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Objective Determining if traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are risk factors for Parkinson's disease (PD). This constitutes a research priority for the Veterans Administration (VA) with implications for screening policy and prevention. Methods Population-based, matched case-control study among veterans using VA health care facilities from October 1, 1999, to September 30, 2013. We identified 176,871 PD cases and 707,484 randomly selected PD-free matched controls. PD, TBI, and PTSD were ascertained by validated International Classification of Disease 9th revision (ICD)-9 code-based algorithms. We examined the association between both risk factors and PD using race-adjusted conditional logistic regression. Results The overall study cohort prevalence for TBImild , TBInon-mild , and PTSD was 0.65%, 0.69%, and 5.5%, respectively. Both TBI and PTSD were significantly associated with PD in single-risk factor race-adjusted analyses (conditional odds ratio [cOR] = 2.99; 95% confidence interval [CI]: 2.69-3.32), 3.82 (95% CI: 3.67-3.97), and 2.71 (95% CI: 2.66-2.77) for TBImild , TBInon-mild , and PTSD, respectively). There was suggestive positive interaction observed with comorbid PTSD/TBI in dual-risk factor analyses, with significant 2.69-fold and 3.70-fold excess relative PD risk in veterans with TBImild and TBInon-mild versus those without TBI when PTSD was present versus 2.17-fold and 2.80-fold excess risk when PTSD was absent. Interpretation Our study was the first to demonstrate that both TBI and PTSD are independently associated with increased relative PD risk in a diverse nationwide cohort of military service veterans, and the first to suggest a potential modest synergistic excess risk in those with comorbid TBI/PTSD. Longitudinal research is needed to confirm these suggestive findings. ANN NEUROL 2020 ANN NEUROL 2020;88:33-41.

OBJECTIVES This study assessed frequency of caregiver identification and needs of a sample of persons with dementia (PWDs) and their caregivers to determine whether needs were addressed and whether documentation increased with growing levels of self-reported relationship problems and burden. DESIGN Cross-sectional design using data from electronic medical record (EMR) review and baseline research assessments (Burden Interview and Mutuality Scale). Items from a caregiver assessment tool were used to identify documentation of important factors in clinical guidelines. SETTING Michael E. Debakey VA Medical Center, Houston, TX. PARTICIPANTS A total of 211 PWDs from a randomized controlled trial testing a psychosocial intervention for preventing aggression in PWDs. MEASUREMENTS EMRs for 12 months before participation in the original study were abstracted, using a tool created by the authors to assess documentation of information deemed important to caregiver assessment in clinical guidelines (eg, caregiver needs, caregiver well-being, and caregiving context). The first two authors reviewed the EMRs, adjusting the tool, based on questions that arose. RESULTS Of 211 EMRs of PWDs reviewed, 177 (89%) identified caregivers. Of these, 88% identified the caregiver by name or relation to the PWD, 28% assessed caregiver well-being, and 41% assessed caregiver needs. All EMRs assessing caregiver needs showed provision of caregiver support (including psychoeducation, skills training, or referrals for additional aid). Levels of self-reported caregiver burden were not associated with documentation of assessment; however, higher levels of self-reported relationship problems were positively associated with increased caregiver contact documentation and negatively associated with caregiver need documentation and Alzheimer Association referrals. CONCLUSION Healthcare providers identified caregivers in most of the sample, but less than 50% assessed their well-being and needs. J Am Geriatr Soc 67:1604-1609, 2019.

Objectives The study replicated and extended previous findings by investigating relationships between positive and negative religious coping and psychological distress in minority older adults. Methods Older adults were evaluated during screening and baseline procedures of a psychotherapy clinical trial for late-life worry and anxiety. Participants were age 50 years or older and recruited from low-income and predominantly minority neighborhoods. Participants screening positive for worry (PSWQ-A ≥ 23) with no significant cognitive impairment (Six-Item Screener for cognitive impairment ≤2) completed a diagnostic interview and baseline assessments. Positive and negative religious coping were assessed with the positive and negative coping subscales of the Brief Religious Coping scale. Psychological distress was assessed with measures of depression, anxiety, and worry. A set of multiple linear regression models were used to evaluate the relationship between religious coping and each measure of psychological distress. Results Negative religious coping was associated with greater anxiety, worry, and depression. Positive and negative religious coping interacted such that positive religious coping buffered the effects of negative religious coping on anxiety and depression. Significant main effects and interactions remained after controlling for age, gender, race, years of education, and study. Conclusions The findings of this study are consistent with prior work showing that negative religious coping is associated with greater psychological distress. This study replicates previous findings that positive religious coping may buffer the harmful effects of negative religious coping and extends understandings of the specific psychological impacts that positive and negative religious coping may have on older, minority adults.

