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Author Affiliations: Division of Neurology, Department of Medicine (Drs Swartz, Gao, Sahlas, and Black) and Department of Psychiatry (Drs Lanctot and Streiner), Sunnybrook Health Sciences Centre, and Institute of Medical Science, University of Toronto (Drs Behl, Swartz, Sahlas, Lanctot, Streiner, and Black), Toronto, Ontario; Division of Neurology, Department of Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec (Dr Bocti); and Kunin-Lunenfeld Applied Research Unit, Baycrest, Toronto (Dr Streiner).
To investigate changes in cognition, function, and behavior after 1 year in patients with Alzheimer disease being treated with cholinesterase inhibitors, in relation to the presence or absence of subcortical hyperintensities involving the cholinergic pathways.
One-year prospective cohort study.
Memory Clinic, Sunnybrook Health Sciences Centre, University of Toronto.
Ninety patients with possible/probable Alzheimer disease who were being treated with cholinesterase inhibitors at baseline.
Yearly standardized neuropsychological testing and brain magnetic resonance imaging (MRI). The Cholinergic Pathways Hyperintensities Scale (CHIPS) was applied to baseline MRIs to rate the severity of subcortical hyperintensities in cholinergic pathways. The consensus-derived Age-Related White Matter Changes (ARWMC) Rating Scale was used as a general measure of white matter disease burden.
Main Outcome Measures
Tests of global cognition, function, and behavior and specific cognitive and functional domains.
Patients in the low CHIPS group were equivalent to those in the high CHIPS group with regard to baseline demographic characteristics, cognitive severity, and vascular risk factors. After covarying age and education, no differences were found after 1 year in overall cognition, function, and behavior or on memory, language, and visuospatial tasks. Patients in the high CHIPS group showed improvement on executive function and working memory tasks compared with those in the low CHIPS group. For the ARWMC scale, groups with and without white matter abnormalities were equivalent on baseline demographics and in cognitive, functional, and behavioral outcomes.
Cerebrovascular compromise of the cholinergic pathways may be a factor that contributes more selectively than does total white matter lesion burden to response to cholinergic therapy in Alzheimer disease, particularly on frontal/executive tasks.
Cholinesterase inhibitors (CHEIs) provide symptomatic benefits in mild to moderate Alzheimer disease (AD).1 Executive function tests may be most sensitive to cholinergic treatment.2 Cells in the basal forebrain are the source of cholinergic output to the hippocampus and the cerebral cortex. The trajectories of the unmyelinated cholinergic fibers from the nucleus basalis of Meynert to their synaptic endings in the neocortex have been traced immunohistochemically in the human brain. These fibers consist of 2 discrete bundles traveling medially through the cingulum and laterally through the external capsule, then fanning out to all neocortical areas.3 Strategic ischemic lesions in these pathways, in the absence of AD pathology, have been demonstrated in a young patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)4 and vascular dementia of Binswanger type.5
Subcortical hyperintensities (SHs) usually represent small-vessel ischemic disease, including incomplete or complete infarction. Strategically located SHs in cholinergic pathways are associated with greater relative deficits in executive function in patients with AD who also have cerebrovascular disease and vascular cognitive impairment.6,7
Given this potentially more specific cognitive impact and results from large-scale clinical trials in vascular dementia8 and mixed dementia9 suggesting benefits with CHEI treatment, we investigated changes in cognition, function, and behavior after 1 year in treated patients with AD, in relation to the presence or absence of SHs in the cholinergic pathway. We hypothesized that patients with cholinergic pathway injury from vascular disease matched in cognitive status may have less relative AD pathology and that the partial injury caused by vascular disease in the cholinergic pathways might be more amenable to treatment with CHEIs. Thus, we predicted that treated patients with more severe cholinergic pathways involvement (high Cholinergic Pathways Hyperintensities Scale [CHIPS] score) would show less decline compared with patients with no or minimal cholinergic tract involvement (low CHIPS score), especially on frontal/executive tasks.
Participants were recruited from the Sunnybrook Dementia Study, a longitudinal imaging observational study of AD and other dementias, if they had sufficient English fluency, visual and auditory acuity to complete neuropsychological testing, and baseline magnetic resonance imaging (MRI) and neuropsychological testing less than 12 weeks apart. The study sample was derived from 183 patients of the Memory Clinic at the Sunnybrook Health Sciences Centre, University of Toronto, who met criteria of the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders Association for probable (n = 180) or possible (n = 3) AD, if cerebrovascular disease was the only other contributing pathology. Those with lacunar infarcts were excluded (Figure 1).
