bluuebunny/crossref_metadata_2025 huggingface dataset:
Food Insecurity Is Associated With Depressive Symptoms Among Brazilian Community Older Adults
Authors: Freiria Carolina , Silva Graziele , Hara Larissa , Fattori André , Borim Flavia , Brito Tábatta , Corona Ligiana
Published: December 2020

Food security can be defined as when the individual has access to food consumption in adequate quality and quantity, respecting aspects such as age, physiological condition and cultural habits. While international studies showed the association of Food Insecurity (FI) and many negative health outcomes, like depressive symptoms, less is known about food insecurity among older people in Brazil, especially about its association with health. The aim of this study is to analyze the relationship between FI and Depressive Symptoms (DS) among community older Brazilian adults. Were included in this study 493 community older people with 60+. Geriatric Depression Scale were used to measure DS and for assessment of FI was used the short version of the Brazilian Food Insecurity Scale, added with one question involving functional limitations to buy food. Logistic regression was used to estimate the odds ratio (OR) adjusted for covariates (e.g., sex, education, age and familiar income). The prevalence of FI were 42.4% and the prevalence of DS were 71.5% of population. The prevalence of DS was higher in the group with FI than among those without F (78.9% vs 65.8% respectively; p=0.001). In the adjusted regression analysis, the chance of presenting positive symptomatology for depression was 1.87 times higher among the older people with FI (CI 1.18 –2.91; p=0.007). The findings demonstrate high prevalence of FI and DS indicating the importance of FI screening among community-based older people in order to avoid possible negative health outcomes in this population, such as the development of depressive symptoms.
Training Medical Residents to Address Social Determinants of Health for Better Health Outcomes
Authors: Zell Angela , Ilardo Joan , Olomu Adesuwa , Meghea Cristian , Rayamajhi Supratik
Published: December 2020

Gaps exist in training medical residents to assess social determinants of health (SDOH) related to chronic conditions. To address the need for better screening, we partnered with two Internal Medicine (IM) residency programs based in Lansing and Flint (Michigan) to pilot the Caring for Patients with Chronic Conditions (CPCC) project. IM residencies train internists with expertise in diagnosis, treating chronic conditions, promoting health through wellness education, and preventing and managing diseases. CPCC incorporated information during didactic sessions that residents could apply during their clinical activities that can influence their current and future clinical practice patterns. Presentations and panels from local community organizations on specific topics were incorporated into the curriculum that address needs of patients age 50 and older. To build on this education, the residents adapted the Office- Guidelines Applied in Practice (Office-GAP) checklist to identify SDOH affecting a patient’s ability to managed chronic conditions. Using this tool: 1) involves resident training; 2) provides a decision support checklist; 3) influences patient activation; and 4) increases provider and patient communication through shared decision making. The checklist includes questions for patient response pertaining to SDOH that prevents them from managing their chronic conditions in addition to the level of action the patient is willing to do. Areas identified are discussed between patient and resident increasing patient activation. Referrals to community-based resources to identified SDOH needs are guided by the clinic’s care manager. The Office-GAP tool is administered during three subsequent visits to ensure that patients actually accessed the community resources.
The Impact of Cognitive Impairment on Resource Utilization During Medicare Home Health Care
Authors: Burgdorf Julia , Wolff Jennifer
Published: December 2020

Older adults with cognitive impairment have unique care needs that often lead to greater levels of health care utilization. Prior work suggests that older adults with cognitive impairment access home health care at higher rates; yet, recent Medicare home health payment system revisions exclude patient cognitive status when determining risk adjustment. This research examines the relationship between patient cognitive status and resource utilization during Medicare home health care. We examine 1,217 (weighted n=2,134,620) community-dwelling older adults who received Medicare-funded home health between 2011-2016, using linked nationally representative survey data from the National Health and Aging Trends Study (NHATS), home health patient assessment data, Medicare claims data, and Medicare Provider of Services files. We use weighted, multivariable negative binomial regressions to model the relationship between patient dementia status and the expected number of total visits and number of each visit type (nursing, therapy, and aide) during home health. Models adjusted for patient sociodemographic characteristics and health and functional status during home health, as well as home health provider characteristics. Among Medicare home health patients, the presence of cognitive impairment during home health is associated with 2.87 additional total visits (p<0.001), 1.27 additional nursing visits (p<0.01), and 1.23 additional therapy visits (p=0.04) during the home health episode. Findings suggest that recent revisions to the Medicare home health payment system may disincentivize home health care for older adults with dementia and/or financially penalize home health providers whose patient populations have a greater dementia burden.
Agreement Between Proxy-Rated and Self-Reported Quality of Life for Persons With Dementia
Authors: Sakka Mariko , Igarashi Ayumi , Fukui Chie , Noguchi-Watanabe Maiko , Inagaki Asa , Takaoka Manami , Kobayashi Hiromi , Yamamoto-Mitani Noriko
Published: December 2020

