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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.
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.
Introduction: Introduction: Paramedics frequently make immediate life-altering decisions with minimal clinical information. This applies to their decision to treat an unconscious patient with naloxone when the history of an opioid overdose cannot be readily established. Among patients treated by paramedics with naloxone, our objective was to compare patient demographics, treatment interventions and clinical response between patients with and without a confirmed history of an opioid overdose. Methods: Methods: This was a retrospective cohort study design of consecutive patients treated with naloxone by paramedics between January 1, 2016, and June 30, 2017. Patients were classified based on whether paramedics did or did not document a history of an opioid overdose. Baseline characteristics, treatment interventions, and response to naloxone were compared between groups. Comparisons were done using a chi-squared or Fishers exact test. Results: Results: We identified 294 patients of whom 113 (38%) did not have a confirmed history of an opioid overdose. The groups were similar in gender, bystander CPR, and bystander administration of naloxone. There were no differences in the presence of pinpoint pupils, initial oxygen saturation, initial Glasgow Coma Score (GCS), respiratory rate, or time on scene. Both patient groups were managed similarly with respect to route of naloxone administration and the use of a bag valve mask. All patients who were intubated were in the no confirmed history group (n=5; p=.003). Post naloxone there were no differences in last recorded vital signs except the no confirmed history group was less likely to achieve a GCS 10 (57% versus 89%; p<.001). The overall post-naloxone development of agitation (9%) was moderate while the need for physical/chemical restraint (2%) was low with no differences between groups. All patients were transported to the hospital. Conclusion: Conclusion: A substantial proportion of patients who received naloxone did not have a confirmed history of an opioid overdose. These patients closely resembled those with a confirmed history with respect to demographics and physical characteristics. The primary difference was a lower proportion of patients with no confirmed history who achieved a post naloxone GCS 10. Despite a moderate development of post naloxone agitation, paramedics were able to manage most of these patients without the use of physical/chemical restraints.
Gravitational interactions allow one to investigate the nature of matter in the universe independent of the properties that make it luminous. Much as studies of the dynamics of galaxies and clusters of galaxies have indicated the presence of dark matter, gravitational lensing provides an independent probe of the large scale distribution of dark matter in the universe.
Our understanding of the complex relationship between schizophrenia symptomatology and etiological factors can be improved by studying brain-based correlates of schizophrenia. Research showed that impairments in value processing and executive functioning, which have been associated with prefrontal brain areas [particularly the medial orbitofrontal cortex (MOFC)], are linked to negative symptoms. Here we tested the hypothesis that MOFC thickness is associated with negative symptom severity.
This study included 1985 individuals with schizophrenia from 17 research groups around the world contributing to the ENIGMA Schizophrenia Working Group. Cortical thickness values were obtained from T1-weighted structural brain scans using FreeSurfer. A meta-analysis across sites was conducted over effect sizes from a model predicting cortical thickness by negative symptom score (harmonized Scale for the Assessment of Negative Symptoms or Positive and Negative Syndrome Scale scores).
Meta-analytical results showed that left, but not right, MOFC thickness was significantly associated with negative symptom severity (βstd = −0.075; p = 0.019) after accounting for age, gender, and site. This effect remained significant (p = 0.036) in a model including overall illness severity. Covarying for duration of illness, age of onset, antipsychotic medication or handedness weakened the association of negative symptoms with left MOFC thickness. As part of a secondary analysis including 10 other prefrontal regions further associations in the left lateral orbitofrontal gyrus and pars opercularis emerged.
Using an unusually large cohort and a meta-analytical approach, our findings point towards a link between prefrontal thinning and negative symptom severity in schizophrenia. This finding provides further insight into the relationship between structural brain abnormalities and negative symptoms in schizophrenia.
