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Item does not contain fulltext BACKGROUND: Sepsis is a leading cause of morbidity and mortality after surgery. Most studies regarding sepsis do not differentiate between patients who have had recent surgery and those without. Few data exist regarding the risk factors for poor outcomes in pediatric postsurgical sepsis. Our hypothesis is pediatric postsurgical, and medical patients with severe sepsis have unique risk factors for mortality. METHODS: Data were extracted from a secondary analysis of an international point prevalence study of pediatric severe sepsis. Sites included 128 pediatric intensive care units from 26 countries. Pediatric patients with severe sepsis were categorized into those who had recent surgery (postsurgical sepsis) versus those that did not (medical sepsis) before sepsis onset. Multivariable logistic regression models were used to determine risk factors for mortality. RESULTS: A total of 556 patients were included: 138 with postsurgical and 418 with medical sepsis. In postsurgical sepsis, older age, admission from the hospital ward, multiple organ dysfunction syndrome at sepsis recognition, and cardiovascular and respiratory comorbidities were independent risk factors for death. In medical sepsis, resource-limited region, hospital-acquired infection, multiple organ dysfunction syndrome at sepsis recognition, higher Pediatric Index of Mortality-3 score, and malignancy were independent risk factors for death. CONCLUSIONS: Pediatric patients with postsurgical sepsis had different risk factors for mortality compared with medical sepsis. This included a higher mortality risk in postsurgical patients presenting to the intensive care unit from the hospital ward. These data suggest an opportunity to develop and test early warning systems specific to pediatric sepsis in the postsurgical population.

Context The osteopathic medical school curriculum is unique because of the inclusion of training in osteopathic manipulative medicine (OMM). Interest in and use of OMM promotes cognitive training in diagnosing conditions, emotional training in the alleviation of pain, and physical training in the application of OMM. Osteopathic manipulative medicine may mitigate a reduction in empathy levels of medical students and explain why osteopathic medical students do not follow the declining pattern of empathy previously reported in allopathic medical students. Objective To examine whether favorable opinions of OMM are positively correlated with overall student empathy as well as the cognitive, emotional, and behavioral subcomponents of empathy. Methods Institutional review board approval was obtained to measure empathy in medical students attending the Midwestern University/Chicago College of Osteopathic Medicine for this cross-sectional study. The 20-item Jefferson Scale of Empathy medical student version (JSE-S) was distributed via email to first-year students at the beginning of the 2016-2017 academic year and at the end of the academic year to all students. Items were divided into cognitive, emotional, and behavioral categories. Items related to demographics, interest and use of OMM and the osteopathic philosophy, frequency of touch, and personality were also included in the survey. Data were analyzed using SPSS software and presented as mean (SEM). Statistical significance was set at P Results Of the 801 students the survey was sent to at the end of the 2016-2017 academic year, 598 students completed the survey, for a response rate of 75%. When accounting for the effect of gender with a multivariate analysis of covariance, there were no differences in empathy scores across school years. When empathy scores from first- and second-year students were combined and compared with combined third- and fourth-year students’ scores to examine the difference between empathy in students during academic and clinical training, a difference in the mean (SEM) JSE-S empathy score was noted (114.6 [0.7] and 112.0 [0.7], respectively; P=.01); however, the effect size was small (partial η2=0.01). Interest in OMM and the osteopathic philosophy were significantly associated with higher empathy scores (P2=0.08). Conclusion Interest in and use of OMM are associated with higher empathy scores and empathy subcomponents. Training and use of OMM should be examined as a mechanism contributing to the durability of empathy in the osteopathic medical profession.

To evaluate the efficacy of a self-administered cognitive training program for improving cognition in normal elderly persons.A multisite, randomized control, double-blind trial was conducted with 28 experimental participants (MCompared to the AC group, the EI group displayed significant gains on targeted executive (p = .002) and memory (p.001) composites, but not the emotion (p = .105) composite. Training-induced benefits were also observed for the EI group on untrained items within global cognition (BCRS, p = .002) and functional abilities (DAD, p.001; FRS, p = .042). The percentage of participants who showed reliable performance improvements was greater for the EI than AC on executive (55.5% vs. 12.5%), memory (55% vs. 19.5%) and functional (41% vs. 7.5%) ability. Participant recruitment and compliance rates were enhanced by the involvement of a physician.Results support the efficacy of self-directed cognitive training in reliably improving cognitive and functional abilities in normal older adults. While physicians are critical in enhancing the delivery of regimented treatment, the present study illustrates the potential for self-directed prophylactic training in deterring the development of cognitive decline.

