human
***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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results INTRODUCTION A body of basic science and clinical research has been generated on the manual muscle test ( MMT ) since its first peer- review ed publication in 1915 . The aim of this report is to provide an historical overview , literature review , description , synthesis and critique of the reliability and validity of MMT in the evaluation of the musculoskeletal and nervous systems . METHODS Online re sources were search ed including Pubmed and CINAHL ( each from inception to June 2006 ) . The search terms manual muscle testing or manual muscle test were used . Relevant peer- review ed studies , commentaries , and review s were selected . The two review ers assessed data quality independently , with selection st and ards based on predefined method ologic criteria . Studies of MMT were categorized by research content type : inter- and intraexaminer reliability studies , and construct , content , concurrent and predictive validity studies . Each study was review ed in terms of its quality and contribution to knowledge regarding MMT , and its findings presented . RESULTS More than 100 studies related to MMT and the applied kinesiology chiropractic technique ( AK ) that employs  MMT  in its methodology were review ed , including studies on the clinical efficacy of MMT  in the diagnosis of patients with symptomatology . With regard to analysis there is evidence for good reliability and validity in the use of MMT for patients with neuromusculoskeletal dysfunction . The observational cohort studies demonstrated good external and internal validity , and the 12 r and omized controlled trials ( RCTs ) that were review ed show that MMT findings were not dependent upon examiner bias . CONCLUSION The MMT employed by chiropractors , physical therapists , and neurologists was shown to be a clinical ly useful tool , but its ultimate scientific validation and application requires testing that employs sophisticated research models in the areas of neurophysiology , biomechanics , RCTs , and statistical analysis Applied Kinesiology ( AK ) is a scientifically unproven method used in complementary medicine to recognize the (in)tolerance of dental material s. Test-retest reliability of AK was examined . The working hypothesis was the assumption that the reliability of AK would not exceed r and om chance . Two dentists qualified in AK examined 112 volunteers to determine individual (in)tolerance toward two dental composite material s. After the first examination , 31 subjects were excluded from further testing . At the end of the open test phase , 34 of 81 participants had been classified as “ tolerant ” , and seven as “ intolerant ” to both material s. The remaining 40 individuals showed a combination of either tolerant ( to material I)/intolerant ( to material II ) , or the reverse ( n = 20 each ) . Retrieval rate was tested under blind conditions . In 14 cases , the results of the open and blinded tests matched , whereas in 26 cases they did not ( 95 % confidence interval , 21%-52 % ; p = 0.98 ) . This outcome confirmed our working hypothesis OBJECTIVE To determine phobic and nonphobic subject response to a provocative threat stimulus and to determine variables that confound the response . DESIGN R and omized blind examiner test-retest of r and omized phobic and control subjects with qualitative , semistructured , informal postint-ervention interview . SETTING Private chiropractic clinic . SUBJECTS Thirteen phobic individuals , as determined by the Diagnostic and Statistical Manual of Mental Disorders , Third Edition-Revised ( DSM-III-R ) , and 14 control volunteer subjects . INTERVENTION Manual muscle testing  was performed while each subject viewed a threat stimulus ( i.e. , a cue word on a printed card ) . The results were recorded as " weak " or " strong . " RESULTS The analysis of data demonstrates poor inter- ( K = -0.19 ) and intraexaminer reliability ( K = -0.14(- ) + 0.29 ) the test for independence for valid muscle testing was strong for both examiners ( p = .462 , p = 1.00 ) . When confounding variables were corrected for , the validity of muscle testing increased to 91 % . CONCLUSION This preliminary inquiry demonstrates the need for musculoskeletal , attentional and presensitized subject variables to be controlled to ascertain if muscle testing can be reliably used as a tool to identify emotional arousal OBJECTIVES To investigate pathogenetic mechanisms related to the lacrimal and lymphatic gl and s in patients with thyroid-associated orbitopathy ( TAO ) , and the potential of applied kinesiology diagnosis and homeopathic therapeutic measures . DESIGN Prospect i ve . SETTING S/LOCATION Thyroid outpatient unit and a specialized center for complementary medicine ( WOMED , Innsbruck ; R.M. and H.M. ) . SUBJECTS Thirty-two ( 32 ) patients with TAO , 23 with a long-st and ing disease , and 9 showing discrete initial changes . All patients were euthyroid at the time of the investigation . INTERVENTIONS Clinical investigation was done , using applied kinesiology methods . Departing from normal reacting muscles , both target organs as well as therapeutic measures were tested . Affected organs will produce a therapy localization ( TL ) that turns a normal muscle tone weak . Using the same