Family caregiver readiness to adopt smart home technology to monitor care-Dependent older adults: A qualitative exploratory study

AIMS

The aim of this study was to explore factors that influence family caregiver readiness to adopt health smart home technology for their care-dependent older adult family member. Health smart homes are designed to remotely monitor the health and wellness of community-dwelling older adults supporting independent living for as long as possible. Accordingly, if the health smart home is deployed into the home of a care-depended older adult, it can potentially support family caregivers by facilitating workforce participation and give piece of mind to the family caregiver who may not live close to the older adult. However, wider adoption of health smart home technologies into the homes of community-older adults is low, and little is known about the factors that influence the readiness of family caregivers to adopt smart home technologies for their care-dependent older adults.

DESIGN

A qualitative Descriptive study design was utilized.

METHODS

Qualitative data were collected between 2019 and 2020 via semi-structured interviews. Thematic analysis of interviews was completed, and data were organized into themes.

RESULTS

Study findings show that caregiver readiness (N = 10) to adopt smart home technology to monitor older adult family members were influenced by five primary themes including a 'big brother effect', 'framing for acceptance', 'data privacy', 'burden' and 'cost.'

CONCLUSION

Family caregivers were open to adopting smart home technology to support the independent living of their older adult family members. However, the readiness of family caregivers was inextricably linked to the older adults' readiness for smart home adoption. The family caregiver's primary concern was on how they could frame the idea of the smart home to overcome what they viewed as hesitancy to adopt in the older adult. The findings suggest that family caregivers endeavour to balance the hesitancy in their older adult family members with the potential benefits of smart home technology.

IMPACT

Family caregivers could benefit if their care-dependent older adults adopt smart home technology. Recognizing the role of caregivers and their perspectives on using smart home technologies with their care-dependents is critical to the meaningful design, use and adoption.

Piloting Smart Home Sensors to Detect Overnight Respiratory and Withdrawal Symptoms in Adults Prescribed Opioids

BACKGROUND

Novel strategies are needed to curb the opioid overdose epidemic. Smart home sensors have been successfully deployed as digital biomarkers to monitor health conditions, yet they have not been used to assess symptoms important to opioid use and overdose risks.

AIM

This study piloted smart home sensors and investigated their ability to accurately detect clinically pertinent symptoms indicative of opioid withdrawal or respiratory depression in adults prescribed methadone.

METHODS

Participants (n = 4; 3 completed) were adults with opioid use disorder exhibiting moderate levels of pain intensity, withdrawal symptoms, and sleep disturbance. Participants were invited to two 8-hour nighttime sleep opportunities to be recorded in a sleep research laboratory, using observed polysomnography and ambient smart home sensors attached to lab bedroom walls. Measures of feasibility included completeness of data captured. Accuracy was determined by comparing polysomnographic data of sleep/wake and respiratory status assessments with time and event sensor data.

RESULTS

Smart home sensors captured overnight data on 48 out of 64 hours (75% completeness). Sensors detected sleep/wake patterns in alignment with observed sleep episodes captured by polysomnography 89.4% of the time. Apnea events (n = 118) were only detected with smart home sensors in two episodes where oxygen desaturations were less severe (>80%).

CONCLUSIONS

Smart home technology could serve as a less invasive substitute for biologic monitoring for adults with pain, sleep disturbances, and opioid withdrawal symptoms. Supplemental sensors should be added to detect apnea events. Such innovations could provide a step forward in assessing overnight symptoms important to populations taking opioids.