Cognitive impairment is common in patients with pain. While symptoms of pain are effectively treated with osteopathic manipulative treatment (OMT), the cognitive complaint is vastly ignored. Pain-induced cognitive dysfunction can be severe and is particularly apparent in working memory and attention. There is good reason to expect cognitive responsiveness to OMT. Previous research has reported the effects of OMT on related psychiatric outcomes, including relief from depression and anxiety, suggesting that OMT may produce more cortical benefits than is currently thought. The rationale to link OMT to cognition comes from the tenets of osteopathic medicine: body unity, homeostasis, and the structure-function relationship. The present article provides background evidence to support the hypothetical link between OMT and cognitive benefits and proposes a physiological mechanism of how OMT could exert its effect on cognition. Research strategies are discussed to test the hypotheses that are generated from the proposed theoretical framework.

Contains fulltext : 200437.pdf (Publisher’s version ) (Closed access) OBJECTIVES: The impact of nutrition status on outcomes in pediatric severe sepsis is unclear. We studied the association of nutrition status (expressed as body mass index z score) with outcomes in pediatric severe sepsis. DESIGN: Secondary analysis of the Sepsis Prevalence, Outcomes, and Therapies study. Patient characteristics, ICU interventions, and outcomes were compared across nutrition status categories (expressed as age- and sex-adjusted body mass index z scores using World Health Organization standards). Multivariable regression models were developed to determine adjusted differences in all-cause ICU mortality and ICU length of stay by nutrition status. SETTING: One-hundred twenty-eight PICUs across 26 countries. PATIENTS: Children less than 18 years with severe sepsis enrolled in the Sepsis Prevalence, Outcomes, and Therapies study (n = 567). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Nutrition status data were available for 417 patients. Severe undernutrition was seen in Europe (25%), Asia (20%), South Africa (17%), and South America (10%), with severe overnutrition seen in Australia/New Zealand (17%) and North America (14%). Severe undernutrition was independently associated with all-cause ICU mortality (adjusted odds ratio, 3.0; 95% CI, 1.2-7.7; p = 0.02), whereas severe overnutrition in survivors was independently associated with longer ICU length of stay (1.6 d; p = 0.01). CONCLUSIONS: There is considerable variation in nutrition status for children with severe sepsis treated across this selected network of PICUs from different geographic regions. Severe undernutrition was independently associated with higher all-cause ICU mortality in children with severe sepsis. Severe overnutrition was independently associated with greater ICU length of stay in childhood survivors of severe sepsis.

The Collective Article 'New Mediterranean Biodiversity Records' of the Mediterranean Marine Science journal offers the means to publish biodiversity records in the Mediterranean Sea. The current article is divided in two parts, for records of native and alien species respectively. The new records of native fish species include: the slender sunfish Ranzania laevis and the scalloped ribbonfish Zu cristatus in Calabria; the Azores rockling Gaidropsarus granti in Calabria and Sicily; the agujon needlefish Tylosurus acus imperialis in the Northern Aegean; and the amphibious behaviour of Gouania willdenowi in Southern Turkey. As regards molluscs, the interesting findings include Ischnochiton usticensis in Calabria and Thordisa filix in the bay of Piran (Slovenia). The stomatopod Parasquilla ferussaci was collected from Lesvos island (Greece); the isopod Anilocra frontalis was observed parasitizing the alien Pteragogus trispilus in the Rhodes area. The asteroid Tethyaster subinermis and the butterfly ray Gymnura altavela were reported from several localities in the Greek Ionian and Aegean Seas. The new records of alien species include: the antenna codlet Bregmaceros atlanticus in Saronikos Gulf; three new fish records and two decapods from Egypt; the establishment of the two spot cardinal fish Cheilodipterus novemstriatus and the first record of the marble shrimp Saron marmoratus in semi-dark caves along the Lebanese coastline; the finding of Lagocephalus sceleratus, Sargocentron rubrum, Fistularia commersonii and Stephanolepis diaspros around Lipsi island (Aegean Sea, Greece); the decapod Penaeus hathor in Aegean waters; the decapod Penaeus aztecus and the nudibranch Melibe viridis in the Dodecanese islands; the finding of Pinctada imbricata radiata in the Mar Grande of Taranto (Ionian Sea, Italy) and the Maliakos Gulf (Greece).

