Characterization of Vitamin B12 Supplementation and Correlation with Clinical Outcomes in a Large Longitudinal Study of Early Parkinson's Disease.

ObjectiveIn Parkinson's disease (PD), vitamin B12 levels are lower, and comorbid B12 deficiency has been associated with the development of neuropathy and early gait instability. Because little is known about B12 supplement use in PD, we sought to evaluate its use in a large PD cohort and, as an exploratory analysis, to determine whether baseline characteristics or disease progression differed according to B12 supplementation.MethodsWe utilized data collected as part of the National Institutes of Health Exploratory Trials in PD (NET-PD) Long-term Study (LS-1), a longitudinal study of 1,741 participants. We stratified subjects into 4 groups according to daily supplement use: no B12, multivitamin (MVI) containing < 100 μg B12, B12 ≥ 100 μg, and MVI + B12 ≥ 100 μg. Clinical outcomes were assessed at 3 years for each group using the Unified Parkinson's Disease Rating Scale (UPDRS), its subscores, and selected individual questions.ResultsOf the 1,147 participants who completed the 3-year visit, 41% took an MVI, 2% took B12, 3% took MVI + B12, and 54% reported taking no supplements. At 3 years, no significant differences in clinical outcomes were observed. However, there was a trend toward lower hazard ratios for developing sensory symptoms (UPDRS Item 17) in the MVI (p = 0.08) and B12 + MVI (p = 0.08) groups compared to that in the no supplement group.ConclusionThese results show that supplementation with vitamin B12 ≥ 100 μg is uncommon in early PD. The finding of a trend toward a lower hazard ratio for the development of sensory symptoms in those taking an MVI or B12 + MVI warrants further study

Individual, social, and environmental factors associated with physical activity and walking

Background: Participation in physical activity (PA) is influenced by a multitude of factors. Traditionally, research has focused on several theoretical frameworks focusing on the individual ; however, they do not necessarily take into consideration other influencing factors such as the social environment or the physical or built environment. As such, a comprehensive socio-ecological model considering a multiplicity of factors is useful in explaining behaviour. Aims: To 1) assess the prevalence of the individual level correlates and their association with PA and walking; 2) assess the prevalence of environmental determinants and neighbourhood characteristics and the association between these and PA and walking behaviours; 3) explore within a comprehensive and socio-ecological approach, the contribution of the individual, social, and environmental factors in predicting PA and walking. Methods: The studies used in this thesis are national, random-digit dialling telephone-based surveys of a representative population sample within Canada. All research questions and procedures underwent ethics review at York University. The studies incorporated a two-stage probability selection process to select a survey respondent, and included a number of standard self-report measures across the data collection cycles. PA and all-domain walking were measured using the telephone-administered, short International Physical Activity Questionnaire, the neighbourhood environment was measured using an abbreviated version of the Neighbourhood Environment Walkability Scale (NEWS), and individual factors such as knowledge about amount of PA required for guidelines, beliefs about the benefits of PA, self-efficacy, intention, and initial behaviour changes. Walking for transport was measured through the Physical Activity Monitor and walking for recreation were measured through an adapted version of the Minnesota Leisure-Time PA questionnaire (for the 2007 collection only). Complex sampling methods were required to take into account stratification by province or territory within Canada. Complex samples cross-tabulation procedures were used to calculate the prevalence estimates of Canadians meeting the PA and walking guidelines and 95% confidence intervals. The relationship between factors predicting sufficient activity and sufficient walking were examined using complex samples logistic regression procedures that were reflect the sample design. This thesis explored associations and the relative strength of the factors as the independent measures predicting sufficient PA and sufficient walking as the dependent measures, using age, sex, and education as covariates for each of these models. Chapter Six expands this model by including walking for recreation and transportation, and examining sub-population groups. Results: Individual factors (e.g., self-efficacy, intention, and some trial behaviours) and social factors were associated with sufficient PA and certain types of walking. Relatively few environmental factors were associated with sufficient walking (all domain and domain-specific) or sufficient PA. The relationship between high density neighbourhoods and higher rates of walking (generally and specific), and the availability of supportive walking facilities with various modes of walking were evident. Proximity of many shops and the presence of sidewalks were associated with the highest quartile of walking for transport. A greater number of the individual factors predicted walking and PA compared to the environmental/neighbourhood factors, within the context of a full socio-ecological model. Findings differed when stratified by age and sex of respondents. Conclusions: The results suggest that individual factors may be more relevant for predicting activity and walking than environmental factors, or at least should be considered in their inter-relationship with environmental factors when developing environment-based interventions. Although the inter-relationship between individual factors, social factors and the built environment are important, understanding individual factors are critical for determining strategies and interventions to promote PA among certain populations with traditionally lower levels of activity. Findings suggest that within countries like Canada, with a relative abundance of supportive environments, more specific and detailed measures of the perceived and objective physical environment may be required in order to achieve sufficient variation

