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Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
The apparent diffusion coefficients of strontium in compacted bentonites were investigated at various concentrations of NaHCO3. Purified sodium bentonite Kunipia-F® was compacted with a jig into cylindrical pellets 10 mm in diameter and 10 mm high with dry densities of 1.0 to 1.6 Mg/m3. Each bentonite pellet was inserted into an acrylic resin column and saturated with carbonated water containing 0.1 to 1.0 M NaHCO3 for more than 1 month. The face of the bentonite specimen was spiked with 5 μL of 1.0 M SrCl2 tracer solution. After a few weeks, the strontium diffusion profiles were measured by inductively coupled plasma-mass spectrometry. The apparent diffusion coefficients of strontium decreased slightly with increasing dry density. NaHCO3 concentrations of 0.5 M decreased the apparent diffusion coefficients of strontium by half at a dry density of 1.0 Mg/m3 and quarter at 1.6 Mg/m3. At a higher NaHCO3 concentration of 1.0 M, no strontium diffusion profile was observed, whereas white precipitate was observed on the face of the bentonite specimen where it was spiked with strontium. This white precipitate could be strontianite, which is strontium carbonate. Diffusion experiments using cesium were carried out for comparison, and the presence of carbonate had no effect on the apparent diffusion coefficient.
In Canada, reimbursement recommendations on drugs for common and rare indications (for example, orphan drugs) are made through the pan-Canadian Oncology Drug Review (pCODR) and the Common Drug Review (CDR). However, some stakeholders have called for a separate mechanism for orphan drugs, arguing that existing processes place too much weight on their high price tags. The purpose of this study was to examine factors associated with positive recommendations on drugs for rare diseases.
Information was extracted from CDR and pCODR recommendations on drugs for diseases (prevalence of less than 1 in 2,000) up to April 2018. Univariate and multivariate logistic regression models were applied to explore the influence of the following variables on recommendations: year; prevalence; clinical safety and effectiveness (safety, quality of life, symptoms, surrogate outcomes, and survival); quality of evidence (availability of comparative data, external validity, and bias); unmet need; treatment cost; and incremental cost-effective ratio (ICER). Two-way interactions were also tested.
Of 128 recommendations, fifty-four (77 percent) and forty (69 percent) were positive for cancer and non-cancer indications, respectively. For cancer indications, all submissions reporting meaningful improvements in surrogate, quality of life, and survival outcomes were significantly more likely to have a positive recommendation. Submissions showing a lack of external validity were significantly less likely to receive a positive recommendation. For non-cancer indications, more recent submissions and those presenting no safety issues were associated with positive recommendations. Prevalence, treatment cost, and ICER were not determinants of positive or negative recommendations.
For both cancer and non-cancer orphan drugs, impact on clinical safety and effectiveness, rather than cost, appears to be a key factor in the formulation of recommendations.
Many population-based studies identify surgical complications using hospital discharge abstract databases (DAD). With DAD, however, complications occurring after the discharge date cannot be followed up. This study used physician claims data to identify the complications of partial nephrectomy, and to compare the rates of complications of open, laparoscopic, and robot-assisted nephrectomies.
Physician claims, DAD, and ambulatory care data from April 2003 to March 2016 were provided by Alberta Health. DAD and ambulatory care data were used to extract information on patients with kidney cancer who underwent partial nephrectomy. All physician claims within 30 days before and after surgery for the cohort were extracted. The numbers of the same International Classification of Diseases, Ninth Revision (ICD-9), codes before and after surgery were compared. If a number increased after surgery, this diagnosis was initially identified as a complication. All diagnoses with neoplasms were excluded. The incidence rates of complications for the three surgery groups were calculated. Chi-squared tests were conducted for the following nephrectomy comparisons: laparoscopic versus open; robot-assisted versus open; and robot-assisted versus laparoscopic.
