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: The purpose of the current study was to determine whether the implementation of a season-long team-building intervention program using team goal setting increased perceptions of cohesion . The participants were 86 female high school basketball players from 8 teams . The teams were r and omly assigned to either an experimental team goal - setting or control condition . Each participant completed the Group Environment Question naire  ( GEQ ; Carron , Brawley , & Widmeyer , 2002 ; Carron , Widmeyer , & Brawley , 1985 ) , which assessed cohesion at both the beginning and end of the season . Overall , the results revealed a significant multivariate effect , Pillai 's trace F(12 , 438 ) = 2.68 , p = .002 . Post hoc analyses showed that at the beginning of the season , athletes from both conditions did not differ in their perceptions of cohesion . However , at the end of the season , athletes in the team goal - setting condition held higher perceptions of cohesion than athletes in the control condition . Overall , the results indicated that team goal setting was an effective team-building tool for influencing cohesiveness in sport teams The purpose of this study was to investigate the role played by goal difficulty and goal origin ( i.e. , self-set vs. assigned ) on the performance of patients with brain injuries in a simple arithmetic task . Eighty-seven patients with either cerebral vascular accidents or traumatic brain injuries were investigated . Patients were r and omly assigned to one of three conditions : ( 1 ) one in which a specific , high goal was assigned , ( 2 ) one in which a “ do your best ” goal was given , and ( 3 ) one in which a personal goal has to be stated . The results indicate that both goal difficulty and goal origin had an influence on performance . Assigned difficult goals lead to better performance than assigned easy goals . Self- setting a goal did not increase performance to the same level than the assignment of a difficult goal . This lower performance increase with self-set goals can be explained by the fact that participants selected goals which were not as difficult as the assigned difficult goal .  Self-set goals were attained by most of the patients and only 1 patient showed a high discrepancy between self-set goal and actual performance . These findings suggest that goal origin and goal difficulty are important moderators in the goal setting process . Furthermore , patients with brain injuries do not necessarily set unrealistic high goals The Effect of Goal Setting Difficulty on Serving Success in Table Tennis and the Mediating Mechanism of Self-regulation Goal setting difficulty has been shown to contribute to athletic performance ( Burton et al. , 2000 ) . However , the potential mediating mechanism of goal difficulty on performance is unclear . Therefore , the purpose of this study was to verify the effect of goal setting difficulty on serving success in table tennis , and determine if self-regulation is the mediating variable . The current study used serving success within a one minute period as the task , and the " Athlete 's Self-regulation in Motor Learning " as the measurement tool . The experiment was design ed as a 3 ( serving frequency : 20/min , 23/min , and 26/min ) x 2 ( serving placement : left " small triangle " , and right " small triangle " ) model . Participants ( N = 60 ) in the current study were students from a physical education school . These participants were r and omly assigned into the experimental and control groups . After the intervention , differences in self-regulation ( p < 0.001 ) and serving success ( p < 0.05 ) between the experimental and control groups were significant . For the experimental groups , there was a significant difference in self-regulation ( p < 0.001 ) and serving success ( p < 0.05 ) before and after the experiment . Serving frequency had a main effect on self-regulation ( F ( 5 , 24 ) = 12.398 , p < 0.01 ) and serving success ( F ( 5 , 24 ) = 37.601 , p < 0.001 ) . Moderately difficult goal setting contributed to athletic performance . Regression analysis using bootstrapping methods revealed that self-regulation partially mediated the relationship between the two This research examined the impact of goal - setting conditions on memory beliefs and performance among older and younger adults . After baseline recall and assessment of beliefs , participants were assigned to goal - setting , goals plus feedback , or control . Then , additional recall trials were followed by repeated memory beliefs assessment s. For both younger and older adults , performance , motivation , and self-efficacy were affected positively by goal - setting . The impact of goals plus feedback was mixed and varied as a function of age and dependent measure . Success rates for reaching memory goals , which were low for the older adults , may have been a factor in these results . Adults ' self-set recall goals were predicted initially by baseline performance and self-efficacy . On the final trial , goals were predicted by last trial performance , self-efficacy , and control beliefs OBJECTIVE To examine the effects of different levels of goal specificity and difficulty on Latino children 's performance and physical activity ( PA )  levels in an after-school program incorporating an interactive dance program ( Dance Dance Revolution [ DDR ] ; Konami Corporation ) . DESIGN Comparison study . SETTING Rose Park Elementary School , Salt Lake City , Utah . PARTICIPANTS Ninety-eight Latino children in the first through sixth grade s , aged 7 to 13 years . INTERVENTION After the pretest , the participants were r and omly assigned into 1 of the following 3 goal - setting conditions : ( 1 ) easy , ( 2 ) difficult , and ( 3 ) best effort ( hereinafter referred to as do-your-best goal ) . MAIN OUTCOME MEASURES Participants ' PA levels were measured using piezoelectric pedometers  , and steps per minute were used as the outcome variable . Participants ' total points for their dance on television screens were retrieved as their performance scores . These outcome variables were assessed again 8 weeks later ( posttest score ) . RESULTS The multivariate analysis of covariance yielded a significant main effect for the goal - setting condition . Follow-up tests revealed that children who set specific ( easy or difficult ) goals had significantly greater increased PA levels ( mean scores , 10.34 for easy and 22.45 for difficult ) and DDR performance ( 0.011 for easy and 0.67 for difficult ) than those in the do-your-best group ( 0.83 for PA and 0.17 for performance ) . In addition , children 's increased PA levels in the difficult- goal group were significantly higher than those in the easy- goal group . CONCLUSIONS The easy- and difficult- goal groups show a significant improvement on DDR performance . The difficult- goal group also displays the highest improvement on PA levels . Strategies to enhance children 's  DDR performance and PA levels are discussed in relation to the extant goal - setting literature IMPORTANCE " Nudges " that influence decision making through subtle cognitive mechanisms have been shown to be highly effective in a wide range of applications , but there have been few experiments to improve clinical practice . OBJECTIVE To investigate the use of a behavioral " nudge " based on the principle of public commitment in encouraging the judicious use of antibiotics for acute respiratory infections ( ARIs ) . DESIGN , SETTING , AND PARTICIPANTS R and omized clinical trial in 5 outpatient primary care clinics . A total of 954 adults had ARI visits during the study timeframe : 449 patients were treated by clinicians r and omized to the posted commitment letter  ( 335 in the baseline period , 114 in the intervention period ) ; 505 patients were treated by clinicians r and omized to st and ard practice control  ( 384 baseline , 121 intervention ) . INTERVENTIONS The intervention consisted of displaying poster-sized commitment letters in examination rooms for 12 weeks . These letters , featuring clinician photographs and signatures , stated their commitment to avoid inappropriate antibiotic prescribing for ARIs . MAIN OUTCOMES AND MEASURES Antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses in baseline and intervention periods , adjusted for patient age , sex , and insurance status . RESULTS Baseline rates were 43.5 % and 42.8 % for control and poster , respectively . During the intervention period , inappropriate prescribing rates increased to 52.7 % for controls but decreased to 33.7 % in the posted commitment letter condition . Controlling for baseline prescribing rates , we found that the posted commitment letter result ed in a 19.7 absolute percentage reduction in inappropriate antibiotic prescribing rate relative to control ( P = .02 ) . There was no evidence of diagnostic coding shift , and rates of appropriate antibiotic prescriptions did not diminish over time . CONCLUSIONS AND RELEVANCE Displaying poster-sized commitment letters in examination rooms decreased inappropriate antibiotic prescribing for ARIs . The effect of this simple , low-cost intervention is comparable in magnitude to costlier , more intensive quality -improvement efforts . TRIAL REGISTRATION clinical trials.gov identifier : NCT01767064 This study aim ed to determine whether motor function and performance is better enhanced by intensive physiotherapy or collaborative goal - setting in children with cerebral palsy ( CP ) . Participants were a convenience sample of 56 children with bilateral CP classified at level III or below on the Gross Motor Function Classification System ( GMFCS ) , aged between 3 and 12 years . A 2 x 2 factorial design was used to compare the effects of routine amounts of physiotherapy with intensive amounts , and to compare the use of generalized aims set by the child 's physiotherapist with the use of specific , measurable goals negotiated by the child 's physiotherapist with each child , carer , and teacher . Following the six-month treatment