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Identifying risk factors of individuals in a clinical-high-risk state for psychosis are vital to prevention and early intervention efforts. Among prodromal abnormalities, cognitive functioning has shown intermediate levels of impairment in CHR relative to first-episode psychosis and healthy controls, highlighting a potential role as a risk factor for transition to psychosis and other negative clinical outcomes. The current study used the AX-CPT, a brief 15-min computerized task, to determine whether cognitive control impairments in CHR at baseline could predict clinical status at 12-month follow-up.
Baseline AX-CPT data were obtained from 117 CHR individuals participating in two studies, the Early Detection, Intervention, and Prevention of Psychosis Program (EDIPPP) and the Understanding Early Psychosis Programs (EP) and used to predict clinical status at 12-month follow-up. At 12 months, 19 individuals converted to a first episode of psychosis (CHR-C), 52 remitted (CHR-R), and 46 had persistent sub-threshold symptoms (CHR-P). Binary logistic regression and multinomial logistic regression were used to test prediction models.
Baseline AX-CPT performance (d-prime context) was less impaired in CHR-R compared to CHR-P and CHR-C patient groups. AX-CPT predictive validity was robust (0.723) for discriminating converters v. non-converters, and even greater (0.771) when predicting CHR three subgroups.
These longitudinal outcome data indicate that cognitive control deficits as measured by AX-CPT d-prime context are a strong predictor of clinical outcome in CHR individuals. The AX-CPT is brief, easily implemented and cost-effective measure that may be valuable for large-scale prediction efforts.
In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.
Despite considerable academic attention to the role of family caregivers within the general population, little research has been conducted with Indigenous families. This qualitative study aims to fill that gap by focusing on the experiences of Metis caregivers providing care for older Metis adults. Focus groups and interviews were conducted with Metis family caregivers (n = 79), Metis Elders (n = 11) and formal caregivers (n = 8). Although there are considerable parallels in the caregiving experiences identified in this Metis study with those already documented in the literature, there are nonetheless important differences for providing culturally responsive care to Metis seniors.
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.
In the study of approximate methods for solving ordinary differential equations, an interesting question arises. To state it roughly for a single first order expression, let y0(t) be the solution of the equation
which satisfies the initial condition y(a) = na. Let nb be an approximation to the value of y0 at a later time, t = b.
Over the past half-century video games have become a significant part of our cultural environment, in part, by leading advances in both technology and artistic innovation. In recent years librarians and researchers have recognized these games as cultural objects that require collection and curation. Developing and maintaining collections of this fast moving and somewhat ephemeral media, however, poses challenges due to constantly advancing technology and a corresponding lack of consistent terminology. This article addresses the literature and critical issues surrounding collections of video games within libraries and presents a case study of the University of Michigan’s Computer and Video Game Archive (CVGA), one of the largest academic archives of its kind. Moreover, video games are situated in a humanistic approach to the field of game studies as the article draws on the relevance of methods from art history and film studies.
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.
Cervical cancer is one of the most common cancers in women worldwide and is globally a leading cause of death among women. Nearly all of invasive cervical cancers are caused by persistent human papillomavirus (HPV) infection and resultant progression of cervical intraepithelial neoplasia (CIN). Common symptoms of cervical cancer include irregular vaginal bleeding or postcoital bleeding, vaginal discharge, and signs of ureteral, venous, or lymphatic compression. Stage is the most important predictor of survival; cervical cancer is staged clinically. The stage of the cancer dictates treatment, which typically consists of either surgery or chemoradiation for early stages, and chemoradiation or systemic chemotherapy for advanced stages. Early detection of cervical dysplasia and vaccination against HPV are effective in preventing cervical cancer.
Statement of the Problem
In the United States, about 13,000 new cases are diagnosed per year and about 4,000 women will die from the disease . The death rate from cervical cancer decreased by 70 percent since the implementation of the Papanicolaou test (Pap test) in the mid-1940s; because preinvasive lesions are detected, cervical cancers can be diagnosed at an early stage.
Multiple factors have been associated with the development of cervical cancer. This malignancy most commonly develops at the squamocolumnar junction on the cervix where the cells are most actively undergoing metaplastic change from columnar to squamous epithelium. Infection with HPV is detected in more than 99 percent of cervical cancers. Typically the progression from dysplasia to invasive cancer requires several years, although wide variations exist. Although more than 70 different subtypes of HPV have been identified, women infected with high-risk subtypes have an increased risk of developing dysplasia and a subsequent malignancy. The most common high-risk subtypes are HPV-16 and HPV-18. These account for 70 percent of cervical cancers in the United States . The E6 protein product of these high-risk HPVs binds to the tumor suppressor protein p53, which is thought to disrupt the p53-dependent control of the cell cycle . The E7 protein causes an inactivation of the tumor suppressor retinoblastoma gene (Rb) via its interaction with the Rb protein, whose normal function is seen with the negative control of cell growth .
