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Multiple genes/variants have been implicated in various epileptic conditions. However, there is little general guidance available on the circumstances in which genetic testing is indicated and test selection in order to guide optimal test appropriateness and benefit. This is an account of the development of guidelines for genetic testing in epilepsy, which have been developed in Ontario, Canada. The Genetic Testing Advisory Committee was established in Ontario to review the clinical utility and validity of genetic tests and the provision of genetic testing in Ontario. As part of their mandate, the committee also developed recommendations and guidelines for genetic testing in epilepsy. The recommendations include mandatory prerequisites for an epileptology/geneticist/clinical biochemical geneticist consultation, prerequisite diagnostic procedures, circumstances in which genetic testing is indicated and not indicated and guidance for selection of genetic tests, including their general limitations and considerations. These guidelines represent a step toward the development of evidence-based gene panels for epilepsy in Ontario, the repatriation of genetic testing for epilepsy into Ontario molecular genetic laboratories and public funding of genetic tests for epilepsy in Ontario.
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.
Prediction of suicidal behaviour is an aspirational goal for clinicians and policy makers; with patients classified as ‘high risk’ to be preferentially allocated treatment. Clinical usefulness requires an adequate positive predictive value (PPV).
To identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours.
A systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours.
For all scales combined, the pooled PPVs were: suicide 5.5% (95% CI 3.9–7.9%), self-harm 26.3% (95% CI 21.8–31.3%) and self-harm plus suicide 35.9% (95% CI 25.8–47.4%). Subanalyses on self-harm found pooled PPVs of 16.1% (95% CI 11.3–22.3%) for high-quality studies, 32.5% (95% CI 26.1–39.6%) for hospital-treated self-harm and 26.8% (95% CI 19.5–35.6%) for psychiatric in-patients.
No ‘high-risk’ classification was clinically useful. Prevalence imposes a ceiling on PPV. Treatment should reduce exposure to modifiable risk factors and offer effective interventions for selected subpopulations and unselected clinical populations.
It is increasingly essential for medical researchers to be literate in statistics, but the requisite degree of literacy is not the same for every statistical competency in translational research. Statistical competency can range from ‘fundamental’ (necessary for all) to ‘specialized’ (necessary for only some). In this study, we determine the degree to which each competency is fundamental or specialized.
We surveyed members of 4 professional organizations, targeting doctorally trained biostatisticians and epidemiologists who taught statistics to medical research learners in the past 5 years. Respondents rated 24 educational competencies on a 5-point Likert scale anchored by ‘fundamental’ and ‘specialized.’
There were 112 responses. Nineteen of 24 competencies were fundamental. The competencies considered most fundamental were assessing sources of bias and variation (95%), recognizing one’s own limits with regard to statistics (93%), identifying the strengths, and limitations of study designs (93%). The least endorsed items were meta-analysis (34%) and stopping rules (18%).
We have identified the statistical competencies needed by all medical researchers. These competencies should be considered when designing statistical curricula for medical researchers and should inform which topics are taught in graduate programs and evidence-based medicine courses where learners need to read and understand the medical research literature.
Jubal (1956) is one of three Westerns that Delmer Daves made in successive years with actor Glenn Ford, the two others being 3:10 to Yuma (1957) and Cowboy (1958). As with most of Daves’ cinematic output, there has thus far been little academic writing on Jubal. This is a point well made by Kent Jones who, in one of his two introductory essays accompanying the 2013 Criterion Blu-Ray releases of 3: /10 and Jubal, writes: “Many of Delmer Daves’ films are beloved, but to say that he remains a misunderstood and insufficiently appreciated figure in the history of American movies is a rank understatement.” Despite his having directed two of the most celebrated Westerns of the so called “classical” era—in addition to 3:10, there is Broken Arrow (1950)—and despite his work across multiple genres, the film theorists who championed the talents of his contemporaries have somehow not awarded Daves the status of auteur. Whilst the likes of Anthony Mann, John Ford, and Howard Hawks are often among those most-praised, particularly as directors of Westerns, auteur theory seems to have passed Delmer Daves by. As Jones puts it, Daves “could be counted as one of its casualties.” Frankly, Daves’ reputation as one of the great directors of Hollywood Westerns could be cemented by Broken Arrow alone. However, what strikes one upon several viewings of his lesser-regarded Jubal are not its Western credentials (although these are clearly in evidence) but its relation to other classical-era Hollywood genres and styles. In particular, it is notable how farJubal's narrative is affected by film noir.
It is often said that through its most notorious trope, the femme fatale, the style of film noir presented a challenge to the dominant ideological values expressed by Hollywood: the male protagonist as hero, the heterosexual, monogamous couple, the family unit as social ideal, and, in particular, to the typically passive roles assigned female characters. On the other hand, it is thought that Westerns (along with other established Hollywood genres) are generally supportive of these values. Beyond celebrating frontier mythology through the “domestication of the wilderness,” the Western is understood to have championed male agency whilst reducing the role of the female in the narrative to that of a virtual cipher.
As the first comprehensive study of Daves's career, this collection of essays seeks to deepen our understanding of his work, and also to problematize existing conceptions of him as a competent, conventional and even naïve studio man.
I much prefer the audience not to know that there's a director. That's my general thesis in regard to directing.
Delmer Daves is the property of those who can enjoy stylistic conviction in an intellectual vacuum. The movies of Delmer Daves are fun of a very special kind. Call it Camp or call it Corn. The director does not so much transcend his material as mingle with it.
Andrew Sarris, The American Cinema
American critics have never taken Delmer Daves seriously, and the way things look, they probably never will.
Jean-Pierre Coursodon, American Directors
It is tempting, in introducing a book of this nature, to declare at the outset something like, “Delmer Daves is the best filmmaker you've never heard of!” Alas, we cannot resort to such rhetoric—not because Delmer Daves is not a great, critically overlooked filmmaker, but because you likely have heard of him. Daves is remembered principally as a maker of Westerns, and of two Westerns in particular: Broken Arrow (1950) and 3:10 to Yuma (1957). The former, about an Army scout who brokers a peace treaty between the American government and the Chiricahua Apache, offered viewers a comparatively nuanced, sympathetic depiction of Native American culture, and in so doing helped to transform how American Indians are represented in cinema. The latter, a stylish, psychological frontier drama about a poor farmer who agrees to help escort a dangerous outlaw to the train that will take him to prison, is frequently considered among the best Westerns of the 1950s, and was even subject to a high-profile remake in 2007. As these synopses suggest, however, Broken Arrow and 3:10 to Yuma are quite different films, and are remembered for different reasons: the former for its sociocultural significance, the latter for its style. This perceived difference, it turns out, matters a great deal.
Making the jump from discussing individual films to discussing filmmakers normally requires us to detect consistency, not difference. Identifying recurring features of style or theme across multiple films implies the underlying presence of an impelling, organizing personality: an artist who imbues his work with his own vision of the world.