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The Law Society appears to think that Catholic priests are legally required to solemnise the remarriage of divorced people. And that Baptist pastors must preside over the union of athiests. Or has it got something very wrong?
To my shame, I didn't put in a submission on Louisa Wall's Marriage (Definition of Marriage) Amendment Bill. In my defence, I was busy with other stuff when the submission date rolled around and I assumed (and still assume) that support for this legislative measure is so deep and broad (both in Parliament and in society as a whole) that it is going to become law without my help.
But those aren't very good excuses for not doing the right thing. So this post is partly by way of a guilty ex post facto attempt to have a public say on the issue. But it's also an attempt to counter what I think is a wrongheaded and potentially scare-mongering submission on the Bill from the New Zealand Law Society.
Before l get to that latter issue, let me just set out for the record my views on the principles behind the Bill as it stands. Same-sex couples should be allowed the same legal right to marry as straight couples currently enjoy. I think my argument on this point is so powerful that it's not necessary to talk about it.
Beyond that fundamental issue, I don't really care if some religious organisations refuse to conduct marriage ceremonies for same sex couples. To my mind, if a church or other religious group doesn't want teh gayz or lesbos getting hitched in its buildings by its minister, that's a hang-up which reflects badly on its moral worldview. It's wrong ... but there's lots of things that religious groups think and do that I believe to be wrong (just as there's lots of things that religious groups think and do that I believe to be right). And as a good, card-carrying liberal, I think that religious groups (like other groups in society) ought to be allowed to think and do (at least some) things that I happen to believe are wrong.
So if the effect of Louisa Wall's Bill was to require religious organisations (or, more precisely, those who act as ministers or officiants for religious organisations) to solemnise the marriage of same-sex couples when that religious organisation does not want to do so, then that would be a bad thing.
However, does the Bill do this? An Auckland lawyer, Ian Bassett, produced a legal opinion for Family First that says it would. And now the Law Society, in its submission on the Bill, has echoed that conclusion (or, at least, said the conclusion might be correct).
To begin with, I note that these legal views run counter to the Human Rights Commission's take on the issue. And as that is the body most likely to consider any challenge to a religious group's refusal to marry a same sex couple, its dismissal of the issue ought to carry some weight.
Furthermore, I think that the Law Society's opinion on the Bill is (with respect) both poorly argued and, if correct, vastly more destabalising for religious organisations than the Society itself recognises. In fact, the consequences of the claim that the Society makes are so extreme that I think they indicate that something is fundamentally wrong with its submission. Explaining just why this is so requires a bit of a tour through the law on marriage (sorry!).
Up until 1993, the only relevant legislation was the Marriage Act 1955. Under this Act (which still applies today), to be married you first must apply for a marriage licence from a "Registrar" (a state official). Once you've got this licence, for you to actually become married you then must have your marriage "solemnised" by the marriage celebrant named in the licence - who may or may not be a religious official. The Marriage Act then contains lots of convoluted rules about who gets to be a recognised marriage celebrant, as well as some exemptions from the rule that a marriage must be solemnised by a celebrant, in an effort to cater to all the weird and wonderful forms of religious/spiritial beliefs around how "marriage" should happen.
(As an aside, what Louisa Wall's Bill would do is, in essence, allow same sex couples to apply for and receive a marriage licence just like straight couples can at present. A couple getting a marriage licence would then need to go through the additional step of having their marriage solemnised by the celebrant named on the marriage licence ... whereupon they would become "married".)
However, the Marriage Act then contains section 29, which states:
A marriage licence shall authorize but not oblige any marriage celebrant to solemnize the marriage to which it relates.
Why is this in the Act? Well, when a person applies for a marriage licence, they have to say who is going to carry out the marriage. But the applicant doesn't have to prove to the Registrar that the person they name as the celebrant has actually agreed to solemnise the marriage - it's simply a case of the applicant telling the Registrar "I'll be getting married to this person, at this place, with this celebrant carrying out the legal niceties" and the Registrar then granting the licence to so so.
So, what section 29 makes clear is that just because an applicant has obtained a licence from the State saying that a given celebrant can marry them, that licence doesn't then mean the celebrant has to do so. Otherwise, an applicant for a marriage licence could bind an otherwise unwilling celebrant to the task simply by naming her or him to do so on the licence application - even if the named celebrant is a Catholic priest and the applicant a thrice-divorced woman (a point I'll be coming back to).
Or, to put it another way, section 29 is a recognition of the separation between the State and the Church(es): the State licences you to wed, but you still have to get a Church's (or other celebrant's) agreement to actually marry you ... and the first process does not imply anything for the second.
So much for the story up until 1993. Because in that year, the Human Rights Act (HRA) was enacted.
Most importantly, the HRA sets out a range of "prohibited grounds of discrimination". One of these prohibited grounds is sexual orientation (although there are also a bunch of others, to which I'll return). Then, the HRA states that:
It shall be unlawful for any person who supplies goods, facilities, or services to the public or to any section of the public—
(a) to refuse or fail on demand to provide any other person with those goods, facilities, or services; or
(b) to treat any other person less favourably in connection with the provision of those goods, facilities, or services than would otherwise be the case,—
by reason of any of the prohibited grounds of discrimination
Now, the Law Society in its submission thinks that this provision might be very important. Because, it says, if marrying people is a "service" that a religious group provides to the public, then a religious group (or its officiant) that refuses to marry a same sex couple would be in breach of this privision of the HRA. And that would be an unlawful action that would open the religious group (or its officiant) to legal sanction.
(I note that the Law Society's submission doesn't actually say that marriage is a service provided by a Church. Rather, in a single sentence it equivocates that:
While a particular minister of religion might not consider him or herself to be offering "services" to the "public" (or a section of it), this is far from clear and is at least vulnerable to challenge.
With respect, a point as critical to the Society's submission as this is deserved a bit more research ... simply saying "this might be argued about!" isn't very compelling legal analysis.)
Well, that would all seem pretty cut and dried. If marrying people is a "service" (which it may or may not be ... the Law Society simply says it is arguable), then the law says you have to provide it to same and opposite sex couples alike. Except that (in a section not referenced by the Law Society, which is surprising to say the least), the HRA also states that:
To avoid doubt, an act or omission of any person or body is not unlawful [under the HRA] if that act or omission is authorised or required by an enactment or otherwise by law.
