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Faster pace car for NASCAR 2Home / PC - Windows /
This page contains NASCAR 2 Codes for PC - Windows called "Faster pace car" and has been posted or updated on Aug 14, 2008 by sagajohnson. Let us know what you think of this Code by thumbs voting.
- Developer: Not Set
- Publisher: Not Set
- Genre: Not Set
- Release Date: Not Set
- ESRB: Not Set
Faster pace car
Create a backup copy of the file before proceeding. Enter the game directory and find the file that corresponds to a track, such as "/nascar2/tracks/bristol/bristol.txt". You can edit the speed of the pace car by locating the line that begis with "PACEA". Change the last two numbers in the speed (it can have more than two digits) that you want to be the pace speed. Because the pace car is slow at accelerating, it will most likely not reach anything extreme but it still exceeds its normal speeds by far.
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Stuck on this game? Set a specific, clearly defined question and let others answer your question or view answers to previously asked questions. If you think you are an NASCAR 2 expert then please try to help others with their questions.
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"I love our Library. It provides the soul of downtown in many ways."
Nile Rodgers,
Grammy award-winning musician, producer, composer, arranger, philanthropist and writer
received the Westport Library Award at
BOOKED for the evening
May 15, 2014
BOOKED for the evening is the Library's signature fundraising event. On this occasion, the Library honors an individual whose work reflects the purpose of the Library—to nurture the love of learning and to enhance our understanding of the world.
Michael Ross of the Westport Country Playhouse served as narrator and New Yorker music critic Sasha Frere-Jones was a presenter. Music made famous by Nile Rodgers was performed by Keith Robinson, guitarist; Jessie Wagner, vocalist; Tony Lewis, drums; Lenny Underwood, keyboard; Billy Grant, bass and vocals; and Carleigh Jade, vocalist.
For more information about sponsorship opportunities, contact Cindy Clark at cclark [at] westportlibrary [dot] org (subject: Sponsorship%20Opportunity) or 203.291.4824.
BOOKED for the evening: Highlights Through 2013


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Fred Luter Morning Session at Empowered Conference
Dr. Fred Luter, President of the Southern Baptist Convention, speaks at the 2014 Empowered Conference Tuesday morning in Hampton, VA.
Dr. Fred Luter, President of the Southern Baptist Convention, speaks at the 2014 Empowered Conference Tuesday morning in Hampton, VA.
The Empowered Conference was March 11, 2014 at Liberty Baptist Church in Hampton and featured speakers Dr. Fred Luter and Dr. Alvin Reid.
April 8 & 10 | A special day honoring church administrative and ministry assistants.
Mark Your Calendar
May 6 | Jefferson Lakeside Country Club, Richmond, VA
Download resources and view photos and videos from the 2014 Prayer Summit with Claude King and Richard Blackaby
June 1-7, 2014 | Baltimore, Maryland | Crossover is a Southern Baptist evangelism initiative that takes place each year in conjunction with the Southern Baptist Convention.
Feb 22 - Roanoke | Mar 8 - Fredericksburg | Mar 22 - Richmond | Iron Sharpens Iron is a one-day equipping conference for men featuring national keynote speakers, masculine worship, 16 different equipping workshops and resources specific to men.
June 16-24, 2014 Mission trip to Argentina
July 16-22, 2014 - "Acts 1:8 Families" will be in Montreal, Canada!
June 22-27, 2014 "Acts 1:8 Families" will be in Wise, VA at GracePoint Church.
January 8, 2014 | Richmond | A day for pastors from around Virginia to join together in leading prayer at the state capitol.


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Dr. Michael Scoppetuolo, MD
Medical Oncology, St Barnabas Cancer Center
- 94 Old Short Hills Rd Ste 1
Livingston, NJ 07039
- 1 Office Location
- (973) 322-5200
Dr. Michael Scoppetuolo has been practicing medicine for 35 years. Dr. Scoppetuolo graduated from the Rosalind Franklin University/ Chicago Medical School in 1979. He practices medicine in Livingston, NJ and specializes in Medical Oncology. Dr. Scoppetuolo is affiliated with Memorial Sloan Kettering Cancer Center and Saint Barnabas Medical Center. He speaks English and Spanish.
Gender: Male
Years in Practice: 35 Years
Languages Spoken: English, Spanish
Medical School: Rosalind Franklin University/ Chicago Medical School
Graduation Date: 1979
Hospital Affiliations: Memorial Sloan Kettering Cancer Center, Saint Barnabas Medical Center
Specialties: Medical Oncology


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Madaket House Rental Photos and Description
House, 3 Bedrooms, 2.5 Baths, (Sleeps 6)
Accommodations: House, 3 Bedrooms, 2.5 Baths (Sleeps 6)
Located on picturesque Long Pond Drive just a 10 minute bike ride to Madaket Beach and a 3 minute walk to the NRTA shuttle bus to town, which runs throughout the day and most of the night. The NRTA shuttle also transports bikes.
Traditional Nantucket Cape home set back from road with plenty of parking. Enjoy the beautiful Madaket sunsets on the deck overlooking yard with room to play and watch the bunnies nibble away.
First floor includes open living room, with wood burning fireplace for cool Nantucket nights, dining and kitchen. Also on the first floor is the master bedroom and full bath. Upstairs are two bedrooms with hall bath. Living room has large screen TV with cable and DVD player. Family room with tv, ping pong table, half bath and large laundry room in basement.
Additional amenities include wireless hi-speed internet, washer, dryer, board games, beach chairs, a cooler, boogie boards and beach towels for your enjoyment. The backyard deck has dining for 6, seating area and a gas grill. Hot and cold outdoor shower at end of deck.
NOTE: No Smoking. No Parties. Pet allergies: Owner has had dog at house. Office space above garage is locked and not included in rental.
Keywords: House
- Suitability:
- Minimum Age Limit for Renters
- children welcome
- non smoking only
- pets not allowed


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Steven J. Ricca was named to the 2014 Woodward White list of Best Lawyers in America in the practice areas of Environmental, Land Use & Zoning Law and Land Use and Zoning Litigation. He is a partner with Jaeckle Fleischmann & Mugel, LLP.
Subscribe now to search our database of 6524 Buffalo Business First People on the Move submissions and download their contact information.


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Ciao Italia
ESCAROLE RULES! - SCAROLA GOVERNA!Series Website »
Episode Guide »
Mary Ann prepares Sumptuous Escarole and Ricotta Calzones, stuffed Escarole and an Escarole Salad.
Vermont transplant and Guster frontman Ryan Miller seeks out far-fetched friends across the state! Available exclusively online.
A second HD broadcast service offering alternative programming and more content from local and regional producers.


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Altincizme Provides HARMANâs JBL VERTEC® Line Arrays and Soundcraft® Vi6 Console in Turkey for Efes Pilsen One Love Festival
The One Love Festival took place at the famous Santralistanbul venue and celebrated its 11th consecutive year with performances by internationally renowned artists including Kaiser Chiefs, Pulp, Damien Rice and Kimbra.
The main PA system at the Festival featured 24 VERTEC VT4889 fullsize line array elements (12 per side), powered by eight Crown VRack complete amplification systems. A Soundcraft Vi6 console was used as the FOH console at the Festival.
âIt was the smoothest VERTEC I have ever heard,â said Chris Leckie, FOH Engineer for Kaiser Chiefs, who has also used the Soundcraft Vi6 and Vi1 digital consoles for the bandâs most recent world tour.
âIâm grateful to be mixing on a Soundcraft board and continue to love my job, which is the most important part. With the help of Soundcraft it only gets better,â Leckie recently noted.
Founded in the late 1950s, Altincizme (owned by Serdar and Serhan Altincizme) is the oldest and most successful systems-for-hire company in Turkey, supported by HARMANâs Turkish distributor, SF Ses ve Isik Sistemleri Ltd.
For more information on Altincizme, please visit www.altincizme.com
HARMAN (www.harman.com) designs, manufactures and markets a wide range of audio and infotainment solutions for the automotive, consumer and professional markets â supported by 15 leading brands, including AKG, Harman Kardon, Infinity, JBL, Lexicon and Mark Levinson. The company is admired by audiophiles across multiple generations and supports leading professional entertainers and the venues where they perform. More than 20 million automobiles on the road today are equipped with HARMAN audio and infotainment systems. HARMAN has a workforce of about 13,400 people across the Americas, Europe and Asia, and reported sales of $4.4 billion for the fiscal year ended June 30, 2012.
Related Topics: Audio Playback, Line Array, Loudspeakers, News, Product Applications
First UK InfoComm CTS-I Prep Course
Arch Enemy Finds an Ally in HARMANâs Soundcraft Vi6 Digital Console
Event Enterprises Supplements NEXO M28 Arsenal, Adds Yamaha QL5 and DSRs
Texas Crew Productions Meets âIRONMANâ Challenge with Zylight F8 LED Fresnel
X2O Media to Present Two Sessions at the Next|Video Conference @ GV Expo
Advanced Systems Group Adds Ed Chen to Sales Staff
FSR's New HuddleVU Collaboration System Earns Tech & Learning 2014 Award of Excellence
Nitin Sawhney Transcends With Martin Audio MLA At Albert Hall


