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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.
Leaf colour characteristics of 730 sweetpotato, Ipomoea batatas (L.) Lam. (Convolvulaceae), plant introduction (PI) accessions from the USDA sweetpotato germplasm collection were evaluated during 2012–2014. Colorimetry data for the abaxial and adaxial leaf surfaces were recorded using a tristimulus colorimeter and the CIE 1976 L*a*b* and CIE L*C*h* colour spaces. Most accessions (725 of 730 PIs) had dark-to-medium green leaves, but two PIs had totally purple leaves, and three PIs had yellow or yellow-green (chartreuse) leaves. For mature, field-grown green leaves, values for the red-green coordinate (a*) averaged −12.4 for the adaxial and −10.4 for the abaxial leaf surface. Values for the blue-yellow coordinate (b*) averaged 17.2 for the adaxial and 17.3 for the abaxial leaf surface. Hue angle (h*) for green leaves averaged 120.9° for the adaxial and 126.2° for the abaxial leaf surface. Colour saturation (Chroma, C*) averaged 21.3 for the adaxial and 20.2 for the abaxial leaf surface. Lightness (L*) averaged 35.4 for the adaxial and 47.2 for the abaxial leaf surface of green leaves. Late in the season, over one-half (53.9%) of the 730 PIs showed some level of purple pigmentation in the leaf lamina. Late-season purple leaves were collected and colour coordinates were recorded for 118 PIs grown in the field. For purple leaves, values for a*, b*, C*, L* and h* averaged 2.3, 6.2, 7.9, 28.2 and 64.4° for the adaxial surface and −1.0, 12.7, 13.9, 43.1 and 87.0° for the abaxial leaf surface, respectively.
Identifying routes of transmission among hospitalized patients during a healthcare-associated outbreak can be tedious, particularly among patients with complex hospital stays and multiple exposures. Data mining of the electronic health record (EHR) has the potential to rapidly identify common exposures among patients suspected of being part of an outbreak.
We retrospectively analyzed 9 hospital outbreaks that occurred during 2011–2016 and that had previously been characterized both according to transmission route and by molecular characterization of the bacterial isolates. We determined (1) the ability of data mining of the EHR to identify the correct route of transmission, (2) how early the correct route was identified during the timeline of the outbreak, and (3) how many cases in the outbreaks could have been prevented had the system been running in real time.
Correct routes were identified for all outbreaks at the second patient, except for one outbreak involving >1 transmission route that was detected at the eighth patient. Up to 40 or 34 infections (78% or 66% of possible preventable infections, respectively) could have been prevented if data mining had been implemented in real time, assuming the initiation of an effective intervention within 7 or 14 days of identification of the transmission route, respectively.
Data mining of the EHR was accurate for identifying routes of transmission among patients who were part of the outbreak. Prospective validation of this approach using routine whole-genome sequencing and data mining of the EHR for both outbreak detection and route attribution is ongoing.
Recovery of multidrug-resistant (MDR) Pseudomonas aeruginosa and Klebsiella pneumoniae from a cluster of patients in the medical intensive care unit (MICU) prompted an epidemiologic investigation for a common exposure.
Clinical and microbiologic data from MICU patients were retrospectively reviewed, MICU bronchoscopes underwent culturing and borescopy, and bronchoscope reprocessing procedures were reviewed. Bronchoscope and clinical MDR isolates epidemiologically linked to the cluster underwent molecular typing using pulsed-field gel electrophoresis (PFGE) followed by whole-genome sequencing.
Of the 33 case patients, 23 (70%) were exposed to a common bronchoscope (B1). Both MDR P. aeruginosa and K. pneumonia were recovered from the bronchoscope’s lumen, and borescopy revealed a luminal defect. Molecular testing demonstrated genetic relatedness among case patient and B1 isolates, providing strong evidence for horizontal bacterial transmission. MDR organism (MDRO) recovery in 19 patients was ultimately linked to B1 exposure, and 10 of 19 patients were classified as belonging to an MDRO pseudo-outbreak.
Surveillance of bronchoscope-derived clinical culture data was important for early detection of this outbreak, and whole-genome sequencing was important for the confirmation of findings. Visualization of bronchoscope lumens to confirm integrity should be a critical component of device reprocessing.
