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Psychiatric patients who refuse nourishment.

Recently publicized court cases focused attention on two individuals who wished to be permitted to starve themselves to death in health care facilities. These cases constitute one variation of a more common event arising in medical practice: the patient's refusal to take nourishment voluntarily. The authors discuss medical, ethical, and legal considerations relevant to such refusals and analyze two clinical examples of patients who refused nourishment. The authors suggest that physicians restrict coercive feeding to individuals who are incompetent or suffering from serious mental disorders and adamantly refuse nourishment, as for these individuals the benefits of involuntary nourishment outweigh its risks.

Adult↗

A procedure for the safety evaluation of natural flavor complexes used as ingredients in food: essential oils.

A scientifically based guide has been developed to evaluate the safety of naturally occurring mixtures, particularly essential oils, for their intended use as flavor ingredients. The approach relies on the complete chemical characterization of the essential oil and the variability of the composition of the oil in the product intended for commerce. Being products of common plant biochemical pathways, the chemically identified constituents are organized according to a limited number of well-established chemical groups called congeneric groups. The safety of the intake of the each congeneric group from consumption of the essential oil is evaluated in the context of data on absorption, metabolism, and toxicology of members of the congeneric group. The intake of the group of unidentified constituents is evaluated in the context of the consumption of the essential oil as a food, a highly conservative toxicologic threshold, and toxicity data on the essential oil or an essential oil of similar chemotaxonomy. The flexibility of the guide is reflected in the fact that high intake of major congeneric groups of low toxicologic concern will be evaluated along with low intake of minor congeneric groups of significant toxicological concern (i.e., higher structural class). The guide also provides a comprehensive evaluation of all congeneric groups and constituents that account for the majority of the composition of the essential oil. The overall objective of the guide is to organize and prioritize the chemical constituents of an essential oil in order that no reasonably possible significant risk associated with the intake of essential oil goes unevaluated. The guide is, however, not intended to be a rigid checklist. The Flavor and Extract Manufacturers Association (FEMA) Expert Panel will continue to evaluate each essential oil on a case by case basis applying their scientific judgment to insure that each natural flavor complex is exhaustively evaluated.

Animals↗

An assessment of emergency medicine residency graduates' perceptions of the adequacy of their residency training.

A study of emergency medicine residency training graduates was conducted to determine their perceptions of the quality of their graduate training. A sample of 300 individuals was randomly selected from a population of 1,000 persons graduating from 1982 through 1984. Respondents were asked to use a scale of 1 to 5 (with 1 being highest) to rate the adequacy of their residency training relative to 20 major core content areas. A 50% response rate (N = 151) was achieved. Mean ratings of residents' perceptions of the adequacy of their training relative to the core content ranged from 1.7 to 3.24. Training in resuscitation and stabilization, principles of emergency care, and general assessment were among the most highly rated, while training in physician interpersonal skills, disorders related to the immune system, and cutaneous disorders were rated the lowest. Overall, residents were quite positive in their perceptions regarding the quality of their training. They indicated plans to attend continuing medical education programs to reinforce some of their training and to address some of the deficiencies they perceived in residency training. Programs are encouraged to conduct similar surveys with their own graduates to assess particular strengths and weaknesses.

Adult↗

Transvenous pacing: a seminal transition from the research laboratory.

In the late 1950s, nonsurgical catheter therapies for the treatment of various disorders did not exist, although surgery was at its highest level of development in the classic sense: extirpation of organs, incision and drainage, diagnostic biopsy. Today we live in an era of diagnostic and therapeutic methods based on catheters: observation, aspiration, drainage, stretching, and manipulation by means of relatively atraumatic tubes. The development of catheter techniques has spawned undreamed-of specialties, industries, and professional societies. Although catheters had been used before then in research laboratories, Furman's clinical application of electrode-tipped venous catheters in treating patients with complete heart block and Stokes-Adams seizures represents a turning point. This advance may be regarded as the catalytic and seminal event for the growth of catheter technologies, which are so prominent in the world of medicine today, and their application to many fields of medicine and surgery.

