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International Psychogeriatrics
URL: /core/journals/international-psychogeriatrics
Published on behalf of International Psychogeriatric Association
Volume 23 - Issue 4 - May 2011
The misleading simplicity of advance directives
Cees M. P. M. Hertogh
The question of what constitutes a dignified old age has always been a topic of philosophical enquiry. Already in the writings of the stoic philosophers we can find relevant contributions to an ethic of "successful" aging. Seneca, for instance, reflects upon the pleasures of old age in several of his famous "Letters to Lucilius" (Seneca, 1967). However, he also writes about the bad years that may lie ahead and confides to his pupil: "Do not hear me with reluctance as if my statement applied directly to you, but weigh what I have to say. It is this. I shall not abandon old age, if old age preserves me intact for myself, and intact as regards to the better part of myself; but if old age begins to shatter my mind, and pull its various faculties to pieces, if it leaves me, not life, but only the breath of life, I shall rush out of a house that is crumbling and tottering . . ."
Cognitive function and risk for depression in old age: a meta-analysis of published literature
Chang-Quan Huang, Zheng-Rong Wang, Yong-Hong Li, Yi-Zhou Xie, Qing-Xiu Liu
Background: We assessed the relationship between cognitive impairment (including mild cognitive impairment with no signs of dementia, and dementia) and risk for depression in old age (60 years and older).
Methods: MEDLINE, EMBASE and the Cochrane Library database were used to identify potential studies. All of the clinical studies that produced data on the association between cognitive function and risk of depression among individuals aged 55 years or older were identified and included in this review. The studies were classified into cross-sectional and longitudinal subsets. The quantitative meta-analysis of cross-sectional and longitudinal studies were performed. For prevalence and incidence rates of depression, odds risk (OR) and relative risk (RR) were calculated, respectively.
Results: Since all but two studies found in the search were for individuals aged 60 years or over, we assessed and reported on results for this larger group only. In this review we included 13 cross-sectional and four prospective longitudinal studies. The quantitative meta-analysis showed that, in old age, individuals with non-dementia cognitive impairment had neither significant higher prevalence nor incidence rates of depression than those without (odds risk (OR): 1.48, 95% confidence intervals (95% CI): 0.87–2.52; relative risk (RR): 1.12, 95% CI: 0.62–2.01). In old age, individuals with dementia had both significant higher prevalence and incidence rates of depression than those without (OR: 1.82, 95% CI: 1.15–2.89; RR: 3.92, 95% CI: 1.93–7.99).
Conclusions: Despite the methodological limitations of this meta-analysis, we found that in old age, there was no association between depression and cognitive impairment with no dementia; however, there was a definite association between depression and dementia and thus dementia might be a risk for depression.
A review of the effectiveness of memory interventions in mild cognitive impairment (MCI)
Joshua Stott, Aimee Spector
Background: Mild cognitive impairment (MCI) is commonly associated with memory impairment. There have been a number of studies attempting to ameliorate this through memory interventions including memory rehabilitation and training. The current paper reviews the evidence for the effectiveness of such interventions in enhancing learning of specific information, their impact on untrained material, compensation for memory impairment and improving everyday functioning.
Methods: The literature was systematically searched for studies focusing on interventions targeting memory impairment in MCI using relevant search terms. Studies were screened for inclusion or exclusion using a priori criteria and, once identified, studies were examined for quality using pre-specified criteria.
Results: A total of 226 studies were identified in the search, ten of which were included in the final review. Only one study was an RCT of "adequate" methodology. It was tentatively suggested that people with MCI can learn specific information, although there was little evidence to suggest that memory training can generalize. There was some limited evidence of ability to learn to compensate for memory difficulties and contradictory findings regarding improvement in everyday life.
Conclusions: The poor methodological quality of the included studies implies that the ability to draw conclusions is limited. MCI is a controversial concept and there is a need for good quality trials examining the efficacy of memory interventions. There are some indications that memory impairment in MCI might best be targeted by interventions developing compensatory strategies and targeting the learning of specific information relevant to the individual.
Discontinuing cholinesterase inhibitors: results of a survey of Canadian dementia experts
Nathan Herrmann, Sandra E. Black, Abby Li, Krista L. Lanctôt
Background: Cholinesterase inhibitors (ChEIs) are being used for increasingly long periods of time, even in patients with severe Alzheimer's disease. Because there is little data to help clinicians to decide on when it is safe and appropriate to discontinue ChEIs after long-term use, practices may vary widely.
Methods: An internet-based survey was undertaken of Canadian dementia experts (geriatric psychiatrists, neurologists, geriatricians) involved in clinical trial research. Recommendations for ChEI discontinuation were determined based on responses to questions dealing with patient/caregiver preference, administrative considerations, effectiveness, and adverse events.
Results: There was reasonable consensus that ChEIs should be discontinued based on patient and caregiver preference, and in the presence of severe bothersome adverse events. There was much less consensus on issues related to effectiveness – in particular, what constitutes greater than expected decline. There was a general reluctance to rely on any single measure of cognition, function and/or behavior, and in particular, the MMSE was seen as unhelpful for making decisions about discontinuation.
Conclusion: Recommendations for discontinuing ChEIs after long-term use from a survey of dementia experts are presented. Ideally, clinical practice guidelines based on controlled discontinuation trials are needed.
Kana Pick-out Test and brain perfusion imaging in Alzheimer's disease
Yuki Kishimoto, Seishi Terada, Shuhei Sato, Naoya Takeda, Hajime Honda, Osamu Yokota, Yosuke Uchitomi
Background: The Kana Pick-out Test (KPT), which was developed in Japan, is suitable for evaluating frontal lobe function and screening for mild dementia. However, the neural substrates involved remain to be elucidated. The aim of the present study was to identify the regional perfusion patterns in the brain associated with performance scores on the KPT in patients with mild Alzheimer's disease (AD), using brain perfusion assessed by single photon emission computed tomography (SPECT).
Methods: Twenty AD patients with high scores on the KPT and 20 age- and sex-matched AD patients with low scores were selected from 227 consecutive Japanese patients of the Memory Clinic of Okayama University Hospital. All 40 subjects underwent brain SPECT with 99mTc-ethylcysteinate dimer, and the SPECT images were analyzed by Statistical Parametric Mapping.
Results: With the exception of KPT scores, no significant differences were found between high and low scoring groups with respect to Addenbrooke's Cognitive Examination scores, Mini-mental State Examination scores, or the depression score of the Neuropsychiatric Inventory subscale. Compared to patients with high scores on the KPT, AD patients with low scores on the KPT showed significant hypoperfusion in the left subgenual cingulate gyrus (SGC) extending to the right SGC.
