text:
- About this Journal ·
- Abstracting and Indexing ·
- Advance Access ·
- Aims and Scope ·
- Annual Issues ·
- Article Processing Charges ·
- Articles in Press ·
- Author Guidelines ·
- Bibliographic Information ·
- Citations to this Journal ·
- Contact Information ·
- Editorial Board ·
- Editorial Workflow ·
- Free eTOC Alerts ·
- Publication Ethics ·
- Reviewers Acknowledgment ·
- Submit a Manuscript ·
- Subscription Information ·
- Table of Contents
International Journal of Alzheimer's Disease
Volume 2010 (2010), Article ID 417615, 7 pages
Are Guidelines Needed for the Diagnosis and Management of Incipient Alzheimer's Disease and Mild Cognitive Impairment?
1Fondazione Santa Lucia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome 00179, Italy
2Institute of Biomedical Technologies, CNR, 20090, Segrate, Italy
3Department of Neuroscience, University of Rome Tor Vergata, Rome 00173, Italy
Received 3 May 2010; Accepted 5 July 2010
Academic Editor: Lucilla Parnetti
Copyright © 2010 Katie Palmer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Current research is aiming to push the boundaries of the point at which a diagnosis of Alzheimer Disease (AD) can be made. Clinical syndromes such as Mild Cognitive Impairment (MCI) and various clinical and biological markers of AD may help to identify people in the early stage of AD, before a full dementia syndrome is present. In the first part of this paper, we discuss whether MCI represents incipient AD, and examine some of the methods currently used in research to identify AD patients in the preclinical phase. In the second part, we discuss whether specific guidelines are needed for the diagnosis and management of MCI and incipient AD, and consider the potential impact of this on clinical practice and public health from the perspective of patients, caregivers, and healthcare providers.
1. Introduction: The Concept of MCI and Incipient AD
Currently, dementia of the Alzheimer type is diagnosed clinically according to diagnostic criteria [1]. These criteria include deficits in memory and other cognitive functions, and the symptoms have a gradual onset and progressive deterioration. The H. Braak and E. Braak [2, 3] staging describes an increasing burden of the neuropathological hallmarks of Alzheimer disease (AD), neurofibrillary tangles, and amyloid plaques, with increasing dementia severity, mainly starting in the brain regions associated with memory functioning such as the hippocampus and entorhinal cortex. Evidence now clearly shows that the disease starts before the symptoms of a full dementia syndrome are present. AD related pathology, such as beta amyloid deposition, may already begin occurring even ten to twenty years before a clinical diagnosis of dementia can be made [4]. Furthermore, deficits in cognitive functioning may start to appear three [5], six, or even up to ten years [6] before a clinical diagnosis of AD.
Several syndromes that identify patients at high risk of developing dementia—or "preclinical, early AD" syndromes—have been proposed, including Mild Cognitive Impairment (MCI) and others; for a review see Mariani and colleagues [7]. A decade ago, Petersen et al. [8] proposed diagnostic criteria to describe patients who were neither normal nor demented, but had a mild form of cognitive impairment characterized by memory deficits. The MCI paradigm is based on the assumption that patients with AD develop symptoms, particularly memory impairment, gradually and, therefore, there may be an intermittent stage between normal aging and dementia characterized primarily by episodic memory deficits. These MCI patients have a high risk of progressing to a full dementia syndrome within a few years [8], although, as discussed later, the evolution is heterogeneous.
In the last decade, much focus has been paid to identifying clinically diagnosable syndromes of incipient AD. Criteria for MCI, and other syndromes, have been revised several times [9–11], with interest in identifying specific characteristics of MCI patients who are at the highest risk of progressing to AD. People with MCI progress to dementia at a rate of about 6% to 15% per year [7, 8, 12, 13], although the condition is heterogeneous and some MCI patients do not develop dementia. As discussed in a recent systematic review of MCI [7], a number of factors have been suggested to further predict conversion to AD in MCI patients, and it is becoming increasingly evident that biomarkers, such as cerebrospinal fluid (CSF) markers including beta-amyloid1-42 and total tau protein, may have a good accuracy for identifying impending AD in MCI patients [14] compared to healthy controls. Although the differential diagnostic capacity of using CSF markers between the preliminary states of various dementia disorders has not yet been thoroughly studied, the discoveries regarding AD are pushing the boundaries as to when AD can be identified and diagnosed in individuals.
2. Guidelines for AD and Dementia
Guidelines for the diagnosis and management of AD and other dementias are regularly published, updated, and revised in the USA and elsewhere in the world [15–19]. The latest European recommendations for the diagnosis and management of AD were published by the European Federation of Neurological Societies (EFNS) [17]. These evidence-based guidelines were created through a consensus process to provide guidance for physicians concerning diagnostic evaluation and management of dementia, including pharmacological and nonpharmacological treatment, management of behavioral and psychological symptoms of dementia (BPSD), counseling and support for caregivers, and so forth. The EFNS guidelines state that the recommendations are relevant only to dementia, and do not include MCI. Recently, Dubois et al. [20] published new diagnostic criteria for the early detection of AD. These were proposed as research criteria, rather than for clinical diagnosis and patient management, and incorporate clinical evidence of episodic memory loss (isolated or with other cognitive deficits) with biomarkers (CSF, neuroimaging, genetic) to identify patients in an early, predementia stage of AD. The criteria are novel because rather than focusing on the dementia syndrome they focus on clinical, biological, structural, and biochemical presence of AD in a predementia phase. These, and other, criteria for syndromes of early preclinical phases of AD raise controversial questions in the scientific and medical world. Should physicians diagnose MCI or incipient AD? Should MCI patients be treated? How should physicians and healthcare workers manage the healthcare of patients with MCI? Should dementia guidelines be revised to incorporate MCI? In this paper, we will discuss the disadvantages and advantages of omitting MCI and incipient AD from dementia guidelines, and discuss the potential impact on clinical practice and public health from the perspective of patients, caregivers, and healthcare providers.
3. Does MCI Represent Incipient AD?
The first relevant question to ask in this discussion is whether syndromes such as MCI truly represent an early preclinical phase of AD. Research both from clinical- and population-based samples suggest that MCI patients have a high risk of progressing to a full dementia syndrome; a meta-analyses [12] of longitudinal studies of individuals with MCI reported an annual conversion rate of 8.1% in clinical settings, and 6.8% in community-based settings. Pooled-analysis [13] suggests that about one third of MCI patients will convert to AD, with a higher conversion rate in the first few years following MCI diagnosis. However, it has consistently been shown that not all MCI patients will develop AD [7, 12], and that cognitive impairment in the elderly has heterogeneous risk factors [21] and potentially diverse etiologies and causes [11]. Although neuropathological studies on MCI patients indicate that pathological findings in the brain structures involved in memory represent a transition between normal aging and AD, many concurrent pathological abnormalities are also present in these patients, including vascular lesions and argyrophilic grain disease [22]. Further, neuropathological investigations in patients who progressed from MCI to AD show a heterogeneous pathological outcome [23]. In addition, not all AD patients pass through a clinically identifiable stage of MCI with subjective and objective memory deficits present prior to dementia diagnosis [24]. Thus, the evidence suggests that, although MCI does represent a group of individuals with a high risk of progressing to AD, MCI does not equal incipient AD because not all MCI patients will develop AD.
As mentioned previously, much work has been done to further characterize MCI patients to identify which individuals are most likely to develop AD. Therefore, although patients with a clinical diagnosis of MCI do not necessarily have AD, there are subsets of MCI patients who have a neurodegenerative AD etiology, and are in the early phase of AD. Functional markers, cognitive testing, hippocampal and entorhinal cortex atrophy, neuropsychiatric disorders, genetic factors such as Apolipoprotein E (ApoE) epsilon 4 (ε4) allele, increased age, low education, and motor dysfunction are all markers that have been shown to identify which MCI patients have the highest risk of developing AD [7]. It is also evident that combining factors (including neuroimaging, clinical, and sociodemographic markers) [25, 26] increases the prediction for identifying which MCI patients will progress to AD. Indeed, Dubois and colleagues' research criteria for the early detection of AD [20] incorporate clinical evidence of cognitive deficits with neuroimaging, CSF, and genetic biomarkers. However, it is not yet clear which markers and cutoff values are the best for identifying incipient AD patients; although Dubois and colleagues make some suggestions for biomarkers, such as hippocampal volume loss, it was emphasized that research should identify and validate other biomarkers and neuroimaging regions of interest in the future. It is worth noting that although combining markers will help to increase the positive predictive value for identifying which MCI patients will develop AD, ultimately this may lead to a drop in the other diagnostic values. Tests and markers with high positive predictive value are likely to have lower sensitivity, especially at the population level. Therefore, very few patients with AD will be able to be identified in the early stage of the disease.
As discussed elsewhere in this special issue, much research effort has been made in the field of biomarkers, particularly CSF, for identifying patients in the early, predementia, phase of AD. A multicenter study of the CSF markers in MCI patients has shown innovative results concerning the use of beta-amyloid1-42, total tau protein, and tau phosphorylated at position threonine 181, which was found to have a good accuracy for identifying impending AD in MCI patients [14]. This was one of the first studies to pool the data from a large range of single center studies. It showed that the positive predictive value of these CSF markers for identifying incipient AD in MCI patients was 62%, with a sensitivity of 83%. However, despite these promising results, the findings should be viewed with caution. An editorial by Petersen and Tojanowski [27] highlighted the clinical variability of the MCI patients as well as the variability in CSF measurements in the different centers in Mattsson and colleagues' work. Further, they acknowledged that although the sensitivity and specificity of the CSF markers were adequate for screening, they did not have high enough accuracy to be used as diagnostic tests, although they may be useful for use in clinical trials [27]. Interestingly, the positive predictive value showed that 62% of MCI patients developed AD when a combination of the three CSF markers was used [14]. However, this positive predictive value needs to be compared with other markers and clinical syndromes. Before taking into consideration other markers, the cumulative conversion rate from MCI to AD across studies is 31.4% [13]. Furthermore, other studies have shown that this positive predictive value can be increased by combining other, less invasive, markers. For example, a prediction model using five factors (functional and olfactory markers, cognitive testing, and MRI measures of hippocampal volume and entorhinal cortex volume) had a positive predictive value of more than 80% for identifying incipient AD in MCI patients [25].
There are important limitations to consider when examining clinical and laboratory markers in MCI patients. First, laboratory samples are mainly taken from clinical patient populations, which may not be representative of the general population. Consequently, the sensitivity of a laboratory measure evaluated in a clinical sample does not reflect the level of sensitivity of the test if used at the population level. Second, a study in the general population showed that half of AD patients have no subjective complaints about their memory performance up to one to three years before AD diagnosis, and one fifth show absolutely no cognitive deficits [24]. This highlights the heterogeneity of patients in the preclinical phase of AD. It is likely that patients who seek medical advice for cognitive problems are at a more advanced stage of cognitive impairment, closer to the diagnosis of AD, which will affect the accuracy of measurements of sensitivity and predictive values in markers such as CSF values. Finally, the multicenter study by Mattsson et al. [14] found that the diagnostic validity of CSF markers had less accuracy in the multicenter analysis than the accuracy reported in single-center settings. This highlights the importance of replicating positive results from single centers, which are often conducted on small study populations, and the need for more multicenter trials and meta-analyses to determine the accuracy of biomarkers for identifying incipient AD.
