The urobiome in men and women: a clinical review

BACKGROUND

Antibiotic therapy alone is unable to control recurrent urinary tract infection (UTI); uropathogens have become multiresistant, and alternative strategies are needed. Far from sterile, the urinary tract contains various low-biomass microbiota, some of whose members appear to protect against clinical UTI.

OBJECTIVES

This narrative review summarizes (a) the current knowledge of male and female urobiomes in healthy and diseased states, as well as their interplay among sexual partners and (b) clinical trials to date assessing probiotic and other nonantibiotic measures to reduce UTI.

SOURCES

We used the PubMed interface to search Ovid Medline for articles describing urogenital flora, UTI, UTI dysbiosis, the effects of sexual intercourse on urogenital flora, and clinical trials of probiotics as UTI prophylaxis.

CONTENT

The healthy urobiome of women contains several Lactobacillus species, some of which may impede Escherichia coli growth in the urinary tract. Although Lactobacilli have been found in male urethral microbiota, their presence in male bladder microbiota is less certain. Distal male urethral and vaginal microbiomes of male and sexual female partners influence one another, but more research is needed on the direct interplay of their full urobiomes. Clinical trials assessing the therapeutic potential of Lactobacilli have been largely underpowered and highly varied in tested formulations and routes and frequencies of administration; as such, they have failed to show a clear benefit. Faecal microbiota transplantation for recurrent Clostridium difficile infection was shown, in a retrospective study of seven patients, to reduce recurrent UTI as a side effect.

IMPLICATIONS

The urobiome in men and women is complex, variable, and still understudied. Although there is hope that Lactobacilli and faecal microbial transplantation could be future nonantibiotic options for recurrent UTI, both require more pharmacologic and clinical research to identify optimal preparations and routes of administration.

Educational achievement and pain disability among women with chronic pelvic pain

OBJECTIVE

This study examined the relationship of level of educational (LOE) achievement to pain experience, affective disturbance, and perceived disability among women with chronic pelvic pain presenting for pain treatment.

METHODS

187 patients completed a battery of self-report inventories assessing pain, psychological status, and functional ability. Educational attainment was stratified across five levels from "less than high school" to "graduate/professional school."

RESULTS

Significant inverse associations were found between lower educational achievement and more severe pain, somatic preoccupation, emotional suffering and guardedness, and functional impairment. No differences were obtained across the groups for age, duration of pain, or symptoms of depression.

CONCLUSIONS

These data provide support for the importance of socioeconomic factors, particularly LOE, in furthering our understanding of the morbidity observed among women suffering chronic pelvic pain.

Nomenclature of magnetic, incommensurate, composition-changed morphotropic, polytype, transient-structural and quasicrystalline phases undergoing phase transitions. II. Report of an IUCr Working Group on Phase Transition Nomenclature

A general nomenclature applicable to the phases that form in any sequence of transitions in the solid state has been recommended by an IUCr Working Group [Acta Cryst. (1998). A54, 1028-1033]. The six-field notation of the first Report, hereafter I, was applied to the case of structural phase transitions, i.e. to transformations resulting from temperature and/or pressure changes between two crystalline (strictly periodic) phases involving modifications to the atomic arrangement. Extensive examples that illustrate the recommendations were provided. This second Report considers, within the framework of a similar six-field notation, the more complex nomenclature of transitions involving magnetic phases, incommensurate phases and transitions that occur as a function of composition change. Extension of the nomenclature to the case of phases with less clearly established relevance to standard schemes of transition in equilibrium systems, namely polytype phases, radiation-induced and other transient phases, quasicrystalline phases and their transitions is recommended more tentatively. A uniform notation for the translational periodicity, propagation vector or wavevector for magnetic and/or incommensurate substances is specified. The notation adopted for incommensurate phases, relying partly on the existence of an average structure, is also consistent with that for commensurate phases in a sequence. The sixth field of the nomenclature is used to emphasize the special features of polytypes and transient phases. As in I, illustrative examples are provided for each category of phase sequence.

Outcomes after surgery for thoracic outlet syndrome

PURPOSE

This study determined whether there is an association between psychological and socioeconomic characteristics and the long-term outcome of operative treatment for patients with sensory neurogenic thoracic outlet syndrome (N-TOS).

METHODS

Clinical records, preoperative psychological testing results, and long-term follow-up questionnaire data were reviewed for consecutive patients who underwent surgery for N-TOS from 1990 to 1999. Multivariate logistic regression models were developed as a means of identifying independent risk factors for postoperative disability.

RESULTS

Operative decompression of the brachial plexus via a supraclavicular approach was performed for upper extremity pain and paresthesia with no mortality and minimal morbidity in 170 patients. After an average follow-up period of 47 months, 65% of patients reported improved symptoms, and 64% of patients were satisfied with their operative outcome. However, 35% of patients remained on medication, and 18% of patients were disabled. Preoperative factors associated with persistent disability include major depression (odds ratio [OR], 15.7; P =.02), not being married (OR, 7.9; P =.04), and having less than a high school education (OR, 8.1; P =.09).

