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Current American Thoracic Society (ATS) standards promote the use of race and ethnicity-specific reference equations for pulmonary function test (PFT) interpretation. There is rising concern that the use of race and ethnicity in PFT interpretation contributes to a false view of fixed differences between races and may mask the effects of differential exposures. This use of race and ethnicity may contribute to health disparities by norming differences in pulmonary function. In the United States and globally, race serves as a social construct that is based on appearance and reflects social values, structures, and practices. Classification of people into racial and ethnic groups differs geographically and temporally. These considerations challenge the notion that racial and ethnic categories have biological meaning and question the use of race in PFT interpretation. The ATS convened a diverse group of clinicians and investigators for a workshop in 2021 to evaluate the use of race and ethnicity in PFT interpretation. Review of evidence published since then that challenges current practice and continued discussion concluded with a recommendation to replace race and ethnicity-specific equations with race-neutral average reference equations, which must be accompanied with a broader re-evaluation of how PFTs are used to make clinical, employment, and insurance decisions. There was also a call to engage key stakeholders not represented in this workshop and a statement of caution regarding the uncertain effects and potential harms of this change. Other recommendations include continued research and education to understand the impact of the change, to improve the evidence for the use of PFTs in general, and to identify modifiable risk factors for reduced pulmonary function.

The practice of using race or ethnicity in medicine to explain differences between individuals is being called into question because it may contribute to biased medical care and research that perpetuates health disparities and structural racism. A commonly cited example is the use of race or ethnicity in the interpretation of pulmonary function test (PFT) results, yet the perspectives of practicing pulmonologists and physiologists are missing from this discussion. This discussion has global relevance for increasingly multicultural communities in which the range of values that represent normal lung function is uncertain. We review the underlying sources of differences in lung function, including those that may be captured by race or ethnicity, and demonstrate how the current practice of PFT measurement and interpretation is imperfect in its ability to describe accurately the relationship between function and health outcomes. We summarize the arguments against using race-specific equations as well as address concerns about removing race from the interpretation of PFT results. Further, we outline knowledge gaps and critical questions that need to be answered to change the current approach of including race or ethnicity in PFT results interpretation thoughtfully. Finally, we propose changes in interpretation strategies and future research to reduce health disparities.

Background: The fractional exhaled nitric oxide (FENO) test is a point-of-care test that is used in the assessment of asthma. Objective: To provide evidence-based clinical guidance on whether FENO testing is indicated to optimize asthma treatment in patients with asthma in whom treatment is being considered. Methods: An international, multidisciplinary panel of experts was convened to form a consensus document regarding a single question relevant to the use of FENO. The question was selected from three potential questions based on the greatest perceived impact on clinical practice and the unmet need for evidence-based answers related to this question. The panel performed systematic reviews of published randomized controlled trials between 2004 and 2019 and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework to develop recommendations. All panel members evaluated and approved the recommendations. Main Results: After considering the overall low quality of the evidence, the panel made a conditional recommendation for FENO-based care. In patients with asthma in whom treatment is being considered, we suggest that FENO is beneficial and should be used in addition to usual care. This judgment is based on a balance of effects that probably favors the intervention; the moderate costs and availability of resources, which probably favors the intervention; and the perceived acceptability and feasibility of the intervention in daily practice. Conclusions: Clinicians should consider this recommendation to measure FENO in patients with asthma in whom treatment is being considered based on current best available evidence.

The typical partner dance venue will have a standardised layout conducive to the space’s function as a marketplace in which attendees can display their own bodies as commodities. Dancers in the venue will have invested time and money in training, clothing, and grooming to demonstrate the value of their bodies according to the dance’s typically heteronormative standards. The reward for successful marketing is physical access to other similarly well-marketed bodies. The social enforcement of this system occurs primarily at the moment between songs, when large numbers of attendees engage in a simultaneous process of partner selection.

Background: In March 2020, many elective medical services were canceled in response to the coronavirus disease 2019 (COVID-19) pandemic. The daily case rate is now declining in many states and there is a need for guidance about the resumption of elective clinical services for patients with lung disease or sleep conditions.Methods: Volunteers were solicited from the Association of Pulmonary, Critical Care, and Sleep Division Directors and American Thoracic Society. Working groups developed plans by discussion and consensus for resuming elective services in pulmonary and sleep-medicine clinics, pulmonary function testing laboratories, bronchoscopy and procedure suites, polysomnography laboratories, and pulmonary rehabilitation facilities.Results: The community new case rate should be consistently low or have a downward trajectory for at least 14 days before resuming elective clinical services. In addition, institutions should have an operational strategy that consists of patient prioritization, screening, diagnostic testing, physical distancing, infection control, and follow-up surveillance. The goals are to protect patients and staff from exposure to the virus, account for limitations in staff, equipment, and space that are essential for the care of patients with COVID-19, and provide access to care for patients with acute and chronic conditions.Conclusions: Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a dynamic process and, therefore, it is likely that the prevalence of COVID-19 in the community will wax and wane. This will impact an institutions mitigation needs. Operating procedures should be frequently reassessed and modified as needed. The suggestions provided are those of the authors and do not represent official positions of the Association of Pulmonary, Critical Care, and Sleep Division Directors or the American Thoracic Society.

The typical partner dance venue will have a standardised layout conducive to the space's function as a marketplace in which attendees can display their own bodies as commodities. Dancers in the venue will have invested time and money in training, clothing, and grooming to demonstrate the value of their bodies according to the dance's typically heteronormative standards. The reward for successful marketing is physical access to other similarly well-marketed bodies. The social enforcement of this system occurs primarily at the moment between songs, when large numbers of attendees engage in a simultaneous process of partner selection.

BackgroundObservational studies suggest that beta-blockers may reduce the risk of exacerbations and death in patients with moderate or severe chronic obstructive pulmonary disease (COPD), but these findings have not been confirmed in randomized trials.MethodsIn this prospective, randomized trial, we assigned patients between the ages of 40 and 85 years who had COPD to receive either a beta-blocker (extended-release metoprolol) or placebo. All the patients had a clinical history of COPD, along with moderate airflow limitation and an increased risk of exacerbations, as evidenced by a history of exacerbations during the previous year or the prescribed use of supplemental oxygen. We excluded patients who were already taking a beta-blocker or who had an established indication for the use of such drugs. The primary end point was the time until the first exacerbation of COPD during the treatment period, which ranged from 336 to 350 days, depending on the adjusted dose of metoprolol.ResultsA total of 532 patients underwent randomization. The mean (±SD) age of the patients was 65.0±7.8 years; the mean forced expiratory volume in 1 second (FEV1) was 41.1±16.3% of the predicted value. The trial was stopped early because of futility with respect to the primary end point and safety concerns. There was no significant between-group difference in the median time until the first exacerbation, which was 202 days in the metoprolol group and 222 days in the placebo group (hazard ratio for metoprolol vs. placebo, 1.05; 95% confidence interval [CI], 0.84 to 1.32; P = 0.66). Metoprolol was associated with a higher risk of exacerbation leading to hospitalization (hazard ratio, 1.91; 95% CI, 1.29 to 2.83). The frequency of side effects that were possibly related to metoprolol was similar in the two groups, as was the overall rate of nonrespiratory serious adverse events. During the treatment period, there were 11 deaths in the metoprolol group and 5 in the placebo group.ConclusionsAmong patients with moderate or severe COPD who did not have an established indication for beta-blocker use, the time until the first COPD exacerbation was similar in the metoprolol group and the placebo group. Hospitalization for exacerbation was more common among the patients treated with metoprolol. (Funded by the Department of Defense; BLOCK COPD ClinicalTrials.gov number, NCT02587351.).

Background: Spirometry is the most common pulmonary function test. It is widely used in the assessment of lung function to provide objective information used in the diagnosis of lung diseases and monitoring lung health. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for conducting spirometry. Improvements in instrumentation and computational capabilities, together with new research studies and enhanced quality assurance approaches, have led to the need to update the 2005 technical standards for spirometry to take full advantage of current technical capabilities.Methods: This spirometry technical standards document was developed by an international joint task force, appointed by the American Thoracic Society and the European Respiratory Society, with expertise in conducting and analyzing pulmonary function tests, laboratory quality assurance, and developing international standards. A comprehensive review of published evidence was performed. A patient survey was developed to capture patients experiences.Results: Revisions to the 2005 technical standards for spirometry were made, including the addition of factors that were not previously considered. Evidence to support the revisions was cited when applicable. The experience and expertise of task force members were used to develop recommended best practices.Conclusions: Standards and consensus recommendations are presented for manufacturers, clinicians, operators, and researchers with the aims of increasing the accuracy, precision, and quality of spirometric measurements and improving the patient experience. A comprehensive guide to aid in the implementation of these standards was developed as an online supplement.

Radon is the leading cause of lung cancer among non-smokers. Exposure in schools may be harmful to schoolchildren and staff. However, states differ considerably in their approaches to mandating radon testing and mitigaiton in schools. In this study, 126 survey responses were received and analyzed from parents of K-12 children in Vermont, USA. Qualitative data were obtained by interviewing two parents for their views and concerns about radon in schools. Our results showed that only 51% of parents believed that radon affects the lungs and only 39% identified it as a carcinogen. 91% believed their children's schools should act to address elevated radon levels and 87% supported mandated mitigation. These data suggest that there is already overwhelming support for radon regulation in schools among parents of K-12 children. Parents with children in elementary school were significantly more likely to support radon testing, mitigation, and legislation than parents with older children. This suggests that these parents may be strong advocates to encourage legislative action. Parents with more knowledge about radon were significantly more likely to support radon testing in schools. Educating parents about exposure to radon at school and its association with lung cancer could strengthen existing community support for legislation mandating radon testing and mitigation.

Rationale: Anxiety is a common comorbidity of chronic obstructive pulmonary disease (COPD) that is associated with higher morbidity and mortality. We evaluated three anxiety screening questionnaires: the Generalized Anxiety Disorder 7-Item Scale (GAD-7), the Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), and the Anxiety Inventory for Respiratory Disease (AIR).Objectives: To evaluate and compare the test performance characteristics of three anxiety screening questionnaires, using the Mini-International Neuropsychiatric Interview (MINI), version 7.0, as the "gold standard."Methods: Individuals with COPD were recruited at 16 centers. The MINI and questionnaires were administered by trained research coordinators at an in-person visit and readministered by telephone 2-4 weeks later. A composite score for the presence of any Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) anxiety disorder was computed, based on the MINI as the gold standard, compared with a participant screening positive on self-report measures for these analyses.Results: Two hundred and twenty eligible individuals with COPD were enrolled; 219 completed the study. Eleven percent were identified as having a DSM-V anxiety disorder, based on the MINI. Elevated anxiety symptoms based on questionnaires were 38% for the AIR, 30% for the GAD-7, and 20% for the HADS-A. Area under the receiver operating characteristic curve (AUC) was highest for the GAD-7 (0.78; 95% confidence interval [CI], 0.69-0.87), followed by the HADS-A (0.74; 95% CI, 0.64-0.84) and the AIR (0.66; 95% CI, 0.56-0.76). The AUC for the GAD-7 was significantly greater than for the AIR (P = 0.014). Sensitivity was not statistically different among the questionnaires: 77% for the GAD-7, 63% for the HADS-A, and 66% for the AIR. The HADS-A had the highest specificity, 85%, which was significantly higher than that of the GAD-7 (77%; P

