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Patriotic Remix
- Regular price $75.00
- 5 available
Spotlight Gymnastics Floor Exercise Music
All of our patriotic gymnastics floor music is arranged to optimize your floor routine for the highest possible score. All of our floor music tracks are available in different time lengths with limited inventory to ensure you will stand out on the floor. With limited sales, we are working towards helping gymnasts step into the spotlight! With Jumptwist gymnastics floor music, you will never wonder when your music is going to begin. All of our floor music has the signature Jumptwist Beep sound followed by a 1-2 count, so you are always ready for your routine.
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Orthognathic Surgery (Jaw Surgery) | Stony Brook, NY
Orthognathic surgery is needed when jaws don't meet correctly and/or teeth don't seem to fit with jaws. Teeth are straightened with orthodontics and corrective jaw surgery repositions a misaligned jaw. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly.
Don't Live With Dental Pain Any Longer
Who Needs Orthognathic Surgery?
People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing function, speech, long-term oral health and appearance. Injury to the jaw and birth defects can also affect jaw alignment. Orthodontics alone can correct bite problems when only the teeth are involved. Orthognathic surgery may be required for the jaws when repositioning is necessary.
Difficulty in the following areas should be evaluated:
- Difficulty in chewing, biting or swallowing
- Speech problems
- Chronic jaw or TMJ pain
- Open bite
- Protruding jaw
- Breathing problems
Any of these symptoms can exist at birth, be acquired after birth as a result of hereditary or environmental influences, or as a result of trauma to the face. Before any treatment begins, a consultation will be held to perform a complete examination with x-rays. During the pre-treatment consultation process, feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your dental team can make the decision to proceed with treatment together.
Orthognathic Surgery Presentation
To provide you with a better understanding of orthognathic surgery, we have provided the following multimedia presentation. Many common questions pertaining to orthognathic surgery are discussed.
Technology & Orthognathic Surgery
Dr. Jonke, Dr. Guariglia, Dr. Jamdar, Dr. First or Dr. Mundiya uses modern computer techniques and three-dimensional models to show you exactly how your surgery will be approached. Using comprehensive facial x-rays and computer video imaging, we can show you how your bite will be improved and even give you an idea of how you'll look after surgery. This helps you understand the surgical process and the extent of the treatment prescribed. Our goal is to help you understand the benefits of orthognathic surgery.
If you are a candidate for corrective jaw surgery, Drs. Jonke, Guariglia, Jamdar, First or Mundiya will work closely with your dentist and orthodontist during your treatment. The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional, and healthy dental-facial relationship.

subset: commoncrawl


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Monday, March 17, 2008
Boti: a unique cutting instrument
To kick off RCI Bengal, I decided to showcase two essential instruments from the Bengali or rather Indian Kitchen. One of them you see here today. I am not sure if this was used all over India, so please enlighten me.
I know for sure that almost all respectable household in Eastern part of India carry it and though it has been relegated to the dark corner besides the "alu-piyaj er jhuri" after the advent of shiny Anjali knives, it is till brought out on good days when Ma's knee doesn't hurt that much and there is ample time to sit on the floor and take care of the myriad veggies.
Yes I am talking about "The Boti", a unique cutting instrument, used by Bengali women where you have to squat on the floor, press the wooden plank to the floor with your feet and cut fruits and veggies on the sharp, curved menacing looking iron blade. You have both your hands free to hold the veggie and peel and then cut it.
The serrated tip pf the boti also served the purpose of grating coconut and it was much faster than any other method I have seen.
A larger version of the same boti, with a bigger blade is used for gutting & cutting fish. So you see the average Bengali household would carry not one but at least 3 boti of different sizes and a separate one for the Puja Room alone.
Growing up I hardly saw my Ma or Aunts use knives for chopping veggies, fruits yes but veggies no. The daily morning ritual would be to sort out the veggies bought fresh from the market or from the "sabjiwali" who brought fresh fares home and then would start the peeling, chopping, cutting. The various boti were brought out and the household help along with the oldest member of the family would sit down on the floor to start on their task. Gossips were shared and tea sipped at while the veggies were cubed and the fish gutted.
As we moved away from the joint family to another city, the morning chores were no longer that leisurely for my Ma but the boti still held its place. I too was apprenticed in cutting vegetables with the boti and took to it ok, though I wasn't very fast with it.
Slowly my Ma's knee started giving her trouble and squatting on the floor was no longer that easy. It was the household help who was in total charge of he boti now until one fine afternoon, the intruder came home. A chopping board and a set of shiny knives entered the household but the boti was yet to be ousted. No one was really happy with the knives and the chopping board and my Ma grumbled about how it wasn't the same thing.
My Ma now largely relies on the knives and I got her a good set from here, but the boti is still there and the help still uses it to cut veggies.
The pic as you see here is one sent by my Baba from Calcutta. I do not have one here so could not take any more pics. Though the pic is not exactly an artist's delight, I thought this would be a nice entry for Click:Metal hosted at Jugalbandi, to celebrate "The Boti"
Note: Bring on your entries for RCI-Bengal, a event started by Lakshmi and hosted this time around by humble me. And mail me at firstname.lastname@example.com
Also remember to link back to RCI Bengal post from your entry posts in your blog
44 comments:
- AnonymousMarch 18, 2008 4:05 AM
oh i remember this...in telugu we'd call it "kathipeeta" meaning quite literally knife and chopping board....infact i think its somewhere up in the attic....and yes my grandmother swore it was much better and faster than using a knife...brought back loads of nostalgia...thanks for posting on this....ReplyDelete
hi sandeepa, in konkani we call it "addeli".my ma-in-law uses only the addeli,she even peels the skins of papaya/pineapple etc.I am also learning to use the addeli these days..hehe!!ReplyDelete
Hi Sandeepa! thats avery nice entry.we call it pankhi in oriya and yes the post did make me miss my home:)ReplyDelete
It's "bothi" for us :-)ReplyDelete
Hello Sandeepa..We call it "aruvamanai" in Tamil.I have been reading your blog for a while now.Have tried some of your recipes and they have been a big hit with my Bong hubby :) I really enjoy reading your posts and am looking forward to RCI roundup.ReplyDelete
- AnonymousMarch 18, 2008 6:44 AM
hi, we call it "vili" / "morli" in marathi. my mom still uses it for cutting vegies ..ReplyDelete
Yes, it is very common in Maharashtrian kitchens too, called "vili". I never did learn how to use one, and neither does my mother. But the lovely lady who has cooked lunch in my parents' home for decades...she raises her eyebrows at knives and continues to use the "vili" every single day, at lightening speed!ReplyDelete
Oh Yes! this instrument has its pride of place in any kitchen. My mom still uses, though she perches on the kitchen counter and works with it. Knives just don't "cut it" over there :)ReplyDelete
Hey, Sandeepa, nice. We discussed this earlier, remember? All the varieties I've seen, including the one at home, have a swan-like blade.ReplyDelete
- AnonymousMarch 18, 2008 8:50 AM
when i stepped into my baung ma-in-law's kitchen for the first time I felt at home since i had seen it in my marathi, punjabi, gujrati, kannadiga, friends's home back in bombay. i am a maloo but we do the same thing in our house when we have to cut blocks of meat. we arrange one end of our knife vertical between the two toes of the feet and the head of the knife on half a coconut - just like the boti. my maloo mom should have just one boti or vili..things would have been less scarier ! but then she wanted to preserve the maloo culture !! can you beat that !!!ReplyDelete
My both grandmothers have this in their kitchen. It's called "Mane`" if I recall it correctly, use it for chopping veggies and the top part is used to grate halved coconut with shell intact. They have a larger one with a plate like wooden under the grater and they sit on the longer and wider plank of wood.ReplyDelete
I was always scared to go near it since that sickle like thingie is so sharp and always sat openly upright in the kitchen! ;P
Great entry, loved it. See you in May, take care Sandeepa, hugs to you!:))
oh yes!! My grand mom had it too... We caleld it "thuriyo mane" in Kannada.... they used it to grate coconut and also chop veggies! Thanx for bringing back old memories :)ReplyDelete
that is a fantastic pic. your baba should participate in click mote often. :)ReplyDelete
Hey Sandeepa, we have it too and call it "daat" in Punjabi :). It is used to chop saag and other greens.ReplyDelete
Great picture!
