The usability of daytime and night-time heart rate dynamics as digital biomarkers of depression severity

BACKGROUND

Alterations in heart rate (HR) may provide new information about physiological signatures of depression severity. This 2-year study in individuals with a history of recurrent major depressive disorder (MDD) explored the intra-individual variations in HR parameters and their relationship with depression severity.

METHODS

Data from 510 participants (Number of observations of the HR parameters = 6666) were collected from three centres in the Netherlands, Spain, and the UK, as a part of the remote assessment of disease and relapse-MDD study. We analysed the relationship between depression severity, assessed every 2 weeks with the Patient Health Questionnaire-8, with HR parameters in the week before the assessment, such as HR features during all day, resting periods during the day and at night, and activity periods during the day evaluated with a wrist-worn Fitbit device. Linear mixed models were used with random intercepts for participants and countries. Covariates included in the models were age, sex, BMI, smoking and alcohol consumption, antidepressant use and co-morbidities with other medical health conditions.

RESULTS

Decreases in HR variation during resting periods during the day were related with an increased severity of depression both in univariate and multivariate analyses. Mean HR during resting at night was higher in participants with more severe depressive symptoms.

CONCLUSIONS

Our findings demonstrate that alterations in resting HR during all day and night are associated with depression severity. These findings may provide an early warning of worsening depression symptoms which could allow clinicians to take responsive treatment measures promptly.

Predictors of engagement with remote sensing technologies for symptom measurement in Major Depressive Disorder

BACKGROUND

Remote sensing for the measurement and management of long-term conditions such as Major Depressive Disorder (MDD) is becoming more prevalent. User-engagement is essential to yield any benefits. We tested three hypotheses examining associations between clinical characteristics, perceptions of remote sensing, and objective user engagement metrics.

METHODS

The Remote Assessment of Disease and Relapse - Major Depressive Disorder (RADAR-MDD) study is a multicentre longitudinal observational cohort study in people with recurrent MDD. Participants wore a FitBit and completed app-based assessments every two weeks for a median of 18 months. Multivariable random effects regression models pooling data across timepoints were used to examine associations between variables.

RESULTS

A total of 547 participants (87.8% of the total sample) were included in the current analysis. Higher levels of anxiety were associated with lower levels of perceived technology ease of use; increased functional disability was associated with small differences in perceptions of technology usefulness and usability. Participants who reported higher system ease of use, usefulness, and acceptability subsequently completed more app-based questionnaires and tended to wear their FitBit activity tracker for longer. All effect sizes were small and unlikely to be of practical significance.

LIMITATIONS

Symptoms of depression, anxiety, functional disability, and perceptions of system usability are measured at the same time. These therefore represent cross-sectional associations rather than predictions of future perceptions.

CONCLUSIONS

These findings suggest that perceived usability and actual use of remote measurement technologies in people with MDD are robust across differences in severity of depression, anxiety, and functional impairment.

Burden of sleep disturbance in non-Hispanic Black pregnant women

STUDY OBJECTIVES

Non-Hispanic Black pregnant women disproportionately experience poor perinatal outcomes compared to other racial/ethnic groups. Sleep disruption has emerged as a risk factor for adverse pregnancy outcomes but there are limited data in minority pregnant women. We examined the prevalence of habitual snoring and its timing of onset with several key sleep-wake disturbances and their associations with perinatal outcomes in a cohort of non-Hispanic Black pregnant women.

METHODS

Third trimester non-Hispanic Black pregnant women were recruited from a large, academic medical center and screened for habitual snoring - and its timing relative to pregnancy - sleep quality, symptoms of insomnia, excessive daytime sleepiness, as well as daytime function. Clinical diagnoses of hypertensive disorders of pregnancy were obtained along with delivery outcomes.