Which then brings us back to section 29 of the Marriage Act. Because, as this section authorises a marriage celebrant to refuse to marry any given couple even if they have received a valid licence to do so, then a celebrant would seem able to continue to do so on the grounds of the couple's sexual orientation irrespective of the provisions of the HRA.
"Ah!", says the Law Society, "but section 29 may not actually say what it seems to say!" Because in this bright new age of human rights, a court could very well read this nearly 60 year old provision as saying something like:
A marriage licence shall authorize but not oblige any marriage celebrant to solemnize the marriage to which it relates unless that celebrant refuses to solemnize the marriage because of a prohibited ground of discrimination.
And if a court were to do so, there would then be no legal protection against the operation of the HRA for a religious group that refused to marry a same-sex couples.
Well, maybe. I can't definitively say that the Law Society is wrong on this. Courts can do all sorts of odd things, and the ability to mess with statutory language in order to produce "rights friendly" outcomes is just one of them. But I think there's pretty good context and consequence based reasons for thinking that a court wouldn't do what the Law Society suggests it might.
Because the only "prohibited ground of discrimination" I've talked about so far in this post has been sexual orientation. But this is far from the entirety of the HRA's reach. You can read all the prohibited grounds here, so for now I'll just pick a few very relevant ones out:
- sex, which includes pregnancy and childbirth;
- marital status, which means being ... a party to a marriage or civil union that is now dissolved, or to a de facto relationship that is now ended;
- religious belief;
- ethical belief, which means the lack of a religious belief, whether in respect of a particular religion or religions or all religions.
Here's why they matter - put in bolded italics so that the point is made in its full, glorious impact:
If the Law Society is right that, if Louisa Wall's Bill passes, a religious organisation will not legally be able to refuse to marry same sex couples, then since 1993 religious organisations could not legally refuse to marry a couple for any of the above listed reasons.
That's right. If the Law Society's analysis is correct and the Marriage Act, s 29 won't protect religious organisations who don't want to marry same sex couples, then by that very same analysis the Catholic Church's refusal to marry divorced persons has been unlawful since 1993 ... it's based on an individual's marital status, which also is a prohibited ground of discrimination. Equally, by the Law Society's analysis, a Baptist pastor who tomorrow refuses to solemnise the marriage of a athiest couple on the basis that they aren't Christian believers is unlawfully discriminating on the basis of their ethical belief.
In fact, if the Law Society's analysis is right, then since 1993 basically every conceivable reason that a religious group would have for not solemnising a particular marriage between two people was unlawful. And that is, it seems to me, a consequence that is so extreme as to call into question the logic that produces it. In short, if a legal analysis leads you to an absurd conclusion, then something has gone wrong with it irrespective of its formal coherence.
Furthermore, as I noted above, section 29 of the Marriage Act is a recognition that the State and the Church(es) - as well as other religious groupings - have quite different roles in relation to marriage. The State issues marriage licences, based on some standard rules as to who can and can't be married. But the decision of a religiously motivated marriage celebrants to act on that licence involves moral or spiritual factors entirely separate to the State's; factors such as "do I think this union is sanctified in the Lord's eyes", or "are the persons wishing to enter into marriage within our congregation suitable to do so", or the like. So the former decision to issue a licence cannot bind the latter decision to solemnise the union because they are reached on fundamentally different grounds ... as section 29 recognises.
Given this legislative context, the chances of a Court messing with this separation of State from Church(es) and saying (in essence) "if the State thinks someone can marry, then you Churches must marry them irrespective of your moral/spiritual beliefs" are very, very slim-to-negligible. In fact, the chances are so slim that I'm prepared to say they are as close to zero as we can get in this world of quantum uncertainties and black swan events.
So, my message is this: the risk that a Church minister (or other religious officiant) in a post-same sex marriage world will have to solemnise the marriage of a same sex couple against his or her will is exactly the same as the risk that a Catholic priest has faced since 1993 of having to solemnise the marriage of a thrice-divorced woman. And if you haven't been tearing your hair out in horror at the prospect of the latter, then why are you now worrying about the former?


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We aimed to characterize the association between jaw muscle contractions and respiratory events in patients with obstructive sleep apnea syndrome (OSAS) and to investigate the responsiveness of the contractions to respiratory events in comparison with that of leg muscles in terms of arousal types and sleep states.
Polysomnographic (PSG) recordings were performed in 19 OSAS patients (F/M: 2/17; 53.1 ± 13.7 years; AHI: 31.8 ± 19.9/h) with no concomitant sleep bruxism or other sleep-related movement disorders. Muscle contractions of unilateral masseter (MAS) and anterior tibialis (AT) muscles were scored during sleep in association with graded arousals (microarousals and awakenings) related or unrelated to apneahypopnea events.
Arousals were scored for 68.2% and 52.3% of respiratory events during light NREM and REM sleep, respectively. Respiratory events with arousals were associated with longer event duration and/or larger transient oxygen desaturation than those without (ANOVAs: p < 0.05). Median response rates of MAS events to respiratory events were 32.1% and 18.9% during NREM and REM sleep. During two sleep states, MAS muscle was rarely activated after respiratory events without arousals, while its response rate increased significantly in association with the duration of arousals (Friedman tests: p < 0.001). A similar response pattern was found for AT muscle. Motor responsiveness of the two muscles to arousals after respiratory events did not differ from responsiveness to spontaneous arousals in two sleep stages.
In patients with OSAS, the contractions of MAS and AT muscles after respiratory events can be nonspecific motor phenomena, dependent on the duration of arousals rather than the occurrence of respiratory events.
Kato T; Katase T; Yamashita S; Sugita H; Muraki H; Mikami A; Okura M; Ohi M; Masuda Y; Taniguchi M. Responsiveness of jaw motor activation to arousals during sleep in patients with obstructive sleep apnea syndrome. J Clin Sleep Med 2013;9(8):759-765.
