Environmental Impact Essay Example | Topics and Well Written Essays - 4500 words

Environmental Impact - Essay Example This paper illustrates that in making the judgments on the various broad impacts identified in the preceding section, it was considered that two major impacts – that on human beings and on the flora and fauna – were of equal importance: the first, because of their direct impact on humans at present, and the second, because of their protracted impact well into the future that will affect succeeding generations of humans and the ecology and biosphere of the broader environment. The significance criteria employed in the following discussions were adapted from the United Nations University EIA Significance Criteria. The subsequent explanation based on the criteria, the mitigation measures, and the residual impacts follow thereafter. a. Effects on human beings, buildings and man-made features Significance Criteria 1) Disturbance to human settlements 2) Adverse effects on safety 3) Adverse effects on human health 4) Loss of areas or environmental components that have cultural , recreational or aesthetic value; 5) Disturbance to economic activities 6) Increase in ambient and peak noise levels. Disturbance to human settlements Traffic is expected to increase significantly in five major areas, but there currently is a good amenity for the Gipsy Lane (180% increase in traffic) while Thurmaston Lane (105% increase) passes through the industrial environment. Sandhills Avenue, where traffic is expected to increase most (695% increase) has good amenity with adjoining free space which may later be factored in to accommodate the increase in traffic. For these three areas, and therefore the negative impact is not expected to be substantial.

Business Entities Case Study Example | Topics and Well Written Essays - 500 words

Business Entities - Case Study Example This is especially important in the aviation industry since the risk of loss is considerably higher as the investment is higher. Therefore if the company faces any loss, Stanton would not have to bear the loss from his individual pocket. Most entities formed in the aviation industry as limited liability companies because of this main reason (Speciale, 2006). Another benefit of his form of business entity is that Stanton can choose this own tax paying option. As a member of the LLC, Stanton can chose to either be taxed as a sole proprietorship as he was doing before of he can choose to be taxed as partnership or a corporation. Since Stanton would have to pay low taxes as a sole proprietor given the current tax rates, he should opt for taxing his LLC as sole proprietor (Speciale, 2006). However, turning the business into an LLC is not without its cons. Stanton would have to face certain disturbances in the business. This primarily includes filing the proper paperwork for turning the company into an LLC which is a long process. Changing the company from sole proprietorship to Limited Liability Company also requires certain investment and the company is no longer a small company operated by one single owner. Also when new members would enter the business, the paperwork for the company would naturally increase as for every major decision, written approvals from the members would be required (Speciale, 2006). Apart from this, Stanton, by choosing to form an LLC would require new members to join the company. This, in turn, would mean loss of full control over the company. Right now, Stanton is the only investor, manager and controller of the business and therefore he can make any decisions regarding the business. However, when new members will bring their investment in the business, they would demand certain control over the business. As a result, control over the decision making process would be shared (Speciale, 2006). Also Stanton would now

Daoism as a way as systems thinking Essay Example | Topics and Well Written Essays - 2000 words

Daoism as a way as systems thinking - Essay Example ophers from the nearest past made conclusion that forwarded them to system thinking: we are surrounded by interdependent natural and non-natural systems. Complexity of our lives makes us to face great number of natural and non-natural systems, which are often difficult for our understanding but we cannot escape from their effect. To generalize, we can say that our live is a period when we learn how to face, co-exist, comprehend or overcome systems that creates problems on our way. So we watch and deal ever changing systems that form us and we form them. As mentioned earlier system thinking appeared long ago it was defined in 1956. In the essay I will turn to system thinking in Daoism and how the ideas touches modern world. I will overview the following points in Daoism in terms of system thinking: nature, human being, technology, and organization. Daoism is often considered to be an important argument when talking about nature and environmental problems. And it is quite true, if you overview different world wide religions, as Christianity or Islam, you are unlikely to find so many statements about nature and importance of nature in the system of human life. Therefore Daoism it taken as a first source of ecological research and promotion of co-existence with nature in the world complex. Though environmental trends in Daoism have been revealed only recently and up to the 80s texts of the Daoist teachers, e.g. Daode jing and Zhuangzi were only magical and mystical for the common public, only in-depth research of the text and in some way fashionable feng shui trend in the western countries, helped to show the public that Daoism was on much extent study about fears what human activity could do with nature and why people had to think before proceeding with any actions on the natural sites. The Taoist philosophy doesn’t take nature as a whole substance; Daoism treats it as a complex of elements that creates a whole system. In Daoism elements of nature are considered

