***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: STUDY OBJECTIVES To develop a sleepiness scale devoid of semantic or geometric elements . DESIGN Subjects were asked to rank in order 7 cartoon faces representing degrees of sleepiness . We used Thurstone 's scaling procedure to transform these rankings into an interval scale , which allowed us to eliminate 2 of the faces . The remaining 5 faces were ranked again using other subjects . In a validation study , subjects rated their perceived level of sleepiness using our scale and other sleepiness scales . Employed shiftworkers and school-going children used our scale to assess its practical applicability . SETTING S Research and diagnostic sleep laboratories , pre- primary to tertiary institutions , shift-working industry . PARTICIPANTS Ethnically diverse healthy and sleep-disordered adults ( n = 490 ) , and school-going children ( n = 345 ) . MEASUREMENTS AND RESULTS Our faces scale correlated with the Karolinska Sleepiness Scale ( P < .05 ) , the Stanford Sleepiness Scale ( P < .04 ) , and a visual analog scale measuring sleepiness ( P < .0001 ) . Shiftworkers showed a time-on-task effect on the evening shift ( P < .0001 ) and a peak in sleepiness at 4:00 and 5:00 ( P < .0001 ) on the night shift . Eight to 10 year old children appeared sleepier than older children throughout a school day ( P < or = .02 ) and became sleepier as the day progressed ( P < .0001 ) . We confirmed that our scale measures sleepiness , uncontaminated by pain , anger , or happiness . CONCLUSIONS We have devised a sleepiness scale  suitable for people too young or insufficiently educated to employ more-conventional scales . We envisage the scale being used for diagnostic , therapeutic , and research purpose In this study , the authors sought to determine the effects of length and clarity on response rates and data quality for two food frequency question naires ( FFQs ) : the newly developed 36-page Diet History Question naire ( DHQ ) , design ed to be cognitively easier for respondents , and a 16-page FFQ developed earlier for the Prostate , Lung , Colorectal , and Ovarian ( PLCO ) Cancer Screening Trial . The PLCO Trial is a 23-year r and omized controlled clinical trial begun in 1992 . The sample for this sub study , which was conducted from January to April of 1998 , consisted of 900 control and 450 screened PLCO participants aged 55 - 74 years . Controls received either the DHQ or the PLCO FFQ by mail . Screenees , who had previously completed the PLCO FFQ at baseline , were administered the DHQ . Among controls , the response rate for both FFQs was 82 % . Average amounts of time needed by controls to complete the DHQ and the PLCO FFQ were 68 minutes and 39 minutes , respectively . Percentages of missing or uninterpretable responses were similar between instruments for questions on frequency of intake but were approximately 3 and 9 percentage points lower ( p < or = 0.001 ) in the DHQ for questions on portion size and use of vitamin/mineral supplements , respectively . Among screenees , response rates for the DHQ and the PLCO FFQ were 84 % and 89 % , respectively , and analyses of questions on portion size and supplement use showed few differences . These data indicated that the shorter FFQ was not better from the perspective of response rate and data quality , and that clarity and ease of administration may compensate for question naire length The purpose of this study was to develop and test the Verran and Snyder-Halpern ( VSH ) Sleep Scale , an instrument to subjectively measure sleep characteristics . Four major sleep factors and their associated characteristics were proposed for the Sleep Scale . Subjects completed three r and omly ordered sleep question naires on three consecutive weekday mornings within the first two hours after arising . Scales included the  VSH Sleep Scale , a sleep question naire and a sleep log .  The VSH Sleep Scale had a reliability coefficient of .82 ( theta ) . Construct validity was examined by factor analysis and correlations between Sleep Scale items and corresponding items on the two other study instruments . Scale validity also was assessed by the known groups method . Beginning support for the validity of the VSH Sleep Scale is provided It seems sensible to tailor treatments of  insomnia  in relation to the presenting characteristics of the sleeper and of the complaint . This report describes the first study formally to examine the comparative effectiveness of tailored and untailored ( r and omly allocated ) treatments . We developed a question naire to facilitate the design ing of individualized programmes . Results indicated that statistical analysis may underestimate the benefits of tailoring . Measures of clinical ly significant change , however , suggested that  tailored treatment though it may be highly effective , is no more so than stimulus control therapy Background : Insomnia is a prevalent health complaint that is often difficult to evaluate reliably . There is an important need for brief and valid assessment tools to assist practitioners in the clinical evaluation of insomnia complaints . Objective : This paper reports on the clinical validation of the  Insomnia Severity Index ( ISI )  as a brief screening measure of insomnia and as an outcome measure in treatment research . The psychometric properties ( internal consistency , concurrent validity , factor structure ) of the ISI were evaluated in two sample s of insomnia patients . Methods : The first study examined the internal consistency and concurrent validity of the ISI  in 145 patients evaluated for insomnia at a sleep disorders clinic . Data from the ISI were compared to those of a sleep diary measure . In the second study , the concurrent validity of the  ISI  was evaluated in a sample of 78 older patients who participated in a r and omized-controlled trial of behavioral and pharmacological therapies for insomnia . Change scores on the  ISI  over time were compared with those obtained from sleep diaries and polysomnography .  Comparisons were also made between ISI scores obtained from patients , significant others , and clinicians . Results : The results of Study 1 showed that the  ISI  has adequate internal consistency and is a reliable self-report measure to evaluate perceived sleep difficulties . The results from Study 2 also indicated that the ISI is a valid and sensitive measure to detect changes in perceived sleep difficulties with treatment . In addition , there is a close convergence between scores obtained from the ISI patient 's version and those from the clinician 's and significant other 's versions . Conclusions : The present findings indicate that the ISI is a reliable and valid instrument to quantify perceived insomnia severity . The ISI is likely to be a clinical ly useful tool as a screening device or as an outcome measure in insomnia treatment research As part of the Women 's Health Initiative Study , the 5-item Women 's Health Initiative Insomnia Rating Scale ( WHIIRS ) was developed . This article summarizes the development of the scale through the use of responses from 66,269 postmenopausal women ( mean age = 62.07 years , SD = 7.41 years ) . All women completed a 10-item question naire concerning sleep . A novel resampling technique was introduced as part of the data analysis . Principal-axes factor analysis without iteration and rotation to a varimax solution was conducted for 120,000 r and om sample s of 1,000 women each . Use of this strategy led to the development of a scale with a highly stable factor structure . Structural equation modeling revealed no major differences in factor structure across age and race-ethnic groups . WHIIRS norms for race-ethnicity and age subgroups are detailed The Sleep Disorders Question naire ( SDQ ) is a 176-item question naire design ed to diagnose the presence of common sleep disorders . This study set out to assess the validity of a Dutch translation of the SDQ . Scores on 145 question naires were analyzed . A cluster analysis of these scores revealed the following clusters : healthy , depression , insomnia , narcolepsy , and apnea . The cluster classification proved correct for 67 % of the subjects , as determined on the basis of polysomnography . These results show that the Dutch  SDQ  is a reasonably valid instrument for diagnosing sleep disorders 
    Output:
    
Sleep domains have been review ed , and several sleep instruments have been identified .