bluuebunny/crossref_metadata_2025 huggingface dataset:
Population-Based Dementia Screening Program in Kuopio: The Effect of Education, Age, and Sex on Brief Neuropsychological Tests
Authors: Koivisto Keijo , Helkala Eeva-Liisa , Reinikainen Kari J. , Hänninen Tuomo , Mykkänen Leena , Laakso Markku , Pyörärälä Kalevi , Riekkinen Paavo J.
Published: March 2014

A neuropsychological screening battery including the Mini-Mental State Examination and four other brief cognitive tests (Russell's Adaptation of the Visual Reproduction Test, Trail Making Test, Verbal Fluency Tests on letters and category, and the Buschke Selective Reminding Test) was administered to a randomly selected population sample of 403 subjects aged 68 to 77 years to evaluate the effect of education, age, and sex on test scores. The difference in neuropsychological screening tests between various education groups (3 years or less, 4 to 6 years, 7 years or more) was statistically highly significant, even after the adjustment for the effect of age. The subscores and total scores were lowest in the minimal education group on every neuropsychological test. Education correlated more strongly than age with all neuropsychological test scores and subscores. The effect of sex on test results was seen only in some subscores of brief neuropsychological tests but not in a single item of the Mini-Mental State Examination. On the basis of our results, the effects of education, age, and sex have to be evaluated before using brief neuropsychological tests in population-based dementia screening. ( J Geriatr Psychiatry Neurol 1992;5:162–171).
Subclinical Dementia: Relevance of Cognitive Symptoms and Signs
Authors: Persson Göran , Skoog Ingmar
Published: March 2014

In 1971 and 1972, a representative sample of 70-year-old people (n = 392) from a population study was rated with regard to psychiatric symptoms and signs. Subjects showing evidence of dementia of any degree, including slight and questionable, were excluded (n = 18). The remaining 374 subjects were followed longitudinally for 9 years. Thirty-eight subjects developed severe dementia during this period. They were compared to those who did not with regard to 19 reported and 17 observed items concerning general psychopathology, seven reported items concerning sleep, and a global rating of mental health. Five items correlated with the development of severe dementia: number of remembered dreams per week, latency of speech, speed of speech, difficulties in finding words, and memory for recent events. A stepwise logistic regression procedure demonstrated that a low frequency of remembered dreams, a reduced memory for recent events, and difficulties in finding words made independent contributions to the prediction of dementia. There were no differences with regard to affective items. There were no differences between the subjects who developed senile dementia of the Alzheimer type and those with multi-infarct dementia. The results thus support the hypothesis that symptoms pertaining to cognitive functions are the first to appear in the development of dementia. ( J Geriatr Psychiatry Neurol 1992;5:172–178).
Alzheimer's Disease or Plaque Disease? Two Cases at the Frontier of a Definition
Authors: Engel Peter A. , Vinters Harry V. , Grunnet Margaret
Published: March 2014

Atypical dementias confront the adequacy of current diagnostic concepts. The two patients with atypical dementia syndromes described here shared common postmortem features of numerous neocortical neuritic (senile) plaques and microvascular amyloid, sparing of hippocampus and substantia nigra, and the virtual absence of neurofibrillary tangles. Microscopically, the two differed only by the presence of a few subcortical Lewy bodies in case 1. These similar morphologic features were associated with dramatically different clinical presentations. In the first patient, visual hallucinations, Capgras' syndrome, cognitive slowing, myoclonus, parkinsonism, and primitive reflexes evolved over 3 years. Memory and language were relatively spared. In the second, dysphagia, nonfluent aphasia, hypophonia, motor perseveration, and a severe disorder of attention developed during this 18-month illness. At autopsy, an unrecognized colon malignancy was found. Despite high neuritic plaque counts in cortex, neither the clinical nor the pathologic criteria for Alzheimer's disease adequately describe either case. The cases will be examined first as clinical, then as neuropathologic, entities. From this approach, we conclude that a specific clinical dementia syndrome may be expressed by several neuropathologic “diseases” and that a variety of clinical syndromes may represent a single neuropathologic diagnosis. This strategy identifies a conceptual dichotomy between Alzheimer's syndrome and postmortem Alzheimer's disease. Meticulous clinical and neuropathologic observation is essential in advancing an understanding of the relationship between the two. ( J Geriatr Psychiatry Neurol 1992;5:200–209).
To Drive or Not To Drive: Preliminary Results From Road Testing of Patients With Dementia
Authors: Kapust Lissa Robins , Weintraub Sandra
Published: March 2014

There has been considerable debate about whether driving privileges should be revoked from patients with a diagnosis of dementia and whether highway safety policies should come under closer scrutiny for all elderly. Two case studies are reported of patients with a diagnosis of probable Alzheimer's disease who participated in a pilot project to assess driving. Subjects underwent neurologic and neuropsychological evaluation. Caregivers were included in psychosocial assessments. Patients participated in a specially designed driving evaluation, including an actual road test. Although both patients had mild-to-moderate cognitive impairment on standard tests, one of the patients was deemed safe to drive on the road test while the other was not. These preliminary results suggest that driving skill may not be predictable solely on the basis of the office examination. A road competency test provides a more objective and direct measure on which to base a decision of such important consequence. Implications for public policy and the role for healthcare providers in this process are discussed. ( J Geriatr Psychiatry Neurol 1992;5:210–216).
Pattern of Use of Antidepressants in Long-Term Care Facilities for the Elderly
Authors: Conn David K. , Goldman Zalman
Published: March 2014