Worship in Modern-Day Society: Evaluating Music of Corporate Worship

Background Church services today incorporate a wide variety of worship music, stylistically and lyrically, depending on the congregation. Some churches place great importance on the gospel being included in the songs, while others focus more on the emotions felt during the songs. While there are churches that maintain an eclectic mix of the two, other churches have a significant imbalance in the worship songs they choose to sing each week. Matt Boswell says, “Every worship experience, in its order and content, is an expression of the congregation’s liturgy. It communicates something about your church, your doctrine, and the order of your priorities.”1 As the local church gathers, there must be a clearer knowledge of why mankind has been created to worship as well as God’s design for worship both corporately and individually. The church gathers to worship vertically, personally, and horizontally. Statement of the Purpose There has been much deliberation on what songs are best for worship within the church. Over the last few decades, personal preference, and not the Word of God, seems to motivate song selection. Scott Connell warns that song choice should not be based upon “popularity, preference or pressure.”2 The purpose of this research paper is to explore God’s design for worship songs within the local church and provide detailed biblical guidance on worship with God. Scholarly wisdom, the Word of God, and church service evaluations are the primary sources for this paper. Response to God through song is evident throughout Scripture. Psalm 57 declares, “I will give thanks to You, O Lord, among the peoples; I will sing praises to You among the nations” (Psalm 57:9, English Standard Version). God’s Word gives believers guidance on praising God in ways that are pleasing and acceptable to Him. To equip the church family with worship God’s way, worship leaders and pastors must be diligent in telling and retelling the story of Jesus Christ in creative ways. Research Questions Various ways to apply these discoveries will be discussed in detail to assist the church in worshiping God on His terms. Specific research questions include: 1) What does the Bible say about worshiping God’s way? 2) How can the church equip their people better with more biblical worship? What is working? What needs to change? As these questions are explored, the specific focus will be lyrics of hymns and praise songs in general within the church setting. A focused study on Keith and Kristyn Getty’s lives, music writing, and ministry is included in the biblical worship research, as their music is primarily used for the recital portion of this project. Research and Recital Plans The recital will include selections from the Gettys library of music and a few additional songs that fit the model of a five-component worship song assessment. These components include 1) A high view of God, 2) Jesus, the gospel story, 3) My story and personal reflection, 4) Call to Respond, and lastly, 5) The commission. The recital will follow these guidelines

Cat's claw creeper vine, Macfadyena unguis-cati (Bignoniaceae), invasion impacts: comparative leaf nutrient content and effects on soil physicochemical properties