The Best Form of Public Spending Essay Example | Topics and Well Written Essays - 250 words

The Best Form of Public Spending - Essay Example Nevertheless, there is a need for various governments to choose the appropriate and best way to spend resources. Since high poverty level is common in many countries, it, therefore, constitutes the biggest problem in the world. Statistics show that 50% of the world population lives below the poverty level of $ 2.50 a day. The actual numbers from the record estimate this number to be 3 billion people in the entire world. It, therefore, means that over half of the world population suffers since they live on less than $ 2.50 a day thus cannot afford to purchase most of their needs. Moreover, 22000 children die daily due to the effects of poverty in the world (Pogge, 2008). Thus, the best form of public spending entails allocating funds and using them to reduce and alleviate poverty. Â  The major function of every government is to protect its citizens from the effects of poverty. Supporting this reduces misery among the citizens thereby ensuring that they appreciate and support the government by being patriotic and loyal. Consequently, since high poverty increases the levels of depression, its reduction minimizes depression levels in citizens thus, improving the living standards (Coate, Knight & National Bureau of Economic Research, 2009). Through the allocation of adequate resources and using it in funding various projects aimed at reducing poverty levels and empowering its citizens, the government spends its resources in the best way possible. Â  In conclusion, the best form of public spending should be that with the greatest benefit to citizens. Thus, every government should strive at reducing the level of poverty in the world since this will curb human suffering and improve their living standards. However, this role should not only be left to the government. Individuals need to offer assistance to the government thereby ensuring the success of the initiative.

Child abuse Research Paper Example | Topics and Well Written Essays - 250 words - 1

Child abuse - Research Paper Example Neglect means â€Å"failure to provide for a child’s basic needs† (Joint Commission Resources, 2002, p. 6). Physical abuse include inflicting harm or injury to a child via burning, biting, or punching whereas physical neglect means failure to provide the child with basic necessities like food and shelter (Joint Commission Resources, 2002, p. 6). Emotional abuse include verbal or non-verbal actions that can cause a child to suffer from emotional, behavioural, or mental injury. Other than incest, sexual abuse includes rape cases, sexual intercourse, or touching the child’s genital areas (Dickey, 2013). This Convention serves as the â€Å"first legally binding international instrument to incorporate the full range of human rights—civil, cultural, economic, political and social rights† (Unicef, 2005). This Convention aims to educate the people about the child’s right to live, become educated, receive medical care assistance, and be protected from abusive people and exploitation (Rasooldeen, 2011; Unicef, 2005). In Islam, each child has a â€Å"right to life and equal life chances† (Islamweb, 2013). In fact, part of the 3rd commandment in Islam highlighted the need to preserve the child’s life. On top of the Islamic rule, Saudi has ratified the said Convention in 1996 (Rasooldeen, 2011). However, it is sad to say that child abuse remain rampant in Saudi Arabia (Dickey, 2013). Despite the Islamic rule about child protection and signing of the UN Convention on the Rights of the Child, child abuse still exists in Saudi Arabia. Therefore, people in this country should continuously fight for children’s rights to live in a safe environment. Dickey, C. (2013, February 8). The Daily Beast. Retrieved February 21, 2013, from Saudi Arabia’s Child-Rape Case: Female Activists Fight to Prevent Abuse:

