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FREE PROPERTY APPRAISAL OF YOUR Kewdale HOME
Book Your Free No Obligation Kewdale Home Appraisal by Real Estate Agent Mark Burgess.
Mark Burgess – Selling Real Estate across Perth and Kewdale
Dear Kewdale Home Owner,
Or should I say Kewdale home seller.
Here are 3 questions I want you to ask yourself before choosing your real estate agent.
Will my chosen real estate agent do a thorough and well-researched appraisal?
I have seen Kewdale house sellers or in nearby areas miss out on tens of thousands to over a hundred thousand dollars when selling their property due to fast decisions based on poor house appraisal packages. In some instances, the appraisal has been on the low end to help the agent get a quick sale. It's easy to sell cheap. On the flip side, I have seen overpriced properties that get no interest due to being overpriced and then get sold in desperation at below an achievable price due to financial or time pressures.
I make sure I research your area, type of property and the market thoroughly to come up with a realistic and achievable selling price range for you property.
I will tell you if I think you are dreaming and why, with the facts to back up my decision, and I will tell you if you can achieve more than what you thought.
My appraisals are thorough
2. Will my chosen Kewdale real estate agent be cheap or the best value?
There are negotiators and there are great negotiators when it comes to selling Kewdale property. As a fisherman it takes skill to both hook and then land a big fish and in real estate, it takes skill to negotiate with a potential buyer so that they see all the fantastic aspects and the opportunity your property provides. Buying is both a very stressful yet exciting emotional time for new homeowners and I maximise in the mind of a buyer the value of your property. I don't roll over for Kewdale property buyers on low and below value offers because I have the negotiating skills to keep your prospective buyers engaged and excited about your property. Cheap rates often indicate a lack of negotiating skill and thinking you can save a few thousand dollars could lead to missing out on tens of thousands of dollars that could be used on your next property. Often what you can lose is more than a year's wages if you don't get a top gun negotiator like myself.
I would recommend asking for names of 3 previous clients from the last 2 months and their phone numbers from each Kewdale real estate agent that comes to do an appraisal. Then call these clients and ask them what they really thought of the sales result, the process and the outcome from that agent.
3. What marketing campaign will you run to generate interest in my Kewdale property?
Successful selling relies on getting potential buyers to your property fast and cost-effectively and that's where we excel. As a Kewdale real estate agent with a long successful track record of marketing and selling property, we can advise based on the type of property you are in, the appropriate kinds of marketing and budget to allocate to get a fantastic result.
We can even auction your property as auctioning Kewdale property is a fast way to sell your home, or determine if your pricing is too high for what the market will bear at the moment.
I will provide a marketing campaign plan, simply called a marketing action plan (MAP) which is a MAP of how we are going to maximise the sale price of your property in the minimum time frame possible.
Choosing a real estate agent is often like Forest Gump's box of chocolates
And, you may feel the same about contacting me so I make all my clients 3 promises as follows.
- I will do thorough research on your Kewdale property and be truthful with my recommendations with your best interests at heart
- I will provide recommendations on what you can do to cost-effectively to improve your selling price and selling time frame, or whether to leave certain upgrades.
- I will communicate regularly and often to ensure you are kept up to date with sales activity on the way to selling your home, all the way through to settlement.
So all I ask is that you choose me to be one of your three local area Kewdale real estate agents that appraise your home.
You will then be assured that you are comparing professional, capable agents to sell your Kewdale home for the maximum amount in the minimum time frame
Mark Burgess
Selling in Kewdale
30 Years in Real Estate
P.S. I would like to suggest some local Perth businesses who may be of use to you in your Kewdale property preparations or in the sales process.
Building Inspection
You are likely going to be buying another property, possible not in Kewdale and will need a great building inspector. Peter Barnes is the best with thorough reports and well priced. Give this Kewdale building inspector a call before you put an offer in on a new property.
Mortgage Broker
Money, money money. The right loan and the right loan structure across your assets will save you tens of thousands of dollars and can save you from bank bullying in cases of lean times. Kerry Franklin will come out to you as your Kewdale mortgage broker and work out what you can spend on your next property after reviewing your current situation.
Business Accountant Kewdale
If you run a small business or a big business and are selling and buying then running your decisions and getting advice from your local Perth Accountant can potentially save you thousands. We recommend you speak to Kevin Dobra from Applecross Accountants if you don't have a good accountant already. Phone: 0410 636 320
Plumber for Leaking Taps and Everything Else
Get your home's plumbing issues sorted out before inspection day with Kris Walker from splash and Gas plumbing. As a general plumber and gas plumber, he does excellent Kewdale plumbing work for a very good price. Kris is a lovely guy who'm you would refer to your own mother. I have.
Heat Pumps
Better than gas or electric and cutting energy costs by up to 70%, a Kewdale hot water heat pump storage tank is both a green way and money saving way to replace your old and dying Kewdale home hot water system.
Insulation Replacement Kewdale
If you find your house getting colder or hotter faster then it might be time to replace your roof insulation. This is also valuable to do before selling a home.
Money Management
Financial security is within the reach of all working Australians and Money Management Kewdale reveals the secrets to a life without constant financial strain, and how to build a life of comfort, pleasure, and financial abundance.
Parenting Order Kewdale
At West Family Lawyers, we can provide you with legal advice and assistance in a wide range of family law matters.
Emergency Hot Water Plumbers
Got not hot water? Contact Emergency hot water plumbers Kewdale today for 24/7 call-out service for all hot water emergencies.
Property Lawyers
If your garden is looking dead or unloved, then planting a beautiful advanced tree from Arborwest tree Farm Kewdale. Arborwest Tree Farm is proud to be the leading supplier of quality mature and advanced trees in Western Australia.
Lawn Mowing
keeping up appearance is so important when selling a house. Poor lawn-cutting practices will severely damage your lawn, causing it to dry out, show dead patches and reduce the street appeal of your property. Street appeal sells and green grass keeps properties on average 3-5 degrees cooler then their dry and concreted counter parts.
Commercial Lawyers Kewdale
Commercial and Intellectual Property Lawyers. We Do Things Differently – Fixed Price Quotes, Free Initial Consultations and Excellent Service. Quest Legal – Grow With You
Pest Control
Keep on top of any pest problems to stop them from escalating into anything big. Pest Control in Kewdale including Pest Inspections when buying properties to check for termite activity should always be done. The man to call is Collin Shultz from Megatec Pest Control on 0435 785 999.
Commercial Vacuum Repairs
Perth Commercial Vacuum repairs, no matter the brand or the type of breakdown, U clean Supplies will get you back to cleaning fast.
Childcare Centres For Sale
If you are looking to sell or buy a childcare centre, then look no further. Childcare centres for sale in Kewdale have successfully sold many childcare businesses. For professional service contact Ric Today.
Pest Control Services We Provide in your Kewdale
- Ant Control
- Bed Bug Control
- Bee Control
- Cockroach Control
- Rat Control
- Mice Control
- End of Lease Flea Treatment
- Flea Control
- Flea Treatment
- Silverfish Control
- Possum Removal
- Spider Control
- Termite Inspection
- Termite Treatment
- Wasp Control
Furniture Removalist
Moving house? Or are you moving into your dream home you just purchased? For a great removals company call Fernandos Half Price for your Kewdale furniture removalist needs. They are experienced and sure to take care of your furniture and belongings.
Electrician Kewdale
Getting a house checked over before buying or just wanting to update and check over your current electrical work in the house. Kewdale Electrician does Emergency or general work on your new property.
Luxury Custom Home Builder
Can't find your dream home on the market? Have you thought about building your dream home? Luxury Custom Home Builders Kewdale are expects in creating luxury dream homes across Perth.
Chiropractic to fix your back after heavy lifting
Hurting yourself during moving is pretty common and you shouldn't leave it untreated.Chiropractic Clinic for Kewdale movers has a professional team that will handle your injury with care, getting you back on your feet to enjoy your new home to the fullest.
Vacate Cleaning Services
Making sure the house is clean after you move out is essential whether you are renting or selling. If you are renting then you have to have the place spotless to get your bond back. Whereas having a clean house when selling is also important. Check out Jo Crisp from Turnaround Cleaning. Lovely lady and great work on 0417 033 018
Settlement Agency Services
When you are buying a property, it is necessary for all the paperwork to be completed and all the promises to be fulfilled in the contract for the sale of the property. Such work is known as conveyancing. If you don't want to do this yourself, you must employ a licensed settlement agent or a lawyer with a current practising certificate in law to attend all these details on your behalf. We can recommend a few settlement agents. Give me a call and I can give you the low down.
Shade Sails
I know two Kewdale shade sail companies I can recommend. Sail City Kewdale always work to the best quality and use the best quality materials available.
Pull Down Awnings
Channel blinds are of the Pulldown awnings Kewdale most popular products in our collection of exterior blinds. This exquisitely stylish shade system is perfect for open-air environs in the home or business. It is extremely strong and durable to dutifully serve in harsh outdoor environments.
Retractable Screens
Retractable screens Kewdale not only look good, they are functional in keeping out bugs and thieves while meeting fresh air into your house. Retractable Screen Company Kewdale screens are manufactured in our Bayswater factory using components sourced locally and from Japan and China. Each screen is individually produced.
Alarm System
It's proven that having an alarm system in Kewdale can reduce your chances of being broken into dramatically, often chiefs are after a quick and easy steal which means when they see your alarm system they will often steer clear of your house.
CCTV Security System
Now you have found your dream home it's time to protect your dream home with a CCTV Security System, Austguard security Kewdale offer a range of CCTV systems that will ensure your belongings indoor new house will be safe.
Security Roller Shutters
Classic Shutters Kewdale are built to the highest standards. not only do they offer protection and temperature control they can add value to your home. Keep the costs of your new home down by installing security roller shutters.
Security Screens and Doors
Be it a sleek looking marine-grade stainless steel secure mesh door, a perforated Aluminium screen or a Diamond Grille aluminium security door, Security Screens doors in Kewdale are a smart move to increase your level of safety and avoid any issues.
Lock Smith
Lock Smith in Kewdale provides a wide range of Residential and Commercial locksmithing services around the clock. If you are looking for a trustworthy, readable, experienced and licence locksmith who comes to Kewdale then contact me for a number.
Whether your re painting your house to sell or you just want a change in the home you just bought getting a professional painter in can make all the difference. Graham Kavanagh strives to provide the highest quality and best value house painting service in Kewdale.
Small Home Renovations (GKHI)
Add value and space to your house, weather it's indoor or outdoor GKD home improvement Kewdale can create a unique and beautiful renovation for you. Refurbishments, Alterations and Renovations of all budget types.
Bathroom and Laundry Tiler
Bathrooms are usually the first room you see in the morning and the last room you see at night before going to bed, meaning you want it to be a place you walk into and love. boring or old tiles can really effect the way a bathroom feels, Bathroom floor tiling Kewdale will get your bathroom walls and floor up to your standards.
Plumber Kewdale
Need a qualified and professional plumber to install your hot water system? Then look no further than Universal Plumbers to install any type of hot water system.
Tree Lopper
Overgrown trees are often the first sign to home buyers that the house isn't well kept. However, trees aren't always easy to trim or remove on your own. Let a local Kewdale tree lopper do the hard work for you and help get your garden back under control. Call me for a number.
Glazier – Glass Repairs
If you have broken or cracked glass in your Kewdale home, A localKewdale Glass repairer who is an experienced glazier and can help fix your broken windows fast. Cracked or damaged glass can be a potential hazard so it is important to fix such hazards fast. Contact me for a number.
Quality paving needed around your Kewdale home. I have contacts in this space.
Laundry Renovations
Sadly laundries are often the most neglected room in your home. That's because it's often a purely functional room, with no thought given to design, functionality and aesthetics. It doesn't have to be this way. There are many local Kewdale laundry renovations tradespeople have performed countless laundry renovations across Perth suburbs that leave the homeowners impressed and amazed. I have details of several tried and trusted tradespeople I can confidently refer to you.
Chimney Flue Cleaning Kewdale
Nothing sells in winter like a fireplace. But don't let the flue build up with ash and soot as it can cause chimney fires that can explode out the flue and spread a fire into your house. By using SmartBurn available at Bunnings, you will dramatically reduce your chances of a dangerous and expensive chimney flue fire in your Kewdale house. Chimney Flue Cleaner Kewdale in a tube. Learn more about their multi-award winning product.
Window Cleaning Kewdale
Window cleaning is job that many people hate so why not get in a company that love turning dirty, dusty, hard to see through windows into shiny masterpieces. Your garden will look amazing through your clean windows and help sell your property faster. Get local Kewdale window cleaner Damian Lindsell in for a professional, thorough and all round great value window clean.
Family Law Mediation Kewdale
Minimise the distress of separation for all parties by dealing with the trauma of family breakdown with impartial, professional mediation. Get Family Law Mediation Kewdale lawyers can help you with their mediation services.
Car Smash Repair Kewdale
Need smash repair in Kewdale, then Balcatta Panel and paint are car accident and respray specialists. They are insurance approved independent Auto body repair workshop, with a fully qualified team. With no need to call to book an appointment drive in for insurance and private quotes.
Logbook Service for Your Vehicle
Keeping on top of your vehicle servicing can be difficult because getting to a workshop during working hours is hard. Super Quick Oil Change are a mobile mechanic that can come to you for oil changes and logbook servicing in Kewdale.
Rim Repairs Kewdale
Rim repairs for Kewdale car owners. Rim Clinic will come to you with their mobile Rim Repairs. Learn how to care for your rims correctly to help make any repairs last longer.
Audiovisual Equipment Hire
Got a big event coming up? Audiovisual hire Kewdale have assisted in ensuring many school performances, corporate conferences, community events and weddings have gone to plan. With their professional team and many successful events under their belt contact Ashton Audio for all your audiovisual needs.
Business Law Kewdale
Any business owner can have times when you might be confused or in need of some legal advice for their business, especially small businesses. Clairs Keeley lawyers are experts in Business law and want to help you with all your business law needs.
Wedding Photography Kewdale
Planning a wedding and still looking for a photographer for your Kewdale wedding? Moments Photography LOVE weddings and want to capture all your special moments on your special day! Their talent photographers will work with you to ensure your personality shows through in the final photos.
Commercial refrigeration repairs Kewdale
Are you experiencing problems with your fridges? Are you in need of a fast, skilled and efficient commercial refrigerator repairs Kewdale Technician? Then Pacer WA's commercial refrigeration repairs team can ensure that your Kewdale business can get back to doing what you do best.
Cleaning Equipment Kewdale
Do you own a business? Then you know you need quality window cleaning system to keep your business clean. We supply a large range of quality commercial cleaning supplies making us a one stop shop for all your commercial cleaning needs.
No hot water?
Cold water coming from hot taps in your Kewdale home? Quokka plumbing can hop right onto fixing it. They will come to you in Kewdale to make sure you have your hot water back ASAP.
Business Coaching
Are you frustrated with where your business is at and want to take your business to the next level? Business Coaching Harvey will help you get your business to get back on track.
Back Door Replacement
Bought a new house but not loving the doors? Back door replacement Kewdale will replace the back doors on your new home making sure you love every part of your new home!
Acoustic Insulation Kewdale
Can you hear all the traffic that goes by your house? or everything your neighbors do? Then maybe it's time to upgrade your insulation to an acoustic insulation that will block out the noise.
Accountant Kewdale
Do you need a qualified accountant that will cover all things from Superannuation, insurance, and of course all things tax related.
Green Waste Removal
Do you need rubbish or junk removed, Mr Junk Rubbish has you covered.


