text:
TriZPUG October 2010 Meeting: repoze.catalog
Chris Rossi will deliver a short demonstration of new functionality in repoze.catalog, a Python indexing and searching framework, as well as a quick introduction to repoze.catalog for those who aren't aware of what it is or why they might want to use it. As always, lightning talks of ten minutes or less on other topics are also welcome. Anything you've learned about Python, no matter how trivial, can be a lightning talk.
For more information, visit
- What
- Meeting
- When
- 2010-10-28 from 19:00 to 21:00
- Where
- Carrboro Creative Coworking, 205 Lloyd Street, Suite 101, Carrboro
- Name
- Chris Calloway
- Contact Email
- firstname.lastname@example.com
- Contact Phone
- 599-3530


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Diamondback 20-60x60 Spotting Scope
Born into the bloodline of our popular Diamondback family, this all-new spotter delivers outstanding performance—clearly a superb choice when you need a heavyweight performer in a light, compact package. The Diamondback optics guarantee a bright image throughout the magnification range and, as true to all Diamondback optics, the rugged construction stands up to rough use in the field.
- Eyepiece cap
- Objective lens cover
- View-through carry case
VIP Unconditional Lifetime Warranty
Optical Features
|Dielectric Prism Coatings
|Multi-layer coatings provide the clearest, brightest, most color-accurate images possible.
|XR Lens Coatings
|Vortex proprietary XR anti-reflective coatings, fully multi-coated on all air-to-glass lens surfaces, increase light transmission for maximum brightness.
Construction Features
|Porro Prism
|Offers maximum image quality and performance in a traditional design.
|Straight Body Design
|Valued for speedy target acquisition and ease of use. Most compatible design for use with car window mounts.
|Optics are sealed with O-rings to prevent moisture, dust, and debris from getting inside the spotting scope.
|Nitrogen gas purging delivers fogproof, waterproof performance.
|Ultra-hard, scratch-resistant coating protects exterior lenses from scratches, oil and dirt.
Convenience Features
|Adjustable Eyecup
|Twists up and down for comfortable viewing with or without eyeglasses.
|Reduces glare and shields the objective lens from raindrops and snow.
|Rotating Tripod Ring
|Allows rotation of the eyepiece to a sideways position—most useful for viewing through an angled spotting scope body on a car window mount.
No posts found

subset: commoncrawl


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Recent News
May 03, 2013
Wisconsin Firm Recalls Frozen Pizzas Due To Possible Foreign Matter Contamination
The Missouri Department of Health and Senior Services received information regarding a recall of Nestlé Pizza Company's frozen pizzas that may be contaminated with extraneous materials.
The following products are subject to USDA recall: [Label]
- California Pizza Kitchen© Limited Edition Grilled Chicken with Cabernet Sauce, UPC 71921 00781; production code is 3059525952.
- DiGiorno© Crispy Flatbread Pizza Tuscan Style Chicken, UPC 71921 02663; production codes are 3057525922 and 3058525921.
Each product package above has an establishment number of P-5754.
In addition, the following products are subject to FDA recall:
- DiGiorno© pizzeria!™ Bianca/White Pizza, UPC 71921 91484; production code is 3068525951.
- California Pizza Kitchen (CPK) Crispy Thin Crust White©, UPC 71921 98745; production codes are 3062525951, 3062525952 and 3063525951.
Small fragments of plastic were found in the CPK Crispy Thin Crust White Pizza. The problem was related to the lot of spinach used in the production of three additional varieties of pizza subject to recall. The fragments are of clear, brittle plastic, in irregular triangles, and may have sharp edges.
All the pizzas being recalled were produced between February 26 and March 9 of this year and shipped to retail establishments nationwide.
The full recall can be found at www.fsis.usda.gov/News_&_Events/Recall_031_2013_Release/index.asp.


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It didn't start pretty for the Chesapeake Bayhawks during Saturday's Major League Lacrosse semifinal at Harvard Stadium in Cambridge, Mass., but a momentum-changing string of four points in 48 seconds left the Bayhawks smiling at the end.
Kyle Dixon, the man dubbed Reggie Miller for his record-holding 28 two-point goals this season, scored back-to-back deuces in the second quarter to rally Chesapeake (11-4) past the Boston Cannons (9-6) with a 16-10 victory.
The Bayhawks will look to become the first team in MLL history to win four league titles as they take the field against the Denver Outlaws (12-3) on Sunday at 3 p.m. Chesapeake last captured the crown in 2010.
"It's a game-changer," Dixon said of the two-point goal, a non-factor in the college game. "And it got some momentum going in our direction. After that, we couldn't miss the net."
The feeling was a welcome one for a team that missed the cage completely on 10 of 17 shots taken in the opening 15 minutes.
At the opposing end, Boston was perfect. The Cannons scored on each one of their five shots in the first quarter, prompting Chesapeake coach Dave Cottle to consider removing goalie Kip Turner, who won an MLL title as a member of the Cannons a year ago.
"After the first quarter, if he didn't start making the save I was going to go to [backup T.C. DiBartolo]," Cottle said.
But Turner, much calmer after finishing the game with 14 saves, laughed it off.
"He better not have thought about yanking me," he said. "Coach tells me every day to fight. I'm going to keep fighting."
Mike Stone, who grew up in nearby Wellesley, Mass., led the way for Boston with two goals and two assists in the first half, and it wasn't until the second quarter that Chesapeake started to struggle against MLL Offensive Player of the Year Paul Rabil.
Rabil, who set the single season points record this year with 72, dished out his second assist on a slick pass that sliced through the heart of Chesapeake's defense and presented Ari Sussman with an easy finish, putting the Cannons up 7-4 with 11 minutes to go in the half.
And while Rabil continued to command defensive attention, the Bayhawks responded by ramping up the physicality. Rabil returned the favor, laying a crushing hit on Michael Kimmel which forced Rabil to spend the next 60 seconds in the penalty box.
With Boston ahead 7-5 and down a man, Chesapeake turned the tables on the defending champs.
Dixon stormed down the field and fired a two-point bullet from outside the arc to even the score, and 48 seconds later he gave the 8,090 fans at the antique stadium an instant replay. With Boston midfielder Matt Smalley backing toward his own goal, Dixon crept forward slowly before firing a quick bullet, again from two-point range, to put the Bayhawks ahead, 9-7.
"I kept watching Smalley's feet and as soon as he hit the line, I pulled up," said Dixon, whose shot has been clocked as high as 104 miles per hour, which he says isn't that fast. "I just get it off really quick. And you can see how important those two-pointers are. That's a huge swing."
Boston coach Steve Duffy said his team couldn't respond after the back-to-back goals by Nixon.
"That was a big momentum switch for them," Duffy said. "That's their game. We tried to fight through it but we weren't able to."
Turner's suddenly exceptional play between the pipes didn't help the Cannons' comeback chances. He made a point-blank save as the horn sounded to end the first half and looked like a different player in the last 30 minutes.
Ben Rubeor also found his groove in the second half, scoring five of his six goals to bury the Cannons in their own backyard.
Dixon leads Chesapeake to MLL championship game with win over Boston
It didn't start pretty for the Chesapeake Bayhawks during Saturday's Major League Lacrosse semifinal at Harvard Stadium in Cambridge, Mass., but a momentum-changing string of four points in 48 seconds left the Bayhawks smiling at the end.


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"This week, I'm going to blow up Nintendo headquarters." This anonymous online message appeared on September 10 of this year. Japanese police moved quickly to find out who was responsible for the threat — as well as other threats to blow up Ise Grand Shrine, one of Japan's most important Shinto shrines.
The police in Mie Prefecture located the computer where the threats apparently came from and brought the 27 year-old man who owned it into police custody. A week later he was released. The man, it seems, was apparently the victim of a computer virus. And it seems he was not the virus' first victim.
According to police reports via NHK, the 27 year-old's computer was infected with a type of computer virus previously unseen in Japan. The virus enabled a third party the ability to control the host computer.
This is apparently what happened to animator Masaki Kitamura, who's worked on a whole host of projects, such as Yu-Gi-Oh! (storyboard), Zone of the Enders: Idolo, Tiger & Bunny (episode director), and Mobile Suit Gundam 00 (storyboard, assistant director, and episode director).
"I will ram into pedestrian paradise, and after stabbing indiscriminately with a knife, I will commit suicide.
In July, a message appeared on the Osaka city inquiry page, which read, "I will commit a massacre in Otaroad next Sunday. I will ram into pedestrian paradise, and after stabbing indiscriminately with a knife, I will commit suicide." Otaroad is in Nipponbashi, Osaka's geek district. It's an area with heavy foot traffic — a pedestrian paradise, if you will. The threat seemed similar to the 2008 attack in Akihabara in which seven people ended up dead and 10 were injured.
This time, Osaka police traced the Otaroad threat and discovered it was from a high-speed wireless LAN device owned by Kitamura, who at the time said, "I have zero recollection of doing this." Japanese police have released Kitamura, after supposedly detecting the same virus that was discovered in the 27 year-old's computer. The assertion is now that his computer could also have been controlled remotely.
As previously mentioned, news reports state that this virus is new to Japan. Authorities are now investigating how both of these computers were infected and how the virus spread, as well as continuing to look for the culprit.
大阪市に殺人予告、第三者の疑い=ウイルス感染で脅迫文言―演出家、無実か [Yahoo! Japan]


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Heliconia - Parque Nacional Carara, Costa Rica (2003)
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LAS VEGAS – Spencer Dinwiddie scored 20 points and Colorado picked up a much-needed win at the Pac-12 tournament, holding off Oregon State 74-68 in the first round Wednesday.
Colorado (21-10) needed a couple of wins in Las Vegas to boost its NCAA chances and got off to a good start by dominating Oregon State defensively most of the second half.
Xavier Johnson had 16 points and Andre Roberson 12 for the fifth-seeded Buffaloes, who moved on to face No. 4 seed Arizona in Thursday's quarterfinals.
Oregon State (14-18), the No. 12 seed, pulled off one of the biggest upsets in Pac-12 tournament history by knocking off top-seeded Washington last year and dimmed Colorado's NCAA hopes with a win in Boulder last weekend.
The Beavers fell short of repeating either performance by struggling against Colorado's defense, hitting 7 of 25 from 3-point range.
Start a dialogue, stay on topic and be civil.
If you don't follow the rules, your comment may be deleted.


