***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: This study examined the effects of indoor gardening on socialization , activities of daily living ( ADLs ) , and perceptions of loneliness in elderly nursing home residents . A total of 66 residents from two nursing homes participated in this two-phase study . In phase one , experimental group 1 participated once a week for 5 weeks in gardening activities while a control group received a 20-minute visit . While no significant differences were found between groups in socialization or perceptions of loneliness , there were significant pretest-posttest differences within groups on loneliness and guidance , reassurance of worth , social integration , and reliable alliance . The results also demonstrated gardening interventions had a significant effect on three ADLs ( transfer , eating , and toileting ) . Phase two examined differences in the effects of a 5-week versus a 2-week intervention program . Although no significant within-group differences were noted in socialization , loneliness , or ADLs , the 5-week program was more effective in increasing socialization and physical functioning This study sought to enhance the well-being of older nursing home residents who pace and w and er by enriching their nursing home environment . Visual , auditory , and olfactory stimuli were added to the nursing home unit environment to simulate two types of environments : a home environment and an outdoor nature environment . Participants seemed to prefer the enhanced environments by choosing to spend more time in them , and by sitting on benches in those environments . There was a trend toward less trespassing , exit-seeking , and other agitated behaviors being exhibited in the enhanced environment , and residents were observed to manifest more pleasure in it . Staff members and family members definitely expressed a preference for the enhanced environment over the regular one . Although effects on residents were limited , this approach offers a low-cost method for making the nursing home environment a better place for those residents Social engagement , which is defined as the maintenance of many social connections and a high level of participation in social activities , has been thought to prevent  cognitive decline in elderly persons . Associations between a socially engaged lifestyle and higher scores on memory and intelligence tests have been observed among community-dwelling older persons ( 1 - 5 ) . Short-term interventions to foster social and intellectual engagement have enhanced cognition among nursing home residents ( 6 ) and patients with dementia ( 7 ) . In animal studies ( 8) , mature rodents exposed to complex social and inanimate environments showed better maze-learning ability than those in sparser surroundings . Social engagement challenges persons to communicate effectively and participate in complex interpersonal exchanges . Besides providing a dynamic environment that requires the mobilization of cognitive faculties , social engagement may also indicate a commitment to community and family and engender a health-promoting sense of purpose and fulfillment . Another putative benefit of social engagement is greater availability of emotional support from relatives and friends . Lack of such support can predict adverse health outcomes ( 9 ) , but its influence on cognitive decline has not been examined . Although published findings on cognitive function are suggestive , interpretation of available epidemiologic data is hampered by method ologic and conceptual shortcomings . Most studies are not longitudinal assessment s of representative population -based cohorts but cross-sectional observations of volunteers or other special sample s. Adjustment for potential confounders , such as education or health status , is often lacking . Finally , although the concept of social engagement is intuitively accessible , it has been difficult to measure this construct . Early studies viewed previous favorable socioeconomic or occupational status as synonymous with social engagement in old age ( 1 ) ; this precluded examination of more salient or malleable postretirement behaviors . Recent investigations ( 10 - 12 ) , however , have used narrowly defined indicators ( for example , marital status or specific recreational activities ) to make inferences about the effect of late-life social environments on cognition . Other investigations ( 5 ) have used composite activity scales as proxies for social engagement but have not distinguished between activities that dem and a high level of externally directed attention and those that do not . Social and solitary pursuits are also rarely disaggregated , although each may affect cognitive function differently . We determined whether a global measure of social disengagement  was associated with incident cognitive impairment in a large cohort of community-dwelling elderly persons followed for 12 years . We acknowledge the potential salutary influence of solitary mental pursuits , but we focused on whether interpersonal connections and activities can prevent cognitive decline . Convincing demonstration of such an association could motivate elderly persons , their families , and their care providers to maintain active relationships . It would also justify continued funding for community-based and institutionally based social programs for elderly persons and the adoption of social policies in which activities of older persons are valued . Methods Participants The study sample was drawn from the New Haven , Connecticut , site of the Established Population s for Epidemiologic Studies of the Elderly ( EPESE ) project , described in detail elsewhere ( 13 ) . The New Haven cohort is a multistage probability sample of 2812 noninstitutionalized persons 65 years of age or older who were living in New Haven , Connecticut , in 1982 . Sample s were drawn from three housing strata : public ( income-restricted ) housing for elderly persons , private housing for elderly persons , and community housing .  