SMART HOME DATA VISUALIZATION FOR PROACTIVE HEALTH MONITORING OF COMMUNITY DWELLING OLDER ADULTS

The role of Ambient Assistive Living and smart home technologies, which utilize unobtrusive sensors to detect changes in health, is becoming increasingly important in the delivery of healthcare services to older adults. However, these technologies must be designed to meaningfully incorporate into clinicians’ decision making. Research has shown when clinicians are engaged in the design process of smart home systems, the accuracy and efficacy of the systems are improved. We present the process undertaken by a team of nurse researchers and computer science engineers to design clinically meaningful behavior markers derived from smart home sensor data that can be used by nurses to proactively identify changes in patient status. During the first phase of design, nurse researchers qualitatively analyzed time series from smart home sensors installed in the homes of community dwelling older adults and identified patterns in these data related to significant health changes. From this analysis, we assembled a candidate list of 15 sensor-based behavior metrics, such as percent time spent in each room or frequency of bathroom use. During the second phase of design, we will build on lessons we learned from participatory design to create behavior markers and visualizations that are inspired by clinical experience. These include visualizing behavior change over time, highlighting behavioral anomalies at multiple time scales, and calculating markers that are not directly observable such as time spent out of home. Lessons learned from clinicians using the data visualizations to proactively screen for health changes in near real time will also be discussed.

Nurse-in-the-loop smart home detection of health events associated with diagnosed chronic conditions: A case-event series

Background

Telehealth and home-based care options significantly expanded during the SARS-CoV2 pandemic. Sophisticated, remote monitoring technologies now exist that support at-home care. Advances in the research of smart homes for health monitoring have shown these technologies are capable of recognizing and predicting health changes in near-real time. However, few nurses are familiar enough with this technology to use smart homes for optimizing patient care or expanding their reach into the home between healthcare touch points.

Objective

The objective of this work is to explore a partnership between nurses and smart homes for automated remote monitoring and assessing of patient health. We present a series of health event cases to demonstrate how this partnership may be harnessed to effectively detect and report on clinically relevant health events that can be automatically detected by smart homes.

Participants

25 participants with multiple chronic health conditions.

Methods

Ambient sensors were installed in the homes of 25 participants with multiple chronic health conditions. Motion, light, temperature, and door usage data were continuously collected from participants' homes. Descriptions of health events and participants' associated behaviors were captured via weekly nursing telehealth visits with study participants and used to analyze sensor data representing health events. Two cases of participants with congestive heart failure exacerbations, one case of urinary tract infection, two cases of bowel inflammation flares, and four cases of participants with sleep interruption were explored.

Results

For each case, clinically relevant health events aligned with changes from baseline in behavior data patterns derived from sensors installed in the participant's home. In some cases, the detected event was precipitated by additional behavior patterns that could be used to predict the event.

Conclusions

We found evidence in this case series that continuous sensor-based monitoring of patient behavior in home settings may be used to provide automated detection of health events. Nursing insights into smart home sensor data could be used to initiate preventive strategies and provide timely intervention.

Tweetable abstract

Nurses partnered with smart homes could detect exacerbations of health conditions at home leading to early intervention.

Factors influencing community-dwelling older adults' readiness to adopt smart home technology: A qualitative exploratory study

AIMS

Ageing-in-place for older people could be more feasible with the support of smart home technology. Ageing in-place may maximize the independence of older adults and enhance their well-being and quality of life, while decreasing the financial burden of residential care costs, and addressing workforce shortages. However, the uptake of smart home technology is very low among older adults. Accordingly, the aim of this study was to explore factors influencing community-dwelling older adults' readiness to adopt smart home technology.

DESIGN

A qualitative exploratory study design was utilized.

METHODS

Descriptive data were collected between 2019 and 2020 to provide context of sample characteristics for community-dwelling older adults aged ≥65 years. Qualitative data were collected via semi-structured interviews and focus groups, to generate an understanding of older adult's perspectives. Thematic analysis of interviews and focus group transcripts was completed. The Elderadopt model was the conceptual framework used in the analysis of the findings.

RESULTS

Several factors influenced community-dwelling older adults' (N = 19) readiness to adopt smart home technology. Five qualitative themes were identified: knowledge, health and safety, independence, security and cost.

CONCLUSION

Community-dwelling older adults were open to adopting smart home technology to support independence despite some concerns about security and loss of privacy. Opportunities to share information about smart home technology need to be increased to promote awareness and discussion.

