human
***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: Aim : To investigate the acceptability and feasibility of adapted group therapy for anxiety in children with autism spectrum disorder in a pilot r and omised controlled trial . Method : A total of 32 children aged 9–13 years were r and omised to immediate or delayed therapy using the ‘ Exploring Feelings ’ manual ( Attwood , 2004 ) . Child and parent groups were run in parallel , for seven weekly sessions , under the supervision of experienced psychologists . The primary blinded outcome measures addressed change in overall functioning and in severity of the primary anxiety diagnosis after 3 months . Results : Children met diagnostic criteria for 1–6 anxiety disorders ( median 3 ) . At end point , both parents and children in the immediate therapy group were more likely to report a reduction in anxiety symptoms . Fidelity of delivery of the group therapy was high , and attendance was 91 % . Conclusions : This pilot trial established that children and families were willing to be recruited and r and omised , the outcome measures were acceptable , the format and content of the groups were feasible within UK child and adolescent mental health services , the intervention was appreciated by families and attrition was very small BACKGROUND Children with high-functioning autism spectrum disorders ( ASD ) are at high risk for developing significant anxiety . Anxiety can adversely impact functioning across school , home and community environments . Cognitive behavioral therapies ( CBT ) are frequently used with success for children with anxiety symptoms . Modified CBT interventions for anxiety in children with ASD have also yielded promising results . METHODS Fifty children with high-functioning ASD and anxiety were r and omizedto group CBT or treatment-as-usual ( TAU ) for 12 weeks . Independent clinical evaluators , blind to condition , completed structured interviews ( Anxiety Disorders Interview Schedule – Parent Version;ADIS-P ) pre- and post-intervention condition . RESULTS Forty-seven children completed either the CBT or TAU condition . Results indicated markedly better outcomes for the CBT group . Significant differences by group were noted in Clinician Severity Ratings , diagnostic status , and clinician ratings of global improvement . In the intent-to-treat sample , 10 of 20 children ( 50 % ) in the CBT group had a clinical ly meaningful positive treatment response , compared to 2 of 23 children ( 8.7 % ) in the TAU group . CONCLUSIONS Initial results from this r and omized , design ed treatment study suggest that agroup CBT intervention specifically developed for children with ASD may be effective in decreasing anxiety . Limitations of this study include small sample size , lack of an attention control group , and use of outcome measures normed with typically developing This pilot study tested the effect of cognitive behavioral therapy ( CBT ) on  parent-reported autism symptoms . Nineteen children with autism spectrum disorders and an anxiety disorder ( 7–11 years old ) were r and omly assigned to 16 sessions of CBT or a waitlist condition . The CBT program emphasized in vivo exposure supported by parent training and school consultation to promote social communication and emotion regulation skills . Parents completed a st and ardized autism symptom checklist at baseline and posttreatment/postwaitlist and 3-month follow-up assessment s. CBT outperformed the waitlist condition at posttreatment/postwaitlist on total parent-reported autism symptoms ( Cohen ’s d effect size = .77 ) . Treatment gains were maintained at 3-month follow-up . Further investigation of this intervention modality with larger sample s and broader outcome measures appears to be indicated OBJECTIVE A consumer-oriented efficacy assessment in clinical trials should measure changes in chief complaint and consumer request ( symptoms of most concern to patient/caregiver ) , which may be diluted in change scores of multisymptom scales . METHOD In the Research Units on Pediatric Psychopharmacology ( RUPP ) Autism Network 8-week double-blind trial of risperidone versus placebo , the chief concerns of parents were collected at 0 , 4 , and 8 weeks ( endpoint ) , in addition to st and ardized primary measures . Blinded clinical judges rated change from baseline to 4 and 8 weeks on a 9-point scale ( 1 = normalized , 5 = unchanged , 9 = disastrous ) ; 94 participants had usable data . RESULTS The most common symptoms identified by parents were tantrums , aggression , and hyperactivity . Interrater reliability was excellent . Mean ratings at endpoint were 2.8 + /- 1.2 on risperidone and 4.5 + /- 1.3 on placebo ( p < .001 ) . Ratings were collinear with Clinical Global Impression-Improvement and Aberrant Behavior Checklist Irritability subscale ( primary dimensional measure ) . Effect size d was 1.4 , compared to 1.2 on the Aberrant Behavior Checklist Irritability subscale . Effect sizes varied twofold by symptom category , largest for self-injury ( 2.11 ) and tantrums ( 1.95 ) . CONCLUSIONS Risperidone was superior to placebo in reducing symptoms of most concern to parents of autistic children with irritable behavior .  