Hi Sandeepa, we call it viLi in Marathi! My Mum , grandma used this , i was taught how to use it, but preferred knife ;)ReplyDelete
My Mom still prefers the viLi!
and we now have a 'new fnagled' one... it has a longish screw under the 'knee plate' which one uses to affix the thing to the kitchen platform ( indian platforms have this border) and so the boti/ viLi is propped on the platform and one cuts veges standing!
it's a comfortable piece to grated the coconut than all other modern one's.ReplyDelete
Nice entry Sandeepa..
Nice postReplyDelete
will be back
hey Sandeepa, in konkani we call it AadoLLi. We keep two at home one for veggies and one exclusively for fish.ReplyDelete
As divya said, we call it "Addoli/advali".My mom does not like to use knives, she always uses this. It was a must in my home when I was in Bangalore. Now I have learnt to live without it :(. Such a handy tool....ReplyDelete
- AnonymousMarch 18, 2008 5:44 PM
What a surprise!! It is Boti indeed!ReplyDelete
Reminds me of grandmother and her generation instantly! My Ma is more efficient on the boti but her knees do not allow her to use it that much. It's a great idea to gift good set of knives to them. What a lovely post Sandeepa (as usual). Ahh...ekhon bujte parcho keno tomai fire ashar jonno jhamela korchilam aamra shobai.
I am back ..ReplyDelete
What a knife.. I havn't seen this before in my life..
I am back ..ReplyDelete
What a knife.. I havn't seen this before in my life..
Wow, its nice to know that the "Boti" is not an alien instrument to you all and it is used in a diff avtaar all over India
Amazing, and I thought it is a Bengali birth right :)
It felt like revisiting childhood. But I too have one hidden behind my gas cylinder. I don't use it, but my Bong maid needs it and so does my Mom whenever she is here. My Mom suffers from severe joint aches, so has found an innovative position of using it while standing, fixing it between herself and the wall above the kitchen table...but still... refuses to be bogged down to using the knives.ReplyDelete
- AnonymousMarch 19, 2008 7:31 AM
Yeah....we use it in Mangalore too.In konkani its called "kaanthne".Some of them dont have the blade,just the portion to grate the coconut.ReplyDelete
I have seen this in some Maharashtra's house also I have seen it in Tamilnadu state, I don't know what they call it .ReplyDelete
We Gujarati people dont use it , Neither had I seen that in nay house if Gujarat .
When I see people cutting veggie using Boti ,It scares me , and I never dared to give it a try :)) .
Baap rey! I had even forgotten about the boti... now kitchens have gone high tech with knives and food processors! Brought visions of when I was little back... (a long long time ago of course)ReplyDelete
- AnonymousMarch 19, 2008 4:18 PM
oooh I have one and I love it, I also have a boti like thingy which scrapes coconut. Both provide an interesting topic of conversation for my canadian friends when they are over for dinner. Both are well used, they keep the senses sharp.ReplyDelete
- AnonymousMarch 19, 2008 5:04 PM
hi sandeepa,ReplyDelete
in kannada we call it-``kaayi turiyo mane´´..still today my mother uses this..and she doesnt chop the veggies using knife and board!!
We call it "aruvamanai" - and yes it was used for everything from grating coconuts(the tip was a rounded serrated one) to peeling pumpkins.....I would still love to grate coconut on it rather than those pesky new fangled ones!ReplyDelete
Its a wonder how each state in india use the same thing..with different names!..looks great..we still use it...though in daily hectic schedule, we prefer the table top board..:)..nice entry!ReplyDelete
Ooo ... brings back crazy memories of childhood - when my sis and I would want to try grating a coconut on this. And my mom would start flipping out :)ReplyDelete
Hey we also use that in oriya kitchen. My mom still finds it easy.It is called paniki.ReplyDelete
very nice website
It is called Paniki in Odiya..I feel scared to use it. Have seen it being used back home..ReplyDelete
We call it 'aruvamanai' in south TamilNadu. It used anywhere from scraping coconut to cutting fish. I was so happy to see it here. Its been ages since I saw one. Thanks.ReplyDelete
- AnonymousMay 18, 2008 12:18 PM
In some part of South Bihar, presently Jharkhand, it is called "Hansua"(Hun-s-oo-wa) esp. common amongst Radhi Kayastha community. I tried buying this in a Gujarati store in New Jersey. They didn't seem to understand what I was talking about. Could someone please translate this in Gujarati? Moreover, people in my village in Jharkhand use this as their regular vegetable cutter and believe me; this stuff chops vegetables in rocketting speed if one knows how to use it.ReplyDelete
I have linked this post to one of my posts...hope that's okay?!ReplyDelete
Hi... I'd like to know what a boti is called in Sylheti - does anyone know?ReplyDelete
- manjariOctober 20, 2010 2:23 AM
woo thanks a lot for your wonder ful post and the wonderful comments.ReplyDelete
BOTI in bengali, kathipeeta in telugu,
addeli/advali in konkani,pankhi in oriya, aruvamanai in tamil , vili/morli in tamil .mane/ thuriro mane in kannada , daat in panjabi, hansua in bihar, hasiya in m.p. ,kaanthne in manglore...
my question is that is there any specific name for this in english.
Hi, i just wrote a buzz about my grand mother today, and was searching for the english word for this "viLi" as we call it in Marathi. My mom, granny and even our maid is very accustomed to using it, like you said, its very handy for grating coconut. I can use it with ease too, but now use chopping board and knives.ReplyDelete
thnk u to all.. these all commnts r helpful 2 me, bcoz im designing studnt n now findind a prodct with problem n i choosen hasiya or konkani as my prodct so dat i can improve its design to not have any problm 2 any1 due 2 d joint prblm or anythng else.. n old age people can also get enjoy 2 use 2 cut veggies.. thnx again :)ReplyDelete
and i got lots of information by d hlp of u guys, diffrnt names in difffrent languages...ReplyDelete
I've never seen or heard about this cutting instrument. Makes me wonder if some restaurants still use this.ReplyDelete
Thank you for this interesting article!ReplyDelete
Do you know the history of the boti? And why people use it instead of other cutting instrument like knife?


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We welcome all fans of the Android operating system, in this article you will learn how to root access on Sencor Element P430, running on the Android OS, it will help you to discover all the features of the mobile device.
Root for Android devices
This superuser in the Android operating system (in other words, it elevated privileges). You can control the clock speed of the processor and graphics card, overclock, delete unnecessary APK application, including pre-developer.
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Get root access will be via Rootkhp Pro free program.
- Download the Rootkhp Pro
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Attention! The end result may depend on the firmware version of your mobile device
Download Rootkhp Pro latest version
How to use Rootkhp instruction – click here or search in Google use query "Rootkhp Pro You android devices".
You wish donate for project – click here.


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HART - Foam 3-in1 Plyo Box
Regular price $122.04
Sale price $122.04 Regular price
HART - Foam 3-in1 Plyo Box
Product description
Shipping & Return
Shipping cost is based on weight. Just add products to your cart and use the Shipping Calculator to see the shipping price.
We want you to be 100% satisfied with your purchase. Items can be returned or exchanged within 30 days of delivery.


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Saliju - Yummy 2-Ply - Babette
Saliju - Yummy 2-Ply - Babette
In Stock: 0
This colorway is a Babette: every skein and every batch is a bit different, but Babs has a method of recreating these artistic colorways. The photograph is an example of representative skeins from this colorway; the skein you receive may differ somewhat. If you have any questions about the color, please give us a call or email to ask for a photo - we are always happy to describe our current batch for you to make sure it meets your needs!