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ECB's Draghi Leaves Door Open to Stimulus
Central Bank Holds Rates After Outlining a Raft of Measures Last Month to Boost Euro-Zone Economy
FRANKFURT—European Central Bank President Mario Draghi kept the door open to additional stimulus including large-scale asset purchases if needed to fight excessively low inflation, while rejecting concerns over super-easy monetary policies at the ECB and other central banks. (Follow our live blog).
The ECB also announced sweeping changes to its decision-making and communications, including fewer policy meetings and the publication of meeting minutes starting in January 2015....


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How NFL.com analysts are projecting the first-round picks for the Arizona Cardinals in the 2013 NFL Draft:
Matt "Money" Smith
No. 7: Lane Johnson, OT, OklahomaI wasn't willing to watch them pass on Geno Smith when it looked like Drew Stanton would be taking the snaps this season, but you can sell Carson Palmer to that fan base. Johnson helps to solidify an offensive line that was horrible last season. Get your QB project in the second or third round, or try again next year.
» Full mock draft
Charles Davis
No. 7: Lane Johnson, OT, OklahomaThe star of the NFL Scouting Combine (Big Man category) will help Carson Palmer acclimate quicker, allowing the new QB to find WR Larry Fitzgerald downfield.
» Full mock draft
Daniel Jeremiah
No. 7: Lane Johnson, OT, OklahomaThere has been plenty of chatter about the Cardinals passing on an offensive tackle in favor of a pass rusher. If they decide to go in that direction, Ziggy Ansah and Barkevious Mingo are two names to keep in mind.
» Full mock draft
Bucky Brooks
No. 7: Jonathan Cooper, G, North CarolinaThe Cardinals' trade for Carson Palmer, which likely took them out of the quarterback market in the first round, made rebuilding the offensive line a priority. Cooper is an athletic freak with the talent and skill to become a perennial Pro Bowler early in his career.
» Full mock draft
Akbar Gbajabiamila
No. 7: Lane Johnson, OT, OklahomaArizona's quarterbacks struggled mightily last season, but it didn't help that they were being knocked around all game. The Cardinals' top priority has to be beefing up their protection. Johnson has built a bunch of momentum from the Senior Bowl and NFL Scouting Combine and would be an ideal pick.
» Full mock draft
Gil Brandt
No. 7: Lane Johnson, OT, OklahomaThe fast-rising prospect has been one of the surprises of the pre-draft season. The funny thing was, for some reason, there weren't any offensive line coaches at Oklahoma's Pro Day to work him out. I can't figure out why that happened. The Cardinals could also opt for a quarterback.
» Full mock draft
Charley Casserly
No. 7: Barkevious Mingo, DE, LSUThe Cardinals fill a huge need with an outside pass rusher and take a quarterback later in the draft.
» Full mock draft
Josh Norris
No. 7: Luke Joeckel, OT, Texas A&MWith the moves this team made at the quarterback position, some pass protection is an obvious fit.
» Full mock draft


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Who doesnt love a portable party? Bring the bar wherever you are with this bar cart, founded atop caster wheels for must-have mobility. Crafted from iron, its frame features a tubular design that connects to two handles, making movement a cinch. Its three oval tiers are crafted from wood, and provide the perfect place to perch glasses, cocktail mixers, and more as you greet guests all around your next party. Frame Material: Metal Overall: 30 H x 26 W x 16 D Overall Product Weight: 16.37 lb. Total Weight Capacity: 100 lb.
Everyone know bar cart is a good product. Many peoples are waiting to buy Three Posts bar cart with special discount price. Many peoples prepare to buy bar cart on winter or special event times But Many peoples don't know bar cart may be out of stock soon Today you should to check amount product in stock to buy Three Posts bar cart before it was out of stock. Have you noticed that the Dining Room or Dining Room that looks bright and tasteful is sometimes not the place to buy Leslie Bar Cart by Three Posts, chic design and style in one style only. Matching the opposite or the unlikely together is part of making the room look as good as it looks. For beginners, this would be confusing at the time of purchase. Today we take a look at the opposite pairing process to check the list of efficient shopping next time than to know the color. Knowing the color tone is very important to choose the right pair. We usually divide the color into two tones: hot tones and cool tones. Cool colors are black, blue, purple, blue, green, green, light green and yellowish green. The hot colors are yellow, orange, yellow, orange, red, and magenta. The middle colors are black, white, and brownish gray, resulting in the opposite coloration in the same ratio. Choose the right color Color is the first thing we often confuse to buy bar cart first. You sometimes think of colors like one, but the furniture in the market is another color. So before you start coloring. First, choose the main color scheme. I would like to appear in a room 3, 4, or 70% of the room before the principle of color choice is not difficult. The overall tone is usually cool. Let's see what color you like, your style, or your wall as a whole. You like the modern style, you can choose the main color tone is white, gray, black, blue or you like the vintage. It may be black, brown, sweet like a white tone, pastel cream like the natural selection of brown beige, so fill the opposite color. In fact, the opposite pair of colors has a simple observation principle. It looks completely different, such as white - black, blue - red, yellow - blue, orange - black. The fact is, we do not rely on the hot color match with that cool tone. Just like the feeling is enough. The technique is to try to fill in the opposite color. By more than 30% of the room. Let's see some interesting colors here! Three Posts bar cart Orange is a color couple that gives a modern, modern feel. Try to color the main furniture is white, gray and black and add a little orange to add a freshness to the Dining Room. May be mixed with the opposite orange color, such as blue indigo, etc. Three Posts bar cart Yellow is very good with black tone. Yellow color will drive the black. The dark blue tone may be added a bit. Three Posts bar cart Red is a color scheme that requires extreme care in decoration. I would recommend using a red color that is not too fresh for the beginner. Red is a very noticeable color scheme, so it does not need to be used much.
Customer Reviews
Value Quality Price
ExcellentSleeping depends on many factors, whether it is comfort. Stress level Or even the room temperature. But wait! The most important thing to overlook is the bed and the Dining Room which will make you sleep and rest fully! For those who are deciding to buy a bed and the Dining Room , yes, the Index Living Mall has some simple tips. You will not be disappointed! Get started with the brands and stores you dream of. Of course, that style is number 1 and comfort is followed closely by the change of mind in the soft bed. If you exceed the budget. Look for stores and brands that you like, maybe he can help you find your dream bed in the budget you have! Do not look at the eyes to try to sleep. Bedding is not just for comfort. If it is possible, try to sleep to see if you like it. You sleep alone or lie with your partner. If you sleep with your partner, you must choose together to ensure that the bed is large enough. Check that the thickness is good. And most importantly, try to match the design of the bed will work very. Do your homework by checking the size of the room before. The size of the bar cart will depend on the size of the bed and the size of the Dining Room if you do not check the size of the bar cart . The time it takes to actually place it may be too large or too small to look unbalanced. Do not forget to check other furniture sizes. The size of the bed is standard from the Twin Size (3.5 X 6.5 feet) Queen (5 X 6.5 feet). Size King (6 X 6.5 feet). The level of comfort is 40-45 centimeters, but if you like the style of a mini will choose a little mattress. The design of the bed we may choose from the material we are satisfied. If it is a wooden bed, it will make you feel warm. Fabric bed cool Elegant leather couch for easy cleaning Steel durable and classic. Pay attention to beds with drawers or storage. The bar cart should be the most comfortable room to fully relax. A bed can help you keep your clutter free. Beds with drawers and storage are very useful for limited spaces. And even if there are Dining Room stores to back up, it would be very good to invest in Dining Room healthy. Sleeping devices are very important for sleep. So, invest with Dining Room to help you with your health. Dining Room Healthy spring back and many types to choose from. Before making a purchase, check out the various websites. Help in making good decisions.
Value Quality Price
AmazingIf you are a collector, and also enjoy Dining Room matches that are exciting. Sometimes you may find that the home is full of many nationalities who come together without knowing it. We know that one of the rooms suitable for storing or displaying chic pieces is inevitable in bar cart or bar cart . What if your bar cart has limited space? This is fun ideas. For the bar cart can show and look clean with the same time better. The room is decorated in soft colors. For this, whether it is a bar cart or any room. At home, it can be used together and use the tone. Light or medium color in the bar cart will make you feel relaxed. Take a look at the natural color of the wood, bare or white, select the shelves to control the wall. For bookshelves or bookshelves, it is best to choose the same color as the wall or to control the tone in the same direction. Use transparency to help. Choose a room with a lot of light or a room with mirrors. Dining Room with transparent components. Like a coffee table Sofa or armchair Or a layer decorated with acrylic or clear glass, it makes the room look very airy. Group of decorations in the same style close together. Frame may be grouped. Collectors or decorations of the same style are placed near each other to help increase the space used in other parts, such as bringing the picture frame or decoration together. Use carpets to attract attention. Instead of choosing a distinctive sofa. I try to use carpet as a hero, it is not good. Because adding a color to the room will make the room look boring. But the time did not look, we are still airy. Refreshing with tree size. For a small room If there are trees or flowers decorated in various angles. It will be very refreshing. Should be selected in the right size. Put a flower on a flower vase on a vase. Or choose a room with bonsai. The height of the tree may be chosen as the main form. With mirror Add dimension to the room to see a lot. It should be a mirror that reflects the image is not fooled. It should be cleaned often, not too close to the mirror too close to the mirror to make it more cluttered. Use Dining Room to benefit many. If your sofa is a design that can store. Or the closet to open the show when needed, it will help the bar cart look up immediately. Choose your dress with the wall. Do not leave the wall open. Try to decorate the wall with the floor can be displayed. Choose Dining Room to move easily. Take a look at Dining Room with wheels for easy mobility or Dining Room that can be folded. If you need space to do something else.
Value Quality Price
NicelyThis is such a great and delicate bar cart. It's very pretty. I purchased one for myself and my friend. I would definitely recommend this product if you're in the market for a cute bar cart. great gift for any age! it looks a little cheap but still very cute!
How to Buy Bar Cart
Because Bar Cart can impact your health, your comfort, and your efficiency, it can change your life. While this realization can make buying Bar Cart a bit challenging, it is essential. You want to buy Leslie Bar Cart by Three Posts that fits, supports and enhances the way you live. If you are new to buying Bar Cart or have discovered that the furniture you have isn't helping you, here are some suggestions:
- You Need to Ask Yourself These Questions Before You Buy Anything
- Find Your Style
- Buy the Greenest Bar Cart
- Judge Bar Cart Quality Like a Pro
- Check Wood Furniture for Quality
- Avoid These Top 10 Bar Cart Buying Mistakes
- Be More Knowledgeable About Fibers


