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Older adults with bipolar disorder are at increased risk of developing dementia. The literature suggests lithium treatment may reduce the incidence of dementia. This study sought to inform clinical practice in the Veterans Affairs (VA) health system by estimating the effect of past year lithium receipt on dementia incidence among Veterans with bipolar disorder. Divalproex receipt was used as a comparison. Using VA medical records, 121,094 Veterans aged 50 and older with a diagnosis of bipolar disorder but no dementia diagnosis were identified in fiscal years 2005-2019. Follow-up continued until dementia diagnosis, 36 months from the index date, death, or the end of fiscal year 2020, whichever came first. 4347 (3.6%) were diagnosed with dementia during follow-up. Time-varying indicators of receipt of lithium and divalproex in the prior 365 days were calculated for each day, categorized as 301-365, 61-300, 1-60, or 0 days of receipt. Unadjusted Cox proportional hazards regression analyses indicated reduced dementia incidence with 301-365 (HR=0.86, 95% Confidence Interval [95%CI] 0.75-0.99) and 61-300 (HR=0.75, 95%CI 0.65-0.87) days of lithium receipt, compared to 0 days. For divalproex, 301-365 (HR=1.34, 95%CI 1.23-1.47) and 61-300 (HR=1.13, 95%CI 1.03-1.23) days of receipt were each associated with increased dementia incidence. Lithium effects were not statistically significant after adjusting for age, sex, race, ethnicity, medical comorbidities, and antidepressant, antipsychotic, and anxiolytic medication receipt. Divalproex effects remained statistically significant. Past year divalproex, but not lithium, receipt was significantly associated with dementia incidence among VA patients with bipolar disorder when adjusting for demographics and medical comorbidities.

We present evaluation results after one year of implementation by nine BRO Teams. Monthly checklists documented consistent composition across teams: a psychologist, social worker and nurse. Social workers were recognized as having a critical role in implementation, serving as a referral source and liaison between the CLC, Veteran/family, and community facility. Early implementation focused on team and program development with barriers including unprotected time for Team members. In the first year, the nine teams enrolled 70 Veterans, discharging 86% to community facilities. Characteristics of the Veterans suggest Teams are reaching the complex Veteran targeted by the model. Barriers to successful discharge include community facility inexperience/training and confidence to manage complex residents. COVID emerged as the leading barrier to outreach to internal and external partners and providing transitional support to the Veteran after discharge. We discuss the impact of these preliminary findings on future implementation and dissemination of the model.

The traditional isoscaling technique has been used to analyze all isotopically identified particles from 70 Zn+ 70 Zn and 64 Zn+ 64 Zn collisions at 35 MeV/u. Two additional techniques, using an energy-averaged ratio and using the data present in the tail of energy spectra, are compared to the traditional method and show similar results. Isoscaling fit parameters α and β are found both globally and for each individual series of constant Z and N . The data are then split up between emitted fragments and projectile-like fragments. Isoscaling values for the two different types of fragments are shown to be different, emphasizing the importance of experimentally distinguishing between projectile-like fragments and emitted fragments in order to achieve accurate isoscaling parameters.

Older adults may exhibit symptoms of Post-Traumatic Stress Disorder (PTSD) after a traumatic event, even if they do not meet the criteria for a full diagnosis. This sub-clinical PTSD affects 7-15% of older adults and is associated with elevated depressive symptoms, suicidal ideation, and poorer physical health. Individuals with sub-clinical PTSD often experience worsening symptoms, resulting in a full diagnosis of PTSD, albeit late onset. This evaluation informs the Veterans Health Administration (VHA)’s understanding of the developmental course of PTSD in older Veterans. VHA administrative data were used to examine health characteristics and service utilization in the five years before and five years after the initial VHA documentation of PTSD. We identified a cohort of Veterans (n=27,610), alive and with at least 1 encounter in all evaluation years, with a first PTSD diagnosis documented between ages 50-59, a cohort outside of the average age of diagnosis, but before Medicare eligibility. We compared periods before and after diagnosis across different ages of first diagnosis (50-54, 55-59). Veterans diagnosed at later ages (55-59) had a greater number of mental and physical health conditions. Increasing VHA use preceded a PTSD diagnosis in both groups, but the increase was steeper among those diagnosed at 55-59. Future analyses will compare these patterns to those of Veterans diagnosed at younger ages. Findings from this work may provide a profile of persons at risk for late-life PTSD for use in targeting interventions earlier to reduce the risk of developing worsening PTSD symptoms in late life.

