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identifi ed the common presenting symptoms of PAH as dyspnea on exertion, edema, fatigue, and chest pain; in this registry, the median time between P ulmonary arterial hypertension 1 (PAH) is an uncommon disorder characterized by abnormal increases in pulmonary artery pressure (PAP), normal pulmonary capillary wedge pressure (PCWP), and increased pulmonary vascular resistance (PVR). 2 PAH results in right ventricular pressure/volume overload leading to right ventricular failure and death. 3 Patients with PAH are often diagnosed late in the course of the disease when the pathologic changes are advanced and irreversible. [4][5][6][7] Diagnosis of PAH at this stage is associated with poor prognosis for survival, 8,9 underscoring the importance of early disease recognition and treatment. Abbreviations: 6MWD 5 6-min walk distance; LVEDP 5 left ventricular end-diastolic pressure; PAH 5 pulmonary arterial hypertension; PAP 5 pulmonary artery pressure; PCWP 5 pulmonary capillary wedge pressure; PVR 5 pulmonary vascular resistance; RAP 5 right atrial pressure; REVEAL 5 Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management; RHC 5 right-sided heart catheterization

Two studies addressed alternative explanations for 3 pieces of evidence supporting the existence of moral hypocrisy. In Study 1, no support was found for the idea that low salience of social standards accounts for falsifying the result of a coin flip to assign oneself a more desirable task. In Study 2, no support was found for the idea that responses of those who honestly win the flip account for the higher ratings of morality of their action by participants who assign themselves the more desirable task after flipping the coin. Also, no support was found for the idea that responses of those who honestly win the flip account for the inability of personal moral responsibility measures to predict moral action. Instead, results of both studies provided additional evidence of moral hypocrisy.

Objective To investigate the cross-sectional association between COPD severity and disturbed sleep and the longitudinal association between disturbed sleep and poor health outcomes. Methods 98 adults with spirometrically-confirmed COPD were recruited through population-based, random-digit telephone dialing. Sleep disturbance was evaluated using a 4-item scale assessing insomnia symptoms as: difficulty falling asleep, nocturnal awakening, morning tiredness, and sleep duration adequacy. COPD severity was quantified by: FEV1 and COPD Severity Score, which incorporates COPD symptoms, requirement for COPD medications and oxygen, and hospital-based utilization. Subjects were assessed one year after baseline to determine longitudinal COPD exacerbations and emergency utilization and were followed for a median 2.4 years to assess all-cause mortality. Results Sleep disturbance was cross-sectionally associated with cough, dyspnea, and COPD Severity Score but not FEV1. In multivariable logistic regression, controlling for sociodemographics and body-mass index, sleep disturbance longitudinally predicted both incident COPD exacerbations (OR=4.7; p=0.018) and respiratory-related emergency utilization (OR=11.5; p=0.004). In Cox proportional hazards analysis, controlling for the same covariates, sleep disturbance predicted poorer survival (HR=5.0; p=0.013). For all outcomes, these relationships persisted after also controlling for baseline FEV1 and COPD Severity Score. Conclusions Disturbed sleep is cross-sectionally associated with worse COPD and is longitudinally predictive of COPD exacerbations, emergency health care utilization, and mortality.