While quality of life (QOL) is an important endpoint of homecare for persons with dementia (PWD), PWDs often have difficulty in articulating their QOL by themselves. Instead proxy-rating is often used. However, evidence is still scarce regarding to what extent proxy-ratings reflect actual QOL of PWDs. We examined the association between self-report QOL by PWDs and proxy-rated QOL. We conducted a questionnaire survey to PWDs who were 75 years and older, their family, and homecare nurse in charge of the PWD. Two measures were used: 1) a newly developed, 4-item self-report for QOL of PWDs, and 2) a standardized, 6-item proxy-rating dementia QOL scale. In the self-report, the PWD were asked about their daily mood or satisfaction in life in brief, easy-to-understand sentences. The self-reports and proxy-ratings were compared using intraclass correlation coefficients (ICC). Data from 382 PWDs, 248 family caregivers and 124 nurses were used. The mean age of PWD was 85.9 years and 60.5% were female. The proxy-rating by nurses were more strongly associated with self-reports, compared to the association between family proxy rating and self-reports (r = 0.351, p < .001; r = 0.236, p < .001, respectively). Proxy ratings by spouses and biological children were significantly associated with self-report (r = 0.257, p =.004; r =. 204, p = .006, respectively), while rating by children-in-law were not (r = 0.217, p = .160). Proxy-ratings may not be an appropriate substitute for self-report. Homecare nurses may evaluate the QOL of PWD better than their family caregiver.
Home Safety Evaluation Model for Older Adults With Recurrent Falls
Authors: Valencia Willy Marcos , Cabrera Kimberly , Hsu Vincent
Published: December 2020

Recurrent falls are a major threat in older adults. Home environment can be a hazard, but it is potentially modifiable/reversible. In Miami VA, occupational therapists conduct home safety evaluations (HSE) to ascertain the need for modifications to reduce falls risk. We reviewed the cohort of high-risk, recurrent falls patients evaluated at our Falls Prevention Clinic (FPC) between August 2017 to November 2019, to evaluate the impact of HSE. We identified 48 Veterans, age 76.5±6.9 years, of whom 15 (31.3%) reported 1-2 falls/year, 18 (37.5%) reported 3-4 falls/year, and 15 (31.3%) reported ≥5 falls/year. Twenty-eight (58.3%) were offered a HSE. Within these subjects, 74.2% reported falling at least once within their home, 43.8% had fear of falling, 5 (17.9%) had a history of substance or alcohol abuse. We observed that 29 (60.4%) would benefit from the addition of grab bars and 26 (54.2%) could benefit from toilet adjustments. Twelve (25.0%) were recommended to install bed rails. Only 15 (31.3%) Veterans agreed to all recommendations, 25 (52.1%) declined due to preference, and 8 (16.7%) declined for other reasons. Only 8 (16.7%) of these Veterans lived alone. Another factor is that 11 (22.9%) Veterans were renting and 32 (66.7%) owned their homes. Addressing and improving environmental hazards may ameliorate the risk for recurrent falls. Our next steps are to evaluate the extent of home modifications, and the long-term changes in falls/year. Further research needs to determine the long-term efficacy and cost-effectiveness of HSE, and how it can be more accessible to the community.
Bedside Ultrasound Measures of Muscle Mass and Frailty Measures in Community-Dwelling Older Adults
Authors: Madden Kenneth , Feldman Boris , Arishenkoff Shane , Meneilly Graydon
Published: December 2020

The age-associated loss of muscle mass and strength in older adults is called sarcopenia, and it is associated with increased rates of falls, fractures, hospitalizations and death. Sarcopenia is one of the most common physical etiologies for increased frailty in older adults, and some recent work has suggested the use of Point-of care ultrasound (PoCUS) measures as a potential measure of muscle mass. The objective of this study was to examine the association of PoCUS measures of muscle thickness (MT) with measures of frailty in community-dwelling older adults. We recruited 150 older adults (age >= 65; mean age 80.0±0.5 years, 66 women, 84 men) sequentially from 5 geriatric medicine clinics (Vancouver General Hospital). We measured lean muscle mass (LMM, by bioimpedance assay) and an ultrasonic measure of muscle quantity (MT, vastus medialis muscle thickness) in all subjects, as well as two outcome measures of frailty (FFI, Fried Frailty Index; RCFS, Rockwood Clinical Frailty Scale). In our models, MT showed an inverse correlation with the FFI (Standardized β=-0.2320±0.107, p=0.032) but no significant correlation with the RCFS (Standardized β = -0.025±0.086, p=0.776). LMM showed no significant association with either FFI (Standardized β=-0.232±0.120, p=0.055) or RCFS (Standardized β = -0.043±0.119, p=0.719). Our findings indicate that PoCUS measures show potential as a way to screen for physical manifestations of frailty and might be superior to other bedside methods such as bioimpedance assay. However, PoCUS measures of muscle thickness will likely miss patients showing frailty in the much broader context captured by the RCFS.
Air Pollution and Gerontological Constructs Among Patients With End-Stage Kidney Disease
Authors: McAdams-DeMarco Mara , Jones Miranda , Feng Yijing , Walston Jeremy , Chu Nadia , Segev Dorry
Published: December 2020