Rating individualized participant-chosen target symptoms seems a reliable , sensitive , efficient , and consumer-friendly way to assess treatment effect and might have clinical application OBJECTIVE To examine the reliability and validity of the 66-item Screen for Child Anxiety Related Emotional Disorders-Revised ( SCARED-R ) , a question naire for measuring a broad range of DSM-defined anxiety disorder symptoms , in a sample of clinical ly referred youths . METHOD The SCARED-R was administered to children/adolescents and their parents during the st and ard intake assessment .  SCARED-R scores were compared against Child Behavior Checklist ( CBCL ) scores , DSM-IV axis I classifications , and global assessment of functioning ( GAF ) ratings . RESULTS In this sample of clinical ly referred youths , the  SCARED-R  was reliable in terms of internal consistency and showed reasonable child-parent agreement . Furthermore , SCARED-R scores correlated significantly with CBCL internalising but not with externalising . Within the group of children with anxiety disorders , SCARED-R scores were also negatively associated with children 's daily functioning as rated on the GAF scale . Finally ,  SCARED-R scores had satisfactory discriminant validity ( both between anxiety disorders and other problems and within anxiety disorders ) , and appeared to have reasonable value for predicting specific anxiety disorders . CONCLUSION The SCARED-R is a valuable addition to the arsenal of question naires that are used for the assessment of anxiety in youths Objectives For the measurement of  patient-reported outcomes , such as ( health-related ) quality of life , often many measurement instruments exist that intend to measure the same construct . To facilitate instrument selection , our aim was to develop a highly sensitive search filter for finding studies on measurement properties of measurement instruments in PubMed and a more precise search filter that needs less abstract s to be screened , but at a higher risk of missing relevant studies . Methods A r and om sample of 10,000 PubMed records ( 01 - 01 - 1990 to 31 - 12 - 2006 ) was used as a gold st and ard . Studies on measurement properties were identified using an exclusion filter and h and search ing . Search terms were selected from the relevant records in the gold st and ard as well as from 100 systematic review s of measurement properties and combined based on sensitivity and precision . The performance of the filters was tested in the gold st and ard as well as in two validation sets , by calculating sensitivity , precision , specificity , and number needed to read . Results We identified 116 studies on measurement properties in the gold st and ard . The sensitive search filter was able to retrieve 113 of these 116 studies ( sensitivity 97.4 % , precision 4.4 % ) . The precise search filter had a sensitivity of 93.1 % and a precision of 9.4 % . Both filters performed very well in the validation sets . Conclusion The use of these search filters will contribute to evidence -based selection of measurement instruments in all medical fields The goals of this study were twofold : to examine the psychometric properties of the  Multidimensional Anxiety Scale for Children ( MASC ) in a clinical sample of 193 children and adolescents who had received a diagnosis of major depressive or anxiety disorder , and to discriminate between these two groups of patients . Participants had volunteered in r and omized psychopharmacological clinical trials . The MASC four-factor structure was confirmed and its subscales were found to be reliable . The MASC correlated well with other self-report measures of anxiety , and less so with measures of depressive symptoms . The MASC subscales and two MASC items as well as age differentiated between anxious and depressed pediatric patients . If these results are replicated in an independent study , those items could be used by clinicians to discriminate between these two disorders . The MASC is a clinical ly useful measure to discriminate between anxious and depressed pediatric patients . Limitations due to the highly selective sample are noted BACKGROUND Children with autism spectrum disorders often present with comorbid anxiety disorders that cause significant functional impairment .  