Risk factors associated with HPV infection include multiple sexual partners, history of other sexually transmitted infections, high parity, immunosuppression, and cigarette smoking .
A model devised by Thorpe & Li (J. Fluid Mech., vol. 758, 2014, pp. 94–120) that predicts the conditions in which stationary turbulent hydraulic jumps can occur in the flow of a continuously stratified layer over a horizontal rigid bottom is applied to, and its results compared with, observations made at several locations in the ocean. The model identifies two positions in the Samoan Passage at which hydraulic jumps should occur and where changes in the structure of the flow are indeed observed. The model predicts the amplitude of changes and the observed mode 2 form of the transitions. The predicted dissipation of turbulent kinetic energy is also consistent with observations. One location provides a particularly well-defined example of a persistent hydraulic jump. It takes the form of a 390 m thick and 3.7 km long mixing layer with frequent density inversions separated from the seabed by some 200 m of relatively rapidly moving dense water, thus revealing the previously unknown structure of an internal hydraulic jump in the deep ocean. Predictions in the Red Sea Outflow in the Gulf of Aden are relatively uncertain. Available data, and the model predictions, do not provide strong support for the existence of hydraulic jumps. In the Mediterranean Outflow, however, both model and data indicate the presence of a hydraulic jump.
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.
Very-long-baseline Interferometry (VLBI) has opened for study a broad new spectrum of geophysical phenomena including: direct observation of the tectonic motions and deformations of the Earth's crustal plates, observations of unprecedented detail of the variations in the rotation of the Earth, and direct measurement of the elastic deformations of the Earth in response to tidal forces. These new measurements have placed significant constraints on models of the interior structure of the Earth; for example, measurements of the variations in the Earth's nutation have been shown to be particularly sensitive to the shape of the core-mantle boundary. The VLBI measurements will allow us to construct a global reference frame accurate at the centimeter level. Such a frame will be essential to studying long-term global changes, especially those changes related to sea-level variations as recorded by tide gauge measurements.
We have observed 3 moderate redshift clusters using a combination of 7 intermediate band filters and 2 CCDs in order to derive photometric information for cluster galaxies from 400 nm to 900 nm. Preliminary results are presented for 2 clusters: Abell 1942 (z=0.224) and Abell 1525 (z=0.259) from 580 nm to 860 nm. The CCD photometry reaches a limit equivalent to RF=21 mag with a precision of better than 0.1 mag. The galaxy colours derived from the intermediate band measurements are generally consistent with those expected at the appropriate redshift. However, in Abell 1525, and to a lesser extent in Abell 1942, a large proportion of cluster members have far red (720–860 nm) colours redder than expected. Many of these galaxies have blue photographic BJ-RF colours. A possible explanation for the anomalous CCD colours is that these galaxies possess a strong emission line component which enters the far red filter at z=0.25.
Project IRIS (International Radio Interferometric Surveying) was set up under the IAG and COSPAR to provide an operational system that would employ Very-Long-Baseline Interferometry (VLBI) techniques to monitor variations in the rotation of the Earth. Currently the IRIS-A network, with stations at Westford, MA, Ft. Davis, TX, Richmond, FL, and Wettzell, FRG, conducts 24-hour observing sessions every five days to produce determinations of pole position, UT1, and nutation in addition to other parameters of geophysical and astrometric interest. The resulting Earth orientation parameters (EOP) have been shown to have an accuracy of 1 to 2 milliseconds of arc in pole position, and 0.05 to 0.1 milliseconds of time in UT1. In order to observe the relatively large higher frequency variations in UT1, daily 45-minute observing sessions are conducted using the single baseline between Westford and Wettzell. Intercomparison of the UT1 values from the daily and the 5-day series indicates that the accuracy of the daily values is better than 0.1 millisecond of time.
The longer term objectives of the IRIS project include improving the monitoring of Earth orientation by increasing the sampling rate and accuracy of the observations. In April, 1987, the IRIS-P network, with stations in Kashima, Japan, Fairbanks, AK, Ft, Davis, TX, and Richmond, FL began monthly 24-hour observing sessions, and a second series of daily UT1 observing sessions was begun using the stations in Richmond and Bologna, Italy. The additional networks will provide redundancy that will improve the reliability of the system and allow the accuracy of the EOP values to be estimated.
The IRIS UT1 time series provides, for the first time, sufficient accuracy and temporal resolution to look for the few percent increase in k/C caused by the anelastic response of the mantle. Initial results presented here suggest that improved methods of accounting for the dynamics of the oceans and atmosphere may be required before the intertwined variations in UT1 can be fully separated.