You will be shown the abstract of a medical clinical trial report. Your task is to extract all the findings from this report into a JSON array. Each finding should contain the following five elements:

- Intervention: The medical intervention being tested. This should be a text span copied from the input passage.
- Comparator: The baseline against which the intervention is being evaluated. This should be a text span copied from the input passage. If no comparator is reported, set to `null`.
- Outcome: The medical outcome whose effect is being measured. This should be a text span copied from the input passage.
- Effect: The effect of the intervention on the outcome, relative to the comparator. The effect should be one of the following three values: ("significantly increased", "significantly decreased", "no significant difference").
- Evidence: The evidence for the effect. This should be a text span copied from the input passage.

Please format your output as a JSON array. Each entry in the output should be an array containing the 5 elements listed above, in the following order: [<intervention>, <comparator>, <outcome>, <effect>, <evidence>].

For example, an output with two findings might read:
```
[["aspirin", "placebo", "headache severity", "significantly decreased", "Mean headache severity was significantly decreased in the aspirin group compared to the placebo group (p < 0.05)."], ["aspirin", "placebo", "weight loss", "no significant difference", "We did not observe any difference in weight loss between the group given aspirin relative to the control group"]]
```

There are 1 finding(s) in the abstract below. Please extract them. Output only the JSON array with these 1 findings. Do not include any additional text.

Abstract:
ABSTRACT.BACKGROUND: Despite widespread implementation of syndromic surveillance systems within public health agencies, previous studies of the implementation and use of these systems have indicated that the functions and responses taken in response to syndromic surveillance data vary widely according to local context and preferences. The objective of the Syndromic Surveillance Evaluation Study was to develop and implement standardized supports in local public health agencies in Ontario, Canada, and evaluate the ability of these supports to affect actions taken as part of public health communicable disease control programs.

ABSTRACT.METHODS: Local public health agencies (LPHA) in Ontario, which used syndromic surveillance based on emergency department visits for respiratory disease, were recruited and randomly allocated to the study intervention or control group. The intervention group health agencies received standardized supports in terms of a standardized aberrant event detection algorithm and a response protocol dictating steps to investigate and assess the public health significance of syndromic surveillance alerts. The control group continued with their pre-existing syndromic surveillance infrastructure and processes. Outcomes were assessed using logbooks, which collected quantitative and qualitative information about alerts received, investigation steps taken, and public health responses. The study was conducted prospectively for 15 months (October 2013 to February 2015).

ABSTRACT.RESULTS: Fifteen LPHAs participated in the study (n = 9 intervention group, n = 6 control group). A total of 1,969 syndromic surveillance alerts were received by all LPHAs. Variations in the types and amount of responses varied by LPHA, in particularly differences were noted by the size of the health unit. Smaller health units had more challenges to both detect and mount a response to any alerts. LPHAs in the control group were more likely to declare alerts to have public health significance and to initiate any action. Regression models using repeated measures showed an interaction between the year (Year 1 versus Year 2) and the intervention as well as an interaction between year and sustained nature of the alert. Both of these were linked to the control health units reporting more "watchful waiting".

ABSTRACT.CONCLUSIONS: This study raises questions about the effectiveness of using standardized protocols to improve the performance of syndromic surveillance in a decentralized public health system. Despite efforts to create standardized protocols and engage public health agencies in the process, no significant differences in the effective use of syndromic alerts were observed beyond year 1. It also raises questions about the minimum capacity of the agency and minimum population size that are required for an effective response.

Findings:
[["Standardized aberrant event detection algorithm and response protocol", "Pre-existing syndromic surveillance infrastructure and processes", "Effective use of syndromic alerts after 1 year", "no significant difference", "Despite efforts to create standardized protocols and engage public health agencies in the process, no significant differences in the effective use of syndromic alerts were observed beyond year 1."]]