***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 Many critical appraisal tools ( CATs ) exist for which there is little or no information on development of the CAT , evaluation of validity , or testing reliability . The proposed CAT was developed based on a number of other CATs , general research methods theory , and reporting guidelines but requires further study to determine its effectiveness . OBJECTIVES To establish a scoring system and to evaluate the construct validity of the proposed critical appraisal tool before undertaking reliability testing . METHODS Data obtained from this exploratory study along with information on the design of the proposed CAT were combined to evaluate construct validity using the St and ards for educational and psychological testing which consist of five types of evidence : test content , response process , internal structure , relations to other variables , and consequences of testing . To obtain data for internal structure and relations to other variables , the proposed CAT was analysed against five alternative CATs . A r and om sample of 10 papers from six different research design s across the range of health related research were selected , giving a total sample size of 60 papers . RESULTS In all research design s , the proposed CAT had significant ( p<0.05 , two-tailed ) weak to moderate positive correlations ( Kendall 's τ 0.33 - 0.55 ) with the alternative CATs , except in the Preamble category . There were significant moderate to strong positive correlations in the quasi-experimental ( τ 0.70 - 1.00 ) , descriptive/exploratory/observational ( τ 0.72 - 1.00 ) , qualitative ( τ 0.74 - 0.81 ) , and systematic review ( τ 0.62 - 0.82 ) design s and to a lesser extent in the true experimental ( τ 0.68 - 0.70 ) design . There were no significant correlations in the single system research design s. CONCLUSIONS Based on the results obtained , the theory on which the proposed CAT was design ed , and the objective of the proposed CAT there was enough evidence to show that inferences made from scores obtained from the proposed CAT should be sound Background The prevalence of obesity increased while certain measures of physical fitness deteriorated in preschool children in China over the past decade . This study tested the effectiveness of a multifaceted intervention that integrated childcare center , families , and community to promote healthy growth and physical fitness in preschool Chinese children . Methods This 12-month study was conducted using a quasi-experimental pretest/posttest design with comparison group . The participants were 357 children ( mean age = 4.5 year ) enrolled in three grade levels in two childcare centers in Beijing , China . The intervention included : 1 ) childcare center intervention ( physical activity policy changes , teacher training , physical education curriculum and food services training ) , 2 ) family intervention ( parent education , internet website for support , and family events ) , and 3 ) community intervention ( playground renovation and community health promotion events ) . The study outcome measures included body composition ( percent body fat , fat mass , and muscle mass ) , Body Mass Index ( BMI ) and BMI z-score and physical fitness scores in 20-meter agility run ( 20M-AR ) , broad jump for distance ( BJ ) , timed 10-jumps , tennis ball throwing ( TBT ) , sit and reach ( SR ) , balance beam walk ( BBW ) , 20-meter crawl ( 20M-C ) ) , 30-meter sprint ( 30M-S ) ) from a norm referenced test . Measures of process evaluation included monitoring of children ’s physical activity ( activity time and intensity ) and food preparation records , and fidelity of intervention protocol implementation . Results Children in the intervention center significantly lowered their body fat percent ( −1.2 % , p < 0.0001 ) , fat mass ( −0.55 kg , p < 0.0001 ) , and body weight ( 0.36 kg , p < 0.02 ) and increased muscle mass ( 0.48 kg , p < 0.0001 ) , compared to children in the control center . They also improved all measures of physical fitness except timed 10-jumps ( 20M-AR : −0.74 seconds , p < 0.0001 ; BJ : 8.09 cm , p < 0.0001 ; TBT : 0.52 meters , p < 0.006 ; SR : 0.88 cm , p < 0.03 ; BBW : −2.02 seconds , p < 0.0001 ; 30M-S : −0.45 seconds , p < 0.02 ; 20M-C : −3.36 seconds , p < 0.0001 ) . Process evaluation data showed that the intervention protocol was implemented with high fidelity . Conclusions The study demonstrated that a policy-driven multi-faceted intervention can improve preschool children ’s body composition and physical fitness . Program efficacy should be tested in a r and omized trial . Trial registration ChiCTR-ONRC-14004143 Excess weight gain in American Indian/Alaskan native ( AI/AN ) children is a public health concern . This study tested ( 1 ) the feasibility of delivering community-wide interventions , alone or in combination with family-based interventions , to promote breastfeeding and reduce the consumption of sugar-sweetened beverages ; and ( 2 ) whether these interventions decrease  Body Mass Index ( BMI ) -Z scores in children 18–24 months of age . Three AI/AN tribes were r and omly assigned to two active interventions ; a community-wide intervention alone ( tribe A ; n = 63 families ) or community-wide intervention containing a family component  ( tribes B and C ; n = 142 families ) . Tribal staff and the research team design ed community-tailored interventions and trained community health workers to deliver the family intervention through home visits . Feasibility and acceptability of the intervention and BMI -Z scores at 18–24 months were compared between tribe A and tribes B & C combined using a separate sample pretest , posttest design . Eighty-six percent of enrolled families completed the study .  