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The cost of medical care and the rising of health insurance premiums continues to make your health insurance options a #1 priority when considering your health insurance choices. The information below may help some of your questions about health/ medical insurance so you can make an intelligent choice at a reasonable price.Call one of our reliable agents and get all your answers about Obamacare.
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plans. The differences include the choice of providers, out-of-pocket costs for covered services and how bills are paid. There is no one "best" plan for everyone. Some plans are better than others for your or your family's health care needs, but no one plan will pay for all the costs associated with your medical care.
Here is a brief description of the types of available health insurance plans: Indemnity Plans; Managed Care Options; and Government-sponsored Health Insurance
A. Indemnity Plans
Cafeteria/Flexible Spending Plans
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Indemnity Health Plans
allow you to choose your health care providers. You can go to any doctor, hospital or other provider for a set monthly premium. The plan reimburses you or your health care provider on the basis of services rendered. You may be required to meet a deductible and pay a percentage of each bill. However, there is also often an annual limit on out-of-pocket expenses, so that once an individual or family reaches the limit, the insurance covers the remaining eligible medical expenses in full. Indemnity plans sometimes impose restrictions on covered services and may require prior authorization for hospital care or other expensive services.
"Basic and Essential" Health Plans
provide limited health insurance benefits at a considerably lower cost. When buying such a plan, it is extremely important to read the policy description carefully because these plans don't cover some basic treatments, such as chemotherapy, certain prescriptions and maternity care. Furthermore, rates vary considerably because, unlike indemnity plans or a managed care option, premiums are community rated and are based on age, gender, health status, occupation or geographic location.
Health Savings Accounts (HSA)
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C. Government-sponsored Health Insurance
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is a federal government program for people 65 and older, or those with certain disabilities, that pays part of the costs associated with hospitalization, surgery, doctors' bills, home health care and skilled-nursing care.
State Children's Health Insurance Program (SCHIP)
is administered at the state level and provides health care to low-income children whose parents do not qualify for Medicaid. SCHIP may be known by different names in different states.
Military Health Care
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State-specific Plans
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Indian Health Service (IHS)
is a Department of Health and Human Services program offering medical assistance to eligible American Indians at HIS facilities. In addition, the HIS helps pay the cost of selected health care services provided at non-HIS facilities.
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With great experience as a Anaheim Realtor and servicing all areas in Orange County, I help both buyers and sellers meet their real estate objectives. I have extensive knowledge of each of the communities located in and around Anaheim, and I will work tirelessly on your behalf to make your next Garden Grove home buying or Westminster home selling experience a pleasant and successful one.
For sellers, it is my commitment to help sell your home or property in a timely fashion while helping you attain the highest possible price for your real estate. If you are interested in receiving a free home valuation, I encourage you to fill out my free home valuation form.
For buyers looking for homes or other real estate opportunities here in Anaheim or other surrounding communities, I will work with you to find your ideal home. I will provide you with all of the necessary tools for finding the right property. From free access to search almost all Orange County area homes, to the ability to fill out My Dream Home Finder Form, everything I can possibly provide will be at your service. In addition, once we've narrowed down what you are looking for, we can begin the home showing process so you can get a closer look at the homes that should be a good fit. I help negotiate the best possible deal for my clients with each and every real estate transaction.
Nothing satisfies me more than seeing the smiles that come with a successful real estate transaction. Thanks again for considering me as your Realtor.


