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CME Disclosure
Thomas W. Meeks, M.D., Nicole Lanouette, M.D., Sharon Dawes, Ph.D., Department of Psychiatry, University of California, San Diego, San Diego, CA. Ipsit Vahia, M.D., Barry Lebowitz, Ph.D., Department of Psychiatry, University of California, San Diego, San Diego, CA; and Sam and Rose Stein Institute for Research on Aging, San Diego, CA.
These authors report no relevant financial relationships to disclose.
Dilip V. Jeste, M.D., Department of Psychiatry, University of California, San Diego, San Diego, CA; and Sam and Rose Stein institute for Research on Aging, San Diego, CA; and VA San Diego, CA, Healthcare System, San Diego, CA.
Grant support in the form of medication supplies for NIH funded grant: Astra Zeneca, Bristol Myers Squibb, Eli Lilly, Janssen.
Address correspondence to Thomas Meeks, M.D., Assistant Professor of Psychiatry, Division of Geriatric Psychiatry, VA San Diego Healthcare System, 3350 La Jolla Village Drive, Building 13, 4th floor Mail Code 116A-1, San Diego, CA 92161; e-mail: email@example.com
To provide optimal care, the approach to psychiatric evaluation and diagnosis in older adults requires special attention to several issues. There are important biological, psychological, and social changes associated with either aging itself or with generational differences. In this review, we will address some of the most important aspects of assessment and diagnosis that make geriatric psychiatry a unique subspecialty, including age-related variability in the clinical presentation of common psychiatric disorders, assessment and diagnosis of cognitive disorders and medical comorbidity, and common psychosocial challenges faced by older adults. Although geriatric psychiatrists are uniquely positioned to address the complexities of psychiatric illness in older adults, the fact remains that the majority of older adults who seek psychiatric care will see general adult psychiatrists without subspecialty training. However, with continued vigilance to the issues outlined below, psychiatrists from a variety of training backgrounds can skillfully assess and diagnose psychiatric illnesses in older adults.
There is some confusion in the psychiatric literature regarding the incidence, prevalence, and illness course of psychiatric disorders in late life. This can be partly attributed to a paucity of studies focused on determining the epidemiology of psychiatric illnesses in older adults (2). Moreover, there is a common belief (and some empirical evidence) that psychiatric disorders (except dementia) are less prevalent in older adults than in younger populations (3). Yet, these studies have certain limitations. Behavioral and neurovegetative symptoms of psychiatric illness frequently overlap with those of general medical conditions, and increasing age is generally accompanied by increased medical comorbidity, which creates diagnostic conundrums in the evaluation of older adults. In addition, age-related changes in the body and brain, as well as cohort effects, can lead to atypical manifestations of psychiatric illness, resulting in inaccurate or overlooked psychiatric diagnosis (4). Increasingly, however, it is recognized that special care needs to be given to psychiatric assessment of the older patient. Awareness and subsequent clinical recognition of the differences in symptoms between older and younger age groups may help reduce both psychiatric and medical comorbidity. Table 1 outlines age-related differences in the clinical features of several major psychiatric illnesses. Estimates of incidence and prevalence as well as prognosis and illness course are included.
Overview of Noncognitive Psychiatric Disorders in Older Adults
It is important to note that available information on psychiatric disorders in older adults is based on research conducted using diagnostic criteria from either the DSM or ICD, both of which were almost invariably developed from models of illness in mostly younger or middle-aged adults. However, it has become increasingly evident that use of these criteria may result in an underestimation of the prevalence of psychiatric disorders in older persons, largely because these criteria have not been validated in older populations (25). Symptoms of psychiatric illness in older adults do not always correspond with criteria described in the standard diagnostic manuals, a phenomenon also seen and more widely recognized among children and adolescents. Ultimately, as research on age-related changes in the brain expands, we will gain a more sophisticated understanding of differences in clinical symptoms of psychiatric illness as a function of age. Creating age-specific diagnostic criteria on the basis of evolving knowledge of this process will allow clinicians to better identify symptoms, diagnose illness, and devise treatments for management of late-life psychiatric disorders. For now, awareness of variable presentations of psychiatric disorders in older adults, as reviewed in Table 1, enables the clinician to be more attuned to the psychiatric needs of older adults.
Unlike the disorders described in Table 1, cognitive disorders are unequivocally more prevalent as age increases, and competency in assessing cognition is an essential skill for clinicians caring for older adults. This encompasses the use of cognitive screening assessments, early detection and education about dementias, treatment of comorbid disorders that masquerade as dementia, attention to family system and caregiver issues, referral to and collaboration with other professionals such as neurologists and neuropsychologists, and reassurance when cognitive changes are the result of normal aging.
There is a common public (and even professional) misconception that dementia is a sine qua non of aging. Although age is the most prominent risk factor for dementia, half or more of adults older than age 85 retain normal cognitive functioning (26). Cognitive impairments that meet the diagnostic criteria for dementia should never be dismissed as normal aging. Nonetheless, it is also valuable to recognize that there are some changes in cognition that are age-related and not considered pathological. Examples of such age-related cognitive changes include some decline in free recall and consistently slower processing speed. However, more crystallized abilities (vocabulary and general knowledge) tend to remain stable or even, in some circumstances, increase with age (27). When appropriate, reassurance about benign cognitive changes of aging can allay significant anxiety for older adults, who are increasingly cognizant of illnesses such as Alzheimer's disease.
The most widely recognized standardized cognitive assessment used in clinical settings is the Folstein Mini-Mental State Examination (MMSE) (28). The MMSE is useful primarily as a screening tool, although it may also be used as a crude proxy for illness progression in persons with dementia. Cutoffs for "normal" versus "abnormal" scores vary by age and educational attainment (29), in addition to possible cultural variations (30). Criticisms of the MMSE have included a relative lack of assessment of certain cognitive domains (e.g., executive functioning) and insensitivity to early dementia, especially in older adults with high intelligence and educational attainment (31).
Other screening cognitive tests have been developed to address possible limitations of the MMSE. The Mini-Cog Test, which uses only three-item registration and recall separated by the Clock Drawing Test, is somewhat quicker to administer than the MMSE, and is useful in certain settings such as primary care and the emergency room, and appears to have sensitivity and specificity for dementia similar to that of the MMSE (32). Other examples include the Saint Louis University Mental Status examination (33) and the Montreal Cognitive Assessment (34) (Figure 1), which have more extensive memory and executive function assessment than the MMSE.
The Montreal Cognitive Assessment.