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Dr. Forrest J. Robinson, DO
Family Medicine, Elmhurst Clinic
- 1100 Lake St Ste 230
Oak Park, IL 60301
- 1 Office Location
- (331) 221-9300
Dr. Forrest J. Robinson has been practicing medicine for 25 years. Dr. Robinson graduated from the Midwestern University/ Chicago College of Osteopathic Medicine in 1989. He practices medicine in Oak Park, IL and specializes in Family Medicine. Dr. Robinson is affiliated with Elmhurst Memorial Hospital. He speaks English and Spanish.
Gender: Male
Years in Practice: 25 Years
Languages Spoken: English, Spanish
Medical School: Midwestern University/ Chicago College of Osteopathic Medicine
Graduation Date: 1989
Hospital Affiliations: Elmhurst Memorial Hospital
Specialties: Family Medicine


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Phoenix Condo Rental Photos and Description
2 bedrooms, 2 baths, sleeps 4 - 5
So much to do in Phoenix this fall and winter!!!
Arizona Coyotes Hockey
Phoenix Suns Basketball
Arizona Cardinals Football
Arizona State Football and Basketball
Arizona State Fair
Arizona Fall League baseball
Concerts Galore!!!!!
so much to do!!!!!
****and don't forget Superbowl 2015****
Enjoy the warm Arizona sunshine, sit by the community pool, play golf, go shopping or enjoy professional sports! It's all here in a great resort like setting. This condo is newly remodeled and updated, with all new furnishings, electronics, art, accessories, luxurious bedding, and linens. Spotlessly clean, non-smokers, non-pets, ready for your next vacation! This condo is a 2 bedroom located downstairs. Enjoy outdoor patio, bright, open floor plan, large community greenbelt area. One visit and you'll be back every year! Canadian owned, professionally managed!
Gated community less than 3 miles away from professional sports stadiums: Camelback Ranch, Spring Training baseball home to Chicago White Sox and LA Dodgers; University of Phoenix Stadium, home to the Arizona Cardinals; Gila River Arena, home to the Arizona Coyotes Hockey team; Westgate shopping & entertainment district plus the new Tanger Outlet Mall for all your shopping needs!!!!; Many golf courses w/in a 20 minute drive and 1 across the street.
It's all here!!!
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Non-smoking, no pets, please.
LEARN MORE! : Learn more about the community at : http://desertbreezecondos.com
- Suitability:
- Long-term Renters Welcome
- children welcome
- non smoking only
- pets not allowed
- suitable for elderly or infirm
- wheelchair accessible
About robbie mamalygo
Just your average Canadian hardworking family, living in Victoria, British Columbia, Canada
robbie mamalygo purchased this condo in 2011
Why robbie mamalygo chose Phoenix
We chose this property because as self-professed Sports Nuts ....this Condo is Perfect....Its close to Baseball, Football, Hockey, Golf, Tennis, Nascar Racing, Gyms...and its just a fantastic place to relax!!!!
Guestbook comments from the manager
I Stayed at Desert Breeze the week of November 9th to the 16th to catch the Nascar races down at the Phoenix International Raceway. Everything looks exactly like in the pictures. The pool and Hot tub are just excellent and well cared for....just like the pictures. The condo was perfect for me and my friends. The price was affordable compared most of the others we looked at. The best part was the location. Getting to and from the Airport was much easier than we anticipated. Everything we needed or wanted to see was so close. The Racetrack, the Golf Course and especially the Westgate Center (where we ended up spending our evenings) were either a close drive or cheap Taxi.
We would definitely stay at this condo again whenever we come to Phoenix again!


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Short animation or live action movies, often based on children's books.
Come to the library, check out the show, get a library card, and enjoy some books!
Upcoming Events
- Preschool Films
- Tuesday, November 25, 2014Marina, Marina Childrens' Area
- Preschool Films
- Monday, December 1, 2014Ingleside, Ingleside Meeting Room
- First Friday Fun Flicks!
- Friday, December 5, 2014Portola, Portola Meeting Room
*Funded by Friends of the San Francisco Public Library.


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Independent Contractor
Independent Contractors are not considered employees of the University, are not eligible for benefits, and are not paid through Boston University payroll.
Before engaging an individual (or a company with only one employee) to do work for the University as an "Independent Contractor," "consultant," "freelancer" or "vendor," you must evaluate whether he or she should be classified as an Employee OR Independent Contractor. Services from an Independent Contractor are paid through a shopping cart in SAP.
Please visit the Service Providers and Agency Temps webpage on the Sourcing and Procurement website for guidelines on how to determine eligibility for the Independent Contractor classification. This site also lists the process steps for hiring Independent Contractors.
If you have any questions, or need assistance, please email.


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The numbers have shifted for four teams following this past weekend's developments. Joe Fortenbaugh
Not much has changed in the eyes of Las Vegas bookmakers following the conclusion of the 2013 NFL draft.
Adjustments have been made to four teams since our last update on March 17, which came at the end of the free agent feeding frenzy. The LVH sports book in Las Vegas has dropped the Tampa Bay Buccaneers from 60/1 to 40/1 while New Orleans, Arizona and the New York Jets have all shifted in the opposite direction.
Here's the complete rundown:
Hit me up on Twitter: @JoeFortenbaugh
NOV 26 Joel Corry
Inside a performance-based contract
Elvis Dumervil will be handsomely rewarded after his big night in New Orleans.
NOV 25 Jeff Fedotin
Does Mike Evans deserve Rookie of the Year?
Tampa Bay wide receiver has a TD in four straight games.
NOV 20 Joel Corry
Will there be first ballot Hall of Famers in 2015?
A detailed look at the eight candidates vying for that unique honor.
NOV 18 Dion Caputi
Cleveland quarterback Brian Hoyer has overcome long odds to put his team in contention for a playoff berth.


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Dolph Lundgren loves to show his muscular body


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Beautiful Yorkie pups
Beautiful full breed Yorker pups. 4 girls 1 boy Girls £300 boy £250 Pups will have full health check and be wormed. Dad is very tiny 2kg and mum is 4kg. Parents can be seen as their both family pets. £50 deposit will secure pups Pups will be rea
- DOB:30 Sep 2014
- Rehome date:25 Nov 2014


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Find records of Florence Reid
Find birth, death, marriage, military, and other records of Florence Reid at Ancestry.com.Search for records
Biography & Family History Add details
Florence Reid (1902 - 1982) was born on May 24, 1902. She was born into the Reid family.
Florence had no-known relationships. Florence died in June 1982 at 80 years of age.
Florence Reid's last known residence is at Newberg, Yamhill County, Oregon.
The data on this page comes from the official record for Florence Reid in the SSDI (United States Social Security Master Death Index). What is the SSDI?
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LAHAINA, Hawaii (AP) — Trey Kell scored 15 points and No. 15 San Diego State shot its way into the Maui Invitational championship game, romping over Pittsburgh 74-57 Tuesday night.
HONG KONG (AP) — Hong Kong authorities cleared more street barricades from a pro-democracy protest camp in a volatile district Wednesday, part of a two-day operation in which police arrested more than 100 people, including key student leaders.
NEW YORK (AP) — JayVaughn Pinkston had the go-ahead basket and game-saving block in the final minute to lift No. 12 Villanova over No. 19 Michigan 60-55 in the Legends Classic championship game Tuesday night.


text:
The University of Kentucky Board of Trustees has approved UK Athletics' $45-million project to build a new football training facility adjacent to Commonwealth Stadium and the Nutter Field House.
Click here for the original story.
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ASIAN SCREAM QUEENS: Jin-hie (Phone)
ABOUT: My name is Jin-hie, although some like to call me disturbed. I like to say I was passionate. I was a schoolgirl from South Korea who was madly in love with a man named Chang-hoon. We shared many special moments together, and he was especially fond of my piano playing. His favorite song was Moonlight Sonata! Even though Chang-hoon was married, that didnĘĽt stop my love for him. To show my adoration, I even … Continue reading
Film Review: Phone (2002)
SYNOPSIS: Soon after Ji-won gets a new cell phone, her friend's young daughter, Yeong-ju, puts it to her ear and immediately begins screaming in terror. When other strange things start happening in connection with the phone, Ji-Won does some investigating and discovers that of the people before her who had the same number, almost all of them died suddenly under unusual circumstances. As Yeong-ju's behavior becomes increasingly alarming, Ji-won digs deeper into the circumstances surrounding … Continue reading


