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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.
The Upper Cretaceous Kanguk Formation of the Sverdrup Basin, Canadian Arctic Islands, contains numerous diagenetically altered volcanic ash layers (bentonites). Eleven bentonites were sampled from an outcrop section on Ellesmere Island for U–Pb zircon secondary ion mass spectrometry dating and whole-rock geochemical analysis. Two distinct types of bentonite are identified from the geochemical data. Relatively thick (0.1 to 5 m) peralkaline rhyolitic to trachytic bentonites erupted in an intraplate tectonic setting. These occur throughout the upper Turonian to lower Campanian (c. 92–83 Ma) outcrop section and are likely associated with the alkaline phase of the High Arctic Large Igneous Province. Two thinner (<5 cm) subalkaline dacitic to rhyolitic bentonites of late Turonian to early Coniacian age (c. 90–88 Ma) are also identified. The geochemistry of these bentonites is consistent with derivation from volcanoes within an active continental margin tectonic setting. The lack of nearby potential sources of subalkaline magmatism, together with the thinner bed thickness of the subalkaline bentonites and the small size of zircon phenocrysts therein (typically 50–80 μm in length) are consistent with a more distal source area. The zircon U–Pb age and whole-rock geochemistry of these two subalkaline bentonites correlate with an interval of intense volcanism in the Okhotsk–Chukotka Volcanic Belt, Russia. It is proposed that during late Turonian to early Coniacian times intense volcanism within the Okhotsk–Chukotka Volcanic Belt resulted in widespread volcanic ash dispersal across Arctic Alaska and Canada, reaching as far east as the Sverdrup Basin, more than 3000 km away.
Depression is associated with increased mortality, however, little is known about its variation by ethnicity.
We conducted a cohort study of individuals with ICD-10 unipolar depression from secondary mental healthcare, from an ethnically diverse location in southeast London, followed for 8 years (2007–2014) linked to death certificates. Age- and sex- standardised mortality ratios (SMRs), with the population of England and Wales as a standard population were derived. Hazard ratios (HRs) for mortality were derived through multivariable regression procedures.
Data from 20 320 individuals contributing 91 635 person-years at risk with 2366 deaths were used for analyses. SMR for all-cause mortality in depression was 2.55(95% CI 2.45–2.65), with similar trends by ethnicity. Within the cohort with unipolar depression, adjusted HR (aHRs) for all-cause mortality in ethnic minority groups relative to the White British group were 0.62(95% CI 0.53–0.74) (Black Caribbean), 0.53(95% CI 0.39–0.72) (Black African) and 0.69(95% CI 0.52–0.90) (South Asian). Male sex and alcohol/substance misuse were associated with an increased all-cause mortality risk [aHR:1.94 (95% CI 1.68–2.24) and aHR:1.18 (95% CI 1.01–1.37) respectively], whereas comorbid anxiety was associated with a decreased risk [aHR: 0.72(95% CI 0.58–0.89)]. Similar associations were noted for natural-cause mortality. Alcohol/substance misuse and male sex were associated with a near-doubling in unnatural-cause mortality risk, whereas Black Caribbean individuals with depression had a reduced unnatural-cause mortality risk, relative to White British people with depression.
Although individuals with depression experience an increased mortality risk, marked heterogeneity exists by ethnicity. Research and practice should focus on addressing tractable causes underlying increased mortality in depression.
Antineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined.
To examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive.
Individuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy.
Of 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four.
A small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery.
High-dose vitamin A supplementation (VAS) may affect mortality to infectious diseases in a sex-differential manner. Here, we analysed the long-term immunological effects of neonatal vitamin A supplementation (NVAS) in 247 children, who had been randomly allocated to 50 000 or 25 000 IU vitamin A (15mg and 7·5mg retinol equivalents, respectively) or placebo at birth. At 4–6 months of age, we assessed bacille Calmette–Guérin (BCG) scarification, and we analysed in vitro responses of TNF-α, IL-5, IL-10, IL-13 and IFN-γ in whole blood stimulations to phytohaemagglutinin (PHA), purified protein derivative (PPD), tetanus toxoid and lipopolysaccharide. There were no differences between the two doses of NVAS, and thus they were analysed combined as NVAS (any dose) v. placebo. All analyses were performed unstratified and by sex. NVAS increased the chance of having a scar after BCG vaccination in females (NVAS v. placebo: 96 v. 71 %, proportion ratio: 1·24; 95 % CI 1·09, 1·42), but not in males (Pfor interaction=0·012). NVAS was associated with significant sex-differential effects on the pro- to anti-inflammatory cytokine ratios (TNF-α:IL-10) to PPD, tetanus toxoid and medium alone, which were increased in females but decreased in males. In addition, IL-17 responses tended to be increased in NVAS v. placebo recipients in males but not in females, significantly so for the PHA stimulation. The study corroborates sex-differential effects of VAS on the immune system, emphasising the importance of analysing VAS effects by sex.
