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: OBJECTIVE To determine overall , test-retest and inter-rater reliability of posture indices among persons with idiopathic scoliosis . DESIGN A reliability study using two raters and two test sessions . SETTING Tertiary care paediatric centre . PARTICIPANTS Seventy participants aged between 10 and 20 years with different types of idiopathic scoliosis ( Cobb angle 15 to 60 ° ) were recruited from the scoliosis clinic . MAIN OUTCOME MEASURES Based on the XY co-ordinates of natural reference points ( e.g. , eyes ) as well as markers placed on several anatomical l and marks ,  32 angular and linear posture indices taken from digital photographs in the st and ing position were calculated from a specially developed software program . Generalisability theory served to estimate the reliability and st and ard error of measurement ( SEM ) for the overall , test-retest and inter-rater design s. Bl and and Altman 's method was also used to document agreement between sessions and raters . RESULTS In the r and om design , dependability coefficients demonstrated a moderate level of reliability for six posture indices ( ϕ=0.51 to 0.72 ) and a good level of reliability for 26 posture indices out of 32 ( ϕ≥0.79 ) . Error attributable to marker placement was negligible for most indices . Limits of agreement and SEM values were larger for shoulder protraction , trunk list , Q angle , cervical lordosis and scoliosis angles . The most reproducible indices were waist angles and knee valgus and varus . CONCLUSIONS Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis . Despite the good reliability of marker placement , other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time CONTEXT Previous long-term studies of idiopathic scoliosis have included patients with other etiologies , leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability .  Late-onset idiopathic scoliosis ( LIS ) is a distinct entity with a unique natural history . OBJECTIVE To present the outcomes related to health and function in untreated patients with LIS . DESIGN , SETTING , AND PATIENTS Prospect i ve natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948 . At 50-year follow-up , which began in 1992 , 117 untreated patients were compared with 62 age- and sex-matched volunteers . The patients ' mean age was 66 years ( range , 54 - 80 years ) . MAIN OUTCOME MEASURES Mortality , back pain , pulmonary symptoms , general function , depression , and body image . RESULTS The estimated probability of survival was approximately 0.55 ( 95 % confidence interval [ CI ] , 0.47 - 0.63 ) compared with 0.57 expected for the general population . There was no significant difference in the demographic characteristics of the 2 groups . Twenty-two ( 22 % ) of 98 patients complained of shortness of breath during everyday activities compared with 8 ( 15 % ) of 53 controls . An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80 degrees and a thoracic apex ( adjusted odds ratio , 9.75 ; 95 % CI , 1.15 - 82.98 ) . Sixty-six ( 61 % ) of 109 patients reported chronic back pain compared with 22 ( 35 % ) of 62 controls ( P = .003 ) . However , of those with pain , 48 ( 68 % ) of 71 patients and 12 ( 71 % ) of 17 controls reported only little or moderate back pain . CONCLUSIONS Untreated adults with LIS are productive and functional at a high level at 50-year follow-up . Untreated LIS causes little physical impairment other than back pain and cosmetic concerns Study Design : This was a prospect i ve blinded validity and reliability analysis . Objective : The aim of this study was validation and reliability evaluation of the Scoligauge iPhone app . Background : The scoliometer is used to clinical ly measure the rib hump in scoliosis as a means to evaluate the axial trunk rotation . The increasing availability of smartphone with built-in accelerometer led to the development of a vast number of applications to measure angles . Of these , the Scoligauge mimics a scoliometer . The aim of this study was to compare the validity of the Scoligauge iPhone application without an associated adapter with the traditional scoliometer and to test the reliability of the application in a clinical setting . Methods : Two observers measured the rib hump deformity on 34 consecutive patients with idiopathic scoliosis with an average Cobb angle of 24.2±13.5 degrees ( range , 4 to 65 degrees ) . Measurements were made with an iPhone without the adapter and with a scoliometer . The validity as well as the interobserver and intraobserver reliability were calculated using the intraclass