text:
|Home | About | Journals | Submit | Contact Us | Français
There is an urgent need to identify subjects with Alzheimer's disease (AD) in the predementia phase, but validated diagnostic approaches are currently lacking. In this paper, we present the background, design and methods of a study, which aims to develop clinical criteria for predementia AD. We also present baseline characteristics of the subjects included. The study was part of the multicentre DESCRIPA project, which is being conducted within the network of the European Alzheimer's Disease Consortium.
Clinical criteria will be based on a prospective cohort study of non-demented subjects older than 55 years and referred to a memory clinic. At baseline, a number of markers and risk factors for AD were collected, including demographic variables, measures of performance in activities of daily living, cognitive, neuroimaging and genetic markers, and serum and cerebrospinal fluid markers. Subjects will be reassessed annually for 2–3 years, and we will evaluate which combination of variables best predicts AD-type dementia at follow-up.
Between 2003 and 2005, 881 subjects were included from 20 memory clinics. Subjects were on average 70.3 years old, and had 10.4 years of education. The average score on the Mini-Mental State Examination was 27.4.
Alzheimer's disease (AD) is one of the most common neurodegenerative disorders, with a prevalence rising from 0.2% in subjects aged between 55 and 65 years to 27% in subjects older than 85 years [1]. According to the current diagnostic criteria for AD, the diagnosis can only be made when a subject is demented [2]. There is an urgent need to diagnose AD in the predementia phase [3]. This will allow physicians to start interventions that may improve cognition, or prevent the progression of the disease at an earlier stage than is currently possible.
There are as yet no evidence-based criteria for predementia AD. A large number of predictors or risk factors for AD in non-demented subjects have been identified, but none of them can individually diagnose predementia AD with sufficiently high sensitivity and specificity [4]. There is evidence that a combination of variables may diagnose predementia AD with good accuracy [5,6,7]. A recent proposal for research criteria for AD suggested using a combination of variables to diagnose AD in non-demented subjects [3]. However, these approaches need to be validated and could be improved further.
In order to investigate which combination of variables can best identify subjects with predementia AD, the 'Development of Screening Guidelines and Clinical Criteria for Predementia AD' (DESCRIPA) study was set up. The study consists of a clinical and population-based part. The objective of the clinical part is to develop criteria for the diagnosis of predementia AD that can be used in clinical practice. The aim of the population-based part is to develop screening guidelines for predementia AD in the general population. In this paper, we will describe the outline of the clinical part of the DESCRIPA study. We will also present baseline characteristics of the subjects included in the study.
The clinical part of the DESCRIPA study is a prospective cohort study. Non-demented subjects with cognitive complaints are to be followed for 2–3 years. At baseline, variables were collected that could be markers of predementia AD, and we will investigate which combination of variables can best predict conversion to AD-type dementia at follow-up. The design took into account that the study should have sufficient statistical power to test a combination of predictor variables, and that the criteria for predementia AD should allow easy implementation in clinical practice. For the latter reason, the data collection closely followed the routine clinical practice in each centre and we allowed variability between centres in cognitive tests, clinical rating scales and neuroimaging tools, as described below. Centres were selected from the European Alzheimer's Disease Consortium (EADC), and included 20 outpatient clinics from 11 European countries. Each of these centres held a memory clinic specialized in the diagnosis and treatment of memory disorders. The memory clinics were located in departments of psychiatry (5 centres), neurology (7 centres), and geriatrics (8 centres; see appendix 1 for a list of the participating centres). The European Commission funded the study as a concerted action within the 5th Framework Programme, and provided support for coordination, pooling and data analysis from 1 January 2003 to 1 July 2007, but not for data collection. Subjects were enrolled between 1 March 2003 and 1 March 2005. Each centre collected a minimal dataset, while other parts of the study were optional depending on local clinical practice and local funding possibilities for data collection.
Inclusion and exclusion criteria were chosen in order to select a population in which criteria for predementia AD would be most useful. Inclusion criteria were new referral to a memory clinic because of a cognitive complaint and an age of 55 years or over. Exclusion criteria were dementia according to DSM-IV criteria at baseline, referral because of a high family risk in otherwise normal subjects, history of schizophrenia, bipolar disorders or recurrent psychotic disorders, and any somatic, psychiatric or neurological disorder that may have caused the cognitive impairment (see appendix 2 for overview of inclusion and exclusion criteria). In cases where doubt existed as to whether the cognitive impairment could be attributed to a specific cause, subjects were included in the study. All centres enrolled consecutive newly referred patients, while 3 centres also retrospectively enrolled subjects that were selected from a database.
The local Medical Ethical Committee in each centre approved the study. Subjects were asked to provide a written informed consent except in 2 centres, in which the study was considered to be regular patient care and no specific consent was needed.
At the baseline assessment, data were collected on variables that were tested as potential markers of predementia AD, variables needed for the characterization of subjects and variables needed for diagnostic purposes. In 13 centres, the baseline assessment followed routine clinical practice. Four centres extended or changed part of the routine assessment with additional assessments and tests especially for the DESCRIPA study. In 3 centres, another study on markers of predementia AD was conducted at the same time and the baseline assessment in these centres followed the protocol of those studies. All centres collected data on demographics, cognitive and non-cognitive symptoms, medical history, functional impairment and cognitive performance. In addition, a brief physical examination was undertaken. In a subset of centres, data were collected on social and cognitive activities, neuroimaging, quantitative electroencephalography (Q-EEG), genetic risk factors, markers in serum and plasma, and markers in cerebrospinal fluid (CSF). The baseline assessment included the following variables.
Demographic data included age, gender, level of education and level of occupational achievement.
Data were collected on the start of the symptoms, course of the symptoms, main complaints and non-cognitive symptoms.
Data were collected on the number of first-degree and second-degree relatives with dementia and vascular disorders.
Data were collected on conditions that may be associated with cognitive impairments such as vascular disorders and vascular risk factors, psychiatric disorders, endocrine disorders and severe somatic disorders. Data were provided by the patient and/or caregiver or extracted from medical files if available.
All medications taken were recorded and classified in a number of categories.
Smoking and alcohol intake measurements were based on the interview with patient and caregiver.
In all but 2 centres, data were collected on cognitive, physical and social activities. Cognitive activities were assessed using a 7-item scale [8], physical activities with a 5-item scale, hobbies and social activities (e.g. member of a club, volunteer work in church) were assessed using structured questions. For each activity, the frequency and the average number of hours involved per week was rated.
Data were collected on weight, height, blood pressure, primitive reflexes, extrapyramidal symptoms, gait disturbances and other focal neurological signs. Assessments were undertaken according to local practice.
The Mini-Mental State examination was administered in all centres [9]. A clock-drawing test was done in all but 1 centre.
The effect of cognitive impairment on global functioning was measured with the Clinical Dementia Rating Scale (CDR, 18 centres), the Global Deterioration Scale (GDS, 7 centres) and the Cognitive Impairment Rating Scale functional part (CIRS-FP, 17 centres). The CDR rating was based on a regular clinical interview in 11 centres, a structured interview in 4 centres, and either a regular or structured interview in 3 centres. The CIRS-FP assesses effect of cognitive impairment on daily functioning in the domains of memory, language, executive function/problem solving, praxis/visuoconstruction and attention/concentration (see http://www-np.unimaas.nl/scales/cirs). In order to pool data from centres that used different scales, a variable of mild functional impairment will be used that reflects a similar degree of impairment on each scale. Mild functional impairment on the CDR was defined as a CDR sum of boxes score of at least 1.5 or a score of 1 in one of the CDR boxes, on the GDS it was defined as a score of at least 3, and on the CIRS-FP as a rating of at least mild impairment in the memory domain. The overlap in the definition of mild functional impairment according to different scales was good [76% for the overlap between CDR and GDS (n = 294, χ2 = 39, p < 0.001), 67% for the overlap between CDR and CIRS-FP (n = 688, χ2 = 68, p < 0.001) and 79% for the overlap between GDS and CIRS-FP (n = 290, χ2 = 56, p < 0.001)].
Instrumental activities of daily living (IADL) or activities of daily living (ADL) function was measured with the Blessed Dementia Rating Scale (3 centres) [10], the Lawton IADL scale (9 centres) [11], the Katz ADL scale (8 centres) [12], the Alzheimer's Disease Cooperative Study ADL scale (1 centre) [13], the Bayer ADL or self-rating Bayer ADL scale (3 centres) [14], the Bristol ADL scale (1 centre) [15] or the Barthel Index (2 centres) [16]. Four centres did not use any IADL or ADL scale. In order to pool data from centres that used different scales, individual items that assessed the same activities will be pooled, and the number of IADL or ADL items impaired will be used as a predictor.
Non-cognitive symptoms were measured with the Neuropsychiatric Inventory (13 centres) [17], or the Behave-AD scale (1 centre) [18]. Depression severity was measured with the Hamilton Depression Rating Scale (HDRS, 5 centres) [19], the Montgomery Åsberg Rating Scale (MADRS, 4 centres) [20], the 15-item Geriatric Depression Scale (GDS-15, 7 centres) [21], the Cornell Scale for Depression in Dementia (Cornell, 4 centres) [22] or the Centre of Epidemiological Studies depression scale (CES-D, 1 centre) [23]. One centre did not use any depression rating scale. In order to pool data from different depression scales, we dichotomized scores for clinically significant depressive symptomatology on each scale. These cut-offs were a score >13 on the HDRS [24], a score >14 on the MADRS [24], a score >7 on the GDS-15 [25], a score >10 on the Cornell [22] and a score >24 on the CES-D [26].
All centres performed cognitive testing but the cognitive tests administered varied. In 18 centres, a standardized protocol was administered by a neuropsychologist in all patients. In 2 centres, tests were administered by a physician as part of the clinical assessment. We selected for each centre a primary test for verbal memory, language, attention and executive function, and visuoconstruction, which was identical or similar to tests used in other centres. We also selected alternative tests for each primary test in case subjects had missing data for the primary test. The primary tests selected for each domain are listed in appendix 3. Raw scores were converted to age-, education-, and gender-corrected z-scores according to normative data of healthy control subjects, and these z-scores were used for further analysis. If possible, the same normative data set was used in each centre (see appendix 3). Neuropsychologists were also asked to give a global rating of the cognitive impairment in the domains of memory, language, executive function/problem solving, praxis/visuoconstruction, and attention/concentration using the CIRS-cognitive part (see http://www-np.unimaas.nl/scales/cirs).
MRI was the primary imaging modality in 9 centres, computed tomography (CT) in 9 centres, and single photon emission computed tomography (SPECT) in 2 centres. In addition, SPECT imaging was performed on a regular basis in 4 other centres as well. Neuroimaging markers of predementia AD that were tested include medial temporal lobe atrophy and white matter lesions on MRI or CT using qualitative rating scales [27, 28]. On SPECT scans, perfusion was investigated as a marker of predementia AD.
Q-EEG was performed in 5 centres. Frequency band analysis was used to identify markers of predementia AD.
The apolipoprotein E genotype was determined at baseline in 17 centres. APOE genotype was determined on genomic DNA extracted from EDTA anticoagulated blood using the polymerase chain reaction technique. In a subset of subjects, DNA was stored for future analysis.
Each centre provided data on the routine biochemical and haematological laboratory data. In addition, serum and plasma were collected and stored at −80°C for further analysis in 13 centres. Planned analyses include measurement of β-amyloid 1–42 and 1–40 in plasma.
CSF was collected in 9 centres. Planned analyses include measurement of β-amyloid 1–42, total τ, and τ phosphorylated at threonine 181.
In 19 centres, subjects were reassessed annually for 2–3 years. The follow-up assessment consisted of a standardized questionnaire about cognitive complaints, non-cognitive symptoms, current drug use, medical disorders, physician attendance and hospitalization in the period after the previous assessment. In addition, the MMSE and clock-drawing test were scored, and the same scales for functional impairment and IADL/ADL and cognitive tests used at baseline were administered. In case of possible dementia, further diagnostics were performed, including a physical examination, assessment of depression severity, and laboratory and neuroimaging investigations where appropriate. If a subject refused to attend the follow-up assessment or a follow-up assessment could not be arranged, a telephone interview was conducted that included the same standardized questionnaire as described above, the CDR, and the Telephone Interview for Cognitive Status [29]. In 1 centre, the follow-up was conducted according to routine clinical practice. Subjects from this centre who were not seen at follow-up were contacted 2 years after the baseline assessment by telephone, as described above.
Dementia was diagnosed according to the DSM-IV criteria [30], AD was diagnosed according to NINCDS-ADRDA criteria [2], vascular dementia according to NINCDS-AIREN criteria [31], Lewy Body dementia according to the McKeith criteria [32], and fronto-temporal lobe dementia according to the Neary criteria [33].
Clinicians were asked to make the diagnosis at follow-up blinded to data collected at baseline, but in some centres clinicians had access to baseline cognitive and neuroimaging data. Therefore, an endpoint committee, blinded to the baseline assessment data, will review all clinical diagnoses. Each follow-up diagnosis will be reviewed by 2 members of the endpoint committee. If this diagnosis disagrees with the diagnosis provided by the centre, other members of the endpoint committee will review the case. The final diagnosis will be established by consensus. If no consensus can be obtained, the subject is considered not demented.
The main outcome measure will be conversion to AD-type dementia according to the NINCDS-ADRDA criteria of probable or possible AD at follow-up. As many subjects with predementia AD will not progress to AD-type dementia during the follow-up period of 2 years [34], a secondary outcome measure will be used which includes subjects with AD and non-demented subjects with amnestic mild cognitive impairment (MCI) at follow-up. These non-demented subjects with amnestic MCI are supposed to be at a higher risk of AD at longer follow-up intervals.
In case of missing data, investigators were asked to specify the reason why data were missing. Prespecified reasons for missing data were patient refusal, technical problems, data not in the centre's standard protocol, contraindication for assessment and lack of time.
