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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, MD 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, MD 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
Journal: Psychological Medicine , First View
Published online by Cambridge University Press: 12 July 2019, pp. 1-13
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.
Influence of green light illumination at night on biological characteristics of the oriental armyworm, Mythimna separata (Lepidoptera: Noctuidae)
K.-N. Kim, Y.-C. Jo, Z.-J. Huang, Hye-Seng Song, K.-H. Ryu, Q.-Y. Huang, C.-L. Lei
Journal: Bulletin of Entomological Research , First View
Published online by Cambridge University Press: 17 June 2019, pp. 1-8
The oriental armyworm, Mythimna separata is an important crop pest in eastern Asia. Nocturnal insects, including nocturnal moths, have phototactic behavior to an artificial light source. Phototactic behavior in insects is species-specific in response to different wavelengths of light sources. Our previous study showed that green (520 nm) light emitting diode (LED) light resulted in a significantly higher phototactic behavior in M. separata moths compared to the other wavelength LED lights. The goal of the present study is to investigate the influence of green light illumination on biological characteristics of different developmental stages in M. separata. Our results revealed that when different developmental stages of M. separata were exposed to the green light illumination in a dark period, several biological characteristics in all developmental stages except for egg stage were positively changed, but those of F1 generation M. separata which are next generation of the adults exposed to the green light did not significantly change compared with the control level. These findings suggest that green light illumination at night (or dark period) has a positive effect on the development and longevity of M. separata.
Complete sequence analysis of human norovirus GII.17 detected in South Korea
H. Kim, Y. J. Won, L. H. Kang, A. R. Lee, J. I. Han, C. I. Suh, S. Y. Paik
Journal: Epidemiology & Infection / Volume 147 / 2019
Published online by Cambridge University Press: 29 May 2019, e203
Norovirus, a major cause of gastroenteritis in people of all ages worldwide, was first reported in South Korea in 1999. The most common causal agents of pediatric acute gastroenteritis are norovirus and rotavirus. While vaccination has reduced the pediatric rotavirus infection rate, norovirus vaccines have not been developed. Therefore, prediction and prevention of norovirus are very important. Norovirus is divided into genogroups GI–GVII, with GII.4 being the most prevalent. However, in 2012–2013, GII.17 showed a higher incidence than GII.4 and a novel variant, GII.P17-GII.17, appeared. In this study, 204 stool samples collected in 2013–2014 were screened by reverse transcriptase-polymerase chain reaction; 11 GI (5.39%) and 45 GII (22.06%) noroviruses were identified. GI.4, GI.5, GII.4, GII.6 and GII.17 were detected. The whole genomes of the three norovirus GII.17 were sequenced. The whole genome of GII.17 consists of three open reading frames of 5109, 1623 and 780 bp. Compared with 20 GII.17 strains isolated in other countries, we observed numerous changes in the protruding P2 domain of VP1 in the Korean GII.17 viruses. Our study provided genome information that might aid in epidemic prevention, epidemiology studies and vaccine development.
Evidence of causal effect of major depression on alcohol dependence: findings from the psychiatric genomics consortium
Renato Polimanti, Roseann E. Peterson, Jue-Sheng Ong, Stuart MacGregor, Alexis C. Edwards, Toni-Kim Clarke, Josef Frank, Zachary Gerring, Nathan A. Gillespie, Penelope A. Lind, Hermine H. Maes, Nicholas G. Martin, Hamdi Mbarek, Sarah E. Medland, Fabian Streit, Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium, Substance Use Disorder Working Group of the Psychiatric Genomics Consortium, 23andMe Research Team, Arpana Agrawal, Howard J. Edenberg, Kenneth S. Kendler, Cathryn M. Lewis, Patrick F. Sullivan, Naomi R. Wray, Joel Gelernter, Eske M. Derks
Journal: Psychological Medicine / Volume 49 / Issue 7 / May 2019
Published online by Cambridge University Press: 01 April 2019, pp. 1218-1226
Print publication: May 2019
Despite established clinical associations among major depression (MD), alcohol dependence (AD), and alcohol consumption (AC), the nature of the causal relationship between them is not completely understood. We leveraged genome-wide data from the Psychiatric Genomics Consortium (PGC) and UK Biobank to test for the presence of shared genetic mechanisms and causal relationships among MD, AD, and AC.
Linkage disequilibrium score regression and Mendelian randomization (MR) were performed using genome-wide data from the PGC (MD: 135 458 cases and 344 901 controls; AD: 10 206 cases and 28 480 controls) and UK Biobank (AC-frequency: 438 308 individuals; AC-quantity: 307 098 individuals).
Positive genetic correlation was observed between MD and AD (rgMD−AD = + 0.47, P = 6.6 × 10−10). AC-quantity showed positive genetic correlation with both AD (rgAD−AC quantity = + 0.75, P = 1.8 × 10−14) and MD (rgMD−AC quantity = + 0.14, P = 2.9 × 10−7), while there was negative correlation of AC-frequency with MD (rgMD−AC frequency = −0.17, P = 1.5 × 10−10) and a non-significant result with AD. MR analyses confirmed the presence of pleiotropy among these four traits. However, the MD-AD results reflect a mediated-pleiotropy mechanism (i.e. causal relationship) with an effect of MD on AD (beta = 0.28, P = 1.29 × 10−6). There was no evidence for reverse causation.
This study supports a causal role for genetic liability of MD on AD based on genetic datasets including thousands of individuals. Understanding mechanisms underlying MD-AD comorbidity addresses important public health concerns and has the potential to facilitate prevention and intervention efforts.
Inflammatory cytokines and mononuclear cells in sudden sensorineural hearing loss
S H Yoon, M E Kim, H Y Kim, J S Lee, C H Jang
Journal: The Journal of Laryngology & Otology / Volume 133 / Issue 2 / February 2019
Published online by Cambridge University Press: 11 February 2019, pp. 95-101
This study evaluated tumour necrosis factor-α, interleukins 10 and 12, and interferon-γ levels, peripheral blood mononuclear cells, and clusters of differentiation 17c and 86 expression in unilateral sudden sensorineural hearing loss.
Twenty-four patients with unilateral sudden sensorineural hearing loss, and 24 individuals with normal hearing and no history of sudden sensorineural hearing loss (who were attending the clinic for other problems), were enrolled. Peripheral blood mononuclear cells, and clusters of differentiation 11c and 86 were isolated and analysed. Plasma and supernatant levels of tumour necrosis factor-α, interferon-γ, and interleukins 10 and 12 were measured.
There were no significant differences with respect to age and gender. Monocyte population, mean tumour necrosis factor-α level and cluster of differentiation 86 expression were significantly increased in the study group compared to the control group. However, interferon-γ and interleukin 12 levels were significantly decreased. The difference in mean interleukin 10 level was not significant.
Increases in tumour necrosis factor-α level and monocyte population might play critical roles in sudden sensorineural hearing loss. This warrants detailed investigation and further studies on the role of dendritic cells in sudden sensorineural hearing loss.
Diarrhoea, enteric pathogen detection and nutritional indicators among controls in the Global Enteric Multicenter Study, Kenya site: an opportunity to understand reference populations in case–control studies of diarrhoea
D. M. Berendes, C. E. O'Reilly, S. Kim, R. Omore, J. B. Ochieng, T. Ayers, K. Fagerli, T. H. Farag, D. Nasrin, S. Panchalingam, J. P. Nataro, K. L. Kotloff, M. M. Levine, J. Oundo, K. Laserson, R. F. Breiman, E. D. Mintz
Published online by Cambridge University Press: 15 November 2018, e44
Given the challenges in accurately identifying unexposed controls in case–control studies of diarrhoea, we examined diarrhoea incidence, subclinical enteric infections and growth stunting within a reference population in the Global Enteric Multicenter Study, Kenya site. Within 'control' children (0–59 months old without diarrhoea in the 7 days before enrolment, n = 2384), we examined surveys at enrolment and 60-day follow-up, stool at enrolment and a 14-day post-enrolment memory aid for diarrhoea incidence. At enrolment, 19% of controls had ⩾1 enteric pathogen associated with moderate-to-severe diarrhoea ('MSD pathogens') in stool; following enrolment, many reported diarrhoea (27% in 7 days, 39% in 14 days). Controls with and without reported diarrhoea had similar carriage of MSD pathogens at enrolment; however, controls reporting diarrhoea were more likely to report visiting a health facility for diarrhoea (27% vs. 7%) or fever (23% vs. 16%) at follow-up than controls without diarrhoea. Odds of stunting differed by both MSD and 'any' (including non-MSD pathogens) enteric pathogen carriage, but not diarrhoea, suggesting control classification may warrant modification when assessing long-term outcomes. High diarrhoea incidence following enrolment and prevalent carriage of enteric pathogens have implications for sequelae associated with subclinical enteric infections and for design and interpretation of case–control studies examining diarrhoea.
Polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) in urban soils of Glasgow, UK
Alexander W. Kim, Christopher H. Vane, Vicky L. Moss-Hayes, Darren J. Beriro, C. Paul Nathanail, Fiona M. Fordyce, Paul A. Everett
Journal: Earth and Environmental Science Transactions of The Royal Society of Edinburgh / Volume 108 / Issue 2-3 / January 2019
Concentrations of total organic carbon (TOC), total petroleum hydrocarbons, polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) were determined in 84 near-surface soils (5–20cm depth) taken from a 255km2 area of Glasgow in the Clyde Basin, UK, during July 2011. Total petroleum hydrocarbon range was 79–2,505mgkg–1 (mean 388mgkg–1; median 272mgkg–1) of which the aromatic fraction was 13–74 % (mean 44 %, median 43 %) and saturates were 28–87 % (mean 56 %, median 57 %). ∑16 PAH varied from 2–653mgkg–1 (mean 32.4mgkg–1; median 12.5mgkg–1) and ∑31 PAH range was 2.47–852mgkg–1 (mean 45.4mgkg–1; median 19.0mgkg–1). ∑PCBtri-hepta range was 2.2–1052μgkg–1 (mean 32.4μgkg–1; median 12.7μgkg–1) and the ∑PCB7 range was 0.3–344μgkg–1 (mean 9.8μgkg–1; median 2.7μgkg–1). The concentration, distribution and source of the persistent organic pollutants were compared with those found in urban soils from other cities and to human health assessment criteria for chronic exposure to chemicals in soil. Total concentrations encountered were generally similar to other urban areas that had a similar industrial history. Benzo[a]pyrene concentrations were assessed against four different land use scenarios (irrespective of current land use) using generic assessment criteria resulting in six of 84 samples exceeding the residential criteria. Isomeric PAH ratios and relative abundance of perylene suggest multiple and environmentally modified pyrogenic PAH sources, inferred to be representative of diffuse pollution. ∑PCB7 concentrations were exceeded in 10 % of sites using the Dutch target value of 20μgkg–1. PCB congener profiles were environmentally attenuated and generally dominated by penta-, hexa- and hepta-chlorinated congeners.
Factors affecting piglet mortality during the first 24 h after the onset of parturition in large litters: effects of farrowing housing on behaviour of postpartum sows
J. Yun, T. Han, S. Björkman, M. Nystén, S. Hasan, A. Valros, C. Oliviero, Y. Kim, O. Peltoniemi
Journal: animal / Volume 13 / Issue 5 / May 2019
The present study aimed to identify the factors that affect immediate (within 24 h after farrowing onset) postnatal piglet mortality in litters with hyperprolific sows, and investigate their associations with behaviour of postpartum sows in two different farrowing housing systems. A total of 30 sows were housed in: (1) CRATE (n=15): the farrowing crate closed (0.80×2.20 m) within a pen (2.50×1.70 m), and (2) OPEN (n=15): the farrowing crate open (0.80×2.20×1.80 m) within a pen (2.50×2.40 m) with a provision of 20 ls of hay in a rack. A total of 518 live born piglets, produced from the 30 sows, were used for data analyses during the first 24 h after the onset of parturition (T24). Behavioural observations of the sows were assessed via video analyses during T24. Total and crushed piglet mortality rates were higher in OPEN compared with CRATE (P<0.01, for both). During T24, the OPEN sows tended to show higher frequency of postural changes (P=0.07) and duration of standing (P=0.10), and showed higher frequencies of bar-biting (P<0.05) and piglet trapping (P<0.01), when compared with the CRATE sows. During T24, the mortality rates caused by crushing were correlated with the piglet trapping event (r=0.93, P<0.0001), postural changes (r=0.37, P<0.01), duration of standing (r=0.32, P<0.01) and frequency of bar-biting behaviour (r=0.51, P<0.01) of the sows (n=30). In conclusion, immediate postnatal piglet mortality, mainly due to crushing, may be associated with potential increases in frequency of postural changes, duration of standing and incidence of piglet trapping in postpartum sows in the open crate system with large litters.
Longitudinal association between trust, psychological symptoms and community engagement in resettled refugees
Angela Nickerson, Belinda J. Liddell, David Keegan, Ben Edwards, Kim L. Felmingham, David Forbes, Dusan Hadzi-Pavlovic, Alexander C. McFarlane, Meaghan O'Donnell, Derrick Silove, Zachary Steel, Miranda van Hooff, Richard A. Bryant
Journal: Psychological Medicine / Volume 49 / Issue 10 / July 2019
Published online by Cambridge University Press: 30 August 2018, pp. 1661-1669
Print publication: July 2019
The mental health and social functioning of millions of forcibly displaced individuals worldwide represents a key public health priority for host governments. This is the first longitudinal study with a representative sample to examine the impact of interpersonal trust and psychological symptoms on community engagement in refugees.
Participants were 1894 resettled refugees, assessed within 6 months of receiving a permanent visa in Australia, and again 2–3 years later. Variables measured included post-traumatic stress disorder symptoms, depression/anxiety symptoms, interpersonal trust and engagement with refugees' own and other communities.
A multilevel path analysis was conducted, with the final model evidencing good fit (Comparative Fit Index = 0.97, Tucker–Lewis Index = 0.89, Root Mean Square Error of Approximation = 0.05, Standardized Root-Mean-Square-Residual = 0.05). Findings revealed that high levels of depression symptoms were associated with lower subsequent engagement with refugees' own communities. In contrast, low levels of interpersonal trust were associated with lower engagement with the host community over the same timeframe.
Findings point to differential pathways to social engagement in the medium-term post-resettlement. Results indicate that depression symptoms are linked to reduced engagement with one's own community, while interpersonal trust is implicated in engagement with the broader community in the host country. These findings have potentially important implications for policy and clinical practice, suggesting that clinical and support services should target psychological symptoms and interpersonal processes when fostering positive adaptation in resettled refugees.
Microstructural Development in Melt-spun Nd2Fe14B Under High Magnetic Field Annealing
Lin Zhou, Tae-Hoon Kim, Brandt Jensen, Kewei Sun, Olena Palasyuk, Ikenna C. Nlebedim, Matthew J. Kramer, Michael A. McGuire, Orlando Rios, Ben S. Conner, William G. Carter, Michael S. Kesler
Journal: Microscopy and Microanalysis / Volume 24 / Issue S1 / August 2018
Published online by Cambridge University Press: 01 August 2018, pp. 958-959
Spatially localized multi-scale energy transfer in turbulent premixed combustion
J. Kim, M. Bassenne, C. A. Z. Towery, P. E. Hamlington, A. Y. Poludnenko, J. Urzay
Journal: Journal of Fluid Mechanics / Volume 848 / 10 August 2018
Published online by Cambridge University Press: 04 June 2018, pp. 78-116
Print publication: 10 August 2018
A three-dimensional wavelet multi-resolution analysis of direct numerical simulations of a turbulent premixed flame is performed in order to investigate the spatially localized spectral transfer of kinetic energy across scales in the vicinity of the flame front. A formulation is developed that addresses the compressible spectral dynamics of the kinetic energy in wavelet space. The wavelet basis enables the examination of local energy spectra, along with inter-scale and subfilter-scale (SFS) cumulative energy fluxes across a scale cutoff, all quantities being available either unconditioned or conditioned on the local instantaneous value of the progress variable across the flame brush. The results include the quantification of mean spectral values and associated spatial variabilities. The energy spectra undergo, in most locations in the flame brush, a precipitous drop that starts at scales of the same order as the characteristic flame scale and continues to smaller scales, even though the corresponding decrease of the mean spectra is much more gradual. The mean convective inter-scale flux indicates that convection increases the energy of small scales, although it does so in a non-conservative manner due to the high aspect ratio of the grid, which limits the maximum scale level that can be used in the wavelet transform, and to the non-periodic boundary conditions, which exchange energy through surface forces, as explicitly elucidated by the formulation. The mean pressure-gradient inter-scale flux extracts energy from intermediate scales of the same order as the characteristic flame scale, and injects energy in the smaller and larger scales. The local SFS-cumulative contribution of the convective and pressure-gradient mechanisms of energy transfer across a given cutoff scale imposed by a wavelet filter is analysed. The local SFS-cumulative energy flux is such that the subfilter scales upstream from the flame always receive energy on average. Conversely, within the flame brush, energy is drained on average from the subfilter scales by convective and pressure-gradient effects most intensely when the filter cutoff is larger than the characteristic flame scale.
P.002 Exosomal miR-204-5 and miR-632 in CSF are candidate biomarkers for frontotemporal dementia: a GENFI study
R Schneider, P McKeever, T Kim, C Graff, J van Swieten, A Karydas, A Boxer, H Rosen, B Miller, R Laforce, D Galimberti, M Masellis, B Borroni, Z Zhang, L Zinman, JD Rohrer, MC Tartaglia, J Robertson
Journal: Canadian Journal of Neurological Sciences / Volume 45 / Issue s2 / June 2018
Published online by Cambridge University Press: 27 June 2018, p. S16
Background: To determine whether exosomal microRNAs (miRNAs) in CSF of patients with FTD can serve as diagnostic biomarkers, we assessed miRNA expression in the Genetic FTD Initiative (GENFI) cohort and in sporadic FTD. Methods: GENFI participants were either carriers of a pathogenic mutation or at risk of carrying a mutation because a first-degree relative was a symptomatic mutation carrier. Exosomes were isolated from CSF of 23 -pre-symptomatic and 15 symptomatic mutation carriers, and 11 healthy non-mutation carriers. Expression of miRNAs was measured using qPCR arrays. MiRNAs differentially expressed in symptomatic compared to pre-symptomatic mutation carriers were evaluated in 17 patients with sporadic FTD, 13 patients with sporadic Alzheimer's disease (AD), and 10 healthy controls (HCs). Results: In the GENFI cohort, miR-204-5p and miR-632 were significantly decreased in symptomatic compared to pre-symptomatic mutation carriers. Decrease of miR-204-5p and miR-632 revealed receiver operator characteristics with an area of 0.89 [90% CI: 0.79-0.98] and 0.81 [90% CI: 0.68-0.93], and when combined an area of 0.93 [90% CI: 0.87-0.99]. In sporadic FTD, only miR-632 was significantly decreased compared to sporadic AD and HCs. Decrease of miR-632 revealed an area of 0.89 [90% CI: 0.80-0.98]. Conclusions: Exosomal miR-204-5p and miR-632 have potential as diagnostic biomarkers for genetic FTD and miR-632 also for sporadic FTD.