CONCLUSION

Operative decompression was beneficial for most patients. Psychological and social factors, including depression, marital status, and education, are associated with self-reported disability. The impact of the preoperative treatment of depression on the outcome of TOS decompression should be studied prospectively.

Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study

In the past decade, changing attitudes toward breast reconstruction among both patients and providers have led a growing number of women to seek breast reconstruction after mastectomy. Although investigators have documented the psychological, social, emotional, and functional benefits of breast reconstruction, little research has evaluated the effects of procedure choice on these outcomes. The current study prospectively evaluated and compared psychosocial outcomes for three common options for mastectomy reconstruction: tissue expander/implant, pedicle TRAM, and free TRAM techniques. In a prospective cohort design, patients undergoing postmastectomy reconstruction for the first time with expander/implant, pedicle TRAM, or free TRAM procedures were recruited from 12 centers and 23 plastic surgeons in the United States and Canada. Before reconstruction and at 1 year after reconstruction, patients were evaluated by a battery of questionnaires consisting of both generic and condition-specific surveys. Outcomes assessed included emotional well-being, vitality, general mental health, social functioning, functional well-being, social well-being, and body image. Baseline (preoperative) scores and the change in scores (the difference between postoperative and preoperative scores) were compared across procedure types using t tests and analysis of covariance. Preoperative and 1-year postoperative surveys were obtained from 273 patients. Procedure type was reported in 250 patients, of whom 56 received implant reconstructions, 128 pedicle TRAM flaps, and 66 free TRAM flaps. A total of 161 immediate and 89 delayed reconstructions were performed. Among women receiving immediate reconstruction, significant improvements were observed in all psychosocial variables except body image. However, no significant effects of procedure type on these changes over time existed. Similarly, delayed reconstruction patients had significant increases in emotional well-being, vitality, general mental health, functional well-being, and body image. Although the choice of reconstructive technique did not significantly impact most of these outcomes, significant differences existed among procedure types for three psychosocial subscales. Patients undergoing delayed expander/implant reconstructions reported greater improvements in vitality and social well-being relative to women receiving delayed TRAM procedures. By contrast, delayed TRAM patients noted significantly greater gains in body image compared with women choosing delayed expander-implant reconstruction. The authors conclude that both immediate and delayed breast reconstructions provide substantial psychosocial benefits for mastectomy patients. Although the choice of reconstructive procedure does not seem to significantly affect improvements in psychosocial status with immediate reconstruction, our data suggest that procedure type does have a significant effect on gains in vitality and body image for women undergoing delayed reconstruction.

Psychosocial and sexual functioning in women with vulvodynia and chronic pelvic pain. A comparative evaluation

OBJECTIVE

To determine whether women with vulvodynia differ from women with chronic pelvic pain and normal controls in their psychological functioning, somatic preoccupation, pain experience and sexual functioning.

STUDY DESIGN

Cross-sectional, self-report study of women presenting to University of Michigan specialty and general clinics for the treatment of vulvodynia or chronic pelvic pain or seeking a routine gynecologic examination. All subjects completed questionnaires assessing demographic characteristics, pain, depressive symptoms, general affective state, marital adjustment, functional activity, somatic complaints, exposures, and medical and sexual history. Univariate analyses, chi 2 tests, analyses of variance and logistic regression were used to assess associations between these variables and the diagnostic category.

RESULTS

Women with vulvodynia (n = 31) were similar to asymptomatic control women (n = 23) in demographic characteristics, sexual relationship variables, sexual behaviors, current and past depression, somatic sensitivity, and history of sexual or physical abuse. Women with chronic pelvic pain (n = 18) were younger and less educated than the other two groups and were more likely to have a history of physical and sexual abuse, to report recent depression and to screen positive for current depression, to have more work absences and to have more somatic complaints.

CONCLUSION

Women with vulvodynia are psychologically similar to control women but differ significantly from women with chronic pelvic pain. A primary psychological cause of vulvodynia is not supported.

Negative affect, self-report of depressive symptoms, and clinical depression: relation to the experience of chronic pain

OBJECTIVE

The goal of this study was to examine the relative importance of global affective distress, self-report of depressive symptoms, and presence or absence of major depression to the experience of chronic pain.

SETTING

A multidisciplinary pain program at a university medical center was the setting for this study.

PATIENTS

Subjects in this study were 211 consecutive patients with chronic pain.

OUTCOME MEASURES

Pain duration, compensation, and litigation status were controlled for in the statistical analyses, as each correlated significantly with at least one of the measures of affect. Global affective distress was assessed using the Global Severity Index (GSI) from the Brief Symptom Inventory. The Beck Depression Inventory and the Center for Epidemiological Studies Depression Scale were used as measures of self-report of depressive symptoms. Presence or absence of major depression was based on DSM-IV criteria.