Criteria for predementia AD will be developed in several ways. First, a prediction rule will be constructed using logistic regression models and receiver operating characteristic curves. Variables will be entered stepwise in the order in which they are collected in the diagnostic work-up, so variables that can be easily obtained are entered first (e.g. demographics) while variables that are more difficult to obtain (e.g. CSF measures) are entered later. To reduce the number of variables, only variables will be entered in the analysis that are different between subjects with or without probable or possible AD at follow-up on univariate tests at a p value of 0.10 or less. After each step, it will be determined which variables in the model can be left out without reducing the overall predictive accuracy. The final model will consist of variables that are retained in the model after each step. This model will be converted to a prediction rule [35].
Secondly, a non-guided forward stepwise logistic regression model will be applied [36]. In the first step, variables that are different between subjects with or without AD-type dementia at follow-up on univariate tests at a p value of 0.10 or less will be entered. Analysis will be undertaken in different sets of subjects, as not all data are available for all subjects. In this way, the shortest diagnostic algorithm with a good predictive accuracy (AUC >0.85) will be established. Thirdly, the Predementia Alzheimer's Disease Scale (PAS) will be scored [5]. The PAS is a scale, which consists of 6 markers of predementia AD. It will be determined which cut-off score can best differentiate between subjects with or without predementia AD. In addition, the PAS will be adjusted or extended with other variables if these variables are predictive on univariate tests. In addition, the dataset will be used to cross-validate other diagnostic algorithms for predementia AD [3].
We planned to enrol 800 subjects, of which it was estimated that 20% would progress to AD-type dementia after 2 years. Taking into account a loss to follow-up of 15%, the number of subjects developing AD-type dementia was estimated to be 136. This number would be sufficient to allow 14 variables in a multivariate analysis, according to the guideline that the number of variables in such an analysis should equal the number of subjects in the smallest outcome group divided by 10 [37].
A total of 893 subjects met inclusion and exclusion criteria. Of these, 881 subjects (99%) agreed to participate in the study. The number of subjects enrolled was higher than planned as we allowed participation of centres that joined the EADC after the start of the study. Subjects who refused (n = 12) were younger (65.4 vs. 70.3 years, p = 0.02) and had less years of education (7.7 vs. 10.4 years, p = 0.02) than those who participated. Gender did not differ between the 2 groups. The number of subjects per centre was between 10 and 113 (average 44). The majority of the subjects were prospectively enrolled (n = 835, 95%). The other subjects were retrospectively identified from an existing database. A selection of the baseline characteristics is shown in table table1.1. Subjects were on average 70.3 years old and had 10.4 years of education. About two thirds had been referred by a physician (mainly the general practitioner), while one third were self-referrals or had been referred otherwise; 76% of the subjects came to the memory clinic with an informant. Overall cognitive impairment as measured with the MMSE was mild, and 93% of the subjects had a CDR overall score of 0.5. Depression at baseline was present in 11% of the subjects.
Data on medical history were available for 871 (99%) of the subjects (table (table2).2). A history of hypertension in 45% of the subjects was the most frequently reported comorbidity, followed by hypercholesterolemia (35%), an atherosclerotic disorder (22%) and depression (21%). A history of hypothyroid or hyperthyroid dysfunction was reported in 109 subjects (12%, 3 subjects reported a history of both hypo- and hyperthyroid dysfunction), of whom 73 (67%) received pharmacological treatment at the time of the baseline assessment. Diabetes mellitus was reported in 93 subjects (11%), of whom 60 (65%) received pharmacological treatment at the time of the baseline assessment.
Cognitive tests had been performed in 862 subjects (98%). The reason for no cognitive data was refusal in 3 subjects, physical limitation in 1 subject, administrative error in 1 subject and was unknown in 14 subjects. The z-scores of the primary cognitive tests are shown in table table1.1. Delayed recall was the most impaired and visuoconstruction the least.
CT scans were performed in 314 subjects at baseline, MRI scans in 435 subjects, SPECT scans in 154 subjects and Q-EEG in 198 subjects. CSF was collected in 193 subjects. The results of these assessments will be reported separately.
We noted marked differences in baseline characteristics between the centres. For example, the average age ranged between centres from 66 to 74 years, the average number of years of education from 7 to 14.1, the average MMSE score from 24.4 to 29.1 and the average z-score of the delayed recall test from −2.63 to −0.05 (table (table33).
We described the outline of a study, which aims to develop evidence-based criteria for predementia AD, and we presented baseline characteristics of the subjects included in the study. The main features of the study design were that we used a combination of variables to develop diagnostic criteria, selected subjects who were representative of the clinical population in which criteria would be used, and followed routine clinical practice.
We selected consecutive newly referred subjects to a memory clinic older than 55 years who were not demented and had no obvious cause of the cognitive impairments. We did not require subjects to have a specific degree of cognitive or functional impairment, because predementia AD can present without cognitive or functional impairments in up to 60% of subjects [38,39,40]. While broad inclusion criteria will include all subjects with predementia AD, the disadvantage is that the conversion rate to AD-type dementia is lower than if stricter inclusion criteria were used. However, the large number of subjects included will allow multivariate analysis of markers of conversion with sufficient statistical power.
We followed routine clinical practice in order to generate criteria that may have a generalized clinical applicability. We noted a substantial variation in scales and cognitive tests used between the centres. This variation may partly be explained by differences in setting as, for example, psychiatrists may prefer other depression rating scales than neurologists or geriatricians. In addition, the variation may reflect the fact that we included centres from different countries, as in some countries tests and scales are being used that have been validated and for which norms are available in that country. The variation in scales and tests is a challenge for the pooling of data. For cognitive data, we will use age, education and gender-corrected z-scores, as it is assumed that the z-score indicates a similar degree of impairment in a cognitive domain, even if different tests have been used. In a similar way, scores on depression scales and scales for functional impairment will be dichotomized according to equivalent cut-offs on each scale. Not all variables could be collected in all centres as part of regular patient care. This implies that criteria for predementia AD that would require MRI imaging or CSF sampling, for example, may not be applicable in these settings. We will approach this problem by developing a diagnostic algorithm with a stepwise approach, so variables that can be easily collected in clinical practice should be scored first [5].
A number of other large prospective clinical multicentre studies in non-demented subjects with cognitive impairments have been conducted. Some of these studies aimed to investigate markers of predementia AD, such as the Prediction for Alzheimer's Disease (PréAL) study in France [41], the prospective MCI study of the Italian Interdisciplinary Network on Alzheimer's disease (ITINAD; [42]), and the Competence Net Dementias study in Germany, while other studies were not designed for this purpose but still could be used for this such as the Canadian Collaborative Cohort of Related Dementias (ACCORD) study in Canada [43] and the Alzheimer's Disease Neuroimaging Initiative (ADNI) in North America [44]. In addition, a number of drug trials in subjects with MCI with a follow-up of at least 1 year have been conducted, and these studies may also be used to test markers of predementia AD [7, 39, 45, 46]. A selection of the design characteristics of these studies is shown in table table4.4. It can be seen that all studies except the ACCORD study used more restrictive inclusion criteria than the DESCRIPA study. In addition, most studies used additional criteria for excluding subjects with possible dementia at baseline, for example with an MMSE score or a score on a scale for functional impairment. We did not apply such a cut-off as we intended to include subjects who were not demented according to clinical judgment, even though it is possible that the threshold for diagnosing dementia could vary between centres.
The characteristics of the subjects included in the DESCRIPA study indicates that very mild to mildly impaired subjects were included. Vascular, endocrine and psychiatric comorbid disorders were common even though we excluded subjects in which comorbid disorders were considered the main cause of the cognitive impairments. We will investigate whether these comorbid disorders may influence outcome at follow-up. The baseline characteristics are comparable to those from other prospective clinical multicentre studies in non-demented subjects with cognitive impairments, as shown in table table55.
We noted substantial differences in baseline characteristics between centres. This may reflect differences in referral patterns and settings between the centres. It is also likely that as a result the conversion rate to AD will vary substantially between centres. We will investigate to what extent this variation in baseline characteristics influences the diagnostic accuracy of criteria of predementia AD in each centre.
The study had some limitations. The follow-up period of 2–3 years is relatively short as it may take up to 10 years before subjects with predementia AD convert into AD-type dementia [34, 47, 48]. Using the diagnosis of AD-type dementia at the 2- or 3-year follow-up as the outcome measure may therefore lead to a false-negative diagnosis of predementia AD in a number of subjects. Therefore, we will also use a composite outcome measure including subjects with AD-type dementia and non-demented subjects with amnestic MCI, who are at a high risk of progressing to AD-type dementia at longer follow-up intervals. We also plan to extend the follow-up period to 5 years.
In subjects who refuse to come for the follow-up, a telephone interview instead of a personal examination will be conducted, and this may yield inaccurate information on current cognitive status. We will therefore repeat analysis after exclusion of subjects in which the diagnosis was based on a telephone interview. Another limitation is that not all variables will have been collected in all centres, which limits the power of some of the multivariate analysis. In addition, the different scales and tests used may not be equivalent. However, this variability reflects clinical practice, and by allowing this the results may be easier to implement.
In conclusion, there is an urgent need to diagnose AD before subjects reach a diagnosis of dementia, and the DESCRIPA study has been designed to contribute to the development of evidence-based criteria for predementia AD.
The project has been funded by the European Commission as part of the 5th Framework Programme (QLK-6-CT-2002–02455). The centre in Bucharest received support from the Ana Aslan International foundation. We would like to thank Nico Rozendaal for his help with the design of the database and data management. We would like to thank Alzheimer's Disease Neuroimaging Initiative [ADNI; Principal Investigator (PI): Michael Weiner; NIH grant U01 AG024904] research group and the Competence Net Dementias study research group for providing data in table table5.5. The ADNI was funded by the National Institute on Aging and the National Institute of Biomedical Imaging and Bioengineering (NIBIB), and received contributions from other organizations as listed at www.adni-info.org. The Competence Net Dementias study received funding from the Federal Ministry on Education and Research (www.kompetenznetz-demenzen.de).
Department of Psychiatry and Neuropsychology, University of Maastricht, The Netherlands [F.R.J. Verhey (PI), P.J. Visser (co-PI), I. Ramakers].
LENITEM – Laboratory of Epidemiology and Neuroimaging & Telemedicine, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy [G.B. Frisoni (site PI), C. Geroldi, M. Belussi].
Department of Neurology, Alzheimer Centre, VU Medical Centre, Amsterdam, The Netherlands [P. Scheltens (site PI), P.J. Visser, L. van de Pol].
NVS Department, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden [L.-O. Wahlund, B. Winblad (site PIs), Y. Freund-Levi, V. Jelic, A.-C. Tysen].
Institute National de la Santé et de la Recherche Medicinale INSERM U 888, Montpellier, France [J. Touchon (site PI), F. Portet, M. Messaoudi].
Aristotle University of Thessaloniki, Memory and Dementia Centre, 3rd Department of Neurology, G. Papanicolaore General Hospital, Thessaloniki, Greece [M. Tsolaki (site PI), C. Pornari, F. Fotiadou].
Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Sweden [L. Minthon (site PI), A. Wallin, J. Mauritzson].
Department of Internal Medicine and Clinical Gerontology, Toulouse University Hospital, Toulouse, France [B. Vellas (site PI), P.-J. Ousset].
Fundació ACE, Barcelona, Spain [M. Boada (site PI), M. Buendia].
Clinical Neurophysiology Unit, Department of Endocrinological and Metabolic Sciences, University of Genoa, Genoa, Italy [G. Rodriguez (site PI), F. Nobili, N. Girtler, C. De Leo, A. Brugnolo, B. Dessi].
Division of Geriatric Psychiatry, Zentralinstitut für Seelische Gesundheit, University of Heidelberg, Mannheim, Germany [L. Frölich (site PI), M. Damian, S. Schwarz, M. Syren, C. Knorr, S. Thorvaldsen].
Kingshill Research Centre, Swindon, UK [R. Bullock (site PI), A. Marriott].
Department of Geriatrics, Hopital Broca, Paris, France [A.-S. Rigaud (site PI), H. Lenoir].
'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania [L. Spiru (site PI), I. Ioancio].
Department of Neurology, Kuopio University Hospital, Kuopio, Finland [H. Soininen (site PI), T. Pirttilä, co-investigator, M. Hallikainen], and Department of Radiology (R. Vanninen).
Department of Geriatrics, Radboud University Medical Centre, Nijmegen, The Netherlands [M. Olde-Rikkert (site PI), M. Verbeek, R. Esselink, R. Kessels, J. Claassen, R. Melis, M. Vernooij-Dassen].
The Research Institute for the Care of Older People (RICE), Bath, UK [R. Jones (site PI), J. Mann, J. Gifford].
Department of Care of The Elderly, University of Bristol, Frenchay Hospital, Bristol, UK (G. Wilcock, J. Haworth, P. Kehoe).
Alzheimer Memorial Centre and Geriatric Psychiatry Branch, Dementia and Neuroimaging Section Department of Psychiatry, Ludwig-Maximilian University, Munich, Germany [H. Hampel (site PI), S. Teipel, M. Ewers, K. Bürger, M. Omerovic].
Institute Born-Bunge, ZNA Middelheim, University of Antwerp, Belgium [P.P. de Deyn (site PI), S. Engelborghs, J. Saerens, N. Le Bastard, M. Van Buggenhout].
|Inclusion criteria
|Exclusion criteria
|Number of centres
|Reference for normative data used1
|6 centres [50], 1 centre [51], 1 centre [52], 1 centre locally collected norms
|Word list of CERAD neuropsychological battery [53]
|2 centres [54], 1 centre [55]
|Hopkins Verbal Learning Test [56, 57]
|2 centres [54], 1 centre locally collected norms
|Grober-Buschke Test [58]
|ADAS-Cog 10-word list [60]
|Selective Reminding Test [61]
|Locally collected norms
|Logical Memory Test [62]
|1-min verbal fluency for animals [63]
|2-min verbal fluency for animals [64]
|1-min verbal fluency for fruits, animals or car types [65]
|1-min fluency for words starting with 'F', A' and 'S' [66]
|Locally collected norms
|Attention and executive function
|Time to complete Trail Making Test parts A and B [67]
|18 centres [54], 1 centre [55]
|Copy of the Rey-Osterrieth complex figure [68]
|Copy CERAD figures [53]
|2 centres [54], 1 centre [55]
|Copy figures from the AMIPB [70]
|Locally collected norms
|Copy figures subtest from the MDB [52]
|Cube analysis test of the VOSP [71]
|Locally collected norms
RAVLT = Rey Auditory Verbal Learning Test; CERAD = Consortium to Establish a Registry for AD; AMPIB = Adult Memory and Information Processing Battery; MDB = Mental Deterioration Battery; VOSP = Visual Object and Space Perception battery.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


