Diagnostic accuracy of depression questionnaires in adult patients with diabetes: a systematic review and meta-analysis

Importance Comorbid depression is common among patients with diabetes and has severe health consequences, but often remains unrecognized. Several questionnaires are used to screen for depression. A systematic review and meta-analysis regarding the diagnostic accuracy of depression questionnaires in adults with diabetes is unavailable. Objective To conduct a systematic review and meta-analysis to evaluate the diagnostic accuracy of depression questionnaires in adults with type 1 or type 2 diabetes. Data sources PubMed, Embase and PsycINFO were searched from inception to 28 February 2018. Study selection Studies were included when the diagnostic accuracy of depression questionnaires was assessed in a diabetes population and the reference standard was a clinical interview. Data extraction and synthesis Data extraction was performed by one reviewer and checked by another. Two reviewers independently conducted the quality assessment (QUADAS-2). Diagnostic accuracy was pooled in bivariate random effects models. This study is reported according to PRISMA-DTA and is registered with PROSPERO (CRD42018092950). Main Outcome(s) and measure(s) Diagnostic accuracy, expressed as sensitivity and specificity, of depression questionnaires in an adult diabetes population. Results A total 6,097 peer-reviewed articles were screened. Twenty-one studies (N= 5,703 patients) met the inclusion criteria for the systematic review. Twelve different depression questionnaires were identified, of which the CES-D (n=6 studies) and PHQ-9 (n=7 studies) were the most frequently evaluated. Risk of bias was unclear for multiple domains in the majority of studies. In the meta-analyses, five (N= 1,228) studies of the CES-D (≥16), five (N= 1,642) of the PHQ-9 (≥10) and four (N=822) of the algorithm of the PHQ-9 were included in the pooled analysis. The CES-D (≥16) had a pooled sensitivity of 85.0% (95%CI, 71.3-92.8%) and a specificity of 71.6% (95%CI, 62.5-79.2%); the PHQ-9 (≥10) had a sensitivity of 81.5% (95%CI, 57.1-93.5%) and a specificity of 79.7% (95%CI, 62.1-90.4%). The algorithm for the PHQ-9 had a sensitivity of 60.9% (95%CI, 52.3-50 90.8%) and a specificity of 64.0% (95%CI, 53.0-93.9%). Conclusions and relevance This review indicates that the CES-D had the highest sensitivity, whereas the PHQ-9 had the highest specificity, although confidence intervals were wide and overlapping. The algorithm for the PHQ-9 had the lowest sensitivity and specificity. Given the variance in results and suboptimal reporting of studies, further high quality studies are needed to confirm the diagnostic accuracy of these depression questionnaires in patients with diabetes

Signal robustness dependency on sensor contact force in a novel photoplethysmography-based multi-purpose sensing device

A new photoplethysmography-based device called the Multiphotodiode Array (MPA) was validated to successfully measure the PWV in the vasculature of the distal phalanx of healthy subjects. It comprises an array of photodiodes and an array of opposing LEDs to detect blood volume changes due to the passing pressure pulse wave in the vasculature of the distal phalanx of the index finger. This study aimed to discern how the signal robustness of a novel modular sensor based on the technology of the MPA is dependent on the contact force between the vascularized tissue and the sensor surface. PWV data was collected as the distal phalanx of the left index finger from 26 subjects was placed on the Force Alterable- MPA (FA-MPA). Contact force was altered by placing differing weights (0-300g, 50g increments) on top of the phalanx using a linear stage. Contact force was determined as weight measured by a scale underneath the FA-MPA. PWV and weight data was collected from a total of 182 measurements. Measurements were pooled in 8 weight groups between 0 and 400g at increments of 50g according to the weight that was measured during that measurement. PWV data per weight group was analyzed for three characteristics: 1. Pulse Wave Quality Ratio (PWQR); 2. PWV variance; 3. Realistic and non-negative values for PWV. ANOVA of PWQR resulted in a significant effect between weight groups (p = 6.91E-7). Further qualitative judging of data resulted in the recommendation to thoroughly redesign the FA-MPA for structural and electrical integrity and measurement protocol for elimination of movement and placement artifacts and to reiterate the experiment for the contact force range of 1.96 to 4.43N.Mechanical Engineering | BioMechanical Desig