IMPACT

Wider adoption of smart home technology globally into the model of aged care can have positive impacts on caregiver burden, clinical workforce, health care utilization and health care economics. Nurses, as the main providers of healthcare in this sector need to be knowledgeable about the options available and be able to provide information and respond to questions know about ageing-in-place technologies to best support older adults and their families.

Behavioral Differences Between Subject Groups Identified Using Smart Homes and Change Point Detection

With the arrival of the internet of things, smart environments are becoming increasingly ubiquitous in our everyday lives. Sensor data collected from smart home environments can provide unobtrusive, longitudinal time series data that are representative of the smart home resident's routine behavior and how this behavior changes over time. When longitudinal behavioral data are available from multiple smart home residents, differences between groups of subjects can be investigated. Group-level discrepancies may help isolate behaviors that manifest in daily routines due to a health concern or major lifestyle change. To acquire such insights, we propose an algorithmic framework based on change point detection called Behavior Change Detection for Groups (BCD-G). We hypothesize that, using BCD-G, we can quantify and characterize differences in behavior between groups of individual smart home residents. We evaluate our BCD-G framework using one month of continuous sensor data for each of fourteen smart home residents, divided into two groups. All subjects in the first group are diagnosed with cognitive impairment. The second group consists of cognitively healthy, age-matched controls. Using BCD-G, we identify differences between these two groups, such as how impairment affects patterns of performing activities of daily living and how clinically-relevant behavioral features, such as in-home walking speed, differ for cognitively-impaired individuals. With the unobtrusive monitoring of smart home environments, clinicians can use BCD-G for remote identification of behavior changes that are early indicators of health concerns.

Iterative Design of Visual Analytics for a Clinician-in-the-Loop Smart Home

In order to meet the health needs of the coming "age wave," technology needs to be designed that supports remote health monitoring and assessment. In this study we design clinician in the loop (CIL), a clinician-in-the-loop visual interface, that provides clinicians with patient behavior patterns, derived from smart home data. A total of 60 experienced nurses participated in an iterative design of an interactive graphical interface for remote behavior monitoring. Results of the study indicate that usability of the system improves over multiple iterations of participatory design. In addition, the resulting interface is useful for identifying behavior patterns that are indicative of chronic health conditions and unexpected health events. This technology offers the potential to support self-management and chronic conditions, even for individuals living in remote locations.

A conceptual framework for clinicians working with artificial intelligence and health-assistive Smart Homes

The Smart Home designed to extend older adults independence is emerging as a clinical solution to the growing ageing population. Nurses will and should play a key role in the development and application of Smart Home technology. Accordingly, conceptual frameworks are needed for nurse scientists who are collaborating with multidisciplinary research teams in developing an intelligent Smart Home that assists with managing older adults' health. We present a conceptual framework that is grounded in critical realism and pragmatism, informing a unique mixed methodological approach to generating, analyzing, and contextualizing sensor data for clinician-based machine learning. This framework can guide nurse scientists in knowledge construction as they participate in multidisciplinary health-assistive Smart Home and artificial intelligence research. In this paper, we review philosophical underpinnings and explicate how this framework can guide nurse scientists collaborating with engineers to develop intelligent health-assistive Smart Homes. It is critical that clinical nursing knowledge is integrated into Smart Home and artificial intelligence features. A conceptual framework and practical method will provide needed structure for knowledge construction by nurse scientists.

Using Smart City Technology to Make Healthcare Smarter

Smart cities use information and communication technologies (ICT) to scale services include utilities and transportation to a growing population. In this article we discuss how smart city ICT can also improve healthcare effectiveness and lower healthcare cost for smart city residents. We survey current literature and introduce original research to offer an overview of how smart city infrastructure supports strategic healthcare using both mobile and ambient sensors combined with machine learning. Finally, we consider challenges that will be faced as healthcare providers make use of these opportunities.