coefficient ( ICC ) and the Bl and -Altman test . Results : The mean difference between the scoliometer and the Scoligauge application was 0.4 degrees [ 95 % confidence interval ( CI ) of ±3.1 degrees ] with an ICC of 0.947 ( P<0.001 ) . The intraobserver and interobserver ICC were 0.961 ( P<0.001 ) and 0.901 ( P<0.001 ) , respectively . The mean intraobserver difference was 0.0 degrees ( 95 % CI of ±2.7 degrees ) and the mean interobserver difference was 0.1 degrees ( 95 % CI of ±4.4 degrees ) . Conclusions : The intraobserver and interobserver reliability of the Scoligauge iPhone app , as well as its validity compared with the scoliometer , are excellent . The mean differences between measurements are small and clinical ly not significant . Thus , the Scoligauge application is valid for clinical evaluation even without special adapter . Level of Evidence : Level I ( Diagnostic Study ) Background Screening tests play a significant role in rapid and reliable assessment of normal individual development in the entire population of children and adolescents . Body posture screening tests carried out at schools reveal that 50 - 60 % of children and adolescents demonstrate body posture abnormalities , with 10 % of this group at risk for progressive spinal deformities . This necessitates the search for effective and economically feasible forms of screening diagnosis . The aim of this study was to assess the reliability of clinical evaluation of body posture compared to objective assessment with the Zebris CMS-10 system ( Zebris Medical GmbH ) . Methods The study enrolled 13 - 15-year-old pupils attending a junior secondary school ( mean age 14.2 years ) . The study group consisted of 138 participants , including 71 girls and 67 boys , who underwent a clinical evaluation of the body posture and an examination with the Zebris CMS 10 system .  Results Statistically significant discrepancies between the clinical and objective evaluation were noted with regard to lumbar lordosis in boys ( n = 67 ) and thoracic kyphosis in girls ( n = 71 ) . No statistically significant differences in both groups were noted for pelvic rotation and trunk position in the frontal plane . Conclusions 1 . The finding of significant discrepancies between the results of assessment in the sagittal plane obtained in the clinical examination and Zebris CMS-10-based assessment suggests that clinical evaluation should be used to provide a general estimation of accentuation or reduction of spinal curvatures in the sagittal plane.2 . The clinical evaluation of posture is reliable with regard to assessment in the frontal plane.3 . The Zebris CMS-10 system makes the clinical examination significantly more objective with regard to assessment of the physiological curvatures and may be used to make screening tests more objective with regard to detecting postural defects We did a prospect i ve study of 291 children and adolescents with idiopathic scoliosis to identify possible correlations between clinical ( scoliometer value , age , height ) and radiographic ( Cobb angle , Nash-Moe rotation , Risser iliac apophysis classification ) parameters to predict the curve angle . There was a statistically significant correlation between thoracic , thoracolumbar , and lumbar scoliometer values and the thoracic , thoracolumbar , and lumbar Cobb angles , respectively ( Pearson ’s r-0.685 , 0.572 , and 0.677 , respectively ) . There was a statistically significant correlation between Cobb angle in the thoracic , thoracolumbar , and lumbar spine and the patients ’ age and height . Mathematical formulas that predict the Cobb angle of thoracic , thoracolumbar , and lumbar scoliosis using the scoliometer measurements are reported Study Design A prospect i ve study was conducted in a young homogenous adolescent population , with the use of the scoliometer . Objectives To create a mathematic formula that provides the accurate Cobb angle of idiopathic scoliosis with the use of the scoliometer only . Summary of Background Data The scoliometer is an accepted method for detection and evaluation of scoliosis during screening programs . To the authors ' knowledge , there are no previous methods and formulas to estimate the approximate Cobb angle using only the scoliometer . Methods Several clinical ( scoliometer value , age , and sex ) and radiographic ( Cobb angle , Perdriolle of the apical vertebra , Risser iliac apophysis classification ) parameters from 442 ( 4.37 % ) of 10,109 screened adolescents who had a scoliometer value of at least 7 ° were taken and correlated using the simple and multiple linear regression