Cardiac Catheterization↗

Photochemical and photobiological studies of a furonaphthopyranone as a benzo-spaced psoralen analog in cell-free and cellular DNA.

Photobiological activities of the benzo-spaced psoralen analog furonaphthopyranone 3 have been investigated in cell-free and cellular DNA. The molecular geometry parameters of 3 suggest that it should not form interstrand crosslinks with DNA. With cell-free DNA no evidence for crosslinking but also not for monoadduct formation was obtained; rather, the unnatural furocoumarin 3 induces oxidative DNA modifications under near-UVA irradiation. The enzymatic assay of the photosensitized damage in cell-free PM2 DNA revealed the significant formation of lesions sensitive to formamidopyrimidine DNA glycosylase (Fpg protein). In the photooxidation of calf thymus DNA by the furonaphthopyranone 3, 0.29 +/- 0.02% 8-oxo-7,8-dihydroguanine (8-oxoGua) was observed. With 2'-deoxyguanosine (dGuo), the guanidine-releasing photooxidation products oxazolone and oxoimidazolidine were formed predominately, while 8-oxodGuo and 4-HO-8-oxodGuo were obtained in minor amounts. The lack of a significant D2O effect in the photooxidation of DNA and dGuo reveals that singlet oxygen (type II process) plays a minor role; control experiments with tert-butanol and mannitol confirm the absence of hydroxyl radicals as oxidizing species. The furonaphthopyranone 3 (Ered = -1.93 +/- 0.03V) should act in its singlet-excited state as electron acceptor for the photooxidation of dGuo (delta GET ca -6 kcal/mol), which corroborates photoinduced electron transfer (type I) as a major DNA-oxidizing mechanism. A comet assay in Chinese hamster ovary (CHO) AS52 cells demonstrated that the psoralen analog 3 damages cellular DNA upon near-UVA irradiation; however, no photosensitized mutagenicity was observed in CHO AS52 cell cultures.

Animals↗

The effect of nanocrystal surface structure on the luminescence properties: photoemission study of HF-etched InP nanocrystals.

InP nanocrystals with narrow size distribution and mean particle diameter tunable from approximately 2 up to approximately 7 nm were synthesized via the dehalosilylation reaction between InCl3 and tris(trimethylsilyl)phosphine. Specific capping of the nanocrystal surface with a shell of organic ligands protects the nanocrystals from oxidation and provides solubility of the particles in various organic solvents. InP nanocrystals with enhanced photoluminescence (PL) efficiency were obtained from the initial nanocrystals by photoassisted etching of the nanocrystal surface with HF. The resulting PL quantum efficiency of InP nanocrystals dispersed in n-butanol is about three orders of magnitude higher when compared to the nonetched InP samples and approaches approximately 40% at room temperature. High-resolution photoelectron spectroscopy with the use of synchrotron radiation was applied to reveal the changes of the nanocrystal surface responsible for the dramatic improvement of the PL efficiency. The analysis of high-resolution P 2p core-level spectra confirmed significant changes of the nanocrystal surface structure induced by the postpreparative treatments and allowed us to propose the description of the etching mechanism. In the nonetched InP nanocrystals, some surface P atoms generate energy states located inside the band gap which provide nonradiative recombination pathways. Photoassisted treatment of InP nanocrystals with HF results in selective removal of these phosphorous atoms from the nanocrystal surface. The reconstructed surface of the etched InP nanocrystals is terminated mainly with In atoms and is efficiently passivated with tri-n-octylphosphine oxide ligands.

Journal Article↗

Ring-strain effects on the oxidation potential of enediynes and enediyne complexes.

The metal-enediyne complexes [(eta 5-C5H5)Fe[eta 5-1,2-C5H3C identical to C(CH2)nC identical to]] (4, n = 4; 5, n = 5) and [(eta 5-C5H5)-Fe[eta 5-1,2-C5H3(C identical to C Me)2]] (6) were prepared from 1,2-diethynylferrocene (3). Complexes 4 and 5 were characterized in the solid state by X-ray crystallographic analysis. The structures of 4 and 6 were determined by computation using ab initio methods. A correlation was observed between ring-strain and increased ease of electrochemical oxidation along the series 6 (+0.164 V) to 5(+0.152 V) to 4 (+0.123 V). A similar trend in ionization potentials was identified in both the gas phase and in solution by computational methods.