4. Do We Need Guidelines for the Diagnosis and Management of MCI?
MCI is a frequently occurring syndrome in the elderly. A European longitudinal study [28] reported an incidence rate per 1000 person years of between 11.4 for amnestic-MCI and 33.8 for other types of cognitive impairment, and prevalence data suggests that cognitive impairment syndromes in younger nondemented elderly actually exceed dementia prevalence [29]. Given that MCI is a frequent syndrome in older people, and that individuals with MCI have a high risk of progressing to AD [7, 12], this raises the question of what should be done with such patients. As mentioned earlier, guidelines for the management of dementia often do not include recommendations for patients with MCI. However, many of the issues regarding both diagnosis and management of dementia may also be relevant to the large number of elderly persons suffering from MCI, who may or may not be in the early stage of AD. Clinically, MCI could be viewed, not as a disease or disorder per se, but as a risk factor for AD. Risk factors such as this are commonly addressed in other areas of medicine. Many conditions have been shown to predispose an individual to a higher risk of developing another medical condition, such as hypertension for stroke and myocardial infarction, dyslipidemia for stroke and other vascular disease, diabetes for osteoporosis and so forth. In good clinical practice, clinicians explain the risks associated with such conditions with their patients, and plan appropriate care and management. In this way, MCI should be viewed as a clinical syndrome that has a high risk of progressing to AD. Thus, if clinicians were to consider MCI, not as incipient AD, but as a risk factor for developing AD, certain issues concerning management and treatment that have been raised for dementia, may be relevant also to MCI.
5. Treatment of MCI
First, although dementia disorders such as AD are currently not curable, there are a number of symptomatic pharmaceutical treatments that are recommended in guidelines for dementia [17, 30]. Conversely, there are currently no approved drugs for the treatment of MCI or early preclinical AD. Clinical trials on MCI patients have had limited success; none of the trials, including donepezil, rivastigmine, rofecoxib, galantamine, and vitamin E, have demonstrated convincing effects for delaying progression from MCI to AD [31, 32]. However, other trials are ongoing, and data on subsets of MCI patients have identified potentially promising avenues for future research. For example, although randomized-control trials on cholinesterase inhibitors such as donepezil have shown little or no reduction in the risk of conversion from MCI to AD [33–35], the results of one trial suggested that MCI patients with depressive symptoms treated with donepezil had a lower risk of conversion to AD [36]. Without the availability of effective treatment strategies, and in the absence of approved drugs for the treatment of MCI or incipient AD, one may question the benefits of diagnosing such syndromes. Thus, dementia guidelines, such as those proposed by EFNS, might be right to avoid discussing disease-specific treatment strategies for MCI, since MCI per se is not a disease, and currently there are no approved drugs for MCI. However, pharmacological treatments are not the only recommendations suggested in current guidelines for dementia, and the other recommendations might be of relevance to MCI patients as well as those with dementia, including suggestions for diagnosis, management of BPSDs, and support for families and caregivers.
6. Nonpharmacological Treatment and Interventions
Although there are no currently approved pharmacological treatments for MCI, nonpharmacological interventions have also been the focus of recent research. Management of risk factors and somatic disorders, lifestyle changes, and cognitive intervention programmes may be beneficial to certain patients, and may be advantageous as they might have less side effects and risks than pharmacological drugs. Cognitive rehabilitation studies in MCI [37–39] have showed improvement in ADL functioning, mood, and memory following training, although there is no evidence for delayed progression from MCI to AD. Further, if MCI patients are told of their high risk of developing AD, there are possibilities for modifying risk factors associated with AD, such as diet, somatic, and lifestyle factors [40]. Further, as it has been shown that MCI has heterogeneous risk factors [21] and that MCI may have diverse somatic, psychiatric, and neurological etiologies [11], the modification of somatic and lifestyle factors may be beneficial to the overall health of MCI patients, even those who are not in a preclinical phase of AD.
7. Disclosure of MCI Diagnosis
There is ongoing debate as to whether a formal diagnosis of MCI should be made and disclosed to patients in the clinical setting. The fact is that increasing numbers of elderly people are approaching physicians complaining of memory problems, and there is a high incidence of both MCI and other syndromes of cognitive impairment in the elderly [28]. There may be some benefits to disclosing a diagnosis of MCI to a patient and discussing the associated risk of developing AD. First, it allows patients to plan for their future before their cognitive impairment becomes severe, including financial planning, and the planning of care and living arrangements for the future. Second, in some cases it may be helpful for individuals to have a formal diagnosis that somewhat explains their symptoms. From the physician's perspective, giving an early diagnosis may be beneficial as the patient will have better cognitive capacities to understand the diagnosis and discuss future treatment and care options; indeed, studies have shown that physicians are often reluctant to disclose a diagnosis of dementia in more severe stages of the disease due to lack of comprehension by the patient [41]. Furthermore, physicians may be concerned that disclosing a diagnosis of dementia may trigger catastrophic events in the patient such as depression or suicide. However, a study by Carpenter et al. [42] examined changes in depression and anxiety both in patients and their relatives before and after the diagnosis of dementia. They found that there were no changes in depression status in either patients or their next-of-kin after a disclosure of a dementia diagnosis, but levels of anxiety decreased substantially after receiving the diagnosis. This supports the idea that receiving a formal diagnosis that explains the symptoms and memory loss can actually be beneficial to a patient.
Interesting lessons can also be learned from studies investigating the effect of disclosing genetic risk of AD to individuals, such as ApoE 4, a cardiovascular risk factor which is also associated with an increased risk of developing AD [43]. Both MCI and the ApoE ε4 genotype are associated with a higher risk of AD but do not represent a definite risk; that is, not all patients with MCI or ApoE 4 will develop AD. The REVAL study group [44] investigated the effect of disclosing AD risk (both ApoE genotype and a numeric risk estimate) to family members of AD patients using a randomized-control trial design. They found no differences in short-term psychological symptoms such as anxiety, depression, or distress between people who were told that they had a genetic risk of developing AD (ApoE carriers) than those who were not told their genotype. However, when questioned after one year, individuals were more likely to recall their genotype than their numerical lifetime risk estimate of AD [45]. The authors suggested that clinicians, therefore, needed to find an appropriate manner to communicate AD risk and probabilities. Most interestingly, however, was that disclosure of genetic AD risk was associated with a change in behaviors; a large proportion of individuals made changes to their long-term healthcare insurance after learning they were ApoE 4 carriers [46] and more than half made changes to their health behavior, such as vitamin intake and exercise [47]. Although specific studies on the disclosure of MCI diagnosis are needed, the results of there studies on disclosing genetic AD risk suggest potentially beneficial effects of informing an at-risk individual that they have a high risk of developing AD.
8. Recommendations for the Management of BPSD
Although there are no approved treatments for MCI, patients with this syndrome might have other related symptoms that can be treated. The EFNS guidelines for dementia stipulate that physicians should be aware of the importance of treating behavioral and psychiatric symptoms for the potential benefit of the patients and carers. This may also be relevant to MCI patients. Studies both from clinical- and population-based samples consistently report a high burden of BPSD in MCI patients, particularly depression, anxiety, and irritability (for a review see Monastero and colleagues [48]). Indeed the pattern of BPSD in MCI are similar to those observed in patients with dementia, and symptoms have been observed in more than one third of patients, with many studies reporting a higher prevalence [48], even up to 85%. Nevertheless, the role of BPSD in MCI remains unclear and, thus, treatment of specific symptoms or psychiatric disorders in this group of patients is controversial. A population-based study showed that anxiety in MCI patients was associated with an ongoing AD related neurodegeneration [49], and clinical-based studies suggest a similar role for apathy [50–52]. In contrast, depression in MCI is generally not associated with progression to AD [49, 53]. There are currently no clinical trials investigating the effect of treating BPSD and psychiatric disorders in MCI patients, and thus it is not known whether pharmacological treatments are effective either in slowing the progression from MCI to AD or in reducing the severity of neuropsychiatric symptoms in these patients. Indeed, the situation is similar for patients already in the stage of clinical dementia; current guidelines for dementia [17] highlight these controversies.
9. Patient Guidelines and Advice
Guidelines on MCI for healthcare workers as well as patients have already been published in America. In 2010, the American Academy of Physician Assistants [54] published guidelines for physician assistants, stating that they should be able to recognize and treat MCI and dementia. Specific suggestions were made for screening tools, cognitive and somatic evaluation of at-risk patients, as well as tentative recommendations for treatment strategies. A Patient Page, published in the Journal of the American Medical Association [55], aims to provide patients and families with general information about MCI, including possible conditions associated with MCI, a description of diagnostic techniques, and some recommendations for prevention, mainly the management of high blood pressure and other chronic conditions, as well as social activities and dietary changes. A patient and family fact sheet on MCI, published in The Neurologist [56] describes potential causes of cognitive impairment in the elderly, rather than focusing specifically on AD, and describes diagnostic procedures and examination that might be conducted on patient with suspected cognitive problems. It also makes suggestions for life style changes, including social and dietary changes.
10. Conclusions
In conclusion, MCI is not a disease or disorder, but a risk factor for developing dementia and AD. Although studies examining biological markers and other factors in MCI patients have identified markers that further increase the risk of developing AD in these patients, we are still not at a stage where we can accurately identify with 100% accuracy which patients are in the early phase of AD. Consequently, current guidelines for the diagnosis and management of AD and dementia often do not include specific suggestions for MCI. Despite this, many of the recommendations made for patients with dementia, may also be relevant to people with MCI. Therefore, peer-reviewed, consensus guidelines for the diagnosis and management of incipient AD or MCI might be beneficial in the future. However, it is imperative to focus future research on identifying more accurate diagnostic markers to define incipient AD, and to study the effect of informing patients that they have a high risk of developing AD, in terms of psychological reactions and potential benefits for planning appropriate management and prevention strategies in MCI patients.