Conclusions: Our results suggest that functional activity of the SGC is closely related to scores on the KPT. KPT might be a promising strategy to use in detecting early stages of AD with low SGC function.
Clinical and economic characteristics associated with direct costs of Alzheimer's, frontotemporal and vascular dementia in Argentina
Galeno Rojas, Leonardo Bartoloni, Carol Dillon, Cecilia M. Serrano, Monica Iturry, Ricardo F. Allegri
Published online by Cambridge University Press: 03 November 2010, pp. 554-561
Background: The economic cost of dementia is high and can be predicted by cognitive and neuropsychiatric profiles. The differential costs of the various subtypes of dementia are unknown in Argentina, and this study therefore aimed to compare these costs.
Methods: Patients with a diagnosis of dementia of Alzheimer-type (DAT), frontotemporal dementia (FTD) and vascular dementia (VaD), and their primary caregivers, were evaluated between 2002 and 2008.
Results: 104 patients with dementia (DAT = 44, FTD = 34, VaD = 26) were screened and matched by age and educational level with 29 healthy subjects. Demographic variables showed no significant differences among dementia patients. The annual direct costs were US$4625 for DAT, US$4924 for FTD, and US$5112 for VaD (p > 0.05 between groups). In the post hoc analysis VaD showed higher hospitalization costs than DAT (p < 0.001). VaD exhibited lower medication costs than FTD (p < 0.001). DAT exhibited higher anti-dementia drug costs; FTD had higher psychotropic costs. In the multivariate analysis, depression, activities of daily living, and caregiver burden were correlated with direct costs (r2 = 0.76).
Conclusions: The different dementia types have different costs. Overall, costs increased with the presence of behavioral symptoms, depression and functional impairment of activities of daily living.
Predictors of subjective and objective caregiving burden in older female caregivers of adults with intellectual disabilities
Yueh-Ching Chou, Li-yeh Fu, Li-Chan Lin, Yue-Chune Lee
Background: Informal, unpaid, and lifelong older caregivers of adults with intellectual disabilities (ID) are usually female and most often are mothers of adults with ID. However, research exploring different predictors of subjective and objective burden among these older female caregivers is sparse. The objective of this study was to examine whether the subjective and objective burden as well as positive appraisals are predicted by the same or different variables linked to the caregivers and the adults with ID.
Methods: Face-to-face interview questionnaires were administered in a city in Taiwan in 2006–2007 and 350 female family caregivers aged 55 years and older completed the interview in their homes. The independent variables included adult care demands and caregiver variables, while the dependent variables were caregivers' subjective burden, caregivers' objective burden and caregivers' positive appraisals.
Results: The results demonstrated that adult care demands were associated more with the objective than the subjective caregiving burden. The strongest predictors of both subjective and objective burden were the care recipient's instrumental activities of daily living functionality, caregiver's age, and caregiver's health status. The significant predictors for positive caregiving appraisals were the caregiver's age and the caregiver's level of social support.
Conclusions: The results indicate that both the subjective and objective burdens were mostly related to the same factors, that is, to the characteristics of the older female caregivers and the recipients of care with ID. On the other hand, positive attitudes towards caregiving roles were only associated with caregiver variables.
Motives for caring: relationship to stress and coping dimensions
R. Romero-Moreno, M. Márquez-González, A. Losada, J. López
Background: Although research has highlighted the importance of including cultural factors in the analysis of caregiver stress, little is known about the effects of motives for caregiving on the stress and coping process. This study is aimed at analyzing the dimensional structure of the Cultural Justifications for Caregiving Scale – Revised (CJCS-R), and the effects of motives for caregiving on stressors, caregiver resources and outcome variables.
Methods: Dementia caregivers (N = 166) were interviewed and the following variables were assessed: motives for caregiving (CJCS-R), stressors (frequency of behavioral problems), resources (rumination, cognitive reappraisal), and outcomes (depression, anxiety and anger).
Results: A bidimensional structure was obtained for the CJCS-R, and the two factors were labeled Intrinsic and Extrinsic motives for caregiving. Participants were divided into four groups corresponding to four motivation profiles: HIHE = High Intrinsic Motives + High Extrinsic motives; LILE = Low Intrinsic Motives + Low Extrinsic Motives; HILE = High Intrinsic Motives + Low Extrinsic Motives; and LIHE = Low Intrinsic Motives + High Extrinsic Motives. No differences between groups were found in frequency of behavioral problems. Caregivers in the LIHE group had significantly worse consequences on caregiver resources and outcome variables compared to the other groups.
Conclusions: The results support the usefulness of considering motives for caregiving as a multidimensional construct. Analyzing caregivers' motivation profiles may constitute a useful strategy for identifying caregivers at risk. Caregivers scoring simultaneously low on intrinsic motives and high on extrinsic motives may be at particular risk for negative caregiving outcomes.
The age-prospective memory-paradox: an exploration of possible mechanisms
Katharina M. Schnitzspahn, Andreas Ihle, Julie D. Henry, Peter G. Rendell, Matthias Kliegel
Background: The age-prospective memory-paradox describes the general pattern of age-related deficits in laboratory-based prospective memory tasks and age-related benefits in naturalistic tasks that are carried out in participants' everyday lives. However, the mechanisms which are critical in determining the direction of age effects remain poorly delineated.
Method: Twenty young and 20 old adults performed a laboratory and a naturalistic prospective memory task, which were similar in structure and demand. Several factors highlighted in recent theoretical models as potentially important to understanding the paradox (motivation, metacognitive awareness, activity absorption, control over the task) were assessed and their contribution to the age paradox empirically explored.
Results: First, analyzing mean level age differences, the paradox was confirmed. Second, exploring possible correlates of the paradox revealed that, while low levels of daily activity absorption, high motivation and good metacognitive awareness were associated with age benefits in prospective memory performance in the naturalistic task, high ongoing activity absorption and low control over the prospective memory cue seem important for understanding age deficits in lab-based tasks.
Conclusion: The current study confirms the age-prospective memory-paradox within one sample and with carefully matched laboratory and naturalistic tasks. Additionally, it takes an important step forward in clarifying the role of different factors in understanding age effects across these different contexts. The results indicate that the relative importance of different factors vary as a function of assessment context, with conceptual as well as applied implications.
Validation of the Literacy Independent Cognitive Assessment
Seong Hye Choi, Yong S. Shim, Seung-Ho Ryu, Hui Jin Ryu, Dong Woo Lee, Jun-Young Lee, Jee H. Jeong, Seol-Heui Han
Background: Low education and illiteracy are associated with an increased risk of dementia. This study aimed to develop a neuropsychological test battery applicable to both illiterate and literate elderly and to assess its reliability and validity for a diagnosis of dementia.