analysis . Results Cobb angle and scoliometer value were statistically significantly correlated to each other . Two mathematic formulas were created to predict the Cobb angle of the thoracic and lumbar scoliosis , with similar sensitivity and accuracy . The thoracic and lumbar scoliometer values were statistic significantly correlated with the thoracic and lumbar Cobb angle ( P = 0.0254 and P = 0.0015 , respectively ) . The lumbar scoliometer value was significantly correlated with lumbar apical vertebra Perdriolle value . Also , the thoracic and lumbar Cobb angles were significantly correlated with thoracic and lumbar apical vertebra ( P = 0.0001 and P = 0.0015 , respectively ) . Conclusions In the present study , the authors have constructed two mathematic formulas , which provide accurately the scoliotic Cobb angle in young adolescents using only the scoliometer with a deviation of 5.63 ° for thoracic curves and 5.79 ° for lumbar curves . The authors recommend that all physicians engaged in scoliosis screening programs use the scoliometer based on the mathematic formulas that the authors developed . They believe that this method will reduce the cost of school screening programs , the overdiagnosis , and the unnecessary exposure to irradiation of this young population in the future BACKGROUND The complex skeletal deformations that accompany Idioapthic Scoliosis pose a challenge to the clinician to non-invasively discriminate Idiopathic Scoliosis patients from children with no pathology . Therefore , the focus of this study is to non-invasively evaluate the position and amplitude of displacement of the pelvis , shoulders and thorax during quiet st and ing of Idiopathic Scoliosis patients and control subjects . METHODS The quiet st and ing posture of 18 healthy adolescent females and 22 Idiopathic Scoliosis subjects was evaluated using an Optotrak 3020 position sensor over a period of 120 s , with 4 repeat trials . Outcome measures included the mean position , root mean square amplitude and range over the duration of 120 s trials for both linear and angular measures of the pelvis , thorax and shoulders . Appropriate sample times were chosen and evaluated for stability over the 120 s period , and between trial reliability was evaluated . FINDINGS There was a significant difference between groups for the mean position of the shoulder blade rotation in reference to the base of support and to the pelvis . The Idiopathic Scoliosis patients had a significantly larger root mean square amplitude of anterior-posterior displacement of the T1 and S1 spinous processes in reference to the base of support . There was no difference between the sample duration s to estimate the mean position of the body segments , however the root mean square increased significantly . INTERPRETATION This study demonstrates that postural abnormalities are evident during quiet st and ing in Idiopathic Scoliosis patients BACKGROUND CONTEXT Three-dimensional ( 3D ) deformations of the spine are predominantly characterized by two-dimensional ( 2D ) angulation measurements in coronal and sagittal planes , using anteroposterior and lateral X-ray images . For coronal curves , a method originally described by Cobb and for sagittal curves a modified Cobb method are most widely used in practice , and these methods have been shown to exhibit good-to-excellent reliability and reproducibility , carried out either manually or by computer-based tools . Recently , an ultralow radiation dose-integrated radioimaging solution was introduced with special software for realistic 3D visualization and parametric characterization of the spinal column . PURPOSE Comparison of accuracy , correlation of measurement values , intraobserver and interrater reliability of methods by conventional manual 2D and sterEOS 3D measurements in a routine clinical setting . STUDY DESIGN / SETTING Retrospective nonr and omized study of diagnostic X-ray images created as part of a routine clinical protocol of eligible patients examined at our clinic during a 30-month period between July 2007 and December 2009 . PATIENT SAMPLE In total , 201 individuals ( 170 females , 31 males ; mean age , 19.88 years ) including 10 healthy athletes with normal spine and patients with adolescent idiopath 
    Output:
    
agent
iPhone measurements correlated well with scoliometer measurements .
2D photography results had a moderate to high correlation with 3D topography results .
Conclusions Overall , strong levels of evidence exist for iPhone and scoliometer measurements , with a high to very high reliability and moderate to very high validity .