Despite some evidence that neuroleptic medication is overused or misused in long-term care facilities for the elderly, there has been virtually no attention paid to the pattern of use of antidepressants in these facilities. All patients in long-term care in a geriatric hospital and a home for the aged who were receiving antidepressants were identified; 10.5% of the patients in the hospital and 12.7% in the home for the aged were receiving an antidepressant. The rate of use of antidepressants on the different units ranged from 0% to 26.8%. The most commonly prescribed antidepressant was doxepin followed by nortriptyline. The mean dose of antidepressant was 34.8 mg. Although depression was the most common reason for the prescription of an antidepressant (69% of patients receiving one), other reasons included pain, agitation, aggression, and insomnia. Patients had been receiving antidepressants for up to 10 years, with a mean duration of 32 months. The majority of patients (60%) had a history of depression predating their institutional admission. Patients receiving antidepressants were compared to a group not receiving antidepressants, who were matched for age, sex, unit, and attending physician. Patients receiving antidepressants were more likely to have a history of stroke (33.8% versus 16.9%). There was no significant difference between the two groups regarding the prevalence of dementia, Parkinson's disease, thyroid disease, malignant tumor, congestive heart failure, or diabetes mellitus. Prospective studies are required to determine the efficacy of antidepressants in this population and to identify factors that can predict a positive response to treatment. ( J Geriatr Psychiatry Neurol 1992;5:228–232).
Limitation of the Mini-Mental State Examination for the Detection of Amnesia
Authors: Benedict Ralph H.B. , Brandt Jason
Published: March 2014

The present study demonstrates the limitation of the Mini-Mental State Examination (MMSE) for detecting the amnestic syndrome. Although neuropsychological testing yielded severe memory deficits in all of the 11 amnesic patients tested, six of the patients obtained total MMSE scores above the standard cutoff score of 24. Further, only six patients completely failed the MMSE recall item, and three patients performed errorlessly on this item. Results from one postencephalitic patient are presented in detail. She performed the serial sevens task very quickly and subsequently recalled all three of the to-be-remembered words. Her performance on other memory tests confirmed that a longer retention interval than that provided by the MMSE is necessary to elicit her memory disorder. ( J Geriatr Psychiatry Neurol 1992;5:233–237).
A Survey of Retirement Planning by Texas Psychiatrists
Authors: Baker F.M. , Warren Bruce H. , Muraida JoLynn , Muraida Gerard
Published: March 2014

Forty-six percent (274 of 600) of the members of the Texas Society of Psychiatric Physicians responded to a mailed survey that addressed retirement issues. Forty-seven percent of respondents were 60 to 69 years of age. Only 12% were female. Ninety-one percent were white, with 86% of respondents married. Only 24% of the sample (66 of 274) were retired at the time of the survey. Although engaged in more than one area of professional activity, 71% were involved in private practice, with 51% practicing in a private office. The major reasons for retiring were “a full life and ready to change pace” (52%) and “retired to pursue other interests” (25%). Twenty percent retired because of physical illness. A mixed financial package formed their retirement package, which included social security (80%), personal savings (73%), Keogh (64%), and state/US government monies (39%). Retired psychiatrists were interested in receiving additional information on successful patterns of retirement (21%), maintaining emotional and physical health (17%), and material on the problems and trials of retirement (15%). Leisure-time activities were varied, and most psychiatrists reported two to four activities. According to 39% of the sample, retirement should be discussed during medical school, 46% indicated that it should be discussed during residency training, and 80% selected Continuing Medical Education courses. ( J Geriatr Psychiatry Neurol 1993;1:14–19).
Combined Use of Labetalol and Nifedipine in Controlling the Cardiovascular Response From ECT
Authors: Figiel Gary S. , DeLeo Bernard , Zorumski Charles F. , Baker Kristin , Goewert Arden , Jarvis Michael , Smith Deborah S. , Mattingly Gregory , Ruwitch Joseph
Published: March 2014

Serious cardiac complications have been reported to occur in elderly depressed patients during a course of electroconvulsive therapy (ECT). As a result, cardiac medications are being used more often to dampen the cardiovascular response that occurs during an ECT treatment. Specifically, labetalol (a mixed α- and β-blocker) has been shown to effectively control the heart rate during ECT. However, on occasion, patients may still exhibit sustained elevations of blood pressure during ECT when receiving labetalol. The optimum clinical management of these patients is unclear. The authors report on the safety and efficacy of combining nifedipine with labetalol to control blood pressure during ECT in ten elderly patients whose blood pressures were not adequately controlled by labetalol alone. No adverse effects were noted, nor did nifedipine appear to shorten seizure duration. ( J Geriatr Psychiatry Neurol 1993;1:20–24).
Weight Loss in Alzheimer's Disease
Authors: Du Wei , DiLuca Chiara , Growdon John H.
Published: March 2014