Previous studies have shown that muscle contractions in the respiratory-related orofacial muscles (e.g., tongue) often occur after apnea and hypopnea events during sleep in patients with OSAS. Among the orofacial muscles, the jawclosing masseter (MAS) muscle is also activated in association with apnea and hypopnea events,1–5 and jaw closures from the jaw opening posture are often observed at the termination of the respiratory events.6,7 Since the MAS muscle is known to produce a large biting force during sleep and wakefulness,8–10 its contractions can produce a mechanical load on orodental structures. In fact, approximately 10% of OSAS patients are aware of jaw motor activity during sleep.11 This awareness is associated with jaw symptoms.11 An oral appliance is often used to manage OSAS, since it increases or maintains the upper airway space by holding the mandible and/or tongue in a forward position. OSAS patients often encounter jaw symptoms (pain/discomfort) during an initial period following the commencement of oral appliance use.12–15 In addition, longterm use of an oral appliance is associated with dentoskeletal changes,13 suggesting that oral appliances can impose a certain level of mechanical load on orodental structures. Thus the occurrence of MAS contractions may be a significant physiological factor as well as a source of additional mechanical load on orodental structures in cases where OSAS is managed with an oral appliance.
Current knowledge/Study Rationale: This study was aimed to investigate whether jaw motor events following respiratory events are specifically associated with respiratory disturbance in OSAS patients without sleep related movement disorders. We evaluate the responsiveness of jaw and leg muscles to arousals related or unrelated to respiratory events.
Study Impact: The contractions of jaw and leg muscles are nonspecific motor phenomena in response to arousals rather than respiratory events. Jaw muscle contractions can remain to occur in OSAS patients using an oral appliance. Nonspecific motor events can be a confounding factor for assessing motor events and associated clinical symptoms in patients with frequent arousals such as OSAS.
Although it has been proposed that MAS contractions play a supporting role in reinstating the compromised upper airway,16 physiological understanding of MAS contractions in patients with OSAS is limited. MAS contractions are usually associated with the termination of apneahypopnea events, while MAS contractions do not always occur after respiratory events in patients with OSAS.1–5 Previous studies have reported that MAS contractions after respiratory events occur in association with an increase in heart rate, which is a typical sign of arousal response,2,3 suggesting that the arousals associated with respiratory events are an underlying condition for MAS contractions in association with respiratory events. In patients with OSAS, varying degrees of arousal events were found to occur in relation to respiratory events.17–21 As there is a hierarchy of arousal responses,22 motor activation is more frequently observed in response to a higher level of arousals.14,23 However, the association between MAS contractions and the level of arousals after respiratory events has not been investigated in OSAS patients. In addition, in patients with OSAS, some arousals can be associated with respiratory events, while other arousals are not related to respiratory events. It is not known whether MAS is more responsive to arousals related to or unrelated to respiratory events. It also remains to be demonstrated whether the motor responsiveness of the jaw muscles is compatible with that of other muscles in the body.
The aims of this study are to characterize the association between MAS contractions and respiratory events in patients with OSAS and to investigate the responsiveness of MAS contractions to respiratory events in comparison with that of leg muscles in terms of arousal types and sleep states.
Fifty-four patients (F10:M44; Age: 51.9 ± 15.1 years) had been newly referred to Osaka Kaisei Hospital Sleep Medicine Center with suspected sleep apnea. They were first interviewed by sleep physicians (MO, MO, and MT) and were suspected of having OSAS based on a history of excessive daytime sleepiness, sleep disturbances, snoring, and witnessed respiratory pauses in sleep. They did not have a history of pulmonary, heart, liver or kidney disease, stroke, or other neurological disorders, and did not take sleeping pills. All patients were enrolled for a routine PSG examination. On the night of PSG recording, these patients gave written informed consent to participate in the study. They were asked to fill out a self-administered questionnaire on sleep disturbance and orofacial symptoms. After evaluating PSG data, we excluded the data of 35 patients from the final analysis for the following reasons: (1) 17 patients were aware of signs symptoms of sleep bruxism (tooth grinding during sleep and morning jaw symptoms) according to the self-administered questionnaires; (2) 4 patients did not fill out the questionnaires; (3) 4 patients with AHI index < 5 /h; (4) 9 patients had periodic leg movements in sleep (PLMS) with PLMS index > 10 /h, and (5) one patient was suspected of having an REM sleep behavior disorder. Finally, data from 19 patients (F2:M17; age: 53.1 ± 13.7 years) were used for the analysis. We also confirmed that none of these patients exhibited tooth grinding and rhythmic masticatory muscle activity (RMMA) during sleep. The study was approved by the institutional review board at the Osaka Kaisei Hospital, Osaka, Japan.
PSG consisted of continuous recordings from 6 electroencephalographic (EEG) leads (F3-M2, F4-M1, C3-M2, C4-M1, O1-M2, O2-M1), 2 electrooculographic leads (ROC-M2, LOC-M2), 5 electromyographic leads (2 submental and bilateral anterior tibialis [AT] and unilateral MAS muscles), nasal cannula with a pressure transducer and thermal sensor for nasal airflow, strain gauges for thoracic and abdominal movements, pulse oximetry, and electrocardiography. Simultaneous audiovideo recording was made. Subjects went to bed at their usual bedtime or before 23:30, and the recording was terminated after 6:30.
Sleep stages were scored for 30-sec epochs according to the international standard criteria.24 Apnea and hypopnea were defined following the rules of the American Academy of Sleep Medicine.24 An apnea was defined as ≥ 90% reduction in airflow for ≥ 10 sec; hypopnea as ≥ 50% reduction of airflow for ≥ 10 sec associated with arousals or with ≥ 3% reduction in oxygen saturation. Transient arousals such as microarousals ([mAR] 3-15 sec) and awakenings ([AW] > 15 sec) were scored according to the criteria.20,24,25 Arousals were scored as respiratory related when they were synchronous with the termination of the respiratory event, while those without a preceding respiratory event were scored as spontaneous arousals. To confirm that patients had no concomitant sleep related movement disorders in the jaw and leg muscles, RMMA and periodic leg movements were scored according to the criteria for sleep bruxism and PLMS.24,26,27
The following sleep and respiratory variables were calculated: total sleep time (TST), total recording time (TRT), sleep efficiency (SE), sleep latency, percentage of sleep stages, and the frequency of transient events per hour of sleep (e.g., awakenings, microarousals, PLMS, RMMA, and respiratory events [apneas and hypopneas]). The duration of apneahypopnea events was measured, and the oxygen desaturation in relation to respiratory events was calculated as the difference between the oxygen saturation (SpO2) before apnea- hypopnea events and minimum SpO2 after the events. Table 1 shows the demographic and PSG data in 19 patients. Patients had little sleep Stage NREM3. Only 3 patients had respiratory events (9-26) during stage NREM3, and 6 had only one event. Since the number of respiratory events was too low to allow us to analyze the data, the data on Stage NREM3 were excluded from the following analyses.