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
Journal: The British Journal of Psychiatry / Volume 212 / Issue 6 / June 2018
Published online by Cambridge University Press: 02 May 2018, pp. 377-385
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.
MP23: A collaborative quality improvement initiative to improve the time to electrocardiogram in patients with chest pain presenting to the emergency department
H. C. Lindsay, J. Gallaher, C. Wright, L. Korchinski, C. Kim Sing
Journal: Canadian Journal of Emergency Medicine / Volume 20 / Issue S1 / May 2018
Published online by Cambridge University Press: 11 May 2018, pp. S48-S49
Introduction: For patients with chest pain, the target time from first medical contact to obtaining an electrocardiogram (ECG) is 10 minutes, as reperfusion within 120 minutes can reduce the risk of death and adverse outcomes in patients with ST elevation myocardial infarction (STEMI). In 2007, Vancouver Coastal Health (VCH) began tracking key indicators including time to first ECG. The Vancouver General Hospital (VGH) Emergency Department (ED) has been troubled with the longest door to ECG times in the region since 2014. In 2016, the VGH ED Quality Council developed a strategy to address this issue, with an aim of obtaining ECGs on 95% of patients presenting to the VGH ED with active chest pain within 10 minutes of presentation within a 6 month period. Methods: The VGH ED Quality Council brought together frontline clinicians, ECG technicians, and other stakeholders and completed a process map. We obtained baseline data regarding the median time to ECG in both patients with STEMI and all patients presenting with chest pain. Root cause analysis determined two main barriers: access to designated space to obtain ECGs, and the need for patients to be registered in the computer system before an ECG could be ordered. The team identified strategies to eliminate these barriers, identifying a dedicated space and undergoing multiple PDSA cycles to change the workflow to stream patients to this space before registration. Results: Our median times in patients with STEMI have gone from 33 minutes to 8 minutes as of June 2017. In all patients presenting with chest pain, we improved from a median of 36 to 17 minutes. As of April 2017 we are obtaining an ECG within 10 minutes in 27% of our patients, compared to 3% in 2016. Given the limitations in our data extraction process, we were not able to differentiate between patients with active chest pain versus those whose chest pain had resolved. Conclusion: By involving frontline staff, and having frontline champions providing real time support, we were able to make significant changes to the culture at triage. We cultivated sustainability by changing the workflow and physical space, and not relying on education only. While we have improved the times for our walk-in patients, we have not perfected the process when a patient moves immediately to a bed or presents via ambulance. Implementing small changes and incorporating feedback has allowed us to identify these new challenges early.
MP44: TEC4Home heart failure: using home telemonitoring to decrease ED readmissions and clinical flow
H. Novak Lauscher, K. Ho, J. L. Cordeiro, A. Bhullar, R. Abu Laban, J. Christenson, H. Harps, N. Hawkins, E. Karim, C. Kim Sing, C. McGavin, C. Mitton, T. Smith
Introduction: Patients with Heart failure (HF) experience frequent decompensation necessitating multiple emergency department (ED) visits and hospitalizations. If patients are able to receive timely interventions and optimize self-management, recurrent ED visits may be reduced. In this feasibility study, we piloted the application of home telemonitoring to support the discharge of HF patients from hospital to home. We hypothesized that TEC4Home would decrease ED revisits and hospital admissions and improve patient health outcomes. Methods: Upon discharge from the ED or hospital, patients with HF received a blood pressure cuff, weight scale, pulse oximeter, and a touchscreen tablet. Participants submitted measurements and answered questions on the tablet about their HF symptoms daily for 60 days. Data were reviewed by a monitoring nurse. From November 2016 to July 2017, 69 participants were recruited from Vancouver General Hospital (VGH), St. Pauls Hospital (SPH) and Kelowna General Hospital (KGH). Participants completed pre-surveys at enrollement and post-surveys 30 days after monitoring finished. Administrative data related to ED visits and hospital admissions were reviewed. Interviews were conducted with the monitoring nurses to assess the impact of monitoring on patient health outcomes. Results: A preliminary analysis was conducted on a subsample of participants (n=22) enrolled across all 3 sites by March 31, 2017. At VGH and SPH (n=14), 25% fewer patients required an ED visit in the post-survey reporting compared to pre-survey. During the monitoring period, the monitoring nurse observed seven likely avoided ED admissions due to early intervention. In total, admissions were reduced by 20% and total hospital length of stay reduced by 69%. At KGH (n=8), 43% fewer patients required an ED visit in the post-survey reporting compared to the pre-survey. Hospital admissions were reduced by 20% and total hospital length of stay reduced by 50%. Overall, TEC4Home participants from all sites showed a significant improvement in health-related quality of life and in self-care behaviour pre- to 90 days post-monitoring. A full analysis of the 69 patients will be complete in February 2018. Conclusion: Preliminary findings indicate that home telemonitoring for HF patients can decrease ED revisits and improve patient experience. The length of stay data may also suggest the potential for early discharge of ED patients with home telemonitoring to avoid or reduce hospitalization. A stepped-wedge randomized controlled trial of TEC4Home in 22 BC communities will be conducted in 2018 to generate evidence and scale up the service in urban, regional and rural communities. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.
HIV and viral hepatitis coinfection analysis using surveillance data from 15 US states and two cities
K. A. Bosh, J. R. Coyle, V. Hansen, E. M. Kim, S. Speers, M. Comer, L. M. Maddox, S. Khuwaja, W. Zhou, A. Jatta, R. Mayer, A. D. Brantley, N. W. Muriithi, R. Bhattacharjee, C. Flynn, L. Bouton, B. John, J. Keusch, C. A. Barber, K. Sweet, C. Ramaswamy, E. F. Westheimer, L. VanderBusch, A. Nishimura, A. Vu, L. Hoffman-Arriaga, E. Rowlinson, A. O. Carter, L. E. Yerkes, W. Li, J. R. Reuer, L. J. Stockman, T. Tang, J. T. Brooks, E. H. Teshale, H. I. Hall
Journal: Epidemiology & Infection / Volume 146 / Issue 7 / May 2018
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.
A vascular endothelial growth factor A genetic variant is associated with improved ventricular function and transplant-free survival after surgery for non-syndromic CHD
Constantine D. Mavroudis, Daniel Seung Kim, Nancy Burnham, Alexandra H. Morss, Jerry H. Kim, Amber A. Burt, David R. Crosslin, Donna M. McDonald-McGinn, Elaine H. Zackai, Meryl S. Cohen, Susan C. Nicolson, Thomas L. Spray, Ian B. Stanaway, Deborah A. Nickerson, Mark W. Russell, Hakon Hakonarson, Gail P. Jarvik, J. William Gaynor
Journal: Cardiology in the Young / Volume 28 / Issue 1 / January 2018
Published online by Cambridge University Press: 20 September 2017, pp. 39-45
We have previously shown that the minor alleles of vascular endothelial growth factor A (VEGFA) single-nucleotide polymorphism rs833069 and superoxide dismutase 2 (SOD2) single-nucleotide polymorphism rs2758331 are both associated with improved transplant-free survival after surgery for CHD in infants, but the underlying mechanisms are unknown. We hypothesised that one or both of these minor alleles are associated with better systemic ventricular function, resulting in improved survival.
This study is a follow-up analysis of 422 non-syndromic CHD patients who underwent neonatal cardiac surgery with cardiopulmonary bypass. Echocardiographic reports were reviewed. Systemic ventricular function was subjectively categorised as normal, or as mildly, moderately, or severely depressed. The change in function was calculated as the change from the preoperative study to the last available study. Stepwise linear regression, adjusting for covariates, was performed for the outcome of change in ventricular function. Model comparison was performed using Akaike's information criterion. Only variables that improved the model prediction of change in systemic ventricular function were retained in the final model.
Genetic and echocardiographic data were available for 335/422 subjects (79%). Of them, 33 (9.9%) developed worse systemic ventricular function during a mean follow-up period of 13.5 years. After covariate adjustment, the presence of the VEGFA minor allele was associated with preserved ventricular function (p=0.011).
These data support the hypothesis that the mechanism by which the VEGFA single-nucleotide polymorphism rs833069 minor allele improves survival may be the preservation of ventricular function. Further studies are needed to validate this genotype–phenotype association and to determine whether this mechanism is related to increased vascular endothelial growth factor production.
