Relationship between staffing ratios and effectiveness of inpatient psychiatric units.

OBJECTIVE: Most staffing models designed for adult psychiatric hospitals are based on the well-known relationship between high staff-patient ratios and high effectiveness of treatment units. Staffing ratios likely gain their predictive power by serving as a proxy measure for the amount of attention patients receive from staff. This study directly measured the amount of attention that patients received from staff to determine whether it could account for the variance in unit effectiveness predicted by staffing ratios and serve as a better predictor of unit effectiveness. METHODS: Data from 22 wards in state or Department of Veterans Affairs mental health institutions, which housed 673 short- and long-stay patients, were analyzed. Only full-time direct care staff were included in the calculation of staff-patient ratios. The amount of attention provided to patients by staff was determined over seven days by a highly reliable observational assessment system. The two best social-action outcome measures over a six-month period were adjusted for confounding variables to provide residualized indexes of unit effectiveness. RESULTS: Staff-patient ratios significantly predicted unit effectiveness as indexed by residualized community tenure, accounting for 24 percent of the variance. However, staff-patient ratios did not significantly predict unit effectiveness as indexed by net gain in discharge rates. Taking into account the amount of staff attention received by patients significantly improved the prediction of community tenure by 36 percent and the net gain in discharge rates by 66 percent over staffing ratios alone. The amount of staff attention also accounted for the relationship between staffing ratios and community tenure. CONCLUSIONS: Staffing decisions should be made on the basis of more precise information about treatment requirements, not just staffing ratios.

Antioxidant capacity of oat (Avena sativa L.) extracts. 2. In vitro antioxidant activity and contents of phenolic and tocol antioxidants.

Oat milling fractions were examined for concentrations of total phenolics, tocols, and phenolic acids and in vitro antioxidant activity to determine their potential as dietary antioxidants. Methanolic extracts of pearling fractions, flour and aspirations from flaking, and trichomes had high, intermediate, and low antioxidant activities, respectively, evaluated by the beta-carotene bleaching method. Pearling fractions were also highest in total phenolics and tocols. p-Hydroxybenzoic acid, vanillic acid, caffeic acid, vanillin, p-coumaric acid, and ferulic acid were identified and quantified by HPLC. Three avenanthramides and an unidentified ferulate derivative were also detected. Total phenolic content was significantly correlated with antioxidant activity, and regression equations that predicted antioxidant activity from phenolic and tocol concentrations were calculated. Antioxidant activity, evaluated by beta-carotene bleaching, was correlated with measures of oxygen radical absorbance capacity and low-density lipoprotein oxidation. These data indicate a potential for oat products, especially those enriched in outer layers of the groat, to contribute to dietary intakes of antioxidant phytonutrients.

Antioxidant capacity of oat (Avena sativa L.) extracts. 1. Inhibition of low-density lipoprotein oxidation and oxygen radical absorbance capacity.

Milled oat groat pearlings, trichomes, flour, and bran were extracted with methanol and the fractions tested in vitro for antioxidant capacity against low-density lipoprotein (LDL) oxidation and R-phycoerythrin protein oxidation in the oxygen radical absorbance capacity (ORAC) assay. The oxidative reactions were generated by 2,2'-azobis(2-amidinopropane) HCl (AAPH) or Cu(2+) in the LDL assay and by AAPH or Cu(2+) + H(2)O(2) in the ORAC assay and calibrated against a Trolox standard to calculate Trolox equivalents (1 Trolox equivalent = 1 TE = activity of 1 micromol of Trolox). The antioxidant capacity of the oat fractions was generally consistent with a potency rank of pearlings (2.89-8.58 TE/g) > flour (1.00-3.54 TE/g) > trichome (1.74 TE/g) = bran (1.02-1.62 TE/g) in both LDL and ORAC assays regardless of the free radical generator employed. A portion of the oat antioxidant constituents may be heat labile as the greatest activity was found among non-steam-treated pearlings. The contribution of oat tocols from the fractions accounted for <5% of the measured antioxidant capacity. AAPH-initiated oxidation of LDL was inhibited by the oat fractions in a dose-dependent manner, although complete suppression was not achieved with the highest doses tested. In contrast, Cu(2+)-initiated oxidation of LDL stimulated peroxide formation with low oat concentrations but completely inhibited oxidation with higher doses. Thus, oats possess antioxidant capacity most of which is likely derived from polar phenolic compounds in the aleurone.