Demographic and polysomnographic data in 19 patients
(more ...)
Motor activations in MAS and AT muscles were scored when the EMG level was ≥ 10% of the maximum voluntary contraction (MVC) before sleep. Minimum duration criteria were 0.25 sec for MAS events and 0.5 sec for AT events.24,27 A motor event occurring within 10 sec after the termination of a respiratory event was considered to be apneahypopnea related in case that arousal was not scored after a respiratory event. Motor response rates for the 2 muscles were calculated for the respiratory events without arousals (no arousal: NA) and with mAR and AW as well as spontaneous mAR and AW. Since 2 muscles were occasionally activated in response to a single respiratory event or spontaneous arousal, the number of muscles activated was counted as 2 (both MAS and AT muscles), 1 (either muscle), or 0 (neither muscle was activated), to assess the coincidence that motor events of the 2 muscles responded to the same arousals.
Data are presented as mean ± SD or median (range). For pairwise comparisons, paired t tests and Wilcoxon tests were used appropriately. The duration of respiratory events and decrease in SpO2 were compared between arousal levels by repeated measure ANOVAs with post hoc paired t-tests. The response rate of motor activity to respiratory events was compared between arousal levels using Friedman tests with post hoc Wilcoxon tests for each muscle in either NREM or REM sleep. For these tests, the level of statistical significance was set at p < 0.05. Response rates to arousals were compared between respiratory related and spontaneous arousals by Wilcoxon tests for each muscle in either NREM or REM sleep. Due to multiple comparisons, the level of statistical significance was set at p < 0.0125. We used SYSTAT 11 for Windows (SYSTAT software Inc., USA) for statistical analyses.
The majority of apneahypopnea events (204.2 ± 140.3 events) were scored in NREM sleep (84.4% ± 13.2% in NREM sleep and 15.6% ± 13.2% in REM sleep, N = 19). In NREM sleep, twothirds of respiratory events (68.2% ± 15.5%) were followed by transient arousals, while half of the respiratory episodes were associated with arousals during REM sleep (52.3% ± 24.1%); transient arousals were scored more frequently after respiratory events in NREM sleep than in REM sleep (paired t-test: p < 0.01).
The following variables were analyzed for NREM sleep in 19 patients and for REM sleep in 15 patients, since either or both types of transient arousals were not scored after respiratory events. In NREM sleep, duration of respiratory events did not differ among 3 types of respiratory events (e.g., nonarousal [NA] events, events with mAR and AW; Table 2). In REM sleep, the duration of respiratory events differed among the 3 types of respiratory events (ANOVA: p < 0.05). The duration of respiratory events with AW was significantly elongated compared to NA events (post hoc paired t test: p < 0.05; Table 2). The decrease in oxygen saturation was significantly different among the 3 types of respiratory events in NREM sleep (ANO-VA: p < 0.01) and in REM sleep (p < 0.05). In NREM sleep, it was significantly lower for NA events than for events with mAR (Table 2, post hoc paired t-test: p < 0.001) and those with AW (p < 0.05). In REM sleep, the decrease in oxygen saturation was significantly larger for the event with AW than for NA events (Table 2, post hoc paired t-test: p < 0.05).
Duration and oxygen desaturation for three types of respiratory events
In NREM sleep, 32.1% (7.2-88.9) of respiratory events were followed by MAS contractions. The response rate of MAS contractions to respiratory events differed significantly between NA events and those with mAR and AW (Figure 1, Friedman test: p < 0.001). The contractions were found to occur increasingly from 6.1% (0-100) to 40.0% (5.1-88.6) and 85.4% (18.2-100) as the duration of post-respiratory arousals became elevated from NA to AW (post hoc Wilcoxon tests: p < 0.001 [N = 19]). AT muscle was activated after 21.7% (4.2-82.0) of respiratory events during NREM sleep. A significant difference in the responsiveness of AT muscle was found between arousal levels (Friedman test: p < 0.001): AT muscle was activated more frequently when respiratory events were followed by a higher intensity of arousals in NREM sleep (NA: 4.2% [0-66.7]; mAR: 25.5% [0-85]; AW: 78.3% [14.3-100]) (Figure 1, post hoc Wilcoxon tests: p < 0.001). The number of muscles activated following a respiratory event increased from 0.3 (0 -1.7) to 0.8 (0.1-1.3) and 1.6 (0.4-2.0) as arousal response to respiratory events became more intense in NREM sleep (Figure 1, Friedman test: p < 0.001, post hoc Wilcoxon tests: p < 0.001).
During NREM and REM sleep, masseter (left column) and anterior tibialis (middle column) muscles were activated most frequently when awakenings (AW) occurred after respiratory events; they were activated least frequently when no EEG arousals (NA) occurred (Friedmann tests: p < 0.001). Right column shows that the number of muscles that are activated after respiratory events increased significantly during NREM and REM sleep as the arousal levels were elevated (Friedmann tests: p < 0.001). mAR, microarousal. ***p < 0.001 for post hoc Wilcoxon tests. The data are presented by median (minimum - maximum). Please see the results of statistical analysis in the text.
Responsiveness of masseter and anterior tibialis muscles to three types of respiratory events during NREM and REMDuring NREM and REM sleep, masseter (left column) and anterior tibialis (middle column) muscles were activated most frequently when awakenings (AW) occurred after respiratory events; they were activated least frequently when no EEG arousals...
In REM sleep, respiratory events (18.9% [2.4-57.1]; N = 15) were less frequently associated with MAS contractions than in NREM sleep. However, a similar significant difference between the arousal levels was found during REM sleep (Figure 1, Friedman test: p < 0.001): MAS activations became more frequent in association with arousal levels (NA: 0% [0-12.7]; MA: 20.0% [0-100]; AW: 81.8% [0-100]; post hoc Wilcoxon tests: p < 0.001 [N = 15]). AT muscle contraction was scored in 12.5% (0-75.7) of respiratory events. Similar to MAS muscle, the response rate of AT muscle was significantly associated with arousal levels (Figure 1, Friedman test: p < 0.001): the response of AT muscles increased significantly from NA (0% [0-14.5]) to mAR (8.7% [0-94.1]) and AW (85.7% [0-100]) (post hoc Wilcoxon tests: p < 0.001 [N = 15]). The two muscles were activated more frequently with arousal intensity (0.0 [0-0.3], 0.4 [0-1.4], and 1.5 [0-2.0]) (Figure 1, Friedman test: p < 0.001 [N = 15]).
