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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.
Low loss, ferroelectric, fully-printed varactors for high-power matching applications are presented. Piezoelectric-induced acoustic resonances reduce the power handling capabilities of these varactors by lowering the Q-factor at the operational frequency of 13.56 MHz. Here, a quality factor of maximum 142 is achieved with an interference-based acoustic suppression approach utilizing double metal–insulator–metal structures. The varactors show a tunability of maximum 34% at 300 W of input power. At a power level of 1 kW, the acoustic suppression technique greatly reduces the dissipated power by 62% from 37 W of a previous design to 14.2 W. At this power level, the varactors remain tunable with maximum 18.2% and 200 V of biasing voltage.
Childhood maltreatment (CM) plays an important role in the development of major depressive disorder (MDD). The aim of this study was to examine whether CM severity and type are associated with MDD-related brain alterations, and how they interact with sex and age.
Within the ENIGMA-MDD network, severity and subtypes of CM using the Childhood Trauma Questionnaire were assessed and structural magnetic resonance imaging data from patients with MDD and healthy controls were analyzed in a mega-analysis comprising a total of 3872 participants aged between 13 and 89 years. Cortical thickness and surface area were extracted at each site using FreeSurfer.
CM severity was associated with reduced cortical thickness in the banks of the superior temporal sulcus and supramarginal gyrus as well as with reduced surface area of the middle temporal lobe. Participants reporting both childhood neglect and abuse had a lower cortical thickness in the inferior parietal lobe, middle temporal lobe, and precuneus compared to participants not exposed to CM. In males only, regardless of diagnosis, CM severity was associated with higher cortical thickness of the rostral anterior cingulate cortex. Finally, a significant interaction between CM and age in predicting thickness was seen across several prefrontal, temporal, and temporo-parietal regions.
Severity and type of CM may impact cortical thickness and surface area. Importantly, CM may influence age-dependent brain maturation, particularly in regions related to the default mode network, perception, and theory of mind.
Workforce shortages in psychiatry are common worldwide. The international literature provides insights into factors influencing decisions to train in psychiatry but is predominately survey based. This national cohort study aimed to identify the characteristics of doctors who were most likely to apply to psychiatry training programmes. The sample comprised doctors who entered UK medical schools in 2007/8 and who made first-time specialty training applications in 2015. The association between application to psychiatry and doctors' sociodemographic and educational characteristics was examined using multivariable logistic regression.
Those most likely to apply were White, privately educated older doctors with below average performance at medical school.
To reduce workforce shortages, psychiatry must make itself more attractive to all doctors, especially those from underrepresented groups such as state-educated Black and minority ethnic individuals. Otherwise, national policies to widen participation in the study of medicine by such groups may exacerbate the current recruitment crisis.
Innovation Concept: Competence by Design (CBD) was implemented nationally for Emergency Medicine (EM) residents beginning training in 2018. One challenge is the need to introduce residents to Entrustable Professional Activities (EPAs) that are assessed across numerous clinical rotations. The Royal College's resources detail these requirements, but do not map them to specific rotations or present them in a succinct format. This is problematic as trainees are less likely to succeed when expectations are unclear. We identified a need to create practical resources that residents can use at the bedside. Methods: We followed an intervention mapping framework to design two practical, user-friendly, low-cost, aesthetically pleasing resources that could be used by residents and observers at the bedside to facilitate competency-based assessment. Curriculum, Tool or Material: First, we designed a set of rotation- and stage-specific EPA reference cards for the use of residents and observers at the bedside. These cards list EPAs and clinical presentations likely to be encountered during various stages of training and on certain rotations. Second, we developed a curriculum board to organize the EPA reference cards by stage based upon our program's curriculum map. The curriculum board allows residents to view the program's curriculum map and the EPAs associated with each clinical rotation at a glance. It also contains hooks to hang and store extra cards in an organized manner. Conclusion: We believe that these practical and inexpensive tools facilitated our residency program's transition to competency-based EPA assessments. Anecdotally, the residents are using the cards and completing the suggested rotation-specific EPAs. We hope that the reference cards and curriculum board will be successfully incorporated into other residency programs to facilitate the introduction of their EPA-based CBD assessment system.
