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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.
Deep brain stimulation (DBS) is an effective treatment for the motor symptoms of Parkinson’s disease (PD). The lived experience of people with PD suggests a process of adjustment follows. This study aimed to explore the adjustment and associated education and support needs of people with PD undergoing DBS and their family members across the continuum of the DBS experience.
A structured qualitative description study including semi-structured interviews with people with PD (n = 14), family members (n = 10) and clinicians (n = 11) was conducted to explore lived experiences, needs, perspectives and clinical considerations. Inductive analysis indicated common temporal stages related to undergoing DBS, and the related experiences and needs were mapped.
Four stages, each with unique needs, emerged: Considering DBS involved needs for peer-based education and realistic, meaningful goal setting; Surgery and Support shifted to clinical support related to the surgery and support for the person and their family around immediate changes experienced; Seeking Stability focused on timely clinical and practical support for the person and family around new changes and challenges to symptoms, behaviours and roles; and Next Steps involved direction and support for reengagement in the self-management of the condition, and current and future changes related to PD.
All participants with PD and their family members in this study indicated that overall their experiences with DBS had led to positive changes in their symptoms and lives. Consideration of different needs at different times in the process may be applied within clinical practice to support adjustment.
Intrauterine myocardial infarction is a rare and frequently fatal diagnosis. It has been presented in the literature only as case reports and short series. We present a case report of a coronary occlusive intrauterine myocardial infarction and survival and present a systematic review of the literature. This is the first summative description of current data on intrauterine and perinatal myocardial infarction. We performed the systematic review based on the guidelines established by the PRISMA statement. Our population of intrauterine and perinatal myocardial infarction included published cases who presented as a live birth within the first 28 postnatal days, and had a diagnosis of myocardial infarction. We conducted descriptive statistics and regression analysis on short-term mortality as the primary outcome. After applying exclusion criteria we described 84 individual cases of myocardial infarction from 63 full-text articles including our own case. Presentation within the first 12 hours was associated with mortality (OR 3.90, p=0.004). Treatment modalities were varied and inconsistently recorded. The aetiologies and comorbidities are varied in our systematic review. We would have a low threshold to perform viral testing, consider anticoagulation early and coronary imaging if feasible. The use of extracorporeal membranous oxygenation may serve as a bridge to cardiac recovery.
The expanding volume of publications on Buddhism in America in the last two and a half decades bears witness to the emergence of an exciting new subfield within American religion, on the one hand, and within Buddhist studies, on the other. For Americanists, it reflects a growing recognition of the ways in which non-Western religions are altering the American religious landscape. As such, it is part of an emerging awareness of the increasingly pluralistic and multicultural nature of American society at the turn of the millennium. For Buddhologists, the spread of Buddhism in America opens a new chapter in the long history of the geographical and cultural diffusion of the religion since its founding in India some 2,500 years ago. This new subfield thus holds the prospect of studying what promises to be a momentous development in the history of Buddhism, and it affords an opportunity to study the acculturation of the tradition as it is actually occurring. Clearly this is a field where both Americanists and Buddhologists have much to contribute and much to learn from one another.
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.
Self-related constructs feature prominently in cognitive models of both social anxiety and depression. However, few studies have simultaneously investigated the unique relationship between self-related constructs and social anxiety and depression, while also controlling for the association between the two variables. In the present study, 522 undergraduate students completed measures of maladaptive self-beliefs, self-esteem, self-criticism, self-focused attention, self-concept clarity, social comparison, and social anxiety and depression. Bivariate correlations demonstrated that self-related constructs not only significantly correlated with social anxiety but also with depression and other self-variables. When entered simultaneously, multiple regression analyses indicated that maladaptive self-beliefs were uniquely and positively associated with social anxiety and depression, while self-esteem and self-concept clarity were uniquely and negatively associated with social anxiety and depression. A unique positive association between private self-consciousness and depression was also found. Maladaptive self-beliefs and self-esteem were the constructs most strongly associated with social anxiety and depression respectively. These findings underscore the importance of a negative self-concept even in subclinical presentations and suggest that several key self-related constructs may represent transdiagnostic vulnerability factors linking social anxiety and depression. Future research should continue to uncover unique relationships between self-related variables and social anxiety and depression in both clinical and non-clinical samples.
Despite significant needs, patients with chronic obstructive pulmonary disease (COPD) make limited use of palliative care, in part because the current models of palliative care do not address their key concerns.
Our aim was to develop a tailored model of palliative care for patients with COPD and their family caregivers.