The process of arriving at the 90 study patients with Alzheimer disease (AD). MMSE indicates Mini-Mental State Examination.
To be included, patients underwent standardized assessments at baseline and at annual follow-up visits. The baseline assessments occurred within 1 month before or after the start of therapy with donepezil hydrochloride or 2 months after the start of therapy with rivastigmine tartrate or galantamine hydrobromide. All patients were receiving treatment throughout the study, titrated to the maximum tolerated dose. All achieved the therapeutic range. The burden of cerebrovascular risk factors and comorbid disease was documented for each patient.10
Although patients had SHs on their MRIs, none had severe enough white matter disease to meet the imaging criteria established by the National Institute of Neurological Disorders and Stroke–Association Internationale pour la Recherche et l'Enseignement en Neuroscience for possible or probable vascular dementia.11
The cognitive assessment included the Mattis Dementia Rating Scale (DRS)12 as a test of general cognition; California Verbal Learning Test (CVLT)13 to assess learning and memory; Boston Naming Test14 as a language index; backward digit span test15 to measure working memory; Controlled Word Association Test using the letters F, A, and S16 as a test of phonemic fluency; Wisconsin Card Sorting Test (WCST)17; and Trail-Making Test A18 to sample executive functions. The Trail-Making Test B18 could not be used because several patients were unable to complete the test. The Rey-Osterrieth Complex Figure Test19 was used to probe visuospatial attention and visuoconstructive skill. The Disability Assessment for Dementia Scale (DAD) total score and separate scores for instrumental and basic activities of daily living were used to assess functional capacity.20 Behavioral symptoms were assessed on the Behavioral Pathology in Alzheimer Disease Scale (BEHAVE-AD).21
All brain images were acquired using a 1.5-T MRI system (Signa; General Electric Medical Systems, Milwaukee, Wis). A 12-minute, standard interleaved spin-echo acquisition (T2 and proton density [PD]) was performed in the axial plane, covering the whole brain and using 3-mm-thick sections (echo time, 30.80 milliseconds; revolution time, 3000 milliseconds; number of excitations, 0.5; field of view, 20 × 20 cm; and matrix, 256 × 192 pixels), as well as 3-dimensional T1-weighted imaging with 1-mm-thick sections (echo time, 5.35 milliseconds; flip angle, 35°; number of excitations, 1; field of view, 20 × 20 cm; and matrix, 256 × 192 pixels).
Axial sections from T2- and PD-weighted MRIs were used to rate SHs in cholinergic pathways using a recently developed visual rating scale7 (Figure 2 and Figure 3).
Example of mild Cholinergic Pathways Hyperintensities Scale score as illustrated on T2-weighted magnetic resonance images. A, Low external capsule: anterior (right = 0, left = 0) and posterior (right = 0, left = 0). Add scores and multiply by 4 for a subtotal of 0. B, High external capsule: anterior (right = 0, left = 0), posterior (right = 0, left = 0), and cingulate (right = 0, left = 0). Add scores and multiply by 3 for a subtotal of 0. C, Corona radiata: anterior (right = 1, left = 0), posterior (right = 0, left = 1), and cingulate (right = 0, left = 0). Add scores and multiply by 2 for a subtotal of 4. D, Centrum semiovale: anterior (right = 0, left = 0), and posterior (right = 0, left = 0). Add scores and multiply by 1 for a subtotal of 0. The total score for all sections is 4. Arrow shows subcortical hyperintensity in a cholinergic pathway. E, Immunohistochemical tracings of the cholinergic pathways from Selden et al3 (reprinted with permission from Oxford University Press), with levels for the selected sections (A-D).
Example of severe Cholinergic Pathways Hyperintensities Scale score as illustrated on T2-weighted magnetic resonance images. A, Low external capsule: anterior (right = 2, left = 0) and posterior (right = 0, left = 0). Add scores and multiply by 4 for a subtotal of 8. B, High external capsule: anterior (right = 1, left = 0), posterior (right = 2, left = 0), and cingulate (right = 0, left = 0). Add scores and multiply by 3 for a subtotal of 9. C, Corona radiata: anterior (right = 2, left = 2), posterior (right = 2, left = 2), and cingulate (right = 0, left = 0). Add scores and multiply by 2 for a subtotal of 16. D, Centrum semiovale: anterior (right = 1, left = 1) and posterior (right = 2, left = 1). Add scores and multiply by 1 for a subtotal of 5. The total score for all sections is 38. Arrows show subcortical hyperintensities in cholinergic pathways. E, Immunohistochemical tracings of the cholinergic pathways from Selden et al3 (reprinted with permission from Oxford University Press), with levels for the selected sections (A-D).
