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Original Article
Reliability and validity of the Childhood Cancer Survivor Study Neurocognitive Questionnaire
Article first published online: 12 SEP 2008
DOI: 10.1002/cncr.23809
Copyright © 2008 American Cancer Society
Volume 113, Issue 8, pages 2188–2197, 15 October 2008
Additional Information
How to Cite
Krull, K. R., Gioia, G., Ness, K. K., Ellenberg, L., Recklitis, C., Leisenring, W., Huang, S., Stovall, M., Robison, L. L. and Zeltzer, L. (2008), Reliability and validity of the Childhood Cancer Survivor Study Neurocognitive Questionnaire. Cancer, 113: 2188–2197. doi: 10.1002/cncr.23809
Publication History
- Issue published online: 3 OCT 2008
- Article first published online: 12 SEP 2008
- Manuscript Accepted: 30 MAY 2008
- Manuscript Revised: 27 MAY 2008
- Manuscript Received: 14 MAR 2008
Funded by
- National Cancer Institute. Grant Number: U24-CA55727
- American Lebanese Syrian Associated Charities
- Abstract
- Article
- References
- Cited By
- Childhood Cancer Survivor Study;
- neurocognitive;
- questionnaire;
- late effects
Up to 40% of childhood cancer survivors may experience neurocognitive impairment in 1 or more specific domains. As such, regular monitoring has been recommended for patients exposed to cranial irradiation and/or antimetabolite chemotherapy. This study reports the results of a questionnaire developed to identify those survivors who may be experiencing neurocognitive problems.
Participants for this study were 7121 members of the Childhood Cancer Survivor Study cohort (6739 survivors and 382 siblings). These participants completed a new neurocognitive questionnaire designed to assess functions commonly affected by cancer therapy, as well as a standard measure of emotional functioning. A measure of cognitive and emotional functioning was also completed on a subset of the patients roughly 7 years before the current questionnaire. Responses to the questionnaires among subgroups of survivors were then analyzed to examine the reliability and validity of the new neurocognitive questionnaire.
Four reliable factors were identified that assessed task efficiency, emotional regulation, organization, and memory skills. These neurocognitive factors accurately discriminated survivors who were at "high risk" for neurocognitive dysfunction, because of neurologic abnormalities or a history of intensive focal cranial irradiation, from healthy "low-risk" survivors and siblings.
The questionnaire demonstrated excellent reliability, as well as construct and discriminative validity. It appears to be a practical and efficient tool for monitoring neurocognitive outcomes in adult survivors of pediatric cancer. Cancer 2008. © 2008 American Cancer Society.
Today in the US, approximately 80% of the nearly 12,000 children and adolescents diagnosed with cancer each year can expect to survive at least 5 years.1 With increased survival, attention has turned to quality of life and functional outcome after treatment, including neurocognitive performance. Studies suggest up to 40% of childhood cancer survivors may experience neurocognitive impairment in 1 or more specific domains (eg, processing speed, attention, memory).2‒5 Impairment in these domains impede the learning of new information, along with maintenance of previously learned information, and ultimately lead to declines in global intellect. This in turn results in poor academic and vocational success, low self-esteem, and behavioral or emotional disorders.
Regular monitoring of neurocognitive outcomes has been recommended for patients exposed to cranial irradiation and/or antimetabolite chemotherapy during treatment of pediatric cancer.6 Ideally, such monitoring would involve routine comprehensive neurocognitive evaluations. However, this approach may not be practical for a variety of reasons, including excessive cost, required time, and limited professional resources. This study reports the results of a questionnaire developed to identifying those survivors who may be experiencing neurocognitive problems.
Questionnaires are an established method for screening a variety of functions. Such scales have been used for many years in the assessment of emotional and behavioral problems in children (eg, the Child Behavior Checklist, Behavior Assessment System for Children), as well as adults (eg, Minn Multiphasic Personality Inventory, Brief Symptom Inventory).7‒10 The assessment of children typically involves completion of ratings by parents/guardians, whereas it is customary to collect self-reports for adults. More recently, the use of rating scales has expanded to aid in the assessment of health-related behaviors or outcomes, such as sleep habits,11 quality of life,12 and neurocognitive function.13, 14 A recent extension of neurocognitive ratings has been the focus on specific executive functions.15, 16
Currently, there are 2 scales designed to assess general neurocognitive functioning in adults. The Cognitive Behavior Rating Scales (CBRS) was standardized in adults aged 30 to 89 years, and generates measures of language deficits, agitation, need for routine, depression, higher cognitive deficits, memory, dementia, apraxia, and disorientation.14 The CBRS focuses on significant impairment and is generally used in the assessment of individuals with dementia. The Neurobehavioral Functioning Inventory (NFI) was standardized on adults aged 17 to 80 years, and generates indices of depression, somatic complaints, memory/attention problems, communication difficulties, aggression, and motor deficits.13 The NFI is typically used in rehabilitation settings for treatment planning and tracking change over time.
There are 2 widely used scales designed to evaluate executive functions in adults. Executive functions are generally defined as abilities required for the planning, implementing, monitoring, and adaptation of behavior for success in one's environment.17, 18 The Behavior Rating Inventory of Executive Function (BRIEF) is a widely used questionnaire designed to assess real-world aspects of executive dysfunction in children.19 The recently released adult version of the BRIEF (BRIEF-A) includes 2 scales: Behavioral Regulation Index (BRI) and Metacognition Index (MI). BRI is comprised of 4 subscales (Inhibit, Shift, Emotional Control, and Self-Monitor), and the MI is comprised of 5 subscales (Initiate, Working Memory, Plan/Organize, Task Monitor, and Organization of Materials).16 The Frontal Systems Behavior Scale (FrSBe) was originally developed for use in adults and includes 3 major scales: Apathy, Disinhibition, and Executive Dysfunction.15
The utility of these scales in the assessment of functioning in long-term survivors of childhood cancer is uncertain. When neurocognitive deficits do occur in long-term survivors, they typically involve problems with attention, processing speed, and/or memory.4, 5, 20 The CBRS and NFI have demonstrated sensitivity to general dysfunction and emotional adjustment in dementia and after acute brain injury.14, 21 However, neither of these scales differentiate between specific neurocognitive skills. The BRIEF-A and FrSBe focus on assessment of executive dysfunction, which may indeed be impacted in long-term survivors. However, neither measure includes assessment of attention, processing speed, or memory. Furthermore, the sensitivity and specificity of these scales have not been evaluated in adults who are long-term survivors of childhood cancer.
The European Organization for Research and Treatment of Cancer has developed a quality of life instrument that includes a measure of cognitive function.22 Although this scale does appear sensitive to the effects of a variety of cancers and therapies,23 the cognitive scale is 1-dimensional, and thus does not separate skills into neurocognitive subdomains that may demonstrate treatment specificity.
The purpose of the current study was to report the utility of a new rating scale developed for the ongoing Childhood Cancer Survivor Study (CCSS).24 This Neurocognitive Questionnaire (CCSS-NCQ) was constructed to assess skills that are reported to be sensitive to the effects of radiation and antimetabolite chemotherapy in long-term cancer survivors, as well as skills included in currently established measures of executive functions.
Participants for these analyses were members of the CCSS cohort. The CCSS is a retrospective cohort study designed to evaluate the impact of childhood cancer and its treatment on long-term function and health. Details of the criteria for cohort inclusion have been reported previously.24 Briefly, eligible participants were treated for 1 of 8 childhood cancer diagnoses at 26 institutions between 1970 and 1986 when younger than 21 years of age. Cohort entry was limited to those individuals who survived for at least 5 years after their original diagnosis. The human subjects committee at each of the collaborating institutions approved the study protocol before participant enrollment. Participants provided informed consent for the questionnaires and separate consent for medical record abstraction. Medical record abstraction was completed for all consenting participants. Study participants completed a 24-page baseline questionnaire between 1995 and 1996. This questionnaire surveyed sociodemographic information, medical history, and functional limitations. A second follow-up questionnaire, which included the CCSS-NCQ, was completed between 2002 and 2004 (the full survey questionnaire is available at http://www.stjude.org/SJFile/ccss_fu2.pdf; the CCSS-NCQ). Participants in the current analyses completed both the baseline questionnaire and the second follow-up survey, including the CCSS-NCQ. A total of 7121 participants from the original cohort completed the CCSS-NCQ. Diagnoses and demographics are presented in Table 1.
|Survivors (n=6739)
|Siblings (n=382)
|<High school graduate
|High school graduate
|College graduate
|CNS tumor
|Hodgkin lymphoma
|Non-Hodgkin lymphoma
|Wilms tumor
|Soft tissue sarcoma
|Bone cancer
|Age at interview
|Age at diagnosis
The CCSS-NCQ was developed by selecting a subset of items represented in an early investigational version of the BRIEF-A, to which additional items were added (the CCSS-NCQ was administered before the publication of the BRIEF-A). In conjunction with the primary author of the BRIEF,19 versions of items were selected to represent the following cognitive constructs: Organization of Materials, Working Memory, Plan/Organize, Initiate, Inhibit, and Emotional Control. To this item list, additional items were added that focused on processing speed, memory, and academic functioning. This resulted in the 25-item CCSS-NCQ. The items were presented with instructions asking participants to report the degree to which they experienced any of the 25 problems over the past 6 months. Possible responses were presented using a Likert scale ranging from 1 ("Never a Problem") to 3 ("Often a Problem"). Of the participants who completed the CCSS-NCQ, 6739 were survivors, and 382 were siblings.