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EL5G13 - Eleganza™ 8wt Egyptian Cotton Royal Blue Thread
EL5G13 - Eleganza™ 8wt Egyptian Cotton Royal Blue Thread
This gorgeous 8wt, 2-ply 100% long staple Egyptian cotton thread is double-gassed and mercerized, resulting in a wonderfully smooth and lustrous surface that allows the thread to glide beautifully through all types of fabrics and fibres. The thread's tight twist creates beautifully firm stitches while its surface sheen produces a luxurious finish to embellishment stitchery. Offered in 200 different colours ranging from saturated solids to subtle tone-on-tone and random dyed contrasting variegates, Eleganza™ is a perfect match for your next hand work or embellishment project.
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Weight: 8wt
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Frequently Asked Questions (FAQs)
1. Is 'Journal of Tourism and Hospitality Management' a refereed journal?
Answer: Yes, Journal of Tourism and Hospitality Management is a fully peer reviewed journal. It follows double blind peer review policy. The journal strictly maintains the academic review policy and publication ethics.
2. Is 'Journal of Tourism and Hospitality Management' an international journal?
Answer: Yes, Journal of Tourism and Hospitality Management is an international journal. Although the journal is published in U.S.A., the journal welcomes the contributions from researcher/academician of all the countries of the world.
3. Does this journal assign DOI?
Answer: Yes. Each paper published in Journal of Tourism and Hospitality Management a DOI®number, which appears beneath the author's affiliation in the published paper. Click HERE to know what is DOI (Digital Object Identifier)? Click HERE to retrieve Digital Object Identifiers (DOIs) for journal articles, books, and chapters.
4. Is the journal published in print?
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5. Is the journal indexed?
Answer: Yes, the journal is abstracted/indexed in: CrossRef, Cabell's, Ulrich's, Griffith Research Online, Google Scholar, Education.edu, Informatics, Universe Digital Library, Standard Periodical Directory,Gale, Open J-Gate, EBSCO, Journal Seek, DRJI, ProQuest, BASE, InfoBase Index, OCLC, IBSS, Academic Journal Databases, Scientific Index.
6. What is E-Publication FirstTM?
Answer: E-Publication FirstTM is a feature offered through our journal platform. It allows PDF version of manuscripts that have been peer reviewed and accepted, to be hosted online prior to their inclusion in a final printed journal. Readers can freely access or cite the article. The accepted papers are published online within one week after the completion of all necessary publishing steps.
7. Is the journal published in USA?
Answer: Yes, the journal is published in USA under the supervision of the Institute's U.S. Center.
8. What is the frequency of the journal?
Answer: The frequency of the journal is semi-annually (2 issues per year).
9. Is there any specific submission deadline?
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10. I want to know more about the review and publication process of the journal.
Answer: View the journal's submission and review policy section.
11. How much time does the journal take for complete review process?
Answer: The complete review process takes maximum two weeks after the acknowledgement of the submission e-mail of the contributor.
12. When my paper will be published after the acceptance of my paper?
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13. When I will get the print copy of the journal?
Answer: The contributor gets the print copy of the journal within four weeks after online publication.
14. Who is the publisher of the journal?
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15. I want to submit a paper to your journal. Does it fall within the scope of the journal?
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Answer: Visit the 'Submission' menu of the journal. If you face any problem, contact with the executive editor at firstname.lastname@example.com
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Answer: Yes. There is a publication fee in the journal. The publication processing fee for a research paper is 220 USD. The author/corresponding author will get one print copy. However, the author may order for additional print copy. The charge for each additional print copy is 30 USD. The publication fee is charged only for accepted paper. The author/corresponding author has to pay the publication as per the method determined by the executive editor. The author will get official receipt of publication fee with proper seal and signature.
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Answer: Copyrights for articles published in the journal are retained by the authors, with first publication rights granted to the journal. The journal/publisher is not responsible for subsequent uses of the work. It is the author's responsibility to bring an infringement action if so desired by the author.
19. Does the journal have plagiarism policy?
Answer: Yes. The editorial board is very strict regarding plagiarism. The journal believes that taking the ideas and work of others without giving them credit is unfair and dishonest. Copying even one sentence from someone else's manuscript, or even one of your own that has previously been published, without proper citation is considered plagiarism-use your own words instead. The editorial board retains the absolute authority to reject the review process of a submitted manuscript if it subject to minor or major plagiarism and even may cancel the publication upon the complaint of victim(s) of plagiarism.
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Answer: Yes. Visit the 'Manuscript Preparation Guidelines' menu of the journal.
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Answer: No, the journal is published in English. But the authors of other languages can submit their papers to International Multilingual Journal of Contemporary Research.
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text:
This page displays sold house prices for Northease Gardens in Hove.
Northease Gardens in Hove BN3 consists predominantly of semi-detached houses. Properties on Northease Gardens typically have values around £350,000 - £450,000, ranging upwards of £450,000 for larger semi-detached houses.
|Detached house, Freehold
|8th August 2007
|Semi-detached house, Freehold
|31st May 2007
|Detached house, Freehold
|20th April 2007
|Semi-detached house, Freehold
|12th December 2013
|Detached house, Freehold
|31st January 2002
|Semi-detached house, Freehold
|29th October 2008
|Semi-detached house, Freehold
|8th February 2002
All sold house price data on Hove Online is provided under license from the Land Registry for England and Wales. We cannot be held responsible for errors or omissions. N.B. Sold prices are reported up to 3 months in arrears from date of house sale so there may be a delay for some sold properties to appear on this site. Data produced by Land Registry © Crown copyright 2023.
Map showing Northease Gardens in Hove.


text:
Call Hartford & Ratliff Co., Inc. for air conditioning repair and replacements, professional air duct cleaning, ventilation problems, and heat pump repair, and seasonal safety inspections. We are your complete Home Air Comfort Specialists.
Call the HVAC Specialists, Hartford & Ratliff Co., Inc. today for high-efficiency air conditioning installations that will keep you and your family in low cost, eco-friendly comfort all year!


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Ohaus Rods, Frames & Supports CLR-UBASEC, Cast Iron
Original price $57.00 - Original price $57.00
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OverviewLabJaws offers the largest selection of Lab-Frame Kits, Lab-Lifts, Rods and Support Stands in the industry to hold glassware safely. Whether you're looking for a standard lab-frame or a customizable set-up, we have options to fit any space or application. Select from 13 pre-configured lab-frame kits (connectors and feet included) to rods which can be purchased individually and combined with LabJaws accessories to build a customized frame.ApplicationsChromatography, Distillation, Titrations, Electrolysis, Chemistry, Research & Development, Quality Control, Ring Stands, Water Baths, Cleanroom Applications, Acid Fume Hood ApplicationsDisplayN/AOperationLab-frame kits include all components necessary to build a lab-frameCommunicationN/AConstructionNickel-plated zinc, stainless steel, fiberglass, aluminum, cast aluminum, anodized aluminum (Stainless steel is autoclavable and corrosion-resistant. Aluminum is lightweight yet strong. Cast iron with black enamel finish is chemical-resistant.)Design FeaturesN/A
Type Support Stand Base Material Cast Iron


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Support the creator and artists fairly and legally.
Listen without limits or ads on the creator channels you support.
More music and stuff from Dan here https://linktr.ee/dan_aux


text: Build an international network There are many ways to network internationally. Not necessarily the semester in "first-rate universities" We generally advise against international travels solely for the purposes of polishing your CV. Mobility should always rank secondary to research output, ideally it should be integrated into a research project in order to generate added value.The SNSF excellence fellowships enable you to spend time at a foreign university and work on parts of your doctoral thesis abroad. Moving to a new location with family and partner might be a little difficult, despite the fact that the SNSF awards partner and child allowances. Attending conferences is a little easer compared to moving overseas. The SAGW and the University of St.Gallen offer financial support. You might want to adopt a strategic approach to planning these opportunities: check the list of participants in advance and think about who you would like to connect with. Do not skip the informal part of the programme, especially if you know you are not a born strategic networker.International networking can also happen at your home university. Maybe there is an opportunity at your institute to organise a conference and get in touch with well-known researchers.


text:
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Sol 1156: Instrument Deployment Camera (IDC)
NASA's InSight Mars lander acquired this image using its robotic arm-mounted, Instrument Deployment Camera (IDC).
This image was acquired on February 26, 2022, Sol 1156 where the local mean solar time for the image exposures was 14:29:15.076 PM. Each IDC image has a field of view of 45 x 45 degrees.
Credits: NASA/JPL-Caltech