Axial sections from either T2- or PD-weighted MRIs were used to evaluate the degree of white matter changes visible in the baseline images.22 The images were assessed in random order by 2 experienced raters (C.B. and F.G.) blind to clinical and demographic information.
Groups were separated into low CHIPS (score, <4) and high CHIPS (score, ≥4) groups by using a median split (median score, 4). The median split supported the clinical impression that a total score of 0, 1, 2, or 3 represented few hyperintensities with minimal pathway involvement. Independent-samples t tests were performed for age, education, duration of illness, and baseline Mini-Mental State Examination (MMSE) score. We performed χ2 analyses, including the Fisher Exact test, for sex, number of vascular risk factors, and cerebrovascular, cardiac, and peripheral vascular disease. The P values were corrected for multiple comparisons by using the Holm correction.23
Groups were separated into patients with and without lesions in the subcortical gray and cerebral white matter on the basis of ratings of the Age-Related White Matter Changes Rating Scale (ARWMC), also using a median split (median rating, 3). We performed independent-samples t tests for the means of continuous variables and χ2 analyses, including the Fisher Exact test, for categorical variables (as described in the preceding paragraph). Again, the P values were corrected for multiple comparisons by using the Holm correction.
Spearman rank correlation coefficients were used to compute associations between the 2 rating scales. Two raters (C.B. and F.G.) independently assessed a validation sample while blinded to clinical information to derive intraclass correlation coefficients as a measure of interrater and intrarater reliability.7 The CHIPS rating scale showed excellent agreement for both interrater (intraclass correlation coefficient, 0.97) and intrarater (intraclass correlation coefficient, 0.94) reliability.7
Separate repeated measures multivariate analyses of covariance (MANCOVAs) were performed for CHIPS and ARWMC scores to compare the groups on cognitive, functional, and behavioral measures, after covarying age and education.
The 90 patients followed up in this study were comparable on baseline demographic characteristics of age, education, and MMSE score (mean score, 23.5) to those lost to follow-up (mean MMSE score, 18.1) and to those unwilling to continue the longitudinal study (mean MMSE score, 23.2). In addition, we found no significant difference between the 3 groups with regard to MMSE score (Figure 1).
Because most of this sample was recruited when donepezil was the only CHEI available, most (approximately 80%) were receiving donepezil and the rest were receiving rivastigmine or galantamine in equal proportions. No patients discontinued the study because of adverse events. When adverse effects did occur, patients were successfully switched to another CHEI right away.
Forty-two patients had no or minimal cholinergic pathway involvement and constituted the low CHIPS group. CHIPS involvement was identified in 48 patients, who constituted the high CHIPS group (range, 0-48 white matter changes). The low CHIPS group was not significantly different from the high CHIPS group on baseline demographic characteristics, cognitive severity, vascular risk factors, or the presence of cerebrovascular, cardiac, and peripheral vascular disease after correcting for multiple comparisons (Table 1). The groups did not differ significantly on baseline neuropsychological performance after correcting for multiple comparisons (Table 2).
There was a significant group × time interaction on the overall MANCOVA (F1,73 = 4.4; P = .04) after covarying age and education. The repeated measures MANCOVA results indicated no significant differences over time in scores on the MMSE, overall DRS, Boston Naming Test, CVLT (acquisition after 5 trials, long delay free recall), Trail-Making Test A, and Rey-Osterrieth Complex Figure Test. Furthermore, no difference was seen in functional ability or behavior between the 2 groups after 1 year.
Compared with the low CHIPS group, the high CHIPS group showed a significant increase on the number correct on the WCST (F1,73 = 9.5; P = .002) and fewer perseverations to previous response after 1 year (F1,73 = 8.5; P = .005). The high CHIPS group also showed less decline on the backward digit span test (F1,73 = 6.9; P = .01) (Table 3).