The Behavior Problem Index (BPI)25 was originally developed for the National Health Survey by taking a subset of questions from the Child Behavior Checklist.26 These questions were completed by parents of adolescents 12-17 years of age during the baseline questionnaire (ie, 1995-1996). For each of the 32 items, parents were asked to describe their child's behavioral and emotional functioning. Possible responses were presented using a Likert scale ranging from 1 ("Not True") to 3 ("Often True"). The BPI has recently been validated in a CCSS sample.27 In that report, the following 5 factors were identified: Depression/Anxiety, Headstrong Behavior, Attention Deficit, Peer Conflict, and Antisocial behavior. Of those participants who completed the CCSS-NCQ, 1671 parents had completed the BPI during the baseline questionnaire.
The Brief Symptom Inventory-18 (BSI) is an 18-item screening questionnaire designed to assess symptoms of depression, anxiety, and somatic complaints.9 Participants were asked to describe the extent to which they have been distressed or bothered by each symptom in the previous 7 days. Possible responses were presented using a Likert scale ranging from 1 ("Not at All") to 5 ("Extremely"). This measure was collected in the CCSS follow-up survey at the same time the CCSS-NCQ was obtained. As with the latter scale, 6739 survivors and 382 siblings completed the BSI. A recent report using the CCSS sample has supported the initial factor structure of the BSI in adult survivors of childhood cancer: Depression, Anxiety, and Somatic Complaints.28
To recap, the BPI was administered once during the baseline survey conducted between 1995-1996, whereas the BSI and CCSS-NCQ were each administered once during a follow-up survey conducted between 2002 and 2004.
Statistical Analyses
An exploratory factor analysis was conducted using all reports collected from siblings who completed the 25-item CCSS-NCQ. The maximum likelihood method was used to extract the factors, which were then subjected to a promax (oblique) rotation. Internal consistency of the factors was assessed using Cronbach Alpha.29 A confirmatory factor analysis was then conducted using all reports from cancer survivors. The weighted least squares method was used, as the multivariate normal assumption was in doubt.
Construct validity of the factors was explored by comparing performance on the CCSS-NCQ factors to the BPI items collected on the CCSS baseline questionnaire. Although the BPI was collected roughly 7 years before the CCSS-NCQ, the BPI was administered during adolescence, a period of development when cognitive patterns become engrained. When attention problems persist into adolescence, they typically continue into adulthood and expand to impact executive functioning.30, 31 Thus, parent report of significant problems during adolescent should be reflected in self-reports, even 7 years later. Concurrent validity was examined by comparing the established factor scores to the factors from the BSI, which was also collected during the second follow-up questionnaire. Discriminative validity was examined by comparing the CCSS-NCQ factors between cancer survivors at "high risk" to those at "low risk" for neurocognitive dysfunction. For this purpose 2 "high-risk" groups were defined: 1 group (n = 172) included all survivors with epilepsy and/or cerebrovascular abnormalities (ie, Neurologic group); the other group (n = 247) included survivors treated with high-dose (≥35 Gray [Gy]) cranial radiation therapy (CRT) to the frontal area of their brains (ie, Frontal CRT group). A cutoff of ≥35-Gy CRT was established based on the attempt to identify a "high-risk" group for validation of the instrument. In a recent review of CRT effects on late neurocognitive sequelae, >35 Gy was a level consistently associated with significant impairment.32 Although lower doses of CRT and chemotherapy treatment (eg, 18 Gy CRT + intrathecal [IT] and/or high dose intravenous [IV] methotrexate) present elevated risk, the risk is not consistently perceived to be "high." Furthermore, at least 2 recent reports question the impact of lower doses of CRT and chemotherapy on neurocognitive functions.33, 34 Neurocognitive dysfunction has also been consistently reported in samples of adults with epilepsy,35‒39 stroke,40‒42 and cerebrovascular abnormalities.43‒45 Increased incidence of such neurologic disorders has been documented in survivors of childhood cancer treated with cranial radiation.46, 47 These "high-risk" groups were compared with a "low-risk" group of healthy survivors who had no history of central nervous system (CNS) disease, no history of CNS treatment, and no history of major organ complication or procedures (n = 688). These groups were also compared with the sibling group (n = 382). Multivariate analysis was done to assess group differences. As a method to evaluate clinical significance of the ratings, performance on each scale was reclassified based on the frequency of an item being rated as "Often a Problem" (ie, the highest possible rating available). The frequency of these ratings were then calculated for the sibling group, and logistic regression was used to evaluate odds ratios (ORs) for the likelihood of higher scores in each scale for each of the "high-risk" and "low-risk" survivor groups compared with the siblings. Robust standard errors were calculated based on generalized estimating equation methods, to account for intrafamily correlation between survivors and siblings, and were used to obtain 95% confidence intervals. All regression models were adjusted for age and sex. Two-sided P values <.05 were considered significant.
During the exploratory factor analysis (EFA) in 382 siblings, 4 factors met criteria for retention based on eigenvalues, assessment of the scree plot, and face validity of grouped items. In interpreting the rotated factor pattern, an item was said to load on a given factor if the factor loading was 0.40 or greater. The factor loadings from the exploratory analysis and the internal consistency estimates of the rotated factors are presented in Table 2. Four factors representing 19 of the 25 variables were obtained: Task Efficiency, Emotional Regulation, Organization, and Memory. The Task Efficiency factor accounted for the major proportion of variance and was comprised of items related to initiating and completing tasks in a rapid manner. Emotional Regulation significantly contributed to the overall variance and was comprised of items related to emotional reactivity and frustration tolerance. The Organization factor was comprised of items related to organization of the individual's environment. The fourth factor, Memory, was comprised of items related to both working memory and long-term memory (ie, recall of information learned previously).
|Task Efficiency
|Emotional Tolerance
|Gets upset easily*
|Takes longer to complete work*
|Does not think of consequences†
|Forgets instructions easily*
|Problems completing my work*
|Difficulty recalling things learned before*
|Gets frustrated easily*
|Mood changes frequently*
|Different ways to solve a problem†
|Forgot what doing in middle of things*
|Problems with self-motivation*
|Trouble finding things in bedroom*
|Easily overwhelmed*
|Trouble with multitasking*
|Blurts things out†
|Desk/workspace a mess*
|Trouble remembering things
|Trouble prioritizing activities*
|Reads slowly*
|Slower than others*
|Does not work well under pressure*
|Trouble solving math problems†
|Internal consistency‡
Confirmatory analysis (CFA) was conducted in the survivor population (n = 6739) using the 4-factor solution from the EFA. The goodness of fit index (GFI) was 0.91, and the root mean square error of approximation (RMSEA) was 0.05. RMSEA is an index of fit that is less influenced by sample size, with recommended levels being 0.05 or below.48 These indices suggest a reasonable fit of the 4-factor structure to the cancer survivor sample. A CFA was also conducted using only those survivors determined to be at "high risk" for neurocognitive dysfunction (ie, the Neurologic group and the Frontal CRT group). The fit index for this at-risk group was acceptable (GFI = 0.93). As part of the consideration of other factor solutions in explaining the pattern of data from the survivors, additional CFAs were conducted. CFA was used with a single factor to determine whether the combined response to all 25 items best explained the variability in survivor responding. This resulted in a significantly reduced fit index (GFI = 0.83). A CFA was also conducted using a 2-factor solution based on the factors from which the represented items on the BRIEF-A were selected (ie, Behavioral Regulation and Metacognition). Again, this resulted in a significantly reduced fit index (GFI = 0.88). Thus, the 4-factor solution produced the best fit during confirmation.
Construct validity of the 4 CCSS-NCQ factors was demonstrated through correlation with the BPI factors. Of the 4 factors derived, Task Efficiency was expected to correlate most highly with the BPI factor Attention Deficit. This was, in fact, the resultant outcome. Table 3 presents correlations between the factors on the 2 rating scales, along with kappa coefficients (κ). Kappa is an index of agreement between dichotomous variables, which attempts to account for base rates in the population, with "fair agreement" being a coefficient ≥0.20.49, 50 The relevance of these correlations and agreement coefficients is increased through recognition that the questionnaires were completed by 2 different raters (ie, cohort completed the CCSS-NCQ, whereas parents completed the BPI) over an interval of roughly 7 years (ie, the BPI was completed between 1995 and 1996, and the CCSS-NCQ was completed between 2002 and 2004). Of note, the Depression/Anxiety factor from the BPI was correlated more strongly with the CCSS-NCQ Emotional Regulation than any of the other NCQ factors. Overall, the pattern of correlations with the BPI provides initial support for the 4-factor constructs associated with the CCSS-NCQ.
