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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.
I explore the bases of a ‘distributionalist’ approach to syntactic categories, that is, an approach that makes distinctions on the basis of purely syntactic (as opposed to, say, semantic) criteria. I focus on the phenomenon of ‘mixed projections’, where a syntactic phrase appears to display properties of more than one syntactic category, as analysed within the framework of Lexical-Functional Grammar. I argue that of the three syntactic criteria called upon in the definition of syntactic categories within this approach, only one, the internal syntactic structure of a phrase, is a sufficient criterion for syntactic categorization. This leads to a more restricted definition of category mixing and implies a more restricted approach to categorization in general.
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.
Despite lessons learned from the recent Ebola epidemic, attempts to survey and determine non-health care worker, industry-specific needs to address highly infectious diseases have been minimal. The aircraft rescue and fire fighting (ARFF) industry is often overlooked in highly infectious disease training and education, even though it is critical to their field due to elevated occupational exposure risk during their operations.
Supervisors perceived Frontline respondents to be more willing and comfortable to encounter potential highly infectious disease scenarios than the Frontline indicated. More than one-third of respondents incorrectly marked transmission routes of viral hemorrhagic fevers. There were discrepancies in self-reports on the existence of highly infectious disease orientation and skills demonstration, employee resources, and personal protective equipment policies, with a range of 7.5%-24.0% more Supervisors than Frontline respondents marking activities as conducted.
There are deficits in highly infectious disease knowledge, skills, and abilities among ARFF members that must be addressed to enhance member safety, health, and well-being. (Disaster Med Public Health Preparedness. 2018;12:675-679)
This paper reviews the evidence for environmental change during the Lateglacial period (c.14.7–11.7 ka), perhaps the most intensively studied episode in the Quaternary history of Scotland. It considers first the stratigraphic subdivision and nomenclature of the Lateglacial, before proceeding to a discussion of the various lines of proxy evidence that have been used to reconstruct the spatial and temporal patterns of environmental change during this time period. These include pollen and plant macrofossil data; coleopteran and chironomid records; diatom data; stable isotope and geochemical records; and evidence for human activity. The paper then considers the principal methods that have been employed to date and correlate Lateglacial events: radiocarbon dating; surface exposure dating; varve chronology; and tephrochronology. This is followed by an examination of the constraints imposed on environmental reconstructions, an account of the ways in which the evidence can be employed in the development of an event stratigraphy for the Lateglacial in Scotland, and a proposal for a provisional Lateglacial type sequence (stratotype) at Whitrig Bog in SE Scotland. Emphasis is placed throughout on the potential linkages between the Scottish records and the isotopic signal in the Greenland ice cores, which forms the stratigraphic template for the N Atlantic region. The paper concludes with a discussion of the strategies and approaches that should underpin future research programmes on Lateglacial environmental change in Scotland.
Marine-geological and -geophysical data collected from the continental shelf in Pine Island Bay, Antarctica, reveal a complex paleo-subglacial drainage system controlled by bedrock topography and subglacial meltwater discharge. Significant amounts of freely flowing meltwater existed beneath former ice sheets in Pine Island Bay. Subglacial drainage is characterized by descriptions of glacial landforms imaged on the sea floor and sedimentary deposits collected in piston cores. Bedrock geology is characterized using seismic data. Large-scale landforms on the shelf include channels and cavities incised into impermeable crystalline bedrock. There is a transition from randomly oriented channels on the inner shelf to a dendritic pattern of elongate channels on the middle shelf. On the outer shelf, a change in basal conditions occurs where sedimentary deposits bury crystalline bedrock. No evidence for flowing meltwater exists on sedimentary substrates. Instead, meltwater formed at the ice–sediment contact was incorporated into the sediments, contributing to development of a deforming bed, which was sampled in piston cores. Characterization of subglacial meltwater processes that occurred in the past may aid in understanding the role meltwater plays in stability of the West Antarctic ice sheet today.
Rural communities face barriers to disaster preparedness and considerable risk of disasters. Emergency preparedness among rural communities has improved with funding from federal programs and implementation of a National Incident Management System. The objective of this project was to design and implement disaster exercises to test decision making by rural response partners to improve regional planning, collaboration, and readiness. Six functional exercises were developed and conducted among three rural Nebraska (USA) regions by the Center for Preparedness Education (CPE) at the University of Nebraska Medical Center (Omaha, Nebraska USA). A total of 83 command centers participated. Six functional exercises were designed to test regional response and command-level decision making, and each 3-hour exercise was followed by a 3-hour regional after action conference. Participant feedback, single agency debriefing feedback, and regional After Action Reports were analyzed. Functional exercises were able to test command-level decision making and operations at multiple agencies simultaneously with limited funding. Observations included emergency management jurisdiction barriers to utilization of unified command and establishment of joint information centers, limited utilization of documentation necessary for reimbursement, and the need to develop coordinated public messaging. Functional exercises are a key tool for testing command-level decision making and response at a higher level than what is typically achieved in tabletop or short, full-scale exercises. Functional exercises enable evaluation of command staff, identification of areas for improvement, and advancing regional collaboration among diverse response partners.
ObaidJM, BaileyG, WheelerH, MeyersL, MedcalfSJ, HansenKF, SangerKK, LoweJJ. Utilization of Functional Exercises to Build Regional Emergency Preparedness among Rural Health Organizations in the US. Prehosp Disaster Med. 2017;32(2):224–230.