The Engineering Development Array: A Low Frequency Radio Telescope Utilising SKA Precursor Technology
Randall Wayth, Marcin Sokolowski, Tom Booler, Brian Crosse, David Emrich, Robert Grootjans, Peter J. Hall, Luke Horsley, Budi Juswardy, David Kenney, Kim Steele, Adrian Sutinjo, Steven J. Tingay, Daniel Ung, Mia Walker, Andrew Williams, A. Beardsley, T. M. O. Franzen, M. Johnston-Hollitt, D. L. Kaplan, M. F. Morales, D. Pallot, C. M. Trott, C. Wu
Journal: Publications of the Astronomical Society of Australia / Volume 34 / 2017
Published online by Cambridge University Press: 17 August 2017, e034
We describe the design and performance of the Engineering Development Array, which is a low-frequency radio telescope comprising 256 dual-polarisation dipole antennas working as a phased array. The Engineering Development Array was conceived of, developed, and deployed in just 18 months via re-use of Square Kilometre Array precursor technology and expertise, specifically from the Murchison Widefield Array radio telescope. Using drift scans and a model for the sky brightness temperature at low frequencies, we have derived the Engineering Development Array's receiver temperature as a function of frequency. The Engineering Development Array is shown to be sky-noise limited over most of the frequency range measured between 60 and 240 MHz. By using the Engineering Development Array in interferometric mode with the Murchison Widefield Array, we used calibrated visibilities to measure the absolute sensitivity of the array. The measured array sensitivity matches very well with a model based on the array layout and measured receiver temperature. The results demonstrate the practicality and feasibility of using Murchison Widefield Array-style precursor technology for Square Kilometre Array-scale stations. The modular architecture of the Engineering Development Array allows upgrades to the array to be rolled out in a staged approach. Future improvements to the Engineering Development Array include replacing the second stage beamformer with a fully digital system, and to transition to using RF-over-fibre for the signal output from first stage beamformers.
Lateral neck dissection affects the voice in thyroid cancer patients
I-C Nam, J-S Bae, S-H Lee, J-O Park, S-Y Kim, Y-H Joo, Y-H Park, D-I Sun
Journal: The Journal of Laryngology & Otology / Volume 131 / Issue 10 / October 2017
Print publication: October 2017
This study aimed to identify the effect of lateral neck dissection on voice change in thyroidectomised patients.
Medical records from 264 patients who underwent thyroidectomy with (n = 65) or without (n = 199) lateral neck dissection were reviewed. Clinical and voice evaluation data were compared between the two groups.
Patients who underwent surgery that included lateral neck dissection had lower fundamental frequencies and speaking fundamental frequencies. They also had a higher incidence of asymmetric mucosal wave and vocal fold oedema on videostroboscopy during the first month after surgery, with the incidence of vocal fold oedema remaining significantly higher at three months. Self-assessed voice quality scores were significantly higher in lateral neck dissection patients at both one and three months after surgery.
In thyroidectomised patients, lateral neck dissection lowers the vocal pitch in the initial period after surgery and induces vocal fold oedema that persists for several months. Although most objective parameters improved within a month, subjective symptoms lasted for longer.
Epidemiology and hospital readmission associated with complications of Staphylococcus aureus bacteremia in pediatrics over a 25-year period
J. LE, Q. DAM, T. TRAN, A. NGUYEN, F. C. ADLER-SHOHET, S. KIM, K. SCHMIDT, J. M. LIEBERMAN, J. S. BRADLEY
Journal: Epidemiology & Infection / Volume 145 / Issue 12 / September 2017
Published online by Cambridge University Press: 27 July 2017, pp. 2631-2639
We sought to comprehensively assess the prevalence and outcomes of complications associated with Staphylococcus aureus bacteremia (SAB) in children. Secondarily, prevalence of methicillin resistance and outcomes of complications from methicillin-resistant S. aureus (MRSA) vs. methicillin-susceptible S. aureus SAB were assessed. This is a single-center cross-sectional study of 376 patients ⩽18 years old with SAB in 1990–2014. Overall, 197 (52%) patients experienced complications, the most common being osteomyelitis (33%), skin and soft tissue infection (31%), and pneumonia (25%). Patients with complications were older (median 3 vs. 0·7 years, P = 0·05) and more had community-associated SAB (66% vs. 34%, P = 0·001). Fewer patients with complications had a SAB-related emergency department or hospital readmission (10% vs. 19%, P = 0·014). Prevalence of methicillin resistance increased from 1990–1999 to 2000–2009, but decreased in 2010–2014. Complicated MRSA bacteremia resulted in more intensive care unit admissions (66% vs. 47%, P = 0·03) and led to increased likelihood of having ⩾2 foci (58% vs. 26%, P < 0·001). From multivariate analysis, community-associated SAB increased risk and concurrent infections decreased risk of complications (odds ratio (OR) 1·82 (1·1–3·02), P = 0·021) and (OR 0·58 (0·34–0·97), P = 0·038), respectively. In conclusion, children with SAB should be carefully evaluated for complications. Methicillin resistance remains associated with poor outcomes but have decreased in overall prevalence.


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Drone Geofencing
Professional drone management software
GestaDRONE
Remote pilot
Non-standard scenarios : explainations and impacts
Non-standard scenarios : explainations and…
Non-standard and European drone scenarios: good to know.
From December 2, 2021 (the date could be postponed by 2 years), any new drone operator will have to use European scenarios as part of their ConOPs. Existing drone operators will be able to continue carrying out their missions under national scenarios (S1, S2, S3) until December 31, 2023 if they wish. Today's post aims to recall the European drone scenarios defined under European drone regulations with a strong focus on non-standard scenarios.
European drone scenarios of the open category
There are 3 European scenarios: A1, A2 and A3. They concern low-risk operations: visual flights at a height of less than 120 meters outside the public space of urban areas with class UAS C0, C1, C2, C3, C4.
Classless series drones will be able to operate in a limited open category (A1 limited, A2 limited, A3 limited) during the transition period. These are the same scenarios with a few more stringent restrictions.
European drone scenarios of the specific category
The standard scenario (STS-1) covers line-of-sight operations (VLOS) carried out with a class C5 UAS (CE marked) at a maximum height of 120 m above a controlled area on the ground in a populated environment and / or unpopulated. This scenario has strong similarities with the national S3 scenario (in populated areas).
The standard scenario (STS-2) covers operations that can be carried out out of sight (BVLOS) in an unpopulated or sparsely populated environment, with the UAS located at a maximum distance of 1 km from the remote pilot. This distance can be increased to 2 km if airspace observers are present.
The evolutions take place at a maximum height of 120 m above a controlled area on the ground in an environment with low population density, with a UAS of class C6 (CE marking). This scenario has strong similarities with the national S2 scenario.
Non-standard European drone scenarios
The open and specific categories cover the vast majority of drone uses. However, in rare cases it may be necessary to fly outside of these scenarios. Three cases were identified by the aviation authorities:
SORAs (Specific Operations Risk Assessment)
SORA is a systematic risk assessment methodology for the types of drone operations subject to prior authorization. The method makes it possible to establish a sufficient level of confidence for the DGAC to grant an operating license to the operator.
It allows the evaluation of the concept of operation envisaged and its breakdown into 6 specific levels of assurance and integrity (S.A.I.L.). It then recommends the objectives to be achieved for each level of S.A.I.L., in line with the means to be implemented to make these risks acceptable and therefore theft possible.
The authorization request (covering one or more operations) is made to the DSAC / IR.
PDRAs (Pre-Defined Risk Assessment)
PDRAs are used for classless drones, for drones whose characteristics do not allow classification or for drones operating in specific high risk environments.
It aims to simplify the authorization procedure as the risks (SAIL) have already been assessed using the SORA methodology by EASA.
There are two types of PDRA: PDRA-S (These PDRAs are modeled on European STS, except that the drone does not carry a class identification label) and PDRA-G (These PDRAs cover other types of exploitation relatively common in the EU).
PDRA-S01 (PDRA "mirror" of the STS-01), allowing to fly under the conditions of this scenario without a CE marked C5 drone but with similar characteristics, to be demonstrated by the operator;
PDRA-S02 (STS-02 "mirror" PDRA), allowing flight under the conditions of this scenario without a CE-marked C6 drone (but with similar characteristics, to be demonstrated by the operator);
PDRA-G01 (formerly PDRA-01). Flight out of sight in sparsely populated area, at less than 120m in height, less than 1km distance from the remote pilot, or at a maximum distance of 1 km from a visual observer of the drone (also called "EVLOS": flight in extended view) ;
PDRA-G02: sight flight in sparsely populated area in airspace reserved for the operation;
PDRA-G03: flight out of view in "atypical" space (space sufficiently close to the ground or to obstacles for it to be possible to estimate that the probability of encountering a manned aircraft is very low) in an area of low population.
Possible applications are, for example: surveillance by autonomous drone, logistics transport drone above an industrial site, etc.). This PDRA is being evaluated by the EASA.
PDRA-G04: long-distance out of view type flight in non-segregated space and sparsely populated area (applications: high elongation operations, network surveillance, etc.).
Additional traffic detection measures (ADS-B in, FLARM, etc.) and notification to other airspace users are implemented to ensure a low probability of collision with a manned aircraft. It is on this PDRA that the continuation of "type S4" operations after 2021 will be based.
This PDRA is currently being evaluated by EASA.
LUC (Light UAS Operator Certificate)
The LUC is the equivalent of part of the MANEX. It contains in particular: (i) The privileges of the operator; (ii) The types of authorized operations; (iii) The applicable procedures; and (iv) A safety management system.
LUC holders have to meet high standards. In return, this legal entity obtains the right to practice with certain privileges.
It is intended for professional operators who mainly carry out repetitive operations. The operator holding an LUC can then carry out flights without having to make a declaration or obtain an administrative authorization.
It must be approved by a competent authority (DSNA or DSAC / IR) unlike the MANEX that we usually use. Hold an L.U.C. is very restrictive and not suitable for smallholders. The L.U.C. is rather intended for large contractors.
On January 1, 2021, the MAP disappeared from a national regulatory point of view in favor of the MANEX. This regulatory change thus allowed a French UAS operator to be able to operate in any European state (harmonization of operating procedures between the different member states.