|Task Efficiency, r (κ)
|Emotional Regulation, r (κ)
|Organization, r (κ)
|Memory r (κ)
|Behavior Problem Index
|0.25 (0.13)
|0.27 (0.19)
|0.12 (0.08)
|0.20 (0.10)
|Headstrong Behavior
|0.24 (0.10)
|0.30 (0.16)
|0.15 (0.07)
|0.21 (0.10)
|Social Deviance
|0.22 (0.11)
|0.27 (0.17)
|0.18 (0.10)
|0.20 (0.14)
|Attention Deficit
|0.40 (0.21)
|0.32 (0.18)
|0.25 (0.14)
|0.32 (0.19)
|Peer Conflict
|0.32 (0.16)
|0.25 (0.16)
|0.17 (0.07)
|0.26 (0.14)
|Brief Symptom Inventory
|0.44 (0.27)
|0.49 (0.34)
|0.23 (0.17)
|0.35 (0.23)
|0.35 (0.20)
|0.38 (0.24)
|0.20 (0.13)
|0.34 (0.22)
|0.38 (0.22)
|0.49 (0.32)
|0.23 (0.12)
|0.34 (0.19)
Concurrent validity was assessed through comparison of responses to the CCSS-NCQ and the BSI, both of which were completed during the same assessment. Here, it was expected that the CCSS-NCQ Emotional Regulation factor would correlate more highly with the BSI factors than would the other CCSS-NCQ factors. Again, as evident in Table 3, this was the resultant outcome. Significant correlations were found between Emotional Regulation and the BSI Depression factor, P < .0001, as well as the BSI Anxiety factor, P < .0001. Kappa coefficients indicated the highest agreement between the Emotional Regulation factor on the CCSS-NCQ and all factors on the BSI. Task Efficiency and the Memory factors from the CCSS-NCQ were also correlated with the BSI factors.
Discriminative validity was examined by comparing the neurocognitive factors between cancer survivors who are at "high risk" versus "low risk" for neurocognitive dysfunction. As described above, a "Neurologic" group and a "Frontal CRT" group were compared with a group of "Healthy" survivors and a sibling group. Multivariate analysis was done to assess group differences. As presented in Table 4, after controlling for age and sex, there were significant differences between the 4 groups on the scores for Task Efficiency, Emotional Regulation, Organization, and Memory. For all factors, both the Neurologic and Frontal CRT groups displayed more overall symptoms than the Healthy survivors group. No significant differences were identified between the 2 "high-risk" groups, or between the Healthy survivors and the siblings. Although the Frontal CRT group displayed more symptoms than the Healthy survivors, this was not simply a function of diagnosis with a CNS tumor. The entire CCSS sample included 801 patients with CNS tumors, whose performance spanned the entire range of possible scores on Task Efficiency (range, 9-27), Emotional Regulation (range, 3-9), Organization (range, 3-9), and Memory (range, 4-12). Thus, some CNS tumor patients reported no impairment, whereas others appeared significantly impaired.
|Group 1 Frontal CRT Mean (SD)
|Group 2 Neurologic Mean (SD)
|Group 3 Healthy Mean (SD)
|Group 4 Sibling Mean (SD)
|Group Comparison*
|Task efficiency
|16.5 (5.18)
|16.2 (5.17)
|11.8 (3.26)
|11.9 (3.12)
|Emotional regulation
|5.5 (1.81)
|5.7 (1.81)
|5.1 (1.67)
|5.0 (1.60)
|4.9 (1.77)
|5.0 (1.80)
|4.4 (1.50)
|4.6 (1.61)
|2>3,4 1>3
|7.6 (2.47)
|7.1 (2.36)
|5.8 (1.85)
|5.8 (1.77)
As a method to demonstrate clinical significance, ratings were reclassified based on the frequency of occurrence of an item being rated as "Often a Problem" (ie, the highest possible rating available on the CCSS-NCQ). Logistic regression was used to calculate ORs for the Healthy survivors group, the Neurologic group, and the Frontal CRT group compared with the sibling group. Table 5 presents the result of this analysis. Compared with siblings, the "high-risk" groups demonstrated significantly increased rates of problem ratings for each of the 4 CCSS-NCQ factors, particularly for Task Efficiency and Memory. Equally important to note is the finding that the "low-risk" group of Healthy survivors demonstrated no significant increase in likelihood of problems compared with the sibling sample.
|Task Efficiency OR (95% CI)
|Emotional Regulation OR (95% CI)
|Organization OR (95% CI)
|Memory OR (95% CI)
|Siblings (Ref)
|Healthy survivors
|1.0 (0.7-1.4)
|1.4 (1.0-2.0)
|0.9 (0.6-1.3)
|1.4 (0.9-2.0)
|Neurologic survivors
|6.8 (4.5-10.2)
|2.7 (1.8-4.1)
|2.0 (1.3-3.1)
|4.6 (3.0-7.2)
|Frontal CRT survivors
|7.0 (4.8-10.2)
|2.5 (1.7-3.7)
|2.1 (1.4-3.1)
|7.0 (4.7-10.5)
In this study, we examined the validity of a brief self-report questionnaire in the assessment of neurocognitive functioning in long-term adult survivors of childhood cancer. This new questionnaire was designed to expand upon available questionnaire options by including items hypothesized to be sensitive to the effects of cancer therapy. Although current options tend to assess executive functions or behavioral symptoms, they generally do not focus on assessment of attention skills, processing speed, or memory and learning functions. Thus, for the new questionnaire, items addressing these specific skills were added to contextually similar items currently used to assess executive functions. The resultant CCSS-NCQ identified 4 factors that assess attention and processing speed (ie, "Task Efficiency"), emotional reactivity and frustration tolerance (ie, "Emotional Regulation"), organization of one's environment (ie, "Organization"), and working and long-term memory (ie, "Memory"). These 4 factors demonstrated good internal consistency, with a consistent pattern in both adult survivors of childhood cancer and their adult siblings. In addition, the procedure used with the development of this new measure ensured the control for demographic variables that are often relevant to cognitive functioning. That is, whereas the currently available measures of executive functions are standardized on a reference sample equated to the US Census, the CCSS-NCQ is referenced to siblings with a similar educational level and background. For example, the reference sample for the BRIEF-A includes 25.8% college graduates, which is consistent with the 24.7% in the 2002 US Census.16 However, this is significantly less than the 46.6% college graduation rate in the current CCSS sample. As cognitive abilities are impacted by educational experiences, using a reference group with lower educational attainment may result in underestimation in the rate of symptoms of mild cognitive dysfunction.
The factors derived from this new questionnaire correspond to established neurocognitive constructs. Emotional regulation, organization, and working memory are classically identified as neurocognitive abilities that fall within the category of "executive functions."17 Attention, processing speed and long-term memory are important neurocognitive skills related to more basic levels of information processing.18 Task Efficiency correlated well with attention deficits, as evident on the BPI, even when reported by different raters across a span of many years. This finding may suggest the presence of a persistent and pervasive pattern of symptoms that is apparent to both the survivor and significant others. The Emotional Regulation factor also correlates well with the BSI, an established measure of emotional symptomatology. Although the CCSS-NCQ and BSI factors appear to address different aspects of emotional symptoms, with the BSI focusing on the emotional experience and the CCSS-NCQ focusing on emotional control, they are related, as would be expected, because experience is a necessary precursor to control. Of note, ratings on the BSI were also moderately correlated with the Task Efficiency and Memory factors from the CCSS-NCQ. This is not unexpected, as current literature demonstrates a relationship between active emotional symptoms and symptoms of attention and memory problems.51‒54 That is, emotional state can interfere with attention to and retention of new information.
The CCSS-NCQ demonstrated excellent discriminative validity. Ratings on the factors discriminated between healthy survivors and survivors at risk for neurocognitive impairment. Survivors with a history of an identified neurological event (ie, stroke or epilepsy) reported significantly more symptoms than healthy survivors. Similarly, survivors with a history of intense cranial radiation therapy (ie, ≥35 Gy) to the frontal area of their brains reported significantly more symptoms than healthy survivors, although they did not significantly differ from survivors with neurological events. Although the ORs for frequently occurring problem behaviors were significantly higher in these at-risk groups across all 4 CCSS-NCQ factors, the Task Efficiency and Memory factors appeared particularly impacted by an increased risk level. This finding is consistent with the literature that indicates problems with attention, processing speed, and memory as being a pattern commonly observed in long-term cancer survivors who have a history of CNS disease and/or CNS treatment.4, 5, 20 In fact, in a recent meta-analysis of 28 empirical studies, the average reported effect size in survivors of childhood leukemia was slightly higher for measures of attention and processing speed than was the effect size for measures of executive functions.5 The combination of this difference between risk groups with the lack of a significant difference between healthy survivors and siblings may suggest that the symptoms reported on the CCSS-NCQ are specific to CSN disease and/or CNS treatment rather than the general cancer experience.
The initial findings of this investigation suggest that the CCSS-NCQ is a reliable and valid method for monitoring neurocognitive outcomes in adult survivors of pediatric cancer. Such monitoring is recommended following treatment with cranial irradiation and/or antimetabolite chemotherapy.6 Ideally, all such individuals would undergo routine neurocognitive evaluations. However, as such evaluations are difficult to obtain, the CCSS-NCQ may offer a practical and efficient alternative for research purposes.
