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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.
To investigate the extent of suspected hybridization between the brolga Antigone rubicunda and the Australian sarus crane Antigone antigone gillae, first noted in the 1970s, we analysed the genetic diversity of 389 feathers collected from breeding and flocking areas in north Queensland, Australia. We compared these with 15 samples from birds of known identity, or that were phenotypically typical. Bayesian clustering based on 10 microsatellite loci identified nine admixed birds, confirming that Australian cranes hybridize in the wild. Four of these were backcrosses, also confirming that wild Australian crane hybrids are fertile. Genetic analyses identified 10 times more hybrids than our accompanying visual field observations. Our analyses also provide the first definitive evidence that both brolgas and sarus cranes migrate between the Gulf Plains, the principal breeding area for sarus cranes, and major non-breeding locations on the Atherton Tablelands. We suggest that genetic analysis of shed feathers could potentially offer a cost-effective means to provide ongoing monitoring of this migration. The first observations of hybrids coincided with significantly increased opportunities for interaction between the two species when foraging on agricultural crops, which have developed significantly in the Atherton Tablelands flocking area since the 1960s. As the sarus crane is declining in much of its Asian range, challenges to the genetic integrity of the Australian sarus crane populations have international conservation significance.
No studies to date have investigated cumulative anticholinergic exposure
and its effects in adults with intellectual disabilities.
To determine the cumulative exposure to anticholinergics and the factors
associated with high exposure.
A modified Anticholinergic Cognitive Burden (ACB) scale score was
calculated for a representative cohort of 736 people over 40 years old
with intellectual disabilities, and associations with demographic and
clinical factors assessed.
Age over 65 years was associated with higher exposure (ACB 1–4 odds ratio
(OR) = 3.28, 95% CI 1.49–7.28, ACB 5+ OR = 3.08, 95% CI 1.20–7.63), as
was a mental health condition (ACB 1–4 OR = 9.79, 95% CI 5.63–17.02, ACB
5+ OR = 23.74, 95% CI 12.29–45.83). Daytime drowsiness was associated
with higher ACB (P<0.001) and chronic constipation
reported more frequently (26.6% ACB 5+ v. 7.5% ACB 0,
Older people with intellectual disabilities and with mental health
conditions were exposed to high anticholinergic burden. This was
associated with daytime dozing and constipation.
Approximately half of the variation in wellbeing measures overlaps with variation in personality traits. Studies of non-human primate pedigrees and human twins suggest that this is due to common genetic influences. We tested whether personality polygenic scores for the NEO Five-Factor Inventory (NEO-FFI) domains and for item response theory (IRT) derived extraversion and neuroticism scores predict variance in wellbeing measures. Polygenic scores were based on published genome-wide association (GWA) results in over 17,000 individuals for the NEO-FFI and in over 63,000 for the IRT extraversion and neuroticism traits. The NEO-FFI polygenic scores were used to predict life satisfaction in 7 cohorts, positive affect in 12 cohorts, and general wellbeing in 1 cohort (maximal N = 46,508). Meta-analysis of these results showed no significant association between NEO-FFI personality polygenic scores and the wellbeing measures. IRT extraversion and neuroticism polygenic scores were used to predict life satisfaction and positive affect in almost 37,000 individuals from UK Biobank. Significant positive associations (effect sizes <0.05%) were observed between the extraversion polygenic score and wellbeing measures, and a negative association was observed between the polygenic neuroticism score and life satisfaction. Furthermore, using GWA data, genetic correlations of -0.49 and -0.55 were estimated between neuroticism with life satisfaction and positive affect, respectively. The moderate genetic correlation between neuroticism and wellbeing is in line with twin research showing that genetic influences on wellbeing are also shared with other independent personality domains.
We sought to conduct a major objective of the CAEP Academic Section, an environmental scan of the academic emergency medicine programs across the 17 Canadian medical schools.
We developed an 84-question questionnaire, which was distributed to academic heads. The responses were validated by phone by the lead author to ensure that the questions were answered completely and consistently. Details of pediatric emergency medicine units were excluded from the scan.
At eight of 17 universities, emergency medicine has full departmental status and at two it has no official academic status. Canadian academic emergency medicine is practiced at 46 major teaching hospitals and 13 specialized pediatric hospitals. Another 69 Canadian hospital EDs regularly take clinical clerks and emergency medicine residents. There are 31 full professors of emergency medicine in Canada. Teaching programs are strong with clerkships offered at 16/17 universities, CCFP(EM) programs at 17/17, and RCPSC residency programs at 14/17. Fourteen sites have at least one physician with a Master’s degree in education. There are 55 clinical researchers with salary support at 13 universities. Sixteen sites have published peer-reviewed papers in the past five years, ranging from four to 235 per site. Annual budgets range from $200,000 to $5,900,000.