- G. McKhann, D. Drachman, M. Folstein, R. Katzman, D. Price, and E. M. Stadlan, "Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease," Neurology, vol. 34, no. 7, pp. 939–944, 1984.
- H. Braak and E. Braak, "Neuropathological stageing of Alzheimer-related changes," Acta Neuropathologica, vol. 82, no. 4, pp. 239–259, 1991. View at Scopus
- H. Braak and E. Braak, "Staging of Alzheimer's disease-related neurofibrillary changes," Neurobiology of Aging, vol. 16, no. 3, pp. 271–278, 1995. View at Publisher · View at Google Scholar · View at Scopus
- C. R. Jack Jr., V. J. Lowe, and V. J. Lowe, "Serial PIB and MRI in normal, mild cognitive impairment and Alzheimers disease: implications for sequence of pathological events in Alzheimers disease," Brain, vol. 132, no. 5, pp. 1355–1365, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- L. Bäckman, S. Jones, A.-K. Berger, E. J. Laukka, and B. J. Small, "Cognitive impairment in preclinical Alzheimer's disease: a meta-analysis," Neuropsychology, vol. 19, no. 4, pp. 520–531, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- H. Amieva, M. Le Goff, and M. Le Goff, "Prodromal Alzheimer's disease: successive emergence of the clinical symptoms," Annals of Neurology, vol. 64, no. 5, pp. 492–498, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- E. Mariani, R. Monastero, and P. Mecocci, "Mild cognitive impairment: a systematic review," Journal of Alzheimer's Disease, vol. 12, no. 1, pp. 23–35, 2007. View at Scopus
- R. C. Petersen, G. E. Smith, S. C. Waring, R. J. Ivnik, E. G. Tangalos, and E. Kokmen, "Mild cognitive impairment: clinical characterization and outcome," Archives of Neurology, vol. 56, no. 3, pp. 303–308, 1999. View at Scopus
- R. C. Petersen, R. Doody, and R. Doody, "Current concepts in mild cognitive impairment," Archives of Neurology, vol. 58, no. 12, pp. 1985–1992, 2001. View at Scopus
- R. C. Petersen, "Mild cognitive impairment as a diagnostic entity," Journal of Internal Medicine, vol. 256, no. 3, pp. 183–194, 2004. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- B. Winblad, K. Palmer, and K. Palmer, "Mild cognitive impairment—beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment," Journal of Internal Medicine, vol. 256, no. 3, pp. 240–246, 2004. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- A. J. Mitchell and M. Shiri-Feshki, "Rate of progression of mild cognitive impairment to dementia—meta-analysis of 41 robust inception cohort studies," Acta Psychiatrica Scandinavica, vol. 119, no. 4, pp. 252–265, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- A. J. Mitchell and M. Shiri-Feshki, "Temporal trends in the long term risk of progression of mild cognitive impairment: a pooled analysis," Journal of Neurology, Neurosurgery and Psychiatry, vol. 79, no. 12, pp. 1386–1391, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- N. Mattsson, H. Zetterberg, and H. Zetterberg, "CSF biomarkers and incipient Alzheimer disease in patients with mild cognitive impairment," Journal of the American Medical Association, vol. 302, no. 4, pp. 385–393, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- Alzheimer's Association, "2009 Alzheimer's disease facts and figures," Alzheimer's and Dementia, vol. 5, no. 3, pp. 234–270, 2009.
- R. N. Kalaria, G. E. Maestre, and G. E. Maestre, "Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors," The Lancet Neurology, vol. 7, no. 9, pp. 812–826, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- G. Waldemar, B. Dubois, and B. Dubois, "Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline," European Journal of Neurology, vol. 14, no. 1, pp. e1–e26, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- C. Caltagirone, A. Bianchetti, and A. Bianchetti, "Guidelines for the treatment of Alzheimer's disease from the Italian association of psychogeriatrics," Drugs and Aging, vol. 22, supplement 1, pp. 1–26, 2005. View at Publisher · View at Google Scholar · View at Scopus
- M. Musico, C. Caltagirone, and C. Caltagirone, "Italian Neurological Society guidelines for the diagnosis of dementia: revision I," Neurological Sciences, vol. 25, no. 3, pp. 154–167, 2004. View at Scopus
- B. Dubois, G. Picard, and M. Sarazin, "Early detection of Alzheimer's disease: new diagnostic criteria," Dialogues in Clinical Neuroscience, vol. 11, no. 2, pp. 135–139, 2009. View at Scopus
- R. Monastero, K. Palmer, Q. Chengxuan, B. Winblad, and L. Fratiglioni, "Heterogeneity in risk factors for cognitive impairment in non-demented elderly: a population based longitudinal study," American Journal of Geriatric Psychiatry, vol. 22, pp. 60–69, 2007.
- R. C. Petersen, J. E. Parisi, and J. E. Parisi, "Neuropathologic features of amnestic mild cognitive impairment," Archives of Neurology, vol. 63, no. 5, pp. 665–672, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- G. A. Jicha, J. E. Parisi, and J. E. Parisi, "Neuropathologic outcome of mild cognitive impairment following progression to clinical dementia," Archives of Neurology, vol. 63, no. 5, pp. 674–681, 2006. View at Scopus
- K. Palmer, L. Bäckman, B. Winblad, and L. Fratiglioni, "Early symptoms and signs of cognitive deficits might not always be detectable in persons who develop Alzheimer's disease," International Psychogeriatrics, vol. 20, no. 2, pp. 252–258, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- D. P. Devanand, X. Liu, and X. Liu, "Combining early markers strongly predicts conversion from mild cognitive impairment to Alzheimer's disease," Biological Psychiatry, vol. 64, no. 10, pp. 871–879, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- K. Kantarci, S. D. Weigand, and S. D. Weigand, "Risk of dementia in MCI: combined effect of cerebrovascular disease, volumetric MRI, and 1H MRS," Neurology, vol. 72, no. 17, pp. 1519–1525, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- R. C. Petersen and J. Q. Trojanowski, "Use of Alzheimer disease biomarkers: potentially yes for clinical trials but not yet for clinical practice," Journal of the American Medical Association, vol. 302, no. 4, pp. 436–437, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- B. Caracciolo, K. Palmer, R. Monastero, B. Winblad, L. Bäckman, and L. Fratiglioni, "Occurrence of cognitive impairment and dementia in the community: a 9-year-long prospective study," Neurology, vol. 70, no. 19, pp. 1778–1785, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- D. De Ronchi, D. Berardi, M. Menchetti, G. Ferrari, A. Serretti, E. Dalmonte, and L. Fratiglioni, "Occurrence of cognitive impairment and dementia after the age of 60: a population-based study from northern Italy," Dementia and Geriatric Cognitive Disorders, vol. 19, no. 2-3, pp. 97–105, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- J. Neugroschl and M. Sano, "An update on treatment and prevention strategies for Alzheimer's disease," Current Neurology and Neuroscience Reports, vol. 9, no. 5, pp. 368–376, 2009. View at Publisher · View at Google Scholar · View at Scopus
- V. Jelic, M. Kivipelto, and B. Winblad, "Clinical trials in mild cognitive impairment: lessons for the future," Journal of Neurology, Neurosurgery and Psychiatry, vol. 77, no. 4, pp. 429–438, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- M. R. Farlow, "Treatment of mild cognitive impairment (MCI)," Current Alzheimer Research, vol. 6, no. 4, pp. 362–367, 2009. View at Publisher · View at Google Scholar · View at Scopus
- R. C. Petersen, R. G. Thomas, and R. G. Thomas, "Vitamin E and donepezil for the treatment of mild cognitive impairment," The New England Journal of Medicine, vol. 352, no. 23, pp. 2379–2388, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- T. Sobów and I. Kłoszewska, "Cholinesterase inhibitors in mild cognitive impairment: a meta-analysis of randomized controlled trials," Neurologia i Neurochirurgia Polska, vol. 41, no. 1, pp. 13–21, 2007. View at Scopus
- R. S. Doody, S. H. Ferris, and S. H. Ferris, "Donepezil treatment of patients with MCI: a 48-week randomized, placebo-controlled trial," Neurology, vol. 72, no. 18, pp. 1555–1561, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- P. H. Lu, S. D. Edland, E. Teng, K. Tingus, R. C. Petersen, and J. L. Cummings, "Donepezil delays progression to AD in MCI subjects with depressive symptoms," Neurology, vol. 72, no. 24, pp. 2115–2121, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- L. Jean, M.-E. Bergeron, S. Thivierge, and M. Simard, "Cognitive intervention programs for individuals with mild cognitive impairment: systematic review of the literature," American Journal of Geriatric Psychiatry, vol. 18, no. 4, pp. 281–296, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- E. Talassi, M. Guerreschi, M. Feriani, V. Fedi, A. Bianchetti, and M. Trabucchi, "Effectiveness of a cognitive rehabilitation program in mild dementia (MD) and mild cognitive impairment (MCI): a case control study," Archives of Gerontology and Geriatrics, vol. 44, supplement 1, pp. 391–399, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- A. Kurz, C. Pohl, M. Ramsenthaler, and C. Sorg, "Cognitive rehabilitation in patients with mild cognitive impairment," International Journal of Geriatric Psychiatry, vol. 24, no. 2, pp. 163–168, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- L. E. Middleton and K. Yaffe, "Promising strategies for the prevention of dementia," Archives of Neurology, vol. 66, no. 10, pp. 1210–1215, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- H. Johnson, W. P. Bouman, and G. Pinner, "On telling the truth in Alzheimer's disease: a pilot study of current practice and attitudes," International Psychogeriatrics, vol. 12, no. 2, pp. 221–229, 2000. View at Scopus
- B. D. Carpenter, C. Xiong, and C. Xiong, "Reaction to a dementia diagnosis in individuals with Alzheimer's disease and mild cognitive impairment," Journal of the American Geriatrics Society, vol. 56, no. 3, pp. 405–412, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- C. Purnell, S. Gao, C. M. Callahan, and H. C. Hendrie, "Cardiovascular risk factors and incident alzheimer disease: a systematic review of the literature," Alzheimer Disease and Associated Disorders, vol. 23, no. 1, pp. 1–10, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- R. C. Green, J. S. Roberts, and J. S. Roberts, "Disclosure of APOE genotype for risk of Alzheimer's disease," The New England Journal of Medicine, vol. 361, no. 3, pp. 245–254, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- S. L. Eckert, H. Katzen, and H. Katzen, "Recall of disclosed apolipoprotein E genotype and lifetime risk estimate for Alzheimer's disease: the REVEAL study," Genetics in Medicine, vol. 8, no. 12, pp. 746–751, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- C. D. Zick, C. J. Mathews, J. S. Roberts, R. Cook-Deegan, R. J. Pokorski, and R. C. Green, "Genetic testing for Alzheimer's disease and its impact on insurance purchasing behavior," Health Affairs, vol. 24, no. 2, pp. 483–490, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- S. Chao, J. S. Roberts, T. M. Marteau, R. Silliman, L. A. Cupples, and R. C. Green, "Health behavior changes after genetic risk assessment for Alzheimer disease: the REVEAL study," Alzheimer Disease and Associated Disorders, vol. 22, no. 1, pp. 94–97, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- R. Monastero, F. Mangialasche, C. Camarda, S. Ercolani, and R. Camarda, "A systematic review of neuropsychiatric symptoms in mild cognitive impairment," Journal of Alzheimer's Disease, vol. 18, no. 1, pp. 11–30, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- K. Palmer, A. K. Berger, R. Monastero, B. Winblad, L. Bäckman, and L. Fratiglioni, "Predictors of progression from mild cognitive impairment to Alzheimer disease," Neurology, vol. 68, no. 19, pp. 1596–1602, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- B. Vicini Chilovi, M. Conti, M. Zanetti, I. Mazzù, L. Rozzini, and A. Padovani, "Differential impact of apathy and depression in the development of dementia in mild cognitive impairment patients," Dementia and Geriatric Cognitive Disorders, vol. 27, no. 4, pp. 390–398, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- P. H. Robert, C. Berr, and C. Berr, "Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer's disease. A one-year follow-up study," Clinical Neurology and Neurosurgery, vol. 108, no. 8, pp. 733–736, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- K. Palmer, F. Di Iulio, A. Varsi, et al., "Neuropsychiatric predictors of progression from amnestic-Mild Cognitive Impairment to Alzheimer's Disease. The role of depression and apathy," Journal of Alzheimer's Disease, vol. 20, pp. 175–183, 2010.
- L. Rozzini, B. V. Chilovi, M. Trabucchi, A. Padovani, and P. J. Modrego, "Depression is unrelated to conversion to dementia in patients with mild cognitive impairment," Archives of Neurology, vol. 62, no. 3, pp. 505–506, 2005. View at Scopus
- G. A. Boissonneault, "MCI and dementia: diagnosis and treatment," Journal of the American Academy of Physicians Assistants, vol. 23, no. 1, pp. 18–21, 2010.
- J. M. Torpy, C. Lynm, and R. M. Glass, "JAMA patient page. Mild cognitive impairment," Journal of the American Medical Association, vol. 302, no. 4, p. 452, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
- C. A. Kernich, "Patient and family fact sheet. Mild cognitive impairment," Neurologist, vol. 15, pp. 303–304, 2009.