Personality disorders (PD) are defined by longstanding patterns of dysfunctional behavior and associated with higher risk for adverse outcomes, such as suicide and comorbid mental health (MH). Despite recognition that PDs manifest differently as individuals age, few studies have examined PDs in older adults. VHA serves a significant population of older Veterans, providing a valuable opportunity to explore PD in older ages. Using FY2019 administrative data, we compare documented PDs, MH, and VHA use in a cohort of recent Veteran VHA users 50 years and older, across six age groups. At least one PD was documented for 0.8% of the total cohort, decreasing with age from 1.8% (50-54) to 0.2% (75+). Among those with PD, 98% had a comorbid MH disorder with the greatest percent having a major depressive disorder (69.7%). Except for dementia, comorbid mental health disorders generally decreased with age. Suicide risk flags were documented for 8.2% of cohort Veterans with PD compared to 0.7% with MH only. Behavior risk flags were documented for 4.3% of cohort Veterans with PD compared to 0.3% with MH only. The presence of both flags decreased with age. Compared to cohort Veterans with MH only, those with PD had more than twice the number of outpatient MH encounters and 1.5 times more psychiatric hospitalizations and ED visits for MH. Differences in care were consistent across age. However, differences in use were greatest for Veterans ages 55-64. The need to address crises resulting in the use of inpatient and ED is discussed.

We study neutron-proton equilibration in dynamically deformed nuclear systems by investigating the correlations between the three largest fragments produced in collisions of $^{70}\mathrm{Zn}+^{70}\mathrm{Zn}$ at 35 MeV per nucleon. The rotation angle is interpreted as a measure of the duration of contact between the regions of the excited projectile-like fragment as it decays. In this work we address questions of whether there is a simultaneous or a double rupture scenario, sizing of the fragments, and alignment of the configuration.

The VA Measurement Based Care (MBC) in Mental Health (MH) Initiative supports implementing patient reported outcome measures (PROMs) for MH treatment planning and shared decision-making as a routine aspect of care. Using VHA administrative data, we identified Veterans initiating a new MH treatment episode (index encounter), i.e. prior 6-months without VHA MH encounters. We compare MH diagnoses, medications, and encounters during the 6-months from and including the index encounter by age (50-64; 65-79; 80+) between Veterans receiving 1 or more measures (PROM) to those receiving none (noPROM). The percentage of PROM Veterans decreased with age: 26.7% (50-64); 18.5% (65-79); 12.5% (80+). Consistent across age, PROM Veterans had more encounters than noPROM Veterans. In the year before treatment initiation, a smaller percentage of PROM Veterans had multiple MH diagnoses (21.0% v. 29.1%). At treatment initiation, both groups were equally likely to have multiple diagnoses (20.7% v. 20.1%); a higher percentage of the noPROM group were diagnosed with schizophrenia (3.8% v. 1.0%), bipolar (4.5% v. 2.2%), or PTSD (29.2% v. 21.8%). Substance use disorder and major depression were more prevalent in the PROM group. These patterns held across age categories. A smaller percentage of PROM Veterans had been prescribed psychotropic medication during the index encounter (32.8% v. 42.8%). For PROM Veterans, an average of 3 measures were received 1.5 months apart. The number of measures declined and the interval between measures increased with age. Potential barriers and possible efforts to target the use of PROMs with older Veteran patients are discussed.