Forty-eight patients had no or minimal white matter changes, whereas 42 patients had more severe changes (range, 0-19 white matter changes). The group with no or minimal changes did not differ significantly from the more severe group on baseline demographic characteristics, cognitive severity, and vascular risk factors after correcting for multiple comparisons (Table 4). There were also no differences in the baseline neuropsychological performance.
The MANCOVA results were not significant for changes in cognitive performance on the ARWMC after 1 year, taking into account age and education (F1,73 = 1.02; P = .32). The correlation between the CHIPS and ARWMC scores was high (Spearman ρ = 0.78; P<.001).
Treated AD patients with a high CHIPS score decline less after 1 year on executive and working memory tasks believed to implicate left dorsolateral prefrontal function, whereas no differences emerged in overall white matter disease burden, even though ARWMC scores correlated with CHIPS scores.
Previous studies6,24 demonstrate that estimates of total white matter lesion volume do not correlate with global cognitive impairment or memory impairment; rather, white matter lesion burden is thought to contribute primarily to the dysexecutive syndrome. Some evidence suggests that SHs within the frontal white matter tracts are especially detrimental relative to other locations25 and may relate particularly to dorsolateral prefrontal function.26 Although cholinergic tracts were not specifically examined in those studies, the presence of SHs in cholinergic pathways correlated with poorer scores on executive function tasks in a preliminary study of patients with AD and vascular cognitive impairment.6
In our methodology study7 using CHIPS, strategically located SHs in cholinergic pathways correlated with performance on the DRS, an executively loaded cognitive battery. The general white matter disease burden scale, however, did not correlate with cognitive performance, although it was highly correlated with the CHIPS score. This suggested that strategic compromise of the cholinergic pathways may more specifically relate to executive functions.
Eleven patients overlapped between the current study and our methodology study.7 In the present study, although there was a trend toward a significant correlation, the correlation may not have reached significance because of the smaller range of CHIPS scores (0-48). The CHIPS scores ranged from 0 to 70 in the previous study.7
The risk of clinical expression of dementia increases when the burden of neuropathologic changes exceeds a certain threshold, but this can be modified by various genetic and environmental factors. In particular, the risk can be amplified by the presence of vascular pathology.27 This finding has been corroborated in other studies, which also suggested that white matter lesions can influence the clinical expression of AD pathology in an additive or synergistic manner.28- 32 In some studies, most of the variance for cognitive loss was explained by vascular lesions and not by neurofibrillary tangles or amyloid plaques,33,34 particularly when the AD changes were mild.35
Given no differences in baseline neuropsychological performance between the low and high CHIPS groups in our sample, it is possible that patients with AD and SHs in cholinergic tracts may be reaching the same level of cognitive impairment as those with little white matter disease but by different mechanisms. Partial injury to cholinergic projections could exacerbate executive impairments, requiring less damage to the cholinergic neurons from AD pathology for the same degree of impairment. The resulting cholinergic synaptic deficiency may be more amenable to rescue by acetylcholinesterase inhibition, expressed as less decline in some executive function tasks. Recent trials of vascular dementia treated with CHEIs report positive, though modest, cognitive benefits.9 A recent study5 suggested that damage and disintegration of the cholinergic pathways in vascular dementia of Binswanger type may be due in part to a preferential susceptibility of these pathways to ischemic lesions.
A few studies using computed tomography36,37 and MRI38,39 to rate white matter changes have examined the influence of SHs on cognitive decline in patients being treated for AD. In general, results suggest that the presence of SHs may be associated with increased response to therapy after 1 year,38,39 no response,36 or worse response after 6 months.37 Those studies have been limited in that they were based on a small sample size, used simple cognitive measures, and studied white matter lesions that were spread throughout the hemispheres and included lacunar infarcts.
Studies are lending credibility to the idea that white matter lesions due in part to vascular risk factors play a role in the evolution of AD dementia.40 Ischemic white matter lesions have consistently been associated with a history of hypertension.41 Such injury increases the likelihood that individuals with AD lesions will express the dementia syndrome, and some suggest that these subjects may be more likely to benefit from cholinergic therapies.42 Unrecognized cerebrovascular disease in AD becomes especially common in older age.6,43 The frequency of silent infarcts increases with age, and silent infarcts increase risk of clinical dementia.44
However, involvement of cholinergic pathways may explain only part of the story; myelinated association fibers in the superior longitudinal fasciculus that join anterior and posterior cortical regions likely intermingle with the unmyelinated cholinergic pathways and are also important for working memory and executive control. Hence, it is possible that some of these differential effects could relate to association tract compromise as well. Application of new techniques such as diffusion tensor imaging may allow better appreciation of injury to the long association tracts such as the superior longitudinal fasciculus.