Crystallography, X-Ray↗

The contribution of hope to the quality of life among aging African Americans: 1980-1992.

This study examined age differences between 1979-80 and 1992 in the quality of life of African Americans using panel data from the National Survey of Black Americans. Of particular interest was the role of the hope dimension of personal efficacy in accounting for variance in general well-being, beyond that contributed by social demographic and economic indicators. Hierarchical regression analyses revealed that hope and family satisfaction in 1980 consistently accounted for significant amounts of variance in general life satisfaction in the 1992 fourth wave of data among all three cohorts. For older respondents, increased frequency of contact with friends and family help were the most important contributors to high satisfaction. Across waves in all age cohorts family satisfaction and contact with friends were most important in contributing to life satisfaction. Implications for further research on well-being among African Americans were discussed.

Adolescent↗

[Indications for electric stimulation of the heart in disorders of atrioventricular conductivity].

The authors analyse the indications for electric stimulation of the heart in disorders of atrioventricular conduction on the basis of personal experience (1000 odd electric stimulations). Two main factors, the frequency and severity of Morgangni-Adams-Stokes attacks and the state of hemodynamics, should be taken into account when the indications for electric cardiac stimulation are considered. In choosing the therapeutical measures and methods, due consideration should also be given to the etiology of the block. Morgagni-Adams-Stokes attacks are an absolute indication for permanent electric stimulation. The authors believe that as a method for the management of atrioventricular block electric stimulation of the heart has no absolute contraindications.

Evaluation Studies as Topic↗

The Gabriella Miller Kids First Data Resource for genomic research in pediatric cancer and congenital anomalies.

Nine-year-old brain tumor patient Gabriella Miller challenged members of Congress to "stop talking and start doing" when providing federal funding for research into cures for pediatric cancer and congenital anomalies. Though she ultimately lost her life to that cancer, her advocacy efforts resulted in the 2014 Gabriella Miller Kids First Research Act, launching the Gabriella Miller Kids First Pediatric Research Program at the National Institutes of Health (NIH). The overarching goal of the Gabriella Miller Kids First Pediatric Research Program is to help researchers uncover new insights into the biology of childhood cancer and congenital anomalies. Following the signing of the Gabriella Miller Kids First Research Act 2.0 in January 2025, the program has been extended at NIH through 2028 to advance the groundwork laid in the program's first ten years. The Gabriella Miller Kids First Data Resource Center has since honored her legacy by building a comprehensive data resource for genomic research into pediatric conditions. Data from more than 30,000 participants annotated with demographic and clinical information related to their diagnoses have been released for secondary research and analysis using the center's web-based platforms. This paper analyzes the outcomes of the initiative and highlights breakthroughs made by the larger research community resulting from the availability of this data resource. We explore the future expansion of the data resource to include new modalities and tools for supporting life-saving research for children like Gabriella Miller.

Humans↗

The FEMA GRAS assessment of hydroxy- and alkoxy-substituted benzyl derivatives used as flavor ingredients.

This publication is the ninth in a series of safety evaluations performed by the Expert Panel of the Flavor and Extract Manufacturers Association (FEMA). In 1993, the Panel initiated a comprehensive program to re-evaluate the safety of more than 1700 GRAS flavoring substances under conditions of intended use. Elements that are fundamental to the safety evaluation of flavor ingredients include exposure, structural analogy, metabolism, pharmacokinetics and toxicology. Flavor ingredients are evaluated individually and in the context of the available scientific information on the group of structurally related substances. Scientific data relevant to the safety evaluation of the use of hydroxy- and alkoxy-substituted benzyl derivatives as flavoring ingredients is evaluated. The group of hydroxy- and alkoxy-benzyl derivatives was reaffirmed as GRAS (GRASr) based, in part, on their self-limiting properties as flavoring substances in food; their rapid absorption, metabolic detoxication, and excretion in humans and other animals; their low level of flavor use; the wide margins of safety between the conservative estimates of intake and the no-observed-adverse effect levels determined from subchronic and chronic studies and the lack of significant genotoxic and mutagenic potential. This evidence of safety is supported by the fact that the intake of hydroxy- and alkoxy-substituted benzyl derivatives as natural components of traditional foods is greater than their intake as intentionally added flavoring substances.