In order to determine whether weight loss is a core symptom or secondary manifestation of Alzheimer's disease, we analyzed weight change in 81 outpatients with Alzheimer's disease. During a mean 2.9 years of observation, the mean absolute weight loss was 1.9 ± 0.8 kg, and the mean weight loss per year was 0.7 ± 0.3 kg. Although statistically significant ( P < .05), the mean absolute weight loss was only 3% of initial body weight. Data analyses revealed that weight change was significantly ( P < .0001) correlated with decreased independence in self-feeding. Weight change was not related to duration of dementia, clinical measures of dementia severity, psychiatric symptoms, or medications. These observations support the view that weight loss is a consequence of Alzheimer's disease and does not reflect specific brain lesions. ( J Geriatr Psychiatry Neurol 1993;1:34–38).
Neuroanatomic Substrates of Depression in the Elderly
Authors: Krishnan K. Ranga Rama
Published: March 2014

The causes of depression in the elderly are poorly understood. The concept that psychological and social factors are the primary contributors to the occurrence of depression in later life, though intuitively appealing, is not supported by available evidence. In addition, genetic factors are less significant in patients presenting with depression for the first time in later life. In this article, the following hypotheses are examined: (1) the aging process facilitates emergence of depression in later life; (2) cerebrovascular pathology plays a role in the etiology of depression in the elderly; and (3) the site and location of changes in the brain provide a basis for understanding neuroanatomic substrates of depression in the elderly. The role of the basal ganglia and different basal ganglia circuits in the pathophysiology of depression is discussed. The clinical significance of the findings of structural changes in the brain are also discussed. ( J Geriatr Psychiatry Neurol 1993;1:39–58).
Christ Existing as Concrete Community Today
Authors: McBride Jennifer M.
Published: March 2014

Bonhoeffer’s ecclesiology summed up in his axiom, “Christ existing as community,” establishes the church as a “reality of revelation”—the continued manifestation of Christ in the world. This central notion drives Bonhoeffer’s theological and pragmatic search for new social forms that make the Gospel concrete. Requisite for full appropriation of Bonhoeffer’s legacy is a turn toward contemporary Christian communities trying to follow Jesus’ teachings with similar intentionality and seriousness. To this end, the article places Bonhoeffer’s well-known reflections on discipleship alongside the lived experience of the Open Door, an interracial, residential Christian activist and worshipping community in Atlanta, Georgia, USA that for 30 years has been engaged in works of mercy and justice for homeless and incarcerated persons. When read through the lens of Bonhoeffer’s discipleship theology, the founding and life-work of the Open Door helps readers rethink and re-imagine the kind of ecclesial spaces and structures needed to foster radical discipleship formation strong enough to confront unjust realities that oppose God’s reign today.
Ecclesial Priestly Mediation in the Theology of Dietrich Bonhoeffer
Authors: Greggs Tom
Published: March 2014

This article considers priestly mediation in the theology of Dietrich Bonhoeffer. Little material exists in Bonhoeffer’s corpus that directly addresses the issue of priesthood. However, this article argues that the primary way in which Bonhoeffer construed priestliness is in relation to certain motifs associated with mediation focused on his theological approach to the church. There is a symbiotic twofold relationship in this. First, the article considers what one might think of as Bonhoeffer’s account of how the priestliness of the church is felt internally: Christ establishes a mode of sociality in the church which arises from mediation not only between God and humanity, but between human beings and other human beings; this is part of Christ’s salvific work. Second, there is an account of the external relationality established between the church and the world according to Bonhoeffer, whereby in Christ, the church shares in the task of vicarious representative responsibility for the world. This description of the church’s nature and life bears the hallmarks of priestliness. It is argued that for Bonhoeffer priesthood was an identity held collectively in the church as the person of Christ in the world today, rather than being a quality possessed by individuals, whether for all Christians or merely some.
Formed While Following: Dietrich Bonhoeffer’s Asymmetrical View of Agency in Christian Formation
Authors: McGarry Joseph
Published: March 2014