text:
We are glad that you were able to attend the Istoria Conference and would love to get your feedback to help us improve future events at Coastal Church. The following survey should take 1-2 minutes to complete and your comments would be much appreciated.
Pastor Dave Koop introduces the Istoria Conference
2013 Conference Speakers
- All
- 2013 Istoria Conference
Jim Krueger
After graduating from Marquette University with a degree in Journalism, Jim Krueger won two Addy Awards during his first year as a copywriter. A year later he became a creative director at Marvel Comics and has since become president and publisher of his own comic book entertainment company, 26 Soldiers. Jim was also named as one of the top ten writers in comics and an innovator in the field by Wizard Magazine.
Gordon Pennington
Former director of marketing for Tommy Hilfiger, Gordon Pennington is an international consultant to corporations, governments and institutions. His clients have included J.P. Morgan, Chase, CBS, British Airways, Mercedes Benz and others. He currently serves with Burning Media Group in New York.
Pastor Willie George
Willie George is the founding and lead pastor of Church on the Move in Tulsa, Oklahoma. Today, the effectiveness of his vision is revealed in the amazing second-generation leadership team at Church on the Move. The same communicative skills that marked Willie George as a children's minister have positioned him as the Senior Pastor of one of America's most innovative churches.
Braden Douglas
Braden Douglas, a seasoned marketer with over 10 years of experience, has fused strategic planning and unique creative designs to form the backbone of Relevention Marketing Inc. – one of the fastest growing results-based marketing agencies in British Columbia.
Pastor Dave Koop
Pastor Dave Koop is the Istoria Conference host and senior pastor of Coastal Church, located in beautiful downtown Vancouver, Canada. Pastor Dave has a passion for reaching highrise communities, and using story and creative communication as tools for reaching today's culture.