Objective Peaceful Living, a cognitive-behavioral treatment (CBT) for late-life generalized anxiety disorder (GAD), produced positive outcomes in GAD severity, anxiety, depression, insomnia, and mental health quality of life relative to usual care with treatment delivered by either bachelor-level lay providers (BLPs) or PhD-level expert providers (PLPs). We examined long-term maintenance of gains during 12 months following CBT for patients in this trial who received the intervention delivered by BLPs and PLPs and completed post-treatment assessments. Methods Participants were 112 older adults (mean age, 66.83 years) with GAD recruited from primary care who received CBT from BLPs (n = 52) or PLPs (n = 60) and completed post-treatment assessments. Assessments were given at post-treatment and at 6- and 12-month follow-up. Primary outcomes assessed long-term maintenance of gains in worry (Generalized Anxiety Disorder Severity Scale) and anxiety (State-Trait Anxiety Inventory, Structured Interview Guide for the Hamilton Anxiety Scale). Secondary outcomes assessed depression (Patient Health Questionnaire), mental health quality of life (Medical Outcomes Study Short Form – mental wellness scale), and sleep (Insomnia Severity Index). Results At 6- and 12-month follow-ups, post-treatment reductions in GAD severity, anxiety, depression, and improvements in mental health quality of life and sleep were maintained for patients in both groups. No differences were found, based on provider group. Conclusion Treatment of late-life anxiety delivered by nonexpert lay providers working under supervision of licensed providers has lasting benefits. These findings support the potential of new models of care for older adults that may expand reach of mental health services. Copyright © 2016 John Wiley & Sons, Ltd.

Objective This study compared mental health service utilization by treatment modality and determined predictive factors of use among younger-adult (18–35 years), middle-aged adult (36–64 years), and older-adult veterans (65+ years) with a newly recognized diagnosis of depression and/or anxiety disorder. Methods This retrospective study used data from the Veterans Health Administration National Patient Care Database outpatient and inpatient treatment files during the 2010 fiscal year (N = 583,692). Results Younger adults were the most likely to use mental health services, followed by middle-aged adults and then older adults. Age was found to be one of the greatest predictors of utilization of mental health services, with odds of use being threefold among younger adults compared with older adults. Conclusions Continued efforts are needed to improve the awareness of, access to, and receipt of mental health services in veterans, particularly older adults, with depression and anxiety disorders. Published 2015. This article is a U.S. Government work and is in the public domain in the USA

Background Vascular diseases are a major cause of morbidity and mortality, particularly in diabetic patients. Stem/progenitor cell treatments with bone marrow-derived cells show safety and promising outcomes, albeit not without some preprocedural adverse events related to cell collection and mobilization. We describe a novel technology for generating a therapeutic population (BGC101) of enriched endothelial progenitor cells (EPCs) from non-mobilized blood, using dendritic cells to specifically direct stem/progenitor cell activity in vitro. Methods and results Selected immature plasmacytoid and myeloid dendritic cells from 24 healthy and two diabetic donors were activated with anti-inflammatory and pro-angiogenic molecules to induce specific activation signals. Co-culturing of activated dendritic cells with stem/progenitor cells for 12–66 h generated 83.7 ± 7.4 × 106 BGC101 cells with 97% viability from 250 mL of blood. BGC101, comprising 52.4 ± 2.5% EPCs (expressing Ulex-lectin, AcLDL uptake, Tie2, vascular endothelial growth factor receptor 1 and 2, and CD31), 16.1 ± 1.9% stem/progenitor cells (expressing CD34 and CD184) and residual B and T helper cells, demonstrated angiogenic and stemness potential and secretion of interleukin-8, interleukin-10, vascular endothelial growth factor and osteopontin. When administered to immunodeficient mice with limb ischemia (n = 40), BGC101 yielded a high safety profile and significantly increased blood perfusion, capillary density and leg function after 21 days. Cell tracking and biodistribution showed that engraftment was restricted to the ischemic leg. Conclusions These observations provide preliminary evidence that alternatively activated dendritic cells can promote the generation of EPC-enriched stem/progenitor cells within a 1-day culture. The resulting product BGC101 has the potential for treatment of various vascular conditions such as coronary heart disease, stroke and peripheral ischemia. Copyright © 2014 John Wiley & Sons, Ltd.

We study the ultra-relativistic Euler equations for an ideal gas, which is a system of nonlinear hyperbolic conservation laws. We first analyze the single shocks and rarefaction waves and solve the Riemann problem in a constructive way. Especially, we develop an own parametrization for single shocks, which will be used to derive a new explicit shock interaction formula. This shock interaction formula plays an important role in the study of the ultra-relativistic Euler equations. One application will be presented in this paper, namely, the construction of explicit solutions including shock fronts, which gives an interesting example for the non-backward uniqueness of our hyperbolic system. Copyright © 2014 John Wiley & Sons, Ltd.

