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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.
Patients with congenital diaphragmatic hernias often have concomitant congenital heart disease (CHD), with small left-sided cardiac structures as a frequent finding. The goal of this study is to evaluate which left-sided heart structures are affected in neonates with congenital diaphragmatic hernias.
Retrospective review of neonates between May 2007 and April 2015 with a diagnosis of a congenital diaphragmatic hernia was performed. Clinical and echocardiographic data were extracted from the electronic medical record and indexed to body surface area and compared to normative values. Univariable regression models assessed for associations between different variables and length of stay.
Data of 52 patients showed decreased mean z scores for the LVIDd (–3.16), LVIDs (–3.05), aortic annulus (–1.68), aortic sinuses (–2.11), transverse arch (–3.11), and sinotubular junction (–1.47) with preservation of the aorta at the diaphragm compared to age-matched normative data with similar body surface areas. Regression analysis showed a percent reduction in length of stay per 1 mm size increase for LVIDd (8%), aortic annulus (27%), aortic sinuses (18%), sinotubular junctions (20%), and transverse arches (25%).
Patients with congenital diaphragmatic hernias have significantly smaller left-sided heart structures compared to age-matched normative data. Aortic preservation at the diaphragm provides evidence for a mass effect aetiology with increased right-to-left shunting at the fetal ductus resulting in decreased size. Additionally, length of stay appears to be prolonged with decreasing size of several of these structures. These data provide quantitative evidence of smaller left-sided heart structures in patients with congenital diaphragmatic hernias.
The mechanical properties of metallic glasses are often tuned by annealing, which influences these properties by adjusting the relaxation and/or crystallization status of the glasses. Here, we studied the hardness and modulus of Pt57.5Cu14.7Ni5.3P22.5 bulk metallic glass annealed at different temperatures by nanoindentation, where the annealing gives the material different fictive temperatures and fractions of crystallization. It is found that both reducing the fictive temperature of a fully amorphous sample and increasing the degree of crystallization in a partially crystallized sample increase hardness and modulus. Combining the two approaches, elevated hardness and modulus values are found for composite materials containing both crystalline and amorphous phases when they are compared to chemically identical alloys featuring similar percentages of crystalline and amorphous phases that have been prepared by annealing at higher temperatures. Our findings indicate that the mechanical properties of the platinum-based alloys can be customized by processing them with targeted heat treatments.
Energy-filtered transmission electron microscopy provides an opportunity to map the nanoscale elemental composition in polymeric systems. Nevertheless, it presents its own set of unique challenges in its application to soft materials. Here, we outline an optimized protocol for elemental mapping in soft materials using sulfur mapping of polymer/fullerene mixtures as an example. Three factors are crucial: (1) focusing at zero-loss, (2) using an objective aperture, and (3) maximizing signal-to-noise and counts for the chosen imaging conditions. Analyzing the corresponding source images, bright field images, and thickness maps can ensure optimum conditions are achieved for elemental mapping of polymers.
Astrophyllite has been found in alkalic pegmatite dykes on the two sides of Kangerdlugssuaq fjord. At the eastern locality, Kraemers Island, the dyke is silica oversaturated and the astrophyllite occurs in a broad tabular crystal habit. The dyke at the western locality, Bagnaesset, is silica undersaturated and the astrophyllite occurs in elongated prisms of acicular habit. Electron probe analyses of the crystals of the two habits have shown systematic chemical differences which not only relate to Mn and Ti compositional variations, but also reveal departures from ideal stoichiometry in varying degrees. Based on this latter feature a model involving polysomatism has been constructed which may explain the differences in crystal habit.
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: Take Home Naloxone (THN) programs prevent death from opioid poisoning by training laypersons to recognize an overdose and administer naloxone. Dispensing THN through the emergency department (ED) is particularly critical because an ED visit for opioid poisoning strongly predicts future mortality. Many EDs have implemented THN programs, yet almost no literature examines the reach of such initiatives. To address this gap, we conducted a chart review of all patients presenting for opioid poisoning to an urban tertiary hospital, with a large ED-based THN program. This exploratory study hypothesized that more than 50% of ED patients presenting for opioid poisoning would be offered a THN kit. Methods: Data on demographics, clinical characteristics, and THN kit dispensing were extracted and analyzed from the charts of all ED patients presenting with a primary diagnosis of opioid poisoning between April 1 2016 and April 30 2017. Logistic regression analyzed predictors of being offered a THN kit. Results: A total of 347 ED visits for 301 unique patients occurred during the study period. The mean age ± SD of patients was 38 ± 14 years, and 69% were male. In 49% of ED visits, a THN kit was offered; 73% of these episodes had a THN kit dispensation. Patients who were male (AOR=1.94; 95% CI 1.11 - 3.40), and reported that their overdose was unintentional (AOR=2.95; 95% CI 1.04 8.35) and caused by illegal opioids (AOR=4.73; 95% CI 2.63 8.52) were significantly more likely to be offered a THN kit. Conclusion: ED-based THN programs have the potential to reach significant proportions of patients at high risk of mortality. However, these programs may have differential reach within the target population. Further research is needed to examine barriers and facilitators to offering all eligible ED patients a THN kit.
