Pilgrim Psychiatric Center

During Refueling Outage 18 (RFO18, April 2011) Pilgrim Nuclear Power Station (PNPS) identified crack-like indications on the Steam Separator Lifting Lugs. A multi-disciplinary engineering effort was undertaken to determine the cause of the cracking and prepare the technical justification for long term operation of the lifting lugs. This approach focused on addressing the potential for future degradation due to the existing indications, and the resulting effects on the hardware and its function. A materials evaluation concluded that intergranular stress corrosion cracking (IGSCC), most likely associated with cold work present in the as-fabricated steam separator, was the cause of the indications found on the lifting lugs. To support long term operation of the lifting lugs at PNPS, a structural evaluation was completed using ANSI N14.6 and NUREG-0612 criteria with a conservative bounding configuration. Crack growth rates, based on BWRVIP-76 guidance of 5E-5 in/hr for length and 2.2E-5 in/hour for depth, were used in the analyses. The evaluation concluded that PNPS could continue with long term operation of the Steam Separator. Consistent with standard practice, a general heavy loads examination was performed in 2013 (RFO19), confirming no discernable changes. The general examination will be repeated in 2015 (RFO20), and an examination of the lifting lugs is planned for the 2017 Refueling Outage (RFO21) to confirm that the indication behavior is consistent with the evaluation results.

The focus of this article is on moving beyond the first step or stage of welcoming people with disabilities into congregations in general—particularly through segregated programs and activities or “mainstreaming approaches” for people with intellectual disabilities—toward the full inclusion of people with disabilities into the rich, active life of a church.

*Pilgrim Psychiatric Center, 998 Crooked Hill Road, West Brentwood, New York, 11717; †Creedmoor Psychiatric Center, 80-45 Winchester Blvd., Queens, New York, 11427.

Non-cooperative decision-making problems in a decentralized supply chain can be characterized and studied using a stochastic game model. In an earlier paper, the authors developed a methodology that uses machine learning for finding (near) optimal policies for non-zero sum stochastic games, and applied their methodology on an N-retailer and W-warehouse inventory-planning problem. The focus of this paper is on making the methodology more amenable to practical applications by making it completely simulation-based. It is also demonstrated, through numerical example problems, how this methodology can be used to find (near) equilibrium policies, and evaluate short-term rewards of stochastic games. Short-term rewards of stochastic games could be, in many instances, more critical than equilibrium rewards. To our knowledge, no methodology exists in the open literature that can capture the short-term behaviour of non-zero sum stochastic games as examined in this paper.

Geriatric patients with chronic schizophrenia are at increased risk for parkinsonism and cognitive impairment, but the relationship between the two has been insufficiently studied. (1) To determine the prevalence of parkinsonism in a cohort of institutionalized geriatric patients with chronic schizophrenia (N=79). (2) To examine the relationship of parkinsonism to potentially relevant variables including cognitive functioning, positive and negative symptoms, sex, age, age at first hospitalization, psychopharmacological regimen and tardive dyskinesia (TD). Tremor, rigidity and bradykinesia were rated on a five-point severity scale. Clinically significant parkinsonism was defined by the unambiguous presence of at least two of those signs. TD was assessed with the Modified Simpson Dyskinesia Scale. Schizophrenic symptoms were rated with the Positive and Negative Syndrome Scale, and cognitive functioning with the Mini-Mental State Examination and the Consortium to Establish a Registry for Alzheimer's Disease battery. The prevalence of parkinsonism was 19% and was significantly higher in women than in men. Age was a significant predictor of parkinsonism. Independent of age, bradykinesia was significantly correlated with MMSE, fluency and naming. Tremor, rigidity and medication status did not correlate with any cognitive variable assessed. Cognitive measures did not differ between subjects meeting and not meeting criteria for clinically significant parkinsonism. Rigidity and bradykinesia were significantly correlated with negative symptoms but no parkinsonism sign correlated with positive symptoms. Twelve subjects received ratings consistent with both TD and parkinsonism; however, no parkinsonian variable predicted the co-occurrence of TD. The present correlations suggest potential overlap among the neural substrates for bradykinesia, cognitive impairment and negative symptoms; however, further research is required to clarify that issue.

Background. Chronically hospitalized geriatric inpatients with schizophrenia are at particular risk for both tardive dyskinesia (TD) and cognitive impairment but have been insufficiently studied in this regard. Similarly, the relationship between TD and cognitive impairment has not been adequately addressed in this population. Objectives. (1) To determine the prevalence of TD in a cohort of chronically institutionalized schizophrenic geriatric inpatients. (2) To examine the relationship between the manifestations of TD in various body regions and several potentially related variables including current pharmacological regimen, age, age at first hospitalization and cognitive status. Method. TD was assessed by the Modified Simpson Dyskinesia Scale and cognitive status by the Mini-Mental State Examination (MMSE). The relationship between manifestations of TD and other variables was examined by t-tests, ANOVA, MANOVA and correlational analysis. Results. The prevalence of TD was 60%. Prevalence increased with age but was not related to current antipsychotic or anticholinergic regimen. Mean MMSE score did not differ between groups of patients with and without TD as defined by the criteria of Schooler and Kane (1982); however, the mean MMSE score was significantly (p<0·004) lower in subjects with orofacial TD as defined by Waddington and Youssef (1996), and the difference was not entirely accounted for by the older age of the latter group. Conclusions. TD and cognitive impairment both increase with age. However, TD alone does not account for the severity of cognitive impairment in this population. The present study provides further support for the hypothesis that the correlation between TD and cognitive impairment holds primarily for the orofacial manifestations of TD. © 1998 John Wiley & Sons, Ltd.