***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: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted  fever response  ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " blunted " fevers ( Tmax less than 101 degrees F ) , about one-fourth demonstrated an adequate change in temperature from baseline ( delta T greater than or equal to 2.4 degrees F ) but failed to reach 101 degrees F because of a low baseline . Most infections ( 89 % ) had a Tmax greater than 99 degrees F. CONCLUSION Establishing a nursing home patient 's basal temperature and monitoring for changes in temperature ( delta T greater than 2.4 degrees F ) and /or lowering the threshold for recognition of fevers ( to 99 degrees or 100 degrees F ) in nursing home residents with a change in function should assist in early recognition of infections INTRODUCTION The vital signs are an important component of patient assessment . With respect to body temperature ; there has been a move away from mercury-in-glass thermometers toward the relatively inexpensive , safer to use infrared tympanic , auricular , or ear thermometer . Although already in widespread use , the reliability of these devices has increasingly been called into question . Few studies , however , have considered that the problem might reside outside the device itself . OBJECTIVE To investigate the correlation between left ear temperature and right ear temperature using an infrared tympanic thermometer ( ITT ) . DESIGN A prospect i ve , single-blind trail with r and omized assignment of the first ear to be assessed . SETTING /LOCATION Welsh Institute of Chiropractic ( WIOC ) , University of Glamorgan . SUBJECTS One hundred and thirty two ( 132 ) asymptomatic subjects who were opportunistically sample d on entry into the WIOC . None of the subjects had any neurologic deficit , or any known underlying pathologic problems . All were students at the University of Glamorgan ( age range , 18 - 48 years ) . A smaller sample of the same cohort was used on a separate occasion to compare ITTs from 2 different manufacturers using the same protocol . INTERVENTION Measurement of ear ( ear canal/tympanic ) temperature bilaterally using an ITT . OUTCOME MEASURES Bilateral asymmetry in ear canal temperature . Analysis consisted of nonparametric statistical tests , using Spearman 's correlation for comparison and the Wilcoxon matched pairs test for differences . RESULTS In 132 subjects who completed the main study , although a degree of correlation was found , the relationship did not extrapolate through zero . At temperatures more than 0.4 degrees C above or below 36.7 degrees C , there was a significant difference in temperature in the left compared with the right ear . Additionally , the left ear tended to register a lower temperature than the right ear at temperatures below 36.7 degrees C , whereas the left ear tended to read a higher temperature than the right ear above 36.7 degrees C. CONCLUSIONS The authors suggest that clinicians consider measuring both ears , and take the greater of the readings to be a more accurate reflection of the patient 's core temperature . The difference may perhaps even be related to the person 's health . This change in methodology should increase the reliability of the measurement and go some way toward restoring confidence in the use of ITT devices Background —Human aging is characterized by a marked increase in muscle sympathetic nerve traffic ( MSNA ) . No information exists , however , on the effects of aging on skin sympathetic nerve traffic ( SSNA ) and on its reflex modulation by thermoregulatory mechanisms . Methods and Results —In 13 young , 11 middle-aged , and 12 elderly healthy subjects , we measured  arterial blood pressure ( Finapres ) , skin temperature ( thermocouples ) , and resting MSNA and SSNA ( microneurography ) . Measurements also included the SSNA responses to ( 1 ) an acute increase and reduction ( ±8 ° C ) in room temperature , each lasting 45 minutes and ( 2 ) an acoustic stimulus capable to trigger an emotional arousal . Although resting MSNA was progressively and significantly ( P < 0.05 ) increased from young to middle-aged and elderly groups , SSNA was significantly ( P < 0.05 ) reduced in the latter compared with the former 2 groups . Cold exposure induced a SSNA increase that was significantly ( P < 0.01 ) smaller in the elderly than in young and middle-aged subjects . Conversely , heat