A total of 1,890 kidney cancer patients had partial nephrectomies. Among them, 1,080, 411, and 399 had open, laparoscopic, and robot-assisted nephrectomies, respectively. One patient who had two different nephrectomies on the same day was excluded from analysis. The robot-assisted group had lower rates of digestive complications (ICD-9: 537–578, 787, 789, 998.6) and infections (ICD-9: 004–041, 998.5) than the open group, and higher rates of genitourinary complications (ICD-9: 584–599, 788, 997.5) than the laparoscopy group. The robot-assisted group had lower rates than the open group for most of the complication categories, but the differences were not statistically significant.
Robot-assisted surgery appears to be superior to open surgery, but no better than laparoscopic surgery, in terms of minimizing the risk of complications following partial nephrectomy.
Depression is increasingly recognized as a chronic and relapsing disorder. However, an important minority of patients who start treatment for their major depressive episode recover to euthymia. It is clinically important to be able to predict such individuals.
The study is a secondary analysis of a recently completed pragmatic megatrial examining first- and second-line treatments for hitherto untreated episodes of non-psychotic unipolar major depression (n = 2011). Using the first half of the cohort as the derivation set, we applied multiply-imputed stepwise logistic regression with backward selection to build a prediction model to predict remission, defined as scoring 4 or less on the Patient Health Quetionnaire-9 at week 9. We used three successively richer sets of predictors at baseline only, up to week 1, and up to week 3. We examined the external validity of the derived prediction models with the second half of the cohort.
In total, 37.0% (95% confidence interval 34.8–39.1%) were in remission at week 9. Only the models using data up to week 1 or 3 showed reasonable performance. Age, education, length of episode and depression severity remained in the multivariable prediction models. In the validation set, the discrimination of the prediction model was satisfactory with the area under the curve of 0.73 (0.70–0.77) and 0.82 (0.79–0.85), while the calibration was excellent with non-significant goodness-of-fit χ2 values (p = 0.41 and p = 0.29), respectively.
Patients and clinicians can use these prediction models to estimate their predicted probability of achieving remission after acute antidepressant therapy.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
The apparent diffusion coefficients of La, Nd, Eu, Dy, Er, and Lu in compacted bentonites were investigated at various bicarbonate concentrations. The apparent diffusion coefficients of these lanthanides tended to decrease with increasing dry density. At bicarbonate concentrations below 0.25 M, lanthanum had the largest diffusion coefficient (ca. 10-13 m2/s) at 1.0 Mg/m3, and the diffusion coefficient decreased with increasing atomic number. On the other hand, at bicarbonate concentrations above 0.25 M, lutetium had the largest diffusion coefficient, and the diffusion coefficient decreased with decreasing atomic number. In particular, lanthanum and neodymium had diffusion coefficients below 10-14 m2/s, even at 1.0 Mg/m3. The diffusion coefficient of europium was around 10-13 m2/s at 1.0 Mg/m3 and was influenced less by the bicarbonate concentration. The diffusion coefficient of lutetium increased from 2 × 10-14 to 10-12 m2/s as the bicarbonate concentration was increased to 1.0 M. The concentration of carbonate ion in the pore water of bentonite is estimated to be much lower than that in solutions in contact with bentonite from the viewpoints of solubility and chemical species of lanthanides.
Recently, rehabilitation therapists have become involved in cancer rehabilitation; however, no communication skills training that increases the ability to provide emotional support for cancer patients has been developed for rehabilitation therapists. In addition, no study has examined associations between rehabilitation therapists’ communication skills and their level of autistic-like traits (ALT), which are in-born characteristics including specific communication styles and difficulty communicating with patients. In this study, we aimed to investigate whether confidence in communicating with patients mitigates communication difficulties experienced by rehabilitation therapists who have high levels of ALT.
Rehabilitation therapists who treat patients with cancer completed self-administered postal questionnaires anonymously. Scores were obtained on the Autism-Spectrum Quotient short form, confidence in communication, and communication difficulties. We used covariance structure analyses to test hypothetical models, and confirmed that confidence in communication mediates the relationship between ALT and perceived communication difficulties.
Participants included 1,343 respondents (49.6%). Autism-Spectrum Quotient scores were positively correlated with communication difficulties (r = 0.16, p < 0.001). The correlation was mitigated by confidence in communication in the fit model. However, higher confidence in creating a supportive atmosphere was associated with more difficulty in communication (r = 0.16, p < 0.001).