RESULTS

In 235 women the vast majority (80%) reported three or more sleep-wake disturbances, and almost half had at least five disturbances. Sixteen percent endorsed pre-pregnancy snoring and 20% pregnancy-onset snoring. Women with pregnancy-onset snoring had significantly increased odds of poor sleep quality aOR 8.2, trouble staying asleep aOR 3.6, waking up too early aOR 2.7, excessive daytime sleepiness aOR 2.3, and poor daytime function aOR 8.7 but no relationship with perinatal outcomes. In contrast, pre-pregnancy snoring was related to chronic hypertension, pre-term delivery and fetal growth restriction; aOR 2.6, aOR 2.8, and aOR 5.1 respectively.

CONCLUSIONS

Sleep-wake disturbances confer a significant burden to pregnant non-Hispanic Black women, an infrequently studied yet disproportionately affected population. Contributions of maternal sleep to racial disparities in perinatal health should be a priority for public health research.

Insights into targeting young male drivers with anti-speeding advertising: An application of the Step approach to Message Design and Testing (SatMDT)

In Australia, young drivers aged 17-25 years comprise 13% of the population yet account for 22% of all road deaths with young males over-represented in such trauma. Speeding represents a major contributing factor and advertising campaigns have long focused on promoting anti-speeding messages in the effort to reduce drivers' speeds. Positioned within a larger program of research aimed at developing, piloting, and evaluating a range of theoretically-informed anti-speeding messages, the current study reports results relating to the final phase of the research, the evaluation. Six messages were devised in accordance with the guiding framework, the Step approach to Message Design and Testing ([SatMDT]; Lewis et al., 2016) and based on the findings emerging from earlier qualitative and quantitative studies within the program of research. N=938 licensed drivers (n=455 males, 48%) aged 17-62 years completed an online survey. To ensure a controlled test of the persuasiveness of the message content, the messages were presented in an audio-based format and thus were devoid of potential confounds, such as images. The messages sought to address a particular belief (i.e., behavioural, normative, control) and to focus either on emphasising the positive aspects which make speeding less likely or challenging the negative aspects which make speeding more likely. Thus, key to this evaluation was to test the persuasiveness of the message content in terms of the particular belief and focus it was addressing. Participants were randomly assigned to either the Control condition (i.e., no exposure to a message) or the Intervention condition (i.e., exposed to one of the six messages presented as an audio-recorded message within the survey). Persuasiveness was assessed via a range of outcome measures including both direct (i.e., third-person perceptions, message rejection) as well as indirect measures (i.e., intentions, willingness to speed). Age, gender, and message type were independent variables (IVs), together with issue involvement as a covariate (or IV) in the study's analyses. Overall, positive persuasive effects, and a relative absence of any negative, dissuasive effects, were found for two messages, Glass Cars and The Lift. These messages addressed the same salient belief, control beliefs, with the former emphasising the factors which discourage speeding and the latter message challenging those factors which encourage speeding. The implications of the findings are discussed in terms of the insights they offer for the key content of future anti-speeding messages.

Psychosocial presentation of revisional LAGB patients: a qualitative study

This qualitative study offers insight into the experiences, expectations, perceptions and beliefs that may lead to laparoscopic adjustable gastric band patients' failure to achieve expected weight loss and seek revisional bariatric surgery. The 23 participants from two sites were interviewed and data were analysed from a grounded theory methodology in order to build a causal model. Analysis of participants' reports identified 'unrealistic expectations of the LAGB' as the core category. Additionally, the restriction of the band had a negative impact on participants' social interactions, leading to feelings of deprivation and, thus, to a desire for reward from food choices and consequently an increase of consumption of high-calorie-dense foods. These foods were chosen because of their specific texture or ability to provide reward. The resulting increase in weight or failure to achieve excess weight loss, led to feelings of shame and loneliness and emotional eating resulting in increased the consumption of rewarding foods. Thus, identifying unrealistic expectations of laparoscopic adjustable gastric band (LAGB) and emotional eating behaviours are important in those who are present initially for primary bariatric and revisional bariatric surgery, as they may contribute specifically to these patients' weight regain and consequent failure to achieve excess weight loss.