Invloed van toevoegingen aan het werkmedium op warmteoverdracht in een warmtewisselaar

Bluerise has developed a system that uses cold seawater to cool down a fresh water loop. This loop is used for fresh water production. The goal of this study is to improve the overall heat transfer coefficient of the working medium in this system by at least 5%, which will also reduce its size. The overall heat transfer can be improved by adding various additives to the water, although this new medium also requires more power to pump it through the system. The examined additives are: immiscible- and miscible fluids, and nanoparticles. After a theoretical analysis it became clear that only the nanoparticles improve the heat transfer. Experiments showed that a 0.5 and 1 %vol Al2O3 nanoparticles suspended in water gives respectively an enhancement of the heat transfer coefficient of between 0.8% and 22.3% compared to water, not taken into account agglomeration or pollution of the system. However, with a higher pressure-drop, the ratio of pump power needed per heat transfer deteriorated by a maximum of 80%, so although the initial goal of a 5% improvement of heat transfer coefficient is achieved, additional impacts need to be taken into account

Comparative analysis of the digestibility of sewage fine sieved fraction and hygiene paper produced from virgin fibers and recycled fibers

Sewage fine sieved fraction (FSF) is a heterogeneous substrate consisting of mainly toilet paper fibers sequestered from municipal raw sewage by a fine screen. In earlier studies, a maximum biodegradation of 62% and 57% of the sewage FSF was found under thermophilic (55 °C) and mesophilic (35 °C) conditions, respectively. In order to research this limited biodegradability of sewage FSF, this study investigates the biodegradation of different types of cellulosic fibers-based hygiene papers including virgin fibers based toilet paper (VTP), recycled fiber based toilet paper (RTP), virgin pulp for paper production (VPPP) as a raw material, as well as microcrystalline cellulose (MCC) as a kind of fiberless reference material. The anaerobic biodegradation or digestibility tests were conducted under thermophilic and mesophilic conditions. Results of the experiments showed different biomethane potential (BMP) values for each tested cellulose fiber-based substrate, which might be associated with the physical characteristics of the fibers, type of pulping, presence of lignin encrusted fibers, and/or the presence of additive chemicals and refractory compounds. Higher hydrolysis rates (Kh), higher specific methane production rates (SMPR) and shorter required incubation times to achieve 90% of the BMP (t90%CH4), were achieved under thermophilic conditions for all examined substrates compared to the mesophilic ones. Furthermore, the biodegradability of all employed cellulose fiber-based substrates was in the same range, 38-45%, under both conditions and less than the observed FSF biodegradability, i.e. 57-62%. MCC achieved the highest BMP and biodegradability, 86-91%, among all cellulosic substrates.Sanitary Engineerin

Aqueous Redox Chemistry and the Electronic Band Structure of Liquid Water

The electronic states of aqueous species can mix with the extended states of the solvent if they are close in energy to the band edges of water. Using density functional theory-based molecular dynamics simulation, we show that this is the case for OH^– and Cl^–. The effect is, however, badly exaggerated by the generalized gradient approximation leading to systematic underestimation of redox potentials and spurious nonlinearity in the solvent reorganization. Drawing a parallel to charged defects in wide gap solid oxides, we conclude that misalignment of the valence band of water is the main source of error turning the redox levels of OH^– and Cl^– in resonant impurity states. On the other hand, the accuracy of energies of levels corresponding to strongly negative redox potentials is acceptable. We therefore predict that mixing of the vertical attachment level of CO₂ and the unoccupied states of water is a real effect