***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 Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers It has been suggested that gain-framed messages are more effective than loss-framed messages in promoting low-risk health behaviors such as physical activity . Because of a heightened health concern and possible medical complications , older adults with type 2 diabetes ( T2D ) may consider physical activity to be risky . This study examined whether a reverse message-framing effect would be found among older adults with T2D . The participants included 211 sedentary and older adults with T2D recruited from an outpatient clinic . The participants were r and omly assigned to receive either gain-framed or loss-framed messages and wore an accelerometer to monitor their physical activity for 2 weeks . The participants who received loss-framed messages were more physically active than those who received gain-framed messages ( β = 0.13 , p = .033 ) . This loss-frame advantage might be attributable to the heightened perceived risks among older out patients with T2D and the temporarily activated prevention-focused orientation in a clinical setting BACKGROUND Increasing physical activity ( PA ) levels in older adults represents an important public health challenge . The purpose of this study was to evaluate the feasibility of combining individualized motivational messaging with pedometer walking step targets to increase PA in previously inactive and insufficiently active older adults . METHODS In this 12-week intervention study older adults were r and omized to 1 of 4 study arms : Group 1 - -control ; Group 2 - -pedometer 10,000 step goal ; Group 3 - -pedometer step goal plus individualized motivational feedback ; or Group 4 - -everything in Group 3 augmented with biweekly telephone feedback . RESULTS 81 participants were r and omized into the study , 61 participants completed the study with an average age of 63.8 ± 6.0 years . Group 1 did not differ in accumulated steps/day following the 12-week intervention compared with participants in Group 2 . Participants in Groups 3 and 4 took on average 2159 ( P < .001 ) and 2488 ( P < .001 ) more steps/day , respectively , than those in Group 1 after the 12-week intervention . CONCLUSION In this 12-week pilot r and omized control trial , a pedometer feedback intervention partnered with individually matched motivational messaging was an effective intervention strategy to significantly increase PA behavior in previously inactive and insufficiently active older adults OBJECTIVES Recent interventions report positive results following a multi-component campaign to increase  stair climbing .  This study investigated the effectiveness of volitional and motivational components of a  stair-climbing  intervention in the workplace . Design . Interrupted time-series design . METHODS Ascending stair/lift choices , coded by gender , were observed between 08:00 - 10:00 and 14:15 - 16:15 on weekdays , in four university buildings ( n = 14,138 ; 46 % female ) . Baseline observations ( stage 1 ; 5 days ) preceded a motivational intervention , that is , a poster positioned inside the lift(s ) , that was positioned in each building ( stage 2 ; 5 days ) . Next a volitional intervention , that is , point-of-choice prompt , supplemented the motivational one ( stage 3 ; 8 days ) . Logistic regression analysis of stair/lift choices included the independent variables of intervention components , gender , time of day , building height , number of lifts , and pedestrian traffic . RESULTS There was no significant change in stair climbing when the motivational component was positioned alone ( Odds Ratio [ OR ] = 0.93 , 95 % Confidence Interval [ CI ] = 0.85 - 1.02 , p = .123 ) . In contrast , stair climbing increased significantly when the volitional component , that is , the point-of-choice prompt , was added ( OR = 1.23 , 95 % CI = 1.14 - 1.32 , p < .001 ) . During both stages , building height , number of lifts , time of day , and pedestrian traffic were all associated with stair climbing . No significant gender effects were seen . CONCLUSIONS A motivational component positioned alone , inside the lift(s ) did not increase stair climbing . When a volitional component was added , that is , point-of-choice prompt positioned at the time and place where individuals choose their method of ascent , stair climbing increased significantly . Visibility of a prompt at the time behavioural choice is made appears necessary to change actual behaviour OBJECTIVE To present the effects of a relatively modest environmental intervention on biological cardiovascular risk indicators . METHOD A controlled trial , including two worksites . Measurements ( i.e. , body composition , blood pressure and serum cholesterol ) took place at baseline and at 3- and 12-month follow-up . The 12-month environmental intervention ( The Hague , The Netherl and s , 2004 ) consisted of : a ' Food'-part : to stimulate healthier food choices by means of product information in the canteen , and a ' Steps'-part : focused on stimulating stair use by means of motivational prompts in staircases and on elevator doors . RESULTS Significant differences in change between groups ( n=540 ) in favor of the intervention group were found on : [ 1 ] total cholesterol for women ( -0.35 mmol/l ) ; [ 2 ] HDL for men at 3 months ( 0.05 mmol/l ) and 12 months ( 0.10 mmol/l ) ; and [ 3 ] the total-HDL ratio for the total intervention group at 3 and 12 months ( -0.45 mmol/l ) . Both groups showed a decrease in all body composition values at both follow-ups . A significant difference in change in systolic BP was found in favor of the control group ( approximately 4 mm Hg ) , due to an increase in the intervention group at both follow-ups . CONCLUSIONS Based on the contrasting results , this modest environmental intervention was ineffective in reducing cardiovascular risk in a population of office workers Objective : The authors examined whether alcohol-related negative consequences decreased among students exposed to an intervention .  