The objective is to test the effectiveness of Partners in Dementia Care (PDC), a care-coordination program that integrates and improves access to medical and nonmedical services, while strengthening the informal care network and providing information, coaching, and emotional support. PDC was delivered via a partnership between Veterans Affairs (VA) Medical Centers (VAMCs) and Alzheimer's Association chapters, for caregivers of veterans with dementia living in the community and receiving primary care from the VA. The initial sample was 486 caregivers of 508 veterans with diagnosed dementia. Outcomes were evaluated for 394 and 324 caregivers who completed 6- and 12- month follow-up, respectively. PDC had a standardized protocol that included assessment and reassessment, action planning, and ongoing monitoring. It was delivered by telephone and e-mail for cost efficiency and the ability to handle caseloads of 100 to 125. Care coordinators from VAMCs and Alzheimer's Association chapters worked as a team using a shared computerized record. A variety of caregiver outcomes was measured after 6 and 12 months. Intervention group caregivers had significant improvements in outcomes representing unmet needs, three types of caregiver strains, depression, and two support resources. Most improvements were evident after 6 months, with more-limited improvements from Months 6 to 12. Some outcomes improved for all caregivers, whereas some improved for caregivers experiencing more initial difficulties or caring for veterans with more-severe impairments. PDC is a promising model that improves linkages between healthcare services and community services, which is a goal of several new national initiatives such as the National Plan to Address Alzheimer's Disease and a proposed amendment to the Older Americans Act.

Despite recent advances in therapy, breast cancer remains the second most common cause of death from malignancy in women. Chemotherapy plays a major role in breast cancer management, and combining chemotherapeutic agents with non-chemotherapeutic agents is of considerable clinical interest. Cucurbitacins are triterpenes compounds found in plants of the Cucurbitaceae family, reported to have anti-cancer and anti-inflamatory activities. Previously, we have shown antiproliferative activity of cucurbitacin B (CuB) in breast cancer, and we hypothesized that combining CuB with chemotherapeutic agents can augment their anti-tumor effect. Here, we show that a combination of CuB with either docetaxel (DOC) or gemcitabine (GEM) synergistically inhibited the proliferation of MDA-MB-231 breast cancer cells in vitro. This antiproliferative effect was accompanied by an increase in apoptosis rates. Furthermore, in vivo treatment of human breast cancer orthotopic xenografts in immunodeficient mice with CuB at either low (0.5 mg/kg) or high (1 mg/kg) doses in combination with either DOC (20 mg/kg) or GEM (12.5 mg/kg) significantly reduced tumor volume as compared to monotherapy of each drug. Importantly, no significant toxicity was noted with low dose CuB in combination with either DOC or GEM. In conclusion, combination of CuB at a relatively low concentration with either of the chemotherapeutic agents, DOC or GEM, shows prominent antiproliferative activity against breast cancer cells without increased toxicity. This promising combination should be examined in therapeutic trials of breast cancer.

Little research has been done on the use of antidepressants among homebound older adults, especially low-income homebound older adults, and their perceptions of the effectiveness of their medication. The purposes of this study were to examine self-reported use of antidepressants among depressed homebound older adults, class and type of antidepressants used, individual-level correlates of antidepressant use, and users’ perceptions of the effectiveness of antidepressants. Data on self-reported use of antidepressants were obtained as part of a feasibility study of short-term telehealth problem-solving therapy for depressed low-income homebound adults (n = 162) aged 50 or older. The 24-item Hamilton Rating Scale for Depression (HAMD) was used to assess depression severity. The findings show that about half of the study participants were taking antidepressants, with 26.6% of those on antidepressants rating their medications very effective and 21.5% rating them effective. Female gender was positively, but older age and being Black/African American were negatively associated with the likelihood of antidepressant use. Perceived effectiveness of antidepressants was negatively associated with older age and the HAMD score. The findings suggest that personalized approaches to depression management may be needed in subgroups of depressed older adults, including culturally tailored medication counseling in Black/African-American older adults.

We present a new and self-contained theory for mapping properties of the boundary operators for slit diffraction occurring in Sommerfeld's diffraction theory, covering two different cases of the polarisation of the light. This theory is entirely developed in the context of the boundary operators with a Hankel kernel and not based on the corresponding mixed boundary value problem for the Helmholtz equation. For a logarithmic approximation of the Hankel kernel we also study the corresponding mapping properties and derive explicit solutions together with certain regularity results.