Histidine availability alters glucagon gene expression in murine alphaTC6 cells.

Because individual amino acids (AA) stimulate glucagon release from pancreatic alpha-cells, the purpose of this study was to determine if individual AA could influence glucagon gene expression. Preproglucagon mRNA levels were 67% lower (P < 0.05) in mouse alphaTC6 cells incubated for 12 h in amino acid-free medium compared with cells incubated in complete medium containing all 20 AA. A time-course study indicated that alphaTC6 cells incubated in amino acid-free medium +/-1 micromol/L puromycin or amino acid-containing medium plus puromycin exhibited similar preproglucagon mRNA decreases over 12 h. When 1 micromol/L actinomycin was added to medium with or without AA, ppG mRNA concentrations decreased (P < 0.05) for 3h; however, values at 12 h were not different than those at 3 h. Deletions of single AA from complete medium demonstrated that only histidine removal or depletion reproduced the decrease in ppG mRNA observed in amino acid-free medium. We conclude that histidine is involved in the regulation of preproglucagon mRNA levels in alphaTC6 cells and that this regulation may be operative during both transcriptional and post-transcriptional events.

Availability of eIF4E regulates skeletal muscle protein synthesis during recovery from exercise.

We examined the association of the mRNA cap binding protein eIF4E with the translational inhibitor 4E-BP1 in the acute modulation of skeletal muscle protein synthesis during recovery from exercise. Fasting male rats were run on a treadmill for 2 h at 26 m/min and were realimented immediately after exercise with either saline, a carbohydrate-only meal, or a nutritionally complete meal (54.5% carbohydrate, 14% protein, and 31.5% fat). Exercised animals and nonexercised controls were studied 1 h postexercise. Muscle protein synthesis decreased 26% after exercise and was associated with a fourfold increase in the amount of eIF4E present in the inactive eIF4E.4E-BP1 complex and a concomitant 71% decrease in the association of eIF4E with eIF4G. Refeeding the complete meal, but not the carbohydrate meal, increased muscle protein synthesis equal to controls, despite similar plasma concentrations of insulin. Additionally, eIF4E.4E-BP1 association was inversely related and eIF4E.eIF4G association was positively correlated to muscle protein synthesis. This study demonstrates that recovery of muscle protein synthesis after exercise is related to the availability of eIF4E for 48S ribosomal complex formation, and postexercise meal composition influences recovery via modulation of translation initiation.

Preexercise meal composition alters plasma large neutral amino acid responses during exercise and recovery.

This study was designed to determine the effect of ingesting three preexercise meals on energy metabolism during exercise and recovery and to relate metabolic perturbations to subjective and objective measurements associated with central fatigue. Twelve subjects consumed isoenergetic meals consisting of oat, wheat, or corn cereals 90 min before cycling. A fasting trial served as the control. Blood samples and cognitive function, perceived hunger, and sleepiness measurements were obtained before and after feeding and during recovery when self-selected food intake was also measured. After meal ingestion, plasma insulin was lower for oat than for wheat or corn whereas the ratio of tryptophan to large neutral amino acids (LNAAs) for corn was less than for all others. During exercise, the tryptophan-LNAA ratio increased from preexercise values for the fasting and wheat trials, but exercise performance was unaffected. During recovery, tryptophan:LNAA increased from postexercise values in fasting trials. Also, hunger and fatigue ratings were greater in fasted subjects, but self-selected food intake measured at the end of the recovery period was not different among groups. We conclude that preexercise meal consumption affected tryptophan:LNAA before, during, and after exercise, but these changes were not sufficient to alter physical and cognitive performance.

