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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 purpose of this study was to assess, through participant self-assessment, the effectiveness of a rapid response team curriculum based on the World Health Organization (WHO) Ebola Virus Disease Consolidated Preparedness Checklist, Revision 1.
A pre-and-post survey for the purpose of process improvement assessment involving 44 individuals was conducted in Angola. The survey was conducted before and after a 6-day training workshop held in Luanda, Angola, in December 2017. A paired t-test was used to identify any significant change on six 7-point Likert scale questions with α <.05 (95% CI).
Two of the 6 questions, “I feel confident the team can effectively work together to accomplish its assigned goals and objectives during a suspected contagious hemorrhagic fever disease outbreak” and “I understand basic pandemic response concepts” changed significantly from the presurvey to the postsurvey. The 4 remaining questions had near statistical significant change or an upward trend.
This Angolan rapid response team training curriculum based on WHO guidelines, After Action Reports, and internationally accepted standard operating procedures provides the nation of Angola with the confidence to rapidly respond at the national level to a highly infectious contagion in the region. (Disaster Med Public Health Preparedness. 2019;13:577-581)
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.
Introduction: Choosing Wisely Canada has identified blood transfusions as a priority area for improving clinical appropriateness. Relevant recommendations include Dont transfuse blood if other non-transfusion therapies or observation would be just as effective. In parallel with this recommendation, the Alberta division of Towards Optimized Practice (ToP) has developed guidelines for the treatment of iron deficiency anemia (IDA) that emphasize the use of non-transfusion therapies (i.e. parenteral or oral iron, in appropriate patients). Choosing Wisely also emphasizes strategies to better engage patients in shared decision making. Methods: In order to better engage patients in shared decision making about their treatment options, both physician and patient handouts were developed using an iterative process. The development of the patient-facing documents began with a synthesis of educational materials currently available to patients with IDA. Clinical leaders from nine different specialties (Emergency Medicine, Family Medicine, Day Medicine, Hematology, and others) were continually engaged in the development of content using a consensus model. A focus group of ESCN patient advisors was assembled to review materials with an emphasis on: (1) Are the patient materials easily understood? (2) Are intended messages resonating while avoiding unintended messaging? (3) What information do patients require that has not been included? Following the focus group, revisions were made to patient materials and a subsequent online survey confirmed that the final version addressed any issues they had raised. Results: A four-page patient handout/infographic was developed utilizing best practices in information design, and in physician and patient engagement. Content includes the causes and symptoms of IDA, progressive treatment options from dietary changes to transfusion, and the four Choosing Wisely questions to discuss with your doctor. Conclusion: Patient education materials can be developed according to best practices in information design and stakeholder engagement. Patient focus groups demonstrate that such materials are easier to understand, and better equip patients to engage in shared decision making.
This paper addresses activities carried out in a late-sixteenth or seventeenth century Maya council house (popol nah) just before its abandonment. Structure 719 at the site of Zacpeten in the central Peten lakes district is considered a noble residence remodeled into a council house with an adjacent temple. Excavations revealed quantities of de facto refuse inside the structure's two rooms and around the exterior; recent studies focused on ceramics, lithics, faunal remains, and net sinkers. The back room held abundant lithics and diverse fauna, with evidence of grinding red pigment and snapping obsidian prismatic blades into segments for fashioning arrow points. Pottery and faunal remains indicate feasting, as well as possible use of animal parts in ritual and in making ceremonial objects. The Group 719 complex served as a center of production of various goods and community ritual until its abrupt abandonment, likely in the first decade or so of the eighteenth century.
A number of diseases of ruminants are related to deficiencies of vitamin E and selenium (Se). Nutritional myopathy or white muscle disease (Blaxter and Sharman, 1953; Oksanen, 1965; Allen, Bradley, Berrett, Parr, Swannack, Barton and MacPhee, 1975; McMurray and McEldowney, 1977) affects the young bovine. Crawley and Bradley (1978) have described a sudden death syndrome in Se-deficient, bucket-fed, calves, which disappeared when Se was added to the diet.
The clinical signs of copper (Cu) deficiency are largely non-specific and a number of laboratory tests have been used extensively to assist in diagnosis. Among these are whole blood, plasma and serum Cu and caeruloplasmin (McMurray, 1980). However, for any marker to be useful diagnostically, it is necessary to identify any factors which can affect it. Plasma and serum Cu are not equivalent but are related by the equation:
Serum Cu (mg/l) = 11.7 + 0.66 plasma Cu (mg/l). The regression was obtained from the means of 24 groups of suckler cows and calves (> 10 animals/group). The equivalent relationship between serum and plasma caeruloplasmin is:
Serum caeruloplasmin = 0.0018
+ 0.59 plasma caeruloplasmin.
Units of caeruloplasmin are absorbance units in the phenylene diamine assay.
Thus, the range of normality will depend on the sample being used for the assay. The reduction in serum values is due to the loss of caeruloplasmin during blood clotting.
We found recently that sodium hydroxide, when used as a grain preservative, will rapidly destroy vitamin E in barley (McMurray, Blanchflower and Rice, 1980). This observation has been applied experimentally to make diets deficient in vitamin E which are already naturally deficient in selenium (Se). Such barley, when supplemented with other essential minerals and vitamins plus either soya bean protein or urea, will allow moderate growth (0.7 kg/day) when fed to young ruminants.