Macfadyena unguis-cati (L.) Gentry (Bignoniaceae) is a major environmental weed in coastal Queensland, Australia. There is a lack of quantitative data on its leaf chemistry and its impact on soil properties. Soils from infested vs uninfested areas, and leaves of M. unguis-cati and three co-occurring vine species (one exotic, two native) were collected at six sites (riparian and non-riparian) in south-eastern Queensland. Effects of invasion status, species, site and habitat type were examined using univariate and multivariate analyses. Habitat type had a greater effect on soil nutrients than on leaf chemistry. Invasion effect of M. unguis-cati on soil chemistry was more pronounced in non-riparian than in riparian habitat. Significantly higher values were obtained in M. unguis-cati infested (vs. uninfested) soils for ~50% of traits. Leaf ion concentrations differed significantly between exotic and native vines. Observed higher leaf-nutrient load (especially nitrogen, phosphorus and potassium) in exotic plants aligns with the preference of invasive plant species for disturbed habitats with higher nutrient input. Higher load of trace elements (aluminium, boron, cadmium and iron) in its leaves suggests that cycling of heavy-metal ions, many of which are potentially toxic at excess level, could be accelerated in soils of M. unguis-cati-invaded landscape. Although inferences from the present study are based on correlative data, the consistency of the patterns across many sites suggests that M. unguis-cati may improve soil fertility and influence nutrient cycling, perhaps through legacy effects of its own litter input

Carsey Perspectives: New Hampshire's Electricity Future

Over the past decade a number of factors have transformed global and national energy markets. Access to low-cost natural gas has been a significant part of this trend. Nationally, natural gas-fired power generation was expected to have exceeded coal-fired power generation for the first time in 2016,  and in New England about 50 percent of electricity is now generated from natural gas. With natural gas now such a large part of New England's energy mix, there is a concern that the demand for heating and electricity during cold periods will cause spikes in wholesale electricity prices and that demand may be greater than the available pipeline capacity to deliver natural gas. The region's utility industry has proposed the expansion of pipeline capacity to meet this seasonal increase in the demand for natural gas

Phospho.ELM:a database of experimentally verified phosphorylation sites in eukaryotic proteins

BACKGROUND: Post-translational phosphorylation is one of the most common protein modifications. Phosphoserine, threonine and tyrosine residues play critical roles in the regulation of many cellular processes. The fast growing number of research reports on protein phosphorylation points to a general need for an accurate database dedicated to phosphorylation to provide easily retrievable information on phosphoproteins.DESCRIPTION: Phospho.ELM http://phospho.elm.eu.org is a new resource containing experimentally verified phosphorylation sites manually curated from the literature and is developed as part of the ELM (Eukaryotic Linear Motif) resource. Phospho.ELM constitutes the largest searchable collection of phosphorylation sites available to the research community. The Phospho.ELM entries store information about substrate proteins with the exact positions of residues known to be phosphorylated by cellular kinases. Additional annotation includes literature references, subcellular compartment, tissue distribution, and information about the signaling pathways involved as well as links to the molecular interaction database MINT. Phospho.ELM version 2.0 contains 1703 phosphorylation site instances for 556 phosphorylated proteins.CONCLUSION: Phospho.ELM will be a valuable tool both for molecular biologists working on protein phosphorylation sites and for bioinformaticians developing computational predictions on the specificity of phosphorylation reactions.</p

Carsey Perspectives: New Hampshire\u27s Electricity Future; Cost, Reliability, and Risk

May 2017 update PointLogic Energy, a source for natural gas pipeline flow and capacity in the original report, has recently updated its models for calculating natural gas flow in the Tennessee Gas Pipeline in New England. This model update has resulted in significant changes to their previous estimates. Most importantly, data obtained from PointLogic Energy in December 2016 supported the finding that overall net gas flow in the “Tennessee Gas Pipeline: NY to MA” was from Massachusetts to New York from 2013–2016; their revised models indicate a net flow during the same period from New York to Massachusetts. To be conservative, we have removed analysis of natural gas pipeline flow and capacity from this report that relied on the original data obtained from PointLogic Energy. Instead, we use estimates of natural gas pipeline flow and capacity published in a 2014 ICF International report that was commissioned by ISO New England (Exhibit 2-3, pp. 12)a and information provided by the U.S. Energy Information Administration.b Please click here to read the previous version of this publication. In this perspectives brief, authors Cameron Wake, Matt Magnusson, Christine Foreman, and Fiona Wilson examine the cost of electrical power in New Hampshire and New England, the reliability of the electrical power system in terms of its ability to meet demand, and the risk New Hampshire ratepayers might face from various proposals to secure or increase the supply of electricity. They find evidence that near-term levels of demand and supply pose no threat to grid reliability, that current pipeline capacity is adequate, and that better contracting practices and other “soft-infrastructure” changes combined with the promotion of energy efficiency and renewable energy will have at least as large a return on investment as expanded pipeline capacity, without exposing ratepayers to higher electricity rates stemming from expensive infrastructure investments