Geochemical and related studies have been made of near-surface sediments from the River Clyde estuary and adjoining areas, extending from Glasgow to the N, and W as far as the Holy Loch on the W coast of Scotland, UK. Multibeam echosounder, sidescan sonar and shallow seismic data, taken with core information, indicate that a shallow layer of modern sediment, often less than a metre thick, rests on earlier glacial and post-glacial sediments. The offshore Quaternary history can be aligned with onshore sequences, with the recognition of buried drumlins, settlement of muds from quieter water, probably behind an ice dam, and later tidal delta deposits. The geochemistry of contaminants within the cores also indicates shallow contaminated sediments, often resting on pristine pre-industrial deposits at depths less than 1m. The distribution of different contaminants with depth in the sediment, such as Pb (and Pb isotopes), organics and radionuclides, allow chronologies of contamination from different sources to be suggested. Dating was also attempted using microfossils, radiocarbon and 210Pb, but with limited success. Some of the spatial distribution of contaminants in the surface sediments can be related to grain-size variations. Contaminants are highest, both in absolute terms and in enrichment relative to the natural background, in the urban and inner estuary and in the Holy Loch, reflecting the concentration of industrial activity.
Legionnaires’ disease (LD) incidence in the USA has quadrupled since 2000. Health departments must detect LD outbreaks quickly to identify and remediate sources. We tested the performance of a system to prospectively detect simulated LD outbreaks in Allegheny County, Pennsylvania, USA. We generated three simulated LD outbreaks based on published outbreaks. After verifying no significant clusters existed in surveillance data during 2014–2016, we embedded simulated outbreak-associated cases into 2016, assigning simulated residences and report dates. We mimicked daily analyses in 2016 using the prospective space-time permutation scan statistic to detect clusters of ⩽30 and ⩽180 days using 365-day and 730-day baseline periods, respectively. We used recurrence interval (RI) thresholds of ⩾20, ⩾100 and ⩾365 days to define significant signals. We calculated sensitivity, specificity and positive and negative predictive values for daily analyses, separately for each embedded outbreak. Two large, simulated cooling tower-associated outbreaks were detected. As the RI threshold was increased, sensitivity and negative predictive value decreased, while positive predictive value and specificity increased. A small, simulated potable water-associated outbreak was not detected. Use of a RI threshold of ⩾100 days minimised time-to-detection while maximizing positive predictive value. Health departments should consider using this system to detect community-acquired LD outbreaks.
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.
Year to decade-long cyclic period changes have been observed in many classes of close binaries. The Algol binary WW Cygni shows a cyclic change in its orbital period with an amplitude of slightly more than 0.02 days and a period of 56 years. A hypothetical third or fourth body does not satisfactorily explain the observed variation in the orbital period. The change in luminosity and color of the system at primary eclipse minimum are in agreement with the model proposed by Applegate for a magnetic cycle induced period change in WW Cygni. We have commenced monitoring 9 close binaries for evidence of the luminosity and color changes consistent with the magnetic cycle hypothesis. δ Librae is suggested as a case suitable for observation with an optical interferometer to test the third body proposed for this Algol system.
The Star Centre is a national astronomy and space science base which
facilitates public access to news and information
promotes public awareness, interest, enjoyment and understanding.
The Star Centre meets these twin aims by providing an information service which can be accessed in a variety of ways and by offering a menu of public observing events.
The concept of a national astronomy base developed as part of the Centre for Science Educations growing portfolio of initiatives in both the formal education sector and the wider umbrella of the Public Understanding of Science. In December 1996 the Star Centre was launched with the aid of a Royal Society COPUS development grant and matching funding from Sheffield Hallam University.
Mixing piglets pre-weaning at 14 days of age has been shown to improve post-weaning performance and reduce skin lesions caused by fighting without any detrimental affects on pre-weaning performance and behaviour (Allen et al., 2000). The stress associated with weaning has been shown to alter immune function of piglets and increase their susceptibility to infections. The aim of this experiment was to assess the effect of mixing piglets pre-weaning on their humoral and cell-mediated immune responses post-weaning.
The Moon forms one end-member in the planetary mass series Earth-Venus-Mars-Mercury-Asteroids-Moon (Weissman 1999). Having a detailed understanding of the nature and evolution of the two end-members of this series, rather than of just the Earth, has increased the value of other data and inferences by orders of magnitude. As a consequence of obtaining an understanding of the evolution of a second planet, we now can look at other terrestrial planets with far greater insight than ever would have been possible otherwise (Fig. 1).
Glacier response to climate can be characterized by a single time-scale when the glacier changes sufficiently slowly. Then the derivative of volume with respect to area defines a thickness scale similar to that of Jóhannesson and others, and the time-scale follows from it. Our version of the time-scale is different from theirs because it explicitly includes the effect of surface elevation on mass-balance rate, which can cause a major increase in the time-scale or even lead to unstable response. The time constant has a dual role, controlling both the rate and magnitude of response to a given climate change. Data from South Cascade Glacier, Washington, U.S.A., illustrate the ideas, some of the difficulty in obtaining accurate values for the thickness and time-scales, and the susceptibility of all response models to potentially large errors.