Frailty is triggered by inflammatory pathways among patients with end-stage kidney disease (ESKD). Exposure to air pollution is associated with increased inflammation and as such may be a determinant of frailty in patients with ESKD. Therefore, we sought to estimate the impact of household-level exposure to fine particulate matter (particles <2.5μm in diameter [PM2.5]) on frailty and other gerontological constructs among patients with ESKD. We leveraged a prospective, two-center cohort study of 1,482 adults with ESKD (2014-2019) from 40 US states. The physical frailty phenotype (PFP), SPPB, ADL/IADL dependence and 3MS global cognitive impairment were assessed at transplant evaluation. Household-level air pollution was estimated as annual average PM2.5 concentrations at each participant’s address using SEDAC national air pollution data. We estimated the odds of these gerontologic constructs using adjusted logistic regression by quartiles of PM2.5 concentrations accounting for confounders including socioeconomic status. Compared to patients with PM2.5 concentrations in the lowest quartile (<9.3µg/m3), those with exposure to the 3rd quartile (10.0-11.1µg/m3) had 1.50-fold (95%CI:1.04-2.17) increased odds of frailty. However, exposure to PM2.5 concentrations in the second (9.3-10.0µg/m3) and fourth quartiles (>11.1µg/m3) were not significant. Those with PM2.5 in the 3rd (OR=1.60, 95%CI:1.19-2.16) or 4th (OR=1.61, 95%CI:1.20-2.16) quartile had an increased risk of having dependence in ADLs or IADLs. PM2.5 was not associated with SPPB or cognitive impairment. Among ESKD patients, fine particulate matter was associated with greater frailty and dependence burden, although these association may not be linear. Further study of the role of inflammation on these associations are needed.
Life Review in Dementia: The Value of Identity
Authors: Walsh Diane , Ulatowska Hanna , Santos Tricia , Aguilar Sara , Patterson Rebecca
Published: December 2020

The stories told by veterans with dementia provide new insights into person-centered care for healthcare professionals. In this qualitative exploratory study, life review in seven WW II veterans with mild-moderate dementia was examined. Participants with mild-moderate dementia were selected from a larger study of seventy oldest-old veterans. Semi-structured interviews were conducted to elicit testimonial language about memorable war experiences, including their perception and evaluations of the war. The interviewer provided questions and prompts to facilitate responses when necessary. Despite decreased declarative memory manifested via reduction in details and specificity of information within narratives, participants demonstrated a desire to share their war time experiences. Veterans selected appropriate memories to share, indicating their preserved sense of self. They provided a general evaluation of their wartime experiences when prompted. Veterans expressed various types of identity related to both their social origin and their experience of participating in the war. Identities of social origin revealed cultural identities which were expressed via their sense of humor. Wartime identities include being a survivor, a patriot, and a tolerant person. Veterans also described how the GI Bill helped them become college educated. This study suggests that identity is relatively preserved more so in individuals with mild versus moderate dementia when producing autobiographical stories. The process of life review brings identity to the surface. Acknowledging the identity of individuals with dementia is essential to care as it recognizes the value of the person. Additionally, eliciting significant autobiographical memories serves as a valuable means of social engagement and connection.
Addressing Gun Safety and Dementia: Training Professionals in the Community
Authors: Orsulic-Jeras Silvia , Powers Sara , Empeno Jessica , Lagasca Regina , Abrams Amy , Barker Sarina , McDaniel Rebecca , Hanna Marcie
Published: December 2020

As the number of Alzheimer’s disease and related dementia (ADRD) cases grow, first responders will have more frequent interactions with individuals living with ADRD within the community. Recognizing the lack of dementia training among first responders and through the support of an Administration for Community Living grant, Alzheimer’s San Diego partnered with local law enforcement to support and educate first responders on local ADRD resources, referral systems for families and caregivers, and disease-related information, in hopes of building stronger dementia capable services within San Diego County. To date, 249 first responders have participated in dementia education trainings and completed the related evaluations that aimed to understand their experiences with and knowledge of dementia. On average, participants were 44.74 years old (SD=18.45) and served 8.72 years (SD=7.99) on their job. Majority were male (n=189), had some college education (n=94), and identified as White/Caucasian (n=105) or Hispanic/Latino (n=92). Although objective knowledge (as measured by a shortened version of the Alzheimer’s Disease Knowledge Scale [ADKS]) did not significantly differ from pre- to post-test, participants’ perceived subjective knowledge about dementia significantly increased from pre-test (M=1.17, SD=0.77) to post-test (M=1.89, SD=0.66); t(141)=10.56, p<.001. Encouragingly, participants who reported receiving prior training on dementia had significantly higher ADKS scores at both pre- and post-test compared to those who did not have prior training. Results highlight the need for ongoing dementia-related training for law enforcement and the importance of evaluation requirements. Discussion will focus on policy implications and how communities can support dementia capability among first responders.
Associations Between Social Engagement and Physical Activity Among Community-Dwelling Older Adults With Dementia
Authors: Yoshikawa Aya , Smith Matthew , Ory Marcia
Published: December 2020