Yummy 2-Ply
This 2-ply superwash Merino is wonderful for cowls, scarves, shawls, and lightweight sweaters.
Size: 400 yd / 3.9 oz (365m / 110g) skeins
Content: 100% superwash Merino wool
Gauge: Fingering weight. 7-9 stitches per inch on US 0-2.
Care Instructions: Machine wash gentle. This yarn should be dried flat for best results.


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When you're looking for a partner to help you negotiate the complexities of selling a home, you've come to the right place. The experience, dedication and strong communication you'll receive here will help ensure the successful and profitable sale of your home.
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Get assistance in determining current property value, crafting a competitive offer, writing and negotiating a contract, and much more. Contact me today.


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Head Light Set
Crystal Headlight Set
Crystal Headlight Set; Clear Lens; Chrome Housing; w/Corner Lights; Pair;
Crystal Headlight Set, Clear Lens, Chrome Housing, w/Corner Lights, Pair, . Guaranteed To Improve Your Vehicles Appearance. Rigorously Tested For Fit And Function. Simple Plug And Play. No Modifications Required. Easy Installation Using Common Hand Tools. Uses Stock Mounting Locations And Hardware. D.O.T. Compliant To S.A.E. Standards. Sold As A Pair.
Anzo USA offers the best quality performance lighting products at the lowest cost. All ANZO USA products are S.A.E. (Society Automotive Engineers) and D.O.T. (Department of Transportation) compliant to FMVSS no. 108 (Federal Motor Vehicle Safety Standards); and manufactured in a state-of-the-art ISO 9002 and QS 9000 quality certified factory. In order to ensure perfection, we rigorously test every ANZO USA lighting products in a Thermo-Hygrometer (temperature and humidity chamber) and Rain-Resistant Tester. As well as thoroughly exposing all of our products to intense photometric testing to guarantee strict compliance with local, state, federal and international standards. All of our lighting products are designed using CAD/CAM computerized equipment and these modern designs are then tested using a 3-dimensional testing machine to insure precision and accuracy in the research, development and design of our molds.


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Mudrakwik Customer Care Number: Customer care service numbers, toll-free helpline numbers, their official address, official email address and official social media pages of Mudrakwik are mentioned below. If you need more details, just comment below. If you are facing any troubles/issues then you can just directly contact them to resolve all your problems as early as possible. You can also submit/send your complaints here. Now, we are just sharing Mudrakwik customer care numbers. Just scroll the page down to see Mudrakwik customer care numbers and other details.
Mudrakwik Customer Care Number, Toll-Free Number, and Office Address
All important contact information of Mudrakwik are mentioned here in this page including Mudrakwik online support form, phone number, contact number, and office address. You can easily bookmark this page too for your future purposes. Bookmark option is available in any web browsers such as Google Chrome, Firefox, Opera, Safari etc. If you notice toll-free numbers in this page then you should definitely bookmark this because toll-free numbers are very useful, you don't need to pay any kind of charges for lodging your complaint or raising your queries, asking any details about their products and services to their official customer care executive. You can talk as much as possible without paying any extra penny from your pocket.
Company Name: Mudrakwik – Instant Loan App
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Email Address: firstname.lastname@example.com
Office Address: 502, 6th Floor, Stellar spaces, Opp. Zensar Technology, Kharadi South Main road, Kharadi, Pune – 411014.
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Mudrakwik Customer Care Number, Toll-Free Number, and Office Address
We mentioned this company's phone number, toll-free number, official email address, and office address. You can make a call to them, mail them, otherwise if you like the old style then you can write them a letter too if they have any office address. Let's imagine that you are still unsatisfied after contacting them! In this case, you have to take more strict action against the company. Now, you can do whatever you want.
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Coast To Coast Ribbed Pillar Candle - WhiteRegular price $18.95 Save $-18.95
Light up your home with this sleek Coast To Coast Ribbed Pillar Candle. This stylish white candle is tastefully ribbed and is the perfect decor element. At 15 x 7 cm, this candle is the ideal size for most candle holders in your home and will bring a touch of sophisticated style to any space.
Ribbed pillar candles are unscented, drip-free, and use a 100% natural cotton wick for a calm flame. Hand-poured from refined wax and designed for a long-lasting burn of 75 hours.
Shipping Information
We ship Australia wide.
We use Australia Post or Sendle to deliver our products at a flat rate of $10 per order within Australia or FREE shipping if purchasing $200.00 or more (up to 3kgs) - exluding bulky items as stated on the items page description. Please contact store for a transport quote if required.
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Orders will be shipped within 24 -72 hours of receipt of payment, unless your order is placed on a Saturday, Sunday or Public Holiday, in which case an additional 24 hours may be required to pack & ship your order. Please allow 7-10 working days delivery time - delays may occur with Australia Post or Sendle due to COVID restrictions. We ask for your patience.
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In addition to your Statutory Rights, should you change your mind, we will happily exchange or refund providing the following conditions have been met:
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Ready to Buy, Sell or Rent a Property?
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Doug Martin
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Jason Martin
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Find Your Next Home
Imagine the first place you lived as a young adult. Now imagine trying to fit your life today into that space. Not pretty, right?
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There's no doubt about it—with high student loan debt and two recessions in the rearview mirror, many millennial feel that the deck is stacked against them when it comes to homeownership.
And it's not just millennials—Americans of all ages are facing both financial challenges and a tough housing market. But stepping onto the property ladder can be more doable than many realize, especially in today's low mortgage rate environment.
While many buyers are holding out for their dream home, embracing the concept of a starter home can open a lot of doors.4 In fact, that's the route that most first-time homebuyers take—the average home purchase for a 20-something is about 1,600 square feet.
While the average size increases to around 1,900 square feet for buyers in their 30s, it's not until buyers reach their 40s that the average size passes 2,000 square feet.5
Chosen carefully, a starter home can be a great investment as well as a launchpad for your life together. If you focus on buying a home you can afford now with strong potential for appreciation, you can build equity alongside your savings. This puts you into a position where you can trade up to a larger home in the future if your needs change.6
Mortgage rates are historically low, making now the perfect time to purchase your first home together. A lower interest rate can save you tens of thousands of dollars over the life of your loan, which can significantly increase the quality of home you can get for your money.
But what if both halves of a couple don't have good credit? You may still have options. First, boosting a credit score can be easier than you think—simply paying your credit cards down below 30% of your limit can go a long way. But if that's not enough to boost your score, you might consider taking out the mortgage in only the better-scoring partner's name.
The downside is that applying for a mortgage with only one income will reduce your qualification amount. And if you take that route, make sure you understand the legal and financial implications for both parties should the relationship end.
Whether you've lived in a rental together for years or are sharing a home for the first time, you know that living together involves some compromises. But there are certain home features that can make life easier in the future if you identify them now. The number of bathrooms, availability of closet space, and even things like kitchen layout can make a big difference in your day-to-day life and relationship.
Your home's location will also have a significant impact on your quality of life, so consider it carefully. What will commuting look like for each of you? And if you have different interests or hobbies—say, museums vs. hiking—you'll need to find a community that meets both your needs.
Need some help identifying the ideal location that fits within your budget? We can match you with some great neighborhoods that offer the perfect mix of amenities and affordability.
Contact the Martin Group.
Having kids changes things—fast. With a couple of rowdy preteens and maybe some pets in the mix, that 1,600 square foot home that felt palatial to two adults suddenly becomes a lot more cramped.
Whether you've just had your first child or are getting to the point where your kids can't comfortably share a bedroom any longer, there's plenty to consider when you're ready to size up to a home that will fit your growing family.
For many parents, the desire to give their kids the best education—especially once they are in middle and high school— surpasses even their desire for more breathing room. In fact, 53% of buyers with children under 18 say that school districts are a major factor in their home buying decisions.7
Of course, better funded (and often higher ranking) schools correspond to higher home prices. However, when push comes to shove, many buyers with kids prefer to sacrifice a bit of space to find a home in their desired location.
