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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.
In 2013, the national surveillance case definition for West Nile virus (WNV) disease was revised to remove fever as a criterion for neuroinvasive disease and require at most subjective fever for non-neuroinvasive disease. The aims of this project were to determine how often afebrile WNV disease occurs and assess differences among patients with and without fever. We included cases with laboratory evidence of WNV disease reported from four states in 2014. We compared demographics, clinical symptoms and laboratory evidence for patients with and without fever and stratified the analysis by neuroinvasive and non-neuroinvasive presentations. Among 956 included patients, 39 (4%) had no fever; this proportion was similar among patients with and without neuroinvasive disease symptoms. For neuroinvasive and non-neuroinvasive patients, there were no differences in age, sex, or laboratory evidence between febrile and afebrile patients, but hospitalisations were more common among patients with fever (P < 0.01). The only significant difference in symptoms was for ataxia, which was more common in neuroinvasive patients without fever (P = 0.04). Only 5% of non-neuroinvasive patients did not meet the WNV case definition due to lack of fever. The evidence presented here supports the changes made to the national case definition in 2013.
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.
An updated compilation of published and new data of major-ion (Ca, Cl, K, Mg, Na, NO3, SO4) and methylsulfonate (MS) concentrations in snow from 520 Antarctic sites is provided by the national ITASE (International Trans-Antarctic Scientific Expedition) programmes of Australia, Brazil, China, Germany, Italy, Japan, Korea, New Zealand, Norway, the United Kingdom, the United States and the national Antarctic programme of Finland. The comparison shows that snow chemistry concentrations vary by up to four orders of magnitude across Antarctica and exhibit distinct geographical patterns. The Antarctic-wide comparison of glaciochemical records provides a unique opportunity to improve our understanding of the fundamental factors that ultimately control the chemistry of snow or ice samples. This paper aims to initiate data compilation and administration in order to provide a framework for facilitation of Antarctic-wide snow chemistry discussions across all ITASE nations and other contributing groups. The data are made available through the ITASE web page (http://www2.umaine.edu/itase/content/syngroups/snowchem.html) and will be updated with new data as they are provided. In addition, recommendations for future research efforts are summarized.
Mild behavioral impairment (MBI) describes later life acquired, sustained neuropsychiatric symptoms (NPS) in cognitively normal individuals or those with mild cognitive impairment (MCI), as an at-risk state for incident cognitive decline and dementia. We developed an operational definition of MBI and tested whether the presence of MBI was related to caregiver burden in patients with subjective cognitive decline (SCD) or MCI assessed at a memory clinic.
MBI was assessed in 282 consecutive memory clinic patients with SCD (n = 119) or MCI (n = 163) in accordance with the International Society to Advance Alzheimer's Research and Treatment – Alzheimer's Association (ISTAART–AA) research diagnostic criteria. We operationalized a definition of MBI using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Caregiver burden was assessed using the Zarit caregiver burden scale. Generalized linear regression was used to model the effect of MBI domains on caregiver burden.
While MBI was more prevalent in MCI (85.3%) than in SCD (76.5%), this difference was not statistically significant (p = 0.06). Prevalence estimates across MBI domains were affective dysregulation (77.8%); impulse control (64.4%); decreased motivation (51.7%); social inappropriateness (27.8%); and abnormal perception or thought content (8.7%). Affective dysregulation (p = 0.03) and decreased motivation (p=0.01) were more prevalent in MCI than SCD patients. Caregiver burden was 3.35 times higher when MBI was present after controlling for age, education, sex, and MCI (p < 0.0001).
MBI was common in memory clinic patients without dementia and was associated with greater caregiver burden. These data show that MBI is a common and clinically relevant syndrome.
Although many pests constrain rice production, weeds are considered to be the major barrier to achieving optimal yields. A predictive model based on naturally occurring mixed-species infestations in the field would enable growers to target the specific weed group that is the greatest contributor to yield loss, but as of now no such models are available. In 2013 and 2014, two empirical hyperbolic models were tested using the relative cover at canopy closure of groups of weed species as independent variables: grasses, sedges, broadleaves, grasses and sedges combined, grasses and broadleaves combined, and all weed species combined. Models were calibrated using data from experiments conducted at the California Rice Experiment Station, in Biggs, CA, and validated across four sites over 2 years, for a total of 7 site-year combinations. Of the three major weed groups, grasses, sedges, and broadleaves, the only groups positively related to yield loss in the multispecies infestation were grasses. At the model calibration site, grasses and sedges combined best predicted yield loss (corrected Akaike information criterion [AICc]=−21.5) in 2013, and grasses alone best predicted yield loss (AICc=−19.0) in 2014. Across the validation sites, the model using grasses and sedges combined was the best predictor in 5 out of 7 site-years. Accuracy of the predicted values at the model validation sites ranged from 6% mean average error to 17% mean average error. No single model and set of parameters accurately predicted losses across all years and locations, but relative cover of grasses and sedges combined at canopy closure was the best estimate over the most sites and years.