Methods: We developed the Literacy Independent Cognitive Assessment (LICA), which consists of 13 subtests assessing memory, language, visuoconstruction, executive function, attention and calculation. We investigated its reliability and validity on 152 patients with dementia, 66 with mild cognitive impairment and 639 normal controls.
Results: The subtests were found to be applicable to most of the illiterate normal controls (97.3%) and were found to have high inter-rater reliabilities (r = 0.85–1.00, p < 0.001) and moderate to high test-retest reliabilities (r = 0.50–0.86, p < 0.001). The LICA performed well in discriminating participants across Clinical Dementia Rating stages and showed excellent internal consistency and good concurrent validity with the Korean Mini-mental State Examination in both literate and illiterate participants. The area under the curve of the receiver operating characteristic was 0.985 in each of the two literacy groups. Sensitivity and specificity of the LICA to make a diagnosis of dementia was 91.9% and 91.8% at the cutoff point of 186.0 in the literate subjects and 96.2% and 91.1% at the cutoff point of 154.5 in the illiterate subjects. The battery was factored into two separate factors consisting of verbal memory tests and tests for other cognitive domains.
Conclusion: The LICA is a valid and reliable instrument for a diagnosis of dementia in both illiterate and literate elderly.
Use of nurse-observed symptoms of delirium in long-term care: effects on prevalence and outcomes of delirium
Jane McCusker, Martin G. Cole, Philippe Voyer, Johanne Monette, Nathalie Champoux, Antonio Ciampi, Minh Vu, Eric Belzile
Background: Previous studies have reported that nurse detection of delirium has low sensitivity compared to a research diagnosis. As yet, no study has examined the use of nurse-observed delirium symptoms combined with research-observed delirium symptoms to diagnose delirium. Our specific aims were: (1) to describe the effect of using nurse-observed symptoms on the prevalence of delirium symptoms and diagnoses in long-term care (LTC) facilities, and (2) to compare the predictive validity of delirium diagnoses based on the use of research-observed symptoms alone with those based on research-observed and nurse-observed symptoms.
Methods: Residents aged 65 years and over of seven LTC facilities were recruited into a prospective study. Using the Confusion Assessment Method (CAM), research assistants (RAs) interviewed residents and nurses to assess delirium symptoms. Delirium symptoms were also abstracted independently from nursing notes. Outcomes measured at five month follow-up were: death, the Hierarchic Dementia Scale (HDS), the Barthel ADL scale, and a composite outcome measure (death, or a 10-point decline in either the HDS or the ADL score).
Results: The prevalence of delirium among 235 LTC residents increased from 14.0% (using research-observed symptoms only) to 24.7% (using research- and nurse-observed symptoms). The relative risks (and 95% confidence intervals) for prediction of the composite outcome, after adjustment for covariates, were: 1.43 (0.88, 1.96) for delirium using research-observed symptoms only; 1.77 (1.13, 2.28) for delirium using research- and nurse-observed symptoms, in comparison with no delirium.
Conclusions: The inclusion of delirium symptoms observed by nurses not only increases the detection of delirium in LTC facilities but improves the prediction of outcomes.
The relationship between worthlessness and mortality in a large cohort of Chinese elderly men
Samuel Y. Wong, Jason C. Leung, Jean Woo
Background: This study explored the relationship between "worthlessness" and all cause non-suicide mortality in Chinese elderly men.
Methods: Data from interviews of 1999 men aged 65 years and over were collected. Clinically significant depressive symptoms were measured using the validated Chinese version of Geriatric Depression Scale. "Worthlessness" was defined by one of the 15 questions from the Geriatric Depression Scale with a yes/no response. All-cause mortality over six years was collected using data from the National Death Registry with adjudication by 4-monthly telephone interviews. Two men were excluded after suicide death.
Results: Age-adjusted mortality rates at five years were 44.3 and 23.9 per 1,000 person years for those who felt "worthless" and those did not, respectively. The adjusted relative risk for all-cause mortality associated with feeling worthless was 1.34 (95% CI: 1.02–1.76) after adjusting for potential confounders that included age, marital status, education, smoking, alcohol consumption, number of chronic diseases, self-rated health, body mass index, cognitive status, physical activity, occupation and maximum lifetime income. There was no statistically significant association between other depressive symptoms or overall depression and mortality.
Conclusion: Worthlessness may be independently associated with all-cause mortality in Chinese elderly men.
Multimorbidity and its relation to subjective memory complaints in a large general population of older adults
S. Aarts, M. van den Akker, K. J. Hajema, A. M. van Ingen, J. F. M. Metsemakers, F. R. J. Verhey, M. P. J. van Boxtel
Background: Multimorbidity has been suggested to be associated with a variety of negative health-related outcomes. The present study was designed to evaluate the association between multimorbidity and subjective memory complaints.
Methods: This cross-sectional study was based on data obtained from a postal survey designed by the Public Health Service (Gemeentelijke Gezondheids Dienst, GGD) involving 15,188 persons aged 55 years and over living independently in Limburg, the Netherlands. Multivariate logistic regression analyses, adjusted for potentially important covariates, were performed to evaluate the association between self-reported multimorbidity and three outcomes related to subjective memory complaints.
Results: Multimorbidity was indeed related to subjective memory complaints. The association between multimorbidity and subjective memory complaints was positively influenced by age. Moreover, multimorbidity was related to the degree of worrying about memory complaints in people who perceived themselves as forgetful. Multimorbidity was also associated with reporting a larger increase in these subjective memory complaints during the past year. In this latter case, multimorbidity had more prognostic capability in men than in women. Psychological distress was related to all three subjective memory-related outcome measures.
Conclusions: In our sample, which was representative of the Dutch population, multimorbidity was associated with subjective memory complaints. The relationship between multimorbidity and subjective memory complaints differed between men and women and between age groups.
Social engagement and depressive symptoms of elderly residents with dementia: a cross-sectional study of 37 long-term care units
Adriana P. A. van Beek, Dinnus H. M. Frijters, Cordula Wagner, Peter P. Groenewegen, Miel W. Ribbe
Background: Social engagement and depression are important outcomes for residents with dementia in long-term care. However, it is still largely unclear which differences in social engagement and depression exist in residents of various long-term care settings and how these differences may be explained. This study investigated the relationship between social engagement and depressive symptoms in long-term care dementia units, and studied whether differences in social engagement and depressive symptoms between units can be ascribed to the composition of the resident population or to differences in type of care setting.
Methods: Thirty-seven long-term care units for residents with dementia in nursing- and residential homes in the Netherlands participated in the study. Social engagement and depressive symptoms were measured for 502 residents with the Minimum Data Set of the Resident Assessment Instrument. Results were analyzed using multilevel analysis.
