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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.
Methods
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
Results
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).
Conclusions
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
The concept of nobility in the middle ages is the focus of this volume. Embracing regions as diverse as England (before and after the Norman Conquest), Italy, the Iberian peninsula, France, Norway, Poland, Portugal, and the Romano-German empire, it ranges over the whole medieval period from the fifth to the early sixteenth century. The articles confront many of the central issues about the origins and nature of `nobility', its relationship with the late Roman world, its acquisition and exercise of power, its association with military obligation, and its gradual `pacification' and transformation into a more or less willing instrument of royal government (indeed, the symbiotic relationship between royal, or imperial, and noble power is a recurring theme). Other ideas historically linked to the concept of nobility and discussed here are `nobility' itself; the distinction between nobility of birth and nobility of character; chivalry; violence and its effects; and noblewomen as co-progenitors and transmitters of nobility of blood.
Dr ANNE DUGGAN teaches in the Department of History at King's College London.
Measurements of the mechanical properties of snow are essential for improving our understanding and the prediction of snow failure and hence avalanche release. We performed fracture mechanical experiments in which a crack was initiated by a saw in a weak snow layer underlying cohesive snow slab layers. Using particle tracking velocimetry (PTV), the displacement field of the slab was determined and used to derive the mechanical energy of the system as a function of crack length. By fitting the estimates of mechanical energy to an analytical expression, we determined the slab effective elastic modulus and weak layer specific fracture energy for 80 different snowpack combinations, including persistent and nonpersistent weak snow layers. The effective elastic modulus of the slab ranged from 0.08 to 34 MPa and increased with mean slab density following a power-law relationship. The weak layer specific fracture energy ranged from 0.08 to 2.7 J m−2 and increased with overburden. While the values obtained for the effective elastic modulus of the slab agree with previously published low-frequency laboratory measurements over the entire density range, the values of the weak layer specific fracture energy are in some cases unrealistically high as they exceeded those of ice. We attribute this discrepancy to the fact that our linear elastic approach does not account for energy dissipation due to non-linear parts of the deformation in the slab and/or weak layer, which would undoubtedly decrease the amount of strain energy available for crack propagation.
We have mapped the southern galaxies NGC 613, 1313, 1433, 1566, 1672 and 2442 in the 12CO(J = 1 → 0) transition with the 15-m Swedish European Submillimetre Telescope (SEST). The sample is based on galaxies previously observed in radio continuum with the Molonglo Observatory Synthesis Telescope (MOST). Strong emission is seen from the barred galaxies NGC 613 and NGC 2442 and from the active galaxies NGC 1566 and 1672. The weakest emission was from NGC 1433, while the Sd spiral NGC 1313 was not detected.
This collection of papers is dedicated to David Kendall (Professor of Mathematical Statistics in the University of Cambridge) on the occasion of his 65th birthday. The content of the contributions indicates the breadth of his interests in mathematics and statistics, and the interrelation between mathematical analysis, the theory of probability, and mathematical statistics. The topics will interest postgraduate and research mathematicians.
Most electrolytic zinc plants have to deal with dissolved magnesium in their process liquors, as zinc sulphide concentrates contain small amounts of magnesium. Applied magnesium bleed methods are generally expensive and environmentally unfriendly. Recently, a new approach was suggested and discussed, which involves selective magnesium fluoride precipitation from purified zinc sulphate solutions. X-ray fluorescence measurements of these precipitates indicated that the ratio Mg:F is not 1:2 as would be expected if the precipitate was MgF2, which should be formed on a theoretical basis. It was inferred that fluoride was partly substituted by hydroxyl groups. Analytical techniques such as infrared absorption spectrometry, X-ray diffraction, and thermogravimetry were combined in order to verify this hypothesis. The precipitate indeed appeared to be a magnesium fluoro- hydroxide compound containing physically bound water. The results contribute to the understanding of the required operating conditions of the proposed process.
