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Links to videos and more
This is a link to the slide show we made of Caitlin. It's long, because it was just too hard to make it any shorter.
This one has lower resolution, but can be viewed on mobile devices.
30:56 Cheering for Caitlin Mobile Device Slideshowby Jeff Downing 313 views


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"It will take a decade before they believe in hope and change," said GOP pollster Ed Goeas. Worse, he said, younger voters are "disillusioned" with Obama and have turned "cynical" of his rhetoric.
He recently traveled to Raleigh, N.C., and Columbus, Ohio, to conduct focus groups with voters aged 18-29 who backed Obama in 2008. He found them gravely concerned about unemployment, the economy and gas prices. "They are very decidedly unhappy," he said.
Mostly, they are upset that the president didn't make good on his promises. "There is no belief that the economy is getting better," he found.
Goeas was part of a group of pollsters that conducted focus groups with former Obama supporters for the GOP analyst outfit Resurgent Republic. Typical of the comments he collected for a report on the focus groups was one from a North Carolina voter who said that Obama "promised the moon and could not even deliver the upper atmosphere."
Employment is the key issue among younger voters and he said that half of his focus group said they were under- or unemployed. "Underemployment is a major theme," said Goeas.
The price of gas is also a bummer for the younger voters. "Gas prices can kind of be the last straw," said Goeas.
The findings are not good news for Obama's reelection campaign, and the president's team knows it. Getting younger voters enthused to show up at the polls in the fall is a key strategy. In 2008, he won two-thirds of the vote.

subset: commoncrawl


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Do you know your risk factors for high blood pressure? You can't do anything about some risk factors. But other risk factors can be changed. Learn about the risk factors for high blood pressure by taking this quiz.
An excess of cholesterol can build up in the arteries, narrowing them and slowing or blocking blood flow to the heart. Take this quiz to learn more about cholesterol and its role in your health.
Atherosclerosis, or coronary artery disease (CAD), plays a major role in the leading cause of death in this country: heart attack. Learn more about this disease and a common procedure used to treat it.
All Quizzes...
Experts are increasingly urging people to know their BMI, a figure that takes into account not just weight but also height to indicate body fat.
Your target heart rate is the range at which sustained physical activity - running, cycling, swimming laps, or any other aerobic exercise - is considered safe and effective.
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- Sam Ash Gift Guides
- Hot Deals
- Guitars
- Bass
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- Live Sound
- Keyboards
- Microphones & Wireless
- Recording
- DJ & Lighting
- Drums
- Books/DVDs
- Band/Orchestra
To automatically re-order this item before you run out, select the recurring order option during checkout.
The MS 6 adds 6 stereo inputs to any audio system. This allows an A/B comparison of sound sources, or additional stereo returns to a mixer (ie. tape 1 thru 6). The inputs and output are balanced XLR connectors, so installation is quick and easy.
|Other Features
|MS 6 adds 6 stereo inputs to any audio system
MS6 Input Switcher
The manufacturer's warranty covers parts for one year and labor for one year from date of purchase. The warranty excludes damage from misuse, abuse, and contains other exclusions.


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Commission Meeting
November 10, 1999
Second Floor Conference Room--10:00
Tentative Agenda
The Commission will meet via telephone conference call to consider
and take appropriate action on the following agenda items:
The Commission will go into closed session pursuant to Iowa Code
21.5(1)(d) and Iowa Code 21.5(1)(f) to review and discuss the following:
1. November 3, 1999 Investigation Committee's Report.
2. Open Complaint
The Commission will convene to consider and take appropriate action
on the following agenda items.
A. Open complaint cases as necessary.
B. Adjourn.
If you require the assistance of auxiliary aids or
services to participate in or attend the meeting because of a disability,
please call our ADA Coordinator at (515) 281-7468, if you are
hearing impaired, call Relay Iowa TTY at 1-800-735-2942.


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A Red Flag Fire Weather Alert has been lifted by the South Carolina Forestry Commission.
The Forestry Commission said it lifted the alert because of some rain, higher relative humidity values, decreased winds, and cooler temperatures.
These conditions also alleviate some of the strain on Forestry Commission equipment and personnel.
Due to a major structure fire in Horry County, a burning ban remains in effect there until lifted by the Horry County Fire Dept.
The views expressed are not those of this site, this station or its affiliated companies. By posting your comments you agree to accept our terms of use.blog comments powered by Disqus


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Building permits rise — better times ahead?
The number of permits for new homes issued in February was the highest since October 2008. Housing starts declined slightly from January.
Builders started construction on fewer new homes in February, but pulled more construction permits, indicating that the housing market may be inching out of the doldrums.
The number of building permits issued in February rose 5.1%, equivalent to an annual construction pace of 717,000 homes. That's the highest number since October 2008 and 34.3% above last February's number.
According to the Commerce Department, the number of housing starts fell 1.1% from January, to a rate of 698,000 homes. That was an increase of 34.7% from last February's pace.
Post continues below
"Builders are reporting increased buyer interest and are expecting demand for new homes to improve in the coming months, but continue to exercise caution regarding new projects until that interest translates into more signed sales contracts," Barry Rutenberg, chairman of the National Association of Home Builders and a homebuilder from Gainesville, Fla., said in a news release.
He cited three ongoing challenges for new-home sales: tight lending conditions, the difficulty of obtaining accurate appraisals and competition from distressed properties, which makes it harder for homeowners to sell existing homes and buy new construction.
Looking at the statistics by region:
- Midwest: Housing starts up 3% and permits up 14.7%.
- South: Housing starts up 1.5% and permits down 1.9%.
- Northeast: Housing starts down 12.3% and permits up 14.3%.
- West: Housing starts down 5.9% and permits up 12.8%.
Analysts joined the builders in expressing cautious optimism for better times ahead.
"The housing market continues to recover at a very gradual rate," said Sal Guatieri, an economist at BMO Capital Markets, to Bloomberg. "The increase in permits likely flags further strength in the months ahead."


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The world of social media gets bigger every day with new websites and apps popping up all over the place.
The latest app to hit the market is already making quite an impression. It's called Vine, and it allows anyone to upload 6 seconds of high-definition video right to their Twitter feed. But it's popularity has some parents concerned.
Twitter owns the newest, hottest app called Vine. It sprouted up in the social media landscape a week ago and it's already the number one downloaded app in the Apple store.
Its popularity is growing amongst teens just like Twitter and Instagram.
Vine combines both YouTube and Twitter qualities -- users get mere seconds to create a video message.
You don't need a cameraman, you can shoot six seconds of video on your phone.
Video plus quick sharing of Twitter -- 140 characters -- and this is the marriage of those two.
The 6-second clip loops and the results are fascinating. Social media expert Jeff Moriarty showed us a newly launched website dedicated to only showing various Vines. It's called Vine Peek.
"It's almost like being a voyeur that can teleport all over the world, you'll see someone eating lunch, someone sky diving, someone's poodle," says Moriarty.
But within a week -- porn has already infiltrated in what started out as an innocent app under search words like #porn and #sex.
Users can already find an expansive video library of explicit 6-second pornographic clips.
"It does concern me," says parent Chris Harris.
Harris has a 13-year-old, and says having a conversation is the first step to keeping your teen safe.
"Talked to her about it. I look through her stuff. She shows me what's on there."
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Allan Edwards, HoustonI feel we are in somewhat of a technology revolution, more so than the '90s, primarily because of smartphones, apps, and the type of "programs" available. Here are a few items I seem to not use these days:Business cards. I find myself never giving out business cards. I meet prospects who want to build new homes, and they never ask for them and I don't offer them. It is almost like a qualifying tactic: If you can't find me via Google, then I probably don't want to build your house. Okay, that's a little extreme, but you get...
Consultant for the home improvement industry Dennis Schaefer discusses how builders are...
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Mattias AdolfssonJuxtapoz // Friday, 07 Jul 2006
Mattias Adolfsson is a man with a wife and two daughters, one cat, and one dog. He lives in Göteborg, Sweden where he works all day and draws all night. He does lovely line drawings, maybe mostly of multiple buildings, both real and make-believe. He draws other things too - people and animals and whatnot. Sometimes he colors them in. Go see his website here: www.mattiasadolfsson.se
The Illustrationmundo spotlight: www.illustrationmundo.com/audio/artist/60/
His artful blog: mattiasa.blogspot.com


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: June 2008: Dream Snapshots, Tel Aviv :
an excerpt by Jacqueline Osherow
I'm sure they never
dreamed of Jewish
beaches, lorded over
by luxury hotels,
with views of daughters
of Jerusalem, their
ornaments tinkling not
just on their feet but
in their belly?buttons,
shockingly visible
between their flimsy
smidgeons of bikinis . . .
(though there is – God
be praised – walled?in
section, which would
no doubt have enraged
progressive dreamers,
for women on odd,
men on even days . . . .)