Further replication in larger community-based samples would be informative, and periods of follow-up longer than 1 year would be needed to determine more definitively whether strategically located SHs in cholinergic pathways affect cognitive decline in patients with AD and influence response to CHEIs.
Our data suggest that white matter changes previously described as "non-specific," when in strategic locations such as the cholinergic tracts, may correlate with different patterns of cognitive decline and modulate responsivity to cholinergic treatment in AD. Evaluating the degree of compromise of cholinergic pathways would be useful in future studies of cholinergic therapy in AD and vascular dementia because it may shed light on the heterogeneity in individual responses to treatment, especially in frontal/executive tasks.
Correspondence: Pearl Behl, PhD, Faculty of Medicine, University of Toronto, 160 Russell Jarvis Dr, Markham, Ontario, Canada L3S 4E8 (firstname.lastname@example.com).
Accepted for Publication: July 7, 2006.
Author Contributions:Study concept and design: Bocti, Swartz, and Black. Acquisition of data: Behl, Gao, and Black. Analysis and interpretation of data: Behl, Swartz, Sahlas, Lanctot, Streiner, and Black. Drafting of the manuscript: Behl, Streiner, and Black. Critical revision of the manuscript for important intellectual content: Bocti, Swartz, Gao, Sahlas, Lanctot, Streiner, and Black. Statistical analysis: Behl, Swartz, and Streiner. Obtained funding: Black. Administrative, technical, and material support: Black. Study supervision: Bocti, Swartz, Sahlas, Streiner, and Black.
Financial Disclosure: Dr Bocti has served as a consultant to or on speakers bureaus for Pfizer Inc, Janssen-Ortho, and Lunbeck. Dr Lanctot has received honoraria and contact research funding from or served as a consultant to Pfizer Inc and Janssen-Ortho Inc. Dr Sahlas has received honoraria from Pfizer Inc, Sanofi-Aventis, and Boehringer Ingelheim. Dr Black has received honoraria or operating funds from or served as a consultant to Pfizer Inc, Janssen-Ortho Inc, Novartis Pharmaceuticals, H. Lundbeck, Myriad Pharmaceuticals, Sanofi-Aventis, Astra-Zeneca, Boehringer Ingelheim, and Novo Nordisk.
Funding/Support: This study was supported in part by grant 13129 from the Canadian Institutes of Health Research, the Alzheimer Society of Canada, the Alzheimer's Association (United States), and the L. C. Campbell Foundation.
Role of the Sponsor: This study was conducted independently of any pharmaceutical company sponsorship.
Previous Presentation: This study was a poster presentation at the Second Congress of the International Society for Vascular, Cognitive, and Behavioural Disorders; June 8-12, 2005; Florence, Italy.
Acknowledgment: We thank the following institutions for personal support: Ontario Graduate Scholarship, Scace Graduate Fellowship, Scottish Rite Charitable Foundation (Dr Behl), the Alzheimer Society of Canada (Dr Bocti), and the Heart and Stroke Foundation Centre for Stroke Recovery (Drs Swartz and Streiner). We also thank Mario Masellis, MD, for his valuable feedback.
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Created in this Craftsy class
Learn new quilting techniques, make new friends and create a sampler quilt! Laura Nownes demonstrates 10 fabulous blocks and numerous techniques in this FREE class.
Other projects made as part of this class:
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Hi nmackay, I saw that you were going to be making your flying geese for this BOM. I just wanted to tell you that the sizes on the instruction packet are the finished quilt size. So when you make the geese, they have to measure at 3 1/2 x 6 1/2 when you finish the block. when sewn into the quilt they will be the 3x6. I don't have a geese ruller that size so what I did was make the 4x8 geese and cut it down to the right size. I hope that helps a little.
btw, I love this block the blues go well with all the other colors.

subset: commoncrawl


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Empire (1910 automobile)
From Wikipedia, the free encyclopedia
The Empire was an American automobile manufactured from 1910 until 1919. Marketed as "the little aristocrat", the Empire 20 was a four-cylinder shaft-driven runabout built in Indianapolis. The model "A" was a conventional runabout for three passengers with a rumble seat. The model "B" had two bucket seats, a longer hood and was geared higher to attain faster speeds.