Results: Residents of psychogeriatric units in nursing homes experienced low social engagement. Depressive symptoms were most often found in residents of psychogeriatric units in residential homes. Multilevel analyses showed that social engagement and depressive symptoms correlated moderately on the level of the units. This correlation disappeared when the characteristics of residents were taken into account.
Conclusions: Social engagement and depressive symptoms are influenced not only by individual characteristics but also by the type of care setting in which residents live. However, in this study social engagement and depressive symptoms were not strongly related to each other, implying that separate interventions are needed to improve both outcomes.
Detection of depression in older adults by family and friends: distinguishing mood disorder signals from the noise of personality and everyday life
Paul R. Duberstein, Yan Ma, Benjamin P. Chapman, Yeates Conwell, Joanne McGriff, James C. Coyne, Nathan Franus, Marnin J. Heisel, Kimberly A. Kaukeinen, Silvia Sörensen, Xin M. Tu, Jeffrey M. Lyness
Background: The capacity of friends and family member informants to make judgments about the presence of a mood disorder history in an older primary care patient has theoretical, clinical, and public health significance. This study examined the accuracy of informant-reported mood disorder diagnoses in a sample of primary care patients aged 65 years or older. We hypothesized that the accuracy (sensitivity and specificity) of informant reports would vary with the patient's personality.
Methods: Hypotheses were tested in 191 dyads consisting of patients and their friends or relatives (informants) recruited from primary care settings. Gold-standard mood disorder diagnoses were established at consensus conferences based on a review of medical charts and data collected in a structured interview with the patient. Patients completed an assessment battery that included the NEO-Five Factor Inventory.
Results: Sensitivity and specificity of informant-derived mood disorder diagnoses were related to patient personality. Sensitivity of informant-derived lifetime mood disorder diagnoses was compromised by higher Extraversion and higher Agreeableness. Specificity of informant-derived lifetime mood disorder diagnoses was compromised by lower Agreeableness and higher Conscientiousness.
Conclusion: Patient personality has implications for the accuracy of mood disorder histories provided by friends and family members. Given that false negatives can have grave consequences, we recommend that practitioners be particularly vigilant when interpreting collateral information about their extraverted, agreeable patients.
The immunhistochemical examination of GABAergic interneuron markers in the dorsolateral prefrontal cortex of patients with late-life depression
Ahmad Khundakar, Christopher Morris, Alan J. Thomas
Background: The "vascular depression" hypothesis has sought to explain differences in etiology between early and late life depression, and has been reinforced by recent imaging and morphometric studies. Gamma-aminobutyric acid (GABA) is thought to play a major role in the neurobiology of depression. However, it is unclear whether there is an effect on GABA neuronal subpopulations in an elderly depressed cohort. This study therefore examined immunohistochemically two calcium-binding proteins, calretinin and parvalbumin, which have been demonstrated to bind to two distinct GABAergic interneuron subpopulations, within the dorsolateral prefrontal cortex (DLPFC) of elderly depressed patients, against age-matched controls.
Methods: Post-mortem tissue was obtained from nine controls and 11 depressed patients for the parvalbumin study and seven controls and 14 depressed patients in the calretinin study, and the mean percentage per area of immunohistochemical staining of the two antibodies was measured in individual layers and across the whole of the DLPFC.
Results: The study found a reduction in parvalbumin immunostaining in layer 6 (p = 0.05) of the DLFPC in elderly depressed patients. However, no significant changes were found in parvalbumin or calretinin immunostaining in the any other layer of the DLPFC in elderly depressed patients.
Conclusion: The study does not suggest any change in GABA interneuron subpopulations, though significant reductions in layer 6 may represent subtle disturbance in GABA parvalbumin-expressing interneuron and glumatatergic pyramidal projection neuron regulation in late-life depression.
Post-traumatic stress symptoms linked to hidden Holocaust trauma among adult Finnish evacuees separated from their parents as children in World War II, 1939–1945: a case-control study
Pentti Andersson
Background: The aim of this study was to identify long-term effects of diagnostic criteria on the Post Traumatic Stress Disorder Checklist (PCL-C) for a test group of Finnish evacuees from World War II and compare the outcome effect with a control group of children who lived in Finland during the war in 1939–1945.
Methods: 152 participants were recruited by the local leader of the Finnish War Child Association in Sweden and Finland. The selected group answered questions on the Post Traumatic Stress Disorder Checklist (PCL-C) and the EMBU (Swedish acronym for "Own Memories of Parental Rearing").
Results: Evidence suggests a link between childhood parental separation and termination of the internalized attachment hierarchy of origin in a detachment process among Finnish evacuees. Based on the Post Traumatic Stress Disorder Total (PCL-C) diagnosis an extreme traumatization for 36.7% of the test group subjects was identified, including a hidden Holocaust trauma in the population of Finnish evacuees.
Conclusions: The study met the criteria for satisfying global evidence value. Sixty-five years after the end of World War II and in line with other studies on war children, the data show high levels of different trauma exposures from the war with 10.6 higher risk (odds ratio) for the exposed group of Finnish evacuees. Despite some limitations, the data highlight the need for further investigation into different parts of the detachment process among seriously traumatized groups to reveal resilience and other dimensions of importance in professional mental health creation.
Psychotherapy of an older adult with an avoidant personality disorder
S. P. J. van Alphen
This case describes the differential diagnosis and treatment of a 70-year-old man with an avoidant personality disorder. It illustrates that diagnostic assessment and treatment of personality problems in the elderly are possible in mental health care. It demonstrates that multiple stand-alone treatment modules can form part of a single course of adaptation-focused treatment of personality disorders. An interpersonal approach forms an important basis for tackling the typical interpersonal difficulties that occur in axis-II disorders.
A late form of neurosyphilis manifesting with psychotic symptoms in old age and good response to ceftriaxone therapy
Erdem Güler, Thomas Leyhe
Neurosyphilis can present with psychiatric symptoms. The late form can occur in old age with psychosis, paranoid delusions, affective disorders or cognitive impairment. Here we present a case of neurosyphilis in an elderly woman who, over six months, progressively manifested personality changes and paranoid delusions which were initially suspected as Alzheimer's disease. Psychotic symptoms showed a good response to antibiotic treatment. We conclude that neurosyphilis is a relevant differential diagnosis in patients developing severe psychiatric symptoms in old age. As a causal antibiotic treatment is possible this infectious disease should be considered seriously in gerontopsychiatric patients.
Are late-onset eating disorders in the elderly really the more common variant? Concerns around publication bias
James Main, Leena Reddy, Maja Lazarevic, Paul J. Whelan
Lapid et al. (2010) provide a fascinating insight into the much over-looked problem of eating disorders (EDs) in older adults and highlight the fact that an ED is often not considered in our differential when assessing elderly patients.


