, Beth, Brookfield, CtIamiceli, Jennifer, Brookfield, CtJoy, Christaine, Danbury, CtKirei, Alicia, Seymour, CtKniery, Tyler, Southbury, CtLong, Paula, Naugatuck, CtLopez, Leticia, Waterbury, CtMcGorty-Katz, Shawna, East Haven, CtMestek, Brian, Waterbury, CtMurphy, Timothy, New Fairfield, Ct*Nadeau, Rebecca, Prospect, CtNazzaro, Lauren, Danbury, CtPilla, Pasquale, Oakville, CtRene, Patrick, Stamford, Ct*Sanden, Merrill, Ellington, Ct*Stegmaier, Jennifer, Oxford, CtTaylor, Melissa, New Fairfield, Ct

Hart, Karen, Washington, DC*Smith, Jacqueline, Washington, DC*

Jensen, Karen, Millsboro, De*Mollohan, Stacey, Dover, De*Trush, Patricia, Wilmington, De*

Acevedo, Danitza, Tampa, FlAli, Habibah, Kissimmee, Fl*Anderson, Larrel, Pembroke Pines, FlArchibal, Sylvio, West Palm Beach, FlArchilla, Abner, Jupiter, FlBaez, Hansel, Tampa, Fl*Beales, Christopher, Tallahassee, FlBelmo, Javier, Miami, Fl*Breakey, Linda, Tampa, FlBrenner, Scott, Miami, FlBrissett, Lavellie, Orlando, FlBrown, Sharneka, Tallahassee, FlBussey, Dawn, Saint Petersburg, Fl*Butala, Kinjal, Altamonte Springs, FlCarr, Terri, Gulf Breese, Fl*Cherevko, Natalia, Longwood, Fl

Cobbold, Ernest, Tallahassee, FlCox, Carl, Plant City, FlDallas, Tiffany, Pompano Beach, FlDeralus, Sandy, Delray Beach, FlDevuyst, Blanca, West Palm Beach, FlDort, Roselor, West Palm Beach, FlDrewke, Vanessa, Gainesville, Fl*Drigotas, Martin, Naples, FlElliott, Joseph, Tampa, FlEstica, Roges, Lake Worth, FlEzell, Errica, Coconut Creek, FlFerry, Nicolle, Lutz, FlFertil, Cindy, Miami, FlFlateau, Melissa, Brandon, FlFleurgin, Farens, Miami, Fl*Fuller, John, Wellington, FlGarcia, Jackeline, Boynton Beach, FlGill, Tabitha, Largo, FlGonzalez Sanchez, Gina, Riverview, FlGonzalez, Nora, Tampa, FlGordon, Tamieka, West Palm Beach, FlGorman, Donna, Plant City, FlHair, Amanda, Orlando, Fl*Hanson, Vernisa, Palm Beach Gardens, FlHarrison, Jislayne, Tampa, FlHichborn, Chad, Brandon, FlHilaire, Bob, Tampa, FlHodges, Christine, Palm Harbor, Fl*Howard, Jennifer, Boca Raton, FlHoward, Rebecca, Plantation, FlJackson, Kurchelle, Miramar, FlJamison, Ashley, Miami, FlJannat, Abu, North Palm Beach, FlJenkins, Cameron, Tallahassee, FlJimmy, Stevens, Coral Springs, FlJones, Raymond, Wellington, FlJoseph, Noah, Leesburg, Fl*Kastrenakes, Karen, Land O Lakes, Fl*Kelsey, Tiffany, Lake Worth, FlLachman, Mervin, Clearwater, FlLarsen, Kae, Jacksonville, Fl*Leazenby, Mary, Port Charlotte, Fl*Litschauer, Stacey, Jupiter, FlLyman, Iciara, Tallahassee, FlMacharaga, Wilfred, Newberry, Fl*Martinez, Juan, Miami, Fl*Martini, Kathy, Clearwater, Fl*Meikle, Desreen, Boynton Beach, FlMeyer, Mark, Delray Beach, FlMilhomme, Widlune, Tallahassee, FlMills, Charles, Tampa, FlMoore, Cathy, Tampa, Fl*Morales, Maggie, Seminole, FlNicholas, Andrew, Tallahassee, FlNicolas, Yvis, Tallahassee, FlNotman, Sara, Royal Palm Beach, FlOrozco, Ivis, Miami, Fl*Palmer, Alexandria, Pensacola, FlParchment, Bradwell, West Palm Beach, FlPatel, Brijal, Fort Myers, Fl*Pierre, Mahana, Tallahassee, FlProphete, Kehatilde, Jupiter, FlPuerto, Pamela, Lake Worth, FlQuinn, McKinsey, Valrico, FlQuistad, Laureen, Tampa, Fl*Rake, Elizabeth, Tampa, FlReed, Shantel, Daytona Bch, FlReynolds, Sherica, Tallahassee, FlRitzenthaler, Tiana, Lutz, FlRoberts, Kalvin, Miami, FlRubin, Darren, Wesley Chapel, FlSampedro, Rosa, Miami, Fl*Sanchez, Richard, Miramar, Fl*Sanders, Jessica, Gainesville, Fl*Schaffren, Celeste, Sarasota, FlScott, Ramone, Tallahassee, FlSeckley, Lisa, Land O Lakes, Fl

D

F


New Members

Shelton, Jacqueline, Cooper City, FlSisco, Michele, Winter Park, FlSmith, Karen, Tampa, FlSteen, Elizabeth, Navarre, Fl*Succuer, Franklin, Tampa, FlTibby, Mary, St Petersburg, Fl*Tran, Kath, Pinellas Park, FlTurner, Jasmine, Orlando, FlUrbina, Signe, Miami, FlViciere, Vanessa, Palm Beach Gardens, FlWard, Keante, Tallahassee, FlWarhurst, Kelly, Loxahatchee, FlWashington, Camille, Tallahassee, FlWhite, Mary, Fernandina Beach, FlWilliams, Sabrina, Lake Wales, FlWilloughby, Susan, Ocala, Fl*Wilson, Brenda, Land O Lakes, Fl*Wilson, Latecia, Orlando, Fl

Avant, Keith, Lithonia, Ga*Bongiovanni, Russ, Marietta, Ga*Bush, Cassandra, Hephzibah, Ga*Conklin, Steven, Acworth, Ga*Crumley, Kathy, Rossville, Ga*Davis, Davetta, Fort Valley, Ga*Fraiz, Fabian, Buford, Ga*Green, Michelle, Ellenwood, Ga*Hastings, Bill, Woodstock, Ga*Hill, Aurora, Roswell, GaHooks, Rodney, Waycross, GaJames, Cornell, Atlanta, Ga*Jessop, Kevin, Marietta, Ga*Lockwood, Wade, Cartersville, Ga*Moore, Roy, Grayson, Ga*Morency, Dotty, Douglasville, Ga*Murray, Brent, Atlanta, Ga*Smith, John, Sharpsburg, Ga*Stracke, Kimberly, Leesburg, Ga*