Effect of astaxanthin on cycling time trial performance

We examined the effect of Astaxanthin (AST) on substrate metabolism and cycling time trial (TT) performance by randomly assigning 21 competitive cyclists to 28 d of encapsulated AST (4 mg/d) or placebo (PLA) supplementation. Testing included a VO2max test and on a separate day a 2 h constant intensity pre-exhaustion ride, after a 10 h fast, at 5% below VO2max stimulated onset of 4 mmol/L lactic acid followed 5 min later by a 20 km TT. Analysis included ANOVA and post-hoc testing. Data are Mean (SD) and (95% CI) when expressed as change (pre vs. post). Fourteen participants successfully completed the trial. Overall, we observed significant improvements in 20 km TT performance in the AST group (n=7; -121 s; 95% CI, -185, -53), but not the PLA (n=7; -19 s; 95% CI, -84, 45). The AST group was significantly different vs. PLA (P<0.05). The AST group significantly increased power output (20 W; 95% CI, 1, 38), while the PLA group did not (1.6 W; 95% CI, -17, 20). The mechanism of action for these improvements remains unclear, as we observed no treatment effects for carbohydrate and fat oxidation, or blood indices indicative of fuel mobilization. While AST significantly improved TT performance the mechanism of action explaining this effect remains obscure.

Does obesity predict knee pain over fourteen years in women, independently of radiographic changes?

OBJECTIVE

To examine longitudinal patterns in body mass index (BMI) over 14 years and its association with knee pain in the Chingford Study.

METHODS

We studied a total of 594 women with BMI data from clinic visits at years (Y) 1, 5, 10, and 15. Knee pain at Y15 was assessed by questionnaire. Associations between BMI over 14 years and knee pain at Y15 were examined using logistic regression.

RESULTS

BMI significantly increased from Y1 to Y15 (P < 0.0005) with medians (interquartile ranges) of 24.5 kg/m(2) (22.5-27.2 kg/m(2) ) and 26.5 kg/m(2) (23.9-30.1 kg/m(2) ), respectively. At Y15, 45.1% of subjects had knee pain. A greater BMI at Y1 (odds ratio [OR] 1.34, 95% confidence interval [95% CI] 1.05-1.69), at Y15 (OR 1.34, 95% CI 1.10-1.61), and change in BMI over 15 years (OR 1.40, 95% CI 1.00-1.93) were significant predictors of knee pain at Y15 (P < 0.05). BMI change was associated with bilateral (OR 1.61, 95% CI 1.05-1.76, P = 0.024) but not unilateral knee pain (OR 1.22, 95% CI 0.73-1.76, P = 0.298). The association between BMI change and knee pain was independent of radiographic knee osteoarthritis (OA). The strength of association between BMI and knee pain at Y15 was similar during followup measurements.

CONCLUSION

Over 14 years, a higher BMI predicts knee pain at Y15 in women, independently of radiographic knee OA. When adjusted, the association was significant in bilateral, not unilateral, knee pain, suggesting alternative pathologic mechanisms may exist. The longitudinal effect of BMI on knee pain at Y15 is equally important at any time point, which may assist reducing the population burden of knee pain.

Response efficacy: the key to minimizing rejection and maximizing acceptance of emotion-based anti-speeding messages

This study sought to improve understanding of the persuasive process of emotion-based appeals not only in relation to negative, fear-based appeals but also for appeals based upon positive emotions. In particular, the study investigated whether response efficacy, as a cognitive construct, mediated outcome measures of message effectiveness in terms of both acceptance and rejection of negative and positive emotion-based messages. Licensed drivers (N=406) participated via the completion of an on-line survey. Within the survey, participants received either a negative (fear-based) appeal or one of the two possible positive appeals (pride or humor-based). Overall, the study's findings confirmed the importance of emotional and cognitive components of persuasive health messages and identified response efficacy as a key cognitive construct influencing the effectiveness of not only fear-based messages but also positive emotion-based messages. Interestingly, however, the results suggested that response efficacy's influence on message effectiveness may differ for positive and negative emotion-based appeals such that significant indirect (and mediational) effects were found with both acceptance and rejection of the positive appeals yet only with rejection of the fear-based appeal. As such, the study's findings provide an important extension to extant literature and may inform future advertising message design.

