Attenuated peripheral oxygen extraction and greater cardiac output in women with posttraumatic stress disorder during exercise

Posttraumatic stress disorder (PTSD) is associated with an increased risk of developing cardiovascular disease, especially in women. Evidence indicates that men with PTSD exhibit lower maximal oxygen uptake (V̇o2max) relative to controls; however, whether V̇o2max is blunted in women with PTSD remains unknown. Furthermore, it is unclear what determinants (i.e., central and/or peripheral) of V̇o2max are impacted by PTSD. Therefore, we evaluated the central (i.e., cardiac output; Q̇c) and peripheral (i.e., arteriovenous oxygen difference) determinants of V̇o2max in women with PTSD; hypothesizing that V̇o2max would be lower in women with PTSD compared with women without PTSD (controls), primarily due to smaller increases in stroke volume (SV), and therefore Q̇c. Oxygen uptake (V̇o2), heart rate (HR), Q̇c, SV, and arteriovenous oxygen difference were measured in women with PTSD (n = 14; mean [SD]: 43 [11] yr,) and controls (n = 17; 45 [11] yr) at rest, and during an incremental maximal treadmill exercise test, and the Q̇c/V̇o2 slope was calculated. V̇o2max was not different between women with and without PTSD (24.3 [5.6] vs. 26.4 [5.0] mL/kg/min; P = 0.265). However, women with PTSD had higher Q̇c [P = 0.002; primarily due to greater SV (P = 0.069), not HR (P = 0.285)], and lower arteriovenous oxygen difference (P = 0.002) throughout exercise compared with controls. Furthermore, the Q̇c/V̇o2 slope was steeper in women with PTSD relative to controls (6.6 [1.4] vs. 5.7 [1.0] AU; P = 0.033). Following maximal exercise, women with PTSD exhibited slower HR recovery than controls (P = 0.046). Thus, despite attenuated peripheral oxygen extraction, V̇o2max is not reduced in women with PTSD, likely due to larger increases in Q̇c.NEW & NOTEWORTHY The current study indicates that V̇o2max is not different between women with and without PTSD; however, women with PTSD exhibit blunted peripheral extraction of oxygen, thus requiring an increase in Q̇c to meet metabolic demand during exercise. Furthermore, following exercise, women with PTSD demonstrate impaired autonomic cardiovascular control relative to sedentary controls. We interpret these data to indicate that women with PTSD demonstrate aberrant cardiovascular responses during and immediately following fatiguing exercise.

Perinatal Symptoms and Treatment Engagement in Female Veterans

INTRODUCTION

Women veterans using Veterans Health Care Administration maternity benefits have a high prevalence of mental health disorders, including depression, PTSD, and anxiety. Additionally, women with psychiatric histories often experience a relapse or worsening of symptoms during pregnancy and postpartum. Adequate perinatal mental healthcare engagement is critical to optimizing outcomes for mother and child.

MATERIALS AND METHODS

This study evaluated psychiatric symptom severity and predictors of women veteran's mental health treatment engagement during pregnancy and postpartum at the VA North Texas Health Care System. Seventy women using Veterans Health Administration were assessed longitudinally via chart review and interviews (including the Edinburgh Postnatal Depression Scale) during pregnancy and postpartum. A Friedman test was used to evaluate the change in symptom severity during (1) the 6 months before pregnancy, (2) pregnancy, and (3) postpartum. Multivariate logistic regressions were used to determine predictors of attending outpatient mental health appointments. Potential predictors examined included sociodemographic factors, symptoms of depression, history of military sexual assault, presence of a pre-pregnancy psychiatric diagnosis, and attendance of mental health appointments before pregnancy.

RESULTS

Approximately 40% of participants demonstrated at least mild psychiatric symptoms before pregnancy, and symptom severity did not significantly change across the perinatal period (pre-pregnancy, pregnancy, and postpartum) X2 (2, n = 70) = 3.56, P = .17. Depressive symptoms during the 2nd or 3rd trimester were a significant predictor for attendance of mental health appointments during both pregnancy (OR = 1.18, 95% CI, 1.04 to 1.34) and postpartum (OR = 1.18, 95% CI, 1.02 to 1.36). An active psychiatric diagnosis during the 6 months before pregnancy was also a significant predictor of attendance following delivery (OR = 14.63, 95% CI, 1.55 to 138.51).