Burlison, Melissa, Waianae, HiGanzler, Erin, Wahiawa, Hi*Judy Ann, Baoit, Ewa Beach, HiLee, Diane, Pearl City, HiLiang, Ka Yi, Honolulu, HiMullen, Joshua, Mililani, HiPoling, Jennifer, Honolulu, HiRamiro, Malia, Kaneohe, HiStricker, Ikaika, Honolulu, Hi

Dueker, Tara, North Liberty, IaEndahl, Eric, Iowa City, Ia*Fiser, Amy, Marion, IaVinson, Jasmine, Altoona, Ia*

Ball, Greg, Twin Falls, Id*Parsons, James, Moscow, Id*Spurgeon, Randy, New Plymouth, Id*

Abuisba, Ammar, Lombard, IlAnderson, Allison, Chicago, IlBrahmbhatt, Hemali, Crystal Lake, IlCantrall Thomas, Rita, Rockford, IlColleran, Leah, Palatine, Il*Daum, Ferrara, Crystal Lake, IlDexter, Amanda, Tinley Park, IlDietz, Jessica, Crystal Lake, IlEllens, Troy, Chicago, IlGittings, Shelly, Stronghurst, Il*Grant, Amy, Chicago, Il

Gullikson, Troy, Machesney Park, Il*Hahn, Brian, Metamora, Il*Haugen, Kaitlin, Elk Grove Village, IlHays, Becky, Columbia, Il*Hudson, Jeremy, Aurora, Il*Kevorkian, Jillian, La Grange Park, IlLamorena, Emilee, Morton Grove, IlLovrich, Margaret, Midlothian, Il*Lutz, Amanda, Oak Park, IlMcCaw, Monte, Poplar Grove, Il*Melson, Shannon, Maywood, IlMinyo, Liezel, Oak Lawn, Il*Orr, Mary, Yorkville, IlPatel, Snehal, Des Plaines, IlPrince, Clamika, Broadview, IlRodriguez, Debra, Granville, Il*Rodriguez, Vanessa, Chicago, Il*Roskos, Drew, Oak Forest, Il*Sargent, Elisa, Winnebago, Il*Sharif, Abdurahman, Glen Ellyn, IlShelton, Rahkal, Chicago, Il*Speckan, Katie, Vernon Hills, IlStefanska, Monika, Chicago, IlSulaiman, Adewunmi, Chicago, IlYoung, Christina, Wheaton, Il*Zhodi, Parviz, Lake Zurich, Il

Albitz, Robert, South Bend, InAlmojaibel, Abdullah, Indianapolis, InBaker, Shazia, Thorntown, In*Bangert, Suzanne, West Lafayette, In*Birkey, Bonnie, Middlebury, InBlacketter, Erin, South Bend, InBowers, Dwight, Goshen, InBrewer, Brittany, North Judson, InBryant, Kimberly, Mishawaka, InChandler, Cara, Fishers, InChawo, Nsanachione, South Bend, InCox, Jannllie, Cloverdale, InEaly, Aimee, Bargersville, In*Eguasa-Omoruyi, Eseosa, Hammond, InEngland, Ross, Indianapolis, In*Fey, Derek, South Bend, InFisher, Edward, Elkhart, InFu, Yi, South Bend, InHaarer, Timothy, Goshen, InHandley, Amanda, Mishawaka, InHicks, Megan, Carmel, InHolderread, Stacy, Elkhart, InHuffman, Marcus, Bedford, In*Lambdin, Sara, Bristol, InLarrew, Melissa, New Carlisle, InMalott, Jessica, Quincy, InMarkand, Rajesh, Camby, InMills, Lori, South Bend, InMurray, Amanda, Mishawaka, InNicely, Kendra, Elkhart, InPhipps, Jessica, Elkhart, InReaves, Alicia, Elkhart, InRoe, Kala, Topeka, InSaros, Jacqueline, Mishawaka, InSchock, Kimberly, Osceola, InStahly, Sandy, South Bend, InStrauch, Gina, Rolling Prairie, InTimmins, Antony, Goshen, InTurner, Staci, Carmel, InWekony, Thomas, South Bend, InZimmer, Teneen, Elkhart, In

Alhubechy, Atheer, Pratt, Ks*Caraway, Shera, Olathe, Ks*Dobbie, Rosemary, Harveyville, Ks*Findley, Tiffany, Salina, Ks*Henry, Allison, Wichita, Ks*

Keyser, Gaylene, Galena, Ks*McMillin, David, Topeka, KsMead, Matt, Abilene, Ks*Phoenix, Donna, Wichita, KsWassenberg, Irene, Marysville, Ks*Watson, Charles, Kansas City, KsWhitaker Holscher, Deborah, Paola, Ks*Wolf, Jordan, Bennington, Ks*

Barrett, Michele, Somerset, Ky*Baxter, Martin, Nicholasville, Ky*Buccola, Valerie, Louisville, Ky*King, William, Harold, Ky*Murphy, Dawn, Louisville, Ky*Rigel, Vanessa, Oak Grove, KyThompson, Mark, Lawrenceburg, Ky*

Berthelot, Lacy, Prairieville, La*Bongiovanni, Judith, Baton Rouge, LaBurnham, Jerry, Arcadia, LaCobb, Rebecca, Shreveport, LaCrowell, Jonathon, Tickfaw, LaDuncan, Diane, New Orleans, La*Dupree, Sean, Walker, La*Hughes, John, Bossier City, LaO’Daniel, Melissa, Prairieville, LaRobichaux, Roxanne, Lockport, La*Savoie, Michelle, Baton Rouge, LaYoung, Katherine, Haughton, LaYoung, Melissa, Minden, La

Boisselle, Holly, Merrimac, Ma*Brock, Heidi, Bridgewater, Ma*Cato, Michele, Foxboro, Ma*Dejesus, Jhovanny, Lynn, Ma*Govoni, Mike, Springfield, Ma*Gramazio, Kathleen, Brockton, Ma*Jacobs, Kara, Amesbury, Ma*Jacobs, Kimberly, Hopkinton, Ma*Jendrock, Sheryl, Chelmsford, Ma*Jiang, Youchun, Natick, Ma*Manzone, Tracey, New Bedford, Ma*McCollam, Mavis, Cambridge, Ma*Patel, Hetal, Leominster, Ma*Pruitt, Kayla, Springfield, Ma*Roy, Holly, Adams, Ma*Roy, Robert, Linwood, Ma*Vandecarr, David, Waltham, Ma

Baust, Colleen, Thurmont, Md*Blake, Myrna, Ellicott City, Md*Bromley, Jaime, Salisbury, MdBucher, Jamie, Waldorf, Md*Burns, Liana, Landover, MdDoukoure, Audrey, Germantown, MdIden, Tesa, Hancock, MdJoiner, Patricia, Easton, Md*Lindenmeyer, Robert, Timonium, Md*Mersha, Genanesh, Burtonsville, MdNguti, Charles, Hyattsville, Md*Sherman, Latrina, Owings Mills, Md*Wierzbicki, David, Cumberland, Md*Young, Lillian, Upper Marlboro, Md*