Assessing the effectiveness of low-pressure ultraviolet light for inactivating Mycobacterium avium complex (MAC) micro-organisms

AIMS

To assess low-pressure ultraviolet light (LP-UV) inactivation kinetics of Mycobacterium avium complex (MAC) strains in a water matrix using collimated beam apparatus.

METHODS AND RESULTS

Strains of M. avium (n = 3) and Mycobacterium intracellulare (n = 2) were exposed to LP-UV, and log(10) inactivation and inactivation kinetics were evaluated. All strains exhibited greater than 4 log(10) inactivation at fluences of less than 20 mJ cm(-2). Repair potential was evaluated using one M. avium strain. Light repair was evaluated by simultaneous exposure using visible and LP-UV irradiation. Dark repair was evaluated by incubating UV-exposed organisms in the dark for 4 h. The isolate did not exhibit light or dark repair activity.

CONCLUSIONS

Results indicate that MAC organisms are readily inactivated at UV fluences typically used in drinking water treatment. Differences in activation kinetics were small but statistically significant between some tested isolates.

SIGNIFICANCE AND IMPACT OF THE STUDY

Results provide LP-UV inactivation kinetics for isolates from the relatively resistant MAC. Although UV inactivation of Mycobacterium species have been reported previously, data collected in this effort are comparable with recent UV inactivation research efforts performed in a similar manner. Data were assessed using a rigorous statistical approach and were useful towards modelling efforts.

The theory of planned behaviour: self-identity, social identity and group norms

The aim of the present study was to examine further the role that self-identity plays in the theory of planned behaviour and, more specifically, to: (1) examine the combined effects of self-identity and social identity constructs on intention and behaviour, and (2) examine the effects of self-identity as a function of past experience of performing the behaviour. The study was concerned with the prediction of intention to engage in household recycling and reported recycling behaviour. A sample of 143 community residents participated in the study. It was prospective in design: measures of the predictors and intention were obtained at the first wave of data collection, whereas behaviour was assessed two weeks later. Self-identity significantly predicted behavioural intention, a relationship that was not dependent on the extent to which the behaviour had been performed in the past. As expected, there was also evidence that the perceived norm of a behaviourally relevant reference group was related to behavioural intention, but only for participants who identified strongly with the group, whereas the relationship between perceived behavioural control (a personal factor) and intention was strongest for low identifiers.

Pharmacokinetics in nonhuman primates of a prototype carbapenem active against methicillin-resistant Staphylococcus aureus

Pharmacokinetic parameters were determined for imipenem-cilastatin and a carbapenem antibiotic, L-695,256, active against methicillin-resistant Staphylococcus aureus in rhesus monkeys and a chimpanzee. L-695,256 had larger areas under the concentration-time curve than imipenem-cilastatin (30 +/- 5 versus 24 +/- 1 micrograms.h/ml in the rhesus monkeys and 77 versus 60 micrograms.h/ml in the chimpanzee) and a longer half-life at beta phase (1.2 +/- 0.1 versus 0.6 +/- 0.1 h in the rhesus monkeys and 1.0 versus 0.8 h in the chimpanzee). Resistance to hydrolysis by the renal dehydropeptidase-I allowed L-695,256 to be administered as a single agent.