RESULTS AND CONCLUSIONS

The GSI, Beck Depression Inventory, and Center for Epidemiological Studies Depression Scale were significantly correlated with each measure of the experience of pain, although clinical depression was only significantly related to self-reported disability and negative thoughts about pain. The self-report measures of depression maintained their relation to the dependent measures when the somatic items from the scales were removed, suggesting that the relations were not spuriously due to the influence of pain symptoms on the scales. When examining the unique contribution of each variable to the experience of pain (by simultaneously controlling for the other measures of affect), the GSI was uniquely related to the sensory and affective components of pain. Self-report of depressive symptoms was more highly related to a measure of the evaluative component of pain and uniquely related to self-reported disability and negative thoughts about pain. The results are discussed within the context of theoretical models of the relation between pain and affect, and suggestions for future research are presented.

Chronic myofascial pain: knowledge of diagnosis and satisfaction with treatment

OBJECTIVE

To examine the relation between pain patients' knowledge of pain diagnosis and their satisfaction with pain treatment. It was hypothesized that myofascial pain (MP) patients would be less knowledgeable regarding their diagnosis and less satisfied with the results of pain treatment.

DESIGN

Cross-sectional.

SETTING

Multidisciplinary pain clinic.

PATIENTS

Patients (n=65) were divided into two groups after multidisciplinary assessment: MP patients (n=30) and a mixed group of chronic pain patients (MCP) (n=35) with neurologic or rheumatologic disorders.

MAIN OUTCOME MEASURES

Patient self-report of their knowledge of pain diagnosis and scores on standardized measures of pain intensity, depressive symptoms, and functional disability.

RESULTS

MP patients were significantly less accurate in identifying their diagnosis and the source of their pain and were more likely to believe they suffered a physiologic disturbance "more serious and different" than their physicians had suggested. MP patients were also significantly more dissatisfied with the treatment for pain by physicians and reported particular dissatisfaction with the informational aspects of physician-patient communication. No group differences were obtained for measures of pain severity, depression, disability, pain duration, or compensation/litigation status.

CONCLUSION

MP patients appear to have less accurate beliefs regarding their pain symptoms and express more dissatisfaction with physician efforts to treat their pain. These findings emphasize the importance of patient education as a component of chronic pain intervention, particularly for MP patients.

The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors

PURPOSE/OBJECTIVES

To evaluate the effects of 10 weeks of aerobic exercise on depressive and anxiety symptoms and self-esteem of breast cancer survivors.

DESIGN

Experimental, crossover.

SETTING

Midwestern university town.

SAMPLE

Twenty-four breast cancer survivors (mean time following surgery 41.8 months; ranging from 1 to 99 months) recruited via mail and cancer support groups. The mean age of the sample was 48.9 years.

METHODS

Subjects were assigned randomly into exercise (EX), exercise-plus-behavior modification (EX + BM), and control groups. EX and EX + BM groups exercised aerobically four days/week at > or = 60% of age-predicted maximum heart rate for 10 weeks. Data were collected pretest, post-test, and crossover (12 weeks following post-test). Because pretest or post-test scores showed no statistical differences between EX and EX + BM groups, data were combined to form one group.

MAIN RESEARCH VARIABLES

Aerobic exercise (four days/ week; 30-40 minutes/session), depression, (Beck Depression inventory), anxiety (Speilberger State-Trait Anxiety Inventory), and self-esteem (Rosenberg Self-Esteem Inventory).

FINDINGS

Pre- to post-test analyses revealed that women who exercised had significantly less depression and state and trait anxiety over time compared to controls. After the crossover, the control group demonstrated comparable improvements in both depressive and state anxiety scores. Self-esteem did not change significantly. Subjects who received exercise recommendations from their physicians exercised significantly more than subjects who received no recommendation.

CONCLUSIONS

Mild to moderate aerobic exercise may be of therapeutic value to breast cancer survivors with respect to depressive and anxiety symptoms but not to self-esteem. A physician's recommendation to exercise appears to be an important factor in a patient's exercise adherence.

IMPLICATIONS FOR NURSING PRACTICE

To Improve depressive and anxiety symptoms following breast cancer surgery, healthcare professionals should consider recommending mild to moderate exercise.

Giant lymph node hyperplasia (Castleman's disease) presenting with chylous pleural effusion

A case of giant lymph node hyperplasia (Castleman's disease) with an original presentation of a chylous pleural effusion occurred in a female adolescent. CT scans showed mediastinal lymphadenopathy. Lymph node biopsy was consistent with the plasmacytic variant of Castleman's disease.

Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis

OBJECTIVE

This study examined the ability of two self-report questionnaires, the Beck Depression Inventory (BDI) and the Center for Epidemiological Studies-Depression Scale (CES-D), to discriminate between chronic pain patients with and without major depression. Since previous research has suggested that medical conditions such as chronic pain can influence the endorsement of items that measure neurovegetative symptoms of depression, the accuracy of each of these questionnaires was also assessed eliminating these items.

SUBJECTS

These included 132 consecutive patients with chronic pain, 44 of whom were diagnosed as suffering from major depression according to DSM-IV criteria.

METHODS

Patients were administered a battery of questionnaires that included the CES-D and BDI. They were also interviewed by a clinical psychologist to determine the presence or absence of major depression.

RESULTS

Both questionnaires were able to discriminate significantly between persons with and without major depression. Removal of the somatic items on each questionnaire did not improve their accuracy. Discriminant function analysis revealed an optimal cut-off score of 21 for the BDI, and 27 for the CES-D. Overall hit rates at these cut-offs for the two questionnaires were comparable, while the CES-D had somewhat better sensitivity (81.8% vs. 68.2%). Conversely, the BDI had slightly better specificity (78.4% vs. 72.7%).

CONCLUSION

The results suggest that both questionnaires have good predictive validity among chronic pain patients, and decisions regarding the use of one questionnaire rather than the other may depend upon the goals of the user and the setting within which the questionnaire is used.

The relationship between symptoms of post-traumatic stress disorder and pain, affective disturbance and disability among patients with accident and non-accident related pain

Recent studies have reported a high prevalence of symptoms of post-traumatic stress disorder (PTSD) among individuals with chronic pain. Studies suggest that persons with pain and PTSD also display higher levels of affective disturbance. In the present study we examined self-reports of pain, affective disturbance, and disability among pain patients with and without symptoms of PTSD. Patients without PTSD symptoms were further subdivided into persons whose pain was the result of an accident or insidious in onset. Thus, three groups were examined: (1) persons with accident related pain and high PTSD symptoms (Accident/High PTSD); (2) persons with no or few symptoms of PTSD whose pain was accident related (Accident/Low PTSD); and (3) patients whose pain was not accident related and did not have PTSD symptoms (No Accident). No Accident patients were older than persons with accident related injuries, and both accident related pain groups were more likely than No Accident patients to be involved in litigation or receiving compensation. Thus, these variables were controlled for in the statistical analyses. Self-report of pain was also included as a covariate in the analyses examining group differences in affective disturbance and disability. Accident/High PTSD patients displayed higher levels of self-reported pain compared to the other two groups. The Accident/High PTSD group also had the highest levels of affective disturbance. Both accident groups tended to report greater disability compared to patients whose pain was not accident related. These findings suggest that PTSD symptoms in chronic pain patients are associated with increased pain and affective distress. Accident related pain, even without the presence of PTSD symptoms, appears to be associated with greater disability. The results indicate that the identification and treatment of PTSD symptoms in refractory pain patients may be a critical albeit subtle factor in the effective management of suffering and disability in this population.

Maternal distress and perceptions of infant development following extracorporeal membrane oxygenation and conventional ventilation for persistent pulmonary hypertension

Neurodevelopmental outcome and concurrent maternal distress were examined for infants who suffered persistent pulmonary hypertension at birth and were treated with either extracorporeal membrane oxygenation (ECMO) (n = 19) or conventional ventilation (CV) (n = 15). Mothers were asked to complete inventories assessing their infant's (mean age 8.74 months) developmental growth as well as their own psychological health. Relevant sociodemographic and treatment parameters were also entered into the analysis. The results indicated that ECMO and CV infants did not differ on developmental indices and impairment rates were 15-23% respectively, similar to previous reports. In addition, ECMO and CV mothers did not differ in their reports of psychological distress. Correlational analyses revealed that length of treatment for ECMO but not CV infants significantly predicted developmental delay and maternal distress. For CV mothers, maternal distress was associated with the perception of delayed language. The results are discussed in terms of the limited morbidity associated with ECMO and CV interventions and the possible role of a 'vulnerable child syndrome' in understanding the maternal-infant relationship following ECMO therapy.

Zygomycosis due to Mucor circinelloides in a neutropenic patient receiving chemotherapy for acute myelogenous leukemia

Mucor circinelloides form circinelloides has rarely been associated with human disease, even in immunocompromised patients. We report a case of cutaneous zygomycosis caused by M. circinelloides in a 23-year-old neutropenic woman receiving consolidation chemotherapy for acute myelogenous leukemia. The organism was exquisitely susceptible to amphotericin B. Despite the fact that the patient was profoundly neutropenic for an additional 3 weeks, the lesions began to resolve during therapy, and no surgical debridement was required.