The gold standard of cognitive assessment is formal neuropsychological testing, typically performed by a specialist in neuropsychology. Referral for neuropsychological testing may be particularly useful if diagnosis is uncertain (e.g., early Alzheimer disease versus dementia of depression), as various forms of dementia exhibit somewhat distinct profiles of relative strengths and impairments early in the course of illness (35). Table 2 lists the most common variants of cognitive disorders among older adults, along with clinically distinguishing features including typical neuropsychological profiles. In moderate-to-severe stages, most forms of dementia eventually cause diffuse and nonspecific impairment across multiple cognitive domains. One must also keep in mind that the most troubling symptoms of dementia are often the accompanying psychological and behavioral changes, which affect up to 80% of persons with dementia across the illness course and which frequently increase caregiver burden and the likelihood of patient institutionalization (55). Evaluation for depressive symptoms, psychosis, sleep disturbance, and agitation is a crucial part of the evaluation of cognitive disorders in older adults, and progress is being made toward establishing reliable diagnostic categorization of such neuropsychiatric symptoms of dementia (56).
Overview of Cognitive Disorders Among Older Adults
There are several traditionally distinct (although admittedly sometimes overlapping) cognitive domains that can be assessed with neuropsychological testing, and abbreviated assessments of each domain are also possible in the clinical setting. Some of the most frequent cognitive domains as conceptualized by neuropsychology today are described below:
Cognitive testing of older adults should be conducted with several caveats in mind. For example, there is a lack of age-appropriate normative data on many tests for the oldest-old age groups and certain cultural groups. Many older people have sensory or motor impairments that may interfere with certain tasks independently from cognition per se. Subtle cognitive deficits may be very difficult to detect, especially in high-functioning or highly educated older adults. Even the best of cognitive testing may leave questions unanswered, and in these circumstances the trajectory of change in cognition over time can be very informative.
Clinicians may often be asked to evaluate the decision-making capacity of older adults. Competency usually refers to an evaluation derived from legal adjudication. Decisional capacity is the preferred term when describing a clinician's evaluation of a patient's decision-making abilities. Evaluation of decisional capacity is most commonly prompted when a patient declines a recommended treatment (73). Two other common scenarios involve capacity to drive and to decide on one's living environment (74). Clinicians are required in a few and allowed in most states to report cases of dementia to motor vehicle departments. There is no clinical consensus for how to determine when a person should have his or her driver's license revoked. Although the safety of the public and patient is clearly important, this must be balanced with the possible adverse consequences of license revocation on a person's sense of independence and practical mobility. On-road driving tests may represent the best available option in questionable cases. Equally contentious at times is the dilemma of when an older adult needs to enter a structured living environment (i.e., assisted living or nursing home), also reflecting basic ethical conflicts between paternalism and respect for autonomy.
Older adults are certainly at increased risk for impaired decisional capacity. Dementia is often the most prominent illness in clinicians' minds when considering impaired decisional capacity. Psychosis and depression may also impair decisional capacity in older adults via emotional factors, such as paranoid delusions or severe hopelessness. However, psychiatric illness and dementia do not invariably impair decisional capacity (75, 76). Several qualities have been consistently described as necessary for decisional capacity. The four most commonly cited criteria are
Because of the increased risk for impaired decisional capacity, it is vitally important to encourage older patients to execute advanced directives proactively before such impairments occur.
Psychiatry is perhaps unique among medical specialties in that it has traditionally emphasized functional impairment as part of its disease constructs, but functional assessments are especially germane in the evaluation of older adults and are an essential component of what distinguishes geriatrics as a subspecialty (78). Functional impairment increases with age and is often overlooked or marginalized in importance if one focuses too narrowly on symptomatology. All psychiatric assessments of older adults should include a basic history of functioning in both instrumental (e.g., driving, cooking, and managing finances) and basic (e.g., grooming, eating, and walking) activities of daily living. Standardized assessments are available as well, including the Lawton Instrumental Activities of Daily Living scale (79) and the Older Americans Resources and Services (OARS) Multidimensional Functional Assessment Questionnaire (80).
Given the link between the use of most psychotropic medications and increased risk for falls (81), specific assessments of mobility may also be useful for psychiatrists caring for older adults. Perhaps the simplest and most sensitive screening for fall risk is the Timed Get-Up and Go Test (82). This test entails asking the patient to rise from a chair without using his or her arms, walk about 10 feet, turn around, and sit back down (again without using his or her arms). If the patient takes more than 10 seconds to complete the examination or exhibits obvious unsteadiness, then further evaluation of gait and balance is indicated.
Nowhere is the mind-body connection more evident than in the psychiatric assessment of older adults. Although a medical assessment is an integral part of the initial evaluation for all persons presenting with psychiatric symptoms, it is especially important for older adults. Older adults are at increased risk for delirium (83), polypharmacy (84), and many medical conditions, all of which can present primarily or even exclusively with psychiatric symptoms. As providers with both psychological and medical training, psychiatrists are uniquely positioned to provide an integrated medical and psychological evaluation of the older adult presenting with behavioral or psychological symptoms. Even when a medical disorder is not the direct physiological cause of psychiatric illness, the impact of chronic medical illness on quality of life and functional ability is often apparent in the lives of older adults and relevant to psychiatric assessment and treatment (85). For instance, medical illness is associated with increased risk for suicide among older adults (86).
As with any medical or psychiatric assessment, the best approach is to start with a thorough history. A medical history is, of course, part of any psychiatric evaluation. We will therefore highlight some special considerations to keep in mind in the initial psychiatric assessment of older adults. Always consider obtaining collateral information, particularly when patients exhibit any cognitive impairment (87). Even cognitively intact older adults may withhold or fail to recognize important historical information that family members can provide, although balancing the relative validity of contradictory perspectives requires consideration of several possible competing motivations and family dynamics.
Given the prevalence of delirium and psychiatric illness due to a medical condition in late life, it is important for a clinician to keep these diagnoses at the top of the differential diagnosis when conducting psychiatric evaluations of older adults (88). Obtaining a thorough understanding of the time course of the psychiatric symptoms can be one of the best clues as to whether delirium or a medical condition is implicated in the etiology (e.g., increased suspicion for a medical etiology when symptom onset is acute or when new physical symptoms overlap chronologically with new psychiatric symptoms) (87). Some cases may be readily apparent (e.g., confusion and hallucinations accompanying 2 days of fever and cough associated with pneumonia), but many require a higher level of vigilance (e.g., depression associated with hypercalcemia due to an occult parathyroid adenoma) (89). There may also be complex reciprocal relationships between medical conditions and psychiatric symptoms (e.g., the interplay between anxiety and dyspnea in chronic obstructive pulmonary disease) (90).
The nature and pattern of psychiatric symptoms may also yield clues as to whether they may be due to medical illness. For example, visual, olfactory, or tactile (versus auditory) hallucinations increase suspicion for medical causes (91). Early morning awakening is a classic symptom of melancholic depression, whereas repeated nighttime awakenings often occur with nocturia due to benign prostatic hypertrophy, persistent pain, or severe gastroesophageal reflux (92). In addition, cognitive impairment accompanied by inattention and an altered level of consciousness points toward delirium, often underrecognized as a medical emergency (83).
Most primary psychiatric illnesses (other than cognitive disorders) manifest well before old age, such that the first episode of an illness after age 40 significantly raises suspicion for an underlying medical problem (93). As in the history of present illness, one should assess whether prior symptoms or episodes could have been related to medical illness. If no prior link to medical illness is identified, it is, of course, important to remember—and remind our medical colleagues—that previous psychiatric illness does not preclude delirium or psychiatric illness due to a medical condition being part of the current presentation.
