A non-pharmacologic approach to address challenging behaviors of Veterans with dementia: description of the tailored activity program-VA randomized trial

BACKGROUND: Behavioral symptoms accompanying dementia are associated with increased health care costs, reduced quality of life and daily functioning, heightened family caregiver burden, and nursing home placement. Standard care typically involves pharmacologic agents, but these are, at best, modestly effective, carry serious risks, including mortality, and do not address behavioral symptoms families consider most distressful and which may prompt nursing home placement. Given dementia’s devastating effects and the absence of an imminent cure, the Veterans Administration has supported the development and testing of new approaches to manage challenging behaviors at home. METHODS/DESIGN: The Tailored Activity Program – Veterans Administration is a Phase III efficacy trial designed to reduce behavioral symptoms in Veterans with dementia living with their caregivers in the community. The study uses a randomized two-group parallel design with 160 diverse Veterans and caregivers. The experimental group receives a transformative patient-centric intervention designed to reduce the burden of behavioral symptoms in Veterans with dementia. An occupational therapist conducts an assessment to identify a Veteran’s preserved capabilities, deficit areas, previous roles, habits, and interests to develop activities tailored to the Veteran. Family caregivers are then trained to incorporate activities into daily care. The attention-control group receives bi-monthly telephone contact where education on topics relevant to dementia is provided to caregivers. Key outcomes include reduced frequency and severity of behavioral symptoms using the 12-item Neuropsychiatric Inventory (primary endpoint), reduced caregiver burden, enhanced skill acquisition, efficacy using activities, and time spent providing care at 4 months; and long-term effects (8 months) on the Veteran’s quality of life and frequency and severity of behavioral symptoms, and caregiver use of activities. The programs’ impact of Veterans Administration cost is also examined. Study precision will be increased through face-to-face research team trainings with procedural manuals and review of audio-taped interviews and intervention sessions. DISCUSSION: The Tailored Activity Program – Veterans Administration is designed to improve the quality of life of Veterans with dementia and lessen the burden of care on caregivers. Activities are tailored to reflect the Veteran’s preserved capabilities and interests to enhance active engagement, while not taxing areas of cognition that are most impaired. TRIAL REGISTRATION: ClinicalTrials.gov, NCT0135756

Anti-correlations in the degree distribution increase stimulus detection performance in noisy spiking neural networks

Neuronal circuits in the rodent barrel cortex are characterized by stable low firing rates. However, recent experiments show that short spike trains elicited by electrical stimulation in single neurons can induce behavioral responses. Hence, the underlying neural networks provide stability against internal fluctuations in the firing rate, while simultaneously making the circuits sensitive to small external perturbations. Here we studied whether stability and sensitivity are affected by the connectivity structure in recurrently connected spiking networks. We found that anti-correlation between the number of afferent (in-degree) and efferent (out-degree) synaptic connections of neurons increases stability against pathological bursting, relative to networks where the degrees were either positively correlated or uncorrelated. In the stable network state, stimulation of a few cells could lead to a detectable change in the firing rate. To quantify the ability of networks to detect the stimulation, we used a receiver operating characteristic (ROC) analysis. For a given level of background noise, networks with anti-correlated degrees displayed the lowest false positive rates, and consequently had the highest stimulus detection performance. We propose that anti-correlation in the degree distribution may be a computational strategy employed by sensory cortices to increase the detectability of external stimuli. We show that networks with anti-correlated degrees can in principle be formed by applying learning rules comprised of a combination of spike-timing dependent plasticity, homeostatic plasticity and pruning to networks with uncorrelated degrees. To test our prediction we suggest a novel experimental method to estimate correlations in the degree distribution

Rural Georgia: To Be or Not to Be Zoned

A variety of public policies in Georgia can influence a community’s economic development potential. Zoning is one of these policies. In 1983, the Georgia State Constitution gave individual counties home rule power to conduct zoning and planning activities. The Georgia Planning Act of 1989 mandated that all communities in Georgia adopt a comprehensive plan, but did not require adoption of a zoning ordinance to enforce, or implement, the plan. As of 2001, 63 counties in Georgia, all rural, have not adopted a zoning ordinance. Community leaders of non-zoned counties often find it challenging to convince their citizens of real benefits to zoning. Opponents of zoning often consider such regulation an unnecessary governmental intrusion on their property rights. Zoning advocates often cite quality-of-life advantages, such as protecting homeowners from unwanted uses next door, but such advantages vary in the eye of the beholder and sometimes do not provide enough incentive to sway the opposition. The purpose of this investigation was to evaluate whether there are economic development benefits related to zoning. Given that an unlimited number of factors affect a community’s economic development potential, it is not possible to state with certainty that just one factor is responsible for a community’s economic development progress. In other words, one factor, such as a specific public policy, cannot be the sole explanation for a community’s development. However, economic development patterns may be observed when comparing communities with one of these factors to communities without. This investigation sought to compare counties with a zoning policy to counties without one.Georgia Rural Economic Development Center (GREDC) at East Georgia Colleg

Note and Comment

Effect of Taking Possession of Mortgaged Property Under a Chattel Mortgage as Against a Junior Mortgagee; The Effect of the Reunion of the Cumberland Presbyterian Church With the Presbyterian Church in the United States of America Upon the Property of the Former; The Exclusive Use of Part of Railroad Station Grounds by Hackmen; Conflict of Jurisdiction in Bankruptcy Cases Between Federal and State Courts; Right of the Legislature to Amend Corporate Charters Under the Reserved Power; Can A Purchaser From a Tenant Acquire Title by Adverse Possession?; Can a Mortgagor After the Execution of the Mortgage Create an Easement in the Mortgage Security?; The Ohio Bulk Sales Law

Radiative absorption enhancements by black carbon controlled by particle-to-particle heterogeneity in composition.

Black carbon (BC) absorbs solar radiation, leading to a strong but uncertain warming effect on climate. A key challenge in modeling and quantifying BC's radiative effect on climate is predicting enhancements in light absorption that result from internal mixing between BC and other aerosol components. Modeling and laboratory studies show that BC, when mixed with other aerosol components, absorbs more strongly than pure, uncoated BC; however, some ambient observations suggest more variable and weaker absorption enhancement. We show that the lower-than-expected enhancements in ambient measurements result from a combination of two factors. First, the often used spherical, concentric core-shell approximation generally overestimates the absorption by BC. Second, and more importantly, inadequate consideration of heterogeneity in particle-to-particle composition engenders substantial overestimation in absorption by the total particle population, with greater heterogeneity associated with larger model-measurement differences. We show that accounting for these two effects-variability in per-particle composition and deviations from the core-shell approximation-reconciles absorption enhancement predictions with laboratory and field observations and resolves the apparent discrepancy. Furthermore, our consistent model framework provides a path forward for improving predictions of BC's radiative effect on climate

Denton Wheat : A New Variety for North Texas.

20 p