To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
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.
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.
We present an analysis of the active hydrologic system of MacAyeal Ice Stream (MacIS), West Antarctica, from a synthesis of multiple remote-sensing techniques: satellite laser altimetry; satellite image differencing; and hydrologic potential mapping (using a satellite-derived DEM and a bedrock DEM from airborne radio-echo sounding). Combining these techniques augments the information provided by each one individually, and allows us to develop a protocol for studying subglacial hydrologic systems in a holistic manner. Our study reveals five large active subglacial lakes under MacIS, the largest of which undergoes volume changes of at least 1.0 km3. We discuss the hydrologic properties of this system and present evidence for links between the lakes. At least three of the lakes are co-located with sticky spots, i.e. regions of high local basal shear stress. We also find evidence for surface elevation changes due to ice-dynamic effects (not just water movement) caused by changes in basal resistance. Lastly, we show that satellite radar altimetry is of limited use for monitoring lake activity on fast-flowing ice streams with surfaces that undulate on ∼10 km length scales.
The Folkton ‘Drums’ constitute three of the most remarkable decorated objects from Neolithic Britain. New analysis using Reflectance Transformation Imaging and photogrammetry has revealed evidence for previously unrecorded motifs, erasure and reworking. Hence these chalk drums were not decorated according to a single, pre-ordained scheme, but were successively carved and recarved over time. Such practices may have been widespread in the making of artefacts in Neolithic Britain. The study of these drums also demonstrates the ability of these new techniques not only to record visible motifs, but to document erased and reworked motifs clearly.
Reintroductions aim to re-establish species within their historical ranges through the release of wild- or captive-bred individuals following extirpation (or extinction) in the wild. There is no general agreement on what constitutes a successful reintroduction but the probability of the population achieving long-term persistence should be addressed. Here we review a 10-year trial reintroduction of the great bustard Otis tarda, a globally threatened bird species, to the UK and assess the long-term population viability. Despite changes in rearing and release strategy, initial post-release survival probability remained consistently low, with only 11.3% of bustards (n = 167) surviving from release to 1 year post-release. Nineteen breeding attempts were made by eight females; however, only one chick survived > 100 days after hatching, and no wild juveniles have recruited into the population. Using demographic rates from the UK population and wild populations elsewhere, and stochastic population modelling, we investigate the viability of this reintroduced population by predicting population size over the next 10 years. Under current demographic rates the population was predicted to decline rapidly. Self-sufficiency was predicted only using the highest estimates from the UK population for first-year and adult survival, and recruitment rates from wild populations elsewhere. Although changes have been made in rearing, release strategies, habitat management and release sites used, these changes appear to have a modest effect on long-term viability. Substantial improvements in survival rates and productivity are necessary to establish a viable great bustard population in the UK, and we consider this unlikely.
Capability theorists have suggested different, sometimes incompatible, ways in which their approach takes account of the value of freedom, each of which implies a different kind of normative relation between functionings and capabilities. This paper examines three possible accounts of the normative relation between functionings and capabilities, and the implications of each of these accounts in terms of degrees of paternalism. The way in which capability theorists apparently oscillate between these different accounts is shown to rest on an apparent tension between anti-paternalism (which favours an emphasis on capabilities) and anti-fetishism (which favours an emphasis on functionings). The paper then advances a fourth account, which incorporates a concern with the content-independent or ‘non-specific’ value of freedom. Only the fourth account would remove all traces of paternalism from the capability approach. Whatever reasons advocates of the capability approach might have had for rejecting this fourth account, those reasons are not internal to the capability approach itself.
Doppler Imaging of starspots on young solar analogues is a way to investigate the early history of solar magnetic activity by proxy. Doppler images of young G-dwarfs have yielded the presence of large polar spots, extending to moderate latitudes, along with measurements of the surface differential rotation. The differential rotation measurement for one star (RX J0850.1-7554) suggests it is possibly the first example of a young G-type dwarf whose surface rotates as almost a solid body, in marked contrast to the differential rotation of other rapidly rotating young G-dwarfs and the present-day Sun. Overall, our Doppler imaging results show that the young Sun possessed a fundamentally different dynamo to today.