Blondin, Michael, York Beach, MeGreen, David, Portland, Me

Beckman, Lindsay, Oakley, MiBonk, Jane, Saginaw, Mi*Campbell, Nichole, Flint, MiCrunden, Melanie, Davison, MiDalrymple, Jennifer, Plainwell, Mi*

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New Members

Dillard, Najah, Mount Morris, MiDingman, Catherine, Holly, Mi*Edgar, Mark, Ithaca, Mi*Flowers, Lynne, Sterling Heights, Mi*Gilliam, John, Clio, MiGreen, Amanda, Flushing, MiHandley, Leon, Flint, MiHandley, Margareat, Flint, MiJones, Stephanie, Brighton, MiKeppler, Teresa, Dexter, Mi*Latter, Sarah, Genesee, MiMladin, Cornelia, Ann Arbor, Mi*Moore, Melissa, Chesterfield, Mi*Myers, Jana, Burton, MiNelson, Amanda, Grand Blanc, MiNelson, Justin, Grant, Mi*Oberlee, Patricia, Commerce Township, Mi*Ouedraogo, Kierra, Flint, MiRandolph, Tarnisha, Flint, MiRoiter, Rosemary, Gaines, MiRomanowski, Nichole, Flint, MiSaunders, Rosa, Goodrich, MiSchneider, Karen, Manchester, Mi*Scott, Yolanda, Flint, MiSerratos, Angelita, Detroit, MiSisco, Tiffany, Flint, MiSlocum, Ann, Dewitt, Mi*Smith, Tamara, Flint, MiTate, Cindy, Highland, Mi*Thomas, Tasha, Mount Morris, MiTulgestka, Maria, Alpena, Mi*Verdoux, Shea, Owosso, MiWendt, Marie, Grand Blanc, MiWiggins, Roderick, Flint, Mi

Sorenson, Kim, Saint Paul, Mn*

Agins, Nicholas, Saint Louis, Mo*Anderson, Loretta, Kansas City, MoAnderson, Rhonda, Odessa, MoBrown, Mary, Columbia, Mo*Church, Ashley, Ash Grove, Mo*Collins, Wilma, Joplin, Mo*Cox, Cheri’, Kansas City, Mo*Dameron, Marci, Kansas City, Mo*Deer, Teresa, Fenton, Mo*Domachowski, Jason, Eureka, Mo*Finley, Betsy, Columbia, Mo*Hesterly, Scott, Republic, MoHicks, Charlie, Lees Summit, Mo*Hooker, Cherita, Kansas City, MoHuffman, Gary, Saint Joseph, Mo*Meinert, Kerrie, Kansas City, Mo*Moss, Cynthia, Joplin, Mo*Murray, Jill, Kansas City, Mo*Rice, Ryan, Kansas City, MoRogers, Brandi, Belton, MoRogers, Roy, Zalma, Mo*Smith, Carmen, St Louis, Mo*Tokarchuk, Nadezhda, Ballwin, Mo*

O’Neil, Orville, Saipan, MP*

Alberson, Kelly, Olive Branch, Ms*Amacker, Melinda, Poplarville, MsEdwards, Benny, Brandon, MsFells, Tacarra, Picayune, MsGardner, Lauren, Hattiesburg, MsGatlin, Kayla, Hattiesburg, MsHelton, Billy, Petal, MsInmon, Stacey, Hattiesburg, MsJames, Brittany, Petal, MsKent, Brandi, Baldwyn, MsMoak, Brett, Columbia, MsRogers, Laura, Hattiesburg, MsTaylor, Whittney, Picayune, MsTolar, Jana, Columbia, Ms

Waltman, Tonya, Saucier, MsWells, Ashley, Foxworth, MsWheat, Laura, Purvis, MsWheeless, Herman, Hattiesburg, MsWilliams, Kristina, Hattiesburg, MsWood, Samantha, Purvis, Ms

Anderson, Krystykka, Great Falls, MtBecton, Stephanie, Great Falls, MtFertterer, Clancey, Belt, MtHoldorf, Jessica, Great Falls, MtLawson, Tedi, Great Falls, MtMcSwain, Brandi, Great Falls, MtO’Brien, Katherine, Conrad, MtValdez, Jordan, Great Falls, Mt

Amasa, Lawrence, Charlotte, NC*Bartle, Renee, Cary, NC*Battle, Catherine, Weddington, NC*Blackwell, Shannon, Browns Summit, NC*Burgess, Seth, Charlotte, NC*Coble, Donna, Graham, NC*Cook, Jennifer, Richlands, NC*Cullinan, Mary Ann, Greensboro, NC*Detterman, Fred, Wilmington, NC*Galloway, Laurie, Huntersville, NC*Gordon, Keisha, Roanoke Rapids, NCGreene, Velma, Banner Elk, NC*Grzych, Richard, Matthews, NC*Hall, Kara, Concord, NC*Hilliard, Pat, Thomasville, NCHowell,Rcp, James, Durham, NC*Hunt, Janel, Kernersville, NCJallow, Ousman, Charlotte, NC*Jessup, Gerald, Oak Ridge, NC*Larrimore, Steffani, Wilmington, NC*Lawrence, Carol, Greensboro, NC*Long, Patricia, Trinity, NC*Martin, Robyn, Greenville, NC*McLaughlin, Blaise, Thomasville, NC*Miller, Ryan, Browns Summit, NCMoody, Philip, Pfafftown, NC*Napolis, Michael, Winston Salem, NC*Patel, Bindiya, Raleigh, NCPerdue, Amy, Reidsville, NC*Richardson, Sherri, Greensboro, NCSlonac, Robert, Wake Forest, NC*Smith, Robert, Maiden, NC*Tenneson, Annette, High Point, NC*Walton, Barbara, Durham, NC*Williams, Brittany, Albemarle, NCWilliams, Kenneth, Carthage, NC*Williams, Kent, Hillsborough, NC*Witschey, Amy, Harrisburg, NC*

Avard, Timothy, Omaha, Ne*Holm, Tracy, Roca, Ne*

Kinchen, Roger, Windham, NHLabrecque, Jamie, Concord, NH*Weatherby, Judith, Epping, NH*

Ablett, Kaitlyn, Egg Harbor City, NJAcosta, Jose, Hillside, NJ*Aponte, Reinaldo, Jackson, NJArango, Oscar, Rockaway, NJ*Aucello, Anthony, Merchantville, NJBalnis, Richard, Dorothy, NJ*Barot, Khyati, Middletown, NJBassey, Okon, Egg Harbor Twp, NJBaumhauer, Matthew, Riverton, NJBielicki, Daniel, Glassboro, NJBoone, Valenskie, Willingboro, NJBostard, Kendra, Cape May Court House, NJ