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This disc is the outcome of Frank Almond's mission to chronicle in an artistically meaningful way the performing history of the 1715 Stradivari violin named after the Polish violinist Karol Lipiński. Its programme maps the instrument's ownership through almost three centuries, reflecting its possession by a student of Tartini, Lipiński, (embracing his close associations with Schumann's circle), the Röntgen family and eventually, via other violinists, by Almond himself.
Almond does not use the optimum musical text for his account of Tartini's 'Devil's Trill' Sonata, which, though not especially stylish, is sweet-toned, athletic and suitably demonic, underpinned by his rock-solid technique. He and pianist William Wolfram seem more at ease in the Romantic idiom, forming a cohesive unit and finding a winning balance between assertiveness and lyricism. This is the case whether in their well-shaped reading of Julius Röntgen's Brahmsian Violin Sonata no.2, lightened by its folk-influenced centrepiece, their appropriately reflective, mercurial interpretation of Schumann's intense Second Violin Sonata op.121, or in Almond's technically proficient but somewhat eccentric version of Lipiński's Caprice op.29 no.3. In this close yet finely balanced recording, the instrument's pedigree is especially demonstrated in the duo's compelling, emotional accounts of the expansive outer movements and the chorale variations of Schumann's Sonata.
From the May 2013 issue. Subscribe to The Strad or download our digital edition as part of a 30-day free trial.
Anne Akiko Meyers (violin) English Chamber Orchestra/David...
Victor Romanul (violin) Michael Zaretsky (viola)
Dene Olding (violin), Goldner Quartet, Joan Rodgers...


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Alakef's Commitment to Sustainability
For over two decades, Alakef Coffee has dedicated itself to bringing you the finest coffees available from countries around the world. Our business has supported direct links between local and world markets. We buy green coffee; we sell roasted beans to customers throughout the Midwest, who in turn, sell coffee beverages to their customers. Along the way, that chain also involves suppliers, transportation and financial components that are interdependent on each other.
Using the definition of sustainability as "the potential for long-term maintenance of well being, which has environmental, economic, and social dimensions," Alakef has been a supporter of sustainability from the inception of our business.
The economic aspect of sustainability is detailed above, but the other two dimensions of environmental and social are also important to us.
Alakef Coffee has always had an aggressive recycling program, and now with the advent of innovations such as corn starch based packaging materials, we are able to take steps to further reduce what we use and put back into the environment. Our chief roasting by-products (coffee chaff and jute bags) have been regularly stocking compost bins, mulching gardens, insulating trees and hauling hunting decoys around Minnesota and Wisconsin for years.
We hope to improve upon these efforts by working with our local customers and coffee shops to draw more attention to environmental issues and cooperate with them to reduce their waste and overall footprint as well.
Whatever our impact is locally, we also fully understand our global presence and the impact we have on people halfway around the world. Our continued involvement in the Rainforest Alliance, Fair Trade and USDA Organic certification programs are but a beginning for us as we attempt to improve the lives and surroundings of those who work so hard to provide us with the coffee upon which we have built our livelihoods and reputations. We are committed to building upon that and encourage our community of customers to join us in participating.
Steps we have taken:
-Alakef Coffee first attained its Organic Certified status in 2000.
-We joined the Fair Trade program in 2001.
-We attained Kosher certification in 2004.
-We participate in the Trees for the Future (http://www.plant-trees.org/). Every year, through this program we plant enough trees in a coffee growing region of Honduras to help offset our carbon footprint.
-Most of our decomposable byproduct is recycled back into our community by way of the gardens and compost bins of our neighbors, area farmers, and local community garden programs. We recycle all paper, cans and plastics that we can divert from our garbage.
-Employees are encouraged to use minimum impact modes of transportation when traveling to and from the roasterie. We have one person who rides his bicycle throughout the year, even in the snow.
-Our commitment to making Alakef Coffee as environmentally and socially conscious as possible is ongoing. We will always investigate alternative energy programs to reduce our consumption and seek out new ways to further reduce our overall waste by making use of more environmentally friendly products and packaging as they become accessible to us.


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46 U.S. Code § 30909 - Security
Source(Pub. L. 109–304, § 6(c),Oct. 6, 2006, 120 Stat. 1519.)
|Revised Section
|Source (U.S. Code)
|Source (Statutes at Large)
|46 App.:743 (last sentence).
|Mar. 9, 1920, ch. 95, § 3 (last sentence), 41 Stat. 526; Pub. L. 97–31, § 12(25)(A), Aug. 6, 1981, 95 Stat. 155.
The words "civil action" are substituted for "proceeding" for consistency in this chapter and with rule 2 of the Federal Rules of Civil Procedure (28 App. U.S.C.).
The table below lists the classification updates, since Jan. 3, 2012, for this section. Updates to a broader range of sections may be found at the update page for containing chapter, title, etc.
The most recent Classification Table update that we have noticed was Tuesday, August 13, 2013
An empty table indicates that we see no relevant changes listed in the classification tables. If you suspect that our system may be missing something, please double-check with the Office of the Law Revision Counsel.
|Description of Change
|Session Year
|Public Law
|Statutes at Large
LII has no control over and does not endorse any external Internet site that contains links to or references LII.


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Next, you'll be asked to connect with Twitter. Rest assured, we will never send a tweet from your account
without your permission.
We will send you an email with an invite soon.
Tomcat marking your sofa? Cats may spray if they're stressed or upset about other cats inside or outside. #pethealth #petbehavior #pets
RT @ASPCA_APCC: Did you know certain types of lilies can be #deadly to #cats? PLEASE check our website before buying a #lily!
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RT @AskTheCatDoctor: #Cat diarrhea is among the top reasons #cats are brought to the #vet, and for good reason --
See what's Trending Now for @petdocks
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Virtuemart Manufacturer Module
Virtuemart Manufacturer Module is compatible with Virtuemart Version 2.x.x and Joomla 2.5. The module will help you show manufacturers with their beautiful logo thumbnails, brand name and a number of products.
The module is very flexible to use in many situations with options below:
- Show logo on/off
- Width & heighth of logo thumbnails can be set default in Virtuemart admin panel
- Logo is always hyperlinks to manufacturer browser pages
- Show manufacturer names on/off
- Products display on/off
- List of manufactures based on names / random
- Limit a number of Manufacturers
- Numbers of column (numbers of manufacturer per row)
Video Demo
Virtuemart Extensions FAQsQuestion: Can I translate these extensions into other languages like Spanish, Chinese …?
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Question: Does this Extension compatible with Virtuemart 1.5?
Answer: All our Virtuemart extensions is compatible with Virtuemart 2.x.x and Joomla 2.x.x. Currently we do not support Joomla 3.x.x
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1-800-369-4669 | Live Chat | Contact Us
75 keychain flashlights $75
Product Details
About this product:
• ABS plastic key finder is extremely easy to operate
• Includes receiver that attaches to keychain and credit card-shaped key finder
• Finder beeps and lights flash when it gets close to keys
• Has 120-ft. detection range
• Includes batteries and instructions for immediate use
• Dimensions: 5-1/8"W x 4"H x 3/4"D, tin case
• Image area: 1-1/4"W x 7/20"H
Simplify finding your keys and promoting your brand with customizable Key Finder Keyfobs. Just connect the receiver to your keychain and keep the remote handy. When you need to locate your keys, simply turn on the remote unit's switch and the receiver will beep and the lights will flash when your keys are within 120 feet. Since these logoed remotes are always with you, your brand will always be on hand, reliable as always. Personalized key finders make great employee-appreciation gifts and can be used as part of prize packages to entice customers to visit your store or attend a company-sponsored event.
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Fatigue: ManagementFatigue can come and go or stay constant for a while. Fatigue from chemotherapy tends to occur a few days after the treatment, peaks, and then gets better before the next treatment. Fatigue from radiation may not happen right away.
Tell Your Healthcare Team How You Feel During Treatment for Penile Cancer


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Flip a coin. If heads, the Defending Pokémon is now Confused. If tails, both the Defending Pokémon and Spinda are now Confused.
The Pokémon Company International is not responsible for the content of any linked website that is not operated by The Pokémon Company International. Please note that these websites' privacy policies and security practices may differ from the Pokémon Company International's standards.


