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Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis – ERRATUM
- Yin Wu, Brooke Levis, Kira E. Riehm, Nazanin Saadat, Alexander W. Levis, Marleine Azar, Danielle B. Rice, Jill Boruff, Pim Cuijpers, Simon Gilbody, John P.A. Ioannidis, Lorie A. Kloda, Dean McMillan, Scott B. Patten, Ian Shrier, Roy C. Ziegelstein, Dickens H. Akena, Bruce Arroll, Liat Ayalon, Hamid R. Baradaran, Murray Baron, Charles H. Bombardier, Peter Butterworth, Gregory Carter, Marcos H. Chagas, Juliana C. N. Chan, Rushina Cholera, Yeates Conwell, Janneke M. de Manvan Ginkel, Jesse R. Fann, Felix H. Fischer, Daniel Fung, Bizu Gelaye, Felicity Goodyear-Smith, Catherine G. Greeno, Brian J. Hall, Patricia A. Harrison, Martin Härter, Ulrich Hegerl, Leanne Hides, Stevan E. Hobfoll, Marie Hudson, Thomas Hyphantis, Masatoshi Inagaki, Nathalie Jetté, Mohammad E. Khamseh, Kim M. Kiely, Yunxin Kwan, Femke Lamers, Shen-Ing Liu, Manote Lotrakul, Sonia R. Loureiro, Bernd Löwe, Anthony McGuire, Sherina Mohd-Sidik, Tiago N. Munhoz, Kumiko Muramatsu, Flávia L. Osório, Vikram Patel, Brian W. Pence, Philippe Persoons, Angelo Picardi, Katrin Reuter, Alasdair G. Rooney, Iná S. Santos, Juwita Shaaban, Abbey Sidebottom, Adam Simning, Lesley Stafford, Sharon Sung, Pei Lin Lynnette Tan, Alyna Turner, Henk C. van Weert, Jennifer White, Mary A. Whooley, Kirsty Winkley, Mitsuhiko Yamada, Andrea Benedetti, Brett D. Thombs
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- Journal:
- Psychological Medicine / Volume 50 / Issue 16 / December 2020
- Published online by Cambridge University Press:
- 19 August 2019, p. 2816
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Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis
- Yin Wu, Brooke Levis, Kira E. Riehm, Nazanin Saadat, Alexander W. Levis, Marleine Azar, Danielle B. Rice, Jill Boruff, Pim Cuijpers, Simon Gilbody, John P.A. Ioannidis, Lorie A. Kloda, Dean McMillan, Scott B. Patten, Ian Shrier, Roy C. Ziegelstein, Dickens H. Akena, Bruce Arroll, Liat Ayalon, Hamid R. Baradaran, Murray Baron, Charles H. Bombardier, Peter Butterworth, Gregory Carter, Marcos H. Chagas, Juliana C. N. Chan, Rushina Cholera, Yeates Conwell, Janneke M. de Man-van Ginkel, Jesse R. Fann, Felix H. Fischer, Daniel Fung, Bizu Gelaye, Felicity Goodyear-Smith, Catherine G. Greeno, Brian J. Hall, Patricia A. Harrison, Martin Härter, Ulrich Hegerl, Leanne Hides, Stevan E. Hobfoll, Marie Hudson, Thomas Hyphantis, Masatoshi Inagaki, Nathalie Jetté, Mohammad E. Khamseh, Kim M. Kiely, Yunxin Kwan, Femke Lamers, Shen-Ing Liu, Manote Lotrakul, Sonia R. Loureiro, Bernd Löwe, Anthony McGuire, Sherina Mohd-Sidik, Tiago N. Munhoz, Kumiko Muramatsu, Flávia L. Osório, Vikram Patel, Brian W. Pence, Philippe Persoons, Angelo Picardi, Katrin Reuter, Alasdair G. Rooney, Iná S. Santos, Juwita Shaaban, Abbey Sidebottom, Adam Simning, Lesley Stafford, Sharon Sung, Pei Lin Lynnette Tan, Alyna Turner, Henk C. van Weert, Jennifer White, Mary A. Whooley, Kirsty Winkley, Mitsuhiko Yamada, Andrea Benedetti, Brett D. Thombs
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- Journal:
- Psychological Medicine / Volume 50 / Issue 8 / June 2020
- Published online by Cambridge University Press:
- 12 July 2019, pp. 1368-1380
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Background
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.
