Measurement invariance of the Patient Health Questionnaire-9 (Phq-9) depression screener in U.S. adults across sex, race/ethnicity, and education level: Nhanes 2005-2014

Indiana University-Purdue University Indianapolis (IUPUI)Importance: Despite its widespread use in clinical settings and in behavioral medicine research, little is known about the psychometric performance of the PHQ-9 across major U.S. sociodemographic groups. Thus, utilizing a large sample representative of the U.S. population and confirmatory factor analysis (CFA), we determine the factor structure and measurement invariance of the PHQ-9 across groups based on sex, race/ethnicity, and education level. Objective: Our objective was to address key knowledge gaps by definitively determining the factor structure and measurement invariance of the PHQ-9 across major U.S. sociodemographic groups based on sex, race/ethnicity, and education level. Design: The continuous National Health and Nutrition Examination Survey (NHANES) is a cross-sectional, epidemiologic study designed to assess the health and nutritional status of the U.S. population. We examined data from the 2005-2014 survey years. Setting: NHANES is uses a stratified multistage probability sampling approach to enroll civilian, non-institutionalized adults and children in the U.S. Participants: For our final sample, we selected the 26,202 adult respondents with no missing PHQ-9 data. The factors of interest were sex (49.3% men, 50.7% women), race/ethnicity (48.9% non-Hispanic White, 23.7% non-Hispanic Black, 17.8% Mexican American, 9.7% other Hispanic), and education level (9.9% less than 9th grade, 16.6% 9th-12th grade but no diploma, vii 23.7% high school graduate/GED or equivalent, 28.9% some college or Associate’s degree, 20/8% college graduate or above). Main Outcome(s) and Measure(s): The Patient Health Quessionnaire-9 (PHQ-9) Results: Results revealed that the best solution for the PHQ-9 consists of a cognitive/affective factor (items 1. anhedonia, 2. depressed mood, 6. feelings of worthlessness, 7. concentration difficulties, 8. psychomotor disturbances, and 9. thoughts of death) and a somatic factor (items 3. sleep disturbance, 4. fatigue, and 5. appetite changes; RMSEA = 0.034, RMSEA 90% CI = 0.032–0.036, TLI = 0.984, CFI = 0.988). To evaluate measurement invariance, we then conducted single-group and multiple-group CFAs to carry out the 5 steps of measurement invariance testing. Dimensional, configural, weak factorial, strong factorial, and strict factorial invariance was established for the PHQ-9 across the sex, race/ethnicity, and education level groups, as all models demonstrated close fit and the ΔCFI was < 0.010 for all steps. Conclusions and Relevance: Using a U.S. representative sample, we determined that a two-factor solution for the PHQ-9 with a cognitive/affective factor and a somatic factor is invariant across sex, race/ethnicity, and education level groups. Therefore, clinically, the PHQ-9 is an acceptable measure to utilize in major U.S. sociodemographic groups, extending the use of this depression screener from the primary care clinic to the community. Additionally, we show that PHQ-9 cognitive/affective and somatic subscale scores have the same meaning and can be compared across major U.S. sociodemographic groups and provide a consistent, evidence-based approach to computing PHQ-9 subscale scores to be used in future studies

The Virtual Ambience with Electronic Human Resource Management System: A Systematic Literature Review

There is no exception that organisation and Human Resource Management were greatly influenced by the Information Technology. There is no doubt about it that the use of informationtechnology bringsbenefits such as cost reduction, time savings and strategic transformation. The term E-HRM can be described as the plan schedules for systematic dimensions , proper implementation of those corollaries and usage of applied sciences in the networking technonlogy for both net working and supporting atleast both the individual or collective actors in their shade in the acting of the HR activities . Both the terms electronic human resources management and the virtual human resource management systems doesn?t go with the same interpretations that is being streamlined by Lepak and Snellas ?Thenetworkfounded structure built on partnerships and typically framed by networking technologies to support the organisation attain, develop and deploy intellectual capital.It?s not even wrong to say that thedecentralization of Human Resourcefunctions to manage and workers is the essence of E-HRM. The access of those functions typically can be availed through intranet or other web technology channels. When such kind of facilities are provided with in the organisation it helps the managers and employees in empowering themselves to perform the chosen HR functions in a way relieving the HR Department from those tasks. In a way the Human Resource personnel?s needs to be liberal on the working activities rather than on the premeditated issues of Human resources and these all processes helps the organisation in saving the cost by not recruiting more staff in HR and likewise the administrative work pressure is eased. It is even foreseen that E-HRM grows and renovates the part of a business culture while there would be changes apparently but the need is to be inculcated to a substantial measure. The introductory researchon CIPD survey (2007)resultedthat ?The shared services, outsourcing and E-HR have had relatively little impact on costs or staff numbers?

