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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.
Contemporary dictionary-based approaches to sentiment analysis exhibit serious validity problems when applied to specialized vocabularies, but human-coded dictionaries for such applications are often labor-intensive and inefficient to develop. We demonstrate the validity of “minimally-supervised” approaches for the creation of a sentiment dictionary from a corpus of text drawn from a specialized vocabulary. We demonstrate the validity of this approach in estimating sentiment from texts in a large-scale benchmarking dataset recently introduced in computational linguistics, and demonstrate the improvements in accuracy of our approach over well-known standard (nonspecialized) sentiment dictionaries. Finally, we show the usefulness of our approach in an application to the specialized language used in US federal appellate court decisions.
Awareness can be defined as a response to, or evaluation of, an aspect of one’s situation or internal state. Awareness becomes impaired as dementia progresses; however, the exact nature and degree of impairment in advanced dementia remains unclear. The extent to which caregivers understand or make assumptions about the level and nature of awareness in advanced dementia may have a significant impact on their ability to appropriately respond to and care for the person with dementia. This systematic review examines the literature regarding professional caregiver perceptions about awareness in advanced dementia.
A systematic search of online literature databases (PsychInfo, Medline, Embase, CINAHL) was conducted up to January 15, 2018, using a range of search terms related to dementia, awareness and caregiver attitudes.
The systematic review included a total of 10 qualitative studies that were heterogeneous in aspects of design, including analyses. Narrative synthesis was used to integrate results. Four major themes were identified from review of the papers: how professional caregivers defined awareness; professional caregiver beliefs about what influences the expression of awareness; professional caregiver beliefs around how to assess awareness in advanced dementia; and the perceived impact of episodes of increased awareness on the person with dementia and caregiver. Sub-themes were identified within each of these areas.
This review highlights the importance of professional caregiver perceptions of awareness in advanced dementia. Supporting professional caregivers to assess and understand the nature of awareness in advanced dementia would improve their approach to care and outcomes for people with dementia.
This article reports on the experience of Special Masters appointed to regulate pretrial phases of a large civil antitrust suit. It describes techniques for expediting discovery, determining claims of privilege in production of documents, establishing stipulations of undisputed facts, and controlling and resolving disputes arising in discovery. It suggests a “managerial” approach to pretrial that is flexible and experimental and that may be useful in controlling the pretrial phase of other “big” cases.
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.
The marker technique has been used widely in trout digestibility studies due to practical difficulties in obtaining “true” faeces samples directly from fish. However this technique is also relatively difficult and there are few good systems for faeces collection. Reliable data on raw material digestibilities are therefore scarce. Traditionally, chromic oxide has been used as a marker. However this substance can give rise to skin allergies in humans and has been implicated as a carcinogen. Jagger et al., (1992) suggested that titanium dioxide could be used successfully as a digestibility marker in pig diets. The present study was designed to determine the digestibility of four feed ingredients for trout (prairie meal, maize distillers, soya 50 and extruded wheat) and to evaluate the use of chromic oxide or titanium dioxide as a digestibility marker in fish diets.
Each test ingredient was included in a basal diet at 0, 100, 200, 300 and 400 g/kg. Titanium dioxide and chromic oxide were included in the basal diet at 1 and 3.7 g/kg respectively.
Along the base of glaciers and ice sheets, the sliding of ice over till depends critically on water drainage. In locations where drainage occurs through Röthlisberger channels, the effective pressure along the base of the ice increases and can lead to a strengthening of the bed, which reduces glacier sliding. The formation of Röthlisberger channels depends on two competing effects: (1) melting from turbulent dissipation opens the channel walls and (2) creep flow driven by the weight of the overlying ice closes the channels radially inward. Variation in downstream ice velocity along the channel axis, referred to as an antiplane shear strain rate, decreases the effective viscosity. The softening of the ice increases creep closure velocities. In this way, even a modest addition of antiplane shear can double the size of the Röthlisberger channels for a fixed water pressure or allow channels of a fixed radius to operate at lower effective pressure, potentially decreasing the strength of the surrounding bed. Furthermore, we show that Röthlisberger channels can be deformed away from a circular cross section under applied antiplane shear. These results can have broad impacts on sliding velocities and potentially affect the total ice flux out of glaciers and ice streams.
The Germanwings 9525 incident drew significant attention to the ‘plane-assisted suicide’ construct, yet little scientific literature exists on this topic. This paper reviews the available literature and applies lessons from the suicide-homicide and men’s mental health literature to better understand this construct from a scientific perspective.
A systematic review of the relevant clinical literature was undertaken.
Multiple lines of evidence suggests the applicability and relevance of suicide-homicide research and men’s mental health to the plane-assisted suicide phenomenon. Plane-assisted suicides occur within an overwhelmingly male, middle aged population who, in addition to suicide, commit large scale acts of murder. Issues of divorce, separation, and threats to masculinity appear integral to an effective prevention program.