MethodsWe conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
Results16 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).
ConclusionsPHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Probability of major depression diagnostic classification using semi-structured versus fully structured diagnostic interviews
- Brooke Levis, Andrea Benedetti, Kira E. Riehm, Nazanin Saadat, Alexander W. Levis, Marleine Azar, Danielle B. Rice, Matthew J. Chiovitti, Tatiana A. Sanchez, Pim Cuijpers, Simon Gilbody, John P. A. Ioannidis, Lorie A. Kloda, Dean McMillan, Scott B. Patten, Ian Shrier, Russell J. Steele, Roy C. Ziegelstein, Dickens H. Akena, Bruce Arroll, Liat Ayalon, Hamid R. Baradaran, Murray Baron, Anna Beraldi, Charles H. Bombardier, Peter Butterworth, Gregory Carter, Marcos H. Chagas, Juliana C. N. Chan, Rushina Cholera, Neerja Chowdhary, Kerrie Clover, Yeates Conwell, Janneke M. de Man-van Ginkel, Jaime Delgadillo, Jesse R. Fann, Felix H. Fischer, Benjamin Fischler, Daniel Fung, Bizu Gelaye, Felicity Goodyear-Smith, Catherine G. Greeno, Brian J. Hall, John Hambridge, Patricia A. Harrison, Ulrich Hegerl, Leanne Hides, Stevan E. Hobfoll, Marie Hudson, Thomas Hyphantis, Masatoshi Inagaki, Khalida Ismail, Nathalie Jetté, Mohammad E. Khamseh, Kim M. Kiely, Femke Lamers, Shen-Ing Liu, Manote Lotrakul, Sonia R. Loureiro, Bernd Löwe, Laura Marsh, Anthony McGuire, Sherina Mohd Sidik, Tiago N. Munhoz, Kumiko Muramatsu, Flávia L. Osório, Vikram Patel, Brian W. Pence, Philippe Persoons, Angelo Picardi, Alasdair G. Rooney, Iná S. Santos, Juwita Shaaban, Abbey Sidebottom, Adam Simning, Lesley Stafford, Sharon Sung, Pei Lin Lynnette Tan, Alyna Turner, Christina M. van der Feltz-Cornelis, Henk C. van Weert, Paul A. Vöhringer, Jennifer White, Mary A. Whooley, Kirsty Winkley, Mitsuhiko Yamada, Yuying Zhang, Brett D. Thombs
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- Journal:
- The British Journal of Psychiatry / Volume 212 / Issue 6 / June 2018
- Published online by Cambridge University Press:
- 02 May 2018, pp. 377-385
- Print publication:
- June 2018
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Background
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.
AimsTo evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
MethodData 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.
ResultsA 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).
ConclusionsThe 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 interestDrs 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.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Chapter 14 - Acute lung injury and the acute respiratory distress syndrome
- from Section 4 - Pulmonary
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
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- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 154-171
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20 - Lung
- from PART V - INFLAMMATORY DISEASES/HISTOLOGY
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- By Bruce D. Levy, Brigham and Women's Hospital and Harvard Medical School
- Edited by Charles N. Serhan, Peter A. Ward, University of Michigan, Ann Arbor, Derek W. Gilroy, University College London
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- Fundamentals of Inflammation
- Published online:
- 05 April 2014
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- 26 April 2010, pp 253-258
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Summary
Inflammation in the lung is common in both physiologic responses as well as many respiratory illnesses. In particular, chronic inflammation is associated with a variety of prevalent disorders, including asthma, chronic obstructive pulmonary disease, bronchiectasis, and interstitial lung diseases [1 – 3]. For purposes of host defense, an overexuberant inflammatory response can also lead to respiratory disorders. For example, inhalation of pathogens, toxins, or specific allergens initiates an acute inflammatory response that characterizes acute exacerbations of bronchiectasis, COPD, and asthma [1, 4]. Perhaps the most extensively investigated example of acute inflammation and its spontaneous resolution is pneumonia. In this chapter, a common clinical presentation of pneumonia is provided with examples of its radiographic appearance and histology during both the initiation and resolution phases of the illness.