People with dementia (PWD) tend to experience loneliness and physical inactivity, which increases their risk of negative health outcomes such as depression and declined physical functioning. Research indicates the link between supportive social environments and physical activity (PA), yet this association is not fully studied among PWD. This cross-sectional study investigated associations between social engagement and moderate (i.e. walking for exercise) and vigorous PA among PWD. A subset sample of community-dwelling Medicare beneficiaries in the 2015 National Health and Aging Trends Study, representing PWD including possible (n = 779) and probable (n = 902) dementia, were analyzed using survey-weighted logistic regression analysis. All analyses were controlled for sociodemographic characteristics, living arrangement, physical functioning, and the number of chronic conditions. The majority of participants was 80 years or older (52.5%), female (53.1%), White (67.4%), had a high school or higher education (64.0%), and two or more chronic conditions (74.1%). Living alone (OR = 1.60, 95%CI 1.22, 2.10), knowing their community well (OR = 1.56, 95%CI 1.12, 2.16), and going out for enjoyment (OR = 1.93, 95%CI 1.37, 2.73) were associated with moderate PA. In addition to going out for enjoyment (OR = 2.40, 95%CI 1.65, 3.53), attending organized activities (OR = 1.97, 95%CI 1.15, 3.39) and working as a volunteer (OR = 1.63, 95%CI 1.04, 2.57) were associated with vigorous PA. Findings suggest that enjoyable activities and community familiarity may facilitate walking behavior among PWD. Integrating events and volunteer activities within communities is encouraged for supporting active living among PWD.
Development and Psychometric Examination of a Short-Form Dementia Attitudes Scale
Authors: Ebert Alexandria , Steele Jenessa , Patrick Julie Hicks
Published: December 2020

With the increase in research related to people directly and indirectly affected by Alzheimer’s Dementia and related disorders (ADRD), there is a need for short, psychometrically-sound instruments to assess the variety of influences on the quality of life for the person with dementia (pwd) and their care partners. We sought to develop and assess a short version of the Dementia Attitudes Scale (DAS; O’Connor & McFadden, 2010) for use in such endeavors. Using a sample of 321 adults (Mage = 39.7, range 20 to 70 yrs; 47% female), we surveyed a host of individual characteristics (e.g., age, personality, experience with pwd) and several current measures of attitudes about pwd. Ten days later, 162 of these adults completed a retest of the DAS. Results of a confirmatory factor analysis supported the 2-factor solution reported by O’Connor and McFadden. Internal consistency was acceptable for the Comfort factor (Time 1alpha = .83; T2 alpha = .82) and for the Knowledge factor (Time 1 alpha = .86; Time 2 alpha = .87). These estimates are similar to those in the original report. Due to limitations of coefficient alpha we also used structural equations to examine the regression weights for each item as a function of chronological age and experience. These analyses showed that the factor structure was robust when considering these individual characteristics. Finally, we compared different scale lengths using a series of ROC curves. We discuss our results in the context of providing brief and psychometrically-sound measures for use in large survey studies.
Predictors of Physical Resilience in Older Adults
Authors: O’Brien Catherine , Holtzer Roee
Published: December 2020

Physical resilience (PR), which denotes one’s ability to resist functional physical decline, can be operationalized through longitudinal assessments on the Short Physical Performance Battery (SPPB). Dual-task walking (DTW) is predictive of adverse outcomes but its role in predicting incident PR has not been assessed. Herein, we determined whether velocity during Single-Task-Walk (STW) and Dual-Task-Walk (DTW) conditions predicted incident loss of PR and identified moderators of this relationship. Participants were 163 (mean age=75.5; %female=52) non-demented, community-dwelling older adults with baseline SPPB scores of 10-12. At baseline, individuals completed neuropsychological testing, the SPPB and DTW paradigm. Cognitive reserve was evaluated using the Wide Range Achievement Test (WRAT-3) and speed of processing was assessed using the Symbol Digit Modalities Test (SDMT). Individuals with SPPB scores < 10 were categorized as not physically resilient. Those with scores of 10 or higher were categorized as physically resilient. At three-year follow up 75.4% (n=123) of participants remained physically resilient while 24.5% (n=40) lost PR. Binary logistic regression revealed that slower DTW (OR= 0.96, p= 0.033, 95%CI [.926, .997]), but not STW velocity (OR= 1.00, p= 0.861, 95%CI [0.962, 1.048]), was a significant predictor of PR loss. Moreover, moderation analyses revealed that DTW velocity predicted PR loss only among individuals who had lower baseline scores on the WRAT-3 (OR=0.937, p=0.004, 95%CI [.896, .979]) and SDMT (OR=0.949, p=0.018, 95%CI [.909, .991]). We propose that cognitive reserve and speed of processing influenced the utility of DTW velocity in predicting PR loss among community-residing older adults.
Cognitive Activity as a Moderator of Educational Attainment and Work Status in Cognitive Aging
Authors: Stieger Mirjam , Lachman Margie
Published: December 2020

