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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.
Euscelidius variegatus (Kirschbaum) (Hemiptera: Cicadellidae) is a leafhopper known to vector phytoplasmas in cultivated vines (Vitis vinifera Linnaeus (Vitaceae)) of western Europe. Its occurrence has been recorded in western North America more than 60 years ago, but so far not in eastern North America, including Canada. In the last 15 years, three specimens have been found in Ontario near and around vineyards. Here we report the first record of E. variegatus in Canada and eastern North America.
It is known that in steady-state potential flows, the separation of a gravity-driven free surface from a solid exhibits a number of peculiar characteristics. For example, it can be shown that the fluid must separate from the body so as to form one of three possible in-fluid angles: (i)
or (iii) an angle such that the surface is locally perpendicular to the direction of gravity. These necessary separation conditions were notably remarked upon by Dagan & Tulin (J. Fluid Mech., vol. 51 (3), 1972, pp. 529–543) in the context of ship hydrodynamics, but they are of crucial importance in many potential-flow applications. It is not particularly well understood why there is such a drastic change in the local separation behaviours when the global flow is altered. The question that motivates this work is the following: outside of a formal balance-of-terms argument, why must cases (i)–(iii) occur and furthermore, what are the connections between them? In this work, we seek to explain the transitions between the three cases in terms of the singularity structure of the associated solutions once they are extended into the complex plane. A numerical scheme is presented for the analytic continuation of a vertical jet (or alternatively a rising bubble). It will be shown that the transition between the three cases can be predicted by observing the coalescence of singularities as the speed of the jet is modified. A scaling law is derived for the coalescence rate of singularities.
This paper investigates the passive and active control strategies to provide a physical assistance and rehabilitation by a 7-DOF exoskeleton robot with nonlinear uncertain dynamics and unknown bounded external disturbances due to the robot user's physiological characteristics. An Integral backstepping controller incorporated with Time Delay Estimation (BITDE) is used, which permits the exoskeleton robot to achieve the desired performance of working under the mentioned uncertainties constraints. Time Delay Estimation (TDE) is employed to estimate the nonlinear uncertain dynamics of the robot and the unknown disturbances. To overcome the limitation of the time delay error inherent of the TDE approach, a recursive algorithm is used to further reduce its effect. The integral action is employed to decrease the impact of the unmodeled dynamics. Besides, the Damped Least Square method is introduced to estimate the desired movement intention of the subject with the objective to provide active rehabilitation. The controller scheme is to ensure that the robot system performs passive and active rehabilitation exercises with a high level of tracking accuracy and robustness, despite the unknown dynamics of the exoskeleton robot and the presence of unknown bounded disturbances. The design, stability, and convergence analysis are formulated and proven based on the Lyapunov–Krasovskii functional theory. Experimental results with healthy subjects, using a virtual environment, show the feasibility, and ease of implementation of the control scheme. Its robustness and flexibility to deal with parameter variations due to the unknown external disturbances are also shown.
The Dicyemida and Orthonectida are two groups of tiny, simple, vermiform parasites that have historically been united in a group named the Mesozoa. Both Dicyemida and Orthonectida have just two cell layers and appear to lack any defined tissues. They were initially thought to be evolutionary intermediates between protozoans and metazoans but more recent analyses indicate that they are protostomian metazoans that have undergone secondary simplification from a complex ancestor. Here we describe the first almost complete mitochondrial genome sequence from an orthonectid, Intoshia linei, and describe nine and eight mitochondrial protein-coding genes from Dicyema sp. and Dicyema japonicum, respectively. The 14 247 base pair long I. linei sequence has typical metazoan gene content, but is exceptionally AT-rich, and has a unique gene order. The data we have analysed from the Dicyemida provide very limited support for the suggestion that dicyemid mitochondrial genes are found on discrete mini-circles, as opposed to the large circular mitochondrial genomes that are typical of the Metazoa. The cox1 gene from dicyemid species has a series of conserved, in-frame deletions that is unique to this lineage. Using cox1 genes from across the genus Dicyema, we report the first internal phylogeny of this group.
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.
An unprecedented outbreak of Ebola virus diseases (EVD) occurred in West Africa from March 2014 to January 2016. The French Institute for Public Health implemented strengthened surveillance to early identify any imported case and avoid secondary cases.
Febrile travellers returning from an affected country had to report to the national emergency healthcare hotline. Patients reporting at-risk exposures and fever during the 21st following day from the last at-risk exposure were defined as possible cases, hospitalised in isolation and tested by real-time polymerase chain reaction. Asymptomatic travellers reporting at-risk exposures were considered as contact and included in a follow-up protocol until the 21st day after the last at-risk exposure.
From March 2014 to January 2016, 1087 patients were notified: 1053 were immediately excluded because they did not match the notification criteria or did not have at-risk exposures; 34 possible cases were tested and excluded following a reliable negative result. Two confirmed cases diagnosed in West Africa were evacuated to France under stringent isolation conditions. Patients returning from Guinea (n = 531; 49%) and Mali (n = 113; 10%) accounted for the highest number of notifications.