exposure induced a SSNA reduction that was significantly ( P < 0.05 ) smaller in elderly than in young and middle-aged subjects . Compared with SSNA in young individuals , the SSNA change from cold to warm temperature was reduced by 61 % in the elderly group . This was not the case , however , for the SSNA responses to the arousal stimulus , which were superimposable in the 3 groups . Conclusions —These data provide the first demonstration of a dichotomy in the MSNA and SSNA responses to aging . They also show that aging markedly impairs thermoregulatory control of SSNA and that this impairment might participate at the age-related SSNA decrease The present study is part of a more extensive investigation dedicated to the study and treatment of age‐dependent changes/disturbances in the circadian system in humans . It was performed in the Tyumen Elderly Veteran House and included 97 subjects of both genders , ranging from 63 to 91 yrs of age . They lived a self‐chosen sleep‐wake regimen to suit their personal convenience . The experiment lasted 3 wks . After 1 control week , part of the group ( n=63 ) received 1.5 mg melatonin ( Melaxen ™ ) daily at 22:30 h for 2 wks . The other 34 subjects were given placebo . Axillary temperature was measured using calibrated mercury thermometers at 03:00 , 08:00 , 11:00 , 14:00 , 17:00 , and 23:00 h each of the first and third week . Specially trained personnel took the measurements , avoiding disturbing the sleep of the subjects . To evaluate age‐dependent changes , data obtained under similar conditions on 58 young adults ( both genders , 17 to 39 yrs of age ) were used . Rhythm characteristics were estimated by means of cosinor analyses , and intra‐ and inter‐individual variability by analysis of variance ( ANOVA ) . In both age groups , the body temperature underwent daily changes . The MESOR ( 36.38±0.19 ° C vs. 36.17±0.21 ° C ) and circadian amplitude ( 0.33±0.01 ° C vs. 0.26±0.01 ° C ) were slightly decreased in the elderly compared to the young adult subjects ( p<0.001 ) . The mean circadian acrophase was similar in both age groups ( 17.19±1.66 vs. 16.93±3.08 h ) . However , the inter‐individual differences were higher in the older group , with individual values varying between 10:00 and 23:00 h. It was mainly this phase variability that caused a decrease in the inter‐daily rhythm stability and lower group amplitude . With melatonin treatment  , the MESOR was lower by 0.1 ° C and the amplitude increased to 0.34±0.01 ° C , a similar value to that found in young adults . This was probably due to the increase of the inter‐daily rhythm stability . The mean acrophase did not change ( 16.93 vs. 16.75 h ) , although the inter‐individual variability decreased considerably . The corresponding st and ard deviations ( SD ) of the group acrophases were 3.08 and 1.51 h ( p<0.01 ) . A highly significant correlation between the acrophase before treatment and the phase change under melatonin treatment indicates that this is due to a synchronizing effect of melatonin . Apart from the difference in MESOR , the body temperature rhythm in the elderly subjects undergoing melatonin treatment was not significantly different from that of young adults . The data clearly show that age‐dependent changes mainly concern rhythm stability and synchronization with the 24 h day . A single daily melatonin dose stabilizes/synchronizes the body temperature rhythm , most probably via hypothermic and sleep‐improving effects Preliminary data on the use of infrared emission detection ( IRED ) tympanic thermometers suggest that operator technique may be important in IRED readings . No systematic investigation of specific technique and available IRED devices has previously been performed . In a prospect i ve , blinded trial , 40 healthy adult subjects using six IRED thermometers with two techniques were examined in r and om sequence . Differences between IRED tympanic , oral , and rectal temperatures were compared using ANOVA . Significant differences were observed between all temperatures , the IRED devices , and the method of probe insertion . Differences between oral or rectal temperatures and IRED tympanic readings were reduced by an ear tug ( as for routine otoscopy ) for all but one device . An " ear tug " results in increased IRED readings that may improve accuracy of tympanic thermometers using IRED 
    Output:
    
Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks .