Alien Registration- Cote, Louis (Allagash, Aroostook County)

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A Preaching Strategy Toward Spirituality, Renewal and Unity at the Cornerstone Seventh-day Adventist Church

Problem In September 2015, I was assigned by the British Columbia Conference of the Seventh-day Adventist Church as sole pastor of the Cornerstone Adventist Church. Upon arrival and surveying the congregation it was clear the church was in a state of decline. There was a high percentage of inactive membership, as evidenced in low Sabbath worship attendance, lack of ministry participation, and members failing to invite others to church. There was also conflict due to a lack of spirituality, unity, and renewal. This had also negatively affected the church membership. Method The professional dissertation project utilized conflict resolution literature, preaching practices relating to conflict resolution, and congregational renewal literature. Using these strategies, I formulated a series of seminars— preaching revival and renewal sermons—to assist in resolving the current conflicts and prepare the church to resolve future disagreements while growing successfully. Results The results of the method used reveal that this project was an effective means in bringing renewal to the Cornerstone Seventh-day Adventist Church, thus laying a foundation for future conflict resolution. The research was helpful, for it enriched the seminar series. The survey questionnaire helped guide in the selection of the seminar content and made it more relevant to the participants. In addressing the specific concerns of the congregation, greater unity and spirituality were realized. Conclusions Being a part of this project was satisfying. The opportunity to preach relevant sermons in a seminar format, informed by extensive research, demonstrated that there are resources available to bring unity to a group and set the stage for future conflict resolution strategy. Involving the congregation in the project reaped positive results. The surveys provided opportunity for participants to suggest desired sermon topics or scripture passages for clarity or understanding. This increased the congregation\u27s spirituality through the spoken word of God and created greater unity among the members

Allergen bronchoprovocation test:an important research tool supporting precision medicine

PURPOSE OF REVIEW: Allergen bronchoprovocation test (ABT) has been used to study asthma pathophysiology and as a disease-modelling tool to assess the properties and efficacy of new asthma drugs. In view of the complexity and heterogeneity of asthma, which has driven the definition of several phenotypes and endotypes, we aim to discuss the role of ABT in the era of precision medicine and provide guidance for clinicians how to interpret and use available data to understand the implications for the benefits of asthma treatment. RECENT FINDINGS: In this review, we summarize background knowledge and applications of ABT and provide an update with recent publications on this topic. In the past years, several studies have been published on ABT in combination with non-invasive and invasive airway samplings and innovative detection techniques allowing to study several inflammatory mechanisms linked to Th2-pathway and allergen-induced pathophysiology throughout the airways. SUMMARY: ABT is a valuable research tool, which has strongly contributed to precision medicine by helping to define allergen-triggered key inflammatory pathways and airway pathophysiology, and thus helped to shape our understanding of allergen-driven asthma phenotypes and endotypes. In addition, ABT has been instrumental to assess the interactions and effects of new-targeted asthma treatments along these pathways

Health Expect

BACKGROUND: The patient has always been at the centre of the evidence-based medicine model. Case-based critical reviews, such as best-evidence topics, however, are incomplete reflections of the evidence-based medicine philosophy, because they fail to consider the patient's perspective. We propose a new framework, called the 'Shared Decision Evidence Summary' (ShaDES), where the patient's perspective on available treatment options is explicitly included. METHODS: Our framework is grounded in the critical appraisal of a clinical scenario, and the development of a clinical question, including patient characteristics, compared options and outcomes to be improved. Answers to the clinical question are informed by the literature, the evaluation of its quality and its potential usefulness to the clinical scenario. Finally, the evidence synthesis is presented to the patient to facilitate the formulation of an evidence-informed decision about the treatment options. KEY RESULTS: Using three similar but contrasted clinical scenarios of patients with low back pain, we illustrate how considering the patient's preferences on the proposed treatment options impact the bottom line, a synthetic formulation of the answer to the focused question. ShaDES includes clinical and psychosocial components, transformed in a searchable question, with a full search strategy. CONCLUSIONS: ShaDES is a practical framework that may facilitate clinical decisions adapted to psychological, social and other relevant non-clinical characteristics of patients

Zooplankton assemblages along the North American Arctic: Ecological connectivity shaped by ocean circulation and bathymetry from the Chukchi Sea to Labrador Sea