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November 27, 2014
The Grand Junction Police Department held a community notification meeting Thursday night to inform the public.
It is the second meeting of it's kind within a month. Law enforcement officials and experts spoke to community members about a sexually violent predator who recently moved to Colorado. Officials disclosed to the public the address of a sexually violent predator who recently moved into Grand Junction. 57 year old Ernest Welton moved to Colorado from Wyoming about six months ago.
The public was not notified sooner because in Weldon's state, he is not classified the same way as he is here. So it was a more lengthy process for law enforcement to classify him.
But Thursday night's meeting wasn't only held to disclose Weldon's whereabouts, but also as a way to make the public more aware about sex offenders so that they can help assist law enforcement.
Experts also disclosed some facts and statistics about sex offenders, along with some background legislative history. The meeting also outlined the offenders rights and treatment methods for sexually violent predators.
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Added Jul 23, 2012
Warwickshire, Mi...
Using Burda Doryon #6045 without any modifications or re-sizing I made a playsuit out of plaid brushed cotton for an autumn outfit
Full blog posts here: http://elationcreations.wordpress.com/2012/07/17/doryon-6045-burda-jumpsuit-preparation-part-one/
Here http://elationcreations.wordpress.com/2012/07/23/doryon-6045-burda-jumpsuit-part-two-finished-item-alert/
Jul 25, 2012, 10.15 AMby MissMaddiePi
Awesomeness! I've been searching for "THE" romper pattern – and your version, especially the fabric choice & knowing you didn't alter the pattern – make me think I have found it. Although you are clearly a talented seamster, I think you just might have missed your true calling . . . Modeling skinnies have nothing on you! Hmmm . . . Maybe the reason this pattern looks so good is because of the smile, styling, and enthusiasm of its model and maker! Thanks for posting – I'm officially INSPIRED!
Jul 27, 2012, 10.25 AMby elation creations
This is the loveliest post I have ever received :) Thank you so much for your compliments and I am so happy to inspire others! I loved this project and also love showing off clothes I have made :) lol
Go grab yourself 2m some brushed cotton and get making :) My blog has more detailed help and photos so check it out to see why I am smiling so much :) x
Jul 24, 2012, 12.21 AMby darkhorse
Super cute!
Jul 24, 2012, 04.46 PMby elation creations
Thank you very much :)
Jul 23, 2012, 08.53 PMby freaky-philomeen
now that is what I'd call a funny garment! really cute, the whole outfit is great ;))
Jul 23, 2012, 10.16 PMby elation creations
Thank you very much! I worked hard on the fabric choice so it fit in with my style and current wardrobe. :) x
Jul 23, 2012, 06.54 PMby Mary Athey
super cute xx
Jul 23, 2012, 08.42 PMby elation creations
Thank you :) x
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Chambray Shirts Under $75
A strong wardrobe is nothing without key foundation pieces. With the weather cooling down, it's prime time to add a chambray shirt to your style repertoire. Effortlessly cool and the perfect layering piece, this button-up can be worn with practically everything, from leather skirts to skinny jeans and even a pencil skirt for a casual office look. Shop our perfect picks — all under $75 — featuring brands like Gap, Madewell, and Mango for an instant Fall update.
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100% Cotton. Machine wash. Imported. Premium lightweight chambray with a pale blue wash. Long sleeves with single button cuffs. Spread collar. Front button placket. Patch pocket on chest. Rear shoulder yoke. Straight silhouette with a relaxed, easy fit like wearing your boyfriend's shirt. Curved shirttail hits below the hips.
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Constructed in smooth lightweight chambray, this breezy women's work shirt from Lauren Jeans Co. effortlessly channels the carefree spirit of warm-weather days with optional rolled cuffs for versatile style. straight point collar 2-button barrel cuffs can be rolled up and secured with a single-button tab at the sleeve split back yoke for a smooth, contoured shoulder button-through patch pockets at the chest 7-button placket with faux mother-of-pearl buttons curved hem with side gussets cotton; dry clean Imported.
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Classic heavy chambray oxford featuring a slim, modern fit. 100% Heavy Chambray Cotton construction Medium is approximately 27 7/8" (70.8cm) in total length Size medium chest width approximately 23" (58.4 cm) 8-button closure Single front pocket Reinforced collar to hold its shape through repeated washing
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Eleven people on board a Russian interior ministry transport plane were killed on Sunday when it crashed in the far eastern Yakutia region.
The plane bound for the city of Irkutsk crashed at 0505 IST shortly after taking off from Mirny airport, Ria-Novosti said.
The bodies of all the crew members have been found, a local official was quoted as saying by the news agency, adding that the plane was not carrying any cargo.
A panel has been formed to probe the cause of the accident.
Keywords: Russian plane crash, Yakutia


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The Norfolk resident, who has lived in the southern city for some 107 years, now lives at a transitional care hospital. Last year on her 110th birthday, Burden was feted by her city with the county's top politicos, family members, and various entrepreneurs who all gathered to honor her on the milestone birthday. On her birthday, May 7th, the city even proclaimed the event "Lela Burden Day."
Burden, who according to her only truly started living life at age 90 when she began traveling with her senior group, even competed in the Senior Olympics when she was 100-plus years young. Despite her mileage, Burden does not think she is ancient at all, au contraire, she told WTKR at her 111th birthday party this past May, "I'm not old yet; I'm still a young lady!"
That's right Burden, age ain't nothing but a number! Congratulations!
Also On Black America Web:
November 17-23: This Week in Black History
http://ioneblackamericaweb.files.wordpress.com/2013/11/november-17-1950-howardrollins.jpg?w=180&h=180&crop=1 http://ioneblackamericaweb.files.wordpress.com/2013/11/november-18-1996-lionelr.jpg?w=180&h=180&crop=1 http://ioneblackamericaweb.files.wordpress.com/2013/11/november-19-1964-thesupremes.jpg?w=180&h=180&crop=1 http://ioneblackamericaweb.files.wordpress.com/2013/11/november-20-1954-lavernbaker.jpg?w=180&h=180&crop=1 http://ioneblackamericaweb.files.wordpress.com/2013/11/november-21-2002-haddabrooks.jpg?w=180&h=180&crop=1
Originally seen on http://newsone.com/