Although often overlooked in older adults, substance abuse, particularly alcohol and prescription drug abuse (94, 95), is an important potential contributor to medical and psychiatric problems. Thus, it is always worth evaluating whether substance intoxication, withdrawal (especially postoperatively), abuse, or dependence could be contributing to an older adult's presenting psychiatric symptoms. A lifetime of substance use may lead to multiple medical sequelae in older adults (96, 97), including various cancers, nutritional deficiencies, and organ failure, all of which may themselves cause secondary cognitive and psychological symptoms.
Some of the most relevant disorders to investigate, because of their contribution to neuropsychiatric symptoms and/or their high comorbidity with psychiatric illnesses include endocrine disorders (e.g., hypo-/hyperthyroidism, hypo-/hyperparathyroidism, and diabetes mellitus) (98), cardiovascular disorders (e.g., coronary artery disease and cerebrovascular disease) (99), and rheumatological disorders (e.g., rheumatoid arthritis, osteoarthritis, and polymyalgia rheumatica) (100). Persistent pain disorders are quite common in older adults, are often comorbid with anxiety and depression, and may increase suicide risk (101, 102). Taking a sexual history may seem uncomfortable or unnecessary with older adults, but this reluctance reflects an ageist attitude. Sexual functioning is often an important component of the physical and emotional health of older adults, and many psychotropic medications may adversely affect sexual desire and/or performance.
One of the best contributions a physician can make to an older adult's care is a thorough review of all his or her medications (84). Iatrogenic psychiatric symptoms can arise from medication side effects and drug-drug interactions but often go undetected (103). Medication assessments should include obtaining a full list of all medications the patient is taking including over-the-counter and herbal medications and supplements, assessing dosing schedules, determining how often patients are really taking medications (looking for over- and underuse), asking about side effects, and checking for drug-drug interactions (104). If potential problems, such as unnecessary or redundant medications or possible psychiatric side effects, are identified, working with a patient's primary care physician or team to minimize these problems can be invaluable in improving an older adult's medical and psychiatric condition. Particular attention should be given to minimizing the cumulative anticholinergic burden of medications in older adults, often the result of several concomitant medications whose anticholinergic effects are underrecognized (105). Geriatric care is often as much or more about removing iatrogenic culprits of illness as prescribing additional treatments.
Although psychiatrists typically do not do physical examinations as part of their initial medical assessment, these may be appropriate under certain circumstances. Certainly routine vital signs, including pain severity, weight, and orthostatic blood pressure measurements, may identify medical conditions that may alter one's diagnosis or treatment as well as potentially serious side effects of psychotropic drugs (e.g., anticholinergic or proadrenergic drug-induced tachycardia predisposing to cardiac complications, antiadrenergic-induced orthostasis predisposing to falls, and medication-associated weight gain or loss predisposing to a host of adverse medical consequences) (106, 107). Although vital signs may be an important clue to medical emergencies, one must also keep in mind age-associated changes in the physiology of vital signs (e.g., infection in the absence of fever or increased carotid sinus sensitivity) (108, 109).
Examinations for tardive dyskinesia and parkinsonism are particularly important when a clinician is prescribing antipsychotics for older adults, given that age increases the risk of these motor complications (110). The mental status examination of older adults consists largely of the same components included in the assessment of younger adults, with the notable exception that more extensive cognitive assessment, including evaluation for delirium, is often needed. Evaluation for suicidal ideation should be at the forefront of clinical assessments in light of the elevated rates of completed suicide among older adults, mostly accounted for by white men (111).
Depending on an older adult's presentation and the treatment options being considered, a variety of laboratory tests may be indicated in the medical assessment of an older adult presenting with psychiatric symptoms. Laboratory tests to consider routinely obtaining include the following: 1) thyroid function tests (e.g., thyroid-stimulating hormone), because thyroid disease may cause depression, anxiety, and cognitive impairment (112); 2) electrolyte levels, because alterations of these may significantly affect the central nervous system (e.g., hyponatremia-induced delirium due to the syndrome of inappropriate antidiuretic hormone or selective serotonin reuptake inhibitor treatment) (113); 3) renal function tests (blood urea nitrogen and serum creatinine), because renal function is often reduced by age or age-associated illness, which may significantly affect the pharmacokinetics of medications (114); 4) hepatic function tests (e.g., alanine aminotransferase and aspartate aminotransferase), because psychopathological conditions may significantly contribute to chronic liver disease via alcohol use and comorbid hepatitis C infection (115); 5) complete blood count, because anemia may explain fatigue/depression, leukocytosis may point to an undetected infection, and many psychotropic drugs have hematopoietic side effects (116); 6) lipid panel and fasting glucose, particularly if a patient is already taking or considering starting medications that could cause metabolic syndrome (117); 7) rapid plasma reagin to test for syphilis and HIV antibodies if the patient has risk factors and consents, because prejudicial views of older adults may lead clinicians to dismiss their current or past sexual activity (118); 8) urine drug screen to assess for substance use and breathalyzer or blood alcohol level, especially in emergency room settings, where, again, age may inappropriately lower clinicians' vigilance for substance use (95); 9) urinalysis, because urinary tract infection may present exclusively with mental status changes in older adults (119); 10) vitamin B12 and folate levels, because deficiencies of these increase with age and may contribute to both depression and cognitive impairment (42); and 11)drug levels of any prescription drugs patients are taking, especially those with low therapeutic indices (e.g., lithium, anticonvulsants, digoxin, and tricyclic antidepressants).
Other diagnostic tests to be considered in certain situations include the following: 1) chest radiograph for respiratory symptoms, signs of delirium, or fever; 2) neuroimaging (magnetic resonance imaging or computed tomography) to evaluate for stroke, mass lesions, or normal pressure hydrocephalus (120); 3) electrocardiogram for acute mental status change, cardiorespiratory symptoms, or consideration of psychotropic agents that may alter cardiac conduction (e.g., lithium, tricyclic antidepressants, and certain antipsychotics) (121); 4) electroencephalogram for paroxysmal symptoms that could be due to seizures, unusual or subacute dementias (e.g., Creutzfeld-Jacob disease), or diagnostic confusion between delirium versus dementia (although generalized slowing is present in both delirium and more advanced cases of dementia) (122); and 5) lumbar puncture in patients with atypical cognitive disorders, fever without a clear etiology, or suspected neurosyphilis (123).
Many invasive (e.g., lumbar puncture) or expensive (e.g., magnetic resonance imaging) tests may be unnecessary with a careful history and physical examination. Although the use of neuroimaging is clinically routine in the assessment of delirium, dementia, and late-onset psychiatric disorders, there is debate as to its cost-effectiveness and clinical yield in the absence of historical (e.g., acute onset) or physical examination findings (e.g., focal neurological symptoms) that raise suspicion for certain neurological disorders (124, 125). The explosion of research in functional neuroimaging has yet to yield significant clinical applications, although this is anticipated in upcoming years with promising techniques such as in vivo amyloid imaging (126). Currently, the only psychiatric application of functional neuroimaging approved by Medicare is the use of positron emission tomography in differentiating Alzheimer-type versus frontotemporal dementia in patients with clinically unclear illness (127).
