***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: Background This is the second and final report for our study design ed to compare two generic sofosbuvir products for the degree and speed of virologic response to a dual anti-hepatitis C virus ( HCV ) treatment protocol . We aim ed to test the applicability of the early virus response kinetics and the very rapid virologic response ( vRVR ) rate as quick outcome measures for accelerated comparative efficacy studies and as a foundation for a personalized response-guided therapy . Methods Fifty eligible chronic HCV patients were r and omized to either one of two generic sofosbuvir products ( Gratisovir or Grateziano ) at a daily dose of one 400 mg tablet plus a weight-based ribavirin dose . Data were compared between the groups for early virus response kinetics and vRVR rates in relation to the rates of final sustained virologic response at week 12 posttreatment ( SVR12 ) . Results The Log10 transformed virus load ( Log polymerase chain reaction ) curves showed fairly similar rapid decline during the first 2 weeks , with no significant difference between the groups at four analysis points throughout the study by repeated- measures factorial analysis of variance test ( P=0.48 ) . The SVR12 rates were 96 % ( 95 % confidence interval , 79.6%–99.9 % ) in Gratisovir group ( 24/25 ) and 95.7 % ( 95 % confidence interval , 78%–99.9 % ) in Grateziano group ( 22/23 ) . There was no statistically significant difference found by exact test ( P>0.999 ) . There was a significant association between the vRVR and the SVR12 , with 100 % positive predictive value ( 38/38 of those who had vRVR , achieved a final SVR12 ) and 82.6 % sensitivity ( among the total 46 with SVR12 , 38 were having vRVR ) . Conclusion We can conclude from our study that the early HCV response kinetics and the vRVR rates could be used as sensitive quick markers for efficacy ( with a very high positive predictive value for SVR12 ) , based on our accelerated comparative efficacy research model . This might open the way for new models of accelerated equivalence efficacy studies along with the bioequivalence kinetics studies to test a generic drug against a reference . Also , the early response kinetics and the vRVR might be used as qualifiers for a personalized course of treatment . This could shorten unnecessarily long treatment courses in rapid responders and might help to avoid relapses in slow responders Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers BACKGROUND & AIMS We performed a prospect i ve study to investigate the effects of a sustained viral response ( SVR ) on outcomes of patients with hepatitis C virus ( HCV ) infection and compensated cirrhosis . METHODS We collected data from 1323 patients included in the prospect i ve Agence Nationale pour la Recherche sur le SIDA et les hépatites virales ( ANRS ) viral cirrhosis ( CirVir ) cohort , recruited from 35 clinical centers in France from 2006 through 2012 . All patients had HCV infection and biopsy-proven cirrhosis , were Child-Pugh class A , and had no prior liver complications . All patients  received anti-HCV treatment before or after inclusion ( with interferon then with direct antiviral agents ) and underwent an ultrasound examination every 6 months , as well as endoscopic evaluations . SVR was considered as a time-dependent covariate ; its effect on outcome was assessed by the Cox proportional hazard regression method . We used a propensity score to minimize confounding by indication of treatment and capacity to achieve SVR . RESULTS After a median follow-up period of 58.2 months , 668 patients ( 50.5 % ) achieved SVR . SVR was associated with a decreased incidence of hepatocellular carcinoma ( hazard ratio [ HR ] compared with patients without an SVR , 0.29 ; 95 % confidence interval [ CI ] , 0.19 - 0.43 ; P < .001 ) and hepatic decompensation ( HR , 0.26 ; 95 % CI , 0.17 - 0.39 ; P < .001 ) . Patients with SVRs also had a lower risk of cardiovascular events ( HR , 0.42 ; 95 % CI , 0.25 - 0.69 ; P = .001 ) and bacterial infections ( HR , 0.44 ; 95 % CI , 0.29 - 0.68 ; P < .001 ) . Metabolic features were associated with a higher risk of hepatocellular carcinoma in patients with SVRs , but not in patients with viremia . SVR affected overall mortality ( HR , 0.27 compared with patients without SVR ; 95 % CI , 0.18 - 0.42 ; P < .001 ) and death from liver-related and non-liver-related causes . Similar results were obtained in a propensity score-matched population . CONCLUSIONS We confirmed a reduction in critical events , liver-related or not , in a prospect i ve study of patients with HCV infection and compensated cirrhosis included in the CirVir cohort who achieved an SVR . We found an SVR to reduce overall mortality and risk of death from liver-related and non-liver-related causes . A longer follow-up evaluation is required to accurately describe and assess specific risk factors for complications in this population Background The most recent European Association for the Study of the Liver ( EASL ) 2016 Guidelines on treatment of hepatitis C ( HCV ) , allowed for shortening the course of treatment for some subsets of patients with sofosbuvir/ledipasvir and with grazoprevir/elbasvir based on cutoff baseline HCV RNA values . We hypothesized that it would be prudent to also consider an objective ly assuring very rapid , on-treatment , virologic response to therapy at week 2 ( vRVR ) before taking