This article investigates Dietrich Bonhoeffer’s distinct understanding of the correlation between the church’s discipleship and its conformation to Christ’s form. Bonhoeffer’s thought highlights a provocative question regarding spiritual formation and the life of the church: Is Christian formation the proper aim of discipleship, and thus its product, or is it a consequence of discipleship, and hence its byproduct? Though Bonhoeffer disagreed with the idea that formation occurs as Christians “strive to become like Jesus,” he does acknowledge that formation occurs by Christians striving towards something. This article pays particular attention to understanding how this “something” for which Christians strive relates to God’s work of conformation and thereby highlights Bonhoeffer’s distinct perspective on human and divine agency in the process of Christian formation. The article engages relevant sections of Discipleship to develop core aspects of Bonhoeffer’s thought regarding the relationship between the life of the church and the specifically formative nature of Christian existence. This permits me to note the effects of discipleship and how these effects correspond to what the disciple intends in following Christ. On this basis, we recognize the difference between what disciples intend in their obedience to Christ and what God works through their discipleship. This reveals a strict asymmetry within Bonhoeffer’s account of Christian life and its effects, and draws attention to God’s sole agency in Christian formation. For Bonhoeffer, Christian formation is determined by an asymmetrical agency, in which formation in Christ is a byproduct of the church’s discipleship to Christ, even as such formation is not—indeed cannot—be its original objective.
Developing a Theologia Crucis: Dietrich Bonhoeffer in the Harlem Renaissance
Authors: Williams Reggie
Published: March 2014

In 1928–29, Dietrich Bonhoeffer was an assistant pastor in Barcelona, Spain, where he delivered twenty sermons and three academic lectures. The last two of his Barcelona lectures demonstrate the intellectual acumen of a brilliant scholar, but some of the content of the lectures was not consistent with his legacy of prophetic resistance to the Nazis and their Christian supporters, the German Christian movement. In Barcelona Bonhoeffer spoke in favor of nationalism, which he later opposed. In a brief statement about the 1928–29 Barcelona lectures, Bonhoeffer’s best friend and biographer Eberhard Bethge said, simply “it was the theologia crucis that saved him from this line of thought.” This article argues that during his Sloane Fellowship year, 1930–31, Bonhoeffer was a student of New York’s Harlem Renaissance, where he was put in contact with a tradition that recognized Jesus as active and present in the daily lives of marginalized people, identifying with suffering and shame, as a redemptive presence in oppression. That tradition put Bonhoeffer in contact with his own German Lutheran theological tradition of the theologia crucis, helping him to see racist oppression as it is in this world, a problem that Christians must address, and to advocate solidarity with Jesus, who is hidden in the world, in suffering and shame.
Psychological research and South Africa’s violence prevention responses
Authors: Seedat Mohamed , van Niekerk Ashley , Suffla Shahnaaz , Ratele Kopano
Published: March 2014

South Africa’s unprecedented levels of violence, which trigger significant health, economic, and social consequences, are marked by pronounced gendered, age-related, and socio-economic features. Extensive poverty, prolonged unemployment and income inequality, gender inequality, patriarchal notions of masculinity, exposure to abuse in childhood and compromised parenting, access to firearms, pervasive alcohol misuse, and fragilities in law enforcement are among the many factors inherent to the social dynamics of violence. We briefly describe some of psychology’s recent contributions to violence prevention research and interventions. The review, by no means a comprehensive one, is intended to encourage reflections and conversations about how psychology may increase its influence as a critical and intervention-oriented discipline alongside other disciplines, such as public health, social work, criminology, anthropology, development studies, social medicine, and urban studies. We suggest that as much as it is important for psychology to provide a relevant research response, it is equally important for psychology to undertake critical work on the responses to violence, including the intellectual traditions that underlie such responses.
Teaching Associates
Authors: Jungels Amanda M. , Brown Marni A. , Stombler Mindy , Yasumoto Saori
Published: March 2014

Faculty members and graduate student instructors (GSIs) spend a significant portion of their time in the classroom. Much of the literature calls for formal training for graduate students in pedagogy and teaching techniques (DeCesare 2003), and increasing attention has been paid to the benefits of informal supports for GSIs, such as peer networks. But scholars have paid far less attention to examining how formal and informal mechanisms of support might be bridged, thus strengthening support for GSIs. In this article, we explore and demonstrate the importance of bridging available support systems for GSIs, specifically through a position occupied by an advanced GSI, called the Teaching Associate. Using focus groups, semistructured interviews, and surveys, we argue that the Teaching Associate offers formal and informal forms of support for graduate student instructors and their departments and we advocate their use in teacher training.
Energy-saving-oriented group-elevator dispatching strategy for multi-traffic patterns
Authors: Zhang Jinglong , Zong Qun
Published: March 2014

Energy-saving elevator dispatching has been recognized as a challenging issue in building transportation, and we develop a novel energy-saving dispatching strategy for regenerative group-elevator system. Group-elevator dispatching is a typical combinatorial optimization problem, and three keys of the dispatching optimization are optimization method, objective, and model. The three keys of energy-saving-oriented elevator dispatching are studied in this paper. First, robust optimization method is introduced to handle dispatching optimization under uncertain elevator traffic flows; uncertain flows influence energy-saving dispatching seriously. Second, dispatching energy-objective function for regenerative group-elevator system is derived both schedule energy for four traffic patterns (up-peak, down-peak, up/down-mixed, and night) and return energy for two peak patterns (up-peak and down-peak) are considered. Third, four robust optimization-dispatching models for four traffic patterns are built, and optimization objectives of four models are minimizing the energy-objective function. Moreover, because we cannot solve robust optimization models with uncertain parameters directly, model counterpart transformation is studied. Finally, we solve the four transformed models by Linear Interactive and General Optimizer software and obtain robust optimization-dispatching solutions. In practice, four energy-saving-dispatching robust optimization models are switched according to real-time traffic patterns, and elevators are dispatched based on the dispatching solutions. We reduce elevator system-energy consumption effectively and keep average waiting time of the passengers acceptable under multi-traffic patterns. Simulation results demonstrate the validity of our strategy.