Based on information gathered within a program of studies (qualitative research exploring experiences, a cohort study examining service use), an expert advisory committee evaluated and integrated data, developed responses, formulated principles to inform care, and made recommendations for practice. The informing studies were conducted in two Australian states: Victoria and South Australia.
A series of principles underpinning the model were developed, including that it must be: (1) focused on patient and caregiver; (2) equitable, enabling access to components of palliative care for a group with significant needs; (3) accessible; and (4) less resource-intensive than expansion of usual palliative care service delivery. The recommended conceptual model was to have the following features: (a) entry to palliative care occurs routinely triggered by clinical transitions in care; (b) care is embedded in routine ambulatory respiratory care, ensuring that it is regarded as “usual” care by patients and clinicians alike; (c) the tasks include screening for physical and psychological symptoms, social and community support, provision of information, and discussions around goals and preferences for care; and (d) transition to usual palliative care services is facilitated as the patient nears death.
Significance of results:
Our proposed innovative and conceptual model for provision of palliative care requires future formal testing using rigorous mixed-methods approaches to determine if theoretical propositions translate into effectiveness, feasibility, and benefits (including economic benefits). There is reason to consider adaptation of the model for the palliative care of patients with other nonmalignant conditions.
We consider the question “Is every nonzero generic degree a density-1-bounding generic degree?” By previous results  either resolution of this question would answer an open question concerning the structure of the generic degrees: A positive result would prove that there are no minimal generic degrees, and a negative result would prove that there exist minimal pairs in the generic degrees.
We consider several techniques for showing that the answer might be positive, and use those techniques to prove that a wide class of assumptions is sufficient to prove density-1-bounding.
We also consider a historic difficulty in constructing a potential counterexample: By previous results  any generic degree that is not density-1-bounding must be quasiminimal, so in particular, any construction of a non-density-1-bounding generic degree must use a method that is able to construct a quasiminimal generic degree. However, all previously known examples of quasiminimal sets are also density-1, and so trivially density-1-bounding. We provide several examples of non-density-1 sets that are quasiminimal.
Using cofinite and mod-finite reducibility, we extend our results to the uniform coarse degrees, and to the nonuniform generic degrees. We define all of the above terms, and we provide independent motivation for the study of each of them.
Combined with a concurrently written paper of Hirschfeldt, Jockusch, Kuyper, and Schupp , this paper provides a characterization of the level of randomness required to ensure quasiminimality in the uniform and nonuniform coarse and generic degrees.
Infants and young children are frequently colonized with C. difficile but rarely have symptomatic disease. However, C. difficile testing remains prevalent in this age group.
To design a computerized provider order entry (CPOE) alert to decrease testing for C. difficile in young children and infants.
An interventional age-targeted before-after trial with comparison group
Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, Tennessee.
All children seen in the inpatient or emergency room settings from July 2012 through July 2013 (pre-CPOE alert) and September 2013 through September 2014 (post-CPOE alert)
In August of 2013, we implemented a CPOE alert advising against testing in infants and young children based on the American Academy of Pediatrics recommendations with an optional override. We further offered healthcare providers educational seminars regarding recommended C. difficile testing.
The average monthly testing rate significantly decreased after the CPOE alert for children 0–11 months old (11.5 pre-alert vs 0 post-alert per 10,000 patient days; P<.001) and 12–35 months old (61.6 pre-alert vs 30.1 post-alert per 10,000 patients days; P<.001), but not for those children ≥36 months old (50.9 pre-alert vs 46.4 post-alert per 10,000 patient days; P=.3) who were not targeted with a CPOE alert. There were no complications in those children who testing positive for C. difficile.
The average monthly testing rate for C. difficile for children <35 months old decreased without complication after the use of a CPOE alert in those who tested positive for C. difficile.
While kept at the Rockefeller Museum in East Jerusalem, many Dead Sea Scroll fragments were exposed to castor oil by the original team of editors in the course of cleaning the parchments. Castor oil must be regarded as a serious contaminant in relation to radiocarbon dating. If modern castor oil is present and is not removed prior to dating, the 14C dates will be skewed artificially towards modern values. In Rasmussen et al. (2001), it was shown that the standard AAA pretreatment procedure used in the 2 previous studies dating Dead Sea Scroll samples (Bonani et al. 1992; Jull et al. 1995) is not capable of removing castor oil from parchment samples. In the present work, we show that it is unlikely that castor oil reacts with the amino acids of the parchment proteins, a finding which leaves open the possibility of devising a cleaning method that can effectively remove castor oil. We then present 3 different pretreatment protocols designed to effectively remove castor oil from parchment samples. These involve 3 different cleaning techniques: extraction with supercritical CO2, ultrasound cleaning, and Soxhlet extraction—each with their own advantages and disadvantages. Our data show that the protocol involving Soxhlet extraction is the best suited for the purpose of decontaminating the Dead Sea Scrolls, and we recommend that this protocol be used in further attempts to 14C date the Dead Sea Scrolls. If such an attempt is decided on by the proper authorities, we propose a list of Scroll texts, which we suggest be redated in order to validate the 14C dates done earlier by Bonani et al. (1992) and Jull et al. (1995).