CONCLUSION

Our results demonstrate that women with prior histories of mental health conditions will continue to be symptomatic, and this is a good predictor of mental health treatment engagement during the perinatal period.

Abnormal sympathetic neural recruitment patterns and hemodynamic responses to cold pressor test in women with posttraumatic stress disorder

The novel findings of the present study are that women with posttraumatic stress disorder (PTSD) have an augmented pressor response to the sympathoexcitatory stimulus of a cold pressor test (CPT) compared with healthy control subjects. Although integrated muscle sympathetic nerve activity burst responses were not significantly different between groups, total sympathetic action potential discharge in response to the CPT was markedly elevated in women with PTSD exhibiting increased firing of low-threshold axons as well as the recruitment of latent subpopulations of larger-sized axons that are otherwise silent at baseline. Aberrant autonomic circulatory control in response to sympathoexcitatory stimulus may in part explain the propensity toward developing hypertension and cardiovascular disease in this population.

Early onset neurocirculatory response to static handgrip is associated with greater blood pressure variability in women with posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a psychiatric illness that is more prevalent in women, and accumulating evidence suggests a link between PTSD and future development of cardiovascular disease. The underlying mechanisms are unclear, but augmented sympathetic reactivity to daily stressors may be involved. We measured muscle sympathetic nerve activity (MSNA), blood pressure (BP), and heart rate responses in 14 women with PTSD and 14 healthy women (controls) during static handgrip (SHG) exercise to fatigue at 40% of maximal voluntary contraction (MVC). Two minutes of postexercise circulatory arrest (PECA) was followed immediately after SHG to fatigue. MVC and the time to fatigue during SHG did not differ between groups (both P > 0.05). At the first 30 s of SHG, women with PTSD showed augmented sympathetic neural [mean ± SD, ∆MSNA burst frequency (BF): 5 ± 4 vs. 2 ± 3 bursts/30 s, P = 0.02 and ∆MSNA total activity (TA): 82 ± 58 vs. 25 ± 38 arbitrary units/30 s, P = 0.004] and pressor (∆systolic BP: 10 ± 5 vs. 4 ± 3 mmHg, P = 0.003) responses compared with controls. However, MSNA and BP responses at fatigue and during PECA were not different between groups. More interestingly, the augmented initial neural and pressor responses to SHG were associated with greater awake systolic BP variability during ambulation in women with PTSD (MSNA BF: r = 0.55, MSNA TA: r = 0.62, and SBP: r = 0.69, all P < 0.05). These results suggest that early onset exercise pressor response in women with PTSD may be attributed to enhanced mechano- rather than metaboreflexes, which might contribute to the mechanisms underlying the link between PTSD and cardiovascular risk.NEW & NOTEWORTHY The novel findings of the current study are that women with posttraumatic stress disorder (PTSD) exhibited augmented sympathetic neural and pressor responses at the first 30 s of submaximal isometric muscle contraction. More interestingly, exaggerated neurocirculatory responses at the onset of muscle contraction were associated with greater ambulatory awake systolic blood pressure fluctuations in women with PTSD. Our findings expand the knowledge on the physiological mechanisms that perhaps contribute to increased risk of cardiovascular disease in such a population.