Although medical disorders and neurobiological changes associated with aging are at the forefront of considerations in psychiatric assessments of older adults, a balanced biopsychosocial perspective remains crucial as well. The comfort level of older adults (at least the current cohort) with mental illness and psychiatric evaluation must be considered to develop the rapport needed for any other aspect of assessment (128). Older adults also tend to face somewhat unique psychosocial stressors that may have tremendous relevance for the symptoms at hand. For instance, acting as a caregiver for a disabled relative is associated with high rates of depression and is often used in research as a prototypical model of stress (129). Accumulating medical (and at times psychiatric or cognitive) illnesses often result in disability and loss of independence (including forced moves to senior living communities) that challenge the resilience and self-concepts of older adults. Other forms of loss, including deaths of friends and family, are common, and grief reactions may ensue that warrant careful attention for clinically significant depressive symptoms (130). DSM-IV-TR (131) outlines several features that are believed to help distinguish normal versus abnormal bereavement, such as suicidal ideation, persistent worthlessness, and severe, persistent functional impairment. Such losses and personal disabilities may trigger psychological struggles regarding one's own mortality that may be very relevant in psychotherapy with older adults, but clinicians often avoid this topic because of discomfort (132). Another sometimes surprising stressor for older adults is retirement, which may challenge persons whose self-identity and structured activities center around their occupation (133). Although these challenges confronting older adults may seem daunting, it is also worthwhile to note the positive coping strategies used by many older adults so that clinicians also work to facilitate the person's innate strengths. Possible psychological benefits of increased age include, on average, better emotional regulation (134) and, according to many cultural beliefs, increased wisdom (135).
For these and other reasons, social support is an important predictor of the health outcomes of older adults (136, 137). Psychiatric assessment and care of older adults thus requires careful attention to social networks and often includes family members in the assessment and treatment of the older adult in a manner akin to that used for children and adolescents (with important similarities and differences in the dynamics encountered, including struggles for autonomy and role reversals). The increasing diversity of the aging population in the United States also warrants increasing attention to culturally competent psychiatric assessments, including awareness of linguistic barriers, differing cultural concepts of both aging and illness, and possible roadblocks to health care access (138).
In summary, psychiatric assessment of older adults is both challenging and rewarding. Therapeutic nihilism and ageism may taint the enthusiasm some clinicians have for working with older adults affected by neuropsychiatric illness, but careful attention to the issues summarized briefly in this review can help ensure that such clinical experiences are rewarding for both older patients and the clinicians who care for them. Psychiatric assessment of older adults should remind psychiatrists of why they are often called upon to set the example for biopsychosocial care in clinical medicine. Medical comorbidity requires attention to clinical issues that overlap with other fields of medicine, unique psychosocial stressors, and the stigma of mental illness associated with aging require careful attention to the human relationship between clinician and patient, and the importance of social support and extended family involvement call for a broad, systems-based approach to the psychiatric care of older adults. Integrating these various components of assessment and diagnosis will be crucial for the wide variety of psychiatrists who will be increasingly called upon to care for the rapidly expanding population of older adults.
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It is a storm, Harrison said, that his Panthers must weather early on if his team is to have any chance of defeating the Cartersville Purple Hurricanes tonight at Weinman Stadium.
"It's going to be a challenge for us, but we are going to need to play four quarters of football if we want to beat Cartersville," he said.
Harrison's respect for the Panthers' first-round opponent in the Class AAA state playoffs and its coach stems from his playing days at Stephens County and as a coach with the Flowery Branch Falcons.
"I was the quarterback at Stephens County and coach Barden was its offensive coordinator," Harrison said. "When I was at Flowery Branch, we would bring our team up to Cartersville to participate in the mini-camps that were held there."
Harrison spent six seasons at Franklin County and four seasons at Flowery Branch before taking the helm at Jackson County this year. The Panthers finished the regular season 6-4 overall, 4-3 in region play and as the No. 4 seed out of Region 8-AAA. The Panthers average 27 points on offense, while giving up an average of 26 points per game. Jackson County ended the regular season with a 44-28 loss to Morgan County.
"We've got a real challenge in front of us, but we'll be ready to play," he said.
Waiting for them will be the heavily favored 10-0 Purple Hurricanes, who are the No. 1 seed out of Region 5-AAA, and ranked sixth statewide in Class AAA. Cartersville's regular season concluded on the road with a 42-7 win over the Ringgold Tigers. The 42 points scored against the Tigers is identical to the same number Cartersville's offense has been averaging through 10 games. On defense, the Purple Hurricanes have held opponents to less than two touchdowns per game.
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Karl's version of Parkinson's Law: Work expands to exceed the time alloted it.


text:
Happy Birthday Larry Mullen Jr!
Not only is today Larry Mullen Jr's 51st birthday, but it is also the 11th anniversary of the night Larry and I shared a drink – the second Elevation Providence show on Larry's 40th birthday 10.31.01. Here is what I wrote about that night:
October 31, 2001 – Providence 2 – Larry's 40th Birthday
This was the best show ever! There will never be another one like it! I woke up outside around 8am – pretty good sleeping outside in 30 degrees for 5 hours. I went up to the warm hotel room until about 10am, then had some breakfast. I stayed in the GA line all day without leaving, except to take a shower around 3:30. I got everyone in the GA line to sign the big orange birthday card I made for Larry. I put my name and email address on the back just in case. The band didn't arrive until after we were inside Dunkin Donuts Center. Me, Tasha and Paola wore our Larry Mullen Band shirts. We got our spots at the rail up front and center between Bono and Adam. I held up my birthday card for Larry as they walked on stage, but he didn't notice it. There were many, many signs including one saying, 'Bono let Larry sing.' During Elevation, Bono sang, ' Celebration' then said, 'Happy Birthday.' After Stuck in a Moment, Larry's 40th birthday celebration began. We sang Happy Birthday to Larry. A birthday cake was brought out and presented to Larry. Bono said, 'Larry loves chocolate cake!' Larry pretended to throw the cake out into the audience. Larry took the mic and came to the front to talk while Bono sat behind the drums. Larry said, 'Bono can't play the drums. It took me 40 years to get up front. I'm glad I'm spending my birthday with 18,000 of my closest friends. I feel like I could borrow money from you.' Then Bono asked for a bottle of champagne, which he shook up a la ZooTV and sprayed the audience. Edge took a swig, then Larry drank and continued to drink for the next few songs. After Kite, Larry got off the drums and made a B line for me. I got my card and present in hand so I could give it to him, but that's not why he was there. He gave me the champagne bottle – with champagne still in it. I drank some then shared it with Paola and Tasha. Larry wanted to share his birthday with ME! He wanted ME to have a drink on his birthday. I was SO excited that I didn't even know they played Wild Honey - I thought it was Staring at the Sun. I didn't really come around until Please. After Pride, Larry came back over to me so I could give him the birthday card and Elvis tee shirt I had for him. I said, 'Thank you. Happy Birthday.' He smiled and said, 'Thank You.' He looked into my eyes, just like he had in Jersey a few weeks earlier when he gave me his drum stick. Then Paola gave Larry her Larry scrapbook, which contains the picture of him hugging me. Later on, Bono noticed our shirts, shook his head and smiled. Before leaving the stage Larry took Michelle's Elvis sunglasses with sideburns and put them on. I was so elated after the show – walking around hugging the champagne bottle. What an amazing Larry night! I will never forget it!