On May 18, 2012, the AAC meeting agreed to begin a new OWLSnet planning process. The previous plan covered the years 2007 through 2010. However, work on a new plan was delayed until the NFLS Board and OWLS Board completed a new Automation Services Agreement and new OWLSnet membership agreements were in place.
For information about the previous planning process, view the OWLSnet Plan: 2007-2010.


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Idiom ∕ Trends
See also: court ruling investigation
"justice" in the news
Example collocations
Trump obstructed justice
brought to justice
justice minister
obstruct justice
Publications and example sentences
Susan Collins, R-Maine, is still facing backlash from Democrats for her 2018 vote to confirm Justice Brett Kavanaugh to the Supreme Court.
Her father Victor Olabode vowed the family would "fight for justice".
After retiring from soccer Sukur went into politics, winning a seat in Turkey's parliament as a member of President Recep Tayyip Erdogan's right-wing Justice and Development Party in 2011.
Justice Minister Masako Mori said Sunday she has ordered an investigation after Ghosn issued a statement saying he was in Lebanon.
TOKYO (AP) -- Japan's justice minister says the flight of former Nissan Chairman Carlos Ghosn as he awaited trial on financial misconduct charges was inexcusable and vowed to beef up immigration checks.
The justice system is still stacked against women
That decision came after several high-profile miscarriages of justice, including a case where a mother was sent to a labour camp after demanding justice for her daughter who had been raped.
The most recent example of this comes from Poland, where the country's Supreme Court had to warn the governing Law and Justice party that its proposed judicial reforms could violate European law so blatantly that it might be booted out of the EU.
That is a founding principle for crucial projects such as the single market or justice.
If I were Alisson I'd certainly be tempted to call the trainers on, for the sake of poetic justice if nothing else.
Justice Minister vows greater freedoms through new Human Rights Action Plan
In late March or early April, the justices will hear a trio of cases—two involving the House of Representatives, one a prosecutor in New York—on subpoenas of Mr Trump's financial documents from his banks and accounting firm.
Youth climate activists also pushed for a global strike on the conference's final official day, protesting that human rights and social justice had been sidelined.
The Lib Dems have the most radical approach to crime and justice
Shall any man be above Justice?
Ms Jones' family said their daughter, from Stratford-upon-Avon in Warwickshire, had a "great passion" for supporting victims of criminal justice.
The charity Action for Children said the new provisions would ensure children were treated as children within the justice system.
Justice Simon Moore ordered that the suppression order which prevents naming the defendant would remain in place indefinitely until lifted by the court.
Israel's attorney general has charged Prime Minister Benjamin Netanyahu with bribery, fraud and breach of trust in three cases, the justice ministry says.
France Elodie Kulik murder trial after 17-year fight for justice
The justices are considering whether the Trump administration can shut down a program that shields about 700,000 young immigrants from deportation.
This is a step also concerning social justice.
It was just one of countless acts of violence by dog owners who decide to take justice in their own hands against a crime that has been occurring all over Vietnam for years.
Altun underlined Turkey's unquestionable determination to bring justice to those who seek to terrorize the region.
"It is essential that we follow all lines of inquiry and bring those responsible for these tragic events to justice," he said, while urging anyone with knowledge of the pair to get in touch with police.
"This doesn't feel like justice yet," she said.
SHARYA CAMP, Iraq (Reuters) - Islamic State leader Abu Bakr al-Baghdadi's death will mean nothing to 19-year-old rape victim Jamila unless the Islamic State militants who enslaved her are brought to justice.
"Last night, the United States brought the world's No. 1 terrorist leader to justice," the president said in a national address from the White House.
Social justice marketing is grand for the hoop audience in the United States but looks far less attractive to an authoritarian power in Beijing.
"Last night the United States brought the world's No.1 terrorist leader to justice," Trump said in extended remarks describing the raid.
The US justice department has launched a criminal investigation into the origins of the Mueller inquiry, US media report.
South Korean authorities arrested the wife of a former justice minister on Thursday who was at the center of a graft scandal and was a close political confidant of President ...
"We are standing in solidarity with campaigners across the United States... for justice and freedom for LGBT people.
Spokespeople for the Muslim Brotherhood and the Freedom and Justice Party described Morsi's death as "premeditated murder" and an "assassination.
We must have justice.
Ivan Zhdanov, the director of Alexey Navalny's Anti-Corruption Foundation (FBK), says a donation from Spain was made deliberately to give Russia's Justice Ministry an excuse to list his organization as a "foreign agent.
Turkey has carried out a principled process for the sake of justice while others were trying to serve their own benefits, the country's ruling Justice and Development Party (AKP) said on Oct. 2.
Turkey works to serve cause of justice: AKP spokesperson
How can justice flow in the Northern Territory when Aboriginal lives are treated with callous indifference?
He also said Turkey continues to seek justice for murdered Saudi journalist Jamal Khashoggi and Mohammad Morsi, Egypt's first democratically elected prime minister.
"Until all coup plotters are brought to justice, we will not quit going after them," said the president.
Now I'm not saying that the sledgehammer of eternal justice (Ian Ronald Bell) is in the same class as old Stevie but in 2013 He did look a cut above.
Justice Minister Yoko Kamikawa confirmed that the six Aum Shinrikyo cult members remaining on death row had been executed on July 26.
A 21-year-old man, from Loughton, has been arrested on suspicion of death by dangerous driving, causing serious injury by dangerous driving and perverting the course of justice.
The violent episode stopped the city in its tracks, prompting urgent reviews in the state government's health and justice portfolios.
The victims deserve justice and they will get it," Barr said.
The justice department and the FBI have both launched investigations into his death in New York, amid questions surrounding the circumstances.
"We would have preferred he lived to face justice.
Epstein's Victims Still Want Justice Despite His Apparent Suicide In Jail
"We need to know that they got this person and that there's justice.
The rapper, who has become an outspoken advocate for criminal justice reform, claimed a legal victory after a Pennsylvania appeals court ruled in his favor on Wednesday.
Turkey's intelligence agency and Foreign Ministry have been working hard on the issue, ruling Justice and Development Party (AKP) spokesperson Ömer Çelik told reporters.
Turkey's former Deputy Prime Minister Ali Babacan on July 8 announced that he was resigning from the ruling Justice and Development Party (AKP).
Despite their grief, we hope this will help them find some closure and justice for Mackenzie.
People were protesting the country's prime minister, Andrej Babiš, and his justice minister.
The 5-4 vote on Thursday saw justices divided along ideological lines, with the court's conservative majority penning the opinion.
Güven also said that ruling Justice and Development Party (AKP) candidate Binali Yıldırım received 44.99 percent of the votes.
Erdoğan also on vowed to pursue justice for this sudden and unexplained death.
Ms Hood denies perverting the course of justice.
It wasn't until she saw Perugia prosecutor Giuliano Mignini in the Netflix documentary that she truly understood his "genuine and noble motivation" to find justice for Kercher.
Amanda Knox breaks down in tears as she tells a criminal justice festival in Italy that she is afraid of further accusations despite being cleared of killing British student Meredith Kercher
Speaking to reporters at the Turkish embassy residence, Justice Minister Abdulhamit Gül said given international conventions and agreements the U.S. and Turkey have signed, some steps should have been taken by now.
"We talked about justice, the law and democracy," she added.
Sarawut Benjakul, secretary-general of the Courts of Justice, has also asked the judge in question, Krairat Veerapattanasuwan, for an explanation of his actions.
The ruling Justice and Development Party (AKP) of President Recep Tayyip Erdogan last month lost the mayorship of Turkey's biggest city by a narrow margin, but Mr Erdogan refused to accept defeat.
The Justice and Development Party (AKP) and the Nationalist Movement Party (MHP) had appealed for the annulment of the Istanbul polls due to alleged irregularities. A recount confirmed İmamoğlu still was ahead of AKP's Binali Yıldırım.
"To AJ's family: It is my hope that you may have some solace in knowing that AJ is no longer suffering and his killers have been brought to justice," Black said.
Out of the nine people initially detained in connection with the attack, only one, Osman Sarıgün, a member of the Justice and Development Party (AKP); remains in custody.
Turkey's Supreme Election Board (YSK) has declined a request from the ruling Justice and Development Party (AKP) to disenfranchise civil servants who were dismissed with decree laws in the wake of the July 2016 coup attempt.
Both Justice and Development Party (AKP) and Nationalist Movement Party (MHP) officials had lashed out at the CHP and its leader for engaging with the Peoples' Democratic Party (HDP), a party they regard as the political wing of the PKK.
Speaking after Friday prayers in Istanbul, Erdoğan said the elections were over but the legal process was ongoing due to his ruling Justice and Development Party's (AKP) objections to the vote counts.
Turkey's ruling Justice and Development Party (AKP) said early on April 2 it plans to ask the Supreme Election Council (YSK) to resolve a dispute over invalid votes in mayoral elections for Istanbul and Ankara.
He criticized poverty in Istanbul and said this picture cannot be a display of "social justice.
Nine federal departments and agencies are affected by the shutdown, including Agriculture, Commerce, Justice, Homeland Security, Housing and Urban Development, Interior, State, Transportation and the Treasury.
Justice Minister Takashi Yamashita announces the executions of two death row inmates at a news conference Thursday at his ministry in Tokyo.
Social justice news.
The role of evangelical Christianity in American politics has been a hotly discussed topic this year, intersecting with front-burner issues like immigration, the Supreme Court and social justice.
"Difficult to do it justice with just four photos, however the Moscow Metro is something else – visually breathtaking.
"What are you talking about by asking for his release? There is justice in this country. Fifty-three of our brothers were killed by them," he said, vowing that justice will be served.