We describe the performance of the Boolardy Engineering Test Array, the prototype for the Australian Square Kilometre Array Pathfinder telescope. Boolardy Engineering Test Array is the first aperture synthesis radio telescope to use phased array feed technology, giving it the ability to electronically form up to nine dual-polarisation beams. We report the methods developed for forming and measuring the beams, and the adaptations that have been made to the traditional calibration and imaging procedures in order to allow BETA to function as a multi-beam aperture synthesis telescope. We describe the commissioning of the instrument and present details of Boolardy Engineering Test Array’s performance: sensitivity, beam characteristics, polarimetric properties, and image quality. We summarise the astronomical science that it has produced and draw lessons from operating Boolardy Engineering Test Array that will be relevant to the commissioning and operation of the final Australian Square Kilometre Array Path telescope.
From June 15 to 28, 1991 the Compton Gamma-Ray Observatory (CGRO) observed the radio-loud quasar 3C 273. All four CGRO instruments detected radiation from this quasar in their relevant energy range (from 20 keV to 5 GeV). Simultaneous and quasi-simultaneous observations (spanning the time period May 27 – July 25, 1991) by instruments sensitive at other wavelengths have also been obtained. The data from all these observations spanning the frequency range from ∼ 109 Hz to ∼ 1026 Hz were collected and analysed. The resulting energy-density spectrum is shown in the figure below. It shows two maxima, one in the UV, another one at low-energy γ-rays which have nearly the same strength (the corresponding luminosities per decade of frequency for H0 = 60(km/s)/Mpc are 3.2·1046 erg/s and 2.7·1046 erg/s, respectively). A break of the spectrum at low-energy γ-rays is evident. From a detailed analysis a break energy of (2±1.5) MeV could be derived corresponding to a frequency of (4.8±3.6)·1020 Hz. The observed spectral break between X- and γ-rays is ∼ 0.8, much higher than the value of 0.5 predicted by some models. A more detailed paper on this topic is in preparation (Lichti et al.).
Gravitational lens surveys are of cosmological interest because they provide a way to measure the gravitational field of both luminous and dark matter. Many of the other methods used to detect the presence of dark matter, such as studies of galaxy rotation curves and cluster dynamics, require that there be luminous objects in the gravitational field that act as tracers of the mass. This may introduce a selection effect. In constrast, in studies of gravitational lenses, the beacon we observe can be far (at distances of order one thousand Mpc) from the gravitational field. In this paper we describe a VLA survey designed to detect gravitational lensing on sub-arc second and arc second scales. We also present a preliminary result of the radio data: we find that the density of matter in the form of a uniform, comoving number density of 1011 to 1012M⊙ compact objects, luminous or dark, must be substantially less than the critical density.
It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions.
A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined.
Data from 2705 participants across ten RCTs of self-guided web-based interventions for depression were analysed. The multivariate analysis indicated that male gender [relative risk (RR) 1.08], lower educational level (primary education, RR 1.26) and co-morbid anxiety symptoms (RR 1.18) significantly increased the risk of dropping out, while for every additional 4 years of age, the risk of dropping out significantly decreased (RR 0.94).
Dropout can be predicted by several variables and is not randomly distributed. This knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at risk.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
Perennial ryegrass (Lolium perenne L.) cultivars have been developed to express higher levels of leaf water-soluble carbohydrates (WSC), but expression of this ‘high sugar’ trait varies between environments and is likely to be further influenced by the extent of plant re-growth. The herbage WSC concentration and the ratio of WSC to crude protein (WSC : CP) in high sugar cultivars AberMagic and SF Joule were therefore compared with a control cultivar, Arrow, under cool temperate Tasmanian conditions and two defoliation interval treatments. The irrigated cultivars were subjected to defoliation at either the 1·5-leaf or 3-leaf stage of re-growth, and additional components of nutritive value (fibre concentrations and metabolizable energy content) and dry matter (DM) yields were measured throughout a 12-month period (March 2011 to March 2012). The high sugar trait was consistently expressed in AberMagic, which under both the 1·5-leaf and 3-leaf stages defoliation intervals, displayed the highest WSC concentration (mean 194 and 247 mg/g DM, respectively, compared with 153 and 178 mg/g DM for Arrow) and highest WSC : CP ratio (mean 0·74 and 1·29, respectively, compared with 0·58 and 0·85 for Arrow). Defoliation at the 3-leaf stage of regrowth ensured greater expression of the high sugar trait in both AberMagic and SF Joule, as measured by the increase in WSC concentration and WSC : CP ratio as a result of increasing defoliation interval. The strength and consistency of trait expression in AberMagic under the 3-leaf stage defoliation interval warrants further research to investigate its effect on rumen nitrogen (N) partitioning and milk production in this environment.
