***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 Although effective topical repellents provide personal protection against malaria , whether mass use of topical repellents in addition to long-lasting insecticidal nets can contribute to a further decline of malaria is not known , particularly in areas where outdoor transmission occurs . We aim ed to assess the epidemiological efficacy of a highly effective topical repellent in addition to long-lasting insecticidal nets in reducing malaria prevalence in this setting . METHODS A cluster r and omised controlled trial was done in the 117 most endemic villages in Ratanakiri province , Cambodia , to assess the efficacy of topical repellents in addition to long-lasting insecticidal nets in controlling malaria in a low-endemic setting . We did a pre-trial assessment of village accessibility and excluded four villages because of their inaccessibility during the rainy season . Another 25 villages were grouped because of their proximity to each other , result ing in 98 study clusters ( comprising either a single village or multiple neighbouring villages ) . Clusters were r and omly assigned ( 1:1 ) to either a control ( long-lasting insecticidal nets ) or intervention ( long-lasting insecticidal nets plus topical repellent ) study group after a restricted r and omisation . All clusters received one long-lasting insecticidal net per individual , whereas those in the intervention group also received safe and effective topical repellents ( picaridin KBR3023 , SC Johnson , Racine , WI , USA ) , along with instruction and promotion of its daily use . Cross-sectional surveys of 65 r and omly selected individuals per cluster were done at the beginning and end of the malaria transmission season in 2012 and 2013 . The primary outcome was Plasmodium species-specific prevalence in participants obtained by real-time PCR , assessed in the intention-to-treat population . Complete safety analysis data will be published seperately ; any ad-hoc adverse events are reported here . This trial is registered with Clinical Trials.gov , number NCT01663831 . FINDINGS Of the 98 clusters that villages were split into , 49 were assigned to the control group and 49 were assigned to the intervention group . Despite having a successful distribution system , the daily use of repellents was suboptimum . No post-intervention differences in PCR plasmodium prevalence were observed between study groups in 2012 ( 4·91 % in the control group vs 4·86 % in the intervention group ; adjusted odds ratio [ aOR ] 1·01 [ 95 % CI 0·60 - 1·70 ] ; p=0·975 ) or in 2013 ( 2·96 % in the control group vs 3·85 % in the intervention group ; aOR 1·31 [ 0·81 - 2·11 ] ; p=0·266 ) . Similar results were obtained according to Plasmodium species ( 1·33 % of participants in the intervention group vs 1·10 % in the intervention group were infected with Plasmodium falciparum ; aOR 0·83 [ 0·44 - 1·56 ] ; p=0·561 ; and 1·85 % in the control group vs 2·67 % in the intervention group were infected with Plasmodium vivax ; aOR 1·51 [ 0·88 - 2·57 ] ; p=0·133 ) . 41 adverse event notifications from nine villages were received , of which 33 were classified as adverse reactions ( 11 of these 33 were cases of repellent abuse through oral ingestion , either accidental or not ) . All participants with adverse reactions fully recovered and 17 were advised to permanently stop using the repellent . INTERPRETATION Mass distribution of highly effective topical repellents in re source -sufficient conditions did not contribute to a further decline in malaria endemicity in a pre-elimination setting in the Greater Mekong subregion . Daily compliance and appropriate use of the repellents remains the main obstacle . FUNDING Bill & Melinda Gates Foundation Background The approximately 1100 medical journals now active in China are publishing a rapidly increasing number of research reports , including many studies identified by their authors as r and omized controlled trials . It has been noticed that these reports mostly present positive results , and their quality and authenticity have consequently been called into question . We investigated the adequacy of r and omization  of clinical trials published in recent years in China to determine how many of them met acceptable st and ards for allocating participants to treatment groups . Methods The China National Knowledge Infrastructure electronic data base was search ed for reports of r and omized controlled trials on 20 common diseases published from January 1994 to June 2005 . From this sample , a subset of trials that appeared to have used r and omization methods was