Practical application: Group-elevator system spends much unnecessary energy because of the uncertainty of elevator passenger-traffic flows. This paper develops an energy-saving elevator-dispatching optimization strategy, which is immune to the uncertainty of four typical traffic flows. In practice, we update the group-elevator controller by our algorithm to realize energy-saving dispatching of regenerative group-elevator system under multi-traffic patterns.
Percutaneous heart valves; past, present and future
Authors: Rozeik MM , Wheatley DJ , Gourlay T
Published: March 2014

Percutaneous heart valves provide a promising future for patients refused surgery on the grounds of significant technical challenges or high risk for complications. Since the first human intervention more than 10 years ago, over 50 different types of valves have been developed. The CoreValve and Edwards SAPIEN valves have both experienced clinical trials and the latter has gained FDA approval for implantation in patients considered inoperable. Current complications, such as major vascular bleeding and stroke, prevent these valves from being commonly deployed in patients considered operable in conventional surgery. This review focuses on the past and present achievements of these valves and highlights the design considerations required to progress development further. It is envisaged that, with continued improvement in valve design and with increased clinical and engineering experience, percutaneous heart valve replacement may one day be a viable option for lower-risk operable patients.
Imminence of death among hospital inpatients: Prevalent cohort study
Authors: Clark David , Armstrong Matthew , Allan Ananda , Graham Fiona , Carnon Andrew , Isles Christopher
Published: March 2014

Background:

There is a dearth of evidence on the proportion of the hospital population at any one time, that is in the last year of life, and therefore on how hospital policies and services can be oriented to their needs.

Aim:

To establish the likelihood of death within 12 months of a cohort of hospital inpatients on a given census date.

Design:

Prevalent cohort study.

Participants:

In total, 10,743 inpatients in 25 Scottish teaching and general hospitals on 31 March 2010.

Results:

In all, 3098 (28.8%) patients died during follow-up: 2.9% by 7 days, 8.9% by 30 days, 16.0% by 3 months, 21.2% by 6 months, 25.5% by 9 months and 28.8% by 12 months. Deaths during the index admission accounted for 32.3% of all deaths during the follow-up year. Mortality rose steeply with age and was three times higher at 1 year for patients aged 85 years and over compared to those who were under 60 years (45.6% vs 13.1%; p < 0.001). In multivariate analyses, men were more likely to die than women (odds ratio: 1.18, 95% confidence interval: 0.95–1.47) as were older patients (odds ratio: 4.99, 95% confidence interval: 3.94–6.33 for those who were 85 years and over compared to those who were under 60 years), deprived patients (odds ratio: 1.17, 95% confidence interval: 1.01–1.35 for most deprived compared to least deprived quintile) and those admitted to a medical specialty (odds ratio: 3.13, 95% confidence interval: 2.48–4.00 compared to surgical patients).

Conclusion:

Large numbers of hospital inpatients have entered the last year of their lives. Such data could assist in advocacy for these patients and should influence end-of-life care strategies in hospital.
Balancing Clinical Experience in Outpatient Residency Training
Authors: Stahl James E. , Balasubramanian Hari Jagannathan , Gao Xiaoling , Overko Steven , Fosburgh Blair
Published: March 2014

Background. To receive adequate training experience, resident panels in teaching clinics must have a sufficiently diverse patient case-mix. However, case-mix can differ from one resident panel to another, resulting in inconsistent training. Method. Encounter data from primary care residency clinics at Massachusetts General Hospital from July 2008 to May 2010 (64 residents and ~3800 patients) were used to characterize patients by gender, age, major disease category (both acute and chronic, e.g., Cardio Acute, Cardio Chronic, etc., for a total of 44 disease categories), and number of disease categories. Imbalance across resident panels was characterized by the standard deviation for disease category, patient panel size, and annual visit frequency. To balance case-mix in resident panels, patient reassignment algorithms were proposed. First, patients were sorted by complexity; then patients were allocated sequentially to the panel with the least overall complexity. Patient reassignment across resident panels was considered under 3 scenarios: 1) within preceptor, 2) within a group of preceptors, and 3) across the entire practice annually. Results were compared with case-mix (pre-July 2012) and post-July 2012. Results. All 3 reassignment algorithms produced significant reductions in standard deviation of either number of disease categories or diagnoses across residents when compared with baseline (pre-July 2012) and actual July 2012 reassignment. Reassignment across the clinic and group provided the best and second best scenarios, respectively, although both came at the cost of initially reduced patient-preceptor continuity. Conclusion. Systematically reallocating patient panels in teaching clinics potentially can improve the consistency and breadth of the educational experience. The method in principle can be extended to any target of health care system reform where there is patient or clinician turnover.
Utilization of coal fly ash in solidification of liquid radioactive waste from research reactor
Authors: Osmanlioglu Ahmet Erdal
Published: March 2014