Reduced expression of the epidermal growth factor signaling system in preeclampsia

INTRODUCTION

The epidermal growth factor (EGF) signaling system regulates trophoblast differentiation, and its disruption could contribute to perinatal disease. We hypothesized that this pathway is altered in preeclampsia, a disorder associated with trophoblast apoptosis and failure to invade and remodel the uterine spiral arteries.

METHODS

Six EGF family peptides and a truncated EGF receptor splice variant (p110/EGFR) were examined using immunohistochemistry in the trophoblast of placentas (N = 76) from women with preeclampsia, and compared to placentas from women of similar gestational age (GA) with preterm labor (PTL) or small for gestational age (SGA) fetuses, as well as normal term placentas. EGF, transforming growth factor-α (TGFA), and heparin-binding EGF-like growth factor (HBEGF) were evaluated using ELISA in maternal plasma from another 20 pregnancies with or without preeclampsia. Cell death was evaluated in the HTR-8/SVneo human cytotrophoblast cell line using TUNEL to evaluate the protective effects of EGF peptides.

RESULTS

Trophoblast HBEGF, TGFA, and EGF were significantly reduced in preeclampsia compared to PTL and SGA, while p110/EGFR accumulated significantly on the surface of the chorionic villi (p < 0.05). Plasma EGF levels were significantly decreased in preeclamptic patients, compared to non-preeclamptic patients (p < 0.05). HBEGF, EGF, TGFA, epiregulin, and betacellulin each blocked cytotrophoblast cell death in vitro (p < 0.05).

DISCUSSION

Three members of the EGF family are dysregulated in placentas with preeclampsia, whereas p110/EGFR, a potential EGF receptor antagonist, is overexpressed. These findings are consistent with the concept that disruption of the EGF signaling system contributes to aberrant trophoblast development associated with preeclampsia.

Results of the ALEGRIA study in Luxembourg. An epidemiological, observational study to describe symptom impact and control in patients with GERD and an evaluation of the GERD Impact Scale

BACKGROUND AND STUDY AIMS

The aim of this observational study was to perform the first epidemiology study in a primary care patient population with GERD in the Grand Duchy of Luxembourg and to evaluate the added value of the GERD Impact Scale (GIS) patient questionnaire.

PATIENTS AND METHODS

152 Patients with symptoms of GERD from 20 study centers were included. At visit 1, demographic data including lifestyle factors and the patients' symptoms were recorded. GERD symptoms and their severity, treatment changes and the GIS were all assessed at baseline (visit 1), visit 2 (4-6 weeks) and visit 3 (8-14 weeks). Analyses were performed on an intent-to-treat basis.

RESULTS

142 patients were included in the analysis, which comprised 50% men and 50% women with a mean BMI of 27 kg/m2. Documented lifestyle factors included consumption of caffeine-containing beverages (87% of patients), stress (62%) and alcohol consumption (53%); 44% of patients were smokers or ex-smokers. The median duration of GERD was 2.0 years. Upon inclusion, 46% were receiving, or had received, proton pump inhibitors (PPIs), antacids (44%), H2-receptor antagonists (21%) or no treatment (21%). PPIs were prescribed at the first visit in the majority of cases (94%) with 75% of patients being prescribed esomeprazole with a median daily dose of 40 mg. The GIS score correlated well with the clinician's judgment of symptom severity and was reported to help determine the appropriate treatment and evaluate the patient's response in approximately 80% of patients.

CONCLUSIONS

In this, the first epidemiological study on GERD patients in the Grand Duchy of Luxembourg, data was obtained as planned. The novel patient questionnaire was judged to be helpful by the physician and data shows that the GIS may have an added value over current assessments.