Vibrometry testing for carpal tunnel syndrome: a longitudinal study of daily variations

The method of limits procedure was used to obtain 84 120Hz vibration thresholds, over a 3-month period, on four age-matched women with different levels of carpal tunnel syndrome (CTS). Each woman used a keyboard for 4 hours a day during work. Testing was conducted in a room with a temperature of 28 degrees C +/- 2 degrees C after 20 minutes acclimation. Results indicate vibration thresholds vary significantly from day to day and also demonstrate how a single vibrometry measure may falsely identify the participant's true CTS condition. Specifically, a single measure could account for a negative CTS determinations in affected wrists or positive CTS determinations in healthy wrists. Subsequent analysis revealed menses related fluid retention and day of the week increase the vibration thresholds. Analyzing the levels of fluid retention by day of the week indicates a compounding effect of the personal and occupational risk factors.

Human basic tear fluid osmolality. II. Importance of processing strategy

Osmolalities of 100 human inferior tear prism fluid samples collected from two subjects and 100 standard solution samples (290 mOsm/Kg) were determined from their melting-point temperatures with the Clifton Nanoliter Osmometer. Accuracy and reliability comparisons were made for endpoints obtained using a single-sample simultaneous-recalibration (SS/SR) strategy, vs a lowest-of-six periodic-recalibration (LS/PR) strategy. Tear fluid osmolality values based on the LS/PR strategy were significantly lower (hypotonic) than for the SS/SR strategy (overall mean = 302.4 and 307.8 mOsm/Kg, respectively; p < 0.0012). The mean difference (5.4 mOsm/Kg) resulted from the combined effects of machine drift and reduced reliability of endpoint determination for tear fluid in comparison to that of a homogenous standard solution. LS/PR osmolality was linearly correlated to SS/SR osmolality with a slope of 0.433 and the two endpoint strategies resulted in equivalent values at 298.4 mOsm/Kg. Eighty-four percent (84%) of individual osmolality readings were greater than 298.4 mOsm/kg, and an 'averaging-type' effect caused LS/PR osmolalities to be increasingly less than SS/SR values above this value. These outcomes from two subjects were approximated by a parallel statistical model. We suggest that physiological representation of basic human tear fluid is more accurate using the single-sample simultaneous-recalibration strategy. Basic human tear prism fluid is more hypertonic and has a greater within-subject range in normal (non-dry eye) humans than previously realized.

Human basic tear fluid osmolality. I. Importance of sample collection strategy

Osmolalities of 200 human tear prism fluid samples collected from two subjects were determined from their melting-point temperatures with the Clifton Nanoliter Osmometer by calibration with 200 standard solution samples (290 mOsm/kg). Comparisons were made between tear fluid osmolalities obtained using a single-sample simultaneous-recalibration method: 1) for tear samples collected using finely-drawn microcapillaries without biomicroscopy, vs secondly with biomicroscopic observation by illumination of only the sampling area on the inferior tear prism, the two collections separated by an interval of 10 min; and 2) for samples collected without biomicroscopy before, vs after a 10-min interval. Tear fluid collection using a biomicroscope resulted in values that were significantly lower than those collected without (overall mean = 299.5 and 306.6 mOsm/kg, respectively; p < 0.0001). The difference (7.1 mOsm/kg) may have resulted from mechanical, photic, and/or psychogenic reflex stimulation due to biomicroscopy, as the 10-min interval had no osmotic effect on samples collected without biomicroscopy. Based on these results from two subjects, we suggest that relatively rapid, repetitive collections of human tear prism fluid can be made without significantly disturbing the osmotic outcome. However, physiological representation of basic human tear fluid is more accurate by avoidance of reflex-inducing collection methods that were formerly considered unobtrusive. Basic human tear prism fluid is more hypertonic, by at least 7 mOsm/kg, than generally realized.