subset: commoncrawl


text:
Tag Archives: style
Our Vibe via Tel Aviv, Israel
Vintage by Misty's Poolside Runway Show 2013
Spring Trending with Vintage by Misty
Shop now online VBM or visit us at 818 N Central Avenue Phoenix Arizona 85004
Happy Spring, Love Misty
Green Moment with Vintage by Misty
Stop and Shop VBM's Sale
Bring in the new year with a little revamping! Stop being boring add some vintage into your life, Shop Vintage By Misty up to 50% off the entire shop!!! Birkin Approved
818 N Central Avenue Phoenix Arizona 85004
My Vibe: Closet Tour with Phoenix New Times
MOD Magazine + Vintage by Misty
Vintage by Misty was featured in the latest issue of MOD Magazine check out the official link here http://mod-magazine.com/read/ make sure to follow Vintage by Misty on Facebook , Pintrest , Twitter and Tumblr
Day 16 to Day 21 Vintage by Misty
Style Talk with Vintage by Misty
Misty's Vintage Fashion Style Talk with Jill Laine Style, I'm so honored to be a part of something very special. We can not give you details just yet but here is a taste of whats to come with Vintage By Misty and Jill Laine Style….it's HUGE!!!!


text:
National Vocational Qualification
National Vocational Qualifications (NVQs) are work based awards in England, Wales and Northern Ireland that are achieved through assessment and training. In Scotland they are known as Scottish Vocational Qualification (SVQ).
To achieve an NVQ, candidates must prove that they have the ability (competence) to carry out their job to the required standard. NVQs are based on National Occupational Standards that describe the 'competencies' expected in any given job role. Typically, candidates will work towards an NVQ that reflects their role in a paid or voluntary position. For example someone working in an admin office role may take an NVQ in Business and Administration.
There are five levels of NVQ ranging from Level 1, which focuses on basic work activities, to Level 5 for senior management.
- Level 1
- Competence that involves the application of knowledge in the performance of a range of varied work activities, most of which are routine and predictable. At comprehensive schools, Level 1 is equivalent to one GCSE at grade D-G.
- Level 2
- Competence that involves the application of knowledge in a significant range of varied work activities, performed in a variety of contexts. Collaboration with others, perhaps through membership of a work group or team, is often a requirement. At comprehensive schools, Level 2 is equivalent to one GCSE at A*-C
- Level 3
- Competence that involves the application of knowledge in a broad range of varied work activities performed in a wide variety of contexts, most of which are complex and non-routine. There is considerable responsibility and autonomy and control or guidance of others is often required. At Sixth Form Colleges, Level 3 can be worth 1-5 A levels at A*-C.
- Level 4
- Competence that involves the application of knowledge in a broad range of complex, technical or professional work activities performed in a variety of contexts and with a substantial degree of personal responsibility and autonomy. Responsibility for the work of others and the allocation of resources is often present.
- Level 5
- Competence that involves the application of a range of fundamental principles across a wide and often unpredictable variety of contexts. Very substantial personal autonomy and often significant responsibility for the work of others and for the allocation of substantial resources features strongly, as do personal account abilities for analysis, diagnosis, design, planning, execution and evaluation
For Year 10 students starting NVQ courses in September 2013, the qualification will not be equivalent to a GCSE.
- Level 6
- Award 1 to 12 units, Certificate 12 to 36 units, Diploma 37 and above, approximately equivalent to a Bacholors/Honours degree level qualification.
- Level 7
- Award 1 to 12 units, Certificate 12 to 36 units, Diploma 37 and above, approximately equivalent to post-Graduate diploma/certificate or Masters degree level qualification.
- Level 8
- Award 1 to 12 units, Certificate 12 to 36 units, Diploma 37 and above, approximately equivalent to Doctoral degree level. However, it is often the case that Doctorial degree are subject to a lengthy, research project under minimal guidance that offer an original contribution to an academic subject area; an NVQ lacks most of these elements, therefore while of the same standard and degree of specialision but not of the same merit in regards to originality of contribution. [1] .
Approximate academic equivalents[edit]
Research by the London School of Economics[edit]
NVQs are not formally defined in terms of equivalence to conventional academic qualifications. However for the compilation of social statistics and other purposes, approximate equivalences have to be established. The following equivalences are used by the London School of Economics's Research Lab[2]
- NVQ 1 = foundation GNVQ, three to four GCSEs at grades D-E, Business & Technology Education Council (BTEC) first certificate.
- NVQ 2 = four or five GCSEs at grades A*–C, BTEC first diploma.
- NVQ 3 = two or more A levels, BTEC Ordinary National Diploma (OND), City & Guilds Advanced Craft.
- NVQ 4 = BTEC Higher National Certificate (HNC) or Higher National Diploma (HND), or City & Guilds Full Technological Certificate / Diploma
Qualifications and Curriculum Development Agency[edit]
The Qualifications and Curriculum Authority and Office of the Qualifications and Examinations Regulator have a list of academic equivalents that varies from LSE's:
University for the Creative Arts[edit]
- equivalent diploma, Foundation degree, nursing or teaching qualification, HNC
- equivalent diploma, HND
- equivalent to Undergrad Certificate, Honours degree
- equivalent Graduate diploma, Masters degree
- equivalent Post Graduate diploma, Doctoral degree
City and Guilds[edit]
Licentiateship (post nominal: LCGI) sits on level 4 of the National Qualifications Framework,[3] and is therefore comparable to lower NVQ level 4.[4] Both Graduateship (GCGI) and Associateship (ACGI) are at level six of the National Qualifications Framework,[3] compared by OFQUAL to the highest category NVQs of level 4.[4] Membership (MCGI) is placed on NQF level 7, and Fellowship (FCGI) on level 8,[3] compared by OFQUAL to NVQs of level 5.[4] City & Guilds itself ties each NVQ to the level on the NQF with the same number.[3]
Both Graduateship (GCGI) and Associateship (ACGI) have been awarded, before the year 2004, at level 5 of NVQ.
The Associateship has continued to be conferred since 1887 upon graduates of Imperial College who have been awarded a Bachelor of Science (Engineering), Bachelor of Engineering, or Master of Engineering degree in a discipline previous studied at the City & Guilds College.
Both Graduateship (GCGI) and Associateship (ACGI) are at same academic level.
The NVQ Framework classifies the economy into the following areas:
- Tending animals, plants and land
- Extracting and providing natural resources
- Constructing
- Engineering
- Manufacturing
- Transporting
- Providing goods and services
- Providing health, social and protective services,
- Providing business services
- Communicating
- Developing and extending knowledge and skill
See also[edit]
- Education in England
- Education in Wales
- Education in Scotland
- Education in Northern Ireland
- General National Vocational Qualification
- Advanced Vocational Certificate of Education
- National Qualifications Framework
- [1]
- Qualifications and Credit Framework - replacement for National Qualifications Framework
- ^ http://www.graduates.co.uk/how-do-nvqs-stack-up-against-degrees/
- ^ McIntosh, Steve and Steedman, Hilary (1999). Qualifications in the United Kingdom 1985–1999 (HTML tables). London School of Economics Research Laboratory Data Service [distributor].
- ^ a b c d City and Guilds: Qualification comparison. Accessed 2 October 2010.
- ^ a b c Explaining the National Qualifications Framework. Accessed 2 October 2010.
Further reading[edit]
- WOOD, R., JOHNSON. C, Blinkhorn,S. & HALL, J. (1989) Boning, Blanching and Backtracking: Assessing Performance in the Workplace. Research and Development Series 46. Sheffield: Training Agency
External links[edit]
- Qualifications and Curriculum Authority: NVQs
- Edexcel NQF grid
- National Qualifications Framework
- Scottish Qualifications Authority
- AimHigher PDF
- Comparing Qualifications across countries
- NVQ Course Information
- Qualification Comparisons
- Oxford Brookes University qualification framework
- University of Cambridge International Qualifications
- NVQ Courses
- NVQ Training


