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The following database contains a listing of drugs approved by the Food and Drug Administration (FDA) for sale
in the United States. Drug information typically includes the drug name, approval status, indication of use, and
clinical trial results.
Find out more about the types of drugs included in this listing.
Byvalson (nebivolol and valsartan); Allergan;
For the treatment of hypertension, Approved June 2016
Yosprala (aspirin and omeprazole); Aralez Pharmaceuticals;
For the prevention of cardiovascular and cerebrovascular events, Approved September 2016
Ameluz (aminolevulinic acid hydrochloride); Biofrontera Pharma;
For the treatment of actinic keratoses, Approved May 2016
Eucrisa (crisaborole) ointment; Pfizer;
For the treatment of atopic dermatitis, Approved December 2016
Taltz (ixekizumab); Eli Lilly;
For the treatment of plaque psoriasis and active psoriatic arthritis, Approved March 2016
Adlyxin (lixisenatide); Sanofi Aventis;
For the treatment of type II diabetes, Approved July 2016
Soliqua 100/33 (insulin glargine and lixisenatide injection); Sanofi Aventis;
For the treatment of inadequately controlled type II diabetes, Approved November 2016
Xultophy 100/3.6 (insulin degludec and liraglutide injection); Novo Nordisk;
For the treatment of inadequately controlled type II diabetes, Approved November 2016
Onzetra Xsail (sumatriptan nasal powder) ; Avanir;
For the treatment of migraine, Approved January 2016
Zinplava (bezlotoxumab); Merck;
For the treatment of recurrent Clostridium difficile infection in patients receiving antibacterial treatment, Approved October 2016
Spinraza (nusinersen); Biogen;
For the treatment of spinal muscular atrophy, Approved December 2016
Afstyla (Antihemophilic Factor (Recombinant), Single Chain); CSL Behring;
For the treatment of hemophillia A, Approved May 2016
Idelvion (Coagulation Factor IX (Recombinant), Albumin Fusion Protein); CSL Behring;
For the treatment of hemophilia B, Approved March 2016
Kovaltry [Antihemophilic Factor (Recombinant)]; Bayer ;
For the treatment of hemophillia A, Approved March 2016
Opdivo (nivolumab); Bristol-Myers Squibb;
For the treatment of classical Hodgkin lymphoma, Approved May 2016
Venclexta (venetoclax); AbbVie;
For the treatment of chronic lymphocytic leukemia with 17p deletion, Approved April 2016
Defitelio (defibrotide sodium); Jazz Pharmaceuticals;
For the treatment of hepatic veno-occlusive disease with renal or pulmonary dysfunction following HSCT, Approved March 2016
Ocaliva (obeticholic acid); Intercept Pharmaceuticals;
For the treatment of primary biliary cholangitis, Approved May 2016
Vemlidy (tenofovir alafenamide); Gilead Sciences;
For the treatment of chronic hepatitis B , Approved November 2016
Zepatier (elbasvir and grazoprevir); Merck;
For the treatment of chronic HCV genotypes 1 or 4 , Approved January 2016
Descovy (emtricitabine and tenofovir alafenamide); Gilead;
For the treatment of HIV-1 infection and pre-exposure prophylaxis , Approved April 2016
Epclusa (sofosbuvir and velpatasvir) ; Gilead Sciences;
For the treatment of hepatitis C, Approved June 2016
Odefsey (emtricitabine, rilpivirine, and tenofovir alafenamide); Gilead Sciences;
For the treatment of HIV-1 as initial therapy, Approved March 2016
Vaxchora (Cholera Vaccine, Live, Oral); PaxVax;
For active immunization against Cholera, Approved June 2016
Anthim (obiltoxaximab); Elusys Therapeutics;
For the treatment of inhalational anthrax , Approved March 2016
Syndros (dronabinol oral solution); Insys Therapeutics;
For the treatment of anorexia associated with AIDS and nausea and vomiting associated with cancer chemotherapy, Approved July 2016
Exondys 51 (eteplirsen); Sarepta Therapeutics;
For the treatment of Duchenne muscular dystrophy with mutated DMD gene amenable to exon 51 skipping, Approved September 2016
Zinbryta (daclizumab) ; Biogen;
For the treatment of relapsing multiple sclerosis, Approved May 2016
Cabometyx (cabozantinib); Exelixis;
For the treatment of advanced renal cell carcinoma, Approved April 2016
Lenvima (lenvatinib); Eisai;
For the treatment of advanced renal cell carcinoma, Approved May 2016
Rayaldee (calcifediol) ; Opko Health;
For the treatment of secondary hyperparathyroidism in adults with stage 3 or 4 chronic kidney disease, Approved June 2016
Briviact (brivaracetam); UCB;
For the treatment of partial onset seizures related to epilepsy, Approved February 2016
Carnexiv (carbamazepine); Lundbeck;
replacement therapy when oral administration is not feasible, in adults with seizures, Approved October 2016
Nuplazid (pimavanserin); Acadia Pharmaceuticals;
For the treatment of hallucinations and delusions associated with Parkinson's disease, Approved April 2016
Nuplazid (pimavanserin); Acadia Pharmaceuticals;
For the treatment of hallucinations and delusions associated with Parkinson's disease psychosis, Approved May 2016
Troxyca ER (oxycodone + naltrexone); Pfizer;
For the management of severe pain, Approved August 2016
Intrarosa (prasterone vaginal insert); Endoceutics;
For the treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy, due to menopause, Approved November 2016
Rubraca (rucaparib); Clovis Oncology;
For the treatment of advanced ovarian cancer in women with deleterious germline or somatic BRCA mutation, Approved December 2016
Keytruda (pembrolizumab); Merck;
For the treatment of head and neck squamous cell cancer , Approved August 2016
Lartruvo (olaratumab) ; Eli Lilly;
For the treatment of soft tissue sarcoma, Approved October 2016
Opdivo (nivolumab); Bristol-Myers Squibb;
For the treatment of recurrent or metastatic squamous cell carcinoma of the head and neck, Approved November 2016
Sustol (granisetron); Heron Therapeutics;
For the prevention of chemotherapy-induced nausea and vomiting, Approved August 2016
Tecentriq (atezolizumab); Genentech;
For the treatment of urothelial carcinoma and metastatic non-small cell lung cancer, Approved May 2016
Humira (adalimumab); Abbvie;
For the treatment of uveitis, Approved July 2016
Xiidra (lifitegrast); Shire;
For the treatment of dry eye disease, Approved July 2016
Bevespi Aerosphere (glycopyrrolate and formoterol fumarate); AstraZeneca;
For the treatment of chronic obstructive pulmonary disease, Approved April 2016
Cinqair (reslizumab); Teva Pharmaceuticals;
For the treatment of severe asthma, Approved March 2016
The criteria for CenterWatch's FDA-Approved Drugs follow the definitions established by the Tufts Center for the Study of Drug Development and the FDA's definitions of a new drug approval or a new molecular entity.
Database inclusions:
New Molecular Entities (NME) is defined by the FDA as a medication containing an active substance that has never before been approved for marketing in any form in the United States. The database also includes some recombinant proteins and biologics that were approved by the FDA's Center for Drug Evaluation and Research (CDER).
Database exclusions:
Diagnostic agents, generics, over-the-counter products, medical devices, and biologic compounds not approved by CDER. Other exclusions are new dosages and new administrations of previously-approved compounds.
Copyright © 1995-2015 CenterWatch.


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Teddy Bears
Hand crocheted Oeko-Tex 100 certified (Confidence in Textiles) teddy bear. Mr. Dino is about 20 cm high in sitting position, and when you press the belly, it says a soft squeaking sound. We use very soft bamboo yarn, which is perfect for babies and small children. Of course all of our products have the CE mark and are all approved within the European regulations. The filling is sealed in a bag. Furthermore, the bamboo yarn has the FSC certification, which means that nature has been taken into consideration both when cultivating and harvesting the bamboo. All products are of premium quality and have many beautiful details. They can be hand washed at 30 degrees Celsius. Everything is with animals, because we just love animals!

