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Hala Sultan Tekke is a large Bronze Age city located on the southeastern littoral of Cyprus. The city flourished from approximately 1650 BC to 1150 BC according to the archaeological evidence. Since 2010, Swedish excavations have exposed four new city quarters (CQ1–4) with three occupational phases, the 14C dating of which is of highest importance also for other contemporaneous cultures. The finds demonstrate vast intercultural connections in the Mediterranean and even with southern Scandinavia. In 2014, roughly 500 m to the east of CQ1, one of the richest cemeteries on the island was discovered. According to the archaeological evidence, the finds from the city date mainly to the 13th and 12th centuries BC. However, many of the wealthy tombs and the offering pits from the cemetery are considerably older with the oldest finds dating to the 16th century BC. This raises the question where the city quarters belonging to the oldest finds from the cemetery are situated. The radiocarbon (14C) dates from Hala Sultan Tekke have much influence on the dating of related sites because of numerous imports from a vast area. We present here new 14C data obtained in the course of the current excavations, which add to sets of already existing data.
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.
After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.
Thin hole transport layers are important elements in organic semiconductor-based devices. Metal oxides are an encouraging material class for this purpose, as they may provide sufficient hole conduction in combination with excellent electron blocking properties. Both, long-term device stability, which may often be limited by the thermal stability of interfaces, and higher temperature processing steps, benefit strongly from the existence of thermally stable metal oxide interlayers. Provided that thermally stable electrodes can be fashioned, the stability of organic active layers—for example, in organic field effect transistors, light emitting diodes, or photovoltaic (OPV) devices can be investigated. Here, we apply this concept and report about the study of hole mobility (µh) in single-carrier-hole-only devices in dependence of thermal annealing up to the above the actual melting temperature of regio-regular poly(3-hexylthiophene-2,5-diyl) (P3HT).
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.
This study uses two novel archaeobotanical techniques – crop carbon and nitrogen isotope analysis and functional weed ecology – to determine directly how the intensity of agricultural practice changed from the Neolithic to the Early Iron Age in south-west Germany, with the emergence of fortified hilltop settlements (Fürstensitze or chiefly seats) regarded as the first urban centres in central Europe. The crop isotope and functional weed ecological evidence suggest that surplus cereal production in the Early Iron Age was achieved through sustained use of manure combined with expansion in arable cultivation, both developments that are connected with more widespread use of animal traction. The increased scale of cultivation is broadly apparent across rural as well as fortified hilltop centres in the Early Iron Age, and considerable variability in manuring intensity is consistent with agricultural decision-making at a local level rather than centralised control. Additionally, the more intensive manuring of hulled six-row barley, used in beer production, demonstrates that the political importance of drinking and feasting in Early Iron Age society was reflected in crop husbandry practices. In terms of animal husbandry, faunal isotope data reveal a radical decrease in forest cover, potentially reflecting an expansion in the scale of herding accompanying that of arable cultivation. Site-specific patterning points to a range of herding strategies, from specialised herding of cattle at the Heuneburg to generalised patterns of livestock management at rural sites.
Little is known about the Endangered Grevy's zebra Equus grevyi in far northern Kenya, where the species exists in small, isolated populations at the periphery of its range. Understanding the threats facing this species is a prerequisite for effective conservation planning but its rarity makes obtaining accurate information challenging. We set out to establish the current status of, and attitudes towards, Grevy's zebra in northern Kenya using local knowledge as the primary source of information. Pastoralists perceived Grevy's zebra to be in decline as a result of drought, lack of pasture and water, and hunting for consumptive use. There was also evidence of competition with livestock. Attitudes towards Grevy's zebra were predominantly positive, influenced by a range of perceived benefits of living alongside the species, and an absence of severe costs. Coupled with evidence of local conservation efforts in several locations, this is a positive starting point for community-based conservation.
