***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: Thermotolerance and heat acclimation are key adaptation processes that have been hitherto viewed as separate phenomena . Here , we provide evidence that these processes may share a common basis , as both may potentially be governed by the heat shock response . We evaluated the effects of a heat shock response-inhibitor ( quercetin ; 2,000 mg/day ) on established markers of thermotolerance [ gastrointestinal barrier permeability , plasma TNF-α , IL-6 , and IL-10 concentrations , and leukocyte heat shock protein 70 ( HSP70 ) content ] . Heat acclimation reduced body temperatures , heart rate , and physiological strain during exercise/heat stress ) in male subjects ( n = 8) completing a 7-day heat acclimation protocol . These same subjects completed an identical protocol under placebo supplementation ( placebo )  . Gastrointestinal barrier permeability and TNF-α were increased on the 1st day of exercise/heat stress in quercetin ; no differences in these variables were reported in placebo .  Exercise HSP70 responses were increased , and plasma cytokines ( IL-6 , IL-10 ) were decreased on the 7th day of heat acclimation in placebo ; with concomitant reductions in exercise body temperatures , heart rate , and physiological strain . In contrast , gastrointestinal barrier permeability remained elevated , HSP70 was not increased , and IL-6 , IL-10 , and exercise body temperatures were not reduced on the 7th day of heat acclimation in quercetin . While exercise heart rate and physiological strain were reduced in quercetin , this occurred later in exercise than with placebo . Consistent with the concept that thermotolerance and heat acclimation are related through the heat shock response , repeated exercise/heat stress increases cytoprotective HSP70 and reduces circulating cytokines , contributing to reductions in cellular and systemic markers of heat strain . Exercising under a heat shock response-inhibitor prevents both cellular and systemic heat adaptations BACKGROUND This study evaluated adding reflective thermal inserts ( RTI ) to reduce the physiological strain during exercise-heat stress with a radiant load . RTI were used with a U.S. Army desert battle dress uniform , body armor , and helmet . METHODS Four male volunteers attempted four trials ( 10 min rest followed by 100 min walking at 1.56 m x s(-1 ) ) . All trials were at 40.0 degrees C dry bulb ( Tdb ) , 12.4 degrees C dew point ( Tdp ) , 20 % RH , and 1.0 m x s(-1 ) wind speed . On 2 d , there was supplementary irradiance ( + 1 ) with globe temperature ( Tbg ) = 56.5 degrees C and on 2 d there was no supplementary irradiance ( -I ) with Tbg approximately Tdb . Trial conditions were : 1 ) RTI and armor with supplementary irradiance ( RA+I ) ; 2 ) plain armor with supplementary irradiance ( PA+I ) ; 3 ) RTI and armor with no supplementary irradiance ( RA-I ) ; and 4 ) plain armor with no supplementary irradiance ( PA-I ) . RESULTS Endurance times were not significantly different among trials . With one exception , armor and helmet interior and exterior surface temperatures were not significantly different between either RA+I and PA+I or RA-I and PA-I. Temperature on the inside of the helmet in RA+I ( 47.1 + /- 1.4 degrees C ) was significantly lower than in PA+I ( 49.5 + /- 2.6 degrees C ) . There were no differences for any physiological measure ( core temperature , heart rate , mean weighted skin temperature , forehead skin temperature , sweating rate , evaporative cooling , rate of heat storage ) between either RA+I and PA+L or RA-I and PA-I. CONCLUSIONS Results showed no evidence that wearing RTI with body armor and helmet reduces physiological strain during exercise-heat stress with either high or low irradiance BACKGROUND A prospect i ve , longitudinal analysis of injuries sustained by a large combat-deployed maneuver unit has not been previously performed . METHODS A detailed description of the combat casualty care statistics , distribution of wounds , and mechanisms of injury incurred by a U.S. Army Brigade Combat Team during " The Surge " phase of Operation Iraqi Freedom was performed using a central ized casualty data base and an electronic medical record system . RESULTS Among the 4,122 soldiers deployed , there were 500 combat wounds in 390 combat casualties . The combat casualty rate for the Brigade Combat Team was 75.7 per 1,000 soldier combat-years . The % killed in action ( KIA ) was 22.1 % , and the % died of wounds was 3.2 % . The distribution of these wounds was as follows : head/neck 36.2 % , thorax 7.5 % , abdomen 6.9 % , and extremities 49.4 % . The percentage of combat wounds showed a significant increase in the head/neck region ( p < 0.0001 ) and a decrease in the extremities ( p < 0.03 ) compared with data from World War II , Korea , and Vietnam . The percentage of thoracic wounds ( p < 0.03 ) was significantly less than historical data from World War II and Vietnam . The % KIA was significantly greater in those soldiers injured by an explosion ( 26.3 % ) compared with those soldiers injured by a gunshot wound ( 4.6 % ; p = 0.003 ) . Improvised explosive devices accounted for 77.7 % of all combat wounds . CONCLUSIONS There was a significantly higher proportion of head/neck wounds compared with previous U.S. conflicts . The 22.1 % KIA was comparable with previous U.S. conflicts despite improvements in individual/vehicular body armor and is largely attributable to the lethality of improvised explosive devices . The lethality of a gunshot wound in Operation Iraqi Freedom has decreased to 4.6 % with the use of individual body armor 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 
    Output:
    
Active cooling devices may decrease the physiological strain associated with wearing IBA in hot environments .