approach , specific counteracting therapies ( i.e. , tonsillitis nosode and lymph mobilizing agents ) were tested . OUTCOME MEASURES Change of lid swelling , of ocular movement discomfort , ocular lock , tonsil reactivity and Traditional Chinese Medicine criteria including tenderness of San Yin Jiao ( SP6 ) and tongue diagnosis were recorded in a grade d fashion . RESULTS Positive TL reactions were found in the subm and ibular tonsillar structures , the pharyngeal tonsils , the San Yin Jiao point , the lacrimal gl and , and with the functional ocular lock test . Both Lymphdiaral ( Pascoe , Giessen , Germany ) and the homeopathic preparation chronic tonsillitis nosode at a C3 potency ( Spagyra , Grödig , Austria ) counteracted these changes . Both agents were used therapeutically over 3 - 6 months , after which all relevant parameters showed improvement . CONCLUSIONS Our study demonstrates the involvement of lymphatic structures and flow in the pathogenesis of TAO . The tenderness of the San Yin Jiao point correlates to the above mentioned changes and should be included in the clinical evaluation of these patients The study investigated the effects of fatigue and task repetition  on the relationship between integrated electromyogram and force output during subjective clinical testing of upper extremity muscles . Muscles were studied under two conditions differing in the nature and duration of constant force production ( SHORT-F ) and ( LONG-F ) . The findings included a significant relationship between force output and integrated EMG , a significant increase in efficiency of muscle activity with task repetition , and significant difference between Force/integrated EMG ratios for muscles labeled “ Strong ” and “ Weak ” in the LONG-F condition . This supports Smith 's 1974 notion that practice results in increased muscular efficiency . With fatigue , integrated EMG activity increased strongly and functional ( force ) output of the muscle remained stable or decreased . Fatigue results in a less efficient muscle process . Muscles subjectively testing “ Weak ” or “ Strong ” yield effects significantly different from fatigue The effect of either the muscle spindle cell receptor technique of applied kinesiology or a placebo technique on isometric strength of the right quadriceps femoris muscle group was studied among 20 normal human subjects . Peak , perpendicular maximal values of isometric quadriceps femoris muscle force was measured by a force transducer . Three training sessions consisting of three trials of peak maximal contractions of the isometric quadriceps femoris muscle were performed by all subjects . After the three training sessions , matched pairs of subjects were formed from a r and order list of each subject 's mean values of isometric quadriceps femoris muscle strength on the third session . One subject of a matched pair was then r and omly assigned to either an experimental ( applied kinesiology ) or control ( placebo ) group for the testing session . No significant differences in mean values of isometric quadriceps femoris muscle strength between the matched pairs for control and experimental subjects were noted . Within the context of a normal population , the applied kinesiology technique does not appear to augment isometric quadriceps femoris muscle strength The pilot study attempted to determine whether subjective muscle testing employed by Applied Kinesiology practitioners , prospect ively determine those individuals with specific hyperallergenic responses . Seventeen subjects were found positive on Applied Kinesiology ( A.K. ) muscle testing screening procedures indicating food hypersensitivity ( allergy ) reactions . Each subject showed muscle weakening ( inhibition ) reactions to oral provocative testing of one or two foods for a total of 21 positive food reactions . Tests for a hypersensitivity reaction of the serum were performed using both a radio-allergosorbent test ( RAST ) and immune complex test for IgE and IgG against all 21 of the foods that tested positive with A.K. muscle screening procedures . These serum tests confirmed 19 of the 21 food allergies ( 90.5 % ) suspected based on the applied kinesiology screening procedures . This pilot study offers a basis to examine further a means by which to predict the clinical utility of a given substance for a given patient , based on the patterns of neuromuscular response elicited from the patient , representing a conceptual expansion of the st and ard neurological examination process The purpose of this study was to determine whether Educational Kinesiology ® integration movements or repatterning in conjunction with the integration movements affect the response times of college students to a visual stimulus . Ten men and ten women were r and omly assigned to each of the three conditions : control , Edu-K movement , or repatterned Edu-K movements . Each subject was pretested on simple and choice response-time tasks . Following the pretest , subjects in the control group sat quietly for 10 minutes . The movement group utilized seven Brain Gym ® activities . Subjects in the repatterned group experienced Dennison 's Laterality Repatterning prior to doing the same Brain Gym activities . All subjects were then retested to assess changes in performance using 30 trials of each task . Statistical analyses indicated significant