text:
The Brattleboro Selectboard took up a number of somewhat ordinary agenda items at their postponed regular meeting Monday evening. Facility updates, grants, certificates of mileage, parking lot contracts and other mundane matters were handled with ease. There was a minor TIF tiff, too.
The high points, perhaps, were discussions of solar net meter credits, the new energy coordinating volunteer position, and news that the most recent storm broke our sidewalk plow.
I confess. The first 15 minutes or so were missed due to a streaming glitch, which had me reloading web pages and talking with Vlasta at BCTV. She and Roland got things working again quickly.
I'm guessing that there was some mention of snow in addition to the approval of minutes, after which we joined the meeting in time for the first official agenda item.
Police and Fire Facility Projects Update
Town Manager Peter Elwell gave the board his regular update on progress at the three facilities projects.
The West Brattleboro Fire Station has been used for a meeting of the building committee. Finishing work will take place over the next couple of weeks, a blower test will be held soon, and the Fire Department will soon be moving in to their new station. A ribbon-cutting and dedication will be held in once it warms up and after the old station comes down.
At Central Fire Station, steel was delivered a bit late but with no significant consequence to the schedule, and the steel frame is now being assembled. The building should be done in November of 2017.
Work to prepare the tenant space for the Brattleboro Reformer continues and is expected to be completed in early March. A bit of interior demolition work is going on in the space for the police and work will ramp up once the Reformer moves in.
Trivia fans can note that office furniture for the Central Fire Station comes from the Vermont Department of Corrections' furniture making program at a cost of about $7,000.
Approve 2017 Certificate of Highway Mileage
Department of Public Works Director Steve Barrett told the board that every year they send the State of Vermont a verification of Brattleboro's road classification and number of miles. "It verifies classification and number of miles, and that's used to distribute state aid."
Usually this document has few changes, he explained, but in the last year Brattleboro has discontinued .10 miles of Minshall Street to become a Town Trail, and Wickopee Hill Road was reclassified from a Class 3 to Class 4 highway.
Brattleboro now has 6.42 miles of Class 1 highway, 13.89 miles of Class 2 highway, 64.64 miles of Class 3 highway, and 22.207 miles of state highway, for a total of 107.527 miles in town.
We have 7.83 miles of Class 4 roads, and .10 miles of Legal Trail.
Kate O'Connor asked how the state aid was determined. Barrett said that each year the state determines a budget, and we get a percentage for each mile depending on how the road is classified. He added that this year's changes were minor and would vary the state aid by small amounts.
Engineering Services for Parking Lot Improvements
Stevens & Associates received $27,000 for design, bidding, and project oversight of parking lot improvements. Harmony Lot, Preston Lot, Harris Lot, and parking at Gibson-Aiken are included in the project.
Patrick Moreland explained the contract is about 9% of the $300,000 to be spent on parking improvements this year, which he said was a reasonable amount to spend to make sure all projects are managed well.
David Gartenstein, David Schoales, and Dick DeGray all had questions about why the contract being presented hadn't been put out to bid.
Officially, there is no requirement that professional services be put out to bid, and in this case, the Town staff felt Stevens & Associates were well-qualified, knew the parking lots well, and understood the retaining wall and Harmony Lot.
Elwell also noted that there wasn't much time to gather bids this time around if the board expected the work to be done this season at a reasonable cost. He suggested future contracts such as this could be put out to bid with proper lead times built in to the schedule.
The board generally liked the idea of future bidding, and approved the contract.
Sidewalk Plow Breakdown
Steve Barrett wanted the public to know that the sidewalk plow broke today, causing a delay in plowing while a chain drive was repaired. The plow is back in action, he said, but with the snow blowing attachment it might take a bit longer than usual to get all the sidewalks clear.
Brattleboro used to have three sidewalk plows.
John Allen asked why Maple Street sidewalks weren't cleared. Barrett said it had been, but was removed from the plow list during budget cuts in previous years.
Sky Solar Net Metering Agreement
Brattleboro will purchase solar net metering credits through the Windham Solid Waste Management District Group Net Metering project (WSWMDGNMP, for short.) The Brattleboro Selectboard voted to authorize the Town Manager to enter into the agreement.
Town Attorney Bob Fisher endorsed the contract he had worked on. He said the price is $0.139 per kWh for the 18 largest municipal electric agreements, and is expected to save $86,000 in the first year, though the rate may go up or down if the market price for electricity changes.
Being located in Brattleboro, the solar array is expected to generate an additional $57,000 of tax revenue, and may help stabilize the finances of the WSWMD.
Tad Montgomery asked what percentage of Brattleboro's electric load was covered in the agreement. No one knew for sure, but there was a guesstimate of perhaps 20%, and he was told they would get the precise number to him.
Montgomery asked if the energy credits could be transfered within town accounts, and was told they could be re-allocated. He suggested the Town increase the percentage of credits.
Right of First Refusal - 1037 Western Avenue
Brattleboro has a right of first refusal on the property at 1037 Western Ave. The property owner has received a bona fide offer, so the Town must decide if it should be purchased ($400,000), or release the right and pass on the offer.
This property is adjacent to the A.W. Richards Housing at 1063 Western Ave., and Brattleboro's legal interest stems from earlier partnerships and transactions at the location.
The decision was quick. "Does anyone want to buy it?" asked Gartenstein. Fellow board members remained silent.
The board chose to pass on the offer of purchase and allow the sale by Brattleboro Real Estate Investments to the other buyer, Yitzchok Raskin.
Volunteer Energy Coordinator Position
Brattleboro's Energy Coordinator position has been vacant for some months now. To help keep project momentum, the Energy Committee's Chair Michael Bosworth and Town Manager Elwell drafted a volunteer energy coordinator position description.
Kate O'Connor wanted it to be clear that this was not a Town employee, but a citizen volunteer. Elwell said that by having the board appoint, rather than hire, it helps to keep that important distinction.
David Schoales was against this, arguing instead for a stipend to go with the position. "I hope Representative Town meeting will vote to go back to what we had."
Tad Montgomery reminded the board that the Energy Committee endorsed the idea of a paid position, either full or part time, or a volunteer with a $10,000 stipend. The paid element was essential to be able to hire someone to help get grants. He also suggested sharing job descriptions with Hartford, VT, when the time comes, as they had hired someone full-time as an Energy Coordinator.
Elwell explained that this position allows for a someone to volunteer immediately, and still allows for later consideration of a part-time or full-time position by the board. "The full gamut will be reviewed in the months ahead. This is a quick way to see if a volunteer can step forward for a while."
The Selectboard approved of the position description 4-1, Schoales against, and is now taking applications from those who'd like to be considered.
Tax Increment Financing
The Brattleboro Selectboard joined Brattleboro Development Credit Corporation (BDCC) in advocating for Brattleboro's access to the State of Vermont's Tax Increment Finance (TIF) Program. BDCC paid $5,000 to join a consortium hoping to lobby the state to make the TIF district more widely available.
Town Manager Elwell explained that the TIF program allows for towns to form special tax districts to promote development. Increased taxes in the district from economic development could then be used for municipal infrastructure projects related to that development.
There's no immediate need for such a district, and it would take a lot of work to implement, said Elwell. Still, staff recommended advocating for the district in order to be able to use it in the future, if a situation arises where it would make sense.
Adam Grinold of BDCC said that "a TIF may not be needed today, but we see it as a necessary tool for future projects. We can't anticipate that a developer will spend time to arrange for a TIF district [on their own] - It needs to be on the shelf ready for them."
DeGray asked some specifics about a Brattleboro TIF district, but was generally told that the answers will not be known until the state allows for exploration of TIF districts.
He was told that the Town would likely set a boundary for a district, and that the difference in tax income from the property due to new improvements would be applied to infrastructure improvements related to that project for some undetermined period of time.
David Schoales and Kate O'Connor felt it smart to offer an endorsement of BDCC's TIF efforts. "It's good to be in solidarity with towns that want to do this," said O'Connor. "We'll need them [when we want hub town help]. There's nothing negative about it."
Gartenstein said he wouldn't support BDCC because BDCC had made "no efforts to help the Town with regional economic hub issues." He didn't see the need for a TIF in Brattleboro.
Grinold disagreed that BDCC had done nothing for the Town, pointing to growth in the Grand List. Gartenstein reiterated that he was talking specifically of regional economic hub issues.
BDCC got their support 3-2, with DeGray and Gartenstein against.
Interlibrary Loan Courier Grant
Brattleboro accepted $180 to help fund interlibrary loan courier expenses.
Elwell introduced the agenda item. "It's a $180 grant..."
"I'm ready for a motion," said Gartenstein.
The funding comes from the Vermont Department of Libraries. Green Mountain Courier is used for delivery.
Small grants don't need the board's approval for application, but sometimes receiving a grant requires the board to take action to accept and appropriate it, no matter how small the amount.
Aquatic Nuisance Grant
Brattleboro's Planning Department received the go-ahead to apply for a grant to fund an aquatic biologist to survey, document, and create signs regarding invasive aquatic species, specifically the water chestnut. The project will include the Connecticut River, West River, Sunset Lake and South Pond.
$3,800 toward the effort will come from the Vermont Department of Environmental Conservation Watershed Management Program, if the grant is approved. Laurie Calahan will do the work with the help of volunteers.
Other invasive species they'll be monitoring include Eurasian milfoil, curly leaf pondweed, Japanese knotweed, and phragmites.
Preventing the spread of invasive species is part of Brattleboro's Town Plan.
$950 of the grant will be matched by volunteer hours.
Committee Appointments
Ariel Nelson has been appointed to the Citizen Police Communications Committee through June 2017.