the decision of shortening the treatment duration . So we planned this study to test whether a dual sofosbuvir/daclatasvir ( SOF/DCV ) treatment duration tailored according to achieving vRVR to 8 or 12 weeks is non-inferior to the recommended fixed 12 weeks course in non-cirrhotic Egyptian chronic HCV genotype-4 patients . Methods The study was conducted in an outpatient setting according to a prospect i ve , r and omized , open-label , comparative , non-inferiority study design . A hundred twenty eligible , non-cirrhotic , chronic HCV patients were r and omly assigned ( 1:1 ) to receive daily doses in the form of one Gratisovir 400 mg table ( generic sofosbuvir produced by Pharco Pharmaceuticals , Alex and ria , Egypt ) plus one Daktavira 60 mg tablet ( generic daclatasvir produced by Dawood Pharm , Egypt ) for either a fixed 12 weeks duration ( reference group ) or a response tailored duration ( test group ) . In the test group the treatment duration was tailored according to the virus load tested by real time PCR into 8 weeks for patients who had undetectable HCV RNA level in their serum by the end of the second week of treatment ( vRVR ) ) , or 12 weeks for those who did not show vRVR . The primary outcome of the trial was the proportions of patients achieving SVR12 ( HCV RNA below lower level of quantification at week 12 after end of treatment ) . The comparison between groups was based on testing the null hypothesis of inferiority of the response-tailored group with a pre-specified margin of non-inferiority ( NI-m ) of 0.1 ( 10 % ) . The protocol was registered with a WHO Clinical Trial Registration ID : ACTRN12617000263392 . https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=372041 Findings Starting from Jun , 5 2016 , a hundred twenty eligible patients from 4 outpatient clinics in Alex and ria , Egypt were r and omized to either a fixed duration group  ( reference group : n = 60 patients ) or a response tailored duration group  ( test group : n = 60 patients ) . During the whole period of the study , only 1 patient dropped-out from each group . Both were lost to follow-up after the 4th week 's visit . Baseline characteristics in both groups were almost matching . Fifty eight out of the total 60 intention-to-treat ( ITT ) patients in the reference group achieved SVR12 ( 96.67 % ( 95 % confidence interval ( CI ) : 88.64–99 % ) . Whereas , 59 out of the total 60 ( ITT ) patients in the test group achieved SVR12 ( 98.33 % ( CI : 91.14–99.71 % ) . The per- protocol ( PP ) analysis , excluding patients who dropped-out before collecting their final result , showed that 58/59 ( 98.31 % ( CI : 91–99.7 % ) ) of patients in the reference group and 59/59 ( 100 % ( CI : 93.89–100 % ) of the test group achieved SVR12 . Non-inferiority was declared since the upper bound of the two-sided 95 % CI for the difference in proportions of SVR12 between groups ( P(reference ) − P(test ) ) did not exceed the specified non-inferiority margin of + 0.1 ( 10 % ) , both in ITT population ( − 1.67 % , CI : − 9.8%–+5.9 % ) , and in the PP population ( − 1.69 % , CI : − 9%–+ 4.58 % ) . No fatalities or serious adverse events were reported during the period of the study . Similar rates of non-serious adverse events were reported in both groups with a trend of higher incidence rate in the fixed 12 weeks group ; all were mild in severity . Interpretation Shortening the duration of therapy based on observed vRVR could provide a prudent basis to avoid unnecessary long treatment courses . This could not only reduce the drug exposure and the risk of adverse drug reactions , but also cut the cost of full treatment course with such expensive medications by one third . This could economize the treatment budget at the individual out-of-pocket level as well as the public health services and insurance levels and allow for better utilization of public health re sources Background Following publication of the PRISMA statement , the UK Centre for Review s and Dissemination ( CRD ) at the University of York in Engl and began to develop an international prospect i ve register of systematic review s with health-related outcomes . The objectives were to reduce unplanned duplication of review s and provide transparency in the review process , with the aim of minimizing reporting bias . Methods An international advisory group was formed and a consultation undertaken to establish the key items necessary for inclusion in the register and to gather views on various aspects of functionality . This article describes the development of the register , now called PROSPERO , and the process of registration . Results PROSPERO offers free registration and free public access to a unique prospect i ve register of systematic review s across all areas of health from all around the world . The dedicated web-based interface is electronically search able and available to all prospect i ve registrants . At the moment , inclusion in PROSPERO is restricted to systematic review s of the effects of interventions and strategies to prevent , diagnose , treat , and monitor health conditions , for which there is a health-related outcome .Ideally , registration should take place before the research ers have 
    Output:
    
Conclusion Generic direct-acting agents are highly effective for treating hepatitis C. Generic agents should be considered in re source -constrained setting s for decreasing the burden of liver disease in HCV-infected patients