This study tested a modular cognitive behavioral therapy ( CBT ) program for children with this profile . A st and ard CBT program was augmented with multiple treatment components design ed to accommo date or remediate the social and adaptive skill deficits of children with ASD that could pose barriers to anxiety reduction . METHOD Forty children ( 7 - 11 years old ) were r and omly assigned to 16 sessions of CBT or a 3-month waitlist ( 36 completed treatment or waitlist ) . Therapists worked with individual families . The CBT model emphasized behavioral experimentation , parent-training , and school consultation . Independent evaluators blind to treatment condition conducted structured diagnostic interviews and parents and children completed anxiety symptom checklists at baseline and posttreatment/postwaitlist . RESULTS In intent-to-treat analyses , 78.5 % of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment , as compared to only 8.7 % of the waitlist group . CBT also outperformed the waitlist on diagnostic outcomes and parent reports of child anxiety , but not children 's self-reports . Treatment gains were maintained at 3-month follow-up . CONCLUSIONS The CBT manual employed in this study is one of the first adaptations of an evidence -based treatment for children with autism spectrum disorders . Remission of anxiety disorders appears to be an achievable goal among high-functioning children with autism BACKGROUND The aim of the study was to evaluate the effectiveness of a brief CBT intervention for anxiety with children diagnosed with Asperger syndrome ( AS ) . A second interest was to evaluate whether more intensive parent involvement would increase the child 's ability to manage anxiety outside of the clinic setting . METHODS Seventy-one children aged ten to twelve years were recruited to participate in the anxiety programme . All children were diagnosed with AS and the presence of anxiety symptoms was accepted on parent report via brief interview . Children were r and omly assigned to one of three conditions : intervention for child only , intervention for child and parent , wait-list control . RESULTS The two intervention groups demonstrated significant decreases in parent-reported anxiety symptoms at follow-up and a significant increase in the child 's ability to generate positive strategies in an anxiety-provoking situation . There were a number of significant differences between the two interventions to suggest parent involvement as beneficial . CONCLUSIONS The sample of children with AS in this study presented with a profile of anxiety similar to a sample of clinical ly diagnosed anxious children . The intervention was endorsed by parents as a useful programme for children diagnosed with Asperger syndrome and exhibiting anxiety symptoms , and active parent involvement enhanced the usefulness of the programme . Limitations of the study and future research are discussed We compared the effects of a 16-week Cognitive-Behavioral Therapy ( CBT ) program and a Social Recreational ( SR ) program on anxiety in children with Autism Spectrum Disorders ( ASD ) . Seventy children ( 9–16 years old ) were r and omly assigned to either of the programs ( nCBT = 36 ; nSR = 34 ) . Measures on child ’s anxiety using the Spence Child Anxiety Scale — Child ( SCAS-C ) and the Clinical Global Impression — Severity scale ( CGI-S ) were administered at pre- , post-treatment , and follow-ups ( 3- and 6-month ) . Children in both programs showed significantly lower levels of generalized anxiety and total anxiety symptoms at 6-month follow-up on SCAS-C. Clinician ratings on the CGI-S demonstrated an increase in the percentage of participants rated as “ Normal ” and “ Borderline ” for both programs . Findings from the present study suggest factors such as regular sessions in a structured setting , consistent therapists , social exposure and the use of autism-friendly strategies are important components of an effective framework in the management of anxiety in children and adolescents with ASD OBJECTIVES The revised version of the Screen for Childhood Anxiety Related Emotional Disorders ( SCARED-R ) is a recently developed self-report question naire for measuring DSM-IV defined anxiety disorder symptoms in children . The current study examined the treatment sensitivity of the SCARED-R. METHODS Thirty-six children ( aged 8 - 13 years ) who fulfilled the criteria for generalized anxiety disorder , separation anxiety disorder , and /or social phobia received either group or individual cognitive-behavioural treatment . Children completed the  SCARED-R  and a traditional measure of childhood anxiety , the State-Trait Anxiety Inventory for Children ( STAIC ) , at three points in time : ( 1 ) 6 months before treatment ( i.e. baseline ) , ( 2 ) pre-treatment , and ( 3 ) post-treatment . RESULTS Results showed that children 's SCARED-R and STAIC scores did not change from baseline to pre 
    Output:
    
agent
Overall three question naires were found robust in their measurement properties , the Spence Children 's Anxiety Scale , its revised version - the Revised Children 's Anxiety and Depression Scale , and also the Screen for Child Anxiety Related Emotional Disorders .