The exchange kinetics of Gd(DTPA-BMEA) with the radioactive tracer Eu(III) have been studied in aqueous solution of 0.15 M ionic strength and 25°C. The exchange is a first-order reaction with the rate expression containing both acid-dependent and acid-independent terms. At pH>6, the exchange is governed by direct reaction of Eu(III) ions with Gd(DTPA-BMEA), while below pH 6, the rate determining step is proton-catalyzed dissociation of the complex with a first-order dependence on [H+]. The relatively slow association and dissociation of the Ln(DTPA-BMEA) complexes can be attributed to steric effects related to the binding of the two methoxyethylamide groups.

Introduction Research in the field of the aging brain has evolved to the extent that it is now commonly understood that actively engaging in cognitive tasks provides the potential of being beneficial in affecting the trajectory of age-related cognitive decline. What remains to be examined is the extent, and type, of program required to effect change in aging cognitively impaired individuals. Methods To address this issue, a cognitive program focusing on the use of visuospatial (VS)/visuomotor (VM) elements was applied to a group of six older individuals with identified progressive cognitive impairments. It was hypothesized that using tasks with VS and VM components may be beneficial in supporting overall brain performance, and subsequently assist individuals to perform well in various cognitive and behavioral tasks. Results Results showed that on many evaluative measures individuals remained stable, or improved in performance with medium-to-large effect sizes (e.g., 0.3–1.0). Thus, in a cognitively impaired population sample where decline would be the norm, our participants improved or remained stable. Conclusion The novel application of a VS/VM training program shows promise in addressing global cognitive decline, by targeting a brain area susceptible to early disruptions and providing it with additional and ongoing stimulative tasks in an effort to bolster its functioning and subsequently overall brain functioning.

The complexation thermodynamics of lanthanide ions by 1,2,3-benzenetricarboxylate (hemimellitate), 1,2,4-benzenetricarboxylate (trimellitate) and 1,2,4,5-benzenetetracarboxylate (pyromellitate) ligands were studied using potentiometric, calorimetric and extraction techniques. The measurements were obtained at an ionic strength of 0.10 M (NaClO4) and at 25 °C. The results were compared to analogous values of benzoate, isophthalate and o-phthalate complexation. The apparent increased stability of these complexes above that expected for a typical bidentate complex is in fact merely a statistical factor. The ΔH101 and ΔS101 of these complexes reflect relatively strong dehydration of metal and ligand ions upon complex formation.

[sup 1]H-NMR shift data were measured for the diamagnetic La[sup 3+] and Lu[sup 3+] complexes with diethylenetriaminepentaacetate-N,N[prime]-bis(methylamide) (DTPA-BMA) at different temperatures. Quartet splitting of the methylene protons of the terminal acetate groups and of the amide groups upon complexation with metal ions is indicative of long-lived metal-nitrogen bonds and short-lived metal-oxygen bonds. The observation of two quartets for the terminal acetates and the splitting of the N-methyl singlet upfield is attributed to the presence of more than one conformation in solution. Thermodynamic data indicate that DTPA-BMA acts as an octadentate ligand toward lanthanide ions and possibly as a hexadentate ligand toward Ca[sup 2+], Cu[sup 2+], and Zn[sup 2+] ions. Fluorescence data for the Eu[sup 3+] complex support the octadentate behavior of the ligand toward lanthanides and indicate that the complex contains one coordinated water molecule. 16 refs., 4 figs., 4 tabs.

The stability constants for the formation of NpO2L and NpO2HL (L = AMP, ADP, or ATP) have been measured potentiometrically in solutions of 0.10 M (NaClO4) ionic strength and at 25°C. The order of complexation strength was ATP4− > ADP3− > AMP2− as expected for systems with dominant ionic interactions. The results obtained were compared to complexation of the alkaline earths and trivalent lanthanide ions by the same series of ligands.

Cristallisation dans Pnn2 avec a = 8,860, b = 11,007 et c = 16,316 A, Z = 4; affinement jusqu'a R = 0,040. Coordination octaedrique autour de Fe. Les deux molecules d'eau sont liees par le proton requis par la neutralite electrique et forment un cation H 5 O 2 . Les deux coordinats sont orthogonaux. Les protons des deux molecules d'eau sont lies aux atomes O carboxylate qui ne sont pas coordines a l'atome Fe.