Structural brain measures are employed as endophenotypes in the search for schizophrenia susceptibility genes. We analyzed two independent structural imaging datasets with voxel-based morphometry and with source-based morphometry, a multivariate, independent components analysis, to determine the stability and heritability of regional gray matter concentration abnormalities in schizophrenia. The samples comprised 209 and 102 patients with schizophrenia and 208 and 96 healthy volunteers, respectively. The second sample additionally included non-ill siblings of participants with and without schizophrenia. A standard voxel-based analysis showed reproducible regional gray matter deficits in the affected participants compared with unrelated, unaffected controls in both datasets: patients showed significant gray matter concentration deficits in cortical frontal, temporal, and insular lobes. Source-based morphometry (SBM) was applied to the gray matter images of the entire sample to determine the effects of diagnosis on networks of covarying structures. The SBM analysis extracted 24 significant sets of covarying regions (components). Four of these components showed significantly lower gray matter concentrations in patients (p < .05). We determined the familiality of the observed SBM components based on 66 sibling pairs (25 discordant for schizophrenia). Two components, one including the medial frontal, insular, inferior frontal, and temporal lobes, and the other including the posterior occipital lobe, showed significant familiality (p < .05). We conclude that structural brain deficits in schizophrenia are replicable, and that SBM can extract unique familial and likely heritable components. SBM provides a useful data reduction technique that can provide measures that may serve as endophenotypes for schizophrenia.
The watermark disease is caused by the bacterium Erwinia salicis. It affects six species of tree willow and of these the white willow (Salix alba) and certain of its varieties are particularly susceptible. Unusually for a bacterial disease, the pathogen only colonises the xylem tissues, which become discoloured as a result. Watermark causes severe losses in S. alba var. caerulea, the cricket bat willow, and in several Dutch clones of S. alba which have been widely planted in that country. Although numerous studies have been made of its epidemiology since the disease was first reported in 1924, the infection process remains clusive. Recent research, much of it unpublished, points to the widespread occurrence of symptomless infection, and the possible role of this in the transmission of disease through the propagating material.
We discuss the preparation and electrical properties of B-doped μc-Si:H thin films prepared by reactive magnetron sputtering in a hydrogen containing ambient. The B-concentration, and hence the dark conductivity, have been varied by controlling the rf power supplied to two sputtering targets, one, of undoped c-Si, and the other of B-doped c-Si. Films deposited from either target alone display dark conductivity activation energies of approximately 0.5 eV due to Fermi level pinning by native donorlike defects and B-doping for samples prepared from the undoped and B-doped targets, respectively. Films deposited by simultaneously sputtering undoped and B-doped targets display activation energies which first increase to approximately 0.7 eV and then decrease as the fraction of power supplied to the B-doped target is increased. For the combination of deposition parameters used, the cross over point between B-compensated, n-type films, and B-doped p-type films occurs for powers of 50 W supplied to the B-doped target and 100 W to the undoped target. B-compensated samples display trends in photoconductive properties essentially identical to results for μc-Si:H samples prepared by remote plasma CVD. However, IR studies indicate that the material shows significant post-deposition oxide formation. TEM studies confirm the existence of a low-density, porous network. Work is underway to optimize the structural aspects of this material.