But when you're moving to a new community, it can be tough to figure out what the local schools are actually like—and online ratings don't tell the whole story. That's why talking to a local real estate agent can be a gamechanger. We don't just work in this community; we know it inside and out.
For many families, living space is a key priority. Once you have teenagers who want space to hang out with their friends, a finished basement or a rec room can be a huge bonus (and can help you protect some quieter living space for yourself).
A good layout can also make family life a lot easier. For example, an open plan is invaluable if you want to cook dinner while keeping an eye on your young kids playing in the living room.
If you think that you might expand your family further in the future, be sure that the home you purchase has enough bedrooms and bathrooms to accommodate that comfortably.
Try to think about how each room will fit into your day-to-day. Are you anticipating keeping the house stocked to feed hungry teenagers? A pantry might rise to the top of the list.
Dreading the loads of laundry that come with both infants and older kids (especially if they play sports)? The task can be much more bearable in a well-designed laundry room.
Imagine a typical day or week of chores in the house to identify which features will have the biggest impact.
Chances are, you won't find every nice-to-have in one home, which is why identifying the must-haves can be such a boon to the decision-making process. We can help you assess your options and give you a sense of what is realistic within your budget. Contact the Martin Group.
When we talk about empty nesters, we usually think about downsizing. With kids out of the house, extra bedrooms and living space can quickly become more trouble than they're worth.
While the average buyer under 55 trades up to a larger home, buyers over 55 are more likely to purchase a smaller or similarly sized but less expensive home. Even in the highest age groups, the majority of home purchases fall in the single-family category.
According to research by the National Association of Realtors, by the time buyers reach their 70s, the median home size drops to 1,750 square feet.5 But there's plenty for empty nesters to think about besides square footage.
What factors are driving your decision to move? Identifying those early in the process can help you narrow down your search. For example, do you want to have space for a garden, or would you prefer to avoid dealing with lawn care altogether?
What about home maintenance? In many cases, a newer home will require less maintenance than an older one and a smaller one will take less time to clean.
You may also want to consider townhomes, condos, or other living situations that don't require quite as much upkeep.
Many empty nesters have retired or are nearing retirement age. This could be your chance to finally pursue hobbies and passions that were just too hard to squeeze into a 9-5. If you're ready to move, consider how you'd like to spend your days and seek out a home that will help make that dream a reality. For some, that might mean living near a golf course or a beach. For others, being able to walk downtown for a nice dinner out is the priority. And with more time to spend as you wish, proximity to a supportive community of friends and family is priceless.
Let's face it—we can't escape aging. If you're looking for a home to retire in, accessibility should be front-of-mind.8 This may mean a single-story home or simply having adequate spaces on the first floor to rearrange as needed.
While buying a home that you plan to renovate from the start is a viable option, being forced into renovations (because of the realities of aging) a few years down the road could seriously dig into your nest egg.
Location matters, too—if your family will be providing support, are they close by? Can you easily reach necessities like grocery stores and healthcare?
While it's tempting to put it out of our minds, a few careful considerations now can make staying in your home long-term much more feasible.
One thing is for sure—life never stands still. And your housing needs won't, either. In the United States, the median duration of homeownership hovers around 13 years.9 That means many of us will cycle through a few very different homes as we move through different life stages.
At each milestone, a careful assessment of your housing options will ensure that you are well-positioned to embrace all the changes to come.
Whatever stage you're embarking on next, we're here to help. Our insight into local neighborhoods, prices, and housing stock will help you hone in on exactly where you want to live and what kind of home is right for you.
We've worked with home buyers in every stage of life, so we know exactly what questions you need to ask. Buying a home—whether it's your first or your tenth—is a big decision, but we're here to support you every step of the way.
We support the Fair Housing Act and Equal Opportunity Housing.
We can help you.
Let's talk.
Realtor® Broker
Realtor® Agent


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The Dogfather Sweatshirt – Funny Gift For Dad Sweatshirt – Sweatshirt for dad – Funny Gift S,M,L,XL,2XL,3XL
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Planned Giving
Powerful and Simple Way to Support Our Work
Outright Gift of Life Insurance
When the original purpose for a life insurance policy no longer applies—such as educating children now grown or providing financial security for a spouse—your policy can become a powerful and simple way to support our work. There are three ways to give life insurance to Kalamazoo College:
Name us a beneficiary of the policy. This gift is as simple as updating your beneficiary designation form with the policy holder. You can designate us as the primary beneficiary for a percentage or specific amount. You can also make us the contingent beneficiary so that we will receive the balance of your policy only if your primary beneficiary doesn't survive you.
Make an outright gift of an existing policy. You can name us as owner and beneficiary of an existing policy. You qualify for a federal income tax charitable deduction when you itemize on your taxes. If you continue to pay premiums on the policy, each payment is tax deductible as a charitable gift when you itemize.
Make an outright gift of a new policy. You can take out a new policy and irrevocably name K as the owner and the beneficiary of the insurance contract. This method may be particularly attractive for the younger donor. Whether you make one single premium payment for the policy or pay annual premiums, each payment is tax deductible as a charitable gift when you itemize on your taxes.
How You Can Benefit From Giving Life Insurance
Learn more about this simple gift by downloading your FREE copy of our informative guide Change Lives With Life Insurance.View My Guide
See How It Works
Next Steps
- Contact Andy Miller at 269.337.7327 or firstname.lastname@example.com for additional information on life insurance.
- Seek the advice of your financial or legal advisor.
- If you include K in your plans, please use our legal name and federal tax ID.
Legal Name: Kalamazoo College
Address: 1200 Academy St., Kalamazoo, MI 49006
Federal Tax ID Number: 38-1358014
Information contained herein was accurate at the time of posting. The information on this website is not intended as legal or tax advice. For such advice, please consult an attorney or tax advisor. Figures cited in any examples are for illustrative purposes only. References to tax rates include federal taxes only and are subject to change. State law may further impact your individual results. Kalamazoo College does not currently issue charitable gift annuities in Alabama, Arkansas, California, Florida, Hawaii, Maryland, New Jersey, New York, North Dakota, Tennessee, or Washington. Oklahoma residents: A charitable gift annuity is not regulated by the Oklahoma Insurance Department and is not protected by a guaranty association affiliated with the Oklahoma Insurance Department. South Dakota residents: Charitable gift annuities are not regulated by and are not under the jurisdiction of the South Dakota Division of Insurance.


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The Insight Story - Issue 7
A data-based snapshot of the New Zealand international education sector to keep you updated on the health and recovery of the sector.
New Zealanders' Perceptions of the International Education Sector report 2020
This report provides fresh insights into what New Zealanders know, think and feel about international education in a COVID environment. The findings show half of New Zealanders are poised to become active supporters of international education if they see and hear more stories about the broad benefits of international education.
For any comments or questions, please email email@example.com


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Figure 1. Incidence of generalized anxiety disorder (GAD) and other mental disorders. Estimated age-specific cumulative incidence (A) and age-of-onset distribution (B and C).
Figure 2. Comparison of anxiety-specific risk variables among anxiety disorders without comorbid depression (Dep). Risk variables are parental generalized anxiety disorder (GAD) (A), childhood separation events (B), behavioral inhibition (C), and parental overprotection (D). For all the specific anxiety disorders, interanxiety comorbidity was possible. *Hazard ratio is significant at the .05 level.
Customize your JAMA Network experience by selecting one or more topics from the list below.
Beesdo K, Pine DS, Lieb R, Wittchen H. Incidence and Risk Patterns of Anxiety and Depressive Disorders and Categorization of Generalized Anxiety Disorder. Arch Gen Psychiatry. 2010;67(1):47–57. doi:10.1001/archgenpsychiatry.2009.177
© 2023
Controversy surrounds the diagnostic categorization of generalized anxiety disorder (GAD).
To examine the incidence, comorbidity, and risk patterns for anxiety and depressive disorders and to test whether developmental features of GAD more strongly support a view of this condition as a depressive as opposed to an anxiety disorder.
