***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 AND OBJECTIVE Neuroimaging studies have demonstrated dysfunction in the brain reward circuit in individuals with online gaming addiction ( OGA ) . We hypothesized that virtual reality therapy ( VRT ) for OGA would improve the functional connectivity ( FC ) of the cortico-striatal-limbic circuit by stimulating the limbic system . METHODS Twenty-four adults with OGA were r and omly assigned to a cognitive behavior therapy ( CBT ) group or VRT group . Before and after the four-week treatment period , the severity of OGA was evaluated with Young 's Internet Addiction Scale ( YIAS ) . Using functional magnetic resonance imaging , the amplitude of low-frequency fluctuation ( ALFF ) and FC from the posterior cingulate cortex ( PCC ) seed to other brain areas were evaluated . Twelve casual game users were also recruited and underwent only baseline assessment . RESULTS After treatment , both CBT and VRT groups showed reductions in YIAS scores . At baseline , the OGA group showed a smaller ALFF within the right middle frontal gyrus and reduced FC in the cortico-striatal-limbic circuit . In the VRT group , connectivity from the PCC seed to the left middle frontal and bilateral temporal lobe increased after VRT . CONCLUSION VRT seemed to reduce the severity of OGA , showing effects similar to CBT , and enhanced the balance of the cortico-striatal-limbic circuit Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Craving is a strong desire to consume that emerges in every case of substance addiction . Previous studies have shown that eliciting craving with an exposure cues protocol can be a useful option for the treatment of nicotine dependence . Thus , the main goal of this study was to develop a virtual platform in order to induce craving in smokers . Fifty-five undergraduate students were r and omly assigned to two different virtual environments : high arousal context ual cues and low arousal context ual cues scenarios ( 17 smokers with low nicotine dependency were excluded ) . An eye-tracker system was used to evaluate attention toward these cues . Eye fixation on smoking-related cues differed between smokers and nonsmokers , indicating that smokers focused more often on smoking-related cues than nonsmokers . Self-reports of craving are in agreement with these results and suggest a significant increase in craving after exposure to smoking cues . In sum , these data support the use of virtual environments for eliciting craving Previous studies have shown the efficacy of virtual reality ( VR ) environments that reproduce smoking-related stimuli for increasing self-reported craving and psychophysiological reactivity in smokers . However , no study to date has attempted to simulate smoking behavior itself by means of VR technology . The aim of this study was to assess the effect of smoking a virtual cigarette on self-reported craving levels and heart rate ( HR ) in a sample of smokers . Participants were 45 smokers r and omly assigned to three VR conditions built into a virtual pub : smoking a virtual cigarette , throwing virtual darts at a virtual dartboard or just being in the virtual pub . Results showed that smoking a virtual cigarette significantly increased self-reported craving and HR when compared to the other two conditions . These results reveal that simulation of smoking behavior in a VR environment functions as an efficacious proximal cue that can be used for triggering craving under the cue-exposure paradigm Traditional cue reactivity provides a methodology for examining drug triggers and stimuli in laboratory and clinical setting s. However , current techniques lack st and ardization and generalization across research setting s. Improved method ologies using virtual reality ( VR ) cue reactivity extend previous research st and ardizing exposure to stimuli and exploring reactions to drug cues in a controlled VR setting . In a controlled pilot trial , 13 nicotine-dependent participants were allowed to smoke ad libitum then exposed to VR smoking and VR neutral cues and compared on craving intensity . VR smoking cues significantly increased craving compared to VR neutral cues . On average , craving intensity increased 118 % during exposure to VR smoking cues . Implication s for substance abuse research and treatment using VR to assess cessation and anticraving medications are discussed Objective : Virtual reality (VR)-based cue reactivity has been successfully used for the assessment of drug craving . Going beyond assessment of cue reactivity , a novel VR-based treatment approach for smoking cessation was developed and tested for feasibility . Method : In a r and omized experiment , 10-week treatment feasibility trial , 46 nicotine-dependent adults , completed the10-week program . Virtual reality skills training ( VRST ) combined with nicotine replacement therapy ( NRT ) was compared to NRT alone . Participants were assessed for smoking behavior and coping skills during , at end of treatment , and at posttreatment follow-up . Results : Smoking rates and craving for nicotine were significantly lower for the VRST group compared to NRT-only group at the end of treatment . Self-confidence and coping skills were also significantly higher for the VRST group , and number of cigarettes smoked was significantly lower , compared to the control group at follow-up . Conclusions : Feasibility of VRST was supported in the current study Background : Educating physicians and other health care professionals about the identification and treatment of patients who drink more than recommended limits is an ongoing challenge . Methods : An educational r and omized controlled trial was conducted to test the ability of a st and -alone training simulation to improve the clinical skills of health care professionals in alcohol screening and intervention . The “ virtual reality simulation ” combined video , voice recognition , and nonbranching logic to create an interactive environment that allowed trainees to encounter complex social cues and realistic interpersonal exchanges . The simulation included 707 questions and statements and 1207 simulated patient responses . Results : A sample of 102 health care professionals ( 10 physicians ; 30 physician assistants or nurse practitioners ; 36 medical students ; 26 pharmacy , physican assistant , or nurse practitioner students ) were r and omly assigned to a no training group ( n = 51 ) or a computer-based virtual reality intervention ( n = 51 ) . Professionals in both groups had similar pretest st and ardized patient alcohol screening