Bottega, Justin, Old Bridge, NJBoyle, Jason, Mine Hill, NJBrady, Bethany, Monroe Township, NJCabey, Joseph, Toms River, NJCarducci, Cain, Pennsauken, NJCharles, Jeffrey, Maplewood, NJCherrington, Louise, Fair Haven, NJCiepiela, Elizabeth, Medford, NJ*Cole, Shane, Union, NJ*Conenna, Cristina, Vineland, NJCorcoran, Christopher, Burlington, NJCurreri, Toni, Colts Neck, NJDavis, Dorien, Clementon, NJDecollibus, Maria, Marlboro, NJDevivo, Erin, Ocean, NJDomanski, Michelle, Blackwood, NJDriscoll, Stephen, Toms River, NJEdwards, Cindy, Sicklerville, NJEllis, Norris, Morganville, NJEndrinal, Micheal, Oceanport, NJFamuyiwa, Olufunmilayo, Somerset, NJFerraina, Ann, Runnemede, NJFiorello, Michael, Red Bank, NJFluhardy, Kristie, Cherry Hill, NJFrancia, John Paul, Sicklerville, NJGarretson, Justina, Atco, NJGreeley, Ashley, Middletown, NJGreva, Arber, Howell, NJHand, Nicholas, Garwood, NJHauger, Shannon, Williamstown, NJHelfrey, William, Freehold, NJ*Howarth, Dean, Gibbsboro, NJHubmaster, Sandra, Eht, NJ*Ihnken, Nancy, Howell, NJKeenan, Jacqueline, Matawan, NJKurzydlowski, Patricia, Keyport, NJLane, Jr, David, Barrington, NJLiggayu, Rodolfo, Edison, NJ*Louis Jacques, Stanley, Jackson, NJMacasadia, Dino, Red Bank, NJMalia, Donna, Lumberton, NJMartin, Laka, Belford, NJMartin-Swain, Nicole, Pennsauken, NJMatchett, Judy, Shamong, NJ*Mayada, Ahmed Fahmy, Princeton, NJ*McDevitt, Caitlin, West Deptford, NJMcEnroe, Elizabeth, Millington, NJMerlin, Sarah, Ocean Gate, NJMitschele, Karen, Leonardo, NJMollano, Nicole, Middletown, NJNegron, Laurie, Pittsgrove, NJO’Neal, Tania, Trenton, NJOreggio, Tinowa, North Plainfield, NJ*Osei Owusu, Justice, Freehold, NJOwoiya, Adejoke, Piscataway, NJPisciotti, Patricia, Toms River, NJPui Ming, Yip, Edison, NJReid, Bernadette, Jackson, NJ*Reyes, Angel, Franklinville, NJRichmond, Tamara, Oakhurst, NJRobinson, Muriel, Lindenwold, NJSakhan, Irina, Vineland, NJSherwood, Lisa, Riverdale, NJ*Silva, Christine, Howell, NJ*Smith, Melinda, Mullica Hill, NJ*Stanton, Kimberly, Haddon Heights, NJTayson, Josil, Neptune, NJTesfaye, Alemtsehay, Freehold, NJTietz-Boker, Jakob, Bellmawr, NJUlerick, Alicia, Sewell, NJVelasquez, Noemi, Vineland, NJWalker, Derek, Egg Harbor Twp, NJWalls, Bryonette, Asbury Park, NJWeyant, Jane, West Milford, NJ*Wieczerzynski, Madalyn, Swedesboro, NJ*Yoder, Jr, William, Collingswood, NJ

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New Members

Baldauf, Richard, Las Cruces, NM*Duarte, Rosa, Las Cruces, NMGarcia, Modesta, Las Cruces, NMHaynie, Lara, Farmington, NM*Hinojosa, Amanda, Las Cruces, NMMerryfield, Rick, Roswell, NMMontoya, Antoinette, Albuquerque, NM*Phan, Heather, Albuquerque, NM*Rhodes, Charles, Los Lunas, NM*Thompson, Diana, Las Cruces, NMTully, Genevieve, Brimhall, NM*Zuniga, Jerry, Las Cruces, NM*

Bell, Andy, Las Vegas, NvBrown, Jowanna, Las Vegas, NvCapistrano, Marylyn, Las Vegas, NvClay Jr, Henry, Las Vegas, NvDavis, Ron, Las Vegas, Nv*Dumadag, Kalan, Las Vegas, Nv*Eady, Klinton, North Las Vegas, NvFalla, Jason, Las Vegas, NvFountain, Cassandra, Las Vegas, NvManalo, Gerard, Las Vegas, NvMata, Bryan, Las Vegas, NvMcPhail, Mary-Rose, Las Vegas, NvMitchell, Jacob, Las Vegas, NvMorehouse, Alexander, Las Vegas, Nv*Murray, Wei, Las Vegas, NvObrador, Sherrylin, Las Vegas, NvOtremba, Jennifer, Las Vegas, NvPagulayan, Dominique, Las Vegas, NvPriest, Randall, Las Vegas, NvRogers, Kade, Las Vegas, NvSmith Vi, Hearley, Las Vegas, NvStudd, Kristi, Las Vegas, NvVega, Veronica, Las Vegas, NvVillarico, John, Las Vegas, NvZaichick, Lee, Las Vegas, Nv

Abdallah, Hilmi, Cherry Valley, NY*Allen, Chelsea, Dexter, NYAllen, Stephen, Lacona, NYAnderson, Lapiane, Uniondale, NYArcuri, Erin, Syracuse, NYBackus, Timothy, Rodman, NYBerns, Timothy, Fairport, NY*Bico, Elma, Utica, NYBostaxidzic, Sanela, Utica, NYBrewster, Mamie, Arkport, NY*Brown, Danielle, Port Leyden, NYButton, Mary, Batavia, NY*Cascio, Debra, Stony Brook, NY*Clarke, Rachael, Schenectady, NY*Coleman, Frances, Whitesboro, NYCollins, Christine, Utica, NY*Dack, Alexander, Ilion, NYDel Aguila, Anne-Marie, Haverstraw, NYDelanovic, Jasna, Utica, NYDichristina-Walker, Emile, Attica, NY*Dimare, Melissa, Whitesboro, NYEsthappan, Simon, Staten Island, NY*Florez, Andrew, Holtsville, NY*Foley, Deborah, Liverpool, NYGianotti, Carmlee, Utica, NYGuerriero, Miranda, Nesconset, NYGurdo, Cabryn, Utica, NYHill, Rachel, Troy, NY*Hollis, Jacob, Watertown, NYJordan, Laura, North Babylon, NYKlish, George, Penfield, NY*Knight, Rachel, Rome, NYKraeger, Nicole, Utica, NYKuehnle, Christopher, Little Falls, NYLasher, Brittany, Fort Plain, NYLegerme, Steeve, Springfield Gardens, NY*Lew, Kimberly, Utica, NYLeyderman, Elina, Wantagh, NY*