No imported case of EVD was detected in France. We are confident that our surveillance system was able to classify patients properly during the outbreak period.
We use credit card data to estimate the impact of increasing minimum payments on delinquency, payments, spending, and write-offs. Our identification strategy exploits an unusual institutional feature: Borrowers can use their account to make purchases with both revolving loans (on which minimum payments increased) and term loans (on which there was no change). Payment increases by delinquent borrowers are insufficient to match increasing minimums, resulting in lower cure rates and an increase in write-offs. Affected borrowers migrate away from these accounts by decreasing charges and increasing payments, consequently lowering the interest earned by the bank.
Ice rises play key roles in buttressing the neighbouring ice shelves and potentially provide palaeoclimate proxies from ice cores drilled near their divides. Little is known, however, about their influence on local climate and surface mass balance (SMB). Here we combine 12 years (2001–12) of regional atmospheric climate model (RACMO2) output at high horizontal resolution (5.5 km) with recent observations from weather stations, ground-penetrating radar and firn cores in coastal Dronning Maud Land, East Antarctica, to describe climate and SMB variations around ice rises. We demonstrate strong spatial variability of climate and SMB in the vicinity of ice rises, in contrast to flat ice shelves, where they are relatively homogeneous. Despite their higher elevation, ice rises are characterized by higher winter temperatures compared with the flat ice shelf. Ice rises strongly influence SMB patterns, mainly through orographic uplift of moist air on the upwind slopes. Besides precipitation, drifting snow contributes significantly to the ice-rise SMB. The findings reported here may aid in selecting a representative location for ice coring on ice rises, and allow better constraint of local ice-rise as well as regional ice-shelf mass balance.
The Randolph Glacier Inventory (RGI) is a globally complete collection of digital outlines of glaciers, excluding the ice sheets, developed to meet the needs of the Fifth Assessment of the Intergovernmental Panel on Climate Change for estimates of past and future mass balance. The RGI was created with limited resources in a short period. Priority was given to completeness of coverage, but a limited, uniform set of attributes is attached to each of the ~198 000 glaciers in its latest version, 3.2. Satellite imagery from 1999–2010 provided most of the outlines. Their total extent is estimated as 726 800 ± 34 000 km2. The uncertainty, about ±5%, is derived from careful single-glacier and basin-scale uncertainty estimates and comparisons with inventories that were not sources for the RGI. The main contributors to uncertainty are probably misinterpretation of seasonal snow cover and debris cover. These errors appear not to be normally distributed, and quantifying them reliably is an unsolved problem. Combined with digital elevation models, the RGI glacier outlines yield hypsometries that can be combined with atmospheric data or model outputs for analysis of the impacts of climatic change on glaciers. The RGI has already proved its value in the generation of significantly improved aggregate estimates of glacier mass changes and total volume, and thus actual and potential contributions to sea-level rise.
Lithium and quetiapine are considered standard maintenance agents for bipolar disorder yet it is unclear how their efficacy compares with each other.
To investigate the differential effect of lithium and quetiapine on symptoms of depression, mania, general functioning, global illness severity and quality of life in patients with recently stabilised first-episode mania.
Maintenance trial of patients with first-episode mania stabilised on a combination of lithium and quetiapine, subsequently randomised to lithium or quetiapine monotherapy (up to 800 mg/day) and followed up for 1 year. (Trial registration: Australian and New Zealand Clinical Trials Registry – ACTRN12607000639426.)
In total, 61 individuals were randomised. Within mixed-model repeated measures analyses, significant omnibus treatment × visit interactions were observed for measures of overall psychopathology, psychotic symptoms and functioning. Planned and post hoc comparisons further demonstrated the superiority of lithium treatment over quetiapine.
In people with first-episode mania treated with a combination of lithium and quetiapine, continuation treatment with lithium rather than quetiapine is superior in terms of mean levels of symptoms during a 1-year evolution.
Organic light-emitting diodes (OLED) offer the potential to replace conventional light sources such as incandescent bulbs and fluorescent tubes. The question which thin-film technology is most favorable to produce OLED on an industrial scale is still unanswered. The most established technology for the deposition of small-molecule organic layers is vacuum thermal evaporation. A comparably novel technology is organic vapor phase deposition (OVPD), which offers some unique features in terms of adjustable process parameters such as deposition chamber pressure (P) and substrate temperature (TS). The impact of these parameters on the morphology of organic single layers as well as on the performance of OLED is mostly unknown. In this work, phosphorescent red OLED were produced with different TS and a strong influence on the device efficiency was found. Atomic force microscopy measurements were conducted to investigate the morphology of the hole injection and hole transport layers of the devices deposited at different TS. In addition to this, the influence of TS and P on the performance of fluorescent blue OLED and the morphology of organic single layers was tested. By varying TS and P for the emission layer only, current efficiencies in the range from 4.3 to 6.8 cd/A were found despite the fact that all devices had the same structure. Atomic force microscopy measurements conducted on organic single layers which were deposited at the same process conditions showed rms values ranging from 1.4 to 57 nm.
