You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
The influence of ice slurry ingestion on maximal voluntary contraction following exercise-induced hyperthermia
Abstract 1:
The purpose of this study was to determine whether ingestion of a small bolus of ice slurry ( 1.25 g kg−1 ) could attenuate the reduction in maximal voluntary isometric contraction ( MVC ) torque output during a 2-min sustained task following exercise-induced hyperthermia . On two separate occasions , 10 males ( age : 24 ± 3 years , $ $ \dot{V}{\text{O } } _ { { 2 { \text{peak } } } } $ $ : 49.8 ± 4.7 ml kg−1 min−1 ) ran to exhaustion at their first ventilatory threshold in a hot environment ( 34.1 ± 0.1 ° C , 49.5 ± 3.6 % RH ) . Prior to and after exercise , subjects performed a 2-min sustained MVC of the right elbow flexors in a thermoneutral environment ( 24.6 ± 0.8 ° C , 37.2 ± 4.5 % RH ) . The post exercise MVC was performed immediately following the ingestion of either 1.25 g kg−1 of ice slurry ( −1 ° C ; ICE ) or warm fluid ( 40 ° C ; CON ) , in a counterbalanced and r and omised order . Run time to exhaustion ( 42.4 ± 9.5 vs. 41.7 ± 8.7 min ; p = 0.530 ) , and rectal ( 39.08 ± 0.30 vs. 39.08 ± 0.30 ° C ; p = 0.934 ) and skin temperatures ( 35.26 ± 0.65 vs. 35.28 ± 0.67 ° C ; p = 0.922 ) and heart rate ( 189 ± 5 vs. 189 ± 6 beats min−1 ; p = 0.830 ) at the end of the run were similar between trials . Torque output during the post-exercise 2-min sustained MVC was significantly higher ( p = 0.001 ) following ICE ( 30.75 ± 16.40 Nm ) compared with CON ( 28.69 ± 14.88 Nm ) . These results suggest that ice slurry ingestion attenuated the effects of exercise-induced hyperthermia on MVC , possibly via internal thermoreceptive and /or temperature-related sensory mechanisms


Title 2:
The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
Abstract 2:
OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity


Title 3:
Drink temperature influences fluid intake and endurance capacity in men during exercise in a hot, dry environment.
Abstract 3:
The effect of different drink temperatures on the perception of exertion and exercise endurance has not been extensively investigated . Consequently , the purpose of the present study was to examine the effect of drink temperature on fluid intake and endurance during cycling in the heat . Eight healthy , non-acclimated males ( 26 + /- 7 years ; maximum oxygen uptake , 54 + /- 5 ml kg(-1 ) min(-1 ) ; mean + /- S.D. ) cycled to exhaustion at 34 degrees C and at 65 % of their peak aerobic power , consuming a drink at either 19 degrees C ( CON ) or 4 degrees C ( COLD ) . Six of the eight subjects cycled for longer during COLD , with exhaustion occurring at 62 + /- 4 min , compared to 55 + /- 4 min for CON ( P < 0.05 ; mean + /- S.E.M. ) . Subjects consumed significantly more fluid during COLD compared to CON ( 1.3 + /- 0.3 l h(-1 ) compared to 1.0 + /- 0.2 l h(-1 ) ; P < 0.05 ) . Heart rate tended to be lower by approximately 5 beats min(-1 ) during COLD , and rectal temperature during the second half of the exercise period was approximately 0.25 degrees C lower during the COLD trial ; however , these trends were not significant ( P = 0.08 and P = 0.07 , respectively ) . No differences were observed between trials for ventilation , concentrations of prolactin , glucose and lactate or perceived exertion . It is concluded that a drink at 4 degrees C during exercise in the heat enhances fluid consumption and improves endurance by acting as a heat sink , attenuating the rise in body temperature and therefore reducing the effects of heat stress


Title 4:
Voluntary dehydration and alliesthesia for water.
Abstract 4:
The purpose of this experiment was to explore the complex relationship between fluid consumption and consumption factors ( thirst , voluntary dehydration , water alliesthesia , palatability , work-rest cycle ) during a simulated 14.5-km desert walk ( treadmill , 1.34 m X s-1 , 5 % grade , 40 degrees C dry bulb/26 degrees C wet bulb , and wind speed of approximately 1.2 m X s-1 ) . Twenty-nine subjects were tested ( 30 min X h-1 , 6 h ) on each of two nonconsecutive days . The subjects were r and omly assigned to one of three groups : tap water ( n = 8) , iodine-treated tap water ( n = 11 ) , or iodine-treated flavored tap water ( n = 10 ) . The temperature of the water was 40 degrees C during one trial and 15 degrees C on the other . Mean sweat losses ( 6 h ) varied between 1.4 kg ( warm iodine-treated ; 232 + /- 44 g X h-1 ) and 3.0 kg ( cool iodine-treated flavored ; 509 + /- 50 g X h-1 ) . Warm drinks were consumed at a lower rate than cool drinks ( negative and positive alliesthesia ) . This decreased consumption result ed in the highest percent body weight losses ( 2.8 and 3.2 % ) . Cooling and flavoring effects on consumption were additive and increased the rate of intake by 120 % . The apparent paradox between reduced consumption concomitant with severe dehydration and hyperthermia is attributed to negative alliesthesia for warm water rather than an apparent inadequacy of the thirst mechanism . The reluctance to drink warm iodine-treated water result ed in significant hyperthermia , dehydration , hypovolemia , and , in two cases , heat illness


Title 5:
Gastric emptying of cold beverages in humans: effect of transportable carbohydrates.
Abstract 5:
Eight healthy subjects , aged 39.0 ¿ 2.4 years , consumed four 6 % carbohydrate-electrolyte solutions containing either one ( glucose or fructose ) or two transportable carbohydrates in single ( glucose + fructose ) or bound ( sucrose ) forms . Solution osmolalities ranged from 250 to 434 mOsm/kg H2O . The test solutions were ingested at rest in the amount of 6 ml/kg of body weight at a temperature of 12 ¿ C. Gastric emptying rate was measured by repeated aspirations via a nasogastric tube using the modified George double-sampling technique . The intragastric temperature was determined by a temperature probe attached to the nasogastric tube . There were no significant differences in gastric emptying rates and gastric volumes among the solutions . Intragastric temperature dropped from 36.5 ¿ C to 23.3 ¿ 3 ¿ C immediately after beverage ingestion but recovered to above 30 ¿ C within 5 min . These data suggest that the gastric emptying rate of the specified beverages is not affected by the number and type of carbohydrates or by solution osmolalities within the tested range . Within 5 min after ingestion , cold beverages are warmed to above 30 C in the stomach . This infers that the effect of cold solution temperature on gastric emptying rate is likely to be small and transitory
CONCLUSION Cool beverage temperatures ( < 22 ° C ) significantly increased fluid palatability , fluid consumption , and hydration during exercise vs. control ( ≥22 - ° C )