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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 head and neck cancers as a whole are the most common cancers among males in India. Technological advancements have led to an improvement in radiation therapy (RT) techniques with subsequent reduction in normal tissue complications. To correct patient set-up errors, an off-line correction method like no action level (NAL) protocol may be used as a preferred protocol particularly for a busy department. The objectives of the study were to measure the translational set-up errors using kV cone-beam computed tomography (CBCT) in patients undergoing intensity modulated radiotherapy (IMRT) in head and neck cancers and also to optimise clinical target volume (CTV) to planning target volume (PTV) margin using NAL protocol.
Material and methods:
On the first 5 days of RT, patient’s position was verified by kV-CBCT and then weekly during the course of treatment. The comparison between the reference and kV-CBCT images was performed, and the shifts measured and recorded. The mean error from the initial five consecutive fractions was corrected on the sixth daily fraction. Displacements in all the directions were measured. The population systematic and random errors were determined and used to estimate PTV margins according to the van Herk formula.
A total of 322 images were analysed. Before correction, 15, 12 and 9% patients had systematic error ≥3 mm on X, Y and Z axes, but after correction this was reduced to 9, 0 and 0%. The total percentage of patients whose set-up margin was ≥5 mm before correction was 5, 6·25, 3·75%, but after correction it reduced to 1·88, 0, and 0·63%. The margins of total population were reduced to 63, 65 and 56% after correction on X, Y and Z axes, respectively.
A simple off-line NAL protocol can correct the set-up errors without daily on-line imaging in patients undergoing IMRT and hence acting as a resource sparing alternative. Five millimetre margin to CTVs was adequate and safe to overcome the problem of set-up errors in head and neck IMRT.
Decisions about which health and social services to include in the publicly funded services basket are complex. Several criteria need to be taken into account in decision-making (DM), as well as ethical, economic and organizational issues. Nowadays a global consensus supports the view that citizens’ values and preferences must guide DM. To elicit these values and concerns regarding publicly funded services, the Quebec Health and Welfare Commissioner recently conducted a vast public consultation on the population viewpoints. Parts of this consultation targeted criteria for DM, approaches to assess new or current services and perspectives on appropriateness of care.
Various consultation methods were used in complementary steps: a representative population survey (n=1850), six regional focus groups (n=62), a call for briefs (n=52) for groups that wished to share their views, consultation meetings (n=35) with diverse stakeholders and a call for personal accounts (n=2633). It also held five deliberation sessions (18 citizens and 9 experts) over the course of the project on major related issues.
The need to ensure the appropriateness of covered services was one of the strongest themes emerging from the consultation. Citizens want that the appropriateness evaluation be carried out under certain conditions: transparently, in explicit DM processes, using criteria that are clear and adaptable according to the disease or problem. The whole evaluation process needs to be well documented, showing clearly the data used and rejected, so that they can understand the decision and see on what basis it is supported. Among the usual criteria for DM, those related to cost are less valued whereas others are considered incomplete.
Citizens have clear viewpoints and expectations regarding DM criteria and processes for resource allocation. Decision-makers must take them into account to ensure that the basket of insured services is representative of social values and preferences.
We simultaneously estimate the four parameters of a subcritical Heston process. We do not restrict ourselves to the case where the stochastic volatility process never reaches zero. In order to avoid the use of unmanageable stopping times and a natural but intractable estimator, we use a weighted least-squares estimator. We establish strong consistency and asymptotic normality for this estimator. Numerical simulations are also provided, illustrating the favorable performance of our estimation procedure.
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.
The response of Arctic ice masses to climate change is studied using ice cores containing information on past climatic and environmental features. Interpretation of this information requires accurate chronological data. Absolute dating of ice cores from sub-polar Arctic glaciers is possible using well-known radioactive layers deposited by atmospheric nuclear tests (maximum fallout in 1963) and the Chernobyl accident (1986). Analysis of several isotopes (3H, 137Cs) shows that 3H provides the most accurate dating of the 1963 maximum, as indicated also in comparison with results from total-beta measurements (90Sr and 137Cs). Mean annual net mass balances are derived from the dated ice cores from 1963 up to the date of the drillings. The 137Cs and 3H deposited by nuclear tests, after decay correction, are used to define a melt index for all 13 ice cores studied. The relative strength of melting and percolation post-depositional processes is studied on the basis of these 137Cs and 3H deposits.