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Biz and Theresa remember back to what it was like celebrating Mother's Day as kids. In retrospect, Mom may have gotten a raw deal, including having to share her dime-store, rock-hard but selected-with-love, chocolates. Plus, we talk about introducing solids and wonder if anyone cares what we feed our kids. Eleni Mandell returns to talk about her new album, "Let's Fly A Kite," and about touring with 3-year-olds (it's apparently super).
Subscribe to One Bad Mother in iTunes
Join our mailing list!
Follow One Bad Mother on Twitter
Follow Biz on Twitter
Follow Theresa on Twitter
Check us out on Facebook and like us!
Share your genius and fail moments! Call 206-350-9485
The new album: Let's Fly a Kite
Follow Eleni Mandell on Twitter @EleniMandell
Show Music
Opening theme: Summon the Rawk, Kevin MacLeod (incompetech.com)
Ones and Zeros, Awesome, Beehive Sessions (http://awesomeinquotes.com, also avail on iTunes)
Mom Song, Adira Amran, Hot Jams For Teens (www.adiraamram.com, available on iTunes)
Like Dreamers Do, Eleni Mandell, Lets Fly A Kite (http://elenimandell.com, also avail on iTunes)
Closing music: Mama Blues, Cornbread Ted and the Butterbeans (www.cornbreadted.com)


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Overview of Governance Resources
The Governance pages describe how we work and what we're working on. Pages below contain links to features identified for current and near term development.
Current Activities
We track scheduled and near term work in JIRA. See the Current Activities page for our high level priority areas and for links to what we are actively developing and what items have been identified for completion by the next release of GMAT.
Ticket System
We use JIRA as a bug database, and as a tracking tool for scheduled work. Below are links to items such as guidelines for when and how to submit a ticket and how we schedule and track work items.


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Somewhere on this blog I mentioned my dis-interest in pre-season Minnesota Wild games...although the games do NOT get us any closer to the Stanley Cup, I decided this pre-season is rather attractive thanks to the hot match-ups…Jets, Penguins, Blues - I love to hate those teams and look forward to buying a cheap ticket to see them at Xcel. A regular season ticket for those match-ups is twice as expensive.
Just look at the prices on Ticket King for
I am for sure buying a pair of the cheap Minnesota Wild tickets and going to lace up one of my Wild jerseys and cheer on the team …. For a moral victory of course and maybe to see a fight.


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Responsible for the design and development of voice, video, radio-frequency, and/or data communications networks.
1. Analyzes voice, video, radio-frequency, and/or data communications networks, including planning, designing, evaluating, selecting, and upgrading operating systems and protocol suites and configuring communication media with concentrators, bridges, and other devices.
2. Plans network layouts and configures systems to user environments.
3. Analyzes network topologies and traffic and capacity requirements.
4. Supports the acquisition of hardware and software as well as subcontractor services as needed.
5. May provide technical support and troubleshooting to users.
6. May perform network administration duties.
7. Provides guidance and work leadership to less-experienced network personnel and may have supervisory responsibilities.
8. May serve as technical team or task leader.
9. Maintains current knowledge of relevant technology as assigned.
10. Participates in special projects as required.Education
Bachelors Degree in Computer Science, Engineering, or a related technical discipline, or the equivalent combination of education, technical certifications or training, or work experience.Qualifications
8-10 years of directly related experience in network analysis and design.
As a trusted systems integrator for more than 50 years, General Dynamics Information Technology provides information technology (IT), systems engineering, professional services and simulation and training to customers in the defense, federal civilian government, health, homeland security, intelligence, state and local government and commercial sectors.With approximately 32,000 professionals worldwide, the company delivers IT enterprise solutions, manages large-scale, mission-critical IT programs and provides mission support services.GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.


