Establishing a New Research Agenda for Studying Psychiatric Emergency Room Treatment Decisions

With the growing complexity of treatment decisions made at presentation to a psychiatric emergency room (PER) and the increasing influence of managed care on the decision-making process, it is increasingly important to establish a new and more sophisticated research agenda for studying PER decision making. The main goal of this paper is to propose a comprehensive conceptual model of the PER decision-making process that will facilitate active pursuit of such a research agenda. The proposed model presents both traditional and emerging elements of the PER decision-making process (i.e., determinants, mediating mechanisms, and outcomes) and explicates the nature of the relationships among them at different levels of analysis. The model's theoretical and empirical implications for future research are discussed and suggestions are made as to the research designs and methods needed to pursue this agenda.     

Changes in Quantity and Sources of Dietary Fiber from Adopting Healthy Low-Fat vs. Healthy Low-Carb Weight Loss Diets: Secondary Analysis of DIETFITS Weight Loss Diet Study

The daily intake of dietary fiber is well below the recommended levels in the US. The effect of adopting a low-fat vs. a low-carbohydrate weight loss diet on fiber intake is of interest but not well-documented, especially when both approaches promote high-quality food choices. The objective of this paper is to compare the quantity and sources of dietary fiber between a healthy low-fat (HLF) vs. healthy low-carbohydrate (HLC) diet group when consumed over 12 months in a weight loss diet study. In this secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) study, the amount and sources of dietary fiber were examined in generally healthy adults, 18–50 years of age, Body Mass Index (BMI) 28–40 kg/m², randomized to HLF or HLC for 12 months, who had available 24-h recalls at 0 (n = 609), 3 (n = 549), 6 (n = 491), and 12 (n = 449) months. The dietary intake was estimated by the Nutrition Data System for Research (NDS-R). The sources of fiber were determined for the major food groups. Significantly more total dietary fiber was consumed by HLF at every post-randomization time point, and, at 12 m, was 23.04 ± 9.43 g vs. 18.61 ± 8.12 g for HLF vs. HLC, respectively, p < 0.0001. In both diet groups at 12 months, the highest amount of dietary fiber came from non-starchy vegetables (4.13 ± 3.05 g and 5.13 ± 3.59 g). The other primary sources of fiber at 12 months for the HLF group were from whole grains (3.90 ± 3.13 g) and fruits (3.40 ± 2.87 g), and, for the HLC group, were from plant protein and fat sources, such as nuts and seeds, their butters, and avocados (2.64 ± 2.64 g). In the DIETFITS study, the difference in the total fiber intake for the HLF vs. HLC groups was more modest than expected. The HLC group consumed reasonably high amounts of fiber from high-protein and high fat plant-based sources.     

Racial and Ethnic Differences in Eating Duration and Meal Timing: Findings from NHANES 2011–2018

Background: In addition to quantity and quality, meal timing and eating duration are additional dietary characteristics that impact cardiometabolic health. Given that cardiometabolic health disparities exist among racial and ethnic groups, we examined whether meal timing and eating duration are additional diet-related differences among racial and ethnic groups. Methods: Participants (n = 13,084) were adults (≥20 years) from the National Health and Nutrition Examination (NHANES, 2011–2018) Survey. Times of first and last meal and the interval between them (eating duration) were derived from two 24-h dietary recalls. Multiple linear regression analyses compared these variables among race and ethnicity after adjusting for potential confounders. Results: Compared to non-Hispanic White adults, the first mealtime was significantly later for Mexican American (23 min), Non-Hispanic Asian (15 min), Non-Hispanic Black (46 min), and Other Hispanic (20 min) and Other Racial (14 min) adults (all p < 0.05). Mexican American and Non-Hispanic Asian adults had a significantly different last mealtime by 13 min earlier and 25 min later, respectively, compared to Non-Hispanic White adults. Compared to Non-Hispanic White adults, the mean eating duration was shorter for other Hispanic (20 min), Mexican American (36 min), and Non-Hispanic Black (49 min) adults. Conclusions: Meal timing and eating duration are additional dietary characteristics that vary significantly among racial and ethnic groups.     

Strategies for assessing the implications of malformed frogs for environmental health

The recent increase in the incidence of deformities among natural frog populations has raised concern about the state of the environment and the possible impact of unidentified causative agents on the health of wildlife and human populations. An open workshop on Strategies for Assessing the Implications of Malformed Frogs for Environmental Health was convened on 4-5 December 1997 at the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina. The purpose of the workshop was to share information among a multidisciplinary group with scientific interest and responsibility for human and environmental health at the federal and state level. Discussions highlighted possible causes and recent findings directly related to frog deformities and provided insight into problems and strategies applicable to continuing investigation in several areas. Possible causes of the deformities were evaluated in terms of diagnostics performed on field amphibians, biologic mechanisms that can lead to the types of malformations observed, and parallel laboratory and field studies. Hydrogeochemistry must be more integrated into environmental toxicology because of the pivotal role of the aquatic environment and the importance of fates and transport relative to any potential exposure. There is no indication of whether there may be a human health factor associated with the deformities. However, the possibility that causal agents may be waterborne indicates a need to identify the relevant factors and establish the relationship between environmental and human health in terms of hazard assessment.     