This comprehensive review of academic activities in emergency medicine across Canada identifies areas of strengths as well as opportunities for improvement. CAEP and the Academic Section hope we can ultimately improve ED patient care by sharing best academic practices and becoming better teachers, educators, and researchers.
Coconut, Cocos nucifera L., is a tree that is cultivated to provide a large number of products, although it is mainly grown for its nutritional and medicinal values. Coconut oil, derived from the coconut fruit, has been recognised historically as containing high levels of saturated fat; however, closer scrutiny suggests that coconut should be regarded more favourably. Unlike most other dietary fats that are high in long-chain fatty acids, coconut oil comprises medium-chain fatty acids (MCFA). MCFA are unique in that they are easily absorbed and metabolised by the liver, and can be converted to ketones. Ketone bodies are an important alternative energy source in the brain, and may be beneficial to people developing or already with memory impairment, as in Alzheimer's disease (AD). Coconut is classified as a highly nutritious ‘functional food’. It is rich in dietary fibre, vitamins and minerals; however, notably, evidence is mounting to support the concept that coconut may be beneficial in the treatment of obesity, dyslipidaemia, elevated LDL, insulin resistance and hypertension – these are the risk factors for CVD and type 2 diabetes, and also for AD. In addition, phenolic compounds and hormones (cytokinins) found in coconut may assist in preventing the aggregation of amyloid-β peptide, potentially inhibiting a key step in the pathogenesis of AD. The purpose of the present review was to explore the literature related to coconut, outlining the known mechanistic physiology, and to discuss the potential role of coconut supplementation as a therapeutic option in the prevention and management of AD.
Variation in human cognitive ability is of consequence to a large number of health and social outcomes and is substantially heritable. Genetic linkage, genome-wide association, and copy number variant studies have investigated the contribution of genetic variation to individual differences in normal cognitive ability, but little research has considered the role of rare genetic variants. Exome sequencing studies have already met with success in discovering novel trait-gene associations for other complex traits. Here, we use exome sequencing to investigate the effects of rare variants on general cognitive ability. Unrelated Scottish individuals were selected for high scores on a general component of intelligence (g). The frequency of rare genetic variants (in n = 146) was compared with those from Scottish controls (total n = 486) who scored in the lower to middle range of the g distribution or on a proxy measure of g. Biological pathway analysis highlighted enrichment of the mitochondrial inner membrane component and apical part of cell gene ontology terms. Global burden analysis showed a greater total number of rare variants carried by high g cases versus controls, which is inconsistent with a mutation load hypothesis whereby mutations negatively affect g. The general finding of greater non-synonymous (vs. synonymous) variant effects is in line with evolutionary hypotheses for g. Given that this first sequencing study of high g was small, promising results were found, suggesting that the study of rare variants in larger samples would be worthwhile.
Australia has a long history of establishing protected areas and they are now the cornerstones of its national and regional conservation strategies, covering over 13% of the country. There are large regional variations in levels of coverage, with most large protected areas placed far from dense human populations and away from productive agricultural land. Most of the recent growth in coverage has been driven by Indigenous Protected Areas and private protected areas, a trend that is likely to increase in the future. It is difficult to say how effective protected areas are in conserving biodiversity due to shortcomings in monitoring and evaluation, but the data that exist show that biodiversity outcomes are variable and that management effectiveness could be substantially improved. Threats to the protected area system are currently increasing with strong government pressure to allow extractive industries, such as mining, logging and grazing, and damaging recreational uses such as hunting to occur on land that is currently protected. If this trend continues, the future holds a great deal of uncertainty for Australia’s protected areas.
For centuries people all over the world have set aside places to which they ascribe special values. The reasons for this have been many and various but they are linked by a central purpose – to protect something that humankind perceives as valuable. Over the past century, as human populations have grown and their use of natural resources has increased, so the need to protect the remaining natural areas has also grown. Formally protected areas have become the centrepiece of the global strategy for nature conservation. These are areas where human activities are restricted and that are managed with the primary purpose of nature conservation (Dudley 2008). Australia is no exception in using protected areas as the cornerstones of its national and regional conservation strategies and is a signatory to the Convention on Biological Diversity (CBD). The CBD is an international legally binding treaty that commits Australia to achieving a number of conservation targets.
In this chapter we outline and discuss statistical approaches to the analysis of contest data, with an emphasis on testing key predictions and assumptions of the theoretical models described in Chapters 2 and 3. We use examples from an array of animal taxa, including cnidarians, arthropods and chordates, to illustrate these approaches and also the commonality of many key aspects of contest interactions despite the differing life histories and morphologies (including weaponry) of these organisms. We first deal with the analysis of contest outcomes, a useful approach for determining which traits contribute to an individual's resource holding potential (RHP). Here we outline alternative statistical approaches that treat the outcome as either an explanatory (independent) variable or as the response (dependent) variable. In both cases, we treat a single contest as one ‘experimental unit’ and consider ways in which multiple measures taken from the same experimental unit should be accounted for in the analysis. Thus, we introduce paired and repeated measures approaches for contest data and also the calculation of composite measures. We then discuss more complex mixed models, which are particularly useful for dealing with multi-party contests when multiple individuals from the same group occur in more than one observation. Having established what factors influence RHP, one might then ask questions about the roles of information-gathering and decision-making during contests. These questions are prompted by the theoretical models of dyadic contests discussed in Chapters 1 and 2, and we consider the advantages and limitations of using analysis of contest duration to distinguish between ‘mutual-’ and ‘self-assessment’ type contests. An additional tool that we can use to address this question is the analysis of escalation and de-escalation patterns, and we thus shift the focus to within-contest behavioural changes.