Over the last 10 yr, California has experienced a series of ever-worsening droughts. Rice, traditionally a flooded crop, has come under increasing scrutiny with respect to its water use, leading to proposals to evaluate alternative irrigation systems. For growers, weed competition is one of the most limiting factors to maintaining high yields, so understanding the shifts among species in weed communities under the proposed alternative irrigation systems is vital. A field study was conducted from 2012 to 2014 to compare weed population and growth dynamics with three irrigation systems: (1) a conventional water-seeded control system (WS-Control), with a permanent flood of 10 to 15 cm from planting until 1 mo prior to harvest; (2) a water-seeded alternate wet and dry system (WS-AWD), with the field flooded from planting until canopy closure, after which floodwater was allowed to subside and the field was reflooded when the soil volumetric water content reached 35%; and (3) a drill-seeded alternate wet and dry system (DS-AWD), with rice drill seeded and then flush irrigated to establish the crop, after which the field was flooded until canopy closure and then underwent an alternate wet and dry (AWD) treatment similar to WS-AWD. In the AWD treatments, there were two drying periods, neither of which occurred after the heading stage. The dynamics of major weed species were evaluated using plant density counts (2012) and relative cover and biomass (2013 and 2014). Grasses (sprangletop and watergrass species) dominated the DS-AWD system; sedges, broadleaves, and grasses dominated both WS systems. The WS-AWD system increased smallflower umbrella sedge relative cover at canopy closure, relative dry weight at harvest, and percent frequency when compared with the WS-Control system. Yields did not differ across treatments when weeds were controlled (P>0.05); in the absence of herbicides, yields in the WS-AWD were equivalent to the WS-Control (ranging from 40 to 65% of the herbicide-treated yields) and zero in the DS-AWD due to weed pressure.
Introduction: Point of care ultrasound has become an established tool in the initial management of patients with undifferentiated hypotension. Current established protocols (RUSH, ACES, etc) were developed by expert user opinion, rather than objective, prospective data. We wished to use reported disease incidence to develop an informed approach to PoCUS in hypotension using a “4 F’s” approach: Fluid; Form; Function; Filling. Methods: We summarized the incidence of PoCUS findings from an international multicentre RCT, and using a modified Delphi approach incorporating this data we obtained the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. The modified Delphi tool was developed to reach an international consensus on how to integrate PoCUS for hypotensive emergency department patients. Results: Rates of abnormal PoCUS findings from 151 patients with undifferentiated hypotension included left ventricular dynamic changes (43%), IVC abnormalities (27%), pericardial effusion (16%), and pleural fluid (8%). Abdominal pathology was rare (fluid 5%, AAA 2%). After two rounds of the survey, using majority consensus, agreement was reached on a SHoC-hypotension protocol comprising: A. Core: 1. Cardiac views (Sub-xiphoid and parasternal windows for pericardial fluid, cardiac form and ventricular function); 2. Lung views for pleural fluid and B-lines for filling status; and 3. IVC views for filling status; B. Supplementary: Additional cardiac views; and C. Additional views (when indicated) including peritoneal fluid, aorta, pelvic for IUP, and proximal leg veins for DVT. Conclusion: An international consensus process based on prospectively collected disease incidence has led to a proposed SHoC-hypotension PoCUS protocol comprising a stepwise clinical-indication based approach of Core, Supplementary and Additional PoCUS views.
Introduction: Point of care ultrasound (PoCUS) provides invaluable information during resuscitation efforts in cardiac arrest by determining presence/absence of cardiac activity and identifying reversible causes such as pericardial tamponade. There is no agreed guideline on how to safely and effectively incorporate PoCUS into the advanced cardiac life support (ACLS) algorithm. We consider that a consensus-based priority checklist using a “4 F’s” approach (Fluid; Form; Function; Filling), would provide a better algorithm during ACLS. Methods: The ultrasound subcommittee of the Australasian College for Emergency Medicine (ACEM) drafted a checklist incorporating PoCUS into the ACLS algorithm. This was further developed using the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. A modified Delphi tool was developed to reach an international consensus on how to integrate ultrasound into cardiac arrest algorithms for emergency department patients. Results: Consensus was reached following 3 rounds. The agreed protocol focuses on the timing of PoCUS as well as the specific clinical questions. Core cardiac windows performed during the rhythm check pause in chest compressions are the sub-xiphoid and parasternal cardiac views. Either view should be used to detect pericardial fluid, as well as examining ventricular form (e.g. right heart strain) and function, (e.g. asystole versus organized cardiac activity). Supplementary views include lung views (for absent lung sliding in pneumothorax and for pleural fluid), and IVC views for filling. Additional ultrasound applications are for endotracheal tube confirmation, proximal leg veins for DVT, or for sources of blood loss (AAA, peritoneal/pelvic fluid). Conclusion: The authors hope that this process will lead to a consensus-based SHoC-cardiac arrest guideline on incorporating PoCUS into the ACLS algorithm.