Bea Coffin is a 56-year-old woman who presents with a new cough and dyspnea. She has felt ill for about 3 days. Her cough is productive of blood-tinged green phlegm. She has also had fevers, chills, and sweats that are getting worse. The symptoms began with the sudden onset of right sided chest pain that makes it difficult to take a deep breath. She has tried acetaminophen and an expectorant, but these interventions have not been successful in controlling her symptoms. She is a lifelong nonsmoker and has no significant past medical history.
29 - Asthma
- from PART VI - ANIMAL MODELS OF INFLAMMATION
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- By Bruce D. Levy, Brigham and Women's Hospital and Harvard Medical School
- Edited by Charles N. Serhan, Peter A. Ward, University of Michigan, Ann Arbor, Derek W. Gilroy, University College London
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- Fundamentals of Inflammation
- Published online:
- 05 April 2014
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- 26 April 2010, pp 376-384
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Summary
INTRODUCTION
Asthma is a disease of chronic airway inflammation. This condition is prevalent worldwide and accounts for significant morbidity, excess mortality, and substantial health care expenditures [1, 2]. Asthma is clinically defined by three characteristics, namely reversible airflow obstruction, airway hyperresponsiveness, and airway inflammation [1]. There is no cure for asthma, but many therapies have been developed to lessen the burden of the disease. In light of the need for additional therapeutics to treat and ultimately cure asthma, several animal experimental models have been developed to perform preclinical investigation of asthma pathogenesis and novel therapeutics. Simply stated, asthma is only a human disease. None of the current animal models entirely recapitulates asthma [3], but they have proven very useful in the investigation of asthma traits. In this chapter, the most common animal models of asthma and their features will be described with particular attention to the airway inflammatory responses.
ASTHMA PATHOBIOLOGY
Asthma has a complex pathogenesis and can be considered a clinical syndrome of intermittent dyspnea, wheezing, chest tightness, and/or cough. In most subjects, airway inflammation is present [1]. The inflammatory cell infiltrate is enriched with eosinophils, T lymphocytes and, in some cases, neutrophils, especially in the setting of asthma exacerbations. This complex, chronic airway inflammation is likely initiated and driven by signals from sentinel cells in the airway, including airway epithelia and dendritic cells, responding to provocative stimuli.
10 - Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)
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- By Scott L. Schissel, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, Bruce D. Levy, Brigham and Women's Hospital and Harvard Medical School Boston, MA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
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- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
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- 10 August 2006, pp 142-157
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Summary
Introduction and definitions
Acute lung injury (ALI) is a devastating disorder caused by many underlying medical and surgical diseases; and, when complicated by severe hypoxemia, is termed the acute respiratory distress syndrome (ARDS). In 1967, Ashbaugh and colleagues first described some key features of ARDS, including: (a) respiratory distress and tachypnea (b) severe hypoxemia (c) diffuse alveolar infiltrates on chest radiography and (d) decreased lung compliance, all occurring in the setting of an acute medical or surgical illness. While this descriptive definition lacks specificity, it encompasses the fundamental concept that ALI is diffuse lung injury caused either by a direct (e.g., aspiration of gastric contents) or an indirect (e.g., sepsis) pulmonary insult.
In hopes of standardizing clinical care and research studies, attempts have been made to apply more strict criteria to the definition of ARDS. Murray and colleagues in 1988 proposed a comprehensive definition of ARDS, including details on: the severity of lung injury, the mechanism of lung injury, and the presence of non-pulmonary organ dysfunction. Lung injury was quantified based on the severity of 4 parameters and termed the Lung Injury Score (LIS); it includes: (a) the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2), (b) the level of positive end-expiratory pressure (PEEP) applied during mechanical ventilation, (c) the static lung compliance, and (d) the extent of alveolar infiltrates on chest radiographs.