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If you are a subscriber to the JCSM (including members of the AASM), please login to access the journal.
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Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership
Attended polysomnography (PSG) is a common procedure and is regarded as relatively safe. There have been few systematic evaluations of adverse events occurring during PSG. An understanding of the frequency and type of the adverse events during PSG should inform risk mitigation plans and the development of guidelines for sleep center accreditation. We aimed to identify, tabulate, and classify all adverse events that occurred during overnight PSG conducted at an accredited sleep center over a five-year period.
All adverse events occurring from Jan 1, 2005, to Dec 31, 2010, at the Center for Sleep Medicine, Mayo Clinic, were identified. Information was collated from calls made to emergency responders, to the adverse event reporting system, and events forwarded to the medical director.
A total of 36,141 PSGs were performed over the study duration. Fifty-eight adverse events occurred during the study period (1 event/623 PSGs). Most adverse events were cardiac in nature (17/58; 29.3%), a majority involving acute chest pain. Falls were the next most common (20.6%), followed by neurologic (8.6%), pulmonary (3.4%), and psychiatric (3.4%) events. The rest were classified as miscellaneous.
There were no patient deaths during PSGs. The majority of patients experiencing an adverse event were transported to the emergency room (37/58; 63.79%). Of these, 15/37 (40.54%) were admitted to the hospital, and 3 required an ICU bed.
Adverse events during a PSG were relatively uncommon. Previous emphasis on cardiac arrhythmias may be overstated, as chest pain and patient falls were commonest and resulted in hospitalization more often.
Kolla BP; Lam E; Olson E; Morgenthaler T. Patient safety incidents during overnight polysomnography: a five-year observational cohort study. J Clin Sleep Med 2013;9(11):1201-1205.
An influential report issued by the Institute of Medicine in 1999, "To Err is Human," launched an era of unprecedented activity to improve safety in the American hospital.1 Only more recently has attention been turned to a more keen understanding of outpatient safety.2 Given that there are more than 300 outpatients for every one inpatient encounter, the almost exclusive focus on the inpatient environment for improving patient safety may be likened to looking for keys lost in the dark part of the parking lot under the streetlamp on account of the improved lighting conditions.2
Polysomnography (PSG) is a method of recording and analyzing physiologic measures associated with sleep and breathing in patients with sleep diseases. In clinical practice, it entails attended monitoring of sleeping patients, often with purely diagnostic intent, but since approximately 85% of tested patients are suspected of having sleep-related breathing disorders, PSG oftentimes is performed during the introduction of positive airway pressure (PAP) or other treatment modalities. In many ways, this monitoring, measuring, and interpreting physiologic signals is an activity that resembles those performed in "observation" areas used by some emergency centers or inpatient settings, with a few seminal differences intended. First, sleep centers generally intend to evaluate patients who are considered medically stable other than their sleep diseases, rather than those who have presented with chiefly acute medical illnesses. Secondly, sleep studies are attended by sleep technologists or respiratory therapists, not registered nurses or physicians, as one finds in the acute care setting. Finally, and importantly, PSG is not uniformly provided in settings equipped for ill or infirm patients. Instead, polysomnography may be performed in facilities inside a hospital, those that are adjacent to an acute care facility, or those operated as independent testing facilities, not attached to any other medical care facility. Less than half of such facilities (2,415 centers as of 2011) are accredited by the American Academy of Sleep Medicine (AASM), and only a few hundred are accredited by The Joint Commission (TJC). The rest are without known accreditation, and are therefore without any known safety standard requisites.
Current Knowledge/Study Rationale: Although polysomnography is a common medical procedure performed in various settings across the United States, there is very little known about the breadth of patient safety issues encountered during polysomnography. This study sought to catalogue the variety of patient safety incidents encountered during over 36,000 consecutive attended polysomnography tests at a single integrated academic medical center.
Study Impact: We found that patient safety incident occurred in 1 of every 623 polysomnograms, and that chest pain, falls, and acute neurological events were the most common. These findings suggest that future emphasis on improving patient safety be oriented towards fall reduction, ensuring access to timely evaluation of acute medical problems, and thorough medical evaluation prior to PSG.
The number of PSGs performed in the United States was estimated to be around 1.17 million in 2001, and more recent estimates indicate the number may have quadrupled concurrently with an increase in annual Medicare payments for PSG from $62 million to $235 million from 2001 to 2009.3,4 Thus, it is surprising that with almost certainly more than 4 million PSGs performed in varied settings annually, we have scant information about the safety of sleep studies and sleep centers. Thus far, a single multicenter study sought to quantify the frequency of predominantly cardiac events during polysomnography,5 but to our knowledge, there are no published studies tabulating the wide range of patient safety incidents that may occur. We sought to examine and classify all identifiable patient safety incidents occurring during overnight stays at our accredited sleep center over a five-year period.
We identified all reported safety incidents occurring at the Center for Sleep Medicine, Mayo Clinic, Rochester, MN, between Jan 1, 2005, and Dec 31, 2010. Safety incidents were defined as any patient safety concern that was reported to the medical director, the institutional safety "event line," or events that resulted in summoning emergency medical personnel or that resulted in the patient being transferred to the emergency department.
Over the study period, safety incidents were recorded in several different databases: emergency call logs, safety event database, and the medical director's concern log. First, we searched the log of all calls made to emergency responders during the study duration. During the initial portion of the study, the sleep center was located inside the hospital facility, and critical care physicians who were on call from the critical care unit provided emergency coverage. Calls for assistance to these physicians were recorded in the health record, but not in a separately indexed database. However, in 2008 the sleep center moved to an outpatient setting, and emergency coverage was provided by emergency medical technicians summoned using standard emergency medical services (EMS). All calls made to the emergency medical technicians were recorded at a central repository, and this was accessed to obtain information regarding adverse events occurring during this study period. For patients who were hospitalized, information regarding their hospital course was obtained.
At our institution, during overnight PSG, when sleep technologists encounter cardiopulmonary arrest CPR is commenced, the code team alerted and the medical director is notified. In cases where tachy/bradyarrhythmias with clinical symptoms of chest pain/pressure, dyspnea, syncope/pre-syncope are encountered, the emergency medical response team and the medical director are notified. With sinus arrest > 3 seconds or ventricular tachycardia coinciding with oxyhemoglobin desaturation, nasal CPAP is commenced and the medical director notified.
In addition, in accordance with our institutional policy, patient safety events such as medication errors or falls were reported via an "event line" phone call and stored in a central adverse event database. Finally, consistent with policy and accreditation standards, PSG technologists reported all complications to the lead technologists in the morning following the study, and adverse events were then forwarded to the Medical Director of the Center for Sleep Medicine, Mayo Clinic.
All of the databases were queried to identify safety incidents. Only incidents occurring during the overnight stay in the sleep center were included. For the study purposes, this included events occurring from the time patients presented to the sleep lab reception area at night until they were discharged the following morning. Once identified, the medical records were then reviewed to obtain further information regarding any emergency care including whether they were transferred to the emergency department (ED), care received in the ED, if patients required hospitalization, and any pertinent details from their inpatient course if admitted.
The safety incidents were classified into cardiovascular, neurological, pulmonary, psychiatric, falls, and other miscellaneous events. For patients suffering a fall, information regarding hypnotic administration during the PSG and whether fall precautions were in place was obtained. Any injuries resulting from the fall were clarified upon review of the medical record. The study was approved by the Mayo Clinic Institutional Review Board (IRB 12-000494).
During the study period, a total of 36,141 PSGs were performed at the Center for Sleep Medicine, Mayo Clinic, Rochester, MN. During this time period, a total of 111 calls were made to the emergency medical services. Thirty-nine adverse events were reported to the safety event line, and 27 events were reported to the medical director of the sleep lab (Figure 1).
Flow of patient related safety events January 1, 2005-December 31, 2010
(more ...)
After excluding duplicates and events that did not occur during the overnight stay in the sleep center, there were a total of 58 adverse events during the study period. Eighty-five events that occurred during the day while the patients were being evaluated in the sleep clinic (not during PSG) were excluded from evaluation. The rate of adverse events was 1 event per 623 PSGs. Of the adverse events reported, the majority (17/58; 29.3%) were cardiovascular in nature. Falls were the next most frequent adverse event reported (12/58; 20.7%), followed by neurological (5/58; 8.6%), psychiatric (2/58; 3.4%), and pulmonary events (2/58; 3.4%). The rest of events were classified as miscellaneous (20/58; 31.6%; Table 1).
All patient related safety events occurring during the study period
Of the cardiac events, the majority involved chest pain (12/17). Arrhythmias accounted for 4/17, and the remaining patient suffered cardiac syncope. The majority of patients who experienced a cardiac event were transferred to the ED (15/17). Seven of these patients were admitted to an inpatient service. None of the patients who developed chest pains were found have suffered a myocardial infarction. The arrhythmias noted were sinus tachycardia (1 patient), bradycardia with Mobitz II block (1 patient), and atrial fibrillation (2 patients). Atrial fibrillation was complicated by the development of rapid ventricular rate in one patient and a variable AV conduction block in another.
A substantial number of patients who sustained a fall during their overnight PSG received zolpidem, which was prescribed by the sleep provider, during the sleep study (41.6%). Seven of the patients who sustained a fall were on fall precautions (58.3%) as requested by the physician ordering the sleep study. Apart from two instances of minor skin bruising and knee discomfort that did not require further attention, the rest of the patients did not sustain serious injury following the fall. Two patients who sustained a fall were transported to the ED; neither was admitted.
The neurological events consisted of 2 instances of syncope, one of a seizure, and one patient who suffered a transient ischemic attack (TIA). There was also one instance of a patient with a severe headache who was found to have meningitis. The patient who developed a seizure during the PSG had a prior history of seizures. Four of the 5 patients with neurological events were transported to the ED; 2 of these patients were admitted. The patient with meningitis required ICU care.
Two patients experienced pulmonary adverse events during the study period. One developed dyspnea and another had hemoptysis. Both were transported to the ED and the patient with dyspnea was found to have pneumonia and was admitted to an inpatient bed.
Among patients who experienced psychiatric adverse events, one had a psychogenic seizure-like spell and another had an episode where they refused to open their eyes or respond to gentle stimulation. This was later characterized as psychogenic coma (DSM IV TR diagnosis of dissociative disorder NOS). This patient was transported to the ED and was admitted to an inpatient psychiatric service. The patient had no prior psychiatric history and was being evaluated for spells at the time of the PSG.
There were a total of 20 events we classified as miscellaneous. Fourteen of these patients required an ED evaluation, and 5 of these patients were hospitalized. Among the miscellaneous events, two patients experienced epistaxis during PSG. One patient had a prior history of nosebleeds and developed epistaxis after the application of PAP. The other patient had undergone an ENT surgery 2 weeks prior to PSG, and PAP was not applied during the sleep study. In both instances the patients required ED evaluation where nasal packing was applied; neither patient was admitted.