EBay and Siebel Companies Essay Example for Free

EBay and Siebel Companies Essay EBay EBay is an American, online auction and shopping company in which people and businesses buys and sells goods and services worldwide over the internet. It is a well established company with localized websites in several other countries. The website was established in 1995 in San Jose, California by a French born Iranian computer programmer Pierre Omidyar (Patsuris, 2003). Anything can be sold at eBay as long as it is not an illegal. For example appliances, computers, furniture, equipments and vehicles are listed, bought and sold daily. Large international companies such as IBM sell their newest products and other services on eBay using competitive auctions and fixed-priced storefronts. The company has a well structured eBay express site that acts as a standard internet shopping site for consumers who own United States addresses. EBay generates revenue from a number of fees charged on its services based on various factors. Siebel Siebel systems Inc is a software company that deals in the design, development, marketing and support of customer relationship management (CRM) applicants. The company was founded by Thomas Siebel in 1993.  Initially it was known for its sales force automation products. Later, it expanded into the broader customer service applications that included customer relationship management (CRM) (Kerstetter, 2003). The company benefited from the explosive growth of the CRM market in the late 1990’s. By 1999, Siebel systems was the fastest growing company in United States. With growth of electronic commerce, Siebel formed strategic alliances and made several acquisitions to provide e-business solution for CRM and related areas. The two companies have for a long time experienced a massive growth. They have enjoyed prominence in the market since early 1990’s. However they seem to have taken totally different directions. Whereas eBay is still expanding incredibly, Siebel is on the verge of collapse. EBay has indeed developed superbly from its humble beginning. Currently, at least 30 million people buy and sell over 20 billion dollars in merchandise. Over 150, 000 entrepreneurs earn a living selling on eBay. The company provides a new way of doing business. EBay has an exceptional educational system that teaches people on how to sell on its website. It has a payment system that allows buyers to make electronic payments to sellers who can’t afford a merchant credit card account (Hof, 2003). The company has a different way of management in this era. Through the web, eBay citizens have a full time access to every activity performed in the company. The whole system is very transparent. Products and services are subjected to close scrutiny by customers before any business deal is undertaken. (Hof, 2003). The transparency involved in eBay business makes customers and vendors to be collaborators and colleagues. The company has a superb management that can be borrowed by many. It is based on cooperation and finesse not coercion and force. EBay executives work like civil servants rather than corporate managers (Hof, 2003). This enables the company to stay in touch with the needs of customers. This approach offers a lot of benefits to the company. Good management at eBay is shown by its financials. The company profits shot from 176 to 250 million dollars in the year 2002. Net sales from transaction fees on 15 million dollars in gross revenue hit 1. 2 billion dollars (Hof, 2003). This growth has made the company enjoy supremacy in the market. The company has done well to reduce problems of shipping goods, simplifying payments and cracking down crooks on the site. The company always listens to the needs of customers to improve its services. This is done through constant meetings with sellers and buyers asking for their opinions, complains, and suggestion to improve their services (Hof, 2003). As a result users feel part of the company and take necessary initiatives to expand the company’s economy. EBay has a well organized way ensuring security of its business. It has a special police unit that helps to crack down any fraud activities which can turn off prospective customers. It has a Trust and safety department staffed by several EBay employees all over the world (Hof, 2003). As businesses on EBay grow larger, the market is also expanding. As EBay is achieving financial supremacy Siebel takes an opposite route. Although the two companies started almost at the same level, Siebel currently faces a stiff competition from other companies. It has been on the down ward trend in recent years. The giant company of 1990’s has collapsed than its rivals. For example, revenue in 2002 lost by 22% to reach at 1. 