skill scores : 53.2 ( experimental ) vs 54.4 ( controls ) , 52.2 vs 53.7 alcohol brief intervention skills , and 42.9 vs 43.5 alcohol referral skills . After repeated practice with the simulation there were significant increases in the scores of the experimental group at 6 months after r and omization compared with the control group for the screening ( 67.7 vs 58.1 ; P < .001 ) and brief intervention ( 58.3 vs 51.6 ; P < .04 ) scenarios . Conclusions : The technology tested in this trial is the first virtual reality simulation to demonstrate an increase in the alcohol screening and brief intervention skills of health care professionals The urge to gamble is a psychological , physiological , and emotional state involved in the maintenance of pathological gambling . The ability of repeated exposure to a virtual gambling environment to modify the urge to gamble and perceived self-efficacy ( PSE ) is investigated . Ten video lottery players move throughout a virtual bar with five video lottery terminals five times . The urge to gamble and PSE do not significantly vary during exposure to the gambling environment . However , the desire to gamble significantly increases when passing from the practice environment to the gambling environment . These findings suggest that virtual reality is viable for use in exposure , but that a sole 20-minute session does not set the extinction process into motion . Future studies should be conducted on virtual exposure over the course of several sessions , with the addition of a cognitive restructuring intervention Virtual reality ( VR ) can be used in the treatment of gambling disorder to provide emotionally charged context s ( e.g. , induce cravings ) where patients can practice cognitive behavior therapy ( CBT ) techniques in the safety of the therapist ’s office . This raises practical questions , such as whether the cravings are sufficient to be clinical ly useful but also manageable enough to remain clinical ly safe . Pilot data are also needed to test the development of a treatment manual and prepare large r and omized control trials . This paper reports on three studies describing ( a ) cravings induced in VR compared to real gambling and a control game of skill with no money involved  ( N = 28 frequent gamblers and 36 infrequent gamblers ) ; ( b ) the usefulness of a treatment protocol with only two CBT sessions using VR  ( N = 34 pathological gamblers ) ; and ( c ) the safety of a four-session treatment program of CBT in VR  ( N = 25 pathological gamblers ) . Study 1 reveals that immersions in VR can elicit desire and a positive anticipation to gamble in frequent gamblers that are ( a ) significantly stronger than for infrequent gamblers and for playing a control game of skill and ( b ) as strong as for gambling on a real video lottery terminal . Study 2 documents the feasibility of integrating VR in CBT , its usefulness in identifying more high-risk situations and dysfunctional thoughts , how inducing cravings during relapse prevention exercises significantly relates to treatment outcome , and the safety of the procedure in terms of cybersickness . Results from Study 3 confirm that , compared to inducing urges to gamble in imagination , using VR does not lead to urges that are stronger , last longer , or feel more out of control . Outcome data and effect sizes are reported for both r and omized control pilot trials conducted in inpatient setting s. Suggestions for future research are provided , including on increasing the number of VR sessions in the treatment program Pilot studies revealed promising results regarding crushing virtual cigarettes to reduce  tobacco addiction . In this study , 91 regular smokers were r and omly assigned to two treatment conditions that differ only by the action performed in the virtual environment : crushing virtual cigarettes or grasping virtual balls . All participants also received minimal psychosocial support from nurses during each of 12 visits to the clinic . An affordable virtual reality system was used ( eMagin HMD ) with a virtual environment created by modifying a 3D game . Results revealed that crushing virtual cigarettes during 4 weekly sessions led to a statistically significant reduction in nicotine addiction ( assessed with the Fagerström test ) , abstinence rate ( confirmed with exhaled carbon monoxide ) , and drop-out rate from the 12-week psychosocial minimal-support treatment program . Increased retention in the program is discussed as a potential explanation for treatment success , and hypotheses are raised about self-efficacy , motivation , and learning Cigarette smokers , when confronted with cues associated with smoking , evidence strong reactions , including increased attentional bias toward those smoking-related cues . These reactions have not been extensively studied in young adult smokers , a group that research suggests may respond differently than adults or adolescent smokers . Furthermore , the impact of olfactory cues , such as cigarette smoke , on attentional bias has not been explored in young adult smokers . In this pilot study , 20 nicotine-dependent young adult smokers were r and omized to receive scent cues or no scent cues and were exposed to four virtual reality ( VR ) rooms containing sensory and social content , including smoking or neutral cues . Participants entered a neutral VR room , followed by two different smoking VR rooms , and closed with the same neutral room . Subjective attention to smoking cues and thoughts about smoking responses were recorded upon exiting each room . Significant increases in attention to cues and thoughts about smoking were found when young adult smokers were exposed to VR smoking environments , but the inclusion of olfactory cues did not result in significantly higher attention to cues or thoughts about smoking . Results suggest that while further research is necessary to underst and the impact of olfactory cues , VR appears to be an effective methodology for cue exposure studies exploring attentional bias in young adult smokers INTRODUCTION Cue-induced craving is a major motivator of smoking behavior , and , more importantly , a predictor of relapse . Previous studies demonstrated 
    Output:
    
Conclusions : This overview suggest that VR provide benefits in the assessment and treatment of substance use disorders and behavior addictions and achieve high levels of ecological validity .
While , craving provocation in VR is effective across addiction disorders , treatments based exclusively on virtual exposure to drug related cues as shown heterogenous results