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Five years of trapping uredospores in rain samples resulted in their detection on an average of 22 days earlier than in the impaction traps, and 36 days before the first appearance of stem rust on a susceptible cultivar. On many occasions the presence of uredospores in rain samples was not followed by the occurrence of wheat rust in the field. [ABSTRACT FROM AUTHOR]

The effect of climatic warming on the dehardening potential of bilberry (Vaccinium myrtillus L.) in a northern boreal environment (65 deg.N) was studied. Natural stands of bilberry were heated artificially in winter. No reference point for the heating was set, since the purpose was to follow the fluctuations in ambient air temperatures. Thesewere 2--3 deg.C higher in the heated plots than in the control plotsfrom October to May. Frost resistance (LT50) and the pH of cell effusate were monitored throughout. Bud phenology was assessedin May and related to various biochemical analyses, including glucose, fructose, sucrose, starch and total and reduced glutathione. Frostresistance started to decrease earlier in the heated plants, as did the pH of the cell effusate. Bud phenology was in accordance with theLT50 and pH results, since new growth had emerged in the heated plants by the beginning of May, when the controls still displayed dormancy. Concentrations of glucose, fructose and sucrose were significantly lower in the heated bilberries while concentrations of starch were higher. The heated plants also exhibited the lowest glutathione concentrations, but the difference was only marginal. The redox state of glutathione showed no difference between the treatments. Theresults suggest that a small elevation in air temperature can accelerate dehardening in the bilberry. It is thus concluded that climatic warming may entail a real risk of early dehardening and further frostdamage for the bilberry. [ABSTRACT FROM AUTHOR]

Background: The few previous studies that have estimated the incidence of cerebral cavernous malformations (cavernomas) have reported incidence rates of 0.2-1.9/100,000 for diagnosed cavernomas. Our aim was to describe incidence trends of cavernomas by clinical presentation., Methods: We conducted a retrospective cohort study of cavernomas diagnosed at two university hospitals in Finland (Kuopio University Hospital, KUH and Tampere University Hospital, TAUH). Cavernoma diagnoses during 2004-2020 were identified from the KUH and TAUH Care registry databases and verified from medical records and diagnostic imaging studies. We calculated the age-standardized incidence rates using the European standard population and analysed incidence trend and changes in trend by sex, age group, and calendar year using Poisson regression., Findings: A total of 669 cavernoma diagnoses were identified during 2004-2020 in the combined KUH and TAUH population. The age-standardized incidence rate was 2.01/100,000 (95% confidence interval (CI) 1.85-2.16) for all cavernoma diagnoses, 1.25/100,000 (1.13-1.37) for asymptomatic, 0.75/100,000 (0.66-0.85) for symptomatic, and 0.46/100,000 (0.39-0.53) for ruptured cavernomas. No significant difference in the incidence of cavernoma diagnoses was seen between the KUH and TAUH populations or between the sexes. Incidence of cavernomas was highest at ages 40-59 years and low in those under 20 or over 80 years of age. Incidence of diagnosed cavernomas, especially asymptomatic, increased during the study period., Interpretation: In our population-based study, incidence of cavernomas was higher than previously reported and increased during the study period. The burden imposed by cavernomas on healthcare system is considerable and increasing., Funding: The Research Council of Finland, Kuopio University Hospital, Tampere University Hospital, and Wellbeing services county of Pirkanmaa., Competing Interests: Authors declare no competing interests. Dr. Halmela has received a travel grant from the State funding for university-level health research, Tampere University Hospital, Wellbeing services county of Pirkanmaa, in order to present part of this work at the 2024 annual meeting of the Scandinavian Neurosurgical Society in Aalborg, Denmark. Dr. Auvinen has received research grants for a prostate cancer screening trial from the following sources: Cancer Foundation Finland, Sohlberg Fooundation, and State funding for university-level health research, Tampere University Hospital, Wellbeing services county of Pirkanmaa. Dr. Auvinen has also received a travel grant from the European Society of Urology, and is a board member for the Finnish Society of Epidemiology, for the PRAISE-U study, for the ProBase trial, and the UN committee UNSCEAR. Dr. Frösen has received research grants from The Research Council of Finland (Academy of Finland, Clinical Investigator grant), from the Kuopio University Hospital, and by State funding for university-level health research, Tampere University Hospital, Wellbeing services county of Pirkanmaa. In addition, Dr. Frösen has received travel grants to participate to the ARISE I consensus meeting in May 2023 in Arlington, VA, USA and the ARISE II consensus meeting in May 2024 in Washington D.C., USA., (© 2024 The Authors.)