Objective This study identified factors in patients with diabetes associated with risk of developing dementia. Research Design and Methods This retrospective, longitudinal study used a national cohort of US Veterans with diabetes 65 years or older to examine incidence of dementia over 2 years. A multivariable Cox regression model was used to estimate risk of developing dementia associated with sociodemographic factors, use of diabetes medications, and duration of diabetes. Results In all, 377 838 patients (average age, 75.53 ± 6.07 years) were studied. Over the 2 year follow-up, 14 580 (3.85%) were diagnosed with dementia. Major risk factors for dementia were age >75 years (75–85 years, hazard ratio [HR] 2.092, 95% confidence interval [CI] 2.017–2.169; ≥85 years, HR 3.468, CI 3.274–3.672), race black versus white, HR 1.218, CI 1.164–1.274), Southern residence (HR = 1.181, CI 1.133–1.232), and diabetes duration (HR for 5 years or more, 1.428, CI 1.357–1.504). There was a reduced HR for dementia with use of an oral hypoglycemic agent (HR 0.940, CI 0.909–0.972) and HMG-CoA reductase inhibitors (HR, 0.875, CI 0.846–0.906). There was no change in HR with insulin use (HR 1.024, CI 0.983–1.067). Conclusions Several important factors were identified that are associated with increased dementia risk, and two factors were identified that are associated with reduced risk. It will be important to ascertain whether risk-factor modification reduces the HR for dementia in persons with diabetes, and to further examine effects of medication use for comorbid conditions. Copyright © 2010 John Wiley & Sons, Ltd.

To explore the association between posttraumatic stress disorder (PTSD) and dementia in older veterans. DESIGN: Administrative database study of individuals seen within one regional division of the Veterans Affairs healthcare network. SETTING: Veterans Integrated Service Network 16. PARTICIPANTS: Veterans aged 65 and older who had a diagnosis of PTSD or who were recipients of a Purple Heart (PH) and a comparison group of the same age with no PTSD diagnosis or PH were divided into four groups: those with PTSD and no PH (PTSD+/PH−, n=3,660), those with PH and no PTSD (PTSD−/PH+, n=1,503), those with PTSD and a PH (PTSD+/PH+, n=153), and those without PTSD or a PH (PTSD−/PH−, n=5,165). MEASUREMENTS: Incidence and prevalence of dementia after controlling for confounding factors in multivariate logistic regression. RESULTS: The PTSD+/PH− group had a significantly higher incidence and prevalence of dementia than the groups without PTSD with or without a PH. The prevalence and incidence of a dementia diagnosis remained two times as high in the PTSD+/PH− group as in the PTSD−/PH+ or PTSD−/PH− group after adjusting for the confounding factors. There were no statistically significant differences between the other groups. CONCLUSION: The incidence and prevalence of dementia is greater in veterans with PTSD. It is unclear whether this is due to a common risk factor underlying PTSD and dementia or to PTSD being a risk factor for dementia. Regardless, this study suggests that veterans with PTSD should be screened more closely for dementia. Because PTSD is so common in veterans, this association has important implications for veteran care.

This report considers the conceptual and methodological concerns confronting clinical investigators seeking to generate knowledge regarding the tolerability and benefits of pharmacotherapy in geriatric bipolar disorder (BD) patients.There is continuing need for evidence-based guidelines derived from randomized controlled trials that will enhance drug treatment of geriatric BD patients. Therefore, we present the complex conceptual and methodological choices encountered in designing a multisite clinical trial and the decisions reached by the investigators with the intention that study findings be pertinent to, and can facilitate, routine treatment decisions.Guided by a literature review and input from peers, the tolerability and antimanic effects of lithium and valproate were judged to be the key mood stabilizers to investigate with regard to treating bipolar I disorder manic, mixed, and hypomanic states. The patient selection criteria are intended to generate a sample that not only experiences common treatment needs but also represents the variety of older patients seen in university-based clinical settings. The clinical protocol guides titration of lithium and valproate to target serum concentrations, with lower levels allowed when necessitated by limited tolerability. The protocol emphasizes initial monotherapy. However, augmentation with risperidone is permitted after three weeks when indicated by operational criteria.A randomized, controlled trial that both investigates commonly prescribed mood stabilizers and maximizes patient participation can meaningfully address high-priority clinical concerns directly relevant to the routine pharmacologic treatment of geriatric BD patients.

Summary Improving the excitation conditions in two-photon fluorescent lithography reduces the size of the fabricated structures to nanometre scales. We demonstrate that a precise control of the illumination profile and the scanning speed of the laser beam is enough to decrease the photo-polymerization volume of resins by orders of magnitude. This work also shows experimental evidence of surface effects that yield a different polymerization intensity threshold compared with bulk. Such phenomenon enables to perform a non-linear optical nanolithography in a simple way, allowing fast-prototyping procedures. We present a detailed study of the polymer growth process using fluorescence and atomic force microscopy.

The diffraction of monochromatic light is considered for a plane screen with an open infinite slit by solving the vectorial Maxwell–Helmholtz system in the upper half-space with the Fourier method. With this approach we can represent each solution satisfying an appropriate energy condition by its boundary fields in the Sobolev spaces H±1/2. We show that Sommerfeld's theory using a boundary integral equation with Hankel kernels for the so-called B-polarization is covered by our approach, but in general it violates a necessary energy condition. Our representation includes also solutions which are not covered by Sommerfeld's theory. Copyright © 2007 John Wiley & Sons, Ltd.