subset: commoncrawl


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Co-captain Keith Wright leads Harvard in scoring (11.4 ppg) and rebounding (6.8 rpg) (Gil Talbot).
- Game Notes (PDF)
- Live Statistics
- Live Video (ESPN3.com)
- Live Audio (GoCrimson.com)
- Harvard Ranked in AP and ESPN/USA Today Coaches Polls for First Time
The Particulars
No. 24/25 Harvard, which is off to its best start since the 1984-85 season (8-0), heads back on the road to face No. 9/9 Connecticut (7-1) Thursday evening in a game shown live at 7 p.m. on ESPN2/ESPN3.com. Harvard is looking to become the first Ivy League team to start 9-0 since Columbia in 1969-70.
Game Coverage
The game will be broadcast live on ESPN2/ESPN3.com. Bob Wischusen, Doug Gottlieb and Andy Katz will have the call on television. WHRB's Scott Reed and Charlie Hobbs will have the audio call on GoCrimson.com. Live statistics will also be available for the game at GoCrimson.com.
Series History
Harvard and Connecticut have met 16 times on the hardwood, with the Huskies owning a 14-2 lead in the series, which began in 1921-22. Last season, the Huskies emerged with an 81-52 victory in Hartford, Conn. Keith Wright led the Crimson with 18 points and seven rebounds, while Kemba Walker had 20 points for UConn.
Last Time Out
Jonah Travis, the Ivy League Rookie of the Week, scored a career-high 19 points and grabbed a career-best 10 rebounds for his first double-double in an 80-70 win over Seattle Sunday. Laurent Rivard added 12 points, while Brandyn Curry and Kyle Casey chipped in with eight points apiece.
UConn's Last Time Out
In an 85-72 victory against Arkansas Saturday, Ryan Boatright led the way for UConn with 23 points, shooting 8-of-12 from the field and 2-of-3 from long distance. Jeremy Lamb contributed 14 points, while Tyler Olander scored 12 and Shabazz Napier added seven assists to go along with nine points.
Casting Ballots
The Crimson is ranked No. 24 in this week's ESPN/USA Today coaches poll and No. 25 in the AP rankings, marking the first time in program history Harvard is ranked in a major poll. The Crimson is the first Ivy team ranked in the AP poll since Princeton was rated No. 8 in the final poll of the 1997-98 season. Cornell was the last team ranked in the coaches poll, garnering a spot at No. 17 in the final poll of that season.
Harvard is the only Ivy League team to have received a vote in a major national poll this season.
RPI Watch
Harvard currently sits at No. 22 in the RPI, according to collegerpi.com. The Crimson earned the highest ranking in program history, No. 14, Dec. 2.
Unbeaten Crimson
Harvard entered the week as one of 15 undefeated teams remaining in the country, along with Xavier, Syracuse, Marquette, Louisville, Indiana, Ohio State, Illinois, Missouri, Baylor, Kansas State, Tulane, Creighton, Murray State and Kentucky.
Defense Wins Games
The Crimson enters the week 10th in the country in scoring defense (54.4 points allowed per game).
Harvard had not allowed more than 49 points in four straight games (Nov. 24-Dec. 1) for the first time since the 1946-47 season, which was prior to the invention of the shot clock and the 3-point line.
Harvard Against the Big East
The Crimson owns a 6-38 record all-time against current members of the Big East conference.
Harvard Against the BCS
The Crimson is scheduled to play at least four BCS opponents this season (vs. Utah at Battle 4 Atlantis Nov. 24, Florida State at Battle 4 Atlantis Nov. 25, at Connecticut Dec. 8 and at Boston College Dec. 29). The Crimson is 2-0 against BCS teams this season after downing Utah, 75-47, at the Battle 4 Atlantis opening round, and topping No. 20 Florida State, 46-41, in the semifinal round. Harvard was 2-3 against the BCS last year, defeating Boston College for the third straight time and downing Colorado.
Harvard owns a 7-8 record against BCS conferences under Tommy Amaker. The Crimson has defeated BC three times and topped Michigan, Colorado, Utah and Florida State during Amaker's tenure. The Crimson has also defeated at least one BCS team in each of the last five seasons.
Lavietes Is The Place To Be
Harvard is riding a 19-game win streak at home, a program record. The current win streak at home is the longest for Harvard at Lavietes Pavilion and is tied for the seventh longest current streak in the NCAA. Duke and Kentucky are enjoying the longest current streak with 39 straight home wins.
Nation's Current Longest Home Win Streaks
Through (Dec. 4)
Duke 39
Kentucky 39
Ohio State 30
Notre Dame 24
Temple 23
Purdue 22
Harvard 19
George Mason 18
Bucknell 17
Road Warriors
The Crimson, which currently owns a 6-0 record in road/neutral sites, will play a total of 18 road/neutral games this winter. Harvard set a program record for road/neutral wins in 2009-10 with 10, and the Crimson followed up with nine road victories last season. Harvard is 3-0 on the road and 3-0 in neutral sites in 2011-12.
Battle 4 Atlantis
Harvard went 3-0 at the Battle 4 Atlantis tournament Nov. 24-26, winning the inaugural title. The Crimson downed Utah, No. 20 Florida State and Central Florida and did not allow more than 49 points in any of the three games. Keith Wright was named tournament MVP after averaging 10.0 points and 7.3 rebounds per game.
Harvard Against Ranked Opponents
When Harvard played No. 4 Connecticut Dec. 22, 2010, it marked the first time the Crimson had faced a team ranked that high since Harvard fell at No. 1 Duke, 118-65, Nov. 30, 1991.
Harvard earned the program's first-ever victory over a ranked opponent when the team downed No. 17 Boston College, 82-70, Jan. 7, 2009. The Crimson picked up a second win over a top 25 team by defeating No. 20 Florida State, 46-41, Nov. 25, 2011.
On The Big Screen
The Crimson will play at least seven games on national or regional television this season: Battle 4 Atlantis Nov. 24-26 (HDNet and Versus), at Connecticut Dec. 8 (ESPN2), at Boston University Dec. 10 (NESN) at Boston College Dec. 29 (ESPN3) and at Princeton Feb. 11 (ESPNU).
Harvard is 3-0 on TV this year after earning a 75-47 win over Utah, a 46-41 victory over No. 20 Florida State and a 59-49 win over Central Florida at the Battle 4 Atlantis tournament.
Crimson Runs Deep
With 19 players on its roster, Harvard is tied for the sixth largest team in the country, trailing only Air Force (22), Army (22), Cornell (21), Syracuse (20) and Navy (20). Montana State, Columbia and New Orleans also have 19 players.
Kings of Massachusetts' Courts
The Crimson is currently on a 12-game winning streak against schools from the Commonwealth of Massachusetts since falling to Northeastern in overtime, 76-71, Dec. 10, 2008, including four straight wins over Holy Cross and three against Boston College.
Harvard is 2-0 this season against Massachusetts teams, having defeated MIT and Holy Cross in the first two games of the season. The Crimson will also face Boston University and BC this season.
Head Coach Tommy Amaker
Tommy Amaker (Duke '87) is in his fifth season as head coach of the Harvard men's basketball team. He registered his 250th career coaching victory Dec. 4, 2011 against Seattle at Lavietes Pavilion. Amaker has guided Harvard to its national ranking, as the Crimson was ranked No. 25 in the AP poll and No. 24 in the ESPN/USA Today coaches ranking on Dec. 5, 2011. Amaker also led the Crimson to its first Ivy League title as well as the program's first appearance in the NIT. In addition, the Crimson established a program record with 23 victories in 2010-11.
He brings a 250-190 career head coaching record into today's game, including a 74-51 mark at Harvard, a 108-84 record at Michigan and a 68-55 record at Seton Hall.