Nuclear magnetic resonance spectroscopy and ultrasound

The work described in this thesis is directed to the examination of the hypothesis that ultrasound may be used to perturb molecular motion in the liquid phase. These changes can then be detected by nuclear magnetic resonance (NMR) in spin-lattice and spin-spin relaxation times. The objective being to develop a method capable of reducing the pulsed NMR acquisition times of slowly relaxing nuclei. The thesis describes the theoretical principles underlying both NMR spectroscopy and ultrasonics with particular attention being paid to factors that impinge on testing the above hypothesis. Apparatus has been constructed to enable ultrasound at frequencies between 1 and 10 mega-hertz with a variable power up to 100W/cm-2 to be introduced in the NMR sample. A broadband high frequency generator is used to drive PZT piezo-electric transducer via various transducer to liquid coupling arrangements. A commercial instrument of 20 kilo-hertz has also been employed to test the above hypothesis and also to demonstrate the usefulness of ultrasound in sonochemistry. The latter objective being, detection of radical formation in monomer and polymer ultrasonic degradation. The principle features of the results obtained are: Ultrasonic perturbation of T1 is far smaller for pure liquids than is for mixtures. The effects appear to be greater on protons (1H) than on carbon-13 nuclei (13C) relaxation times. The observed effect of ultrasonics is not due to temperature changes in the sample. As the power applied to the transducer is progressively increased T1 decreases to a minimum and then increases. The T1's of the same nuclei in different functional groups are influenced to different extents by ultrasound. Studies of the 14N resonances from an equimolar mixture of N, N-dimethylformamide and deuterated chloroform with ultrasonic frequencies at 1.115, 6, 6.42 and 10 MHz show that as the frequency is increased the NMR signal to noise ratio decreases to zero at the Larmor frequency of 6.42 MHz and then again rises. This reveals the surprising indication that an effect corresponding to nuclear acoustic saturation in the liquid may be observable. Ultrasonic irradiation of acidified ammonium chloride solution at and around 6.42 MHz appears to cause distinctive changes in the proton-nitrogen J coupling resonance at 89.56 MHz. Ultrasonic irradiation of N, N-dimethylacetamide at 2 KHz using the lowest stable power revealed the onset of coalescence in the proton spectrum. The corresponding effect achieved by direct heating required a temperature rise of approximately 30oC. The effects of low frequency (20 KHz) on relaxation times appear to be nil. Detection of radical formation proved difficult but is still regarded as the principle route for monomer and polymer degradation. The initial hypothesis is considered proven with the results showing significant changes in the mega-hertz region and none at 20 KHz

A Survey On Data Mining Techniques and Applications

Data Mining refers to the analysis of experimental data sets to seek out relationships and to summarize the data in ways in which are each comprehensible and helpful. Compared with alternative DM techniques, Intelligent Systems (ISs) based mostly approaches that embody Artificial Neural Networks (ANNs), fuzzy pure mathematics, approximate reasoning, and derivative-free optimisation strategies similar to Genetic Algorithms (GAs), are tolerant of impreciseness, uncertainty, partial truth, and approximation. This paper reviews varieties of Data Mining techniques and applications

