***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 : Bright light therapy in seasonal affective disorder ( SAD ) has been studied extensively . However , little attention has been given to subsyndromal seasonal affective disorder ( SSAD ) or the use of bright light in the workplace . Many patients using bright light boxes  complain of the inconvenience of use . Much of this inconvenience involves the often‐recommended early timing of the bright light therapy .  Patients , who already have difficulty awakening , often have difficulty using the bright light therapy soon after awakening before going to work . If bright light could be used effectively in the workplace , the treatment would be more convenient ; the improved convenience would probably improve compliance . In this study , we studied the effectiveness of bright light therapy  in subjects with SSAD in the workplace , comparing morning bright light with afternoon bright light STUDY OBJECTIVES Light can induce an acute alerting response in humans ; however , it is unknown whether the magnitude of this response is simply a function of the absolute illuminance of the light itself , or whether it depends on illuminance history preceding the stimulus . Here , we compared the effects of illuminance history on the alerting response to a subsequent light stimulus . DESIGN A r and omized , crossover design was used to compare the effect of two illuminance histories ( 1 lux vs. 90 lux ) on the alerting response to a 6.5-h 90-lux light stimulus during the biological night . SETTING Intensive Physiologic Monitoring Unit , Brigham and Women 's Hospital , Boston , MA . PARTICIPANTS Fourteen healthy young adults ( 6 F ; 23.5 ± 2.9 years ) . INTERVENTIONS Participants were administered two 6.5-h light exposures ( LE ) of 90 lux during the biological night . For 3 days prior to each LE , participants were exposed to either 1 lux or 90 lux during the wake episode . MEASUREMENTS AND RESULTS The alerting response to light was assessed using subjective sleepiness ratings , lapses of attention , and reaction times as measured with an auditory psychomotor vigilance task , as well as power density in the delta/theta range of the waking EEG . The alerting response to light was greater and lasted longer when the LE followed exposure to 1 lux compared to 90 lux light . CONCLUSION The magnitude and duration of the alerting effect of light at night depends on the illuminance history and appears to be subject to sensitization and adaptation Background The effect of indoor environment may have an influence on the performance , productivity health and well-being of office workers . Methods Environmental factors such as indoor temperature and illumination have been investigated at three levels . A neurobehavioral test ( NBT ) has been proposed for the evaluation of office workersc performance . A field lab to emulate an office has been created . In controlled condition of environmental factors , the neurobehavioral test was conducted . The response time and the number of errors in each test have been recorded . A r and omized block factorial design was used to analyze the responses of office worker ’s performance . Results The results revealed that the independent and interaction effect of temperature and illumination have significant effect on the office workers ’ performance . The effect of indoor room temperature has more influences than the effect of illumination . The effect of indoor temperature has 38.56 % of contribution on the performance . The optimum levels of indoor temperature at 21 ° C and illumination at 1000 lux have improved the work performance and health of office workers . Conclusion The indoor room temperature and illumination are more influence on the performance of the office workers . It may be concluded that the impact of indoor room temperature ( 38.56 % ) is more on the office worker ’s performance than the effect of illumination ( 19.91 % ) . Further , it may be concluded that the optimum level of indoor room temperature ( 21 ° C ) and illumination ( 1000lux ) have improved the work performance , health and productivity of office workers Light can elicit both circadian and acute physiological responses in humans . In a dose response protocol men and women were exposed to illuminances ranging from 3 to 9100 lux for 6.5 h during the early biological night after they had been exposed to <3 lux for several hours . Light exerted an acute alerting response as assessed by a reduction in the incidence of slow-eye movements , a reduction of EEG activity in the theta-alpha frequencies ( power density in the 5 - 9 Hz range ) as well as a reduction in self-reported sleepiness . This alerting response was positively correlated with the degree of melatonin suppression by light . In accordance with the dose response function for circadian re setting and melatonin suppression , the responses of all three indices of alertness to variations in illuminance were consistent with a logistic dose response curve . Half of the maximum alerting response to bright light of 9100 lux was obtained with room light of approximately 100 lux . This sensitivity to light indicates that variations in illuminance within the range of typical , ambient , room light ( 90 - 180 lux ) can have a significant impact on subjective alertness and its electrophysiologic concomitants in humans during the early biological night A cross sectional survey investigating " building sickness " was carried out in two buildings with similar population s of office workers but differing ventilation systems , one being fully air conditioned with humidification and the other naturally ventilated . The prevalence of symptoms related to work was assessed by a question naire administered by a doctor . A stratified , r and omly selected sample of workers was seen ( 84 % response ) . Building sickness includes several distinct syndromes related to work , most of which were significantly more common in the air conditioned building than the naturally ventilated building -- namely , rhinitis ( 28 % v 5 % ) , nasal blockage and dry throat ( 35 % v 9 % ) , lethargy ( 36 % v 13 % ) , and headache ( 31 % v 15 % ) . The prevalence of work related asthma and humidifier fever was low and did not differ significantly between the two buildings . An environmental assessment of the offices was performed to attempt to identify possible factors responsible for the differences in the prevalence of disease . Globe temperature , dry bulb temperature , relative humidity , moisture content , air velocity , positive and negative ions , and carbon monoxide , ozone , and formaldehyde concentrations were all measured . None of these factors differed between the buildings , suggesting that building sickness is caused by other factors We explored the illumination exposure of middle-aged adults to determine normal values and to explore