During 2021, the DGAC, for the sake of supporting the transition, allowed operators to use their MAP under the name MANEX by: (i) Removing any reference to articles of law 2012, 2015 and 2017 ; (ii) Compliance with the decrees of December 20, 2020, in particular on night flights, French digital identification devices, etc.
As a drone operator, you will have to redesign your MANEX from December 2, 2021 using the European framework defined by EASA which will be put online at the end of July 2021 by the DGAC (Directorate General of Civil Aviation) .
This is evolving strongly and you will be asked to describe your activity in a much more detailed and structured way, called Concept of Operations (ConOPS). One of the key points of the change in regulations concerns the fact that the operator must specify for each of its ConOPS the list of aircraft and personnel authorized for execution.
In addition, there are many uncertainties regarding the time that will be necessary for drone manufacturers to approve their new drones (class of drones). It is therefore interesting for operators to find out about PDRAs or SORAs.
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AMCHP > About AMCHP > Newsletters > Pulse Newsletter > Archive > 2011 > September 2011 > Success Stories
Declining Infant Mortality Rates in Maryland: The Babies Born Healthy Initiative
By Bonnie S. Birkel, CRNP, BSN, MPH
Director, Maryland Center for Maternal and Child Health
As is the case in many states, racial and ethnic disparities exist for 10 of the 14 leading causes of death in Maryland. It is no surprise that infant mortality is among these. In recognition, Gov. O'Malley has made reducing infant mortality (and the racial disparity in infant mortality) one of the 15 strategic goals tracked by the Governor's Delivery Unit (GDU). Fortunately, Maryland experienced a 10 percent decrease in infant mortality rates from 2008 to 2009 and a 7 percent decrease from 2009 to 2010, reducing rates to 6.7 per 1,000 live births (click here for the full report). This success is due in part to efforts spearheaded by the Maryland Center for Maternal and Child Health (CMCH) with many public and private sector partners at the state and local level.
Babies Born Healthy (BBH) is a collaborative, interagency program focused on three primary strategies for improving birth outcomes – healthier women prior to and between pregnancies (i.e. interconception); early enrollment in prenatal care; and post-delivery follow-up for high-risk infants and mothers. Efforts have been targeted to jurisdictions where infant mortality and racial disparities in pregnancy outcomes are highest – Baltimore City, Prince George's County and Somerset County (Dorchester County was added in April 2011).
A new comprehensive women's health model has expanded family planning services to include risk assessment and screening for chronic diseases. Through close partnership with Medicaid, a new Accelerated Certification of Eligibility (ACE) process assures Medicaid-eligible women that they will have access to prenatal care as early as possible and a Quickstart prenatal care visit is offered at health departments in the target jurisdictions. To ensure that high-risk babies and mothers receive post-partum follow-up, a statewide standardized post-partum discharge referral process is being developed and a post-partum Infant and Maternal Referral Form has already been implemented statewide (more information available here).
Promoting safe sleep has also been an integral component of the program. A safe sleep video developed by the B'More for Healthy Babies program in Baltimore City has been distributed widely around the state (video available here). Key partners in all of these efforts have been the Department of Health and Mental Hygiene Office of Minority Health and Health Disparities, the Governor's Office on Children, the Maryland Department of Human Resources, the Community Health Resources Commission, the Maryland Patient Safety Center and Carefirst.
For more information on Babies Born Healthy, please contact Maura Dwyer, DrPH, Health Policy Analyst, Maryland Center for Maternal and Child Health, at (410) 767-3702 or mdwyer@dhmh.state.md.us.
The MIME and DIME Programs: Challenges and Successes of Implementing Interpregnancy Care among High-Risk Mississippi Women
By Juanita Graham, MSN RN
Connie Bish, PhD
Lei Zhang, PhD
Danielle Seale, LCSW
Mississippi has the highest state rate of infant mortality in the United States. Over the past several years, new studies and programs have been implemented to address maternal and infant health. Modeling a program implemented in Georgia, the Mississippi State Department of Health (MSDH) implemented pilot programs in two communities among women who delivered a very low birth weight infant. Very low birth weight accounts for more than half of Mississippi infant deaths each year. The pilot communities are predominantly African American with high rates of poverty, low birth weight (LBW) deliveries, infant mortality and morbidity combined with low rates of health insurance coverage and access to primary care services. The Metropolitan Infant Mortality Elimination (MIME) and Delta Infant Mortality Elimination (DIME) programs give varying perspectives – urban and rural – of implementing interpregnancy care in Mississippi.
The MIME and DIME projects have three aims for program participants: (1) Improve overall health status and optimize child spacing; (2) Reduce subsequent poor pregnancy outcomes; and (3) Share program findings with maternal and child health stakeholders. The projects are highly collaborative, incorporating partnerships and contractual agreements between state, private and community-based resources.
Since recruitment began in February 2009, 110 women have enrolled in the projects. Case studies of success stories and challenges are being documented. A large staff dispersed across a large geographic area in DIME provided unique challenges in case management that the urban MIME program did not experience. Extensive evaluation activities are being implemented to assess both health and financial outcomes. Early data suggest improved outcomes and achievement of adequate child spacing. With these successes in mind, the MSDH is implementing expanded access to basic components of the program. The vision for these programs is to provide more women with the knowledge and services needed to be proactive in reproductive health decisions and preconception health.
Generally speaking, healthier mothers have healthier babies. Thus, improving the health of mothers prior to pregnancy could improve outcomes for Mississippi infants and their families. If proven effective, MSDH plans to expand the MIME and DIME programs to other areas of the state upon availability of adequate funding. For more information, contact Juanita Graham, DNPc, MSN, RN, Health Services Chief Nurse, Mississippi State Department of Health at juanita.graham@msdh.state.ms.us.
HRSA/MCHB's Division of Healthy Start and Perinatal Services Interconception Care Learning Collaborative (ICC-LC)
By Stacey D. Cunningham, MSW, MPH
Executive Director, National Healthy Start Association
In 2008, the Division of Healthy Start and Perinatal Services (DHSPS) in the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB) launched one of the largest action learning collaboratives, with over 500 individuals representing the federal Healthy Start Initiative. The ICC LC strives to improve the health and well-being of women and infants served by all 104 Healthy Start grants by advancing the quality and effectiveness of women's health during interconception care in each project. The overarching goal is to apply a quality improvement "learning collaborative" model to improve non-clinical, community-based services in all Healthy Start communities across the country. DHSPS focused on interconception care and the outcomes show how ICC research can be translated into practice. Currently, the projects are completing the third cycle of the collaborative.
The ICC LC uses the Plan-Do-Study-Act (PDSA) model developed by the Institute for Healthcare Improvement to integrate evidence-based practice and innovative community-driven interventions to improve care in specific topic areas. Healthy Start grantees were placed in collaborative groups based on their choice of five core content areas from which they chose in each of the three cycles. These areas included case management; family panning/reproductive health; healthy weight; ICC risk screening/assessment; maternal depression; and primary care linkages. Within each core content area, each collaborative selects one of the three change concepts to work on within their individual project area. The three change areas are strengthening partnerships and linkages among community providers; advancing use of evidence-based tools, data collection and performance monitoring; and improving staff training and protocols to improve quality and consistency. A total of 16 collaboratives were formed with the 104 projects.
Each cycle helped grantees move forward in the collaborative process. Cycle I focused on training grantees on the PDSA process; Cycle II focused on creating and implementing measures; and Cycle III currently uses the continued and improved reporting of measures by each collaborative. Each of the 16 collaboratives chose common measures as a small group in Cycle II. The data collected from each collaborative demonstrated improvement and include examples, such as 31 linkages/partnerships were established, reestablished or strengthened; 111 women were screened using selected tools; and 87 Healthy Start community staff were trained on the updated or established protocols.
For more information on the Interconception Care Learning Collaborative, contact DHSPS at (301) 443-0543.


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Tanakh (Judaism)
Torah (Instruction)
Bereshit
Shemot
Wayiqra
Bemidbar
Nevi'im (Prophets)
Shofetim
Shemuel
Melakhim
Yeshayahu
Yirmeyahu
Yekhezqel
Ketuvim (Writings)
Mishlei
Five Megillot (Scrolls)
Shir Hashirim
Eikhah
Qohelet
Daniyyel
Ezra–Nehemiah
Divre Hayyamim
Old Testament (Christianity)
1–2 Kings
1–2 Chronicles
Major prophets
Deuterocanonical
Baruch / Letter of Jeremiah
Additions to Daniel
Orthodox only
Odes
Orthodox Tewahedo
1 Enoch
1, 2, and 3 Meqabyan
Paralipomena of Baruch
Broader canon
The Book of Proverbs (Hebrew: מִשְלֵי, Mīšlē, "Proverbs (of Solomon)") is a book in the third section (called Ketuvim) of the Hebrew Bible and a book of the Christian Old Testament.[1] When translated into Greek and Latin, the title took on different forms: in the Greek Septuagint (LXX) it became Παροιμίαι (Paroimiai, "Proverbs"); in the Latin Vulgate the title was Proverbia, from which the English name is derived.