Breastfeeding initiation and 6-month duration increased 14 and 15 % , respectively , in all tribes compared to national rates for American Indians . Breastfeeding at 12 months was comparable to national data . Parents expressed confidence in their ability to curtail family consumption of sugar-sweetened beverages . Compared to a pretest sample of children of a similar age 2 years before the study begun , BMI -Z scores increased in all tribes . However , the increase was less in tribes B & C compared to tribe A ( −0.75 , P = 0.016 ) . Family , plus community-wide interventions to increase breastfeeding and curtail sugar-sweetened beverages attenuate BMI rise in AI/AN toddlers more than community-wide interventions alone In systematic review s , evidence -based practice and journal clubs critical appraisal tools are used to rate research papers . However , little evidence exists on whether the critical appraisal tool , subject matter knowledge or research design knowledge affect the appraisal of research papers . A match paired r and omised trial was conducted in August/September 2010 in the Faculty of Medicine , Health and Molecular Science , James Cook University , Australia . Ten participants in total were r and omly assigned to two groups using either an informal appraisal of research ( IA group ) or the Crowe Critical Appraisal Tool ( CCAT group )  , a general critical appraisal tool . Participant independently appraised five research papers , where each paper had a different research design . The scores allocated to the papers by each group were analysed . The intraclass correlation coefficient for absolute agreement was 0.76 for the informal appraisal group and 0.88 for the Crowe Critical Appraisal Tool group . The G study showed that in the informal appraisal group 24 % of variance in scores was attributable to either the rater or paper × rater interactions , whereas this was 12 % in the Crowe Critical Appraisal Tool group . Analysis of covariance showed that there were statistically significant results in the informal appraisal group for subject matter knowledge ( F(1,18 ) = 7.03 , P < 0.05 1 tailed , partial η² = 0.28 ) and rater ( F(4,18 ) = 4.57 , P < 0.05 1 tailed , partial η² = 0.50 ) . Kendall 's tau correlation coefficient also showed a significant weak positive relationship ( τ = 0.38 , P = 0.03 ) between total score and subject matter knowledge for the informal appraisal group . The Crowe  Critical Appraisal Tool was more reliable than an informal appraisal of the research papers . In the informal appraisal group , there were significant effects for rater and subject matter knowledge , whereas the Crowe Critical Appraisal Tool almost eliminated the rater effect , and no subject matter knowledge effect was apparent . There was no research design knowledge effect in either group . The Crowe Critical Appraisal Tool provided much better score reliability and should help readers with different levels and types of knowledge to reach similar conclusions about a research paper THE R AND OMIZED controlled trial ( RCT ) , more than any other methodology , can have a powerful and immediate impact on patient care . Ideally , the report of such an evaluation needs to convey to the reader relevant information concerning the design , conduct , analysis , and generalizability of the trial . This information should provide the reader with the ability to make informed judgments regarding the internal and external validity of the trial . Accurate and complete reporting also benefits editors and review ers in their deliberations regarding su bmi tted manuscripts . For RCTs to ultimately benefit patients , the published report should be of the highest possible st and ard OBJECTIVE To examine the reliability of scores obtained from a proposed critical appraisal tool ( CAT ) . STUDY DESIGN AND SETTING Based on a r and om sample of 24 health-related research papers , the scores from the proposed CAT were examined using intraclass correlation coefficients ( ICCs ) , generalizability theory , and participants ' feedback . RESULTS The ICC for all research papers was 0.83 ( consistency ) and 0.74 ( absolute agreement ) for four participants . For individual research design s , the highest ICC ( consistency ) was for qualitative research ( 0.91 ) and the lowest was for descriptive , exploratory and observational research ( 0.64 ) . The G study showed a moderate research design effect ( 32 % ) for scores averaged across all papers . The research design effect was mainly in the Sampling , Results , and Discussion categories ( 44 % , 36 % , and 34 % , respectively ) . The scores for research design s showed a majority paper effect for each ( 53 - 70 % ) , with small to moderate rater or paper × rater interaction effects ( 0 - 27 % ) . CONCLUSIONS Possible reasons for the research design effect were that the participants were unfamiliar with some of the research design s and that papers were not matched to participants ' expertise . Even so , the proposed CAT showed great promise as a tool that can be used across a wide range of research design OBJECTIVE Document the impact of Let 's Go ! , a multi setting community-based childhood obesity prevention program on participants in 12 communities in Maine . METHODS The study used repeated r and om telephone surveys with 800 parents of children to measure awareness of messages and child behaviors . Surveys were conducted in schools , child care programs , and afterschool programs to track changes in policies and environments . RESULTS Findings show improvements from 2007 to 2011 : Children consuming fruits and vegetables increased from 18 % , 95 % CI [ 15 , 21 ] , to 26 % [ 23 , 30 ] ( p < .001 ) ; children limiting sugary drinks increased from 63 % [ 59 , 67 ] to 69 % [ 65 , 73 ] ( p = .011 ) ; and parent awareness of the program grew from 10 % [ 7 , 12 ] to 47 % [ 43 , 51 ] ( p < .001 ) . Participating sites implemented widespread changes to promote healthy behaviors . CONCLUSIONS A multi setting , community-based intervention with a consistent message can positively impact behaviors that lead to childhood obesity 
    Output:
    
The most frequently reported indicators of implementation success were fidelity and coverage .
Determinants related to the social-political context and the organization were most often cited as influencing implementation , in particular , ' collaboration between community partners ' , ' the availability of ( human ) re sources ' and ' time available for implementation ' .
The association between determinants and implementation variability was never explicated .