In 19 patients, 36.5 ± 19.3 spontaneous arousals did not follow respiratory events. Of these, the majority (87.5% ± 9.0%) occurred during NREM sleep.
In NREM sleep, the response of MAS activation was significantly increased from spontaneous mAR (29.4% [4.2-92.3]) to AW (75.0% [25.0-100]) (Wilcoxon test: p < 0.001). Similarly, response rate of AT muscles were higher for AW (60.0% [9.5-100]) than for mAR (22.7% [0-87.5]) in NREM sleep (Wilcoxon test: p < 0.001). The number of muscles activated in response to a single spontaneous arousal was higher for AW (1.5 [0.5-2.0]) than for mAR (0.6 [0.1-1.3]) (Wilcoxon test: p < 0.001). The above variables did not differ between spontaneous and respiratory-related arousals for NREM sleep (Table 3).
Motor responsiveness to arousals in respiratory and spontaneous arousals
Due to less frequent arousals in REM sleep than NREM sleep, motor responses to both spontaneous mAR and AW could be assessed in 10 patients only. Similar to NREM sleep, motor responsiveness to spontaneous arousals showed a significant arousal-dependent increase in REM sleep for MAS (mAR: 0% [0- 100]; AW: 100% [50 -100], Wilcoxon test: p < 0.01), while a trend of increase was found for anterior tibialis muscles (mAR: 12.5% [0-100]; AW: 83.3% [33.3-100], Wilcoxon tests: p = 0.035; Table 3). The number of muscles activated in response to a single spontaneous arousal was higher for AW (1.6 [1.3-2.0]) than for mAR (0.8 [0-2.0]) (Wilcoxon test: p < 0.001). As to the comparison between arousal types in REM sleep, the two muscles were not more responsive to spontaneous than to respiratory-related arousals (Table 3). The number of muscles activated was higher for spontaneous AW (1.6 [1.3-2.0]) than for respiratory-related AW (1.4 [0-2.0]; p < 0.0125), while no difference was noted for the response to mAR (Table 3).
The results show that jawclosing muscles are increasingly activated in relation to the duration of arousals after respiratory events during NREM and REM sleep in patients with OSAS. The responsiveness of jaw muscles to arousals after respiratory events did not differ from that following spontaneous arousals. Moreover, the above pattern of motor response did not differ between the jaw and leg muscles. These findings suggest that, in patients with OSAS, MAS contractions after respiratory events are a nonspecific motor manifestation of the arousal response, dependent on the intensity of arousals.
Previous studies have reported that the MAS muscle was occasionally activated after respiratory events; 14.4% to 54.2% of respiratory events were followed by MAS contractions that exceeded to 20% to 40% of MVC of the MAS muscle regardless of sleep stages.3–5 In this study, 32.1% of respiratory events during NREM sleep and 18.9% during REM sleep were associated with MAS activations that exceeded to 10% MVC. Moreover, the majority of MAS activations occurred more frequently after respiratory events with arousal response than those without, as previous studies have also reported for the MAS and other craniofacial muscles.2–4,23 Although previous studies have shown that cardiac arousals without visually detectable EEG changes have been detected after respiratory events,18,21,23,28 these respiratory events were found to be rarely associated with MAS contractions. This is consistent with the findings of the recent studies in which respiratory efforts and electromyography of the tongue muscles were assessed in relation to respiratory events.23,29,30 However, when transient arousals with visually identifiable EEG changes (e.g., mAR, AW) occurred after respiratory events, the MAS was activated. This result supports a previous suggestion of an association between MAS and arousal response.31 In addition, the probability of the activation was elevated, as the duration of arousals increased from mAR to AW. These results suggest that, in patients with OSAS, the responsiveness of MAS contractions after respiratory events is dependent on the intensity of arousal responses, a finding consistent with results obtained in healthy subjects and patients with sleep disorders.3,22,31
MAS muscles were activated more frequently after respiratory events during NREM sleep than during REM sleep in the present study and in previous studies.1,4 This suggests that the threshold for MAS activation is lower during NREM sleep than during REM sleep due to the presence of active inhibition during the latter sleep state.31 In addition, arousal threshold to respiratory disturbance was higher during REM sleep than NREM sleep since a respiratory event of longer duration and larger amplitude of oxygen desaturation are needed to trigger arousals in REM sleep.17–19,21,29,32,33 In this study, submental muscle activation was needed for scoring arousals during REM sleep,25 indicating that the motor system is released from active inhibition during arousals scored. Under such conditions, MAS muscles are activated more frequently in relation to an increase in the arousal duration. This explains why the frequency of MAS contractions after respiratory events was lower during REM sleep than during NREM sleep but the responsiveness to arousals was in a similar range for the two sleep stages.
It has been reported that respiratory effort at the end of a respiratory event is a key factor for inducing arousals and activating respiratory muscles.29,32 However, arousal-dependent MAS contractions are not explained solely by the association between the degree of respiratory efforts in relation to respiratory events, since the motor responsiveness of MAS muscle to mAR and AW did not differ between arousals with and without preceding respiratory events. Since arousals during sleep are not always coupled with respiratory events in patients with OSAS,18,23,28 the lack of difference in motor responsiveness between respiratory-related and spontaneous arousals, suggests that MAS contraction after a respiratory event is dependent on the arousal response rather than respiratory events per se.