Objective: Methadone Maintenance Therapy (MMT) and detoxification to abstinence are among the most common treatment options for opiate-dependent patients. This paper compares personality traits in detoxified former heroin users and those on MMT in order to assess their relevance to treatment selection. Method: Twenty-six formerly heroin-dependent subjects receiving MMT (MM), 33 formerly heroin-dependent subjects withdrawn from MMT (MW), and 43 healthy controls were compared on the Millon Clinical Multiaxial Inventory-II (MCMI-II) and the Temperament and Character Inventory (TCI). Results: On the TCI, MM patients had higher novelty seeking and lower self-directedness scores than controls. Both MM and MW subjects scored higher than controls on multiple MCMI-II scales. MW but not MM subjects scored higher than controls on two Cluster A Scales and the delusional disorder scale. Conclusion: Schizophrenia-spectrum pathology in former opiate users may be greater than previously recognized and could potentially be relevant to treatment selection.

Objectives: To investigate the reliability and validity of self-reported depression in demented elderly patients. Design: This is the first study to combine the use of multiple depression criteria with dementia and depression control groups. Setting: Houston Veterans Affairs nursing home and geropsychiatric inpatient unit and outpatient clinic, Baylor College of Medicine's Alzheimer's Disease Research Center. Participants: The total sample included 121 volunteer participants, their informants, and their clinicians, forming four diagnostic groups (27 controls, 37 dementia only, 28 depression only, 29 dementia and depression). Measurements: Scales assessing depression, deficit awareness, physical illness, functional disability, caregiver burden, and severity of cognitive impairment were used. Results: Analyses of variance using informant- and clinician-rated depression categories found main effects on patient-reported depression scores for deficit awareness and depression diagnosis but not for dementia diagnosis. Chi-square analyses revealed that demented and depressed patients underreported depression at similarly high rates compared with clinician and informant reports. Regression analyses revealed that deficit awareness accounted for significant variance in self-reported depression accuracy, whereas clinician- or informant-rated depression, severity of cognitive impairment, physical disability, functional status, and caregiver burden were not significant. Conclusion: The results of this investigation suggest that the presence of dementia per se does not predict inaccurate depression self-reports. Deficit awareness, which covaries with dementia, appears to account for the majority of the variance in self-report accuracy. These findings were stable across informant- and clinician-rated depression criteria and multiple analyses.

Delirium is a disturbance of consciousness, cognition and perception that occurs frequently in medically ill patients. Although it is associated with increased morbidity and mortality, it is often not recognised and treated by physicians. Predisposing factors are believed to have multiplicative effects and include dementia, advanced age and male gender. Recently developed models allow for the estimation of the risk of developing delirium during a hospitalisation, based on predisposing factors and acute additional stressors. Although it has been shown to be efficacious, the prevention of delirium is underutilised. Prevention consists of aggressive management of known risk factors and early detection. Limited data exist to support specific pharmacological interventions for its treatment. In this article, the avail-able published literature regarding the prevention and treatment of delirium is systematically reviewed.

The two-phase flow of a flocculated suspension in a closed settling vessel with inclined walls is investigated within a consistent extension of the kinematic wave theory to sedimentation processes with compression. Wall boundary conditions are used to spatially derive one-dimensional field equations for planar flows and flows which are symmetric with respect to the vertical axis. We analyse the special cases of a conical vessel and a roof-shaped vessel. The case of a small initial time and a large time for the final consolidation state leads to explicit expressions for the flow fields, which constitute an important test of the theory. The resulting initial-boundary value problems are well posed and can be solved numerically by a simple adaptation of one of the newly developed numerical schemes for strongly degenerate convection-diffusion problems. However, from a physical point of view, both the analytical and numerical results reveal a deficiency of the general field equations. In particular, the strongly reduced form of the linear momentum balance turns out to be an oversimplification. Included in our discussion as a special case are the Kynch theory and the well-known analyses of sedimentation in vessels with inclined walls within the framework of kinematic waves, which exhibit the same shortcomings. In order to formulate consistent boundary conditions for both phases in a closed vessel and in order to predict boundary layers in the presence of inclined walls, viscosity terms should be taken into account. Copyright © 2001 John Wiley & Sons, Ltd.