Face-to-face, 10-year prospective longitudinal and family study with as many as 4 assessment waves. The DSM-IV Munich Composite International Diagnostic Interview was administered by clinically trained interviewers.
Munich, Germany.
A community sample of 3021 individuals aged 14 to 24 years at baseline and 21 to 34 years at last follow-up.
Main Outcome Measures
Cumulative incidence of GAD, other anxiety disorders (specific phobias, social phobia, agoraphobia, and panic disorder), and depressive disorders (major depressive disorder, and dysthymia).
Longitudinal associations between GAD and depressive disorders are not stronger than those between GAD and anxiety disorders or between other anxiety and depressive disorders. Survival analyses reveal that the factors associated with GAD overlap more strongly with those specific to anxiety disorders than those specific to depressive disorders. In addition, GAD differs from anxiety and depressive disorders with regard to family climate and personality profiles.
Anxiety and depressive disorders appear to differ with regard to risk constellations and temporal longitudinal patterns, and GAD is a heterogeneous disorder that is, overall, more closely related to other anxiety disorders than to depressive disorders. More work is needed to elucidate the potentially unique aspects of pathways and mechanisms involved in the etiopathogenesis of GAD. Grouping GAD with depressive disorders, as suggested by cross-sectional features and diagnostic comorbidity patterns, minimizes the importance of longitudinal data on risk factors and symptom trajectories.
Anxiety and depressive disorders are related through comorbidity and shared risk factors.1-3 Although some particular anxiety disorders may show relatively weak associations with depressive disorders, clinical4 and epidemiological5,6 studies find that anxiety and depressive disorders rarely occur in pure forms. Factor analytic approaches suggest that these data reflect the influence of a higher-order "internalizing" factor.7-10 In the process of revising DSM-IV,11,12 these findings have stimulated calls for rethinking of diagnostic classes13,14 based on data regarding similarities and differences in risk factors.14
Particularly intense inquiry focuses on generalized anxiety disorder (GAD) and major depression.15,16 Factor analysis links GAD more closely to depressive disorders (internalizing anxious-misery dimension) than to other anxiety disorders, such as phobias and panic disorder (internalizing fear dimension).7,9,10 Research on genetics,17-20 personality,21-23 and adversities24,25 also supports this view. However, this view is challenged by many other observations,15,16,26 including those regarding familial factors,25,27 temperament,25,28 life events,29,30 biological characteristics,31 comorbidity,24,32,33 illness course,28,34 cognitive biases,35,36 and treatment.16,37 Despite the considerable research on the relationship between GAD and major depression,24,25,38 to our knowledge, no prior study has used a longitudinal approach to quantify the degree to which similarities and differences in risk profiles and symptom trajectories support a grouping of GAD with depressive as opposed to anxiety disorders. Beyond major depression, considering dysthymia is important given findings regarding comorbidity,32,39-43 structure,7,9,10 and disease course.12
The present study provides data on similarities and differences in developmental features and risk factors of anxiety and depressive disorders. Specifically, we test whether developmental features of GAD are more consistently associated with depressive as opposed to anxiety disorders. Using data from a prospective, longitudinal community study, we will (1) compare incidence and comorbidity patterns of GAD with depressive disorders (major depression and dysthymia) and selected anxiety disorders (panic disorder and phobias) and (2) examine putative family-genetic, temperamental/personality, and environmental factors that might be differentially associated with specific conditions.
The prospective longitudinal Early Developmental Stages of Psychopathology (EDSP) study assessed mental disorders and associated risk factors in a representative sample of 3021 adolescents and young adults aged 14 to 24 years at baseline (T0). The study also includes follow-up surveys (T1, T2, and T3), a family history component (T0, T2, and T3), and parent surveys (T1 and T3). Study methods and design and information on representativeness and response rates have been previously described.44-47
The baseline sample was selected in 1994 from government registries (greater Munich area, Germany). The study emphasized development by sampling 14- to 15-year-old individuals at twice the probability rate and 22- to 24-year-old individuals at half the probability of 16- to 21-year-old individuals. Sample weights account for this sampling scheme in the subsequent analyses.
A total of 3021 interviews were conducted at baseline. The response rate was 70.9%, equal or superior to rates in other large-scale epidemiological studies.48,49 At T1 (range, 1.2-2.1 years after baseline), 1228 interviews (88.0%) were conducted among participants aged 14 to 17 years at baseline. At T2 (range, 2.8-4.1 years after baseline), 2548 participants (84.3%) were interviewed; 2210 (73.2%) were interviewed at T3 (range, 7.3-10.6 years after baseline). For 2797 participants, at least 1 follow-up assessment is available; the overall response rate of 92.6% compares favorably with other studies.50,51 There was no selective attrition from baseline to the 10-year follow-up assessment for participants with GAD (odds ratio, 0.9; 95% confidence interval [CI], 0.5-1.9; P = .81) or other disorders considered herein (all P values >.05).
All participants older than 18 provided written informed consent; for respondents 18 years and younger, parental consent was provided. The EDSP program has been approved by the Ethics Committee of the Medical Faculty of the Technische Universitaet Dresden.
Face-to-face interviews were conducted by trained clinical interviewers using the computer-assisted Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI).52,53 Reliability and validity have been reported previously.53-55 At baseline, the lifetime version of the DIA-X/M-CIDI was used; at follow-up interviews, the interval version was used. All diagnoses were obtained using M-CIDI/DSM-IV algorithms.52 The impairment criterion for phobias was applied when participants were 18 years or older.56
Analyses use aggregated data from baseline to T3 for the following outcomes: (1) anxiety disorders, comprising specific phobias, social phobia, agoraphobia without panic disorder, and panic disorder with and without agoraphobia; (2) depressive disorders, comprising major depressive disorder and dysthymia (excluding bipolar disorders); and (3) GAD (without applying the diagnostic exclusion criteria). These outcomes were chosen based on analyses by Krueger7 and others.9,10 Posttraumatic stress disorder, obsessive-compulsive disorder, and bipolar disorder were excluded from the main analyses because of conflicting findings in structural models5,10,57,58; separation anxiety disorder was assessed in the T1 subsample only. However, these diagnoses were considered in supplementary analyses.
The test-retest reliability ranged from a κ of 0.45 for GAD to 1.00 for panic disorder.53 Inconsistencies in GAD were mainly owing to different responses with regard to the 6-month time duration; however, test-retest reliability of the GAD stem question was good and in the range of other disorders (κ, 0.70). Supplementary analyses considered GAD with a shorter minimum duration. Validity of the DSM-IV/M-CIDI diagnoses compared with independent clinical consensus diagnoses by treating physicians was estimated, with κ ranging from 0.54 for dysthymia to 0.79 for any anxiety disorder, including GAD, to 0.96 for major depressive episodes.54 Age-of-onset reliability estimates were also established with intraclass coefficients ranging from 0.45 for specific phobia, environmental subtype, to 0.97 for GAD and major depressive episodes.53,56
Based on the literature,16,24-27,59,60 we examined the following putative risk factors.
As previously reported,61 parental diagnoses were based on 2 sources: (1) parent interviews at T1 and/or T3 and (2) family history information provided by the offspring at T0, T2, and T3. Interviewed parents (n = 1189) underwent the same assessment procedures as their offspring (DIA-X/M-CIDI). Family history items were designed using a modified version of the Family History Research Diagnostic Criteria62 as a model. At T0, DIA-X/M-CIDI stem questions and questions about treatment were used; at T2 and T3, an extended family history module covered DSM-IV criteria. Parental disorders were aggregated using a priority hierarchy that was determined following examination of agreement patterns between family history report and available parent interview data. This examination demonstrated the highest agreements regarding parental diagnoses, especially in terms of specificity (tends to cause higher bias) at T3 compared with T2 and T0. Parent interview information from T1 and T3 interviews was considered to be the most reliable and was used if available. If parent interview data were not available, T3 family history reports were used, and if these reports were not available, then T2 family history reports and, last, T0 family history reports were used. In the present study, we consider parental GAD (307 of 3021 parents [9.7%]), anxiety disorders (specific phobia, social phobia, agoraphobia, and panic disorder; 770 [21.5%]), depressive disorders (major depression, and dysthymia; 858 [27.7%]), and substance-use disorders (alcohol abuse or dependence, and illicit drug abuse or dependence; no baseline family history information available; 356 of 2764 [12.6%]).