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Gospel Grace
Sunday, 11am- 2pm
Ernestine Yvonne Jones has been a born again Christian for over 30 years and presently attends the Huber Memorial Church where P.M. Smith is the Pastor. She faithfully leads the testimony service every Sunday morning from 7:00a.m. until 7:30a.m., sings with the Praise Team and Mass Choir, is a consistent Saturday bible class student, welcomes the visitors Sundays during the 7:30AM service, is the intro and outro voice-over for the Huber Memorial Living Hope Television Broadcast, which airs every Sunday morning on WNUV-TV Channel 54 from 7:30am until 8:00am.


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Red wines that are more fruit-forward and lighter in tannin and body.
Medium bodied reds that go down easy, with smooth tannins and supple fruit.
Wines where earthy and/or spicy dominate the flavors – typically medium to full body.
Full bodied wines that have concentrated fruit and are higher in alcohol and/or tannins. Some need age.
Extremely dark and concentrated. Open, very persistent and clean with wonderful aromas of blackberries, raspberries, coffee, spices and vanilla. Rich, powerful, extremely concentrated yet elegant and velvety. The silky and ripe tannins make it particularly smooth to the palate. Loads of plum, dark cherry and licorice and a very very long finish. A wine that will keep and further improve for many years.
"Beautiful and perfumed, with blackberry and black cherry aromas. Full-bodied and long, with chewy tannins. Very fresh and balanced."
91 Points
Wine Spectator
"This vineyard selection offers a compact and clean aromatic package that hits all the right notes without being overdone. Blackberry, cherry, vanilla and spice chime in on the palate and help drive the wine's long, chewy finish."
91 Points
Wine Enthusiast
"The 2003 Brunello di Montalcino Altero offers attractive density as flowers, spices, ripe red fruit, chocolate and sweet toasted oak flow from the glass. The wine possesses outstanding nuance and complexity. In this vintage the use of smaller French oak barrels is somewhat penalizing as it accentuates the hard, unripe tannins that are already present in the fruit. As is often the case, the Altero presents a more immediate, rounder style than the regular bottling, but it also develops faster once opened."
90 Points
The Wine Advocate
"Dark, bright red-ruby. Very different on the nose than the regular release, revealing an almost liqueur-like ripeness to its cherry fruit. Ripe, broad and sweet, with a more open-knit texture and considerably more volume than the normale There's plenty of vanillin oak here but has the breadth and sweetness of material to support it. Finishes with substantial dusty tannins and lingering sweetness. Not especially gripping, but there's no shortage of concentration here."
90 Points
International Wine Cellar
Paola Gloder has one of Montalcino's most elevated estates, with vineyards averaging 1476 feet above sea level, southwest of the famed medieval citadel. Both the unique location and altitude privilege the wines of Poggio Antico. The lower hillside terroir south of Montalcino is conducive to powerful and opulent Brunellos. This, combined with the estate's vineyard elevations --...Read More About Poggio Antico
One of the most important wine regions in Italy, Tuscany is home to the cities of Florence and Siena, the districts of Chianti and Brunello di Montalcino, and the wineries of Sassicaia, Tignanello and Ornellaia. Tuscany is also home to the indigenous Italian grape variety, Sangiovese. Most of the wine coming from Tuscany is made from some clone of this...Read More About Tuscany
Sangiovese (SAHN-gee-oh-VAY-zee) Blood of Jove (literally translated) The principal grape of Chianti - in fact, the principle grape of all of Tuscany - has had its ups and downs. For a stint in the 70s and 80s, wines labeled Chianti contained cheap red wine packaged in a straw casked bottle, most popular for the candle holder it would become. But no more. Sangiovese re...Read More About Sangiovese
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text:
am i to understand that your take is to use insufficient, inexact and imperfect css: font-size:0 and negative word-spacing and letter-spacing values to solve a superfluous arbitrary and subjective html markup formatting issue ? :)
the reason i ask is because your css will never solve the problem completely, while correcting an whitespace abuse for formatting will.
i wish all our html css problems would have such a natural and easy solution. it looks quirky to me that hacks like * *+ /\\ are regarded as sound, but a simple solution like tag chaining makes such an opposition.
as for the danger about the code reformatting by the client or by anybody else for that matter, there are hidden dangers when not handling the hammer the way you suppose to, but this doesn't stop the use of it ;) one learns its lesson quickly :) or pays for it until he does :lol:


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Comment on: 'Sixers snap Celtics' 11-game streak with 98-97 win'
Posted 12/19/2009 03:50:03 EST
I personally hate to blame officials for a loss especially with a 15 point lead,but the officiating in this game as in so many others is blatantly brutal by far the worst in any of the big 4 sport,so more »
Comment on: 'Primary goal of secondary accomplished'
Posted 12/14/2009 12:17:23 EST
The pats obviously have some cacer issues in the locker room which fans haven,t seen since terry glenn but what did they expect when lock down corners like samuell are allowed to leave.it seems to me more »
Comment on: 'Brady completes his quest'
Posted 12/14/2009 12:00:19 EST
well,well at the start of the season i predicted that the pats would be lucky to win 11 games that this was a rebuilding year,and most posters busted my @ss saying whats your basis for this prediction more »
Comment on: 'Down in the Bayou'
Posted 12/01/2009 02:39:18 EST
the moronic statements were sure to come out with the beating the pats took last night. bradys not an elitee qb leads the league in stupid statements.first of he had a bad game.everyone does.when i sa more »
Comment on: The%20Belichick%20Error
Posted 11/16/2009 03:28:40 EST
anyone defending coach bb in this situation doesn,t know their butt from their elbow about football and it wasn,t just the terrible call to go for it,clock mgmt was brutal as was his decision to run m more »
Comment on: Lucic%20has%20surgery%2C%20out%204-6%20weeks
Posted 10/20/2009 06:21:06 EDT
well the good news is the ruins can play like this all year and still make the playoffs cause the league stinks.the bad news is they will be lucky to skate out of the first round.i beseech the jacob c more »
Comment on: 'The hits keep coming for Jets'
Posted 10/20/2009 05:54:38 EDT
quit on its coach more »
Comment on: 'The hits keep coming for Jets'
Posted 10/20/2009 05:53:42 EDT
THE ROOSTER HAS COME HOME TO ROOST,IT SURE WAS A GREAT RUN WHILE IT LASTED ALL 3 GAMES I GUESS ALL SUPERBOWL HOPES ARE PINNED TO THE GIANTS IN NEW YORK.BUT I GOTTA SAY I DON,T LIKE SEEING ANY TEAM GO more »
Comment on: 'Status of Patriots linebacker Thomas remains up in air'
Posted 10/20/2009 12:53:49 EDT
I don,t care what anyone says this is absolutley a rebuilding year,if they win 12 games it,s because of good coaching and drafting,this team is dotted with first and second year players.this team lost more »
Comment on: Pats%20release%20LB%20Banta-Cain
Posted 10/19/2009 07:37:07 EDT
hmm i wonder what happened to that sloagan in bill we trust.I HATE HAVING A COACH THAT MAKES DRASTIC MOVES!!!YEA 49 PATRIOT I HATE HAVING A COACH THAT WINS SUPERBOWLS. more »
Comment on: 'Snow can't slow records as Brady, Patriots rout Titans'
Posted 10/18/2009 09:52:11 EDT
driverone as a fan it feels great to whip the tar out of any team.paleocon57 when the pats were 18 and 0 i can assure you no one in the NFL was laughing quite the opposite,in fact if you had half a br more »
Comment on: 'Mental errors cost Bruins'
Posted 10/13/2009 04:26:14 EDT
I haven,t cared about the Ruins since they were up 3-1 to the habs and lost. As long as Jeremy Jacobs owns this team i could care less how they do,and the sad thing is jj will never sell this team,at more »
Comment on: 'Daniels put in his time'
Posted 10/13/2009 04:14:51 EDT
When the Celts won the championship,they really had no backup at point guard and very few people beleived in rondo on paper this team is deeper than 07 rondos a young guy i,m not worried at all about more »
Comment on: 'Broncos coach McDaniels relishes special win'
Posted 10/13/2009 03:54:02 EDT
Mcdaniels just didn,t want to say anything bad about bb beleive you me he knows the patriots second half play was a brutal display of mistakes as of right now brady isn,t the same player he,s had plen more »
Comment on: Are%20Sox%20on%20the%20slide%3F
Posted 10/12/2009 09:00:30 EDT
red sox fans are a bunch of tools 5 days ago about 95% of you were telling us why the sox would upset the yanks and completley overlooking the angels now its papilbons fault,its mgmt,s fault,its theos more »
Comment on: Are%20Sox%20on%20the%20slide%3F
Posted 10/12/2009 08:48:35 EDT
it wasn,t long ago a parade took place and every sign in the crowd said sign mike lowell my how fast things change more »
Comment on: Inconsistency%20an%20issue
Posted 10/12/2009 07:47:54 EDT
BRADY WAS AWFUL more »
Comment on: 'Ravens: Brady got preferential treatment'
Posted 10/06/2009 02:40:54 EDT
bottom line ive seen a hundred bad calls on the pats.and the fact everyone is blaming a dropped pass for the loss is a joke this no name patriot d is whacking the hell out of receivers and their takin more »
Comment on: 'Familiar territory for Belichick and McDaniels'
Posted 10/06/2009 02:29:13 EDT
It is absolutley the lack of oxygen that gives denver an advantage over most teams obviousley having 80 thousand screaming fans helps but you just don,t get used to playing in such high altitudes in a more »
Comment on: 'Ravens: Brady got preferential treatment'
Posted 10/06/2009 02:16:40 EDT
Can anyone tell me why the lawrence phoney maroney experiment isn,t over the pats need to cut their losses with this guy and let ben jarvis green ellis take his rightful spot on the roster he,s earned more »
Comment on: 'Ravens: Brady got preferential treatment'
Posted 10/06/2009 02:04:48 EDT
deisel is their one person out their that can say they thought this d was going to be as good as it is thus far.my logic is this,the pats are in a rebuilding mode with the d yes they are performing at more »
Comment on: 'Ravens: Brady got preferential treatment'
Posted 10/06/2009 01:24:55 EDT
man i love the pats but to say this is a precursor of the afc championship game between these teams is a bit premature with all of the draft picks 1 first 3 second and the following year 2 first round more »
Comment on: 'Catchphrase? A combination tough to beat'
Posted 10/06/2009 01:01:32 EDT
As good as Ray Lewis is just maybe it,s his over enthusiastic attitude that helps blow it for this ravens team,they alway,s seem to make some bonehead move when a call doesn,t go their way,last year t more »
Comment on: 'Catchphrase? A combination tough to beat'
Posted 10/06/2009 12:40:34 EDT
I am alreadt sick of the suggestion that clayton lost the game for the ravens.(he wasn,t in the end zone Bob)with mere seconds remaining their were no guarantee,s the ravens would even score.did it he more »