Proverbs is not merely an anthology but a "collection of collections" relating to a pattern of life which lasted for more than a millennium.[2] It is an example of the biblical wisdom literature, and raises questions of values, moral behaviour, the meaning of human life, and right conduct,[3] and its theological foundation is that "the fear of God (meaning submission to the will of God) is the beginning of wisdom".[4] Wisdom is praised for her role in creation; God acquired her before all else, and through her he gave order to chaos; and since humans have life and prosperity by conforming to the order of creation, seeking wisdom is the essence and goal of life.[5]
Scroll of the Book of Proverbs
The superscriptions divide the collections as follows:
Proverbs 1–9: "Proverbs of Solomon, Son of David, King of Israel"
Proverbs 10–22:16: "Proverbs of Solomon"
Proverbs 22:17–24:22: "The Sayings of the Wise"
Proverbs 24:23–34: "These Also are Sayings of the Wise"
Proverbs 25–29: "These are Other Proverbs of Solomon that the Officials of King Hezekiah of Judah Copied"
Proverbs 30: "The Words of Agur"
Proverbs 31:1–9: "The Words of King Lemuel of Massa,[a] Which his Mother Taught Him"
Proverbs 31:10–31: the ideal wise woman (elsewhere called the "woman of substance").[7]
Papyrus Bodmer VI, featuring a Coptic translation of Proverbs (4th/5th century AD)
"Proverb" is a translation of the Hebrew word mashal, but "mashal" has a wider range of meanings than the short, catchy saying implied by the English word. Thus, roughly half the book is made up of "sayings" of this type, while the other half is made up of longer poetic units of various types. These include "instructions" formulated as advice from a teacher or parent addressed to a student or child, dramatic personifications of both Wisdom and Folly, and the "words of the wise" sayings, longer than the Solomonic "sayings" but shorter and more diverse than the "instructions".[8]
The first section (chapters 1–9) comprises an initial invitation to young men to take up the course of wisdom, ten "instructions", and five poems on personified Woman Wisdom.[9] Verses 1:1-7 constitute an introduction to the whole of this section.[10] Proverbs 10:1–22:16, with 375 sayings, consists of two parts, the first part (10–14) contrasting the wise man and the fool (or the righteous and the wicked), the second (15–22:16) addressing wise and foolish speech.[11] Verse 22:17 opens 'the words of the wise', until verse 24:22, with short moral discourses on various subjects.[12] An additional section of sayings which "also belong to the wise" follows in verses 24:23-34.[13] Chapters 25–29, attributed to the editorial activity of "the men of Hezekiah", contrast the just and the wicked and broach the topic of rich and poor.[14] Chapter 30:1-4, the "sayings of Agur", introduces creation, divine power, and human ignorance.[15]
Solomon writing Proverbs (Gustave Doré)
It is impossible to offer precise dates for the sayings in Proverbs, a "collection of collections" relating to a pattern of life which lasted for more than a millennium.[2] The phrase conventionally used for the title is taken from chapter 1:1, mishley shelomoh, Proverbs of Solomon (the phrase is repeated at 10:1 and 25:1), is likely more concerned with labeling the material than ascribing authorship.[16]
The book is an anthology made up of six discrete units. The Proverbs of Solomon section, chapters 1–9, was probably the last to be composed, in the Persian or Hellenistic periods. This section has parallels to prior cuneiform writings.[17] The second, chapters 10–22:16, carries the superscription "the proverbs of Solomon", which may have encouraged its inclusion in the Hebrew canon. The third unit, 22:17–24:22, is headed "bend your ear and hear the words of the wise". A large part of this section is a recasting of a second-millennium BCE Egyptian work, the Instruction of Amenemope, and may have reached the Hebrew author(s) through an Aramaic translation. Chapter 24:23 begins a new section and source with the declaration, "these too are from the wise". The next section at chapter 25:1 has a superscription to the effect that the following proverbs were transcribed "by the men of Hezekiah", indicating at face value that they were collected in the reign of Hezekiah in the late 8th century BCE. Chapters 30 and 31 (the "words of Agur," the "words of Lemuel," and the description of the ideal woman) are a set of appendices, quite different in style and emphasis from the previous chapters.[18]
The "wisdom" genre was widespread throughout the ancient Near East, and reading Proverbs alongside the examples recovered from Egypt and Mesopotamia reveals the common ground shared by international wisdom.[19] The wisdom literature of Israel may have been developed in the family, the royal court, and houses of learning and instruction;[20] nevertheless, the overwhelming impression is of instruction within the family in small villages.[21]
Excerpt from Proverbs 3 displayed at Portland International Jetport in Portland, Maine
A page of the Book of Proverbs from a Bible from 1497
Along with the other examples of the biblical wisdom tradition – Job and Ecclesiastes and some other writings – Proverbs raises questions of values, moral behavior, the meaning of human life, and righteous conduct. The three retain an ongoing relevance for both religious and secular readers, Job and Ecclesiastes through the boldness of their dissent from received tradition, Proverbs in its worldliness and satiric shrewdness. Wisdom is as close as biblical literature comes to Greek philosophy, of which it was a contemporary; it shares with the Greeks an inquiry into values and reflections on the human condition, although there is no discussion of ontology, epistemology, metaphysics, and the other abstract issues raised by the Greeks. [3]
The rabbinic college almost excluded the Book of Proverbs from the Bible in the late first century. [22] They did this because of its contradictions (the result of the book's origins as not just an anthology but an anthology of anthologies). The reader is told, for example, both to "not answer a fool according to his folly", according to 26:4, and to "answer a fool according to his folly", as 26:5 advises. More pervasively, the recurring theme of the initial unit (chapters 1–9) is that the fear of the Lord is the beginning of wisdom, but the following units are much less theological, presenting wisdom as a transmissible human craft, until with 30:1–14, the "words of Agur", we return once more to the idea that God alone possesses wisdom. [18]
"The fear of God is the beginning of wisdom" (Proverbs 9:10 – the phrase implies submission to God's will).[23] Wisdom is praised for her role in creation ("God by wisdom founded the earth; by understanding, he established the heavens" – Proverbs 3:19). God acquired her before all else, and through her, he gave order to chaos ("When [God] established the heavens… when he drew a circle on the face of the Deeps… when he marked out the foundations of the earth, then I was beside him" – Proverbs 8:27–31). Since humans have life and prosperity by conforming to the order of creation, seeking wisdom is the essence and goal of the religious life.[5] Wisdom, or the wise person, is compared and contrasted with foolishness or the fool, meaning one who is lacking in wisdom and uninterested in instruction, not one who is merely silly or playful (though see the words of Agur for a "fool" who has wisdom and could be seen as playful).
For the most part, Proverbs offers a simplistic view of life with few grey areas: a life lived according to the rules brings reward, and life in violation of them is certain to bring disaster. In contrast, Job and Ecclesiastes appear to be direct contradictions of the simplicities of Proverbs, each in its own way all but dismissing the assumptions of the "wise".[24] Noteworthy also is the fact that the "mighty acts of God" (the Exodus, the giving of the Torah at Sinai, the Covenant between God and Israel, etc.) which make up Israel's history are completely or almost completely absent from Proverbs and the other Wisdom books: in contrast to the other books of the Hebrew Bible, which appeal to divine revelation for their authority ("Thus says the Lord!"), wisdom appeals to human reason and observation.[25]
Later interpretation and influence
The pre-Exilic (i.e. pre-586 BCE) Old Testament allowed no equals to YHWH in heaven, despite the continued existence of an assembly of subordinate servant-deities.[26] The post-Exilic writers of the Wisdom tradition developed the idea that Wisdom existed before creation and was used by God to create the universe:[27] "Present from the beginning, Wisdom assumes the role of master builder while God establishes the heavens, restricts the chaotic waters, and shapes the mountains and fields."[28] Borrowing ideas from Greek philosophers who held that reason bound the universe together, the Wisdom tradition taught that God's Wisdom, Word and Spirit were the ground of cosmic unity.[29] Christianity in turn adopted these ideas and applied them to Jesus: the Epistle to the Colossians calls Jesus "...image of the invisible God, first-born of all creation...", while the Gospel of John identifies him with the creative word ("In the beginning was the Word, and the Word was with God, and the Word was God").[30]
In the 4th century, when Christianity was caught up in heresies and still developing the creeds which would define its beliefs, Proverbs 8:22[31] was used both to support and refute the claims of the Arians. The Arians, assuming that Christ could be equated with the "Wisdom of God" (1 Corinthians 1:24),[32] argued that the Son, like Wisdom, was "created",[31] and therefore subordinate to the Creator; their opponents, who argued that the relevant Hebrew word should be translated as "begot", won the debate, and the Nicene Creed declared that the Son was "begotten, not made", meaning that God and Christ were consubstantial.[33]
"As a dog returns to his vomit, so a fool repeats his folly"
^ Most translate: Lemuel, an oracle (masa) which his mother . . ."[6]
^ Berlin 2011, p. 588.
^ a b Clements 2003, p. 438.
^ a b Alter 2010, pp. xiii–xvii.
^ Longman & Garland 2009, p. 50.
^ a b Boccaccini 2002, p. 106.
^ See Proverbs 31:1, various translations, Biblehub.com
^ Perdue 2012, pp. x–xi.
^ Farmer 1991, pp. 17–20.
^ Perdue 2007, p. 48.
^ Aitken, K. T., 19. Proverbs in Barton, J., and Muddiman, J. (2001), The Oxford Bible Commentary, p. 406
^ de Almeida, João Ferreira, ed. (1974), "Os provérbios", A Bíblia sagrada (Versão revisada de acordo com os melhores textos em hebraico e grego ed.), Rio de Janeiro: Imprensa bíblica brasileira, Junta de educação religiosa, Convenção batista brasileira, xxii:17, Breves discursos morais do sábio acerca de vários assuntos .
^ Proverbs 24:23: New King James Version
^ Farmer 1991, p. 25.