A limitation of the current study is the inability to examine the relationship between the CCSS-NCQ and performance-based assessment using standardized direct measurement of neurocognitive functioning. Direct performance measures are the "gold standard" for assessing neurocognitive functioning in participants. Having such a standard in the CCSS cohort would provide for calculation of enhanced sensitivity and specificity data for the CCSS-NCQ. An additional limitation is that data are not available to examine change in CCSS-NCQ ratings over time. Research is currently underway with a smaller subset of these patients at St. Jude Children's Research Hospital to obtain direct neurocognitive performance measures and to reassess performance using the CCSS-NCQ. These new data will provide more precise indices of sensitivity and specificity, as well as test-retest reliability. A final limitation is related to the type of cancer treatment used in the CCSS cohort. Because this cohort was diagnosed and treated between 1970 and 1986, treatment agents related to neurocognitive dysfunction were primarily CRT and IT methotrexate. High-dose IV methotrexate and dexamethasone, 2 currently used chemotherapy agents associated with neurocognitive dysfunction, were not often used at that time.55, 56
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- 25Behavior Problems Index. Washington, DC: Child Trends Inc; 1986., .
- 26Manual for the Child Behavior Checklist. Burlington: University of Vermont, Department of Psychiatry; 1991..
- 27Behavioral and social outcomes in adolescent survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2007; 25: 3649‒3656., , , et al.
- 28Factor structure of the brief symptom inventory-18 in adult survivors of childhood cancer: results from the childhood cancer survivor study. Psychol Assess. 2006; 18: 22‒32., , , , , .
- 29Coefficient alpha and the internal structure of tests. Psychometrika. 1951; 16: 297‒334..
- 30Stability of executive function deficits into young adult years: a prospective longitudinal follow-up study of grown up males with ADHD. Acta Psychiatr Scand. 2007; 116: 129‒136., , , et al.
- 31Greater attention problems during childhood predict poorer executive functioning in late adolescence. Psychol Sci. 2007; 18: 893‒900., , , et al.Direct Link:
- 32Late neurocognitive sequelae in survivors of brain tumours in childhood. Lancet Oncol. 2004; 5: 399‒408., , , , .
- 33Comparison of long-term neurocognitive outcomes in young children with acute lymphoblastic leukemia treated with cranial radiation or high-dose or very high-dose intravenous methotrexate. J Clin Oncol. 2006; 24: 3858‒3864., , , et al.
- 34The NIH MRI study of normal brain development: performance of a population based sample of healthy children aged 6 to 18 years on a neuropsychological battery. J Int Neuropsychol Soc. 2007; 13: 729‒746., , , et al.
- 35Executive performance on the Wisconsin Card Sorting Test in mesial temporal lobe epilepsy. Eur Neurol. 2007; 57: 39‒46., , , , .
- 36Structured cueing on a semantic fluency task differentiates patients with temporal versus frontal lobe seizure onset. Epilepsy Behav. 2006; 9: 339‒344., , , et al.
- 37Relationship of indicators of neuropathology, psychopathology, and effort to neuropsychological results in patients with epilepsy or psychogenic non-epileptic seizures. J Clin Exp Neuropsychol. 2006; 28: 325‒340., , , .
- 38Is impairment in set-shifting specific to frontal-lobe dysfunction? Evidence from patients with frontal-lobe or temporal-lobe epilepsy. J Int Neuropsychol Soc. 2005; 11: 477‒481., , , , .
- 39Response inhibition and set shifting in patients with frontal lobe epilepsy or temporal lobe epilepsy. Epilepsy Behav. 2005; 7: 438‒446., , , , , .
- 40Neuropsychological and neuroanatomical correlates of perseverative responses in subacute stroke. Brain. 2006; 129(pt 8): 2148‒2157., , , , .
- 41Impaired working-memory after cerebellar infarcts paralleled by changes in BOLD signal of a cortico-cerebellar circuit. Neuropsychologia. 2007; 45: 2016‒2024., , , et al.
- 42Association between mild vascular cognitive impairment and impaired activities of daily living in older stroke survivors without dementia. J Am Geriatr Soc. 2005; 53: 103‒107., , , et al.
- 43Executive cognitive dysfunction without stroke after long-term mechanical circulatory support. ASAIO J. 2005; 51: 764‒768., , , , .
- 44Hypertension and cognitive decline: impact on executive function. J Clin Hypertens (Greenwich). 2005; 7: 598‒604., , , , .
- 45Homocysteine, cerebrovascular disease and brain atrophy. J Neurol Sci. 2004; 226: 25‒29..
- 46
- 47Neuropsychological performance and quality of life of 10 year survivors of childhood medulloblastoma. J Neurooncol. 2005; 72: 245‒253., , , et al.
- 48Factor analysis in the development and refinement of clinical assessment instruments. Psychol Assess. 1995; 7: 286‒299., .
- 49Statistical methods for assessing observer variability in clinical measures. BMJ. 1992; 304: 1491‒1494., .
- 50A reappraisal of the kappa coefficient. J Clin Epidemiol. 1988; 41: 949‒958., .
- 51
- 52Comorbid anxiety disorder in late life depression: association with memory decline over 4 years. Int J Geriatr Psychiatry. 2005; 20: 848‒854., , , et al.
- 53Depression and the causal role of specific memory system degenerations: link may be supported by reported therapeutic benefits of Omega 3 fatty acids. Med Hypotheses. 2007; 69: 67‒69..
- 54Associations among selective attention, memory bias, cognitive errors and symptoms of anxiety in youth. J Abnorm Child Psychol. 2006; 34: 841‒852., .
- 55Prevalence of leukoencephalopathy in children treated for acute lymphoblastic leukemia with high-dose methotrexate. AJNR Am J Neuroradiol. 2005; 26: 1263‒1269., , , et al.
- 56Cognitive sequelae in children treated for acute lymphoblastic leukemia with dexamethasone or prednisone. J Pediatr Hematol Oncol. 2000; 22: 206‒213., , , et al.


text:
Please remember to follow the manual of style and code of conduct at all times.
Check BNN and Bulbanews for up-to-date Pokémon news and discuss it on the forums or in our IRC channel #bulbagarden on irc.systemnet.info.
Check BNN and Bulbanews for up-to-date Pokémon news and discuss it on the forums or in our IRC channel #bulbagarden on irc.systemnet.info.
A-B-C Islands
From Bulbapedia, the community-driven Pokémon encyclopedia.
(Redirected from Island B)
| A-B-C Islands
イロハ諸島 Iroha Archipelago
A-B-C Islands
|The Evolutionary War!
The A-B-C Islands (Japanese: イロハ諸島 Iroha Archipelago) are an anime-exclusive group of islands off the coast of Hoenn that appear in the episode The Evolutionary War!. The islands are located between Lilycove City and Mossdeep City.
Trainers who live on the islands have a rivalry with each other: one group believes Huntail are stronger and another group believes Gorebyss are stronger.
Island A has a Pokémon Center which is also home to a school. On Island B, DeepSeaScales can be found to evolve Clamperl into Gorebyss, while on Island C, DeepSeaTeeth can be found to evolve Clamperl into Huntail. Racing their Huntail and Gorebyss between the islands, as a result, is a common occurrence for the Trainers who reside there.
Pokémon seen on the islands
- The reefs off the shores of these islands resemble particular katakana characters. Island A's reefs make an I (イ), Island B's make a Ro (ロ) while Island C's make a Ha (ハ). This (along with the name of the archipelago) is a reference to Iroha, a traditional way of grouping kana characters. This is somewhat equivalent to western ABC's.
|This article is part of both Project Anime and Project Locations, Bulbapedia projects that, together, aim to write comprehensive articles on the Pokémon Anime and Locations, respectively.
Latest Pokemon News
- Details on PAL region Zygarde distribution revealed: Zygarde available until May 26
- Shiny Xerneas, Shiny Yveltal, Zygarde to be available via Nintendo Network for American region: ...
- Johto Classic Wi-Fi competition announced: Participants to receive special Pokémon
- Pokémon Jukebox to be discontinued: To be phased out over the next two months
- Darkrai code cards available throughout North America: Codes available now

subset: commoncrawl


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List all words ending with frowzier
Only the word frowzier was found, nothing longer.
Some random words: inrush uxorial rhabdocoele heptachlor blab pe had
This is not a dictionary, it's a word game wordfinder.
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Community Calendar
Email announcements to email@example.com and include "Community Calendar" in the subject field. Items submitted less than two weeks...
For the record
Police blotter
Monday, April 111:17 p.m.: A store in the 1000 block of N. Broadway reported that $10,400 in tools and equipment was presumed stolen. A pair of boots was returned.Wednesday, April 1312:56 p.m.: A panhandler at Wal-Mart was arrested on an outstanding warrant.12:58 p.m.: A man was arrested on an outstanding warrant at a car wash on E. Main St.12:09 p.m.: An officer investigated a...
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Today in U.S. Naval History - July 14
1813 - Lt. John M. Gamble, the first marine to command a ship in battle (prize vessel Greenwich in capture of British whaler Seringapatam)
1853 - Commodore Matthew Perry lands and holds first meeting with Japanese at Uraga, Japan
1882 - Sailors and Marines from four U.S. ships land to help restore order at Alexandria, Egypt.
1945 - U.S. warships bombard Kamaishi, Japan; first naval gunfire bombardment of Japanese Home Islands.
1950 - U.S. Marines sail from San Diego for Korean Conflict.
1952 - Laying of keel of USS Forrestal, the first 59,900 ton aircraft carrier.