Women were r and omly sub sample d to achieve equal representation of both sexes . The baseline response rate was 82 % . Trained lay examiners interviewed members of the cohort at home in 1982 , 1985,1988 , and 1994 and by telephone in intervening years . Our study was approved by the institutional review board of Yale University . Measurements Cognitive Function Cognitive performance was measured during in-home interviews with the 10-item Short Portable Mental Status Question naire ( SPMSQ ) ( 14 ) . ( The original item What is the name of this place ? was changed to What is your address ? because this seemed more appropriate for community-dwelling persons . ) Correct answers received 1 point each . If respondents declined to answer 4 or more items or if answers to 4 or more items were missing , the question naire was not scored . Otherwise , a participant 's decision not to answer a question was scored as an incorrect answer and scores on missing items were imputed by assigning the mean score of the nonmissing items . As has been done previously ( 15 - 17 ) , scores were divided into three categories : high ( a score of 9 or 10 ) , medium ( a score of 7 or 8) , and low ( a score of 0 to 6 ) . The validity of the question naire as a cognitive impairment measure has been assessed in a sub sample of respondents at another EPESE site . Participants received detailed medical examinations to determine the presence and severity of cognitive impairment . When medium scores on the SPMSQ and the category of mild impairment were excluded , the question naire 's sensitivity and specificity in identifying moderate or severe impairment were 85 % and 96 % , respectively ( 18 ) . Social Disengagement A comprehensive assessment of social connections and activities was completed during in-home interviews . We examined six indicators of social engagement : presence of a spouse , monthly visual contact with at least three relatives or close friends  , yearly nonvisual contact ( telephone calls or letters ) with at least 10 relatives or close friends , frequent attendance ( at least once per month ) at religious services , membership in other groups , and regular participation in recreational social activities . The Appendix provides exact questions and coding rules for these indicators . A composite social disengagement index was constructed from the six indicators . Five to six social ties received a score of 1 , three to four social ties received a score of 2 , one to two social ties received a score of 3 , and no social ties received a score of 4 . Tie refers to any type of social contact . If scores for more than two indicators were missing , the index was not scored . Emotional Support Perceived availability of emotional support from a social network was assessed with the question , Can you count on anyone to provide you with emotional supportthat is , talking over problems or helping make a difficult decision ? The adequacy of this support was assessed by the question , Could you have used more emotional support than you received ? Covariates We selected the following self-reported variables as potential confounders because they had cross-sectional associations with disengagement or impaired cognition among the cohort or because they are established risk factors for Alzheimer disease or vascular dementia ( both of which are prevalent causes of progressive cognitive decline in elderly persons ) ( 19 , 20 ) . Sociodemographic factors were age , sex , ethnicity ( white or nonwhite ) , education ( 12 years or<12 years ) , annual income ( < $ 10 000 , $ 10 000 , or not given ) , and housing . Health status indicators were the presence of physical disability , which was defined as requiring assistance from another person or special equipment with at least one activity of daily living ( walking across a room , dressing , eating , transferring from bed to chair , bathing , or using the toilet ) ( 21 ) or limitations in gross mobility ( climbing one flight of stairs or walking half a mile ) ( 22 ) ; high-risk cardiovascular profile ( compared with low risk , where high risk was defined as a measured sitting blood pressure>160/95 mm Hg or a history of physician-diagnosed stroke , diabetes , or myocardial infa rct ion ) ; visual impairment ( difficulty in reading ordinary newspaper print ) ; auditory impairment ( difficulty in hearing what a person says without seeing his face if that person talks in a normal voice in a quiet room ) ; and symptoms of depression  ( a score 16 on the Center for Epidemiologic Studies Depression Scale [ 23 ] ) . Health-related behaviors were current smoking status , alcohol consumption , and level of physical activity ( described in the Appendix ) . Statistical Analysis Cognitive decline was defined as a transition to a lower SPMSQ category ( transition from high to medium or low or transition from medium to low ) during a given interval . Respondents with low SPMSQ scores at the beginning of an interval were excluded from consideration during that interval . Incidence of cognitive decline by initial level of social disengagement was estimated over intervals of three lengths:3-year intervals ( 1982 to 1985 and 1985 to 1988 ) , 6-year intervals ( 1982 to1988 and 1988 to 1994 ) , and a 12-year interval ( 1982 to 1994 ) . Approximately20 % of respondents with low SPMSQ scores in 1982 scored higher in 1985 or 1988 and were therefore included in the 1985 to 1988 or 1988 to 1994 analyses . Polytomous logistic regression was used to estimate the relative risk for cognitive decline or death by level of disengagement , controlling for potential confounders . The three outcomes maintenance of cognitive function , cognitive decline , and deathwere treated as unordered categorical variables . To examine the validity of the assumption of a linear dose-response relation between social disengagement and cognitive decline or death , disengagement was initially coded as a set of indicator variables , each corresponding to 1 point on the composite disengagement index . Inspection of the result ing coefficients suggested that modeling disengagement as an ordered categorical covariate was justified ; the addition of quadratic or cubic terms did not substantially improve model fit BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions  to improve the management of cancer pain . Each study assessment was completed independently by two review ers using each tool . We analysed the inter-rater reliability of each tool 's individual domains , as well as final grade assigned to each study . RESULTS The EPHPP had fair inter-rater agreement for individual domains and excellent agreement for the final grade . In contrast , the CCRBT had slight inter-rater agreement for individual domains and fair inter-rater agreement for final grade . Of interest , no agreement between the two tools was evident in their final grade assigned to each study . Although both tools were developed to assess ' quality of the evidence ' , they appear to measure different constructs . CONCLUSIONS Both tools performed quite differently when evaluating the risk of bias or method ological quality of studies in knowledge translation interventions for cancer pain . The newly introduced CCRBT assigned these studies a higher risk of bias . Its psychometric properties need to be more thoroughly vali date d , in a range of research fields , to underst and fully how to interpret results from its application 
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DISCUSSION AND IMPLICATION S There is inconsistent evidence that indoor nature exposures are beneficial for older care residents .
We expect that successful interventions were , at least partly , facilitating social interaction , supporting feelings of autonomy/control , and promoting skill development , that is , factors not necessarily associated with nature per se .