subset: commoncrawl


text:
A screenshot of the greatly revamped Windows 7 desktop, the exciting first glimpse of the new OS in the wild. (Source: Microsoft)
The start menu looks familiar, but it has some changes, including a section for frequently accessed folders. (Source: Microsoft)
Hovering over a taskbar item now generates snappy previews. (Source: Microsoft)
Getting behind the wheel of Windows 7 reveals many changes, some minor, others larger
Microsoft has been very secretive about Windows 7. While it has let leak scant details about how touch functionality will play a critical role in the new OS, more information on how the new OS ticks, and its general feel have been scarce. The Windows team has been using a blog to let out information on the new product, but the stream has been more like a slow trickle, with few concrete explanations of features.
Curiosity about the new OS is unprecedented as many people view the new OS as Microsoft's attempt to atone for the shortcomings of Vista. While Vista was a solid OS with many new features and improvements, it failed to surpass the growth of the wildly popular Windows XP and also fell short in business adoption. Analysts blamed a variety of causes from poor support from hardware partners to factually ambiguous attack ads by Apple.
Regardless, the critical nature of the release to Microsoft cannot be overemphasized.
Now for the first time, a large list of features from Windows 7 has seen the light of day, following the leak of some features a couple days ago. The biggest new feature is the taskbar overhaul. The new taskbar looks foreign indeed with no text. It is filled with icons for easy program selection. Also new to the taskbar is the option to access "jump lists" with a quick right click. For example, right-clicking the Windows Media Player icon allows you to access playlists without having to open the application or waste time fiddling with menus. Finally, hovering over items on the taskbar generates helpful previews.
When you click the desktop, all windows go transparent offering you a free view. This is helpful to glance at gadgets, which have been moved from Vista's sidebar to a fixture on the desktop. This will be helpful to laptops which have lower screen resolutions and can less afford to waste valuable screen space on a separate sidebar.
There's also a really intuitive new window scaling gimmick that you'd think would be the kind of thing that a certain smarmy Cupertino-competitor might cook up. The cool new feature expands windows which you drag up to the top of the screen, and shrinks them as you drag them down the screen. And if you want to tile multiple windows, drag them to the corner of the screen to shrink them to 50 percent, allowing easy 4x4 tiling. The feature is really neat for its seeming simplicity.
The system tray now only displays the items you select, and its been streamlined to be easier and more straightforward to configure. User Account Control, a bane of some less-experienced Vista users who were baffled by its pop ups, reappears in Windows 7, but has been streamlined and fine-tuned. This allows the user to specify by application the level of access, while offering less disruptive annoyance.
Multi-touch features were demoed on a HP TouchSmart PC in a bit more detail. The start menu expands to a large size when you're touching the screen. You can automatically scroll inside any window using your fingers. A large onscreen predictive keyboard is another easily accessible touch feature.
Multiple-monitor management has also been streamlined. Projector setup is now a hotkey-press away. Media Center has adopted a Zune-like look. It displays a new album art screensaver when you're listening to tunes.
As to those hoping for a lighter build, it looks like your dreams may come true. Windows 7 Chief Steve Sinofsky held up his "personal" laptop during the demo. It was running Windows 7 flawlessly on a 1 GHz processor netbook (probably using a VIA processor) with only 1 GB of RAM. It was running very smoothly, with over half the RAM free to use.
However, Microsoft is equally emphasizing power, with support for up to 256 CPUs.
For developers, the big news is the pre-release of the Windows 7 in the form of a API-complete pre-beta, offered to the lucky few. This should help out-the-gate hardware support to be improved from Vista's debut, a major priority for Microsoft.
In all, there's too much to sum up in fine detail, but suffice it to say Windows 7 is shaping up to look very good. Where Vista was, in opinion of some, bloated, Windows 7 offers a light frame scalable to high levels of performance. And for the daily user, as the popularity of the iPhone showed, the sharp looking and greatly overhauled user interface may be the killer app which makes Windows 7 a consumer hit and a must-have upgrade when its released in late 2009 or early 2010.