Limited evidence exists for aesthetic tools TRACE and AI and 2D photography .
These results indicate there are accurate and reproducible anthropometric measures that are inexpensive and applicable in therapy setting s to assess postural asymmetry ; however , these only exist for measurement in the transverse plane , despite 3D characteristics of AIS .
***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 overall , test-retest and inter-rater reliability of posture indices among persons with idiopathic scoliosis . DESIGN A reliability study using two raters and two test sessions . SETTING Tertiary care paediatric centre . PARTICIPANTS Seventy participants aged between 10 and 20 years with different types of idiopathic scoliosis ( Cobb angle 15 to 60 ° ) were recruited from the scoliosis clinic . MAIN OUTCOME MEASURES Based on the XY co-ordinates of natural reference points ( e.g. , eyes ) as well as markers placed on several anatomical l and marks ,  32 angular and linear posture indices taken from digital photographs in the st and ing position were calculated from a specially developed software program . Generalisability theory served to estimate the reliability and st and ard error of measurement ( SEM ) for the overall , test-retest and inter-rater design s. Bl and and Altman 's method was also used to document agreement between sessions and raters . RESULTS In the r and om design , dependability coefficients demonstrated a moderate level of reliability for six posture indices ( ϕ=0.51 to 0.72 ) and a good level of reliability for 26 posture indices out of 32 ( ϕ≥0.79 ) . Error attributable to marker placement was negligible for most indices . Limits of agreement and SEM values were larger for shoulder protraction , trunk list , Q angle , cervical lordosis and scoliosis angles . The most reproducible indices were waist angles and knee valgus and varus . CONCLUSIONS Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis . Despite the good reliability of marker placement , other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time CONTEXT Previous long-term studies of idiopathic scoliosis have included patients with other etiologies , leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability .  Late-onset idiopathic scoliosis ( LIS ) is a distinct entity with a unique natural history . OBJECTIVE To present the outcomes related to health and function in untreated patients with LIS . DESIGN , SETTING , AND PATIENTS Prospect i ve natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948 . At 50-year follow-up , which began in 1992 , 117 untreated patients were compared with 62 age- and sex-matched volunteers . The patients ' mean age was 66 years ( range , 54 - 80 years ) . MAIN OUTCOME MEASURES Mortality , back pain , pulmonary symptoms , general function , depression , and body image . RESULTS The estimated probability of survival was approximately 0.55 ( 95 % confidence interval [ CI ] , 0.47 - 0.63 ) compared with 0.57 expected for the general population . There was no significant difference in the demographic characteristics of the 2 groups . Twenty-two ( 22 % ) of 98 patients complained of shortness of breath during everyday activities compared with 8 ( 15 % ) of 53 controls . An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80 degrees and a thoracic apex ( adjusted odds ratio , 9.75 ; 95 % CI , 1.15 - 82.98 ) . Sixty-six ( 61 % ) of 109 patients reported chronic back pain compared with 22 ( 35 % ) of 62 controls ( P = .003 ) . However , of those with pain , 48 ( 68 % ) of 71 patients and 12 ( 71 % ) of 17 controls reported only little or moderate back pain . CONCLUSIONS Untreated adults with LIS are productive and functional at a high level at 50-year follow-up . Untreated LIS causes little physical impairment other than back pain and cosmetic concerns Study Design : This was a prospect i ve blinded validity and reliability analysis . Objective : The aim of this study was validation and reliability evaluation of the Scoligauge iPhone app . Background : The scoliometer is used to clinical ly measure the rib hump in scoliosis as a means to evaluate the axial trunk rotation . The increasing availability of smartphone with built-in accelerometer led to the development of a vast number of applications to measure angles . Of these , the Scoligauge mimics a scoliometer . The aim of this study was to compare the validity of the Scoligauge iPhone application without an associated adapter with the traditional scoliometer and to test the reliability of the application in a clinical setting . Methods : Two observers measured the rib hump