Background: Interstitial lung diseases (ILD) include a wide range of diseases impacting lung parenchyma and leading to fibrosis and architectural distortion. Chronic cough and dyspnea are common symptoms which affect the quality of life (QoL) in ILD patients. The mechanisms of cough in ILD patients are still unknown. The aim of this study was to prospectively investigate histological, radiological, and physiological determinants of cough-related QoL in ILD patients who underwent transbronchial lung cryobiopsy (TBLC)., Methods: All patients (n = 111) filled in The Leicester Cough Questionnaire (LCQ) and The St George's Respiratory Questionnaire (SGRQ). They underwent lung function tests, forced vital capacity (FVC), forced vital expiratory volume in 1 s (FEV1), diffusion capacity to carbon monoxide (DLCO), high-resolution computed tomography (HRCT), and blood samples before diagnostic TBLC. Two experienced radiologists assessed the extents of following HRCT patterns: ground-glass opacities (GGO), honeycombing, reticulation, traction bronchiectasis, and emphysema. Histology of TBLC were re-analyzed by two experienced pulmonary pathologists and the presence of fibroblast foci, fibrosis, giant cells, granulomas, and honeycombing were recorded., Results: In the median multivariate regression analysis, BMI (-0.19; 95% CI -0.37- -0.014; p 0.035), GGO (-0.38; 95% CI -0.61- -0.15; p 0.001), granulomas (-3.21; 95% CI -6.12- -0.30; p 0.031), and current smoking (2.49; 95% CI 0.12-4.86; p 0.040) showed independent associations with LCQ total score. BMI (1.3; 95% CI 0.20-2.42; p 0.021) and DLCO (-0.51; 95% CI -0.85 - -0.16; p 0.004) showed independent association with SGRQ total score., Conclusion: Determinants of cough-related QoL in ILD patients are multifactorial including physiological, radiological and histological parameters., (© 2024. The Author(s).)

Background: Most patients with idiopathic pulmonary fibrosis (IPF) complain of cough. IPF-associated cough is widely characterized as dry or non-productive. The aim of this study was to compare chronic cough in early stage IPF patients to cough in subjects with chronic cough from a community-based sample and, especially, to investigate whether cough in IPF is less productive than chronic cough in a community-based sample., Methods: The IPF cough population consisted of 46 biopsy-confirmed patients who complained of chronic cough. Control population consisted of subjects with chronic cough, gathered by a community-based email survey sent to public service employees and the Finnish Pensioners' Federation. A case-control setting was applied by having four age, gender, and smoking-status matched subjects from the community sample for each IPF cough patient. A cough specific quality of life questionnaire (Leicester Cough Questionnaire (LCQ)) was filled in by all subjects. The LCQ questionnaire contains 19 questions, each question is scored from 1 to 7 and total score from 3 to 21 with a smaller value indicating more severe impairment., Results: The sputum production frequency, as assessed by LCQ question 2, was 5.0 (3.0-6.0) in the IPF chronic cough population and 5.0 (3.0-6.0) in the community-based chronic cough population (median and interquartile range p= 0.72). The LCQ total score was 14.8 (11.5-18.1) in the IPF chronic cough population and 15.4 (13.0-17.5) in the community-based chronic cough population (p=0.76). The domain impact scores were physical, 4.9 (3.9-6.1) vs. 5.1 (4.5-5.6) (p=0.80); psychological, 4.6 (3.7-5.9) vs. 4.7 (3.9-5.7) (p=0.90); and social, 5.5 (3.7-6.5) vs. 5.5 (4.5-6.3) (p=0.84), respectively. Furthermore, cough response to paint or fumes, cough disturbing sleep, and cough frequency per day did not differ between the groups., Conclusion: Cough in early stage IPF patients was not distinguishable from chronic cough in the community-based population by LCQ. Especially, there was no difference in the self-reported frequency of cough-associated sputum production., (© 2023. The Author(s).)