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Home » News » Business
Ektron helps businesses adapt to a mobile world
William Rogers is CEO and founder of Ektron, a privately held software company headquartered in Nashua that has raised $4.5 million from outside investors. (Courtesy)
"The marketplace has changed so much over the past few years, and the concept of people going online has caused tremendous growth in our industry, and it keeps on changing," said William Rogers, CEO and founder of Ektron, a privately held software company headquartered in Nashua.
"People and businesses have to rethink their website strategies to deal with tablets and smartphones," Rogers said. "Young people expect to have more connected experiences on their Web devices."
Ektron recently launched Ektron 9, which allows businesses to view their webpage layouts on mutichannel devices. Business owners want to know how their page will look on an iPhone, an Android tablet and thousands of other different devices, Rogers said.
"We hide all of those complexities from the marketer, and allow them to get the job done," Rogers said. "Marketers can create a site in the cloud, but don't have to worry about managing and configuring it. It truly is an offering that eliminates the worry."
With his first client being a dental office, Rogers has expanded to provide Web services to customers like Microsoft, NASDAQ and the Sydney Opera House.
"We have been very successful there," said Rogers, explaining more than 35 websites have been developed with partners in that area of the world.
According to Rogers, the layoffs were not a result of the economy, but rather an effort to focus more on the software aspect of the company as opposed to the services portion of the business.
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Very Good Recipes of Roll - 2
There are 1236 Roll recipes on Very Good Recipes.
Page 2 out of 50.
Do you like roll recipes?
Click on the title of a recipe or the photo of a dish to read the full recipe on its author's blog.
Recipes by date | Most popular recipes
Pumpkin Cinnamon Rolls By Make lemonade and more! 11/07/14 02:30 I'm not a really big fan of cinnamon rolls, my hubby is though. I do like them warm from the oven but the leftover ones are not my favorite. One of my favorite things to do is lay in bed on Sat. mornings with my hubby and watch cooking shows (yes we are... Add to my recipe book
Kaju Pista Roll Recipe | Cashew Pistachio Rolls ~Indian Festival Sweets By Desi Fiesta Desi fiesta 11/03/14 14:23 Festivals brings out lots of old memories and happiness, sweets make these festivals more exciting if you have a big sweet tooth . As for in India sweet is considered very auspicious when made offering god. I have seen and amazed of the varieties of sweet... Add to my recipe book
Ratatouille and Roll By Experimental Chefs 11/01/14 02:17 A quick and easy dinner with this Ratatouille and Roll combination. A Cheese and Onion Roll, some ratatouille and new potatoes combine to make dinner in minutes. Simply put some cooked potato and a portion of ratatouille into a microwaveable … Continue... Add to my recipe book
Paneer tikka kathi roll - kathi wrap recipe - paneer recipes By Lemon Kurry 10/31/14 04:29 Preparation: 10 min - Cooking: 10 min Paneer tikka kathi roll - kathi roll with paneer,simla mirch or capsicum with spices and this is made in stove top method.Here comes the recipe with step by step pictures. This is my favorite wrap... Add to my recipe book
Orange Dough with Olive Paste Rolls By A Kingdom for a cake 10/30/14 19:31 Six centuries old recipe According to a very dear and one of my oldest friends, whom I have recently seen again after a long, long time, this recipe is centuries old, 600 years old to be precise. She has always had a refined taste, especially when it comes... Add to my recipe book
Cinnamon rolls By Ricette di Misya 10/29/14 10:00 Preparation: 30 min - Cooking: 1h Le cinnamon rolls sono delle soffici e profumate briochine alla cannella, una preparazione molto diffusa sia nei paesi del nord Europa che in nord America. L'ultima volta che ho mangiato le cinnamon rolls è stato a Berlino, era la mia colazione preferita... Add to my recipe book
Steamed Scallion Flower Rolls/Buns (花卷) By Simply Beautiful and Healthy Living 10/29/14 01:35 Last week I harvested a big bunch of scallions from my mini edible garden. I have been quite eager to try Steamed Scallion Flower Rolls when I first chanced upon it in Facebook. Then, I happened to see a post by Kit quite sometimes back. In fact, this is... Add to my recipe book
Rolnice od bundeve | Winter squash rolls By Jovanke Baštovanke kutlača 10/28/14 00:42 (scroll down for English) Sastojci za tijesto: 3/4 bademovog mlijeka 1/4 kokosovog ulja 1/4 smeđeg šećera 1 paketić suhog kvasca 1/2 šolje pečene bundeve 2 šolje pirovog brašna 1/4 žličice morske soli Sastojci za smjesu*: 2 šolje smjese od bundeve 1/4 meda... Add to my recipe book
Eggless Cinnamon Rolls | Eggless Baking By Babi's Recipes 10/26/14 10:34 I love to bake more than cooking that too working with yeast has become fun and excited now a days.On fine evening I made this for tea time snack,my daughter who is the best critic of my foods... Add to my recipe book
Cheesy Pesto Bread Rolls/Rouleaux de pain de mie complet au Pesto et au Fromage By Priya's Versatile Recipes 10/25/14 22:09 Bread rolls, nothing can satisfy a kid's tastebuds. I have rarely seen kids saying no to breads and obviously bread are life saver for many of us, that too when we dont have anything to dish out for evening snacks especially for kids.I have tried couple... Add to my recipe book
Red Bean Paste Rolls using Straight Dough Method By Simply Beautiful and Healthy Living 10/23/14 07:01 As mentioned earlier in my post on Garlic Butter Bread, I have numerous bread recipes which are waiting for their turn to greet you all. Click at the link for the recipe : Garlic Butter Bread Hence, here is another homemade bread which we love very much.... Add to my recipe book
144.0….The Wasabi Roll By Melissa Likes To Eat 10/23/14 00:06 Last nights was one of those nights. If one thing went wrong, everything went wrong. Homework issues, light fixtures breaking, and the list goes on. I was all set to make a new recipe but by the time I got around to it, I barely felt like eating, let alone... Add to my recipe book
Chocolate Swiss Roll Recipe and Diwali Greetings from RaaaZzzfoodlove By RaaaZzzfoodlove 10/22/14 09:36 Its Diwali celebration here in India and we wish everyone a "Happy Diwali" and present this yummy Chocolate Swiss Roll on this occasion to add to your festive sweet treats. Its a very easy recipe and takes very less time to get done though the recipe looks... Add to my recipe book
Vienna's Rye Bread Rolls By Around the World - in favorite recipes 10/22/14 06:56 I don't know if we were exhausted, or because it was Sunday, or maybe fact that previous day we've been in Thailand, but Vienna and it's people didn't impress me much. I suppose crew from Austrian airlines had something to do with my opinion! (And I'm not... Add to my recipe book
Japan: California Roll By 196 Flavors 10/21/14 16:57 Yes, I am a purist. My friends who know me well know that I am a purist. I have numerous pet peeves, especially when it comes to cooking. Whether it is when someone insists that the original Caesar salad contains chicken or that authentic Niçoise salad... Add to my recipe book
Dates & Groundnuts Roll By Adige 10/21/14 08:30 Dates & GroundNuts Roll : This sweet dish is appeared in Savi Ruchi - Vijaya Karnataka Deepavali Edition. Dates and Groundnuts Roll is a sweet dish. Specially made for Vijaya Karnataka Deepavali Edition. The last day of the entry just thought of sending... Add to my recipe book
Chocolate Pecan Sweet Rolls By Restless Chipotle 10/20/14 16:49 Preparation: 10 min - Cooking: 35 min Light, puffy sweet rolls are filled with chocolate and hazelnuts for a special breakfast treat. The warm rolls ooze chocolaty goodnes! Disclaimer: Smuckers provided Jif Salted Caramel Spread that was used in this recipe. My opinion is my own – as always!... Add to my recipe book
Pumpkin Cinnamon Rolls By Pork Cracklins 10/20/14 00:29 I promise, this is the last time I'll complain about a pumpkin recipe in Baked Elements. I guarantee there are be more pumpkin recipes in my future (Pumpkin Cheesecake Chocolate Swirl Brownies from the brand new, fabulous, just released Baked Occasions).... Add to my recipe book
Greek Omelette Roll with Spinach By A Palatable Pastime 10/15/14 13:58 Beautifully thin omelet filled with creamy spinach filling. Greek Omelette Roll with Spinach by Sue Lau | Palatable Pastime 10.15.14 I was inspired to first make this dish a few months back after Bergy, a friend of mine over at … Continue reading → Add to my recipe book
Make it Yourself - Jelly Roll By The Iowa Housewife 10/15/14 10:00 Jelly Rolls are sponge cakes, only rolled. Because they are thin they bake in minutes. 12 minutes for this recipe, cool quickly and it can be baked, filled and ready to eat in about 90 minutes. Jelly rolls are really easy to make and can be filled with... Add to my recipe book


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I wanna hear him do another Dead President freestyle
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Builder arrested after married couple found stabbed to death in Surrey home
A major manhunt was today underway after the bodies of a man and a woman were found at a home in Surrey.
31 July 2013
24 July 2013
04 June 2013
Ahead of its famous annual festival, which this year also celebrates the centenary of Benjamin Britten, Chris Folley finds there's more to the Suffolk coastal town of Aldeburgh than its classical music connections
29 May 2013
27 May 2013
07 May 2013
The parents of a pregnant woman who is believed to have killed her three children before she fell to her death from a multi-storey car park have asked for them to be buried together.
03 May 2013
17 April 2013
A heavily pregnant woman who fell to her death at a car park before police discovered the bodies of her three young children has been named locally as Fiona Anderson.
16 April 2013
The bodies of three young children were found today after a woman fell to her death at a car park.
15 April 2013


