Paradoxical movement of the lower ribcage at rest and during exercise in COPD patients

Paradoxical inward displacement of the costal margin during inspiration is observed in many chronic obstructive pulmonary disease patients at rest but its importance is unclear.The current authors studied 20 patients (forced expiratory volume in one second 32.6 +/- 11.7, functional residual capacity 186 +/- 32% predicted) and 10 healthy controls at rest and during symptom-limited incremental exercise. With optoelectronic plethysmography, the phase shift between pulmonary and abdominal ribcage volumes and the percentage of inspiratory time the ribcage compartments moved in opposite directions were quantified, using control data to define the normal range of movement.Eight patients showed lower ribcage inspiratory paradox at rest (P+), while 12 patients did not (P-). This was unrelated to resting lung function or exercise tolerance. Total end-expiratory chest wall volume (EEVcw) increased immediately when exercise began in P+ patients, but later in exercise in P- patients. This difference in EEVcw was mainly due to a greater increase of end-expiratory pulmonary ribcage volume in P+ patients. During exercise, dyspnoea increased similarly in the two groups, while leg effort increased more markedly in the patients without paradox.In conclusion, lower ribcage paradox at rest is reproducible and associated with early-onset hyperinflation of the chest wall and predominant dyspnoea at end-exercise. When paradox is absent, the sense of leg effort becomes a more important symptom limiting exercise.British Lung FoundationEuropean Respiratory Society (ERS)ERS COEDPolitecn Milan, TBM Lab, Dipartimento Bioingn, I-20133 Milan, ItalyUniv Liverpool, Ctr Clin Sci, Univ Hosp Aintree, Liverpool L69 3BX, Merseyside, EnglandUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilEuropean Respiratory Society (ERS): 69Web of Scienc

Predicting Young Adults’ Intentions and Involvement in Alcohol-Influenced Aquatic Activity

Globally, alcohol consumption is a public health issue and a risk factor for drownings among young adults. While studies have identified a prominence of alcohol in youth drownings, little is known about the factors that influence young adults’ involvement in alcohol-influenced aquatic activity. The current study aimed to identify the predictors of young adults’ intention to participate, and past participation, in alcohol-influenced aquatic activity. A reliable and valid survey, informed by the Theory of Planned Behavior, was distributed to young adults (aged 18-24 years) educated in the UK and Australia. Cumulative odds ordinal logistic regressions with proportional odds were conducted to establish predictors. Overall, 182 participants completed the survey. Subjective norms (Wald χ2 (2) = 8.43, p = .015), cognitive attitudes (Wald χ2 (2) = 6.40, p = .041) and previous involvement (χ2 (1) = 8.98, p = .003) were significant predictors of intention, whilst the influence of friends (Wald χ2 (2) = 10.99, p = .004) and intention (Wald χ2 (2) = 10.80, p = .005) were significant predictors of behavior. Practitioners should enhance risk awareness and norm perceptions in prevention programs to encourage informed decision making in social aquatic situations

Monetary Policy, Regulation and Volatile Markets

Turmoil in financial markets causes reflection. Is monetary policy conducted in the most efficient way? Are regulatory and supervisory arrangements adequate when market volatility increases and financial institutions come under stress? In the present SUERF Study, we have collected the reflections by an outstanding group of top officials, researchers and observers. The editors are proud to be able to present their joint insights to SUERF readers. The papers were presented at the 27th SUERF Colloquium in Munich in June 2008: New trends in asset management: Exploring the implications.Financial markets, volatility, regulatory and supervisory arrangements, LATW, bubbles, monetary policy, asset prices, interest rate policy, LTCM, Basel II, MiFID, subprime, CDOs

One-year treatment with mometasone furoate in chronic obstructive pulmonary disease

Many patients with chronic obstructive pulmonary disease (COPD) are treated with twice daily (BID) inhaled corticosteroids (ICS). This study evaluated whether daily PM mometasone furoate administered via a dry powder inhaler (MF-DPI) was equally effective compared to twice daily dosing

Treatments for COPD

n/