Cross-sectional findings showed that education differences in memory performance were moderated by frequent cognitive activity (Lachman et al., 2010). The present study examined whether frequent cognitive activity could compensate for lower education when focusing on change in cognitive performance across nine years. The study also explored whether cognitive activity can slow down declines in retired adults as previous research suggested that retiring is associated with an increased risk of cognitive decline (e.g., Wickrama et al., 2013). Longitudinal data from the MIDUS study included N = 3,325 middle-aged and older adults. Outcome variables were two factors of cognitive performance: Episodic Memory (EM) and Executive Functioning (EF). Independent variables were years of education, work status (working vs. retired), and frequency of cognitive activity. The results suggest that cognitive activity moderated the effect of educational attainment on change in EM. Individuals with both higher education and cognitive activity showed the smallest declines in EM. Individuals with lower educational attainment but high cognitive activity had less decline in EM compared to their low education counterparts. Those who increased their cognitive activity over time showed less decline in EF. In terms of work status, working adults had less decline in EM and EF compared to retired adults and retired adults who did not maintain their cognitive activity declined more in EF. The results emphasize the importance of frequent engagement in cognitive activity across the lifespan, which can attenuate cognitive declines especially among those who have lower education or have retired.
Does Cognitive Self-Report Measure Type Differentially Predict Cognitive Decline? A Systematic Review
Authors: Wion Rachel , Hill Nikki , Bell Tyler , Mogle Jacqueline , Yates Jennifer , Bhang Iris
Published: December 2020

Up to 47% of older adults without measurable cognitive impairment report difficulties with memory and thinking which potentially increases their risk for developing cognitive decline. Many measures are used for assessing self-reported cognition; however, certain types of these measures may be more predictive of cognitive decline. The purpose of this systematic review was to compare the role of cognitive self-report measure types in predicting risk for cognitive decline. PubMed, CINAHL, and PsycINFO databases were searched using the following inclusion criteria: longitudinal studies, outcome of cognitive decline, and two or more cognitive self-report measures. A total of 4,319 articles were identified during the initial search and narrowed to 19 final articles. The Quality in Prognosis Studies tool was used to determine study quality. Six comparison themes emerged during synthesis: self-reported cognition or memory with or without worry; self-reported global cognition or self-reported memory; self-reported memory decline and self-reported executive function decline; self-reported cognition and self-reported memory by others; self-reported memory and self-reported memory problems in comparison with peers; and self-reported memory and self-reported memory affecting daily function. Self-reported memory decline with worry and self-reported memory problems by others were most predictive of future impairment. It was difficult to definitively determine whether certain cognitive self-report measure types where more predictive of risk for cognitive decline because there were very few articles in some of the comparison groups. Future investigations of self-reported cognition should focus on using measures that have been shown to be the most efficacious at predicting risk for cognitive decline.
Favorite Activity Patterns Among Older Adults With and Without Dementia: Findings From the NHATS
Authors: Hou Tianxue , Liu Minhui , Miyawaki Christina E , Li Yuxiao , Sun Xiaocao , Tang Siyuan , Szanton Sarah
Published: December 2020

Favorite activities are usually meaningful and valuable to older adults. However, information on favorite activity patterns and their relationship with cognitive function from large samples is still limited. Using Round 1 data from the National Health and Aging Trends Study, we examined favorite activity patterns among community-dwelling older adults with and without dementia (N=6,565). Based on the 8-item Ascertain Dementia (AD8) dementia screening interview, participants were classified into no dementia, possible dementia, and probable dementia. Favorite activity was assessed by asking participants, “What their favorite activity they are currently able to do?” Multinomial logistic regression models were used to examine the association between each of the top three favorite activities and the cognitive impairment categories, controlling for demographics and general health. The sample was on average, 77±7.45 years old, non-Hispanic White (69.8%), female (57.3%), and 35.0% had high school education. The three most popular favorite activities among probable dementia participants were watching TV, walking, and outdoor maintenance. Participants who liked watching TV most were more likely associated with possible dementia (Relative Risk Ratio [RRR] = 1.49, p=0.044) compared to participants without favorite activities. Participants who liked walking most were less associated with possible dementia (RRR=0.58, p=0.003) and probable dementia (RRR=0.39, p<0.001) compared to those without favorite activities. Similarly, participants who liked outdoor maintenance most were less likely to develop possible dementia (RRR=0.48, p<0.001) and probable dementia (RRR=0.27, p<0.001) than participants without favorite activities. Researchers may use older adults’ “active” favorite activities to create tailored interventions to slow dementia progression.
Implementing an Interdisciplinary Committee to Reduce Psychotropic Drug and Increase Behavioral Intervention Use
Authors: Conrad Lauren Hess , Portman David
Published: December 2020