That Providence 2 Elevation show was my favorite U2 show, as well as my favorite concert ever. I doubt there will ever be another night like it. Granted it was Larry's 40th Birthday, and I love Larry, but also for the energy and for the rarities U2 played that night. Slow Dancing was played for the first time on the Elevation tour, and only the 11th time ever. Party Girl and Wild Honey were played for the first time on that leg of Elevation – and I've only heard those songs a couple of times ever. There was just a great energy in Providence that night that I haven't experienced since. I still have that champagne bottle, displayed on my shelf along with Larry's drum stick he gave me in Jersey.
Providence 2 set list 10.31.01: Elevation, Beautiful Day, Until the End of the World, New Year's Day, I Will Follow, Sunday Bloody Sunday, Stuck in a Moment, Happy Birthday Larry, Party Girl, Slow Dancing, Kite, Wild Honey, Please, Bad / 40, Where the Streets Have No Name, I Still Haven't Found What I'm Looking For, Pride, Bullet the Blue Sky, What's Going On, New York, One, When Will I See You Again, Walk On
Happy Birthday Larry Mullen Jr!


text:
Johanna Mosca, Ph.D. – Cultivate Contentment: Use Ancient Wisdom to Thrive
AumBase, Inc
Saturday, February 9, 2013 from 11:30 AM to 1:30 PM (MST)
Sedona, AZ
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When & Where
Sedona Creative Life Center Chapel
333 Schnebly Hill Rd
Saturday, February 9, 2013 from 11:30 AM to 1:30 PM (MST)
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AumBase, Inc
Aumbase, Inc. brings Yoga and other conscious events, workshops, demonstrations and classes to the small, yet powerfully energetic and healing, town of Sedona, Arizona, USA. Founded after the Inaugural 2013 Sedona Yoga Festival, the company is growing rapidly to serve the international Yoga & Healing Arts community in humanity's ongoing Consciousness evolution.
Sedona Yoga Festival, a consciousness evolution conference (Flagship Annual Event)
Deepen your practice and tap into ancient wisdom with three days of yoga, music and energy work in the spiritual center of the West. Intimate venues and authentic teachers create an opportunity for YOU to weave your own experience in the richly colored cultural and natural tapestry that is Sedona.


text:
There's been plenty of chatter in this space lately over the numbers game that vegan activists like to play trying to convince themselves and their followers that hordes of people are eager to jump onto the no-animal-foods-or-products bandwagon.
As citizens of an affluent, highly developed, post-modern society, we have that luxury. We have the luxury of choosing to go vegan, a choice unavailable to billions of people elsewhere on the planet. We shouldn't demonize such a benefit; we should instead be cognizant of, and grateful for, the privileged status of being able to forego the consumption of animal food, should we decide to do so.
But I would go further and argue that veganism is far worse than a mere curiosity, a plaything with which privileged people like to experiment. I would argue that the vegan lifestyle is wasteful, selfish and irresponsible.
Harsh? Not at all, not if one honestly dissects not just the dietary dictates but the environmental and socio-economic consequences that would result if billions of people were to go vegan.
› I say wasteful because if livestock were eliminated both as a source of food and fiber, billions of acres of marginal farmland and rangeland could no longer contribute to human nutrition. Assuming we can all agree that with seven billion-plus people now alive on Earth, the hunter-gather lifestyle is no longer viable. Those billions of souls have to be fed through agricultural activity.
Without being able to use land where precipitation is unpredictable, where soils are too unproductive or growing seasons are too short to raise the crops vegan advocates insist we live on, humanity would lose a huge percentage of its overall food productivity, not to mention the loss of billions of tons of animal manure vital to maintaining the fertility of the acreage that is suitable for conventional farming.
› I say selfish because demanding that people everywhere go veggie would deprive millions of people of the foods, the culture and the lifestyle that have sustained them for millennia. The nomadic herding tribes of sub-Saharan Africa, the native people of the Arctic regions, the aboriginal inhabitants across Polynesia as but a few examples — all of them would have to somehow import most of their food from afar (as if that would even be possible), or abandon both their homelands and their lifestyles.
Such a development would be hugely traumatic, but the selfishness of the vegan philosophy is so profound that most of its disciples never even consider such a scenario, much less express any remorse that their extremist ideas might actually cause more harm than good. It's all about making them feel good about their moral superiority, not about relating to people elsewhere who aren't in a position to even consider giving up all animal foods.