differences in improvement between the groups on the 4-choice task , with the repatterned group showing greater change than the Edu-K movement-only group , who in turn showed greater improvement than the control group . The groups improved by 6 % , 31/2 % , and 1 % , respectively . No group differences were significant on the simple task , although a similar trend was indicated . Men responded faster than women on both tasks ; however , the amount of improvement was similar for both Applied kinesiology is a technique used to assess nutritional status on the basis of the response of muscles to mechanical stress . In this study , 11 subjects were evaluated independently by three experienced applied kinesiologists  for four nutrients ( thiamin , zinc , vitamin A , and ascorbic acid ) . The results obtained by those applied kinesiologists were compared with ( a ) one another , ( b ) st and ard laboratory tests for nutrient status , and ( c ) computerized isometric muscle testing . Statistical analysis yielded no significant interjudge reliability , no significant correlation between the testers and st and ard biochemical tests for nutrient status , and no significant correlation between mechanical and manual determinations of relative muscle strength . In addition , the subjects were exposed in a double-blind fashion to supplements of thiamin , zinc , vitamin A , and ascorbic acid and two placebos ( pectin and sucrose ) and then re-tested . According to applied kinesiology theory , " weak " ( indicating deficiency ) muscles are strengthened when the subject is exposed to an appropriate nutritional supplement . Statistical analysis revealed no significant differences in the response to placebo , nutrients previously determined ( by muscle testing ) to be deficient , and nutrients previously determined ( by muscle testing ) to be adequate . Even though the number of subjects ( 11 ) and nutrients ( 4 ) tested was limited , the results of this study indicated that the use of applied kinesiology to evaluate nutrient status is no more useful than r and om guessing OBJECTIVES To assess the test-retest-reliability and validity of the Health Kinesiology muscle test . PATIENTS Seven patients with clinical ly and allergologically confirmed wasp venom allergy . DESIGN Four Health Kinesiology-examiners tested each patient in a r and om order for 10 verum and 10 placebo bottles . All examiners used the anterior deltoid as indicator muscle . Patients and examiners were completely blinded . OUTCOME MEASURES Weak muscle holds were rated as ' sensitivity ' towards the 
    Output:
    
agent
Conclusion : There is insufficient evidence for diagnostic accuracy within kinesiology , the validity of muscle response and the effectiveness of kinesiology for any condition .
***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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results INTRODUCTION A body of basic science and clinical research has been generated on the manual muscle test ( MMT ) since its first peer- review ed publication in 1915 . The aim of this report is to provide an historical overview , literature review , description , synthesis and critique of the reliability and validity of MMT in the evaluation of the musculoskeletal and nervous systems . METHODS Online re sources were search ed including Pubmed and CINAHL ( each from inception to June 2006 ) . The search terms manual muscle testing or manual muscle test were used . Relevant peer- review ed studies , commentaries , and review s were selected . The two review ers assessed data quality independently , with selection st and ards based on predefined method ologic criteria . Studies of MMT were categorized by research content type : inter- and intraexaminer reliability studies , and construct , content , concurrent and predictive validity studies . Each study was review ed in terms of its quality and contribution to knowledge regarding MMT , and its findings presented . RESULTS More than 100 studies related to MMT and the applied kinesiology chiropractic technique ( AK ) that employs  MMT  in its methodology were review ed , including studies on the clinical efficacy of MMT  in the diagnosis of patients with symptomatology . With regard to analysis there is evidence for good reliability and validity in the use of MMT for patients with neuromusculoskeletal dysfunction . The observational cohort studies demonstrated good external and internal validity , and the 12 r and omized controlled trials ( RCTs ) that were review ed show that MMT findings were not dependent upon examiner bias . CONCLUSION The MMT employed by chiropractors , physical therapists , and neurologists was shown to be a clinical ly useful tool , but its ultimate scientific validation and application requires testing that employs sophisticated research models in the areas of neurophysiology , biomechanics , RCTs , and statistical analysis Applied Kinesiology ( AK ) is a scientifically unproven method used in complementary medicine to recognize the (in)tolerance of dental material s. Test-retest reliability of AK was examined . The working hypothesis was the assumption that the reliability of AK would not exceed r and om chance . Two dentists qualified in AK examined 112 volunteers to determine individual (in)tolerance toward two dental composite material s. After the first examination , 