Objectives: The extent of vascular cognitive impairment (VCI) after stroke varies greatly across individuals, even when the same amount of brain damage is present. Education level is a potentially protective factor explaining these differences, but results on its effects on VCI are inconclusive. Methods: First, we performed a meta-analysis on formal education and VCI, identifying 21 studies (N=7770). Second, we examined the effect of formal education on VCI in young-stroke patients who were cognitively assessed on average 11.0 (SD=8.2) years post-stroke (the FUTURE study cohort). The total sample consisted of 277 young-stroke patients with a mean age at follow-up 50.9 (SD=10.3). Age and education-adjusted expected scores were computed using 146 matched stroke-free controls. Results: The meta-analysis showed an overall effect size (z') of 0.25 (95% confidence interval [0.18–0.31]), indicating that formal education level had a small to medium effect on VCI. Analyses of the FUTURE data showed that the effect of education on post-stroke executive dysfunction was mediated by age (β age −0.015; p<.05). Below-average performance in the attention domain was more frequent for low-education patients (χ2(2)=9.8; p<.05). Conclusions: While education level was found to be related to post-stroke VCI in previous research, the effects were small. Further analysis in a large stroke cohort showed that these education effects were fully mediated by age, even in relatively young stroke patients. Education level in and of itself does not appear to be a valid indicator of cognitive reserve. Multi-indicator methods may be more valid, but have not been studied in relation to VCI. (JINS, 2017, 23, 223–238)
It is well-nigh impossible to give, in a short report, an adequate idea of the enormous activity in Variable-Star Astronomy during the past three years. Without attempting to be complete I shall give a summary of the most important recent occurrences in this field of research.
Statistical data for eclipsing binaries were given by Gaposchkin (Veröff. Berlin-Bab. 9, Heft 5), for long-period variable stars by Ludendorff (Sitz.-ber. Ak. d. Wiss. Berlin, 1932), Thomas (Veröff. Berlin-Bab. 9, Heft 4) and Sterne and L. Campbell (Harvard Annals).
Some valuable catalogues have been issued: a Finding List for Observers of Eclipsing Variables by Dugan (Princeton Contr. No. 15), a Catalogue of Eclipsing Variables, together with a Program of Investigations, by Martinoff (Engelhardt Obs. Bull. No. 2), a Catalogue and Ephemeris of Short-period Cepheids by Zessewitsch (Len. Un. A. 0. Bull. No. 3).
The Commission first took up the question of the inclusion in their subjects of the Zodiacal Light and related phenomena, and in particular the brightness of the night sky, which had been referred to them by the General Assembly. After some discussion, the following resolution, proposed by the acting President, and seconded by Dr Bosler, was adopted: 1. While, in conformity with the motion voted by them at the Harvard Meeting (Transactions, 4, p. 245), this Commission still consider that it is not desirable that Comets should be added to their subjects, they suggest that, since several of theirmembers, active in the field of meteors, are also working on the problem of Zodiacal Light, the latter subject, and related phenomena, might be handled by a Sub-Committee of Commission 22.
The Rev. T. E. R. Phillips submitted a proposal from Commission 16, suggesting that Commission 22 should take from them the subject of comets. After some discussion, in which it was pointed out that, on practical grounds, the methods of observation should outweigh any theoretical considerations in the matter, the following motion was moved by Prof. Öpik, seconded by Prof. Boothroyd, and carried:
“Commission 22 considers that it is not desirable that Comets should be joined to their subject.”
The Draft Report was adopted without modification.