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Honey-soaked hot cross buns
The first time I heard of hot cross buns was during a piano lesson. It was early in my (very short) musical career, so I could only play songs that had a few notes all hovering close to middle C. One day, my teacher opened my book to a song called "Hot Cross Buns," and said, "This is easy. I'm sure you can handle this." And I could.
Along with the song being easy to play, the lyrics were also simple:
"Hot cross buns,
Hot cross buns,
One a penny,
Two a penny,
Hot cross buns."
But like most simple yet catchy songs, it stayed in my head and I wasn't satisfied until a few years later when I finally convinced my mom to make them for our family.
Hot cross buns are a sweet roll served at Easter time. Traditionally, they're sold and served on Good Friday (hence the song's lyrics, which chronicle a hot-cross bun transaction in a more-kind economy). My family, however, also ate them also on Easter morning, which is where a bite of one always transports me.
Before we'd go to church, mom would pull out of the oven a pan of these soft buns sprinkled with raisins and cinnamon. After letting them cool for a few minutes, she'd cross the tops with icing and then we'd grab them while they were still warm to the touch.
I'm kind of a fallen Episcopalian, but I still enjoy following the liturgical calendar and observing some of the traditions that accompany each celebration. Of course, hot cross buns can't be found in the Bible or the Book of Common Prayer, but nonetheless, eating them makes me feel like I'm observing Easter the way that I was raised.
Here is my mom's recipe for hot cross buns. They appear to be a holdover from her granola days when sugar was bad but honey was healthy. No matter, the honey makes them sweet, sticky and soft.
Of course, you don't have to be a Christian to enjoy hot cross buns. There's evidence that these buns hark back to pagan times, but no matter your religious affiliation, you will agree that hot cross buns are indeed heavenly.
Honey-soaked hot cross buns
Ingredients for the buns:
- 1 package dry yeast
- 1/4 cup warm water, plus 2 tablespoons
- 3/4 cup milk
- ½ cup unsalted butter
- 2 tablespoons of honey, plus more for glazing
- 1 teaspoon kosher salt
- ½ teaspoon ground cinnamon
- ½ teaspoon ground nutmeg
- 3 eggs
- 2/3 cup raisins or currants
- 4 cups all-purpose flour, plus more if needed
Ingredients for the frosting:
- 1 cup confectioner sugar
- 2 tablespoons water
- 1 tablespoon honey
- Combine the dry yeast and warm water.Warm over low the milk, butter, salt, and 2 tablespoons of honey until the butter has melted. (Do not let it come to a boil!) Add to the yeast mixture.Whisk in cinnamon, nutmeg, and eggs into the mixture. Add the raisins and slowly stir in the flour, 1 cup at a time.Knead on a lightly floured surface for 5 minutes until the dough is smooth and resilient.Let rise covered in greased bowl until double.Then punch down the dough and divide into 24 balls and place, sides touching, in a greased and floured 9x13 pan and let rise again. With a sharp knife, cut crosses into each bun.Bake at 375° F for 15 minutes.
Glaze with honey (as much or as little as you like) and bake 5 minutes more. Meanwhile, stir together the confectioner sugar, the honey and the two tablespoons of water to make the frosting. When you take the buns out of the oven, cool for 10 minutes, then cross each bun with the frosting.


text:
Urethral Sling Surgery for Stress Incontinence: Before Your Surgery
Current as of: June 16, 2022
Author: Healthwise Staff
Medical Review:Kara C. Taggart MD - Urology
If you or someone you know is experiencing a mental health crisis, call 988 for 24/7 free and confidential crisis support. You do not have to be suicidal to call. Access more info and resources on suicide prevention, emotional and mental health support.
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Current as of: June 16, 2022
Author: Healthwise Staff
Medical Review:Kara C. Taggart MD - Urology
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text:
You are here
Export 10 results:Author [ Title] Type Year
Filters: Author is B. Siciliano [Clear All Filters]
"Visual-servoed parking with limited view angle", in Experimental Robotics VIII, vol. 5, Springer Verlag, 2002, pp. 254-263. [PDF] (220.16 KB),
"Visual appearance mapping for optimal vision based servoing", vol. 54 - Experimental Robotics, Springer, 2009, pp. 353 - 362. [PDF] (1.14 MB),
"Variable Stiffness Actuators for Fast and Safe Motion Control", in Proceedings of the International Symposium on Robotics Research, Springer Verlag, 2003. [PDF] (451.75 KB),
"Safe and Dependable Physical Human-Robot Interaction in Anthropic Domains: State of the Art and Challenges", in Proc. IROS'06 Workshop on pHRI - Physical Human-Robot Interaction in Anthropic Domains, 2006.,
"Robotic Grasping and Manipulation", in Ramsete: Articulated and mobile robots for services and Technology, vol. 270, Berlin Heidelberg, Germany: Springer-Verlag, 2001, pp. 55-74. [PDF] (154.11 KB),
"Robotic Dexterity via Nonholonomy", in Control Problems in Robotics and Automation, Berlin Heidelberg, Germany: Springer Verlag, 1997, pp. 35-49. [PDF] (673.81 KB),
Ramsete: Articulated and mobile robots for services and Technology, vol. 270. Berlin Heidelberg, Germany: Springer-Verlag, 2001 [Online]. Available: http://www.springer.com/?SGWID=6-102-0-0-0,
"On The Problem of Simultaneous Localization, Map Building, and Servoing of Autonomous Vehicles", in Advances in Control of Articulated and Mobile Robots, Springer Verlag, 2004, pp. 223-239. [PDF] (332.91 KB),
"Physical Human-Robot Interaction in Anthropic Domains: Safety and Dependability", in Proc. 4th IARP/IEEE-EURON Workshop on Technical Challenges for Dependable Robots in Human Environments, 2005. [PDF] (322.19 KB),
"An atlas of physical human-robot interaction", Mechanism and Machine Theory, vol. 43, pp. 253-270, 2007. [PDF] (249.19 KB),


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NEW YORK (AP) — Fox will cut "American Idol" to one night for several weeks next spring, part of a reset for a struggling network that will have 11 new series in the coming year including the much-awaited "Batman" prequel "Gotham."
The network will also break up its Sunday animation block by moving in the critical favorite "Brooklyn Nine Nine." It is replacing two of its Tuesday-night comedies with an unscripted show that imagines people setting up a new society in an undeveloped area.
Fox entertainment chief Kevin Reilly said the network plans some 37 hours of "American Idol" content next winter and spring compared with the 50-plus hours that have been running for years. After the initial auditions, the series will probably air a two-hour show once a week. The show's decline from television's biggest phenomenon to just another moderately successful series, combined with a failure to mint new hits, made this season a tough one for Fox.
"'Idol' is not going to come back to be the ratings champion it once was," Reilly said Monday. "But we believe the show can be on for many years to come."
He compared it to CBS' "Survivor," once a sensation but now a dependable, mid-level hit — coincidentally one that frequently beats "Idol" in the ratings.
The "Idol" decline meant fewer people tuning in live to Fox. With network TV's youngest audience, Fox is also hit harder than its rivals in the switch to other forms of viewing that doesn't show up in traditional overnight Nielsen ratings — streaming online, DVR usage and video on demand, Reilly said.
Five of Fox's new series already have a place on Fox's fall schedule, with the rest to come later in the season. "Gotham" has the biggest buzz — Fox says a trailer online has already been seen 6 million times — and will air Monday nights. It follows a 12-year-old future caped crusader in a city teeming with crime. Although Jada Pinkett Smith will play a new character, crime boss Fish Mooney, most of the show's characters will be familiar to followers of the comic book series.
The unscripted "Utopia" will air two episodes a week in the fall, on Tuesdays and Fridays.
Other new series to premiere in the fall are the youthful soap "Red Band Society," a 10-episode series "Gracepoint," based on the British drama "Broadchurch," and "Mulaney," starring John Mulaney as a struggling standup comic.
Fox is canceling "Enlisted," ''Dads," ''Rake" and "Surviving Jack," ''Almost Human" and "The X-Factor."