text:
Bobcats end Celts' streak
CHARLOTTE, N.C. (AP) -- Byron Mullens had 25 points and 18 rebounds, and the Charlotte Bobcats defeated Boston 94-91 Monday night to snap the Celtics' seven-game winning streak.
Kevin Garnett had 16 points and 13 rebounds for the Celtics, but missed a key 18-footer that would have given Boston the lead late in the game. Paul Pierce and Avery Bradley had chances to send the game into overtime in the final seconds, but missed open 3-pointers.
The 7-foot Mullens hit 10 of 16 shots from the field, including 4 of 5 from 3-point range. Ramon Sessions had 19 points for the Bobcats, including the go-ahead jumper from 18 feet with 25.7 seconds left. Kemba Walker had 18 points, six assists and six rebounds, and Gerald Henderson chipped in with 16 points.
Jeff Green had 18 points for the Celtics and Paul Pierce finished with 13 points, eight assists and eight rebounds.
It was a back-and-forth game throughout.
After Henderson gave the Bobcats an 85-84 lead with 3:58 remaining, Jason Terry made a 3 from the wing and Garnett followed with a turnaround jumper in the lane to push the Boston lead to four.
It appeared as though the Bobcats were on their way to another fourth quarter collapse.
But trailing by four, Henderson hit a 3-point with 1:01 left. After Avery Bradley missed an open jumper, Sessions came free off a screen and knocked down an 18-footer to give the Bobcats the lead with 25.7 seconds remaining.
The Celtics called timeout but Garnett missed an 18-footer from the left wing. Mullens grabbed his 18th rebound and the Walker made a pair of key free throws to give the Bobcats a three-point lead with 14.8 seconds left.
Boston set up an inbounds play and Pierce got an open look but missed. He grabbed his own rebound and dished out to the wing for Bradley, but he missed a 3 as time expired.
Despite coming off a triple-overtime win against Denver on Sunday night, the Celtics came out of the gates strong with solid shooting and aggressive defense to take a 48-42 lead at halftime.
As he'd planned to do before the game, coach Doc Rivers went deep into his bench in the first half with 10 players seeing at least 10 minutes of action.
The Bobcats battled back in the third quarter behind 12 points from Mullens to take a 75-72 lead into the fourth. Mullens, who scored Charlotte's first 10 points of the game, did most of his damage from outside, knocking down 3-pointers and turnaround jumpers showing great touch for a big man.
Celtics reserve guard Leandro Barbosa injured his left knee late in the third quarter and did not return. He was carried to the locker room by a trainer and teammate after collapsing near the baseline.
Clippers 107, 76ers 90
PHILADELPHIA -- Chris Paul had 21 points and 11 assists, Blake Griffin scored 20 points and the Los Angeles Clippers cruised to a 107-90 victory over the Philadelphia 76ers on Monday night.
Jamal Crawford also scored 20 points and Matt Barnes had 11 for the Pacific Division-leading Clippers. Eric Bledsoe scored 10 points while DeAndre Jordan grabbed 10 rebounds.
The Clippers closed out their season-high eight-game road trip at 4-4, including consecutive wins at New York and Philadelphia.
Los Angeles won the finale with ease without guard Chauncey Billups and forward Caron Butler. Both players were nursing sore lower backs and were replaced in the starting lineup by Matt Barnes and Willie Green.
Nick Young led the Sixers with 29 points while Jrue Holiday, Evan Turner and Jeremy Pargo had 10 each. Spencer Hawes had 10 rebounds.
If you'd like to leave a comment (or a tip or a question) about this story with the editors, please email us. We also welcome letters to the editor for publication; you can do that by filling out our letters form and submitting it to the newsroom.


text:
The Southwestern Historical Quarterly, Volume 102, July 1998 - April, 1999 Page: 113
This periodical is part of the collection entitled: Southwestern Historical Quarterly and was provided to The Portal to Texas History by the Texas State Historical Association.
- Adjust Image
- Rotate Left
- Rotate Right
- Brightness, Contrast, etc. (Experimental)
- Download Sizes
- Preview all sizes/dimensions or...
- Download Thumbnail
- Download Small
- Download Medium
- Download Large
- High Resolution Files
- Accessibility
- View Extracted Text
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
Book Reviews
With images like these, who indeed could forget the reasons writers and read-
ers and other virtual westerners keep being drawn to stories like this in the first
place? In Desperate Men, the late James Horan never loses sight of the fact that
history is preserved not only because it is important, but because it's fun.
Austin Jesse Sublett
Zane Grey: Romancing the West. By Stephen J. May. (Athens: Swallow Press/Ohio
University Press, 1997. Pp. xviii+18o. Illustrations, preface, notes, refer-
ences, index. ISBN o-8214-1182-9. $14.95, paper).
Pearl Zane Grey, of Zanesville, Ohio, wrote his first story, "Jim of the Cave," at
the age of fifteen, and not long afterward he suffered the first of what would be a
lifetime of critical attacks. When the aspiring author's overzealous, dentist father
found out that his son had indulged in such a frivolous waste of time instead of
concentrating on his dental studies, the stern patriarch ripped up the manuscript
in front of the boy and then proceeded to whip him with a carpet strip. Though
the incident may have had the intended, if temporary, effect of coercing Grey
into dentistry, it also fused in his impressionable mind the act of writing with feel-
ings of self-doubt, guilt, and shame. For the rest of his life, as Grey abandoned
dentistry and doggedly pursued what became an extraordinarily successful writ-
ing career, the author endeavored to overcome his father's ridicule while at the
same time experiencing it anew with every rejection or criticism.
Of course, self-doubt, guilt, and shame are strangers to few writers, regardless
of the level of success they attain, but Grey's remarkable ambition, according to
Stephen J. May, seemed to feed off them to an unusual degree. For May, Grey's
early experiences left him emotionally stunted, "trapped in the enthusiasms of a
fifteen-year-old," and help explain why the author "never matured beyond the
formulaic western romance and why his novels tend to be youth-driven search-
ings for an idealized and ordered world" (pp. 22-23).
Though critics have never liked Grey, his books have retained a faithful audi-
ence. In this small, well-written book, Stephen J. May seeks not to ignore Grey's
faults but to salvage for serious readers what in Grey's work deserves to be val-
ued: the author's earnest spiritual search and genuine appreciation of the
American West. "It is generally the land that saves a poorly conceived character
or an ill-drawn situation" (p. 78), May writes about Desert Gold (1913), but the
observation holds true for all of Grey's best work, the novels written between
1903 and 1925.
James K. Folsom, writing in The Reader's Encyclopedia of the American West in
1977, had these scathing words (among others) to say about Grey: "He is
remembered today primarily as the author who, almost single-handedly, suc-
ceeded in convincing the average reader that absolutely no merit can possibly be
discovered in any western writing whatever." May's volume represents a signifi-
cant step toward a more balanced consideration of one of America's most prolif-
ic and successful writers.
Indiana Historical Society
J. Kent Calder
Upcoming Pages
Here's what's next.
Search Inside
This issue can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Periodical.
Texas State Historical Association. The Southwestern Historical Quarterly, Volume 102, July 1998 - April, 1999, periodical, 1999; Austin, Texas. (texashistory.unt.edu/ark:/67531/metapth101219/m1/138/: accessed January 23, 2018), University of North Texas Libraries, The Portal to Texas History, texashistory.unt.edu; crediting Texas State Historical Association.


text:
Sals Technology & Engineering, LLC
1360 Union Hill Road, Suite 1A
Alpharetta, GA 30004
Website: www.salstechnology.com
Contact: Huy Huynh
Phone: 678-896-8476
Email: email@example.com
A Solution Provider of Clean Water using Advanced Technologies
Biography – Huy Huynh has over a 25-year of knowledge and experiences in Chemical Engineering and Sr. Level Management with large multi-national corporations, advancing with increasing responsibilities in Manufacturing & Operation (practical knowledge of the arts), Process Technology & Optimization (refinement of the arts), Design & Construction (applied knowledge of the arts), Research & Development (innovation of the arts), Global Management role as the Director Process Technology (harnessing the collective intellectual power), Executive Management role as a Sr. Director & Global Head of Manufacturing Process Optimization (delivering technologically advanced, game changing solutions), and finally as the Founder of Sals Technology & Engineering, LLC (create breakthrough technologies and transform industry). As a practicing Chemical Engineer, Mr. Huynh has successfully engaged in the engineering, procurement, construction, management and start-up of multiple brown and green field facilities in excess of 50 million USD. In his management role, Mr. Huynh directly managed diverse multi-national offices and teams in Africa, Asia, Europe and North America, with an annual department budget of 25 million USD and delivering cost benefits in excess of 200 million USD.
Mr. Huynh has expertise in the following areas:
- New product development from concept to commercialization
- Process technology and process engineering
- Engineering, procurement, construction and management
- Plant commissioning and operations
- Manufacturing and process optimization, ISO and cGMP
- Mergers & Acquisitions – assessment, valuation and integration
- Leadership and multi-cultural experiences with global management experiences
Vision – Sals Technology & Engineering's (STE) mission is to develop innovative processes, products and technologies that provide significant breakthroughs or enhancements to current and emerging challenges with water conservation, use, recycle and treatment for a wide range of platforms including point-of-use, portable, off-grid and fixed installations.
Intellectual Property – Huy Huynh has developed two patents pending for advanced water treatment processes. The DFT invention is a transformational filtration technology for solid-liquid and solid-gas separation technologies. The ACT water treatment invention is an innovative process design that provides a total solution for water treatment. The fields of science and technology used in the invention include catalysis, chemistry, electrochemical reaction, mass and energy transfer, material science, microbial control, photochemical reaction, physical chemistry, and physics that are combined with innovative process design to provide a total solution for water treatment. The invention is a departure from the standard drinking water treatment technologies commonly used today.