Use of induced sputum specimens for microbiologic diagnosis of infections due to organisms other than Pneumocystis carinii

The optimal diagnostic approach to pneumonia provides a rapid microbiologic identification of pulmonary pathogens by the least invasive means. The technique of sputum induction has been useful in the evaluation of patients with Pneumocystis carinii or mycobacterial pneumonia. It is not known whether induced sputum samples are preferable for the detection of pathogens other than P. carinii or mycobacteria. Microbiologic yields were evaluated from identically processed induced and conventional sputum samples collected from 509 consecutive patients. No statistically significant differences were found between the microbiologic yields of induced and spontaneous sputum samples. Bacterial pathogens were isolated in 19.6% of induced and 23.5% of routine specimens. Mycobacteria were cultured from 13.1% of routine and 9.4% of induced specimens. Non-Candida albicans fungi grew from 24% of routine and 20% of induced specimens. The process of sputum induction with aerosolized hypertonic saline did not alter either the purulence or the bacterial quantitation of Gram-stained sputum specimens. Sputum induction has been useful for the cytologic diagnosis of malignancy, for the diagnosis of pneumocystosis and tuberculosis, and in patients unable to spontaneously produce sputum samples. The use of induced sputum samples for the diagnosis of other infections may not be necessary when routine sputum specimens are available.

Phase Equilibria and Crystal Chemistry in Portions of the System SrO-CaO-Bi2O3-CuO, Part IV- The System CaO-Bi2O3-CuO

New data are presented on the phase equilibria and crystal chemistry of the binary systems CaO-Bi2O3 and CaO-CuO and the ternary CaO-Bi2O3-CuO. Symmetry data and unit cell dimensions based on single crystal and powder x-ray diffraction measurements are reported for several of the binary CaO-Bi2O3 phases, including corrected compositions for Ca4Bi6O13 and Ca2Bi2O5. The ternary system contains no new ternary phases which can be formed in air at ~700-900 °C.

Activity of topoisomerase inhibitors against Pneumocystis carinii in vitro and in an inoculated mouse model

Five topoisomerase II inhibitors (amsacrine [m-AMSA], two epipodophyllotoxins, and two quinolones) and the alkaloid camptothecin (a topoisomerase I inhibitor) were evaluated to assess their activities against Pneumocystis carinii. In vitro, both etoposide (VP-16) and teniposide (VM-26) at 1 microgram/ml suppressed P. carinii growth. Amsacrine was toxic to P. carinii and to the feeder cells in vitro. Camptothecin suppressed the growth of P. carinii in vitro only at 100 micrograms/ml. Studies in immunosuppressed mice demonstrated the efficacy of teniposide against P. carinii pneumonia, but successful administration of teniposide was schedule dependent with significant toxicity at therapeutic dosages.

Phase Equilibria and Crystal Chemistry in Portions of the System SrO-CaO-Bi2O3-CuO, Part II-The System SrO-Bi2O3-CuO

New data are presented on the phase equilibria and crystal chemistry of the binary systems Sr0-Bi₂0₃ and SrO-CuO and the ternary system SrO-Bi₂O₃-CuO. Symmetry data and unit cell dimensions based on single crystal and powder x-ray diffraction measurements are reported for all the binary SrO-Bi₂O₃ phases, including a new phase identified as Sr₆Bi₂O₉. The ternary system contains at least four ternary phases which can be formed in air at ~900 °C. These are identified as Sr₂Bi₂CuO₆, Sr₈Bi₄Cu₅O_19+x , Sr₃Bi₂Cu₂O₈ and a solid solution (the Raveau phase) which, for equilibrium conditions at ~900 °C, corresponds approximately to the formula Sr_1.8-x Bi_2.2+x Cu_1±x/2O _z .(0.0⩽x⩽~0.15). Superconductivity in this phase apparently occurs only in compositions that correspond to negative values of x. Compositions that lie outside the equilibrium Raveau-phase field often form nearly homogeneous Raveau-phase products. Typically this occurs after relatively brief heat treatments, or in crystallization of a quenched melt.

Videophone use improves maternal interest in transported infants

A telephone video transmission unit was utilized to assist in the attachment of mothers to their transported sick infants. To evaluate its effectiveness, the number of telephone calls to the ICN made by the mothers using the unit was used as a variable to "quantify" interest in their newborns; this was compared with the number of calls made by a matched group of mothers who did not utilize the videophone. There was a significantly larger number of calls made by the study mothers both while hospitalized and after discharge when they no longer had use of the videophone. Use of the unit appeared to alleviate some maternal anxieties and encouraged early endearment by the study mothers. How this affects the long-term relationship between infant and mother will require further follow-up investigation.

Risk factor analysis of intraventricular hemorrhage in low-birth-weight infants

Sixty of 63 newborn infants weighing less than 1,250 gm, admitted consecutively to the Intensive Care Nursery during a 15-month period, were prospectively investigated for the incidence of intraventricular hemorrhage by early computerized tomography or by autopsy. Nineteen of the 60 infants had evidence of IVH. The incidence of IVH was correlated with the presence of possible neonatal, obstetrical, asphyxial, or therapeutic risk factors. There was a significant difference in only one of the risk factors: birth outside the perinatal center. Fifteen of 27 outborn infants (56%) developed IVH, whereas only four of 33 inborn infants (12%) developed IVH (P less than 0.001). There were no statistically significant differences in maternal obstetrical risk factors, infant risk factors, or indices of birth asphyxia in the inborn compared with the outborn infants. However, perinatal therapeutic risk factors differed between the two groups. Outborn infants were less likely to have received betamethasone (P less than 0.001), were less likely to have their arterial blood gases monitored and stabilized during the first 20 minutes after birth (P less than 0.001), and were given more bicarbonate (P less than 0.001) and more boluses of fluid intravenously (P less than 0.02). The risk of IVH in very low birth-weight infants may be significantly decreased by therapeutic factors at birth. Maternal transport to a perinatal center and intensive neonatal resuscitation may contribute to decreasing the incidence of intraventricular hemorrhage.