text: Polk Audio 265-LS In-wall speaker Zoom Front Angled front view (grille removed) Back Photos Videos Item #: 107265LS Review Summary 1 person says In Stock Free Crutchfield lifetime tech support Free Shipping Your price $499.99 each Add to cart + Add to wishlist Email me alerts for this product $449.99 Open Box Buy this item and earn up to 500 Rewards points See more offers and ways to save Special Financing Available x By buying this product you'll earn up to 500 Rewards points. When you sign up for a Crutchfield account, you'll be enrolled in Crutchfield Rewards. You'll earn one point for every dollar you spend on gear from us. You can turn your points into Rewards Cards that you can use toward future purchases. You can sign up for an account now, or after you complete your purchase (you'll get credit for the points either way). Sign up for a Crutchfield account Overview Details Customer Reviews Q&A Articles & Videos Accessories Our take on the Polk Audio 265-LS by Marshall Chase Polk's high-performance 3-way in-wall speaker Polk Audio's 265-LS may be part of their Vanishing series, but one listen and you'll know this in-wall speaker is no "wall flower." The 265-LS offers stellar sound in an inconspicuous design that hides in your wall. Whether you're using this speaker as the basis for a stealth home theater, or a pair for stereo listening, its performance rivals that of Polk's flagship LSi M series traditional loudspeakers. In fact, you can put together a system mixing this in-wall speaker with free-standing LSi M floor-standing or bookshelf models — whatever suits your room and your decorating sense best. Read more Advanced technology for better sound The 265-LS begins with dual 6-1/2" Dynamic Balance drivers, which deliver clear, accurate mids and dynamic lows. Polk's PowerPort® bass venting system reinforces the bottom end for clean, punchy bass. The 265-LS uses Polk's own advanced version of the classic "ring radiator" tweeter for smooth, detailed highs. A wall distance toggle switch lets you compensate for boominess due to installation near a side wall. You also get a tweeter attenuation switch to help you get balanced sound in rooms with lots of reflective surfaces. Finish off by painting the magnetic Sheer-Grille™ to match your wall color, and the 265-LS is ready for showtime. An optional in-wall bracket is recommended for installing the 265-LS in-wall speaker in a home with new construction. Got wire? Most speakers don't include any. Learn more about in-wall wiring at the Crutchfield Learning Center. Shop our selection of in-wall speaker wire. Highlights:1" ring radiator tweeter6-1/2" Dynamic Balance midrange6-1/2" Dynamic Balance woofersound-shaping controlsfrequency response 28-33,000 Hz (-3dB)handles up to 200 wattssensitivity 91 dB8-ohm impedancepaintable Sheer-Grille for stealth installationcutout: 7-1/4"W x 19-3/16"Hmounting depth: 3"warranty: limited lifetimeOur 60-day money-back guarantee Hands-on research from the Crutchfield Labs (what are the Labs?) Features and specs chart | What's in the box? | In-depth notes Features and Specs Enclosure Type In-wall Video Shielded No Tweeter Ring Radiator Midrange Size 6.5 Woofer Size 6.5 Woofer Composition Aerated polypropylene Woofer Surround Rubber Power Range (Watts) 10-200 Sensitivity 91 dB Impedance (Ohms) 8 Frequency Response 28-33kHz Connector Type Spring post Bi-Amp Inputs No Parts Warranty Lifetime Labor Warranty Lifetime Product Research What's in the box? Download owner's manual In-wall 3-way loudspeaker White metal grille Power Port plug Mounting template Owner's Manual "Fitting the Grille to the Wall" label (attached to bag) Online Registration Card Polk Audio product brochure Our Product Research Team At Crutchfield, you'll get detailed, accurate information that's hard to find elsewhere. That's because we have our own in-house Product Research team — they open the box, verify contents, check the owner's manual, and record dimensions, features and specs. We stay on top of new products and technologies to help people make informed choices. Features Connections Mounting Options Dimensions Features Vanishing Series In-Wall Speakers: The Polk Audio Vanishing Series in-wall loudspeakers feature a precision-engineered, minimally flanged design and Polk's exclusive Sheer-Grille, which protrudes only 7mm from its surroundings. Installing virtually flush in your wall, the Polk Audio Vanishing Series in-wall loudspeakers offer a one-cut, drop-in installation and rotating cam stabilizing system. The Vanishing LS series in-wall speakers are timbre-matched to Polk Audio's flagship LSi and LSiM series loudspeakers for seamless blending from speaker to speaker when you're building a speaker system. Dual 6-1/2" Drivers: This Polk Audio Vanishing Series 265-LS in-wall 3-way loudspeaker employs a 6-1/2" Dynamic Balance aerated polypropylene cone midrange driver, and 6-1/2" Dynamic Balance aerated polypropylene woofer, both with rubber surrounds, for a smooth, consistent frequency response. The aerated polypropylene cones are 20% lighter than conventional polypropylene, and 35% lighter than aluminum, to give you clear midrange, punchy bass, and high efficiency. Polk Audio's patented Dynamic Balance technology eliminates unwanted resonances. Ring Radiator Tweeter: The 265-LS employs a 1" Dynamic Balance ring radiator tweeter for detailed highs and superb imaging. This high-performance tweeter features a 15° swivel housing, for more direct high frequency control, excellent off-axis imaging and more placement flexibility. Reflective Room Compensation Control: The Reflective Room Compensation Switch, conveniently located on the front panel, allows you to digitally compensate for harsh reflective surfaces, such as smooth walls, glass windows, and hardwood floors. The filter doesn't merely reduce high frequencies, it simply cuts the level only in the 4-5kHz range where room acoustics most often interfere with performance. The switch is labeled "Tweeter" with two positions: out (normal) and in (filter). Wall Distance Toggle Switch: If you mount your in-wall loudspeakers closer than 2 feet from a side wall, the proximity of the surface can elevate the midbass response between 50 and 200Hz, causing a boomy sound. To compensate, the 265-LS is equipped with the Vanishing Wall Distance Toggle switch, located on the front panel. The filter adjusts the crossover to flatten the response, and tune out the boominess, without sacrificing the deep bass response of the speaker. The switch is labeled "Wall Dist." with two positions: in (<2' ) and out (>2'). PowerPort: The 265-LS features Polk's PowerPort bass venting, a patented port design that enhances the speaker's bass response while eliminating noise caused by the moving air turbulence. The provided foam rubber port plug should be used if you are installing the 265-LS in an area larger than a standard open stud bay. Frequency Response: The overall frequency response of the in-wall loudspeaker is 28Hz to 33kHz, and the -3dB frequency response is 41 to 29kHz. Sheer-Grille: The 265-LS features Polk Audio's exclusive wafer-thin Sheer-Grille, a magnetically-secured metal grille that protrudes only 7mm from its surroundings. The Sheer-Grille can be painted to match your décor, making it virtually indistinguishable from its surroundings. The Sheer-Grille has nearly transparent, ultra-small perforations, and is acoustically inert, for dynamic, unimpeded sound and more uniform coverage, even in larger rooms. The grille's dimensions are 8-7/8" x 20-7/8". Connections Gold-Plated Spring-Loaded Posts: The in-wall loudspeaker has a gold-plated pair of spring-loaded binding posts that can accept up to 12-gauge wire, single- or dual-banana plugs, or pin connectors. Mounting Options Applications: You can use the Polk Audio Vanishing Series 265-LS in-wall loudspeaker as the basis for a stealth home theater, or a hidden two-channel stereo pair. Note: The speaker isn't recommended for installation in high-moisture locations. Rotating Cam System: The Polk Audio in-wall loudspeaker utilizes a rotating cam system to ensure a secure, vibration-free installation. The 265-LS has 8 rotating cams to hold the speaker in place. The cams can be tightened from the front panel with a Phillips-head screwdriver. Installation: The 265-LS can be installed in new or existing construction: Existing Construction: In existing walls, use the included cardboard template for one-cut, drop-in simplicity. Achieve secure, vibration-free efficiency with a simple turn of Polk's Rotating Cam system (8 rotating cams). New Construction: The optional PB LC265i pre-construction brackets should be used for new-build or open-wall retro-fitting. Dimensions Overall Dimensions (with grille) Width = 8-7/8" Height = 20-7/8" Depth=3-3/4" Cutout Dimensions Width = 7-1/4" Height = 19-3/16" Mounting Depth (behind 1/2" drywall) Depth = 3" Weight 9 lbs. Review this product Submit a review and then enter to win a $500 rewards card Polk Audio 265-LS Reviews Average Customer Review: 1 people say: Review this product: Thanks for taking the time to share