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Chronic deep brain stimulation of the subthalamic nucleus for Parkinson's disease: effects on cognition, mood, anxiety and personality traits.
ABSTRACT To evaluate modifications occurring in cognitive functions and behavioural aspects in a group of 72 consecutive patients with Parkinson's disease (PD) 15 months after bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN).
72 consecutive PD patients bilaterally implanted for DBS of the STN were evaluated before and after surgery with a mean follow-up of 15 months. A neuropsychological assessment was performed to evaluate reasoning (Raven Colour Matrices), memory (Bisyllabic Word Repetition Test, Corsi's Block-Tapping Test, Paired-Associate Learning) and frontal executive functions (Trail Making Test Part B, Nelson Modified Card Sorting Test, phonemic and category verbal fluency tasks). Mood and suicidal ideation were evaluated using the Beck Depression Inventory (BDI). Anxiety was measured by means of the State-Trait Anxiety Inventory and personality traits were evaluated with the Structured Clinical Interview for the DSM-III-R Axis II Disorders (SCID-II). Assessment of thought disorders and apathy was based on subitems of the Unified Parkinson's Disease Rating Scale.
The comparisons between pre- and postoperative neuropsychological test scores showed a significant worsening only in phonemic and semantic verbal fluency tasks, while fewer errors were found in the Nelson Modified Card Sorting Test. Globally, behavioural assessment evidenced a small improvement in mood, as assessed by the BDI, in obsessive-compulsive and paranoid personality traits (SCID-II). Thought disorders worsened while suicidal ideation, anxiety and apathy showed no postoperative modifications. The analysis of individual outcomes (+/-1 SD criterion) evidenced a relevant postoperative cognitive decline in 3 patients out of 65 (4.5%). Moreover, following implantation, 1 patients exhibited psychosis (1.5%), 2 patients experienced a clinically relevant worsening of depressive symptoms (3%), 7 patients showed an increase in anxiety (12%) and 3 patients a worsening in depression and anxiety symptoms (3%). On the contrary, 12 patients (20%) showed a relevant improvement in mood and 14 patients (23%) a relevant reduction of anxiety symptoms after the surgery.
The present study confirms that STN DBS is cognitively safe since the only relevant change observed was a mild decrease in verbal fluency tasks. Globally, a small postoperative improvement was found in the BDI, and in two SCID-II subscales concerning obsessive-compulsive and paranoid personality traits, even though postoperative behavioural disturbances can occur in individual patients.
Article: Depression and coping as predictors of change after deep brain stimulation in Parkinson's disease.[Show abstract] [Hide abstract]
ABSTRACT: This study examined changes in motor function and quality of life (QoL) after subthalamic nuclei deep brain stimulation (STN-DBS) in patients with Parkinson disease (PD) and the role of psychosocial predictors on individual changes. Forty-one patients with advanced PD (29 men and 12 women; mean age: 62.0 ± 8.0; disease duration: 14.5 ± 5.7) completed self-report questionnaires before surgery and at 6 and 12 months after surgery. Psychosocial measures assessed coping strategies (Ways of Coping Checklist-Revised), symptoms of depression (Beck Depression Inventory version II), anxiety (State-Trait Anxiety Inventory), and QoL (Parkinson Disease Questionnaire 39 Items, Medical Outcomes Study 36-Item Short-Form Health Survey). After surgery, motor function (Unified Parkinson Disease Rating Scale III and IV), global QoL (Parkinson Disease Questionnaire 39 Items) and Physical Component Summary of the Medical Outcome Study Short Form 36-items Health Survey improved, whereas the Mental Component Summary tended to deteriorate. Depression and anxiety were stable. Improvements in motor function and QoL were associated with younger age, shorter duration of illness, higher baseline distress (depression and anxiety), and changes in problem-focused coping. Improvements in mental QoL were associated with a less frequent use of coping focused on seeking social support. STN-DBS is associated with major positive changes in PD affecting motor function and QoL. These changes are related to psychological variables, including emotional distress and coping. A better focus on these individual characteristics is necessary to improve care of patients with PD who undertake STN-DBS.World Neurosurgery 01/2011; 75(3-4):525-32. · 1.77 Impact Factor
Article: The combined effect of subthalamic nuclei deep brain stimulation and l-dopa increases emotion recognition in Parkinson's disease.[Show abstract] [Hide abstract]
ABSTRACT: Deep brain stimulation of the subthalamic nucleus (DBS) is a widely used surgical technique to suppress motor symptoms in Parkinson's disease (PD), and as such improves patients' quality of life. However, DBS may produce emotional disorders such as a reduced ability to recognize emotional facial expressions (EFE). Previous studies have not considered the fact that DBS and l-dopa medication can have differential, common, or complementary consequences on EFE processing. A thorough way of investigating the effect of DBS and l-dopa medication in greater detail is to compare patients' performances after surgery, with the two therapies either being administered ('on') or not administered ('off'). We therefore used a four-condition (l-dopa 'on'/DBS 'on', l-dopa 'on'/DBS 'off', l-dopa 'off'/DBS 'on', and l-dopa 'off'/DBS 'off') EFE recognition paradigm and compared implanted PD patients to healthy controls. The results confirmed those of previous studies, yielding a significant impairment in the detection of some facial expressions relative to controls. Disgust recognition was impaired when patients were 'off' l-dopa and 'on' DBS, and fear recognition impaired when 'off' of both therapies. More interestingly, the combined effect of both DBS and l-dopa administration seems much more beneficial for EFE recognition than the separate administration of each individual therapy. We discuss the implications of these findings in the light of the inverted U curve function that describes the differential effects of dopamine level on the right orbitofrontal cortex (OFC). We propose that, while l-dopa could "overdose" in dopamine the ventral stream of the OFC, DBS would compensate for this over-activation by decreasing OFC activity, thereby restoring the necessary OFC-amygdala interaction. Another finding is that, when collapsing over all treatment conditions, PD patients recognized more neutral faces than the matched controls, a result that concurs with embodiment theories.Neuropsychologia 08/2012; 50(12):2869-79. · 3.48 Impact Factor
Article: Influence of deep brain stimulation of the subthalamic nucleus on cognitive function in patients with Parkinson's disease.[Show abstract] [Hide abstract]
ABSTRACT: Deep brain stimulation (DBS) is an effective technique for treating Parkinson's disease (PD) in the middle and advanced stages. The subthalamic nucleus (STN) is the most common target for clinical treatment using DBS. While STN-DBS can significantly improve motor symptoms in PD patients, adverse cognitive effects have also been reported. The specific effects of STN-DBS on cognitive function and the related mechanisms remain unclear. Thus, it is imperative to identify the influence of STN-DBS on cognition and investigate the potential mechanisms to provide a clearer view of the various cognitive sequelae in PD patients. For this review, a literature search was performed using the following inclusion criteria: (1) at least 10 patients followed for a mean of at least 6 months after surgery since the year 2006; (2) pre- and postoperative cognitive data using at least one standardized neuropsychological scale; and (3) adequate reporting of study results using means and standard deviations. Of ∼170 clinical studies identified, 25 cohort studies (including 15 self-controlled studies, nine intergroup controlled studies, and one multi-center, randomized control experiment) and one metaanalysis were eligible for inclusion. The results suggest that the precise mechanism of the changes in cognitive function after STN-DBS remains obscure, but STN-DBS certainly has effects on cognition. In particular, a progressive decrease in verbal fluency after STN-DBS is consistently reported and although executive function is unchanged in the intermediate stage postoperatively, it tends to decline in the early and later stages. However, these changes do not affect the improvements in quality of life. STN-DBS seems to be safe with respect to cognitive effects in carefully-selected patients during a follow-up period from 6 months to 9 years.Neuroscience Bulletin 12/2013; · 1.37 Impact Factor
Page 1
Fax +41 61 306 12 34
E-Mail firstname.lastname@example.com
Original Paper
Eur Neurol 2006;55:136–144
Chronic Deep Brain Stimulation of the
Subthalamic Nucleus for Parkinson's Disease:
Effects on Cognition, Mood, Anxiety and
Personality Traits
L. Castelli a P. Perozzo a M. Zibetti a B. Crivelli a U. Morabito a M. Lanotte a
F. Cossa b B. Bergamasco a,
b L. Lopiano a
Casa di Cura Major, S. Maugeri Foundation, Turin , Italy
Department of Neuroscience, University of Turin, and b
Department of Neuromotor Rehabilitation,
between pre- and postoperative neuropsychological test
scores showed a signifi cant worsening only in phonemic
and semantic verbal fl uency tasks, while fewer errors
were found in the Nelson Modifi ed Card Sorting Test.
Globally, behavioural assessment evidenced a small im-
provement in mood, as assessed by the BDI, in obses-
sive-compulsive and paranoid personality traits (SCID-
II). Thought disorders worsened while suicidal ideation,
