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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 double-blinded, randomised, placebo-controlled trial was conducted to determine whether routine pre-operative analgesia is beneficial in reducing post-operative ear pain following bilateral myringotomy and tube placement.
Forty-five children (aged 3–15 years) were randomised to receive either pre-operative analgesics (paracetamol and ibuprofen) (n = 21) or placebo (n = 24). All children underwent sevoflurane gas induction with intranasal fentanyl (2 mcg/kg) to reduce the incidence of emergence agitation. Post-operative pain scores were measured using the Wong-Baker Faces Pain Rating Scale. Median pain scores taken 90 minutes post-surgery, and the highest pain score recorded prior to 90 minutes, were analysed.
There were no statistical differences between the median pain scores at 90 minutes or subsequent need for rescue analgesia. Emergence agitation did not occur in any child. Inadvertent ear trauma, use of an intravenous cannula or airway adjunct did not affect pain scores.
Routine pre-operative analgesia does not reduce pain scores in the early post-operative period. Simple analgesics are effective for rescue analgesia in the minority of cases.
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.
Despite lessons learned from the recent Ebola epidemic, attempts to survey and determine non-health care worker, industry-specific needs to address highly infectious diseases have been minimal. The aircraft rescue and fire fighting (ARFF) industry is often overlooked in highly infectious disease training and education, even though it is critical to their field due to elevated occupational exposure risk during their operations.
Supervisors perceived Frontline respondents to be more willing and comfortable to encounter potential highly infectious disease scenarios than the Frontline indicated. More than one-third of respondents incorrectly marked transmission routes of viral hemorrhagic fevers. There were discrepancies in self-reports on the existence of highly infectious disease orientation and skills demonstration, employee resources, and personal protective equipment policies, with a range of 7.5%-24.0% more Supervisors than Frontline respondents marking activities as conducted.
There are deficits in highly infectious disease knowledge, skills, and abilities among ARFF members that must be addressed to enhance member safety, health, and well-being. (Disaster Med Public Health Preparedness. 2018;12:675-679)
In addition to the more or less steady solar wind, the Sun also ejects mass in highly time dependent events taking place in the corona once every few days at solar activity minimum and as often as three times a day at solar activity maximum (Hundhausen 1988, Low 1986). These events involve large scale reconfiguration of the corona with an expulsion of some 1015g of ionized material into interplanetary space. The High Altitude Observatory (HAO) operates a groundbased internally occulted coronagraph at Mauna Loa, Hawaii, with a field of view of the corona from 1.2 to 2.2R⊙ in heliocentric distance, registering polarization brightness. A second instrument at the same site in Hawaii observes the solar limb in Hα emission to detect chromospheric material from the limb out to 1.5R⊙. HAO also operates an externally occulted coronagraph/polarimeter onboard the NASA Solar Maximum Mission Satellite (SMM) launched in 1980, capitalizing on the advantage of space with a field of view from 1.5 to 6R⊙ to cover the fainter outer corona. Coronal mass ejections involve magnetic field reconfiguration from high in the corona down to the base lying below 1.1R⊙. Important physical insights can be had when simultaneous observations by HAO's three instruments are put together with a common scale and orientation to reveal a mass ejection in the full extent of the solar atmosphere from the limb outward. Combined observations of two mass ejections are presented, one associated with an eruptive prominence and the the other associated with a flare. The significance of these two events is that in both cases, the mass ejection was in fully developed motion and had traveled high into the corona well before the onset of the associated prominence or flare eruption, pointing to an instability in the large scale coronal magnetic field as the underlying cause of the global reconfiguration.
The radiocarbon dating of volcanic ash (tephra) deposits in New Zealand has been difficult on sites remote from the eruption, which contain either little carbon or degraded and contaminated charcoal. Although many studies of contamination removal from macroscopic charcoals from tephra sequences have been made, little attention has been paid to those containing no visible charcoal, because of the difficulty of obtaining sufficient carbon for radiometric dating. We report here experiments using accelerator mass spectrometry to establish a reliable method for dating a low-carbon aeolian and peat deposit containing a tephra horizon. Results so far demonstrate that improvements to existing chemical pretreatment methods are possible, and that dates obtained on oxidized fine-grained residues can approach the maximum age determined on good quality charred wood samples.
This paper outlines a dating program designed to test the reproducibility of radiocarbon dates on different materials of Late-Glacial age (plant macrofossils, fossil beetle remains, and the “humic” and “humin” chemical fractions of limnic sediments) using a combination of radiometric (beta counting) and accelerator mass spectrometry (AMS) techniques. The results have implications for the design of sampling strategies and for the development of improved dating protocols, both of which are important if a high-precision 14C chronology for the Late-Glacial is to be achieved.
14C measured in trace gases in clean air helps to determine the sources of such gases, their long-range transport in the atmosphere, and their exchange with other carbon cycle reservoirs. In order to separate sources, transport and exchange, it is necessary to interpret measurements using models of these processes. We present atmospheric 14CO2 measurements made in New Zealand since 1954 and at various Pacific Ocean sites for shorter periods. We analyze these for latitudinal and seasonal variation, the latter being consistent with a seasonally varying exchange rate between the stratosphere and troposphere. The observed seasonal cycle does not agree with that predicted by a zonally averaged global circulation model. We discuss recent accelerator mass spectrometry measurements of atmospheric 14CH4 and the problems involved in determining the fossil fuel methane source. Current data imply a fossil carbon contribution of ca 25%, and the major sources of uncertainty in this number are the uncertainty in the nuclear power source of 14CH4, and in the measured value for δ14C in atmospheric methane.