deformity on 34 consecutive patients with idiopathic scoliosis with an average Cobb angle of 24.2±13.5 degrees ( range , 4 to 65 degrees ) . Measurements were made with an iPhone without the adapter and with a scoliometer . The validity as well as the interobserver and intraobserver reliability were calculated using the intraclass coefficient ( ICC ) and the Bl and -Altman test . Results : The mean difference between the scoliometer and the Scoligauge application was 0.4 degrees [ 95 % confidence interval ( CI ) of ±3.1 degrees ] with an ICC of 0.947 ( P<0.001 ) . The intraobserver and interobserver ICC were 0.961 ( P<0.001 ) and 0.901 ( P<0.001 ) , respectively . The mean intraobserver difference was 0.0 degrees ( 95 % CI of ±2.7 degrees ) and the mean interobserver difference was 0.1 degrees ( 95 % CI of ±4.4 degrees ) . Conclusions : The intraobserver and interobserver reliability of the Scoligauge iPhone app , as well as its validity compared with the scoliometer , are excellent . The mean differences between measurements are small and clinical ly not significant . Thus , the Scoligauge application is valid for clinical evaluation even without special adapter . Level of Evidence : Level I ( Diagnostic Study ) Background Screening tests play a significant role in rapid and reliable assessment of normal individual development in the entire population of children and adolescents . Body posture screening tests carried out at schools reveal that 50 - 60 % of children and adolescents demonstrate body posture abnormalities , with 10 % of this group at risk for progressive spinal deformities . This necessitates the search for effective and economically feasible forms of screening diagnosis . The aim of this study was to assess the reliability of clinical evaluation of body posture compared to objective assessment with the Zebris CMS-10 system ( Zebris Medical GmbH ) . Methods The study enrolled 13 - 15-year-old pupils attending a junior secondary school ( mean age 14.2 years ) . The study group consisted of 138 participants , including 71 girls and 67 boys , who underwent a clinical evaluation of the body posture and an examination with the Zebris CMS 10 system .  Results Statistically significant discrepancies between the clinical and objective evaluation were noted with regard to lumbar lordosis in boys ( n = 67 ) and thoracic kyphosis in girls ( n = 71 ) . No statistically significant differences in both groups were noted for pelvic rotation and trunk position in the frontal plane . Conclusions 1 . The finding of significant discrepancies between the results of assessment in the sagittal plane obtained in the clinical examination and Zebris CMS-10-based assessment suggests that clinical evaluation should be used to provide a general estimation of accentuation or reduction of spinal curvatures in the sagittal plane.2 . The clinical evaluation of posture is reliable with regard to assessment in the frontal plane.3 . The Zebris CMS-10 system makes the clinical examination significantly more objective with regard to assessment of the physiological curvatures and may be used to make screening tests more objective with regard to detecting postural defects We did a prospect i ve study of 291 children and adolescents with idiopathic scoliosis to identify possible correlations between clinical ( scoliometer value , age , height ) and radiographic ( Cobb angle , Nash-Moe rotation , Risser iliac apophysis classification ) parameters to predict the curve angle . There was a statistically significant correlation between thoracic , thoracolumbar , and lumbar scoliometer values and the thoracic , thoracolumbar , and lumbar Cobb angles , respectively ( Pearson ’s r-0.685 , 0.572 , and 0.677 , respectively ) . There was a statistically significant correlation between Cobb angle in the thoracic , thoracolumbar , and lumbar spine and the patients ’ age and height . Mathematical formulas that predict the Cobb angle of thoracic , thoracolumbar , and lumbar scoliosis using the scoliometer measurements are reported Study Design A prospect i ve study was conducted in a young homogenous adolescent population , with the use of the scoliometer . Objectives To create a mathematic formula that provides the accurate Cobb angle of idiopathic scoliosis with the use of the scoliometer only . Summary of Background Data The scoliometer is an accepted method for detection and evaluation of scoliosis during screening programs . To the authors ' knowledge , there are no previous methods and formulas to estimate the approximate Cobb angle using only the scoliometer . Methods Several clinical ( scoliometer value , age , and sex ) and radiographic ( Cobb angle , Perdriolle of the apical vertebra , Risser iliac apophysis classification ) parameters from 442 ( 4.37 % ) of 10,109 screened adolescents who had a scoliometer value of at least 7 ° were taken and correlated using the simple and multiple linear regression analysis . Results Cobb angle and scoliometer value were statistically significantly correlated to each other . Two mathematic formulas were created to predict the Cobb angle of the thoracic and lumbar scoliosis , with similar sensitivity and accuracy . The thoracic and lumbar scoliometer values were statistic significantly correlated with the thoracic and lumbar Cobb angle ( P = 0.0254 and P = 0.0015 , respectively ) . The lumbar scoliometer value was significantly correlated with lumbar apical vertebra Perdriolle value . Also , the thoracic and lumbar Cobb angles were significantly correlated with thoracic and lumbar apical vertebra ( P = 0.0001 and P = 0.0015 , respectively ) . Conclusions In the present study , the authors have constructed two mathematic formulas , which provide accurately the scoliotic Cobb angle in young adolescents using only the scoliometer with a deviation of 5.63 ° for thoracic curves and 5.79 ° for lumbar curves . The authors recommend that all physicians engaged in scoliosis screening programs use the scoliometer based on the mathematic formulas that the authors developed . They believe that this method will reduce the cost of school screening programs , the overdiagnosis , and the unnecessary exposure to irradiation of this young population in the future BACKGROUND The complex skeletal deformations that accompany Idioapthic Scoliosis pose a challenge to the clinician to non-invasively discriminate Idiopathic Scoliosis patients from children with no pathology . Therefore , the focus of this study is to non-invasively evaluate the position and amplitude of displacement of the pelvis , shoulders and thorax during quiet st and ing of Idiopathic Scoliosis patients and control subjects . METHODS The quiet st and ing posture of 18 healthy adolescent females and 22 Idiopathic Scoliosis subjects was evaluated using an Optotrak 3020 position sensor over a period of 120 s , with 4 repeat trials . Outcome measures included the mean position , root mean square amplitude and range over the duration of 120 s trials for both linear and angular measures of the pelvis , thorax and shoulders . Appropriate sample times were chosen and evaluated for stability over the 120 s period , and between trial reliability was evaluated . FINDINGS There was a significant difference between groups for the mean position of the shoulder blade rotation in reference to the base of support and to the pelvis . The Idiopathic Scoliosis patients had a significantly larger root mean square amplitude of anterior-posterior displacement of the T1 and S1 spinous processes in reference to the base of support . There was no difference between the sample duration s to estimate the mean position of the body segments , however the root mean square increased significantly . INTERPRETATION This study demonstrates that postural abnormalities are evident during quiet st and ing in Idiopathic Scoliosis patients BACKGROUND CONTEXT Three-dimensional ( 3D ) deformations of the spine are predominantly characterized by two-dimensional ( 2D ) angulation measurements in coronal and sagittal planes , using anteroposterior and lateral X-ray images . For coronal curves , a method originally described by Cobb and for sagittal curves a modified Cobb method are most widely used in practice , and these methods have been shown to exhibit good-to-excellent reliability and reproducibility , carried out either manually or by computer-based tools . Recently , an ultralow radiation dose-integrated radioimaging solution was introduced with special software for realistic 3D visualization and parametric characterization of the spinal column . PURPOSE Comparison of accuracy , correlation of measurement values , intraobserver and interrater reliability of methods by conventional manual 2D and sterEOS 3D measurements in a routine clinical setting . STUDY DESIGN / SETTING Retrospective nonr and omized study of diagnostic X-ray images created as part of a routine clinical protocol of eligible patients examined at our clinic during a 30-month period between July 2007 and December 2009 . PATIENT SAMPLE In total , 201 individuals ( 170 females , 31 males ; mean age , 19.88 years ) including 10 healthy athletes with normal spine and patients with adolescent idiopath 
    Output:
    