Lihic, Irfan, Utica, NY*Lisi, John, Camillus, NYLong, Angelita, Oswego, NYLongtin, Bradley, Poland, NYMachicote, Joseph, Queens Village, NY*Masters, Kayla, Fabius, NYMcCann, Michael, Pennellville, NYMcCoy, Karen, Putnam Valley, NY*Mechan, Ryan, Utica, NYMilliner, Erica, Green Island, NY*Musacchio, Lillian, Liverpool, NYNeal, Kurk, Whitesboro, NYNgo, Khoa, Syracuse, NYNihalani, Mausam, Westbury, NY*O’Connor, Christopher, Melville, NYOehler, Russell, Utica, NYOmondi, George, Yorkville, NYPrincip, Miljenko, Utica, NY*Radionov, Andrey, Marcellus, NYRich, Nicholle, Argyle, NY*Ritzel, Corinne, Holland Patent, NY*Rodriguez, Clara, Brooklyn, NY*Rooms, Sherwin, Croton On Hudson, NY*Scialdone, John, Utica, NYShanturov, Dmitriy, Syracuse, NYShirley, Louis, Baldwinsville, NYSilchuk, Miroslava, Frankfort, NYSmith, Clifton, Bronx, NY*Smith, Jessica, Rome, NYSouffrant, Emmanus, Brooklyn, NY*Sullivan, Elizabeth, Utica, NYTomb, Lori, Fayetteville, NYTrombetta, David, Saint Johnsville, NYVaccaro, Valerie, Fayetteville, NYVeneck, Ryan, Rome, NYVosswinkel, Regina, East Setauket, NY*Voytovich, Roman, Utica, NYWinkelman, Peter, Farmington, NY*Wixson, Michael, Liverpool, NYWolfe, Robert, Byron, NY*Yager, Michelle, New Hartford, NY

Beckman, Brittany, Amelia, OhBelden, Laurence, Port Clinton, Oh*Bell, Michelle, Youngstown, Oh*Bucey, Rebecca, Brilliant, Oh*Carentz, Timothy, Mason, Oh*Christmas-Paine, Debbie, Warren, Oh*Cooley, William, West Portsmouth, Oh*Cunningham, Ada, Warrensville Heights, Oh*Dean, Roshell, Dayton, Oh*Defallo, Thomas, Steubenville, Oh*Gander, Albert, Cincinnati, Oh*Hern, Brad, Cincinnati, Oh*Lambert, Jill, Toledo, Oh*Powell, Bonnie, Austintown, Oh*Smiraldo, Joseph, Toledo, OhSmith, Laura, Granville, Oh*Smith, Monica, Cincinnati, Oh*Szunyog, Philip, Strongsville, Oh*Till, Rebecca, Youngstown, Oh*Varkony, Steve, East Liverpool, Oh*Villard, Renee, Canton, OhYanez, Gabriella, Cincinnati, Oh*

Albright, Melanee, Tahlequah, Ok*Blevin, Jennifer, Oklahoma City, OkBrooks, Amy, Oklahoma City, OkCastle, Megan, Newcastle, OkChi, Kenny, Oklahoma City, OkFischer, Hannah, Yukon, OkFranch, Amanda, Norman, OkGist, Lanora, Oklahoma City, OkHarris, Neika, Oklahoma City, Ok

Hindman, Holly, Midwest City, OkKennard, Marlene, Broken Arrow, Ok*Liongco, Marissa, Yukon, OkLoerts, Jamie, Tahlequah, Ok*Markus, Timothy, Tulsa, Ok*Mathew, Jibumon, Yukon, OkNgo, Loan, Oklahoma City, OkPreciado, Carmen, Oklahoma City, OkRoland, Shantee, Oklahoma City, OkSanchez, Misty, Oklahoma City, OkSanders, Bill, Oklahoma City, OkWhittington, Anngela, Oklahoma City, OkWong, Ginmey, Oklahoma City, OkZarco, Phuong, Oklahoma City, Ok

Barbian, Renee, Portland, Or*Hawkins, Anna, Klamath Falls, Or*

Alexandre, Jean Ricot, Warminster, PaAmon, Karen, Saint Thomas, Pa*Atkinson, Andrea, Belle Vernon, Pa*Bachman, Tyler, Lancaster, Pa*Bartlett, Joseph, Valencia, Pa*Beaupre, Jason, East Petersburg, Pa*Bechtel, Ryan, York, PaBen, Chachu, Philadelphia, PaBey, Amber, Pittsburgh, Pa*Black, Jane Lea, Bedford, Pa*Branik, Barry, Belle Vernon, Pa*Braunsar, Anthony, Philadelphia, PaBrest, Todd, Sharpsville, Pa*Castrodale, Phillip, Yardley, PaCavanaugh, James, Pittsburgh, Pa*Clark, Samantha, Erie, PaCoffman, Kimberly, Palmyra, PaCurtis, Kelsey, East Brady, Pa*Delviscio, Amy, Philadelphia, PaDerby, Elaine, Berwick, PaDiehl, Rodney, Bedford, PaDorrycott, Lori, Irwin, Pa*Draheim, Joseph, Ebensburg, Pa*Emma, Lynn, Nanticoke, Pa*Evancho, Thomas, West Mifflin, Pa*Faub, Caroline, Pittsburgh, Pa*Ferrante, Monica, Ivyland, PaForeback, Nicole, Holicong, PaFrancavage, Kelly, Birdsboro, Pa*Fryman, Marie, Irwin, Pa*Guzenski, Wendy, Wyoming, PaHeilman, Shandale, Philadelphia, PaHenry, Kristin, Spring Grove, PaHerrie, Jacob, Pittsburgh, Pa*Holderbaum, Stacy, Blairsville, Pa*Holmes, Gene, Gibsonia, Pa*Hoover, Shannon, York, Pa*House, Courtney, Hanover, PaHughes, Kristin, Philadelphia, PaHunt, Sympia, Hazleton, Pa*Johnson, Jacqueline, Mercer, Pa*Joseph, Sunny, Philadelphia, PaKauffman, Mary, Pittsburgh, Pa*Kempson, Deb, Wrightsville, PaLadasky, Sonia, Bethel Park, Pa*Lipinski, Steven, Pittsburgh, Pa*Malec, Kelly, Johnstown, Pa*Marstell, Sean, Exeter, PaMartin, Paul, Mount Joy, Pa*McBride, Stephanie, Seven Valleys, PaMendez, Jeromy, Philadelphia, PaMerigliano, Janina, Allison Park, Pa*Miller, Lana, Smithfield, Pa*Minor, Angela, Coudersport, PaMishizen, Amanda, Carnegie, Pa*Morgan, Jessica, Canonsburg, Pa*