The German version of the Retrospective Self-Report of Inhibition (RSRI)63 was used at baseline to assess behavioral inhibition, defined as consistent restraint in response to social and nonsocial situations. The RSRI consists of 30 questions about specific childhood behaviors. Internal consistency of the RSRI was considered acceptable in clinical and nonclinical samples. Validity is high, which is reflected by a strong agreement between individuals (self-reports) and their parents (observer reports) regarding the individual's inhibited behaviors as a child, a positive relationship of retrospective self-report and contemporary measures of inhibition, and accounts for variance in general and specific measures of mental health.63 The psychometric properties of the German RSRI were comparable to those of the English version.64 The total mean behavioral inhibition score is used herein.
The German version of the 100-item Tridimensional Personality Questionnaire65 was used at T3 to assess 11 subscales that load on 3 distinct dimensions: novelty seeking, reward dependence, and harm avoidance.66,67 Novelty seeking reflects exploratory activity and aversion to monotony, whereas reward dependence is characterized by the maintenance of reward-inducing behavior and reduction of punishment-eliciting behavior. Harm avoidance indicates the tendency toward behavioral inhibition to avoid punishment, novel stimuli, and nonreward. The Tridimensional Personality Questionnaire is based on Cloninger's general theory of personality and is conceptualized to measure stable traits by self-report. Reliability and construct validity of the German version indicate sufficient psychometric properties.65
A modified German version of the Resilience Scale68 was used at T1 to assess the degree of individual resilience, defined as a protective personality factor that enhances individual adaptation to high-risk status, acute stressors, or recovery from trauma. Resilience has been associated with healthy development among children, adolescents, and adults.69 Reliability and validity of the German Resilience Scale have been established.68,70
Early separation events (492 [15.8%]) were assessed at baseline within the family history section of the DIA-X/M-CIDI and included death of a parent (57 [2.0%]) and parental separation or divorce (436 [13.8%]) before age 10.
The German version of the Questionnaire of Recalled Parental Rearing Behavior71 administered at T1 is based on the Swedish EMBU (Egna Minnen Beträffande Uppfostran)72 and involved offspring assessment of the perceived parental rearing styles with regard to parental rejection, emotional warmth, and overprotection. Reliability and validity of the Questionnaire of Recalled Parental Rearing Behavior have been reported to be high.71,73
The McMaster Family Assessment Device74 was used at T1 to assess 6 dimensions of family functioning via parental interviews. The general functioning scale is used herein (higher scores reflect dysfunctional family functioning), representing the overall family climate. Reliability and validity of the scale have been established.75
Data are weighted by age, sex, and geographic location at baseline to match the distribution of the sampling frame; frequencies (numbers) are unweighted. Stata statistical software, version 10.0,76 was used to compute robust variances, CIs, and P values (by applying the Huber-White sandwich matrix) required when basing analyses on weighted data.77
Age-specific cumulative incidence rates were estimated with the Kaplan-Meier method in survival analysis. Consistent with prior reports,47 disorder age of onset was based on the minimum age reported by the respondent at any of the assessment waves. This definition corresponded well (>90%) with other age-of-onset aggregation methods (eg, using the first or mean of reported ages of onset); the absolute values of differences were at most 1 year, except for major depression and specific phobias, for which the agreement between the mean and minimum methods was slightly lower (86.9% and 83.1%, respectively). For the diagnostic outcome categories, the lowest age of onset of the specific disorders was used. Cox regression analyses with hazard ratios (HRs) were used to assess associations between family-genetic (parental disorders), temperamental/personality (behavioral inhibition, Tridimensional Personality Questionnaire, and resilience), and environmental (early separation, rearing, and family climate) factors and diagnostic outcomes in probands (GAD, anxiety disorder, and depressive disorder). To improve comparability of results, the questionnaire scores were standardized in Cox regressions, resulting in a mean (SD) of 0 (1) in the weighted total sample; the reported associations thus indicate the change in outcome (natural logarithm of HR in Cox regression) per 1-SD increase. All Cox regressions were conducted using age and sex as stratification variables; ie, different curves are fitted according to the values of these variables before assessing the covariates of interest.78 Time-dependent covariates (eg, GAD before outcome) were defined as having ever had the condition before time t using age-of-onset data. Some data were missing because of missing age-of-onset information in outcome or time-dependent covariates.
The estimated age-specific cumulative incidence for GAD at age 34 is 4.3% (n = 106); incidence is 23.2% (n = 732) for other anxiety disorders (phobia or panic disorder), and 28.6% (n = 686) for any depressive disorder (major depressive disorder or dysthymia) (Figure 1A). The cumulative age-of-onset distribution (Figure 1B) reveals the earliest onset for anxiety disorders; GAD shows an age-of-onset slope more similar to the depressive than the anxiety disorders, with core incidence periods occurring in adolescence and early adulthood. The considerable degree of heterogeneity among the anxiety disorders should be noted; panic disorder and agoraphobia have a similarly delayed age-of-onset as GAD (Figure 1C). These patterns contrast with social phobia and particularly specific phobias, for which first onset almost never occurs after adolescence.
Overall, GAD is strongly associated with anxiety disorders (panic and phobias: odds ratio, 7.06; 95% CI, 4.40-11.34; P < .001) and depressive disorders (4.44; 2.83-6.97; P < .001). Phobias (odds ratio, 2.40; 95% CI, 1.94-2.97; P < .001) and panic disorder (3.61; 2.28-5.73; P < .001) also are strongly associated with depressive disorders.
Table 1 presents time-lagged associations between prior and subsequent disorders. Phobias and panic disorder, GAD, and depressive disorders significantly predict the onset of each other. Highest HRs emerge for GAD predicting anxiety disorders (HR, 4.14) and, vice versa, anxiety disorders predicting GAD (5.05). For both directions, the associations of anxiety disorders or GAD with depressive disorders are consistently smaller (HRs, 1.88-2.54) than the anxiety-GAD associations. There were no interactions with time, except that depressive disorders occurred earlier among participants who had experienced prior phobias or panic (main effect for prior anxiety HR, 7.90; P < .001; anxiety × time interaction effect HR, 0.92; P < .001). When adjusting for comorbidity with disorders occurring before the outcome, HRs decreased but remained significant, except that the association between prior depressive disorder and subsequent GAD was reduced to nonsignificance.
Given the significant associations among disorders, we first examined putative risk factors for any depressive or anxiety disorder, including GAD (Table 2). Compared with individuals without anxiety and depression, affected individuals were characterized by a broad familial liability, temperamental/personality, and environmental risk profile.
To examine differential risk profiles and, specifically, whether factors associated with GAD are more closely related to depressive than anxiety disorders, we generated the following diagnostic outcome groups: (A) GAD (n = 106), (B) anxiety alone (phobias or panic disorder but no GAD or depressive disorder; n = 429), (C) depression alone (major depressive disorder or dysthymia but no GAD or anxiety disorder; n = 388), and (D) comorbid depressive and anxiety disorder but no GAD (n = 234). Groups B through D do not include cases with GAD. Group A consisted of few cases without lifetime phobias or panic and depressive disorders (15 [14.4%]) and somewhat more with phobias and panic alone (27 [25.9%]) or depressive disorder alone (22 [19.2%]); the largest subgroup had both anxiety and depressive disorders (42 [40.5%]).
Table 3 shows the frequencies and means for putative risk factors for the 4 diagnostic outcome groups and Table 4 shows the respective associations. Partly different factors are associated with anxiety alone and depression alone. Harm avoidance and, less clearly, parental comorbid anxiety and depressive disorders are associated with both anxiety and depressive disorders. However, parental depressive disorders alone, low resilience, low parental emotional warmth, and high parental rejection appear to be specific to offspring depressive disorders; parental GAD, high behavioral inhibition, exposure to childhood separation events, and parental overprotection, in contrast, appear to be specific to anxiety disorders.
