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: INTRODUCTION AND OBJECTIVES Laryngeal electromyography , together with clinical evaluation , is a valuable tool in voice disorder management . It assesses the integrity of laryngeal nerves and muscles , contributing to the diagnosis of many diseases , especially laryngeal movement disorders . Our purpose was to describe the experience of the first Spanish series with laryngeal electromyography in evaluating  voice disorders .  METHODS A prospect i ve study was design ed to evaluate laryngeal movement disorders with laryngeal electromyography . Both the cricothyroid and thyroarytenoid muscles were tested routinely and , in some cases , the posterior cricoarytenoid muscle . The laryngeal electromyography technique and result interpretation were performed by a laryngologist and a neurophysiologist . RESULTS We included 110 patients , with the most common symptom being dysphonia .  Laryngeal electromyography was performed in 85 % of cases . Primary diagnosis before electromyography was laryngeal immobility . Positive predictive value for diagnosis in cases of paralysis was 88 % . CONCLUSIONS Laryngeal electromyography is a useful adjunct , together with clinical evaluation , for diagnosis and management of motion abnormalities in the larynx in patients who present with dysphonia OBJECTIVES Epidemiologic studies of the prevalence and risk factors of voice disorders in the general adult population are rare . The purpose of this investigation was to 1 ) determine the prevalence of voice disorders , 2 ) identify variables associated with increased risk of voice disorders , and 3 ) establish the functional impact of voice disorders on the general population . STUDY DESIGN Cross-sectional telephone survey . METHODS A r and om sample ( n = 1,326 ) of adults in Iowa and Utah was interviewed using a question naire that addressed three areas related to voice disorders : prevalence , potential risk factors , and occupational consequences/effects . RESULTS The lifetime prevalence of a voice disorder was 29.9 % , with 6.6 % of participants reporting a current voice disorder . Stepwise logistic regression identified specific factors that uniquely contributed to increased odds of reporting a chronic voice disorder including sex ( women ) , age ( 40 - 59 years ) , voice use patterns and dem and s , esophageal reflux , chemical exposures , and frequent cold/sinus infections . However , tobacco or alcohol use did not independently increase the odds of reporting of a chronic voice disorder . Voice disorders adversely impacted job performance and attendance , with 4.3 % of participants indicating that their voice had limited or rendered them unable to do certain tasks in their current job . Furthermore , 7.2 % of employed respondents reported that they were absent from work 1 or more days in the past year because of their voice , and 2 % reported more than 4 days of voice-related absence . CONCLUSIONS The results of this large epidemiologic study provide valuable information regarding the prevalence of voice disorders , factors that contribute to voice disorder vulnerability , and the functional impact of voice problems on the general population Objectives To determine the utility of spectral analysis in the differentiation of adductor-type spasmodic dysphonia ( AdSD ) from muscle tension dysphonia ( MTD ) . Study Design Prospect i ve blinded study . Methods Forty-seven sample s of AdSD-connected speech spectrograms from 27 subjects and 17 sample s of MTD-connected speech spectrograms from 15 subjects were selected from clinical charts and de-identified . These spectrograms were review ed independently and blindly by two speech language pathologists experienced in spectrography . The speech language pathologists design ated the spectrogram as consistent with AdSD and MTD , and these design ations were compared with actual clinical diagnoses . Results The ability to differentiate AdSD from MTD with spectral analysis was 94 % for rater # 1 and 98 % for rater # 2 . No MTD subjects were incorrectly diagnosed as having SD ( 100 % specificity ) . Conclusions This study suggests that experienced speech language pathologists can distinguish AdSD from MTD with a high degree of sensitivity and specificity based on spectral analysis . Spectral analysis is especially useful in cases where perceptual analysis and clinical evaluation alone are insufficient Recent literature suggests a revival of interest in  single-case methodology  ( e.g. , the r and omised n-of-1 trial is now considered Level 1 evidence for treatment decision purpose s by the Oxford Centre for Evidence -Based Medicine ) . Consequently , the availability of tools to critically appraise single-case reports is of great importance . We report on a major revision of our method quality instrument , the Single-Case Experimental Design Scale . Three changes result ed in a radically revised instrument , now entitled the Risk of Bias in N-of-1 Trials ( RoBiNT ) Scale : ( i ) item content was