text:
The Islamic Movement of Nigeria has reacted to the banning of its practice in Kaduna State by Governor Nasir El-Rufai, despite the Freedom of Religion being one of the fundamental human rights every Nigerian is entitled to, according to the 1999 Constitution.
On Thursday 20 October 2016, the group said in a statement by its spokesman, Ibrahim Musa, who was declared wanted by Police,
"Kaduna State government, on Wednesday, officially released a Gazette No.21 of October 7,2016, that has declared the IMN an unlawful society. At the same time, Governor El-rufai said his government 'did not and cannot ban any religion.'
"This two-faced comment of the government of Kaduna State is not only ambiguous but also, indeed, incongruent with reason, logic, law and sanity.
"The Islamic Movement is not a society or association or organization. It is a global concept. Its members are conscious and practicing Muslims who practice Islam the way it ought to.
"Banning the IMN is akin to banning our faith or stopping us from practicing Islamic religion the way we understand it, which KDSG itself admittedly affirmed it has no right to do. To claim otherwise is incongruous."
"Governor Elrufai went to the extreme in his quest to justify this ambivalent position on the so-called ban. One moment he plays the jury and the next he acts the prosecutor at the same time.
"His comment that 'It solemnly declared unlawful a specific group that continues to threaten public order in the state' is bereft of reasons. So is his assertion that 'the IMN was never a registered organization and it refused to conduct itself with full adherence to the laws of this state.' It would be pertinent for KDSG to answer this poser: When was the IMN ever taken to a court of law and convicted of being a threat to public order?
"Elrufai's twisted imagination seeks to mischievously label IMN as violent. This is contrary to evidence anywhere anytime. Only recently, a report by a crisis monitoring group, listed 18 new armed groups that sprang up in Nigeria in the last 17 months, with many of them involved in the killings and kidnap in Kaduna. Not only was IMN not listed, but Governor Elrufai has not turned his attention to those by banning them.
"This ban order is nothing but the portrayal of Kaduna state government as intolerant of religious minorities, and if allowed to stand unchallenged by the good people of Kaduna state, it will lead to a ban on other religious minorities, especially Christians and the Muslims following the Sufi order.
"Governor Elrufai cunningly hides behind the discredited findings and recommendations of Justice Muhammad Garba Judicial Commission of Inquiry to the Zaria massacre, without issuing a white paper on it, which he promised after receiving the report. If the Governor is sincere enough in the peaceful coexistence of Kaduna state, why won't he as well prosecute the Army officers indicted by the Commission for the mass murder of at least 347 people and dumping them in mass grave secretly in the middle of the night?
"IMN rightly believes, Governor Elrufai wants to cover up his complicity in the murder of over a thousand innocent souls in Zaria."


text:
Bible Tools is a client/server program for Bible study. It's written in Python and should eventually (if not now) run everywhere Python can run. The server can even run on a separate computer, if they're connected by a TCP/IP network. You can find the current user documentation here in PDF format. Other documentation is included within the distribution package itself.
Currently there is only a command-line interface, but it's useful already either from the command line itself, or from within your favorite text editor. There are commands for loading and unloading databases as well as extracting verses or ranges of verses and searching on a string or regular expression. Another search command that performs word-oriented searches works already in rudimentary fashion, but still requires a lot of work before prime time.
New features are already started, and somewhat available for use, offer lectionary data based on the historic Christian church year. Eventually, this tool will allow the user to give a command equivalent to saying, "Give me the Epistle and Gospel lessons along with the exact date for the Sunday celebration of All Saints Day next year." Any suggestions for this interface and related functionality are welcome.
A graphical interface is planned, though it's still in the planning stages at this point. Part of the problem is that on Linux (TM), which the author uses at home, the command-line tools are almost 100% sufficient. The other part is that the author has never written a GUI nearly as ambitious as this before, and none at all in Python. It looks like wxPython (wxWindows) will be the GUI toolkit of choice. That should allow the end result to be usable across several platforms without any changes.
If you grab the CVS tree instead of downloading a distribution file, you'll get more stuff to look at. It's not all pretty, but some of it may be useful, depending on what tools and experience you have.
Here are a few links:


text:
GMF Welcome Event Picture
for Greek Mythology Family welcome event.Continue Reading: Apollo
oh and the background's like she's somewhere near the war scene and she's just chillin' and theres ash and fire and stuff.
bet most of you havent heard of her before
so she's no god, but she played some big role in the Trojan War. her role was pretty big cause like shes the reason why achilles decided not to attack greece and she did a lot more but its too long. her family got murdered by Achilles, then got kidnapped and got depressed. and then she got close to him and you know king agamemnom? apollo made him let go of some lady so for compensation, he wanted briseis. so apollo snatched her away and brought her there. and achilles gets mad cause the thinks the king bleeped her but they didnt and they sorta confess in their own ways and apollo got all soft and let them be and happily ever after. THE END
the way i put it prob doesnt make sense but frick it
(c) everything to rightful owners
cs3|bs4|brushes; dA|


text:
My son's bedding came in!
View Single Post
December 19th, 2008, 01:28 PM
Join Date: Oct 2008
Posts: 5
That bedding is sooo cute!!! DF looks so proud! I bet it really feels real to him now!
I like your idea of the white stripe 2/3 of the way up, with two different colours. That sounds really nice, neat, crisp and fresh. I can't wait to see it all put together. The mural sounds nice as well, I think you should wait until the painting is all done and then decide what you want to do. Just incase you want to change your mind, you know?
The furniture is beautiful, by the way. Are you getting all the accents to go with the bedding? Like, the lamp, light switch, etc.? What kind of flooring for you have for the nursery? Carpet, wood?
These bedroom setups are so cute. I came here looking for some additional ideas as I am in the midst of setting up a nursery for my son. I have definitely come away with some great ideas so thanks everyone! Have you heard of this cool product review site, ExpoTV? It's a cool site where you can make money by posting video reviews. The marketing company I work for is actually doing a campaign for them. It's great for learning about new products as well as making money for reviewing products you own. You can check it out at:
View Public Profile
Find all posts by MammaSaid


text:
This product is described as a smile brightening lip shine. The subtle blue sheen is supposed to make your teeth appear whiter. By subtle blue sheen they mean tiny blue sparkles. I like that it has a minty scent, and makes your lips tingle. It feels very moisturizing and stays on for a long time. My only complaint is that the sparkles stick to your lips – as sparkles tend to do – and they're hard to get rid of. I am not sure if it actually makes your teeth appear whiter, but that aside, it is a nice gloss. I'm not sure if it's worth the extra money considering its not terribly more special than a regular gloss, but I do like it.
I actually got this product for free in a gift bag, but I was intending to buy it anyways.
It seems like a regular lip gloss (in a rather odd color) but it's actually so much more.
The price seems like a bit much for lip gloss and I do agree that I wouldn't spend that much on it unless it was really special.
The blue is very subtle and is meant to make your teeth appear whiter. I was skeptical but when I put it one, my lips didn't seem blue at all, but my smile did seem whiter! I asked one of my friends to try it and it happened to her too. Also, the lip gloss has a minty smell which keeps your breath smelling fresh.
It can be worn above of below lipstick and also has a fun packaging (as all Benefit products do).
Plus it isn't sticky!
I love this lip gloss and I would recommend it to anyone!
These reviews are the subjective opinions of ChickAdvisor members and not of ChickAdvisor Inc.


text:
The ShockStop is an intelligently designed bicycle handlebar stem suspension accessory that is designed to absorb energy when you're riding over bumps tin the road.
While shock-absorbing handlebar stems are perhaps most closely associated with mountain biking, the ShockStop is targeted towards regular road biking, which is why it isn't designed to completely eat up massive hits but is rather capable of swallowing minor bumps and vibrations. This handlebar stem makes a clear difference to your ride, gently absorbing vibrations associated with asphalt roads. The system is currently available for preorder for a price of $109, a significant saving over the eventual expected retail price of $139.
By reducing your forearms' own impact as a result of vibrations and bumps, the ShockStop helps you move faster while reducing your chances of suffering numbness and fatigue.
Shock-Absorbing Handlebar Stems
More Stats +/-
Compactly Versatile Multi-Tools
Powerful Bike-Upgrading Kits
Pedal-Mounted Turn Signals
Portable Pneumatic Casts
Updated Urban Scooters
The ShockStop Absorbs Bumps and Vibrations On City Roads
- By: Rahul KalvapalleSep 27, 2016
References: redshiftsports & newatlas
References: redshiftsports & newatlas


text:
Get your child ready for starting school with fun and friendly characters Bip, Bop, and Boo. This workbook is filled with fun activities to help them explore and learn all about shapes and sizes.Children will practice recognising shapes, describing their properties, Read more
Format:Board book
Part of DK's successful My First board book series, My First Shapes features images with clear labels and was created with a preschooler's stage of educational development in mind.Preschoolers can learn about all different shapes in My First Shapes, an informational Read moreAlso available in eBook
Format:Board book
Learn all about shapes with DK Braille Shapes. Designed especially for visually-impaired pre-school children and their parents, this touch-and-feel book takes readers through a collection of cut-out shapes with high-gloss and embossed tactile finishes. Each shape is Read more
Help your child get the right skills for starting school with Colours and Shapes. Support your little ones first steps in early learning and let them match the coloured socks, join the dots and spot the difference.Skills for Starting School is a new series of Read more
Help your child get the right skills for starting school with Matching and Sorting. Support your little ones first steps in early learning and let them match animal groups, sort busy beetles and play with patterns.Skills for Starting School is a new series of Read more
Get ready to play, get ready to learn, get ready for school with Colour Match games Get Ready for School Colour Match Games supports your child's learning development through the early years. These games guide your child's early learning and help you get them Read more
Format:Board book
Teach your child all about shapes and early geometry with Touch and Feel ShapesTwinkly, bumpy, scaly, silky, sandy, sticky and shiny textures in a chunky package will help your child discover and enjoy early geometry. Help them learn about stars, triangles and squares, Read more
Help your baby learn all about playtime with this ebookNow in ebook format, this is a static, generic epub. Your child will love finding the hidden toys.Read them with your baby, they'll love the fun playtime images - perfect for reading aloud and encouraging early Read more