Significance of results
Communication difficulty was linked to rehabilitation therapists’ ALTs. By increasing confidence in areas of communication other than creation of a supportive atmosphere, ALT-related difficulties in communication may be ameliorated. Confidence to create supportive environments correlated positively with difficulty. Communication skills training to increase confidence in communication for rehabilitation therapists should be developed with vigilance regarding ALT levels.
Presence of stars with disparate masses causes great differences in the dynamical evolution of star clusters from the evolution of single component clusters. One remarkable effect is acceleration of the evolution. Another effect is destabilization or stabilization. In two-component clusters equipartition at the cluster centre is nearly achieved if Spitzer's (1969) condition is satisfied. In multi-component clusters equipartition at the cluster centre is achieved if either the range of stellar mass is very narrow or the mass spectrum is very steep. Global equipartition is never achieved. Post-collapse evolution of multi-component clusters is discussed briefly and some remained problems are presented.
NUMO and JAEA have been conducting a joint research since FY2011, which is aimed
to enhance the methodology of repository design and performance assessment in
preliminary investigation stage for the deep geological disposal of high-level
radioactive waste. As a part of this joint research, we have been developing
glass dissolution models which include various processes derived from
glass-overpack-bentonite buffer interaction, considering the precipitation of
Fe-silicates associated with steel overpack corrosion, and Si transport through
altered layer of glass. The objective of this modeling work is to show
comprehensively the lifetime of the vitrified waste due to glass matrix
dissolution timescales through sensitivity analysis, and to identify the
feature/process that most strongly influences the lifetime, and to identify
future R&D issues that would help to improve the nuclide transport
analysis with confidential value and the safety case in future. The sensitivity
analysis suggested that the duration of the glass dissolution might be predicted
in the ranges from 3.8×103 to 1.9×105
years. Also, the results indicated that the precipitation of
Fe–silicate has the strongest influence on the long-team behavior of
In disposing of high-level radioactive waste, the drop in pH in the repository as the iron overpack corrodes must be considered. Plutonium migration behavior may be affected by the pH of pore water in compacted bentonite barriers in high-level waste repositories. To examine the effect of pH on migration behavior, H-bentonite was prepared by treating Japanese Na-bentonite, Kunipia-F, with hydrochloric acid. Diffusion experiments were performed with mixtures of Na- and H-bentonites. The pH value in the pore water of the water-saturated bentonite mixtures decreased from 8 to 3 as the mixing ratio of H-bentonite increased. Diffusion experiments were carried out by using 238Pu then apparent diffusion coefficients were determined from the plutonium distribution in the specimens. The apparent diffusion coefficients were on the order of 10-13 to 10-12 m2/s at pH values lower than 4, whereas they were less than 10-14 m2/s at pH values higher than 6.5. These results indicate that plutonium diffused faster as Pu3+ or PuO22+ due to disproportionation at lower pH while plutonium could be retarded as Pu(OH)40 by sorption on bentonite at higher pH.
In disposal of high-level radioactive waste, carbon steel overpack will be corroded after closure of the repository, creating a reducing, low-pH environment around the repository. A plutonium diffusion experiment was performed over 15 years with Kunigel V1, which is a typical Japanese bentonite that contains about 50% montmorillonite, in contact with an iron coupon. A tracer solution (10 µL) containing 1 kBq of 238Pu was applied at the interface between the iron coupon and compacted bentonite that was saturated with deionized water. After the diffusion period, the plutonium distribution in the bentonite specimen was measured with an alpha scintillation counter, and the iron and sodium distributions were obtained by inductively coupled plasma-mass spectrometry. Plutonium penetrated into the bentonite to a depth of 2 mm, and more than 90% of plutonium remained in corrosion product at the interface. The bentonite around the interface was dark green like green rust or magnetite according to visual observation. Iron was detected throughout the bentonite and there was a particularly high iron concentration from the interface to a depth of 2 mm, whereas the sodium concentration decreased slightly from the interface to 2 mm. We proposed that ferrous ions diffused into bentonite as the iron coupon corroded and precipitated such as magnetite. The magnetite precipitation would decrease the bentonite pH, resulting in the dissolution and migration of plutonium. Small cracks were also observed 2 to 6 mm from the interface and could have been formed by the migration of hydrogen generated by corrosion.