Motor responses in both jaw and leg muscles after respiratory events were similarly correlated with an intensity of arousal response. This suggests that the physiological nature of muscle contractions in patients with OSAS is not specific to jawclosing muscle. However, the two muscles are not always activated coincidently after the same respiratory event when mAR was scored. An increase in arousal duration was associated with the elevation of the probability that the two muscles would be activated. This finding is supported by the previous studies showing that, as arousal intensity increases, facilitatory influences spread over more muscles in the body.31,34
There are several limits to interpreting the results of this study. First, respiratory events, transient arousals and motor activity were assessed using visual scoring, according to the criteria used in the clinical setting and previous studies. With visual scoring, a slight increase in muscle tone was not detected in response to arousals.5,31 In addition, subtle EEG changes that can not be detected by visual scoring can be associated with MAS contractions after respiratory events without arousals in this study. Since we could not assess respiratory efforts by measuring esophageal pressure,35 we could not demonstrate how MAS contraction is linked to respiratory efforts when it occurred after respiratory events.36 The present study did not assess all factors influencing the characteristics of apnea/hypopnea events and arousal responses (e.g., age, body position, circadian rhythm, and upper airway resistance).17–19,21,32,37 Although these factors are also associated with the a severity of OSAS patients symptoms, the present study was performed using a small study sample that included mild to severe OSAS. A large inter-individual difference in arousal threshold and motor responsiveness can be associated with the severity of OSAS. We did not demonstrate whether the responsiveness of MAS contractions was modified by the severity of OSAS: we neither recorded control subjects nor assessed the effects of clinical interventions (e.g., CPAP) on the motor responsiveness.38 Obviously, all the above issues need to be assessed in the future studies.
In conclusion, MAS contraction is an orofacial manifestation of a general motor reaction to arousal occurring during sleep in patients with OSAS. Such nonspecific motor activations contribute secondarily to restoration of a compromised upper airway during respiratory events in collaboration with the activation of respiratory-related muscles in patients with OSAS.16,23,29 On the other hand, the results also show that a certain number of MAS contractions can occur in OSAS patients who have neither clinical signs of sleep bruxism nor PSG findings of RMMA. The chance of MAS contractions may be elevated in response to respiratory events and arousals when sleep structure is fragmented by transient arousals in OSAS patients. A recent study showed that an oral appliance cannot reduce some type of MAS contractions (e.g., tonic activation).39 Thus, nonspecific activations of MAS muscle would not disappear even when oral appliance therapy was successfully controlling respiratory events; they occur as an intrinsic response to arousals in OSAS patients. As well, intrinsic response to arousals can be found in the AT muscle in OSAS patients who did not exhibit PLMS. However, such nonspecific activations in jaw and leg muscles would be a confounding factor in scoring sleep bruxism and PLMS and interpreting their impacts of the commorbidity on clinical symptoms (e.g., orofacial pain, sleepiness) in patients with OSAS as well as vairous sleep disorders.24,40
This was not an industry supported study. Dr. Taniguchi has received speaking fees from Sanofiaventis K.K, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited, Eisai Co., Ltd., MSD K.K., and a manuscript fee from Teijin Limited. The other authors have indicated no financial conflicts of interest.
This study was supported by the intramural research funding from Matsumoto Dental University. This work was performed at Osaka Kaisei Hospital (PSG recordings and sleep analysis) and at Matsumoto Dental University and Osaka University (EMG scoring and data analysis). We also thank physicians and technicians at Osaka Kaisei Hospital Sleep Medical Center for generously supporting this project, and Dr. Alice Petersen for editing the manuscript.
Inoko Y, Shimizu K, Morita O, Kohno M, authors. Relationship between masseter muscle activity and sleep-disordered breathing. Sleep Biol Rhythms. 2004;2:67–8.
Okeson JP, Phillips BA, Berry DT, Cook YR, Cabelka JF, authors. Nocturnal bruxing events in subjects with sleep-disordered breathing and control subjects. J Craniomandib Disord. 1991;5:258–64. [PubMed]
Phillips BA, Okeson J, Paesani D, Gilmore R, authors. Effect of sleep position on sleep apnea and parafunctional activity. Chest. 1986;90:424–9. [PubMed]
Sjöholm TT, Lowe AA, Miyamoto K, Fleetham JA, Ryan CF, authors. Sleep bruxism in patients with sleep-disordered breathing. Arch Oral Biol. 2000;45:889–96. [PubMed]
Yoshida K, author. A polysomnographic study on masticatory and tongue muscle activity during obstructive and central sleep apnea. J Oral Rehabil. 1998;25:603–9. [PubMed]
Miyamoto K, Ozbek MM, Lowe AA, et al., authors. Mandibular posture during sleep in patients with obstructive sleep apnoea. Arch Oral Biol. 1999;44:657–64. [PubMed]
Tsuda H, Lowe AA, Chen H, Fleetham JA, Ayas NT, Almeida FR, authors. The relationship between mouth opening and sleep stage-related sleep disordered breathing. J Clin Sleep Med. 2011;7:181–6. [PubMed Central][PubMed]
Clarke NG, Townsend GC, authors. Distribution of nocturnal bruxing patterns in man. J Oral Rehabil. 1984;11:529–34. [PubMed]
Nishigawa K, Bando E, Nakano M, authors. Quantitative study of bite force during sleep associated bruxism. J Oral Rehabil. 2001;28:485–91. [PubMed]
van der Bilt A, author. Assessment of mastication with implications for oral rehabilitation: a review. J Oral Rehabil. 2011;38:754–80. [PubMed]
Kato T, Mikami A, Sugita H, et al., authors. Negative association between self-reported jaw symptoms and apnea-hypopnea index in patients with symptoms of obstructive sleep apnea syndrome: a pilot study. Sleep Breath. 2013;17:373–9. [PubMed]
de Almeida FR, Lowe AA, Tsuiki S, et al., authors. Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome. J Clin Sleep Med. 2005;1:143–52. [PubMed]
Hoffstein V, author. Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath. 2007;11:1–22. [PubMed Central][PubMed]
Kato T, author. Sleep bruxism and its relation to obstructive sleep apnea–hypopnea syndrome. Sleep Biol Rhythms. 2004;2:1–15.
Tsuda H, Almeida FR, Masumi SI, Lowe AA, authors. Side effects of boil and bite type oral appliance therapy in sleep apnea patients. Sleep Breath. 2010;14:227–32. [PubMed]
Hollowell DE, Suratt PM, authors. Mandible position and activation of submental and masseter muscles during sleep. J Appl Physiol. 1991;71:2267–73. [PubMed]
Findley LJ, Wilhoit SC, Suratt PM, authors. Apnea duration and hypoxemia during REM sleep in patients with obstructive sleep apnea. Chest. 1985;87:432–6. [PubMed]
Noda A, Yasuma F, Okada T, Koike Y, Nakashima N, Yokota M, authors. Age related differences in electroencephalographic and cardiac arousal at the termination of sleep apnea/hypopnea. Intern Med. 2000;39:375–80. [PubMed]
Oksenberg A, Khamaysi I, Silverberg DS, Tarasiuk A, authors. Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. Chest. 2000;118:1018–24. [PubMed]
Schwartz DJ, Moxley P, authors. On the potential clinical relevance of the length of arousals from sleep in patients with obstructive sleep apnea. J Clin Sleep Med. 2006;2:175–80. [PubMed]
Dingli K, Fietze I, Assimakopoulos T, Quispe-Bravo S, Witt C, Douglas NJ, authors. Arousability in sleep apnoea/hypopnoea syndrome patients. Eur Respir J. 2002;20:733–40. [PubMed]
Halasz P, Terzano M, Parrino L, Bodizs R, authors. The nature of arousal in sleep. J Sleep Res. 2004;13:1–23.