The factors associated with GAD overlap with all those that are specific for anxiety disorders (parental GAD, behavioral inhibition, childhood separation events, and parental overprotection). However, they overlap only partly with those that are specific to depressive disorders (parental depressive disorders alone). Furthermore, unlike anxiety and/or depressive disorders, GAD is associated with reward dependence and dysfunctional family functioning.
Similar to GAD, comorbid cases with anxiety and depressive disorders reveal a broad range of strong risk associations. Since GAD cases (group A) revealed comorbidity, we repeated the analysis adjusting for comorbid anxiety and depressive disorders with onsets before GAD. Although the depression-overlap association between parental depressive disorder alone and offspring GAD was diminished (HR, 1.65; 95% CI, 0.96-2.84; P = .07), the anxiety-overlap associations with parental GAD (3.08; 1.86-5.12; P < .001), behavioral inhibition (1.64; 1.34-2.00; P < .001), and childhood separation events (1.94; 1.19-3.17; P = .008) remained significant. Furthermore, the GAD-specific association with reward dependence remained unchanged (HR, 1.43; 95% CI, 1.09-1.87; P = .01). Associations for overprotection and family functioning decreased to nonsignificance, likely owing to limited power in the smaller subsample.
In supplementary analyses, we explored first whether separation anxiety disorder as an early, childhood-onset disorder is a differential predictor for the 4 diagnostic outcome groups. Results reveal that separation anxiety disorder is a significant and specific predictor for phobias and panic alone (HR, 3.48; 95% CI, 1.73-7.00; P < .001) and GAD (7.65; 1.40-41.82; P = .02).
Second, we explored the robustness of findings in Tables 3 and 4 by using different outcome definitions. Based on epidemiological evidence suggesting that current criteria for GAD may be too strict,40,79,80 particularly for youth,32,51 and given that other studies manipulated the threshold definitions for GAD to increase comparability with major depressive disorder,17,18,25 we repeated the analyses using GAD with a shorter minimum duration (3 months and 1 month) (eTable 1). Despite decreasing HRs with decreasing GAD minimum duration, 3 of the 4 GAD anxiety-specific associations remained (parental GAD, behavioral inhibition, and childhood separation events), whereas significance of the GAD depression-specific factor (parental depressive disorder) was attenuated in GAD. When performing analyses using a minimum duration of 3 months for GAD, another indication for risk overlap for GAD and depression was found (low resilience).
Next, following structural models, we chose to consider in our primary analyses only some of the anxiety disorders, focusing on those with consistent loadings on the fear dimension (phobias and panic).7,9,57,58,81 We omitted the DSM-IV anxiety disorders posttraumatic stress disorder and obsessive-compulsive disorder because of conflicting results in structural analyses.5,10,57,58 Including posttraumatic stress disorder and obsessive-compulsive disorder within the anxiety outcome group did not change the primary results (eTable 2).
Then, contrary to procedures in other studies,24,25,38 we considered major depression and dysthymia in our primary analyses following structural7,9,10 and comorbidity findings,32,39-43 but we chose to exclude bipolar cases because of inconclusive results from structural analyses.5,58 Repeating the analyses by focusing on major depression with and without exclusion of mania/hypomania cases did not change the primary results (eTable 3).
Last, we explored whether the anxiety-specific predictors from Tables 3 and 4 appear consistently across the specific anxiety disorders and GAD without comorbid depression. As shown in Figure 2, despite some variations, similarly directed risk patterns emerged across the specific anxiety disorders, except that panic disorder without depression was not associated with increased rates of parental GAD.
Strong comorbidity between anxiety and depressive disorders raises questions about the need to reconceptualize these disorders,13,14,58,82 with particularly intense focus on GAD. The present study contributes novel data relevant to these questions by comparing GAD, other anxiety disorders, and depressive disorders in terms of developmental features and risk factors.
Our results suggest some similarities and differences among GAD, other anxiety disorders, and depressive disorders. Although the age-of-onset distribution for GAD appears more similar to depressive disorders than specific and social phobias, panic disorder and agoraphobia also resembled GAD and depression. Furthermore, temporal comorbidity for GAD showed at least as strong a tie to other anxiety disorders as to depressive disorders. More persuasive evidence linking GAD to anxiety comes from our findings of risk associations in familial, temperamental/personality, and environmental variables. Our findings differentiate patterns for anxiety and depressive disorders, with GAD showing more similarities to anxiety than depression.
The diagnosis of GAD first appeared in the DSM-III,83 when the traditional concept of anxiety neuroses was abandoned in favor of descriptive, phenomenological approaches. Although originally a residual diagnostic class, GAD gained status as a unique condition based on steadily accumulating evidence.32,84-86 At the same time, however, debate has surrounded the categorization of GAD as an anxiety disorder as opposed to a depressive disorder. Most prominently, this debate is fueled by data on comorbidity and factor structure,7,9,10,13,14,38,58 yet other, more substantial work also influences this discussion.15-27,29,31,35-37,82 To date, however, few studies have examined similarities and differences in developmental features and risk factors by directly comparing GAD with other diagnostic groups. Most prior studies compared selected features of GAD and major depression16,24,25 without considering relationships to other anxiety disorders. The present study fills this gap by comparing developmental patterns and risk factors among GAD, anxiety disorders, and depressive disorders, including major depression and dysthymia.
Comparing first anxiety disorders alone and then depressive disorders alone, some common risk associations as well as considerable differences were found. For both groups, harm avoidance was an associated factor, and shared familial liability, reflected by parental comorbid anxiety and depression, was indicated. Parental GAD, behavioral inhibition, childhood separation events, and overprotective rearing, however, were specific to anxiety disorders; a history of parental depression alone, low parental emotional warmth, and high degrees of parental rejection were specific to offspring depressive disorders. These findings are largely consistent with evidence from prior studies suggesting commonalities but also some specificity in the etiopathogenesis of anxiety and depressive disorders.2,3,87-95 Also consistent with prior research25,90 is our finding that comorbid anxiety and depressive disorders reveal an overall broader risk profile. In this context, it should be emphasized that anxiety disorders may themselves be a risk factor for the development of depressive disorders,2 possibly owing to impairments or other characteristics associated with the respective condition.47,96 The incidence and temporal priority patterns indicate a considerable earlier onset of any anxiety disorder compared with depression, particularly owing to the early onset of specific and social phobias. Despite indications for the existence of bidirectional associations between anxiety and depressive disorders, mostly owing to the later-onset agoraphobia and panic disorder, this supports the view that anxiety disorders are powerful risk factors for secondary depression as the most frequent trajectory. This is in agreement with findings from many other studies1,51,97-102 and has led some to suggest that, similar to somatic disorders, staging models may be of potential value for specifying the complexity of developmental patterns of mental disorders.103
Against expectations arising from comorbidity and factor-structure findings, our study provides little evidence that GAD is more similar to depressive than anxiety disorders. As in other studies,24,38,79,104 we do find that GAD and depressive disorders exhibit similar age-of-onset patterns and strong bidirectional associations. However, the predictive association of depression with GAD was attenuated when adjusting for prior anxiety disorders. Moreover, we found an onset pattern in agoraphobia and panic disorder that appeared similar to GAD; we also found strong bidirectional associations between GAD and anxiety disorders, associations that are at least as strong as those to depression. As with other data,32,33,43,105 these observations challenge the suggestion that GAD relates more strongly to depression than to anxiety disorders.