revised and increased to 15 items , ( ii ) two subscales were developed for internal validity ( IV ; 7 items ) and external validity and interpretation ( EVI ; 8 items ) , and ( iii ) the scoring system was changed from a 2-point to 3-point scale to accommo date currently accepted st and ards . Psychometric evaluation indicated that the RoBiNT Scale showed evidence of construct ( discriminative ) validity . Inter-rater reliability was excellent , for pairs of both experienced and trained novice raters . Intraclass correlation coefficients of summary scores for individual ( experienced ) raters : ICCTotalScore = .90 , ICCIVSubscale = .88 , ICCEVISubscale = .87 ; individual ( novice ) raters : ICCTotalScore = .88 , ICCIVSubscale = .87 , ICCEVISubscale = .93 ; consensus ratings between experienced and novice raters ( ICCTotalScore = .95 , ICCIVSubscale = .93 , ICCEVISubscale = .93 . The RoBiNT Scale thus shows sound psychometric properties and provides a comprehensive yet efficient examination of important features of single-case methodology Background Childhood Apraxia of Speech is an impairment of speech motor planning that manifests as difficulty producing the sounds ( articulation ) and melody ( prosody ) of speech . These difficulties may persist through life and are detrimental to academic , social , and vocational development . A number of published single subject and case series studies of speech treatments are available . There are currently no r and omised control trials or other well design ed group trials available to guide clinical practice . Methods / Design A parallel group , fixed size r and omised control trial will be conducted in Sydney , Australia to determine the efficacy of two treatments for Childhood Apraxia of Speech : 1 ) Rapid Syllable Transition Treatment and the 2 ) Nuffield Dyspraxia Programme – Third edition .  Eligible children will be English speaking , aged 4–12 years with a diagnosis of suspected CAS , normal or adjusted hearing and vision , and no comprehension difficulties or other developmental diagnoses . At least 20 children will be r and omised to receive one of the two treatments in parallel . Treatments will be delivered by trained and supervised speech pathology clinicians using operationalised manuals . Treatment will be administered in 1-hour sessions , 4 times per week for 3 weeks . The primary outcomes are speech sound and prosodic accuracy on a customised 292 item probe and the Diagnostic Evaluation of Articulation and Phonology inconsistency subtest administered prior to treatment and 1 week , 1 month and 4 months post-treatment . All post assessment s will be completed by blinded assessors . Our hypotheses are : 1 ) treatment effects at 1 week post will be similar for both treatments , 2 ) maintenance of treatment effects at 1 and 4 months post will be greater for Rapid Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment , and 3 ) generalisation of treatment effects to untrained related speech behaviours will be greater for Rapid Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment . This protocol was approved by the Human Research Ethics Committee , University of Sydney ( # 12924 ) . Discussion This will be the first r and omised control trial to test treatment for CAS . It will be valuable for clinical decision-making and providing evidence -based services for children with CAS.Trial Registration Australian New Zeal and Clinical Trials Registry : The objectives of this study were to determine appropriate acoustic and outcome measures for the evaluation of a method of laryngeal manual therapy ( LMT ) used in the treatment of patients with muscle tension dysphonia ( MTD ) . The effects of this technique were also investigated . The study was based on the hypotheses that the vertical position of the larynx in the vocal tract would lower , that the quality of the voice would normalize , and that a reduction in any vocal tract discomfort ( VTD ) would occur after LMT . This was a small , prospect i ve , repeated measures pilot study in which each member of the research team was " blinded " to all other stages of the study and during which all data were anonymized until the final stage of data analysis . Ten subjects presenting with MTD completed outcome measures and provided audiorecordings immediately before , immediately after , and 1 week after LMT . The Kay CSL 4150 was used for signal acquisition and for some acoustic measurements . Spectrographic evaluation was accomplished with Praat . A new perceptual , self-rating scale , the VTD scale , and a new proforma for use by the clinician for palpatory evaluation , were developed for the study . Relative average perturbation during connected speech was significantly reduced after LMT , indicating a reduction in abnormal vocal function . The severity and frequency of VTD was shown to have reduced after LMT . This pilot study showed positive evidence for LMT as a method of therapy in the treatment of hyperfunctional voice disorders . Its effects were shown to be