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The 7th Edition of Change of Shift is up at kt's blog. Most of the contributions to this week's Change of Shift are by nurses. After reading through some of their posts, I don't know how they manage.
« August 2006 | Main | October 2006 »
The 7th Edition of Change of Shift is up at kt's blog. Most of the contributions to this week's Change of Shift are by nurses. After reading through some of their posts, I don't know how they manage.
Posted at 02:41 PM | Permalink | Comments (1) | TrackBack (0)
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Grand Rounds is up at Tundra Medicine Dreams, the blog of a physician's assistant in southwest Alaska. The posts are interesting; the pictures are gorgeous.
Posted at 09:26 AM | Permalink | Comments (0) | TrackBack (0)
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The computer industry uses version numbers to track the evolution of software. The first release after trial versions is called version 1.0. Major changes are reflected in the first digit of the version number, as in version 2.0. Any minor changes are reflected in the second digit, as in version 2.1. I've recently realized that this labeling scheme could apply to hormones as well. Think of it this way – each decade, along with its associated hormonal changes, is a major version change.
In the midst of writing about Alzheimer's and dementia, I find myself in Hormones 4.9. So far, the transition into middle-aged versions is reflected more in my mental preoccupations than in any physical manifestations. All I think about is aging and dementia.
These topics dominate my conversations now, partly because most of my friends are somewhere near Version 5.0. My colleague Rebekah and I used to talk about technical specifications and industry gossip. But when she called me from Kansas City the other day, my favorite subjects came up. She was driving her dog Max to his acupuncturist appointment, for treatment of arthritis and irritable bowel syndrome. I told her about my scheme for labeling hormonal stages, and we wondered how it would work for dogs.
Then she told me her father-in-law had fallen at the nursing home. "Nine stitches and a bump the size of a prairie chicken egg," she said. "I went to visit him yesterday, and said 'That was really a nasty fall.' 'Fall!' he said, 'I didn't fall – I was taken down by a mob in the bathroom! Then the lady who sits on people at football games got me…."
With a sense of humor and an occasional glass of wine, I figure we can handle Hormones 5.0. But I'm more worried about 6.0 and beyond. It seems no one is immune to serious problems such as Alzheimer's, cancer, and heart disease. Maybe this is why when Gail Rae Hudson (The Mom and Me Journals) and her mother watched the movie Cocoon recently, they decided they would drink from the fountain of youth if they had the chance.
I thought of them when I watched 10 Years Younger yesterday [I had turned on the television for research purposes – really!]. During the program, image experts succeeded in moving a woman's appearance from Hormones 4.9 back to Hormones 3.9 or so. But what good is looking like Version 3.9 if I can't remember where I left my car?
Is there anything we can do to decrease our actual version numbers and avoid serious health problems? As far as I can tell, scientists don't understand aging very well. The most popular idea about why we age is called the Free Radical Theory on Aging. According to this theory, breathing in air allows unstable molecules called oxygen free-radicals to build up in the body. These oxygen free-radicals then combine with other molecules, causing cell damage in a process similar to the way rust damages metal.
Researchers have shown that calorie restriction in mice and other organisms extends their lifespans. Fans of the Free Radical Theory think this may be because reducing food intake decreases the rate of metabolism and thus oxygen intake, and so the amount of free-radicals accumulating in the body also goes down. Some studies have contradicted this hypothesis, though. Even more discouraging, the anti-oxidant vitamins I thought might keep me in the equivalent of Hormones 4.9 for a few more years may not be effective. Maybe the Free Radical Theory of Aging won't lead to Gail's fountain of youth.
But Dr. Craig Atwood at the University of Wisconsin thinks a theory called the Reproductive-Cell Cycle Theory of Aging may eventually show the way. As discussed in an earlier post, he believes the same theory explains the chain of events leading to Alzheimer's disease.
Dr. Atwood's 2004 paper "Living and Dying for Sex: A Theory of Aging Based on the Modulation of Cell Cycle Signaling by Reproductive Hormones," explains how calorie restriction might extend lifespans a bit differently than free radical [theorists, proponents]. The paper was co-authored by Dr. Richard Bowen of Voyager Pharmaceutical Corporation and published in Gerontology in 2004. It outlines the idea that when estrogen and testosterone levels go down in mid-life, the body cranks up other hormones (luteinizing hormone and follicle stimulating hormone, for example) in an attempt to maintain fertility.
"The increased levels of luteinizing hormone and follicle stimulating hormone signal bone, muscle, brain and other cells to divide inappropriately," Dr. Atwood explains, "leading to cell dysfunction and death. This increased cell death leads to tissue dysfunction and disease, thereby killing less fertile older animals or people, preventing them from competing for resources with younger, more fertile individuals."
Dr. Atwood thinks this theory better explains why stresses like extreme calorie restriction, exposure to cold, and "excessive" exercise appear to be associated with longer life, since calorie restriction has been shown to reduce reproductive hormones in female mammals. It may be the body interprets these stresses to mean that it's not a good time to reproduce, and so decreases the amount of sex hormones it manufactures.
Maybe hormones hold the key to real anti-aging, rather than just changing appearances. But what about reports that hormone treatments may not prevent disease and dementia in women? In the U.S., the Women's Health Initiative (WHI) hormone therapy trials were discontinued in 2002 because researchers found somewhat higher rates of some diseases in the group taking hormones. This same study also found that the estrogen plus progestin combination used in the trials didn't prevent cognitive decline and actually seemed to increase dementia in some women over 65.
I asked Dr. Atwood if the results of the Women's Health Initiative trials mean I shouldn't consider taking hormones to decrease my risk of dementia. He said he feels that it's very misleading to extrapolate the results of this study, in which Prempro and Premarin were used, to all forms of hormone replacement therapy. Prempro is a combination of conjugated equine estrogens and progestin in the form of the synthetic medroxyprogesterone acetate, and Premarin is made up of conjugated equine estrogens.
"Current hormone replacement therapies do not come close enough to replicating normal reproductive hormone levels," he says, "since conjugated equine estrogens and medroxyprogesterone are not the major forms of sex steroids in the human body." He points out that the WHI study contradicts results from numerous other animal and human studies showing that natural or bioidentical forms of these hormones protect neurons and may prevent dementia.
Hormones affect men too. A new study by researchers at the University of Washington Veterans Administration Puget Sound Health Care System found that low testosterone levels in men are associated with increased mortality rates. Looking specifically at dementia, the picture seems less clear. Scientists at the University Medical Center Utrecht in the Netherlands studied the link between reproductive hormones and Alzheimer's disease (AD) in 2,974 men, aged 71 to 93 years for six years. They concluded "testosterone levels are not associated with risk for cognitive decline and AD, whereas higher estrogen levels increase risk for cognitive decline and AD". In a small study at the University of California Los Angeles, testosterone supplementation in 16 men with Alzheimer's improved their quality of life as reported by caregivers, but not their cognition.
It doesn't seem to me there's been enough research yet to know how various hormone replacement therapies will affect aging in general, let alone the risk of developing dementia. Dr. Atwood agrees that further research is needed. He and his colleagues are studying the neuroprotective effects of different formulations and delivery methods of female sex hormones.
He reminded me that research on aging and dementia has to have a broader focus than simply looking at estrogen and testosterone levels. "There are many other hormones that become dysregulated in the body following menopause and andropause," he says, "and these have not been studied in any detail. Therefore, the dysregulation of estrogens and testosterone may be only part of the story."
In the meantime, at least in theory, Gail and her mother could try to fool their bodies into keeping levels of luteinizing hormone and follicle stimulating hormone low by subjecting themselves to some of the stresses listed above. It's hard to say whether this would slow their rate of progress to higher versions. For his part, Dr. Atwood doesn't view calorie restriction as very attractive. "Rigorous exercise is the most practical anti-aging strategy until therapies that modulate reproductive hormones are developed," he says.
I don't think Gail will starve her mother, or sign her up for an Ironman race and the Polar Bear Club, but I guess this is the place to say that information in this post is not a substitute for medical advice. These measures could have life-threatening ill effects, particularly in older people.
With software, higher version numbers indicate greater stability and added functionality. Could this be true for life? Although I don't want to develop dementia or another serious disease, I don't really want to go back to Hormones 2.9 or even 3.9 either. So for now, I'll watch for more research on the role of reproductive hormones in Alzheimer's and aging, and head to the gym as often as I can. But I'm rebelling against the idea of looking "10 Years Younger", and am growing my gray hair out. At least people will understand why I can't find my car.
Posted at 01:26 PM in Living with Memory Loss, Reducing Your Risk for Memory Loss, Treatments, What Causes Memory Loss? | Permalink | Comments (1) | TrackBack (0)
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Check out the latest edition of Grand Rounds at Diabetes Mine. To highlight the role of education in medicine, diabetes blogger Amy Tenderich weaves links to participating blogs into a series of fictional emails home from a first-year medical student. Interesting reading.
Posted at 10:41 AM | Permalink | Comments (0) | TrackBack (0)
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In a previous post, I wrote about how a history of depression may increase your risk of developing dementia. This connection is not well understood, and is further complicated by the fact that many Alzheimer's patients are depressed, even when they have no previous history of depressive episodes. If my father had lived long enough, he might have been dealing with depression as well as cerebral amyloid angiopathy and probable Alzheimer's.
Dr. George Zubenko, Professor of Psychiatry at the University of Pittsburgh School of Medicine, spent some time last week helping me make sense of all this.
"The rate of depression in people 65 and over is quite low – a few percent," Dr. Zubenko says. "But somewhere between 30 and 50% of Alzheimer's patients suffer from depression. Some of that is probably due to the realization that they're losing mental capacity – major depressive episodes often seem to be triggered by stressful life events. The much higher rates of major depression in AD [Alzheimer's disease] patients suggest that the emergence of MDD [Major Depressive Disorder] in AD is often the result of the neurodegenerative disorder.
George S. Zubenko, M.D., Ph.D.
It's obvious that major depression increases the suffering of dementia patients and their caregivers. Dr. Zubenko points out that it also exaggerates the patients' disabilities, makes institutionalization more likely, and may hasten death. For these reasons, it's important to diagnose depression in dementia patients. Diagnosis can be tricky, though - doctors don't agree on the definition of "depression" in AD, and it's often difficult for dementia patients to communicate their symptoms.
To help diagnose and characterize depression in Alzheimer's patients, Dr. Zubenko and his coworkers developed a diagnostic interview called Clinical Assessment for Depression in Dementia (CADD). He believes that "major depressive disorder in Alzheimer's disease" is not the same as major depression in non-demented patients. When the CADD was administered to 243 patients with probable Alzheimer's disease and 151 non-demented control patients, the data showed that Alzheimer's-related depression had somewhat different symptoms than "regular" depression. In this study, depressed Alzheimer's patients were less likely to have sleep disturbances or feelings of worthlessness or excessive guilt than non-demented depression patients, but were more likely to have problems concentrating or making decisions.
The results of this same study confirmed other research showing that the prevalence of major depression did not increase with the severity of Alzheimer's disease. This may mean that major depression in Alzheimer's is not related to the overall degeneration of the brain, but rather to degeneration in specific areas. In fact, several studies have shown that major depression in Alzheimer's disease patients is associated with the degeneration of the areas of the brain stem that produce mood-regulating chemicals such as serotonin, noradrenaline, and dopamine. It's unclear whether this is relevant for other types of dementia.
Dr. Zubenko is one of a group of scientists proposing that the next update of the Diagnostic and Statistical Manual of Mental Disorders (a reference manual used by doctors in the U.S.) include more accurate characterizations of various psychiatric symptoms in dementia, including depression. Better diagnosis would be another step towards understanding the causes of and treatment for depression in Alzheimer's.
In the meantime, can doctors help AD patients with depression? Most clinical trials of anti-depressants for depression in Alzheimer's have been relatively small and short term. At first glance, results look mixed, with some trials showing anti-depressants were more effective than placebo, and some not. In one larger study of 511 patients, an anti-depressant significantly improved both depression and memory. Research currently underway may yield more information. Israeli researchers are conducting a trial of Escitalopram (Lexapro, Cipralex)) for depressive syndrome in various dementias, and there's also a U.S.-based trial of Zoloft for depression in Alzheimer's disease.
But the published trial results are really more positive than it first appears, because many show large improvements in the patients taking antidepressants AND in those taking placebos. For example, researchers from the Raul Carrea Institute of Neurological Research in Argentina published the results of a trial of anti-depressants in 41 depressed Alzheimer's patients. The symptoms of depression went away in 47% of patients treated with the anti-depressant, and in 33% of those treated with placebo. The large placebo effect may be due to non-drug factors such as the attention paid to patients and caregivers during clinical trials, or to the fact that depression in Alzheimer's patients seems to come and go. Even though it's not well understood, Dr. Zubenko says this finding means doctors can provide some assistance for AD patients with depression.
"The goals of most controlled clinical trials are somewhat different from the goals of clinical care," he explains. "Most controlled clinical trials are designed to evaluate whether a particular treatment is effective. To accomplish this, the only difference between the treatment and control groups is the specific treatment whose potential benefit is being evaluated. These controlled trials are important because they provide scientific information from which healthcare professionals and caregivers can decide what treatments work for a particular condition and which do not. Doctors recommend treatment plans for individual patients based on this information, but are not limited to one particular treatment approach. In such cases, we often recommend multiple interventions to maximize the likelihood of a beneficial response, hopefully in an organized way, so that we can also infer which interventions are benefiting the patient. This practical approach is especially important when time is of the essence--e.g the patient's condition is deteriorating in ways that place them in harm's way, they are dangerous to others, or when other practical realities limit the available duration of treatment (such as often occurs in inpatient settings)."
Medications are helpful, but "nonspecific clinical interventions can have valuable effects on optimizing function and minimizing disability," Dr. Zubenko says. "Patients who are in physical pain or discomfort, or are impaired in other ways by medical problems or medication side effects, commonly have secondary disturbances of mood and cognition. Performing a complete medical evaluation and optimizing general health care can have significant positive effects on level of function and the quality of life. Supportive care is also important-- improving nutrition among malnourished patients, addressing personal hygiene, normalizing and structuring daily activities, providing a safe environment with activities and aids that facilitate memory and promote normal functioning , and reevaluating these plans periodically to ensure that they remain appropriate to the patient's needs. Based on my clinical experience, major depression in AD patients usually responds best to a multimodal treatment approach.