Repetition of hospital-treated self-poisoning and admission to
psychiatric hospital are both common in individuals who self-poison.
To evaluate efficacy of postcard intervention after 5 years.
A randomised controlled trial of individuals who have self-poisoned:
postcard intervention (eight in 12 months) plus treatment as usual
v. treatment as usual. Our primary outcomes were
self-poisoning admissions and psychiatric admissions (proportions and
There was no difference between groups for any repeat-episode
self-poisoning admission (intervention group: 24.9%, 95% CI 20.6-29.5;
control group: 27.2%, 95% CI 22.8-31.8) but there was a significant
reduction in event rates (incidence risk ratio (IRR)=0.54, 95% CI
0.37-0.81), saving 306 bed days. There was no difference for any
psychiatric admission (intervention group: 38.1%, 95% CI 33.1-43.2;
control group: 35.5%, 95% CI 30.8-40.5) but there was a significant
reduction in event rates (IRR=0.66, 95% CI 0.47-0.91), saving 2565 bed
A postcard intervention halved self-poisoning events and reduced
psychiatric admissions by a third after 5 years. Substantial savings
occurred in general hospital and psychiatric hospital bed days.
University research strategies make statements about research ambitions, but rarely speak directly about scholarly communications. At the same time, communication of all sorts has become central to a university, whether to support recruitment, present a public profile or respond to events. This chapter seeks to explore the relationship between institutional research strategies and scholarly communications and to see how each may have affected the other and how they might do so in the future. It describes the purpose and structure of an institutional research strategy, and how these are changing. It highlights the linkages between strategy, implementation plans and policies, where the latter encourage desired behaviours. In the context of scholarly communications, the research strategy is the public document in which an institution states its commitment to such forms of communication: that discovering new knowledge and sharing that discovery in meaningful ways are at the heart of the institution. The discussion then moves to the changing nature of scholarly communications, including the Open agenda, and questions how scholarly communications fits into the wider spectrum of institutional communications. The chapter concludes that there has probably been little direct connection between research strategies and approaches to scholarly communications, but that this is changing. Both institutions and individual researchers wish to demonstrate the quality, relevance and accessibility of their research, in order to be attractive to collaborators, funders and employers. Successful institutions will ensure that strategy and scholarly communications activities are mutually supportive, to the benefit of both their researchers and the organization.
How have institutional research strategies affected scholarly communications, if at all?
How have changes in scholarly communications affected institutional research strategies?
This chapter addresses these two questions; and to that end it looks at the recent evolution of the institutional research strategy.
University research strategies (and their parent institutional strategies) have tended not to consider scholarly communication directly. Rather, they have tended to be statements about undertaking high-quality, relevant research and translating it into practice or other beneficial outcomes. It is implicit that the results of research will be disseminated, but little attention is paid to how, why and through what media.
At one level, this is neither surprising nor concerning. Indeed, the academic community might be more worried if their institutional strategy became too prescriptive.
High-resolution échelle spectra of 42 nearby southern solar-type stars have been obtained, in a search for young, single, active, and rapidly rotating sun-like stars suitable for Doppler imaging and Zeeman Doppler imaging studies. As a result of this survey, 13 stars were determined to be youthful with ages less than 600 Myr (Hyades age) and eight of these were found to have projected rotational velocities in excess of 15 km s−1. In addition, five spectroscopic binary systems were identified. Of those stars observed for this survey, HD 106506 is the most outstanding target for mapping active regions. It is an apparently young and single star with rapid rotation (v sin i ∼ 80 km s−1), strong Hα chromospheric activity (log R′Hα ∼ −4.2), and deformation of the spectral line profiles indicating the presence of large starspots.