Using continuous SVO2 to assess oxygen supply/demand balance in the critically ill patient

To ensure that tissues are well oxygenated, oxygen supply and demand are now targets of therapy for the critically ill patient. This chapter reviews the physiologic determinants of oxygen supply, how it is threatened by respiratory or cardiac dysfunction or by hemorrhaged or anemic states, and how it can be assessed in individual patients. Activities and conditions that increase tissue oxygen demand are examined so that clinicians can identify those patients whose oxygen demands may be excessive and should be controlled. Failure of tissues to consume enough oxygen is explained in patients with critically low delivery or with the maldistributed blood flow state seen in sepsis. The monitoring of mixed venous oxygen saturation is examined as a method of tracking the threats to supply/demand balance and of guiding treatment that can support the adequate oxygenation of tissue.

Recreational sports and the weekend athlete

It is important to design an exercise program that provides an adequate amount of activity to attain maximal benefits at the lowest risk to the participant. Permanent lifestyle changes in eating and activity habits should be included in the primary goals of all programs.

Effects of a 1-minute back rub on mixed venous oxygen saturation and heart rate in critically ill patients

In this study we evaluated mixed venous oxygen saturation (SvO2) and heart rate responses after a 1-minute back rub in 173 critically ill patients. The back rub was the third and last intervention in a study conducted in intensive care units at four hospitals. For this multiple-intervention study all patients were placed in a supine position to obtain baseline SvO2 and heart rate, then underwent suctioning via endotracheal tube, and were turned to a lateral position. After 15 minutes in a side-lying position, the subjects received a 1-minute back rub. Data were collected immediately after the back rub and at 1-minute intervals for 4 minutes. After the back rub, SvO2 decreased immediately from the mean baseline of 67% to 63% and gradually increased, returning to baseline by minute 4. The mean baseline heart rate of 99 beats/min increased to 103 beats/min immediately after the back rub and gradually decreased after massage, but remained higher than baseline by minute 4. Although the findings were statistically significant (p = 0.0001), these minimal physiologic changes do not represent clinical significance. Based on the findings, the back rub, a traditional nursing measure that can provide comforting touch, represented a minor stimulus affecting heart rate and oxygen demands in most critically ill patients. However, because of the variability found in heart rate and SvO2, individual responses need to be assessed.

The physiologic basis for continuous mixed venous oxygen saturation monitoring

Critically ill patients often have conditions that reduce oxygen delivery and increase oxygen demand. Routine nursing care, such as suctioning, positioning, and bathing, also increases the patient's oxygen demand. If the patient's oxygen demand exceeds the supply, dysrhythmias, hypotension, altered level of consciousness, and other adverse responses can occur. We describe use of continuous monitoring of mixed venous oxygen saturation (SvO2) as a tool to assess the patient's supply/demand balance during nursing care. The physiology of oxygen transport is reviewed, and oxygen delivery, reserve, and consumption are defined. Conditions that decrease oxygen delivery and increase oxygen demand are discussed, and the effects on SvO2 are illustrated. With continuous SvO2 monitoring, critical care nurses can see the effect of their nursing care on the patient's oxygenation and can adjust their care according to the patient's tolerance.

Effects of a lateral turn on mixed venous oxygen saturation and heart rate in critically ill adults

The purpose of this study was to determine the effects of a lateral turn on mixed venous oxygen saturation (SvO2) and heart rate in 183 critically ill adults. Mean SvO2 decreased from a baseline of 67% to 61% saturation (p less than 0.0001) immediately after turning and gradually returned to 66% saturation (p less than 0.002) within 4 minutes. Mean heart rate increased slightly from a baseline of 99 beats/min to 102 beats/min (p less than 0.0001) immediately after turning and decreased slightly to 101 beats/min (p less than 0.0004) within 4 minutes. These statistically significant changes in SvO2 and heart rate were not clinically significant for most patients. However, physiologic responses to turning were highly variable. SvO2 reductions of 25% or more from baseline, heart rate increases and decreases of 10 beats/min or more, and signs of activity intolerance occurred in some patients. Nurses should expect critically ill patients to have a decrease in SvO2 of approximately 9% of baseline and small changes in heart rate after turning. These changes should be transient, with SvO2 and heart rate gradually returning toward baseline levels during the next 4 minutes. If turning triggers large or prolonged changes in SvO2 or heart rate, prompt repositioning and evaluation are needed to prevent adverse effects.