5 million dollars. The stock price faced a massive drop by 94% to reach 8. dollars from its peak of 119 dollars in the year 2000 (Kerstetter, 2003). The company has lost touch with customers. Customers are extremely reluctant to buy company products. It has of recent past suffered from bad publicity, as customers show dissatisfaction. It has lost its strong ground to corporate application leader (SAP). The reputation of the company has been lost. In 2002 the company’s share of customer-management market flopped from 29% to 23% (Kerstetter, 2003). The company faces a managerial crisis. The management is continuously shuffled in pursue of the lost glory. Although the company has introduced new technologies, still the sales are growing weaker every year. However the leaders fail to acknowledge that a problem is looming in the company. As software market grows yearly, Siebel systems can no longer dominate it. The competition has grown so strong that Siebel might never recover. Research show that, the company revenue has been falling at an alarming rate. Many corporations that used to deal with the company currently prefer suppliers who offer broad range of integrated products like corporate planning and human resources (Kerstetter, 2003). The company has done little to decrease the growing number of dejected customers who have lost faith in the company. Many complain of having not met their target even after two years. However top managers still do not realize the problem. The company is trying to develop new technologies as a way of bouncing back to the market. However this is a big gamble. The competing companies like SAP have gained a lot of momentum and will still offer stiff challenge (Kerstetter, 2003). Siebel need to undertake major changes to enable it recover. However this is a journey that will need a total overhaul of the administration and a change in strategies. Unless an urgent step is taken, Siebel will collapse totally. The two companies EBay and Siebel differ a lot because of the path they follow. As EBay enjoys an upward surge to economic and financial superiority, Siebel is struggling a lot. The companies also not only differ in their fortunes but also in their administration setup. EBay has put all the necessary administrational techniques to ensure that the company competes favorably in the market. EBay tends to take into consideration the interests of the customers more than Siebel. The company still holds a lot of following from its customers who are increasing all over the world. The company has superb strategies that make them a force in today’s global market. Siebel need to go back to the drawing board if at all they hope to change the turn of events. The two companies offer a lot of lessons to business, management and all financial undertakings. It is evident that managerial skills are very vital in enabling companies to grow (Hof, 2003). Unless an exciting and creative management is in place, business undertakings can never achieve the best. The management ought to be enterprising and ready to undertake constant changes as a way of keeping the companies alive in the ever changing global market. It is also important to take note of the ever changing consumer needs. All business companies should direct their business towards the needs of consumers. Unless consumers have faith in the company, success will always be elusive. Many companies collapse due to failure to acknowledge the need to keep consumers always in mind. Companies should be ready to shift their short term objectives as consumer needs shift. Technology also plays a big role in the business industry. It is an important factor in any business undertaking. Successful companies embrace new and advanced technology to boast their output (Kerstetter, 2003). That is the only way that customers can stick to the company because of superior output. Companies should strive to embrace new technology to enable favorable competition in the market. It is also important for companies to undertake a thorough research always. Research enables them to read the market trends. In that way companies can be able to keep in touch with the latest market trends.  This can also help to shape the production channels according to the market trend. Companies and business enterprises ought to device means and ways of maintaining faith and trust of their customers. There should be a way of keeping customers hooked up to the company and opening it up for many others. Skillful management can enable companies achieve this. All successful businesses always keep these in mind. As long as a company has good management, respect and trust from customers, it will be easy to introduce new products in the market. EBay serves as an example to be followed by all business enterprises.