As part of a project to investigate the flow of ice at low effective stress, two independent strain-gauge systems were used to measure vertical strain rate as a function of depth and time at Siple Dome, Antarctica. The measurements were made from January 1998 until January 2002 at the ice divide and a site 7km to the northeast on the flank. The strain-rate profiles place constraints on the rheology of ice at low stress, show the expected differences between divide and flank flow (with some structure due to firn compaction and probably ice stratigraphy), and suggest that the flow of the ice sheet has not changed much in the last 8.6 kyr. The strain rates show an unexpected time dependence on scales ranging from several months to hours, including discrete summer events at the divide. Time dependence in strain rate, water pressure, seismicity, velocity and possibly basal motion has been seen previously on the Siple Coast ice streams, but it is especially surprising on Siple Dome because the bed is cold.
A heavy down-hole hammer actuated from the surface by a light composition rope was used to place instrumented probes into the active, 7m thick, clast-rich till underlying a site on Black Rapids Glacier, Alaska, USA, where the ice is 500m thick. A till penetration of about 2.5m was obtained, and greater depths seem possible. The probes measured pore-water pressure and two axes of tilt, which they broadcasted, without wires, to a receiver just above the ice–till interface.
As part of a larger program to measure and model vertical strain around Siple Dome on the West Antarctic ice sheet, we developed a new sensor to accurately and stably record displacements. The sensors consist of optical fibers, encased in thin-wall stainless-steel tubes, frozen into holes drilled with hot water, and stretched from the surface to various depths (up to 985 m) in the ice sheet. An optical system, connected annually to the fibers, reads out their absolute lengths with a precision of about 2 mm. Two sets of five sensors were installed in the 1997/98 field season: one set is near the Siple Dome core hole (an ice divide), and a second set is on the flank 7 km to the north (the ice thickness at both sites is approximately 1000 m). The optical-fiber length observations taken in four field seasons spanning a 3 year interval reveal vertical strain rates ranging from −229 ± 4 ppm a−1 to −7 ± 9 ppm a−1. In addition to confirming a non-linear constitutive relationship for deep ice, our analysis of the strain rates indicates the ice sheet is thinning at the flank and is in steady state at the divide.
When a mass balance is computed using an outdated map, that computation does not reveal the actual mass change. But older maps often must be used for practical reasons. We present a method by which, with a few additional measurements each year, a mass balance computed with an outdated map can be transformed into an actual mass change. This is done by taking into account the influence of changes in areal extent and changes in the surface elevation of the glacier since the map was made. This method is applied to South Cascade Glacier, Washington, U.S.A., as an example. The computed cumulative mass balance from 1970 to 1997 would have been 16% too negative if the 1970 map had not been updated. While the actual volume change of a glacier is relevant to hydrological studies, the change that would have occurred on a constant (or static) surface is more relevant to certain glacier dynamics problems and most climate problems. We term this the reference-surface balance and propose that such a balance, which deliberately omits the influence of changes in area and surface elevation, is better correlated to climatic variations than the conventional one, which incorporates those influences.
The majority of fast radio bursts (FRBs) are poorly localised, hindering their potential scientific yield as galactic, intergalactic, and cosmological probes. LOFT-e, a digital backend for the U.K.’s e-MERLIN seven-telescope interferometer will provide commensal search and real-time detection of FRBs, taking full advantage of its field of view (FoV), sensitivity, and observation time. Upon burst detection, LOFT-e will store raw data offline, enabling the sub-arcsecond localisation provided by e-MERLIN and expanding the pool of localised FRBs. The high-time resolution backend will additionally introduce pulsar observing capabilities to e-MERLIN.
Bore-hole photography demonstrates that the glacier bed was reached by cable-tool drilling in five bore holes in Blue Glacier, Washington. Basal sliding velocities measured by bore-hole photography, and confirmed by inclinometry, range from 0.3 to 3.0 cm/d and average 1.0 cm/d, much less than half the surface velocity of 15 cm/d. Sliding directions deviate up to 30° from the surface flow direction. Marked lateral and time variations in sliding velocity occur. The glacier bed consists of bedrock overlain by a ≈ 10 cm layer of active subsole drift, which intervenes between bedrock and ice sole and is actively involved in the sliding process. It forms a mechanically and visibly distinct layer, partially to completely ice-free, beneath the zone of debris-laden ice at the base of the glacier. Internal motions in the subsole drift include rolling of clasts caught between bedrock and moving ice. The largest sliding velocities occur in places where a basal gap, of width up to a few centimeters, intervenes between ice sole and subsole drift. The gap may result from ice—bed separation due to pressurization of the bed by bore-hole water. Water levels in bore holes reaching the bed drop to the bottom when good hydraulic connection is established with sub-glacial conduits; the water pressure in the conduits is essentially atmospheric. Factors responsible for the generally low sliding velocities are high bed roughness due to subsole drift, partial support of basal shear stress by rock friction, and minimal basal cavitation because of low water pressure in subglacial conduits. The observed basal conditions do not closely correspond to those assumed in existing theories of sliding.