There were two instances of hyperglycemia occurring in patients who had a previous diagnosis of diabetes mellitus. Both these patients required an ED evaluation and an inpatient admission. One of these patients was admitted to an ICU as they developed diabetic ketoacidosis. There were also two instances of parentally delivered physical child abuse recorded during the study period. As all PSGs at our center have video monitoring, these instances were captured on video and documentary evidence was present for these episodes.
Among the other adverse events, one patient developed sepsis. This patient had undergone a PSG that revealed complex sleep apnea and was asked to return for a repeat overnight PAP titration. The patient in the interim underwent a bone marrow biopsy on the day of the titration study. The patient was found to have tachycardia and altered mental status at the sleep center and was transferred to the ED and required an admission to an ICU bed. Another patient who had a recent urethral stent placement developed significant hematuria requiring an inpatient admission and blood transfusion.
A patient developed significant dehydration resulting from a medication error; the patient's son administered the wrong dosage of medication resulting in aggressive diuresis. This patient required inpatient admission to correct an electrolyte imbalance. Other miscellaneous adverse events included a foot laceration following an injury sustained by a patient who cut himself on a piece of broken glass in the shower after his PSG was completed. The other adverse events included an instance of a broken Hickman catheter, severe nausea, vaginal bleeding and one instance where the PSG had to be canceled in a pediatric patient as no guardian was willing to stay overnight with the patient.
In our five-year retrospective review of sleep center overnight stays, adverse events were infrequent, occurring at a rate of at one event for every 623 PSGs. The majority of adverse events were cardiac in nature, followed by falls. The majority of the patients experiencing an adverse event were transported to the ED, and 41% of the patients transported to the ED were admitted to an inpatient setting. There were no deaths at the sleep center during overnight PSG.
Prior research into the adverse effects associated with undergoing a PSG is extremely limited. The only previous study examined reports from multiple sleep centers in 4 states, and defined adverse events as "those requiring immediate medical attention (physician call or emergency room evaluation)" or arrhythmias found by re-scoring teams.5 In that study of 16,084 PSGs, there was one fatality from sudden cardiac death that was preceded by polymorphic ventricular tachycardia and subsequently ventricular fibrillation, 1 case of dyspnea with chest pain, 27 cases of arrhythmias prompting the PSG technologist to request immediate medical attention, and 28 cases of complex ventricular arrhythmias discerned on subsequent review of the PSG, apparently without symptoms. In their study, the event rate was 0.35% and there was 1 death. In our study, we found an overall event rate of 0.16% and no deaths. We also found comparatively fewer arrhythmias. There are several reasons we may have differing rates of adverse events. The definition of a serious adverse event in the Mehra study differs slightly from that of "safety incidents" in ours. The nature of their definition might make low harm level events or near-miss events less likely to have been reported in their study in comparison to ours. In Mehra et al., the technologists were sensitized by the sudden death that occurred early in the study period, and were instructed to be particularly vigilant in arrhythmia reporting. In addition, because the enrolled patients were part of a multicenter study, all PSGs were later reviewed independently, likely resulting in complete ascertainment of all cardiac rhythm abnormalities. Their results may therefore exhibit some degree of observer-expectancy effect. In contrast, at our center more stable arrhythmias such as the development of atrial fibrillation or non-sustained ventricular tachycardia would have been noted by the sleep specialist, but not necessarily reported as patient safety incidents. Therefore, our data underreport the frequency of cardiac arrhythmias during PSG. However, the main focus of our study was to learn about the range of patient safety incidents incurred during an overnight stay in the sleep center; stable arrhythmias, many of which are occurring most nights of the patient's life, may not be of primary interest.
In our retrospective review, falls were the second most common adverse events. Twenty-five percent of patients who sustained a fall required an ED evaluation, fortunately not leading to serious injury, but resulting in increased healthcare expenditure. This represents an opportunity for improvement. The literature reports that 60% of falls happen in homes, 30% in the community, and only 10% in institutions. Nonetheless, in hospitals, patient falls are a leading cause of death for those over 65 years of age, and are among the commonest adverse events reported. Total fall injury costs for those over 65 years old have been estimated at $27.3 billion, and some estimate that by 2020 cost of fall injuries may exceed $43.8 billion.6 National efforts are focusing on the reduction of injurious patient falls to reduce morbidity, mortality, and healthcare costs.7 Our sleep center long ago instituted on the PSG order sheet an opportunity for the sleep specialists to request "fall precautions." Though the majority of patients who fell were placed on fall precautions by the ordering physicians these precautions did not appear to prevent these patients from falling. Patients on fall precautions are routinely assisted with ambulation down the hall and to the toilet, and are often provided with bedside urinals. However, our sleep technologists have not received the same fall mitigation education that our inpatient nurses receive, nor are patients and their families routinely educated in the sleep center regarding potential fall risks. In addition, 5 of the 12 patients who fell received zolpidem, which was prescribed by their sleep provider to ensure adequate amount of sleep was obtained on the night of the PSG. As most patients were instructed to continue on their home medication regimen, other patients might have self-administered hypnotic agents, but information regarding this was not available. Zolpidem has been shown to be associated with an increased fall risk in hospitalized patients, and as patients undergoing PSG might have significant medical comorbidity this prescription practice might need further evaluation to ascertain whether it might result in an increased number of falls in sleep centers as well.8
Three of our patients required hospitalization to an ICU setting. These included a patient who developed serious headache and had developed meningitis, a patient who developed sepsis, and another patient with a prior diagnosis of diabetes who developed ketoacidosis. While the patient who developed ketoacidosis was seen in evaluation on the day of the PSG, there was a lag of a few days between the evaluation and night of PSG in the other two patients. An evaluation by a medical provider closer to the date of the PSG might have resulted in these conditions being picked up earlier, avoiding the necessity of a transfer to the ED and an ICU admission.
Patients who were evaluated at the Center for Sleep Medicine and were thought to a have a high probability of having seizures were referred to the Epilepsy Monitoring Unit for further evaluation, likely resulting in the low number of adverse events related to seizures in our sample.
In our series, we discovered two instances of physical child abuse, which were captured on video. Sleep labs provide a unique opportunity and environment in which interactions between parents and children and also between caregivers and vulnerable adults can be assessed. Most sleep labs also use videography during the PSG, which provides objective evidence of these interactions. Sleep laboratories will need to consider policies regarding how the staff would ensure patient safety, clear guidelines for intervention during the study in case of concern about abuse, and their role in reporting these events to local protection services. The two cases in our series were reported to child protection services and video evidence was cited in the reporting.
Sleep center accreditation strives to improve quality and safety of patient care. Considering the prominence of cardiac-related events, the recognition and response to cardiac arrhythmias in real time requires adequately trained and attentive personnel and appropriate monitoring equipment. The AASM center accreditation standards specify sleep technologist training and job descriptions along with ongoing tests of signal recognition as well as some minimum patient-to-technologist ratios to enhance monitoring. Additionally, the AASM accreditation is quite specific regarding quality of monitoring equipment. The Joint Commission accreditation is somewhat less specific regarding qualifications for sleep technologists, does not specify a staffing level, and does not specify type or quality of monitoring equipment. Both sets of standards address the physical plant of the sleep center, though the AASM standards are far more prescriptive. However, neither accreditation designates fall risk mitigation standards. Other important patient safety concerns, not reported in our series (and not specifically addressed in the AASM accreditation) regards infection control efforts, medication safety (specifically medication control), and patient security. There is room for improvement in current accreditation standards.
In recent times, home sleep testing is being used increasingly, especially in patients with a high pretest probability of having sleep apnea and those without major medical comorbidities. In relation to the adverse safety events associated with PSGs, home sleep testing might result in a decrease in falls and other injuries occurring at the sleep center. However, other events such as cardiac arrhythmias and seizures might be missed.
We tried to capture all the safety incidents that occur during overnight PSG. We were able to collect information from multiple sources ensuring that all voluntarily reported safety incidents were identified. We also were able to access information regarding the outcome of the ED visit and the course of the inpatient stay. However, our study must be viewed in light of some of the limitations inherent to a retrospective review and voluntary reporting. We relied on voluntary reports, which are only one source of patient safety information. Some estimates suggest that such voluntary reporting systems account for less than 10% of all safety incidents that occur in the acute care setting.9,10 Learning about safety incidents via patient reports, via office of patient affairs, surveys, audits using "trigger tools" or random review, and automated review of electronic medical records are all tools that have been more fully developed in the inpatient safety programs, but not yet systematically applied in outpatient venues.
Our retrospective review of 36,141 PSGs revealed that adverse events during a PSG were relatively uncommon, and a minority of these requires hospitalization. Previous emphasis on cardiac arrhythmias may be overstated, as chest pain and patient falls were commonest and resulted in ED evaluation/ hospitalization more often. A small number of adverse events could have been anticipated and likely prevented if patients at risk were identified and medical personnel evaluated these patients prior to the PSG.
This was not an industry supported study. The authors have indicated no financial conflicts of interest. This manuscript does not discuss any off-label or investigational procedures.
Kohn LT, Corrigan J, Donaldson MS, et al., authors. To err is human: building a safer health system. 2000. Washington, DC: National Academy Press.
Wynia MK, Classen DC, authors. Improving ambulatory patient safety: learning from the last decade, moving ahead in the next. JAMA. 2011;306:2504–5. [PubMed]
Office of Inspector General Work Plan, Fiscal Year 2013: Department of Health and Human Services. 2012.
Tachibana N, Ayas NT, White DP, authors. A quantitative assessment of sleep laboratory activity in the United States. J Clin Sleep Med. 2005;1:23–6. [PubMed]
Mehra R, Strohl KP, authors. Incidence of serious adverse events during nocturnal polysomnography. Sleep. 2004;27:1379–83. [PubMed Central][PubMed]
Englander F, Hodson TJ, Terregrossa RA, authors. Economic dimensions of slip and fall injuries. J Forensic Sci. 1996;41:733–46. [PubMed]
Centers for Medicare & Medicaid Services, Partnership for Patients. About the Partnership. What the Partnership Is About. Accessed Oct. 7, 2013. http://partnershipforpatients.cms.gov/about-the-partnership/what-is-the-partnership-about/lpwhat-the-partnership-is-about.html.
Kolla BP, Lovely JK, Mansukhani MP, et al., authors. Zolpidem is independently associated with increased risk of inpatient falls. J Hosp Med. 2013;8:1–6. [PubMed]
Christiaans-Dingelhoff I, Smits M, Zwaan L, et al., authors. To what extent are adverse events found in patient records reported by patients and healthcare professionals via complaints, claims and incident reports? BMC Health Serv Res. 2011;11:49. [PubMed Central][PubMed]
Sari AB, Sheldon TA, Cracknell A, et al., authors. Sensitivity of routine system for reporting patient safety incidents in an NHS hospital: retrospective patient case note review. BMJ. 2007;334:79. [PubMed Central][PubMed]


