***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: OBJECTIVES To show that hearing loss has such a high prevalence in the older population to justify screening , if effective and acceptable methods are available ; and that population take-up and benefit can make a measurable outcome difference in quality of life . DESIGN A population study of people aged 55 - 74 years was undertaken . A clinical effectiveness study of differently organised screening programmes was carried out using a controlled trial to identify those who might benefit from intervention ( and the extent of the benefit ) . A retrospective case-control study examined the very long-term ( more than 10 years ) compliance of patients in using their hearing aids after early identification and determined the extent to which early-identified hearing-impaired people have better outcomes than equivalent people identified later . An examination of the costs and cost-effectiveness of different potential screening programmes was also undertaken . SETTING A population study was design ed in the UK , with specific stages being conducted in more depth on a sample of people from Nottingham and Southampton . The clinical effectiveness study was conducted in general practice s in Nottingham and Bath using a systematic or opportunistic screen . The retrospective case-control study compared a group of early-identified hearing aid users , with control matched for age , gender and occupation , in Cardiff , Glasgow and Manchester . PARTICIPANTS In Great Britain responses were obtained for 34,362 individuals from the postal question naire as part of a population study , 506 were interviewed , 351 were assessed for benefit from amplification and 87 were fitted with a hearing aid . The clinical effectiveness study received 1461 replies from the first-stage question naire screen , with 306 people assessed in the clinic , of whom 156 were fitted with hearing aids . The retrospective case-control study traced 116 previously fitted hearing aid users , who had been identified by a screen , and then conducted a case-control using 50 of these for whom complete data were available , matching with two control groups of 50 people . INTERVENTIONS The major prospect i ve interventions were to introduce amplification through offering people , with minimal hearing impairment , hearing aid(s ) in a rehabilitative setting . In the population study , aids were offered as a monaural in-the-ear ( ITE ) hearing aid and in the clinical effectiveness study people who met the criteria were r and omised to be offered two different ITE hearing aids to be fitted bilaterally . The retrospective case-control study used unilateral and bilateral hearing aids . MAIN OUTCOME MEASURES Prevalence of hearing problems and degree to which services meet need in 55 - 74-year age group .  Public acceptability and individual benefits of hearing screening and intervention as a function of demographic and hearing domain-specific characteristics . Improvement in quality of life . Screening costs and cost-effectiveness as a function of proposed programmes . RESULTS It was found that 12 % of people aged 55 - 74 years have a hearing problem that causes moderate or severe worry , annoyance or upset , 14 % have a bilateral hearing impairment of at least 35 dB hearing level ( HL ) and only 3 % currently receive intervention , through the use of hearing aids .  Good amplification was shown to benefit about one in four of this 55 - 74-year-old population and the degree of hearing loss predicted benefit well . Overall , there was a strong correlation between benefit from amplification and from using hearing aids . Question naires and audiometric screens gave good screening operating characteristics . The systematic screening programme was more acceptable and gave a better response than the opportunistic . About 70 % of those who were offered an aid accepted a bilateral fitting . This increased to 95 % for those with > or = 35 dB HL ( averaged over 0.5 , 1 , 2 and 4 kHz in the better ear ) . The retrospective case-control study showed that long-term hearing aid use was low , unless hearing impairment was quite high ( e.g. > 35 dB HL ) . Those identified early had greater benefit through additional years of use/better adaptation to use than those of the same age and hearing impairment who were fitted with hearing aids later . Different screening programmes were modelled . The 35 dB HL better ear average hearing impairment level was found to be a good , robust and justifiable target group for screening and here the most efficient and practicable method was to use two questions in primary care concerning hearing problems and a hearing screen using a pure tone at 3 kHz 35 dB HL . The average cost of the screening programme was 13 pounds per person screened or about 100 pounds if treatment costs were included . Making the conservative assumption that identification gives an extra 9 years using hearing aids , the costs of screening and intervention were in the range of 800 - 1000 pounds per quality -adjusted life-year when using the Health Utilities Index and about 2500 pounds using the Short Form 6 Dimensions metric . CONCLUSIONS A simple systematic screen , using an audiometric screening instrument , has been shown to be acceptable to people in the age range 55 - 74 years , is likely to provide substantial benefit and may be cost-effective to those in that target group . Hearing screening appears to meet the National Screening Committee 's criteria in most respects , provided screening is targeted at those with at least 35 dB HL better ear average . Based on the research carried out here there is sufficient evidence to support a larger and more definitive study of hearing screening . Further research into who should be referred for and benefit from audiological assessment and provision of hearing aid in a primary care trust setting is needed as is investigation into screening devices and the various aspects of introducing such a programme Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged Auditory training has long been advocated to enhance communication but has never been time or cost-effective . This article describes the concepts underlying the development of a home-based , interactive adaptive computer program design ed to engage the adult hearing-impaired listener in the hearing-aid-fitting process , provide listening strategies , build confidence , and address cognitive changes characteristic of the aging process . An investigation using a between-group , within-subject design with pre- and post-test objective and subjective measures was conducted at five clinical sites . Sixty-five subjects were r and omly placed into two groups , one receiving LACE ( Listening and Communication Enhancement ) immediately following baseline testing and one serving as a control for one month and then receiving training as a crossover group . Results