Optimality and uniqueness of the (4,10,1/6) spherical code

Linear programming bounds provide an elegant method to prove optimality and uniqueness of an (n,N,t) spherical code. However, this method does not apply to the parameters (4,10,1/6). We use semidefinite programming bounds instead to show that the Petersen code, which consists of the midpoints of the edges of the regular simplex in dimension 4, is the unique (4,10,1/6) spherical code.Comment: 12 pages, (v2) several small changes and corrections suggested by referees, accepted in Journal of Combinatorial Theory, Series

An Exploration of the Role of Substance Misuse Nurses in Scotland

Executive Summary Background With the increase of drug misuse over the past two decades, the role of the Substance Misuse Nurse has increased dramatically. Research on the role of nurses working in this field is minimal and there is little known about what they do, what they think about their clients and their role, and how they approach treatment. A pilot study on substance misuse nurses in Grampian indicated that nurses may be key gatekeepers to specialist services and some nurses appeared to have an important role in clinical decision making. However, clinical decision making and other key aspects of nurse practice may vary across services in different geographical areas. This research was designed to gain a better understanding of the role of the substance misuse nurse in Scotland. Aims and Objectives The aim of this research was to describe and analyse the role of substance misuse nurses working with drug misusers in Scotland. The objectives were: • to identify the population of specialist nurses working directly in the management of illicit drug users in Scotland and gain baseline data on their demography, caseload, services provided and level of interaction with other health professionals; • to compare their attitudes to drug misusers with those of other health professionals; • to explore their beliefs about the effectiveness of different treatment options; • to examine their role in the initial client assessment and subsequent management; • to describe their interaction with the client; • to explore their relationship with other professionals. Methods Mixed quantitative and qualitative methods were used. The population of Substance Misuse Nurses and midwives working specifically with drug misusers across Scotland were identified and posted a comprehensive questionnaire. The questionnaire covered issues including qualifications, training, attitudes and beliefs about treatment and aspects of practice such as caseloads, services provided and relationships with other health and social professionals. Face-to-face interviews were conducted with a sub-sample of nurses including a range of gender, experience, and NHS areas. Interviews covered nurses’ assessment and decision making regarding treatment and relationships with other professionals. Observations of specialist nurse and client consultations allowed for some insight into the general structure of the consultation, the setting where the consultation took place and the roles of nurse and client in assessment and treatment planning. Characteristics of SMS nurses and services • A scoping exercise indentified 272 nurses. Of these 244 were sent a questionnaire (the remainder having left or being on sick leave). Of these, 79% responded. • Seventy percent (70%) were Grade G or above indicating a senior level workforce. • Most nurses were employed in substance misuse services (48%) or, similarly, drug and alcohol services (30%). • Formal training (university certificate/diploma) in substance misuse had been undertaken by 40% of nurses, induction training (i.e. at the start of employment) by 62% of nurses. • The median caseload was 38 clients. • The majority of consultations took place in clinical consultation rooms but this was not observed to influence the consultation. • Nurses reported that the average length of a consultation was 38 minutes. All of the observed consultations were scheduled for 30 minutes but half over-ran. Motivation, attitudes and beliefs • The challenging nature of working with drug misusers was a positive motivating factor for nurses working in this field. • Seventy-seven percent (77%) of nurses considered working with drug misusers to be rewarding, although 79% also considered that this population were not easy to deal with. Opinion was split about whether drug misusers could be manipulative in consultations. Initial assessment of clients • Waiting times for assessment were generally an issue of concern to nurses. • A detailed assessment was almost always conducted at the first consultation. • An SMR24 was almost always completed at the first consultation. • Interviews and observation of nurse-client consultations found that the approach to assessment seemed consistent across geographical areas. • Assessment included: brief physical examination, urine sampling, detailed exploration of drug use, exploration of physical