several correlates of daily light exposures . Subjects aged 40 - 64 years in San Diego , CA were recruited by r and om telephone dialing . Subjects completed a demographic interview and the Center for Epidemiologic Studies Depression self-rating scale ( the CES-D ) supplemented with eight questions related to seasonal affective disorders ( SAD ) . Data were analyzed for 106 volunteers who wore a device that monitors illumination exposures and activity . The median subject was exposed to illumination > or = 1000 lux for only 4 % of the time observed , that is , only about 58 min per day were spent in daylight . Subjects scoring higher on the atypical SAD mood symptoms spent less time in bright illumination rs = -0.266 , p = 0.003 . The CES-D depression score was similarly correlated with illumination but of borderline significance ( rs = -0.150 , p = 0.063 ) . These results suggest the hypothesis that many Americans may be receiving insufficient light exposure to maintain optimal mood Background Light exposure can cascade numerous effects on the human circadian process via the non-imaging forming system , whose spectral relevance is highest in the short-wavelength range . Here we investigated if commercially available compact fluorescent lamps with different colour temperatures can impact on alertness and cognitive performance . Methods Sixteen healthy young men were studied in a balanced cross-over design with light exposure of 3 different light setting s ( compact fluorescent lamps with light of 40 lux at 6500 K and at 2500 K and inc and escent lamps of 40 lux at 3000 K ) during 2 h in the evening . Results Exposure to light at 6500 K induced greater melatonin suppression , together with enhanced subjective alertness , well-being and visual comfort . With respect to cognitive performance , light at 6500 K led to significantly faster reaction times in tasks associated with sustained attention ( Psychomotor Vigilance and GO/NOGO Task ) , but not in tasks associated with executive function ( Paced Visual Serial Addition Task ) . This cognitive improvement was strongly related with attenuated salivary melatonin levels , particularly for the light condition at 6500 K . Conclusions Our findings suggest that the sensitivity of the human alerting and cognitive response to polychromatic light at levels as low as 40 lux , is blue-shifted relative to the three-cone visual photopic system . Thus , the selection of commercially available compact fluorescent lights with different colour temperatures significantly impacts on circadian physiology and cognitive performance at home and in the workplace We investigated the effects of improved indoor environmental quality ( IEQ ) on perceived health and productivity in occupants who moved from conventional to green ( according to Leadership in Energy and Environmental Design ratings ) office buildings . In 2 retrospective- prospect i ve case studies we found that improved IEQ contributed to reductions in perceived absenteeism and work hours affected by asthma , respiratory allergies , depression , and stress and to self-reported improvements in productivity . These preliminary findings indicate that green buildings may positively affect public health There are few epidemiological studies on sleep loss and daytime sleepiness in the general adult population of Japan . A total of 4000 adult people , aged 20 and over , were r and omly drawn from five areas of Japan , and 3030 individuals were interviewed and completed a question naire including information about sleep duration and sleep problems . Overall , 29 % slept less than 6 h at night , 23 % reported having insufficient sleep , and 6 % took sleep enhancing medications . The prevalence rates were 21 % for symptoms of insomnia and 15 % for excessive daytime sleepiness . Symptoms of insomnia were more prevalent in the elderly , whereas young people were more likely to report short sleep duration , subjective insufficient sleep and excessive daytime sleepiness . A multiple logistic regression model revealed that excessive daytime sleepiness had significant associations with young people , short sleep duration , insomnia symptoms , subjective insufficient sleep and sleep enhancing medication use . Short sleep duration was the strongest predictor of excessive daytime sleepiness . The findings indicate that sleep loss and excessive daytime sleepiness in the Japanese adult population are common , and comparable to those reported in Western countries . Excessive daytime sleepiness in the general adult population seems more likely to be attributed to short sleep duration Office lighting has been suggested as one of the possible factors in producing ' building sickness ' . Health question naires were completed by 106 out of 109 ( 97 % ) workers in six r and omly sample d multi-occupied offices in each of two buildings , one air-conditioned and one naturally ventilated . There was a significantly higher prevalence of work-related headache and work-related lethargy in the air-conditioned building than in the naturally ventilated one . There was also less daylight in the air-conditioned building and lower mean luminance and illuminance of the work positions despite there being more lights on ( p less than 0.01 ) . The workers had a greater dislike of fluorescent lighting  ( p less than 0.01 ) and overall found the lighting to be less comfortable ( p less than 0.01 ) and glare readings were higher . The workers perceived their control of lighting as poorer ( p less than 0.001 ) and consequently there was less agreement about it ( p less than 0.001 ) . Those with work-related headache found the lighting less comfortable ( p = 0.059 ) and perceived more glare ( p less than 0.05 ) . This study suggests the need to maximize the use of natural light from untinted windows , to reduce the impingement of fluorescent tubes on the line of sight and to return the control of levels of lighting to each individual worker OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also 
    Output:
    
There was no substantial difference in mood , as assessed by the Beck Depression Inventory , or in adverse events , such as ocular , reading or concentration problems , in the short or medium term .
There is very low- quality evidence based on two CBA studies that high CCT light may improve alertness , but not mood , in daytime workers .
There is very low- quality evidence based on one CBA study that high CCT light may also cause less irritability , eye discomfort and headache than st and ard illumination .
There is very low- quality evidence based on one RCT that individually applied blue-enriched light improves both alertness and mood .
There is low- quality evidence based on one RCT that individually administered bright light during the afternoon is as effective as morning exposure for improving alertness and mood in subsyndromal seasonal affective disorder