text:
While many consumers are tightening their belts, there may still be a little left over in the budget for fun. Fall is here, and that means Halloween and pumpkins.
For one local church, that means raising money for a good cause. The proceeds from whichever pumpkin you choose will help the youth group for the Wesley Memorial United Methodist Church in Wilmington.
Youth group director, Kristin Bednarczyk said, "We get an 18-wheeler load of pumpkins every Saturday for five weeks."
The pumpkins come from a Navajo Indian reservation in New Mexico. A national organization, called The Pumpkin Patch Company, out of Greensboro, regulates the prices by size.
Proceeds are split between the youth group and the workers who grow and pick them. It is the youth group's sole fundraiser for the year. So far, it has been a success; proving you do not have to wait until October to get the perfect pumpkin.
"My son bought a decorating carving book. We want to get a pumpkin big enough to do one of those decorations for it," said Robin Mitchell.
The pumpkin patch at the United Methodist Church on South College Road, is open 7 days a week.
The hours are Monday through Saturday, 9 a.m. to 7 p.m. and Sunday 12:30 p.m. through 6:00 p.m.


text:
If your husband looks at other women, watching this FREE video presentation all the way to the end will FINALLY uncover the truth and provide answers to the question on the hearts of millions of women all around the world...
Your Price: $37.00
People all around the world are INVESTING in their relationships with this HUSBAND STOP LOOKING SYSTEM |
"Help...My Husband Looks
at Other Women"
I'm going to show you
AMAZINGLY POWERFUL method to CHANGE YOUR HUSBAND'S HEART
and move him to FIX HIS EYES SECURELY ON YOU ...
Plus I'm going to show you that
it is already PART OF A WOMAN'S
RELATIONAL DNA to do so...
That's right! You....his WIFE....already
hold the secret it takes to ROCKET YOUR HUSBAND'S HEART and INSPIRE
him to MONOGAMOUS EYES that come from
When your husband looks at other women, how do you handle it?
You know how it usually goes. You're out on a date with your husband and his eyes seem to wander to the blonde with the low-cut top sitting nearby or the redhead sashaying by your table.
You find yourself wanting to S C R E A M,
Trying not to make a scene, though, you do what you always do when your husband
looks at other women. You suffer silently and blow it off, but on the inside
those thoughts once again go through your head;
not unattractive, so why do I
always seem to be competing for
my husband's attention?"
Inside you find it despicable!
Inside you find it disturbing!
Inside you find it disheartening!
Those same old feelings of frustration begin to surface!
You start wondering if you will ever be enough.
Boyfriend looks at
other women, too….
"Why can't my boyfriend stop staring at other women?" is on the hearts and minds of single women, too.
If you're single and your boyfriend can't stop looking at other women, you start wondering if you're dating a real jerk or if you are just reading way too much into your boyfriend's wandering eyes.
If you're single and your boyfriend looks at other women, there are some things you can do about it when you have the right information. But, please, please don't overlook that the husbands of the married women going through this were boyfriends before they became husbands.
It is wise to find out as much as you can about this now, so you don't carry unresolved concerns about it into a marriage.
"Is My Relationship
in Trouble?"
Many women can't help wondering if their husband looks at other women because he is unhappy in his marriage, not satisfied with her, or their relationship is spiraling out of control.
They wonder if it is a sign their marriage is in trouble.
Here are some questions you can ask yourself if your husband looks at other women that will help you know if it is URGENT that you act quickly to protect or save your relationship.
If you can't sincerely give a "NO" response to questions like
these I would seek any and all help I could and as fast as I
Even if your relationship doesn't dissolve it can lead to your husband's use
and abuse of pornography and/or a decrease of sexual desire and satisfaction
with YOU his wife.
Denalyn's Story
Maybe you are like Denalyn.
Early in her marriage Denalyn started to feel like a fool about the looks her husband was giving to other women. As she thought back on their relationship, the tale-tale signs were all there when they were dating, but she had brushed them off as him just needing to relationally mature.
Once they married she believed things would change and he would stop staring at other women so much. Now, a couple years into their marriage, things are worse than ever. When they go out, they hardly get through an evening without him losing his focus on other women.
Every time she confronts him about it, he either denies it or he turns it right
back on her that she shouldn't be so jealous. She sometimes cries herself to
sleep at night wishing he could understand some of the betrayal she feels, and
wondering why the CONNECTION she so longs for has never been a reality in their
Carol's Story
Or, maybe you're like Carol.
Carol always thought women were just insecure and were
letting it bother them too much that their men looked at other women. She
didn't think what a man did with his eyes was that big of a deal.
When she met William she couldn't believe her good fortune. He was everything
she had always hoped for in a guy. They started dating and she found her
affection for him growing with each passing day. By this time in her life
she was settled in her career and considered herself to be a person of high
self-esteem and confidence.
She noticed right from the start that William checked out other women when they
went out on dates, but being secure in herself she just didn't let it affect
their time together. She accepted it as something all men do and let it go at
A little over a year into their marriage, she noticed William was becoming less attentive to her and more attentive to staring at other women. Shortly after their first year of marriage he walked out on her for
another woman. In the aftermath Carol discovered later that he had been totally addicted
to porn for several years.
Reflecting on all this through her pain, she found herself thinking that maybe
there is more to what a man does with his eyes than she first realized. Maybe
what a man does with his eyes says more about him than she originally believed.
No More Silent Suffering
Ladies, wouldn't it be great to not have to live with your husband always looking at other women when you are around?
Wouldn't it be great to not have to worry or wonder what he does with his eyes when you're not around?
Just Imagine…
"All men look!
It's just in a man's nature
to look at other women!"
"Just because I'm not eating doesn't mean
I can't still look at the menu."
"Why are women so insecure and jealous?"
These are the type of excuses women all around the world are getting from their husbands who can't stop looking at other women.
Wait, there's a better way!
It's really very simple...
And POWERFUL...
It isn't the norm...
It isn't commonly known...
It isn't practiced or understood by
most women...
what's a girl to do?
You have to get him to turn on the
right switch in his own mind.
There are some things he needs to notice that can have you living BIG in his world and other women living small.
There are some things you need to establish that can have him less interested in ogling other women
a Woman So Longs For
Ladies, you can have him chasing
YOU, flirting with YOU, thinking longingly of YOU and wanting only YOU in his
heart and in his eyes.
You can get so deep into him that his heart blocks out those little
distractions of other women so many men fawn over!
You can make him adore YOU and ONLY YOU!
are notorious for being able to touch a woman's body but not touch her heart.
Men are notorious at letting their hearts get married while their eyes still
"play the field."
Men are notorious for running to beauty that is fleeting with their eyes and
fleeing from beauty that is lasting with their hearts.
But YOU can make his heart and his
eyes connect with the powerful, intelligent, beautiful and irresistible woman
standing in front of him - YOU!
You can make him passionate, connected and present with his heart AND with his
Don't settle for a relationship where your husband looks at other
women and makes you feel less than enough!
Don't settle for being the woman he comes home to but whose eyes went home with
all the other women he visually obsessed over in his day!
Don't just accept it as being, "just the way it is" that he hangs out
at his computer getting his nightly porn fix!
You are of greater worth than that!
You are more deserving than that!
You deserve a relationship that has your husband's heart AND his eyes focused
on you every day!
If your husband looks at other women, get ready for some eye-opening insights on this subject. The right information can equip a woman with what she needs to help make looking at other women have less of a pull on her man's life.
it's time to use those things that are already part of a woman's relational DNA
for nurturing deep relationships to...
Capture His Heart and Elevate Your
Value in His Eyes
It's time to use the POWER a woman naturally has for relational nurturing to connect your husband's eyes with his heart.
We can show you how to help make...
YOU BIGGER IN HIS HEART while other women become SMALLER IN HIS EYES.
Some of What's Inside The eyes of a man so easily betray his heart! They have him distancing himself from his world with his wife while he plays closeness with women distant from his world. pg. 45 If our daughters didn't grow up watching the value men place on looking at women like they do, perhaps more of them wouldn't grow up using their bodies to be valued like they do. pg. 96 |
STOP doing the things that DON'T
WORK! Things like:
What men are so often given by their girlfriends or wives is the incorrect
assumption that confrontation will motivate change.
When a husband looks at other women and his wife confronts him for it long enough, her hope is that he will stop doing the bad behavior and comply with her wishes.
But, CONFRONTATION DOESN'T MOTIVATE CHANGE.
Confrontation simply stifles the bad behavior.
It is a temporary fix where compliance is granted in order to eliminate more confrontation.
many cases, it just makes the man more determined to gawk and stare at other
I do understand the desire to
strike a knee to the groin...
But, a knee to the groin is just
another form of confrontation.
might feel good to the woman whose husband looks at other women to knock
certain body parts up to his Adam's Apple; it might even change his actions while
he's out with his wife, BUT IT WON'T CHANGE HIS HEART.
man confronted doesn't stop;
he often just goes into "Secret Agent Man" mode and feeds his visual
appetites under the radar.
Is this what women really want?
What women really want is a man with...
Monogamous Eyes that
Come from a Monogamous Heart
Get ready for the most comprehensive and detailed information resources of its
kind on this subject of why a husband looks at other women.
You will not find a resource like this anywhere, and it is one that will shake the very foundations of what people often accept and believe about why a husband looks at other women.
This Husband Stop Looking System is written by an author with a decade of writing experience on the subject of lasting relationships. An author who recognizes a very important reality often overlooked when discussing what to do when your husband looks at other women.
That reality is...
...there are way too many men spinning their wheels pouring energy into superficial fantasies fueled by their eyes instead of GETTING ON WITH THE BUSINESS OF DEEPLY LOVING THEIR WIVES.
Imagine right now...
Being on dates with your husband and experiencing that he is giving you the gift of HEART and EYES at home so you are able to...
This is really what women want and what we're talking about isn't it?
It's more than just requiring her husband to stop looking at other women, it is INSPIRING him to change the CONTENT of his HEART which leads to HIM changing the INTENT of his EYES.
about bringing him to a place where HIS HEART begins LEADING HIS EYES instead
of his eyes leading his heart.
The Best Part of it All is...
is just a little of what is
covered in this one-of-a-kind...
will show you 7 types of men and what they teach us about men and their
wandering eyes.
Chances are really great that you are dating or married to one of these seven types of men and don't even know it. Getting familiar with these seven types of men will go a long way at helping a wife/girlfriend better understand the man in her life and his wandering eyes. It will help her better understand why her husband looks at other women so much.
More of What's Inside Men often use the "Men Are Visual" card as if that gives them a "Get Out of Jail Free" card for their wandering eyes. Being visual doesn't free a man to be irresponsible with the heart of the woman he holds in his hands. pg. 16 Visual interests in a woman's beauty is natural, necessary, and part of the human experience for a man, but wise is the man funneling that natural wiring into the circuit board of life supplying light, life and energy to his heart – HIS WIFE. pg. 25 |
We'll also talk about:
Much Is This One-of-a-Kind
Product Going to Cost Me?
Before I answer that, let me ask you some questions…
How much is not having this resource already costing you? I guarantee it's more than what you'll pay for it!
This product will SAVE you more than it will cost you!
There are couples who battle with this for years until their relationships end with great resentment and heartbreak. Not to mention the heartbreak and resentment they feel in their everyday journey together. I've seen it rip couples apart when a husband looks at other women, but it doesn't have to be this way.
How much is the cost of a one hour session with a marriage counselor where you live?
~ The rate where I'm from starts at $100 - $150 an hour
~ Since most marriage counselors see couples one session a week for the first three months, you can expect to pay about $1200 in that period of time if it's at about $100/hr.
If you get this resource and at the end of the day to day connection with your
husband is hope, harmony and healing where discord, discouragement and drama
used to exist over this issue of why do men look at other women, did it really
cost you anything?
~ There's no price tag you can put on a happy marriage
~ Having a husband whose eyes are in tune with his heart to be supercharged by his wife – YOU, is worth just about anything.
A husband with monogamous eyes
coming from a monogamous heart just sounds good doesn't it?
This product will not cost you $1,200!
It will not cost you a $100 session fee with a Counselor!
I'm not even going to charge half of that $100.
You get this one-of-a-kind resource
for only $37.00
Most Weddings cost between $7,000 - $20,000 just to get Two becoming One started. $37.00 is just a drop in the bucket in comparison to help keep Two becoming One going.
When you invest in your relationship with, "How to Inspire Your Husband to Stop LOOKING at Other Women," here is what you get in this HUSBAND STOP LOOKING SYSTEM.
You get, "How to Inspire Your Husband to Stop Looking at Other Women." Plus, you get the THREE VOLUME set of 240 "Reflections on Marriage, Men and their Wandering Eyes." These resources will help a woman better understand her own feelings about this issue, and better help her know what to say to her husband. |
You also get FIVE fabulous SUPER BONUSES bringing the value of this HUSBAND STOP LOOKING SYSTEM to over $200.00
When you claim this special resource,
"How to Inspire Your Husband
to Stop LOOKING at Other Women"
acting now, you'll be taken to a secure order page for your credit/debit card
I use CLICKBANK, a third party
secure processing company with years of successful service and highly respected
Here is what happens when you
purchase this resource that helps a wife better know what to do when her
husband looks at other women:
All these resources are Portable Document Format (PDF digital files) that are delivered immediately upon processing your purchase. Since they are delivered immediately Online, there are:
No hidden charges
No shipping and handling
No waiting
You can be enjoying this resource along with all its bonuses immediately.
You have our100% Money-Back Guarantee
All bonuses that come in this special offer are yours to keep, EVEN IF YOU choose to take advantage of our RISK-FREE GUARANTEE.
It is important that you are satisfied with this investment of, "How to Inspire Your Husband to Stop LOOKING at Other Women." This is why I offer a 100% money back guarantee.
If you are not happy with this product, you have 8-weeks from date of your purchase to let me know and you will be refunded 100% of your purchase price.
If your husband looks at other women and monogamous eyes that come from a monogamous sounds great to you, this resource can help you change his heart forever. It can help you work through all the emotion this issue brings into your own life.
"Why does my husband look at other women so much?" can be one of the most difficult questions to get an answer for that women face. Decide, NOW, to stop it from being an issue in your life and relationship! This "Husband Stop Looking System" can equip and empower you if your husband looks at other women.
Your Price: $37.00
People all around the world are INVESTING in their relationships with this HUSBAND STOP LOOKING SYSTEM |
P. S. "Help! My husband looks at other women!" doesn't have to be a constant source of strife in your relationship. You really can become so big in his heart that other women become small in his eyes. Get started on that journey, today!
P. S. S. I'm really pleased at the number of men also purchasing this "Husband Stop Looking System." I'm not surprised! I have found a lot of men are working through this and trying to find the right answers. This is one of those products I wish had been available as I was finding my way through it all. Way to go men!
Quotes from the Author of,
"How to INSPIRE Your Husband to
STOP LOOKING at Other Women"
©Copyright ALL RIGHTS RESERVED by Stanley J. Leffew
4519 Wavertree Dr.
Missouri City, TX 77459


text:
It was a rough start to the season for last year's 6A South Conference champions. The 6A South Benton Lady Panthers' volleyball team went up against last year's 7A Central Conference champion Conway Lady Wampus Cats and came out on the wrong end of a sweep. The Lady Panthers fell 0-3 (16-25, 16-25, 7-25) as they made too many errors against a powerhouse.
KITSAP COUNTY, Wash. – The Bryant 13-year old All Stars are World Series champions. Bryant defeated Greenville, N.C., 4-3 on Wednesday night to win the Babe Ruth World Series in Kitsap County, Wash., and finish the season undefeated. Bryant went 19-0 in this year's playoffs.
The main focus for Bryant golf Coach Keith Dale last season was to make Bryant golf "bigger." After a pretty good season in 2011, Dale has both of his teams off to rocking starts thus far in 2012.
EL DORADO – The Bryant Hornets and Benton Panthers golf teams both participated in the 17th Annual Simmons First Wildcat Invitational Golf Tournament on Monday. The Bryant girls finished best out of the Saline County schools with a second-place finish behind Conway. The Bryant boys finished fourth and the Benton boys and girls each finished fifth.
Peyton Weaver led the Bryant girls, which totaled a 270 (Conway had 255) with an 83 (+11) followed by Savannah Cathey's 91, Abigail Magee's 96 and Kaylee newell's 127.
After a successful 2011-2012 campaign, the Benton Lady Panthers volleyball team is gearing up for another run through the 6A South Conference where they took first place last season. With a 17-9 record overall last season and a 10-2 conference mark, the Lady Panthers were one game away from the State Championship, losing in the semifinals to Mountain Home.
BRYANT – After problems with inconsistency last season, the Bryant Lady Hornets volleyball team might have things figured out this year. The Lady Hornets finished last season second to volleyball powerhouse Conway in the 7A Central Conferencelast year, and was up 2-0 against Fort Smith Southside in the first two sets in the second round of the State Tournament before inconsistency set in again and the Lady Hornets lost the next three sets and the match to end their season.
The Bryant Black Sox made five errors en route to five unearned runs in a 5-4 loss to the Hub City Bombers (Hattiesburg, Miss.) in the first game of the Mid-South Regional Tournament on Thursday morning in New Orleans. The Black Sox played this morning in a loser's bracket game against Piedmont, Okla., and Bryant has to win at any chance to advance to the American Legion World Series in Shelby, N.C. Results will be in tomorrow's Courier. Two errors in the top of the first inning led to two unearned runs for the Bombers for an early 2-0 deficit for the Black Sox.
The Bryant Black Sox played at 9:30 this morning as they were the opening game of the Mid-South Regional Tournament in New Orleans. The Black Sox played the Hub City Bombers out of Hattiesburg, Miss., and results will be in tomorrow's paper. The Black Sox won the Arkansas American Legion State Tournament sweeping the field to advance to the regional in New Orleans. The winner of the regional will advance to the American Legion World Series held in Shelby, N.C.
NORTH LITTLE ROCK -- The Benton Panther golf team began the season with a dominant performance in the Yellowjacket Invitational Tournament on Monday at Stonelinks Golf Course in North Little Rock. The Panthers boys and girls team each won their side of the tournament against teams they will be playing throughout the year. Led by senior Grace Liles' top score of 79 (+7), the Benton girls team shot a 271 to blow out the competition, which consisted of 7A/6A South conference members, by 13 shots. El Dorado took second with a score of 284, Sheridan 287 and Lake Hamilton shot a 295 for fourth.
The St. Louis Cardinals keep winning, but the Cincinnati Reds and Pittsburgh Pirates, teams which are in front of the Cardinals in the National League Central Division, keep winning too. The Cardinals are currently six games behind first-place Cincy and 2.5 behind Pittsburgh.