problems, discussion of social and family support, housing and employment status and history of involvement in the criminal justice system. • Consultations were often brought to a close by discussing treatment expectations. • Initial assessment could take place over more than one appointment and several appointments could be required before a treatment plan was implemented. Making treatment decisions • Clients were actively encouraged to participate in treatment decisions. • Although 84% of nurses reported they were expected to follow a treatment protocol only 44% said they always did (for any treatment). • Eighty-six percent (86%) of nurses had seen the National Clinical Guidelines (DoH, 1999), and those who were interviewed felt that these provided a good framework for treatment, although they were perhaps lacking in detail. • Nurses reported that they often consulted widely with other health professionals but, most frequently, with the client, before making a treatment decision. • A third of nurses reported writing prescriptions for a doctor to sign. • Seventy percent (70%) of respondents felt nurses should be able write prescriptions but only if they were experienced nurses with appropriate training. Comparing beliefs of nurses with those of GPs and pharmacists Nurses were asked some questions which had been asked of GPs and pharmacists in previous national surveys conducted in 2000. This allowed for comparisons to be made: • When making treatment decisions nurses were less influenced than GPs by the attitude and behaviour of drug misusers. • When making treatment decisions nurses were more influenced than GPs by societal factors such as reducing the transmission of infectious disease. • Nurses were less likely than GPs to favour detoxification as a treatment approach, although 83% of nurses agreed that a community based detoxification programme was an effective tool for the treatment of drug misuse. • Nurses were more confident than GPs about their ability to successfully manage polydrug users. • Nurses and GPs were split in their beliefs about the effectiveness of dihydrocodeine. • Nurses believed more strongly than pharmacists that maintenance prescribing could stop the use of illicit drugs. • Fewer nurses than pharmacists believed that controlled drug dispensing should take place in central clinics rather than community pharmacies. Multidisciplinary working • Over half of nurses considered their relationship with pharmacists, GPs, health visitors/community nurses, hospital doctors and social workers to be good. • Opportunities to discuss services with local policy makers were considered insufficient. • Relationships with GPs seemed positive because nurses felt GPs valued their specialist knowledge. • Nurses had frequent contact with pharmacists and respected the difficulties of a pharmacist’s work. • Relationships with social services were variable. Some nurses felt undervalued by their social work colleagues, or felt there was a lack of joint planning for individual client care. • Nurses were clear about what circumstances should lead to a break in confidentiality between services and of how to go about this. • Integrated drug services were seen as potentially beneficial but there were specific concerns about the implications for clients of sharing information with other agencies and practical concerns about the size of joint assessment tools. Health and Safety at work • Sixty-four percent (64%) of nurses reported that they had been physically or verbally abused by clients, and half of those who had been subject to abuse felt current safety provision in their service was insufficient. Nurses in most areas said that the safety of staff was considered to be a high service priority, but there was evidence from interviews this was still lacking in some areas. • Greater use of personal alarms and alarms in consultation rooms, use of mobile phones, and specialised training were suggested as ways of improving safety. • Nurses said that the majority of their consultations take place in clinics/consultation rooms rather than clients’ homes. • The feeling was commonly expressed among interviewees that their work could be stressful, and this was seen as due to paperwork, excessive caseloads and working in isolation. Discussion of Findings This study provides baseline information which can be used to inform individual nurses, services, policy makers and researchers. Some individual nurses reading this report might find an element that is simply describing what they already know. This is inevitable but it is hoped individual nurses will still find interest in the views and practice of others within their profession. The value of this report is that it has quantified these findings on a national basis, providing robust data for workforce planning and needs assessment. It has not been possible to compare findings, and thus the practice of substance misuse nurses in Scotland, with other areas or countries because there is no comparable published