It's also important to remember that the ongoing care of a patient with AD is a challenging task for the caregiver. Over the intermediate and long term, it is necessary to provide support, education, assistance, and resources to the caregivers as well. Proper attention and support reduces the stress on caregivers and decreases or delays the need for institutionalization. Failure to do so results in poorer outcomes for both patients and caregivers alike."
So, major depression and dementia are closely linked, and our understanding of causes and treatments for both of these diseases is still incomplete. For depression sufferers around the world, there's an increased risk of AD. And for Alzheimer's patients around the world, there's a potential depressive ripple effect, for both patients and caregivers.
Careful medical attention for both the patient and the caregiver may help, but I wonder how many patients and caregivers can get this attention. In my family's experience, it was difficult to coordinate Dad's care between his family physician and his neurologist, let alone "optimize" all the factors Dr. Zubenko talks about. If my father had lived long enough to need intensive caregiving, only minimal assistance and resources would have been available to us.
It's hard to find the silver lining in this research, but Dr. Zubenko put it in perspective for me. "We're trying to treat a complicated behavioral syndrome in the context of degenerative brain disease – any progress is remarkable, and efforts to optimize treatment are well worth it for patients and their family members," he says.
Posted at 01:34 PM in Living with Memory Loss, Reducing Your Risk for Memory Loss, Treatments, What Causes Memory Loss? | Permalink | Comments (4) | TrackBack (0)
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The latest edition of A Change of Shift, a nursing blog carnival, is up at Emergiblog. These posts by nurses, surgeons, patients and others remind me that dementia isn't the only health problem people struggle with...
Posted at 05:34 PM | Permalink | Comments (0) | TrackBack (0)
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Last week, I wrote about a dementia risk score developed by researchers at the Karolinska Institute in Sweden. To put the risk score in perspective, I checked in with Dr. Tiia Ngandu, co-author of the risk score article published in the September issue of Lancet Neurology. Here are her answers to my questions:
Tiia Ngandu, Ph.D.
Karolinska Institute (Sweden) and University of Kuopio (Finland)
Q: Some background information: my dad died of a hemorrhagic stroke last November, and his autopsy showed severe cerebral amyloid angiopathy (CAA) along with probable Alzheimer's disease. He had few of the risk factors I think were involved in calculating the "dementia risk score": his cholesterol was always low, he was not at all overweight, his blood pressure was low, he exercised and had 16 years of education. So, in my father's case, anyway, he would have had a low score, and I think would have been a "false negative" in your study.
A: First of all, I would like to say that the aim of our risk score was not to say definitely that someone will develop dementia or someone will not. That would not be possible, since we are dealing with a disease that is as complex and multifactorial as Alzheimer's disease. Those persons who had more risk factors had a higher risk of developing dementia in 20 years time, but even among those who had the worst risk score, only 35 % developed dementia - that is to say that with our score it is not possible to "label" persons into future demented and nondemented. We hope that the risk score will be more used to inform both physicians and patients about the risk factors behind dementia in a very practical way. We believe that the persons with most risk factors and highest risk score might benefit from both lifestyle and pharmaceutical interventions.
Q: Was a fairly homogeneous population used for the study? [I asked this because results from one population may not apply to another.]
A: All the participants are from Eastern Finland, and they were fairly homogeneous population.
Q: Did you differentiate at all among the various types of dementia? What cognitive or other tests were used to detect dementia?
A: We differentiated between different types of dementia. The majority of patients had AD. The Mini Mental State Examination (MMSE) was used as a screening test, and after screening the patient went through both clinical and neuropsychological examinations. Due to the use of MMSE at the screening, we may have missed persons with mild dementia, especially early vascular dementia.
Q: Were there risk factors considered that were not found to be predictive in this study? Smoking? Family history of dementia? Tooth loss? Genetic status?
A: Risk factors that were considered but not found predictive were midlife smoking and diastolic blood pressure. We did not have information on family history of dementia or tooth loss. ApoE4 was predictive in this study and it was included in a second risk score model. (It was left out from the first one because we wanted to include only parameters that are easily available in primary care settings)
Q: What other risk factors may be considered while you refine the scoring process?
A: Other risk factors that should be considered in the future risk scores are at least diabetes and family history of dementia: those factors have quite a lot of evidence behind them at the moment.
Q: I saw an abstract of a presentation by researchers at Kings College London at the recent Alzheimer's conference in Madrid that says that in the Honolulu Asia-Aging Study, "cholesterol levels in men with dementia, and in particular those with Alzheimer's disease, had declined at least 15 years before the diagnosis and remained lower than men without dementia throughout that period." Do you think this is true in other populations? How might this affect the cholesterol component of your risk score?
A: Some studies have shown that the cholesterol levels (as well as blood pressure levels) decline in demented patients, and that this decline begins already before the diagnosis of dementia can be made. This decline is probably due to the disease process rather than the decline in cholesterol increasing the risk of dementia. In the Honolulu-Asia Aging Study this kind of decline was observed already 15 years before diagnosis. Also the research group from the Honolulu study thought that the decline might be due to early stages of dementia. I don't see that these findings are in any way contradictory to our findings that high cholesterol levels at midlife would increase the risk of dementia. One should keep in mind the trajectories of cholesterol change with aging and in relation to chronic diseases.
Q: The audience for my blog is mostly middle-aged people, many of whom are caregivers for dementia patients. On a practical level, is there anything we should learn from the dementia risk score other than a confirmation that cardiovascular health and education levels appear to be linked to dementia?
A: What I believe that a middle-aged person could learn from our risk score is that there are several things one can do in order to reduce the risk of dementia. Especially the cardiovascular risk factors can be modified with both lifestyles and medications. I think it is quite good news for those who worry that they might become demented and would like to do something to prevent or postpone it. Of course there are still many other and also unknown factors influencing the development of dementia, but we believe that this is a step in the right direction.
Posted at 02:16 PM in Reducing Your Risk for Memory Loss | Permalink | Comments (3) | TrackBack (0)
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Grand Rounds is up at Clinical Cases and Images - interesting reading, even for laypeople!
Posted at 08:48 AM | Permalink | Comments (0) | TrackBack (0)
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For most of his life, my father was calm and happy. "No sweat," he'd say when the furnace blew up or the car wouldn't start. Even when his retail lumberyard burned down, or when his parents died, he seemed to take a Zen attitude towards life. But after he retired, I thought he was more pessimistic than usual. Was this somehow related to his later dementia?
I didn't think much about mood, depression and dementia until I realized it was a topic of discussion on some of the caregiver blogs. In The Yellow Wallpaper, Deb Peterson writes about how her mother's depression after the death of several family members seemed to mark the beginning of her dementia. Paula Martinac (Dementia Blues) reports both her parents were depressed before their declines into dementia. But many people with Alzheimer's disease or dementia have no history of depression. Gail Rae Hudson (The Mom & Me Journals), who describes her mother's condition as "dementia lite," doesn't think her mom has ever been depressed.
Was the change in Dad's mood [I wouldn't call it depression] a normal reaction to retirement? Or was it an understandable reaction to subtle signs of dementia the rest of us didn't see? It makes sense that some dementia patients become melancholy when they realize they're having memory problems.
But rather than dementia causing depression, it seems to be more of a two-way process. Several studies show a history of depression may increase your risk of developing dementia later in life:
• A large retrospective study at the University of Limburg in the Netherlands (published in 1996) and another at the University of Copenhagen in Denmark (2003) found associations between a history of depression and dementia
• When researchers at Rush Alzheimer's Disease Center in Chicago followed Catholic clergy aged 65+ for seven years, they concluded that each depressive symptom reported over the seven year period increased the risk of developing Alzheimer's disease by an average of 19%, and increased average cognitive decline by 24%.
• Scientists at Boston University School of Medicine found a significant association between depression symptoms and Alzheimer's in 1953 patients with Alzheimer's disease and 2093 of their non-demented relatives. The association was most significant when depression symptoms first occurred within one year of the onset of Alzheimer's, but there was still a modest association even when depression first happened more than 25 years before the onset of Alzheimer's. [free registration required to view this article]
Other studies have not been as definitive. University of Ottawa researchers found a weak, but not statistically significant association between a history of depression and Alzheimer's disease after following more than 4600 Canadians aged 65 and older over a five year period.
This year, a team of researchers from the University of Miami Miller School of Medicine and the Wien Center for Alzheimer's Disease and Memory Disorders at Mt. Sinai Medical Center published the results of a systematic review and analysis of the research on this topic. Analyzing data from over 100,000 patients in 22 studies, the researchers concluded that a history of depression does seem to increase the risk of developing Alzheimer's, although the absolute risk is still small. Their data also showed relatively long times between depressive episodes and the onset of Alzheimer's, suggesting that depression may be an independent risk factor for developing Alzheimer's rather than signaling the onset of the disease.
For dementia patients with a previous history of depression, it's also likely their dementia will be more severe than that of patients with no such history. In a recent study, pathologists compared the brains of Alzheimer's patients who had lifelong histories of depression to the brains of Alzheimer's patients who hadn't had depression. The pathologists found that the brains of patients with a history of depression had more of the plaques and tangles associated with Alzheimer's disease than those of patients who hadn't had depression. This increase in plaques and tangles seemed to correlate with the severity of memory loss.
If depression and Alzheimer's are linked, then maybe there's a common underlying cause. Several studies point to cortisol, a stress hormone, as the possible culprit. The thinking is that stress causes the body to release cortisol, and that chronic stress leads to the chronically high levels of cortisol sometimes associated with cognitive impairment and shrinkage of some areas of the brain.
The obvious question is whether lowering cortisol improves memory. I've always had trouble navigating, and this problem gets worse when I'm upset. Could I take something to lower my levels of this hormone before I drive an unfamiliar route? It turns out that for rats, lowering cortisol levels does improve their performance in mazes.
I was disappointed to find it's not so simple for humans. In a small trial of seventeen people, a team headed by researchers from McGill University in Canada found that manipulating cortisol levels did have an effect on memory in some people, but that effect was dependent on historical cortisol levels in each participant or person. If the individual patient had had moderate cortisol levels for a period of five years, blocking cortisol levels actually decreased memory, and adding back cortisol reversed this problem. For patients with historically high cortisol levels and existing memory problems, blocking cortisol didn't improve memory, although increasing cortisol levels made their memory problems worse. This could be because it's the cumulative, long-term exposure to high levels of cortisol that hurt the brain, rather than the level at any one time. Some scientists think problems are caused by the malfunctioning of the receptors for cortisol, rather than the hormone itself.
So, the cortisol and stress connection is intriguing, but at least so far, hasn't yielded the magic formula to fix dementia.
One of reasons it's hard to untangle the relationship of depression and dementia or Alzheimer's disease is that both diseases may have multiple underlying causes. "I think the evidence shows that there may be complex relationships among stress, cortisol (and other neuroendocrine substances), inflammatory markers, cardiovascular disease, and cognition," says Dr. Ray Ownby, Professor of Psychiatry at the University of Miami Miller School of Medicine and the lead author of the scientific review of research on the topic. "Since cardiovascular disease may be related to Alzheimer's disease, it seems quite possible that stress, cortisol, inflammation, depression, and AD may all be related, but we don't know how."
Raymond L. Ownby, M.D., Ph.D., M.B.A.
But even if stress, cortisol and depression were only partially responsible for dementia, could they be considered "modifiable risk factors" for Alzheimer's disease? I asked Dr. Ownby if treating depression could actually lessen a person's chances of developing dementia.
"The possibility that treating depression might lower your risk for Alzheimer's disease is intriguing," he says, "but there simply isn't any evidence that I'm aware of on the subject, other than the possibility that antidepressants can lower levels of some chemicals that may be related to dementing illnesses."
What about the idea that depression can masquerade as dementia? When I first started researching my father's memory problems, several web sites mentioned "pseudo-dementia." According to some of these sites, once you treat the depression, the dementia is reversed. But the diagnosis and prevalence of pseudo-dementia is now in question, and at least one study has shown that many people who seemed to have reversible dementia [their memory problems improved after their depression was treated] later developed [non-reversible] dementia.
Dad didn't have a history of depression, and it's pretty clear most of his dementia was related to cerebral amyloid angiopathy. But if he had lived long enough, depression might have been more of a problem. Treating any depression may have helped his dementia, at least for a while. I'll talk more about that in my next post.
Posted at 03:25 PM in Care, Living with Memory Loss, Reducing Your Risk for Memory Loss, Treatments, What Causes Memory Loss? | Permalink | Comments (8) | TrackBack (0)
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Sometimes the headlines about Alzheimer's research are dramatic, but the lives of dementia sufferers and their caregivers are pretty mundane. In fact, details like preparing meals, balancing a checkbook and bathroom visits take center stage.
If you're tired of reading about dementia, head over to the Carnival of the Mundane hosted at Apartment 2024, and read about the ups and downs of other people's lives.
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Product Recall: We are voluntarily recalling fewer than 8,000 cases of regular Kraft American Singles Pasteurized Prepared Cheese Productlimited to 4 SKUs on two "Best When Used By" dates of February 20, 2015 and February 21, 2015. Click Here.
HEAT oven to 400ºF.
PREPARE stuffing as directed on package. Remove from heat; gently stir in fruit, nuts and sage.
OPEN meat; place cut-sides up, on work surface. Top with stuffing; roll up, starting at one long side. Place, seam-side down, on foil-covered baking sheet sprayed with cooking spray. Season with salt and pepper.
BAKE 45 min. or until meat is done (160ºF). Let stand 10 min. before slicing.