^ Rogers, Robert William (1912). "8. Fragment of Wisdom Literature". Cuneiform parallels to the Old Testament (1 ed.). New York: Eaton & Mains. Retrieved March 13, 2016.
^ a b Alter 2010, pp. 183–85.
^ Smothers 2000, pp. 167–68, 174.
^ Tucker 2000, pp. 163–66.
^ Crenshaw 2000, p. 217.
^ "The Untold Truth of the Book of Proverbs". 28 October 2021.
^ Longman & Garland 2009.
^ Keown 2000, p. 183.
^ Farmer 1998, p. 130.
^ Page Lee 1990, pp. 176–77.
^ Parrish 1990, p. 183.
^ Kaiser 1997, p. 28.
^ Parrish 1990, pp. 183–84.
^ a b Proverbs 8:22
^ 1 Corinthians 1:24
Alter, Robert (2010). The Wisdom Books: Job, Proverbs, and Ecclesiastes: A Translation with Commentary. W.W. Norton & Co. ISBN 978-0-39308073-5.
Berlin, Adele (2011). "Cosmology and creation". In Berlin, Adele; Grossman, Maxine (eds.). The Oxford Dictionary of the Jewish Religion. Oxford University Press. ISBN 978-0-19-973004-9.
Boccaccini, Gabriele (2002). Roots of Rabbinic Judaism: An Intellectual History, from Ezekiel to Daniel. Eerdmans. ISBN 978-0-80284361-6.
Clements, Ronald E. (2003). "Proverbs". In Dunn, James D. G.; Rogerson, John William (eds.). Eerdmans Commentary on the Bible. Eerdmans. ISBN 9780802837110.
Crenshaw, James (2000). "Unresolved Issues in the Wisdom Literature". In Tate, Marvin E.; Ballard, Harold Wayne; Tucker, W. Dennis (eds.). An Introduction to Wisdom Literature and the Psalms. Mercer University Press. ISBN 978-0-86554652-3.
Farmer, Kathleen A. (1991). Who knows what is good? : a commentary on the Books of Proverbs and Ecclesiastes. Wm. B. Eerdmans Publishing. ISBN 978-0-80280161-6.
Farmer, Kathleen A. (1998). "The Wisdom Books". In McKenzie, Steven L.; Graham, Matt Patrick (eds.). The Hebrew Bible Today: An Introduction to Critical Issues. Westminster John Knox Press. ISBN 978-0-66425652-4.
Fox, Michael V. (2000). Proverbs 1–9.
——— (2009). Proverbs 10–31. Yale University Press. ISBN 978-0-30015556-3.
Grabbe, Lester L. (2006). A History of the Jews and Judaism in the Second Temple Period. Vol. 1: The Persian Period (539–331 BCE). Continuum. ISBN 978-0-56704352-8.
Kaiser, Christopher B. (1997). Creational theology and the history of physical science. Brill. ISBN 90-0410669-3.
Keown, Gerald (2000). "The Canonical Shape of the Wisdom Literature". In Tate, Marvin E.; Ballard, Harold Wayne; Tucker, W. Dennis (eds.). An Introduction to Wisdom Literature and the Psalms. Mercer University Press. ISBN 978-0-86554652-3.
Longman, Tremper; Garland, David E. (2009). Proverbs—Isaiah. Zondervan. ISBN 978-0-31059058-3.
Page Lee, H. (1990). "Council, Heavenly". In Watson E. Mills (ed.). Mercer Dictionary of the Bible. Mercer University Press. ISBN 9780865543737.
Parrish, V. Steven (1990). "Creation". In Mills, Watson E. (ed.). Mercer Dictionary of the Bible. Mercer University Press. ISBN 9780865543737.
Perdue, Leo G. (2007). Wisdom Literature: A Theological History. Presbyterian Publishing. ISBN 978-0-66422919-1.
Perdue, Leo G. (2012). Proverbs. Westminster John Knox Press. ISBN 978-0-66423884-1.
Sinnott, Alice M. (2005). The Personification of Wisdom. Ashgate Publishing. ISBN 978-0-75465124-6.
Smothers, Thomas (2000). "Biblical Wisdom in its Ancient Middle Eastern Context". In Tate, Marvin E.; Ballard, Harold Wayne; Tucker, Karl Smith (eds.). An Introduction to Wisdom Literature and the Psalms. Mercer University Press. ISBN 9780865546523.
Tucker, W. Dennis (2000). "Literary Forms in the Wisdom Literature". In Tate, Marvin E.; Ballard, Harold Wayne; Tucker, W. Dennis (eds.). An Introduction to Wisdom Literature and the Psalms. Mercer University Press. ISBN 978-0-86554652-3.
Crenshaw, James L. "Book of Proverbs", The Anchor Bible Dictionary, 1992
Dockery, David S. (general ed.), Holman Bible Handbook, Holman Bible Publishers, Nashville, 1992
Lasor, William Sanford, Hubbard, David Allan, & Bush, Frederic Wm., Old Testament Survey: The Message, Form, and Background of the Old Testament, 1996
Murphy, Roland E., Wisdom Literature: Job, Proverbs, Ruth, Canticles, Ecclesiastes, and Esther. Grand Rapids, 1981
Steinmann, Andrew, "Proverbs 1–9 as a Solomonic Composition", Journal of the Evangelical Theological Society, 43, no. 4
Waltke, Bruce (2004). Book of Proverbs: Chapters 1–15. Wm. B. Eerdmans. ISBN 978-0-8028-2545-2.
Waltke, Bruce (2005). The Book of Proverbs: Chapters 15–31. Wm. B. Eerdmans. ISBN 978-0-8028-2776-0.
Waltke, Bruce K.; De Silva, Ivan D. V. (2021). Proverbs: A Shorter Commentary. Wm. B. Eerdmans. ISBN 978-0-8028-7503-7.
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Online translations of Book of Proverbs:
Jewish translations:
Mishlei – Proverbs (Judaica Press) translation [with Rashi's commentary] at Chabad.org
Christian translations:
Bible Gateway 35 languages/50 versions
Unbound Bible 100+ languages/versions at Biola University
Introduction to the Book of Proverbs a Forward Movement publication
Proverbs public domain audiobook at LibriVox – Various versions
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Draft of the ICNIRP Guidelines on Limiting Exposure to Time-Varying Electric, Magnetic and Electromagnetic Fields (100 kHz to 300 GHz) ready for public consultation.
ICNIRP, Public Consultation, RF
The draft of the ICNIRP Guidelines on Limiting Exposure to Time-Varying Electric, Magnetic and Electromagnetic Fields (100 kHz to 300 GHz) is now ready for public consultation. The draft is comprised of the main guidelines document, and two appendices.
As part of the development of the guidelines, ICNIRP has regularly given draft guidelines presentations to encourage critique and discussion from the many experts who are not members of ICNIRP. From this interaction we believe that the draft guidelines have developed substantially, and in particular into a logical, rigorous and transparent means of providing safety for both general public exposures and workers exposed to radiofrequency fields as part of their occupational duties. Now we expect through this Public Consultation to receive the detail required for further robust critique of this public health document.
Please fill the form and provide your comments using only the template available below.
The consultation process opens on 11 July and terminates on 9 October 2018. After the 90 days consultation period, all comments will be reviewed by the ICNIRP members for finalization of the draft. Information regarding the publication date will be displayed on the ICNIRP website in due course. For time constraints, ICNIRP will not formulate replies to your comments. Rather all comments will be studied and taken into account in the final draft as appropriate.
We greatly value your contribution. Thank you for this ! https://www.icnirp.org/en/activities/public-consultation/consultation-1.html
File(s) for download
ICNIRP_RF_Guidelines_PCD_2018_07_11
ICNIRP_RF_Guidelines_PCD_Appendix_A_2018_07_11(1)
ICNIRP_RF_Guidelines_PCD_Appendix_B_2018_07_11
ICNIRP_RF_PublicConsultationForm2018_07_11(3)
Added note by EMFSA: see https://www.saferemr.com/2018/07/icnirps-exposure-guidelines-for-radio.html
Editorial comments by Joel Moskowitz:
To date, 242 scientists who have published peer-reviewed research on EMF and biology or health have signed the EMF Scientist Appeal. Collectively, these scientists from 41 nations have published more than 2,000 papers on EMF. The Appeal calls on the WHO and the United Nations including its member states to adopt more protective exposure guidelines for EMF including RF radiation in the face of increasing evidence of health risks since these exposures are a rapidly growing form of worldwide environmental pollution.
In a recently published, peer-reviewed paper, "Thermal and non-thermal health effects of low intensity non-ionizing radiation: An international perspective," Belpomme and his colleagues (2018) criticize the WHO due to its reliance upon ICNIRP and its members for expert advice. The paper claims that ICNIRP and its advisors have "close associations with industry," and "conflicts of interest." According to the authors, ICNIRP and its advisors have been engaged in decades of "denial of serious non-thermal effects of RF-EMFs in spite of overwhelming scientific evidence to the contrary."
Moreover, Belpomme and his colleagues criticize ICNIRP's safety limits:
"The specific absorption rate (SAR)-based ICNIRP safety limits were established on the basis of simulation of EMF energy absorption using standardized adult male phantoms, and designed to protect people only from the thermal effects of EMFs. These assumptions are not valid for two reasons. Not only do they fail to consider the specific morphological and bioclinical vulnerabilities of children, but also they ignore the effects known to occur at non-thermal intensities…."