Crucially the articles on measurement properties provided almost no evidence on responsiveness to change , nor on the validity of use of the tools for evaluation of interventions for children with ASD .
***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: Aim : To investigate the acceptability and feasibility of adapted group therapy for anxiety in children with autism spectrum disorder in a pilot r and omised controlled trial . Method : A total of 32 children aged 9–13 years were r and omised to immediate or delayed therapy using the ‘ Exploring Feelings ’ manual ( Attwood , 2004 ) . Child and parent groups were run in parallel , for seven weekly sessions , under the supervision of experienced psychologists . The primary blinded outcome measures addressed change in overall functioning and in severity of the primary anxiety diagnosis after 3 months . Results : Children met diagnostic criteria for 1–6 anxiety disorders ( median 3 ) . At end point , both parents and children in the immediate therapy group were more likely to report a reduction in anxiety symptoms . Fidelity of delivery of the group therapy was high , and attendance was 91 % . Conclusions : This pilot trial established that children and families were willing to be recruited and r and omised , the outcome measures were acceptable , the format and content of the groups were feasible within UK child and adolescent mental health services , the intervention was appreciated by families and attrition was very small BACKGROUND Children with high-functioning autism spectrum disorders ( ASD ) are at high risk for developing significant anxiety . Anxiety can adversely impact functioning across school , home and community environments . Cognitive behavioral therapies ( CBT ) are frequently used with success for children with anxiety symptoms . Modified CBT interventions for anxiety in children with ASD have also yielded promising results . METHODS Fifty children with high-functioning ASD and anxiety were r and omizedto group CBT or treatment-as-usual ( TAU ) for 12 weeks . Independent clinical evaluators , blind to condition , completed structured interviews ( Anxiety Disorders Interview Schedule – Parent Version;ADIS-P ) pre- and post-intervention condition . RESULTS Forty-seven children completed either the CBT or TAU condition . Results indicated markedly better outcomes for the CBT group . Significant differences by group were noted in Clinician Severity Ratings , diagnostic status , and clinician ratings of global improvement . In the intent-to-treat sample , 10 of 20 children ( 50 % ) in the CBT group had a clinical ly meaningful positive treatment response , compared to 2 of 23 children ( 8.7 % ) in the TAU group . CONCLUSIONS Initial results from this r and omized , design ed treatment study suggest that agroup CBT intervention specifically developed for children with ASD may be effective in decreasing anxiety . Limitations of this study include small sample size , lack of an attention control group , and use of outcome measures normed with typically developing This pilot study tested the effect of cognitive behavioral therapy ( CBT ) on  parent-reported autism symptoms . Nineteen children with autism spectrum disorders and an anxiety disorder ( 7–11 years old ) were r and omly assigned to 16 sessions of CBT or a waitlist condition . The CBT program emphasized in vivo exposure supported by parent training and school consultation to promote social communication and emotion regulation skills . Parents completed a st and ardized autism symptom checklist at baseline and posttreatment/postwaitlist and 3-month follow-up assessment s. CBT outperformed the waitlist condition at posttreatment/postwaitlist on total parent-reported autism symptoms ( Cohen ’s d effect size = .77 ) . Treatment gains were maintained at 3-month follow-up . Further investigation of this intervention modality with larger sample s and broader outcome measures appears to be indicated OBJECTIVE A consumer-oriented efficacy assessment in clinical trials should measure changes in chief complaint and consumer request ( symptoms of most concern to patient/caregiver ) , which may be diluted in change scores of multisymptom scales . METHOD In the Research Units on Pediatric Psychopharmacology ( RUPP ) Autism Network 8-week double-blind trial of risperidone versus placebo , the chief concerns of parents were collected at 0 , 4 , and 8 weeks ( endpoint ) , in addition to st and ardized primary measures . Blinded clinical judges rated change from baseline to 4 and 8 weeks on a 9-point scale ( 1 = normalized , 5 = unchanged , 9 = disastrous ) ; 94 participants had usable data . RESULTS The most common symptoms identified by parents were tantrums , aggression , and hyperactivity . Interrater reliability was excellent . Mean ratings at endpoint were 2.8 + /- 1.2 on risperidone and 4.5 + /- 1.3 on placebo ( p < .001 ) . Ratings were collinear with Clinical Global Impression-Improvement and Aberrant Behavior Checklist Irritability subscale ( primary dimensional measure ) . Effect size d was 1.4 , compared to 1.2 on the Aberrant Behavior Checklist Irritability subscale . Effect sizes varied twofold by symptom category , largest for self-injury ( 2.11 ) and tantrums ( 1.95 ) . CONCLUSIONS Risperidone was superior to placebo in reducing symptoms of most concern to parents of autistic children with irritable behavior .  Rating individualized participant-chosen target symptoms seems a reliable , sensitive , efficient , and consumer-friendly way to assess treatment effect and might have clinical application OBJECTIVE To examine the reliability and validity of the 66-item Screen for Child Anxiety Related Emotional Disorders-Revised ( SCARED-R ) , a question naire for measuring a broad range of DSM-defined anxiety disorder symptoms , in a sample of clinical ly referred youths . METHOD The SCARED-R was administered to children/adolescents and their parents during the st and ard intake assessment .  SCARED-R scores were compared against Child Behavior Checklist ( CBCL ) scores , DSM-IV axis I classifications , and global assessment of functioning ( GAF ) ratings . RESULTS In this sample of clinical ly referred youths , the  SCARED-R  was reliable in terms of internal consistency and showed reasonable child-parent agreement . Furthermore , SCARED-R scores correlated significantly with CBCL internalising but not with externalising . Within the group of children with anxiety disorders , SCARED-R scores were also negatively associated with children 's daily functioning as rated on the GAF scale . Finally ,  SCARED-R scores had satisfactory discriminant validity ( both between anxiety disorders and other problems and within anxiety disorders ) , and appeared to have reasonable value for predicting specific anxiety disorders . CONCLUSION The SCARED-R is a valuable addition to the arsenal of question naires that are used for the assessment of anxiety in youths Objectives For the measurement of  patient-reported outcomes , such as ( health-related ) quality of life , often many measurement instruments exist that intend to measure the same construct . To facilitate instrument selection , our aim was to develop a highly sensitive search filter for finding studies on measurement properties of measurement instruments in PubMed and a more precise search filter that needs less abstract s to be screened , but at a higher risk of missing relevant studies . Methods A r and om sample of 10,000 PubMed records ( 01 - 01 - 1990 to 31 - 12 - 2006 ) was used as a gold st and ard . Studies on measurement properties were identified using an exclusion filter and h and search ing . Search terms were selected from the relevant records in the gold st and ard as well as from 100 systematic review s of measurement properties and combined based on sensitivity and precision . The performance of the filters was tested in the gold st and ard as well as in two validation sets , by calculating sensitivity , precision , specificity , and number needed to read . Results We identified 116 studies on measurement properties in the gold st and ard . The sensitive search filter was able to retrieve 113 of these 116 studies ( sensitivity 97.4 % , precision 4.4 % ) . The precise search filter had a sensitivity of 93.1 % and a precision of 9.4 % . Both filters performed very well in the validation sets . Conclusion The use of these search filters will contribute to evidence -based selection of measurement instruments in all medical fields The goals of this study were twofold : to examine the psychometric properties of the  Multidimensional Anxiety Scale for Children ( MASC ) in a clinical sample of 193 children and adolescents who had received a diagnosis of major depressive or anxiety disorder , and to discriminate between these two groups of patients . Participants had volunteered in r and omized psychopharmacological clinical trials . The MASC four-factor structure was confirmed and its subscales were found to be reliable . The MASC correlated well with other self-report measures of anxiety , and less so with measures of depressive symptoms . The MASC subscales and two MASC items as well as age differentiated between anxious and depressed pediatric patients . If these results are replicated in an independent study , those items could be used by clinicians to discriminate between these two disorders . The MASC is a clinical ly useful measure to discriminate between anxious and depressed pediatric patients . Limitations due to the highly selective sample are noted BACKGROUND Children with autism spectrum disorders often present with comorbid anxiety disorders that cause significant functional impairment .  