In the area of electromagnetic metrology, binary coded excitation signals become more and more important and various binary coded sequences are available. The measurement approach is to assess the impulse response function of a device under test by correlating the response signal with the excitation signal. In order to achieve a high measurement reproducibility as well as a high dynamic range, the generated binary coded signals have to provide low-noise. In this contribution, a low-noise signal generator realized with a field programmable gate array is presented. The performance investigation of different kinds of binary coded excitation signals and different correlation concepts have been practically investigated. With a chip rate of 5 Gchip/s, the generator can be utilized for ultra-wideband applications. In order to allow for a low-noise and long-term stable signal generation, a new clock generator concept is presented and results of phase noise measurements are shown. Furthermore, an algorithm to fast and precisely shifting the time lag between two binary coded signals for correlating excitation and response signals with a hardware correlator is presented. Finally, the realized demonstrator system is tested using two commonly used types of binary coded sequences.
The solar magnesium II core-to-wing ratio has been a well-studied proxy for chromospheric activity since 1978. Daily measurements at high spectral (0.1 nm) resolution began with the launch of the Solar Radiation and Climate Experiment (SORCE) in 2003. The next generation of measurements from the Extreme Ultraviolet Sensor (EUVS) on the Geostationary Operational Environmental Satellite 16 (GOES-16) will add high time cadence (every 30 seconds) to the observational Mg II irradiance record. We present a comparison of the two measurements during the period of overlap.
Ultraviolet (UV) Solar spectral Irradiance (SSI) has been measured from orbit on a regular basis since the beginning of the space age. These observations span four Solar Cycles, and they are crucial for our understanding of the Sun-Earth connection and space weather. SSI at these wavelengths are the main drivers for the upper atmosphere including the production and destruction of ozone in the stratosphere. The instruments that measure UV SSI not only require good preflight calibration, but also need a robust method to maintain that calibration on orbit. We will give an overview of the catalog of current and former UV SSI measurements along with the calibration philosophy of each instrument and an estimation of the uncertainties in the published irradiances.
We present a revised chronology for the Kolomoki site (9ER1) in Georgia, occupied primarily during the Middle and Late Woodland periods (ca. 200 BC to AD 1050). The considerable extent of the site has been noted for more than a century but came into sharper focus with the archaeological investigations by Sears (1956) and Pluckhahn (2003). The site includes at least nine mounds, a large central plaza, and a discontinuous habitation area nearly a kilometer in diameter. Previous interpretations assumed gradual and incremental changes in the community plan. We present a greatly revised chronology, based on new investigations in some of the lesser-known portions of the site and a doubling of the number of absolute dates. Bayesian modeling of these and previous dates reveals that, far from the gradualist assumption of previous work, the community at Kolomoki was dynamically transformed several times in its history, reaching its greatest spatial extent and formal complexity in two relatively short-lived phases. In these intervals, the village incorporated permanent residents and visitors into a single community in which daily face-to-face interactions were minimized even as communal identity was celebrated.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
Precise measurements of surface elevation on the Greenland ice sheet have been made almost every year since 1991 by an airborne scanning laser altimeter operated by NASA/Wallops Flight Facility. Results show substantial thinning over large areas near the coast, with a general increase in thinning rates since 1997, in the drainage basins of thinning glaciers, and a recent thickening in the southeast associated with very high snowfall in this region during 2003. Here, we present first results from the comparison of the aircraft data with similar measurements from the laser altimeter aboard NASA’s Ice, Cloud and land Elevation Satellite (ICESat), which was launched in January 2003. These show very close agreement with results inferred solely from the aircraft measurements, indicating that accuracies are similar for both datasets. Broad spatial coverage by satellite, together with the baseline dataset of aircraft measurements, offers the prospects of routine surveys of ice-sheet elevation changes by ICESat and follow-on missions.