For more information about naval history, visit the Naval History and Heritage Command website at history.navy.mil.
Maritime Today
The Maritime Industry's original and most viewed E-News Service
1777 - During the American Revolution, the Continental lugger Surprise, led by Capt. Gustavus conyngham, captures the British mail packet Prince of Orange and the brig Joseph in the North Sea.
GE's Marine Solutions announced it will provide IHI, Tokyo, Japan, with two LM2500 aeroderivative marine gas turbines for the Japan Maritime Self Defense Force's (JMSDF) new 8,
BAE Systems has received a $72 million contract from the U.S. Navy to produce and deliver propulsor systems for Block IV Virginia-class (SSN 774) submarines. The
A ceremony unveiling a historic lifeboat as a new static display in Chatham, Mass. is scheduled for 11 a.m. Friday at U.S. Coast Guard Station Chatham.
The Damen Shipyards Group's Fast Crew Supplier (FCS) 2610 is proving to be every bit as effective in the oil and gas sector as it is in the offshore wind industry.


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2010 Toyota Highlander Hybrid for Sale in Philadelphia, PA
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Things to see and do - Paris
Leaving for France
Hôtel d'Aumont :
Nearby tourist sites
Nearby hotels
Hôtel Saint Merry from153 €Book
Hôtel De Nice from75 €Book
Villa Mazarin from166 €Book
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Eiffel Tower, Paris Moulin Rouge Show and Seine River Cruise
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Hôtel d'Aumont
Hôtel d'Aumont : Michelin's recommendations
Built in the 17C, using plans by Le Vau, this Mansion was refurbished and extended by François Mansart and decorated by Le Brun and Simon Vouet; as to the French-style garden, it was probably designed by Le Nôtre. The inner courtyard and the façades of this building, which today houses the Administrative Court, have a decoration that is almost gaunt.
Useful Information
- Address : 7 rue de Jouy F - 75004 Paris75004Paris
Read also our reports on: Hôtel d'Aumont
- Three Hotels for Young People in the heart of Le Marais
- Antoine Walter, Paris City Hall's Master Clockmaker
- Hôtel de Lauzun: luxury, calm and sensual joy
- French chocolatier Patrick Roger makes art edible
- At 850, Notre Dame Cathedral needs daily upkeep
- "Love locks" over the Seine for Parisian romantics
- French 'chocolate munchers' make fine art of tasting
- Paris' Notre-Dame cathedral celebrates 850 years
- French foodies tuck into caviar workshop
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Daniel Bryan quite arguably is the most popular superstar right now in the WWE. This coming Sunday at Hell In A Cell, Bryan gets another chance to win the WWE title as he will battle Randy Orton in the main event for the vacant WWE title inside the cell structure. The WWE released a video on You Tube with Bryan that shows what he did earlier in his career, his WWE run and has some choice words for Orton. Watch the video above.
Home » Videos » Video: Daniel Bryan Says Randy Orton Has "Never Seen How Violent Daniel Bryan Can Be"
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Johnny Mundo on Lucha Underground, Rocky Romero Talks NJPW + Debut Album
Two guests on the latest podcast! First Brian Fritz speaks with Lucha Underground star Johnny ...


text:
Comments about 'Utah working to implement veterans treatment courts'
- Oldest first
- Newest first
- Most recommended
This veteran has mixed feelings about the proposal.
First, they need to make sure that everyone claiming to be a "veteran" actually served. There are a surprising number of people who claim to be veterans who are not, but pose as such for panhandling, job seeking and other endeavors. They need to be weeded out and sent into the regular court system, with an added charge of impersonating a veteran. (If that is no a crime, then the Legislature can add it to their list for January!)
Second, veterans are drawn from society and will include people with various problems and activities, including criminal acts. Just because they are veterans, that does not mean they deserve special treatment. Crooks need to be punished,
Third, the liberals have been pushing the meme that veterans are some sort of "damaged goods" deserving of sympathy and special treatment and are fragile and untrustworthy. Some are, through no fault of their own, and they deserve our help and support and understanding. This is especially true of combat vets, who truly deserve a break.
But, most vets really do not need special courts, because most don't engage in criminal acts and are doing fine.
- 7:42 p.m. July 6, 2014
- Like (1)
- Report abuse
I agree, this seems to be an attempt to add more labels to our veterans to keep
them disarmed as a threat to peace and gun rights laws. Nothing more threatening
to a Socialist government gone insane than an armed patriotic veteran who can be
a threat to government. There are already laws on the books and most veterans
being labeled with PTSD when discharged and is reported to authorities.
This new threat to veterans as more legalization and documentation to strengthen the states rights to neutralize veterans with more labels and more forced treatments outside the VA administration. Its a civil list of dysfunctional american veterans trained in the art of war who cannot be allowed to their 2nd amendment rights. If a court can label them without proof its easy gun control legislation.
Its not about helping veterans, its about labeling and disarming veterans to criminalize them if they try to defend their rights. More labels means more controls. Instead of attacking their rights they attack their minds and training making them mental criminals at large stripped of their 2nd amendment rights in gun control laws.
- 2:51 a.m. July 7, 2014
- Like
- Report abuse
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Lemony Snicket's (UK - DVD R2)
The two-disc release of the film houses a number of 'Unfortunate' surprises...
Insert the second disc and wait for the main menu to appear. Next, highlight the 'Sinister Special Effects' entry and press enter on your remote. Now highlight the return arrow and press right on your remote, which should reveal an orange swirl. Press enter to view the 'Very Finicky Director' egg.
From the main menu on disc two, highlight the 'Gruesome Galleries' option and press enter on your remote. Next, highlight the return arrow and press right to reveal another orange swirl. Press enter to watch the 'Portrait of the Artist as the Bad Man' egg.
Staying in the 'Gruesome Galleries' section, highlight 'A Woeful World' and press right to highlight Count Olaf's 'eye'. Press enter to watch the 'Eyes Are Everywhere' egg, showcasing the various eye motifs in evidence throughout the film.
Easter Egg by Chris Gould
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$0.17 Cashback
Leveling Mount, Leveling Mount Type Swiveling Stud, Thread Size 1/2-13, Base Dia. 1-7/8 In., Load Capacity 5000 lb., Height 3-1/8 In., Hex 3/4 In., Bolt Length 2 In., Steel Base, Steel Construction, Yellow Zinc Finish, Includes Locking Nut
Martin Furniture 48" Shallow TV Mount in Skyline Walnut
Sold by 3 Storesfrom $159.78$159.78 - $199.98
up to $8.00 Cashback
Embrace a minimalist approach to incorporating entertainment furniture into your living area and free up floor space with Martin Furniture's wall mounted A/V console collection. Entertainment equipment can be easily accessible and not over power your...
Chest Mount Harness for Action Cam AKA-CMH1
Sold by 4 Storesfrom $29.99$29.99 - $99.95
up to $2.25 Cashback
Get to the centre of the action Capture that elusive view point and get closer to the terrain with the AKA-CMH1 chesty. The Action Cam chest mount gives the viewer a greater sense of realism. Change your view Get more interesting angles by...
SANUS VuePoint F107d 13"-32" Full-Motion Wall Mount
Sold by Tech for Lesssale $37.49
$0.75 Cashback
Easily mounted in the home or office, it offers smooth extends, swivels and pans up to 7.6 inch from the wall. Full motion allows easy viewing from multiple angles without the use of tools. Manuals and software might not be included, but can usually...
43 - 70" Full Motion TV Wall Mount
Sold by 5 Storesfrom $116.32sale $116.32 - $189.41
up to $9.47 Cashback
OmniMount OC120FM 43 - 70" Full Motion TV Wall Mount
Manhattan 424691 Universal Flat-Panel TV Full-Motion Wall Mount
Sold by UnbeatableSalesale $61.83
$2.47 Cashback
FeaturesSecurely holds one flat-panel televisionOptimize views with full-motion ±;12° tilt and 180° swivel adjustmentsHeavy-duty steel constructionEasy installation ideal for home, office and commercial applications –...
Pyle 15-32" Flat Panel Dual Arm Cantilever TV Wall Mount
Sold by 2 Storesfrom $19.17sale $19.17 - $20.15
up to $0.77 Cashback
Universal Mounts Fits LCD Display up to 32. VESA Standard: 50 x 50 mm, 75 x 75mm, 100 x 100mm. MAX Load: 44 Lbs. 180 Swivel Left and Right. 20 up and down.
Whalen Furniture - Plug & Play Tv Console For Most Flat-panel Tvs Up To 47"
Sold by 2 Storesfrom $99.98$99.98 - $345.00
Give your LCD, LED or plasma display the home it deserves with this stylish console. Foster a light and open atmosphere in your living room with this modern 41" Flat Panel Console from Whalen Furniture. Supporting a universal TV mount for 45-degree...
Sold by Tech for Lesssale $74.49
$1.49 Cashback
This wall mount loaded with innovative features like Glide Lock Latching with an integrated kickstand for easy cable connection and Centris Technology which provides smooth fingertip tilt adjustment to achieve the ideal viewing angle. With open wall...
IC BY CHIEF 10 - 37 Full-Motion Wall Mount
Sold by 3 Storesfrom $127.49sale $127.49 - $127.99
up to $6.37 Cashback
Full-Motion Mount Features a large open wall plate for easy electrical box placement cable routing and connection. The dual swing arm mount increases functionality of a flat panel providing wide viewing angles and multiple room use in your home. ...