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Your editorial page lends support to state Senator John Keenan's thinly varnished attempt to subvert the will of 63 percent of Massachusetts' voters who favor medical marijuana ("State should assign marijuana from warehouses, not stores," Editorial, 2/7).
Keenan states a concern that the law runs afoul of federal law as one reason for his bill. He would limit cultivation to 10 large sites. Wouldn't that pose an inviting challenge to federal prosecutors looking to make 10 busts?


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Obituary: Mary-Elizabeth 'Betty' McCoun Monroe
Date: January 16, 2013
by: Observer Staff
Mary-Elizabeth "Betty" McCoun Monroe, 85, of Plymouth Harbor, died Jan. 13.
Born Sept. 21, 1927, in New York, during her life she lived in New Jersey; New York City; Chicago; San Mateo, Calif.; Wilmette and Winnetka, Ill.; New Canaan, Conn., for 30 years; Longboat Key; and Plymouth Harbor since 2001.
Mrs. Monroe was a longtime member of All Angels by the Sea Episcopal Church, the Junior League of Sarasota and Bird Key Yacht Club. She enjoyed bridge, dancing, reading and travel.
Mrs. Monroe drove for Meals on Wheels for several years and was active in church, hospital and senior activities.
Mrs. Monroe is survived by her husband of 64 years, Andrew "Perry" Monroe; sons Bill Monroe, of Sarasota, and Steve Monroe, of New Canaan; daughter, Meg Zellinger, of Bowdoinham, Maine; and nine grandchildren.
A funeral service will take place at 2:30 p.m. Friday, Jan. 25, at All Angels by the Sea Episcopal Church, 563 Bay Isles Road, with a reception following in the parish hall.
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The White ThrillApril 19th, 2014
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Arlberger Bike MarathonAugust 23th, 2014
41 Km in total. A challenging mountain bike race to close the triathlon "Arlberg Eagle". [more ...]