text:
In the last week, anger at the BP oil disaster has begun turning into action. Here are some of the things Americans are doing.
When an oil spill coated birds in San Francisco Bay 40 years ago, he quit driving. Then he quit speaking. Madeline Ostrander asked him what he learned in that process that can help us deal with the BP oil spill.
What can you do about the Gulf oil spill?
On Wednesday, the news headlines offered a stark comparison between two possible futures for energy production in America.


text:
Investors Say Alibaba IPO Filing Leaves Many Questions Unanswered
As Alibaba Group Holding Ltd. prepares for what might be one of the biggest initial public offerings in history, it faces the challenge of convincing investors it will be a good buy.
Some may need more prodding.
A number of investors and analysts said Wednesday that the more than 2,000 pages the Chinese e-commerce giant filed Tuesday leave...


text:
- Champions League
Lennon: Don't underestimate Celtic
Celtic manager Neil Lennon has insisted that his side have belief ahead of the first leg of their Champions League last-16 clash against Juventus.
To the surprise of many pundits and fans, the Hoops emerged ahead of Benfica and Spartak Moscow to finish second in Group G behind star-studded Barcelona - whom they famously beat 2-1 at Celtic Park last November - and earn their place in the knockout stages of the tournament for the first time in five seasons.
The Hoops are underdogs with the Serie A champions strong favourites to progress through to the quarter-finals, but Lennon believes that Celtic are there on merit and should not be underestimated.
"I think we have been [underestimated] throughout the whole campaign and going into this game we are being made out to be massive underdogs but I don't quite see it that way myself," Lennon said. "There is a real belief, anything can happen over two games.
"We go into the tie as underdogs but nothing is going to be decided at the end of 90 minutes tomorrow night, it is over two games and we are prepared to play hard football over 180 minutes.
"They have excellent strikers - Mirko Vucinic, Fabio Quagliarella, Sebastian Giovinco, and they have also brought in Nicolas Anelka. But the one who has caught my eye is Alessandro Matri, he looks an excellent young player.
"They are very strong in midfield. Arturo Vidal is playing very well currently, Paul Pogba and Claudio Marchisio, these are class players including Andrea Pirlo who is still one of the finest midfield players in the world. So the team is blessed with fantastic footballers but we knew that before the tie or before any preparation were made. But it would be dangerous to underestimate Celtic. We have proved already this season that we can be a match for anyone.''
The former Hoops player, who described Juventus training at Rangers' Murray Park training complex on Monday as "irrelevant'', also recognises the difference between the Italian giants and Barca.
"They are two different cultures,'' he said. "Juventus are very strong defensively, very well-organised, very consistent in domestic football and they have been very impressive in their Champions League campaign.
"We have done a lot of work on Juventus and I have seen them myself so we will have to change the way we played against Barcelona but that is only natural because Barcelona dominate possession like no other team.''


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My Hometown is Coon Rapids, in West Central Iowa, in Carroll County but near the corner with Audubon, Guthrie and Greene Counties.
I still get the Coon Rapids Enterprise each week. Here is a useful story that lists many of my relatives and where they are now. This family is my maternal grandmother's sister's family - her children, and their children and grandchildren. We shared holiday gatherings with them often in my youth!
Early Christmas dinner guests on December 12 at Helen Nielsen's
home were Junior and Winona Huffman and Marie Nielsen of Audubon;
Darrell and Marjorie Nielsen of Glidden; and Jerry and Annie
Vincent of Jefferson. Holiday guests on December 26 at Helen's
home included her son, Maurice Nielsen of Hartland, WI; also Maurice's
three daughters and families: Jenni Maskel and children Mike
and Mia of Cottage Grove, WI; Erin and Ben Kossow and their children
Tyler and Grant, all of Mukwonago, WI; Paul and Laura Tesch
of Hartland, WI. Other guests were Helen's son and daughter-in-law,
Bob and Ann Nielsen of Lenexa, KS. Everyone left for home on December
29. During the holiday time, Helen received a telephone call
from her third son, Keith and his wife, Karen, of Fort Walton Beach,
From: Coon Rapids Enterprise - Thursday, January 6, 2011/page 4 - online
Families are Forever! ;-)


text:
Cruise Holidays of Edina
(952) 922-4800
Home > River Cruises
Imagine a vacation where you get to explore the treasures of Europe or Asia's most fascinating cities, all in the lap of luxury while only unpacking once. You dock in the heart of each city and English-speaking tour guides help you navigate through captivating town squares and introduce you to local chefs, winemakers or chocolatiers. Each night you escape to the comfort of your stateroom while anticipating the day's next port. Welcome to the world of river cruising. The popularity of river cruises has grown rapidly over the past few years as the word spreads about this wonderful way to explore the world aboard comfortable, modern ships. Cruise Holidays of Edina is an industry leader in helping travelers craft the river cruise itinerary of their dreams, whether it's through Spain and Portugal, France, Germany, Italy, the Netherlands, Switzerland, or a number of other destinations in Europe, Russia or Southeast Asia.
Guests on river cruises are explorers more than they are cruisers. Getting into the history, culture and really becoming immersed in the destination is what these travelers are all about. They also know that a river cruise is one of the best ways to cover a lot of destinations without the wasted time of packing, unpacking and traveling over the road.
Sail down the world's rivers on one of AmaWaterways 15 elegant ships and enjoy your choice of dining venues, revolutionary twin balconies, and fleet of onboard bicycles. Explore AmaWaterways
Avalon Waterways
Avalon's fleet of 12 ships offer wall-to-wall panoramic windows and open air balconies. Try their Culture & Cruise activities to learn and experience local culture and cuisine. Explore Avalon


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Wikiquote:Requests for adminship
Here you can make a request for adminship and other special user rights on English Wikiquote. See Wikiquote:Administrators for what this entails and for a list of current admins.
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text:
Kimberella Cupcakes: A Haiku
Sweet sunshine lemon
Lemon cupcake mixed with cream
Citrus butter dream
It's true; Kimberella's cupcakes bring out the poet in us. Trained as a gourmet chef, you may recognize Kimberly as the proprietress of the Seattle-based catering/personal chef service Herban Palate. Kimberella Cupcakes is her newest venture, and we'll be carefully tracking the progress (a web site is in the works). Her current offerings include flavors like the Sweet Sunshine (see haiku and image above), a citrus-buttercream confection; the Cocoa Cabana, a chocolate cupcake with banana buttercream rolled in flakes of coconut; and the Mint to Be Together, a milk chocolate cupcake with peppermint buttercream. Minimums are quite low, and her rates are affordable--$25 a dozen for full sized cupcakes, or just $12 a dozen for mini cupcakes. Email her at firstname.lastname@example.com for more information on ordering, or to request a custom flavor!