Hangman Ultra-Slim Fixed Wall Mount for 26 to 48 inch LED/LCD TVs (S2040-A)
Sold by 2 Storesfrom $37.01sale $37.01 - $37.04
up to $1.85 Cashback
The Hangman no stud TV hanger will hang any LED thin screen TV in less time than it takes to unpack it. This mount consists of two interlocking aircraft-grade aluminum brackets for secure use. Built-in level Easy tilt for access to cables ...
Manhattan Comfort Cabrini 2.2 Series 86" TV Panel in Nut Brown
Sold by Cymax Storesale $284.93
$11.40 Cashback
Maximize your living room space with the Cabrini 2.2 TV Panel. Includes brackets to mount your TV on the panel and free your floor space and help minimize clutter! The 2 overhead LED lights creates a cozy and homey atmosphere in your living room. Pair...
Mega Mounts Full Motion Wall Mount with Bubble Level for 26-55-inch Displays with HDMI Cable
Sold by 2 Storesfrom $38.99$38.99 - $62.99
up to $1.26 Cashback
Mega Mounts Full Motion Wall Mount for Plasma/LCD/LED TV's is durable and secure. Holds flat screens from 26-inch to 55-inch and can withstand up to 100 lb. Features downward tilt and 180-degree swivel capabilities, for easy viewing from any...
Martin Furniture 60" Ascend Asymmetrical TV Mount in Columbian Walnut
Sold by 3 Storesfrom $135.27sale $135.27 - $169.99
up to $6.80 Cashback
Embrace a minimalist approach to incorporating entertainment furniture into your living area and free up floor space with Martin Furniture's wall mounted A/V console collection. Entertainment equipment can be easily accessible and not over power your...
Sold by UnbeatableSalesale $272.88
$10.92 Cashback
Color/Finish: Black.Contemporary brushed nickel legs.Black tempered safety glass.Chrome cylinder glass supports.TV can sit on top shelf.TV can be mounted to the mount post featuring both swivel and tilt functions.TV can be mounted to the wall...
SUTTLE 1 SE-630LCCU-50 Wall Mount DSL Filter
Sold by Walmart$9.77
Suttle DSL filters isolate telephone equipment impedances that interfere with ADSL communications- Features: mounting lugs for wall mount phones Customer installable- Securely snaps over existing wall jack Meets ANSI T1E1-4 RE 7R2 standards for DSL...
Xmark Fitness XM-2844 Commercial Heavy Bag Speed Bag Stand: XM-2844 Punching Bag
Sold by AppliancesConnection.com$80.00
The primary objection raised to having a heavy bag present at home is the amount of space it consumes. This complaint is no longer valid with the introduction of the XMark Space miser Pivoting Heavy Bag Wall Mount XM2831. Your heavy bag can rota ted...
TygerClaw 37~63 Low-Profile Wall Mount
Sold by 2 Storesfrom $49.15sale $49.15 - $98.99
up to $1.97 Cashback
TygerClaw LCD3404BLK Low-Profile(Fixed) wall mount is designed for most 37 to 63 flat-panel TVs up to 165lbs/75kgs
LG OSW100 Wall Mount For 55EC9300 Curved OLED Television
Sold by Walmart$35.87
EZ Slim Wall Mount for 55EC9300 Curved OLED TV Mount your stunning OLED TV on the wall with the LG OSW100 wall mount. Developed specifically for the 55EC9300 Curved OLED television, this wall mount will help highlight the unique gentle curve and...
McNaughton 94139 LCD 403L Locking Cantilever Mount
Sold by UnbeatableSalesale $89.95
$3.60 Cashback
We heard you RVers and Truckers!! This mount was especially designed for LCD screens that are mounted in moving vehicles! New Locking Cantilever Mount locks your screen securely against the wall with a spring loaded locking pin and pull chain lock...
Speakercraft STP7-B Wall-mount 7" Touch-Panel Controller for MRA-664
Sold by ielectronics$1,000.00
$20.00 Cashback
SpeakerCraft sTP7, a 7" touch panel controller with a contemporary industrial design for control of the SpeakerCraft MRA-664 multi-room audio control system. The touch panel is wall mountable in either portrait or landscape orientation to best suit...
QPower QBOMB12VLSQ Dual Square 12 inch Slot Ported Deep Mount Woofer Enclosure
Sold by UnbeatableSalesale $101.77
$4.07 Cashback
"Q Bomb" is etched in the top of the box.13"H x 5"W slot port in the middle.The slot port walls do not go all the way to the back so each chamber is not sealed.
Stanley 32 - 55 in. Interactive Full Motion Flat Panel TV Mount TLX-350FM
Sold by 2 Storesfrom $214.95sale $214.95 - $222.19
up to $11.11 Cashback
32" to 55" Screen Support - 60 lb Load Capacity - Black Marketing Information High performance dual arm interactive mounting system featuring revolutionary gas shock spring to fluidly control the movement of the FPTV. Easy install and operation. ...
Stay-Put Flex Mount, 12" (304.8mm) Overall Length
Sold by 2 Storesfrom $20.79sale $20.79 - $27.45
up to $0.42 Cashback
PanaVise 12" Stay-Put Flexline Phone Mount Model # 782-12 Panavise heavy duty, double wound flex mounts provide rigidity and continuous reliability. Vinyl clad coating. Patented "pinch design" at the foot prevents loosening. Universal adjust...
65EF9500 65" Class 4K Ultra HD 3D OLED Smart TV with OTW150 Tilting Wall Mount
Sold by World Wide Stereo$4,997.99
$149.94 Cashback
Give everyone at your movie night the perfect view with this LG 65EF9500 65" Class 4K Ultra HD 3D OLED Smart TV with OTW150 Tilting Wall Mount. The included 65" TV comes with the latest visual technology to enjoy three-dimensional programs in stunning...
LEVEL MOUNT DC65PWT POWER TILT MOUNT FITS 37 in. TO 85 in. TVs
Sold by UnbeatableSalesale $118.63
$4.75 Cashback
Easy to use and install the Level Mount DC65PWT is designed to fit any 37-85" Flat Panel TV up to 170 lbs This unit is a motorized tilt mount with a RF remote control that adjusts the screen to tilt up to15 to position the screen for an optimal...
Digicom Digital Universal Articulating Arm TV Mount
Sold by 2 Storesfrom $40.94sale $40.94 - $119.00
up to $1.64 Cashback
Digicom Articulating Arm Mount 10 TO 22 VESA 200Price: $1.00 --gt;Item ID#: PMA-223 Description: Digicom Universal Articulating Arm Mount for TV s 10 TO 22 VESA 200.
Mega Mounts Tilt 42" - 65" TV Wall Mount
Sold by 2 Stores$36.99
up to $0.74 Cashback
Tilt wall mounts will work with most 42-65" LCD/LED Televisions. The super Flush Tilt design is easy to install and remove. Horizontal and vertical position adjustments allow perfect positioning of the screen regardless of the distance of wall...
Metal-Mounting Back Strap 9"
Sold by 3 Storesfrom $1.99$1.99 - $5.99
up to $0.24 Cashback
Install Bay BS9 Metal-Mounting Back Strap, 9": Metal-mounting back strap 9"
Ergotron Universal CPU Holder, 50 lbs Load Capacity
Sold by 7 Storesfrom $32.97sale $32.97 - $59.53
up to $2.55 Cashback
This holder mounts most computers to a variety of surfaces: directly to a wall or under a desk, or to Ergotron Wall Track, Command Post or select Carts. This unit's design is attractive and open, keeping your system cool when it is in use for long...
GLIDE RITE G05-EL Leveling Mount, Glide Rite, 3/8-16, 250 lb.
Sold by Zoro$3.83
$0.08 Cashback
Leveling Mount, Leveling Mount Type Fixed Stud, Thread Size 3/8-16, Base Dia. 2-1/32 In., Load Capacity 250 lb., Height 3 In., Bolt Length 2 In., Non-Skid Base, Steel Construction, Clear Zinc Finish
Ematic Tilting TV Wall Mount Kit with HDMI Cable for 30" - 60" Displays
Sold by 6 Storesfrom $24.25$24.25 - $32.14
up to $0.83 Cashback
The Ematic 30" to 70" TV Wall Mount Kit safely mount your TV to your wall. Adjusts up to 10 of tilt for optimum view. Includes all mounting hardware and features a built-in level for easy installation. 6' HDMI cable included. Designed...
Arrowmounts 32 to 55-inch Full motion TV Mount with 22.6-inch Arm
Sold by 2 Storesfrom $44.08$44.08 - $51.58
up to $1.03 Cashback
This is articulating light duty mid size bracket for 23 to 37 inch screen size with 88lbs capacity. It can swivel plus/minus 90 degrees, and tilt minus 10 degrees (down). Mounting plate extends up to 22 inch from the wall. For 32-55 inch screen ...
Monoprice 12280 Full-Motion TV Wall Mount
Sold by UnbeatableSalesale $83.46
$3.34 Cashback
FeaturesFull-Motion TV Wall Mount.For most 60-100 in. Flat Panels.