More conventional bodywork was later offered; in April 1915 the marque announced production of a 35hp for 1916. The company's final products were a four of 3865 cc and a six of 3670 cc.
- Burgess-Wise, David. The New Illustrated Encyclopedia of Automobiles. BookSales Inc; Rev Upd edition (May 2000). p. 559. ISBN 0-7858-1106-0.
|This article about a brass-era automobile produced between 1905 and 1915 is a stub. You can help Wikipedia by expanding it.


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Dawson and Tyson named BOXTOROW Basketball All-Americans
FSU will face Virginia State on Feb. 25th at 3 p.m.
Broncos led from beginning to end
Broncos tops amongst the league
By: Thomas Parnell
2013-14: Scored 25 points in second collegiate game, a win against Notre Dame College on Nov. 9. It was the first of three consecutive double-digit scoring outputs... Recorded14 points and 11 assists for his first double-double in a loss against UNC Pembroke on Nov. 21. Followed that up with a 11-assist performance at Virginia-Lynchburg and a 10-assist game against Brevard... Named CIAA Rookie of the Week for the week ending Nov. 30.
HIGH SCHOOL: Three-time state champion at Kinston (NC) High School... Two-time Kinston Free Press Area Player of the Year... Averaged 11.7 points and seven assists per game as a senior, when he was named Eastern Plains AA Conference Player of the Year, the East Region's Most Outstanding Player of the State Championship Game and the Most Outstanding Player of the Eastern Regionals. He participated in the Southeast Elite 24 Classic charity game held in Wilmington, NC.
HONORS: CIAA Rookieof the Week(November 30)


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DES MOINES - Mitt Romney narrowly defeated a surging Rick Santorum by just eight votes in the Iowa Republican caucuses Tuesday as voters rendered the first verdict of the 2012 presidential campaign.
It was a chaotic kickoff after a year of campaigning that featured a rotating group of front-runners, and suggested a party deeply divided as it prepares to take on President Obama.
At 2:34 a.m. EST, the Iowa Republican chairman Matt Strawn declared Romney the winner - putting him past Santorum, the former Pennsylvania senator, by all of eight votes. Romney's final vote count was 30,015 to Santorum's 30,007, Strawn said.


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Dirty Bird
- 1 small can, chipotle peppers
- 3 garlic cloves, plus 2 garlic cloves, chopped
- 1/2 cup chicken stock
- 1 pinch dried oregano
- 1 pinch ground cumin
- 1 pinch salt
- 1/4 cup Mexican chocolate
- 2 tablespoons butter
- 1/4 cup onions, chopped
- 2 boneless chicken breasts
In a blender or food processor, add the chipotle peppers, 3 garlic cloves, chicken stock, oregano, cumin, salt, and Mexican chocolate. Blend well.
In a frying pan add butter, remaining chopped garlic, and chopped onions, saute for 5 minutes. Add chicken breasts. Cook until almost done. Add sauce to pan. Reduce the heat and cook until sauce is thick.
Recipe courtesy of Esparza's Tex Mex Caf�, Portland, OR


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Comments about Tony Stewart Women's Neon V-Neck T-Shirt - Neon Green:
More than one size too small. I ordered an XL even tho I wear a Large and I could barely get this on it was so tight. I thought maybe they sent me a youth size but the tags say Ladies. Very disappointing. Definitely returning.
- Sizing:
- Feels full size too small
- Shows Off Team Pride
- Very thin material
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- At The Race
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Comments about Jeff Gordon Ladies Neon V-Neck T-Shirt - Coral:
It's an 'ok' shirt. Shirt material is really thin, so would be good for really hot days.
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Comments about Jeff Gordon Ladies Neon V-Neck T-Shirt - Coral:
I got this shirt to show my support for ol Jeff! It is super cute, the perfect neon coral color. I like that the V is not too deep but still a good size. It is pretty lightweight, you can make it without an undershirt (cami) but I may still wear one. The only thing to watch for is size...it fits more like a juniors shirt than misses, so order big! Perfect shirt if you like bright colors and the number 24!


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List all words ending with underbrims
Only the word underbrims was found, nothing longer.
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Top Definition
Fictional word which has no purpose other than to rhyme with abortion. Famously featured in the movie "Knocked Up".
