***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 The purpose of this study was to evaluate the " Bike Smart " program , an eHealth software program that teaches bicycle safety behaviors to young children . METHODS Participants were 206 elementary students in grade s kindergarten to 3 . A r and om control design was employed to evaluate the program , with students assigned to either the treatment condition ( Bike Smart ) or the control condition ( a video on childhood safety ) . Outcome measures included computer-based knowledge items ( safety rules , helmet placement , hazard discrimination ) and a behavioral measure of helmet placement . RESULTS Results demonstrated that regardless of gender , cohort , and grade the participants in the treatment group showed greater gains than control participants in both the computer-presented knowledge items ( p > .01 ) and the observational helmet measure ( p > .05 ) . CONCLUSIONS Findings suggest that the Bike Smart program can be a low cost , effective component of safety training packages that include both skills-based and experiential training 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 shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Objective —To evaluate the effectiveness of a skills training program in improving safe cycling behavior , knowledge , and attitudes in young children . Methods — Grade 4 children from six elementary schools in East York ( a borough of Metropolitan Toronto ) participated . The intervention — playground based instruction on bicycle h and ling skills by certified instructors — was r and omly allocated to three schools . Altogether 141 children participated : 73 in the intervention group and 68 in the control group , with follow up evaluations available on 117 ( 83 % ) . The primary outcome was safe cycling behavior ( straight line riding , coming to a complete stop , and shoulder checking before a left turn ) . A self report question naire collected data on knowledge and attitudes . Baseline assessment s were made in June , with follow up evaluations in September , 1995 . Results —The prevalence of safe cycling behaviors at follow up in the intervention and control groups respectively , were : straight line riding ( 90 % v 88 % ; p=0.782 ) , coming to a complete stop ( 90 % v 76 % ; p=0.225 ) , and shoulder checking ( 0 % v 2 % ; p=1.000 ) . Over time ( from baseline to follow up ) children in both groups were more likely to maintain straight line riding , less likely to ride on the sidewalk , and less likely to consider that a car had more right to the road . Conclusions —This brief skills training program was not effective in improving safe cycling behavior , knowledge , or attitudes among grade 4 children Two training methods were developed to teach young cyclists ( 8/9 years ) how to behave in priority situations . One method was developed along the lines of the modelling principle . In earlier studies it was shown that this method is effective in teaching crossing strategies to young pedestrians . The other training method was based upon And erson 's Adaptive Control of Thought ( ACT ) theory , which describes the development of cognitive skills by proceduralisation and composition of behaviour and knowledge elements into automatic behaviour sequences . Two groups of children were trained with one of these methods . A control group did not receive traffic-related training in that period . The effect of the training was assessed by a knowledge test and a behaviour test . The results showed that the partly theoretical ACT approach initially result ed in an increased level of knowledge , which was found to have disappeared after a month . The modelling approach did not affect the level of knowledge . Both approaches had an equally positive effect on simple behavioural strategies , such as signalling and visual search behaviour . Correct application of priority rules appeared to be very difficult to teach . There was no effect of the two training methods . It seemed that children apply informal rules rather than formal rules when dealing with other traffic . It is hypothesized that these informal rules should form the starting point for training activities , because formal rules do not fit into children 's cognitive framework of schemes , and therefore can not be stored and retrieved effectively Objectives —To evaluate possible benefits of a school based bicycle safety education program ( “ Bike Ed ” ) on the  risk of bicycle injury in children . Methods —A population based case-control study was undertaken in a region of Melbourne , Australia . Cases were children presenting at hospital emergency departments with injuries received while riding bicycles . Controls were recruited by calling r and omly selected telephone numbers . Data were collected by personal interview . Results — Analysis , based on 148 cases and 130 controls aged 9 to 14 years , showed no evidence of a protective effect and suggested a possible harmful effect of exposure to the bicycle safety course ( odds ratio ( OR ) 1.64 , 95 % confidence interval ( CI ) 0.98 to 2.75 ) . This association was not substantially altered by adjustment for sex , age , socioeconomic status , and exposure , measured as time or distance travelled . Subgroup analysis indicated that the association was strongest in boys ( OR 2.0 , 95 % CI 1.1 to 3.8 ) , younger children , children from families with lower parental education levels , and children lacking other family members who bicycle . Conclusions —It is concluded that this educational intervention does not reduce the risk of bicycle injury in children and may possibly produce harmful effects in some children , perhaps due to inadvertent encouragement of risk taking or of bicycling with inadequate supervision 
    Output:
    
Overall , there was no statistically significant intervention effect on measures of injury .
There is a paucity of high- quality research in the area of bicycle skills training programmes .
Educational and skills training bicycling programmes may increase knowledge of cycling safety , but this does not seem to translate into a decrease in injury rate , or improved bicycle h and ling ability and attitudes