redpajama_set_name: RedPajamaCommonCrawl


What's going on with the treasurer's race?
Equal opportunity at the county?
The commission voted two to one to grant SCDC $25,000. Both Sweet and Cribbins say they have faith in the agency's "new direction" and are confident it will produce results.
Does this story remind you of a former Coos County commissioner?
Sweet is resolute in his decision to ignore the NDAA and the citizens of Coos County who have taken the time to speak.


Want to travel somewhere your money can go twice as far? Look no further than Sofia, Bulgaria! With Wizz Air offering cheap flights, and apartments on Airbnb ranging from 30-60 dollars per night, you can definitely make the most of your trip.
In addition to cheap flights and accommodations, there are numerous free walking tours around Sofia! We participated in Balkan Bites, the first free food tour offered in Europe. Our guide led us to six establishments, each providing a different delicious bite. While tasting we learned how Bulgarian cuisine is a fusion of flavors, formed through the invasion of the Greek, Scythian, Roman, Byzantine and Ottoman empires. The food tour was an enlightening way to explore the culture and cuisine. Other notable free tours include the Free Sofia Tour, which guides you through the major sites and history of Sofia, and the Bohemian Sofia Tour that highlights the years under the Bulgarian Monarchy.
Another tour I highly recommend is the New Sofia Pub Crawl. While it isn't free, it is the perfect introduction to Sofia's vibrant nightlife. Our guides took us to the best spots in the city, many of which we would never have found on our own. Speakeasies and hidden bars with no signage are prominent in Sofia. Homes that once provided comfort to families, are now turned into cozy bars that feel as if you are hanging in an artist's loft. Each place had a different vibe and something interesting to entertain. This wasn't just your average bar crawl; it was informative, stimulating and gave insight to Sofia's youth culture.
If tours aren't your thing, there is plenty to discover on your own. From admiring the architecture of the Alexander Nevsky Cathedral, to browsing at the Zhenski Pazar (Women's Market), or hiking in the Vitosha Mountain, there is much to explore.
The 48 hours I spent in Sofia wasn't enough. I loved the eclectic and artistic energy of this city. With street art and graffiti tags sprayed across every slab of concrete, you can palpate Sofia's complex past and visualize the bright, creative future ahead. Don't wait too long; visit this gem before it becomes a mainstream destination.
That photo with the sunset is gorgeous! You already know how much I love Eastern Europe, so it's a given that Sofia is high on my list of places to explore. Hoping to wrap up a visit to all of the Balkan countries within the next few years and will definitely refer to your guide when I make it to Bulgaria.
Thank you! It was a really cool place to check out! I really wanted to check out more of the country but didn't have time.
Great insight into some free local stuff and what to expect price-wise for accommodation! Looks amazing, and the pub crawl is def something I would love to check out!
The pub crawl was so much fun! The bars were definitely places I wouldn't have found on my own! Glad you found the article insightful!
Your photos are great and I just added Sophia to my list of places to explore!


