***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 Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review ABSTRACT The beneficial effects of probiotic Enterococcus spp . in different hosts , such as mice and humans , have previously been reported in several studies . However , studies of large domestic animals , as well as challenge studies with pathogenic microorganisms , are very rare . Here , we investigated the influence of oral treatment of pigs with the  probiotic bacterium Enterococcus faecium NCIMB 10415 on Salmonella enterica serovar Typhimurium DT104 infections in weaning piglets .  Clinical symptoms , fecal excretion , the organ distribution of Salmonella , and the humoral immune response ( immunoglobulin G [ IgG ] , IgM , and IgA levels ) in serum were examined . A pool of 89 piglets was r and omly divided into probiotic and control groups . The probiotic group received a feed supplement containing E. faecium starting on day 14 postpartum prior to challenge with Salmonella serovar Typhimurium DT104 at 28 days postpartum . After challenge with Salmonella serovar Typhimurium DT104 , piglets in both groups showed no severe clinical signs of salmonellosis . However , fecal excretion and colonization of Salmonella in organs were significantly greater in piglets fed E. faecium . Likewise , the humoral immune response against Salmonella ( serum IgM and IgA levels ) was significantly greater in the probiotic group animals than in control animals . The results of this study suggest that E. faecium NCIMB 10415 treatment enhanced the course of infection in weaning piglets challenged with Salmonella serovar Typhimurium DT104 . However , the probiotic treatment also appeared to result in greater production of specific antibodies against Salmonella serovar Typhimurium DT104 ABSTRACT Contamination of meat products with food-borne pathogens usually results from the carcass coming in contact with the feces of an infected animal during processing . In the case of Salmonella , pigs can become colonized with the organism during transport and lairage from contaminated trailers and holding pens , result ing in increased pathogen shedding just prior to processing . Increased shedding , in turn , amplifies the likelihood of carcass contamination by magnifying the amount of bacteria that enters the processing facility . We conducted a series of experiments to test whether phage therapy could limit Salmonella infections at this crucial period . In a preliminary experiment done with small pigs ( 3 to 4 weeks old ; 30 to 40 lb ) , administration of an anti-Salmonella phage cocktail at the time of inoculation with Salmonella enterica serovar Typhimurium reduced Salmonella colonization by 99.0 to 99.9 % ( 2- to 3-log reduction ) in the tonsils , ileum , and cecum . To test the efficacy of phage therapy in a production-like setting , we inoculated four market-weight pigs ( in three replicates ) with Salmonella enterica serovar Typhimurium and allowed the challenged pigs to contaminate a holding pen for 48 h. Sixteen naïve pigs were r and omly split into two groups which received either the anti-Salmonella phage cocktail or a mock treatment . Both groups of pigs were comingled with the challenged pigs in the contaminated pen . Treatment with the anti-Salmonella phage cocktail significantly reduced cecal Salmonella concentrations ( 95 % ; P < 0.05 ) while also reducing ( numerically ) ileal Salmonella concentrations ( 90 % ; P = 0.06 ) . Additional in vitro studies showed that the phage cocktail was also lytic against several non-Typhimurium serovars Recent research has shown that much preharvest Salmonella enterica infection in pigs occurs immediately before slaughter during this rest period in the contaminated abattoir holding pens . The objective of this study was to evaluate a potential intervention strategy to reduce the prevalence of S. enterica-positive pigs at slaughter , which consisted of resting pigs prior to slaughter on their transport vehicle , instead of in the abattoir holding pen . Additionally , the effect of transportation of pigs from farm to the abattoir on S. enterica prevalence was investigated . A total of 120 animals were included in the experiment , divided in four replicates ( n = 30 pigs per replicate ) . Fecal sample s were collected from each animal at the farm and at the abattoir , where 15 r and omly chosen pigs were unloaded and moved to a holding pen , while the remaining 15 pigs stayed in the transport trailer . After approximately 1.5 h of resting , both groups were slaughtered . Sample s collected included distal ileum portion , cecal contents , and ileocecal lymph node . The overall S. enterica prevalence ( pigs positive in at least one of the sample s collected at slaughter ) was higher for pigs held in the abattoir pens ( 40.7 % versus 13.3 % , P < 0.05 ) . There was no difference ( P > 0.05 ) for the S. enterica prevalence before and after transportation from farm to abattoir ( 5.8 % versus 0.8 % , respectively ) . This study demonstrates that resting pigs on the transport vehicle has the potential to decrease S. enterica levels entering the abattoir This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence A mucosal competitive exclusion culture has been shown to reduce or eliminate Salmonella spp . in poultry . Using similar techniques , a mucosal competitive exclusion culture from swine ( MCES ) was produced from the cecum of a 6-week-old pig . Suckling pigs were inoculated with 5 ml of MCES by oral gavage within 6 h postfarrowing ( PF ) and again at 24 h PE All pigs were challenged with 10(3 ) CFU of Salmonella Choleraesuis at 48 h PF by intranasal instillation , including pigs from two sows that had not been given MCES .  