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: BACKGROUND Streptococcus pneumoniae infections have periodically caused significant morbidity and outbreaks among military personnel , especially trainees . This study evaluated the effectiveness of the 23-valent polysaccharide pneumococcal vaccine ( PPV23 ) in reducing pneumonia in healthy military trainees . METHODS From 2000 - 2003 , 152723 military trainees from 5 US training camps were enrolled in a double-blind , placebo-controlled trial of PPV23 . Participants were closely monitored during basic training for radiographically confirmed pneumonia etiology and loss-of-training days . Participants were also followed using electronic medical encounter data until 1 June 2007 for three additional outcomes : any-cause pneumonia , any acute respiratory disease , and meningitis . RESULTS Comparison of demographic data by study arm suggested the r and omization procedures were sound . During basic training , 371 study participants developed radiographically confirmed pneumonia . None had evidence of S. pneumoniae infection , but other etiologies included adenovirus ( 38 % ) , Chlamydophila pneumoniae ( 9 % ) , and Mycoplasma pneumoniae ( 8 % ) . During the follow-up period , many study participants , in both the vaccine and placebo groups , had clinical encounters for the medical outcomes of interest . However , Cox 's proportional hazard modeling revealed no evidence of a protective vaccine effect during recruit training ( radiographically confirmed pneumonia ) or up to 6.7 years after enrollment ( any-cause pneumonia , any acute respiratory disease , or meningitis ) . CONCLUSIONS Data from this large , double-blind , placebo controlled trial do not support routine use of PPV23 among healthy new military trainees . This clinical trial was registered at clinical trials.gov ( registration number NCT02079701 , http://www . clinical trials.gov/ct2/show/NCT02079701?term=NCT02079701&rank=1 ) The effectiveness of simultaneously administered influenza and pneumococcal vaccines vs. influenza vaccine alone in preventing pneumonia , pneumococcal pneumonia and pneumococcal bacteraemia among the elderly was studied . The vaccines were offered to all persons aged 65 years or older ( N=43,500 ) living in 35 administrative districts in Northern Finl and . A total of 26,925 persons ( 62 % ) decided to participate . Allocation to the vaccination groups took place by year of birth ( odd/even ) . The total follow-up of those vaccinated consisted of 38,037 person years . The incremental effectiveness of the pneumococcal vaccine  was -20 ( 95 % CI -50- + 10 % ) for pneumonia , -20 ( 95 % CI -90- + 20 % ) for pneumococcal pneumonia and + 60 % ( 95 % CI -40- + 90 % ) for pneumococcal bacteraemia . Thus the pneumococcal polysaccharide vaccine did not offer any additional protection from pneumonia among elderly people in Finl and although it reduced the incidence of bacteraemia Objective To determine the efficacy of a 23-valent pneumococcal polysaccharide vaccine in people at high risk of pneumococcal pneumonia . Design Prospect i ve , r and omised , placebo controlled double blind study . Setting Nursing homes in Japan . Participants 1006 nursing home residents . Interventions Participants were r and omly allocated to either 23-valent pneumococcal polysaccharide vaccine ( n=502 ) or placebo ( n=504 ) . Main outcome measures The primary end points were the incidence of all cause pneumonia and pneumococcal pneumonia . Secondary end points were deaths from pneumococcal pneumonia , all cause pneumonia , and other causes . Results Pneumonia occurred in 63 ( 12.5 % ) participants in the vaccine group and 104 ( 20.6 % ) in the placebo group . Pneumococcal pneumonia was diagnosed in 14 ( 2.8 % ) participants in the vaccine group and 37 ( 7.3 % ) in the placebo group ( P<0.001 ) . All cause pneumonia and pneumococcal pneumonia were significantly more frequent in the placebo group than in the vaccine group : incidence per 1000 person years 55 v 91 ( P<0.0006 ) and 12 v 32 ( P<0.001 ) , respectively . Death from pneumococcal pneumonia was significantly higher in the placebo group than in the vaccine group ( 35.1 % ( 13/37 ) v 0 % ( 0/14 ) , P<0.01 ) . The death rate from all cause pneumonia ( vaccine group 20.6 % ( 13/63 ) v placebo group 25.0 % ( 26/104 ) , P=0.5 ) and from other causes ( vaccine group 17.7 % ( 89/502 ) v placebo group ( 80/504 ) 15.9 % , P=0.4 ) did not differ between the two study groups . Conclusion The 23-valent pneumococcal polysaccharide vaccine prevented pneumococcal pneumonia and reduced mortality from pneumococcal pneumonia in nursing home residents . Trial registration Japan Medical Association Center for Clinical Trials JMA-IIA00024 Background : A study was undertaken to evaluate the clinical efficacy of the 23-valent pneumococcal polysaccharide vaccine ( PPV ) in immunocompetent patients with chronic obstructive pulmonary disease ( COPD ) . Methods : A r and omised controlled trial was carried out in 596 patients with COPD of mean ( SD ) age 65.8 ( 9.7 ) years , 298 of whom received PPV .  The main outcome was radiographically proven community acquired pneumonia ( CAP ) of pneumococcal or unknown aetiology after a mean period of 979 days ( range 20–1454 ) . Results : There were 58 first episodes of CAP caused by pneumococcus or of unknown aetiology , 25 in the intervention group and 33 in the non-intervention group . Kaplan-Meier survival curves for CAP did not show significant differences between the intervention and non-intervention arms ( log rank test = 1.15 , p = 0.28 ) in the whole group of patients . The efficacy of  PPV  in all patients was 24 % ( 95 % CI −24 to 54 ; p = 0.333 ) . In the subgroup aged < 65 years the efficacy of PPV was 76 % ( 95 % CI 20 to 93 ; p = 0.013 ) , while in those with severe functional obstruction ( forced expiratory volume in 1 second < 40 % ) it was 48 % ( 95 % CI −7 to 80 ; p = 0.076 ) . In younger patients with severe airflow obstruction  the efficacy was 91 % ( 95 % CI 35 to 99 ; p = 0.002 ) . There were only five cases of non-bacteraemic pneumococcal CAP , all in the non-intervention group ( log rank test = 5.03 ; p = 0.025 ) . Multivariate analysis gave a hazard ratio for unknown and pneumococcal CAP in the vaccinated group , adjusted for age , of 0.20 ( 95 % CI 0.06 to 0.68 ; p = 0.01 ) . Conclusions :  PPV is effective in preventing CAP  in patients with COPD aged less than 65 years and in those with severe airflow obstruction . No differences were found among the other groups of patients with COPD Forty-nine patients with chronic obstructive lung disease ( COPD ) were block-r and omized in four groups to investigate , if different degrees of steroid-load influenced the effect of pneumococcal-vaccination on antibody level and clinical variables during 6 months of follow-up . The groups included 13 patients without systemic steroids for the previous 3 months , all vaccinated at entrance in the study and treated with steroids for 4 weeks . Nine patients had chronic steroid treatment both before and during the investigation ; they were vaccinated at the entrance in the study . Fifteen patients without systemic steroids for the previous 3 months were vaccinated after the end of a 4-week steroid treatment . Twelve patients served as controls , and were not vaccinated . Totally , 60%-78 % of vaccinated patients in the three groups had a rise in antibody level , and a later decrease compared to two of the 12 control patients ( p<0.01 ) . This difference was also significant ( p<0.05 ) for the patients vaccinated at entrance in the hospital . No differences were observed among the clinical variables : pneumonia , exacerbations , admittance to hospital , increase in the use of steroids or beta-agonists , and the use of antibiotics . We conclude that a rise in antibody level after pneumococcal vaccination can be expected in patients with COPD despite of the use of systemic steroids . The clinical effect of vaccination is debatable This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence 
    Output:
    