measurable with both acoustical analysis and the VTD scale The aim of this article is to present a set of evidence levels , accompanied by 14 quality or rigor questions , to foster a critical review of published single‐subject research articles . In developing these guidelines , we review ed levels of evidence and quality /rigor criteria that are in wide use for group research design s , e.g. r and omized controlled trials , such as those developed by the Treatment Outcomes Committee of the American Academy for Cerebral Palsy and Developmental Medicine . We also review ed method ological articles on how to conduct and critically evaluate single‐subject research design s ( SSRDs ) . We then subjected the quality questions to interrater agreement testing and refined them until acceptable agreement was reached . We recommend that these guidelines be implemented by clinical research ers who plan to conduct single‐subject research or who incorporate SSRD studies into systematic review s , and by clinicians who aim to practise evidence ‐based medicine and who wish to critically review pediatric single‐subject research BACKGROUND speechBITE ( http://www.speechbite.com ) is an online data base established in order to help speech and language therapists gain faster access to relevant research that can used in clinical decision-making . In addition to containing more than 3000 journal references , the data base also provides method ological ratings on the PEDro-P ( an adapted version of the PEDro ) scale to assist clinicians in identifying the scientific quality of r and omized ( RCTs ) and non-r and omized control trials ( N RCTs ) . While reliability of the PEDro scale has been established by similar allied health data bases , the reliability of the PEDro-P scale has yet to be reported . AIMS To examine the reliability of PEDro-P scale ratings undertaken by raters on the speechBITE data base and benchmark these results to the published reliability for the original PEDro scale . Both the total score ( out of ten ) as well as each of the 11 scale items were included in this analysis . METHODS & PROCEDURES  speechBITE 's volunteer rater network of 17 members rated the first 100 RCTs and N RCTs on the website . The criterion and overall scores for these ratings were compared with previously published reliability studies using the PEDro scale . Intra-class correlations and per cent agreement measures were used to establish and benchmark reliability . OUTCOMES & RESULTS The speechBITE PEDro-P ratings ranged from fair to excellent for both the total score and for each of the 11 scale items . Furthermore , reliability was equal to that of other data bases . CONCLUSIONS & IMPLICATION S speechBITE users can be confident of the reliability of ratings published on the website . Further analysis of differences between this study and previous PEDro scale reliability studies are discussed In a previous study , female patients in all age categories with a nonorganic dysphonia were found to report significantly more autonomic symptoms and complaints than healthy controls . This could not be confirmed for the male subgroup . The present study is to corroborate and nuance this observation by investigating larger groups , and to determine if , after voice therapy , the number of autonomic symptoms and complaints-particularly those ones that have no obvious relation to voice function-decreases . It is a prospect i ve study with a matched control group ; 184 patients with nonorganic dysphonia and 126 normal controls answered a question naire of 46 questions with 3 subsets and a consistency control . One hundred and one patients received functional voice therapy  and completed the question naire before and after treatment . A matched control group of 42 normal subjects also filled in the question naire two times , with an interval of about 6 months . Neurovegetative symptoms and complaints-voice related and not related-are reported in highly significant excess by patients ( especially but not exclusively females ) with habitual nonorganic voice disorder . After therapy , there is a highly significant reduction in the number of autonomic symptoms and complaints ( related or not related to voice ) , to such an extent that patients report on average no more general neurovegetative symptoms and complaints than healthy controls ( even less ) . The number of neurovegetative symptoms and complaints connected with voice function is also strongly reduced in patients after therapy , but remains in significant excess when compared with controls Rating scales that assess method ological quality of clinical trials provide a means to critically appraise the literature . Scales are currently available to rate r and omised and non-r and omised controlled trials , but there are none that assess single-subject design s. The Single-Case Experimental Design ( SCED ) Scale was developed for this purpose and evaluated 
    Output:
    
agent
Specific " active ingredients " for therapeutic change were not identified .