Hydration studies of lanthanides and actinides are reviewed. In their trivalent state, the two series of elements have similar hydration and hydrolytic behavior. The solid hydrates adopt the tricapped trigonal prism (CN=9) structures whereas in solution, diffraction and solution measurements support a change in hydration number from 9 to 8 with decreasing ionic radii. Thermodynamics of hydration, rates of solvolysis and preferential solvation in mixed solvents are discussed. Changes in hydration and hydrolytic characterization with oxidation state of the central ion are also reviewed.

The thermodynamics of complexation of Th+4 and Ca+2 ions with chlorate, bromate, and iodate ligands were studied using solvent extraction and calorimetric techniques. The measurements were obtained at LOOM (NaClO4) ionic strength and 25[ddot]C. The results are compared to the values for complexation of Eu+3 by the same ligands and are interpreted to reflect outer sphere complexation for the chlorate complexes, an inner sphere complexation for the iodates and mixed behaviour for the bromates.

The reaction mechanism of a Michael-like addition of glycolate (ga, 1) to maleate (male, 2) catalyzed by lanthanide(III) ions in aqueous solution giving carboxymethoxysuccinate (cmos, 3) is discussed with respect to its reaction kinetics. The reaction takes place in a ternary complex of Ln(male)(ga) with the addition of the ionized Ln(III) coordinated hydroxy group of 1 to the olefinic bond of 2 as the rate determining step. The first order rate constant in the ternary complex is around 1 min−1. Since exchange of the ligands is fast, the amount of the ternary complex Ln(male)(ga) formed in the mixed ligand system has to be calculated by its stability constant. The stability constants of Ln(ga)n, Ln(male)n, Ln(cmos)n (n = 1, 2) and Ln(male)(ga) were determined potentiometrically. The pKa for the ionization of the Ln(III) coordinated hydroxyl group of 1 could be obtained indirectly from the reaction kinetics. The existence of the Ln(III) coordinated H−1ga ligand was supported by 13C NMR. The effective charge density of the cation plays an important role in decreasing the pKa of the hydroxyl group of 1 upon coordination. This effect is somewhat counteracted by a concomitant decrease of the nucleophilicity of the resulting alcoholate group in the addition reaction. The La(III) catalyzed reverse reaction (3 → 1 + 2) was found to be stereoselective, resembling enzyme catalysis.

The Fe centre in Na[Fe(C 7 H 3 NO 4 ) 2 ].2H 2 O is surrounded by an approximately octahedral arrangement of two pyridine N and four carboxylate O atoms from the two dipicolinate ligands (dipicolinic acid is 2,6-pyridine-dicarboxylic acid). The mean Fe-N and Fe-O bond distances are 2.05 and 2.02 A, respectively. The complex units are bridged by Na + ions which are coordinated to four carboxylate O atoms (of which three are not used for Fe chelation) and to two water molecules. The six donor O atoms form a distorted octahedron around the Na + ion with the water molecules trans to each other

The stability constants for the formation of the lanthanide chelates LnH 2 DTPP° and LnH 3 DTPP + (DTPP = diethylenetriamine- N , N ′, N ′″-penta-β-propionate) have been measured in solutions of 0.50 M (NaClO 4 ) ionic strength by pH measurement. The similar stabilities of the two complexes indicate that both species involve similar binding sites of the ligand. The similarity in their entropy and enthalpy values also support such a model. Fluorescence data indicate that the primary coordination sphere of the Eu III ion in both complexes contains 5.5±0.5 water molecules compared to the value of 8.8±0.5 for the free Eu III (aq) ion. This is consistent with binding of the lanthanide ion via three donor sites of DTPP.