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SPOKANE, Wash. - More than 70 local volunteers with Keller Williams Realty chose to spend all day making over retired U.S. Army Sergeant Willard "Seth" Van Eyke's yard on the South Hill. Not just because it needed a lot of work, but because Van Eyke can no longer do the work himself.
"I just can't do it the way I used to," Van Eyke said. "I can work probably about 10 minutes at a time and then, I'm done. My body hurts too much and I start losing feelign in my legs and arms."
Seven years ago, Van Eyke survived up to seven Improvised Explosive Device (IED) explosions as a U.S. Army Sergeant serving in Iraq. Today, his army boots rest in his garden as a reminder of what happened.
"Everybody has these lofty ideals about doing it for country and those are there for you, but the reality of it is, you do it for your men and you do it for the guy who's next to you," Van Eyke said. "And the mission becomes coming home."
Van Eyke lost more than his commrades that day. He suffered a traumatic brain injury and he lost much of his physical ability. He can't do the simplist chores he used to: like mowing the lawn or unloading groceries.
The boots are equally as emotional for Van Eyke's wife, Meghan Jones. Even though she didn't know Van Eyke's friend he lost in one of the explosions.
"The thought that it could've been him," Jones said. "It wasn't."
As part of the yard rennovation, volunteers built Van Eyke a new deck and raised flower beds. Van Eyke said the improvements are giving him back some pride
"Being able to walk out my front door and say, 'Okay, I can just maintain that area,' instead of, 'I have to start from scratch,' that's the biggest thing," he said.
"We are both completely overwhelmed at just the generosity of strangers," Jones said
Van Eyke received a Purple Heart before he was medically retired in 2006. He recently went back to school and received his associate's degree in visual communication and graduated at the top of his class.
He is now enjoying spending more time in his yard.