Accelerator-based Ion Beam Analysis (IBA) has been actively used at the Cyclotron Institute (CI) at Texas A&M University (TAMU) to support the undergraduate research program. PIXE (Particle Induced X-ray Emission) and PIGE (Particle Induced Gamma-ray Emission) are examples of traditional ion beam techniques for elemental analysis. In the past year, our laboratory has assembled PIXE and PIGE experiments with the intention of collaborating with other departments and universities in the study of contaminants’ pathways to the environment and characterization of materials and, in addition, contribute didactically to undergraduates involved in the project. The implementation of routine PIXE and PIGE analysis at the CI allows students to perform elemental composition studies nondestructively, for a large number of samples in a variety of matrices (environmental or biological) with minimal time and sample preparation. The experiments were performed at the TAMU CI, using the K150 cyclotron. Each matrix was bombarded with a proton beam that ranged from 3.6 - 6.3 MeV, with an intensity between 5 - 9 nA and a beam spot size of 5 - 10 mm. The resulting x- and gamma-rays were measured with SiPIN, SOO and CdTe high-performance x- and gamma-ray detectors, located at 45° and 135° with respect to the beam direction. We will discuss our recent projects in detail and the impact they have on the research program and on undergraduate education.Accelerator-based Ion Beam Analysis (IBA) has been actively used at the Cyclotron Institute (CI) at Texas A&M University (TAMU) to support the undergraduate research program. PIXE (Particle Induced X-ray Emission) and PIGE (Particle Induced Gamma-ray Emission) are examples of traditional ion beam techniques for elemental analysis. In the past year, our laboratory has assembled PIXE and PIGE experiments with the intention of collaborating with other departments and universities in the study of contaminants’ pathways to the environment and characterization of materials and, in addition, contribute didactically to undergraduates involved in the project. The implementation of routine PIXE and PIGE analysis at the CI allows students to perform elemental composition studies nondestructively, for a large number of samples in a variety of matrices (environmental or biological) with minimal time and sample preparation. The experiments were performed at the TAMU CI, using the K150 cyclotron. Each matrix was bombard...

This study explored whether faculty/student collaboration in learning communities can help fulfill faculty members’ professional developmental needs, and if so, how these teaching experiences in learning communities benefit the faculty and their institution. The research sought to discover if faculty perceived that they experienced rejuvenation because of their participation in learning communities, and as a result of this rejuvenation, did they perceive that they had altered their pedagogy. And finally, the study investigated whether or not faculty perceived if their participation in learning communities affected their stand-alone classes and other college responsibilities such as committee work. This qualitative inquiry used an in-depth phenomenological interview process to seek the data. Six participants from a metropolitan community college in the Southwest were each interviewed three times. The first interview was a life story interview, which focused on teaching careers in general. The second interview asked each to reflect specifically on their learning community teaching experiences, and in the third interview, each was given the opportunity to make meaning from all teaching experiences and indicate if they felt learning communities had affected pedagogy and participation in college activities and responsibilities. The analysis of the transcribed interviews revealed the following themes: a passion for teaching; strong and positive attitudes about students; the importance of learning communities in their teaching experiences; a metaphor about marriage and their teaching partners; the multiple ways their pedagogy had been altered; the need for flexibility if participating in learning communities; and multiple types of faculty benefits, such as how faculty learn more when teaching with a partner, how they use collaboration, and how learning communities provide significant opportunities for faculty development. This study suggests that institutions contemplating

Over the past decade in the United States, there has been growing interest among governmental, academic, environmental, and resource-user communities in managing the ocean in a more comprehensive and ecosystem-based manner. Proposals for new uses of ocean resources and space—most notably from the energy sector—have left resource managers grappling with how to protect our increasingly compromised ocean ecosystems while allowing for sustainable use. Debate over this issue has been heated in New England where proposals for offshore, liquefied natural gas terminals, sand and gravel mining, desalination plants, gas pipelines, and wind and tidal energy facilities have raised concerns among local, state, and federal agencies and the general public about how to manage the diversity of uses and minimise the negative impacts of this intensified development pressure on the marine environment. In response, the region has embraced marine spatial planning as a tool to optimise use and advance ocean health; maximizing what the ocean has to offer in the way of food, transportation, recreation, jobs, and energy, while ensuring protection of the ecosystem. Massachusetts and Rhode Island have completed marine spatial plans (known locally as ‘ocean plans’) for their state ocean waters. More recently, a Northeast Regional Ocean Plan was completed in 2016 to guide management of state and federal ocean waters from Maine to Connecticut. Intensive planning for offshore wind energy development is sparking new scientific research, data collection, and stakeholder collaboration that aims both to advance renewable energy development and to ensure ecosystem protection. In this case study, we focus on marine spatial planning in New England and collaboration between wind energy developers and environmental organisations to advance offshore wind development and effective protection of North Atlantic right whales—one of the world’s most endangered species of marine mammals.