text:
Bud Cauley
Adam Hadwin leads second Web.com Tour Finals event
66. Nick Taylor, Tony Finau, Colt Knost, Jamie Lovemark, David Lingmerth, Kyle Reifers and Oscar Fraustro shot 67. Bud Cauley , a one-stroke winner over Knost last week in the series-opening Hotel Fitness Championship in Fort Wayne, Indiana
Tweek in Review: The Week's Best Tweets
IanJamesPoulter) August 25, 2014 not a bad ride into Liberty National this morning! http://t.co/PZI6CLciEp — Bud Cauley (@BudCauley) August 25, 2014 2) DL III at Sleepy Hollow What a view at Sleepy Hollow today!! pic.twitter.com/2GQ0YUViSL
Golf Capsules
the 50-and-over tour. The Hall of Famer won 15 times on the PGA Tour. WEBCOM TOUR FINALS FORT WAYNE, Ind. (AP) - Bud Cauley won the Hotel Fitness Championship to regain his PGA Tour card, earning $180,000 in the Web.com Tour Finals opener
Ryan Blaum leads Web.com Tour Finals opener
back. Chalmers was 132nd in the FedEx Cup standings, and Hoge was 65th on the Web.com Tour money list. Derek Fathauer, Bud Cauley , Sam Saunders, Tony Finau and Dicky Pride shot 66. Carlos Ortiz, the Mexican player who topped the Web.com Tour money
Live updates: Follow Mickelson, Spieth in Valero Texas Open, round one
150-minute delay due to heavy fog. Get a glimpse at the conditions via the Twitter feeds of Morgan Hoffmann (left) and Bud Cauley (right). • • • Preview coverage • Mickelson readies for 1st Texas Open since 1992 Phil Mickelson's final stroke
Thursday's Sports In Brief
shot an 8-under 62 in the morning session to take a one-stroke lead after the first round of the Travelers Championship. Bud Cauley and Ryan Moore shot 63, and Chad Campbell, Joe Durant, Scott Langley, Eric Axley and Jeff Maggert followed at 64. CORK
Golf Capsules
round with five straight pars. Steele finished two shots off the course record set by Patrick Cantlay in 2011 as an amateur. Bud Cauley and Ryan Moore shot 63, and Chad Campbell, Joe Durant, Scott Langley, Eric Axley and Jeff Maggert followed at 64. Masters
Angel Cabrera builds momentum for British Open
third-round leader has hung on to win the Greenbrier Classic in its five-year existence. Joining Hurley at 9 under were Bud Cauley (64), Bradley (66), Brendon Todd (66), Chris Stroud (69), Cameron Tringale (69) and Will Wilcox (69). The


text: | Fun at the ball parkJune 11, 2014 - Pam RodgersIt's a rare thing to have such beautiful weather three days in a row for baseball. Usually, it's too hot or cold or it rains. For this year's annual Kansas City trip, it was 73 degrees and beautiful. It's great to get the chance to hang out at a ball park and not only see the baseball game, but share it live with thousands of people. Baseball itself hasn't changed much, but everything surrounding the game continues to evolve thanks mainly to the technological world we live in. It's crazy to think how much has changed just in my lifetime. As always, it was great to see my team, the New York Yankees in action (even though they are struggling a little at the moment). It is Derek Jeter's final year, and just as with Mariano Rivera last season, I had to see him in action at least one last time before he takes his place in Memorial Park. It's still odd for me to think about his retirement. Once he hangs it up, all the Yankees of my childhood will be gone. But, I have the rest of the season to deal with that. The Kansas City trip was another good one. I always enjoy my time at The K. I hope we can keep this annual streak alive! | |


text:
here is a work in progress 2. I will post a link of the finished colored version when I can. I hope u like it.
I used your base and this is a work in progress. I am having to do part of it by hand and the rest on the computer. I will post more of this when I get further into it. I hope u like what I have so far.


text:
Pure Bathing Culture - Moon Tides (2013)
Artist: Pure Bathing Culture
Title Of Album: Moon Tides
Year Of Release: 2013
Label: Partisan Records
Genre: Indie, Dream Pop
Total Time: 37:24 min
Format: Mp3
Quality: CBR 320 kbps
Total Size: 101 mb
The album title Moon Tides alludes to self-discovery: "We are deeply inspired by the relationship between the moon and the tides. Particularly in the sense that the tides and the ocean are comprised of water and the element water is often associated with human emotion." While these heady themes can be difficult to explore in a pop song, Pure Bathing Culture makes it feel effortless. "Pendulum" is a perfect mid-tempo album opener that pulses and shines. Other standout tracks from the album — "Dream The Dare", "Twins", "Scotty" and "Golden Girl" — are slices of reverb-drenched, soulful, danceable electro-pop, that musically and lyrically tap into an introspective worship of the natural and psychic mysteries that surround us. Pure Bathing Culture's debut album Moon Tides is optimistic modern music for souls who seek to explore the infinite.
1. Pendulum
2. Dream The Dare
3. Ever Greener
4. Twins
5. Only Lonely Lovers
6. Scotty
7. Seven to One
8. Golden Girl
9. Temples Of The Moon
Pure Bathing Culture - Moon Tides (2013) - High Speed Download |
- 1 voted


text:
Head and Neck Cancer
The head and neck cancer team leads in the diagnosis, treatment, and rehabilitation of both benign and malignant diseases of the head and neck region. Our team employs a multidisciplinary approach to diagnose and treat all types and stages of cancers that occur in the head and neck region, including:
- Oral cancer (lip, mouth, tongue, palate)
- Oropharyngeal cancer (tonsil, tongue base, soft palate) - including Davinci Robotic Surgery (TORS)
- Laryngeal cancer (voice box)
- Hypopharyngeal cancer (throat and swallowing passage cancer)
- Thyroid cancer and tumors
- Parathyroid disease (Hyperparathyroidism) - including Minimally Invasive Radioguided Parathyroidectomy
- Salivary gland tumors
- Cutaneous malignancies of the head and neck
Patients are thoroughly evaluated by our team of physicians and caregivers in order to make the most accurate diagnosis and treatment plan. We provide patients with the information needed to understand their disease and decide on the best treatment plan for them. Treatments may include surgery, radiation, and/or chemotherapy as well as medical therapy. Throughout treatment, we emphasize ongoing communication with patients, families, and referring physicians.
Clinical Corner: What's New in the Treatment of Meniere's Disease?
Meniere's disease does not have a definitive cure but there are treatment options to control the symptoms depending on the stage of the disease. Dietary and lifestyle changes are the first step of the treatment and work very well for the majority of patients with Meniere's disease. Because we believe there is an overlap between Meniere's disease and migraine, we advise patients to refrain from eating foods that have been shown to trigger migraine attacks. Learn more about about new treatments for this disease.


text:
Check out the latest deals and promotions we are offering this month!
Find out what makes our window fashions the best in the industry.
Call now to set up your free in home consultation!
DECO Window Fashions will help you take the stress and hassle out of window covering shopping. Our family owned and operated business works hard to keep our prices competitive and our product quality high, offering you the finest window shades and drapes in Austin.
You will be able to see a large variety of options, such as:
Every detail, from precise planning to exact measurements, are take to insure your windows are properly covered during our professional installation. You can trust that we will dress your windows with style!
Whether you are looking for custom drapery or roman shades, we can assure you that we will provide a great product and true professional installation services. We have everything from bambooo shades and wood blinds to bay window treatments. We only work with the best brands in the industry, brands you can trust for many years to come.
Contact us now at (512) 250 8600 to set up your free in home consultation today!