We defined mesozooplankton biogeography in the North American Arctic to elucidate drivers of biodiversity, community structure, and biomass of this key component of the Arctic marine ecosystem. A multivariate analysis identified four mesozooplankton assemblages: Arctic-oceanic, Arctic-shelf, Coastal-Hudson, and Labrador Sea. Bathymetry was a major driver of the distribution of these assemblages. In shallow waters, Cirripedia and the copepod Pseudocalanus spp. dominated the Coastal-Hudson and Arctic-shelf assemblages, which showed low species richness (19) and biomass (0.28 and 1.49 g C m-2 , respectively).The Arctic-oceanic assemblage occupied the entire North American Arctic, except for shallow breaks in the Canadian Arctic Archipelago downstream of sills blocking the Atlantic Water layer circulation below a depth of 200 m. This assemblage showed high copepod biomass (4.74 g C m-2 ) with a high share of Calanus hyperboreus, C. glacialis, and Metridia longa. In habitats below 200-m depth, C. hyperboreus represented 68% of the copepod biomass, underscoring its role as a keystone species in this ecosystem. Strong numerical representation by the borealAtlantic C. finmarchicus and Oithona atlantica stressed the strong Atlantic influence on the subarctic Labrador Sea assemblage on the northwestern Labrador Sea slope. The mixed Arctic-Atlantic composition of the Labrador Sea mesozooplankton resulted in high species richness (58) and biomass (5.73 g C m-2 ). The low abundance of Atlantic and Pacific taxa in the areas influenced by Arctic currents did not alter the Arctic status of the Arctic-oceanic, Arctic-shelf, and Coastal-Hudson assemblages.This study identifies hotspots of mesozooplankton biomass and diversity in Central Amundsen Gulf, Lancaster Sound, North Water Polynya and Baffin Bay, known for their high biological productivity and concentrations of vertebrate predators. The continental-scale zooplankton mapping furthers our understanding of the importance of bathymetry and ocean circulation for ecological connectivity in a vast and complex portion of the Arctic marine ecosystem

Motor Impairment in PD: Relationship to Incident Dementia and Age

OBJECTIVE: To analyze the relationship of specific motor impairment in idiopathic PD to incident dementia. BACKGROUND: The total Unified PD Rating Scale (UPDRS) motor score at baseline has been associated with an increased risk of developing dementia in PD. METHODS: A cohort of 214 nondemented community-dwelling patients with PD was followed annually with neurologic and neuropsychological evaluations. The association of baseline motor impairment with incident dementia was analyzed using Cox proportional hazards models. Facial expression, tremor, rigidity, and bradykinesia were analyzed as part of subscore A (indicative of dopaminergic deficiency); speech and axial impairment were analyzed as part of subscore B (indicative of predominantly nondopaminergic deficiency). The correlation between the six motor domains and age was also analyzed. RESULTS: Of 173 patients followed for at least 1 year, 50 became demented according to the Diagnostic and Statistical Manual of Mental Disorders, revised 3rd edition (DSM III-R) criteria (mean follow-up, 3.6 +/- 2. 2 years). When both subscores A and B were entered into the Cox model, subscore B was associated with incident dementia (relative risk = 1.19; 95% CI, 1.09 to 1.30; p = 0.0001), in addition to gender, age, and education, whereas subscore A was not (relative risk = 1.03; 95% CI, 0.99 to 1.07; p = 0.19). Of the six motor domains, speech and bradykinesia were associated with incident dementia (p < 0.05), and axial impairment approached significance (p = 0.06). Only axial impairment was correlated with age (correlation coefficient = 0.32; p < 0.001). CONCLUSION: The findings suggest that motor impairment mediated predominantly by nondopaminergic systems is associated with incident dementia in PD. Axial impairment may be the result of a combined effect of the disease and the aging process

The Association of Incident Dementia with Mortality in PD

Objective: To evaluate the association of incident dementia with mortality in a cohort of patients with idiopathic PD who were nondemented at baseline evaluation, controlling for extrapyramidal sign (EPS) severity at each study visit. Background: The development of dementia has been associated with reduced survival in PD. Because EPS severity is associated with both dementia and mortality in PD, the association of dementia with mortality may be confounded by disease severity. Methods: A cohort of patients with PD was followed annually with neurologic and neuropsychological evaluations. The association of incident dementia and the total Unified PD Rating Scale (UPDRS) motor score with mortality in PD was examined using Cox proportional hazards models with time-dependent covariates. All analyses were adjusted for age at baseline, sex, years of education, ethnicity, and duration of PD. Results: Of 180 PD patients, 41 (22.8%) died during a mean follow-up period of 3.9 ± 2.2 years. Among those who died during the study period, 48.8% (20 of 41) became demented during follow-up, as compared to 23.0% (32 of 139) of those who remained alive. Both incident dementia (RR: 2.2, 95% CI: 1.1 to 4.5, p = 0.04) and the total UPDRS motor score at each study visit (RR: 1.04, 95% CI: 1.02 to 1.07, p = 0.001) were associated with mortality in PD when included in the same Cox model. Conclusions: Incident dementia has an independent effect on mortality when controlling for EPS severity. The development of dementia is associated with a twofold increased mortality risk in PD