In this study, the potential utilization of fly ash was investigated as an additive in solidification process of radioactive waste sludge from research reactor. Coal formations include various percentages of natural radioactive elements; therefore, coal fly ash includes various levels of radioactivity. For this reason, fly ashes have to be evaluated for potential environmental implications in case of further usage in any construction material. But for use in solidification of radioactive sludge, the radiological effects of fly ash are in the range of radioactive waste management limits. The results show that fly ash has a strong fixing capacity for radioactive isotopes. Specimens with addition of 5–15% fly ash to concrete was observed to be sufficient to achieve the target compressive strength of 20 MPa required for near-surface disposal. An optimum mixture comprising 15% fly ash, 35% cement, and 50% radioactive waste sludge could provide the solidification required for long-term storage and disposal. The codisposal of radioactive fly ash with radioactive sludge by solidification decreases the usage of cement in solidification process. By this method, radioactive fly ash can become a valuable additive instead of industrial waste. This study supports the utilization of fly ash in industry and the solidification of radioactive waste in the nuclear industry.
The effect of ash composition on gasification of poultry wastes in a fluidized bed reactor
Authors: Di Gregorio Fabrizio , Santoro Donato , Arena Umberto
Published: March 2014

The effect of ash composition on the fluidized bed gasification behaviour of poultry wastes was investigated by operating a pre-pilot scale reactor with two batches of manure obtained from an industrial chicken farm. The experimental runs were carried out by keeping the fluidized bed velocity fixed (at 0.4m s−1) and by varying the equivalence ratio between 0.27 and 0.40, so obtaining bed temperature values between 700 and 800 °C. The performance of the gasification process was assessed by means of mass balances as well as material and feedstock energy analyses, and reported in terms of cold gas efficiency (CGE), specific energy production, low heating value of obtained syngas and yield of undesired by-products. The experimental results indicate the crucial role of ash amount and composition of the two poultry wastes. In particular, higher ash content (25.1% instead of 17.2%) and higher fractions of calcium, phosphorous and potassium (with an increase of 24, 30 and 28%, respectively) induce a dramatic reduction of all the process performance parameters: CGE reduces from 0.63 to 0.33 and the specific energy from 2.1 to 1.1 kWh kgfuel−1. At the same time, the formation of alkali compounds and their behaviour inside the fluidized bed reactor determine an increase of feedstock energy losses, which is related to occurrence of sintering and bridging between bed particles.
Molds and Totems
Authors: Jerolmack Colin , Tavory Iddo
Published: March 2014

The role of nonhumans in social life has recently generated significant scholarly interest. The two main paradigms for explaining the sociological significance of nonhumans are constructivism and actor-network theory. We propose a pragmatist synthesis inspired by George Herbert Mead, demonstrating how interactions with nonhumans help constitute the social self—that is, the identity one constructs by imaginatively looking upon oneself as others would. Drawing upon observations of humans interacting with objects, animals, and nature, we identify two complementary ways that nonhumans organize the social self and enable people to experience group membership in absentia: (1) by molding how one is perceived by others and constraining alternative presentations of self and (2) by acting as a totem that conjures up awareness of, and feelings of attachment to, a particular social group. This formulation moves beyond constructivist claims that nonhumans reflect people’s self-definitions, and it offers a corrective to actor-network theory’s neglect of sociality.
Harrison White as (Not Quite) Poststructuralist
Authors: Seeley J. Lotus
Published: March 2014

This paper explores the overlaps and divergences between network sociologist Harrison White’s second edition of Identity and Control: How Social Formations Emerge (2008) and poststructuralist theories from the past three decades. Although poststructuralist thought is barely discussed in White’s work, comparing the approaches reveals significant convergence. I detail two major overlaps: White’s ideas of control compared to Foucault’s concept of discipline, and White’s conception of identity compared to that of feminist poststructuralists. Differences are apparent also, especially as regards treatment of categorical identities such as gender and race. Then, I turn to two ways poststructuralism and White can be put into productive conversation: how focusing on gender as discursive rather than attributional can help network analysts develop theories that better explain the gendered dimensions of social life, and how using blockmodeling methods can aid feminist poststructuralism in understanding what gender looks like without men’s and women’s bodies present.
Cognitive-Behavioral Treatment of Older Veterans with Substance Abuse Problems
Authors: Schonfeld Lawrence , Dupree Larry W. , Dickson-Fuhrmann Elizabeth , Royer Catherine McKean , McDermott Charles H. , Rosansky Joel S. , Taylor Shane , Jarvik Lissy F.
Published: March 2014