Evaluation of culture media for Paenibacillus larvae applied to studies of antimicrobial activity

This study was conducted to compare different liquid culture media for Paenibacillus larvae growth in order to find the best one to be used in studies on activity of antimicrobial substances, such as essential oils. P. larvae presented poor growth in usual broths such as Mueller-Hinton, commonly employed in antimicrobial activity assays. Growth in liquid media was evaluated using Paenibacillus larvae strains isolated from hives located in different geographical zones. The MYT medium (Mueller-Hinton broth, yeast extract and thiamine) was selected out of the eight liquid media analyzed, as it proved to be the most adequate due to its higher absorbance at 620 nm. The following mean values were obtained from the four P. larvae strains: 0.227 +/- 0.016 for the Cobo strain, 0.279 +/- 0.015 for La Plata strain, 0.758 +/- 0.020 for Mechongué strain and 0.244 +/- 0.0079 for Sierra de los Padres strain, respectively.

[Antimicrobial activity of honey the southeast of Buenos Aires Province against Escherichia coli]

This study assessed the susceptibility of Escherichia coli to the antimicrobial activity of honeys by different techniques. Honeys used were from the southeast region of Buenos Aires province. In order to evaluate antimicrobial activity against Escherichia coli ATCC 25922, solutions containing 0, 1, 5, 10, 25 and 50% (w/v) of honey were prepared. Liquid media (Mueller-Hinton and Mac Conkey broths) were used to assess the Minimal Inhibitory Concentration (MIC) by the serial dilution test. The minimal bactericidal concentration (MBC) was determined by counting on nutritive and Mac Conkey agar. In addition, for the evaluation of total antibacterial activity, the agar diffusion method was used. A reduction of microbial growth of 96% in Mueller-Hinton broth and of 90% in Mac Conkey broth by honey solutions containing 50% and 25% (w/v), was respectively observed. The bactericide action of honey in nutritive agar proved negative. The MBC value in Mac Conkey agar was 25% (w/v) of honey. The methods used for measuring the antibacterial activity in the present work were adequate to prove that honeys are active against E. coli at 25 and 50% (w/v) concentrations. The results obtained by the dilution method with Mueller-Hinton broth and the agar diffusion method were both concordant.

[Inhibition of Paenibacillus larvae employing a mixture of essential oils and thymol]

In vitro antimicrobial activity of a mixture of two essential oils and thymol against Paenibacillus larvae, causal agent of American Foulbrood (AFB), was evaluated. The essential oils were extracted from cinnamon (Cinnamomum zeylanicum) and thyme (Thymus vulgaris). The third component used, thymol, is the major component of the essential oil of thyme which contains 39.9% of thymol. Minimal inhibitory concentration (MIC) in Mueller-Hinton broth by the tube dilution method and minimal bactericide concentration (MBC) on MYPGP agar were evaluated. Thyme registered MIC values of 150-250 microg/ml and MBC values of 200-300 microg/ml, while the MIC and MBC values obtained for cinnamon were of 50-100 microg/ml and 100-125 microg/ml. Thymol showed similar MIC and MBC values of 100-150 microg/ml. No significant differences between the bacterial strains were detected, but significant differences between essential oils and thymol activity were registered (P<0,01). An inhibitory synergetic effect on AFB was observed reducing MIC and MBC values due to the use of a mixture of 62.5% of thyme, 12.5% of cinnamon and 25% of thymol.

Separate sets of neurons of the central nucleus of the amygdala project to the substantia innominata and the caudal pontine reticular nucleus in the rat

The central nucleus of the amygdala (CeA) is generally regarded as a control nucleus of subcortical target systems. Due to its widespread projections to different brain areas it is able to modulate emotional behavior of the organism. However, it is still not clear whether single neurons of the CeA project to different areas or to one target area. Injections of the retrograde tracers Fluorogold and True Blue into target regions of the central nucleus of the amygdala, i.e., the substantia innominata (SI) and the caudal pontine reticular nucleus (PNC), revealed overlapping but otherwise distinct neuronal populations within mainly the medial division of the CeA. From our study we conclude that SI and PNC receive input from different subsets of amygdala neurons.