agent
***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 Streptococcus pneumoniae infections have periodically caused significant morbidity and outbreaks among military personnel , especially trainees . This study evaluated the effectiveness of the 23-valent polysaccharide pneumococcal vaccine ( PPV23 ) in reducing pneumonia in healthy military trainees . METHODS From 2000 - 2003 , 152723 military trainees from 5 US training camps were enrolled in a double-blind , placebo-controlled trial of PPV23 . Participants were closely monitored during basic training for radiographically confirmed pneumonia etiology and loss-of-training days . Participants were also followed using electronic medical encounter data until 1 June 2007 for three additional outcomes : any-cause pneumonia , any acute respiratory disease , and meningitis . RESULTS Comparison of demographic data by study arm suggested the r and omization procedures were sound . During basic training , 371 study participants developed radiographically confirmed pneumonia . None had evidence of S. pneumoniae infection , but other etiologies included adenovirus ( 38 % ) , Chlamydophila pneumoniae ( 9 % ) , and Mycoplasma pneumoniae ( 8 % ) . During the follow-up period , many study participants , in both the vaccine and placebo groups , had clinical encounters for the medical outcomes of interest . However , Cox 's proportional hazard modeling revealed no evidence of a protective vaccine effect during recruit training ( radiographically confirmed pneumonia ) or up to 6.7 years after enrollment ( any-cause pneumonia , any acute respiratory disease , or meningitis ) . CONCLUSIONS Data from this large , double-blind , placebo controlled trial do not support routine use of PPV23 among healthy new military trainees . This clinical trial was registered at clinical trials.gov ( registration number NCT02079701 , http://www . clinical trials.gov/ct2/show/NCT02079701?term=NCT02079701&rank=1 ) The effectiveness of simultaneously administered influenza and pneumococcal vaccines vs. influenza vaccine alone in preventing pneumonia , pneumococcal pneumonia and pneumococcal bacteraemia among the elderly was studied . The vaccines were offered to all persons aged 65 years or older ( N=43,500 ) living in 35 administrative districts in Northern Finl and . A total of 26,925 persons ( 62 % ) decided to participate . Allocation to the vaccination groups took place by year of birth ( odd/even ) . The total follow-up of those vaccinated consisted of 38,037 person years . The incremental effectiveness of the pneumococcal vaccine  was -20 ( 95 % CI -50- + 10 % ) for pneumonia , -20 ( 95 % CI -90- + 20 % ) for pneumococcal pneumonia and + 60 % ( 95 % CI -40- + 90 % ) for pneumococcal bacteraemia . Thus the pneumococcal polysaccharide vaccine did not offer any additional protection from pneumonia among elderly people in Finl and although it reduced the incidence of bacteraemia Objective To determine the efficacy of a 23-valent pneumococcal polysaccharide vaccine in people at high risk of pneumococcal pneumonia . Design Prospect i ve , r and omised , placebo controlled double blind study . Setting Nursing homes in Japan . Participants 1006 nursing home residents . Interventions Participants were r and omly allocated to either 23-valent pneumococcal polysaccharide vaccine ( n=502 ) or placebo ( n=504 ) . Main outcome measures The primary end points were the incidence of all cause pneumonia and pneumococcal pneumonia . Secondary end points were deaths from pneumococcal pneumonia , all cause pneumonia , and other causes . Results Pneumonia occurred in 63 ( 12.5 % ) participants in the vaccine group and 104 ( 20.6 % ) in the placebo group . Pneumococcal pneumonia was diagnosed in 14 ( 2.8 % ) participants in the vaccine group and 37 ( 7.3 % ) in the placebo group ( P<0.001 ) . All cause pneumonia and pneumococcal pneumonia were significantly more frequent in the placebo group than in the vaccine group : incidence per 1000 person years 55 v 91 ( P<0.0006 ) and 12 v 32 ( P<0.001 ) , respectively . Death from pneumococcal pneumonia was significantly higher in the placebo group than in the vaccine group ( 35.1 % ( 13/37 ) v 0 % ( 0/14 ) , P<0.01 ) . The death rate from all cause pneumonia ( vaccine group 20.6 % ( 13/63 ) v placebo group 25.0 % ( 26/104 ) , P=0.5 ) and from other causes ( vaccine group 17.7 % ( 89/502 ) v placebo group ( 80/504 ) 15.9 % , P=0.4 ) did not differ between the two study groups . Conclusion The 23-valent pneumococcal polysaccharide vaccine prevented pneumococcal pneumonia and reduced mortality from pneumococcal pneumonia in nursing home residents . Trial registration Japan Medical Association Center for Clinical Trials JMA-IIA00024 Background : A study was undertaken to evaluate the clinical efficacy of the 23-valent pneumococcal polysaccharide vaccine ( PPV ) in immunocompetent patients with chronic obstructive pulmonary disease ( COPD ) . Methods : A r and omised controlled trial was carried out in 596 patients with COPD of mean ( SD ) age 65.8 ( 9.7 ) years , 298 of whom received PPV .  The main outcome was radiographically proven community acquired pneumonia ( CAP ) of pneumococcal or unknown aetiology after a mean period of 979 days ( range 20–1454 ) . Results : There were 58 first episodes of CAP caused by pneumococcus or of unknown aetiology , 25 in the intervention group and 33 in the non-intervention group . Kaplan-Meier survival curves for CAP did not show significant differences between the intervention and non-intervention arms ( log rank test = 1.15 , p = 0.28 ) in the whole group of patients . The efficacy of  PPV  in all patients was 24 % ( 95 % CI −24 to 54 ; p = 0.333 ) . In the subgroup aged < 65 years the efficacy of PPV was 76 % ( 95 % CI 20 to 93 ; p = 0.013 ) , while in those with severe functional obstruction ( forced expiratory volume in 1 second < 40 % ) it was 48 % ( 95 % CI −7 to 80 ; p = 0.076 ) . In younger patients with severe airflow obstruction  the efficacy was 91 % ( 95 % CI 35 to 99 ; p = 0.002 ) . There were only five cases of non-bacteraemic pneumococcal CAP , all in the non-intervention group ( log rank test = 5.03 ; p = 0.025 ) . Multivariate analysis gave a hazard ratio for unknown and pneumococcal CAP in the vaccinated group , adjusted for age , of 0.20 ( 95 % CI 0.06 to 0.68 ; p = 0.01 ) . Conclusions :  PPV is effective in preventing CAP  in patients with COPD aged less than 65 years and in those with severe airflow obstruction . No differences were found among the other groups of patients with COPD Forty-nine patients with chronic obstructive lung disease ( COPD ) were block-r and omized in four groups to investigate , if different degrees of steroid-load influenced the effect of pneumococcal-vaccination on antibody level and clinical variables during 6 months of follow-up . The groups included 13 patients without systemic steroids for the previous 3 months , all vaccinated at entrance in the study and treated with steroids for 4 weeks . Nine patients had chronic steroid treatment both before and during the investigation ; they were vaccinated at the entrance in the study . Fifteen patients without systemic steroids for the previous 3 months were vaccinated after the end of a 4-week steroid treatment . Twelve patients served as controls , and were not vaccinated . Totally , 60%-78 % of vaccinated patients in the three groups had a rise in antibody level , and a later decrease compared to two of the 12 control patients ( p<0.01 ) . This difference was also significant ( p<0.05 ) for the patients vaccinated at entrance in the hospital . No differences were observed among the clinical variables : pneumonia , exacerbations , admittance to hospital , increase in the use of steroids or beta-agonists , and the use of antibiotics . We conclude that a rise in antibody level after pneumococcal vaccination can be expected in patients with COPD despite of the use of systemic steroids . The clinical effect of vaccination is debatable This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence 
    Output:
    