Reduced left ventricular diastolic function in women with posttraumatic stress disorder

Women are two to three times more likely to develop posttraumatic stress disorder (PTSD) compared with men after exposure to a major trauma, and PTSD is associated with increased risk for cardiovascular disease in later life. The underlying mechanisms are unclear, but alterations in cardiac function may be involved. We hypothesized that women with PTSD have reduced left ventricular (LV) diastolic function. We studied 14 women with PTSD (PTSD group) and 14 women without PTSD (controls) using echocardiography Doppler to evaluate LV diastolic function, including peak velocities (E and A waves) in transmitral flow; diastolic, atrial kick, and systolic waveform velocities (e′, a′, and s′) in tissue Doppler; the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e′); and velocity of propagation ( Vp) . Baseline characteristics including age, body size, blood pressure, and heart rate were not significantly different between the two groups. Compared with the control group, women with PTSD showed greater E/e′ (controls vs. PTSD group: 7.0 ± 1.3 vs. 9.1 ± 1.3, P = 0.002) and smaller Vp (controls vs. PTSD group: 63.7 ± 11.3 vs. 47.5 ± 6.9 cm/s, P = 0.003). These results suggest that women with PTSD have reduced LV diastolic function, which may contribute, at least in part, to the increased risk of cardiovascular disease later in life.

Cerebral blood flow regulation and cognitive function in women with posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is associated with structural and functional alterations in a number of interacting brain regions, but the physiological mechanism for the high risk of cerebrovascular disease or impairment in brain function remains unknown. Women are more likely to develop PTSD after a trauma than men. We hypothesized that cerebral blood flow (CBF) regulation is impaired in women with PTSD, and it is associated with impairment in cognitive function. To test our hypothesis, we examined dynamic cerebral autoregulation (CA) and cognitive function by using a transfer function analysis between arterial pressure and middle cerebral artery blood velocity and the Stroop Color and Word test (SCWT), respectively. We did not observe any different responses in these hemodynamic variables between women with PTSD ( n = 15) and healthy counterparts (all women; n = 8). Cognitive function was impaired in women with PTSD; specifically, reaction time for the neutral task of SCWT was longer in women with PTSD compared with healthy counterparts ( P = 0.011), but this cognitive dysfunction was not affected by orthostatic stress. On the other hand, transfer function phase, gain, and coherence were not different between groups in either the supine or head-up tilt (60°) position, or even during the cognitive challenge, indicating that dynamic CA was well maintained in women with PTSD. In addition, there was no relationship between cognitive function and dynamic CA. These findings suggest that PTSD-related cognitive dysfunction may not be due to compromised CBF regulation.

NEW & NOTEWORTHY Cognitive function was impaired; however, dynamic cerebral autoregulation (CA) as an index of cerebral blood flow regulation was not impaired during supine and 60° head-up tilt in women with PTSD compared with healthy females. In addition, there was no relationship between cognitive function and dynamic CA. These findings suggest that the mechanism of PTSD-related cognitive dysfunction may not be due to CBF regulation.

Exercise for PTSD in Women Veterans: A Proof-of-Concept Study

INTRODUCTION

The safety, feasibility, and efficacy of a 12-week structured exercise program targeting post-traumatic stress disorder (PTSD) in women Veterans of childbearing age was tested in a pilot study.

MATERIALS AND METHODS

Thirty-one women Veterans of childbearing age were enrolled in the study, 22 remained eligible after the baseline assessment, and 16 completed the exercise protocol. The exercise program consisted of moderate intensity aerobic exercise (brisk walking), 4 times a week, for 12 weeks. Data were collected on duration, intensity, and side effects. The Clinician Administered PTSD Scale was administered at baseline and at the end of 12 weeks. Weekly assessments provided data on PTSD and depression symptoms, pain, and quality of life.

RESULTS

Both post-traumatic and depressive symptoms improved significantly by the end of study. There were no adverse events related to exercise. A small focus group provided subjective experiences supporting positive effects of exercise on emotion and physical health.

CONCLUSION

The preliminary results of this study suggests that 12 weeks of moderate intensity aerobic exercise may be a promising intervention for PTSD in women Veterans of childbearing potential. Further controlled studies are warranted to determine efficacy of moderate intensity exercise as a treatment modality for this population.