text:
Gisele Bündchen nude in photos from Vogue Paris. See more of Gisele nude here.
Dutch Treat Strain Review
Name: Dutch Treat
Dispensary: Apothecary 420 (Sherman Oaks)
Grade: B+
Type: Mostly Indica (About 80% Indica, 20% Sativa)
Lineage: Unknown
Price: $20/gram, $60/8th
Looks: Spongey, furry nugs in fingerling shapes. Pale green buds with a few light brown hairs and moderate trichome coverage. Dank and sticky.
Smell: A sweet and sour, citrusy scent. Smelled faintly of cheese. The aroma was reminicient of Trainwreck and Sour Patch Kids.
Taste: A sweet and sour flavor similar to Sour Patch Kids. Smooth vapor with moderate lung expansion. Smooth vapor with moderate lung expansion.
Buzz: Mellow, relaxing stone. Spacey, mildly euphoric and moderately sedating with a comfortable body buzz. Numbing sensations were noticeable around my face. Best for the evening.
Summary: An excellent tasting Indica with a relaxing, stoney buzz. I prefer strains that are more clear headed.
Olivia Wilde nude (Topless! HD!) in a compilation of sex scenes from Deadfall. See Olivia's sex scene from Alpha Dog here.


text: And they run a freaking marathon. After a loooooooooooooooooong grounding from the Internet, many many talks/lectures about appropriate social media behavior, etc, difficult child was, a few days ago, given permission to use the computer. She wanted to play on MovieStarPlanet. She was told ok, but only to play with the outfits and stuff, no chatting. I just discovered that she has been posing as a boy and messaging with girls pretending to "date" them. Just when we were talking about getting her a phone (with Watchdog software installed, of course) again. I'm so annoyed that the FIRST THING SHE DOES when given a teensy bit of privilege is to abuse it! WTH??? Back to no computer, I guess. This child is her own worst enemy.


text:
Images of Chinese flowers – A collection of beautiful and colorful flower images taken with a macro lens. Yunnan Province, Southern China.
Table of Contents
Pictures of flowers of Yunnan taken with a macro lens and a Nikon camera.
Pictures by Matteo Damiani
Enter your email address to subscribe to China-underground and receive notifications of new posts by email.


text:
Phyllis Jean Kruszynski
- 73 years old
- Date of birth: Jun 1, 1941
- Date of passing: Aug 16, 2014
|Let the memory of Phyllis be with us forever
This memorial website was created in memory of our loved one, Phyllis Kruszynski, 73, born on June 1, 1941 and passed away on August 16, 2014. We will remember her forever.
Memorial Tributes
"Mom I love and miss you dearly.I think about you every single day.The day we lost you,I lost my best friend and a piece of my heart.We lost you way to soon.You will forever be in my heart always and forever."
Leave a Tribute:
Invite your family and friends
to visit this memorial:
to visit this memorial:
Subscribe to receive e-mail notifications when others contribute to this memorial.
514 views
Have a suggestion for us?


text: |HARTMANN recently hosted a round of National Continence Roadshows for health professionals, aimed at educating them on the importance of maintaining skin integrity through Active Skin Protection. According to the company, the roadshow also highlighted a distinct and obvious shift in attitude towards incontinence management, namely the importance of combined efforts by both wound care and continence specialists in maintaining optimal patient outcomes. "Wound care and continence care health professionals are now viewing Incontinence Associated Dermatitis as a shared burden," said Aged care sector manager at HARTMANN, Wynette Monserrat. "They are starting to realise that by working together they are able to reach improved patient outcomes through preventive measures such as Active Skin Protection," she added. Pictured above in the thick of a roadshow is HARTMANN's Oliver Krause-Huckleberry and Anthea Reus.


text:
Font Awesome icon usage statistics
Font Awesome information of FLASHPIXS.COM in detail
- 0 types of Font Awesome iconic font are used and found 0 times in total.
- FLASHPIXS.COM used 0 Font Awesome classes per each class in average.
- Font Awesome usage statistics of FLASHPIXS.COM are based on first landing page and within top 1M websites only. Click the font icon to see all websites using it.
- FLASHPIXS.COM includes "http://www.flashpixs.com/wp-content/themes/Avada/assets/fonts/fontawesome/font-awesome.css?ver=3.8.3" to use Font Awesome and information from CSS is like below.
/*! * Font Awesome 4.3.0 by @davegandy - http://fontawesome.io - @fontawesome * License - http://fontawesome.io/license (Font: SIL OFL 1.1, CSS: MIT License) */


text:
I love couponing and a lot of times my weekly menu for our dinners is directly related to items I was able to find on sale. Barilla pasta is already my favorite brand and so when I saw that I could get a box of their new 'Pronto' penne for basically nothing, I jumped at the deal. Continue reading
Chipotle Orange Marmalade Chicken
About a week ago I was craving something different for dinner. My husband is happy with having steak every night, but I decided to make chicken instead. Keep reading to see what I came up with! Continue reading
Rotisserie Chicken Salad for #RotisserieChickenDay
This post is brought to you by Boston Market. All content and opinions, including this recipe, are my own.
Did you know June 2nd is Rotisserie Chicken Day?! I actually didn't either until I received an e-mail from Boston Market asking me to partner with them by sharing a recipe in honor of the occasion. Continue reading
Beef and Asparagus Stir Fry
Last night's dinner was the result of me winging it. I ended up putting together this Beef and Asparagus Stir Fry and it turned out so well I wasn't too sure why I don't try to be spontaneous more often! Continue reading
Surf and Turf Kebobs with Grilled steak and shrimp
It's almost time to turn back our clocks an hour. I have never looked forward to Daylight Savings Time as much as I do this year! The cold has been too much on my Florida wardrobe. We are already getting in the Spring-time mood around here and this Surf and Turf Kebob recipe will put you in the mood too! Continue reading
You need this flatbread pizza recipe in your life
I have never met someone who doesn't like pizza. I am pretty sure the main reason for that is because you can pick and choose toppings that you like and then it perfectly suits you. Continue reading
Basil Cashew Chicken Salad
A few years ago, when I worked for a telecommunications company located just outside of College Park, I really loved to grab lunch at a little place called Roly Poly. This will sound way cheesy, but it was there that I fell in love with the #30 (also known as their Basil Cashew Chicken salad cold rolled sandwich).


text:
Bridge of Faith (BOF) has a sense of unity that transcends through all parts of the organization; from the board meetings, to the HOME, everyone is treated like family. Providing a sense of family, safety, and permanency, is how BOF's program sets itself apart.
Review from Guidestar
Having been part of Bridge of Faith for over 9 years as a board member, I have seen, first hand, the impact on girls and women embraced by all that is made available to them.
Bridge of Faith homes have become places of safety and refuge, where love and compassion go along with guidance and encouragement.
Those who are willing to take advantage of these opportunities have found their lives changed forever.
The best part in being part of Bridge of Faith is see personally the difference that we can make in somebody life.
They come to Us with insecurity not sure what to do or even what they want and little by little they start growing and developing into beautiful women that are forever part of our family
The other part of Bridge of Faith is the store Up Scale were a 2 years old kid can find theirs favorite toy the mother can find the shoes that she was looking for, the father can get a good book at the same time look for a new couch for the living room than and get all of the above for less than $100 Is a pleasure to be part of this dream!
Review from Guidestar
Great thrift shop. Serves many with small budget.
Very caring volunteers.
Review from Guidestar


text:
Status: Closed
Know more about this business than we do? Cool! Please submit any corrections or missing details you may have.Help us make it right
195251attr:barrestaurantsfast foodrestaurant
Be the first YellowBot user to add photos or videos of Carl's Jr
I only eat one hamburger a month so thought I would try the new all natural burger. When I tried to eat it grease ran out of the back of the hamburger all over my plate. It didn't taste good. I couldn't eat it. Also, the fries were soggy and undercooked so I couldn't eat them either. In the future...
This was the strangest Carl's Jr. experience ever. I ordered my usual Western Bacon Cheeseburger, small combo. The guy at the counter was clearly new and needed help entering our order into the register, which I don't fault them for. That's totally fine. At least it got entered in right. They had to tender …
Carls Jr is located at 13837 W Mcdowell Rd in Goodyear and has been in the business of Retail - Mexican Restaurant since 2006.
Carls Jr can be found at W Mcdowell Rd 13837. The following is offered: Restaurants. The entry is present with us since Sep 9, 2010 and was last updated on Nov 14, 2013. In Goodyear there are 27 other Restaurants. An overview can be found here.
If you don't see your business listed on YellowBot, please add your business listing.
YellowBot wants to get your input! If you have a comment, find a bug or think of something neat we should do, let us know by emailing us.
© 2007-2018 Solfo, Inc. – All rights reserved


text:
As the anniversary of September 11th draws near, children may experience a range of new emotions and concerns. They will look to adults for cues on how to react to this devastating event in our country's history.
Your strategy for handling the subject with your children depends largely on your family's personal experience with the attacks. You may find it unnecessary to discuss 9/11 with a very young child, but school-age children are likely to face the topic in their classrooms or amongst their peers.
Below are some tips for interacting with your child around this difficult time. Specific language can be found at the end of this article.
- Prepare children ahead of time. Children in elementary grades or higher may benefit from advanced notice. If desired, let them know they may hear conversations about 9/11 in the coming days and that you are here to answer any questions.
- Be honest. Answer questions as truthfully as possible without offering excessive and unnecessary detail. Your child's age should help determine what information is appropriate to reveal.
- Reassure your children that they are safe. Explain that your family is not in danger and that you are here to protect them. If possible, spend some extra time together.
- Limit television. The media tends to overdo coverage of the event, which can be emotionally draining. Too much exposure can heighten fear, anger, and anxiety.
- Monitor behavior. Does your child seem withdrawn? Is your child acting out or having trouble sleeping? Be on the lookout for changes so you can address them promptly.
- Maintain routines. Make sure that weekly and daily routines are not broken at this time. Consistency provides a sense of security and normalcy.
OPTIONAL LANGUAGE FOR EXPLAINING 9/11 (eliminate details that are too specific for your child's age):
On September 11, 2001 a very sad and scary thing happened in our country. Some bad people wanted to hurt Americans and decided to crash planes into buildings where lots of people worked. It was a terrible day and many people lost their lives. But many people were also saved by brave police officers, firefighters, and even strangers. It was a time when Americans had to try their best to help and comfort each other.
Even though this happened a long time ago, the day is still very hard for people who were there or who lost someone they loved. You might see people looking sad or even crying. You might hear other kids talking about what happened or sharing stories about friends or family members who were there that day.
You should know that nothing like 9/11 has ever happened here again. Special people are in charge of making sure it never will. I will always protect you and keep our family safe. If you feel scared, you can talk to me and I will answer your questions and help you feel better.