work. It is also not possible to give guidelines or examples of ‘good practice’ as this would have involved data collection from clients and other professionals which was outwith this study’s remit. This study has found a reassuring consistence of practice across Scotland. Although many substance misuse nurses work in some degree of isolation there is an apparently high level of discussion and consultation with other service colleagues which provides support. The role of the nurse in the initial assessment and treatment plan is critical. Nevertheless, decisions regarding treatment plans were made largely between nurses and clients, with nurses making use of service protocols/guidelines. Some might question whether a nurse is the most appropriate person to undertake these tasks. Ability to conduct physical examination, some knowledge of pharmacology, mental health and psychology as well as an ability to explore the wider social context is required. On reflection a nurse, with mental health qualifications seems to have the most appropriate skills for this. There is a willingness by nurses to take on the role of prescribing albeit in a limited capacity, and only by very experienced nurses with appropriate training. Currently, a minority of nurses reported writing prescriptions to be signed by doctors, which is possible for doctors with handwriting exemptions. This raises issues about clinical governance. In signing the prescription a GP is still taking responsibility even though s/he may know little about the patient’s current condition. An important strand of a substance misuse nurse’s practice is ongoing support or counselling for clients. This raises issues about models of counselling followed and nurses’ competencies in doing this. The nature or model of counselling used by nurses was not explicitly covered in this research and further exploration of counselling would be an area for future research. Relationships with other professionals, were generally reported to be good. Nurses generally believed GPs valued their role. Comparison of attitudes of substance misuse nurses with earlier surveys of pharmacists and GPs indicates they are more positive in general and about treatment outcomes in particular. Nurses viewed the challenging aspect of working with drug misusers more positively than pharmacists and GPs. Nurses were less positive about their ability to influence policy. Currently substance misuse nurses have little input at policy level. At a local level, through Drug and Alcohol Action Teams (DAATs) this could improve the feeling of ownership towards service developments related to the Joint Future agenda. Service managers are currently the key link between nurses and DAATs. Perhaps a service nurse with more client contact should also attend to provide client feedback. At a national level greater nursing input into policy could give this specialist group a greater feeling of professional cohesion as well as keeping policy makers informed. Concerns about health and safety at work need to be considered at a national professional level as well as locally. Whether these issues should be addressed through the involvement of an organisation such as the Association of Nurses in Substance Abuse (ANSA) or an appointed individual is for discussion. Recommendations • All substance misuse nurses should receive induction training prior to commencing their post. Greater time should be protected to allow participation in training. • There should be further exploration of what models of counselling, if any, are followed to assess whether current training is adequate. • Appointment scheduling may need review as there was evidence that consultation time was routinely underestimated. Frequency of missed appointments needs to be considered at the same time. • Staffing of substance misuse nurses should be expanded in order to reduce: excessive caseloads; lengthy waiting lists; insufficient cover for holidays, training and absences; and occupational stress. • Nurses could be involved in GP training to share their experience of managing difficult cases such as poly-drug users and widen GPs perspective of the social benefits of drug misuse treatment. • Nurses should be kept aware of developments on integrated care for drug misusers. This would allow them to understand the principles behind integrated care and be aware of how their service fits into the overall plan. • Extending the role of senior substance misuse nurses to include the prescribing of controlled drugs should be considered. • A clearer job title should be given to nurses working in substance misuse so that they may be easily identified and representable at both DAAT and Scottish Executive level, e.g. Specialist Nurse in Substance Misuse. • Efforts should be made to improve substance misuse nurses’ opportunities to influence policy. • All substance misuse nurses should be provided with appropriate on going training, procedures and practices to allow them to carry out their work safely