Research is essential for the development of evidence-based emergency medical services (EMS) systems of care. When resources are scarce and gaps in evidence are large, a national agenda may inform the growth of EMS research in Canada. This mixed methods consensus study explores current barriers and existing strengths within Canadian EMS research, provides recommendations, and suggests EMS topics for future study.
Purposeful sampling was employed to invite EMS research stakeholders from various roles across the country. Study phases consisted of 1) baseline interviews of a subsample, 2) roundtable discussion, and 3) an online Delphi survey, in which participants scored each statement for importance. Consensus was defined a priori and met if 80% scored a statement as “important” or “very important.”
Fifty-three stakeholders participated, representing researchers (37.7%), EMS administrators (24.6%), clinicians/ providers (20.7%), and educators (17.0%). Participation rates were as follows: interviews, 13 of 13 (100%); roundtable, 47 of 53 (89%); survey round 1, 50 of 53 (94%); survey round 2, 47 of 53 (89%); and survey round 3, 40 of 53 (75%). A total of 141 statements were identified as important: 20 barriers, 54 strengths/opportunities, 31 recommendations, and 36 suggested topics for future research. Like statements were synthesized, resulting in barriers (n 5 10), strengths/opportunities (n 5 24), and recommendations (n 5 19), which were categorized as time, opportunities, and funding; education and mentorship; culture of research and collaboration; structure, process, and outcome of research; EMS and paramedic practice; and the future of the EMS Research Agenda.
Consensus-based key messages from this agenda should be considered when designing, funding, and publishing EMS research and will advance EMS research locally, regionally, and nationally.
This study forms the first phase in the development of the Canadian National EMS Research Agenda. The purpose was to understand the current state of emergency medical services (EMS) research through the barriers and opportunities perceived by key stakeholders in the Canadian system and to identify the recommendations this group had for moving forward.
This qualitative study was conducted in the spring of 2011 using one-on-one semistructured telephone interviews. Purposeful sampling was used to recruit a cross section of EMS research stakeholders, representing a breadth of geographic regions and roles. Data were collected until thematic saturation was reached. A constant comparative approach was used to develop a basic coding framework and identify emerging themes.
Twenty stakeholders were invited to participate, and saturation was reached after 13 interviews. Thematic saturation was used to ensure that the findings were grounded in the data. Four major themes were identified: 1) the need for additional research education within EMS; 2) the importance of creating an infrastructure to support pan-Canadian research collaboration; 3) addressing the complexities of involving EMS providers in research; and 4) considerations for a national research agenda.
This hypothesis-generating study reveals key areas regarding EMS research in Canada and through the guidance it provides is a first step in the development of a comprehensive national research agenda. Our intention is to collate the identified themes with the results of a larger roundtable discussion and Delphi survey and, in doing so, guide development of a Canadian national EMS research agenda.
The nature of basic equality (what it is that makes us all equals) can have implications not only for the question of the currency of egalitarian justice but also for that of its ‘site’. The latter question is raised by G. A. Cohen in his critique of John Rawls's theory of justice. In this paper I argue that Rawlsian liberals might provide an answer to Cohen's critique by establishing two distinct kinds of basic equality, thus providing a ‘twofold account’ of basic equality. A first kind of basic equality gains moral relevance in the context of respectful relations between individuals, and establishes egalitarian duties between them. A second kind of basic equality gains moral relevance in the context of respectful relations between the state and individual citizens, and establishes egalitarian duties of the state toward citizens. The strength of Cohen's critique depends, in part, on the fact that Rawls identified only one kind of basic equality while at the same time wishing to defend a dualist account of individual and state duties.
Being a healthy traveller involves communication in more than one sense of the word.
Health administrations have a responsibility to prevent illness associated with international travel and trade without undue interference to these inevitable activities. Past experience of travel-associated disease transmission should determine epidemiologically justified and cost-effective preventive measures.