text:
Intuit QuickBooks Enterprise Cost
How much does it cost to purchase and implement Intuit QuickBooks Enterprise?
What is the break-down cost of licenses, maintenance and support, installation, customization, data migration and training?
Here is the real break down cost of Intuit QuickBooks Enterprise implementation:
Intuit QuickBooks Enterprise License cost:
Intuit QuickBooks Enterprise pricing is largely based on the per user per month subscription model. The company offers three separate editions:
- The Simple Start plan cost $12 per month
- The Essentials plan cost $17.50 per month
- The Plus plan cost $21 per month
Customization cost:
Customization cost is significantly more complex to calculate than licensing cost as it depends on functional requirements and specific needs. Here are few key items that effect customization cost:
- Data elements you need to track and present with a dashboard/reports.
- Dashboard, management and operational reports that are needed.
- Workflows and how complex they are.
- Forms to collect additional data.
- User Interface changes.
Data migration cost:
Data migration cost derived from your current software, amount of data, complexity of data, availability of data migration tools and gaps between your current system and you new system. Migrating from excel spreadsheets can also cost a lot of time and money.
Training cost:
Training cost derived from the training approach that you select for your organization:
- End-user training.
- Group/Department training.
- Video /self training.
- Train the trainer approach.
Other implementation cost?
You are welcome to add additional cost to assist the IT community when trying to evaluate the real cost of Intuit QuickBooks Enterprise implementation.
Intuit QuickBooks Enterprise Vs. Alternatives
/per bid event
- Small Business
- Mid-Size Business
/ per year
- Small Business
- Mid-Size Business
/per license
- Small Business
- Mid-Size Business
- Large Enterprises


text:
October 8, 2022 4:32 pm by
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Carnatic Chamber Concerts (CCC) is dedicated to the Bay Area's youth pursuing Carnatic music. CCC provides an encouraging platform for monthly performances and currently supports about 350+ music students of varying levels from many different schools.
CCC is a registered 501 (c)(3) non profit organization (Tax id: 47-2547362)
2023 © All Rights Reserved.
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Research Highlights
Found 6 resultsAuthor [ Title] Type Year
Filters: Author is Levin, I. [Clear All Filters]
A 60 yr record of atmospheric carbon monoxide reconstructed from Greenland firn air." Atmospheric Chemistry and Physics 13, no. 15 (2013): 7567-7585."
Comparisons of continuous atmospheric CH₄, CO₂ and N₂O measurements – results from a travelling instrument campaign at Mace Head." Atmos. Chem. Phys. 14, no. 16 (2014): 8403-8418."
Gas transport in firn: multiple-tracer characterisation and model intercomparison for NEEM, Northern Greenland." Atmospheric Chemistry and Physics 12, no. 9 (2012): 4259-4277."
The global SF6 source inferred from long-term high precision atmospheric measurements and its comparison with emission inventories." Atmos. Chem. Phys. 10, no. 6 (2010): 2655-2662."
A new estimation of the recent tropospheric molecular hydrogen budget using atmospheric observations and variational inversion." Atmos. Chem. Phys. 11, no. 7 (2011): 3375-3392."
Results from the International Halocarbons in Air Comparison Experiment (IHALACE)." Atmospheric Measurement Techniques 7, no. 2 (2014): 469-490."


text:
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You will be following company rules and duties per your positions. You will be supervised by necessary staffs during your training period.
Work Location : Germany
Company Name : Confidential
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Employment Type : Full Time
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Experience Level = Min. six months work experience required for the job.
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text: Last Day of Classes for Seniors Event details:Start dateJune 4, 2020End dateJune 4, 2020CalendarGoogle Calendar iCal feed URL https://www.bishopludden.org/?rhc_action=get_icalendar_events&ID=4516 Get Feed for iCal (Google Calendar). This is for subscribing to the events in the Calendar. Add this URL to either iCal (Mac) or Google Calendar, or any other calendar that supports iCal Feed. Download ICS file Organizer details:OrganizerVenue DetailsVenueInformation