anxiety and apathy showed no postoperative modifi ca-
tions. The analysis of individual outcomes ( 8 1 SD crite-
rion) evidenced a relevant postoperative cognitive de-
cline in 3 patients out of 65 (4.5%). Moreover, following
implantation, 1 patients exhibited psychosis (1.5%), 2 pa-
tients experienced a clinically relevant worsening of de-
pressive symptoms (3%), 7 patients showed an increase
in anxiety (12%) and 3 patients a worsening in depres-
sion and anxiety symptoms (3%). On the contrary, 12
patients (20%) showed a relevant improvement in mood
and 14 patients (23%) a relevant reduction of anxiety
symptoms after the surgery. Conclusions: The present
study confi rms that STN DBS is cognitively safe since the
only relevant change observed was a mild decrease in
verbal fl uency tasks. Globally, a small postoperative im-
provement was found in the BDI, and in two SCID-II sub-
scales concerning obsessive-compulsive and paranoid
personality traits, even though postoperative behav-
ioural disturbances can occur in individual patients.
Copyright © 2006 S. Karger AG, Basel
Key Words
Parkinson's disease ? Deep brain stimulation of the
subthalamic nucleus ? Cognitive functions ? Mood ?
Anxiety ? Personality traits
Objective: To evaluate modifi cations occurring in cogni-
tive functions and behavioural aspects in a group of 72
consecutive patients with Parkinson's disease (PD) 15
months after bilateral deep brain stimulation (DBS) of
the subthalamic nucleus (STN). Methods: 72 consecutive
PD patients bilaterally implanted for DBS of the STN
were evaluated before and after surgery with a mean fol-
low-up of 15 months. A neuropsychological assessment
was performed to evaluate reasoning (Raven Colour Ma-
trices), memory (Bisyllabic Word Repetition Test, Corsi's
Block-Tapping Test, Paired-Associate Learning) and
frontal executive functions (Trail Making Test Part B, Nel-
son Modifi ed Card Sorting Test, phonemic and category
verbal fl uency tasks). Mood and suicidal ideation were
evaluated using the Beck Depression Inventory (BDI).
Anxiety was measured by means of the State-Trait Anx-
iety Inventory and personality traits were evaluated with
the Structured Clinical Interview for the DSM-III-R Axis II
Disorders (SCID-II). Assessment of thought disorders
and apathy was based on subitems of the Unifi ed Par-
kinson's Disease Rating Scale. Results: The comparisons
Received: December 1, 2005
Accepted: March 2, 2006
Published online: May 8, 2006
Lorys Castelli
Department of Neuroscience, University of Turin
via Cherasco 15
IT–10126 Turin (Italy)
Tel. +39 11 6638034, Fax +39 11 6335668, E-Mail firstname.lastname@example.com
© 2006 S. Karger AG, Basel
Accessible online at:
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Chronic DBS of STN for Parkinson's
Eur Neurol 2006;55:136–144
Deep brain stimulation (DBS) of the subthalamic nu-
cleus (STN) has been shown to represent a valid thera-
peutic option for patients with advanced Parkinson's dis-
ease (PD). Several studies have shown a signifi cant ame-
lioration of motor symptoms in STN-stimulated PD
patients [1–3] , with a reduction in dopaminergic treat-
ment dose and in the duration and severity of dyskinesias;
moreover, the improvement in motor function is still ev-
ident after a 5-year period [3] .
Overall neuropsychological evidence is consistent with
a global safety of the surgical procedure [4–8] . The cogni-
tive side-effect most frequently observed after surgery was
a decline in the verbal fl uency tasks, in both the phonemic
and/or semantic domains [5, 7–12] ; on rare occasions, a
mild cognitive decline was also reported in cognitive tasks
such as free recall of words (episodic verbal memory) [5,
9, 13] , judgement of line orientation (spatial functions) [9]
and attention [7] , while postsurgical dementia seems to be
relatively rare [3, 8] . On the contrary, an improvement fol-
lowing surgery was noted in other tasks related to frontal
executive functions, such as in the Trail Making Test Part
B (attention shifting) and the Wisconsin Card Sorting Test
(categorisation and set shifting) [5, 9, 14] .
Concerning psychiatric complications of STN DBS, a
wide range of symptoms are reported, even though most-
ly transient [5, 8, 15] ; these include mild to severe depres-
sive episodes, apathy, hypomania, aggressive and psy-
chotic episodes [3, 5, 8, 13, 15, 16] .
A postoperative mood improvement was observed af-
ter STN DBS [4, 8] ; in a recent review of 23 studies, the
positive effect of DBS on depression is highlighted, with
the majority of PD patients reporting improved or un-
changed mood after surgery [17] . Nevertheless, some PD
patients, despite a clear motor improvement, experienced
mood worsening after the procedure [13, 18, 19] and
some cases of suicide or suicide attempt were also de-
scribed [8, 20, 21] . It was suggested that suicide is more
frequent in PD patients who suffered severe depression
or behavioural disturbances before surgery and had un-
dergone multiple DBS surgery, but this issue is still de-
bated and it requires high attention [20] .
Anxiety, like depression, seems to decrease after sur-
gery, even though it has rarely been investigated [5, 22] ;
in addition, STN DBS seems to be effective in reducing
obsessive-compulsive symptoms whether associated with
PD or not [9, 23] . Nevertheless, so far, no exhaustive as-
sessment of personality traits of STN-operated PD pa-
tients has been performed.
The study of Funkiewiez et al. [8] , evaluating 70 STN-
operated PD patients at 1 and 3 years from surgery,
showed an increase in apathy and thought disorders, par-
ticularly at 3 years, whereas a recent study showed a re-
duction in apathy in STN-operated PD patients with
acute stimulation [24] .
Although the effectiveness of STN DBS on motor
symptoms is largely demonstrated, cognitive and behav-
ioural aspects need to be further clarifi ed. Behavioural
complications negatively affect postoperative manage-
ment and can prevent PD patients from benefi ting from
the motor improvement achieved with DBS [15, 19, 21] .
Moreover, most studies assessing cognitive and behav-
ioural effects of STN DBS have a short-term follow-up
(up to 6 months).
The aim of this study was to assess the postoperative
modifi cations occurring in cognitive functions, mood,
anxiety and personality traits in 72 consecutive PD pa-
tients after bilateral STN DBS, with a mean follow-up of
15 months.
Patients and Procedure
A consecutive series of 72 PD patients bilaterally implanted for
STN DBS were involved in the study and gave their written in-
formed consent. The principal inclusion criteria for the surgical
treatment were the diagnosis of idiopathic PD, the presence of se-
vere motor fl uctuations and drug-related dyskinesias, the absence
of marked atrophy or focal abnormalities on brain MRI, the ab-
sence of dementia or severe cognitive decline, the absence of a
clinically relevant depression, and age less than 70 years [25] . All
patients were submitted to STN DBS following the surgical proce-
dure previously described [26] . A postoperative three-dimensional
MRI was performed to exclude surgical complications and then it
was fused with the pre-operative CT scan to check the corrected
position of the electrodes.
Seven patients were lost to follow-up because of reasons unre-
lated to cognitive or behavioural side-effects and were excluded
from the study.
The remaining 65 PD patients (38 male, 27 female) underwent
motor, neuropsychological and behavioural assessment 2 weeks
before and at a mean of 15 months after surgery (range: 12–20
The motor evaluation was performed according to the Core As-
sessment Program for Surgical Interventional Therapies in Parkin-
son's Disease [27] . In order to assess the rate of motor improvement
induced by STN high-frequency stimulation, data relative to sec-
tion 3 of the Unifi ed Parkinson's Disease Rating Scale (UPDRS)
are reported [27] in two conditions: 'pre-operative medication off'
(med-off) and 'postoperative stimulation on/medication off' (stim-
on/med-off). Antiparkinsonian medications are expressed as le-
vodopa equivalent daily dosage (LEDD) [28] .
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Castelli et al.
Eur Neurol 2006;55:136–144
The neuropsychological and behavioural assessments were per-
formed in the optimal clinical condition for the patients: pre-opera-
tive med-on and postoperative stim-on/med-on condition (daily dos-
age of dopaminergic drugs), except for the 6 patients who complete-
ly stopped the dopaminergic treatment after STN DBS. Some tests
were not administered to the fi rst patients of our series and few oth-
ers were lost during the follow-up period (see tables). Table 1 shows
the main demographic and clinical characteristics of the patients.
Neuropsychological Assessment
All PD patients underwent a standardised cognitive test battery
assessing reasoning, memory and frontal executive functions. The
neuropsychological tests were described in a previous study [29] .
Visuospatial reasoning was evaluated by means of the Raven Col our
Matrices (PM 47) [30] ; verbal and spatial short-term memory were
assessed by means of the Bisyllabic Word Repetition Test (BWR)
[31] and Corsi's Block-Tapping Test (CBT) [31] , respectively. The
assessment of verbal learning was achieved by means of the Paired-
Associate Learning (PAL) [32] , a Wechsler Memory Scale subtest.
Frontal lobe executive functions, including the development of ab-
stract concepts and the shift of attentional and motor sets, were as-
sessed by means of the Trail Making Test Part B [33] and the Nelson
Modifi ed Card Sorting Test (MCST) [34] , a modifi ed version of the
Wisconsin Card Sorting Test. In addition, patients were adminis-
tered the phonemic and category verbal fl uency tasks [31, 35] .
Two parallel forms were used for all the memory tests (BWR,