31 subjects were excluded from further testing . At the end of the open test phase , 34 of 81 participants had been classified as “ tolerant ” , and seven as “ intolerant ” to both material s. The remaining 40 individuals showed a combination of either tolerant ( to material I)/intolerant ( to material II ) , or the reverse ( n = 20 each ) . Retrieval rate was tested under blind conditions . In 14 cases , the results of the open and blinded tests matched , whereas in 26 cases they did not ( 95 % confidence interval , 21%-52 % ; p = 0.98 ) . This outcome confirmed our working hypothesis OBJECTIVE To determine phobic and nonphobic subject response to a provocative threat stimulus and to determine variables that confound the response . DESIGN R and omized blind examiner test-retest of r and omized phobic and control subjects with qualitative , semistructured , informal postint-ervention interview . SETTING Private chiropractic clinic . SUBJECTS Thirteen phobic individuals , as determined by the Diagnostic and Statistical Manual of Mental Disorders , Third Edition-Revised ( DSM-III-R ) , and 14 control volunteer subjects . INTERVENTION Manual muscle testing  was performed while each subject viewed a threat stimulus ( i.e. , a cue word on a printed card ) . The results were recorded as " weak " or " strong . " RESULTS The analysis of data demonstrates poor inter- ( K = -0.19 ) and intraexaminer reliability ( K = -0.14(- ) + 0.29 ) the test for independence for valid muscle testing was strong for both examiners ( p = .462 , p = 1.00 ) . When confounding variables were corrected for , the validity of muscle testing increased to 91 % . CONCLUSION This preliminary inquiry demonstrates the need for musculoskeletal , attentional and presensitized subject variables to be controlled to ascertain if muscle testing can be reliably used as a tool to identify emotional arousal OBJECTIVES To investigate pathogenetic mechanisms related to the lacrimal and lymphatic gl and s in patients with thyroid-associated orbitopathy ( TAO ) , and the potential of applied kinesiology diagnosis and homeopathic therapeutic measures . DESIGN Prospect i ve . SETTING S/LOCATION Thyroid outpatient unit and a specialized center for complementary medicine ( WOMED , Innsbruck ; R.M. and H.M. ) . SUBJECTS Thirty-two ( 32 ) patients with TAO , 23 with a long-st and ing disease , and 9 showing discrete initial changes . All patients were euthyroid at the time of the investigation . INTERVENTIONS Clinical investigation was done , using applied kinesiology methods . Departing from normal reacting muscles , both target organs as well as therapeutic measures were tested . Affected organs will produce a therapy localization ( TL ) that turns a normal muscle tone weak . Using the same approach , specific counteracting therapies ( i.e. , tonsillitis nosode and lymph mobilizing agents ) were tested . OUTCOME MEASURES Change of lid swelling , of ocular movement discomfort , ocular lock , tonsil reactivity and Traditional Chinese Medicine criteria including tenderness of San Yin Jiao ( SP6 ) and tongue diagnosis were recorded in a grade d fashion . RESULTS Positive TL reactions were found in the subm and ibular tonsillar structures , the pharyngeal tonsils , the San Yin Jiao point , the lacrimal gl and , and with the functional ocular lock test . Both Lymphdiaral ( Pascoe , Giessen , Germany ) and the homeopathic preparation chronic tonsillitis nosode at a C3 potency ( Spagyra , Grödig , Austria ) counteracted these changes . Both agents were used therapeutically over 3 - 6 months , after which all relevant parameters showed improvement . CONCLUSIONS Our study demonstrates the involvement of lymphatic structures and flow in the pathogenesis of TAO . The tenderness of the San Yin Jiao point correlates to the above mentioned changes and should be included in the clinical evaluation of these patients The study investigated the effects of fatigue and task repetition  on the relationship between integrated electromyogram and force output during subjective clinical testing of upper extremity muscles . Muscles were studied under two conditions differing in the nature and duration of constant force production ( SHORT-F ) and ( LONG-F ) . The findings included a significant relationship between force output and integrated EMG , a significant increase in efficiency of muscle activity with task repetition , and significant difference between Force/integrated EMG ratios for muscles labeled “ Strong ” and “ Weak ” in the LONG-F condition . This supports Smith 's 1974 notion that practice results in increased muscular efficiency . With fatigue , integrated EMG activity increased strongly and functional ( force ) output of the muscle remained stable or decreased . Fatigue results in a less efficient muscle process . Muscles subjectively testing “ Weak ” or “ Strong ” yield effects significantly different from fatigue The effect of either the muscle spindle cell receptor technique of applied kinesiology or a placebo technique on isometric strength of the right quadriceps femoris muscle group was studied among 20 normal human subjects . Peak , perpendicular maximal values of isometric quadriceps femoris muscle force was measured by a force transducer . Three training sessions consisting of three trials of peak maximal contractions of the isometric quadriceps