Elderly care practitioners are at specific risk of experiencing prolonged moral distress, which is associated with occupational health-related problems, low job satisfaction, and staff turnover. So far, little attention has been paid to the moral concerns specific to elderly care, a field whose importance is constantly growing as the populations in Western countries age. By drawing on seven workshop conversations as data and interaction-oriented focus group research, conversation analysis and discursive psychology as methods, we aim to study the ways in which elderly care practitioners discuss moral distress in their work. We found that the moral distress experienced was related to three topics that arose when client work and teamwork contexts were discussed: the power to influence, equal treatment of people, and collaboration. The interaction in client work and teamwork contexts differed systematically. The discussion on client work was characterised by negotiations on the rights and wrongs of care work, whereas the teamwork discussion engendered emotional outbursts, a potential manifestation of work-related burnout. Hence, attempts to improve the work-related health of elderly care practitioners require time and space for sharing the emotional load, followed by reflection on what could be improved in the work and what institutional solutions could help in morally distressing situations.

Background: The disease course of idiopathic pulmonary fibrosis (IPF) is progressive and occasionally, other types of interstitial lung disease (ILD) may progress similarly to IPF. This study aimed to evaluate risk factors for disease progression within 24 months in patients with various ILDs., Methods: This prospective study obtained 97 patients with a suspected ILD who underwent a transbronchial lung cryobiopsy. The extent of several high-resolution computed tomography (HRCT) patterns was assessed. Due to the inclusion criteria the study population presented a low extent of honeycombing and definite usual interstitial pneumonia (UIP) pattern on HRCT suggesting an early stage of ILD. Disease progression within 24 months despite treatment was defined as a relative decline of ≥ 10% in forced vital capacity (FVC), or a relative decline in FVC of ≥ 5% and one of the three additional criteria: (1) a decline in diffusion capacity to carbon monoxide (DLCO) ≥ 15%; (2) increased fibrosis on HRCT; (3) progressive symptoms, or progressive symptoms and increased fibrosis on HRCT. The same definition was utilized in patients with IPF and other ILDs. Risk factors for disease progression were evaluated in a multivariable logistic regression model., Results: Disease progression was revealed in 52% of the patients with ILD, 51% of the patients with IPF, and 53% of the patients with other types of ILD. A high extent of reticulation on HRCT (Odds ratio [OR] 3.11, 95% Confidence interval [CI] 1.21-7.98, P = 0.019) and never smoking (OR 3.11, CI 1.12-8.63, P = 0.029) were associated with disease progression whereas platelet count (OR 2.06 per 100 units increase, CI 0.96-4.45, P = 0.065) did not quite reach statistical significance., Conclusion: Higher extent of reticulation on HRCT and never smoking appeared to associate with the risk of disease progression within 24 months in ILD patients without honeycombing. Approximately half of the patients with ILD revealed disease progression, and similar proportions were observed in patients with IPF and in other types of ILD., (© 2022. The Author(s).)

Background: The use of a transbronchial lung cryobiopsy (TBLC) is increasing as a diagnostic method of interstitial lung diseases (ILD). This study aimed to evaluate risk factors associated with clinically significant complications of TBLC in ILD patients., Methods: Patients referred to Kuopio or Tampere university hospitals, in Finland, for a suspected ILD were included. The TBLC was performed in an outpatient setting for 100 patients. Patients were mechanically ventilated in general anesthesia. Fluoroscopy guidance and prophylactic bronchial balloon were used. Complications, such as bleeding, pneumothorax, infections, and mortality were recorded. Moderate or serious bleeding, pneumothorax, or death ≤90 days were defined as clinically significant complications. A multivariable model was created to assess clinically significant complications., Results: The extent of traction bronchiectasis (Odds ratio [OR] 1.30, Confidence interval [CI] 1.03-1.65, p = 0.027) and young age (OR 7.96, CI 2.32-27.3, p = 0.001) were associated with the risk of clinically significant complications whereas the use of oral corticosteroids ≤30 days before the TBLC (OR 3.65, CI 0.911-14.6, p = 0.068) did not quite reach statistical significance. A history of serious cough was associated with the risk of pneumothorax (OR 4.18, CI 1.10-16.0, p = 0.036). Procedure associated mortality ≤90 days was 1%., Conclusion: The extent of traction bronchiectasis on HRCT and young age were associated with the risk of clinically significant complications whereas oral corticosteroid use did not quite reach statistical significance. A history of serious cough was associated with the risk of clinically significant pneumothorax., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: There is some previous evidence suggesting that the risk state for psychosis is associated with decreased functioning ability, health-related quality of life (QoL), anxiety and depression. The aim of this study is to identify which factors predict psychosis risk screening status., Methods: The data were collected in Helsinki University Central Hospital, Finland, by an early intervention team. One hundred eighty-one help-seeking adolescents (mean age 15.3 years) completed questionnaires of QoL (16D), alcohol consumption (Alcohol Use Disorders Identification Test), anxiety (Beck Anxiety Inventory), hopelessness (BBeck Hopelessness Scale) and depression (Beck Depression Inventory II). Functioning ability was assessed by the Global Assessment of Functioning, whereas the PROD-screen was used to interview and assess risk symptoms for psychosis., Results: In a logistic regression analysis, a lower functioning ability explained independently (P = 0.006) psychosis risk screening status after age, gender, alcohol consumption, QoL, anxiety, hopelessness and depression symptoms were adjusted., Conclusions: The present results suggest that lower functioning ability is associated independently with psychosis risk screening status. Hence, therapeutic input for those at risk should focus upon improving functioning., (© 2014 Wiley Publishing Asia Pty Ltd.)