your experiences about this product. Please be sure to focus your comments on the product itself. Read our Review Guidelines for more information. Review title * Email Your email won't be visible. Please use the email address that is associated with your order. Display name (e.g., JohnD) Your review will be signed using the display name and location * Your location (e.g., Charlottesville, VA) * Your rating Click on a star to rate the overall product on a scale of 1-5 1500 characters left * Your review Attach a YouTube Review Crutchfield Video Review Guidelines Only submit videos that you made or are authorized to use. Do not submit videos that contain music, video or visuals that are copyrighted and belong to someone else. Please see our Review Guidelines for more information. Submit the URL of your YouTube™ video review or product demonstration. e.g., "http://www.youtube.com/v/o79TWHh598U" 500 characters left Pros 500 characters left Cons * Agree to Terms By checking this box you agree your review becomes the property of Crutchfield, that you are over 18 years of age, that you own or have owned this product, and that you are located within the United States or its territories. Please see our Review Guidelines for more information. We reserve the right (but are not obligated to) review all submissions and edit or remove any review in any manner which we deem necessary. Your review should be posted within seven days. Filter by rating: 5 Star: (0) 4 Star: (0) 3 Star: (0) 2 Star: (0) 1 Star: (0) 4 out of 5 Like a lot Written By Ray, North Potomac, MD on Sunday, October 20, 2013 Crutchfield Customer Review (What's this?) THis is an easy to install, almost "invisible" in the wall speaker. Obviously bass is not so good (need a subwoofer), but could do without one. Like it a lot. My only personal comparison is with a pair of Bowers and Wilkins CWM 800 wall/ceiling speakers. The Polk 265-LS is a better sounding speaker, but if the B&W speakers were still easily available (they have been discontinued, I am told) I would purchase the B&W speakers (but they are not quite as "invisible"). Pros: Easy install, good looking (because they are not obtrusive). Cons: Pretty expensive, for me. 2 out of 6 people found this helpful Was this review helpful? Yes | No 1 question already asked how is the base response if 2 pairs are installed into a motor coach listening to classic rock and rap would i need a sub ? [ TOM Mar 29, 2014 ] 1 answer I forwarded your question to an Advisor and they responded with the following: In a motor coach, these will provide plenty of bass for you. It would not be necessary to add a subwoofer unless you wanted an overpowering, very loud type of bass. The low-end response on these speakers is outstanding. If you would like to discuss further you can contact an Advisor directly by phone (1-800-324-9695) or online chat. [ Krissy Staff Apr 01, 2014 ] Add accessories for the Polk Audio 265-LS Add Accessories Set the volume level in your remote location without going back and forth from room to room. See all categories & accessories Set the volume level in your remote location without going back and forth from room to room. In-wall Volume Controls UL-listed speaker wire is designed to be run through walls and is building code compliant. In-wall Speaker Wire Install these before your drywall goes up to mark your speaker locations for your builder, so you won't need to cut holes later. In-wall/in-ceiling Brackets Have your speakers installed by qualified professionals. Professional Installation A speaker selector will let multiple pairs of speakers act like just one to your receiver. Speaker Selectors & Distributors Niles SVC100K Sliding stereo volume control with impedance magnification Your Price: $129.99 Add to Cart Niles VCS100K Stereo volume control with impedance magnification 4 people say Your Price: $99.99 Add to Cart Russound ALTX-WIRI-2D Electronic volume control with IR sensor and impedance magnification Your Price: $159.00 Add to Cart AudioQuest FLX-14/2 14-Gauge 2-Conductor In-Wall Speaker Cable UL-approved for in-wall use; direct-burial rated (125 feet) 51 people say Your Price: $129.99 Add to Cart AudioQuest FLX-14/4 14-Gauge 4-Conductor In-Wall Speaker Cable UL-approved for in-wall use; direct-burial rated (125 feet) Options 125 feet-$219.99 250 feet-$439.99 UL-approved for in-wall use; direct-burial rated (125 feet) UL-approved for in-wall use; direct-burial rated (250 feet) 2 people say Your Price: $219.99 Add to Cart AudioQuest FLX-16/2 16-Gauge 2-Conductor In-Wall Speaker Cable UL-approved for in-wall use; direct-burial rated (125 feet) 28 people say Your Price: $99.99 Add to Cart AudioQuest FLX-16/4 16-Gauge 4-Conductor In-Wall Speaker Cable UL-approved for in-wall use; direct-burial rated (125 feet) 7 people say Your Price: $159.99 Add to Cart Polk Audio PB LC RT Pre-construction brackets for select Polk in-wall speakers 3 people say Your Price: $59.99 Add to Cart Premium 5-Speaker Home Theater Installation 4 people say Your Price: $369.99 Add to Cart Premium 2-Speaker Home Theater Installation 1 person says Your Price: $239.99 Add to Cart Premium 7-Speaker Home Theater Installation Your Price: $419.99 Add to Cart Premium 6-Speaker Home Theater Installation Your Price: $379.99 Add to Cart Niles SS-4 4-pair speaker selector 23 people say Your Price: $129.99 Add to Cart Niles SS-6 6-pair speaker selector 8 people say Your Price: $174.99 Add to Cart Niles VCS HUB8 8-speaker pair connecting block 6 people say Your Price: $79.99 Add to Cart Russound SS-4.2 4-pair speaker selector 6 people say Your Price: $119.00 Add to Cart Russound SS-6.2 6-pair speaker selector 1 person says Your Price: $159.00 Add to Cart Niles SSVC-2 2-pair speaker selector with volume control 4 people say Your Price: $249.99 Add to Cart Niles SSVC-4 4-pair speaker selector with volume control 7 people say Your Price: $399.99 Add to Cart Niles SSVC-6 6-pair speaker selector with volume control 6 people say Your Price: $474.99 Add to Cart Russound SDB-2.1 2-pair speaker and source selector with volume control 1 person says Your Price: $199.00 Add to Cart Russound SDB-4.1 High-power 4-pair speaker selector with volume control 1 person says Your Price: $399.99 Add to Cart Russound SDB-6.1 High-power 6-pair speaker selector with volume control Your Price: $499.99 Add to Cart Why choose SquareTrade? The #1-Rated Protection Plan Thousands of people have reviewed SquareTrade Protection Plans — and made us #1. 5-Day Service Guarantee & Free Shipping We'll repair or replace your item in five business days or less after we've received it, or your plan is free. And, as always, we pay for all shipping. Protection from Normal, Everyday Use Repairing your average mechanical or electrical failure can cost as much as buying a new device. With SquareTrade, you're covered — including parts and labor. For a more in-depth review and enhanced detailed information on the Polk Audio 265-LS, please visit the Crutchfield website product page (/ISEO-rccbcspd/p_107265LS/Polk-Audio-265-LS.html ). Find the gear that's right for you Ask an expert Your Crutchfield Advisor knows the gear inside and out. Call 1.888.955.6000 Email Compare with other Polk Audio models Polk Audio 265-LSUpgraded drivers for wider ranging sound 4 out of 5: In StockThe Polk Audio 265-LS offers: 1" ring radiator tweeter dual 6-1/2" Dynamic Balance woofers frequency response 28-33,000 Hz View All Product Information$499.99Polk Audio 265 RT6.5" in-wall speaker 4.5 out of 5: In StockThe Polk Audio 265 RT offers: 1" swivel-mount tweeter and dual 6-1/2" woofersfrequency response 45-25,000 HzView All Product Information$299.99 After $50.00 Price BreakPolk Audio 265-LS6.5" in-wall speaker 4 out of 5: In StockThe Polk Audio 265-LS offers: 1" ring radiator tweeter, 6-1/2" midrange and 6-1/2" wooferfrequency response 28-33,000 Hzhandles up to 200 wattsView All Product Information$499.99 Polk Audio 265 RTCompare with $299.99 After $50.00 Price Break You are herePolk Audio 265-LSGet details $499.99 × Front Angled front view (grille removed) Back Searches related to the Polk Audio 265-LS In-wall speaker Polk Audio Polk Audio In-wall Speakers In-wall Speakers under $500 Polk Audio 265-LS reviews Polk Audio 265 RT vs Polk Audio 265-LS Polk Audio 265 RT reviews Polk Audio 265-LS vs Polk Audio MC65 Polk Audio 265-LS vs Polk Audio RC55i Polk Audio 265-LS vs Klipsch KL-6502-THX Polk Audio 265-LS vs Klipsch R-2502-W II


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text: Sugar-high hits downtown By Rebecca Rider firstname.lastname@example.com Wednesday, June 19th, 2013 Text size: A A A Tweet Back To Story Above: Don Vick shows off a new item that was delivered to The Candy Shoppe on Main on Tuesday. Son Tyler and wife Nancy enjoy watching Don start the blade on a toy helicopter that also dispenses candy. A wide assortment of familiar brands of candy and several not so familiar will be offered at The Candy Shoppe on Main. The store will hold its grand opening at the Friday Night Out in a couple of days. Top: Fudge is one of the many sweet items offered at store.


