SAA is a novel blood biomarker of AECOPD that is more sensitive than CRP alone or in combination with dyspnea. SAA may offer new insights into the pathogenesis of AECOPD.

These findings provide insight into the central neurobiology of cough hypersensitivity and suggest that both central amplification of cough sensory inputs and reduced capacity to suppress cough motor behaviours define patients with problematic cough.

Respiratory viruses are associated with severe acute exacerbations of chronic obstructive pulmonary disease (COPD) in hospitalized patients. However, exacerbations are increasingly managed in the community, where the role of viruses is unclear. In community exacerbations, the causal association between viruses and exacerbation maybe confounded by random fluctuations in the prevalence of circulating respiratory viruses. Therefore, to determine whether viral respiratory tract infections are causally associated with community exacerbations, a time-matched case-control study was performed. Ninety-two subjects (mean age 72 yrs), with moderate to severe COPD, (mean FEV(1) 40% predicted), were enrolled. Nasopharyngeal swabs for viral multiplex polymerase chain reaction and atypical pneumonia serology were obtained at exacerbation onset. Control samples were collected in synchrony, from a randomly selected stable patient drawn from the same cohort. In 99 weeks of surveillance, there were 148 exacerbations. Odds of viral isolation were 11 times higher in cases, than their time-matched controls (34 discordant case-control pairs; in 31 pairs only the case had virus and in three pairs only control). Picornavirus (26), influenza A (3), parainfluenza 1,2,3 (2), respiratory syncytial virus (1), and adenovirus (1) were detected in cases while adenovirus (1) and picornavirus (2) were detected in controls. In patients with moderate or severe COPD the presence of a virus in upper airway secretions is strongly associated with the development of COPD exacerbations. These data support the causative role of viruses in triggering COPD exacerbations in the community.

Consumers make dietary decisions based on economic, physiologic, psychologic, sociologic and even spiritual considerations, with hardly a nod to societal implications (see, for example, Nestle, et. al, 1998). Eating in a developed country such as the United States becomes a social and family event, an act of pleasure, that goes far beyond the ingestion of the necessary nutrients to sustain life. People eat for both pleasure and as a biological necessity. This must be remembered if we are to understand the complex world of food choices, dietary quality, and change.Complexity necessitates simplification and abstraction. Human behavior is complex, economic relationships are complex, nutrition is complex; put them together and the entanglements are limitless. We must have a framework to help us sort though the possibilities; abstracting from the realities of life is a requirement, not a choice. Human behavior is so complex that to understand anything a great deal must be assumed. Differences of opinion are a natural outcome of intellectual inquiry. Joan Robinson probably said it best: "The analysis can be extended to any degree of refinement but the more complicated the question the more cumbersome the analysis. In order to know anything, it is necessary to know everything, but to talk about anything, it is necessary to neglect a great deal" (Robinson, 1941).Many forces, most outside the consumer's direct control, shape food demand and food consumption behavior. In Senate testimony more than 20 years ago, Dr. Winikoff of the Rockefeller Foundation said of nutrition, "it is affected by governmental decisions in the area of agricultural policy, economic and tax policy, export and import policy, and involves questions of food production, transportation, processing, marketing, consumer choice, income and education, as well as food palatability and availability. Nutrition is the end result of pushes and pulls in many directions, a response to the multiple forces creating the 'national nutrition environment" (Senate Report, 1977). We focus our attention on factors influencing consumer food choices.Our objective is to examine empirical evidence on the role and influence of economic factors, defined rather broadly, on food choices and subsequent hence, nutritional outcomes. It is not an exhaustive review, but rather we focus on selected studies whose conclusions appear to be supported by a preponderance of the literature. Our goal is to do this in a non-technical fashion. We examine factors such as food prices, household income, nutrition knowledge and awareness, time constraints and time preferences. We do break with the central design of the paper in the last section where we discuss some new, as yet unpublished, findings.