COPD with Cognitive Status in an Elderly Sample

COPD with Cognitive Status in an Elderly Sample COPD with Cognitive Status in an Elderly Sample using the Third National Health and Nutrition Examination Survey Dean Sherzai, MD MAS PhD(c), Rachel Schade, Sonia Vega, Ayesha Z. Sherzai, MD Author’s Affiliations: 1Department of Neurology and Neurological Sciences, Cedar Sinai Health System, Los Angeles, CA, USA; 2Keck Science Department, Pitzer College, Claremont, CA, USA; 3Department of Epidemiology and Biostatistics, Loma Linda School of Public Health, Loma Linda, USA; Department of Neurology, The Neurological Institute of New York, Columbia University Medical Center, New York, New York, USA. Keywords: COPD, cognitive status, dementia, aging Abstract Purpose: Chronic Obstructive Pulmonary Disease (COPD) has been associated with dementia and cognitive impairment. We attempted to assess the relationship between COPD and cognitive impairment in a nationwide database, the National Health and Nutrition Examination Survey (NHANES III). Methods: Data was analyzed from the NHANES III database, a nationally representative cross sectional observational study among older adults. The diagnosis of COPD was based on calculation of FEV1/FVC ratio, with a cutoff of 0.7. The odds of having poor cognitive status was assessed using logistic regression models between COPD and three cognitive tests (immediate recall, delayed recall, and serial subtraction tests), adjusted for demographic variables and medical comorbidities. Results: We identified 17,181,182 individuals with a diagnosis of COPD. The mean age of was 71.5  ± 0.19 years. In the crude model, there was a strong relationship between those with COPD and poor cognitive test scores. This relationship was strengthened in the multivariate model adjusted for demographic variables and vascular comorbidities, such that those with COPD had a higher odds of having impaired immediate recall (OR 2.56, 95% CI 1.44- 4.53), delayed recall (OR 3.10, 95% CI 1.73- 5.52), and serial subtraction tests scores (OR 2.74, 95% CI 1.17- 6.40). Conclusions: Individuals with COPD have a higher odds of having cognitive impairment in this large nationally representative database. Introduction Approximately 35.6 million currently suffer from dementia worldwide, and this number is expected to double by 2030 and triple by 2050 [1]. In the last few years we have become more cognizant of the importance of identifying cognitive decline at the earlier stages when it is more amenable to treatment. We have also become more knowledgeable about possible comorbidities that may propagate the process of cognitive decline and ultimate dementia. Causes of cognitive decline, and possible progression to dementia, are believed to be multifactorial. Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that affects more than 13.5 million people in the United States and has been associated with cognitive decline [2]. To date, there are no definitive treatments for dementia; therefore, much emphasis had been placed on the prevention of dementia, and identification of modifiable risk factors early in the disease process. Multiple studies have reported the association between COPD and either global cognitive deficits with the most severe deficiencies in specific cognitive domains such as perception, motor function or memory [3]. Despite the current body of evidence, the majority of studies are based on a single region, and there are a few studies that used a nationally representative data (Health and Retirement Study). Given that society is facing an increase in the rate of chronic diseases of aging [4], and the lack of large scale investigation on the relationship between COPD and diminished cognitive status, we analyzed this nationwide database, the National Health and Nutrition Examination Survey (NHANES III), to better elucidate this relationship. Materials and Methods NHANES III is a cross sectional health survey conducted by the National Center for Health Statistics (NCHS), performed from 1988 to 1994 in persons aged two months and older in the United States. NHANES has a multistage, probability sampling design used to select participants representative of the civilian, non-institutionalized US population. Our study population consisted of 39,488,973 adults 60 to 89 years. Of these, participants were included if they had measurements for spirometry and the cognitive tests. Based on The Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) standards, cases of COPD were defined based on the patient’s ratio of forced expiratory volume (FEV1) to the forced vital capacity (FVC). Patients with a ratio of less than 0.7 were classified with COPD. Our control group, patients without COPD, was classified by a ratio greater than 0.7. For the older population, NHANES-III measures cognitive status with three cognitive tests: an immediate a nd delayed logical verbal memory test from the East Boston Memory Test, a three word registration/memory task (â€Å"apple,† â€Å"table† and â€Å"penny†) and five serial subtractions by intervals of three. A point was awarded for every correct answer from the three word memory task and the logical verbal memory test. For immediate memory, using a summary score of logical memory (0-6 points) plus three word task (0-3 points), we considered less than 5 out of 9 points to be impaired (low), such that individuals with 0-4 were score ‘low’, and those scoring 5-9 were scored ‘high’. For delayed memory, a summary score of less than 4 out of 9 points was considered impaired (low). Both summary scores are consistent with previous NHANES-III reports. For the test of serial subtractions, any miscalculation during the five trials was considered impaired, and only a perfect score was considered ‘high’. The reported race and ethnicity includes non-Hispanic