Rejection List
With 12 blocks this season, Keith Wright now ranks second in program history with 118 rejections. Brian Cusworth '07 holds the Harvard record with 147 career blocks. Wright's 54 blocks last year also stand second in Harvard history for a single season. Brian Banks '78 had 59 rejections during the 1977-78 campaign.
Wright Among Wooden Preseason Top 50
Senior co-captain Keith Wright was named to the John R. Wooden Award Preseason Top 50 Watch List Oct. 3. Wright, who was the only player from the Ivy League honored, garnered AP and Lou Henson All-America accolades as a junior last season.
Ivy League Season Honors
Laurent Rivard
- Ivy League Honor Roll (Nov. 14, Dec. 5)
Jonah Travis
- Ivy League Rookie of the Week (Dec. 5)
Keith Wright
- Ivy League Player of the Week (Nov. 28).
- Ivy League Honor Roll (Nov. 21)
Carrying The Flag
Harvard (8-0) is the lone unbeaten Ivy League team.
Night and Day
Harvard owns a 5-0 record in night games and a 3-0 mark in day contests in 2011-12.
Assists, No Turnovers
Harvard's duo of Oliver McNally and Brandyn Curry has combined to hand out 56 assists, while only committing 25 turnovers between them.
Feeling It From Long Range
Laurent Rivard drilled a Harvard season-high five treys in the win at Loyola Marymount Nov. 19. At least one Crimson player has drained at least two 3-pointers in all eight games this year.
Making The Most Of It
Oliver McNally went 7-of-7 at the foul line at Holy Cross and shot 6-of-6 at Loyola Marymount and is shooting 86.7 percent from the line this season (26-of-30). Laurent Rivard is also making 86.7 percent of his foul shots (13-of-15). Christian Webster is Harvard's career leader in free-throw shooting, making 88.8 percent of his attempts (169-of-190) over his first three seasons.
Last season, the Crimson ranked second in the nation as a team with an 80.8 percent success rate from the charity stripe (just behind Wisconsin's 81.8 shooting percentage). Harvard owns the NCAA record for team free-throw percentage for a season (82.2 percent in 1983-84). Harvard is currently shooting 72.2 percent from the line this season.
Harvard and Amaker Against Connecticut
The Crimson is 0-2 against UConn under head coach Tommy Amaker.
Hitting Baskets
Keith Wright stands second in the Ivy League in field-goal percentage, hitting 59.4 percent of his attempts this season (38-of-64).
Offense, Defense
Entering the week, the Crimson ranked second in the Ancient Eight in offense (67.6 points per game) and first in defense (54.4 points allowed per game). Harvard also led in scoring margin (+13.2).
Double-Double Show
Keith Wright and Jonah Travis pace the Crimson with one double-double apiece this year. Harvard players combined for 17 double-doubles last season: Keith Wright (12), Brandyn Curry (3) and Kyle Casey (2).
Harvard Down The Stretch
The Crimson is 74.1 percent (43-of-58) from the line in the final five minutes of games this season. Harvard is also shooting 44.4 percent from long distance (4-of-9) during the last five minutes. Harvard has also only been whistled for 20 fouls in the last five minutes, while opponents have been called for 36 fouls.
Dunk Tally - 2011-12
Kyle Casey 4
Keith Wright 4
Steve Moundou-Missi 2
Wesley Saunders 2
Jonah Travis 1
Harvard had a season-high five dunks at Holy Cross Nov. 15.


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- WWE Hall of Famer Sunny was scheduled to host a Royal Rumble viewing party at Highland Park in New York City tonight. Obviously with her being in jail she won't be able to make it. The promoters are looking for a suitable replacement.
- Sources in Japan have confirmed to The Wrestling Observer that Ric Flair suffered a blood clot in his left leg over the weekend, preventing him from returning to the ring in a tag match. Flair was examined in the emergency room but doctors wanted to admit him into the hospital. Flair refused to check in and ended up appearing at the show at ringside, as we noted earlier. Flair is flying back to the US today and is still scheduled for a series of autograph signings in Las Vegas later this week.
- Besides the NXT tournament at yesterday's WWE Royal Rumble Fan Fest, the following matches took place:
* Kofi Kingston beat Drew McIntyre
* Natalya beat Alicia Fox
* Rick Victor beat Percy Watson
* Paige and Sasha Banks beat Emma and Summer Rae
* Bray Wyatt beat Jake Carter
* Sheamus beat Heath Slater
Source: F4WOnline


text: James 11 Report post Posted January 20, 2012 (edited) Rams to Play Patriots in London By StLouisRams.com Posted 14 hours ago Read Discuss Comments: ST. LOUIS, Mo. – The National Football League announced today that the St. Louis Rams will face the New England Patriots in London, England's Wembley Stadium this season. The game, which is part of the NFL's International Series, will take place on Oct. 28 at Noon CST (6 p.m. UK). CBS will provide live television coverage of the contest. The Rams will serve as the home team for this year's contest, and the team has reached an agreement to play a home game at Wembley Stadium in 2013 and 2014 as well. "This is a tremendous honor for our franchise, the city of St. Louis and our fans throughout the world," said Rams owner E. Stanley Kroenke. "We are excited about the opportunity to reach new audiences globally. This is a great platform to showcase the city of St. Louis to London and the UK. "We've seen first-hand the increased popularity of the NFL not only in London but throughout Europe. To play a role in that growth over the next three years will be incredible and is a testament to the many good things happening not only in the NFL but also in the St. Louis Rams organization." The 2012 season marks the sixth-consecutive year in which Wembley Stadium has played host to a regular-season NFL game. The league has held one regular-season game in London each year beginning in 2007. "I'm really looking forward to the opportunity to represent the Rams and the National Football League in London," Rams QB Sam Bradford said. "I'm sure it's going to be a very exciting atmosphere that will provide a great experience for everyone involved in the game." The 2012 International Series contest marks the first time in team history that the Rams will play a regular season game outside of the United States. The Rams participated in the American Bowl during the preseason three times and won all three contests: a 1987 game against the Denver Broncos at Wembley Stadium; a 1989 matchup with the San Francisco 49ers at the Tokyo Dome in Tokyo, Japan; and a 1990 contest against the Kansas City Chiefs at Berlin, Germany's Olympiastadion. Club seats for the Rams-Patriots game will go on sale on Jan. 25. General admission tickets to the game will be available on Feb. 2-3. In the upcoming weeks, the Rams will announce ticket opportunities and travel packages for Rams season ticket holders and fans. http://www.stlouisra...cc-79a4efd1fc9c Edited January 20, 2012 by The Pats 0 Quote Share this post Link to post Share on other sites


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Hi there Spectre,I really enjoyed examining your custom medic. Really top notch. Great attention to detail on all the accessories and paint scheme. I do have to agree with Chewie on the Earthly look to the character. Right now, she looks like she is between two diffrent toy lines; GI Joe and Star Wars. I would recommend the design that is already on the med kit, the circle with verticle lines, should replace any red cross patches and the blue cross patch on her chest. Also, I am not sure you ment to do this or not, the colors you picked, tan and green, looks a lot like Doc from the '80s Joe line. I would research some of the costume designs used in AOTC or ROTS movie extras and compare the color pallet to your figure. Change these things and the figure would then look more Star Wars then GI Joe. Just my opinon. Again, really great work there, I would love to see more of your work in future.Jedi_Master_Ben
... the red cross is a universal symbol here on earth for blood- every culture/nationality recognizes this fact ...
I love these crossovers between Star Wars and GI JOE... so well done. I wonder why they don't make GI JOE figures in the Star Wars style... they'd go over better I think and give us TONS of customizing fodder.
On this custom, wonderful backstory to him and the custom came out great. Good use of parts and the head was a good choice. Almost a bit rough paint (maybe too thick) on his face, but that could be just me. I know I can never paint skin though, and this looks way better than I do.
Great job on the weathering too, not too much at all but enough to bring out details in the sculpt, like the slight wrinkles in the shirt.If they made a new Chuckles in the style, I'd get several.