Glacier response to climate forcing can be heterogeneous and complex, depending on glacier system characteristics. This article presents the decadal evolution of the Tsarmine Glacier (Swiss Alps), a very small and heavily debris-covered cirque glacier located in the Alpine periglacial belt. Archival aerial photogrammetry and autocorrelation of orthophotos were used to compute surface elevation, volume and geodetic mass changes, as well as horizontal displacement rates for several periods between 1967 and 2012. A GPR survey allowed us to investigate glacier thickness (15 m mean) and volume (4 × 106 m3) in 2015 and to anticipate its future evolution. Different dynamics occurred in recent decades because of the heterogeneous surface characteristics. The climate-sensitive upper debris-free zone contrasts with the progressively stagnant heavily debris-covered glacier tongue. Between 1967 and 2012, the glacier lost 1/3 of its initial volume (2 × 106 m3). The average mass balance stabilised at ~−0.3 m w.e. a−1 since 1999. Compared with other local glaciers, the Tsarmine Glacier shows a particular decadal behaviour both in time (divergence of mass balance since the 2000s) and space (inverted ablation pattern). This might be explained by the combined influence of debris cover, shadow, snow redistribution and permafrost conditions on this very small glacier.
As part of the activities of the Collaborative Research Centre ‘SFB 350’, measurements of geodetic and geodynamic changes in the area of the Lower Rhine Embayment and the Rhenish Shield are being performed at different scales in space and time. Continuous borehole tilt measurements and repeated microgravimetric surveys yield information on the local stability of the ground and changes in horizontal gravity gradients that are both dominated by seasonal fluctuations. Results of more than seven years of regular GPS campaigns are discussed in terms of vertical and horizontal point motions. The most prominent motions are man-induced effects occurring in or near the browncoal mining areas, where groundwater withdrawal produces subsidence of up to 2.2 cm/y in the area under investigation. Horizontal and vertical motions at other GPS points are smaller by one order of magnitude and in most cases are only marginally detectable. The eastward motion of two points in the Bergisches Land and the westward motion of two points in the Eifel near the Belgian border may be interpreted as a result of the ongoing extension of the Cenozoic rift system in the western part of the Eurasian plate.
While searches for young stellar objects (YSOs) with the Spitzer Space Telescope focused on known molecular clouds, photometry from the Wide-field Infrared Survey Explorer (WISE) can be used to extend the search to the entire sky. As a precursor to more expansive searches, we present results for a 100 deg2 region centered on the Canis Major clouds.
We evaluated laboratory reports as early indicators of West Nile virus (WNV) disease cases in Texas. We compared WNV laboratory results in the National Electronic Disease Surveillance System Base System (NBS) to WNV disease cases reported to the state health department from 2008 to 2012. We calculated sensitivity and positive predictive value (PPV) of NBS reports, estimated the number of disease cases expected per laboratory report, and determined lead and lag times. The sensitivity and PPV of NBS laboratory reports were 86% and 77%, respectively. For every 10 positive laboratory reports, we expect 9·0 (95% confidence interval 8·9–9·2) reported disease cases. Laboratory reports preceded case reports with a lead time of 7 days. Electronic laboratory reports provided longer lead times than manually entered reports (P < 0·01). NBS laboratory reports are useful estimates of future reported WNV disease cases and may provide timely information for planning public health interventions.
In this work, electrochemically recyclable lithium is analyzed as high energy density, large scale storage material for stranded renewable energy in a closed loop. The strongly exothermic reaction of lithium with carbon dioxide (CO2) yields thermal energy directly comparable to the combustion of coal or methane in an oxygen containing atmosphere. The thermal level of the reaction is sufficient for re-electrification in a thermal power plant compatible process.
The reaction of single lithium particles, avoiding particle-particle interactions, is compared to the combustion of atomized lithium spray in a CO2 containing atmosphere. Particle temperatures of up to 4000K were found for the reaction of single lithium particles in a CO2, nitrogen (N2), oxygen (O2) and steam gas mixture. Furthermore the combustion of atomized lithium spray in both dry CO2 atmosphere and CO2/steam gas mixture was analyzed. The identified solid reaction products are lithium carbonate, lithium oxide and lithium hydroxide. The formation of carbon monoxide (CO) as gaseous reaction product is demonstrated. Carbon monoxide is a valuable by-product, which could be converted to methanol or gasoline using hydrogen.
In Germany, active bat rabies surveillance was conducted between 1993 and 2012. A total of 4546 oropharyngeal swab samples from 18 bat species were screened for the presence of EBLV-1- , EBLV-2- and BBLV-specific RNA. Overall, 0·15% of oropharyngeal swab samples tested EBLV-1 positive, with the majority originating from Eptesicus serotinus. Interestingly, out of seven RT–PCR-positive oropharyngeal swabs subjected to virus isolation, viable virus was isolated from a single serotine bat (E. serotinus). Additionally, about 1226 blood samples were tested serologically, and varying virus neutralizing antibody titres were found in at least eight different bat species. The detection of viral RNA and seroconversion in repeatedly sampled serotine bats indicates long-term circulation of the virus in a particular bat colony. The limitations of random-based active bat rabies surveillance over passive bat rabies surveillance and its possible application of targeted approaches for future research activities on bat lyssavirus dynamics and maintenance are discussed.