As many World War II and Korean Conflict veterans suffering from posttraumatic stress disorder (PTSD) grow older, increasing numbers will be diagnosed with dementia. We retrospectively analyzed patients with dementia, comparing the behavioral disturbances of those with PTSD to those without PTSD. We hypothesized that due to the additive effect of the neurobiological and behavioral changes associated with PTSD and dementia, the dementia with PTSD group would show more agitation and disinhibition than the dementia without PTSD group. Sixteen patients with diagnoses of dementia and PTSD were matched on age and Mini-Mental States Examination (MMSE) scores to 16 patients with dementia without PTSD. Demographic characteristics, co-morbid diagnoses, global Assessment of Functioning (GAF), Cohen-Mansfield Agitation Inventory (CMAI), and paranoid items of Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale for Schizophrenia (PANSS) were assessed. The patients with diagnoses of dementia with PTSD did not differ significantly in their clinical presentation, hospital course, and condition at discharge from patients with dementia without PTSD. Chi-square analysis showed that significantly more subjects in the PTSD group were prescribed anti-depressants compared to the non-PTSD group. Interestingly, within the PTSD group, the subgroup of patients who were former prisoners of war had a significantly higher mean score for paranoia and significantly less verbal agitation. This pilot study reveals that a diagnosis of PTSD alone is not sufficient to influence behavior in veterans with dementia; however, we also present provocative results that patients with more severe trauma (POW) do have changes in their behavior.

This cross-sectional study explored age-related differences in the frequency of diagnosis of personality disorder (PD) among 790 veterans admitted to a psychiatric inpatient unit across three age groups: 20-39, 40-59, and 60+. Older adults obtained a lower frequency (55.4%) of PD diagnosis than middle-aged adults (69.0%), who in turn obtained a lower frequency of PD diagnosis than young adults (75.9%). Older adults and middle-aged adults were less likely to receive a diagnosis of Borderline PD than young adults. Older adults were also less likely to receive a diagnosis of Mixed PD than young adults, but received significantly more diagnoses of Narcissistic PD than young adults. Patients diagnosed with PD had higher rates of psychiatric hospitalization than those with no diagnosis of PD. Older adults and middle-aged adults with PD had significantly fewer psychiatric hospitalizations than young adults with PD, whereas there were no age-related differences in the frequency of medical hospitalizations. These findings are consistent with research suggesting an overall softening of PD features with age, particularly those characteristic of the 'dramatic-erratic', Cluster B types.

Objective Cross-cultural differences in treatment and diagnosis exist in several psychiatric disorders. This study examines phenomenological and treatment differences between Caucasian and African-American patients presenting to a geropsychiatric unit for treatment of behavioral disturbances associated with dementia. Methods One hundred and forty-one Caucasian patients were compared to 56 African-American patients consecutively admitted to a VA geropsychiatric inpatient unit. At admission, differences in behavior disturbances between the two groups were examined using the Mini-Mental State Examination (MMSE), Cohen-Mansfield Agitation Inventory (CMAI), Hamilton Rating Scale for Depression (HAM-D), Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). Differences in treatment were assessed by comparing medication types and doses between the two groups. Results and Conclusion Results showed that Caucasian and African-American patients with dementia and behavioral disturbances presented and responded similarly to like treatment on an inpatient geropsychiatric unit. The similarity between the two groups may be explained by the multi-ethnic make-up of the interdisciplinary treatment team and by the use of standardized scales to measure symptomatology and response. Copyright © 1999 John Wiley & Sons, Ltd.

Summary The tomato yellow leaf curl virus (TYLCV) found in Israel is a whitefly-transmitted monopartite geminivirus. Although geminiviruses have been found in the nuclei of phloemassociated cells, the mechanism of viral invasion is poorly understood. The possible role of the TYLCV capsid protein (CP), the only known component of the viral coat, in virus transport into the host cell nucleus was investigated by monitoring its specific nuclear accumulation in plant and insect cells. CP was fused to the b-glucuronidase (GUS) reporter enzyme to assay nuclear import in petunia protoplasts, and micro-injection of purified fluorescently labeled CP was used to examine its nuclear uptake in Drosophila embryos. Both assays demonstrated that TYLCV CP is transported into plant-and insect-cell nuclei by an active process of nuclear import via a nuclear localization signal (NLS)-specific pathway. Using the GUS assay and deletion analysis, the TYLCV CP NLS sequence was identified in the amino-terminus of the protein.

Behavioral disturbances are commonly encountered in elderly demented patients. The records of all patients admitted to a geropsychiatric inpatient unit within a 2-year period who had a primary diagnosis of dementia and an accompanying behavioral disturbance treated with divalproex sodium were reviewed. Of the 13 patients identified, all tolerated divalproex sodium without significant side-effects. General psychiatric symptoms, overall agitation, physical aggression and non-aggressive physical agitation decreased significantly, but verbal agitation did not. Divalproex sodium is well tolerated and may be effective in ameliorating certain behavioral disturbances in elderly demented patients with agitation.