CBT, PAL) in order to avoid the test-retest effect.
Mood, Anxiety and Personality Trait Assessment
Mood was evaluated by means of the Beck Depression Inven-
tory (BDI), a 21-item self-rated scale [36, 37] . The total score was
obtained considering all items, rated from 0 to 3. Total scores of
0–9 indicate absence of depression, of 10–17 mild depression, of
18–24 moderate depression, and, fi nally, scores higher than 25 are
indicative of severe depression [35] . Suicidal ideation was assessed
by item No. 9 of the BDI, rating from 0 (absence of suicidal ide-
ation) to 3 (indicating the purpose to commit suicide). The State-
Trait Anxiety Inventory (STAI) was used to assess anxiety as a re-
action to episodic stress conditions (STAI-X1) and as a predisposi-
tion to experience persistent anxious behaviour (STAI-X2) [38] .
The semi-structured Clinical Interview for the DSM-III-R Axis
II Disorders (SCID-II) was used to evaluate personality traits. The
SCID-II is composed of a 12-subscore questionnaire (113 items),
each related to a different diagnostic category (avoidant, dependent,
obsessive-compulsive, passive-aggressive, self-defeating, paranoid,
schizotypal, schizoid, histrionic, narcissistic, borderline and anti-
social) [39] . Thought disorders and apathy were assessed by means
of item 2 and item 4 of the UPDRS section 1, respectively.
Statistical Analyses
To compare pre- and postoperative test scores, t tests for paired
samples were run. Correlations between variables were assessed by
means of the Pearson correlation analysis. In order to assess changes
among individual patients after surgery, each raw score was trans-
formed to a standard z-score using means and standard deviation
(SD) values of the total sample at baseline. The clinical criterion of
8 1 SD was used to register a patient as improved or worsened, re-
spectively. Given the explorative nature of the study, a p value
! 0.05 was considered statistically signifi cant. Nevertheless, values
of p between 0.05 and 0.01 should be accepted with caution.
Motor Effectiveness
A signifi cant reduction in motor disability, equal to
50%, was found 15 months after surgery (pre-operative
med-off vs. postoperative stim-on/med-off conditions,
p ! 0.001); moreover, STN stimulation allowed PD pa-
tients to reduce the daily dose of antiparkinsonian drugs
by 56% (p ! 0.001). Six patients completely stopped all
dopaminergic treatments after surgery. Nine patients
(14%) developed dysarthria/hypophonia after STN DBS
(UPDRS part 3, item 18, score 6 2). These data are sum-
marised in table 1 . Stimulation parameters are detailed
in table 2 . A stable pattern of stimulation was usually
reached within the fi rst month after surgery; afterwards,
minimal modifi cations were made in individual patients.
At the moment of the postoperative assessment, the pa-
rameters of the 65 PD patients were stable for a mean
period of 7 months (range 3–17 months).
Neuropsychological Data
Scores from neuropsychological tests are shown in ta-
ble 3 . Tests investigating reasoning (PM 47) and memory
evidenced no changes after STN DBS. Both verbal and
Table 1. Clinical characteristics of the 65 PD patients
Age, years
Education, years
Duration of disease, years
LEDD, mg/day
Before surgery
After surgery
UPDRS part 3
Before surgery, med-off
After surgery, stim-on/med-off
60.5 (6.5)
8.7 (4.2)
15.1 (5.1)
1,010.5 (419.9)
447.1 (284.8)
54.4 (13.4)
27.2 (11.7)
Results are means with SD in parentheses.
Table 2. Stimulation parameters at the time of the postoperative
Right STNLeft STN
Voltage, V
Pulse width, ?s
Rate, Hz
3.3 (0.4)
67.5 (13.1)
143.1 (19.9)
3.3 (0.3)
68.5 (19.3)
142.7 (22.2)
Results are means with SD in parentheses.
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Chronic DBS of STN for Parkinson's
Eur Neurol 2006;55:136–144
spatial short-term memory (BWR, CBT) and verbal learn-
ing (PAL) remained globally stable at follow-up. Concern-
ing frontal executive functions, a signifi cantly lower num-
ber of total errors (p ! 0.02) and perseverative errors
(p ! 0.04) were found in the Nelson MCST, while perfor-
mance in verbal fl uency tasks showed a signifi cant decline
after surgery; this was observed both for phonemic (p !
0.001) and category fl uency tasks (p ! 0.005). The pa-
tients with dysarthric/hypophonic disturbances did not
show a signifi cant difference in the performance in verbal
fl uency tasks when compared to the other PD patients of
the present series. Finally, no signifi cant change was ob-
served in the ability to shift attention between different
sets of stimuli (Trail Making Test Part B).
Analysing changes among individual patients on neu-
ropsychological tests ( table 4 ), the percentage of PD pa-
tients whose performance deteriorated after surgery var-
ied from a minimum of 2% (errors, Nelson MCST) to a
maximum of 26% (phonemic fl uency test), while im-
provements were observed in a minimum of 5% (verbal
fl uency tasks) to a maximum of 32% of the patients (short-
term memory tests). Most of the patients did not show
clinically relevant negative changes at the 15-month fol-
low-up. One patient (1.5%), who developed a progressive
onset dementia according to DSM-IV criteria [40] , also
showed, after some months from surgery, a progressive
motor deterioration unresponsive to levodopa therapy,
urinary incontinence and symptomatic orthostatic hypo-
tension, with a clinical picture suggestive of multisystem
atrophy. This patient evidenced a clinically relevant de-
cline in all the neuropsychological test scores (10/10).
Two other PD patients (3%) evidenced a cognitive wors-
ening with a relevant decline in 6 out of 10 neuropsycho-
logical variables.
n Before surgery After surgeryt test d.f.p
Raven Colour Matrices
Bisyllabic Word Repetition Test
Corsi's Block-Tapping Test
Paired-Associate Learning
Trail Making Test Part B
55 276.2 (172.8)
26.7 (4.6)
4.4 (0.7)
4.4 (0.7)
10.9 (3.1)
27.0 (4.4)
4.2 (0.8)
4.2 (0.8)
10.8 (3.2)
276.2 (166.6)
–0.54 64
1.94 64
1.30 64
0.25 64
0.01 54
Nelson Modifi ed Card Sorting Test
Phonemic fl uency
Semantic fl uency
5.2 (1.5)
8.9 (10.3)
3.5 (5.5)
41.6 (15.7)
17.6 (4.7)
5.6 (1.0)
5.4 (6.2)
1.6 (3.7)
34.3 (14.8)
16.1 (4.3)
–1.72 54
2.66 54
2.21 54
4.42 64 <0.001
3.46 64
Results are means with SD in parentheses. Bold = p value ! 0.05.
Table 3. Neuropsychological test scores
before and 15 months after DBS of STN
n Declined, %Unchanged, %Improved, %
Raven Colour Matrices
Bisyllabic Word Repetition Test
Corsi's Block-Tapping Test
Paired-Associate Learning
Trail Making Test Part B
Nelson Modifi ed Card Sorting Test
Phonemic fl uency
Semantic fl uency
A performance was considered as declined or improved when it was >81 SD.
Table 4. Individual score changes on
neuropsychological tests 15 months after
DBS of STN
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Castelli et al.
Eur Neurol 2006;55:136–144
Behavioural Data
Data of the behavioural scales are shown in table 5 . A
signifi cant improvement was found in mood (p ! 0.01),
investigated by means of the BDI; the PD patients expe-
rienced less depressive symptoms after the surgical treat-
ment. Suicidal ideation (item 9, BDI) was absent in the
pre-operative period ( table 5 ) and remained unchanged
after STN DBS. State and trait anxiety did not vary sig-
nifi cantly.
As for personality traits (SCID-II), we found lower
scores indicative of obsessive-compulsive traits (p !
0.005) and paranoid traits (p ! 0.005) after surgery, while
scores concerning other personality traits did not show
modifi cations. Apathy (item 4, UPDRS part 1) was sub-
stantially stable after surgery, whereas the patients showed
a signifi cantly higher score of thought disorders (item 2,
UPDRS part 1, hallucinations and delusions) at postop-
erative follow-up (p ! 0.001).
As far as individual score changes were concerned ( ta-
ble 6 ), 10% of the patients revealed a clinically relevant
worsening of depressive symptoms (BDI), most of the
patients (70%) remained stable and 20% evidenced an
improvement on mood after surgery. According to BDI
categories, the proportion of patients with severe depres-
sive symptoms decreased from 12% pre-operatively to 8%
15 months after surgery; the absence of depression varied
from 28% before to 48% after surgery, mild depression
from 43 to 32% and moderate depression from 17 to
The score relative to suicidal ideation (item 9, BDI)
increased in 6 patients (10%); however, no patients
reached a score of 3 indicating a clear purpose to commit
suicide, and only 1 patient had a score of 2. State and trait
anxiety were unchanged in the majority of the patients
with less than 20% experiencing higher levels of anxiety
after surgery.
In addition, STN DBS seems to have a positive effect
on obsessive-compulsive and paranoid traits (SCID-II):
only 7% of the patients showed a worsening of these per-
sonality traits on the postoperative assessment, while
more than 20% of patients showed a clinically relevant
A signifi cant increase in scores related to thought dis-
orders was found in 32% of patients. The percentage of
patients with a score 6 2 after surgery was 13% compared
to 5% prior to surgery. Nevertheless, only 1 patient showed
a postoperative score of 4 indicating true psychosis.
Most patients (64%) did not show a signifi cant increase
in apathy scores, 18% improved and an equal percentage
worsened. Both before and after surgery, the proportion
of PD patients with an apathy score 6 2 (clinically rele-
vant) was 8%.
Table 5. Behavioural data before and 15 months after DBS of STN
n Before surgeryAfter surgeryt test d.f.p
Suicidal ideation (item 9, BDI)
14.9 (8.6)
0.16 (0.45)
45.6 (9.5)
46.3 (9.5)
11.6 (7.0)
0.14 (0.39)
44.0 (9.2)
45.3 (9.0)
Thought disorders (item 2, UPDRS part 1)
Apathy (item 4, UPDRS part 1)
2.9 (1.9)
2.9 (1.6)
4.4 (2.1)
2.6 (1.8)
3.6 (2.0)
2.5 (1.5)
1.7 (1.5)
2.4 (1.0)
1.9 (1.4)
3.2 (2.1)
3.0 (2.3)
0.6 (0.9)
0.18 (0.51)
0.35 (0.68)