Channels incised into bedrock, or Nye channels, often form an important component of subglacial drainage at temperate glaciers, and their structure exerts control over patterns and rates of (a) channel erosion, (b) water flow-velocity and (c) water pressure. The latter, in turn, exerts a strong control over basal traction and, thus, ice dynamics. In order to investigate these controls, it is necessary to quantify detailed flow processes in subglacial Nye channels. However, it is effectively impossible to acquire such measurements from fully pressurized, subglacial channels. To solve this problem, we here apply a three-dimensional, finite-volume solution of the Reynolds averaged Navier– Stokes (RANS) equations with a one-equation mixing-length turbulence closure to simulate flow in a 3 m long section of an active Nye channel located in the immediate foreground of Glacier de Tsanfleuron, Switzerland. Numerical model output permits high-resolution visualization of water flow through the channel reach, and enables evaluation of the experimental manipulation of the pressure field adopted across the overlying ice lid. This yields an increased theoretical understanding of the hydraulic behaviour of Nye channels, and, in the future, of their effect on glacier drainage, geomorphology and ice dynamics.
Measurements of surface dynamics on polythermal John Evans Glacier, Nunavut, Canada, over two winter periods and every 7–10 days throughout two melt seasons (June–July 2000, 2001) provide new insight into spatio-temporal patterns of High Arctic glacier dynamics. In the lower ablation zone, mean annual surface velocities are 10–21 m a–1, but peak velocities up to 50% higher are attained during late June/early July. In the upper ablation zone and lower accumulation zone, mean annual surface velocities are typically 10–18 m a–1, and peak velocities up to 40% higher occur during late July. In the upper accumulation zone, mean annual surface velocities are 2–9 m a–1, and motion in mid- to late July exceeds this by up to 10%. Rapid drainage of ponded supraglacial water in the upper ablation zone to an initially distributed subglacial drainage system in mid-June may force excess surface motion in the warm-based lower glacier. The data indicate that the duration of the velocity response may be related to the rate of channelization of the basal drainage, and the velocity response may be transmitted up-glacier by longitudinal coupling. An increase in surface velocities in the middle glacier in late July occurs in conjunction with the opening of two further moulins in the accumulation zone.
The surface velocity of a predominantly cold polythermal glacier (John Evans Glacier, Ellesmere Island, Canada) varies significantly on both seasonal and shorter time-scales. Seasonal variations reflect the penetration of supraglacial water to the glacier bed through significant thicknesses of cold ice. Shorter-term events are associated with periods of rapidly increasing water inputs to the subglacial drainage system. Early-season short-term events immediately follow the establishment of a drainage connection between glacier surface and glacier bed, and coincide with the onset of subglacial outflow at the terminus. A mid-season short-term event occurred as surface melting resumed following cold weather, and may have been facilitated by partial closure of subglacial channels during this cold period. There is a close association between the timing and spatial distribution of horizontal and vertical velocity anomalies, the temporal pattern of surface water input to the glacier, and the formation, seasonal evolution and distribution of subglacial drainage pathways. These factors presumably control the occurrence of highwater-pressure events and water storage at the glacier bed. The observed coupling between surface water inputs and glacier velocity may allow predominantly cold polythermal glaciers to respond rapidly to climate-induced changes in surface melting.