Density profiles of most globular clusters are well fitted by a King (1966) model. The evolution of a King model in the tidal gravitational field of the Galaxy is first discussed. If the concentration parameter c (= log(rt/rc)) is small enough, the evolution is nearly along the King model sequence and c becomes larger. When c becomes large enough (about 2.1), gravothermal instability sets in. The basic properties of gravothermal instability is next discussed. The stability criterion and its interpretation are given. Globular clusters consist of stars with disparate masses, so that finally the evolution of multi-component clusters is discussed. Acceleration of evolution in multi-component clusters and equipartition of the kinetic energies among components are discussed, and conclusions and future problems are given.
To determine the characteristics of acute phase nystagmus in patients with cerebellar lesions, and to identify a useful indicator for differentiating central lesions from peripheral lesions.
Acute phase nystagmus and the appearance of neurological symptoms were retrospectively investigated in 11 patients with cerebellar stroke.
At the initial visit, there were no patients with vertical nystagmus, direction-changing gaze evoked nystagmus or pure rotatory nystagmus. There were four cases with no nystagmus and seven cases with horizontal nystagmus at the initial visit. There were no neurological symptoms, except for vertigo and hearing loss, in any cases at the initial visit. The direction and type of nystagmus changed with time, and neurological symptoms other than vertigo appeared subsequently to admission.
It is important to observe the changes in nystagmus and other neurological findings for the differential diagnosis of central lesions.
It is well known that a supersoluble group has the nilpotent commutator subgroup. But the converse does not hold in general. Therefore, it will be interesting to study the class of groups with nilpotent commutator subgroups. Some results were obtained by B. Huppert  and R. Baer  on this subject.
It is easily seen that the p-length of a group with the nilpotent commutator subgroup is 1 for every p dividing the order of this group. Theorem 1 of this paper may be considered as its local refinement, and is proved in a similar way as B. Huppert . Theorem 2 gives a necessary and sufficient condition for a group to have the nilpotent commutator subgroup in terms of its Hall subgroups. In the last theorem 3 we shall study an interesting class of groups which have maximal subgroups of a certain nature. It turns out that these groups have nilpotent commutator subgroups and admit Sylowtowers.
To evaluate the effectiveness of tympanostomy tube placement in controlling symptoms of intractable Ménière's disease.
Fifteen patients with intractable Ménière's disease underwent tympanostomy tube placement in the affected ear. Post-operative changes in vertigo attacks and hearing level were recorded, and were evaluated according to American Academy of Otolaryngology–Head and Neck Surgery criteria.
At 12 months after treatment, 3 patients (20 per cent) showed complete control of vertigo, 7 (47 per cent) showed substantial control and 2 (13 per cent) showed limited control; 3 patients (20 per cent) required other treatment. At 24 months after treatment, 7 patients (47 per cent) showed complete control of vertigo, 3 (20 per cent) showed substantial control and 1 (7 per cent) showed limited control; 1 patient required other treatment 15 months after tympanostomy tube placement.
There is no definite pathophysiological explanation for the effect of tympanostomy tube placement in reducing vertigo attacks. This treatment is not effective for all patients with intractable Ménière's disease. However, tympanostomy tube placement might be an additional surgical therapeutic option to consider prior to contemplating other, more invasive treatments.
We have developed a “Relative Rates Method” to make bounding calculations regarding radionuclide migration due to uplift/erosion (“exhumation”) of a HLW repository. Results show that this method can apply to a wide range of different uplift rates and erosion rates. In addition, for the long time period, it was shown that the relative difference of uplift rate / erosion rate and potential hydraulic change arising from extreme uplift/erosion could affect radionuclide release and migration, thus uplift/erosion concerns should be fed back to site selection. Our method provides a credible and defensible basis for analysis and interpretation of possible uplift/erosion impacts for future volunteer sites.