Oat, wheat or corn cereal ingestion before exercise alters metabolism in humans.

This study was designed to determine metabolic and physical performance responses to ingestion of pre-exercise meals with different macronutrient and fiber profiles. Twelve physically active subjects (6 males and 6 females) were used to investigate the metabolic and physical performance consequences of consuming pre-exercise meals consisting of oat, corn, or wheat cereals. A fasting trial served as the control, and all subjects received each treatment in a Latin-square design. Blood samples were drawn before and 85 min after meal ingestion, during 90 min of cycling exercise (60% VO2peak), after a 6.4 km performance ride, and during 60 min of recovery. Expired air samples were collected to determine nutrient utilization. Resting carbohydrate oxidation rates and plasma insulin concentrations after oat ingestion were less than after wheat, and corn and wheat ingestion, respectively (P < 0.05). During exercise, the change in plasma glucose from pre-exercise was greater after consuming wheat and corn compared with oat (P < 0.05), and it was inversely related to pre-exercise plasma insulin concentration (r = -0.55, P = 0.0001). Plasma free fatty acid concentrations were inversely related to plasma lactate concentrations (r = -0.58, P = 0.0001). Free fatty acid concentrations and fat oxidation were greater in fasting trials than all others, but performance ride times did not differ among treatments. Plasma branched-chain amino acid concentrations resembled their respective meal profiles throughout exercise, the performance ride, and recovery. These results indicate that pre-exercise meal composition can influence glucose homeostasis during early exercise and plasma branched-chain amino acid concentrations over a substantial range of metabolic demands.

Gastric emptying of water and isocaloric carbohydrate solutions consumed at rest.

This study assessed the gastric emptying rates of water and four isocaloric carbohydrate solutions in resting subjects. On five occasions, subjects ingested 400 ml of water or 6% solutions of glucose, sucrose, maltodextrin, and sucrose+glucose. The double-sampling technique was used to sample stomach contents immediately after ingestion and at 10-min intervals until emptying was complete. Comparisons of various criteria of gastric emptying (percentage of initial beverage volume remaining in the stomach, mean gastric emptying rates, and gross gastric volumes) provided somewhat different results. For example, when gastric emptying was portrayed as the percentage of initial beverage volume remaining in the stomach, the glucose and maltodextrin beverages exhibited significantly slower emptying characteristics; there were no differences in this measure among water, sucrose, and sucrose+glucose. Similar results were noted when changes in gross gastric volumes were compared. However, when the results are expressed as mean gastric emptying rates (in ml.min-1), few differences are noted among beverage treatments. Gastric emptying rate was not influenced by the osmolality of the ingested solutions. The results of this study demonstrate the importance of using more than one measurement criteria to assess and compare gastric emptying characteristics.

Glycemic and insulinemic response to preexercise carbohydrate feedings.

The effects of preexercise hyperinsulinemia on exercising plasma glucose, plasma insulin, and metabolic responses were assessed during 50 min cycling at 62% VO2max. Subjects were fed a 6% sucrose/glucose solution (LCHO) or a 20% maltodextrin/glucose solution (HCHO) to induce changes in plasma insulin. During exercise, subjects assessed perceived nauseousness and light-headedness. By the start of exercise, plasma glucose and plasma insulin had increased. In the LCHO trial, plasma glucose values significantly decreased below the baseline value at 30 min of exercise. However, by 40 min, exercise plasma glucose and insulin values were similar to the baseline value. Exercise plasma glucose and insulin did not differ from baseline values in the HCHO trial. Ingestion of LCHO or HCHO was not associated with nausea or lightheadedness. It was concluded that the hyperinsulinemia induced by preexercise feedings of CHO did not result in frank hypoglycemia or adversely affect sensory or physiological responses during 50 min of moderate-intensity cycling.

Fluid intake during an ultramarathon running race: relationship to plasma volume and serum sodium and potassium.