Domestic Politics and War
- Edited by Robert I. Rotberg, Theodore K. Rabb
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- Book:
- The Origin and Prevention of Major Wars
- Published online:
- 02 December 2009
- Print publication:
- 24 February 1989, pp 79-100
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Summary
It is difficult to read both the theoretical literature in political science on the causes of war and historians' case studies of the origins of particular wars without being struck by the difference in their respective evaluations of the importance of domestic political factors. Whereas historians devote considerable attention to these variables, most political scientists minimize their importance. Domestic political variables are not included in any of the leading theories of the causes of war; instead, they appear only in a number of isolated hypotheses and in some empirical studies that are generally atheoretical and noncumulative. This gap is troubling and suggests that political scientists and historians who study war have learned little from each other. A greater recognition of the role of domestic factors by political scientists would increase the explanatory power of their theories and provide more useful conceptual frameworks for the historical analysis of individual wars.
This study takes a first step toward bridging this gap by examining some of the disparate theoretical literature on domestic politics and war. It examines the relationship between national attributes and war behavior, the relative likelihood of democratic and non-democratic regimes going to war, Marxist and liberal theories regarding the impact of economic structure, the influence of nationalism and public opinion, and the scapegoat hypothesis. First, however, this article takes a closer look at the different treatment of domestic sources of war by political scientists and historians.
The Origins of War: Structural Theories
- Edited by Robert I. Rotberg, Theodore K. Rabb
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- Book:
- The Origin and Prevention of Major Wars
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Wargames: 1914–1919
- Edited by Robert I. Rotberg, Theodore K. Rabb
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- The Origin and Prevention of Major Wars
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- 24 February 1989, pp 249-280
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Summary
Are there really lessons of the past? The past is certainly a source of knowledge, our only source of knowledge given the flow of time, but, strictly speaking, it does not teach lessons. By lessons I mean maxims for attaining particular outcomes in the present or future: for example, Si vis pacem, para helium, or it is better for a prince to be feared than loved. Insofar as these maxims seem to offer guidance for policymakers, they are usually psychological, not historical. They supposedly summarize human traits that persist regardless of changing historical contexts. Other examples might include the notion that appeasement encourages aggression or that “military decision makers will tend to overestimate the feasibility of an operational plan if a realistic assessment would require forsaking fundamental beliefs or values.” Identification of such allegedly constant traits was the goal of philosophical history and may have seemed an appropriate program for historians during the Enlightenment and their policy-studies heirs. Subsequent historians, however, have usually sought to describe changing societal contexts or outcomes.
The Origin and Prevention of Major Wars
- Edited by Robert I. Rotberg, Theodore K. Rabb
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- Published online:
- 02 December 2009
- Print publication:
- 24 February 1989
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Since the development of the modern state system in Europe four centuries ago, there have been ten general wars involving a majority of the major powers and a high level of casualties. Another major war is difficult to conceive of, since it would presumably be the last such conflict, and yet it is not an impossibility. In this volume a distinguished group of political scientists and historians examine the origins of major wars and discuss the problems in preventing a nuclear war.
Introduction
- Edited by Robert I. Rotberg, Theodore K. Rabb
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- The Origin and Prevention of Major Wars
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The Origins of World War II in Europe: British Deterrence Failure and German Expansionism
- Edited by Robert I. Rotberg, Theodore K. Rabb
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- The Origin and Prevention of Major Wars
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- 24 February 1989, pp 281-322
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Summary
Explanations of the origins of World War II tend to emphasize either deliberate, if failed, choices or inexorable processes. The first view indicts Adolf Hitler's aggrandizing choices and preference for violence, and questions the judgment and strategy of the appeasers, personified, correctly or not, by Prime Minister Neville Chamberlain. The second view broadens the focus, pointing to secular changes in relative power between states; to the relation between states' commitments and their ability to uphold and protect them; and to domestic, economic, and cultural dynamics that individually, or in combination, predisposed the situation to conflict. Attention to both dimensions is necessary to appreciate Britain's strategy as the central axis of diplomacy and rivalry with Germany in the 1930s and to distill the “lessons” of the origins of the war.