In Fiscal Year (FY) 2018, the Butler VA Health Care System’s Psychotropic Medication and Behavior Management Committee was identified as a Veterans Integrated Service Network 4 Best Practice. The goal of this committee is to reduce unnecessary psychotropic medication use and polypharmacy and to increase behavioral intervention implementation among Community Living Center (CLC) Veterans. This committee meets quarterly to review Psychotropic Drug Safety Initiative data, behaviors and behavior care plans, and all psychotropic medications prescribed to Veterans. Psychiatric diagnoses, changes to psychotropic medications, and appropriate behavioral interventions are discussed. Committee members take responsibility for action items in accordance with their discipline; documentation of recommendations are made in quarterly behavioral health assessments in CPRS; and follow-up on action items is completed at twice weekly interdisciplinary treatment team meetings, weekly behavior rounds, and/or as needed. From the first quarter (Q1) of FY16 to Q1 FY20, the Butler VA CLC has seen decreased prescriptions of 2 or more anticholinergics (6.6% to 0.80%), antihistamines (12.5% to 5.9%), benzodiazepines (24.7% to 11.0%), and benzodiazepines or sedative hypnotics (23.2% to 9.0%). While prescription of antipsychotic use has increased (Q1 FY20 = 23.8%), the committee will follow Long Term Care Institute guidelines for gradual dose reductions, behavioral interventions, and as needed psychotropic medication PRN use. This committee provides an interdisciplinary forum to discuss and implement beneficial changes to pharmacological and non-pharmacological interventions among all CLC Veterans. The committee is a valuable process for monitoring and reinforcing best practices that may be easily replicated across VA CLCs nationwide.
Objective and Subjective Cognitive Function, and Relations With Quality of Life and Psychological Distress
Authors: Nuzum Hallie , Dorociak Katherine , Kamil-Rosenberg Shirit , Louras Peter , Mostofi Mandana , Fairchild J Kaci
Published: December 2020

Objective and subjective cognitive function have been associated with decreased quality of life and increased psychological distress in older adults. The present study examined relations of objective and subjective cognition with quality-of-life and mental-health outcomes in individuals with amnestic mild cognitive impairment (aMCI). The sample included 98 older adults with aMCI (92.5% male, age = 70.9±9.2 years). Measures included objective cognition (i.e., attention, memory, language, visuospatial abilities, processing speed, executive function, and overall), subjective memory (Multifactorial Memory Questionnaire [MMQ]), quality of life (Dementia Quality of Life [DQoL]), and mental health (Geriatric Depression Scale, Geriatric Anxiety Inventory, and Penn State Worry Questionnaire). Objective and subjective cognition were weakly correlated (range |r| = .00–.23). Objective cognitive measures were largely uncorrelated with quality of life or mental health, with only two significant (p < .05) correlations between Processing Speed and Worry (r = -.24), and Overall Cognition and DQoL Aesthetics (r = .20). Subjective cognition was more strongly correlated with quality of life, including significant (p < .01) correlations between MMQ Abilities and DQoL Negative Affect (r = -.38), and MMQ Contentment and DQoL Positive Affect (r = .28). Additionally, MMQ Contentment and Abilities were significantly (p < .01) negatively correlated with all three mental-health outcomes (range |r| = .28–.43). This study demonstrated that subjective memory, particularly affect and self-appraisal regarding one’s memory capabilities, is more closely related to quality-of-life and mental-health outcomes than objective cognitive performance in an aMCI sample, and, therefore, may represent important targets for intervention.
Poets and Politics at the Court of Antiochus III
Authors: Visscher Marijn S.
Published: December 2020

The fourth chapter explores the literature composed at the court of Antiochus III. First, it discusses literary engagements with the Galatians used to assert authority over Asia Minor against the Attalids. The poetry of Simonides of Magnesia celebrating a Seleucid king fighting the Galatians fits well into the political climate of that time. The second part of the chapter looks at Euphorion of Chalcis, a well-known poet who could be considered an heir of Callimachus. Euphorion never travelled to Alexandria and instead worked for Antiochus III, and his poetry shows a clear interest in Seleucid motives and themes. The chapter ends with a discussion of the work of Hegesianax of Alexandria Troas in the context of Seleucid interactions with Rome. It is shown that his work had a political dimension: Hegesianax’ history of the Troad also included an account of the foundation of Rome and its alleged links with Troy.
Conclusion: The Fame of the Seleucids
Authors: Visscher Marijn S.
Published: December 2020

The conclusion provides a brief summary of the main arguments put forward in Beyond Alexandria. It summarizes the four chapters separately, and highlights the most important points made in each of them. More importantly, the conclusion comes back to the two main arguments of this book that run as two red threads running throughout all the chapters. First, it emphasizes the innovative reading of the different authors discussed in this book as Seleucid writers. By connecting the texts from Megathenes, Patrocles and Demodames, with the writings of Berossus and the Astronomical Diaries, as well as with Euphorion an Hegesianax, Beyond Alexandria provides an new perspective and shows the connections between these texts. Secondly, the conclusion brings out the importance of Seleucid literature on the Hellenistics stage, especially with regards to the Ptolemies. Indeed, Beyond Alexandria argues that the literary production surrounding the Seleucid court plays an important part in the rivalry between these Hellenistic superpowers.
Differentials and Convex Analysis
Authors: Chambers Robert G.
Published: December 2020

Mathematical tools necessary to the argument are presented and discussed. The focus is on concepts borrowed from the convex analysis and variational analysis literatures. The chapter starts by introducing the notions of a correspondence, upper hemi-continuity, and lower hemi-continuity. Superdifferential and subdifferential correspondences for real-valued functions are then introduced, and their essential properties and their role in characterizing global optima are surveyed. Convex sets are introduced and related to functional concavity (convexity). The relationship between functional concavity (convexity), superdifferentiability (subdifferentiability), and the existence of (one-sided) directional derivatives is examined. The theory of convex conjugates and essential conjugate duality results are discussed. Topics treated include Berge's Maximum Theorem, cyclical monotonicity of superdifferential (subdifferential) correspondences, concave (convex) conjugates and biconjugates, Fenchel's Inequality, the Fenchel-Rockafellar Conjugate Duality Theorem, support functions, superlinear functions, sublinear functions, the theory of infimal convolutions and supremal convolutions, and Fenchel's Duality Theorem.
Quality, Valuation, and Welfare
Authors: Chambers Robert G.
Published: December 2020