The human circadian system anticipates and adapts to daily environmental changes to optimise behaviour according to time of day and temporally partitions incompatible physiological processes. At the helm of this system is a master clock in the suprachiasmatic nuclei (SCN) of the anterior hypothalamus. The SCN are primarily synchronised to the 24-h day by the light/dark cycle; however, feeding/fasting cycles are the primary time cues for clocks in peripheral tissues. Aligning feeding/fasting cycles with clock-regulated metabolic changes optimises metabolism, and studies of other animals suggest that feeding at inappropriate times disrupts circadian system organisation, and thereby contributes to adverse metabolic consequences and chronic disease development. ‘High-fat diets’ (HFD) produce particularly deleterious effects on circadian system organisation in rodents by blunting feeding/fasting cycles. Time-of-day-restricted feeding, where food availability is restricted to a period of several hours, offsets many adverse consequences of HFD in these animals; however, further evidence is required to assess whether the same is true in humans. Several nutritional compounds have robust effects on the circadian system. Caffeine, for example, can speed synchronisation to new time zones after jetlag. An appreciation of the circadian system has many implications for nutritional science and may ultimately help reduce the burden of chronic diseases.
Leaf mass per area (MA) is a central ecological trait that is intercorrelated with leaf life span, photosynthetic rate, nutrient concentration, and palatability to herbivores. These coordinated variables form a globally convergent leaf economics spectrum, which represents a general continuum running from rapid resource acquisition to maximized resource retention. Leaf economics are little studied in ancient ecosystems because they cannot be directly measured from leaf fossils. Here we use a large extant data set (65 sites; 667 species-site pairs) to develop a new, easily measured scaling relationship between petiole width and leaf mass, normalized for leaf area; this enables MA estimation for fossil leaves from petiole width and leaf area, two variables that are commonly measurable in leaf compression floras. The calibration data are restricted to woody angiosperms exclusive of monocots, but a preliminary data set (25 species) suggests that broad-leaved gymnosperms exhibit a similar scaling. Application to two well-studied, classic Eocene floras demonstrates that MA can be quantified in fossil assemblages. First, our results are consistent with predictions from paleobotanical and paleoclimatic studies of these floras. We found exclusively low-MA species from Republic (Washington, U.S.A., 49 Ma), a humid, warm-temperate flora with a strong deciduous component among the angiosperms, and a wide MA range in a seasonally dry, warm-temperate flora from the Green River Formation at Bonanza (Utah, U.S.A., 47 Ma), presumed to comprise a mix of short and long leaf life spans. Second, reconstructed MA in the fossil species is negatively correlated with levels of insect herbivory, whether measured as the proportion of leaves with insect damage, the proportion of leaf area removed by herbivores, or the diversity of insect-damage morphotypes. These correlations are consistent with herbivory observations in extant floras and they reflect fundamental trade-offs in plant-herbivore associations. Our results indicate that several key aspects of plant and plant-animal ecology can now be quantified in the fossil record and demonstrate that herbivory has helped shape the evolution of leaf structure for millions of years.
In this work, we propose a model to quantify strain induced conductor
discontinuities based on measuring electrical resistance while applying tensile
strain to metal-polymer systems. Under strain, changing conductor geometry and
induced conductor discontinuity increase electrical resistance. On Kapton
substrates strained to ε = .07, evaporated gold films did not
deform and resistance increase was only caused by geometry change. Conversely,
discontinuity caused 31% and 72% of the resistance increase in evaporated and
printed silver films at the same strain. On PDMS substrates, the same magnitude
of discontinuity, causing 31% of the resistance increase, occurred at only
ε = .024 in evaporated silver films. At the same strain,
discontinuity caused 86% of the resistance increase in evaporated gold films.
Printed silver films were inelastic. The results suggest that traditional
fabrication techniques may be more suitable to flexible hybrid electronics
applications than additively manufactured conductors.