***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: INTRODUCTION AND OBJECTIVES Laryngeal electromyography , together with clinical evaluation , is a valuable tool in voice disorder management . It assesses the integrity of laryngeal nerves and muscles , contributing to the diagnosis of many diseases , especially laryngeal movement disorders . Our purpose was to describe the experience of the first Spanish series with laryngeal electromyography in evaluating  voice disorders .  METHODS A prospect i ve study was design ed to evaluate laryngeal movement disorders with laryngeal electromyography . Both the cricothyroid and thyroarytenoid muscles were tested routinely and , in some cases , the posterior cricoarytenoid muscle . The laryngeal electromyography technique and result interpretation were performed by a laryngologist and a neurophysiologist . RESULTS We included 110 patients , with the most common symptom being dysphonia .  Laryngeal electromyography was performed in 85 % of cases . Primary diagnosis before electromyography was laryngeal immobility . Positive predictive value for diagnosis in cases of paralysis was 88 % . CONCLUSIONS Laryngeal electromyography is a useful adjunct , together with clinical evaluation , for diagnosis and management of motion abnormalities in the larynx in patients who present with dysphonia OBJECTIVES Epidemiologic studies of the prevalence and risk factors of voice disorders in the general adult population are rare . The purpose of this investigation was to 1 ) determine the prevalence of voice disorders , 2 ) identify variables associated with increased risk of voice disorders , and 3 ) establish the functional impact of voice disorders on the general population . STUDY DESIGN Cross-sectional telephone survey . METHODS A r and om sample ( n = 1,326 ) of adults in Iowa and Utah was interviewed using a question naire that addressed three areas related to voice disorders : prevalence , potential risk factors , and occupational consequences/effects . RESULTS The lifetime prevalence of a voice disorder was 29.9 % , with 6.6 % of participants reporting a current voice disorder . Stepwise logistic regression identified specific factors that uniquely contributed to increased odds of reporting a chronic voice disorder including sex ( women ) , age ( 40 - 59 years ) , voice use patterns and dem and s , esophageal reflux , chemical exposures , and frequent cold/sinus infections . However , tobacco or alcohol use did not independently increase the odds of reporting of a chronic voice disorder . Voice disorders adversely impacted job performance and attendance , with 4.3 % of participants indicating that their voice had limited or rendered them unable to do certain tasks in their current job . Furthermore , 7.2 % of employed respondents reported that they were absent from work 1 or more days in the past year because of their voice , and 2 % reported more than 4 days of voice-related absence . CONCLUSIONS The results of this large epidemiologic study provide valuable information regarding the prevalence of voice disorders , factors that contribute to voice disorder vulnerability , and the functional impact of voice problems on the general population Objectives To determine the utility of spectral analysis in the differentiation of adductor-type spasmodic dysphonia ( AdSD ) from muscle tension dysphonia ( MTD ) . Study Design Prospect i ve blinded study . Methods Forty-seven sample s of AdSD-connected speech spectrograms from 27 subjects and 17 sample s of MTD-connected speech spectrograms from 15 subjects were selected from clinical charts and de-identified . These spectrograms were review ed independently and blindly by two speech language pathologists experienced in spectrography . The speech language pathologists design ated the spectrogram as consistent with AdSD and MTD , and these design ations were compared with actual clinical diagnoses . Results The ability to differentiate AdSD from MTD with spectral analysis was 94 % for rater # 1 and 98 % for rater # 2 . No MTD subjects were incorrectly diagnosed as having SD ( 100 % specificity ) . Conclusions This study suggests that experienced speech language pathologists can distinguish AdSD from MTD with a high degree of sensitivity and specificity based on spectral analysis . Spectral analysis is especially useful in cases where perceptual analysis and clinical evaluation alone are insufficient Recent literature suggests a revival of interest in  single-case methodology  ( e.g. , the r and omised n-of-1 trial is now considered Level 1 evidence for treatment decision purpose s by the Oxford Centre for Evidence -Based Medicine ) . Consequently , the availability of tools to critically appraise single-case reports is of great importance . We report on a major revision of our method quality instrument , the Single-Case Experimental Design Scale . Three changes result ed in a radically revised instrument , now entitled the Risk of Bias in N-of-1 Trials ( RoBiNT ) Scale : ( i ) item content was revised and increased to 15 items , ( ii ) two subscales were developed for internal validity ( IV ; 7 items ) and external validity and interpretation ( EVI ; 8 items ) , and ( iii ) the scoring system was changed from a 2-point to 3-point scale to accommo date currently accepted st and ards . Psychometric evaluation indicated that the RoBiNT Scale showed evidence of construct ( discriminative ) validity . Inter-rater reliability was excellent , for pairs of both experienced and trained novice raters . Intraclass correlation coefficients of summary scores for individual ( experienced ) raters : ICCTotalScore = .90 , ICCIVSubscale = .88 , ICCEVISubscale = .87 ; individual ( novice ) raters : ICCTotalScore = .88 , ICCIVSubscale = .87 , ICCEVISubscale = .93 ; consensus ratings between experienced and novice raters ( ICCTotalScore = .95 , ICCIVSubscale = .93 , ICCEVISubscale = .93 . The RoBiNT Scale thus shows sound psychometric properties and provides a comprehensive yet efficient examination of important features of single-case methodology Background Childhood Apraxia of Speech is an impairment of speech motor planning that manifests as difficulty producing the sounds ( articulation ) and melody ( prosody ) of speech . These difficulties may persist through life and are detrimental to academic , social , and vocational development . A number of published single subject and case series studies of speech treatments are available . There are currently no r and omised control trials or other well design ed group trials available to guide clinical practice . Methods / Design A parallel group , fixed size r and omised control trial will be conducted in Sydney , Australia to determine the efficacy of two treatments for Childhood Apraxia of Speech : 1 ) Rapid Syllable Transition Treatment and the 2 ) Nuffield Dyspraxia Programme – Third edition .  Eligible children will be English speaking , aged 4–12 years with a diagnosis of suspected CAS , normal or adjusted hearing and vision , and no comprehension difficulties or other developmental diagnoses . At least 20 children will be r and omised to receive one of the two treatments in parallel . Treatments will be delivered by trained and supervised speech pathology clinicians using operationalised manuals . Treatment will be administered in 1-hour sessions , 4 times per week for 3 weeks . The primary outcomes are speech sound and prosodic accuracy on a customised 292 item probe and the Diagnostic Evaluation of Articulation and Phonology inconsistency subtest administered prior to treatment and 1 week , 1 month and 4 months post-treatment . All post assessment s will be completed by blinded assessors . Our hypotheses are : 1 ) treatment effects at 1 week post will be similar for both treatments , 2 ) maintenance of treatment effects at 1 and 4 months post will be greater for Rapid Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment , and 3 ) generalisation of treatment effects to untrained related speech behaviours will be greater for Rapid Syllable Transition Treatment than Nuffield Dyspraxia Programme treatment . This protocol was approved by the Human Research Ethics Committee , University of Sydney ( # 12924 ) . Discussion This will be the first r and omised control trial to test treatment for CAS . It will be valuable for clinical decision-making and providing evidence -based services for children with CAS.Trial Registration Australian New Zeal and Clinical Trials Registry : The objectives of this study were to determine appropriate acoustic and outcome measures for the evaluation of a method of laryngeal manual therapy ( LMT ) used in the treatment of patients with muscle tension dysphonia ( MTD ) . The effects of this technique were also investigated . The study was based on the hypotheses that the vertical position of the larynx in the vocal tract would lower , that the quality of the voice would normalize , and that a reduction in any vocal tract discomfort ( VTD ) would occur after LMT . This was a small , prospect i ve , repeated measures pilot study in which each member of the research team was " blinded " to all other stages of the study and during which all data were anonymized until the final stage of data analysis . Ten subjects presenting with MTD completed outcome measures and provided audiorecordings immediately before , immediately after , and 1 week after LMT . The Kay CSL 4150 was used for signal acquisition and for some acoustic measurements . Spectrographic evaluation was accomplished with Praat . A new perceptual , self-rating scale , the VTD scale , and a new proforma for use by the clinician for palpatory evaluation , were developed for the study . Relative average perturbation during connected speech was significantly reduced after LMT , indicating a reduction in abnormal vocal function . The severity and frequency of VTD was shown to have reduced after LMT . This pilot study showed positive evidence for LMT as a method of therapy in the treatment of