Alcohols↗

Observation of 1(-)0(-) final states from psi(2S) decays and e(+)e(-) annihilation.

Using CLEO data collected from CESR e(+)e(-) collisions at the psi(2S) resonance and nearby continuum at sqrt[s]=3.67 GeV, we report the first significantly nonzero measurements of light vector-pseudoscalar hadron pair production (including rhopi, omegapi, rhoeta, and K(*0)K0 ) and the pi(+)pi(-)pi(0) final state, both from psi(2S) decays and direct e(+)e(-) annihilation.

Journal Article↗

Structures of the superoxide reductase from Pyrococcus furiosus in the oxidized and reduced states.

Superoxide reductase (SOR) is a blue non-heme iron protein that functions in anaerobic microbes as a defense mechanism against reactive oxygen species by catalyzing the reduction of superoxide to hydrogen peroxide [Jenney, F. E., Jr., Verhagen, M. F. J. M., Cui, X. , and Adams, M. W. W. (1999) Science 286, 306-309]. Crystal structures of SOR from the hyperthermophilic archaeon Pyrococcus furiosus have been determined in the oxidized and reduced forms to resolutions of 1.7 and 2.0 A, respectively. SOR forms a homotetramer, with each subunit adopting an immunoglobulin-like beta-barrel fold that coordinates a mononuclear, non-heme iron center. The protein fold and metal center are similar to those observed previously for the homologous protein desulfoferrodoxin from Desulfovibrio desulfuricans [Coelho, A. V., Matias, P., Fülöp, V., Thompson, A., Gonzalez, A., and Carrondo, M. A. (1997) J. Bioinorg. Chem. 2, 680-689]. Each iron is coordinated to imidazole nitrogens of four histidines in a planar arrangement, with a cysteine ligand occupying an axial position normal to this plane. In two of the subunits of the oxidized structure, a glutamate carboxylate serves as the sixth ligand to form an overall six-coordinate, octahedral coordinate environment. In the remaining two subunits, the sixth coordination site is either vacant or occupied by solvent molecules. The iron centers in all four subunits of the reduced structure exhibit pentacoordination. The structures of the oxidized and reduced forms of SOR suggest a mechanism by which superoxide accessibility may be controlled and define a possible binding site for rubredoxin, the likely physiological electron donor to SOR.

Crystallography, X-Ray↗

The FEMA GRAS assessment of benzyl derivatives used as flavor ingredients.

This publication is the eighth in a series of safety evaluations performed by the Expert Panel of the Flavor and Extract Manufacturers Association (FEMA). In 1993, the panel initiated a comprehensive program to re-evaluate the safety of more than 1700 GRAS flavoring substances under conditions of intended use. Elements that are fundamental to the safety evaluation of flavor ingredients include exposure, structural analogy, metabolism, pharmacokinetics and toxicology. Flavor ingredients are evaluated individually and in the context of the available scientific information on the group of structurally related substances. Scientific data relevant to the safety evaluation of the use of benzyl derivatives as flavoring ingredients is evaluated. The group of benzyl derivatives was reaffirmed as GRAS (GRASr) based, in part, on their self-limiting properties as flavoring substances in food; their rapid absorption, metabolic detoxication, and excretion in humans and other animals, their low level of flavor use, the wide margins of safety between the conservative estimates of intake and the no-observed-adverse effect levels determined from subchronic and chronic studies and the lack of significant genotoxic and mutagenic potential. This evidence of safety is supported by the fact that the intake of benzyl derivatives as natural components of traditional foods is greater than their intake as intentionally added flavoring substances.

