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Little is known about prescribers’ attitudes regarding clinical nurses and antimicrobial stewardship. We conducted focus groups of prescribers and inquired about attitudes regarding nurses and stewardship. During 6 focus groups, prescribers were receptive to nursing involvement in stewardship activities, but noted structural barriers and knowledge gaps that should be addressed.
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.
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.
Increasing the representation of women in science, technology, engineering, and mathematics (STEM) is one of our nation's most pressing imperatives. As such, there has been increased lay and scholarly attention given to understanding the causes of women's underrepresentation in such fields. These explanations tend to fall into two main groupings: individual-level (i.e., her) explanations and social-structural (i.e., our) explanations. These two perspectives offer different lenses for illuminating the causes of gender inequity in STEM and point to different mechanisms by which to gain gender parity in STEM fields. In this article, we describe these two lenses and provide three examples of how each lens may differentially explain gender inequity in STEM. We argue that the social-structural lens provides a clearer picture of the causes of gender inequity in STEM, including how gaining gender equity in STEM may best be achieved. We then make a call to industrial/organizational psychologists to take a lead in addressing the societal-level causes of gender inequality in STEM.
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.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
Transient storage and erosion of valley fills, or sediment buffering, is a fundamental but poorly quantified process that may significantly bias fluvial sediment budgets and marine archives used for paleoclimatic and tectonic reconstructions. Prolific sediment buffering is now recognized to occur within the mountainous upper Indus River headwaters and is quantified here for the first time using optically stimulated luminescence dating, petrography, detrital zircon U-Pb geochronology, and morphometric analysis to define the timing, provenance, and volumes of prominent valley fills. This study finds that climatically modulated sediment buffering occurs over 103–104 yr time scales and results in biases in sediment compositions and volumes. Increased sediment storage coincides with strong phases of summer monsoon and winter westerlies precipitation over the late Pleistocene (32–25 ka) and mid-Holocene (~8–6 ka), followed by incision and erosion with monsoon weakening. Glacial erosion and periglacial frost-cracking drive sediment production, and monsoonal precipitation mediates sediment evacuation, in contrast to the arid Transhimalaya and monsoonal frontal Himalaya. Plateau interior basins, although volumetrically large, lack transport capacity and are consequently isolated from the modern Indus River drainage. Marginal plateau catchments that both efficiently produce and evacuate sediment may regulate the overall compositions and volumes of exported sediment from the Himalayan rain shadow.
The provision of healthcare education in developing countries is a complex problem that simulation has the potential to help. This study aimed to evaluate the effectiveness of a low-cost ear surgery simulator, the Ear Trainer.
The Ear Trainer was assessed in two low-resource environments in Cambodia and Uganda. Participants were video-recorded performing four specific middle-ear procedures, and blindly scored using a validated measurement tool. Face validity, construct validity and objective learning were assessed.
The Ear Trainer provides a realistic representation of the ear. Construct validity assessment confirmed that experts performed better than novices. Participants displayed improvement in all tasks except foreign body removal, likely because of a ceiling effect.
This study validates the Ear Trainer as a useful training tool for otological microsurgical skills in developing world settings.
We describe a versatile array controller developed at RAL and SAAO. The original concept was due to Waltham, van Breda and Newton (1990). A Transputer-based microcomputer forms the heart of the device.
To achieve their conservation goals individuals, communities and organizations need to acquire a diversity of skills, knowledge and information (i.e. capacity). Despite current efforts to build and maintain appropriate levels of conservation capacity, it has been recognized that there will need to be a significant scaling-up of these activities in sub-Saharan Africa. This is because of the rapid increase in the number and extent of environmental problems in the region. We present a range of socio-economic contexts relevant to four key areas of African conservation capacity building: protected area management, community engagement, effective leadership, and professional e-learning. Under these core themes, 39 specific recommendations are presented. These were derived from multi-stakeholder workshop discussions at an international conference held in Nairobi, Kenya, in 2015. At the meeting 185 delegates (practitioners, scientists, community groups and government agencies) represented 105 organizations from 24 African nations and eight non-African nations. The 39 recommendations constituted six broad types of suggested action: (1) the development of new methods, (2) the provision of capacity building resources (e.g. information or data), (3) the communication of ideas or examples of successful initiatives, (4) the implementation of new research or gap analyses, (5) the establishment of new structures within and between organizations, and (6) the development of new partnerships. A number of cross-cutting issues also emerged from the discussions: the need for a greater sense of urgency in developing capacity building activities; the need to develop novel capacity building methodologies; and the need to move away from one-size-fits-all approaches.