Managing posttraumatic stress disorder and major depression in women veterans during the perinatal period

The recent surge in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) era women Veterans, most of whom are younger compared to other women Veterans, presenting with mental health issues is expected to pose new clinical challenges. Treatment of mental health conditions in women Veterans is not considered comprehensive without adequate examination of the impact of reproductive events across the life span, such as their menstrual cycle, pregnancy and postpartum period, and menopausal transition. The overarching aim of this article is to discuss emerging clinical issues in managing common psychiatric conditions such as posttraumatic stress disorder and major depression during pregnancy and postpartum period in the VA healthcare system and secondly, to identify steps to advance the knowledge and understanding of these complex issues. Information to be gained in this area has immediate clinical application in the overall management of major psychiatric conditions in women Veterans during pregnancy and postpartum, and implications for policy-making decisions.

Sequential single-shot imaging of nanoscale dynamic interactions with a table-top soft x-ray laser

We demonstrate the first real-space recording of nanoscale dynamic interactions using single-shot soft x-ray (SXR) full-field laser microscopy. A sequence of real-space flash images acquired with a table-top SXR laser was used to capture the motion of a rapidly oscillating magnetic nanoprobe. Changes of 30 nm in the oscillation amplitude were detected when the nanoprobe was made to interact with stray fields from a magnetic sample. The table-top visualization of nanoscale dynamics in real space can significantly contribute to the understanding of nanoscale processes and can accelerate the development of new nanodevices.

Ultra-high efficiency multilayer blazed gratings through deposition kinetic control

Diffraction efficiency of multilayer-coated blazed gratings (MBG) strongly depends on the perfection of the sawtooth-shaped layers in the overall composite structure. Growth of multilayers on sawtooth substrates should be carefully optimized to reduce groove profile distortion and, at the same time, to avoid significant roughening of multilayer interfaces. In this work, we report on a way to optimize growth of sputter-deposited Mo/Si multilayers on sawtooth substrates through variation of the sputtering gas pressure. We believe a new record for diffraction efficiency of 44% was achieved for an optimized MBG with groove density of 5250 lines/mm at the wavelength of 13.1 nm.

A 10,000 groove/mm multilayer coated grating for EUV spectroscopy

Ultra-high spectral resolution in the EUV and soft x-ray energy ranges requires the use of very high line density gratings with optimal design resulting in use of a Blazed Multilayer Grating (BMG) structure. Here we demonstrate the production of near-atomically perfect Si blazed substrates with an ultra-high groove density (10,000 l/mm) together with the measured and theoretical performance of an Al/Zr multilayer coating on the grating. A 1st order absolute efficiency of 13% and 24.6% was achieved at incidence angles of 11° and 36° respectively. Cross-sectional TEM shows the effect of smoothing caused by the surface mobility of deposited atoms and we correlate this effect with a reduction in peak diffraction efficiency. This work shows the high performance that can be achieved with BMGs based on small-period anisotropic etched Si substrates, but also the constraints imposed by the surface mobility of deposited species.

High-Resolution Imaging by Fourier Transform X-ray Holography

Fourier transform x-ray holography has been used to image gold test objects with submicrometer structure, resolving features as small as 60 nanometers. The hologram-recording instrument uses coherent 3.4-nanometer radiation from the soft x-ray undulator beamline X1A at the National Synchrotron Light Source. The specimen to be imaged is placed near the first-order focal spot produced by a Fresnel zone plate; the other orders, chiefly the zeroth, illuminate the specimen. The wave scattered by the specimen interferes with the spherical reference wave from the focal spot, forming a hologram with fringes of low spatial frequency. The hologram is recorded in digital form by a charge-coupled device camera, and the specimen image is obtained by numerical reconstruction.

NATURE OF THE GROWTH FACTOR FOR THE COLORLESS ALGA PROTOTHECA ZOPFII

Barker's study on the nutritive requirements of Prototheca zopfii indicated that this colorless alga fails to grow in the absence of small amounts of yeast extract. A study of the growth factor requirements of Prototheca has shown that the active constituent of yeast extract necessary for the growth of this organism is thiamin (vitamin B₁). Thiamin can fully replace the complex yeast material and allows, in the basal medium used, a maximum cell yield in concentrations of 1–3 x 10^–7M. Thiamin as such, however, is not essential for the growth of Prototheca zopfii. The alga can develop equally well if supplied with both the thiazole and pyrimidine constituents of this vitamin. These appear to be needed in equimolar proportions. Maximum cell yield is obtained with 3 x 10^–8M concentrations of the two components.

