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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.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
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.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
As part of further investigations into three linked haemorrhagic fever with renal syndrome (HFRS) cases in Wales and England, 21 rats from a breeding colony in Cherwell, and three rats from a household in Cheltenham were screened for hantavirus. Hantavirus RNA was detected in either the lungs and/or kidney of 17/21 (81%) of the Cherwell rats tested, higher than previously detected by blood testing alone (7/21, 33%), and in the kidneys of all three Cheltenham rats. The partial L gene sequences obtained from 10 of the Cherwell rats and the three Cheltenham rats were identical to each other and the previously reported UK Cherwell strain. Seoul hantavirus (SEOV) RNA was detected in the heart, kidney, lung, salivary gland and spleen (but not in the liver) of an individual rat from the Cherwell colony suspected of being the source of SEOV. Serum from 20/20 of the Cherwell rats and two associated HFRS cases had high levels of SEOV-specific antibodies (by virus neutralisation). The high prevalence of SEOV in both sites and the moderately severe disease in the pet rat owners suggest that SEOV in pet rats poses a greater public health risk than previously considered.
The Dark Energy Survey is undertaking an observational programme imaging 1/4 of the southern hemisphere sky with unprecedented photometric accuracy. In the process of observing millions of faint stars and galaxies to constrain the parameters of the dark energy equation of state, the Dark Energy Survey will obtain pre-discovery images of the regions surrounding an estimated 100 gamma-ray bursts over 5 yr. Once gamma-ray bursts are detected by, e.g., the Swift satellite, the DES data will be extremely useful for follow-up observations by the transient astronomy community. We describe a recently-commissioned suite of software that listens continuously for automated notices of gamma-ray burst activity, collates information from archival DES data, and disseminates relevant data products back to the community in near-real-time. Of particular importance are the opportunities that non-public DES data provide for relative photometry of the optical counterparts of gamma-ray bursts, as well as for identifying key characteristics (e.g., photometric redshifts) of potential gamma-ray burst host galaxies. We provide the functional details of the DESAlert software, and its data products, and we show sample results from the application of DESAlert to numerous previously detected gamma-ray bursts, including the possible identification of several heretofore unknown gamma-ray burst hosts.
Neither of the two general councils of the western Church held between the Second and Third Lateran (1139, 1179) produced a large body of legislation: the genuine canons of the Council of Rheims (1148) number eighteen; those of Tours (1163) about ten. But in the great collection of Mansi this meagre store is eked out by an equal weight of additional canons, sixteen for Rheims and ten for Tours. Mansi looked on them with no great favor, but offered no criterion by which their validity and value might be judged. The Rheims canons, so far as I am aware, have never been submitted to critical study. The Tours canons, on the other hand, were examined and shown to be spurious by Seckel in a valuable appendix to his article on the sources of the canons of the English council of 1175, which he published in the Deutsche Zeitschrift für Kirchenrecht in 1899.
The members of some newly formed academic societies peer forward into the future with a nice mixture of enthusiasm and uncertainty: enthusiasm for a subject in which they are so fanatically interested that they have dared to found yet another society; uncertainty whether the world at large will admit that the subject exists, whether it will be accorded proper academic respectability. We share, I hope, this enthusiasm; but we have no grounds for uncertainty. It was the study of the Church’s history, from within, which did more than anything else to lay the foundations for the critical study of historical sources, most notably in the work of Mabillon and the Maurists. The study of the Church’s history, and most particularly the history of its founder, rocked the world in the nineteenth century, and played a large part in providing the intellectual grounds both for modern belief and for modern disbelief. The Church’s history has, in the past, provided the locus classicus of the problem of historical bias: is it possible, the question has been asked times out of number, for historians of different persuasions to agree in the study of the early Church, or of the Reformation? The question is a real one; we cannot confidently say more than that they can, without much difficulty, talk the same language; that true scholars nowadays will not think of not talking the same language. And this fact reveals the extraordinary power of reconciliation which the study of the Church’s history has had. It does not always reconcile; the common pursuit of truth did little to foster good relations between Coulton and Gasquet. But this spirit of reconciliation is clearly a feature of our age. It is part of a much larger movement, of which we are all witnesses. I have seen with my own eyes a Jesuit father give a public lecture in Winchester College; I have not seen, but millions of my fellow-countrymen have, Catholic and Anglican metropolitans sitting side by side in cosy amity in a television studio. We all know how limited, in terms of visible reunion, is the significance of these events; but the movement towards reunion among Protestant churches and towards better relations among all the sane branches of the Christian family is one of the striking historical phenomena of our age; and a movement (if I may strike a personal note) of hope and joy. Beyond doubt the study of the Church’s history and the dominance of the historical outlook over the last century and a half have much to do with this.
The wide span of years which I have boldly claimed in my title is intended to enmesh and hold together for our inspection the first great age of the medieval city, the tenth and eleventh centuries, when the medieval Church first faced the problem of evangelism in growing mercantile communities, and the age when it deployed in the cities and towns of Europe a new army of missionaries in the persons of the friars. The missionary techniques of the friars are familiar and comparatively well documented; the evangelism of the tenth and eleventh centuries is scarcely documented at all. In recent years the dramatic nature of urban history in this early period has been becoming increasingly apparent; and it was in the conviction that the Church’s hand in it could not wholly escape detection that I chose the title for this lecture. Many aspects of this problem have been traced with the closest care; but I justify the breadth and cloudiness of my theme by a conviction that it has rarely been looked at quite from this point of view.
Patterns of abnormal neural activation have been observed during working memory tasks in bipolar I depression, yet the neural changes associated with bipolar II depression have yet to be explored.