The authors describe the initial cohort of participants in the GET SMART program, an age-specific, outpatient program for older veterans with substance abuse problems. Chief among the program's services is a relapse-prevention intervention consisting of 16 weekly group sessions using cognitive-behavioral (CB) and self-management approaches. Group sessions begin with analysis of substance use behavior to determine high-risk situations for alcohol or drug use, followed by a series of modules to teach coping skills for coping with social pressure, being at home and alone, feelings of depression and loneliness, anxiety and tension, anger and frustration, cues for substance use, urges (self-statements), and slips or relapses. Of the first 110 admissions, more than one-third were homeless, which is indicative of the severity of psychosocial distress of the patients, and more than one-third used illicit drugs. A total of 49 patients completed CB treatment groups and 61 dropped out of treatment. At 6-month follow-up, program completers demonstrated much higher rates of abstinence compared to noncompleters. The results suggest that CB approaches work well with older veterans with significant medical, social, and drug use problems.
Portraits of Change: Case Studies from an Elder-Specific Addiction Program
Authors: Royer Catherine McKean , Dickson-Fuhrmann Elizabeth , McDermott Charles H. , Taylor Shane , Rosansky Joel S. , Jarvik Lissy F.
Published: March 2014

The authors describe two case histories of patients served by the GET SMART program that provide a glimpse of typical client substance abuse histories and their remarkable journeys of change. An age-specific outpatient program for older veterans with illicit drug and alcohol dependence, the GET SMART program uses individualized and group treatment interventions in an environment of collaboration, respect, and hope. The program employs the stages of change framework and a clinical framework that includes cognitive-behavioral and motivational interviewing approaches.
Aging and Schizophrenia: Current Health Services Research and Recommendations
Authors: Barry Kristen Lawton , Blow Frederic C. , Dornfeld Maude , Valenstein Marcia
Published: March 2014

Little is known about the functioning and health care use of older patients with schizophrenia. Understanding the use patterns of older patients with schizophrenia, a rapidly growing population, will inform health care planners and policy makers who make decisions about resource allocation and program development. The results are presented from a large-scale study to examine the relationship between age and the use of health services and level of functioning in patients with schizophrenia. Older adults with schizophrenia experienced fewer psychiatric hospitalizations but, once hospitalized, had longer inpatient stays. In contrast, older patients had fewer outpatient psychiatric visits and more medical outpatient visits and medical hospitalizations than younger individuals. The relatively lower use of outpatient psychiatric care by older patients with schizophrenia suggests that there may be barriers to accessing these services. When older patients are hospitalized for psychiatric reasons, their stays are longer. The implications of these findings are discussed.
Late-Life Depression and Mental Health Services in Primary Care
Authors: Wagenaar Deborah Banazak , Mickus Maureen A. , Gaumer Kris A. , Colenda Christopher C.
Published: March 2014

Mental health services in the treatment of late-life depression are critical in the primary care arena. A significant proportion of elderly patients experience depression, a problem causing a far-reaching impact on morbidity, mortality, and quality of life. A number of barriers may prevent effective depression treatment including negative physician and patient attitudes toward the stigma of depression, somatically focused clinical presentations, health care plan constraints, and competing medical demands, as well as gender and geographic isolation. Screening for depression in primary care settings is not always standard fare as physicians may feel confident in their diagnostic abilities. Research addressing effective depression treatment in the primary care setting has been limited to few clinical trials and physician-focused academic detailing. Future research should address real-world scenarios encountered by the primary care physician in their treatment of the “old-old” patient with complex medical comorbidities and functional decline.
Idiopathic Rapid Eye Movement Sleep Behavior Disorder Is a Harbinger of Dementia with Lewy Bodies
Authors: Turner R. Scott
Published: March 2014

Idiopathic rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia clinically linked with the α-synucleinopathies multiple systems atrophy (MSA), Parkinson's disease (PD), and dementia with Lewy bodies (DLB). Available autopsy information is limited but suggests that the pathologic basis of idiopathic RBD may be neuronal loss and Lewy bodies in pigmented monoaminergic nuclei, including the locus coeruleus and substantia nigra, which project to pontine nuclei mediating atonia during REM sleep. Thus, idiopathic RBD may be an α-synucleinopathy per se and a harbinger of impending PD, DLB, or MSA. Inclusion of historical or concurrent idiopathic RBD in the diagnostic criteria for DLB may improve their sensitivity, specificity, and clinical utility. (J Geriatr Psychiatry Neurol 2002; 15:000–000).
Dementia with Lewy Bodies: Neuropathology
Authors: Dickson Dennis W.
Published: March 2014

The pathologic substrate of the clinical syndrome of dementia with Lewy bodies (DLB) remains to be determined. Only a few prospective clinicopathologic studies have been reported. In those reports, most cases of DLB had neocortical or limbic Lewy bodies and Alzheimer-type pathology below threshold for diagnosis of Alzheimer's disease. These results are in accord with recent retrospective clinicopathologic studies of dementia occurring in Parkinson's disease, in which cortical Lewy bodies, rather than concurrent Alzheimer's disease, are increasingly recognized as the pathologic substrate of dementia. Additional clinicopathologic studies are warranted to address the role of other Lewy-related pathology, most notably Lewy neurites, in the cognitive impairment of DLB. (J Geriatr Psychiatry Neurol 2002; 15:000–000).
Which Alzheimer Patients Are at Risk for Rapid Cognitive Decline?
Authors: O'Hara Ruth , Thompson Jean M. , Kraemer Helena C. , Fenn Catherine , Taylor Joy L. , Ross Leslie , Yesavage Jerome A. , Bailey Amber M. , Tinklenberg Jared R.
Published: March 2014