In the 1930s, Britain took over the mantle of maintaining the status quo vis-à-vis Germany. Chamberlain and his associates faced the classic issue of judging the nature of its adversary's ambitions. Morgenthau captured the dilemma for Britain in this period: “While it would be fatal to counter imperialistic designs with measures appropriate to a policy of the status quo, it would be only a little less risky to deal with a policy [of an adversary] seeking adjustments within the status quo as though it were imperialistic.”
Lessons and Analogies from the World Wars
- Edited by Robert I. Rotberg, Theodore K. Rabb
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- The Origin and Prevention of Major Wars
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- 24 February 1989, pp 223-224
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The Origins of War: Explanation of Non-rational Causality
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- The Origin and Prevention of Major Wars
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- 24 February 1989, pp 77-78
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Lessons and Analogies from Early Major Wars
- Edited by Robert I. Rotberg, Theodore K. Rabb
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- The Origin and Prevention of Major Wars
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- 24 February 1989, pp 147-148
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The Origins of the Thirty Years' War
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- The Origin and Prevention of Major Wars
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- 24 February 1989, pp 177-198
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Summary
Among the major wars of modern European history, the Thirty Years' War stands out not only for its duration but also for its striking impact on the international system in which it took place. Before 1618, the Spanish Habsburgs were the central power in a Europe where religious differences were crucial. The war and its Franco-Spanish extension ended in 1659. By that time, France and other nations had increased their power, and religion played a much less important role in defining alliances. Moreover, Europe's center had moved east, as Russia, Prussia, and the Austrian Habsburgs became more powerful.
The war's origins are well known. Conflict in the Holy Roman Empire, especially in the Habsburg lands, over religion and over the power of the emperor provoked a civil war in Bohemia in 1618. The Bohemian war both resurrected and created a network of alliances which caused the conflict to continue into the 1620s. The opportunities offered by the disruption in Germany led the Danes to invade in 1625, and the Swedes and French to intervene in the 1630s, which continued the war by bringing in fresh combatants. The result was a conflict that could not be controlled by the Bohemians and the emperor, who had begun it. They were not allowed to extricate themselves until they had completely exhausted themselves and everyone else; as fitting compensation, the Bohemians and the emperor were important losers.
War and Misperception
- Edited by Robert I. Rotberg, Theodore K. Rabb
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- The Origin and Prevention of Major Wars
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- 24 February 1989, pp 101-126
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Summary
War has so many causes—in part because there are so many kinds of wars—and misperception has so many effects—again in part because there are so many kinds of misperceptions—that it is not possible to draw any definitive conclusions about the impact of misperception on war. But we can address some conceptual and methodological problems, note several patterns, and try to see how misperceptions might lead to World War III. In this article, I use the term misperception broadly, to include inaccurate inferences, miscalculations of consequences, and misjudgments about how others will react to one's policies.
Although war can occur even when both sides see each other accurately, misperception often plays a large role. Particularly interesting are judgments and misjudgments of another state's intentions. Both overestimates and underestimates of hostility have led to war in the past, and much of the current debate about policy toward the Soviet Union revolves around different judgments about how that country would respond to American policies that were either firm or conciliatory. Since statesmen know that a war between the United States and the Soviet Union would be incredibly destructive, however, it is hard to see how errors of judgment, even errors like those that have led to past wars, could have the same effect today. But perceptual dynamics could cause statesmen to see policies as safe when they actually were very dangerous or, in the final stages of deep conflict, to see war as inevitable and therefore to see striking first as the only way to limit destruction.
Contents
- Edited by Robert I. Rotberg, Theodore K. Rabb
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- The Origin and Prevention of Major Wars
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- 24 February 1989, pp v-vi
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