Objective. The tolerability of clonazepam in geropsychiatric inpatients was examined in patients with and without a diagnosis of dementia. Design. Forward-looking retrospective study comprising consecutive patients placed on clonazepam. Setting. A geropsychiatry unit of a large Veterans Affairs Medical Center. Patients. All geropsychiatry inpatients placed on clonazepam over a 21-month period of time. Measure. Mini-Mental State Examination, Brief Psychiatric Rating Scale, Cohen-Mansfield Agitation Inventory and the Rating Scale for Side Effects were performed at admission and discharge as part of an ongoing database. Results. Twenty-four geropsychiatric inpatients were treated with clonazepam (mean dose of 1.2 mg for a minimum of 2 weeks) during the 21 months studied. About one half of the patients had a primary diagnosis of dementia and the remainder had a diagnosis of an affective or psychotic disorder. Two of these patients were discontinued because they had responded to the acute need for clonazepam and a third patient was discontinued because of the development of sedation and confusion. For the remaining 21 patients, scores improved significantly on the Brief Psychiatric Rating Scale (p=0.017), the Cohen-Mansfield Agitation Inventory (p=0.011), the Rating Scale for Side Effects (0.004) and the Global Assessment of Functioning (p=0.000), with no differences in amount of improvement between demented and non-demented patient groups. Scores on the Mini-Mental State Examination remained unchanged. Conclusion. Clonazepam shows promise as a benzodiazepine with good tolerability in the elderly. © 1997 John Wiley & Sons, Ltd.

OBJECTIVE To examine the demographic characteristics and treatment outcomes of nursing home residents admitted to a geropsychiatric inpatient unit. DESIGN A retrospective cohort design based on an ongoing data base effort. SETTING The geropsychiatric inpatient unit of the Houston Veterans Affairs Medical Center Hospital. PARTICIPANTS All admissions to the unit from nursing homes during an 18-month period. MEASUREMENTS Mini-Mental State Examination, Brief Psychiatric Rating Scale, Hamilton Rating Scale for Depression, Cohen-Mansfield Agitation Inventory, Rating Scale for Side Effects, and Global Assessment of Functioning were administered on admission and discharge. RESULTS Paired t tests comparing change scores revealed significant decreases in general psychiatric symptoms (P < .001), depression (P < .001), and agitation (P < .001); significant improvement in global functioning (P < .001); with no significant changes in cognitive status (P = .485) or side effects (P = .120). When the patients were subgrouped according to reasons for admission, paired t tests revealed decreases in violence (CMAI Factor 1; P = .000), psychosis (BPRS thought disorder scale; P = .000 and hostility subscale; P < .008), and depression (HAM-D; P = .002). Four patients were discharged to less restrictive environments, all with chronic mental illnesses. CONCLUSION Inpatient psychiatric hospitalization significantly benefits nursing home residents with and without dementia who are admitted for severe behavior problems.

Age, sex, race, cognitive impairment, level of depression, psychiatric diagnosis and length of time receiving neuroleptic medication have been proposed as risk factors for the development of tardive dyskinesia (TD) in the elderly. The charts of 186 patients were reviewed to collect demographic, diagnostic and structured test data to identify the primary variables associated with TD in a geropsychiatric outpatient community mental health setting. The Mini-Mental State Exam (MMSE) was the only variable consistently associated with TD. MMSE significantly correlated with total Abnormal Involuntary Movement Scale scores, accounted for the most variance in the multiple regression equations, significantly contributed to the logistic regression models and differentiated between those with and without TD.

Psychotic symptoms are commonly encountered in elderly patients both with and without dementia. The authors compared presentation and treatment response between these two groups. Of 206 consecutive admissions to an inpatient geropsychiatry unit, 52 (26%) had psychotic symptoms. Thirteen of these had dementia and 22 had a primary Axis I psychotic disorder without dementia. Both groups presented similarly, improved significantly from admission to discharge and demonstrated equivalent medication side-effect profiles. Elderly psychotic patients with and without dementia improve significantly on antipsychotics and tolerate their side-effects; however, those with dementia receive lower dosages of medication to treat their symptoms.

Accurate and rapid cultivar identification is important for breeders'-rights protection, especially for vegetatively propagated plants. The objective of this study was to test the feasibility of developing cultivar-specific RAPD markers in commercial strawberries (Fragaria ananassa Dutch). Efforts were focused on distinguishing between two newly developed Volcani cultivars, ‘Ofra’ and ‘Dorit’, and six other cultivars, ‘Douglas’, ‘Chandler’, ‘Oso Grande’, ‘Dover’, ‘Nurit’ and ‘Parker’. Reproducible RAPD fingerprints were generated, each containing at least one polymorphic DNA product. A combination of 10 polymorphic DNA products exhibited cultivar-specific patterns enabling the distinction between closely related varieties, such as ‘Ofra’ (which is the progeny of ‘Dorit’ and ‘Parker’) and ‘Dorit’ (which is the progeny of ‘Nurit’ and ‘Dover’). This study shows that RAPD markers can help in the protection of breeders’ rights to strawberry cultivars.

Cognitive deficits occurring with major depression in the elderly are well recognized. However, cognitive differences in depressed patients with and without psychotic features have received little attention. Of 14 consecutively referred elderly patients with major depression, the eight patients with psychotic features had significantly more cognitive deficits on neuropsychological tests than the six patients with major depression without psychotic features. The differences in performance IQ were most remarkable, but the differences extended to verbal IQ subtests, word fluency and memory.