Whites, non-Hispanic Blacks, Mexican-Americans and ‘other’. Smoking was defined by a â€Å"yes† response to the following two questions: â€Å"Have you smoked at least 100 cigarettes during your entire life† and â€Å"Do you smoke cigarettes now†. These questions can be found on the NHANES III household adult questionnaire. Education was stratified in three categories: 12 (some college and beyond). We performed an X2 and t-test analysis to compare demographic characteristics between patients with COPD and patients without COPD. To assess the association between COPD and a low cognitive test score (with high score as reference) crude and adjusted logistic regression analysis were performed. Adjusted potential confounders were age, race-ethnicity, sex, BMI, education status and smoking. Appropriate NHANES-III weighted sampling was applied during this analysis. All data analyses were conducted using SAS (v 9.3; SAS Institute Inc., Cary, NC). Results Table 1 presents the demographics of the population. There were 17,181,182 individuals with COPD; 50.1% were females, 49.9% males and 85.9% were non-Hispanic White. The mean age for patients with COPD was 71.5 ±0.19. In both groups, patients had less than a high school education, were non-smokers and had both hospital and medical coverage. Majority of individuals with COPD scored low on each cognitive test as compared to those without COPD (Table 1). Coronary artery disease was the most prevalent comorbidity in patients with COPD (31.9%) and in patients without COPD (30.4%). In the unadjusted model, participants with COPD had increased odds of impaired scores on each of the three cognitive tests: the immediate recall (OR 2.18, 95% CI 1.81- 2.62), delayed recall (OR 2.25, 95% CI 1.87- 2.70) and serial subtraction test (OR 1.44, 95% CI 1.10-1.90). We then examined the association between COPD and the cognitive tests, initially adjusted by age and race, which diminished the relationship slightly for all three tests, but the relationship was rendered insignificant for the serial subtraction test (OR 1.29, 95% CI 0.95-1.69) (Table 2). Then, we adjusted for age, sex, height, body mass index and education, which did not change the relationship significantly. In the third model, further adjustment for race, poverty income ratio, and medical coverage did not appreciably change the relationship. In the last model, we additionally adjusted for vascular risk factors such as smoking, stroke, hypertension, CHF, diabetes and coronary artery disease. This increased the odds for poor scores for all three tests; immediate recall (OR 2.56, 95% CI 1.44- 4.53), delayed recall test (OR 3.10, 95% CI 1.73- 5.52), and serial subtraction (OR 2.74, 95% CI 1.17- 6.40). Discussion We were able to identify a strong association between COPD and diminished cognitive status across three common cognitive tests. Individuals with COPD had significantly greater odds of impaired verbal memory, and this relationship remained robust after adjusting for potential sociodemographic and vascular risk factors. The relationship between COPD and the serial subtraction test scores was rendered significant after it was adjusted for vascular risk factors. Despite evidence in the extant literature showing an association between race with cognitive status [10], race was not a factor in the relationship between COPD and cognitive status. Our results are consistent with a growing body of evidence that has revealed a strong association between COPD and poor cognitive function. In one of the largest epidemiological studies, The Health and Retirement Study (n=4,150), patients with severe and non-severe COPD had significantly lower cognitive test scores compared to healthy controls. In adjusted models, only patients with severe COPD had the lower scores on the cognitive tests [5]. Furthermore, a dose-response relationship between COPD severity and cognitive dysfunction was previously established, with more severe COPD cases performing worse on the cognitive tests [6]. Notably, a 2013 study demonstrated significantly reduced memory tests scores on the Mini Mental State Exam (MMSE) among patients with COPD but without hypoxemia [7]. Further evidentiary support for global cognitive impairment in patients with COPD was also shown in a study that observed significant differences in executive functioning, working memory, episod ic memory, processing speed, and visuospatial ability [8]. Recently, several COPD studies have combined cognitive testing with neuroimaging, which have revealed significant white matter pathology in this population, with varying degrees of cognitive impairment [8,9,10,11]. The mechanism by which COPD causes cognitive decline is not very clear. COPD results in hypoxemia and hypercapnia, which has been implicated in diminished cognitive status [3,5]. Recent imaging studies have pointed to possible microvascular damage [3], and other studies have implicated chronic inflammatory process causing cognitive decline [12]. Yet others believe that the hypoxic process may cause direct neuronal damage, glial activation and the generation of free radicals which could affect cognitive functioning [13]. Given the prevalence of both COPD and cognitive decline in the elderly population and a probable causal relationship, it is important to further investigate the mechanism underlying the relationship. Limitations As all studies, this one has many limitations that need to be visited. One of the limitations unique to our study was that majority of the individuals in our elderly NHANES population had less than high school education. Given that educations has repeatedly been found to be strongly correlated with resilient cognitive function as well as less susceptible to neurodegeneration, our results could have been confounded by the lower mean education level in