In the current study of 1062 Alzheimer's disease (AD) patients, we employed receiver operating characteristic curve analysis to identify characteristics of patients at increased risk for rapid cognitive decline. The patients are participants at one of the nine Alzheimer's Disease Research Centers of California. Rapid decline was defined as a 3-point or greater loss on the Mini-Mental State Examination (MMSE) per year, post visit. The independent variables were age at clinic visit, age at symptom onset of AD, MMSE at patient visit, years of education, gender, ethnicity, living arrangement, presence of aphasia, delusions, hallucinations, and extrapyramidal signs. Receiver operating characteristic curve analysis indicated that AD patients presenting with moderate to severe aphasia, age at clinic visit of 75 years or less, and an MMSE greater than 7 were at increased risk for rapid cognitive decline. This information could help clinicians target these patients for pharmacologic interventions, facilitate long-term care planning, and potentially create savings by delaying or stabilizing the course of the disease. (J Geriatr Psychiatry Neurol 2002; 15:000–000).
Memory Complaint, Memory Performance, and Psychiatric Diagnosis: A Community Study
Authors: Bassett Susan Spear , Folstein Marshal F.
Published: March 2014

This study examined the prevalence of memory complaint and poor memory performance on brief screening measures within a community sample of 810 adults. All individuals received an extensive household interview and a clinical psychiatric evaluation. Overall, 22% indicated that they currently had trouble with their memory. This percentage increased with age, rising to 43% for those 65 to 74 years old, 51% for those 75 to 84 years old, and 88% for those 85 years of age and older; the percentage indicating memory problems decreased with educational attainment. The prevalence of poor memory performance was 11%, also increasing with less education and increased age, rising to 26% for those 65 to 74 years old and to 40% for those older then 75. Those who complained of memory trouble were twice as likely to show poor memory performance (29%) compared with those who did not complain (15%). Multivariate analysis found age, emotional distress, and physical illness to be independent predictors of memory complaint; age, functional disability, education, and physical illnesses proved to be independently associated with poor memory performance. A higher prevalence of complaints of memory trouble was found not only for those with affective disorders, as might be expected, but also among those with schizophrenic, cognitive, anxiety, and adjustment disorders. However, only individuals with cognitive disorders showed a higher prevalence of poor memory performance.
Successful Treatment With Captopril of an Elderly Man With Polydipsia and Hyponatremia
Authors: Tueth Michael J. , Broderick-Cantwell John
Published: March 2014

A case of severe hyponatremia in a polydipsic 64-year-old man is described. He was unsuccessfully treated with both demeclocycline and lithium carbonate. However, low-dose captopril reversed the polydipsia and resulted in sustained normal serum sodium levels. We believe the antidipsogenic effect of captopril may benefit some patients with polydipsia and hyponatremia.
Aging and Bereavement
Authors: Zisook Sidney , Shuchter Stephen R. , Sledge Paul , Mulvihill Mary
Published: March 2014

This paper compares the grief responses of widows and widowers of different age groups over the 1st year of bereavement. The results strongly suggest that older widows and widowers perceive themselves as adjusting better to their loss and suffering from less depression and fewer anxiety symptoms than their younger counterparts. Furthermore, the oldest widows/widowers demonstrate the most consistent improvement in their levels of distress over time. Thus, when it comes to coping, older persons are not at the disadvantage that certain stereotypes and “clinical wisdoms” have previously suggested. Seniors are every bit as adaptive and able to cope with the severest forms of stress as anyone else, and they are, if anything, less prone to depression than are younger individuals.
Heterogeneity of Vascular Dementia: Mechanisms and Subgroups
Authors: Wallin Anders , Blennow Kaj
Published: March 2014

Today, multiple, thromboembolically generated cerebral infarcts are regarded as the main pathogenetic pathway of vascular dementia (VAD), with multi-infarct dementia (MID) as its clinical counterpart. However, taking into account other vascular mechanisms that may influence the brain, such as vessel-wall damage (atherosclerosis, hyalinosis, amyloid angiopathy, or blood-brain barrier dysfunction), cerebrovascular insufficiency (disturbance of systemic circulation, perfusion vulnerability related to the vascular anatomy of the brain, or disturbance of autoregulation), and hyperviscosity, it is evident that MID is not the only VAD category. The diagnosis of MID ought to be reserved for the combination of progressive dementia associated with cerebral ischemic events and evidence of infarction that is mainly associated with the large cerebral arteries. Subcortical white-matter dementia characterized by frontosubcortical symptomatology, white-matter lesions, and small-vessel involvement with or without lacunes/infarcts—a combination of lacunar dementia and Binswanger's disease—appears to be another important VAD disease.