To assess the relationship between self-selected fluid intake patterns and changes in plasma volume and serum electrolytes during prolonged exercise, five men completed ultramarathon runs ranging from 50 to 100 km. There was a significant relationship between fluid intake and plasma volume changes but no changes occurred in either serum sodium or potassium. Subjects who ingested the most fluid during the race had a modest hemodilution without any changes in serum or potassium. This response may have been influenced by the consumption of beverages containing osmotically active solutes such as sodium and glucose.

Physiological responses to glycerol ingestion during exercise.

To study selected cardiovascular, thermoregulatory, and hormonal responses to the consumption of glycerol solutions during exercise, nine subjects cycled for 90 min at 50% peak O2 uptake in a 30 degree C, 45% relative humidity environment. Beverages tested included a 10% glycerol solution (G), a 6% carbohydrate-electrolyte beverage (CE), the 6% carbohydrate-electrolyte beverage plus 4% glycerol (CEG), and a water placebo (WP) ingested at regular intervals during the first 60 min of exercise. The beverages were administered in counterbalanced order with subjects serving as their own controls. Ingestion of the glycerol solutions resulted in an increase in plasma osmolality and attenuation of the decrease in plasma volume associated with the WP treatment (P less than 0.05). Plasma renin activity was highest with WP (P less than 0.05), and G was associated with increased antidiuretic hormone levels (P less than 0.05). Ratings of perceived thirst were lowest for CEG and G, and the frequency of gastrointestinal distress was greatest for G (P less than 0.05). However, no differences among beverage treatments were observed for heart rate, esophageal temperature, sweat rate, ratings of perceived exertion, or changes in cortisol and aldosterone levels. These data indicate that there are no substantial metabolic, hormonal, cardiovascular, or thermoregulatory advantages to the consumption of solutions containing 4 or 10% glycerol during exercise.

Responses to varying rates of carbohydrate ingestion during exercise.

The purpose of this study was to determine how the ingestion of carbohydrate at varying rates influences physiological, sensory, and performance responses to prolonged exercise at 65-75% VO2max. Ten subjects ingested either a water placebo (WP) or carbohydrate solutions formulated to provide glucose at the rates of 26, 52, and 78 g, h-1 during 2 h of cycling exercise in a cool (10 degrees C) environment. Beverages were administered in a double-blind, counterbalanced design. A 4.8 km performance test followed each 2 h session. The average time required to complete the performance test was less with the carbohydrate feedings than with WP: mean (+/- SE) for WP = 505.0 +/- 18.7 s. 26 g.h(-1) = 476.0* +/- 8.8 s. 52 g.h(-1) = 483.8 +/- 12.7 s. 78 g.h(-1) = 474.3* +/- 19.1 s; *P less than 0.05 vs WP. Carbohydrate feeding resulted in higher plasma glucose and insulin, and lower free fatty acid concentrations than did WP. Changes in plasma osmolality, plasma volume, rectal temperature, lactate, heart rate, respiratory exchange ratio, ratings of perceived exertion, and sensory responses were similar among beverage treatments. Compared with WP, ingestion of the glucose beverages minimized changes in plasma ACTH and cortisol. In summary, carbohydrate feeding at the rates of 26 and 78 g.h(-1) was associated with improved exercise performance. The data further indicate that a dose-response relationship does not exist between the amount of carbohydrate consumed during exercise and exercise performance.

Dietary protein requirements of physically active individuals.