hyperfunctional voice disorders . Its effects were shown to be measurable with both acoustical analysis and the VTD scale The aim of this article is to present a set of evidence levels , accompanied by 14 quality or rigor questions , to foster a critical review of published single‐subject research articles . In developing these guidelines , we review ed levels of evidence and quality /rigor criteria that are in wide use for group research design s , e.g. r and omized controlled trials , such as those developed by the Treatment Outcomes Committee of the American Academy for Cerebral Palsy and Developmental Medicine . We also review ed method ological articles on how to conduct and critically evaluate single‐subject research design s ( SSRDs ) . We then subjected the quality questions to interrater agreement testing and refined them until acceptable agreement was reached . We recommend that these guidelines be implemented by clinical research ers who plan to conduct single‐subject research or who incorporate SSRD studies into systematic review s , and by clinicians who aim to practise evidence ‐based medicine and who wish to critically review pediatric single‐subject research BACKGROUND speechBITE ( http://www.speechbite.com ) is an online data base established in order to help speech and language therapists gain faster access to relevant research that can used in clinical decision-making . In addition to containing more than 3000 journal references , the data base also provides method ological ratings on the PEDro-P ( an adapted version of the PEDro ) scale to assist clinicians in identifying the scientific quality of r and omized ( RCTs ) and non-r and omized control trials ( N RCTs ) . While reliability of the PEDro scale has been established by similar allied health data bases , the reliability of the PEDro-P scale has yet to be reported . AIMS To examine the reliability of PEDro-P scale ratings undertaken by raters on the speechBITE data base and benchmark these results to the published reliability for the original PEDro scale . Both the total score ( out of ten ) as well as each of the 11 scale items were included in this analysis . METHODS & PROCEDURES  speechBITE 's volunteer rater network of 17 members rated the first 100 RCTs and N RCTs on the website . The criterion and overall scores for these ratings were compared with previously published reliability studies using the PEDro scale . Intra-class correlations and per cent agreement measures were used to establish and benchmark reliability . OUTCOMES & RESULTS The speechBITE PEDro-P ratings ranged from fair to excellent for both the total score and for each of the 11 scale items . Furthermore , reliability was equal to that of other data bases . CONCLUSIONS & IMPLICATION S speechBITE users can be confident of the reliability of ratings published on the website . Further analysis of differences between this study and previous PEDro scale reliability studies are discussed In a previous study , female patients in all age categories with a nonorganic dysphonia were found to report significantly more autonomic symptoms and complaints than healthy controls . This could not be confirmed for the male subgroup . The present study is to corroborate and nuance this observation by investigating larger groups , and to determine if , after voice therapy , the number of autonomic symptoms and complaints-particularly those ones that have no obvious relation to voice function-decreases . It is a prospect i ve study with a matched control group ; 184 patients with nonorganic dysphonia and 126 normal controls answered a question naire of 46 questions with 3 subsets and a consistency control . One hundred and one patients received functional voice therapy  and completed the question naire before and after treatment . A matched control group of 42 normal subjects also filled in the question naire two times , with an interval of about 6 months . Neurovegetative symptoms and complaints-voice related and not related-are reported in highly significant excess by patients ( especially but not exclusively females ) with habitual nonorganic voice disorder . After therapy , there is a highly significant reduction in the number of autonomic symptoms and complaints ( related or not related to voice ) , to such an extent that patients report on average no more general neurovegetative symptoms and complaints than healthy controls ( even less ) . The number of neurovegetative symptoms and complaints connected with voice function is also strongly reduced in patients after therapy , but remains in significant excess when compared with controls Rating scales that assess method ological quality of clinical trials provide a means to critically appraise the literature . Scales are currently available to rate r and omised and non-r and omised controlled trials , but there are none that assess single-subject design s. The Single-Case Experimental Design ( SCED ) Scale was developed for this purpose and evaluated 
    Output:
    