Right frontal lobe activation and right hemisphere performance. Decrement during a depressed mood

Evidence from psychiatric patients has suggested that depressive affect may coincide with a decrement in the functioning of the right cerebral hemisphere. We have observed that college students who reported greater depression also reported less vivid imagery. Students undergoing experimental induction of depressive and euphoric moods in the laboratory showed an auditory attentional bias and impaired imagery during the depression condition, while their arithmetic task performance was unchanged. A second mood-induction experiment indicated a depressed mood to be characterized by asymmetrical EEG activation over the frontal lobes, with relatively greater activity in the right frontal region. These observations suggest that anterior regions of the brain may modulate the differential effects of emotional arousal on the information-processing capacities of the cerebral hemispheres.

Nosocomial respiratory syncytial virus infections in an intensive care nursery: rapid diagnosis by direct immunofluorescence

A nosocomial outbreak of respiratory syncytial virus infections involved 8 of 17 infants in an Intensive Care Nursery and one additional infant in the adjoining Newborn Nursery. Immunofluorescent staining of nasopharyngeal specimens was positive in six of seven virologically confirmed cases (86%). One additional case with negative viral cultures was also identified by this technique. Viral isolation in tissue cultures required an average of 4.9 days, whereas results of immunofluorescent studies were available in two to four hours. Rapid identification of infected infants by immunofluorescence permitted prompt institution of infection control measures.

Phase Equilibria and Crystal Chemistry of Rubidium Niobates and Rubidium Tantalates

The phase equilibria relations and crystal chemistry of portions of the Rb₂O-Nb₂O₅ and Rb₂O-Ta₂O₅ systems were investigated for structures potentially useful as ionic conductors. A hexagonal tungsten bronze-type (HTB) structure was found in both systems as well as three hexagonal phases with mixed HTB-pyrochlore type structures. Ion exchange experiments between various alkali ions are described for several phases. Unit cell dimensions and x-ray diffraction powder patterns are reported.

Investigation of Calcium Aluminate Cement Phases Under High Gaseous Pressure

The chemical degradation of refractory cement castable liners is important in the coal gasification process. The system CaO-Al₂O₃-H₂O has been investigated at high temperature and pressure. A pseudobinary reaction diagram was constructed for the system CaO-Al₂O₃-H₂O in steam at 1000 psig. Several experiments were conducted in the CaO-Al₂O₃-H₂O system in CO₂, CH₄, and CO.

Personality correlates of EEG change during meditation

15 seminary students who regularly practiced a form of Christian meditation were given the Minnesota Multiphasic Personality Inventory (MMPI). Electroencephalographic (EEG) signals were recorded and analyzed for percent time alpha during performance of a series of mental arithmetic tasks and also during a period of meditation. Higher scores on the Hypochondriasis scale of the MMPI were associated with increase in alpha as the subject proceeded from the mental arithmetic tasks to the meditation period. This result is discussed in terms of previous research, the pre-meditation level of alpha, and the implications for the use of meditation as a therapeutic procedure.

Phase Equilibria and Crystal Growth in the Alkali Antimonate Systems Sb2O4-NaSbO3/ Sb2O4-KSbO3/, and Sb2O4-NaSbO3-NaF

Phase equilibrium diagrams have been constructed from experimental data for the systems Sb₂O₄–NaSbO₃, Sb₂O₄–KSbO₃, and Sb₂O₄–NaSbO₃–NaF. The system Sb₂O₄–NaSbO₃ contains only an intermediate pyrochlore type solid solution with a maximum melting point of 1490 °C at a Na:Sb atom ratio of 3:5. The Sb₂O₄–KSbO₃ system contains in addition to the pyrochlore phase a compound 3K₂O • 5Sb₂O₅ which melts congruently at about 1450 °C and two polymorphs of K₂O • 2Sb₂O₅. The low temperature form of K₂O • 2Sb₂O₅ was found to be monoclinic P2₁/c with a = 7.178, b = 13.378, c = 11.985 A, β = 124°10′. The melting point of Sb₂O₄ was found to be 1350 ± 5 °C and NaSbO₃ and KSbO₃ both melt congruently at 1555 ± 5 °C and 1410 ± 5 °C respectively. The previously reported cubic form of KSbO₃ was found to be a K⁺ deficient phase stabilized by reaction with atmospheric moisture. A similar cubic phase which appears to be a good Na⁺ ion conductor can be synthesized in the ternary system NaSbO₃–Sb₂O₄–NaF.