[U(C 7 H 5 O 2 ) 2 O 2 ] cristallise dans C2/m avec a=7,604, b=17,408, c=5,296 A, β=95,81 o , Z=2; affinement jusqu'a R=0,058. L'ion uranyl possede une coordination quaternaire. Le polyedre de coordination autour du centre uranium ressemble a un octaedre avec les groupements carboxylates agissant comme donneurs pontants

Background There is a paucity of information regarding visuospatial (VS) and visuomotor (VM) task performance in patients with chronic right fronto-parietal lobe stroke, as the majority of knowledge to date in this realm has been gleaned from acute stroke patients. The goal of this paper is to determine how VS and VM performance in chronic stroke patients compare to the performance of healthy participants. Methods Nine patients with stroke involving the right fronto-parietal region were evaluated against match controls on neuropsychological tests and a computerized visuomotor assessment task. Results Initial evaluation indicated that performance between participant groups were relatively similar on all measures. However, an in-depth analysis of variability revealed observable differences between participant groups. In addition, large effect sizes were also observed supporting the theory that using only conventional examination (e.g., p-values) measures may result in miss-identifying crucial stroke-related differences. Conclusion Through conventional evaluation methods it would appear that the chronic stroke participants had made significant functional gains relatively to a control group many years post-stroke. It was shown that the type of evaluation used is essential to identifying group differences. Thus, supplementary methods of evaluation are required to unmask the true functional ability of individuals many years post-stroke.

The rate of reaction of [Ce(EDTA)(OH)nn−] with H2O2 in 0.10 M KNO3 solution was investigated at various temperatures. The presence of a peroxy intermediate is inferred from spectrophotometric measurements. The general rate equation, is valid for pH 7-9 with n= 1 and 2 complexes involved. The rate constants kl and k2 were determined at 25 °C to be 0.054 and 0.171 M−1 s−1 respectively. The corresponding activation enthalpies, as calculated from Arrhenius plots, were δH1#= 51.3 ± 14.8 and δH2#= 41.8 ± 5.3 kJ m−1 and the activation entropies were δS1#=-97 ± 47 and ΔS2#=−119±17 J K−1 m−1.

The decomposition of hydrogen peroxide in the presence of hydroxonitrilotri(methylenephosphonato)iron(III), [Fe(NTMP)(OH)4−], was studied in nitrate media (μ=0.10–0.26 M) over the 0.2–0.5 mM concentration range for the iron complex and the temperature range 26–40°C. The rate law; $$\begin{gathered} {{ - d[H_2 O_2 ]} \mathord{\left/ {\vphantom {{ - d[H_2 O_2 ]} {dt}}} \right. \kern-\nulldelimiterspace} {dt}} = \left( {\frac{{k_i k_1 k_3 }}{{k_4 }} \cdot K_a } \right)^{0.5} \hfill \\ \times \frac{{[Fe(NTMP)(OH)^{4 - } ][H_2 O_2 ]}}{{[H^ + ]^{0.5} }} \hfill \\ \end{gathered} $$ holds over the 9.3–11.0 pH range. At 26°C, the specific rate constants for the reactions; $$\begin{gathered} [Fe(NTMP)(OH)]^{4 - } + HO_2^ - \mathop \to \limits^{k_i } [Fe(NTMP)(OH)]^{5 - } \hfill \\ + O_2^{ - \cdot } + H^ + \hfill \\ and \hfill \\ [Fe(NTMP)(OH)]^{4 - } + O_2^{ - \cdot } \hfill \\ \mathop \to \limits^{k_1 } [Fe(NTMP)(OH)]^{5 - } + O_2 \hfill \\ \end{gathered} $$ were estimated as 11 and 100 M−1 s−1 respectively. The corresponding activation enthalpies and activation entropies were calculated from a least-squares fit of the temperature-dependence of the specific rate constants. The results support a mechanism where electron-transfer step is the rate-determining step.

A light microscopic study was carried out on testicular aging in the Wistar rat at the ages of 7, 12, 24, 40, 56, 72, 104, and 124 weeks. The following tissular modifications were observed: a progressive decrease in capillary density, a gradually reduced spermatogenic production, and a progressive increase of degenerating tubular areas. The following two questions were raised: (1) Are the vascular modifications responsible for the other alterations? (2) Do the anomalies inducing a decreased number of spermatozoa simultaneously lead to genetic alterations in the morphologically normal spermatozoa with fertilizing ability? This question is particularly interesting owing to our current knowledge of the consequences of the father's age on offspring.