Facility characteristics’ influence on staff injuries was evaluated from 2013-2018 for 105 VA CLCs. Nursing hours, nurse skill-level, resident case-mix (percent of residents with mental health or other conditions) and facility size were evaluated in a multivariable regression model. Overall the average injury rates per year were 2.7 (standard deviation 4.3) and 1.5 (2.7) in STAR-VA enrolled vs. never enrolled sites (p=0.04). Statistically significant predictors for higher staff injury rates included percent of residents with dementia, larger bed facilities, and more mental health employee coverage. Lower staff injury rates were associated with facilities with more short-stay residents. After adjustment for facility characteristics, STAR-VA sites were not an independent predictor for staff injury rates. Sites selected for enrollment in STAR-VA have higher overall injury rates which may be due to facility differences in size, staffing and proportion of residents with dementia. Implications for training and monitoring CLC sites will be discussed.

Previous work has quantified the degree of neutron-proton equilibration in heavy-ion nuclear collisions by observing the convergence of isospin observables (such as the isoscaling parameter α) to an expected value based on similar symmetric reaction systems. We present a new signature of equilibration: the convergence of the isospin asymmetry (as quantified by three isoscaling metrics) of two mirror asymmetric reaction systems toward each other rather than a predefined point. For the reactions of 35 MeV/u Zn64,70+Zn64,70 and Zn64,Ni64+Zn64,Ni64 the neutron-proton equilibration was found to be approximately 80%, and this result is compared directly to previous work. © 2018 American Physical Society.

Neutron-proton equilibration was studied in dynamically-deformed nuclei produced in reactions $^{70}$Zn+$^{70}$Zn at 35A MeV. The composition of the two largest daughters of each excited projectile-like fragment is examined as a function of alignment angle. The lighter fragment is initially neutron rich relative to the heavier fragment, and the compositions evolve towards each other exponentially with increasing angle. The alignment angle, as a result of rotation, is related to time through the angular momentum of the projectile-like fragment, and a rate constant of 3 zs$^{-1}$ is extracted. This corresponds to a mean equilibration time of 0.3 zs. This technique provides a new window through which to gain insight into the nuclear equation of state.

We study neutron-proton equilibration in dynamically deformed nuclear systems by investigating the correlations between the two largest fragments produced in collisions of $^{70}\mathrm{Zn}+^{70}\mathrm{Zn}$, $^{64}\mathrm{Zn}+^{64}\mathrm{Zn}$, $^{64}\mathrm{Ni}+^{64}\mathrm{Ni}$ and $^{64}\mathrm{Zn}+^{64}\mathrm{Ni}$ at $35\phantom{\rule{4pt}{0ex}}\mathrm{MeV}$ per nucleon. The extent of equilibration is investigated using the rotation angle as a clock for the equilibration. The initially dissimilar fragments converge exponentially with consistent rate constants across a wide variety of reaction partners and systems, indicating that the equilibration follows first-order kinetics.

Objectives: The STAR-VA program in Veterans Health Administration Community Living Centers (CLCs, nursing home settings) trains teams to implement a psychosocial intervention with residents with behavioral symptoms of dementia (BSD). Methods: Across 71 CLCs, 302 residents selected as training cases had target behaviors categorized into one of 5 types: physically aggressive (PA), physically nonaggressive, verbally aggressive, verbally nonaggressive, and behavior deficit (BD). Results: Across all groups, there were significant declines in team-rated behavior frequency (36%) and severity (44%), agitation (10%), distress behaviors (42%), depression (17%), and anxiety (20%). The magnitude of changes varied across behavior category. For example, those with a PA target behavior experienced a greater percentage decline in agitation and distress behavior scores, and those with a BD target behavior experienced a greater percentage decline in depressive and anxiety symptoms. Conclusions: STAR-VA, a multicomponent intervention, is generally effective across various types of behavioral symptoms associated with dementia.

