***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 Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results This study evaluated individual differences in levels of  C-reactive protein  ( CRP ) measured in saliva , cross-sectionally and prospect ively , in relation to systemic inflammation and risk for cardiovascular disease ( CVD ) . Plasma and saliva sample s , later assayed for CRP , were collected multiple times from an ethnically diverse group of women seeking help from domestic violence crisis shelters-agencies ( N=107 ; mean age at study start=34 years ) .  Plasma and saliva CRP levels were moderately associated cross-sectionally and across two years . There were indications that saliva CRP levels were , on average , higher in the morning than evening . Higher levels of saliva and plasma CRP were associated with a higher body mass index , but did not differ between women who did and did not smoke . Salivary CRP reliably discriminated between high and low levels of plasma CRP , using a clinical ly relevant cutoff point of 3mg/L , recommended by the American Heart Association . Results build upon an emerging literature suggesting that under specific conditions levels of CRP in saliva may reflect low- grade inflammation and have the potential to serve as a screen for CVD risk status Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Aging is associated with an increased susceptibility to infections and chronic inflammatory diseases . This might be caused by dysregulations of the endocrine system with increased activity of the hypothalamus-pituitary-adrenal ( HPA ) axis and decreased levels of sex steroids . Therefore , we investigated the stress-response of the HPA axis and glucocorticoid ( GC ) sensitivity of pro-inflammatory cytokine production in elderly men , compared to testosterone-treated elderly men and young controls .  Stress-induced increases in cortisol did not differ significantly between experimental groups ( F=2.10 ; p>0.10 ) , but GC sensitivity increased significantly in young controls and testosterone-treated elderly men , while a decrease was found in untreated elderly men ( F=5.28 ; p<0.01 ) . We conclude that the increase in GC sensitivity after stress serves to protect the individual from detrimental increases of pro-inflammatory cytokines , a mechanism that is disturbed in elderly men and partly restored by testosterone treatment Psychosocial factors and  interleukin-6 ( IL-6 ) levels are both related to risk of morbidity and mortality . The aim of this study was to investigate how a broad range of psychosocial factors related to levels of IL-6 in different media . Fifty-nine men and women aged 30 - 65 were recruited from a larger study and selected to cover a broad range of psychosocial status .  IL-6 levels were analyzed in serum , in saliva collected at home at three different time points during a day , and in the supernatant of cell cultures stimulated in vitro with lipopolysaccharide . After adjustments for age , gender , self-reported health problems , and lifestyle factors , IL-6-levels in serum were negatively correlated with coping and self-esteem , and positively correlated with cynicism , hostile affect , hopelessness , depression , and vital exhaustion . In saliva sample s , at all time points , IL-6 levels were positively correlated to cynicism , and IL-6 levels 30 min after awakening were also positively correlated with hopelessness , depression , and vital exhaustion . After adjustment for age and gender , cynicism , depression , and vital exhaustion were negatively correlated to IL-6 levels in the supernatant of cell cultures stimulated in vitro with lipopolysaccharide , but this effect was lost after control for self-reported health problems and lifestyle factors . In conclusion , we found that IL-6 levels in serum and saliva were negatively related to psychosocial re sources and positively related to psychosocial risk factors . These data strengthen the argument that IL-6 is involved in mediating the risk for disease development that has been associated with psychosocial factors 
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Discussion This systematic review will synthesize the evidence regarding salivary markers of inflammation in response to acute stress .
We anticipate variation across studies but hypothesize that salivary markers of inflammation will increase in response to acute stress .