text:
Study partner issue is included as a reason for discontinuation because of the requirement for a study partner to participate in several of the key outcome measures in this trial (eg, Clinical Dementia Rating sum of boxes, ADCS activities of daily living, and Neuropsychiatric Inventory). There were no significant differences in incidence of dropout, adverse events, or serious adverse events (Table 2).aThere could be more than 1 reason for exclusion or study discontinuation.
All randomized participants were included in these intention-to-treat analyses. Error bars indicate 95% confidence intervals. There was no effect of DHA on rate of cognitive change on the Alzheimer's Disease Assessment Scale (ADAS; linear mixed-effects model: P = .41), Clinical Dementia Rating (CDR) sum of boxes (linear mixed-effects model: P = .68), ADCS activities of daily living scale (linear mixed-effects model: P = .38), or Neuropsychiatric Inventory (NPI; linear mixed-effects model: P = .11). Scores for the ADAS-cog and CDR sum of boxes were the prespecified primary outcome measures; others were secondary outcomes.
Error bars indicate 95% confidence intervals. The linear mixed-effects analysis finds no effect of docosahexaenoic acid (DHA) on the rate of ADAS-cog change in APOE ε4–positive participants but when the analysis is confined to APOE ε4-negative participants, the rate of change in ADAS-cog is slower in participants treated with DHA than in participants treated with placebo (linear mixed-effects model: P = .03). There was no evidence of a DHA effect on Clinical Dementia Rating sum of boxes, Alzheimer's Disease Cooperative Study activities of daily living, or Neuropsychiatric Inventory on rates of brain atrophy (see "Results" section).
Customize your JAMA Network experience by selecting one or more topics from the list below.
Quinn JF, Raman R, Thomas RG, et al. Docosahexaenoic Acid Supplementation and Cognitive Decline in Alzheimer Disease: A Randomized Trial. JAMA. 2010;304(17):1903–1911. doi:10.1001/jama.2010.1510
© 2023
Author Affiliations: Department of Neurology, Oregon Health and Science University, Portland (Drs Quinn and Shinto); Department of Neurosciences, University of California, San Diego (Drs Raman, Thomas, and Aisen, and Ms Emond); Martek Biosciences, Columbia, Maryland (Drs Yurko-Mauro and Nelson); Department of Psychiatry, Yale University, New Haven, Connecticut (Dr Van Dyck); Department of Neurology, School of Medicine, New York University, New York (Dr Galvin); Mayo Clinic, Rochester, Minnesota (Dr Jack); and Department of Radiology, University of California, San Francisco (Dr Weiner).
Context Docosahexaenoic acid (DHA) is the most abundant long-chain polyunsaturated fatty acid in the brain. Epidemiological studies suggest that consumption of DHA is associated with a reduced incidence of Alzheimer disease. Animal studies demonstrate that oral intake of DHA reduces Alzheimer-like brain pathology.
Objective To determine if supplementation with DHA slows cognitive and functional decline in individuals with Alzheimer disease.
Design, Setting, and Patients A randomized, double-blind, placebo-controlled trial of DHA supplementation in individuals with mild to moderate Alzheimer disease (Mini-Mental State Examination scores, 14-26) was conducted between November 2007 and May 2009 at 51 US clinical research sites of the Alzheimer's Disease Cooperative Study.
Intervention Participants were randomly assigned to algal DHA at a dose of 2 g/d or to identical placebo (60% were assigned to DHA and 40% were assigned to placebo). Duration of treatment was 18 months.
Main Outcome Measures Change in the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog) and change in the Clinical Dementia Rating (CDR) sum of boxes. Rate of brain atrophy was also determined by volumetric magnetic resonance imaging in a subsample of participants (n = 102).
Results A total of 402 individuals were randomized and a total of 295 participants completed the trial while taking study medication (DHA: 171; placebo: 124). Supplementation with DHA had no beneficial effect on rate of change on ADAS-cog score, which increased by a mean of 7.98 points (95% confidence interval [CI], 6.51-9.45 points) for the DHA group during 18 months vs 8.27 points (95% CI, 6.72-9.82 points) for the placebo group (linear mixed-effects model: P = .41). The CDR sum of boxes score increased by 2.87 points (95% CI, 2.44-3.30 points) for the DHA group during 18 months compared with 2.93 points (95% CI, 2.44-3.42 points) for the placebo group (linear mixed-effects model: P = .68). In the subpopulation of participants (DHA: 53; placebo: 49), the rate of brain atrophy was not affected by treatment with DHA. Individuals in the DHA group had a mean decline in total brain volume of 24.7 cm3 (95% CI, 21.4-28.0 cm3) during 18 months and a 1.32% (95% CI, 1.14%-1.50%) volume decline per year compared with 24.0 cm3 (95% CI, 20-28 cm3) for the placebo group during 18 months and a 1.29% (95% CI, 1.07%-1.51%) volume decline per year (P = .79).
Conclusion Supplementation with DHA compared with placebo did not slow the rate of cognitive and functional decline in patients with mild to moderate Alzheimer disease.
Trial Registration clinicaltrials.gov Identifier: NCT00440050
Docosahexaenoic acid (DHA) is an omega-3 fatty acid identified as a potential treatment for Alzheimer disease. Epidemiological studies have shown that omega-3 fatty acid consumption reduces Alzheimer disease risk and DHA modifies the expression of Alzheimer-like brain pathology in mouse models.
Several studies have found that consumption of fish, the primary dietary source of omega-3 fatty acids, is associated with a reduced risk of cognitive decline or dementia.1-6 Some studies have found that consumption of DHA, but not other omega-3 fatty acids, is associated with a reduced risk of Alzheimer disease.3 Studies of plasma fatty acids have confirmed the dietary studies, finding that plasma levels of omega-3 fatty acids, and especially DHA, are associated with a reduced risk of Alzheimer disease.7,8 The most abundant long-chain polyunsaturated fatty acid in the brain, DHA is enriched in synaptic fractions and is reduced in the brains of patients with Alzheimer disease.9,10 The other major omega-3 fatty acid found in fish, eicosapentaenoic acid, is virtually absent from the brain.
These findings motivated researchers to conduct animal studies that used DHA, rather than mixed omega-3 fatty acids, for intervention studies aimed at reducing Alzheimer disease brain pathology in transgenic mouse models. In mutant amyloid precursor protein (APP) Tg2576 mice, DHA supplementation reduced amyloid β pathology11 as well as the neuritic damage associated with amyloid β plaques.12 In mice carrying 3 mutant transgenes (App, Ps1, Tau) associated with Alzheimer disease pathology, DHA supplementation reduced both amyloid β and tau pathology.13
The plausibility of effective intervention with DHA in humans is further supported by evidence that brain levels of DHA vary with dietary intake, and that the average daily intake of DHA in the US diet is approximately 70 mg,14 which is considerably below the levels noted to be protective in epidemiological studies. Based on all of these considerations, we hypothesized that DHA supplementation would slow the rate of cognitive and functional decline in individuals with Alzheimer disease.
This randomized, double-blind, placebo-controlled trial was conducted by the Alzheimer's Disease Cooperative Study (ADCS), a consortium of academic medical centers and private Alzheimer disease clinics funded by the National Institute on Aging to conduct clinical trials on Alzheimer disease. Fifty-one US centers participated in this trial after obtaining approval from their local institutional review boards. Written informed consent was obtained from study participants, legally authorized representatives, or both, according to local guidelines.
Individuals with probable Alzheimer disease, recruited from the sites' clinic populations, were eligible if (1) their Mini-Mental State Examination (MMSE) score was between 14 and 26, (2) they were medically stable, (3) they consumed on average no more than 200 mg/d of DHA (as assessed by a brief 7-item food frequency questionnaire), and (4) they were not taking DHA or omega-3 fatty acid supplements. Individuals were excluded if they were taking drugs with central anticholinergic effects or sedatives or were receiving any investigational treatment for Alzheimer disease. Stable use (≥3 months) of cholinesterase inhibitors or memantine was permitted.
Randomization was achieved with a centralized interactive voice response system, using a block design with a block size of 5 (3 in the DHA group and 2 in the placebo group). The disproportionate enrollment in the treatment group was intended to enhance recruitment. The treatment period was 18 months. Visits were scheduled every 3 months, with adverse event assessments and pill counts to assess adherence at every visit.
The study drug was an algal-derived DHA (Martek Biosciences, Columbia, Maryland) administered as capsules, dosed as 1 g twice per day for a total daily dose of 2 g. Algal DHA contains approximately 45% to 55% of DHA by weight and does not contain eicosapentaenoic acid. The DHA dose was selected based on evidence that plasma levels increase in a dose-dependent manner up to approximately 2 g/d, while at higher doses no further increase in plasma DHA is seen.15 Placebo capsules (made up of corn or soy oil) were identical in appearance. The adequacy of blinding was assessed by questionnaires completed by caregivers, study coordinators, and site physicians.
The 2 co-primary outcome measures were the rate of change over 18 months on the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog)16 and on the Clinical Dementia Rating (CDR) sum of boxes.17 The ADAS-cog is a 70-point scale that evaluates memory, attention, language, orientation, and praxis, with higher scores indicating greater impairment. The CDR sum of boxes is a global measure assessing memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care.
Secondary outcome measures included change in scores on the MMSE,18 the ADCS's activities of daily living (ADCS-ADL) scale,19 the Neuropsychiatric Inventory (NPI),20 and the Quality of Life Alzheimer's Disease scale.21 All outcome measures were obtained at baseline, 6 months, 12 months, and 18 months with the exception of the MMSE, which was obtained at baseline and at 18 months.
Subpopulations participated in studies of brain imaging (DHA: 53; placebo: 49) and cerebrospinal fluid (DHA: 29; placebo: 15) markers. In those participants, brain magnetic resonance imaging (MRI) or cerebrospinal fluid collection occurred at baseline and at the 18-month visit. The subpopulation was selected as follows: all participants without contraindication to MRI (eg, pacemaker) who were enrolled at trial sites that were also certified Alzheimer's Disease Neuroimaging Initiative (ADNI) sites were invited (but not required) to participate in the MRI substudy. The MRI sequence, as well as methods for across-site standardization and quality control, were those used in the ADNI study.22 The methods of the ADNI study were used to generate brain volumes at baseline and 18 months, which were then used to generate rates of total brain atrophy, hippocampal atrophy, and ventricular enlargement. All participants without contraindication to cerebrospinal fluid examination (eg, anticoagulation) were invited to participate in the cerebrospinal fluid study. In these individuals, lumbar puncture was performed in the morning after an overnight fast.
In the fatty acid analysis for plasma and cerebrospinal fluid, plasma phospholipid fatty acid levels were determined using established methods,23,24 with modifications for cerebrospinal fluid analysis. The fatty acid profiles were expressed as a percentage of the total micrograms of fatty acid (weight percentage).
The primary aim of the statistical analysis was to determine if the rate of cognitive and functional decline differed between participants treated with DHA and participants randomized to placebo. The primary analysis was conducted using linear mixed-effects regression models to assess group differences in rate of change on ADAS-cog and CDR sum of boxes over 18 months. In addition, generalized estimating equations and analysis of covariance (ANCOVA) models were used in sensitivity analyses.