Participants : Beginning in 1999 , approximately 2,500 r and omly selected undergraduates from a 4-year US university annually participated in a Web-based survey over 6 years . Methods : The educational intervention used social norms initiatives . Main outcome measures included recall of intervention , estimated blood alcohol content ( eBAC ) when drinking , and 10 negative consequences from alcohol within the past year . Results : First-year students recalling exposure had lower odds of negative consequences ( odds ratio [ OR ] = 0.78 , 95 % confidence interval [ CI ] = 0.64 - 0.95 ) and of having an eBAC higher than .08 ( OR = 0.76 , 95 % CI = 0.62 - 0.92 ) . Over the 6 study years , the odds among all participants of experiencing ( a ) none of 10 alcohol consequences nearly doubled ( OR = 2.13 , 95 % CI = 1.82 - 2.49 ) and ( b ) multiple consequences decreased by more than half ( OR = 0.43 , 95 % CI = 0.36 - 0.50 ) . Conclusions : These findings have important implication s for US colleges and universities engaged in the reduction of harm associated with alcohol misuse Background While there has been an explosion of mobile device applications ( apps ) promoting healthful behaviors , including physical activity and sedentary patterns , surprisingly few have been based explicitly on strategies drawn from behavioral theory and evidence . Objective This study provided an initial 8-week evaluation of three different customized physical activity-sedentary behavior apps drawn from conceptually distinct motivational frames in comparison with a commercially available control app . Study Design and Methods Ninety-five underactive adults ages 45 years and older with no prior smartphone experience were r and omized to use an analytically framed app , a socially framed app , an affectively framed app , or a diet-tracker control app .  Daily physical activity and sedentary behavior were measured using the smartphone ’s built-in accelerometer and daily self-report measures . Results Mixed-effects models indicated that , over the 8-week period , the social app users showed significantly greater overall increases in weekly accelerometry-derived moderate to vigorous physical activity relative to the other three arms ( P values for between-arm differences = .04-.005 ; Social vs. Control app : d = 1.05 , CI = 0.44,1.67 ; Social vs. Affect app : d = 0.89 , CI = 0.27,1.51 ; Social vs. Analytic app : d = 0.89 , CI = 0.27,1.51 ) , while more variable responses were observed among users of the other two motivationally framed apps . Social app users also had significantly lower overall amounts of accelerometry-derived sedentary behavior relative to the other three arms ( P values for between-arm differences = .02-.001 ; Social vs. Control app : d = 1.10,CI = 0.48,1.72 ; Social vs. Affect app : d = 0.94 , CI = 0.32,1.56 ; Social vs. Analytic app : d = 1.24 , CI = 0.59,1.89 ) . Additionally , Social and Affect app users reported lower overall sitting time compared to the other two arms ( P values for between-arm differences < .001 ; Social vs. Control app : d = 1.59,CI = 0.92 , 2.25 ; Social vs. Analytic app : d = 1.89,CI = 1.17 , 2.61 ; Affect vs. Control app : d = 1.19,CI = 0.56 , 1.81 ; Affect vs. Analytic app : d = 1.41,CI = 0.74 , 2.07 ) . Conclusion The results provide initial support for the use of a smartphone-delivered social frame in the early induction of both physical activity and sedentary behavior changes . The information obtained also sets the stage for further investigation of subgroups that might particularly benefit from different motivationally framed apps in these two key health promotion areas . Trial Registration Clinical Trials.gov OBJECTIVES To study the effects of framed messages on  exercise intention and resolve . DESIGN Two ( type of frame : gain or loss ) × 2 ( type of kernel state : desirable or undesirable outcome ) post-test study . METHODS Participants were recruited online and question ed about their previous exercise behaviour and their exercise risk perception . After this , they were r and omly allocated to one of four messages that were different in terms of positive or negative outcomes ( type of frame ) and in terms of attained or avoided outcomes ( type of kernel state ) . After reading the message , participants indicated their intention and resolve to engage in sufficient exercise . RESULTS No effects were found for intention . For resolve , there was a significant interaction between type of frame , type of kernel state , and exercise adherence . Those who did not adhere to the exercise guideline and read the loss-framed message with attained outcomes reported significantly higher resolve than all other participants . CONCLUSIONS This study indicates the relevance of including attained outcomes in message framing exercise interventions as well as a focus on exercise resolve . STATEMENT OF CONTRIBUTION What is already known on this subject ? Message framing is commonly used to increase exercise intentions and behaviour . Meta-analyses do not provide consistent support for this theory . Very little attention has been paid to resolve and message factors on framing effects . What does this study add ? Framed messages have an effect on exercise resolve , but not 
    Output:
    
For all choice architecture techniques identified , except for message framing , the majority of studies reported a significant effect on behavioral intentions or behavior in presence of the intervention .
The results suggest that prompting can effectively encourage stair use  in adults , especially in presence of a prompt .