The purpose of the present study was to identify Echinococcus multilocularis infection in follow-up of 95 subjects initially seropostive by Emc-ELISA or Emf-ELISA antibody assays and to compare the utility of these assays with specific Em2plus-ELISA and ultrasound screening for E. multilocularis infection. At follow-up seven subjects were seropositive with both methods, while three were seropositive only with Emc-ELISA and 11 only with Emf-ELISA. All subjects were seronegative with Em2plus-ELISA. There were no manifestations of E. multilocularis infestation by ultrasonographic screening. Seropositivity on Emc-ELISA and Emf-ELISA screening tests does not appear to correlate with manifest alveolar echinococcosis identified by ultrasound. A recommendation for further follow-up of subjects found to be seropositive with Emc-ELISA and Emf-ELISA but with no sonographic evidence of disease is not justified at this time.
The nonperturbative renormalization group flow of Quantum Einstein Gravity (QEG) is reviewed. It is argued that there could be strong renormalization effects at large distances, in particular a scale dependent Newton constant, which mimic the presence of dark matter at galactic and cosmological scales.
The aim was to establish the prevalence of large pericardial effusions in the Western Cape Province of South Africa, and to determine the incidence of various types of effusions. A total of 233 patients presented with large pericardial effusions. Each patient underwent tests for HIV, sputum smear and culture, blood culture, blood biochemistry and serological testing. Tuberculous pericardial effusions were diagnosed according to pre-determined criteria. Eighty-four patients (36·1%) were found to be HIV positive; 81 of these (96·4%) had tuberculous pericarditis. More than 65% of the study population was aged between 15 and 39 years. The prevalence of HIV amongst unemployed individuals was 49·0% compared to 30·0% amongst employed individuals. Tuberculous pericarditis was the most common cause of pericardial effusions (69·5%, n=162). It was concluded that tuberculosis (TB) is a leading cause of pericarditis in this province of South Africa. The prevalence of TB confounded by HIV co-infection is steadily increasing, burdening the health-care facilities.
Two series of Ni-Mn-Ga thin films with two different compositions and various thicknesses in the submicron range are investigated with respect to their structural and magnetic properties. The films are fabricated by sputter deposition on alumina substrates and subsequent heat treatment. The martensitic transformation occurs well above room temperature showing a small thermal hysteresis width of about 6 K. The magnetic properties turn out to be thickness-dependent in the submicron range. In particular, in-plane magnetic susceptibilities increase and critical field strengths for onset of saturation decrease for decreasing thickness down to 0.1 μm by factors of 3–5 depending on the chemical composition. The Curie temperature TC decreases by about 25 K for samples with TC higher than the martensitic transformation.
A trench-first dual damascene process has been developed for fat wires (1.26 μm pitch, 1.1 μm thickness) in a 0.18 μm CMOS process with copper/fluorosilicate glass (FSG) interconnect technology. The process window for the patterning of vias in such deep trenches depends on the trench depth and on the line width of the trench, with the worse case being an intermediate line width (lines that are 3X the via diameter). Compared to a single damascene process, the dual damascene process has comparable yield and reliability, with lower via resistance and lower cost.
With the exception of David Carpenter's chapter, all the papers in this volume were presented at the Third International Conference held under the auspices of the Centre for Late Antique and Medieval Studies at King's College London in the Great Hall of the College in April 1998. The theme was ‘Nobles and Nobility in the Middle Ages’, and the conference was planned to enable comparisons to be made across time, from the fifth to the late fifteenth century, and between very different areas and phases of political development, embracing regions as diverse as England (before and after the Norman Conquest), France, Poland, the Romano-German empire, Norway, and Portugal. One of the highlights of the conference was a performance of courtly music presented in the College Chapel by members of the College Choir, under the direction of Mr David Trendell.
Our grateful thanks are due to the British Academy, the Royal Historical Society, and the Humanties Research Committee of King's College London, all of whom provided financial assistance for various aspects of the Conference; to the Isobel Thornley Bequest, whose generous grant made possible the publication of this volume; to the Music faculty of King's for use of the Viscount St David's Room; to the Dean of King's, who allowed the College Chapel to be used for the concert; and to Janet L. Nelson, who translated the papers presented by Martin Aurell and Régine Le Jan.
In addition, the editor wishes to thank the Musées du Mans and the Radio Times Hutton Picture Library for permission to reproduce the illustrations in Plates 1 and 2.