To assess the adequacy of milk and alternatives, Ca and vitamin D intakes in First Nations (FN) youth in Ontario, Canada. Intakes were compared with the general population and dietary standards. Variation in intakes by community (proxy for remoteness) and BMI was examined.
Data were collected by 24 h recall between November 2003 and June 2010. Intakes were analysed descriptively. Variation in intakes, by community and BMI category, was assessed using ANOVA.
Five remote FN communities of the Mushkegowuk Territory (northern Ontario, Canada) and two less-remote southern Ontario FN communities.
Schoolchildren (n 457) in grades 6 to 12.
Compared with Canada's Food Guide recommendations, 72·6 to 84·7 % had an inadequate intake of milk and alternatives depending on age and sex group; 86·2 % of individuals fell below the RDA for Ca; 96·4 % fell below the RDA for vitamin D. Community variation in intakes was detected, although in all cases Fort Albany had higher intakes, even when it was the more northern (remote) community. A BMI × sex interaction was found for intake of milk and alternatives (P = 0·041): an inverse relationship between intake and BMI was seen in females; in males, those who were overweight had the highest intake, followed by normal-weight and obese youth.
The nutritional inadequacies parallel the results of other Canadian studies of Aboriginal populations. Population health interventions to improve intakes are warranted. Moreover, community variation in intakes exists among FN youth in the present study (Fort Albany pairs only), but results were not as expected.
Excavations at Tinney's Lane, Sherborne in 2002 uncovered extensive evidence for Late Bronze Age settlement and pottery production, dating from a short time period probably within the 12th or 11th century cal bc. Well-preserved deposits of burnt stone, broken vessels, and burnt sherds, together with resulting debris redeposited in associated pits, were accompanied by a series of post-hole structures interpreted as round-houses and four-post settings. Environmental evidence in the form of charcoal, charred plant remains, and molluscs has provided important information concerning sources of fuel and water for pottery production as well as allowing a reconstruction of the local vegetation. Finds of fired clay, metal, stone, shale, flint, and bone include items from distant sources, informing topics such as site status and exchange, and include many categories of tools and equipment that would have been used within the pottery-making processes. Analysis of the spatial distribution of these finds amongst the structures and surviving layers of burning has allowed the definition of a series of industrial activity areas, each comprising one or more round-houses, a four-post structure, bonfire bases or pits used for firing, and other pits with specific related functions. Altogether the site has provided some of the best evidence for pottery production within prehistoric Britain.
Field observations from the Trinity Peninsula Group at View Point on the Antarctic Peninsula indicate that thick, southward-younging and overturned clastic sedimentary rocks, comprising unusually coarse conglomeratic lenses within a succession of fine-grained sandstone–mudstone couplets, are the deposits of debris and turbidity flows on or at the foot of a submarine slope. Three detrital zircons from the sandstone–mudstone couplets date deposition at 302 ± 3 Ma, at or shortly after the Carboniferous–Permian boundary. Conglomerates predominantly consist of quartzite and granite and contain boulders exceeding 500 mm in diameter. Zircons from granitoid clasts and a silicic volcanic clast yield U–Pb ages of 466 ± 3 Ma, 373 ± 5 Ma and 487 ± 4 Ma, respectively and have corresponding average εHft values between +0.3 and +7.6. A quartzite clast, conglomerate matrix and sandstone interbedded with the conglomerate units have broadly similar detrital zircon age distributions and Hf isotope compositions. The clast and detrital zircon ages match well with sources within Patagonia; however, the age of one granite clast and the εHf characteristics of some detrital zircons point to a lesser South Africa or Ellsworth Mountain-like contribution, and the quartzite and granite-dominated composition of the conglomerates is similar to upper Palaeozoic diamictites in the Ellsworth Mountains. Unlike detrital zircons, large conglomerate clasts limit possible transport distance, and suggest sedimentation took place on or near the edge of continental crust. Comparison with other upper Palaeozoic to Mesozoic sediments in the Antarctic Peninsula and Patagonia, including detrital zircon composition and the style of deformation, suggests deposition of the Trinity Peninsula Group in an upper plate basin on an active margin, rather than a subduction-related accretionary setting, with slow extension and rifting punctuated by short periods of compression.