our population[14-18]. Another limitation lies with the cognitive testing used by NHANES. Only three cognitive tests were utilized, which does not provide a comprehensive assessment of cognitive function. In addition, the cognitive tests used most likely overlap in the cognitive function they measure, not allowing for specificity. However, the cognitive variables have been validated as a good tool for testing memory [19]. Furthermore, the cross-sectional nature of this paper does not allow us to make a causal link. In addition, the restr icted scope of lifelong socioeconomic status is a limitation, which is strongly associated with both cognitive impairment and COPD. However, it has been demonstrated that individuals with poor socioeconomic status may have a higher risk of developing COPD and lower cognitive reserve [20,21]. The strengths of this study are its large, diverse representative sample, that provided extensive medical history and allowed for control of confounding variables, as well as the objective measure of cognitive impairment and COPD. Also, the spirometry data from NHANES III allowed for more accurate diagnosis of COPD. Conclusion We were able to demonstrate a strong relationship between COPD and diminished cognitive status. We were not able to demonstrate any effect of gender, race, as well as sociodemographic or vascular risk factors on this relationship between COPD and cognitive status. The independent relationship between COPD and cognitive status may provide us an important clue into the pathophysiology of dementia, which needs to be further explored. Declaration of Interest References Prince M, Bryce R, Albanese E, et al. The global prevalence of dementia: a systematic review and meta-analysis. Alzheimers Dementia 2013;9(1):63-75. Ford ES, Croft JB, Mannino DM, et al. COPD Surveillance- United States, 1999-2011 COPD Surveillance. Chest 2013;144(1):284-305. Dodd JW, Getov SV, Jones PW. Cognitive function in COPD. Eur Resp J 2010;35(4):913-922. Dall TM, Gallo PD, Chakrabarti R, et al. An Aging Population And Growing Disease Burden Will Require A Large And Specialized Health Care Workforce By 2025. Health Aff 2013;32(11):2013-2020. Rusanen M, Ngandu T, Laatikainen T, et al. Chronic obstructive pulmonary disease and asthma and the risk of mild cognitive impairment and dementia: a population based CAIDE study. Curr Alzheimer Res 2013;10(5):549-555. Li J, Huang Y, Fei GH. The evaluation of cognitive impairment and relevant factors in patients with chronic obstructive pulmonary disease. Respiration; International Review of Thoracic Diseases 2013;85(2):98-105. Gupta PP, Sood S, Atreja A, Agarwal D. A comparison of cognitive functions in non-hypoxemic chronic obstructive pulmonary disease (COPD) patients and age-matched healthy volunteers using mini-mental state examination questionnaire and event-related potential, P300 analysis. Lung India: official organ of Indian Chest Society 2013;30(1):5-11. Dodd J, Van Den Broek M, Jones P, Charlton R. S92 cognitive function cerebral white matter tract microstructure in COPD. Thorax 2011;66(Suppl 4):A43-A44. Charlton RA, Dodd JW, van den Broek M, et al. Can brain MRI explain cognitive decline in COPD? A pilot study. Eur Resp J 2010;38(Suppl 55):29-36. Chung A, van den Broek MD, Charlton RA, et al. Cognitive Function And Cerebral Functional Connectivity In COPD: A Resting State Functional Magnetic Resonance Imaging Study. Age 2012:65(68):20-27. Dodd JW, Chung AW, van den Broek MD, et al. Brain structure and function in chronic obstructive pulmonary disease: a multimodal cranial magnetic resonance imaging study. Am J Respir Crit Care Med 2012;186(3):240-245. Borson S, Scanlan J, Friedman S, et al. Modeling the impact of COPD on the brain. Int J Chron Obstruct Pulmon Dis 2008;3(3):429-434. Singh B, Mielke MM, Parsaik AK, et al. A Prospective Study of Chronic Obstructive Pulmonary Disease and the Risk for Mild Cognitive Impairment. JAMA Neurol 2014;71(5):581-588. Schmand B, Smit J, Lindeboom J, et al. Low education is a genuine risk factor for accelerated memory decline and dementia. J Clin Epidemiol 1997;50(9):1025-1033. Stern, Y. Cognitive reserve and Alzheimer disease. Alzheimer Dis Assoc Disord 2006;20(2),112-117. Ngandu T, von Strauss E, Helkala EL, et al. Education and dementia What lies behind the association? Neurology 2007;69(14):1442-1450. Scarmeas, N, Stern, Y. Cognitive reserve and lifestyle. J Clin Exp Neuropsychol 2003;25(5):625-633. McDowell I, Xi G, Lindsay J, et al. Mapping the connections between education and dementia. Journal of Clinical and Experimental Neuropsychology 2007;29(2):127-141. Albert M, Smith LA, Scherr PA, et al. Use of brief cognitive tests to identify individuals in the community with clinically diagnosed Alzheimers disease. Int J Neurosci. 1991;57:167-178. Eisner, MD, Blanc, PD, Omachi, TA, et al. Socioeconomic status, race and COPD health outcomes. J Epidemiol Community Health 2011;65(1):26-34. Stern, Y, Tang, M X, Denaro, J, et al. Increased risk of mortality in Alzheimers disease patients with more advanced educational and occupational attainment. Ann Neurol 1995;37(5):590-595. Table 1. Baseline characteristics by COPD status in the NHANES III population * p values derived from t test comparison of means of COPD by population characteristics SD = Standard deviation Table 2: Crude and adjusted odds ratio for COPD and cognitive tests among 17,134,886 individuals in the NHANES III population OR = odds ratio, CI = confidence interval, ref = reference Model 1: adjusted for age and race Model 2: adjusted for age, sex, height, BMI and education Model 3: Model 2 additionally controlled for poverty income ratio, race, and medical coverage Model 4: Model 3 additionally adjusted for stroke, coronary heart disease, hypertension, congestive heart failure, diabetes. 1