The following resolutions were referred to the General Assembly:
1.The Commission recommends that the yearly subsidy granted by the Union to the Cracow Observatory for the publication of the Ephemerides of Eclipsing Binaries be continued (and increased) to the amount of 1000 gold francs.
2.The Commission suggests that, in view of the urgent need for comparison stars for Variables, more especially those requiring international co-operation, a small sub-committee under Dr Shapley be empowered to canvass the needs of observers and to take steps to encourage systematic work on sequences.
3.The Commission endorses the proposal made by Prof. Grouiller to compile a list of unpublished observations of Variable Stars, and recommends that this compilation be published by the Union.
Fourteen members of the committee have failed to respond to correspondence; nearly all of the others have expressed the definite opinion that non-responsive members should be dropped from committee membership when a new list is prepared a few correspondents indicating however, that the policy should be adopted for Commission 27 only if generally adopted for all commissions of the Union.
Sir Frank Dyson submitted the following resolution, which was seconded by Prof. Van Biesbroeck, and carried:
“The Commission recommends that the yearly subsidy of £66, granted since 1928 by the Union to the Central Bureau of Telegrams, be continued.”
The President described some proposals of modifications to the European code which he thought desirable. By using time instead of arc for Right Ascension, and Declination instead of Polar Distance, anybody receiving a telegram would be able to read it directly, without any computations, whereas its security would remain sufficient. This code is, in the main, similar to one which Prof. Förster had suggested many years ago.
The Commission formed a Sub-Commission on Zodiacal Light, presided over by Prof. Issei Yamamoto. The constitution of a sub-commission on the light of the night sky and kindred phenomena was proposed, but left in abeyance, pending the Stockholm Meeting. Dr Jean Dufay kindly consented to write, at the president’s request, a paper on the present state of the problem of the light of the night sky, which is printed with this Report.
The past few years have witnessed a great increase in the amount of work done on meteors and in the number of observers. At several observatories programmes of work have been undertaken in the hope of solving specific problems. Several countries now have flourishing meteor societies, or sections of larger astronomical societies, devoted to this field. To solve the problems that have arisen the help of other scientists, especially in physics, geology, and meteorology, has been enlisted to the mutual benefit of all. Historical research, particularly in Asia, has added much to our knowledge of meteor showers for the past thousand or more years.
The President submitted to the Meeting, with some diffidence, the preliminary set of notations covering the whole field of astronomy, which he had prepared, and which had been printed in the Draft Report. It was, he said, a compromise between different systems of notations. He pointed to some misprints in the Draft Report and invited discussion.
Prof. Stroobant expressed his pleasure that the President had retained a number of the notations which he had presented at the Rome Meeting. While rendering homage to the completeness of the new scheme, he said that it had been submitted at too short a notice to allow a thorough discussion. He therefore proposed, at all events, to postpone a final decision.
Prof. Eddington and Prof. Russell agreed to this view, but emphasized the necessity of the new scheme being printed. They suggested some slight changes in a few of the proposed notations.
After having marked his agreement with Prof. de Sitter, when he stated in his report (p. 27) that at the present moment there do not appear to be any problems in dynamical astronomy requiring combined action and international co-operation, the Chairman briefly reviewed those problems in dynamical astronomy which have been studied in the past four years.
They include methods for the determination of orbits and their adaptation to the use of computing machines; multiple solutions in the problem of the determination of orbits; researches on the final state of dynamical systems with slowly varying parameters (e.g. with varying masses), applications, for instance, to the problem of tides; general dynamical problems of stability and recurrence; lunar theory (problems of convergence, non-uniformity of the rotation of the Earth); problems of perturbations (development of the perturbation function, the Trojan group and other asteroid problems, satellites); the restricted problem of three bodies (numerical investigations and their mathematical foundation, the problems of “sorts” and “groups” [“Klassen”]; analytical investigations on the non-existence of periodic solutions in the range of critical commensurabilities); regularization of the singularities of the problem of three bodies; special cases of the problems of 3 and n bodies; general mathematical theory of the existence of rotating figures of equilibrium; relativity—gravitation—light.