***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the quality of  spirometry performed in primary care practice and to assess the impact of formal training . DESIGN R and omized , controlled prospect i ve interventional study . SETTING Primary care practice , Auckl and City , New Zeal and . PARTICIPANTS Thirty r and omly selected primary care practice s r and omized to " trained " or " usual " groups . One doctor and one practice nurse were nominated to participate from each practice . INTERVENTIONS " Trained " was defined as participation in an " initial " spirometry workshop at week 0 and a " maintenance of st and ards " workshop at week 12 . " Usual " was defined as no formal training until week 12 , when participants they attended the same " initial " workshop provided for the trained group . The study duration was 16 weeks . Each practice was provided with a spirometer to be used at their clinical discretion . MEASUREMENTS AND RESULTS Spirometry data were uploaded weekly and analyzed using American Thoracic Society ( ATS ) criteria for acceptability and reproducibility . The workshops were assessed objective ly with practical and written assessment s , confirming a significant training effect . However , analysis of spirometry performed in clinical practice by the trained practitioners revealed three acceptable blows in only 18.9 % of patient tests . In comparison , 5.1 % of patient tests performed by the usual practitioners had three acceptable blows ( p<0.0001 ) . Only 13.5 % of patient tests in the trained group and 3.4 % in the usual group ( p<0.0001 ) satisfied full acceptability and reproducibility criteria . However , 33.1 % and 12.5 % of patient tests in the trained and usual groups , respectively ( p<0.0001 ) , achieved at least two acceptable blows , the minimum requirement . Nonacceptability was largely ascribable to failure to satisfy end-of-test criteria ; a blow of at least 6 s. Visual inspection of the results of these blows as registered on the spirometer for the presence of a plateau on the volume-time curve suggests that < 15 % were acceptable . CONCLUSIONS Although a significant training effect was demonstrated , the quality of the spirometry performed in clinical practice did not generally satisfy full ATS criteria for acceptability and reproducibility . Further study would be required to determine the clinical impact . However , the ATS guidelines allow for the use of data from unacceptable or nonreproducible maneuvers at the discretion of the interpreter . Since most of the failures were end-of-test related , the FEV1 levels are likely to be valid . Our results serve to emphasize the importance of effective training and quality assurance programs to the provision of successful spirometry in primary care practice This study examined the effect of the st and ing versus the sitting position on spirometric indices in 94 healthy non-obese adult subjects ( 41 men and 53 women ) with the order of testing r and omised . On average all the spirometric indices examined , except the peak expiratory flow rate , were higher in the st and ing compared to the sitting position although the change was only significant at the 5 % level for FEV1 in women . The fall in FEV1 with the change in position was statistically related to the ponderal index but not to age , height or the initial lung function level . A uniform posture for spirometry is recommended in epidemiological studies examining longitudinal trends in lung function , as well as in cross-sectional aetiological studies examining , for instance , the effects of environmental and /or occupational exposures . A uniform posture is also recommended for clinical studies which involve repeated measurements over time , for instance to measure the effect of treatment or the natural history of airways disease OBJECTIVE To investigate the effect of sitting posture on lung capacity and expiratory flow ( LC-EF ) and lumbar lordosis . DESIGN Repeated measures on 1 group of subjects in 4 postures . SETTING Laboratory . PARTICIPANTS Seventy able-bodied volunteers . INTERVENTIONS Postures were assumed r and omly : normal , with full ischial support and flat lumbar support ; slumped , with the pelvis positioned in the middle of seat while leaning against the backrest ; against the back part of the seat without ischial support ( WO-BPS ) , with partially removed ischial support and an enhanced lumbar support ; and st and ing . MAIN OUTCOME MEASURES For LC-EF , forced vital capacity , maximum forced expiratory flow , forced expiratory volume in 1 second , and peak expiratory flow ; and lumbar lordosis . RESULTS All LC-EF measures in st and ing were significantly superior to those in slumped and normal sitting , and 4 measures