This study tested a modular cognitive behavioral therapy ( CBT ) program for children with this profile . A st and ard CBT program was augmented with multiple treatment components design ed to accommo date or remediate the social and adaptive skill deficits of children with ASD that could pose barriers to anxiety reduction . METHOD Forty children ( 7 - 11 years old ) were r and omly assigned to 16 sessions of CBT or a 3-month waitlist ( 36 completed treatment or waitlist ) . Therapists worked with individual families . The CBT model emphasized behavioral experimentation , parent-training , and school consultation . Independent evaluators blind to treatment condition conducted structured diagnostic interviews and parents and children completed anxiety symptom checklists at baseline and posttreatment/postwaitlist . RESULTS In intent-to-treat analyses , 78.5 % of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment , as compared to only 8.7 % of the waitlist group . CBT also outperformed the waitlist on diagnostic outcomes and parent reports of child anxiety , but not children 's self-reports . Treatment gains were maintained at 3-month follow-up . CONCLUSIONS The CBT manual employed in this study is one of the first adaptations of an evidence -based treatment for children with autism spectrum disorders . Remission of anxiety disorders appears to be an achievable goal among high-functioning children with autism BACKGROUND The aim of the study was to evaluate the effectiveness of a brief CBT intervention for anxiety with children diagnosed with Asperger syndrome ( AS ) . A second interest was to evaluate whether more intensive parent involvement would increase the child 's ability to manage anxiety outside of the clinic setting . METHODS Seventy-one children aged ten to twelve years were recruited to participate in the anxiety programme . All children were diagnosed with AS and the presence of anxiety symptoms was accepted on parent report via brief interview . Children were r and omly assigned to one of three conditions : intervention for child only , intervention for child and parent , wait-list control . RESULTS The two intervention groups demonstrated significant decreases in parent-reported anxiety symptoms at follow-up and a significant increase in the child 's ability to generate positive strategies in an anxiety-provoking situation . There were a number of significant differences between the two interventions to suggest parent involvement as beneficial . CONCLUSIONS The sample of children with AS in this study presented with a profile of anxiety similar to a sample of clinical ly diagnosed anxious children . The intervention was endorsed by parents as a useful programme for children diagnosed with Asperger syndrome and exhibiting anxiety symptoms , and active parent involvement enhanced the usefulness of the programme . Limitations of the study and future research are discussed We compared the effects of a 16-week Cognitive-Behavioral Therapy ( CBT ) program and a Social Recreational ( SR ) program on anxiety in children with Autism Spectrum Disorders ( ASD ) . Seventy children ( 9–16 years old ) were r and omly assigned to either of the programs ( nCBT = 36 ; nSR = 34 ) . Measures on child ’s anxiety using the Spence Child Anxiety Scale — Child ( SCAS-C ) and the Clinical Global Impression — Severity scale ( CGI-S ) were administered at pre- , post-treatment , and follow-ups ( 3- and 6-month ) . Children in both programs showed significantly lower levels of generalized anxiety and total anxiety symptoms at 6-month follow-up on SCAS-C. Clinician ratings on the CGI-S demonstrated an increase in the percentage of participants rated as “ Normal ” and “ Borderline ” for both programs . Findings from the present study suggest factors such as regular sessions in a structured setting , consistent therapists , social exposure and the use of autism-friendly strategies are important components of an effective framework in the management of anxiety in children and adolescents with ASD OBJECTIVES The revised version of the Screen for Childhood Anxiety Related Emotional Disorders ( SCARED-R ) is a recently developed self-report question naire for measuring DSM-IV defined anxiety disorder symptoms in children . The current study examined the treatment sensitivity of the SCARED-R. METHODS Thirty-six children ( aged 8 - 13 years ) who fulfilled the criteria for generalized anxiety disorder , separation anxiety disorder , and /or social phobia received either group or individual cognitive-behavioural treatment . Children completed the  SCARED-R  and a traditional measure of childhood anxiety , the State-Trait Anxiety Inventory for Children ( STAIC ) , at three points in time : ( 1 ) 6 months before treatment ( i.e. baseline ) , ( 2 ) pre-treatment , and ( 3 ) post-treatment . RESULTS Results showed that children 's SCARED-R and STAIC scores did not change from baseline to pre 
    Output:
    