Development of unique buttermilk by incorporation of Moringa

The present investigation was aimed at formulating a fermented beverage with incorporation of Moringa Pod Powder (MPP) to develop therapeutic buttermilk. Dahi (prepared from standardized milk) mesophilic/ thermophilic dahi culture. Optimisation of the product formulation was done by using Response Surface Methodolo-gy (RSM) with central composite rotatable design (CCRD) with varying levels of MPP, total milk solids (TMS) in but-termilk and acidity of dahi. It was found that 5.60 % TMS, 0.90 % acidity of dahi and 1.92 % MPP gave the most acceptable product with a desirability of 0.917 which is very high. From amongst various stabilizers, it was found that a blend of 0.04 % pectin and 0.015 % carrageenan most suitable and addition of salt, sugar and spices blend @ 0.5 %, 4.0 %, 0.5% respectively were most acceptable. The proximate chemical composition of Moringa Pod Buttermilk (MPBM) was 11.77 % total solids, 1.51 % protein, 1.84 % fat and 0.89 % ash. One serving size (300 g) of MPBM could be an "excellent source of calcium" having 21 % Daily Value (DV). The product could be labelled as "a good source of Vitamin A, calcium and iron" providing 10, 18 and 11 % DV respectively. MPBM was found to have consid-erable amount of Potassium and Vitamin C and fiber (9.0, 9.0 and 6.5 % DV respectively). The shelf-life of the prod-uct was 20 days under refrigeration (7±2?C). The developed product is rich in fiber and iron, that is conventionally deficient in milk and hence makes the developed product complete food

On Fixed Point theorems in Fuzzy Metric Spaces in Integral Type

Abstract: This paper presents some common fixed point theorems for occasionally weakly compatible mappings in fuzzy metric spaces. Keywords: Occasionally weakly compatible mappings,fuzzy metric space

Review of Breast Conservation Therapy: Then and Now

Breast conservation therapy (BCT), which is the marriage of breast conserving surgery and radiation therapy to the breast, has revolutionized the treatment of breast cancer over the last few decades. Surgical direction had seen a heightened interest in the performance of cosmetically superior partial and segmental resections in breast conservation as well as increased demand by patients for breast preservation. The broadening of approaches to delivery of breast irradiation from whole breast to accelerated partial breast has allowed more patients to opt for breast conservation and allowed for what appears to be comparable measurable outcomes in emerging data. As well, the addition of state-of-the-art chemotherapeutic and hormonal therapies has allowed improved outcomes of patients from both local regional recurrence and overall survival standpoints. This paper will provide an overview of BCT and review some of the newest developments in optimizing this therapy for patients with breast cancer from a surgical-, medical-, and radiation-oncology standpoint

Laparoscopic surgery for Crohn’s disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery

BACKGROUND: Previous meta-analyses have had conflicting conclusions regarding the differences between laparoscopic and open techniques in patients with Crohn’s Disease. The objective of this meta-analysis was to compare outcomes in patients with Crohn’s disease undergoing laparoscopic or open surgical resection. METHODS: A literature search of EMBASE, MEDLINE, The Cochrane Central Register of Controlled Trials and the US National Institute of Health’s Clinical Trials Registry was completed. Randomized clinical trials and non-randomized comparative studies were included if laparoscopic and open surgical resections were compared. Primary outcomes assessed included perioperative complications, recurrence requiring surgery, small bowel obstruction and incisional hernia. RESULTS: 34 studies were included in the analysis, and represented 2,519 patients. Pooled analysis showed reduced perioperative complications in patients undergoing laparoscopic resection vs. open resection (Risk Ratio 0.71, 95% CI 0.58 – 0.86, P = 0.001). There was no evidence of a difference in the rate of surgical recurrence (Rate Ratio 0.78, 95% CI 0.54 – 1.11, P = 0.17) or small bowel obstruction (Rate Ratio 0.63, 95% CI 0.28 – 1.45, P = 0.28) between techniques. There was evidence of a decrease in incisional hernia following laparoscopic surgery (Rate Ratio 0.24, 95% CI 0.07 – 0.82, P = 0.02). CONCLUSIONS: This is the largest review in this topic. The results of this analysis are based primarily on non-randomized studies and thus have significant limitations in regards to selection bias, confounding, lack of blinding and potential publication bias. Although we found evidence of decreased perioperative complications and incisional hernia in the laparoscopic group, further randomized controlled trials, with adequate follow up, are needed before strong recommendations can be made