The crystal structure of the first thallium-bearing gold telluride, honeaite
Au3TlTe2, is reported and its topological novelty
discussed. Honeaite is orthorhombic, space group Pbcm and
unit-cell parameters a = 8.9671(4), b =
8.8758(4), c= 7.8419(5) Å, V = 624.14(6)
Å3 (Z = 4). Its structure has been refined to
R1 = 0.033, wR2 = 0.053, Goof = 1.087. The structure is based upon a corrugated
double-sheet comprising two sub-sheets, each composed of six-memberedrings
of corner-linked TeAu3 pyramids in which the Te lone pair is
stereoactive. Rows of thallium atoms lie in the grooves between sheets and
provide the only inter-sheet connectivity via Tl-Au bonds.
There is extensive Au-Au bonding linking the two sub-sheets of the
double-sheet.The structure is distinct from those of the 1:2
(Au,Ag)-tellurides: calaverite AuTe2, sylvanite
AuAgTe4 and krennerite Au3AgTe8, which
are based upon sheet structures with no connecting inter-sheet atoms. It
also differs fundamentally from the structuresof synthetic phases
Ag18Tl4Te11, both of which have an
analogous stoichiometry. In contrast to the pyramidal TeAu3 group
of honeaite and krennerite, Ag does not form the corresponding
TeAg3 group in itstellurides.
Introduction: Within Alberta, 30% of patients presenting to emergency with minor traumatic brain injury (mTBI) will receive a CT scan before being sent home, regardless of whether it was clinically indicated. Choosing Wisely (CW) Canada recommends using validated clinical decision support to determine whether a CT scan is necessary for patients presenting with a mTBI. In order to provide patients with information on the risks and benefits of CT scans in mTBI and to encourage discussions between patients and their doctor, the Emergency StrategicClinical Network (ESCN) designed a patient focused information visualization on CT scans for head injuries. Methods: The ESCN, Physician Learning Program and CW Alberta partnered with the Mount Royal University Department of Information Design to develop a patient information visualization (infographic) intervention. Students spent a semester developing these infographics on Choosing Wisely recommendations, which were then presented to stakeholders. A student was then selected to develop a final design. Refinement of the design took place in consultation with clinical experts and tested in two patient focus groups. The final design was evaluated against the International Patient Decision Aid Standards checklist. The infographic was posted in 2 local emergency department waiting rooms. A survey was administered to any patients in the waiting room when volunteers were available. The survey was designed to evaluate whether the tool influenced patient beliefs about the risks and benefits of CT scans, and their willingness to engage in a discussion with their doctor. Results: In a 26 day period, 90 patients consented and completed the survey. Before reading the infographic, 33% of patients thought that after a head injury a CT was always a good idea and 63% thought it was sometimes a good idea. 82% and 91% of patients stated the poster helped them understand the indications and risks of CT imaging for mTBI. After viewing the poster, only 15% of patients felt that a CT was always a good idea after a mTBI. Conclusion: The mTBI patient infographic significantly changed patient perceptions regarding the need for CT scans in the setting of mTBI. This study demonstrates that targeted patient education materials can help support CW recommendations.
We argue that a multimodal approach to defining a depictive class of words called ‘ideophones’ by linguists is essential for grasping their meanings. Our argument for this approach is based on the formal properties of Pastaza Quichua ideophones, which set them apart from the non-ideophonic lexicon, and on the cultural assumptions brought by speakers to their use. We analyze deficiencies in past attempts to define this language's ideophones, which have used only audio data. We offer, instead, an audiovisual corpus which we call an ‘antidictionary’, because it defines words not with other words, but with clips featuring actual contexts of use. The major discovery revealed by studying these clips is that ideophones’ meanings can be clarified by means of a distinction found in modality and American Sign Language studies. This distinction between speaker-internal and speaker-external perspective is evident in the intonational and gestural details of ideophones’ use.
The Protoplanetary Discussions conference—held in Edinburgh, UK, from 2016 March 7th–11th—included several open sessions led by participants. This paper reports on the discussions collectively concerned with the multi-physics modelling of protoplanetary discs, including the self-consistent calculation of gas and dust dynamics, radiative transfer, and chemistry. After a short introduction to each of these disciplines in isolation, we identify a series of burning questions and grand challenges associated with their continuing development and integration. We then discuss potential pathways towards solving these challenges, grouped by strategical, technical, and collaborative developments. This paper is not intended to be a review, but rather to motivate and direct future research and collaboration across typically distinct fields based on community-driven input, to encourage further progress in our understanding of circumstellar and protoplanetary discs.
Recent research is making us daily better acquainted with Byzantine religious buildings. Saint Sophia is a byword in architectural history and the Byzantine style has been drawn on in the West perhaps more than any other. But of the secular buildings of Byzantium, of the great palaces so famous in history, few examples have been spared. Accounts tell us of the great palace at Constantinople, but of this vast collection of buildings little more than a single stair remains above ground. Of the palace of the Hebdomon, situated on the Sea of Marmora to the south of the capital, even less is to be seen, though further excavations would probably prove fruitful, and of the mediaeval palace of the Blachernae on the Golden Horn, which served as the Imperial residence after the eleventh or twelfth century, only a single building, the Tekfour Serai, survives.