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.
We derive an effective macroscale description for the growth of tissue on a porous scaffold. A multiphase model is employed to describe the tissue dynamics; linearisation to facilitate a multiple-scale homogenisation provides an effective macroscale description, which incorporates dependence on the microscale structure and dynamics. In particular, the resulting description admits both interstitial growth and active cell motion. This model comprises Darcy flow, and differential equations for the volume fraction of cells within the scaffold and the concentration of nutrient, required for growth. These are coupled with Stokes-type cell problems on the microscale, incorporating dependence on active cell motion and pore scale structure. The cell problems provide the permeability tensors with which the macroscale flow is parameterised. A subset of solutions is illustrated by numerical simulations.
The use of silage additives containing lactic acid bacteria and enzymes to promote a rapid homolactic type fermentation has met with some success in the United States but the little evidence available (see Burghardi, Goodrich and Meiske, 1980) suggests that, for grass silages, the value of this type of additive is limited. However, in laboratory silos, inoculation with lactic acid bacteria has been shown to be effective in reducing proteolysis (Carpintero, Henderson and McDonald, 1979).
The recent availability in the UK of a commercial product containing a lactic acid bacteria inoculum and the non-toxicity and ease of application of this product prompted this investigation, which describes the assessment of a silage prepared with this type of additive in comparison with a well characterized additive, formic acid.
In vitro gas production techniques are becoming increasingly popular as tools to investigate the food quality for ruminant and monogastric herbivores. They are attractive due to their ability to measure the kinetics of digestion associated with the gut microbial fermentation of foodstuffs. It is therefore important to know and understand what factors affect the volume of gas produced, particularly as they relate to repeatability within or between laboratories. In studies involving gas pressure and volume measurement, the chemical composition of the culture medium, the nature of the microbial population and the type and amount of substrate available for fermentation all have a significant influence on gas accumulation. In this study, the manual pressure transducer technique (PTT) of Theodorou et al. (1994) was used to investigate the effect of head-space pressure on the resultant gas production profiles.
Solvency II is currently one of the most sophisticated insurance regulatory regimes in the world. It is built around the principles of market consistency and embedding strong risk management and governance within insurance companies. For business with long-term guarantees, the original basis produced outcomes that were unacceptable to the member states. The original design was amended through Omnibus II. The working party has looked back at the outcome of the final regulation and comments on how well Solvency II has fared, principally from a UK perspective, relative to its initial goals of improved consumer protection, harmonisation, effective risk management and financial stability. We review Pillar 1’s market consistent valuation (including the risk margin and transitional measures) as well as the capital requirements (including internal models). We look at the impact this has on asset and liability management, pro-cyclicality and product design. We look at Pillars 2 and 3 in respect of the Own Risk and Solvency Assessment, liquidity and disclosure. Finally, we stand back and look at harmonisation and the implications of Brexit. In summary we conclude that Solvency II represents a huge improvement over Solvency I although it has not fully achieved the goals it aspired to. There are acknowledged shortfalls and imperfections where adjustments to Solvency II are likely. There remain other concerns around pro-cyclicality, and the appropriateness of market consistency is still open to criticism. It is hoped that the paper and the discussion that goes with it provide an insight into where Solvency II has taken European Insurance regulation and the directions in which it could evolve.