STUDIES ON THE METABOLISM OF THE COLORLESS ALGA PROTOTHECA ZOPFII

The metabolism of Prototheca zopfii was investigated in an attempt to establish the specific function of its growth factor, thiamin. A study of the oxidative decomposition of various substrates by this organism demonstrated that the addition of catalytic amounts of thiamin to vitamin-deficient cells causes a pronounced stimulation in the rate of oxygen utilization during the degradation of certain compounds. The phosphoric ester of thiamin is known to be the prosthetic group of carboxylase. The fact that this enzyme is involved in the decomposition of pyruvic acid suggested that this α-keto acid might be an important intermediate product in the metabolism of Prototheca. Pyruvic acid, however, was not included in the list of organic substances which Barker had reported as utilized by this alga. Barker's observations were confirmed, but subsequent experiments led to serious doubts as to the validity of his interpretation. Further investigations resulted in the establishment of environmental conditions which permit this alga to readily decompose pyruvic acid, as well as nearly all other organic acids tested. This can be accomplished by providing a millieu of sufficiently low pH to insure the presence of undissociated acid molecules. The stimulatory effect on the rate of oxygen consumption, caused by the addition of minute amounts of thiamin to suspensions of vitamin-deficient cells of Prototheca respiring pyruvic acid, indicates that the presence of thiamin results in the synthesis of enzyme systems which are involved in the decomposition of pyruvic acid. Experimental data on the oxidation of pyruvic acid and other organic compounds are discussed in the light of various hypotheses which have been advanced concerning the rôle of carboxylase in the decomposition of pyruvic acid. The conservative conclusion which can be drawn from the available information is that there appears to be no justification for a belief that thiamin and carboxylase are functional in biochemical reactions other than in decarboxylation and carboxylation processes. The discovery of the ability of Prototheca to utilize substituted and dicarboxylic acids led to further studies on the mechanism of oxidative assimilation. The results of these investigations are in agreement with those of Clifton and Logan, and of Doudoroff, and indicate the existence of a relatively simple chemical mechanism of assimilation rather than of a strictly energetic coupling of catabolic and anabolic reactions. A consideration of possible mechanisms for the oxidative assimilation of pyruvic and lactic acids indicates acetic acid as the most likely starting point for the assimilatory process proper. Experimental investigations of the mode of acetate breakdown began with studies on the oxidation of glycolic acid. This substance is shown to be an oxidation catalyst in the metabolism of Prototheca zopfii. The exact nature of the catalytic function has not yet been determined.

Microscopy of extreme ultraviolet lithography masks with 13.2 nm tabletop laser illumination

We report the demonstration of a reflection microscope that operates at 13.2 nm wavelength with a spatial resolution of 55+/-3 nm. The microscope uses illumination from a tabletop extreme ultraviolet laser to acquire aerial images of photolithography masks with a 20 s exposure time. The modulation transfer function of the optical system was characterized.

Nanometer-scale ablation with a table-top soft x-ray laser

Ablation of holes with diameters as small as 82 nm and very clean walls was obtained in poly(methyl methacrylate) focusing pulses from a Ne-like Ar 46.9 nm compact capillary-discharge laser with a freestanding Fresnel zone plate diffracting into third order. These results demonstrate the feasibility of using focused soft x-ray laser beams for the direct nanoscale patterning of materials and the development of new nanoprobes.

Magnetic microstructures and their dynamics studied by X-ray microscopy

Full-field soft X-ray microscopy in combination with X-ray magnetic circular dichroism as contrast mechanism is a powerful technique to image with elemental specificity magnetic nanostructures and multilayered thin films at high lateral resolution down to 15nm by using Fresnel zone plates as X-ray optical elements. Magnetization reversal phenomena on a microscopic level are studied by recording the images in varying external magnetic fields. Local spin dynamics at a time resolution below 100ps can be addressed by engaging a stroboscopic pump-and-probe scheme taking into account the time pattern of synchrotron storage rings. Characteristic features of magnetic soft X-ray microscopy are reviewed and an outlook into future perspectives with regard to increased lateral and temporal resolution is given.