text:
5 Stocks Under $10 Set to Soar
Delafield, Wis. (Stockpickr) -- There isn't a day that goes by on Wall Street when certain stocks trading for $10 a share or less don't experience massive spikes higher. Traders savvy enough to follow the low-priced names and trade them with discipline and sound risk management are banking ridiculous coin on a regular basis.
>>5 Big Trades to Take in February
Just take a look at some of the hot movers in the under-$10 complex from Thursday, including Prima Biomed (PBMD), which is skyrocketing higher by 47%; Glu Mobile (GLUU), which is soaring higher by 24%; Monster Worldwide (MWW), which is ripping higher by 22%; and RealD (RLD), which is spiking higher by 13%. You don't even have to catch the entire move in lower-priced stocks such as these to make outsized returns when trading.
One low-priced stock that recently soared sharply higher after I featured it was China-based medical components player Dehaier Medical Systems (DHRM), which I highlighted in Jan. 16's "5 Stocks Under $10 Set to Soar" at around $4.75 per share. I mentioned in that piece that shares of Dehaier Medical Systems had been uptrending strong recently, with the stock moving higher from its low of $2 a share to its high of $4.80 a share. During that move, shares of DHRM were consistently making higher lows and higher highs, which is bullish technical price action. That move had pushed shares of DHRM within range of triggering a major breakout trade above some near-term overhead resistance levels at $4.80 to $4.85 a share.
>>5 Low-Priced Stocks to Trade for Gains Guess what happened? Shares of Dehaier Medical Systems didn't wait long to trigger that breakout, since the stock started to bust above those key resistance levels the same day my article was published was heavy upside volume. This stock has continued to soar higher since taking out those levels, with shares tagging an intraday high today of $6.36 a share. That represents a monster gain of close to 40% in just a few weeks for anyone who went long DHRM into the breakout strength. You can see here how a low-priced stock can make a monster move once it clears key resistance levels with high volume. Low-priced stocks are something that I tweet about on a regular basis. I frequently flag high-probability setups, breakout candidates and low-priced stocks that are acting technically bullish. I like to hunt for low-priced stocks that are showing bullish price and volume trends, since that increases the probability of those stocks heading higher. These setups often produce monster moves higher in very short time frames. I'm not as eager to recommend investing long-term in stocks that trade less than $10 a share because these names can be very speculative, and the odds for picking the long-term winners aren't great. But I definitely love to trade stocks that are priced below $10. I like to view them as a trading vehicle with lots of volatility and lots of upside when the trade is timed right. >>3 Stocks Breaking Out on Unusual Volume When I trade under-$10 names, I do it almost entirely based off of the charts and technical analysis. I also like to find under-$10 names with a catalyst, but that's secondary to the chart and volume patterns. With that in mind, here's a look at several under-$10 stocks that look poised to potentially trade higher from current levels.Check Out Our Best Services for Investors
Action Alerts PLUS
Portfolio Manager Jim Cramer and Director of Research Jack Mohr reveal their investment tactics while giving advanced notice before every trade.
Product Features:
- $2.5+ million portfolio
- Large-cap and dividend focus
- Intraday trade alerts from Cramer
Quant Ratings
Access the tool that DOMINATES the Russell 2000 and the S&P 500.
Product Features:
- Buy, hold, or sell recommendations for over 4,300 stocks
- Unlimited research reports on your favorite stocks
- A custom stock screener
Stocks Under $10
David Peltier uncovers low dollar stocks with serious upside potential that are flying under Wall Street's radar.
Product Features:
- Model portfolio
- Stocks trading below $10
- Intraday trade alerts
Check Out Our Best Services for Investors
Dividend Stock Advisor
David Peltier identifies the best of breed dividend stocks that will pay a reliable AND significant income stream.
Product Features:
- Diversified model portfolio of dividend stocks
- Updates with exact steps to take - BUY, HOLD, SELL
Trifecta Stocks
Every recommendation goes through 3 layers of intense scrutinyquantitative, fundamental and technical analysisto maximize profit potential and minimize risk.
Product Features:
- Model Portfolio
- Intra Day Trade alerts
- Access to Quant Ratings
Options Profits
Our options trading pros provide over 100 monthly option trading ideas and strategies to help you become a well-seasoned trader.
Product Features:
- Actionable options commentary and news
- Real-time trading community


text:
Intricately crafted, this diamond engagement ring features brilliant micropavé-set diamonds set in platinum with double prongs to showcase your center diamond. Setting includes 1/3 carat total diamond weight.
Absolutely beautiful. ..
Anonymous, Campbell, CA – October 2014
The setting is more petite than it appears in the photo gallery. It was solid and pretty. I love the double prongs that mirror the step cuts in the stone and allows the diamond to be the focus.
Anonymous, HARKER HTS, TX – April 2014
The ring was absolutely beautiful. However, one of the side diamonds was missing from the setting. Blue Nile customer service did an excellent job getting the issue fixed but it took a week even with the overnight shipping.
jeff, minooka, IL – March 2014


text:
At Fort Bragg in North Carolina, Lexy, a 5-year-old German shepherd, is successfully persuading soldiers home from the war to come in and stick with counseling.
Related: One dog's powerful healing effects on two wounded veterans.
Staff Sgt. Dennis Swols said he originally wasn't interested in therapy at all, and certainly didn't believe that having a dog at his counseling sessions would help.
Swols, who has completed seven tours in Afghanistan and Iraq, suffered from post-traumatic stress disorder so severe that he experienced seizures. He said even his kids knew not to sneak up on him from behind.
"I can say the first time I killed someone, I cried," Swols said. "And I never went and got help."
It took the friendship of military therapy dogs like Lexy to get Swols to see past his pride and agree to work with his therapist. The dog lies next to him during his sessions, and pulls even closer when the conversations get difficult and Swols is stressed. He said Lexy had made a difference in his life.
"Without a doubt, without a doubt," Swols said. "I could tell a story. I could cry. I could do anything and she's not going to judge me."
Today there are 2,500 dogs trained in the armed services but Lexy and the dogs at the Warrior Canine Connection in Brookville, Maryland, are among the first to be used to help soldiers heal their minds.
At the Canine Warrior Connection facility, Rick Yount begins training therapy dogs when they're puppies. They learn to sense a soldier's distress.
"We know that emotions have a chemical component to them," Yount said. "These dogs are basically able to detect through scent, your emotional state."
In Bethesda, Maryland, 3-year-old Labrador retriever mix Ron has been trained to bring soldiers both tissues and comfort during therapy sessions. The work these dogs do is so important that the armed services gives these canines military ranks. Lexy is a Lt. Col. and Ron is a one-star general.
"It can comfort them [the soldiers.] Get them through the hard stuff," said psychiatrist Maj. Christine Rumayor who works with Lexy at Fort Bragg. "So they can keep talking and work through their issues."
ABC News' Michael Koenigs contributed to this story.


text:
St. Eugene's Math Program has students learning basic math skills from grades preschool to grade 6. In seventh grade students learn Pre-Algebra to help their transition into Algebra in 8th grade.
Students are exposed to many technological tools including usage of TI-83 scientific calculators and a Smart Board; both of which are used in class frequently.
Students also compete in various local math competitions through the year including; Resurrection High School, Trinity High School and St. Patrick's High School.


text:
Welcome to Honors at Black Hills State University. Honors takes the BHSU commitment to personalized student-centered academic excellence to the next level. Honors offers highly motivated students – regardless of their program of study – a challenging and enriching education and an elite academic and social community. What's more, we make a difference by motivating all students, faculty, and staff to achieve their best. Whether you are an entering freshman, a transfer or continuing student, or a high school student exploring your future, we invite you to consider the program and graduate as a University Scholar.
The BHSU Honors Program is a Member of the National Collegiate Honors Council
The University Honors Program Advantage
Dedicated to knowledge, achievement, and community, the University Honors Program seeks to enrich its students' university experiences. The program is designed to provide the university's top students with the support and individualized instruction they need to pursue their academic and professional goals.
The benefits of the University Honors Program are numerous:
Mission Statement
The University Honors program is about opportunity, community, and leadership. The program provides a unique academic and social community for students committed to academic and personal excellence. From foundations courses and colloquia to the capstone project, the program affords a rigorous and individualized program of study to students with exemplary academic records. Honors courses strive to provide students with faculty mentors, small collaborative communities, and opportunities in research and creative scholarship. The program's student organization offers opportunities for leadership and service to the campus, the community, and beyond. Honors presents highly motivated students – regardless of their major field of study – a challenging and enriching education and university experience. Students who graduate from the program will graduate as University Scholars, both in name and in accomplishment.


text:
Design and Construction of Custom Targeting Vectors
Disruption of a gene in the mouse genome can be achieved by replacing it with its mutant/modified version created in a plasmid vector called the targeting construct. At the mouse genome engineering core facility, we design and generate gene targeting constructs. We use many cloning methods including "recombineering" to generate wide variety of targeting constructs for Cre-lox based conditional knockout or targeted knock-in vectors. We also generate conventional knockout and transgenic constructs. The details of constructing the conditional knockout vector, a most common type of vector, are described below*. The fee for custom (gene specific) conditional targeting vector construction is $5000**.
The project involves multiple steps and these steps are categorized under various stages and sub stages as outlined below
- Designing of the strategy
- Designing of the targeting vector [analysis to make decision about exons to delete, length of 5' and 3' arms, location of LoxP recombination sites etc.]
- Designing of the Southern blotting and/or PCR screening assay
Establishing of the Southern screening method is done at the PI's lab; MGECF will help in troubleshooting if any)
We will discuss the targeting strategy with the Investigator for their approval before we begin work. Our expected timeframe for vector construction is approximately 3 months or less and all efforts will be made to complete well before 3 months! The fees will be billed stage wise after completion of each stage or at the end of last stage.
- Identification and Procuring of the BAC clone (or amplifying/synthesizing the fragments from genomic DNA, if feasible)
- Expansion and testing of the BAC clone
- Construction of the targeting vector
- cloning the outermost boundaries of the genomic region to be swapped into a plasmid backbone
- Recombineering [Gap repairing-actual swapping of genomic region from BAC into plasmid]
- Construction of mini targeting vector to insert first LoxP site
- Recombineering [First LoxP insertion]
- Construction of mini targeting vector to insert first second LoxP and Neomycin sites
- Recombineering [Frt-Neo-Frt-second LoxP insertion]; the final construct
- Testing of the targeting vector
- Sequencing vector insert junction
- Verification of functionality of Frt site
- Verification of functionality of LoxP site
The process of designing and construction of targeting vectors is highly complex and it involves careful consideration of several factors. To ensure that all possible factors (gene location, its promoter, adjacent genes intron/exon spacing, domains etc.) are taken into consideration, such projects require multiple sessions of meeting of the MGECF staff with PI (or PI's lab personnel) to offer teaching and consultation sessions- which is extremely critical. Furthermore, each targeting construct (conditional KO or KI) is unique: in order to best serve the needs of the investigator, it necessitates us in understanding the biological significance of the desired mutation, going through the preliminary data and also reading of the published literature about the gene. A significant amount of time is spent in such activities and therefore we request that the targeting vector design and construction projects should be considered as collaboration.
* Combined knockout and knock-in strategies can also be designed in certain cases. Additional cost involved in designing and building such custom cassettes will depend on the construct design and project needs.
** Targeted knock-in into well-established loci such as ROSA 26 can also be designed at cheaper costs that depend on the complexity and/or availability of the cassettes to be inserted and the number of cloning steps involved.


text:
Sorry, but you haven't selected any favorites yet. Click here to go back and find some favorites.
Or Try One of These Episodes
Georgia Jones Larin Lane & TiffanyBrooks
Aug 01, 2008
78 Votes
Her First Lesbian Sex
Kacey Jordan Kayla Paige & August Night
Feb 21, 2011
130 Votes


text:
Follow @wildesunglasses
Please enter the e-mail address associated with your User account. Your username will be e-mailed to the e-mail address on file.
we accept:
Find us in any of our two exhibitions stores:c/ Joaquin Costa, 2 08001c/ Avinyo, 21 08002
Barcelona, Spain
from: 12:00 a 15:00 and 16:00 a 21:00