Jordan AS, Eckert DJ, Wellman A, Trinder JA, Malhotra A, White DP, authors. Termination of respiratory events with and without cortical arousal in obstructive sleep apnea. Am J Respir Crit Care Med. 2011;184:1183–91. [PubMed Central][PubMed]
American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 2007. Westchester, IL: American Academy of Sleep Medicine.
EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep. 1992;15:173–84. [PubMed]
American Academy of Sleep Medicine. International classification of sleep disorders: diagnostic and coding manual, 2nd ed. 2005. Westchester, IL: American Academy of Sleep Medicine.
Kato T, Lavigne GJ, authors. Sleep bruxism: A sleep related movement disorder. Sleep Med Clin. 2010;5:9–35.
Rees K, Spence DP, Earis JE, Calverley PM, authors. Arousal responses from apneic events during non-rapid-eye-movement sleep. Am J Respir Crit Care Med. 1995;152:1016–21. [PubMed]
Berry RB, Gleeson K, authors. Respiratory arousal from sleep: mechanisms and significance. Sleep. 1997;20:654–75. [PubMed]
Younes M, author. Role of arousals in the pathogenesis of obstructive sleep apnea. Am J Respir Crit Care Med. 2004;169:623–33. [PubMed]
Kato T, Montplaisir JY, Lavigne GJ, authors. Experimentally induced arousals during sleep: a cross-modality matching paradigm. J Sleep Res. 2004;13:229–38. [PubMed]
Krieger J, Sforza E, Boudewijns A, Zamagni M, Petiau C, authors. Respiratory effort during obstructive sleep apnea: role of age and sleep state. Chest. 1997;112:875–84. [PubMed]
Muraki M, Kitaguchi S, Ichihashi H, et al., authors. Apnoea-hypopnoea index during rapid eye movement and non-rapid eye movement sleep in obstructive sleep apnoea. J Int Med Res. 2008;36:906–13. [PubMed]
Kato T, Masuda Y, Kanayama H, Nakamura N, Yoshida A, Morimoto T, authors. Heteroge-neous activity level of jaw-closing and -opening muscles and its association with arousal levels during sleep in the guinea pig. Am J Physiol Regul Integr Comp Physiol. 2010;298:R34–42. [PubMed]
Vincken W, Guilleminault C, Silvestri L, Cosio M, Grassino A, authors. Inspiratory muscle activity as a trigger causing the airways to open in obstructive sleep apnea. Am Rev Respir Dis. 1987;135:372–7. [PubMed]
Kimoff RJ, Cheong TH, Olha AE, et al., authors. Mechanisms of apnea termination in obstructive sleep apnea. Role of chemoreceptor and mechanoreceptor stimuli. Am J Respir Crit Care Med. 1994;149:707–14. [PubMed]
Sforza E, Krieger J, Petiau C, authors. Arousal threshold to respiratory stimuli in OSA patients: evidence for a sleep-dependent temporal rhythm. Sleep. 1999;22:69–75. [PubMed]
Haba-Rubio J, Sforza E, Weiss T, Schroder C, Krieger J, authors. Effect of CPAP treatment on inspiratory arousal threshold during NREM sleep in OSAS. Sleep Breath. 2005;9:12–9. [PubMed]
Arima T, Tomonaga A, Toyota M, Inoue SI, Ohata N, Svensson P, authors. Does restriction of mandibular movements during sleep influence jaw-muscle activity? J Oral Rehabil. 2012;39:545–51. [PubMed]
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CERAE Content Experience
The Effect of Global
The Right to Keep Arms and
The life span Cycle: Epigenesis
study proposal part A
CERAE Content Experience
Rape and Hunger Online games
The Effect of Global
The Right to Keep Arms and
The life span Cycle: Epigenesis
study proposal part A
Synopsis of Mr Mon
Synopsis of Mr Mon
Synopsis of Mr Mon
Summary of Mr Wednesday Essay
Summary of Mr. MOM Creator takes various examples to exhibit that men as the principal child-care provider in this culture could cause what sort of comments and effects.…...
901 views | 23.08.2019
Conflicting Perspectives
Conflicting Viewpoints HSC British Essay Snow Falling about Cedars
п»ї Conflicting perspectives are an inevitable a part of human existence as they happen from the complicated interplay of individual knowledge, social and cultural background and influences. Illustrations of these discrepancies are…...
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Culture is defined as a collective product which differentiates one group from one more. It is often utilized to compare individuals from one nation to those of another, as cultures…...
Cpfr as a Approach
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The Lion King: A Hero's Journey A hero endeavors forth through the world of prevalent day in a region of supernatural question. Fabulous forces are there experienced…...


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Words containing aminodies
Found 1 words containing aminodies. Browse our Scrabble Word Finder, Words With Friends cheat dictionary, and WordHub word solver to find words that contain aminodies. Or use our Unscramble word solver to find your best possible play! Related: Words that end in aminodies
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The Cosmonaut: A Wide-Grip Stylus for Touch Screens
Missed out on the Kickstarter campaign? No worries, head to http://studioneat.com/cosmo/ to sign up to be notified when the Cosmonaut becomes available for sale. You can also follow us on twitter (@studioneat) to receive project updates. Thanks!
Hello friends! Thanks for visiting our Kickstarter page for the Cosmonaut, a minimal, wide-grip capacitive stylus for touch screen devices.
