The Psychosocial and Behavioral Characteristics Related to Energy Misreporting

Energy underreporting occurs in 2% to 85% and overreporting in 1% to 39% of various populations. Efforts are needed to understand the psychosocial and behavioral characteristics associated with misreporting to help improve the accuracy of dietary self-reporting. Past research suggests that higher social desirability and greater eating restraint are key factors influencing misreporting, while a history of dieting and being overweight are more moderately associated. Eating disinhibition, body image, depression, anxiety, and fear of negative evaluation may be related to energy misreporting, but evidence is insufficient. This review will provide a detailed discussion of the published associations among psychosocial and behavioral characteristics and energy misreporting.     

Transport, uptake, and metabolism of blood-borne vasopressin by the blood-brain barrier

Transport, binding, and metabolism of [phenylalanyl-3,4,5-³H(N)]arginine vasopressin (AVP) by the blood-brain barrier (BBB) was studied in adult guinea-pigs by means of a novel vascular brain perfusion (VBP)/capillary depletion technique and HPLC. A time-dependent, progressive brain uptake of ³H-radioactivity was measured over the 10 min period of VBP both in brain homogenates and in brain tissue depleted of cerebral microvessels. The unidirectional blood-to-brain transport constant, K_IN, estimated by multiple-time tissue uptake analysis of the homogenate and postcapillary supernatant, indicated that the BBB transfer rat ffor [³H]AVP (K_IN = 2.37±0.25 μl min⁻¹ per gram brain homogenate) was almost 10 times higher than for simultaneously perfused [¹⁴C]sucrose, a cerebrosvascular space marker. In contrast to homogenate and postcapillary supernatant, the [³H]radioactivity determined in the vascular pellet after dextran density centrifugation of the brain homogenate was very low and only somewhat higher than for [¹⁴C]sucrose. HPLC analysis of the perfused brain tissue revealed time-dependent degradation of the blood-borne neuropeptide. The percentage of intact [³H]AVP as determined in the postcapillary supernatant progressively declined during brain perfusion, from 49% at 1 min to 11.9% at 10 min. The major detectable labeled metabolite was [³H]phenylalanine, the labeled amino acid residue of [³H]AVP. The aminopeptidase inhibitor bestatin (0.5 mM), perfused simultaneously with [³H]AVP by the VBP technique, did not alter tissue uptake of [³H]AVP, indicating that there was no significant hydrolysis of peptide by the luminal BBB surface. The results suggest that rapid in vivo metabolism of AVP occurs after BBB transport in the brain parenchyma with no evidence of significant capillary sequestration, or degradation of AVP by the BBB.     

Adapting the mealtime environment: Setting the stage for eating

In long-term care facilities, mealtime should be an important and exciting event that residents and staff look forward to three times a day. Providing residents with a homelike, pleasant dining atmosphere should promote socialization, enhance awareness, and increase appetities, thereby improving the residents' quality of life. This paper discusses the subtle but strong influence that the environment has in preparing residents for eating. Environmental factors that promote a positive mealtime experience are discussed.     

Low-frequency positive-pressure ventilation with extracorporeal carbon dioxide removal

Successful use of a new technique, low-frequency positive-pressure ventilation with extracorporeal CO2 removal (LFPPV-ECCR) is presented. The association of fulminant respiratory failure with CNS hemangioblastoma, described in the present patient, has been reported only once before, in 1928.     

Longitudinal Prediction of Metabolic Rate in Critically Ill Patients

Background: Indirect calorimetry is the criterion method for assessment of energy expenditure in critically ill patients but is decidedly uncommon. Thus, calculation methods proliferate. Even if indirect calorimetry is available, it usually is not repeated more than weekly on the same patient, creating potential for error. The purpose of the current study was to quantify estimation errors against indirect calorimetry measurements in critically ill patients over time. Methods: In mechanically ventilated, critical care patients, indirect calorimetry was used to measure resting metabolic rate for 7 days. Three estimation methods were compared with the cumulative measurement: the Penn State equations, the American College of Chest Physicians (ACCP) standard (25 kcal/kg body weight), and an extrapolated value based on the first measurement multiplied by 7 days. Results: The cumulative difference between measured resting metabolic rate and the rate predicted by the Penn State equations was ?468 ± 642 kcal (–3.7% ± 5.1% of the measured value). The difference for the ACCP was smaller, but variation was much wider (–387 ± 1597 kcal or ?2.2% ± 11.9% of the measured value). The extrapolated value was ?684 ± 1731 kcal (–4.1% ± 11.4% of measured expenditure). Conclusion: On average, the Penn State equations predict resting metabolic rate over time within 5% of the measured value. This performance is similar to the practice of making 1 measurement and extrapolating it over 1 week. The ACCP method has an unacceptably wide limit of agreement.