were significantly higher than in WO-BPS . In slumped sitting , LC-EF significantly decreased from that in normal sitting . WO-BPS sitting significantly increased 4 of the LC-EF measures from those in the normal sitting . Lumbar lordosis was the highest in st and ing and progressively decreased in WO-BPS , normal , and slumped sitting . CONCLUSIONS Slumped sitting significantly decreased LC-EF and lumbar lordosis . Because it increases the lumbar lordosis and promotes LC-EF , the WO-BPS posture may be a better seating option for people sitting for a prolonged time Background : To increase recognition of airflow obstruction in primary care , we compared two models of spirometry delivery in a target group at risk of chronic obstructive pulmonary disease ( COPD ) . Methods : A 6 month qualitative/quantitative cluster r and omised study in eight practice s compared opportunistic spirometry by “ visiting trained nurses ” ( TN ) with optimised “ usual care ” ( UC ) from  general practitioners ( GPs ) for smokers and ex-smokers , aged over 35 years . Outcomes were : spirometry uptake and quality , new diagnoses of COPD and GPs ’ experiences of spirometry . Results : In the eligible target population , 531/904 ( 59 % ) patients underwent spirometry in the TN model and 87/1130 ( 8 % ) patients in the UC model ( p<0.0001 ) . ATS spirometry st and ards for acceptability and reproducibility were met by 76 % and 44 % of tests in the TN and UC models , respectively ( p<0.0001 ) . 125 ( 24 % ) patients tested with the TN model and 38 ( 44 % ) with the UC model reported a pre-existing respiratory diagnosis ( p<0.0001 ) . Three months after spirometry , when the ratio of forced expiratory volume in 1 s/forced vital capacity ( FEV1/FVC ) was < 0.7 and no prior COPD diagnosis was reported , nine ( 8 % ) participants had a new doctor recorded COPD diagnosis in practice s with the TN model and two ( 8 % ) participants in practice s with the UC model . Mislabelling of participants with a diagnosis of COPD when FEV1/FVC was ⩾0.7 was present in both models prior to and after spirometry . GPs valued high quality spirometry and increased testing of patients at risk of COPD in the TN model . They identified limitations , including the need for better systematic follow-up of abnormal spirometry and support with interpretation , which may explain persisting underdiagnosis of COPD in practice records . Conclusions : Although opportunistic testing by visiting trained nurses substantially increased and improved spirometry performance compared with usual care , translating increased detection of airflow obstruction into diagnosis of COPD requires further development of the model . Trial registration number : Australian Clinical Trials Registry : registration No 12605000019606 OBJECTIVE To determine the ability of patients seen for acute asthma exacerbations in the emergency department ( ED ) to perform good- quality FEV(1 ) measurements . METHODS Investigators from 20 EDs were trained to perform spirometry testing as part of a clinical trial that included st and ardized equipment with special software-directed prompts . Spirometry was done on ED arrival and 30 min , 1 h , 2 h , and 4 h later , and during follow-up outpatient visits . MEASUREMENTS Study performance criteria differed from American Thoracic Society ( ATS ) guidelines because of the population acuity and severity of illness as follows : ability to obtain acceptable FEV(1 ) measures ( defined as two or more efforts with forced expiratory times > /= 2 s and time to peak flow < 120 ms or back-extrapolated volume < 5 % of the FVC ) and reproducibility criteria ( two highest acceptable FEV(1 ) values within 10 % of each other ) . RESULTS Of the 620 patients ( age range , 12 to 65 years ) , > 90 % met study acceptability criteria on ED arrival and 74 % met study reproducibility criteria . Mean initial FEV(1 ) was 38 % of predicted . Spirometry quality improved over time ; by 1 h , 90 % of patients met study acceptability and reproducibility criteria .  Patients with  severe airway obstruction  ( FEV(1 ) < 25 % of predicted ) were initially less likely to meet quality goals , but this improved with time . The site was also an independent predictor of quality . CONCLUSION When staff are well trained and prompt feedback regarding adequacy of efforts is given , modified ATS performance goals for FEV(1 ) tests can be met from most acutely ill adolescent and adult asthmatics , even within the first hour of evaluation and treatment for an asthma exacerbation Aims : To investigate the early pattern of longitudinal change in forced expiratory volume in 1 second ( FEV1 ) among new Chinese coal miners , and the relation between coal mine dust exposure and the decline