Effects of endotracheal suctioning on mixed venous oxygen saturation and heart rate in critically ill adults

The purpose of this multisite study was to determine the effects of endotracheal suctioning on mixed venous oxygen saturation (SvO2) and heart rate in 189 critically ill adults. One-pass, intermittent suction was applied for 10 or fewer seconds, with three prehyperoxygenation and three posthyperoxygenation breaths of 100% oxygen. Subjects at three hospitals (n = 127) underwent suctioning using hyperoxygenation with anesthesia bags and traditional suction catheters (open suction method). Subjects at one hospital (n = 62) underwent suctioning with hyperoxygenation by ventilator and in-line suction catheters (closed suction method). For subjects from all hospital sites combined, the SvO2 decreased from 67% to 64% (p = 0.001), a 4% change from baseline, and returned to baseline within 2 minutes. However, in subjects receiving the open method of suction, SvO2 dropped from 66% to 62% immediately after suctioning and returned to baseline within 4 minutes. In contrast, when the closed suction method was used, SvO2 rose from 67.7% to 67.86% immediately after suctioning, drifting upward to 71% for the next 2 minutes before dropping toward the baseline after 4 minutes. Mean heart rate increased from a baseline of 99 beats/min to 104 beats/min immediately after suctioning (p = 0.001), a 5% change from baseline, and gradually returned to baseline over the next 4 minutes. No significant differences were seen in heart rate between subjects having the open versus closed suction method. In conclusion, the closed suction method showed a higher SvO2 after endotracheal suctioning compared with the open suction method (p = 0.0001). Some form of hyperoxygenation before and after endotracheal suctioning is recommended.

Injuring mechanisms of gunshot wounds

The severity of injury in a gunshot wound is dependent on many factors, including the type of firearm; the velocity, mass, and construction of the bullet; and the structural properties of the tissues that are wounded. Knowledge of ballistics and an appreciation of the wounding potential of certain firearms and their ammunition can help clinicians anticipate the severity of a wound and raise the index of suspicion for occult but severe internal trauma.

Marital conflict and adjustment: speech nonfluencies in intimate disclosure

Speech nonfluency in response to questions about the marital relationship was used to assess anxiety. Subjects were 31 husbands and 31 wives, all white, college educated, from middle- to lower-middle-class families, and ranging from 20 to 30 years of age. Three types of nonfluencies were coded: filled pauses, unfilled pauses, and repetitions. Speech-disturbance ratios were computed by dividing the sum of speech nonfluencies by the total words spoken. The results support the notion that some issues within marriage are more sensitive and/or problematic than others, and that, in an interview situation, gender interacts with question content in the production of nonfluencies.

Intimacy maturity and its correlates in young married couples

Intimate relationships, like the individuals who participate in them, are conceived of as following developmental processes. Five dimensions of intimacy--that is, relationship orientation, caring-concern, commitment, sexuality, and communication--are identified, and an approach to assessing relationship maturity on each of these dimensions is described. In a study of 31 young married couples, scores on each dimension of intimacy maturity were analyzed in relation to gender, gender role (as assessed through an adaptation of the Bem Sex Role Inventory; Bem, 1974), and marital adjustment. There were no significant differences between husbands and wives on any of the intimacy or marital adjustment scales and only a marginal difference on one gender role scale (agency). Patterns of correlations among intimacy, marital adjustment, and gender role scores varied by gender. Not only do there appear to be two marriages (his and hers) in every marriage, but the correlates of these marriages also vary.