The dietary protein requirement of physically active individuals has received considerable scrutiny in recent years. Because the current United States Recommended Daily Allowance (USRDA) for protein (0.8 g/kg/day) already contains a safety margin (0.35 g/kg/day) to assure adequate protein intake, no increment in the USRDA was thought necessary to meet the demands of physical activity. Recently, collective evidence from research techniques utilising nitrogen balance, labelled amino acid isotopes, urea production and 3-methylhistidine excretion indicates that exercise (endurance and weightlifting) can significantly alter protein metabolism and that the dietary protein needs of physically active individuals may exceed the current USRDA. During endurance exercise, protein synthesis is depressed and protein degradation increases. Thus, amino acids become available for oxidation in energy-yielding processes. Amino acid catabolism has been estimated to contribute between 5 and 15% of the energy required during endurance exercise. Definitive conclusions regarding the changes that occur in protein synthesis and protein degradation during weightlifting exercise must await further research. The net contribution of amino acids to the energy required during weightlifting exercise is unknown but, due to the anaerobic nature of the event, it is most likely less than during endurance exercise. However, following both endurance and weightlifting exercise, protein synthesis increases. Based on current research, it is not yet possible to make recommendations for the daily protein needs of exercising individuals. It does appear that physically active individuals require more dietary protein per kilogram of bodyweight than sedentary individuals. However, when protein intake is expressed as a percentage of daily energy intake, physically active and sedentary individuals have similar requirements (approximately 12 to 15% of total energy as protein). Therefore, to cover the protein requirements of both physically active individuals and sedentary individuals it is suggested that future protein allowances be based on a percentage of the daily energy requirements. Protein consumption in excess of the current USRDA may minimise changes in body nitrogen stores, particularly during the first few weeks of training. However, further research is needed before a definitive conclusion can be made regarding protein ingestion and athletic performance.

Involuntary commitments to public mental institutions: issues involving the overrepresentation of blacks and assessment of relevant functioning.

This article contributes to the debate in the mental health and legal systems concerning involuntary commitments to mental hospitals. The focus is on issues involving the overrepresentation of Black people among adults committed to U.S. public mental institutions and issues involving the assessment of relevant behavioral functioning in particular. Empirical findings, legal principles and procedures, and methodological limitations are reviewed to identify problems in current practice and relevant evidence bearing on those problems. Special emphasis is placed on the possible explanations for the overrepresentation of Blacks and on dependable assessments of relevant functioning that are needed to justify the state's coercive power to involuntarily confine people, regardless of race. The article concludes with a summary and recommendations for research and practice.

The effects of glucose, fructose, and sucrose ingestion during exercise.

The purpose of this study was to compare the physiological, sensory, and exercise performance responses to ingestion of 6% glucose, 6% fructose, and 6% sucrose solutions during cycling exercise. Twelve subjects completed three sessions consisting of 115 min of intermittent cycle ergometer exercise at 65-80% of VO2max followed by a timed performance bout requiring the completion of 600 pedal revolutions. During each of five 4-min rest periods, subjects consumed 3 ml.kg LBM-1 of one of the beverages. Beverages were presented in counterbalanced, double-blind fashion. Heart rate, VO2, plasma urate, plasma lactate, respiratory exchange ratio, and carbohydrate combustion rates changed similarly among beverage treatment. However, fructose was associated with lower plasma glucose and serum insulin, a larger loss of plasma volume, greater gastrointestinal distress and relative perceived exertion ratings, and higher plasma or serum concentrations of free fatty acids, fructose, and cortisol values than sucrose or glucose (P less than 0.05). Compared to sucrose and glucose, fructose feeding also resulted in lower lactate and HR values during the performance bout (P less than 0.05). Mean +/- SE cycling performance times were faster with sucrose and glucose than with fructose: 419.4 +/- 21.0 s, 423.9 +/- 21.2 s, and 488.3 +/- 21.1 s, respectively (P less than 0.05). Relative to 6% solutions of sucrose and glucose, ingestion of a 6% fructose beverage is associated with gastrointestinal distress, compromised physiological response, and reduced exercise capacity.

Urban psychiatric commitments: disability and dangerous behavior of black and white recent admissions.

Nationally black patients are overrepresented in public psychiatric institutions and are more likely than white patients to be committed involuntarily. This study of patients from 12 treatment units in the Chicago area, where these patterns were also true, compared the functioning of 227 acute admissions grouped by race (white or black) and admission status (voluntary or involuntary). Patients were assessed by highly trained independent observers using objective measures of dangerous behavior and disability levels, the relevant classes of functioning based on common principles underlying commitment statutes. No evidence was found that racial bias and discrimination in commitment and retention decisions would account for the overrepresentation of blacks among involuntary commitments to public institutions. Rather, the same factors that account for the overrepresentation of blacks compared with whites among all admissions may also explain their overrepresentation among the involuntarily confined. Changes in treatment programming and assessment practices are suggested.