Sub-38 nm resolution tabletop microscopy with 13 nm wavelength laser light

We have acquired images with a spatial resolution better than 38 nm by using a tabletop microscope that combines 13 nm wavelength light from a high-brightness tabletop laser and Fresnel zone plate optics. These results open a gateway to the development of compact and widely available extreme-ultraviolet imaging tools capable of inspecting samples in a variety of environments with a 15-20 nm spatial resolution and a picosecond time resolution.

Glycocalyx-mimetic dextran-modified poly(vinyl amine) surfactant coating reduces platelet adhesion on medical-grade polycarbonate surface

A dextran-modified poly(vinyl amine) comb-like surfactant polymer, poly(N-vinyl dextran aldonamide-co-N-vinyl hexanamide), that can surface-adsorb on hydrophobic polymeric substrates, was designed to improve the interfacial blood-compatibility of polymeric biomaterials. Medical-grade polycarbonate was selected as a model substrate because of its extensive use in blood-contacting biomedical devices like hemodialyzers, blood pumps and oxygenators. The surfactant polymer was physisorbed from aqueous solution onto the polycarbonate substrate. The surfactant coating was stable under dynamic shear conditions in whole blood, as confirmed by fluorescence microscopy and total internal reflection fluorescence (TIRF) experiments with fluorescein-labeled surfactant polymer. The coated disks and uncoated control disks were exposed to platelet-rich plasma (PRP) and whole human blood in a rotating disk system (RDS) to study platelet-adhesion under dynamic shear stress environments. Adhered platelets were stained with fluorescein isothiocyante (FITC)-tagged anti-CD41a monoclonal antibody and imaged by epifluorescence microscopy. Complimentary images were obtained by phase-contrast microscopy. Platelet adhesion on the surfactant-coated disks was reduced by approximately 90%, compared with uncoated disks. The images also showed a concomitant reduction in platelet-derived microparticles on surfactant-coated disks, compared with uncoated disks. The results suggest potential application of carbohydrate-modified surfactant polymers as a glycocalyx-mimetic non-thrombogenic interfacial coating for blood-contacting biomaterials.

Nanoimaging with a compact extreme-ultraviolet laser

Images with a spatial resolution of 120-150 nm were obtained with 46.9 nm light from a compact capillary-discharge laser by use of the combination of a Sc-Si multilayer-coated Schwarzschild condenser and a free-standing imaging zone plate. The results are relevant to the development of compact extreme-ultraviolet laser-based imaging tools for nanoscience and nanotechnology.

Perception of HIV and Safer Sexual Behaviors among Lesbians

There is little data on female-to-female transmission of HIV. Some women who have sex with women (WSW) have other high-risk behaviors that could lead to HIV infection. The belief that WSW are at no risk may lead to unsafe sexual practices. In this study, a convenience sample of 78 women was surveyed in order to explore the perception of HIV risk among lesbians, their sexual behaviors, and their sources of information about safer sex. Fifty-three percent reported they were at low risk for contracting HIV. Women reported knowledge of barrier methods (89% to 99%) and no sex during menstruation (92%). However, 35% to 40% reported no knowledge of less common safer sex practices. Women reported their source of knowledge as media (36%), workshops (22%), and friends (12%). Eighty-five percent stated that their health care provider knew they were lesbian, but only 15% reported receiving safer sex education. Nurses and nurse practitioners are aptly poised to provide critical HIV education and health care for this population.