In this paper we prove an explicit representation formula for the solution of a one-dimensional hyperbolic conservation law with a non-convex flux function but monotone initial data. This representation formula is similar to those of Lax [10] and Kunik [7,8] and enables us to compute the solution pointwise explicitly. This result is a generalization of a theorem given in Kunik [8] where the case of only one inflexion point for the fluxes was considered. Its proof uses the polygonal method of Dafermos [2]. The application of this method leads to a simple explicit construction of the solutions for a Kynch sedimentation process [9] and to an explicit parameter representation for the shock curves evolving during the sedimentation process.

Die Komplexe cis-M(CO)4E′Me3EMe2SiMe3 M=Cr, Mo, W; E, E′=P, As werden zum Vergleich mit den verwandten Chelatkomplexen M(CO)4EMe2SiMe2(CH2)nE′Me2 (n=1, 2) auf zwei verschiedenen Wegen dargestellt: (i) Durch Zweitsubstitution aus M(CO)5E′ Me3 bzw. M(CO)5EMe2SiMe3; (ii) durch Ersatz eines Liganden L′ in cis-konfigurierten Vorstufen M(CO)4(E′ Me3)L′. Die Pentacarbonylderivate M(CO)5E′Me3 und M(CO)5EMe2SiMe3 sind nach dem “indirekten” photochemischen Verfahren zuganglich; die cis-konfigurierten Vorstufen [Et4N][M(CO)4(Cl)E′ Me3], M(CO)4(PMe3)pip, M(CO)4(pip)2, M(CO)4NBD und M(CO)4(E′ Me3)2 bzw. M(CO)4(EMe2SiMe3)2 werden nach modifizierten Literaturvorschriften dargestellt. Als gunstigster Weg zu den Komplexen cis-M(CO)4(E′ Me3)EMe2SiMe3 erweist sich die “direkte” photochemische Zweitsubstitution bei − 78°C. Gute Resultate werden auch bei der thermischen Einfuhrung des zweiten Liganden erzielt; allerdings tritt dabei in erheblichem Umfang Isomerisierung zum trans-Komplex auf. Auch die durch Spaltung der Chelatliganden =Me2ESiMe2CH2E′ Me2 in den Komplexen M(CO)4 zuganglichen cis-Verbindungen M(CO)4(EMe2H)E′Me2CH2SiMe2Cl wandeln sich in Losung bei Raumtemperatur partiell in die trans-Isomeren um. Aus den spektroskopischen Daten [v(CO), Koordinationsverschiebungen Δδ] ist zu folgern, das die Donor/Akzeptor-Eigenschaften der Ligand-Kombinationen E′Me3/EMe2SiMe3 denen der Chelatliganden EMe2SiMe2(CH2)nE′Me2 in guter Naherung entsprechen. Alternative Ligands. XXIX. cis-M(CO)4(E′Me3)EMe2SiMe3 Complexes (M=Cr, Mo, W; E, E′=P, As) — “Open” Analogues of the Chelate Compounds M(CO)4E′ Me2(CH2)nSiMe2EMe2. Complexes of the type cis-M(CO)4(E′Me3)EMe2SiMe3 (M=Cr, Mo, W; E, E′=P, As) have been prepared for comparison with the related chelate complexes M(CO)4EMe2SiMe2(CH2)nE′MeMe2 (n=1, 2) by two different routes: (i) Via substitution of CO by the second ligand in M(CO)5E′Me3 and M(CO)5EMe2SiMe3, respectively; (ii) by replacement of a ligand L′ in precursors M(CO)4(E′Me3)L′. The pentacarbonyl derivatives M(CO)5E′Me3 and M(CO)5EMe2SiMe3 are produced by the “indirect” photochemical method; the cis-precursors [Et4N][M(CO)4(Cl)E′Me3], M(CO)4(PMe3)pip, M(CO)4(pip)2, M(CO)4NBD, and M(CO)4(E′Me3)2 or M(CO)4(EMe2SiMe3)2 have been obtained by modified literature prescriptions. The “direct” photochemical second-substitution at −78°C turns out to be the most favourable way to cis-M(CO)4(E′Me3)EMe2SiMe3 complexes. Good results are also obtained using the thermal introduction of the second ligand for CO; however, considerable isomerization to the trans-complex is observed. Similarly, the cis-compounds M(CO)4(EMe2H)E-e2CH2SiMe2Cl obtained by cleavage of the chelating ligands = Me2ESiMe2CH2E′Me2 in the complexe M(CO)4 are partially transformed to the trans isomers in solution at room temperature. The spectroscopic data [ν(CO), coordination shifts Δδ] lead to the conclusion that the donor/acceptor properties of the ligand combinations E′Me3/EMe2SiMe3 correspond in a good approximation to those of the chelating ligands EMe2SiMe2(CH2)nE′Me2.