Ergotron 45-361-026 Interactive Arm LD Mounting Kit for LCD Display - Polished Aluminum
Sold by 5 Storesfrom $100.97sale $100.97 - $161.53
up to $6.46 Cashback
Factory Sealed The Ergotron 45 361 026 Interactive Arm LD Mounting Kit accommodate the active TV positioning needs of today and tomorrow. Lift, swing or turn your display in any direction. Features 20 inch of vertical adjustment and 15 inch motion...
LEVEL MOUNT DC55MC CANTILEVER MOUNT FITS 26 in. TO 57 in. TVs
Sold by UnbeatableSalesale $235.61
$9.42 Cashback
Easy to use and install the Level Mount DC55MC is designed to fit any 26-57" Flat Panel TV up to 150 lbs. This unit pans up to 30; extends up to 14" tilts up to 15 and swivels to position the screen for an optimal viewing experience. Everything...
TygerClaw CLCD102 TygerClaw 23 in. - 37 in. Tilt Ceiling Mount - Silver
Sold by UnbeatableSalesale $98.52
$3.94 Cashback
This TygerClaw CLCD102 Tilt Ceiling mount is designed for most 23" to 37" flat-panel TVs up to 99lbs/45kgs with tilt degree up to +15°, swivel degree up to 360°, and is constructed from heavy gauge steel for total support and...
SANUS SYSTEMS SF213-B1 Full-Motion Mount for up to 27" Flat Panel TVs (Dual arm;
Sold by AppliancesConnection.com$51.99
The Vision Mount SF213 is a full-motion wall mount for flat-panel TVs and monitors up to 27". Sanus Systems' Virtual Axis technology allows the mount to tilt up and down with the touch of a finger. Full motion allows mount to extend, retract and...
Keeper Flat Bed Mounting Plate KWA011
Sold by 2 Storesfrom $97.64$97.64 - $128.09
up to $6.40 Cashback
Keeper's Flat Bed Mounting Plate is designed to fit the KW9.5 Heavy Duty Winch and the KW13.5 Heavy Duty Winch. Made of steel with a black paint coating, the mounting plate has two bends for added strength. Mount your Keeper winch to a flat bed or...
Kanto FMC4 Kanto FMC4 Full Motion Corner Mount -with Adjustable Pivot For 30 inch to 50 inch TVs
Sold by Best Buy$119.99
The Full Motion FMC4 Corner Mount with adjustable pivot is without a doubt our most versatile television mounting solution available. This TV mount is ideal for almost any type of home installation and is specifically designed to provide the perfect...
Audio Solutions 60'' TV Full Motion Wall Mount
Sold by AVHiFi$129.99
$7.80 Cashback
The FM2260 Full Motion Television Wall Mount has been designed to work with most 22 to 60 inch Plasma, LED and LCD televisions with a maximum weight of 143lbs (65kg). This sturdy flat panel mount is ideal for any wall application, allowing you to...
Universal Flat-Panel Mount - Steel - 160 lb
Sold by 5 Storesfrom $103.99$103.99 - $147.00
up to $6.93 Cashback
Our unique universal series mounts feature our innovative Griplate System (patent pending). This exclusive system accurately supports the appropriate mounting hardware with teeth set in detents along mounting bracket.
Omnimount(r) 10.0 W/C Speaker Mount; Black
Sold by Quill$25.99
$0.78 Cashback
Includes Universal wall/ceiling speaker mount, hardware kit.
Browning Br1015 - Uhf Fully Enclosed Nmo 3/4" Hole Mount
Sold by 4 Storesfrom $14.89sale $14.89 - $20.15
up to $0.74 Cashback
Fully Weatherized, Fully Shielded Zinc Housing; High Frequency Low Loss Up To 1.5 Ghz; Solid Brass Nmo Ring ; Gold Contact Pin; 17ft Rg-58 A/u Cable With Tinned Copper Braid 95% & Tinned Copper Stranded Center Conductor; Uhf Male Pl-259 Connector...
Omnimount Lift 50 Vertical Glide TV Mount for TVs up to 30-50 lbs
Sold by 4 Storesfrom $329.95sale $329.95 - $347.99
up to $16.56 Cashback
OmniMount LIFT70 Lift Mount For 46"-65" Flat-Panel TVs Up To 70 lbs
Arrowmounts 37 to 70-inch Full motion TV Mount with 28.3-inch Arm
Sold by 2 Storesfrom $75.99$75.99 - $81.57
up to $1.63 Cashback
Its mounting plate can swivel 180 degrees, tilt from -5 (upward) to + 15(downward), and extend up to 28 inch (720mm) from the wall. The bracket is for 32 to 50 inch screen size and can hold up to 110lbs (50kg). Hardware is included for wood...
Security Mount - system security under-desk/wall mounting kit
Sold by 2 Storesfrom $55.18$55.18 - $61.30
up to $1.23 Cashback
Aluminum - Silver Marketing Information The Tryten Mac Mini Security Mount is manufactured from 11 gauge Aluminum, is powder coated to match the style of your Mac Mini Computer and includes a Master Keyed high security lock. Each mount comes in...
Arrowmounts AM-CHF4070B TV Mount 40 - 70 in. Fixed Max 800 x 600 mm. VESA
Sold by UnbeatableSalesale $30.18
$1.21 Cashback
FeaturesThis low profile wall bracket keeps TV 11 in. (28 mm.) close to the wallThis wall mount supports most 40 to 70 in. flat TVs up to 132 lbs weightIt is good for boardrooms, digital signage, or home theatersHardware is included...
Lenovo Thinkcentre Tiny Vesa Mount
Sold by UnbeatableSalesale $15.13
$0.61 Cashback
Lenovo thinkcentre tiny vesa mountthinkcentre tiny vesa mount
Mount-it Dual Articulating Arm/Tilt Wall Mount for 13" - 30" LCD
Sold by Walmart$40.99
MOUT1027 Features Finish: Electrostatic powder coat Construction: Hardened steel Mount Type: Wall mount Adjustability: Tilt/Swivel/Articulating/Extending arm Weight Capacity: 33 Pounds Color: Black Compatible Screen Size: Less than 20"/20" - 27"/28" -...
DoubleSight Displays Triple Monitor Tier Extension - 22 lb - Black
Sold by 3 Storesfrom $143.99$143.99 - $189.00
up to $9.45 Cashback
CASE PACK: Each DoubleSight's unique flex stand design allows for easy expansion as your needs change. Tier extensions are adjust for height, tilt, swivel and pivot for a truly custom view. In addition to height, users can also move monitors...
Tygerclaw SM8001BLK Black 3-Axis Dual Speaker Wall Mount - Black
Sold by UnbeatableSalesale $26.31
$1.05 Cashback
The lightweight and compact 3-Axis Dual Speaker Wall Mount is designed for speakers up to 15kgs (33lbs), with free tilt and rotation! This provides an innovative locking mechanism which gives quick and easy installation....
DataComm Flat Panel TV Cable Organizer Remodeling Kit with Power Outlet
Sold by Walmart$34.25
General InformationUse DataComm Electronics' Flat Panel TV Cable Organizer Remodeling Kit with Power Outlet to install power and hide unwanted audio/video (A/V) cables behind your flat panel TV. This kit is ideal for converting an unfinished basement...
OMNIMOUNT 15lb Ceiling Speaker Mount
Sold by 4 Storesfrom $42.59$42.59 - $63.31
up to $3.17 Cashback
Includes complete hardware kit and clamp and jaw. Tilts ±30 degree. Pans 180 degree. Base rotates 360 degree. Polymer-injected ball controls resonance frequencies for better sound. Stainless steel hardware provides strength & durability. ...
Omnimount 25.0 W 25.0 Wall Speaker Mount 7.10In. X 15.00In. X 4.30In.
Sold by 4 Storesfrom $69.61$69.61 - $136.35
up to $6.82 Cashback
Includes complete hardware kit and clamp and jaw. Thread size: 0.375 in.16. Tilts ±30 degree. Pans 180 degree. Base rotates 360 degree. Polymer-injected ball controls resonance frequencies for better sound. Stainless steel hardware...
Manhattan - Mounting kit ( full motion wall mount ) for LCD / plasma panel - steel - screen size: 37" - 70" - mounting i
Sold by 3 Storesfrom $64.33$64.33 - $73.80
up to $1.93 Cashback
Overcome odd floor plans, annoying glare and awkward furniture placements that can diminish flat-panel TV experiences. MANHATTAN Universal Flat-Panel TV Full-Motion Wall Mounts help achieve optimal viewing angles from almost anywhere in the room with...
Manhattan Wall Mount for Flat Panel Display - 37" to 70" Screen Support - 176 lb Load Capacity - Steel - Black
Sold by Walmart$61.51
Get a room with a view. Overcome odd floor plans, annoying glare and awkward furniture placements that can diminish flat-panel TV experiences. MANHATTAN Universal Flat-Panel TV Full-Motion Wall Mounts help achieve optimal viewing angles from almost...


text:
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text:
Volume Discount
Buy 4+Save 5%
Loyalty Program
- Loyalty credit equals to 10% of the final shopping cart price, excluding shipping charges, and is available to be used toward your next order once your current (last) order has shipped.
- You have a pending credit from a previous order. Once the order is shipped out, the credit will be available.
- Each time you place a new order, a loyalty credit equal to 10% of the value of your order will be given to you.