MICA, HLA-B haplotypic variation in five population groups of sub-Saharan African ancestry

The human major histocompatibility complex (MHC) class I chain-related gene A (MICA), located 46 kb centromeric to HLA-B, encodes a stress-inducible protein, which is a ligand for the NKG2D receptor. In addition to its primary role in immune surveillance, data suggest that MICA is involved in the immune response to transplants and in susceptibility to some diseases. In this study, 152 subjects from the Yoruba (n=74), Efik (n=32), and Igbo (n=46) tribes of southern Nigeria, 39 nationwide African-American stem cell donors, and 60 African-American individuals residing in the metropolitan Boston area were studied for MICA, HLA-B allelic variation, haplotypic diversity, and linkage disequilibrium (LD). MICA and HLA-B exhibited a high degree of genetic diversity among the populations studied. In particular, MICA allele and HLA-B-MICA haplotype frequencies and LD in the Efik and Igbo tribes were significantly different from the other study groups. HLA-B and MICA loci demonstrated significant global LD in all five populations (P-values &<0.00001). LD also varied in a haplotype-specific manner. A novel MICA allele was detected in the Boston population. These findings are important from an anthropologic perspective, and will inform future HLA-linked disease association studies in related ethnic groups of African-derived ancestry.

[Microbiological study of dehydrated garlic (Allium sativum L.) and onion (Allium cepa L.)]

A microbiological study during the process and the storage of garlic (Allium sativum L.) and onion (Allium cepa L.) dehydrated, with the additional barriers of blanching or brine immersion, was made. In all raw materials the average counts of aerobic mesophilic bacteria expressed in CFU/g ranged from 1.2 x 10(2) to 1.6 x 10(3), molds and yeasts from 60 to 1.6 x 10(3), Lactobacillus spp. and Leuconostoc mesenteroides subsp. mesenteroides between 10 and 50. Microorganisms identified were Penicillium spp., Monilia spp., Lactobacillus brevis, Leuconostoc mesenteroides subsp. mesenteroides and yeasts in garlic; Mucor spp., Penicillium spp., Monilia spp., Lactobacillus brevis and yeasts in both types of onions. Leuconostoc mesenteroides subsp. mesenteroides was detected in only kind of onion. In dehydrated garlic storage, Penicillium spp., Monilia spp., Lactobacillus brevis and yeasts were detected. In garlic, when a blanching step was carried out no microflora was detected. Mucor spp., Penicillium spp., Monilia spp. and Lactobacillus brevis were identified in both types of dehydrated onions. When brine immersion was included the microflora detected was significantly lower and only Penicillium spp. were found. The use of additional barriers such as blanching or brine immersion produces an important effect on the microbiological stability in these products.

Enlarged spinoglenoid notch veins causing suprascapular nerve compression

OBJECTIVE

To report the magnetic resonance (MR) imaging findings of enlarged veins in the spinoglenoid notch as a cause of suprascapular nerve compression.

DESIGN AND PATIENTS

Six patients presented to MR imaging for evaluation of chronic shoulder pain. Clinical information and MR imaging studies were reviewed. The spinoglenoid notch vascular structures were compared with measurements made in 10 age-matched controls.

RESULTS

Spinoglenoid notch vascular structures measured in 10 asymptomatic age-matched control patients ranged from 1 to 4 mm in diameter with an average of 2.2 mm. The six study patients had vascular structures that ranged from 6 to 10 mm in diameter with an average of 8.4 mm. Atrophy and fatty infiltration of the infraspinatus muscle was noted as an associated finding at MR imaging in all six patients. Surgery was performed in three of the six patients, at which time a venous varix was identified in the spinoglenoid notch in all three patients.

CONCLUSION

We describe distended veins in the spinoglenoid notch. These may be readily apparent at MR imaging and should be distinguished from paralabral ganglion cysts compressing the suprascapular nerve in the absence of labral tears, especially if percutaneous aspiration of a ganglion cyst is entertained.