Memory and Executive Function Impairment Predict Dementia in Parkinson's Disease

We analyzed the association of neuropsychological test impairment at baseline with the development of dementia in idiopathic Parkinson's disease (PD) patients. A cohort of nondemented PD patients from northern Manhattan, NY was followed annually with neurological and neuropsychological evaluations. The neuropsychological battery included tests of verbal and nonverbal memory, orientation, visuospatial ability, language, and abstract reasoning. The association of baseline neuropsychological tests scores with incident dementia was analyzed using Cox proportional hazards models. The analysis controlled for age, gender, education, duration of PD, and the total Unified Parkinson's Disease Rating Scale motor score at baseline. Forty-five out of 164 patients (27%) became demented during a mean follow-up of 3.7 ± 2.3 years. Four neuropsychological test scores were significantly associated with incident dementia in the Cox model: total immediate recall (RR: 0.92, 95% CI: 0.87–0.97, P = 0.001) and delayed recall (RR: 0.73, 95% CI: 0.59–0.91, P = 0.005) of the Selective Reminding Test (SRT), letter fluency (RR: 0.87, 95% CI: 0.77–0.99, P = 0.03), and Identities and Oddities of the Mattis Dementia Rating Scale (RR: 0.85, 95% CI: 0.73–0.98, P = 0.03). When the analysis was performed excluding patients with a clinical dementia rating of 0.5 (questionable dementia) at baseline evaluation, total immediate recall and delayed recall were still predictive of dementia in PD. Our results indicate that impairment in verbal memory and executive function are associated with the development of dementia in patients with PD

Risk of Parkinson disease in carriers of parkin mutations : estimation using the kin-cohort method

Objective: To estimate the risk of Parkinson disease (PD) in individuals with mutations in the Parkin gene. Design: We assessed point mutations and exon deletions and duplications in the Parkin gene in 247 probands with PD (age at onset 50 years) and 104 control probands enrolled in the Genetic Epidemiology of Parkinson's Disease (GEPD) study. For each first-degree relative, a consensus diagnosis of PD was established. The probability that each relative carried a mutation was estimated from the proband's Parkin carrier status using Mendelian principles and from the relationship of the relative to the proband. Setting: Tertiary care movement disorders center. Patients: Cases, controls, and their first-degree relatives were enrolled in the GEPD study. Main Outcome Measures: Estimated age-specific penetrance in first-degree relatives. Results: Parkin mutations were identified in 25 probands with PD (10.1%), 18 (72.0%) of whom were heterozygotes. One Parkin homozygote was reported in 2 siblings with PD. The cumulative incidence of PD to age 65 years in carrier relatives (age-specific penetrance) was estimated to be 7.0% (95% confidence interval, 0.4%-71.9%), compared with 1.7% (95% confidence interval, 0.8%-3.4%) in noncarrier relatives of the cases (P = .59) and 1.1% (95% confidence interval, 0.3%-3.4%) in relatives of the controls (compared with noncarrier relatives, P = .52). Conclusions: The cumulative risk of PD to age 65 years in a noncarrier relative of a case with an age at onset of 50 years or younger is not significantly greater than the general population risk among controls. Age-specific penetrance among Parkin carriers, in particular heterozygotes, deserves further study. Mutations in the Parkin gene (PARK2; GenBank AB009973) are associated primarily with early-onset Parkinson disease (PD), defined as age at onset (AAO) ranging from 45 years or younger to 55 years or younger, but have also been described in PD cases with an AAO older than 70 years. In PD cases with an AAO of 45 years or younger with a mode of inheritance consistent with autosomal recessive transmission, the frequency of Parkin mutations may be as high as 49%, whereas in cases without a family history of PD the range is 15% to 18%. Age at onset is inversely correlated with the frequency of Parkin mutations in both familial and sporadic cases. Several studies have compared the AAO of PD in heterozygous, compound heterozygous, and homozygous Parkin mutation carriers and found that heterozygous cases, both familial and sporadic, have an older AAO. Heterozygous Parkin mutation carriers are more frequently reported among sporadic than familial cases. Information on the risk of PD in individuals who carry Parkin mutations in either the homozygous, compound heterozygous, or heterozygous state (or penetrance) is essential for genetic counseling. The penetrance of Parkin mutations has only been reported for isolated families. Most of the previous study designs sampled PD cases based on family history of PD, which would bias penetrance estimates upwards. To obtain an unbiased estimate of risk, a population-based random sample would be desirable, but Parkin mutations are so rare in the population that such a sample would have to be extremely large to obtain sufficient precision in penetrance estimates. To obtain unbiased estimates of the risk of PD in Parkin carriers despite the low population frequency of Parkin mutations, we used a kin-cohort study design applied to participants in the Genetic Epidemiology of Parkinson's Disease (GEPD) study. The kin-cohort design is highly efficient for estimating penetrance because the relatives' mutation status is not required for the analyses, thus reducing costs for genetic analysis