Clinical signs and rectal swabs were monitored daily , and pigs were allowed to suckle throughout the experiment . All pigs underwent necropsy on day 7 PF , and presence of Salmonella was determined in both qualitative ( 10 tissues ) and quantitative ( two tissues ) sample s. Clinical signs were inapparent in all pigs throughout the experiment . Recovery of Salmonella from rectal swabs was variable . However , 28 % of the gut tissues were positive from the MCES-treated pigs versus 79 % from the control pigs . A 2- to 5-log10 reduction of Salmonella in the cecal contents or ileocolic junction was observed in the MCES-treated pigs when compared with the controls . These data indicate that use of MCES may be a useful approach for control of Salmonella To estimate the global burden of nontyphoidal Salmonella gastroenteritis , we synthesized existing data from laboratory-based surveillance and special studies , with a hierarchical preference to ( 1 ) prospect i ve population -based studies , ( 2 ) " multiplier studies , " ( 3 ) disease notifications , ( 4 ) returning traveler data , and ( 5 ) extrapolation . We applied incidence estimates to population projections for the 21 Global Burden of Disease regions to calculate regional numbers of cases , which were summed to provide a global number of cases . Uncertainty calculations were performed using Monte Carlo simulation . We estimated that 93.8 million cases ( 5th to 95th percentile , 61.8 - 131.6 million ) of gastroenteritis due to Salmonella species occur globally each year , with 155,000 deaths ( 5th to 95th percentile , 39,000 - 303,000 deaths ) . Of these , we estimated 80.3 million cases were foodborne . Salmonella infection represents a considerable burden in both developing and developed countries . Efforts to reduce transmission of salmonellae by food and other routes must be implemented on a global scale Nontyphoidal salmonellosis is the second most frequently reported zoonotic disease in the European Union ( EU ) and is considered to be a major threat to human health worldwide . The most reported Salmonella serovar in the EU is S. Enteritidis , mainly associated with egg contamination , followed by S. Typhimurium , with the latter being the most predominant serovar isolated from pork . These findings suggest that reducing the Salmonella contamination in the pork production might be a good strategy to prevent and control human salmonellosis in the EU . Recently , a quantitative microbial risk assessment ( QMRA ) has been developed to assess the risks for human salmonellosis due to home consumption of fresh minced pork meat in Belgium . The newly developed risk model is called the METZOON model . In the current study , the METZOON model was used to evaluate the effectiveness of different hypothetical Salmonella mitigation strategies implemented at different stages of the minced pork production and consumption chain by means of a scenario analysis . To efficiently evaluate the mitigation strategies , model results were obtained by running simulations using the r and omized complete block design . The effectiveness of a mitigation strategy is expressed using point and interval estimates of the effect size for dependent observations , expressed as the st and ardized difference in population means . The results indicate that the most effective strategies are taken during the slaughter processes of polishing , evisceration , and chilling , and during postprocessing , whereas interventions in the primary production and at the beginning of the slaughter process seem to have only a limited effect . Improving consumer awareness is found to be effective as well This study was design ed to compare Salmonella enterica prevalence in sows held in a holding pen at the abattoir for approximately 2 h ( hold sows ) with sows slaughtered immediately after transport to the abattoir ( no-hold sows ) . Cull sows ( n = 160 ) were sample d from four sampling periods over 8 weeks ( February to March 2002 ) at the abattoir . Sows originated from an integrated swine farm and were sent to a live-hog market and then to the slaughter facility . Before testing , sows entered the abattoir pen and four 100-cm2 four-ply gauze squares were placed r and omly on the pen floor for S. enterica culture . Sows were alternatively assigned to the hold or no-hold group . Sample s collected from sows during slaughter were ileocecal lymph node , cecal contents , transverse colon contents , subiliac lymph node , sponge swabs of the left and right carcass section ( 300 cm2 ) , and chopped meat . Overall , S. enterica was isolated from 44 % ( 35 of 80 ) of the no-hold sows , which was significantly less ( P < 0.05 ) than 59 % ( 47 of 80 ) of the held sows . Also , no-hold sows had a lower cecal content prevalence ( 39 % , 31 of 80 ) compared with that ( 55 % 
    Output:
    
We hypothesize that the presence of absence of one or more of these predictors across studies could help to explain the inconsistent and /or non-significant findings reported for some interventions applied at lairage