showed statistically significant improvements for the trained subjects on all but one of the outcome measures . Barriers facing the widespread implementation of home-based aural rehabilitation are discussed Background Although feedback on performance is generally thought to promote perceptual learning , the role and necessity of feedback remain unclear . We investigated the effect of providing varying amounts of positive feedback while listeners attempted to discriminate between three identical tones on learning frequency discrimination . Methodology /Principal Findings Using this novel procedure , the feedback was meaningless and r and om in relation to the listeners ' responses , but the amount of feedback provided ( or lack thereof ) affected learning . We found that a group of listeners who received positive feedback on 10 % of the trials improved their performance on the task ( learned ) , while other groups provided either with excess ( 90 % ) or with no feedback did not learn . Superimposed on these group data , however , individual listeners showed other systematic changes of performance . In particular , those with lower non-verbal IQ who trained in the no feedback condition performed more poorly after training . Conclusions / Significance This pattern of results can not be accounted for by learning models that ascribe an external teacher role to feedback . We suggest , instead , that feedback is used to monitor performance on the task in relation to its perceived difficulty , and that listeners who learn without the benefit of feedback are adept at self-monitoring of performance , a trait that also supports better performance on non-verbal IQ tests . These results show that ‘ perceptual ’ learning is strongly influenced by top-down processes of motivation and intelligence A software system , SPATS ( patent pending ) , that tests and trains important bottom-up and combined bottom-up/top-down speech-perception skills  is described . Bottom-up skills are the abilities to identify the constituents of syllables : onsets , nuclei , and codas in quiet and noise as produced by eight talkers . Top-down skills are the abilities to use knowledge of linguistic context to identify words in spoken sentences . The sentence module in SPATS emphasizes combined bottom-up/top-down abilities in perceiving sentences in noise . The word-initial onsets , stressed nuclei , and word-final codas are ranked in importance and grouped into subsets based on their importance . Testing utilizes r and om presentation of all the items included in a subset . Training in Quiet ( SNR = 40 dB ) or in Noise ( SNR = 5 dB ) , is adaptively focused on individual listener 's learnable items of intermediate difficulty . Alternatively , SNR-adaption training uses Kaernbach 's algorithm to find the SNR required for a target percent correct . The unique sentence module trains the combination of bottom-up ( hearing ) with top-down ( use of linguistic context ) abilities to identify words in meaningful sentences in noise . Scoring in the sentence module is objective and automatic We assessed the effects of perceptual training of syllable identification in noise on nonsense syllable test ( NST ) performance of new ( Experiment 1 ) and experienced ( Experiment 2 ) hearing aid ( HA ) users with sensorineural hearing loss . In Experiment 1 , new HA users were r and omly assigned to either immediate training ( IT ) or delayed training ( DT ) groups . IT subjects underwent 8 weeks of at-home syllable identification training and in-laboratory testing , whereas DT subjects underwent identical in-laboratory testing without training . Training produced large improvements in syllable identification in IT subjects , whereas spontaneous improvement was minimal in DT subjects . DT subjects then underwent training and showed performance improvements comparable with those of the IT group . Training-related improvement in NST scores significantly exceeded improvements due to amplification . In Experiment 2 , experienced HA users received identical training and testing procedures as users in Experiment 1 . The experienced users also showed significant training benefit . Training-related improvements generalized to untrained voices and were maintained on retention tests . Perceptual training appears to be a promising tool for improving speech perception in new and experienced HA users This paper describes the first phase in the development of the Connected Speech Test ( CST ) . This test of intelligibility of everyday speech has been developed primarily for use as a criterion measure in investigations of hearing aid benefit . The test consists of  48 passages of conversationally produced connected speech .  Each passage contains 25 key words for scoring . All passages are of equal intelligibility for the average normal hearer . Key words vary in intelligibility within a passage but span the same intelligibility range in all passages . Several passages are administered , and the results averaged , to yield a single intelligibility score . For pairs of scores , each based on mean performance across 4 r and omly-chosen passages , the 95 % critical difference is estimated to be about 14 rationalized arcsine units ( rau ) . The performance-intensity function for the CST has a slope of 12 rau/dB signal-to-babble ratio . Investigations of the test are continuing with hearing-impaired listeners Objectives : The goal of this study was to create and vali date a new set of sentence lists that could be used to evaluate the speech perception abilities of hearing-impaired listeners and cochlear implant ( CI ) users . Our intention was to generate a large number of sentence lists with an equivalent level of difficulty for the evaluation of performance over time and across conditions . Design : The AzBio sentence corpus includes 1000 sentences recorded from two female and two male talkers . The mean intelligibility of each sentence was estimated by processing each sentence through a five-channel CI simulation and calculating the mean percent correct score achieved by 15 normal-hearing listeners . Sentences from each talker were sorted by percent correct score , and 165 sentences were selected from each talker and were then sequentially assigned to 33 lists , each containing 20 
    Output:
    
Although significant generalisation of learning was shown to untrained measures of speech intelligibility ( 11/13 articles ) , cognition ( 1/1 articles ) and self-reported hearing abilities ( 1/2 articles ) , improvements were small and not robust .
Where reported , compliance with  computer-based auditory training  was high , and retention of learning was shown at post-training follow-ups .
Our findings demonstrate that published evidence for the efficacy of individual computer-based auditory training for adults with hearing loss is not robust and therefore can not be reliably used to guide intervention at this time .