2.9 (1.9)
3.0 (2.1)
3.8 (2.0)
2.9 (2.0)
3.2 (2.0)
1.8 (1.5)
1.7 (1.4)
2.2 (1.2)
2.0 (1.5)
3.4 (2.4)
3.0 (2.3)
0.8 (1.2)
0.52 (0.76)
0.35 (0.72)
Results are means with SD in parentheses. Bold = p value ! 0.05.
Page 6
Chronic DBS of STN for Parkinson's
Eur Neurol 2006;55:136–144
As for postoperative modifi cations of psychopharma-
cological agents, the percentage of PD patients assuming
anxiolytics decreased from 43 to 32%, whereas the use of
antidepressants increased from 23 to 37% of patients.
The patients assuming antipsychotics drugs were 20%
pre-operatively and 22% after surgery.
Taken together, the analysis of individual outcomes
evidenced that 9 patients of the present series (14%) ex-
perienced a clinically relevant deterioration 15 months
after the surgical procedure. In particular, 3 cases showed
a relevant cognitive decline (4.5%), 1 of whom associated
with increased anxiety and 1 with increased anxiety and
mood worsening, 1 patient developed psychosis (1.5%),
5 patients experienced a clinically signifi cant worsening
of depressive symptoms (8%), 3 of whom (3% of the total)
associated with an increase in anxiety symptoms. Seven
other patients experienced an increase in anxiety symp-
toms alone (12%). Nevertheless, it is worth noting that 12
patients (20%) showed a relevant improvement in mood
and 14 patients (23%) a relevant improvement in anxiety
symptoms after surgery.
A statistically signifi cant correlation between postop-
erative test modifi cations (pre-operative minus postop-
erative values) was found for mood state improvement
(BDI) and motor improvement (UPDRS part 3) (r 60 =
0.3; p ! 0.03), while no correlation was found between
mood changes and LEDD reduction. Also, obsessive-
compulsive and paranoid subscale scores of the SCID-II
showed a correlation between each other (r 60 = 0.6; p !
0.001), whereas no signifi cant correlation was found be-
tween age, duration of illness, and postoperative test
modifi cations. Apathy and verbal fl uency score modifi ca-
tions (phonemic and semantic separately) did not corre-
late with each other.
The present study confi rms that STN DBS can be con-
sidered a relatively safe procedure in terms of cognitive
and behavioural effects. In agreement with most studies
investigating cognitive effects of STN DBS, we found a
signifi cantly lower number of words produced during the
phonemic and semantic verbal fl uency tasks after the sur-
gical procedure [5, 7–12] . Recently, some investigators
have suggested that the decline on these tasks could de-
pend on the postoperative increase in apathy, since verbal
fl uencies are internally guided tasks [8] . Our fi ndings do
not seem to support this hypothesis because no worsening
in apathy scores was detected concomitant with verbal
Suicidal ideation (item 9, BDI)
Thought disorders (item 2, UPDRS part 1)
Apathy (item 4, UPDRS part 1)
A score was considered as increased or lowered when it was >81 SD.
Table 6. Individual score changes on
behavioural tests 15 months after DBS of
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Castelli et al.
Eur Neurol 2006;55:136–144
fl uency decline. An alternative explanation of this neuro-
psychological side-effect might imply a negative effect of
STN stimulation on the frontotemporal network during
execution of a verbal fl uency task, as demonstrated by a
recent PET study [41] . So, STN stimulation could have a
positive effect on routine and automatic activities, but a
negative effect on some tasks that require a higher rate of
cognitive fl exibility [41, 42] .
On the other hand, the PD patient of our series com-
mitted a lower number of perseverative and total errors
on the Nelson MCST; this fi nding is in agreement with
previous studies that reported an improvement on some
aspects of executive functions after STN DBS [5, 14] .
Nevertheless, the same version of this test was used in
both assessments, possibly making the practice effect re-
sponsible for this improvement.
Three patients out of 65 in our series (4.5%) developed
a relevant cognitive decline. This percentage was in line
with the 6.5% of patients with a cognitive decline ob-
served in another study over 3 years [8] . In agreement
with previous studies, a small improvement in mood state
was found after surgery [4, 8, 16] . In addition, a signifi -
cant correlation was observed between postoperative re-
duction of depressive symptoms and motor benefi t in-
duced by the STN stimulation; probably, the improve-
ment in mood could partially arise as a consequence of
the reduction in motor disability. A clinically relevant
mood worsening was experienced by 6 patients (10%); a
similar proportion of mood worsening was reported by
other studies [13, 18, 19] . To date, no univocal explana-
tion for the post-DBS increase in depressive symptoms
has been provided. On the basis of the correlation be-
tween motor improvement and mood state modifi ca-
tions, one might speculate that a lesser degree of motor
improvement after surgery can have a negative effect on
mood. The correlation we found was statistically weak,
so no certain explanation can be derived from it. Indeed
many factors, such as pre-existing illness, drug therapy or
psychological expectations towards the surgical proce-
dure, may be involved in mood modifi cations [43, 44] .
Recently, it has been suggested that following DBS sur-
gery PD patients could be at higher risk of suicide com-
pared to non-operated PD patients [20, 45] . Burkhard et
al. [20] pointed out that patients at higher risk were those
with a previous history of severe depression, even if de-
pression alone could not predict the decision to commit
suicide. In our series, as in the one of Albanese et al. [45] ,
none of the PD patients attempted or committed suicide;
moreover, we provided an index of suicidal ideation, and
we did not fi nd a signifi cant modifi cation after surgery.
However, further studies are necessary to clarify this im-
portant issue, and a careful selection of PD patients suit-
able for surgery, excluding individuals suffering severe
depressive symptoms, should be considered [20] .
Globally, we evidenced no change in anxiety symp-
toms after surgery, at variance with the few other studies
that reported a postoperative reduction in anxiety [5, 22] .
In a single study, a great number of PD patients with some
kind of anxiety disorder after STN DBS were observed;
however, all except one of these PD patients had already
experienced anxiety disorder before surgery [44] . In our
series, 18% of the patients experienced a clinically rele-
vant worsening in anxiety symptoms, concomitant or not
with a worsening of mood, while 23% of the patients
showed a relevant improvement in anxiety.
An interesting fi nding of the present study is the signi-
fi cant reduction of obsessive-compulsive traits after STN
DBS. This is in agreement with other studies [9, 23] and
provides further support for the recent application of DBS
surgery in the treatment of severe obsessive-compulsive
disorder associated or not with PD [15, 23, 46, 47] . It was
suggested that the amelioration of obsessive-compulsive
traits could result from activation of serotonergic fi bers in
the subcortical-limbic circuitry or, alternatively, from cur-
rent diffusion to the limbic part of the STN [15, 23] .
Paranoid personality traits were also ameliorated after
the surgical procedure: STN-stimulated patients become
less distrustful of other people, and the motor benefi t may
allow them to be more autonomous in life and less wor-
ried about negative judgements of others in social situa-
tions. In accordance with another study [8] , thought dis-
order scores evidenced an overall increase after surgery,
but only 1 patient of our series developed permanent psy-
chosis after STN DBS.
Taken together, our results pointed out a total of 9 pa-
tients (14%) that experienced relevant postoperative cog-
nitive or behavioural disturbances following the DBS
As for depression, these behavioural side-effects could
depend on many factors, such as stimulation per se, the
procedure as a whole, the progression of the disease, the
reduction of dopaminergic drug treatment as well as post-
operative psychological adjustments [44] . The present
study does not allow us to discriminate between these
variables. That being said, in our experience it is impor-
tant to moderate the patients' expectations towards the
benefi t of the intervention. Many patients, especially the
ones with pre-operative depression, frequently developed
wild and unrealistic expectations of becoming complete-
ly healthy [20] .
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Chronic DBS of STN for Parkinson's
Eur Neurol 2006;55:136–144
The present study has some limitations that are usu-
ally present in longitudinal studies. First, we did not in-
clude a control group of unoperated PD patients. So, even
if little cognitive decline is usually observed over a period
of 12 months [5, 11] , it is still possible that some of the
cognitive and behavioural modifi cations observed derive
from the progression of the illness independently of the
DBS procedure. Second, since only memory tests were
administered in parallel versions, the improvement ob-
served in other tasks could partially result from practice
effect. However, we can suppose that the test-retest effect
has been partially limited by the suffi ciently long interval
elapsed between the two evaluations.
In conclusion, our fi ndings confi rm that STN DBS did
not lead to cognitive decline or behavioural disturbances
in most of the cases. Nevertheless, since 14% of the STN-
stimulated PD patients experienced neuropsychological
or relevant behavioural disturbances, further studies are
still needed to clarify which pre-operative clinical fea-
tures or postoperative modifi cations can be responsible
for this.
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