The interrelationship between violence, HIV/AIDS, and drug use in incarcerated women

The purpose of this study was to examine how violence co-occurs with drug use and HIV/AIDS high-risk behaviors among women incarcerated for drug use. This study was a supplement to a larger, experimental study designed to reduce HIV/AIDS high-risk behaviors among incarcerated female drug users. The women who participated (N = 170) reported that violence was a major part of their lives and affected many of their behaviors. Among these 170 women, 26.6% used condoms for oral sex, 46.4% for vaginal intercourse, and 65% were either sexually or physically abused. Intimate partner abuse was reported by 33.9% of the women. About 16% reported forced sexual activity, and 17.5% feared their partners. Women who refused to give oral sex to their male partners and those who insisted on condom use during oral sex prior to jail were more likely to be sexually or physically abused (chi 2 = 4.104; chi 2 = 3.886, p < .05, respectively). Although statistically significant interrelationships were not found among the three variables, significant bivariate relationships were found between intimate violence and HIV/AIDS high-risk behaviors.

Cognitive representations of AIDS: a phenomenological study

Cognitive representations of illness determine behavior. How persons living with AIDS image their disease might be key to understanding medication adherence and other health behaviors. The authors' purpose was to describe AIDS patients' cognitive representations of their illness. A purposive sample of 58 men and women with AIDS were interviewed. Using Colaizzi's (1978) phenomenological method, rigor was established through application of verification, validation, and validity. From 175 significant statements, 11 themes emerged. Cognitive representations included imaging AIDS as death, bodily destruction, and just a disease. Coping focused on wiping AIDS out of the mind, hoping for the right drug, and caring for oneself. Inquiring about a patient's image of AIDS might help nurses assess coping processes and enhance nurse-patient relationships.

Self-esteem and optimism in men and women infected with HIV

BACKGROUND

Self-esteem and optimism have been associated with appraisal and outcomes in a variety of situations. The degree to which the contribution of self-esteem and optimism to outcomes over time is accounted for by the differences in threat (primary) or resource (secondary) appraisal has not been established in persons with human immunodeficiency virus (HIV).

OBJECTIVES

To examine the longitudinal relationship of personality (self-esteem and optimism) on primary and secondary appraisal and outcomes of well-being, mood, CD4+ T-lymphocyte count, and selected activities.

METHODS

Men (n = 56) and women (n = 42) infected with HIV completed eight self-report measures twice over 18 months. Hierarchical Multiple Regressions were used to examine the relationship of personality variables on appraisals and outcomes. The mediating effects of primary and secondary appraisals were explored.

RESULTS

Self-esteem uniquely accounted for 6% of the variance in primary appraisal and 5% in secondary appraisal. Optimism accounted for 8% of the unique variance in secondary appraisal. Primary and secondary appraisal mediated differently between personality and outcome variables. A strong predictor of well-being, mood disturbance, and activity disruption at Time 2 was participants' initial level of these variables. Socioeconomic status was a strong predictor of mood.

CONCLUSIONS

Self-esteem and optimism are important but different resources for adapting to HIV disease. Strategies for reducing threats and increasing resources associated with HIV may improve an individual's mood and sense of well-being.

Scanned probe microscopy of electronic transport in carbon nanotubes

We use electrostatic force microscopy and scanned gate microscopy to probe the conducting properties of carbon nanotubes at room temperature. Multiwalled carbon nanotubes are shown to be diffusive conductors, while metallic single-walled carbon nanotubes are ballistic conductors over micron lengths. Semiconducting single-walled carbon nanotubes are shown to have a series of large barriers to conduction along their length. These measurements are also used to probe the contact resistance and locate breaks in carbon nanotube circuits.

Thyroid disease: a review for primary care

Manifestations of thyroid disease include hyperthyroidism and hypothyroidism. In the past, the diagnosis of thyroid disease has been perplexing due to the multisystemic effects of thyroid hormone and the lack of specificity in laboratory tests. New methods of measuring thyroid function have made screening and diagnosis of thyroid dysfunction both more accurate and cost-effective. Testing for thyroid stimulating hormone (TSH) is now a first-line diagnostic procedure and, in some cases, may be the only test indicated. The general pathophysiology of thyroid, the diagnosis and management of thyroid disease, and current screening recommendations are reviewed here.