Background: Several studies have reported on how anxiety disorders and anxiety symptoms are already present before the onset of psychosis. However, anxiety disorders are typically studied in these studies at diagnosis-level. The aim of present study was to investigate the profile of anxiety symptoms in subjects at risk of developing psychosis and to compare the anxiety profile with those who are not at risk., Method: Data were collected at Helsinki University Central Hospital (HUCH) by an early detection and intervention team. Of 185 help-seeking respondents, between 12 and 18 years of age, 59 adolescents were classified as being at risk of psychosis and 126 as not being at risk via an interview conducted by a validated at-risk assessment tool (PROD). Anxiety was measured using the Beck Anxiety Inventory (BAI)., Results: The anxiety total sum score was higher in the at-risk group for psychosis (mean 8.33 vs. 13.34, p = .000). Both subfactors of the anxiety scale, cognitive anxiety (p = .000) and somatic anxiety (p = .000), differed significantly by risk status. After using the Bonferroni correction for multiple analysis, items of relax (p = .000), nervous (p = .002), losing control (p = .000) and faint (p = .002) had statistically significant higher mean scores in the group at risk of psychosis. In logistic regression analysis, being female (p = .015) and the subfactor relating to cognitive anxiety (p = .044) significantly explained the at-risk status for psychosis., Conclusions: Adolescents at risk for psychosis have a higher level of anxiety compared with other help-seeking adolescents. These results should be considered in clinical practice., (© 2012 The Authors. Child and Adolescent Mental Health. © 2012 Association for Child and Adolescent Mental Health.)

Aim: Schizophrenia is a severe illness associated with poor health-related quality of life (HRQoL), and there is some evidence that a risk state for psychosis is associated with decreased HRQoL. The aim of the present study was to investigate group differences in HRQoL in help seekers at risk for psychosis and not at risk for psychosis., Methods: The data were collected by a Finnish early detection and intervention team at Helsinki University Central Hospital. A total of 202 help-seeking adolescents (110 girls, 92 boys; 11-22 years of age) were assessed with a PROD screen and HRQoL scale of 16D., Results: As the main result, subjects at risk for psychosis had a poorer HRQoL index than other help seekers (P < 0.001). An additional analysis of sub-items for the HRQoL at-risk group had poorer mean scores at a statistically significant level after Bonferroni correction for multiple tests in the following sub-items: vitality (P = 0.016), distress (P = 0.016), physical appearance (P < 0.001), school and hobbies (P = 0.016), friends (P = 0.048), mental function (P < 0.001) and depression (P < 0.001). In a logistic regression analysis of sub-items of the HRQoL scale, lower scores in the sub-item of mental function independently explained the at-risk status for psychosis (P = 0.009)., Conclusions: Adolescents at risk for psychosis have a poorer HRQoL index than other help seekers and they also differ in several sub-items, particularly in the lower scores in mental function. In the future, these findings should be considered in the care of adolescents at risk for psychosis., (© 2013 Wiley Publishing Asia Pty Ltd.)