selected . Twenty-one investigators trained in the relevant knowledge , communication skills and quality control issues interviewed the original authors of these trials about the participant r and omization methods and related quality -control features of their trials . Results From an initial sample of 37,313 articles identified in the China National Knowledge Infrastructure data base , we found 3137 apparent r and omized controlled trials . Of these , 1452 were studies of conventional medicine ( published in 411 journals ) and 1685 were studies of traditional Chinese medicine ( published in 352 journals ) . Interviews with the authors of 2235 of these reports revealed that only 207 studies adhered to accepted methodology for r and omization and could on those grounds be deemed authentic r and omized controlled trials ( 6.8 % , 95 % confidence interval 5.9–7.7 ) . There was no statistically significant difference in the rate of authenticity between r and omized controlled trials of traditional interventions and those of conventional interventions . R and omized controlled trials conducted at hospitals affiliated to medical universities were more likely to be authentic than trials conducted at level 3 and level 2 hospitals ( relative risk 1.58 , 95 % confidence interval 1.18–2.13 , and relative risk 14.42 , 95 % confidence interval 9.40–22.10 , respectively ) . The likelihood of authenticity was higher in level 3 hospitals than in level 2 hospitals ( relative risk 9.32 , 95 % confidence interval 5.83–14.89 ) . All r and omized controlled trials of pre-market drug clinical trial were authentic by our criteria . Of the trials conducted at university-affiliated hospitals , 56.3 % were authentic ( 95 % confidence interval 32.0–81.0 ) . Conclusion Most reports of r and omized controlled trials published in some Chinese journals lacked an adequate description of r and omization . Similarly , most so called ' r and omized controlled trials ' were not real r and omized controlled trials owing toa lack of adequate underst and ing on the part of the authors of rigorous clinical trial design . All r and omized controlled trials of pre-market drug clinical trial included in this research were authentic . R and omized controlled trials conducted by authors in high level hospitals , especially in hospitals affiliated to medical universities had a higher rate of authenticity . That so many non-r and omized controlled trials were published as r and omized controlled trials reflected the fact that peer review needs to be improved and a good practice guide for peer review including how to identify the authenticity of the study urgently needs to be developed A r and omized , double-blinded , placebo-controlled study was conducted to examine the effect of spatial repellent ( SR ) in households at risk of malaria in Indonesia . Following presumptive radical cure for malaria in 180 adult men representing sentinels of new infection in four clusters within two villages , all households were given either metofluthrin or placebo mosquito coils . Weekly blood smear screening and human-l and ing mosquito catches were done throughout the 6 months intervention . Malaria infections occurred in 61 subjects living in placebo households and 31 subjects living in SR coil households , suggesting a 52 % protective effect of SR . Likewise , anopheles indoor human l and ing rates were 32 % lower in homes receiving SR coils . Differences in the malaria attack rate between SR- and placebo-treated homes was significant when not accounting for the effects of clustering . When the analysis was adjusted for intra-cluster correlation , the differences between SR- and placebo-treated homes were not statistically significant . The findings provide evidence of SR public health benefit and support a larger trial statistically powered to detect those effects Background Mosquito vectors of malaria in Southeast Asia readily feed outdoors making malaria control through indoor insecticides such as long-lasting insecticidal nets ( LLINs ) and indoor residual spraying more difficult . Topical insect repellents may be able to protect users from outdoor biting , thereby providing additional protection above the current best practice of LLINs . Methods and Findings A double blind , household r and omised , placebo-controlled trial of insect repellent to reduce malaria was carried out in southern Lao PDR to determine whether the use of repellent and long-lasting insecticidal nets ( LLINs ) could reduce malaria more than LLINs alone . A total of 1,597 households , including 7,979 participants , were recruited in June 2009 and April 2010 . Equal group allocation , stratified by village , was used to r and omise 795 households to a 15 % DEET lotion and the remainder were given a placebo lotion . Participants , field staff and data analysts were blinded to the group assignment until data analysis had been completed . All households received new LLINs . Participants were asked to apply their lotion to exposed skin every evening and sleep under the LLINs each night . Plasmodium falciparum and P. vivax cases were actively identified by monthly rapid diagnostic tests . Intention to treat analysis found no effect from the use of repellent on malaria incidence ( hazard ratio : 1.00 , 95 % CI : 0.99–1.01 , p = 0.868 ) . A higher socio-economic score was found to significantly decrease malaria risk ( hazard ratio : 0.72 , 95 % CI : 0.58–0.90 , p = 0.004 ) . Women were also found to have a reduced risk of infection ( hazard ratio : 0.59 , 95 % CI : 0.37–0.92 , p = 0.020 ) . According to protocol analysis which excluded participants using the lotions less than 90 % of the time found similar results with no effect from the use of repellent . Conclusions This r and omised controlled trial suggests that topical repellents are not a suitable intervention in addition to LLINs against malaria amongst agricultural population s in southern Lao PDR . These results are also likely to be applicable to much of the Greater Mekong Sub-region . Trial Registration This trial is registered with number We determined the efficacy of the use of permethrin-impregnated uniforms for prevention of malaria and leishmaniasis in a double-blind , r and omized study of Colombian soldiers on patrol . In the study of malaria , soldiers were issued impregnated uniforms ( i.e. , a shirt , an undershirt , pants , socks , and a hat ) or uniforms washed in water ; the soldiers wore the uniforms day and night for a mean of 4.2 weeks and were observed for an additional 4 weeks . Three ( 3 % ) of 86 soldiers wearing impregnated uniforms contracted malaria , whereas 12 ( 14 % ) of 86 soldiers wearing control uniforms contracted malaria ( P = .015 ) . In the study of leishmaniasis ( soldiers were in the area of endemicity for 6.6 weeks and were observed for 12 weeks thereafter ) , 4 ( 3 % ) of 143 soldiers wearing impregnated uniforms and 18 ( 12 % ) of 143 soldiers wearing control uniforms acquired disease ( P = .002 ) . In the leishmaniasis study , and presumably in the malaria study , breakthrough infections in the treated group were primarily due to bites in unclothed regions of the body ( face and h and s ) . Permethrin-treated uniforms were virtually nontoxic ( there were only two cases of mild skin irritation among 229 subjects ) , and impregnation is quick and inexpensive . Impregnation of clothing with permethrin is suggested for nonimmune population s who are likely to be exposed to malaria or leishmaniasis over a period of 1 - 2 months Background The study sought to determine the effect of using insecticide-treated clothes ( ITCs ) on personal protection against malaria infection . The specific objectives were to determine the effect of using ITCs on the rate of infection with malaria parasites and the effect on indoor mosquito density . Methods This study was done in Dadaab refugee camps , North Eastern Province Kenya between April and August 2002 , and involved a total of 198 participants , all refugees of Somali origin . The participants were selected through multi-stage cluster sampling . Half of the participants ( treatment group ) had their personal clothes worn on a daily basis ( Diras , Saris , Jalbaab s , Ma'awis and shirts ) and their bedding ( sheets and blankets ) treated with insecticide ( permethrin ) . The other half ( comparison group ) had their clothes treated with placebo ( plain water ) .  Indoor mosquito density was determined from twelve households belonging to the participants ; six in the treatment block and six in the comparison block . During pre-test and post-test , laboratory analysis of blood sample s was done , indoor mosquito density determined and question naires administered . Using STATA statistical package , tests for significant difference between the two groups were conducted . Results Use of ITCs reduced both malaria infection rates and indoor mosquito density significantly . The odds of malaria infection in the intervention group were reduced by about 70 percent . The idea of using ITCs for malaria infection control was easily accepted among the refugees and they considered it 
    Output:
    
Authors ' conclusions There is insufficient evidence to conclude topical  or  spatial repellents can prevent malaria .