I won't say it but it rhymes with shmashmortion.
بواسطة Zander_tg نوفمبر/تشرين الثّاني 9, 2007
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Can you define these popular missing words?
the word for abortion when children are present
for all the baby ears in the room...go get a shmashmortion at the shmashmortion clinic!!
بواسطة megg schuu يوليو/تمُّوز 10, 2008
another term for 'abortion'. as used in the movie Knocked Up.
"OK. I won't say it for 'baby-ears' over here, I think you should go get a shma-shmortion. down at the shma-shmortion clinic."
بواسطة $ara stitche$ يونيو/حَزيران 10, 2007


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To purchase a YouTips4U custom-designed T-Shirt please click here: http://cgi.ebay.com/YouTips4U-Custom-De...
To purchase a YouTips4U custom-designed T-Shirt please click here: http://cgi.ebay.com/YouTips4U-Custom-Design-Cotton-T-Shirts-Seen-on-YouTube_W0QQitemZ400064693561QQcmdZViewItemQQptZUS_CSA_WC_Shirts_Tops?var=&hash=item9bff1cde89 To visit me at my blogspot, please click here: http://www.youtips4u.blogspot.com/ Hi everybody, in this tutorial video I show you step by step how to do a Reverse French Braid hairstyle on your own hair. This hair style uses the same technique as doing a regular French braid but theres a special difference which I show you. I break it down and make it easy so you can learn to do it yourself and impress others by doing their hair. It really is beautiful on long and medium length hair. I hope you found this video helpful. Please subscribe because I have so much more to come; something helpful and of interest to everyone. Thanks so much for viewing!


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Reading the John Updike stories: 'Ace in the Hole'
The Library of America recently published 'John Updike: The Collected Stories,' a two-volume boxed set of 186 stories arranged in chronological order.
In a post last week, I explained what's not in this collection and vented a little about that. Now, let's get on to the stories. I'm planning to read one or more a week and comment on them each Wednesday until I finish the collection or fall apart. »Read Full Blog Post
'Revertigo' author Skloot appearing at Boswell
Floyd Skloot's new memoir, "Revertigo" (Terrace Books), covers many topics: a community theater production of "The King and I," New York accents, his mother's remarriage, books he tries but just can't read.
But its big subject is the unexpected, devastating attack of vertigo that struck him on March 27, 2009, and lasted 138 days. In putting together this book, Skloot writes, he realized "my work was exploring balance and its loss, how the forces of uncertainty and sudden change and displacement had shaped me since childhood, as it shapes many of us..." »Read Full Article
Jazz keyboardist Moran throws 'Fats Waller Dance Party'
As the swing era peaked around 1940, pianist-composer Fats Waller was as hot as it got. "Ain't Misbehavin'," currently lighting up the Milwaukee Repertory Theater's Stackner Caberet, demonstrates how Waller's catchy melodies enlivened dancers nationwide.
Then cool and contemporary jazz got more intellectual, as the dancers sat down or moved elsewhere and jazz began its long, continuing decline. »Read Full Article


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Athletic Training Program 2015-2016
Clinical Sites Click here to see our affiliated clincal sites and preceptors!
ATP Faculty & Staff Click here to see individual faculty and staff profiles!
Left to right: Dr. Brian Hughes (Program Director); Gay Anderson (Clincial Coordinator); Samantha Tienken (Instructor/Athletic Trainer); Rachel Brown (Instructor/Athletic Trainer)
ATP Students Click here to see individual student profiles!
Class of 2016
Front Row (left to right): Kelly, Hali, Jessie, Stephanie; Back Row (left to right): Keinoshin, Kelsey, Bri, Takao. Not pictured (Jerrod)
Class of 2017
Front Row (left to right): Kayla B, Kayla G, Paden, Jaime, Michaela; Second Row (left to right): Troy, Hunter, Sierra, Rachel; Third Row (left to right): Tanner, Dylan, Shawnah, Nicole; Back Row (left to right): Mitchell, Dan, Cody. Not pictured: Johnny
Class of 2018
Front Row (left to right): Yoshi, CayCee, Stephanie, Amber, Corie; Back Row (left to right): Mitchell, Akirah, Malik, Alyssa


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Second only to Whirlpool, Haier is the largest manufacturer of refrigerators. They design and manufacture appliances, large and small. Since 2002, Haier has consecutively been ranked first in the row of China's most valuable brands for manufacture of 18 products, including Haier refrigerators, Haier air conditioners, Haier washing machines, televisions, water heaters, personal computers, mobile phones and kitchen appliances.