Temperature-Pressure Phase Relationships in Niobium Pentoxide

A pressure-temperature (P-T) section of the phase equilibrium diagram for Nb2O5 has been determined. Four single phase regions, H-Nb2O5, B-Nb2O5, and two L-Nb2O5 areas, were characterized by x-ray powder diffraction data. The superstructure of L-Nb2O5 was indexed on the basis of similarities to the known superstructures of L-Ta2O5 and confirmed with single crystal electron diffraction data. The correct unit cell is orthorhombic with a = 6.168, b = 29.312, c = 3.938 Å, with the b axis 8 times the subcell (8 × 3.664 Å).

Effect of Oxide Additions on the Polymorphism of Tantalum Pentoxide: III. "Stabilization" of the Low Temperature Structure Type

The "low temperature structure type" of Ta2O5 has been found to occur in two distinct forms with the lowest temperature form having a unit cell 14 times the subcell and an intermediate temperature form with a unit cell 11 times the subcell. The two types form intermediate partially ordered mixtures which are apparently in thermal equilibrium at various temperatures between ~ 1000 and 1350 °C. The addition of MoO3, WO3, SiO2, GeO2, ZrO2, TiO2, B2O3 and Al2O3 each affect the multiplicity of the true unit cell in different ways. WO3, SiO2, GeO2, B2O3, and Al2O3 form phases structurally similar to "low-Ta2O5" which are stable up to the solidus temperatures of the corresponding systems.

Effect of Oxide Additions on the Polymorphism of Tantalum Pentoxide: II. "Stabilization" of the High Temperature Structure Type

The high temperature, apparently tetragonal, polymorph of tantalum pentoxide can be obtained at room temperature by quenching a specimen containing 2-5 mole percent of the following oxides:SnO2, Ga2O3, Cr2O3, Fe2O3, Sc2O3, or MgO. All the x-ray patterns can be indexed on a body centered tetragonal cell with a ≈ 3.830 Å, c ≈ 35.68 Å. However, P2O5, V2O5, Nb2O5, ZrO2, Lu2O3, NiO, or ZnO do not stabilize the tetragonal form at room temperature. Single crystals of scandium "stabilized" Ta2O5 have been grown by the Czochralski technique.

High Temperature Dehydroxylation of Apatitic Phosphates

Sr₁₀P₆O₂₄(OH)₂, (Hex. a = 9.765 Å, c = 7.280 Å), and Ba₁₀P₆O₂₄(OH)₂, (Hex. a = 10.177 Å, c = 7.731 Å), undergo cell parameter contractions at elevated temperatures in air. These can be correlated with progressive dehydroxylation, although neither can be completely dehydrated. Pb₁₀P₆O₂₄(OH)₂, (Hex. a = 9.878 Å, c = 7.432 Å), also does not completely dehydrate in air. A new apatite-like strontium phosphate, (Hex. a = 9.872 Å, c = 7.199 Å), was prepared at elevated temperatures in vacuum.

Effect of Oxide Additions on the Polymorphism of Tantalum Pentoxide (System Ta2O5-TiO2)

The phase equilibrium relationships of the TiO₂-Ta₂O₅ system were determined in air. An equimolar compound, TiTa₂O₇, was found to melt congruently at about 1662 °C and have a monoclinic unit cell a = 20.291 Å, b = 3.804 Å, c = 11.831 Å, β = 120°14', apparently isostructural with TiNb₂O₇. In addition, two other compounds are postulated to occur at about TiO₂:49Ta₂O₅ and TiO₂:7Ta₂O₅ and to dissociate at about 1230 and 1190 °C, respectively. TiO₂ apparently accepts a maximum of 9 mole percent Ta₂O₅ in solid solution at 1630 °C. Two eutectics occur in the system at 54 mole percent Ta₂O₅ and 1650 °C and 31 mole percent Ta₂O₅ and 1630 °C. The high temperature form of Ta₂O₅ is apparently triclinic at room temperature with a = 3.801 Å, b = 3.785 Å, c = 35.74 Å, α = 90°54.4', β = 90°11.5', and γ = 89°59.9'. A metastable transition occurs at 320 °C to a monoclinic form which inverts to tetragonal at 920 °C with a = 3.81 Å, c = 36.09 Å. Several intermediate morphotropic phases are found with up to 9 mole percent TiO₂ in solid solution.