An n-back working memory task was administered during a 3T functional magnetic resonance imaging scan in age- and gender-matched groups of 19 unmedicated, bipolar II depressed subjects and 19 healthy comparison subjects. Whole-brain and region-of-interest analyses were performed to determine regions of differential activation across memory-load conditions (0-, 1- and 2-back).
Accuracy for all subjects decreased with higher memory load, but there was no significant group × memory load interaction. Random-effects analyses of memory load indicated that subjects with bipolar II depression exhibited significantly less activation than healthy subjects in left hemispheric regions of the middle frontal gyrus [Brodmann area (BA) 11], superior frontal gyrus (BA 10), inferior parietal lobule (BA 40), middle temporal gyrus (BA 39) and bilateral occipital regions. There was no evidence of differential activation related to increasing memory load in the dorsolateral prefrontal or anterior cingulate cortex.
Bipolar II depression is associated with hypoactivation of the left medio-frontal and parietal cortex during working memory performance. Our findings suggest that bipolar II depression is associated with disruption of the fronto-parietal circuit that is engaged in working memory tasks, which is a finding reported across bipolar subtypes and mood states.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
The Millimetre Astronomy Legacy Team 90 GHz (MALT90) survey aims to characterise the physical and chemical evolution of high-mass star-forming clumps. Exploiting the unique broad frequency range and on-the-fly mapping capabilities of the Australia Telescope National Facility Mopra 22 m single-dish telescope1, MALT90 has obtained 3′ × 3′ maps towards ~2 000 dense molecular clumps identified in the ATLASGAL 870 μm Galactic plane survey. The clumps were selected to host the early stages of high-mass star formation and to span the complete range in their evolutionary states (from prestellar, to protostellar, and on to
regions and photodissociation regions). Because MALT90 mapped 16 lines simultaneously with excellent spatial (38 arcsec) and spectral (0.11 km s−1) resolution, the data reveal a wealth of information about the clumps’ morphologies, chemistry, and kinematics. In this paper we outline the survey strategy, observing mode, data reduction procedure, and highlight some early science results. All MALT90 raw and processed data products are available to the community. With its unprecedented large sample of clumps, MALT90 is the largest survey of its type ever conducted and an excellent resource for identifying interesting candidates for high-resolution studies with ALMA.
We characterise the Millimetre Astronomy Legacy Team 90 GHz Survey (MALT90) and the Mopra telescope at 90 GHz. We combine repeated position-switched observations of the source G300.968+01.145 with a map of the same source in order to estimate the pointing reliability of the position-switched observations and, by extension, the MALT90 survey; we estimate our pointing uncertainty to be 8 arcsec. We model the two strongest sources of systematic gain variability as functions of elevation and time-of-day and quantify the remaining absolute flux uncertainty. Corrections based on these two variables reduce the scatter in repeated observations from 12%–25% down to 10%–17%. We find no evidence for intrinsic source variability in G300.968+01.145. For certain applications, the corrections described herein will be integral for improving the absolute flux calibration of MALT90 maps and other observations using the Mopra telescope at 90 GHz.
The present article originated out of an attempt to re-edit the letters of Gilbert Foliot, whose career as abbot of Gloucester, bishop of Hereford, and bishop of London covered nearly half of the twelfth century (1139-87). The edition by J. A. Giles is thoroughly unsatisfactory: the text is un-trustworthy, there is no index, and no attempt has been made to date the letters or to arrange them in any coherent order. Nothing could be done at present about the text, since the necessary manuscripts could not be consulted; but it was possible to make an index and with its assistance to arrange the letters in some sort of order and assign to them approximate dates. The chief clues for dating are naturally the names of persons, usually ecclesiastics, mentioned in the letters, but it soon became evident that the only lists available of these ecclesiastics (other than bishops) are for the most part entirely unreliable, and that a complete revision of these lists is a necessary preliminary to any attempt at precise dating, not only of these letters, but also of twelfth-century documents in general. In the thirteenth century, when Patent and Close Rolls begin, there is more positive information, and still more when episcopal registers become available. Before that time, documents were rarely dated, and appointments and deaths of minor officials were not important enough to receive much notice from chroniclers. It is for this early period, when references have to be collected from a number of scattered sources and exact dates are rare, that revision is most needed, and to it we are confining our investigation.
Few men have ever shown a more sublime faith in the divine origin of their mission than the papal reformers of the eleventh century. They set to work with a ‘modest proposal’ to destroy two of the most intimate and powerful foundations of clerical society: they aimed to abolish simony and with it the lay control of patronage; they tried to destroy the family life of the clergy. From one point of view they were doing only what every policeman does—they were trying to enforce the established law. From another point of view their platform was a devastating social revolution. If we may admire the high idealism of Leo IX, Humbert, Hildebrand and Peter Damian, we must also concede that their work had many victims; the legislation of the eleventh-century Popes on clerical marriage must have produced as many broken homes and personal tragedies as the morals of Hollywood. Both Damian the ascetic and Heloise the deserted wife have a claim on our sympathy as historians; and both found their supporters in their own day. Between the unbending demand for the enforcement of celibacy and the view of the Anonymous of York that it was entirely proper for the clergy to be married there were many possible positions. The Anonymous (writing at the turn of the eleventh and twelfth centuries) was propounding opinions already obsolescent; and clerical marriage found few defenders in the middle and late twelfth century. But if the field narrowed, the subtleties of the problem were more fully appreciated. The twelfth century was an age of growing sophistication in lay circles as well as clerical. Nowhere was this more true than in the world of love and of marriage; in that century (whatever the lot of womankind as a whole) the romantic ideal was born, under whose spell we still live. It is the variety and the subtlety of the view-points which give my subject its interest, and also its intractability. Clerical marriage is an exceedingly delicate topic, though it has not always been delicately treated.