Radiocarbon (14C) produced by cosmogenic processes in the atmosphere reacts rapidly with atomic oxygen to form 14CO. The primary sink for this species is oxidation by the OH radical, the single most important oxidation mechanism for pollutants in the atmosphere. Hence, knowledge of the spatial and temporal distribution of 14CO allows important inferences to be made about atmospheric transport processes and the distribution of OH. Because the chemical lifetime of 14CO against OH attack is relatively short, 1–3 months, its distribution in the atmosphere should show modulations due to changes in 14C production caused by variations in the solar cycle. In this work we present a simple methodology to provide a time series of global 14C production to help interpret time series of atmospheric 14CO measurements covering the whole of solar cycle 23. We use data from neutron monitors, a readily available proxy for global 14C production, and show that an existing 6-year time series of 14CO data from Baring Head, New Zealand, tracks changes in global 14C production at the onset of solar cycle 23.
Distribution profiles of radiocarbon in dissolved inorganic carbonate have been measured along two transects in the southern Pacific, east of New Zealand. Use of accelerator mass spectrometry, with its small-sample-size capability, made it possible to sample near-surface waters with a depth resolution of a few tens of meters. Sampling of deeper water was guided by salinity and temperature data transmitted by a conductivity-temperature-depth probe. The measurements, taken over the Chatham Rise, show highly structured profiles that can be correlated with known circulation patterns in this region.
We present the first results from multi-site observations of the δ Scuti star XX Pyx (CD–24°7599). The observations were carried out as the 17th run of the Delta Scuti Network. We collected 583 hr of B, V time-series photometry, resulting in a detection level (4σ) in the amplitude spectrum of 0.5 mmag. We detect 6 new pulsation frequencies, bringing the total number of frequencies known in this star up 19.
Elevated levels of interleukin-6 (IL-6) have been associated with the development of common mental disorders, such as depression, but its role in symptom resolution is unclear.
We examined the association between IL-6 and symptom resolution in a non-clinical sample of participants with psychological distress.
Relative to high IL-6 levels, low levels at baseline were associated with symptom resolution at follow-up [age- and sex-adjusted risk ratio (RR) = 1.15, 95% confidence interval (CI) 1.06–1.25]. Further adjustment for covariates had little effect on the association. Symptomatic participants with repeated low IL-6 were more likely to be symptom-free at follow-up compared with those with repeated high IL-6 (RR = 1.21, 95% CI 1.03–1.41). Among the symptomatic participants with elevated IL-6 at baseline, IL-6 decreased along with symptom resolution.
IL-6 is potentially related to the mechanisms underlying recovery from symptoms of mental ill health. Further studies are needed to examine these mechanisms and to confirm the findings in relation to clinical depression.
This paper brings together the work of the GI Solvency II Technical Provisions working party. The working party was formed in 2009 for the primary purpose of raising awareness of Solvency II and the impact it would have on the work that reserving actuaries do. Over the years, the working party’s focus has shifted to exploring and promoting discussion of the many practical issues raised by the requirements and to promoting best practice. To this end, we have developed, presented and discussed many of the ideas contained in this paper at events and forums. However, the size of the subject means that at no one event have we managed to cover all of the areas that the reserving actuary needs to be aware of. This paper brings together our thinking in one place for the first time. We hope experienced practitioners will find it thought provoking, and a useful reference tool. For new practitioners, we hope it helps to get you up-to-speed quickly. Good luck!
We describe the efficacy of enhanced infection control measures, including those recommended in the Centers for Disease Control and Prevention’s 2012 carbapenem-resistant Enterobacteriaceae (CRE) toolkit, to control concurrent outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) and extensively drug-resistant Acinetobacter baumannii (XDR-AB).
Before-after intervention study.
Fifteen-bed surgical trauma intensive care unit (ICU).
We investigated the impact of enhanced infection control measures in response to clusters of CPE and XDR-AB infections in an ICU from April 2009 to March 2010. Polymerase chain reaction was used to detect the presence of blaKPC and resistance plasmids in CRE. Pulsed-field gel electrophoresis was performed to assess XDR-AB clonality. Enhanced infection-control measures were implemented in response to ongoing transmission of CPE and a new outbreak of XDR-AB. Efficacy was evaluated by comparing the incidence rate (IR) of CPE and XDR-AB before and after the implementation of these measures.
The IR of CPE for the 12 months before the implementation of enhanced measures was 7.77 cases per 1,000 patient-days, whereas the IR of XDR-AB for the 3 months before implementation was 6.79 cases per 1,000 patient-days. All examined CPE shared endemic blaKPC resistance plasmids, and 6 of the 7 XDR-AB isolates were clonal. Following institution of enhanced infection control measures, the CPE IR decreased to 1.22 cases per 1,000 patient-days (P = .001), and no more cases of XDR-AB were identified.
Use of infection control measures described in the Centers for Disease Control and Prevention’s 2012 CRE toolkit was associated with a reduction in the IR of CPE and an interruption in XDR-AB transmission.