Understanding the reimbursement process

Nurse practitioners must be fiscally responsible to obtain reimbursement for services provided. A thorough knowledge of the reimbursement process is required to accomplish this goal. This article explores the reimbursement process, generation of revenue, and personal productivity determination for nurse practitioners. Parameters for billing using the resource-based relative value scale, the Evaluation and Management Documentation Guidelines, the International Classification of Disease, and the Physicians' Current Procedural Terminology code book are explained.

Resolution determination in X-ray microscopy: an analysis of the effects of partial coherence and illumination spectrum

Determining the resolution of a zone plate X-ray microscope is a complicated issue, depending on many factors in addition to the quality of the optic. These include the degree of coherence of the illumination, the illumination spectrum, and the nature of the resolution test object. In this paper, we examine closely how the degree of coherence of the illumination affects the resolution as measured with three typical test patterns. In addition, we determine the extent to which the illumination spectrum affects the resolution. We compare X-ray microscope test images to numerical simulations as a function of coherence and illumination spectrum. We are able to conclude that in these experiments, the resolution of the X-ray microscope is 41 nm, or 40% discrepancy is due to aberrations in the objective zone plate lens.

Extreme-ultraviolet polarization and filtering with gold transmission gratings

The polarization and transmission characteristics of freestanding gold transmission gratings, with 200-nm periods, for extreme-ultraviolet (EUV) radiation (1 < 200 nm) have been measured. We find that EUV transmission through the gratings is dominated by the waveguide characteristics of the gratings and that polarization efficiencies of 90% for wavelengths of 121.6 nm are achievable. Both the EUV polarization and transmission properties are in good agreement with a complete vector, numerical solution of Maxwell's equations. The fraction of open area to total area of the grating has been measured using a 10-keV proton beam and was found to be in good agreement with the microscopic slit and wire dimensions that were obtained by scanning electron microscopy. The use of these gratings for particle measurements in the presence of intense EUV radiation is briefly discussed.

Ultrahigh-Resolution X-ray Tomography

Ultrahigh-resolution three-dimensional images of a microscopic test object were made with soft x-rays collected with a scanning transmission x-ray microscope. The test object consisted of two different patterns of gold bars on silicon nitride windows that were separated by approximately 5 micrometers. Depth resolution comparable to the transverse resolution was achieved by recording nine two-dimensional images of the object at angles between -50 and +55 degrees with respect to the beam axis. The projections were then combined tomographically to form a three-dimensional image by means of an algorithm using an algebraic reconstruction technique. A transverse resolution of approximately 1000 angstroms was observed. Artifacts in the reconstruction limited the overall depth resolution to approximately 6000 angstroms; however, some features were clearly reconstructed with a depth resolution of approximately 1000 angstroms.

Achromatic holographic configuration for 100-nm-period lithography

For the fabrication of large-area, spatially coherent gratings with periods of 100 nm or less, a grating interferometer is preferred over a conventional holographic configuration because of the limited coherence of available sources. Using a configuration that employs two matched fused silica phase gratings and an ArF excimer laser, we obtain high-quality 100-nm gratings in polymethyl methacrylate. We analyze the conditions for achieving high-contrast fringes with such an achromatic holographic configuration and show that the depth of focus depends only on the spatial coherence of the source. We also describe a highly accurate method for calculating the diffraction efficiency of the phase gratings as a function of polarization, incidence angle, and grating structure.

Transmission x-ray diffraction grating alignment using a photoelastic modulator

We have developed a high-resolution alignment technique which utilizes the partial polarization property of fine period transmission gratings. It is especially useful when the grating period is sufficiently small so that there are no visible diffracted orders. This technique uses a photoelastic modulator (PEM) to produce an intensity signal that is proportional to the sine of twice the angle between the grating lines and the PEM crystal axis. The experimentally demonstrated resolution of this technique on 200-nm period gold transmission gratings is better than 1 sec of arc. This technique was developed to align x-ray transmission gratings for spectroscopy and interferometry applications.