New trends in crop breeding include analytical approaches to identify metabolic fingerprints that can be used for associations to the genetic background. The biochemical phenotype, as a result of plant endogenous factors and interaction with the environment, has the potential to increase the accuracy of forecasting regarding agronomical quality factors. In this study a metabolite profile analysis by gas chromatography–mass spectrometry (GC–MS) was conducted on sets of seed material from sugar beet. One set represented high-performing varieties with a close genetic background and with a similar quality in terms of germination capacity. The second set contained seed lots from different genotypes comprising different germination capacities. By multivariate statistical analyses high variance in both sample sets was revealed. These data were further allocated to corresponding metabolite classes. It could be shown that an untargeted GC–MS approach has the power to resolve differences in the molecular phenotypes of related offspring lines. Metabolic profiles were found to correlate more to genotypic differences than to differences in the germination capacity.
Excess accumulation of visceral adipose tissue (VAT) is a known risk factor for cardiometabolic diseases; further, subcutaneous abdominal adipose tissue (SAAT) and the ratio of both (VAT:SAAT ratio) have been discussed as potentially detrimental. Information about the association between diet and adipose tissue is scarce. This study aimed to identify food group intake associated with VAT and SAAT and the VAT:SAAT ratio in a Northern German population. A cross-sectional analysis was conducted in 344 men and 241 women who underwent an MRI to quantify total volumes of VAT and SAAT. Intake of fourteen food groups was assessed with a self-administered 112-item FFQ. Linear regression models adjusted for age, sex, energy intake, physical activity, intake of other food groups and mutual adjustment for VAT and SAAT were calculated to analyse the associations between standardised food group intake and VAT and SAAT, or the VAT:SAAT ratio. Intakes of potatoes (P=0·043) and cakes (P=0·003) were positively and inversely, respectively, associated with both VAT and SAAT. By contrast, intake of cereals was negatively associated with VAT (P=0·045) only, whereas intakes of eggs (P=0·006) and non-alcoholic beverages (P=0·042) were positively associated with SAAT only. The association between eggs and non-alcoholic beverages with SAAT remained significant after further consideration of VAT. Intake of non-alcoholic beverages was also inversely associated with the VAT:SAAT ratio (P=0·001). Our analysis adds to the evidence that intake of foods is independently associated with VAT or SAAT volumes.
Borderline personality disorder is associated with deficits in personality functioning and mentalisation. In a randomised controlled trial 104 people with borderline personality disorder received either transference-focused psychotherapy (TFP) or treatment by experienced community therapists. Among other outcome variables, mentalisation was assessed by means of the Reflective Functioning Scale (RF Scale). Findings revealed only significant improvements in reflective function in the TFP group within 1 year of treatment. The between-group effect was of medium size (d = 0.45). Improvements in reflective function were significantly correlated with improvements in personality organisation.
A total of 90 cows from three commercial farms were used to evaluate the relationship between subclinical mastitis and clinical mastitis and thermal nociceptive threshold. Milk strips from all udder quarters were tested for clinical mastitis with visual inspection of milk and udder alterations and for subclinical mastitis using California Mastitis Test. Milk yield was recorded, milk was sampled and further analyzed for somatic cells count (SCC). Cows were considered healthy when SCC<200 000 cells/ml and no visual alterations in milk and/or udder, with mild subclinical mastitis when SCC>200 000 cells/ml and no visual alterations in milk and/or udder, with moderate subclinical mastitis when SCC>500 000 cells/ml and no visual alterations in milk and/or udder and with clinical mastitis when visual alterations in milk and/or udder were detected. Nociceptive threshold was evaluated with the thermal threshold meter apparatus applied to the rear legs. Thermal threshold (TT) decreased when we compared healthy cows with cows presenting clinical mastitis and tended to decrease when we compare healthy cows with those with moderate subclinical mastitis. TT was lower at the ipsilateral rear leg compared with the contralateral leg to the infected mammary gland. TT linearly decreases as log10SCC increased and it showed sharp decrease as log10SCC exceed the value of 6.4. Increase in one unit of log10SCC increased the odds of low thermal threshold (lower than 55.8°C). Subclinical mastitis might be a welfare issue as it tended to decrease nociceptive thermal threshold.
Lacunar stroke is a small (<2 cm) infarction that accounts for approximately 20% of all strokes. While a third of all stroke patients experience depressive symptoms, the prevalence of depression in the lacunar stroke patient population is unclear. This meta-analysis aimed to synthesize the evidence on the effect of lacunar stroke and deep white matter disease on depressive symptoms.