Here we demonstrate how data from the clinical pulmonary function lab can help students learn about the principle of airway-parenchymal interdependence. We examined the relationship between airway conductance (Gaw) and lung volume (thoracic gas volume, TGV) in 48 patients: 17 healthy; 20 with emphysema, expected to have reduced airway-parenchymal interdependence; and 11 with pulmonary fibrosis, expected to have increased airway-parenchymal interdependence. Our findings support these expectations, with the slope of Gaw vs. TGV being steeper among those with pulmonary fibrosis and flatter among those with emphysema, compared to the slope of the healthy group. This type of analytic approach, using real-world patient data readily available from any pulmonary function laboratory, can be used to explore other fundamental principles of respiratory physiology. NEW & NOTEWORTHY: This report demonstrates how common data obtained from the clinical pulmonary function testing laboratory can be used to illustrate important principles of respiratory physiology. Here we show how the relationship between airway conductance and lung volume across different disease states reflects intrinsic differences in airway-parenchymal interdependence. [ABSTRACT FROM AUTHOR]

Over the past quarter-century, Celtic music has slowly declined on the global stage and been replaced as the de facto pan-European world music by a bricolage of Romani, klezmer and Balkan styles. These primarily East European musics have been adopted, adapted, fused, confused and ultimately claimed by northwestern Europeans as part of a wider project of reimagining their own identities in the post-Cold-war era. The music industry has not given a name to this trend, but the contributors to this volume have come to call it the ‘New Old Europe Sound’.

The Swedish band Räfven use the New Old Europe Sound to claim for themselves and their audiences a postnational, multicultural identity via Jewish and Romani cultural capital. The group facilitate their access to this capital by displacing their claim into a realm of magical realist theatrical fantasy, using (among other things) quasi-Aesopian animal archetypes in their imagery. They reinforce their claim by blurring the boundaries between identities—between human and animal, Romani and Jewish, Swedish and European, European and international, international and Jewish/Romani. Räfven deploy all of these mechanisms along multiple vectors, via liner notes, onstage patter, personae, and musical sound. Their claim functions primarily to promote anti-racist, pro-immigrant ideologies, by allowing both Räfven and their audiences to identify with groups known for their persecution and borderlessness. However, because Räfven is made up entirely of white ethnic Swedes with a primarily white audience, their self-fashioning as icons of multiculturalism also constructs racial homogeneity as unproblematic. Their work is thus just as likely to inspire activism (for audience members who are motivated to realise Räfven’s vision of a multicultural utopia) as complacency (for audience members who imagine that they already are a part of Räfven’s multicultural utopia).

Here I examine the music and discourse of two Swedish non-Jewish chamber klezmer bands, and their strategies for claiming klezmer and distancing it from Jews. One band claims that klezmer, having always been subject to travel and outside influence, was never really Jewish. The other suggests that klezmer was inherited by European non-Jews after the Holocaust. Both arguments are predicated on the Herderian nationalist denial of cultural ownership to landless peoples. I argue that these claims are ultimately about allowing Swedes to mitigate their anxieties concerning Middle-Eastern immigration, by granting them possession of a safely domesticated form of Easternness.

In this article I present an ethnotheory of the music/dance relationship in Swedish polska, based on dance fieldwork and interviews I have conducted with polska dance musicians. I discuss three mechanisms that these musicians use to communicate movement patterns to dancers: iteration (entrainment via repetition), metaphor (timbral weight conveying motional weight), and sympathy (musicians’ movements mapping dance movements). I then discuss how musicians use these mechanisms to control four motional parameters: pulsation (rate and consistency of tempo), lean (degree and direction of tilt over the dance axis) viscosity (level of perceived air resistance), and libration (degree and timing of vertical motion). The work is intended in part as a case study of how theories of both music and dance can benefit from a focused analysis of the relationship between those two domains, as well as how studies of music/dance relations can benefit from the application of ethnographic research techniques.

In the world of Swedish polska dancing, the move toward gender-neutral pedagogy has challenged the established gender hierarchies of the social dance scene. The best dancers are now trained in all possible couple configurations, and serve as models for the rest of the floor. Traditional gender relations tend to reassert themselves, however, when people use the dance to flirt. Men remain the overt agents of seduction, and women accept or reject their advances. I argue that for an egalitarian vision of the dance to become reality, everyone must have equal access to all techniques of flirtation and rejection. Gender-neutral pedagogy has given people the necessary tools, but progress has been slowed by broader social taboos on female sexual desire.