Finally, Belpomme and his colleagues (2018) provide a summary of the peer-reviewed scientific literature that arrives at very different conclusions than ICNIRP's health risk assessment:
"It is urgent that national and international bodies, particularly the WHO, take this significant public health hazard seriously and make appropriate recommendations for protective measures to reduce exposures. This is especially urgently needed for children and adolescents. It is also important that all parts of society, especially the medical community, educators, and the general public, become informed about the hazards associated with exposure to EMFs and of the steps that can be easily taken to reduce exposure and risk of associated disease."
The rules that ICNIRP applies for a study to be included in its health risk assessment seem overly stringent. If other official bodies (e.g., the International Agency for Research on Cancer or the U.S. Environmental Protection Agency) were to adopt such rules, I suspect that very few chemicals would be classified as toxins or carcinogens. By its own admission, ICNIRP is not concerned about protecting animal or plant life from the adverse effects of EMF exposure, and it is arguable that they are truly concerned about protecting humans.
If the claims of some EMF scientists and scientific organizations (e.g., the European Cancer and Environment Research Institute and the Russian National Committee on Non-Ionizing Radiation Protection) are true that ICNIRP's members and scientific advisors are selected because they are biased toward industry, then it is fruitless to engage in ICNIRP's public consultation process (see my posts from May 1 through June 27, 2017.)
Since the credibility of ICNIRP depends heavily upon its association with the WHO, a more fruitful activity for the EMF scientific community might be to convince the WHO and governments not to rely on ICNIRP for EMF guidelines and no longer consult ICNIRP's advisors.


text:
The standard patient preparation included at least 8 hours of fas
The standard patient preparation included at least 8 hours of fasting and patients with a serum glucose level < 120 mg/dL before F-18 FDG administration. PET/CT imaging was performed 60 minutes after the injection of F-18 FDG. Sixty minutes after the administration of F-18 FDG, low-dose CT (30 mAs, 120 kV) covering the area from the base of the MLN2238 mw skull to the proximal thighs was performed for the purpose of
attenuation correction and precise anatomic localization. Thereafter, an BI 6727 emission scan was conducted in the three-dimensional mode. The emission scan time per bed position was 3 minutes and 9 bed positions were acquired. PET data were obtained using https://www.selleckchem.com/products/Cyt387.html a high-resolution whole body scanner with an axial field of view of 18 cm. The average total PET/CT examination time was 30 minutes. After scatter and decay correction, PET data were reconstructed iteratively with attenuation correction and were reoriented in axial, sagittal, and coronal
slices. A row action maximum-likelihood algorithm was used for three-dimensional reconstruction. Visual assessment and quantitative analysis Experienced nuclear medicine physicians blinded to the results of other imaging modalities and the pathologic findings reviewed most the F-18 FDG PET/CT scans. The medical records, including treatment regimens, other medical imaging modalities, and fine needle aspiration biopsies, were reviewed and analyzed. Two
experienced nuclear medicine physicians independently reviewed the PET/CT images and any disagreement was resolved by consensus. To calculate the SUVmax, manually-defined circular regions of interest (ROI) were drawn on the attenuation-corrected emission images throughout the axial planes where a suspicious lesion could be delineated. Statistical analysis The association between the mean SUVmax and clinicopathologic factors was analyzed using a two-tailed Pearson's chi-squared or Fisher's exact test as appropriate. Differences in groups for the mean SUVmax values were tested using one-way ANOVA or the t-test as appropriate.


This reminded me of a new article by Jonathan Last about the natural process of knowledge decay in institutions. He documents the $92 million process of reconstructing the formula for "Fogbank," a substance included in late-Cold War nuclear warheads whose formula had since been lost to history. Knowledge is lost, distorted, housed in human capital. Think of what happens when the admin in your office who's been there for twenty-five years retires. No matter how much she writes down, she still takes away (and does not replace) a vast amount of institutional memory and knowledge.
And when you're dealing with an institution as large and complex as the U.S. government, these kind of gaps are bound to happen frequently. The FAA thinks, "GPS, it's a great system, let's make it the basis of air traffic control." (This is not a post on merits of Next Gen, FYI.) The Pentagon doesn't bring a replacement for the current GPS system on line fast enough. And the OMB, eager to find redundancies in the federal budget, cuts the GPS back-up without knowing about delays in deploying its successor system. This is natural in giant institutions. We should probably be more surprised when systems actually work.


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Clinical Edge
Brief summaries of recent advances in device research and clinical trials, including an implantable sensor designed to measure cancer progression and treatment, new findings on angiogenesis-suppressing genes that protect Down's syndrome patients from cancer, research that implacates two inflammation-related proteins in breast cancer outcomes, and stem-cell implanted contact lenses that repair corneal damage.
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Our monthly update on technology transfer deals--licensing agreements between companies and universities or other research institutions--in the fields of life sciences, including pharmaceuticals, medical devices, in vitro diagnostics and research/analytical instrumentation and reagents.
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A roundup of recent medtech strategic alliances, mergers & acquisitions and financings.
The Garvan Institute of Medical Research
By Mark Ratner
The Garvan Institute of Medical Research became an autonomous research institute in 1984. Sponsored research accounts for one-quarter of Garvan's $14 million 1998 operating income. Going forward, it expects its income to derive approximately one-third from grants, one-third from donations, and one third from commercial activities. The bulk of current revenues from commercial activities come from Eli Lilly, Bristol-Myers, and Merck & Co.
BioPharmaceutical Asia Pacific


text:
The New Power Couple
Michelle Boudin,
Chris Edwards
She helped get two of the most influential women U.S. senators into office. He was president of the international arm of a Fortune 500 company for more than thirty years. In the six years since the new power couple — a term both Bernie Hargadon, eighty-one, and Jill Dinwiddie, sixty-eight, dislike—moved to the Queen City, the couple have broken into the power scene and have been flying under the radar … until now.
Why Power People Love Her
When the couple arrived in Charlotte in 2003, Erskine Bowles (who was running for U.S. Senate at the time) called and asked Dinwiddie to run his campaign. She agreed to head up "Women for Bowles," bringing Madeline Albright to Charlotte and raising $200,000 for the campaign (and Dinwiddie's profile in the process). Now president of the UNC system, Bowles calls Dinwiddie and Hargadon the Get-It-Done Couple. "The governor and I were talking about people you could turn to to make something happen, to do it, and do it well," says Bowles. "We both agreed the first person on the list is Jill. I am a big, big fan."
Her Current Passion
She's spending most of her time as executive director of the North Carolina Council for Women, a position Governor Perdue handpicked her for.
Cool Thing About Her
She just hiked Machu Picchu with a group of ten women from Charlotte.
Her Proudest Achievement
In 1992, California had two women running for Senate: Dianne Feinstein (a sure thing) and Barbara Boxer (a long shot). Dinwiddie convinced her boss (Feinstein) to do a fundraiser sharing the stage with Boxer and popular Texas governor Ann Richards. That fundraiser got Boxer elected. "For me that was proof I could make a difference," Dinwiddie says.
Where to Find Her
North Carolina Arts Council (Governor Perdue recently assigned her)
Levine Museum of the New South (former chair of the development committee)
Planned Parenthood Health Systems (serves on the board)
Lillian's List (former vice chair of development)
Governor Bev Perdue's Kitchen Cabinet (a select group of about a dozen supporters who meet behind closed doors at the governor's mansion to give the Gov honest feedback)
How He Landed on the Queen City Scene
"Soon after we moved here I noticed Opera Carolina was doing one of my favorites, Nabucco," says Hargadon, who has played trumpet for seventy years. "I was really swept away by the opera, the conductor, the whole thing. I wrote a letter to the maestro, we had lunch, and before you know it, I was on the board."
His Current Passion
An avid trumpet player and Navy veteran, Hargadon is a member of Bugles Across America and wants to play Taps at the funerals of World War II veterans.
Cool Thing About Him
If you're skating at The Green during the holidays, look up. You'll probably catch Hargadon standing on the balcony of the couple's loft playing Christmas carols on his trumpet.
His Proudest Achievement
While working in Colombia in 1960, Hargadon helped start a college (sixty men attended the first class). The couple was invited back last year; Hargadon was made an honorary board member, and a building was named in his honor. The school's enrollment is now around 7,500.
Where to Find Him
Opera Carolina (serves on the board)
Charlotte Symphony Orchestra (serves on the board)
WDAV (chaired advisory board of Davidson College's classical radio station)
Power Duos
Who else runs the show in Charlotte
Leon and Sandra Levine
The first couple of philanthropy, the Levines are spoken of with reverence in the nonprofit community due to their recent largesse.
Loy and Susan McKeithen
Indefatigable and generous supporters of the arts, especially N.C. Dance Theatre and the Symphony, the McKeithens — Loy is a well-respected attorney — are powerful behind-the-scenes players.
Tom and Anna Nelson
As CEO of National Gypsum, Tom is a go-to power player in the biz community, and as head of the C. D. Spangler Foundation, Anna makes things happen in the education arena.
Russell and Sally Robinson
The Robinsons have been active on the civic scene for decades, including as cofounders of Levine Museum of the New South; Russell is a prominent attorney.
This article appears in the December 2009 issue of Charlotte magazine.


The Stable has a distinct Regulatory Group of Counsel who have considerable experience in a number of Regulatory forums such as the Nursing and Midwifery Council and the General Medical Council. We have a number of Advocates who are regularly instructed both by Regulatory bodies and by those requiring representation at Hearings. They are also in a position to provide the benefit of their experience to solicitors representing those subject to regulation. Our members also have experience in other regulatory work, including sporting bodies and are available to act in mediations, both for clients and as mediators.