The analytic structure developed in the first six chapters is applied to quality-differentiated production, quality-differentiated pricing, and consumer welfare analysis. The quality-differentiated production problem is developed as a special case of the multiple-output problem for both nonstochastic and stochastic pricing regimes. The "household production" model of Gorman (1956) and Lancaster (1966) is developed in a conjugate dual framework whose solution for rational individuals obeys the zero-maximum (zero minimum) principle. The nominal concepts of compensating variation and equivalent variation are shown to have real-valued (dual) parallels in the compensating benefit and the equivalent benefit. Real, as opposed to nominal, valuation for traded and nontraded goods is treated in the benefit framework. Directional derivatives of distance functions are used to rationalize the frequently observed empirical discrepancy between willingness-to-pay and willingness-to-accept.
Campus Culture and The Three Beliefs
Authors: Redstone Ilana
Published: December 2020

The culture on many campuses centers around competing claims of harm. Relatedly, accusations of bias are one of the most potent and commonly deployed weapons used to attack anyone viewed as asserting opinions that run afoul of any of the three beliefs. In some respects, being a member of a campus community—whether as a student, adjunct or full-time faculty member, or staff member—is like living in an authoritarian country. People in campus communities learn to filter their speech to avoid saying or presenting anything that might be viewed as upsetting and lead to complaints and perhaps to formal disciplinary proceedings. People who are accused of transgressions engage in ritualized apologies to avoid permanent banishment.
The Key Role of Adjuncts
Authors: Redstone Ilana
Published: December 2020

Academic freedom is particularly tenuous for the growing number of college instructors who hold positions that are neither tenured nor on the tenure track. The temporary, one-semester-at-a-time nature of many adjunct contracts creates a set of incentives not to run afoul of college administrations. An adjunct who wants to continue to teach will tread very carefully, with the goal of ensuring that even the most easily offended student in a class doesn’t hear or read anything that might spur the filing of a complaint. The tenuous nature of adjunct appointments is incompatible with strong academic freedom protections. Even if such protections existed, the nature of adjunct positions would make those protections difficult to enforce.
Beyond Academia
Authors: Redstone Ilana
Published: December 2020

This book has focused on academia. However, the broader impact on discourse of the climate we describe isn’t limited to academia: Many aspects of contemporary academic culture are also present outside of academia. Campus culture is reflected particularly strongly in the technology sector, in which many companies have workforces with many relatively recent college graduates. It is also found outside the technology sector, including in media. These environments feature many of the same dynamics that constrain on-campus discourse, including unwritten rules on what can’t be said, call-out culture, and career-imperiling disciplinary investigations for those accused of expressing views inconsistent with the three beliefs.
Solutions
Authors: Redstone Ilana
Published: December 2020

In light of a culture in American academia that is unwelcoming to debate and free inquiry on a growing number of topics, it’s natural to ask whether there are frameworks from outside the academy that provide lessons that could be valuable in improving academic discourse. The answer is yes. Across time and place, innumerable groups have grappled with ways to engage in discourse, to disagree, to debate, to resolve disputes, and to attempt to build understanding and bridge differences. This chapter explores how frameworks from outside academia can provide valuable lessons to improve the campus climate. It then presents a series of recommendations that could significantly improve on-campus tolerance and broaden the scope of discourse.
Afterword
Authors: Rusk Julia E.
Published: December 2020

This afterword presents a vision for well-being policies and actions in the United States, focusing on the experience of the City of Santa Monica, California. The purpose of data is to put it into action. The goal in Santa Monica is to make this a reality, with benefits accruing regularly to every resident, neighborhood, business, and contributor to the community. This was the idea behind Santa Monica’s local Wellbeing Index: harnessing the power of data for the commonwealth that would reveal the story of the people and the community in new ways, and that would help to transform city government. The goal of the Wellbeing Index was to expand the measures of a community far beyond the traditional and economically-focused gross domestic product (GDP). Going forward, the Wellbeing Index will be the tool used to evaluate whether policies, programs, and other City investments are in fact improving community well-being. The chapter also looks at Santa Monica’s programs, such as the Youth Wellbeing Report Card and the Pico Wellbeing Project.
Lunacy and the Colonial State
Authors: Rajpal Shilpi
Published: December 2020

This chapter examines the variegated processes of professionalization, modernization, and Indianization along with the obstacles that colonialism created in their paths. These processes which began at the turn of the twentieth century were far from complete even on the eve of Independence. It argues that psychiatry remained at the margins of medicine as the colonial state maintained an indifference towards the development of the mental sciences. Highlighting contributions of individual psychiatrists and juxtaposing them with those of the colonial state, the chapter locates psychiatrists as historical actors at the centre of the history of colonial psychiatry during the period.
Sex and the Internet
Authors: Guhin Jeffrey
Published: December 2020