The aeroplane transmits disease faster but should not become the scapegoat for travel-associated ill health. Viral influenza can spread rapidly because of air travel but the latter's role in transmission of diseases such as cholera and smallpox in the past or viral haemorrhagic fevers in the future may not be clear cut.
Surveillance activities are essential to enable the earliest possible detection of disease because measures taken with the intention of keeping a disease out of a country cannot be foolproof. Frank and rapid exchange of information between national epidemiological services is essential for effective control of international spread of diseases.
National health administrations have an obligation to provide travellers with reliable information. A specific programme co-opting the medical profession, travel agencies of every form and the media is necessary.
The World Health Organisation should collaborate with national health administrations in the prevention of disease associated with travel.
The formal commissioning of the IRWG occurred at the 1991 Buenos Aires General Assembly, following a Joint Commission meeting at the IAU GA in Baltimore in 1988 that identified the problems with ground-based infrared photometry. The meeting justification, papers, and conclusions, can be found in Milone (1989). In summary, the challenges involved how to explain the failure to achieve the milli-magnitude precision expected of infrared photometry and an apparent 3% limit on system transformability. The proposed solution was to redefine the broadband Johnson system, the passbands of which had proven so unsatisfactory that over time effectively different systems proliferated, although bearing the same “JHKLMNQ” designations; the new system needed to be better positioned and centered in the spectral windows of the Earth's atmosphere, and the variable water vapour content of the atmosphere needed to be measured in real time to better correct for atmospheric extinction.
The great bustard Otis tarda became extinct in the UK during the 19th century due to a combination of factors, including hunting, egg collection and changes in agriculture. In 2003 a 10-year licence was granted to begin a trial to reintroduce the species back to the UK. Here we report on the first 5 years of the trial and assess the progress made towards establishing a founder population. From April 2004 to September 2009 a total of 102 great bustard chicks were imported from Russia and 86 released on Salisbury Plain. Monitoring showed that post-release survival was 18% in the first year following release, and that mortality of released bustards was mainly attributable to predation and collisions. Estimated adult survival was 74%, although the sample size was small. All known surviving great bustards are faithful to the surroundings of the release site, returning throughout the year. A lek has been established where males have been observed displaying to females. The first nesting attempt was in 2007, and in 2009 two females aged 3 and 4 years successfully nested, fledging one chick each. Models incorporating the new demographic estimates suggest that at the end of the 10-year trial period the project can expect to have 8–26 adults as a founder population.
The ability to tailor thin film interface structure is illustrated by the growth of thin ferric oxide films using different deposition parameters. Low-pressure chemical vapor deposition (CVD) has been used to grow α-Fe2O3 on sapphire while pulsed-laser ablation (PLA) followed by low temperature oxidation has been used to grow γ-Fe2O3 on MgO. The structure of the films and of the film-substrate interfaces has been characterized using transmission electron microscopy (TEM) and selected-area diffraction (SAD) in plan view. The different deposition techniques lead not only to the growth of two different polymorphs of ferric oxide but also to different growth mechanisms and film-substrate interface structures. In addition, changes in the thermodynamic conditions during deposition can give rise to different interface structures between the individual structural domains of the film.
The width of the single-phase stability field of nickel titanate spinel (Ni2(1+x)Ti1−xO4) has been determined in order to resolve an ambiguity in the analysis of the microstructure of equilibrated and quenched spinel-containing specimens. Bulk polycrystalline diffusion couples of the constituent oxides, NiO and NiTiO3, have been prepared at several reaction temperatures between 1400°C and 1550°C. The microstructure of the reaction layers of slow-cooled specimens has been examined by SEM and the composition has been mapped using x-ray microanalysis. It is concluded that the nickel titanate spinel phase has a narrow range of stability, and that the stoichiometry of the spinel is temperature dependent. The microstructure of equilibrated and quenched specimens is discussed in light of these findings.