femoris muscle were performed by all subjects . After the three training sessions , matched pairs of subjects were formed from a r and order list of each subject 's mean values of isometric quadriceps femoris muscle strength on the third session . One subject of a matched pair was then r and omly assigned to either an experimental ( applied kinesiology ) or control ( placebo ) group for the testing session . No significant differences in mean values of isometric quadriceps femoris muscle strength between the matched pairs for control and experimental subjects were noted . Within the context of a normal population , the applied kinesiology technique does not appear to augment isometric quadriceps femoris muscle strength The pilot study attempted to determine whether subjective muscle testing employed by Applied Kinesiology practitioners , prospect ively determine those individuals with specific hyperallergenic responses . Seventeen subjects were found positive on Applied Kinesiology ( A.K. ) muscle testing screening procedures indicating food hypersensitivity ( allergy ) reactions . Each subject showed muscle weakening ( inhibition ) reactions to oral provocative testing of one or two foods for a total of 21 positive food reactions . Tests for a hypersensitivity reaction of the serum were performed using both a radio-allergosorbent test ( RAST ) and immune complex test for IgE and IgG against all 21 of the foods that tested positive with A.K. muscle screening procedures . These serum tests confirmed 19 of the 21 food allergies ( 90.5 % ) suspected based on the applied kinesiology screening procedures . This pilot study offers a basis to examine further a means by which to predict the clinical utility of a given substance for a given patient , based on the patterns of neuromuscular response elicited from the patient , representing a conceptual expansion of the st and ard neurological examination process The purpose of this study was to determine whether Educational Kinesiology ® integration movements or repatterning in conjunction with the integration movements affect the response times of college students to a visual stimulus . Ten men and ten women were r and omly assigned to each of the three conditions : control , Edu-K movement , or repatterned Edu-K movements . Each subject was pretested on simple and choice response-time tasks . Following the pretest , subjects in the control group sat quietly for 10 minutes . The movement group utilized seven Brain Gym ® activities . Subjects in the repatterned group experienced Dennison 's Laterality Repatterning prior to doing the same Brain Gym activities . All subjects were then retested to assess changes in performance using 30 trials of each task . Statistical analyses indicated significant differences in improvement between the groups on the 4-choice task , with the repatterned group showing greater change than the Edu-K movement-only group , who in turn showed greater improvement than the control group . The groups improved by 6 % , 31/2 % , and 1 % , respectively . No group differences were significant on the simple task , although a similar trend was indicated . Men responded faster than women on both tasks ; however , the amount of improvement was similar for both Applied kinesiology is a technique used to assess nutritional status on the basis of the response of muscles to mechanical stress . In this study , 11 subjects were evaluated independently by three experienced applied kinesiologists  for four nutrients ( thiamin , zinc , vitamin A , and ascorbic acid ) . The results obtained by those applied kinesiologists were compared with ( a ) one another , ( b ) st and ard laboratory tests for nutrient status , and ( c ) computerized isometric muscle testing . Statistical analysis yielded no significant interjudge reliability , no significant correlation between the testers and st and ard biochemical tests for nutrient status , and no significant correlation between mechanical and manual determinations of relative muscle strength . In addition , the subjects were exposed in a double-blind fashion to supplements of thiamin , zinc , vitamin A , and ascorbic acid and two placebos ( pectin and sucrose ) and then re-tested . According to applied kinesiology theory , " weak " ( indicating deficiency ) muscles are strengthened when the subject is exposed to an appropriate nutritional supplement . Statistical analysis revealed no significant differences in the response to placebo , nutrients previously determined ( by muscle testing ) to be deficient , and nutrients previously determined ( by muscle testing ) to be adequate . Even though the number of subjects ( 11 ) and nutrients ( 4 ) tested was limited , the results of this study indicated that the use of applied kinesiology to evaluate nutrient status is no more useful than r and om guessing OBJECTIVES To assess the test-retest-reliability and validity of the Health Kinesiology muscle test . PATIENTS Seven patients with clinical ly and allergologically confirmed wasp venom allergy . DESIGN Four Health Kinesiology-examiners tested each patient in a r and om order for 10 verum and 10 placebo bottles . All examiners used the anterior deltoid as indicator muscle . Patients and examiners were completely blinded . OUTCOME MEASURES Weak muscle holds were rated as ' sensitivity ' towards the 
    Output:
    