Parametres de complexation des lanthanides avec les coordinats succinate, glutarate, adipate et transcyclohexanedicarboxylate-1,4

The proton NMR spectra of ethylenediamine- NN ′- diacetate- NN ′-di-3-propionate and its complexes with alkaline earth and diamagnetic lanthanide ions are described. Quartet splittings of the methylenic protons of the acetate groups upon complexation with metal ions of high charge density is indicative of long-lived metalnitrogen bonds and short-lived metaloxygen bonds. The observation of two AB quartets for the acetate protons complexed to trivalent ions was attributed to an unsymmetrical distribution of the acetate arms around the central ion. For Mg 2+ complex, the two acetate arms are equivalently disposed and the two quartets collapse into one. For the other alkaline earths, a singlet is observed, indicating that the metalnitrogen bond lifetime is also short. The spectra of the propionate protons are consistent of either an ABCD (LuENDPDA and YENDPDA) or an AA′BB′ (MgENDPDA) spectral pattern. The thermodynamic data support these conclusions and show that substitution of C 2 H 4 CO 2 − groups for CH 2 CO 2 − groups decreases the stability of the complex. This results from weakening of the metalnitrogen interaction due to the expansion of the

The catalysed decomposition of hydrogen peroxide in the presence of ethylenediaminetetrakis(methylene-phosphonato)iron(III) was studied at various temperatures. The observed rate law is given by -d[H2O2]/dt = k1K/([H+] + K) [Fe(CENTMP)]. where K is the acid-dissociation constant of the aquo complex. A mechanism involving the aquation of the ternary hydroxo complex as the rate-determining step is suggested. The values of k1 and pK were determined at 35°C to be 0.62 × 10−2 and 10.09 repectively. Activation enthalpy and activation entropy for the aquation reaction were determined from Arrhenius plots and found to be ΔH‡ = 74.57 kJ mol−1 and ΔS‡ = 202 J K−1 mol−1. The results are compared with previously reported data on catalysis by the structurally related [Fe(EDTA)] species.

The rate of reaction of [Fe(HEDP)] with H2O2 in 0.10 M KNO3 solution was investigated at various temperatures. The observed rate law is given by the expression where k1 and k2 are the rate constants in the presence of [FeHL−] and [FeL2-] complex species, respectively, and K1 is the ionisation constant of [FeHL−]. The rate constants k1 and k2 were determined at 30°C to be 0.024 ± 0.002 and 0.189 ± 0.005 M−1s−1, respectively. The corresponding activation enthalpies (ΔH1 = 73.8 ± 10.5 and ΔH2 = 58.9 ± 0.8 kJ mol−1) and activation entropies (ΔS1 = −33 ± 33 and ΔS2 = −64 ± 2 J K−1 mol−1) were calculated from a least-squares fit to Arrhenius plots. The results are compared with previously reported data for other complexes.

The thermodynamic parameters of complexation of lanthanide cations with N-methylethylenediamine-N,N',N'-triacetate ion (MEDTA) were determined by potentiometric and calorimetric techniques. The measurements were conducted at 25 /sup 0/C and ionic strength of 0.10 and 0.50 M (NaClO/sub 4/). The observed decrease in stability as well as in enthalpy values of Ln-MEDTA chelates compared to EDTA species is attributed to a weaker Ln-N interaction due to the presence of a single acetate arm associated with one of the nitrogens. 14 references, 3 figures, 3 tables.

The thermodynamic parameters of complexation of lanthanide cations by ortho-, meta- and para- methoxybenzoates have been measured using potentiometric and calorimetric techniques at 25 °C and an ionic strength of 0.10 M (NaClO4). The values of logβ101 correlate well with the ligand acid values of pKa, reflecting the strongly ionic nature of the metal-ligand interaction. No evidence is found for extra charge polarization in these aromatic ligands due to the lanthanide complexation.

The /sup 1/H NMR spectra of ethylenediaminetetrakis(methylenephosphonic acid) (ENTMP) and of some metal complexes were interpreted to indicate that the nitrogens are preferentially protonated in the free ligand whereas the phosphonate groups are protonated in the metal complexes. A single ABX pattern for lanthanide-ENTMP complexes is consistent with a time-averaged symmetry for the ligand about the metal involving long-lived lanthanum-nitrogen (Ln-N) and short-lived lanthanum-oxygen (Ln-O) bonds. The /sup 31/P NMR pattern also supports such averaged equivalence of all phosphonate groups. The calcium (Ca) ENTMP complex has short-lived Ca-N and Ca-O bonds. 4 figures, 4 tables.