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The revelation that Bethany Storro was not attacked but instead splashed acid in her own face has left her community shocked and saddened with disbelief, and the hoax has left some angry.
"It makes me sick. I don't understand why would anyone need attention that badly?" said Vancouver, Wash., resident Marjorie Donovan.
Vancouver Police announced Thursday that 28-year-old Storro had fabricated the Aug. 30 attack that left her severely burned and garnered media attention worldwide -- including an invitation to appear on Oprah Winfrey's talk show.
"I'm shocked," was all that Pamela Storro, Storro's former mother-in-law, would say of her former daughter-in-law's alleged confession. Earlier this week she told ABC News that rumors that the acid attack was a hoax were "insane" and that there was "no way" her former daughter-in-law would do this to herself.
Bethany Storro has not made an official statement to the media that the attack was a hoax.
John Pax, the gym owner who held a fundraising to help offset Storro's medical expenses following the attack, said that he too is in "disbelief."
"We put aside our business because we found someone in need, one of our own members," he said. "We felt for her."
Nancy Neuwalt, Storro's mother, said that she is focusing on helping her daughter recover from the tragedy before seeking answers. "As to the question of why she did this, there were no signs and we really don't know why at this point but it is our hope the medical community can find answers," Neuwalt said.
"She has got a long road ahead of her and we are going to walk it with her," she added.
Storro had originally told authorities a stranger had splashed acid in her face while she walked through a popular park in Vancouver, Wash. But police said that soon after they began investigating the claims -- which included releasing a sketch of a suspect Storro claimed was responsible for the attack -- facts weren't adding up.
"Truthfully there were red flags from the beginning," Vancouver Police Commander Marla Schuman told "Good Morning America" today. "Initially just the manner of the attack, when she's talking about being splashed in the face with acid and the demarcation, the placement of injuries on her face… the thought that she was wearing sunglasses at 7:30 at night when she normally doesn't wear sunglasses. Just small things that didn't quite add up to a picture of normalcy," Schuman said.
Police, announcing their investigation was closed Thursday, said they had spent hundreds of hours looking for a perpetrator and did not speculate on Storro's motive.
"She doesn't have a criminal history, we didn't have knowledge of any mental issues," Schuman said today.
Storro's seemingly horrifying story captured international attention and spawned donations to a fund set up for her. Schuman said Storro could face charges if they determine Storro accessed those funds, in addition to a possible charge for filing a false report.
Why Did She Do It?While Storro's hoax is extreme, attention-seeking claims of attacks have been in the news several times over the last few years.
In 2008 a volunteer for the McCain Presidential campaign made up a story about an attacker scratching a letter in her face, and in 2004 a woman in Paris falsely claimed she was marked with swastikas.
Experts report people seeking notoriety for self inflicted wounds is all too common, with 72 percent of self-injury coming from cutting and 35 percent from burning.
"For a brief moment, they inflict this pain, they feel the release, they may get attention and it makes them actually feel better for a short period of time," former FBI Agent Brad Garret told "Good Morning America."
Bethany Storro's Acid Attack Was Self-Inflicted
According to Anytime Fitness owner Pax, nobody close to Storro believed that she could have faked the attack, even when media speculation grew after she pulled out of a schedule appearance on "The Oprah Winfrey Show."
"Obviously [Storro] needs help," said Pax. "And I hope she gets it."
Pax held a fundraiser at his gym last week where he offered a self-defense class at a discounted price to attract more participants. The class, which cost $20 per person, was attended by around 80 people said Pax, garnering more than $800 for Storro's fund.
The money, according to Pax, was turned over to the bank holding on to the account, Riverview Community Bank.
A spokesperson for the bank told ABC News that "quite a buildup of funds had occurred" over the past few weeks. They are still trying to determine how to return the money to donors.
"The account has been frozen until all of this settles down," said bank spokeswoman Phyllis Kreibich. Donations had come in from all over the country, according to the bank.
Storro's Dramatic Tale
Storro originally told police that the woman who attacked her had approached her and said, "Hey pretty girl," causing her to turn around. Then the woman threw a cup of liquid in Storro's face.
Storro appeared on "Good Morning America," her head covered in gauze.
"It was like it almost didn't hurt right away because of the panic, you know, like, what just happened, and you're so focused on that, and then once I let it soak in I could start to feel it burning through my flesh," she said from her hospital bed. She said that by sheer luck, she had bought a pair of sunglasses just minutes before, which protected her eyes.
But as days went on, the attention grew. Storro was invited to be a guest on Oprah Winfrey's show, but then news outlets began to report suggestions that police suspected the attack was faked. On Tuesday the Oprah appearance was canceled.
In a post on her Facebook page last week, which has since been removed, Storro wrote that while she had originally wanted to appear on the show to "inspire people and tell them about Jesus," she changed her mind.
"The show was going to possibly turn into another direction, so my family and I decided not to go on," she wrote. "I hope you understand and will still check in on me."
A spokeswoman for Winfrey's show confirmed to ABCNews.com that Storro had canceled her appearance during which she was expected to speak about "her account of being attacked and scarred with acid." No reason for the cancellation was given by the show.
A Vancouver Voice reporter wrote about visiting the park where Storro was allegedly attacked and spoke to witnesses -- homeless people who identified themselves only by their street names -- who said Storro was "clearly alone when she dropped to the ground screaming." ABC News' Lee Ferran and Ned Potter contributed to this report.


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The saying goes that winning solves everything. But would it for LeBron James? I'm not so sure.
Like a medieval fable gone wrong, this King hasn't seen the error of his ways. He still doesn't get that fans aren't mad at his actual decision to leave Cleveland, but the way "The Decision" show went down.
And he still doesn't understand that the reason he is disliked so much is because he brings it on.
It's the little things that continue to push him back. Getting involved in petty antics like his coughing fit with Dwyane Wade, meant to mimic their opponent Dirk Nowitzki, no matter what they said in response.
Or characterizing those who are rooting against him to fail as people "with personal problems." Really? It's all them, not a bit of you?
It has to be hard to be LeBron James. I can't imagine and I have no clue what it's like. But I'm pretty sure that everyone who is involved in his inner circle—and his business partners are his high school friends—is too scared to bite the hand that feeds it. They're too scared to put the mirror in LeBron's face.
Check it out: Best-selling NBA jerseys
I'm surprised that those who have spent big money on his endorsements haven't done it. Instead, they've just taken a back seat. Out of all of James' sponsors, State Farm was the only one running a relatively new, regular commercial during the Finals. His largest sponsor, Nike, was completely silent this postseason, as was Coca-Cola, which uses James for its Vitaminwater and Sprite brands. McDonald's ran its commercial with LeBron and Dwight Howard, but that was a spot that was a year and half old. Upstart energy strip Sheets is utilizing LeBron everywhere, but that has to do with the fact that James and his business partner Maverick Carter are intricately involved with the brand.
Some will say it will be a tough offseason for those companies that back LeBron James because "The Decision" wasn't righted by an NBA title. I think the scary thing for those that back him off the court is, would a title really change things?
Almost 24 percent of my Twitter followers, who voted in my poll before last night's game, said that LeBron James was the most disliked athlete ever. James was only beaten out by Barry Bonds (29 percent) and surrounded by OJ Simpson (12 percent) and Alex Rodriguez (9 percent).
Would showing up in the fourth quarter and winning two more games really have flip-flopped that sentiment? Hard to believe.
Meet the NBA's Newest Millionaires
Reputation cannot be healed without dominance on the court or course. The only repair can come through championships—LeBron finally getting it done, Tiger beating Jack. But that doesn't mean that Tiger or LeBron will get back to where they once were. LeBron's height in the marketing world might always be remembered as the day before 'The Decision," just like Tiger's was the day before Thanksgiving in 2009.
Winning a title is important for LeBron James. But the right person getting through to him as to why he's in this position to begin with, and for him to accept what they have to say, might be even more important.


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It's the Slow Food NYC Happy Hour—fun, social, and informal! But it's also your opportunity to talk to the leadership of Slow Food NYC and let us know what you think. Got a great idea for an event? Looking for ways to get involved? Want to learn more about Slow Food? Just looking to have a relaxing drink with other "slow" minded people? The "Slur" is your opportunity—free and open to everyone.
Runner & Stone is a neighborhood bakery, restaurant, and bar that believes cooking and eating are communal activities that connect people to one another. The convivial atmosphere features a menu focused on local, seasonal ingredients that are grown, produced, packaged and transported in a responsible manner. The care that goes into the food extends to the bar, where a thoughtful wine and beer list is accompanied by a selection of carefully crafted cocktails. Runner & Stone is also a Slow Food NYC Snail of Approval awardee.
For our Slur, Runner & Stone will be providing all attendees complimentary seasonal bar snacks. Attendance is free, but please make sure to RSVP. We hope to see you there!