Carbohydrate feeding and exercise: effect of beverage carbohydrate content.

The purpose of this study was to determine the effect of ingesting fluids of varying carbohydrate content upon sensory response, physiologic function, and exercise performance during 1.25 h of intermittent cycling in a warm environment (Tdb = 33.4 degrees C). Twelve subjects (7 male, 5 female) completed four separate exercise sessions; each session consisted of three 20 min bouts of cycling at 65% VO2max, with each bout followed by 5 min rest. A timed cycling task (1200 pedal revolutions) completed each exercise session. Immediately prior to the first 20 min cycling bout and during each rest period, subjects consumed 2.5 ml.kg BW-1 of water placebo (WP), or solutions of 6%, 8%, or 10% sucrose with electrolytes (20 mmol.l-1 Na+, 3.2 mmol.l-1 K+). Beverages were administered in double blind, counterbalanced order. Mean (+/- SE) times for the 1200 cycling task differed significantly: WP = 13.62 +/- 0.33 min, *6% = 13.03 +/- 0.24 min, 8% = 13.30 +/- 0.25 min, 10% = 13.57 +/- 0.22 min (* = different from WP and 10%, P less than 0.05). Compared to WP, ingestion of the CHO beverages resulted in higher plasma glucose and insulin concentrations, and higher RER values during the final 20 min of exercise (P less than 0.05). Markers of physiologic function and sensory perception changed similarly throughout exercise; no differences were observed among subjects in response to beverage treatments for changes in plasma concentrations of lactate, sodium, potassium, for changes in plasma volume, plasma osmolality, rectal temperature, heart rate, oxygen uptake, rating of perceived exertion, or for indices of gastrointestinal distress, perceived thirst, and overall beverage acceptance.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum and urinary markers of skeletal muscle tissue damage after weight lifting exercise.

The purpose of this study was to determine whether high intensity weight lifting exercise produces elevations of urinary 3-methylhistidine (3-MH), serum creatine kinase activity (CK), and serum myoglobin concentration (MY), and whether trained weight lifters differed in such responses when compared to a group of untrained subjects. Ten experienced male weight lifters (EWL) and seven untrained male subjects (IWL) performed three sets of six weight lifting exercises at 70%-80% of 1 RM. All subjects consumed a meat-free diet. The 3-MH:creatinine (3-MH:CR) values decreased 24 h and 48 h following exercise (P less than 0.05). The 12-h and 24-h postexercise CK response and the 12-h postexercise MY response increased for both EWL and IWL (P less than 0.05). However, EWL had a lower 24-h postexercise CK response and lower 12-h and 24-h postexercise MY responses compared to IWL (P less than 0.05). Within 48 h following weight lifting exercise, skeletal muscle protein degradation (as assessed by 3-MH:CR values) decreased regardless of prior training experience whereas skeletal muscle tissue damage (as assessed by CK and MY responses) increased. However, prior weight lifting training appeared to diminish the extent of muscle tissue damage.

Inconsistencies in paranoid functioning, premorbid adjustment, and chronicity: question of diagnostic criteria.

Despite the widely held belief that paranoid behavior is associated with good premorbid adjustment, low chronicity, and high current functioning in psychiatric inpatients, inconsistencies in the literature suggest that supportive evidence may be an artifact of the measurement model commonly used to index paranoid status. In a sample of 497 nonorganic inpatients selected from 19 treatment units, paranoid behavior, when measured by a dimensional/cumulative model, was not found to indicate higher functioning and associated relationships, but simply to reflect a narrower class of problem behavior. Only when paranoid status was defined using a traditional model based on the predominance of the defining class of behavior did paranoid subjects demonstrate better premorbid adjustment, lower chronicity, and higher levels of functioning than nonparanoid subjects. Serious problems exist in the use of information obtained from traditional predominance/class models for either theoretical or practical purposes.