period there was a further six-month period of observation . Changes in motor function and performance were assessed by a masked assessor using the Gross Motor Function Measure ( GMFM ) and the Gross Motor Performance Measure ( GMPM ) at three-month intervals . There was no statistically significant difference in the scores achieved between intensive and routine amounts of therapy or between aim -directed and goal -directed therapy  in either function or performance . Inclusion of additional covariates of age and severity levels showed a trend towards a statistically significant difference in children receiving intensive therapy during the treatment period . This advantage declined over the subsequent six months during which therapy had reverted to its usual amount . Differences in goal - setting procedures did not produce any detectable effect on the acquisition of gross motor function or performance This research examined whether and which purpose goals moderate the relationship between task interest and actual performance  and whether assigned goals have different effects ( Study 1 ) than adopted goals ( Study 2 ) . Two studies were conducted using a full 2 X 2 design of the performance-mastery and approach-avoidance distinctions , plus control conditions . In the control conditions , that is , in a neutral purpose goal context , the expected positive relationship between initial task interest and actual performance was found . In a purpose goal context , this link held only for a congruent mastery-approach goal ( either assigned or adopted ) . The gain in task interest found in a neutral purpose context was observed in the purpose goal conditions only when participants attained their purpose goals . It was concluded that having an incongruent purpose goal may undermine the positive effect of prior task interest on actual performance as well as on subsequent task interest OBJECTIVE To evaluate the effectiveness of incorporating two self-regulation strategies ( goal setting and self-monitoring ) into a nutrition education class to enhance dietary fiber self-efficacy and foster a positive change in dietary fiber consumption . DESIGN College students in an introductory nutrition class ( n = 113 ) were r and omly assigned to one of four treatment conditions : goal setting , self-monitoring , goal setting and self-monitoring , and no goal setting and no self-monitoring .  Twenty-six college students from an introductory health class served as the control group . STATISTICAL ANALYSES The main and interaction effects of goal setting and self-monitoring on postintervention variables were analyzed using analysis of covariance with baseline intake levels as the covariate . Analysis of variance was used to examine differences in the mean changes between the groups . Path analysis was conducted to analyze the causal linkage among the pretest and intervening variables to predict postintervention knowledge , self-efficacy , and fiber consumption . RESULTS Goal setting had a significant main effect on dietary fiber self-efficacy and on dietary fiber consumption Subjects who set goals scored 15 % higher on the dietary fiber self-efficacy scale and consumed 91 % more fiber than subjects who did not set goals . Self-monitoring had no significant main effect on either dietary fiber self-efficacy or dietary fiber consumption . There was no significant interaction between goal setting and self-monitoring . Changes in dietary fiber scores differed between the groups . Increases in dietary fiber for the goal setting and self-monitoring group were significantly higher than the goal - setting , self-monitoring , no goal setting and no self-monitoring , and control groups . In addition , the goal setting only group had significantly greater increases in fiber intake than the self-monitoring , no goal setting and no self-monitoring , and control groups . Changes in self-efficacy scores were significantly different between the groups . The goal setting and goal setting and self-monitoring groups had significantly higher self-efficacy scores than the control group . Path analysis revealed that both goal setting and self-monitoring affected dietary fiber consumption through knowledge and dietary fiber self-efficacy , goal setting had a strong direct effect on fiber consumption , and postintervention knowledge affected fiber consumption only through self-efficacy . APPLICATIONS/ CONCLUSIONS Our findings suggest that dietary change requires active self-regulation of food intake . Combining goal setting and self-monitoring significantly enhances dietary behavior change . This strategy can easily be incorporated into nutrition education or counseling programs to enhance dietary behavior change Forty-four children aged 3 to 11 years with quadriplegic cerebral palsy were prospect ively stratified and r and omised into four treatment groups . The acquisition of motor skills was assessed in a 2 x 2 factorial design using the Gross Motor Function Measure . The two factors were conventional amounts of 