Animals↗

The FEMA GRAS assessment of phenethyl alcohol, aldehyde, acid, and related acetals and esters used as flavor ingredients.

This publication is the ninth in a series of safety evaluations performed by the Expert Panel of the Flavor and Extract Manufacturers Association (FEMA). In 1993, the Panel initiated a comprehensive program to re-evaluate the safety of more than 1700 GRAS flavoring substances under conditions of intended use. Elements that are fundamental to the safety evaluation of flavor ingredients include exposure, structural analogy, metabolism, pharmacokinetics and toxicology. Flavor ingredients are evaluated individually and in the context of the available scientific information on the group of structurally related substances. Scientific data relevant to the safety evaluation of the use of phenethyl alcohol, aldehyde, acid, and related acetals and esters as flavoring ingredients is evaluated. The group of phenethylalcohol, aldehyde, acid, and related acetals and esters was reaffirmed as GRAS (GRASr) based, in part, on their self-limiting properties as flavoring substances in food, their rapid absorption, metabolic detoxication, and excretion in humans and other animals, their low level of flavor use, the wide margins of safety between the conservative estimates of intake and the no-observed-adverse effect levels determined from subchronic and chronic studies and the lack of significant genotoxic and mutagenic potential. This evidence of safety is supported by the fact that the intake of phenethyl alcohol, aldehyde, acid, and related acetals and esters as natural components of traditional foods is greater than their intake as intentionally added flavoring substances.

Acetaldehyde↗

Borrelia burgdorferi as a cause of Morgagni-Adams-Stokes syndrome. Long time follow-up study.

According the literature atrio-ventricular blockade (AVB) is the most frequent and well-known symptom of Lyme carditis. Typical signs of complete AVB include fatigue, lethargy and syncope- Morgagni-Adams-Stokes syndrome (MAS). The authors present their results and experience with 5 patients selected from a long-term study (conducted between 1987 and 1998) comprising 58 patients who developed MAS. The authors tried to evaluate the changes especially in the cardiovascular system. They correlated the clinical state with ECG findings, as well as with the levels of the Borrelia burgdorferi antibodies. The following results were obtained: 1) all patients had typical syncope, 2) the clinical course was not complicated (except one patient who developed ventricular fibrillation), 3) two patients had frequent symptomatic and asymptomatic arrhythmia including chest pain and episodic rest dyspnea, 4) subjective difficulties (usually palpitations) correlated with ECG findings (Lown 3a, 3b). The authors also looked for any relationship between clinical difficulties and levels of antibodies. The results obtained with an early permanent pacemaker were less favourable than those reported in the literature. Despite early treatment 2 patients had repeated palpitations and ECG correlates during the next years.

Adams-Stokes Syndrome↗

The FEMA GRAS assessment of aromatic substituted secondary alcohols, ketones, and related esters used as flavor ingredients.

This publication is the 11th in a series of safety evaluations performed by the Expert Panel of the Flavor and Extract Manufacturers Association (FEMA). In 1993, the Panel initiated a comprehensive program to re-evaluate the safety of more than 1700 GRAS flavoring substances under conditions of intended use. The list of GRAS substances has now grown to more than 2100 substances. Elements that are fundamental to the safety evaluation of flavor ingredients include exposure, structural analogy, metabolism, pharmacokinetics and toxicology. Flavor ingredients are evaluated individually and in the context of the available scientific information on the group of structurally related substances. In this monograph, a detailed interpretation is presented on the renal carcinogenic potential of the aromatic secondary alcohol alpha-methylbenzyl alcohol, aromatic ketone benzophenone, and corresponding alcohol benzhydrol. The relevance of these effects to the flavor use of these substances is also discussed. The group of aromatic substituted secondary alcohols, ketones, and related esters was reaffirmed as GRAS (GRASr) based, in part, on their rapid absorption, metabolic detoxication, and excretion in humans and other animals; their low level of flavor use; the wide margins of safety between the conservative estimates of intake and the no-observed-adverse effect levels determined from subchronic and chronic studies and the lack of significant genotoxic and mutagenic potential.

Alcohols↗