Carcinoid Tumor of the Kidney with Morphologic and Immunohistochemical Profile of a Hindgut Endocrine Tumor: Report of a Case

A 54-year-old man underwent a radical nephrectomy for a presumed renal cell carcinoma. The tumor was large, showed areas of cystic degeneration and calcification, and had completely obliterated the normal renal parenchyma. The light microscopic appearance was atypical for renal cell carcinoma, and when electron microscopy revealed innumerable neurosecretory granules a diagnosis of carcinoid tumor was made. The tumor cells were argentaffin- and argyrophil-negative but were chromogranin-, neuron-specific enolase-, and leu-7-positive. When tested with a battery of antibodies against specific polypeptide hormones, the tumor exhibited diffuse pancreatic polypeptide and focal somatostatin immunoreactivity.

Our case represents only the 16th case of carcinoid tumor of the kidney to be reported and the first with demonstrated pancreatic polypeptide immunoreactivity. The predominantly trabecular histology, nonreactivity with silver stains, and immunohistochemical profile of this case are common characteristics of hindgut carcinoids, suggesting that, like rectal carcinoids, renal carcinoids are tumors of hindgut endocrine cells.     

Localization of simian immunodeficiency virus in the central nervous system of rhesus monkeys.

Simian immunodeficiency virus (SIV), like the human immunodeficiency virus (HIV), is a lentivirus that is both immunosuppressive and neurovirulent. Rhesus macaques (Macaca mulatta) inoculated with SIV often develop a giant cell encephalitis similar to that seen in humans infected with HIV. The authors examined SIV expression by immunohistochemistry and RNA in situ hybridization in the cerebrum, cerebellum, choroid plexus, and spinal cord from five macaques with and two macaques without giant cell encephalitis. Selected portions of the central nervous system (CNS) also were examined by electron microscopy. Simian immunodeficiency virus was detected in the CNS of all seven monkeys whether or not they had giant cell encephalitis. Both SIV antigen and RNA were present in all levels of the CNS examined. Macrophage/giant cell lesions always contained viral RNA and antigen and were the only sites where viral particles were detected by electron microscopy. However, SIV antigen and RNA also were commonly associated with small vessels, the choroid plexus, and meninges; these were the only locations where virus was detected in animals without giant cell encephalitis. Immunophenotyping showed that the cellular infiltrates consisted primarily of monocyte/macrophages and occasional CD8-positive T cells. Macrophages and T cells also were present in the stroma of the choroid plexus and were intimately associated with vessels in the CNS of SIV-infected but not uninfected macaques. Simian immunodeficiency virus infection of the macaque CNS provides an excellent model for studying the pathogenesis, treatment, and prevention of HIV-1-encephalitis.     

Human trophectoderm biopsy and secretion of chorionic gonadotrophin.

We have previously developed a technique of trophectoderm biopsy to obtain cells from human blastocysts for preimplantation genetic diagnosis. To determine whether this technique affects the subsequent development of the blastocyst, 45 manipulated blastocysts were observed from days 3 to 14 in culture, the amount of human chorionic gonadotrophin (HCG) secreted by each embryo was measured and these results were compared with those of 26 non-manipulated controls documented in a previous study. A slit was made in the zona pellucida opposite the inner cell mass in 18 of the 45 blastocysts. This increased the rate of hatching but the other morphological changes up to day 14 were similar to those seen in the non-manipulated controls. There was no difference in the mean cumulative HCG secretion by these zona-slit controls (149.8 +/- 45.7 mIU/ml) compared to the non-manipulated controls (146.2 +/- 23.7 mIU/ml). A slit was also made in the zona pellicida of the other 27 blastocysts. Approximately 12-18 h later, in 18 blastocysts a biopsy of the herniating trophectoderm cells (5-30) was performed. The rate of hatching and adherence to the culture dish was similar to the non-manipulated controls. The mean cumulative HCG secretion decreased significantly (57.5 +/- 16.2 mIU/ml, P less than 0.01) after the biopsy procedure. However, if a small biopsy was performed (less than 10 cells removed) the decrease in HCG secretion (87.6 +/- 24.8 mIU/ml) was not significant, whereas when a large biopsy was performed (greater than 10 cells), HCG levels fell to 19.9 +/- 9.1 mIU/ml.(ABSTRACT TRUNCATED AT 250 WORDS)     

Glucocorticoid-dependent transformation by human papillomavirus type 16 E7 coding and 3' noncoding sequences.

The establishment of transformation of primary rodent cells by human papillomavirus (HPV) type 16 DNA requires glucocorticoid hormones (Pater et al., Nature 335, 832-835, 1988). Here we provide evidence by mutational analysis that, in the context of the hormone-regulated HPV 16 promoter/enhancer, the only protein coding sequences of HPV 16 required are those of the E7 gene. Moreover, additional sequences adjacent to the 3' end of E7 coding sequences are also essential for the establishment of the transformed phenotype. Splice donor sites, especially an E7 ORF 3' proximal one, are implicated for this cis-acting function, since specific deletion mutations of these splice sites greatly or completely reduced the frequency of transformation and the level of E7 RNA.