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New Members

Mossor Bush, Peggy, McMurray, Pa*Neveker, Karen, Hanover, PaOvermiller, Dena, Red Lion, PaPestino, Amanda, Monongahela, Pa*Ramirez, Evelyn, Bushkill, Pa*Rogers, Mark, Hermitage, Pa*Satterly, William, Athens, PaSattler, Lucy, Monroeville, Pa*Saxfield, Michele, Dayton, Pa*Siebert, Lisa, York, Pa*Smith, Lori, North Huntingdon, Pa*Sopiak, Jennifer, Canonsburg, Pa*St Leger, John, McKeesport, Pa*Stohon, Kevin, Punxsutawney, Pa*Taylor, Steven, Glenshaw, Pa*Tokar, Beverly, Monongahela, Pa*Totedo, Michael, Donora, Pa*Walker, Calvin, Irwin, Pa*Washington, Rachael, Pittsburgh, PaWeldon, Melanie, Hanover, PaWesolowski, Anthony, Ambridge, Pa*Williams, Carole, Gettysburg, Pa*Worley, Tricia, Jeannette, Pa*Yohe, Alicia, York, Pa

Furlong, Darlene, Warwick, RI*

Bennett, Reed, Lexington, SCCraig, April, Simpsonville, SCGist, McArthur, Union, SC*Hall, Judy, Piedmont, SC*Hodges, Julie, Summerville, SCLangdale, Diane, Greenpond, SCLawson, Cynthia, Roebuck, SCMagee, Mike, Greer, SC*Mata Bravo, Berenice, Indian Land, SC*McClure, Crystal, Easley, SCMcMillan, Jessica, Charleston, SC*Rikard, Benjamin, Whitmire, SC*Vander Brink, Stephanie, Liberty, SC*

Ayers, Ellen, Sioux Falls, SD*Billesbach, Robert, Yankton, SD*Ellwein, Trevor, Sioux Falls, SD*Hart, Lyle, Rapid City, SD*

Cox, Robert, Lyles, Tn*Haynes, Carrie, Lakeland, TnPeterson, Frank, Nashville, TnPierce, Robert, Ooltewah, Tn*Randolph, Kristina, Smithville, Tn*Roark, Phillip, Bartlett, Tn*

Abraham, Bency, Houston, TxAkinrinlola, Bolanle, Galveston, TxAlabi-Peters, Adedayo, Houston, TxAlaniz, Ezequiel, Channelview, TxAli, Sharish, Sugarland, TxBall, Ryan, Plano, TxBhadja, Disha, Pasadena, TxBox, Lori, Santo, Tx*Burns, Darla, Highlands, Tx*Chacko, Asha, Missouri City, TxCook, Jeremy, San Antonio, TxCox, Kevin, Temple, TxDriver, Zara, Buckholts, TxDunn, Sandra, Bedford, Tx*Eaton, Lauren, Abilene, TxEisele, Michelle, Houston, Tx*

Ellis, James, Kingwood, Tx*Emodi Mbunabo, Izukanne, Houston, TxFletcher, Sabrina, Abilene, TxGilbert, Tiffany, Amarillo, TxGillespie, Andrea, Seabrook, Tx*Gonzalez, Elisa, La Blanca, Tx*Guandique, Ruth, Houston, Tx*Hammond, Terry, Fort Worth, TxHaque, Silvana, Houston, TxHavner, Dede, Clyde, TxHo, Nhatrang, Houston, TxHyder, Erin, San Antonio, TxInthaphom, Theodore, Galveston, TxJacob, Shaji, Fort Worth, Tx*Janniere, Ernesto, Plano, Tx*Jaramillo, Juan, Abilene, TxJesrani, Angeli, Sugar Land, TxJokhaker, Namrata, Houston, TxKey, Sarah, Lubbock, Tx*Lacey, Todd, Abilene, TxLangeslay, Sheila, Hockley, TxLazos, Mary, Navasota, Tx*Le, Minh, Houston, TxLeighton, Russell, Irving, TxLeslie, Jamee, Burleson, Tx*Mable, Alonzo, Galveston, TxManz, Jayme, Lueders, TxMaredia, Sanam, Port Arthur, TxMarshall, Monte, Seminole, Tx*Martin, Anita, Humble, Tx*Marvin, Alyssa, Richardson, TxMbagwu, Anthony, Houston, TxMcLeod, Ryan, Tuscola, TxMekhail, Kirolos, San Antonio, Tx*Miller, Gary, San Antonio, TxMomin, Shaheen, Sugar Land, TxMunoz, Moses, Haskell, TxNdouagni, Dominique, Galveston, TxNemec, Julie, Galveston, TxNguyen, Thao, Tomball, TxOdom, Tressie, Montgomery, TxOeur, Vantha, Dickinson, TxOgidan, Ganiat, Houston, Tx*Okonkwo, Gloria, Galveston, TxOkoro, Chinyere, Houston, TxOkoro, Olive, Galveston, TxOlvera, Miscaela, Abilene, TxOrencia, Elmer, Stafford, Tx*Oros, Rhonda, Houston, Tx*Pacheco, Andrea, Houston, TxParmerlee, Trinity, Merkel, TxPatel, Anikaa, Richardson, TxPatel, Priyaa, Houston, TxPatel, Sachin, Houston, TxPhilpot, David, Galveston, TxPickels, Ginger, Abilene, TxQuitanilla, Melissa, Laredo, TxRamirez, Gloria, Houston, Tx*Ramirez, Jessica, Galveston, TxReel, Mary, Abilene, Tx*Richards, Glendon, Del Valle, Tx*Rivera, Karla, Wichita Falls, Tx*Rodriguez, Mary, Abilene, TxSaing, Lundy, Pearland, TxSerna, Kathleen, Houston, Tx*Shahan, Dominque, Abilene, TxShiu, Chilan, Waco, TxStephen, Timi, Stafford, TxThan, Van, Houston, TxThomas, Byju, Sachse, Tx*Thoryk, Christopher, San Antonio, Tx*Treber, Martha, Richardson, Tx*Vaid, Tariq, Richmond, TxValdivia, Jennifer, Houston, TxWilson, Lana, Haltom City, Tx*Wimberley, Debra, Winters, TxYundt, Linda, Irving, Tx*

Ogden, Rebecah, Draper, Ut

Alford, Erika, Roanoke, VaBanks, Maya, Roanoke, VaBrizendine, Kaitlyn, Buena Vista, VaBurford, Rhonda, Staunton, VaButler, Robin, Bumpass, Va*Click, Amanda, Roanoke, VaEasley, Tierra, Roanoke, VaEwell, Shanell, Roanoke, VaFerguson, Colleen, Richmond, Va*Giangola, Laurie, Winchester, Va*Gilliam, Kelly, Rice, VaHall, Madetric, Stafford, Va*Harrison, Lisa, Colonial Heights, Va*Hartman, Benjamin, Rocky Mount, VaHasson, Allison, Troutville, VaJacobs, Megan, Glade Hill, VaJoyce, Kasey, Axton, VaKeith, Amy, Bedford, Va*Kessler, Brad, Daleville, VaKohl, Edwin, Banco, Va*Martin, Heather, Martinsville, VaMcDerby, Matthew, Roanoke, VaMears, Andrew, Charlottesville, Va*Medley Freeze, Nyisha, Danville, Va*Nicely, Kevin, Covington, VaNorris, Bonnie, Troutville, Va*Oliver, Linda, Thaxton, VaOrtiz, Monica, Chesapeake, Va*Petersen, Rachel, Blacksburg, VaPeterson, Catherine, Vinton, VaPhanelson, Torey, Roanoke, VaRosenthal, Howard, Glen Allen, Va*Schwartz, Jessika, Salem, VaSimmons, Diane, Roanoke, VaSmith, Seth, Ferrum, VaSmith, Stacey, Gloucester, Va*Stamper, Sherry, Lebanon, Va*Tawney, Leslie, Floyd, VaTucker, Ken-Nisha, Richmond, Va*Uber, Crystal, Vienna, VaVan Tassell, Darin, Purcellville, Va*Vargas, Conrado, Chesapeake, Va*Walters, Rae, Huddleston, VaWatson, Ryan, Roanoke, VaWillis, Benjamin, Mechanicsville, VaWood, Christopher, Abingdon, VaWood, Tracy, Colonial Heights, Va*

Adan, Marvin, Dupont, WaAli, Bashir, Tukwila, WaAndreasen, Mark, Spokane Valley, WaAndres, Elizabeth, Colville, WaBaker, Jason, Redmond, WaBasinger, Darren, Spokane, WaBock, Joel, Vancouver, Wa*Byham, Doris, Auburn, WaCernuska, Michael, Lynnwood, Wa*Choulaphan, Peter, Seattle, Wa*Davis, Kyle, Tacoma, WaDean, Timothy, Algona, WaDire, Elizabeth, Liberty Lake, WaDonner, Eric, Olympia, WaDunn, Steven, Spokane, WaGebremariam, Lamrot, Spokane, WaGeiger, Kyle, Spokane, WaHendrix, Reba, Deer Park, Wa*

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New Members

Hennessy, Jeffrey, Spokane, WaHyland, Norma, Bellingham, Wa*Jones, Gordon, Spokane Valley, WaKikuchi, Aya, Spokane, WaLaird, Cynthia, Spokane, Wa*Laird, Darrell, Spokane, Wa*Lakey, Holly, Spokane, WaLane, Jereme, Seattle, WaMahaffey, Tara, Seattle, WaMazhukhin, Alex, Renton, WaMcCarson, Roma, Vancouver, Wa*Medina, Marcy, Spokane Valley, WaMoore, Michelle, Issaquah, WaO’Malley, Michael, Spokane, WaOrock Takele, F Jeannine, Walla Walla, Wa*Phillips, Jeremy, Spokane, WaRamsdell, Nicole, Tumwater, WaRiley, Nikki, Spokane Valley, WaRoss, Aaron, Spokane, WaShaver, Marie, Tacoma, WaShelton, Bryan, Renton, WaStark, David, Spokane, WaStephens, Lucinda, Spokane, Wa*Stixrud, Valerie, Seattle, Wa*Tsuber, Nataliya, Spokane, WaTull, Holly, Yakima, Wa*Vicovan, Filip, Renton, WaVongphrachanh, Toutu, Puyallup, WaWhite, Cheryl, Seattle, Wa*Wood, Denise, Tacoma, WaZinicola, Vince, Bonney Lake, Wa

Ahles, Peter, Reedsburg, WiAndler, Angela, Columbus, WiAngel-Wich, Christine, Plover, Wi*Bengtson, Alicia, La Crosse, WiBottoni, Christine, Madison, WiCherrier, Jospeh, Chippewa Falls, Wi*Copeland II, Randolph, Waunakee, Wi

Crary, Tiffany, Grand Marsh, WiDefosse, Carah, Wisconsin Dells, WiFowler, Sharon, Milwaukee, Wi*Geske, James, Janesville, WiGreen, Bradley, Madison, WiKaenel, Rhonda, Montello, WiKletzien, Kory, Middleton, WiKrebs, Chris, Rhinelander, Wi*Langholff, Brianna, Madison, WiMcNally, Joseph, Janesville, WiMeyer, Lisa, Madison, WiMotelet, Jeff, Madison, WiNewcomer, Larry, Browntown, WiO’Brien, Brianna, Madison, WiPeterson, Jennifer, Plover, Wi*Rushing, Robert, Waterford, Wi*Saiahpour, Mahroo, Verona, WiSchmitz, Dale, Jefferson, WiSchnaare, Cynthia, Lyndon Station, WiSchueller, Rebecca, Baraboo, WiSeay, Nathaniel, Verona, WiSmith, Amanda, Sun Prairie, WiSmith, Brittany, Waunakee, WiStarck, Suzanne, Cadott, WiTarsa, Stephanie, Silver Lake, WiTesfasillasie, Robiel, Madison, WiTracy, Abigail, Watertown, Wi

Adkins, Heather, Wayne, WVBrown, Taylor, Huntington, WVCarducci, Valerie, Weirton, WV*Davis, Mark, Chapmanville, WVDillon, Megan, Parkersburg, WVEstephanos, Meskerem, Vienna, WVFarley, Garret, Huntington, WVFranklin, Christy, Huntington, WVGreenlee, Robert, Point Pleasant, WVHambrick, Christine, Huntington, WVHutchison, Amber, St Albans, WV

Legg, Heather, Maysel, WV*May, Kayla, Shady Spring, WVMethax, Jamey, Huntington, WVParsons, Brandi, Branchland, WVScarberry, Kristin, Barboursville, WVSchultz, Janet, Valley Grove, WV*Schwertfeger, Courtney, Bethany, WVSharp, Caitlin, Marlinton, WVSmith, Charmee, Leon, WVSmith, Kaitlin, Culloden, WVSmith, Morgan, Huntington, WVSowards, Nathan, Southside, WVYeager, Whitney, Carigsville, WV

Peterson, Steven, Moorcroft, Wy*Scott, Tiffany, Casper, WyStarkey, Jeff, Casper, Wy*Summerall Jr, Paul, Casper, Wy*

Aird, Renrick, Travis AFB, Ca*Leach, Troy, APO, AE*Moyer, Lacresha, Dyess AFB, Tx

Davis, Juanita, Calgary, Ab, CanadaEspino, Maria, Dorado, Puerto RicoGuimaraes, Shirley, Taguatinga, BrazilHang, Liang-Wen, Taichung, TaiwanMcCoy, Carolyn, Quispamsis, Nb, CanadaMidley, Alejandro, Buenos Aires, ArgentinaWatkins, Lisa, Toronto, On, Canada

International Members

Military Members

Call For AbstractsFor the 2012 OPEN FORUM

in New Orleans, LAAll abstracts MUST be submitted online at

RCJournal.com

Visit RCJournal.com for more details!

Visit the Journal website today for allthe information on the easy way tosubmit your ideas.


For Sale/For Rent

RC Week SpecialsOakes’ Books now on your hospital com-puters and/or your personal I-Pad, tablet,laptop, or smartphone. Free tour @www.RespiratoryUpdate.com or 8 Oakes’books for $99. See www.RespiratoryBooks.com or call (207) 262-0123.

ClassifiedsADVERTISING SECTION

AARC Times Classified Advertising Information & Requirements:

Classified Word Advertisements AARC Members: $50 for 50 words or less; each ad-ditional word, $1. Free Internet placement. Non-members: $60 for 50 words or less; each additionalword, $1.20. Listings are categorized by state. Fol-lowing the state listings are United States/Interna-tional, For Sale/For Rent, Miscellaneous, andSituations Wanted. All copy should be typed double-spaced. All ads will be set in 8-point type. To calcu-late the cost per advertisement, a “word” isconsidered to be one or more letters, numbers, orspecial characters with a space before and after.

Ads are featured on the AARC website for one monthafter publication. Ad may only be placed on the web-site with an insertion order for placement in an AARCpublication. Ad is noncancel able after placement onthe website. NOTE: AARC Times reserves the right torefuse any advertisement not directly relevant to res-

piratory care. AARC Times does not endorse any ad-vertiser, its positions, practices, services, or products.

We reserve the right to make editorial changes forreasons of clarity and consistency. Every effort istaken to avoid mistakes, but AARC Times cannotbe responsible for clerical or printing errors.Deadline for Ad Placement/Cancellation Dead-line for ad placement and written cancellations forthe next available issue is December 24. Blind adsavailable. For Recruitment Advertising Informa-tion, Contact Classified Advertisement AndreaConté • Alhambra Plaza • 725 N. Highway A1A,Suite C-106 • Jupiter, FL 33477 • (561) 745-6793• Fax (561) 745-6795 • [email protected]

Recruitment Display Advertisements

For Recruitment Display Ad Rates, go tohttp://www.aarc.org/marketplace/media_kit/recruitment.pdf, or contact Tim Goldsbury and Associates, Alhambra Plaza, 725 N. Highway A1A,Suite C-106, Jupiter, FL 33477, (561) 745-6793,Fax (561) 745-6795

Respiratory Care InstructorThis position reports directly to theAssociate Dean – Health and Public Safety

Cincinnati State Technical and CommunityCollege (CSTCC) http://www.cincinnatistate.edu is a leading technical and communitycollege known for providing quality, affordableeducation to both degree-seeking and non-degree-seeking students. It offers more than100 degree programs and certificates and isnoted for its cooperative education program –the largest of its kind among two-year collegesin the U.S. In the 2010-11 academic year,nearly 20,000 students enrolled in CincinnatiState courses, which are offered in the day,evening and weekends.

DUTIES: Instruct students in respiratorycare in classroom, lab, and clinical settings.Advise students. Provide classroom teachingon all consortium campuses. Assist incoordination of clinical experiences.

SPECIFICATIONS: Bachelor’s degreerequired. Must be a registered respiratorytherapist (NBRC). Current Ohio RespiratoryCare state license required. Five years ofrespiratory care experience required. Recentteaching experience in respiratory careeither in classroom or clinical settingrequired. Experience teaching at acommunity college preferred. Experiencewith Pediatric care preferred. Currentclassroom technology experience preferred.

MINIMUM STARTING SALARY: $51,557

Application Procedure: Applicants mayapply on-line at www.cincinnatistate.edu(about CS, Human Resources, Employment,Faculty) . Please attach a resume and a listof three references. Finalists will be asked toprovide an original college transcript.

Calendar of Events

AARC & State Society Programs

April 17–19Great Falls, MTMontana State Respiratory ConferenceContact Bill Carmichael at [email protected] or (406) 455-5239

Submissions for thenext available issue are due Dec. 24.

For information onsubmitting calendarevents, contact: BethBinkley, AARC Times9425 N. MacArthurBlvd, Suite 100, Irving,TX 75063-4706 (972) 243-2272 Fax (972) 484-2720 E-mail [email protected]


AARC SummerForumJuly 13-15, 2012(Friday through Sunday)Santa Fe, New Mexico

Save the Dates for

Advertiser Index


CareFusion C4www.carefusion.com

CareFusion 7www.carefusion.com.revel

Cincinnati State Technical and Community College 62www.cincinnatistate.edu

Covidien 39solutions.covidien.com/content/rs-mcgrathmac

General Biomedical 12(800) 558-9449 www.GeneralBiomedical.com

Independence University 62(855) 477-1022 www.independence.edu

Instrumentation Industries, Inc. 12(800) 633-8577 (877) 633-8661 Faxwww.iiimedical.com

To advertise, contact: Tim Goldsbury, Advertising Sales, Alhambra Plaza, 725 N. Highway A1A, Suite C -106, Jupiter, FL 33477, (561) 745-6793, Fax (561) 745-6795, [email protected]. Or contact Beth Binkley, Advertising Assistant, Daedalus Enterprises, Inc., 9425 N. MacArthur Blvd.,

Suite 100, Irving, TX 75063-4706, (972) 243-2272, Fax (972) 484-2720, [email protected].

Company Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pg #

Masimo C2(800) 257-3810 www.masimo.com

Monaghan Medical 25(800) 833-9653 www.monaghanmed.com

Nonin Medical, Inc C3(800) 356-8874 www.onyxvantage.com

Oridion 11www.oridion.com

Pitt County Memorial Hospital 63www.pcmhcareers.com

Tri-anim 53(800) 874-2646 www.tri-anim.com

Company Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pg #

SUBSCRIBER LOYALTY GivesYou MORE EXPERIENCED

CANDIDATES44% of AARC Times subscribers have beenreading AARC Times magazine for morethan 15 years. Long-time subscribers aremore likely to read publications regularlyand respond to advertisements at higherrates. SOURCE: READEX 2003 RESPIRATORY CARE COMPANION SURVEY

☛ AARC Members save money with lowerrecruitment rates than non members.

☛ The lowest recruitment rates in respiratory care.

☛ Immediate Internet Exposure with everyrecruitment ad insertion on line in theAARC Career page (posted online within24 hours of receipt) – seen by 2.2 millionvisitors annually.

☛ Reach candidates in all specialties and care settings.

☛ AARC Times magazine and RESPIRATORY

CARE Journal are the only official publications of the AARC.

Everyone is looking for respiratorytherapists, but there is only one placeto find professional, experienced, andhighly skilled respiratory therapists.You’ll find them reading the AARC’sAARC Times magazine. Unlike othermagazines, our readers have

demonstrated theirprofessionalism by joining theAmerican Association

for Respiratory Care.

CALL JAMES FOR SOLUTIONS FOR YOUR

RECRUITMENT ADVERTISING.

CALL: (561) 745-6793EMAIL: [email protected]

FIND PROFESSIONAL, EXPERIENCED, AND SKILLED RTS AT THE AARCR E S P I R A T O R Y D I R E C T O R S / S U P E R V I S O R S / H U M A N R E S O U R C E M A N A G E R S

Documents

36 - pneumologonava.com · Marsha Cathcart at [email protected]. Letters from members will be considered for publication if they re-late to specific articles appearing in AARC Tımes