    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: The purpose of the current study was to determine whether the implementation of a season-long team-building intervention program using team goal setting increased perceptions of cohesion . The participants were 86 female high school basketball players from 8 teams . The teams were r and omly assigned to either an experimental team goal - setting or control condition . Each participant completed the Group Environment Question naire  ( GEQ ; Carron , Brawley , & Widmeyer , 2002 ; Carron , Widmeyer , & Brawley , 1985 ) , which assessed cohesion at both the beginning and end of the season . Overall , the results revealed a significant multivariate effect , Pillai 's trace F(12 , 438 ) = 2.68 , p = .002 . Post hoc analyses showed that at the beginning of the season , athletes from both conditions did not differ in their perceptions of cohesion . However , at the end of the season , athletes in the team goal - setting condition held higher perceptions of cohesion than athletes in the control condition . Overall , the results indicated that team goal setting was an effective team-building tool for influencing cohesiveness in sport teams The purpose of this study was to investigate the role played by goal difficulty and goal origin ( i.e. , self-set vs. assigned ) on the performance of patients with brain injuries in a simple arithmetic task . Eighty-seven patients with either cerebral vascular accidents or traumatic brain injuries were investigated . Patients were r and omly assigned to one of three conditions : ( 1 ) one in which a specific , high goal was assigned , ( 2 ) one in which a “ do your best ” goal was given , and ( 3 ) one in which a personal goal has to be stated . The results indicate that both goal difficulty and goal origin had an influence on performance . Assigned difficult goals lead to better performance than assigned easy goals . Self- setting a goal did not increase performance to the same level than the assignment of a difficult goal . This lower performance increase with self-set goals can be explained by the fact that participants selected goals which were not as difficult as the assigned difficult goal .  Self-set goals were attained by most of the patients and only 1 patient showed a high discrepancy between self-set goal and actual performance . These findings suggest that goal origin and goal difficulty are important moderators in the goal setting process . Furthermore , patients with brain injuries do not necessarily set unrealistic high goals The Effect of Goal Setting Difficulty on Serving Success in Table Tennis and the Mediating Mechanism of Self-regulation Goal setting difficulty has been shown to contribute to athletic performance ( Burton et al. , 2000 ) . However , the potential mediating mechanism of goal difficulty on performance is unclear . Therefore , the purpose of this study was to verify the effect of goal setting difficulty on serving success in table tennis , and determine if self-regulation is the mediating variable . The current study used serving success within a one minute period as the task , and the " Athlete 's Self-regulation in Motor Learning " as the measurement tool . The experiment was design ed as a 3 ( serving frequency : 20/min , 23/min , and 26/min ) x 2 ( serving placement : left " small triangle " , and right " small triangle " ) model . Participants ( N = 60 ) in the current study were students from a physical education school . These participants were r and omly assigned into the experimental and control groups . After the intervention , differences in self-regulation ( p < 0.001 ) and serving success ( p < 0.05 ) between the experimental and control groups were significant . For the experimental groups , there was a significant difference in self-regulation ( p < 0.001 ) and serving success ( p < 0.05 ) before and after the experiment . Serving frequency had a main effect on self-regulation ( F ( 5 , 24 ) = 12.398 , p < 0.01 ) and serving success ( F ( 5 , 24 ) = 37.601 , p < 0.001 ) . Moderately difficult goal setting contributed to athletic performance . Regression analysis using bootstrapping methods revealed that self-regulation partially mediated the relationship between the two This research examined the impact of goal - setting conditions on memory beliefs and performance among older and younger adults . After baseline recall and assessment of beliefs , participants were assigned to goal - setting , goals plus feedback , or control . Then , additional recall trials were followed by repeated memory beliefs assessment s. For both younger and older adults , performance , motivation , and self-efficacy were affected positively by goal - setting . The impact of goals plus feedback was mixed and varied as a function of age and dependent measure . Success rates for reaching memory goals , which were low for the older adults , may have been a factor in these results . Adults ' self-set recall goals were predicted initially by baseline performance and self-efficacy . On the final trial , goals were predicted by last trial performance , self-efficacy , and control beliefs OBJECTIVE To examine the effects of different levels of goal specificity and difficulty on Latino children 's performance and physical activity ( PA )  levels in an after-school program incorporating an interactive dance program ( Dance Dance Revolution [ DDR ] ; Konami Corporation ) . DESIGN Comparison study . SETTING Rose Park Elementary School , Salt Lake City , Utah . PARTICIPANTS Ninety-eight Latino children in the first through sixth grade s , aged 7 to 13 years . INTERVENTION After the pretest , the participants were r and omly assigned into 1 of the following 3 goal - setting conditions : ( 1 ) easy , ( 2 ) difficult , and ( 3 ) best effort ( hereinafter referred to as do-your-best goal ) . MAIN OUTCOME MEASURES Participants ' PA levels were measured using piezoelectric pedometers  , and steps per minute were used as the outcome variable . Participants ' total points for their dance on television screens were retrieved as their performance scores . These outcome variables were assessed again 8 weeks later ( posttest score ) . RESULTS The multivariate analysis of covariance yielded a significant main effect for the goal - setting condition . Follow-up tests revealed that children who set specific ( easy or difficult ) goals had significantly greater increased PA levels ( mean scores , 10.34 for easy and 22.45 for difficult ) and DDR performance ( 0.011 for easy and 0.67 for difficult ) than those in the do-your-best group ( 0.83 for PA and 0.17 for performance ) . In addition , children 's increased PA levels in the difficult- goal group were significantly higher than those in the easy- goal group . CONCLUSIONS The easy- and difficult- goal groups show a significant improvement on DDR performance . The difficult- goal group also displays the highest improvement on PA levels . Strategies to enhance children 's  DDR performance and PA levels are discussed in relation to the extant goal - setting literature IMPORTANCE " Nudges " that influence decision making through subtle cognitive mechanisms have been shown to be highly effective in a wide range of applications , but there have been few experiments to improve clinical practice . OBJECTIVE To investigate the use of a behavioral " nudge " based on the principle of public commitment in encouraging the judicious use of antibiotics for acute respiratory infections ( ARIs ) . DESIGN , SETTING , AND PARTICIPANTS R and omized clinical trial in 5 outpatient primary care clinics . A total of 954 adults had ARI visits during the study timeframe : 449 patients were treated by clinicians r and omized to the posted commitment letter  ( 335 in the baseline period , 114 in the intervention period ) ; 505 patients were treated by clinicians r and omized to st and ard practice control  ( 384 baseline , 121 intervention ) . INTERVENTIONS The intervention consisted of displaying poster-sized commitment letters in examination rooms for 12 weeks . These letters , featuring clinician photographs and signatures , stated their commitment to avoid inappropriate antibiotic prescribing for ARIs . MAIN OUTCOMES AND MEASURES Antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses in baseline and intervention periods , adjusted for patient age , sex , and insurance status . RESULTS Baseline rates were 43.5 % and 42.8 % for control and poster , respectively . During the intervention period , inappropriate prescribing rates increased to 52.7 % for controls but decreased to 33.7 % in the posted commitment letter condition . Controlling for baseline prescribing rates , we found that the posted commitment letter result ed in a 19.7 absolute percentage reduction in inappropriate antibiotic prescribing rate relative to control ( P = .02 ) . There was no evidence of diagnostic coding shift , and rates of appropriate antibiotic prescriptions did not diminish over time . CONCLUSIONS AND RELEVANCE Displaying poster-sized commitment letters in examination rooms decreased inappropriate antibiotic prescribing for ARIs . The effect of this simple , low-cost intervention is comparable in magnitude to costlier , more intensive quality -improvement efforts . TRIAL REGISTRATION clinical trials.gov identifier : NCT01767064 This study aim ed to determine whether motor function and performance is better enhanced by intensive physiotherapy or collaborative goal - setting in children with cerebral palsy ( CP ) . Participants were a convenience sample of 56 children with bilateral CP classified at level III or below on the Gross Motor Function Classification System ( GMFCS ) , aged between 3 and 12 years . A 2 x 2 factorial design was used to compare the effects of routine amounts of physiotherapy with intensive amounts , and to compare the use of generalized aims set by the child 's physiotherapist with the use of specific , measurable goals negotiated by the child 's physiotherapist with each child , carer , and teacher . Following the six-month treatment period