Power calculations were based in part on analysis of ADAS-cog total score data from the ADCS nonsteroidal anti-inflammatory drugs trial (ADCS-NSAID).25 An estimated decline of 3.8 ADAS-cog points per year in the placebo group (ie, 66% of the observed rate in the ADCS-NSAID) was used for the power analysis. Assuming a 20% annual attrition rate and a 10% annual drop-in rate evenly dispersed along an 18-month treatment period, and an α level of .05, a sample size of 240 for active treatment and 160 for placebo provides 80% power to detect a 33% reduction in the rate of ADAS-cog decline. Power analysis was also performed for the co-primary outcome measure, the CDR sum of boxes, and was also based on the rates of change seen in the ADCS-NSAID trial. Assuming an annual rate of change of 1.47 points per year on the CDR sum of boxes (66% of that seen in the ADCS-NSAID), a sample size of 240 for active treatment and 160 for the placebo group provides 80% power to detect a 32% or larger reduction in the rate of decline in the CDR sum of boxes.
The primary analysis was an intent-to-treat analysis including all randomized participants. That is, participants were analyzed in the group to which they were randomized, regardless of medication adherence. All available assessments for ADAS-cog and CDR sum of boxes were used in the analysis for individuals who discontinued medication. A secondary per-protocol analysis was also performed on all randomized individuals who completed the study (18 months) and ingested at least 80% of the protocol-prescribed study medication as measured by pill count. The linear mixed-effects and generalized estimating equation models do not require imputation of missing data. Multiple imputation26 was used to impute 18-month values for the ANCOVA analyses.
A list of covariates anticipated to be associated with rate of decline on ADAS-cog score, CDR sum of boxes, or both was compiled before study initiation. This list consisted of baseline age, baseline MMSE score, baseline plasma phospholipid DHA level, duration of Alzheimer disease, education level, and apolipoprotein E (APOE) genotype. Each variable was to be included as a covariate in the linear mixed-effects model if both a univariate 2-sample test showed a significant difference in the variable between treatment groups at the α level of .10, and a bivariate measure of association showed a significant association between the variable and the rate of change on the outcome measure at the α level of .15. For the primary analysis, baseline MMSE score was found to be unbalanced between groups and associated with the rates of change in scores on the ADAS-cog and CDR sum of boxes, and was therefore included in the model as a covariate in the analysis of these co-primary outcome measures. Although it was not prespecified as a candidate covariate, sex was also found to be both unbalanced between groups and associated with rate of change on the primary outcome measures, prompting an ad hoc analysis including both sex and MMSE score as covariates.
Several exploratory analyses were specified in the analysis plan prior to study initiation. One was an analysis of the effect of DHA on rate of progression in participants with higher and lower baseline MMSE scores, with the groups divided at the median MMSE score. The second was an analysis of the effect of DHA supplementation on rate of progression among APOE ε4 allele carriers and noncarriers. These exploratory analyses also used linear mixed-effects modeling in both intent-to-treat and per-protocol populations, with the same rules for including covariates.
Statistical software R version 2.7.027 was used for all statistical analyses. For the primary hypothesis, the analysis was duplicated by using SAS version 9 (SAS Institute Inc, Cary, North Carolina) for verification purposes. The significance level was set at a P value of less than .05. All statistical testing was 2-sided.
Participants were recruited between February and November 2007. Clinical activity was completed in May 2009 and the database was locked in June 2009. The flow of study participants is shown in Figure 1. Of 555 individuals screened, 402 met the study criteria and were randomized, 238 to DHA and 164 to placebo. Only sex and baseline MMSE differed between the DHA and placebo-treated populations at a P value of less than .10 (Table 1). Over the course of 18 months, 67 participants in the DHA group (28%) and 40 participants in the placebo group (24%) discontinued taking the study drug, with the minority discontinuing due to adverse events (Figure 1).
As expected, plasma phospholipid DHA increased in the DHA treatment group from 3.18 weight percentage at baseline to 9.80 weight percentage at 6 months, 10.20 weight percentage at 12 months, and 9.82 weight percentage at 18 months (207% increase, P < .001) with no significant change in plasma phospholipid DHA in the placebo group (3.13 weight percentage at baseline and 3.12 weight percentage at 18 months). In a subgroup of 44 participants volunteering for cerebrospinal fluid collection at baseline and 18 months (DHA group: 29; placebo group: 15), a significant 38% increase in cerebrospinal fluid DHA was observed in the DHA group (2.53 weight percentage at baseline and 3.46 weight percentage at 18 months; P < .001) but not in the placebo group (2.50 weight percentage at baseline and 2.17 weight percentage at 18 months; P = .79). Seventy-three participants provided cerebrospinal fluid at baseline but 24 declined or had dropped out by 18 months.
The effect of DHA treatment on the primary and secondary clinical outcome measures is shown in Figure 2. For the primary linear mixed-effects analysis of the rate of change of ADAS-cog and CDR sum of boxes, baseline MMSE score was the only covariate qualifying for inclusion in the model. The rate of mean change in ADAS-cog score over 18 months was 8.27 points (95% confidence interval [CI], 6.72-9.82 points) for the placebo group compared with 7.98 points (95% CI, 6.51-9.45 points) for the DHA group (linear mixed-effects model: P = .41; Figure 2A). The rate of points change on CDR sum of boxes over 18 months was 2.93 (95% CI, 2.44-3.42) for the placebo group compared with 2.87 (95% CI, 2.44-3.30) for the DHA group (linear mixed-effects model: P = .68; Figure 2B). The ad hoc linear mixed-effects analyses including both sex and baseline MMSE score as covariates also did not show a benefit of treatment with DHA on the ADAS-cog (P = .61), CDR sum of boxes (P = .69), or ADCS-ADL (P = .38). Confirmatory generalized estimating equations and ANCOVA analyses did not show a benefit of treatment with DHA.
The linear mixed-effects analysis revealed a rate of decline on the ADCS-ADL of 11.51 (95% CI, 9.57 to 13.45) points change over 18 months for the DHA group compared with the points change of 10.43 (95% CI, 8.41 to 12.45) for the placebo group (linear mixed-effects model: P = .38; Figure 2C). The NPI changed by 2.93 points (95% CI, 0.92 to 4.94 points) over 18 months for the DHA group compared with 5.09 points (95% CI, 2.49 to 7.69 points) for the placebo group (linear mixed-effects model: P = .11; Figure 2D). An ANCOVA analysis showed no change in MMSE score from baseline to 18 months (−3.70 [95% CI, −4.44 to −2.96] points change over 18 months for the DHA group compared with −4.04 [95% CI, −4.85 to −3.23] points change for the placebo group; P = .88).
Among the individuals participating in the MRI substudy (170 had an MRI at baseline and 102 had MRIs at baseline and 18 months [DHA group: 53; placebo group: 49]), an ANCOVA analysis showed no evidence of an effect of DHA treatment on the absolute amount of volume change during 18 months for total brain volume decline (24.7 cm3 [95% CI, 21.4-28.0 cm3] and volume decline of 1.32% [95% CI, 1.14%-1.50%] for the DHA group vs 24.0 cm3 [95% CI, 20-28 cm3] and volume decline of 1.29% [95% CI, 1.07%-1.51%] in the placebo group; P = .79), left hippocampus (141 mm3 [95% CI, 112-170 mm3] in the DHA group vs 175 mm3 [95% CI, 134-216 mm3] in the placebo group; P = .17), right hippocampus (176 mm3 [95% CI, 139-211 mm3] in the DHA group vs 148 mm3 [95% CI, 115-181 mm3] in the placebo group; P = .29), or in total ventricular volume (9.1 cm3 [95% CI, 7.7-10.4 cm3] in the DHA group vs 8.1 cm3 [95% CI, 6.4-9.8 cm3] in the placebo group; P = .55).
In a per-protocol analysis, an identical analysis was performed on only randomized participants who completed the study and ingested at least 80% of study medication. Per-protocol results did not significantly differ from the intent-to-treat results (eTable 1).
The proportion of individuals with at least 1 adverse event, serious adverse event, hospitalization, and death were similar in the active and placebo groups (Table 2). During the blinded phase of the trial, the data and safety monitoring board noted that 3 individuals taking warfarin (of a total of 32 participants taking warfarin at the time of randomization) reported subtherapeutic international normalized ratio (INR) after initiating study drug, and the protocol was revised to require monthly INR testing, which was reported to the medical monitor for all participants taking warfarin for the duration of the trial.
No further cases of study drug–associated INR instability were noted. After unblinding, all 3 participants with an adverse event of decreased INR were found to be receiving active DHA. There was also a single adverse event of increased INR in the placebo group.
The data and safety monitoring board also noted during the blinded phase of the trial that thrombotic events were occurring at a rate higher than expected overall, and such events were monitored closely during the trial. After unblinding, there was no significant difference between treatment and placebo in the incidence of thrombotic events (Table 2).
When asked to guess treatment assignment for each participant at the final study visit, the majority of study partners (48.5%), study coordinators (50%), and site physicians (59.2%) responded "do not know." The proportion correctly guessing the active DHA group was not significantly different for the study partner (22.3% for DHA and 26.4% for placebo; P = .49) or study coordinator (27.1% for DHA and 18.4% for placebo; P = .13), but site physicians were more likely to guess that participants in the DHA group were receiving treatment (21.9% for DHA and 11.3% for placebo; P = .02). The reasons for the ratings (adverse events, perceived efficacy, etc) were not captured.
The planned subgroup analyses were intent-to-treat analyses. Based on a hypothesis that the individuals with the mildest dementia severity at baseline would benefit the most from DHA supplementation, a prespecified analysis of 2 subgroups divided by baseline dementia severity, using the median MMSE score of 21 as the cut point, found no effect of DHA treatment on rate of progression in either the high score (>21) or low score (≤21) MMSE group. Analysis of subgroups of participants divided by global CDR also failed to show evidence of DHA treatment effects in the most mildly impaired participants (eTable 2).
The statistical analysis plan also called for subgroup analyses of populations with and without the APOE ε4 allele. While there was no DHA treatment effect on any outcome measure in the APOE ε4–positive group (eTable 2), those receiving DHA in the APOE ε4–negative group had a significantly lower decline in mean change in ADAS-cog score over 18 months (6.23 points [95% CI, 4.08 to 8.38 points] for 61 participants in the DHA group vs 10.11 points [95% CI, 7.12 to 13.10 points] for 48 participants in the placebo group; linear mixed-effects model: P = .03) (Figure 3). This differential DHA effect was also evident for the MMSE score (−3.36 [95% CI, 2.16 to 4.56] in the DHA group vs −5.12 [95% CI, 3.70 to 6.54] in the placebo group; P = .03), but was not present on the CDR sum of boxes, the ADCS-ADL, or the NPI (eTable 2). An effect of DHA was not seen on rates of brain atrophy among individuals who were APOE ε4–negative and participating in the MRI substudy (DHA group: 21; placebo group: 17).