text:
Silver nanoparticles may adversely affect environment
by Duke University
This shows mesocosms. Credit: Benjamin Colman
In experiments mimicking a natural environment, Duke University researchers have demonstrated that the silver nanoparticles used in many consumer products can have an adverse effect on plants and microorganisms.
Fifty days after scientists applied a single low dose of silver nanoparticles, the experimental environments produced about a third less biomass in some plants and microbes.
These preliminary findings are important, the researchers said, because little is known about the environmental effects of silver nanoparticles, which are found in textiles, clothing, children's toys and pacifiers, disinfectants and toothpaste.
"No one really knows what the effects of these particles are in the environment," said Benjamin Colman, a post-doctoral fellow in Duke's biology department and a member of the Center for the Environmental Implications of Nanotechnology (CEINT).
"We're trying to come up with the data that can be used to help regulators determine the risks to the environment from silver nanoparticle exposures," Colman said. CEINT's research is funded by the National Science Foundation and the Environmental Protection Agency
Previous studies have involved high concentrations of the nanoparticles in a laboratory setting, which the researchers point out, doesn't represent "real-world" conditions.
"Results from laboratory studies are difficult to extrapolate to ecosystems, where exposures likely will be at low concentrations and there is a diversity of organisms," Colman said.
Silver nanoparticles are used in consumer products because they can kill bacteria, inhibiting unwanted odors. They work through a variety of mechanisms, including generating free radicals of oxygen which can cause DNA damage to microbial membranes without harming human cells.
The main route by which these particles enter the environment is as a by-product of sewage treatment plants. The nanoparticles are too small to be filtered out, so they and other materials end up in the resulting wastewater treatment "sludge," which is then spread on the land surface as a fertilizer.
For their studies, the researchers created mesocosms, which are small, man-made structures containing different plants and microorganisms meant to represent the environment. They applied sludge with low doses of silver nanoparticles in some of the mesocosms, then compared plants and microorganisms from treated and untreated mesocosms after 50 days.
The study appeared online Feb. 27 in the journal PLOS One.
The researchers found that one of the plants studied, a common annual grass known as Microstegium vimeneum, had 32 percent less biomass in the mesocosms treated with the nanoparticles. Microbes were also affected by the nanoparticles, Colman said. One enzyme associated with helping microbes deal with external stresses was 52 percent less active, while another enzyme that helps regulate processes within the cell was 27 percent less active. The overall biomass of the microbes was also 35 percent lower, he said.
"Our field studies show adverse responses of plants and microorganisms following a single low dose of silver nanoparticles applied by a sewage biosolid," Colman said. "An estimated 60 percent of the average 5.6 million tons of biosolids produced each year is applied to the land for various reasons, and this practice represents an important and understudied route of exposure of natural ecosystems to engineered nanoparticles."
"Our results show that silver nanoparticles in the biosolids, added at concentrations that would be expected, caused ecosystem-level impacts," Colman said. "Specifically, the nanoparticles led to an increase in nitrous oxide fluxes, changes in microbial community composition, biomass, and extracellular enzyme activity, as well as species-specific effects on the above-ground vegetation."
The researchers plan to continue to study longer-term effects of silver nanoparticles and to examine another ubiquitous nanoparticle – titanium dioxide.
Researchers Examine the Environmental Effects of Silver Nanoparticles
Journal information: PLoS ONE
Provided by Duke University
Citation: Silver nanoparticles may adversely affect environment (2013, February 27) retrieved 20 January 2021 from https://phys.org/news/2013-02-silver-nanoparticles-adversely-affect-environment.html
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Emergency Management is a systematic, organized approach to analyzing, planning, decision making, and assigning resources to mitigate, prepare for, respond to, and recover from all hazards, man-made or natural.
The goal of emergency management is to save lives, prevent injuries, and protect property and the environment if an emergency occurs.
The Erie County Emergency Management Agency is responsible for planning, mitigation, response, and recovery for both natural and man-made disasters in the County. This includes nuclear attack, terrorism, weather phenomena, nuclear power plant accidents, hazardous materials accidents, and any other occurrence deemed a disaster or emergency. With mutual aid agreements, we have also responded to situations in surrounding counties when requested. To accomplish this task, the EMA constantly coordinates with fire, law enforcement, and EMS throughout the County to insure taskings are compatible. We also coordinate plans with other support and relief agencies such as the Red Cross, Salvation Army, area hospitals, local amateur radio and civic/volunteer groups.
We respond to community emergencies and disasters such as: tornados, floods, severe winter storms, earthquakes, and hazardous material (chemical) events and terrorist incidents.
The Agency insures our Emergency Operations Center (EOC) is operational 24 hours a day, seven days a week. This facility provides emergency communications, radio and telephone, along with other features designed to allow EOC members to help manage any disaster that may befall our county. Our Emergency Response vehicle is also outfitted with communications, and other response type equipment, allowing us the capability of a mobile EOC.
Emergency Management is also tasked with maintaining the Erie County 9-1-1 service. Our telecommunications coordinator provides this service, along with helping to maintain all telephones within the county government umbrella.
The Agency employs three full time staff members, an Administrative Assistant, a 9-1-1 Telecommunications Coordinator, and the Agency Director.
Kim Johnson serves as the Emergency Management Agency Administrative Assistant, as well as the Information Coordinator for the Local Emergency Planning Committee. Kim is responsible for all correspondence and financial requirements for the Agency.
Gary Wobser has served as the Erie County 9-1-1 Telecommunications Coordinator for 2 years, and has over 27 years of telecommunications experience. Gary is responsible for all telephone issues such as repairing telephones, programming features on telephones, and assisting all county offices with communications requirements. He is also responsible for maintenance and functionality of Erie County's Enhanced 9-1-1 system. This includes updating the Master Street Address Guide, and resolving all discrepancies that may occur with customer information.
Tim Jonovich is the Erie County EMA Director. Tim has a Bachelors Degree in Emergency Management and an Associates Degree in Fire Protection from the University of Akron. Prior to working for Erie County, Tim has experience as a Director of Emergency Management/9-1-1 Communications and as a Firefighter/EMT.
Funding for the Agency consists of a 25 cent per capita fee for Emergency Management, and a 7 cent per capata fee for Hazardous Materials, for each Erie County Subdivision. We maintain an Emergency Management Performance Grant with the Federal Emergency Management Agency (FEMA) and a Partnership Agreement with the Davis Besse Nuclear Power Station. We also receive a grant from the State Emergency Response Commission for hazardous material planning and exercises. For the last few years, we have received Federal Homeland Security Grants to better prepare the county for acts of terrorism.
National Oceanic & Atmospheric Adm.