STAR-VA is an interdisciplinary, patient-centered, behavioral intervention to help Veterans Affairs Community Living Center (CLC) care teams understand and manage behavior symptoms of dementia (BSD). Empirical support demonstrates distinct subtypes of BSD. While previous evaluations have demonstrated effectiveness, the impact of STAR-VA across behavior subtypes has been recently evaluated. From 2013 to 2017, 352 veterans participated in STAR-VA implementation and evaluation. Target behaviors included physically aggressive (PA; n=75), physically non-aggressive (PNA; n=72), verbally aggressive (VA; n=88), verbally non-aggressive (VNA; n=71), and behavior deficit (BD; n=46). Using a differences-in-differences analytic approach, STAR-VA impact was estimated from pre- to post-assessment by subtype. Results demonstrate: (1) lower odds of rejection of care (Minimum Data Set 3.0) for PA versus PNA, (2) less frequent total aggressive behavior for VA and PA versus BD, and (3) lower Rating Anxiety in Dementia scores for VA and VNA versus PNA. Implications for STAR-VA implementation will be discussed.

The impact of STAR-VA on psychotropic drug use among residents with behavioral symptoms of dementia was evaluated through a difference-in-differences framework. STAR-VA residents enrolled 2013-2017 were evaluated longitudinally pre-post intervention. The primary outcome was the number of as needed administrations with an indication of ‘anxiety’ or ‘agitation’. The analytical cohort included 214 training cases and 1,870 controls from untrained sites meeting eligibility criteria. STAR-VA cases were less white (48% vs. 54%), less black (11% vs. 14%), and had significantly longer median length of stay (830 vs. 261 days), respectively. STAR-VA cases had on average 3.5 as needed doses/month of psychotropic medication before the intervention and 1.7 after, controls averaged 1.8 doses/month. After adjustment for person-time-fixed effects, enrollment was associated with 55% (95% CI:30, 68) reduction or an average 0.8 as needed psychotropic doses/month. Findings demonstrate effectiveness in decreasing as-needed psychotropic drug use among CLC residents, supporting continued implementation of STAR-VA.

Between 2013 and 2018, 86 Community Living Center (CLC) teams received STAR-VA training and consultation and implemented the intervention. Program evaluation has consistently demonstrated that STAR-VA Veteran training cases experience significantly decreased frequency and severity of target behaviors, symptoms of depression, anxiety, and agitation. VA Central Office leaders responsible for ongoing STAR-VA implementation and evaluation sought to understand the program’s systemic impact on important outcomes, if outcomes are maintained, and factors influencing variation in sustained adherence to STAR-VA. This presentation will describe the rationale for and methods used to develop a valid quality improvement metric to assess behavioral symptoms of dementia, to compare Veteran- and site-level outcomes at trained and untrained CLCs, and to identify factors associated with sustained STAR-VA implementation. This partnered evaluation, combining quantitative and qualitative methodologies, is critical for informing operational strategies for promoting STAR-VA and supporting its sustained implementation in VA CLCs.

Persons with dementia frequently demonstrate behavior symptoms of dementia (BSD), associated with poorer outcomes. A measure of BSD was created for routine use in VA Community Living Centers (CLCs). Reliability and validity of Minimum Data Set (MDS 3.0) behavior items was established using exploratory factor analysis and a multitrait, multimethod correlation matrix. 385 CLC residents with BSD were assessed using validated measures of BSD, depression, and anxiety, and team ratings of the frequency and severity of target behaviors identified for intervention. Factor analysis on MDS items closest to baseline resulted in two stable factors. MDS behavior factors related to validated clinical measures in predicted ways at baseline and post-intervention. MDS distress behavior factor sensitivity to change was evaluated by using change score correlations with validated clinical measures. The MDS distress behavior factor can be used routinely, evaluate the impact of intervention effectiveness, and provide quality improvement feedback.