Background: Little is known about how symptoms are changed in adolescents who receive treatment in an early detection and intervention service., Aims: The aims of the present research were to study change in depression, anxiety and hopelessness symptoms in a sample of help-seeking adolescents who participated in a community- and family-oriented early intervention programme., Methods: The data was collected in Helsinki University Central Hospital (HUCH), Finland, by the JERI (Jorvi Early psychosis Recognition and Intervention) early intervention team; 85 help-seeking adolescents filled questionnaires of anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory II) and hopelessness (Beck Hopelessness Scale). The PROD screen was used to assess risk of psychosis., Results: Paired samples t-test of anxiety, depression and hopelessness showed statistically significant improvement on all scales (P < 0.001) in all participants (n = 85) between baseline and the end of intervention. Improvement was significant on scales of anxiety (P = 0.004), depression (P < 0.001) and hopelessness (P < 0.001) for participants at risk of psychosis (n = 34). Effect sizes were from medium to large for changes. After the treatment, of all participants, 68.8% were at a remission level of symptoms in anxiety, 84.7% in symptoms of depression and 88.2% in symptoms of hopelessness. Of sub-group of participants at risk of psychosis, 58.8% were at a remission level of symptoms in anxiety, 76.4% in symptoms of depression and 79.4% in symptoms of hopelessness., Conclusions: Present results suggest that there is both statistically and clinically remarkable improvement in anxiety, depression and hopelessness symptoms after the intervention. These findings should be considered in the psychiatric care of help-seeking adolescents and adolescents at risk of psychosis.

Abstract Objective. Early intervention has been shown to benefit people at-risk for psychosis, but knowledge about how early intervention benefits all help-seeking adolescents is lacking. The aim of the present study was to study change in health-related quality of life (QoL) and functioning ability in help-seeking adolescents who participate in a community- and family-oriented early intervention program. Methods. The data was collected in Finland by an early-intervention team. Ninety help-seeking adolescents between 12 and 21 years of age filled out a questionnaire on QoL (16D) and functioning ability (GAF), which was assessed by workers at the beginning and at the end of the intervention. A PROD screen was used to assess heightened risk of developing psychosis. Results. QoL and functioning ability showed significant differences (p < 0.001) between the beginning and the end of the intervention, as well in a subgroup of participants at heightened risk of developing psychosis (QoL, p = 0.008; GAF, p < 0.001: n = 35). 35.6% improved over the clinical cut-off point in functioning ability and 48.6% of the subjects at-risk. 53.3% reached clinically significant improvement in QoL and 54.2% of the subjects at heightened risk of developing psychosis. Conclusions. The results suggest that there is both statistically and clinically remarkable improvement in QoL and functioning ability after a need-adapted, family- and community-oriented intervention.

Background: Hopelessness has been a widely studied phenomenon in psychotic disorders. However, previous evidence of hopelessness in at-risk state of psychosis is lacking. The primary aim of the present study was to investigate associations between at-risk state of psychosis and the level of hopelessness, the secondary aim being to investigate, at item-level, hopelessness differences in hopelessness profile of adolescents at risk of psychosis., Methods: Hopelessness was assessed with the Beck Hopelessness Scale (BHS) and risk of psychosis with the PROD screen by an early detection team at the Helsinki University Central Hospital in a sample of 200 help-seeking adolescents between 11 and 22 years of age. Of them, 66 were classified as belonging to the at-risk of psychosis group and 134 to the not-at-risk of psychosis group., Results: The at-risk group scored higher in total sum scores of hopelessness than the not-at-risk group (9.15 vs. 6.63, P = 0.002). In an additional analysis of the BHS, the sub-item "I have great faith in the future" (P < 0.001) differed by risk status of psychosis after correction for multiple analysis. In a logistic regression analysis, BHS subfactor III (sum scores of items "I can't imagine what my life would be like in 10 years" and "I don't expect to get what I really want") explained (P = 0.047) the at-risk status of psychosis after age, gender and other BHS subfactors had been adjusted for., Conclusions: Adolescents at risk of psychosis have higher hopelessness than other help-seekers. In light of a heightened possibility of suicidal behaviour, psychiatric care should pay attention to these findings.