The negotiators gathered for the second day in the second session of negotiated rulemaking, or neg reg, for borrower defense. After spending the majority of the first day debating the wording of two particular provisions, the committee made slow progress on Tuesday as it continues to work through eight separate "issue papers" dealing with different topics to consider in rewriting the federal regulation.
The committee began discussing draft regulatory language outlining how a borrower would show he or she suffered financial harm as a result of an institutional misrepresentation. Although the regulatory language did not specifically mention partial relief, many negotiators discussed the draft in the context of partial relief due to ED's recent decision to create a tiered relief system for current borrower defense claims.
Many negotiators took issue with the types of evidence ED provided in the draft language as examples of what borrowers could use to show financial harm, which included documenting things such as a "significant difference" between the borrower's earnings after completing the program and earnings listed for that program of study in marketing materials, a significant difference between the borrower's earnings after completing the program and earnings "for similar borrowers employed in the program's intended occupational field," among other things.
Some negotiators saw the wording of that provision as a potential "get out of jail free" card for bad actors, while others said some form of that provision is necessary to encourage good behavior, and to protect honest institutions from being penalized for a one-off mistake.
Some consumer advocates felt that any statute of limitation would be too harsh against borrowers, while other negotiators suggested changing the wording. For example, Lacey suggested that the three-year time period start upon a student's graduation or withdrawal date. Consumer advocate representatives countered that many borrowers would not be aware of the misrepresentation until many years later, potentially after a larger action from a state agency had taken place.


The AJGA Player Services Department is designed to service your membership needs. Player Services Representatives are trained personnel dedicated to assisting parents and juniors with any questions and concerns. Please read through the FAQ section of the website. If you still have questions, the AJGA Player Services Department can be reached from 8:15 a.m. to 5 p.m. ET, Monday through Friday, by calling (877) 373-2542 or (770) 868-4200 or via email at ajga@ajga.org for general questions/concerns that do not require immediate attention.


text:
Q: Spark out of memory because of values in map function? I have written the following spark job to compare large numbers of textfiles for duplicated paragraphs. I am new to spark and wondering if I have a memory leak because I sometimes run into Out of memory GC exceptions.
  val conf = ConfigFactory.load()
  val partitionsCount = conf.getInt("simtext.partitions")
  val minMatchLength = conf.getInt("simtext.minmatchlength")
  val hdfsDir1 = conf.getString("simtext.hdfs.dir1")
  val hdfsDir2 = conf.getString("simtext.hdfs.dir2")
  val outputDir = conf.getString("simtext.hdfs.output")

  def main(args: Array[String]): Unit = {
    val conf = new SparkConf().setAppName("simtext4s with Spark")
    val sc = new SparkContext(conf)

    val tokenizer = new Tokenizer()

    val tokenizedFiles1 = getTokenizedFilesAsRdd(sc, tokenizer, hdfsDir1)
    val tokenizedFiles2 = getTokenizedFilesAsRdd(sc, tokenizer, hdfsDir2)

    val comparetuples: RDD[CompareTuple] = tokenizedFiles1.cartesian(tokenizedFiles2).map {
      case ((name1, tokens1), (name2, tokens2)) =>
        CompareTuple(TokenizedText(name1, tokens1), TokenizedText(name2, tokens2))
    }

    val results: RDD[CompareResult] = comparetuples.map { compareTuple =>
      val forwardRefTable: SortedMap[Int, Int] = buildForwardReferenceTable(
        compareTuple.combinedTokens,
        minMatchLength
      )
      val similarity: Double = compareTokenLists(
        compareTuple.splitIndex,
        forwardRefTable,
        minMatchLength
      )
      CompareResult(compareTuple.tokenizedText1.name, compareTuple.tokenizedText2.name, similarity)
    }

    results.saveAsTextFile(outputDir)

    sc.stop()
  }

buildForwardRefTable is a method in the same object like the main method:
def buildForwardReferenceTable(tokens: List[String], minMatchLength: Int): SortedMap[Int, Int] = {
  val (_, forwardRefTable) = tokens
    .sliding(minMatchLength)
    .zipWithIndex
    .foldLeft(HashMap.empty[List[String], Int], SortedMap.empty[Int, Int]) {
      case ((lastIndexAcc, forwardRefTableAcc), (slice, index: Int)) =>
        if (lastIndexAcc.contains(slice)) {
          val updatedForwardRefTable = forwardRefTableAcc + (lastIndexAcc.get(slice).get -> index)
          val updatedLastIndexAcc = lastIndexAcc + (slice -> index)
          (updatedLastIndexAcc, updatedForwardRefTable)
        } else {
          val updatedLastIndexAcc = lastIndexAcc + (slice -> index)
          (updatedLastIndexAcc, forwardRefTableAcc)
        }
    }

    forwardRefTable
  }

My question is about the map function in the main method that creates the results value.
It generates for each comparetuple an forward reference table to compare the texts. Does ist store these forward reference tables until the whole map function on all comparetuples is done? Because the behaviour that I would like to have is that it generates the forward reference table and removes it from memory after computing the similarity.
Are there any other big mistakes that could lead to a memory leak? This is my first spark job.

redpajama_set_name: RedPajamaStackExchange