A systematic search of electronic databases was conducted, resulting in the inclusion of 12 studies. Analyses were performed on the effects of lacunar stroke, volume and location of lacunes on depression prevalence, and the effect on depression severity. The effects estimates were calculated in random-effects models.
None of the analyses produced statistically significant results. Lacunar stroke patients had a non-significantly higher prevalence of depression compared to patients with non-lacunar cerebrovascular diseases (OR = 1.46, 95% CI: 0.88–2.43, p = 0.15). Neither thalamic (OR = 1.37 (0.85–2.20), p = 0.19), deep white matter (RR = 1.16 (0.85–1.57), p = 0.35), multiple lacunes (OR = 1.34 (0.81–2.22), p = 0.25), or the volume of lacunes (MD = −4.71 (−351.59–342.18), p = 0.98) had an effect on depression prevalence. Lastly, lacunar stroke did not influence depressive symptom severity (MD = 0.96 (−1.57–3.48), p = 0.46).
The pooled group of patients with lacunar stroke and deep white matter disease appear to have a similar prevalence of depression compared to those with other types of cerebrovascular diseases. However, the small number of studies, heterogeneous comparison groups, and high statistical heterogeneity between studies posed an obstacle to the meta-analysis. To determine appropriate screening and treatment approaches, future research will need to separate lacunar stroke and deep white matter disease patients, and include larger sample sizes and healthy control groups to determine their distinct contributions to depression.
Meta-analyses suggest that reboxetine may be less effective than other antidepressants. Such comparisons may be biased by lower adherence to reboxetine and subsequent handling of missing outcome data. This study illustrates how to adjust for differential non-adherence and hence derive an unbiased estimate of the efficacy of reboxetine compared with citalopram in primary care patients with depression.
A structural mean modelling (SMM) approach was used to generate adherence-adjusted estimates of the efficacy of reboxetine compared with citalopram using GENetic and clinical Predictors Of treatment response in Depression (GENPOD) trial data. Intention-to-treat (ITT) analyses were performed to compare estimates of effectiveness with results from previous meta-analyses.
At 6 weeks, 92% of those randomized to citalopram were still taking their medication, compared with 72% of those randomized to reboxetine. In ITT analysis, there was only weak evidence that those on reboxetine had a slightly worse outcome than those on citalopram [adjusted difference in mean Beck Depression Inventory (BDI) scores: 1.19, 95% confidence interval (CI) –0.52 to 2.90, p = 0.17]. There was no evidence of a difference in efficacy when differential non-adherence was accounted for using the SMM approach for mean BDI (–0.29, 95% CI –3.04 to 2.46, p = 0.84) or the other mental health outcomes.
There was no evidence of a difference in the efficacy of reboxetine and citalopram when these drugs are taken and tolerated by depressed patients. The SMM approach can be implemented in standard statistical software to adjust for differential non-adherence and generate unbiased estimates of treatment efficacy for comparisons of two (or more) active interventions.
In this work, electrochemically recyclable lithium is analyzed as high energy density, large scale storage material for stranded renewable energy in a closed loop. The strongly exothermic reaction of lithium with carbon dioxide (CO2) yields thermal energy directly comparable to the combustion of coal or methane in an oxygen containing atmosphere. The thermal level of the reaction is sufficient for re-electrification in a thermal power plant compatible process.
The reaction of single lithium particles, avoiding particle-particle interactions, is compared to the combustion of atomized lithium spray in a CO2 containing atmosphere. Particle temperatures of up to 4000K were found for the reaction of single lithium particles in a CO2, nitrogen (N2), oxygen (O2) and steam gas mixture. Furthermore the combustion of atomized lithium spray in both dry CO2 atmosphere and CO2/steam gas mixture was analyzed. The identified solid reaction products are lithium carbonate, lithium oxide and lithium hydroxide. The formation of carbon monoxide (CO) as gaseous reaction product is demonstrated. Carbon monoxide is a valuable by-product, which could be converted to methanol or gasoline using hydrogen.