This report outlines a 3-year health care coalition effort to advance and test community capacity for a large-scale hospital evacuation. The multi-year effort utilized a variety workshops, seminars, webinars, tabletops, functional exercises, and culminated with a full-scale exercise testing hospital evacuation. While most hospital evacuation exercises focus on internal movement of patients, this exercise process tested command-level decision making and it tested external partners such as transportation agencies, law enforcement, receiving hospitals, and local emergency management. This process delivered key coalition-building activities and offered a variety of training and exercise opportunities to assist a number of organizations, all at different stages of hospital evacuation planning. The 2012 Hospital Preparedness Program outlined the incorporation of health care coalition activities to transform individual organization preparedness to community-level readiness. This report outlines a health care coalition effort to deliver training and exercises to advance community capacity for a large-scale hospital evacuation.
LoweJJ, HansenKF, SangerKK, ObaidJM. A 3-year Health Care Coalition Experience in Advancing Hospital Evacuation Preparedness. Prehosp Disaster Med. 2016;31(6):658–662.
We present δ13C data from both bulk organic sediment samples and terrestrial plant macrofossils from five high-resolution sedimentary sequences from the United Kingdom from which extensive multiproxy data sets have been obtained. These span the last glacial-interglacial transition. Chronological control has been provided by radiocarbon dating and/or tephrochronology. The results demonstrate that significant shifts in bulk organic δ13C can be identified at key climatic transitions in most of the sites. The data are affected by site-specific influences that restrict their use as chronological markers. However, terrestrial plant macrofossil records are more consistent and reveal shifts that appear to be synchronous and which therefore offer a basis for interregional correlation as well as significant paleoenvironmental information.
The publication during the 1990s of Greenland ice-core records spanning the transition from the Last Cold Stage to the present interglacial (ca. 14–9 14C ka BP) presented new challenges to scientists working on marine and terrestrial sequences from this important time interval. In particular, there is now an overriding imperative to increase the levels of precision by which events during this period can be dated and correlated. We review some of the problems commonly encountered when using radiocarbon dating for these purposes, and consider some of the new approaches that will be required if this dating method is to provide a basis for a high precision chronology for the last glacial-interglacial transition.
Adults with tetralogy of Fallot experience atrial tachyarrhythmias; however, there are a few data on the outcomes of radiofrequency ablation. We examined the characteristics, outcome, and predictors of recurrence of atrial tachyarrhythmias after radiofrequency ablation in tetralogy of Fallot patients.
Retrospective data were collected from 2004 to 2013. In total, 56 ablations were performed on 37 patients. We identified two matched controls per case: patients with tetralogy of Fallot but no radiofrequency ablation and not known to have atrial tachyarrhythmias. Acute success was 98%. Left atrial arrhythmias increased in frequency over time. The mean follow-up was 41 months; 78% were arrhythmia-free. Number of cardiac surgeries, age, and presence of atrial fibrillation were predictors of recurrence. Lone cavo-tricuspid isthmus-dependent flutter reduced the likelihood of atrial fibrillation. Right and left atria in patients with tetralogy of Fallot were larger in ablated cases than controls. NYHA class was worse in cases and improved after ablation; baseline status predicted death. Of matched non-ablated controls, a number of them had atrial fibrillation. These patients were excluded from the case–control study but analysed separately. Most of them had died during follow-up, whereas of the matched ablated cases all were alive and the majority in sinus rhythm.
Patients with tetralogy of Fallot and atrial tachyarrhythmias have more dilated atria than those without atrial tachyarrhythmias. Radiofrequency ablation improves functional status. Left atrial ablation is more commonly required with repeat procedures. There is a high prevalence of atrial tachyarrhythmias, particularly atrial fibrillation, in patients with tetralogy of Fallot; early radiofrequency ablation may have a protective effect against this.
This book continues the series of volumes containing reprints of the papers in the original Cabal Seminar volumes of the Springer Lecture Notes in Mathematics series [Cabal i, Cabal ii, Cabal iii, Cabal iv], unpublished material, and new papers. The first volume, [Cabal I], contained papers on games, scales and Suslin cardinals. The second volume, [Cabal II], contained papers on Wadge degrees and pointclasses and projective ordinals. In this volume, we continue with Parts V and VI of the project: Ordinal definability in models of determinacy and Recursion theory. As in our first two volumes, each of the parts contains an introductory survey (written by John Steel for Part V and by Leo Harrington and Ted Slaman for Part VI) putting the papers into a present-day context.
In addition to the reprinted papers, this volume contains a paper by Kechris and Martin (On the theory of Π13sets of reals, II) that dates back to the period of the original Cabal publications but was not included in the old volumes. Neeman contributed a new paper, An inner models proof of the Kechris–Martin theorem, related to this paper. Steel and Woodin contributed two new papers (A theorem of Woodin on mouse sets, authored by Steel, and HODas a core model, jointly) with recent results that fit well with the topics of Part V. There is also a new paper by Marks, Slaman and Steel (Martin's conjecture, arithmetic equivalence, and countable Borel equivalence relations) that contains earlier, unpublished, as well as new results related to the theme of Part VI. Table 1 gives an overview of the papers in this volume with their original references.
As emphasized in our first two volumes, our project is not to be understood as a historical edition of old papers. In the retyping process, we uniformized and modernized notation and numbering of sections and theorems. As a consequence, references to papers in the old Cabal volumes will not always agree with references to their reprinted versions. In this volume, references to papers that already appeared in reprinted form will use the new numbering. In order to help the reader to easily cross-reference old and new numberings, we provide a list of changes after the preface.