- Loyalty credits expire 60 days after your last purchase with iHerb.
This product is already in your Wish List.
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Expiration Date:?Jan 2020
Expiration Date
The length of time for the expiration date or "best used before" date depends on the type of product, as well as the brand.
Perishable items (such as flax oils or certain probiotics) generally have shorter expiration dates. Although our warehouse is fully air-conditioned, these more fragile items are put in cold storage (freezer or refrigeration unit) for maximum freshness.
Our receiving department does its best to verify and then enter the correct expiration dates for all incoming products. However, discrepancies do occur from time to time. This being said, the exceptionally high turnover at iHerb ensures that our inventory is among the freshest in the industry.
Shipping Weight:?0.5 lbs (0.23 kg)
Shipping Weight
The Shipping Weight includes the product, protective packaging material and the actual shipping box. In addition, the Shipping Weight may be adjusted for the Dimensional Weight (e.g. length, width & height) of a package. It is important to note that certain types of products (e.g. glass containers, liquids, fragile, refrigerated or ice packed) will often require protective packaging material. As such, these products will reflect a higher Shipping Weight compared to the unprotected product.
- Product Code: ADN-00250
- UPC Code: 859975002508
- Package Quantity: 1.7 fl oz (50 ml)
- Dimensions: 2.4 x 2.4 x 2.3 in, 0.3 lbs (0.14 kg)
Product Overview
- Age Defying Fruit Stem Cells
- Non GMO
- Fruit Stem Cell Science
- Brightening
- Non GMO Project Verified
- Verified Gluten Free
- pH Balanced & Hypo-Allergenic
- No Paraben Preservatives
- No Sulfates or Phthalates
- Vegetarian & Cruelty Free
How Does it Work?
Fruit Stem Cells
Malus Domestica Apple/Solar Vitis Grape
- Renew dormant cells
- Repair damaged cells
- Regenerate healthy cells
BioActive 8 Berry Complex
Certified organic portfolio of superfruit antioxidants.
Certified Organic Aloe Vera
Soothes inflammation, oxygenates and hydrates, advances dermal absorption of active ingredients.
Fruit Stem Cell Complex, Vitamin C, and purple carrots, mega-rich in anthocyanin antioxidants, effectively defend against UV damage, hyperpigmentation and premature aging by activating cellular renewal, and boosting collagen and elastin for even tone, firmer texture, and a healthy, luminous complexion.
Suggested Use
Nightly. Apply to clean face and neck.
Other Ingredients
Aloe barbadensis juice*, linum usitatissimum (flax) and borago officinalis (borage) oils*, vegetable glycerin, vaccinium macrocarpon (cranberry) juice*, fruit stem cells (malus domestica, solar vitis) and bioactive 8 berry complex*, cetearyl alcohol, daucus carota (purple carrot) extract*, magnesium ascorbyl phosphate (vitamin C), lauric acid, helianthus annuus (sunflower) oil*, theobroma cacao (cocoa) butter*, hyaluronic acid, persea gratissima (avocado), rosa canina (rosehip) and oenothera biennis (evening primrose) oils*, olive squalane, tocopherol (vitamin E), camellia sinensis (white tea), aspalathus linearis (rooibos) and hibiscus rosa-sinensis extracts*†, allantoin, mangifera indica (mango) butter, phenethyl alcohol, ethylhexylglycerin, citrus aurantium dulcis (orange) oil*.
* Organic
† Fair Trade
For external use only.
Avoid direct contact with eyes.
iHerb Customer Reviews
This night cream is amazing! It really moisturised my skin, but doesn't leave my skin oily or feeling over-moisturised in the morning. It sinks into the skin like a miracle. And after using it for two weeks I've noticed that my complexion became brighter and more even. I haven't noticed a whitening effect per se. The effect is closer to just healthier looking skin. The scent is kind of strong, but goes away quickly.
It smells nice and the texture is great, not oily, light, doesn't block the pores. I noticed a difference on my skin, of course it could be due to my day cream as well but I definately have less breakouts and blackheads ever since using this (and my day cream) and my skin just feels softer overall. I used to change my creams all the time, trying something new but I think this one worth being faithful to.
Andalou Naturals is starting to become one of my favourite skincare brands
Posted by 5462851726470232798 on Aug 09, 2014
This night cream is amazing! It really moisturised my skin, but doesn't leave my skin oily or feeling over-moisturised in the morning. It sinks into the skin like a miracle. And after using it for two weeks I've noticed that my complexion became brighter and more even. I haven't noticed a whitening effect per se. The effect is closer to just healthier looking skin. The scent is kind of strong, but goes away quickly.
Was this review helpful to you?
4 people found the following review helpful
Posted by 5146252840335244305 on Sep 13, 2014
It smells nice and the texture is great, not oily, light, doesn't block the pores. I noticed a difference on my skin, of course it could be due to my day cream as well but I definately have less breakouts and blackheads ever since using this (and my day cream) and my skin just feels softer overall. I used to change my creams all the time, trying something new but I think this one worth being faithful to.
Was this review helpful to you?
3 people found the following review helpful
Good for delicate skin
Posted by Reviewer1905589 on Nov 12, 2014
I have a very sensitive skin and most of brightening product make my skin even more sensitive and give me reddish pimples... This cream just respect my skin and I have the feeling that it is helping with fading the spot. A Small cons will be that it is not en ought moisturizing for my combination skin so sometimes I have to layer oil on top of it. Besides that I really enjoyed it and will probably re-buy it.
Lightweight plus nice scent
Posted by oliews on Dec 01, 2015
I have the day cream - Renewal, Probiotic + C, also from the brightening line. I was quite satisfied with that, so I decided to get the night cream from them to try it out too. This smells like grape jelly from my childhood, and I simply love it. Although this is a night cream, it absorbs really well into my skin; even better than the day cream did. My face feels very smooth after application. However with that said, it is not heavy and thus if you are looking for heavy creams, look for other creams.
Nice Night Creme
Posted by TrueShoppingAdvice on Dec 05, 2015
This night creme has a nice mild doft and lasts very long time. Make sure that you do not use your fingers to take the creme from the jar. Otherwise you will be adding bacteria that deteriorate the beneficial ingredients every time you use the creme. Make also sure that you do not keep the jar open unnecessarily because all plant extracts, almost all vitamins, antioxidants, and other state-of-the-art ingredients break down in the presence of air. Andalou Naturals has included a number of antioxidants to help protect skin against free-radical damage. From extracts like cranberry, vitamin C from magnesium ascorbyl phosphate to white tea and rooibos, there is a range of anti-aging ingredients present. To help moisturize and repair, Purple Carrot + C Luminous Night Cream contains multiple non-fragrant plant oils (flax, borage and sunflower) along with cocoa, shea and mango butter. All of those ingredients kick in antioxidant benefits, too. This creme has worked very well on my combination skin. Purple Carrot + C Luminous Night Cream contains a number of beneficial ingredients and its moisturizing formula is well suited to the needs of those with normal to dry skin. I hope you found this review helpful, if so kindly click the Yes button below, thank you. You are warmly welcome to read my other product reviews too. Enjoy your iHerb journey!


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Benalla Vet Lab contribution recognised
A plaque was unveiled last month to recognise the work of livestock producers and veterinarians in the region.May 9, 2014 3:19am
State Member for Benalla Bill Sykes, Mike Burston and John Copland unveiled a plaque at the former Regional Veterinary Laboratory Benalla site.
The work of livestock producers and veterinarians in the region was acknowledged last month when a plaque was unveiled at the former Regional Veterinary Laboratory Benalla site.
More than 40 employees of the former vet lab and Animal Health field staff gathered at the Sydney Rd site — now home to the Department of Environment and Primary Industries — on April 26 to celebrate the unveiling.
The plaque commemorated the contribution of local livestock producers, vet lab and Animal Health field staff and private veterinarians to the eradication of brucellosis and tuberculosis from north-east Victoria as part of the successful eradication of both diseases from Australia.
The eradication phase of these two diseases ran over two decades and cost more than $1
In doing this Australia achieved a world first, and continued global market access for our beef products was assured.
Former Regional Veterinary Laboratory staff member Tricia Veale said the laboratory also directly and indirectly played a role in the advancement of agriculture and fisheries across Victoria and Australia.
''The laboratory was founded with the support of local livestock producers and with the co-operation of farmers, private veterinarians and Animal Health staff successfully eradicated bovine brucellosis and bovine tuberculosis from north-east Victorian herds,'' Ms Veale said.
At last month's gathering local beef producer Mike Burston spoke about the local livestock producers' initiative to purchase the land on which the vet lab was built and make it available to the government to ensure the lab was located in Benalla.
The plaque was unveiled by the original vet lab director, John Copland, and State Member for Benalla and former Regional Veterinary Officer Bill Sykes
Dr Copland spoke of the wonderful team spirit among the 100 or more staff members and the emergence of the Australian National Fish Health Laboratory at Benalla.
He highlighted the significance of the vet lab's contribution to animal health and welfare in general and the great sense of camaraderie among staff.
Following the unveiling of the plaque, people adjourned to Benalla Golf Club for a meal and to recall many fond memories of working at the Regional Veterinary Laboratory.
The lab opened in 1975 and closed in 1994.
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