Dye-tracer experiments undertaken over two summer melt seasons at polythermal John Evans Glacier, Ellesmere Island, Canada, were designed to investigate the character of the subglacial drainage system and its evolution over a melt season. In both summers, dye injections were conducted at several moulins and traced to a single subglacial outflow. Tracer breakthrough curves suggest that supraglacial meltwater initially encounters a distributed subglacial drainage system in late June. The subsequent development and maintenance of a channelled subglacial network are dependent upon sustained high rates of surface melting maintaining high supraglacial inputs. In a consistently warm summer (2000), subglacial drainage became rapidly and persistently channelled. In a cooler summer (2001), distributed subglacial drainage predominated. These observations confirm that supraglacial meltwater can access the bed of a High Arctic glacier in summer, and induce significant structural evolution of the subglacial drainage system. They do not support the view that subglacial drainage systems beneath polythermal glaciers are always poorly developed. They do suggest that the effects on ice flow of surface water penetration to the bed of predominantly cold glaciers may be short-lived.
The longitudinal pattern of surface velocity of a large, predominantly cold, polythermal glacier (John Evans Glacier, Ellesmere Island, Canada) was measured over summer and winter periods. In the accumulation and upper ablation areas, where ice is predominantly cold-based, summer velocities were slightly higher than overwinter velocities. Predicted velocities due to ice deformation alone in these areas closely matched these observations in the winter, with limited basal motion likely in the summer. In the lower ablation area, where ice is likely warm-based, measured summer velocities were up to double overwinter velocities. Predicted ice deformation could not account for all of these measured velocities in either summer or winter. This suggests that basal motion occurs throughout the year over at least part of the lower ablation area. This finding is supported by radio-echo sounding, subglacial drainage reconstructions and analyses of early-summer meltwater chemistry, which suggest that subglacial water is present throughout the year in this region. In summer, basal motion may account for up to 75% of the total surface velocity throughout the lower ablation area. The inferred rate of basal motion increases sharply directly below a set of moulins by which most surface meltwater reaches the glacier bed.
Depression and obesity are highly prevalent, and major impacts on public health frequently co-occur. Recently, we reported that having depression moderates the effect of the FTO gene, suggesting its implication in the association between depression and obesity.
To confirm these findings by investigating the FTO polymorphism rs9939609 in new cohorts, and subsequently in a meta-analysis.
The sample consists of 6902 individuals with depression and 6799 controls from three replication cohorts and two original discovery cohorts. Linear regression models were performed to test for association between rs9939609 and body mass index (BMI), and for the interaction between rs9939609 and depression status for an effect on BMI. Fixed and random effects meta-analyses were performed using METASOFT.
In the replication cohorts, we observed a significant interaction between FTO, BMI and depression with fixed effects meta-analysis (β=0.12, P = 2.7 × 10−4) and with the Han/Eskin random effects method (P = 1.4 × 10−7) but not with traditional random effects (β = 0.1, P = 0.35). When combined with the discovery cohorts, random effects meta-analysis also supports the interaction (β = 0.12, P = 0.027) being highly significant based on the Han/Eskin model (P = 6.9 × 10−8). On average, carriers of the risk allele who have depression have a 2.2% higher BMI for each risk allele, over and above the main effect of FTO.
This meta-analysis provides additional support for a significant interaction between FTO, depression and BMI, indicating that depression increases the effect of FTO on BMI. The findings provide a useful starting point in understanding the biological mechanism involved in the association between obesity and depression.
We assess ice loss and velocity changes between 1985 and 2014 of three tidewater and five-land terminating glaciers in Godthåbsfjord (Nuup Kangerlua), Greenland. Glacier thinning accounted for 43.8 ± 0.2 km3 of ice loss, equivalent to 0.10 mm eustatic sea-level rise. An additional 3.5 ± 0.3 km3 was lost to the calving retreats of Kangiata Nunaata Sermia (KNS) and Narsap Sermia (NS), two tidewater glaciers that exhibited asynchronous behavior over the study period. KNS has retreated 22 km from its Little Ice Age (LIA) maximum (1761 AD), of which 0.8 km since 1985. KNS has stabilized in shallow water, but seasonally advects a 2 km long floating tongue. In contrast, NS began retreating from its LIA moraine in 2004–06 (0.6 km), re-stabilized, then retreated 3.3 km during 2010–14 into an over-deepened basin. Velocities at KNS ranged 5–6 km a−1, while at NS they increased from 1.5 to 5.5 km a−1 between 2004 and 2014. We present comprehensive analyses of glacier thinning, runoff, surface mass balance, ocean conditions, submarine melting, bed topography, ice mélange and conclude that the 2010–14 NS retreat was triggered by a combination of factors but primarily by an increase in submarine melting.