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text: Board Mike Olson, Chairman Cloudera Expand Mike (@mikeolson) co-founded Cloudera in 2008 and served as its CEO until 2013 when he took on his current role of chief strategy officer (CSO.) As CSO, Mike is responsible for Cloudera's product strategy, open source leadership, engineering alignment and direct engagement with customers. Prior to Cloudera Mike was CEO of Sleepycat Software, makers of Berkeley DB, the open source embedded database engine. Mike spent two years at Oracle Corporation as vice president for Embedded Technologies after Oracle's acquisition of Sleepycat in 2006. Prior to joining Sleepycat, Mike held technical and business positions at database vendors Britton Lee, Illustra Information Technologies and Informix Software. Mike has a Bachelor's and a Master's Degree in Computer Science from the University of California, Berkeley. Tom Reilly Cloudera Expand Tom has a distinguished 30-year career in the enterprise software market. Prior to Cloudera, his most recent role was as vice president and general manager of enterprise security at HP. Previous to HP, Tom served as CEO of enterprise security company ArcSight , which HP acquired in 2010. Tom led ArcSight through a successful initial public offering and subsequent sale to HP. Before ArcSight, Tom was vice president of business information services for IBM, following the acquisition of Trigo Technologies Inc., a master data management (MDM) software company, where he had served as CEO. Tom currently serves as a Board Member for Jive Software, privately held Ombud Inc., ThreatStream Inc. and Cloudera. Tom graduated from the University of California, Berkeley with a Bachelor of Science Degree in Mechanical Engineering. Aneel Bhusri Workday Expand Aneel Bhusri is chairman, co-founder and co-CEO at Workday. Aneel has been a leader, product visionary and innovator in the enterprise IT industry for more than 20 years. Before co-founding Workday in 2005, Aneel held a number of leadership positions at PeopleSoft, including senior vice president responsible for product strategy, business development and marketing, and vice chairman of the board. He has served as an investing partner at Greylock Partners and as chairman of the board at Data Domain (acquired by EMC for $2.5 B in 2009). Aneel holds an M.B.A. from Stanford University and a Bachelor of Science and Arts in electrical engineering and economics from Brown University. Ping Li Accel Partners Expand Ping Li joined Accel in 2004 and focuses primarily on information technology infrastructure and digital media platforms. His areas of interest also include datacenter virtualization, cloud computing, distributed data management and Internet datacenter scalability. He currently is an investor/board member of BitTorrent, Cloudera, Mochi Media, Mu Dynamics, Raptr, Verivue and YuMe, and he is actively involved in Imperva. Ping was also responsible for Accel's investment in Reactivity (acquired by Cisco).Prior to Accel, Ping was a senior product line manager and director of corporate development at Juniper Networks. He managed Juniper's flagship M-series router product portfolio. In addition, Ping worked on Juniper's acquisition of NetScreen Technologies (a $3.5 billion transaction) and led all subsequent security and routing product and R&D integration activities. He also worked as a strategy consultant for McKinsey & Company, advising technology clients in their growth strategies.Ping holds an A.B. from Harvard University, with honors, and an M.B.A. from Stanford University. Kimberly Stevenson Intel Expand Kimberly "Kim" Stevenson is corporate vice president and Chief Information Officer (CIO) of Intel Corporation. She is responsible for the corporate-wide use of Information Technology (IT). Intel's IT organization delivers leading technology solutions and services that enable Intel's business strategies for growth and efficiency. The IT organization is comprised of over 6,000 IT professionals worldwide. Previously, Stevenson was vice president and general manager of Intel's Global IT Operations and Services. In this role she led both the strategic and tactical support of Intel's world-wide infrastructure components, including Data Centers, Network and Telecommunications, Enterprise Application Support, Client computing and a 24x7 internal Service Desk. Dick Williams Webroot Expand Dick Williams is President and CEO of Webroot and brings over four decades of executive and operational leadership experience for technology, software and digital media companies to Cloudera's Board. Dick has worked as CEO or Chairman of several category-defining companies funded by some of the most successful venture capital firms in the world, including Altor Networks (acquired by Juniper Networks), Hyperic (acquired by SprintSource Global), Wily Technology (acquired by Computer Associates) and Illustra Information Technologies (acquired by Informix). He also co-founded and served as chairman of Quokka Sports, an online immersive sports media company. Williams' executive leadership experience began at IBM, where he spent 22 years in a variety of sales, marketing, product and business management roles. Following IBM, he served as President and CEO of Digital Research, which he turned around and sold to Novell. Williams is currently also an outside director of 3VR and LogRhythm. Scott Dietzen Pure Storage Expand Scott Dietzen is currently CEO at Pure Storage, and prior to that was a three-time successful entrepreneur with WebLogic, Zimbra, and Transarc. Most recently, he was President and CTO of Zimbra, a vendor of open source messaging and collaboration software. Zimbra (now part of VMware) was a pioneer of the Web 2.0 and Open Core paradigms. Zimbra was originally acquired by Yahoo!, where Dietzen served as interim SVP of Communications and Communities. Prior to Zimbra, Dietzen was CTO of BEA Systems — acquired by Oracle in 2008, where he helped craft the technology and business strategy for WebLogic. Dietzen came to BEA in 1998 via the acquisition of WebLogic, an innovator in Java and web application server technology. He earned his Ph.D. and M.S. in Computer Science from Carnegie Mellon University.


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10 best independent films of 2012
Crime-thriller 'Peddlers' is an ode to Mumbai. The film narrates the raw story of three characters that share an almost appalling behaviour since childhood. The film was screened at 2012 International Critics' Week, an independent film event which runs parallel to the Cannes Film Festival in southern France.
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After the players had rested we took off for our first training together with the team. Signs of a long flight were nowhere to be found as they took on the pitch. The vibe was focused but chuckled laughs intercepted each other and hinted of a very joyful team spirit.
The more experienced players such as John Mensah and Stephan Appiah took the lead as they went into heavier activities and it became more and more clear the best way to lead is by example.
Some badass workout routines were to be seen as PUMAFootball were glad we could take cover in the shade and not having to move too much. Watching it was exhausting enough, but for them... It is just clear they love what they do.