Background: Depression and psychosis are severe diseases with onset in adolescence., Aims: The aim of this study was to investigate the association between an at-risk status of psychosis and depression symptoms in adolescents., Method: The data were collected by an early intervention team in Finland. The PROD screen was used to assess the risk of psychosis, and Beck Depression Inventory-II was used as a measurement to assess the level of depression symptoms. Of 203 help-seeking respondents, 66 were classified as at-risk for psychosis, and 137 respondents were other help-seekers. The mean age of the subjects was 15.3 years., Results: Subjects at-risk had significantly poorer scores in total scores for depression (p  <  0.001), and in an item-by-item analysis, the subjects at-risk had poorer scores for sadness (p  <  0.001), past failure (p  =  0.001), suicidal thoughts (p  <  0.001), crying (p  =  0.002), agitation (p  =  0.001), loss of energy (p  =  0.002) and concentration difficulty (p  <  0.001). In a logistic regression analysis of items that differed by risk status for psychosis, item of concentration difficulty (p  =  0.038) explained the at-risk status after adjustment for sex., Conclusions: The present results suggest that subjects that are at-risk for psychosis have more depression symptoms than other help-seekers. This should be considered in the psychiatric care of adolescents.

Interlaboratory comparisons for the analysis of mineral oil in polluted soil using the GC-FID method indicate that extraction and cleanup conditions have significant effects on the analytical results. In this investigation a ruggedness test was performed on the extraction and cleanup method for the determination of total petroleum hydrocarbons in soil. A two-level Plackett-Burman design was utilized to study the effect of 11 different method parameters on the extraction recovery of total petroleum hydrocarbons (TPH) in soil. Both qualitative and quantitative factors were investigated. The results indicate that total petroleum hydrocarbons can be relatively reliably monitored through strict implementation of the ISO and CEN draft standards. However, variation in certain method parameters readily affects the validity of the results. The most critical factors affecting TPH recovery were the solvent and co-solvent used for extraction, the extraction time, adsorbent and its weight and sample TPH concentration. Because adaptation of the draft standards especially with respect to these factors easily leads to TPH recoveries higher than 200% or lower than 70%, the validity of the adapted method should always be verified. A proper estimate of the expanded uncertainty should also be appended to TPH results, because only then can the reliability of the results be guaranteed and further justification is gained to support the end-use of the data. This also supports the credibility of the analytical services and prevents the data end-users from drawing misleading conclusions concerning the environmental risks and potential remediation requirements.

Sorbitol plus myo-inositol, betaine and glycerophosphorylcholine (GPC) are cellular osmolytes in the mammalian renal medulla. Galactosemia and hyperglycemia can cause excessive levels of galactitol or sorbitol in several organs via aldose reductase (AR) catalysis. AR inhibitors can reduce these polyols. To examine osmolyte responses to polyol perturbations, male Wistar rats were fed normal diet, the AR inhibitor sorbinil (at 40 mg/kg/d), 25% galactose, or a combination, for 10, 21 and 42 days. All animals at 21 days had higher apparent renal AR activity than at 10 or 42 days, possibly providing resistance to sorbinil. Sorbinil feeding alone tended to increase urinary, plasma and renal urea levels. It reduced AR activity and sorbitol contents in renal inner medulla, though less so at 21 days; other renal osmolytes, especially betaine, were elevated. Galactose feeding caused little change in renal AR activity, and resulted in high galactose and galactitol contents in renal medulla, urine, blood and lens (and higher renal Na+ contents at 10 days). Renal sorbitol, inositol and GPC decreased, while betaine contents trended higher at all times. Sorbinilgalactose feeding reduced renal AR activities and galactitol contents (again less so at 21 days), urine, blood and lens galactitol, and further reduced renal sorbitol contents. At 10 and 21 days it tended to raise renal betaine more, and restore inositol (but not GPC) contents to control levels. At 42 days it reduced renal and urinary Na+ and galactose, and decreased renal betaine to control levels. Under most conditions, total renal (non-urea) organic osmolyte contents (presumed to be mostly intracellular) and Na+ plus galactose contents (presumed mostly extracellular) changed together such that cell volumes may have been maintained. The exception was 10 days on galactose, where total osmolytes appeared too low. In galactose-fed animals, urine/plasma ratios suggest some renal galactitol efflux, and cellular galactitol probably helps maintain osmotic balance rather than cause swelling.