The Cosmonaut was born out of our desire to have a really great stylus for our iPads. We love to sketch out quick ideas or doodle on our tablets, and using a stylus is much better than a finger for such tasks. We bought several different models currently available on the market but they all suffered the same problem: they were designed to look and feel like a pen. But why? Writing or drawing on the iPad feels nothing like using a pen or pencil. For one, tablets are ideal for low fidelity sketching. Also, it is pretty awkward to rest your palm on the screen of the device because it throws off the capacitive detection. Writing on a tablet feels like writing on a dry erase board: fast, simple, low fidelity. The perfect tablet stylus is one that feels like a dry erase marker.
Dan created a blog post about this very idea right after our first Kickstarter campaign ended, and quite a few people seemed to be keen on it, so we decided to start designing a solution. After immersing ourselves in research, prototyping, and design iteration, we've arrived at something that we think is pretty great. It's comfortable to hold and effortlessly glides over the glass surface of the tablet. It just feels right.
In returning to Kickstarter for our second project, we wanted to try something different. You may notice that there is only one pricing tier to the right, for $1. That is not a mistake. Inspired by Radiohead, we wanted to try out a pay-as-you-wish pricing model. Pledge whatever value you feel the Cosmonaut is worth to you. A few things to keep in mind:
- There are only 3000 pledging slots available. So, if everyone only pledges $1, the funding goal of $50,000 will obviously not be met.
- The funding goal of $50,000 was arrived at after getting quotes from our manufacturer (in the USA).
- If we meet our funding goal (which would be awesome!) it means we will be able to sell the Cosmonaut in our online store later on. We are thinking it will retail for $25. Perhaps this price can be used as a guide for your own contribution.
- Get them while they're hot! Once the 3000 slots run out, you won't be able to get a Cosmonaut until they become available in our online store. Consider it a limited edition run to test the feasibility of a full scale run.
- Based on the timetable our manufacturer gave us, we should begin shipping the Cosmonauts in June.
- There are two prototypes featured in the video above: a "look and feel" prototype and a functional prototype. We are continuing to refine / improve the design (including the tip) but the final design will have that same form and spirit of the prototypes.
- The Cosmonaut is compatible with any capacitive touch screen device. Eg. iPad, iPhone, iPod Touch, Samsung Galaxy Tab, Motorola Xoom, etc.
This is the first we are aware of a pay-as-you-wish pricing model for a physical, tangible product. We are interested to see how it turns out!
Once again, we can't thank you all enough for your continued support. You are allowing us to continue to do what we love. As always, the Cosmonaut is the labor of love of two individuals, Tom Gerhardt and Dan Provost. We are the two dudes who brought you the Glif just 4 months ago, and are looking forward to another project!
Funding period
- (23 days)


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Special Content: Repraps for EducationThis is part of a series of posts about starting and facilitating a project-based 3D printer club at a local elementary school, with the ultimate goal of replicating the program at schools everywhere. We'll be posting as many details as possible, including lesson plans and supporting materials. For more information about the entire project, including a listing of posts related to it, please visit the 3D Printer Club for Schools project page.
Here's a quick update on some of the projects we've been working on this year:


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This is "Art for the Heart". Each Sunday we create + share a new lock screen for your smart phone or tablet (or both), and/or desktop screen saver, featuring a thought for the week. We access our devices constantly - so that means this is a great way to constantly see God's inspiration & love.
We encourage you to share it with your family & friends on Instagram, Twitter, Facebook, and Pinterest too!
Don't forget to use #HOMWF when sharing Heart of Mary with others :)


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The ENSG forms part of the National Polytechnic Institute of the University of Lorraine. The life of the School began in 1908 with the creation of IGAN (the Nancy Institute of Applied Geology) by René Nicklès.
Major dates in the history of ENSG include:
1938: The position of IGAN Director falls to Marcel Roubault.
1944: By decree of the Minister for National Education, IGAN becomes the École Supérieure de Géologie appliquée et de Prospection minière. The concours system of competitive examinations is introduced for gaining entry to the School programme, which has an academic duration of 3 years.
1948: The School becomes ENSG: the École Nationale Supérieure de Géologie appliquée et de Prospection minière.
1959: Construction of new buildings at the Montet in Vandoeuvre begins, allowing the School to welcome a greater number of students and broaden its activities.
1961: The first group of buildings, the 'Laboratoires de Recherches Géologiques de Nancy-Vandoeuvre' is inaugurated. The Laboratories comprise the Centre de Recherches Pétrographiques et Géochimiques, the Centre de Recherches Radiogéologiques and the Centre de Recherche sur la Valorisation des Minerais.
1971: Construction of a new building: the Centre de Mécanique des sols et des roches (Soil and Rock Mechanics Centre). 1971 is also marked by the formation of INPL (the National Polytechnic Institute of Lorraine) from the merger of five Grand Ecoles: ENSG, ENSAIA, ENSEM, ENSIC and ENSMN.
1992: Students attend their courses at two different sites: Nancy and Vandoeuvre. A reconstruction plan is put in place with a view to constructing additional buildings that will enable all the courses to be taught on a single site.
1998: Inauguration of the new ENSG buildings at the INP site of the University of Lorraine in Vandœuvre.
2008: The ENSG Centenary, celebrating 100 years of the School. With a variety of activities and exhibitions, the centenary is an opportunity for local schools and members of the general public to discover the Geosciences and, through the many industries and ENSG partners present, the different Geoscience-related careers.
2011: ENSG is awarded the status of "Sciences of the Universe Observatory" — Lorraine Earth and Environment Observatory. This status allows the School to carry out observation projects of national interest in the Sciences of the Earth and Universe.
2012: Birth of the University of Lorraine and ENSG's inclusion as an associate member in the Institut Mines-Telecom network.


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S.R. 14, Cedar Breaks, Opens Memorial Day Weekend!
Today May 24th, S.R. 14 is finally opening to allow traffic through to Cedar Breaks abd Duck Creek Village. The Southern Utah community has been looking forward to this since last October when a massive landslide wiped out 800 feet of the popular scenic roadway.
The road will not yet be paved so motorists will be traveling on road base (dirt/gravel) during this time. The road will open at 3:00pm on Thursday, May 24, and will remain open until 7:00am on Tuesday, May 29. After that time, the road will be closed during the day and opened each night from 7:00pm to 7:00am, except on Friday when the road will open at 5:00pm and remain open through the weekend until Monday at 7:00am. This will continue to be the schedule now through the month of July.
Distant view of SR 14 in October 2011.