there was a further six-month period of observation . Changes in motor function and performance were assessed by a masked assessor using the Gross Motor Function Measure ( GMFM ) and the Gross Motor Performance Measure ( GMPM ) at three-month intervals . There was no statistically significant difference in the scores achieved between intensive and routine amounts of therapy or between aim -directed and goal -directed therapy  in either function or performance . Inclusion of additional covariates of age and severity levels showed a trend towards a statistically significant difference in children receiving intensive therapy during the treatment period . This advantage declined over the subsequent six months during which therapy had reverted to its usual amount . Differences in goal - setting procedures did not produce any detectable effect on the acquisition of gross motor function or performance This research examined whether and which purpose goals moderate the relationship between task interest and actual performance  and whether assigned goals have different effects ( Study 1 ) than adopted goals ( Study 2 ) . Two studies were conducted using a full 2 X 2 design of the performance-mastery and approach-avoidance distinctions , plus control conditions . In the control conditions , that is , in a neutral purpose goal context , the expected positive relationship between initial task interest and actual performance was found . In a purpose goal context , this link held only for a congruent mastery-approach goal ( either assigned or adopted ) . The gain in task interest found in a neutral purpose context was observed in the purpose goal conditions only when participants attained their purpose goals . It was concluded that having an incongruent purpose goal may undermine the positive effect of prior task interest on actual performance as well as on subsequent task interest OBJECTIVE To evaluate the effectiveness of incorporating two self-regulation strategies ( goal setting and self-monitoring ) into a nutrition education class to enhance dietary fiber self-efficacy and foster a positive change in dietary fiber consumption . DESIGN College students in an introductory nutrition class ( n = 113 ) were r and omly assigned to one of four treatment conditions : goal setting , self-monitoring , goal setting and self-monitoring , and no goal setting and no self-monitoring .  Twenty-six college students from an introductory health class served as the control group . STATISTICAL ANALYSES The main and interaction effects of goal setting and self-monitoring on postintervention variables were analyzed using analysis of covariance with baseline intake levels as the covariate . Analysis of variance was used to examine differences in the mean changes between the groups . Path analysis was conducted to analyze the causal linkage among the pretest and intervening variables to predict postintervention knowledge , self-efficacy , and fiber consumption . RESULTS Goal setting had a significant main effect on dietary fiber self-efficacy and on dietary fiber consumption Subjects who set goals scored 15 % higher on the dietary fiber self-efficacy scale and consumed 91 % more fiber than subjects who did not set goals . Self-monitoring had no significant main effect on either dietary fiber self-efficacy or dietary fiber consumption . There was no significant interaction between goal setting and self-monitoring . Changes in dietary fiber scores differed between the groups . Increases in dietary fiber for the goal setting and self-monitoring group were significantly higher than the goal - setting , self-monitoring , no goal setting and no self-monitoring , and control groups . In addition , the goal setting only group had significantly greater increases in fiber intake than the self-monitoring , no goal setting and no self-monitoring , and control groups . Changes in self-efficacy scores were significantly different between the groups . The goal setting and goal setting and self-monitoring groups had significantly higher self-efficacy scores than the control group . Path analysis revealed that both goal setting and self-monitoring affected dietary fiber consumption through knowledge and dietary fiber self-efficacy , goal setting had a strong direct effect on fiber consumption , and postintervention knowledge affected fiber consumption only through self-efficacy . APPLICATIONS/ CONCLUSIONS Our findings suggest that dietary change requires active self-regulation of food intake . Combining goal setting and self-monitoring significantly enhances dietary behavior change . This strategy can easily be incorporated into nutrition education or counseling programs to enhance dietary behavior change Forty-four children aged 3 to 11 years with quadriplegic cerebral palsy were prospect ively stratified and r and omised into four treatment groups . The acquisition of motor skills was assessed in a 2 x 2 factorial design using the Gross Motor Function Measure . The two factors were conventional amounts of 
    Output:
    