We are measuring 36Cl in the upper part of the 1966 Camp Century deep core, using the tandem-accelerator mass-spectrometry facility at the University of Rochester. There are two primary motivations for measuring 36Cl in ice. The first is to look for correlations between 36Cl concentrations and changes in solar activity. Previous studies of 10Be and 14C (Stuiver and Quay 1980, Raisbeck and others 1981, Beer and others 1983) have demonstrated that the production of these radio-isotopes increases during periods of low solar activity. When the sun is active, the magnetic field induced by the solar wind deflects galactic cosmic rays from the inner solar system and thereby lowers the production of radio-isotopes. Our study of 36Cl in ice dating back to A.D. 1550, from Camp Century, Greenland, shows that there was an increase in 36Cl production during the Maunder Minimum (1650–1715). However, climatic variations introduce fluctuations of a factor of 2 or more over short periods and the Maunder Minimum peak is only readily apparent when the data are smoothed mathematically.
The second motivation for measuring 36Cl in ice is to test the possibility that the ratio of 36Cl to 10Be will provide a means for dating ice over 50 000 years old (Nishiizumi and others 1983). The dependence on both solar activity and climatic fluctuations mentioned above precludes dating with a single radio-isotope. If, however, the production rates of 36Cl and 10Be are each proportional to the cosmic-ray flux and are transported identically to the ice sheet, these fluctuations would cancel and the ratio of 36Cl to 10Be would provide a radiometric means of dating very old ice. The half-lives for 36Cl (3.0 × 105 years) and 10Be (1.6 × 106 years), combine to give a “half-life” for the 36Cl/10Be ratio of 3.7 × 105 years.
Unfortunately, preliminary results from Camp Century, Greenland, show that it will almost certainly not be possible to use the 10Be/36Cl ratio for dating. 10Be and 36Cl have been measured in more than 20 samples; the 10Be/36Cl ratio varied, without any obvious pattern, from below 5 to over 15. Additional evidence comes from Antarctica. We found that the 10Be/36Cl ratio changed significantly within a short depth interval within a single block of ice and that the calculated age of ice based on 10Be/36Cl differed from the age of an embedded meteorite, ALHA82102 (personal communication from K. Nishiizumi).
A variation in the 10Be/36Cl ratio may be caused by climatic effects: for example, changes in air circulation between the stratosphere and the troposphere in the polar region, in combination with chemical processes that affect aerosol chlorine and beryllium differently. Also, the 10Be/36Cl ratio is smaller than expected, indicating that there may be additional sources of 36Cl. If there is a source of 36Cl that varies independently from the galactic cosmic-ray flux, this would result in variations in the isotope ratio. Discovery of the cause of the variations may result in a new tool for understanding paleoclimate.
Objectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.
Tropical tropical montane cloud forests (TMCFs) cover a small portion of the Earth, yet they are significant biodiversity hotspots and centres of endemism, and they provide important hydrological and biogeochemical functions that affect human livelihoods. Given their fundamental sensitivity to climate, TMCFs also serve as an early warning system for climate change impacts. This paper outlines a new international initiative, CloudNet, that aims to promote integrated research across TMCFs, and introduces a special issue that reviews emerging themes and topics in the ecology of TMCFs, highlighting knowledge gaps and suggesting new directions for research. CloudNet is helping coordinate several new research projects and protocols: (1) a global repository of TMCF data and meta-analyses across multiple sites; (2) a multi-site study of plant functional traits across TMCFs; (3) a multi-site study of decomposition processes across TMCFs; (4) a protocol for standardizing climate data collection across TMCFs. These studies are intended to evaluate the extent to which general patterns emerge, accounting for biogeographic, phylogenetic and environmental differences among sites. Common data collection across TMCFs should also allow better integration across disciplines, such as linking nutrient limitation, seed production and propagule recruitment, and enable cross-site comparisons of how TMCFs respond to drivers of global change, including rising cloud bases, increasing temperatures, altered disturbance regimes, biological invasions and extinction, and changing human land use.