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Differentiation of narcolepsy without cataplexy from idiopathic hypersomnia relies entirely upon the multiple sleep latency test (MSLT). However, the test-retest reliability for these central nervous system hypersomnias has never been determined.
Patients with narcolepsy without cataplexy, idiopathic hypersomnia, and physiologic hypersomnia who underwent two diagnostic multiple sleep latency tests were identified retrospectively. Correlations between the mean sleep latencies on the two studies were evaluated, and we probed for demographic and clinical features associated with reproducibility versus change in diagnosis.
Thirty-six patients (58% women, mean age 34 years) were included. Inter-test interval was 4.2 ± 3.8 years (range 2.5 months to 16.9 years). Mean sleep latencies on the first and second tests were 5.5 (± 3.7 SD) and 7.3 (± 3.9) minutes, respectively, with no significant correlation (r = 0.17, p = 0.31). A change in diagnosis occurred in 53% of patients, and was accounted for by a difference in the mean sleep latency (N = 15, 42%) or the number of sleep onset REM periods (N = 11, 31%). The only feature predictive of a diagnosis change was a history of hypnagogic or hypnopompic hallucinations.
The multiple sleep latency test demonstrates poor test-retest reliability in a clinical population of patients with central nervous system hypersomnia evaluated in a tertiary referral center. Alternative diagnostic tools are needed.
Trotti LM; Staab BA; Rye DB. Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia. J Clin Sleep Med 2013;9(8):789-795.
The central nervous system (CNS) hypersomnias manifest as excessive daytime sleepiness with or without prolonged nocturnal sleep in the absence of demonstrable nocturnal sleep pathology or insufficient sleep. They include the entities of narcolepsy with and without cataplexy and idiopathic hypersomnia. Narcolepsy with cataplexy is a chronic disease characterized by short latencies to both sleep and REM sleep on daytime nap opportunities during the multiple sleep latency test (MSLT) and is caused by immunogenetically mediated loss of hypocretin.1 Cataplexy is a clinical feature highly specific to hypocretin-deficient narcolepsy, although is not always evident near the onset of sleepiness. The remaining CNS hypersomnias begin at a similar age, are much less likely to be associated with hypocretin deficiency,1–4 and lack a pathognomonic sign or symptom.5,6 They have many features in common, including hallucinations and sleep paralysis,1,4 unrefreshing naps,7,8 sleep drunkenness,1,7,8 and prolonged nocturnal sleep.8–10 Therefore, differentiation between narcolepsy without cataplexy and idiopathic hypersomnia relies solely on the MSLT4 and the propensity for REM sleep to intrude into more than one daytime nap.
Perhaps because of the lack of a single defining characteristic or known pathophysiology, patients with narcolepsy without cataplexy and idiopathic hypersomnia not infrequently present to tertiary sleep centers for a second opinion regarding their diagnoses. In such instances, the clinical question frequently arises of whether or not to repeat an MSLT. Test-retest reliability of the MSLT is high in narcoleptics when two testing protocols are conducted within three weeks of each other.11 Intertest intervals are generally much longer in clinical practice, and in that case the stability of MSLT features has not been established. We therefore evaluated the test-retest reliability of the MSLT in a clinic population of patients with narcolepsy without cataplexy and idiopathic hypersomnia.
Current Knowledge/Study Rationale: Differentiation of the syndromes of idiopathic hypersomnia and narcolepsy without cataplexy relies exclusively on the presence or absence of REM periods during the multiple sleep latency test. The test-retest reliability of the MSLT in these conditions, when applied in clinical practice, is unknown.
Study Impact: Test-retest reliability of the MSLT is poor in idiopathic hypersomnia and narcolepsy without cataplexy, because of changes in measured sleepiness and in number of REM onsets. Alternative diagnostic strategies are needed.
Patients with a clinical syndrome consistent with a CNS hypersomnia (i.e., reports of problematic, excessive daytime sleepiness persisting ≥ 3 months despite adequate or supranormal habitual sleep durations, not explained by other causes of daytime sleepiness) who had undergone 2 MSLTs were identified using separate billing, clinic, and research databases of different durations collectively spanning a period of 18 years. All patients diagnosed with narcolepsy without cataplexy or idiopathic hypersomnia were included. To minimize potential bias that could be introduced by relying upon an MSL threshold predefined as pathological in a study intended to examine the test's reliability, we also included subjects identified with "physiologic hypersomnia." This designation required the presence of a clinical syndrome otherwise indistinguishable from idiopathic hypersomnia or narcolepsy without cataplexy but that did not meet the MSL threshold of < 8 min required for these diagnoses. Patients with unequivocal cataplexy or incomplete MSLT data (e.g., absence of data regarding mean sleep latency or sleep onset REM periods (SOREMS)) were excluded. Additionally, data were collected regarding patient demographics and clinical characteristics (Epworth Sleepiness Scale [ESS] scores, age at symptom onset, presence of sleep paralysis or sleeprelated hallucinations, habitual sleep duration, medication use at the time of study, family history of hypersomnia, and body mass index [BMI]). This study was approved by our institutional review board.
Correlation between mean sleep latencies (MSL) on the 2 MSLTs was performed using Spearman correlation. Bland-Altman plots were constructed to allow visual inspection of the data, with the 95% limits of agreement calculated as ± 1.96*(standard deviation of the difference between paired test measurements). To determine the stability of clinical diagnosis based on MSLT, a diagnosis was assigned following ICSD-2 criteria7 as follows: sleep latency < 8 min and > 1 sleep onset REM period was diagnosed as narcolepsy without cataplexy; sleep latency < 8 min and < 2 SOREMs was diagnosed as idiopathic hypersomnia; sleep latency > 8 min (regardless of the presence or absence of SOREMs) was diagnosed as normal. Diagnoses for each individual were compared between the 2 MSLTs. To evaluate for the effects of medication on the stability of MSLT-based diagnosis, medication usage was characterized as changed or unchanged (specifically considering wakepromoting medications and selective serotonin and/ or noradrenergic reuptake inhibitors), and a Fisher exact test was performed comparing medication class changes with diagnosis change. As an exploratory analysis, demographic and clinical features were compared between those whose diagnosis changed and those whose diagnosis remained the same, using χ2 or Fisher exact test for categorical variables and Wilcoxon-Mann-Whitney test for continuous variables. Clinical characteristics across final diagnostic categories were compared using the Fisher test for categorical variables and Kruskal-Wallis test for continuous variables.
Thirty-six patients met inclusion criteria (see Table 1). The cohort was 58% female with a mean age of 34 (± 13) years at the time of first MSLT (range 15-56 years). Symptoms began at the age of 22 (± 11) years. The mean Epworth Sleepiness Score was 16 (± 5). Onethird of patients had a family history of a central nervous system hypersomnia or undiagnosed excessive daytime sleepiness. Two subjects were a mother-daughter pair. Cerebrospinal fluid measurements of hypocretin were available in 18 subjects (mean 290.2, SD 114.7). The time between studies ranged from 2.5 months to 16.9 years with an average length between studies of 4.2 ± 3.8 years. Based on the final MSLT, diagnoses included idiopathic hypersomnia (N = 13), narcolepsy without cataplexy (N = 7), and physiologic hypersomnia (N = 16); clinical features by diagnostic category are presented in Table 2 and were similar across groups except the presence of hallucinations, age of onset, and severity of sleepiness as measured by ESS. Based on the initial MSLT-based diagnosis, none of these 3 or other clinical features were significantly different across diagnostic categories, except female gender (85.7% of idiopathic hypersomnia patients, 33.3% of narcolepsy without cataplexy patients, and 57.1% of physiologic hypersomnia patients, p = 0.01) and age at first study (32.9 years for idiopathic hypersomnia, 38.3 years for narcolepsy without cataplexy, and 25.3 years for physiologic hypersomnia, p = 0.046). Diagnoses of comorbid mood disorders were common, primarily depression (N = 9), but also bipolar disorder (N = 2). Serious medical comorbidities occurred in 28% of subjects, and included HIV (N = 1), diabetes (N = 2), pulmonary hypertension (N = 1), anemia (N = 2), treated obstructive sleep apnea (N = 1), polycystic ovarian syndrome (N = 1), ulcerative colitis (N = 1), thyroid disease (N = 2), and epilepsy (N = 1). At the time of the first MSLT, 3 patients were taking a psychostimulant (dextroamphetamine, dextroamphetamine/amphetamine, or pemoline), and 3 were taking an antidepressant (fluoxetine, sertraline). For the second MSLT, 3 patients were taking a wakepromoting agent (dextroamphetamine/amphetamine, modafinil) and 7 antidepressants (citalopram, duloxetine, escitalopram, fluoxetine, sertraline, venlafaxine). Overall, change in stimulant or antidepressant medication between studies was not uncommon, occurring in 40% of patients.