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Ben Lomond Dance Programs Dance Classes.pdf
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- Antique Jewelry
- The Ages
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Antique Tiffany Art Deco Diamond Engagement Ring
Just say Tiffany & Company and a group of admirers gather. The name is lyrical and synonymous with "good taste" and this scarce vintage platinum ring lays testament to that statement. Centered is a brilliant cut transitional diamond of .90 carats. The F color VS1 clarity diamond does justice to the trademark setting.
Accenting the sides are six (6) baguette and four (4) transitional brilliant cut diamonds with an additional total diamond weight of .18 carats (G-H color; VS clarity) bringing the total estimated diamond weight for the ring to 1.08 carats of sheer glitter and shine.
The platinum mount, supremely elegant is hand made. Its lines are sleek and, in such a compact space surprisingly detailed in its forms and design. Pair this with a wedding ring or on its own - it speak volumes of a forever love. This one is sure to be a "yes".
Date: Circa 1935.
Comes with a GIA certificate for the center diamond which has been removed for weight and grading.
Measurements: 1/4 of an inch (0.8 cm) in length north to south on the hand and rises 1/4 of an inch (0.8 cm) in height off the finger. Weight of 3.2 grams (2.1 dwt).
Ring Size: US 6-1/4 (UK M; Euro or Int. Circum. 52.5 mm; Int. Dia. 16.7 mm; Japan 12) and easily can be sized to fit most. Ring sizing information.
Hallmarks: Tiffany & Co, Irid Plat.
Condition: Excellent.
Origin: American.
Note: The main diamond has been removed from the mount for accurate weight and grade. All other diamonds have not been removed to preserve the integrity of the setting. These diamond weights have been approximated by measurement and formula and may vary from actual weights.
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Contact us: by phone 0 811 480 420 (9:30 – 6:00, M-F, excluding holidays) or by mail: firstname.lastname@example.com
Classic V-necked sweaterS9-K2-CE0006
This classic men's sweater enables you to add a touch of colour to your shoulder season wardrobe. It sticks to the traditional vee neck and comes in the finest cotton. For a more casual look, you can certainly wear it with a polo shirt.
Collar : V neck
Sleeve: long
Composition : 100% cotton
Never hang your cardigan on a hanger, this gesture may alter the shape of the shoulders. Simply fold it and store it.
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Same day delivery to France – 25€ : Your order placed before midday will be delivered in the evening between 5.00pm and 9.00pm, at the destination of your choice in Paris, Levallois-Perret and Neuilly-sur-Seine, by courier driving an electric vehicle.
Delivery to the euro zone – 15€ : Your parcel will be delivered in hand signed-for within 5 days, as soon as your items are available to ship. A note will be left in your letterbox and a second delivery will be attempted if you are not present the first time, in order to ensure the good reception of your goods. Deliveries are carried out Monday to Friday.
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Packaging : Your Smalto suits and outerwear pieces will be delivered in a suit cover, individually packed in a giftbox baring the colours of the House of Smalto.


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This Soccer Mezuzah was designed by Reuven & Tzipora Mazel. A husband and wife design team, their combined creative and artistic efforts have led them to become leaders in innovative Jewish art and gifts. Their love and appreciation for Jewish motifs and history has found its medium of expression through art. This Mezuzah is most noted for its Intricate details, vibrant colors and fantastic design.
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It looks like Auto Expo 2010 in Hawkesbury, Ontario will be the only Canadian location in the upcoming season. I always try to do a couple Canadian-based episodes per season since the show has such a strong and loyal north-of-the-border following, but it just didn't work out that way this year.
No worries tho, this little town on the Ontario/Quebec border about halfway between Ottawa and Montreal puts on a heck of a show and packed about 700 cars into just about every nook and cranny the town had. It'll make an episode that all Canadians can be proud of!
The day was a bit chilly, but we were certainly given a warm reception. And they fixed us up with a couple of the coolest golf carts I've ever seen to get around in.


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HOME Baltimore Ravens Gear Baltimore Ravens Hats Baltimore Ravens Hats Fitted $20 to $40 (30 items) Product ID: 1411213
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There's nothin' better than showing love for the best city in the USA — Baltimore! Boast your Ravens spirit while also letting everyone know that you're a Ravens fanatic with this Plasma hat from '47 Brand. This fitted cap has a two-toned look with distressed details, a 3D-embroidered Ravens logo on the crown and the team name on the back. Your Baltimore devotion will be seen when you sport this cap. Small fits 6 3/4 - 7. Medium fits 7 - 7 1/4. Large fits 7 1/4 - 7 1/2. XL fits 7 1/2 - 7 5/8.
- 100% Cotton
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Replace your drumhead with a bold, new look with this Evans head.
This Inked by Evans Graphic Kick Drumhead uses a high resolution printing system, providing photo-quality resolution applied directly to the drumhead film for an uncompromised sound with a striking look. The replacement drumhead is a 7.5mm single ply with a 10mm internal overtone control ring.
Make your statement with this Evans drumhead. Own it today!
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