Phase Equilibria as Related to Crystal Structure in the System Niobium Pentoxide-Tungsten Trioxide

The phase equilibrium diagram for the binary system niobium pentoxide-tungsten trioxide has been constructed from results of x-ray diffraction studies on both single crystals and powders and from fusion characteristics. Twelve stable compounds have been found in the system. The exact composition of eight of these compounds has been established by single crystal analyses at the Nb2O5:WO3 ratios of 6:1, 13:4, 7:3, 8:5, 9:8, 1:1, 4:9, and 2:7. The approximate compositions of the remaining four other phases are 30:1, 6:11, 1:11, and 1:15. The 6:1, "6:11", 4:9, and 2:7 phases melt eongruently at 1476, 1378, 1380, and 1357 °C, respectively. The "30:1", 7:3, 8:5, 9:8, "1:11", and "1:15" phases melt incongruently at 1470, 1440, 1385, 1375, 1356, and 1358 °C, respectively; and the 13:4 and 1:1 phases decompose before melting at 1435 and 1115 °C, respectively. The 8:5, 9:8, "6:11", 2:7, "1:11", and "1:15" compounds are shown on the phase diagram as having minimum temperatures of stability. One metastable phase having a narrow range of composition near the 3:8 ratio was also encountered. Although Nb2O5 apparently exhibits no solid solution, WO3 was found to accept a maximum of three mole percent niobia in solid solution enabling all the reported polymorphs of WO3 to be obtained at room temperature.

Phase Equilibria in the System Vanadium Oxide-Niobium Oxide

The phase diagram for the pseudo-binary system V2O5-Nb2O5 was constructed from fusion characteristics and x-ray diffraction data. Three compounds were postulated for the system. The compound VNb9O25 and V2Nb23O62 were found to melt incongruently at about 129O °C and 1322 °C respectively. The third compound occurring at about 93 to 94 mole percent Nb2O5 melted incongruently at approximately 1332 °C. Apparently,Nb2O5 accepted up to 5 mole percent V2O5 in solid solution, however, V2O5 did not accept any appreciable Nb2O5 in solid solution. In addition, the Nb2O5 rich portions of the following binary systems were reinvestigated: ZnO - Nb2O5, NiO - Nb2O5, A12O3 - Nb2O5, TiO2 - Nb2O5, and ZrO2 - Nb2O5. In each case an Nb2O5 solid solution had been reported previously in excess of 9O mole percent Nb2O5.However, subsequent data indicated that these Nb2O5 solid solutions contained discrete compounds which are related to those found in the pseudo-binary V2O5 - Nb2O5.

Phase Equilibrium Relations in the Binary System Barium Oxide-Niobium Pentoxide

A large portion of the phase equilibrium diagram for the binary system barium oxide-niobium pentoxide has been constructed from observations of fusion characteristics and X-ray diffraction data. In the system five binary compounds were observed with BaO: Nb₂O₅ ratios of 5:2, 1:1, 6:7, 3:5, and 1:3 and a 6:1 compound was postulated. The 1:1 compound was found to melt congruently at 1,455 °C and have only one stable polymorph, although a second metastable polymorph can also be prepared. The 5:2 compound melts congruently at 1,542 °C; the 6:7, 3:5, and 1:3 phases melt incongruently at 1,330, 1,290, and 1,315 °C, respectively. The phase relations of the 6:1 compound could not be determined due to the reaction between this phase and platinum metal. No 2:1 compound was observed in this system.

Solid State Reactions Involving Oxides of Trivalent Cations

Selected mixtures in 69 binary systems involving Al2O3, Ga2O3, Cr2O3, Fe2O3, Sc2O3, In2O3, Y2O3, and the rare earth oxides were studied by X-ray diffraction techniques after heat treatment at various temperatures. A plot of the radii of the A+3 cations versus the radii of B+3 cations shows the regions of stability for the different structure types found for the double oxides of the trivalent cations. The following structure types were encountered: A, B, and C-type rare earth oxide; corundum, beta gallia; kappa alumina; garnet; perovskite; and several types which could not be definitely related to known structures. The majority of A+3B+3O3 compounds have the perovskite structure. Several phases, including (1-x)Fe2O3·xAl2O3 ss and (1-x)Fe2O3·Ga2O3 ss, appear to have structures similar to kappa alumina. Solid solution definitely occurs in many of the garnet type compounds which contain gallia. Based on the data collected in this survey, the subsolidus phase equilibria relationships of 79 binary systems were drawn.

Phase Equilibria in Systems Involving the Rare-Earth Oxides. Part I. Polymorphism of the Oxides of the Trivalent Rare-Earth Ions

The polymorphic relationships of the pure rare-earth oxides have been reinvestigated using X-ray diffraction methods for identification of phases. The oxides of the trivalent rare earth ions crystallize in three different types: A, B, and C. Each oxide has only one truly stable polymorph: La₂O₃, Ce₂O₃, Pr₂O₃, and Nd₂O₃ belong to the A type; Sm₂O₃, Eu₂O₃, and Gd₂O₃ to the B type; Tb₂O₃, Dy₂O₃, Ho₂O₃, Er₂O₃, Tm₂O₃, Yb₂O₃, and Lu₂O₃ to the C type. In addition Nd₂O₃, Sm₂O₃, Eu₂O₃, and Gd₂O₃ have low-temperature, apparently metastable, C-type polymorphs. The low-temperature form inverts irreversibly to the stable form at increasingly higher temperatures for decreasing cation radius.