Patient characteristics
(more ...)
Clinical characteristics by final diagnostic category
The average mean sleep latency on the first MSLT was 5.5 min (± 3.7) and on the repeat study was 7.3 (± 3.9) min, with mean sleep latencies ranging from 1 min to 18.4 min. There was no significant correlation of mean sleep latencies between studies (r = 0.17, p = 0.31). On the first study, 27.8% of subjects had no SOREMs and 50% had ≥ 2 SOREMs. On the second study, 50% of subjects had no SOREMs and 30.6% had ≥ 2. Bland-Altman plots of these variables (Figure 1) reveal very wide 95% limits of agreement for both mean sleep latencies and SOREMs, as well as a tendency for those with the highest mean values to exhibit the greatest variability. MSLT-based diagnosis frequently changed between studies (Figure 2). On repeat testing, only 17 patients (47%) retained the same diagnosis: 8 with IH, 5 with narcolepsy without cataplexy, and 4 normal (regardless of the number of SOREMs). Changes in diagnosis resulted from the mean sleep latency crossing the threshold of 8 min (N = 15, 42%) and the number of SOREMs crossing the threshold of ≥ 2 (N = 11, 31%), with both dependent variables crossing their diagnostic thresholds in 4 (11%) patients. Changes in diagnosis were not related to a change in stimulant or antidepressant medication (Table 1). Considering only those patients known to have been free of stimulant and antidepressant medications for both MSLTs, diagnosis remained the same in 45%. In exploratory analyses, a change in diagnostic category was not related to time between studies, findings on the preceding overnight polysomnography, the presence of comorbid psychiatric or medical disorders, or most symptoms of hypersomnia. The only variable that differed between those whose diagnosis changed and those whose diagnosis remained the same was the more frequent presence of hypnogogic or hypnopompic hallucinations (present in 33% of the diagnosis change group and none of the other group, p = 0.02). All 6 patients with hallucinations changed to a final diagnosis of physiologic hypersomnia, 4 from a diagnosis of narcolepsy without cataplexy and 2 from idiopathic hypersomnia.
Horizontal dashed lines are drawn at the 95% limits of agreement. MSL, mean sleep latency; MSL1, MSL on first test; MSL2, MSL on second test; SOREMs, sleep onset REM period (SOREM1 and SOREM2 for first and second test, respectively).
Bland-Altman plots for test-retest reliability of mean sleep latency and sleep onset REMsHorizontal dashed lines are drawn at the 95% limits of agreement. MSL, mean sleep latency; MSL1, MSL on first test; MSL2, MSL on second test; SOREMs, sleep onset REM period (SOREM1 and SOREM2 for first and second test,...
Arrows represent patients whose diagnosis changed from the first to the second MSLT. MSLT1, first MSLT; MSLT2, second MSLT; SOREMs, sleep onset REM periods. N-C, narcolepsy without cataplexy; IH, idiopathic hypersomnia.
MSLT-based diagnosis on repeat MSLTArrows represent patients whose diagnosis changed from the first to the second MSLT. MSLT1, first MSLT; MSLT2, second MSLT; SOREMs, sleep onset REM periods. N-C, narcolepsy without cataplexy; IH, idiopathic hypersomnia.
MSLT-based diagnoses of narcolepsy without cataplexy and idiopathic hypersomnia demonstrated poor stability in clinical practice among patients evaluated in a tertiary clinic. Diagnoses changed in half of patients over an average of four years. This occurred because of changes in both sleepiness level (i.e., the MSL) and the propensity for REM sleep (i.e., SOREMs). Over 40% of patients had a change in MSL that crossed the conventional hypersomnia threshold of 8 minutes.7 In three patients, an apparently pathological level of sleepiness emerged after the initial diagnostic MSLT was interpreted as normal. In twelve, there was presumptive resolution of previously documented objective sleepiness, despite persistence of clinically significant subjective sleepiness. Such high rates of false negative and false positive MSLT results have also been highlighted in previous studies. An 8-minute MSL threshold, for example, fails to capture 22% to 39% of patients who otherwise meet clinical criteria for a CNS hypersomnia.9,12 Consistent with this, an average MSL of 8.3 minutes has been reported for patients with idiopathic hypersomnia.13 Type I error may also be problematic, as MSL < 8 was reported in 25% of one population-based sample.14 Collectively, these studies and our data call into question the appropriateness of an 8-minute threshold in capturing the complaint of sleepiness expressed by patients with nonhypocretin deficient CNS hypersomnias, and differentiating it from asymptomatic controls.
Over thirty percent of our patients crossed the threshold of two or more SOREMs between studies. Three patients initially diagnosed with narcolepsy met criteria for idiopathic hypersomnia on repeat testing, and one patient's diagnosis changed from idiopathic hypersomnia to narcolepsy without cataplexy. Excellent specificity of two or more SOREMs for narcolepsy has been suggested.15 Extension of the MSLT to diverse medical and neurological populations, however, demonstrates that although sensitive for hypocretin-deficient narcolepsy,15 the specificity of multiple SOREMs is poor. Multiple SOREMs can occur in other conditions associated with sleepiness, such as sleep apnea, Kleine-Levin syndrome, and Parkinson disease.14,16,17 Multiple SOREMs are also common in the general population, occurring in 3.9% to 13.1% of subjects.14,18 Nonetheless, SOREMs remain the sole electrodiagnostic feature that discriminates narcolepsy without cataplexy from idiopathic hypersomnia.4 The number of SOREMs is influenced by sex, sedating antidepressants, and shift work,14 but neither of the first two factors were associated with diagnosis change in our patients (shift work status was unknown). Collectively, these data and the absence of apparent therapeutic or biological significance to multiple SOREMs19 argue that the continued use of SOREMs to distinguish narcolepsy without cataplexy from idiopathic hypersomnia is not justified.