text:
The early detection of the symptoms of ADHD in children would greatly help in easier management and treatment of the condition in the future. ADHD or Attention Deficit Hyperactivity Disorder is currently suffered by millions of children. If this condition is not given attention right away, this would then persist through adulthood and would ruin the child's chance of living a more normal and happier life. Each parent must recognize the different symptoms of ADHD in children in order to determine when to seek help from the medical experts in case one of their children shows signs and symptoms of ADHD.
Symptoms of ADHD in Children
The different symptoms of ADHD in children are categorized into three:
• Hyperactivity– The child is observed to be hyperactive, fidgety and restless all the time. In a school setting, the child is also observed to transfer from one seat to the other despite the teacher's reprimand to stay in one's own seat. Also, at playtime, the child would become too active and causing disturbance, hence, would usually result to rejection from a group.
• Impulsiveness – The child with ADHD is also observed to become overly involved in every activity. The child also has the tendency to cut a conversation impolitely to supply one's own opinion. The child is not interested in anyone's story but his/her own.
• Inattention – The child with ADHD has a difficulty in focusing on one thing at a time. He/she has a very short attention span and is easily distracted when something fascinating would catch his/her eye. Usually, when someone talks to a child with ADHD, the child would seem to listen at first and would visibly drift off later on. This would result to poor absorption of information and would affect the child's ability to follow simple instructions.
If these characteristics or behaviors are present in your child, it is essential to keep an eye on him or her, and note that medical advice should be sought from the doctors once the symptoms have gone on for at least six months.
Treatment of ADHD in Children
If the symptoms of ADHD in children have been present for at least six months, the child should be taken to the experts for further assessment. If the child is indeed diagnosed with ADHD, the doctor would usually prescribe medications to help the child maintain concentration and focus. Examples of these drugs include methylphenidate and amphetamine. Along with the medication, the child's parents and loved ones play an important role in the treatment of the child's condition because constant encouragement, understanding and patience is needed. The people that surround the child should always try to make him/her feel that he/she is important and accepted.
Parents should be aware of the symptoms of ADHD in children so that the appropriate treatment option can be explored early on. Otherwise, ADHD can have a big negative impact on the child's life both now and even up to adulthood. However, the parent should also be very careful in making assumptions. It should be remembered that many of the symptoms of ADHD are found in children not afflicted by the disorder. It is still best to consult a doctor to make the diagnosis.
Related posts:


text:
Printing & Framing Options
Interested in purchasing one of our fine art prints? Please know that we've taken care to select high quality, fine art digital printing for each of our images. Our fine art prints are individually and carefully printed so please allow 3-4 weeks for delivery. (Right now we're only delivering to the United States.) We offer several print sizes and finishing options for each image. The following describes the options that will be available to you in our secured shopping cart:
- All images are printed on Hahnenuhle Fine Art paper. You may chose from a lovely eco-friendly 290G Bamboo Fine Art Paper or a bright and beautiful, high-gloss 325G Baryta Fine Art Paper. You may make your selection at check-out.
- Every paper print comes matted (2″, white w/ white core unless otherwise noted). You may choose to receive a matted only print. It will be mounted onto an acid-free double weight mat board for durability that you may then frame yourself.
- Or, you may choose to receive your paper print matted and framed. Our frames are 2″ black with a natural looking grain. They come with a high-quality, scratch resistant plexi-glass, sealed backing to keep out humidity, and are ready to hang.
- Some images are also available as canvas wraps, a beautiful and contemporary look for a fine art print. The image naturally wraps around the sides of the canvas frame. The back of the frame is professionally sealed with black paper and comes ready for hanging.
We hope you enjoy our galleries. If you need assistance when ordering, please contact us here.


text:
Nia and I recently started going to a weekly music class in our Miraflores neighborhood. It's a steal of a deal at $4 a session for an hour of music. Carlos, the musician, is quite versatile too. Each class he plays the Cajón (the peruvian drum box), his guitar AND his trumpet. The kids bring their own instruments too and practice playing their drums loudly and softly.
All the other good children sit in their Mommies/Nannies laps and pound their drum as told. Does my child? HELL NO. She pretty much goes crazy the minute the music starts. This kid L-O-V-E-S music, which I'm thrilled about. Just wish she'd be willing to sit still a bit more. Maybe when she's 11 months…
Not gonna lie, it's good for Mommies too because the entire thing is in Spanish so I get to practice using some basic (translation: kid-speak) words that are good to know. I'm making great progress on my farm animals and commands (sit, stand, play, hands up, etc).
To our future visitors – GET EXCITED because you're gonna love going to Spanish music class!


text:
Easy to use, web ready, multi user help desk
Thank you for downloading QUAD Help Desk from our download portal.
Current files are located on the following IPs: 184.108.40.206126.96.36.199
Outer mirror site one (www.dennisbaggottandsons.com)
Outer mirror site two (www.dbandsons.com)
Note: We prefer to use WinZip, WinRar, WinAce, 7zip to extract zip, rar, 7z, ace files. For data iso files we recommend you use freeware Daemon Toos lite.
Note: All files listed on this site are tested by the ESET Smart Security. If you like to test this file by another security software we recommend you select some in our antivirus section.
Customer Support, Web enabled help desk


text:
JuniKae Randall interviews Philip Hogen, chairman of the National Indian Gaming Commission, about how Indian gaming affects local and statewide communities.
For more information visit Prairie Public website
© 2018 PBS & WGBH Educational Foundation. All rights reserved.
You must be logged in to use this featureLog In Enter Code Need an account?


text:
The Tupolev Tu-22M (Туполев Ту-22М) (NATO reporting name: "Backfire") is a supersonic, swing-wing, long-range strategic and maritime strike bomber developed by the Soviet Union. Significant numbers remain in service with the Russian Air Force.
The first prototype, Tu-22M0, first flew on 30 August 1969. The resultant aircraft was first seen by NATO observers shortly thereafter. For several years it was believed in the West that its service designation was Tu-26. During the SALT negotiations of the 1980s the Soviets insisted it was the Tu-22M. At the time, Western authorities suspected that the misleading designation was intended to suggest that it was simply a derivative of the Tu-22 rather than the more advanced and capable weapon it actually was.
During the Cold War, the Tu-22M was operated by the VVS (Soviet Air Force) in a strategic bombing role, and by the AVMF (Aviatsiya Voyenno-Morskogo Flota, Soviet Naval Aviation) in a long-range maritime anti-shipping role.
The Tu-22M was first used in combat in Afghanistan from 1987 to 1989. Its usage was similar to the United States Air Force deployment of B-52 Stratofortress bombers in the Vietnam War, dropping large tonnages of conventional ordnance. The Russian Federation used the Tu-22M3 in combat in Chechnya during 1995, performing strikes near Grozny.
At the time of the dissolution of the Soviet Union, some 370 remained in CIS service. Production ended in 1993. The fleet strength was about 84 aircraft in 2008, with an additional 93 in reserve.
Source: Wikipedia, "Tupolev Tu-22M", available under the CC-BY-SA License.


text:
It appears that your browser settings are preventing this page from loading the latest version. You may be seeing
old information or you may run into errors because of this. Your system time settings can also cause this issue. Please check that your system time is correct.
View full details at EstateSales.NET: https://www.EstateSales.NET/CA/Brea/92821/1345644
Processing huge inventory - more photos soon!
Please come see us on Day 1. Feels like 123 great items.
Black Forest style carved bear coat rack
Tom Taber carved pheasant statue
Vintage pay phone
Royal Albert china - old country roses
Fenton glass
Thanksgiving & Christmas Collectibles & decor
Josef Birthday Girls Set from age 1 to 21
Spode Christmas Tree china set - large set with many extra pieces
Curios & Display cabinets
2 table & chair sets
Vinyl Records, 33 1/3 & 45 rpm
Costume Jewelry
Huge buffet
Small Buffets
Liquor cabinet
Chest with mirror
China, Noritake
Original artwork
Wine Barrel
Precious Moments
Tea cups & Saucers
Southwest ceramics
Porcelain Dolls
Dollhouse Miniatures
Mosaic tables
Coffee tables
Accent tables
vintage skis & snowshoes
End of Pictures
Click the 'Start Over' button to view the pictures again.
Start Over
Many people like to find several liquidation sales to go to when they are out and about. Here are some pages that might help:
If your browser is having trouble seeing the above pictures, please click this link to try a different way to see the pictures.
If you are always having to click this link in order to the see the pictures, please
submit your browser information
to us so we can try to fix this for you.
You've chosen to view sales in our alternate mode. Would you like us to remember this setting for you?


text:
That's an interesting quote. People like Al Sharpton are very necessary, though. The country needs leaders like him who can open commentary about the troubles, wrongs, and hardships of people just like us, who we might not otherwise ever know about. Things that raise very serious questions. People deserve to be informed about these things. I can relate to the notion that Sharpton can seem like he's being self-serving sometimes… but I think the media element is what seems to wash out the perceived sincerity of who he is. And I don't think he NEEDS a job anymore…. do you? As far as money is concerned. Maybe he needs to maintain a purpose, though. Plenty of old men work hard for that reason alone.
Police don't go through Dog-Whisperer-Ceaser-Milan training, you know? And personally, the only dog I'm willing to risk being bit by is my own.
the.infinite Where do I begin?
SHARE THIS PAGE View Viral Dashboard ›