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Interview with Rob Shavell, CEO and co-founder of DeleteMe
A look into data, data collection, and what we can do to protect our data onlineRead more...
In part two of my interview with Ooyala CEO and Co-founder Bismarck Lepe, he talks in more detail about how his company is expanding their offering within the online video platform market with a key focus on personalizing the consumer experience and at the same time helping their content owners build a real business. In the previous post, he described that in the new media consumption world of today the consumer is the new brand manager and is in control of what they see when they want to see it. Ooyala has analyzed where the industry is headed, based on data collected by Quantcast, and believes that the current market for online video platform is roughly of 300,000 customers who are people who are willing to pay for an online video platform. For startups within the online video space, Lepe emphasizes that you need to know how to make your customers successful and help them build their businesses.
Larry Kless: When we spoke a few months back you talked about the subscription model and your plans to roll it out in Q2. Where is that now?
Bismarck Lepe: We've already started rolling it out with a couple of sports teams as a white-label and a pay-per-view model and one of the other monetization options that we're most likely going to be adding is licensing, and actually allowing content owners to license their content out to distributors. This has definitely been as evolution. When we look the majority of the dollars being made in the offline world the majority is actually made at the licensing phase. People who are taking digital rights and buying it for a certain window and a certain region and then figuring out how to target that content and sell that content to their market. There's so much content that's being created for online that the need for that marketplace is actually pretty rich, and I think it's also very rich for people who are taking their offline content and pushing it online and creating little clips for it. So I think it's going to be another monetization opportunity for content owners that will really start helping subsidize the creation of high quality content.
Larry Kless: What's next? What are you going to build on from there in terms of expanding throughout the following quarters? What's important?
Bismarck Lepe: I think what's really important for us right now is personalization and bundling of content. Really figuring out our audience either at the profile by profile level or if we're provided any individual log in and customizing the viewing experience for each one of those viewers. One of the problems with monetization today is that most people look at it on a title by title basis. But if you can actually create these dynamic and virtual networks around an audience then you can actually get bigger ticket prices. You can almost create a hybrid subscription and monetization model that mimics a lot of what the cable industry does today. So it's this hybrid of you pay your monthly cable subscription but then you also see advertising. And lot of what we're doing right now is being able to create these dynamic networks on the fly based on the content that's flowing through the system.
Larry Kless: Can you talk about the journey? Where you started and where you're at now. I understand that initially the tools were built because of the idea to be a destination site but the tools were just so great that changed.
Bismarck Lepe: I think we've taken advantage of the fact that content owners are putting more and more of their content online and we're realizing that the content owners want to be the masters of their future and they don't necessarily want to work with individual destination sites to power all of their video. Even today although Hulu has been successful in terms of getting mindshare, I don't necessarily know if that's going to be the model that's going to work for all content owners. Because again, it's very difficult for a destination site like that to get to profitability when they're only taking a fraction of a fraction of a dollar.
Larry Kless: Hulu is a good example too of the studios doubling down on two of the screens, computer and television and an iPhone app sometime soon.
Bismarck Lepe: I think that they're are going to be successful in gaining mindshare but ultimately I think what's going to be most successful is, a lot of these individual sites are built around a specific audience base as oppose to trying to aggregate as much viewership around all of the content that's out there. Because I think the economics are just not going to work for a lot of these property owners. But we'll see, I think what Hulu has done is actually get a certain level of adoption and acceptance at the studio level that is also helping raise all ships in the video space. You know people who are providing analytic solutions, people who are providing ad serving solutions, people who are providing CDN services.
Larry Kless: Finally from the distribution standpoint for content owners they're finally able to sink their teeth into real analytics with online video versus the Nielsen ratings. In looking at your list of customers on your web site it's pretty diverse. It must feel good to be able to provide this level of service to such a wide variety of customers.
Bismarck Lepe: Yes, and in June some of the customers we signed include Warner Media that owns Rolling Stone and US magazine, the Philadelphia Eagles and even Cesar Millan "The Dog Whisperer."
You know, I'm extremely bullish on this industry as is true with most sea changes in technology or ways of thinking. There are a lot of players, there are a lot companies that try to blaze a new trail. Some of them are successful and some of them are not and I think we're now starting to see some really good traction with the people that own the content and the people who are consuming the content online.
Larry Kless: So you've built in the API structure and extensible modules. How about the pricing structure?
Bismarck Lepe: So again, were focusing on the top 300,000 publishers that are out there and we have an enterprise solution that gives big companies multi-level access and multi-level access controls to the individual pieces of content, sophisticated analytics, live streaming and at the low-end a five figure annualized deal to six figures annualized deal and then we have our self-serve product that is available to anyone and everyone that wants to publish. Obviously they need to pay an hourly basis for the content that they use but we want to make sure that we enable the building of businesses all sizes with our platform and on our platform.
Larry Kless: So what drives you? What make the company tick? Being a long distance runner, what makes you put on those shoes and run everyday in this race?
Bismarck Lepe: For me, it's making sure that we are personalizing that media experience. I should never have to see a tampax ad I should only see content that's interesting to me and the Internet allows us to do that. And more and more of video is going to be delivered over IP which means across all screens we're going to be able to personalize that experience and that's our goal. Our goal is not just to build a publishing platform but to build a personal media platform.
Larry Kless: What sort of advise would you give a startup getting into this saturated market? What are the key differentiators?
Bismarck Lepe: I think you need to know how to make your customers successful. It's not just about taking their money but it's about helping them build businesses, and the way we think we're going to help our customers build businesses is by focusing on the consumer and continuing to drive the best possible experience with our platform. Now as a business owner and starting a company, at the end of the day, as long as if you're in a good a industry and you have good people it's going to be sheer force of will. As a startup you either sink or swim and that's it, there's no middle ground.
Larry Kless: In terms of your company, it seems that anytime you see news now you almost can't see a sentence that says Brightcove without seeing Ooyala in the same sentence. You also mentioned having drinks with Jeremy Allaire recently. How is it within the online video platform space? Is it a community of innovation or cut-throat competition?
Bismarck Lepe: I think that the people who are going to be successful in this space are going to realize that there's so much opportunity out there and that at this point everyone should be focused on helping make the pie as big as we can make it, and then we'll figure out it gets divvied up. But in the near term on the higher end there actually isn't that much competition and there isn't enough business out there for everyone who is approaching it the right way.
Larry Kless: So you never take a day off, do you?
Bismarck Lepe: You know, this really isn't a job so everyday is a day off. I love what I do.
Larry Kless: So overall it sounds like it's been a good journey so far with plenty of road left to cover.
Bismarck Lepe: I've been very lucky to have great team mates, great founders, great investors and a phenomenal industry. Back when I first got a taste of this when we were working on Google's first foray into the video space with Google Video, the studios and the broadcasters weren't as receptive to testing online video initiatives. But that has definitely changed, I think everybody understands that all video will eventually be delivered over IP, that the consumer is going to be in control and that they need to come to the table and talk to startups and they themselves need to push initiative in order to be relevant 5 years from now.
A look into data, data collection, and what we can do to protect our data onlineRead more...
We discuss the inspiration behind the product, its subscription-model, and tips for securing fundingRead more...
Jennifer Esposito, formerly of GE Healthcare and Intel, has joined the company VP of HealthRead more...
Joined Vator on
Ooyala is a video technology company that provides an integrated platform enabling the delivery, management, and monetization of high quality video content. Focused on innovation and scalability, Ooyala is committed to providing the most comprehensive video solutions to companies worldwide.Ooyala is headquartered in Mountain View, Ca with sales operations in New York, NY and London, UK.
"Ooyala" means cradle in Telugu, a Southern Indian language. We like the name because it demonstrates what we are doing -- cradling a new form of innovation.
Ooyala was founded in early 2007 by Sean Knapp, Belsasar Lepe and Bismarck Lepe - all former Google employees. While at Google, they worked on the development and launch of various monetization and content distribution products such as AdSense, AdWords and Google Web Search. After four years of engineering and product development at the biggest Internet company in the world, the three left Google to start Ooyala. Ooyala has raised over 10 million dollars in funding and has in excess of 5000 publishers using its syndication platform - Backlot. Ooyala's goal is to build a successful technology company that focuses on delivering the best video experience to video content providers, advertisers and most importantly consumers.


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One Towne Park Plaza, Norwich, CT 06360
Patient Access
Click here for secure access to your health care team.
Welcome to Neurology Associates
Neurological care and affordable MRIs in Norwich CT
We welcome you to Neurology Associates, LLC, the largest provider of expert neurological care and low cost MRIs in Eastern Connecticut. For over twenty years the highly trained, board certified physicians along with our skilled technical staff have been providing advanced, compassionate care for our patients.
Our team provides comprehensive diagnostic and treatment services for a wide range of neurological disorders and many of our physicians have advanced fellowship specialty training. Services include, but are not limited to;
|Peripheral Neuropathy
|Parkinson's disease
|Multiple Sclerosis
|Spine disorders
|Workman's Compensation
We recognize that our patients prefer timely diagnosis, and we've gathered an impressive array of diagnostic modalities on-site so we can provide rapid service as much as possible.
Chief amongst these services is our state of the art 1.5T Siemens Avanto MRI which provides highly detailed and accurate pictures to aid in diagnosis of neurological disorders. Depending on your insurance regulations, our superb MRI technicians and staff can provide same day service so you see your doctor and get your imaging completed in one visit, with one co-pay and minimal loss of time from your busy life. Our prices are only a fraction of our competition, making us the best place for an inexpensive MRI in CT. We also provide on-site insurance pre-authorization so patients have the peace of mind their imaging is covered appropriately by their insurance company.
We have one of the largest Multiple Sclerosis clinics in Connecticut and provide comprehensive care to those suffering from this and related diseases. We provide an on-site infusion center with expert nursing care but without the hassle of large hospital infusion centers.
Our clinic provides comprehensive neuromuscular services including nerve conduction studies (NCS) and electromyography (EMG) for diagnosis of a range of disorders involving nerve and muscle including peripheral neuropathy and carpal tunnel amongst others. We also provide Botox (botulinum toxin) for a range of neurological disorders including headaches.
Epilepsy services include on-site EEG (electroencephalogram) with expert technical services as well as multi-day ambulatory EEG capability. Frequently we can provide EEG testing the day of visit, again with the goal of streamlining diagnosis and treatment.
For decades Neurology Associates has provided timely Workman's Compensation care with the goal of accurate diagnosis, a comprehensive treatment plan and ultimately a speedy return to work. We have dedicated staff to streamline the complexities of Workman's Compensation cases.
Our entire office operates on a state of the art, CCHIT certified electronic medical records system by Greenway Medical Technologies which allows comprehensive medical record keeping, patient confidentiality and the ability for the patient to interact with his or her health care providers electronically. This capability extends our services on-line and provides added convenience to our patients.
We look forward to meeting you and providing compassionate and expert neurological care.


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Phoenix is blessed with gifted women who are in leadership positions that add significant value to the life of our city. We recognize that women in leadership are often a minority on the staff of our churches and organizations and encounter challenges as well as unique opportunities in their development as leaders.
Our monthly breakfasts bring together these women to share, pray, and challenge one another to lead out of a deep love for God and the people we have been entrusted to serve.
Please RSVP so that we can have enough breakfast!


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UNICEF works in more than 190 countries and territories to help children survive and thrive, from early childhood through adolescence.
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