To some extent, the frequent change in MSLT results in our study may have reflected a key feature of the central hypersomnias, namely fluctuations in symptom severity. Prior work with the MSLT has shown that MSLT retest reliability is highly dependent on the population under study. In healthy subjects, the MSL has retest reliability as high as 0.97 over 4-14 months.20 In contrast, in Parkinson disease, the correlation between mean sleep latencies on consecutive days is only 0.53-0.73,21 and in insomniacs studied over eight months, it is only 0.44.22
Alternatively, there were limitations to our study that might have affected the results. Only patients with a clinical indication for repeat MSLT, i.e., persistent sleepiness, were eligible for inclusion. This may have created selection bias for more severely affected, medically refractory patients. A spontaneous remission rate of 11% has been reported in patients with idiopathic hypersomnia.13 As all patients in the present study reported persistent subjective sleepiness, our data do not address the test retest reliability of the MSLT in patients with primary hypersomnias but spontaneous remission of symptoms. Repeat testing was less often performed when the initial diagnostic MSLT was normal (< 20%). The choice to retest patients with MSLT-based diagnoses of idiopathic hypersomnia or narcolepsy without cataplexy might reflect physician or patient discomfort with these diagnoses, in which pathophysiology, treatment, socioeconomic, and prognostic implications remain ill-defined.23 In idiopathic hypersomnia in particular, evidencebased treatment standards are lacking,24 and data suggest that wake promoting agents are often incompletely effective.13,25 The average of 4 years between studies, with a maximum of 17 years, speaks to the chronicity of sleepiness experienced by these patients, but might have contributed to poor test-retest reliability. We sought to determine the reliability of testing as it is performed in clinical practice, rather than in a controlled, prospective research setting. With such a study design, as in clinical practice, factors such as treatment effects and changes in sleepwake cycle that may affect the MSLT could not be held constant. We were unable to detect any relationships between medication changes, time between MSLTs, or other available clinical features (excluding sleeprelated hallucinations) with a change in diagnosis, but our relatively small sample size does not allow us to entirely rule out this possibility. Other factors for which data were not available, such as changes in depression severity or sleep wake schedule, might have influenced the results. Alternatively, differences in the performance or interpretation of MSLTs may have affected the results (e.g., the MSLTs were generally performed at different sleep laboratories and interpreted by different individuals). The MSLT, for example, is well known to be affected by physiological levels of arousal that are distinct from sleepiness.26 The factors influencing arousal per se can be difficult to control on a single clinical MSLT, let alone a second one performed in a unique environment and under different conditions. It is less likely that scoring variability accounts for our findings as the MSLT has high interrater and intrarater reliability.14,27,28 Given these factors, our data suggests poor test-retest reliability of the MSLT in the nonhypocretin deficient CNS hypersomnias when used over time in clinical practice, although it is possible that test retest reliability would improve if tested within the confines of a tightly controlled research protocol.
Our results suggest that continued adherence to the 8-minute MSL threshold in defining hypersomnia syndromes in clinical practice is problematic. The distinction between narcolepsy without cataplexy and idiopathic hypersomnia based on MSLT testing alone also does not appear justified. It is possible that idiopathic hypersomnia and narcolepsy without cataplexy are manifestations of the same underlying pathology or exist along a spectrum with overlapping features. Family studies of narcolepsy (with and without cataplexy) support this assertion, as family members of narcoleptics have higher rates of narcolepsy, but also of idiopathic hypersomnia, excessive daytime sleepiness, and abnormal multiple sleep latency tests.29–32 Idiopathic hypersomnia is sometimes characterized as a rare disease,19 but one implication of our findings is that prevalence estimates in clinical or population cohorts are likely to be underestimates. Alternative diagnostic strategies are needed to more accurately and reliably characterize the nonhypocretin deficient CNS hypersomnias. Recognizing this need, some investigators have advocated for continuous daytime polysomnography, ad libitum sleep polysomnography, or changes to the MSLT scoring criteria.9,12,33 Similar to the MSLT, however, these alternatives are time and labor intensive. More cost-effective measures are needed, in addition to identification of a biomarker with diagnostic and therapeutic significance. While deficiencies in histamine have been proffered as one such biomarker,2 these results were not replicable with more sensitive technologies.34 Recent work suggests that somnolence in the CNS hypersomnias may derive from a gain in function in endogenous γ-aminobutyric acid (GABA) signaling mediated by a naturally occurring constituent of cerebrospinal fluid that allosterically modulates GABAA receptors.35 Ultimately, the identification of biomarkers will improve diagnostic accuracy in these conditions.
This was not an industry supported study. Dr. Trotti has consulted for UCB Pharma, Inc. Dr. Rye has consulted for or served on advisory boards of UCB Pharma Inc., Merck, Inc., Impax Laboratories, and Jazz Pharmaceuticals. Dr. Staab has indicated no financial conflicts of interest.
Bassetti C, Gugger M, Bischof M, et al., authors. The narcoleptic borderland: a multimodal diagnostic approach including cerebrospinal fluid levels of hypocretin-1 (orexin A). Sleep Med. 2003;4:7–12. [PubMed]
Kanbayashi T, Kodama T, Kondo H, et al., authors. CSF histamine contents in narcolepsy, idiopathic hypersomnia and obstructive sleep apnea syndrome. Sleep. 2009;32:181–7. [PubMed Central][PubMed]
Dauvilliers Y, Baumann CR, Carlander B, et al., authors. CSF hypocretin-1 levels in narcolepsy, Kleine-Levin syndrome, and other hypersomnias and neurological conditions. J Neurol Neurosurg Psychiatry. 2003;74:1667–73. [PubMed Central][PubMed]
Heier MS, Evsiukova T, Vilming S, Gjerstad MD, Schrader H, Gautvik K, authors. CSF hypocretin-1 levels and clinical profiles in narcolepsy and idiopathic CNS hypersomnia in Norway. Sleep. 2007;30:969–73. [PubMed Central][PubMed]
Khatami R, author; Baumann CR, Bassetti CL, Scammell TE, editors. Idiopathic hypersomnia. Narcolepsy: pathophysiology, diagnosis and treatment. 2011. Springer; p. 357–66.
Billiard M, author; Thorpy M, Billiard M, editors. Idiopathic hypersomnia. Sleepiness: causes, consequence, and treatment. 2011. NY: Cambridge University Press; p. 126–35.
American Academy of Sleep Medicine. International classification of sleep disorders: diagnositic and coding manual (ICSD-2). 2nd ed. 2005. Westchester, Illinois: American Academy of Sleep Medicine.
Vernet C, Arnulf I, authors. Narcolepsy with long sleep time: a specific entity? Sleep. 2009;32:1229–35. [PubMed Central][PubMed]
Vernet C, Arnulf I, authors. Idiopathic hypersomnia with and without long sleep time: a controlled series of 75 patients. Sleep. 2009;32:753–9. [PubMed Central][PubMed]
Roth B, author. Narcolepsy and hypersomnia. 1980. New York: Karger.
Folkerts M, Rosenthal L, Roehrs T, et al., authors. The reliability of the diagnostic features in patients with narcolepsy. Biol Psychiatry. 1996;40:208–14. [PubMed]
Pizza F, Vandi S, Detto S, et al., authors. Different sleep onset criteria at the multiple sleep latency test (MSLT): an additional marker to differentiate central nervous system (CNS) hypersomnias. J Sleep Res. 2011;20:250–6. [PubMed]
Anderson KN, Pilsworth S, Sharples LD, Smith IE, Shneerson JM, authors. Idiopathic hypersomnia: a study of 77 cases. Sleep. 2007;30:1274–81. [PubMed Central][PubMed]
Mignot E, Lin L, Finn L, et al., authors. Correlates of sleep-onset REM periods during the Multiple Sleep Latency Test in community adults. Brain. 2006;129:1609–23. [PubMed]
Amira SA, Johnson TS, Logowitz NB, authors. Diagnosis of narcolepsy using the multiple sleep latency test: analysis of current laboratory criteria. Sleep. 1985;8:325–31. [PubMed]
Chervin RD, Aldrich MS, authors. Sleep onset REM periods during multiple sleep latency tests in patients evaluated for sleep apnea. Am J Respir Crit Care Med. 2000;161:426–31. [PubMed]
Rye DB, Bliwise DL, Dihenia B, Gurecki P, authors. FAST TRACK: daytime sleepiness in Parkinson's disease. J Sleep Res. 2000;9:63–9. [PubMed]
Singh M, Drake CL, Roth T, authors. The prevalence of multiple sleep-onset REM periods in a population-based sample. Sleep. 2006;29:890–5. [PubMed]
Mignot E, author. Excessive daytime sleepiness: population and etiology versus nosology. Sleep Med Rev. 2008;12:87–94. [PubMed]
Zwyghuizen-Doorenbos A, Roehrs T, Schaefer M, Roth T, authors. Test-retest reliability of the MSLT. Sleep. 1988;11:562–5. [PubMed]