Aircraft laser-altimeter surveys during the 1990s showed near-coastal parts of the Greenland ice sheet to be thinning; despite slow thickening at higher elevations, the ice sheet lost mass to the ocean. Many outlet glaciers thinned more rapidly than could be explained by increased melting during the recent warmer summers, indicating dynamic imbalance between glacier velocity and upstream snow accumulation. Results from more recent surveys, presented here, show that thinning rates have increased in most coastal regions. For almost half of the surveys, these increases might have resulted from increases in summer melting, but rapid thinning on others is indicative of dynamic changes that increased with time. In particular, thinning rates on the three fastest glaciers increased to tens of m a−1 after 2000, and other observations show an approximate doubling in their velocities. The deep beds of these glaciers appear to have a strong influence on rates of grounding-line retreat and thickness change, with periods of glacier acceleration and rapid thinning initiated by flotation and break-up of lightly grounded glacier snouts or break-up of floating ice tongues. Near-simultaneous thinning of these widely separated glaciers suggests that warming of deeper ocean waters might be a common cause. Nearby glaciers without deep beds are thinning far more slowly, suggesting that basal lubrication as a result of increased surface melting has only a marginal impact on Greenland outlet-glacier acceleration
As part of the Ross Ice Shelf Geophysical and Glaciological Survey (RIGGS), ice velocities were measured on the Ross Ice Shelf (RIS) during 1973–78. Comparisons of these with velocity estimates at the same locations derived from RADARSAT synthetic aperture radar (SAR) measurements in 1997 and 2009 show velocity reduction in the southeast quadrant of the ice shelf by almost 200 m a−1, with deceleration rates increasing with time. Large areas of ice shelf in this region are lightly grounded, forming an ‘ice plain’ that increases local buttressing of the ice streams. ICESat measurements show this ice plain to be thickening. The observed decrease in ice-shelf velocities implies a total reduction in the mass of ice flowing into the RIS from the West Antarctic ice sheet (WAIS) by ∼23 Gt a−1, shifting the mass balance of the WAIS drainage basin from strongly negative in the 1970s to strongly positive in 2009. The resulting decrease in ice advection should lead to ice-shelf thinning further seaward of the ice plain. This thinning would reduce the lateral drag and back-stress of the shelf ice, further contributing to thinning through an increase in spreading rate. ICESat measurements show recent thinning of most of the freely floating ice shelf.
With amphibians declining globally, conservation breeding and reintroduction programmes are increasingly important management tools. Here we examine whether these conservation initiatives are targeting species at the greatest risk of extinction. We compared conservation needs of species involved in conservation breeding programmes to those of their closest relatives not involved in such programmes, using eight variables related to immediate and future extinction risk. We found that species in breeding programmes were more likely to be threatened and were equally range-restricted and specialized as their closest relatives not being bred for conservation purposes. This suggests that in contrast to patterns reported for zoo holdings more generally, these conservation initiatives target species of conservation priority in the short and medium term.
Interactions between human lysozyme (HL) and the lipopolysaccharide (LPS) of Klebsiella pneumoniae O1, a causative agent of lung infection, were identified by surface plasmon resonance. To characterize the molecular mechanism of this interaction, HL binding to synthetic disaccharides and tetrasaccharides representing one and two repeating units, respectively, of the O-chain of this LPS were studied. pH-dependent structural rearrangements of HL after interaction with the disaccharide were observed through nuclear magnetic resonance. The crystal structure of the HL-tetrasaccharide complex revealed carbohydrate chain packing into the A, B, C, and D binding sites of HL, which primarily occurred through residue-specific, direct or water-mediated hydrogen bonds and hydrophobic contacts. Overall, these results support a crucial role of the Glu35/Asp53/Trp63/Asp102 residues in HL binding to the tetrasaccharide. These observations suggest an unknown glycan-guided mechanism that underlies recognition of the bacterial cell wall by lysozyme and may complement the HL immune defense function.
The eruptive variable V838 Mon was discovered on Jan 6, 2002. Due to a subsequent phase of almost constant brightness and a spectral appearance which is unlike classical novae, speculations have been made about its nature. Either it was a very peculiar, slow nova defining a new class, an eruptive event in an evolved star as in the case of Sakurai’s Object but in a much earlier phase, or something completely different.
We analyzed birth order differences in means and variances of height and body mass index (BMI) in monozygotic (MZ) and dizygotic (DZ) twins from infancy to old age. The data were derived from the international CODATwins database. The total number of height and BMI measures from 0.5 to 79.5 years of age was 397,466. As expected, first-born twins had greater birth weight than second-born twins. With respect to height, first-born twins were slightly taller than second-born twins in childhood. After adjusting the results for birth weight, the birth order differences decreased and were no longer statistically significant. First-born twins had greater BMI than the second-born twins over childhood and adolescence. After adjusting the results for birth weight, birth order was still associated with BMI until 12 years of age. No interaction effect between birth order and zygosity was found. Only limited evidence was found that birth order influenced variances of height or BMI. The results were similar among boys and girls and also in MZ and DZ twins. Overall, the differences in height and BMI between first- and second-born twins were modest even in early childhood, while adjustment for birth weight reduced the birth order differences but did not remove them for BMI.