Haier was ranked first of China's Top 10 Global Brands by China State Bureau of Quality and Technical Supervision (CSBTS) for refrigerators and washing machines. On August 30, 2005, Haier was ranked 1st of China's Top 10 Global Brands by the Financial Times. Many say that this is because of the attention to detail and function. From toasters to espresso machines and compact refrigerators, Haier doesn't overlook the creature comforts that consumers demand.
Haier also offers a specialized Haier wine refrigerator. It offers a glass door for viewing and regulated temperatures, your wine can stay organized and most importantly-perfectly chilled. The brand also has a selection of range cookers and stoves as well as matching venting hoods. When it comes to cleaning clothes, their washer and dryer line is top shelf. The innovative Front Load Ten Cycle washer can make anyone's life easier
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Nivea, owned by the German company Beiersdorf, began in 1911 when Beiersdorf developed a water-in-oil emulsifier as a skin cream with Eucerit Nivea cream which was made from lanolin, the first stable emulsion of its kind. The company's owner, Oskar Troplowitz, named it Nivea from the Latin word which means "snow-white". During the 1930s, Beiersdorf began producing products such as Nivea tanning oils, shaving creams, shampoo and Nivea facial toners. The first Nivea deodorizing soap appeared in 1951, expanding into a full line of Nivea soaps through the 1960s.
However, every time Nivea expanded, they analyzed their direction to make sure they remained focused on skin care, avoiding the temptation to branch out into other areas which might dilute their product quality over time. The company did not launch the Nivea lip care line until 2008, once they felt confident they could provide the same level of quality to this new product as they do for other Nivea skin care products. Today, Nivea Body lotions, Nivea body soaps and Nivea night creams are joined by products created for specific skin conditions, including Nivea cellulite treatments with L-Carnitine, a substantial antioxidant which breaks down lipids. Eucerin (which began as Eucerit), remains one of the top brands in the Nivea line, which also includes La Prairie and Hansaplast, proving that for Nivea, offering some of the best skin care products available, products that really work, remains their primary concern.
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Live. Work. Play. What is the ideal mix?
PSCU employees will tell you there's no need for such distinction when the work you do makes you happy, and the people you work for treat you with respect.
Apply today to be part of the nation's leading Credit Union Service Organization (CUSO) and one of the Top 50 Best Places to Work in the Bay Area.
Founded in 1977, longtime CEO Dave Serlo built a foundation of noble standards for employees when he shaped the culture of PSCU. He placed emphasis on the idea that credit unions should be served by organizations devoted to their unique principles and values, and to this day, that tradition continues.
Why Work Here
- Salary and Paid Time Off – you'll be hard pressed to find better compensation and a more generous vacation policy anywhere in the Bay area than PSCU. We think your time away from home is worth more! Medical – we take health seriously and that means comprehensive medical benefits for you and your family, as well as free wellness benefits including everything from an onsite gym to seminars and regular health screenings.
- 401k – saving for retirement is important and we're here to help, with great company matching and personal consultants to guide you along the way.
- Locations – no matter which of the three PSCU locations you work at, you're guaranteed newly remodeled environments and eloquent touches that make your space feel as much like home as possible.
- Fun & Food –PSCU goes above and beyond to offer a host of exciting, year-round activities and even free snacks, food and coffee and all three of our beautiful campuses. As a PSCU employee you can join the company band, Rockovate, take part in personal training sessions, enter the yearly talent competition, party down at our July 4th and Holiday celebrations, and much more!
What We Do
PSCU is the nation's leading Credit Union Services Organization (CUSO), as we represent more than 800 credit unions. We offer industry-leading credit, debit and prepaid card servicing to more than 18 million cardholders, and innovative bill payment solutions to over a million online bill payment subscribers.
Since 1977, PSCU has been a leading provider of traditional and online financial services to credit unions. We also provide a range of ecommerce solutions options to include mobile/digital wallets and mobile banking. All of these services are backed by outstanding support from our 24/7/365 call centers located (hyperlink word "located" to our "Locations" landing page) throughout the United States. Each call center performs 24/7/365 member servicing, new member acquisitions, cross selling, lending, and collections as well as support for our credit, debit, and prepaid cardholders; and our online bill payment subscribers.