West Antarctic climate and surface mass balance (SMB) records are sparse. To fill this gap, regional atmospheric climate modelling is useful, providing that such models are employed at sufficiently high horizontal resolution and coupled with a snow model. Here we present the results of a high-resolution (5.5 km) regional atmospheric climate model (RACMO2) simulation of coastal West Antarctica for the period 1979–2015. We evaluate the results with available in situ weather observations, remote-sensing estimates of surface melt, and SMB estimates derived from radar and firn cores. Moreover, results are compared with those from a lower-resolution version, to assess the added value of the resolution. The high-resolution model resolves small-scale climate variability invoked by topography, such as the relatively warm conditions over ice-shelf grounding zones, and local wind speed accelerations. Surface melt and SMB are well reproduced by RACMO2. This dataset will prove useful for picking ice core locations, converting elevation changes to mass changes, for driving ocean, ice-sheet and coupled models, and for attributing changes in the West Antarctic Ice Sheet and shelves to changes in atmospheric forcing.
Wet feeding beneficially affects feed intake and growth rates of poultry in hot climates (Forbes 2003). Fermenting liquid feeds for pigs has been shown to reduce microbial contamination of the feed (Beal et al., 2002) and this could be an added advantage in hot climates. The most desired property of fermented feed is a high lactic acid concentration produced by lactic acid bacteria (LAB) as the fermenting organisms. This high lactic acid concentration resulting in a low pH is responsible for the antimicrobial activity of fermented feeds. This activity is important for food and environmental safety. Grain sorghum is widely used as a food and animal feed cereal in many parts of Africa, Asia and the semi-arid tropics world-wide. It is recognised that differences in the colour of sorghum varieties are due mainly to their concentration of polyphenol compounds mainly tannins. These compounds have some antimicrobial properties and may affect the activity of lactic acid bacteria used to ferment liquid feeds. Little is known about the lactic acid fermentation of sorghum grain for fermented feeds in monogastric nutrition. The present study was designed to compare the fermentation of red and white sorghum with LAB for inclusion as a component of poultry diets.
Due to the practical advantages of fermenting the carbohydrate-rich cereal component of fermented feeds separately and combining it with the protein-rich components just before feeding (Beal et al., 2005; Moran et al., 2006), it is desirable to have a high lactic acid concentration in the fermented cereal component so as to minimise the dilution effect on the acid concentration and pH of the feed when mixed with the protein-rich component at feeding. With the same cereal substrate and lactic acid bacteria (LAB), a key factor that might influence lactic acid production is the particle sizes produced at milling which could affect the amount of sugars available for microbial enzymatic fermentation. Further more, Anguita et al. (2006) indicated that technological processing of ingredients promotes higher starch hydrolysis in addition to increasing the amount of soluble non-starch polysaccharides and modifications in the physicochemical properties depending on the nature of the feed ingredients. The present study was designed to investigate the effect of particle size on fermentation of sorghum for poultry feed.
Farrowing and lactation are two of the most critical phases of pork production. A relatively high proportion of pig losses occurs during these periods. Rapid bacterial colonisation of piglets’ sterile gut and underdeveloped immune system represents a very dangerous combination of events. The most significant factors affecting the microflora of the piglet’s gut is its mother and the environment into which it is born. Therefore, management interventions and nutritional regimes that influence the microbiology of the sow’s faeces in a beneficial way are likely also to influence the neonate. Work at the University of Plymouth and at Foulum in Denmark has shown that feed may be fermented successfully with lactic acid bacteria (LAB) and that this process reduces the number of salmonellae and coliforms in the feed and consequently in the lower gastrointestinal tract (Brooks et al. 2001). Recent studies strongly support the hypothesis that orally administered LAB stimulate the immune system, both at the local and systemic level. This combination of effective immunity and reduced level of environmental contamination with faecal pathogens can lead to improved management of sows for increased litter size and weight at weaning time.
The control of enteropathogens at farm level is an important aspect of food safety. Contamination of poultry carcasses and eggs with human enteropathogens such as Salmonella spp and Campylobacter spp and subsequent dissemination through in the food chain continues to be a public health concern. In pigs, surveillance studies have shown that feeding liquid diets, and particularly fermented liquid diets reduces the incidence of Salmonella positive herds. Liquid pig feed fermented with lactic acid bacteria for 24 h at 30°C contains ca 200 mMol L-1 of lactic acid and has a pH of 3.8-4.0. This renders the feed resistant to contamination by potential pathogens and, when challenged with high doses of Salmonella or E. coli these organisms are rapidly eliminated from the feed (Beal et al 2002). Feeding fermented liquid feed (FLF) to pigs lowers the gastric pH to 4 or less, reduces the coliform population and increases the lactic acid bacteria: coliform ratio (LAB: Coli) in the gut (van Winsen et al 2001, Scholten et al 2002). The objective of this study was to determine if similar beneficial effects on the gut microflora could be achieved in poultry fed fermented mash diets.