Gerard W. Frank

Identifying Chronic Obstructive Pulmonary Disease in Primary Care of Urban Underserved Patients: Tools, Applications, and Challenges

Among urban low-income and minority patients with compromised access or low adherence to primary care, exacerbations of unrecognized but symptomatic moderate to severe chronic obstructive pulmonary disease (COPD) cause avoidable emergency room visits and hospitalizations. Detection and management of COPD before a first exacerbation reduces morbidity and disability, forestalls cardiorespiratory complications, improves health-related quality of life, and reduces health care costs. However, current efforts in ascertainment and care of COPD have insufficiently improved outcomes in underserved groups. Effective COPD care requires access to detection and management resources: screening tools to identify who may have COPD, spirometric diagnosis, smoking cessation assistance, vaccinations, stage-appropriate pharmacotherapy, and rehabilitation. This article describes recent advances in tools suitable for assisting COPD identification in primary care practices and discusses their applications in urban underserved populations. The validated COPD Population Screener is readily understood by patients, self-scored, available online (www.copdscreener.com), and usable in community outreach as well as primary care settings. Symptom-based risk stratification with a validated questionnaire provides a rational trigger targeting limited spirometry resources to patients most likely to have COPD. Case finding is the first step of COPD management to reduce its individual and public health burden.

The crystal and molecular structure of 2-methylhexahelicene

The crystal structure of 2-methylhexahelicene, C27Ht8, which is isomorphous with that of 2-bromohexahelicene, has been refined with diffractometer data. Crystals grown from the racemic mixture are optically pure and have orthorhombic symmetry. The space group is P2t2121, with a= 17.561, b= 13.285, and c=7.733 A; Z=4. Refinement was carried out by full-matrix least-squares and converged to an R value (on Fo) of 0.045. The hexahelicene nucleus has an approximate twofold axis normal to the helix axis. A number of unusually short C-C bonds are found around the periphery of the helix, while those in the helix core are lengthened, a pattern found in other fused aromatic molecules. The overall average bond length is 1.41 + 0-02 ~. The medial rings are significantly distorted into a boat conformation, and the interplanar angle between the terminal rings is 54.8 °. Short intramolecular non-bonded contacts are found in the helix core, about 3 A for carbon-carbon interactions and 2.5/~, for carbon-hydrogen interactions. The molecule shows rigid-body libration about the helix axis.

Diffusing Capacity and Alveolar Volume

asked to police medical professionals and interfere in the doctorpatient relationship. This sets a dangerous precedent in which a document does not just give us the science about a somewhat controversial scenario but is asking the insurance industry and the US Food and Drug Administration to trump physician judgment in an area that is not black and white. In conclusion, we believe that this clinical commentary only creates more problems for the practicing clinician who is in the trenches and has only muddied up the trench for those of us who are in the field.