There is increasing interest in the use of additive manufacturing (AM) for Ni-based superalloys due to their various applications in the aerospace and power-generation sectors. Ni-based superalloys are known to have a complex chemistry, with over a dozen alloying elements in most alloys, enabling them to achieve outstanding high-temperature mechanical performance as well as oxidation resistance when processed using conventional routes (e.g., casting and forging). Nonetheless, this complex chemistry results in the formation of various phases that could affect their processability using AM, resulting in cracking. Furthermore, due to the directional solidification and rapid cooling associated with AM processes, the alloys experience significant anisotropy due to the epitaxially grown microstructure, as well as the residual stresses that can sometimes be difficult to mitigate using thermal postprocessing techniques. This article highlights the outstanding issues in Ni-based superalloys AM processing, with special emphasis on defect formation mechanisms, process optimization, and residual stress development.
A satisfactory understanding of the origin of the dependence of galaxy properties on their environment has remained, so far, out of reach. In the light of numerous observational results and substantial theoretical progress obtained for clusters of galaxies in the last few years, a primary goal is to understand how the star formation activity depends on cluster substructure, i.e. on the merging/accretion history of a cluster. In this contribution we present a case in which it is possible to identify the cluster environment, and in particular the intracluster medium and the recent infall history of galaxies onto the cluster, as the cause for an abrupt change in the star formation histories of a subset of galaxies in the Coma cluster.
Impulse control disorders (ICDs) have become a widely recognized non-motor complication of Parkinson's disease (PD) in patients taking dopamine replacement therapy (DRT). There are no current evidence-based recommendations for their treatment, other than reducing their dopaminergic medication.
This study reviews the current literature of the treatment of ICDs including pharmacological treatments, deep brain stimulation, and psychotherapeutic interventions.
Dopamine agonist withdrawal is the most common and effective treatment, but may lead to an aversive withdrawal syndrome or motor symptom degeneration in some individuals. There is insufficient evidence for all other pharmacological treatments in treating ICDs in PD, including amantadine, serotonin selective reuptake inhibitors, antipsychotics, anticonvulsants, and opioid antagonists (e.g. naltrexone). Large randomized control trials need to be performed before these drugs can be routinely used for the treatment of ICDs in PD. Deep brain stimulation remains equivocal because ICD symptoms resolve in some patients after surgery but may appear de novo in others. Cognitive behavioral therapy has been shown to improve ICD symptoms in the only published study, although further research is urgently needed.
Further research will allow for the development of evidence-based guidelines for the management of ICDs in PD.
We present an investigation of the halo dynamics of M31 using planetary nebulae velocities. We have performed on-band [OIII] and off-band continuum imaging for a 3.6 square degree area centred on M31 and follow-up spectroscopy for over 600 planetary nebulae candidates. In the future the halo mass will be measured and the mass distribution and velocity anisotropy will be constrained as a function of radius.
We observed three 0.44 square degree fields centered on the Coma cluster center (Coma-1), about 1 degree SW of the Coma center (Coma-3), and on a control field in SA57 with the mosaic CCD camera at the prime focus of the 4.2-m William Herschel Telescope. We detected 5628, 5020, and 4323 galaxies down to R = 22 mag in Coma-1, Coma-3, and SA57 fields, respectively. We measure the magnitude and color within the variable aperture r90 in which about 90% of the total flux is included. The histograms of (B–R) colors of galaxies are made for four magnitude bins of width ΔR = 2 mag covering 13 < R < 21 mag for each of the three fields. The mean colors and the 1σ scatters of the Coma galaxies are obtained by a histogram subtraction technique (Coma-1/3 minus SA57). We find a very shallow slope of the color-magnitude relation (CMR), Δ(B–R)/ΔR=−0.0037, which indicates nearly a constant (B–R) color over 6 magnitude in 15 < R < 21 mag (−19.5 < MR < −13.5 at Coma cluster). Dwarf galaxies are dominant in this magnitude range, and we conclude that the mean color of dwarf galaxies in the Coma clusters is nearly constant at (B–R) ∼ 1.6–1.7, which is similar to the color of the faint end of giant elliptical galaxies.
The red variables whose amplitude is larger than 1.3 mag in the MOA database are studied for the LMC. Among 3 196 such stars, 532 stars are likely to be Miras or red semiregular variables. The period–colour relation of these stars is shown.
A large database of CCD photometry for 1.4 million stars towards both the LMC and the SMC, which has been established by the MOA project, is a useful resource to study variable stars. In our preliminary study, variables identified as β Lyrae type stars and Herbig Ae/Be stars have been found amongst blue stars.