Integrated Ocean Drilling Program Leg 307 Site U1318 is one of the few relatively complete middle Miocene drillcores from the North Atlantic (Porcupine Basin, offshore southwestern Ireland). Using benthic foraminiferal stable carbon and oxygen isotopes, the existing age model for Site U1318 was improved. The stable isotope record displays globally recognized isotope events, used to revise the existing magnetostratigraphy-based age model. Two intervals contained misidentified magnetochrons which were corrected. The sampled interval now has a refined age of 12.75–16.60 Ma with a temporal resolution of c. 29 ka.
In 1983, Tulin published a report proposing a framework for reducing the equations for gravity waves generated by moving bodies into a single nonlinear differential equation solvable in closed form (Proceedings of the 14th Symposium on Naval Hydrodynamics, 1983, pp. 19–51). Several new and puzzling issues were highlighted by Tulin, notably the existence of weak and strong wave-making regimes, and the paradoxical fact that the theory seemed to be applicable to flows at low speeds, ‘but not too low speeds’. These important issues were left unanswered, and despite the novelty of the ideas, Tulin’s report fell into relative obscurity. Now, 30 years later, we will revive Tulin’s observations, and explain how an asymptotically consistent framework allows us to address these concerns. Most notably, we demonstrate, using the asymptotic method of steepest descents, how the production of free-surface waves can be related to the arrangement of integration contours connected to the shape of the moving body. This approach provides a new and powerful methodology for the study of geometrically nonlinear wave–body interactions.
Protecting seabirds is a global conservation priority given that 29% of seabird species are threatened with extinction. One of the most acute threats to seabirds is the presence of introduced predators, which depredate seabirds at all life stages, from eggs to adults. Consequently, eradication of invasive predators has been identified as an effective and commonly used approach to seabird conservation. Seabird recovery following the eradication of predators is influenced by complex and interacting environmental and demographic factors, and there are gaps in our understanding of species-specific responses. We reflect on the recovery of seabirds on islands cleared of predators, drawing on the equilibrium theory of island biogeography, and synthesize key influences on recovery reported in the literature. We present a regionally specific case study on the recovery of seabird colonies (n = 98) in the Hauraki Gulf, New Zealand, which is a hotspot of seabird diversity (27 species), with a long history of eradications of invasive predators. We found that on islands cleared of predators seabirds recover over time, and such islands have more diverse seabird assemblages than islands that never had predators. Recovery appears to be influenced by a suite of site- and species-specific factors. Managers may assume that given enough time following eradication of predators, seabirds will recolonize an island. Although time is a factor, proximity to source populations and human activities has a significant effect on recolonization by seabirds, as do demographic traits, colonizing ability and habitat suitability. Therefore, integrating expected site and species-specific recovery responses in the planning of eradications should help guide post-eradication management actions.
Beat H. Walpoth, Division of Cardiovascular Surgery, University Hospitals of Geneva, Switzerland,
Marie Meyer, Dept. of Anesthesia, University Hospital, Lausanne, Switzerland,
Christophe Gaudet-Blavignac, Division of Medical Information Sciences, University Hospitals of Geneva, Switzerland,
Philippe Baumann, Division of Medical Information Sciences, University Hospitals of Geneva, Switzerland,
Pierre Gilquin, Division of Medical Information Sciences, University Hospitals of Geneva, Switzerland,
Christian Lovis, Division of Medical Information Sciences, University Hospitals of Geneva, Switzerland
Accidental hypothermia can be of multiple aetiologies and is often related to an accident in a cold environment and contrasts with urban hypothermia. People living in the cold such as workers, fishermen and military personnel are at risk. More recently there is an increase in unprepared lay people practicing leisure activities such as winter sports, thus exposing themselves to hypothermia in case of an accident. Most of the cases concern mild hypothermia which does not need hospitalization or medical assistance. In contrast, deep hypothermia, with or without cardiac arrest, is rare and carries a high mortality in healthy adults and children [1, 2, 3].
Induced hypothermia which has been used for cardiac surgery as well as therapeutic hypothermia used for brain ischaemia, are medically indicated and highly monitored and therefore cannot be compared to accidental hypothermia. Patients with induced hypothermia may reach the same degree (< 28°C) but are in controlled narcosis and are normally cooled down and rewarmed by Cardiopulmonary Bypass (CPB) . Therapeutic hypothermia cools the patient to mild hypothermia (32–34°C) to enhance a better and faster functional brain recovery .
The concept of applying the technique of CPB rewarming, as used in induced deep hypothermic cardiac arrest, to victims of accidental hypothermia with temperatures below 28°C and cardio-respiratory arrest was initiated successfully by Prof. Ueli Althaus at the University Hospital Insel in Bern, Switzerland over 30 years ago . Since that time our team and other Swiss universities started to use this method and we published a multi-centre study showing a long-term sequelae-free survival rate of 47% after rewarming of 32 deep accidental hypothermic patients in cardiac arrest using cardiopulmonary bypass (CPB) . Due to the fact that many patients died from post-rewarming complications, we and others have shown the beneficial effect of using extra-corporeal life support (ECLS) such as prolonged ECMO use after rewarming for cardiovascular and pulmonary dysfunctions [8, 9].