Further research in the understanding of plane-assisted suicide as a product of neuropsychiatric disorder may advance such prevention efforts and have the opportunity to reduce the loss of life in future tragedies.
We examine a problem that is confronted frequently by political science researchers seeking to model longitudinal data: what to do when one suspects a lag between the realization of a regressor and its effect on the outcome variable, but one has no theoretical reason to suspect a particular lag length. We examine the theoretical challenges posed by atheoretic lags, review existing methods for atheoretic lag analysis—most notably distributed lag specifications—and their shortcomings, and present an alternative approach for atheoretic lag analysis based on Bayesian model averaging (BMA). We demonstrate the use and utility of our approach with two examples: the litigant signal model in American politics and modernization theory in political economy. Our examples show the increasing difficulty of analyzing models with atheoretic lags as the set of possible specifications increases, and demonstrate the effectiveness of BMA for the modal type of specification in time-series cross-sectional applications.
Using a combination of pollen, non-pollen palynomorphs (NPPs) and charcoal particle stratigraphies from sediment cores from two sites, along with historical records, we reconstructed paleoenvironmental change in mid-coastal California. The San Antonio Creek section contains a discontinuous, Holocene-length record, while Mod Pond includes a continuous late Holocene record. Together the records allow for interpretation of most of the present interglacial. The longer record documents coastal sage scrub and chaparral dominated by woodland elements early in the Holocene to about 9000 yr ago, a potential decline in woodland communities with drying conditions during the middle Holocene to about 4800 yr ago, and an expansion of coastal sage scrub with grassland during the late Holocene. Evidence for climatic fluctuations during the last 1000 yr at Mod Pond is equivocal, suggesting that the Medieval Climate Anomaly–Little Ice Age had modest impact on the Mod Pond environment. However, evidence of significant environmental change associated with cultural transitions in the 18th–19th centuries is stark. Introduction of non-native plants, establishment of cattle and sheep grazing, missionization of the native population, changes in burning practices during the Spanish period and enhanced cropping activities during North American settlement worked together to substantially modify the mid-California coastal landscape in about a century's time.
Strategies to dissect phenotypic and genetic heterogeneity of major depressive disorder (MDD) have mainly relied on subphenotypes, such as age at onset (AAO) and recurrence/episodicity. Yet, evidence on whether these subphenotypes are familial or heritable is scarce. The aims of this study are to investigate the familiality of AAO and episode frequency in MDD and to assess the proportion of their variance explained by common single nucleotide polymorphisms (SNP heritability).
For investigating familiality, we used 691 families with 2–5 full siblings with recurrent MDD from the DeNt study. We fitted (square root) AAO and episode count in a linear and a negative binomial mixed model, respectively, with family as random effect and adjusting for sex, age and center. The strength of familiality was assessed with intraclass correlation coefficients (ICC). For estimating SNP heritabilities, we used 3468 unrelated MDD cases from the RADIANT and GSK Munich studies. After similarly adjusting for covariates, derived residuals were used with the GREML method in GCTA (genome-wide complex trait analysis) software.
Significant familial clustering was found for both AAO (ICC = 0.28) and episodicity (ICC = 0.07). We calculated from respective ICC estimates the maximal additive heritability of AAO (0.56) and episodicity (0.15). SNP heritability of AAO was 0.17 (p = 0.04); analysis was underpowered for calculating SNP heritability of episodicity.
AAO and episodicity aggregate in families to a moderate and small degree, respectively. AAO is under stronger additive genetic control than episodicity. Larger samples are needed to calculate the SNP heritability of episodicity. The described statistical framework could be useful in future analyses.
In this study, biodegradable foams were produced using cellulose nanofibrils (CNFs) and starch (S). The availability of high volumes of CNFs at lower costs is rapidly progressing with advances in pilot-scale and commercial facilities. The foams were produced using a freeze-drying process with CNF/S water suspensions ranging from 1 to 7.5 wt. % solids content. Microscopic evaluation showed that the foams have a microcellular structure and that the foam walls are covered with CNF`s. The CNF's had diameters ranging from 30 nm to 100 nm. Pore sizes within the foam walls ranged from 20 nm to 100 nm. The materials` densities ranging from 0.012 to 0.082 g/cm3 with corresponding porosities between 93.46% and 99.10%. Thermal conductivity ranged from 0.041 to 0.054 W/m-K. The mechanical performance of the foams produced from the starch control was extremely low and the material was very friable. The addition of CNF's to starch was required to produce foams, which exhibited structural integrity. The mechanical properties of materials were positively correlated with solids content and CNF/S ratios. The mechanical and thermal properties for the foams produced in this study appear promising for applications such as insulation and packaging.