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Rationale: The identification of early chronic obstructive pulmonary disease (COPD) is essential to appropriately counsel patients regarding smoking cessation, provide symptomatic treatment, and eventually develop disease-modifying treatments. Disease severity in COPD is defined using race-specific spirometry equations. These may disadvantage non-White individuals in diagnosis and care. Objectives: Determine the impact of race-specific equations on African American (AA) versus non-Hispanic White individuals. Methods: Cross-sectional analyses of the COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) cohort were conducted, comparing non-Hispanic White (n = 6,766) and AA (n = 3,366) participants for COPD manifestations. Measurements and Main Results: Spirometric classifications using race-specific, multiethnic, and "race-reversed" prediction equations (NHANES [National Health and Nutrition Examination Survey] and Global Lung Function Initiative "Other" and "Global") were compared, as were respiratory symptoms, 6-minute-walk distance, computed tomography imaging, respiratory exacerbations, and St. George's Respiratory Questionnaire. Application of different prediction equations to the cohort resulted in different classifications by stage, with NHANES and Global Lung Function Initiative race-specific equations being minimally different, but race-reversed equations moving AA participants to more severe stages and especially between the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0 and preserved ratio impaired spirometry groups. Classification using the established NHANES racespecific equations demonstrated that for each of GOLD stages 1-4, AA participants were younger, had fewer pack-years and more current smoking, but had more exacerbations, shorter 6-minute-walk distance, greater dyspnea, and worse BODE (body mass index, airway obstruction, dyspnea, and exercise capacity) scores and St. George's Respiratory Questionnaire scores. Differences were greatest in GOLD stages 1 and 2. Race-reversed equations reclassified 774 AA participants (43%) from GOLD stage 0 to preserved ratio impaired spirometry. Conclusions: Race-specific equations underestimated disease severity among AA participants. These effects were particularly evident in early disease and may result in late detection of COPD. [ABSTRACT FROM AUTHOR]

The article looks at the inherent tensions between the ethical priorities of law enforcement and health care. it mentions that law enforcement officials (LEOs) commit to serve the community, whereas healthcare professionals (HCPs) commit to serving individual patients. It informs that health professionals might feel obligated to report incidents of suspected police use of excessive force, as advocates for their patients.

Summary A n experimental study was conducted to evaluate a training course in problem-solving and decision-making given to three levels of management at a large southeastern paper mill. The course was conducted early in 1963 by an instructor from a firm specializing in management development. Approximately fifty management personnel attended the course. The twenty-hour offering conducted during the afternoon and evening had as its objective to increase the speed and accuracy of problem-solving and decision-making by the course participants. Evaluation of the training program involved the utilization of three distinct methods of appraisal. A course-end questionnaire was used to obtain the reaction of trainees to the program. A controlled experiment was used to determine the effect of the training on learning. In addition, observations were made of trainee participation in the practical-work periods during the course to determine any relation between learning and amount and types of participation. The results of the course-end questionnaire indicated that trainees felt the course was worthwhile and the material learned could be used on the job. In the controlled experiment, the criteria of learning employed were performance on the Watson-Glaser Critical Thinking Appraisal and on problems similar to those used in the training program. The control group used in the experiment was made up of members of the top three levels of management at the West Virginia Pulp and Paper Company Mill at Charleston, South Carolina. The portion of the experiment to show the effect of the training on learning resulted in no significant improvement in scores on the test devices used. The observation of trainee participation during the practical-work periods of the training program added little to the overall results of the evaluation. It did substantiate some of the suggestions for improving the training; and it showed an improvement in the attitude of trainees on the last day of training over what it had been the first day. In view of the fact that the entire program lasted only twenty hours, it would probably have been presumptuous to expect a significant amount of improvement from the training. To realize improvement in learning and in performance on the job, it was recommended that the over-all program be continued. In this regard it was suggested that formal refresher training be given to the original participants at periodic intervals and that a longer program be conducted for subsequent participants. [ABSTRACT FROM AUTHOR]