Most important, risk profiles revealed that overlapping factors were either not specific for GAD and depressive disorders (harm avoidance) or were accounted for by comorbidity (parental depressive disorder alone). In contrast, other factors (parental GAD, behavioral inhibition, childhood separation events, and parental overprotection) showed a more consistent pattern of overlap between GAD and anxiety disorders. Therefore, with the possible exception of a familial liability for depressive disorders, no evidence was found for common risk factors for depressive disorders and GAD differing from those of anxiety disorders; relatively consistent evidence was found, however, for specific commonalities in risk associations for anxiety disorders and GAD that differ from those of depressive disorders. These findings are generally in line with previous indications that, although the genetic contributions to GAD and major depression may be the same,17-19 other, environmentally mediated factors may differ.15-19,24-30
Only a few prior studies examined the question of differential risk factors in GAD and major depression.16,24,25 One methodologically sound study25 compared pure GAD and pure major depression in a large representative birth cohort and found, consistent with our study, a set of risk factors for GAD that is not shared with major depression. Beyond this, our study adds evidence that, in terms of risk constellations, GAD seems to be more closely related to anxiety than depressive disorders. Specifically, GAD was associated with each of the factors for which anxiety specificity was indicated (parental GAD, behavioral inhibition, childhood separation events, and parental overprotection), factors previously shown to be related to various anxiety disorders.106,107
Overall, our data suggest that there is little evidence for GAD being more closely related to depressive than anxiety disorders. Of significance, this conclusion appears to be robust even with variations in methods. Findings in our risk analyses were largely retained when, in accordance with the procedures of other studies, the minimum duration requirement for GAD was decreased to increase comparability to major depression (eTable 1),17,18,25 when the depression group was restricted to major depression cases with or without consideration of hypomania or mania (eTable 3),24,25,38 and when posttraumatic stress disorder and obsessive-compulsive disorder were additionally considered among the anxiety disorders (eTable 2), as suggested by the DSM-IV.12 Additional support for our conclusion comes from the finding that childhood separation anxiety disorder, consistent with earlier studies,108 was found to be a strong predictor for both GAD and phobias/panic but not for depressive disorders. Moreover, GAD was still related with the anxiety-specific predictors when adjusting for comorbidity and when considering only GAD without comorbid depression. Therefore, none of the analyses revealed findings in favor of a different conclusion.
Of note, although anxiety-specific predictors were found across various individual anxiety disorders, there was also some indication for heterogeneity. Particularly for GAD, reward dependence and adverse family functioning appeared as specific predictors. Although the high levels of reward dependence in our participants with GAD were unexpected given previous findings from patient studies,109,110 overall, our findings favorably agree with prior research on family dysfunction and distress111,112 as well as indications for poor childhood attachment experiences and vulnerable current state of mind with respect to attachment in GAD.113 However, more work is needed to understand the specific contribution of these factors in the development of GAD. More generally, our findings suggest increasing research on genetic, biological, and environmental factors as well as their interplay in critical time periods114-116 to identify diagnosis-specific etiological pathways and mechanisms involved in the development of complex psychopathological conditions.
Of course, our study is not without limitations. First, with a maximum age of 34 years, our sample is relatively young. Individuals with anxiety disorder alone and depressive disorder alone may still develop comorbidity with the other group. Second, owing to the sample including relatively few GAD cases without any comorbid lifetime anxiety or depressive disorder, we were not able to perform analyses among cases with GAD alone. Third, consistent with other studies,24,25,38 we did not apply the DSM-IV diagnostic exclusion rules for GAD. However, this poses a tough test of our research question because this procedure avoids artificially lowering comorbidity with depressive disorders. Of note, a body of research shows that applying exclusion criteria does not drastically decrease prevalence rates for GAD,105 and even GAD without comorbid depression is characterized by functional impairments and disabilities117; eliminating the exclusion criterion for GAD has been suggested.118 Fourth, the relatively low test-retest reliability of the GAD DSM-IV/M-CIDI diagnosis should be noted. Still, the test-retest reliability of the GAD stem question was good,53 and supplementary analyses considering GAD with shorter minimum durations revealed similar results. Fifth, we did not use a strictly prospective analysis approach for all risk factors119 because this would have drastically limited the study power and, thus, the generalizability of the results. The selection of predictor variables was based on empirical evidence suggesting the temporal precedence of these factors in the development of mental disorders. For example, although one could consider the assessment as being confounded, we included temperamental/personality measures as predictors because personality and temperament are conceptualized as traits, largely genetically determined, measurable early in life, and relatively stable over time.120-124 Finally, we examined a restricted number of predictor variables and cannot exclude the possibility that more overlapping risk profiles would emerge under consideration of more or other factors. The choice of variables must be carefully considered when validating diagnoses for purposes of accurate classification.125
To conclude, based on our findings and considerations, anxiety and depressive disorders appear to be remarkably different with regard to risk constellations and temporal longitudinal patterns. Generalized anxiety disorder appears to clearly differ from depression, and our study results provide novel evidence that GAD is in fact closer to anxiety disorders than to depressive disorders. Although more work is needed on the unique etiological pathways for GAD, it seems premature, at the least, to classify GAD with the depressive disorders.
Correspondence: Katja Beesdo, PhD, Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Chemnitzer St 46, 01187 Dresden, Germany (email@example.com).
Submitted for Publication: November 18, 2008; final revision received February 26, 2009; accepted April 21, 2009.
Financial Disclosure: Dr Beesdo has received speaking honoraria from Pfizer and Eli Lilly. Dr Lieb has received speaking honoraria from Wyeth. Dr Wittchen has received research support from Eli Lilly and speaking honoraria from Novartis and Pfizer; he also has been a consultant for Eli Lilly, GlaxoSmithKline Pharmaceuticals, Novartis, and Pfizer.
Funding/Support: This work is part of the EDSP study, which is funded by grants 01EB9405/6, 01EB 9901/6, EB01016200, 01EB0140, and 01EB0440 from the German Federal Ministry of Education and Research. The field work and analyses were also supported in part by grants LA1148/1-1, WI2246/1-1, WI 709/7-1, and WI 709/8-1 from the Deutsche Forschungsgemeinschaft.
Additional Contributions: Hans-Ulrich Wittchen, PhD, and Roselind Lieb, PhD, are principal investigators of the EDSP study. Kirsten von Sydow, PhD; Gabriele Lachner, PhD; Axel Perkonigg, PhD; Peter Schuster, PhD; Michael Höfler, PhD; Holger Sonntag, DiplPsych; Tanja Brückl, PhD; Elzbieta Garczynski, DiplPsych; Barbara Isensee, PhD; Agnes Nocon, DiplPsych; Chris Nelson, PhD; Hildegard Pfister, DiplInf; Victoria Reed, PhD; Barbara Spiegel, DiplSoz; Andrea Schreier, PhD; Ursula Wunderlich, PhD; Petra Zimmermann, PhD; Katja Beesdo, PhD; Antje Bittner, PhD; Silke Behrendt, PhD; and Susanne Knappe, DiplPsych, are current or past core staff members of the EDSP group and managed field and data work. Jules Angst, MD (Zurich, Switzerland); Jürgen Margraf, PhD (Basel, Switzerland); Günther Esser, PhD (Potsdam, Germany); Kathleen Merikangas, PhD (National Institute of Mental Health, Bethesda, Maryland); Ronald C. Kessler, PhD (Harvard University, Boston, Massachusetts), and Jim van Os, PhD (Maastricht, the Netherlands), provided scientific advice on the design of the EDSP study.


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What is Workers' Compensation Insurance?
Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence.
Additional Information about Workers' Comp Insurance
While plans differ among jurisdictions, provision can be made for weekly payments in place of wages (functioning in this case as a form of disability insurance), compensation for economic loss (past and future), reimbursement or payment of medical and like expenses (functioning in this case as a form of health insurance), and benefits payable to the dependents of workers killed during employment (functioning in this case as a form of life insurance).
General damages for pain and suffering, and punitive damages for employer negligence, are generally not available in workers' compensation plans, and negligence is generally not an issue in the case.
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EBC Yellow Stuff Brake Pads DP41798R
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Yellow Stuff Brake Pads
- Part #: DP41798R
- Front Pair
$139.97Free Shipping
Select your vehicle details above to ensure item compatibility.
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