This study was designed to determine if supplementation with DHA would slow the rate of cognitive and functional decline in patients with mild to moderate Alzheimer disease. Despite enrollment of the target population of individuals with low baseline DHA, increase of plasma phospholipid and cerebrospinal fluid DHA in the group treated with DHA, and ample progression of randomized participants on the primary outcome measures, there was no evidence of benefit of DHA supplementation in this population. In the subgroup of participants with paired MRI scans, DHA had no effect on change in volume of hippocampus, whole brain, or ventricles. The hypothesis that DHA slows the progression of mild to moderate Alzheimer disease was not supported, so there is no basis for recommending DHA supplementation for patients with Alzheimer disease.
A large proportion of randomized participants (28% of the DHA group and 24% of the placebo group) did not complete the study. This attrition rate is within the spectrum seen in recent 18-month trials for Alzheimer disease, higher than seen in a study of homocysteine-lowering B vitamins,28 but lower than reported with tarenflurbil.29 Because a minority of participants cited adverse events as the reason for dropping out, we hypothesize that the dropout rate was driven by the perception of lack of efficacy. For future studies of similar therapies intended to slow the rate of decline rather than result in perceptible symptomatic effects, it may be important to temper the expectations of participants or run the risk of a dropout rate that may limit the ability to generalize study results.
However, because the dropout rate was only modestly greater than anticipated in the statistical analysis plan, and because the rate was not significantly different between the 2 groups in this study, the findings in the overall study population appear to be reliable. Some caution must be exercised, however, in interpreting the parallel results from the MRI substudy. This subpopulation represents a convenience sample, relying on participant volunteerism and site expertise rather than random selection to guide enrollment. A previous analysis has shown that this MRI subpopulation at baseline did not significantly differ from the total study population,30 and the MRI outcomes are consistent with the clinical outcomes of the trial, but it is still important to note that the MRI study population is not a statistical sample of the overall study population.
Because part of the rationale for the trial was epidemiological evidence that DHA use before disease onset modifies the risk of Alzheimer disease, it remains possible that an intervention with DHA might be more effective if initiated earlier in the course of the disease in patients who do not have overt dementia. Although the analysis in this study of the subpopulation of participants with baseline MMSE scores of greater than 20 failed to provide support for this hypothesis, other studies have reported post hoc analyses showing positive omega-3 fatty acid treatment effects in less impaired individuals, with MMSE scores of 27 through 30.31 However, clinical trials of omega-3 fatty acids in healthy elderly individuals have failed to show cognitive benefits within 6 months (Mental Health in Elderly Maintained with Omega-3 [MEMO] study, n = 302)32 to 2 years (Older People and n-3 Long-Chain Polyunsaturated Fatty Acids [OPAL] study, n = 867)33 of treatment. Because these healthy elderly individuals do not experience significant cognitive decline in this time frame, however, the absence of a cognitive effect does not exclude the possibility of a neuroprotective effect of DHA in individuals at risk of decline. Individuals intermediate between healthy aging and dementia, such as those with mild cognitive impairment, might derive benefit from DHA supplementation, although further study will be necessary to test this hypothesis.
The propensity of DHA to be oxidized may also be considered in interpreting these results. Some have suggested that increased oxidative burden is a risk in DHA supplementation studies34 but most studies have not supported this theoretical risk,35,36 and there is no evidence that DHA treatment had an adverse effect in this trial. However, in one small study of DHA with and without a co-administered antioxidant (lutein), unimpaired elderly participants randomized to combined DHA plus antioxidant derived greater benefit on selected cognitive outcome measures than participants receiving DHA alone or placebo,37 providing support for the hypothesis that the clinical benefit of DHA supplementation may depend on the availability of circulating antioxidants to protect the DHA from oxidation after ingestion.
In an exploratory analysis, we found that APOE ε4–negative participants who received DHA supplementation showed a benefit on the ADAS-cog and MMSE. However, the significance testing was not adjusted for multiple comparisons. Furthermore, the apparent treatment effect in APOE ε4–negative participants was not seen on the CDR sum of boxes, ADCS-ADL, NPI, or brain atrophy, weakening the interpretation that this effect is clinically meaningful. On the other hand, several epidemiological studies indicate that a protective effect of omega-3 fatty acids with respect to dementia may be confined to APOE ε4–negative individuals,38-40 so an APOE genotype–specific effect is plausible. Confirmation of our exploratory findings in an independent randomized controlled study would be necessary to infer a beneficial effect of DHA in APOE ε4–negative individuals with Alzheimer disease.
In summary, these results indicate that DHA supplementation is not useful for the population of individuals with mild to moderate Alzheimer disease.
Corresponding Author: Joseph F. Quinn, MD, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, CR-131, Portland, OR 97239 (firstname.lastname@example.com).
Author Contributions: Dr Quinn had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Quinn, Yurko-Mauro, Nelson, Weiner, Shinto, Aisen.
Acquisition of data: Quinn, van Dyck, Galvin, Weiner, Aisen.
Analysis and interpretation of data: Quinn, Raman, Thomas, Nelson, van Dyck, Emond, Jack, Weiner, Aisen.
Drafting of the manuscript: Quinn, Raman, Galvin, Emond.
Critical revision of the manuscript for important intellectual content: Quinn, Raman, Thomas, Yurko-Mauro, Nelson, van Dyck, Galvin, Jack, Weiner, Shinto, Aisen.
Statistical analysis: Raman, Thomas, Emond, Aisen.
Obtained funding: Quinn, Nelson, Weiner, Shinto, Aisen.
Administrative, technical, or material support: Raman, Yurko-Mauro, Nelson, van Dyck, Jack, Weiner, Aisen.
Study supervision: Quinn, van Dyck, Aisen.
Financial Disclosures: Drs Yurko-Mauro and Nelson reported being employees of Martek Biosciences, manufacturers of docosahexaenoic acid (DHA). Drs Quinn and Aisen reported being named as co-inventors on a patent for DHA for the treatment of Alzheimer disease in apolipoprotein E ε4–negative individuals, which was filed in July 2009 with Dr Yurko-Mauro as the inventor. Data lock for this trial was completed June 2009, the primary analysis was completed and results presented in July 2009, the patent was filed by Martek Biosciences in July 2009. Drs Quinn and Aisen were added as co-inventors in February 2010. Drs Quinn and Aisen have waived personal rights to royalties related to this patent. No other authors reported disclosures.
Funding/Support: This study was supported by grant UO1-AG10483 from the National Institute on Aging. The placebo and DHA study drugs were provided by Martek Biosciences. Martek also provided plasma and cerebrospinal fluid measurements of fatty acids, as well as partial financial support for the magnetic resonance imaging substudy.
Role of the Sponsor: The study design was approved by an oversight committee of the National Institute on Aging. Representatives from the National Institute on Aging participated in meetings of the steering committee of the Alzheimer's Disease Cooperative Study during the course of the trial. The National Institute on Aging was not otherwise involved in the design and conduct of the study, or in the analysis of data or preparation of the manuscript. Martek employees participated in design of the study and in revision of the manuscript, but were not involved in data management or data analysis.
Independent Statistical Analysis: The statistical analysis was conducted by the Alzheimer's Disease Cooperative Study Data Core. Martek employees did not participate in the statistical analysis and did not have access to the data prior to the completion of data analysis.
Alzheimer's Disease Cooperative Study Group Investigators: Lon Schneider, MD (University of Southern California, Los Angeles), Michael Rafii, MD (University of California, San Diego), Nancy Barbas, MD (University of Michigan, Ann Arbor), David Knopman, MD (Mayo Clinic, Rochester, Minnesota), Rachelle Doody (Baylor College of Medicine, Houston, Texas), Karen Bell, MD (Columbia University, New York, New York), James Galvin, MD (New York University School of Medicine, New York), Daniel Marson, PhD (University of Alabama, Birmingham), Mary Sano, PhD (Mt Sinai School of Medicine, New York, New York), Raj Shah, MD (Rush University Medical Center, Chicago, Illinois), Ranjan Duara, MD (Wien Center for Clinical Research, Miami, Florida), Marilyn Albert, PhD (Johns Hopkins School of Medicine, Baltimore, Maryland), Amanda Smith, MD (University of South Florida, Tampa), Steven Ferris, PhD (New York University Medical Center, New York), Gregory Jicha, MD (University of Kentucky, Lexington), Oscar Lopez, MD (University of Pittsburgh, Pittsburgh, Pennsylvania), Anton Porsteinsson, MD (University of Rochester, Rochester, New York), Ruth Mulnard, PhD (University of California, Irvine), Myron Weiner, MD (University of Texas Southwestern Medical Center, Dallas), James Lah, MD (Emory University, Atlanta, Georgia), Jeffrey Burns, MD (University of Kansas, Lawrence), John Ringman, MD (University of California, Los Angeles), Neill Graff-Radford, MD (Mayo Clinic, Jacksonville, Florida), Martin Farlow, MD (Indiana University, Bloomington), Christopher van Dyck, MD (Yale University School of Medicine, New Haven, Connecticut), Paul Solomon, MD (Memory Clinic, Bennington, Vermont), Jacobo Mintzner, MD (University of South Carolina, Columbia), George Grossberg, MD (St Louis University, St Louis, Missouri), Scott McGinnis, MD (Brigham and Women's Hospital, Boston, Massachusetts), Marwan Sabbagh, MD (Banner Sun Health Research Institute, Sun City, Arizona), Anil Nair, MD (Boston University, Boston, Massachusetts), Thomas Obisesan, MD (Howard University, Washington, DC), Stephen Thein, PhD (Pacific Research Network, San Diego, California), Paula Ogrocki, MD (Case Western Reserve University, Cleveland, Ohio), Charles DeCarli, MD (University of California, Davis), Horacio Capote, MD (Dent Neurologic Institute, Amherst, New York), Sanjay Asthana, MD (University of Wisconsin, Madison), Pierre Tariot, MD (Banner Research Institute, Phoenix, Arizona), Douglas Scharre, MD (Ohio State University, Columbus), Earl Zimmerman, MD (Albany Medical College, Albany, New York), Kevin Foley, MD (St Mary's Health Care, Grand Rapids, Michigan), Jeff Williamson, MD (Wake Forest University School of Medicine, Winston-Salem, North Carolina), Elaine Peskind, MD (University of Washington, Seattle), Brian Ott, MD (Rhode Island Hospital, Providence), Wesson Ashford, MD (Stanford University, Palo Alto, California), Gary Duncan, MD (Meharry Medical Clinic, Nashville, Tennessee), Paul Aisen, MD (Georgetown University, Washington, DC), and Chuang-Kuo Wu, MD (Northwestern University, Chicago, Illinois).
Data and Safety Monitoring Board: Karl Kieburtz, MD (University of Rochester School of Medicine and Dentistry, Rochester, New York), Bruce Miller, MD (University of California, San Francisco), Richard Kryscio, PhD (University of Kentucky, Lexington), and George Alexopoulos, MD (Weill Cornell Medical College, New York, New York).
Clinical Monitors: Karen Croot, BA, Viviana Messick, BS, Alan Pamoleras, BA, and Rebecca Ryan-Jones, PhD (all with the University of California, San Diego), Gina Garcia-Camillo, MD, and Mario Schittini, MD, MPH (Mount Sinai School of Medicine, Bronx, New York), Kris Gravanda Brugger, BA, and Pamela Saunders, PhD (Georgetown University, Washington, DC); and Janet Kastelan, MA (New York University, New York).


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