Trotti L, Rye D, Bliwise D, authors. Comment on Shpirer et al. ("Excessive daytime sleepiness in patients with Parkinson's disease: a polysomnographic study"). Mov Disord. 2007;22:1520[PubMed]
Roehrs TA, Randall S, Harris E, Maan R, Roth T, authors. MSLT in primary insomnia: stability and relation to nocturnal sleep. Sleep. 2011;34:1647–52. [PubMed Central][PubMed]
Bayon V, Leger D, Philip P, authors. Socio-professional handicap and accidental risk in patients with hypersomnias of central origin. Sleep Med Rev. 2009;13:421–6. [PubMed]
Morgenthaler TI, Kapur VK, Brown T, et al., authors. Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. Sleep. 2007;30:1705–11. [PubMed Central][PubMed]
Lavault S, Dauvilliers Y, Drouot X, et al., authors. Benefit and risk of modafinil in idiopathic hypersomnia vs. narcolepsy with cataplexy. Sleep Med. 2011;12:550–6. [PubMed]
Bonnet MH, author. ACNS clinical controversy: MSLT and MWT have limited clinical utility. J Clin Neurophysiol. 2006;23:50–8. [PubMed]
Drake CL, Rice MF, Roehrs TA, Rosenthal L, Guido P, Roth T, authors. Scoring reliability of the multiple sleep latency test in a clinical population. Sleep. 2000;23:911–3. [PubMed]
Chen L, Ho CK, Lam VK, et al., authors. Interrater and intrarater reliability in multiple sleep latency test. J Clin Neurophysiol. 2008;25:218–21. [PubMed]
Guilleminault C, Mignot E, Grumet FC, authors. Familial patterns of narcolepsy. Lancet. 1989;2:1376–9. [PubMed]
Hublin C, Partinen M, Koskimies S, authors. Familial narcolepsy in Finland. Acta Neurol Scand. 1991;83:388–93. [PubMed]
Chen L, Fong SY, Lam CW, et al., authors. The familial risk and HLA susceptibility among narcolepsy patients in Hong Kong Chinese. Sleep. 2007;30:851–8. [PubMed Central][PubMed]
Wing YK, Chen L, Lam SP, et al., authors. Familial aggregation of narcolepsy. Sleep Med. 2011;12:947–51. [PubMed]
Pizza F, Moghadam KK, Vandi S, et al., authors. Daytime continuous polysomnography predicts MSLT results in hypersomnias of central origin. J Sleep Res. 2013;22:32–40. [PubMed]
Dauvilliers Y, Delallee N, Jaussent I, et al., authors. Normal cerebrospinal fluid histamine and tele-methylhistamine levels in hypersomnia conditions. Sleep. 2012;35:1359–66. [PubMed Central][PubMed]
Rye DB, Bliwise DL, Parker K, et al., authors. Modulation of vigilance in the primary hypersomnias by endogenous enhancement of GABAA receptors. Sci Transl Med. 2012;4:161ra51.


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Teacher resources and professional development across the curriculum
Teacher professional development and classroom resources across the curriculum
Course Overview
The Habitable Planet is a multimedia course for high school teachers and adult learners interested in studying environmental science. The Web site provides access to course content and activities developed by leading scientists and researchers in the field.
About this course // Using this site
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This is a lesson where learners explore magnetic forces, fields, and the relationship between electricity. Learners will use this information to infer how the Earth generates a protective magnetic field.
This activity introduces students to the visible light spectrum, and demonstrates what happens to the appearance of an image when certain wavelengths of light are blocked by filters or made visible using special tools. Students are lead through experiments with light and filters, demonstrating th
This is a lesson about radiation and the various sources of radiation that a spacecraft may encounter in its journey.
In this field activity, students conduct a visual survey of a hydrology study site, and collect information about land cover and water quality. These observations are used to stimulate research-able questions about land cover and water chemistry that can be the focus of future investigations.
This is a lesson about the search for life on Mars. Learners will participate in three activities. In the first activity (Imaginary Martians) learners will compare a fictional organism with what they know about life on Mars today.
This four-page color brochure describes the science of NASA's GLAST mission, as well as providing tables that summarize the instrumental parameters and the mission participants.
This is an activity about perspective. Learners will examine pictures of objects up close and far away to try and figure out what they are.
On a bright, sunny day, learners will use tonic water to detect ultraviolet (UV) light from the Sun. This activity is from the DIY Sun Science app and is for ages 7 and up
This is a paper model of the Nuclear Spectroscopic Telescope Array (NuSTAR) satellite.
This is an activity about modeling and the scientific process. Learners will discuss the models they created in the previous three activities as models of forces that shape the surface of planets, and talk about the similarities and differences between models and real events.


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Fuzhou gets ready for first FIVB beach volleyball event of the year
The conference began with Director of Fuzhou Sports Bureau Mr. Huang Qiqin introducing the event, by emphasizing its status with more than 100 high-level players from 34 countries participating. As with last year, all the matches are open free to all fans. He also pointed out that the event is aimed to go hand in hand with the preparation of the first National Youth Games, which will be held in Fuzhou.
Secretary General of Fuzhou Municipal Government Mr. Liang Dong, Director of
Fuzhou Sports Bureau Mr. Huang Qiqin, China Volleyball Association representative
Mr. Cui Long, and Fujian's beach volleyball world champion Xue Chen attended
the conference.
Chinese beach volleyball star Xue Chen will be seen on the beach with new teammate Xia Xinyi, who is only 17 years old. The team is still in a run-in period, and she confessed that she is adjusting to act as a big sister, offering professional instructions to the former basketball player. On the other hand, Xue praised her extraordinary physique and expressed expectation to attend the 2016 Rio Olympic Games.
"We are still accumulating experiences and building rapport," Xue said. "We will spare no efforts to win."
Xue won her first world tournament gold medal when she was 17. However, the record was broken by her partner Xia at the Phuket Open when she was only 16. She expressed her congratulations with a little bit of pity.
"It's a great chance to introduce my hometown to my beach volleyball friends," Xue said. "I am proud of my hometown."
It is the second time Fuzhou will stage the FIVB Open event. Last year, Xue Chen and her former partner Zhang Xi started their fruitful season by clinching the gold medal here. The tournament this year is scheduled to kick off Tuesday, while the finals for men and women will take place Saturday and Sunday respectively.
The Fuzhou Open is one of 11 FIVB Beach Volleyball Opens on the 2014 FIVB World Tour, including seven double-gender, two men-only and two women-only tournaments, adding numerous
possibilities for athletes to compete in high quality, FIVB international


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Cute, candy-colored and surprisingly powerful, these palm-sized mini-vibes are quiet and will buzz on for five hours on one little battery.
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Brand: Iroha
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Texture: Smooth
Color: Pink or Purple / Yellow
Power Source: 1 AAA
Length: 2.2 inches
Diameter: 1.75 inches
Intensity: 2/5
Volume: 2/5
Warranty: 90 Days
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Predictive Analytics Workshop Austin TX
Sep 13th - All Day
St. Edwards University Professional Education Center - 9420 Research Blvd Suite 200 (2nd Floor) Austin, TX 78759
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- See automated data preparation that incorporates structured and unstructured data from a variety of data sources so you can focus on analysis rather than preparation.
- Determine whether IBM SPSS Modeler software is an ideal fit for your business needs.
Seats are limited, register today!


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Giving Military Spouses the Help They Deserve
By Mika Cross on February 15, 2017
At the Department of Labor's Veterans' Employment and Training Service, we know that training veterans for skilled work or helping them prepare for their next interview enhances their ability to live the American dream. A steady, meaningful job provides security for both veterans and their families.
Providing support to military spouses is an equally important part of the department's goal to expand opportunities for all U.S. workers. Like veterans and transitioning service members, military spouses deserve assistance to achieve their personal career goals.
Many of the programs we support are available for both veterans and their spouses—and below are a few highlights:
Veterans, transitioning service members and military families can find free employment and training services at nearly 2,500 American Job Centers in local communities across the country. We also help maintain the National Labor Exchange, used in all 50 states and 3 territories (D.C., Guam, and Puerto Rico) by tens of thousands of employers, with an average of 2.1 million daily job listings collected from corporate job listings, state job banks and the federal government's USAJOBS.