The Internet was widely understood as a good thing at these schools, yet it also had risks: pornography, unsupervised access to the opposite sex, and a tendency to coarsen discourse and interactions. Maybe the greatest risk was also the most existential: what if the Internet led children away from the faith? The Internet and sex were often discussed together at these schools, and so this chapter also highlights how discussions of sexuality at all four schools emphasized the importance of virginity and minimized the possibility of same-sex attractions except as temptations from a fallen world. Students were divided about how they could best engage questions of fairness to LGBTQ people, and at least one bisexual student at Good Tree shared her struggles with the author, saying she wanted to avoid the temptation of a gay relationship, but she believed people with attractions like hers should be more welcomed and understood.
Generalized Empirical Likelihood-Based Kernel Estimation of Spatially Similar Densities
Authors: Wen Kuangyu , Wu Ximing
Published: December 2020

This study concerns the estimation of spatially similar densities, each with a small number of observations. To achieve flexibility and improved efficiency, we propose kernel-based estimators that are refined by generalized empirical likelihood probability weights associated with spatial moment conditions. We construct spatial moments based on spline basis functions that facilitate desirable local customization. Monte Carlo simulations demonstrate the good performance of the proposed method. To illustruate its usefulness, we apply this method to the estimation of crop yield distributions that are known to be spatically similar.
Rényi Divergence and Monte Carlo Integration
Authors: Geweke John , Durham Garland
Published: December 2020

Rényi divergence is a natural way to measure the rate of information flow in contexts like Bayesian updating. This chapter shows how Monte Carlo integration can be used to measure Rényi divergence when (as is often the case) only kernels of the relevant probability densities are available. The chapter further demonstrates that Rényi divergence is central to the convergence and efficiency of Monte Carlo integration procedures in which information flow is controlled. It uses this perspective to develop more flexible approaches to the controlled introduction of information; in the limited set of examples considered here, these alternatives enhance efficiency.
The Prayer Book Sung
Authors: Hefling Charles
Published: December 2020

The Book of Common Prayer makes explicit provision for some of its words to be either “sung or said.” Vocal music, choral or congregational, has been a feature of Prayer Book services from the first. The original version of the text was set to music in 1550 by John Marbeck; since then, a tradition of “parochial music” has augmented Divine Service with metrical paraphrases of the Psalms, while “cathedral music” has developed a unique form of recitation known as Anglican chant, together with a genre of musical settings for choirs of the canticles at Morning and Evening Prayer.
Maurice Bourgue
Authors: Fiala Michele
Published: December 2020

Maurice Bourgue is a French oboist, chamber musician, composer, and orchestra conductor who won international competitions in Geneva, Birmingham, Munich, Prague, and Budapest. In this chapter he discusses his career and its evolution, gives advice for those entering competitions, discusses national styles, and relates his most memorable performances.
Nathan Hughes
Authors: Fiala Michele
Published: December 2020

Nathan Hughes is principal oboe of the Metropolitan Opera and serves on the faculties of the Juilliard School and Rutgers University. In this chapter, he discusses his early life and career, the influence that opera has had on his performance, and the use of mental practice in performance preparation. He also shares ideas on interpretation, reeds, breathing, support, fundamentals and vibrato. He also offers advice to those who are auditioning.
Omar Zoboli
Authors: Fiala Michele
Published: December 2020

Omar Zoboli is professor at the Musikhochschule Basel, Switzerland. He won first prize at the International Competition of Ancona and at the Italian Television (RAI) Competition for Young Performers in 1978. In this interview, he discusses his early career, studying with Heinz Holliger, and his inspirations. He also talks about his sound concept and performance on period instruments. Zoboli speculates about Antonino Pasculli’s instrument and reeds. He talks about tone production and his teaching philosophy. Finally, he talks about repertoire, solo playing, and jazz improvisation.
Domesticating Descartes, Renovating Scholasticism
Authors: Hamid Nabeel
Published: December 2020

This article studies the academic context in which Cartesianism was absorbed in Germany in the mid-seventeenth century. It focuses on the role of Johann Clauberg (1622-1665), first rector of the new University of Duisburg, in adjusting scholastic tradition to accommodate Descartes’s philosophy, thereby making the latter suitable for teaching in universities. It highlights contextual motivations behind Clauberg’s synthesis of Cartesianism with the existing framework such as a pedagogical interest in Descartes as offering a simpler method, and a systematic concern to disentangle philosophy from theological disputes. These motivations are brought into view by situating Clauberg in the closely-linked contexts of Protestant educational reforms, and debates around the proper relation between philosophy and theology. In this background, it argues that Clauberg nevertheless retains an Aristotelian conception of ontology for purely philosophical reasons, specifically, to give objective foundations to Descartes’s metaphysics of substance. In conclusion, Clauberg should not be assimilated either to Aristotelianism or to Cartesianism or, indeed, to syncretic labels such as ‘Cartesian Scholastic’. Instead, he should be read as transforming both schools by drawing on a variety of elements in order to address issues local to the academic milieu of his time.