of lung function . Methods : The early pattern of lung function changes in 317 newly hired Chinese underground coal miners was compared to 132 referents . This three year prospect i ve cohort study involved a pre-employment and 15 follow up health surveys , including a question naire and spirometry tests . Twice a month , total and respirable dust area sampling was done . The authors used a two stage analysis and a linear mixed effects model approach to analyse the longitudinal spirometry data , and to investigate the changes in FEV1 over time , controlling for age , height , pack years of smoking , mean respirable dust concentration , the room temperature during testing , and the group × time interaction terms . Results : FEV1 change over time in new miners is non-linear . New miners experience initial rapid FEV1 declines , primarily during the first year of mining , little change during the second year , and partial recovery during the third year . Both linear and quadratic time trends in FEV1 change are highly significant . Smoking miners lost more FEV1 than non-smokers . Referents , all age less than 20 years , showed continued lung growth , whereas the miners who were under age 20 exhibited a decline in FEV1 . Conclusion : Dust and smoking affect lung function in young , newly hired Chinese coal miners . FEV1 change over the first three years of employment is non-linear . The findings have implication s for both methods and interpretation of medical screening in coal mining and other dusty work : during the first several years of employment more frequent testing may be desirable , and caution is required in interpreting early FEV1 declines AIM To examine whether exposure to the Spirometry Fundamentals ™ CD-ROM results in improved quality of spirometry testing in primary care . METHODS Spirometry tests performed in 20 intervention and 19 control practice s were analysed using American Thoracic Society grade s A and B for ' passing ' and grade s C , D and F for ' failing ' . Intervention effects on spirometry quality were assessed using r and om effects multivariate logistic regression . RESULTS Adjusted analyses revealed no intervention effect . The likelihood of passing tests was higher in paediatrics-only practice s ( adjusted odds ratio ( AOR ) 2.60 , 95 % confidence interval ( CI ) 1.32 to 5.12 ; p=0.01 ) . Hospital or university-based clinics had a lower performance than private or community-based practice s in unadjusted analysis ( 7 % vs. 22 % passing tests ; p=0.05 ) . However , this relationship was not significant in adjusted analyses . CONCLUSIONS Spirometry Fundamentals ™ is insufficient to improve the quality of spirometry in primary care , suggesting the need for more comprehensive multifaceted training re sources RATIONALE Underst and ing normal lung development and aging in health and disease , both in men and in women , is essential to interpreting any therapeutic intervention . OBJECTIVES We aim ed to describe lung function changes in healthy never-smoking males and females , from adolescence to old age , and to determine the effects of smoking and those derived from quitting . METHODS Prospect i ve cohort study within all participants of the Framingham Offspring cohort who had two or more valid spirometry measurements during follow-up ( n = 4,391 ; age range at baseline 13 to 71 yr ) , with a median follow-up time of 23 years . MEASUREMENTS AND MAIN RESULTS To best fit the curves describing FEV(1 ) changes with age to raw data , we used a generalized additive model with smooth terms and incorporating the subject-specific ( longitudinal ) r and om effects . We found that : ( 1 ) healthy never-smoker females achieve full lung growth earlier than males , and their rate of decline with age was slightly , but not significantly , lower ; ( 2 ) smoking increases the rate of lung function decline , both in males and in females ; ( 3 ) there is a range of susceptibility to the effects of smoking . The presence of respiratory symptoms at baseline and /or a respiratory diagnosis during follow-up appears to identify a group of susceptible smokers ; and ( 4 ) quitting smoking has a beneficial effect at any age , but it is more pronounced in earlier quitters . CONCLUSIONS Lung function changes from adolescence to old age differ in males and females , smoking has similar deleterious effects in both sexes , and quitting earlier is better Lung function testing of a r and om population sample in the eight SAPALDIA ( Swiss study on air pollution and lung diseases in adults ) centres had to be performed simultaneously , within one year , by eight teams and 23 technicians 
    Output:
    
Effective technician training and feedback can improve the quality of spirometry testing .