We lead a three-day DOL employment workshop, for transitioning service members and their spouses, as part of the Transition Assistance Program to prepare service members for things like resume writing, interview skills and salary negotiation. Our course curriculum is also available for free online and in a new eBook.
We work with state and local employers to recognize the skills that veterans and military spouses bring to the workforce, and encourage them to recognize the credentials earned by military spouses. There's no reason to have to start from scratch each time a military spouse crosses a state line due to their partner's permanent change of station or deployments. We also help promote on-the job training opportunities like the registered apprenticeship program, which is a great pathway into high-growth industries.
We continue to engage employers about hiring veterans and military spouses. We also support national efforts, such as the U.S. Chamber of Commerce Foundation's Hiring Our Heroes Program and the Department of Defense's Military Spouse Employment Program. We recently co-led a free employment webinar with the Spouse Employment and Career Opportunities program specifically covering what is offered for military spouses.


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EMORY, Va. --- Emory & Henry College
Head Football Coach Don
Montgomery has resigned, citing personal reasons,
Director of Athletic Myra Sims announced
Monday. Montgomery served at the helm of the Wasps' program for the
past nine years, compiling a 45-45 record.
"It has been a great nine years. The toughest part is leaving the players, but I wish them the best of luck in the future," Mongtomery said in a statement. "I am resigning for personal reasons and will more than likely return to Ohio to be closer to my children and grandchildren. I feel that this decision is fitting at this point in my career."
During his tenure, 24 players were named to the All-ODAC First Team including Marshall Doss, Caleb Jennings and Devan Sproles, who were each named ODAC Players of the Year. Jennings earned First-Team All-America honors in 2009 and won the Lanier Award, given to Virginia's Best Small College player. Kyle Boden was tabbed as ODAC Scholar-Athlete and was selected to the Academic All-America Second Team last year.
"Emory & Henry was fortunate to have a man like Don Montgomery at the helm of the football program over these last nine years. I have tremendous respect for his work ethic and for his dedication to coaching and to the sport of football," commented Sims. "Coach Montgomery is a leader who has displayed great loyalty to the student-athletes on his teams as he truly cares about helping them to develop into men of character and class. I know that he has made a difference in the lives of many young men. I wish Coach Montgomery the best of luck as he moves into the next phase of his life and career."
A nationwide search for Emory & Henry's next football coach will begin immediately. Until a new head coach is named, current Associate Head Coach Rob Grande will serve as Acting Head Coach for E&H.
--- This release is
courtesy of the Emory & Henry College sports information
department. --


text:
Hollywood is obsessed with comic book superheroes these days. Disney's (NYSE:DIS) Marvel Cinematic Universe continues growing rapidly and Time Warner (NYSE:TWX.DL) is close to finally uniting DC's Justice League.
These films focus on familiar characters like Spider-Man, not-so-familiar ones such as Thor, and utterly obscure ones like Ant-Man. However, there are still plenty of heroes and heroines out there in the comic book universe who deserve a feature film.
Let's take a look at three of these overlooked characters and weigh their chances of making it to the big screen.
Spawn (Image Comics)
The first character, and the one most likely to get his own film soon, is Spawn.
Spawn, formerly known as the government assassin Al Simmons, was betrayed by his superiors and murdered on the battlefield. After he went to Hell, he made a deal with the devil to return to Earth to see his wife again. Unfortunately, he was sent back to five years later as a demonic soldier of Hell, only to find out that his wife had moved on and married his best friend.
To be fair, Spawn already had his shot at the big screen back in 1997. However, the movie was awful, and currently holds a dismal 19% rating on Rotten Tomatoes. There were two main reasons the first film failed.
First, the movie was written in an age when the only two real creative inspirations for comic book films were Tim Burton and Joel Schumacher's carnival-like takes on Batman. Second, the special effects were atrocious, even for its time. Despite the film's shortcomings, however, it grossed $88 million worldwide on a production budget of $40 million. Naturally, New Line Cinema (a subsidiary of Time Warner), wanted a sequel.
Unfortunately, the follow-up has been stuck in development hell since 1998, mainly due to the constantly changing demands of Spawn's creator, Todd McFarlane. McFarlane initially wanted to reboot the franchise, focusing on the detectives Sam and Twitch, turning Spawn into a mute character instead.
McFarlane, who began writing a new film in 2009, claimed that it would be "more of a horror movie and a thriller movie, not a superhero one." He later inexplicably compared the film to Martin Scorsese's crime drama The Departed.
Despite McFarlane's questionable approach to rebooting his character, there has been tremendous interest in the project. Michael Jai White, who starred as Spawn in the original film, has expressed interest in returning. Jamie Foxx, who stars as Electro in The Amazing Spider-Man 2, is also reportedly interested in the title role.
I have mixed feelings about Spawn as a film. On one hand, McFarlane could finally make a film that does the comic book justice. On the other hand, it could crash and burn like the two Ghost Rider films.
Huntress (DC Comics)
Despite being a well-known character in the Batman comics, a live-action version of Huntress has only appeared twice -- once as a main (albeit highly modified) character in the short-lived WB series Birds of Prey (2002) and another time in two episodes of the CW series Arrow (2012-present).
Huntress, in many ways, is DC's female version of Marvel's Punisher. She is the alter-ego of Helena Bertinelli, whose family was murdered by the Mafia at the age of 8. After a violent streak as a self-styled vigilante, she was exiled from Gotham City by Batman, who believed that she was uncontrollable. She eventually returns to Gotham, becoming Batman's unlikely ally, although he still opposes her desire to kill.
Bringing the Huntress into the DC Cinematic Universe, which currently consists of Henry Cavill's Superman, Ben Affleck's Batman, and Gal Gadot's Wonder Woman, would be a wise choice for three reasons.
First, Huntress is a perfect foil for Batman and Superman, who both have issues with taking lives. Second, introducing her into the new, non-Nolan Batman universe would open the door for other Batman comic book characters -- such as Oracle, Nightwing, and Robin -- to eventually join.
Third, movie audiences love "girl power" these days -- Hunger Games: Catching Fire has already grossed $771 million at the box office worldwide on a production of budget of $130 million. Even Huntress' weapon of choice, a crossbow, is similar to Katniss Everdeen's trademark bow and arrow.
Ninjak (Valiant Entertainment)
Last but not least, Ninjak, a forgotten hero from the 1990s, would make a great movie character.
Ninjak was created by Joe Quesada, one of my favorite comic book artists and the Chief Creative Officer of Marvel Entertainment, and writer Mark Morelli. The character originally starred in two series from Valiant Comics and Acclaim Comics between 1994 and 1997, and was reintroduced in 2012.
Ninjak is the alter-ego of Colin King, the son of a British spy who was raised in Japan. Like Bruce Wayne, he plays the part of the rich playboy, but he carries out a secret mission to avenge his father's death. His vigilante missions eventually attract the attention of the secret SHIELD-like Weaponeer organization, which recruits him and outfits him with camouflage body armor and a wide array of high-tech gadgets.
In other words, Ninjak is James Bond with a katana. There are four reasons I think this movie could be a surprise hit.
First, the movie rights to Ninjak would probably be cheap to obtain. Second, the character is still recognizable to 30-something year-olds who are now reliving their childhood with the recent flood of Marvel and DC movies. Third, the new James Bond films, while well made, lack the high-tech absurdity that the older films relished. Ninjak could bring that charm back to the big screen.
Last but not least, audiences still love over-the-top, high-tech ninja combat. Snake Eyes and Storm Shadow are probably still the most popular characters from the two critically lambasted G.I. Joe films, which have nonetheless grossed $678 million at the box office.
Paul W.S. Anderson, the director of the Resident Evil films, attempted to acquire the film rights for Ninjak back in the mid-1990s, but Acclaim, which was focused at the time on making video games and comics, rejected the offer. Now that Valiant Comics has returned as Valiant Entertainment, it may be time to rethink the offer.
A final thought
What's your take, dear readers? Do you agree or disagree with my choices? Let me know what other forgotten comic book heroes you would like to see on the big screen in the comments section below!
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