The myelin basic protein gene is expressed in differentiated blood cell lineages and in hemopoietic progenitors

Myelin basic proteins (MBP) are major constituents of the myelin sheath of oligodendrocytes and Schwann cells in the central nervous system and the peripheral nervous system, respectively. We previously showed that MBP-related transcripts are present in the bone marrow and the immune system. These mRNAs are transcribed from a region called 0', consisting of three exons, located upstream of the classical MBP exons; these three exons belong to the long MBP gene otherwise called "Golli-MBP." The most abundant of these mRNAs, now called HMBP (hemopoietic MBP), encompasses the sequence encoded by the region 0' plus exon 1 and part of intron 1 of the classic MBP gene. Antisera to recombinant HMBP proteins are immunoreactive with proteins of about 26-28 kDa in brain, thymus, and spleen. This report demonstrates that HMBP proteins are present in the vast majority (>95%) of thymic T cells, which express the corresponding transcripts, as do mature T cells from lymph nodes and spleen. HMBP mRNAs and proteins are also manifest in the majority of spleen B lymphocytes and in B cell lines. In addition to lymphoid cells, HMBP proteins are in all types of myeloid lineage cells, i.e., macrophages, dendritic cells, and granulocytes, as well as in megakaryocytes and erythroblasts. Finally, HMBP proteins are present in CD34+ bone marrow cells, and, furthermore, in highly proliferative cultures, these CD34+ cells express HMBP RNAs and proteins. Thus, MBP gene products are present both in the nervous system and in the entire hemopoietic system.

Determination of benzoyl peroxide and benzoic acid levels by HPLC during wheat flour bleaching process

Freshly milled wheat flour has a pale yellow color due to its carotenoids content. Benzoyl peroxide is a bleaching agent typically used to give such flour a better appearance. This free-radical initiator promotes carotenoids oxidation, thereby producing less colored compounds, and benzoic acid is a main final product. Samples of wheat flour were treated with 150 ppm of benzoyl peroxide to begin a bleaching process, and then subjected to ethyl ether extraction at different intervals of time. Benzoyl peroxide and benzoic acid levels in these extracts were monitored by means of HPLC in individual experiences. The resulting concentration of benzoyl peroxide after 9 days of contact with the bleaching agent was 11 ppm, dropping afterward to nondetectable levels. A maximum value for benzoic acid of 16 ppm was found after 12 h of bleaching. Subsequently this level decreased continuously until reaching a residual value of 6 ppm after 3 months.

Local and systemic cytokine responses during experimental human influenza A virus infection. Relation to symptom formation and host defense

To further understand the role of cytokine responses in symptom formation and host defenses in influenza infection, we determined the levels of IL-1beta, IL-2, IL-6, IL-8, IFN-alpha, TGF-beta, and TNF-alpha in nasal lavage fluid, plasma, and serum obtained serially from 19 volunteers experimentally infected with influenza A/Texas/36/91 (H1N1) and correlated these levels with various measures of infection and illness severity. We found that IL-6 and IFN-alpha levels in nasal lavage fluids peaked early (day 2) and correlated directly with viral titers, temperature, mucus production, and symptom scores. IL-6 elevations were also found in the circulation at this time point. In contrast, TNF-alpha responses peaked later (day 3 in plasma, day 4 in nasal fluids), when viral shedding and symptoms were subsiding. Similarly, IL-8 peaked late in the illness course (days 4-6) and correlated only with lower respiratory symptoms, which also occurred late. None of IL-1beta, IL-2, or TGF-beta levels increased significantly. These data implicate IL-6 and IFN-alpha as key factors both in symptom formation and host defense in influenza.

Hematopoietic bone marrow in the adult knee: spin-echo and opposed-phase gradient-echo MR imaging

Hematopoietic bone marrow in the distal femur of the adult may be mistaken for a pathologic marrow process in magnetic resonance imaging of the knee. We investigated the incidence of hematopoietic marrow in the distal femur in a series of 51 adult patients and compared spin-echo (TR/TE in ms: 500/35, 2000/80) and opposed-phase gradient-echo (0.35 T, TR/TE in ms: 1000/30, theta = 75 degrees) magnetic resonance images. Zones with intermediate to low signal intensity on T1-weighted spin-echo and opposed-phase gradient-echo sequences representing hematopoietic marrow within high signal intensity fatty marrow were observed in 18 of the 51 patients. Five patterns of marrow signal reduction were identified; type 0: uniform high signal, i.e., no signal change; type I, focal signal loss; type II, multifocal signal loss without confluence; type III, confluent signal loss; and type IV, complete homogeneous reduction in marrow signal. Opposed-phase gradient-echo sequences demonstrated markedly greater red-yellow marrow contrast than conventional spin-echo sequences. Follow-up studies in three patients using a gradient-echo sequence with TE varying from 10 to 21 ms at 1-ms increments showed a cyclic increase and decrease in red and yellow marrow signal intensity depending on the TE. The contribution of intravoxel chemical shift effects on red-yellow marrow contrast in opposed-phase gradient-echo images was verified by almost complete cancellation of the TE-dependent marrow signal oscillation with use of a chemically selective pulse presaturating the water protons. Hematopoietic marrow in the adult distal femur in the absence of hematologic abnormalities is found primarily in women of menstruating age.(ABSTRACT TRUNCATED AT 250 WORDS)

[Residual and reconverted hematopoietic bone marrow in the distal femur. Spin-echo and opposed-phase gradient-echo MRT]

The distal femur contains usually only fatty marrow in the adult. We investigated the incidence of areas of residual and reconverted hematopoietic marrow in the distal femur in a series of 50 adult patients using conventional spin-echo and opposed-phase gradient-echo MR images. Zones with intermediate to low signal intensity in both sequences representing hematopoietic marrow within high signal intensity fatty marrow were observed in 17 of the 50 patients. Opposed-phase gradient-echo sequences demonstrated significantly greater red-yellow marrow contrast than conventional spin-echo sequences. Residual red marrow may represent a biologic variation of the normal adult pattern of red-yellow marrow distribution in women of menstruating age. Reconverted red marrow appears to be related to increased erythrocyte demand. It should not be mistaken for bone marrow malignancy. Absence of epiphyseal involvement, cortical destruction and soft-tissue mass in residual and reconverted hematopoietic marrow are helpful differential criteria.

Gastric H,K-ATPase topography: amino acids 888-907 are cytoplasmic

Gastric acidification is mediated by H,K-ATPase, an integral protein of apical membranes of gastric parietal cells. Hydropathy analysis of H,K-ATPase alpha subunit primary structure predicts eight transmembrane (TM) domains, while omeprazole-binding data were interpreted in terms of ten TM domains (Mercier et al. (1991) FASEB J. 5, A749). In the present study, tryptic hydrolysis of gastric mucosal microsomes gave a set of peptides which bound the monoclonal antibody HK 12.18, a highly specific probe of the H,K-ATPase. An antiserum against the C-terminus of H,K-ATPase alpha subunit bound the same peptides, and one smaller peptide. The binding data suggested a putative epitope for HK 12.18, and a 20-mer peptide encompassing this site was synthesized. This peptide bound directly to HK 12.18, displaced HK 12.18 from microsomal H,K-ATPase, and blocked HK 12.18 immunostaining of gastric parietal cells. In addition, intact gastric microsomes competitively inhibited binding of HK 12.18 to peptide-BSA conjugate. Taken together, these data place the HK 12.18 epitope between amino acids 888-907 and identify this domain as cytosolic. This result specifically excludes a pair of TM domains between the sixth and seventh TM alpha helices of the H,K-ATPase and supports a secondary structure model with eight TM domains.

Behaviour studies of the fungicide cymoxanil in two strains of the fungus Botrytis cinerea and in haemolymph of locust and lobster. I. In situ monitoring by internal surface reversed-phase high-performance liquid chromatography

A method for following the metabolism of the fungicide cymoxanil in various biological media is described. By using a recently developed high-performance liquid chromatographic method, with an internal surface reversed-phase column, it is unnecessary to clean up the sample before analysis. Thus this technique makes monitoring in fungi as well as in arthropod haemolymph easier and faster.